Health Policy

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 ┬ádevelop 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