(CNN) The Tennessee Department of Health is halting all adolescent vaccine outreach, even for vaccines not related to Covid-19, according to internal documents.
The halt impacts all outreach to adolescents, including Covid-19 second-dose reminders, HPV reminders and kindergarten vaccination surveys, according the documents circulated within the department obtained by CNN and first reported by The Tennessean.
The department of health did not respond to CNN inquiries on whether outreach and vaccination practices on Covid -19 or other vaccinations had changed.
The move comes amid a brewing controversy in the state, which is lagging in vaccinations against Covid-19, over parental consent for vaccinations.
Dr. Michelle Fiscus, who says she was fired as the state's medical director of the vaccine-preventable diseases and immunization after an argument over vaccinating children against coronavirus, told CNN she and other health officials have been under pressure as Covid-19 vaccinations have become increasingly politicized.
She saw that scrutiny come to a head when she shared a memo that laid out a state policy, which allows minors ages 14-17 receive medical care without parental consent.
Legislators quickly began contacting the health department asking questions about the memo that some said undermined parental authority. On Monday, Fiscus who is a pediatrician, was fired from her role.
According to the documents, Fiscus would typically release communications in August acknowledging National Immunization Awareness Month, but was told last week that according to the commissioner, Lisa Piercey, there would be no outreach this year.
She learned that the halt on outreach even included communications for flu school vaccinations and infant immunizations, Fiscus told CNN's Chris Cuomo on Tuesday.
Fiscus said her firing was a symptom of a trend in many public health departments across the country. In her state, she sees a "bowing of the department of health to some saber-rattling of some of our legislators who felt that it was inappropriate to share the mature minor doctrine that has been Tennessee Supreme Court case law since 1987."
And the politics around vaccines that began with Covid-19 has spread into a more widespread mistrust of all vaccines, she said.
"These viruses and bacteria that can wreak havoc with these diseases are nonpartisan, they don't care who you are or who you voted for," she said. "And the way to prevent disease is with immunization."
The National Association of County and City Health Officials (NACCHO) told CNN in May that more than 250 public health officials had left their jobs since the pandemic started -- many of them against their will, and others under pressure from people opposed to public health efforts to control the pandemic.
Fiscus said she is worried about the safety of the people of her state. "I am angry that public health is political in this state," she told CNN. "Public health should never, ever, ever be political," she added.
"People all through state government are scared to death that they are going to lose their jobs over this. We are not permitted to do what is right and evidence based and what is recommended by CDC and other national experts on how to manage this pandemic. As a result, our case counts are going up. We only have 38% of Tennessee residents vaccinated, and Delta is coming over from our border states in Arkansas and Missouri."
Earlier Monday, three health policy experts published a commentary in the Journal of the American Medical Association's JAMA Pediatrics arguing that teens should be allowed to decide for themselves whether to get vaccinated.
"Children and adolescents have the capacity to understand and reason about low-risk and high-benefit health care interventions. State laws should therefore authorize minors to consent to COVID-19 vaccination without parental permission," Larissa Morgan of the University of Pennsylvania Carey Law School, Jason Schwartz of Yale University and Dominic Sist of the Department of Medical Ethics and Health Policy at the University of Pennsylvania wrote.
"In the context of vaccination, some older minors may possess a more accurate understanding of the risks and benefits of a vaccine than their hesitant guardians."