A global pandemic converging with a vaccinations crisis is a nightmare scenario for public health. It is also coming closer to becoming our waking reality: COVID-19 alongside outbreaks of any number of vaccine-preventable illnesses, such as the measles, severe pneumonia, or meningitis (to name a few possibilities).
Some of the danger of that happening is because of the pandemic itself, some because of our institutional and public reaction to it, and the rest because of preexisting behavioral trends — all of which threaten to create a perfect storm of distrust of vaccines and public health authorities, the biggest victims being an entire generation of children who would grow up susceptible to any number of diseases that should have been on their way to eradication. Pediatricians were already on the front lines trying to convince increasingly wary parents to vaccinate, and their jobs have only become more difficult as a result of the pandemic and the lockdown measures instituted to alleviate it. One Chicago-area pediatrician told me, “Everything we’ve accomplished [on vaccines] we’ve lit a torch to.”
The pandemic’s share of the blame is obvious: COVID-19 is deadly and communicable enough that the development of a vaccine has become key to certain officials’ willingness to reopen parts of the country fully.
The behavioral trends are straightforward: According to one study, between 2009 and 2018, 27 U.S. states saw declines in childhood vaccinations, with three of those states falling below a 90% vaccination rate. According to the National Institutes of Health, “In 2000, measles was declared to be eliminated in the United States.” By 2019, however, outbreaks had returned to multiple states. “Without renewed focus on measles vaccination efforts, the disease may rebound in full force.”
Then there’s public health officials’ and political institutions’ self-inflicted wound.
In early February, the chairman of the New York City Council Health Committee, Mark Levine, encouraged New Yorkers to come to Chinese New Year celebrations in Chinatown, tweeting: “In powerful show of defiance of #coronavirus scare, huge crowds gathering in NYC’s Chinatown for ceremony ahead of annual #LunarNewYear parade. Chants of ‘be strong Wuhan!’ If you are staying away, you are missing out!”
It all went downhill from there.
The tidal wave of COVID arrived on our shores, and along with it, what we thought we knew about the virus seemed to change hourly. Surface transmission went from a major concern to a minor threat. The public was told (by the Centers for Disease Control and Prevention, no less) not to wear face masks, which were supposedly of dubious effectiveness and in short supply. Now, we’re told that studious mask-wearing has been effective in beating the spread of the virus, even in places that didn’t shut down. Children are super-spreaders; no, they’re not. Asymptomatic spread is somewhere between likely and “very rare” — except if we’re talking about presymptomatic when we think we’re talking about asymptomatic. Confused yet? And that’s not even to mention the World Health Organization’s scandalous misinformation early on to help China cover up its role in spreading the virus and lying to save face.
It’s hard to keep up with all of the conflicting information we have been authoritatively told from scientists who are supposed to be beyond questioning, beyond reproach, and, most importantly, beyond the reach of partisan and international politics.
That kind of framing of authority is important. People need to believe that those in the medical and public health community know more about science than us and that they’re above the political fray. It’s hard to imagine a scenario in which public health officials could have undermined their credibility more than they have in 2020, and that decline in trust will have implications for decades to come.
When gatherings began as restrictions were lifted, when families visited the beach in Florida or the hairdresser in Georgia, we were assured that these activities would be met with at-capacity hospitals and morgues. A writer for the Atlantic called it an “experiment in human sacrifice.” But then came the police killing of George Floyd and the resulting protest movements nationwide. No matter what one may believe about the importance of a national conversation on race, there should have been no debate about the continued importance of promoting the same social distancing guidelines we were being fed just weeks ago — as long as that’s what officials’ actually believed, of course. Now, our political and medical leadership act as though the relative virtuousness of a cause is the most important factor. “We should always evaluate the risks and benefits of efforts to control the virus,” Jennifer Nuzzo, a Johns Hopkins epidemiologist, tweeted. “In this moment the public health risks of not protesting to demand an end to systemic racism greatly exceed the harms of the virus.” Earlier in the pandemic, a Florida lawyer visited the beaches dressed as the Grim Reaper to discourage families from gathering there. Mere weeks later, he was photographed attending a much more tightly packed Black Lives Matter protest.
Many other health officials appear keenly aware of the damage the shifting recommendations are doing to public trust. Jeffrey Flier, the former dean of Harvard Medical School, explained to one D.C. publication, “Many public health experts have already severely undermined the power and influence of their prior message. We were exposed to continuous, daily COVID death counts, and infections/deaths were presented as preeminent concerns compared to all other considerations — until nine days ago. Overnight, behaviors seen as dangerous and immoral seemingly became permissible due to a ‘greater need.'”
The pediatrician in Chicago wearily told me about some colleagues who considered publicly joining the protests, as many other medical professionals across the country have done. He stood his ground against those working in his practice doing so because, he told me, “We spent months telling our patients to stay indoors, and if we march in the protests, they won’t trust us ever again. As it is, the damage in trust of doctors and the medical system is incalculable.”
That’s when patients do come back. For pediatricians around the country, that day can’t come soon enough. The American Academy of Pediatrics has warned about a drop in vaccinations, which the organization as well as three pediatricians I spoke with estimate to be between 40% and 50%. Recent trade journals reported, “From February 16 to April 12, there was a 19.8% decrease in DTaP [diphtheria, tetanus, pertussis] vaccinations, a 29.1% decrease in MMR [measles, mumps, rubella] vaccinations and a 40.2% decrease in HPV [human papillomavirus] vaccinations, according to data provided by PCC (an independent firm that provides pediatric electronic health records software).”
The financial cost of operating with a skeleton staff, few sick visits, and canceled well visits is so burdensome that many practices are losing money every day they stay open. Post-lockdown, time will be at a greater premium, and doctors will be faced with patients who spent the past several months marinating in anti-vaccine propaganda in the form of viral YouTube videos that ostensibly addressed the COVID crisis but also starred leading voices in the anti-vaccine movement. Thanks to the popularity of one in particular, Plandemic, and fears about mandatory vaccination requirements for a potential new COVID vaccine, one administrator for an anti-vaccine group on Facebook told me her group has experienced explosive growth, with scores of families joining. They are, she says, initially drawn in by their fear of a COVID vaccine but soon are exposed to the full array of anti-vaccine literature.
The COVID crisis and public health authorities’ response to it have created a vacuum of trust, and hucksters have stepped into that void to turn back the clock on modern medicine. And heartbreakingly, it’s children who will bear the brunt of the suffering when the public begins to see the reemergence of diseases that should have been relegated to the dustbins of history.
Bethany Mandel (@bethanyshondark) is a stay-at-home and homeschooling mother of four and a freelance writer. She is an editor at Ricochet.com, a columnist at the Forward, and a contributor to the Washington Examiner’s Beltway Confidential blog.
