Addressing health inequity: A critical step towards a successful national vaccine rollout strategy

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

The COVID-19 vaccines have provided much needed doses of hope as consumers eagerly wait for their shots. However — due to competing pressures of managing inadequate supplies, complex state-managed distribution plans, emerging viral variants, and unaddressed health disparities — the national vaccine rollout has fallen short of its intended goals.

To date, more than 40 million have received at least one dose of a COVID-19 vaccine, and 16+ million people are currently fully-vaccinated. On average, providers around the country are administering 1.6 million doses per day. According to experts, 70 to 90 percent of the population will need to be vaccinated if we are to achieve herd immunity and return to normal everyday activities.

The delays in the vaccine rollout have been attributed to variations among states and territories, which have been expected to set their own distribution plans and eligibility criteria. All states have made the vaccine available for healthcare workers, and nearly 43 states and the District of Columbia have expanded their eligibility to include occupation-based vaccination programs. These include members of the non-medical essential workforce, like grocery store employees and police officers.

While vaccine hesitancy among some Americans remains a problem, it’s becoming less of a concern as more and more people are getting vaccinated. COVID-19 has further exposed both vulnerabilities in our infrastructure and social determinants of health — conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect their overall health — that threaten to impede access. Throughout the rollout, vulnerable communities have experienced barriers in booking vaccine appointments due to limited access to broadband, phones, and accessible, affordable transportation.

Vaccine hesitancy and social determinants of health remain the primary obstacles in the rollout process. Going forward, addressing health disparities will be a critical strategy in realizing a successful national response, because — without health equity — the virus will continue to ravage the most vulnerable communities. The National Consumers League supports comprehensive strategies to address the glaring disparities in health and access that COVID-19 has exposed.

Does your baby’s food contain toxic metals?

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By Nailah John, Program Associate

As a mother, I once fed my baby with baby food only to later be told that some baby foods contain toxic metals at levels that exceed what experts and governing bodies say are safe. Congressional investigators have found dangerous levels of toxic heavy metals in many popular baby food brands. The World Health Organization says that the top 10 chemicals of concern for infants and children include arsenic, lead, cadmium, and mercury.  This exposure to heavy metals in childhood is linked to permanent dips in IQ, an increased risk of future criminal activity, and damaged long-term brain function.

Some pediatricians and children’s health experts say that heavy metals are found in soil and contaminate crops grown in it. Heavy metals can also get into food during manufacturing and packaging processes. However, the amount that is allowed in baby food products exceeds the limit. The nonprofit Healthy Babies led a national investigation and found that 95 percent of baby foods tested contain toxic chemicals. Fifteen foods accounted for half the risk, with rice-based foods at the top. Making these food and lifestyle changes can help reduce toxic metal residue:

  • Choose rice-free snacks over rice-based ones. Try a frozen banana or a chilled cucumber instead of rice-based teething biscuits.
  • Opt for oatmeal over rice cereal.
  • Give tap water over fruit juice.
  • Rather than sticking strictly to baby food made from sweet potatoes and carrots (which contain higher levels of metals), opt for baby food made from other fruits and vegetables.
  • Make your own baby food by buying, washing, and blending your own fruits and vegetables.
  • Don’t get stuck in the baby food phase. Baby food is meant to be transitional, used only for a few months. Introduce your babies to sources of protein like fish—salmon, tuna, cod, whitefish, and pollock.
  • Visit the pediatrician often in the first two years of your child’s life. This can help to identify any developmental problems.
  • Limit heavy metal exposure in other ways. Heavy metals are also found in peeling or chipping paint in older homes built before 1978.
  • Don’t smoke or vape as secondhand and even thirdhand smoke (or residue from smoking on furniture or clothes) may expose children to metals like cadmium and lead.

While individuals can do their part, the most significant changes will have to come through enforced legislation and stronger regulations on baby food. According to the recent congressional report, toxic metals in tested baby food eclipse safe levels, “including results up to 91 times the arsenic level, up to 177 times the lead level, up to 69 times the cadmium level, and up to 5 times the mercury level.” The report recommended that the Food and Drug Administration require baby food manufacturers to test their finished products for toxic heavy metals and label products that contain them. One of the most powerful ways of creating change is by calling your Member of Congress and urging them to use their voice to address the issue of heavy toxic metals in baby foods. As a mother, I plan to do so and so should you.

What the new COVID-19 variants mean for consumers

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

Viruses mutate, and SARS CoV-2—more commonly known as COVID-19—is no exception to that rule. When a virus evolves and mutates from its predominant virus, all that we know about it changes as well. It may be too soon to glean what impact the variants could have on vaccine rollout and efficacy, but the Centers for Disease Control and Prevention (CDC) have provided the detailed evidence they’ve uncovered thus far.

Three new strains of COVID-19 have been identified presently in four countries: the United Kingdom (B.1.1.7), Japan and Brazil (P.1), and South Africa (B.1.351). These new variants have not been observed to be more deadly, nor have they made people sicker, but one thing they all have in common is that they are more contagious than COVID-19. Cases for these strains have been found in 33 countries, including the United States.

While the variants all differ slightly in their function, they all possess a specific mutation called D614G — a shared trait that allows these new strains to spread more quickly than the predominant virus. The strain found in the United Kingdom, B.1.1.7, has an estimated 50 percent transmissibility rate, or how quickly it spreads from person to person. Considering ongoing efforts to release new vaccines for inclusion in a national rollout to curb this pandemic, a mutating virus presents unique challenges for an already overburdened healthcare system.

So, what does this mean for travel, testing, vaccines, and so on? The CDC has released a helpful questionnaire for individuals to consider before they pursue travel, requesting that people delay non-essential travel whenever possible. For those that plan to travel, the CDC has released guidance which states that individuals traveling via air into the United States must provide proof of a negative test result or documentation of recovery, before boarding their flight. Masks are required on all forms of public transportation, including planes. The CDC has issued travel notices regarding global travel and each country’s corresponding risk-level.

Scientists are continuously gathering data to determine how the variants will impact the efficacy of certain therapies, vaccines, and tests. Until further evidence suggests, states are reluctant to enforce stringent lockdown procedures. According to public health experts, the best way to rein in the transmission of these highly contagious variants and to ensure a successful vaccine rollout, is to practice physical distancing and double masking. Layering two masks, as double masking suggests, provide added layers of protection and a better-fitting face covering. Not all masks are equal. To learn more about how to maximize protection against the coronavirus with masks, click here.

As new information emerges, it is important to adjust our safety measures to successfully navigate an ever evolving situation. Consumers are understandably experiencing pandemic-fatigue. Rest assured that the fruits of our collective efforts are closer than they appear, if only we work together towards protecting ourselves and our communities from unnecessary transmission.

Mask up! New Executive Order mandating mask-wearing a welcome development

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

On January 20, just hours following a historic inauguration, President Biden signed an Executive Order (EO) requiring mask-wearing on federal property and inside airports, planes, trains, ships, and intercity buses. Effective immediately, refusing to wear a mask in these locations will now be considered a federal offense. The President also called on governors and local health officials to encourage mask-wearing and social distancing. This comes as especially good news for airlines and their employees, as they now have a federal rule protecting them from passengers who refuse to wear masks inflight, in turn ensuring everyone’s safety.

The EO is the latest of many efforts to halt the spread of COVID-19 by influencing behavior around this necessary public health measure. The mandate to require mask-wearing is also poised to complement President Biden’s call to action for the American public to commit to 100 days of mask-wearing, during the early days of his presidency. Epidemiologists agree that concerted efforts towards pandemic-related precautions can significantly reduce COVID-19 cases in the country, providing much-needed relief for health care facilities currently operating beyond maximum capacity.

Over the course of the pandemic, mask-wearing has unfortunately morphed into a highly polarizing political issue. More than 405,000 Americans have perished in the last year, and irresponsible behavior, such as a stubbornness towards wearing masks, will only further exacerbate the crisis. There are many contributing factors behind this phenomenon, but a lot of it distills down to misinformation and propaganda.

The bottom line is that masks save lives and are powerful tools in preventing the spread of COVID-19. They should be worn to protect the wearer, as well as those they come into contact with. The EO mandating the use of masks is a great step in encouraging civic responsibility in containing the virus. As we forge ahead in our persistence against the coronavirus, consumers are encouraged to maintain adherence to federal health guidance pertaining to physical distancing, the usage of masks, and other public health measures.

The evolution of American alcohol policy — and what’s next

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By Nailah John, Program Associate

Alcohol is consumed by billions of consumers the world over. Humans drink alcohol for many reasons, including enjoying the taste or coping with stress while others consume alcohol because of social influences. More than 85 percent of people around the world consume alcohol. America’s alcohol policy has seen many ups and downs over many decades from prohibition in the 1920s to the end of prohibition in 1933, National Minimum Drinking Age Act in 1988, the Alcohol Beverage Labeling Act 1988 (ABLA), and the continued efforts for a “Nutritional Facts Label” on all alcoholic beverages by consumer advocacy groups.

Every other consumable product on the supermarket shelves is required to have a Nutritional Facts Label. That label has a list of required information about a food’s nutrient content, such as the calories, protein, vitamins, fat, sugar, sodium, and fiber. This is critically important consumer information for guiding healthy choices.

After Prohibition In 1935, the Federal Alcohol Administration governed alcohol regulation. In 2003, the Alcohol and Tobacco Tax and Trade Bureau (TTB) was formed, and alcohol continued to be regulated by this federal agency. Since the 1970s, consumer advocacy groups have worked for a comprehensive label on all alcoholic products. In 2003, the Center for Science in the Public Interest (CSPI) and the National Consumers League made a hard push for a nutritional facts label. Manufacturers asked for voluntary labels, making the argument that putting nutrition facts on all bottled of alcohol would make consumers think that alcohol was nutritious. In 2004, TTB sided with manufacturers and issued guidelines that allowed them to list calories, carbs, protein, and fat­—but only if they wished to do so voluntarily. In 2021, NCL and other groups are recommitting ourselves to this consumer information campaign.

The Dietary Guidelines 2020-2025 lay out the existing recommendations for sugar and alcohol, which recommend moderate alcohol consumption––up to one alcoholic drink per day for women and up to two per day for men. The CDC warns that alcohol consumption is associated with a variety of short and long-term health risks: high blood pressure, various cancers, motor vehicle accidents, violence, and sexually risky behavior. The CDC guidelines also note that pregnant women should refrain from alcohol consumption and that those with certain condition should avoid alcohol. That is true as well with certain medications.

More than half—55 percent—of Americans say they have had alcohol in the past month. An estimated 14.5 million American adults age 12 and older battled an alcohol use disorder, or 5.3 percent of this population. The bottom line is that if you drink, do so in moderation per the CDC and DGAC guidelines. And join with consumer advocates fighting for a nutritional facts label to be put on all alcoholic beverages.

COVID vaccine: Credit where credit is due

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By Sally Greenberg, NCL Executive Director

It’s almost a miracle. We now have safe and effective vaccines to fight SARS CoV2, commonly known as COVID-19, the devastating illness that has swept across the globe and—as of January 16, 2021—has killed more than 390,938 Americans and infected 23.5 million in less than a year.

Nearly 40 percent of those who’ve died were beloved older Americans in long-term care facilities, where the disease spread like wildfire, and who were often unable to say goodbye to loved ones.

Sadly, many who contracted the illness and survived spent lengthy hospital stays clinging to life on respirators. Of those who recovered, millions report COVID’s debilitating long-term effects. The United States has four percent of the world’s population but nearly a fifth of its recorded coronavirus deaths—the most of any country. Think of this: we have lost in less than one year eight times the number of Americans who died in the whole Vietnam war, and nine times the number who die in car accidents each year.

But now there’s light at the end of the tunnel because, in record time, America’s pharmaceutical companies have successfully developed safe and highly effective vaccines. Since the SARS CoV 2’s grip over America in late March of 2020, all medical experts could talk about—beyond washing hands, wearing masks, and social distancing—was getting a vaccine to prevent this illness. But vaccines typically take many years to develop so, we were told, don’t hold your breath. And yet here we are.

Consumer groups and members of Congress have been known to criticize the pharmaceutical industry. I get it; too many drugs are expensive and out of reach for millions of Americans, and that must be addressed. But it’s also important to acknowledge value of the public private partnership and the vast resources these companies have put into the R&D and bringing to market life-saving vaccines.

The COVID-19 pandemic is a prime example. The leading vaccines developed for COVID-19 are here, thanks to the dedication of industry leaders and scientists. Pfizer CEO Albert Bourla shifted the company’s focus to singlemindedly developing a COVID vaccine, leveraging its substantial scientific and medical expertise, as well as 20 years of research on previous SARS-like illnesses. Pfizer committed hundreds of millions of dollars of its own resources to building a manufacturing network, and companies agreed to share their knowhow. These efforts were critical in achieving an effective and safe vaccine in record time. And in creating a distribution system that could maintain the very cold temperatures needed to preserve, especially the Pfizer vaccine, before it is administered.

Our government doesn’t have the resources to make that happen alone. Yes, something close to $10 billion in taxpayer dollars through Operation Warp Speed went to companies to assist with the rapid development of a vaccine, but Pfizer didn’t accept government funding for the initial development of the vaccine (though the company did receive $1.95 billion for manufacturing and nationwide distribution of 100 million doses).

And now we have Moderna, which also received more than $1 billion in funding, joining Pfizer in making available a two-dose vaccine that is safe and 95 percent effective, with Johnson & Johnson, Merck, and Novavax not far behind with vaccines that may only require one dose. The public-private partnership model works. And consumers won’t have to pay to receive these shots. Experts tell us we should have five vaccines available by March or April, which is important because it gives healthcare providers options for different populations.

The next challenge is getting it into the arms of enough of us so that we can reach herd immunity, which means at least 60-70 percent of the population needs to be vaccinated.

And while this process has been disappointingly slow, this is largely because states haven’t been given adequate resources from the federal government to support a massive vaccination program. That said, more than a million Americans and counting have now been vaccinated and, under the incoming Biden-Harris Administration and a Democratic Congress, vast additional resources will be going to support for states and localities. The good news for vaccines is that there is high demand for the shots. My own Washington, DC community has offered thousands of appointments for shots online in the morning and they are taken immediately.

We have many to thank for this vaccine’s rapid development, but we must acknowledge the success of this uniquely American public-private partnership. We applaud the heroic work of Pfizer, Moderna, and the other companies to speed R&D and clinical trials of thousands of patients, to ensure a vaccine that is safe and effective. And kudos also to the trusted scientists at FDA and CDC for reviewing the data, ensuring the safety and efficacy of the vaccines, and approving them.

A special thanks is due to two esteemed FDA directors: former director Dr. Scott Gottlieb and our current FDA head Dr. Stephen Hahn, who gave us the straight scoop this past year and promised and delivered on FDA’s integrity and reliance on science throughout the process. And of course, we owe a deep debt of gratitude to our national hero, Dr. Anthony Fauci, who provided honest, science-based advice to the American people throughout these tense and trying times, despite pressure from the Trump Administration to play down the pandemic. Americans clearly agree, as evidenced by “Thank You, Dr. Fauci” signs on lawns across America!

MLK legacy needed in 2021 more than ever

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By Sally Greenberg, NCL Executive Director

As our nation celebrates Dr. Martin Luther King Day this week, let’s not forget the beautiful legacy of Dr. King at this difficult time in America.

Dr. King was a role model for all of us in how to bring about change peacefully. “True pacifism,” or “nonviolent resistance is a courageous confrontation of evil by the power of love,” Dr. King wrote. What America needs now—perhaps more than ever before—is Dr. King’s message and his devotion to nonviolent racial equality.

Here in Washington, DC, the 704+ thousand of us who call this city home (and still have no voting rights in Congress) are surrounded by tall fences, members of the National Guard carrying AK 47s, and barbed wire. This is sadly necessary to protect the President and Vice President at their January 20 Inauguration from violence by the likes of the white supremacist mobs who were wearing Trump hats, carrying Confederate flags, and who stormed the Capitol on January 6. Many chanted “Hang Mike Pence,” Mr. Trump’s own Vice President, and searched for Speaker Nancy Pelosi in hopes of assassinating her.

How ironic that as we celebrate the life of the remarkable American icon and civil rights leader, Dr. Martin Luther King, the Memorial in his honor on the National Mall must be closed due to threats of violence.

King taught us that violence is not inevitable nor necessary to effect social change. Over the past year, 93 percent of Black Lives Matter protests were peaceful. Dr. King would have been proud of that.

So here’s to Dr. Martin Luther King, who was and remains a role model to so many Americans and an inspiration to millions more.

Ensuring completion of series for the COVID-19 vaccine

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

After 10 dark months and over 350,000 lives lost, there is finally light at the end of the tunnel in the fight against COVID-19. Developing a vaccine for COVID-19 in such a short timeframe was made possible by dedicated efforts on the part of scientists, public health experts, and private and public partnerships. It is truly a triumphant medical achievement.

Now health care providers face another summit to scale—ensuring compliance for the vaccine to encourage efficacy and herd immunity. The leading vaccines for COVID-19, Pfizer BioNTech, and Moderna, will require two doses to ensure efficacy. Evidence has shown that when a vaccine involves multiple doses, nearly 50 percent of patients fail to return for a second dose. Clearly, aside from the distribution and administration, ensuring completion of series for the vaccine will be a critical logistical challenge.

It is estimated that 75 to 85 percent of the population will need to be vaccinated in order to reach herd immunity. That’s a lot of people. And if we account for the odds of those who will receive the vaccine and do not complete their series, we’ve got a long road ahead before the pandemic is behind us.

While both the Pfizer BioNTech and Moderna vaccines were found to be 95 percent effective, require two doses, and use similar mRNA vaccine technology, they differ in timelines. The Pfizer BioNTech vaccine requires two doses that are spaced three weeks apart, and Moderna’s vaccine requires two doses that are spaced four weeks apart. Coordinating efforts to ensure that patients get the correct vaccine in a timely manner, will be a massive undertaking.

There are multiple barriers to address in order to enhance vaccine compliance to end the pandemic. The vaccine is expected to induce flu-like symptoms and may deter some patients from getting their second dose if they aren’t warned about what to expect. Common side effects of the vaccine include headache, fever, chills, soreness at the site of delivery, and fatigue, but patients will need transparency about all potential side effects.

All patients who receive the COVID-19 vaccine will be given vaccine cards (see below). These cards will help track the type of vaccine administered, the dosage, date, and other information pertinent to providers and patients to ensure the completion of a series. Similar to contact tracing, massive follow up will be required via text messages, along with other interventions to remind patients of their upcoming second dose.

Source: CNN

The Food and Drug Administration (FDA) has issued a statement on the importance of properly adhering to FDA-issued vaccine guidelines. The vaccines have been issued with specified dosages and are scheduled at timed intervals. Individuals are instructed against reducing the number of doses (only taking one shot), extending the length of time between their booster vaccines, or changing guidance that is not rooted in evidence-based science, as it will directly impact the efficacy of the vaccine. Until new data is released by scientists and manufacturers of the COVID-19 vaccine regarding changes in dosage or schedules, FDA encourages continued adherence to its current issued guidance.

Vaccine hesitancy will surely further complicate matters. A study conducted by the Kaiser Family Foundation revealed that African Americans are increasingly skeptical of a COVID-19 vaccine. The findings allude to generational distrust of government and medical institutions by people of color, specifically, African Americans, where vaccine hesitancy has been influenced by lived experiences with discrimination and systemic racism. A successful vaccination plan will not only consider the herculean task of distribution and administration but should provide credible outreach within communities of color to foster confidence in the COVID-19 vaccine.

The National Consumers League continues to educate consumers on the importance of vaccine safety and compliance through our advocacy and engagement with the FDA. Our best line of defense against the pandemic is vaccine confidence and adherence. We encourage all who are able to get vaccinated for their own health and the health of their loved ones and community.

Jeanette Contreras portrait

2021 rings in new health care protections for consumers

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By NCL Director of Health Policy Jeanette Contreras

Surprise medical bills occur when patients unknowingly receive care from a provider who is not in their health insurance plan’s network. As the first COVID-19 vaccinations are administered, Congress has passed landmark legislation to ensure consumers needn’t worry about surprise medical bills from emergency medical services.

The passage of this legislation couldn’t come soon enough, as more than 476,000 Americans hospitalized with the coronavirus have already incurred exorbitant medical debt from COVID-19 treatment. Now, thankfully, 2020 will come to a close with renewed optimism in the American health care system.

This new law will also protect consumers from surprise billing from out-of-network ambulance and air ambulance trips, which can amount to tens of thousands of dollars in medical bills. Most patients are conscientious consumers, careful to find a doctor that accepts their insurance before making an appointment. However, in the case of an emergency, a patient faces the possibility of receiving care from an out-of-network doctor in an out-of-network hospital.

As Congress debated legislative fixes to surprise billing, the Administration showed political will toward finding a solution with the issuance of Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First, which includes principles on surprise billing. In a July 2020 report addressing surprise billing, the U.S. Department of Health and Human Services (HHS) further urged Congress to act, recognizing that 41 percent of insured adults nationwide were surprised by a medical bill in the past two years.

Following Executive Order 13877, HHS finalized a set of regulations to address price transparency for consumers. The first rule set to take effect on January 1, 2021, requires hospitals to publicly list standard charges for the items and services that they provide. The second rule, set to take effect in 2022, demands similar transparency from most health plans and issuers of health insurance coverage. These regulations offer consumers more control over their health care spending and better information as they shop and compare health coverage options for themselves and their families.

The new HHS regulations, coupled with the surprise billing legislation, amount to the greatest consumer protections in America’s health care system since the Affordable Care Act. Consumers with health insurance should not have to worry about surprise medical bills—especially during a pandemic. The health care system will be a little more consumer-friendly in 2021, which is good news for all of us.

Is your honey real?

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By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

Honey is one of my favorite sweeteners. And I’m not alone. The global demand for honey is extremely high with the market size value in 2020 at 9.79 billion. But are we buying the authentic thing?

This high demand has resulted in market fraud and adulteration. Insider has stated that honey is the third-most-faked food in the world behind milk and olive oil. Assessing the quality of honey can be difficult because of the production process or adulteration with cane sugar or other ingredients.

In the United States, 400 million pounds of honey ends up in our food every year. Most of it is adulterated product from China. Manufacturers either dilute real honey by adding syrups derived from plants or they chemically modify the sugars in those syrups so they look like real honey. Honey consumers in the U.S., and across the globe, are being duped and need to be made more aware of how to tell if the honey they purchased is real or fake.

Here are several ways to spot fakes:

  1. Crystallization – real honey crystallizes over a period of time once kept in a cool dark place. Adulterated honey will always retain the same consistency.
  2. Water test – drop a teaspoon of honey in water. If the honey is pure, it will not easily mix with water but will become slightly thicker in texture.
  3. Microwave test/heat test – place a bowl of honey in the microwave and heat it for a minute. If it caramelizes, then it is real honey. If it bubbles, it is not.
  4. Paper test – put 2 teaspoons of honey on a plate and put paper on it. If the paper soaks the honey, then it is adulterated.

As the demand for honey increases, one would expect that the price of honey would increase. However, the opposite has occurred since the supply of adulterated honey has increased and driven global honey prices down. This has resulted in beekeepers barely being able to sell their honey for a profit.

Another major issue that adulterated honey causes is the threat to pollination and our food systems. Vice highlights that bees help produce 90 commercially-grown crops in the U.S. and have brought in over $24 billion to the economy. Without beekeepers, we would have a failed food system.

Consumers should seek out raw, organic, unadulterated honey that will not have negative impacts on our beekeepers, our crop, and our economy. If you buy a plant-based burger, you would like to know the nutritional value and ingredients of the product and it should be the same for honey or any product that we consume.

I would recommend that each consumer watch the Netflix documentary Rotten. The episode called “Lawyers, Guns and Honey” shows the reasons behind low production of authentic honey and the impact of the dwindling bee population on our environment.