Four Western states, led by Democratic officials, recently announced their independent recommendations for three key seasonal vaccines. This move serves as a clear challenge to Health Secretary Robert F. Kennedy Jr.’s attempts to alter federal vaccine policies.
The newly formed West Coast Health Alliance, comprising health officials from California, Oregon, Washington, and Hawaii, advises that all residents aged six months and older get their flu shot this fall. Their guidelines also endorse widespread COVID-19 vaccination, specifically including pregnant individuals and all children between six months and two years old. Furthermore, they recommend RSV vaccines for infants under eight months, adults over 75, and individuals with specific health vulnerabilities.
These comprehensive guidelines largely align with established clinical recommendations from both federal authorities and leading national medical bodies, such as the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians.
However, the states’ advice differs from that of the Centers for Disease Control and Prevention (CDC) under Mr. Kennedy’s leadership. The current CDC no longer suggests the COVID-19 vaccine for healthy pregnant women and recommends it for healthy children only after consulting a physician. The CDC has not significantly altered its flu vaccine guidelines and has yet to issue official recommendations for RSV vaccines.
This week marks a critical meeting for the federal Advisory Committee on Immunization Practices (ACIP), where recommendations for several vaccines, including those for COVID-19, hepatitis B, and measles, are on the agenda for potential revision. Notably, Health Secretary Kennedy disbanded and replaced the entire committee this summer, appointing new members with a history of questioning vaccine safety and effectiveness.
The release of the Western states’ guidelines coincided with a Senate health committee hearing where Susan Monarez, the former director of the CDC, testified. She stated that she was dismissed by Mr. Kennedy for her refusal to endorse his vaccine recommendations without prior scientific review.
The four states’ health officers, all medical doctors, emphasized that their guidelines were developed in collaboration with leading medical organizations and experts. They also highlighted that these new recommendations aim to alleviate pressure on hospitals this winter by curbing community transmission and severe illnesses within their states.
Dr. Erica Pan, Director of the California Department of Public Health, affirmed that their goal is to assure residents that “a robust public health, healthcare, and scientific community will remain united” to offer essential data, empowering individuals to make informed health decisions.
According to the governor’s office, California’s state law now mandates that health insurers cover these recommended vaccinations. However, it remains uncertain whether insurers in Oregon, Washington, and Hawaii will face similar requirements for individuals not covered by federal guidelines. Health experts generally agree that covering vaccinations is cost-effective, as it helps prevent more expensive hospitalizations.
This isn’t the first time Western states have collaborated on health matters; a similar working group was established during the COVID-19 pandemic to bolster public trust in vaccines. Northeastern states are also reportedly discussing coordinated vaccine recommendations.
Data from KFF, a nonpartisan health research organization, indicates that adult COVID-19 and flu vaccine coverage in these four states during the 2024-2025 season was marginally higher than the national average. RSV vaccination data at the state level was not available.
While seasonal vaccine uptake is usually lower than that of routine childhood immunizations like the MMR vaccine, which guards against measles, mumps, and rubella, even those childhood vaccination rates have been declining. Currently, the majority of kindergartners reside in states with vaccination rates insufficient for widespread community immunity.
The Trump administration’s divergence from established medical vaccine recommendations is anticipated to persist. The federal ACIP committee, which Mr. Kennedy dissolved and reconstituted, is reportedly poised to suggest restrictions on hepatitis B vaccinations for newborns soon.
Concurrently, Florida’s surgeon general declared an end to all vaccine mandates in the state, including those for school attendance. Jennifer Kates of KFF notes that states preemptively reacting to potential federal vaccine policy changes signals a growing “blue state-red state divide,” likely to intensify following the upcoming ACIP meeting.
Below are the full vaccine recommendations provided by the Western states:
COVID-19 Vaccine Guidance
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Children aged 6-23 months; children aged 2-18 years with risk factors; or children never previously vaccinated against COVID-19. All children in close contact with high-risk individuals.
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Individuals who are pregnant, planning a pregnancy, postpartum, or lactating.
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Adults aged 65 and older; adults under 65 with risk factors; adults in close contact with high-risk individuals.
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Any adult or child desiring vaccination, regardless of the above categories.
Influenza (Flu) Vaccine Guidance
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All individuals aged 6 months and older, including those who are pregnant, planning pregnancy, postpartum, or lactating.
RSV Vaccine Guidance
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Infants younger than 8 months; children aged 8-19 months with identified risk factors.
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All pregnant individuals between 32-36 weeks gestational age.
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Adults aged 75 and older; adults aged 50-74 with identified risk factors.