I Spy With My Little Eye... Public Health At Work
Moving from "this is public health" to "we are all public health"
In non-pandemic times, public health is in the background. The work we do is usually unseen and often not credited to us. To quote my favorite epidemiologist, Dr. Bill Foege (former Director of CDC and the man responsible for the vaccination strategy that eradicated smallpox) —
“No one is going to come up to you {as a public health professional} and tell you thanks because they didn’t get measles; thanks because they didn’t get a tropical disease; or thanks because they didn’t get this or that.
They won’t know they were supposed to.”
From complex clinical trials to anti-smoking campaigns; warning labels on wine about the dangers associated with drinking while pregnant to conducting surveys about smoking, drug use, and sex among teenagers…
As public health professionals, we ensure your water is safe to drink, air is clean to breath, that sewage is not dumped into waterways, and that risk factors for diseases like cancer are communicated to you. We created screening tests for cancer and teach your kids to brush their teeth and wash their hands.
THIS IS PUBLIC HEALTH.
Without knowing it, you have trusted the public health community to keep you and your family safe.
Something as simple as a 4-way stop intersection is a public health intervention aimed at preventing a car crash and slowing down traffic (often to prevent a pedestrian from being hit). Most days when I leave my house, I come to a 4-way stop that looks something like this…
When you come to a 4-way stop, you are expected to stop and then take turns so that each car can get safely through the intersection. Your ability to get safely through such an intersection is dependent on the other three drivers stopping at their stop signs and all all four drivers taking their turn.
And so it is with vaccines…
One of the questions I am asked most often is why should I get vaccinated now? with the Delta variant here, why even bother? I’m not going to get that sick? why stick a needle in my arm and receive a treatment before I am sick?
(Privately, I am pulling my hair out!)
But seriously —
Getting vaccinated - from an individual point of view - is like stopping at your stop sign at a 4-way stop. If you stop, you will prevent crashing or hitting another driver with your car. When you are vaccinated against COVID-19 you are protected developing severe disease, just as you prevent a crash when you stop at the stop sign.
It is possible to get rear-ended at the stop sign even if you stopped appropriately. This is similar to a breakthrough infection — where an individual who is fully vaccinated develops the disease in spite of the fact that they are fully vaccinated. When you are rear-ended at a stop sign, there is some bumper damage that needs to be fixed, but the airbags do not inflate and serious damage usually does not occur. So it is with a breakthrough infection. The vaccinated individual will show symptoms (and feel lousy), but severe disease, hospitalizations, and death are prevented.
If the other three drivers fail to stop, they are going to crash - you will be impacted by the decisions made by others. When you are stopped and there is a crash in front of you, it is likely that the crash will block the intersection. And you will not be able to get where you are going. It is also possible (worst case scenario) the crashed cars fly into your section of the intersection causing severe damage to your car.
And so it is with vaccines — if you are vaccinated but 75% of those around you (or three of the four cars at the 4-way stop) are not vaccinated, you are either going to be exposed to or suffer the consequences of low community vaccination rates.
When all four drivers fail to stop, a serious crash occurs. When four unvaccinated individuals get together, the disease continues to spread and the development of new variants is perpetuated. Illness and possibly death will occur.
When the COVID-19 vaccines were approved in earlier this year, the idea was to get (at a bare minimum) the vast majority of individuals vaccinated as quickly as possible. This is equivalent to expecting most drivers to stop at a 4-way stop. When this happens the SARS-CoV-2 virus hits a dead-end every time it bumps into a vaccinated person. Cases decrease AND the speed at which the virus evolves slows.
The reason we do not see measles, smallpox, polio, or whooping cough is because individuals got vaccinated (stopped at their stop sign) and as a community so many of us got vaccinated that we created immunity (we all stopped at our stop sign) that slows or even stops the spread of highly contagious infectious diseases.
I never expected so many people to refuse their COVID-19 vaccine.
When it comes to vaccines, preventing the spread of disease, and stopping a pandemic — THIS IS PUBLIC HEALTH. As a community, public health professionals have kept you healthy throughout the past, we expect (dare I say, demand) some respect. When we provide evidence and explanations for why we all need to get vaccinated, we are doing so to keep you safe, to ensure your health. We want to prevent disease or a car crash before it happens.
Public health does not want to close down schools or cripple the economy. We want to ensure your safety and help you live a long, healthy life. In the middle of a pandemic (key phrasing there — middle of a pandemic — it is not over, not even close), we know how to slow disease spread, keep you healthy, and bring this pandemic to an end. We need your trust and your confidence in our public health expertise, tools, policies, and interventions. We need you to understand that we can see the big picture, and we are worried about what is to come in the fall (more on this later in the week).
If you understand the value of stopping at a 4-way stop intersection, please take the time to understand how this relates to vaccinations and the pandemic. We need to create a world in which we do not just see public health, but where we all participate in the work of public health.
We need to transition from “this is public health” to
WE ARE ALL PUBLIC HEALTH.
And it all starts with vaccinations…