August 22, 2023

Good morning, Vitals readers. Today's newsletter is 936 words or a 3½-minute read.

Situational awareness: The FDA approved the first vaccine that can be given to pregnant patients to protect infants against RSV.

1 big thing: The next abortion litmus test

Illustration: Sarah Grillo/Axios

Democrats are mobilizing for what they widely view as the next major referendum on abortion rights: this fall's Virginia state legislature elections.

Why it matters: Virginia is the lone southern state that hasn't banned or restricted abortion since the Supreme Court struck down federal protection of the procedure and provides another off-year test of its potency as a campaign issue following Ohio's special election this month.

The big picture: Democrats hold a majority in the Virginia state Senate, while Republicans control the House of Delegates. Only a handful of seats in each chamber are seen as competitive.

State of play: Virginia Democrats were encouraged by abortion rights supporters' recent success in Ohio, where voters rejected a ballot measure that would have made it harder to preserve abortion rights in the state.

  • House Democrats launched abortion-related ads in 14 legislative districts last week attacking Republicans for wanting to restrict access, and they're planning to send hundreds of canvassers "to warn people about this MAGA threat to abortion."

The other side: A memo released in July by the Republican State Leadership Committee said the GOP will focus its messaging on education, the economy and crime.

  • "These three issues are driving enthusiasm among Republican voters and will serve as critical factors in key battleground districts across the Commonwealth," the memo reads.

Between the lines: Virginia's voters will offer a high-profile test of how much Roe v. Wade's demise drives voter sentiment — and if pocketbook issues and concerns about schools and crime have the same reach.

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2. Waiting on boosters as cases climb

Illustration: Shoshana Gordon/Axios

As COVID-19 cases and hospitalizations creep up during a summer wave of heightened virus activity, updated vaccines are still likely weeks away, Axios' Jason Millman writes.

Why it matters: Americans have largely tuned out COVID, but the latest uptick is a reminder that the virus continues to circulate and mutate — though the threat is far below pandemic-era levels.

  • Health officials face a challenge convincing a pandemic-fatigued public to get an updated COVID shot, as vaccine uptake has declined with each successive booster.

What we're watching: The updated COVID shots from Pfizer, Moderna and Novavax are expected to become available in the third or fourth week of September.

  • Regulators earlier this summer decided the shots should target the XBB.1.5 variant, then the country's most dominant. Since then, the EG.5 variant has become dominant, and FL.1.5.1 is gaining steam.
  • Experts expect the updated shots will be protective against those variants, which both descended from XBB.
  • Scientists are still racing to understand the new BA.2.86 variant, which has been identified as a "variant under monitoring " given its large number of mutations.

The big picture: For Americans wondering if they should get boosted now or hold out for updated shots, the general consensus is that many people could wait a few weeks longer. However, the calculation could be different for higher-risk groups.

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3. Seniors can soon spread out drug costs

Illustration: Rebecca Zisser/Axios

Medicare enrollees will soon have the option to pay out-of-pocket prescription drug costs in monthly installments, rather than all at once when they receive their medications.

Driving the news: Medicare issued draft guidelines yesterday spelling out how it will implement the change, which begins in 2025 and was part of the Inflation Reduction Act's drug cost reforms, Axios' Maya Goldman writes.

  • While the program, called the Medicare Prescription Payment Plan, won't reduce enrollees' overall prescription costs, it could give seniors some financial relief by letting them spread out payments across the year.

The details: The guidelines say insurers must reimburse pharmacies for the full cost-sharing amount that seniors otherwise would have paid upfront.

  • CMS also outlined how insurers should handle monthly billing for out-of-pocket costs, along with other operational details.

What's next: Medicare is accepting feedback on the guidance until Sept. 20, and expects to release a final version in early 2024. It will also issue additional guidance next year on other issues, like enrollee outreach and information on plan bidding.

4. Record gun deaths among kids

Data: Pediatrics analysis of CDC data; Chart: Axios Visuals
Data: Pediatrics analysis of CDC data; Chart: Axios Visuals

Firearm deaths among children in the U.S. hit a new high in 2021, surpassing the previous record set during the pandemic's first year.

Driving the news: The study in Pediatrics, based on federal data, points to the worsening of an already distressing trend, after guns became the leading cause of death for children in 2020, Axios' Ivana Saric writes.

By the numbers: There were 4,752 pediatric firearm deaths in 2021, or a rate of 5.8 per 100,000 people — an 8.8% increase from the year before.

  • Between 2018 and 2021, the pediatric firearm death rate rose 41.5%.
  • Communities have color have been disproportionately affected. About half of children killed by guns were Black, and Black children accounted for the greatest increase in death rate.

What they're saying: There had been some thought that gun deaths among kids might have receded in 2021, one year removed from the toughest pandemic restrictions.

  • But study indicates the country may have moved to an "alarming new baseline" for pediatric gun deaths, study author Chethan Sathya of New York's Northwell Health told NBC.

5. Catch up quick

🦠 People who had even mild COVID cases are at heightened risk two years later for a host of problems typical of long COVID. (Washington Post)

🔎 Minnesota's attorney general is investigating Allina Health over allegations it denied non-emergency care to patients with large unpaid bills. (Star Tribune)

🏛️ A court decision blocking part of Georgia's ban on most gender-affirming care for minors throws a new legal wrinkle into state efforts to restrict care. (Axios)

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