Ode to Charles Darwin

4 Jan, 2016
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“In the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed.”                               ― Charles Darwin

Immunization, since its beginning, has always walked a tense line between individual rights to choice and societal rights to health. A tense line between rights and responsibilities – the right to choose, with the caveat that it does not injure those around you.

On the 1st January, 2016, California launched a new law (Senate Bill 277) which curbs personal belief exemptions for vaccination. The move to rescind the personal belief exemption was sparked by the Disneyland measles outbreak in Southern California one year ago, which spread to multiple states in the US, and became a tipping point in tolerance of non-vaccinators.  The high visibility of Disneyland – the so-called “The Happiest Place on Earth” – contributed to the outrage.

Between February and December 2015, the US reported 113 cases related to the outbreak in Disneyland. In July, 2015 the first American in 12 years died of measles. The total number of measles cases in the US was actually much higher in 2014 – 667 cases across 27 states – that was just the kindling which started to stir up resent among those who vaccinate towards those who don’t, culminating in the 2015 outrage which pushed the reversal of the personal belief exemption.

In June 2015, another incident, this time in Spain, fuelled tensions between those who value vaccination and those who opt out. After nearly one month hospitalized in intensive care, a six-year-old boy named Pau died of diphtheria. His parents had refused vaccination. It was the first case of diphtheria in Spain in 29 years, and the first case in 32 years in Pau’s home region of Catalonia. It too, provoked public debate about those who choose not to vaccinate.

In Australia, on the 1st January, 2016, a “No Jab, No Play” legislation was enacted, also in reaction to vaccine refusers and their impact on public health. While medical reasons for non-vaccination are still valid, “conscientious ­objection” to vaccination is no longer an option. Non-vaccination removes the right to subsidies for childcare.

In another significant 2015 saga of public trust and cooperation challenges, Ebola loomed large. At the end of December, WHO reported 28,637 cases of Ebola virus disease and 11,315 deaths.

The initial response to the Ebola outbreak was not one of public cooperation and trust. Denialism that Ebola existed in the most affected countries, distrust of local and international organizations, and visceral fear of the highly fatal disease were among the barriers to publics cooperating with the needed public health measures to tame the outbreak. Over time, with concerted efforts and community engagement, the Ebola response moved into a largely cooperative effort and all three of the most affected countries – Guinea, Liberia and Sierra Leone – were declared Ebola-free by the end of 2015. The Ebola recovery phase is far from over, and Ebola vaccine trials continue to prevent similar crises in future, but those too have required significant trust-building and cooperation.

These are just a few, albeit canary-in-the-mine, stories from the past year, all related to the fragile balance between individual choice and public cooperation.

This entry was posted on Monday, January 4th, 2016 at 6:24 pm and is filed under Blog.

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Literature Literature archive

Biswal . 2019 NEJM DOI: 10.1056/NEJMoa1903869
Piot P, Larson HJ, O'Brian KL, et al 2019 NATURE Vol. 575, pages119–129.
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