walkitout (walkitout) wrote,
walkitout
walkitout

The Politics of Vaccination, expect updates

Last night, on TRMS, the possibility that Rand Paul, Chris Christie and other possible candidates for the Republication nomination for President in 2016 might be using vaccination as a wedge issue finally arose. My immediate response was, what, they finally noticed? Maddow brought in Rekha Basu, a columnist from the Des Moines Register, who managed to so thoroughly annoy me that I was yelling intemperate things at the TV. Rekha Basu's argument about what Republicans are doing is disturbing, because she walks right into two traps presented by vaccination as a wedge issue. The first trap is that there is inherent conflict between being pro-vaccination and supporting the right of others to participate in that choice based on personal beliefs. This is a crucial error and very characteristic of errors made by India (cf sterilization campaigns). Vaccination, like family planning, works best when there it's cheap, easily available, well explained and there are acceptable solutions available to address common problems. And vaccination, like population control measures, tends to sour political discourse when the state becomes crudely coercive and refuses to listen to its constituents. Others who _were_ okay with what was going on are then easily swayed to resistance.

The second trap she walked into is the Republican effort to generalize the conflict over vaccination into a conflict over who should win when families have one idea over what to do and the state has another idea. Statist thinking can lead to really awesome places. If the state really does think of itself as the final authority on child rearing within its jurisdiction, and parents are merely agents of it, the state is very likely to start thinking that they could hire people to do a better job than parents and, lickety split, you have widely available, inexpensive child care on offer for everyone more or less from birth. (Ever wonder why a lot of people right of center resist child care subsidies? This is why.) As much as I really dislike organized religion, and as much as I would love to have universal, inexpensive, high quality day care for all, I'm not prepared to sign up for the idea that the state should always win when there is a disagreement with families over child rearing practices. I think this is best handled, if not on an actual case by case basis, then something very close to a case by case basis. Which is how we do it now. It is a classic, American, messy compromise.

You can be PRO VACCINATION, support a religious, heck, even a personal belief exemption (honestly, if you think there's a difference, you're really not a very good agnostic, so fuck you anyway), and support family participation in the decision making. These are NOT NOT NOT incompatible issues. On The View on January 29th, the women were all talking about vaccination and very in favor thereof -- but they were also all saying that they'd spaced out the shots and not done them on the standard schedule. That is, honestly, a lot of what choice looks like. Choice also looks like people going in to see their doctor and discussing the tradeoffs, and deciding, yeah, we'll do this lot, but not that one over there (the routine vaccination schedule and the school mandated schedule are not identical, and a vaccination for something like rotavirus only makes sense for very young children, and not even for all of them). If you force everyone to use a medical exemption, you'll wind up creating a huge amount of work for the board signing off on the medical exemptions -- or you'll just wind up with a bunch of doctors listening to stories about everyone's family history of terrible reactions and agreeing to a medical exemption that would otherwise have gone down a different route. And while at least a few people in California are thinking they can head down the Mississippi path, meanwhile, there's pressure in Mississippi to loosen things up a bit.

I've been pushing boosters for adults (and, apparently, initial MMR vaccination, for adults who never got it because of the 1957 rule, is important -- who knew?) and support for setting up routine vaccinations in developing nations as a better way to address the Disneyland Measles problem. That's a classic left of center strategy to combine a technocratic solution with left wing values of Help Everyone Everywhere. There are other approaches (status quo, honestly, will probably win, because it usually does, thus making me happy, because that's the slow version of what I want to do anyway). But I've been distressed to watch a lot of people whose politics I agree with and who I love and respect as individuals get sucked into the ideological purity maw presented by Republican shenanigans, looking for a wedge issue more appealing to the middle than being anti-choice and anti-gay.

Don't walk into that one.

ETA:

I'm not the only person noticing this, which suggests that my husband's theory that Republicans aren't that smart is, alas, not true.

http://www.msnbc.com/msnbc/the-tricky-gop-politics-vaccination

Here's something about the safety issues associated with mass campaigns, such as the measles campaigns in the Philippines in 2011 and 2014. I recognize the value of mass campaigns while, at the same time, I feel great trepidation associated with their risks. I don't think this is sustainable -- you need to switch to the routine, nurse or doctor delivered and one-on-one approach that we use in developed nations.

Turns out WHO agrees:

http://www.who.int/injection_safety/toolbox/en/AM_SafetyCampaigns.pdf

Waste generated (sharps, especially) by the campaigns present logistical and safety issues. Also, adverse reactions compromise the ability to do future mass campaigns -- or any kind of vaccination at all.

"Two of the most notable challenges are injection safety and
adverse events following immunization (AEFI). Firstly,
with respect to injection safety, the large number of
injections to be administered and the large volume of waste
generated pose added strains on the system. This increases
the probability that breaches in safety may occur. Secondly,
with respect to AEFI, there might be the perception of
increased rates of AEFI.

...

If not prevented or managed properly, these safety issues
can result in transmission of infections, impaired public
and donor confidence in the campaign, and ultimately,
reduced coverage and public health impact."

The balance of the discussion is devoted to how to mitigate these issues.

Mass campaigns against polio in the Middle East started about a year ago, in response to a case of wild polio of Pakistani origin.

http://www.unicef.org/media/media_73006.html

Gaps in vaccination associated with war zones have always been a problem. They were why many people believed even smallpox could never be eradicated. But we did succeed -- and not by ending war.
Tags: health, politics
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