For the past couple of months, the information the Centers for Disease Control shares with medical providers about vaccines, diseases and health information has been conflicting or hard to obtain. As a result, doctors and other medical professionals in New Hampshire say they are now relying more heavily on information from other governing bodies on disease prevention and vaccinations.
Typically, the CDC regularly communicates with providers in late summer about how diseases are spreading across the world and the patterns of how these illnesses may affect specific groups like the elderly, children and pregnant people. That information is particularly valuable as flu and cold season approaches in mid-September.
But the CDC’s Health Action Network hasn’t been updated since March.
Dr. Gabriela Andujar Vazquez, an epidemiologist at Dartmouth Hitchcock Medical Center, said the CDC defines the standards of how medical professionals approach public health needs — like how transmissible a strain of illness is — and what risks a disease poses for the population.
“Professional societies will also either align with CDC or be very specific about their patient population,” Andujar said. “So we have in general always used CDC as sort of a framework.”
With this information, local healthcare providers and national healthcare organizations issue guidelines on what the response to a disease should look like.
Lately, conflicting information from federal agencies and federal officials has made that more challenging. Thursday, U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. was criticized by senators of both parties for his oversight of the CDC and misinformation about vaccine safety and efficacy.
Andujar says Dartmouth Hitchcock is looking at other health organizations, like the World Health Organization and the European CDC, for information. Andujar said groups like the American College of Physicians and the Association for Family Medicine Practitioners also look at vaccine roll outs, which medical providers can also base their own guidance on.
“We were used to CDC being, like, the standard of evidence based,” Andujar said. “We're trying to sort of navigate: How do we bridge the gaps of evidence base and knowledge in the absence of having maybe information that we used to rely on from the CDC?”
The CDC, along with the FDA, issues guidance on what populations are recommended to get vaccines for COVID-19, flu and other illnesses. Without federal approval for certain populations to receive vaccines — in particular, COVID-19 — insurance carriers may not cover the cost.
Brendan Williams, president and CEO of the New Hampshire Health Care Association, which works with nursing homes and elder care providers in the state, said the situation can also lead to hesitation from pharmacists, and even doctors, to give out vaccines to patients.
“Let's say you are under the age of 65: Is a pharmacy going to be willing to give you the vaccine based on your, say, so that you have one of these underlying health conditions, or are they going to be worried about doing that? Is a doctor going to be willing?” Williams said. “Typically a doctor can give you a vaccine off label, just based on his or her medical judgment. Are they going to be worried about liability now in this current atmosphere?”
Williams is concerned with how nursing home residents get COVID-19, influenza and RSV vaccines. He’s worried that conflicting information from the CDC and federal health officials about vaccine safety and efficacy could exacerbate vaccine hesitancy.
“RSV is something that traditionally was something that you really thought of relative to kids but now it's recommended that older adults get vaccinated against it,” Williams said. “That's been a little harder, I think, for folks to want to get vaccinated against RSV.”
Williams notes that it’s not just residents in nursing homes who may have to weigh whether or not they should get the vaccine, but their loved ones and others who have decisions about their care.
The delay of information, lack of communication and conflicting information has spurred distrust in the CDC from Williams.
“I have no faith in the Center for Disease Control and Prevention at this point,” Williams said.
Georgia Maheras is the Senior Vice President of Policy and Strategy at the Bi-State Primary Care Association, which predominantly works in primary care across Vermont and New Hampshire. She said without health guidelines from the CDC, she is looking to other organizations like WHO and even epidemiologist journals.
“There are different clinical groups that are pulling together other ways to share information so that it is broadly available, easily available, and isn't behind a paywall or anything like that so that anyone can access that information," she said.
Health providers note that the American College of Physicians and the Association for Family Medicine Practitioners have come up with guidance around the COVID-19 vaccine for adults and older patients. The American College of Obstetricians and Gynecologists has been issuing guidance around vaccines in the event nothing comes from the CDC.
For now, clinical groups and healthcare organizations are working together to share clear and consistent information with as many providers and patients as possible. The New Hampshire Department of Health and Human Services has also recently updated recommendations about respiratory virus immunizations to providers.
Editor’s note: This story has been updated to reflect guidance released by the New Hampshire Department of Health and Human Services on the morning of Friday, September 5th.
Correction: An earlier version of this story misspelled the name of Dr. Gabriela Andujar Vazquez.
