Written by Carey S. Cadieux, PhD, RN, AHN-BC, RYT, FAAN
As many of us struggle with the threats to public health under the current adminsitration, we may feel unempowered and discouraged. It’s important as patient and population advocates, and as the largest number of healthcare care providers, that we take steps toward finding small ways we can make a difference. Sharing our knowledge and calling for what is right for the health of the American people is something we can do in our everyday lives.
I have been greatly concerned about access to vaccines. For about a week in my state of New York, I haven’t been able to access a COVID vaccine as a prescription is required. For a number of reasons I couln’t obtain a prescription even though I have qualifying factors and I was about to travel to another state to obtain care until the Governor Hochul of New York wrote an executive order that ensures that all the people of New York State can receive a COVID vaccines without a prescription. Her executive order ensures that for the next 30 days, all NEw Yorkers can access a COVID vaccine, and the legislature will be charged with creating an official long term legislative move that will ensure access to all vaccines remain in place for New Yorkers. Ideally her actions alongside those of the governors of Massachusetts, California, and New Mexico will be replicated by other states.
Meanwhile, we have an opportunity to make our voices heard to the Avdisory Committee on Immunization Practices (ACIP) and the CDC prior to their next meeting in 7 days time. Until Spetember 13 @11:59 pm EDT, you can send a comment to the committee expressing your concerns the ACIP will be discusisng revisions to vaccines that can be adminstered to children and the vaccine schedule that dictates how ACA insurance is used (or not) to pay for vaccines. Their recommendations will also apply to the Vaccines for Children program, which has been highly successful at ensuring children have access to vaccines.
The call for comments can be read here: file:///Users/careycadieux/Downloads/CDC-2025-0454-0001_content%20(1).pdf
Your own comments with a 500 word maximum can be made here: https://www.regulations.gov/document/CDC-2025-0454-0001/comment
It’s important to consider what you want the ACIP to hear; while personal stories may be moving, it’s also appropriate that we include data and factual information in our comments. Start by letting the committee know you are an RN and why you are writing the comment. Include some links to articles or websites to support your ideas. Tell them what you want them to do. Remain professional. Include stats if you find them. Also, my entry is approaching the 5k word limit, but even just a few hundred works can have an impact.
You have the power!
Here is an example I submitted today (at the time of this blog posting it is still awaiting approval).
As a registered nurse with a PhD, an interest in public health, a fellow of the American Nurses Association Advocacy Institute, a Fellow of the American Academy of Nursing, and a background in public policy, I am deeply concerned about the current state of the CDC’s vaccine stance and the next steps for the ACIP. The recent proposal to limit access to the hepatitis B, MMRV, RSV, and COVID vaccines could end up being disastrous for the United States citizens. This is likely to end up costing the country and its citizens greatly on many levels. The ACIP vote, scheduled for September 2025, will, in great part, determine the future of our nation’s health.
There is a significant public health concern that people, particularly children, should be vaccinated, and that the vaccines be covered by marketplace/ACA insurance, as well as the Vaccines for Children Program. A study performed by the National Institutes of Health with scientists from Henry Ford Health found that the some of the most impactful risk factors for the spread of COVID-19 in households include obesity and children as vectors (Siebold et al., 2022).
Our public health system needs to vaccinate people to reach and/or maintain herd immunity for many preventable diseases. Herd immunity refers to the evidence-based concept where enough people are vaccinated to prevent the rapid spread of infectious agents. According to the Cleveland Clinic (2022), achieving herd immunity from COVID-19 required vaccination levels of up to 85% of the population, which we failed to achieve; hence, COVID-19 is now considered to be an endemic disease. Restricting access to vaccines contradicts the well-established scientific evidence that vaccines protect populations from infectious diseases, decrease overall healthcare costs, and safeguard vulnerable populations (Ashby & Best, 2021).
The ACIP must also consider the cost of ongoing vaccine hesitancy and the lack of public health system support for accessing vaccines. A Kaiser Family Foundation study estimated that the cost of 690,000 vaccine-preventable COVID-19 hospitalizations in June-November 2021 was $13.8 billion (Kaiser Family Foundation, 2021). The CDC’s own research has found that the Vaccines for Children Program is effective. From 1994 to 2023, this program prevented 508 million lifetime cases of illness and 32 million hospitalizations, while also saving $540 billion in direct medical costs and $2.7 trillion in societal costs (Zhou et al., 2024).
Additionally, vaccine-preventable diseases (VPD) in people over age 50 are not just costly; VPD hospitalized patients incurred worse clinical outcomes, greater loss of independence, and increased mortality and morbidity versus control groups (Hartman et al., 2024). The indirect costs of low vaccination rates include lost productivity, increased public health costs, diversion of public health resources, and higher insurance premiums. At a time when societal and US debts are rising at an alarming rate, not supporting access to free vaccines on a clearly defined and evidence-based schedule is an ingredient of a recipe that results in US economic failure.
Instead of focusing on restricting vaccines, the CDC and the ACIP should be focusing on overcoming vaccine hesitancy so that adults and children can be properly vaccinated according to an evidence-based schedule. In the best interest of the health of the US citizens, the proliferation of fear around vaccines needs to come to a halt, and the polarization of vaccine acceptance needs to be rebuked. The CDC needs to overcome vaccine hesitancy by supporting doctors, nurses, and pharmacists in their efforts to educate people about the acceptance of vaccines and their effectiveness at maintaining both individual health and the health of the population. The APIC, by supporting an evidence-based CDC vaccination schedule and a regulatory system that encourages vaccination for children and adults, could address the main components of vaccine hesitancy: lack of confidence in vaccines, complacency, and lack of vaccine access/ convenience (Gregory et al., 2023). The ACIP and CDC should not be creating road blocks around the people’s access to life saving vaccines.
When considering the moral and ethical implications of vaccine programs and mandates, governments must always prioritize maximizing public benefit and minimizing public harm (Jalilian et al., 2023). The unintended consequences of the ACIP not fully supporting an evidence-based vaccination schedule from the CDC, include increased costs to the system, further division of the US population around this issue, and growing vaccine hesitancy.
I urge the ACIP to vote in favor of evidence-based decisions regarding vaccine effectiveness and ensuring availability to all people in the population. You are charged with minimizing harm, overcoming vaccine hesitancy, enhancing access to vaccines, and reducing overall costs to the US government and the American people.
References:
Ashby, B. & Best, B. (2021). Herd immunity. Current Biology, 31(4), R174-R177. https://doi.org/10.1016/j.cub.2021.01.006
Cleaveland Clinic. (2022). Herd immunity. https://my.clevelandclinic.org/health/articles/22599-herd-immunity
Gregory, P., Gill, M., Datta, D., & Austin, Z. (2023). A typology of vaccine hesitancies: Results from a study of community pharmacists administering COVID-19 vaccinations during the pandemic. Research in Social and Administrative Pharmacy, 19(2), 332-342. https://doi.org/10.1016/j.sapharm.2022.09.016
Hartmann, M., Servotte, N., Aris, E., Doherty, T.M., Salem, A., & Beck, E. (2024). Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis. BMC Public Health 24, 2960. https://doi.org/10.1186/s12889-024-20145-0
Jalilian, H., Amraei, M., Javanshir, E., Jamebozorgi, K., & Faraji-Khiavi, F. (2023). Ethical considerations of the vaccine development process and vaccination: A scoping review. BMC Health Services Research, 23(1), 255. https://doi.org/10.1186/s12913-023-09237-6
Kaiser Family Foundation. (2021). Unvaccinated COVID patients cost the US health system billions of dollars. https://www.kff.org/covid-19/unvaccinated-covid-patients-cost-the-u-s-health-system-billions-of-dollars/
Seibold, M. A., Moore, C. M., Everman, J. L., Williams, B. J. M., Nolin, J. D., Fairbanks-Mahnke, A., Plender, E. G., Patel, B. B., Arbes, S. J., Bacharier, L. B., Bendixsen, C. G., Calatroni, A., Camargo, C. A., Jr, Dupont, W. D., Furuta, G. T., Gebretsadik, T., Gruchalla, R. S., Gupta, R. S., Khurana Hershey, G. K., Murrison, L. B., … HEROS study team. (2022). Risk factors for SARS-CoV-2 infection and transmission in households with children with asthma and allergy: A prospective surveillance study. The Journal of Allergy and Clinical Immunology, 150(2), 302–311. https://doi.org/10.1016/j.jaci.2022.05.0
Zhou, F., Jatalaoui, T.C., Leidner, A.J., Carter, R.J., Dong. X., Santoli, J., Stokely, J.M., Daskalakis, D.C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of Vaccines for Children Program- United States, 1994-2023. MMWR Morbidity & Mortality Weekly Report, 73, 682-685. https://www.cdc.gov/mmwr/volumes/73/wr/mm7331a2.htm
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