Turmoil at the Centers for Disease Control and Prevention and states’ beginning to take more control of their own vaccine decisions threaten to fracture the once-national consensus around immunization, setting the stage for a reorganization of the way vaccination recommendations work across the United States.
The moves together point toward an increasingly stark divide emerging in the United States around vaccinations, with some Republican-led states starting to roll back or eliminate mandates while Democrat-led states split from the CDC to come up with their own vaccination guidance.
On Wednesday, California, Oregon and Washington announced they are forming a public health alliance to provide “credible information” about vaccine safety in response to the recent firing of CDC Director Susan Monarez, the resignations of top scientists that followed her ousting and the Food and Drug Administration’s new controversial guidelines for who should get Covid shots.
Last week, New Mexico’s Health Department announced it was ordering pharmacies to “remove potential barriers and ensure access to COVID-19 vaccines.” Colorado did the same Wednesday.
Also Wednesday, Florida’s surgeon general, Dr. Joseph Ladapo, moved to eliminate vaccination mandates across the state, including in public schools. Other states have also weighed rolling back vaccination mandates, most notably Texas, where dozens of anti-mandate bills have been introduced in the Legislature.
The split comes as once-fringe and long-debunked claims about the health risks of vaccinations have found mainstream appeal and been embraced by the Trump administration.
“Repeatedly hearing that vaccines cause autism or that an mRNA vaccine will alter your DNA can erode public trust,” said Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco, referring to two of the most common pieces of vaccine misinformation.
For decades, the federal government, in close collaboration with infectious disease experts, has crafted guidelines for who should receive vaccinations and when. States and medical organizations used the guidelines to administer shots to millions of people, and insurance companies relied on them to determine payment. The recommendations were based on clinical studies and aimed to minimize both individual and societal risk.
But as vaccine hesitancy has skyrocketed in the wake of the Covid-19 pandemic and online misinformation campaigns, vaccination mandates have become a political flashpoint. Distrust in vaccines has created a rift that threatens to split the country into two distinct zones, delineated not by borders or geography but by state governments’ stances on the medical establishment’s right to dictate who must get a jab and who gets a pass.
In an op-ed Tuesday in The Wall Street Journal, Health and Human Services Secretary Robert F. Kennedy Jr. described “cloth masks on toddlers, arbitrary 6-foot distancing, boosters for healthy children, prolonged school closings, economy-crushing lockdowns, and the suppression of low-cost therapeutics in favor of experimental and ineffective drugs” as “irrational” policies that had a “devastating” toll on Americans.
Lockdowns and school closures certainly had economic and mental health drawbacks, and data suggests that vaccinated and unvaccinated people may transmit the virus at similar rates because they have comparable viral loads — or amounts of virus in their respiratory tracts — according to a 2022 paper in The Lancet Infectious Diseases.
However, the vaccines were effective at reducing hospitalizations and the number of severe Covid cases, two factors that overwhelmed health care systems early in the pandemic and precipitated lockdowns in the United States and around the world.
Once Covid vaccines became available at the end of 2020, following intense investment by the first Trump administration, states started to ease lockdowns and social distancing rules.
What didn’t let up — and still hasn’t — was the fear around the purported dangers of the new Covid shots, which were developed using a new type of vaccine technology, known as mRNA, that was at once revolutionary but difficult to understand.
The novelty compounded the uncertainties about the long-term health repercussions of a previously unknown virus and the pervasive feelings of loss the pandemic created, including loss of personal freedoms. That created the perfect conditions for divisiveness over vaccinations, Chin-Hong said, and the Covid shots became an easy scapegoat.
“The vaccine is something you could focus on, instead of a general feeling of loss,” he said.
Kennedy, among the highest-profile figures of the once-small anti-vaccine movement, was confirmed as HHS secretary as he struck a more moderate tone on vaccines, which he has since abandoned.
In June, Kennedy gutted a 17-person independent vaccine advisory committee at the CDC. He replaced the members with a group that included vaccine skeptics and people critical of the Covid vaccines. In early August, he also cut $500 million in mRNA vaccine contracts.
After the FDA approved a new version of the Covid vaccine in May, Kennedy announced that the CDC would recommend that doctors administer the shots only to adults ages 65 and above, as well as people with certain pre-existing conditions. Previously, Covid vaccinations were recommended more widely.
Following that change, the American Academy of Pediatrics took the unusual step of issuing its own vaccination recommendations — the first time in 30 years its guidelines were significantly different from the federal government’s.
“It is going to be somewhat confusing. But our opinion is we need to make the right choices for children to protect them,” Dr. James Campbell, vice chair of the academy’s infectious diseases committee, told NBC News.
That might have been the first visual fracture in the country’s growing vaccine divide.
The governors of California, Oregon and Washington are following in those footsteps, saying they are working to provide unified recommendations to “ensure residents remain protected by science, not politics.” They warned that there will be severe consequences if the CDC becomes “a political tool that increasingly peddles ideology instead of science.”
“President Trump’s mass firing of CDC doctors and scientists — and his blatant politicization of the agency — is a direct assault on the health and safety of the American people,” the statement said.
HHS criticized Democratic-run states in a statement for pandemic policies that “eroded the American people’s trust in public health agencies.” It also defended the CDC’s Advisory Committee on Immunization Practices.
“ACIP remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and Gold Standard Science, not the failed politics of the pandemic,” the statement said.
The news release announcing the West Coast Health Alliance on Wednesday criticized the CDC’s dismantling, saying there is an absence of consistent, science-based federal leadership in public health. It said the alliance’s shared principles will be finalized “in the coming weeks.”
Without clarity from the federal government, individual states may begin to craft their own public health orders. New Mexico’s Health Department announced last week that it was ordering pharmacies to “remove potential barriers and ensure access to COVID-19 vaccines” after some pharmacies said they couldn’t administer the new versions of the Covid shots until the CDC advisory panel met and issued its official guidance.
Insurance companies, which look to the federal government for guidance about what’s covered by health plans, will also be figuring out the changing landscape in coming months.
Vaccines recommended by the Advisory Committee on Immunization Practices are generally free because of provisions in the Affordable Care Act, also known as Obamacare, and the Inflation Reduction Act of 2022.
Tina Stow, a spokesperson for the health insurance industry group AHIP, said in a statement that the organization was reviewing the FDA announcement and would monitor upcoming recommendations from the CDC “on considerations around coverage,” alongside its members.
“Individual health plans and plan sponsors will be prepared to make coverage decisions informed by science, the latest medical evidence and data,” she said. “This process will be evidence-based, evaluate multiple sources of data, including but not limited to ACIP, and will be informed by customer needs.”
Coverage decisions for vaccinations can also hinge on recommendations from medical organizations like the American Association of Pediatrics.
More chaos unfolded at the CDC in recent days after the White House said it was firing Monarez as its director after she refused to resign. Attorneys for Monarez said she “refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts” and “chose protecting the public over serving a political agenda.”
Her dismissal sparked a mass exodus of top CDC officials. Nine former directors and acting directors accused Kennedy of endangering Americans in an essay Monday in The New York Times.
“During our respective C.D.C. tenures, we did not always agree with our leaders, but they never gave us reason to doubt that they would rely on data-driven insights for our protection, or that they would support public health workers,” they wrote.
They urged Congress to “exercise its oversight authority” over HHS and called on state and local governments and philanthropic givers to fill in the gaps where possible.
Kennedy defended his decisions, including gutting the CDC, in his own guest essay Tuesday in The Wall Street Journal. He accused the CDC of squandering public trust for decades.
He wrote that the organization should focus on infectious diseases — its original mission — and that other programs focused on chronic diseases, such as diabetes or heart conditions, should be moved away from the CDC.
“The CDC must restore public trust — and that restoration has begun,” Kennedy wrote.
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