Another Pandemic 'To Do' on the List for Schools: Contact Tracing

KFF Health News, May 13, 2021

Public health officials and educators are teaming up to track students who may have been exposed to the coronavirus.

This article was published on Thursday, May 13, 2021 in Kaiser Health News.

By Brett Dahlberg, WCMU

Chris Hodges, the principal of Gaylord High School in Otsego County, Michigan, never thought he'd be a contact tracer.

"I definitely thought, you know, 'Why — why am I doing this?'" he said with a laugh. "That's not what I went to school for."

In what has become a regular part of his school day, Hodges fields reports on his charges such as hearing from the Health Department of Northwest Michigan that a student had tested positive for the novel coronavirus and was in school for three days when she might have been contagious.

One Tuesday in April, after the school day was over, he found himself walking the almost-empty halls with a laptop and a tape measure, making a list of other students who sat close enough to their sick classmate that they would need to quarantine.

Lisa Peacock, health officer for the department, said that without the school district's help it would be "literally impossible" to keep up with contact tracing.

The school-age population has accounted for a growing share of recent coronavirus cases across northern Michigan, and Peacock said quickly identifying people exposed to those cases and telling them how to quarantine is crucial to protecting communities and containing spread.

When Hodges first started helping the health department with contact tracing, he found himself calling teachers on weekends, holidays and late in the day after they'd gone home, asking them where a particular student sat and struggling to orient himself in the classroom as they described the student's position over the phone.

It happened so often that he's now requiring each teacher to keep an up-to-date seating chart in a bright-yellow folder on top of their desk so he can find it easily.

But in this case, the teacher, Hannah Romel, was still at school. The student Hodges was tracing is in her yearbook class, which has different seating arrangements every day. Romel handed Hodges the three charts, and he got to work.

In each place Romel had marked the student, Hodges extended his tape measure to the surrounding desks.

Teachers have spaced their seats out as much as they can, he said, but sometimes they can't quite get to the 6-foot distance required to avoid counting as close contact.

(The federal Centers for Disease Control and Prevention updated its guidance last month to allow for 3-foot distancing between desks, but only in communities where transmission is low. In this district, Superintendent Brian Pearson said, during Michigan's recent surge in cases, 6-foot separation is the standard.)

Hodges moved quickly, both because if he didn't complete the contact tracing the same day, the school can't open the next, and because he wanted to get in touch with the families of students exposed to the virus right away.

"We want to make those phone calls as soon as we can, so that those students aren't at work, aren't at church, aren't going to other people's houses. We want to prevent the spread of COVID not only inside our walls, but in our community," he said.

Hodges will then pass on information about who was in close contact with the student to the local health department. Other nearby school districts run similar operations.

Nationally, this kind of relationship between schools and health departments is not typical in normal times, but it is happening with some regularity during the pandemic, said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials.

Public health funding has declined over the past few decades, she said, forcing local departments to cut staff members who could have boosted their contact-tracing capacity.

Still, getting schools and health departments to work together can greatly help communities, Casalotti said.

Peacock, the local health officer, said that once her staffers get word of exposures at local schools, they will also get in touch with the families to talk them through the details.

"People always have questions," she said. "They have questions about 'What does this mean? What does it mean that I'm quarantined for 14 days?' We recognize that."

And, in some cases, the health department needs more information than Hodges can give, Peacock said. They might want to find out whether a coronavirus variant is at play, or do a more detailed investigation of how students got sick and where they were when contagious.

Back in Romel's yearbook classroom, Hodges found two students sat just shy of 6 feet from their classmate who tested positive. They'll need to quarantine for two weeks from the date of their last exposure.

Romel said she's still surprised to hear the news that a student is sick.

"I worry about the kid," she said. "I hope that it's a mild case, and they get to just be OK and get back to school after their quarantine period and come back and be learning with us again."

After a quick chat with Romel about whether the class did any group work on the days in question (they didn't, which Hodges said is a relief, because it complicates his process), he headed off to the next classroom.

In all, 14 students will be quarantined as a result of exposure to this coronavirus case.

It's a lot, Hodges said, but it's a far cry from the number of quarantines stemming from a single day last month when 15 students tested positive, and each of them had several close contacts.

Making phone calls to families informing them their child will need to stay home from school for up to two weeks is not an enjoyable part of the day, for him or the families, said Hodges, but he's gratified to play a role in mitigating the extent of the pandemic.

This story is from a reporting partnership that includes WCMU, NPR and KHN.

You've Added Your Kids to Your Health Plan. What About Mom?

KFF Health News, May 13, 2021

California would be the first state to extend commercial health insurance benefits to dependent parents.

This article was published on Thursday, May 13, 2021 in Kaiser Health News.

By Samantha Young

SACRAMENTO — When Laura Chavez's 74-year-old mom needed eye surgery last month, Chavez paid cash for the procedure.

The cost? $15,000 — and that was for just one eye. She couldn't afford both.

Her mom, Esperanza Chavez, doesn't qualify for Medicare because of her immigration status. And she can't find a private health insurance plan under $1,000 a month.

"We're constantly having to make decisions based on costs rather than 'Is this medication really going to help keep you alive and healthy?'" said Laura Chavez, 41, a San Franciscan whose mother has diabetes. "It's just unfair to have to think about it that way."

Now a California lawmaker is pushing a bill that would require private health plans regulated by the state to extend coverage to some subscribers' parents. Business groups and others fear the legislation could jack up insurance premiums, but the bill has strong backing from health advocacy and immigrants' rights organizations, as immigrants make up a sizable portion of California's uninsured population.

Policyholders can already add children up to age 26 to their health plans — a benefit available nationally under the Affordable Care Act. But California would be the first state to extend the benefit to dependent parents, who are expensive to cover because they are older and sicker than the overall population, health experts say.

"This is groundbreaking and, quite frankly, a shift in the paradigm about the way we think about people getting healthcare," said Assembly member Miguel Santiago (D-Los Angeles), author of AB 570. "The bottom line is we want everybody to get healthcare, and we will fight every angle to ensure that people get adequate healthcare."

Many states have experimented with how to cover America's roughly 33.2 million uninsured people, about 400,000 of whom are 65 or older. California's income-eligible children can receive public health insurance regardless of their immigration status, New Jersey parents can cover a dependent child up to age 31, and Floridians can cover their kids up to age 30 so long as they aren't married or don't have dependents of their own.

One group that would benefit from California's legislation, backers say, would be green card holders who haven't met the five-year waiting period to qualify for Medicare and Medicaid, and those here without legal permission.

While striving to cover parents is a laudable goal, said Sherry Glied, a former assistant secretary at the U.S. Department of Health and Human Services during the Obama administration, employers could face higher insurance premiums.

"This is an expensive population, and it's also susceptible to real risks," said Glied, now dean of New York University's Robert F. Wagner Graduate School of Public Service.

Glied fears some people would abuse the coverage. For instance, she said, someone could bring an ailing parent into the country on a tourist visa, sign them up on their employer's health plan and arrange for the treatment they need.

California already gives income-eligible unauthorized immigrants up to age 26 full benefits from Medi-Cal, the state's version of Medicaid for low-income people. Lawmakers are considering separate proposals to further broaden Medi-Cal eligibility. One bill targets undocumented immigrants age 65 and up, and another would make all Californians eligible regardless of age or immigration status. Similar efforts have failed repeatedly over the past several years because of cost concerns, but California now has a $75.7 billion budget surplus.

Unlike the Medi-Cal measures, which rely on state funding, the bill authored by Santiago, working with California Insurance Commissioner Ricardo Lara, would transfer the cost onto employers and insurance companies. It would allow parents or stepparents — regardless of age — whose children claim them as dependents on their taxes to be added to private health plans regulated by the state. They include job-based plans and those purchased on the open market or through Covered California.

Employer-sponsored plans regulated by the federal government would not be subject to the bill.

The Assembly Health Committee has approved the bill, which needs to clear the Assembly Appropriations Committee before heading to the full Assembly for a vote.

It's hard to pinpoint how many Californians could benefit from the measure. Nationwide, about 3.4 million people were claimed as dependents on their children's tax returns in 2019, and an estimated 400,000 of them lived in California, according to an analysis by the California Health Benefits Review Program.

The overwhelming majority of those parents already have health coverage through Medicare or Medicaid, the analysis concluded, leaving 20,000 to 80,000 Californians who could benefit.

Despite the relatively small number, California employers say this mandate would raise premiums by $200 million to $800 million a year, depending on how many people signed up.

"Small employers will be forced to reassess how much they can contribute to employees' dependent premiums," Preston Young, a policy advocate at the California Chamber of Commerce, told lawmakers at a recent Assembly Health Committee hearing.

Lara, California's insurance commissioner — whose parents were once undocumented immigrants — said the bill would help the poorest of the Golden State's families, giving those with no other options "substantial peace of mind."

"When we needed care as children, our parents were always there for us," Lara said. "As our parents age, a lot of us in turn have become their caretakers."

Chavez finds herself in the role of caretaker to her children and her mother. She has insurance for herself and her two daughters through her employer, the nonprofit organization Challenge Day.

But she can't afford to buy a comprehensive insurance plan for her mom on the open market. A bare-bones policy, Chavez said, costs more than $1,000 a month because her mom has preexisting conditions. She doesn't qualify for Medicare or Medicaid because she is in the United States without authorization.

If Chavez could add her mom to her job-based policy, she wouldn't have to pay cash for her mom's needs, and the whole family could share one deductible and one cap for out-of-pocket costs, she said.

"It would bring significant financial relief," Chavez said. "Every month, there are charges we have to budget for and pay for. God forbid she has to go to the emergency room."

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Healthcare Foundation.

Samantha Young: syoung@kff.org, @youngsamantha

Don't Eat the Yellowstone Snow: Elite Ski Resort Aims to Turn Sewage Into Powder

KFF Health News, May 12, 2021

The Yellowstone Club, a ski and golf resort just north of Yellowstone National Park, has asked the Montana Department of Environmental Quality for a permit to allow it to use wastewater for snowmaking operations on its ski slopes. 

This article was published on Wednesday, May 12, 2021 in Kaiser Health News.

By Justin Franz

An exclusive Montana resort wants to turn sewage into snow so that its rich and famous members can ski its slopes in a winter season that’s shrinking because of climate change.

The Yellowstone Club — a ski and golf resort just north of Yellowstone National Park that counts Bill Gates, Justin Timberlake and Jessica Biel among its members — has asked the Montana Department of Environmental Quality for a permit to allow it to use wastewater for snowmaking operations on its ski slopes.

About a dozen other ski areas across the U.S. have used wastewater to make artificial snow before, but the Yellowstone Club would be the first in Montana. The technique has also been used in Europe and Australia.

Officials at the club say the program would not only ensure the slopes can open on time, usually in late November and early December, but also replenish the area’s watershed and keep streams running longer into the season. And it would allow the growing Big Sky resort area to handle its increasing wastewater volumes.

“It’s an outside-the-box-idea,” said Rich Chandler, environmental manager for the club. “But it also checks a lot of boxes.”

Is it a safe plan for the rich and famous who will occasionally ingest it when they wipe out on the slopes? The short answer from state officials is yes. The method is safe for people and the environment as long as there is close monitoring to ensure contamination levels stay within standards, according to an environmental analysis.

But, the state officials said, that analysis did not study potential pollutants for which there are no environmental standards in wastewater, such as traces of prescription drugs.

A similar effort to turn wastewater into snow was controversial at the Arizona Snowbowl ski resort near Flagstaff. To combat snowless winters there, the resort in the early 2000s purchased wastewater from Flagstaff and pumped it from the treatment plant to the ski area, where it would be turned into snow and sprayed onto the San Francisco Peaks.

That drew protests from the Hopi Tribe, which said the artificial snow posed risks to public health and the environment and would desecrate a mountain it considers sacred. The tribe lost a legal challenge to prevent the Arizona ski area from moving ahead with the plan. In December 2012, the ski area fired up its snow guns and started making powder.

During the legal fight, environmental groups, including the Center for Biological Diversity, raised specific concerns about how wastewater can reduce local aquatic populations and cause some male fish to take on female appearances and reproductive traits.

Wastewater’s effect on human health also raises concerns. Although modern water treatment can eliminate many pollutants — and, in some instances, prepare that water for human consumption — some elements still escape the process, specifically pharmaceuticals. The research is in its infancy, but a 2017 study by the United Nations Educational, Scientific and Cultural Organization found that only half of the pharmaceutical compounds were removed in the water treatment process. It noted that evidence suggests some of the chemicals could affect human reproductive systems, too, just as studies have shown on aquatic life.

“Modern wastewater treatment plants mostly reduce solids and bacteria by oxidizing the water. They were not designed to deal with complex chemical compounds,” said Birguy Lamizana-Diallo, program management officer at the United Nations Environment Program and an expert on wastewater treatment.

Officials in Montana are quick to point out differences between their plan and what happened in Arizona. For one, the ski area near Flagstaff often makes all its snow from treated wastewater, whereas the Yellowstone Club will use it, at least initially, on only about 10% of the 2,700 acres of skiable terrain and usually only in October and November to create a base layer for its ski runs. Come December, most of the snow people would be skiing and riding on would be natural.

But perhaps the biggest difference between the two projects is the level of support the Yellowstone Club has for its plan, which is backed by environmental and conservation groups including the Gallatin River Task Force, the Association of Gallatin Agricultural Irrigators and Trout Unlimited.

The idea to turn Big Sky’s wastewater into snow has been brewing for more than a decade and emerged from a collaboration between the Yellowstone Club and other local groups concerned about depleted snowpack due to climate change, which could starve area creeks and streams of water later in the season.

Yellowstone already uses treated wastewater to hydrate its golf courses, and in 2011 it teamed up with the Montana DEQ and the Gallatin River Task Force to see if they could safely turn the same water into snow. Chandler, the club’s environmental manager, said they successfully turned a half-million gallons of wastewater into 2 acres of snow about 18 inches deep.

Kristin Gardner, executive director of the Gallatin River Task Force, said the snowmaking process effectively re-treats the wastewater by blasting it out of a filtered snowmaking gun that atomizes the water.

“It’s an added layer of security for the human health side of things,” Chandler said.

Chandler said the information gathered from the pilot study forms the core of the ski club’s application with the Montana DEQ. A draft permit tentatively approving the project has been issued by the state agency, and a final decision is expected later this year.

Officials at DEQ said that the wastewater used to make snow will be treated to the highest standards possible and that they can issue permits only to projects that will not pollute state waters. But the effect of pharmaceuticals remains uncharted territory. Amy Steinmetz, public water supply bureau chief, said that neither the DEQ nor the U.S. Environmental Protection Agency has standards to specifically treat wastewater for pharmaceuticals.

“The science is still emerging on that,” she said.

If the DEQ does issue its final permit this year, the Yellowstone Club will most likely begin turning wastewater into snow in late 2022. It would then be required to post signage advising skiers not to consume the snow. Similar signage can be found at Arizona Snowbowl.

Chandler said that the Yellowstone Club is proud of the collaborative work and that, ultimately, the process will benefit the community and watershed. Making more snow and increasing the snowpack during the winter, Chandler estimates, will increase the summer runoff in area creeks by about 19 days, a big win in the increasingly arid West. It’s also better than the alternative, he said: treating the wastewater and then just pushing it directly into the Gallatin River.

“It’s not like the Earth is producing more water, so we have to use what we have effectively,” he said.

COVID Fears Keep Many Latino Kids Out of Classrooms

KFF Health News, May 12, 2021

Latinos have been hit disproportionately hard by COVID, and many families are opting out of in-person learning.

This article was posted on Wednesday, May 12, 2021 in Kaiser Health News.

By Heidi de Marco  

EAST LOS ANGELES — For the past year, 13-year-old twins Ariel Jr. and Abraham Osorio have logged on to their online classes from their parents' flower shop. Ariel nestles in a corner among flowers, bows and stuffed animals. Abraham sets up on a small table in the back, where his dad used to work trimming flowers and keeping the books.

It's not ideal for learning: It's loud. It's cramped. It's bustling with people. Still, when the twins' mother, Graciela Osorio, recently had the chance to send her kids back to Brightwood Elementary in Monterey Park, California, she decided against it.

"After what we went through with their father, I'd rather keep them at home where I know they are safe," said Graciela, 51. "There's only a month left. It doesn't make sense that they return for such a short time."

The boys' father, Ariel Osorio Sr., 51, died of COVID-19 in January, four weeks after a trip to Mexico to visit his mother. He fell ill quickly and wasn't able to say goodbye to his children.

"I miss his presence," Abraham said. "I'm used to seeing him sit in his chair working, but not anymore."

Latinos have been hit disproportionately hard by COVID, and many families are opting out of in-person learning.

In California, Latinos make up 39% of the state's population but account for 47% of COVID deaths, according to the state Department of Public Health. Nationally, their risk of death from COVID is 2.3 times higher than that of whites.

Latinos are vulnerable to the highly transmissible coronavirus because they are more likely than non-Hispanic whites to work essential jobs that expose them to the public, said David Hayes-Bautista, a professor of public health and medicine at UCLA and co-author of a January study on this topic. They are more likely to lack health insurance, which may make them less likely to seek medical care, he said. And they are more likely to live in multigenerational households, which means the virus can spread quickly and easily within families.

"Many of them are essential workers and the breadwinners for their families and don't have the luxury of telework, of physical distancing and self-isolation," said Alberto González, a senior health strategist at UnidosUS, a Latino advocacy group in Washington, D.C.

The Osorio family has lived in a multigenerational household since Ariel died, and Graciela had to keep other family members in mind when deciding whether to send her boys back into the classroom.

In February, Graciela and the twins moved in with her 74-year-old mother, Cleotilde Servin, in East Los Angeles. Ten people now share the roughly 1,000-square-foot home, squeezing by one another in the kitchen every morning.

Graciela's mother and the other adults in the home have been vaccinated, but the children haven't. Even though she instructs her sons to wear their masks and doesn't allow them to visit friends, she's terrified of what could happen if her kids caught the virus at school and brought it home.

"My mother is active and takes vitamins, but it still worries me," Graciela said. She got COVID from her husband and gave it to her sister and niece. "I don't want anyone else to get sick," she said.

State and local education officials don't have recent data on in-person attendance by race, but an EdSource analysis of California Public Health Department data from February shows that white students were more likely to attend school in person than other students. The analysis showed that 12% of Latinos were attending in-person classes at least some of the time, compared with 32% of whites and 18% of all students.

The Los Angeles Unified School District, the second-largest in the country, serves more than 600,000 students and reopened for in-person learning in mid-April. Only some campuses are open, mostly elementary schools, and are running on hybrid schedules, combining on-campus classes with distance learning.

"We've upgraded the air filtration systems in every classroom, reconfigured school facilities to keep all at a school appropriately distanced, doubled the custodial staff, and we'll provide weekly COVID testing at school for every student and staff member," district superintendent Austin Beutner said in his weekly recorded video update on March 22.

In a statement released May 4, Beutner said 40% to 50% of elementary school students are now back in schools in "more affluent" communities compared with roughly 20% in low-income communities.

"We see the greatest reluctance for children to be back in schools from families who live in some of the highest-needs communities we serve," he said.

Brightwood Elementary is a K-8 school with 870 students, about half of whom are Asian American and 40% Latino, said principal Robby Jung. Just 15% of students are back on campus, he said, and, of those, about one-third are Latino.

For the Osorio family, the overriding reason the eighth grade twins are not back at Brightwood is fear.

Like so many other Latino families — roughly 28,000 Latinos have died of COVID in California — they are reeling from the grief and trauma that the disease has already wrought, and the fear of what it could do if it struck again.

"The boys are seeing a therapist to deal with their dad's death," Graciela said. "I know I should probably talk to someone, too."

With the memory of her husband's death still so fresh that she can't speak of him without crying, Graciela is still adjusting to the emotional toll, and to the day-to-day realities of running a flower shop by herself.

Originally from Guerrero, Mexico, she started Gracy's Flower Shop with her husband in 1997. Ariel took care of the finances at home and at the shop and was the better English speaker of the two.

"Now being alone with the boys, it's more difficult to keep up," she said.

During the COVID lockdowns, the boys joined the couple at the shop. Her husband sat next to their children while they attended school online, helping with their homework and acting as the main contact for the school.

"They were always with us," Graciela said. "They grew up in the flower shop, so they didn't have a problem setting up their school stations there."

Brightwood reopened its doors April 12, offering in-person learning two days a week for a few hours a day, with the rest of the sessions online. Graciela said the limited schedule doesn't work with her role as the family breadwinner.

"I would have to take them to school, pick them up for lunch and then bring them back," she said. "I can't do that. I have to work."

But mostly she's keeping them off campus because she doesn't want to lose another family member. She said she knows online classes aren't the same as in-person instruction "but they have been keeping their grades up," she said. "I thank God I have good boys. They listen. They understand why I kept them home."

The last day of school is May 28. Ariel and Abraham said they're looking forward to high school in the fall. Still dealing with their father's death, the boys, who are shy and reserved by nature, are torn between returning to school in person or continuing their classes online.

"We might go back," Abraham said. "For now, we keep each other company."

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Healthcare Foundation.

Heidi de Marco: heidid@kff.org, @Heidi_deMarco

Biden Boasts About Equitable Senior Vaccination Rate by Race Without Data to Back It Up

KFF Health News, May 12, 2021

"There's virtually no difference between white, Black, Hispanic, Asian American," referring to vaccination rates among Americans 65 and up. -- President Joe Biden.

This article was posted on Wednesday, May 12, 2021 in Kaiser Health News.

By Victoria Knight

During May 3 remarks on the American Families Plan, President Joe Biden boasted that there was not much disparity in the vaccination rates for white Americans and Americans of color who are at least 65.

"And what's happening now is all the talk about how people were not going to get shots, they were not going to be involved — look at what that was — we were told that was most likely to be among people over 65 years of age," said Biden. "But now people over 65 years of age, over 80%, have now been vaccinated, and 66% fully vaccinated. And there's virtually no difference between white, Black, Hispanic, Asian American."

This isn't the only time that Biden has made that claim.

He went even further on April 27 during remarks on the COVID-19 response: "And, by the way, based on reported data, the proportion — the proportion of seniors who have been vaccinated is essentially equal between white and seniors of color. … As a matter of a fact, if I'm not mistaken, there are more Latinos and African American seniors that have been vaccinated, as a percentage, than white seniors."

However, the national data that Biden keeps touting — vaccination statistics regarding both race and age — is not public. We asked the White House for the information underlying this claim, but officials did not provide specifics.

So, we moved on to the Centers for Disease Control and Prevention. Spokesperson Chandra Zeikel told KHN-PolitiFact on May 6 that "unfortunately, we don't have available a data breakdown of both racial demographics and age together." Zeikel didn't respond to a follow-up question asking when or if the CDC would be publishing this data, but current CDC vaccination data is broken down only by race/ethnicity and shows significant differences, with white Americans far outpacing the percentage of other groups getting a shot. It also shows that the rate of vaccinations among some groups, including Black and Latino Americans, does not match their share of the population, though new CDC data shows there has been some progress on this front in the past two weeks.

That made us wonder about the premise of Biden's statement. We turned to experts for their take.

"As far as I know, there is no comprehensive publicly available data on vaccination rates by race/ethnicity and age," Samantha Artiga, vice president and director of the racial equity and health policy program at KFF, wrote in an email. "As such, we are not able to assess whether there are racial disparities in vaccinations among people over 65 years of age."

What about other state-level data or anecdotes that might support Biden's claim? Let's dive in and see.

A Small Number of States Report Both Age and Race Together

At least seven states track vaccination based on a combination of age and race, according to Artiga: Michigan, South Carolina, West Virginia, Kansas, Minnesota, Washington and Vermont. (Vermont tracks only two racial categories: non-Hispanic white and a combination of Black, Indigenous and people of color.)

The results from some of these states show that racial disparities do exist in the older age groups.

In Michigan, for instance, over 50% of non-Hispanic white people ages 65 to 74 had completed their vaccinations as of May 11. Other racial groups — non-Hispanic Black people; Asian American and Pacific Islanders; and Hispanics — all trailed by about 10 percentage points. The exception was the Native American and Alaska Natives category, which was within 4 percentage points of white people.

And as of May 11 in Kansas, the rate at which white people in that same age group were vaccinated was higher than the rates of Black people and Native Hawaiian/Pacific Islanders.

In Vermont, for those 65 and up, about 79% of people of color had received at least one dose of the vaccine, compared with 85% of white people as of that date.

"With the exception of Vermont, which has the distinction of being the only state to target BIPOC [Black, Indigenous and people of color] populations by race explicitly, these are examples of states in which the numbers are not doing well in their equity efforts," Dayna Bowen Matthew, dean of the George Washington University Law School and an expert in racial disparities in healthcare, wrote in an email.

Minnesota is one of the few states in which people of color are actually being vaccinated at higher rates than white people — with 93% of Asian/Pacific Islanders and 87.5% of Black/African Americans age 65 and over having received at least one shot, compared with 81.5% of white people as of May 11.

Some states are vaccinating similar percentages of their population of Black or Hispanic people, Matthew said, however that data does not distinguish by age group.

According to Bloomberg's COVID-19 Vaccination Racial Gap tracker, New Mexico, Idaho, Oregon and Utah have vaccinated approximately the same percentage of Black Americans as are represented in each state's population. Maine, Ohio, Alabama, Louisiana and Missouri have achieved similar population-based rates for the Hispanic population.

KFF provides weekly updates on national and state race/ethnicity data of those who have received vaccinations, which have consistently shown that Black and Hispanic people are receiving smaller shares of vaccinations compared with their shares of the total population, while white people are receiving a higher share. The May 5 weekly update, for instance, found that based on the 42 states that share race/ethnicity data, the percentage of white people who have received at least one COVID vaccine dose (39%) was roughly 1.5 times higher than the rates for Black (25%) and Hispanic people (27%). (KHN is an editorially independent program of KFF.)

It's also important to note that data on race and ethnicity information has not been gathered for many people who have been vaccinated. As of May 3, the CDC reported that race and ethnicity were known for only 55% of all people who had received at least one vaccine dose. And three states, Montana, New Hampshire and Wyoming, don't report race/ethnicity data at all.

How to Approach Vaccine Equity, Experts Say

Nneka Sederstrom, chief health equity officer at Hennepin Healthcare in Minneapolis, said that her state has done an "excellent job" vaccinating the 65-and-older population but that there's still a lot of work to be done to reach communities of color.

We "will need more direct tactics to reach" those who haven't yet been vaccinated, "and help address any issues of hesitancy due to lack of knowledge or systemic barriers," Sederstrom wrote in an email.

Ensuring that vaccines are available at primary care providers is also important, said Dr. Georges Benjamin, executive director of the American Public Health Association.

"The truth of the matter is, the more vaccinators that we can get that are placed where people are every day, where it becomes a routine part of your life, such as going … into your doctor's office for a regular visit, that's a winner," said Benjamin.

But, Dr. Uché Blackstock, founder of Advancing Health Equity, an organization that advocates to end bias and racism in healthcare, said she would set the bar for vaccine equity success higher than just an equally proportionate share of a certain racial/ethnic population receiving their vaccine doses.

"What success in vaccine equity would look like would be if Black people or Hispanic people were overrepresented in terms of vaccine received since they have been disproportionately impacted by the pandemic," said Blackstock. So even though Biden quotes these statistics that lack data behind them, if the evidence did support them, it would still not be enough, she said.

In fact, the CDC does describe vaccine equity in those terms: "preferential access and administration to those who have been most affected by COVID-19."

Our Ruling

Biden has repeatedly claimed that vaccination rates among white people and people of color age 65 and older are virtually the same — or even higher among people of color.

No public national data from the CDC or another database has been released to support this assertion.

For the few states that do report data on age and race/ethnicity combined, the numbers suggest that, for the most part, obvious disparities persist in the vaccination rates for white seniors and seniors of color. In several states, vaccine administration rates are more proportional to the percentage of the Black and Hispanic populations, but the data covers all age groups. National data for all age groups also shows that rates of vaccinations for Black and Hispanic people lag behind that of white people.

Existing data paints one story on vaccine equity, while Biden's words paint another.

Without data to back it up, we rate Biden's statement False.

Sources:

The Associated Press, "AP Fact check: Biden overstates how many Americans immunized," May 3, 2021

Bloomberg News, COVID-19 Racial Gap Tracker, accessed May 5, 2021

Centers for Disease Control and Prevention, "Demographic Characteristics of People Receiving COVID-19 Vaccinations in the United States," accessed May 10, 2021

Centers for Disease Control and Prevention, "County-Level COVID-19 Vaccination Coverage and Social Vulnerability — United States, December 14, 2020-March 1, 2021," March 26, 2021

Email exchange with Centers for Disease Control and Prevention spokesperson Chandra Zeikel, May 6, 2021

Email exchange with White House administration official, May 6, 2021

Email interview with Manuel Pastor, director of the University of Southern California Equity Research Institute, May 5, 2021

Email interview with Nneka Sederstrom, chief health equity officer at Hennepin Healthcare in Minneapolis, May 5, 2021

Email interview with Samantha Artiga, vice president and director of the racial equity and health policy program at KFF, May 5-6, 2021

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KFF, Latest Data on COVID-19 Vaccinations Race/Ethnicity, May 5, 2021

Michigan.gov, COVID-19 vaccine dashboard, accessed May 10, 2021

Minnesota.gov, "Vaccine Data," accessed May 10, 2021

NBC News, "Biden Hails Progress on Vaccine Equity, but Some Local Leaders Paint a Different Picture," May 3, 2021

Phone/email interview with Dayna Bowen Matthew, dean and Harold H. Greene Professor of Law at the George Washington University Law School, May 6-7, 2021

Phone interview with Dr. Georges Benjamin, executive director of the American Public Health Association, May 6, 2021

Phone interview with Dr. Uché Blackstock, founder of Advancing Health Equity, May 6, 2021

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Victoria Knight: vknight@kff.org, @victoriaregisk

What the Slowing Vaccine Rates Mean for One Rural Montana County

KFF Health News, May 11, 2021

Gaps in vaccine uptake are starting to show, especially in rural America, leaving many communities grappling with an imperfect pandemic endgame.

This article was published on Tuesday, May 11, 2021 in Kaiser Health News. This story also ran on NPR.

By Katheryn Houghton

KALISPELL, Mont. — The covid vaccination operation at the Flathead County fairgrounds can dole out 1,000 doses in seven hours. But demand has plummeted recently, down to fewer than 70 requests for the shots a day.

So, at the start of May, the northwestern Montana county dropped its mass vaccination offerings from three to two clinics a week. Though most of those eligible in the county haven’t yet gotten a dose, during the final Thursday clinic on April 29, few cars pulled up and nurses had time to chat between patients.

“It’s a trickle,” said Flathead City-County Health Officer Joe Russell. “Not enough people will get vaccinated to reach herd immunity, not in Flathead County and maybe not in Montana.”

Daily covid vaccination rates are falling nationwide. Gaps in vaccine uptake are starting to show, especially in rural America. That leaves many communities grappling with an imperfect pandemic endgame.

Flathead stands out as one of Montana’s most populated counties to fall behind. There, 25% of people had been fully vaccinated by May 10. To compare, nearly 33% of Montanans were fully vaccinated, and that figure is closer to 35% nationwide.

Flathead County is a medical destination for the top corner of the state, a gateway to Glacier National Park and neighbor to two tribal nations. It’s Montana’s fourth-largest county by population with more than 103,000 people, yet it’s rural — 18 people per square mile. It’s also conservative, with the majority of residents voting for former President Donald Trump last year. National polling has shown rural Americans and Republicans to be among the most resistant to getting vaccines.

Russell said he hopes at least 40% of Flathead County residents eventually get the shots. That’s well below the 70% to 80% believed to be needed to create widespread protection from the pathogen that has stalled normal life.

Public health experts worry about reservoirs of the virus fueling outbreaks. That possibility further strains year-old tensions in places such as Flathead County, where strangers and family members alike can be split on whether the virus is a threat and the decision to wear a mask marks where people stand. Covid vaccines are the latest phase of that divide.

Cameron Gibbons, who lives outside Kalispell, has worried about how covid could affect her 13-year-old son. He’s had coughs turn into lung infections that landed him in the emergency room for trouble breathing, so the family has played it safe during the pandemic.

“We haven’t seen family in a long time because they haven’t chosen to be careful, which is OK, as long as when we get back to normal we can all set our differences aside,” Gibbons said. “Now there’s this judgment of ‘Oh, you got the vaccine.’”

Some of Montana’s most vaccinated places overlap with tribal nations. Chelsea Kleinmeyer, the health director of the Confederated Salish and Kootenai Tribes, said the tribes’ members seemed to largely accept vaccines after the pandemic disproportionately sickened and killed Native Americans. But the reservation crosses four counties, including Flathead.

“We travel to those counties every single day,” Kleinmeyer said. “It goes back to: Are we really protected against this virus, these variants, if we don’t achieve herd immunity?”

States are shifting from mass clinics to bringing shots to where people are, but that strategy, too, can be unpredictable. The same day of the county’s final Thursday clinic, the local health system hosted a walk-in clinic in the middle of the Flathead Valley Community College campus in Kalispell. Most of the chairs for people to wait 15 minutes post-shot remained empty and, by early afternoon, the clinic had to send 200 doses to the county health department to avoid wastage.

Although organizers had hoped to vaccinate at least 100 people that day, Audra Saranto, a registered nurse who heads Kalispell Regional Healthcare’s vaccination team, said she counts the college event as a success — 50 people got vaccines who might otherwise not have.

The health system may host similar clinics at major job sites, like for a lumber company. A mobile team will offer shots in busy places like farmers markets, even if it means risking people not following up for a second dose.

It’s not surprising that covid vaccinations aren’t universally accepted yet in this divided county. Flathead’s board of health deadlocked over mask rules and crowd size limits amid the area’s worst covid outbreaks. Two top county health officials resigned in the past year. Thousands of people have signed dueling petitions to remove or keep one board of health member who had stirred doubt over covid-19 cases and opposed mask rules.

And the city of Kalispell is home to state Sen. Keith Regier, a Republican who repeated false claims on the Senate floor last month that covid vaccines may contain microchips to track people. Regier said in an interview he was “offering caution in how we progress with this vaccination.”

Meanwhile, Whitefish, roughly a 20-minute drive from Kalispell, has maintained a mask ordinance that has outlasted the statewide mandate. Banners downtown show local leaders asking people to mask up so people can pray together and keep schools open. Even so, the rule isn’t always followed there.

At the county’s final Thursday clinic, John Calhoun, 67, undid his pearl snap shirt to get his second shot and joked with the nurse, “I’m doing this so Joe Biden doesn’t throw me in jail.”

Calhoun said he hopes being vaccinated will help him ease tensions the next time someone tells him to wear a mask. He believes covid-19 is real but doesn’t think it’s as serious as health officials claim, even though he has diabetes, a risk factor for covid complications.

“Nothing seems to bother me all that bad,” Calhoun said. “I had a horse fall on me, broke my hip, and once stabbed myself with a hunting knife. All that caused me a bit of a problem, but other stuff just doesn’t bother me.”

He decided to get the shot after an old high school friend with a degree in biochemistry told him it was important — an opinion Calhoun trusted over those of government-paid experts and liberal politicians who he said have used the pandemic to grab more power.

Calhoun said he’s still trying to talk his wife, Lola, into getting vaccinated to play it safe: “She’s one of those ladies that you don’t talk her into much.”

Lola Calhoun, 59, said she got her shingles vaccine within the past year because she trusts the protection it offers. When it comes to covid, she said she’d rather risk the virus than be injected with vaccines that feel too new, despite decades of research underpinning their unprecedented development.

“The covid vaccine to me is experimental and we are the case studies,” she said. “Maybe a year from now, I’ll see what happens to these people who got the vaccine.”

On a recent evening, Ray Sederdahl, 63, sat on his girlfriend’s Kalispell porch while his grandkids picked dandelions. The Air Force veteran said even if he wasn’t skeptical of the vaccines, he thinks of covid as an illness that’s much like the flu.

“The VA keeps trying to get me to schedule an appointment and I just say, ‘At this time, I’ll pass,’” Sederdahl said. “A lot of the older vets I talk to, they didn’t get it either, and they’re not gonna get it.”

To Sederdahl, things feel normal enough. Businesses are open and he doesn’t have to wear a mask most places.

Erica Lengacher, an intensive care unit nurse in Kalispell who has worked covid units and vaccine clinics, said she’s sad but not surprised that vaccine rates are slowing. But, she said, the overall feeling at the county’s vaccine clinics is hopefulness — people are still showing up, even if the crowds are smaller.

Lengacher said Flathead was hit so hard this winter, she hopes some natural immunity from those already infected, along with the growing vaccination levels, will be enough to hold off further outbreaks over the next few months.

“Just given our lifestyle — single-family homes, no public transportation, a few people per square mile — we may get away with it,” Lengacher said. “But there’s a big question mark of how variants show up here. There are just a lot of big question marks.”

As of May 10, the county had 116 confirmed active cases of covid, up from 71 on April 23.

Masks at the Campfire: Summer Camps for Kids With Medical Needs Adapt to Covid

KFF Health News, May 11, 2021

While mitigating the risk of covid infections at any of the country’s approximately 15,000 camps is a priority, it is an imperative for camps hosting people who might be at higher risk of serious illness.

This article was published on Tuesday, May 11, 2021 in Kaiser Health News. This story also ran on The Washington Post.

By Sandy West

Olivia Klassen’s face lights up when she talks about summer camp. She loves to do the scavenger hunt with her camp friends. She also loves paddleboarding, swimming in the lake and “kitchen raids.” But what she loves most is being surrounded by kids who, just like her, have Type 1 diabetes — which allows her to focus on having fun instead of being different.

“Camp is a top priority for me,” Klassen, 13, said of Camp Ho Mita Koda. “I don’t really feel the same without camp. That’s my second family, my home away from home. Being there makes me feel like a normal kid, because everyone is doing the same things I do.”

Camp Ho Mita Koda, in Newbury Township, Ohio, is one of about 300 American summer camps focused on people with special health concerns, including developmental disabilities or dietary and medical needs, said Colette Marquardt, executive director of the American Camp Association’s Illinois office. It is one of the few overnight special needs camps that remained in-person last year, and it will welcome campers again this year even though it could be months more before kids younger than 12 can be vaccinated against covid-19.

While mitigating the risk of covid infections at any of the country’s approximately 15,000 camps is a priority, it is an imperative for camps hosting people who might be at higher risk of serious illness, Marquardt said. Last summer, many medical camps developed “virtual camps” — often with care packages containing supplies for art projects and other camp activities — after organizers were unable to overcome logistical, equipment and staffing needs to operate in person safely.

Some medical camps will remain virtual this summer, while others are easing back into in-person activities with shortened overnight camps, day camps and family camps. Camp Ho Mita Koda, building off last summer, will offer weeklong overnight camps again this year with multiple layers of protocols in place.

The camp will again have fewer campers each session and will require physical distancing, covid testing and quarantining by staff members — most, if not all, of whom will have been vaccinated. Campers, who will be organized into small cabin cohorts that will stay together for the duration of the camp, will be required to wear masks when engaging with anyone outside their cohort. Masks will not be required while sleeping, eating, swimming or showering.

“Families and kids want and need camp,” said Ian Roberts, director at Camp Ho Mita Koda. “It is pretty evident with the number of registrations we see each week.”

Special needs camps commonly offer traditional activities such as swimming, zip lining, horseback riding and archery, but they also fill a powerful role for campers and their families, said Marquardt. A camper may be the only kid in their school who has diabetes or a food allergy or uses a wheelchair — which can feel isolating. But at camp, they are surrounded by people with the same or similar challenges. They also get a chance to experience independence and take part in activities they may have thought were off-limits before.

“It’s a place where the people who go to camp get to do the things they see other kids doing that they didn’t think they could do,” said Arbie Hemberger. Her 46-year-old daughter, Cindy, who has mild cerebral palsy, has attended an Easterseals camp in Nebraska since she was 6.

Because special needs camps have medical staffers on-site, they often provide a respite for parents who lack other caregivers for their kids. Hemberger, who lives in Nebraska, said she didn’t have anyone with whom she could easily leave her daughter when Cindy was young. So camp became the one week each year she and her husband could relax and take some time for themselves.

“You don’t have to worry about her because you know she’s with people who know what to do and are going to take good care of her,” she said.

While many of the traditional summer camps that offered in-person sessions last year operated safely by following guidelines from the American Camp Association, as well as rules from local and state health departments, there were exceptions.

For example, at a Wisconsin overnight camp for high school students, 76% of students and staffers tested positive for covid after one camper developed symptoms. The camp had required negative tests prior to arrival. While staffers were required to wear masks, campers were not, and physical distancing was not observed in sleeping cabins.

“While there were definitely stories of camps that had outbreaks, most did not,” said Marquardt. With a year of experience, she said, camps are in an even better position to operate safely this year.

However, for some special needs camps, the risk remains too great — at least for this summer.

The American Diabetes Association’s 23 overnight and 20 day camps will remain virtual this year, with organizers hoping to return to in-person events next year. Michelle Foster, program director, said it was just too risky to operate so many camps across the country while navigating local coronavirus regulations and case rates, as well as securing enough equipment and personnel. Diabetes can be a complicating factor for covid.

Foster said she thinks the ADA will continue to offer at least some virtual camp options well into the future because they reach more people throughout the country — and abroad — who may not otherwise be able to attend.

This summer, Easterseals Nebraska will offer its virtual camp, but it also has developed a variety of in-person programs this year, including an overnight campout at the Omaha zoo, and “sampler camps” with two hours of activities, such as fishing or crafts.

Cindy Hemberger and her mom began registering her as soon as they got word she could attend a three-day day camp, in which campers will meet at a different location, like a zoo or state park, each day.

“It was fun to do it in virtual, but I wanted to do it in person,” Cindy said. “It’s important.”

Jami Biodrowski, the camp’s director, agreed. The camp has served people ranging in age from 5 to 86. Attendees include people of all abilities, including those who require wheelchairs or have autism or mental health challenges. In the past, some younger campers didn’t have special needs but were the siblings of campers, or their parents wanted them to spend time with people who have different needs.

Biodrowski said the isolation and lack of connection so many people have felt during the pandemic is what life is regularly like for many of her campers. And for them, the pandemic just exacerbated those issues.

“We knew we were important before, but man, now we really know,” she said.

In Ohio, Roberts was determined last summer to bring kids back to the now 92-year-old Ho Mita Koda, which he described as “a world-class camp that just happens to do diabetes very well.” Like other directors of special needs camps, he hears from parents and campers — past and present — that the sense of independence and the friendships made with others who experience life the same way helps inspire the kids to more confidently embrace a future with diabetes.

Olivia Klassen, who lives in the western suburbs of Cleveland, first attended camp in 2019, shortly after she was diagnosed. She and her family were a bit in shock, and she was embarrassed to answer questions about the bag of medical supplies she had to keep with her at all times. Her parents said that, when they picked her up on the last day of camp, she was joyful and determined. She organized a diabetes awareness day at her school a few months later, and now runs Instagram and YouTube accounts dedicated to talking about life with diabetes.

“I do not think Olivia would be where she is today with her diagnosis had it not been for camp,” said Sandi Klassen, her mom. “That was just a huge catalyst in showing her that, first off, you are not alone and that, second, you are capable of doing more than you think you are. It’s life-changing.”

Riding Herd on Mental Health in Colorado Ranching Country

KFF Health News, May 11, 2021

The American Farm Bureau Federation found that about 3 in 5 rural adults reported that the pandemic has affected mental health in their communities, while two-thirds of farmers and farmworkers said the pandemic has impacted their mental health.

This article was published on Tuesday, May 11, 2021 in Kaiser Health News. This story also ran on People.com.

By Vignesh Ramachandran and Eli Imadali

KIOWA, Colo. — The yellow-and-green facade of Patty Ann’s Cafe stands out on the main street of this ranching community just 25 miles from the Denver suburbs. Before the pandemic, the cafe was a place for ranchers to gather for meals and to swap stories.

“Some people would call it almost like a conference room,” said Lance Wheeler, a local rancher and regular at the cafe. “There are some guys that, if you drive by Patty Ann’s at a certain time of day, their car or truck will always be there on certain days.”

When covid-19 restrictions closed in-person dining across Colorado last year, Patty Ann’s opened a takeout window. Customers spread their food on the hoods of their trucks and ate there while sharing news and commiserating over the stresses of ranching during the pandemic.

Keeping that community hub operating has been vital for the ranchers around Kiowa as the pandemic takes its toll on mental health in agricultural communities where health providers are scarce and a “pull yourself up by your own bootstraps” mentality is prevalent.

The pandemic over the past year has been a surprising boon for many farms and ranches as higher consumer demand amid food shortages has boosted business.

But coupled with everyday worries about weather and commodity prices, the pandemic also has led to mental health challenges, including serious stress, anxiety and depression among farmers and ranchers, health officials said. The American Farm Bureau Federation found that about 3 in 5 rural adults reported that the pandemic has affected mental health in their communities, while two-thirds of farmers and farmworkers said the pandemic has impacted their mental health.

Treatment for mental health problems caused or worsened by the stress and isolation of the pandemic has obstacles particular to ranching and farming country. The stigma of acknowledging the need for mental health care can prevent people from seeking it. For those who overcome that obstacle and look for help, they are likely to find underfunded, understaffed and underequipped health providers who often don’t have the bandwidth or expertise for sufficient mental health support.

“I guess my cows are my therapists,” joked Wheeler. The 54-year-old rancher said he has felt the stress of the added responsibility of providing meat to customers in a time of food shortages, particularly at the beginning of the pandemic. But he feels lucky to have a family that supports him.

Similar to other Rocky Mountain states, Colorado has one of the highest suicide rates in the country. The rates are often worse in the state’s rural communities, a factor consistent with rural Americans’ risks nationwide: A Centers for Disease Control and Prevention report examining 2001-15 data found the suicide rate in rural counties was more than 17 per 100,000 people, compared with about 15 per 100,000 in small and medium-sized metro counties and about 12 per 100,000 in large metro counties.

Kiowa is in Elbert County, whose 1,850 square miles of mostly dusty, flat plains start where the affluent bedroom communities of Denver end. The county has no urgent care center or hospital like its suburban neighbors, just four clinics to serve a population of 27,000.

Dwayne Smith, Elbert County’s public health director, said that to help solve the problem residents need to talk with their health providers as candidly about their mental health challenges as about skin cancer or heart disease.

“In a more conservative community, where historically mental health issues may not have been talked about as openly and as comfortably as in the [Denver] area, you have to work diligently to increase people’s comfort level,” Smith said. “Even saying the words ‘anxiety,’ ‘depression,’ ‘mental health’ — all those things that in prior generations were very much a taboo subject.”

The public health crisis is just an added burden to the already high stress on people in the agricultural industry. “Farmers and ranchers are absorbing a lot of the shocks to the system for us: hailstorms, pest outbreaks, drought, markets — they’re adjusting for all that to keep food production moving,” said Colorado’s agriculture commissioner, Kate Greenberg.

Unpredictable weather, a volatile commodity market and a 700-acre grass fire cost Laura Negley, a rancher in the southeastern town of Eads, a lot of income around 2012. Negley’s and her husband’s families have been in agriculture since the late 1600s and early 1700s, and they are now the third generation on the same Colorado land.

But she was devastated after those losses, followed by her youngest child’s departure for college. “That’s kind of when the wheels fell off for me. And then I kind of spiraled down,” Negley said.

Negley, now 59, said she initially didn’t recognize she needed help even though she was deep into her “dark place” of depression and anxiety, but her brother encouraged her to see a counselor near him in Greeley. So, when the cattle were done grazing for the season, Negley spent six winter weeks getting counseling 200 miles north. Those visits eventually transitioned to phone counseling and an anti-anxiety medication.

“I do think you have to have a support group,” said Negley, who said her faith has helped her, too.

Over the years, slashed budgets to local health departments have cut to the bone. In Elbert County, Smith is one of just three full-time employees in his department. About 15 years ago, it had at least six nurses. It now has none. It is trying to hire one.

“We have a lack of health providers” in rural America, Negley said. “The ones we do have are doing their best — but they’re trying to wear multiple hats.”

Agencies in Colorado recognize the need to improve mental health services offered to rural residents. Colorado Crisis Services has a hotline and text-messaging number to refer people to free, confidential support. And the state is working on tailored messaging campaigns to help farmers and ranchers understand those numbers are free and confidential to contact. These services can help: According to the CDC, for every adult death by suicide, about 230 people think seriously about suicide.

A bill introduced in Colorado’s legislature would boost funding for rural rehabilitation specialists and help provide vouchers for rural Coloradans to get behavioral health services.

“We have to be flexible: What works in Denver does not work in La Junta” or the rest of rural Colorado, said Robert Werthwein, director of the state’s Office of Behavioral Health.

But in tightknit small towns, ranchers say, even if the resources are there the stigma remains.

“These are normal people with normal problems. We’re just trying to, perhaps first and foremost, destigmatize mental health needs and resources,” Smith said.

Stigmas are something 26-year-old Jacob Walter and his family want to help tackle. As Walter was growing up, a friend’s father and another friend’s mother died by suicide. Before Walter left the family’s ranch in southeastern Colorado to start his sophomore year in college, he lost his own father, Rusty, to suicide in 2016. Walter said there were few local resources at the time to help people like his dad, and the nearest town was 45 minutes away.

Rusty was involved in many community service organizations and gave a lot of his time to others, Walter said, but he suffered from depression.

“The day before he committed suicide, we had been talking at the kitchen table, and he was just talking about [his depression], and he said: ‘You know, you can always get help and stuff.’”

That’s the message agricultural leaders like Ray Atkinson, communications director at the American Farm Bureau Federation, say should be conveyed most: It’s OK to acknowledge when you need help.

“If your tractor needed maintenance … you would stop what you’re doing and you’d get it working right before you go try and go out in the field,” Atkinson said. “You are the most important piece of equipment on your farm.”

This Small Canadian Drugmaker Wants to Make J&J Vaccines for Poor Nations. It Needs More Than a Patent Waiver.

KFF Health News, May 10, 2021

As coronavirus deaths ravage Brazil and India and other countries across the globe, pressure to force J&J, AstraZeneca, Novavax, Pfizer and Moderna to waive their intellectual property protections and share their technology reached a crescendo this week. 

This article was published on Thursday, May 6, 2021 in Kaiser Health News.

By Sarah Jane Tribble and Arthur Allen

Biolyse Pharma Corp., which makes injectable cancer drugs, was gearing up to start making generic biologic drugs, made from living organisms. Then the pandemic hit.

Watching the covid death toll climb, the company decided its new production lines and equipment could be converted to making vaccines for poorer countries without the means to do so.

John Fulton, a consultant for the Canadian company, emailed Janssen, the Johnson & Johnson subsidiary that makes the vaccine, which employs a live, though disabled, virus. Biolyse sought a license so it could produce 20 million of J&J’s shots.

When J&J’s rejection form letter finally arrived, it misspelled his name: "Dear Mr. Folton, Thank you for your interest …"

Smaller companies like Biolyse may command more attention from the big corporate vaccine manufacturers after the Biden administration announced support Wednesday for a proposal to waive patent protections for covid-19 vaccines and therapies.

As coronavirus deaths ravage Brazil and India and other countries across the globe, pressure to force J&J, AstraZeneca, Novavax, Pfizer and Moderna to waive their intellectual property protections and share their technology reached a crescendo this week. 

Yet while Biden’s support of the waiver might be good optics, experts said, it won’t be enough.

Moderna, which did not respond to requests for comment, announced in October that it would not enforce its covid-related patents during the pandemic. Even so, no known independent producer has used the available patents to replicate the company’s mRNA vaccine. Experts say that’s telling.

“You can’t manufacture its vaccine unless you have access to trade secrets as well as the patents,” said Brook Baker, a law professor at Northeastern University who participated in early conversations on the creation of the World Health Organization’s Covid-19 Technology Access Pool, or C-TAP. To date, no vaccine technology has been added to the pool.

The patents alone wouldn’t be enough. A manufacturer would also need access to internal processes: the technology and know-how that bring a vaccine to life. They’d need skilled scientists and technicians from the original company to train their staff for months. On top of that, every manufacturer in the world would be on the hunt for the limited supplies of single-use bioreactor bags, vials and adjuvants.

In the best-case scenario, sharing patents is only a tiny step in the vastly complex work of making a covid vaccine, which relies on sophisticated new technologies. At its worst, they say, waiving patents would strain already taxed supply chains and encourage counterfeiting and shoddy production that could result in dangerous or ineffective vaccines, besmirching the reputation of vaccination for years.

Instead of focusing on patents, some say, global leaders should subsidize additional production of existing vaccines at discount prices through groups like Gavi, the Vaccine Alliance, which already funds billions annually in discounted vaccines for the developing world.

Dr. Stanley Plotkin, the inventor of the rubella vaccine and a consultant to vaccine makers, said allowing inexperienced companies to produce vaccines “could be a disaster for covid vaccines and for vaccines in general.”

Plotkin proposed that an intellectual property transfer be allowed to happen only if a regulatory authority, such as the Food and Drug Administration, inspected the receiving company and agreed it was competent.

Proponents of the waiver argue that without urgent action, many more people will die. “At this pace,” 9 of 10 people in the developing world will remain unvaccinated this year ― and it could be “at least 2024” before many nations achieve mass immunization, according to an open letter to President Joe Biden last month from more than 170 Nobel laureates, former prime ministers and heads of states.

“I think we’re going to find very soon that this Canadian company is just a drop in the bucket,” said Niko Lusiani, a senior adviser for Oxfam America who helped gather signatures. “There are many manufacturers ready to come on line.” Even more, he said, there is capacity to be built if those technologies are available and the investors are not facing trade sanctions for doing so.

U.S. Trade Representative Katherine Tai’s statement on Wednesday was carefully worded, saying the U.S. will “actively participate in text-based negotiations” on the global stage to support the waiver. It would require the approval of all 164 member nations.

Tai, picked by Biden in December, met with more than two dozen parties integral to the global vaccine supply chain, including executives of AstraZeneca, Novavax, J&J, Pfizer and Moderna as well as nonprofit proponents of the waiver and Bill Gates. The Microsoft founder and philanthropist, who helped establish global vaccination efforts, has come out in opposition to the waiver. Gates had urged Oxford to commercialize its vaccine after it initially promised to donate the rights to any drugmaker to manufacture for the public good. Oxford gave AstraZeneca sole rights, with no guarantee it would be offered at a low cost, and retained a stake in the profits.

Michael Watson, a longtime vaccine industry official and current consultant to Moderna, called forcing companies to give away their licenses a “dangerous precedent.”

“The problems that we are trying to solve are reliability, quality, cost and access to vaccine supply,” he said. “These can all be done through established market mechanisms of partnerships, licensing, disruptive innovation, tax breaks, incentives and government funding without attacking the market mechanisms that made all of this possible in the first instance.”

Bio Farma, the state vaccine producer in Indonesia, is planning to produce one of the Chinese vaccines. The Brazilian company Fiocruz is making AstraZeneca’s vaccine, as is the Serum Institute of India. All these deals involve technology transfer and training, as well as raw materials.

Dr. George Siber, a vaccine expert currently consulting with six vaccine companies worldwide, including mRNA vaccine maker CureVac, said that without the technology transfer “we’re talking about years of work” to figure out how to replicate a vaccine.

Vaccine manufacturers have partnered across the globe ― and it has been akin to a high-end matchmaking process with the vaccine makers signing voluntary licensing deals only with trusted manufacturers.

Thomas Cueni, director-general of the International Federation of Pharmaceutical Manufacturers and Associations, said that with each partnership the original vaccine manufacturer is stretched “to the limits because really there’s a lot of hand-holding, there’s a lot of knowledge sharing, training of skilled workers.”

To emphasize the work involved, Cueni pointed to the mRNA vaccine of Pfizer-BioNTech, which has more than 280 components and 86 suppliers from 19 countries.

It’s not likely, Cueni added, that the covid vaccine makers will willingly partner with a company unless they mutually agreed to do so.

“Do you think that if you try to coerce companies already stretched out, they would then give you not just the recipe, the blueprint, but really show you how to do it?” he said.

J&J spokesperson Jake Sargent declined to confirm the email interaction with Biolyse. But he said in an email that only a limited number of manufacturers can produce its vaccine safely, with high quality, and to scale. J&J assessed nearly 100 production sites and, in the end, selected fewer than a dozen.

For the manufacturers, supplies are also a hurdle. As more companies get into the game of making vaccines globally, there simply won’t be enough ingredients.

Pfizer’s Sharon Castillo wrote in an email that if companies begin to buy up scarce supplies in the hope of manufacturing a vaccine using technology developed by others, “it will make it harder, not easier, to manufacture vaccines in the near term.”

Through COVAX, Castillo said, Pfizer will deliver up to 40 million doses in 2021 to countries across the globe such as Bosnia, Tunisia, Rwanda, Peru, the West Bank and the Gaza Strip, and Ukraine. 

Nicole Lurie, a senior adviser at the Coalition for Epidemic Preparedness Innovations, said the waiver does not address the short-term need for supplies or the potential for countries to donate excess doses.

Manufacturers have already announced that they hope to supply up to 14 billion doses of vaccines globally in 2021 ― that’s triple the previous annual vaccine output, according to a discussion paper posted by IFPMA and organized for an international summit on shortages.

The report warned that a shortage of supplies may result in several current covid manufacturers not being able to meet current vaccine manufacturing commitments. There’s concern about the need for single-use bioreactor bags used for cell culture and fermentation for all vaccines. And, the lipid nanoparticles used to create mRNA vaccines are also in tight supply, with only a few capable suppliers currently operating at scale.

So far, more than 1.21 billion vaccines doses have been administered worldwide, but mostly in the U.S. and other wealthy countries. Canada’s Biolyse said that if it can manufacture the J&J vaccine, a small developing country has committed to buying it.

Without a voluntary consent from the manufacturer, though, Biolyse is now working to obtain a compulsory license to produce the J&J vaccine, which would force J&J to waive its intellectual property rights. Such a legal maneuver is allowed under current international law, but the Canadian government would have to support Biolyse’s license application. So far, it has not.

Canadian officials have met with Biolyse and other companies, as well as international vaccine developers, about the feasibility of making their products in Canada, said Sophy Lambert-Racine, a spokesperson for Innovation, Science and Economic Development Canada.

The “existing Canadian biomanufacturing assets were deemed to be of an insufficient scale or utilized technology platforms which were not suitable to the needs of these firms,” said Lambert-Racine, adding that the Canadian government is now investing more than $1 billion into covid vaccine and therapeutics research and development.

Biolyse is a small company with about 50 employees, including “scientists who have spent their working lives producing vaccines,” Fulton said. The company has said it still needs about $4 million in financing to finish setting up manufacturing lines.

Claude Mercure, a co-founder of Biolyse, said that even if the company doesn’t share the patent and the technology, he is confident his company can figure out how to make the J&J vaccine, which uses a disabled adenovirus to deliver instructions to the body on fighting the coronavirus. In recent weeks, though, other independent scientists have reached out to collaborate and potentially develop a new vaccine.

Trying to remake the J&J vaccine without a technology transfer and partnership would potentially take years, but with a strategic partnership Biolyse could be making vaccines within four to six months, Biolyse executives said.

Regardless of what happens with the waiver, the tenor of international conversation about intellectual property rights puts pharmaceutical companies on notice, said Mara Pillinger, a senior associate in global health policy and governance at Georgetown’s O’Neill Institute for National and Global Health Law.

“Large parts of the world are not going to suffer with covid until [the industry] gets around to prioritizing them,” she said.

5 Things to Know About Health Care Changes in Montana

KFF Health News, May 10, 2021

Here are five substantial health-related policies that emerged from the recently ended session.

This article was published on Friday, May 7, 2021 in Kaiser Health News.

By Matt Volz

HELENA, Mont. — The 2021 Montana legislative session will be remembered as one of the state’s most consequential as a Republican-led legislature and governor’s office passed new laws restricting abortions, lowering taxes and regulating marijuana.

But the debate over those and other highly publicized issues may have caused other meaningful legislation related to health care to slip off the public’s radar. Here are five substantial health-related policies that emerged from the recently ended session. They include bills that Gov. Greg Gianforte has signed or is expected to sign into law.

1. The permanent expansion of telehealth

One byproduct of the covid-19 pandemic has been the widespread use of computers, tablets and smartphones for medical and behavioral health appointments instead of in-person office visits. Telehealth has particularly benefited Montana’s large rural population during the pandemic.

“A lot of Montanans are in very rural areas and often need to take extended time off work, drive long distances, find child care just so they can attend a routine health care appointment,” said state Sen. Jen Gross (D-Billings).

Gross sponsored one of two Montana bills that make permanent the expanded telehealth regulations set by emergency order at the start of the pandemic last year. The new laws redefine telehealth to include nonclinical health services, require private insurers and Medicaid to cover telehealth services and authorize state licensing boards to set rules regulating the practice.

The new laws also allow audio-only telehealth appointments, which supporters say are needed for rural areas without broadband internet coverage. An exception is that a doctor can’t certify a patient for the state’s medical marijuana program by phone without a previously established doctor-patient relationship. Telehealth by text messaging and fax alone is also still illegal.

The boom in virtual health care is being met with concern by local providers who worry that large out-of-state providers might poach patients and by regulators who see the potential for telehealth scams and fraud.

2. The weakened authority of local public health officials

Lawmakers fettered local public health officials with legislation after local health departments implemented and enforced state and federal recommendations to stop the spread of the coronavirus, such as mask mandates, limits on gathering and bans on indoor dining.

Many public health officials have faced threats and harassment over their work to enforce those covid restrictions, leading to high rates of turnover in health departments across the nation.

One measure passed by Republican-majority lawmakers ensures that any Montana public health order can be changed or repealed by elected officials, such as a county commission, and it bans officials from placing any restrictions on attending church services.

Another measure bars public health officials from issuing orders that restrict the ability of a private business to operate. There are some exceptions, such as restaurant health inspections. A third allows citizens to amend or reject public health orders by referendum, while a fourth overturned a law that penalized law enforcement officials who refused to enforce public health orders.

State lawmakers also added a provision in a bill on how to distribute the federal aid in the American Rescue Plan Act that would withhold 20% of any infrastructure grant made to a city, town or county if that local government enforces covid restrictions such as mask mandates and restaurant limits. Gianforte lifted those statewide restrictions after taking office, and the provision takes aim at local governments, like Gallatin County, that decided to keep their own restrictions.

“It’s time for us to make sure the state is open,” said Rep. Frank Garner (R-Kalispell), who backed the provision.

3. Making it more difficult to stay enrolled in Medicaid expansion

Lawmakers cut funding for the state Medicaid expansion program’s 12-month continuous eligibility provision, which has allowed people enrolled in the program to receive benefits for a full year, regardless of changes to their income.

Continuous eligibility is meant to reduce the churning of Medicaid expansion rolls as people are added and removed if their income fluctuates, such as with seasonal work.

Instead, those enrollees will be required to certify their eligibility more than once a year. Department of Public Health and Human Services spokesperson Jon Ebelt said in an email that the department has reached out to the federal Centers for Medicare & Medicaid Services for guidance on how to make the change after the pandemic emergency ends.

Nearly 98,000 Montana adults were enrolled in the Medicaid expansion program in March, according to the most recent data.

4. Anti-vaccinators make their mark

Riding a wave of opposition toward the covid vaccines, the Montana Legislature passed a bill that makes it more difficult to require workers to be vaccinated as a condition of employment. That measure received much publicity and several last-minute amendments in the session’s final days as hospitals and long-term care facilities warned it would force them to require face masks for employees and permanently ban visitors. The bill that passed “poses a significant threat to public safety,” Montana Hospital Association CEO Rich Rasmussen said.

Another consequential vaccination bill that received less attention will make it easier for parents to obtain medical exemptions for their children for vaccines required by schools. State law requires kids to be vaccinated against illnesses such as measles and pertussis to go to school, but students can be exempted for religious or medical reasons.

Previously, a physician needed to sign off on a medical exemption. The new law allows a wide range of health professionals to do so, including nurses, pharmacists, massage therapists, chiropractors and nutritionists. It also makes it more difficult for schools to share exemption data with health officials.

Some parents who testified in support of the bill during legislative hearings said they wanted a medical exemption option because their children might need that medical documentation in the future to attend college or get a job that might not accept a religious exemption.

The state health department and the American Academy of Pediatrics opposed the legislation. “This bill has the effect of making medical exemptions extremely easy to obtain in cases where they might not be warranted,” said Dr. Lauren Wilson, a pediatrician and vice president of the Montana chapter of the American Academy of Pediatrics.

5. Hearing aids for kids

Lawmakers passed a bipartisan measure that will require private insurers and the state employee health plan to cover hearing amplification devices and services for children 18 and under.

The new law won’t affect a large number of people in the state, but supporters said it will make a difference in the lives of families who spend $6,000 every three to five years on hearing aids for their children.

Kiera Kirschner of Bozeman testified before lawmakers during the session that her 2½-year-old son was born with hearing loss and has had hearing aids since he was 2 months old.

“My son did not choose to have hearing loss,” Kirschner said. “He needs hearing aids so he can grow and develop. They’re medically necessary.”

Montana is the 26th state to require such insurance coverage, and insurers said they did not oppose the measure because the total cost would not be significant.

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