Health officials from 10 Northeast states officially band together. New Hampshire remains out.

After months of informal talks, health officials from 10 Northeastern states have announced they’re forming a bloc called the Northeast Public Health Collaborative to issue vaccine guidance and coordinate public health efforts independent of the federal government. New Hampshire is not among them.

Officials from New York, Massachusetts, Maine, Rhode Island, Connecticut, New Jersey, Pennsylvania, Maryland, and Delaware announced the collaboration in a press release Thursday after months of unofficial discussions. Vermont officials said on social media Thursday it’s also involved in the collaboration. Representatives from several of the states previously met in person in Rhode Island in August.

The group said it would be collaborating on vaccine recommendations, data collection, and emergency preparedness, among other health efforts.

The effort comes amid turmoil at the federal Centers for Disease Control and Prevention and the Department of Health and Human Services. The Trump administration has tried to fire roughly 10,000 Health and Human Services employees, including 2,400 at the CDC, though many of those firings were halted by courts. Those fired include CDC Director Susan Monarez, whose layoff inspired four top CDC officials to resign in protest. Under the leadership of Health Secretary Robert F. Kennedy Jr., the CDC is no longer recommending COVID-19 vaccines for healthy children or pregnant women. He fired 17 members of the CDC’s vaccine advisory committee and replaced many of them with skeptics. And he cut roughly $500 million from a series of mRNA vaccine research projects.

On Thursday, the Northeast collaborative made its first recommendations, which depart from Kennedy’s recent changes to CDC guidelines in that they recommend the COVID-19 vaccine for healthy children 6 months to 2 years old and pregnant women. For children ages 2 to 18, they recommend weighing a child’s risk level for COVID-19. That’s consistent with what national medical organizations such as the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists recommend.

New Hampshire is the only New England state not to join the collaborative. The New Hampshire Department of Health and Human Services and Gov. Kelly Ayotte’s office did not respond to the Bulletin’s requests for comment. However, Massachusetts Public Health Commissioner Dr. Robert Goldstein told a Bulletin reporter in Boston last week they are “actively communicating” with New Hampshire health officials on the effort. He said the collaborative is speaking with several other states that aren’t publicly involved.

“We’re having real conversations with red states, and they appreciate what we’re doing and lean on what we’re doing,” Goldstein said. “And also they can’t politically be the ones who are publicly coming out with the guidance.”

Dr. Puthiery Va, director of the Maine Center for Disease Control and Prevention, in a statement, called the group “an incubator for solutions in public health,” adding that Mainers are “known for their resilience, neighborly support, and a collaborative approach to solving community challenges.”

The Northeast Public Health Collaborative is now one of two such health blocs. Earlier this month, four Western states — California, Oregon, Washington, and Hawaii — banded together to create the West Coast Health Alliance. That bloc has been more vocal in identifying their collaboration as a response to the Trump administration. 

In a joint statement, the governors of California, Oregon, and Washington said that “President Trump’s mass firing of CDC doctors and scientists — and his blatant politicization of the agency — is a direct assault on the health and safety of the American people” and that “California, Oregon, and Washington will not allow the people of our states to be put at risk.”

On Wednesday, the West Coast Health Alliance issued its first set of recommendations. The group also recommends the COVID-19 vaccine for healthy children 6 months to 2 years old and pregnant women. And for children aged 2 to 18, they also recommend weighing a child’s risk level for COVID-19.

Neither the White House nor the Department of Health and Human Services immediately responded to the Bulletin’s request for comment about the Northeast Public Health Collaborative.

Some in the public health world are torn about this new development. Dr. Debra Houry, the former CDC chief medical officer who resigned last month in protest of Kennedy and the Trump administration’s upheaval of the CDC, said she worries about medical tourism by state.

“I get why people are doing it,” Houry, speaking to a group of health journalists in Massachusetts last week, said. “But it’s going to cause some confusion and haves and have-nots.”

Dr. Megan Ranney, dean of the Yale School of Public Health, said she worries about “a balkanization of public health.”

Still Northeastern state health departments are touting their move.

“Whether it’s responding to a pandemic or an outbreak or preparing for a large-scale event such as the upcoming FIFA World Cup, with three host cities in the Northeast, working together helps keep our residents safe and healthy,” New Jersey Acting Health Commissioner Jeff Brown said in the release. “We look forward to continuing to do so with our colleagues in the Collaborative.”