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IHS Provides Updates on Timeline and Resources for Seasonal Influenza, RSV, and COVID-19 Vaccines

On September 22, 2023, the Indian Health Service (IHS) sent a Dear Tribal Leader Letter (DTLL) and Dear Urban Indian Organization Leader Letter (DULL) to provide an update concerning seasonal vaccines and resources available for vaccine-related activities to purchase COVID-19 vaccines. In the letter, IHS discussed vaccines for Influenza, Respiratory Syncytial Virus (RSV), and COVID-19.

IHS provided the following updates:

Influenza Vaccine

Supply of the 2023-2024 seasonal influenza vaccine is expected to be adequate to provide access for all recommended age groups, including the influenza vaccines preferentially recommended for people ages 65 years and older. The Centers for Disease Control and Prevention (CDC) continues to recommend the seasonal influenza vaccine for all people ages six months and older. September and October are the best times for most people to get vaccinated.

RSV Vaccine

Vaccination to prevent RSV is also available for certain high-risk persons. This includes approved RSV vaccines available for persons ages 60 years and older, and one of the RSV vaccines, ABRYSVO, is approved for use in pregnant individuals 32-36 weeks gestational age to prevent lower respiratory tract disease (LRTD) and severe LRTD in infants from birth through 6 months of age. There is also the long-acting monoclonal antibody, nirsevimab, which has been approved and recommended to prevent RSV for all infants under 8 months entering their first RSV season, and all American Indian and Alaska Native children ages 8-19 months entering their second RSV season.

COVID-19 Vaccine

In September, the Food and Drug Administration approved and authorized, and the CDC recommended, an updated monovalent mRNA COVID-19 vaccine designed to protect against the currently circulating strains of the virus. All people ages 6 months and older, regardless of prior COVID-19 vaccination status, are recommended to receive this vaccine. The vaccine is now available, so please do not wait to get your updated COVID-19 vaccine.

Like other adult vaccines, after regulatory approval/authorization and recommendation, the updated 2023-2024 COVID-19 vaccines (Pfizer, Moderna, and Novavax, once authorized) will be commercially available through the channels used to procure other routine vaccines. Updated COVID-19 vaccines are available in retail pharmacies.

Vaccines will be available to uninsured or underinsured adults through the HHS Bridge Access Program for a limited time. CDC’s Bridge Access Program provides no-cost COVID-19 vaccines to adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs. This program will end by December 31, 2024.

Pediatric COVID-19 vaccines will continue to be available to all American Indian and Alaska Native children via the CDC’s Vaccines for Children (VFC) program. The VFC program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. The CDC buys vaccines at a discounted rate for distribution to registered VFC providers. Children who are eligible for VFC vaccines are entitled to receive those vaccines recommended by the Advisory Committee on Immunization Practices. Eligible children are children through 18 years of age who meet at least one of the following criteria are eligible to receive VFC vaccine:

  • Medicaid eligible: A child who is eligible for the Medicaid program. (For the purposes of the VFC program, the terms “Medicaid-eligible” and “Medicaid-enrolled” are equivalent and refer to children who have health insurance covered by a state Medicaid program)
  • Uninsured: A child who has no health insurance coverage
  • American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25 U.S.C. 1603)
  • Underinsured

For any questions related to vaccines, please contact CAPT Kailee Fretland, Pharmacist, Office of Clinical and Preventive Services, IHS, by e-mail at kailee.fretland@ihs.gov.

For any questions pertaining to COVID-19 supplemental funding, please contact Ms. Jillian Curtis, Chief Financial Officer, IHS, by e-mail at jillian.curtis@ihs.gov.

NCUIH Vaccine Advocacy

The National Council of Urban Indian Health (NCUIH) has long supported equitable vaccination access for urban American Indian and Alaska Native people.  With support from the CDC, NCUIH has been working to promote equitable adult vaccination and prevent severe illnesses such as COVID-19 and influenza.  We do this by enhancing the resource and evidence base, developing effective strategies for health care organizations, and creating culturally appropriate materials for individual clinicians that reflect the needs of urban American Indian and Alaska Native people.

Join NCUIH on November 9, 2023, for the second session in our vaccine Community of Learning (CoL) series, “Paths to Vaccine Equity: Annual Vaccinations.” Speakers from NCUIH and Amy Pisani, CEO of Vaccinate Your Family, will discuss the new RSV vaccine and updates to the COVID-19 and influenza vaccines. Participants will learn how collaboration with vaccine organizations can help support vaccine awareness and patient education.

For more information on NCUIH’s vaccine advocacy work, please click here.

HHS Provides Updates on COVID-19, Vaccine Recommendations, and No-Cost Vaccine Access Program

On September 19, 2023, the Department of Health and Human Services (HHS) Office of Intergovernmental and External Affairs (IEA) held a briefing on COVID-19 Vaccine Updates. This call was led by Secretary Xavier Becerra and included updates from the Director of the Centers for Disease Control and Prevention (CDC), Dr. Mandy Cohen, and the Director of the Center for Biologics Evaluation and Research (CBER) at the Food and Drug Administration (FDA), Dr. Peter Marks, on the new COVID vaccine, CDC’s Bridge Access Program which provides no-cost COVID-19 vaccines, ongoing mitigation measures, and Strategic National Stockpile (SNS).

Vaccine Recommended as Best Measure Against Long COVID

Currently, there is an underlying immunity due to 97% of people across the United States either having been vaccinated or had COVID previously. However, based on data it, appears that this protection decreases over time. The most protection is provided in the first 4-6 months after receiving the vaccine, and it can take up to two weeks for your immune system to build up the immunity needed to fight off the virus.

The CDC is concerned as we are still seeing hundreds of people die every week, with people over 65 at the highest risk for negative outcomes. Secretary Beccera highlighted the need for assistance from the public because people are dying in numbers we weren’t seeing as recently as a month ago. Regarding long COVID, the CDC shared there is still much to be learned. In the meantime, the recommendation continues to be to receive the vaccine as it’s the best way to reduce any risk of getting long COVID. Both the CDC and FDA recommend that everyone over the age of 6 months receive not only the updated COVID vaccine, but the flu and RSV (Respiratory Syncytial Virus) vaccines as well.  Dr. Cohen mentioned that the Maternal RSV vaccine will be available soon, specifically for expecting mothers which, as of September 22, is officially recommended by the CDC. There is a strong emphasis from HHS, CDC, and the FDA to get vaccinated as this is the first time we have ever had immunizations for all three major respiratory viruses.

Updated COVID Vaccine Available at No-Cost through Bridge Access Program

The FDA has approved a new COVID vaccine, updated to match the strain that is currently circulating. The FDA recommendation is for those ages 5 years and older to receive a single dose, regardless of whether an individual has previously been vaccinated. For ages 6 months to 4 years, children are eligible to receive two doses of either Moderna or Pfizer. An important note for the immunocompromised is that a second or additional vaccine may be necessary. If someone currently has COVID but wants to receive the new vaccine, it is recommended to wait two months from the time since having COVID or receiving a previous vaccination. Dr. Marks reiterated confidence in the safety and effectiveness of these updated vaccines, while recognizing they may need to be updated on an annual basis, similar to what is done for the seasonal influenza vaccine.

Even though we are outside of the Public Health Emergency (PHE), Dr. Cohen emphasized that the updated COVID vaccine will still be available for free. This is either through insurance or through the CDC’s Bridge Access Program for those uninsured or underinsured where vaccines can be received at pharmacies such as CVS or Walgreens. Follow this link to find sites where free vaccines can be obtained, as well as additional resources. Secretary Beccera explained that this bridge program has received substantial funding from HHS, and that HHS has been in contact with private plans, as well as Medicaid and Medicare, so that there are no issues with receiving the vaccine at no cost.

Other COVID Related Updates

HHS’ Project NextGen will begin working with scientists to explore what next steps may be necessary to continue combatting the spread of the virus. Related to this, Secretary Beccera gave an update on the Strategic National Stockpile (SNS), which is a resource to supplement state and local supplies during public health emergencies. It can be utilized as a short-term buffer when the supply of these materials is not immediately available or is not sufficient to match immediate need. Currently, the SNS is being prepared so that there isn’t an emergency situation where there aren’t enough masks, vaccines, or tests available. Secretary Becerra explained that they have learned from the pandemic as to what they need to do to be prepared, especially in addressing supply chain issues.

IHS Director Provides COVID-19 Funding Update: Rescissions Impact $419 Million, $900 Million Remaining for IHS COVID Activities

On Thursday, June 30, 2023, Indian Health Service (IHS) Director Roselyn Tso released a Dear Tribal Leader and Dear Urban Indian Organization Leader Letter to provide an update on the status of COVID-19 supplemental appropriations provided to the IHS in Fiscal Year (FY) 2020 and FY 2021. In June 2023, President Biden signed the Fiscal Responsibility Act of 2023 (FRA) (Public Law 118-5) into law, which rescinds certain unobligated COVID-19 supplemental funding balances. Approximately $419 million of COVID-19 funding that was transferred to the IHS from COVID-19 appropriations is impacted by the enacted rescissions. IHS has nearly $900 million in remaining COVID-19 funding. These remaining resources are predominately for the uses of ongoing COVID-19 testing, treatment, and vaccination of patients at IHS-operated hospitals and health clinics, and other mitigation activities; and purchasing and distributing personal protective equipment, along with COVID-19 tests, therapeutics, and vaccines, at no cost to IHS, Tribal, and Urban Indian health programs through the IHS National Supply Service Center.

Background

In FY 2020 and FY 2021, over $9 billion was appropriated or made available to the IHS from six emergency supplemental bills to combat the novel coronavirus. On June 3, 2023, President Biden signed the Fiscal Responsibility Act of 2023 (FRA) (Public Law 118-5) into law. The FRA suspends the public debt limit through January 1, 2025, establishes new discretionary spending limits, and rescinds certain unobligated COVID-19 supplemental funding balances, among other items.

Prior to the enactment of the FRA, IHS continued to obligate COVID-19 funding and the Agency obligated approximately $600 million during the month of May. The FRA protects IHS funds, particularly those that were directly appropriated to the Agency in the American Rescue Plan Act (ARPA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. However, approximately $419 million of COVID-19 funding that was transferred to the IHS from COVID-19 appropriations is impacted by the enacted recissions.

The rescinded funds were intended to support a variety of ongoing COVID-19 mitigation and recovery activities. For example:

  • COVID-19 testing, treatment, and vaccination activities at IHS-operated hospitals and health clinics, and other mitigation activities;
  • The purchase and distribution of PPE, COVID-19 tests, therapeutics, and vaccines at no cost to IHS, Tribal, and urban Indian health programs over the next several years by the IHS NSSC; and
  • The establishment, expansion, and sustainment of a public health workforce.
 Resources:

Resource: An Overview of the Impact of Medicaid on Health Care of American Indians and Alaska Natives

The National Council of Urban Indian Health (NCUIH) recently released an infographic showcasing the impact of Medicaid on health care for American Indian and Alaska Native (AI/AN) people. This document highlights data and statistics on AI/AN Medicaid coverage and enrollment, the impact of Medicaid funding on Indian healthcare providers, information on COVID-19 and Medicaid unwinding, and how Medicaid affects Urban Indian Organizations (UIOs) and urban AI/ANs.

About the Indian Health Service and Medicaid

Medicaid is a joint federal-state program that provides health insurance to eligible persons, including eligible AI/ANs. Indian healthcare providers bill Medicaid for services provided to Medicaid beneficiaries and Medicaid reimbursements are a critical source of funding to support the operation of the Indian Health system, comprised of the Indian Health Service (IHS), Tribal Health Programs, and UIOs. The federal government has a trust responsibility to provide federal health services to maintain and improve the health of AI/AN people. Due to historic underfunding of IHS, Medicaid is crucial to supporting healthcare services for AI/AN people and is critical to fulfilling the United States’ trust responsibility to maintain and improve AI/AN health.

Medicaid Coverage in AI/AN Communities

AI/AN people depend upon Medicaid to receive their healthcare coverage and services. In 2020, over 1.8 million AI/ANs were enrolled in Medicaid, meaning almost 1/5 of the AI/AN population is covered by Medicaid. Of which, 46.2% of Medicaid enrollees are AI/ANs from the ages of 0-18, and 46.5% are from the ages of 19-64.

Medicaid and Urban AI/AN Communities

UIOs help serve the approximately 70% of AI/AN people who live in urban areas. In 2019, Medicaid covered 1.3 million urban AI/ANs, including 30% of urban AI/AN adults under the age of 65. Comparatively, Medicaid covered 19.8% of all urban U.S. adults under the age of 65.

The Relocation and Termination Era and Federal Indian Boarding Schools have resulted in many AI/AN peoples living in metro areas, or cities. Below is a list of the metro areas that contain the highest population of AI/ANs who are enrolled in Medicaid. UIOs provide key services to almost all of the top metro areas where IHS-Medicaid beneficiaries live.

Medicaid: A Critical Source of Funding for Indian Health Care Providers

Medicaid reimbursements are a purely supplemental source of funding for IHS, as federal law prohibits appropriators from considering Medicaid revenue when determining IHS appropriations. Because the Medicaid program receives Mandatory appropriations and is not subject to the annual appropriations process, Medicaid revenue is particularly essential for Indian health providers when IHS funding is reduced or interrupted by budgetary disagreements.

Medicaid remains the largest secondary source of funding for UIO clinics. In 2020, 33% of the total population served at UIOs were Medicaid beneficiaries, and 35% of the AI/AN population served at UIOs were Medicaid beneficiaries.

Covid-19 and Medicaid Unwinding

In March 2020, the Families First Coronavirus Response Act (FFCRA) Medicaid and Children’s Health Insurance Program (CHIP) “continuous coverage” requirement allowed people to retain Medicaid coverage and receive needed care during the COVID-19 Pandemic Public Health Emergency (PHE).

In December 2022, the Consolidated Appropriations Act, 2023 was signed into law, separating the continuous coverage provision from the COVID-19 PHE and setting an end date for the provision on March 31, 2023. This means that states may resume reviewing all Medicaid enrollees’ eligibility for coverage, a process referred to as “unwinding,” on April 1, 2023, and will begin ending coverage for those found ineligible. States must meet certain federal reporting and other requirements during the unwinding period. NCUIH recently released a Medicaid unwinding toolkit for UIOs as they prepare for changes in Medicaid coverage.

Native people may be at an increased risk of disenrollment in Medicaid and CHIP programs during the Medicaid unwinding period. In fact, Medicaid coverage losses are estimated to take twice the toll on AI/AN communities than they will take among non-Hispanic white families. It is estimated that 12% of all AI/AN children and 6% of all AI/AN adults nationwide will lose CHIP or Medicaid coverage as state Medicaid programs return to normal operations. On April 24, NCUIH and 227 other organizations sent a multi-group letter to the Department of Health and Human Services (HHS) Secretary Xavier Becerra calling on the Administration to use their full powers provided in the Consolidated Appropriations Act of 2023 to safeguard Medicaid coverage and outlines specific steps the Administration can take to avoid wrongful terminations. Inadequate health insurance coverage is a significant barrier to healthcare access, and the loss of coverage may exacerbate the significant healthcare disparities faced by AI/AN communities.

NCUIH Releases “2022 Annual Policy Assessment”

The Policy assessment informs urban Indian organization policy priorities in 2023, identifies traditional healing barriers, and addresses mental and behavioral health needs.

2022 Policy Assessment thumbnailThe National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2022 Annual Policy Assessment. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2023, as they relate to the Indian Health Service (IHS) designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The focus groups were held on October 18, 21, and 24, 2022. Additional information was also collected from the UIOs via a questionnaire sent out on November 15, 2022.

Together these tools allow NCUIH to work with UIOs to identify policy priorities in 2023 and identify barriers that impact delivery of care to Native patients and their communities.  Of 41 UIOs, 26 attended the focus groups and/or participated in the questionnaire. This is the third year that NCUIH has conducted the assessment via focus groups and follow up questionnaire. This is also the highest response from UIOs NCUIH has seen since following this process.

Overview of Policy Assessment

2022 Policy Assessment chartAfter the height of the COVID-19 pandemic, newfound priorities were identified for 2023, including workforce development and retention, increased funding for traditional healing, and expanded access to care and telehealth services. Existing priorities also remain a key focus across UIOs, especially increasing funding amounts for the urban Indian health line item and IHS, maintaining advance appropriations for IHS, establishing permanent 100% Federal Medical Assistance Percentage (FMAP) for UIOs, reauthorizing the Special Diabetes Program for Indians (SDPI), and increasing behavioral health funding.

 

Key findings from the discussions are as follows:

  • Funding Flexibility is Key to Expanding Services
  • Need for Funding Security Remains a Priority
  • Advance Appropriations Mitigates Funding Insecurities Generated by Government Shutdowns and Continuing Resolutions
  • Facility Funding Directly Impacting UIOs
  • Permanent 100% FMAP Increases Available Financial Resources to UIOs
  • Workforce Concerns Amidst Inflation and Market Changes
  • Traditional Healing Crucial to Advance Comprehensive Native Healthcare
  • Addressing Access and Quality of Native Veteran Care
  • Health Information Technology and Electronic Health Record Modernization
  • New Barriers Limit UIO Distribution of Vaccines
  • HIV, Behavioral Health, and Substance Abuse Report
  • Reauthorizing the Special Diabetes Program for Indians
  • UIOs Find Current NCUIH Services Beneficial

Next Steps

NCUIH will release a comprehensive document of the 2023 Policy Priorities in the coming weeks.

Past Resources:

RESOURCE: COVID-19 Public Health Emergency Medicaid Unwinding Toolkit Released

The National Council of Urban Indian Health (NCUIH) recently released a Medicaid unwinding toolkit for urban Indian organizations (UIOs) as they prepare for changes in Medicaid coverage at the end of the COVID-19 pandemic Public Health Emergency (PHE). After the PHE, states will resume normal operations, which includes processing eligibility renewals and ending coverage for individuals no longer eligible for Medicaid and CHIP in a process known as “unwinding.” This document outlines the impact of Medicaid unwinding on American Indians/Alaska Natives (AI/ANs) and the steps UIOs can take to assist their patients with their coverage, such as working with their state, Tribes, federal agencies, and their community.

Background

Medicaid Unwinding Toolkit

Prior to the pandemic’s PHE, Medicaid provided health insurance for more than one-third of AI/AN adults.  At the beginning of the pandemic, the Families First Coronavirus Response Act (FFCRA) Medicaid and Children’s Health Insurance Program (CHIP) “continuous coverage” requirement  allowed people to retain Medicaid coverage and receive needed care during the PHE.

Medicaid Unwinding Toolkit

After the PHE, states will resume normal operations, which includes processing eligibility renewals and ending coverage for individuals no longer eligible for Medicaid and CHIP in a process known as “unwinding.” According to the Department of Health and Human Services (HHS), nearly 15 million people could lose their current coverage. This will be the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act (ACA). This process is expected to disproportionately impact AI/ANs, particularly those living off-reservation.

While the unwinding process will vary by state, each state will have up to 12 months to start an eligibility renewal for every individual enrolled in their entire Medicaid and CHIP population. The unwinding process will create several challenges and will result in a loss or gaps in coverage for individuals.

Impact on AI/AN Communities

Medicaid Unwinding Toolkit

AI/ANs may be at an increased risk of disenrollment in Medicaid and CHIP programs once the PHE ends. Medicaid coverage losses are estimated to take twice the toll on AI/AN communities than they will take among non-Hispanic white families. Disenrollment of AI/ANs from Medicaid and CHIP will have significant consequences for the health and well-being of Native people – these programs are critical to fulfilling the United States’ trust responsibility to maintain and improve AI/AN health. Inadequate health insurance coverage is a significant barrier to healthcare access and often causes patients to delay or avoid medical care altogether. Alarmingly, when the PHE expires, 12% of all AI/AN children and 6% of all AI/AN adults nationwide are expected to lose CHIP or Medicaid coverage.

Medicaid Unwinding Toolkit

Medicaid-eligible AI/ANs face challenges in enrolling coverage due geographical remoteness, limited access to internet or phone service, language barriers, cultural factors, distrust of government programs, lack of knowledge of the benefits of coverage, or movement between non-reservation and reservation land.

Medicaid Unwinding and UIOs

UIOs play an important role in enrolling AI/ANs in Medicaid and CHIP as well as treating Medicaid beneficiaries, and will therefore, be critical in informing and helping eligible AI/AN maintain enrollment if eligible or explore other options. NCUIH’s resource highlights ways in which UIOs can work with states and other partners including Tribes and Tribal organizations, federal agencies like CMS and Indian Health Service (IHS), and their local communities:

Work with Your State

  • Request a meeting your state regarding unwinding.
  • Request that your state share renewal data via a spreadsheet or database so that you can speak with beneficiaries who utilize your services.
  • Work with your state to develop targeted communication for AI/AN communities about the state’s unwinding activities.
    • States can leverage Unwinding Communications Toolkit materials published by the Centers for Medicare & Medicaid Services (CMS).
    • Ask your state to provide AI/AN-specific guidance on maintaining coverage through Affordable Care Act (ACA) Marketplace plans for those no longer eligible for Medicaid. AI/AN beneficiaries may have access to low-cost zero and limited cost-sharing plans on the Exchanges.
  • Advocate that your state apply for Section 1902(e)(14)(a) waivers if necessary and applicable.

Work with Tribes

  • Collaborate with Tribes to request a meeting with your state regarding unwinding.
  • Develop partnerships with Tribes to provide necessary information to AI/AN beneficiaries.

Work with CMS, Indian Health Service (IHS), and Partner Organizations

  • Request consultation and confer with CMS and IHS to discuss coverage loss concerns and oversight.
  • Culturally appropriate materials are available through CMS, IHS, and the National Indian Health Board.

Work with Your Community

  • Work with beneficiaries to ensure that their contact information is updated with the state Medicaid office, including addresses, emails, and phone numbers, to ensure that individuals receive information on renewals.
  • Screen for potential Medicaid eligibility for all patients and refer current Medicaid recipients to your benefit specialists to update applications.
  • Engage community partners, health plans, and the provider community to encourage individuals to update their contact information and to provide assistance with renewals.
  • Educate patients, including utilizing outreach and educational materials in your clinic waiting rooms, patient rooms, and patient registration/in-take desks, regarding the unwinding and the risk of a loss in coverage.

Bivalent COVID-19 Targeting Vaccine Formula Approved as Booster for 5-11 Year Olds

On October 12, 2022, the US Food and Drug Administration (FDA) amended the previously issued emergency use authorizations (EUAs) for both the Moderna COVID-19 and Pfizer-BioNTech COVID-19 bivalent vaccine formulas, authorizing their use as a single booster dose for those 5-11 years old. Following FDA’s announcement, Centers for Disease Control (CDC) released a decision memo, signed by Director Rochelle Walensky, expanding the recommendations for the use of bivalent vaccines matching the EUA expansions. As such, the Moderna formulation is now available for use in children six and older, at least two months post-completion of a primary series or previous booster dose. The Pfizer formulation is now authorized for use in children five and older, at least two months post-completion of a primary series or booster dose.

Background

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of it, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized, and 2.2 times more likely to die due to COVID-19. Indian country has had highly successful vaccine rollouts and urban Indian organizations (UIOs) have been instrumental in the success of vaccinating AI/AN populations in urban areas. As of October 2022, AI/ANs have some of the highest vaccination administration rates in the US with 75.7% of AI/ANs having received at least one dose, and 62.9% having completed the primary series. However, just under half of AI/ANs (47.3%) have received their first booster, and even less have received the second booster dose (37.4%), per CDC data.

The National Council of Urban Indian Health (NCUIH) will continue to monitor and provide updates on any changes in COVID-19 vaccine guidance, or other COVID-19 updates. For more information on the changes to COVID-19 vaccine guidance or the success UIOs have had with the vaccine rollout, see below:

New Omicron Targeting Vaccine Formula Approved as Booster Dose for Individuals 12 years and Older

On August 31, 2022, the US Food and Drug Administration (FDA) amended the previously issued emergency use authorizations (EUAs) for both the Moderna and the Pfizer-BioNTech (Pfizer) COVID-19 vaccines to authorize the use of bivalent formulations for boosters. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend both the Moderna and Pfizer bivalent formulation boosters on September 1, 2022. This new formulation, which can be administered at least two months following the completion of a primary series or a previous booster dose, targets both the original virus and the current Omicron variants.  During a monthly call with Tribal and urban Indian organization (UIO) leaders, the Indian Health Service (IHS) stated that it started shipping the bivalent formulation the week of Labor Day and that these boosters will replace all booster formulations once rolled out. Currently, Omicron variants make up more than 99% of COVID-19 cases within the US.

As it stands, the monovalent (original) COVID vaccine is no longer the recommended booster for people ages 12 and up. In order for an individual to be considered ‘up to date’ on their COVID vaccination, they must have received the bivalent booster, regardless of previous booster status. Individuals who have previously caught COVID-19 can be vaccinated up to three months after the infection.

Background

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of the pandemic, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized, and 2.2 times more likely to die to due COIVD-19.

Indian Country has had highly successful vaccine rollouts and UIOs have been instrumental in the success of vaccinating AI/AN populations in urban Areas. As of August 2022, AI/ANs have the highest vaccination administration rates in the US with 74.5% of AI/ANs having received at least one dose of one of the three previously available COVID-19 vaccines, per CDC data.

CDC Endorses Fourth COVID-19 Vaccine for Adults

On Tuesday, July 19, 2022, the Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, MD, MPH, endorsed the CDC Advisory Committee on Immunization Practices’ recommendation for Novavax’s COVID-19 vaccine as another primary series option for adults 18 and older. Novavax’s vaccine, Adjuvanted, was granted an emergency use authorization on July 13, 2022, by the US Food and Drug Administration.

The Novavax vaccine, Adjuvanted, is another two-dose vaccine that will be available to administer to adults 18 and older in the coming weeks. The Novavax vaccine is administered three weeks apart and uses a more traditional technology for vaccine delivery. In total, there are now four different COVID-19 vaccines for adults 18 and older to choose from; Moderna, Pfizer, Johnson & Johnson, and Novavax.

Background

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of the pandemic, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized and 2.2 times more likely to due to du COIVD-19.

Indian Country has had highly successful vaccine rollouts and Urban Indian Organizations have been instrumental in the success of vaccinating AI/AN populations in urban Areas. As of July 2022, AI/ANs have the highest vaccination administration rates in the US with 73% of AI/ANs having received at least one dose of one of the three previously available COVID-19 vaccines, per CDC data.

CDC Expands Eligibility of COVID-19 Boosters for Youth

On Thursday, May 19th, the Centers for Disease Control and Prevention (CDC) expanded eligibility of COVID-19 vaccine boosters for everyone 5-years and older. This expansion follows a meeting of the Advisory Committee on Immunization Practices’ (ACIP) and its recommendations. With this expansion of eligibility, the CDC recommendations for children are the following:

  • Children 5-11 years old should receive a booster shot 5 months post initial series of the Pfizer-BioNTech vaccine
  • Children 12 and older, who are immunocompromised, should receive a second booster at least 4 months after their first booster.

If you are eligible for a booster, be it the first or second dose of such, and you have not had one since December 2021, now is the time to do so. To see if you are eligible for a booster, click here.

COVID-19 and Native Communities

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of it, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized, and 2.2 times more likely to die due to COVID-19. Since the pandemic began, nearly 5 million kids, ages 5 to 11, have been diagnosed with COVID, 15,000 have been hospitalized, and over 180 have died.

Indian Country has had highly successful vaccine rollouts and Urban Indian Organizations (UIO) have been instrumental in the success of vaccinating AI/AN populations in urban areas. As of June 2022, AI/ANs have the highest vaccination administration rates in the U.S with 73% of AI/ANs having received at least one dose of the COVID-19 vaccine, according to CDC Vaccine Administration Data. As of June 2022, UIOs that use IHS vaccine distribution have administered over 174,105 doses of the COVID-19 vaccine and fully vaccinated 67,883 people.

KRC Articles

Racial and Ethnic Differences in Encounters Related to Suicidal Behavior Among Children and Adolescents With Medicaid Coverage During the COVID-19 Pandemic

Authors: Mir M. Ali, PhD1; Kristina D. West, MS, LLM1; Joel Dubenitz, PhD1; Pamela End of Horn, DSW2; David Paschane, PhD2; Sarah A. Lieff, PhD, MPH3

Publication Year: 2023

Last Updated: June 26, 2023

Keywords: Covid-19; Mental and Behavioral Health; Suicide and Suicide Prevention

 

Short Abstract: The COVID-19 pandemic prompted a surge in mental health needs among adolescents and young adults,1 including an increase in suspected suicide attempts. 2 Before the pandemic, suicide was a major public health concern among youth. 3 The pandemic has also called attention to, and in some cases exacerbated, existing inequities in health care delivery, 4 but little is known about racial and ethnic differences in health care encounters related to suicidal behavior among children and adolescents during the pandemic.

 

Abstract: The COVID-19 pandemic prompted a surge in mental health needs among adolescents and young adults,1 including an increase in suspected suicide attempts. 2 Before the pandemic, suicide was a major public health concern among youth. 3 The pandemic has also called attention to, and in some cases exacerbated, existing inequities in health care delivery, 4 but little is known about racial and ethnic differences in health care encounters related to suicidal behavior among children and adolescents during the pandemic. This is particularly true for American Indian or Alaska Native youth. American Indian and Alaska Native persons experienced higher suicide-related mortality compared to the general US population prior to the pandemic.5 We examined racial and ethnic differences in encounters related to suicidal behaviors among a national sample of children and adolescents covered under Medicaid or Children’s Health Insurance Program (CHIP) during the first year of the pandemic.

 

Source: Link to Original Article.

Source: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2806204

Type of Resource: Peer-reviewed scientific article

 

One Pager:

The Relationship between Sextortion during COVID-19 and Pre-pandemic Intimate Partner Violence: A Large Study of Victimization among Diverse U.S Men and Women

Authors: Asia A. Eaton, Divya Ramjee, and Jessica F Saunders

Publication Year: 2023

Last Updated: January 30, 2023

Journal:

Keywords: Covid-19; Sexual Abuse; Violence

 

Short Abstract: In a large and diverse sample of U. S. adults, we assessed participants’ experience with pre-COVID in-person intimate partner violence (IPV) victimization and with sextortion victimization during COVID to better understand the relationship between these phenomena.

 

Abstract: In a large and diverse sample of U. S. adults, we assessed participants’ experience with pre-COVID in-person intimate partner violence (IPV) victimization and with sextortion victimization during COVID to better understand the relationship between these phenomena. Experiencing sexual IPV pre-COVID increased the likelihood that men and women would experience sextortion during COVID. Men, Black and Native women, LGBTQ individuals, and emerging adults more often experienced sextortion during COVID than other groups. Implications for research on technology-facilitated sexual violence and practice with survivors are explored.

 

Source: Link to Original Article.

Funding:

Code:

Source: https://www.tandfonline.com/doi/abs/10.1080/15564886.2021.2022057

Type of Resource: NCUIH data products

 

One Pager:

COVID Vulnerability and Impact Summary for Urban Natives (VISUN) — April 2023

Email to Request Report: research@ncuih.org

Authors: Alexander Zeymo

Publication Year: 2023

Last Updated: June 12, 2023

Keywords: Covid-19; Infection Disease; Vaccination/Immunization

 

Short Abstract: This report is created using data that is publicly available and provided directly to the National Council for Urban Indian Health from the Office of Urban Indian Health. This report should be used for grant writing purposes and informative guidance for policy and advocacy about the status of COVID-19 and COVID-19 vaccination levels for American Indian/Alaska Native (AI/AN) people living in urban areas. If you would like to have access to this report, please send an email to research@ncuih.org. ***Please be aware, in section two, four counties were erroneously deleted from the analysis (07/12/2023).

 

Type of Resource: NCUIH data products

COVID Vulnerability and Impact Summary for Urban Natives (VISUN) — May 2023

Email to Request Report: research@ncuih.org

Authors: Alexander Zeymo

Publication Year: 2023

Last Updated: July 24, 2023

Keywords: Covid-19; Vaccination/Immunization

 

Short Abstract: This is a summary report compiled by NCUIH on the impact of the COVID-19 pandemic in the urban Native American community during the month of May 2023. This report highlights the level and severity of COVID-19 infections in UIO service areas, tracking recent trends in vaccinations, and reviewing recent news and research relevant to the urban AI/AN community. If you would like to have access to this report, please send an email to research@ncuih.org.

 

Type of Resource: NCUIH data products

COVID-VISUN: COVID Vulnerability and Impact Summary for Urban Natives March 2023

Email to Request Report: research@ncuih.org

Authors: Alexander Zeymo

Publication Year: 2023

Last Updated: May 26, 2023

Keywords: Covid-19; Infection Disease; Vaccination/Immunization

 

Short Abstract: This is a summary report compiled by NCUIH on the impact of the COVID-19 pandemic in the urban Native American community during the month of March 2023. This report highlights the level and severity of COVID-19 infections in UIO service areas, tracking recent trends in vaccinations, and reviewing recent news and research relevant to the urban AI/AN community. If you would like to have access to this report, please send an email to research@ncuih.org. ***Please be aware, in Section Two, four counties were mistakenly deleted from the analysis. Estimates for the Portland, Omaha, Reno, and Helena service areas may be inaccurate for tables and statistics in Section Two. (07/11/2023)

 

Type of Resource: NCUIH data products

Narratives from African American/Black, American Indian/Alaska Native, and Hispanic/Latinx community members in Arizona to enhance COVID-19 vaccine and vaccination uptake

Authors: Matt Ignacio, Sabrina Oesterl , Micaela Mercado, Ann Carver, Gilberto Lopez 3, Wendy Wolfersteig 2, Stephanie Ayers, Seol Ki , Kathryn Hamm, Sairam Parthasarathy, Adam Berryhill, Linnea Evans, Samantha Sabo, Chyke Doubeni

Publication Year: 2023

Last Updated: April 2023

Journal:

Keywords: Awareness; Covid-19; Cultural Sensitivity and Appropriateness; Health Disparities; Infection Disease; Minority Groups; Vaccination/Immunization

 

Short Abstract: The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals.

 

Abstract: The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals. To reduce disparities and promote health equity, researchers from Arizona State University, Mayo Clinic in Arizona, Northern Arizona University, and the University of Arizona formed a partnership with community organizations to conduct state-wide community-engaged research and outreach. This report describes results from 34 virtually-held focus groups and supplemental survey responses conducted with 153 AA/B, HLX, and Native community members across Arizona to understand factors associated with COVID-19 vaccine hesitancy and confidence. Focus groups revealed common themes of vaccine hesitancy stemming from past experiences of research abuses (e.g., Tuskegee syphilis experiment) as well as group-specific factors. Across all focus groups, participants strongly recommended the use of brief, narrative vaccination testimonials from local officials, community members, and faith leaders to increase trust in science, vaccine confidence and to promote uptake.

 

Source: Link to Original Article.

Funding:

Code:

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942760/

Type of Resource: Peer-reviewed scientific article

Disparity in Access to Virtual Care for Urinary Tract Infections During the COVID-19 Era

Authors: Molly E DeWitt-Foy, Jacob A Albersheim, Shawn T Grove, Lina Hamid, Sally Berryman, Sean P Elliot

Publication Year: 2023

Last Updated: January 2023

Journal: Société Internationale d'Urologie Journal

Keywords: Covid-19; Infection Disease; Urinary; Telehealth

 

Short Abstract: Objective: To characterize the difference in uptake of virtual care for urinary tract infections (UTIs) by demographic variables in the COVID-19 era.

 

Abstract: Objective: To characterize the difference in uptake of virtual care for urinary tract infections (UTIs) by demographic variables in the COVID-19 era. Methods: We conducted a retrospective review of outpatient encounters for UTIs across a large health care system. The cohort was defined as patients with an encounter diagnosis of UTI via in-person or virtual care (telephone or technology-supported care), between March 1, 2020, and February 28, 2021. Analysis was limited to the first UTI encounter of the year for each patient. We compared the use of in-person and virtual visits by demographic variables using chi-square tests and multivariate logistic regression. Results: A total of 6744 patients, with a mean age of 61 years, were seen for UTI during the study period. The majority of patients were White (85.5%) and female (83.7%) and were seen in person (55.9%). Of those seen virtually, 52.0% participated in telephone-only visits, and 47.9% were seen via technology-supported care, using video or chat-based platforms. On multivariate logistic regression, age under 30, lowest-quartile income, male sex, and a primary language other than English increased the odds that patients had been seen in person. Among those seen virtually, age over 50 significantly increased the odds of a telephone visit, as did being Black or Native American, having a lower-quartile income, and speaking a non-English primary language. Conclusions: Although the expansion in virtual care has given some patients easier access to necessary care, the “digital divide” has worsened existing disparities for certain vulnerable populations. We demonstrate a difference in uptake of virtual health care by age, race, primary language, and income.

 

Source: Link to Original Article.

Funding:

Code:

Source: https://www.siuj.org/index.php/siuj/article/view/233/180

Type of Resource: Peer-reviewed scientific article

Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States

Authors: Xu Gao, Fan Lv, Xinyuan He, Yunyu Zhao, Yi Liu, Jian Zu, Linda Henry, Jinhai Wang, Yee Hui Yeo, Fanpu Ji, Mindie H. Nguyen

Publication Year: 2023

Last Updated: January 2023

Journal: Journal of Hepatology

Keywords: Covid-19; Liver Disease

 

Short Abstract: Background & Aims The pandemic has resulted in an increase of deaths not directly related to COVID-19 infection. We aimed to use a national death dataset to determine the impact of the pandemic on people with liver disease in the USA, focusing on alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD).

 

Abstract: Background & Aims The pandemic has resulted in an increase of deaths not directly related to COVID-19 infection. We aimed to use a national death dataset to determine the impact of the pandemic on people with liver disease in the USA, focusing on alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). Methods Using data from the National Vital Statistic System from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) platform and ICD-10 codes, we identified deaths associated with liver disease. We evaluated observed vs. predicted mortality for 2020–2021 based on trends from 2010–2019 with joinpoint and prediction modelling analysis. Results Among 626,090 chronic liver disease-related deaths between 2010 and 2021, Age-standardised mortality rates (ASMRs) for ALD dramatically increased between 2010–2019 and 2020–2021 (annual percentage change [APC] 3.5% to 17.6%, p <0.01), leading to a higher observed ASMR (per 100,000 persons) than predicted for 2020 (15.67 vs. 13.04) and 2021 (17.42 vs. 13.41). ASMR for NAFLD also increased during the pandemic (APC: 14.5%), whereas the rates for hepatitis B and C decreased. Notably, the ASMR rise for ALD was most pronounced in non-Hispanic Whites, Blacks, and Alaska Indians/Native Americans (APC: 11.7%, 10.8%, 18.0%, all p <0.05), with similar but less critical findings for NAFLD, whereas rates were steady for non-Hispanic Asians throughout 2010–2021 (APC: 4.9%). The ASMR rise for ALD was particularly severe for the 25–44 age group (APC: 34.6%, vs. 13.7% and 12.6% for 45–64 and ≥65, all p <0.01), which were also all higher than pre-COVID-19 rates (all p <0.01). Conclusions ASMRs for ALD and NAFLD increased at an alarming rate during the COVID-19 pandemic with the largest disparities among the young, non-Hispanic White, and Alaska Indian/Native American populations. Impact and implications The pandemic has led to an increase of deaths directly and indirectly related to SARS-CoV-2 infection. As shown in this study, age-standardised mortality rates for alcohol-associated liver disease and non-alcoholic fatty liver disease substantially increased during the COVID-19 pandemic in the USA and far exceeded expected levels predicted from past trends, especially among the young, non-Hispanic White, and Alaska Indian/Native American populations. However, much of this increase was not directly related to COVID-19. Therefore, for the ongoing pandemic as well as its recovery phase, adherence to regular monitoring and care for people with chronic liver disease should be prioritised and awareness should be raised among patients, care providers, healthcare systems, and public health policy makers.

 

Source: Link to Original Article.

Funding:

Code:

Source: https://www.sciencedirect.com/science/article/pii/S0168827822029944

Type of Resource: Peer-reviewed scientific article

COVID Vulnerability and Impact Summary for Urban Natives (VISUN) — February 2023

Email to Request Report: research@ncuih.org

Authors: Alexander Zeymo

Publication Year: 2023

Last Updated: March 17, 2023

Keywords: Covid-19; Infection Disease; Vaccination/Immunization

 

Short Abstract: This report is created using data that is publicly available and provided directly to the National Council for Urban Indian Health from the Office of Urban Indian Health. ***Please be aware, in Section Two, four counties were mistakenly deleted from the analysis. Estimates for the Portland, Omaha, Reno, and Helena service areas may be inaccurate for tables and statistics in Section Two. (07/11/2023)

 

Type of Resource: NCUIH data products

Food Insecurity Trajectories in the US During the First Year of the COVID-19 Pandemic

Authors: Jin E. Kim-Mozeleski; Stephanie N. Pike Moore; Erika S. Trapl; Adam T. Perzynski; Janice Y. Tsoh; Douglas D. Gunzler

Publication Year: 2023

Last Updated: January 19, 2023

Journal: CDC Preventing Chronic Disease

Keywords: Covid-19; Nutrition

 

Short Abstract: The objective of this study was to characterize population-level trajectories in the probability of food insecurity in the US during the first year of the COVID-19 pandemic and to examine sociodemographic correlates associated with identified trajectories.

 

Abstract: Introduction The objective of this study was to characterize population-level trajectories in the probability of food insecurity in the US during the first year of the COVID-19 pandemic and to examine sociodemographic correlates associated with identified trajectories. Methods We analyzed data from the Understanding America Study survey, a nationally representative panel (N = 7,944) that assessed food insecurity every 2 weeks from April 1, 2020, through March 16, 2021. We used latent class growth analysis to determine patterns (or classes) of pandemic-related food insecurity during a 1-year period. Results We found 10 classes of trajectories of food insecurity, including 1 class of consistent food security (64.7%), 1 class of consistent food insecurity (3.4%), 5 classes of decreasing food insecurity (15.8%), 2 classes of increasing food insecurity (4.6%), and 1 class of stable but elevated food insecurity (11.6%). Relative to the class that remained food secure, other classes were younger, had a greater proportion of women, and tended to identify with a racial or ethnic minority group. Conclusion We found heterogeneous longitudinal patterns in the development, resolution, or persistence of food insecurity during the first year of the COVID-19 pandemic. Experiences of food insecurity were highly variable across the US population, with one-third experiencing some form of food insecurity risk. Findings have implications for identifying population groups who are at increased risk of food insecurity and related health disparities beyond the first year of the pandemic.

 

Source: Link to Original Article.

Funding:

Code:

Source: https://www.cdc.gov/Pcd/issues/2023/22_0212.htm#print

Type of Resource: Peer-reviewed scientific article