Overlapping emergencies are straining the country’s public health workforce and threatening critical vaccination campaigns


Health officials are banking on vaccinations to contain monkeypox and poliomyelitis before they become permanent threats in the United States. They rely on updated boosters to restore waning immunity to Covid-19. With the flu expected to return to the United States this fall, flu shots could be key to preventing serious illness and keeping hospitals from being overwhelmed.

While the federal government will facilitate the transmission of these vaccines to the states, it will be the 2,820 state and local health departments that will lead the work of getting shot, and public health experts say it is not clear that these offices have enough funds or staff to finish the job.

“I think it’s deeply concerning,” said Dr. Peggy Hamburg, former New York City health commissioner and former commissioner of the United States Food and Drug Administration. “It’s hard to imagine how national and local health services can all step up, and they desperately need additional support.”

“I think we have to recognize that this is a very vulnerable time,” said Hamburg, who recently chaired a commission for the nonprofit Commonwealth Fund on how to modernize the country’s public health system.

After nearly three years of battling vaccine hesitancy, politics and a global pandemic, the country’s public health workers are frayed and leaving their posts. More than one in four health department heads quit their jobs during the pandemic, some after being harassed and threatened with death. Studies are underway to measure the extent to which these losses have extended to their staff.

Now, these exhausted agencies are being asked to tackle new threats like monkeypox without additional funding to deal with them.

“Overwhelmed is an understatement”

Can these agencies get away with it?

“Probably not,” says Caitlin Rivers, epidemiologist and assistant professor at the Johns Hopkins Center for Health Security in an email to CNN. “Public health is chronically underfunded and understaffed. Substantial capacity was built during the COVID-19 response – for example, contact tracing teams – but many jurisdictions have reduced this infrastructure. Covid money is largely inflexible, so it can’t really be used for other threats like monkeypox.”

The country’s vaccinators say they are struggling.

“Overwhelmed is an understatement,” said Claire Hannan, executive director of the Association of Immunization Managers.

Hannan said his members had not received any funding to conduct a monkeypox vaccination campaign. Yet they have just been asked to change the way the vaccine is administered, from a more familiar injection under the skin to a shallower method that injects the vaccine between the layers of the skin, which requires training for the do it right. The hope is that intradermal injections, which require a fifth of a regular dose, can quickly increase stocks of this hard-to-obtain vaccine.

As a result, immunization managers are scrambling to find money and staff to order vaccines, manually track inventory, transport vaccines to where they are needed, train providers, and collect and return data. to federal health agencies such as the Centers for Disease Control and Prevention.

On top of that, orders have started for updated boosters to protect against the BA.4 and BA.5 subvariants of the Omicron strain of the novel coronavirus, which were promised to Americans in mid-September.

Allocations in those early orders have been lower than expected, Hannan said, forcing city and state health officials to develop plans for who should be on the front lines to get them, if demand was initially expected to exceed supply.

Additionally, many cities are now testing their sewage for poliovirus after it was recently detected in Rockland County, New York and New York. If further community spread is suspected, these areas may need to mount vaccination campaigns to protect residents who have not been vaccinated, such as recent immigrants or young children who missed routine vaccinations during the pandemic. .

In the United States, children typically receive four doses of the polio vaccine by age six, but many children have fallen behind on their shots. Globally, the pandemic has caused the biggest drop in childhood vaccination rates in 30 years, according to the World Health Organization. Health officials fear that the erosion of this coverage has paved the way for the return of other infectious diseases, such as measles.

“A disruption or gap in vaccine delivery prepares us for further outbreaks,” said Dr. Davidson Hamer, an infectious disease specialist at Boston University.

Mistrust fuels hostility and hesitation

Vaccines are considered one of the greatest triumphs of modern medicine, second only to drinking water as a cost-effective health intervention. Every year, they prevent millions of deaths worldwide. In their first year of use, Covid-19 vaccines averted nearly 20 million deaths, according to a recent study.

Still, vaccine hesitancy has grown, fueled by misinformation on social media. While more than three quarters of Americans are vaccinated against Covid-19, 19% say they will definitely not receive a Covid-19 vaccine.

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If all of these challenges weren’t enough, annual flu shots are set to roll out soon, and they could be especially important this fall.

Influenza has made a comeback in Australia this year for the first time since the pandemic began. US health officials are watching Australia’s flu season closely for clues about what could be happening here. They predict we could see more flu transmission this year than we’ve had in the past two years, and flu vaccinations will be key to preventing hospitalizations and deaths.

“I think right now we have a perfect storm in the vaccine world going on in this country,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy.

He points out that even though the average daily deaths from Covid-19 are much lower than they were in 2020 and 2021, the United States is still averaging more than 400 a day, making it the fourth leading cause of deaths in the country. Most of those deaths are in unvaccinated people, according to the CDC.

Overall, more than one in five Americans are still unvaccinated against Covid-19, and that number doesn’t seem likely to budge. Vaccination rates are mostly stagnant.

It would take a more robust and better funded public health workforce to restore confidence in vaccines.

A recent study by the Beaumont Foundation, a non-profit organization that works to strengthen public health, found that the public health system needs 80,000 more full-time employees – a whopping 80% increase from to current staff – to provide basic community services, such as monitoring and controlling the spread of infectious diseases.

Brian Castrucci, the organization’s president and CEO, said America won’t be able to restore its public health workforce until people appreciate and respect the work they do.

“What we’ve seen during Covid is a fringe anti-vax movement going mainstream, putting our nation’s safety, security and economic prosperity at risk,” Castrucci said. “It will be more and more difficult to vaccinate.

“We are privileged as a society in which we have not seen children on crutches due to polio. Nobody is in an iron lung. And that has left us somewhat numb to the potential of this that could actually happen,” he said. “These are virulent diseases.”


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