America’s frontline physicians call on Congress to support immunization infrastructure and COVID-19 vaccine development

By AOA Staff


This letter, written on behalf of 590,000 physicians and medical students represented by six medical associations including the AOA, requests that Congress supports the nation’s immunization infrastructure and the physicians who deliver needed vaccinations to America’s children and families.

A copy of the letter is below:

Sept. 10, 2020

The Honorable Mitch McConnell
Majority Leader
U.S. Senate
Washington, DC 20510

The Honorable Charles Schumer
Minority Leader
U.S. Senate
Washington, DC 20510

The Honorable Nancy Pelosi
Speaker of the House
U.S. House of Representatives
Washington, DC 20515

The Honorable Kevin McCarthy
Minority Representative
U.S. House of Representatives
Washington, DC 20515

Dear Majority Leader McConnell, Leader Schumer, Speaker Pelosi, and Leader McCarthy:

As organizations that together represent over 590,000 physicians on the frontlines of the COVID-19 epidemic, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association, and the American Psychiatric Association write to express the urgent need to support the nation’s immunization infrastructure and the physicians who deliver needed vaccinations to America’s children and families.

Vaccination rates have significantly declined since the beginning of the pandemic as visits to primary care physicians have dropped.¹ ² Many physicians are facing severe financial challenges in light of significant reductions in caseloads due to guidance and state directives to delay care. At the same time, medical practices are facing higher costs related to personal protective equipment (PPE), workforce training, telehealth implementation, and practice redesign. Physicians are working to safely meet the needs of their patients by instituting infection control measures ranging from redesigning waiting rooms to conducting drive-through vaccinations. Practices are also facing significant costs for improved technologies to remind patients when they are due for vaccines and for the significant amount of time it takes to counsel patients on immunizations, particularly those who are hesitant to receive them.

A strong vaccine delivery system must be an essential part of the strategy to end the COVID-19 epidemic. It is critical to ensure that as many patients as possible catch up on missed vaccinations, receive the flu shot this fall, and receive a COVID-19 vaccine when it is available. Payment for vaccines must reflect the increased costs for physicians taking extraordinary measures to ensure that their patients receive vaccines. It is therefore essential that Congress act to significantly improve payment rates for immunization administration. The proposed 2021 Medicare Physician Fee Schedule (MPFS) appropriately recognizes the important need to increase vaccine payment and proposes significant increases to payment for immunization administration. These proposed rates would not take effect until January 1, 2021. We call on Congress to pass legislation to (1) immediately implement the vaccine administration payment increases proposed in the 2021 MPFS, and (2) require state Medicaid programs to align their vaccine payment with these same rates for the duration of the public health emergency, with the cost fully funded by the federal government.

Additionally, there is an important role for the federal government to play in encouraging patients to return to their physician practices for important preventive care and vaccines. Patients are missing routine screenings and procedures needed to prevent the onset of serious health conditions—and while the flexibilities that have been implemented for telehealth services have been helpful, they are not sufficient to meet all needs, including provision of immunizations. Early in the COVID-19 epidemic, patients were discouraged or prohibited from seeking out non-emergency care. However, since that time, physicians have taken significant efforts to ensure that their offices are incredibly safe places to receive care. Physician practices are open, safe, and essential. In addition, with the closure of workplaces, many adults will not have access to their typical source of the flu vaccine. This will require concerted efforts to encourage individuals to return to their primary care physician practice for the flu shot and other recommended vaccines this fall. We urge Congress to fund activities such as communications campaigns to restore public confidence in the safety of receiving medical care during the pandemic and to encourage individuals to receive needed preventive care and vaccines.

Vaccine hesitancy, particularly with respect to a new COVID-19 vaccine, threatens to impede our nation’s ability to emerge from this epidemic. Largely driven by online misinformation, an increasing number of patients in recent years have become more hesitant to receiving vaccines according to expert recommendations for themselves and their children. Additional drivers for hesitancy specific to the COVID-19 vaccine include concerns about safety and efficacy due to the rapid development timeline for COVID vaccines. Initial surveys suggest that 75% of individuals would get vaccinated if a COVID-19 vaccine were made available and only 30% would want to get vaccinated as soon as a vaccine becomes available.³ ⁴Restoring confidence in the safety and effectiveness of vaccines will be crucial to ensuring uptake of a COVID-19 vaccine.³ ⁴ ⁵

We strongly supported the goals of the Vaccine Awareness Campaign to Champion Immunization Nationally and Enhance Safety (VACCINES) Act of 2019 (H.R. 2862) prior to the current coronavirus outbreak—and the current pandemic makes this bill especially crucial. This legislation seeks to support research to better understand vaccine hesitancy, spread public awareness of the importance of vaccinations, and increase vaccination rates across the lifespan. Due to the spread of the COVID-19 virus, this legislation is needed now more than ever to help ensure fewer Americans are receptive to misinformation about the virus and any potential vaccine. We urge you to address vaccine hesitancy and promote vaccine confidence by promptly enacting the VACCINES Act.

Our organizations are encouraged by the progress being made in the development of vaccines for COVID-19. The availability of such vaccines will be hugely important for our patients and for our nation. However, it is critical to ensure that these vaccines are not approved for use until research has shown them to be safe and effective. In addition, we must make sure that the effort to achieve a vaccine quickly does not come at the expense of ensuring that the vaccine works and is safe for everyone. Children and pregnant and lactating women have yet to be meaningfully included in COVID-19 vaccine research. We call on Congress to conduct continued oversight over the COVID-19 vaccine development and distribution process, including ensuring that pregnant women; children; Black, Indigenous, Latinx, and other populations that face inequities in care or with unique needs are included in this important research and appropriately prioritized in distribution plans.

Thank you for your attention to these critical issues related to vaccines. We look forward to working with you to strengthen our nation’s response to the COVID-19 epidemic.


American Academy of Family Physicians
American Academy of Pediatrics
American College of Obstetricians and Gynecologists
American College of Physicians
American Osteopathic Association
American Psychiatric Association

¹ Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:591–593. DOI: icon.
² Filer W, Malone Y. 2019 to 2020 Decline in Administered Immunizations Across the Lifespan due to COVID ambulatory care and public health visit reductions. VaxCare. 2020.
³ Schaffer DeRoo S, Pudalov NJ, Fu LY. Planning for a COVID-19 vaccination program. JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.8711
⁴ Trujillo KL, Motta M. A majority of vaccine skeptics plan to refuse a COVID-19 vaccine, a study suggests, and that could be a big problem. Published May 4, 2020. Accessed May 6, 2020. vaccine-skeptics-plan-to-refuse-a-covid-19-vaccine-a-study-suggests-and-that-could-be-a-big-problem-137559
⁵ Gostin LO, Salmon DA. The Dual Epidemics of COVID-19 and Influenza: Vaccine Acceptance, Coverage, and Mandates. JAMA. 2020;324(4):335–336. doi:10.1001/jama.2020.10802