After recent moves by the US Department of Health and Human Services to restrict the approval and use of some vaccines — and signs that more changes might be coming — some states and private partnerships are scrambling to ensure that vaccines will still be available to those who want them.
People familiar with various efforts that are underway described them as necessary but not ideal.
“When you start splintering the message from the federal government down states and local health departments, people end up losing faith in everybody. They don’t know who to believe,” said one official familiar with several ongoing efforts who spoke on the condition they not be named because they weren’t authorized to share the details of those plans.
Several groups, for example, are working to create panels of subject matter experts who would review the latest science behind vaccines and make evidence-based recommendations for their use, much like the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, or ACIP, has done for the past 60 years.
Nine states have banded together to create the Northeast Public Health Collaboration, which is staffed by state and city health officials. The group is organized into committees, and their work has intensified quickly in response to shifting federal health priorities and deep cuts to health agencies, according to a person familiar with the group who was not authorized to share the details of their plans.
“They’re specifically looking at how, as a collaborative of states, they can address gaps in federal support and resources moving forward in key public health areas,” the person said. One of the areas they’re preparing to address is flagging federal support for vaccines, but the member states also have efforts underway to address pandemic preparedness, laboratory services, epidemiology and other key public health priorities.
One state represented in that group, Maine, has even recently struck language in its vaccine access law referencing ACIP and created a pathway to purchase vaccines outside of the federal Vaccines for Children Program, which provides vaccines for free to children whose families can’t afford them, and which public health advocates fear may also be under threat.
Organizers for the effort declined to offer many specifics about the collaboration. They described their work as being in an early stage and said the collaboration was intended only to share information between partners. They stressed that it was not intended to replace or duplicate any federal programs.
“New York state maintains its commitment to protecting access to essential public health services and regularly engages in informal conversations with other states to share information and best practices on public health preparedness,” said a spokesperson for the New York State Department of Health, one of the states involved in the effort.
The Massachusetts Department of Health also declined to share more specific details about the collaboration but issued a statement: “The Department of Public Health is committed to maintaining access to evidence-based vaccines for all people in the state. As federal policy decisions are proposed and enacted that impact vaccine infrastructure, Massachusetts is evaluating what may be necessary to have undisrupted access.”
Like Maine, Colorado recently passed legislation to protect coverage for a range of preventive services, including vaccines. In the event the federal government repeals, modifies or gets rid of recommendations for preventive services made by ACIP, the US Preventive Services Task Force or the Health Resources and Services Administration, the new law gives the state’s health commissioner leeway to make rules based off recommendations as they existed in January.
HHS Secretary Robert F. Kennedy Jr.’s decision to bypass ACIP’s process and change the recommendations for Covid-19 vaccines for healthy children and pregnant women in May was a red flag for vaccine access, according to a source familiar with the deliberations of state health departments who asked not to be named because they were not authorized to share the details of those discussions.
His subsequent decision to dismiss all 17 sitting members of ACIP and replace them with eight of his own choices, including several new members who have expressed doubts about the safety and effectiveness of vaccines, spurred the drive for change at the state level, the official said.
“I think states are concerned that, based on these early indications, potentially there will be some new challenges for them in terms of being able to support and offer vaccines,” the official said, “and so I think they are trying to think of different ways in this new environment that we’re in that they still are able to provide vaccines.”
ACIP’s recommendations are intertwined with state laws in numerous ways, according to the Association of State and Territorial Health Officials, which created a reference list.
For example, several states – including Minnesota, Vermont and Maine – have laws that allow pharmacists and even dentists to give vaccines as long as they’re recommended by ACIP. Changing those recommendations could affect the ability of pharmacists or other health care providers to deliver certain shots.
States like New Mexico, Missouri and Alabama tie their requirements for public school enrollment to the most recent version of ACIP’s recommendations.
Additionally, states sometimes require educational materials for vaccines to hew to ACIP recommendations. Tennessee, for example, requires hospitals to provide parents of newborns with information about pertussis, or whooping cough, and about the availability of a vaccine for pertussis, using information that’s in line with ACIP recommendations.
Beyond state efforts, there are nonprofit startups working to maintain vaccine access.
One such effort is the Vaccine Integrity Project, which is being coordinated by the Center for Infectious Disease Research and Policy at the University of Minnesota and supported by an unrestricted grant from Walmart heiress Christy Walton. The group’s steering committee comprises medical and public health experts, former elected officials and former leaders of federal agencies.
The initiative aims to counter disinformation around vaccines and provide updated guidelines on their use based on evolving science and safety information.
It’s also seeking to work with states to help them identify ways their vaccine access laws and funding mechanisms may need to change so they can continue to deliver vaccines to their health care providers and pharmacies.
“The emergence of organizations that collaborate to help fill the gap in the federal government is happening, and it needs to happen,” said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.
“We have to be very forward-thinking about it, because these are programs and services that impact every community in this country in different ways, some more than others. And therefore the impact of programs and services being reduced or whole scale being removed or going away is not known, but we can be sure it will impact the health of every community in this country,” Freeman said.