As the Trump administration shakes up recommendations for childhood vaccines, a growing number of states are moving quickly to ensure vaccines remain free and health care workers are protected from lawsuits.
“States are stepping in to protect their communities proactively,” said Dr. David Higgins, a practicing pediatrician in Aurora, Colorado, and vice president of the Colorado chapter of the American Academy of Pediatrics.
Colorado is one of at least six states — along with Alaska, California, Illinois, Maryland and Vermont — that have introduced vaccine-related bills in recent months, in an unprecedented break from the Centers for Disease Control and Prevention, which overhauled the childhood vaccine schedule in early January.
Colorado’s Senate Bill 32 stands out as the most extensive of the proposals.
It would expand malpractice liability protections for health care providers — including doctors, nurses, pharmacists, clinics, hospitals and insurance companies — related to childhood vaccines recommended by the American Academy of Pediatrics, the leading pediatricians group, as well as the CDC’s vaccine advisory committee.
This protection is important because lawsuits can be used by anti-vaccine groups as a tactic to dissuade health workers, state programs or clinics from giving childhood vaccines, lawmakers say.
“We are not going above and beyond; we are just trying to preserve the environment that health care in the U.S. has been functioning in,” said Democratic Colorado state Sen. Kyle Mullica, an emergency department nurse who introduced the legislation. “This does not protect someone if they go out of the norms and do something wrong. It just tries to prevent the weaponization of lawsuits related to vaccines.”
So far, 28 states have broken from the CDC’s new childhood vaccine recommendations to various degrees, according to KFF, a nonpartisan health care research group. The shifts away from federal guidelines range from legislation that would make sure vaccines remain free, and protect health care workers from lawsuits, to relying on guidance from the AAP.
The CDC’s change in guidance dropped recommendations that all babies should be protected against hepatitis A, hepatitis B, RSV, dengue and two types of bacterial meningitis. Almost immediately, the AAP and at least 12 other major medical groups, including the American College of Obstetricians and Gynecologists and the American Medical Association, reiterated their recommendations for childhood vaccination against 18 diseases.
Until now, most states have defaulted to federal guidance and liability protections for vaccines. Some states also have contracts that allow them to purchase vaccines from the CDC for the cheapest price available.
“States that are not taking proactive steps to clarify these issues are going to see disruption in the vaccine delivery system in their state, whether that’s for legal reasons, liability reasons or simply confusion,” Higgins warned.
Under Kennedy’s guidance, the CDC’s vaccine advisory committee has taken steps to undermine support for childhood vaccination. Kennedy, an anti-vaccine activist, has repeatedly and incorrectly linked vaccines to autism and abruptly fired all 17 members of the CDC’s vaccine advisory committee, replacing them with several vaccine critics. Shortly after, the committee pared back the number of vaccines recommended for all children.
While Kennedy focuses public attention on the “Eat Real Food” campaign to discourage ultra-processed foods and promote the revised dietary guidelines, it’s fallen to Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, to voice support for vaccines. On CNN in early February, as the largest outbreak of measles in decades escalated in South Carolina, Oz urged people to “take the vaccine, please.”
Vaccines required for school
States determine vaccine requirements for schoolchildren. They allow families to opt out of immunizations for medical reasons, and many allow religious vaccine exemptions for kids attending public school. Dorit Reiss, a professor at the University of California College of the Law, San Francisco, said states have previously deviated from the CDC’s vaccine schedule, but “this is the first time that states have wholesale broken away from federal guidance.”
Higgins worries that without clear, science-backed guidance from the federal health agencies, “vaccine policy becomes fractured.”
For example, Colorado’s new bill would ensure liability protection for vaccine providers, as well as allow pharmacists to prescribe and administer vaccines, and it would require insurance companies in the state to cover the HPV vaccine. It would also make state immunization program funding available to providers, to cover any vaccine-related cost that is not subsidized by the federal government’s immunization program funding.
The bill would also allow health officials to follow vaccine guidance from the AAP, the American Academy of Family Physicians, the ACOG and the American College of Physicians, in addition to the CDC. The proposed law was approved by the Senate in early February.
It “aims to preserve access to science-backed vaccines to people in Colorado who want them,” Higgins said.
The bill is now in the Colorado House. If passed, the law would take effect in August.
Protecting access, state by state
In Alaska, where about one-third of the population is enrolled in Medicaid, concerns are centered around preserving its health department’s ability to purchase vaccines at a discounted price.
Alaska has a partnership that allows the state health department to purchase in bulk all the vaccines it anticipates Alaskans will need in the following year. This allows the state to give free vaccines for children and adults to usually small, rural clinics through the Alaska Immunization Program and the Alaska Vaccine Assessment Program. Federal programs make vaccines free for many children — including those who are uninsured or eligible for Medicaid — but not everyone. Alaska’s program ensures that everyone who wants a CDC-recommended vaccine can get one.
“We purchased our vaccines for 2026 based on the old CDC schedule, including the six vaccines that have been deemed optional,” said Alaska state Rep. Andrew Gray, a Democrat, who introduced HB 238. (Among them, Alaska state health officials still universally recommend hepatitis B vaccines for all infants in the state, where hepatitis B rates are nearly triple national rates.)
“The fear is that we don’t know what is going to happen as far as purchasing our vaccines in bulk. The cost of health care in Alaska is especially steep. If there was one state that cannot afford to have thousands of sick kids, it’s Alaska,” Gray said.
In early January, Maryland Gov. Wes Moore introduced a pair of bills — together called the Vax Act — that would pull the state’s guidelines away from the federal vaccine schedule. If passed, the legislation, which would take effect in July, would give the state’s health secretary the power to draft state vaccine guidelines based on federal agencies, along with state organizations and professional medical organizations. It wouldn’t extend any legal protections for providers, but would require insurance companies to cover any vaccine recommended by the Maryland Department of Health.
“We have been working very closely with our boards on what they are hearing from their communities and where they need additional support right now,” Dr. Meena Seshamani, the Maryland health secretary, said. “What we are hearing is that support is needed around vaccine guidelines.”
Vermont introduced a similar bill in January that would allow the state to issue its own vaccine recommendations. If passed, the legislation would also require health insurers to cover immunizations that are recommended by the state without a copay.
In December, Illinois Gov. JB Pritzker issued an executive order that gave the state’s health department the authority to draft its own vaccine guidelines based on science, independent of the CDC’s recommendations. California’s Assembly Bill 144, passed in September, allows the state’s health department to include recommendations from the AAP, ACOG and the American Academy of Family Physicians when drafting the state’s vaccine guidance. Insurance companies are also required to cover any vaccine recommended by the California Department of Public Health.
A patchwork approach
The fractured vaccine policy is already underway.
Last year, Idaho lawmakers passed what they called a medical freedom act, which prevents schools, businesses or officials from requiring vaccines or medical tests. Since then, anti-vaccine groups have stepped up efforts to ban school requirements, with bills introduced in at least nine states, according to The New York Times.
While Colorado pushes to expand vaccine access by putting liability protections into state law, Florida’s Senate Bill 408 would allow people who have allegedly been injured by vaccines to sue drug manufacturers that advertise the products. Under the current federal laws, people bringing such lawsuits likely would not win their cases, but the threat of increased liability “would also scare off providers from offering vaccines,” Reiss said.
“Different states will have different policies that either increase vaccine access or decrease it, and we will see this social experiment play out in real time,” Reiss said. “Unfortunately, kids will get sick and die.”
