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Public health officials are turning to immunizations to curb monkeypox and polio before they become permanent threats in the United States. They are counting on updated boosters to restore dwindling immunity to Covid-19. With influenza expected back in the US this fall, flu shots could be crucial to preventing serious illness and keeping hospitals from being overwhelmed.
While the federal government will make it easier to get those shots to the states, it will be the 2,820 state and local health departments that will be spearheading the work to get gun shots, and public health experts say it’s not clear whether these offices have sufficient funds or staff to do the job.
“I think it’s deeply concerning,” said Dr. Peggy Hamburg, former health commissioner for New York City and former commissioner of the U.S. Food and Drug Administration. “It’s hard to imagine how state and local health officials can mobilize everyone, and they desperately need additional support.”
“I think we have to recognize that this is a very vulnerable time,” said Hamburg, who recently led a commission for the nonprofit Commonwealth Fund 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 have frayed and are leaving their posts. More than one in four Health Department heads have quit their jobs during the pandemic, some after harassment and death threats. Studies are underway to measure how deeply these losses affected their employees.
Now these exhausted authorities are being asked to tackle new threats like monkeypox with no additional funds to deal with them.
“Overwhelmed is an understatement”
Can these agencies pull it off?
“Probably not,” says Caitlin Rivers, an epidemiologist and assistant professor at the Johns Hopkins Center for Health Security, in an email to CNN. “Public health care is chronically underfunded and understaffed. Significant capacity has been built during the COVID-19 response, such as contact tracing teams, but many jurisdictions have dismantled that infrastructure. The money from Covid is largely inflexible, so it can’t really be used for other threats like monkeypox.”
The nation’s vaccinators say they’re struggling.
“Overwhelmed is an understatement,” said Claire Hannan, executive director of the Association of Immunization Managers.
Hannan said its members did not receive funds to conduct a monkeypox vaccination campaign. However, they have just been asked to change the way the vaccine is given, moving from a more familiar injection under the skin to a more shallow method where the vaccine is injected between layers of skin, which requires training to do it to do right. The hope is that intradermal injections, which require one-fifth of a regular dose, can rapidly increase supplies of this elusive vaccine.
As a result, immunization managers scramble to find money and staff to order vaccines, manually track inventories, ship vaccines to places where they are needed, train providers, and collect and send data back to federal health agencies like the US centers Disease Control and Prevention.
In addition, the order of updated boosters for protection against the BA.4 and BA.5 subvariants of the Omicron strain of the new coronavirus, which were promised to Americans by mid-September, has begun.
Allotments in those early orders were smaller than expected, Hannan said, forcing city and state health officials to develop plans about who should be first in line to receive them should demand initially exceed supply.
Additionally, many cities are currently testing their sewage for poliovirus, following recent detections in Rockland County, New York and New York City. If additional community spread is suspected, these areas may need to conduct vaccination campaigns to protect residents who have not received the vaccination, such as B. recent immigrants or young children who missed routine vaccinations during the pandemic.
Children in the US typically get four doses of the polio vaccine by age six, but many children have fallen behind on their immunizations. According to the World Health Organization, the pandemic has led to the largest drop in childhood vaccination rates worldwide in 30 years. Health officials fear the erosion of that coverage has set the stage for the return of other infectious diseases, like measles.
“An interruption or gap in the supply of vaccines prepares us for further outbreaks,” said Dr. Davidson Hamer, an infectious disease specialist at Boston University.
Distrust fuels hostility and hesitation
Vaccines are considered one of modern medicine’s greatest triumphs, second only to clean water as a cost-effective health measure. Every year they prevent millions of deaths around the world. According to a recent study, the Covid-19 vaccines prevented nearly 20 million deaths in their first year of use.
But vaccination hesitancy has increased, 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.
As if all of these challenges weren’t enough, annual flu shots are coming up soon, which could be especially important this fall.
Influenza made a comeback in Australia this year for the first time since the pandemic began. United States health officials are closely monitoring the flu season in Australia for clues as to what might be happening here. They predict we could see more flu transmissions this year than in the last two years, and flu shots will be key to preventing hospitalizations and deaths.
“I think right now we’re going through a perfect vaccine world storm in this country,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy.
He points out that although average daily Covid-19 deaths are much lower than in 2020 and 2021, the US still averages more than 400 a day, making it the fourth leading cause of death in the nation. Most of these deaths occur in unvaccinated people, according to the CDC.
Overall, more than one in five Americans is still not vaccinated against Covid-19, and that number doesn’t appear to be changing. Vaccination rates mostly stagnate.
It would take a more robust and better-funded public health workforce to restore confidence in vaccines.
A recent study by the de Beaumont Foundation, a nonprofit organization dedicated to strengthening public health, found that the public health system needs 80,000 additional full-time employees – a whopping 80% increase from current staff levels – to provide basic community services, such as monitoring and controlling the spread of infectious diseases.
Brian Castrucci, president and CEO of that organization, says America will not be able to restore its public health workforce until people value and respect their jobs.
“What we’ve seen during Covid is a fringe, anti-vaccination movement that’s moving more mainstream and endangering our nation’s security and economic prosperity,” Castrucci said. “It’s getting harder and harder to get vaccinated.”
“We are privileged as a society that we have not seen children on crutches from polio. Nobody is in an iron lung. And it’s made us a little numb to the potential of what could really happen,” he said. “These are virulent diseases.”
