U.S. States Form Health Alliances in Response to Federal Public Health Landscape

By: Jacqueline Powers

Image by Birdies100; CC BY-SA 2.0

On September 3, 2025, California, Oregon, and Washington announced the West Coast Health Alliance, a partnership aimed at coordinating a regional public health response amid a tense and changing federal landscape.¹ Citing the Centers for Disease Control and Prevention’s diminishing credibility by the federal government, Governors Newsom, Kotek, and Ferguson emphasized the need to provide evidence-based immunization recommendations to prevent negative health outcomes for their residents.¹ 

Soon after, the Northeast Public Health Coalition was announced on September 18, 2025, made up of Connecticut, Maine, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island.² In addition to providing vaccine recommendations, the coalition intends to collaborate on public health preparedness, data collection, infectious disease management, and laboratory services.² On October 15, 2025, the Governors Public Health Alliance was launched, the largest partnership of fifteen states across the U.S.³ This latest alliance is a nonpartisan initiative that will support national coordination of public health at the gubernatorial level.³

While a wave of new health alliances has been declared in the past two months, this is not the first time regional public health coalitions have been formed.⁴ In April 2020, the Western States Pact and a northeastern multi-state council were created to facilitate regional approaches towards re-opening the economy and controlling the spread of COVID-19.^5,6 

In a world of local, state, federal, and now regional health guidelines, understanding the role of these multi-state health alliances can be complicated. The federal government issues public health guidance, but it is ultimately the states’ decision to follow it.⁴ Within these regional health alliances, participating members recognize that each state and its cities have their own needs and priorities and may adapt initiatives as needed.² Therefore, guidance from these bodies may be at odds with one another.

Recent changes to vaccine recommendations are an example of this contrasting messaging from federal and state governments and regional health alliances. At the federal level, guidance under U.S. Health and Human Services Secretary Robert F. Kennedy has limited COVID-19 vaccine accessibility, with the FDA authorizing COVID-19 vaccines only for older and at-risk individuals.^7-9 To counter this, some states and regional health coalitions have created their own guidelines. The Northeast Public Health Coalition expanded on these federal recommendations to include children over six months to 18 years.⁷ Notably, they recommended that all adults be vaccinated. Some states have also issued orders allowing pharmacists to give COVID-19 vaccines to anyone who wants one, pushing back on federal authorizations.⁷

More evidence is needed to fully understand the impact of these regional health alliances. On one hand, having different recommendations from various bodies may be confusing, especially when news streams are reporting contradictory information. It will take time to see whether alliances will influence vaccine uptake and the adoption of public health guidelines. On the other hand, these coalitions are opportunities to protect science and promote evidence-based public health policies. Regional collaboration may expand public health capabilities through enhanced data collection and sharing, surveillance, and coordinated action as public health threats cross borders. The full effect of these regional health alliances is unclear in the early days of formation, but they do demonstrate that public health remains a priority no matter the political climate.

1. https://www.gov.ca.gov/2025/09/03/california-oregon-and-washington-to-launch-new-west-coast-health-alliance-to-uphold-scientific-integrity-in-public-health-as-trump-destroys-cdcs-credibility/
2. https://www.nyc.gov/site/doh/about/press/pr2025/announce-northeast-public-health-collaborative.page 
3. https://govactalliance.org/news/govact-pressrelease-govsforhealth-launch/ 
4. https://www.kff.org/other-health/states-are-forming-health-alliances-can-they-make-a-difference-for-public-health-policy/ 
5. https://www.gov.ca.gov/2020/04/13/california-oregon-washington-announce-western-states-pact/
6. https://nj.gov/governor/news/news/562020/approved/20200413a.shtml 
7. https://www.reuters.com/business/healthcare-pharmaceuticals/northeast-us-states-form-health-alliance-response-federal-vaccine-limits-2025-09-18/ 
8. https://www.reuters.com/business/healthcare-pharmaceuticals/us-drops-covid-vaccine-recommendations-healthy-children-pregnant-women-2025-05-27/ 
9. https://www.cmadocs.org/newsroom/news/view/ArticleId/50974/FDA-restricts-COVID-19-vaccine-approval-deepening-confusion-for-physicians-and-patients