RFK Jr. drives a wedge between red and blue states on vaccines
Vaccine policy has begun to fracture along state and political lines in the United States, with some states breaking away from guidelines set by the Trump administration and others going even further to loosen vaccine requirements.
The contrast was on stark display Wednesday as Washington, Oregon and California announced a coalition to make shot recommendations to counter what they called the Trump administration’s “destruction” of the Centers for Disease Control and Prevention. Hours later, Florida announced it would become the first in the nation to end all school vaccine mandates.
Health and Human Services Secretary Robert F. Kennedy Jr.’s changes to U.S. vaccine policy have prompted some states to break from the federal government and chart their own approaches to vaccination, moves that public health experts fear could lead to unprecedented confusion among doctors and patients. Kennedy is set to appear before senators at a hearing at 10 a.m. Thursday, where he is expected to face questions about vaccines.
Democratic governors have promised to continue promoting coronavirus vaccines and other shots that Kennedy and his allies are targeting or no longer recommending. States in the newly announced “West Coast Health Alliance” plan to coordinate vaccine recommendations based on the guidance of national medical organizations, saying the federal government is politicizing science. In the Northeast, a coalition of eight states has for months discussed launching a similar regional collaboration that could also order vaccines for their residents directly from manufacturers, rather than relying on federal health agencies for guidance, health officials said.
“In the absence of federal leadership, we will have 50 states doing 50 different things,” Kyle McGowan, a former chief of staff at the CDC during the first Trump administration, said in a text message. “We saw this during the early stages of COVID as well with states just doing what they hoped was right because of the chaos at the federal level.”
Florida Surgeon General Joseph A. Ladapo, who compared vaccine mandates to slavery, announced a shift away from all vaccine requirements, including long-standing ones for diseases such as measles and polio. He said he was proud to be the first state to do so, which would require the support of the state legislature for most vaccines, marking a retreat from a public health practice dating to the 19th century.
It remains to be seen whether other red states will follow the lead of Florida, which is widely considered an outlier on public health issues. Parents of all political backgrounds overwhelmingly support school vaccination requirements, according to a Washington Post-KFF poll conducted in July and August.
In Florida, 82 percent of parents said public schools should require vaccines for measles and polio, with some health and religious exceptions, while 17 percent said schools shouldn’t require those vaccines.
That is similar to the country overall, where 81 percent of parents support requirements for those vaccines and 18 percent oppose them. Among parents, support was 75 percent among Republicans, 80 percent among independents, and 91 percent among Democrats.
Thaddeus Smith, a 38-year-old father of two in Tallahassee who responded to the poll, said the move to eliminate school vaccine mandates felt like “overkill.”
“I grew up with vaccine mandates. I mean, I don’t see anything wrong with it if people can still opt out,” Smith said. “It seems like there’s a divide when it comes to red states and blue states.”
Many red states and blue states have similar vaccination policies. Mississippi, Alabama, Georgia and Texas require children from kindergarten to 12th grade to have had five of the most common childhood vaccinations, including DTaP (diphtheria, tetanus and pertussis); polio; hepatitis B; measles, mumps and rubella (MMR); and chicken pox to attend school. That’s similar to California and New York, although those states are stricter by not allowing religious exemptions.
But red-state officials don’t want to draw attention to those similarities because of politics, according to a state health official who spoke on the condition of anonymity to discuss private conversations. “The only reason they’re not talking about it is their governors don’t see eye to eye,” the official said.
Officials in blue states have become outspoken in drawing a contrast to the Trump administration and Kennedy. They are especially leery of how Kennedy, the founder of an anti-vaccine organization, purged the CDC committee that recommends immunizations, replacing its members with individuals who have pledged to reexamine the childhood vaccine schedule. Kennedy also pressured CDC director Susan Monarez to change vaccine policy and fire senior staff before the White House ousted her, prompting the resignation of top CDC officials who protested his vaccine policies.
“Our communities deserve clear and transparent communication about vaccines - communication grounded in science, not ideology,” Sejal Hathi, director of the Oregon Health Authority, said in a statement. “That is why Oregon is committed, alongside California and Washington, to leading with science and delivering evidence-based recommendations that protect health, save lives, and restore confidence in our public health system.”
Andrew Nixon, a spokesman for the Department of Health and Human Services, criticized the West Coast states as “Democrat-run states that pushed unscientific school lockdowns, toddler mask mandates, and draconian vaccine passports during the COVID era” that eroded trust in public health agencies.
The CDC’s vaccine advisory panel “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,” Nixon said in a statement.
The rollout of updated coronavirus vaccines has been mired in confusion since the Food and Drug Administration last week narrowed approval to groups considered at high risk. The CDC vaccine committee has not weighed in and is not scheduled to meet until Sept. 18. In nearly 20 states, pharmacists cannot administer vaccines that have not been recommended by the committee, according to Brigid Groves, the vice president of professional affairs at the American Pharmacists Association. As a result, CVS is requiring prescriptions for people to get vaccinated for the coronavirus in some states
Officials in New Mexico, Massachusetts, Pennsylvania and Colorado have issued orders allowing pharmacies to administer coronavirus vaccines without prescriptions in response to the confusion. No states run by Republican governors took similar moves.
“What I am most concerned about is these changes will leave it so people cannot access vaccines because their pharmacy may not be able to carry it,” said Anne Zink, a former chief medical officer for Alaska and senior clinical fellow at Yale’s School of Public Health. “Their insurance may not cover it, limiting individual choice to protect themselves or the family, and this will be additionally burdensome for those who cannot get vaccinated, like a kid with cancer who now has to worry about additional infectious diseases in everyday life, including school.”
State health officials have for months said Kennedy is dismantling the U.S. vaccine system and undermining messaging about the public health benefit of immunizations.
“A federal structure is being damaged to the point of which it may no longer be valuable,” said Stanley Plotkin, a physician who is among the inventors of vaccines against rubella, rotavirus and other pathogens. “So the question is how to deal with that.”
Those state officials, clinicians, insurers and others have been mobilizing behind the scenes to preserve access to vaccines and to work with medical associations to provide doctors and patients with explanations of the science and evidence-based recommendations.
A group of public health researchers and others have formed the Vaccine Integrity Project, based at the University of Minnesota, which is designed to compile and share medical evidence that the CDC traditionally provides. In mid-August, the group held a Zoom meeting, similar to those held by the CDC vaccine committee, where subject-matter experts presented extensive reviews of recent research about the safety and effectiveness of coronavirus, flu and RSV vaccines for children, pregnant women and people with weakened immune systems.
The politicization of vaccine policy in recent years has gone beyond the coronavirus.
West Virginia’s new Republican governor has sought religious exemptions to school vaccine mandates with the endorsement of Kennedy, but has faced opposition among some fellow Republicans in the state legislature. West Virginia has some of the toughest vaccine requirements in the nation, even as it went from a Democratic stronghold to a deep-red state.
Louisiana has ended mass vaccine promotion, as part of its shift right and a Republican governor succeeding a Democrat last year. The state’s new surgeon general, Ralph Abraham, has eased flu vaccine requirements for health care workers and this week criticized hepatitis B vaccination for infants.
The drift from long-standing vaccine policies in red states has concerned some of their residents.
Gisel Saumat, 43, a former middle school teacher from Miami Springs, Florida, said she had mixed feelings about state officials planning to end school vaccine requirements, reflecting many Americans’ complicated attitudes toward vaccines.
She shied away from coronavirus vaccines for her three children because she thought they were rushed into development and does not plan to get them vaccinated against HPV, a common virus that can cause certain cancers later in life. But she said she also sees the value of early vaccinations and wants ones that have long been in place to remain.
In 2014, her infant son almost died of pertussis, or whooping cough, contracted shortly before he was scheduled to be vaccinated. The respiratory illness killed many children before a vaccine became available in the 1940s, according to the CDC.
“Even the doctor couldn’t believe he got whooping cough,” Saumat, a Republican, said.
Tina Descovich, CEO of Moms for Liberty, an influential group of conservative parental rights activists, applauded Florida’s move to eliminate vaccine mandates.
“Parents have the fundamental right to direct the upbringing of their children - and nowhere is that more important than their medical care,” Descovich said in a statement.
- - -
David Ovalle, Aaron Schaffer, Scott Clement, Emily Guskin and Rachel Roubein contributed to this report.
GRAPHIC
https://washingtonpost.com/documents/c54fd3fe-5781-44f0-a66c-7942292ce486.pdf