Representatives from Vermont’s Department of Health and seven other Northeastern states met last week to form a regional public health coalition that can respond to challenges passed down from the federal government amid dramatic changes brought on by the administration of President Donald Trump, such as disparities in vaccine recommendations or losses in lab funding.
Vermont’s interim health commissioner, Julie Arel, confirmed that she and her principal adviser went to the meeting in Providence, Rhode Island, as did the state epidemiologist, lab director and other senior staff members in the Department of Health. The meeting was first reported by the Boston Globe.
Arel described a collaboration in its preliminary stages: “The intent of that meeting in Rhode Island was to start to say, ‘What is this thing?’ We haven’t really defined it. We haven’t really decided what it is we’re doing with this.”
Still, she sees an increasing need for interstate collaboration as the federal Centers for Disease Control and Prevention restricts funding for lab testing and departs from scientific consensus on its immunization messaging.
“The biggest issue for public health right now is the uncertainty coming from the federal government,” Arel said. “That level of uncertainty is really hard for entities that are as heavily funded by federal grants as we are.”
No more than a week after the regional meeting, the federal center’s director, Susan Monarez, was forced out of the position, reportedly due to her objections to Health and Human Services Secretary Robert F. Kennedy Jr.’s efforts to change vaccine recommendations. On Wednesday, Monarez’s lawyers posted a letter on X that claimed her ouster was due to her refusal to “rubber-stamp unscientific, reckless directives and fire dedicated health experts.”
The CDC’s chief medical officer, the director of the National Center for Immunization and Respiratory Diseases, the director of the National Center for Emerging and Zoonotic Infectious Diseases and the director of Office of Public Health Data, Surveillance and Technology all resigned that same day.
On Thursday, Vermont Sen. Bernie Sanders called for a bipartisan congressional investigation into Monarez’s firing, citing in his statement the dangers to public health posed by what he called a “reckless” and “dangerous” decision.
The regional meeting last week centered on questions of infectious disease epidemiology, vaccines, laboratory sciences and emergency preparedness, Arel said. The coalition included all of the New England states except New Hampshire, as well as New Jersey, New York and Pennsylvania.
“There may be times where we are looking to provide more information than maybe the CDC is. But every state is going to need to do its own thing,” she added, explaining that the idea is that the regional coalition could be a source of guidelines and resources for states to act on independently.
Attendees were particularly interested in discussing how states might navigate a situation where the CDC’s vaccine recommendations split from state health officials’ scientific consensus, Arel described.
On Wednesday, the FDA issued approvals for updated Covid vaccines and removed emergency authorizations for their use, which had broadened access to the shots. Kennedy posted on X that the current authorization makes the Moderna, Pfizer and Novavax vaccines available to patients over 12 years old after consulting with their doctors. Still, the end of the emergency designation is expected to make it more challenging for individuals to get the shots without that approval.
In a Thursday email to VTDigger, Vermont Department of Health spokesperson Kyle Casteel added that what qualifies as an underlying condition to make someone eligible for the vaccine, and how it is proven to someone administering the vaccine, remains unclear.
The CDC is still expected to issue a recommendation for who should receive those vaccines. In June, Kennedy replaced the vaccine panel at the CDC with vaccine skeptics, and many worry that the panel’s recommendation may further limit access to Covid immunization when it meets in mid-September.
“The approval of this fall’s COVID vaccine has not followed the typical approval process, and we are still assessing recommendations and potential impacts so we can provide guidance to Vermonters about who can get the vaccine and where,” Casteel wrote. “We are working to reduce any access barriers as much as we can and will keep sharing information as it becomes available.”
He added that the state will continue to communicate with counterparts in other states to inform how to move forward with the confusion surrounding the federal directives.
Officials at the coalition meeting discussed areas of collaboration in which states can find efficiencies by acting as a larger group — such as buying bulk lab supplies as a region, which would bring cost savings to Vermont as a small state. When the loss of federal funding reduces resources for the state Department of Health, those savings can make a big difference, Arel said.
Other ideas for collaboration would leverage regional cooperation in less tangible ways — like brainstorming and coordinating messaging, public information campaigns or collectively strategizing on how to overcome public health challenges as they arise.
The collaboration Arel described is still at the stage of laying the groundwork and relationships for when the need to collectively act arises: “We don’t want to get out ahead of anything,” she said. “A lot of it has been making those relationships stronger.”
