Last week -- during National Immunization Awareness Month -- President Donald Trump signed an executive order calling for revamped recommendations for childhood vaccinations, like those for measles, mumps and rubella. The order advocates for separating the shots into single-disease shots to be administered at different appointments. During the announcement, President Trump linked the number and timing of vaccines to rising rates of autism, despite scientific evidence of any link.
Meanwhile, experts say access to vaccines is especially important for people with intellectual and developmental disabilities (IDD). To learn more, WAMC's Lower Hudson Valley Bureau Chief Elias Guerra spoke with Brittany Miske, Vice President of Health Care Management and Quality Officer for Care Design New York, the state's care coordination health home that serves individuals with IDD.
INTERVIEW TRANSCRIPT
Editor's note: This conversation has been lightly edited for clarity.
Guerra: Why is it especially important for people with intellectual or developmental disabilities to get vaccinated and what are some of the challenges there?
Miske: So vaccines are important for folks with IDD because it allows your body to develop a defense against viruses and diseases it wouldn't normally have otherwise, right? So you go out in the community to a concert, have a family gathering, etc. Someone might be ill with the flu. If you hadn't received your flu vaccine, that would be the first time your body would be seeing the flu and it would have a more dramatic response and potentially severe without the vaccine, could have complications or result in the hospital.
Individuals with IDD more specifically often have changes to their upper respiratory, their airway, and how they breathe, which can put them at risk for breathing difficulties when they do get sick. They also tend to have multiple chronic conditions.
During COVID, and I hope that stays in our past, right? But you may have heard the term immunocompromised. That came to the forefront of discussions. And what that means is people that have multiple chronic conditions, that makes their immune system less effective. They can't fight viruses and illnesses as well. And folks with IDD often are immunocompromised, meaning they get sicker, quicker, and worse. So as far as barriers with folks with IDD, it's multifactorial.
No one wants to go to their doctor, right? We don't want to go to our doctor and get a shot, get our blood work. It's uncomfortable.
Folks with IDD, they often struggle with barriers with transportation. A lot of folks are dependent on Medicaid transportation, which is a very difficult system to navigate, schedule specific times, and or others to bring them to those appointments. Additionally, going to a doctor's office can create a lot of sensory overload, right? Bright lights, noises, new environment. And that can result in behaviors such as stimming or folks just not wanting to be in that setting, resulting in not getting the preventive care that you went to the office for.
So, ensuring that the healthcare provider knows that someone might be coming in and needs some extra support to get through that appointment can be really helpful to overcome those barriers.
Guerra: And I mean, we saw this with COVID, but a lot of people are very hesitant about getting vaccines. What is that conversation like when you're telling somebody who's is concerned about getting vaccinated?
Miske: So, it's perfectly natural to be concerned with getting a treatment or a vaccine, right? We want to make sure that what we're putting in our bodies isn't going to have a negative consequence. So what I usually encourage folks to do is talk to their providers, have really honest conversations about what your concerns are and what your risks are as a person. Everyone's risks are a little different. And if you're advocating on behalf of someone, trying to communicate their wishes as well. Right.
Individuals with IDD are often spoken over. They aren't allowed to speak their mind, or people make decisions for them. Make sure that you're taking them into the conversation with you and not making those decisions for them, having informed discussions. Additionally, vaccines get a lot of oversight before they come to the market. They're one of the safest ways we can develop that immunity, that defense I talked about earlier against viruses and diseases. They go through lots of testing and monitoring to make sure that they are safe for the general population.
Guerra: There's been a lot of big changes in healthcare, with Medicaid, and SNAP. So, just as somebody who works with people with IDDs, I wonder if there's been any specific challenges that you have seen recently.
Miske: Sure. So, what you're bringing attention to here is right the Medicaid population and then who of those individuals may have intellectual and developmental disabilities, which is a fair amount. In most cases, most of our folks have New York State Medicaid coverage. And with that group, there are challenges, right, with getting recertified for Medicaid status, and along with that comes SNAP.
So the population as a whole has been an excluded population for a lot of the criteria because of the conditions that they struggle with, right? A chronic disability, not everyone can work. Not everyone can meet those work requirements. So there has been allowed some flexibility in meeting those requirements.
However, our care managers, I have to say at Care Design, are really great at making sure they know when due dates are for certain things, when they know when renewals are, and following up with families and individuals to make sure that we have as little lapse, if at any, in those services as possible. And really that's their role is to coordinate those services and know when those things are coming to ensure people receive continuity of services.
