Tennessee has decided to halt all vaccine outreach for children and adolescents preparing to head back to school, which will cost lives and could worsen the state's current resurgence of COVID-19 cases, the pediatrician fired last week as the state's top immunization official said.
Dr. Michelle Fiscus is especially afraid that students from communities of color and low-income families could become the latest casualties in what she calls a politicized tug-of-war over vaccines and the pandemic.
"The timing is really bad," Fiscus said.
Tennessee has placed a moratorium on state-coordinated immunization promotions for children while also having one of the nation's lowest COVID-19 vaccination rates - 38% of Tennesseans are fully vaccinated against the virus. Meanwhile, cases of the more contagious delta variant are surging amid mixed pandemic messaging from officials and general COVID-19 fatigue.
"I'm fearful of what this is going to look like as school begins," said Fiscus, former medical director of vaccine-preventable diseases and immunization programs at the Tennessee Department of Health.
In an interview Wednesday with Chalkbeat, Fiscus discussed the dangers of anti-vaccine rhetoric and offered advice to pandemic-weary school leaders for the coming academic year, including districts that have opted to loosen or eliminate mask mandates.
Her firing Monday by Dr. Lisa Piercey, Tennessee's health commissioner, came just days after Piercey halted state-sponsored immunization events on school properties. The commissioner also ordered a moratorium on COVID-19 vaccine messaging aimed at adolescents.
The state has indicated Fiscus was fired over management issues. A health department spokeswoman said Tennessee supports vaccine outreach "while being mindful of hesitancy and the intense national conversation that is affecting how many families evaluate vaccinations in general."
But Fiscus believes the orders stem from a legislative hearing last month when Piercey was grilled by angry Republican lawmakers who charged that Fiscus was targeting minors for mass vaccinations without parental consent.
The Q&A below has been lightly edited for brevity and clarity.
Chalkbeat: What will be the impact of the state's decision to eliminate COVID-19 vaccine outreach to teens?
Fiscus: We've had this vaccine available since May 10 for adolescents - plenty of time to get to herd immunity. But we're at less than 13% fully vaccinated right now for kids 12-15 and nearly 24% for ages 16-20. That's a largely unvaccinated youth population who will return to hallways and pep rallies and basketball games and not wearing masks.
Is Tennessee positioned to launch a new school year safely?
The timing is really bad. School starts in three or four weeks in most places in Tennessee, and we're going to bring in kids 11 and under with no ability to protect themselves with a vaccine, no remote learning to speak of, less physical distancing and masking. It's important to know that this delta variant is more transmissible and is impacting children more severely than what we saw with the original COVID cases. In the last two weeks, our cases [for all ages] have gone up 400% [to 4,700 active cases], and the vast majority of those have been among the unvaccinated.
Last school year, you had almost weekly conference calls with Tennessee school leaders to offer information on how best to navigate the pandemic. What recommendations would you give those same leaders now?
They should spread the message that children 12 and older and their school staff need to be vaccinated. For those who aren't fully vaccinated, they should wear a mask when they're in school. And for kids 11 and under who aren't eligible for vaccination, mask mandates should absolutely stay in place.
As for in-person vs. remote learning, I totally agree with the need to prioritize in-person learning. But schools have got to take mitigation steps seriously if they're going to stay in person. If they don't, this delta variant is going to come through like a tidal wave, and we're going to have sick and dead kids. We've already had 10 Tennessee kids die of COVID [since the pandemic began].
The state's recent moratorium on vaccine outreach went beyond COVID-19 to include all vaccine-preventable diseases for children and youth. What are the possible ramifications?
We were told to do no communications whatsoever this August around National Immunization Awareness Month. We've always done a media blitz, sent out a press release, asked the governor for a proclamation, but all of that was halted this year. We had reminder cards ready to mail out to parents whose children were missing a vaccine, but they didn't go out.
All of this hurts public health. There will be children who die from HPV-related cancers because they missed their vaccine during the pandemic and nobody reminded them to get it done. We have communities who are vulnerable to measles. And if you think COVID is contagious, wait until we have another measles outbreak because measles is nine times more infectious than COVID. California's got a measles outbreak right now.
Tennessee law requires that, before entering kindergarten, children are up to date with their immunizations against diseases such as measles, mumps and rubella. The state had a pre-pandemic vaccination rate of 95% for those children. How will the outreach moratorium affect that process?
It's always been hard, but it will be harder now. Three things could happen. First, more kids showing up to kindergarten will be told they can't go to school because they're not vaccinated, so Mom and Dad will have to leave work to take them to their doctor or the health department to get vaccinated before they can come back. Second, a parent who learns their child can't come to school may decide to file a religious exemption out of convenience, which would be committing perjury under Tennessee law. Third, a school may not do their due diligence in reviewing immunization records, so that we have unvaccinated kids attending who shouldn't be there.
What does this moratorium mean for children of color and lower-income communities with historically lower vaccination rates?
Disparities in Tennessee vaccinations used to be most pronounced with flu shots, but now we're seeing a widening gap in routine childhood vaccinations and kids not being up to date by age 2 in our African American communities.
When you're talking about low-wage earners working multiple jobs and friends or family watching their kids, parents don't have the time to take their child to the health department or to a clinic to get vaccinated. Their priority is getting food on the table and a roof over their heads. We're hurting these communities when we remove the ability of parents to get their children vaccinated at school in partnership with their local health departments. And these are communities that already have higher rates of chronic disease - diabetes, heart disease, hypertension - that we know die disproportionately from COVID-19.
Getting vaccination services at schools is preferred by so many parents. It's just easier. It's free. Kids can get their shots with their peers, so it's more comfortable. There's no reason to disrupt that routine.
Will urban areas be hardest hit?
They have the bulk of low-income populations, but fortunately, our metro health partners [in Memphis, Nashville, Knoxville, Chattanooga, Jackson, and Sullivan County] are independent of this mess. They're still doing in-school vaccinations and ramping up those back-to-school communication efforts. But for our rural poor populations, partnerships have been canceled between the department of health and school systems to provide vaccinations for back to school and for flu in the fall. Now those families are left to figure out where they're going to get their kids vaccinated.
Ultimately, public trust is key to good public health. How will Tennessee regain trust in its public health systems after so much infighting over vaccines, especially for school-age children?
I hope Tennesseans will still trust their local health departments. Local health officials are not being deceitful. They are doing everything they can to care for families but they've been handcuffed under a toxic environment in which individuals with political agendas and aspirations have sold out the people of Tennessee. Local health workers are true heroes and champions of public health.
"Tennessee's fired immunization chief blasts halt to outreach for kids" was originally published by Chalkbeat, a nonprofit news organization covering public education. Sign up for their newsletters at bit.ly/tnchalk.