In a recent piece for msnbc.com, Geoffrey Cowley paints a dark picture of the impact sequestration cuts will have on critical global and domestic public health services. Particularly alarming are the cuts that would dump 212,000 uninsured or under-insured children from federally funded state vaccination programs, even as a pertussis—or whooping cough—epidemic is peaking in many states.
Pertussis is a serious, highly contagious bacterial infection that can land children and adults in the hospital. But it can be fatal for infants—just hearing the sound of it is frightening. It is easily preventable as part of the routine childhood immunization schedule and booster shots given to adults as part of a Tdap (combination tetanus, diphtheria, and pertussis) vaccine. The purpose of the Tdap booster is to protect adults from getting infected, but also to protect children and infants from the disease. Besides the obvious suffering it causes, pertussis incurs millions of dollars annually in hospitalization costs alone, often in the most expensive areas—the ER and ICU. Meanwhile, the vaccine itself costs about $25 for CDC-contracted purchasers, $40-60 for patients in doctors’ offices and walk-in clinics, and it’s covered by most insurers.
Cutting state funding for vaccinations of any kind is penny-wise and pound-foolish. The timing makes this even more alarming. It’s true that, on average, rates of new pertussis infections are gradually beginning to decline after a decade of exponential growth. But, there are still 20 states in which the incidence of pertussis exceeds the national incidence of 13.4 cases per 100,000 person-years. (In this context, a person-year is defined as one person affected by pertussis in one year.) The rates in the top five of those 20 states—Wisconsin, Vermont, Minnesota, Washington, and North Dakota—blow the national number away. In 2012, for example, the Wisconsin Department of Public Health reported 104.9 cases per 100,000.
Last year, local and regional media outlets in epidemic states covered this story in earnest, reporting statistics and covering health department pleas for mass vaccinations. Although a few outlets continue their focus—Bountiful, Utah’s Daily Clipper ran a story on March 4—most local coverage has dwindled. The national media has historically done its part, but some outlets of late appear to be looking for new angles to what isn’t an old story. Liz Szabo, in a February 8th USA Today article, picked up on a letter in the New England Journal of Medicine in which researchers described a mutated strain of the pertussis bacterium—which Szabo, among other reporters, described as “a vaccine-resistant strain of pertussis.” Writing at The Daily Beast on February 22, Slate’s Amanda Schaffer criticized the “dozens of news spots, blog posts, and even resources for doctors that have fretted over the emergence of ‘vaccine-resistant pertussis’”, calling that description “wrong.” Schaffer interviewed with one of the NEJM authors who debunked the idea that this strain was vaccine-resistant, and ended her story with a plea for readers to “roll up those sleeves.”
Schaffer’s was an important public service announcement and an interesting angle.
Here’s another: There is an overlap between the 20 states where pertussis incidence exceeds national rates and the 11 states that allow exemptions from school immunization requirements based on philosophical, in addition to religious, beliefs. And that’s in addition to medical exemptions. In fact, the top five states mentioned earlier all have such philosophical exemption laws on the books. Seeing those exemptions as potential contributors to their states’ pertussis outbreaks, some politicians and public health officials have debated their worth and, in some cases, worked to eliminate them.
The battle over state immunization requirement exemptions is a woefully underreported story, but there are a couple of bright spots. A recent segment on Vermont Public Radio covered one state legislator’s fight to eliminate philosophical exemptions for pertussis immunization only, given Vermont’s escalating problem. And three cheers to Helena Rho of Canada’s (yes, Canada) National Post Wire Services for pointing out on February 26 that anti-vaccine activists are thwarting that effort. Scenarios similar to Vermont’s can be found in Arizona, California, and Washington, among other states. Reporters in these states and elsewhere: roll up those sleeves.
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