The pandemic illustrated how a rift between the CDC and workplace safety officials can have serious repercussions. Most recently, the giant hospital system Sutter Health in California appealed a citation from the state’s Division of Occupational Safety and Health, known as Cal/OSHA, by pointing to the CDC’s shifting advice on when and whether N95 masks were needed at the start of the pandemic. By contrast, Cal/OSHA requires employers in high-risk settings like hospitals to improve ventilation, use air filtration, and provide N95s to all staff exposed to diseases that are — or may be — airborne.

The agencies are once again at odds. The CDC’s advisory committee prescribes varying degrees of protection based on ill-defined categories, such as whether a virus or bacteria is considered common or how far it seems to travel in the air. As a result, occupational safety experts warn that choices on how to categorize covid, influenza, and other airborne diseases — and the corresponding levels of protection — may once again be left to administrators at hospitals, nursing homes, and jails or prisons.

Eric Berg, deputy chief of health at Cal/OSHA, warned the CDC in November that, if it accepted its committee’s recommendations, the guidelines would “create confusion and result in workers being not adequately protected.”

Also called respirators, N95 masks filter out far more particles than looser-fitting surgical masks but cost roughly 10 times as much, and were in short supply in 2020. Black, Hispanic, and Asian health workers more often went without N95 masks than white staffers, which helped explain why members of racial and ethnic minorities tested positive for covid nearly five times as often as the general population in the early months of the pandemic. (Hispanic people can be of any race or combination of races.)

Cal/OSHA issued dozens of citations to health care facilities that failed to provide N95 masks and take other measures to protect workers in 2020 and 2021. Many appealed, and some cases are ongoing. In October, the agency declined Sutter’s appeal against a $6,750 citation for not giving its medical assistants N95 masks in 2020 when they accompanied patients who appeared to have covid through clinics. Sutter pointed to the CDC’s advice early in the pandemic, according to court testimony. It noted that the CDC called surgical masks an “acceptable alternative” in March 2020, “seemed to recommend droplet precautions rather than airborne precautions,” and suggested that individuals were unlikely to be infected if they were farther than 6 feet away from a person with covid.

This is a loose interpretation of the CDC’s 2020 advice, which was partly made for reasons of practicality. Respirators were in short supply, for example, and physical distancing beyond 6 feet is complicated in places where people must congregate. Scientifically, there were clear indications that the coronavirus SARS-CoV-2 spread through the air, leading Cal/OSHA to enact its straightforward rules created after the 2009 swine flu pandemic. Workers need stiffer protection than the general population, said Jordan Barab, a former official at the federal Occupational Safety and Health Administration: “Health workers are exposed for eight, 10, 12 hours a day.”

The CDC’s advisory committee offers a weaker approach in certain cases, suggesting that health workers wear surgical masks for “common, often endemic respiratory pathogens” that “spread predominantly over short distances.” The draft guidance pays little attention to ventilation and air filtration, and advises N95 masks only for “new or emerging” diseases and those that spread “efficiently over long distances.” Viruses, bacteria, and other pathogens that spread through the air don’t neatly fit into such categories.

“Guidelines that are incomplete, weak, and without scientific basis will greatly undermine CDC’s credibility,” said a former OSHA director, David Michaels, in minutes from an October meeting where he and others urged CDC Director Mandy Cohen to reconsider advice from the committee before it issues final guidance next year.

Although occupational safety agencies — not the CDC — have the power to make rules, enforcement often occurs long after the damage is done, if ever. Cal/OSHA began to investigate Sutter only after a nurse at its main Oakland hospital died from covid and health workers complained they weren’t allowed to wear N95 masks in hallways shared with covid patients. And more than a dozen citations from Cal/OSHA against Kaiser Permanente, Sharp HealthCare, and other health systems lagged months and years behind health worker complaints and protests.

Outside California, OSHA faces higher enforcement obstacles. A dwindling budget left the agency with fewer workplace inspectors than it had in 45 years, at the peak of the pandemic. Plus, the Trump and Biden administrations stalled the agency’s ongoing efforts to pass regulations specific to airborne infections. As a result, the agency followed up on only about 1 in 5 covid-related complaints that employees and labor representatives officially filed with the group from January 2020 to February 2022 — and just 4% of those made informally through media reports, phone calls, and emails. Many deaths among health care workers weren’t reported to the agency in the first place.

Michaels, who is now on the faculty at the George Washington University School of Public Health, said the CDC would further curtail OSHA’s authority to punish employers who expose staff members to airborne diseases, if its final guidelines follow the committee’s recommendations. Such advice would leave many hospitals, correctional facilities, and nursing homes as unprepared as they were before the pandemic, said Deborah Gold, a former deputy chief of health at Cal/OSHA. Strict standards prompt employers to stockpile N95 masks and improve air filtration and ventilation to avoid citations. But if the CDC’s guidance leaves room for interpretation, she said, they can justify cutting corners on costly preparation.

Although the CDC committee and OSHA both claim to follow the science, researchers arrived at contradictory conclusions because the committee relied on explicitly flawed trials comparing health workers who wore surgical masks with those using N95s. Cal/OSHA based its standards on a variety of studies, including reviews of hospital infections and engineering research on how airborne particles spread.

In decades past, the CDC’s process for developing guidelines included labor representatives and experts focused on hazards at work. Barab was a health researcher at a trade union for public sector employees when he helped the CDC develop HIV-related recommendations in the 1980s.

“I remember asking about how to protect health care workers and correction officers who get urine or feces thrown at them,” Barab said. Infectious disease researchers on the CDC’s committee initially scoffed at the idea, he recalled, but still considered his input as someone who understood the conditions employees faced. “A lot of these folks hadn’t been on hospital floors in years, if not decades.”

The largest organization for nurses in the United States, National Nurses United, made the same observation. It’s now collecting signatures for an online petition urging the CDC to scrap the committee’s guidelines and develop new recommendations that include insights from health care workers, many of whom risked their lives in the pandemic.

Barab attributed the lack of labor representation in the CDC’s current process to the growing corporate influence of large health systems. Hospital administrators prefer not to be told what to do, particularly when it requires spending money, he said.

In an email, CDC communications officer Dave Daigle stressed that before the guidelines are finalized, the CDC will “review the makeup of the workgroups and solicit participation to ensure that the appropriate expertise is included.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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The event was held in Alpharetta, Georgia, aired on Fox News, and moderated by Sean Hannity. Our PolitiFact partners examined the two state officials’ wide-ranging statements. You can read the full coverage here.

Newsom has relished taunting DeSantis on social media and Fox News and, earlier this year, he invited DeSantis to debate — arguing that the red-state policies DeSantis has passed are stripping Americans of their freedoms. DeSantis counters that he is the stronger defender of freedom, and has blasted California as “the petri dish for American leftism” and argues that “everything [President Joe] Biden is doing, they would accelerate.”

True to the event’s billing, the nation’s culture wars were front and center on the debate stage. DeSantis portrayed California as a failed state with rampant crime and homelessness led by an “elite” politician too liberal for the rest of the country. “They have failed because of his leftist ideology,” DeSantis said.

Newsom shot back, playing up California’s immense economy and describing his state as one without peer. He expressed his commitment to Biden’s reelection. He also called out DeSantis for his covid-19 policies, saying more Floridians died of covid due to his more relaxed public health rules: “Tens of thousands of people lost their lives and for what, Ron?”

Abortion was a clear flashpoint. Newsom defended California’s strong abortion protections and attacked DeSantis, alleging he “criminalizes” women and doctors. He also suggested that if DeSantis became president, he would further roll back abortion rights nationwide. Newsom, asked by Hannity if he would sign a law banning abortion later in pregnancy, argued that such cases are extremely rare.

“I trust the mother and her doctor to make that decision,” he said.

The two also sparred over book bans, parental rights, and policies regarding the LGBTQ+ community.

DeSantis criticized Newsom on California’s growing homelessness, which he said contributed to the “destruction of qualify of life” in the state.

Newsom pointed out that the crisis has been brewing for decades. He noted, though, that under his leadership, billions of dollars in taxpayer money has been directed toward countering homelessness. He also boasted about the state’s investments in mental health and addiction programs.

“The difference is I’m the first governor in California history to take this head-on,” Newsom said, arguing that under his policies 68,000 people have been moved off the streets and into shelter or housing.

Here are the health-related claims PolitiFact examined:

Covid-19 Lockdowns

Newsom borrowed a page from Trump’s playbook by misleadingly portraying DeSantis as a lockdown leader. Newsom’s comments focused on DeSantis’ actions in the pandemic’s first few weeks, when nearly all governors operated in lockstep. Newsom omits that DeSantis reopened earlier than most governors in spring 2020.

“You passed an emergency declaration before the state of California did,” Newsom said. “You closed down your beaches, your bars, your restaurants. It is a fact.”

Many local governments closed beaches for a limited time, but DeSantis did not close them statewide.

DeSantis issued an executive order on March 17, 2020, directing Floridians to “limit their gatherings” at beaches to no more than 10 people and to “support beach closures at the discretion of local authorities.”

He also ordered beaches in Broward and Palm Beach counties to close for 11 days, following recommendations from local officials and the Centers for Disease Control and Prevention. The governor’s refusal to close most beaches to spring break crowds drew heavy criticism and litigation.

Newsom was on firmer ground in his claim about closing bars. DeSantis ordered all bars and nightclubs closed for 30 days. Restaurants did not close. His March 17 order said restaurants were limited to 50% customer capacity and had to separate seating by 6 feet.

Governors nationwide issued multiple orders in March 2020 in response to the pandemic. DeSantis issued an order March 1 to establish covid response protocol and direct a public health emergency. On March 4, Newsom declared a state of emergency to help California prepare for the pandemic.

Florida’s Abortion Limits and DeSantis’ Abortion Survivor Story

As Hannity pressed Newsom on whether he supported any abortion restrictions, Newsom attacked Florida’s abortion laws.

“He signed a bill banning any exceptions for rape and incest,” Newsom said of DeSantis. “And then he said it didn’t go far enough and decided to sign a six-week ban … that criminalizes women and criminalizes doctors.”

DeSantis signed legislation in 2022 that outlawed abortions after 15 weeks of pregnancy. It does not make exceptions for cases of incest, rape or human trafficking but includes an exception for a mother’s life.

DeSantis signed a stricter bill in April that bans abortions after six weeks of pregnancy. Whether the law takes effect hinges on how the Florida Supreme Court rules in a lawsuit against the current 15-week ban. The 2023 law does contain exceptions, including to save a pregnant woman’s life or in cases of fatal fetal anomalies. Abortions for pregnancies involving rape, incest, or human trafficking would be allowed until 15 weeks of pregnancy if a woman has documentation such as a restraining order, police report, or medical record.

The law penalizes physicians, but whether it also criminalizes women is less clear, so we have rated a similar claim Half True. The law says that anyone who “actively participates in” an abortion commits a third-degree felony, which opens the door to prosecutors charging women, but we don’t yet know whether they will or how courts would respond to such charges. DeSantis has also said that he doesn’t want women prosecuted, only doctors.

Defending the law, DeSantis repeated an anecdote from the first GOP presidential debate about a Floridian named Penny Hopper. Miriam “Penny” Hopper is a real person, and an anti-abortion activist. Some of the details about her birth story have been called into question.

Hopper said she survived an abortion attempt in Florida in 1955. Her claim has been featured by anti-abortion groups and used to support what abortion opponents call “born alive” bills in state legislatures, which aim to protect infants who survive abortions, even though there are federal laws for that purpose.

In interviews, Hopper has said she had been delivered around 23 weeks of gestation after her mother went to a hospital in Wauchula, Florida, while experiencing bleeding. Hopper said the doctor induced labor, and she was born at 1 pound, 11 ounces, and that the doctor told staff to discard her “dead or alive.” She said her grandmother found her the next day on the hospital porch in a bedpan. Then, Hopper said, a nurse volunteered to take her to a larger hospital that was about 40 miles away.

That a baby born at 23 weeks could survive overnight without medical attention in 1955 is medically dubious, experts said. From the 1950s through 1980, “newborn death was virtually ensured” for infants born at or before 24 weeks of gestation, the American College of Obstetrics and Gynecology says on its website.

The Washington Post also reported that contemporaneous newspaper accounts offer a different scenario at the hospital, and said the staff spent days keeping her alive before arranging a police escort to rush her to another hospital.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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Both men have led their respective states since 2019, and they’ve lately been engaged in an escalating feud. While Newsom isn’t running for president himself — yet — he’s a key surrogate for President Biden. Fox News is playing up the faceoff, which it’ll host, as “The Great Red Vs. Blue State Debate.” 

The Health 202 is a coproduction of The Washington Post and KFF Health News.

The debate promises to put America’s culture wars front-and-center. Abortion. Homelessness. Transgender health care. The coronavirus pandemic response. Health coverage for undocumented immigrants. Even drag shows, DEI and Disney’s First Amendment rights.

Though conservative TV host Sean Hannity is moderating the 90-minute showdown in Alpharetta, Ga., seemingly a home-field advantage for DeSantis, Newsom is relishing the confrontation after goading Florida’s governor into going head-to-head. 

Both men use each other’s states as punching bags. DeSantis portrays Newsom as too liberal for America, presiding over a failed state where homelessness and crime are rampant, citizens are forced to mask up and get vaccinated, and access to abortion and public assistance like Medicaid is too easy, breaking society morally and financially.

In a fundraising video for his presidential campaign, DeSantis called California “the petri dish for American leftism,” adding that “everything Biden is doing — they would accelerate and they would cause this country to collapse. That is not the future that we need. Florida shows a model for revival, a model based on freedom.”

Newsom has blasted DeSantis as a “small pathetic man” and argues that small-d democracy itself is at stake in the presidential election. His political operation paid for an ad on Florida’s airwaves this year in which Newsom told Sunshine State residents: “Freedom — it’s under attack in your state.”

He has knocked DeSantis’s education policies that restrict teaching gender and sexuality to schoolchildren as well as laws the Florida governor pushed through the legislature banning abortion after six weeks and limiting gender transition-related health care. 

“Your Republican leaders, they’re banning books, making it harder to vote, restricting speech in classrooms,” Newsom said in his ad. “Even criminalizing women and doctors. Join us in California, where we still believe in freedom.”

Newsom’s health and education policies are largely the opposite of DeSantis’s. He’s expanded access to gender-affirming care for children and adults, and is expanding Medicaid beginning Jan. 1 to cover lower-income undocumented immigrants. Backed by the Democratic-controlled state legislature, Newsom led an effort in 2022 to enshrine the right to abortion in the state constitution, and he’s fought to block local school districts from restricting access to certain books.

While DeSantis directs resources to the presidential campaign, where he’s struggling to maintain his second-place standing in the GOP primary behind front-runner Donald Trump, Newsom struck again this month with another Florida ad buy, this time centered on reproductive health and abortion access. 

The ad alleges that DeSantis has criminalized doctors and women seeking an abortion after six weeks and argues that they could be arrested “by order of Governor Ron DeSantis.”

Both men face a monumental test in their debate. Newsom must demonstrate his loyalty to Biden, the Democratic Party leader and the actual candidate next November, while scoring points against DeSantis.

DeSantis, a wooden public speaker who struggles to connect with his audiences, has faced some criticism in Republican circles for a lackluster campaign. He’s got to persuade GOP voters that he’s a formidable option to Trump, without any major gaffes. 

The proxy battle could shape not only next year’s presidential contest, but the 2028 field of White House contenders as well.

One other hot-button issue we’re watching for is homelessness, considering nearly one-third of all homeless Americans live in California. Expect DeSantis to hammer Newsom over Californians fleeing for cheaper living elsewhere — including to Florida. Newsom, meanwhile, will play up the unprecedented investment he’s spearheaded to combat the humanitarian crisis (without clear results as of yet).

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On the campaign trail to win another term in the White House, though, he also has knocked the use of those very vaccines. In October, for example, he unleashed a barrage of social media attacks on Ron DeSantis’ pandemic record by reposting claims that the Florida governor — who is running against him in the Republican presidential primaries — was too active in vaccinating Sunshine State residents.

In a further twist, Trump simultaneously circulated an MSNBC article suggesting DeSantis wasn’t vaccinating his constituents enough.

Trump’s tap dance — touting Operation Warp Speed’s success at developing vaccines while criticizing vaccine use — is emblematic of how pandemic politics are intensifying broader vaccine politics. Republican presidential candidates currently trailing the former president in polls are contorting their messaging to court the party’s vaccine-skeptical voters. No one embraces, without qualification, the utility of a public health measure that has saved millions of lives.

Like Trump, even the more establishment candidates can’t seem to avoid embracing the anti-vaccine leanings of the party’s base. Take Nikki Haley, who formerly served as governor of South Carolina and ambassador to the United Nations and has been rising in the polls. In the waning days of the Trump administration, she was pro-vaccine. But by the end of November 2021, in an interview with the Christian Broadcasting Network, she repeated dubious anti-vaccine claims: for instance, that the vaccine could undermine a woman’s fertility. (Studies consistently show no effect.)

The GOP has gained the allegiance of “a minority of people who feel very strongly about the safety of vaccines,” Robert Blendon, a Harvard professor of public health, told California Healthline. Presidential candidates are trying to use this sensibility as “a cultural issue” to signal distrust in scientists, other experts, and government authority in general, he said.

The resulting dynamic carries the risk of reaching beyond the current election cycle to affect public health policy in years to come, leading to lower rates among schoolchildren and seniors of vaccinations that protect them from measles, shingles, and HPV. Even as candidates try to weaponize this rhetoric, they’ve had little luck in changing the former president’s front-runner status.

A recent KFF survey of adults about their plans to get vaccinated against the flu, respiratory syncytial virus, known as RSV, and covid found that partisanship remains a key predictor of how people view vaccines. Confidence in the safety of the updated covid vaccines split sharply along party lines, with more than 8 in 10 Democrats saying they trust the new shots, compared with 1 in 3 Republicans.

But unease about covid or the vaccines is not Republican primary voters’ top issue — Blendon said concerns around the border, crime, and inflation are — and it’s not clear vaccine-focused attacks hurt Trump.

“I didn’t like his response to covid,” says an Iowa business owner featured in a critical ad from a well-funded political action committee that questioned Trump’s handling of the pandemic. “I thought he probably got led a little bit by the bureaucrats,” he says, hitting Trump on his bragging about the development of the vaccine and contrasting Trump unfavorably with certain governors the man in the ad thought performed better against covid. (Images of DeSantis, otherwise unnamed, flash by.)

The result? The ad “produced a backlash” and, when audience-tested with focus groups, improved the former president’s support, according to a memo summarizing the political action committee’s attempts to dent the front-runner.

Candidates nonetheless are trying to make hay, acknowledged Joe Grogan, who led the Domestic Policy Council during the Trump administration. But “I think people have a lot of other targets for ire about the pandemic.”

“Trump is not at the top of the list for Republican primary voters,” Grogan said. “He’s not on Page 2. Or 3, or 4. It begins with the media, the public health bureaucracy, or Big Tech companies.”

Voters have strong, yet divided and sometimes inconsistent, opinions. Some, like Joshua Sharff, 48, of Chesapeake, Virginia, are opposed to the covid vaccines and to candidates who support the shots as safe and effective. Sharff describes himself as a conservative voter who intends to support the Republican nominee for president. Though he’s vaccinated, he said, “If you’re a governor or a president and you tell me that I have to take a vaccine that has not been tried, that has not been tested, and ignores the science, that’s a problem for me. You’re taking away my freedoms as an American citizen.”

These positions have led Sharff away from Trump — and toward DeSantis, who has promoted anti-vaccine and anti-public health positions in his quest for the nomination.

Trump “pushed the vaccine very hard and recently came out, when he began to get pushback on it, that it was somebody else’s fault,” Sharff said. “That’s not true.”

Other Republican voters said the vaccine is not key to their vote.

“It will not sway my vote one way or another,” said Kimberly Hunt, 59, of Melville, Tennessee.

In chasing these voters, some candidates are distancing themselves from initial, pro-vaccine positions to embrace outspoken views against the shot. Vivek Ramaswamy, a biotech entrepreneur, started out as a vaccine cheerleader. But then he flipped, coming out against vaccine mandates and saying this summer that he regretted getting vaccinated. (His wife, a doctor, said she had no regrets.)

The most vocal of all is DeSantis.

Appearing on the right-leaning “PBD Podcast” on Oct. 30, DeSantis attacked Trump and “the corrupt medical swamp in D.C.” for overselling a vaccine that, despite the initial federal guidance, could not prevent infection or transmission of covid. The Centers for Disease Control and Prevention recommends the vaccine for anyone 6 months and older to protect against serious illness.

Though he initially encouraged people to get vaccinated in early 2021, DeSantis pivoted months later, banning vaccine passports for businesses and government entities, and later approving legislation prohibiting vaccine mandates in the state. That fall, he also appointed a new Florida surgeon general, physician Joseph Ladapo, whose guidance on covid vaccines contradicts CDC recommendations. DeSantis formed a Public Health Integrity Committee to assess, and generally dispute, federal health recommendations.

When the CDC released new vaccine guidance in September, Florida responded with its own advisory casting doubt on the safety of the boosters.

This anti-vaccine positioning hasn’t helped DeSantis. He has been losing support nationally and is generally polling third behind Haley and Trump in New Hampshire, a key early primary state. He headlined a “medical freedom” town hall in Manchester on Nov. 1 with Ladapo as a special guest.

Among the candidates remaining, DeSantis may be the most famous convert to the politics of anti-vaccination, but, with this subject, Haley has more experience.

In the 2021 CBN interview, she said “mandates are not what America does.” But the forceful declaration is merely the end of an ambivalent record, and, for critics, demonstrates her willingness to get in sync with the demands of the GOP base. As a state legislator, she supported 2007 legislation that included a mandate for HPV vaccines before voting against it; and later, as governor, she vetoed an effort to promote those vaccinations.

Bakari Sellers — now a commentator on CNN, but at the time a lawmaker who spearheaded that bill — told California Healthline, “That’s the biggest Nikki Haley issue that there is: She kind of has her finger in the air.”

The issue of vaccines may affect the general election: Even as Trump defends his vaccine record, it’s nevertheless clear he has support from the anti-vaccine crowd. An analysis by Politico, for example, found overlap among donors to independent presidential candidate Robert F. Kennedy Jr., who is staunchly opposed to vaccines, and Trump.

The willingness among politicians to assail what’s traditionally looked on as a foundational achievement of public health is likely to lead to turbulence for doctors themselves. Allison Ferris, a primary care physician and an associate professor at Florida Atlantic University, said people should be listening to their doctors and not to presidential candidates about whether to take the new covid vaccines. But that message is hard to deliver in the current climate.

“It is a tricky position to be in,” said Ferris, who co-authored recently released guidance advising doctors to counsel patients that frequent covid vaccination will likely become a necessity.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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Sin embargo, en la campaña electoral para conseguir otro mandato en la Casa Blanca, Trump ha criticado el uso de esas mismas vacunas.

En octubre, por ejemplo, desató una ola de ataques contra Ron DeSantis en las redes sociales al postear afirmaciones relacionadas con la estrategia del gobernador de Florida durante la pandemia. Trump acusó a DeSantis, quien compite contra él para representar al partido republicano en las elecciones presidenciales de 2024, de ser demasiado activo a favor de la vacunación en su estado. 

Y, en un giro inesperado, Trump hizo circular simultáneamente un artículo de MSNBC sugiriendo que DeSantis no estaba vacunando lo suficiente a los residentes de la Florida.

Los vaivenes de Trump, que promociona el éxito de la “Operación Warp Speed” en el desarrollo de vacunas y al mismo tiempo critica su uso, es emblemático de cómo la politización de la pandemia sigue influenciando el discurso alrededor de las vacunas.

Los otros aspirantes republicanos a la presidencia también usan el argumento de las vacunas para cortejar a los votantes, aunque hayan salvado millones de vidas.

Al igual que Trump, incluso los candidatos más conservadores no han podido eludir las tendencias antivacunas de la base del partido. Nikki Haley, ex gobernadora de Carolina del Sur y ex embajadora de Estados Unidos ante las Naciones Unidas, que ha estado subiendo en las encuestas, estaba a favor de las vacunas en los últimos días del gobierno de Trump.

Pero a fines de noviembre de 2021, en una entrevista con Christian Broadcasting Network, repitió falsas afirmaciones, por ejemplo que las vacunas podrían impactar en la fertilidad de las mujeres. (Estudios científicos no han demostrado ningún efecto).

El partido republicano se ha ganado la lealtad de “una minoría con opiniones fuertes acerca de la seguridad de las vacunas”, dijo a JFF Health News Robert Blendon, profesor de salud pública de la Universidad de Harvard. Los candidatos presidenciales están usando esta postura como “una cuestión cultural” para señalar la desconfianza en los científicos, otros expertos y la autoridad gubernamental en general, agregó.

La dinámica resultante podría impactar más allá del ciclo electoral, y afectar la política de salud pública en los próximos años. Esto derivaría en tasas de vacunación más bajas para enfermedades como el sarampión, el herpes zóster y el VPH entre los niños en edad escolar y las personas mayores.

Pero incluso cuando los candidatos intentan manipular este discurso, no han podido superar al ex presidente.

Según una encuesta reciente de KFF que preguntó a adultos si se iban a vacunar contra la gripe, el virus respiratorio sincitial (conocido como RSV) y covid, el partidismo siguió siendo un predictor clave de cómo la gente ve las vacunas.

La confianza en la seguridad de las vacunas actualizadas de covid se divide en líneas partidistas: más de 8 de cada 10 demócratas dicen que confían en las nuevas vacunas, en comparación con 1 de cada 3 republicanos.

Pero la inquietud por covid o las vacunas no es la principal preocupación de los votantes en las elecciones primarias presidenciales. Blendon dice que la situación en la frontera con México, el crimen y la inflación son temas más presentes, y no está claro que los ataques enfocados en las vacunas perjudiquen a Trump.

“No me gustó su respuesta al covid”, dice el propietario de un negocio de Iowa en un anuncio crítico publicado por un comité de acción política bien financiado que cuestionó el manejo de la pandemia por parte de Trump. “Pensé que seguramente se dejó guiar por los burócratas”, agrega el hombre, al tiempo que critica a Trump por hacer alarde del desarrollo de la vacuna y lo compara desfavorablemente con ciertos gobernadores que en su opinión se desempeñaron mejor contra el covid. (Aunque no se lo menciona por nombre, el anuncio invoca imágenes de DeSantis).

¿El resultado? El anuncio produjo “una respuesta negativa”, y en un sondeo con grupos de enfoque, aumentó el respaldo al ex presidente, según un memorando que resume los intentos del comité de acción política de frenar el avance de Trump.

Los votantes tienen opiniones fuertes pero divididas y a veces inconsistentes. Algunos, como Joshua Sharff, que tiene 48 años y vive en Chesapeake, Virginia, se oponen a las vacunas contra covid y a los candidatos que las califican como seguras y eficaces.

Sharff se describe a sí mismo como un votante conservador que va a apoyar al candidato republicano. Aunque está vacunado, dijo: “Si eres gobernador o presidente y me dices que tengo que ponerme una vacuna que no ha sido probada y que ignora la ciencia, eso es un problema para mí. Me estás quitando mis libertades como ciudadano estadounidense”.

Esto ha alejado a Sharff de Trump y lo ha acercado a DeSantis, que ha promovido posturas antivacunas y anti-salud pública en su campaña para la nominación. Trump “impulsó mucho la vacuna, y cuando empezó a recibir críticas por eso, dijo que fue culpa de otra persona”, dijo Sharff. “Eso no es cierto.”

Para otros votantes republicanos, la vacuna no es un factor clave. “No influirá en la dirección de mi voto”, dijo Kimberly Hunt, que tiene 59 años y vive en Melville, Tennessee.

Para tratar de atraer a estos votantes, algunos candidatos se están distanciando de sus posturas iniciales a favor de las vacunas y adoptan abiertamente la postura opuesta. Vivek Ramaswamy, un empresario de biotecnología, comenzó como un fuerte defensor de las vacunas. Pero luego dio un giro y se manifestó en contra de los mandatos de vacunación, diciendo este verano que se arrepentía de haberse vacunado. (Su esposa que es doctora dijo que no se arrepentía).

El más expresivo de todos es DeSantis.

En su aparición en el programa de derecha “PBD Podcast” el 30 de octubre, DeSantis atacó a Trump y “el pantano médico corrupto de Washington, DC” por promover excesivamente una vacuna que, a pesar de las pautas iniciales del gobierno federal, no previene la infección o la transmisión del covid. Los Centros para el Control y Prevención de Enfermedades (CDC) recomiendan la vacuna para todas las personas de 6 meses en adelante para protegerse contra síntomas graves.

Aunque al principio de 2021 alentó a la gente a vacunarse, DeSantis dio un giro meses después, aprobando una ley que prohibió los mandatos de vacunas en el estado. Ese otoño, también nombró a un nuevo cirujano general de Florida, el doctor Joseph Ladapo, cuyas recomendaciones con respecto a las vacunas contra covid contradicen las de los CDC. DeSantis estableció un Comité de Integridad de Salud Pública para evaluar y, en general, cuestionar las pautas de salud federales.

En septiembre, cuando los CDC publicaron recomendaciones actualizadas para las vacunas, Florida respondió con su propio aviso, arrojando dudas sobre la seguridad de los nuevos refuerzos contra covid.

Este posicionamiento antivacunas no ha ayudado a DeSantis. Ha perdido apoyo a nivel nacional y ocupa el tercer lugar en las encuestas, por debajo de Haley y Trump, en New Hampshire, un estado clave para las primarias. DeSantis encabezó una asamblea pública sobre “libertad médica” en Manchester el 1 de noviembre, con Ladapo como invitado especial.

Entre los candidatos restantes, DeSantis puede ser el converso más famoso a la política antivacunas, pero Haley tiene más experiencia en el tema.

En la entrevista con Christian Broadcasting Network en 2021, dijo que “los Estados Unidos no hacen mandatos de vacunas”. Pero esta contundente declaración llega después de una larga trayectoria de posturas ambivalentes y, para los críticos, demuestra su disposición a adaptarse a las demandas de la base republicana. Como legisladora estatal, Haley apoyó una ley de 2007 que incluía el mandato de vacunar contra el VPH pero después votó en contra. Luego, como gobernadora, vetó un esfuerzo para promover esa misma vacuna.

Bakari Sellers, un ex-legislador que encabezó ese proyecto de ley y que ahora es comentarista de CNN, dijo a KFF Health News: “Ese es el mayor problema de Nikki Haley, que siempre sigue la corriente”.

La cuestión de las vacunas podría afectar las elecciones generales: aunque Trump defiende su narrativa sobre las vacunas, está claro que cuenta con el apoyo de los antivaxx. Según un análisis de Politico, por ejemplo, Trump comparte donantes con el candidato presidencial independiente Robert F. Kennedy Jr., que se opone firmemente a las vacunas.

El hecho de que los políticos estén dispuestos a atacar algo que tradicionalmente se consideró un logro fundamental de la salud pública probablemente genere problemas para los profesionales médicos. Allison Ferris, doctora de atención primaria y profesora asociada de Florida Atlantic University, dijo que la gente debería escuchar a sus doctores y no a los candidatos presidenciales al momento de decidir si recibir las vacunas contra covid. Pero ese mensaje es difícil de transmitir en el clima político actual.

“Es una posición difícil”, dijo Ferris, coautora de una guía reciente para profesionales de salud sobre las nuevas vacunas. Ferris aconseja que los doctores le comuniquen a sus pacientes que la vacunación frecuente contra covid probablemente se convertirá en una necesidad.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Kissane’s autoimmune arthritis seems to make her susceptible to unusual vaccine side effects. After getting an mRNA booster last year, her joints ached so painfully that her doctor prescribed steroids to dampen the inflammation. She still considers the mRNA vaccines “miraculous,” knowing covid could be far worse than temporary aches.

Nonetheless, when the pain subsided, she pored through studies on Novavax’s shot, a vaccine that is based on proteins rather than mRNA and has been used since early 2022 in other countries. Data from the United Kingdom found that people more frequently reported temporary reactions — like low fevers, fatigue, and pain — as their immune system ramped up in the days following booster vaccination with Moderna’s mRNA vaccine versus the one by Pfizer. And those boosted with Novavax’s had fewer complaints than either of those. That finding was corroborated in an analysis of international data published last year.

Such studies have driven people with long covid and chronic fatigue syndrome (also known as myalgic encephalomyelitis, or ME/CFS) to seek out Novavax, too, since the FDA and the Centers for Disease Control and Prevention greenlighted Novavax’s vaccine — updated to protect against recent omicron coronavirus variants — about three weeks after recommending updated mRNA vaccines in September.

Waiting paid off for Kissane, whose arm was briefly sore. “It was a dramatically different experience for me,” she said. “I hope that plays out for others.”

Another group who waited on Novavax are biologists who geek out over its technology. When asked why he opted for Novavax, Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, replied on X, formerly known as Twitter: “Because I am [a] vaccine nerd, I like insect cell produced vaccines.”

Whereas mRNA vaccines direct the body to produce spike proteins from the coronavirus SARS-CoV-2, which then train a person’s immune system to recognize and fight the virus, Novavax simply injects the proteins. These proteins are grown within moth cells in a laboratory, while other protein-based shots use cells from mammals. And Novavax has said that a special ingredient derived from the bark of Chilean soapbark trees enhances the vaccine’s power.

Research suggests that the Novavax vaccine is about as safe and effective as the mRNA shots. Its main disadvantage is arriving late to the scene. Vaccine uptake has plummeted since the first shots became widely available in 2021. Nearly 70% of people got the primary vaccines, compared with fewer than 20% opting for the mRNA covid boosters released last year. Numbers have dwindled further: As of Oct. 17, only 5% of people in the United States had gotten the latest covid vaccines, according to the Department of Health and Human Services.

Daniel Park, an epidemiologist at George Washington University, said low rates might improve if people who felt lousy after their last mRNA shots gave Novavax a try. It protects against severe illness, but researchers struggle to specify just how effective this and other vaccines are, at this point, because studies have gotten tricky to conduct: New coronavirus variants continuously emerge, and people have fluctuating levels of immunity from previous vaccines and infections.

Still, a recent study in Italy suggests that Novavax is comparable to mRNA vaccines. It remained more than 50% effective at preventing symptomatic covid four months after vaccination. Some data suggests that mixing and matching different types of vaccines confers stronger protection — although other studies have found no benefit.

Given all this, Park held out for the Novavax vaccine on account of its potentially milder side effects. “Between a demanding full-time job and two young kids at home, I wanted to stay operational,” he said. His arm was sore, but he didn’t have the 24-hour malaise accompanying his last mRNA shot.

Most people don’t strike a fever after mRNA shots. Even when they do, it is brief and therefore far less detrimental than many cases of covid. In fact, most reactions are so minor that they’re hard to interpret. During clinical trials on mRNA vaccines, for example, up to a third of people in the placebo group reported fatigue and headaches after injection.

People with ME/CFS and long covid — a potentially debilitating condition that persists months after a covid infection — have responded to covid vaccinations in a wide variety of ways. Most participants with long covid in an 83-person Canadian study said their levels of fatigue, concentration, and shortness of breath improved following vaccination. Inflammatory proteins that have been linked to long covid dropped as well.

However, larger studies have yet to corroborate the hopeful finding. Jennifer Curtin, a doctor who co-founded a telehealth clinic focused on long covid and ME/CFS, called RTHM, said vaccines seem to temporarily aggravate some patients’ conditions. To learn how Novavax compares, she posted polls on X in late October asking if people with long covid or ME/CFS felt that their symptoms worsened, improved, or stayed the same after Novavax. Most replied: unchanged.

“It’s not scientific, but we need to figure it out since these folks don’t want to get covid,” Curtin said. “My patients are all wondering about what vaccine to get right now.”

Adding to the uncertainty, the rollout of Novavax and mRNA vaccines has been bumpy as pharmacies struggle to predict demand and insurance companies figure out how to reimburse providers for the shots. Unlike previous vaccine offerings, these options are no longer fully covered by the federal government. A testament to this season’s struggle to get vaccinated is that at least one do-gooder has created an online tool to find open appointments for Novavax.

Buoyed by anecdotes of relief from others with long covid, Hayley Brown, a researcher at the Center for Economic and Policy Research who has the condition, opted for Novavax recently. Unfortunately, her symptoms have flared. She said a temporary discomfort will still be preferable to risking another infection. “As someone with long covid, the idea of getting covid again is terrifying.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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But she can’t.

A rule added to Texas’ budget that went into effect Sept. 1 forbids health departments and other organizations funded by the state government to advertise, recommend, or even list covid vaccines alone. “Clinics may inform patients that COVID-19 vaccinations are available,” the rule allows, “if it is not being singled out from other vaccines.”

Texas isn’t the only state curtailing the public conversation about covid vaccines. Tennessee’s health department homepage, for example, features the flu, vaping, and cancer screening but leaves out covid and covid vaccines. Florida is an extreme case, where the health department has issued guidance against covid vaccines that runs counter to scientific studies and advice from the Centers for Disease Control and Prevention.

Notably, the shift in health information trails rhetoric from primarily Republican politicians who have reversed their positions on covid vaccines. Fierce opposition to measures like masking and business closures early in the pandemic fueled a mistrust of the CDC and other scientific institutions and often falls along party lines: Last month, a KFF poll found that 84% of Democrats said they were confident in the safety of covid vaccines, compared with 36% of Republicans. It’s a dramatic drop from 2021, when two-thirds of Republicans were vaccinated.

As new vaccines roll out ahead of the expected winter surge of covid, some health officials are treading carefully to avoid blowback from the public and policymakers. So far, vaccine uptake is low, with less than 5% of Americans receiving an updated shot, according to the Department of Health and Human Services. Wells fears the consequences will be dire: “We will see a huge disparity in health outcomes because of changes in language.”

A study published in July found that Republicans and Democrats in Ohio and Florida died at roughly similar rates before covid vaccines emerged, but a disparity between parties grew once the first vaccines were widely available in 2021 and uptake diverged. By year’s end, Republicans had a 43% higher rate of excess deaths than Democrats.

Public health initiatives have long been divisive — water fluoridation, needle exchanges, and universal health care, to name a few. But the pandemic turned up the volume to painful levels, public health officials say. More than 500 left their jobs under duress in 2020 and 2021, and legislators in at least 26 states passed laws to prevent public officials from setting health policies. Republican Arkansas state Sen. Trent Garner told KFF Health News in 2021, “It’s time to take the power away from the so-called experts.”

At first, vaccine mandates were contentious but the shots themselves were not. Scott Rivkees, Florida’s former surgeon general, now at Brown University, traces the shift to the months after Joe Biden was elected president. Though Florida Gov. Ron DeSantis initially promoted covid vaccination, his stance changed as resistance to covid measures became central to his presidential campaign. In late 2021, he appointed Joseph Ladapo surgeon general. By then, Ladapo had penned Wall Street Journal op-eds skeptical of mainstream medical advice, such as one asking, “Are Covid Vaccines Riskier Than Advertised?”

As bivalent boosters rolled out last year, the Florida health department’s homepage removed information on covid vaccines. In its place were rules against mandates and details on how to obtain vaccine exemptions. Then, early this year, the department advised against vaccinating children and teens.

The state’s advice changed once more when the CDC recommended updated covid vaccines in September. DeSantis incorrectly said the vaccines had “not been proven to be safe or effective.” And the health department amended its guidance to say men under age 40 should not be vaccinated because the department had conducted research and deemed the risk of heart complications like myocarditis unacceptable. It refers to a short, authorless document posted online rather than in a scientific journal where it would have been vetted for accuracy. The report uses an unusual method to analyze health records of vaccinated Floridians. Citing serious flaws, most other researchers call it misinformation.

Scientifically vetted studies, and the CDC’s own review, contradict Florida’s conclusion against vaccination. Cases of myocarditis following mRNA vaccines have occurred but are much less frequent than cases triggered by covid. The risk is sevenfold higher from the disease than from mRNA vaccines, according to an analysis published in a medical journal based on a review of 22 other studies.

Since leaving his post, Rivkees has been stunned to see the state health department subsumed by political meddling.

About 28,700 children and adults from birth to age 39 have died of covid in the United States. Florida’s anti-vaccine messaging affects people of all ages, Rivkees added, not just those who are younger.

He points out that Florida performed well compared with other states in 2020 and 2021, ranking 38th in covid deaths per capita despite a large population of older adults. Now it has the sixth-highest rate of covid deaths in the country.

“There is no question that the rise of misinformation and the politicization of the response has taken a toll on public health,” he said.

As in Florida, the Texas health department initially promoted covid vaccines, warning that Texans who weren’t vaccinated were about 20 times as likely to suffer a covid-associated death. Such sentiments faded last year, as state leaders passed policies to block vaccine mandates and other public health measures. The latest is a prohibition against the use of government funds to promote covid vaccines. Uptake in Texas is already low, with fewer than 4% of residents getting the bivalent booster that rolled out last year.

At Lubbock’s health department, Wells managed to put out a press release saying the city offers covid vaccines but stopped short of recommending them. “We aren’t able to do as big a push as other states,” she said.

Some health officials are altering their recommendations, given the current climate. Janet Hamilton, executive director at the Council of State and Territorial Epidemiologists, said clear-cut advice to get vaccinated against covid works when people trust the scientific establishment, but it risks driving others away from all vaccines. “It’s important for public health to meet people where they are,” Hamilton said.

Missouri’s health department took this tack on X, formerly known as Twitter: “COVID vaccines will be available in Missouri soon, if you’re in to that sort of thing. If not, just keep scrolling!”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Pero no puede.

Una norma agregada al presupuesto de Texas, que entró en vigencia el 1 de septiembre, prohíbe a los departamentos de salud y otras organizaciones financiadas por el gobierno estatal anunciar, recomendar o incluso enumerar las vacunas contra covid por sí mismas.

La norma permite que “las clínicas informen a los pacientes que las vacunas contra covid-19 están disponibles si no se las destaca de otras vacunas”.

Texas no es el único estado que restringe la conversación pública sobre estas vacunas. La página de internet del Departamento de Salud de Tennessee, por ejemplo, ofrece información sobre la gripe, el vapeo y la detección del cáncer, pero omite hablar de covid y de las vacunas. Florida es un caso extremo: su Departamento de Salud ha emitido directrices contra estas vacunas que van en contra de los estudios científicos y los consejos de los Centros para el Control y Prevención de Enfermedades (CDC).

El cambio en la información sobre salud sigue la retórica de políticos, principalmente republicanos, que han dado marcha atrás en sus posturas sobre las vacunas de covid.

La feroz oposición a medidas como el uso de máscaras y el cierre de negocios, al principio de la pandemia, alimentó la desconfianza hacia los CDC y otras instituciones científicas, y a menudo coincide con líneas partidistas: el mes pasado, una encuesta de KFF reveló que el 84% de los demócratas confiaba en la seguridad de las vacunas contra covid, frente al 36% de los republicanos. Es un descenso drástico desde 2021, cuando dos tercios de los republicanos estaban vacunados.

Ante la llegada de las nuevas vacunas, algunas autoridades de salud actúan con cautela para evitar el rechazo del público y de los responsables políticos. Hasta el momento, la aceptación de las vacunas es baja: menos del 5% de los estadounidenses han recibido la vacuna actualizada, según el Departamento de Salud y Servicios Humanos (HHS). Wells teme que las consecuencias sean nefastas: “Veremos una enorme disparidad de los impactos en la salud debido a los cambios en el lenguaje”.

Un estudio publicado en julio descubrió que los republicanos y demócratas de Ohio y Florida morían en tasas más o menos similares antes de que aparecieran las vacunas de covid, pero la disparidad entre partidos creció una vez que las primeras vacunas estuvieron ampliamente disponibles en 2021 y la aceptación fue divergente. A finales de año, los republicanos tenían una tasa de exceso de muertes, un 43% más alta que los demócratas.

Las iniciativas de salud pública llevan tiempo creando polémicas: la fluoración del agua, el intercambio de agujas y la atención de salud universal, por nombrar algunas. Pero la pandemia agravó la situación, según los funcionarios de salud pública.

Más de 500 dejaron su trabajo bajo coacción en 2020 y 2021, y los legisladores de al menos 26 estados aprobaron leyes para impedir que funcionarios públicos establecieran políticas de salud. Trent Garner, senador republicano por Arkansas, dijo a KFF Health News en 2021: “Es hora de quitarles el poder a los llamados expertos”.

Al principio, los mandatos de vacunación fueron polémicos, pero las vacunas en sí no lo eran. Scott Rivkees, ex cirujano general de Florida, ahora en la Universidad Brown, sitúa el cambio en los meses después de que Joe Biden fuera elegido presidente.

Aunque el gobernador de Florida, Ron DeSantis, promovió inicialmente la vacunación contra covid, su postura cambió cuando la resistencia a las medidas sobre covid se convirtió en un elemento central de su campaña presidencial. A finales de 2021, nombró a Joseph Ladapo cirujano general. Para entonces, Ladapo había escrito artículos de opinión en The Wall Street  Journal en los que se mostraba escéptico con los consejos de la medicina tradicional, como uno en el que se preguntaba: “¿Son las vacunas de covid más arriesgadas de lo que se anuncia?”.

Con la introducción de las vacunas bivalentes el año pasado, la página web del Departamento de Salud de Florida eliminó la información sobre las vacunas de covid. En su lugar había normas contra los mandatos y detalles sobre cómo obtener exenciones de las vacunas. Luego, a principios de este año, el departamento desaconsejó vacunar a niños y adolescentes.

El consejo del estado cambió una vez más cuando los CDC recomendaron vacunas actualizadas contra covid en septiembre. DeSantis declaró, de manera incorrecta, que las vacunas “no habían demostrado ser seguras o eficaces”. Y el departamento de salud modificó sus orientaciones para decir que los hombres menores de 40 años no debían vacunarse porque el departamento había realizado investigaciones y consideraba inaceptable el riesgo de complicaciones cardíacas como la miocarditis.

El informe se refiere a un documento breve, y sin autor, publicado en Internet en lugar de en una revista científica, donde se habría comprobado su veracidad. El informe utiliza un método poco habitual para analizar los historiales médicos de los floridanos vacunados. Citando graves defectos, la mayoría de los demás investigadores lo califican de información errónea.

Estudios científicamente constatados, y la propia revisión de los CDC, contradicen la conclusión de Florida contra la vacunación. Se han dado casos de miocarditis a causa de vacunas con ARNm, pero son mucho menos frecuentes que los casos provocados por covid. Según un análisis publicado en una revista médica a partir de una revisión de otros 22 estudios, el riesgo es siete veces mayor por esta enfermedad que por las vacunas de ARNm.

Desde que dejó su cargo, Rivkees ha visto con estupor cómo el departamento estatal de salud quedaba condicionado por las intromisiones políticas.

Unos 28,700 niños y adultos desde el nacimiento hasta los 39 años han muerto de covid en Estados Unidos. El mensaje antivacunas de Florida afecta a personas de todas las edades, añadió Rivkees, no sólo a los más jóvenes.

Señaló que Florida se desempeñó bien en comparación con otros estados en 2020 y 2021, ocupando el puesto 38 en muertes por covid per cápita a pesar de tener una gran población de adultos mayores. Ahora tiene la sexta tasa más alta de muertes por covid del país.

“No hay duda de que el aumento de la desinformación y la politización de la respuesta han pasado factura a la salud pública”, dijo Rivkees.

Al igual que en Florida, el departamento de salud de Texas promovió inicialmente las vacunas contra covid, advirtiendo de que los tejanos que no estaban vacunados tenían 20 veces más probabilidades de sufrir una muerte asociada a covid.

Pero esta visión se desvaneció el año pasado, cuando los líderes estatales aprobaron políticas para bloquear los mandatos de vacunación y otras medidas de salud pública. La última es la prohibición del uso de fondos públicos para promover las vacunas contra covid. En Texas, la aceptación de la vacuna ya es baja, con menos del 4% de los residentes vacunados con el refuerzo bivalente que se puso en marcha el año pasado.

En el departamento de salud de Lubbock, Wells se las arregló para publicar un comunicado de prensa diciendo que la ciudad ofrece vacunas contra covid, pero se abstuvo de recomendarlas. “No podemos hacer tanta campaña como en otros estados”, afirmó.

Algunos funcionarios de salud han modificado sus recomendaciones, dada la presión en la que viven. Janet Hamilton, directora ejecutiva del Council of State and Territorial Epidemiologists, dijo que el consejo dejó claro que vacunarse contra covid funciona cuando la gente confía en la comunidad científica, pero se corre el riesgo de alejar a otros de todas las vacunas. “Es importante que la salud pública vaya al encuentro de todas las personas”, afirmó Hamilton.

El Departamento de Salud de Missouri adoptó esta táctica en X (ex Twitter): “Las vacunas de covid estarán disponibles en Missouri en breve… si te interesan estas cosas. Si no, ¡sigue mirando posteos!”.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Pero más de un mes después, las versiones pediátricas de las nuevas vacunas contra covid, para niños de 6 meses a 11 años, siguen siendo difíciles de encontrar.

Una combinación de problemas —desde tecnicismos sobre quién puede vacunar a los niños pequeños hasta la falta de información correcta en internet sobre los sitios de vacunación— sigue impidiendo que los padres se aseguren de que sus hijos estén protegidos.

“Nadie tiene información precisa sobre dónde realmente están las dosis. Es simplemente un desastre logístico absoluto tratar de encontrar información y me estaba volviendo loca”, dijo Anne Hamilton, una residente de Los Ángeles, que buscó durante semanas una dosis pediátrica para su hijo Jimmy de 4 años.

Hamilton consultó primero con el sistema de salud de su hijo. El sitio de internet ofrecía citas de vacunación solo para adultos.

En el sitio web, “la ventana que aparece dice ‘se esperan nuevas vacunas para finales de septiembre, inténtelo de nuevo más tarde’. Es frustrante leer ese mensaje cuando estamos en octubre y no te dan ninguna otra información”, dijo.

Un problema que ha causado dolores de cabeza a los padres ha sido intentar encontrar dosis cubiertas por sus aseguradoras. Por primera vez desde el inicio de la pandemia, el gobierno federal no paga directamente a los fabricantes por las dosis de covid, un proceso que permitió a médicos y farmacéuticos recibir envíos de forma gratuita.

Ahora, las farmacias y los médicos tienen que pagar por adelantado las dosis a los proveedores para almacenarlas. Y las familias necesitan usar su seguro médico para pagarles a los proveedores, y eso puede ser complicado.

Después de días de buscar en internet y muchas pistas falsas, Hamilton finalmente encontró una farmacia a más de una hora de distancia, en Palmdale, con dosis pediátricas. Llamó para asegurarse de que realmente tuvieran vacunas, y que también aceptaran Medi-Cal, el seguro de su hijo. Después hicieron el viaje de una hora. Pero cuando llegaron, los farmacéuticos dijeron que no podían aplicarle la vacuna a Jimmy porque tenía menos de 18 años. Hamilton llamó a Medi-Cal para aclarar.

“El representante en la línea de Medi-Cal nos explicó que debíamos realizar el proceso a través del programa de Vacunas para Niños”, dijo. “No sabía qué era este programa”.

Según el programa de Vacunas para Niños del gobierno federal, el hijo de Hamilton solo podía recibir la vacuna de un proveedor participante.

“Nadie publicó la información de que los niños con Medi-Cal debían vacunarse a través del programa de Vacunas para Niños”, dijo Hamilton.

“Nadie tiene información sobre cómo encontrar una clínica cercana porque la mitad ni siquiera figuran en el sitio myturn.gov”, dijo, refiriéndose a un sitio web de citas para vacunas administrado por el estado de California.

Hamilton fue dirigida a un sitio web diferente, también estatal, que se suponía mostraría la ubicación de los proveedores de vacunas para niños en todo el estado.

“El sitio web simplemente no funciona”, dijo Hamilton después de tratar de navegarlo.

Frustrada, envió un correo electrónico al Departamento de Salud Pública de California (CDPH), que le dijo que sabían que el sitio web no funcionaba y que “los técnicos estaban trabajando en ello”. Nadie del CDPH se ofreció a ayudarla ni a indicarle la lista de proveedores que necesitaba, dijo Hamilton.

Después de que KFF Health News y NPR le preguntaran al CDPH por qué el mapa habilitado por Google de Vaccines for Children no funcionaba, arreglaron el sitio web. Sin embargo, muestra solo los proveedores participantes y no indica si esos médicos y farmacias tienen vacunas pediátricas contra covid. Los padres deben llamar a los proveedores individualmente para ver si están aceptando pacientes o constatar con el sitio web federal vacunas.gov.

Hamilton quedó frustrada y llorando.

“Conozco padres de todo el país que están buscando dosis. Es una búsqueda para todos en este momento”, dijo.

En Estados Unidos hay dos sistemas de vacunas paralelos, y el que usan los niños depende de su seguro. Los que tienen seguro médico comercial reciben vacunas a través del mercado comercial. Pero los que tienen seguros del gobierno, como Medi-Cal, reciben vacunas a través del programa Vacunas para Niños, financiado con fondos federales. Solo los proveedores participantes, como el pediatra del condado de Orange, Eric Ball, pueden administrarles la vacuna.

En el marco del programa Vacunas para Niños, “en realidad hacemos un pedido, las vacunas nos llegan, el gobierno ya las ha pagado y luego las distribuimos a los pacientes que tienen esos seguros, de forma gratuita”, explica Ball.

Para los niños cubiertos por planes comerciales, los proveedores de atención médica deben comprar la cantidad que creen que necesitarán con anticipación. Pero Ball dijo que muchos pediatras no almacenan ni administran la vacuna contra covid a esos niños porque no pueden solventarlo.

“Muchos consultorios pediátricos somos pequeñas empresas, y esto significa que tenemos que gastar mucho dinero por adelantado para poder comprar estas vacunas y luego esperar semanas o meses para recuperarlo”, dijo.

Si los padres buscan vacunas en una farmacia, pueden enfrentar otro obstáculo: las regulaciones que restringen los tipos de proveedores que pueden administrar vacunas a los niños. Los farmacéuticos pueden vacunar a niños de 3 años o más según una ley federal temporal. Eso deja fuera a los niños de entre 6 meses y 3 años, que tienen que consultar a un médico.

“En nuestra oficina, tenemos una lista muy larga de familias que están esperando el día en que lleguen nuestras vacunas contra covid para finalmente poder empezar a vacunar. Ha habido mucha frustración”, dijo Ball.

La oficina de Ball participa en ambos sistemas de vacunas pediátricas. A través de Vacunas para Niños, su práctica recibió algunas dosis pediátricas, pero solo puede administrarlas a pacientes que califican.

Esperó un mes por un envío de solo 100 dosis de la vacuna pediátrica contra covid para sus pacientes con seguro comercial. No es suficiente para satisfacer la demanda.

“Es una pena porque hemos perdido muchas oportunidades desde que se aprobó esta vacuna hace más de un mes”, dijo.

“Hemos tenido muchos pacientes que vienen y quieren vacunar a sus hijos, especialmente niños pequeños y bebés que no tienen la protección de las vacunas anteriores”.

St. John’s Community Health es una clínica de una red de seguridad financiada con fondos federales con varios sitios en todo el condado de Los Ángeles. La red atiende a niños y familias de bajos ingresos, y para sus vacunas pediátricas la clínica depende del programa Vacunas para Niños.

Pero Jim Mangia, su presidente, dijo que para la nueva vacuna pediátrica contra covid se están recortando los pedidos y no están recibiendo las dosis que solicitaron.

“Pedimos 3,000 la semana pasada; recibimos 500”, dijo.

Pero Mangia dijo que St. John’s brinda atención a 50,000 niños. Debido al déficit, no anuncian la vacuna contra covid ni envían correos electrónicos o mensajes de texto para correr la voz, como suele hacer el personal.

“Básicamente estamos esperando”, agregó. “Si alguien la pide, le proporcionamos la vacuna, pero no estamos haciendo el nivel de alcance que normalmente hacemos para vacunar a la gente porque todavía no tenemos suficiente suministro”.

El programa Vacunas para Niños está a cargo de los CDC. En una visita reciente a Los Ángeles, la directora de los CDC, Mandy Cohen, dijo que no tenía conocimiento de ningún problema con el suministro o el pedido de vacunas contra covid.

“No hay límite de pedidos. Estamos escuchando que se están recibiendo los envíos en tres o cuatro semanas”, dijo. “Diré, personalmente, que el pediatra de mi hijo tiene la vacuna y ha tenido una clínica de vacunación contra covid, por lo que la vacuna está disponible”.

Jimmy, el hijo de Anne Hamilton, finalmente recibió la vacuna a través de una clínica temporal administrada por el condado de Los Ángeles. Se siente afortunada de haberla encontrado.

“Le dije a una de mis amigas que iba a vacunar a mis hijos y me dijo: ‘¿Encontraste una vacuna pediátrica? No puedo creerlo’”.

A Ball le preocupa lo que significará la lenta implementación para los bebés y niños pequeños vulnerables, que son demasiado pequeños para haber sido vacunados antes y deben recibir varias inyecciones antes del aumento previsto de covid en invierno.

“Si queremos vacunar a estos niños para el Día de Acción de Gracias y las vacaciones de invierno, es fundamental que comencemos a hacerlo ahora porque no es una situación única. Necesitamos que estos bebés reciban múltiples dosis durante varias semanas antes de que puedan estar adecuadamente protegidos”, dijo.

Mientras tanto, los niños siguen infectándose. Uno de los pacientes de 4 años de Ball dio positivo el mismo día que su consultorio finalmente recibió 100 dosis de la vacuna pediátrica. La madre del niño había intentado vacunarlo antes, pero no pudo encontrar un proveedor que tuviera dosis.

“Como pediatra, lo único que me duele más que ver a un niño enfermarse o estar internado es que se enferme o deba ser internado por algo que yo podría haber evitado. Y si no tengo las herramientas para evitarlo, me duele y es muy triste”, dijo Ball.

Este artículo proviene de una asociación que incluye a LAist, NPR y KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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But more than a month later, the pediatric versions of the new covid shots, for children 6 months to 11 years old, are still difficult to find. A confluence of problems — from technicalities about who can give shots to small kids to the lack of accurate information online on where the kid-sized doses can be found — are still preventing parents from making sure their children are protected.

“Nobody has accurate information on where doses actually exist. It’s just an absolute logistical mess trying to find information and it was driving me insane,” said Anne Hamilton, a Los Angeles resident, who searched for weeks to find a pediatric dose for her 4-year-old son, Jimmy.

Hamilton checked first with her son’s health system. The website was offering vaccine appointments only for adults.

On the website, “the popup says ‘new vaccines are expected in late September, try again later.’ Well, that’s a frustrating message to read when it’s October and they’re not giving you any other information,” she said.

One problem that has caused headaches for parents has been trying to find doses covered by their insurance. For the first time since the start of the pandemic, the federal government isn’t paying manufacturers directly for covid shots, a process that allowed doctors and pharmacists to receive shipments for free. Now, pharmacies and doctors have to pay upfront for vaccine doses from suppliers to stock them on-site. And families need to use their health insurance to pay providers for them — and that can be complicated.

After days searching online and many false leads, Hamilton finally found a pharmacy over an hour away in Palmdale with pediatric doses. She called to make sure they actually had the shots and also accepted Medi-Cal, her son’s government insurance. After being assured of both, they made the hourlong drive. But when they arrived, the pharmacists said they couldn’t give Jimmy the shot because he was under 18 years old. Hamilton called Medi-Cal to clarify.

“The Medi-Cal phone representative explained to us that they need to go through the Vaccines for Children Program,” she said. “So we’re like, all right, we don’t know what this program is.”

Under the federal government’s Vaccines for Children program, Hamilton’s son could get a shot only from a participating provider.

“Nobody put out the information that children on Medi-Cal needed to be vaccinated through the Vaccines for Children program,” Hamilton said.

“Nobody has information on how to find a pop-up [clinic] near you because half of those aren’t even listed on the myturn.gov page,” she said, referring to a vaccine appointment website run by the state of California.

Hamilton was directed to a different California-run website that was supposed to show the location of Vaccines for Children providers across the state.

“The website just flat-out doesn’t work,” Hamilton said after checking it.

Frustrated, she emailed the California Department of Public Health, which told her they were aware the website was down and said “IT was working on it.” No one from CDPH offered to help Hamilton or direct her to the provider list she needed, she said.

After KFF Health News and NPR asked CDPH why Vaccines for Children’s Google-enabled map was not working, the website was fixed. However, it shows only participating providers while neglecting to indicate if those doctors and pharmacies have pediatric covid vaccines in stock. Parents must either call providers individually to see if they are taking patients and have the shot or try to cross-reference with the federal vaccines.gov website.

Hamilton was left frustrated and in tears.

“I know parents all over the country who are looking for doses. It’s a hunt for everyone right now,” she said.

There are two parallel vaccine systems in the U.S., and the one children use depends on their insurance. Children with commercial health insurance get vaccines through the commercial market. But kids with government insurance such as Medi-Cal get shots through the federally funded Vaccines for Children program — and only participating providers, like Orange County pediatrician Eric Ball, can give them the shot.

Under the Vaccines for Children program, “we actually place an order, the vaccines come to us, the government has paid for them already, and then we distribute them to patients who have those insurances, for free,” Ball explains.

For children covered by commercial insurance plans, health care providers need to purchase the amount they think they’ll need ahead of time. But Ball said many pediatricians aren’t stocking or administering the covid shot for those children, because they can’t afford to.

“A lot of pediatric practices are small businesses, and this means we have to expend a lot of money upfront to be able to buy these vaccines and then wait weeks or months to get that recouped,” he said.

If parents seek shots at a pharmacy, they may confront another obstacle: regulations that restrict the types of providers who can administer vaccines to children. Pharmacists can vaccinate children 3 years and older under a temporary federal law. That leaves out children between 6 months and 3 years old, who have to see a medical doctor.

“We have a very long list in our office of families who are waiting for the day that our covid vaccines come in so we can finally start vaccinating them. There’s been a lot of frustration,” Ball said.

Ball’s office participates in both pediatric vaccine systems. Through Vaccines for Children, his practice received some pediatric doses, but he can administer them only to qualifying patients.

For his commercially insured patients, it took over a month to get a delivery of just 100 pediatric covid vaccine doses. It’s not nearly enough to meet the demand.

“It’s a shame because we’ve had so many missed opportunities since this vaccine was approved over a month ago,” he said.

“We’ve had lots of patients who come in who want to get their kids vaccinated, especially young children and babies who don’t have the protection of previous vaccines.”

St. John’s Community Health is a federally funded safety-net clinic with multiple sites across Los Angeles County. The network serves low-income children and families, and for its pediatric vaccines the clinic is dependent on the Vaccines for Children program.

But President Jim Mangia said that for the new covid pediatric vaccine, their orders are being cut and they aren’t receiving the doses they requested.

“We ordered 3,000 last week; we got 500,” he said.

But St. John’s provides care for 50,000 children, Mangia said. Because of the shortfall, St. John’s isn’t advertising the covid vaccine or doing email or text blasts to spread the word, as the staff typically might.

“We’re basically holding back,” he said. “If someone asks for it, we’re providing the vaccine, but we’re not doing the level of outreach that we normally do to get people vaccinated because we don’t have enough supply yet.”

The Vaccines for Children program is run by the CDC. On a recent visit to Los Angeles, CDC Director Mandy Cohen said she was not aware of any covid vaccine supply or ordering issues.

“There’s no ordering caps. We’re hearing that folks are getting shipments within three or four weeks,” she said. “I will say, personally, my kid’s pediatrician has vaccine and has had a covid vaccine clinic, so the vaccine is out there.”

Anne Hamilton’s son Jimmy finally got the shot through a pop-up clinic run by LA County. She feels lucky to have found it.

“I told one of my friends that I was going to get my kids their shots, and she said, ‘You found pediatric vaccine? I can’t believe it.'”

Ball is concerned about what the slow rollout will mean for vulnerable babies and toddlers, who are too young to have been vaccinated before and should get multiple shots before the predicted winter covid surge.

“If we want to get these children vaccinated for gatherings such as Thanksgiving and the winter holidays, it’s critical that we start doing this now because this is not a one-and-done kind of situation. We need these babies to get multiple doses over multiple weeks before they can be adequately protected,” he said.

Meanwhile, children continue to get infected. One of Ball’s 4-year-old patients tested positive on the same day Ball’s medical office finally received 100 doses of the pediatric vaccine. The boy’s mother had tried to get him vaccinated earlier but couldn’t find a provider with the shots.

“As a pediatrician, the only thing that hurts me worse than seeing a child get sick or hospitalized is them getting sick or hospitalized by something that I could have prevented. And if I don’t have the tools to prevent that, it hurts me and it’s very sad,” Ball said.

This article is from a partnership that includes LAist, NPR, and KFF Health News.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).