If the health department must issue any information about vaccines, staff are instructed to strip the agency logo off the documents.

The health department will also stop all COVID-19 vaccine events on school property, despite holding at least one such event this month. The decisions to end vaccine outreach and school events come directly from Health Commissioner Dr. Lisa Piercey, the internal report states.

Additionally, the health department will take steps to ensure it no longer sends postcards or other notices reminding teenagers to get their second dose of the coronavirus vaccines. Postcards will still be sent to adults, but teens will be excluded from the mailing list so the postcards are not "potentially interpreted as solicitation to minors," the report states.

These changes to Tennessee's vaccination strategy, detailed in an COVID-19 report distributed to health department staff on Friday, then reiterated in a mass email on Monday, illustrate how the state government continues to dial back efforts to vaccinate minors against coronavirus. This state's approach to vaccinations will not only lessen efforts to inoculate young people against coronavirus, it could also hamper the capacity to vaccinate adults and protect children from other infectious diseases.

And these changes will take effect just as the coronavirus pandemic shows new signs of spread in Tennessee. After months of declining infections, the average number of new cases per day has more than doubled in the past two weeks – from 177 to 418. The average test positivity rate has jumped from 2.2% to 5.4% in the same time period.