This article was updated 9/10/2025 to include new vaccine guidance from the ACOG, AAFP and AAP.
By Gina Shaw
Pennsylvania, Colorado and Massachusetts became the latest states to break with the CDC’s vaccine recommendations this week, separately announcing their own policies regarding COVID-19 vaccinations. The moves follow the Sept. 2 announcement from a coalition of Western states (California, Oregon and Washington) that they had formed the West Coast Health Alliance to provide unified, evidence-based vaccine and other health policy recommendations in response to sweeping changes at the CDC, particularly the firing of its director, the removal of seasoned advisors and the appointment of officials known for their opposition to vaccination, under Health and Human Services Secretary Robert F. Kennedy Jr.
In addition, the American Academy of Family Physicians (AAFP) has released their own recommendations, which state that all individuals—starting at children 6 months and older—should get their COVID shots. This is aligned with new recommendations from the American Academy of Pediatrics (AAP). The AAFP recommendations also align with the American College of Obstetricians and Gynecologists (ACOG)'s new guidelines recommending pregnant and lactating people to receive COVID immunizations.
At the urging of Gov. Josh Shapiro, Pennsylvania’s Board of Pharmacy voted to allow pharmacists in the state to follow vaccine recommendations from other trusted health authorities, after the FDA announced restricted criteria for the COVID-19 vaccine. Those authorities include the ACOG, AAP, AAFP, and FDA.
“In the days between the Trump administration’s changes and today’s board vote, major pharmacies had stopped giving the COVID vaccine to anyone in Pennsylvania because the Advisory Committee on Immunization Practices (ACIP) has not yet issued recommendations on the new COVID vaccine,” according to a statement from the governor’s office. “Before today’s board vote, Pennsylvania pharmacists could follow only ACIP’s vaccine recommendations. Today’s vote changes that, allowing PA pharmacists to follow the vaccine recommendations of other trusted authorities restoring access and cutting through the confusion.
“The Trump administration’s outrageous decision to limit access to the COVID vaccine is an affront to Pennsylvanians’ personal freedoms. I called on the State Board of Pharmacy to hold a special meeting to bring clarity to the people of Pennsylvania,” Mr. Shapiro said. “Healthcare decisions should be up to individuals—not the federal government and certainly not RFK Jr. My Administration will continue to protect health care access for all Pennsylvanians.”
“Following today’s regulatory action by the Pennsylvania Board of Pharmacy, CVS Pharmacy will ensure COVID-19 vaccinations are available as soon as possible at our locations throughout Pennsylvania,” said Sid Tenneti, the senior vice president, Retail Pharmacy, CVS Health, in the statement.
Pharmacists in Colorado will also be authorized to administer the latest COVID-19 vaccines to residents aged 6 months and older, without a physician prescription, announced Gov. Jared Polis on Sept. 3. The orders take effect Sept. 5 and will remain in place through September 2026 unless rescinded. “This order ensures that Colorado takes every step possible to prevent hospitalizations, protect frontline health care workers, and preserve critical health care resources. Equitable vaccine access is a cornerstone of protecting the public’s health,” said Jill Hunsaker Ryan, the executive director of the Colorado Department of Public Health and Environment, in a statement.
And on Sept. 4, Massachusetts Gov. Maura Healey announced that the state’s Department of Public Health (DPH) had updated its vaccine administration policyto permit the DPH commissioner to determine which routine vaccines can be administered by pharmacists in Massachusetts. Previously, pharmacists were limited to only the vaccines recommended by ACIP, which led CVS and Walgreens to not offer COVID-19 vaccines in the state. The DPH also issued a standing order allowing “all qualified pharmacy personnel at Massachusetts pharmacies to dispense and administer the COVID-19 vaccine in Massachusetts to all eligible persons.”
Ms. Healey also said the DPH and the Division of Insurance will require insurance carriers to cover vaccines recommended by the DPH, which the governor’s office said makes Massachusetts the first state to guarantee insurance coverage of vaccines recommended by the state. She said Blue Cross Blue Shield of Massachusetts and the Massachusetts Association of Health Plans support the state’s actions.
“Massachusetts is also leading efforts to create a public health collaboration with states in New England and across the Northeast, committed to safeguarding public health as the federal government backs away from its responsibilities,” the press release added.
“This multistate collaborative is focused on developing evidence-based recommendations on vaccinations, disease surveillance, emergency preparedness and supporting state public health labs.”
Leaders from other Northeastern states have also called for the region to follow the West Coast Health Alliance’s example. “The COVID vaccine has saved 2.5 million lives across the globe since its introduction,” said Connecticut Senate Majority Leader Bob Duff (D-Norwalk) in a statement issued jointly with Senate President Martin M. Looney (D-New Haven). “When his own staff is resigning and walking out of offices to protest his actions, it’s clear we can no longer fully trust the CDC, FDA or HHS. It’s with that foresight that I commend the West Coast Health Alliance and call upon Connecticut and our allies in the Northeast to follow suit. The people of New England and the Northeast, home to some of the best colleges and health care in the nation, deserve confidence when researching the best health decisions for themselves.”
What does this uncertainty mean for insurance coverage of vaccines nationwide? That remains unclear. “We’re working closely with our members to review the recent FDA announcement and will be monitoring the forthcoming meetings and recommendations from ACIP and CDC on considerations around coverage,” said Tina Stow, a spokesperson for AHIP (America’s Health Insurance Plans). “Individual health plans and plan sponsors will be prepared to make coverage decisions informed by science, the latest medical evidence and data. This process will be evidence-based, evaluate multiple sources of data, including but not limited to ACIP, and will be informed by customer needs.”
For more than a decade, health plans have covered ACIP-recommended vaccines without cost sharing, in line with federal requirements as part of the Affordable Care Act (ACA) and Inflation Reduction Act (IRA). Under the IRA, Medicare Part D and Medicaid plans are required to adhere to ACIP recommendations immediately upon the CDC director’s signature and provide coverage of these vaccines at no cost to the beneficiary. Under the ACA, for commercial plans, any changes stemming from subsequent ACIP recommendations could only be implemented in the next benefit year.
The current state of confusion, with multiple authorities issuing vaccine recommendations, harkens back to the period before the mid-1990s, when the United States moved to unified, harmonized vaccine recommendations issued by ACIP. At that time, the AAP and ACIP had similar but not identical recommendations, which created confusion for clinicians and parents.
In February 1994, the AAP, ACIP and the AAFP convened with the FDA, National Institutes of Health, CDC and other stakeholders to design a single, scientifically valid, easy-to-use schedule with specified ages and acceptable ranges. That consensus model was later extended to adults, with ACIP publishing the first adult immunization schedule in 2002, with the AAFP, ACOG and the American College of Physicians (ACP) (MMWR Morb Mortal Wkly Rep 2014;63[42]:955-958).
“What is being done now with ACIP is essentially violating that consensus, because the schedule was originally developed with the participation of groups like ACOG, AAFP, the AAP and ACP, the AMA [American Medical Association], and others,” said Walter Orenstein, MD, a professor emeritus of medicine at Emory University School of Medicine, in Atlanta, former associate director of the Emory Vaccine Center, former director of the U.S. Immunization Program, and former assistant surgeon general of the U.S. Public Health Service, in an interview with Infectious Disease Special Edition. “Those organizations are no longer being included in the decision-making, and we have a group that clearly is making recommendations that defy what most of the scientific community would recommend.”
In June, Mr. Kennedy retired the complete ACIP panel and appointed vaccine skeptics in their place. In an editorial in STAT, published Sept. 4, three of the dismissed members of the prior ACIP panel, speaking for the entire group of 17, declared that Americans are losing the ability to choose vaccination, warning that “the transparency, independence, and scientific rigor that once characterized ACIP have vanished,” they wrote. “We call on policymakers, professional societies, and the public to demand a return to evidence-based, transparent vaccine policy free from political interference. Protecting access to vaccines is not only a matter of science—it is a matter of safeguarding the health and future of our nation.”
Dr. Orenstein suggested that the prior members of ACIP should work together with organizations like the AAP, ACOG and others, as well as the new regional health alliances, to develop a cohesive, unified vaccine schedule, possibly under the auspices of the Vaccine Integrity Project at the Center for Infectious Disease Research and Policy at the University of Minnesota. “I think that would be very helpful,” he said. “We need to get the real experts together with a unified message around these vaccine recommendations and schedules.”
