Four western states have collaboratively issued their own recommendations regarding the distribution of Covid, flu, and RSV vaccines this fall. This move acts as a counterbalance to anticipated new vaccine guidelines from the Trump administration, which has replaced key scientific figures in the federal health department with vaccine skeptics and critics.

These new recommendations emerge following testimony from the recently dismissed CDC director, Susan Monarez, to Congress. Monarez expressed concerns that under the leadership of Robert F Kennedy Jr, appointed by Trump to head the Department of Health and Human Services, there could be potential attempts to restrict vaccine access for children and others in need, without proper scientific evaluation.

The guidelines from California, Oregon, Washington, and Hawaii, collectively known as the West Coast Health Alliance, advise Americans to get the Covid-19 vaccine if they are pregnant, aged 65 or older, have certain risk factors, or simply wish to be protected. The states also recommend that very young children, from 23 months to six years old, as well as older children and teenagers with risk factors or those who have not been vaccinated before, receive the Covid vaccine this year.

Dr. Kenneth Fink, director of Hawaii’s health department, stated, “These recommendations are a collaborative effort, made with humility and based on science, to fulfill our responsibilities to our communities and the public at large.”

The western states’ recommendations sharply contrast with the current Covid-19 vaccine guidelines from the Trump administration. Experts highlight the unprecedented move by Kennedy, a well-known vaccine skeptic, who announced in May that the federal government would no longer advise pregnant individuals and children to receive the Covid-19 vaccine.

The states of California, Washington, and Oregon established the West Coast Health Alliance in early September, shortly after Monarez’s removal from her position due to conflicts with Kennedy over his attempts to alter federal vaccine policies in contradiction to established scientific findings. Hawaii has since joined the alliance.

In contrast with the acting head of Trump’s CDC, a former speechwriter and investment executive with no medical or scientific background, the state health officers who developed the new recommendations “are all medical doctors”, according to a statement from California governor Gavin Newsom. The recommendations are also based on guidance from major health associations, including the American Academy of Pediatrics.

The release of the western states’ winter vaccine recommendations come one day before a federal advisory committee on immunization is expected to meet to review current vaccine standards, potentially re-examining federal recommendations about which routine vaccinations children should receive, including standard vaccinations against hepatitis B and HPV (human papillomavirus).

Kennedy purged the existing members of the Advisory Committee on Immunization Practices (ACIP) in June, a move the head of one public health association called a “coup”, and replaced them with his own experts.

Even one Republican senator who is a medical doctor, Louisiana’s Bill Cassidy, has spoken out in concern about the risk of rescinding the recommendation for an infant hepatitis B vaccine, arguing that protecting newborns against the virus had been a tremendous success in making Americans healthier.

In late August, Cassidy issued a statement calling for a postponement of the ACIP meeting, which is scheduled to begin on Thursday, arguing: “If the meeting proceeds, any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership.”

Monarez, who served less than one month as the CDC director, warned in congressional testimony on Wednesday that Kennedy had told her in late August that “the childhood vaccine schedule would be changing starting in September, and I needed to be on board with it”, and said that he had subsequently fired her after she would not pledge to “commit in advance to approving every ACIP recommendation, regardless of the scientific evidence”, and because she resisted firing career public health officials responsible for vaccine policy without cause.

In response to questions about western states providing alternate vaccine guidelines, a spokesperson for Trump’s Department of Health and Human Services defended the ACIP committee, saying it “remains the scientific body guiding immunization recommendations in this country”, and that “HHS will ensure policy is based on rigorous evidence and Gold Standard Science, not the failed politics of the pandemic”.

“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,” the spokesperson said in a statement.

Although Trump officials have claimed that any adult who wants a Covid-19 vaccine will still be able to get one regardless of the federal guidelines, experts say this is “misleading”, and that federal guidelines profoundly shape how insurance companies reimburse the cost of vaccines and how pharmacies provide them, potentially creating serious practical and financial hurdles for Americans who still want to be vaccinated.

“If vaccine protections are weakened, preventable diseases will return,” Monarez testified on Wednesday.

Lauren Gambino, Madeleine Aggeler and Melody Schreiber contributed reporting