By The Herald Editorial Board
The next time you go to your pharmacy for a vaccine or booster for you or your child, you might have less of a shot at getting a shot.
According to recent media reports, a nurse who works at Harboview Medical Center in Seattle was turned away by two separate pharmacies after requesting a covid booster shot. Leigh Halderman, reported CNN earlier this month, is pregnant and wanted the vaccine because she had experienced some complications with her first pregnancy and her obstetrician had recommended the covid booster.
Halderman went to a Walgreens and checked in. “As soon as the pharmacist saw that I was pregnant, they were like, ‘We cannot give this to you,’ ” she told CNN. “‘We’re only giving it to immunocompromised people right now.’”
Yet, the American College of Obstetricians and Gynecologists points to research that pregnant women who have covid are more likely to to have a cesarean birth, preeclampsia, eclampsia and blood clots; more likely to need care in an intensive care unit or with a ventilator; and more likely to die. As well, the vaccine for pregnant mothers provides protection for infants until 6 months of age when they can receive their own shot.
Halderman consulted her primary care provider and obstetrician, but neither had the vaccine in stock. And when she then went to a Safeway pharmacy, she was turned away again because of her pregnancy.
This follows a decision by Health and Human Services Secretary Robert F. Kennedy Jr. in late May that the Centers for Disease Control and Prevention would drop its long-held guidance that recommended the covid vaccine for “healthy children and healthy pregnant women.” The CDC later amended that guidance to again recommend the vaccine for children 6 months and older.
This is guidance that typically had been determined by the CDC’s Advisory Committee on Immunization Practices, with final approval by the CDC’s director. But earlier this month Kennedy dismissed all 17 members of the vaccine panel and began replacing them with new members, at least some of whom are vaccine skeptics or have promoted conspiracy theories about vaccines. As well, a director for the CDC has yet to be confirmed by the Senate.
And that guidance is significant as it can determine which vaccines will be covered by insurance plans and if pharmacies will dispense them. While no changes were made to the childhood vaccine schedule after a two-day meeting of the immunization panel, the committee made clear its intention to revisit that schedule.
‘A blind spot’ for county health: The news, also covered by public radio station KNKX (88.5 FM), caught the notice of Dr. James Lewis, health officer for the Snohomish County Health Department, as health providers, pharmacies and patients struggle with the confusion following policy and personnel changes and turmoil within the federal Department of Health and Human Services and the CDC.
At the same time it’s produced “a blind spot” for the department, Lewis said in an interview this week, as public health officials confront the confusion and advise patients about vaccines and providers about their duties.
The reports of two pharmacies turning away at least one prospective patient didn’t involve Snohomish County pharmacies, Lewis said, but did involve national chain pharmacies with outlets in the county.
“I don’t know if this was an individual pharmacist making that decision, or a company policy following federal guidance,” Lewis said, although he suspects it’s been policy for such national chains to follow federal CDC guidance.
“That being said, our state Department of Health did issue guidance that says Washington state providers should continue to provide covid vaccines as they were previously recommended before the changes from Secretary Kennedy,” he said. “Providers here in Washington should be following that state guidance.”
The state Department of Health continues to recommend that everyone 6 months and older, including pregnant women, receive the current covid-19 vaccine and boosters to protect against severe illness.
“Our priority,” reads the DOH website, “remains ensuring equitable access to COVID-19 vaccines. The COVID-19 virus continues to pose serious health risks in Washington state, including hospitalizations, long COVID, and preventable deaths. These risks are most prominent in pregnant people, young children, older adults, people with chronic conditions, and those who remain unvaccinated.”
Both the American College of Obstetricians and Gynecologists and the American Pharmacists Association have urged the CDC to return its guidance to recommend the covid vaccine for pregnant women.
National chains, however, may decide to set a blanket policy that covers all stores they operate, sticking with the CDC guidance to avoid a patchwork of state rules.
‘Pharmacy deserts’: The limitations on who can get access to which vaccines and other medications is further complicated by the continued expansion of “pharmacy deserts,” where people in rural and urban areas live more than 15 minutes from a pharmacy, an expansion that has been driven by the closure of privately owned community-based pharmacies, such as the closure of Darrington’s pharmacy in June of 2023, and closures of regional chains. Last week, Bartell Drugs, a long-running regional chain, announced the closure of its remaining 20 locations and the pending rebranding of those locations to national chain CVS.
At the height of the covid pandemic it was common for doctors’ offices and medical providers such as The Everett Clinic — now Optum — to make the vaccine available during office visits or schedule vaccine clinics. More recently, pharmacies had resumed the practice of routinely offering vaccines.
It can be difficult, Lewis said, for medical providers to carry a sufficient inventory of vaccines, particularly for adults, further relying on pharmacies to administer vaccines.
“Because most pharmacies are national organizations, if we change a lot of federal level guidance, and the pharmacies continue to defer to federal level guidance, then that’s really going to hinder people’s ability to get vaccines that they want to get,” Lewis said.
There’s also a problem looming, the health officer said, regarding recommendations from the new vaccine advisory panel in regard to vaccine availability through the CDC’s Vaccines for Children program, which provides free vaccines for low-income families. The vaccines available are tied directly to the recommendations of the CDC’s advisory panel.
Families who wanted a specific vaccine no longer available through the program would have to pay out of pocket, Lewis said, and that’s if they can find a pharmacy or provider that has it in stock and will give the shot.
Thursday, the reconstituted advisory panel walked back longstanding recommendations for flu vaccines that contain thrimersol, a preservative that the anti-vaccine movement has falsely linked to autism. Dozens of studies have shown the ingredient to be harmless, according to the Food and Drug Administration.
Personal responsibility: Lewis has recommended to the state Department of Health that it work with the pharmacy association to look at what regulatory authority the state may have to require pharmacies in the state provide the vaccine to pregnant women who request it.
At the same time, he also recommends that pregnant women ask their doctors for a prescription for the vaccine to present at pharmacies. The county health department also wants to hear from anyone who is having difficulty in obtaining a vaccine.
”We want to hear from people if they are running into these problems, because we do want to amplify this and see how widespread this is,” Lewis said.
As a reconstituted CDC advisory panel prepares to make wholesale changes to vaccine schedules that could affect the cost and access to vaccines for children and adults, individuals and families will have to work more closely with their doctors to protect their health.
And they should be raising their concerns with their members of Congress regarding Secretary Kennedy’s leadership, his handpicked advisers and their preconceived and ill-informed meddling in public health policy.
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