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Why the CDC has recommended new COVID boosters for all

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Everyone over the age of 6 months should get the latest COVID-19 booster, a federal expert panel recommended Tuesday after hearing an estimate that universal vaccination could prevent 100,000 more hospitalizations each year than if only the elderly were vaccinated.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted 13-1 for the motion after months of debate about whether to limit its recommendation to high-risk groups. A day earlier, the FDA approved the new booster, stating it was safe and effective at protecting against the COVID variants currently circulating in the U.S.

After the last booster was released, in 2022, only 17% of the U.S. population got it — compared with the roughly half of the nation who got the first booster after it became available in fall 2021. Broader uptake was hurt by pandemic weariness and evidence the shots don't always prevent COVID infections. But those who did get the shot were far less likely to get very sick or die, according to data presented at Tuesday's meeting.

The virus sometimes causes severe illness even in those without underlying conditions, causing more deaths in children than other vaccine-preventable diseases, as chickenpox did before vaccines against those pathogens were universally recommended.

The number of hospitalized patients with COVID has ticked up modestly in recent weeks, CDC data shows, and infectious disease experts anticipate a surge in the late fall and winter.

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The shots are made by Moderna and by Pfizer and its German partner, BioNTech, which have decided to charge up to $130 a shot. They have launched national marketing campaigns to encourage vaccination. The advisory committee deferred a on a third booster, produced by Novavax, because the FDA hasn't yet approved it. Here's what to know:

Who should get the COVID booster?

The CDC advises that everyone over 6 months old should, for the broader benefit of all. Those at highest risk of serious disease include babies and toddlers, the elderly, pregnant women, and people with chronic health conditions including obesity. The risks are lower — though not zero — for everyone else. The vaccines, we've learned, tend to prevent infection in most people for only a few months. But they do a good job of preventing hospitalization and , and by at least diminishing infections they may slow spread of the disease to the vulnerable, whose immune may be too weak to generate a good response to the vaccine.

Pablo Sánchez, a pediatrics professor at The Ohio who was the lone dissenter on the CDC panel, said he was worried the boosters hadn't been tested enough, especially in kids. The vaccine strain in the new boosters was approved only in June, so nearly all the tests were done in mice or monkeys. However, nearly identical vaccines have been given safely to billions of people worldwide.

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When should you get it?

The vaccine makers say they'll begin rolling out the vaccine this . If you're in a high-risk group and haven't been vaccinated or been sick with COVID in the past two months, you could get it right away, says John Moore, an immunology expert at Weill Cornell Medical College. If you plan to travel this holiday season, as he does, Moore said, it would make sense to push your shot to late October or early November, to maximize the period in which protection induced by the vaccine is still high.

Who will pay for it?

When the ACIP recommends a vaccine for children, the government is legally obligated to guarantee kids free coverage, and the same for commercial insurance coverage of adult vaccines. For the 25 to 30 million uninsured adults, the federal government created the Bridge Access Program. It will pay for rural and community health centers, as well as Walgreens, CVS, and some independent pharmacies, to provide COVID shots for free. Manufacturers have agreed to some of the doses, CDC said.

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Will this new booster work against the current variants of COVID?

It should. More than 90% of currently circulating strains are closely related to the variant selected for the booster earlier this year, and studies showed the vaccines produced ample antibodies against most of them. The shots also appeared to produce a good immune response against a divergent strain that initially worried people, called BA.2.86. That strain represents fewer than 1% of cases currently. Moore calls it a “nothingburger.”

Why are some doctors not gung-ho about the booster?

Experience with the COVID vaccines has shown that their protection against hospitalization and death lasts longer than their protection against illness, which wanes relatively quickly, and this has created widespread skepticism. Most people in the U.S. have been ill with COVID and most have been vaccinated at least once, which together are generally enough to prevent grave illness, if not infection — in most people. Many doctors think the focus should be on vaccinating those truly at risk.

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With new COVID boosters, plus flu and RSV vaccines, how many shots should I expect to get this fall?

People tend to get sick in the late fall because they're inside more and may be traveling and gathering in large family groups. This fall, for the first time, there's a vaccine — for older adults — against respiratory syncytial virus. Kathryn Edwards, a 75-year-old Vanderbilt University pediatrician, plans to get all three shots but “probably won't get them all together,” she said. COVID “can have a punch” and some of the RSV vaccines and the flu shot that's recommended for people 65 and older also can cause sore arms and, sometimes, fever or other symptoms. A hint emerged from data earlier this year that people who got flu and COVID shots together might be at slightly higher risk of stroke. That linkage seems to have faded after further study, but it still might be safer not to get them together.

Pfizer and Moderna are both testing combination vaccines, with the first flu-COVID shot to be available as early as next year.

Has this booster version been used elsewhere in the world?

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Nope, although Pfizer's shot has been approved in the European Union, Japan, and South Korea, and Moderna has won approval in Japan and Canada. Rollouts will start in the U.S. and other countries this week.

Unlike in earlier periods of the pandemic, mandates for the booster are unlikely. But “it's important for people to have access to the vaccine if they want it,” said panel member Beth Bell, a professor of public health at the University of Washington.

said that, it's clear the risk is not equal, and the messaging needs to clarify that a lot of older people and people with underlying conditions are dying, and they really need to get a booster,” she said.

ACIP member Sarah Long, a pediatrician at Children's Hospital of Philadelphia, voted for a universal recommendation but said she worried it was not enough. “I think we'll recommend it and nobody will get it,” she said. “The people who need it most won't get it.”

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1961

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mississippitoday.org – Jerry Mitchell – 2024-05-23 07:00:00

MAY 23, 1961

From front to back, John Lewis, Martin Luther King Jr., Ralph Abernathy and James Farmer held a 1961 press conference to announce that the Rides would continue. Credit: AP

Days after a violent attack by a white mob, James Farmer, John Lewis, Ralph Abernathy and Martin Luther King Jr. announced at a conference in Montgomery, Alabama, that the Freedom Rides would continue. Lewis was wearing bandages from the beating he received in Montgomery.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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New law allows low-income pregnant women to receive prenatal care earlier

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mississippitoday.org – Sophia Paffenroth – 2024-05-23 06:00:00

Low-income pregnant women can access timely prenatal care regardless of their Medicaid application status thanks to legislation passed by lawmakers this year.

The change brings Mississippi in line with 29 other states and Washington, D.C. The American College of Obstetricians and Gynecologists has long championed the practice for its ability to improve maternal outcomes.

“Presumptive eligibility simply removes some of the red tape so that individuals can have immediate access to this coverage, especially women of color who are disproportionately affected by coverage disruptions,” explained Taylor Platt, senior of health policy at the American College of Obstetricians and Gynecologists. 

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The , which will be effective July 1, allows pregnant women whose household income is at or below 194% of the federal poverty level – about $29,000 annually for an individual – to be presumed eligible for Medicaid and 60 days of coverage for outpatient care while their applications for Medicaid coverage are being processed. 

Without presumptive eligibility, Medicaid-eligible pregnant women are forced to go without care or pay out of pocket during this interim period. 

Pregnancy presumptive eligibility makes the largest difference in states that have not expanded Medicaid, explained Usha Ranji, the associate director of women's policy at KFF. That's because in states with expansion, the majority of income-eligible women are already on Medicaid and aren't subject to this no-coverage interim period. 

“There are a lot of people who are uninsured (in Mississippi) and who will only qualify for Medicaid once they become pregnant,” Ranji said. “Not surprisingly, people in expansion states tend to have had coverage for a longer period before the pregnancy.”

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Before passing House Bill 539, Mississippi was one of only three states with neither pregnancy presumptive eligibility or Medicaid expansion. 

Medicaid eligibility is restrictive in Mississippi. In addition to falling below an income threshold, must belong to one of three categories to qualify for Medicaid: parenting, pregnant or disabled. After months of negotiations, a bill that would expand Medicaid in Mississippi died late in the session this year.

First-time mothers only become eligible for Medicaid once they become pregnant, meaning their application processing time can cut well into their first trimester. Applications for pregnancy Medicaid can take up to 45 days to be approved, according to the Division of Medicaid.

Medicaid funds more than two-thirds of births in Mississippi, the state with the second highest rate of births financed by Medicaid in the country.

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If everyone eligible for presumptive eligibility took advantage of it, the policy could affect tens of thousands of pregnant women. 

“Medicaid is an important player in the state's maternal health ,” Ranji said. “… Presumptive eligibility could really a lot of people in the state.”

Early prenatal care has been proven to mitigate a number of pregnancy-related problems including hypertension – the leading cause of maternal mortality in Mississippi and across the country.

“You may miss infections that could be easily treated early but now have gone untreated, that can to increased complications during your pregnancy, or you may have health conditions that need to be addressed early,” explained Dr. Charlene Collier, a member of the Mississippi Maternal Mortality Committee and a Jackson-area OB-GYN. “Even more dangerous, there could be an ectopic pregnancy or an abnormal pregnancy that can lead to serious risk to yourself.”

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Last year, the Legislature passed a bill to guarantee Mississippi mothers care for 12 months postpartum. Now, along with presumptive eligibility, low-income pregnant women should receive care from the start of their pregnancy through one year postpartum. Experts hope these policies will not only help maternal and infant mortality rates but also health disparities. 

People of color are disproportionately subject to discontinuous coverage, according to a 2020 study published in Obstetrics and Gynecology, with nearly half of all Black women experiencing disruptions in insurance coverage from pre-pregnancy to postpartum. 

Rep. Missy McGee, R-Hattiesburg, in talks regarding Medicaid expansion during a public meeting at the state Capitol, Tuesday, April 23, 2023. Credit: Vickie D. King/Mississippi Today

House Medicaid Chair Missy McGee, a Republican from Hattiesburg, authored the bill. She said the policy is a no-brainer in a state boasting some of the highest maternal and infant mortality rates in the country. 

The Division of Medicaid estimates that presumptive eligibility will cost the state $567,000 annually, which McGee says is “a minimal investment for a tremendous benefit to women in our state.”

That cost includes medical services and overhead for women initially presumed eligible but later determined ineligible. Doctors will be reimbursed for any prenatal care they provide to pregnant women who they deem eligible for Medicaid according to income.

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Not all doctors will choose to participate, explained Matt Westerfield, spokesperson for the Division, but those who do will receive training from the agency to help them make eligibility determinations.

Providing presumptive eligibility for the thousands of pregnant women on Medicaid in the state will cost roughly half as much as it costs the state to pay for just one infant's prolonged stay in a neonatal intensive care unit – which can easily top $1 million, according to a study published in the American Medical Association Journal of Ethics. 

Mississippi has the highest rate of preterm births in the country.

It's an example of how fronting a small amount of money for preventative care can save the state millions of dollars in the long , explained Dr. Anita Henderson, a Hattiesburg pediatrician and former president of the state pediatric association. 

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“The return on investment is going to be great,” Henderson said. “Because if we can prevent even just one premature baby that might cost the state a million dollars, then the program pays for itself. So the healthier we can get that mom, the healthier we can get that baby.”

How to know if you qualify

Anyone who is pregnant and makes at or below 194% of the federal poverty level qualifies for Medicaid and for presumptive eligibility. These individuals can start receiving care as soon as they find out they're pregnant by showing proof of monthly income to a doctor at a qualifying location. A spokesperson from the Division of Medicaid told Mississippi Today that the agency will communicate to the public which locations are participating in presumptive eligibility, but said that they “are still working on what that outreach will look like.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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6,000 U.S. doctors urge the Supreme Court to keep abortions in medical emergencies legal

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mississippitoday.org – Shefali Luthra, The 19th – 2024-05-22 13:24:05

Originally published by The 19th

Nearly 6,000 , hailing from all 50 states, have drafted a letter asking the Supreme Court to uphold a federal that requires hospital emergency departments to provide abortions when they are needed to stabilize .

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The letter, organized by the left-leaning Committee to Protect and shared first with The 19th, concerns the case Idaho v. United States, which the high court heard in April.

In that case, the federal has argued that the Emergency Medical Treatment and Labor Act — a 1986 law known as EMTALA — requires that hospitals participating in the federal Medicare program provide abortions if doing so is the necessary treatment in an emergency. Idaho has contested that interpretation, and argued that its state-level ban supersedes federal law. Idaho's current ban allows an exception only if the procedure will save the life of the pregnant person, but not if it will otherwise preserve their health. 

“We know firsthand how complications from pregnancy can very quickly to a medical crisis, requiring immediate care and treatment,” states the letter, which was signed by doctors across specialties whose abilities to provide care could be affected by a ban, oncology, emergency medicine and anesthesiology. “These patients' complications can range from a miscarriage to heavy bleeding, from placental abruption to a stroke from severe preeclampsia – and doctors and health professionals in emergency departments must be to use the full range of medical options to save these patients' lives, including abortion.”

The case is one of two abortion-related challenges the court has heard this term, and one of the first since the overturn of Roe v. Wade in the 2022 decision Dobbs v. Jackson Women's Health Organization. A decision is expected this June. 

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The court has held that, while this case is pending, the federal government cannot enforce EMTALA in Idaho. As a result, patients in the midst of medical emergencies have flown to Utah — the next closest state with abortion access — to treatment.

Abortions that would be covered by EMTALA constitute only a tiny fraction of terminations performed in the United States. Still, the case has sparked tremendous concern among physicians. 

“If someone is having a crisis and part of the treatment involves an abortion — or any procedure or intervention that might be deemed an abortion by a prosecutor down the road — that is something we shouldn't have to think about,” said Dr. Rob Davidson, a Michigan-based emergency physician and the committee's executive director. “When I have a pregnant woman having a crisis, my first call should be to an OB, and not a lawyer.”

It's not clear how the Supreme Court will rule, but their decision could have implications well beyond abortion. Already, the fear of violating strict abortion bans has deterred aspiring and practicing physicians from setting up shop in states with such laws — particularly in Idaho, which has seen an exodus of maternal-fetal medicine specialists in the almost two years since Roe's fall. Physicians in the state worry a court finding in favor of Idaho might exacerbate that trend. 

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Legal scholars say that if the court finds EMTALA does not protect abortion as one form of emergency medical care, states could subsequently restrict other treatments — undercutting the law's core holding that patients who present at emergency rooms are guaranteed to at least receive stabilizing treatment.

“The basis of Dobbs is states have the power to regulate medical care. If you extend that to EMTALA, you open up EMTALA to whatever drama a state wants to play out in its emergency rooms,” Sara Rosenbaum, a professor emerita of health law and policy at George Washington University who has written extensively about EMTALA, told The 19th last month.

This could theoretically include prohibiting hospitals from providing emergency care for patients with HIV or substance use disorder — treatment they would ordinarily be required to provide.

“What if someone says, ‘We don't believe in harm reduction programs for opioid use disorder, so we don't think we should provide naloxone kits when patients leave the ER?'” Davidson asks. “This is bad enough that I don't have to imagine what could happen next, or what else they could carve out. But you're opening a Pandora's box.”

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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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