While the federal government will facilitate the transfer of these vaccinations to the states, it will be the 2,820 state and local health departments that will lead the work of getting the shots fired, and public health experts say it is not clear that these offices have sufficient funding or staff to do the job.
“I think it’s deeply troubling,” said Dr. Peggy Hamburg, former health commissioner for New York City and former commissioner of the US Food and Drug Administration. “It’s hard to imagine how state and local health services can 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 nonprofit Commonwealth Fund on how to modernize the country’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 worn out and leaving their jobs. More than 1 in 4 health department heads have left their jobs during the pandemic, some after harassment and death threats. Studies are being done to measure how deeply these losses extended to their personnel. Now, these depleted agencies are being asked to deal with new threats like monkeypox without additional funding to deal with them.

“Exaggeration is an understatement”

Can these services do this? “Probably not,” Caitlin Rivers, an epidemiologist and assistant professor at the Johns Hopkins Center for Health Security, says in an email to CNN. “Public health is chronically underfunded and understaffed. Significant capacity was built during the response to COVID-19 — for example, contact tracing teams — but many jurisdictions have destroyed that infrastructure. Money for Covid is largely rigidly, so they can’t really be used for other threats like monkeypox.” The nation’s vaccinators say they are struggling. “Exaggerated is an understatement,” said Claire Hannan, executive director of the Association of Immunization Managers. Hannan said her members have not received any funding to carry out a monkeypox vaccination campaign. However, they have just been asked to change the way the vaccine is given, moving from a more intimate injection under the skin to a shallower method that squirts the vaccine between the layers of the skin, which requires training to do properly. The hope is that intradermal shots, which require one-fifth the normal dose, can quickly increase supplies of this hard-to-get vaccine. As a result, immunization officials struggle to find money and staff to order vaccines, manually track inventory, move shots to the locations where they are needed, train providers, and collect and send data to federal health agencies such as the Centers for Disease Control and Prevention. of the USA Disease Control and Prevention. In addition, ordering has begun for updated boosters to protect against the BA.4 and BA.5 subvariants of the Omicron strain of the new coronavirus, which have been promised to Americans by mid-September.
Allotments in those 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 the demand initially exceeds supply.
In addition, many cities are currently testing their wastewater for poliovirus after it was recently detected 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 unvaccinated residents, such as recent immigrants or young children who missed routine vaccinations during the pandemic.
Children typically receive four doses of the polio vaccine by age six in the US, but many children have fallen behind on their shots. Globally, the pandemic has led to the biggest decline in childhood vaccination rates in 30 years, according to the World Health Organization. Health officials fear that the erosion of that coverage has set the stage for the return of other infectious diseases, such as measles. “A break or gap in vaccine delivery sets us up for further outbreaks,” said Dr. Davidson Hammer, an infectious disease expert at Boston University.

Distrust breeds hostility and hesitation

Vaccines are considered one of the greatest triumphs of modern medicine, second only to clean water as an economic health intervention. Every year, they prevent millions of deaths worldwide. In their first year of use, Covid-19 vaccines prevented nearly 20 million deaths, according to a recent study. However, vaccine hesitancy has grown, fueled by misinformation on social media. While more than three-quarters of Americans have been vaccinated against Covid-19, 19% say they will definitely not get a Covid-19 vaccine. If all these challenges weren’t enough, annual flu shots are coming out soon and could be especially important this fall.
Flu has returned to 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 could be happening here. They expect we could see more flu transmission this year than we’ve had in the past two years, and flu shots will be key to preventing hospitalizations and deaths. “I think right now we have a perfect storm in the world of vaccines happening in this country,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy. He points out that although average daily deaths from Covid-19 are much lower than they were in 2020 and 2021, the US still averages more than 400 per day, making it the fourth leading cause of death in the country. 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 likely to abate. Vaccination rates are mostly stagnant. A stronger public health workforce, and a better funded one, would be needed to rebuild confidence in vaccines. A recent study by The de Beaumont Foundation, a nonprofit organization working to strengthen public health, found that the public health system needs 80,000 more full-time staff — a whopping 80 percent increase over current staffing levels — to provide essential community services such as monitoring and controlling the spread of infectious diseases. Brian Castrucci, the organization’s president and CEO, says America won’t be able to rebuild its public health workforce until people value and respect the work they do. “What we’ve seen during Covid is a fringe movement against criminality that moves further, jeopardizing the safety, security and economic well-being of our nation,” Castrucci said. “It will be increasingly difficult to vaccinate.”
“We’re privileged as a society that we haven’t seen children on crutches from polio. Nobody has an iron lung. And that’s kind of numbed us to the possibilities of what could actually happen,” he said. “These are infectious diseases.”