NASHVILLE — First came public service ads alerting teenagers in Tennessee that they were eligible to get vaccinated for Covid-19. Then, the state’s top immunization leader, Dr. Michelle Fiscus, distributed a memo that suggested some teenagers might be eligible for vaccinations without their parents’ consent.
By this week, Dr. Fiscus said she was fired — a circumstance she attributed to pushback among Republican lawmakers in the state, who have complained that the Tennessee Department of Health had gone too far in its efforts to raise awareness of the shot among young people.
Dr. Fiscus, the health department’s medical director for vaccine-preventable diseases and immunization programs, is one of scores of public health officials across the United States who have quit or been forced from their jobs in a pandemic that was unlike anything they had tackled before and in a political climate that has grown increasingly split over the coronavirus and the vaccines.
A review published in December by Kaiser Health News and The Associated Press found that at least 181 state and local public health leaders in 38 states had resigned, retired or been fired since April 1, 2020.
“It’s just a huge symptom of just how toxic the whole political landscape has become,” Dr. Fiscus said in an interview on Tuesday. “This virus is apolitical — it doesn’t care who you are or where you live or which president you preferred.” Still, she added, “It’s just been a very difficult thing for us to overcome.”
A spokesman for the Tennessee Department of Health declined on Tuesday to comment on Dr. Fiscus’s departure, saying the agency could not discuss personnel matters.
The Tennessean, the Nashville newspaper that earlier reported Dr. Fiscus’s dismissal, also reported on Tuesday that the health department was pulling back its vaccination outreach efforts to children for all diseases — not just the coronavirus — amid the backlash from lawmakers.
Internal emails obtained by The New York Times suggested that agency officials had scaled back some plans in recent weeks for publicizing vaccinations.
In a statement, the health department said it was continuing to conduct vaccine outreach efforts, including those for children. Still, the agency said, “Being that trustworthy messenger means we are mindful of hesitancy and the intense national conversation that is affecting how many families evaluate vaccinations in general.” The statement added, “We are simply mindful of how certain tactics could hurt that progress.”
The tumult comes as virus cases are rising in Tennessee, as vaccinations have slowed, and as concerns about the Delta variant are emerging in parts of the country.
As in much of the United States, Tennessee’s virus outlook has improved significantly since the winter, when cases soared. But in the past two weeks, the number of newly reported cases has climbed, with a statewide average of more than 460 cases daily, according to a Times database. Yet the vaccination rate has stalled; about 43 percent of the population has received at least one vaccine dose, lagging behind a national rate of 56 percent.
Campaigns to raise awareness about the vaccines have not resonated in parts of Tennessee, where a hesitance has hardened especially among white, rural conservatives, Dr. Fiscus said. “It seems like there’s nothing that we can do to to get the message through,” she said.
Anger from lawmakers intensified after the memo by Dr. Fiscus was circulated to medical providers explaining a so-called mature minor doctrine, which allows doctors to treat patients between the ages of 14 and 18 without parental consent under a State Supreme Court ruling from 1987. The memo repeated information that has been publicly available on the health department’s website for years.
July 13, 2021, 7:28 p.m. ET
In recent weeks, lawmakers have pointed to the memo and to advertisements from the agency on social media, contending that the department was going too far in its efforts to reach teenagers. During hearings, lawmakers even raised the prospect of dissolving the department.
“When you have advertisements like this, with a young girl with a patch on her arm, all smiling,” Scott Cepicky, a Republican state representative, said as he held up a printout of a social media post during a recent hearing. “We all know how impressionable our young people are, and wanting to fit in in life.”
On Tuesday, Mr. Cepicky declined to comment on Dr. Fiscus’s dismissal, according to a representative for him.
The issue of whether and when teenagers should be able to consent to health care decisions has been reignited in the debate over the Covid-19 vaccines. Some parents’ rights proponents say parents should have the ultimate authority over their child’s medical care, particularly if they have concerns about the safety of the vaccines. But many legislators and public health officials have supported allowing children as young as 12 to get vaccinated without parental consent.
“Why would we want to discourage anyone, no matter their age, from being vaccinated during a pandemic?” said Dominic A. Sisti, an author of recommendations for adolescent consent and vaccines that were published this week in JAMA Pediatrics. “Teenagers have the capacity to weigh costs and benefits and they often know a lot more about the vaccines than their vaccine-hesitant parents.”
Forty states require parental consent for vaccinating children under the age of 18. But some states are now moving to tighten restrictions on when teenagers can consent to the Covid-19 vaccines in particular, arguing that because federal agencies have only authorized them for emergency use, parents should have more power to prohibit their children from getting them.
During the legislative hearing in Tennessee last month, Lisa Piercey, the state health commissioner, sought to calm lawmakers’ concerns, saying, “Under no circumstance is the department encouraging children to seek out vaccination without parental consent.”
She said she was aware of only eight cases in which the doctrine had been invoked to vaccinate a minor. Three of them were here own children, she said, vaccinated while she was at work.
Since then, the health department has dialed back its campaign, removing posts informing the public that people 12 and older were eligible to be vaccinated.
Dr. Fiscus said she had been a pediatrician in private practice before entering the public health realm. She took over as director of the state’s immunization program in 2019. She had been burned out in private practice, she said, tired of dealing with insurance companies and trying to make ends meet.
Even then, she said, she had confronted a hesitance to a range of vaccines with her clients, trying to convince parents that they were not only safe but essential.
Years later, she found herself back in the same spot, on a far larger scale.
“Nobody else in this state needs to die from Covid-19 because we have effective vaccines,” she said. “And the fact that we have elected and appointed officials that are putting barriers up to protecting those Tennesseans is, I think, it’s unforgivable.”
Jan Hoffman contributed reporting.