A boom and bust of community health workers

Presented by Kaiser Permanente

With Carmen Paun

Driving the day

RUNNING OUT OF MONEY — Community health workers, who have used their local connections to encourage Covid-19 care through the pandemic, saw a major increase in federal funding through the pandemic.

But the money is starting to run out, and many community health workers trained through the pandemic face layoffs, your host reports.

The federal government has invested well over half a billion dollars into training and sustaining more community health workers, who work as brokers to connect underserved populations to care and help them navigate the health system.

But without that funding’s continuation, some government officials and health experts say their work — which can go beyond Covid to make progress on other chronic diseases — will be cut short. Thousands have already been laid off, according to community health worker association leaders.

“We’ve got, unfortunately, a lot of chronic disease across our state. We’ve got a lot of comorbidities across our state — the health needs haven’t really changed,” said Allison Owen, deputy director at the Office of Rural Health in the North Carolina Department of Health and Human Services. “Everybody still needs those resources. And I think community health workers will continue to be invaluable in those spaces.”

Some lawmakers have said they want to continue funding the programs, but a divided Congress, with many members worried about government spending, makes the prospect of pandemic-level funding unlikely for the coming years.

But unless more funding arrives, more layoffs could be ahead.

North Carolina has laid off hundreds, according to the state’s community health worker association. In Arizona and California, many workers are leaving their jobs because they can’t find sustainable pay.

“There should start to be CHWs coming off the production line, but the big question is, will they find jobs,” said Carol West, interim executive director at the California Association of Community Health Workers. “I’m not sure they will.”

WELCOME TO MONDAY PULSE, where we still feel like we’re catching up from a big news day Friday — and gearing up for more of the same this week.

Do you have tips on what to expect with the end of the public health emergency? Or do you have a sense of what’s going on in the CDC? Let me know at [email protected].

TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Daniel about his reporting on community health workers’ impending layoffs and why many public health officials would like to keep this workforce to tackle other health challenges, like diabetes and obesity, especially after spending millions to train them.

Covid

EMERGENCY NO MORE — Two major decisions — one last week and one this week — offer perhaps the clearest sign yet that the powers that be no longer consider the Covid pandemic an emergency.

The WHO announced Friday that Covid is no longer an international public health emergency, POLITICO’s Ashleigh Furlong reports.

The WHO decision followed a recommendation from a committee of global health experts that found the situation no longer meets the criteria to be classified as a public health emergency of international concern.

That decision comes just days before the White House plans to end the U.S.’ national Covid public health emergency — a move that will roll back many of the government’s pandemic responses from the last three years.

It’s another indication of a shifting attitude and response to the pandemic, even as much of the world had moved on months or even years ago.

But the declarations also come as some countries and communities have little or no vaccination coverage, as many people continue to live with long Covid and the total death toll from the virus approaches 7 million globally.

Still, leaders are taking on hopeful tones, offering the new phases as a natural result of the downward trend of Covid’s impact on many.

At the Agencies

WALENSKY OUT — CDC Director Rochelle Walensky’s departure was announced Friday, blindsiding many public health officials and offering another hint of a new era of pandemic response, POLITICO’s Krista Mahr and Adam Cancryn report.

Walensky guided the president’s response to the Covid pandemic from his first day in office — a task that continued to be difficult as Covid deaths remained high and new variants continued to take hold, with many refusing vaccination.

Last year, Walensky began the process of reorganizing the agency after acknowledging that its “performance did not reliably meet expectations” through the pandemic.

She will step down June 30, though the announcement’s timing could be seen as a connection between the leadership change and the end of the Covid public health emergency.

“Dr. Walensky helped lead an unprecedented whole-of-government response during a historic pandemic,” HHS Secretary Xavier Becerra said in a statement after the change was announced. “We are living our lives again and the American people are safer now because Dr. Walensky led the CDC with real facts and science. She did not yield to the pressures of expediency or politics. And she always put people first.”

The announcement comes just after Adam reported that the White House has had trouble filling another key role: to lead the next phase of the government’s pandemic response and preparation.

RULING ON OTC BIRTH CONTROL — A decadeslong push to get the FDA to approve an over-the-counter birth control pill is approaching its final stretch this week, POLITICO’s Katherine Ellen Foley and Alice Miranda Ollstein report.

Reproductive health advocates have argued for years that an OTC birth control pill would increase access to contraception and decrease unwanted pregnancies. Support for the pill has mushroomed as access to abortion has all but disappeared in more than a quarter of the country since Roe v. Wade was overturned last summer — even as anti-abortion advocates have argued the FDA shouldn’t grant approval to an OTC option.

Getting HRA Pharma’s Opill approved is far from guaranteed.

The first OTC candidate doesn’t have adequate data to support its use in a nonprescription setting, the FDA indicated in documents released before an advisory meeting scheduled for this week, Katherine and our David Lim report.

The documents, prepared for a meeting of the agency’s independent advisers, considered whether available data is robust enough to support OTC use.

At the meeting, the committees will vote on whether the benefits of the drug’s OTC status outweigh potential risks.

The pill contains progestin, a hormone that prevents pregnancy, and is about 93 percent effective, according to the CDC. Progestin-only pills are generally safe, but HRA Pharma, owned by over-the-counter drugmaker Perrigo, needed to demonstrate that users could successfully follow instructions to take Opill without a health care provider’s guidance.

Global Health

PEPFAR PERSONNEL MOVES — Several staff changes are on the way in the office that leads the President’s Emergency Plan for AIDS Relief.

John Nkengasong, the U.S. global AIDS coordinator and special representative for health diplomacy, announced several changes in an email obtained by Carmen:

Tracy Carson, the U.S. health attaché at the Permanent Mission in Geneva, will join the office as chief of staff.

Nikki Tyler, previously the United States Agency for International Development’s global health bureau deputy director in the Center for Innovation and Impact, has joined the office as director of partnerships. She will lead partnerships with the private sector and foundations to help deliver on PEPFAR’s five-year strategy.

Gelila Teshome has joined as executive director, responsible for operational and administrative support. She was recently the director of operations at the White House’s National Security Council.

Jirair Ratevosian, who had several roles in the office, including chief of staff and, most recently, the first senior adviser for health equity policy, has left to return to California, where he will pursue “local civic engagement,” Nkengasong wrote.

What We're Reading

The Atlantic reports on what’s left of the pandemic beyond the emergency declarations.

The New York Times reports on the possibility of thousands coming to the border with the end of the public health emergency this week.

The Economist reports on how USAID is changing its global strategy.