In May 2023, Texas passed a provision in its state budget that prevents any group funded by the state health department from promoting or advertising COVID-19 vaccines.
To learn more about how local advocates and health workers have adapted to this change, Public Good News spoke with Rekha Lakshmanan, chief strategy officer at The Immunization Partnership.
Lakshmanan shared more about TIP’s findings on vaccine issues across the state and how community health workers can turn to advocacy to help.
Here’s more of what Lakshmanan said.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
Public Good News: A provision in the Texas State Budget prohibits state-funded entities from promoting or advertising COVID-19 vaccines, but still allows them to distribute COVID-19 vaccines. How has this decision affected the communities you partner with?
Rekha Lakshmanan: We have heard from some community partners where they took what they saw in the budget language to be exactly what it was, which is ‘OK, we can’t promote the COVID-19 vaccine by itself. That means we can’t do a COVID-19-only vaccine clinic. But we understand that we can talk about COVID-19 vaccines when we’re talking about all the other vaccines,’ which is the correct interpretation of the way it was written in the budget.
But we had other community partners who interpreted it differently. Some said, ‘Well, we’re actually afraid to even promote any kind of vaccine, so we’re not gonna go out into the community and educate about it,’ because they feared some type of repercussions or getting into trouble just because of vaccines in general. So, you can imagine in those communities where community partners were interpreting this provision in a very strict manner that the community at large was missing out both in education as well as in vaccinations.
All that to say that there’s been a significant spillover effect. The provision created a lot of confusion, uncertainty, and a lot of frustration.
Looking at vaccination rates—over the course of the next year or so, we’ll have to look and see where they are, especially in those areas that interpret that provision differently.
One of the other kinds of practical reality of that provision took place in Corpus Christi last summer. There, the city council tried to pass a motion that would have required COVID-19 vaccine recipients to sign an Informed Consent Requirement before being vaccinated that included a bunch of non-factual information. So, what we saw was a local government now contemplating policy related to vaccines, which we had not really seen a whole lot before.
So, it’s a little bit of a whack-a-mole situation, because it’s coming from a number of different angles.
We’ve seen more skepticism, and that has been a result of the pandemic and skepticism around just even routine childhood vaccines.
PGN: What are you looking out for in 2025? What are your organization’s priorities?
R.L.: One of the things that we are actively watching for and advocating against is the weakening of school vaccine requirements.
We’re seeing attempts to undo these requirements. And these are guidelines that we’ve had for over 50 years now. They are extremely helpful and important because they ensure that children are vaccinated against communicable diseases.
When children go to school, it’s a congregate setting. And if you have a case of measles, for example, introduced in a school, and you have children who are either under-vaccinated or not vaccinated against measles, what’s going to happen? We’re going to see a measles outbreak in a school.
So, we have school requirements for a reason, but we’re seeing concerted, active attempts to either weaken them or just completely say, ‘Ah, we don’t need it.’
And even though we do have school requirements in Texas, you know, parents can opt their kids out. But, there are a few steps that parents have to go through to opt out of required school immunizations.
We want those steps to remain in place because we want parents to make a thoughtful and informed decision before they go get an exemption. Because, if your child is exempt from a vaccine and, lo and behold, you have a disease outbreak for which that child is not vaccinated, then that child can’t go to school; that child can potentially fall sick, which is what we want to avoid.
We’re also trying to alert our community partners that we all need to speak up and have one voice, that we need to ensure that children go to healthy schools.
Parents already have to deal with so many different things when they send their child off to school, there’s so many worries that they have. The one thing they don’t have to worry about, if kids are vaccinated, is falling ill.
But if we make it a free-for-all, as what is being proposed, then at the end of the day, it’s going to be the children who are going to suffer the consequences.
PGN: What do you wish that community health workers knew about advocacy and childhood vaccines?
R.L.: Generally, advocacy is easy. It may feel scary, but it really is easy, because community partners advocate on an everyday basis. You know, when they meet with a client, when they meet with a family, when they educate, essentially, that is advocacy work.
We advocate on an everyday basis, and so there really is no mystery to it.
From a childhood vaccination standpoint, I don’t want us going down a road where all the amazing work everyone has done over the last 50, 60, 70 years supporting public health, you know, supporting families to get their kids vaccinated, to see that completely undone and done in vain.
That’s why we all have to really work together and put up a united front that enough is enough.
People should not expect that others are going to take care of this issue, because if one person thinks, ‘Oh, someone else can deal with it, someone else can take care of it,’ well then others are going to think the same thing.
And now you have nobody working on this issue, and then we just see all the hard work that’s been done over the years just get completely washed away.
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