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‘A perfect storm’: Advocating to prioritize children’s health through crisis

March 1, 2023

For pediatricians across the country, last fall felt like their version of March 2020.

A surge in pediatric respiratory illnesses, playing out against the backdrop of the youth mental health crisis. Significant capacity issues, from workforce to pediatric hospital bed shortages. Shortages of medications and medical devices that families rely on for their children.

“It was a perfect storm that showed cracks in the system,” said Daniel A. Rauch, M.D., FAAP, chair of the AAP Committee on Hospital Care.

Pediatricians were on the front lines, navigating daily crises, calling for short- and long-term solutions to address the surge, and doing everything they could to reassure families and care for their patients.

The message from the Academy and its members was clear: The crisis required urgent action from government leaders. And it was going to take long-term work and a commitment to prioritizing children’s health to address the systemic issues that contributed to the crisis.

“We must treat pediatric care not as an afterthought,” Dr. Rauch said.

Elevating concerns

Even before the surge was making national headlines, pediatricians were sounding the alarm and the Academy was hearing from its members. Children were leaving hospitals without being seen, patient transfers were being denied, families faced long wait times and pediatric practices were overwhelmed with patients.

“We were surviving,” said Benson Hsu, M.D., M.B.A., FAAP, chair of the AAP Section on Critical Care Executive Committee. When he reached out to section members to ask what they needed, there was “an overwhelming desire for advocacy,” he said.

The AAP connected members to town halls organized by the Department of Health and Human Services (HHS) Administration for Strategic Preparedness and Response, which were critical to information-sharing across hospitals. Then-AAP President Moira A. Szilagyi, M.D., Ph.D., FAAP, wrote an op-ed published by CNN on how the overwhelmed health care system was impacting families and what was needed to address the crisis.

“Several factors have led us to this moment — the respiratory illnesses, a crisis in mental health and reduced hospital capacity,” she wrote. “But the underlying cause is a more fundamental issue: This is what happens when we fail to invest in children’s health care.”

Calling for action

After learning that COVID-19 flexibilities allowing providers to scale up services did not apply to the respiratory virus surge, the AAP and Children’s Hospital Association sent a letter to President Joe Biden and HHS Secretary Xavier Becerra, J.D., asking for an emergency declaration to support a national response to the situation.

The letter said pediatric care capacity at the hospital and community levels was at a “breaking point” and that “pediatric hospitals and pediatricians are being asked to support more care and higher levels of care than ever before.”

Dr. Hsu said he saw “AAP stand up and say, ‘our members need this right now. This is the pediatric version of the beginning of the pandemic.’”

The call to action garnered national media attention, and the AAP led a virtual media tour to get advice to families.

In response to the AAP’s advocacy efforts and with respiratory illnesses continuing to spread, HHS sent a letter to all governors acknowledging the strain on overwhelmed health care systems. It also clarified that regulatory and administrative authorities provided by the COVID-19 public health emergency (PHE) declaration also applied to the spread of illnesses like respiratory syncytial virus (RSV) and the flu.

This legal clarification allowed states and providers to use flexibilities available under the PHE such as triaging patient care more efficiently with parking lot clinics and providing flexibilities for telehealth care across state lines.  

A few states took their own actions (e.g., Colorado and Oregon declared statewide emergencies), and the AAP provided advocacy guidance to chapters on responding to the crisis.

Maintaining the drumbeat, supporting families

The Academy remained in contact with Biden administration officials to lift up pediatrician perspectives and urge comprehensive action.

Additionally, the AAP collected information on drug and device shortages from members, chapters, committees, council and sections and shared it with the Food and Drug Administration.

On the public-facing messaging front, the Academy pursued extensive communications work to ensure families had timely information and resources on, from guidance for parents on amoxicillin alternatives to tips on how to differentiate among the flu, RSV and COVID.

Pushing for policy change

The Academy continues to push for policies that prioritize children’s health and address the underlying factors that led to the situation.

“The health care system must be more attentive to the needs of children,” said Steven E. Krug, M.D., FAAP, chair of the AAP Council on Children and Disasters Executive Committee.

The AAP recently submitted comments to the HHS National Advisory Committee on Children and Disasters, outlining its recommendations to improve the country’s readiness and response to the needs of children following a public health emergency or disaster.

Following are among the recommendations:

  • Improve inclusion of primary care pediatricians and pediatric medical homes in disaster planning and response.
  • Increase Medicaid payment to appropriate levels, at least at parity with Medicare, to pediatric primary care clinicians, including for mental health care. “The closure of pediatric units in recent years due to lack of profitability and staffing shortages should be a wake-up call about the consequences of underpaying for the care of children,” the comments state.
  • Bolster the Strategic National Stockpile so it is equipped to support ongoing shortages of pediatric drugs and devices and ensure medical countermeasures, like vaccines, exist for children.

The Pandemic and All-Hazards Preparedness Act, which authorizes the National Advisory Committee on Children and Disasters, is up for reauthorization this year. The AAP will be advocating that the legislation is reauthorized without delay.

The Academy also will continue urging government leaders to advance policies that keep children’s health at the forefront and address the ongoing challenges that have impacted pediatric health care.

“Our goal should be to not allow decisionmakers — at all levels of government — to forget about this and to address the underlying problems,” Dr. Krug said.

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