California’s late summer COVID surge is showing signs of peaking, but the state’s war with the Trump administration over vaccines is just beginning.
Coronavirus levels in California’s wastewater remain “very high,” according to the U.S. Centers for Disease Control and Prevention, as they are in much of the country. But some other COVID-19 indicators are starting to fall in the Golden State.
The shift comes as California state officials and mainstream medical organizations are breaking from the Trump administration’s recent revisions to federal vaccine guidelines.
The changes, made under the leadership of vaccine-skeptic Health and Human Services Secretary Robert F. Kennedy Jr., have been so dramatic that a number of medical experts and officials now express little to no confidence in two key agencies within that department — the CDC and Food and Drug Administration.
A key turning point came in June, when Kennedy ousted everyone on the CDC’s respected Advisory Committee on Immunization Practices, which issues recommendations on who should receive various types of vaccines.
Their replacements — some of whom have criticized vaccines and spread misinformation, according to the Associated Press — have led officials and other experts in some states to doubt or dismiss the latest CDC guidance.
The CDC’s immunization committee “is no longer a trusted source for vaccine guidance,” Dr. Matt Willis, the former public health officer for Marin County, wrote on the blog Your Local Epidemiologist in California.
In the past, medical and scientific groups were confident in the CDC’s data analysis and trusted the agency’s vaccine guidelines. And so that guidance informed key matters including which vaccines should be covered by insurance, and professional medical societies were aligned on immunization recommendations, according to Dr. Erica Pan, the director of the California Department of Public Health and state health officer.
“Now what we’re seeing is a divergence,” Pan said during a webinar Tuesday.
California is moving away from the CDC’s guidance and toward recommendations issued by medical groups, such as professional organizations of pediatricians, family physicians, obstetricians and gynecologists.
“We’ll be aligning our immunization recommendations with trusted national medical professional organizations,” rather than the CDC, Pan said, “given the termination of the vaccine experts with that subject matter expertise.”
A number of local health departments, including from Los Angeles, Orange and San Francisco counties, are endorsing the California Department of Public Health’s vaccine guidance.
A Reuters/Ipsos poll said that just 1 in 4 Americans believe that the recommendations for fewer vaccines from the Trump administration were based on scientific evidence and facts.
California, Washington, Oregon and Hawaii have also united to establish the West Coast Health Alliance, which is intended to provide science-based immunization guidance. Pan said the alliance isn’t intended to be a competitor to the Advisory Committee on Immunization Practices, but to evaluate guidance from other professional medical groups “to make recommendations for our states and for our insurers.”
Already, compared with the CDC, the California Department of Public Health has far more expansive recommendations on who should get the now-available updated COVID vaccine.
It recommends that all adults get vaccinated, as the American Academy of Family Physicians recently endorsed; that those who are pregnant get vaccinated, as endorsed by the American College of Obstetricians and Gynecologists; and that the youngest children — ages 6 months to 23 months — get vaccinated, as endorsed by the American Academy of Pediatrics.
California and the pediatricians group also recommend all children with underlying health conditions get vaccinated. They also say any child should be able to get the vaccine if their parents wish.
The FDA, on the other hand, has approved COVID-19 vaccines only for those ages 65 and older, as well as younger individuals with underlying medical conditions. That means non-senior-age adults may need to either talk with a medical provider before they can get vaccinated or “attest” to a pharmacy that they have an underlying medical condition that makes them eligible.
The CDC also recently said that it now has “no guidance” on whether pregnant women should get the vaccine.
Some experts have noted that the guidance is contradictory, given that the CDC also says people who are at risk of severe illness if they get COVID-19 should get vaccinated — and pregnant women are.
In some states, pharmacy chains are being forced to ask people to bring in a prescription authorizing them to get the COVID-19 vaccine, at least for another week. As of Friday, CVS said that was the case in Arizona, Florida, Georgia, Louisiana, Maine, North Carolina, Oregon, Utah and West Virginia, as well as the District of Columbia.
The CDC could be poised to make getting a vaccine even more difficult for some Americans. The Advisory Committee on Immunization Practices is weighing a plan to recommend the COVID-19 vaccine only for those ages 75 and older, and instruct younger people to speak with a healthcare provider before they get the vaccine, the Washington Post reported Friday. That could mean an additional hurdle for even younger seniors to get the vaccine.
The Advisory Committee on Immunization Practices is expected to meet Thursday and Friday.
There is some indication that vaccine providers are taking an expansive view of who can be inoculated, however.
Kaiser Permanente unveiled a website announcing that its members ages 6 months and older can get the updated COVID vaccine at its facilities at no cost.
“Vaccination remains one of the safest and most effective ways to help protect against severe illness. This includes children and families whose health would be at risk if they got COVID-19,” Kaiser says.
On its site for California members, Kaiser said people don’t need to provide additional documentation to get the vaccine, nor do they need an individual prescription.
The official CDC list of conditions that could justify getting the vaccine is also extensive, including risk factors like being overweight, physically inactive or having ever smoked.
A Times reporter visiting a large retail pharmacy was also told that a qualifying reason for a person under the age of 65 to get the COVID-19 vaccine was if they had a family member who was at risk of severe illness.
Some Californians were subjected to tough eligibility questions in the first days the shots were available. But Dr. Peter Chin-Hong, a UC San Francisco infectious diseases expert, said that everybody he’s talked to recently “seem to have been getting it without problems, which is reassuring to me, because I want to get one, too.”
The California Legislature is also taking action. State lawmakers on Friday passed Assembly Bill 144, which would allow the California Department of Public Health to not just rely on the federal government to outline what kinds of vaccines insurance providers are required to cover, but also take into account guidance from professional medical societies.
“At a time when misinformation is fueling fear and mistrust, we must safeguard the proven standards that keep families and communities healthy,” California Medical Assn. President Dr. Shannon Udovic-Constant said in a statement supporting the legislation.
Pan said she expects COVID-19 cases to decline statewide by October. Flu and respiratory syncytial virus are expected to begin ramping up by early October, and the combined respiratory viral season is expected to peak at the end of December and the start of January in California.
One of the changes to vaccine recommendations this year is that the RSV vaccine is now recommended for adults as young as 50 who are at increased risk of severe illness, Pan said. Previously, the recommendation was for adults ages 60 to 74 at increased risk for severe illness. All adults ages 75 and older are also recommended to get the RSV vaccine.
Another disease to watch out for is pertussis, also known as whooping cough. Sen. Bill Cassidy (R-La.), who is also a physician, said on social media Thursday that his state is suffering its worst whooping cough outbreak in 35 years, with 368 cases this year, including two infants who died. “Most hospitalized were not up-to-date on vaccines,” Cassidy wrote.