Infectious Disease Outbreaks and Prevention
For the first time in its history, our state is dealing simultaneously with three infectious disease outbreaks: COVID-19, MPox, and polio. Throughout the height of the Covid-19 pandemic, as well as the MPox and polio outbreaks, MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response has educated physicians on how they can work best with the State’s public health infrastructure to prevent the spread of these communicable diseases, including through regular meetings with the NYS Department of Health (DOH) and other local public health agencies.
COVID-19. The COVID-19 pandemic has reshaped so many aspects of our lives —from health habits and work environments to social norms. The World Health Organization still classifies the COVID-19 pandemic as an acute global emergency. Many governments face uncertainties about how to prioritize at a time when the pandemic appears to be in transition but when the risk of emergence of new variants and future surges remains real. In the United States, many people have some protection, or immunity, against COVID-19 due to vaccination, previous infection, or both. This immunity, combined with the availability of tests and treatments, has greatly reduced the risk of severe illness, hospitalization, and death from COVID-19 for many people. At the same time, some people—such as those who are older, are immunocompromised, have certain disabilities, have certain underlying health conditions, or who live in underserved communities—continue to be at higher risk for serious illness.
COVID-19 immunizations have played a significant role in mitigating the loss of life from the virus. New York’s immunization rate is 79% for adults and children. The new boosters that include the BA variants will provide continued protection. MSSNY supports mandatory COVID-19 vaccination among all school-aged children, now that the Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) have confirmed the safety and efficacy of the COVID-19 vaccines in the pediatric population. MSSNY also supports a requirement for the administration of the influenza vaccine for all school-age children who attend childcare, pre-kindergarten, K-12, and college and universities in New York State, unless medically contraindicated. The American Academy of Pediatrics (AAP) also supports this requirement.
MPox. MPox is a rare, viral infection that can result in hospitalization or death. MPox spreads through close, physical contact between people. Based on the current outbreak, certain populations are affected by MPox more than others, including men who have sex with men. Based on previous outbreaks of MPox around the world, some groups may also be at heightened risk for severe outcomes if they contract MPox. This includes people with weakened immune systems, the elderly, children under 8 years of age, and the pregnant. In New York State there are approximately 4,000 cases of MPox. There is a vaccine licensed by the FDA as a two-dose series for the prevention of MPox among adults ages 18 years and older. Statewide eligibility currently includes the following New Yorkers: individuals with recent exposure to a suspected or confirmed MPox case within the past 14 days; those at high risk of a recent exposure to MPox, including gay men, members of the bisexual, transgender, and gender non-conforming community, and other communities of men who have sex with men; individuals who have engaged in intimate or skin-to-skin contact with others in the past 14 days in areas where MPox is spreading; individuals who have had skin-to-skin contact with someone in a social network experiencing MPox activity, including men who have sex with men who meet partners through an online website; and any individual that may be at risk of future exposure to infection withMPox.
Polio. Successful vaccination campaigns in the 1950s resulted in poliovirus being declared eliminated in the United States in
- However, the case of an individual paralyzed by polio and the finding of the virus in wastewater in the lower Hudson Valley and New York City has resulted in a new immunization program for 2-year-old children by the NYS DOH, in collaboration with the local health departments.
Prevention of diseases continues to remain a top MSSNY priority and the best way to prevent or ameliorate the severity of these diseases, including COVID-19, MPox, and polio is through immunizations. Vaccines are safe and effective—and they save lives. Vaccination programs have allowed us to “get back” some normalcy during the pandemic and they have helped organized medicine and the state combat MPox and polio outbreaks.
The vaccination of school-age children, teens, and young adults promotes herd immunity. This protects elderly populations and the immunocompromised who are at highest risk of serious complications of influenza. Therefore, MSSNY supports an influenza and COVID-19 vaccine requirement for all school-age children who attend childcare, pre-kindergarten, K-12, and college and universities in New York State, unless medically contraindicated.
In 2019, MSSNY together with many other groups supported a law to require that every child attending a public, private or parochial school receives the appropriate immunizations, except where there is a medical contraindication. However, our State has seen an increase in the number of medical exemptions issued to school-age children from vaccination requirements. MSSNY has strongly encouraged physicians to follow the CDC guidance when issuing a medical exemption and has reminded that falsely certifying a medical exemption form could result in a disciplinary action.
Needed Public Efforts. Vaccination doesn’t just protect those receiving the vaccine. Critically, vaccines help to prevent spread to others, including infants who are too young to be vaccinated and those who are unable to receive a vaccine due to a health condition. MSSNY continues to support state funding for a public health campaign to promote immunizations to educate “vaccine-hesitant” individuals. MSSNY also supports requiring all public, private, and parochial schools in New York State and New York City to report immunization rates and medical exemptions to one central NYS Department of Health database, to help effectively track immunization rates throughout the state.
MSSNY supports universal reporting of adult immunizations to the New York State Immunization Information System (NYSIIS), either directly or via health information exchanges, and supports removing the requirement for patient permission to report adult vaccines to the registry.
Improving Women’s Health
In light of the decision by the U.S. Supreme Court to overturn Roe v. Wade, preserving the right for women to have access to reproductive and sexual health care services is even more critical. Abortion has been legal under New York State law since 1970 – three years before the Roe v. Wade decision. MSSNY is strongly opposed to any federal or state legislation that would prohibit physicians from exercising clinical judgment in the delivery of medical care, and strongly supported legislation enacted this year to protect physicians from legal sanctions in New York for providing needed patient care illegal in other states, but legal in New York. MSSNY supports legislation and other efforts to expand access to emergency contraception, including making emergency contraception more readily available, and will continue to support sexual health education programs amongst adolescents.
Reducing Substance Abuse
MSSNY actively works to increase physician awareness and leadership to combat the opioid and pain crisis and supports efforts to expand access to MAT (medications for addiction treatment) including methadone for patients with opioid use disorders.
As we continue to confront the problem, it is important to note the enormous progress that has been made. According to data provided by IQVIA, prescription opioid volume dropped 46% in the US between 2012 and 2021, and in New York decreased by nearly 50%. Certainly, this progress is the result of comprehensive efforts by many, including the physician community, to better ensure that the prescribing of pain medications is appropriate to the patient’s needs. Concurrently, the New York Legislature enacted numerous measures to further regulate opioid prescribing, including a 2012 law to require consultation with the I-STOP database prior to a controlled substance prescription; and a 2016 law to require all DEA-registered prescribers to take Continuing Medical Education coursework on pain management and limiting initial acute pain medication prescriptions to 7 days. MSSNY is currently revising this course to keep it up to date with changes in the law on the state and federal levels and to address the revision of the CDC chronic pain guidelines.
Protecting Against Unintended Effects. It is also important to ensure that efforts to address one problem do not create another. We must protect against the misapplication of rigid guidelines. In 2018, a law was enacted in New York to require all prescriptions for treating patients’ chronic pain to be consistent with CDC chronic pain guidelines. These CDC guidelines are themselves being revised to address the unintended effect that physicians were reluctant to appropriately prescribe opioids to relieve patients’ pain because of a fear of prosecution by disciplinary bodies. As a member of the AMA Substance Use and Pain Care Task Force, MSSNY strongly supports the changes to the CDC guidelines including the removal of specific dosage and day limits for an opioid prescription and the emphasis on patient-physician shared decision-making, largely absent from the 2016 guidelines. MSSNY and the AMA expressed their appreciation to the CDC for acknowledging that the rigid limits of the 2016 guidelines were widely misapplied and resulted in widespread harm to patients with pain, including care delayed and denied, and even death by suicide. We also appreciate that the CDC has acknowledged the harm caused by an inappropriate focus on “pain as the fifth vital sign.”
Confronting the Realities of Recreational Marijuana. With the implementation of legalized cannabis, MSSNY continues to support efforts to protect the public from inappropriate marketing tactics that could lead to substance abuse. According to a SAMHSA 2019 National Survey of Drug Use among people aged 12 or older, the percentage who were marijuana users in the past year increased from 11% (or 25.8 million people) in 2002 to 17.5% (or 48.2 million people) in 2019. The report also said that among people aged 12 or older, the number of past year initiates of marijuana use increased from 2.2 million people in 2002 to 3.5 million people in 2019. Among those 12-17, perceived great risk of harm from smoking marijuana weekly declined from 40.6% in 2015 to 34.6% in 2019.
Safe Injection Facilities. MSSNY supports the creation of pilot studies to assess the role of Safe Injection Facilities and that pilot locations include New York City and two other areas outside NYC. Additionally, MSSNY advocates that these pilot studies provide screening, support, and referral for treatment of substance use disorders and co-occurring medical and psychiatric conditions, and provide education on harm reduction strategies including Naloxone training.
Challenging decision-making concerning end-of-life care has increased the burden on physicians, patients, and family members. These challenges have divided family members, physicians, and the social fabric of society. When intimate knowledge of end-of-life choices have not been discussed between doctor and patient, an ever-changing medical environment with shifting social mores, economic influences, and legislative mandates can muddle already difficult medical decisions. Further complexities arising from an acute crisis in the use of narcotic analgesics have also frustrated patients and providers in dealing with prevention and relief of pain at end of life. To address these challenges, MSSNY supports:
- Developing a state central depository for eMOLST (Medical Orders for Life Sustaining Treatment) forms.
- Requiring adequate reimbursement for end-of-life care.
- Expanded options for obtaining affordable long-term-care insurance.
- Urging NYS DOH to develop educational resources for physicians, allied professionals, and patients on end-of-life care.
- Urging NYS DOH to simplify the hospice recertification process.
Reaffirming MSSNY Policy 95.989 in opposition to Physician Assisted Suicide and Euthanasia.