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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

States have permission to make their monkeypox vaccines go a lot farther

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Good morning, everyone. Thanks for brightening my day yesterday with cat pics. ☀ As always, tips to

Today’s edition: President Biden will sign legislation today aimed at helping veterans exposed to toxic burn pits. The president will announce his intent to appoint Monica Bertagnolli as the new director of the National Cancer Institute. But first … 

441,000 monkeypox vaccine doses could become 2.2 million doses

The Biden administration is seeking to stretch its dwindling supply of monkeypox vaccine doses amid criticism over its response to the growing crisis.

Federal health officials unveiled a new strategy yesterday that aims to vaccinate up to five times as many people against the virus, our colleagues Dan Diamond and Fenit Nirappil report. The new tactic changes the way providers administer the shots, leaving state and local officials scrambling to make adjustments to their procedures.

Shortly after the announcement, health departments said they’ll review — and may need more — federal and state guidance on the change and will assess whether they have the necessary needles and supplies. Vaccinators may also need additional training on the new plan to inject doses under the top layer of the skin, a nontraditional way of administering vaccines. 

  • “Many local health departments are still assessing the impact this would have in their communities, particularly when it comes down to logistics, including ensuring vaccinators are trained and confident in the updated method of administration,” Adriane Casalotti, the chief of government and public affairs at the National Association of County and City Health Officials, told The Health 202.

More from Dan:

The details

Demand for monkeypox shots is outstripping supply as the record outbreak of the virus has infected nearly 9,500 people in the United States. That’s why the administration is seeking new ways of expanding its current supply. 

Here’s how the change announced yesterday works: Rather than inject doses of the Jynneos vaccine into fatty tissues under the skin — the typical way of administering vaccines — the shots would instead be injected under the top layer of the skin, a tactic known as intradermal injection. This change essentially maximizes the immune reaction to the shot and lets vaccinators administer just one-fifth of the original dose, Dan and Fenit explain. 

Under the new plan, the country’s remaining 441,000 doses could be stretched to offer 2.2 million shots. In a news briefing yesterday, federal health officials stressed that the new approach wouldn’t compromise the safety or efficacy of the vaccine, which is still intended as a two-dose vaccine.

“We encourage jurisdictions to utilize the alternative dosing method as quickly as possible, and we’ll be your partner in this step every step of the way,” Robert Fenton, White House monkeypox response coordinator, said at a news briefing yesterday.

FDA Commissioner Robert Califf:

Questions remain

State and local officials are determining how to adjust to the new dosing changes — and expect to have questions in the coming days. This comes as the Biden administration considers at least 1.6 million gay and bisexual men to be at the highest risk for monkeypox and are urging them to get vaccinated.

“There's a lot of questions about just the logistics of what the requirements are, and I think those will get sorted out over the next couple of days,” said Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials. 

The San Francisco Department of Public Health says it’s awaiting instructions from the state health department on how to account for and register each dose when multiple doses are taken from single vials. The department, like several other major health associations, said the vaccine may require additional training for staff — and could be slower to administer. 

Biden officials noted that the method has been used before, like for tuberculosis skin tests, but recognized that some health professionals may not be as familiar with the tactic. For instance: The Centers for Disease Control and Prevention is sending guidance to vaccine providers “to help ensure this new strategy can be implemented quickly and as seamlessly as possible,” said Rochelle Walensky, the agency’s director. 

White House prescriptions

On tap today: Biden to sign landmark veterans burn pit health-care bill

After years of struggles by activists and a recent rocky path through Congress, President Biden will sign legislation today to expand health-care and disability benefits to millions of veterans exposed to toxic burn pits during their time in the military. 

The legislation marks a significant political and personal achievement for Biden, who has wondered publicly whether burn pits contributed to the brain cancer that killed his son, Iraq War veteran Beau Biden, and has vowed to help other former service members exposed to the toxins.

Specifically, the PACT Act will fund $280 billion worth of new allocation for veterans health programs, along with making it easier for veterans to qualify for services at the Department of Veterans Affairs, remove the burden of proof for some veterans diagnosed with 23 conditions and strengthen toxic exposure research. 

More from Biden:

First in The Health 202: Biden to appoint new NCI director

Biden will officially announce today his intent to appoint surgical oncologist Monica Bertagnolli as the next director of the National Cancer Institute

Bertagnolli, a physician at Brigham and Women’s Hospital, will replace Norman “Ned” Sharpless, who stepped down as NCI director in April. With a budget of $7 billion, NCI is integral to Biden’s cancer moonshot initiative to slash the U.S. cancer death rate in half over the next 25 years. Stat first reported Biden's intention to nominate Bertagnolli last month.

State scan

All eyes are on state supreme court elections in a post-Roe America

The Supreme Court’s decision overturning constitutional abortion rights has transformed what were once-sleepy state judiciary races into high-energy elections nationwide, particularly in places where judges could soon be asked to rule on access to the procedure, The Post’s James Bikales and Praveena Somasundaram report. 

Thirty states are holding state supreme court elections this November, with 85 seats on the ballot. Many of those are nonpartisan races or elections to retain a sitting judge. But in Ohio, Illinois, Michigan and North Carolina, the outcome of the contests could determine which party controls the state’s top court. Both Democrats and Republicans are pouring funding into contested elections, with some groups endorsing and financially supporting judicial candidates for the first time. 

Democrats, in particular, are trying to convince voters that supporting Democratic justices will speed up abortion protections, as opposed to trying to end the filibuster or pass a federal law codifying access to the procedure.

Meanwhile, across the country …

  • In Georgia: The Biden administration is suspending implementation of Georgia’s plan to opt out of in favor of letting agents, brokers and other entities sell Obamacare plans.
  • In Alaska: Anchorage Health Director Joe Gerace resigned this week amid questions over whether he had overstated and misrepresented both his educational and military background. A press release from the city attributed the resignation to health issues, including a stroke last week that left him hospitalized, American Public Media and Alaska Public Media write in a joint investigation.
  • In Michigan: Democrats are working to win over women who might otherwise be inclined to vote Republican and turn out base voters who’ve been difficult to motivate. This comes as the purple state, which has competitive races for governor and Congress, gears up for what is shaping up to be one of the country’s most consequential battlefronts over abortion rights, The Post’s Hannah Knowles reports.

On the Hill

First in The Health 202: Warren probes state abortion bans’ impact on health care

Sen. Elizabeth Warren (D-Mass.) is requesting information from five major health-care organizations as part of her office’s probe into whether state abortion bans enacted by Republican-led legislatures are affecting access to pregancy and reproductive care.

Warren posed a series of questions seeking the groups’ perspectives on whether state-imposed restrictions are impacting patients and physicians, as well as if they’ve given guidance to members about how to perform their duties in light of abortions bans. 

Here are the five groups Warren is seeking information from by Sept. 9. (None of the organizations immediately commented on the letter when contacted by The Health 202.)

  • The American Medical Association
  • Physicians for Reproductive Health
  • National Nurses United
  • The American Pharmacists Association
  • The American Hospital Association

In other health news

America’s system for the disabled is faltering

Private agencies providing services for the intellectually and developmentally disabled are strapped for cash. And the years-long dire warnings of an inability to provide housing and staff support without fresh state and federal dollars are bearing out, Politico’s Dan Goldberg reports. 

The coronavirus pandemic coupled with record inflation has had lingering effects, and already some agency directors have had to shutter their doors. Some are having trouble recruiting and retaining staff, forcing families on yearslong wait lists to get into programs.

One CEO in Maine has closed four group homes over the past 18 months. In Connecticut, one provider closed 10 homes. In Oklahoma, dozens of residential units haven’t been filled because there’s not enough staff.

That’s left residents living with siblings or their older parents, some of whom are in need of their own care. If they become wards of the state, they are sent to live in larger facilities, which are institutional settings the country tried to swear off nearly a half-century ago, Dan writes.

Health reads

Monkeypox Likely Circulated for Years Before Outbreak, Scientists Say (By Denise Roland | The Wall Street Journal)

Access to trauma care is improving across the country, but progress remains uneven (By Edward Chen | Stat)

Covid Sewage Surveillance Labs Join the Hunt for Monkeypox (By Mark Kreidler | Kaiser Health News)

Sugar rush

Thanks for reading! See y'all tomorrow.