A coronavirus long-view: taking vaccines seriously

April 15, 2020 12:15 am

Photo of vaccination by Fiona Goodall/Getty Images.

Like all Americans, Ohioans are understandably anxious to return to school, work, and recreation. Gov. Mike DeWine has repeatedly assured us that he won’t keep the state-at-home order in place a day longer than necessary. But the COVID-19 pandemic presents us with a moment of decision. We had better decide wisely.

It’s becoming increasingly clear that social distancing is the strategic policy that is keeping COVID-19 transmission numbers from skyrocketing. I say this, of course, with the important caveat that we have absolutely no idea how many Ohioans actually have COVID-19. We only know how many cases have presented themselves in Ohio’s hospitals or have been confirmed in other ways. Testing in our state remains abysmal — slightly fewer total tests than in Tennessee, which has almost half of Ohio’s population. 

If reopening our society is the goal, then we must have a plan in place that does not depend on social distancing. Yes, we are going to have to make major changes. We may need to recognize that handshakes and other forms of routine touching will need to largely disappear from the social norms that make up many of our interactions.

We will likely have to grow accustomed to testing before entering certain kinds of spaces, or even allowing “contact tracing” through our mobile devices. How we function in public spaces, from houses of faith to sports arenas, from convention centers to fairgrounds to theaters, from offices to factories, will have to be rethought from the ground up. 

But there is another discussion we need to have now. All around us, we see the stakes of not taking transmissible disease seriously. The lingering belief in long-debunked relationships between developmental disorders and vaccines have led too many Ohioans to refuse to vaccinate themselves and their children.

The result is that Ohio’s kindergartners are vaccinated several points below national averages. This failure has too many of Ohio’s children — as well as immunocompromised children and adults who cannot get vaccinated for health reasons — vulnerable to getting sick or dying from preventable disease. Ohio’s children lag behind national averages for key immunizations.

There is a large gap between what we say and what we do in this area. For example, we hear lots of talk about how much we wish we could cure cancer. Yet, despite the availability of Gardasil 9, a vaccine that can prevent cervical cancer, these vaccines remain recommended but not required in Ohio, with very few Ohioans opting to protect their children

It’s important that we harness this current moment to get our collective house in order. One of the paradoxes of vaccines is that when they are doing what they were intended to do and protecting us, the experience of seeing what disease can do can largely disappears from view.

Though some older Americans may remember, fewer and fewer among us know what measles, mumps, rubella, diphtheria, tuberculosis, or even polio look like. The luxury of not having these direct experiences, and the awareness they entail, is a direct result of effective vaccination.

Then again, it’s also true that we largely sit and watch while thousands of Americans die each year from influenza. Though that vaccine is notoriously variable, it’s clear that an increase in flu vaccination would save lives. Nevertheless, social media is rife with skeptics and resisters. 

But now, with COVID-19, we have a new snapshot of what a widespread disease looks like. Out of tragedy there is opportunity, and we shouldn’t squander it.

Bill Gates, who has for the last several years warned us, including in a widely watched Ted Talk, about the risks posed by a viral pandemic, now argues that we simply will not be able to safely congregate for sporting events and other large gatherings without a vaccine, regardless of the achievements of social distancing and contact tracing in flattening the current curve.

Are those Americans who have resisted vaccinating themselves and their children going to line up for a COVID-19 vaccine — when and if one is developed and made widely available — while refusing the vaccine schedules we’ve long had in place? Or will they learn from the current moment?

If public health experts are right about the long-term danger that COVID-19 poses, we had better hope that a vaccine is on its way. The truth is, even if it is, we know it is a long way off, with the consensus falling somewhere on the order of 18 months — and that is only “if everything goes well.” That’s a long time to wait, so the question is what conversations we should be having in the meantime.

Controversial though it may be, we will have to rethink the religious and philosophical exemptions that undermine Ohio’s ability to attain herd immunity. Absent an official state rollback of such exemptions, as New York, West Virginia, and a handful of other states have implemented, health care systems, to start, need to show leadership by removing such exemptions. A wave of others — from higher education to religious, governmental, and business leaders — should follow suit. 

Unfortunately, I’m not optimistic about the prospects of this kind of leadership. Though DeWine has been praised for his implementation and extension of the state’s stay-at-home order, that order continues to exempt religious institutions.

When some churches, such as the Solid Rock Church, continued to meet at great risk to the public, DeWine merely rebuked that decision, noting that “It is not a Christian thing to do…to hurt people.” He appealed to religious leaders to use good judgment. The better approach would have been to not have made the exemption in the first place. 

The success of social distancing and observing DeWine’s stay-at-home order has demonstrated what we can accomplish as a society when we mobilize individually for the greater good. We see the effects in this decisive action in Ohio’s hospitals, which have thus far avoided being overwhelmed by virus patients. Vaccine operates on a similar logic.

In the words of Ohio Department of Health Director Dr. Amy Acton, those who are staying home, doing their individual part, are “heroes” because of what they contribute to the whole.

If we wish to be among one another again, and if reestablishing our state’s economic and social activity is important to us, then we have no choice but to learn from the coronavirus pandemic that vaccine resistance, against all scientific evidence, is not an option moving forward.

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Dan Skinner
Dan Skinner

Dan Skinner is Associate Professor of Health Policy at Ohio University’s College of Osteopathic Medicine, located on the Dublin campus. He is the host of Prognosis Ohio, a health care podcast produced in collaboration with WCBE, a Central Ohio NPR affiliate. Follow Dan at @danielrskinner.