December 3, 2021 Edition
CHEAC has published its latest version of the #WeArePublicHealth newsletter, highlighting the work of California local health departments in protecting and promoting the health of their communities. The latest edition features health departments engaged in COVID-19 vaccination efforts, tobacco prevention and control, and chronic disease prevention, among other activities.
The full newsletter is available here.
The California Legislature is set to return to Sacramento to resume the second year of the 2021-22 Legislative Session in one month on January 3, 2022. Lawmakers are anticipated to face a number of significant issues upon their return to the Capitol, including issues related to health and human services implementation (e.g., CalAIM, Children and Youth Behavioral Health Initiative), COVID-19 pandemic response, education, and drought response and emergency preparedness.
Of note, officials and offices occupying the current Capitol Annex have been in the process of moving to a new state office building (termed the “swing space”) about one block from the Capitol in preparation of annex’s demolition and reconstruction. The project is anticipated to take multiple years to complete, with lawmakers expected in the swing space for the next four years. The swing space will house all lawmaker offices, as well as the Governor and Lieutenant Governor’s offices.
Amid the physical move to a new building, California’s nonpartisan Citizens Redistricting Commission continues its work in redrawing congressional and legislative district maps. The commission is anticipated to finalize maps this month, leaving many current officeholders and those seeking political office up in the air.
Numerous lawmakers over the past several weeks have been appointed to new roles or announced new endeavors, at least in part due to vacancies of other offices and redistricting efforts occurring at the state level.
Assembly Speaker pro Tempore Kevin Mullin, representing San Mateo County, recently announced he will be running in 2022 for the congressional seat to be vacated by his mentor Congresswoman Jackie Speier. Assembly Member Rudy Salas, representing Kern and Kings counties, announced he would challenge Congressman David Valadao, and Senator Sydney Kamlager of Los Angeles County recently filed paperwork for the Congressional seat to be vacated by Congresswoman Karen Bass who is running to be the Mayor of the City of Los Angeles.
Governor Gavin Newsom this week appointed Assembly Member Ed Chau of Los Angeles County to serve as a Judge in the Los Angeles County Superior Court. Chau’s appointment follows the departure of Assembly Member David Chiu of San Francisco after San Francisco Mayor London Breed appointed Chiu as the new city attorney. Also, this week, Assembly Member Jim Frazier, representing Contra Costa, Sacramento, and Solano counties, announced he will resign his Assembly seat on December 31 to seek a job in the transportation sector.
With just a handful of weeks remaining before the Legislature returns to Sacramento, 2022 is already shaping up to be a dynamic and eventful year in California government and politics.
This week, the California State Assembly convened two informational hearings related to public health in locations throughout the state. We highlight these hearings below:
Hernandez Testifies at Assembly Select Committee on Social Determinants of Health
On Wednesday, the Assembly Select Committee on the Social Determinants of Health convened its inaugural hearing in La Mesa in San Diego County. The committee is chaired by Assembly Member Dr. Akilah Weber of San Diego County. The hearing provided an overview of the elements that comprise the social determinants of health (SDOH) and how the social determinants of health impact communities throughout California.
The hearing featured four public health experts to discuss types of SDOH, as well as medical and public health equity. Dr. Rohan Radhakrishna, Deputy Director of the Office of Health Equity at the California Department of Public Health (CDPH), set the context for health equity and social determinants of health. Dr. Liz Hernandez, CHEAC Executive Committee Member and Acting Director of Public Health Services in San Diego County, detailed the role of the local health department in promoting healthy communities through policy, systems, and environmental approaches. Dr. Rodney Hood, President and Chairman of the Multicultural Health Foundation, provided a compelling presentation of the history of racism in medical care and the impacts of health inequities in the U.S., and Dr. David Carlisle, President and CEO of the Charles R. Drew University of Medicine and Science, additionally presented.
The agenda for the Select Committee on the Social Determinants of Health is available here. A video recording of the hearing is available here.
Assembly Select Committee on Infectious Diseases Explores Health Equity
On Tuesday, the Assembly Select Committee on Infectious Diseases, chaired by Assembly Member Mike Gipson of Los Angeles County, convened an informational hearing on health inequities in California. The hearing was held in Carson in Los Angeles County and featured an overview of inequities experienced by certain populations in the state. CDPH’s Dr. Rohan Radhakrishna, as well as two professors from Charles R. Drew University of Medicine and Science and the University of California Irvine, provided the committee background and context on health inequities, including those that were exacerbated and exposed during the COVID-19 pandemic.
The second panel of the hearing featured a handful of community-based organizations involved in public health and health services programming. The panelists each described health equity impacts on their clients and populations and their organizations’ work in addressing health inequities.
The agenda for the Select Committee on Infectious Diseases is available here. A video recording of the hearing is available here.
The California Department of Health Care Services (DHCS) on Tuesday, December 7 from 2:30 pm to 3:30 pm will host a webinar on recently released data exchange and reporting requirements for ECM and Community Supports as part of the CalAIM Initiative.
DHCS will provide an overview of the guidance documents and corresponding data flows with a focus on the exchange of information that will occur between managed care plans (MCPs) and ECM and Community Supports providers. The webinar is geared toward ECM and Community Supports providers, Whole Person Care lead entities, MCPs, and others engaged in the implementation of CalAIM ECM and Community Supports. Time will be reserved at the end of the webinar for participant questions and answers.
Registration is required and available here.
Last Friday, the World Health Organization (WHO) classified a new COVID-19 variant B.1.1.529, or Omicron, as a “variant of concern” following reports of cases to the WHO by South Africa. Researchers continue to study the virus mutations, its impacts on transmissibility and disease severity, and effectiveness of prior infection, vaccines, and current tests and treatments.
Following the identification of the new variant, President Joseph R. Biden, Jr. issued a proclamation suspending and restricting entry of immigrants and noncitizens from a series of countries in Southern Africa. The proclamation took effect on Monday and remains in effect until terminated by the President.
Despite these restrictions, the first case of the Omicron variant detected in the U.S. occurred on Wednesday in San Francisco. According to the CDC, the individual was a traveler who returned from South Africa the week prior and had begun experiencing mild symptoms. Laboratory partners at the University of California, San Francisco worked closely with officials in identifying the new variant case.
A joint statement from the California Department of Public Health (CDPH) and the San Francisco Department of Public Health (SFDPH) urged Californians to remain vigilant against the variant, but not to panic. CDPH is increasing COVID-19 testing at airports for arrivals from countries identified by the CDC, and health officials continue to encourage residents to receive a vaccine, wear masks in indoor settings, get tested, and stay home if sick.
As studies continue into the new variant, additional information is anticipated over the coming weeks.
On Thursday, President Joseph R. Biden, Jr. announced a series of new actions to protect Americans from COVID-19, including the Delta and Omicron variants, this winter. The Administration’s new actions come as additional cases of the Omicron variant continue to be identified in the U.S. and globally.
The new set of actions include:
- Boosters for All Adults – President Biden will announce steps to ensure that the nearly 100 million eligible Americans who have not received their booster shot to receive one as soon as possible. The CDC updated its booster guidance, recommending that all adults receive a booster dose. As part of this broader push for booster doses, the Administration announced expanded booster availability at federal pharmacy chains, new public education efforts, a partnership with AARP, and notices to Medicare beneficiaries encouraging vaccination.
- Vaccinations to Protect Kids and Keep Schools Open – The Biden-Harris Administration reiterated its approach to getting more children ages five and older vaccinated and keeping schools open for in-person instruction. President Biden announced a new effort to launch hundreds of family vaccination clinics throughout the country, as well as a new requirement for Medicaid to pay health care providers to talk to families about getting their children vaccinated. Medicaid will cover COVID-19 vaccine counseling visits for children and youth up to age 21 with 100 percent federal funding throughout the public health emergency and the following year. The Administration is additionally reviewing school COVID-19 prevention policies and expressed support of an independent scientific review of a vaccine for those under age 5.
- Expanding Free At-Home Testing – To expand access and affordability of COVID-19 tests, HHS, the Department of Labor, and the Treasury will issue guidance by January 15 to clarify that individuals who purchase OTC COVID-19 diagnostic tests will be able to seek reimbursement from their group health plan or health insurance issuer and have the insurance cover the cost during the public health emergency. For uninsured and underserved communities, the Administration is expanding community distribution of free tests through neighborhood sites such as health centers and rural clinics.
- Stronger Public Health Protocols for International Travel – The U.S. is strengthening its pre-departure testing protocols by requiring all inbound international travelers to test within one day of departure globally, regardless of nationality or vaccination status. The Administration is also extending the requirement to wear a mask on airplanes, rail, and public transit through March 18, 2022. The requirement was previously set to expire next month.
- Protecting Workplaces to Keep Businesses Open – The President calls on businesses to continue to take steps to ensure worker protection by requiring their workers to get vaccinated or tested weekly.
- Rapid Response Teams to Battle Rising Cases – The Administration will continue to ensure states have help they need as they battle rising COVID-19 cases, including through deploying over 60 federal teams of health and public health personnel. The Administration is also announcing a $20 million investment in the Medical Reserve Corps (MRC) to assist in areas with rising cases.
- Supplying Treatment Pills to Prevent Hospitalization and Death – The Administration notes that new COVID-19 treatments may be on the horizon to prevent hospitalization and death, and the Administration is taking steps to secure 13 million doses of antiviral courses for distribution to Americans.
- Continued Commitment to Global Vaccination Efforts – President Biden highlighted the U.S. donation of 1.2 billion COVID-19 vaccine doses to global countries and announced the acceleration of delivery of 200 million more doses in the next 100 doses to global countries.
- Preparing for All Scenarios – The Biden-Harris Administration continues to prepare for all scenarios, including if updated vaccinations or boosters are needed to respond to the Omicron variant. President Biden reiterated the Administration’s ongoing close collaboration with medical and scientific experts on COVID-19 trends and variants.
Additional information from the White House is available here.
On Monday, U.S. Centers for Disease Control and Prevention (CDC) Director Dr. Rochelle Walensky announced the CDC has strengthened its recommendation for booster doses for individuals ages 18 and older. Per the CDC, everyone ages 18 and older should get a booster shot either when they are six months after their initial Pfizer or Moderna series or two months after their initial J&J vaccine.
The CDC’s previous guidance authorized Americans to receive a booster shot. The CDC took the steps to strengthen its booster recommendation following the emergence of the Omicron variant worldwide.
Additional information is available here.
This week, Pfizer and BioNTech submitted a formal request to the U.S. Food and Drug Administration (FDA) to expand the emergency use authorization (EUA) of a booster dose of the COVID-19 vaccination to include individuals ages 16 and 17. Currently, only people ages 18 and older are eligible for a COVID-19 booster dose in the U.S., and it must be six months after receiving the Pfizer or Moderna vaccine or two months after the Johnson & Johnson vaccine.
Pfizer and BioNTech in October announced results of a randomized study of 10,000 people 16 years of age and older showing a booster dose “restored vaccine protection against COVID-19 to the high levels achieved after the second dose.”
Reports suggest the FDA is anticipated to act promptly on Pfizer’s request, possibly granting approval within the coming week, making booster doses available to several million teenagers in the U.S.
The U.S. Centers for Disease Control and Prevention (CDC) announced today it is revising the current Global Testing Order to shorten the timeline required for testing for all international air travelers to one day before departure to the United States. The one-day testing policy is anticipated to help protect travelers and the health and safety of American communities from COVID-19.
Beginning December 6, all air travelers, regardless of citizenship or vaccination status, will be required to produce a negative pre-departure COVID-19 viral test taken the day before they board their flight to the U.S. The CDC continues to recommend that all travelers receive a COVID-19 viral test 3-5 days after arrival, and that unvaccinated travelers should quarantine for seven days after travel.
Additional information is available here.
On Tuesday, the U.S. Food and Drug Administration (FDA) Antimicrobial Drugs Advisory Committee (AMDAC) narrowly recommended that the agency issue its first emergency use authorization (EUA) for Merck’s investigational oral antiviral medication for the treatment of mild to moderate COVID-19 in adults with high risk of severe COVID-19 or hospitalization.
The drug, molnupiravir, has been shown to have a relative risk reduction of hospitalization or death of 30 percent compared to a placebo group. The Merck drug is intended to be taken within five days of symptom onset, twice per day for five days.
Members of the FDA AMDAC raised some concerns around the effectiveness of the pills, potential impacts on pregnant persons, and the potential for the development of harmful mutations in the spike protein of the virus. Despite these concerns, the panel voted 13-10 to recommend the FDA issue an EUA for the product. A decision from the FDA is anticipated over the coming days.
Another antiviral pill from Pfizer is anticipated to be reviewed by the FDA AMDAC over the coming weeks. The Pfizer drug has been found to have significantly better effectiveness against hospitalization and death based on clinical trial data completed to date.
Additional information on the Merck drug and FDA panel vote is available here.
A new report released by the U.S. Department of Health and Human Services (HHS) found significant increases in the use of telehealth that helped maintain access to some health services during the COVID-19 pandemic. The report, produced by researchers in the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE), also found that telehealth services were accessed more in urban areas than rural communities, and Black Medicare beneficiaries were less likely than White beneficiaries to utilize telehealth.
The Centers for Medicare and Medicaid Services (CMS) utilized emergency waiver authorities enacted by Congress and existing regulatory authorities to implement policies expanding access to telehealth services during the pandemic. The HHS report found that the share of Medicare visits conducted through telehealth in 2020 increased 63-fold, from approximately 840,000 in 2019 to 52.7 million. Telehealth was particularly helpful in offsetting potential foregone behavioral health care in 2020, according to HHS.
CMS recently announced that for the first time outside of the COVID-19 public health emergency, Medicare will pay for mental health visits furnished by Rural Health Clinics and Federally Qualified Health Centers via interactive video-based telehealth and audio-only telephone calls. CMS is also permanently eliminating geographic barriers and allowing patients in their homes to access telehealth services for diagnosis, evaluation, and treatment of mental health disorders.
Additional information from HHS is available here.
On Wednesday, President Joseph R. Biden, Jr. issued a proclamation commemorating World AIDS Day and calling on states, territories, and the American people to join the HIV community in activities to remember those who have lost their lives to AIDS. As part of the President’s proclamation, the White House detailed a series of actions to accelerate the fight against HIV/AIDS in the U.S. and abroad.
These actions include:
- Releasing the National HIV/AIDS Strategy – The national strategy provides a framework and direction for the Administration’s policies, research, programs, and planning through 2025 and leads the country toward ending the HIV epidemic in the U.S. by 2030. The new strategy incorporates the latest data on HIV trends, expands the focus on addressing the social determinants of health, encourages reform of state HIV criminalization laws, and adds a new focus on opportunities to engage with the private sector.
- Hosting the Global Fund’s Seventh Replenishment Conference – President Biden underscored his commitment to the United States hosting the Global Fund to Fight AIDS, Tuberculosis, and Malaria Replenishment Conference in 2022. As a founding member of the Global Fund, the U.S. will ensure that the anniversary of the establishment of the fund accelerates progress to end the HIV/AIDS epidemic by 2030.
The Biden-Harris Administration additionally highlights several HIV-related actions taken during their term, including reinstating the White House Office of National AIDS Policy and requesting significant investments to End the HIV Epidemic domestically.
Additional information from the Biden-Harris Administration is available here.
Today, the Biden-Harris Administration announced the release of the new National Action Plan to Combat Human Trafficking, detailing the country’s strategy to addressing human trafficking. The plan delineates actions and resources across numerous federal agencies and emphasizes collaboration with state and local governments, the private sector, and non-governmental partners.
The National Action Plan retains a central focus on the foundational pillars of U.S. and global anti-trafficking efforts relative to prevention, protection, prosecution, and partnerships. Within the U.S. Department of Health and Human Services (HHS), Administration officials will provide trauma-informed training and technical assistance to agency staff and partners, strengthen screening tools and referral protocols, design more inclusive service programs, and expand prevention efforts. Specific HHS activities in the National Action Plan include:
- Enhance community-coordinated response to human trafficking of youth through grants, programs, training, resources, and partnerships
- Establish and implement a National Human Trafficking Prevention Action Plan
- Provide information and facilitate discussions about forced labor in public health supply chains
- Work with social media and technology industry on the development of innovative efforts to prevent human trafficking
- Strengthen two-generation approaches to strengthen economic self-sufficiency through early childhood development, postsecondary and employment pathways, social capital, and economic assets
- Increase access to mental health and other health services, including developing outreach campaigns that stress the importance of mental health and wellbeing
Additional information, including the full plan, from the White House is available here.
The Bipartisan Policy Center (BPC), in partnership with a series of other coalition groups including the National Association of County and City Health Officials (NACCHO), this week released its new report “Public Health Forward: Modernizing the U.S. Public Health System.” The report details a five-year roadmap for public health leaders and elected officials to build a more equitable, robust, and sustainable public health system in the U.S.
Recommendations were formed by a bipartisan task force of current and former governors, mayors, elected representatives, nonprofit, public health, and health care executives. The report sets forth a framework for a 21st century public health system, as well as a series of recommended actions for policy makers and public health leaders.
Recommendations are organized across the following areas with specific action items:
- Financing – The report establishes a vision of sufficient, predictable, and flexible funding for the public health system, enabling it to sustain healthy communities and act quickly to protect the public from expected and unexpected health issues.
- Action #1: Provide flexible funding and maximize existing assets to support public health services and capabilities, including those needed to address health inequities.
- Action #2: Evaluate the social and economic impact of public health programs and strategies.
- Data and Information Technology – The report outlines a vision of a robust, modern, interoperable, and secure public health information system to deliver real-time, accurate, and actionable data to policy makers, health departments, and other stakeholders to detect new or growing threats, identify groups that may be at risk, and respond quickly with well-targeted policies and programs.
- Action #1: Strengthen the collection of timely and actionable public health data to guide programs, respond to emergencies, and address health inequities.
- Action #2: Invest in data sharing between public health departments and health care entities.
- Workforce – The report details a vision of a highly skilled, trained, and diverse public health workforce to provide evidence-informed programs and services to address community health needs, encourage healthy behaviors, and act swiftly to respond to emerging threats. Staff also feel supported and are incentivized to pursue long careers in governmental public health.
- Action #1: Invest in the recruitment and retention of a diverse and inclusive governmental public health workforce.
- Action #2: Improve hiring and promotion policies and processes to ensure high-quality public health services.
- Public Health Laws and Governance – The report envisions modernized laws, policies, and statutes to protect and promote the public’s health in a manner that reflects ongoing threats and challenges and ensures public health authority remains intact and protected.
- Action #1: Review, evaluate, and modernize public health governance structures and statutory responsibilities.
- Action #2: Support and clearly communicate the roles of public health departments to the public.
- Partnerships – The report sets forth a vision for public health departments to partner with various sectors (e.g., housing, food, transportation) and stakeholders (e.g., faith-based organizations, health care) toward to shared goal of providing a fair and just opportunity for all to achieve good health and wellbeing.
- Action #1: Incentivize partnerships between public health departments and other sectors.
- Action #2: Establish a dedicated body charged with routinely monitoring, assessing, and influencing the implications for health in all government sector policy discussions.
- Community Engagement – The report envisions public health departments partnering with community members toward the shared goal of providing a fair and just opportunity for all to achieve good health and wellbeing.
- Action #1: Invest in long-term relationship-building and partnership development with residents and community-based organizations and in Tribal consultation
- Action #2: Invest in the capacity of CBOs and provide resources to support collaboration with public health departments.
The report reiterates the unique opportunity for the sector to reimagine public health in a bipartisan fashion with the goal of an equitable, effective, and sustainable public health system.
The full BPC report is available here.
The California Department of Health Care Services (DHCS) was recently accepted into the U.S. Centers for Medicare & Medicaid Services’ (CMS) Infant Well-Child Visits Learning Collaborative Affinity Group. The group is part of CMS’ Maternal and Infant Health Quality Initiative, which is intended to support states in implementing quality improvement projects that improve the utilization and quality of well-child visits for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries ages 0 to 12 months. DHCS has partnered with Children Now and several Medi-Cal managed care plans and providers in this initiative.
The affinity group will provide technical assistance to state Medicaid and CHIP agencies and their partners through group workshops and one-on-one meetings. QI advisors and subject matter experts will provide states with individualized guidance, including QI tools, to identify, implement, and test strategies to improve infant well-child visits and then spread those changes that prove successful. Participating states will meet monthly from October 2021 to October 2022 (with additional technical assistance available until October 2023) to develop and test data-driven interventions. States will work with CMS to improve their performance on the CMS Child Core Set measure (Well-Child Visits in the First 30 Months of Life) and to identify other relevant indicators to track QI.
Additional information is available here.
The Newsom Administration on Wednesday announced the availability of nearly $300 million in Clean California grants, calling on local communities to apply for funds to support projects to clean and beautify local streets, tribal lands, parks, and transit centers throughout the state. The new grants are part of Governor Gavin Newsom’s Clean California Initiative, which invests $1.1 billion over multiple years to remove trash, create jobs, and engage communities to transform public spaces.
According to the Newsom Administration, Clean California is an expansion of existing litter abatement efforts that will remove 1.2 million cubic yards of trash from state highways yearly. Up to 11,000 jobs are anticipated to be created, including for people exiting homelessness, at-risk youth, veterans, those reentering society from incarceration, local artists, and students.
Local governments can now submit proposals of up to $5 million to beautify their communities and address trash and debris. Caltrans anticipates receiving proposals from agencies in all 58 counties and will award approximately 200 grants to projects statewide. The state will match local investments and address the needs of more severely underserved communities to meet a goal of funding 300 local projects throughout California over the three-year program.
Additional information from the Governor’s Office is available here.