Katelyn, THANK YOU. This may be one of the most important things you can do - provide clear simple factual information, particularly with kindness and compassion. The kernel of truth in his claims is the dangerous part because it can be presented out of context. I'm enormously grateful for your thorough response!
RFK Jr. was a huge part of those 89 measles deaths in Samoa. He's part of the Disinformation Dozen. He's 1 of 12 people responsible for more than 60% of health and vaccine disinformation on the internet and social media. He is a known danger to public health and safety and his willingness to peddle lies is the reson he was nominated in the first place. Being the absolute worst person for the job is now the most important job requirement for anyone in this current administration.
Just brilliant, so sensitive to the complexity of people’s understandings. I am aware of many people of good faith who gravitate toward RFK Jr.’s approaches for just the reasons you state. It is important, more than ever in these times, not to demonize people, but to do our best to engage thoughtfully. Team YLE shows us how. I have restacked and encourage all here to circulate this essay as widely as you can.
As always, thank you for providing so much helpful info. I recommend your Substack all the time. There's a lot of confusing info going around now about whether or not boosters are needed based on what year one was born, whether they had measles, when they were vaccinated, etc. I wonder if you could shed some light on that.
The recommendation is that people born between 1957-1989 get a MMR booster as the vast majority of us only got one dose, not two. People born before 1957 are typically immune due to exposure. Having your titers tested may be required for insurance to cover it but it's not a guarantee of immunity even if you have titers for measles. If possible, get a booster.
Born in 64 here. Had my titers done last week. Measles good, rubella good, no mumps. Will be getting an MMR vaccine. Also checked Hepatitis B antibodies which was given when I was about 34. None. It’s a recommendation by my doctor, but since I’ve nursed both parents through their deaths and don’t work in a medical field, I’ll probably pass on the Hep series. Not trusting the long term availability of vaccinations with Kennedy. He’s an idiot.
Provided you had the recommended 3 doses of Hep B (documented, 4 doses with Twinrix) having titres was a waste of $$, paradoxical 'immune amnesia' or "sub therapeutic titre" is not unexpected.
If you were exposed to Help B your B-cells memory will immediately rally to your defences.
The only test for a true non-response to Help B series is 4-6 wk's post series tittes taken, if not adequate repeat & reassess.
Rarely, an individual can be shown to be a "non-response" and cautioned as such.
Same recommendation for 2-dose series for Hep A...if an individual one had one dose Hep A giving the 2nd post 10+ yr's is effective. Was point, albeit TMI, there is no need in most cases to restart a vaccination series, initial dose (e.g. Hep A) or doses are the primary for immunity. JJF Phm 🇨🇦
Your challenge is not how to speak to vaccine denial but how to weather the next 46 months. For many of these people living in the most rural of places their decisions are based on years of oral history, cow patch myths, etc. Science is just another way to confuse us. Better diet? Mac and Cheese with Tabasco Sauce on top. Exercise? Jumping out of your seat at the Friday Night high school football game.
Why am I so cynical? I've lived in rural areas. Not West Texas; Central California. Same story in either place. And I've lived in New Mexico.
Your job for the next 46 months is damage control.
It's not so much that the outbreak is located in a rural area, it's in a religious (Mennonite) community that tends to be self-sufficient and disinclined to seek assistance from government and public health agencies.
Good info. Good point. However as this spreads outside their closed world, the outsiders generally hold similar anti–science beliefs. We're in for a long 46 months.
Rural areas have a mixture of people, just like urban areas. There are many perceptive, smart people in rural areas, and they can be engaged, if the engagement is respectful to them.
Here is a risk from Measles I just learned from my daughter, a teacher in an L.A. public school. An older child there is dying from the measles he caught as an infant. Measles encephalitis can lie in wait.
I am a general pediatrician and I have a related question. Can you please comment (here or in another posting) about the risks and benefits of vaccinating early (before 12 months old), even with two more doses given after 12 months, as is the current recommendation? I found a study from November 2024 (link below) showing that giving MMR before 8.5 months increases the likelihood of inadequate seroconversion later in life. This presents a significant concern because, although these children initially developed protective antibody levels, the diminished responses to MMR revaccinations pose an increased risk for potential future outbreaks (for them and even passive immunity to their children). Because of this, I have hesitated to vaccinate the 6-11 month olds unless they are definitely in an area with an outbreak, are traveling to one, or traveling internationally. But with the concerns about reduced monitoring, testing, and reporting (and intentional toppling of our already shaky public health infrastructure as a whole), should we be considering that there may be or may soon be a local outbreak we don't yet know about, so should vaccinate early anyway? Thank you so much for all you do!
Long-term Dynamics of Measles Virus–Specific Neutralizing Antibodies in Children Vaccinated Before 12 Months of Age. Clinical Infectious Diseases, ciae537, https://doi.org/10.1093/cid/ciae537. Published: 04 November 2024
I have tried one several Substack postings to engage discussion, as to waning maternal antibodies for measles...gone 3-4 mo's! Can't vaccine the pregnant mom or soon to be. Giving the newborn MMR before the recommended age does not count, yes presents the challenge of lasting immunity when given the 2 countable doses.
I asked the question not rhetorically but what should public health individuals & clinicians be advising? Certainly, acceptable herd immunity of 95% offers protection. However, what advise should be given...hide your children less than 12 mo's🤔 Those kids vaccinated sub 12 mo's may require booster doses into the adult yr's?
Thank you for such clear explanations, as always. And thank you for acknowledging why people gravitate to solutions outside the western medical system. I think the "Moms for RFK" phenom has been fueled by that medical system, which for years denied women's realities and forced them to suffer needlessly, and then turn to "doing their own research" when the internet made more information available to the public. Many have been successful in finding answers and relief outside of western medicine, and those denials and misdiagnoses bred a deep distrust for the whole system. I really feel that acknowledging this is a key step to bridging the gap and having necessary conversations.
That is an intriguing hypothesis, that the historic focus on male health and male subjects might have soured mothers who are responsible for family health against evidence based medicine. (For us there was too often for generations more guesswork and less evidence-based, compared to males.)
Yes, that’s a big part of it. But honestly, most people didn’t necessarily realize that research was only done on men until more recently that came into public discourse. It’s the lack of answers for many but also the gaslighting of women rather than admit to not having information about their health issues.
Appreciate the info! As far as applications, I've read that the communities most at risk in Texas are largely faith communities, which means their ministers could dramatically influence their behaviors. It strikes me that, if church and state weren't so segregated in the US, we could make a big difference in this conversation by donating Federal funds to their ministry. That might be cost-effective as well as a mercy for the parishioners. Then it occurred to me that somebody like Bill Gates has the resources to stand in for the Feds in this matter, but I wouldn't expect Elon Musk to step up. So, anybody close to a benevolent foundation? Or shall we just let Texans serve as a cautionary tale to the rest of the country?
We need to end all exceptions besides medical exceptions to vaccination. Vaccine mandates have been constitutional for 120 years. And no, we absolutely do not need to get rid of separation of church and state. It's unconstitutional for the two to be involved. We need to enforce the Constitution and not allow the current involvement of the GOP with religion, especially Christianity. No one's religious beliefs are allowed to inform our laws or government. Freedom of religion is also freedom FROM religion. Separation of Church and State is a foundational principle of our
Constitution and government.
"History, I believe, furnishes no example of a priest- ridden people maintaining a free civil government. This marks the lowest grade of ignorance of which their civil as well as religious leaders will always avail themselves for their own purposes." --Thomas Jefferson to Alexander von Humboldt, 1813
I’m not for federal funds to the ministry, but I’m all for a Melinda Gates or MacKenzie Scott like program to target these areas. Both are huge philanthropists in their own right.
Faith leaders are influencing their congregations already. Unfortunately, you're incorrect in assuming that they are *pro*-vaccination.
The outbreak started in a Mennonite community, a community that generally does not vaccinate or have much contact with the modern medical system overall. And this article was referenced in last week's newsletter:
Er... I was actually assuming the opposite of what you assumed I was assuming. That's why I was thinking that the prospect of relief from chronic budgetary strictures would tempt some of these clergy to re-align with the scientific view re vaccination.
The vast majority of vaccine exceptions are religious exemptions. According to a lot of Christians the Bible forbids the from using baccinece because they are made with animal products (horseshoe crab blood is used a a stabilizer and preservative in basically every medication ever made). The Bible says the blood of man and animals shall not mix. Which is why no exemptions should be allowed except for medical exemptions. Because vaccine mandates have been constitutional for 120 years. Vulnerable communities can no longer safely participate in public life because of anti-vaxxers, most of whom are religious.
Vaccine mandates have been upheld as Constitutional since 1905
The Supreme Court explicitly upheld vaccine mandates against deadly diseases in Jacobson v Massachusetts where it explained: "the rights of the individual in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand.' We live in a country of ordered liberty, not individual autonomy that paves the way to the deaths of others. In short, it is not the right of every American citizen to catch and transmit a potentially fatal infection.' Public health and safety supercedes individual rights every time.
I have always found Ken Rothman's formulation of causality useful -- as laid out in his text Modern Epidemiology. The idea is that for any given disease outcome, there are a series of component causes. Some of these causes are sufficient by themselves; some are necessary but not sufficient; several different combinations of component causes can amount to a sufficient cause.
When you look at Reye's syndrome in children, for example, it may follow chickenpox or influenza. But most children with influenza don't get Reye's syndrome. They have to also have been given aspirin for their influenza. And, most people who get influenza and take aspirin still don't get Reye's syndrome -- there must be at least one other factor (unknown to me right now) that must be present to constitute a sufficient cause. Aspirin alone, without influenza, also does not lead to Reye's Syndrome. So, you can prevent Reye's syndrome by not giving children aspirin when they have influenza -- or, to be safe, when they have fever and cough. That's why young children today are basically never given aspirin. You could of course also prevent Reye's Syndrome by eliminating influenza in children, but (unfortunately) we don't know how to do that yet.
So, in children without measles vaccination who get measles, vitamin A can apparently reduce severity of disease somewhat -- but only if they were previously vitamin A-deficient. Children can still get severe measles disease even if they are not deficient in vitamin A, unfortunately. I have seen no evidence that taking vitamin A, whether you are deficient in it or not, can prevent measles infection in the first place.
Having said all this, we should acknowledge that the measles case-fatality rate (the proportion of infected people who die) was going down in the US even before measles vaccine was introduced -- decline in mortality without a decline in the number of measles cases. It is possible that vitamin A deficiency was formerly common in American children and became less common over time. Or some other factor that led to increased risk of death from measles, among those who were infected, was becoming less common. Or treatment of bacterial complications of measles with antibiotics starting in the 1940s was leading to reduced mortality. (There is probably more known about this than is accessible in my feeble brain right now.)
In veterinary med Vitamin A can help when a ferret shelter gets hit with canine distemper (a related disease) which is also best prevented with sufficient, spaced vaccinations (more than one for kits or unvaccinated adults)
BUT
Ferrets and a number of other members of Carnivora have millions of years of ancestors who ate most of hunted animals including their livers, so they are adapted for a diet that is much higher in Vitamin A than is safe for humans, and a number of the diets fed to them may not be sufficient for ferrets in that regard. Also, it does NOT replace vaccination for them, either, and that is the major line of defense in a shelter with canine distemper. It does help with ferret survival, though. (I do not know if the same applies to dog shelters.)
(On the other hand, compared to humans, it is easier to dangerously over-dose Vitamin D in members of carnivora whose ancestors not only were fur covered but had mostly crepuscular activity (times of low light). For them, giving too much D can be a kidney destroying mistake.
If memory serves, New World monkeys need more D than Old World recent ancestry primates. Anyway, just don’t generalize broadly across species w nutrients.)
I can not recall which historic explorer it was, nor Arctic or Antarctic, but the leader of an expedition was in even worse health than the rest by the time they were forced to eat their dogs. Figuring that livers were extra healthy the leader was fed those. The livers of many members of Carnivora are especially high in Vitamin A. Some can be fatal for humans. It did not turn out well for him.
As vital as a compassionate approach is, I think it’s important to acknowledge the other kinds of harm this belief system can cause, and find ways to combat the underlying beliefs as well (though perhaps not while dealing with an active outbreak).
If you’re in control of your own health, then being ill is at least partially your own fault. That’s an incredibly harmful way of thinking and leads to a lot of stigma around chronic illnesses and illness in general.
And it’s incredibly pervasive across many walks of life. As a child, I had teachers who thought my ADHD was an excuse or meant I was stupid. As an adult, I deal with having to explain that no, we don’t know what causes CFS, but yes, we are certain that it’s not just a lack of exercise. And I’m incredibly lucky; I live in a college town where a lot of people have a much higher than average understanding of biology and medicine.
But it’s much easier to think that the kid you didn’t like in school was just a bad kid than that their brain worked differently and they needed someone to teach them things that came naturally to others. And it’s much easier to think that someone who works in tech doesn’t get enough exercise than accept that an incredibly common virus that is often mistaken for a childhood cold could cause lifelong damage.
Or that someone with depression or anxiety just isn’t trying hard enough. Or someone who needs mobility aids but can walk short distances without them is faking it. Or that cancer patients all did something that caused their cancer.
The world is an easier place when you have control, but also when you don’t have to put in extra effort because it’s their own fault anyway.
If you’re in control of your own health, then being ill is at least partially your own fault. That’s an incredibly harmful way of thinking and leads to a lot of stigma around chronic illnesses and illness in general.
And it’s incredibly pervasive across many walks of life. As a child I had teachers who thought ADHD was an excuse or meant I was stupid. As an adult I deal with having to explain that no, we don’t know what causes CFS but yes, we are certain that it’s not just a lack of exercise. And I’m incredibly lucky, I live in a college town where a lot of people have a much higher than average understanding of biology and medicine.
But it’s much easier to think that the kid you didn’t like in school was just a bad kid than that their brain worked differently and they needed someone to teach them things that came naturally to others. And it’s much easier to think that someone who works in tech doesn’t get enough exercise than accept that an incredibly common virus that is often mistaken for a childhood cold could cause lifelong harm.
Of that someone isn’t trying hard enough or is lazy. Or someone must have done something to cause their cancer. Or that someone with allergies is just lying because they don’t want to eat something.
The world is an easier place when you have control, but also when you don’t have to put in extra effort because it’s their own fault anyway. We need to find ways to use this same compassion outside of emergencies, to head off these kinds of emergencies but also to reduce the barriers for people who already have enough problems to deal with.
Thank you for explaining the underlying ideas that bolster vaccination hesitancy. They are relevant for everyone, but especially so for regions like west TX and NM where self-reliance is not a choice but a necessity. A public health campaign that says “you can choose to take control of your health by getting vaccinated” might be an effective way to reach hesitant people. Unfortunately, that will not solve the problem for people in severe healthcare shortage areas. Sometimes it is difficult to get a vaccine even if you want one.
I lived in NM and west TX for decades. If you rely on Medicaid, as an enormous share of the population do, it is very, very difficult to find a doctor except via an emergency room. In entire regions, there are NO DOCTORS who will see Medicaid patients. They simply refuse. (Mandating that providers see Medicaid patients is known to backfire and cause a loss of practitioners because the problem is reimbursement related.)
Emergency departments do not administer vaccines (except for tetanus.) General practitioners do not typically have it. Finding a vaccination as an adult during an outbreak can be very difficult. MMR expires so pediatricians order it in limited quantities so it will be used promptly. That is why the CDC sent 2000 doses.
It would be interesting to know if the measles outbreak extends across the border, or whether Mexico experiences any outbreaks at all. Vaccination rates are unusually high in some very poor Texas-Mexico border counties and I would love to know why.
Thank you again for this great article! I love the 3 points about why people gravitate to this kind of rhetoric. So powerful.
Also- you think if RFK was so into vit A then he’d be supportive of GE golden rice which adds vitamin A to rice to help supplement those who are deficient. You think he’d support agricultural GE science that may help make food production more plentiful (reducing crop loss) or create foods with more nutrients (like golden rice or other options still in research)! But yet again, even though he champions this vitamin for measles he’s against this biotechnology advancement in agriculture and food. It’s consistent with his science denialism on the whole.
Katelyn, THANK YOU. This may be one of the most important things you can do - provide clear simple factual information, particularly with kindness and compassion. The kernel of truth in his claims is the dangerous part because it can be presented out of context. I'm enormously grateful for your thorough response!
Love, Daniel
Ditto! This post should be used in training courses for public health officials.
RFK Jr. was a huge part of those 89 measles deaths in Samoa. He's part of the Disinformation Dozen. He's 1 of 12 people responsible for more than 60% of health and vaccine disinformation on the internet and social media. He is a known danger to public health and safety and his willingness to peddle lies is the reson he was nominated in the first place. Being the absolute worst person for the job is now the most important job requirement for anyone in this current administration.
Just brilliant, so sensitive to the complexity of people’s understandings. I am aware of many people of good faith who gravitate toward RFK Jr.’s approaches for just the reasons you state. It is important, more than ever in these times, not to demonize people, but to do our best to engage thoughtfully. Team YLE shows us how. I have restacked and encourage all here to circulate this essay as widely as you can.
As always, thank you for providing so much helpful info. I recommend your Substack all the time. There's a lot of confusing info going around now about whether or not boosters are needed based on what year one was born, whether they had measles, when they were vaccinated, etc. I wonder if you could shed some light on that.
The recommendation is that people born between 1957-1989 get a MMR booster as the vast majority of us only got one dose, not two. People born before 1957 are typically immune due to exposure. Having your titers tested may be required for insurance to cover it but it's not a guarantee of immunity even if you have titers for measles. If possible, get a booster.
Born in 64 here. Had my titers done last week. Measles good, rubella good, no mumps. Will be getting an MMR vaccine. Also checked Hepatitis B antibodies which was given when I was about 34. None. It’s a recommendation by my doctor, but since I’ve nursed both parents through their deaths and don’t work in a medical field, I’ll probably pass on the Hep series. Not trusting the long term availability of vaccinations with Kennedy. He’s an idiot.
Provided you had the recommended 3 doses of Hep B (documented, 4 doses with Twinrix) having titres was a waste of $$, paradoxical 'immune amnesia' or "sub therapeutic titre" is not unexpected.
If you were exposed to Help B your B-cells memory will immediately rally to your defences.
The only test for a true non-response to Help B series is 4-6 wk's post series tittes taken, if not adequate repeat & reassess.
Rarely, an individual can be shown to be a "non-response" and cautioned as such.
Same recommendation for 2-dose series for Hep A...if an individual one had one dose Hep A giving the 2nd post 10+ yr's is effective. Was point, albeit TMI, there is no need in most cases to restart a vaccination series, initial dose (e.g. Hep A) or doses are the primary for immunity. JJF Phm 🇨🇦
Your challenge is not how to speak to vaccine denial but how to weather the next 46 months. For many of these people living in the most rural of places their decisions are based on years of oral history, cow patch myths, etc. Science is just another way to confuse us. Better diet? Mac and Cheese with Tabasco Sauce on top. Exercise? Jumping out of your seat at the Friday Night high school football game.
Why am I so cynical? I've lived in rural areas. Not West Texas; Central California. Same story in either place. And I've lived in New Mexico.
Your job for the next 46 months is damage control.
It's not so much that the outbreak is located in a rural area, it's in a religious (Mennonite) community that tends to be self-sufficient and disinclined to seek assistance from government and public health agencies.
Good info. Good point. However as this spreads outside their closed world, the outsiders generally hold similar anti–science beliefs. We're in for a long 46 months.
Rural areas have a mixture of people, just like urban areas. There are many perceptive, smart people in rural areas, and they can be engaged, if the engagement is respectful to them.
Here is a risk from Measles I just learned from my daughter, a teacher in an L.A. public school. An older child there is dying from the measles he caught as an infant. Measles encephalitis can lie in wait.
SSPE is a tragedy, 100% fatal & yes presents yr's follow a natural infection 😢
I am a general pediatrician and I have a related question. Can you please comment (here or in another posting) about the risks and benefits of vaccinating early (before 12 months old), even with two more doses given after 12 months, as is the current recommendation? I found a study from November 2024 (link below) showing that giving MMR before 8.5 months increases the likelihood of inadequate seroconversion later in life. This presents a significant concern because, although these children initially developed protective antibody levels, the diminished responses to MMR revaccinations pose an increased risk for potential future outbreaks (for them and even passive immunity to their children). Because of this, I have hesitated to vaccinate the 6-11 month olds unless they are definitely in an area with an outbreak, are traveling to one, or traveling internationally. But with the concerns about reduced monitoring, testing, and reporting (and intentional toppling of our already shaky public health infrastructure as a whole), should we be considering that there may be or may soon be a local outbreak we don't yet know about, so should vaccinate early anyway? Thank you so much for all you do!
Long-term Dynamics of Measles Virus–Specific Neutralizing Antibodies in Children Vaccinated Before 12 Months of Age. Clinical Infectious Diseases, ciae537, https://doi.org/10.1093/cid/ciae537. Published: 04 November 2024
I have tried one several Substack postings to engage discussion, as to waning maternal antibodies for measles...gone 3-4 mo's! Can't vaccine the pregnant mom or soon to be. Giving the newborn MMR before the recommended age does not count, yes presents the challenge of lasting immunity when given the 2 countable doses.
I asked the question not rhetorically but what should public health individuals & clinicians be advising? Certainly, acceptable herd immunity of 95% offers protection. However, what advise should be given...hide your children less than 12 mo's🤔 Those kids vaccinated sub 12 mo's may require booster doses into the adult yr's?
Thank you for such clear explanations, as always. And thank you for acknowledging why people gravitate to solutions outside the western medical system. I think the "Moms for RFK" phenom has been fueled by that medical system, which for years denied women's realities and forced them to suffer needlessly, and then turn to "doing their own research" when the internet made more information available to the public. Many have been successful in finding answers and relief outside of western medicine, and those denials and misdiagnoses bred a deep distrust for the whole system. I really feel that acknowledging this is a key step to bridging the gap and having necessary conversations.
That is an intriguing hypothesis, that the historic focus on male health and male subjects might have soured mothers who are responsible for family health against evidence based medicine. (For us there was too often for generations more guesswork and less evidence-based, compared to males.)
Yes, that’s a big part of it. But honestly, most people didn’t necessarily realize that research was only done on men until more recently that came into public discourse. It’s the lack of answers for many but also the gaslighting of women rather than admit to not having information about their health issues.
Appreciate the info! As far as applications, I've read that the communities most at risk in Texas are largely faith communities, which means their ministers could dramatically influence their behaviors. It strikes me that, if church and state weren't so segregated in the US, we could make a big difference in this conversation by donating Federal funds to their ministry. That might be cost-effective as well as a mercy for the parishioners. Then it occurred to me that somebody like Bill Gates has the resources to stand in for the Feds in this matter, but I wouldn't expect Elon Musk to step up. So, anybody close to a benevolent foundation? Or shall we just let Texans serve as a cautionary tale to the rest of the country?
We need to end all exceptions besides medical exceptions to vaccination. Vaccine mandates have been constitutional for 120 years. And no, we absolutely do not need to get rid of separation of church and state. It's unconstitutional for the two to be involved. We need to enforce the Constitution and not allow the current involvement of the GOP with religion, especially Christianity. No one's religious beliefs are allowed to inform our laws or government. Freedom of religion is also freedom FROM religion. Separation of Church and State is a foundational principle of our
Constitution and government.
"History, I believe, furnishes no example of a priest- ridden people maintaining a free civil government. This marks the lowest grade of ignorance of which their civil as well as religious leaders will always avail themselves for their own purposes." --Thomas Jefferson to Alexander von Humboldt, 1813
I didn't mean to suggest the contrary!
I’m not for federal funds to the ministry, but I’m all for a Melinda Gates or MacKenzie Scott like program to target these areas. Both are huge philanthropists in their own right.
Faith leaders are influencing their congregations already. Unfortunately, you're incorrect in assuming that they are *pro*-vaccination.
The outbreak started in a Mennonite community, a community that generally does not vaccinate or have much contact with the modern medical system overall. And this article was referenced in last week's newsletter:
https://www.wfaa.com/article/news/local/tarrant-county/texas-school-vaccination-rates-measles-outbreak-mercy-culture-church-prep-school-landon-schott/287-26756b75-973d-422c-a01a-4b480d3cdf02
Er... I was actually assuming the opposite of what you assumed I was assuming. That's why I was thinking that the prospect of relief from chronic budgetary strictures would tempt some of these clergy to re-align with the scientific view re vaccination.
The vast majority of vaccine exceptions are religious exemptions. According to a lot of Christians the Bible forbids the from using baccinece because they are made with animal products (horseshoe crab blood is used a a stabilizer and preservative in basically every medication ever made). The Bible says the blood of man and animals shall not mix. Which is why no exemptions should be allowed except for medical exemptions. Because vaccine mandates have been constitutional for 120 years. Vulnerable communities can no longer safely participate in public life because of anti-vaxxers, most of whom are religious.
Vaccine mandates have been upheld as Constitutional since 1905
The Supreme Court explicitly upheld vaccine mandates against deadly diseases in Jacobson v Massachusetts where it explained: "the rights of the individual in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand.' We live in a country of ordered liberty, not individual autonomy that paves the way to the deaths of others. In short, it is not the right of every American citizen to catch and transmit a potentially fatal infection.' Public health and safety supercedes individual rights every time.
I have always found Ken Rothman's formulation of causality useful -- as laid out in his text Modern Epidemiology. The idea is that for any given disease outcome, there are a series of component causes. Some of these causes are sufficient by themselves; some are necessary but not sufficient; several different combinations of component causes can amount to a sufficient cause.
When you look at Reye's syndrome in children, for example, it may follow chickenpox or influenza. But most children with influenza don't get Reye's syndrome. They have to also have been given aspirin for their influenza. And, most people who get influenza and take aspirin still don't get Reye's syndrome -- there must be at least one other factor (unknown to me right now) that must be present to constitute a sufficient cause. Aspirin alone, without influenza, also does not lead to Reye's Syndrome. So, you can prevent Reye's syndrome by not giving children aspirin when they have influenza -- or, to be safe, when they have fever and cough. That's why young children today are basically never given aspirin. You could of course also prevent Reye's Syndrome by eliminating influenza in children, but (unfortunately) we don't know how to do that yet.
So, in children without measles vaccination who get measles, vitamin A can apparently reduce severity of disease somewhat -- but only if they were previously vitamin A-deficient. Children can still get severe measles disease even if they are not deficient in vitamin A, unfortunately. I have seen no evidence that taking vitamin A, whether you are deficient in it or not, can prevent measles infection in the first place.
Having said all this, we should acknowledge that the measles case-fatality rate (the proportion of infected people who die) was going down in the US even before measles vaccine was introduced -- decline in mortality without a decline in the number of measles cases. It is possible that vitamin A deficiency was formerly common in American children and became less common over time. Or some other factor that led to increased risk of death from measles, among those who were infected, was becoming less common. Or treatment of bacterial complications of measles with antibiotics starting in the 1940s was leading to reduced mortality. (There is probably more known about this than is accessible in my feeble brain right now.)
In veterinary med Vitamin A can help when a ferret shelter gets hit with canine distemper (a related disease) which is also best prevented with sufficient, spaced vaccinations (more than one for kits or unvaccinated adults)
BUT
Ferrets and a number of other members of Carnivora have millions of years of ancestors who ate most of hunted animals including their livers, so they are adapted for a diet that is much higher in Vitamin A than is safe for humans, and a number of the diets fed to them may not be sufficient for ferrets in that regard. Also, it does NOT replace vaccination for them, either, and that is the major line of defense in a shelter with canine distemper. It does help with ferret survival, though. (I do not know if the same applies to dog shelters.)
(On the other hand, compared to humans, it is easier to dangerously over-dose Vitamin D in members of carnivora whose ancestors not only were fur covered but had mostly crepuscular activity (times of low light). For them, giving too much D can be a kidney destroying mistake.
If memory serves, New World monkeys need more D than Old World recent ancestry primates. Anyway, just don’t generalize broadly across species w nutrients.)
I can not recall which historic explorer it was, nor Arctic or Antarctic, but the leader of an expedition was in even worse health than the rest by the time they were forced to eat their dogs. Figuring that livers were extra healthy the leader was fed those. The livers of many members of Carnivora are especially high in Vitamin A. Some can be fatal for humans. It did not turn out well for him.
As vital as a compassionate approach is, I think it’s important to acknowledge the other kinds of harm this belief system can cause, and find ways to combat the underlying beliefs as well (though perhaps not while dealing with an active outbreak).
If you’re in control of your own health, then being ill is at least partially your own fault. That’s an incredibly harmful way of thinking and leads to a lot of stigma around chronic illnesses and illness in general.
And it’s incredibly pervasive across many walks of life. As a child, I had teachers who thought my ADHD was an excuse or meant I was stupid. As an adult, I deal with having to explain that no, we don’t know what causes CFS, but yes, we are certain that it’s not just a lack of exercise. And I’m incredibly lucky; I live in a college town where a lot of people have a much higher than average understanding of biology and medicine.
But it’s much easier to think that the kid you didn’t like in school was just a bad kid than that their brain worked differently and they needed someone to teach them things that came naturally to others. And it’s much easier to think that someone who works in tech doesn’t get enough exercise than accept that an incredibly common virus that is often mistaken for a childhood cold could cause lifelong damage.
Or that someone with depression or anxiety just isn’t trying hard enough. Or someone who needs mobility aids but can walk short distances without them is faking it. Or that cancer patients all did something that caused their cancer.
The world is an easier place when you have control, but also when you don’t have to put in extra effort because it’s their own fault anyway.
If you’re in control of your own health, then being ill is at least partially your own fault. That’s an incredibly harmful way of thinking and leads to a lot of stigma around chronic illnesses and illness in general.
And it’s incredibly pervasive across many walks of life. As a child I had teachers who thought ADHD was an excuse or meant I was stupid. As an adult I deal with having to explain that no, we don’t know what causes CFS but yes, we are certain that it’s not just a lack of exercise. And I’m incredibly lucky, I live in a college town where a lot of people have a much higher than average understanding of biology and medicine.
But it’s much easier to think that the kid you didn’t like in school was just a bad kid than that their brain worked differently and they needed someone to teach them things that came naturally to others. And it’s much easier to think that someone who works in tech doesn’t get enough exercise than accept that an incredibly common virus that is often mistaken for a childhood cold could cause lifelong harm.
Of that someone isn’t trying hard enough or is lazy. Or someone must have done something to cause their cancer. Or that someone with allergies is just lying because they don’t want to eat something.
The world is an easier place when you have control, but also when you don’t have to put in extra effort because it’s their own fault anyway. We need to find ways to use this same compassion outside of emergencies, to head off these kinds of emergencies but also to reduce the barriers for people who already have enough problems to deal with.
Well spoken 👍
Thank you for explaining the underlying ideas that bolster vaccination hesitancy. They are relevant for everyone, but especially so for regions like west TX and NM where self-reliance is not a choice but a necessity. A public health campaign that says “you can choose to take control of your health by getting vaccinated” might be an effective way to reach hesitant people. Unfortunately, that will not solve the problem for people in severe healthcare shortage areas. Sometimes it is difficult to get a vaccine even if you want one.
I lived in NM and west TX for decades. If you rely on Medicaid, as an enormous share of the population do, it is very, very difficult to find a doctor except via an emergency room. In entire regions, there are NO DOCTORS who will see Medicaid patients. They simply refuse. (Mandating that providers see Medicaid patients is known to backfire and cause a loss of practitioners because the problem is reimbursement related.)
Emergency departments do not administer vaccines (except for tetanus.) General practitioners do not typically have it. Finding a vaccination as an adult during an outbreak can be very difficult. MMR expires so pediatricians order it in limited quantities so it will be used promptly. That is why the CDC sent 2000 doses.
It would be interesting to know if the measles outbreak extends across the border, or whether Mexico experiences any outbreaks at all. Vaccination rates are unusually high in some very poor Texas-Mexico border counties and I would love to know why.
Thank you again for this great article! I love the 3 points about why people gravitate to this kind of rhetoric. So powerful.
Also- you think if RFK was so into vit A then he’d be supportive of GE golden rice which adds vitamin A to rice to help supplement those who are deficient. You think he’d support agricultural GE science that may help make food production more plentiful (reducing crop loss) or create foods with more nutrients (like golden rice or other options still in research)! But yet again, even though he champions this vitamin for measles he’s against this biotechnology advancement in agriculture and food. It’s consistent with his science denialism on the whole.
Just so interesting how it all intertwines.
Keep up the good work and thank you!
Ignore what RFKJ says and anything you hear about health on Fox News, especially the idiots on The Five.
fYI, I am a conservative but also a Physician who reads the peer reviewed literature.
Outstanding, as always!
I found this posting especially cogent, since it adroitly addresses all the relevant issues.