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

Statewide Average Kindergarten MMR Vaccination Rate Now at 91%; Well Below the Community Immunity Threshold for Measles

State law requires the ADHS to collect data about the vaccination rates for Child Care/Preschool; Kindergarten; and 6th grade. Schools submit the data to the ADHS each fall (deadline is November 15) and in the spring ADHS is required to publish the data by school. Rather than showing the actual vaccination rates, the system records the percentage of exemptions (personal, medical and religious) as a proxy for vaccination rates.

ADHS posted the data this week (which ironically is National Infant Immunization Week). There are some aggregate tables but also a big giant spreadsheet with the vaccination rate by school. A clever parent that knows how to sort in Excel could quickly find the vaccination rate for their kid’s school. Here’s the big file with all the school data: Arizona Reporting Schools Coverage

There are also some summary tables with coverage levels for various vaccines by geographic region:

The news isn’t good. As has been the case throughout the Ducey Administration, childhood vaccination rates have continued their insidious decline, with the statewide immunization rate for Kindergarteners now at 91%, well below the community immunity threshold for measles of 95%.

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). Also as usual… Yavapai had the lowest vaccination rates with MMR coverage at only 74% and nearly 10% of students totally unvaccinated among Kindergarteners.

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 several evidence-based strategies that can be implemented at a statewide level, but such initiatives require leadership by a state health department and governor…  something that’s in short supply in Arizona these days.

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.

Perhaps childhood vaccination will again become a priority when we get a new governor & state health director in 250 days.

CMS Finalizes Medicare Coverage Policy for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease

CMS Finalizes Medicare Coverage Policy for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease

Medicare will cover monoclonal antibodies that target amyloid (or plaque) for the treatment of Alzheimer’s disease CMS, as a part of this decision, will provide enhanced access and coverage for people with Medicare participating in CMS-approved studies, such as a data collection through routine clinical practice or registries.

This decision is specific to individuals who have a clinical diagnosis of mild cognitive impairment due to Alzheimer’s Disease or mild dementia with a confirmed presence of plaque on the brain.

Editorial Note: I think this is a good decision. FDA’S advisory committee urged former FDA Commissioner Woodcock not to approve Aduhelm because the data were unclear whether the drug is effective. This approach will allow for data collection to determine whether it actually works. It will also cut down on the enormous drain that would have occurred to the Medicare Trust Fund that would have occurred given that the drug costs a whopping $56,000 per year per patient.

April 25, 2022 Legislative Roundup

Budget Drama

The highlight last week at the state legislature was an attempt to get the budget negotiations started by trying to pass a ‘skinny budget’ – which is basically a carbon copy of last year’s budget with some tweaks for enrollment in state programs and population growth.

A series of about a dozen ‘skinny’ budget bills were brought up for votes in the House Appropriations Committee by Chair Regina Cobb. The pitch made by the chair to the committee was that the skinny budget would pass and then members, including Democrats, could propose floor amendments.

The drama wasn’t very long-lasting because the first bill failed 7-6 with Rep. Udall and Hoffman voting no with all the Democrats (for different reasons). The drama left the room as bill after bill met the same fate- losing 7-6. If there are other strategies for the upcoming week- I don’t know what they are.

Bad Bills Pass

Last Monday, the Senate have final approval to two bad bills that have been sent to the goveronr for his rubber stamp. The most harmful is HB2616 which permanently takes universal masking away as a public health intervention in classrooms.

It’s roundabout way says schools can’t require kids to wear masks ‘without the express consent of the parent‘, nullifying the intervention because classroom masking only works when it’s universal (basic masks are good at stopping particles from leaving mouths and noses but they’re poor filters except for N95’s and equivalent).

HB2498 stops cities/counties from ever requiring a COVID vaccine for staff. This one is less harmful than HB2616 in that it’s limited in scope and only applies to the COVID-19 vaccines.

TAPI has a campaign and send Dr. England’s letter to both Governor Ducey and Dr. Carmona at AZDHS urging a veto: https://whyimmunize.salsalabs.org/TelltheGovernortoVetoHB2498

I expect the governor to enthusiastically sign both this upcoming week.

Several other bad bills are poised for floor votes this upcoming week. No agendas have been posted yet- so I’ll spare you any details right now- but stay tuned to my blog and Policy Committee action alerts as things can happen.

Among the bills I expect to see action are SB 1009, which greatly restricts the public health emergency authority that future governors have. While our current governor under-used and at times mis-used that authority to harm the COVID response, I’m hopeful that we will never again have a governor that will as brazenly misuse emergency authority the way this one has- and so it would be nice to keep the authority in tact.

 See our April 18, 2022 Legislative Roundup for the list of bills we’re following. Here is this week’s Spreadsheet Tracker

AZ Supreme Court Legislates from the Bench: Decrees A Top State Individual Income Tax Rate of Only 2.5%

Decree Will Make It Much Harder to Address Pressing Public & Social Determinants of Health Issues

Last week the Arizona Supreme Court set a new individual state income tax rate of 2.5% decreasing revenue to the state by more than $1B annually, perhaps more. Here’s what went down:

Voters approved Proposition 208 in 2020, which imposed a surcharge of 3.5% on incomes above $250,000 for single filers ($500K for joint filers) with the proceeds earmarked for K-12 education. The state’s maximum marginal individual income tax rate was 4.5%, so after Prop 208 the top rate should have been 8%.

The majority in the legislature didn’t like what the voters had approved, so they passed a law that did an end-around the surcharge last year. They set a flat tax of 2.5% for those not subject to the Proposition 208 surcharge. The tax rate for those subject to the surcharge was capped at 4.5%. People subject to the surcharge would pay the 3.5% into the Proposition 208 fund and another 1% into the state’s general fund.

People that didn’t like Prop 208 sued and that case worked its way through the courts. Last week the AZ Supreme Court ruled that the proceeds from Prop 208 were subject to a spending cap that had been approved by voters decades ago. 

But, instead of finding that the Prop 208 money was subject to the spending limit and allowing it to be collected but not spent unless the legislature approved annual increases in the limit (which they can do under the decades old initiative), the Court nullified the surcharge, setting the income tax limit at 2.5% instead of the pervious 4.5%.

In summary, Arizona had a top individual income tax rate of 4.5%. Voters increased it to 8% with Prop 208. The Legislature returned it to 4.5%… but last week the Arizona Supreme Court dismissed that cap and set the top individual state income tax rate at only 2.5%.

Editorial note: This action from the state supreme court is flat-out legislating from the bench, the very thing that Governor Ducey and many ‘conservatives’ rail about. But when legislating from the bench helps himself and his wealthy pals, it’s hunky dory.

If you recall, the Governor expanded the Court by 2 seats even though the court said they didn’t need more justices. By packing the court, he has achieved a key objective: drastically lowering taxes on the wealthy through the bench.

AZ Hospital Compare

Let’s face it.  When it comes to being in control as a consumer- information is power.  And being in control of your own health and health care is probably one of the most important things you can do as you go through life.  Up until the last couple of years, the healthcare world has been opaque when it comes to getting the information that you need to make good decisions- whether it’s quality indicators or costs.  But that’s changing rapidly- especially in Arizona.

That’s why, back in 2013 our team developed Arizona Hospital Compare which provides Arizona consumers with data on quality, care, costs, and charges at Arizona hospitals.  The info on Arizona Hospital Compare can help you make better decisions when choosing a hospital for childbirth or an elective procedure.  It can also help you negotiate price if you’re paying cash.  Hospital administrators can use the data to make sure they’re on track for their own goals and compare themselves to the competition.

For example, if you need an operation, you may want to look at how safe hospitals are for patients needing surgery.  You also might want to look at some of the quality data that comes from patients themselves.  If you’re planning to have a baby, you can look up the percentage of births by hospital that end up in C sections (there’s a wide range).

The costs and charges sections give the most recent data available for how much hospitals are charging on average and how much those services cost the hospital to provide. 

Like I said- information is power when it comes to making smart decisions as a consumer- and our new AZ Hospital Compare site provides you with more information to put you in the driver seat.

AzPHA thanks ADHS for keeping Az Hospital Compare going (albeit they have only loaded data through 2019).  

Journal Article of the Week: Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21

Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21

The global all-age rate of excess mortality due to the COVID-19 pandemic was 120·3 deaths per 100000 of the population, and excess mortality rate exceeded 300 deaths per 100 000 of the population in 21 countries.

The number of excess deaths due to COVID-19 was largest in the regions of south Asia, north Africa and the Middle East, and eastern Europe.

At the country level, the highest numbers of cumulative excess deaths due to COVID-19 were estimated in India, the USA, Russia, Mexico, Brazil, Indonesia, and Pakistan. Among these countries, the excess mortality rate was highest in Russia (374 deaths per 100, 000) and Mexico (325 per 100,000), and was similar in Brazil (186 per 100,000).

Note: Arizona’s per capita COVID death rate is 415 per 100,000, making Arizona the worst in the entire globe in this study if we were a country, thanks mostly to the decisions made by Governor Ducey and former ADHS Director Christ.

Interpretation: The full impact of the pandemic has been much greater than what is indicated by reported deaths due to COVID-19 alone. Strengthening death registration systems around the world, long understood to be crucial to global public health strategy, is necessary for improved monitoring of this pandemic and future pandemics.

In addition, further research is warranted to help distinguish the proportion of excess mortality that was directly caused by SARS-CoV-2 infection and the changes in causes of death as an indirect consequence of the pandemic.

A Final Report Card on the States’ Response to COVID-19

The 50 states and their governors and legislators made many of their own pandemic policy choices to mitigate the damage from the virus.

This study is a report card of how pandemic health, economy, and policy varied across the 50 states. It examines three variables: health outcomes, economic performance throughout the pandemic, and impact on education. 

The authors rank Arizona 37th overall (considering all 3 factors), giving Arizona a grade of D. Not surprisingly, Arizona was the absolute worst in the country in the health component (51st) because, according to their metric, Arizona has had the highest per-capita COVID death rate in the country.

A Final Report Card on the States’ Response to COVID-19

AzPHA Looking for Intern to Examine Firearm Epidemiology in Arizona

For decades, injuries have been the leading cause of death among kids in the U.S. In fact, injuries are responsible for more deaths among children and adolescents than all other causes combined.

For more than 60 years, car crashes were the leading cause of injury-related death among kids. Beginning in 2017, firearm-related injuries took their place to become the most common cause of death from injury. Crossing Lines — A Change in the Leading Cause of Death among U.S. Children | NEJM

Are you a public health student looking for experience by examining firearm epidemiology in Arizona? AzPHA has an internship/research opportunity regarding firearm safety in Arizona. Gather and review data, speak with stakeholders, write a white paper, influence policy in Arizona. We need you! 

Wanted: Researcher interested in firearm safety to author a white paper for AzPHA. Funding and internship available. 

Turn your public health internship into change for Arizonans! AzPHA seeks a white paper on firearm safety. The right candidate will have an interest in data, epidemiology, and public health policy. Funding available. 

Contact Kelli Donley Williams for more infoKellidonley@gmail.com

Note: It’s the job Arizona Department of Health Services’ job to do this kind of epidemiological work. Sadly, because governor Ducey and current ADHS top leadership are so pro firearm, current ADHS leadership is unwilling to do this type of analysis. We’ll do it for them just like we’ve done throughout the COVID-19 pandemic.

Federal District Court in Florida Strikes Down CDC’s Transportation Mask Requirement

The U.S. Federal District Court for Mid-Florida (Tampa) just threw out the CDC’s regulation requiring people to wear masks on public transportation. The court’s 59 page decision (see the Health Freedom Defense Fund v. Biden decision) found that CDC exceeded their statutory authority and didn’t follow the proper administrative procedures under the Administrative Procedures Act when they established the regulation.

The transportation mask requirement was definitely a needed public health intervention. We’re lucky that the lawsuit was filed late in the pandemic and that this decision came down after cases and hospitalizations had dropped precipitously. It’s likely that the CDC/Biden will appeal the decision to the appellate court system, so it’s possible that a higher court will keep the mask requirement in place pending hearing the appeal…  but they also might not take the case and if they do, they might let the lower court ruling stand during the process.

We should know the answers to those questions soon…  but in the meantime, it looks like masks will no longer be required on jets and other forms of public transport like subways and busses etc.

Meanwhile, in a separate but similar case, Arizona joined 20 other states filing a similar lawsuit in the same federal district court challenging the CDC’s 2021 emergency regulation requiring people over the age of two to wear masks on public transportation, airplanes, trains, and transport hubs like airports and train stations. [See the CDC Rules: 86 FR 8025 – Requirement for Persons To Wear Masks While on Conveyances and at Transportation Hubs 86 Fed. Reg. 8,025.].

Editorial Note: It’s curious that the plaintiffs in both cases chose to file in the same Tampa district court. It’s almost like they were shopping for a favorable judge, dontcha think?

The crux of the arguments in both cases is that CDC exceeded their statutory authority under the Public Health Service Act [42 U.S.C. § 264(a)]. Plaintiffs believe that law doesn’t authorize CDC to establish their emergency rule requiring masks in those environments. The suit also argues that CDC didn’t use proper administrative procedures when they established the rule (failing to consider lesser alternatives and not following the APA’s notice and comment requirements).

Once these two cases are fully adjudicated, we’ll get more clear information from the courts about the extent of the CDC’s authority to quickly establish rules during public health emergencies and whether there is latitude for the agency to take some shortcuts while establishing regulations during public health emergencies.

Note: According to Jennifer L. Piatt, JD, Deputy Director of the Network – Western Region Office, “…the US Supreme Court has already started to give us a sense of how broadly it views the CDC’s authority to act in times of crisis. In Alabama Association of Realtors v. HHS, the Supreme Court indicated that CDC did not have the authority to issue a nationwide eviction moratorium under the Public Health Service Act, 42 U.S.C. § 264(a). This is the same section at issue in this new case on transportation masking requirements. Alabama Realtors has thus already demonstrated that the Court is willing to limit CDC’s authority under this section of the Public Health Service Act (PHSA), and it’s possible that the Court’s language in that decision may illuminate or drive some of the lower courts’ interpretations in this case.”

Resource Note: When you have questions about public health law that come up in the course of your work, a terrific resource is the Network for Public Health Law. They are a terrific, free, resource that can help you think through your legal questions by researching laws and case law to help you make decisions. It’s not legal advice, but a terrific resource. Here’s a place to start when you have questions: How We Can Help – Network for Public Health Law.

April 18, 2022 Legislative Roundup

The bill logjam appears to be easing a bit this coming week, but not in a good way at least so far. There are two harmful bills that will be heard on the Senate floor on Monday (called 3rd read).

The most harmful is HB2616 which permanently takes universal masking away as a public health intervention in classrooms. It’s roundabout way says schools can’t require kids to wear masks ‘without the express consent of the parent‘, nullifying the intervention because classroom masking only works when it’s universal (basic masks are good at stopping particles from leaving mouths and noses but they’re poor filters except for N95’s and equivalent).

HB2498 stops cities/counties from ever requiring a COVID vaccine for staff. This one is less harmful than HB2616 in that it’s limited in scope and only applies to the COVID-19 vaccines.

We urge you to contact any Senator that you think might listen to you and urge them to vote no on both of these on Monday, but especially HB2616. List of Senators is here: Senate Member Roster.
See Our Weekly Bill Tracker
Bill Overview: Select Bills AzPHA is Supporting

Maternal/Child Health

SB1272 AHCCCS; postpartum care; eligibility; Passed Senate 26-2; Passed House Health & Appropriations; Ready for Floor Vote

Access to Care

HB2144 health insurance coverage; biomarker testing Passed House 59-0; Passed Senate Finance; Ready for Floor

Special Needs

HB2157 supplemental appropriations; community-based services SIGNED

HB2113 developmental disabilities; Down syndrome SIGNED

HB2111 appropriation; healthy families program – Passed house 40-17; Waiting for Senate Rules Committee

Social Determinants

HB2060 supplemental nutrition assistance program; Passed House 44-15; Passed Senate Health 7-1. Ready for Senate Floor

HB2484 forcible entry; detainer; filing fee Passed House 59-0; SIGNED

Environmental

HB2255 fireworks use, limitations, prohibition Passed House. Ready for Senate Floor

State Hospital/Behavioral Health

SB1716 state hospital; governing board; governance Passed Senate 27-0; Passed House Health 9-0.

SB1444 state hospital; administration; oversight Passed Senate; Passed House Health; Rules then Floor

SB1641 health care institutions; civil penalties Passed Senate 28-0. Passed House Health, Still needs Appropriations

SB1162 opioid prescriptions; intractable pain; exceptions Passed Senate 27-0. Passed House & Sent Back to Senate

SB1210 mentally ill; transportation; evaluation; treatment; Passed Senate. Passed House Health 8-0. Rules then Floor.

 

Bill Overview: Select Bills AzPHA Is Opposing

Vaccines/Disease Control

HB2086 ADHS; school immunizations; exclusions Passed House 31-28; Passed Senate Health 5-3. Rules then Floor

SB1009 state of emergency; executive powers Passed Senate 16-13; Ready for House Floor Vote

HB2453 mask requirement; prohibition Passed House 31-28. Ready for Senate Floor Vote

HB2616 mask mandates; minors; parental consent Passed House 31-28. ACTION ALERT: Senate Floor Vote Monday 

HB2161 parental rights; schools; educational records Passed House 31-28. Senate Floor Vote Monday

HB2498 COVID-19; vaccination requirements; prohibition. Passed House. ACTION ALERT: Senate Floor Vote Monday

Social Determinants

SB1164 – abortion; gestational age; limit SIGNED

Government

SB1175– noncustodial federal monies; appropriation Passed Senate 16-13; Ready for House Floor 

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