DHSS Director's Message

Rural Health Transformation - Public Comment

As mentioned in the last Director's Message, the State has established a public comment portal to inform the Rural Health Transformation Program authorized by the “One Big Beautiful Bill” Act (OBBBA) application. The public is asked to submit priorities, strategies and specific opportunities that should be considered when developing the State’s application for the funds. It is important to note, this is not a portal for requesting funding. As the State Office of Rural Health, the department’s goal in sharing this information is to increase awareness of the opportunity to inform the State’s application.

Vaccine Access

Significant shifts in federal public health and immunization leadership have occurred this summer. Coinciding with the change in leadership, the Advisory Committee on Immunization Practices (ACIP) is scheduled to meet on Sept. 18-19 to discuss recommendations on certain immunizations with the possibility that votes may be taken. The headlines have primarily focused on potential changes to the COVID-19 vaccine recommendations, though the posted agenda for the meeting includes discussion on vaccinations for Hepatitis B, MMRV, and RSV as well.

The percentage of kindergarten students in Missouri vaccinated against diseases like measles and whooping cough is dropping each year as more parents and guardians turn in religious exemptions to their schools. Only 90% of Missouri kindergarten students were immunized against measles, mumps and rubella in 2024. That's down from 94.6% five years prior. Some counties have rates nearing 75%.  According to the CDC, a community needs a vaccination rate of at least 95% to be adequately protected from measles outbreaks.

On Aug. 27, the FDA approved the 2025-2026 COVID-19 vaccine for adults 65 and older and people 6 months to 64 years old with conditions that put them at high risk for severe illness. This has created some confusion for Missourians seeking the vaccine and for providers related to the availability and insurance coverage of the vaccines.

While revisions to polices and recommendations continue to evolve, we can shed some light on a few things.

• Missourians may experience difficulty obtaining the vaccine from a pharmacy or provider because they don’t have the vaccine on hand. Many providers still have not received the '25-26 vaccine or have just started to get their vaccine supply in the last few days.
• In Missouri, pharmacists are authorized to administer the COVID-19 vaccine as outlined in Section 010, RSMo, and pursuant to rule promulgation found at 20 CSR 2220-6.050 in accordance with FDA guidelines. 
• Outside of Medicare Part B, mandated insurance coverage of COVID-19 vaccines is tied to an Advisory Committee on Immunization Practices (ACIP) recommendation.  
• ACIP recommendations have a direct influence on the Vaccines for Children (VFC) program that is federally funded but administered by DHSS. The VFC program covers all immunizations included in the pediatric immunization schedules determined by ACIP, meaning that the removal of a particular immunization from its recommendations could affect VFC services.

The department will continue to monitor and communicate on changes to vaccine recommendations and provide clarifying information as available. For the time being, we encourage anyone interested in COVID vaccination to consult with their physician as many pharmacies are requiring a physician's prescription. If using a pharmacy, they should call ahead to inquire of its availability and requirements. 

Policy Message:
Community Water Fluoridation

In 2025, there have been 12 states that introduced bills to prohibit community water fluoridation or repeal fluoridation requirements, with Utah and Florida being the two states to pass pertinent legislation. The MAHA Commission Report cites a meta-analysis of studies that indicates there is a negative correlation between IQ and children exposed to fluoride levels above recommended levels.

The finding in the analysis comports with what is known: that fluoride has a positive health benefit in appropriate amounts but can have negative effects on health when consumed in doses higher than recommended. The potential dangers of higher doses do not mean fluoride is not safe at appropriate amounts nor does it invalidate the benefits.

A recent commentary in the JAMA Health Forum delves into this topic as well, and points out that community water fluoridation is essential for preventing dental health issues that cost patients, insurers and Medicaid more money. Academic literature identifies that non-fluoridated areas experience higher Medicaid spends per child on dental procedures and communities that cease community water fluoridation experience increases in cavity-related treatment costs.

The recently released Make Our Children Healthy Again Strategy Report contains the following fluoridation-related items:

• “Following the completion of studies on fluoride, CDC and USDA will educate Americans on the appropriate levels of fluoride, clarify the role of EPA in drinking water standards for fluoride under the Safe Drinking Water Act, and increase awareness of the ability to obtain fluoride topically through toothpaste.”
• EPA, USDA, and NIH “will assess ongoing evaluations of water contaminants and update guidance and prioritizations of certain contaminants appropriately. For example, EPA will review new scientific information on the potential health risks of fluoride in drinking water to inform CDC recommendations.”
• “The CDC, informed by data and scientific review from NIH and EPA, will update recommendations regarding fluoride... in water.”

2025 Walk to End Alzheimer’s

DHSS has our own shirt design this year! You can purchase short and long sleeve shirts, crewneck sweatshirts and hoodies. Proceeds from each purchase will go to the Alzheimer’s Association. The deadline to order shirts is Monday, Sept. 22.

Did You Know…?

According to most recent data:

• There are currently more than 1.1 million Missourians over the age of 60.
• Estimates suggest that older adults will outnumber minors for the first time by 2030 and older adults will greatly outnumber minors by 2060.
• Approximately 15% of the state's residents have a disability, the most common of which is mobility disabilities.

The Master Plan on Aging Page contains additional information.