Advocating for emergency air transport coverage

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This spring, NCL sent a letter to the CEOs of Cigna, Aetna, and UnitedHealth Group, urging them to enter into productive negotiations with air medical service providers to ensure coverage of emergency air medical transportation. The ask came as the COVID-19 pandemic spread across the country, making air medical services even more essential, particularly in rural America.

“We are increasingly concerned about emergency air medical access during this crisis, and believe this life-saving care should be covered by every insurance plan,” said NCL Associate Director of Health Policy Nissa Shaffi.

“We are asking that insurers review the robustness of their coverage policies and immediately enter into network negotiations with air medical providers so that this critical service is covered, and patients are never left with a bill they cannot pay.”

At-home vision assessments no replacement for in-office visits

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With COVID-19 keeping many of us at home, companies claiming to offer at-home vision tests are ramping up their marketing, despite the fact that there is no U.S. Food and Drug Administration-approved at-home device that people can use to self-conduct a vision assessment, let alone a full eye examination. These devices aren’t even proven to provide an accurate vision prescription. NCL has long recommended an annual, in-person eye exam as part of consumers’ annual health and wellness routines.

“Consumers need to be wary of products that mistakenly claim that their at-home devices can provide an eye exam or a vision prescription and should instead consult their eye doctors who are available to help provide safe solutions,” said NCL Associate Director of Health Policy Nissa Shaffi.

Sorting through bogus health claims

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Across the United States, people are rising to the historic health needs and challenges posed by coronavirus, with healthcare workers on the frontlines risking their lives, and businesses pivoting to manufacture much-needed medical and protective supplies.

But deep concerns about the health implications—what happens to people who contract the disease from a health and financial perspective—are top of mind for many of us. And a cynical minority has seized on the crisis to employ unscrupulous, and frankly dangerous, marketing tactics to promote bogus products claiming to protect users against the coronavirus or provide relief for those infected—as well as peddling downright phony coronavirus testing products.

“These false claims touting unproven medical benefits are nothing more than craven attempts to take advantage of fearful consumers,” said NCL Executive Director Sally Greenberg.

“Moreover, they spread misinformation among consumers anxiously seeking ways to stay safe and healthy amidst the coronavirus crisis.”

In an op-ed in The Hill published in May, Greenberg noted that a number of CBD manufacturers and stores are falsely promoting unproven medical benefits of CBD products.

A CBD store in Portland, OR, for example, was recently ordered by the office of the state’s attorney general to take down signs claiming that its products could boost immunity against COVID-19.

“False claims such as this are particularly dangerous as consumers anxiously attempt to stay safe and healthy amidst the coronavirus crisis,” said Greenberg. “The need for science-backed treatments is significant and we must ensure products are tested and regulated for safety.”

Contrary to claims being made by CBD marketers that products containing cannabidiol can help those suffering from coronavirus, recent studies have actually found potential harmful side effects of cannabis products on infected coronavirus patients. Aurelius Data cautions the public against the potential harmful side effects that can come from consuming cannabis products with Tetrahydrocannabinol (THC) if a patient is infected with COVID-19. And studies have shown that many unregulated CBD products have been found to contain THC, though the labels may not disclose this.

“In these uncertain times, we urge consumers to continue to take precautions,” said Greenberg. “We urge everyone to follow CDC guidelines for COVID-19, practice safe social distancing, and at the same time avoid THC products and all untested, unregulated CBD products to help keep your family, friends, and communities safe.”

The overlooked epidemic: COVID-19 and its relationship to opioids

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By NCL Health Policy intern Talia Zitner

The coronavirus pandemic isn’t the only major public health crisis plaguing America. As the country struggles to contain COVID-19, the pandemic has seen a corollary rise in incidents of opioid usage and overdose. A major disruption in the way people suffering from opioid addiction receive treatment may ultimately prove critical to understanding how the opioid epidemic is directly affected by the coronavirus.

When lawmakers passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act in March, opioid treatment centers were not eligible to receive any of the $50 billion in funding that was allocated for Medicare providers. As a result, these essential centers—often under-supported and understaffed—saw their workforce getting ill or leaving to care for loved ones. Additionally, job loss and illness have left those already at risk of opioid addiction more vulnerable to relapse and death.

A key problem is the patient’s ability to get a prescription for addiction-managing drugs. Many centers rightly offer only one pill a day to their patients, but as the pandemic has forced the need for physical distancing and lack of physical contact, it has become increasingly difficult for people to get their medication. Long lines and hours-long wait times dissuade patients from getting their daily dosage. Few patients qualify for more than one dose per day, and few doctors are authorized to prescribe larger amounts of opioid managing medication.

Sadly, the coronavirus pandemic has overshadowed the opioid epidemic that continues to haunt millions of Americans. During this difficult time, the government should focus on the risk of opioid abuse and overdose and put more money into treatment programs and centers. Without support, more people will succumb to opioid addiction, lack of access to treatment, and death, further burdening the health care system.

Talia is a Washington, DC native and a rising sophomore at Wesleyan University, where she is studying English. Beyond health policy, Talia’s interests are in journalism, law, and social justice.

NCL leads advocates in urging FDA to protect patient access to critical therapy for preterm birth

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By Sally Greenberg, NCL Executive Director

The National Consumers League and 14 leading health organizations and individual providers have collaborated in sending a letter to the Food and Drug Administration (FDA) as the agency considers whether to withdraw the only FDA-approved therapy that reduces the risk of preterm birth in women with a history of preterm birth.

Why did we and our fellow advocates decide to send this letter in the midst of the COVID-19 pandemic? Several important reasons.

First, preventing preterm birth is always a vital cause—during or without a pandemic. The leading cause of infant death in the United States, premature birth has devastating effects on families and is very costly to our health care system. For babies who do survive, short and long-term complications can accompany preterm birth. For mothers, a history of spontaneous preterm birth is a leading risk factor for recurrent preterm birth, yet providers have only one therapeutic option – hydroxyprogesterone caproate or “17P,” in one branded and five generic forms – to prevent recurrent preterm birth for these at-risk mothers.

Taking away these options—especially in the midst of a pandemic—would be concerning for pregnant women who are at high-risk for preterm birth, including those that reduce their risk of being admitted to the hospital for early delivery.

Secondly, as recent events surrounding both COVID-19 and continued fundamental rights injustices have reminded us, a profound and systemic inequity exists in the United States where institutional racism contributes to health disparities—including preterm birth and infant mortality. COVID-19 has disproportionally impacted African American women, the same population that is most likely to experience preterm birth. The preterm birth rate among U.S. black women is 49 percent higher than the rate among all other women, according to the March of Dimes.

Thirdly, 17P is the only FDA-approved therapy that reduces the risk of preterm birth and has been used for nearly a decade. We are concerned that removing access to the only FDA-approved therapy may deepen maternal and infant health inequities that exist within the U.S.

It is also troubling that if providers cannot access FDA-approved forms of 17P, this may expose pregnant women to compounded medications, which have no labeling to provide guidance on administration, contraindications, or potential side effects.

Removing 17P products in the absence of suitable alternatives would leave patients and providers significantly disadvantaged in the fight against prematurity. While we recognize the FDA is encountering tremendous challenges in addressing the COVID-19 pandemic, it is important to underscore the public health need for continued access to approved treatment options, and we trust that the agency will consider the patient impact as they evaluate this issue.

To add your voice to the letter to FDA, urging the agency to preserve patient access to the only FDA-approved therapy to reduce the risk of preterm birth, you can sign on here.

The impact of COVID-19 on child labor

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By Child Labor Coalition intern Ellie Murphy

Combatting child labor during a global pandemic is a staggering challenge. In countries like Ghana, the Ivory Coast, Bangladesh—and dozens more—school cancellations and lost family income may push children into the labor market. Once in, it may be hard for them to get out and return to school. In the face of this dire emergency, governments, the corporate world, and charitable institutions will need to support vulnerable families during this unprecedented time.

There is a strong correlation between access to education and preventing child labor. “Lack of access to education keeps the cycle of exploitation, illiteracy, and poverty going—limiting future options and forcing children to accept low-wage work as adults and to raise their own children in poverty,” noted the children’s advocacy group, Their World.

With nine in 10 children across the globe prevented from attending school in person, Human Rights Watch notes that interrupting formal education will have a huge impact on children and jeopardize their opportunity for better employment opportunities in the future: “For many children, the COVID-19 crisis will mean limited or no education, or falling further behind their peers.”

Poverty is the single greatest cause of child labor. Because many parents have lost or will lose their jobs, children are facing increased pressure to supplement family incomes. “Children work because their survival and that of their families depend on it, and in many cases because unscrupulous adults take advantage of their vulnerability,” notes the International Labour Organization.

Countries are being impacted by COVID-19 differently, but developing countries are expected to feel more negative consequences than developed countries, according to a report from WorldAtlas.com. Tourism and trade helps fuel many of these economies and the COVID pandemic has devastated both sectors.

Developing countries—primarily in Africa and Asia—already house 90 percent of working children, according to the International Journal of Health Sciences. Economic pressure from the pandemic will likely drive even more children into the workforce.

Before the pandemic, child labor in West Africa was widespread. 2.1 million child laborers were employed by cocoa farms in the Ivory Coast and 900,000 children on cocoa farms in Ghana, according to researchers from Tulane University. Ghana and the Ivory Coast produce about 60 percent of the world’s cocoa—a critical ingredient in chocolate. A recent Voice of America (VOA) article included predications that “there will be increased economic pressures on farming families, and ongoing school closures in Ghana [meaning] children are more likely to accompany their parents to their farms and be exposed to hazardous activities.”

The VOA cited research by the International Cocoa Initiative that analyzed the impacts of income loss on child labor rates in the Ivory Coast and found that a 10 percent drop in income for families in the cocoa industry is expected to produce a 5 percent increase in child labor.

Bangladesh, which had a reported 1.2 million children trapped in the worst forms of child labor in 2015, according to *the ILO, is also at risk of seeing child labor increase. Most Bangladeshi workers—*87 percent—earn money in the informal economy performing daily labor, unpaid work for their family, or piece-rate work. COVID-19 impacts have left families struggling with a severe drop in income of around 70 percent in many cases. Many adults and children who work making parts of products like garments have seen their income disappear entirely. “Those who depend on daily wages, for example, day labourers, rickshaw pullers, construction workers, street vendors, workers at small informal factories have lost their incomes with the hit of the pandemic,” noted researchers with the Institute for Development Studies. With this dramatic loss of income, it is expected that families will turn to their children to earn more money to buy basic necessities for survival.

In an effort to combat the potential increase in child labor, human rights organizations have urged governments to support families during this crisis—including the use of cash transfer programs. This entails direct cash payments to destitute families. Sometimes there are strings attached to the payments. Families that accept the money must promise to keep children in school and not allow them to enter the labor market. Cash transfers, often involving small amounts of money, have proven effective, in varying degrees, in reducing child labor in many countries.

In the COVID-19 pandemic, even small amounts of money might prevent starvation—or keep children out of the labor market. Save the Children argues that cash transfers help reduce the rate of child mortality, increase access to education, and reduce child abuse. Researchers Jacobus DeHoop and Eric Edmonds recently noted that 133 countries were working on social protection responses that provide financial support to vulnerable families in an effort to combat an increase in child labor during this time. Human Rights Watch has a series of recommendations for governments, including cash transfer payments.

Government efforts alone may not be enough. Companies that employ vulnerable demographics must also respond. Verité, an organization that works to eliminate abusive labor and empower workers, issued a series of *recommendations to help companies address COVID impacts. Among the recommendations was a call for companies that work in areas with high rates of child labor to monitor “hot spots” for exploitation and intervene when necessary. Additionally, Verite urged companies to provide benefits for families who experience a loss of a parent due to the pandemic, make work remote when possible, and provide longer sick leaves for employees.

The COVID-19 crisis calls for innovative efforts to protect vulnerable families and children. As Jo Becker, the children’s rights advocacy director at Human Rights Watch, notes “the choices governments make now are crucial, not only to mitigate the worst harm of the pandemic, but also to benefit children over the long term.” By providing families with desperately needed resources during this unprecedented time, it may be possible to help curtail the increase of child labor worldwide.

In the last two decades, the world has seen the number of child laborers drop by nearly 100 million. “We do not want to see those hard-won gains reversed,” said Reid Maki, director of child labor advocacy for the National Consumers League and the coordinator of the Child Labor Coalition. “Concerted and robust action is required.” The actions that those in power take today will have long-lasting impacts that go far beyond COVID-19.

Ellie Murphy is a rising junior at Tufts University, majoring in International Relations and Sociology.

*Links are no longer active as the original sources have removed the content, sometimes due to federal website changes or restructurings

NCL statement condemning threats to public health officials

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June 25, 2020

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC—The National Consumers League (NCL) is deeply concerned with the rise in harassment and threats to public health leaders across the country in response to the nationwide shutdowns due to COVID-19.

Public health leaders are being subjected to pressure following guidelines regarding social distancing and face mask usage. Critics of these guidelines have politicized preventive health measures due to perceived disruptions in personal liberties. They have resorted to “doxxing” public health officials—a practice that involves revealing someone’s private information, such as place of employment and residential address, publicly over the Internet. Other intimidation tactics that have been employed include protesting outside of health officials’ homes to incite fear.

These tactics have created hostile work environments for public health officials, leading to 27 resignations or request of reassignments across 13 states—in the interest of personal safety. Public health workers also fear that these actions could potentially have a negative effect on recruiting people into pursuing careers in the public health field.

“Public health departments are already underfunded and understaffed, and in the midst of this pandemic, we need our full arsenal of public health experts on the front lines,” said NCL Executive Director Sally Greenberg. “We cannot afford to lose any personnel in this space at this time. The U.S. is already behind regarding testing and other preventive measures. We need to let public health workers do their jobs to keep us safe, informed, and empowered regarding our health.

“NCL unequivocally condemns the threats placed against our public health workers. We rely on these individuals to keep us healthy, and we need them now more than ever. All they ask from us in return in our cooperation in flattening the curve.”

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Vaccine hesitancy and the unique challenge of COVID-19

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headshot of NCL Health Policy intern Talia

By NCL Health Policy intern Talia Zitner

Around the globe, researchers and scientists are racing to find a vaccine for the COVID-19 virus. Developing a safe, effective, and affordable vaccine is already a challenging feat, but vaccine hesitancy presents another unique challenge to scientists, government researchers, and community leaders.

“Vaccine hesitancy” refers to the reluctance or refusal to be vaccinated or have one’s children vaccinated against a disease, even if a vaccine is proven to be safe and effective. Vaccine hesitancy poses dangers to both the individual and their community, since exposure to a contagious disease puts the person at risk, and they are far more likely to spread the disease to others if they won’t get vaccinated. Ironically, these communities may be the most vulnerable to COVID-19, and a serious effort must be made to create a sense of comfort around the COVID-19 vaccine once it’s available to the public.

Not to be confused with the vaccine-hesitant, “anti-vaxxers” represent a movement of people who dispute the safety of vaccinations and challenge laws that mandate vaccinations. This is a more insidious movement funded by dubious sources (reportedly, one New York couple has donated millions of dollars to the movement) that deceptively politicize public health measures under the guise of protecting personal liberties.

Public health agencies are trying to get vaccination levels to 95 percent to guarantee herd immunity. Some concerns that are top of mind for consumers include knowing the timeframe for a vaccine, who will have access to it, what it will cost consumers, if anything, and how states will determine methods of enforcing vaccination. The possibility of a COVID-19 vaccine also begs the question of whether vaccination will be mandatory for public schools and government workers.

Perhaps one of the most important projects right now surrounding vaccine hesitancy is the Vaccine Confidence Project (VCP), which is dedicated to “conducting a global study to track public sentiment and emotions around current and potential measures to contain and treat COVID-19.” Using a mix of population surveys and social media tracking, VCP “will investigate perception and sentiment of COVID-19 social distancing measures and potential medical tools globally.” This project will be essential moving forward, as it will continue to inform understanding on how the global population perceives the eventual vaccine.

As of now, VCP reports that only 25 percent of African Americans—a population that has been disproportionately hit by the virus—plan to get the COVID-19 vaccine. Why is this the case? Due to lack of access to hospitals, pharmacies, doctors and clinics in Black communities, failure to expand Medicaid, and other root causes; the COVID-19 pandemic has laid bare the disparities in our health care system.

To ensure herd immunity—which is somewhere north of 90 percent immunity—much work needs to be done, especially with the Black community, to increase confidence when a COVID-19 vaccine is released. At this time, Black leaders such as former U.S. Surgeon General, Dr. Regina Benjamin, and current U.S. Surgeon General Dr. Jerome Adams, are among those leading the charge to encourage public health efforts such as advocating for face-mask usage and collaborating with the National Newspaper Publishers Association (NNPA) Coronavirus Task Force and Resource Center, which provides expertise on the virus and its impact on the Black community.

Another community that will be crucial to prioritize surrounding vaccine hesitancy is the older Americans. The New York Times reported that of the “241 interventional COVID-19 studies undertaken in the United States and listed on clinicaltrials.gov…37 of these trials—testing drugs, vaccines and devices—set specific age limits and would not enroll participants older than 75, 80 or 85 years old. A few even excluded those over 65.” Why would older Americans trust a vaccine not tested for their age groups? Clinical trials will need to include people across all ages, otherwise, this will only increase vaccine hesitation. The vaccine must be safe and effective, and ample outreach must be conducted to ensure vaccine confidence across all demographics.

There are many questions left to be addressed. As we continue to navigate preventive measures for COVID-19, independent researchers and organizations will become increasingly more important to guiding decision making before and after a vaccine is developed.

Vaccine hesitancy is a global problem that will only be compounded by the COVID-19 pandemic. Fostering vaccine confidence will be imperative when the second wave of the virus sweeps the globe, as it inevitably will.

Talia is a Washington, D.C. native, and a rising sophomore at Wesleyan University, where she majors in English. Beyond health, Talia’s interests are in journalism, law, and social justice.

Top of mind: HHS’s reversal of Obama-era transgender nondiscrimination healthcare protections

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

On June 12, the Trump Administration finalized a rule that proposed to revise, and in effect reverse, Obama-era protections offered in Section 1557 of the Affordable Care Act (ACA). Section 1557, known as the Health Care Rights Law, prevents discrimination of patients based on “race, color, national origin, sex, age, or disability.” In 2016, the Obama Administration expanded the definition of sex to encompass aspects of gender identity as well—extending protections to transgender and gender non-conforming individuals. 

The finalized rule will drastically impact how LGBTQ individuals navigate their health care and health insurance, with regard to nondiscrimination protections. The rule would essentially affect aspects of coverage related to access, cost-sharing, and health plan benefits, specifically, denial of treatment based on someone’s gender transition and/or a provider’s moral or religious beliefs.

The U.S. Department of Health and Human Services (HHS) released a statement following this news expressing that reinstating the original definition of the protections offered would relieve the American people of approximately $2.9 billion in “unnecessary regulatory burdens”. These so-called burdens also include eliminating mandates for regulated entities to provide patients and customers with language accessibility pertaining to health care literature.

Considering the nexus of a global pandemic, civil unrest due to systemic racism, compounded by the epidemic of fatal violence against Black transgender people – the timing of this rule is not only inopportune but exceptionally cruel. The National Consumers League is appalled at the reversal of these protections during a pandemic that is disproportionately impacting vulnerable communities. We urge health insurers and providers to do the right to protect patients by keeping politics out of professional medical judgment when providing services to their patients and customers.

Keeping meatpacking workers safe in the age of COVID-19: A view from the front lines

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By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

Meatpacking plants across America have become hot spots for COVID-19. Many plants have had to close due to the rapid increase in cases, with hundreds of workers contracting COVID-19 and a tragic number dying from the deadly virus.

Many packing plants have reopened over the past couple of weeks but the question still remains:  what measures have been put in place to address working conditions?

We interviewed someone who has firsthand knowledge of what is happening on the inside.  Robyn Robbins is the director of occupational health and safety at the United Food and Commercial Workers Union (UFCW). She has worked for UFCW for the past 24 years and prior to this position she was the Assistant Director for 18 years. UFCW is one of the largest labor unions in America. The Union represents workers in meatpacking, poultry, food processing industry, retail grocery, and healthcare—all considered to be essential workers.

Robbins told us: “Many workers are getting sick and dying, and the industry has a history of exploiting workers.” Indeed, the meat industry does not have an admirable record on protecting workers from hazards long before COVID-19. Meatpacking plants on average can employ up to 5,000 workers under one roof, and the conditions are very challenging.  Workers work closely on production lines, sometimes “shoulder to shoulder,” and the areas where they congregate off the line—such as break rooms and locker rooms—can get crowded.  The virus can spread quite easily under these conditions. And the industry has not done enough to allow workers to socially distance both on the production floor and off, or to notify the union when workers are infected, and who else has been exposed, so that the spread of the virus can be contained.

Even amid the pandemic, the demand for meat and poultry is constant. As a result, meatpacking plants have reopened, albeit not at full capacity.  Robbins noted that OSHA (Occupational Safety and Health Administration)—the federal agency that regulates safety and healt—has taken a backseat and has not done on-site inspections. “There are no safety standards that regulate COVID-19 and no clear requirements or regulations that companies are required to follow and therefore there is no way to force companies to actually take precautionary measures recommended by the CDC to protect workers,” Robbins said. She went onto say that “OSHA is the only Federal government entity that can require companies to do anything to protect workers during this pandemic.”

UFCW local union representatives and stewards are in the plants and work hard to get companies to do the right thing to protect workers through the collective bargaining process. “The challenge is trying to get the companies to space workers out on the production floor, which does require some slowing down of line speeds; some of the companies are doing the right thing by spacing workers out but many are not, and are relying too much on protective equipment and plastic barriers, which have not been proven to offer any protection, when it is really about putting more distance between people,” Robbins told us. Social distancing in break rooms is another challenge. Companies have made some effort to effectively separate tables and are putting tents outside for workers to take breaks in those designated areas. They are also staggering shift times in order to reduce the number of workers in break areas at any one time.

Robbins noted: “not all companies are testing workers when they should be, which is a major problem.” UFCW is calling on meatpacking plants to test workers, but companies are reluctant. “If companies worked more closely with the union, they would collectively be able to come up with strategies to isolate workers, redistribute the work, and be more effective over all in addressing the issues relating to COVID-19 and meatpacking workers.”

UFCW doesn’t agree that reopening of plants should take place where there have been outbreaks and where unsafe working conditions exist, unless the companies have taken the steps necessary to protect workers from exposure to COVID-19. “The companies that did shut down made the right decision to sanitize and clean the plants,” said Robbins. “Some have also started screening workers, set up hand sanitizing stations, providing masks, spacing out common areas, giving workers face shields and putting up plastic barriers on the floor between workers where it is possible – although again, there is no data to show that plastic barriers do anything to stem the spread of the virus.”

But this is still not enough. UFCW wants to see workplaces reconfigured so that workers can be six feet apart, both on the production floor and off. This is crucial for stemming the spread of the virus.

Robbins said sick leave policies vary tremendously. “There are 500 local unions around the country, and the UFCW has been pushing for 14 days’ sick leave, successfully bargaining for this in contracts. Some companies are using a combination of different ways to allow workers to stay home when sick, many suspending their normal sick leave policy and making them more flexible. Some companies use a combination of paid sick days and short-term disability so that workers can stay home to recover and then return to work in a safe way. But not all companies are doing this; a few are even revoking paid sick leave policies that were in place at the beginning of this crisis.  This only will result in sick workers coming to work, because they have to in order to earn a living, and the virus will continue to spread, both inside plants, and outside in their communities.  It is bad corporate policy.”

Due to the thousands of cases of COVID-19 in meatpacking plants and many plants not operating at full capacity, meat shortages may continue. In closing, we so appreciate UFCW representing worker interests and Robyn Robbins’ service on NCL’s Board of Directors.