Core public health functions that we really need

I am a retired public health nurse with 27 years experience in communicable disease surveillance. I hunted down scary diseases to prevent others from getting sick. I worked with dreaded diseases such as meningitis, tuberculosis, measles, and syphilis. I witnessed the suffering and death of infectious diseases. But good things happened, too. With awe and amazement, I watched vaccination programs eliminate common diseases.

When I became a nurse in 1982, the most common form of infant meningitis was from a bacteria called Haemophilis influenza type b, or HIB. HIB disease causes severe infections, hospitalizations and death. If the baby survived, they were often left with neurological problems. Introduced in 1987, the HIB vaccine virtually eliminated this condition. Medical schools lamented that their interns would complete their entire training without ever having the chance to treat a case of HIB meningitis! 

I worked in the Texas School for the Blind, which cared for children damaged by rubella. Mexico did not have the rubella vaccine until 1985. If contracted in the first sixteen weeks of pregnancy, rubella causes severe birth defects such as profound intellectual impairment, blindness and deafness. The kids I saw in Texas had microcephaly, or abnormally small heads. It marked me forever to sit in a room full of disabled children knowing it was only lack of political will which sealed their fate.

The public health laws are effective! School vaccination requirements have given us a society where we are not afraid of dying from a plague. Polio has become a distant memory in our grandparents lives. Congenital rubella is very rare. Measles was eradicated from the US in the year 2000.

But this can break down if we are not vigilant. Measles is burning through the country. We have handicapped ourselves by firing the people who respond to public health emergencies. We need epidemiologists and nurses on the ground coordinating efforts.

Success of public health victories means that people have forgotten the horrors of disease. No one has seen the lockjaw of tetanus, or infants choking from pertussis, or malformed skulls of congenital rubella. Our very success has opened the door to complacency. Parents are misled by conspiracy theorists. Pockets of susceptible populations combined with malpractice of cutting our essential public health programs puts our country in a precarious position. It is just a matter of time before measles comes to your day care, your school, your church.

This comes at a time when access to health care is being curtailed. Cuts to Medicaid will leave children and pregnant women uninsured. Rural hospitals will be forced to close. Clinics will be shuttered. Nursing Homes will be emptied. This administration is taking us backwards to an unkind past.

An example of what we should not do is from the state of Idaho. A new law prohibits publicly funded medical services to undocumented persons. The law forbids prenatal care, immunizations, and communicable disease testing to “illegals.” This is in direct contradiction to the guidelines of the CDC. The cruel law makes Idahoans less safe, and thereby, surrounding states such as Utah less safe.

By not immunizing everyone, you create a reservoir of susceptible people where measles can thrive. By prohibiting communicable disease testing, you hamstring public health investigators who seek out deadly diseases like tuberculosis. I was a TB nurse for eight years. We treated people who had been contagious for months before diagnosis. A single case of TB can infect hundreds of others. By refusing prenatal care, women can die from gestational diabetes or eclampsia, a dangerous complication of pregnancy. Idaho will have blood on its hands.

We need a coherent, comprehensive public health policy. The drastic cuts to the CDC, NIH, and the safety net programs will adversely affect us all. U.S. Health and Human Services Secretary Robert F. Kennedy Jr. has turned his back on expert advice of the public health pioneers who have wrought health victories that were unimaginable to our grandparents. We must demand that our legislators carry out their responsibility to provide essential services to their constituents.