Key Takeaways
- The MD Vax Act of 2026 would allow Maryland to set vaccination recommendations independent from federal guidelines.
- State guidelines would rely on a combination of guidance from medical organizations including the American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American Academy of Family Physicians (AAFP), as well as federal recommendations prior to recent changes.
- The Vax Act could have broader implications on the issue of state vs federal authority and could set precedent similar actions in other states as well as further detachment of state health policies from federal agencies.
In January 2026, Maryland Governor Wes Moore announced Senate Bill 385, and the companion bill HB637, the Vax Act of 2026, a move pushing the limits of state authority over public health. The Vax Act was introduced in the Maryland Senate on January 27th under the official bill title, Public Health – Recommendations for Immunizations, Screenings, and Preventive Services – Pharmacist Administration and Required Health Insurance Coverage.
Introduction to the Vax Act of 2026
The announcement of the Vax Act comes in response to the finalization of changes to federal vaccine guidelines, determined by the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control (CDC), in early January 2026. This reduction in the childhood vaccine schedule is only one of many recent federal public health policy amendments made by HHS under the leadership of Robert F. Kennedy Jr.. In an effort to reposition the United States from the higher to the lower end of vaccine recommendations among peer nations, the CDC now recommends immunization for all children against 11 diseases, rather than 18 as in 2024. The vaccines no longer universally recommended are now shifted into lower categories of being recommended for certain high-risk groups or after clinical discussion.
The bill primarily allows the Maryland Secretary of Health to establish childhood vaccine guidelines, general immunization recommendations, and other preventative care guidance. These guidelines are said to be made in line with what they determine to be general scientific consensus, relying on recommendations from national medical organizations and certain state and federal agencies. The bill further ensures that pharmacists are permitted to administer all routine vaccines to patients three years of age and older based on prior federal recommendations, active as of December 2024. Health insurance companies must still cover all immunizations for routine use, regardless of their status under state or federal guidance, without any cost-sharing.
Legislative Context for the Vax Act of 2026
In December 2025, when CDC changes were clear but not yet finalized, Illinois Democrats passed HB767 to permit the Illinois Department of Public Health to publish vaccine guidelines based on the recommendations of the state’s Immunization Advisory Committee. This change shifted the state away from relying on federal health guidance and established precedent for similar actions in Maryland if the Vax Act were to be enacted. Maryland and the Moore administration have also taken actions of their own to establish a basis for the introduction of the Vax Act. In September 2025, Maryland joined the Northeast Public Health Collaborative, a regional coalition of states and cities formed to collaborate on public health policies and preparedness. The coalition involves Democrat-led states and cities and was created citing concerns about inconsistency in federal public health policy.
Arguments in Favor
Alignment with the Medical Community
The Vax Act aims to rely heavily upon health guidance distributed by medical organizations including the American Academy of Pediatrics (AAP), and the American College of Obstetricians and Gynecologists (ACOG). While these organizations have often previously aligned with the federal government on immunization recommendations, they strictly oppose the recent removal of certain childhood vaccine recommendations. Many physicians already act in accordance with this facet of the Vax Act in their continued reliance on AAP, ACOG, and AAFP recommendations when discussing immunizations with their patients.
Resolution of Confusion
In a recent hearing on SB385, Lieutenant Governor Aruna Miller stated that federal changes to vaccine schedules have created “confusion and instability” that has threatened the health of Americans. Michael Osterholm, epidemiologist and former member of President Biden’s COVID-19 Advisory Board, adds that he believes confusion is intentional, sown to create doubt about vaccines. Miller proposed that the Vax Act would resolve this confusion for Marylanders by providing alternative recommendations from the state government.
Arguments in Opposition
Distraction from State Priorities
While the Moore administration proposes that the Vax Act would reduce confusion, critics of the Vax Act condemn the bill for failing to take meaningful action and only adding to confusion surrounding government health guidance and politicization of public health. Because Maryland has taken previous actions to ensure insurance coverage of immunizations regardless of federal status and the bill does not create any vaccine mandates or requirements, testimonies to the Senate Finance Committee found the Vax Act unnecessary and unimportant. Many Maryland Senate Republicans find the bill redundant and politically-driven, with Senate Minority Leader Steve Hershey stating that instead of countering the federal administration, the “governor needs to focus on what’s going on here in the state.”
Assessment of Peer Nations and Potential for Vaccine Harms
To determine the specific changes in the childhood vaccine schedule, HHS conducted an assessment of immunization schedules in countries determined to be peer nations of the United States. This assessment comes to the determination that the U.S. is an outlier, recommending more vaccines than other countries, and therefore should lessen the vaccine schedule to better meet the suggestions of other nations. This is based on the belief among HHS officials that the potential harms of vaccines are not well understood, and receiving less vaccines would lessen a child’s risk of potential, unknown side effects. HHS determined that without “placebo-controlled randomized trials” and “post-marketing cohort studies comparing exposed and unexposed populations,” trials not possible for existing vaccines under ethics requirements, “we do not have the basic data needed to assess potential vaccine harms.” This argument is consistent with opposition to the Maryland Vax Act, as critics of the bill find the evidence that would be relied upon in MD recommendations inadequate.
Future Considerations
The introduction of the Vax Act of 2026 in Maryland has the potential to incite changes beyond the boundaries of the bill, action only exacerbated if the bill were to become law. In the same way Illinois’s HB767 established precedent for state-level vaccine guidance and a disentanglement with federal health agencies under the Trump administration, the MD Vax Act has the potential to incite further similar action in other states, particularly those in the Northeast Public Health Collaborative. The bill also provokes the question of how far states can go to rebuke federal authority. As the Vax Act progresses through the Maryland General Assembly and is subject to debate and discussion on both sides of the aisle, Maryland will have to contend with the prospect of what the Vax Act could mean for Maryland’s relationship and separation of authority with the federal government.
Frequently Asked Questions
- Have other states taken actions similar to the Vax Act?
- Illinois passed a similar bill in December 2025, but other states have also taken legislative actions to reject federal vaccine schedule changes, including New Jersey and Massachusetts.
- Where is the bill in the process of becoming a law?
- In both the House and the Senate, the Vax Act has been read once and referred to a committee, the Health Committee in the House and Finance Committee in the Senate.
- When would the Vax Act take effect?
- If enacted, the Vax Act would become effective on July 1, 2026.