In this March 2, 2021, file photo, Hollie Maloney, a pharmacy technician, loads a syringe with Pfizer's COVID-19 vaccine at the Portland Expo in Portland.  Credit: Robert F. Bukaty / AP

Federal health officials authorized COVID-19 booster shots for adults in certain groups in recent months with the goal of prioritizing those at highest risk of infection and severe disease.

Centers for Disease Control and Prevention guidance recommends boosters for adults ages 65 and older, as well those 18 and older who live in long-term care facilities, who have medical conditions and who work or live in “high-risk settings.”

Now, states overwhelmed with COVID-19 cases are taking matters into their own hands.

California and Colorado health officials announced this week that any adult can receive a COVID-19 booster shot as long as they are at least six months past their second dose of the Pfizer or Moderna vaccine, or at least two months past their Johnson & Johnson shot.

But can states override federal health guidance?

“Yes, they can and they are,” James Hodge, director of the Center for Public Health Law and Policy at Arizona State University, told McClatchy News in an interview. “There’s nothing within the Food and Drug Administration’s authorization of the current vaccine boosters that limits that.”

“And the CDC’s recommendations are just that — recommendations,” added Hodge, who is the director of the Western Region Office of the Network for Public Health Law.

Technically, the FDA authorized COVID-19 boosters for adults, any specifics beyond that are considered advice, Hodge said, meaning “there’s nothing legally stopping Colorado and California from taking the maneuvers they’ve done.”

California’s Department of Public Health said Nov. 9 that vaccine providers should “not turn a patient away who is requesting a booster” as long as they “self-determine their risk of exposure” and are eligible regarding the timing of their initial COVID-19 vaccine doses.

Colorado Gov. Jared Polis signed an executive order on Nov. 10 declaring the state as high risk for COVID-19 exposure and spread. Because of the declaration, everyone in Colorado is living in a high-risk setting, placing the state’s booster move within federal health guidance bounds.

“What Coloradans need to know and understand is the high rates of COVID in Colorado mean everyone is at high risk. That means you need a booster if you are six months past your second shot,” Conor Cahill, press secretary for Gov. Polis’ office, told McClatchy News in an email.

“The Governor has been disappointed with the overly complex message from the CDC and the FDA on boosters and won’t allow that to harm Coloradans who want the additional protection,” Cahill said.

The governor’s order says there were only 623 hospital beds left across Colorado as of Nov. 10, with 95 percent of intensive care beds and 94 percent of medical/surgical beds occupied.

What happens if pharmacies refuse state orders?

McClatchy News called local and national pharmacy chains in Colorado and found local stores are following Polis’ booster order while national stores, such as Walgreens, are sticking to guidance set forth by federal health officials.

Hodge of Arizona State said “this could be a problem.”

“These are state-based licensed enterprises no matter whether they’re a national chain or not,” he said. “I think there’s going to be some issues if Walgreens, for example, continues to reflect a refusal to implement what governor policies clearly asked to be done.”

The state’s executive order does not include any definitive penalties for pharmacies that go against the governor’s policies.

“If there is a penalty to be paid for it, it’s going to come through other state law,” which could entail an investigation into the pharmacy’s license or include some sanction against the business, Hodge said.

But it’s unlikely federal health officials will involve themselves in state affairs.

“In Democratically led states like California and Colorado, you’re seeing the sort of promise and potential for widespread acceptance and uptake of vaccines as their way out of at least some of these preventable deaths and other complications, and I think those governors and their administrations are playing it based on that card,” Hodge said. “I don’t believe federal authority is going to step in and say ‘whoa, hold up here.'”

That could happen, however, if the country faces a COVID-19 booster supply issue in the event other states follow California and Colorado’s footsteps, which is likely, Hodge said. But it’s unlikely all states, particularly conservative ones, will open boosters for all.

More than 27.7 million people in the U.S. have received COVID-19 boosters as of Nov. 12, a CDC tracker shows.

Katie Camaro, The Sacramento Bee