Spotlight Exclusives

‘Bridge’ Program Offering COVID Vaccine to Uninsured Adults Set to Shutter

Chrissie Juliano Chrissie Juliano, posted on

A federal program that has delivered more than 800,000 free COVID vaccine doses to uninsured adults is set to end in August, leaving underserved communities with dwindling options as the fall vaccination season begins. Chrissie Juliano, executive director of the Big Cities Health Coalition, spoke with Spotlight recently about the looming end of the Bridge Access Program and the impact it could have. The transcript of that conversation has been lightly edited for length and clarity.

Why don’t we start with some basic information about the Big Cities Health Coalition?

The Big Cities Health Coalition is a forum for leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to protect and promote the health and safety of the 61 million people they serve—about 20% of the U.S. population. Our membership criteria are based on city populations, so it’s half a million people or more. In some cases, it’s a county health department, but membership is really based on the city population.

We were founded in 2002 around this idea that there’s something unique and different about big cities and about being a big city health commissioner. We focus primarily on urban health issues or how health issues show up in cities and how the response can differ. Like with the opioids crisis, what you do, who you talk to, how you intervene, may be different in a big city than in rural America. We really focus on strengthening the public health system writ large at all levels of government so folks can prevent and respond to challenges both routine and emergent. We focus, as I said, a lot on overdose prevention and substance misuse, community safety and violence prevention, health equity and racial justice, and how you prepare at a system level to respond to infectious diseases and other emergencies.

I’m sure the coalition was consumed by COVID for a few years. How much is that still on your radar screen for you and your members at this point?

I think it’s a little more on their radar screen than definitely the general public. When you work at a local health department, whether it’s in a big city or a small city, you’re really in the community and you’re really trying to figure out who needs what to be as healthy and safe as possible. So, I think it hasn’t been dismissed quite as much across our membership as it has been in other parts of the country. And I think when you layer on avian flu and things like that, there’s still a lot of conversations about what if we had to pivot? What would that look like? What have we learned?

So, let’s talk about the Bridge Access program and what it has done and why it’s going away.

The Bridge Access program was created so that people who were uninsured or underinsured could get access to COVID vaccines. There were one more than 1.4 million COVID vaccines given to more than 800,000 people through the Bridge Access program. The federal government basically provided resources to and partnered with retail pharmacies, and not just big box pharmacies, but also pharmacies that could be down the street in your community. The idea was really to make vaccines available to whomever needed it in their community, largely free of cost, and it filled an important gap.

That said, it will be discontinued in August because of the claw back of COVID dollars by Congress. And I think what it shows is we need systems in place that are not just dependent on the private healthcare system, and that’s both because of costs and also because of access to vaccines. At the height of COVID, there were challenges for people to just find a vaccine whether or not they were uninsured. We need to be really thinking about how everyone who wants a vaccine, no matter how old, no matter where they live, should have access to not just COVID, not just flu, but a bundle of vaccines that are really going to prevent disease across the board.

One of the things some folks forget about vaccines is they’re only as good as how vaccinated your community is, right? That’s how we have measles outbreaks. If there’s a pocket of unvaccinated folks, measles are going to pop up. Now, generally you’re protected if you’re vaccinated, but ideally, we’d have full coverage so that we don’t have diseases that were previously eradicated reemerging. So, I think the other piece of all of this is we need to get back to thinking about vaccines big picture and not just about COVID.

And Bridge Access was specific to COVID, right? There has not been a program to offer free vaccination for a host of things.

Not on this scale. There are sometimes programs through local health departments, but not to the extent of we the federal government are purchasing this vaccine, and you can walk in off the street no matter who you are and get it.

And are there are some potential alternatives that might be helpful in the absence of Bridge Access?

I think there are policy interventions that cost money and need political will that could bridge that gap, no pun intended. But we don’t fully fund health care in this country. We really make people work to be healthy. One of the things that we support and have been fairly vocal on with Congress is an adult vaccine program. And this has been proposed the past three years in the president’s budget, but it hasn’t been funded. It’s a program similar to Bridge that would allow adults who are uninsured or underinsured to get a host of vaccines free of charge. We’ve seen with COVID and with other programs that when you take that copay out of the calculus and you make it easy and inexpensive for people to get vaccinated, more and more people will do so.

When cost sharing for vaccines under Medicare Part D was eliminated, more people got vaccinated. I often think that those of us who think about and make policy don’t realize just how cost sensitive so many people are even when it comes to health care. And so again, for me, it’s really thinking about how can you have the most people with the most uptake for vaccines and other preventive measures too.

And for your members, it’s not like there’s available budget at the local level to really fill in the gaps here. There needs to be a federal investment.

I think probably in some places there are limited funds that are really targeted at the most in need but not to the scope and scale that we saw with Bridge or even when the federal government was just giving vaccines to states and localities. I think for the scope and scale that we’re talking about it would need to be a federal program and it would need to be connected to things like immunization registries. It really needs to be more coordinated across the country so that we know where the gaps are, who’s covered and what the uptake is.

And do you find that it’s more difficult to advocate for these sorts of policies now? I’m guessing that the opposition pre-COVID was mostly fiscal, and now you’ve got at least a certain dollop of anti-vaccine views that you have to counter as well?

I still think the main roadblock is money. I think in a different budget environment, we could potentially get past the politics. It’s a huge problem—anti-vaxxers, lack of science data, etc. But I also think it’s easy for those of us who advocate in this space or make policy in this space to just say, oh, it’s the anti-vaxxers, or those people won’t do that. I’m not sure that the loudest voice is often the one we should be listening to. I feel like it’s really the political will to invest dollars, which would be substantial. I think that’s the biggest hurdle.

But you also now have the proof point from Bridge Access, that if you build it, people will come and, and there is a cost savings to the system as a whole from that.

Yes. Whether it’s vaccines or other things, we do not invest in prevention in this country. We really do need to think about how investments across the board could both save us money in the long run but then also make us healthier, I think the other thing is we know vaccines work. Notwithstanding politics and anti-vaxxers, we have good evidence that vaccines prevent illness and disease. And so, if there were ever a big prevention program, we should continue to invest in it, filling those gaps around vaccines. Even for people who have private insurance, it’s often expensive to get shingles or pneumonia vaccines.

We’ve been so caught up in the COVID vaccine and the pandemic that we really need to think big picture again. And the re-emergence of measles is really evidence that we need to make sure people get vaccinated, whether they’re insured or not. In the measles outbreak in Chicago recently, it was due to migrants who came here who were not vaccinated. The health department tried to vaccinate them, but there weren’t dollars available. So, even when you try to fill gaps, and even when you have the best laid plans, we still don’t have enough people vaccinated for these routine diseases, let alone COVID and things like that.

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