Smallpox was responsible for millions of deaths across the millennia, to include its unintentional, and at times intentional introduction to indigenous peoples across the globe who lacked immunity. During the 20th century alone, an estimated 300-500 million people died, more than the entire population of the United States in 2018. The observation by Edward Jenner, an English physician, that milk maids who had contracted cowpox appeared to be resistant to smallpox led to the development of the first vaccine. Through a concerted global effort of vaccination, smallpox was declared eradicated in 1980, considered the greatest achievement in international public health.
Polio likewise is an infection that has affected millions, mostly children, over the course of the past few centuries. Waves of epidemics occurred during the early 1900s, ironically often in developed countries where improved sanitary efforts prevented infants, aided by maternal antibodies, from exposure to the virus through contaminated water supplies. Young children contracted the infection, often leading to lifelong paralysis or death. Recognition of its cause led to the development of the Salk and Sabin vaccines in the 1950s. Many adults can still remember lining up in schools as children for their vaccinations, parents looking to ensure their health and safety. When the Global Polio Eradication Initiative began in 1988, more than 1000 children were paralyzed every
These are but two examples that led to vaccinations declared one the ten greatest public health accomplishments of the 20th century. But what if science remained rooted in old theories and “fake science” and vaccines had never been developed? Imagine methods of social distancing were the norm – self- and forced quarantines, isolation, avoidance of public spaces and activities, and children being prevented from attending school. Given the lack of prevention, medicine would only be able to treat the complications. While a mathematical exercise to attempt to calculate the number of deaths that would occur, it’s not a stretch to realize it would be significantly more than currently occur for these vaccine-preventable diseases (VPDs). Thankfully, this hasn’t occurred, and we do know an estimated 21.1 million deaths have been prevented by the measles vaccine worldwide, there have been only two reported cases of diphtheria between 2004 and 2014 and only 15 reported cases of rubella since 2012 in the United States. The successes of vaccination have served as its worst enemy, with generations far-removed from experiencing most of these diseases.
Vaccine denial and hesitancy are providing an opportunity, however, to visit this dystopic possibility. Whether it’s based upon a distrust of science/medicine, the pharmaceutical industry, embracing of false science, or the belief that natural is better, there have been outbreaks of these diseases, to include measles, declared eliminated in the United States in 2000, for which vaccination is 97% effective. The World Health Organization has identified vaccine hesitancy as one of the ten greatest threats to global health in 2019.
As a physician, I recited the Hippocratic oath upon graduation, that included the phrase – primum non nocere – first do no harm. Medical ethics, dominated by the importance of personal autonomy is contrasted, and at times seemingly in conflict with the utilitarian and communitarian approaches of public health that emphasize the greatest good for the greatest number. A core belief of public health is the interdependence of individuals, however, and it it this interdependence that serves as a complement to autonomy rather than its antagonist.
Public health officers serve … “[to] maintain health…control and prevent the spread of any dangerous, contagious or infectious diseases that may occur [RCW 70.05.070].” This responsibility requires the best use of science and medical knowledge to make decisions that impact the entire community, acknowledging they may at times appear in conflict with the rights of the individual. But if we are to have a healthy community, we need to acknowledge the interdependence of all, not the independence of some. “Public health is what we, as a society, do collectively, to assure the conditions in which people can be healthy [IOM, 1988.]”
Dr. Lutz is a board-certified family medicine physician who is currently the health officer for Spokane Regional Health District and Asotin County Public Health.
Subscribe to the Morning Review newsletter
Get the day’s top headlines delivered to your inbox every morning by subscribing to our newsletter.