DR. LEWIS: “Knee-Jerk Reactions Will Harm Tennessee’s Children”
“Knee-Jerk Reactions Will Harm Tennessee’s Children”
An Op-Ed from Dr. Terri Lewis of Tennessee
In recent days, the contingent of state legislative anti-vaxxers successfully browbeat the Tennessee Department of Health into cancelling childhood vaccine outreach programs – not just for COVID19, but for all routine childhood immunization programs.
On face, it appears that the TN Dept of Health, responsible for public health in 89 of Tennessee’s 95 counties excluding major metropolitan areas where local agencies wield more authority, will no longer conduct public outreach for any preventable childhood communicable disease.
‘Don’t ask, don’t tell’ seems to be the new public health strategy.
Tennessee lags behind the nation in all measures of disease prevention through vaccination. As of July 13, the number of fully vaccinated Tennesseans for COVID settled at 2,599,234 or 38.06% of the population. Overall, Tennessee ranks 33rd among the 50 states with a childhood vaccination rate of 79.9% against a population of 6,944,260. Tennessee currently meets HP2030 targets for 2 out of 3 vaccination-related measures for 24-month old children.
But there are significant gaps.
Many of Tennessee’s children have not completed the entire series of vaccines for preventable illnesses in the last decade. Minority children are less likely to be fully immunized. Some parents refused any and all routine immunizations.
Progress toward meeting vaccination rates for children up to the age of 24 months is located on theTNDOH website [1].
As concerning is the announcement by Dr. Tim Jones, Chief Medical Officer, that henceforth, no vaccination efforts will be conducted for routine childhood vaccines, with the HPV vaccine particularly singled out.
No outreach includes “pre-planning” for flu shots events at schools and back to school vaccines, and by inference, routine immunizations for infants, toddlers, teens and college students. Responsibility for back to school vaccines will become the responsibility of the Tennessee Dept of Education, not the TNDOH.
The elements of a successful outreach effort are well documented.
First, parental and community education and messaging around the safety, efficacy, and importance of childhood immunization is essential to ensure that children receive the full complement of preventive vaccines. With the gap in health insurance coverage for children this is an important function of the TNDOH at the county level across the state.
Second, there must be ready access to immunizations at every opportunity. The percent of children without health insurance increased from 5.2% in 2018 to 5.7% in 2019, with Hispanic children most represented in the childhood insurance coverage gap [2]. By fall of 2020, 9% of Tennessee children were uninsured, more than twice the level at the same time in 2019, according to the Vanderbilt Center for Child Health Policy[3]. Brief periods of being uninsured can have long-term effects on the health of children and their achievement in school… children who lose their insurance miss important immunizations and go months with major unaddressed problems…” [J. Zickafoose, MD, MS, Monroe Carrell Children’s Hospital at Vanderbilt]. Children who fall into the coverage gap are least likely to receive preventive care.
Third, reliable and readily accessible immunization records that provide a non-duplicated reflection of on-time immunizations are important for ensuring an accurate personal history for personal health management. This responsibility lies with health providers, not the Tennessee Department of Education. Lack of health coverage will magnify the negative impact of the childhood coverage gap where the health system fails to conduct routine outreach.
Finally, preventable childhood diseases are on the rise with the reduction in vaccination rates. Uninsured children are particularly vulnerable. When compared with privately insured children, uninsured children have more health disadvantages including need for medical or dental care; greater severity of illness, more hospitalizations and higher mortality rates; more vaccine-preventable disease; and higher rates of chronic illness such as asthma and diabetes [4].
The announced actions that resulted decisions to termination vaccine program leadership and cease immunization program outreach will have harmful effects resulting in tangible, measurable harms to Tennessee’s children and youth.
I strongly encourage the re-examination of these knee-jerk reactions to pressures exercised from certain sectors of the population.
[1] https://www.tn.gov/
[2] https://www.
[3] https://www.vumc.org/
Dr. Terri Lewis
Silver Point, TN
Global Immunization Action Network Team
@TheTNHoller