Been a while…

Too long in fact. The world has changed a lot and we are in turmoil on many fronts. I hope to provide some insight on some hot topics shortly. CDC potentially losing funding, Yellow Fever and Mumps are reemerging threats just to name a few issues we face. I will get back very soon (I promise) to address these things. In the meantime, I haven’t updated my last guest blog entry at the Scientific Parent from September 2016. That should hold you for a short time as I get back on track and start my webpage and look to start other projects which I hope will be a more critical look at health issues and society at large. Until then…be vigilant!

–W

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California Passes SB 277: No more personal or religious exemptions for vaccines

After many weeks of debate from legislators and stakeholders on both sides of the vaccine issue, Gov. Jerry Brown (D) signs California State Bill 277 into law on Tuesday June 30th. This bill co-authored by state Senators Richard Pan (D-Sacramento) and Ben Allen (D-Santa Ana) requires that all children in the state are to be vaccinated prior to entering public or private school with no exemptions granted for religious or personal reasons. California now becomes the third state to allow only for medical exemptions to vaccination.  The law will go into effect on July 1, 2016, but until that time what will happen among those who opposed the bill? Could this possibly be an opportunity for reflection on the outcome of this bill by those who oppose it? The data is clear, vaccines work.

The legislature, hearing the will of the people who first hand saw the effects (directly and indirectly) of a measles outbreak sought and achieved a solution that will protect children in the long run and promote a healthier state of California. But for those who continue to hold on to the gross misinformation that vaccines are harmful, cause autism or are ineffective, that “naturally acquiring” the disease is the “way it was intended” are more of a danger to a society that has become more mobile and has increased exposure to many more populations that may or may not have been properly vaccinated from preventable disease. At this point in civilization, we have access to levels of knowledge not seen in eras past. The problem is that many either do not know how to synthesize what sources are proper or in most cases don’t care to hear nor accept that vaccines are an unprecedented success and that in order to live together in a society, disease is a fact of life. Many diseases we have not yet controlled, we only have the means to cure, others we have neither control nor cure. What is so difficult about being proactive not just for oneself but to be a member of a society who is vaccinated and vaccinates their children? That is responsibility. Plain and simple.

As ruled in Jacobson v. Massachusetts (197 US 11 1905), the defendant Mr. Jacobson felt that his 14th Amendment rights were violated when the city of Cambridge, MA required that he be vaccinated for smallpox. The Supreme Court ruled that under the police powers of states in times of medical emergency (in this case a high prevalence of smallpox in the city of Cambridge) that the city was well within their right to implement compulsory vaccination. The opponents of this legislation are planning their next move and I think that this matter could be taken up by the Supreme Court at some point in the future. Jacobson v. Massachusetts provides a seminal example in case law that will be a major influence and reference if this law is challenged in the courts. Groups such as A Voice for Choice is planning to ask for a public referendum that will put a hold on the law. It will be interesting to see if this will be a successful effort and if not will the courts be the next step. Resisting the law is unfortunate, more time and effort could be spent engaged in dialogue among the stakeholders. If we understood the resistance a bit better, the education and outreach could be better. Instead, Senator Pan has been receiving threats for his efforts and a new fight is brewing due to this new law. California is the new testing ground for laws such as these that only grant medical exceptions and if (and potentially when) it reaches the courts, this will provide a new case law precedent that will serve as the guideline for future efforts to solidify vaccination efforts nationally.

Background information for this blog was obtained via the San Jose Mercury News

The Power of Herd Immunity

The state of California is currently debating legislation that will require all children to be vaccinated. Senate bill 277 will ensure that 10 childhood diseases will be prevented as the law will direct that vaccines for these diseases must be administered prior to admission to kindergarten or any daycare setting. Under this proposed law, only medical exemptions will be allowed to circumvent mandatory vaccination.

Vaccine exemptions exist in many forms and vary from state to state as to which are legal and how they are granted. One major type is that of a personal exemption. These exemptions are based on the belief that vaccines do more harm that good or that calling for mandatory vaccination is an infringement on personal liberty, that no government entity has the right to mandate vaccination. Personal exemptions however greatly undermine the power of medical exemptions which are important for those who cannot be vaccinated due to documented medical conditions. Religious exemptions are granted when vaccination policies are at odds with a person’s religious beliefs. Of the exemptions I have just briefly described, religious and medical exemptions appear to be the most reasonable to grant as the practice of one’s religion is a right granted by the constitution while medical as I mentioned is stating that the vaccine could be harmful to an individual’s health due to a preexisting medical condition.

No matter which of the three exemptions are granted, vaccination is still very important. Establishment of herd immunity and maintaining a high percentage of vaccinated individuals within a population reduces the incidence of disease within a population. How? I will use a very simplistic example with ten people (we know that this is an inappropriate sample size, but this is to illustrate the point).

Scenario 1: Of the ten people in this population, only 1 is vaccinated (10% vaccination rate), 1 person is infected (10% infection rate) and the remaining eight people are not vaccinated. Thus, we have 80% of this example population that is susceptible to disease and with a low vaccination rate, infection is rapid among the non-vaccinated.

Scenario 2: Vaccination rate increases to 50% (5 vaccinated individuals), only one infected individual and four non-vaccinated. Here, susceptibility has been halved from scenario 1 (40%) but it is still not enough to keep infection from passing readily through this population.

Maximum protection of the population (vaccinated as well as the non-vaccinated), we need the vaccination rate to be at 90% or higher and only 10% of the population is susceptible to infection. Looking at that, 10% may still be too high of a susceptibility rate but what this number really means is that the chances of infection are greatly lowered and can really be better defined as sporadic. This is due to the high percentage of the population that acts essentially to buffer the effects of the infection among the population.

In a perfect world, 100% of the population would be vaccinated, thus no one would suffer from disease. A rate of 90% is acceptable, although with the current state of vaccination in the U.S., this number has dwindled, placing us in a very dire state. If not for yourself. vaccinate for the good of all. Our fortunes against infectious disease rise and fall with every action we take or every opportunity we squander.

Rubella elimination in the Americas and the Vaccine effectiveness argument

Vaccines are arguably the most successful public health intervention of the 20th Century. The successes that have been noted in reducing disease and deaths are immeasurable and hopefully there are many more successes to come with the current work being done with Polio. Within the last 15-20 years, the anti-vaccine movement has become a major player not only in debating the effectiveness and safety of vaccines, they have become an entrenched force that has driven down the community (Herd) effectiveness of vaccine through their non-compliance with vaccination standards. Many of their main arguments are invalid (autism/vaccine link) and their stubbornness to comply claiming personal exemptions bring harm to children. Each position previously mentioned is one in the same since many anti-vaxers forgo vaccines because of a personal belief and/or their rights are being infringed upon by a paternalistic governmental force.

This week, it was reported that Rubella has been eliminated from the Americas. This is highly historic as the efforts and gains made in the Americas can begin the worldwide elimination of Rubella worldwide. To what can we thank for this development? It would have to be the MMR vaccine! Through the use of the MMR vaccine, we have the power to eliminate vaccine prevenatble disease worldwide to end major suffering. Vaccine preventable diseases can be eliminated from out world and bring about a higher standard of health, improving life expectancy, reducing infant and child mortality due to these diseases and have a major effect on health costs.

Preventative health from a vaccination standpoint makes sense as we look not only to reduce disease burden, but we also want to reduce health costs for treatments later in life. Vaccination is an investment, there are costs to vaccination but those paying the costs must see these costs as investments in individual and community health. These investments MUST be made at the beginning of life to control health costs at the end of life. More investment at the front end keeps health costs low, improves overall coverage for all and can allow for coverage more more acute and complex health issues later in life. There is no excuse for not wanting to vaccinate when we can see that their effects on disease burden are obvious!

The tug-of-war between pro-vaccine and anti-vaccine movements continue. With smallpox declared eradicated 35 years ago and two other diseases heading towards eradication, another check can be placed in the column for the pro-vaccine movement while the foundation of the anti-vaccine movement suffers another blow.

HIV Epidemic in Southern Indiana: Why the social aspects of disease need to be addressed

Last week, the CDC declared a HIV epidemic in Scott County Indiana. As early as January, there were seven noted cases of HIV in an area that suffers from high levels of poverty and injection drug use. Both poverty and drug use as social factors are very commonly seen in many populations and drive HIV rates. It has been known for many years that sharing needles with someone who is HIV positive is one major means of contracting the virus. What we have not done as a society is to address head on the issues that drive infection rates. Why have we not established needle exchanges to provide clean needles for addicts?

Gov. Mike Pence (R-Indiana) with advice from the CDC team in Scott County agreed to allow temporary needle exchanges to slow the infection rates. What Gov. Pence is not doing is allowing for the establishment of exchanges for a longer term. For Gov. Pence and many on the political right, needle exchanges are a problematic issue. Saying “needle exchange” in politically right leaning circles in akin to saying that you support illicit dug use. The British government during the term of Margaret Thatcher instituted needle exchange programs for the good of the health of the United Kingdom. The decision although politically divisive, saved lives and it helped to reduce HIV infection rates among IV drug users dramatically. To me, this issue is a no brainer. Short-term needle exchange programs will be helpful in Scott County, but in order to not repeat an epidemic of this magnitude or worse in an area where poverty drives a culture where sexual networks can form and the drug culture is rampant. Political views override the best interests of many in this country.

Needle exchanges, while allowing for addicts to stay safe and reduce the chances of contracting HIV doesn’t halt the use of drugs. What if we could offer rehabilitation while these exchanges operate? It would stand to reason that there are factors which lead individuals to drug use, during an exchange while we are offering them protection against reusing/sharing used needles we could also  develop and expand resources to help individuals break the addiction cycle. But if we break teh cycle of addiction by dealing with all of the underlying factors associated with a particular person’s addictions, then how do they continue on a clean path when poverty continues to be prevalent and pathological in their community. I do not have the answers on how poverty can be conquered, but it starts with opportunity. So many of our politicians say that they are pro-USA for jobs and manufacturing but they continue to sanction loopholes for corporations that ship jobs to other countries. Poverty persists because those who want to work and want to make a LIVING WAGE cannot do so because of the lack of semi-skilled work. Not every job should require a college degree but with the right training, we can provide work that gives every impoverished American the ability to contribute to all aspects of our economy. HIV is not just about a disease, it is very much about the factors that lead to acquiring the disease. Until we see that diseases such as HIV, TB and neglected tropical diseases are intimately linked with poverty, we will continue to struggle with controlling or eradicating their deadly effects from our world.

Recent FDA rulings prompt important questions

About a month ago, the Food and Drug Administration (FDA) ruled that antibiotics should not be used in livestock for the purpose of promoting growth. As with most FDA rulings, they do not garner a lot of weight as their decisions are non-binding. In a surprise however, many livestock farmers who were polled about the ruling have stated that they would comply with the ruling. For years, we have seen the outcome of use of antibiotics in livestock as the numbers of antibiotic resistant bacteria types and associated infections rise. Now that the FDA has taken this intervening step, we now have to consider finding a balance in this process. Antibiotics still have a place in the raising of livestock as a means to insure that one sick animal does not infect an entire herd. As a preemptive action, antibiotics should still be used and used judiciously to reduce the potentially devastating economic effects of the loss of livestock due to illness.

A few days after the antibiotics ruling, the FDA also asked manufacturers of antibacterial products to conduct additional research to prove that an active ingredient, triclosan is safe for long-term use. Triclosan has been shown in lab testing to have deleterious effects, especially on children. In lab rats, triclosan has been shown to decrease thyroid hormone, affect metabolism and reproduction. These companies have to prove that triclosan, in it’s current formulation will not have these long term effects or will, if not shown have to reformulate their products without triclosan. It is interesting to note, the FDA first ruled on the use of triclosan in 1978, when it was in limited use. As the use of this chemical has expanded. the FDA felt it was in the interest of consumers to call for this review in advance of a potential new ruling on triclosan’s use in 2016.

FDA rulings have very little teeth as far as compliance and enforcement are concerned. I have been saying for a few years now that the role of the FDA needs to be drastically changed in order to better serve the needs of consumers and to insure that rulings truly have the force of law behind them. Without any major changes on the horizon, it will appear that the only way that proper regulation is in place will be via the legislative branch through the passing of new laws that will reduce antibiotic use and if triclosan is shown to be problematic in long-term use, that the chemical be regulated more closely or outright banned for use. Before that, we need to have alternatives, safe alternatives to triclosan so that our antimicrobial products still have usefulness in this era of unprecedented antimicrobial resistance.

Additional reading: FDA antimicrobial resistance strategy
Press release on safety of antimicrobial soaps