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Each year the U.S. battles seasonal influenza, leaving millions of people sick, hospitalized, or worse. As COVID-19 cases continue to rise, it is crucial for all eligible individuals to receive a flu vaccine to help reduce the likelihood of contracting both flu and COVID-19.

On Dec. 3, the International Day of People with Disabilities commemorates disability rights and brings awareness to essential issues for those with disabilities by promoting the “well-being of persons with disabilities in all spheres of society.” While the ADA laid a critical foundation for disability rights, the work to ensure equitable access to services and needs continues, including access to state and local emergency preparedness and response activities like crisis communication, access to resources, allocation of vaccine and other medical countermeasures, and transportation.

As public health officials lead the pandemic response, clear direction-setting in every state and territories is vital to assure our planning and implementation is fair and focused on those most at need. These are not entirely unprecedented times—1918 pandemic flu killed almost 700,000 Americans. Even then, despite increasing understanding of respiratory disease transmission, many leaders—including public health leaders—downplayed the pandemic and refused to take effective steps to limit large gatherings and encourage mask wearing. Changing behavior, or introducing new social norms, was as difficult then as it is now. We have to learn from history if we are to effectively respond to our present reality.

If there is any word to describe 2020 it is “unprecedented,” with the work of health agencies front and center since COVID-19 emerged in the U.S. But as we approach Public Health Thank You Day and the Thanksgiving season, ASTHO wants to send a special appreciation to our entire state and territorial public health workforce. We have been so impressed by your tireless work to address COVID-19 in your jurisdictions and you have wowed us all with your dedication and commitment to the work of health protection and improvement. Thank you all for all you do to keep your communities healthy!

Each September, the United States observes National Preparedness Month, a month dedicated to raising awareness of public health preparedness. Preparedness—a field that readies our nation to respond to a range of emergencies—is a newer public health discipline, advanced by lessons learned from each response to a public health threat. While significant progress has been made over the past 20 years, the COVID-19 pandemic has shed light on the need to strengthen state and local capabilities to address future emergencies. The history of public health preparedness is worth understanding, as each current and future response is impacted by lessons from the past.

As the Delta variant spreads across the country and increases the number of COVID-19 cases, the strain it is placing on the nation’s health system continues to grow. The surge of COVID-19 patients is contributing to a shortage of the medications and equipment used to treat the disease. As these limitations grow, decisions will need to be made as to which patients receive resources and care and which patients don’t. To guide these decisions, policies called crisis standards of care are often established to maximize resource benefit and ensure they are distributed equitably.

On Aug. 23, 2021, the FDA announced full approval of Pfizer and BioNTech’s mRNA vaccine for COVID-19. ASTHO has answers to five key questions about the approval and what it means for state and territorial health officials: What does the FDA’s approval approve; what did we learn from the FDA’s safety and efficacy review; How long did the approval process take, and when could we see more FDA-approved vaccines; What does FDA approval mean for vaccine confidence; What does FDA approval mean for employer and university vaccine mandates.

This policy update emphasizes the importance of policymakers choosing to increase funding for public health infrastructure and important initiatives, such as health equity, in the wake of the COVID-19 pandemic.

Researchers estimate more than 140,000 children in the United States experienced the death of a parent or grandparent caregiver between April 1, 2020 and June 30, 2021. The study highlights disturbing disparities in caregiver deaths by race and ethnicity. Hispanic, Black, and American Indian/Alaska Native children were at 1.1 to 4.5 times higher risk of losing a caregiver than non-Hispanic White children. These inequities result from structural and social conditions such as discrimination, living in under-resourced neighborhoods, barriers to accessing healthcare, experiencing food insecurity, and economic instability.

Pharmacies have long been instrumental partners in providing lifesaving vaccines nationwide. As state and territorial health officials evaluate their COVID-19 response, planners must include input from the pharmacy community when identifying areas for improvement, as well as best vaccination practices in advance of future public health emergencies.

With many of the state and territorial legislatures reconvening over the next few weeks, we can look forward to new (and not-so-new) legislation start to crop up that will impact public health. To help navigate the new legislative sessions, ASTHO’s "2021 Legislative Prospectus" series highlights eight priority policy areas jurisdictions will address during this year. Each prospectus in the series provides a brief overview of the issue, the issue’s impact on health, and recent legislative trends aimed at addressing the issue. This year, ASTHO developed prospectuses on COVID-19, e-cigarettes, HIV, influenza, maternal mortality and morbidity, neonatal abstinence syndrome (NAS), polyfluoroalkyl substances (PFAS), and rural health.

As COVID-19 emerged and spread in the U.S., people working and residing in long-term care facilities have experienced a significant burden of COVID-19 cases and deaths. As of Oct. 8, deaths associated with these facilities account for 40% of total COVID-19 deaths in the U.S. Health officials have taken measures to improve their funding and capacity.

Conditioning school attendance on student vaccinations is an evidence-based way of maintaining and increasing vaccine coverage. State law establishes school vaccination requirements which apply not only to public schools but often to private schools and childcare facilities as well. All states allow an exemption for those where a vaccine poses a medical risk. Several states also allow non-medical exemptions, often based on an asserted religious, philosophical, or personal belief of the parents or child opposing vaccinations. However, a few states have recently abolished all non-medical exemptions.

2020 has been a year of unprecedented events, and the past few months have already shown that they do not exist in a vacuum. While the country continues to respond and cope with the COVID-19 pandemic, many extreme weather events have already occurred, and are additional infectious disease challenges to consider. Responding to these events in the current conditions presents unique challenges to responders and communities.

On Dec. 3, International Day of Persons with Disabilities, ASTHO is commemorating nearly 12 months of supporting disability and preparedness specialists in state and territorial health agencies. Throughout 2021, ASTHO embedded 20 full-time disability and preparedness specialists within state and territorial public health agencies to ensure an inclusive approach to emergency preparedness. This is the first of a multi-part series spotlighting these embedded experts.

The disparities experienced during the COVID pandemic have brought a national focus to health equity in our nation. The attention and resources currently being provided to help address health inequities provide an opportunity that I have never experienced in my public health career. There are still challenges, but we have an opportunity to build momentum for the first time in decades if we can focus on implementing evidence-based strategies, demonstrating change and documenting our progress.

As communities around the country continue to navigate the complexities of COVID-19 management and prevention this fall, reliable resources are needed for connecting public health leaders with the latest information on treatment. HHS's Combat COVID website provides information and tools for both the public and public health officials to learn about available COVID-19 treatments and clinical trial research underway to identify new treatments.

In addition to the countless hours worked during the COVID-19 pandemic, many public health workers are also grappling with how to repay outstanding federal loans. In response, the U.S. Department of Education (DOE) recently announced temporary relief to current and future Public Service Loan Forgiveness (PSLF) program participants as a result of the COVID-19 pandemic.

State Health Officials Commend Public Health Emergency Declaration to Address Opioid Epidemic ARLINGTON, VA—Members of the Association of State and Territorial Health Officials (ASTHO) joined President Donald Trump and First Lady Melania Trump today at the White House for a meeting declaring the nation’s opioid crisis a public health emergency.  “While emergency declarations are normally reserved for natural disasters or infectious disease outbreaks, the President’s announcement recognizes the work that states and territories are already undertaking to address the crisis and will allow for increased collaboration and coordination of regional and federal assets across the country for an even more effective response,” says John Wiesman, ASTHO president and secretary of health at the Washington State Department of Health. “We hope the public health emergency declaration, combined with future additional federal investments in substance abuse treatment and prevention, will lead to fewer deaths and better health for all Americans.” State and territorial health officials have been at the frontlines of this crisis working to address the many facets of the epidemic. Six states have already declared emergencies in their jurisdictions: Alaska Arizona, Florida, Maryland, Massachusetts, and Virginia. “While federal leadership has been working hard in partnership with states to address this crisis, many states have taken executive and legislative action to address the epidemic including implementing new laws and regulations around prescribing and providing additional funding for treatment services and evidence-based public health interventions to prevent substance misuse in the first place,” says Michael Fraser, ASTHO’s executive director. “The federal emergency adds to the work that states and territories have been doing in many different ways across the country.” Treating and preventing substance use disorders and addiction is very complex. “Opioid addiction is challenging because many people first become addicted when receiving the medications through the healthcare system. Addiction is not a moral failing on the part of the individual; it is a health condition we must address in healthcare and across all sectors as a society at the national, state, and community levels,” says Jay Butler, ASTHO’s immediate past president and chief medical officer for the Alaska Department of Health and Social Services. “Addiction is treatable and, more importantly, preventable with appropriate evidence-based interventions. The declaration today will help us respond even more effectively to the loss of life and devastating impact of substance misuse and addiction.” ASTHO, in partnership with the National Association of State Alcohol and Drug Abuse Directors (NASADAD), recently released a framework on public health responses to the opioid crisis that was developed to assist health officials in combating the epidemic. As federal agencies and Congress look to implement their response to this public health emergency, ASTHO urges national leaders to provide additional resources focusing on both treatment and prevention of addiction. “This is a crisis we ultimately are not going to arrest—or treat—our way out of; instead, we have to prevent our way out of this,” adds Fraser. “Like any public health emergency, addressing this problem calls for important steps to prevent the disease in the first place. We hope that the President and First Lady’s attention to the opioid epidemic will help us focus on both treatment and prevention. That is the work of public health, and states and territories are committed to mustering all resources available to end this epidemic.” ASTHO Press Release Boilerplate website yes

In anticipation of the upcoming presidential election in November, the Republican and Democratic National Committees released their platforms. These platforms provide an overview of values, policies, positions, and principles on various domestic and foreign issues deemed most important to the two political parties. For the upcoming 2020 elections, delegates of the Republican National Committee approved a resolution that renewed support for the platform adopted in 2016 and the Democratic National Committee approved a 2020 platform. Although both platforms touch on a diverse list of issues, there are several that are of interest to health and public health.