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Content verified September 26, 2022
With the CDCs approval of a new Pfizer and Moderna booster on September 1, County-sponsored clinics must provide only the new boosters. People getting first or second doses are not affected.
Our booster clinics for ages 12+ have switched to the updated bivalent booster. Due to initialsupply, we currently recommend appointments for these boosters. Maryland's Vaccine Locatorprovides information on pharmacies and other providers who also have booster appointments.
Novavax vaccine is available by appointment to persons age 12 and over. Learn more about Novavax and make an appointment.
At County-run clinics: appointments recommended; drop-ins welcome but bivalent booster supply is limited and will depend on availability.
You may see this pop-up message: "Clinic appointments slots are currently being booked by others. Please check back later to see if any appointments have become available."It means that
If you need help making an appointment at a County-run clinic, or an in-home appointment, call 240-777-2982 or email c19vaccination@montgomerycountymd.gov.
For veteransenrolled in VA Healthcare: Washington DC VA Medical Center| Martinsburg VA Medical Center
For an online record of your COVID-19 vaccination, view your account in Maryland MyIR. MyIR is Maryland's online immunization record system. It is considered your official record of vaccination.
If you have trouble accessing your online record, use the MyIR Help. If your record does not show up on MyIR, request help for an "unmatched record".
If you were vaccinated at a County-operated clinic, we can email you a copy of your record. To request a copy, email c19vaccination@montgomerycountymd.gov or call 240-777-2982.
We cannot provide duplicate CDC vaccination cards.
See clinic maps, bus service options, and driving directions
See the Montgomery County Vaccine Distribution Dashboard.
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Partnership with trusted community organizations, a diverse bilingual workforce, and a grassroots communication and outreach strategy were key to a successful community based vaccination clinic aimed at expanding uptake and access among Latinos with limited English proficiency.
The COVID-19 pandemic has disproportionately affected minority groups including Latinos and especially among Latinos with limited English proficiency. Once vaccines became available, Latinos lagged behind in COVID-19 vaccination coverage, especially during the early phase of vaccination roll out. Latino migrants with irregular migrant status faced unique challenges to access vaccination, including language barriers, concerns about immigration status, and lack of familiarity navigating the US health care system. A nationally representative study in the US showed that in May, two thirds of undocumented Latinos reported uncertainty about their eligibility and concerns about social security or government ID requirements, and 43% did not know where to go. They also reported difficulty obtaining vaccine information in Spanish and registering through digital portals, and most were unaware that in the US the vaccine was available for free, regardless of immigration status.
The investigators of this study had a personal interest in expanding access to vaccination to this vulnerable group. Dr. Page is an infectious disease specialist from Uruguay and during the pandemic, she and co-author Ben Bigelow helped establish a coalition between the Johns Hopkins Health System, religious leaders, and community organizations to open a bilingual COVID-19 hotline and implement free SARS-CoV2 community-based testing to target disadvantaged Latinos in Baltimore City and surrounding areas. Leveraging this infrastructure, the trust gained through this initiative, and the expertise of bilingual and bicultural community health workers, the team implemented vaccination clinics at one of the local churches to facilitate access for Latinos with limited English proficiency.
What we did
Eighteen free community vaccination events with bilingual staff were conducted between February 26, 2021, and May 7, 2021. Between 150 and 200 first doses per week were allocated for this initiative.
A variety of outreach methods were used to increase vaccine uptake. The number for the bilingual COVID-19 hotline was distributed to vaccinated individuals to share with their networks and advertised through Spanish language local media outlets and community partners (passive outreach). In addition, the community health workers canvased Latino neighborhoods and laborer sites to offer appointments for vaccination (street outreach). Walk-up appointments became allowed as the pandemic progressed (walk-up).
What we found
Was this outreach successful? How should future groups aim to target disadvantaged communities?
Our free community-based vaccination initiative expanded access for Latinos with limited English proficiency at high risk for COVID-19 during the early phase of the immunization program in the United States. However, this was a small scale intervention and more work needs to be done nationwide to minimize disparities in COVID-19 and other health outcomes. What should future groups do to insure high-uptake of community programs?
1. Partners with trusted community organizations and structures.
As pent-up demand for vaccination nationwide has subsided, community-based initiatives that can leverage social networks and build community trust. This can both increase access to and normalize vaccination for marginalized or vaccine-hesitant individuals.
2. Have a bilingual and bicultural workforce with flexible appointment scheduling.
The coalition participated in more than 40 Spanish language community informational forums, and the clinical director was designated a bilingual Maryland GoVAX COVID-19 vaccine ambassador. These combined efforts helped mitigate language barriers, concerns about immigration status, and lack of understanding about the healthcare system.
3. Increase the use of high-touch and low-tech approaches.
Our outreach methods overcame technical barriers by focusing on low-tech approaches. These methods included in-person outreach, hotline access, Spanish language media, and word of mouth that were easy to navigate and did not rely on advanced digital or health literacy.
To learn more, read our article in the November 2022 issue of the Journal of Public Health Management and Practice.
Dr. Kathleen Page is an infectious disease specialist at Johns Hopkins School of Medicine. She is originally from Uruguay and her work focuses on promoting health equity for Latinos immigrants with limited English proficiency through community-engaged program development, implementation and evaluation.
Related
Paul Offit, director of the Vaccine Education Center at the Childrens Hospital of Philadelphia, does not mince words when describing the scientific legacy of the Covid-19 vaccines: The mRNA shots, he said, are the greatest scientific achievement in my lifetime.
Yet as the weather starts to turn cold and as officials push for more people to get their new booster shot before an expected winter coronavirus surge, public health leaders are battling skepticism and apathy toward the vaccines. Worse, experts fear the politicized backlash to the Covid-19 vaccines is already fostering skepticism about routine vaccinations generally, from childhood immunizations to flu shots.
Across the country, Republican lawmakers have drafted a pile of anti-vaccine mandate bills this year, chipping away at a foundational health practice for the last half-century. More than 80 anti-vaccine bills have been introduced in state legislatures, according to academics tracking the phenomenon, dwarfing the number of countervailing pro-vaccine bills. Public health experts are preparing for an all-out war on school mandates and other vaccine measures in states like Texas.
Childhood vaccination rates fell during the 2020-21 school year, the equivalent of 35,000 kids not being up to date on their shots. Although that might be an effect of missed checkups during the worst of the pandemic, there are other signs that faith in vaccines might be falling: Fewer Americans said this year and last year that they will get the flu shot compared to the few years before, according to a new poll from the National Foundation for Infectious Diseases. The fear among experts is that these drops are not a pandemic-driven blip but an accelerating trend, following a decades-long drift in trust in childhood vaccines; we should get updated numbers early next year.
This Covid-19 booster is likely the last time the government will offer a free shot to all Americans. We are moving away from a pandemic footing and into an age when reformulated Covid boosters are part of the routine vaccination schedule. That should be a cause for celebration: They are miracles of scientific ingenuity, delivered faster and proving more effective than most experts believed possible at the start of the pandemic. They have helped avert tens of millions of deaths worldwide, by some estimates.
And yet many Americans dont trust them. If anything, the controversies around the vaccines driven by a mix of political opportunism, polarization, and misinformation may ultimately undermine faith in vaccines broadly among certain pockets of the population for years to come.
Information gets you so far, but only so far. Its not a knowledge deficit but a trust deficit, Offit said. Its a level of denialism thats hard to grasp.
Its befuddling in part because the life-and-death stakes should already be clear. A new study from a group of Yale University scholars found that Republicans experienced a meaningfully higher death rate from Covid-19 than Democrats and the difference was almost entirely concentrated in the period after the vaccine became available.
These effects will continue to be felt this winter and beyond. According to new survey data from the Pew Research Center, just 4 percent of Americans say they have gotten the updated bivalent booster shot targeted to the omicron variant of Covid-19. Combined with those who say they will probably get another booster dose (44 percent), less than half of Americans are expecting to stay current with their Covid vaccinations, despite the urging of public health officials.
New projections from the Commonwealth Fund estimated that, if vaccination rates were to remain unchanged in the next few months, the US will be averaging about 1,200 deaths from Covid-19 every day by March, three times the number of daily deaths being reported right now.
If, on the other hand, 80 percent of eligible Americans were to receive the latest boosters, as many as 90,000 lives could be saved over that period.
Experts are also bracing for a severe flu season, in part because of the lagging vaccination rates, which are usually below 50 percent annually.
But what is clear by now is projections like these, or all the pleading of public health leaders, cannot overcome the rampant anti-vaccine skepticism that has taken hold in the US, particularly on the right. As Dorit Reiss, a UC Hastings law professor who is tracking anti-vaccine legislation in the states, put it to me, the pandemic turbocharged things that were already happening.
Weve seen increasing politicization of vaccine mandates before the pandemic, she said. But not to the degree were seeing now.
And with the anti-vaccine movement growing stronger, experts expect its adherents to grow only more ambitious, targeting the school vaccine mandates that have been critical up to now in eradicating diseases like measles, mumps, and polio.
Eventually, Covid will start to dissipate. But its not like this whole ecosystem that was put in place is going to fold up the tent and go home, said Peter Hotez, co-director of Texas Childrens Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine. They have their sights set on childhood vaccinations.
Vaccine skepticism remains a minority position in the US. Nearly 70 percent of eligible Americans have been fully vaccinated against Covid-19. More than 8 in 10 continue to say that getting childhood vaccinations is important. But that consensus is not quite as strong as it once was.
In 2001, according to Gallups polling, 94 percent of Americans said it was extremely or very important for parents to get their children vaccinated. In 2019, that figure had dropped to 84 percent. Gallup hasnt asked that survey question again in a while, but the Kaiser Family Foundation asked something similar in July. They found 89 percent of parents or guardians said they kept their children up to date on vaccines. But 1 in 10 said they had skipped some or all of the scheduled vaccines for their kids.
People with doubts are often finding support from their political representatives. Both Hotez and Offit said that anti-vaccine sentiments have gained more of a foothold on the right in recent years. Once upon a time, vaccine hesitancy did not have a clear political bent: Some people on the left were doubtful of vaccines for what Offit called purity reasons (they dont want to put unnatural products in their body) and some people on the right were making arguments based on liberty and freedom.
But over the last decade, Hotez said, an alliance between anti-vaccine activists and right-wing political groups has driven much more skepticism among Republican voters. In Gallups 2019 poll, the share of Republicans who said getting childhood vaccinations was important had plummeted to 79 percent, from 93 percent in 2001. The drop among Democrats, meanwhile, was much more modest, from 97 percent in 2001 to 92 percent in 2019, and even prior pockets of left-wing vaccine skepticism have become more supportive of vaccines during the pandemic.
That alliance was born as the anti-vaccine movement began to deemphasize debunked links to autism and instead embraced the concept of medical freedom a message, especially in the wake of the Tea Party and the Obamacare debate, that appealed to conservative activists and their voters. Politicos Arthur Allen wrote in 2019 that that libertarian demand for medical freedom has displaced the traditional GOP view that its a civic responsibility to immunize your kids to prevent the spread of disease for a growing number of Republican officials and their supporters.
Then Covid-19 happened. First, the Trump administration and many of its political allies downplayed the threat of the virus and then, even after their own program helped develop lifesaving vaccines in record time, largely framed the question of whether to get this shot that could help end the pandemic as a matter of personal choice.
The Trump administration made [the pandemic] a partisan issue. I think were paying the price for that, Reiss said. It was a missed opportunity because, pandemic failures aside, the vaccines were a bipartisan effort. One administration started them and another distributed them. It could have been a come-together moment.
Its not very hard to imagine an alternate universe where the successful development and deployment of Covid-19 vaccines engendered renewed faith in vaccines generally. Instead, the campaign against all vaccinations seems to be gaining steam.
Hotez said that, in Texas, he is anticipating a full-throttle assault against childhood vaccination requirements in schools during the upcoming legislative session. According to Reisss review of the public health legislation database at the National Conference of State Legislatures, at least 88 bills have been introduced in state legislatures in 2022 that would roll back school vaccine requirements or eliminate the right of a minor to make their own decisions about getting vaccinated. She counted just 10 pro-vaccine bills. And nearly half of the anti-vaccine bills extended beyond the Covid-19 shots, she said, to block schools from requiring other kinds of vaccinations as well.
Even if they dont pass, legislators think this is an area they should focus on and there is political capital to be gained, Reiss said. Theres a real risk that, in some places, attitudes toward vaccines will be harmed in the long term.
School mandates do drive up vaccination rates; the science on that is clear. And the occasional measles outbreak in areas with low local vaccination rates has shown how quickly these diseases can recover and spread when given the opportunity.
Yet the US seems to be coming out of the pandemic not only lagging in seasonal Covid-19 and flu shots but also with many politicians eager to roll back the measures that had once made routine vaccinations the rare issue to have more than 90 percent approval from the American public.
Do that, Offit warned, and we will take a giant step backward in controlling these diseases.
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Sandra Lindsay, RN was previously director of nursing critical care at Long Island Jewish (LIJ) Medical Center in New Hyde Park.
She was the first American to get vaccinated against Covid-19. Now, the Presidential Medal of Freedom winner is getting a promotion.
On December 14, 2020, Sandra Lindsay, RN volunteered to become the first American vaccinated with the Pfizer-BioNTech Covid-19 vaccine. According to a statement from Northwell Health, as a woman of color and proud Jamaican immigrant, Lindsays message also struck an authentic tone with communities of color and Caribbean peoples alike.
Her ID badge and scrubs reside at the Smithsonians National Museum of American History. And for her community health efforts, President Joe Biden awarded Lindsay with the Presidential Medal of Freedom during a White House ceremony in July.
After 29 years in nursing, most recently serving as director of nursing critical care at Long Island Jewish (LIJ) Medical Center in New Hyde Park, Lindsay was made vice president of public health advocacy by Northwell Health.
Im grateful for Sandras willingness to serve as an example for her own team members as the first person at Northwell to get vaccinated and then to continue to advocate for vaccines and vaccine equity at every turn, including at the United Nations and the White House, said Michael Dowling, president and CEO at Northwell. Its clear Sandra is destined to serve as a public health advocate and excited to elevate her to this role.
Lindsay emigrated to the United States from Jamaica in 1986, graduated from Borough of Manhattan Community College in 1993 as valedictorian of her nursing program and joined Lenox Hill Hospital one year later as an oncology nurse.
While continuing her education, she served as a critical care nurse manager at Lenox Hill before transitioning to LIJ.
When the pandemic struck New York State in March 2020, Queens quickly became the epicenter and according to Northwell, no hospital treated more cases than LIJ. She oversaw expansion of the hospitals intensive care unit capacity by 212 percent to care for critically ill Covid-19 patients.
Lindsay saw the opportunity to get vaccinated nine months later as a game-changer, so she volunteered to be the first at Northwell. But, by a quirk of timing, Lindsay was acknowledged as the first person in the U.S. to receive the Pfizer vaccine an internationally-celebrated turning point in the deadly pandemic.
Her latest appointment is a continuation of her evolution from frontline clinician to spokesperson and health advocate.
I plan to work collaboratively with my colleagues to positively influence social and health issues that are priorities for our communities in New York, throughout the U.S. and globally, said Lindsay. I chose a career in health care because I believe in raising the health of everyone. I plan to advance the mission at Northwell Health of compassionate and equitable care.
More about Sandra Lindsay, RN:
MOH said it would also roll out bivalent vaccines for booster jabs later this month.
"This updated bivalent vaccine will provide better protection against newer COVID-19 variants," it said.
"MOH will therefore replace the original Moderna/Spikevax vaccines with the updated bivalent version from Oct 17, 2022, for all vaccinations using the Moderna/Spikevax vaccine, for all adults aged 18 years and above.
"Hence, for persons aged 50 and above, or for persons yet to achieve minimum protection, as they are at higher risk of severe illness from COVID-19 infection, they should take the bivalent vaccines."
The Pfizer/Comirnaty bivalent vaccine is undergoing evaluation and is expected to be available by the end of this year, the ministry added.
It also announced a transition away from the current system of counting jabs.
"Instead of counting the number of shots and boosters we receive, we will transit to a new definition of up-to-date vaccination," the ministry said.
"This is similar to influenza vaccination, where individuals are advised to take them periodically, so as to protect ourselves against new strains of the endemic influenza virus as they arise."
Under this regime, MOH said it would recommend that those aged five years and above complete three mRNA or Novavax/Nuvaxovid doses, or four Sinovac-CoronaVac doses, to achieve minimum protection.
"After achieving minimum protection, persons aged 50 years and above should receive an additional booster dose between five months to one year from their last dose, to keep up-to-date with their COVID-19 vaccination," said the ministry, adding that it recommended taking the bivalent vaccine for this booster.
"Individuals will be considered up-to-date with their COVID-19 vaccination if they have received at least the minimum protection and their last vaccine dose was received within the past one year."
The Countermeasures Injury Compensation Program (CICP) provides some benefits to Americans who have experienced injuries or deaths as a result of a COVID-19 shot and other countermeasures recommended to prevent, diagnose, or treat the disease.
But without the development of a vaccine injury table by the Health Resources and Services Administration (HRSA), the burden of proof lies with the petitioner and not the government to prove causation in order to establish eligibility.
Thats because an injury table is the standard of proof in determining compensation, according to Wayne Rohde, an author who has written extensively on the National Vaccine Injury Compensation Program (NVICP) that covers injuries from the recommended vaccines routinely administered to children and/or pregnant women.
The standard of proof is a way to determine whether the petition measures up to a certain standard to award compensation, Rohde told The Epoch Times.
HRSA, an agency under the Department of Health & Human Services (HHS), is in charge of the CICP.
A vaccine injury table lists the injuries and conditions caused by the vaccine and the time periods in which the first symptom of these injuries and conditions must occur after receiving the vaccine, the Centers for Disease and Prevention (CDC) explains (pdf). If both the injury or condition and the specified timeframe are met, it is presumed that the vaccine was the cause and compensation would be awarded.
However, if an individual does not meet the requirements listed on the injury table, it then falls on the person filing the claim to prove that the vaccine caused the injury or condition.
Such a table eliminates the extra burden put on petitioners who are already suffering severe adverse reactions or have lost a loved one, according to Mark Sadaka, a vaccine lawyer whos helped more than 60 people file a COVID-19 injury claim.
If theres a vaccine injury table, that burden shifts from the person to the other side, Sadaka, told The Epoch Times, adding that the purpose of the table is thegovernment acknowledging that this vaccine can cause the injury and then puts the burden on the other party to disprove it.
All four COVID-19 injections administered in the United States under emergency use authorization, and the federally approved Pfizer (Comirnaty) and Moderna (Spikevax) shots, are covered under the CICP.
The federal agency did not reply to queries about the injury table. But in August and December 2021,HRSA spokespersons told The Epoch Times in an email that the CICP has not yet developed an injury table for COVID-19 countermeasures and that an injury table for COVID-19 medical countermeasures will be developed when there is sufficient data to meet the compelling, reliable, valid, medical, and scientific evidence standard.
The compensation program has received over 9,000 complaints in the two years since COVID-19 appeared compared to the 500 claims filed between 2010 and 2020, where 30 claims were compensated, totaling over $6 million.
Yet none of the 7,084 claims alleging injury or death from the vaccines or the 2,804 claims related to drugs and devices have been paid compensation. Three claims have been found eligible for compensation but are still awaiting a medical benefits review, according to HRSA.
One eligible claim is the result of anaphylaxis, and two claims are the result of myocarditis, the federal agency wroteon Sept. 1.
Sadaka said that many of the claims hes helped file have still not been assigned to someone in the agency although its been over a year since the necessary paperwork was submitted.
So far, theyve gone nowhere. Theyre not even assigned to anybody. Theres some sort of procedural hellhole and that no one knows whats happening with it, Sadaka said.
Rohde said he began submitting Freedom of Information Act (FOIA) requests to HHS and HRSA at the beginning of the year to find out whether the agency had developed or planned to develop a COVID-19 vaccine injury table.
HRSA states that they do not have any records or documents of any existing injury table specific to the COVID-19 jab nor have any plans to develop one, Rohde wrote in an article.
In a Sept. 14 email reply to Rohdes FOIA request for copies of discussions regarding the COVID-19 vaccine table, or development of the table, the HHS said, Upon receipt, your request was sent to HRSAs Division of Injury Compensation Programs who informed our office that they do not have records responsive to your request.
Without a specific injury table, then how will the petitions be measured regarding if the jab could have induced or created a specific medical condition? Rohde asked, adding that is what is called a standard of proof.
John Howie, a trial lawyer focused on vaccine and personal injuries, told The Epoch Times in anearlier interview that the compensation program is only a feel good program where there is no transparency like a true judicial process nor a provision for attorneys fees, thus making it difficult for any injured individual to even retain a lawyer. Furthermore, any appeals are handled by [three] people hand-selected by HHS to review the claim.
The CICP is the payer of last resort, meaning only medical expenses that have not been paid by insurance, lost wages, and a death benefit for people whove died are compensated. The program doesnt allow payment for pain and suffering, or attorneys fees like in a traditional compensation program, regardless if an individual is severely disabled following the administration of a vaccine or other countermeasures.
Unlike a traditional program, people only have one year from the date that the covered countermeasure was received to file and there is no public disclosure of decisions, according to Rohde.
On Aug. 16, 2021, it was announced in the Federal Register (pdf) that the HHS had established and adopted a smallpox countermeasures injury table even though the last naturally occurring case of smallpox was reported in 1977 and monkeypox was not declared a public health emergencyuntil August 2022.
The injury table includes a list of covered smallpox countermeasures, required time intervals for the first symptom or manifestation of onset of injuries, and the accompanying Qualifications and Aids to Interpretation (QAI), which set forth definitions and other requirements necessary to establish Table injuries, the HHS wrote.
The Table informs the public about serious physical injuries known to be directly caused by covered countermeasures and creates a rebuttable presumption of causation for eligible individuals whose injuries are listed on the Table and meet the Tables requirements, the agency added.
Rohde said that HRSA sent him the smallpox injury table in a response to a FOIA requesting true and accurate copies of the records, documents relating to the definition and decision-making process for the standard of proof on all countermeasures injury petitions.
In a Sept. 21, 2022,email reply, HRSA said its Division of Injury Compensation Programs (DICP) hadlocated 34 pages containing a copy of The Federal Registry Countermeasures Injury Compensation Program, Final Rule, that explains the standard of proof that DICP uses, released in its entirety.
The federal government had quietly snuck the table in without letting the public know, Rohde said.
There was no announcement, he added. I looked everywhere, if there was an announcement in August of 2021. There was no press, no press release, theres nothing in the HRSA website, the CICP website, nothing!
The injuries and conditions listed on the smallpox injury table, according to Sadaka have similarities between this document and whats seen in the literature for COVID-19 adverse events.
Some of the conditions listed on the table include anaphylaxis, syncope, and myocarditis, pericarditis, or myopericarditis.
Emails to HRSA inquiring about the reason for adopting the smallpox countermeasure injury table went unanswered, so The Epoch Times could not verify whether the table is being used to measure and decide on claims related to the COVID-19 injection.
The CICP was set up in 2010 to provide compensation for any injuries and deaths that resulted from the use of a covered countermeasure under the 2005 Public Readiness and Emergency Preparedness (PREP) Act (pdf).
Under the PREP Act, COVID-19 vaccine manufacturers, providers, distributors, and program planners are immune from lawsuits related to vaccine injuries and death, unless it can be shown that there was willful misconduct in the production of the vaccine by the company.
The CICP was not really designed as a national compensation program, Rohde said, as it was more of a regional program focused on disasters such as from hurricanes the avian flu scare, anthrax, and regional emergencies.
Rohde said the compensation program lacks adequate funding to pay all of the claims filed so far. It doesnt have a funding mechanism or a trust fund like the traditional compensation program that is funded by anexcise tax of $0.75 per dose or disease that is prevented. For example, the measles, mumps, and rubella (MMR) vaccine is taxed at $2.25 because it prevents three diseases. The excise tax thengoes into a trust fund that is managed by the Department of Treasury.
In a response to a different FOIA that Rohde submitted asking for the total compensation budget for fiscal year 2020 to 2024, HRSA revealed how underfunded the CICP is.
In 2021 and 2022, over $931,000 was budgeted for compensation under the CICP, with the budget increasing to $5 million for 2023. No estimate has been completed for 2024. Whereas, the traditional compensation program has $3.9 billion in the vaccine injury trust fund.
The 2021 and 2022 budget would only be able to pay out two claims of death each year before running out of funds since the CICP pays a one-time maximum death benefit of over $370,000 (pdf). For lost wages, the annual compensation is capped at $50,000 per year.
How can this be? Our government, more precisely, HRSA is planning to compensate only one possibly up to three petitions this year, Rohde wrote in August 2022.In the NVICP, the estimated dollar amount for compensation in FY 2022 could be around $225 million for a projected 850 damage awards.
Authors of a study published in the Journal of Law and the Biosciences calling for a reform to the CICP, said that the program lacks accountability, transparency, and cost-effectiveness efficiency, with 94% of its total costs spent on administration rather than compensation. CICPs ability to compensate is also questionable.
They added, If COVID-19 claims were compensated at its historical rate, CICP would face around $21.16 million in compensation outlays and $317.94 million in total outlays, 72.1 times its current balance.
To ensure just compensation for injured petitioners during COVID-19 and future public health emergencies, we recommend Congress (1) initiate a major reform by relocating CICP from DHHS to the Claims Court or (2) keep CICP within DHHS and make incremental changes by permitting judicial review of DHHS administrative adjudication of CICP claims. We further recommend Congress audit and adjust budgets for CICP and DHHS promptly propose an injury table for COVID-19 claims.
Although arbitrators in Canada have considered whether an employer in a unionized workplace can place an employee on unpaid leave for failing to comply with its mandatory COVID-19 vaccination policy, the British Columbia Supreme Court in Parmar v. Tribe Management Inc., 2022 BCSC 1675 rendered the first civil court decision examining whether an employer can do so in a non-unionized workplace. The court rejected the employees argument that she had been constructively dismissed when, after she refused to comply with her employers policy, she was placed on an unpaid leave of absence. The court found the employers actions reasonable and that the employees losses were the result of her personal choice not to follow the policy.
Background
On October 5, 2021, the employer, a condominium property manager, announced it was implementing a policy that would require all employees to become fully vaccinated by November 24, 2021. The policy permitted medical and religious exemptions, and extra time for employees who were unable to meet the deadline.
The employee, an accounting professional, advised the employer that she would not comply with the policy but made no request for a medical or religious exemption. Among other things, she expressed concern about the vaccines hasty preparation, and fear of possible side effects and health issues. The employee asked if she could work exclusively from home, or on a hybrid basis with strict compliance to safety protocols and rapid testing on her days in the office. She argued the policy was unreasonable as it made no exceptions for employees who could work entirely or almost entirely from home. The employer responded that there would be no exceptions to the policy.
On November 25, 2021, the employer advised the employee that, due to her non-compliance with the policy, she would be put on an unpaid leave of absence from December 1, 2021, to February 28, 2022, but subsequently the employer made the leave indefinite. The employee alleged that by placing her on leave, the employer constructively dismissed her.
Decision
The court began its analysis by noting that the employees employment contract expressly provided that she would comply with the employers policies, as amended from time to time at the employers discretion. Accordingly, subject to the implied qualification that its policies would be reasonable and lawful, the employer was allowed to implement and amend workplace policies and the employee was obliged to comply with them.
The court determined that the reasonableness of the employers policy must be assessed based on the state of knowledge about COVID-19 at the time it was implemented and the extraordinary circumstances of the pandemic in the winter of 2021 and January 2022, as well as in the context of the employers obligation to protect the health and safety of its employees, clients, and residents in the buildings it managed. It noted that private-sector employers were strongly encouraged to implement policies that aligned with government vaccine mandates and directives. In addition, the court took judicial notice of COVID-19s easy transmissibility and potential to cause death, and the ability of vaccines to reduce the severity of symptoms and bad outcomes.
The court stressed that in implementing the policy, the employer was required to balance the employees personal beliefs against the employers interest in ensuring that it protected the health and safety of its other employees, and ultimately the former had to yield to the latter. The court found the policy was a reasonable and lawful response to the uncertainty of the pandemic based on the information that was available to the employer; it reflected the prevailing approach at the time; it was not arbitrarily or selectively applied; it allowed employees to take a position against vaccination without losing their employment because they would be put on leave; the employee placed on leave could return to their employment if they became vaccinated; the policy reflected the employers statutory obligation under s. 21 of the provinces Workers Compensation Act to, among other things, ensure the health and safety of its workers; and, finally, the employer intended to review the policy as more became known about COVID-19, and if the pandemic subsided, the employee could return to work without discipline.
While the court acknowledged the employees right to hold her beliefs about the COVID-19 vaccination and to protect her bodily integrity, it did not believe this entitled her to impact other employees or, potentially, the thousands of residents in buildings for whom the employer provided property management services. The court stressed also that the employees beliefs did not entitle her to be excepted from the policy given her senior management position and the fact that she was the only employee who refused to comply with it. The court concluded that the employers policy was reasonable.
In its reasoning, the court emphasized that the employee chose to remain unvaccinated; it was her voluntary decision to resign; in refusing to comply with the policy she repudiated her employment contract; rather than accepting that repudiation the employer acted reasonably in putting the employee on an unpaid leave; and any losses suffered by the employee from being put on unpaid leave were the result of her personal choice not to follow the employers reasonable policy.
Although the court acknowledged that it is extraordinary for an employer to enact a workplace policy that impacts an employees bodily integrity, it concluded that to do so was reasonable in the context of the extraordinary health challenges posed by the global COVID-19 pandemic. Such policies do not force an employee to be vaccinated; rather they force an employee to choose between getting vaccinated, and continuing to earn an income, or remaining unvaccinated, and losing their income, and the employee made her choice.
Upon determining that the employee had failed to meet the test for constructive dismissal and that her claim would be dismissed, the court said:
A reasonable employee in [the employees] shoes would not have felt in all the circumstances than an unpaid leave as a consequence of failing to comply with the [policy] was a substantial alteration of an essential term of the employment contract. This is confirmed by the fact that all but one of her fellow employees complied with the [policy] and that most adult Canadians have since been vaccinatedmany as a condition of continued employment.
Bottom Line for Employers
The question whether a policy is reasonable may turn on the policys language and the facts of the case. With that in mind, non-unionized employers that implemented a policy may derive encouragement from the courts findings in Tribe Management that the employers policy was reasonable, the employer had the right to place a non-compliant employee on unpaid leave, and, in doing so, the employer did not constructively dismiss the employee.
The court in Tribe Management adopted an attitude we have seen arbitrators express repeatedly; first, that an employees right to their personal beliefs is outweighed by an employers obligation to protect the health and safety of its other employees; and second, that a mandatory COVID-19 vaccination policy does not force an employee to become vaccinated, rather it forces them to choose between becoming vaccinated and continuing to receive their income, and refusing to become vaccinated and losing their income.
AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts inmedicineon COVID-19, monkeypox, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
AMA's vice president of science, medicine and public health, Andrea Garcia, JD, MPH discusses the latest from the CDC on monkeypox treatments and universal masking guidelines for health care settings. Also covering new Omicron boosters and "most resistant variant" emerging in the UK. AMA Chief Experience Officer Todd Unger hosts.
Learn more at the AMA COVID-19 resource center.
Unger: Hello and welcome to the AMA Update video and podcast, an ongoing series covering a range of health care topics affecting the lives of physicians and patients. Today, we have our weekly look at the headlines with AMA's Vice President of Science, Medicine and Public Health Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago.
Andrea, let's start off by talking about the new bivalent booster. Word on the street is the uptake is on the slow side. Is that the truth?
Garcia: Yeah, well, reports have suggested that the updated boosters are having a visibility problem and that's according to a recent report by the Kaiser Family Foundation. By mid- to late September, nearly half of adults had heard little to nothing about these new boosters and I think there are many others who are confused about whether they are eligible to receive these new vaccines. The exception that we're seeing is older adults.
Since the initial rollout, people 65 and older, who are the most vulnerable to COVID complications, have been the largest group to get vaccinated and they also displayed the broadest awareness of the new booster, according to the survey. I think this is where physicians can play a really important role in educating patients and asking about them about the updated booster at annual checkups or other appointments.
Unger: Absolutely. And we talked last week about the availability for the next age group younger, that's 5 to 11, thinking that would be mid-Ocotber, which is right around the bend, of course. Is that progressing as expected?
Garcia: Yeah. If you're following the media reports, it looks like FDA authorization for these updated COVID boosters could be available for younger kids as soon as early October. Of course, those vaccines will have to be authorized by FDA and recommended by the CDC for use in those age groups. We do know that both Pfizer and Moderna have asked FDA to authorize those boosters for young children, and we're currently waiting on the review of that data and that authorization by FDA.
As we've discussed, these boosters target the original COVID-19 strain and the Omicron BA.4, BA.5 subvariants, so they're just like the boosters that became available to those 12 and older in September. I think it's important to keep in mind that those original monovalent booster doses from Pfizer and Moderna do remain available for this younger population. And then according to the CDC guidance, children and adults who have recently had COVID could consider delaying their booster dose for three months.
Unger: Now, we, of course, are already in October and heading quickly toward winter. Do we have any idea what to expect as we head into what is typically heavy season in terms of surges both for possibility of COVID and for flu?
Garcia: Well, it looks like the United Kingdom may be heading into a fall COVID wave, and experts say the U.S. may be next. I think we've talked before that, historically, what happens in the U.K. with COVID is reflected here within a matter of weeks. So this wave may be driven by several new and highly immune-evasive strains of the virus, all of which, for now, seem to be subvariants of Omicron. So one called BA.2.75.2 appears to be spreading quickly in India, Singapore and areas within Europe, and one virologist called this new strain the most resistant variant we've ever evaluated.
Researchers in China and Sweden have also found this variant can evade nearly all of the monoclonal antibodies that are used for treating COVID-19. But here in the U.S., right now, BA.5 remains the dominant variant but its proportion is starting to decline. And we're seeing BA4.6 and BF.7 starting to increase. We know the virus keeps evolving and experts know that many more people have recovered from infection or have received that additional vaccine dose, including the Omicron-specific booster. So there's really hope that that is going to boost our overall antibody levels going into the fall and winter.
Unger: Well that is some worrisome news, and I guess we should not take for granted the trend that we've been seeing. Are we continuing to see that decline or are we seeing any hints of a surge at this point?
Garcia: So most northeastern states are seeing cases start to increase in the past two weeks, and in the west, we're seeing case counts climbing in states such as Montana, Washington and Oregon. But nationally, if we look at those numbers, COVID cases have continued to fall. We're at just over 46,000 cases per day being reported nationwide. It's the lowest level since April of 2022 and a decrease of 24% over the past two weeks.
Unger: And on the hospitalization and deaths, those stats, kind of similar story to what we were seeing last week, which is perplexing. What is the word there?
Garcia: So hospitalizations are falling. The daily average is 27,596 people hospitalized with COVID. Nationally, they've declined by 12% over the past two weeks. Deaths remain that most concerning statistics nationally. We're still hovering around 400 deaths reported per day on average. That number is down 12% over the past two weeks.
Unger: Well, in more COVID-19 news, the U.S. Department of Health and Human Services released two reports on long COVID in response to a memo from President Biden calling for a government response on this issue, which is still very incredibly important and lots of questions there. Andrea, what can you tell us about those reports?
Garcia: Well we know that long COVID or post-COVID conditions continue to be pervasive problems. They're affecting between 7 and 23 million Americans and causing lost work hours for at least a million Americans. One of the HHS reports outlines a national research agenda around prevention, diagnosis and treatment of long COVID. These reports are really the first time HHS has collected all of the long COVID research into one place, which, according to Dr. Rachel Levine, who's the assistant secretary for health with HHS, helps to create a cohesive path to move forward.
The second report is designed to help patients, families and communities and public, private organizations, and it compiles 200 federal services and supports for people who have long-term effects of COVID-19. And according to Dr. Levine, this data shows that between 5% and 30% of people with COVID will experience some form of long COVID.
Unger: That's interesting, because we talked to several experts over the course of the pandemic and those numbers, they've really held. So hopefully we'll continue to learn more about long COVID and how to address that. And we'll follow all that research as it comes out. We'll also continue to see changes in our current COVID response.
Last Monday, the CDC revised its guidance about universal masking in health care facilities. What do we need to know about this?
Garcia: Well, this decision reflects a major departure from the CDC's previous infection prevention and control recommendations for universal masking in health care settings, and the CDC states that relaxing of the masking guidance reflects high levels of vaccine- and infection-induced immunity and, of course, the availability of effective treatments and prevention tools. I think it's important to keep in mind that this is not an across-the-board lifting of masking in health care settings, which, based on some of the reporting out there, it could be seen that way. But this change really applies to facilities that are not in areas of high COVID transmission.
We know that about 73% of the U.S. is experiencing high rates of COVID transmission and the removal of masks in health care settings is not going to apply to most of the country right now. When SARS-CoV-2 community transmission levels are not high, it's going to be up to individual health care facilities to choose whether or not to require universal masking. So you'll see those decisions being made on a local level within each facility.
Unger: Andrea, let's turn our attention now to another virus of concern, which is monkeypox. How are the numbers looking this week?
Garcia: Well, overall, the virus is showing signs of waning in the U.S., which is easing some fears about the virus spilling into populations of older adults, pregnant women and young children. However, we are seeing case numbers going up in a few states, such as Indiana, Virginia and Massachusetts, and Hispanic and Black men are making up nearly 2/3 of those infected. There have been over 26,000 reported cases of monkeypox in the U.S. and the U.S. accounts for nearly 40% of the global case count.
I think, in addition, it's important to note that the CDC has shared that there have been severe manifestations of monkeypox among people who are immunocompromised due to HIV or other conditions. This indicates that HIV status should be determined for sexually active adults and adolescents with suspected or confirmed monkeypox.
Unger: Well, related to this, the CDC also issued a new warning about monkeypox. What is the clarification there?
Garcia: Yeah, so CDC issued a health advisory last Thursday about severe illness in people with monkeypox as observed in the U.S. in the current outbreak. And, again, people who are immunocompromised are at higher risk for severe manifestations. This alert came as Ohio reported an individual with monkeypox died. This was the third known death of a patient with monkeypox in the U.S.
The Ohio Department of Health on Friday said that an adult male with monkeypox had died and the individual did have other health conditions. The first death due to monkeypox was confirmed last month in LA County. The county public health department and the CDC said the person had a severely weakened immune system and had been hospitalized. And there was also a patient in Harris County, Texas, who had monkeypox and died in August.
The virus' role in that death and the impact of monkeypox are still being confirmed. I think, with that being said, it's important to note that deaths from monkeypox are still extremely rare, and globally, among 67,000 reported cases in the current outbreak, there have been 27 deaths, according to the WHO.
Unger: Andrea, is there any news that we need to know about the vaccine and treatments that are being used to help contain the outbreak?
Garcia: So last week, the CDC announced that it's expanding the eligibility for the JYNNEOS monkeypox vaccine, and that is now to include higher-risk people who've not been exposed to the virus. So it's really shifting to a pre-exposure prophylaxis strategy. And while some research does suggest that a single dose of the two-dose vaccine may not protect sufficiently against that virus, according to data shared by CDC last Wednesday, men at high risk for monkeypox were 14 times more likely to be infected if they were unvaccinated and that was compared to those who were at least two weeks past their first dose of the vaccine.
This research reflects early data collected on the efficacy of the monkeypox vaccine. I think it's an important milestone in the administration's fight against monkeypox. And we heard CDC Director Dr. Rochelle Walensky say that this new data provides us with a level of optimism that the vaccine is working as intended. On the treatment side, we know that Siga Technologies did win a DOD contract for its Tpoxx antiviral treatment and Tpoxx is the drug that is available via CDC's expanded access protocol to treat monkeypox virus.
Unger: Well, I think optimism is a good note to end today's discussion on. Andrea, thanks so much for being here. We'll be back soon with another AMA Update. You can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
