Governor Wes Moore, a Democrat, has signed legislation that formally disentangles Maryland's public health guidance from a key federal advisory committee, a direct response to the panel's restructuring under Health and Human Services Secretary Robert F. Kennedy Jr. The new law, known as the Vax Act, mandates that the state's health secretary will now issue official recommendations for immunizations, screenings, and preventive services.
Decoupling from Federal Guidance
For decades, states have typically aligned their vaccine policies—such as school entry requirements and insurance coverage standards—with recommendations from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP). This panel traditionally reviews data after a vaccine receives FDA approval to advise on its use for different populations. Maryland's move represents a significant break from this long-standing practice, reflecting a deepening rift between certain states and federal health authorities.
The legislation was spurred by Kennedy's overhaul of the ACIP last year, during which he dismissed all 17 original members and appointed new ones, some of whom have publicly questioned vaccine safety. "Our vaccine policy will be driven by science, not driven by internet conspiracy theories," Moore stated during the bill signing ceremony. The governor emphasized that the state would now prioritize guidance from established medical organizations like the American Academy of Pediatrics and the American Academy of Family Physicians.
Credibility Crisis and Legal Challenges
The reconstituted ACIP has since voted to downgrade recommendations for several vaccines, including those for COVID-19 and the hepatitis B shot administered at birth. This shift prompted a legal challenge, resulting in a federal judge last month temporarily blocking the panel's future actions and freezing some of Kennedy's prior moves. The judge questioned the qualifications of the new members to recommend immunizations for the public.
However, the Trump administration recently published a new charter for the advisory committee, a maneuver that could potentially circumvent the court's ruling and reinstate Kennedy's changes. This ongoing legal and administrative battle has created widespread uncertainty, prompting several states to act independently. The controversy is part of a broader pattern of federal-state friction on health policy, similar to disputes seen in other areas, such as when the CDC leadership blocked a vaccine effectiveness report over internal disagreements.
Major medical groups have also distanced themselves from the revamped federal panel. The American Academy of Pediatrics declined to participate in what it labeled an "illegitimate" ACIP meeting last summer, charting its own independent course. This fragmentation marks a departure from the previous era, where leading medical organizations routinely collaborated with federal health agencies on immunization guidelines.
A Growing State-Level Movement
Maryland is now among a coalition of Democratic-led states, including California, Maine, Colorado, and Massachusetts, seeking to insulate their public health systems from the federal government's current stance on vaccines. This trend highlights how states are increasingly asserting autonomy in policy areas where they perceive federal action as unreliable or politically motivated.
This kind of state-level defiance against federal direction is not isolated to healthcare. It echoes conflicts in other regulatory spheres, such as the intensifying legal showdown over prediction market regulation, where companies are challenging state authority. Furthermore, the Supreme Court's evolving jurisprudence continues to reshape the federal-state balance, with recent rulings that threaten dozens of state occupational licensing laws, creating new battlegrounds.
The Vax Act fundamentally reshapes how Maryland will determine which vaccines are recommended for its residents and under what circumstances. By establishing a state-centric process, officials aim to ensure continuity and evidence-based standards, regardless of future shifts in federal health policy or leadership.
