The governors in Oregon, Washington, California and Hawaii have formed an alliance to counter the Centers for Disease Control and Prevention. The group has said the step was necessary because the agency’s decisions are being politicized under the leadership of U.S. Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist.

Last month, the Food and Drug Administration approved the COVID-19 booster shot, but limited who should get it to those over 65 and other people at high risk. The Advisory Committee on Immunization Practices, a group of unpaid experts who evaluate the safety and efficacy of shots on behalf of the CDC, is meeting Friday to make its own recommendations.

On Wednesday, the four-state group, known as the West Coast Health Alliance, took preemptive action. They released their own recommendations for the COVID-19 booster shot, saying that anyone who chooses protection should be able to get it.

“This is preserving choice for anyone in Oregon who’s choosing protection from COVID-19 with a safe and effective vaccine for their child or for themselves. That is extremely important, not just here in Portland, but in rural Oregon,” Dr. Dean Sidelinger, the state’s health officer, said on OPB’s “Think Out Loud” Thursday.

These highlights from the conversation with Sidelinger have been edited for clarity and length. A full transcript of the interview is available here.

COVID-19 vaccine recommendations

Dave Miller: I want to start with the recommendations themselves, and the ways in which Oregon and its neighbors now differ from the federal government. As I see it, there’s actually some real overlap between the federal government now and these states when it comes to people over the age of 65 and people with underlying health conditions. So, let’s just begin there. Do you see meaningful differences?

Dr. Dean Sidelinger: I definitely see meaningful differences, and I think the reason that the governors directed the health departments in our four states to examine the evidence and to come out with independent recommendations was because we wanted to make sure it was based on the science.

So, even though there’s overlap with what the Food and Drug Administration said — with those over 65 and those with underlying conditions — the changes that the FDA made in limiting the scope of vaccines on the label didn’t have data behind it.

So we wanted to make sure that we could come out with some recommendations that say, “OK, here are our recommendations, here’s why we’re saying that, and here’s the information you need to make a choice for yourself and your family.”

Miller: You’re saying that what the states have now added is more evidence behind those [decisions]. But there are bigger disagreements for other groups — for healthy adults and older kids. That’s where it gets more complicated. So, what exactly are Oregon, Washington, California, and Hawaii recommending right now for those groups?

Sidelinger: What we say is that everyone who wants a vaccine, who desires protection — 6 months and older — should have access to it. But, we also say that there are certain people in certain groups who should get a vaccine because they’re at higher risk.

Let me start with one, again, where there’s agreement with what the FDA came out and said: Individuals 65 and older. They have the highest rates of hospitalization, so the highest rates of more serious COVID of any other age group, and we recommend that they all get vaccinated to give them protection.

But the second-highest rate of hospitalization among age groups is kids under 2. So kids aged 6 months old, which is when the vaccine is available, through 23 months. We recommend that they all get vaccinated because they’re at high risk for severe disease. And about half the kids who are hospitalized don’t have an underlying condition in that age group, so we can’t parse it out and say ‘just the young kids who have an underlying condition.’

There are many things that put people at risk: immunocompromising conditions, so their body may not be able to fight off an infection as well and they should receive a dose, and often extra doses, in conversation with their provider to provide the best protection. People with underlying conditions — whether that be diabetes or lung disease, being obese or other pieces — put people at higher risk for being hospitalized and having serious complications. They should all be vaccinated.

People who live in a congregate setting — think of a dorm for young adults, think of a skilled nursing facility or an assisted living facility. For many folks recovering from a disease or older folks who have longer-term stays, that puts them at higher risk because of the exposure. Then people who work in a health care setting or other occupational settings where they have increased exposure, should get protection. But that leaves open many other reasons people want to get protected: living at home with a spouse who may be undergoing chemotherapy for cancer, and you want to get protected not just for yourself but to help protect your spouse.

So we say that anyone who chooses that protection for themselves, or the people around them, should be able to choose it. But the people at highest risk really should be talking to their providers about getting the vaccine.

How the states developed their recommendations

Miller: How did these four states actually come up with this whole set of recommendations?

Sidelinger: What we did is the state health officials, the health officers in those states, came together and met and said, ‘OK, we need to look at the data that’s out there.’

We reviewed all of the data that’s out there, compiled that into a report, posted it publicly, had a public presentation of that data and allowed experts to ask questions. That compiled information was reviewed by many of the professional medical societies. The American Academy of Pediatrics have had a vaccine recommendation schedule long before the CDC did, and the American College of Obstetricians and Gynecologists has been making recommendations about protection of people planning to be pregnant, people who are pregnant or people who’ve recently delivered, and so they reviewed the evidence and came up with recommendations for their specific populations.

Taking all of that together, looking at the data on who’s getting sick in adults, underlying conditions and their interplay, the health officials amongst the four states — with our immunization experts — compiled these recommendations.

Effectiveness of the COVID-19 booster

Miller: What do studies show about the likelihood that successive boosters prevent transmission?

Sidelinger: What we know about our COVID vaccinations and the protection has really changed as the disease has changed and as the number of people who’ve been vaccinated or recovered from illness has changed.

So what we can say very definitively is the vaccine is very efficacious. It works very well at preventing serious disease, that includes hospitalization. It also works well at preventing long COVID for people who get it. But in the short term, after you’re vaccinated, you also have protection from getting the disease at all. That protection isn’t as long lasting as the protection, as the protection that keeps you out of the hospital. But your body’s response to the vaccine creates antibodies that help fight off an infection. So in those months following vaccination, if you’re exposed, you’re less likely to become ill.

Over the longer period, those antibodies that are circulating in our bloodstream kind of go away and we rely on the cells to produce more antibodies. That takes some time. So, that may be why four, five or six months following your vaccination, you may get exposed to someone and you may get sick. But then those cells ramp up, they produce those antibodies and fight off the infection, and keep you out of the hospital.

Miller: Let’s talk about a particular potential patient: a healthy 40-year-old with no risk factors who has already had a series of vaccine shots and boosters over the years and got COVID. They come to you and they ask you, ‘should I get the booster? Do you recommend that I get it? How would you respond?

Sidelinger: I think that’s having a conversation. So what does a booster mean? A booster for you might mean that if over the next several months, you’re exposed to people who have COVID, you may not get sick.

If you get sick, that may not put you in the hospital because you’re relatively healthy, but you may be laid up and not able to work, not be able to participate in social activities you are looking forward to. And you may feel lousy like anyone who’s had COVID or the flu. Just because you’re not in the hospital doesn’t mean you’re sitting at home enjoying yourself on the couch.

So, a vaccine can offer you protection from that over the next several months, and also minimize or lower your chances of getting long COVID if you do get sick. For you, the risks of the vaccine are very low. This vaccine is very safe, it’s been used tens of millions of times across the world.

There’s a small, slight risk in adolescent males and young adult males of myocarditis, or inflammation around the heart. That seems to be short-lived, may not cause any symptoms and occurs at lower rates than it does with the disease itself. So given those facts, what do you think about getting vaccinated? That’s where I would leave it, that we would have that conversation after they learn the facts.

Access to the COVID-19 booster

Miller: Does the release of these recommendations for Oregon mean that if Oregonians, let’s say for the category healthy adults, that if they want the vaccine, it’s recommended that they get it? Does it mean that they will be able to have access to it and get it for free?

Sidelinger: I would say mostly yes.

In Oregon, a few important things happened [Wednesday]. In addition to the schedule, because the Advisory Committee on Immunization Practices doesn’t have a recommendation yet on the updated COVID vaccine, pharmacists couldn’t give it, by protocol, in Oregon. They relied on a prescription from a provider.

So the Board of Pharmacy — working with OHA and other state agencies and the governor’s office — passed a couple of rules yesterday to remove COVID, RSV and flu from the standard protocol process, and then created new protocols for each of those diseases referencing the West Coast Health Alliance recommendations.

Those were adopted by their board yesterday, and went into effect yesterday, so that people can once again go to a pharmacy and get a vaccine without a prescription. It may take some time for you to be able to walk in and get it, but that access point is being restored here in Oregon.

Cost is another piece. So actions we could take at the state where we could work with a bulletin to our Medicaid providers, Oregon Health Plan, and say that nothing has changed, you’ll continue to cover these vaccines for your patients without a cost.

For private insurers that are regulated by the state, they’re required for COVID to cover those vaccines without a cost. There’s some insurers that aren’t regulated by the state, only regulated at the federal level or outside of the state. We are having conversations and encouraging continued coverage, but that’s why we advise people to check with their HR or insurer about coverage before they go. But for many Oregonians, coverage hasn’t changed, it’ll be without co-pay, and the state has taken actions to ensure that.

Politicization of public health

Miller: This is an alliance, these four states led by Democrats, which seems like it could run the risk of just deepening the politicization of vaccines. So I’m wondering what the long-term public health strategy is for gaining bipartisan trust, not just vaccines, but in the whole idea of public health as opposed to a bifurcated, even more politicized system.

Sidelinger: I worry about that as well. It is painful for me as a public health professional who’s based my career on data and science and trying to encourage people to make healthy choices, and to support those healthy choices, to see that undermined by my federal colleagues. And let me just say that there are thousands of CDC and FDA employees right now that are continuing to try and follow the science and do the right thing, and the politicization and the direction is coming from the top. They’re trying to do some amazing work, but certainly there is a partisan divide.

The actions that we took yesterday are preserving choice for people. This is preserving choice for anyone in Oregon who’s choosing protection from COVID-19 with a safe and effective vaccine for their child or for themselves. That is extremely important, not just in Portland, but in rural Oregon.

Because, again, these vaccines work. They keep people out of the hospital, they make sure that if we need a hospital bed — for a car accident, a heart attack or COVID, whatever — that we’re going to be more likely to have it because people have chosen protection.

So I think having that conversation, focusing on what we know and focusing on giving people the information to make healthy choices, is where we need to go. But it is going to take a long time to recover from this polarization and politicization of what was an extremely well-respected system for public health under the CDC and ACIP. That really has been dismantled.

News Source : https://www.opb.org/article/2025/09/18/west-coast-covid-19-vaccine-guidelines-oregon-health-officer/