NASHVILLE—Less than a week before she was ousted as the top vaccine official in Tennessee, Dr. Michelle Fiscus received a package at her office. It had been sent via Amazon without any note or indication of who might be behind it, she told The Daily Beast.
Inside was a black leather muzzle with nylon straps that looked to be made to fit a dog.
Fiscus, who became head of the state’s immunization program in January of 2019 and practiced as a pediatrician in Middle Tennessee for 17 years, already knew she had a target on her back. At a June legislative hearing, she’d been singled out by name by Republican state lawmakers upset about the health department’s teen-focused vaccine outreach; at least one of them even threatened to dissolve the department over it.
In particular, GOP lawmakers seized on a memo Fiscus had sent to medical providers who administer vaccines in which she outlined the state’s Mature Minor Doctrine. It stems from a 1987 state Supreme Court decision that allows doctors to vaccinate minors above the age of 14 without parental consent.
The contentious hearing made headlines in Tennessee before the issue largely receded from the news. But within the Republican-dominated state government, pressure continued to mount. Two weeks ago, according to Fiscus’ husband, she was warned by supervisors that she might be fired. Then, on Monday, with COVID-19 cases rising again in the state and the share of Tennesseans fully vaccinated stuck below 40 percent—one of the worst rates in the country—she was terminated.
“Morale is terrible, and every day we were waiting for more restrictions on what we could do,” Dr. Fiscus told The Daily Beast.
Her ouster was the end-result of what interviews with lawmakers, health officials, and residents in the state suggest has been a titanic and bitterly partisan struggle over how to reach vaccine holdouts. Now, critics of the Republican majority in the state say Fiscus’ firing is poised to send the vaccine push even further off the rails—all to appease extremists.
“It is pretty clear what happened is that some ultra-conservatives in the state who bought into anti-vaccine and COVID-denialism were out for blood, and the governor’s administration offered up the head,” Senate Minority Leader Jeff Yarbo (D-Nashville) told The Daily Beast.
The Governor’s office did not respond to The Daily Beast’s request for comment. A spokesperson for the House Republican Caucus referred a request for comment to the Department of Health and the governor’s office, noting they “do not make personnel decisions regarding the executive branch.”
Bill Christian, a spokesperson for the Tennessee Department of Health, told The Daily Beast, “We cannot comment on HR or personnel matters. To be clear, our vaccination efforts have not been halted or shuttered.”
But Fiscus says her ouster is exactly what it looks like—a public-health official refusing to bow to anti-vaxxers or those catering to them in positions of power, and paying a price.
“Today, a 14-year-old in Tennessee can still go and get a vaccine without parental consent,” she told The Daily Beast. “According to the decree from the Tennessee Supreme Court ruling in 1987. I didn’t make the rule. I communicated to our providers that were getting COVID-19 vaccines what the rule was.”
That may be true, but it’s getting harder than ever for kids in Tennessee to access shots.
Fiscus’ firing was followed on Tuesday by a bombshell report from The Tennessean that the health department will cease all vaccine-related outreach to minors—not just for COVID-19, but for other diseases like the flu and HPV. The paper also reported that the health department will stop hosting COVID-19 vaccine events at schools and even stop sending postcards reminding teenagers who’ve been partially vaccinated to get their second dose.
Christian, the health spokesperson, explained it this way: “We are simply taking this time to focus on our messaging and ensure our outreach is focused on parents who are making these decisions for themselves and their families.”
But insiders say Tennessee has in a matter of weeks gone from being just another southern state with a vaccine-hesitancy problem to a showcase for Republicans who cower before hardcore anti-vaccine activists.
In May, days after the state began to administer vaccinations to children ages 12 and older, Fiscus sent a letter to more than 900 vaccine providers, clarifying that they could inoculate minors without a parent or guardian in the room.
The decision to inform providers about this option—stemming from what advocates describe as long-settled court precedent—touched a nerve among Republican lawmakers. In the heated June hearing, several state legislators spoke out against the health department promoting the fact that teenagers could get vaccinated on state social media accounts, calling it “reprehensible” and likening one ad providing life-saving information to “peer pressure.”
“The Department of Health is targeting our youth,” state Rep. Scott Cepicky (R-Culleoka) said during the hearing, while holding up a printout of the Facebook ad, according to The Tennessean. “When you have advertisements like this, with a young girl with a patch on her arm all smiling, we know how impressionable our young people are.”
“For a department of ours to make it seem like you need a vaccine ... to fit in is peer pressure applied by the state of Tennessee,” Cepicky added. “Personally, I think it's reprehensible that you would do that, that you would do that to our youth.”
State Sen. Kerry Roberts (R-Springfield) reiterated a colleague’s complaint against flyers and advertisements featuring children with the phrases “Tennesseans 12+ eligible for vaccines” and “Give COVID-19 vaccines a shot.”
“Market to parents, don’t market to children. Period,” he said during the hearing, according to the outlet.
Cepicky and Roberts did not respond to The Daily Beast’s request for comment.
The Tennessean also reported last month that Lisa Piercey, the health department commissioner whose name was on Fiscus’ resignation letter, tried to assuage the Republican outrage. Specifically, Piercey said in the hearing that private healthcare providers and doctors in the state could deny shots without parental permission.
Internal emails obtained by the New York Times and The Tennessean show the state has halted vaccine-education efforts aimed at people under 18 for a variety of ailments, including the flu. Among the emails included was a directive from Piercey to remove the department’s logo from all vaccine-related materials going forward, and a note from another official to stop “proactive outreach regarding routine vaccines.” (Some major metro areas in their state have their own health-department policies, and are poised to continue vaccine outreach.)
As in many states, right-wing activists banded together in Tennessee earlier in the pandemic to oppose social-distancing and other safety measures, including vaccines.
One local group powering pushback in the Volunteer State is called Tennessee Stands. On their website, the group says they “completely reject the myth that non-pharmaceutical interventions such as mask mandates, stay-at-home orders, school closures, and business closures had any effect whatsoever on the magnitude or the trajectory of the pandemic.” Tennessee Stands has filed lawsuits against state and local officials over various public-health mandates and regulations, and was behind legislation that would allow religious exemptions to future COVID vaccine mandates at schools.
Similar legislation was ultimately passed into law. A spokesperson for the group did not respond to a request for comment for this story.
Beyond rote right-wing activism, in Tennessee, anti-vaccine sentiment has previously exploded into violence. A 36-year-old woman was arrested in May after witnesses said she drove her SUV through a COVID vaccination tent while yelling “no vaccine.”
Lawmakers are worried the state is increasingly catering to conspiracy theorists. Meanwhile, COVID deaths are rising, and the state’s best hope for boosting its lagging rollout may be tough to replace.
“What person who is qualified to do her job would want that job now?” Sen. John Ray Clemmons (D-Nashville), asked in an interview with The Daily Beast. “Are they going to take that job because they are some ‘wink wink’ understanding they are not going to fulfill all the tasks of the job?”
Calling out his Republican colleagues, Clemmons said “using kids as a political tool” and Fiscus as a “political scapegoat” will only continue to harm the already fragile public health system in Tennessee.
“You have to wonder what their endgame is here,” he said. “Right now, it looks like a short-sided political move to score some points from a handful of extremists.”