healthy child

SACRAMENTO — Gov. Gavin Newsom signed a law giving California the power to set its own immunization schedules based on state health experts and independent medical groups — a sharp break from decades of reliance on guidance from the federal government.

The move came the same day that California and its West Coast allies issued joint recommendations for COVID-19, flu and RSV vaccines, part of a regional alliance formed to counter what they say is a politicized U.S. Centers for Disease Control.

“Our states are united in putting science, safety, and transparency first — and in protecting families with clear, credible vaccine guidance,” said the governors of California, Oregon, Washington and Hawaii, which make up the West Coast Health Alliance.

The flurry of vaccine actions came as lawmakers and the University of California proposed a $23-billion ballot measure to replace federal research dollars lost to Trump-era cuts, underscoring efforts by Democrats in the state to shield science and public health from shifting federal policies. The measure, if passed by the California Legislature when lawmakers return in January, would go before voters in November 2026.

“The loss of critical federal funding awarded to the University of California presents an unprecedented and perilous moment for the state and its communities,” Theresa Maldonado, UC vice president for research and innovation, said in a statement.

The healthcare clash comes following a wave of COVID cases and as the annual flu season nears. For decades, the CDC has been the nation’s trusted authority on vaccines — setting childhood immunization schedules, guiding which shots adults should receive and shaping state health policies across the country.

Now, at the direction of Health and Human Services Secretary Robert F. Kennedy Jr., a Trump ally, the CDC fired top leadership, lost senior scientific advisors and remade its vaccine advisory committee with members who the Associated Press found spread misinformation and conspiracy theories about immunizations.

Kennedy, a longtime vaccine skeptic, has defended the shakeup as necessary to create trust and “eliminate politics from science.”

“They deserve the truth and that’s what we’re going to give them for the first time in the history of the agency,” Kennedy told the Senate Finance Committee earlier this month during a contentious hearing.

The overhaul triggered a fierce backlash as more than 1,000 employees at the health agency and national health organizations have called on Kennedy to resign. Some states, however, have embraced the approach — Florida announced plans to become the first state to end all vaccines mandated, including for schoolchildren.

The polarization is taking a toll. A recent KFF poll found Americans are increasingly uncertain about public health guidance and whether new recommendations from the administration will make them more or less safe.

Public health experts say that not only are vaccines crucial for the health of individuals and the community but they also ultimately save money — preventing sickness and the rise in healthcare costs that would accompany widespread disease outbreaks.

The changes in federal vaccine recommendations have been sweeping. The Food and Drug Administration, which falls under Kennedy’s purview, now requires adults 65 and younger and otherwise healthy — who report no underlying health issues — to consult with a healthcare provider before getting the COVID vaccine. Similarly, the CDC requires parents of healthy children to talk to a healthcare provider before their child can receive the COVID vaccine, a barrier the American Academy of Pediatrics called “deeply troubling.”

The American Academy of Pediatrics issued its own COVID vaccine guidance, countering what the CDC recommended, that says all young children 6 months to 23 months should be vaccinated, as well as certain high-risk older children. The group has also said that older children should be offered the vaccine if their parents request it.

The CDC also changed its vaccine schedule from recommending the COVID vaccine to all pregnant women to offering “no guidance” as to whether healthy pregnant women should get the vaccine. In response, the American College of Obstetricians and Gynecologists recommended that people receive the updated COVID-19 vaccine at any point during their pregnancy.

California said it too will reject CDC guidance, starting with the recommendations released Wednesday from the West Coast Health Alliance. Those recommendations were developed by health officers and subject matter experts from each state, who considered guidelines from medical organizations such as the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians.

The COVID-19 vaccine recommendations from the West Coast Health Alliance include vaccinating all children 6 months to 23 months and those 2 years old to 64 years old with risk factors. The alliance also recommended all pregnant and postpartum women or those planning to become pregnant to be vaccinated.

The alliance recommended children 6 months and older and all adults and pregnant women to receive the flu shot. For the RSV vaccine, the alliance recommends it for children younger than 8 months, as well as anyone 75 years or older. The alliance recommends the RSV vaccine for all other ages if a person has risk factors.

“We want the people who live and work in our states to know that there is a strong public health, healthcare and scientific community that will continue to stand together to provide and use the data and evidence needed for you to make healthy choices, and we are here to protect our communities,” said Dr. Erica Pan, director of the California Department of Public Health, in a statement.

NEW YORK — For the first time in 30 years, the American Academy of Pediatrics is substantially diverging from U.S. government vaccine recommendations.

The group’s new COVID-19 recommendations — released Tuesday — come amid a tumultuous year for public health, as vaccine skeptics have come into power in the new Trump administration and government guidance has become increasingly confusing.

This isn’t going to help, acknowledged Dr. James Campbell, vice chair of the AAP infectious diseases committee.

“It is going to be somewhat confusing. But our opinion is we need to make the right choices for children to protect them,” he added.

The AAP is strongly recommending COVID-19 shots for children ages 6 months to 2 years. Shots also are advised for older children if parents want their kids vaccinated, the AAP said.

That differs from guidance established under U.S. Health Secretary Robert F. Kennedy Jr., which doesn’t recommend the shots for healthy children of any age but says kids may get the shots in consultation with physicians.

Children ages 6 months to 2 years are at high risk for severe illness from COVID-19, and it was important that recommendations continue to emphasize the need for them to get vaccinated, said Campbell, a University of Maryland infectious diseases expert.

Vaccinations also are recommended for older children who have chronic lung diseases or other conditions that put them at higher risk for severe disease, the AAP said.

In a statement, Department of Health and Human Services spokesperson Andrew Nixon said “the AAP is undermining national immunization policymaking with baseless political attacks.”

He accused the group of putting commercial interests ahead of public health, noting that vaccine manufacturers have been donors to the AAP’s Friends of Children Fund. The fund is currently paying for projects on a range of topics, including health equity and prevention of injuries and deaths from firearms.

The 95-year-old Itasca, Illinois-based organization has issued vaccination recommendations for children since the 1930s. In 1995, it synced its advice with recommendations made by the federal government’s Centers for Disease Control and Prevention.

There have been a few small differences between AAP and CDC recommendations since then. For example, the AAP has advised that children get HPV vaccinations starting at age 9; the CDC says that’s OK but has emphasized vaccinations at ages 11 and 12.

But in 30 years, this is the first time the recommendations have differed “in a significant or substantial way,” Campbell said.

Until recently, the CDC — following recommendations by infectious disease experts — has been urging annual COVID-19 boosters for all Americans ages 6 months and older.

But in May, U.S. Health Secretary Robert F. Kennedy Jr. announced that COVID-19 vaccines are no longer recommended for healthy children and pregnant women. A few days later, the CDC issued language that healthy children may get the shots, but that there was no longer a “should” recommendation.

The idea that healthy older kids may be able to skip COVID-19 boosters has been brewing for some time among public health experts. As the COVID-19 pandemic has waned, experts have increasingly discussed the possibility of focusing vaccination efforts on people 65 and older — who are among those most as risk for death and hospitalization.

A CDC expert panel in June was set to make recommendations about the fall shots. Among the options the panel was considering was whether suggest shots for high-risk groups but still giving lower-risk people the choice to get vaccinated.

But Kennedy bypassed the group, and also decided to dismiss the 17-member panel and appoint his own, smaller panel, that included vaccine skeptics. Kennedy also later excluded the AAP, the American Medical Association and other top medical organizations from working with the advisers to establish vaccination recommendations.

Kennedy’s new vaccine panel has yet to vote on COVID-19 shot recommendations.

The panel did endorse continuing to recommend fall flu vaccinations, but also made a decision that led to another notable difference with the AAP.

The new advisory panel voted that people should only get flu vaccines that are packaged as single doses and do not contain the preservative thimerosal.

The AAP said there is no evidence of harm from the preservative, and recommended doctors use any licensed flu vaccine product that’s appropriate for the patient.

Stobbe writes for the Associated Press.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

WASHINGTON  — Public health advocates won a big case in the Supreme Court on the last day of this year’s term, but the victory came with an asterisk.

The decision ended one threat to the no-cost preventive services — from cancer and diabetes screenings to statin drugs and vaccines — used by more than 150 million Americans who have health insurance.

But it did so by empowering the nation’s foremost vaccine skeptic: Health and Human Services Secretary Robert F. Kennedy Jr.

Losing would have been “a terrible result,” said Washington attorney Andrew Pincus. Insurers would have been free to quit paying for the drugs, screenings and other services that were proven effective in saving lives and money.

But winning means that “the secretary has the power to set aside” the recommendations of medical experts and remove approved drugs, he said. “His actions will be subject to review in court,” he added.

The new legal fight has already begun.

Last month, Kennedy cited a “crisis of public trust” when he removed all 17 members of a separate vaccine advisory committee. His replacements included some vaccine skeptics.

The vaccines that are recommended by this committee are included as preventive services that insurers must provide.

On Monday, the American Academy of Pediatrics and other medical groups sued Kennedy for having removed the COVID-19 vaccine as a recommended immunization for pregnant women and healthy children. The suit called this an “arbitrary” and “baseless” decision that violates the Administrative Procedure Act.

“We’re taking legal action because we believe children deserve better,” said Dr. Susan J. Kressly, the academy’s president. “This wasn’t just sidelining science. It’s an attack on the very foundation of how we protect families and children’s health.”

On Wednesday, Kennedy postponed a scheduled meeting of the U.S. Preventive Services Task Force that was at the center of the court case.

“Obviously, many screenings that relate to chronic diseases could face changes,” said Richard Hughes IV, a Washington lawyer and law professor. “A major area of concern is coverage of PrEP for HIV,” a preventive drug that was challenged in the Texas lawsuit that came to the Supreme Court.

By one measure, the Supreme Court’s 6-3 decision was a rare win for liberals. The justices overturned a ruling by Texas judges that would have struck down the popular benefit that came with Obamacare. The 2012 law required insurers to provide at no cost the preventive services that were approved as highly effective.

But conservative critics had spotted what they saw was a flaw in the Affordable Care Act. They noted the task force of unpaid medical experts who recommend the best and most cost-effective preventive care was described in the law as “independent.”

That word was enough to drive the five-year legal battle.

Steven Hotze, a Texas employer, had sued in 2020 and said he objected on religious grounds to providing HIV prevention drugs, even if none of his employees were using those drugs.

The suit went before U.S. District Judge Reed O’Connor in Fort Worth, who in 2018 had struck down Obamacare as unconstitutional. In 2022, he ruled for the Texas employer and struck down the required preventive services on the grounds that members of the U.S. Preventive Services Task Force made legally binding decisions even though they had not been appointed by the president and confirmed by the Senate.

The 5th Circuit Court put his decision on hold but upheld his ruling that the work of the preventive services task force was unconstitutional because its members were “free from any supervision” by the president.

Last year, the Biden administration asked the Supreme Court to hear the case of Xavier Becerra vs. Braidwood Management. The appeal said the Texas ruling “jeopardizes health protections that have been in place for 14 years and millions of Americans currently enjoy.”

The court agreed to hear the case, and by the time of the oral argument in April, the Trump administration had a new secretary of HHS. The case was now Robert F. Kennedy Jr. vs. Braidwood Management.

The court’s six conservatives believe the Constitution gives the president full executive power to control the government and to put his officials in charge. But they split on what that meant in this case.

The Constitution says the president can appoint ambassadors, judges and “all other Officers of the United States” with Senate approval. In addition, “Congress may by law vest the appointment of such inferior officers” in the hands of the president or “the heads of departments.”

Option two made more sense, said Justice Brett M. Kavanaugh. He spoke for the court, including Chief Justice John G. Roberts and Justice Amy Coney Barrett, and the court’s three liberal justices.

“The Executive Branch under both President Trump and President Biden has argued that the Preventive Services Task Force members are inferior officers and therefore may be appointed by the Secretary of HHS. We agree,” he wrote.

This “preserves the chain of political accountability. … The Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect.”

The ruling was a clear win for Kennedy and the Trump administration. It made clear the medical experts are not “independent” and can be readily replaced by RFK Jr.

It did not win over the three justices on the right. Justice Clarence Thomas wrote a 37-page dissent.

“Under our Constitution, appointment by the President with Senate confirmation is the rule. Appointment by a department head is an exception that Congress must consciously choose to adopt,” he said, joined by Justices Samuel A. Alito and Neil M. Gorsuch.