Despite the challenging policy environment created by the COVID-19 pandemic, the ACR has consistently engaged with policymakers to ensure the voice of rheumatology is heard when important decisions are being made that impact practices and patients. Throughout the pandemic, the ACR has engaged with federal, regulatory and state leaders on many issues, such as patient access to hydroxychloroquine, state licensing issues with telemedicine and emergency funding to sustain practices. Advocacy efforts are continuing with our latest outreach to state leaders to ensure that patients on immunosuppressants have access to COVID-19 vaccination.
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Late last year, as COVID-19 vaccines began to enter the marketplace, the ACR recognized that providers and patients would need vaccine guidance. The COVID-19 Vaccine Clinical Guidance Task Force was created with the goal of developing guidance and recommendations for rheumatology patients. This kind of guidance generally takes quite some time to develop, but the task force expedited the process and completed the guidance on a compressed timeline, with approval by the Board of Directors on Feb. 8. The guidance recognized that patients on immunosuppressants have increased vulnerability to COVID-19 infection. The advocacy implications of this guidance became clear: These patients are at increased risk of adverse outcomes and need priority access to vaccinations.
The ACR’s Committee on Rheumatologic Care (CORC) recognized an opportunity for engaging policymakers to ensure that the ACR’s guidance was reflected in state policy. With the vaccination guidance as a framework, CORC worked with the ACR’s Government Affairs Committee and the Affiliate Society Council to draft letters to state policymakers making the case that immunosuppressed patients should be given priority access to COVID-19 vaccinations. As plans for the outreach effort coalesced, research revealed that four states had already opened vaccinations to immunosuppressed patients. That left 46 states to target for outreach. The ACR, working with state and local rheumatology societies, sent letters to the governors, lieutenant governors and insurance commissioners of all of the target states to advocate for patients who are on immunosuppressant treatment to have early access to COVID-19 vaccines. It was a massive undertaking that drew on a roadmap developed during the ACR’s outreach on hydroxychloroquine shortages.
Coordinated Efforts
In the weeks following the publication of the ACR guidance and state outreach efforts, many states opened vaccinations to immunosuppressed patients. Many more are planning to follow suit over the coming weeks. Some states are also considering a further step of expanding vaccine eligibility to the broader population of patients with autoimmune and inflammatory rheumatic diseases, a group at higher risk for hospitalization and worse outcomes with COVID-19 compared to the general population. It would be easy to stop now, proclaim victory and move on to the next challenge, but it is important to highlight the process that led to this success.
This effort involved multiple ACR departments and committees and built on a long history of working with internal and external partners, including state and local rheumatology societies. The connections between different ACR priorities, such as clinical guidance and advocacy, may not always be immediately clear. But the effort to improve COVID-19 vaccination of rheumatology patients, from the development of clinical guidance though state outreach to get those patients access to vaccines, has been a shining example of the great strength of ACR advocacy.
One of the most effective parts of rheumatology’s advocacy capacity comes from the ability to translate the work of the ACR into strong, actionable public policy recommendations, then amplify those messages through member engagement. ACR/ARP members sent over 500 messages to state leaders supporting the ACR’s position on vaccinations. Additionally, our volunteer leaders and staff put in countless hours, often on evenings and weekends, to execute every phase of this strategy, from the formulation of the clinical guidance to the final media outreach. It took many different parts of the ACR working together to achieve this win for the patients that our members treat. It is, however, an important reminder of how strong and effective this organization and the rheumatology community can be when working toward a common goal. After more than a year of living in this pandemic, patients are one step closer to resuming a normal life because of the work of the ACR and its members. That is truly an accomplishment to celebrate.
Joseph Cantrell, JD, is the senior manager of state affairs for the ACR.