Washington, DC (November 30, 2011) – Vermont ranks 11th in the nation in funding programs to prevent kids from smoking and help smokers quit, according to a national report released today by a coalition of public health organizations.

Vermont currently spends $3.3 million a year on tobacco prevention and cessation programs, which is 32 percent of the $10.4 million recommended by the U.S. Centers for Disease Control and Prevention (CDC). Other key findings for Vermont include:

• Vermont this year will collect $108 million in revenue from the 1998 tobacco settlement and tobacco taxes, but will spend just 3.1 percent of it on tobacco prevention programs. This means Vermont is spending just 3 cents of every dollar in tobacco revenue to fight tobacco use.
• Since 2009, Vermont has cut funding for tobacco prevention by 37 percent, from $5.2 million to $3.3 million.
• The tobacco companies spend $19 million a year to market their products in Vermont. This is 5 times what the state spends on tobacco prevention.

The annual report on states’ funding of tobacco prevention programs, “A Broken Promise to Our Children: The 1998 State Tobacco Settlement 13 Years Later,” was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association, Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.

Vermont has been a leader in the fight against tobacco with a high cigarette tax ($2.62 per pack) and a strong smoke-free workplace law. However, the large cut in tobacco prevention funding has put the state’s progress at risk. Vermont dropped from 9th in the ranking to 11th this year.

“Vermont has been a real leader in fighting tobacco use, but has taken a big step backward by cutting funding for its tobacco prevention program,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “To continue making progress, Vermont should restore funding for tobacco prevention. Even in these difficult budget times, tobacco prevention is a smart investment that saves lives and saves money by reducing tobacco-related health care costs.”

“Vermont has had over ten years of success in reducing adult and youth smoking rates. In order to continue this success the state must make a long-term investment in preventing kids from starting to smoke and helping smokers quit,” said Director of Health Promotion and Public Policy for the American Lung Association in Vermont Rebecca Ryan.

American Heart Association Government Relations Director Tina Zuk said it is this adequate investment in the program that will save lives and dollars. “With the previous investment Vermont has made in its Tobacco Control Program, the youth smoking rate dropped from 18% in 2009 to 13% in 2011. Adult smoking rates also dropped from 17.6% to 15%. But that doesn’t mean there is no more work to be done. Each year in Vermont, 700 more kids become regular smokers, tobacco 800 lives and costs the state $233 million in health care bills.”

The Coalition for a Tobacco Free Vermont noted that Vermont has been able to make a huge impact on youth smoking rates partially due to media and public education efforts. That funding was cut dramatically last year and further cuts could cause youth smoking rates to rise again.

Nationally, the report finds that most states are failing to adequately fund tobacco prevention and cessation programs. Altogether, the states have cut funding for these programs to the lowest level since 1999, when they first started receiving tobacco settlement payments. Key national findings of the report include:

• The states this year will collect $25.6 billion from the tobacco settlement and tobacco taxes, but will spend just 1.8 percent of it – $456.7 million – on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.
• States have cut funding for tobacco prevention programs by 12 percent ($61.2 million) in the past year and by 36 percent ($260.5 million) in the past four years.
• Only two states – Alaska and North Dakota – currently fund tobacco prevention programs at the CDC-recommended level.

The report warns that the nation’s progress in reducing smoking is at risk unless states increase funding for programs to prevent kids from smoking and help smokers quit. The United States has significantly reduced smoking among both youth and adults, but 19.3 percent of adults and 19.5 percent of high school students still smoke.

Tobacco use is the leading preventable cause of death in the U.S., killing more than 400,000 people and costing $96 billion in health care bills each year.

More information, including the full report and state-specific information, can be obtained at www.tobaccofreekids.org/reports/settlements.

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(TUESDAY, Sept. 21) – Senator Patrick Leahy (D), Senator Bernie Sanders (I), and Congressman Peter Welch (D) on Tuesday announced that the Vermont Department of Health will receive $1.1 million in federal support for public health programs.

The Centers for Disease Control and Prevention funding will support a new five-year program to link Vermont’s Blueprint for Health with existing public health data, support local public health programs and combat chronic disease. The Vermont grant is part of a $42.5 million nationwide investment in public health made possible by the Patient Protection and Affordable Care Act (H.R. 3590).

“This investment in the high quality programs run by the Vermont Department of Health will provide an important boost to public health services and improve the quality of care available to all Vermonters,” said Leahy, Sanders and Welch. “By strengthening coordination between local, state and national health care authorities, this grant will ensure that Vermonters receive the best public health services available.”

According to the Vermont Department of Health, the new award will strengthen Vermont’s ability to reduce the costly burden of chronic diseases by increasing attention to preventing illness and complications. It will support the work of the Department’s local prevention teams, which implement CDC best practices for health promotion and disease prevention at the local level. The grant will also link public health data systems and electronic health records to evaluate the effectiveness of Department programs.

“We are delighted with this opportunity to strengthen the connections between Health Department programs and Vermont’s Blueprint for Health initiative,” said Dr. Wendy Davis, Commissioner of the Vermont Department of Health. “Achieving meaningful health reform is not only about reforming the health care delivery system but must include sincere and sustained attention to effective population health and community-based prevention strategies.”

In August, Leahy, Sanders and Welch wrote the Department of Health and Human Services in support of Vermont’s grant application.

In their letter, the Vermont delegation wrote, “CDC’s grant program represents a unique and timely opportunity for Vermont to systematically increase the performance management capacity of its public health departments. The grant would assist Vermont in ensuring that public health goals are effectively and efficiently met.”

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Photo of the H1N1 virus

Swine flu vaccine has been slow to arrive in Vermont, and because of the shortage, health officials have been forced to ration inoculations.

Vermont Department of Health has given top priority to the mass vaccination of schoolchildren, and the first school clinics start this week.

The youngest, most at-risk children, age 6 months to five years, must get vaccinations from private doctors who are typically backlogged with patient requests, or wait for immunizations at public clinics, even though the Centers for Disease Control and Prevention recommends that this age group receive inoculations first when vaccine is in short supply.

Dr. Wendy Davis, commissioner of VDH, says she has directed the initial shipments of vaccine to local providers and school clinics. The department won’t launch public clinics until next week. So far it has only posted announcements on its Web site for public clinics in Manchester Center and Middlebury.

“I think the challenge people are feeling as parents and health care provider offices is related to the vaccine delays,” Davis says. “Providers are receiving vaccine, but they are going through it very quickly. I can understand how a parent might call on a certain day and they might be told ‘Call us back next week and we’ll see what we get.’ I’m hearing that provider offices have different strategies for doing this. Some are planning weekend clinics. Some are doing walk-in clinics every afternoon. Some are doing it by appointment.”

On Monday, VDH launched the first of its clinics in 330 Vermont schools. Because of the vaccine shortage, 19 out of 49 school clinics planned this week have been delayed, according to The Barre-Montpelier Times Argus.

As of Oct. 23, the Centers for Disease Control and Prevention shipped 34,200 doses to Vermont – about half of what is needed to inoculate the 65,000 schoolchildren VDH estimates will be immunized in Vermont.

Last Wednesday, Davis confirmed 45 cases of swine flu for the week ending Oct. 17 and announced that the virus is now widespread in Vermont. At schools around the state, dozens of absences had been reported because of suspected illness. Most of the cases in Vermont, according to Davis, have been mild.

Dr. Louis DiNicola, the president of the Vermont chapter of the American Academy of Pediatrics, says his office has been extremely busy. He’s seeing many cases of flu-like illness, most of which he says are H1N1.

DiNicola, who has practiced medicine for 30 years, said, “It’s been the most difficult (flu) year I can remember.”

Given the current shortages of vaccine, it’s not clear yet how the department is planning to ensure the vaccination of very young children, who are at greater risk of complications from the swine flu, hospitalizations and death, according to the CDC.

Nationally, H1N1 vaccine has been allocated to states based on population numbers, according to VDH. The first few thousand doses (all that was available until this week) were given to health care providers, staff and the most vulnerable patients.

“While we wish we had the vaccine sooner, it’s certainly not slowing down our planning,” Davis said. “We are just receiving shipments that are ramping up from thousands per week to 10s of thousands per week. The expectation is that there will be more vaccine flowing in larger quantities as we move through the (flu) season, ultimately with the goal of making it available to anyone who wants it.”

The CDC guidelines, which VDH is obliged to follow, state that specific groups, including children under age 4, should be inoculated first when supplies are not yet widely available. (The other most vulnerable
“subsets” include children with medical conditions, pregnant mothers and adults with health problems, such as asthma, cystic fibrosis and heart disease.)

Patsy Tassler, epidemiologist for VDH, says, “We’re rolling it out as equitably as we can, as we get allocations of vaccine, making sure so that hospitals and providers, and in the coming weeks, schools, have vaccine.”

DiNicola recommends that parents call providers twice a week until they can get an appointment.

“Doctors are distributing the vaccine as fairly as possible to the highest risk populations,” DiNicola says.

At his own practice, DiNicola is scheduling same-day appointments for very young children when vaccine is available, and referring most school-age children to the clinics. He has a nurse on his staff whose primary responsibility is immunization.

“If someone dropped enough vaccine on our doorstep, we’d open an immunization clinic for patients,” he says.

Not all pediatricians, however, agreed to give swine flu shots. Some private physicians opted out of the government vaccination program, DiNicola says, because the required paperwork was too onerous.

So why didn’t the Department of Health publish a list of “participating” physicians? Larry Crist, director of the Office of Public Health Preparedness, says the department didn’t want to swamp local practices.

DiNicola says they really didn’t have time to publish it. Physicians were asked to turn in their paperwork three weeks ago, he says.

“The Health Department officials are doing the best they can,” DiNicola says. “We should have had 3,000 to 4,000 vaccines (by Friday), and we only had 100 last week.”

DiNicola highly recommends vaccinating children even if it appears that they may have already been exposed or had a flu-like illness. He says the peak of the H1N1 flu outbreak may be a month or so away.

Davis agrees. At a press conference last week she said, “With this first wave that has come through, although many people may be affected, many people may be spared.” She said in the second wave of the pandemic, many people could benefit from vaccination.

The U.S. Department of Health and Human Services describes H1N1 as a pandemic, a global disease outbreak of a new highly contagious influenza virus that causes serious illness among people who have little or no immunity to it.

On Saturday, President Barack Obama announced a national emergency in order to enable hospitals to set up off-site facilities for patients, if necessary. Swine flu is now considered widespread in 46 states.

The CDC has confirmed 95 pediatric deaths from H1N1 since April 2009. Of these, the majority were among children between the ages of 6 months to 2 years, according to DiNicola. The incidence of hospitalization has been the highest among children under 4, according to the CDC.

The swine flu has caused the hospitalization of 20,000 people in the United States, and more than 1,000 deaths have been attributed to the virus, according to The Washington Post.

Seasonal flu typically causes 36,000 deaths a year nationwide, according to Davis. What makes swine flu worrying is that it attacks healthy young people under the age of 24, while seasonal flu typically leads to complications and death among the very young, the sick and the very old.

What follows is a press release from VDH sent on Oct. 23 to schools and health care providers in Vermont.
2009-2010 H1N1 Influenza Season Update #4
Vaccination of School-Age Children

To: Health Care Providers, Hospitals, Infection Control Practitioners, Schools, Home Health Agencies
From: Wendy Davis, MD, Commissioner of Health
Date: October 23, 2009

– Please Distribute Widely –

School based vaccination clinics
Last week, the Centers for Disease Control & Prevention (CDC) notified states that vaccine manufacturers are experiencing delays in the production of the 2009 H1N1 vaccine. Since that time, the Vermont Department of Health (VDH) has been working with our many partners – including health care providers and schools – to review our vaccination plans and make adjustments as needed.

The first school clinics will begin on October 26; subsequent school clinics will occur less frequently than previously planned and some will need to be rescheduled. We will continue to provide vaccine to health care providers, hospitals, health agencies, and to schools as soon as we can, based on vaccine supply.

Our goal continues to be to move vaccine to providers and clinics as quickly as possible, to ensure vaccination of those individuals who need it most, including school-aged children.

Public and Private schools
• All private, parochial, independent and public schools were offered the opportunity to provide vaccine to their students in a school setting. The vaccination efforts are voluntary.
• Schools with 300 or more students were offered Health Department-run clinics.
• Schools with fewer than 300 students were asked to run their own clinics. Some chose to combine with other schools making them eligible for a Health Department-run clinic.
• We collaborated with small schools which are without a school nurse, and schools with a nurse working limited hours, to provide vaccinator staffing from either the Vermont Emergency Response Volunteer (VERV) vaccinator pool or contracted nursing staff.
• Schools that have not already scheduled a vaccination clinic are still able to do so. If interested in providing vaccine to students, schools may call their Health Department district office. Due to vaccine supply delays, newly scheduled clinics may not occur until December/January.
Parents in schools during vaccination clinics
• Parents have been encouraged to not attend the Health Department-run school based clinics. This is for logistical and security reasons, including making sure clinic flow is not slowed to a point where we are not able to vaccinate all the children scheduled for that day.
• Ultimately, the decision to allow parents to accompany their child during clinic is a local school decision.

Vaccine in provider offices
• It is our hope that vaccinating children at the school based clinics will help keep providers from being overwhelmed by calls and demand for vaccine from parents of children who can receive it at school. At the same time, we recognize that not all these children will be vaccinated at a school clinic, and that providers are faced with managing the currently limited supply of vaccine.
• Health Department continues to follow the CDC guidance, and is focusing its vaccination efforts on the ACIP identified target groups – taking care of those individuals who need it most. Please see the attached ACIP guidance for when initial supply of vaccine is not adequate to meet immediate and short term demand.
• Because of vaccine supply delays, Health Department recommends that providers balance the CDC guidance with their patient needs when determining which patients should receive the H1N1 vaccine. The attached guidance should help providers in making these determinations.

Other (non-school) vaccine availability sites
Public Clinics
• VAHHA agencies will begin conducting public clinics for the target group population in early November.
• Once scheduled, a frequently updated list of these public H1N1 clinics will be available online at the Health Department Web site: http://healthvermont.gov/prevent/flu/flu_clinics_h1n1.aspx. Members of the public may also dial 2-1-1 for information.

Provider Offices
• Health Department is recommending that patients not be instructed to call around to other providers to seek H1N1 vaccine. Patients should be in contact with their own provider, can check the above Health Department Web site, or dial 2-1-1 .

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Outbreak incidences mild, further vaccine delays will mean rescheduling some clinics

Dr. Wendy Davis

List of schools offering vaccination clinics

The state confirmed 45 cases of the flu virus strain H1N1 in Vermont for the week ending Oct. 17. At a press conference today, Dr. Wendy Davis, commissioner of the Vermont Department of Health, said the spread of the virus is “widespread,” affecting every region of the state.

The Centers for Disease Control and Prevention has a complete list of symptoms and recommendations for avoiding the flu.

Listen to Dr. Wendy Davis, commissioner of the Vermont Department of Health, speak at the press conference on H1N1 held 1 p.m. today at the Vermont Department of Health in Burlington.
Oct. 21, 2009 audio from Department of Health press conference

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