Public health’s vital mission compromised

We have a lot of public heroes. We tend to think of the firefighters, EMTs and police who arrive at an accident, save lives, care for the injured, and clean up the mess. But we often ignore some lower profile public heroes, who we literally depend on for the health of our community.

You can find some of these heroes in public health clinics. These workers — the nurses, doctors, medical assistants — are the front line for a healthy society, providing care to infants and mothers, assessing chronic diseases, persuading people to quit smoking, ensuring restaurant food is healthy, and leading the fight against communicable diseases.

This year we may be losing the public health fight against one disease most of us thought was conquered half a century ago: whooping cough. Some 1,500 cases have been reported this year, 10 times the number of cases from all of last year.

It is a serious disease, especially for babies, and easy to transmit as it’s spread by coughing and sneezing. Last year an infant in Lake Stevens died from it. Now Northwest Washington is the epicenter of this epidemic.

There is a highly effective vaccination for whooping cough: DTaP. This protects children against three diseases: diphtheria, tetanus, and whooping cough. Children need five DTaP shots by the time they turn 6. For adolescents and adults, a booster vaccination will protect them from the whooping cough. So the first thing to protect yourself is to double check with your doctor to make sure you are up to date with this vaccination.

But this isn’t just about protecting yourself, it’s about protecting the whole community. Adults are the reservoir for the disease and yet fewer than 10 percent of them have had a booster. Then there is the idea that kids don’t need to be vaccinated. Some parents can do this because everyone else’s kids are vaccinated, and they’re protected by “herd immunity.” That means contagion can’t spread and even the unvaccinated kids are safe, as free riders.

When too many people make this choice, however, even 5 percent, herd immunity is compromised. The unvaccinated kids can and do spread whooping cough, sometimes even to those who have been vaccinated. Older people and those with weak immune systems are especially vulnerable — and that is the start of an epidemic.

So choosing to let a child go unvaccinated is not a benign decision. Parents who do this are endangering the health and wellbeing of their children, and many others. Medical studies have proven there is no link between vaccines and autism, or any other medical condition. For those who think they are doing the good “no chemical-medications/natural” thing, they are actually endangering their kids, neighbors and community.

In the absence of laws requiring all of us to be vaccinated, public education and persuasion become even more important. That’s the role of public health. But it is hard to hold the front line against epidemics when you lose resources.

The Snohomish Health District has been cut by almost one-third. In 2007 and 2008 there were 18 nurses and health workers in clinics, vaccinating kids and adults. Now there are 12 workers to serve a population of more than 720,000 in Snohomish County. That’s 12 people to persuade the parents of the 7,000 kids who are not vaccinated, but are enrolled in school, that their children are vectors for disease and they should be vaccinated. That’s 12 people for more than half a million adults who have not gotten their whooping cough booster vaccination.

In 1999 voters approved an initiative to decrease motor vehicle excise taxes. Snohomish County residents gave Initiative 695 over 60 percent support. A portion of those taxes went to public health — a little more than $2 million. The Legislature scrambled to make up that loss with money from the general budget.

We made do until the banks brought down the economy in 2008. Then public revenue fell, and funding for public health was cut. Today, that $2 million could pay for 60,000 whooping cough vaccinations or 40 public health workers. But as a society, we seem to be moving away from caring about our community, and more toward caring only for ourselves.

That shift is reflected by our everyday choices — both letting our children go unvaccinated, and cutting funding for critical programs to prevent the next epidemic. What a trade-off. But we made those choices, and now we are living with the consequences.

Originally published at the Everett Herald