Doctors outraged after Texas bans health departments from promoting COVID vaccines

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Public health agencies in Texas and across the world spent most of 2021 working overtime to distribute the COVID vaccine, the public’s best defense against the virus that has killed more than 100,000 Texans since 2020.

Now, though, that same work is effectively banned in Texas.

A provision in the state’s budget passed in May 2023 prohibits any entity funded by the state health department from promoting COVID vaccines in fiscal years 2024 and 2025.

The provision, known as Rider 40, has meant that local public health departments have stopped almost all outreach encouraging Texans to get the latest COVID vaccine. Local health departments have stopped hosting COVID vaccination clinics and have even stopped distributing pamphlets that encourage getting a COVID vaccine.

“This particular rider is within Texas’ legal and constitutional power to adopt,” said Dr. William Sage, a professor of law and medicine at Texas A&M University. “But I think it’s a really bad idea.”

The goal of public health agencies, Sage said, is to convey useful, accurate information, such as informing people that staying up-to-date with COVID vaccines is the best way to protect yourself from becoming seriously ill or dying from the coronavirus.

“Why dictate by law that a whole bunch of useful, accurate information can’t be conveyed?” Sage said.

The rider, which went into effect Sept. 1, says that no general revenue funds appropriated to the Department of State Health Services “may be used for the purpose of promoting or advertising COVID-19 vaccinations in the 2024-25 biennium.” The rider also notes that “to the extent allowed by federal law, any federal funds allocated to DSHS shall be expended for activities other than promoting or advertising COVID-19 vaccinations.”

Riders “convey specific instructions on how agency funds can be collected or spent” and follow traditional line items in the state budget, according to the Legislative Reference Library of Texas.

The rider does not prevent local health departments from distributing the COVID-19 vaccine at all, according to emails sent by state health department employees obtained by the Star-Telegram through a records request. Rather, departments are being told not to single out the COVID-19 vaccine from any other vaccination that is recommended by the U.S. Centers for Disease Control and Prevention.

It “is important to avoid distributing materials that specifically promote the COVID-19 vaccine,” a legislative liaison for the department’s immunization section wrote in response to questions from Tarrant County Public Health.

The liaison told an employee of Tarrant County Public Health that the department should not distribute pamphlets that recommended getting a COVID-19 vaccine, like one pamphlet that recommend pregnant people get vaccinated to protect themselves and their children.

The ban means a reversal of public health’s initial response to COVID-19 in 2021, which health departments across the state hosted COVID vaccine clinics and urged residents to get vaccinated to protect themselves. In 2021, Tarrant County Public Health hosted numerous COVID-19 vaccine clinics, bringing pop-up events to local schools, churches, and businesses. Such events are now prohibited under the rider.

Also in 2021, the state health department worked to educate Texans about the increased risk of dying from COVID-19 unvaccinated Texans faced. “A new Texas DSHS study shows that in September 2021, unvaccinated people in Texas were 20x more likely to die from COVID-19 and 13x more likely to test positive,” the health department wrote in November 2021 on X. Such a message would violate state law just two years later.

Public health experts agree that getting a COVID-19 vaccine and subsequent booster provide excellent protection against getting seriously ill or dying from the coronavirus. Although many Americans now have some form of protection from vaccines or prior illnesses, the virus is still causing illness and death, especially in older adults and adults with comorbidities.

Local health departments can host vaccine clinics, as long as other recommended vaccines, like the seasonal flu vaccine, are offered alongside the COVID-19 vaccine, a state health department employee wrote in response to a question from the El Paso County Public Health Department.

The Texas ban is part of a broader trend in Texas and other states reacting to the politicization of pandemic response measures, said Erica White, a research scholar at Center for Public Health Law and Policy at Arizona State University’s law school.

In late 2020 and early 2021, both Republican and Democratic leaders across the nation championed COVID-19 vaccines as the best step to preventing illness and death. Now, attitudes toward COVID vaccines are increasingly divided by party lines. A poll conducted by KFF in November found that political partisan was playing an “outsized role in vaccine attitudes,” with 55% of Republicans polled saying they would definitely not get the latest COVID-19 vaccine, compared with 12% of Democrats.

The budget rider was written by State Sen. Bob Hall, a Republican from Edgewood. Hall was one of the Senate’s most vocal opponents of COVID vaccines during the 2023 legislative session, and during one committee meeting compared COVID treatments to medical experimentation done by Nazis during the Holocaust.

Hall’s chief of staff did not immediately respond to an email asking for comment Wednesday.

The rider is one of several pieces of legislation approved during the 2023 legislative session that curbed public health authority.

Kateyln Jetelina, an epidemiologist who focuses on COVID-19 and other public health issues, called the rider an “absolute tragedy.”

“Public health departments are one of the most trusted sources of health information to people. And, if they are muffled, it will impact the health of communities,” Jetelina wrote in an email. “I’m very concerned about the implications not just with COVID-19 but for diseases down the road.”