Despite what’s coming out of Washington, Connecticut’s public health commissioner says the state has not changed its recommended vaccine schedule. Dr. Manisha Juthani joins Dr. Alessi to discuss the state of public health, beyond the confusion over current government recommendations. Topics include Connecticut’s standing among the most vaccinated states, the challenges of public health policy, access to health care, how the flu shot formula is determined, some of the Department of Public Health’s lesser-known functions, and how she came to be DPH commissioner.
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Watch a video of this interview:
https://youtu.be/BA1Tg6CXA9A
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we bring you up to date and timely medical information provided by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery, in addition to a grant from Coveris.
This podcast is not designed to modify or in any way influence your medical care. That should only be done with the cooperation of your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have with me today my guest, Dr. Manisha Juthani. Dr. Juthani is a medical doctor and she also serves as the Commissioner of the Connecticut Department of Public Health.
Dr. Juthani: Thank you so much for having me.
Dr. Alessi: Manisha, let’s start with a little bit about your background. How’d you end up with this job?
Dr. Juthani: It’s a really interesting story, actually. I was an Infectious Disease Physician in practice at Yale School of Medicine, was there for about 20 years, ran the fellowship program, saw patients, did research, and then the COVID-19 pandemic hit, and we as a hospital had to figure out a way to care for a hospital full of COVID-19 patients, had to expand our fellowship services from 3 services to 10 over three different hospitals. And as the pandemic wore on, the first wave was our biggest hit. And in the second wave, if you think back, it was December of 2020, and indoor dining had reopened in the state of Connecticut. And, we were seeing patients coming in who never left their home, but whose son went to a restaurant or a bar and came home and infected their immunocompromised mother. Or somebody who had just had a transplant who, again, never left their home, but whose relative went to a restaurant and brought the virus back home. Again, remember back to December, 2020, this was pre vaccines.
Dr. Alessi: Sure.
Dr. Juthani: And at that time, a friend of mine said, let’s write a letter to the governor complaining, and would you sign on asking him to shut down indoor dining again? And I said, yeah, I can sign on to that.
And I’m seeing these patients myself. So I signed on. And the governor, to his credit, said, there are a bunch of these physicians complaining, and I think we should meet with them. So, he met with us and I told him the stories of the patients that I was seeing, and he said, you know, “Manisha, I think the people of Connecticut need to hear what you have to say, will you come onto one of my press conferences?”
So I said, sure. And the next week I was on one of his press conferences. And even though I had a feeling the policy of the administration was not gonna change because I know the governor really felt like businesses had struggled, and if people were gonna gather, they were either gonna gather at home or gather in restaurants, so might as well let the restaurants stay open.
And I thought that may be the case, but I still advised people what he asked me to do, and that really built a connection for us and a foundation for public health principles, maybe you could say. And six months later they asked me to take this job, which was a complete diversion from what I had done for 20 years of my life.
And here we are, four years in running that I have stuck with it.
Dr. Alessi: Do you like it?
Dr. Juthani: I do really like it. And maybe part of that is in infectious diseases you are tasked with dealing with emergent problems and challenges, and I was brought into one, which was the COVID pandemic and public health, as you already mentioned, is the backbone of so much in our society.
And so, I really started to enjoy more than just addressing the pandemic in the job. And now we’re in a phase where we are losing guidance from the federal government on certain things, and so now I feel a responsibility to the state to try to lead us during a time when we do not have the same guidance that we’ve been used to at a federal level.
Dr. Alessi: I’m glad you brought that up because it’s something I planned on discussing with you. So, I mean, we’re at a stage now where people don’t trust the CDC. They have opted for ideology over science. In fact, Peter Hotez just wrote a book, right, Science Under Siege.
So, we sit here in Connecticut and we hear about South Carolina, New Mexico, all these measles outbreaks. We hear about this rising flu. Are we safer here in Connecticut?
Dr. Juthani: I do believe we are safer for several reasons. First of all, although we have vaccine hesitancy, at the moment, we are the most vaccinated state as it relates to measles in the country when you look at kindergarten vaccination rates at 98.7%. So, we lasted two years without a case of measles.
I thought for the last two years we would have one. We had our first in December of 2025. But that one case did not lead to any other cases so far. We’ve made it through one incubation period. We’re waiting for a second, so there is still a small chance, but that says a lot about the herd immunity we have in the state.
So, I think that reflects on our population at large. I would also say as it relates to the flu, we have vaccination rates this year that are finally higher than they were at this same time last year. That means that people know we’re in the middle of a flu surge and they’re getting vaccinated. Now, do we have more people that we could vaccinate? For sure.
And that’s why we continually try to message that it’s still not too late to get a flu vaccine. But I do think that we are safer. We do have a very highly immunized population. We do have lots of people that have questions, and it’s our job in medicine to answer those questions. But in many ways, as it relates to vaccine preventable diseases, I do think we are safer.
Dr. Alessi: You brought up the flu, right? And a lot of people we now know we’re dealing with an H3N2 or the Clade K, or whatever nomenclature it has, but it’s not something we were ready for, in terms of the guesswork. Can you talk a little bit about the guesswork that’s involved? Because I think a lot of people don’t understand that it takes so much guesswork to figure out which strain is gonna affect everyone.
And can you also mention the importance of still getting the vaccine, even if it’s not a bullseye?
Dr. Juthani: Every year the flu goes with the weather. So, seasonally, what we look for and plan around is what were the strains circulating in the Southern Hemisphere during their winter that then usually predicts what strains are going to impact the Northern Hemisphere in our winter, and the cycle goes on and on, year over year.
So, for this year’s flu vaccine, we looked at what the Southern Hemisphere had, the vaccine components were put forward, and you’re right, it’s not a hundred percent match, however, it is still doing pretty well.
And we have data from Europe and we’re looking at data from here in the United States. Different estimates based on children or older adults, anywhere from 30 to 60% protection from hospitalization and death. And that’s still pretty good as it relates to a flu vaccine. So, the key difference that I think people need to understand is that the childhood vaccine schedule that we talk about is really meant to prevent disease.
When we talk about measles, 97% of people will not get measles, if you’ve gotten both shots. With the flu shot, it’s not necessarily preventing disease altogether, but it is preventing you from severe disease and it’s preventing you from prolonged disease, it’s preventing you from going into the hospital and it’s preventing you from dying. That is considered a success, as it relates to the flu shot. And let me tell you, when you think about days lost from work, from school, potentially being in the hospital, that is still really, really important. And we are seeing that play out even now with the current flu shot.
It’s not a total miss.
Dr. Alessi: Good. I wanna get to, you mentioned the standard vaccine schedule, and in the past week we’ve seen our illustrious CDC decide that it’s time to change that. Yet, again, not based on any science that I’m aware of, and so how do we get around that here in Connecticut?
Because it’s almost ludicrous, right? That we have to think of how to keep people safe here when our federal authorities are telling us something different. So, what’s your plan to get the word out that we still need to do that?
Dr. Juthani: The few things that we’ve been doing ever since this announcement came out are, number one, make clear that in Connecticut, the recommended vaccine schedule to prevent 17 diseases as opposed to just 11, which is what the new guidance recommends, has not changed in Connecticut. We’re still recommending the same schedule.
The second thing is that out of that schedule, there is a subset that are required for in-person school attendance. Again, that schedule is not changing.
Dr. Alessi: See, and that’s what I always thought. I always thought school attendance was where the rubber meets the road. So, now what?
Dr. Juthani: The way it works in Connecticut is the Department of Public Health establishes a standard that should be met for schools to maintain safe communal education. The point of school standards is that when you have highly communicable diseases that can be prevented and you have certain children that may not even be able to get those vaccines, we wanna try to protect the community at large. And so, that schedule was last updated in 2011.
It’s been a long time since that schedule was updated. And, it’s actually in our regulations as a state what that schedule is. As you mentioned, there’s been no new science put forward to suggest that we should not be vaccinating school aged children against meningitis, hepatitis A, hepatitis B.
These are three vaccines for which the recommendations changed by the federal government, and that are on our required list of school vaccines. So, given that, we have no new changes in recommendations. Those are standing as they have been. The other thing to make clear is that these vaccines are available even though the recommendation changed from recommend to shared clinical decision making on these vaccines. They’re still available. They’re still covered by insurance, and there’s no evidence that has changed. So, what message we’ve been trying to get out is that although you are hearing a change from the federal government, for people in Connecticut, status quo is what we are hoping for.
That’s the best way to protect our kids.
Dr. Alessi: Manisha, I’m gonna switch gears a little bit because we’ve been spending a lot of time talking about infectious disease, but as the Commissioner of Public Health, you have a lot more responsibility than just outbreaks, right? I mean, we still have food safety, water safety. How do you go about doing all of that? I mean, I don’t think people understand that. And you also oversee practitioner licensure, right? Not just physicians, but dentists and everything else. How do you get your arms around that, and what’s the biggest problem that keeps you up at night?
Dr. Juthani: So you’re absolutely right. I learn something new every day because we do do so much. We have regulatory functions, which means that we need to keep certain industries accountable to make sure that our hospitals are safe, our nursing homes are safe, our providers are doing what they’re supposed to do, and that our water is safe for people to drink. These are regulatory functions that the Department of Public Health does. We have functions as it relates to communicable diseases, as you mentioned. A whole host of infectious diseases that we try to prevent, whether they be vaccine preventable, or whether they be things that are endemic in society, things like tuberculosis, HIV. There are many things that we monitor at the level of the state: Lyme disease, obesiosis, all different types of infectious diseases. And then we have a bunch of diseases that are more chronic diseases that we also do interventions on: cancer prevention, diabetes prevention, hypertension prevention, a whole host of diseases.
And then we prepare for the scenarios what we don’t know is coming. If we get a power outage and a nursing home loses power, what are we going to do for the safety of those nursing home residents? Some of that responsibility comes back to the Department of Public Health.
So, you’re absolutely right. There’s something new I have to think about every single day. There are things that I don’t even know what to plan for sometimes and new things that come up because new diseases come up, new problems come up, new scenarios come up, and we try to plan for all of those as we go forward.
Dr. Alessi: So, what’s the biggest problem? What’s the biggest thing that’s always on your mind?
Dr. Juthani: Right now the thing that’s really on my mind is the fact that people don’t know where to turn and there is an inherent lack of trust that developed during the COVID-19 pandemic, which has been morphed into a different type of distrust now. And the messaging that we are hearing from the federal government only creates more confusion.
So, what gives me most concern is that people don’t know where to turn, don’t know who to trust, and we can tell people to talk to their doctor, to talk to their provider, to listen to that person. But you know, the reality is that when providers have 15 minute slots to go over highly complex issues, it is very difficult for a provider to answer all the questions that somebody might be coming up with in addition to the specific health questions that that individual has.
So, I really have been spending a lot of this year, this past year, 2025, coming now into 2026, trying to figure out how to get ahead of this, and yet what I get challenged with is not knowing what new hit is going to come that’s gonna throw us off course, that’s gonna lead us down a different rabbit hole where people now have additional questions and concerns that they might not have had yesterday.
Dr. Alessi: Something you mentioned, and I think is important, and I think it’s access to health care and physicians. So, I mean, you oversee physicians and regulation. And, I mean, how do we attract more physicians to come to Connecticut? I have to tell you, Connecticut to some degree is a hostile environment from a medical-legal standpoint.
I mean, we’ve all heard this and we know that. But how do we get especially primary care physicians, ‘cause we train so many physicians here and at Yale and at Quinnipiac, and they leave. What are your thoughts on that?
Dr. Juthani: So the first thing I’d say is that we do have people who leave, but we also have a very robust training environment in Connecticut. So, we have outstanding residency programs and fellowship programs, and so by the very nature of that, there is going to be some attrition. There’s going to be people who come here, train here, and go elsewhere. Your other point though, on being able to recruit primary care into this state is a real challenge.
We know that there’s been an expansion of the primary care workforce, whether it be PAs, NPs, who are also helping to fill some of the primary care needs in the state. But part of that also is because we do have a hard time recruiting and retaining people who do wanna practice primary care. I do think that there are things that have happened in the legislative sessions in these last couple years, you know, potentially increasing rates of reimbursement for some providers.
These are small things, but you know, the reality is we have a long way to go as it relates to that, and I do think that when we train Connecticut natives, they often do wanna stay in Connecticut or come back to Connecticut. So, we’ve had a physician’s working group that the legislature has asked and tasked with trying to come up with strategies.
For the last two years, they’ve been meeting to come up with strategies to help retain physicians in the state of Connecticut. We’ve talked about loan forgiveness. That is one strategy. But you know, the reality is when we look at some of these medical schools around the country that have gone to free tuition, they are not necessarily training up more primary care physicians.
They are ending up recruiting some of the most talented physicians because they’ve now become the most competitive places to go because it’s tuition free. And many of them are going on to be very highly specialized. So, I think it’s been a very challenging nut to crack throughout this country, actually.
And I do think that we’ve tried to do certain things to help facilitate retaining primary care providers, but there’s definitely more to do.
Dr. Alessi: Are there any discussions statutorily, to protect physicians, like they do in other states against frivolous malpractice suits, and things such as that? ‘cause when you go, you know many physicians are in private practice, when you go to pay that med mal bill, it’s a big deal. Is there ever any discussion about that?
Dr. Juthani: That is a topic that comes up all the time and it is not something under the purview of the Department of Public Health, so we don’t have any controls over it, but particularly this physician working group that I mentioned that comes up every single year. And I think when we talk about tort reform and potentially having physicians be in a situation where they could be more protected from that type of situation, I know that it is something that many physicians bring up every year.
Dr. Alessi: I’m gonna shift gears on you again. Injury prevention, right? The CDC has an injury prevention center that has now closed due to funding, and when we think of injury prevention we don’t think of public health. But, certainly now we’re seeing, you know, the promotion of bicycle helmets, God forbid, a motorcycle helmet but, in addition to that, you know, seat belts and things such as that, those are public health moves. Do we have our own injury prevention commission or a center that work on these issues?
Dr. Juthani: That is another part of DPH. So, in fact, we have a large group that works on injury prevention. As you mentioned, there are things like helmets and seat belts. Seat belts are one of the most profound public health interventions that we’ve had in this country.
Dr. Alessi: It’s right there with cigarette smoking, right? The surge in generals...
Dr. Juthani: Yeah, Absolutely. Absolutely.
And so, you know, when I tell people that, as you know, think about seat belts.
If you look at the 1960s to the number of people who died in car crashes to today, seat belts are one of the most impressive public health interventions that are out there. And most people don’t think of that as a public health intervention, but it is. And helmets are the same thing.
Suicide prevention, that is also in our injury prevention work. Gun safety, we have a lot of funding that we get from the state that we have funded 18 different groups to date to work on gun buyback initiatives, locks and safes. A whole bunch of other interventions that work with children from a young age to try to prevent them from engaging in gun violence down the road, primary prevention of gun violence in the first place.
You think about opioid overuse and unfortunately deaths that occur from that. That is a core data function that we do at the Department of Public Health. Figuring out when people die from opioid overdoses, which drugs they might be dying from. We have a lab that tests for those types of things, and we generate a report regularly where we partner with other sister agencies and towns throughout our state so they know what’s actually happening in their jurisdictions.
That’s just a smattering of the types of injury prevention work that happens at DPH.
Dr. Alessi: Any discussion about, since you brought it up, in terms of injury prevention in drug overdose, safe sites. They have them in some cities. They naturally have them in Europe. Has that ever been under discussion here in Connecticut, safe places for people to go and use narcotics?
Dr. Juthani: It’s been under vigorous debate for the last three years, I believe. And, you know, I’ve heard people from New York that have talked about it and in other places, and I know that one of the challenges in Connecticut and right now in particular is that because we know that there have been certain federal laws in place that make it challenging to open these facilities, it has posed a challenge here in Connecticut.
So, it has remained under discussion and under debate, and every single legislative session it has come up.
Dr. Alessi: In closing, I wanna ask you what’s the next innovation we’re gonna hear about in public health?
Dr. Juthani: You know, I have often thought of what new vaccine might be out there? What scientific inquiry might be out there that might help us get to the next level as it relates to public health? I hate to say that I’m in a position right now where I’m just trying to preserve the status quo. And I say that because we’re in a situation right now where mRNA vaccine research has been completely cut.
If you think about the COVID vaccines that came to market so quickly and people had a lot of concerns over, how could that happen so quickly. That’s because money was put into research and technology and innovation in a way that we were on the precipice of cancer cures from mRNA technology and all of that has been stopped in its tracks.
Dr. Alessi: And the money was put in by the same people who took it away.
Dr. Juthani: It was, that’s correct. I mean, that was an accomplishment of the first Trump administration, and so to think about what we could have been doing today, tomorrow, or the next day, what cure was just over the horizon that we now won’t have. When we think about HIV vaccine research that was just eliminated.
You know, we’ve made strides in that arena for a very long time. Having said that, look, we want to work with this administration where we can find common ground. And in government, it is our job to try to find a path forward. We recently had new dietary guidelines that came out.
Dr. Alessi: Sure.
Dr. Juthani: Now do I agree with everything that’s in there? Not everything.
You know, I would say take saturated fats in moderation, and that means butter and red meat, et cetera. But, if we can have Americans think about eating real food and actually operationalizing that, where they minimize sugar, minimize alcohol, eat real food, eat real fruits and vegetables, and there are people who aren’t doing that, who start doing that because this messaging resonates with them, that would be a win.
That is what we all should be doing. That is what the old guidelines also said, but it’s packaged in a different way. And maybe there are more people that it will reach. So, I think that I really, really worry about scientific inquiry in this country. The United States of America was the beacon of research in our academic centers, at the NIH, in private industry.
That does not mean that new things still won’t happen. In public health, the interventions are often very, very simple. And we’ve done great strides with that, right? Like, if you think about water safety, going back to the origin of water safety, they realized that, this was in London, there was an area where cholera was happening and everybody was getting cholera.
And they realized that if you just kept water different, you know, sewage separate from drinking, and you just purify the drinking water, people all of a sudden stopped getting diseases. If you think about our restaurants, you do simple food safety things, people can go to a restaurant and eat the food safely. But if you don’t, then you’re gonna get sick.
Dr. Alessi: Absolutely.
Dr. Juthani: These are the types of interventions we’ve done in public health. Seat belts, as I mentioned, helmets. These are the vast things that we’ve done. But again, in public health, our successes are when things don’t happen. So when things don’t happen, people think things don’t work right. And so right now, unfortunately, I think we’re in a phase where there’s a little bit of pullback from public health.
Fortunately in Connecticut, maybe less so, but we need to keep on reminding people when we do have the successes so that we can give the opportunity for new and other innovative public health interventions to actually come forward, which are often simple interventions, but can make a huge difference.
Dr. Alessi: Thank you. Thank you for your time today, and thank you for keeping us safe.
Dr. Juthani: Thank you for having me, and it’s been my pleasure to be here.
Dr. Alessi: Many thanks to our guest today, Dr. Manisha Juthani, who is the Commissioner for the Connecticut Department of Public Health. If you have questions or ideas for future programs, you can reach out to me at healthyrounds@uchc.edu.
Jennifer Walker is Executive Producer of the Healthy Rounds Podcast. Chris DeFrancesco is our Studio Producer here at the Healthy Rounds Podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.
