BATON ROUGE, LA - The Louisiana Department of Health (LDH) pushed back against COVID-19 misinformation in today’s Louisiana House Committee on Health and Welfare.
The Louisiana Department of Health continues to move through the process of adding the COVID-19 vaccine to the School Immunization schedule. This proposed rule is being promulgated through the normal, deliberate and transparent rule-making process. Today’s legislative hearing was the next step in that process - and LDH welcomed the members’ questions and the opportunity to clarify misinformation.
“The intentional spread of health disinformation is especially dangerous during a pandemic because it confuses and can mislead families who have legitimate questions,” said State Health Officer Dr. Joseph Kanter. “The Louisiana Department of Health is committed and will continue to share the facts but we alone can’t win the fight against dis- and misinformation. To do so will take all of us – and it starts with us demanding better. Many of us spread misinformation unintentionally; we are trying to inform others who don’t realize the information is false. If you’re not sure, don’t share.”
U.S. Surgeon General Dr. Vivek Murthy has warned that health misinformation poses a grave threat to our nation and is costing U.S. lives during the pandemic.
Dr. Joseph Kanter’s opening statement to the House Committee is included below.
A few key facts:
- LDH is proposing for the COVID-19 vaccine to be added to the School Immunization Schedule only for ages which have received full licensure and approval from the FDA, which currently is ages 16 and up. Full licensure and approval from the FDA signify the very highest endorsement of safety and efficacy from the U.S. government.
- Louisiana law allows parents to easily exempt their child from a vaccine on the Immunization Schedule by simply claiming a medical, religious or personal/philosophical exemption. If COVID-19 is added to the schedule parents will be easily able to exempt their children from this vaccine as well.
- No one is immune to COVID-19 and its severe outcomes, including children. Over 25% of COVID-19 infections in Louisiana have been in children, resulting in 18 deaths and over 275 cases of Multi-system Inflammatory Syndrome in Children (MIS-C).
TESTIMONY TO THE LOUISIANA HOUSE COMMITTEE ON HEALTH AND WELFARE
Dec. 6, 2021
Joseph M. Kanter, MD, MPH
State Health Officer
Louisiana Department of Health
Chairman Bagley and members of the Committee, thank you for the opportunity to be here today and provide further information on the Louisiana Department of Health’s (LDH) proposed rule adding the COVID-19 vaccine to the School Immunization Schedule. I am joined by Director of Legal, Audit, and Regulatory Compliance, Stephen Russo, and State Epidemiologist Theresa Sokol. It is our pleasure to be here.
Before I begin, let me take this opportunity to publicly thank the approximately 7,000 members of Team LDH who have worked tirelessly throughout this 21-month pandemic, often putting the needs of their state and community ahead of their own and their families. In this season of thanksgiving and reflection let there be no doubt the high degree of gratitude we have for them and their selfless efforts.
Notice of intent to amend Title 51, Chapter 7 of the Louisiana Administrative Code, the section of code dealing with the Public Health Immunization Schedule, was initially provided by Secretary Courtney Phillips to legislative leadership on September 10, and the notice and proposed rule were published in full in the September 20 issue of the Louisiana Register. A second notification was again provided by Secretary Phillips to legislative leadership on November 10 and indicated no request for a public hearing was received by LDH during the stipulated time frame. It was our intentional decision to pursue promulgation of this rule through the normal and standard rulemaking process which affords transparency and the opportunity for all stakeholders to voice support or concerns. Because of our desire for transparency this rule was decidedly not enacted through emergency order or decree.
If enacted, this rule would add the COVID-19 vaccine to the School Immunization Schedule maintained by the Office of Public Health only for the ages for which the vaccines have received full licensure and approval by the U.S. Federal Drug Administration (FDA). Currently this would apply only for students aged 16 years and older. As written, this rule would not currently impact students below the age of 16.
Louisiana law affords students and parents broad ability to exempt themselves from the vaccines listed in the School Immunization Schedule. Students and parents can easily indicate their choice to not receive a scheduled vaccine for either medical, religious or philosophical/personal reasons. This is the normal state of affairs in Louisiana today and the addition of the COVID-19 vaccine would be no different. A student or family who did not want to receive the COVID-19 vaccine, as per the exemptions afforded in Revised Statute 17:170, would remain free to make that choice for themselves.
The intent of LDH is to implement this rule in the 2022 Fall school semester. Each November schools are expected to report to LDH the number of students who meet the published immunization schedule or who have submitted exemptions. If this rule is enacted, 11th and 12th grades will report on COVID-19 vaccinations and exemptions starting November 2022. This provides schools and families ample time to prepare.
This rule change is a priority for the Department of Health because we believe the loss of life endured throughout the 21 months of this pandemic, and particularly the loss of young life, has simply been untenable. A total of 18 children have died with COVID-19 in Louisiana. Of those, 9 children died during our most recent Delta surge. Many more have been hospitalized. Over 275 children in our state have suffered from Multisystem Inflammatory Syndrome in Children (MIS-C), some of whom remain in critical condition. Vaccines are our single greatest tool to fight back against COVID-19’s profound toll of morbidity and mortality. Moreover, the vaccines available to us are a true gift, the fruits of a bipartisan and interdisciplinary development process that exemplified the very best of what America can achieve - a medical and public health feat of herculean proportions. The Pfizer vaccine has since received full licensure and approval by the FDA, the highest endorsement of safety and efficacy offered by the U.S. government. Although in Louisiana it always remains a student’s or parent’s choice, we owe it to our next generation to reduce as many barriers as we can to ensure they have the upmost opportunity for protection.
The effort to save lives in this unprecedented pandemic is hindered by the unintentional promotion of myths and misinformation, and the deliberate propagation of intentional disinformation. As a practicing emergency physician, I can tell you firsthand of the patients I have cared for who fell victim to mis- and disinformation, and some who paid the ultimate price. It is an easy trap to fall into, as this pandemic has been fast-paced and often confusing. U.S. Surgeon General Dr. Vivek Murthy has referred to COVID-19 and related vaccine misinformation as one of the most urgent public health threats we face today. In the interest of providing families the most accurate information possible, I’ll address a few of the more recent myths we have seen.
It is incorrect to suggest COVID-19 does not impact children or adolescents. In this last Delta surge over 25% of new COVID-19 cases were in children. As noted, 18 children have died, over 275 have been inflicted with the severe condition MIS-C, and many others have experienced the deleterious, persistent effects of long COVID. In addition, studies have also shown children and adolescents are highly effective vectors of COVID-19 and often spread the disease to their older family members.
It is incorrect to suggest the 3 COVID-19 vaccines available in the US are experimental. The terms investigational or experimental are used by FDA to refer to therapeutics or vaccines which are currently undergoing phase 1, phase 2 or phase 3 clinical trials. The Moderna and Johnson & Johnson vaccines have been granted Emergency Use Authorization, a designation given after progression through phase 1, 2 and 3 trials in an effort to expedite usage when time is of the essence. The E in EUA stands for Emergency, not Experimental. Once a drug receives Emergency Use Authorization it is no longer investigational or experimental. Still further, the Pfizer vaccine has received FDA’s full licensure and approval for ages 16 and up, the very highest endorsement of safety and efficacy the US government has to offer. As it relates to this proposed rule, the COVID-19 vaccine will only be added to the schedule for ages which have received the high endorsement of full FDA licensure and approval.
It is incorrect to suggest vaccines are only worthwhile if they eradicate infections. Eradication is actually a very, very high bar. We have eradicated smallpox and are close to eradicating polio, but for the remaining vaccine-preventable diseases that we include on the School Immunization Schedule, breakthrough infections are a known and expected occurrence. No vaccine is 100%, and the efficacy of the COVID-19 vaccine is on par with the other vaccines on the schedule. Breakthrough infections can and do happen. You may recall two outbreaks of mumps on the LSU campus in the recent past. In 2017, 58 cases of mumps were identified at LSU, of which 53 students were fully vaccinated and experienced breakthrough infections. In 2020, 21 student cases were identified on campus of which 17 were fully vaccinated. To illustrate this point further, over the past 5 years, 70% of all pertussis (whooping cough) cases in Louisiana, and 46% of all varicella (chickenpox) cases in Louisiana were in people who were fully vaccinated. In fact it was reported just last week that of all childhood cases of mumps nationwide since 2007, about 94% of these infections were in individuals already fully vaccinated. Breakthrough infections are simply a fact of life when it comes to vaccines, and their occurrence decreases as vaccination rates go up and levels of circulating virus go down. In medicine we refer to the ability of a vaccine to prevent disease and infection as sterilizing immunity. Some vaccines do provide sterilizing immunity, namely smallpox and measles. But many other vaccines, including many which are included on the School Immunization Schedule, protect against disease but do not provide sterilizing immunity. The vaccines for mumps, pertussis and the version of polio vaccine recommended for use in the U.S., like the COVID-19 vaccines, protect against disease but do not provide true sterilizing immunity. This does not negate their value nor does it negate the lives saved by their promotion and usage.
It is incorrect to infer “vaccine-preventable disease” as requiring complete and absolute protection. As mentioned, no vaccine is 100% effective 100% of the time. The term “vaccine preventable” refers to the ability of a vaccine to markedly reduce the high amount of morbidity and mortality inflicted by a pathogen upon a population in the absence of widespread deployment of a vaccine. Infections will often be common until an overwhelming majority of a population has received durable immunity, and breakthrough infections can still occur. The CDC considers at least 17 diseases to be “vaccine preventable.” None of these have vaccines that provide 100% absolute protection, many provide protection against disease but not sterilizing immunity against infection, and as noted, breakthrough infections can be commonplace particularly during an outbreak. Few things in medicine are absolute and vaccines are certainly no different. But they do greatly reduce human suffering and the COVID-19 vaccines, thankfully, are no different.
It is incorrect to imply COVID-19 vaccines are substantively different from other vaccines. As with all modern medicine, vaccine technology has advanced as scientists and physicians research and learn more. Vaccines that were cutting-edge decades ago are in some instances considered rudimentary now and have been replaced by newer, safer, and more effective versions. There are also various types of vaccines- no two are exactly alike. Included in our current School Immunization Schedule are live attenuated vaccines, inactivated vaccines, acellular and protein subunit vaccines that actually do not contain any whole virus or bacteria, and toxoid vaccines which are even further removed from the virus or bacteria they are designed to protect against. Some require just 2 doses for adequate protection, others require 4 or even 5 doses. In this context the COVID-19 vaccines are no different. Some, like the Johnson & Johnson, are a more commonplace viral vector vaccine. Others, like the Pfizer and Moderna, employ messenger RNA to achieve the same effect. The vaccines currently on our Immunization Schedule truly run the gamut in terms of type, components, and frequency of doses or boosters needed.
Ultimately, we must recognize the profound impact COVID-19 has had on our lives these past 21 months. Over 14,800 of our friends, family, and neighbors in Louisiana have lost their lives. Children have certainly not been spared, and nationally for the month of September, COVID-19 was the 6th leading cause of death among children aged 5-14, and 4th leading cause of death among individuals aged 15-24. Vaccines are the single best tool we have to fight back. We need to encourage and promote their use while continuing to respect the tradition of parental autonomy which has served us well in Louisiana to date. I appreciate your time today and your partnership throughout this very challenging pandemic. Mr. Russo, Ms. Sokol, and myself would be happy to answer any questions you may have.
About the Louisiana Department of HealthThe Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state residents. The Louisiana Department of Health includes the Office of Public Health, Office of Aging & Adult Services, Office of Behavioral Health, Office for Citizens with Developmental Disabilities, and Healthy Louisiana (Medicaid). To learn more, visit www.ldh.la.gov or follow us on Twitter, Facebook or our blog.
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