Category Archives: vaccines

My Millennial Doctor Peers Think They're Walking Into a Crisis Regarding Health Care, Doctors Need to Understand Health Care and Buttagieg’s Health Care Plan, Corona Virus and Kobe.

Dr. Daniel E. Choi announced that ”Hey man, just wanted you to be one of the first to know that I put in my 90-day resignation notice at the hospital. Planning to pursue exec MBA…”

I did a double take at this shocking text from an orthopedic surgery colleague who was also a close friend. What? He was quitting?

We had just slaved through 5 years of orthopedic surgery residency, 1 year of fellowship, and just passed our oral boards. We were now supposed to be living the dream. All of that delayed gratification: throwing away our 20s holed up in the library, taking call endlessly on weekends and holidays. We did it for the ultimate privilege of being attending surgeons for our patients one day.

I called him right away and he confirmed my suspicions about why he quit. As an employed physician in a hospital system, he felt that he was sadly just becoming a cog in the machine, a “provider” generating relative value units. Administrators who had never done a day of residency or even stepped foot in his clinic wanted to provide “guidance” on how he should practice medicine. Overall, he felt that medicine was a sinking ship on which doctors were losing autonomy quickly and that this was a path leading straight to burnout.

I felt I had to let the Twitterverse know.

This tweet went viral and it was clear that I was on to something. I had struck a nerve with many of my physician colleagues. Surprisingly, many physicians empathized with my friend and didn’t blame him for looking elsewhere in finding a fulfilling career. Some physicians even thought he was doing the right thing.

I was getting really curious. I followed up with a Twitter poll: “Physicians, are you actively making plans for early retirement or considering how to possibly exit medicine in the near future?” Sixty-five percent of physicians who replied were considering an early exit from medicine.

This poll result was consistent with my own observation that early retirement online physician groups are burgeoning. Physician Side Gigs on Facebook, which seeks to help “physicians interested in pursuing opportunities outside of traditional clinical medicine…as a way to supplement or even replace their clinical income,” has over 50,000 members. Another Facebook group, Physicians on FIRE, aims to help physicians reach “Financial Independence. Retire Early” and has over 4000 members.

It is difficult to determine whether these physicians seeking early retirement are just wishfully complaining or actually planning an exit strategy. Many physicians answering the Twitter poll clarified that they loved treating and helping their patients but that the system had just become too difficult to deal with. Did this many physicians really want to leave the practice of medicine? What does that mean for our impending physician shortage? Why do so many of us feel the urge to get out?

Many discussions with disenchanted physicians ensued after that poll. In these discussions, I have found several common reasons that have pushed my colleagues to leave medicine.

Devaluation of Physicians on All Fronts

Devaluation appears to be happening on many fronts, according to my discussions with doctors online. There is the use of the term “provider” to replace “physician,” which more of us are finding offensive.

Mid-level providers who are cheaper for health systems to hire are replacing physicians. Reimbursements from commercial payers are declining. Health policy “experts” unfairly blame rising healthcare costs on physicians and have pushed legislators to find ways to lower physician compensation further. There are fewer physician meeting spaces in hospitals, such as doctors’ lounges or physician dining rooms, which used to serve as important spaces for physicians to commiserate and collaborate.

Overall, I sense great disappointment and anger among physicians about what many perceive to be increasing disregard for the tremendous amount of sacrifice physicians have made to complete their training. Physicians increasingly regret all of that time away from family or dropping their personal interests and hobbies during medical school and residency.Most shocking to me, however, is that physicians who speak out about such devaluation are often labeled “greedy doctors” by health policy “experts,” the press, and even fellow physicians (usually in the later stages of their career).

Loss of Autonomy and Independent Physician Opportunities

Personally, I’ve always wanted to be my own boss and I knew fairly early on in training that I wanted to enter private practice. I thought private practice would allow me to insulate myself from many of the forces that pushed my orthopedic surgery colleague to quit.

Mine is not the popular path, however, as the number of millennial physicians who are entering private practice has rapidly declined over the past decade. According to Medscape’s Residents Salary & Debt Report 2019, 22% of residents say they anticipate becoming either a practice owner or partner. According to a survey by the Physicians Foundation and Merritt Hawkins, only 31.4% of physicians identified as independent practice owners or partners in 2018. In 2012, independent physicians made up 48.5% of all doctors.

The survey even revealed that 58% of doctors do not think that hospital employment is a positive trend and concluded that “many physicians are dubious about the employed practice model even though they have chosen to participate in it, perhaps fearing that employment by hospitals will lead to a loss of clinical and administrative autonomy.”

I used to wonder why more of my millennial physician colleagues did not choose private practice as a career path and why so many were choosing hospital-based employment. A line I saw on Twitter sums it up: “Private practice is no longer about profitability. It’s about financial sustainability.” With greater consolidation within healthcare, independent doctors have lost much of their leverage when trying to negotiate fair rates with commercial payers.

In addition, the costs of purchasing an electronic health record and running a staff to deal with authorization and billing issues have made private practice extremely difficult. If more private practice opportunities existed, I am sure that my millennial colleagues would absolutely take them to maintain their independence. However, such independent practice opportunities continue to diminish, and millennial physicians may be pressured to take the only available positions: hospital employment with possible restrictions on autonomy.

Is Your Career Worth Your Own Life?

On average, one doctor a day in the United States ends his or her own life. Physicians commit suicide at a rate twice that of the general population, and over 1 million patients will lose their doctors to suicide every year. Pamela Wible, MD, who studied 1363 physician suicides, points out that “assembly-line medicine kills doctors” and that “pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients.”

Just a couple of months ago, my fellowship director forwarded me an email about a young orthopedic surgeon who had committed suicide, Thomas Fishler. He was known to be a brilliant surgeon whom colleagues and patients loved, and is survived by his young daughter. My fellowship director included in his email, “I know you have an awareness of the risks that those in our profession often face.”

Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.

Physician suicide is heartbreaking and screams crisis. What is driving brilliant doctors to the edge? I believe it’s further evidence of compounding external pressures that are making the practice of medicine increasingly intolerable. Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.

I get chills as I push the thought quickly out of my mind: Am I being subjected to this risk? All physicians have their tough days but I have never been anywhere close to being suicidal. But seriously—is it really worth it if I am at even a small risk of becoming that miserable?

Is There an Impending Crisis?

The average millennial physician completes training, looks around, and sees his or her profession in complete shambles. Burnout is rampant. Doctors are committing suicide daily. Many seem to be miserable over their lack of autonomy and loss of standing. The physician starts to take a hard look at the career they are about to embark on and begins to have serious doubts. Then the physician remembers that student loan debt. The average medical student loan debt in 2018, according to AAMC , was $198,000. There’s really no way out at this point; even if your job is going to make you miserable, you are going to push through because you’re on the hook.

And this is where I start to get seriously worried. We will have an entire generation of graduating physicians who will be subjected to forces that have never been present in medicine before. And these forces are actively causing distress and misery among some of my colleagues.

I know that my millennial colleagues have tremendous resilience and grit, as every generation of physicians has in the past. But how long will they put their heads down and fight against these ominous forces before they decide that they’ve had enough and jump ship just like my orthopedic colleague did?

Hope in Advocacy to Avert Crisis

Don’t get me wrong—practicing medicine is still the greatest privilege, and I know that every one of my millennial physician colleagues loves their patients dearly. I am honored that my patients entrust me to take away their pain and suffering in the operating room. I’ve studied and trained for 14 years to become an attending orthopedic spine surgeon; I’m not giving up this privilege that easily. And neither are most millennial physicians.

Millennials may be viewed as entitled, but many of us see that as comfort in advocating for themselves and questioning the status quo.” I believe that millennial physicians will not quietly accept the current state of affairs.

I see many impassioned millennial physician advocates becoming active in organizations like the Medical Society of the State of New York or the American Medical Association. These organizations already do excellent advocacy work, and I predict that millennial physicians will become a powerful force within such organizations to protect their profession. Through a unified voice, organized medicine is truly our strongest hope in enacting systemic changes that can prevent further physician demoralization and burnout.

We’re not giving up just yet. The crisis can be averted. Our patients and profession depend on it.

America’s healthiest and unhealthiest states

Cortney Moore noted that when it comes down to the popular saying that “health is wealth,” the states that have high revenue streams and median household incomes also have populations that are wellness-focused. Particularly, the states with the healthiest people are concentrated in the northern half of the U.S. and West Coast, according to America’s Health Rankings annual report conducted by the United Health Foundation.

The United Health Foundation analyzed the 50 states on five core categories, including model behaviors, community and environmental factors, public policies for health care and preventative care, clinical care and the overall health outcomes that result from the previous four.

America’s Health Rankings used a composite index of over 30 metrics to create its annual snapshot of statewide healthy populations, which ultimately helped the organization determine the healthiest to the unhealthiest.

Moreover, the report cited the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” in addition to individual genetic predispositions to disease.

The healthiest state is Vermont, which has moved up from 20th place in 1990 to first place in 2019, according to America’s Health Rankings data. In the past 15 years, the state has decreased its air pollution by 47 percent – with fine particles per cubic meter going down from 9.7 to 5.1 micrograms. Additionally, Vermont’s disparity in health status decreased from 49 percent to 17.4 percent in the past year. Other strengths the report noted include low incidences of chlamydia, violent crime and the percentage of uninsured residents.

For the 2019 fiscal year, with the exception to the month of December (which data has yet to be released for at the time of publication), the state of Vermont made over $955 million in revenue from general funds, according to the Agency of Administration. More than $113 million came from health care taxes and assessments that were collected between January 2019 and November 2019.

The median household income in Vermont is $60,076, according to data from the U.S. Census Bureau, which is close to the national median of $61,937. Moreover, average employee health care premium contributions for a family in the state is said to be $4,996, according to independent researchers at the Commonwealth Fund.

When it comes down to those who have government-funded health insurance plans, the Centers for Medicare and Medicaid Services do not have up-to-date figures since it is collected on a quinquennial basis. However, the agency found that Vermont reported a little over $5.7 million in 2015 for health care expenditures, as noted in an infographic by the Kaiser Family Foundation.

Outside the Green Mountain State, the other states that rounded out America’s Health Rankings top 10 are Massachusetts, Hawaii, Connecticut, Utah, New Hampshire, Minnesota, New Jersey, Washington and Colorado.

The unhealthiest state is Mississippi, which has maintained close to 50th place from 1990 to 2019, according to America’s Health Rankings data. Since 1993, low birthweight in Mississippi increased from 9.6 percent to 21 percent of live births. In the past five years, premature death increased by seven percent from 10,354 to 11,043 years lost to people who died before age 75. Premature mortality has increased on a national scale in addition to diabetes and obesity. Other challenges the report noted include a high cardiovascular death rate and percentage of children in poverty.

For the fiscal year of 2019, the state of Mississippi made $166 million in revenue collections, according to the Mississippi Legislative Budget Office, which surpassed the state’s estimate by $30.5 million.

The median household income in Mississippi is $43,567, according to data from the U.S. Census, which is $18,370 less than the national median. Average employee health care premium contributions for a family in the state is $5,133, according to the Commonwealth Fund, which is only $137 more than the premiums employees in Vermont are paying. But, when coupled with Mississippi’s lower median income, the cost of health coverage is substantial.

Mississippi also surpassed Vermont in spending on government-funded health insurance plans. The Centers for Medicare and Medicaid Services found that Mississippi reported over $21.5 million in 2015 for health care expenditures.

The other states that rounded out America’s Health Rankings bottom 10 were primarily in the South, including, South Carolina, Kentucky, Tennessee, West Virginia, Oklahoma, Alabama, Arkansas and Louisiana. Indiana was the only Midwestern state to land on the lower one-fifth of the unhealthiest states list.

On a national scale, American health is a mixed bag. Since 2012, smoking among adults has decreased from 24 percent to 16.1 percent, however, obesity among adults increased to 30.9 percent from 11 percent while diabetes among adults increased to 15 percent from 9.5 percent.

In the past three years, drug-related deaths have increased by 37 percent from 14 to 19.2 deaths per 100,000 people. When compared to America’s Health Rankings data from 2007, that is a 104 percent increase.

Environmental conditions have improved as air pollution decreased by 36 percent since 2003 and violent crime decreased by 50 percent since 1993. In the past four years, frequent mental distress increased from 11 percent to 13 percent, which has resulted in an increase of mental health providers, according to the report.

Infant mortality has decreased by 43 percent from 10.2 to 5.8 deaths per 1,000 live births in the past 29 years. However, low birth weight has increased by four percent from eight to 8.3 percent in the past three years, which also happens to be a 19 percent increase from 1993.

The average American spends more than $11,000 per year on health care and accounted for 17.7 percent of the U.S. GDP, according to estimates from the Centers for Medicare and Medicaid Services. With spending projected to grow at an average rate of 5.5 percent per year, the U.S. will reach nearly $6 trillion in health care spending by 2027.

Buttigieg’s health care plan would save money while Warren and Sanders plans would cost trillions, analysis finds

Associate Editor Adriana Belmont reported that Health care has been a contentious topic among the Democratic presidential candidates: Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-MA) support Medicare for All while Mayor Pete Buttigieg (D-IN) and former Vice President Joe Biden offer alternatives to universal health care.

A new analysis from the Committee for a Responsible Federal Budget (CRFB) took a look at the different plans and found that while each proposal would reduce the number of uninsured Americans, the least costly would be Buttigieg’s plan.

“Mayor Buttigieg’s plan would reduce deficits by $450 billion,” according to CFRB, adding that the policy would also “increase gross spending by $2.85 trillion, reduce costs by $1.2 trillion, and raise $2.1 trillion through direct and additional offsets.”

Through Buttigieg’s Medicare for All Who Want It plan, everyone would automatically be involved in universal health care coverage for those who are eligible. The policy would also expand premium subsidies for low-income individuals, cap out-of-pocket costs for seniors on Medicare, and limit what health care providers change for out-of-network care at double what Medicare pays for the same service. At the same time, those who still want to stay on private insurance can do so.

“This is how public alternatives work,” Buttigieg said. “They create a public alternative that the private sector is then forced to compete with.

CRFB estimated that the Indiana mayor’s plan would reduce the number of uninsured by between 20 to 30 million “by improving affordability and implementing auto-enrollment as well as retroactively enrolling and charging premiums to those who lack coverage.” 

‘Building on Obamacare’

Joe Biden’s health care plan, described as “building on Obamacare,” has an estimated gross cost of $2.25 trillion and would add $800 billion to deficits over 10 years. The CRFB also found that “it would reduce costs by $450 billion” and “raise $1 trillion through direct and additional offsets.”

Biden’s plan would reduce the number of uninsured by 15 to 20 million Americans and reduce national health expenditures by 1%. 

Some of his biggest revenue drivers in his plan include coverage expansion revenue feedback, which would create a public option, and end deductibility of prescription drug advertising. Additionally, his capital gains tax and “tax at death” would generate $550 billion.

‘Federal health expenditures would increase somewhat more’

Sen. Sanders, one of the original proponents of Medicare for All, has a plan that’s projected to add $13.4 trillion to deficits over a decade at a gross cost of $30.6 trillion. It would also raise $12.5 trillion in revenue through direct offsets and raise another $3 trillion through additional offsets.

His proposals to eliminate medical debt would cost $100 billion and would raise $1.7 trillion by reducing the costs of prescription drugs. To generate more money for the plan, Sanders would establish a 4% income surtax (projected to raise $4 trillion) and 7.5% employer payroll tax (estimated $4 trillion added). One significant cost in his plan, though, is offering universal long-term care — which would cost $29 trillion. 

“The reality is that Medicare for All will save American families thousands of dollars a year because they will no longer be paying premiums, deductibles and co-payments to greedy private health insurance companies,” Warren Gunnels, senior advisor for the Sanders campaign, told Yahoo Finance in a statement.

“If every major country on earth can guarantee health care to all and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States of America cannot do the same.”

Overall, between 2021 to 2030, the CFRB estimated that Sanders’ plan would increase national health expenditures by 6%, “meaning that federal health expenditures would increase somewhat more than non-federal health spending would fall.”

‘Magical math’ or ‘the biggest middle class tax cut ever’?

Sen. Warren’s plan closely resembles Sanders’ in terms of cost. She stated her plan would cost $20.5 trillion in federal spending over a decade. CFRB found that the plan “would add $6.1 trillion to deficits over ten years under our central estimate.”

Experts disagree over the cost of Warren’s numbers, with one calling it “magical math” and another referring to Warren’s plan as “the biggest middle class tax cut ever.”

According to CRFB, the plan would increase gross spending by $31.75 trillion, reduce costs by $4.7 trillion, raise $14.2 trillion in revenue through direct offsets, and raise another $6.75 trillion through additional offsets. Her health care plan is estimated to increase costs by about 3%, but “the magnitude of these increases would decline over time.”

A major way to fund the plan would be through tax reform. By essentially eliminating tax breaks with private health insurers and requiring employers to contribute to her Medicare for All, she’s projected to generate an estimated $14.2 trillion. Other means of generating revenue for her plan include her wealth tax and a tax on bonds, stocks, and derivatives.

Both the Warren and Sanders plans would reduce the number of uninsured Americans by 30 to 35 million and “nearly eliminate” average premiums and out-of-pocket costs.

Patients can’t afford for doctors to misunderstand the healthcare business

Caroline Yao reported that When I was in medical school, my teachers started a lot of their stories with the same phrase:

“Back in my day, I still helped patients who couldn’t pay.”

“Back in my day, we didn’t have 100 checklists.”

“Back in my day, I didn’t need permission from insurance companies to do my job.”

“Back in my day, a yelp review couldn’t ruin my reputation.”

It happened so often that I wondered if I had shown up to the medical profession 30 years too late. Had I signed up for a sham fairytale?

I had thought doctors were autonomous, benevolent masters with kind voices and encyclopedic knowledge. After entering the field, I’ve found most young doctors struggle to balance convention versus empowerment, and doing good versus doing well. Doctors are the ugly stepchild of healthcare reform; too privileged to warrant help, but too powerless to do our jobs better.

I performed more than 2,500 surgeries during my residency training, and I am embarrassed to say that I do not know what a single one of my patients paid for their operations.

I later learned at the public hospital, surgeons were reimbursed $35 for each emergency appendectomy performed. Where did all that money go? Why didn’t the doctors question the system, or try to regain some control?

The provider will see you now

Somewhere along the way, my title as a doctor has been reduced to “provider,” and my worth dictated by administrators, insurance companies—and the government. The Hippocratic Oath I earnestly recited upon starting medical school is challenged everyday by a system of perverse incentives, where hospitals are paid more for treating the sick than keeping the patient well.

In 2013, 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine; 81% felt they lacked an understanding of healthcare legislation.

Is the answer that doctors should participate more in determining patient fees and reimbursement schedules? History shows that when doctors controlled payments more directly, graduated systems based on ability to pay were subtle but more ubiquitous. In the era of Aristotle, wealthy physicians did not accept payment, while poorer ones requested them. When 9th-century physician and scholoar Ishaq bin Ali al-Ruhawi wrote the first book of medical ethics, he described physicians as business owners who provided free services during times of patronage from caliphs and sultans. Throughout medieval Europe and during the Ottaman Empire, doctors treated the poor with the help of subsidies from royal courts and churches. Notable physicians such as Sir William Osler, legendary French surgeon and anatomist Guillaume Dupuytren, and physician and founder of Dickinson College, Benjamin Rush also charged rich and poor patients based on a self-made sliding scale.

Today, governments, universities, religious groups, and philanthropists are essentially modern-day barons who fund healthcare for the indigent through public hospitals, grants, and charitable work.

In the US, some physicians are granted partial and full student debt forgiveness from the government for working in underserved or rural communities. However, the majority of physicians who volunteer at free clinics, teaching hospitals, charities, or medical missions often do so only because their practice is flexible or lucrative enough to allow them both time away from paying jobs and the financial means to offer free services.

While physicians in private practice have autonomy over who they treat and how much they charge, physicians who work in hospital systems are more and more removed from managing the whole patient.

In 1983, 76% of doctors owned their own practice versus only 47% in 2016. Young physicians today are fundamentally unaware of the business side of medicine, and that’s bad news for everyone. As is the fact that medical students and residents are consistently and idealistically mentored to ignore the costs of materials and treatments we recommend.

We are taught to deliver care based on strict scientific evidence: the “gold standard” of care. Said gold standard, however, does not account for price, diminishing returns, convenience, or pain. The treatment that works best for a lab rat in a cage does not always translate to the most appropriate care for a person who has far more complex needs.

The cost of your health

A more pragmatic physician understands that patients who are underinsured, uninsured, or improperly educated will often forgo procedures, clinic visits, and medications when those interventions are too expensive or inconvenient.

Cost-conscious surgeons know that using instruments to tie stitches instead of hand-tying stitches can often result in a 10-fold cost savings without sacrificing quality.

I did not know how prohibitively expensive everyday surgical consumables cost until I went on humanitarian missions abroad and worked with surgical teams that could not afford these luxuries. I learned that hemostatic fabric we used like disposable napkins in the US cost $40 for a post-it sized square. A five-inch silicone band-aid costs $20. Bioengineered skin substitutes cost $10,000 for a palm-sized sheet.

My lack of price-awareness is fairly common. Many doctors have stopped accounting for the cost portion of a cost-benefit analysis.

And where doctors have leaned away from understanding cost, others have stepped in. Hospital administrators, governments, and insurance companies now manage the costs of healthcare. Correspondingly, physician compensation is estimated to be under 10% of total US national healthcare spending today. Overhead, administration, ancillary staff, malpractice insurance, and pharmaceuticals account for the majority of costs. For an appendectomy and associated care in 2018, the Medicare allowable compensation for a surgeon’s work is $394; meanwhile, healthcare watchdog organizations quote $13,000 as the fair price for hospitals to charge a patient and US hospitals bill an average of $31,000.

Most surgeons working in large hospitals are unaware of these numbers. They are therefore unable to tell patients how much they will be billed for a given operation. A surgeon in the 1830s in the company of the likes of Dr. Dupuytren would know these numbers.

Patients are often dismayed or surprised that their doctor cannot earnestly explain the cost-benefits of different treatments. A 2013 survey by the Journal of the American Medical Association found that 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine and 81% felt they lacked an understanding of healthcare legislation.  As surgeons, we have slowly let ourselves become exclusively technicians. Just like Aristotle and Plato said.

By turning our noses up at the business of medicine, we have lost ownership over our patients, and the agency to advocate for them. As Osler said, “The good physician treats the disease. The great physician treats the patient who has the disease.”

We as physicians and surgeons need to recover our identity and learn the business skills that our teachers have forgotten, but our forefathers stood up for.

As China’s Coronavirus Cases Rise, U.S. Agencies Map Out Domestic Containment Plans

Richard Harris reported that China has reported a large surge of cases of the novel coronavirus — upping its count from under 3,000 to over 4,500 as of Tuesday morning. More than 100 deaths have been reported. It is spreading rapidly in many provinces, and sporadic cases have now been reported in 18 other locations outside of China, including Australia, France and Canada.

In the United States, the case count remains at five — all people who had recently returned from Wuhan, China. And at a news conference Tuesday, top U.S. health officials reiterated that the disease — while serious — is not currently a threat to ordinary Americans.

“At this point, Americans should not worry for their own safety,” said Alex Azar, health and human services secretary, at the press briefing Tuesday.

While risk to most Americans remains low, Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, noted that “risk is dependent on exposure” and that health care workers or others who know they have been in contact with a person exposed to the virus should take precautions.

The federal government continues to adjust its approach to preventing the disease from taking hold in the U.S. On Monday night, the CDC and the State Department announced that a travel advisory recommending that Americans avoid travel to China when at all possible.

Airport screening is also being expanded from five airports to 20, with the goal of screening all passengers returning from China and letting people know what they should do if they fall ill after they get home.

The CDC is conducting contact investigations of people known to have been in contact with the five patients with confirmed infections, monitoring them for symptoms and testing them if concerning symptoms emerge.

Officials at the CDC are eager to get into China in order to help scientists there answer key questions — such as whether the virus can spread from people who don’t show any symptoms of illness. Azar said at the news conference that he had been pressing his counterpart in China for permission to send investigators.

That plea has been answered, at least to a certain extent. On Tuesday, the World Health Organization announced that it had the green light to send outside experts to China. It was not immediately clear whether that will include scientists from the CDC.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, explained that federal agencies are taking a three-pronged approach to respond to the novel coronavirus: developing and improving diagnostic tests, investigating experimental antiviral drugs, and working to develop a vaccine.

He said if it turns out that the virus can spread from someone who is not showing any symptoms, there would be some changes in the public health response. Similar coronaviruses from past outbreaks — severe acute respiratory syndrome and Middle East respiratory syndrome — did not spread in the absence of symptoms, but that doesn’t mean the new one will behave the same way. Viruses such as measles and influenza can be spread from people who aren’t showing signs of disease.

“Even if there is some asymptomatic transmission, in all the history of respiratory-borne viruses of any type, asymptomatic transmission has never been the driver of outbreaks,” Fauci said. “The driver of outbreaks has always been a symptomatic person.”

And lastly condolences go out to the Bryant family and the other members of the helicopter crash in southern California. Kobe will be sure missed but loss of kids really upsets a father like me the most!

States Move To Restrict Parents’ Refusal To Vaccinate Their Kids. Our Goal and the Rest of the World!

50201675_1876827435780240_8947739925063663616_nI don’t know whether you all remember my last few sentences of last week’s post but I was so encouraged this week because it seems that maybe some of the politicians are reading my blog (yeah right!?!?) or they recognize the severity of the measles problem today. So, I want to continue the discussion starting with a number of States who get the message.

Patti Neighmond wrote that all U.S. states require most parents to vaccinate their children against some preventable diseases, including measles, mumps, rubella, and whooping cough, to be able to attend school. Such laws often apply to children in private schools and day care facilities as well as public schools.

At the same time, beyond medical exemptions, most states also allow parents to opt out of this vaccination requirement for religious reasons. And 17 states permit other exemptions — allowing families to opt out of school vaccination requirements for personal or philosophical reasons.

Michelle Mello, a professor of law and health research and policy at Stanford University, says the bar for claiming an exemption from vaccine requirements has been very low in many states. “You can believe that vaccines don’t work or that they are unsafe or they simply fly in the face of your parenting philosophy,” she says.

But this winter’s outbreaks of measles across the nation are resulting in challenges to many exemptions: At least eight states, including some that have experienced measles outbreaks this year, want to remove personal exemptions for the measles vaccine. And some states would remove the exemption for all vaccines.

Most of this year’s measles cases have been among children who were not vaccinated against the virus.

Once considered eradicated in the U.S., measles has sickened at least 159 people since the start of 2019, according to the Centers for Disease Control and Prevention, in outbreaks ranging from Washington and Oregon to Texas and New York. Last year, there were 372 reported cases of measles nationwide.

The move among state legislatures to tighten vaccine requirements is good news to Diane Peterson, the associate director for immunization projects with the pro-vaccine advocacy group Immunization Action Coalition.

“Measles is not like a common cold,” Peterson says. “Children get very, very sick and can be hospitalized,” she says, adding that measles can even lead to death.

The virus is highly contagious, airborne and easily spreads. It can survive in the air for a couple of hours.

“A patient with measles can go to the doctor, cough in the exam room and two hours later another patient coming into the same exam room can be infected,” Peterson says.

The virus is spreading fast this winter, she says, because of the “pockets of children who have not been vaccinated, mostly due to parents who have decided not to vaccinate them.”

This leaves not only those unvaccinated school children vulnerable to the virus but also many adults who have suppressed immune systems and infants who are not old enough to be vaccinated.

According to the Association of State and Territorial Health Officials, bills to restrict exemptions are now pending in a growing number of states.

None of this sits well with activists who want their states to maintain personal and philosophical exemptions.

“Nobody should sit in judgment of another person’s religious and spiritual beliefs,” says Barbara Loe Fisher, a spokesperson for the National Vaccine Information Center, a group that lobbies against mandatory vaccination and thinks parents should have a choice. “No person should be allowed to force someone to violate their conscience when they’re making a decision about the use of a pharmacological product that carries a risk of harm.”

The scientific consensus about any risk from vaccines is that serious side effects are extremely rare. A suggestion that immunization might be tied to severe consequences like autism was debunked years ago after findings supporting that link were proved fraudulent.

Mello, the Stanford law professor who has been following the exemption debate, notes that the courts have repeatedly held that when a public health intervention is necessary to safeguard the public, individuals generally can be required to give up some personal liberty, particularly if that liberty is tied to a government benefit like school.

So far, only three states — Mississippi, West Virginia and California — prohibit nearly all vaccine exemptions, including the one exempting families who say their religious belief conflicts with vaccination. (All states allow medical exemptions when, for example, a child has a compromised immune system.)

The California state Legislature made that decision in 2015, less than a year after the state experienced a significant measles outbreak that got its first foothold among unvaccinated children visiting Disneyland.

A measles outbreak in the US has triggered debate on the ease with which parents can opt out of mandatory vaccine rules.

I noted last week that a total of 159 people have come down with the disease in 10 states since January, but one small area, in particular, Clark County in Washington State, has illustrated the dangers of these exemptions, which are sought for religious, personal or philosophical reasons.

Just north of Portland, Oregon, Clark County accounts for 65 measles cases, 47 of them among children under age 10. In almost all 65 cases, patients had not been vaccinated.

Fifteen years ago, 96 percent of school children aged five in Clark County got measles shots. But in 2017-2018, the proportion was down to 84 percent.

In some schools, mainly private ones, the rate of use of the so-called MMR vaccination against measles, mumps, and rubella was only 20 to 30 percent. In some of the schools, more than half the students had received exemptions.

Local lawmakers in Washington State have responded to the outbreak by advancing legislation that would do away with exemptions on personal or philosophical grounds. Opt-outs for religious reasons would still be allowed.

Such exemptions are widely available in the United States. Only three of the 50 states—California, Mississippi, and Virginia do not allow them.

California did away with exemptions for personal reasons in 2015. In the most populous US state, exemptions are permitted only for medical reasons.

In recent years other states have toughened their laws. Connecticut, for instance, requires parents claiming an exemption for religious reasons to provide a yearly, notarized statement to this effect. Since 2015, Delaware has allowed schools to temporarily exclude non-vaccinated kids.

Vermont wants to get rid of religious exemptions, after eliminating those sought for philosophical reasons four years ago, according to The Washington Post. Arizona, Iowa, Minnesota are also debating stricter laws.

Congressional hearing

The US Congress will hold a hearing Wednesday on the issue of vaccinating children.

Overall, the vaccination rate of kids in the US has remained stable, according to the Centers for Disease Control and Prevention, which monitors such trends closely.

It reports that in the 2017-2018 school year, around 95% of American kindergarteners were vaccinated against MMR, chicken pox and diphtheria, tetanus and whooping cough.

But the national rate masks wide disparities from state to state and even from one school to the next, as the case of Clark County illustrates.

And health authorities are alarmed because the previous school year was the third in a row in which requests for exemptions from vaccination increased, even though the rises were small.

And the proportion of kids reaching age two without having received any kind of vaccination is also growing, albeit slowly: 0.9 percent of children born in 2011 to 1.3 percent among those born in 2015. Vaccination-free kids were practically unheard of at the turn of the century.

Exemptions alone do not explain why children are not vaccinated. Many vaccines are recommended for American children in their first two years of life—the CDC advises they be used for 14 diseases—and this is hard for parents to keep up with, especially for vaccines that require three or four shots.

Another problem is access to health insurance. Children in families without such insurance make up a disproportionate amount of those who go without shots, according to the CDC.

In Congress, the measles outbreak has prompted lawmakers to act.

The disease routinely infected American kids before a vaccine was introduced in 1963. Before that, it killed 400 to 500 people a year in the US. In 2000 it was declared eliminated. But since then, over the years anywhere from 50 to 600 cases have been reported annually.

Two US senators recently called on the CDC to explain what it is doing in response to what they called “pockets of unvaccinated people.”

‘We Need to Get to Zero’ on Measles: NIAID Chief to House Panel

I think we all agree and members from both parties express support for measles, mumps, and rubella vaccine

Our friend Joyce Frieden, the News Editor of MedPage Today, reported that the views that some House committee members expressed Wednesday in favor of vaccination brought to mind a line from a character on a British television show: “I am unanimous in this.”

“It wasn’t until the development of the MMR [measles, mumps, and rubella] vaccine that we as a country were able to stop this horrific illness,” said Rep. Diana DeGette (D-Colo.), chairman of the House Energy & Commerce Subcommittee on Oversight and Investigations, at a hearing on recent measles outbreaks in the U.S. “But despite that success, here we are again 20 years later.”

Rep. Greg Walden (R-Ore.), a ranking member of the full Energy & Commerce Committee, noted that one in four people diagnosed with measles will end up being hospitalized. “If we don’t reverse the downward trend in vaccination, we risk bringing back measles in full force,” he said.

DeGette called the recent measles outbreaks “a real cause for national concern” and pointed out that the national measles vaccination rate for children stands at 91%.

“That may seem high to some, but it’s well below the 95% vaccination rate required to protect communities and give them herd immunity,” she said. “And while the overall national rate of MMR vaccines is currently at 91%, the rate in some communities is much lower — some as low as 77%. Outbreaks like the one we’re seeing with measles remind us of just how interconnected our communities are … As a nation, to stop the spread of deadly diseases, we have to address the root cause of the problem and we have to define concrete steps … We need to support additional research into vaccine safety to further increase consumer confidence in these vaccines.”

Nearly 160 Cases This Year

Once again the numbers are important and so from Jan. 1, 2019 to Feb. 21, 2019, there have been 159 confirmed measles cases in 10 states, Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, told the committee. The states reporting outbreaks include California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington. In 2018, 372 people in 25 states and the District of Columbia were reported to have measles; most of those cases involved unvaccinated people, she added.

Although measles was officially eliminated in the U.S. in 2000, and the rate of measles vaccination coverage is fairly high nation-wide, “there are pockets of people who are vaccine hesitant who delay or even refuse to vaccinate themselves and their children,” which can cause outbreaks, Messonnier said. Many of those live in close-knit communities where they share the same religious beliefs or ethnic backgrounds as their neighbors. Others simply have a strong personal belief against vaccination.

“In the past 5 years, there have been 26 measles outbreaks of more than five cases, 12 of which were in close-knit communities, including a Somali community in Minnesota in 2017 and Orthodox Jewish communities in New York City and New York state in 2018; these 12 outbreaks account for over 75% of cases in the past 5 years,” she said, adding that “Vaccine hesitancy is the result of a misunderstanding of the risk and seriousness of disease combined with misinformation regarding the safety and effectiveness of vaccines. However, the specific issues fueling hesitancy vary by community” and must be attacked locally with the help of the CDC.

The federal government’s Vaccines for Children (VFC) program is a “critical component” of the fight against vaccine-preventable diseases, Messonnier said. “Because of VFC, we have seen significant decreases in disparities in vaccination coverage … For each dollar invested [in the program], there are $10 of societal savings and $3 in direct medical savings.”

‘I Am a Measles Survivor’

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, said that measles was “one of the most contagious pathogens we know of” and explained that since the virus has been well sequenced, “we can tell, when the virus is reintroduced into our country, from where it comes.” For example, researchers were able to determine that a measles virus that led to an outbreak among a community of Hasidic Jews in Brooklyn in New York City came from Israel.

“I consider it really an irony that you have one of the most contagious viruses known to man, juxtaposed against one of the most effective vaccines that we have, and yet we don’t do and have not done what could be done — namely, completely eliminate and eradicate this virus.” Fauci showed a slide delineating the recent outbreaks. “This slide is really unacceptable; this is a totally vaccine-preventable disease … What we all should strive for, that measles in the United States, we need to get to zero.”

A few hearing participants shared their own experience with the disease. “I am a measles survivor,” said Rep. Michael Burgess, MD (R-Texas). “I was at an age where the measles vaccine was not available. Even though I was very young when that happened, I still remember … the heart-shaking chills, the muscle pain, and the rash that’s [emblematic] of measles.” Fauci said he also had the disease and that it was “very uncomfortable and very scary.” Rep. Brett Guthrie (R-Ky.), the subcommittee’s ranking member said that one of his close childhood friends “was essentially born without a hand” after the friend’s mother contracted rubella during her pregnancy. “I’ve always thought of measles and how devastating it can be.”

Guthrie also asked Fauci whether people could “self-medicate” with vitamin A to prevent measles. Fauci responded that children with vitamin A deficiency who get measles “have a much more difficult course, so vitamin A [supplements] can actually protect you from some of the toxic and adverse effects,” but that doesn’t apply in developed countries where such deficiencies are rare. “It doesn’t prevent measles, but it’s important in preventing complications in societies in which vitamin A deficiency might exist,” he said.

The Thimerosal Question

Burgess asked about whether thimerosal — a mercury-containing preservative often mistakenly claimed to cause problems with vaccines — was in the measles vaccine. “No, it’s preservative-free,” said Fauci. Burgess asked whether there was ever any evidence that mercury or thimerosal was unsafe. Messonnier said thimerosal had been removed from vaccines “out of an abundance of caution at a time when there wasn’t enough evidence, but evidence since then has been very conclusive” that thimerosal is safe.

The hearing was also marked by a few disruptions, including some shouts from the audience when Fauci, responding to a question, said that the measles vaccine couldn’t cause encephalitis. DeGette told the audience that such disruptions were in violation of House rules; Messonnier then said that the vaccine doesn’t cause brain swelling or encephalitis in healthy children.

Guthrie remarked that whether or not parents choose to vaccinate their children, they do so with the best of intentions. “Whatever decisions they’re making, they’re making it in the love and best interest of their child,” he said. “So I think it’s important we do have the science … and people with credentials and reputations to present this evidence, and hopefully people have the opportunity to see it and read it.”

Measles cases soar worldwide, UN warns of ‘complacency’

Outside of the U.S., I think it is necessary to see how this disease is affecting other countries. I brought up the statistics regarding the incidence and the deaths in the Philippines but on a broader scale Cynthia Goldsmith reviewed the statistics with regard  of the measles problem in the world and noted that just 10 countries were responsible for three-quarters of a global surge in measles cases last year, the UN children’s agency said Friday, including one of the world’s richest nations, France.

Ninety-eight countries reported more cases of measles in 2018 compared with 2017, and the world body warned that conflict, complacency and the growing anti-vaccine movement threatened to undo decades of work to tame the disease.

“This is a wakeup call. We have a safe, effective and inexpensive vaccine against a highly contagious disease—a vaccine that saved almost a million lives every year over the last two decades,” said Henrietta Fore, executive director of UNICEF.

“These cases haven’t happened overnight. Just as the serious outbreaks we are seeing today took hold in 2018, lack of action today will have disastrous consequences for children tomorrow.”

Measles is more contagious than tuberculosis or Ebola, yet it is eminently preventable with a vaccine that costs pennies.

But the World Health Organization last year said cases worldwide had soared nearly 50 percent in 2018, killing around 136,000 people.

Ukraine, the Philippines, and Brazil saw the largest year-on-year increases. In Ukraine alone, there were 35,120 cases—nearly 30,000 more than in 2017.

Brazil saw 10,262 cases in 2018 after having none at all the year before, while the Philippines reported 15,599 cases last year compared to 2,407 in 2017.

Taken together, the ten nations accounting for 75 percent of the increase from 2017 to 2018 account for only a tenth of the global population.

The countries with the highest rate of measles last year were Ukraine (822 cases per million people), Serbia (618), Albania (481), Liberia (412), Georgia (398), Yemen 328), Montenegro (323) and Greece (227).

While most of the countries that experienced large spikes in cases are beset by unrest or conflict, France saw its caseload jump by 2,269.

In the United States, there was a 559 percent year-on-year increase in cases from 120 to 791.

Misinformation and mistrust

The resurgence of the disease in some countries has been linked to medically baseless claims linking the measles vaccine to autism, which have been spread in part on social media by members of the so-called “anti-vax” movement.

The WHO last month listed “vaccine hesitancy” among the top 10 most pressing global health threats for 2019.

“Almost all of these cases are preventable and yet children are getting infected even in places where there is simply no excuse,” Fore said.

“Measles may be the disease, but all too often the real infection is misinformation, mistrust and complacency.”

In war-torn Yemen, where health services in many regions have collapsed, UNICEF and the World Health Organization joined with local authorities last month in a campaign to vaccinate some 13 children aged six months to 15 for measles and rubella.

UN officials estimated that 92 percent of the targeted children were jabbed during the one-week push, which ended on February 14.

Yemen also figured on UNICEF’s “top 10” list of countries showing the largest increases last year in measles cases with a 316 percent hike, from 2,101 cases in 2017 to 8,742 cases in 2018.

Other countries with huge jumps last year compared to 2017 are Venezuela (4,916 more cases, up 676 percent), Serbia (4,355 more cases, up 620 percent), Madagascar (4,307 more cases, up 5,127 percent), Sudan (3,496 more cases, up 526 percent) and Thailand (2,758 more cases, up 136 percent).

A few countries saw declines in the number of confirmed cases of measles.

In Romania, reported cases dropped 89 percent from 8,673 to 943, and in Indonesia, the number declined by 65 percent from 11,389 to 3,995.

Nigeria, Pakistan, Italy, and China also saw drops of 35 to 55 percent.

So, the number of worldwide resurgence of cases of measles is huge and we as a community need to step up and push our healthcare community and the government to step up and demand that we protect our youth both here in the U.S.A. and yes, in the world. Also, we need to ignore the politics and the misinformation and mistrust and get the job done for our kids, and future generations!

 

 

 

 

As U.S. measles outbreaks spread, why does ‘anti-vax’ movement persist? And Look at What is Happening in the Philippines!

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I had to discuss this topic again due to the recent deaths of children who haven’t been vaccinated. It struck a nerve because back, when a friend of mine’s daughter was pregnant, before delivery of our their granddaughter, her future pediatrician, and ObGyn, told her and her husband that all people who came in contact with their future baby should be vaccinated for pertussis, diphtheria etc. Her in-laws said that they were against vaccinations. Their daughter was crushed and she called her father in tears. What to do and what to suggest to their family?

Simple, my suggestion was to tell his daughter to tell the family or have her husband tell his family that if they wanted to visit and see their future niece and granddaughter they needed to be vaccinated or just don’t visit and get a hotel room and then they could see the baby through the glass front door or through the windows. It is about the baby and not about them!

So, when I read the next two articles with the deaths due to measles I was enraged. Parents who are the anti-vaxers, it is about the children and not about their idiot beliefs formed by non-data and from a British physician who had his license taken away.

Dennis Thompson, a HealthDay reporter reported that Measles outbreaks across the United States—including one in Washington state where 50 cases have now been identified—have again shone the spotlight on parents who resist getting kids vaccinated.

These outbreaks are a clear sign of the fraying of “herd immunity,” the overall protection found when a large majority of a population has become immune to a disease, said Dr. Paul Offit. He is director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

“Measles is the most contagious of the vaccine-preventable diseases, so it’s always the first to come back when you see a drop in herd immunity,” Offit said.

The World Health Organization has taken notice, and recently declared the anti-vaxxer movement a major threat to public health.

Given this, why does anti-vaccine sentiment continue to thrive in certain locales throughout America?

Offit suspects it’s because people have forgotten just how bad diseases like measles, chickenpox and whooping cough can be.

“It’s happening because people aren’t scared of the diseases,” Offit said. “I think vaccines in some ways are victims of their own success.”

But other factors come into play, including a reluctance to give a slew of vaccines to a young child so early in life, now-debunked fears of a link to autism, a feeling that diseases are a natural part of childhood, and a deep-seated distrust of the medical community.

Measles outbreaks were “inevitable,” said Dr. Dawn Nolt, an associate professor of pediatric infectious disease at OHSU Doernbecher Children’s Hospital in Portland, Ore. She lives close to the Washington border, where the biggest current measles outbreaks rage.

“Pockets of communities where there are low vaccine rates are ripe to be ground zero for an outbreak,” Nolt said. “All you need is one person in that community. We knew this was going to happen.”

That’s particularly true of measles, which is incredibly virulent.

Offit explained “you don’t have to have face-to-face contact with someone who has measles. You just have to be within their air space within two hours of their being there.”

According to Nolt, despite its power to spread, there are three questions that typically come up with parents who are hesitant about having their children vaccinated against measles: Is the vaccine safe? Is the vaccine needed? Why shouldn’t I have freedom of choice regarding my child’s vaccinations?

“I think what’s important is to really understand that families have certain concerns and we need to understand those concerns,” Nolt said. “We can’t lump them all together and think that that one conversation serves all of their concerns.”

Parents’ concerns regarding vaccination are often first sparked by the recommended vaccine schedule, Offit said.

“What’s happened is we ask parents of young children in this country to get vaccines to prevent 14 different diseases,” Offit said. “That can mean as many as 26 inoculations during those first few years of life, as many as five shots at one time, to prevent diseases most people don’t see, using biological fluids most people don’t understand.”

So, it’s important that doctors explain to parents that these vaccines are “literally a drop in the ocean” compared to the myriad immune system triggers a child encounters each day, Offit said.

“Very quickly after birth, you have, living on the surface of your body, trillions of bacteria, to which you make an immune response,” Offit explained. “The food you eat isn’t sterile. The dust you inhale isn’t sterile. The water you drink isn’t sterile. You’re constantly being exposed to bacteria to which you make an immune response.”

Doctors also still have to deal with an erroneous 1998 study that linked vaccinations and autism, said Dr. Talia Swartz, an assistant professor of infectious diseases with the Icahn School of Medicine at Mount Sinai, in New York City.

The study was later found to be fraudulent and withdrawn, but “significant press has continued to raise concern about this, even though these concerns have been refuted based on large-scale population studies,” Swartz said.

It’s important to emphasize that these vaccines are heavily tested for safety, said Lori Freeman, CEO of the National Association of County and City Health Officials.

As to whether vaccines are needed, outbreaks provide a powerful argument in favor of that premise, experts said.

However, some parents still greet outbreaks with a shrug.

Nolt said that “some people think vaccines aren’t needed because the disease is more ‘natural’ than the vaccine.”

And arguments based on altruism—vaccinating your child to protect the rest of the community, especially kids who can’t be vaccinated—only go so far, she added.

“I think that resonates with people who have close family or friends who are immunocompromised. For someone who hasn’t had that experience, I think that’s a harder sell,” Nolt said.

Offit is also pessimistic that outbreaks alone will convince hesitant parents to have their kids vaccinated.

“I think children are going to have to die [for attitudes to change],” Offit said. “In regards to measles, you’re probably going to have to get 1,000 to 2,000 cases a year to start to see measles deaths again, but that can happen. Before there was a measles vaccine, which came into the United States in 1963, every year you’d see about 500 children die of measles.”

The “freedom of choice” argument can be the most difficult for doctors to counter, Nolt said. Accumulated distrust of organized medicine, federal regulators and pharmaceutical companies isn’t something a pediatrician can easily counter through conversation.

Now, look at the measles problem in the Philippines!

The Philippines says 136 people have died in a measles outbreak

The Philippine health secretary said Monday that 136 people, mostly children, have died of measles and 8,400 others have fallen ill in an outbreak blamed partly on vaccination fears.

A massive immunization drive that started last week in hard-hit Manila and four provincial regions may contain the outbreak by April, Health Secretary Francisco Duque III said. President Rodrigo Duterte warned in a TV message Friday of fatal complications and urged children to be immunized.

“No ifs, no buts, no conditions, you just have to bring your children and trust that the vaccines … will save your children,” Duque said by telephone. “That’s the absolute answer to this outbreak.”

Infections spiked by more than 1,000 percent in metropolitan Manila, the densely packed capital of more than 12 million people, in January compared to last year, health officials said.

About half of the 136 who died were children aged 1 to 4 and many of those who perished were not inoculated, the officials said.

Duque said a government information drive was helping restore public trust in the government’s immunization program, which was marred in 2017 by controversy over an anti-dengue vaccine made by French drugmaker Sanofi Pasteur which some officials linked to the deaths of at least three children.

The Philippine government halted the anti-dengue immunization drive after Sanofi said a study showed the vaccine may increase the risks of severe dengue infections. More than 830,000 children were injected with the Dengvaxia vaccine under the campaign, which was launched in 2016 under then-President Benigno Aquino III. The campaign continued under Duterte until it was stopped in 2017.

Sanofi officials told Philippine congressional hearings that the Dengvaxia vaccine was safe and effective and would reduce dengue infections if the vaccination drive continued.

“It seems the faith has come back,” Duque said of public trust on the government’s immunization drive, citing the inoculation of about 130,000 of 450,000 people targeted for anti-measles vaccinations in metropolitan Manila in just a week.

Measles is a highly contagious respiratory disease caused by a virus which can be spread through sneezing, coughing and close personal contact.

Complications include diarrhea, ear infections, pneumonia, and encephalitis, or the swelling of the brain, which may lead to death, according to the Department of Health.

A Parent-To-Parent Campaign To Get Vaccine Rates Up

Alex Olgin noted that in 2017, Kim Nelson had just moved her family back to her hometown in South Carolina. Boxes were still scattered around the apartment, and while her two young daughters played, Nelson scrolled through a newspaper article on her phone. It said religious exemptions for vaccines had jumped nearly 70 percent in recent years in the Greenville area — the part of the state she had just moved to.

She remembers yelling to her husband in the other room, “David, you have to get in here! I can’t believe this.”

Up until that point, Nelson hadn’t run into mom friends who didn’t vaccinate.

“It was really eye-opening that this was a big problem,” she says.

Nelson’s dad is a doctor; she had her immunizations, and so did her kids. But this news scared her. She knew that infants were vulnerable — they can’t get started on most vaccines until they are 2 months old. And some kids and adults have diseases that make them unable to get vaccines, so they rely on herd immunity.

Nelson was thinking about public health a lot back then and was even considering a career switch from banking to public health. She decided she had to do something.

“I very much believe if you have the ability to advocate, then you have to,” she says. “The onus is on us if we want to change.”

Like a lot of moms, Nelson had spent hours online. She knew how easy it is to fall down internet rabbit holes and into a world of fake studies and scary stories.

“As somebody who just cannot stand wrong things being on the internet,” Nelson says, “if I saw something with vaccines, I was very quick to chime in ‘That’s not true’ or ‘No, that’s not how that works.’ … I usually get banned.”

Nelson started her own group, South Carolina Parents for Vaccines. She began posting scientific articles online. She started responding to private messages from concerned parents with specific questions. She also found that positive reinforcement was important and would roam around the mom groups, sprinkling affirmations.

“If someone posts, ‘My child got their two-months shots today,’ ” Nelson says, she’d quickly post a follow-up comment: “Great job, mom!”

Peer-focused groups around the country doing similar work inspired Nelson. Groups with national reach like Voices for Vaccines and regional groups like Vax Northwest in Washington state take a similar approach, encouraging parents to get educated and share facts about vaccines with other parents.

Nationally, 91 percent of children ages 19 to 35 months old have their vaccination for measles, and rates for other vaccinations range from 82 to 92 percent. But in some communities, the rate is much lower. In Clark County, Wash., where a measles outbreak is up to 63 cases, about 76 percent of kindergartners come to school without all their vaccines.

Public health specialists are raising concerns about the need to improve vaccination rates. But efforts to reach vaccine-hesitant parents often fail. When presented with As reported by facts about vaccine safety, parents often remained entrenched in a decision not to vaccinate.

Pediatricians could play a role — and many do — but they’re not compensated to have lengthy discussions with parents, and some of them find it a frustrating task. That has left an opening for alternative approaches, like Nelson’s.

Nelson thought it would be best to zero in on moms who were still on the fence about vaccines.

“It’s easier to pull a hesitant parent over than it is somebody who is firmly anti-vax,” Nelson says. She explains that parents who oppose vaccination often feel so strongly about it that they won’t engage in a discussion. “They feel validated by that choice — it’s part of a community, it’s part of their identity.”

The most important thing is timing: People may need information about vaccines before they become parents. A first pregnancy — when men and women start transitioning into their parental roles — is often when the issue first crops up. Nelson points to one survey study from the Centers for Disease Control and Prevention that showed 90 percent of expectant women had made up their minds on vaccines by the time they were six months pregnant.

“They’re not going to a pediatrician [yet],” Nelson says. “Their OB-GYN is probably not speaking to the pediatric vaccine schedule. … So where are they going? They are going online.”

Nelson tries to counter bad information online with facts. But she also understands the value of in-person dialogue. She organized a class at a public library and advertised the event on mom forums. Nelson was nervous that people opposed to vaccines, whom she calls “anti-vaxxers,” might show up and cause a scene. Vaccine opponents had already banned her from some online forums.

“Are they here to rip me a new one? Or are they here to learn about vaccines?” Nelson wondered. “I just decided, if they’re here I’m going to give them good information.”

Amy Morris was pregnant, but she drove an hour and a half to attend the class. Morris wasn’t the typical first-time mom Nelson was trying to reach. She already had three kids. But during this pregnancy, she was getting increasingly nervous about vaccines. She had recently had a miscarriage, and it was right around the time she had gotten a flu shot. Morris had been reading pro- and anti-vaccine posts in the mom forums and was starting to have some doubts. In Nelson’s class, she learned the risks of not vaccinating.

“That spoke to me more than anything,” said Morris.

Now, holding her healthy 8-month-old son, Thorin, on her lap, she says she’s glad she went because she was feeling vulnerable.

“I always knew it was the right thing to do,” Morris said. “I was listening to that fear monster in the back of my head.”

Nelson says that fear is what the anti-vaccine community feeds on. She has learned to ask questions to help parents get at the root of their anxiety.

“I do think they appreciate it when you meet them sympathetically and you don’t just try and blast facts down their throat,” Nelson said.

Nelson is now trying to get local hospitals to integrate that vaccine talk into their birthing classes. She’s studying for a master’s degree in public health at the University of South Carolina and also works with the Bradshaw Institute for Community Child Health & Advocacy. She’s even considering a run for public office.

House lawmakers to investigate measles outbreak

As reported by our old friend Susannah Luthi, now Congress is wading into the debate over the controversial “philosophical exemption” to immunization, with a key House committee investigation into the recent measles outbreaks that have hit at least 67 people across four states.

The House Energy and Commerce Committee’s oversight panel will hold a bipartisan hearing on the outbreak and response efforts next Wednesday, Feb. 27.

Committee Chair Frank Pallone (D-N.J.) and ranking member Greg Walden (R-Ore.) joined oversight panel Chair Diana DeGette (D-Colo.) and ranking member Brett Guthrie (R-Ky.) in a statement that warned the influx of vaccine-preventable diseases is a serious public health threat.

“Measles is a highly contagious, life-threatening virus that was previously eliminated in the United States thanks to the success of the measles vaccine,” the lawmakers wrote. “Unfortunately, measles cases are on the rise as a consequence of the virus’s transmission among unvaccinated groups.”

The conversation around vaccinations has been escalating inside the Beltway in recent weeks after an initial batch of more than 40 cases of measles was reported in Oregon and Washington state.

In late January, Washington Democratic Gov. Jay Inslee declared a state of emergency due to the outbreak.

Vaccines had eliminated the virus in the U.S. by 2000, but it can return with overseas travelers and spread among the unvaccinated.

Food and Drug Administration Commissioner Dr. Scott Gottlieb has been vocal on Twitter about the public health threat, urging immunizations and suggested to Axios last week that the federal government may have to step in.

In a Tuesday interview on CNN, he elaborated further, warning that if “certain states continue down the path that they’re on, I think they’re going to force the hand of the federal health agencies.”

I believe that the only reason for not vaccinating children should be allergies to a component of the vaccine. We can’t lose any more children to ignorant parents and or incorrect data regarding complications of the vaccines.

So, even if we gave the Democrats everything that they want, where everything including education, money for not working, and of course free health care for all would that solve this problem? I think not!!