A growing number of states are taking action to ensure broad access to COVID-19 vaccines as respiratory virus season approaches.
The state-level moves come after the FDA limited approval of updated shots to individuals 65 and older, and those with at least one condition that puts them at high risk for severe disease. The narrow approvals drew criticism from healthcare groups, which have said the decision will cause confusion and create new access hurdles, which could limit uptake and further strain the nation’s healthcare system in the coming months.
The Advisory Committee on Immunization Practices, which provides vaccine recommendations to the CDC, met Sept. 18-19 to discuss and vote on vaccines for COVID-19, hepatitis B, and measles, mumps, rubella and varicella. For COVID-19 vaccines, the committee unanimously voted to recommend patients engage in shared decision-making with their healthcare provider when deciding whether to get vaccinated, emphasizing the vaccine’s risk-benefit equation for patients younger than 65.
The decision contrasts past recommendations from ACIP that all individuals 6 months and older receive COVID-19 vaccines.
Before and after the meeting, several states issued executive orders, circumventing ACIP to follow other national healthcare organizations or taking different steps to expand access to COVID-19 vaccines.
Editor’s note: The list is not exhaustive and will continue to be updated.
California: On Sept. 3, the country’s most populous state banded with Oregon and Washington to form a health alliance to coordinate vaccine recommendations. Two weeks later, the states released a unified guidance for the 2025-26 virus season based on guidelines from medical associations.
Oregon: The state is part of the West Coast Health Alliance with California and Washington. During the COVID-19 pandemic, western states formed a similar working group to boost public confidence in vaccines.
Washington: The state joined California and Oregon to craft their own vaccine recommendations based on guidance from the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Academy of Family Physicians.
Colorado: The state issued a public health order Sept. 3 that will allow pharmacists to administer vaccines without individual prescriptions to patients 6 months and older. It also requires the Colorado Department of Public Health and Environment to work with the state’s insurance division to ensure vaccines are fully covered for Medicaid members.
Pennsylvania: The commonwealth’s pharmacy board voted Sept. 3 to direct pharmacists to follow guidance from select national healthcare organizations, rather than solely from ACIP. Pennsylvania will follow recommendations from the FDA, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the American Academy of Family Physicians.
New York: In a Sept. 5 executive order, Gov. Kathy Hochul declared a disaster related to federal access to vaccines. The directive allows pharmacists to administer COVID-19 vaccines without a prescription to anyone 3 years or older, including pregnant women and healthy adults and children. On Sept. 18, the state — and six other states — recommended COVID-19 vaccines for all infants 6 to 23 months of age and all adults 19 and older.
Minnesota: Gov. Tim Walz signed an executive order Sept. 8 directing the state epidemiologist to issue a standing order for COVID vaccines. The move will “provide greater flexibility for healthcare providers and pharmacists to provide the vaccine,” according to a news release. State officials clarified that this process is not dependent on recommendations from ACIP, meaning the vaccines will be available irrespective of the committee’s recommendations on who should receive the updated shots.
New Jersey: Under an executive directive issued by the state’s health department Sept. 9, anyone 6 months and older is eligible to receive the updated COVID vaccine. The department also passed a standing order that authorizes pharmacists to administer the vaccines to individuals 3 and older. Children younger than 3 will be able to receive a vaccine directly from their healthcare provider.
Connecticut: Gov. Ned Lemont signed a series of actions Sept. 10 aimed at ensuring broad access to the vaccines. The state’s health department shared interim guidance recommending the vaccine for everyone who qualifies based on the FDA’s eligibility criteria. Through the Department of Consumer Protection, Connecticut pharmacists are advised to provide the vaccine to anyone who falls outside of the limited eligibility criteria without a prescription. Meanwhile, the Connecticut Insurance Department issued a bulletin reaffirming that coverage of the vaccines is required under state-issued insurance policies “regardless of ACIP’s position.”
Hawaii: On Sept. 17, the state announced it had joined the West Coast Health Alliance, which includes California, Oregon and Washington state.
Massachusetts: The state joined the Northeast Public Health Collaborative, which aligned its guidance with the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the American Academy of Family Physicians. The collaborative also includes Connecticut, Delaware, Maine, Maryland, New Jersey, Pennsylvania, Rhode Island and Vermont.
What are retail pharmacy giants doing?
CVS, the nation’s largest pharmacy chain with more than 9,000 locations, is offering COVID-19 vaccines without a prescription in almost every state, according to The Washington Post. Until the CDC makes a formal decision, a prescription will be needed in Florida, Georgia, Louisiana and Utah, according to the Post.
Walgreens said on its website that residents in Georgia, Louisiana, Utah and the District of Columbia will need a COVID-19 vaccine prescription, while a prescription is not necessary in other states.
