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News Brief: Booster approvals, need for nurses, VA Secretary Denis McDonough

STEVE INSKEEP, HOST:

Millions of additional Americans have final approval to get a coronavirus booster shot.

SCOTT DETROW, HOST:

If you've been with us these last few days, you have heard us cover this story many times as the process twisted and turned through several layers of federal approval. The last step came late yesterday from the Centers for Disease Control. Everybody who got a J&J shot is cleared for a booster and so are many other people.

INSKEEP: NPR health correspondent Rob Stein has the details. Rob, good morning.

DETROW: Good morning, Steve.

INSKEEP: So what are the new rules?

ROB STEIN, BYLINE: The CDC is now recommending boosters for many of the recipients of all three vaccines, the Moderna, that Johnson & Johnson and the Pfizer. And they're specifying exactly who should be eligible for those boosters. Last night's green light came several hours after CDC advisers endorsed a half-dose of the Modenra vaccine and a full dose of the J&J vaccine as boosters. The Pfizer vaccine has been available as a booster for about a month.

INSKEEP: Right.

STEIN: This means boosters will now be available for tens of millions of people who got any of the three vaccines.

INSKEEP: And this was a contentious question - right? - about exactly who should be eligible for what.

STEIN: Yeah. Absolutely. You might remember that the White House originally announced boosters would be available to anyone who was fully vaccinated by September 20. But when it came to the Pfizer booster, the CDC advisory committee balked and only recommended boosters for the elderly. But then CDC Director Rochelle Walensky overruled that...

INSKEEP: Right.

STEIN: ...And made Pfizer boosters much more widely available, not to everyone, but to everyone aged 65 and older and any younger adults at risk because of other health problems or risky living situations or jobs. And there was a lot of debate about that again during yesterday's day-long meeting. Several experts said they still aren't convinced boosters are needed for so many younger, otherwise healthy people. And these vaccines can have side effects - they're very rare but can be quite serious, like blood clots among younger women from the J&J vaccine. Inflammation of the heart among younger men from the Moderna and Pfizer. But in the end, the committee voted unanimously to let Moderna recipients get boosters as easily as Pfizer recipients, and opened up boosters to anyone aged 18 or older who got the J&J shot at least two months ago. So Steve, this means you're finally eligible to get a booster.

INSKEEP: Well, thank you, because I got the J&J shot. So anybody who got the J&J shot can go get another one. And I'm likely to get...

STEIN: That's right.

INSKEEP: ...Get to work on that this weekend.

STEIN: OK.

INSKEEP: And it sounds like I can pick any vaccine for the next shot. Is that right?

STEIN: That's right. That's right. The CDC advisers were very clear that they wanted to give people a lot of flexibility and try to clear up some of the confusion that's been created by all this back and forth. Here's Dr. Beth Bell from the University of Washington.

BETH BELL: I think that a really important aspect of all of this is being clear and not dancing on the head of a pin so that we don't further confuse the American people.

STEIN: So anyone who got a Pfizer or Moderna can pick up either one of those as their booster. They seem to work about equally well. And people who got the J&J can go with a Moderna or Pfizer this time since it looks like those shots boost immunity much better than another J&J. But, you know, some people may not be able to find one of those vaccines. Or they might feel more comfortable getting the same one again. And younger men worried about that heart inflammation associated with Moderna or Pfizer vaccines may want to go with a J&J shot. That's OK, too. Younger women worried about those blood clots may want to stay away from another J&J. They'll be up to people, hopefully consulting with their doctors, to decide what to do.

INSKEEP: Rob, thanks.

STEIN: You bet, Steve.

INSKEEP: That's NPR health correspondent Rob Stein.

(SOUNDBITE OF MUSIC)

INSKEEP: All right. Just when the nation really needs more nurses, it's growing harder to enter the profession.

DETROW: Yeah. A lot of nurses have been leaving their jobs, pushed out by overwhelming caseloads during the pandemic. And the need is so dire that some hospitals are hiring nursing students before they graduate. Some people may feel inspired to enter a field where they're needed. But it is surprisingly tough to get in.

INSKEEP: NPR's Yuki Noguchi has been looking into this. Yuki, good morning.

YUKI NOGUCHI, BYLINE: Good morning, Steve.

INSKEEP: Why should it get harder to become a nurse?

NOGUCHI: Well, one main reason is that there just aren't enough people to teach nursing. So there are lots of applicants to nursing school but schools just can't take that. For example, there's often 800 people applying to community college nursing programs with just 50 slots to fill.

INSKEEP: Wow, which is worse odds than an Ivy League school, maybe.

NOGUCHI: Exactly. And that's just among community colleges. At four-year colleges and universities, 80,000 prospective nursing students weren't accepted last year.

INSKEEP: OK. Wow. So why would they not be able to find more teachers to accommodate more students?

NOGUCHI: Well, that's a chronic issue. And teaching pays only about half of what a typical hospital nurse makes. And teaching requires a master's or Ph.D. So - you know, few people can afford to pay for those degrees and only to end up earning less. Add to that the financial pressures caused by the pandemic itself, like a spouse losing a job, and what we're seeing is more faculty leaving their jobs in search of higher paying work, which alarms people like Sharon Goldfarb. She teaches nursing near San Francisco and surveyed 91 community colleges in California and found a decline of 30% in the faculty during the pandemic.

SHARON GOLDFARB: To lose an additional 30% has been devastating. There is not a school I know of that isn't desperately looking for nursing faculty.

NOGUCHI: And that disrupts classes.

GOLDFARB: Some schools went on hiatus. Some schools reduced their enrollment, so they took even fewer students. You know, some schools, they scramble so much they actually have to extend semesters.

NOGUCHI: Also, Steve, many teachers are in their late 50s and 60s, so another third of the nation's nursing faculty will retire within four years.

INSKEEP: Wow. OK. So suppose you're one of the students who does get in and gets one of these few slots, is there also an issue with paying for it as there is for so much education?

NOGUCHI: Yeah. That's been a factor even before the pandemic, you know? Many complain about the financial sacrifice needed to get through that schooling and training. Nathan Ballenger (ph) talked to me about that. He's 46 and lives in the Denver area with his wife and three kids. He's a salesman but dreamed of working in medicine. And so over the last 15 years, he's tried three times to make that dream come true, including during the pandemic.

NATHAN BALLENGER: I went and got certified as an EMT just to get my foot in the door because I'm so hungry to get into the nursing field or into the medical field.

NOGUCHI: But the cost of schooling and training were just too great. So his dream just languishes.

BALLENGER: It's hard for me to say that I see a path towards it regardless of the fact that I hold it in my mind and in my heart as something that I sure wish I could have done in this lifetime.

INSKEEP: That's a loss. What's being done about it?

NOGUCHI: Well, the American Hospital Association says hospitals recently upped their compensation and recruitment. So some are offering full scholarships or loan repayment. And as we mentioned, some students are hired even before they graduate. Or, you know, hospitals are now training new graduates in the specialties where they're needed most. You know, hospitals are also lending their nurses to teach at nursing schools. This is an issue, Steve, because of burnout, you know? Opening up that bottleneck is critical globally. So it's not just that the world needs to keep graduating nurses, but we actually need to graduate more nurses than ever.

INSKEEP: Yuki, thanks for the update, really appreciate it.

NOGUCHI: Thank you.

INSKEEP: NPR health correspondent Yuki Noguchi.

(SOUNDBITE OF MUSIC)

INSKEEP: How soon can American veterans expect disability aid for sicknesses suffered after serving overseas?

DETROW: The head of the Department of Veterans Affairs promises an answer soon.

DENIS MCDONOUGH: I have one job here, right? Let's take care of the vets, full stop.

DETROW: Denis McDonough talked to NPR about a range of cancers and respiratory diseases. Some seem connected to the use of burn pits, the military practice of constantly burning hazardous trash on remote bases. The VA chief says his agency approved disability for some diseases but not others.

INSKEEP: NPR's Quil Lawrence covers veterans and joined us for that conversation here in Washington, D.C., yesterday. Hey there, Quil.

QUIL LAWRENCE, BYLINE: Hey.

INSKEEP: What makes this question of burn pits and related ailments such a huge focus for veterans?

LAWRENCE: Well, just straight ahead, nearly a quarter-million veterans have self-reported that they are experiencing some sort of ailment from - and having been - they believe it's because they were exposed to these giant burn pits, primarily in Iraq and Afghanistan. I mean, these were pits - the infamous one was in Balad in Iraq. It was 10 acres. It looked like a city block burning down. Twenty-four hours a day, seven days a week, burning hundreds of tons of waste - batteries, trash. And for veterans who slept next to - in a barracks next to that smoke and came home with lung disease, at first the U.S. government response to their complaints was sort of denial and then disbelief and sort of gaslighting. And now, then, in recent years, they were invited to register on this burn pit registry. McDonough said he had been hearing about these problems before he became secretary.

MCDONOUGH: We all have friends who have served in Iraq and Afghanistan. Almost to a person, they tell me it was three months, six months before they felt like they could actually breathe normally again when they work out, for example, when they'd run.

LAWRENCE: But advocates are still wishing that the VA would aggressively work on some of the most deadly conditions that they think are connected to burn pits, like constrictive bronchiolitis, lung disease. They say that there is enough evidence from peer reviewed study to make that connection.

INSKEEP: Well, why has the VA approved disability for some conditions, like asthma, but not these more severe ones?

LAWRENCE: McDonough told us in the interview that he's trying to learn why there isn't more urgency to seek more scientific input from different sources as sort of an urgent response for some of these veterans who maybe don't have much time because of their illnesses.

MCDONOUGH: I think it's a failing of the United States government that it took until now that anybody in that 30-year window has gotten any payment or benefits for the maladies that they've suffered in the meantime.

LAWRENCE: And he told us, he's still asking why, presumably of his own department, why that connection hasn't been made yet.

INSKEEP: Quil, I want people to know that Denis McDonough, during this interview, also began talking about your reporting. You had reported at the beginning of this week about a veteran seeking mental health care because he was having suicidal ideation. He was told, we can get you an appointment in March. There were some complexities to the case. But it was an agonizing story. And McDonough insisted that, on the whole, wait times are not too bad. But then he added this.

MCDONOUGH: There's inevitably going to be pockets where vets have to wait too long.

INSKEEP: How is the military doing? How is the VA doing in providing mental health support?

LAWRENCE: Well, in terms of emergency care, they seem to be doing pretty good. But the fact is that mental health care providers are scarce all over the country. And the VA is feeling that same crunch. So in rural areas, like where that veteran was, it is hard to find someone in the private sector or at the VA. They say they're using telehealth and trying to hire more providers.

INSKEEP: Quil, thanks for this insight. I really appreciate it.

LAWRENCE: Thank you, Steve.

INSKEEP: That's NPR's Quil Lawrence. He covered the war in Afghanistan for years and then came home and now covers veterans. Transcript provided by NPR, Copyright NPR.