Tennessee abandons vaccine outreach to minors — and not just for COVID-19

Layla Haji, 17, winces as she receives her COVID-19 vaccine during a mass vaccination event at Valor Collegiate Academy Saturday, April 10, 2021 in Nashville, Tenn.
Brett Kelman
Nashville Tennessean
  • The changes show how Tennessee is dialing back efforts to vaccinate minors against coronavirus.
  • The state is also detecting a growing number of infections from the delta variant.
  • Tennessee lags behind most of the nation in the race to immunity.

The Tennessee Department of Health will halt all adolescent vaccine outreach – not just for COVID-19, but for all diseases – amid pressure from Republican state lawmakers, according to an internal report and agency emails obtained by the Tennessean. If the health department must issue any information about vaccines, staff are instructed to strip the agency logo off the documents.

The health department also will stop all COVID-19 vaccine events on school property, despite holding at least one such event this month. The decisions to end vaccine outreach and school events come directly from Health Commissioner Dr. Lisa Piercey, the internal report states.

Additionally, the health department will take steps to ensure it no longer sends postcards or other notices reminding teenagers to get their second dose of the COVID-19 vaccines. Postcards will still be sent to adults, but teens will be excluded from the mailing list so the postcards are not “potentially interpreted as solicitation to minors,” the report says.

These changes to Tennessee’s vaccination strategy, detailed in an COVID-19 report distributed to health department staff on Friday, then reiterated in a mass email on Monday, illustrate how the state government continues to dial back efforts to vaccinate minors against COVID-19. This state's approach to vaccinations will not only lessen efforts to inoculate young people against COVID-19 but could also hamper the capacity to vaccinate adults and protect children from other infectious diseases.

And these changes will take effect just as the coronavirus pandemic shows new signs of spread in Tennessee. After months of declining infections, the average number of new cases a day has more than doubled in the past two weeks, from 177 to 418. The average coronavirus test positivity rate has jumped from 2.2% to 5.4% in the same time period.

IN HER OWN WORDS:Tennessee's former top vaccine official releases scathing statement about health department

The state is also detecting a growing number of infections from the coronavirus delta variant, a more transmissible form of the virus that is sparking outbreaks among unvaccinated populations in Arkansas and Missouri. Tennessee’s count of known delta variant cases rose from 27 on June 24 to 125 as of last Thursday, according to state virus data. The true count is probably much higher because testing of the variant is done sparingly.

The changes to Tennessee's vaccination strategy will affect the majority of the Volunteer State, which lags behind most of the nation in the race to immunity. Only 38% of Tennesseans are fully vaccinated, and at the current pace the state won't be 50% vaccinated until March, according to health department estimates. The agency holds responsibility for public health in 89 of Tennessee’s 95 counties, excluding major metropolitan areas where local agencies wield more authority.

'No proactive outreach regarding routine vaccines'

After the health department's internal COVID-19 report was circulated on Friday, the rollback of vaccine outreach was further detailed in a Monday email from agency Chief Medical Officer Dr. Tim Jones.

Jones told staff they should conduct "no proactive outreach regarding routine vaccines" and "no outreach whatsoever regarding the HPV vaccine." 

Staff were also told not to do any "pre-planning" for flu shots events at schools. Any information released about back-to-school vaccinations should come from the Tennessee Department of Education, not the Tennessee Department of Health, Jones wrote.

"Any kinds of informational sheets or other materials that we make available for dissemination should have the TDH logo removed," Jones wrote.

The health department did not confirm or dispute the existence of Jones’ email. In a written statement, department spokeswoman Sarah Tanksley credited the state’s past outreach for high vaccination rates among children – for example, 95% of kindergarteners were fully vaccinated last school year.

Emails:Health officials halt vaccine events for teens amid conservative pressure

Tanksley said the agency is now responding to “an intense national conversation that is affecting how many families evaluate vaccinations in general" and plans more market research into the roots of vaccine hesitancy. 

“Tennessee is on solid footing when it comes to childhood immunizations and will continue to keep information and programming in place for parents,” Tanksley said. “We are simply mindful of how certain tactics could hurt that progress.”

Usually, the health department regularly advocates for vaccinating kids against many diseases without controversy. 

For example, in 2019 the department published at least 15 tweets that either explicitly recommended minors be vaccinated or featured a child in a pro-vaccine image or video. The agency's outreach campaign recommended vaccination against the flu, measles, mumps, rubella and human papillomavirus, or HPV, among others.

Decisions to ratchet back outreach come amid pressure from conservative lawmakers, who have embraced misinformation about the coronavirus vaccine, said Dr. Michelle Fiscus, Tennessee's former top vaccine official.

Fiscus was fired without explanation on Monday. Fiscus said she was scapegoated to appease lawmakers, who had described routine vaccine outreach as “reprehensible.”

“This is a failure of public health to protect the people of Tennessee," Fiscus said Monday. “When the people elected and appointed to lead this state put their political gains ahead of the public good, they have betrayed the people who have trusted them with their lives.” 

No more COVID-19 vaccine events at schools

Until now, the county health officials under the purview of the Department of Health have used schools as venues for coronavirus vaccination drives, and at least some of those events have primarily served adults, not minors.

Two weeks ago health officials held a two-day vaccination drive at Woodlawn Elementary School, outside Clarksville. Under the agency’s new rules, events like this will no longer be permitted across most of the state.

This shift is worrisome to Brian Haile, CEO of Neighborhood Health, a group of nonprofit clinics providing vaccines in and around Nashville.

In many rural Tennessee counties, school gymnasiums are one of the few venues large enough to hold a vaccination event indoors, with air conditioning, with enough space for social distancing, Haile said.

“I’m not saying it’s impossible,” Haile said, “but one of the things this is going to do is really limit access to vaccines in rural areas.”

Holly Cross, Oak Ridge Schools/Special to The Oak Ridger
Lori Gupton, Oak Ridge High School's nurse, vaccinates James Mitchell, of Jefferson Middle School, on Friday, February 26, 2021, at the high school during a vaccination clinic for all employees in the school system. In an online meeting with the Tennessee Press Association Monday, Gov. Bill Lee said 60,000 Tennesseans were vaccinated for COVID-19 last Friday.

Tanksley, the health department spokeswoman, confirmed the agency would end COVID-19 vaccination events at schools, in a part because of low demand, and said “no decisions had been made” about offering other vaccines at schools.

Tanksley said the agency ended events on school property “out of an abundance of caution” because vaccination efforts were “perceived by some to give the wrong impression regarding parental consent.”

“While the location may change,” Tanksley said, “the effort to vaccinate individuals who choose to receive it continues."

When asked about the decision stop sending vaccine reminder postcards to teenagers, Tankley said the health department always intended these postcards to go to parents and was taking new steps to ensure they were never sent to minors.

After Tennesseans receive their first dose of a coronavirus vaccine, the Tennessee Department of Health sends a postcard like this one to remind them to get a second dose. But, as the agency rolls back vaccine outreach, it will no longer send these reminders to minors.

Tanksley said the agency’s online vaccine scheduling system also sends out automated reminder emails, but the agency is working to alter the system so reminders never go to minors and are instead rerouted to their parents.

Lawmakers threaten ending entire health department

The Tennessee Department of Health began backing off vaccination outreach in the wake of a contentious legislative hearing in mid-June in which several conservative lawmakers chastised Piercey for efforts to vaccinate teenagers.

Lawmakers accused the agency of attempting to circumvent parents and peer-pressure minors to be vaccinated, then discussed dissolving the entire health department to stop its vaccine advertisements. Department leaders were scheduled to reappear before the same group of lawmakers for more questioning on July 21.

“I have never said that I want to dissolve and reconstitute the Department of Health,” said Rep. Scott Cepicky, R-Culleoka, who proposed ending the agency on June 16. "What I said is, when we come back next month, I want that as a consideration.”

Rep. Scott Cepicky, R-Culleoka, holds up a print out of a Tennessee Department of Health Facebook post promoting vaccinations while questioning the agency on June 16. Cepicky proposed the possibility of dissolving the entire agency to stop it from "peer pressuring" teenagers to get vaccinated against coronavirus.

In the wake of the June hearing, the health department quietly began to make changes. The agency deleted Facebook and Twitter posts that gently recommended vaccines to teens. Internal emails revealed agency leaders ordered county-level staff not to hold any vaccination events intended for adolescents and only advertise events as available to the “general population.”

The changes to Tennessee’s vaccination strategy drew quick scorn online, where some worried political interference would leave the state more vulnerable to the virus.

Chelsea Clinton, a global health advocate and daughter of former President Bill Clinton and former Secretary of State Hillary Clinton, tweeted that the agency’s actions were “so disturbing.”

“Public health officials in Tennessee should be encouraging teenagers to get vaccinated, not capitulating to anti-vaxxers,” Clinton tweeted. “Teens who don’t get vaccinated against #COVID-19 are at greater risk of hospitalization, death, long-haul COVID.”

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.