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Pediatricians who head state health departments confront COVID challenges :

September 1, 2021

Pediatricians who have been guiding their state through the pandemic have discovered what it’s like to walk a political tightrope.

Resistance by state leaders and others to COVID-19 mitigation efforts has led to an exodus of high-level officials, who have quit or been forced out of their positions.

One example is AAP Board Member Michelle D. Fiscus, M.D., FAAP, who was fired in July from her role as a top vaccine official in Tennessee after encouraging eligible adolescents to get vaccinated (

The targeting of public health officials who deliver messages to mask and vaccinate — and correct misinformation — has been discouraging to many in the field.

“This is really both troubling and disappointing at the same time because we have created a culture of accepting misinformation,” said Howard Zucker, M.D., J.D., FAAP, health commissioner of New York.

Dr. Zucker is among at least seven pediatricians — most of them AAP Fellows — who have been appointed as their state’s top health official. He lamented the tendency to target and threaten experts simply because of a difference in beliefs that can be based on misinformation.

But the pushback he has received has come from a fraction of New York’s 20 million residents, said Dr. Zucker, a pediatric anesthesiologist, intensive care specialist and pediatric cardiologist.

“My job is to make sure that the health of all New Yorkers is paramount. If I were one of those 20 million and not the commissioner, I would expect the person who is the health commissioner to have my best interests at heart,” he said.

Michelle Hofmann, M.D., M.P.H., M.H.C.D.S., FAAP, co-director at the Utah Department of Health, said a supportive executive branch has bolstered the health department’s ability to encourage pediatric vaccinations.

“But some local political figures have been quite vocal, questioning the role of vaccinating children when (the state’s) hospitalization rates and deaths remain so low,” noted Dr. Hofmann, who also is state health officer.

She said the intersection of public health and politics has been one of the more eye-opening parts of her position.

“For so long, I have viewed myself, like so many pediatricians do, as a stalwart advocate for children’s health,” she said.

One way she deals with resistance to getting kids vaccinated is to “coalesce around shared goals.” To that end, Dr. Hofmann recently discovered a statistic that is helping reframe her advocacy efforts: nearly two in every 1,000 U.S. children have lost a primary or secondary caregiver to COVID-19.

“The deep, lifelong impact of a child losing a parent or close grandparent is something to prevent — and a goal we all may be able to coalesce around,” she said.

The North Carolina Department of Health and Human Services is employing numerous strategies to ensure that COVID-19 vaccines “are easy and everywhere,” said Elizabeth Cuervo Tilson, M.D., M.P.H., FAAP, state health director and chief medical officer.

“We know many who remain unvaccinated continue to have questions about the vaccines, so we are committed to sharing factual information and answering those questions,” she said.

Still, the effort to get all eligible people vaccinated remains an uphill battle. Scenarios like the firing or harassment of officials and vocal resistance are in the back of some leaders’ minds.

“I think it places health departments in a very difficult position to continue to champion vaccines,” said José R. Romero, M.D., FAAP, secretary of the Arkansas Department of Health.

Dr. Romero brings rare expertise regarding vaccines to the role. He also is immediate past chair of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, served on ACIP’s COVID-19 vaccines workgroup and chaired the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee.

A virologist, Dr. Romero has been especially concerned about the recent rise in pediatric COVID-19 cases in the state.

“I can tell you right now that our admissions have gone up in the (Arkansas) children’s hospital 500% in one month. And the ICU admissions have gone up significantly on the same order. These kids are sicker … and my overall feeling is that this version of the virus (the delta variant) may be more pathogenic than the original version.”

There also is a glimmer of hope that public health messages may have gotten through, he said. Data show a rapid uptake of the vaccine recently by Arkansas parents. In addition, at press time, the governor was seeking to have a law that forbids school mask mandates amended as COVID-19 infections surged.

“There’s always a body of individuals who won’t accept the current state of knowledge, and you just have to learn to try to work with them as much as possible and build bridges where you can and then go forward,” Dr. Romero said.

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