Vaccines and Politicians: Public Health vs Private Ambition

Child with Diptheria

“There’s a woman who came up crying to me tonight after the debate. She said her daughter was given that vaccine.  She told me her daughter suffered mental retardation as a result. There are very dangerous consequences.”

--Michele Bachmann

"I have heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after [hepatitis B and measles] vaccines...I don't think there's anything extraordinary about resorting to freedom."

--Rand Paul, MD, United States Senator, R-Ky

Measles Killed 450,000 in 2014

No discussion about vaccines and public health should turn on, or even begin with anecdotes about a single case. Vaccines and the public health are about numbers, statistics, risks and benefits.

Tetanus

But they are also about the evils of the diseases we vaccinate against. The simple truth is, because we have not seen much of measles, diphtheria, polio, and influenza in this country, we have forgotten how nasty these illnesses once were, and could be again.

In a sense, we are the victims of our own scientific success: People no longer remember the terror of a polio outbreak in a community, not to mention more remote scourges like diphtheria or tetanus or measles or influenza. Influenza killed more people during the war years of World War I than all the battles of that war did.

Having just said anecdotes are unscientific, let me tell an anecdote about one of my patients who I bullied into having an influenza vaccine. She got Guillain Barre syndrome, a sort of short-lived polio like state, following the vaccine, a rare but well known risk of the influenza vaccine. She wound up in a wheel chair for four months. But that did not stop me from bullying my sons and friends and patients to get influenza vaccines. I get one every year, even this year when it wasn't as effective.

Why? Another anecdote: When I was in training at the New York Hospital, I admitted a  lovely 21 year old woman with influenza from the Emergency Room. She was blue as a frozen foot and she died five hours later. Influenza, nothing we could do. A young life, snuffed out. 

Why would a man who went to medical school inveigh against vaccinations? Because he is playing to an audience which values individual freedom above all other values--the libertarians, who do not want the good of the group to determine what any individual might want to do or think.

So Rand Paul and, it must be noted, Chris Christie, pander to this group, making the question of "choice" of vaccine into a struggle between freedom and governmental oppression rather than a choice to protect the many from the irrational few.

The fact is, we are talking about public health. If we were talking about the family living off the grid in the wilds of Wyoming or Montana, people who never came into contact with anyone else, outside members of their own family, then we would not be concerned so much about their choices and the impacts on public health.

Polio

But, when you have people living among other people, that is, people who live in suburbs, towns or cities, who send their kids to public schools, who shop at public shopping malls, who use public bathrooms, who eat in public restaurants, who swim at community swimming pools, who attend church and Christmas parties with other members of their community, then you have to think about more than individual's freedom. What that individual does affects the health, life and freedom of all those members of the group he might infect.

We do not allow people to defecate or urinate on their own lawns, or in the street, for fear of contagion. That, too, is public health.

That's the thing about the diseases we vaccinate against: They are infectious, which is to say, they pass from person to person, or from person to public water supply or from child to child. The nature of public health is a concern about the public and the "right" of the individual to start an epidemic is overwhelmed by the concern for the welfare of the many. 

It is understandable when an uneducated ignoramus, say Chris Christie, says vaccination should be a matter of "choice" for parents.  That you can write off as an honest lapse into idiocy. 

But when a man who went to medical school, who has to know better, like Rand Paul,  decides to frame the world of contagion and pestilence through the lens of the rights of the individual, you know you are looking at some deeply bizarre and cynical political calculation.

Does some public health officer have the right to tell some parent--who is worried about a vaccine turning her walking, talking, healthy beautiful child into some autistic monster--does the government have the right to insist that her child must be vaccinated against measles? Well, DUH! Of course! The public health service, a governmental agency which is supposed to protect the public. The agency of the government should be concerned about the many, and that agency not only can but should stomp ruthlessly all over anyone who would put his neighbors at risk. 

Would you have Rand Paul saying the same thing in the middle of an Ebola outbreak, if we had an effective vaccine against Ebola? 

Very doubtful. And why? Because the emotional argument--the visual images of what dying Ebola patients look like--would overwhelm any discussion about individual freedom of choice. The same should be true for measles, diphtheria,  polio, tetanus and influenza. The fact is, while Mr. Paul tries to pretend he is being thoughtful and open minded about the rights of those frightened parents, he is accepting the proposition their emotion, their irrationality should trump the cold, statistics based rationality in favor of mass vaccination programs. 

A very canny propagandist once remarked it is easier to sell the big lie than the small one. Your adversaries are so dumbstruck by the stupidity of what you are saying, they do not even know where to begin. That is where we are now, in a sense, with Rand Paul, Chris Christie, Michele Bachmann and all those freedom loving, God fearing, Tea Party  upright citizens who sail with them. Their frame of reference is so far out, we do not even have a common language--only Barney Frank ever seemed to have a Democratic response to these irrationalists: Looking one in the eye at a press conference, he asked, "Excuse me, m'am, but on what planet do you spend the majority of your time?"

I have told this story before, and will likely tell it again, because I think it is the most elegant argument in favor of vaccinations I have ever heard--forgive me for repeating myself. When Dave Garroway stepped up to the podium to introduce Jonas Salk, Garroway told his audience he had been at home, in his bedroom, pulling on his tuxedo, adjusting his bow tie and  thinking about what he should say by way of an introduction, when his seven year old son appeared beside him and seeing the tuxedo and bow tie,  asked his father what the big occasion was.
Garroway told him, "Well, I'm going to introduce the man who conquered polio, the man who made the first successful polio vaccine." 
And his son asked, 'What's polio, Dad?'"

 Then Garroway smiled and  looked at his audience: "Can you imagine any seven year old of our generation, who would not have known what polio was?"

Jonas Salk said that was the best introduction he had ever had. 
I


{NB: If advertising appears on this web page, please know Mad Dog has tried to prevent it. Some new way Google can monetize, apparently}