Blue states eye rival health rules to defy RFK Jr.

• "Any public health response that is dependent on a patchwork of state actions is going to necessarily be less effective and less efficient" than a federal policy, said Samuel Bagenstos, who was general counsel to the Department of Health and Human Services in the Biden administration.

Between the lines: The fractures show that Democratic leaders in California, Massachusetts and other states see political gain in picking fights with Kennedy.

• And it could be part of a broader push toward what some analysts are calling "soft secession," in which states create rival systems to limit the power of the Trump administration.

Driving the news: Massachusetts Gov. Maura Healey announced Thursday that her state will require health insurers to cover vaccines recommended by its health department and not rely only on Centers for Disease Control and Prevention recommendations.

• New Mexico's health department last week issued a public health order to ensure that all residents can obtain COVID-19 vaccines, in response to guidelines Kennedy announced that restrict them to high-risk patients.
• The move "was really a show of support for vaccine access in the state," Miranda Durham, the New Mexico health department's chief medical officer, told Axios.
• "We want people to know that this is going to be a choice in New Mexico."

Since then, Massachusetts, Colorado and Pennsylvania have all cleared barriers that would have prevented pharmacies in the state from providing broad access to COVID-19 vaccines this fall.

• California, Oregon and Washington on Wednesday also unveiled a collaborative effort to issue their own evidence-based immunization recommendations. Healey is leading the charge for a similar compact for Northeast states, she said.

Illinois has its own state vaccine advisory committee that will still consider recommendations from the CDC's Advisory Committee on Immunization Practices. But it's also considering other data sources before providing official guidance by the end of September, said Sameer Vohra, the state's director of public health.

• "The events of last week, with the resignations of senior experts and the termination of the CDC director, shows that ... [the CDC] is very difficult to trust at the moment," Vohra told Axios.
• The New Republic reported last week that Illinois is considering purchasing COVID-19 vaccines in bulk directly from pharmaceutical manufacturers. The state's health department told Axios that it's "exploring every avenue" to make sure residents have access to vaccines.

The other side: "Democrat-run states that pushed unscientific school lockdowns, toddler mask mandates, and draconian vaccine passports during the COVID era completely eroded the American people's trust in public health agencies," HHS communications director Andrew Nixon said in a statement to Axios.

• "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," he added.

Florida also is forging its own path, but in an opposite direction of blue states. The state's surgeon general, Joseph Ladapo — known for his anti-vaccine views — announced this week that the state will end all school vaccine mandates.

• HHS on Thursday sent a letter to states reminding them that providers and immunization programs that participate in the federal program that funds free vaccines for eligible kids must respect state religious and conscience-based vaccine exemptions.

Catch up quick: Over the past century, the U.S. has coalesced around a public health system, in which the federal government provides uniform guidance and resources to states, said Bagenstos, now a law professor at the University of Michigan.

• "The reason is because infectious diseases don't respect state borders," he said.
• But the legal infrastructure of public health is state-based, he said, which gives governors and legislators leeway to create their own guidance for residents.
• Additionally, doctors are free to prescribe Food and Drug Administration-approved medications off-label. Even though the FDA this year has only authorized updated COVID-19 boosters for seniors and those with underlying health conditions, providers can give patients who don't meet those criteria access to the vaccines.

Yes, but: Blue states moving away from CDC vaccine guidelines could create more confusion around best practices if their decisions draw on different data sources or diverge significantly from each another, Paul Offit, pediatrician and vaccine expert at the Children's Hospital of Philadelphia, told the New York Times.

• And efforts to purchase vaccines in bulk or stand up public vaccination clinics would cost large sums — just as states brace for the loss of billions of federal dollars for their Medicaid programs.
• "Illinois cannot match the capacity and capability in which the federal government had for this," Vohra said. "But we do have our own series of medical professionals, epidemiologists, really reviewing the Illinois data."