Archive for the ‘public health’ category

To Vaccinate Or Not – The Story Of Gotcha

February 3, 2015

This past week, Governor Chris Christie and Senator Rand Paul fell prey to the sensational aspects of a free press. Both GOP Presidential hopefuls were asked whether Americans should be required to be vaccinated or left to decide for themselves. Mindful of the upcoming primaries, both who know better about public health, waffled giving the nod to individual rights. The press had a field day.

Christie and Paul invite these questions unintentionally when they agree to interviews which they hope will raise the public awareness of them. Never the less, there should be some judgement applied to the message the major news agencies are sending when they jump on a sound bite.

Rand Paul is a medically trained eye doctor and must know the relationship of vaccinations and public health. Governor Christie must also understand the public health inferences since he was quick to impose mandatory quarantines for returning Ebola healthcare workers. Being a politician, however, is practicing the art of speaking to the audience and telling them what they want to hear. In interviews, the audience is not always specified.

Individual rights and religious rights are frequently used to justify the reason someone refuses vaccination. Sometimes these positions have been coupled with so called scientific data.   In a recent controversy involving vaccine preservatives, the “scientific facts” were subsequently debunked. Still many insist it is their right to refuse vaccination. Hmmm.

From an individual rights perspective, Paul and Christie have a valid point that public policy should include the views of those who reject vaccination. From a public health perspective, however, it becomes much more complicated. Vaccination has been overwhelmingly shown to protect the public so mandating vaccination should be accepted… for most Americans. There will be, unfortunately,  individual cases where some people cannot tolerate vaccines.  There must be a way out for these people, I would think.

End of story? No.

If someone refuses or is unable to take public policy approved vaccinations, they still bear a responsibility to not hurt others. The whole point of mass vaccination is the protection of everyone, not just the person vaccinated.

The “ambush interview” type of questions that Rand and Christie fielded are a disservice to public health. Just as with the Ebola scare, public officials suddenly get confused on the role of public health and individual rights. Common sense goes out the window and in its place flows the “prepared talking point”.

If the purpose of these interviewers’ questions was to embarrass Paul and Chrisite, then they scored their points. If the purpose was to get an informed opinion about a serious public health issue, they missed the mark.


Kaci Hickox Public Enemy?

October 30, 2014

Kaci Hickox’s restricted travel has now grabbed the front pages and the 7/24 news outlets. The story is perfect for the news media. It requires no intelligence or thought. It simply requires someone to hold an opinion. Is this nurse a public enemy?

Ms Hickox presents a great face for women, and for informed public health. There is no PC with Ms Hickox. She seeks no favors from the public trough and is prepared to stand her ground. Her defense, modern science and recent experience.

Medical experts have said that Ebola is not contagious until the onset of symptoms. Even then, there is a view that during the initial onset, like not feeling well or the first recognition of fever, someone is still not contagious.   It is only when the full presentation of symptoms where bodily fluids (vomit, spit, and diarrhea) come in contact with another unprotected person is there a chance to spread Ebola.

Ms Hickox apparently is confident she will recognize the onset and until then she feels she should be free to move around. Hmmm.

Maine public health officials have asked Ms Hickox to voluntarily isolate herself for 21 days. Ms Hickox has said no thanks. So what might be next?

Most likely the Maine Public Health officials will appeal to a court that Ms Hickox must be forcibly restrained. The Court will decide not on the merits but rather that the Maine Public Health organization has the regulatory power to order restraint. Hmmm.

Next, Ms Hickox side will sue the State of Maine claiming they had instituted controls not justified by the science involved (over stepped their authority). Before long one of two things will occur. Ms Hickox will come down with full blown Ebola, or the 21 days will pass with no occurrence. Maine will in that case offer to drop their charges if Ms Hickox does the same. Hmmm.

The US Ebola scare is a dry run for what might happen if we experience a real influenza outbreak.

There is a clear difference at the extremes between individual civil rights and protection of the population at large. This difference becomes harder to recognize the closer to the center one gets. Common sense and thankfully modern science can resolve this conundrum.

Unfortunately it will require leaders and not run of the mill politicians to sort this out. Even sadder, the country seems to have an excess of politicians and few leaders.

Thanks to Ms Hickox for again making this clear.