News

Remembering Dr. Elizabeth “Liz” Tam

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The Hawaii Journal of Health & Social Welfare (below) shares a fond memory of Dr. Elizabeth “Liz” Tam, HSRHA former treasurer. Her work with the HSRHA was highlighted in the article.
 
Dr. Tam is a very dear friend and colleague, who was the only academic professor that promoted community participatory research (VOG project), hiring research assistants from within the community.  Her contributions are many and I would like to share with our community how much she means to us. 
Mahalo,
auntie Jessie
See attached file for Additional Information

MAYOR ROTH LIFTS ALL COUNTY COVID RESTRICTIONS

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From: Johnasen, Cyrus
Sent: Monday, February 28, 2022 2:50 PM
Subject: MAYOR ROTH LIFTS ALL COUNTY COVID RESTRICTIONS

Aloha!

Mayor Mitch Roth announces the termination of Hawaiʻi County’s Thirteenth Supplementary Emergency Proclamation, declaring an end to all County emergency rules related to COVID-19. As a result, effective immediately, there will no longer be a limit on gathering sizes (indoor and outdoor), which ultimately removes the County’s coveted mechanism for ‘special gatherings’ review and approval. However, residents must still adhere to the Governor’s Emergency Proclamation Related to COVID-19 (Omicron Variant), which includes indoor mask-wearing, Safe Travels requirements, and testing/vaccination requirements for County and State employees. The Governor’s emergency order will remain in effect until March 25 unless otherwise acted upon. It is unclear if the Governor will extend his emergency rules beyond then.

Please see the attached release for more information. I’ve also attached a copy of the rescinded rule and termination of proclamation for your review.

Additionally, please see Mayor Roth’s recorded announcement here:
                        https://www.youtube.com/watch?v=-gWtsDsk_kM

Mahalo,
Cyrus Johnasen
Public Relations
County of Hawaiʻi
Office of the Mayor
cyrus.johnasen@hawaiicounty.gov
808.345.9434

NRHA – National Rural Health Association NEWSLETTER (Feb 17, 2022)

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NRHA Today
Membership Blog Events Subscribe 2/17/2022
NRHA Today
In this issue:
4 days left to nominate colleagues, yourself for NRHA awards
NRHA thanks 500+ Policy Institute attendees for joining us
Vaccine mandates not causing widespread labor shortages
Why a treatable cancer disproportionately kills Black women
Mental health needs of economically distressed farm families
Bounties, bonuses leave small hospitals behind in staffing
Exploring health disparities: ‘Rural hospitals are drowning’
How digital health lays groundwork for future care strategy
Now accepting presentations for NRHA’s RHC, CAH Conferences
Health literacy: Definitions, influences, rural inequities
NRHA announces new volunteer leadership for 2022 and beyond
New study shows Delta hit rural America particularly hard
NRHA webinars on telebehavioral health, rural ACOs
Nursing schools must accommodate rising demand, interest
Why aging in place is even harder in rural areas
Dental faculty, teaching health center GME funding available
HHS releases additional $2B in COVID relief payments
Rural EMS workers depart as emergency services demand grows
Rural dental program expands to school to reach residents
Fact sheets on rural colorectal, cervical cancer prevention

4 days left to nominate colleagues, yourself for NRHA awards

Consider nominating your favorite rural health individual, program, or organization by Feb. 21 so they may be honored nationally for their contributions to rural health. Each year NRHA honors outstanding individuals and organizations in the field of rural health who have dedicated their time and talents to improving the health and well-being of others. Previous Rural Health Award recipients have stretched the boundaries of possibility by forging innovative programs and services, making rural life healthier and more compassionate. Selections will be made solely on the basis of a 300 to 500-word narrative, which is part of the nomination form. To ensure accountability, either the nominee or nominator must have a connection to NRHA through membership. Awardees will be honored with a special ceremony during NRHA’s Annual Rural Health Conference May 10-13 in Albuquerque, N.M.

NRHA thanks 500+ Policy Institute attendees for joining us

We’re thrilled that more than 500 rural health advocates could join us for NRHA’s virtual 33rd Rural Health Policy Institute last week. We thank you for advocating on behalf of rural health. Our Government Affairs team has created an advocacy campaign for attendees follow up with their elected officials. You can catch up on any sessions you may have missed — and let your colleagues know what they missed, as anyone can still register to view all sessions on demand. Simply choose a session from the agenda and click the green Replay button to watch the recording. You’ll see all presentation materials provided to NRHA at the bottom of each session page. Be sure to download advocacy materials provided by NRHA’s Government Affairs team to continue your advocacy by setting up and preparing for congressional visits. When rural advocates speak up, people listen – Sen. Dick Durbin (D-Ill.) issued a press release detailing his visit with Illinois rural health advocates. You can view a great recap of the full event via NRHA and other event participants on Twitter.

Vaccine mandates not causing widespread labor shortages

Health care organizations have often avoided vaccine mandates, fearful of backlash and labor shortages – but on-ground reports have suggested employers have not faced this outcome. “Anecdotally, on a national basis … most rural hospitals report anywhere from 40 to 70 percent of their employees are vaccinated,” says NRHA’s Brock Slabach, suggesting rural workers are more suspicious of the vaccine. Many rural providers remain concerned about the potential impact of mandates. “The harsh reality in rural Texas is you don’t have to lose many staff … to threaten your ability to provide care,” says NRHA member John Henderson of TORCH. A growing number of states are seeking rural hospital waivers, and some unvaccinated workers are citing religious exemptions. The Georgia Health Policy Center will host leaders from NRHA and other organizations for a webinar on updates to the Rural Health Clinic COVID-19 Vaccine Distribution Program at 2 p.m. CST Feb. 22. NRHA has developed the Rural Vaccine Confidence Initiative to help rural health stakeholders communicate COVID-19 vaccine efficacy and safety in their own words at the local level.

Why a treatable cancer disproportionately kills Black women

Across the United States, Black women have a significantly higher chance than white women of dying from cervical cancer. A new study focusing on Georgia finds that “neglect and exclusion” from the nation’s broken health care system are to blame. NRHA member Jan Eberth also reports that people in rural areas with the proportionately least white population – especially American Indian, Alaska Native, and Black rural communities – live farthest from life-saving care. “The data confirms a lot of other details that we’ve been seeing historically across the United States, and this is something that we deal with all the time in our work,” says NRHA’s Brock Slabach. To confront Montana’s unmet health and wellness needs, Montana State University is launching a new doctoral program in Indigenous and rural health, and the University of Kansas School of Medicine, an NRHA member, recently announced the formation of the Kansas Center for Rural Health. The All of Us Research Program is hosting a webinar at 11 a.m. CST Feb. 22 on Black maternal health in honor of Black History Month.

Mental health needs of economically distressed farm families

According to NRHA, male farmers, ranchers, and other agricultural managers have a significantly higher rate of suicide deaths at 43.2 per 100,000 compared to the average across all other occupations of 27.4 per 100,000. Given recent global economic and climate trends, such behavioral health consequences will likely remain a public health concern for the foreseeable future. In a recent report coauthored by multiple NRHA members, the RUPRI Health Panel offers guidance for specific federal and state policy responses to address the behavioral health needs of rural farm families. Additionally, a new study coauthored by NRHA member Tyrone Borders of the University of Kentucky looks at serious mental illness and mental health treatment utilization among adults residing in nonmetropolitan and metropolitan counties. Let’s achieve the pinnacle of rural health in the Land of Enchantment with more than 80 sessions, including many focused on rural behavioral health, at NRHA’s 45th Annual Rural Health Conference May 10-13 in Albuquerque, N.M.

Bounties, bonuses leave small hospitals behind in staffing

Already strained by the pandemic, hospitals are desperate to staff their facilities as the Omicron variant spreads. With no end in sight, hospitals have taken to enticing workers from other facilities – but this has made it nearly impossible for smaller facilities to compete. “We need to mobilize all of the resources that we have to figure out how we’re going to solve this problem, and it starts with a systemic approach,” says NRHA’s Brock Slabach. “We can’t just pay our way out of this through bonuses and bounties.” At many facilities, vacancies have reached new highs prompted by turnover, competition, and dissatisfaction. “When you’re talking about a small town and lower salaries throughout those smaller rural communities, competing against urban locations has always been problematic,” says NRHA CEO Alan Morgan. Let’s achieve the pinnacle of rural health in the Land of Enchantment with sessions focused on real workforce solutions at NRHA’s 45th Annual Rural Health and Rural Medical Education Conferences May 10-13 in Albuquerque, N.M.

Exploring health disparities: ‘Rural hospitals are drowning’

According to a report by NRHA member Chartis Center for Rural Health, which was first shared at NRHA’s Rural Health Policy Institute last week, the pandemic has placed even more pressure on rural hospitals and communities, particularly due to rising health disparities and inequity, workforce shortages, and revenue cuts. The Chartis Center also recently named their annual top 100 critical access, rural, and community hospitals. Since 2010, more hospitals have closed in Tennessee than almost any other state. A recent report explores Medicaid expansion and other possible solutions to this crisis. Additionally, safety net hospitals have faced losses of up to $9 million due to a handful of drug companies limiting 340B discounts on prescription drugs dispensed through community pharmacies, according to 340B Health, an NRHA member. The bipartisan Save America’s Rural Hospitals Act was recently introduced to the 117th Congress to raise the rural health safety net, which is crucial to the survival of rural communities.

How digital health lays groundwork for future care strategy

Virtual care technology is giving health system administrators new ideas on how to deliver care inside the hospital. Baptist Health is one of many health systems using digital health to improve ICU services and connect providers throughout the Arkansas-based 11-hospital network, improving care at the bedside and enabling small, rural hospitals to reduce transfers and care for more patients. Executives say the platform allows them to coordinate care from main hospitals in Little Rock and give outlying hospitals with fewer resources the support they need. Additionally, stakeholders in Nebraska have recently unveiled a blueprint for expanded broadband access in the state, particularly in small communities. Let’s achieve the pinnacle of rural health in the Land of Enchantment by exploring broadband and telehealth access strategies at NRHA’s 45th Annual Rural Health Conference May 10-13 in Albuquerque, N.M.

Now accepting presentations for NRHA’s RHC, CAH Conferences

NRHA is accepting session proposals for our 2022 Rural Health Clinic and Critical Access Hospital Conferences, which will be held Sept. 20-23 in Kansas City, Mo, our hometown. The goal of NRHA’s RHC and CAH events is to share effective practices, policies, and information and provide insights and best practices addressing many of the access, quality, and patient safety issues confronted by critical access hospitals and rural health clinics. Five interest tracks are available for Critical Access Hospital Conference submissions: innovation, financial, leadership, quality, and best practices. Join us in the City of Fountains this fall and be part of NRHA’s fastest-growing events for rural clinic and hospital leaders, educators, staff, advocates, and other stakeholders.

Health literacy: Definitions, influences, rural inequities

According to a recent Rural Health Information Hub report, a lack of health literacy can lead to inequities, particularly in rural areas. “Providers can forget to translate their information back into plain language for their patients,” says Stan Hudson of Wisconsin Health Literacy. “This lends to the creation of an unequal system of information sharing in health care. Health care providers don’t always consider that their use of jargon alone can lead to an information divide or inequity.” Additionally, RHI Hub recently updated their topic guide on recruitment and retention for rural health facilities, including strategies and incentives to help communities attract health care providers and information on compensation, benefits, and incentives that rural facilities might offer.

Upcoming events

Annual Rural Health Conference
May 10-13
Albuquerque, N.M.

Rural Hospital Innovation Summit
May 10-13
Albuquerque, N.M.

Health Equity Conference
May 10
Albuquerque, N.M.

Rural Medical Education Conference
May 10
Albuquerque, N.M.

SRHA Leadership Conference
TBA
TBA

Rural Health Clinic Conference
Sept. 20-21
Kansas City, Mo.

Critical Access Hospital Conference
Sept. 21-23
Kansas City, Mo.

Rural Health Policy Institute
Feb. 7-9
Washington D.C.

NRHA leadership spotlight
NRHA announces new volunteer leadership for 2022 and beyond

NRHA leadership is secure for 2022 and beyond, thanks to recent elections for Board of Trustees and open Rural Health Congress positions.NRHA members chose Leslie Marsh as president-elect. Marsh, a longtime NRHA member and rural health advocate who serves as CEO at Lexington Regional Health Center, will assume the duties of NRHA president in 2023.

Elected in 2021, Beth O’Connor of the Virginia Rural Health Association will serve as president in 2022.

NRHA is pleased to announce the following individuals elected by their peers to serve as constituency group chairs:

  • Hospitals and Health Systems: Steve Barnett, Sandusky, Mich.
  • Public Health: Cody Mullen, West Lafayette, Ind.
  • State Association Council: Ryan Kelly, Madison, Miss.
  • Statewide Health Resources: Kristine Sande, Grand Forks, N.D.
  • Student: Ada Pariser, Michigan State University

View NRHA’s Rural Health Congress page to see the full list of leaders and representatives, including Public Health Constituency Group representative and student Justin Kearley, as proudly reported by East Tennessee State University.

New study shows Delta hit rural America particularly hard

A new study found that rural counties had 2.4 times more COVID infections per 100,000 people than urban areas between July 1 and Aug. 31, 2021, when the Delta variant surged. In many rural areas, unvaccinated patients continue to overwhelm hospitals, and leaders are worried low vaccination rates will prolong the pandemic. Despite these challenges, NRHA CEO Alan Morgan and the COVID Collaborative’s John Bridgeland expressed optimism in a recent op-ed. “We’re optimistic 2022 will bring renewed efforts and progress in our work to help rural Americans overcome vaccine hesitancy and accelerate the day when all Americans can safely return to leading active and productive lives,” they write. The Georgia Health Policy Center will host leaders from NRHA and other organizations for a webinar on updates to the Rural Health Clinic COVID-19 Vaccine Distribution Program at 2 p.m. CST Feb. 22. A generational challenge has emerged in rural health care, but your community doesn’t have to go it alone. For more in-depth analysis, discussion, and advocacy alerts, join NRHA as a member.

NRHA webinars on telebehavioral health, rural ACOs

NRHA Partner National Consortium of Telehealth Resource Centers will host a webinar at 2 p.m. CST Feb. 22 on how rural hospitals can respond to and contain a cyber attack in 14 minutes or less. This session will introduce tactical incident response, a proven approach to cybersecurity incident response for rural hospitals that prepares teams to respond to a high-velocity attack or violent attack and address an attack in progress within a critical response window. NRHA Partner Caravan Health will host a webinar at 2 p.m. CST Feb. 23 on how rural ACOs earned more than $100 million in shared savings and expanded their 340B programs up to 50 percent. Participants will learn hidden opportunities in the program for ACO participants; review how to implement audit-ready strategies for improving claims capture; and more. Let’s achieve the pinnacle of rural health in the Land of Enchantment with more than 80 sessions on topics including alternative payment models and more at NRHA’s 45th Annual Rural Health Conference May 10-13 in Albuquerque, N.M.

Nursing schools must accommodate rising demand, interest

Nurse training programs are usually located in metro areas, drawing students from rural communities not only for school but potentially the rest of their careers, according to NRHA. “While there are no shortcuts to training competent nurses ready to enter today’s health care environment, enhancing access to nursing programs is the next best solution,” says Charnelle Lee of Western New Mexico University. Omak Family Medicine Residency Program in Washington recently received accreditation to develop a family medicine rural training track, and Southern Illinois University’s School of Medicine aims to train physicians to work in rural areas by providing them with rural clinical experience. Let’s achieve the pinnacle of rural health in the Land of Enchantment with more than 80 sessions on topics including workforce growth at NRHA’s 45th Annual Rural Health and Rural Medical Education Conferences May 10-13 in Albuquerque, N.M.

Why aging in place is even harder in rural areas

Aging in place is especially challenging for those living in rural areas. “Housing stock tends to be older and of poorer quality, there is less access to health care, and those in rural areas are generally lower-income,” says NRHA member Carrie Henning-Smith of the University of Minnesota. Many state programs designed to help older adults stay in their homes do not have an explicit rural focus. In Montana, about 20 percent of the population is over the age of 65, more than any other western state, and the majority of them wish to age at home. This has left many older adults struggling to find and access the care they need. Additionally, some stakeholders suggest courts and the FTC should approve hospital mergers that help the underserved, particularly as data from the North Carolina Rural Health Research Program, an NRHA member, shows that 138 rural hospitals have closed since 2010.

Dental faculty, teaching health center GME funding available

HRSA is now accepting applications for the Dental Faculty Loan Repayment Program through March 22. The purpose of this program is to increase the number of dental and dental hygiene faculty in the workforce by assisting dental and dental hygiene training programs to attract and retain faculty. HRSA is also accepting applications for the Teaching Health Center Graduate Medical Education Program through March 31. This program aims to support the training of residents in primary care residency training programs in community-based ambulatory patient care centers. Programs will prepare residents to provide high quality care, particularly in rural and underserved communities, and develop competencies to serve these diverse populations and communities.

HHS releases additional $2B in COVID relief payments

HHS recently announced it is releasing more than $2 billion in Provider Relief Fund payments to 7,600 provider organizations facing financial shortcomings due to the COVID-19 pandemic. The money follows a December distribution of nearly $9 billion, with both falling under $17 billion fourth phase of HRSA’s relief program. HHS has also announced the availability of $19.2 million in American Rescue Plan funding to support and expand community-based primary care residency programs. Awardees will use this funding to train residents to provide quality care to diverse populations and communities, particularly in underserved and rural areas. Finally, HHS is providing $66.5 million in American Rescue Plan funding to eight grantees to expand outreach efforts in 38 states and the District of Columbia to increase COVID-19 vaccine confidence and vaccinations.

Rural EMS workers depart as emergency services demand grows

Many Minnesota ambulance services are struggling to respond to emergency calls as workers leave the field in pursuit of better pay and working conditions. The exodus comes as demand for emergency medical services is increasing statewide. “There’s communities right now taking a good look at their services to try to figure out what to do,” says Mark Jones of the Minnesota Rural Health Association, an NRHA member. “When 911 is called, I am very confident that at some point an ambulance will get there. The concern is whether the rural ambulance services are able to answer the call in a timely manner.” Let’s achieve the pinnacle of rural health in the Land of Enchantment with more than 80 sessions on topics including rural emergency hospitals and more at NRHA’s 45th Annual Rural Health Conference May 10-13 in Albuquerque, N.M.

Rural dental program expands to school to reach residents

Dental screenings will begin in early February as part of the new Northampton County Public Schools dental program partnership in Virginia. Information collected will be used to assess the oral health status of all NCPS children as well as connect children with urgent needs with care. Eventually permanent dental offices will be established at each of the NCPS’ three public schools that will provide both preventive care and treat children with existing dental disease. HRSA is now accepting applications for the Dental Faculty Loan Repayment Program through March 22. The purpose of this program is to increase the number of dental and dental hygiene faculty in the workforce by assisting dental and dental hygiene training programs to attract and retain faculty.

Fact sheets on rural colorectal, cervical cancer prevention

New fact sheets coauthored by NRHA members from the Rural and Minority Health Research Center look at colorectal and cervical cancer prevention in rural health clinics in South Carolina. Patients in rural areas undergo cancer screening less frequently than urban patients with corresponding higher cancer incidence and mortality. This study used a mixed methods design to investigate perceptions and practices regarding cervical and colorectal cancer prevention at rural health clinics. Study results support the need for increased technical and material resources at RHCs to improve uptake of colorectal and cervical cancer screening.

Any policy or opinion included herein is not endorsed by NRHA unless otherwise specified.

National Rural Health Association
816.756.3140
7015 College Blvd. Suite 150, Overland Park, KS 66211

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ISOLATION / QUARANTINE – RELEASE DATE CALCULATOR 

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Aloha Kākou,

Department of Health’s across the country now have this handy tool to help determine isolation/quarantine, when the isolation/quarantine ends, when you should test.

The Hawaii DOH has it on their website, and you can find it here: https://health.hawaii.gov/coronavirusdisease2019/release-calculator/.

With guidance changing frequently, let’s encourage our communities to use a reliable resource versus word of mouth based on an inaccurate social media post. 😊

Have a wonderful weekend!!!
Be well,
Vanessa Carlson
Program Manager
Project Director-Kuleana Health

P.O. Box 7158
Hilo, Hawaii  96720
Work:  808.756.9637
Mobile:  808.936.7427
Email: vcarlson@communityfirsthawaii.org

Invitation to Participate in Survey on Health Messaging (Expires 28-Feb-2022)

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(Feb 11, 2022) The Office of Regional Health Operations (ORHO) in the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Health (OASH), is requesting your support in an important initiative aimed at increasing community knowledge and confidence in vaccines among older African American adults with a focus on community health workers (CHWs).  We would appreciate you disseminating this survey within your organization and networks, particularly among African American community health workers aged 50 and older.
 
Project Overview
ORHO connects people, convenes local partners, and establishes networks to promote and advance the public health and safety of the American people. Regional Health Administrators (RHAs) within each of the 10 HHS Regional Offices serve to foster coordination and collaboration across federal departments and HHS agencies and as extensions of OASH to ensure that HHS priorities are translated and implemented at the local, state, tribal, and national levels.
Recently, HHS released the National Strategic Plan for Vaccines 2021–2025, highlighting the specific need to “reduce disparities and inequities, increase access to and use of routinely recommended vaccines across the lifespan.”  Vaccine uptake for adults has been low, and disparities persist among racial and ethnic populations. To address these disparities and encourage vaccination among adults, promotional materials on herpes zoster (shingles) and pneumococcal (pneumonia) vaccines were developed, with a specific goal of reaching African Americans aged 50 and older.
We would like to invite you to participate in a brief online survey specific to vaccine messaging and vaccine uptake. Survey responses will be anonymous and should take about 20 minutes to complete.   Your participation is important and will help ORHO to:
  • Assess the effectiveness of culturally appropriate promotional materials to increase community knowledge of and confidence in herpes zoster and pneumococcal vaccines among African American CHWs over the age of 50.
  • Assess perceptions of risk, barriers, and motivations related to general uptake of adult vaccines, including the COVID-19 vaccine.
 
Accessing the Survey
To access and complete the survey, please click on the following link:
              https://www.surveymonkey.com/r/Region-9-CHW-Survey.
This link can also be forwarded to individuals and organizations within your networks. We kindly request that the survey be completed no later than Monday February 28, 2022.
Thank you in advance for your participation. If you have any questions about this project, please contact Corstella Johnson (corstella.johnson@hhs.gov). If you are having technical difficulties completing the survey, please contact CHWsurveyhelp@mayatech.com.
  
Kay A. Strawder, JD, MSW
Senior Public Health Advisor – Region 9
Office of Regional Health Operations
Faafetai ma le fa’aaloalo lava,
Chantelle Eseta Matagi
State of Hawaii Department of Health
Community Liaison & Coordinator for the Immunization Branch
PH: (808)693-6427

CDC panel endorses COVID-19 vaccine boosters for all adults

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BY NATHANIEL WEIXEL - 11/19/21 03:21 PM EST

A key outside advisory group to the Centers for Disease Control and Prevention (CDC) has endorsed the use of COVID-19 booster shots for all adults, a one-size-fits-all approach designed to simplify eligibility.

If CDC Director Rochelle Walensky signs off on the broader use, as expected, the extra shots will be available immediately to all adults, as long as they are six months past the final dose of a Pfizer or Moderna vaccine, or two months after a Johnson & Johnson dose.

The recommendation from the panel comes just hours after the Food and Drug Administration (FDA) authorized both Pfizer and Moderna’s booster shots for everyone over the age of 18.

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Pfizer applied to the FDA earlier this month for an expansion of the emergency authorization for its booster shot to make it available to anyone 18 or older. Moderna announced just this week that it too had asked the FDA to allow its booster to be given to all adults.

Boosters for everyone has always been the Biden administration’s goal, but until now federal health authorities have stopped short of such a policy, and instead recommended boosters for only specific populations — those over age 65, anyone at high risk because of work or where they live, or those with an underlying medical condition.

The primary COVID-19 vaccination continues to provide good protection against severe disease and death, even as effectiveness against milder infection has waned. But cases have been steadily rising across the country, and authorities have said they want to stave off another winter surge.

The current recommendations, while fairly broad, have caused confusion. While people over the age of 65 are most at risk from waning vaccine immunity, fewer than 40 percent of them have received a booster, according to CDC data.

“The current guidelines, though well-intentioned and thoughtful, generate an obstacle to uptake of boosters. In pursuit of precision, they create confusion,” Nirav Shah, president of Association of State and Territorial Health Officials, told the panel.

The panel did not make a distinction in their recommendation between the two types of mRNA vaccines, despite the potential for increased risk of myocarditis — a type of heart inflammation — in young men after receiving Moderna’s vaccine.

CDC officials told the panel it’s too early to draw conclusions on the risk of myocarditis after the third dose of mRNA vaccines, because teens and younger adults haven’t yet been boosted in large enough numbers.

Several other countries have discouraged use of the Moderna vaccine in people younger than 30 because of that risk.