\u201cWe\u2019re really seriously considering not doing COVID vaccines this year,\u201d said Laura Kittross, public health program manager for the Berkshire Regional Planning Commission, which coordinates with 18 Western Massachusetts municipalities. <\/p>\n
Kennedy\u2019s open skepticism of vaccines and his recent decisions that include changing guidelines on who should get COVID vaccines have state officials and public health professionals questioning whether they can continue to rely on what used to be a smooth-running system. In response, Massachusetts officials are exploring creating an alternate vaccine policy, which could include an unprecedented collaboration with neighboring states to replicate some of the work federal health agencies <\/b>typically perform. <\/p>\n
\u201cAt this moment we can\u2019t always look to the CDC [Centers for Disease Control and Prevention] for the guidance we received previously,\u201d Dr. Robbie Goldstein, the state\u2019s commissioner of the Department of Public Health, said during a DPH-hosted panel Wednesday that focused on vaccination. \u201cThis is a little bit of building the plane while we fly it.\u201d<\/p>\n
The discussion was eagerly awaited by health providers throughout Massachusetts who say keeping up with vaccine recommendations is difficult enough without conflicting messages from Washington. <\/p>\n
\u201cPediatricians are overwhelmed and really looking for guidance,\u201d said Dr. Everett Lamm, cochair of the state chapter of the American Academy of Pediatrics\u2019 Immunization Initiative. <\/p>\n
Typically, a CDC advisory panel every June <\/b>recommends vaccines for seasonal spikes in flu, RSV, and, more recently, COVID. Under Kennedy, that process has been haphazard. In June, he fired<\/a> every member of the committee, and replaced them with a smaller group who generally have less experience with vaccines but share some of his political positions.<\/p>\n An HHS spokesperson said Kennedy considered the previous version of the Advisory Committee on Immunization Practices, or ACIP, as a rubber stamp that failed to critically evaluate scientific evidence. <\/p>\n \u201cSecretary Kennedy has replaced vaccine groupthink with a diversity of viewpoints on ACIP,\u201d the HHS statement said. <\/p>\n The spokesperson did not reply to questions about the delayed COVID shot recommendations.<\/p>\n The new ACIP committee members recommended in June<\/a> that thimerosal, a preservative, be eliminated from all vaccines. The mercury-containing compound is used in just 4 percent of flu doses in the United States but has long been associated, falsely, with autism. The panel\u2019s decision to give credence to a debunked conspiracy theory alarmed health experts.<\/p>\n \u201cI think the level of trust for information coming out of the CDC right now is somewhere between negative one and zero,\u201d said Michael Osterholm, a University of Minnesota vaccine expert who participated in the forum Wednesday.<\/p>\n For local authorities such as Kittross, the delay hinders efforts to protect people in one of the state\u2019s least vaccinated regions. By this time last year, groups such as the regional planning commission would have begun ordering roughly 2,000 COVID vaccine doses. <\/p>\n While Berkshire County\u2019s lower inoculation rates are in part due to a streak of vaccine hesitancy, Kittross said, it is also a consequence of limited access to medical care in a rural area. <\/p>\n \u201cI think it\u2019s really difficult for people here,\u201d she said. \u201cYou don\u2019t walk past a CVS on your way to work.\u201d<\/p>\n It isn\u2019t too late to order COVID vaccine, she said, but the clock is ticking, and at roughly $120 a dose, it\u2019s a cost local health departments cannot afford to foot without a guarantee insurers will reimburse them.<\/p>\n Many of the state\u2019s 351 local public health agencies face the same uncertainty, said Carlene Pavlos, executive director of the Massachusetts Public Health Alliance.<\/p>\n \u201cMany are <\/b>not <\/b>making decisions about ordering vaccines until they know there will be insurance coverage,\u201d she said. \u201cIf there isn\u2019t, they will be unable to order.\u201d<\/p>\n Hospitals, too, are waiting to learn whether their workers will be required to get COVID shots.<\/p>\n \u201cIt\u2019s time to preorder COVID vaccines, and we don\u2019t even know who will qualify for COVID vaccines in the fall,\u201d said Dr. Shira Doron, hospital epidemiologist at Tufts Medical Center.<\/p>\n The website for the CDC advisory panel notes a meeting is expected to be held in August or September. If it does end up recommending COVID vaccines, providers would have time to obtain doses for the coming winter, officials said.<\/p>\n The confusion and changing guidance from the federal government prompted Governor Maura Healey to propose legislation<\/a> in July to give the state more leeway in determining which vaccines are covered by its <\/b>Vaccine Purchase Trust Fund, which funds free inoculations for children. Right now, the fund can support only vaccines recommended by the CDC panel.<\/p>\n Massachusetts is in discussions with Connecticut, Maine, New York, and Rhode Island to coordinate vaccine recommendations without input from the CDC panel, public health officials said. While in the planning stages, states would likely rely on advice from national professional societies, such as the American Academy of Pediatrics and Infectious Disease Society of America, to provide coordinated guidance to public health and medical providers. <\/p>\n Meanwhile, an initiative run by Osterholm of the University of Minnesota called the Vaccine Integrity Project is gathering reams of information on vaccines to help professional societies make recommendations. He acknowledged it will not be able to replicate in total the work of the CDC advisory committee.<\/p>\n \u201cThat was a pretty seamless system in terms of assessment,\u201d <\/b>Osterholm said. \u201cI would just say that it\u2019s our loss.\u201d<\/p>\n Other health experts said it is important participating states coordinate recommendations, both to bolster public trust and increase the likelihood insurers will cover vaccines without federal approval. Each state giving its own vaccine recommendations would cause chaos, experts said.<\/p>\n \u201cIt\u2019s OK for us to tweak the language a little bit but it\u2019s not OK for each of us to have a different recommendation,\u201d Goldstein said. <\/p>\n It is unclear, though, if insurers, which are required to cover vaccines recommended by the CDC panel, would do the same for those suggested by regional public health collaboratives. In a statement, Blue Cross Blue Shield, Massachusetts\u2019 largest private insurer, said it did not rely exclusively on CDC recommendations to determine what vaccines it would cover. <\/p>\n \u201cWe strongly support vaccine access and view it as a critical part of public health and preventive care,\u201d Blue Cross said in the statement. \u201cWhen deciding what vaccinations to cover, we examine the published evidence as well as national guidelines from expert bodies.\u201d<\/p>\n Goldstein said other insurers have been open to relying on vaccine authorities other than the federal government. It saves insurers money to prevent costly illnesses in their customers, he said. <\/p>\n MassHealth, the state-run Medicaid program, said in a statement that it is able to cover vaccines not recommended by the CDC panel.<\/p>\n Kennedy has in many ways reshaped the federal public health apparatus to reflect his skeptical, and in some cases unproven views on vaccine safety and efficacy. The CDC lifted COVID vaccine recommendations for healthy children and pregnant women and this month Kennedy canceled $500 million<\/a> in federal funding for research to create new mRNA vaccines. MRNA vaccines protected millions of people during COVID and can be produced quickly, making them a potentially lifesaving resource during another pandemic.<\/p>\n Yet even if Massachusetts can establish a vaccine policy independent of Washington, the fracturing of what used to be a consensus among public health authorities could worsen the country\u2019s already significant undercurrent of vaccine hesitancy. <\/p>\n \u201cI think we\u2019re already seeing that it\u2019s impacting vaccination rates,\u201d Goldstein said. \u201cNational rhetoric has increased vaccine hesitancy on all types of vaccines.\u201d <\/p>\n Jason Laughlin can be reached at jason.laughlin@globe.com<\/a>. Follow him @jasmlaughlin<\/a>.<\/p>\n