Dramatic, alarming, dangerous — for months, experts quoted widely in national press outlets have used these words to describe 2020’s ebb of vaccination coverage. As of May, the CDC had already recognized a significant disruption to childhood immunizations and attributed it to COVID-19. “Havoc” is — quite correctly — the word AAFP President Gary LeRoy, M.D., of Dayton, Ohio, used at the time

[physician giving injection to patient]

Now, with the infection map still glowing red, we’ve started hearing another dire word: twindemic.

“Even a mild flu season could stagger hospitals already coping with COVID-19 cases,” warned a New York Times story a couple of weeks ago. Public health officials, it went on, “are worried large numbers of people could forgo flu shots, increasing the risk of widespread outbreaks.”

We know.

Family physicians, always serving on the flu-shot front lines (while ensuring that patients adhere to other immunization recommendations), work every year to combat misconceptions and protect as many patients as possible.

And you’ll be crucial to providing whatever COVID-19 vaccine emerges from the trials now taking place, having also been on the front lines of the pandemic from the start.

That’s why the Academy’s Government Relations team recently took advantage of the chance to help draft legislation meant to move the vaccination needle in the right direction. The resulting bill — the Community Immunity During COVID-19 Act (H.R. 8061) — is good for family physicians and patients.

It’s also a good example of how we build relationships to advance our advocacy.

Earlier this year, having met with U.S. Rep. Lauren Underwood, D-Ill., when the nurse and freshman lawmaker was first elected, we supported her Black Maternal Health Momnibus legislation. Not long after that, AAFP member Natalie Choi, M.D., of Geneva. Ill., participated in a COVID-19 Facebook live event with Underwood. So the Academy was a natural touch point for the congresswoman’s staff as work progressed on writing policy to prepare for an eventual COVID-19 vaccine.

Reflecting our advocacy on immunizations, H.R. 8061 would

  • provide $560 million to state and local public health organizations to encourage partnerships with health care professionals, including primary care physicians;
  • support efforts to raise awareness about insurance coverage options for people who need vaccinations; and
  • require the CDC to issue evidence-based patient counseling guidance to physicians.

Because we were in the room, Underwood and co-sponsoring Rep. Kim Schrier, D-Wash., understood that AAFP members will be at the fore of delivering the COVID-19 vaccine, and that regaining lost immunization ground is now a whole other campaign in the pandemic fight. Their legislation recognizes the importance of the patient-centered medical home and the physician-patient relationship. And it has already earned broad support among medical and health care professionals.

Historically, vaccine issues have stayed in the background, with policymakers looking annually at how to deal with the flu and occasionally throwing headline-grabbing money at, say, fighting influenza H1N2. But COVID-19 has recalibrated that conversation, and we’re working to make sure primary care is at the center of it.

It’s a big advocacy target, and the Academy was already aiming at it from several directions. We were in on setting the CDC’s 2020 immunization schedules, and we’ve lobbied for policy to prevent vaccination recordkeeping from gouging or otherwise burdening physicians

AAFP Medical Director for Quality and Science Amy Mullins, M.D., has been part of these efforts, and she joined Underwood and Schrier for a national press briefing to promote the legislation when it was introduced. She told me last week that the bill’s goal of improving vaccine confidence is in step with the Academy’s push to help members educate their patients.

“We have patients who feel hesitant about getting their needed vaccines,” she said, “and we work to address that and build their confidence so they get what’s prescribed and necessary — especially this fall as we have overlapping threats.

“We need to encourage our patients to trust the science. That’s a piece that’s been under attack lately — the Academy, with the Group of Six, spoke out in July to urge support for the CDC and evidence-based medicine. We must convey to our patients that vaccines are rooted in science.”

More than 90% of family physicians give immunizations in their practices(www.ncbi.nlm.nih.gov), she added, making them key to rebuilding, well, community immunity.

“There’s a lot of vaccines that are required, especially in kids,” Mullins said. “In a time when we know that vaccination rates are down by about 40%, catching up is not a simple process. You need a trusted partner. Your family physician knows what immunizations you need and what you’ve had. I don’t know that you can get that from a retail clinic, which doesn’t know where you are in your vaccination schedule.”

Academy Board Chair John Cullen, M.D., of Valdez, Alaska, signed a similar message in the AAFP’s Aug. 19 letter supporting H.R. 8061. (447 KB PDF)

“The legislation recognizes that a patient-centered medical home is an ideal setting for outreach activities and for discussing each person’s unique health status,” the Academy wrote to Underwood. “This is especially vital when considering the needs of individuals with chronic conditions, those who are pregnant, or older adults who may be at high risk for both traditional infectious diseases, like influenza, as well as for contracting severe COVID-19.”

This, then, is how we’re doing our part to guard against a twindemic.

Underwood has said she wants to bundle H.R. 8061 into the next COVID-19 relief package. We expect to see other immunization initiatives in separate legislation this year. And, as never before, we expect to see our advocacy — and yours — in the policies that rebuild the country’s public health.

By Stephanie Quinn, Senior Vice President, Advocacy, Practice Advancement and Policy