Will Humble Reproductive Health, Wills Blog

Arizona Supreme Court to Hear Abortion Care Case Appeal

The Arizona Supreme Court has agreed to hear and decide which of Arizona’s conflicting statutes about abortion care are the law of the land. Arizona has at least 2 competing statutes in the books. A law from 1864 and recoded in 1901 says that abortion care is illegal unless the procedure is needed to save the life of the mother.

ARS 13-3603. Definition; punishment A person who provides, supplies or administers to a pregnant woman, or procures such woman to take any medicine, drugs or substance, or uses or employs any instrument or other means whatever, with intent thereby to procure the miscarriage of such woman, unless it is necessary to save her life, shall be punished by imprisonment in the state prison for not less than two years nor more than five years.

A competing law from 2022, ARS 36-2322, states that abortion care is legal up to 15 weeks gestation, and beyond 15 weeks in a ‘medical emergency’.

ARS 36-2322 (B): B. Except in a medical emergency, a physician may not intentionally or knowingly perform, induce, or attempt to perform or induce an abortion if the probable gestational age of the unborn human being has been determined to be greater than fifteen weeks.

The state supreme court said last week they’ll hear the case (Planned Parenthood v Brnovich). The court didn’t release a date for oral arguments, so it’s impossible to predict when an eventual ruling might come out. If the court rules that the 1864/1901 law applies, legal abortions would effectively end in Arizona “unless it is necessary to save her life”.

When the US Supreme Court’s Dobbs ruling came out, former Republican Arizona Attorney General Mark Brnovich was able to convince a Pima County Superior Court judge to lift a 1973 injunction stopping implementation of Arizona’s territorial-era law outlawing abortion, and for a few months, abortions were illegal in Arizona beginning on September 24, 2022.

Planned Parenthood appealed that ruling, and in December 2022, a 3-judge panel of the Arizona Court of Appeals overturned the Pima County court ruling, saying that 2022 law limiting abortions to less than 15 weeks gestation and the 1864/1901 law could be “harmonized”… legalizing abortion care up to 15 weeks again…  which is where it stands today.

Expect a main component of the arguments to focus on the session law that accompanied the passage of 2022’ SB1161 (the 15-week law) which stated in the legislative intent section that: This act does not:

“…  Repeal, by implication or otherwise, section 13-3603 (the territorial era ban), Arizona Revised Statutes, or any other applicable state law regulating or restricting abortion.”

Expect the Alliance Defending Freedom (the group now representing Arizona’s 1964 law) to argue that the language above makes it clear the Legislature and Governor Ducey intended the 1864/1901 abortion to come back into effect if Roe were to be overturned, which of course it was.

Until the AZ Supreme Court makes its ruling, abortion care will likely remain legal up to 15 weeks gestation.

Planned Parenthood and other stakeholders have launched a plan to place an amendment in Arizona’s Constitution that would legalize abortion care up to the point of viability (about 24 weeks). See: Advocates to pass a ballot measure legalizing abortion in 2024.

That measure would require 383,923 valid signatures by July 2024 to make the ballot, will need to survive legal challenges to keep it off the ballot. If it survives that, voters will need to approve it by 50% plus one vote.

See: Reproductive-Rights-in-Arizona-1884-2022

Arizona Supreme Court to decide whether to reinstate 1864 abortion ban (azcentral.com)

Ray Stern Arizona Republic

Will Humble Uncategorized

CDC MMWR Explains their Recommendation that Kids <8mos Entering RSV Season Get the New RSV Monoclonal Antibody Injection

New MMWR: Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023 | MMWR

Respiratory syncytial virus (RSV) is the leading cause of hospitalization among U.S. infants. In July 2023, the Food and Drug Administration approved nirsevimab, a long-acting monoclonal antibody, for passive immunization to prevent RSV-associated lower respiratory tract infection among infants and young children.

On August 3, 2023, ACIP recommended nirsevimab for all infants aged <8 months who are born during or entering their first RSV season and for infants and children aged 8–19 months who are at increased risk for severe RSV disease and are entering their second RSV season.

On the basis of pre–COVID-19 pandemic patterns, nirsevimab could be administered in most of the US from October through the end of March. Nirsevimab can prevent severe RSV disease among infants and young children at increased risk for severe RSV disease.

The cost will be $495 for private health insurance. The government (VFC) price will be $395. CDC says the ROI pencils out at that price (e.g., preventing hospitalizations etc.).

Will Humble Early Childhood, Prevention, Wills Blog

WIC in Jeopardy in AZ as Counties Consider Dropping the Program: Finances Making Running WIC Untenable

Congress Needs to Pass the Pass the Healthy Meals, Healthy Kids Act (H.R.8450) Including Changes to TITLE III—Modernizing WIC

Child Nutrition Reauthorization (including reauthorizing the WIC program) comes up for renewal every five years, but Congress hasn’t reauthorized or updated the provisions and funding in the Act since 2010.

You heard that right. Congress hasn’t updated the statutes or funding in the WIC program since 2010 – thirteen years ago. The current law, the Healthy, Hunger-Free Kids Act of 2010 (Public Law 111-296), expired in 2015.

Child Nutrition Reauthorization Resources | National WIC Association

Ever since then Congress has just been kicking the can down the road and keeping the programs as-is through the annual appropriations process, via something called a continuing resolution – which allows them to continue to work.

However, this means we are 8 years overdue for changes that are needed to make federal child nutrition programs workable – especially WIC. The most urgent needs are to modernize and update WIC benefits and funding to account for increased costs due to inflation.

Text – H.R.8450 – 117th Congress (2021-2022): Healthy Meals, Healthy Kids Act | Congress.gov | Library of Congress

Federal reimbursement for WIC has gotten so bad that some county health departments are considering dropping their WIC programs. The word on the street is that nobody else will pick up the slack when a county quits because the business case is now upside down in WIC.

How Does WIC Work?

WIC is a federally funded program that supplies important nutritional services and support for eligible pregnant and postpartum individuals and their children until age 5. WIC uses nutritional education, breastfeeding support, nutrition help, and referrals to more services as mechanisms to improve the health of the low-income individuals it serves.

Family income needs to be below 185% of the federal poverty limit in order to qualify (slightly more generous than AZ’s Medicaid participation standard)

WIC money goes to states who further manage the overall program. ADHS mostly distributes the money to the county health departments and federally qualified health centers to implement WIC programming.

Arizona currently has 140 WIC clinics (run by 33 agencies) serving 165,422 individuals.

Funding for WIC flows through the US Department of Agriculture but Congress authorizes the amount.  Way back in 2010 congresses’ appropriations covered the costs associated with implementing WIC programs… but that’s no longer the case – mostly because the Act is now 13 years old.

Some states and local clinics may supplement this funding to improve access or more services. The State of Arizona does not, but a couple of counties do.

WIC Participation at a Glance

–          37% of AZ-born infants are on WIC,

–          87% of WIC participants are on AHCCCS (Medicaid),

–          52% of eligible Arizonans (mothers and children) participate in WIC,

–          $21,213 average family income,

–          $47.7M spent at AZ food retailers.

WIC is Becoming Unsustainable for Counties & FQHCs

WIC clinics (counties, FQHC’s, tribes) get their money based on a formula that includes caseload and food costs into consideration… but the funding formula hasn’t been updated in 13 years.

Staffing costs currently present the biggest challenge to local clinics, especially for clinics with large service areas. Insufficient pay and high workload lead to short staffing.

As a result, short-staffed clinics are unable to spend adequate time with each client or keep up with their caseload. When clinics fall short of their caseload, their funding drops for the next year, causing a cascade.

WIC has a Return on Investment of 3x

The United States has experienced inflation near 40% since 2010, when WIC funding was last adjusted and reauthorized. WIC benefits now have less buying power, lessening the incentive to take part in the program.

Studies suggest that every $1 spent on WIC results in up to a $3.13 reduction in spending for Medicaid programs. This is particularly pertinent given the large overlap between WIC and Medicaid recipients. Reductions in poor health outcomes because of nutrition aid programs such as WIC are also expected to save significant amounts in private healthcare as well.

AzPHA Recommendations

Congress needs to pass the Healthy Meals, Healthy Kids Act (H.R.8450) now. HR 8450 would save WIC by:

  • Updating funding formulas to actually cover staffing and administrative costs;
  • Modernizing WIC benefits to include online shopping (easier participation); and
  • Evaluating effectiveness of telehealth for WIC visits (makes participation easier).
Resources
Will Humble Disease Control, Wills Blog

Influenza Vaccine Makeup for this Fall

Each spring in the Northern Hemisphere scientists get together and examine global surveillance data (from both hemispheres) and decide what strains should be included in the upcoming flu season’s vaccine.

It’s important to get it right because how effective the vaccine ends up being depends on whether it correctly guesses what antigens to target. FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) met back in March to select the strains to focus on for the 2023-2024 U.S. influenza season.

The committee recommended that the vaccines for the U.S. 2023-2024 influenza season have the following antigens for the egg-based vaccines. The strain below in bold is the one that has been updated from last year’s shot:

  • A/Victoria/4897/2022 (H1N1)pdm09-like virus;
  • A/Darwin/9/2021 (H3N2)-like virus;
  • B/Austria/1359417/2021-like virus (B/Victoria lineage);
  • B/Phuket/3073/2013-like virus (B/Yamagata lineage). 

For trivalent influenza vaccines for use in the U.S. for the 2023-2024 influenza season, depending on the manufacturing method of the vaccine, the committee recommended A(H1N1)pdm09, A(H3N2) and B/Austria/1359417/2021-like virus (B/Victoria lineage).

How well flu vaccine works can depend in part on the match between the vaccine viruses and circulating viruses. Preliminary estimates show that last season, people who were vaccinated against flu were about 40% to 70% less likely to be hospitalized because of flu illness or related complications.

Will Humble Professional Development, Wills Blog

Public Health Journalism This Week

AZ may permanently pay parent caregivers. Public comment ends Monday (azcentral.com)

Hobbs’ heat emergency sparks criticism, could change policy | Arizona Capitol Times (azcapitoltimes.com)

Abortion pill to stay on the market until U.S. Supreme Court ruling after appeals court order (azmirror.com)

Maricopa County heat-associated deaths jump to 89 so far in 2023 (azcentral.com)

Summer COVID-19 surge, measles emerging in more adults – Arizona PBS (azpbs.org)

Hobbs’ heat emergency sparks criticism, could change policy | Arizona Capitol Times (azcapitoltimes.com)

Gov. Katie Hobbs names new slate for Arizona-Mexico Commission (azcentral.com)

Here’s how Phoenix-area schools are handling COVID-19 this year (azcentral.com)

Will Humble Early Childhood, Medicaid, Wills Blog

AHCCCS Exploring Making Parent Caregiver Reimbursement Permanent for ALTCS Members

Comments Due by 5pm Monday

In the early stages of the COVID-19 pandemic AHCCCS launched an initiative allowing AZ parents who are caregivers for children (minors) with disabilities (and enrolled in the long-term care system called ALTCS) to get paid for their caregiving.

The move was absolutely necessary at the time because so many caregivers were unable to work either because of risk factors or because they were in isolation or quarantine for long periods. Many caregivers dropped out of the workforce altogether or perished during the pandemic.

The initiative has been popular among parents who, for years, have struggled to find caregivers for their children. AHCCCS also saw benefits as the care network expanded greatly (one of their charges from their parent organization – the Centers for Medicare and Medicaid Services or CMS).

See AHCCCS’ Parents as Paid Caregivers Waiver Request

AHCCCS has been exploring whether to make the program permanent, allowing parents who qualify to get reimbursed for “attendant” care (bathing, eating, grooming, and using the bathroom etc.) indefinitely. Note: The proposal doesn’t include reimbursement for “habilitation” care, which is more structured and goal oriented.

Right now, about 20% of the 17,000 kids enrolled in AHCCCS and living at home & receiving home and community-based services are getting their services from parents as the paid caregiver. The remaining 13,500 are being served by caregivers who are not their parents.

AHCCCS has been accepting comments on the proposal for some time now – but the final deadline to comment ends at 5pm Monday.

Comments may be submitted by 5pm Monday August 21 via e-mail to waiverpublicinput@azahcccs.gov
See: AZ may permanently pay parent caregivers. Public comment ends Monday
Will Humble Early Childhood, Maternal Health, Public Health, Wills Blog

Phyllis Primus, BSN, MPH, PhD: A Live Well Lived

Arizona lost a long-time public health professional on July 18th when Phyllis Primas passed away.

In addition to groundbreaking academic and public health work at ASU, Phyllis worked at ADHS for several years in maternal & child health and later in nursing at Maricopa County Public Health.

Phyllis was a long-time member of AzPHA, joining in October 1976, shortly after arriving in Arizona for a teaching post at ASU.

She wasn’t just an AZPHA member…  she was a long-time sustaining member at the ‘Patron’ level (a $500/year support level). Phyllis also served in several leadership positions on AzPHA Board of Directors, including a term as President.

Phyllis Primas, BSN, MPH, PhD. was born in Allentown, PA. She received her doctorate in higher education administration from the University of Pittsburgh. After graduation, she was Associate Director of a public health demonstration project in West Africa through the University of Pittsburgh.  

She moved to Arizona in 1975 and accepted a position at the Arizona State University College of Nursing, teaching community health courses in the graduate program. 

She also chaired thesis programs and was awarded a federal grant to develop and maintain a community health clinic for the homeless, Breaking the Cycle. 

Phyllis left ASU in 1981 for a position at the Arizona Department of Health Services as Manager of Community Maternal and Child Health. In 1985, she was hired as the Director of Nursing at the Maricopa County Health Department and later returned to ASU.

She had a robust research and program planning profile, authoring many reports which you can see on this ASU Research Profile. She retired from ASU in 2002 as a Professor Emerita.   

Other community involvements included as Associate Dean for the original UA College of Public Health. She was a founding member of AzPHA’s active retiree group that Barbara Burkholder hosts.

Phyllis Primus: A Live Well Lived

Will Humble Disease Control, Public Health, Wills Blog

Global, National & Local Measles Update

Although measles was declared eliminated in the United States in 2000, almost 1,300 cases of measles were reported in 31 states in the U.S. in 2019— the greatest number since 1992. The 2019 U.S. measles outbreaks were all linked to travel-related cases that reached at-risk populations (un or under vaccinated against measles) in the United States.

Increase in Measles Cases — United States, January 1–April 26, 2019, | MMWR

Outbreaks can happen in areas where people may be unvaccinated or under-vaccinated, including the United States. Right now, measles outbreaks are occurring in every region of the world. Measles can enter the United States through infected travelers entering or travelling through to the U.S. as well as through infected U.S. travelers returning from other countries.

Top 10 Countries with Global Measles Outbreaks

Rank      Country        Number of Cases

1             India                   67,592

2             Yemen                 23,680

3             Pakistan               5,853

4             Cameroon            4,926

5             Nigeria                 4,389

Over 61 million doses of measles-containing vaccine were postponed or missed due to COVID-19 related delays in supplementary immunization activities. This increases the risk of bigger outbreaks around the world, including the United States.

Childhood Vaccination Rates Continue to Drop In the 2021-2022 School Year

As the years have gone by, more and more people are becoming susceptible to measles. Pretty much everyone over 63 had measles as a kid and those that recovered have lifetime immunity. Cases of measles plummeted in the US after mass vaccination campaigns in the early 1960s. The US (and Arizona) enjoyed very high vaccination rates in the next 4 or 5 decades…  but after that vaccination levels started declining coinciding with the ‘anti-vax’ movement.

Vaccination rates continued to slide over the last 10 years, and the statewide immunization rate for Kindergarteners now at 91%, well below the community immunity threshold for measles of 95%. Kids that don’t get caught up (or get vaccinated once they turn 18 because their parents had not vaccinated them as kids) will remain susceptible to infections as an adult. Cases of measles tend to be worse among kids under 5 and adults over 20.  Measles Clinical Information

Right now, most susceptible people in the US are under 25 years old, as childhood measles vaccination rates were very high between 1963 and 2000. Most outbreaks of measles in the US these days are a result of a susceptible young adult (unvaccinated) travels abroad to a country with lots of measles and return to communities with low vaccination rates.

Vaccination rates aren’t uniform across the state. Yuma and Santa Cruz counties continue to enjoy the highest vaccination rates (above 95% for MMR among Kindergarteners). Yavapai consistently has the lowest vaccination rates with MMR coverage at only 74% and nearly 10% of students totally unvaccinated among Kindergarteners.

The ‘Vaccines for Children’ Program Is Critical to Maintaining Childhood Vaccination Rates… but Provider Participation Plummeted During the Ducey Administration

Another continuing trend… students enrolled in charter schools have vaccination rates much lower than students in district public schools. Also, higher income districts tend to have lower vaccination rates.

There are evidence-based strategies that can be implemented at a statewide level, but such initiatives require leadership by a state health department.

Interventions to increase pediatric vaccine uptake: An overview of recent findings

For information on school immunization requirements, review the Guides to Arizona Immunization Requirements for Child Care/Preschool and Grades K-12.

Will Humble Public Health, Wills Blog

Public Health Journalism this Week

Gov. Hobbs declares heat emergency in 3 Arizona counties

The declaration makes $200,000 in taxpayer dollars available to those three counties through the state Department of Emergency Management to reimburse them for heat responses. The order directs ADHS to study ways to centralize or coordinate heat relief and cooling centers. The order also creates two new cooling centers that will be on the grounds of the Arizona Capitol.

Hobbs declares heat state of emergency

Gov. Katie Hobbs’ health director was sabotaged. So was Arizona

EG.5 strain of COVID-19 has been increasing in Arizona

Dave Engelthaler: “Rather than being a summer blockbuster, it’s really more like a boring sequel. This is just the latest iteration of omicron. And everything we’ve seen in really the last year and a half has been totally omicron and they all act like omicron.”

Americans suffer when health insurers place profits over people

Initiative campaign launches in Arizona to expand abortion rights

Campaign launches to give Arizonans a constitutional right to abortion access
Will Humble Disease Control, Wills Blog

What’s Up with COVID These Days?

Even though the state and federal public health emergencies are over it doesn’t mean COVID is over or that we’re not getting reports of illness. Labs and clinicians that find a case of COVID are still supposed to report that data to the state and county health departments. The state and county also still get some COVID hospitalization data. So, what are they finding this Summer?

EG.5 strain of COVID-19 has been increasing in Arizona

Not much really. Throughout the course of the pandemic, we’ve seen pretty consistent surges of infection every six months…  consistent with community neutralizing antibody titers (which wane after 6 months). T-cell immunity lasts a lot longer and protects well against severe disease. Nationwide, COVID hospitalizations have been up slightly in the last couple weeks (12%) but in Arizona it’s down about 25%.

The burden in hospital emergency departments these days is due to dehydration and heat-related illnesses.

Gov. Hobbs declares heat emergency in 3 Arizona counties

It’s still possible we will observe an upswing in infections in the next month or two…  or it could be that the pattern has changed and will change to a pattern more like cold viruses and influenza.

Nationally, the Omicron strain called XBB.1.9.2 has taken the top spot in the US, accounting for about 17% of new COVID-19 cases. In the UK, EG.5.1, nicknamed “Eris,” accounts for about 15% of COVID-19 cases, making it the second most prevalent variant there. The rise of EG.5.1 is also notable in Asia, where it was originally detected.

Symptoms of EG.5.1 are similar to the common cold or allergies, with sore throat, runny nose, clogged nose, sneezing, dry cough, and headache as the leading symptoms. Shortness of breath, loss of smell, and fever are not on the list.

Meanwhile, the FDA’s expert advisory committee (VRBPAC) is recommending that the US shift to a monovalent booster shot this fall. That monovalent shot would drop the old ancestral strain antigen and strictly focus on the XBB-lineage of the Omicron variant with a preference for XBB.1.5.

See: Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2023 | FDA

Here’s the FDA’s one page summary of why they think the fall booster should focus on XBB.1.5: Recommendation for the 2023-2024 Formula of COVID-19 vaccines in the U.S.. The CDC’s advisory committee – the Advisory Committee on Immunization Practices (ACIP) hasn’t yet made a recommendation about the makeup of the fall COVID vaccine – but it’s a safe assumption they’ll be in line with VRBPAC.

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