Invisible Public Health Can Quickly Become Public Danger
Donald Trump is following through on his plans. He has nominated outsiders to cabinet positions for which the candidates lack experience and qualifications. However, none so far are as dangerous as the announcement of Robert F. Kennedy, Jr. to head Health and Human Services. In this position he will oversee the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. If confirmed he will be the health czar of America.
As most are aware, RFK Jr. is a noted vaccine conspiracist and skeptic. In my book, The Rich Flee and the Poor Take the Bus, I wrote about a recent example of the dangers of vaccine skepticism. In 2008 Ukraine had one of the highest measles vaccination rates (94%) in the world. It was roughly two percentage points higher than the U.S. at the time. Then a teenage boy died. A group of vaccine skeptics, much like RFK Jr., spread a false story that a vaccine was to blame despite medical reports to the contrary. The rumors took hold and measles vaccination rates plummeted. By 2015 only 42 percent of children under two-years-old had received their standard first measles vaccination and only thirty-one percent had received the standard second dose by age six. It did not take long before measles erupted. In 2016 there were only 102 cases of measles across Ukraine but by 2018 there were over 50,000.
In 2018 Serhiy Butenko was an 18-year-old medical student living in Vinnytsia. Not uncommon for his age as a college student, Serhiy become ill with mononucleosis. As he was fighting off this infection, he was exposed to one of the many measles cases circulating throughout his homeland. As his physician, Dr Alexandra Popovich, told the BBC, “This mononucleosis weakened his immune system, so it could not fight properly against the measles virus.” Despite being vaccinated and boosted on schedule as a child, Serhiy contracted measles and died in early 2019. His death was an unnecessary tragedy that was a direct consequence of the vaccine mis-information that took hold in the country a decade prior. Without the large outbreak that this mis-information created, Serhiy would be with us as a physician today.
In 2024, we don’t worry much about measles in the U.S. But that is because our vaccination rates are high enough that exposure to measles is rare. However, as we see in the case of Ukraine, it is very easy to allow vaccine skepticism to take hold and to have that safety disappear quickly.
Even modest drops in vaccination rates can create unexpected danger because of uneven patterns of vaccination. As I wrote in a September newsletter, unvaccinated children tend to appear in clusters within specific schools and neighborhoods. For instance, California allowed personal belief exemptions to vaccine mandates until 2016. Just before eliminating these exemptions California had an overall vaccination rate of about 93%. However, the rate varied greatly across schools. Among private schools, 20% of schools had fewer than 80% of their kindergarteners vaccinated for measles and 11% of private schools had vaccination rates below 70%. Imagine a lunch room in one of these schools with 200 students present. In such a room there would be forty to sixty unvaccinated students present at the same time. If any one of them had been infected, the entire group would have been exposed all at once. Further, some children are not able to be vaccinated because of medical conditions. Others may have a temporarily weakened immune system, or did not take to the vaccine and remain susceptible to infection. These children would be exposed too. But their exposure would not be through their own choice. Like Serhiy they would be exposed by the choice of others.
This is where RFK Jr.’s rhetoric of free parental choice becomes so dangerous. He doesn’t see the effect that each parent’s choice has on children other than their own. This is the danger of a world where everyone looks out for their own self-interest. In this world we lose our community and we lose our public health. There is an old saying in public health: “when public health works it is invisible.” With RFK, Jr. at the helm, invisible public health can quickly become very visible public danger. For those of us that understand this danger, we need to be proactive in fighting whatever mis-information comes about. It will literally be a fight for life and death.
Troy Tassier is a professor of economics at Fordham University and the author of The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.