From Policy to Practice

**IMPORTANT: This article contains mentions of measles and vaccine hesitancy. If you feel uncomfortable with these topics, please refrain from reading.

The line between politics and health is often blurry at best; while we often elect officials because of their stances on issues regarding economics, international affairs, etc., stances on healthcare and timely health issues are often overlooked. However, the lives of individuals are at least partially determined by the health stances of elected officials. 

Take measles for example. While not completely eradicated worldwide, the first measles vaccine was created in 1963 and has been proven effective in reducing cases over the past few decades. (1) Over the past ten years, while measles cases have fluctuated in the US, they have generally been very low. Measles, especially in countries with strong public health infrastructure, is a highly preventable disease. The CDC recommends that all children at least receive 2 doses of the MMR vaccine; one dose is generally provided to children between the age of 12 and 15 months and the second dose is generally provided to children between the ages of 4 and 6 years. (2) Below, I provide a graph of reported measles cases in the US per year. (3)

From local level officials to national leaders, every elected official plays a role in healthcare infrastructure and delivery. Healthcare in this way is similar to a fancy meal served at a restaurant. Every restaurant employee plays a role in the quality of the meal provided and the time it takes to prepare, from the waiters, the chefs, the servers, and the cashiers. Additionally, and especially in a large restaurant, the waiters and servers play an outsized role relative to administrative employees; while administrative employees oversee restaurant management, the individuals directly overseeing individual and table service are the ones in close proximity. Similarly, in the US, where health infrastructure serves millions of people over a vast geographical area, local, community, and state public health officials play an important role in distributing and allocating public health resources while national officials coordinate large-scale policy. 

Below, I explore the recent spike in measles cases in Florida. (4) While measles cases have experienced a recent global rise, in the US, Florida has seen one of the most troubling resurgences of the disease. In 2021, Florida Governor Ron De Santis hired Dr. Joseph Ladapo for the state surgeon general position. Since his tenure began, Dr. Ladapo has expressed concern over state and national vaccination policy, arguing that mRNA vaccines may negatively affect health and fueling ongoing national debates over the importance of vaccination. As the measles epidemic began, Dr. Ladapo opposed federal recommendations, letting parents decide whether to send their children to school although most recommended that children exposed to measles should isolate for at least three weeks. Dr. Ladapo argued that because a vast majority of individuals in the state of Florida are vaccinated for measles, a state of herd immunity was reached where a few unvaccinated or potentially infected individuals would not cause significant disease spread. 

However, an analysis of vaccination levels in various states identifies that amongst kindergarteners in Florida, a state of herd immunity has not yet been reached. (5)

Because measles is highly infectious, roughly 95% of individuals must be vaccinated to achieve a level of herd immunity. The measles vaccine has an effectiveness rate of 96%, essentially promising that 96 out of 100 people will gain measles immunity upon vaccination. (6) If a vast majority of individuals have immunity, those without immunity are not at significant risk for contracting a disease. However, if vaccine skepticism propagated by officials such as Dr. Ladapo becomes more mainstream and fewer and fewer parents vaccinate their children, we may see a resurgence of long thought to be extinct diseases. 

Regardless, this trend is most concerning for children as for most diseases, mortality is greatest for infants, adolescents, and the elderly. CDC research suggests that 0.1% of affected children will develop brain swelling or encephalitis and that the mortality from measles for children may be between 0.1 and 0.3%. (4) Even more concerning, when reviewing historical trends for measles over the past three decades, mortality appears greatest for those between 0 and 14 years of age. (7) From 1990 to 2019, mortality for those under 5 years of age has been significantly higher than that of any other age group. Furthermore, mortality rates appear to decrease with age. 

Regardless, lax vaccination policy that contradicts empirical research has significant downstream effects on individual and community level health. 

In my articles, I frequently view health as a cascade of effects driven by national, state, and local policymakers. While patient care and biomedical innovation remain important drivers of health outcomes, the lives of those around us are significantly influenced by policymakers and elected officials. Viewing healthcare as an “effects cascade” that starts broad and has downstream effects upon individual health portrays health officials as having a pivotal role in determining our lives and those around us. 

While we often view our elected officials as agreeable or not based upon their economic stance and opinions on controversial political issues, it is time we take a hard look at their perspectives on health, as their policies may have long-lasting repercussions on us and our communities.