Representatives from Vermont and seven other Northeastern states gathered last week in Providence, Rhode Island, to lay the groundwork for a new regional public health coalition. The timing of the meeting, which took place between August 25 and August 31, 2025, was anything but coincidental. With dramatic shifts in federal public health policy under President Donald Trump’s administration—ranging from abrupt changes in vaccine recommendations to deep cuts in laboratory funding—state leaders say they’re feeling the pressure to band together and chart their own course.
"The biggest issue for public health right now is the uncertainty coming from the federal government," Vermont’s interim health commissioner Julie Arel told VtDigger. "That level of uncertainty is really hard for entities that are as heavily funded by federal grants as we are." Arel, along with her principal adviser, the state epidemiologist, lab director, and other senior staff from Vermont’s Department of Health, attended the meeting, which also included representatives from all New England states except New Hampshire, plus New Jersey, New York, and Pennsylvania.
The coalition, still in its infancy, has yet to define its precise mission. "The intent of that meeting in Rhode Island was to start to say, ‘What is this thing?’ We haven’t really defined it. We haven’t really decided what it is we’re doing with this," Arel acknowledged. Still, the urgency was palpable. Attendees focused on infectious disease epidemiology, vaccines, laboratory sciences, and emergency preparedness. With federal agencies increasingly pulling back, the states are looking to each other for guidance and support.
Just days after the Rhode Island meeting, the federal Centers for Disease Control and Prevention (CDC) was rocked by a dramatic shakeup. On August 27, 2025, CDC director Susan Monarez was forced out, reportedly for objecting to Health and Human Services Secretary Robert F. Kennedy Jr.’s efforts to change vaccine recommendations. Monarez’s lawyers posted a letter on X (formerly Twitter) asserting her ouster was due to her refusal to "rubber-stamp unscientific, reckless directives and fire dedicated health experts." The fallout was swift: the CDC’s chief medical officer, the directors of the National Center for Immunization and Respiratory Diseases, the National Center for Emerging and Zoonotic Infectious Diseases, and the Office of Public Health Data, Surveillance and Technology all resigned that same day.
The political reverberations were immediate. On August 28, Vermont Senator Bernie Sanders called for a bipartisan congressional investigation into Monarez’s firing, warning that the decision posed "reckless" and "dangerous" risks to public health.
These seismic changes at the federal level have left state health officials in a bind, especially as the CDC’s vaccine recommendations appear increasingly out of step with the scientific consensus in many states. Vermont’s Julie Arel explained that the regional coalition could become a critical source of guidelines and resources, allowing states to act independently if CDC guidance diverges from local scientific judgment. "There may be times where we are looking to provide more information than maybe the CDC is. But every state is going to need to do its own thing," she said.
Adding to the confusion, on September 1, the Food and Drug Administration (FDA) approved updated Covid vaccines and ended emergency authorizations that had previously expanded access. According to Health and Human Services Secretary Kennedy, the new authorization makes Moderna, Pfizer, and Novavax vaccines available to patients over 12 years old, but only after consultation with their doctors. The end of the emergency designation is expected to make it more difficult for individuals to get the shots without that approval, and the CDC is still expected to issue a recommendation for who should receive them.
Yet even those recommendations are in flux. In June, Kennedy replaced the CDC’s vaccine advisory panel with vaccine skeptics, and the panel is expected to meet in mid-September to determine new guidelines. Vermont Department of Health spokesperson Kyle Casteel noted in a September 1 email to VtDigger that eligibility criteria and proof requirements for the vaccine remain unclear. "The approval of this fall’s COVID vaccine has not followed the typical approval process, and we are still assessing recommendations and potential impacts so we can provide guidance to Vermonters about who can get the vaccine and where," Casteel wrote. "We are working to reduce any access barriers as much as we can and will keep sharing information as it becomes available."
For small states like Vermont, the stakes are particularly high. The loss of federal funding—already acute in the wake of recent grant cancellations—means that any cost-saving measures are welcome. In late March 2025, the Department of Health and Human Services canceled nearly 700 CDC grants nationwide, totaling about $11 billion, according to reporting by KFF and the Tampa Bay Times. The brunt of these "clawbacks" fell on red states, while blue states that pursued legal action managed to retain most of their grant funding.
At the coalition meeting, participants discussed ways to leverage their regional strength. One idea: pooling resources to buy laboratory supplies in bulk, a move that could bring significant savings to smaller states. "When the loss of federal funding reduces resources for the state Department of Health, those savings can make a big difference," Arel said. Other collaborative opportunities include coordinating public health messaging, sharing information campaigns, and collectively strategizing on how to overcome new challenges as they arise.
But for now, the coalition is mainly about building relationships and laying the groundwork for future action. "We don’t want to get out ahead of anything," Arel emphasized. "A lot of it has been making those relationships stronger."
As the CDC’s role in public health guidance becomes more uncertain and federal funding remains in jeopardy, the states’ move to form a regional coalition signals a new era of decentralized, state-driven public health leadership. The hope among coalition members is that by working together, they can navigate the choppy waters ahead—whether that means sharing resources, coordinating responses to emerging threats, or simply providing a united front when federal agencies falter.
With the CDC’s vaccine panel poised to issue new recommendations in mid-September and state officials still struggling to interpret the latest federal directives, the next few weeks will be critical. For now, Vermont and its regional partners are preparing as best they can, determined to protect public health even as the ground shifts beneath their feet.
