Resurgence of Vaccine-Preventable Diseases in 2023 and Beyond: Policy Actions for Nurse Practitioners
Contributed by Health Policy Committee member Ashleigh F. Bowman, DNP, RN, CRNP, CPNP-AC
A resurgence of diseases once quelled by vaccines presents a formidable threat to pediatric patients in 2023 and beyond. The COVID-19 pandemic coupled with an already growing camp of vaccine hesitancy has created an environment conducive to the spread of vaccine-preventable diseases1. Outbreaks of measles posed an imminent threat to child health pre-pandemic2, and recent outbreaks among un- or undervaccinated children are making national headlines3. While safe and effective vaccines for diseases such as measles have existed for many decades4, missed vaccination opportunities based on philosophical or religious exemptions2, lack of information regarding childhood vaccines from health care providers, and now delayed well-child checks during the pandemic have contributed to the steady decline in uptake of recommended pediatric immunizations1.
The key drivers behind the resurgence of vaccine-preventable diseases highlight the role that nurse practitioners (NPs) play in promoting child health. At the microsystem level, NPs frequently serve as primary care counsel families about routine vaccine safety and efficacy and provide immunizations required for school entry. The clinical role NPs play in immunizing children is well-established.
Continued and directed policy and advocacy efforts are needed to prevent the ongoing resurgence of vaccine-preventable diseases. The National Association for Pediatric Nurse Practitioners (NAPNAP) actively supports not only immunizing all children but also advocating for policies that ensure vaccines remain affordable and available to all families, families receive evidence-based education on immunizations and support for global vaccination programs5. Now more than ever, it is critical that children receive routine immunizations and that local, state, and federal policies are aligned with this end goal.
A summary of policy and advocacy actions and priorities for pediatric-focused NPs include:
- Vaccine requirements in K-12 schools and daycares6
- Education requirements for families seeking vaccination exemptions for school entry
- Affordable and equitable access to vaccines for all children
- Addressing social determinants of health that specifically impact vaccine uptake in historically underserved and marginalized communities1
- Utilizing centralized vaccine databases and reminder systems7
- Funding support for global vaccination programs7
1 Olusanya, O. A., Bednarczyk, R. A., Davis, R. L., & Shaban-Nejad, A. (2021). Addressing parental vaccine hesitancy and other barriers to childhood/adolescent vaccination uptake during the coronavirus (COVID-19) pandemic. Frontiers in Immunology, 12, article 663074. https://doi.org/10/3389/fimmu.2021.663074
2 Hotez, P. (2019). American and Europe’s new normal: The return of vaccine-preventable diseases. Nature, 85, 912-914. https://doi.org/10.1038/s41390-019-0354-3
3 Howard, J. (2022, December 7). Measles outbreak in central Ohio grows to more than 50 children, driven by “lack of vaccination.” Retrieved from https://www.cnn.com/2022/12/06/health/measles-outbreak-spreads-ohio/index.html
4 Talbird, S. E., Carrico, J., La, E. M., Carias, C. Marshall, G. S., Roberts, C. S., Chen, Y.-T., & NyakuDrPh, M. K. (2022). Impact of routine childhood immunization in reducing vaccine-preventable diseases in the United States. Pediatrics, 150(3), e2021056013. https://doi.org/10.1542/peds.2021-056013
5 The National Association of Pediatric Nurse Practitioners. (2022). NAPNAP position statement on immunizations. Journal of Pediatric Health Care. https://www.jpedhc.org/article/S0891-5245(22)00091-8/pdf
6 Haeder, S. F. (2021). Joining the herd? U.S. public opinion and vaccination requirements across educational settings during the COVID-19 pandemic. Vaccine, 39, 2375-2385. https://doi.org/10.1016/j.vaccine.2021.03.055
7 Skolnik, A., Bhatti, A., Larson, A., & Mitrovich, R. (2021). Silent consequences of COVID-19: Why it’s critical to recover routine vaccination rates through equitable vaccine policies and practices. Annals of Family Medicine, 19(6), https://doi.org/10.1370/afm.2730
Throughout 2022, NAPNAP’s Child Health Policy Learning Collaborative has hosted highly informative meetings with special guests from leading organizations. Members can log-in to view past meetings here.
Midterm Elections Reshape 118th Congress
Incumbent Sen. Raphael Warnock defeated Republican challenger Herschel Walker in a Dec. 6 Georgia runoff election to give Democrats a 51-seat Senate majority in the 118th Congress, although the margin was shaken by Arizona Sen. Kyrsten Sinema’s Dec. 9 announcement that she would leave the party and register as an independent. The Senate changes came after Republicans narrowly flipped majority control of the House in the November midterm elections. House Democrats will also be under new leadership in the incoming Congress, with Speaker Nancy Pelosi (D-CA) and Majority Leader Steny Hoyer (D-MD) stepping down from their posts. Democrats tapped Rep. Hakeem Jeffries of New York to succeed Pelosi as Democratic leader, with Massachusetts Rep. Katherine Clark and California Rep. Pete Aguilar taking over as the party’s second and third-ranking leaders. House Republicans retained Rep. Kevin McCarthy of California as their leader, but intraparty conflicts within the Republican’s slim majority is raising doubts that McCarthy can garner the 218 votes needed to be elected Speaker when the new Congress convenes Jan. 3.
The new Congress will also bring changes among nursing’s champions in Congress. Longtime Democratic nursing leader Eddie Berniece Johnson of Texas retired, while Republican nurse practitioner Jennifer Kiggans won a closely-contested Virginia seat. Nurse Rep. Lauren Underwood (D-IL) won reelection and was elected co-chair of the Democratic Policy and Communications Committee. There will also be significant changes in House and Senate committee leadership in the new Congress, with Republicans taking charge of House committees and retirements reshaping key Senate panels. Committee assignments will be finalized after lawmakers take office in January.
Lawmakers Struggle to Agree on Fiscal 2023 Spending
With funding for federal agencies set to run out on Dec. 16, congressional leaders are still far apart on a final fiscal 2023 appropriations bill, leaving funding for nursing education, workforce, and research programs uncertain. More than two months into the fiscal year, House and Senate leaders have yet to agree on the topline allocation of funds for defense and domestic programs, preventing committees from negotiating funding levels for individuals agencies and programs. Another stopgap measure to extend funding for government programs appears inevitable but the length of the extension is uncertain. While appropriators want to agree on an omnibus bill to fund the government through next September, the odds of pushing negotiations into the new Congress in January are increasing.
Congress hasn’t completed any of the 12 separate spending bills for fiscal 2023, although the House approved a measure that would boost funding for nursing workforce development programs by $44 million and Senate appropriators proposed a $38 million increase. However, if negotiators reduce the amount of money allocated to domestic programs those proposed increases are likely to shrink.
Year-End Health Legislation Remains Unclear
While congressional appropriators struggle to agree on funding government programs, House and Senate leaders are also wrestling to put together a year-end package of legislative priorities that could include a lengthy list of health care policies. However, any proposal would have to win the support of at least ten Republican senators to avoid a filibuster and would have to be paid for by additional revenue or cuts in other spending, making an expansive agreement unlikely.
Leaders of House and Senate health committees see extending Medicaid funding for Puerto Rico and U.S. territories as a “must pass” priority, and there is strong bipartisan support for acting on behavioral and mental health proposals – although the two chambers differ on specific policies. Health care providers are pressing lawmakers to prevent cuts in Medicare payments set to begin in January, address maternal health needs including requiring 12-month Medicaid postpartum coverage, and 12-month continuous eligibility for children’s coverage. Supporters of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program are also pushing the Senate to act on legislation (H.R. 8876) overwhelmingly passed by the House Dec. 2 to reauthorize and expand the program before its current funding runs out. Nursing organizations are pressing to include provisions making waivers to practice barriers permanent and expanding nursing education infrastructure to address shortages.
Health Officials Brace For Winter Surge In Infectious Diseases
A post-Thanksgiving uptick in COVID-19 patients hit U.S. hospitals as health systems struggled to contend with waves of patients with RSV and influenza infections, with COVID hospitalizations reaching their highest level in three months in early December. Public health authorities worried that the increasing number of COVID patients add to the strain on hospitals already under pressure from influenza and respiratory syncytial virus (RSV) after nearly 20,000 patients were hospitalized with influenza during Thanksgiving week.
The Biden administration launched a new six-week campaign in November to urge Americans to catch up on COVID-19 boosters, acknowledging that vaccination and booster rates continued to be lower than they should be. Vaccine makers Pfizer and BioNTech asked the Food and Drug Administration on Dec. 4 to authorize their updated COVID-19 vaccine for emergency use in children under 5. The new shot that targets the original strain and two Omicron subvariants is currently authorized as a booster dose for individuals ages 5 and up in the U.S.
Supreme Court Hears Arguments on Patients’ Rights To Sue
In oral arguments, Nov. 8 Supreme Court justices didn’t signal where they’ll land on a case that could affect the ability of patients to bring lawsuits to enforce federal civil rights laws. The case, Health and Hospital Corp. v. Talevski, pits the family of nursing home patient Gorgi Talevski against Health and Hospital of Marion County, an Indiana public health agency. The family alleges that Talevski, who has since died, was abused and given psychotropic drugs against his will while in the care of a county nursing home in violation of the 1987 Federal Nursing Home Reform Act.
The court is considering whether those laws do provide a private right of action, and its ruling could have major implications for people who receive other federally funded services, like housing, foster care and nutrition. NAPNAP has joined a wide range of legislators, patient advocates and health care organizations in submitting briefs supporting individuals’ right to sue. The Supreme Court is expected to rule by next June.
Advocates Push to Preserve Immigrant Protections
Groups supporting immigrants who came to the U.S. as children are pushing Congress to enact legislation in the lame duck session that would protect the Deferred Action for Childhood Arrivals (DACA) after a federal appeals court ruled in October that program that protects nearly 600,000 young immigrants from deportation is illegal. The federal 5th Circuit Court of Appeals allowed those already enrolled in the program to renew their status but blocked any new applications for enrollment, affirming a 2021 lower court decision. Advocates fear that the Supreme Court will agree to strike down the program and that a Republican-led House will block any effort to pass legislation authorizing the program in the 118th Congress.
Migrant advocates are also concerned that the Biden administration may impose new limits on the number of migrants who could apply for asylum in the U.S as it implements a court-ordered end public health expulsions under Title 42 of the Public Health Service Act on Dec. 21. Reports suggest that the administration is considering policies to prohibit migrants fleeing persecution from seeking refuge in the U.S. unless they were first denied safe harbor by another country.
In Other News
Student Debt Payment Freeze Extended With Relief Plan On Hold
The Biden administration announced Nov. 22 that it would again extend a pandemic-era pause on payments for federal student loans as courts weigh the fate of its debt forgiveness program. The payment pause, which was first implemented during the Trump administration and extended multiple times, had been set to end on Dec. 31. Officials had hoped to have forgiven some debt by then so borrowers’ balances would be lower, or in some cases wiped altogether, before payments resumed. But the President’s program to forgive up to $20,000 in student loan debt for millions of borrowers has been challenged by a host of lawsuits. The Department of Education said payments will resume 60 days after the relief program is implemented or by Sept. 1 if the litigation isn’t resolved by the end of June.
Meanwhile, the Supreme Court agreed Dec. 1 to decide the case filed by six Republican-led states to overturn the loan forgiveness program, effectively leaving the initiative blocked nationwide for at least another two months. The administration sought an immediate reversal of an 8th Circuit Court of Appeals ruling that paused the program, but the justices declined that request and instead set oral arguments in the case for February.
Medical Groups Fight Challenge to Preventive Care Coverage
A coalition of health professional groups urged a Texas federal judge Dec. 1 to preserve the Affordable Care Act’s coverage of preventive services, arguing that gutting the requirements would be disastrous for patient care. In an amicus brief led by the American Medical Association, the groups asked Judge Reed O’Connor to exercise discretion and refrain from issuing a nationwide injunction that would invalidate every significant recommendation from the U.S. Preventive Services Task Force, warning that “preventive care would be in grave jeopardy for tens of millions of Americans.”
O’Connor ruled in September that the ACA’s process for determining what kinds of preventive care must be fully covered by private health insurance is unconstitutional, putting at risk free screenings for colorectal and other cancers, depression screenings and hypertension screenings, and other service. He added that the process violated the Constitution because task force members are not appointed by the President or confirmed by the Senate, yet its recommendations are binding. While O’Connor found for the plaintiffs, he postponed ruling on the scope of relief or remedy. Additional briefs from both sides in the case are due in January.