1190: State Health Leaders Outline Strategies Ahead of Respiratory Virus Season

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Thursday, August 20, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

As the 2026-27 respiratory virus season approaches, state health departments are preparing communities for influenza, COVID-19, and RSV, while working to strengthen vaccine confidence and access. On today's show, we'll hear excerpts from a briefing on Tuesday, August 18, where public health leaders from Connecticut, Alabama, New York, and Alaska discussed strategies for reaching people through trusted messengers, addressing vaccine hesitancy with empathy, and making vaccination easier to access. We'll kick things off with ASTHO President and Commissioner for the Connecticut Department of Public Health, Dr. Manisha Juthani.

MANISHA JUTHANI: 

As we know, the season is around the corner, and we have been preparing in health departments for the upcoming season when we know that we will always encounter influenza, COVID-19, and RSV, which are the three prominent respiratory viruses for which we have ways to protect ourselves, which are with vaccinations. Vaccinations remain the most effective tool to prevent severe illness, hospitalization, and death. And public health departments around the country, whether it be your local health department, state health department, have been preparing providers, pharmacies, hospitals, laboratories, all to be ready for this upcoming season, all to be ready with vaccinations on-hand, to be able to do what we can to protect our communities. Public health agencies focus on making vaccines available in a timely fashion. And we want to take a moment today to reinforce our support, not only for the respiratory viral disease vaccinations that we will talk through, but also for routine childhood vaccinations. We know that public confidence and trusted messengers are important to be able to help ensure that our communities get vaccinated, and letting people talk to their own providers is the best way that we can do that. In Connecticut, we launched our Protect Who Matters Most campaign, which is what you see in my backdrop behind me. And this is a series of four different videos, which are in different styles of music that are trying to reach people where they are at, giving answers to questions on how vaccines work, how are they made, how are they monitored, how do we ensure continued safety? And the major goal is to help people who are all just trying to take care of their families and give people confidence that what we want to be able to do is say that there is no question that is a wrong question. There is no question that shouldn't be answered, because that's what people deserve. And so these videos are there to be used in the community by our providers, in educational settings, so that people can see how vaccinations can be more accessible.

SHEEHAN: 

Now to Scott Harris, ASTHO's immediate past president and state health officer for the Alabama Department of Public Health.

SCOTT HARRIS: 

We're going to talk a good bit today about this upcoming respiratory virus season, and a big part of that, of course, is going to deal with immunizations. And I wanted just to kick off this part of of our meeting just describing some of the things that we've been thinking about here in Alabama and trying to deal with vaccine hesitancy. It's a tremendous issue for all state health departments. It's been a particular interest to us in our state. During the pandemic, we really had dedicated resources to go out and do, you know, focus groups and listening sessions and lots of surveys and really try to figure out attitudes about why people make the decisions they make around vaccination. And the lessons that we have taken from that, I really don't think would be surprising to any of you. But trying to implement them is is a little bit tricky, and it's really challenging sometimes to keep in the forefront of our mind those lessons that we learned as we're trying to change the traditional public health communications that we have have been used to. I think it's clear that even though it's important for us to give accurate information, information alone is not going to be enough to help people make up their mind. We've really begun to view this as an issue of building trust in the community as opposed to providing accurate information for everyone. Clearly, accurate information is necessary, but that by itself is not going to be enough. The lessons that we have really taken from talking to people who are hesitant about vaccines, first of all, I think the most important one is that people who aren't receiving vaccinations now aren't some big monolithic group. There's a lot of nuance involved in the decisions that people make about their health. People who haven't chosen to vaccinate their children at this point actually still want their children to be healthy, right? They're people who still want to have good health themselves. They see the decisions they're making as rational decisions, and they're not, you know, some partisan statement that they're trying to make. They actually feel that they're doing the right thing for their family. So, it's been very important for us to ask why they believe the way that they believe. We know that almost everyone has trusted sources that they get their information from. In many cases, that's their health care provider. Certainly, health care providers are a very important source of information, and with a longstanding relationship, there can be a lot of trust involved. But we also see others, institutions or other individuals as well. In our state, for example, we have a lot of faith-based initiatives, houses of faith that are involved in providing information to the community and helping people understand how to obtain health care and so on, and that's become a very important link in what we do. Schools, universities also are often really important partners for us, who can sort of serve as the trusted messenger to talk to parents and and particularly parents with young children in a way maybe that public health as a state institution cannot. The overall lesson is that one size doesn't fit all. And so the way that we try to put that into practice has to do with our work primarily with those trusted messengers. We have changed the way that we try to educate physicians and nurses and pharmacists who are administering vaccines. We we do want to give them information about what the data shows. We still want them to know this vaccine in this population is expected to produce this effect and avoid this bad outcome. And yet, we also want to tell them it's important to listen to people with empathy. It's important to ask why people are making the decisions that they're making. It's important to be respectful. It's important to understand you can't always convince someone at the first visit to do all the things that you would like for them to do. And that's really become part of our communication program. So, I know we're going to talk more about this as we go along. I have some examples that I'll share with you. We, even in Alabama, are struggling with an increase in non-medical exemptions being requested by families. So, we know that we still have a lot of work to do, but I wanted you to understand sort of how we're thinking about that here.

SHEEHAN: 

Here's Dr. James McDonald, ASThO board member and commissioner of the New York State Department of Health.

JAMES MCDONALD: 

You know, I know the vaccines we have in the United States are really the best we've ever had and really the best protection for our children and our communities. You know, I often think about it like our children are our present, but also our future, and in New York, protecting our children is really paramount. So New York State does require certain vaccines for school entry. New York State law does not allow for religious exemption, yet does allow for a medical exemption. You know, as we look to the coming fall and winter, where respiratory illness is going to become more common, I think it's helpful to look at last year. And I I just want to take a moment just to sort of like last year's flu season in the United States was significant. It was significant in New York State as well. You know, just to put some numbers around that, in New York State we saw 27,000 hospitalizations related to flu last year. Of those, a little over 3,200 were children, and sadly, there were 15 children who passed away last year from flu in New York State. And, you know, we talked a bit about RSV as well, but just to put context around RSV, in New York State we saw over 14,000 hospitalizations for RSV. Of that number, over 4,000 were children, and sadly, there were seven children who passed away from RSV. And when I think about COVID in New York State last year, we had over 13,000 hospitalizations. Now, 778 of those were children, and there were four children who passed away. You know, it's interesting. All three of these diseases do have vaccines that will help prevent serious outcomes. And, you know, it's important to know that, you know, generally when there's a pediatric death from flu or RSV or COVID, you know, usually what we found was it was a child who wasn't immunized. Sometimes they just weren't old enough to be immunized, or sometimes there was another reason. So I think it's just context about, you know, flu, and RSV, and COVID. I want to just touch a little bit, though, on measles just for a moment. You know, right now in the United States, we're tracking one of the worst years for measles we've ever had in the United States. So far, you know, we've had almost 2,600 cases, over 300 more than last year, and there's still a lot of this year left to go. You know, when I look at New York State, we've had 22 cases so far in New York State, and and just for context about that, we had 48 cases last year. You know, we haven't seen a large outbreak of measles in New York State since 2019, yet, you know, of course, that could happen. The reason we haven't seen large outbreaks in New York, though, is because we do have solid overall immunization rates, and we we have a an approach to this, too. Like whenever we have a case, the local health department, the state health department works with the family, health care facility. If there's people around somebody who had measles who weren't vaccinated, we make sure we get a vaccine to them. We also offer post-exposure prophylaxis as well to protect people as well. And then, you know, make sure that people are following and have their questions answered so that they do know what's going on with this because we really do want to limit spread. And I think it just gets to like when I think about our strategy in New York State regarding promoting vaccines in general, I think it's important to remember, you know, New York State is made of many different cultures, a very diverse state. You know, sometimes I think of New York as the United States of New York. And I love how variety, how much variety there is in New York State. And I think it's important to remember when you think about vaccine promotion, it's really like, it's not like there's one problem with one solution, you know, and so our overall strategic approach is really, one, keep the vaccine confident confident, but also to make sure the vaccine hesitant, you know, feel welcome. And our threefold approach could really be simply said like we want to relate, we want to educate, we want to facilitate. You know, when I say relate, I know people have trust issues and I respect that. We want to build relationships. We want to make sure we have earned the right to be heard, understand concerns, because it really isn't a one-size-fits-all solution. You know, we do work with the local health departments, community-based organizations, health care providers, community groups. One-on-one as needed, we really do try to relate with everybody and try to make sure people have respectful conversations. When I talk about education, when we educate, yes, we educate professional groups, we educate physicians, health care providers, also local health departments, but also community-based organizations. We do a fair amount through the media, whether it's owned media, social media, earned media, but it's really important to know that we have given a lot of technical advice as well, but often we just really help arrange one-on-one education as well. And when I talk about the last word there, facilitate, you know, we recognize that sometimes it's just, how do you get timely access to a vaccine? How do we help a local health department get vaccine? It may surprise people to know sometimes we have local health departments do point of distribution events, and sometimes it starts in somebody's kitchen because that's where the community feels welcome. But we also facilitate enforcing our regulations and requirements because that's something that we do as well. You know, as I close with my final thoughts, I think it's important to know the New York State Department of Health recently this year celebrates its 125th birthday, and I'm, you know, I'm very fortunate to be the 18th commissioner of the New York State Department of Health. And I was thinking about the first four decades of what it was like to be the commissioner of the New York State Department of Health, and they had a lot of different challenges than I have. You know, I had different challenges. They had different challenges. But if you were commissioner for the first four decades of the New York State Department of Health, keep in mind one out of 10 children with polio were dying from polio. One out of five kids with diphtheria were dying from diphtheria. You know, because of improvements in health care, public health, and yes, because of vaccines, this never happens anymore. And it reminds me, you know, public health is public, and public health helps everyone, and vaccines are part of that.

SHEEHAN: 

And Dr. Robert Lawrence, ASTHO member and chief medical officer for the Alaska Department of Health.

ROBERT LAWRENCE: 

I think what I'd like to emphasize is just that our overall strategy, regardless of where we are in the U.S., our strategy in public health that works because of coordination of care at the federal, the state, and the local level. It's appropriate that you hear from my friend Dr. McDonald in New York first, and now Alaska, because there in New York is a monument to public health in Alaska and the nation. There in Central Park, there is a statue of a dog named Balto, and that dog was the lead dog on a public health emergency response 100 years ago, 1925, in what was called the Serum Run to Nome, Alaska. That was a time when diphtheria was one of the respiratory diseases, as you just heard. Diphtheria in that day caused one out of every five funerals that you would go to in rural parts of the state, and there was an outbreak in Nome, Alaska. There was an emergent telegram that was sent by a Curtis Welch to the federal U.S. Public Health Service, and that telegram sent off a transport emergent response in which diphtheria antibodies were transported, first by railroad, and then by dog sled over 674 miles across the Alaska wilderness, across mountains, rivers, across the tundra, with 20 mushers in a relay race with 150 dogs, sometimes going into headwinds in 50 below weather. And do you know, over five and a half days from the time that that telegram was sent, the serum, the antibodies arrived in Nome with every single vial intact because of the coordination of care, and that that community was rescued. There were only five deaths that year in that epidemic, and that became a story that ignited the imagination of the whole nation. That led to reports in major cities, and then, like I said, a monument even in New York State, and that story is the one that still inspires everything that we do in public health. Now, 100 years later, we recognize that public health, at its best, is incredibly complex, but when well coordinated, we are still able to save lives, and for many of you across the nation, that story, as you know, now plays out every day. It was just a couple of months ago I received a desperate-not telegram, but a text from one of our dear physicians working in rural Alaska, and she said, I need over 100 doses of a rabies vaccine for a rural community where we had a mass exposure to rabies of a fox that got into a village, exposed a family of dogs with puppies. The children had played with these puppies, and that could have turned into quite a tragic event. But that text sent set off the very same story that you heard from 100 years ago, where our public health team was able to connect to our federal partners and work with the CDC and manufacturers, and then through the state with local tribal health organizations, all the way down to the local level, were able to coordinate an emergent transport. We didn't have to use a dog sled. We used Alaska Airlines and [were] able to get the medication exactly where it was needed and prevented a great tragedy. And my point there is, I don't know that that story now ignited the imagination of the nation. I don't know that it became newsworthy. But each of you who work in public health know now, 100 years later, that's exactly how our work works well. That's the heart of what we do in every strategy that you hear us talk about; is built on this understanding that what we really are doing is building bridges, so that at the time there's a need, in preparation for, in this case, respiratory season. What really makes things work is this coordination of care in Alaska. The bridges that we are trying to build in preparation for the respiratory season include making sure that we've shored up that coordination with all of our trusted communicators and partners throughout the state in Alaska. That includes health care organizations and pharmacies, and our Department of Corrections and others. But in Alaska, it's important that we work with our tribal health organizations because they cover so much of the vast state of Alaska, working in areas of the frontier. We also have built up over the years our Immunization Information System that we call VacTrAK, and this is a robust system that now works very well in Alaska and has the potential for anyone in Alaska to be able at a moment's notice to look up their vaccination status, even using their iPhone, and that has been an incredible tool to put in the hands of people. Recognizing, as you heard from Dr. Harris, that just putting information in people's hands is not enough. How we communicate and really empowering our trusted messengers is important, and so we've looked very carefully at our communications and turn those communications into communications that are creative, and warm, and clear, so that the vaccine schedule itself is now produced on a magnet that can be put on refrigerators, and I even keep it at home. That is so clear and easy to read, and our kids will go and look at it when it's their turn to go to the doctor to know what they're due for. Then the other thing that we've done in Alaska that's been very helpful is to build out a universal vaccine procurement program or a bulk purchasing program, where the state actually it purchases vaccines in a bulk type of system, which is paid into by our various insurance companies, by the health care organizations, by our tribal health organizations, the Department of Corrections pays into this, and it allows us to lower the cost of vaccines by about 20 or 30% across the board, while at the same time making vaccines available to every child and every adult in Alaska. And so that has been one of the most successful things that we've seen over the last 10 years in Alaska. And so my point there, though, is that in each of those cases, our strategy is built on asking, How can we build those bridges and solidify that coordination of care, so that when there's a need, regardless of the size of the community, the location of the community, so we are able to respond from the federal, from the state, all the way through the local level, so that the person with their trusted provider can receive what's needed?

SHEEHAN: 

These have been excerpts from the ASTHO deskside briefing, Preparing for Respiratory Virus Season. We heard from ASTHO President and Commissioner of the Connecticut Department of Public Health, Dr. Manisha Juthani, Scott Harris, ASTHO's immediate past president and state health officer for the Alabama Department of Public Health, Dr. James McDonald, ASTHO board member and commissioner of the New York State Department of Health, and Dr. Robert Lawrence, ASTHO member and chief medical officer for the Alaska Department of Health.

Immunization remains one of the most effective tools in public health: protecting against preventable diseases, mitigating outbreaks, and reducing long-term health care costs. To inform a forward-looking roadmap for immunization leadership over the next five years, ASTHO engaged national immunization partners and health officials. The resulting resource highlights priorities, strategies, and coordinated actions to consider for strengthening immunization programs nationwide. Learn more at the link in the show notes.

ASTHO offers resources to help public health agencies prepare for and respond to respiratory virus threats. Explore guidance and tools for COVID-19 response, as well as resources on influenza preparedness, response, and cross-sector coordination on ASTHO's Influenza and COVID-19 resource pages at the links in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.