Overlapping emergencies strain the nation’s public health workforce and threaten critical vaccination campaigns

Health officials are banking on vaccines to contain monkey pox and polio before they become serious threats in the United States. They are relying on updated boosters to restore weakened immunity against Covid-19. With influenza expected to reoccur in the United States this fall, flu shots could be critical to preventing serious illness and keeping hospitals from being overwhelmed.

While the federal government will make it easier for states to get these vaccines, it will be the 2,820 state and local health departments that will lead the charge, and public health experts say it’s not clear that these offices have enough funding or staff. do the work

“I think it’s deeply troubling,” said Dr. Peggy Hamburg, former New York City health commissioner and former commissioner of the US Food and Drug Administration. “It’s hard to imagine how state and local health departments can mobilize, and they need more 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 nation’s public health system.

After nearly three years of grappling with vaccine hesitancy, politics and a global pandemic, the nation’s public health workers are outraged and leaving their posts. More than 1 in 4 health department leaders quit their jobs during the pandemic, some after harassment and death threats. Studies are underway to measure how deeply those losses extended to their employees.

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

‘To express is an understatement’

Can these agencies remove it?

“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 is chronically underfunded and understaffed. Substantial capacity was built during the COVID-19 response — for example, contact tracing teams — but many jurisdictions have damaged that infrastructure. Covid money is largely inflexible, so it’s really Can’t be. Will be used for other threats like monkeypox.”

The nation’s vaccinators say they are struggling.

“It’s a small thing to express,” said Claire Hannan, executive director of the Association of Vaccine Administrators.

Hannan said his members have not received any funds to carry out the monkey pox vaccination campaign. Yet they have been asked about changes in how the vaccine is given, switching from subcutaneous injections to a method that injects the vaccine between the layers of the skin, something that requires training to do correctly. The hope is that intradermal shots, which require one-fifth the regular dose, could soon increase the supply of this hard-to-obtain vaccine.

As a result, vaccine managers are scrambling to find the money and staff to order vaccines, manually track inventory, ship shots to the locations where they are needed, train providers, and collect and transmit data to federal health agencies such as federal health agencies. Disease control and prevention.

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

Allocations to these initial orders are smaller than expected, Hannan said, forcing city and state health officials to develop plans for who should be first in line to pick them up, should demand initially outstrip supply.

In addition, several cities are testing their sewage for poliovirus following recent detections in Rockland County, New York, and New York City. If further community spread is suspected, those areas may need to mount vaccination campaigns to protect unvaccinated residents, such as recent immigrants or young children who missed routine vaccinations during the pandemic.

Children typically get four doses of the polio vaccine by age six in the U.S., but many children fall behind on their shots. Globally, according to the World Health Organization, the pandemic has caused the biggest drop in childhood vaccination rates in 30 years. Health officials fear that the erosion of this coverage has set the stage for the return of other infectious diseases such as measles.

“Breaks or gaps in vaccine delivery set us up for more outbreaks,” said Dr. Davidson Hammer, an infectious disease expert at Boston University.

Mistrust breeds hostility and reluctance

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

However, vaccine hesitancy has increased, due to misinformation on social media. While more than three-quarters of Americans have been vaccinated against COVID-19, 19% said they would definitely not get a vaccine against COVID-19.

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If all these challenges weren’t enough, annual flu shots will be rolling out soon, and they may be especially important this fall.

Influenza made a comeback in Australia this year for the first time since the pandemic began. Health officials in the United States are watching Australia’s flu season closely for clues about what might be happening here. They expect to see more flu transmissions this year than in the past two years and that flu vaccines will be key to preventing hospitalizations and deaths.

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

He pointed out that although the 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 country. According to the CDC, most of those deaths are in unvaccinated people.

Overall, more than 1 in 5 Americans still haven’t been vaccinated against Covid-19, and that number doesn’t seem likely to decrease. Vaccination rates are mostly stable.

Rebuilding trust in vaccines requires a stronger public health workforce, and a better funded one.

A recent study by The Beaumont Foundation, a nonprofit organization working to strengthen public health, found that the public health system needs 80,000 more full-time employees—an 80% increase over current staffing levels—to provide basic community services. Monitoring and controlling the spread of infectious diseases.

Brian Castrucci, president and CEO of that organization, says America can’t rebuild its public health workforce until people appreciate and respect what they do.

“What we’ve seen during Covid is a fringe anti-vax movement moving into the mainstream, threatening the safety, security and economic prosperity of our nation,” Castrucci said. “It’s going to get harder and harder to vaccinate.”

“We’re privileged as a society to not see a child on crutches from polio. Nobody’s on an iron lung. And it’s kind of numbed us to the potential of what could actually happen,” he said. “These are viral diseases.”

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