HRSA Needs to Require Covid-19 Vaccine for All Ryan White Grantees

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

"The liberty secured by the Constitution of the United States does not import an absolute right in each person to be at all times, and in all circumstances, wholly freed from restraint, nor is it an element in such liberty that one person, or a minority of persons residing in any community and enjoying the benefits of its local government, should have power to dominate the majority when supported in their action by the authority of the State."[1]

Since 1905, when the Supreme Court rendered its fateful decision in Jacobson v. Massachusetts, it has been the law of the land that state governments have the authority to enforce compulsory vaccination laws. The Court ruled, "it is within the police power of a State to enact a compulsory vaccination law, and it is for the legislature, and not for the courts, to determine."[2] The debate at the time was focused on smallpox vaccinations; today it is the highly-effective Covid-19 vaccinations at issue. Yet today, people living with HIV/AIDS increasingly don't view liberty and public health as being mutually-exclusive.

Jacobson v. Massachusetts

It has been widely accepted that the same authority granted to states to protect public health also extends to the federal government, and as such the ADAP Advocacy Association previously urged the Health Resources & Services Administration (HRSA) to require the Covid-19 vaccine for all Ryan White grantees. Our POZ brothers' and sisters' lives depend on it!

With the U.S. Food & Drug Administration (FDA) granting full approval to the Covid-19 vaccine developed by Pfizer, BioNTech, it is in the public health interest to require the vaccination for any personnel who could encounter clients living with HIV/AIDS. Jeffrey R. Lewis, President & CEO of the Legacy Health Endowment, contends that the precedent established by the Jacobson case extends to the federal government, too. 

"As a nation, we need to have a consistent vaccine policy," said Lewis. "This means all federal agencies and the programs they fund and operate cannot escape their responsibility."

Over one hundred years ago in writing for the Supreme Court's 7-2 majority, Justice John Marshall Harlan argued, "Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others.”[3]

Justice John Marshall Harlan (Wikipedia)

It is incumbent on all public health professionals - whether they be physicians, nurses, pharmacists, social workers, phlebotomists, or clinicians - working directly with immunocompromised populations to do so with their safety in mind. That is why both the federal and state governments require a litany of recommended vaccinations for frontline workforce, including Hepatitis B, Influenza, MMR, Varicella, Tdap. Global events and current circumstances dictate the Covid-19 vaccination now be among the vaccine requirements for all Ryan White grantees coming into direct contact with their clients.

The policy change is even more paramount considering numerous studies on the intersection between HIV and Covid-19. For example, there is a reduced vaccine response in people with HIV/AIDS. Many studies have shown increased risk factors for hospitalization among HIV patients infected with Covid-19. In fact, one large study finds HIV status increases the odds of dying from Covid-19 by at least 30 percent.

In supporting the policy change, Edward Hamilton, Executive Director of the ADAP Educational Initiative argued, "Our clients deserve to know they're receiving care from a program that puts their health and safety first. HRSA and other federal agencies do indeed have the regulatory and administrative authority to require grantee staff to be vaccinated as a mandatory grant condition to protect our vulnerable populations. HRSA cannot expect clients to follow their guidance if they aren't willing to hold grantees and their staff to the same standard. In addition, grant conditions are not impacted by any state law or governor's executive order."

The number of hospitals and health systems requiring Covid-19 vaccination for employees is growing, according to Becker's Hospital Review. Here are the healthcare organizations that have announced mandates. These hospitals and health systems are clearly abiding by the "First, Do No Harm" principle, which requires that healthcare providers weigh the risk that a given course of action will hurt a patient against its potential to improve the patient’s condition.[4]

Photo Source: The English Farm

Retired Registered Nurse Wanda Brendle-Moss, who is currently enrolled in North Carolina's AIDS Drug Assistance Program, calls the proposed requirement common sense. "Frontline workers are special people because they dedicate their lives to public health and they provide needed supports and services to their patients," submits Brendle-Moss. "Caring for illness is part of their job, but so is protecting them from other potential illnesses or infections. As someone living with a chronic illness and compromised immune system, I'd like to think the people caring for me care enough about me to get vaccinated against Covid-19."

It should come as no surprise that Covid-19 vaccine mandates are widely supported by major health care groups such as the American Medical Association, American Nurses Association, American Academy of Pediatrics, Association of American Medical Colleges and National Association for Home Care and Hospice, among many others. A growing chorus of hospitals and health care systems are now requiring the Covid-19 vaccine. Isn't it time for the state-level public health institutions to do the same, including all Ryan White grantees?

[1] Jacobson v. Massachusetts, 197 U.S. 11 (1905). Retrieved online at https://supreme.justia.com/cases/federal/us/197/11/.
[2] Jacobson v. Massachusetts, 197 U.S. 11 (1905). Retrieved online at https://supreme.justia.com/cases/federal/us/197/11/.
[3] Canellos, Peter S. (2021, September 8). The Surprisingly Strong Supreme Court Precedent Supporting Vaccine Mandates. Politico Magazine. Retrieved online at https://www.politico.com/news/magazine/2021/09/08/vaccine-mandate-strong-supreme-court-precedent-510280
[4] Bailin, Patsy (2018, October 15). Applying the “Do No Harm” Principle to Health Data. Datavant. Retrieved online at https://medium.com/datavant/applying-the-do-no-harm-principle-to-health-data-c3c3d33ad062#:~:text=Traditionally%20applied%2C%20the%20“do%20no%20harm”%20principle%20requires,condition.%20In%20short%2C%20to%20perform%20a%20cost-benefit%20analysis

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.