Health providers have widely used telehealth to mitigate the spread of COVID-19 infection and to improve access to healthcare services thanks in large part to policy changes and regulations. This brief explores how state and territorial health agencies (S/THAs) are responding to COVID-19 through telehealth policy and operational changes, as well as how telehealth has quickly emerged as a tool to improve health equity.
ASTHO, in collaboration with CDC, provided full-time disability and preparedness specialists to 17 jurisdictions to better meet the needs of people with disabilities. In this brief, specialists share their thoughts on why people living with disabilities may be hesitant to get the COVID-19 vaccine and some approaches public health officials can take to address vaccine hesitancy in people living with disabilities.
This guide is designed to help leaders prepare for and structure discussions on strategies to mitigate challenges to healthcare capacity during the 2023 fall and winter respiratory illness season.
According to the federal government, a homebased individual is someone who requires the help of another person or supportive device to leave the home, someone who is advised against leaving the home by a physician, and/or someone for whom it is extremely taxing to leave the home. Compared to non-homebased adults, homebased people are more likely to be older, have lower income, and belong to racial minority groups—as well as live with disabilities, chronic health conditions, and comorbidities. Individuals who are homebased therefore tend to be at increased risk for COVID-19 morbidity and mortality.
For many individuals living with disabilities, inaccessible vaccination websites have been a significant barrier to receiving the COVID-19 vaccine. Recent studies have found that many vaccination websites do not reliably meet accessibility standards. This brief discusses how several disability rights laws apply to COVID-19 vaccine registration websites and offers considerations for state and territorial health agencies as they work to improve website accessibility for people living with disabilities.
The COVID-19 pandemic spotlighted health inequities at national, state, and local levels. This report details the role immunization can play in reducing these disparities, informed directly by conversations ASTHO held with state equity and immunization leaders from March-July 2021. These conversations have been distilled into 20 key actions health agencies can take to make an impact.
This episode highlights COVID-19’s impact on overdose-related deaths during the postpartum period, also known as the fourth trimester. There has been a significant increase in postpartum overdose-related deaths in recent years—a problem that has only been exacerbated by the COVID-19 pandemic.
Nirav Shah, Director of Maine Center for Disease Control and Prevention, and Joe Smyser, CEO of Public Good Projects, discuss countering COVID-19 vaccine misinformation.
This bonus episode is taken from a virtual news conference on Thursday, July 29, 2021. In it, Nirav Shah (Maine), Karyl Rattay (Delaware), and Joseph Kanter (Louisiana), discuss the latest issues related to the COVID-19 pandemic—mask guidance, back to school issues, and the surging Delta variant.
On this bonus episode of Public Health Review, we discuss how a business or government can create vaccine credentials that are more sophisticated than the paper cards from CDC, but that also protect people’s personal information.
On this bonus episode, Jim Ivey, chief operating officer at Chexout, discusses the importance of interoperability and makes the case that public health organizations need to invest in software that will adapt to their changing needs in both ongoing disease outbreaks and emerging infections.
On this bonus episode, Jim Ivey, chief operating officer at Chexout, discusses the importance of interoperability and makes the case that public health organizations need to invest in software that will adapt to their changing needs in both ongoing disease outbreaks and emerging infections.
On this bonus episode of Public Health Review, we chat with Stanley Campbell, CEO and CTO EagleForce. Campbell is an expert in artificial intelligence who knows how to leverage data in the fight against disease.
Each video in this series focuses on a unique topic and features stories from ASTHO’s disability and preparedness specialists in the field. The videos demonstrate how they work to ensure information, testing, and COVID-19 vaccination sites are accessible for people living with disabilities
In-depth analysis on state health policy surrounding immunization. This is part of ASTHO's annual legislative prospectus series.
In-depth analysis on state health policy surrounding immunization. This is part of ASTHO's annual legislative prospectus series.
Partnering with Birthing Hospitals to Protect Babies Against RSV Partnering to Protect Babies Against RSV Susan Kansagra, Michelle Fiscus, Kim Martin Learn how immunization programs partnered with birthing hospitals to expand participation in Vaccines for Children and better protect babies against RSV. In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended the use of monoclonal antibodies (mAbs) to prevent respiratory syncytial virus (RSV) in infants, a major milestone in newborn immunization. Unlike vaccines, which stimulate the body’s immune system to produce its own protection over time, mAbs work right away by giving the body ready-made protection against infection. This is especially important for newborns who do not have the protection of maternal RSV vaccination, which causes them to face a higher risk of severe RSV illness and need protection as early as possible. In response to the 2023 ACIP recommendation, state and territorial immunization programs acted quickly to ensure these new protections reached the babies who needed them most. One of the most effective strategies was partnering with birthing hospitals to expand participation in the Vaccines for Children (VFC) program, a federally funded initiative that provides vaccines to children at no cost to their families who might otherwise be unable to afford them. This program enabled the delivery of RSV mAbs — such as nirsevimab and now clesrovimab — to VFC-eligible newborns without any financial burden on their families. High Stakes, Strong Results The stakes were high, as RSV is the leading cause of infant hospitalizations in the United States. It was previously responsible for an estimated 58,000 to 80,000 hospitalizations and up to 300 deaths in children under age five each year. Data on RSV mAbs showed significant results, reducing RSV-related emergency department visits by 63% and hospitalizations by as much as 80%. Administering RSV mAbs in the first few days after birth, during RSV season, ensures that infants are protected before their first exposure — a critical step in reducing illness and health care burden. Strategies for Success Health departments played a leading role in bringing birthing hospitals into the VFC program. Many hospitals were not previously enrolled, often due to limited awareness, logistical barriers, or concerns about administrative burdens. Immunization programs responded by 1) launching targeted outreach, 2) offering tailored technical assistance, 3) simplifying enrollment processes, and 4) providing guidance on proper storage, eligibility screening, and documentation. The Impact of Stronger Partnerships These efforts have generated measurable results: The number of birthing hospitals enrolled in the VFC program increased from 292 in the 2023 season to 1,012 in 2025, boosting coverage from 10% to 36% of all U.S. birthing hospitals. This clearly demonstrates that these partnerships are effective and make a real difference in protecting infants’ health. State data further highlights this success and shows that collaboration across states, hospitals, and public health partners is crucial for achieving measurable impact: Virginia nearly doubled the number of birthing hospitals enrolled in the VFC program, increasing from six to 11 within one year. The state’s immunization program implemented an innovative Replacement Model to simplify requirements and collaborate closely with hospital teams to overcome barriers. Similarly, California provided resources, developed an enrollment checklist, and communicated the benefits of enrollment to birthing hospitals. Finally, across six states, 33 hospitals, and 400 clinics over two RSV seasons, Intermountain Health coordinated a system-wide approach that developed educational tools, enrolled hospitals in VFC, and addressed supply shortages. It also piloted a Replacement Model where mAb product was purchased by the hospital and doses administered to VFC-eligible babies were replaced with VFC-funded stock. These efforts also strengthened relationships between public health programs and birthing institutions. Trust and communication improved, and hospitals became more engaged in broader immunization goals (e.g., access to other birth-dose vaccines like hepatitis B). This expanded partnership not only protected newborns during RSV season but reinforced the capacity of immunization programs to mobilize quickly, implement new recommendations, and ultimately improve health outcomes. Compared to prior seasons, RSV-associated hospitalization rates were 28%-43% lower in 2024-2025, which was the first season with widespread availability of mAbs and maternal RSV vaccine. Future Opportunities Health departments have used a number of strategies to increase VFC enrollment by hospitals and mAbs coverage as a whole, including: Using birth volume data to prioritize outreach to additional hospitals for enrollment in the VFC program. Ensuring linkage to Immunization Information Systems to determine maternal RSV vaccination status and quickly identify eligible infants. Working with health systems on standing orders and protocols to help providers administer mAbs rapidly to eligible infants. Bringing hospitals and payers together to provide financial models that support universal coverage. While bundled payments for labor and delivery stays have been a barrier for private payer coverage, the high ROI for preventing future RSV-related health care utilization may provide additional opportunities for payers to consider alternative coverage models. Sharing promising practices through a Learning Collaborative webinar series developed by the Association of Immunization Managers, in coordination with CDC. The rapid rollout of RSV mAbs through the VFC program is a model of success. It shows that when public health agencies and health care partners work together, we can deliver lifesaving interventions, even in complex, high-volume settings like birthing hospitals. As new immunization tools emerge in the years ahead, the infrastructure, lessons and relationships built through this effort will continue to support the goal of protecting all children from the very start. article yes
Read about deference to ACIP vaccine recommendations in state and territorial vaccine policy, following recent changes to the committee.
Downstream Effects of CDC Adopting ACIP Recommendations for COVID-19 and MMRV Vaccines Downstream Effects of CDC Adopting ACIP Recommendations Susan Kansagra, Andy Baker-White, Meredith Allen, Kimberly Martin, Ericka McGowan Learn about the downstream effects of CDC adopting ACIP recommendations for COVID-19 and MMRV vaccines, as states examine how their policies and laws intersect. On Oct. 6, CDC adopted the recommendations that the Advisory Committee on Immunization Practices (ACIP) made in September — specifically, individual-based decision-making for COVID-19 vaccine and separate measles, mumps, and rubella vaccine, and the varicella vaccine in toddlers. The adoption of these recommendations now sets in motion a cascade of other processes that influence access to vaccines. In addition, several states have begun to examine how their state level policy and laws intersect with ACIP recommendations given the delay in adoption and the uncertainty of the process going forward. COVID-19 Vaccine Recommendation CDC adopted the recommendation for shared clinical decision-making for the COVID-19 vaccine for those six months and older. The adoption of this ACIP recommendation has a ripple effect on coverage and access: It enables states to begin ordering COVID-19 vaccine under the Vaccines for Children program. It allows state Medicaid programs that link coverage to ACIP recommendations to cover the cost of the vaccine. It enables pharmacists to provide the COVID-19 vaccine under the federal PREP act declaration — as opposed to or in addition to state law, which varies by state. Many state health departments issued standing orders and executive orders to enable pharmacists to administer in the meantime. It requires health insurers to cover the cost of the vaccine, as the Affordable Care Act ties insurance coverage requirements to ACIP recommendations. Though, prior to the meeting, health insurers indicated they would do so anyway this year. MMRV Recommendation The CDC also adopted the recommendation for separate varicella (V) and measles, mumps, rubella (MMR) vaccines rather than the MMRV vaccine (combined measles, mumps, rubella, varicella) for children under four years. As background, current guidance allows either MMRV or MMR + V to be administered to children 12-47 months. However, because of a small but higher risk of febrile seizures for dose one, they are recommended to be administered separately (MMR + V), unless families express a preference for MMRV. Only about 15% of children currently receive MMRV for the first dose, and the general consensus is that this decision will result in some changes but not significantly impact access to vaccines: The adoption of this recommendation means that VFC will no longer cover MMRV for children under four, but it continues to cover separate MMR and V vaccines. Since many state Medicaid plans tie vaccine coverage to ACIP recommendations, coverage of MMRV by state Medicaid will vary depending on this language, though separate MMR and V vaccines would continue to be covered. Private insurers can choose to cover MMRV and will likely continue to in the short term but are not required to. They are required to cover separate MMR and V vaccines. How States Are Preparing for the Future As it stands now, ACIP recommendations, particularly for respiratory viral season, are not that different than prior years – with influenza, RSV, and the COVID-19 vaccine recommended (the latter with shared clinical decision making). However, the delayed and unpredictable process has led many states to examine how closely they are tied to ACIP in law, regulation, or practice. Over 600 statutes across U.S. states and territories reference ACIP — whether for pharmacist vaccine authority, school entry, health care worker or other requirements. States have considered a variety of actions to ensure they maintain access to vaccinations for their jurisdictions including: Passing or introducing legislation that allows the state health department to use ACIP guidance from previous years or recommendations from other bodies (e.g., medical provider organizations) in state law, as it relates to school entry, pharmacist authority, and others. Issuing standing orders and executive orders to enable pharmacists to administer vaccines in the absence of ACIP recommendations. Examining Medicaid state plan language to determine how to interpret requirements when ACIP is referenced and considering updates to that language (e.g., North Carolina). Issuing state requirements for insurers on vaccine coverage (e.g., Oregon, California, Hawaii). Examining use of state funds to purchase vaccines. Supplemental Resources Tracking State Actions on Vaccine Policy and Access by KFF Vaccine Resources by the Common Health Coalition States Take Action to “Immunize” Vaccine Access by Mandy Cohen, Julian Polaris, and Liz Dervan Vaccine Integrity Project — Fall Immunization Information by the Center for Infectious Disease Research and Policy Special Thanks - Blog - Downstream Effects of CDC Adopting ACIP Recommendations Padding Block - Large Related Content - Blog - Downstream Effects of CDC Adopting ACIP Recommendations article yes
This toolkit details structure and outcomes of ASTHO’s Vaccine Equity Project to help jurisdictions in their pursuit of vaccine equity.