Publicly, NH never joined Northeast Public Health Collaborative. Privately, it’s deeply involved.

When 10 Northeastern U.S. states came together in September to announce a new public health collaborative amid turmoil within federal health agencies, New Hampshire was the only state in the region not included. However, behind closed doors, New Hampshire was directly involved in the group from an early stage and continues to be involved today, internal emails obtained by the Bulletin reveal.

In September, the New York City health department and 10 state health departments — New York, Massachusetts, Maine, Vermont, Rhode Island, Connecticut, New Jersey, Pennsylvania, Maryland, and Delaware (Virginia, Boston, and Philadelphia have since joined the collaborative) — announced they were banding together to create the Northeast Public Health Collaborative, with New Hampshire conspicuously absent. The health bloc had been in the works for the better part of a year by the time of the announcement. 

A trove of more than a thousand pages of emails and other documentation obtained by the Bulletin in a series of public records requests across multiple states shows that New Hampshire officials were heavily involved in the group’s formation and that the state was considered part of the collaboration.

That includes regularly attending meetings of the collaborative from its earliest stages, helping brainstorm ideas, and participating in the collaborative as recently as this month.

“For now, please do not include New Hampshire (on the public announcement of the collaborative),” New Hampshire Associate Health Commissioner Patricia Tilley wrote to a colleague on the collaborative. “I will continue to participate on leadership calls, as we are welcome and able.”

The collaborative was created in response to seismic changes within the federal government’s public health apparatus under Health Secretary Robert Kennedy Jr. and President Donald Trump.

Among Trump’s first actions after returning to the White House were slashing the federal government’s biomedical research budget and firing thousands of federal health officials. In June, Kennedy, a longtime vaccine detractor, fired every member of the government’s Advisory Committee on Immunization Practices. He later replaced many of them with fellow vaccine skeptics who have since scaled back some of the government’s vaccine recommendations, though a federal judge recently paused those changes on the grounds they were unscientific and handled improperly. 

The Northeast Public Health Collaborative is now issuing its own recommendations and collaborating on data sharing and emergency preparedness independent of the federal government.

Massachusetts Health Commissioner Dr. Robert Goldstein told the Bulletin in September the group was designed to “backfill if parts of CDC start to fail and augment where CDC maybe wasn’t doing a good job in the first place.” At the time, he said his team was “actively communicating” with New Hampshire public health officials about the effort. Before the Bulletin obtained the emails and documents, the extent of those communications was unknown. Goldstein said the collaborative was “having real conversations” with multiple Republican-controlled states but that “they can’t politically be the ones who are publicly coming out with the guidance.” New Hampshire is the region’s only state with a Republican trifecta — governor, House, and Senate — in power.

The records obtained by the Bulletin show that state health departments in the region have been meeting since around February 2025.

A slideshow presentation sent to other state health officials by Maine State Epidemiologist and Chief Medical Officer Dr. Isaac Benowitz appears to describe the early conversations that led to the group’s formation. The slideshow is dated Feb. 10, 2025, and titled “Northeast Collaboration: Opportunities for Resource-Sharing Across State Lines.” It describes the group as a response to the “rapidly-changing federal landscape that could have direct and indirect impacts on public health resources and capacity.” The slideshow asks:

• “What are the opportunities to collaborate across state lines to supplant existing state and/or federal public health capacity?”
• “What if state health departments lost all federal funds?”
• “What if we continued getting current funding levels but CDC was partially or completely unavailable?”
• It also said that Maine and Massachusetts’ health departments had met three times and were “eager to include other Northeast states in the conversation.”

A separate planning document that appears to have been created much later in the process says the collaborative’s “Million Dollar Question” is whether they’ll “hire staff, acquire communications tools, reach and serve the people in the states we serve.”

Several state health departments throughout the Northeast proceeded to meet over videoconference regularly, including the New Hampshire Department of Health and Human Services, per the documents. New Hampshire State Epidemiologist Dr. Benjamin Chan, Bureau of Emergency Preparedness Chief Stephanie Locke, and Tilley were listed as attendees in meeting minutes obtained by the Bulletin. Some groups met weekly, others biweekly or monthly. Chan, Tilley, and New Hampshire Director of Public Health Iain Watt all served on the regional collaboration’s “leadership group,” per emails.

Locke organized biweekly meetings for “the Northeast Collaboration: Preparedness Subgroup,” the emails show. When the group was crafting an official agreement, Locke helped brainstorm ideas by suggesting the group look at a previous agreement between Northwestern U.S. states and British Columbia and Yukon in Canada for inspiration. Locke attended a meeting as recently as March 12.

Chan planned a conference for the Northeastern state epidemiologists, though it’s unclear if that was part of the collaborative’s work or routine meetings of fellow epidemiologists.

Tilley suggested the collaborative create workgroups on tuberculosis in jails and prisons, arboviral diseases, rural health, and homestead food policies.

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Some of the emails and meeting minutes, which are partially redacted, include topics for discussion such as:

• “Potential talking points for responding to questions about recent HHS, FDA, and CDC actions”;
• “One Big, Beautiful Bill — how does this shape our landscape”; 
• “the potential pitfalls of undermining ACIP (the Advisory Committee on Immunization Practices) recommendations.”

Other topics of discussion suggest routine public health work, such as preparations for the upcoming FIFA World Cup matches in Boston, Philadelphia, and New Jersey; insect-borne viruses detected in New Hampshire; or the idea of collaborating on vaccine purchases.

Among the redacted parts of the documents appears to be the group’s discussion about how to react to the federal government’s decision to end COVID-19 vaccine recommendations for healthy children 6 months to 2 years old and pregnant women. Roughly three months after that discussion, the collaborative issued its first public recommendation: healthy children 6 months to 2 years and pregnant women should in fact be vaccinated for COVID-19.

In a May email, a New York State health official, Elana Goldenkoff, wrote: “The Collaboration (CT, MA, ME, NH, NJ, NY, NYC, RI, VT) first convened in early 2025, and is now meeting regularly working together to monitor and navigate the evolving public health landscape and ensure a coordinated approach across the region.” A separate document lists the New Hampshire Department of Health and Human Services in a list of agencies in the collaborative.

In August, the state health officials met in person in Rhode Island to discuss the collaborative. It was previously reported that New Hampshire health officials did not attend. However, the emails obtained by the Bulletin suggest that New Hampshire officials were invited to meetings during that conference virtually and when asked about the matter, the New Hampshire Department of Health and Humans Services neither confirmed nor denied their virtual presence.

In an August email, ahead of that in-person meeting, Benowitz, the Maine epidemiologist, wrote to New Hampshire’s Tilley: “Hi Trish, I chatted with Thiery and she let me know that you and your team can’t make it to Providence. Do you have a moment to chat this week? I want to make sure that I steer the regional work in a way that leaves the most space for NH to stay engaged where you’re able to. I also know that, at the national level, different states may go in different directions based on their politics but a lot of us see more similarities in priorities at the program level, and I’m interested in your thoughts about how we can move public health forward for all states, not just some of them.”

In September, as they were putting together an announcement, New York Deputy Public Health Director Eli Rosenberg emailed Tilley to ask: “This release will name the participating jurisdictions, but not describing the degree of participation so I just wanted to clarify whether you think we should be including or excluding New Hampshire at this point?”

Tilley replied, “For now, please do not include New Hampshire,” though she said she “will continue to participate on leadership calls, as we are welcome and able.”

“Thanks Tricia,” Benowitz wrote. “I’m glad we still get to work with you, and we can work around those constraints.”

At another point, Rosenberg said: “New Hampshire was excluded from some earlier coverage of the Providence meeting, since you all didn’t attend, but obviously we think you’re valued members at whichever level of participation is feasible. Are you comfortable if we name that New Hampshire is participating?”

Tilley responded: “The following is what we’ve been sharing with media when they ask about New Hampshire’s participation. Feel free to use any part of that that makes sense that highlights that we participate in information and learning with our neighbors. New Hampshire Department of Health and Human Services shares expertise and collaborates with neighboring states and regional partners to ensure Granite Staters have access to accurate information and public health recommendations that best serve New Hampshire.”

In response to an emailed list of questions from the Bulletin, Jake Leon, spokesperson for the New Hampshire Department of Health and Human Services, said in a statement: ​​“The Collaborative is one of several hubs for communication and information sharing among states, but ultimately, New Hampshire maintains independence in making its own policy decisions to ensure they best serve New Hampshire residents. New Hampshire regularly engages at the national and regional levels to ensure residents have access to the best possible care, information, and public health recommendations as they make important health care decisions with their providers.”

He cited a WalletHub report that ranked New Hampshire’s health care system as best in the country and said “DHHS will ensure New Hampshire remains #1 by continuing to share expertise with neighboring states and collaborate with federal, regional, and local partners to inform our public health recommendations for patients to evaluate with their health care providers.”

Gov. Kelly Ayotte’s office did not respond to the Bulletin’s request for comment, including questions about whether politics played a role in New Hampshire not publicly joining the coalition.

Meanwhile, California, Oregon, Washington, and Hawaii have also created a similar but independent health bloc called the West Coast Health Alliance. This group has been even more forceful in opposing Trump’s health agenda, saying in a joint statement: “President Trump’s mass firing of CDC doctors and scientists — and his blatant politicization of the agency — is a direct assault on the health and safety of the American people. The CDC has become a political tool that increasingly peddles ideology instead of science, ideology that will lead to severe health consequences.” Emails obtained by the Bulletin show that the two groups have spoken to each other.