Oregon, Washington, California, and Hawaii formalized the West Coast Health Alliance to uphold evidence-based public health as federal policy retreats. The alliance recommended updated COVID-19 vaccines for anyone 6 months or older at no cost, contradicting federal guidance limiting eligibility.

The alliance emerged after the Trump administration revised the childhood vaccine schedule and revoked COVID-19 EUAs. West Coast states reaffirmed the AAP schedule. Health insurers committed to covering all ACIP-recommended vaccines with no cost-sharing through 2026.

Oregon's nonmedical vaccine exemption rates hit a record high — nearly 10% of kindergarteners. The alliance gives OHA institutional cover for aggressive vaccine promotion.

Watch for: Whether the alliance expands beyond vaccines. The interstate model could influence responses to Medicaid restructuring. The immediate test: reversing Oregon's rising exemption trend before the 2026-2027 school year.