Tennessee summarily fires its principal vaccine official, Dr. Michelle Fiscus

Amid the surge in the Delta strain of the coronavirus cases across Tennessee, the state government summarily fired its top vaccination official, Dr. Michelle Fiscus, the medical director for vaccine-preventable diseases and immunizations programs, on Monday afternoon without providing any explanation of her termination.

The following day, Tennessee Republican state lawmakers ordered the Department of Health to discontinue all adolescent vaccine outreach initiatives, under the threat of dissolving the department, not just for COVID-19, but for all diseases.

Dr. Michelle Fiscus

This included the HPV vaccine, which has been proven safe and highly effective, when provided to adolescents before they begin having sexual relations, to protect them against a virus implicated in cervical cancer. There will also be no back-to-school messaging to more than 30,000 parents who were not able to get their children the measles vaccine last year.

According to the department emails obtained by The Tennessean, the Nashville daily newspaper, “County-level employees [were instructed] to halt vaccination events focused on adolescents and stop online outreach to teens.” Additionally, pro-vaccine Facebook posts and flyers from its website showing teens with Band-Aids on their shoulders, indicating anyone 12 years old or more was eligible for vaccination, have been removed.

What appeared to have outraged the right-wing lawmakers was a legal doctrine that allows the administration of vaccines to “unaccompanied minors” as young as 14 without explicit consent from their parents. The “Rule of Sevens” states, “Between the ages of 14 and 18, there is a rebuttable presumption of capacity, and the physician may treat without parental consent unless the physician believes that the minor is not sufficiently mature to make his or her own health care decision.”

This principle allows health professionals to render medical assistance to juvenile drug abusers, treat sexually transmitted diseases, provide prenatal care, or treat emergency cases. The rule does not, however, permit minors to obtain an abortion.

Health Commissioner Dr. Lisa Piercey, during questioning on June 16, 2021, standing before the Government Operations Committee, explained that the doctrine had been invoked only eight times across the state.

Representative Scott Cepicky, R-Culleoka, accused the department of health of sidestepping parental authority to target children and called the action “reprehensible.” He added, “When you have advertisements like this, with a young girl with a patch on her arm, all smiling, we all know how impressionable our young people are and wanting to fit in in life.”

Representative Scott Cepicky, Republican-Culleoka. Screen shot from Tennessee General Assembly Video Stream.

He later made a motion that passed with the support of his Republican colleagues to reconvene the health department before the committee on July 21 for additional questions and consider “dissolving and reconstituting” the agency. This initiative has the support of Republican Governor Bill Lee.

Instead of embracing the expertise of public health experts, epidemiologists, and infectious disease specialists, the Republican right has sought to foment a backlash against them, fueled by the antiscientific hysteria of fascist politicians like Trump, fundamentalist preachers, and the ultra-right media.

Dr. Fiscus, Tennessee’s top vaccine official with years of experience, said during a media interview on Tuesday, “It’s a huge symptom of just how toxic the whole political landscape has become. This virus is apolitical; it doesn’t care who you are or where you live, or which president you preferred. It’s just been a very difficult thing for us to overcome.”

In another statement, she wrote, “I am not a political operative, I am a physician who was, until today, charged with protecting the people of Tennessee, including its children, against the preventable diseases like COVID-19.” She bluntly noted, “It was my job to provide evidence-based education and vaccine access so that Tennesseans could protect themselves against COVID-19. I have now been terminated for doing exactly that!”

According to Kaiser Health News, legislatures in at least 24 states have drafted legislation to dismantle or weaken the powers of public health officials. As of the end of December 2020, more than 180 state and local public health leaders in 38 states had resigned, retired, or been fired.

After being fired from her position, Dr. Fiscus submitted a statement published in The Tennessean titled, “ I am afraid for my state .”

She wrote, “Today, I became the 25th of 64 state and territorial immunization program directors to leave their position during this pandemic. That’s nearly 40% of us. And along with our resignations or retirements or, as in my case, push from office, goes the institutional knowledge and leadership of our respective COVID-19 vaccine responses. I will not sit quietly by while our public health infrastructure is eroded in the midst of a pandemic.

“We are a group of dedicated public health professionals who have worked endless hours to make COVID-19 vaccines, the ONE tool we have to effectively end the scourge of the COVID-19 pandemic, available to every person in our jurisdictions. Along the way we have been disparaged, demeaned, accused, and sometimes vilified by a public who chooses not to believe in science, and elected and appointed officials who have put their own self-interest above the people they were chosen to represent and protect…

“I have been terminated for doing my job because some of our politicians have bought into the anti-vaccine misinformation campaign rather than taking the time to speak with the medical experts. They believe what they choose to believe rather than what is factual, and evidence-based. And it is the people of Tennessee who will suffer the consequences of the actions of the very people they put into power.”

The United States has currently fully vaccinated 48.2 percent of its population. Tennessee has barely exceeded 38 percent of its people. Only seven other states have lower vaccination rates. Besides Wyoming and Idaho, they are all located in the Southeast of the country. In Tennessee, new cases are rising once more, having climbed 67.7 percent from the prior week, while the vaccination rate has dropped 70 percent from the previous week.

According to the data from the Centers for Disease Control and Prevention (CDC), the five states with the most significant one-week jump in cases per capita all have much lower full vaccination rates compared to the rest of the country—Florida 43 percent, Nevada 43 percent, Missouri 40 percent, Arkansas 35 percent, and Louisiana 36 percent. In a CNBC analysis, among 463 counties with infection levels of at least 100 cases per 100,000 residents, more than 80 percent have vaccinations rates below 40 percent.

On May 10, 2021, the US Food and Drug Administration expanded the Emergency Use authorization for the Pfizer-BioNTech COVID-19 Vaccine to prevent COVID-19 to adolescents 12 through 15 years of age. This amended the original EUA issued on Dec 11, 2020, that authorized the vaccine’s use in those 16 or older.

Vaccines have proven efficacious in preventing, even for the Delta variant, severe disease and hospitalizations, while side effects and disabling complications have been extremely rare. With the call to resume all in-class instructions by the end of summer, unvaccinated children will not only be potentially impacted, but they will also be the dominant vector for the continued perpetuation of the pandemic.