In the Northeast, nine states have joined to save common-sense safeguards against infectious disease with vaccines.

On the West Coast, California, Oregon and Washington have created a similar compact, sharing resources and surveillance.

Maryland has yet to join one of these partnerships, but the idea is under discussion.

It should be.

As U.S. Health and Human Services Secretary Robert F. Kennedy Jr. blows up America’s public health system, some states are at the forefront of efforts to save it.

“I see what we’re doing as the ultimate battle of our nation, which is a conversation about states’ rights and federal rights,” said Dr. Robbie Goldstein, the Massachusetts commissioner of health. “When does a state have the responsibility, and when does the federal government have the responsibility?”

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Until this year, the federal government led many aspects of modern public health. It’s abdicating that role under RFK and President Donald Trump.

The Food and Drug Administration, the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices, and other agencies are all in a self-inflicted spiral of layoffs, firings and budget cuts.

Kennedy, an outspoken anti-vaccine activist, is trashing the vaccine recommendations that pharmacies and insurance companies rely upon. Maryland and other states have issued their own guidance, but infectious diseases don’t observe borders.

Shaun Truelove, a research epidemiologist at the Johns Hopkins Bloomberg School of Public Health, said assuming a larger role allows states to encourage or force insurers to cover vaccines and campaigns urging people to get them.

That could counter Kennedy’s retreat.

“Yes,” Truelove said, “as long as the states can continue to get vaccines from the manufacturers.”

States already cooperate on public health, both regionally and nationally.

“We have always collaborated with those around us, because that’s how public health works, right?” Goldstein said.

Public health directors in the Northeast began meeting at the start of the COVID pandemic. When Donald Trump returned to office in January, those conversations shifted to an administration eager to put politics over science.

“In the past few months, we’ve taken those discussions and turned from deliberation to action,” Goldstein said. “We’re now moving forward with specific actions that are positioning the Northeast’s public health, I think, in a stronger place than if we were to do this alone, one state at a time.”

These include evidence-based vaccine recommendations, disease surveillance through hospital reporting, shared emergency preparedness and supporting state public health labs.

That last one should have been listed first.

Kennedy has decimated the CDC and its labs. More than 2,400 researchers have been laid off, and the director was fired over vaccine policy.

Some states have labs almost as renowned as CDC’s, doing everything from infectious disease testing to screening newborns. Maryland’s J. Mehsen Joseph Public Health Laboratory at Johns Hopkins is among the best.

States without equivalent resources, such as Delaware, would benefit from sharing.

For now, states rely on the National Healthcare Safety Network to monitor outbreaks. There have been no moves by Kennedy to cut it, or to block states from going around his vaccine pullback.

Even if he does, the law is probably on the side of the states.

The Constitution allows states to form compacts. Maryland belongs to one that regulates East Coast rockfish catches.

Buying vaccines is where the conflict might come. The federal government is the nation’s largest purchaser, vaccinating half of U.S. children through its Vaccines for Children Program. Pharmacies are another huge buyer.

Kennedy has tried to defund research on new mRNA vaccines, the kind developed for COVID, but not vaccine purchases. Yet.

If he does, states could buy and distribute them together to keep costs low. Kennedy might challenge that.

This is all new. Massachusetts Gov. Maura Healey announced the Northeast compact on Sept. 4, a day before Gov. Wes Moore announced Maryland’s guidelines.

Maryland should join with Delaware, Pennsylvania and the other states in the Northeast cooperative. State health officials won’t say why they are hesitating, but it’s not hard to guess.

Collaboration exists at the national level, just not with this frequency or focus on vaccines. Maryland is vulnerable to retaliation by the Trump administration, particularly through more layoffs at the National Institutes of Health.

Shifting responsibility for vaccine policy to the states will require more money when budgets are tight. The United States chronically underinvests in public health, and the feds aren’t paying the states to pick up its slack.

There also remains hope that public support for vaccinations will win the day. U.S. Sen. Angela Alsobrooks was among the first in Congress to call on Trump to fire Kennedy.

“Vaccination is not a 50-50 issue,” Goldstein said. “It is not a red state-blue state issue. It’s not a Democrat-Republican issue. Vaccination is actually a universally held belief across this country.”

Even Trump may support vaccines, although his comments are inconsistent and wacky.

“I think we have to be very careful,” the president said the same day Moore announced guidance in Maryland. “Look, you have some vaccines that are so amazing.”

Truelove, the infectious disease researcher, said Maryland’s summer bump in COVID-19 cases is peaking at 100 to 150 people hospitalized every week. This winter could be a bit more severe, with 250 to 300 hospitalizations a week.

Fewer vaccinations, though, would mess up the forecast for all communicable diseases.

Texas was the first to chip away at school vaccine requirements, including the MMR for measles, mumps and rubella. A West Texas measles outbreak spread to New Mexico.

Florida is up next. It plans to drop requirements for chickenpox, hepatitis B, Haemophilus influenzae type b and diseases like meningitis.

West Virginia Gov. Patrick Morrisey ordered public schools to allow religious and moral exemptions for vaccinations in January, but it’s tied up in court.

If he wins, any outbreak could spread to Western Maryland. The population is small, but every chink in the system that saved millions from childhood disease and COVID is another vulnerability.

“We’re seeing a shift in vaccination and willingness to get vaccinated within different states,” Truelove said, “and it unfortunately aligns with political leanings.”