Washington is teaming up with Oregon and California to form an alliance that will soon issue recommendations around COVID-19 vaccinations, an effort to counter last week’s decision from federal regulators to approve the shots for just a portion of the population.
The West Coast Health Alliance, as the three-state group will be known, plans to review scientific data and guidance from professional medical associations when coming up with vaccine recommendations that are unified, consistent and evidence-based, the states’ governors said in a joint news release Wednesday. The alliance is a direct response to President Donald Trump’s “destruction” of the U.S. Centers for Disease Control and Prevention, which “has become a political tool that increasingly peddles ideology instead of science,” the states said.
The mission is to offer West Coast residents credible information about vaccine safety and efficacy, the group said. But state leaders still appear to be working out specifics around what accessibility will look like in the fall, including whether health insurance plans will cover the shots.
Those details will involve input from state health officials, pharmacies, insurance regulators, private insurers and others.
For now, officials say they are determined to ensure the message is clear about a vaccine that’s credited with saving millions of lives.
“It’s been concerning to watch what has been happening over a period of time under this federal administration around the CDC,” Washington state Secretary of Health Dennis Worsham said in a Wednesday news conference. “We need to stand for the values of who we are and be able to point people to what we feel are science-based approaches.”
The group is mainly focused on issuing COVID vaccine recommendations at this point, rather than childhood or other immunizations, said Worsham, who was appointed to the state’s top health position earlier this year. Guidance will largely be based on expertise from national groups like the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and family medicine and gerontology associations, he added.
The alliance plans to publish its guidance around COVID vaccines in the coming days, Worsham said.
Those recommendations will likely differ from the vaccine approvals the U.S. Food and Drug Administration issued last week, which greenlit updated COVID vaccines from Pfizer, Moderna and Novavax that target newer variants. But unlike in previous years, the approval applies only to adults over 65, and anyone 6 months and older who has “at least one underlying condition” that puts them at higher risk of complications from COVID.
The FDA did not approve the updated shots for healthy children and younger adults.
The next step in rolling out new vaccines in the U.S. typically falls to the CDC’s Advisory Committee for Immunization Practices, or ACIP.
Health Secretary Robert F. Kennedy Jr. dismissed that entire group this year, replacing members with his picks, several of whom are vaccine skeptics.
The panel reviews data from clinical trials, put together by the CDC, then makes a recommendation to the CDC director. Once the CDC director signs off on a vaccine, the recommendation is published in the Federal Register and put on the agency’s immunization schedule.
The vaccine schedule is key, as it sets the rate insurance companies are obligated to pay for immunizations under the Affordable Care Act. It allows many patients, including Medicaid members and those with private insurance, to get several vaccines covered.
But the CDC’s advisory committee has not yet issued recommendations for the new COVID shots and has repeatedly delayed meetings, which prompted Washington, Oregon and California to form the health alliance, Worsham said.
Because the FDA has not approved new COVID vaccines for healthy kids and adults under 65, those shots are now considered “off-label” for those populations, Worsham said. In Washington, physicians can prescribe and administer COVID shots for off-label use for healthy kids and younger adults, but that isn’t the case for all providers.
Only some pharmacists, for example, can prescribe off-label medications, depending on their individual collaborative practice agreements — formal relationships between pharmacists and physicians or other health care providers that allow pharmacists to provide expanded services, said Jenny Arnold, CEO of the Washington State Pharmacy Association.
Pharmacies can change their collaborative agreements to allow pharmacists to prescribe based on professional association guidance, rather than CDC or FDA policies, Arnold said. Many have started to do so this week, she said.
Washington leaders are also exploring a “standing order,” which is generally issued by the state health officer and would allow pharmacists to dispense medication based on patient care need, regardless of their collaborative agreements, Arnold said.
Arnold said she was hopeful Washingtonians would not face significant issues accessing updated COVID shots from pharmacies.
Ironing out the insurance side could be “a bit more complicated,” Worsham said during the news conference.
It’s not yet clear if all health insurance plans, particularly those administered by the federal government or large employers, will continue to cover COVID vaccines for non-FDA-approved groups, he said.
“We’re working on that right now with the governor’s office,” Worsham said. “It will be a process we’ll have to learn more about going forward.”
By late Wednesday afternoon, however, several Washington insurance companies — including Premera Blue Cross, Kaiser Permanente and Regence BlueShield — had affirmed their commitment to covering updated COVID vaccines for all patients, regardless of federal changes.
“We will continue to follow evidence-based medicine guidelines, review federal and state guidelines along with professional societies on vaccines, and look forward to the recommendations from West Coast Health Alliance,” Premera said in a statement sent to The Seattle Times.
Regence added in a statement that the Northwest insurer will “rigorously follow the science in determining coverage of preventive services.”
Stephanie Marquis, spokesperson for the state Office of the Insurance Commissioner, also confirmed that COVID shots will still be covered by small-group and individual plans, regardless of age, through 2026.
“If people want a vaccine and it was covered at the time the plan was filed (earlier this year), their health plan has to cover it,” Marquis said.
The state Office of the Insurance Commissioner does not regulate large employer-funded plans, self-funded plans or Medicare or Medicaid coverage, which could all still see changes in COVID vaccine coverage.
There’s also the question of vaccine supply, and whether states can order enough shots through the federal government, given the new restrictions on who should get them, Marquis said.
Hours after the West Coast Health Alliance’s announcement, vastly different news came out of Florida, which plans to become the first state to eliminate childhood vaccine mandates.
Worsham said he and other West Coast health leaders feel “strengthened as a system.
“It’s really about trying to build efficiency and a clear voice where there’s so much noise at this time,” he said.
Information from The Oregonian and The Seattle Times archives was included in this report.
Elise Takahama: 206-464-2241 or etakahama@seattletimes.com. Elise Takahama is a health reporter at The Seattle Times, where she writes about public health issues, the business of health care, medical research and health equity gaps in Washington, among other news. Born in Seattle and raised in Southern California, she’s previously covered breaking news, crime and K-12 education in the Los Angeles and Boston areas.