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vaccinations

Vaccine roundup

Just a few news stories (and a Twitter thread) of interest from recent days.

How do you get a COVID-19 vaccine? In Texas’ rollout, it’s a game of luck and chance

Still, the contrast shows just how sharp and seemingly random the divide has emerged between those who are able to get the vaccine easily and those who cannot. In the fourth week of Texas’ vaccine rollout, a dermatology practice in Bellaire got 300 doses while Hope Clinic, which serves Houston’s poor and immigrant communities, got 100, according to the state’s most current list.

County registration hotlines have crashed under the volume of applicants while some doctors reported fielding calls from friends asking how to move to the front of the line.

In the month since the vaccines got federal approval, getting them into arms of the most vulnerable has been anything but smooth. Distribution has lagged. Demand has far outstripped supply. Critics call it yet another chapter in the failed government response to a virus that arrived nearly a year ago.

“There does seem to be no discernible distinction between those who are getting the vaccine and those who aren’t,” said Elena Marks, CEO of Houston’s Episcopal Health Foundation, an organization that works to improve health care access for poor.

Such unevenness is happening not just among the public but also within the medical community. At some small and midsize private practices, access to the vaccine remains elusive for front-line health care workers who regularly treat COVID patients, doctors say. Yet employees of large medical practices and big-name facilities are vaccinating staff that is not in direct contact with patients and in some cases working from home.

Clogged phone lines and ethical dilemmas: Texas health providers scramble to roll out vaccine with little state guidance

Texas has largely left the vaccine rollout process in the hands of local providers like Tarrytown Pharmacy, one of more than 1,000 providers approved to vaccinate Texans. And outside of dictating the first two groups allowed to receive it, providers say the state has given little instruction or information on when allotments will arrive, how immunization operations should be organized and what principles ought to be followed in prioritizing within groups 1A and 1B.

As they spearhead vaccination in a state of 29 million people, hospitals, pharmacies and community health centers alike across Texas built new scheduling systems from scratch, struggled to sync their patient information systems with the state’s and answered to an increasingly anxious public wondering when their turn for the shot will come — all while helping fight the COVID-19 pandemic during its highest peak in Texas.

“Every space I have is booked. I have phones going off the hook saying, ‘Where’s mine?’” said Dr. James McCarthy, chief physician executive for the Memorial Hermann Health System in Houston. “The demand is insatiable right now. Everybody wants it today, and we just don’t have enough vaccines. It will take months.”

The state’s initial allocation of 1.2 million doses had been shipped by Jan. 3, according to state health officials, and another January shipment was expected to bring the state’s total allotment to 1.7 million. That’s still hundreds of thousands of doses short of the roughly 1.9 million necessary to provide just a first dose of vaccine to those Texas health care workers and residents of long-term care facilities eligible in group 1A.

But before many of those first in line had received a dose, the state allowed providers to start administering the vaccine to the second group — about 8 million people older than 65 or at least 16 with certain medical conditions. A Department of State Health Services official said there is some overlap between groups 1A and 1B (doctors and other health care workers over age 65, for example).

The sudden announcement to open vaccinations to the second group — just a week after the first distribution of vaccines for the first group — caught many providers off guard.

“It was in response to all of the chatter and angst to ‘Oh my God, they haven’t given all their vaccines out,’ and it’s been five days,” said McCarthy of Memorial Hermann. “I thought we would get all the health care workers done, and then we would move on. I didn’t think we’d be doing them simultaneously.”

Greg Abbott’s Politics Create a Vaccine Stampede

But Texas decided to do things differently than the CDC. While the state’s designated first tier matched that of the feds, its second tier included all Texans age 65 and older, as well as those with preexisting health conditions that make them vulnerable to severe cases of COVID-19. This approach put lower priority on police and younger essential workers, like grocery clerks or restaurant servers, many of whom were bitter about the state’s decision. Then, just before the new year, Governor Greg Abbott and his state health department changed the game further. On December 29, state health commissioner John Hellerstedt ordered providers to start vaccinating those in the second tier immediately, even though many in the first tier remained unvaccinated. Abbott backed him up in a tweet: “The state urges vaccine providers to quickly provide all shots.”

In an instant, I effectively had been moved to the front of the vaccination line. The problem was finding where that line began. Abbott had started a stampede.

There were too many eligible people chasing too little vaccine. The Texas Department of State Health Services reported that it had received 1.3 million doses. But Abbott had authorized another 8 million people to receive the vaccine even though providers weren’t anywhere near finished inoculating the 1.9 million Texans in what was supposed to be the first-tier priority group. Abbott’s declaration got too many in the state (even those under 65 and without any severe health conditions) thinking vaccines were more widely available. With few providers actually offering shots to the general public, the Hunger Games of vaccination had begun.

Advocates worry vaccines will be out of reach for Black and Hispanic neighborhoods devastated by COVID-19

COVID-19 has been disproportionately deadly for communities of color in Texas. And advocates for those communities are worried that they will have more trouble accessing vaccinations than the white population because of where vaccination sites are located.

“We already saw huge disparities in death rates and people getting [coronavirus] infections, and there wasn’t availability of resources like health care for brown and Black communities suffering tremendously,” said Kazique Prince, interim executive director for the Central Texas Collective for Racial Equity, a nonprofit association based in Austin. “I’m very nervous and anxious that this [vaccination effort] is not going to work out for us.”

According to the Texas Department of State Health Services data, more than half of the fatalities in Texas due to COVID-19 have been Hispanic individuals and almost 10% have been Black people. Yet the state’s designated vaccination sites — mostly hospitals, clinics, nursing homes and pharmacies — are concentrated in more affluent areas where those facilities tend to be located.

And, just as a reminder:

Health officials in Austin are considering opening a makeshift hospital as its intensive care units fill up. Patients in North Texas are being treated in lobbies or in hallways. And hospitals around Laredo, Abilene and College Station have three or fewer intensive care unit beds open, according to state data.

A week into the new year, hospitalizations in Texas have well-surpassed a deadly summer wave that overwhelmed health care workers in the Rio Grande Valley. Health experts have long warned of a dark winter — with a public tired of following safety precautions, a raging pandemic and cold weather drawing people indoors where the virus can more easily spread. Add to that holiday gatherings and increased levels of travel, which health officials say are already being reflected in the growing numbers of hospitalized coronavirus patients.

New year, same story. We deserve so much better. We’ll get better soon from the federal government. When will we get it from our state government?

Abbott speaks about the vaccination effort

It’s going great! We swear!

More than 877,000 Texans have received a COVID-19 vaccine since they first began arriving in Texas nearly four weeks ago, and that number is expected to increase by at least 50,000 more per day, Gov. Greg Abbott said Monday.

“Never before in the history of this state has Texas vaccinated so many people so quickly, “ Abbott said during remarks at the Esports Stadium Arlington & Expo Center, a newly-designated “vaccination hub” that local health officials said can vaccinate thousands per day. “It’s stunning to see what we’ve accomplished.”

The Arlington center, home to the city’s mass vaccination effort since December, is among 28 sites designed by the state as hubs.

“Our goal is, by the end of the week, we have no vaccines left,” said Tarrant County Judge B. Glen Whitley. The county’s health district was allotted 9,000 doses in the most recent shipment this week.

The hubs are meant to streamline vaccinations at a time when the state is seeing an unprecedented surge in COVID-19 cases, deaths, and hospitalizations. Texas continues to prioritize vaccinating health care workers, people who are 65 and older, and those with medical conditions that increase their risk of hospitalization or death if they contract the virus.

The large sites will receive most of the state’s next shipment of 158,825 COVID-19 vaccine doses this week. Just over 38,000 doses will go to 206 additional providers across the state, including several in rural counties that until recently had not received an allotment.

Officials promise bigger allotments in the weeks and months to come, but a patchwork local system of vaccine distribution, among other issues, has created a tumultuous rollout to the long-awaited vaccine.

On Monday, Abbott said Texas expects to see an additional 310,000 first doses per week for the rest of January and up to 500,000 second doses earmarked for those who have already received the injection in Texas. Continued increases are expected, Abbott said, depending on the federal government allotments.

[…]

The data on the number of doses administered has a reporting lag of at least two days, Abbott said, but added that Texans will start to see a significant uptick in those numbers as this week’s vaccinations are reported.

“You are going to see those numbers increase, as it turns out, somewhere between 50,000 and 75,000 per day,” Abbott said.

Texas Health Commissioner John Hellerstedt said the rate and scale of the state’s rollout has been “a really amazing operation” and said the creation of the hubs would ratchet up the rate of administration.

“Through the kind of vaccination operation we see here, we’re very confident it’s going to accelerate here even more,” Hellerstedt said. “It is really the way forward.”

That’s a lot of number being thrown at us. For sure, 50K per day is a big improvement over the “100K per week” we were at earlier in the year. That was a six-years-to-full-vaccinations pace, whereas 50K per day will get everyone vaccinated in 20 months. At the promised high end of 75K per day, we’re at about 13 months. Still not great – we sure would like to finish this task before 2022, wouldn’t we? – but at least in a timeframe we can envision. Note though that we are not at that pace yet – the 310K first doses per week rate is less than 50K per day, and puts us back at an almost-two-years duration. Again, I do expect things will get better, assuming of course that Abbott and the rest of our state leaders don’t reject federal assistance in the name of stupid partisan politics, but every week it takes us to get up to speed is that much longer to get to where we want to be. The hub approach is a sensible model, but it’s going to take a lot of effort and resources to make it work.

The Minute Maid mega-vaccine center

More like this, please.

The city partnered with the Astros organization to transform [Minute Maid Park] into a site to provide the Moderna vaccine to up to 3,600 health care workers, residents ages 65 and older, and patients with underlying medical conditions. Vaccine distribution was moved from the Bayou City Event Center, which was needed for a different event, giving the city a sneak peek at how the stadium would operate as a mega-site when it officially opens in the coming week.

Divided into three sections, the stadium’s lower level was reserved for the elderly and those with mobility challenges. Volunteers first led participants to a section to complete additional paperwork for the vaccine, then to a waiting area and the official vaccination stations, and finally, an observation area, where health workers watched for any adverse or allergic reactions at least 15 minutes.

[…]

[Mayor Sylvester] Turner, who toured the site, greeting residents with fist and elbow bumps and encouraging volunteers and essential workers, said Minute Maid Park is the largest vaccination site that the city has hosted so far — inoculating 350 people an hour and tripling the total amount of people vaccinated last Saturday at the Bayou City Event Center.

U.S. Rep. Sheila Jackson Lee, who attended an afternoon press conference at the ballpark, said it’s also the first model of a mega-site in the country, which could serve as an example for other major cities also looking to establish similar sites.

The outcome, however, was more than Turner and health officials had originally expected.

The city had around 1,000 doses of the vaccine as of Thursday and decided to scale back vaccinations for the weekend when a delivery was not received, but by Friday morning, the city unexpectedly received an additional 2,600 vaccines, Turner said. The city and the Houston Health Department quickly switched gears, scheduling appointments with people who had pre-registered to ensure that the vaccine was distributed and not sitting, wasted on shelves. They also opened up registration, receiving an additional 1,000 applicants within 20 minutes, Turner said.

Marcel Braithwaite, the Astros’ senior vice president of business operations, said the stadium had already begun preparing earlier in the week and officials were confident in the infrastructure.

“It was more about the logistical flow” and ensuring that there was enough physical space within the building to allow for social distancing in waiting areas and immunization pods, Braithwaite said.

This is great, and as a proof of concept it’s clear that this model can work well. I meant it literally when I said “more like this”, because we’re going to need to replicate this on a much bigger scale in order to make progress against COVID. Remember what I said about the scope of the problem. There’s nearly five million people in Harris County. If we want to get everyone vaccinated by the end of the year, we need to be doing over sixteen thousand inoculations per day, every day. That means we need the equivalent of five of these mega-centers, again operating every day. We need them to be accessible by public transit, we need them open at night so as to get people who can’t get off work (remember those 24-hour early voting centers we had last year? Like that), we need them to take all comers whether they have insurance or a personal physician or access to the Internet to make an appointment, we need people working at these locations who speak a broad variety of languages, and we need all of the personnel for this to be local, both to minimize COVID risk (so no one has to travel) and because literally everywhere else will be doing the same thing so we can’t expect to bring in volunteers from other places. Oh, and baseball season will start in April, so at some point Minute Maid becomes unavailable. How’s all that sound? It’s what we need. And we’re going to need a highly-functional federal government, as well as a much better response from the state government, to have a chance.

Coronavirus 2.0

Happy New Year.

The first known case of a new and possibly more contagious coronavirus strain has been reported in Texas, in an adult male resident of Harris County who had no history of travel, according to the state health services department and County Judge Lina Hidalgo.

The variant known as B.1.1.7 was first identified in the United Kingdom, where it has spread quickly, and cases have been found in several U.S. states, including California and Colorado. It does not cause a more severe disease, and vaccines “are expected to be effective against it,” the health services department said, citing the existing scientific evidence.

“The fact that this person had no travel history suggests this variant is already circulating in Texas,” said Dr. John Hellerstedt, commissioner of the state’s health services department. “Genetic variations are the norm among viruses, and it’s not surprising that it arrived here given how rapidly it spreads.”

While this variant doesn’t appear to be any nastier, as far as we know, and should still be covered by the vaccines, it is apparently capable of spreading faster. Really makes you want to stay away from people, doesn’t it?

On the plus side, maybe.

State officials will start distributing most of Texas’ vaccine doses next week to a handful of large pharmacies and hospitals, creating “vaccination hubs” where more people can get a shot quickly, the Department of State Health Services announced Thursday.

“As the vaccination effort continues to expand to people who are at a greater risk of hospitalization and death, in addition to frontline health care workers, these vaccination hubs will provide people in those priority populations with identifiable sites where vaccination is occurring and a simpler way to sign up for an appointment with each provider,” the department said.

Those hubs could vaccinate more than 100,000 people next week, officials said.

DSHS issued a survey earlier this month to vaccine providers gauging their ability to operate community vaccination sites. The state will release the final list of large-scale providers later this week, after the federal government decides how many doses Texas will receive next week.

We expect another 200K total doses next week as part of this preparation. That’s good, but as we’ve discussed before, the numbers remain daunting. Texas has almost 30 million people in it. At 100K shots a week, you’re looking at six years to get everyone vaccinated. The optimistic interpretation of this story is that 100K per week is a starting point, and we’ll accelerate from there. Great, I sure hope so, but if we want to get enough of the state done to get close to herd immunity this year, we need to get to 500K per week, and every week we operate at less than that makes the target number have to be a little higher. (A better and more organized federal response will surely help.) I know, it’s a hard problem, everyone’s doing the best they can (well, not really, but let’s be generous for these purposes), and so on, but this is the math. As someone once said, the stars may lie but the numbers never do.

There is a website for COVID vaccine signups in Houston

You can’t use it right now, but it’s there.

Houston’s Health Department launched an online portal for residents to apply for an appointment at its COVID-19 vaccine clinic Monday but quickly ran out of available slots for the remainder of the month.

“The response to Houston’s first COVID-19 vaccine clinic was massive, quickly filling the appointment slots for the department’s current vaccine allocation,” Mayor Sylvester Turner said at a City Hall news conference where he was about to get his own shot in the arm.

“The vaccine clinic appointments are booked for the rest of this month, and the department is not taking additional appointments at this time.”

Turner said the city is working to set up additional sites and create additional capacity, although it is unclear when new appointments will be available. Turner said the city hopes to open a “mega site” on Saturday.

The portal, available at houstonemergency.org/covid-19-vaccines, added another way for qualifying residents to book for an appointment. A hotline also is available at 832-393-4220.

The city clinic vaccinated nearly 2,000 residents with the Moderna vaccine in two days. It is accepting residents from the first two phases of the state’s distribution plan, which include front-line emergency workers, people 65 and older, and those over 16 with certain high-risk health conditions.

It’s a good start, but at 2K shots a day, we’re talking two years to get to 75% distribution in the city. We’d like to go a little faster than that. Obviously, the city is limited by how much vaccine it can get, as well as the state regulations. Harris County had its own rough rollout thanks to confusion over who was allowed to sign up. On that first front at least, help is on the way, so maybe in another month or two we’ll see much higher numbers. And at least there is now a central location for this for Houston residents, something that had been sorely lacking before.

There’s some more vaccine coming to Texas, but it’s still not a lot.

On Monday, state health officials announced that 325,000 additional vaccine doses would be getting into the hands of 949 providers in 158 Texas counties over the next week, part of the first round of vaccinations for front-line health workers as well as nursing home residents, Texans over 65 and those with certain medical conditions, among others. Some 121,875 doses are earmarked for long-term care facilities such as nursing homes and assisted-living centers.

But with the number of vaccine doses available still falling far short of what’s needed to cover those who are eligible — and with state officials pushing hospitals and other providers to administer vaccine doses that the providers say they don’t have, aren’t sure are coming or have already administered — confusion and frustration have surrounded the initial few weeks of the vaccination rollout.

Providers have 24 hours to report their vaccination statistics to the Department of State Health Services, and the agency updates its numbers each afternoon with data reported by midnight the day before, so the state’s numbers could lag up to two days behind the reality on the ground.

Officials from the White House down to local doctors have warned that it would take months to have vaccine doses available to everyone who wants one.

“The problem is unrealistic expectations based on the reality on the ground,” said Marshall Cothran, CEO of the Travis County Medical Society, which received 700 doses through a local partnership and had them all scheduled within 48 hours for physicians and staff who are not affiliated with hospitals or other care organizations.

With the new shipments this week, the state has been allotted a total of 1.5 million doses through the first four weeks of distribution, officials said Monday. Providers in 214 of the state’s 254 counties will have received shipments by the end of the week, health officials said.

Some 793,625 doses had been received by providers by midnight Sunday, according to the Texas Department of Health Services.

Of those, 414,211 — just over half of those delivered — had been administered, according to the agency’s dashboard.

Hardesty said the nearly 16,000 doses his facility received are being administered “fast and furiously,” and about 10,000 people have gotten their first dose, with second doses to start in the next week.

“We’re giving them as quickly as we can,” he said.

I don’t doubt that, but let’s be clear that 1.5 million doses is five percent of the state’s population, and that 414K is just a bit more than one percent. Seven hundred doses for Travis County, with 1.3 million people, is a drop in the bucket. If you vaccinated 700 people a day in Travis County, it would take you six years to get everyone. In the end, this won’t take anywhere near that long, but we are talking months, and in the meantime the hospitals are also dealing with an insane surge in new cases. I can’t emphasize enough how much we needed to keep a lid on this, and how badly we failed at that.

Anyway. Here was the Harris County website for vaccine registration, which is still up but doesn’t have any method for signing up for a COVID shot at this time. Dallas County has its own website, while Bexar County had a similar experience as Houston did. It will get better, I’m sure, but the early days are going to be chaotic.

It still looks grim in the Houston area

Brace yourselves.

As Houston left 2020 in the rearview mirror, the coronavirus continued to spread throughout the region unchecked, with some of the highest positivity rates since the start of the pandemic.

And that spike will only continue to climb, experts warn, because the numbers do not take into account additional surges tied to holiday gatherings from Christmas and New Year’s celebrations. The pandemic has already claimed the lives of more than 4,600 people from Greater Houston.

The positive test rate statewide hit a record Friday at 21.15 percent, according to a Houston Chronicle review — surpassing the previous high mark, 20.55 percent, in July.

“It’s looking bad,” said Dr. Peter Hotez, a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine. “We still haven’t seen the full impact of what’s happened after Christmas and New Year’s, so you know it won’t get better — it’s only going to get worse.”

The positivity rate and hospitalization capacity data are such that more businesses will have to shut down, and others will have to reduce capacity, under Greg Abbott’s executive order. You’d think, given how much he hates the idea of shutting anything down, that Abbott would be working extra hard to get people to wear masks and observe social distancing and so on, but you’d be wrong.

As for the vaccination effort, that remains its own challenge.

Mayor Sylvester Turner on Friday announced the opening of a public clinic that will administer doses of the Moderna vaccine. Health care workers, people over 65 and people with serious underlying health conditions are eligible and must make an appointment by calling 832-393-4220 between 7:30 a.m. and 4:30 p.m. starting Saturday.

But Hotez warned that Harris County and others across Texas face a “daunting” challenge to vaccinate enough people to neutralize the virus’ danger.

In Harris County, public health authorities will have to ramp up a vaccine distribution program to administer the medicine to some 500,000 residents a month, he said — a volume that the Texas Medical Center and other hospitals, clinics and medical practices aren’t equipped to handle.

“We’re not anywhere close to that,” he said.

Instead, the county should consider opening vaccination centers at places such as NRG Stadium or the George R. Brown Convention Center, he said.

“If we can just gear up to get people vaccinated, then nobody has to lose their lives from COVID-19,” he said.

Understand that even at 500K a month, it will take nearly ten months to vaccinate everyone in Harris County. Even if all we “need” is 75% of the people to be vaccinated, we’re still looking at seven months. This is going to take awhile, and we need to stay on the defensive until then.

How’s the vaccine rollout going?

Not very quickly.

Top Texas officials again urged health care providers to administer more coronavirus vaccines Tuesday, the same day the state reported that the proportion of Texans whose coronavirus tests come back positive has hit levels not seen since a summer wave of cases that overwhelmed some hospitals.

The state reported Tuesday that 163,700 Texans had been vaccinated with at least one dose of the vaccine. About 1.2 million doses have been allocated to providers across the state through the first three weeks since their arrival, according to the Department of State Health Services.

“A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans,” Gov. Greg Abbott said in a tweet Tuesday evening.

That tweet came after health officials asked providers that received doses of the COVID-19 vaccine to “immediately vaccinate” all eligible Texans, including people 65 and older and those who are at least 16 with a qualifying medical condition. That renewed push echoed a statement Dr. John Hellerstedt, commissioner of the Texas DSHS, sent to providers last week directing them to “administer their entire allotment with all deliberate speed.”

“Dr. Hellerstedt put out that statement today to make it clear to all providers that people over the age of 65 and people with medical conditions that put them at greater risk of severe disease of death from COVID-19 are eligible to receive vaccine now,” said spokesperson Douglas Loveday. “Vaccine supply remains limited but more vaccine will be delivered to providers each week. It will take time to vaccinate everyone in those priority groups.”

To be fair, lots of states are stuck in low gear right now, but even accounting for that, Texas is in the back of the pack. There are distribution problems, and there is confusion over who can get a vaccine and where and how they can get it.

A single state website and hotline, with accurate and updated information about vaccine locations and supplies sure would be nice. What we have here evokes the old proverb that a person with one watch knows what time it is, and a person with two watches is never sure. Maybe when Greg Abbott and Ken Paxton are finished harassing the city of Austin, they can spend a few minutes thinking about that. In the meantime, hospitals are pushing back against the claim that they are the bottleneck.

The state’s largest hospital association is pushing back against a suggestion from Gov. Greg Abbott and the state’s top health official that a large number of coronavirus vaccines could be going unused in Texas hospitals.

The back and forth comes as the state vaccine dashboard shows that just 205,463 Texans had received the first dose of the coronavirus vaccine as of midweek, although 678,925 doses have been shipped around the state.

Abbott and Dr. John Hellerstedt, the commissioner of the Texas Department of State Health Services, sounded the alarm Tuesday, urging health care providers to begin vaccinating people 65 and over and those with underlying health conditions, including pregnant women, if they have concluded the first phase of vaccinations.

But most hospitals in the state are still vaccinating the first group of eligible Texans — hospital staffers working directly with coronavirus patients; long-term care residents and staff; emergency workers; and home health care workers — or have not yet received any shipments of the vaccine, according to Carrie Williams, spokeswoman for the Texas Hospital Association, which represents more than 85% of the state’s acute-care hospitals and health care systems.

“Vaccine is not sitting on hospital shelves,” Williams said, suggesting the state’s immunization reporting system has caused delays in reporting data. “With regard to data, we have no certainty it is accurate at this point in time. The number of doses administered is higher than what’s indicated.”

While the number of vaccines shipped across Texas is accurate, there have been “varying reports of the actual number of vaccines administered,” a spokesman for the Texas Division of Emergency Management said Wednesday.

The agency launched a website Wednesday showing up-to-date numbers of vaccine doses and therapeutics available at health care providers.

Abbott spokeswoman Renae Eze touted the website as a source of “real-time reporting system to show vaccine usage data from health care providers across Texas.”

The site, however, does not show how many COVID-19 vaccine doses have been administered.

[…]

For their part, hospital directors say the call from state leaders to move onto the next tier of vaccinations has caused chaos across the state as hospitals try to manage a vaccine rollout and a growing number of COVID-19 patients, Williams said.

“Hospitals are being flooded with calls from the general public seeking vaccine, which creates further operational challenges,” she said. “And, there are still hospitals that have not received any vaccine for their frontlines.”

The story doesn’t indicate what the URL of this new website is. The TDEM website is here, but all I found on a cursory search was information about testing, not about vaccines. This WFAA story about the bumpy vaccine rollout says that this DSHS page is the state’s main vaccine information center, but it’s mostly about eligibility. The story also reports, as Miya Shay did in her tweet, that DSHS and TDEM have two different maps showing providers who have received vaccine doses, and advise people to reach out to providers with their questions. That is not going to help with the flood of questions hospitals are already getting. Meanwhile, State Rep. Donna Howard tried to answer some questions on Twitter:

You can read the thread, but it largely comes down to lags in reporting, the timing of distribution, and confusion over who is eligible. For a guy who’s emphatically rejected calls for further COVID restrictions because the vaccines will save us all, you’d think Greg Abbott would want to put more effort into getting the vaccine distribution part of it right. Just a thought, but maybe this should be a campaign issue next year. What has been your experience trying to chase down a vaccine, for yourself or for a family member?

UPDATE: Later last night, the Trib published this longer story that covers all of the topics I’ve touched on here and more. At some point, Greg Abbott really needs to feel some heat for this.

A new high in hospitalizations

This is fine.

The Texas Department of State Health Services reported Monday a pandemic high 11,351 hospitalizations from COVID-19.

This surpasses the previous all-time high of 10,893, which occurred on July 22.

The record comes in the midst of a holiday season public health experts worry could exacerbate the already rapidly spreading virus and following an increase in cases weeks after Thanksgiving.

This hospital data does not account for people who are hospitalized but have not gotten a positive test, and DSHS says some hospitals may be missing from the daily counts. As of Monday, the state is also reporting 49 deaths from COVID-19, a lagging indicator of the extent of transmission rates, and more than 12,800 new confirmed COVID-19 cases. Reported cases may have appeared lower the last few days because some local health departments did not report data to the state over the holiday week.

Earlier this month, Texas’ ICU capacity was already the lowest since the start of the pandemic, leaving health care experts worried hospitals could be pushed to the brink as coronavirus cases continue to climb. Across the state, COVID-19 patients occupy 17.8% of the state’s hospital beds, and only 745 staffed ICU beds are still available.

At a press conference Monday, Mark Escott, Austin’s interim medical director and health authority, said that this week alone, “ICU utilization” is up 62% in Travis County and that hospital beds could become scarce in a matter of weeks.

“Our projections forward into the new year continue to look worse and worse day after day,” Escott said. “I think right now it appears we’re going to enter 2021 in a state of emergency.”

This is fine:

This is fine:

Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, said he anticipated a major fall surge amid a wave of new infections in West Texas and the Panhandle.

Those areas are among the hardest hit in the country, he said.

“Up in Midland and places like that, it’s still a really tough area,” he said, adding, “In terms of surges, I’m maybe a little less worried about the Texas Medical Center. But in other parts of the state, it’s going to be a real concern.”

There are 745 ICU beds available across the state, according to data from the Department of State Health Services, the lowest number available since the pandemic’s surge during the summer. Among 63,679 staffed hospital beds, 13,416 are available statewide.

Further, 15 of the state’s Trauma Service Areas are reporting that more than 15 percent of their total hospital capacity is taken up by COVID-19 patients, crossing the threshold for what the state considers “high hospitalizations.”

At the Texas Medical Center, the weekly average of new COVID patients has more than doubled since early November, from 104 to 248. Medical center data from Sunday shows 1,594 total COVID patients and another 404 in the ICU. There are 1,298 total occupied ICU beds with hundreds more available, the data shows.

“The medical center has gotten a lot of heft, in terms of being able to accommodate COVID patients,” Hotez said.

[…]

The sporadic use of masks has contributed to the surge, said Hotez, adding that he doesn’t anticipate the number of statewide hospitalizations decreasing anytime soon. He noted that the number of beds is less of a concern than the number of trained staff available.

Hotez said he did not know how much Christmas gatherings would impact the number of infections. But he warned people that New Year’s celebrations would be the “best party the COVID virus can hope to have.”

“I would just say any kind of New Year’s celebration is fraught with risk ,” he said. “Because when you have this high level of transmission going on in the state, anytime you bring four or five people together, there’s a good likelihood they’re going to have COVID.”

I’m really scared for what the next few weeks may bring. Wear your mask, practice social distancing, avoid indoor gatherings, and try to survive until you can get vaccinated.

Next in line for the vaccine

Attention will shift to more vulnerable populations.

Texans who are 65 years old and older, and those who are at least 16 with certain chronic medical conditions will be next in line for the COVID-19 vaccine, the Texas Department of State Health Services announced Monday.

“The focus on people who are age 65 and older or who have comorbidities will protect the most vulnerable populations,” said Imelda Garcia, chair of the state Expert Vaccine Allocation Panel and DSHS associate commissioner for laboratory and infectious diseases. “This approach ensures that Texans at the most severe risk from COVID-19 can be protected across races and ethnicities and regardless of where they work.”

The vaccine, which arrived in Texas on Dec. 14, has been available so far only to front-line health care workers and residents of long-term care facilities. There are nearly 1.9 million Texans in that group, so it will likely take a few weeks before the state transitions to the next phase, state health officials said.

The state expects to receive 1.4 million vaccine doses by the end of the month. Eligible facilities under the current phase include hospitals, pharmacies, nursing homes and Texas Department of Criminal Justices facilities.

The city of Houston will also receive 6,000 doses that are ticketed for firefighters and health care workers, so that’s good. A list of comorbidities that would get you onto the eligible list for the vaccine is in the article, so click over and check it out if you think this may apply to you or someone you know. But do keep in mind that bit about it taking a few weeks to transition into that next phase, because it will take awhile to get through the first phase. We need to continue to practice prevention so as not to sicken and kill many more people needlessly.

Indeed, for those of us in Houston, the next few weeks are looking rough.

The spread of COVID-19, steadily increasing in Houston and Texas since the beginning of November, is expected to accelerate in coming weeks, according to the latest modeling, a trajectory that could make the city and state one of the nation’s next hot spots.

The models project COVID-19 numbers — cases, hospitalizations, deaths — to continue rising in Houston and many other parts of Texas before likely peaking sometime in January. Parts of the state at crisis levels the past month have peaked.

“There’s a lot of concern about the Houston area as we enter the Christmas season,” said David Rubin, a pediatrician and director of The Children’s Hospital of Philadelphia’s PolicyLab, which produces one of the models. “If I were to say what areas in the country still have the potential to surge, the Houston area definitely would be one of them.”

Rubin and others urged everyone to hunker down over the coming holiday period in an attempt to limit the damage from the coronavirus’ seeming last onslought before gradually deployed vaccines can begin to shut down the pandemic. He noted widespread deployment won’t be in time to affect Houston’s winter peak.

[…]

“What’s concerning is that so many regions of Texas look to be hit about the same time,” said Spencer Fox, associate director of the UT COVID-19 Modeling Consortium. “It’s a sad trend at a time when the vaccines are almost within reach.”

The Houston-area trends are worrisome in two of the models. Fox’s group projects 2,121 COVID-19 hospitalizations in the area on Jan. 15, for instance, an increase of 36 percent over the 1,561 such admissions for Dec. 17.

In addition, the CHOP PolicyLab modeling shows the number of Harris County COVID-19 cases should nearly double by the end of the first week of January. The model projects 2,919 cases on Jan. 7, up from 1,478 on Dec. 14.

A third forecast, by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), projects the number of deaths in Texas will peak Jan. 5 at 292. The model, the only one of the three that projects more than a few weeks out, says daily deaths would total 280 on that date assuming universal mask wearing but reach 345 by late January if mandates are eased.

Thanks partly to the vaccines, the IHME model projects the number of daily Texas deaths will decrease dramatically after the Jan. 5 peak — 138 on Feb. 1, 55 on March 1 and 17 on April 1. The vaccine’s most immediate effect is expected to be more of reducing severe illness and deaths than cases.

The IHME model does not project past April.

In all, 28,134 COVID-19 Texas deaths are expected as of Dec. 31, according to the IHME model. All but 2,700 of those came after June 30.

“That’s a devastating loss of lives in just a six-month period,” said Dr. Peter Hotez, a Baylor College of Medicine infectious disease specialist and vaccine scientist. “Has Texas ever lost so many lives in such a short time?”

The CHOP PolicyLab foresaw the June/July spike, though they were more alarmist than the situation turned out to be. But between the holidays and the colder weather that makes outdoor dining less feasible, the conditions are certainly there for an uptick. We all know what to do about this, it’s just on us to actually do it.

Another poll about the COVID vaccine

A little better.

Texans now appear a little more likely to get vaccinated against the COVID-19 virus than a few months ago, according to a new survey.

The survey, conducted by the Episcopal Health Foundation, found 63 percent of people in the state say they’re likely to get the vaccine when it becomes available. The percentage was 59 in a survey the foundation released in October.

The percentage is up significantly from a University of Texas/Texas Tribune poll conducted in October. It found only 42 percent of Texans said they’d get the vaccine.

The phrasing of the two surveys was different. The UT/TT survey asked if respondents would get a low-cost coronavirus vaccine if it were available; the Episcopal foundation survey asked if respondents were “very likely/unlikely” or “somewhat likely/unlikely” to get the vaccine.

Thirty-seven percent said they were “very likely” to get the vaccine in both the new poll and the one released in October. The number “somewhat likely” grew from 22 to 26 percent.

The number “very unlikely” to get the vaccine dropped from 28 to 20 percent.

See here for more on that UT/Texas Tribune poll, here for the Episcopal Health press release, and here for the poll data. I believe the number of people who want to get vaccinated will continue to rise, though there’s certainly a ceiling on it. Some of that is partisan – there’s a distinct split in this poll – and some of it is the usual anti-vaxxer BS. Overall, though, I think a combination of the desire to return to normalcy and general societal acceptance of the vaccine will get us to a decent level. There will still be the need to do outreach, and to meet people where they are on this. We can’t afford to take any chances with this.

We still need more than the vaccines

The vaccines are great, don’t get me wrong, and they couldn’t have come at a better time, but they’re going to take awhile to be administered, and in the meantime a whole lot of people are still getting sick and dying.

Gov. Greg Abbott on Thursday applauded the arrival of the new coronavirus vaccine, calling it a “monumental medical miracle” as he sought to boost morale amid some of the pandemic’s toughest days.

Speaking outside a UPS distribution center in Austin, the governor painted an especially rosy picture of the weeks ahead, promising a swift vaccine rollout even as national supplies are limited and the state is reporting high numbers of new daily infections. Hospitals in some cities across Texas have been overrun with COVID-19 patients.

The vaccine, which began rolling out on Monday, “is on a daily basis saving lives and beginning to restore normalcy in our community,” Abbott said.

About 90,000 doses have been distributed in Texas already, and another 150,000 were being shipped out on Thursday. The first batch is intended for health care workers treating COVID-19 patients.

State health officials are still determining whom to prioritize from there, including teachers, public safety employees and prisoners. The governor himself has yet to be inoculated but said he plans to at “the appropriate time.”

Texas expects to receive 1.4 million doses by the end of the year, not quite enough to treat all of the 1.6 million health care workers who would be eligible.

[…]

State and national health experts have cautioned that it will be well into 2021 before vaccines become widely available and that infections will continue to spread as long as some resist safety measures such as physically distancing and masking in public.

“It’ll still be weeks, perhaps months, before it is absolutely available to anyone who chooses to have it,” said John Hellerstedt, commissioner of the Texas Department of State Health Services. “In the meantime we need to continue the kinds of things that have gotten us this successful so far.”

Abbott has so far refused to tighten the state’s mask mandate or impose other new restrictions, even as county officials have asked for them as they battle new waves of infections. On Monday the state reported nearly 18,000 new confirmed and probable cases, as well as 252 deaths. More than 24,000 Texans have died from COVID since March.

For a very sobering look at where we’re headed, read this:

What is the one thing that could mitigate this? Another lockdown, with a mask mandate alongside it. What is the one thing that could mitigate the devastating economic effect of another lockdown? A truly adequate COVID stimulus package from Congress. What are the two things Greg Abbott is never going to do? You get the picture.

There’s also this.

The start of COVID-19 vaccinations for health care workers has sparked hope that the end of the pandemic crisis is within sight, but when it comes to vaccine distribution, this is still the easy part. Local and state health agencies say they will struggle to get hundreds of millions of doses of the vaccines to the general public without a huge amount of additional funding. Even if Congress does manage to pass a compromise relief bill, the amount it provides may not be enough.

The fates of the vaccine and the relief bill, both months in the making, are linked. The $900 billion proposal that Democrats and Republicans on Capitol Hill continue to debate has a number of provisions to mitigate the COVID economic crisis, including additional unemployment benefits and small business support. The latest available version also contains $6 billion in vaccine distribution funding for state and local health departments. But groups that represent state and local health departments say that this funding, while crucial, won’t be sufficient to distribute the vaccine on a massive scale as efficiently and widely as possible.

“We see the $6 billion that’s on the table as an important down payment to scale up staffing, develop and enact communications plans to address vaccine hesitant populations, and enroll more vaccinators,” Jasmine Berry, the communications director at the Association for Immunization Managers, says in an email. “There’s still going to be a need for additional funding for state and local health agencies.”

What’s more, the already months-long delay in getting this funding to state and local health departments may create problems down the line, as the country’s vaccination campaigns expand beyond health care workers and nursing homes.

“Where we’ll really start to see potential delays, or where we are not as successful as we could have been, may be as we move through the phases to the next group, where there’s a much larger population that would need to be served,” says Adriane Casalotti, the chief of government and public affairs at the National Association of County and City Health Officials, which represents local health departments.

How much of the vaccination tab are Greg Abbott and the Legislature willing to pick up if Mitch McConnell continues to block any COVID relief bills from passing? A miracle’s no good if you can’t access it.

Abbott is right that the vaccines will save lives and restore normality to our lives. But only if we live long enough to get vaccinated, and only if the funding is there to make sure everyone can get vaccinated. These things aren’t going to happen by themselves.

More people in Houston than you think have had COVID

About one in seven, which is an awful lot.

Mayor Sylvester Turner

Nearly 1 in 7 Houstonians have been infected with the coronavirus, city officials announced Monday, the infection’s true prevalence according to a study of antibodies in blood samples taken from people at their homes.

The study, conducted by Baylor College of Medicine and the city health department, found 13.5 percent of people tested had antibodies to the virus in their blood in mid-September, about four times the number revealed through diagnostic testing at the time.

“Thank God a vaccine is on the way because without one, given these numbers, we would need five to six times the number of infections to achieve herd immunity,” said Dr. Paul Klotman, president of Baylor. “It would also mean five to six times the number of deaths.”

[…]

Dr. David Persse, the city’s health authority, said he wasn’t sure if the Houston antibody percentage “is good news or bad news.” He said “the takeaway is that the virus is more active in the community than we can otherwise tell.”

Klotman and some others said the percent of Houstonians infected was less than they had expected. The head of the Centers for Disease Control and Prevention last summer said the number of people who’ve been infected is likely 10 times higher than the number of confirmed cases, and one study found New York City was about 20 percent in late April.

The Houston finding suggests about 250,000 Houstonians had been infected as of Sept. 19, the last day blood samples were collected. Only 57,000 infections had been identified by traditional viral testing at that time.

Persse said it is nearly impossible to predict what the percentage will be in January, but Klotman said he believes it has grown appreciably in the past nearly three months.

The test identifies those who previously have been infected with the virus by the presence of antibodies, proteins the immune system makes to fight infections. It is not a diagnostic test that identifies people with active disease, COVID-19.

The study was done by city health employees calling households in randomly selected Census blocks and asking for volunteers to give a blood sample for testing. Harris County launched a similar effort next month, and the city of Houston will do another round in early 2021. I’ll be very interested to see how the three compare. So far, the antibodies people get for having and recovering from COVID-19 are known to last a few months, and beyond that it’s not fully clear how susceptible such a person is. This also shows the dire need for masking and social distancing, because there have been – and are, and will be – a lot of people walking around who don’t know they’re sick. They themselves may be fine, but they could wind up infecting others who won’t be. The vaccines will be a huge help, but we’re still a long way away from that blessed day. So yeah, please keep wearing your mask and avoiding indoor gatherings. The Press has more.

Can we get enough people vaccinated?

It’s going to take a lot of work.

In poll after poll, alarming numbers say they don’t plan to be inoculated with the vaccine, whose 95 percent efficacy rate in trials exceeded everyone’s expectations. It’s scientists’ nightmare: create one of medicine’s landmark achievements only to have large numbers of people not bother to get it.

But that appears to be the reality. Although the numbers appear to have improved since drugmakers Pfizer and Moderna reported their impressive trial results last month, about 40 percent of Americans tell poll takers they don’t plan to get a COVID-19 vaccine. In Texas, only 42 percent say they will.

Public health officials fear such numbers will hinder the campaign to shut down the greatest scourge since the 1918 Spanish influenza.

At stake is a possible squandering of the chance to get COVID-19 under control by late summer, to save countless lives that will be lost the longer it takes to stop the spread of the virus. Also at stake is an increased potential for a more lethal or contagious strain of the virus to emerge, always a threat as long as an infection continues to circulate.

“The hesitancy is bad for getting the population vaccinated to obtain herd or community immunity, which would allow for activities to become normal again,” said Kirstin Matthews, a fellow in science and technology policy at Rice University’s Baker Institute. “The Biden administration will need to find ways to gain public trust in the Centers for Disease Control and Prevention and FDA to ensure communities take the vaccine.”

A national task force led by Johns Hopkins Center for Health Security and Texas State University’s anthropology department added that “if poorly designed and executed, a COVID-19 vaccine campaign in the U.S. could undermine the increasingly tenuous belief in vaccines and public health authorities who recommend them, especially among people most at risk of COVID-19 impacts.”

[…]

Vaccine mistrust has been building for years, fueled by a small but growing movement that works to exempt children for “reasons of conscience” from school-required inoculations. But the COVID-19 vaccine has brought a new audience to such groups, like Texans for Vaccine Choice. Its leader told publications this summer that its phones were ringing off the hook with calls from people who said they’d gotten other vaccines but don’t want this one.

Neil Johnson, a physicist at George Washington University who studies anti-vaccine groups on social media, has estimated that in recent months, 10 percent of people on Facebook asking questions about vaccines have switched to anti-vaccine views.

“It’s going to be a bumpy road,” said Peter Hotez, a vaccine scientist at Baylor College of Medicine. “Given media scrutiny and an aggressive anti-vaxxer movement, particularly in Texas, any adverse vaccine events are going to be amplified.”

The story cites this Texas Tribune poll from October. I feel like things are probably a bit better now, mostly because it’s clear we will now have a competent administration that takes the pandemic seriously in charge of getting the vaccine out. For sure, messaging is going to be key to this, and all of us will need to play a part to make sure our family and friends have good information and make good choices. This Twitter thread has some good advice.

There will no doubt be significant resistance no matter what, and we may have to reach a point where we impose sanctions on people who could get the vaccine but haven’t. I don’t know what that might look like, and honestly I’m not sure if there’s a practical way to do what I’m suggesting. It’s way premature at this point anyway, but it’s best to be prepared for all possibilities. And as much as anything, we need to be prepared to fight off any effort in the Lege to coddle the anti-vaxxers, who already have had way too much influence, and success. If we can just avoid not making things worse, that will be a big win.

UPDATE: See this NPR story for evidence of growing confidence in the COVID vaccine.

Here comes the vaccine

Houston’s first doses have arrived.

Months of waiting for a COVID-19 vaccine to arrive in Houston are almost — but not quite — over, as hospitals prepare to move the first doses from sealed subzero shipments and into the arms of thousands of front-line health care workers this week.

About 19,500 doses of Pfizer’s vaccine will arrive Monday at four medical centers in Texas: MD Anderson Cancer Center in Houston, Methodist Dallas Medical Center, Wellness 360 at UT Health San Antonio and UT Health Austin’s Dell Medical School, according to the Texas Department of State Health Services, which is overseeing deliveries of the first vaccine approved and shipped in the United States.

Another 75,075 doses will arrive at 19 additional sites on Tuesday, including seven in the Houston area. By midweek, 27 hospitals in the Houston region, most of them Texas Medical Center hospital system flagships or suburban campuses, will have received doses.

Officials on Sunday at some Houston hospitals compared it to waiting on an Amazon delivery: The package is confirmed, but the email with the tracking number and details hasn’t arrived. The first inoculations in Houston could happen in days, depending on when those shipments appear, said Dr. Marc Boom, president of Houston Methodist.

“If it arrives tomorrow, we will have a full day of vaccinations on Tuesday,” Boom said Sunday. “If it’s Tuesday, depending on what time, we could have some people come in. … I have people scheduled literally in five-minute slots.”

[…]

Under a tiered plan developed by public health leaders, the first vaccine doses will be given to front-line hospital workers. Later shipments will allow hospitals to administer doses to patients at high risk of contracting COVID-19 and developing serious complications, likely in January.

And after that it gets trickier. And it could get even trickier still.

Here are some basic outlines of what’s happening. As we learned last week the Trump White House skimped on actually buying enough doses of vaccine from Pfizer. But the federal government will cover the actual purchase of vaccines. The White House says the military is in charge of and has a plan to actual get the supplies to the states. And though we don’t know all the details let’s assume they have that covered. But that only appears to be getting the crates of supplies to a central staging point in each state. That’s not a negligible job. But it’s only a relatively small part of actually getting the country vaccinated. You need public health campaigns. You need staging areas and distribution from wherever the military drops it off to actual health centers and vaccination centers around each state. And finally you need a small army of medical professionals to actually administer the doses. It’s a big job and the Trump administration hasn’t funded any of that or devised any national plan.

In the absence of any federal plan or budget the CDC and HHS have cannibalized existing budgets to get some money to states for planning. But the sums are by most estimates an order of magnitude less than the amount needed.

State governments would be hard pressed to fund an operation like that during the best of times. But states and local governments around the country are already pushing massive cuts because of the dislocations caused by the pandemic. Through much of the latter part of 2020 the assumption was that this would be dealt with in a follow-up stimulus plan. But of course that never happened.

What the White House has arranged funding for is a critical but relatively small part of the vaccination effort: vaccinations for people in assisted living facilities and health care workers. Those are the two most critical populations. They should go first, and the plan is to get those people vaccinated in December and January. But that leaves the great bulk of the population unvaccinated. The plan is for that phase to end around Feb 1. Meanwhile CARES Act funding, which states can use for various purposes, has to be spent by Dec. 31.

That’s all that’s funded. It’s like a trap door set up for Biden to fall through. So as you can see, today’s excitement and anticipation over the vaccine is cued up to turn sharply to disappointment in February when people start asking where their shots are and blame the train wreck on President Biden. No plan. And no funding to implement a plan. Of course that is potentially catastrophic in human terms. But a lag in vaccination means not only more suffering and death but more delay in allowing the economy to get back on its feet, since people aren’t going to go to restaurants and participate in public life until case numbers drop dramatically.

That…would be bad. I suppose as long as there are still talks for another COVID relief bill, or if Dems win both Georgia Senate runoffs, we still have hope. But yeah, that could be a problem.

Also a problem:

The White House Coronavirus Task Force is increasingly suggesting that states including Texas begin shutting down again, saying in reports sent to state leaders this month that they aren’t doing enough to slow the worst surge in COVID cases that the country has seen.

“This surge is the most rapid increase in cases; the widest spread of intense transmission, with more than 2,000 counties in COVID red zones; and the longest duration of rapid increase, now entering its 8th week, that we have experienced,” say the reports, sent to Texas and other states on Dec. 6. “Despite the severity of this surge and the threat to hospital systems, many state and local governments are not implementing the same mitigation policies that stemmed the tide of the summer surge; that must happen now.”

Texas, the report says, “must increase mitigation to prevent ongoing community spread,” including “significant reduction in capacity or closure of public and private indoor spaces, including restaurants and bars.”

The task force’s reports over the last several weeks, meanwhile, have consistently pointed to the success of European countries — many of which have shuttered restaurants, bars and other businesses — in stemming the outbreak.

“The majority of the United States is not mitigating similarly,” Dec. 6 state report says.

You know how I feel about this. Do your best to take care of yourself, because Greg Abbott isn’t going to do anything to help you. The Trib has more.

The vaccine distribution challenge

Having a vaccine for COVID-19 is wonderful. Being able to make it available to everyone who needs it is a big challenge.

With cases spiking to over 10 million, the virus is everywhere, and spreading deeply into every corner of the country. This is where the Biden administration will face its biggest challenge, especially as it pertains to rolling out a potential vaccine.

My home state of Texas is a great example. A 2016 report from the Texas Department of State Health Services illustrates the terrible state of rural health care. According to DSHS, 235 of Texas’ 254 counties were medically underserved. There were many isolated counties with little to no access to health care. Some even lacked a single doctor.

This has been a crisis a long time in the making. As the Texas Observer recently noted, in 2019, Texas budgeted $17.7 million for infectious disease surveillance, prevention, and epidemiology—and over $400 million for border security. So even when a vaccine is delivered, it will be going to a state that is understaffed and underfunded.

Lipscomb County, population 3,302 as of 2010, in the northeast corner of the Texas panhandle, doesn’t have a doctor. It is worth noting that Lipscomb County is a 550-mile drive from Austin. Portland, Maine, is a closer drive to Washington, D.C., than those 3,302 isolated souls.

Given this isolation and lack of resources, the vaccines themselves present a logistical challenge alone that borders on the impossible for rural America. The Pfizer vaccine, now the leading contender, will require ultra-cold storage of at least -94 degrees Fahrenheit and two rounds of shots. Another leading vaccine candidate from Moderna also requires cold storage, albeit not to the same extent, according to the company. Typically, hospitals and large clinics have this capability. Small towns lacking even the most basic health clinics do not.

To deploy the Pfizer vaccine or any other one, health planners will have to figure out a way to deliver it to rural areas while maintaining its required temperature long enough to ensure that the population receives both doses. This scene will be repeated all across small-town America. This presents a big risk: An uncoordinated federal roll out of vaccines requiring ultra-cold storage could leave state and local governments competing for resources much like they were competing for PPE earlier in the pandemic.

The Trib expands on this.

How effectively public health officials can prioritize and distribute millions of doses of the new vaccines across a state that covers 270,000 square miles and more than 170 rural counties will determine how quickly Texas turns a corner in a pandemic that is again surging across the state and pushing hospitals to the brink in West Texas and the Panhandle.

The task is made more difficult because the Texas Department of State Health Services, which is largely responsible for the distribution effort, won’t know which vaccines it’s receiving, and how many doses, until one or more is approved by the U.S. Food and Drug Administration.

They will also have to combat misinformation and persuade vaccine skeptics — and those unnerved by the coronavirus vaccines’ historically swift development — of the benefits of being inoculated. World Health Organization experts have said that up to a 70% vaccine coverage rate for COVID-19 may be needed to reach population immunity through vaccination. In the 2019-20 flu season, only about 37% of adults younger than 65 received a flu vaccine. The rate was about 65% for seniors.

“We haven’t seen any efforts that are this broad since probably a polio vaccination in the 1950s,” said Dr. Mark McClellan, a former head of the FDA who has advised Abbott about the pandemic.

“The people who are most likely to benefit from vaccination are people who may have difficulty connecting to health care,” such as elderly people and residents of low-income communities who often lack health insurance, he added — compounding the logistical challenges.

The vaccine is expected to initially be in short supply, and will be first distributed to a state-selected group of people considered to be essential workers or most vulnerable to being severely sickened.

[…]

It’s still unclear, beyond a list of murky priority groups such as health care workers, who will get the vaccine during the initial months when supplies are scarce. In the coming weeks, a state panel of experts is expected to publish more specific recommendations about who will be eligible for a vaccine and when.

Early estimates from the Texas Department of State Health Services found there are more than 5 million people who are vulnerable or work in front-line jobs that increase their exposure risk. That includes more than 3.9 million people who are 65 or older, more than 638,000 health care personnel, more than 327,000 acute care hospital employees, more than 137,000 nursing home residents and more than 66,000 emergency medical workers.

The state’s adult population also includes more than 9.4 million Texans with underlying medical conditions that could increase their risk for severe illness associated with COVID-19.

So yeah, it’s a big problem, and there are many questions that need to be answered, some of which will spark heated debate. In the meantime, as both stories noted, the pandemic rages on, meaning we could be trying to vaccinate people while we’re still in conditions that still demand social distancing and will put everyone involved in the process at risk. So you know, maybe we should try a little harder to contain the spread right now. Just a thought.

UPDATE: From the Trib:

Health care workers will be the first people in Texas to receive a COVID-19 vaccine once one receives emergency approval from the U.S. government, and on Monday a state panel of vaccine experts and politicians revealed which workers in the health field will receive top priority.

The “first tier” recipients, according to the panel’s new guidelines, include:

  • Hospital-based nurses, doctors, custodians and other workers who have direct contact with patients
  • Staff of nursing homes or other long-term care facilities who work directly with residents
  • Emergency medical services providers such as paramedics and ambulance drivers
  • Home health aides who manage “vulnerable and high-risk” patients

Certainly reasonable. We’ll see how it goes after that.

Prevention > treatment

I mean, more treatments for COVID is a good thing, but you know what’s better? Not getting COVID in the first place. Maybe we can try doing better on that?

Gov. Greg Abbott traveled to Lubbock on Thursday to tout a newly approved coronavirus treatment, without saying how many doses are available or announcing any new restrictions to slow the virus’s spread as infections continue to surge.

Speaking at his first news conference on the pandemic in over two months, the governor said the treatment, made by Eli Lilly and similar to the one that President Donald Trump received last month, has already been distributed to Lubbock and other areas with overcrowded hospital systems, including Midland, Amarillo and El Paso.

“They have enough right now where they can begin the process and treat patients at least for the next several days,” Abbott said. He said he expects additional treatments to arrive in the coming weeks, as well as the first few shipments of a coronavirus vaccine, which could arrive by late December and would go to first responders.

“The cavalry is coming,” he said.

The governor added firmly that the state will not be locking down again, a measure used this spring to slow the initial wave of infections, and insisted that local officials have all tools they need to slow local outbreaks, including a mask mandate in place since the summer and mandatory occupancy reductions for regions where the number of COVID-19 patients exceed 15 percent of total hospital capacity for seven straight days.

In a companion article, Abbott gives three pieces of “good news”, which are this new treatment, that new treatment, and the forthcoming vaccines. All of which is great, and I can’t wait till the vaccines are widely available, but none of that really deals with the current crisis. Effective treatments assumes a fully functional health care system, and right now we have overcrowded hospitals and doctors and nurses who are getting thoroughly burned out. I also assume these treatments aren’t free, and in case you’d forgotten the state of Texas is one of the plaintiffs in a lawsuit that if successful would take away health insurance from millions of people – that’s on top of the millions who already don’t have it here in our state. Plus, and I can’t say this often enough, the economy is not going to get back to full steam until people feel safe from the virus. It’s not enough to say “if you get sick we’ll help you get better”, especially if you’re a person who is immunocompromised or has various co-morbidities or doesn’t have sick leave or child care or health insurance. How many more people need to get sick and die before Greg Abbott can be bothered to care?

Our vaccination rates are down, too

I wish I had a snappy intro for this, but I just don’t.

The summer months are typically the busiest of the year in Dr. Kenya Parks’ office, a steady flow of parents trotting in their little ones to receive immunizations required for school attendance.

But the numbers are way down this year, one more casualty of the COVID-19 pandemic.

“It’s quite noticeable,” said Parks, a pediatrician with UTHealth and UT Physicians, the practice of doctors at the University of Texas’ McGovern Medical School in Houston. “Parents who usually pack our offices around now instead are putting off or canceling or just not showing up for appointments. They’re scared.”

Such fear is a primary reason for an average 44 percent drop in the number of doses administered in the Texas Vaccines for Children program during the early months of the pandemic, according to a new state report. The trend puts Texas at risk of vaccine-preventable disease outbreaks, a potential disaster when school starts up.

The drop is particularly high for immunizations for measles — 55 percent — the highly infectious disease declared eradicated in the United States 20 years ago but now experiencing a resurgence. The drop in doses administered is slightly higher in the Houston area, site of a measles outbreak in 2019 and identified in a study the same year as one of the nation’s hot spots, vulnerable to an even bigger outbreak.

The overall Texas trend is concerning because the state’s vaccination rates were bad even before the pandemic. The state last year failed to meet minimal national goals for eight of 11 immunizations and barely squeaked by for the three it did meet.

“It’s like we got an F in eight classes and a D- in three, and now things are getting worse, when we can least afford it,” said Allison Winnike, president of the Immunization Partnership, a Houston-based vaccine advocacy organization. “That’s why it’s crucial parents call their pediatricians, get their kids in for their vaccinations if they’re not up to date.”

The good news, if you want to call it that, is that this doesn’t seem to be the result of changing attitudes about vaccinations. It’s about fear of the virus, which is something we can be a bit more hopeful will change in the not-too-distant future. But this is also a real risk factor for reopening schools, which I haven’t seen any official acknowledgement of. Risking a COVID-19 outbreak to force in-person school at a predetermined date is bad enough. Risking a measles outbreak on top of that is even worse. You can blame the parents if you want for the decisions they’ve made – I for one would be more compassionate, but you do you – but that doesn’t change the fact that this is a thing that will need to be dealt with, and that’s likely going to require some time. Are Greg Abbott and the TEA even thinking about this?

Anti-vaxxers gonna anti-vaxx

Every step of the way, they are an obstacle to public health.

The Texas group that lobbies against vaccine mandates is now launching a campaign against COVID-19 contact tracing, the public health measure used for decades around the world to contain disease spread.

Texans for Vaccine Choice this week called on its members to contact Gov. Greg Abbott and let him know they “do not wish to be monitored or surveilled for any reason” in response to a new state program hiring and training workers to identify people who’ve come into close contact with those who recently tested positive for the coronavirus. Such people are then asked to quarantine until testing shows they don’t have the disease.

“The government should stop thinking its job is to keep everyone healthy and instead focus on protecting our rights,” says a post on the organization’s website. “We here at TFVC will remain vigilant as our government expands greatly and the threats to our members grow.”

The campaign drew an immediate rebuke from Dr. Peter Hotez, the Baylor College of Medicine infectious disease specialist who has led public health’s fight against the anti-vaccine movement, which he holds responsible for the resurgence of vaccine-preventable diseases such as measles and whooping cough.

Thanks to the movement’s efforts, some 60,000 Texas parents currently obtain non-medical exemptions for school vaccines, some 25 times higher than 2003, the first year such exemptions were allowed. A 2018 study by Hotez found Houston and three other Texas cities rank among the 15 metropolitan “Shotspots” of such exemptions.

“Awful to see the #antivax lobby in Texas now going the extra measure to halt #COVID-19 prevention,” Hotez tweeted Tuesday in reply to a Texans for Vaccine Choice tweet alerting people to the campaign. “In the name of fake ‘health freedoms’ slogans, they aspire to land thousands of Texans in our hospitals and ICUs.”

John Wittman, a spokesman for Abbott, noted that a contact tracing program was part of the guidelines laid out by President Donald Trump in order to reopen the state and has been used in Texas and the country for decades. He said the program is “completely voluntary” and that the state health department has “taken steps to ensure it protects individuals’ liberty and privacy.”

There are certainly questions to be raised about the state’s contact tracing plan, though those questions should mostly be about competence and cronyism. I can sort of see the rationale behind the anti-vaxx movement, if I squint and do some deep-breathing exercises. The point of contact tracing is to find and notify people who may have come into contact with a person who has tested positive for COVID-19. I’m really hard-pressed to see what the problem is with that, beyond the usual tinfoil-hat paranoia about RFID chips, UPC codes, and our precious bodily fluids. We already know we have a long fight ahead over an eventual coronavirus vaccine, which is now a partisan issue as well as another thing for these people to froth about. The rest of us need to recognize this for what it is, which is a direct threat to our health. What are you going to do about that, Governor?

Perspective on the anti-vaxx situation

Maybe it’s not as bad as we think.

It’s certainly true that pockets of vaccine refusal persist in this country, as they have for many years. If those pockets are now experiencing greater numbers of measles cases, it may be on account of dire trends in far-off places.

This global explanation only kicks the can a little farther down the road, however. Measles cases are spreading here because they’re spreading overseas—OK, fine. But why is measles spreading overseas?

[…]

Are vaccination rates really on a downward trajectory? Once again, the actual data complicate this narrative. Global immunizations against measles, like those in the U.S., are at or near an all-time high. Since the start of this century, the proportion of people around the world who have received at least one dose of the measles vaccine has increased by almost one-fifth. Meanwhile, the use of a second dose of the vaccine (which makes it more effective) has more than quadrupled on the global scale. In 2000, just 15 percent of people were getting both shots. Now, that number is up to 67 percent and still rising.

The salutary effects of all this work could not be more apparent. The global number of people who contract measles and the global number of people who die from it have each gone down by about 80 percent since 2000. As recently as 1980, more than 4 million cases of measles were reported every year. Despite massive population growth since then—an uptick of several billion people, worldwide—the annual number of measles cases has dropped to about one-fiftieth of what it used to be, to a few hundred thousand cases per year.

Given all this recent progress, the global measles crisis that’s underway seems somewhat paradoxical.

Basically, the argument is that outbreaks like we’ve seen with measles tend to burn quickly through the susceptible population, then run out of steam, and that the biggest cause of not being vaccinated in the US is not anti-vax foolishness but lack of access to medical care. The author argues that the full picture of the data is often not represented or mis-represented in media stories, which has caused some level of overreaction among vaccine proponents. There’s a lot of detail, so read it all and see what you think.

Bankrolling the anti-vaxxers

This is why we can’t have nice things.

A wealthy Manhattan couple has emerged as significant financiers of the anti-vaccine movement, contributing more than $3 million in recent years to groups that stoke fears about immunizations online and at live events – including two forums this year at the epicenter of measles outbreaks in New York’s ultra-Orthodox Jewish community.

Hedge fund manager and philanthropist Bernard Selz and his wife, Lisa, have long donated to organizations focused on the arts, culture, education and the environment. But seven years ago, their private foundation embraced a very different cause: groups that question the safety and effectiveness of vaccines.

How the Selzes came to support anti-vaccine ideas is unknown, but their financial impact has been enormous. Their money has gone to a handful of determined individuals who have played an outsize role in spreading doubt and misinformation about vaccines and the diseases they prevent. The groups’ false claims linking vaccines to autism and other ailments, while downplaying the risks of measles, have led growing numbers of parents to shun the shots. As a result, health officials have said, the potentially deadly disease has surged to at least 1,044 cases this year, the highest number in nearly three decades.

The Selz Foundation provides roughly three-fourths of the funding for the Informed Consent Action Network, a three-year-old charity that describes its mission as promoting drug and vaccine safety and parental choice in vaccine decisions.

Lisa Selz serves as the group’s president, but its public face and chief executive is Del Bigtree, a former daytime television show producer who draws big crowds to public events. Bigtree has no medical credentials but holds himself out as an expert on vaccine safety and promotes the idea that government officials have colluded with the pharmaceutical industry to cover up grievous harms from the drugs. In recent weeks, Bigtree has headlined forums in ultra-Orthodox Jewish communities in Brooklyn and Rockland County, New York, both areas confronting large measles outbreaks.

“They should be allowed to have the measles if they want the measles,” Bigtree told reporters outside the Brooklyn meeting on June 4. “It’s crazy that there’s this level of intensity around a trivial childhood illness.”

It’s like Margaret Mead said: Never doubt that a small group of thoughtless, super-wealthy citizens can change the world for the worse; indeed, it’s the main thing that does.

See ya, Stickland

Good riddance.

Former legislator

State Rep. Jonathan Stickland, a firebrand conservative Republican from Bedford and one of the most vocal members of the Texas House, announced Monday he will not run for reelection in 2020.

Stickland, first elected to represent House District 92 in 2012, broke the news to supporters in an email, saying he had “determined it is not in the Lord’s will for me to seek re-election.”

“Instead,” he wrote, “I intend to dedicate more time to my family, my church, and my business.”

While in office, Stickland established a reputation as one of the House’s more pugnacious members, often taking to the chamber’s back microphone to debate — and sometimes kill — pieces of legislation. Stickland typically argued he was pushing back against bills in the name of liberty and freedom, a nod to the hardline conservative values he aligned himself with.

[…]

Although Stickland was at times effective with his procedural maneuvers and tactics in the House, he didn’t pass his first bill until this year.

“I’ve been waiting a long time for this moment — seven years,” he told colleagues as the House passed his measure to ban red light cameras in the state. “The people of Texas have been waiting a longer time than I have.”

While Stickland prided himself on his lone wolf image, the lawmaker was deeply unpopular with a faction of members and constituents who disagreed with his approach to politics. In the 2018 general elections, Stickland, running for a fourth term, almost lost to a little-known Democratic challenger.

Stickland was an utter waste of space. His political beliefs ranged from risible to reprehensible. From anti-vaxxing to rape apologia, you could always count on Stickland to be loudly and aggressively on the wrong side of just about any issue. The next Legislature is already in better shape for Stickland’s absence. His departure also opens up a swing district, though I’m honestly not sure that it will be easier for a Dem to win without Stickland on the ballot. Be that as it may, let me just say good-bye to someone who truly deserves to hear that word. May I never have to hear his name again. The DMN has more.

Our vaccine exception rates keep going up

A small change to the law in 2003 has had a big effect over time.

As measles cases hit a 25-year high in the United States, Texas medical experts fear the state could see the next outbreak of a vaccine-preventable disease. Texas has reported 15 confirmed cases of measles so far in 2019, six more than in all of 2018.

Health officials are watching pockets of Texas closely because of the number of parents requesting exemptions under Texas’s broad vaccine exemption law. Texas is one of 16 states that allow parents to bypass vaccine requirements for enrolling their kids in school by claiming a conscientious exemption, along with citing medical or religious concerns. Just last month, Washington ended conscientious exemptions on the heels of a large measles outbreak with over 70 reported cases. Three states — California, West Virginia and Mississippi — only allow medical exemptions.

Texas’ exemption law used to be stricter. In 2003, a state senator proposed loosening restrictions via a three-page amendment to a 311-page bill. After five minutes of discussion, the amendment was approved. The bill was soon signed into law. Sixteen years later, former state Sen. Craig Estes said the change to Texas’ vaccine laws that he helped enact should be reviewed in the current public health climate.

“Obviously we didn’t ever imagine what would happen,” Estes, a Republican from Prosper, told The Texas Tribune. “With what’s happened recently, I would encourage the legislature in the future to revisit that issue and debate it.”

The speedy way in which the Texas Legislature weakened the state’s vaccine exemption rules suggests that, like Estes, few in office at the time thought it would put Texas at risk for future outbreaks. However, while experts suggest Texas is now vulnerable, efforts to change the exemption law have been dead on arrival in the Capitol.

“There will be a terrible measles epidemic in Texas, and children will be hospitalized in intensive care units, just like they are in New York right now,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said last month. “That will wake up the state Legislature to realize that there’s a problem and close those exemptions.”

Kindergarteners must have 10 immunizations to be enrolled in Texas schools. Since 2006, when the state first started reporting the data, the exemption rate for kindergarteners in Texas has risen from 0.3% for the 2005-06 school year to 2.15% for the 2018-19 school year.

In Texas, school districts, private schools and charter schools are required to report their vaccine exemption rates per vaccine. The data collection is done through a survey administered by the Texas Department of State Health Services, but some schools don’t report consistently, leaving gaps in the data.

The data shows certain communities — like the Dallas Independent School District — have seen a recent spike in conscientious exemptions for kindergarteners. Others — like El Paso ISD — have seen exemptions recently plummet. Some smaller private schools, meanwhile, have exemption rates that are significantly higher than those of other schools. The Austin Waldorf School had the highest vaccine exemption rate for the 2018-19 school year, at 52.9%. Alliance Christian Academy had the second-highest rate at 40.6%.

When enough of a community is immunized against a disease, that group has what’s known as herd immunity, meaning there is a low risk of a disease spreading. Vaccine-preventable disease have different herd immunity thresholds. Measles, which is highly contagious, has a high herd immunity threshold of 95%. According to a state report for the 2018-19 school year, Texas kindergarteners statewide had coverage levels higher than 95% for all required vaccines. Yet the data from individual school districts and private schools suggests that some communities may fall short of meeting that threshold for some vaccines.

The fact that a Waldorf school is atop this list shows the problem is very much bipartisan, though the main anti-vax legislators these days are all Republicans. I’ve repeated this a million times, but the only way to improve things is to throw those anti-vax legislators out of office. Next year is a great opportunity to do that as three of them – Jonathan Stickland, Bill Zedler, and Matt Krause – all had close elections in 2018. The rest is up to us. Now go read the rest of the story for the history of how we got to this point.

Our measles risk

Do I spend too much time worrying about stuff like this, or do I not spend enough time on it?

Harris County is one of the nation’s most vulnerable counties to a measles outbreak, according to a new study based on international travel and the prevalence of non-medical vaccine exemptions.

The study, published Thursday in the journal Lancet Infectious Diseases, ranks Harris County as the county 9th most at risk of having clusters of people contract measles, the highly contagious, potentially fatal virus that has re-emerged as a public health threat after having been largely eradicated at the turn of the century. Tarrant and Travis counties also are at high risk of an outbreak, according to the study.

“Texas’ showing is on par with the other 16 states that allow vaccine exemptions for conscientious or personal reasons,” said Sahotra Sarkar, a University of Texas Austin professor and the study’s lead author. “You can expect the state, like other parts of the nation, to see more cases.”

Sarkar said Harris County’s vulnerability is mostly the result of its considerable international travel. The county’s number of non-medical vaccine exemptions was not among the state’s highest in a Texas health department report released earlier this week.

[…]

The new study was conducted by Sarkar and a Johns Hopkins University researcher using risk assessment models similar to one they used to correctly predict that Zika, the mosquito-born virus that can cause serious birth defects, would first affect Texas and Florida after it began spreading from the Southern Hemisphere midway through this decade. It also correctly predicted areas already experiencing measles outbreaks, such as Washington, Oregon and New York.

The authors didn’t consider the locations of measles cases already recorded. Instead, they looked at non-medical vaccine exemptions, international air travel and the incidence of measles in countries from which people came to the United States, particularly India, China, Mexico, Japan, Ukraine, Philippines and Thailand. In all, some 112,000 people have been diagnosed with measles outside the U.S. this year, according to the World Health Organization.

Peter Hotez, a Baylor College of Medicine professor of infectious disease and vaccine advocate, called the new study an advance over research he published last year that identified “15 hotspots” of vaccine exemptions among a subset of states. Harris County ranked seventh on that list.

“I think this is a nice refinement on our first attempt,” said Hotez. “It confirms the high risk of Texas counties to measles, something that we’ll need to consider seriously when planning for epidemics.”

It’s not clear what if anything can be done to mitigate this particular risk, so I’m back to wondering how much I should worry about it. Keep working to close the gap in vaccination rates, I guess. It annoys the crap out of me that we have to worry about this sort of thing in 2019, but here we are.

Measles, schmeasles

Eh, no biggie.

With U.S. measles cases this year reaching historic levels since being practically eradicated nearly 20 years ago, a host of bills targeting vaccination policies in Texas don’t appear to be gaining traction in the Legislature.

The U.S. Centers for Disease Control and Prevention has confirmed 704 cases of the measles in 22 states so far this year, the most of any year since 1994. Fifteen of those cases have been in Texas, the Texas Department of State Health Services said.

Considering the scope of the crisis, Rekha Lakshmanan, policy director for the Immunization Partnership, a group devoted to eradicating vaccine-preventable diseases, said lawmakers this session are missing an important opportunity to pass what she called “common-sense immunization laws,” among them bills aimed at increasing data transparency.

Notable among those measures are Senate Bill 329, filed by Sen. Kel Seliger, R-Amarillo, which would require the Department of State Health Services to publish the immunization opt-out rates for individual public schools. Currently, the health department is only required to post this information for districts as a whole and private schools. Another, House Bill 1966 by Rep. Gene Wu, D-Houston, would empower child care facilities to list their immunization opt-out rates for parents who are interested.

Vaccine advocates say making this data available would help parents choose the best place to send their children, particularly if the children have compromised immune systems and can’t be vaccinated.

“If you cannot vaccinate your child, then you need to place them in a child care facility with children who are vaccinated, I think, for the obvious reason that you know those children would not spread it to your child if there is a contagion that goes through the population,” Wu said of his legislation.

Opponents say the information does not reflect the overall health of a facility and could lead to kids being discriminated against for not being vaccinated, even though names would not be published.

Lawmakers heard testimony on both bills in committee hearings last week but did not vote on either. Next week is the deadline for the House to advance bills. The Senate has until May 22.

See here, here, and here for some background. This story was from the weekend, so please note that the House deadline for voting out bills is tonight at midnight. After that, it’s Senate bills or attaching amendments if your bill died in committee. The anti-vaxxers complaints do not move me. I see this as a matter of giving parents the information they need to make good choices. If that means that preschools and child care facilities are less inclined to take kids whose parents chose not to vaccinate them because it’s bad for their business, well, that should tell you something.

Also, too:

Amid a record-breaking national outbreak of measles, the number of Texans who exempt their children from vaccination for non-medical reasons took another big leap this past school year.

The number increased 14 percent in 2018-2019, continuing a 15-year-long trend that public health officials worry is leaving communities vulnerable to the resurgence of preventable diseases such as measles, which has been confirmed this year in 23 states, including Texas. The number of measles cases this year is the largest since 1994.

“Seeing non-medical exemptions increase again on a double-digit scale should create outrage for everyone,” Allison Winnike, president and CEO of the Houston-based Immunization Partnership, said in a statement. “It’s time for Texans to take action.”

Porfirio Villarreal, public information officer for the Houston health department, added that it’s “disappointing to see yet another rise in the number of parents opting out of life-saving vaccines, mostly due to the vast amount of misinformation on the internet and social media channels.”

The number of exemptions are still small, 64,176, but they represent a roughly 2,000 percent increase since 2003, when the state began allowing parents to decline immunization requirements for reasons of conscience. There were about 3,000 in 2003-2004, and a little under 57,000 in 2017-2018.

[…]

Texas is one of 17 states that allow waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only three states — California, Mississippi and West Virginia — don’t grant exemptions on religious grants. All 50 states allow exemptions for medical conditions, such as a compromised immune system.

Of course, tightening up the rules for exemptions is not on the table at all. The report that produced this data breaks it down by school district but – as we know – not by individual school. I don’t even know what else to say.

There’s only one solution to the anti-vax crisis

They have to be beaten at the ballot box. There’s no other way.

On the South steps of the Texas Capitol, state Rep. Briscoe Cain prayed that the children standing beside him would not be mocked for their parents’ decision not to vaccinate them.

“We ask that you strengthen these children … we ask that you shield them,” said Cain, R-Deer Park. “May government leaders never forget that parents know what is best for their children.”

On Thursday, more than 300 anti-vaccination advocates and their children rallied with Texans for Vaccine Choice to support bills filed by a handful of state lawmakers that would require doctors to provide families with both the “benefits and risks of immunization,” and make it easier to opt out.

“I walk these halls and I see … the fun they are poking at our children and our families, and it angers me,” said the group’s president, Jackie Schlegel, who said her daughter is disabled due to complications from a vaccine. “The time is now to stand up, to be here for your families, to be here for your children, the ones who do not have a voice.”

Statewide data shows a steady rise in children whose parents have claimed conscientious exemptions from vaccine requirements. In 2018, 76,665 individuals requested affidavits for the exemption, an 18.8-percent increase over 2017, and a 63.8-percent increase since 2014, according to the Texas Department of State Health Services.

As the movement grows, Texas has seen a series of outbreaks of infectious diseases that were thought to have been virtually eliminated in the U.S.

You can see what we’re up against. Measles are back, someone was walking around the Capitol with whooping cough, idiots are deliberately exposing their own children to chicken pox, it goes on and on. Reason, civic duty, compassion for the immunocompromised, nothing moves these people. The one thing we can do is throw the legislators who coddle them out of office. Diminish their power, and the rest takes care of itself. So, just as a reminder:

Jonathan Stickland, HD92, won in 2018 by a 49.8% to 47.4% margin, in a district where Beto O’Rourke got 48.3% of the vote.

Matt Krause, HD93, won in 2018 by a 53.9% to 46.1% margin, in a district where Beto O’Rourke got 48.2% of the vote.

Bill Zedler, HD96, won in 2018 by a 50.8% to 47.2% margin, in a district where Beto O’Rourke got 49.5% of the vote.

I wish I could make a case for Briscoe Cain’s vulnerability, but alas, he’s in one of the two most Republican districts in Harris County. Still, take those three out and you’ve really weakened the anti-vax core. You want to see fewer kids get easily preventable diseases in Texas? There’s your starting point.

The anti-vaxxers keep on coming

Eternal vigilance, and some more problematic legislators getting booted out of office, are required.

Among the new Texas proposals is an “informed consent” bill filed by state Representative Bill Zedler, an outspoken anti-vaccine member of the House Public Health Committee. Zedler drew national attention after he downplayed the resurgence of measles, which he had as a child, telling the Observer last month, “Today, with antibiotics and that kind of stuff, they’re not dying [of measles] in America.” (Hundreds of Americans died of measles each year before the disease was considered eradicated in 2000, thanks in large part to the development of a vaccine. Also, antibiotics don’t treat measles, which is a virus.)

[…]

bill filed by state Senator Bob Hall, R-Edgewood, would ban vaccines that haven’t met criteria that Hall — a retired business owner — has determined the U.S. Food and Drug Administration should be using for approval. The bill also requires the state health department to post online a “disclosure of any known injuries or diseases caused by the vaccine” and that the vaccine be “evaluated for [its] potential to: cause cancer, mutate genes, affect fertility or cause infertility, and cause autism spectrum disorder.”< The bill is “dangerous” and a “misunderstanding of how science and clinical trials work,” Lakshmanan said. Any link to autism, first proposed in a now-retracted study, has been repeatedly debunked. “The insinuation of this legislation is that vaccines are not well-tested and not safe, which is erroneous, incorrect and misleading,” she said. Hall did not respond to a request for comment.

Also of top concern for immunization advocates are proposals to make it even easier to opt out of vaccine requirements, even as “conscience” exemptions have skyrocketed in Texas from about 2,300 in 2003 to nearly 53,000 in 2017. A bill filed by House Freedom Caucus member Jonathan Stickland, R-Bedford, would allow nurses to sign off on exemption forms rather than just doctors. Another, from state Representative Tony Tinderholt, would prohibit doctors from refusing to see patients who aren’t vaccinated. And one from caucus member Matt Krause would make it easier to submit vaccine exemptions, and prevent the state health department from tracking them. Health experts say this would prevent the state from preparing for potential disease outbreaks, as well as make it impossible for families of very young or immunocompromised kids to know which communities have low vaccination rates.

See here for some background. You can find all these bills and more by going to the Texas Legislature Online page and doing a word/phrase search for “immunization”. It’s not always easy to tell with the language in these bills, but SB1813 by Sen. Jose Rodriguez, which appears to loosen requirements for pharmacists to administer vaccinations, looks good. I don’t see anything positive relating to the so-called “conscience clause” exemption, which is what allows parents to enroll unvaxxed kids in school because they don’t want to get them immunized. I don’t think we’re there yet for something like this. The best we can do this session is most likely going to be not letting anything bad get passed. Then we need to follow it up by beating as many of these anti-vax schmoes at the ballot box as we can. Make note of those names, these are the targets of interest.

Can we turn the anti-vax tide in the Lege this session?

It sure would be nice, and this needs to be the primary goal.

In Texas, children are required to have certain sets of vaccinations before they can be enrolled in public school – including the vaccine for measles.

But parents who have “reasons of conscience” for not wanting their children to be vaccinated are allowed to opt out of vaccinations, a practice that experts say is forming a dangerous trend that helped fuel the most recent measles outbreak.

Statewide, there was only one confirmed case of measles in each of 2016 and 2017. In 2018, there were nine confirmed cases of measles, authorities say.

There are seven confirmed cases so far in 2019.

The legislature does not define what constitutes a “reason of conscience,” meaning that any parent, for any reason, can decide not to immunize their children against dangerous and sometimes deadly diseases.

Close to 57,000 children in Texas went to public schools unvaccinated in 2018 for non-medical reasons, according to Allison Winnike, president and CEO of The Immunization Partnership. She said those numbers are growing year-over-year since the non-medical, “reasons of conscience” exemption went into effect almost two decades ago.

Concerns about the rise in measles cases is the fulcrum for this. Anti-vaxxers had a good session in 2017, but their advantage is more partisan than non-partisan, and a couple of their leading advocates – Reps. Bill Zedler and Jonathan Stickland – both had close wins in 2018 and will be big targets in 2020, along with others in Tarrant County.

All this is good, but so far the only vaccine-related bill I could find of any value was SB 329 by Sen. Kel Seliger would require a biennial report on any outbreaks of vaccine-preventable diseases and the number of children without vaccines under the “reasons of conscience” law, but it doesn’t change the “reasons of conscience” law itself. That’s where we need to go, and we may as well get started on it this session. And we’d better not wait, because the anti-vaxxers are actively trying to make things worse.

A bill filed in the Texas Legislature this month by Representative Matt Krause, a member of the far-right House Freedom Caucus, would make it easier for parents to request vaccine exemptions. A similar version was left pending after a House Public Health Committee hearing in 2017, but Krause’s new bill would go further, explicitly preventing the state health department from tracking the number of exemptions. Even though the exemption data doesn’t include anything that could identify individual students and is only available at the school district level, Krause and Zedler point to fears among anti-vaxxers that they will be tracked and bullied. “We’ve seen instances in California, stuff like that, where they start hunting people down,” [anti-vax Rep. Bill] Zedler said.

Public health officials say the proposal would curb their ability to identify and stop disease outbreaks, and parents of immunocompromised kids would have even less information to decide where to send their children to school.

“This is the modus operandi for anti-vaxxers in Texas: to promote exemptions, obfuscate and minimize transparency,” said Peter Hotez, a leading vaccine scientist and dean for the National School for Tropical Medicine at Baylor Medical School. “To do this in the middle of a measles outbreak in Texas is especially unconscionable.”

[…]

Krause, who is also backed by Texans for Vaccine Choice, argues that his legislation merely streamlines the process for parents who will obtain the exemptions anyway. He dismissed the many concerns raised by medical professionals last session. “They did a very good job of painting the worst-case scenario,” Krause told the Observer. “I’m not so sure those fears are founded.”

Krause acknowledged that he has already fielded concerns about his bill, in particular the clause preventing the state from tracking vaccine exemptions. He said he would be willing to scrap that language “if Texans for Vaccine Choice or some other vaccine choice groups or other folks from the medical community say that’s a bad idea.” Texans for Vaccine Choice did not respond to a request for comment.

Rep. Krause’s bill is HB1490. He won by eight points in 2018, so be sure to find a good opponent for him too. As I’ve said many times before, the anti-vaxxers are better organized and far more vocal – Rep. Gene Wu notes his recent encounter with this bunch – but I continue to believe they’re a small minority. This needs to be an issue people lose election over, because the stakes are getting higher. Vox, Mother Jones, and Daily Kos have more.

Measles comes back to Houston

We all vaccinated our kids, right?

Five cases of measles have been confirmed in the greater Houston area, a regional cluster that makes Texas the eleventh state this year to report the highly contagious disease until recently thought virtually eliminated in the U.S.

The cases, all announced Monday, include three in Harris County, one in Galveston County and one in Montgomery County. They involve four children, all under 2 years of age, and a woman between the ages of 25 and 35. All are doing well now.

“This is a reminder for people to be on guard and be up to date on their vaccinations,” said Dr. Umair A. Shah, executive director for Harris County Public Health. “Measles, a serious disease, is in our community.”

Measles, caused by an airborne virus, is particularly dangerous, capable of causing serious neurological disorders and death in infants and the developing fetus in pregnant women. It is spread through direct contact with discharge through the nose and mouth as well as coughing and sneezing.

Shah said it was too early to say whether the five cases might be the start of a local outbreak. The counties are monitoring anyone exposed to the measles patients while they were contagious to see if they develop symptoms. None has so far.

Dr. Peter Hotez, an infectious disease specialist at Baylor College of Medicine and Texas Children’s Hospital, said he’s concerned because in the pre-vaccine era, measles typically peaked in the late winner and early spring. He said “a perfect storm could be coming.”

[…]

It was unclear Monday if a lack of vaccination played a role in any of the Houston-area cases. All four children had received the first of the two shots — the second is given between the ages of 4 and 6 — and the woman said she’d been vaccinated, though the county is still working to confirm that through records.

Shah noted that the first dose of the MMR (measles, mumps and rubella) vaccine is fully protective in 85 percent of those who get it, but there’s no way of knowing if a child is in that group or the 15 percent who need the second shot to receive full protection.

Shah also noted that the person or persons who originally transmitted the virus may have been unvaccinated, he said.

The good news is that this outbreak is limited. This story said that Houston’s vaccination rate is above the national average, while this other story says just the opposite; I’m not sure what to make of that. It’s still a lot of cases at one time, and we’re already close to the nine cases total in Houston from last year. It could be worse, as the people in the greater Portland area can attest, but there’s no reason at all why it should be. You can listen to a short but timely interview with Dr. Hotez about the resurgence of measles here, and Texas Monthly has more.

Ebola treatment progress

This is encouraging.

Texas scientists who developed an effective vaccine for the deadly Ebola virus are now reporting promising results with new medication to better treat full-blown cases of the disease.

In a laboratory study published this week, researchers at the University of Texas Medical Branch at Galveston showed a single injection of two antibodies successfully treated monkeys infected with all strains of the virus, a significant advance on current treatment options which only cover one strain and require multiple injections.

“This medication would give doctors an advantage in situations where we don’t know which strain of Ebola is going to pop up next,” said Thomas Geisbert, a UTMB professor of microbiology and immunology and the study’s primary investigator. “The fear now, with all our eggs in one basket, is we’ll get burned with the outbreak of a strain there’s no protection against.”

Geisbert said the study results, published Wednesday in Cell Host & Microbe, suggest the medication would be effective even if Ebola viruses evolve over time, and Larry Zeitlin, president of Mapp Biopharmaceutical Inc., the drug manufacturer, said it should “reduce the burden on health-care workers in the field during outbreaks.”

[…]

New medications are increasingly being used in the Congo to treat Ebola, most notably ZMapp, which was initially deployed late in the first outbreak. But those medications work only against the Zaire strain and require multiple injections, a challenge in Third World settings. ZMapp, for instance, must be given three times, each a few days apart, and by infusion which takes up to five hours. The single infusion of MBP134 only takes minutes.

“That’s a huge advantage in chaotic outbreaks or reactive settings where it’s often difficult to track down and identify patients to give them a second dose,” said Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital.

Hotez added that “of course, all of this needs to be confirmed in human clinical trials.” He said the current outbreak in the Congo “looks like a good time for such an evaluation.”

See here and here for some background. I don’t have anything to add here, I just thought we could all use a bit of positive news.

Where the anti-vaxxers are

A lot of them are right here.

Four Texas cities, including Houston, rank among the 15 metropolitan “hotspots” of vaccine exemptions, more than any other state, according to a new study.

The study found Austin, Fort Worth and Plano also are among the nation’s cities with the highest number of kindergartners not getting vaccinated for non-medical reasons. Since 2009, the proportion of children opting out of such recommended vaccines increased in Texas and 11 other states, the study showed.

“There are some scary trends we were able to identify,” said Dr. Peter Hotez, a Houston vaccine scientist and one of the study authors. “They’re a sign that anti-vaccine groups, such as Texans for Vaccine Choice, have been very successful at lobbying efforts – both of the Texas legislature and through social media and other advocacy — to convince parents not to vaccinate their kids.”

[…]

The overall number of people invoking non-medical exemptions isn’t yet high enough to threaten herd immunity, the idea that vaccination of most of the population provides protection for those individuals without immunity to a contagious disease. But public health officials fear clusters of “anti-vaxxers” could leave some children vulnerable.

Texas’ increasing exemptions have been well documented. Though the number is still small, they have spiked from less than 3,000 in 2003 to more than 45,000 of the state’s roughly 5.5 million schoolchildren today, a 19-fold increase.

Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital said he undertook the study because of the Texas increase. He said wanted to look at whether it was a phenomenon unique to the state or mirrored elsewhere. National vaccination rates haven’t changed much in recent years.

You can see the study here. Dr. Hotez is correct to identify the political problem as being a key aspect to this. One clear pathway to getting more kids vaccinated is to take away or at least tighten up the so-called “conscience” objections to vaccines. If the law says you have to vaccinate your kids, the odds are pretty good that you will. But first you have to pass such a law, and right now we have a legislature that’s not inclined to do that.

The anti-vaxxers had another good legislative session

Sure would be nice if we could put a stop to this.

It was mid-April, more than halfway through the legislative session, and Texans for Vaccine Choice was finally getting the fight it had been spoiling for. On April 11, a bill to require schools to report the number of unvaccinated kids had been heatedly debated in a House committee. Doctors, public health experts, parents and others had testified in favor of House Bill 2249, calling it a transparency measure that would simply provide information about vaccination rates at individual schools. The matter was pressing, they said, because more and more parents were opting their kids out of vaccinations using a “reasons of conscience” exemption created by the Legislature in 2003. Without action, recent high-profile outbreaks of mumps and measles in Texas would only grow worse.

But Texans for Vaccine Choice has a radically different frame. While the pro-vaccination crowd appeals to legislators on the basis of science and public health, the anti-vaxxers have their own funhouse mirror version. Vaccines contain toxic chemicals, they say. They cause autism. They overwhelm the immune system. But more than that, the activists, many of them mothers, framed their position as one of parental choice and personal freedom — a message that commands attention at the Texas Legislature.

“The responsibility for my son does not fall on the state or any other family,” said one woman at the committee hearing. “And I would never rely on the herd to keep my son safe.”

Two days later, Texans for Vaccine Choice held a “Freedom Fight” rally on the South Steps of the Capitol. The event featured two prominent members of the far-right House Freedom Caucus, Jonathan Stickland and Bill Zedler, close allies of the anti-vaccination activists.

“Someone asked me the other day, ‘Why do you associate with those crazy vaccine people?’” said Stickland. “I said, ‘Because I am one’.”

Stickland went on to lay out a case for “choice.”

“Where there is risk, there must be choice,” he said. “It’s not government’s job to try to influence our behavior. … The state of Texas doesn’t own our kids. They should be looking for ways to protect parents because we know what’s best for our kids.”

[…]

In the final days of the 85th legislative session, it looked like the pro- and anti-vaccine lobbies were going to have to make do with a draw. But at the 11th hour, a discussion over a bill authored by Representative Gene Wu, D-Houston, requiring Child Protective Services to give new children in its custody medical exams, suddenly turned into a feverish argument about vaccines.

Urged on by Texans for Vaccine Choice, Zedler proposed a surprise amendment that would exclude vaccinations from those checkups. Vaccines, he insisted, “do not qualify as emergency care.” He was joined by several Republican members of the Freedom Caucus, with Representative Tony Tinderholt, R-Arlington, arguing that it was an “issue of liberty.”

A plea from Representative Sarah Davis, R-West University Place, a cancer survivor, failed to move the majority of Republicans. Davis proposed a measure that would at least require foster children to be vaccinated against cervical cancer. Her proposal was defeated in a 74-64 vote. Zedler’s amendment, meanwhile, was adopted 74-58.

Though Wu’s bill died in the Senate, a similar version of Zedler’s amendment found its way onto another child welfare bill and was signed into law by Governor Abbott.

Texans for Vaccine Choice considered the session a win. In early June, the group held a victory party that featured a fajita buffet and “chips fried in a dedicated gluten free frier.“) Photos on the group’s Facebook page show Tinderholt posing with an American flag hat while Zedler opted for a crown.

Pro-vaccine lobbyist Jason Sabo is anxious that mainstream Republicans, who might ordinarily have voted against potentially harmful anti-vaccination legislation, now see it as a primary issue.

“Only the extreme of the extreme show up to vote in the primaries: the anti-vaxxers, the pro-gun people, and the anti-annexation guys. Get four or five of these groups together and you have a bloc. And it’s really smart,” Sabo told the Observer. “So next session we have a choice: We either do the same thing and get the same results, or we come back with a different strategy.”

See here for some background. Rep. Wu’s bill was HB39, and the record vote on the Zedler amendment is here. You will note that only Republicans voted for the Zedler amendment. All Democrats, and a half dozen or so Republicans voted against it. If this isn’t a partisan issue by now, it’s pretty close. I think the “different strategy” that is needed here is to recognize that this is a campaign issue, for both March and November, and to treat it as such. Follow the model of the Texas Parent PAC, recruit and support some pro-vaccination Republicans in strong-R districts, and support Democratic candidates in competitive districts, for which there ought to be more than usual this cycle. Bill Zedler won with 57% of the vote in 2016, Stickland with 55.6%; Tinderholt didn’t have a Dem challenger in 2016, but won with 56% in 2014. None of these districts are unassailable, and maybe – just maybe – making vaccinations an issue might swing a few votes away from these guys, none of whom have anything but hardcore Republican brand loyalty to recommend them. Perhaps there’s a better strategy to stem these losses in the future, but if so I don’t know what it is. I can’t guarantee that pro-vaccination forces will be successful if they try to win a few elections, but I can guarantee they’ll have a much better time of it in the 2019 legislative session if they do.

Bill to allow discrimination in adoptions and foster care passes the House

Shameful.

Rep. James Frank

Under House Bill 3859, which advanced on a 94-51 vote, providers would be protected from legal retaliation if they assert their “sincerely held religious beliefs” while caring for abused and neglected children. The measure would allow them to place a child in a religion-based school; deny referrals for abortion-related contraceptives, drugs or devices; and refuse to contract with other organizations that don’t share their religious beliefs.

Rep. James Frank, the Wichita Falls Republican who authored the bill and an adoptive father, said repeatedly during a lengthy debate Tuesday that his legislation is not meant to be exclusionary but to give providers some certainty when it comes to legal disputes. He described opposition to the bill as “fabricated hysteria.”

“You can be successful, but it will cost you,” Frank said. “The bill declares a winner and says, ‘You are protected.'”

But Democratic lawmakers who lined up at a podium at the back of the House chamber to question Frank said the legislation would give religious groups license to discriminate against LGBT — or Jewish or divorced — parents who want to foster or adopt, or to avoid getting children vaccinated. A vast array of things could be classified as a “sincerely held religious belief,” they said.

“We’re further casting these children off,” said Rep. Jessica Farrar of Houston. “We’re making it more difficult for them to be adopted.”

See here for the background. The original sin here is the state accepting the idea that it’s okay for faith-based groups to treat children who don’t conform to their faith differently than those who do. By its very definition, it’s not acting in the best interests of the child, but of the providers, who last I checked were supposed to have the best interests of the child as their primary concern. And the “sincerely-held beliefs” dodge is just that, for as Chuck Smith said in that earlier story there are a lot of harmful beliefs out there. Remember this?

So check out the short exchange in the video clip above between Cohen and Becky Riggle, a pastor at Houston’s Grace Community Church. Riggle was testifying against [HERO], arguing that it violates the religious freedom of business owners and others in Houston who think LGBT people are sinful. If a business owner has the right to refuse service to LGBT people because the owner’s religious beliefs are offended, Cohen asks, then should business owners also be able to refuse service to other people — like, say, Jews — for the same reason?

Riggle, clearly realizing she’s trapped by her own argument, proceeds to trip all over her tongue in trying to respond. She ultimately suggests that yes, religious freedom would allow her to discriminate against Jews. But she insists “that’s not the issue” in the case of the Houston ERO.

Actually, that’s exactly what this is about — whether someone’s religious beliefs give them a free pass to discriminate against anyone they choose in civil society.

“Sincerely held” is not a synonym for “commendable” or “worthwhile”. This is a bad idea and it will be directly harmful to children who are already pretty damn vulnerable. ThinkProgress, the Observer, and the Chron have more.

Oh, and on a separate note, there was this:

A foster care bill in the House turned into a heated debate on vaccinations for children on Wednesday.

The bill from Rep. Gene Wu, D-Houston, is part of the state’s attempt to reform its foster care system. Wu’s House Bill 39, which won preliminary approval, would limit on the number of kids a Child Protective Services worker could supervise. It would also require speedy medical evaluations of children entering the foster care system.

Rep. Bill Zedler, R-Arlington and vice chairman of the staunchly conservative Texas Freedom Caucus, authored an amendment to the bill that would have restricted doctors from including vaccinations in initial medical examinations for children. Zedler said children could be removed from their homes by Child Protective Services, and then given an unwanted vaccination.

On the floor, Zedler told lawmakers that vaccines don’t protect public health and should not be considered an emergency medication. “The vaccination is only for that child to protect that child,” he said.

[…]

Zedler’s amendment had both Democrats and Republicans up in arms. Rep. Sarah Davis, R-West University Place, attempted to change Zedler’s amendment to allow doctor’s to distribute a vaccine if it has been proven to prevent cancer. Davis, who has previously been an advocate for vaccinations, said she was “dumbfounded” that lawmakers would vote against preventing cervical cancer.

“My amendment empowers doctors to practice medicine,” Davis said during a testy exchange with Rep. Jeff Leach, R-Plano. “I think this is so important that we can eradicate cervical cancer.”

Leach said he was concerned that Davis’ amendment would revoke parental rights who do not believe in vaccination, and “rip that decision from the parents and the child and give it to the doctor.”

Emphasis mine. Zedler’s amendment passed, while Davis’ attempt to modify it was defeated. Here are the 2016 election numbers in Zedler’s district and in Leach’s district. Sure would be nice to have some better representatives in those two districts, wouldn’t it? The Trib has more.

Making vaccination information public

I support this.

While most parents in Texas vaccinate their children, the number of parents opting out of immunizations for non-medical reasons is on the rise. Since Texas changed its laws to allow parents to opt out citing a conscientious objection, the number of unvaccinated children has shot up more than 1,700 percent in 13 years, to 45,000 from 2,300. In response, parents and health advocates are backing an effort to increase public reporting on how many students who have skipped vaccines attend each school.

Currently, that data is housed at the state level and available via an open-records request. County and school district-level data also is available online.

House Bill 2249 would require the Texas Department of State Health Services to publish school-by-school data that would indicate the total number of students who forgo vaccinations, including those who opt out by choice, such as a religious objection. No names or identifying information would be listed.

Advocates for publishing the data say the information would offer parents insight into their child’s school and help them weigh whether to switch, particularly for parents of medically fragile children like Riki Graves’ daughter, Juliana. Now 3, she received a new heart at 18 days old, and doctors say she will need to attend a school where least 95 percent of the students are immunized.

“My job as a transplant mom is to protect that organ,” said Graves as she drove from her home in Sugar Land to Austin where she plans to testify before the House Public Health Committee on Tuesday. “We have the data … there’s no reason not to publish it.”

Opponents say there are plenty of reasons, including children’s medical privacy.

“If this is truly about keeping children safe, we have to have that honest conversation about keeping all people safe. It puts a target on the backs of children whose parents have chosen to opt out for various different reasons,” said Jackie Schlegel, a mother of three and executive director of Texans for Vaccine Choice, a grass-roots parent group that has ballooned in recent years as the movement against vaccinating children has gained traction. The group is planning a rally at the Capitol on Thursday, dubbed the “freedom fight.”

“At schools where you do have a high number of opt-out, we are creating a witch hunt against families, and that’s just unacceptable,” Schlegel said.

We clearly have a different definition of “unacceptable”. I think knowing that a given school has a high rate of unvaccinated children is something any parent would want to know. HB 2249 has four co-authors, two of whom )JD Sheffield and John Zerwas) are medical doctors, which ought to tell you something. As the story notes, an identical bill passed the House in 2015 but never got a hearing in the Senate. Let’s hope this year’s version meets a better fate. The Trib has more.

Still talking vaccines and measles

Because it keeps needing to be talked about.

Earlier this month, Dr. Peter J. Hotez, a pediatrician at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, detailed a disturbing prediction for 2017 in an op-ed for the New York Times: the country could be facing a measles outbreak, and the Lone Star State could among the earliest casualties. “Texas, where I live and work,” Hotez wrote, “may be the first state to once again experience serious measles outbreaks.”

[…]

The spread of measles—one of the most contagious and deadliest diseases—could be stopped by the Eighty-fifth Texas Legislature, where there are currently pending bills that take aim at correcting the anti-vaccination trend. In December, State Representative Donna Howard, a Democrat representing Austin, filed a bill that would require parents and students who choose not to be vaccinated to indicate that they will “opt-out,” as opposed to the current system in which people must “opt-in” in order to be vaccinated. The bill would also require education for parents and students before they choose to opt-out. A similar bill filed by Representative Sarah Davis, a Republican from Houston, would require parents to complete an online educational course to inform them about the dangers of opting out of vaccination.

But anti-vaxxers make up a strong political bloc, and they’ve successfully thwarted pro-vaccination efforts in the Lege before. In 2015, state Representative Jason Villalba of Dallas tried to pass a law that would have entirely removed the exemption protection for parents who claimed to have a “conscientious objection” to vaccinations. His proposal was promptly torn to pieces by a few thousand members of a Facebook group for Texas anti-vaxxers, which formed a PAC, Texans for Vaccine Choice, that ultimately killed Villalba’s bill.  “These people, they literally said it to my face—they hate me,” Villalba told the Texas Tribune in April 2016, after his bill flopped. “This is a group that is very dedicated, very organized; this issue is very important to them.” Even after the bill failed, the PAC kept on Villalba. Jackie Schlegel, the PAC’s creator, told KUT in January that PAC members “knocked on nearly 10,000 doors for his challenger.” Villalba narrowly avoided defeat. Villalba told KUT that he supports Representative Davis’s bill, but it seems unlikely he’ll try to revive his own. “I’m not interested in a suicide mission on this issue,” Villalba told the Tribune last April.

Texas remains one of only seventeen states that allow parents to exempt their children from receiving vaccinations due to philosophical objections. None of the currently pending bills in the Lege would change that. Still, the Texans for Vaccine Choice PAC has already started to push back against the pro-vaccine billse. The anti-vax crowd is active on social media, and let Davis know that they were upset about her bill. In several exchanges with these folks on Twitter in late January, Davis shot down claims that vaccines cause autism by calling such assertions “alternative facts.

See here and here for some background, then go read Rep. Davis’ Twitter battle with the anti-vaxxers. I’ve never been a big fan of hers, but my respect for her is higher than ever after seeing that. Despite the fact that the anti-vaxxers have a friend in the White House, I do believe we can get one or both of Rep. Davis and Rep. Howard’s bills passed. The anti-vaxxers are as we know an organized and vocal minority, but in the end they are still a minority. We do have them outnumbered, and we need to remember that. If you’ve gotten yourself in the habit of calling your legislators about this and that these days, please add these two bills to your list of things you ask them to support.