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Tennessee transfer to halt vaccine outreach to teenagers ‘extremely disturbing’

Tennessee move to halt vaccine outreach to teens 'incredibly disturbing'

Director of the Centers for Disease Control and Prevention (CDC) Dr. Rochelle Walensky testifies during a Senate Appropriations Subcommittee hearing to examine the FY 2022 budget request for the Centers for Disease Control and Prevention on May 19, 2021 in Washington,DC.

Jim Lo Scalzo | AFP | Getty Images

Tennessee’s decision to cease vaccine outreach to teenagers while in the midst of a pandemic is “incredibly disturbing,” the head of the Centers for Disease Control and Prevention said Thursday.

“I find this incredibly disturbing. Not only is it disturbing for Covid, but it is disturbing for all vaccine-preventable illnesses,” CDC Director Dr. Rochelle Walensky said in an interview Thursday with CBS This Morning.

The state’s department of health reportedly decided to cease adolescent vaccine outreach for all vaccines, not just for Covid, effectively ending all government communication or education initiatives to teens in the state about vaccines.

The decision made headlines when the state’s medical director for vaccine-preventable diseases and immunization programs at the Tennessee Department of Health, Dr. Michelle Fiscus, was fired after she sent a memo to physicians outlining state policy that allows minors to seek medical care without parental approval.

Department spokesman Bill Christian said in a statement to CNBC that the state hasn’t halted its immunization program for children and continues to support “those outreach efforts. Providing information and access are routine public health functions, and that has not changed.”

He didn’t specifically say whether the state’s outreach program itself was halted.

The Tennessean, a newspaper in Nashville reported on Tuesday that it had gained access to internal reports and emails that instructs Tennessee Department of Health staff to subsequently strip the agency’s logo off of any disseminated vaccine education materials.

In another email that the Tennessean claims was sent from the agency’s Chief Medical Officer, Dr. Tim Jones, he told staff they should do “no proactive outreach regarding routine vaccines.” Staff was also reportedly told not to do any pre-planning for flu shots events at schools. In the emails, Jones reportedly said that any school-related vaccine information should come from the state’s Department of Education.

The newspaper also claims that internal documents reportedly indicate that the agency was directed by Health Commissioner Dr. Lisa Piercey to halt all Covid vaccine events on school property and to no longer send postcards or other notices reminding adolescents to return for their second doses of Covid shots.

On Thursday, the agency released a statement labeling the circulating reports as misinformation. “There has been no disruption to the childhood immunization program or access to the Covid-19 vaccine while the department has evaluated annual marketing efforts intended for parents,” Piercey said in the statement.

The statement does not address reports that the agency halted vaccine outreach for adolescents.

Fiscus said she began to feel the pressure after she highlighted a public document from a state Supreme Court case ruling that allows residents above the age of 14 to seek medical treatment without the consent of a parent “unless the physician believes that the minor is not sufficiently mature to make his or her own health care decisions,” according to the ruling.

“I am not a political operative, I am a physician,” Fiscus told MSNBC. She said she was told she was “poking the bear” and that she needed to work on her political awareness after publicizing the public document. Republican lawmakers likened the state’s adolescent vaccine outreach to peer pressure, she said.

Tennessee has one of the worst Covid vaccination rates in the country, fully immunizing just 38% of its total population, according to CDC data. The state is also seeing increasing Covid cases, with the average number of daily new cases spiking from 177 to 418 in just the past two weeks.

“We now have our most hesitant population being rural male conservative whites, who really do hang their hat on this political ideology that Covid-19 isn’t real, isn’t a threat, or that getting the vaccine somehow props up the left-wing part of our political system,” she told MSNBC.

The state and others with low vaccination rates are starting to see cases climb as the delta variant takes hold in the U.S.

“This is something that we anticipated … that we would see in areas of high vaccination, low case rates, and now we see in areas of low vaccination, high case rates,” Walensky said.

Walensky said a spike in infections could come in the next few months but that if more people get vaccinated now, the nation can “prevent what could happen in the fall.”

Correction: A previous version of the headline misquoted Dr. Rochelle Walensky.

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The C.D.C. and N.I.H. launch a fast, at-home testing initiative in Tennessee and North Carolina.

The C.D.C. and N.I.H. launch a rapid, at-home testing initiative in Tennessee and North Carolina.

The Centers for Disease Control and Prevention and the National Institutes of Health announced a new initiative on Wednesday to see if the frequent and widespread use of rapid coronavirus tests is slowing the spread of the virus.

The program will provide free antigen testing at home to everyone in two communities, Pitt County, NC, and Hamilton County, Tennessee, for free, bringing a total of 160,000 people to test for the coronavirus three times a week for a while a month.

“This is exactly what I and others have been calling for almost a year – widespread, accessible, rapid testing to contain transmission,” said Michael Mina, Harvard University epidemiologist who advocated rapid rapid testing at home programs.

He added, “It’s something anyone can do if they take 30 seconds out of the day three times a week to do the test.”

Antigen tests are cheaper and faster than PCR tests, which are the gold standard for diagnosing Covid-19, the disease caused by the virus. However, they are less sensitive and more prone to false negative results. Mathematical models have shown that if these tests are used frequently, they can still reduce the transmission of the virus.

The tests can help identify people who may not realize they are infectious and cause them to self-isolate before they can transmit the virus to others. Real world data is limited, however, and with virus cases still high across the country, testing is still essential, according to public health experts.

“We have all hypothesized that large-scale home testing could stop the chain of transmission of the virus and allow communities to discover many more cases,” said Bruce Tromberg, who heads the National Institute for Biomedical Imaging and Bioengineering and its rapid acceleration directs the diagnostic program that provides the tests for the initiative. “All mathematical models predict that. But this is an example from the real world, real life. “

Residents who choose to participate in the program can have the tests brought to their home or collect them from local distribution locations. An online tool guides participants through the testing process and helps them interpret their results. Residents can also volunteer to take surveys to see if frequent tests have changed their behavior, knowledge of Covid-19, or their minds about vaccination.

Researchers from the University of North Carolina and Duke University will compare the positivity, case, and hospitalization rates in these two communities with those in other similar communities that are not in the program.

A. David Paltiel, Professor of Health Policy and Management at the Yale School of Public Health, described the start of a real-world study of the effectiveness of rapid home screening as “simply good news.” However, he cautioned that the results need to be interpreted carefully, especially if residents who choose to participate in the initiative are not representative of the entire community.

“We know that self-selection tends to bring out the concerned and a disproportionate number of people who are already Covid-aware or Covid-conscientious,” he said.

“It will be great to see how it works when it’s in the hands of people who really care,” he added. However, he said the results may not be broadly applicable to screening programs that require participation, as may be the case with some workplace and school programs.

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An 11th-Hour Approval for Main Modifications to Medicaid in Tennessee

An 11th-Hour Approval for Major Changes to Medicaid in Tennessee

12 days to go, the Trump administration approved a long-conservative goal on Friday: to issue a state’s Medicaid funding as a block grant with a spending cap.

The structural experiment in Tennessee, which would go into effect after legislative approval, would take 10 years. Block grants to Medicaid were a priority for Seema Verma, the administrator of the Centers for Medicare and Medicaid Services and a former advisor who helped states write exemption requests.

“We tried to get some of the successes that we thought were some of the positive things about block grants that people have been talking about for years,” Ms. Verma said. “And we tried to address some of the criticisms.”

Patient advocates in Tennessee, concerned that the new structure would result in poor people losing access to health care, are planning a lawsuit, and the Biden administration will almost certainly try to reverse this if they get the Department of Health and takes over human services.

But over the past week the Trump administration has tried to slow the reverse of its Medicaid experiments. Traditionally, such exemptions are agreements between HHS and states that can be severed with minimal effort. But Ms. Verma has sent letters to Medicaid state directors asking them “as soon as possible” to sign new contracts outlining more detailed procedures for terminating exemptions. Under the terms of the contract, the federal agency undertakes not to terminate a waiver with less than nine months’ notice.

“It’s so obvious,” said Joan Alker, executive director of the Georgetown Center for Children and Families. “She’s trying to handcuff the Biden administration.”

Ms Verma said the treaties are a way to ensure that exceptions are only revoked if they are harmful. “We want to make sure that people don’t get into office and end waivers on a political whim,” she said.

The waiver allows Tennessee, one of a dozen states that have not adopted the Medicaid extension under Obamacare, to abandon the normal structure of the Medicaid program. In this structure, the federal government lays down detailed rules about who must be covered and what services are offered to them in exchange for an indefinite obligation to pay part of the bills of Medicaid patients. Tennessee would be given new freedom to change what services its program covers, but its funding would be capped on a formula each year.

When Tennessee spends less than the block grant amount, 55 percent of the savings can be spent on a wide range of health-related services. If it spends more, the difference must be made up with government funds. The waiver places some restrictions on the aspects of the program that can be changed and would allow the spending cap to be increased as more people are enrolled with Medicaid, as would normally be the case in an economic downturn.

A key area of ​​flexibility in the exemption concerns prescription drugs. In general, Medicaid has to cover a wide variety of medications, but is guaranteed to pay the lowest price of any US buyer. Tennessee is allowed to renegotiate prices with drug companies and may decline drug coverage if it considers prices too high. Massachusetts filed a waiver requesting a similar agency without a broader block grant, and that was denied.

In Tennessee, doctors and hospital groups, among others, have criticized the proposal. “The vast majority of comments CMS received were against Tennessee’s proposed demonstration,” the approval document said.

Governor Bill Lee, a Republican, described the program as a “legacy achievement”.

“We have shown that partnership is a better model than dependency,” he told reporters.

Waiver statements were a core part of Ms. Verma’s tenure with the Medicaid agency. In addition to the Tennessee Block Grant Waiver, she has approved Medicaid’s work requirements for certain adults in 12 states. Federal courts have repeatedly repealed these exemptions, and few of them are in force.

Michele Johnson, executive director of the Tennessee Justice Center, a legal aid group that helps poor Tennesseans, said she was trying to encourage lawmakers to oppose the waiver. A block grant she has always turned down fits particularly well with a public health crisis where health spending could accelerate in unusual ways. “The only way this makes sense is for the Trump administration to burn everything down on the way to the door,” she said.

She also noted a history of challenges the state faced in running its more traditional Medicaid program. “It is hard to imagine that a state would be less suitable for a block grant than ours,” she said.

Sheryl Gay Stolberg contributed to the coverage.