A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation (green paper)


Renata E. Mares MIPH, BScN, BA Kin

Aug 22, 2026

Please use this document in any way that you wish. You can freely use this document (with citation; see our creative commons license in the footer of this and all pages on this site)  The format for citing the document is shown at the end of the table of contents. If you wish to have other ideas integrated into this document, or included on this web site, please contact us or the author directly renata@adaptablefolks.com

1.     Introduction
2.     Planetary Health is Nursing Work
3.     Commercial Determinants of Harms and Health: Get Political  
4.     Nursing Is Not a Buffer for System Failure
5.     Against the Medical-Industrial Complex
6.     Our Commitment
7.     A Call to Conscience and Action
8.     About the Author
9. Reference list (see image)

Citation: Mares, R. E. (2026). A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation (green paper). https://nursemanifest.com/2026/08/31/a-nursing-manifesto-for-2030-human-care-against-extraction-and-exploitation-green-paper/

Foreword

I came across this incredible blog post about A Nursing Manifesto 2000 written by three incredible nurses and academics: Richard Cowling, Peggy Chinn, Sue Hagedorn in 2000 and I thought to develop a parallel manifesto which brings together some of the books I have been reading over the past 5 years post-pandemic and some which reaches further back to the 80s 90s, 2000s, till present time.

The world have shifted quite a bit since this manifesto was developed and shared. In and of itself, it reads like something to aspire to. Maybe when I started my nursing career as a new graduate back in 2008, it would have been something to aspire to in my own work, career, research and teaching. But now I find some pretty troubling things not only missing from this manifesto as historical accounts, including the troublesome origins of the nursing and medical profession / culture, but it needs to be updated for the year 2030 and beyond.

But first, take some time to read and get familiar with A Nursing Manifesto 2000: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/

Below is the introduction to A Nursing Manifesto: A Call to Conscience and Action written in 2000. I am sharing here just the initial Introduction, but please do have a read of the entire manifesto as it discusses the ideals and principles, inspiration, concerns, vision and suggestions for actions. It also describes the authors and their positionality and about the art contained within this blog.

A Nursing Manifesto: A Call to Conscience and Action (2000)

by Richard Cowling, Peggy Chinn, Sue Hagedorn

Introduction (excerpt)

“As nurses, we reach for meaningful expressions of our values, too often finding overwhelming constraint and resistance, sometimes within ourselves and sometimes imposed from without. We are calling for a movement to awaken those precious and powerful ideals that are rooted in nursing’s worldwide historical traditions. We call forth the written and spoken voice of nursing to be claimed and reclaimed. We seek to inspire the fullest expression of the heart of nursing through individual and collective acts. We believe there are profound possibilities in claiming our individual and professional sovereignty” … link to full manifesto here: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/#intro

My initial thoughts on this this first paragraph would be:

  • Awakening the so called ‘precious and powerful ideals’ is definitely a good thing, but how does nursing as a profession and value-based career wrestle with the monolith it has created the lack of diversity over the course of centuries
  • Rooted in nursing’s worldwide historical traditions: would these discuss how Nightingale-like nursing is rooted in supporting war and military efforts? Would these traditions address the issues of explicitly racism, sexism, and harmful medical cultural administrative practice over the course of the centuries? Our current professional associations are build as empires where lack of diverse leadership opportunities persist and patriarchal hierarchies are celebrated as excellence.
  • Attrition in nursing and healthcare is at crisis levels, yet no one talks explicitly about trauma and cPTSD experienced not from patients, toxic teams, but administrative and regulatory practices. Anyone care to elaborate here?

As I was reading this incredible manifesto and remembering back to the year 2000, I started to draw both parallels and the need to advance these exact thoughts to the years 2030 and beyond. At first I had the idea of taking each section and paragraph and write my thoughts in support and opposition. But then I thought, why not take all that I have read and know and develop something totally new yet complementary. Building upon my elders’ work.

Believe it or not, I have a fear of writing my own voice and ideas down. I don’t want to hurt feelings and I do get intimidated by folks who are much more qualified than myself, and therefore, I have the feeling that maybe I should not share what I have to say. I am now slowly building back my lost confidence and also recognizing that part of nuanced and critical thinking is (sometimes) getting things wrong, and sometimes right but too soon. So, I want to share both what I might be thinking that is wrong and also my worries about the nursing profession that I love so much. After nearly 20 years in this profession across specialties like orthopedic/trauma, medical/surgical units, mental health, public and community health, policy and education, I feel that I did my authentic best in trying to build the new and not getting lost in the challenges of the past. However, burnout happens to all of us, some more resilient than others. I am accepting that I might have pushed too hard for change and lacked the skills of relationship building. My past of being a refugee and immigrant female child who grew up in post-Communist Romania and Hungary could add to some of these reasons. The urgency to alleviate struggles for others was a real cause and drive for me. I never understood how a bunch of smart people could just sit around the table and talk about action, while people were struggling. Access to healthcare is access to people’s tax dollars. Talking was seemingly a waste of time from my perspective, as an early career public health nurse. I was searching to find people who felt the same urgency (or at least understood my motivations) as I did to act and help get folks out of poverty, get access to health and social services, and not just talk about it in meetings.

I may have been naïve and rushed. I was give the privilege of a profession to do good and alleviate harms. However, without trusted relationships, money doesn’t flow and people remain in poverty, in struggles that are the result of structures and systems I wanted to adapt. Some lessons we learn the hard way. I am now re-learning to build the confidence to talk, share ideas, and build relationship among people who are looking to advance the only huma-centered profession still remains. (I might be biased in this view) Is the last human job a nurse? Or so I assume in this manifesto. Or maybe the last human jobs are human-collaborations across sectors. Yes, that sounds more like it. But first we need to pivot (yes, just like that couch on a Friends episode from Feb 1999) and pay those human-collaboration jobs a fair wage.

Therefore, I am using my LinkedIn platform to share my ideas of A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation – a draft (2026) paralleling what has been written in 2000 and adding in some of my ideas from the list of resources that I will share at the very end of this writing. It might give future nurses in undergraduate and graduate studies something to ponder beyond the status quo of the nursing/ healthcare profession and education. We need to get out of ‘our’ status quo cultural box.

As always, I am open to discussions and opposing views that are shared respectfully.

1. INTRODUCTION

‘We’ are nurses (diverse with complex/ adaptive skills professionals) at a time when care is being remade by machines, markets, and systems that measure human worth in data points, risk scores, productivity targets, and billing codes.

We do not reject technology.

We reject technology without accountability.

Artificial intelligence, automation, surveillance, and predictive systems have entered hospitals, homes, clinics, long-term care, and public health. They promise efficiency while too often deepening abandonment. They sort people by profitability, automate denials, intensify workloads, erase human judgment, and place the burdens of flawed systems on those already made vulnerable by racism, colonialism, poverty, disability, gender oppression, and displacement.

We have seen what happens when an algorithm is treated as neutral while it inherits the inequities of the world that trained it. We have seen staffing systems call exhaustion as ‘optimization’. We have seen virtual care become a substitute for accessible, relational care. We have seen automation used not to relieve nurses of harmful labour, but to eliminate jobs, deskill practice, and demand that fewer workers do more with less.

This is not innovation.

It is extraction.

We are nurses practicing amid converging emergencies: widening inequality, climate breakdown, poisoned water, forced displacement, worsening chronic illness, automated exclusion, and healthcare systems increasingly governed by commercial interests rather than public need.

We affirm that health is inseparable from the conditions in which people are born, grow, work, live, age, and die. Health begins with breathable air, safe homes, nourishing food, clean water, meaningful connection, cultural continuity, freedom from violence, and a stable living planet. No hospital, algorithm, drug, or procedure can compensate for a society that systematically destroys these foundations.

The medical-industrial complex has transformed illness into revenue, crisis into market opportunity, and health into a commodity distributed according to wealth, insurance status, postal code, citizenship, and institutional power. It profits from endless treatment while neglecting clean air, safe housing, food security, living wages, disability justice, mental health, reproductive freedom, and the conditions that allow people to live well before they become patients.

We reject the fiction that health care exists apart from the world. The same systems that commodify illness extract from workers, communities, lands, and waters. The medical-industrial complex profits from treatment while underinvesting in prevention; corporations profit from pollution while public systems absorb the resulting disease; technology firms market “innovation” while shifting social, environmental, and clinical risks onto patients, caregivers, and frontline workers.

This is not an accident. It is a political choice.

We refuse to accept a healthcare system that calls itself advanced while people wait in pain, workers burn out and become patients themselves (Chapman, 2023), communities are poisoned, and the planet warms. (Check out the underlying drivers of planetary harms by Planetary Health Alliance website: culture, values, behaviour, consumption, population size/demographic changes, technology) https://planetaryhealthalliance.org/what-is-planetary-health/

Nursing must be more than the human face placed on an inhumane system. Our role is not to make austerity appear compassionate, to absorb the moral injury created by unsafe conditions, or to quietly compensate for decisions made by executives, insurers, technology firms, regulators and governments far from the bedside.

Our ethical obligation is to care and to confront what makes care impossible.

2. Planetary Health is Nursing Work

Planetary health is not an optional specialty or a future concern. It is present in every heat-related illness, asthma exacerbation, contaminated water supply, food insecurity assessment, infectious-disease outbreak, wildfire evacuation, pregnancy complication, mental-health crisis, and preventable death.

We recognize the health of people as inseparable from the health of lands, waters, ecosystems, and climate. Indigenous peoples have long carried knowledge of these relationships and of stewardship, reciprocity, and collective responsibility. Nursing must listen, learn, and act without appropriating that knowledge or repeating colonial systems of control.

We will advocate for health systems that reduce rather than export harm: low-carbon care, ethical procurement, less waste, resilient infrastructure, safe transportation, sustainable food systems, and emergency planning led with (not imposed upon) affected communities.

Clean water is a health right, not a commercial asset. Water insecurity, contamination, privatization, boil-water advisories, drought, flooding, and inadequate sanitation are nursing concerns because they produce infection, chronic disease, reproductive harm, trauma, displacement, and death. We will name water injustice as a clinical and public-health emergency, especially where it follows colonial dispossession, industrial pollution, and neglect of rural, remote, and Indigenous communities.

3. Commercial Determinants of Harm and Health: Get Political

We confront the commercial determinants of health: the corporate practices that shape exposure to harm, access to care, public policy, and the very definition of health.

Industries profit when people consume products that damage their bodies or environment, including tobacco and nicotine corporations, alcohol producers, ultra-processed food companies, fossil-fuel industries, extractive mining interests, pharmaceutical monopolies, private equity firms, surveillance platforms, and vendors of unaccountable health technology, and digital-addictive designs and digital-afterlife industries. Their influence reaches advertising, research, regulation, education, political lobbying, clinical guidelines, and data infrastructure.

We reject the normalization of harm as “consumer choice” when choices are engineered through marketing, pricing, scarcity, misinformation, racism, design inequity and unequal power.

We also recognize that commercial power can shape health positively only when it is democratically governed, transparent, and subordinated to the public good. Products, technologies, and services must be assessed not simply by revenue or technical novelty, but by their effects on equity, ecological sustainability, worker safety, community control, and long-term health. (my favourite slogan: war brings neither peace nor climate justice, defund military spending).

4. Nursing Is Not a Buffer for System Failure

Nursing is not low-paid emotional labour designed to absorb the failures of health and social systems. It is not a flexible reserve workforce to be stretched during crises, disciplined through precarity, or replaced by automation when budgets demand it.

Nursing knowledge is scientific, relational, ethical, political, and ecological. Nurses assess changing conditions, interpret uncertainty, build trust, notice patterns others miss, coordinate care across fragmented systems, protect rights, respond to suffering, and advocate for structural change. This expertise cannot be reduced to tasks, scripts, dashboards, or a layer of “human oversight” added after an algorithm has already shaped a person’s options.

We reject the use of artificial intelligence and automation to intensify work, monitor workers, remove professional judgment, automate benefit or treatment denials, or redirect accountability away from corporations and institutions. A nurse must never be expected to legitimize a harmful system simply because a person remains nominally “in the loop.”

Technology must serve care, not govern it. Any system used in health care must be transparent, independently audited, accessible, privacy-protective, environmentally accountable, and open to challenge by patients, families, nurses, and communities. It must be assessed for bias, labour impacts, energy and water use, supply-chain harms, and effects on access, not only for accuracy or cost savings.

5. Against the Medical-Industrial Complex

The medical-industrial complex converts suffering into revenue. It treats health as a market, patients as customers, records as assets, and workers as costs to be minimized. It normalizes private equity, monopolies, predatory pricing, medical debt, pharmaceutical profiteering, commercialization of data, and the outsourcing of public responsibilities to corporations.

We refuse a health system that boasts of technological progress while people cannot obtain primary care, medication, safe housing, home care, reproductive services, mental-health support, palliative care, or culturally safe care.

We oppose austerity disguised as efficiency. We oppose privatization disguised as innovation. We oppose surveillance disguised as safety. We oppose extraction disguised as care.

A just health system must be universal, public, adequately funded, community-rooted, culturally safe, accessible, and accountable to the people it serves. It must invest upstream: in income security, public housing, education, food sovereignty, disability justice, harm reduction, clean water, healthy ecosystems, and meaningful public-health capacity.

6. Our Commitment

We therefore commit ourselves to:

  • Defend human dignity over speed, profit, automation, and institutional convenience.
  • Defend health as a collective right and reject its treatment as a commodity.
  • Identify and confront commercial practices that produce illness, environmental destruction, inequity, and barriers to care.
  • Follow the leadership of communities most affected by environmental injustice, commercial exploitation, and institutional neglect.
  • Insist that every artificial intelligence system used in health care be transparent, independently audited, explainable, contestable, and governed with meaningful public and worker participation.
  • Refuse algorithms that reproduce discrimination or replace clinical judgment, informed consent, and relationships of trust. Stand against racism, colonialism, ableism, sexism, homophobia, transphobia, class exploitation, and xenophobia in health systems and society.
  • Demand that technology reduce harmful work and expand access to care, not intensify surveillance, cut staffing, deskill nursing, or deny services. My post on nursing profession and branding https://www.linkedin.com/feed/update/urn:li:activity:7496682545108025345/
  • Organize for safe staffing, fair wages (like programmers and coders once were paid), public health infrastructure, union rights, and workplaces where nurses can speak honestly without retaliation (regulatory harms have still not been addressed explicitly and attrition continues to crisis levels). My post on trauma: https://www.linkedin.com/feed/update/urn:li:activity:7496346149822287873/ ; my post on regulatory harms https://www.linkedin.com/feed/update/urn:li:activity:7496353936921071616/
  • Treat climate disruption as a health emergency created by unequal systems of extraction, and advocate for care that protects communities and the living world.
  • Stand with patients and communities against medical debt, privatization (yes Canada, you too), predatory pharmaceutical practices, corporate consolidation, and the commodification of suffering (CDoH, 2022). post on global power demand by 2030 https://www.linkedin.com/feed/update/urn:li:share:7255265303691997184/
  • Advocate for public, universal health systems free from corporate capture and private-profit priorities.
  • Center the knowledge and leadership of Indigenous peoples, Black communities, disabled people, migrants, low-income communities, and all those harmed first and worst by unequal systems. (Can we please collect wealth tax, and stat? Harrington, 2025)
  • Protect the right of every person to understand, question, and refuse the technologies affecting their body, records, treatment, and future. (Once people lose mental capacity, at any age, what happens to their digital footprint and logins. Read up on digital-afterlife industry) my post: https://www.linkedin.com/feed/update/urn:li:activity:7496323674120048640/
  • Practice solidarity across professions, sectors, and borders, because no individual nurse can solve harms produced by structural power.
  • Protect clean water, sanitation, healthy ecosystems, and climate stability as indispensable conditions of health.
  • Treat nursing expertise as essential to governance, policy, technology design, climate adaptation, public health, and community-led care, not as inexpensive labour or an afterthought in executive decisions.
  • Build care systems based on solidarity, reciprocity, prevention, justice, and ecological repair.

7. A Call to Conscience and Action

In 2030, conscience requires more than compassion.

It requires courage. Not only to speak for/with patients, families and communities, but to speak against professional toxic culture, leadership, and stagnant professional envelopment. It requires collective action against the systems that manufacture illness and call the consequences unavoidable.

It requires us to ask not only, “Can this technology be used?” but “Who does it serve? Who exposed to/ bears its risks? Who profits? What forms of care, labour, and life does it displace?” Who is left waiting, excluded, displaced, or silenced?

I have held a role as a nurse informatics, merging duplicate files because IBM refused to adapt their infrastructure. Are informatics professionals seen as human-in-the-loop or human-exploited-in-the-loop?

It requires us to understand that a healthy society cannot be built on exhausted workers, disposable patients, automated exclusion, or a damaged planet. We CAN however, pivot workforce roles and pay people to do human jobs, like witnessing and delivering care where it’s needed. (Pugh, 2026)

Care cannot be ethical if it relies on ecological destruction. Innovation cannot be just if it is built on surveillance, dispossession, or underpaid labour. Health cannot exist where water is unsafe, homes are unaffordable, ecosystems are collapsing, and human needs are subordinated to corporate return.

We will not be reduced to exhausted labour, automated compliance, or human cover for decisions made by machines and markets.

We call on nurses to reclaim our collective (yet, diverse) voice. We call on health workers to organize. We call on institutions to place care above revenue (wealth tax helps here). We call on governments to regulate health technologies in the public interest and to fund universal, accessible, community-rooted health care.

We call on the public to reject a future in which the right to health is determined by an algorithm or a balance sheet.

Care is not a product. Health is not a privilege. People are not (just) data to be extracted and sold.

The planet is not expendable.

We will not be silent witnesses to systems that harm in the name of progress.

We will practice, organize, resist, and build a future in which care remains human, collective, just, and sustainable.

We are nurses. We are advocates, clinicians, educators, organizers, researchers, knowledge holders, and defenders of the conditions required for life.

We will care for people and we will fight for the world in which people can be well.

8. About the Author

The Nursing Manifesto 2030 builds upon and expands The Nursing Manifesto 2000, the pioneering work of Richard Cowling, Sue Hagedorn, and Peggy Chinn. In the age of AI, provenance is one of the most important forms of acknowledgement, demonstrating that ideas and thoughts never simply appear, but are cultivated, grazed, turned over, and digested with time, patience, and communal support. The original authors all came from white, middle-class backgrounds and grew up in diverse regions of the United States (New York, Hawaii, Virginia), with relatively privileged access to education, travel, and cultural experiences. Yet early in their lives, each followed personal and political paths that challenged the status quo, often to the chagrin of family and friends. Though not always overtly “political” on the surface, their journeys reflected a deep yearning for peace, justice, and the caring, nurturing values they perceived to be at the heart of nursing. They came together to prepare the text for A Nursing Manifesto 2000, informed by their shared awareness of the deeply political nature of personal choices.

Renata E. Mares, author of The Nursing Manifesto 2030: Human Care Against Extraction and Exploitation (green paper), brings both continuity and distinct difference to this legacy. Born in 1984 in Oradea, Romania, a region marked by Hungarian legacies and Romanian cultural tensions since the 1920s (Treaty of Trianon), she became a refugee at age four when her family fled the communist regime in 1988. She grew up in post-communist Hungary (schooling) and Romania (summer vacations), experiences that shaped her social justice and ethical compass, and led her to challenge oppressive and racist systems throughout her nursing career. Her father and brother spend fiver years (1990-95) in Rochester, New York in hopes for her mother and herself to follow but at that time families could not easily join. Her family immigrated to Guelph, Ontario, Canada in 1996 and has called this place home even across her decades of travel and nursing. Since nursing school in Canada (2003–2008) and continuing through diverse roles in ortho-trauma, med-surg, rehabilitation, mental health, long-term care, public health, outbreak management, policy consulting, education, and global humanitarian work (2009–2019), she has consistently challenged the status quo, even when it meant alienating friends, colleagues, and family. Today, she firmly believes nursing remains the most human-centered profession, uniquely positioned to challenge profiteering practices, build regulatory and safety guardrails through healthy public policy, and resist automation of human-care work. Grateful to the original manifesto authors for helping her articulate the political nature of her own choices, she writes in hopes that reflection, awareness, and philosophy will offer others the same healing she has found through two decades of honest practice in nursing and across the health system.

9. References

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“Overdue Reckoning” Gatherings Postponed


Due to unforeseen conflicts, we need to postpone the gatherings planned for April 18th and 25th. We will post plans for resuming the discussions here – so stay tuned! Meanwhile, please used the comments below to share your ideas and reflections on your experiences – an participate in a bit of online discussion!

Overdue Reckoning Sessions Scheduled!


Register here

The original “Overdue Reckoning” team – Lucinda, Christina and Peggy – have scheduled four sessions that will examine the government assault against people of color, particularly Black and Brown Americans and immigrants, rooted in structural racism and systemic oppression, and explore how these policies harm not only targeted communities but society as a whole.

Save the dates!

March 28, April 4, 18 & 25. 5 pm Eastern

We are creating this Zoom space for 4 weeks so that we can talk about our experiences, what we are feeling, experiencing, and how what is happening is real. It is life and death for some of us. It is affecting all of us in ways that are harmful and destructive. It is also creating the opportunity and the necessity to build community.

None of us can tackle the challenges alone. We need honest conversations. We can no longer be silent. We need to build community so that we can be strategic

We are creating a space in which we can talk about our experiences, what we are feeling, experiencing, and how what is happening is real. Life and death for some of us.

We need to build community to overcome the fear that is intended to disempower us. We need to build community so that we can take strategic action. All of us, as nurses, joined together in our resolve to reckon with racism, and with the governmental powers that have now been activated to bring harm on our communities.

Register to join us in these vital discussions – we will send the zoom link to everyone who registers a short time before the first session on March 28th.

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Nurses’ Voices as a Political Force


We acknowledge that there have been a few formal statements from nursing organizations in response to these actions. See in particular the strong Statement from the Washington State Nurses Association on the killing of Alex Pretti. National Nurses United has organized to oppose ICE presence in healthcare facilities. On January 24th the ANA issued a brief statement about the killing of Alex Pretti, but without mentioning their own Code of Ethics. See also Nursing Groups, Colleagues Speak Out on Killing of ICU Nurse in Minnesota. The National Black Nurses Association issued a powerful statement on January 25th –

2/3/2026 Update on organization statements

American Nurses Association (with petition “Demand Truth for Alex Pretti”)

Nurses for America

Standing Up For Access to Vaccines in the United States


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 immunityhttps://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 Research23(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 Immunology150(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