State and local public health entities are becoming increasingly self-reliant amidst federal policy and budget uncertainty. This was evident at the National Association of County and City Health Officials (NACCHO) 2026 Preparedness Summit, during which Avalere Health Advisory experts heard firsthand about how federal public health policy changes over the past year  are affecting state and local health departments’ capacity to prepare for public health emergencies, implement community programs, and engage with their communities.

Key Themes

Request for Open Local, State, and Federal Communication: Officials from the Centers for Disease Control and Prevention (CDC) reiterated the need for open lines of communication with state and local health departments, highlighting the importance of hearing about their resource needs. Federal officials also acknowledged how uncertainties in the policy environment and budget constraints are impacting state and local leaders. These budget constraints may be poised to continue, as previewed in the Fiscal Year 2027 President’s Budget Request, although Congress rejected the largest proposed cuts to immunization programs in 2026. Further, competing federal, state, and local public health policy priorities could challenge ongoing collaboration, although the nomination of Dr. Erica Schwartz for CDC Director could shift these dynamics.

Taking Advantage of Existing Policy Vehicles: Panelists highlighted the utility of the Emergency Management Assistance Compact (EMAC), an agreement between states, DC, Puerto Rico, Guam, and the US Virgin Islands to share assets, supplies, personnel, and other resources during emergencies and guarantee reimbursement. While speakers noted that EMAC could present opportunities for collaboration, funding, and interstate deployment, they also acknowledged that its use varies by state. Potential solutions to this uneven adoption and use included putting national emergency declaration templates in place for quick governor sign-off to facilitate rapid resource deployment and cross-agency collaboration.

Persistent Funding and Workforce Concerns: Public health officials noted that inadequate funding for state and local public health—often via flat federal discretionary appropriations—is a persistent issue. For example, federal funding for the CDC’s Section 317 Immunization Program, which supports state vaccine purchasing for uninsured adults and other immunization programs, was set at $683.9 million for each fiscal year from 2023 to 2026. Compounding this challenge are reported concerns about institutional knowledge loss resulting from federal reductions in force and contract cancellations. One speaker called on conference attendees to communicate the impact of federal public health funding on local-level outcomes to federal policymakers, both directly and through national representation from organizations like NACCHO.

Looking Ahead

Federal, state, and local officials acknowledged that, amidst a new and uncertain public health landscape, close collaboration will continue to be essential. Many went further to state that this collaboration relied significantly on trust—between colleagues and with the public—emphasizing the importance and value of effective communication.

Avalere Health’s vaccines experts can develop tailored messaging for state and local audiences to facilitate this communication. Further, our team can identify novel solutions to current public health resource constraints that enable cross-jurisdictional collaboration to promote immunization.

As the public health policy landscape continues to change, Avalere Health’s Vaccines Team can help you prepare flexible evidence, policy, and access strategies in the face of uncertainty. To learn how, connect with us.