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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/content/dam/tn/health/documents/cedep-weeklyreports/2020-24-Month-Old-Survey.pdf

[2] https://www.aappublications.org/news/2020/12/01/researchupdate120120

[3] https://www.vumc.org/health-policy/tennessee-poll-uninsured-kids-covid19-2020

[4] https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/Uninsured_children/state/TN

Dr. Terri Lewis

Silver Point, TN

Global Immunization Action Network Team

https://www.giant-int.org/

 

 

 

@TheTNHoller

REP. CLEMMONS ON THE FISCUS FIRING: “I’M INFURIATED”

Rep. John Ray Clemmons shared his feelings on Governor Lee firing Dr. Fiscus for doing her job and trying to keep Tennesseans safe, saying all Tennesseans should be “infuriated” at Lee for caving to the extreme science-denying right. Clemmons also expresses disappointment with TN Dept. of Health commish Dr. Lisa Piercey for not standing up for Dr. Fiscus.

DR. FISCUS CALLS GOV. LEE “TOXIC TO WORK UNDER”

Today Tennessee’s top immunizations expert Dr. Michelle Fiscus is making the rounds on national shows talking about her firing at the hands of Governor Lee for doing her job and trying to keep Tennessee safe. She isn’t holding back. Below are some clips.

HEALTH DEPT’S FISCUS FIRED FOR DOING HER JOB

Today, Dr. Michelle D Fiscus, who serves as the Medical Director of Tennessee’s Vaccine Preventable Diseases and Immunization program, has been fired from her role by Governor Lee’s administration.

This comes in the wake of public pressure from elected Republicans, who have threatened to dissolve the department because of what they perceive to be a push to encourage young Tennesseans to get vaccinated, which might be reasonably considered to be part of her job.

Last month in a government ops committee meeting things got heated when Republicans learned the Tennessee Department of Health had been allowing young Tennesseans over 14 to get the COVID-19 vaccine if they so chose even without their parents signing off on it.

The Health Department did this because the law allows them to, and because the data shows the vaccine is protecting people – almost every single Tennessean to die of the disease in recent months has been unvaccinated – but that didn’t stop Rep. Scott Cepicky and others from attacking the department and threatening dissolution.

The number of younger Tennesseans to get the vaccine without parental approval was exactly eight, three of which were TN Dept of Health commissioner Dr. Lisa Piercey’s own children.

The Fiscus firing is pretty clearly Governor Lee’s way of sacrificing her to the extreme right in an effort to alleviate some of the pressure.

In essence, Dr. Fiscus is being fired for doing her job as she tries to get Tennesseans vaccinated.

We are currently towards the very bottom in terms of vaccine intake, in no small part because of a lack of leadership at the top, not only from Rep. Cepicky, but also from TN House GOP caucus chair Jeremy Faison, who has actively been trying to dissuade Tennesseans from getting the vaccine.

Tennessee Republicans have also gotten plenty of help from Fox News and other conservative sites, who have been repeatedly and constantly disparaging the vaccine even though they themselves have been vaccinated, including Fox chief Rupert Murdoch.

The cynicism is breathtaking.

STATEMENT FROM DR. FISCUS:

July 12, 2021

Today I became the 25th of 64 state and territorial immunization program directors to leave their position during this pandemic. That’s nearly 40% of us. And along with our resignations or retirements or, as in my case, push from office, goes the institutional knowledge and leadership of our respective COVID-19 vaccine responses.  I will not sit quietly by while our public health infrastructure is eroded in the midst of a pandemic.

We are a group of dedicated public health professionals who have worked endless hours to make COVID-19 vaccines, the ONE tool we have to effectively end the scourge of the COVID-19 pandemic, available to every person in our jurisdictions.  Along the way we have been disparaged, demeaned, accused, and sometimes vilified by a public who chooses not to believe in science, and elected and appointed officials who have put their own self-interest above the people they were chosen to represent and protect.

On May 6, 2021, in advance of the approval of the Pfizer COVID-19 vaccine for 12-15 year olds and in response to multiple questions I had received regarding the rules around vaccinating minors, I reached out to Tennessee Department of Health’s general counsel to request a statement regarding Tennessee’s Mature Minor Doctrine that resulted from a Tennessee Supreme Court Ruling in Cardwell v Bechtol in 1987. In response, I received a document attached to an email stating, “Sure—Attached is the new summary of the doctrine that has just recently been posted to the website and is blessed by the Governor’s office on the subject. This is forward facing so feel free to distribute to anyone.” On May 10, 2021, I copied and pasted the language provided to me into a memo that was distributed only to providers who were administering COVID-19 vaccines. A recipient of that memo was upset that, according to Tennessee Supreme Court case law, minors ages 14-17 years are able to receive medical care in Tennessee without parental consent and posted the memo to social media. Within days, legislators were contacting TDH asking questions about the memo with some interpreting it as an attempt to undermine parental authority. Let me be clear: this was an informational memo containing language approved by the TDH Office of General Counsel which was sent to medical providers by the medical director of the state’s immunization program regarding the guardrails set 34 years ago by the Tennessee Supreme Court around providing care to minors.

What has occurred in the time between the release of this memo and today, when I was terminated from my position as medical director of the vaccine-preventable diseases and immunization program at the Tennessee Department of Health, can only be described as bizarre. On May 19th TDH was asked to appear before the Government Operations Committee due to the concern that the memo was “a bit of a prodding or encouraging to vaccinate children without parental consent”.  This was followed by a series of requests from members of the Committee for data around the impact of COVID-19 on children and a request to appear before the Committee again on June 16. It was at that June 16th meeting that the Department was accused of “targeting” youth through Facebook messaging and its actions were described as “reprehensible” by one Committee member. That member went on to call for the “dissolving and reconstitution” of the Department of Health in the midst of a pandemic where one out of every 542 Tennesseans has died from COVID-19 on their watch and less than 38% of Tennesseans have been vaccinated. It is the mission of the Tennessee Department of Health to “protect, promote and improve the health and prosperity of the people of Tennessee” and protecting them against the deadliest infectious disease event in more than 100 years IS our job. It’s the most important job we’ve had in recent history. Specifically, it was MY job to provide evidence-basededucation and vaccine access so that Tennesseans could protect themselves against COVID-19. I have now been terminated for doing exactly that. Each of us should be waking up every morning with one question on our minds: “What can I do to protect the people of Tennessee against COVID-19?”. Instead, our leaders are putting barriers in place to ensure the people of Tennessee remain at-risk, even with the delta variant bearing down upon us.

What’s more is that the leadership of the Tennessee Department of Health has reacted to the sabre rattling from the Government Operations Committee by halting ALL vaccination outreach for children.  Not just COVID-19 vaccine outreach for teens, but ALL communications around vaccines of any kind. No back-to-school messaging to the more than 30,000 parents who did not get their children measles vaccines last year due to the pandemic.  No messaging around human papilloma virus vaccine to the residents of the state with one of the highest HPV cancer rates in the country. No observation of National Immunization Awareness Month in August. No reminders to the parents of teens who are late in receiving their second COVID-19 vaccine. THIS is a failure of public health to protect the people of Tennessee and THAT is what is “reprehensible”. When the people elected and appointed to lead this state put their political gains ahead of the public good, they have betrayed the people who have trusted them with their lives.

I was told that I should have been more “politically aware” and that I “poked the bear” when I sent a memo to medical providers clarifying a 34 year old Tennessee Supreme Court ruling. I am not a political operative, I am a physician who was, until today, charged with protecting the people of Tennessee, including its children, against preventable diseases like COVID-19. I have been terminated for doing my job because some of our politicians have bought into the anti-vaccine misinformation campaign rather than taking the time to speak with the medical experts. They believe what they choose to believe rather than what is factual and evidence-based. And it is the people of Tennessee who will suffer the consequences of the actions of the very people they put into power. The public health professionals at the Tennessee Department of Health have worked themselves to exhaustion to protect Tennesseans from this virus. They are heroes. They have prevented suffering and saved countless lives. They are to be honored and commended, not cursed and vilified. And the “leaders” of this state who have put their heads in the sand and denied the existence of COVID-19 or who thought they knew better than the scientists who have spent their lives working to prevent disease… who have ignored the dead and dying surrounding them—even when their own colleagues have fought for their lives—they are what is “reprehensible”. I am ashamed of them. I am afraid for my state. I am angry for the amazing people of the Tennessee Department of Health who have been mistreated by an uneducated public and leaders who have only their own interests in mind. And I am deeply saddened for the people of Tennessee, who will continue to become sick and die from this vaccine-preventable disease because they choose to listen to the nonsense spread by ignorant people. At this point, you are going to get vaccinated or you are going to get sick. Yes, not getting the vaccine is a personal choice.  It’s true that you are likely to survive COVID-19.  It’s the 1 out of every 542 people surrounding you that will suffer the consequences of an unfortunate decision to remain vulnerable to this horrible disease.

May God bless the people of Tennessee.

Michelle D. Fiscus, MD FAAP