It started last January in West Texas. Members of a Mennonite community in the rural town of Gaines — its residents tight-knit, God-fearing and largely against vaccines — began developing strange symptoms. First came fatigue and body aches. Then red blotchy rashes. By the time it became clear the culprit was a measles outbreak, the disease killed two otherwise healthy children with no preexisting conditions. It spread, rampant, throughout the state until Texas announced the end of its outbreak in August. The seven-month saga resulted in 762 confirmed cases, with 99 requiring hospitalization.
That outbreak was the largest of its kind on American soil since 2000, when the illness was declared eliminated in the United States. Health experts and scientists attributed its severity in part to declining vaccination rates, fueled by anti-vaccine rhetoric and a lack of clear health guidance from the Centers for Disease Control and Prevention. A KFF investigation found that local officials reached out to the government agency to figure out how to handle the outbreak at its outset, but did not receive support in time and instead had to consult independent medical professionals. Even after officials got the outbreak under control, the infectious disease advanced beyond state borders. Measles outbreaks have reached as far as Western states like California, Colorado, Washington, Utah, New Mexico and Arizona. In Utah alone, there have been hundreds of reported measles outbreaks since 2025, including in Salt Lake City, Holladay, Orem and St. George.
Today, the United States is at risk of having its elimination status for the disease revoked by the World Health Organization. But its spread is a symptom of a larger problem in public health. For the first time in its 80 years as the nation’s premier health agency, the CDC is shattered. Many Americans no longer trust it, health practitioners no longer cite it, and it no longer stands as the single source of truth for Americans looking for health guidance. In response, states are forming health alliances to issue their own policies. On September 3, California, Oregon and Washington led the charge by launching the West Coast Health Alliance, which was joined by Hawaii the following day. This alliance is the first of its kind to directly challenge the federal government’s wavering stance on vaccination. It brings together medical experts and doctors across the four states to issue their own immunization recommendations for residents.
The CDC is shattered. In response, states are forming health alliances to issue their own policies, namely, the West Coast Health Alliance.
“The CDC has become a political tool that increasingly peddles ideology instead of science, ideology that will lead to severe health consequences,” Oregon’s Gov. Tina Kotek, Washington’s Gov. Bob Ferguson and California’s Gov. Gavin Newsom wrote in a joint statement. “California, Oregon and Washington will not allow the people of our states to be put at risk.”
Although each of the states is helmed by a Democratic governor, the alliance has bipartisan support and is directly inspiring similar moves across the country. Two weeks after the West Coast Health Alliance was announced, the Northeast Public Health Collaborative brought Connecticut, Maine, Massachusetts, New Jersey, New York, Pennsylvania and Rhode Island together under the same premise. Then a month later, 15 governors — a third of whom come from Western states — created the Governors Public Health Alliance to coordinate between the two alliances and provide a new national authority to the growing number of Americans who no longer trust the federal government for direction on health or emergency preparedness. “At this point, a majority of people have little to no trust in federal authorities when it comes to determining the childhood vaccine schedule,” says Josh Michaud, an associate director with the Global and Public Health Policy program at KFF, a nonpartisan health policy organization. “Because of this politicization, practitioners, providers, parents, and people who have to make decisions about vaccinating their child or recommendations for others to do so will no longer know where to turn.”
What alliances do is attempt to braid together all the states that have frayed from a once-cohesive following of government guidance. “States are doing what they need to do,” says Richard Besser, who served as the director of the CDC in 2009 and is now the CEO and president of the Robert Wood Johnson Foundation, one of the nation’s largest private philanthropies dedicated to advancing health equity. “Which is stepping up and ensuring that people in their states are protected and also trying to make sure that there’s some consistency in a given region.” Most notably, in the West.
Western states lead the charge
Western states have long prioritized independence from the federal government in enacting public health policy. In 2020, the “Western States Pact,” including California, Oregon, Washington, Colorado and Nevada, was formed to review the newly created Covid-19 vaccines and coordinate pandemic restrictions in line with what states believed would best curb infections within their borders. So when the CDC removed six routine immunizations from its childhood vaccine schedule earlier this year — hepatitis A and B, Covid-19, influenza, rotavirus and meningococcal disease, which causes meningitis — Western states, unsurprisingly, took similar action.
In spite of the new CDC guidelines, the West Coast Health Alliance endorsed the American Academy of Pediatrics’ immunization schedule, which still suggests children receive vaccines for hepatitis, Covid-19, flu and RSV. California went even further by passing a new law enshrining its right to impose future immunization guidelines based on guidance from organizations like the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists — regardless of federal endorsement. In the past, the CDC has largely aligned with those organizations, but in light of their schism on vaccines, states are left to choose a side.
Still in its infancy, the alliance is largely focused on improving access to and awareness of vaccines in Western states. An analysis from NBC found that vaccination rates have shown a significant decline across more than 70 percent of counties and jurisdictions nationwide since 2019. Those declines range anywhere from less than a percentage point to more than 40 percent. Last year alone, more than 400 bills attacking everything from vaccines to fluoride were introduced in state legislatures across the country. Health policy has begun to feel partisan, leading to drastically different messaging from place to place. That’s why, in Democratically-run states like Washington, students are required to complete more than 10 immunizations to attend school, while a bill in the Republican-controlled Florida Legislature would make it the first state to no longer require any vaccines for children.
What alliances do is attempt to braid together all the states that have frayed from a once-cohesive following of government guidance.
“There’s a lot of discussion about trust right now. Part of the challenge with that discourse is it assumes that building trust is completely within the control of the public institutions that are trying to rebuild that trust,” says David Scales, a sociologist and internal medicine physician who serves as the chief medical officer at Critica, a nonprofit focused on preventing the spread of scientific and medical misinformation online. “It is very difficult, if not impossible, for public health and other public institutions to rebuild trust when we’re in an information environment where lots of people are actively trying to undermine trust in those institutions.”
Public health issues have sparked debate in the United States for centuries. Americans have been arguing about vaccines, specifically, for generations. But changes in federal health leadership and a dismantling of the CDC have placed urgency on the matter. Last flu season, the hospitalization rate for patients sick with complications of influenza reached its highest point in more than a decade nationwide, with states like Oregon, New Mexico and Idaho hit especially hard. As of writing, seven Western states are dealing with a measles outbreak. New threats keep cropping up, and infectious diseases in the region are worsened by everything from a changing climate to a patchwork of different health policies. Eventually, the alliance plans to influence public health beyond immunization. For now, though, the primary objective is addressing the immediate health threats.
In its quest, the West Coast Health Alliance and other iterations inspired by it could steer the country in one of two ways: It could contribute to the growing fragmentation of public health already underway in America, or it could bandage a region in an otherwise tattered health care landscape.
A healthy dose of reality
If there’s any lesson to take away from the initial measles outbreak in West Texas, it’s that viruses fail to respect borders. They get picked up on public transit, in schools and at churches — anywhere human beings come into contact with one another — then carted off to other counties, states and countries. They are notoriously difficult to contain, even through physical means like social distancing or quarantining. So while the alliance arms residents with knowledge and vaccines, there’s only so much it can control when other states don’t offer the same protections.
The Constitution protects the rights of state and local governments to guide their citizens with whatever public health decisions they deem fit. That tapestry of difference and independent decision-making is what helps define America. It’s what makes alliances possible. But it’s also what creates the conditions necessary for diseases to spread in the first place. When states operate under different health guidelines, illnesses spread. All it takes is one vacation, school trip or work event out to contract something like measles and bring it back home. The West Coast Health Alliance is an attempt to bring states together under a safe umbrella of guidance. It’s an attempt at some semblance of singularity, harkening back to when it was customary for governments and health organizations to comply with CDC guidance without much doubt or protest. But it’s fighting the biology of germs that know no borders.
The West Coast Health Alliance could contribute to the growing fragmentation of public health, or it could bandage a region in an otherwise tattered health care landscape.
While only a little over 23 percent of the U.S. population lives in the West, the region is extremely dependent on tourism, which brings a steady influx of travelers from across the country and all over the world to communities throughout the region. That reality arguably negates much of the efficacy of state alliances. And not only viruses thrive in a disjointed health landscape — feelings of uncertainty and anxiety intensify when vaccine requirements, for example, vary wildly from state to state or region to region, offering different sources of truth. “It’s inevitable that there will be some differences between different regions as they come forward with recommendations,” Besser says, “and all of this does sow confusion among the public.”
It doesn’t help that the best and worst health care systems can be neighbors. Last year, seven of the top 20 states ranked highest for their health systems by the Commonwealth Fund were in the West: Hawaii, Washington, Colorado, Oregon, Utah, Idaho and California. The scoring was based on factors like access to care, quality of care, efficiency of services, health outcomes, income disparity and racial equity. But Utah, Wyoming, Arizona and Montana all ranked in the bottom half of public funding per resident by the University of Minnesota’s State Health Access Data Assistance Center, due in no small part to the concentration of rural communities with limited public health infrastructure in the region. Isolated areas of the Mountain West have long been identified as one of the most vaccine-hesitant regions in the country.
They might not be a miracle cure, but health alliances have been proven to help set effective, cohesive public health priorities, and the West Coast Health Alliance is setting a national precedent. Health care in the U.S. already looks different from what it did several years ago. But this new approach could stand to change that even more, for worse or for, hopefully, better. “One of the things that’s clear is that infectious diseases don’t respect borders, and so having really good relationships is so important,” Besser says. “I think that will be the way we go forward.”
This story appears in the April 2026 issue of Deseret Magazine. Learn more about how to subscribe.