State governments across the country are increasingly taking vaccine policy into their own hands, raising the prospect that Americans’ access to COVID-19 shots could soon depend heavily on where they live.
The shift follows sweeping changes at federal health agencies and new limits imposed by the Food and Drug Administration (FDA), which last week approved fall COVID boosters only for adults 65 and older and those with serious health conditions. Healthy adults and children who want the vaccine now need prescriptions — a move that has left states scrambling to fill the gaps.
States Act Amid Federal Uncertainty
New York has declared a “statewide disaster emergency” to ensure residents retain access to vaccines. Massachusetts is requiring insurers to cover shots endorsed by state health officials, even if they fall outside federal recommendations. New Mexico issued a public health order enabling pharmacists to keep giving COVID vaccinations widely.
On the West Coast, governors from Oregon, Washington, California, and Hawaii launched the West Coast Health Alliance to coordinate vaccine policy, citing concerns about ideology overtaking science in federal decision-making. States in the Northeast are exploring similar regional collaborations.
“We’re seeing something happen that we’re concerned about, and we’re not going to wait to see how it plays out,” said Dennis Worsham, Washington State’s health secretary, during a September 3 briefing.
Federal Disruptions and Credibility Concerns
The turmoil traces back to upheaval within the Centers for Disease Control and Prevention (CDC) and its vaccine advisory committee, ACIP. In June, Health and Human Services Secretary Robert F. Kennedy Jr. dismissed longstanding members of the panel and installed new advisers, many of whom share his skepticism toward vaccines. Several prominent CDC leaders have since resigned.
That shake-up has rattled confidence among state health leaders. “To have that body abandoned and replaced by people who are not experts in the field is terrible,” said Dr. Jeffrey Koplan, a former CDC director. “Where we are now is a royal muddle.”
States are now turning to other trusted sources, including the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and a new Vaccine Integrity Project launched at the University of Minnesota by former CDC officials.
Confusion on the Ground
The lack of unified guidance is already causing confusion for patients and providers. Pharmacies in some states are restricting access to shots for people under 65, while others are relying on state laws to maintain wider availability.
“This is the first time since the COVID vaccine has been available that there’s any question whether pharmacists can prescribe it,” said Kyle Robb of the American Society of Health-System Pharmacists.
New Mexico’s health secretary Gina DeBlassie said her state had no choice but to act. “We’re removing barriers and we want to ensure access,” she said.
Sharp Divides Between States
While blue states move to preserve access, Florida is heading in the opposite direction. At a press conference on September 3, Florida Surgeon General Dr. Joseph Ladapo denounced COVID vaccines as “poison” and compared mandates to slavery. He announced plans to end all vaccine requirements in the state.
Such stark contrasts highlight the growing patchwork of vaccine rules across the nation. “While there’s always been some variation state-by-state, what we’re seeing now is an amplification because of the lack of a federal coordinating entity,” said Dr. Susan Kansagra of the Association of State and Territorial Health Officials.
What Comes Next
The CDC’s restructured advisory panel is scheduled to meet later this month to vote on recommendations for COVID, Hepatitis B, and other vaccines. But many states have already signaled they may chart their own course regardless of what the federal body decides.
For public health experts, the divergence underscores the risks of a fragmented national approach. “Vaccines are one of the most important public health interventions in our lifetimes,” said Dr. Erica Pan, California’s state health officer. “We want to make sure we continue to protect our communities.”
Until clarity returns, Americans may find their eligibility — and even the ability to walk into a pharmacy for a shot — determined more by state borders than federal health policy.
