Children ages 5-11 should be vaccinated against COVID-19 with the Pfizer/BioNTech vaccine, the CDC's Advisory Committee on Immunization Practices (ACIP) said on Tuesday. [MedPage 11.2.2201]

ACIP voted 14-0 to recommend vaccinating this population with a two-dose regimen of 10 μg apiece, 21 days apart, citing the favorable benefit-risk association, the idea of restoring normalcy to children, and especially the extensive data presented by FDA and CDC staff.

"Today is a monumental day in the course of this pandemic and one that many of us will be very eager to see," said CDC Director Rochelle Walensky, MD, once again addressing the panel. She added that since the first vaccines were authorized for ages 16 and up, the question has been when protection might be expanded to younger children. 

This is a "recommendation likely to have tremendous impact," Walensky said. She said she was eager to see how committee members "interpret what we know and acknowledge areas of uncertainty."

Walensky also said that 745 children have died of COVID during the pandemic, including 94 children ages 5-11, and over 2,300 children in this population have been diagnosed with multi-system inflammatory syndrome (MIS-C).

Many committee members spoke as parents and grandparents and explained how they have vaccinated their children and grandchildren. Consumer representative Veronica McNally, JD, got a bit choked up when talking about how she would vaccinate her child after this recommendation, and would do so to prevent "the 95th death" in a child.

In an unusual move, several liaison representatives from the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), National Association of Pediatric Nurse Practitioners (NAPNAP), and the Pediatric Infectious Diseases Society (PIDS) read statements in support of vaccination for this age group prior to the ACIP vote.

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Healthcare algorithms are frequently used to guide decision making for the direct care of patients and for population management. An AHRQ project is reviewing published research on: how algorithms and algorithm-informed decision tools can introduce racial or ethnic bias into care; how the use of algorithms affect racial/ethnic disparities in access to and quality of care and health outcomes; strategies to avoid bias in algorithms; and standards for the development of equitable algorithms. AHRQ is accepting public comment on the key questions that will inform this evidence review. Access the draft key questions and the online form to provide comments by 11:59 pm ET Nov. 15.

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The Robert Wood Johnson Foundation established a commission to better understand the ways in which the nation’s health data infrastructure perpetuates inequities. Now the National Commission to Transform Public Health Data Systems offers its recommendations on how data can be best collected, shared, and used to improve health equity—and RWJF will fund projects that carry out these findings. 

Download 54-page report here

Charting a Course for an Equity-Centered Data System 

Recommendations from the National Commission to Transform Public Health Data Systems 

Data are the building blocks for how we describe the health of people and the communities

where they live—stories that emerge from data help the nation understand and contextualize

what drives or impedes health and how structural factors like racism and other forms of 

discrimination influence one’s ability to live a healthy life.

The Issue

The COVID-19 pandemic laid bare the gaps in our public health and health data infrastructure and illuminated the many ways in which they perpetuate vast health inequities. To work toward a modernized health data system, the Robert Wood Johnson Foundation established a first-of-its-kind National Commission to Transform Public Health Data Systems to reimagine how data are collected, shared, and used, and identify the investments needed to improve health equity. Commissioners examined both the systems and the data needed to ensure public health information works for all, including: who the data we collect elevates, who is being centered in our data, who is being excluded, and why.   

The Commission’s recommendations for the nation call on government at all levels, business, community-based organizations, philanthropy, and others to take specific action to reimagine and modernize the public health data system.

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Health and Human Services Secretary Xavier Becerra today announced the release of the new HHS Overdose Prevention Strategy, designed to increase access to the full range of care and services for individuals who use substances that cause overdose, and their families.  This new strategy focuses on the multiple substances involved in overdose and the diverse treatment approaches for substance use disorder.

“With this new strategy, we’re breaking new ground to address the full range of drug use and addiction that can result in overdose and death,” said Secretary Becerra. “We’re changing the way we address overdoses. Our new strategy focuses on people -- putting the very individuals who have struggled with addiction in positions of power. And thanks to the American Rescue Plan, we can address what so many people have seen in recent years: a rise in overdoses that can risk a person’s life – and affect their entire family.”

The overdose epidemic has developed over the past decades, from increases in the prescribing of opioids in the 1990s, to rapid increases in heroin overdoses starting around 2010, to growth in overdoses from illicitly-manufactured synthetic opioids like fentanyl beginning in 2013. The epidemic continues to evolve, underscored by increased overdose deaths involving stimulants.

The new strategy prioritizes four key target areas—primary prevention, harm reduction, evidence-based treatment, and recovery support—and reflects the Biden-Harris Administration principles of maximizing health equity for underserved populations, using best available data and evidence to inform policy and actions, integrating substance use disorder services into other types of health care and social services, and reducing stigma.

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Healthcare is a personal and individualized relationship between a provider and patient. Each patient is treated according to their particular symptoms and personal health characteristics. For this reason, the wide variability in patient responses to the same medical treatments must be acknowledged and accounted for in making public health decisions. Yet, there has been a lack of specific government guidance to help those with autoimmune diseases navigate COVID-19 vaccination. [MedPage Today 10.22.2021-10.25.2021]

Public health officials must focus more on the unique needs of patients with autoimmune disease or they will miss achieving long-term public health and vaccination goals.

Many of us either have an autoimmune disease or know someone living with one, such as multiple sclerosis (MS), rheumatoid arthritis, lupus, Crohn's disease, psoriasis, or others. While the pandemic is difficult for all of us, these patients have faced higher rates of severe COVID-19 and death.

The incomplete messaging on vaccination for this population is only making things more challenging. Patients with autoimmune diseases who are taking drugs that may suppress their immune response have been told the vaccines may not fully benefit them, if at all. In August, the CDC stated: "giving [immunocompromised patients] an additional shot is almost not considered a booster" because "it's considered part of what their original regimen should have been." Following this, the CDC issued a blanket recommendation that all patients on active treatment with "drugs that may suppress [their] immune response" receive an additional dose of a COVID-19 mRNA vaccine. More recently, FDA amended the emergency use authorizations (EUA) for the Pfizer-BioNTech and Moderna vaccines to allow for use of a booster dose by people at high risk of severe COVID-19, and for all Johnson & Johnson recipients. CDC clarified who is considered high-risk by endorsing boosters for adults with underlying medical conditions, which includes people in an "immunocompromised state." Taken together, current guidance appears to cumulatively recommend autoimmune patients taking drugs that may suppress their immune system secure both an additional dose and a booster, but in fact the CDC and FDA have still not weighed in on this specific scenario.

It's true that some patients with autoimmune disease on therapies that affect their immune system experience a reduction in immune response, thereby impairing their ability to achieve the full benefits of COVID-19 vaccines. However, emerging evidence suggests this diminished immune response may not be the rule; some of these patients may achieve similar vaccination benefits from a standard COVID-19 vaccine regimen as the general population. Reconciling this distinction could have major implications in health policy and the ability to determine not merely the percentage of those vaccinated, but more importantly, a better understanding of overall public immunity to COVID-19 after vaccination.

Take MS for example. A new peer reviewed study published in the Journal of Neuroimmunology examines the immune response to mRNA vaccines for COVID-19 in patients with MS who simultaneously are being treated with immunomodulating therapies. The study determined that certain medications for MS did not blunt the vaccine response in these patients, finding overall that "[v]accination and [these therapies] can be timed to maintain disease control and also allow effective vaccination against SARS-CoV-2." Public health officials should be disseminating this information to the MS community to potentially increase understanding of their protection from COVID-19 and enable more informed healthcare decisions.

This study provides important information for patients suffering from MS; it indicates these patients might not have to compromise between treating their disease and eliciting a standard immune response to the COVID-19 vaccine. But the study also raises the bigger public health question of vaccine effectiveness in the autoimmune disease space. Public health leaders should focus on researching how different therapies for the whole spectrum of autoimmune diseases affect COVID-19 vaccine response. While it is encouraging that NIH is investigating the antibody response from an additional dose in autoimmune disease patients who had a suboptimal response to an initial COVID-19 vaccine regimen, it is just as important to research which autoimmune therapies do allow for a vaccine response similar to that of the general population.

The CDC encourages patients taking drugs that may suppress their immune response -- such as many patients with an autoimmune disease -- to act like they are unvaccinated regardless of their vaccination status. They are advised to wear a mask, maintain social distance, and avoid crowds and poorly ventilated indoor spaces. When public health officials again relax recommended precautionary measures for the general population, a more nuanced understanding of which patients in the immunocompromised community should continue to follow restrictive measures is vital. Without such information, members of this heterogenous population may be unnecessarily curtailing activities of daily living.

COVID-19 is not going away any time soon. Public health officials must focus more on the unique needs of patients with autoimmune disease or they will miss achieving long-term public health and vaccination goals. The administration, FDA, and CDC must provide tailored guidance on which autoimmune disease therapies do and do not have an impact on vaccine effectiveness. This information will empower physicians to treat these patients with more precise approaches and public health officials to make evidence-based health policy. Most importantly, it can give patients with autoimmune disease a chance to reclaim their lives.

Kirk Taylor, MD, serves as senior vice president of North America Medical Affairs for EMD Serono, the biopharmaceutical business of Merck KGaA, Darmstadt, Germany.

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Illinois expects to receive an initial shipment of 500,000 doses of the Pfizer-BioNTech COVID-19 vaccine once it receives federal approval for use in children ages 5 to 11 years old, Gov. JB Pritzker announced Monday.[Health News Illinois 10.26.2021] 

"Thanks to scientists and doctors who've worked tirelessly for the last year, we are likely just days away from having the COVID-19 vaccine available for 1.1 million more Illinois children, ages 5 to 11," Pritzker said at a Chicago press conference. "As soon as the (Food and Drug Administration) and the (Centers for Disease Control and Prevention) have signed off, these kid-sized doses and kid-sized needles will be shipped out to pharmacies, pediatricians and other providers across Illinois.”

Nearly 306,000 of the initial doses will go to the state, 73,000 will go to the city of Chicago and over 100,000 will head to the federal government’s pharmacy partners.

The Illinois Department of Public Health has started to enroll pediatric offices to provide COVID-19 shots, with over 2,200 locations and providers already enrolled to provide doses to eligible children. The agency is also working with federally qualified health centers, local health departments and family practitioners to ensure equitable access to vaccines.

“I am urging every single parent or guardian to do this for their child, make a plan to get them vaccinated for COVID-19,” said IDPH Director Dr. Ngozi Ezike.

IDPH reported 1,565 new COVID-19 cases and eight deaths on Monday.

The new cases bring the state’s total to 1,686,048, while the death toll is 25,648.

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Industry lobbyists, business groups and private individuals all met with White House officials last week to ask for a push-back on the implementation of a COVID vaccine mandate for private companies, CNBC reported Oct. 25. [Becker's Hospital Review 10.25.2021] 

The administration is conducting its final review of the mandate, which will require companies with 100 or more employees to ensure their staff are fully vaccinated or undergo weekly testing. The mandate is estimated to affect around two-thirds of the private sector workforce. The Office of Management and Budget received the final rule Oct. 12 and is soon expected to finish its review, after which the mandate will quickly take effect. 

Employers are worried that the mandate will drive even more employees to quit amid the highest level of turnover in 20 years. A poll from health policy analysis firm KFF, published last month, revealed  30 percent of unvaccinated employees said they would rather leave their companies than comply with testing or get vaccinated. The responses in these polls are often exaggerated, however, according to financial services company Goldman Sachs. Goldman Sachs' research suggested that the mandate would actually encourage employment by reducing COVID transmission and creating a safer work environment to invite back the five million workers who left due to the pandemic.  

Industry lobbyists raised concerns about the cost of weekly testing. "If folks are allowed to refuse vaccination, and the employer takes testing obligations from a cost standpoint, then there's no real motivation for those employees to get the vaccine," Evan Armstrong of the Retail Industry Leaders Association said.

The National Retail Federation asked for 90 days for employees to comply with the mandate, effectively pushing back the order until January 2022. The Business Roundtable, another lobbyist group, also told CNBC  the administration should allow time for employees to comply.  Ed Egee, a lobbyist at the National Retail Federation, told CNBC, "This mandate cannot be implemented in 2021 without having serious repercussions on the American economy.

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Behavioral health providers call on Pritzker to provide $120 million for workforce challenges Behavioral health providers want Gov. JB Pritzker to steer $120 million in state and federal funds their way to address a workforce crisis exacerbated by the COVID-19 pandemic.  Illinois Association for Behavioral Health CEO Jud DeLoss said a majority of his members have had to cut back this year on treatments and services due to inadequate staffing levels. He said the issue took root before the pandemic.  As recently as 2019, the association said the state had only about a quarter of the behavioral healthcare professionals it needed in designated shortage regions.  “Behavioral health providers need this cash injection by Dec. 1 and they need it without unnecessary new programs, grant applications or complex red tape,” DeLoss plans to tell lawmakers Friday during a subject hearing initiated by his group, according to testimony provided ahead of time.  To help finance workforce retention and recruitment, DeLoss called on Pritzker to direct $50 million to behavioral health providers from funding the state received from the American Rescue Plan Act for mental health funds, as well another $54 million from federal COVID-19 money for substance use disorders. He said Pritzker could also draw upon $40 million in recreational cannabis tax revenues allocated for mental health and substance use disorders.  "The accelerating and dramatic loss of Illinois behavioral health workers – administrative and clinical staff alike – and a dwindling ability to recruit new workers by community health providers in your districts is why I am before this Committee today: to ask for your help to defuse the workforce shortage crisis," said DeLoss in written testimony to be delivered on Friday. "We are asking the Pritzker Administration to release $120 million for recruitment and retention efforts by behavioral healthcare providers by December 1." ###

A House committee approved a plan Wednesday incentivizing new owners to reopen closed hospitals in Illinois. [Health News Illinois 10.21.2021]

The bill would allow a reopened hospital to continue to receive enhanced Medicaid rates for certain services at the same rate as the prior hospital, if the facility closed within three calendar years. That rate would stay in place until utilization data for the new facility is available for the Medicaid inpatient utilization rate calculation.

House Majority Leader Greg Harris, D-Chicago, told members of the House’s Executive Committee that the proposal is in response to the number of hospital closures in recent years and is intended to “help bridge the gap and incentivize” new owners to reopen facilities in underserved communities.

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[American Public Health Association]

PROBLEM

Pre-Pandemic

People experiencing unsheltered homelessness — such as those sleeping in parks and vehicles, or on streets — were at higher risk of physical and mental health issues than their sheltered counterparts. (see Reference #1)

1 in 3 individuals experiencing homelessness is unsheltered.

The overall rate of homelessness grew from 2018-2019, due to an increase in the unsheltered population, particularly through growth in these groups. 

28% Native American
10% gender non-conforming
10% Black
12% female
43% transgender

NOW

Those experiencing unsheltered homelessness are at high risk of COVID-19 morbidity and mortality because they are less connected to health care and other support systems and more likely to have other health conditions. And, the groups that have increased the unsheltered population also represent those most at risk of negative health consequences of COVID-19. Despite increased risk, the true impact of the pandemic on the unsheltered is unknown, due to extremely limited data. 

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