Health officials are counting on vaccinations to contain monkeypox and polio before they become a permanent threat in the United States. They are counting on updated boosters to restore waning immunity to Covid-19. With flu expected to hit the U.S. this fall, flu shots could be key to warding off serious illness and keeping hospitals from becoming overwhelmed.
While the federal government will facilitate getting these inoculations to states, it will be the 2,820 state and local health departments that will lead the way in getting the guns fired, and public health experts say it’s not clear that these offices have enough have the money or staff to get the job done.
“I find it very concerning,” said Dr. Peggy Hamburg, former health commissioner for New York City and former commissioner of the United States Food and Drug Administration. “It’s hard to imagine how state and local health departments can all mobilize, 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 committee for the non-profit Commonwealth Fund on the modernization of the country’s public health system.
After struggling for nearly three years with hesitation over vaccines, politics and a global pandemic, the country’s public health workers are frayed 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 deep these losses extended to their workforce.
Now these exhausted agencies are being asked to tackle new threats like monkey pox without additional funding to tackle them.
‘Overwhelmed is an understatement’
Can these agencies make it happen?
“Probably not,” Caitlin Rivers, an epidemiologist and assistant professor at the Johns Hopkins Center for Health Security, said in an email to CNN. “Public health is chronically underfunded and understaffed. Significant capacity has been built during the COVID-19 response — for example, contact tracing teams — but many jurisdictions have phased out that infrastructure. Covid money is largely inflexible, so it can’t really be used for other threats like monkey pox.”
The country’s vaccinators say they are having a hard time.
“Overwhelmed is an understatement,” said Claire Hannan, executive director of the Association of Immunization Managers.
Hannan said its members have not been given any money to run a monkey pox vaccination campaign. Yet they have just been asked how the vaccine is administered, by switching from a more familiar injection under the skin to a shallower method where the vaccine is injected between the layers of skin, something that requires training to do it correctly. The hope is that intradermal injections, which require one-fifth of a normal dose, could quickly increase supplies of this hard-to-get vaccine.
As a result, immunization managers are looking for funds and staff to order vaccines, manually maintain inventory, transport shots to the locations where they are needed, train suppliers, and collect data and return it to federal health agencies. such as the US Centers for Disease Control and Prevention.
In addition, the ordering of 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, has begun to be ordered.
Allotments in these early orders were smaller than expected, Hannan said, forcing city and state health officials to develop plans for who should be first in line to get them, if demand initially exceeds supply.
In addition, many cities are currently testing their wastewater for polio virus after it was recently discovered in Rockland County, New York and New York City. If there is a suspicion of further spread in the community, those areas may need to set up vaccination campaigns to protect residents who have not had the injection, such as recent immigrants or young children who missed routine vaccinations during the pandemic.
Children in the US usually receive four doses of the polio vaccine by the time they are six years old, but many children have fallen behind with their shots. According to the World Health Organization, the pandemic led to the largest drop in childhood vaccination rates in 30 years worldwide. Health officials fear the erosion of this cover has paved the way for the return of other infectious diseases, such as measles.
“An interruption or hiatus in vaccine supply sets us up for further outbreaks,” said Dr. Davidson Hamer, an infectious disease specialist at Boston University.
Mistrust breeds hostility and hesitation
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, the Covid-19 vaccines prevented nearly 20 million deaths, a recent study found.
Still, hesitation about vaccines has grown, fueled by misinformation on social media. While more than three-quarters of Americans have been vaccinated against Covid-19, 19% say they certainly won’t get a Covid-19 vaccine.
If all these challenges weren’t enough, annual flu shots will be rolling out soon, and they could be especially important this fall.
Influenza made a comeback in Australia this year for the first time since the start of the pandemic. United States health officials are closely monitoring the Australian flu season for clues as to what could be happening here. They expect that we could get more flu this year than in the past two years, and flu vaccinations will be key to avoiding hospitalizations and deaths.
“I think we have a perfect storm in the vaccine world in this country right now,” said Michael Osterholm, who leads the Center for Infectious Disease Research and Policy.
He points out that while average daily Covid-19 deaths are much lower than in 2020 and 2021, the US still averages more than 400 per day, making it the country’s fourth leading cause of death. Most of those deaths are in unvaccinated people, according to the CDC.
Overall, more than 1 in 5 Americans are still unvaccinated against Covid-19, and that number doesn’t seem to be decreasing. Vaccination coverage is largely stagnant.
A more robust public health workforce, and a better funded workforce, would be needed to rebuild confidence in vaccines.
A recent study by The de Beaumont Foundation, a nonprofit dedicated to strengthening public health, found that the public health system needs 80,000 more full-time employees — a massive 80% increase over its current workforce — 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 cannot restore its public health workforce until people appreciate and respect the work they do.
“What we have seen during Covid is a fringe anti-vax movement that is becoming more mainstream and endangering the safety, security and economic prosperity of our country,” Castrucci said. “It’s getting harder and harder to vaccinate.”
“We’re privileged as a society where we haven’t seen children with polio crutches. Nobody has an iron lung. And it has left us somewhat numb to the potential of what could really happen,” he said. “These are virulent diseases.”