Vaccine policy is rapidly fracturing along party lines under Health Secretary Robert F. Kennedy Jr., setting the United States on a path for a patchwork of policies and a likely dip in vaccination rates.
Some blue states, fearing the federal government’s antagonistic stance towards vaccines and eager to draw a political contrast with the Trump administration, are stepping up to create their own policies. Red states are going in the opposite direction, loosening or even ending vaccine requirements.
Experts said differing state policies could lead to confusion among doctors and patients, and varying levels of insurance coverage.
“It’s going to be, not quite the Wild Wild West, but pretty close for the next few years,” said Georges Benjamin, executive director of the American Public Health Association.
Already, pharmacies in a handful of states no longer administer COVID-19 shots, or require a prescription, due to confusion over recent federal changes.
Last week, states on both sides began taking matters into their own hands.
A coalition of West Coast, Democratic-led states formed a new public health alliance to provide “science-driven” advice on vaccines, in defiance of Kennedy. Washington, Oregon, Hawaii and California said they will provide “evidence-based unified recommendations to their residents” based on the guidance of national medical organizations.
“Our communities deserve clear and transparent communication about vaccines — communication grounded in science, not ideology,” Oregon Health Authority Director Sejal Hathi said in a statement.
“Vaccines are among the most powerful tools in modern medicine; they have indisputably saved millions of lives. But when guidance about their use becomes inconsistent or politicized, it undermines public trust at precisely the moment we need it most,” Hathi said.
That same day, Florida went in the complete opposite direction and announced it was ending all school vaccine mandates.
Florida Surgeon General Joseph A. Ladapo, a vaccine skeptic who compared vaccine mandates to slavery, said he was proud to be the first state to do away with all vaccine requirements, including longstanding ones for measles and polio.
“What you put into your body is because of your relationship with your body and God,” Ladapo said. “The government does not have that right.”
It’s unclear yet whether other states will follow Florida. But there are other ways states are moving to change vaccine access. In West Virginia, for instance, Gov. Patrick Morrisey (R) has been pressuring for more religious exemptions for school-age children’s vaccinations.
States have always been able to make their own public health policies, but the federal government’s recommendations have helped align and standardize guidance.
“The reason we’ve set up these very transparent processes, that have outside experts to advise the CDC, to advise the FDA on this, is so that each state didn’t have to go at this alone,” said Mandy Cohen, the former CDC director under President Biden who is now a national advisor at Manatt Health.
“I think we all wish that we had a fully functioning federal process right now, and that’s not what we’re seeing,” Cohen said, so blue states are trying to figure out how to compensate.
“Now, [states are] needing to get their source of evidence and recommendations from other places,” Cohen said.
Massachusetts became the first state to impose its own rules requiring health insurance companies to cover immunizations recommended by the state’s health department.
New York Gov. Kathy Hochul (D) issued an executive order allowing pharmacists to prescribe and administer COVID-19 vaccines for the next 30 days.
Last week, New Mexico’s health department issued an order to remove potential barriers and ensure access to COVID-19 vaccines for all residents at pharmacies across the state.
The divide is growing starker ahead of a meeting next week of the Centers for Disease Control and Prevention (CDC) vaccine advisory panel, which is expected to vote on key vaccine recommendations.
The fallout could reshape the interaction between states and the federal government for years to come.
A positive recommendation from the panel means that virtually all insurers will cover the vaccines for free. But blue state leaders are wary of the panel and have been outspoken against the changes Kennedy has made.
Kennedy fired the entire committee in June and replaced its members with vaccine skeptics who have pledged that no topics are off-limits, including changes to the childhood vaccine schedule.
“Now that there’s concern that those recommendations are going to be changed, not based on data or science, we are going to start to see states go in these different directions,” said Jen Kates, senior vice president and director of the Global Health & HIV Policy Program at KFF.
A lot of the backlash to vaccines has been tied by Republican political and health leaders to the public health measures and messaging of the COVID-19 pandemic.
For instance, HHS spokesman Andrew Nixon criticized the West Coast state moves as being made by “Democrat-run states that pushed unscientific school lockdowns, toddler mask mandates, and draconian vaccine passports during the COVID era.”
Cohen, who took over as CDC director in 2023, said she worked hard to change the perception of the agency. And she noted Susan Monarez, who was ousted as CDC director last month, wasn’t even at the agency during the COVID pandemic.
“Trust was up at CDC, but was there work to do? Absolutely. But that this is all tied back to [CDC outrage], I think it’s just not accurate anymore,” Cohen said.
