FFFM | Strengthening immunization access and advocating for public health

Welcome to Fighting for Family Medicine. I'm David Tully, Vice President of Government Relations and a member of the AAFP's advocacy team. In this episode, you'll hear how the academy advocates for family physicians in the vaccine space, as well as the importance of engaging coalitions and what family physicians can do to help amplify this work. You can explore more resources related to this episode in the show notes.

The country has come a long way in disease prevention, in large part thanks to vaccines. I'm here today with Julie Riley, the AAFP's Manager of Legislative Affairs, to discuss how the academy advocates at the federal and state levels to ensure vaccines are widely available, easy to find, and affordable for all Americans.

There's a lot that goes into the work behind the scenes, so let's get into it. Julie, thanks for joining me on the podcast. Thank you.

Good to have you here. So let's dive in. Can you give our listeners an inside look at the Academy's priorities when it comes to advocating for vaccines?

Sure. So I'd group our vaccine priorities into two buckets: coverage and infrastructure.

In the coverage bucket, we advocate for insurance coverage of all recommended vaccines to include counseling and administration so patients can get vaccinated when and where they need it. I know one of the most frustrating coverage gaps for family physicians is in Medicare Part B, which only covers four vaccines: flu, COVID, pneumonia, and hep B.

And many other vaccines, like RSV or shingles, are covered through the Part D or pharmacy plan. And we know that patients are just so much more likely to actually be vaccinated if the physician can not only recommend but provide it in that same visit. Otherwise, the patient can forget to visit the pharmacy or worse, in some cases, they may get to the pharmacy counter and realize they don't actually have Part D coverage, and so that leaves them with a big bill, and they skip vaccination entirely.

We've been meeting with congressional offices and educating them about this coverage gap for a while now. And recently, we've been in active discussions with potential sponsors and hope to have legislation introduced this fall that would close that coverage gap. And we still have a way to go, but we are definitely making progress in that bucket.

The second bucket is a big one, vaccine infrastructure. And that includes everything from funding for vaccine programs that provide access to the uninsured, to funding immunization information systems, and to preserving science-based recommendations. And in the last year, we've really spent a lot of time on advocacy related to ACIP or the Advisory Committee on Immunization Practices.

Just as background context here, Congress established ACIP to advise the CDC on vaccine recommendations, and ACIP recommendations set essentially what's like a minimum floor of what insurance plans have to cover. So those recommendations are a really big deal for coverage as well. But last year, Secretary Kennedy completely overhauled ACIP membership and processes, and ACIP narrowed some of the recommendations.

Then in January, the CDC adopted this completely revised childhood immunization schedule that was based on a comparison to "peer nations.” And that schedule removes or downgrades recommendations for a lot of routine childhood vaccines like rotavirus. And then in March, a court essentially issued an order that blocks ACIP from meeting, and it stops CDC from adopting that alternative childhood schedule.

So for right now, coverage is restored to where it was back in spring of 2025. While all this was happening, AAFP was engaging through public statements, formal comment letters to the administration, outreach to Congress, and we were even able to secure a spot for Dr. Furr to comment at an ACIP meeting and express concerns to the voting members directly.

And throughout all of our advocacy, we've called for ACIP to restore qualified voting members, restore family physicians to participating in those ACIP work groups that develop recommendations, and to restoring science-based processes like the use of grade criteria and evidence to recommendation frameworks.

We've also created Speak Outs to help family physicians amplify this message and contact their members of Congress about it, and we've endorsed the Family Vaccine Protection Act, which would help restore ACIP membership and processes.

Great, really appreciate you giving that overview. There's been a lot of activity over the last year. We've been engaged in a lot of conversations internally and externally, and we've also created space for our members to get engaged. I really appreciate that you laid that foundation for our listeners.

So, there's been some breaking news, and that is that we have a new confirmed director at the Centers for Disease Control.

Julie, can you talk a little bit about what we're looking forward to most now that we have a confirmed CDC director in place?

Sure. So, as we've engaged with CDC staff over the last year, it's clear that they've been navigating significant changes with limited resources, so I think finally having a confirmed leader in place should really help with that, and we're really optimistic that Dr. (Erica) Schwartz will rely on science, evidence, and her public health expertise as she leads the CDC. And at the AAFP, we're always ready to work with her and to protect and improve the health of Americans. So I think we're happy to have her in place.

I think one of her first challenges will be responding to the President's recent executive order on what I think it's called Gold Standard vaccine recommendations. And that order is directing agencies to implement this revised schedule that I mentioned earlier, the one that was blocked by the courts. In addition to having agencies try to implement that, it does other things, like it's calling for the MMR vaccine to be split into three separate products, and the agencies have ninety days to respond to that order.

Remember, the CDC is really blocked from implementing the schedule, so there's not really a lot they can do there. But we know the order is also directing HHS to convene a task force on safer childhood vaccines, and there are reports that Dr. Schwartz has a seat on that committee. There are also reports that she's indicated that she's representing CDC staff and, and scientifically-based views during those meetings, so I think it's a positive thing that she will be included.

We're seeing HHS also start to take other actions related to the order that may impact CDC. Like earlier today, the Office of the Secretary of HHS issued a request for information on vaccine recommendation categories. Some of the vaccine recommendations the CDC makes are universal, but others are risk-based.

There's also a category for shared clinical decision-making, and the RFI says that these responses will be used by the new task force on safer childhood vaccines. Now, CDC didn't issue the RFI, but in the past, CDC has defined and operationalized these vaccine recommendation categories. We're working on a response to the RFI, but we also hope that CDC and Dr. Schwartz will continue to bring insight and expertise to that task force based on their medical and public health background. And I also want to flag the AAFP has a Speak Out campaign available to members who want to engage on this executive order. It's directed to Congress to encourage them to provide oversight to the agencies that are tasked with implementing it.

And Julie, I appreciate you talking about the RFI, and I think one clarification for our listeners is that we sort of have a two-part strategy with this recent RFI. One part is that we're asking for more time because they're really giving us less than 30 days to be able to respond, but we also plan to kind of provide a more comprehensive set of recommendations, kind of as they're thinking about kind of vaccine structuring.

So can you take, just take a moment to kind of explain that to our listeners?

Yeah. So the date of the RFI, we kind of had like a pre-notice that dropped on Friday, the 21st. So if you looked at the deadline it set, which was September 20th, it would give a reader of the Federal Register less than 30 days to respond to the notice. And given what's in that RFI, how broad it is, it talks about so many different things and potential new categories that have not been considered before, less than 30 days is really not a feasible amount of time to have a complete response. I mean, they're asking for something where they really need a lot of information and guidance, and we want to make sure that all stakeholders can do that.

So our first step, which we're working on right now, is to send a letter just requesting for an extension to that deadline, and that's been done a lot in this administration where they've issued something with 30 days or less notice, and people have successfully advocated to get an extension. And so we're hoping to push that deadline out to near the end of October, which would give us a much longer timeline to prepare a more complete response.

But in the event we don't get the extension, we still are planning to work, we're still working on the response. We kind of have two teams working on it right now to make sure that we're prepared regardless, but again, want to make sure we have full time to, to fully respond to what that RFI is asking.

Great. I appreciate that clarification. So shifting gears a little bit, I wanted to talk a little bit about the work that we do with external coalitions, and I know you're going to speak to vaccines in a moment, but I want our viewers or listeners to kind of come away with an understanding that in order for our advocacy to really be effective, it really requires us to kind of lean on external relationships and find policy alignment amongst other stakeholders.

And so we have done a lot of work in the coalition space around vaccines. So Julie, I wonder if you could take a moment and share with our listeners a little bit about the coalitions that we're part of and why coalition is so important, especially on the subject of vaccines.

Yeah. So the AAFP serves on a couple of coalitions.

We actually are on the steering committee of the Adult Vaccine Access Coalition (AVAC), and that's a group of healthcare providers, public health organizations, patient advocates and manufacturers, and we're all focused on improving vaccine access for adults. AVAC covers a whole bunch of different things, including coverage policy, but also provider reimbursement and that broader immunization infrastructure that I was talking about earlier.

The reason why coalitions like AVAC are so important is that it helps us amplify our voice, but it also kind of strengthens the quality of our advocacy by bringing together stakeholders who may not always agree on everything, but we do have a set of shared priorities that can help improve vaccination rates and access.

I know with AVAC, there's just such a broad and diverse group there, and they have touched almost every aspect of the vaccine landscape, that it really provides policymakers who work with us a wealth of expertise on a whole bunch of issues. And some of these are areas where the AAFP may not have a ton of focus, like what it takes to get vaccines delivered in a long-term care facility, for example. But obviously, things that we care about or would want to support, essentially. So this gives us cover for a much wider range of vaccine issues than we might traditionally think about. The other thing AVAC does is it often creates opportunities for us to educate both Congress and the federal agencies on really specific challenges in the vaccine landscape and to advance policy solutions.

So for example, we've worked with a small group of members to educate administration officials on reforms that are needed in the Vaccine Injury Compensation Program specifically. So that's one of the groups we're with. We also just joined the Coalition for Health Funding, and that really expands our ability to advocate for investments in vaccine infrastructure and other critical public health programs.

Beyond our formal coalition groups that we're part of, we're also in a lot of informal coalitions that have popped up in the past year, kind of in the midst of all these changes in vaccine policy. These are kind of a lot of informal calls where everyone shares notes on what's happening, what they're seeing, either at the federal or state level, talk about how groups are responding, and sometimes we're sharing information that is not always available, and so it just helps us kind of prepare and gives us context that we might not have otherwise.

Great. So as we wrap up our time together, Julie, we've heard a lot about this in the news, about trust in government and institutions being on the decline, but the one thing that has remained a constant is that people really still have strong trust in their physicians as sort of a stable individual that they can come to for questions about their vaccines or therapeutic.

And I wonder if you can talk a little bit about how family physicians continue to help amplify the work that we're doing here in Washington.

Family physicians are among the most trusted voices in healthcare, and that trust is just so important right now, especially with that executive order that I just mentioned.

I think that is creating more questions and impacting public confidence in vaccines, especially the current childhood schedule and in the MMR vaccine in particular. So one of the most powerful things family physicians can do right now is just continue having vaccine conversations with patients and families.

There is survey after survey that shows that a physician's recommendation is one of the strongest drivers of vaccine confidence and uptake. Current guidelines are available on the website, but I also want to flag the AAFP website also has a lot of resources on how to talk to patients about vaccines, which could be helpful.

And in addition to talking to patients, we also encourage physicians to share their experiences with policymakers. So when Congress or federal agencies hear directly from physicians about how policy impacts them or their patients, those stories are just incredibly impactful.

We have a Speak Out available now on vaccines that I mentioned earlier. It's in the show notes. It mentions that executive order. I also want to flag one other thing about that order that physicians can think about is that it also directs states to look at that revised schedule and consider using it for any state requirements for vaccines. It also encourages expanded exemptions.

So if you're not already involved in state-level advocacy, it's definitely something to keep an eye out for, so you're just going to want to stay connected to your state chapter and be mindful of what could be happening at the state level as well. And then finally, if you're not one already, please become an advocacy ambassador. It keeps you up to date on future Speak Outs and other advocacy opportunities and especially what we're doing in vaccines.

Sounds great. Thanks, Julie. I really appreciate your time, and grateful for the work that you're managing here and look forward to having you back on the podcast in the future to update our listeners on what's happening in the vaccine space. Thanks again for your time today. Thank you.

Thanks for joining us today. You can find out what the AAFP is doing to advocate for you, your patients, and your practices, and how you can get involved by visiting our website at www.aafp.org/advocacy. Be sure to check out the show notes for more links and details about today's episode.

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