NASHVILLE, Tenn. (CN) — Buckling under pressure from Republican state lawmakers, the Tennessee Department of Health has fired its immunization program director, who upon her firing said the agency has stopped all vaccine outreach — not just for Covid-19 — to adolescents, a move experts say will hurt broader immunization efforts.
The shakeup comes as the state has seen a 429% increase in new Covid-19 cases over a 14-day period, the highest percent change in the country as of Wednesday, with just 38% of its population fully vaccinated, according to New York Times coronavirus data.
Minors between the ages of 14 and 17 may still be able to get vaccinated without parental consent under the state’s mature minor doctrine — precedent set by the Tennessee Supreme Court in 1987 which states that minors 14 and above can be medically treated without parental consent if their provider determines they’re “sufficiently mature.”
Only eight minors have sought immunization on their own, Health Commissioner Lisa Piercey told lawmakers during a contentious June 16 joint hearing. In those cases, she said, the parents were aware and consented but could not be present.
The doctrine came under fire by Republican lawmakers at that hearing after they learned the state’s former immunization program director Michelle Fiscus distributed a summary of the doctrine in a memo to health care providers administering Covid-19 vaccines.
In a lengthy statement published in full by the Tennessean on Tuesday after her firing, Fiscus noted the summary is posted to the agency’s website and was “blessed by the governor’s office.”
But GOP lawmakers did not share that blessing.
“[Fiscus] may have not said, ‘Go ahead and vaccinate these kids,’ but boy she sure gave the roadmap on how to do it and get around it with the law,” Representative Scott Cepicky, R-Culleoka, said at the June 16 Government Operations Committee hearing. “Unbelievable that would happen in our great state of Tennessee."
Senator Janice Bowling, R-Tullahoma, said her concern was with the “misapplication” of the mature minor doctrine.
“I, as deputy speaker, am encouraging the Department of Health to back off the misapplication, the misunderstanding of a judicial doctrine and to go back to what the law is,” she said.
Cepicky also suggested the agency be dissolved and reconstituted, and several other Republicans voiced concerns over what they called targeted “marketing” to minors, accusing the health department of “peer-pressuring” teens into getting immunized.
“The approach of targeting children and adolescents with vaccine marketing — first of all, you have to say, ‘Is it actually targeting it or is it just making public health announcements that the vaccine is available for these age groups?’” said Dr. Molly Martin, a pediatrician and principal investigator of a National Institutes of Health effort to strengthen Covid-19 vaccine confidence and access.
“Any child health provider would say that you need to involve adolescents, especially in the decisions around their health,” she said in an interview.
Piercey, the health department's commissioner, responded to lawmakers’ concerns, stating that “under no circumstance is the department encouraging children to seek out vaccination without parental consent.”
“If you will allow me to speak somewhat frankly,” she said, “I think there is a sense that we're hiding in dark alleys and whispering to kids, ‘Hey, come get vaccinated.’ We're not doing that.”
But since the June hearing, the department gave in to the right-wing pressure, firing Fiscus and removing social media posts that stated Tennesseans ages 12 and older are eligible for vaccines.
Additionally, an internal report stated the department is to strip its logo off any documents sharing information about vaccines, stop all Covid-19 vaccine events on school property, and stop sending reminders to teenagers to get their second dose of the coronavirus vaccine, according to the Tennessean.
Reminders will still be sent to adults, the Nashville-based newspaper reported, but teens will be excluded from the mailing lists so the notices aren’t “potentially interpreted as solicitation to minors.”
In a statement to Courthouse News, the health department denied shuttering its immunization program for children, saying it's “simply mindful of how certain tactics could hurt that progress.”
But Martin noted one of the main ways to hurt an immunization program for children is to not promote it and hold back information on its availability.
“Not promoting a public health intervention right now, such as a Covid vaccination is doing a disservice to the population that’s eligible for that,” the pediatrician said. “Children need to go to school pretty soon. They are at high risk for spreading Covid because of their behaviors as adolescents."
She added, “They should be made aware that they have access to the vaccine, and the vaccine should be made available to them. And the information around it should not be linked to any kind of false information around the safety or efficacy of the vaccine.”
Health department spokeswoman Sarah Tanksley explained the agency was already pulling out of vaccine events, including some that were on school property, “due to the low demand for vaccine uptake and the drawdown of the National Guard at health departments across the state.”
As far as postcard reminders, Tanksley said it has always been practice to send reminders to the parent of a minor, and “out of an abundance of concern” health officials have reevaluated the process to ensure those reminders are sent to parents.
But Fiscus’ statement contradicts that. She said the department is halting all communications around vaccines of any kind.
Martin said linking standard childhood vaccinations to Covid-19 vaccines is unprecedented.
“The concerns for the Covid vaccine have not been the concerns for standard child vaccinations, so joining those two issues is a very political move, and it doesn't make sense from a public health or scientific standpoint,” she said.
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