Why this decision is so perplexing.


Tennessee is one of the least-inoculated states in the country, with only 38 percent of the state fully vaccinated. Instead of doing everything possible to improve that number, the Tennessee Department of Health has decided to halt adolescent vaccine outreach and cease all COVID vaccination events on school property, the Tennessean reported on Monday.

But it’s an even bigger mess than that: The new vaccine policy, which comes from Health Commissioner Dr. Lisa Piercey, isn’t limited to COVID. All vaccine outreach is to be stopped, including back-to-school outreach for routine vaccinations such as measles or HPV. And the change comes alongside news that the state’s top vaccine official, Dr. Michelle Fiscus, has been fired after passing along legal guidance to vaccine providers detailing the state’s mature minor doctrine, which allows 14- to 17-year-olds to obtain medical care without parental consent.

Slate spoke with Tennessee-based pediatrician and public health researcher Stephen Patrick about the TDH’s new policy, how he’s seen attitudes toward vaccines change in recent years, and whether independent organizations will be able to do the work of vaccine outreach themselves. Our conversation has been condensed and edited for clarity.

Grace Woodruff: What was your reaction when you heard about the TDH’s decision to halt all vaccine outreach to adolescents?

Stephen Patrick: It’s very worrisome. We know that we’re already behind the ball when it comes to vaccination for kids—routine vaccination for kids—after COVID-19. A lot of vaccines were delayed. … What I’m worried about too is that it sends the wrong message more broadly about the value of vaccination. I think it’s a critical time for public health, for pediatricians, to keep talking about vaccination and why we do it. Vaccination really is the cornerstone of both public health and pediatrics.

How concerned are you about what’s happening right now with COVID and how the TDH’s decision will impact vaccination rates and cases?

Very concerned, no question about it. There’s a report [Thursday] morning that there’s been a tripling of COVID infections in the state. We know that people who are dying from COVID are, by and large, unvaccinated. If you look collectively at the messaging and the attitudes—we are fostering harm, when we aren’t spreading positive messages about vaccines in the state. I worry about what that will do to our ability to combat COVID.

Prior to the TDH’s decision, what was the attitude toward children getting routine vaccinations in Tennessee?

Before COVID-19, we had relatively high vaccination rates in Tennessee. While pediatricians in the last decade have seen more worries and more vaccine hesitancy, there hasn’t been anything quite like this before. It was really the conversations around the COVID-19 vaccine—and the conspiracy theories that permeated—that became a perfect storm for vaccine hesitancy. That’s really worrisome and problematic, and I worry it could have generational harm.

My hope is that it rapidly shifts back. Like many things, I don’t think there’s one specific cause. I think we’ve seen an erosion of trust in public health and politicization of public health over the last 18 months. I think this is a symptom of that, and another leap in a worrisome direction for caring for the public’s health.

How are other public health officials and pediatricians in the state responding to this news?

My colleagues are really disturbed by this. … Vaccines have always been a routine part of the summer! Kids go back for sports physicals, for band camp, and you have outreach for routine vaccination. It shouldn’t be any different this year. We should follow the science and do the things we know protect kids and our communities.

If TDH officials want to disseminate information on vaccines, they are instructed to strip the department logo from the documents. How do you think that these moves could impact people’s trust in public health guidance?

There was poll of Tennessee parents—from the Vanderbilt University Medical Center’s Center for Child Health Policy released in early spring—that looked at their concerns. One of those concerns was who do parents trust in Tennessee for information on vaccines and COVID-19. Consistently, the TDH was rated at the top. When you have a trusted partner for parents, it’s really important that that trusted partner has a really public stance on the virtues of vaccination.

Who might fill that gap?

It’s really a critical role of state public health agencies. My hope is that the TDH will reassess their decision.

At the same time, we see pediatricians in the state and the medical community more broadly speaking out really positively about vaccines. … We’ve done public messaging, we’ve written editorials, we’ve worked in community organizations. … But it does feel like an uphill battle, particularly in weeks like this where the narrative trends so negative toward something that is so foundational.

Will halting vaccine outreach have equity implications?

Yes, no question about it. We know that COVID-19—in terms of the disease burden and the complications of the disease—disproportionately impacts Black and Hispanic families. We also know that we’ve had some lower rates of vaccine uptake from those families, and a little bit more worry about the vaccine from Black parents. That makes the outreach even more important. It is worrisome overall that we’re hesitating to do vaccine outreach. One of the pieces here is that the reasons for low vaccine uptake are complicated. One of the reasons relates to trust. As medical and public health professionals, we have to do things that foster trust in the community, and I worry that the TDH actions and the public discussion of them further erodes trust.

Supporters of Tennessee’s decision to stop actively encouraging adolescents to get the COVID vaccine argue that teens are too impressionable and unable to make their own health decisions. They also cite statistics that show youth are at “low risk” for the virus. How would you respond to someone making that argument?

We’ve seen complications from COVID-19 in children. There’s also a broader, bigger issue: We’ve gone through a pandemic that has had devastating consequences—beyond the illnesses—to adolescent mental health, to food insecurity. One of the things that’s really important to normalize kids’ lives and their access to food is getting back to school. And getting back to school safely. The path toward that is vaccinating kids. We need to protect kids before they go back to school.

I worry that we’re failing to see what a miracle this vaccine is, in the midst of this pandemic, and how fortunate and blessed we are to not only have it, but to have it at such a degree—its availability here in the United States in comparison to the rest of the world. COVID-19 hit after a period of chronic disinvestment in public health, and I hope that when we emerge from this, we begin to realize the critical role of public health in protecting all of us. But right now? I’m worried we haven’t gotten that message.

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