'Vaccines are the best protection we have.' West Coast states issue their own guidance ahead of feds

The West Coast Health Alliance has released its recommendations for who should get the Covid, flu, and RSV vaccines this fall. The alliance is a new partnership between Washington, Oregon, California, and Hawaii to issue joint, science-based vaccine guidance in the face of concerns that the federal government can no longer be relied on to recommend vaccines based on the best available information.

“Vaccines are the best protection we have against serious illness due to COVID-19, flu, and RSV, and they can also help reduce spread and ease pressure on our health care system,” Washington state health officer Dr. Tao Sheng Kwan-Gett wrote in a press release. “Our recommendations are designed to protect those most at risk, including young children, older adults, people who are pregnant, those living in group settings, and anyone who lives or works with vulnerable people.”

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The alliance released its recommendations just ahead of the CDC’s vaccine advisory committee meeting this week; that committee plans to discuss and vote on new Covid vaccine guidelines on Friday.

The West Coast alliance advises that everyone 6 months and older, including pregnant people, get the annual flu shot.

It recommends the RSV vaccines for all babies under 8 months and all adults over 75. It says toddlers between 8 and 19 months old or people aged 50 to 75 with risk factors — such as premature birth for babies, or lung disease for adults — should also get vaccinated against RSV.

The Covid vaccine recommendations are the most complicated, though the guidelines say that everyone who chooses protection should get it. That’s in line with Washington state’s standing order that ensures that everyone in the state can get the vaccine without a prescription.

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Beyond that, the guidelines say everyone 6 to 23 months old or over 65 should get the vaccine, as should everyone who’s pregnant or has risk factors like diabetes, asthma, or inactivity — or anyone who smokes or ever has smoked. Also, the alliance recommends the vaccine to anyone who lives or works with other people with those risk factors. About two thirds of American adults fall into at least one of the high-risk categories, and so most people either have one of the conditions, or live or work with someone who does.

The federal guidelines about the Covid vaccine are currently unclear. They have changed several times in recent months, and the guidance from the FDA and CDC is, in some cases, contradictory.

The CDC changed its Covid vaccine guidance outside of its normal process in May, when health secretary Robert F Kennedy, Jr., weighed in about whether children and pregnant people should get the shot. After that, the agency removed any recommendation one way or the other for pregnant people, and said children could get the shot in consultation with their health care provider.

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But that guidance could change yet again when the CDC’s vaccine advisory committee meets this week. In June, Kennedy fired all the experts who were previously on that committee and who had gone through years-long vetting processes to check their expertise and any potential conflicts of interest. Kennedy replaced them with new members, some of whom have expressed skepticism about Covid vaccines in the past.

The FDA normally only decides whether to authorize a vaccine or not, and leaves specific guidance to the CDC, but last month the FDA stepped outside of its historical role and only authorized the vaccine for people over 65 or with certain health risks. That means others who want the vaccine might need to go to a doctor’s office or get a prescription for it — though, in Washington, thanks to the health officer’s standing order (a prescription that covers everyone in the state), that step is not necessary.

In the face of these shifts at the federal level, experts recommend turning to professional organizations such as the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists for science-based vaccine guidance. The West Coast Health Alliance said they also consulted these groups’ guidelines when developing their recommendations.