'Silent' spread of polio in New York prompts CDC to consider additional vaccinations for some people

Overlapping emergencies stress nation’s public health workforce and threaten critical vaccination campaigns

Health officials are pinning their hopes on vaccinations to control monkeypox and polio before they become a long-term threat to the United States. They are counting on an updated booster to restore weakened immunity to Covid-19. Influenza is expected in the U.S. this fall, and a flu shot could be critical to preventing serious illness and preventing hospitals from being overwhelmed.

While the federal government will facilitate getting these vaccines to states, the 2,820 state and local health departments will spearhead the immunization effort, and public health experts say it’s unclear whether those offices have enough funding or staff to get the job done.

“I think it’s very concerning,” said Dr. Peggy Burger, former New York City health commissioner and former commissioner of the U.S. Food and Drug Administration. “It’s hard to imagine how state and local health departments are mobilizing, they desperately need additional support.”

“I think we have to recognize that this is a very fragile time,” said Hamburg, who recently chaired a nonprofit federal funding committee charged with how to modernize the nation’s public health system.

After nearly three years of battling vaccine hesitancy, politics and a global pandemic, the country’s public health workers are exhausted and left. More than a quarter of health department leaders have resigned during the pandemic, some following harassment and death threats. Research is underway to measure the extent to which these losses are affecting employees.

Now, these resource-drained agencies are being asked to tackle new threats like monkeypox without additional funding.

“Overwhelmed is an understatement”

Can these institutions do it?

“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. A lot of capacity was built during the COVID-19 response — for example, contact tracing teams — but many jurisdictions have shut down that infrastructure. Covid funding has largely been It’s not flexible, so it really can’t be used against other threats like monkeypox.”

Vaccinators in the country say they are struggling.

“Overwhelmed is an understatement,” said Claire Hannan, executive director of the Association of Immunization Managers.

Hannan said her members have not received any funding for a vaccination campaign against monkeypox. However, they’ve just been asked how to change the way the vaccine is administered, from the more familiar subcutaneous injection to a shallower method of spraying the vaccine between layers of skin, which requires training to do correctly. The hope is that intradermal injections requiring one-fifth of the usual dose could rapidly increase the supply of this hard-to-obtain vaccine.

As a result, immunization administrators are scrambling to find funds and personnel to order vaccines, manually track inventories, ship vaccines where they are needed, train providers and collect and send data back to federal health agencies like U.S. centers. Disease Control and Prevention.

On top of that, orders for updated boosters have begun to protect against the BA.4 and BA.5 subvariants of the new coronavirus Omicron strain, which were promised to Americans in mid-September.

Hannan said the allocations for these early orders were smaller than expected, forcing city and state health officials to develop plans for who should get the orders first if demand initially outstrips supply.

In addition, many cities are currently testing sewage for poliovirus after the recent detection of poliovirus in Rockland County and New York City. If more community transmission is suspected, vaccination campaigns in these areas may be needed to protect residents who have not been vaccinated, such as newcomers or young children who missed routine immunizations during the pandemic.

In the United States, children typically receive four doses of the polio vaccine at age 6, but many children fall behind. Globally, the pandemic has led to the biggest setback in childhood vaccination rates in 30 years, according to the World Health Organization. Health officials worry that this weakening of coverage sets the stage for a resurgence of other infectious diseases, such as measles.

“Disruptions or gaps in vaccine supplies have prepared us for further outbreaks,” said Dr. Davidson Hammer, an infectious disease expert at Boston University.

Mistrust fuels hostility and hesitation

Vaccines are considered one of the greatest achievements of modern medicine, second only to clean water as a cost-effective health intervention. Every year, they prevent millions of deaths around the world. A recent study found that the Covid-19 vaccine prevented nearly 20 million deaths in the first year of use.

However, due to misinformation on social media, hesitation about a vaccine has increased. While more than three-quarters of Americans have been vaccinated against Covid-19, 19% said they would definitely not be vaccinated against Covid-19.

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If all these challenges weren’t enough, the annual flu vaccine is coming, and they could be especially important this fall.

The flu is making a comeback in Australia this year for the first time since the pandemic began. U.S. health officials are closely watching Australia’s flu season for clues about what might be happening here. They predict we may see more influenza transmission this year than in the past two years, and flu vaccination will be key to preventing hospitalizations and deaths.

“I think now we have a perfect storm in the vaccine community in this country,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy.

He noted that while the average daily death toll from Covid-19 is well below the levels seen in 2020 and 2021, the U.S. is still averaging more than 400 deaths a day, making it the fourth leading cause of death in the United States. According to the CDC, most of these deaths were of unvaccinated people.

Overall, more than one in five Americans remains unvaccinated against Covid-19, and that number doesn’t appear to be changing. Vaccination rates have mostly stagnated.

Rebuilding confidence in vaccines will require a stronger and better-funded public health workforce.

A recent study by The de Beaumont Foundation, a nonprofit dedicated to strengthening public health, found that the public health system needs an additional 80,000 full-time staff — 80 percent higher than 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, said the U.S. will not be able to restore its public health workforce unless people value and respect the work they do.

“What we’ve seen during Covid is that fringe anti-vaccination movements become more mainstream, jeopardizing the safety, security and economic prosperity of our country,” Castrucci said. “It’s going to be harder and harder to get vaccinated.”

“As a society where we don’t see children on polio crutches, we’re honored,” he said. “Nobody’s in an iron lung. That leaves us a little numb to what’s really possible.” deadly disease.”

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