State Advisory Boards and the Politics of Expertise in US Public Health.

Abstract

This essay examines the evolving relationship between public health expertise and politics in the United States, focusing on the emergence of state advisory boards during and after the COVID-19 pandemic. While public health decision-making has always involved political trade-offs, recent developments reflect a more direct politicization of federal institutions, including changes in advisory committee composition, constraints on scientific autonomy, and declining public trust. In response, several states have created independent advisory bodies to review federal guidance and guide vaccination policy. This article draws on examples from the Western States Scientific Safety Review Workgroup and a state vaccine advisory committee in Connecticut. These initiatives represent an important institutional adaptation to contested federal expertise. However, the latest proliferation of state advisory structures may also fragment scientific authority, complicate coordination during emergencies, and introduce new challenges for accountability and equity. The growing role of state-level expertise reveals the emergence of a more polycentric form of public health governance, raising questions about how scientific authority is organized, trusted, and contested in an era of political polarization. (Am J Public Health. Published online ahead of print September 3, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308661).