Louisiana’s surgeon general puts basic health care out of reach in a poor, unhealthy state

An internal Louisiana Department of Health memo from Surgeon General Ralph Abraham surfaced last week with resounding directives to staff regarding its role in public vaccination efforts.

While not blatantly discounting the efficacy of vaccines, Abraham signaled a significant step back for the state’s role in promoting and administering them. 

“Rather than instructing individuals to receive any and all vaccines, LDH staff should communicate data regarding the reduced risk of disease, hospitalization and death associated with a vaccine and encourage individuals to discuss considerations for vaccination with their health care provider,” the surgeon general wrote.

It all seems innocuous enough until you get to the part where Abraham — a physician and veterinarian – mentions his department’s history in promoting vaccines through public health fairs, media campaigns and working with parish health units.

“While we encourage each patient to discuss the risks and benefits of vaccination with their provider, LDH will no longer promote mass vaccination,” he wrote.

“I don’t know what that means,” New Orleans Health Director Dr. Jennifer Agenvo told our news partners at WVUE-TV Fox 8. “Every year I’ve been here and before me, the New Orleans Health Department and the state health department have worked together on really successful mass vaccination events.”

Avegno said the city will disregard Abraham’s messaging and continue with its own vaccination events.

U.S. Sen. Bill Cassidy was also critical of his fellow Republican physician’s policy move, though his words lose a little steam when you consider his vote for anti-vax conspiracy theorist Robert F. Kennedy Jr. for U.S. health secretary. Still, Cassidy reflected on his own experience running large-scale immunization programs. 

“Things like vaccine fairs keep a child from having to miss school and a mother from having to miss work,” Cassidy said in a statement. “That is the reality of today’s medicine. To say that cannot occur and that someone must wait for the next available appointment ignores that reality.”   

Abraham has yet to offer any public explanation of his memo, but his department issued a news release the same day in which the surgeon general and his top deputy, Dr. Wyche Coleman III, explained their personal health care philosophy in broad strokes.

“As a nation, we must recognize that there is no miracle pill for the major population health problems we face,” the doctors wrote. “The solution to increased spending and declining outcomes in our country is unlikely to come in the form of a pill or a shot. Much of the solution will likely come down to the usual hard work of improving diet, increasing exercise, and making better lifestyle choices.”

This is a condescending statement in which both doctors assume the public turns to the government for their every health need, and citizens depend solely on public officials for guidance on their wellbeing. Abraham and Coleman also mistakenly assume everyone in Louisiana has the same access to healthy food, adequate exercise time and – easily the most obtuse assumption from the two physicians – medical care.

Vaccine legislation is a loser in Louisiana, but misinformation wins anyway: analysis

The latest data show 1 in 7 people in the state do not have reliable access to healthy food, according to the food bank collaborative Feeding Louisiana. 

Rankings from United Health Foundation place Louisiana at 38th in the nation in terms of the number of adults who meet recommended exercise guidelines, with only 27% reaching that benchmark.

As for health care access, rankings consistently place Louisiana near the bottom in mortality rates for cancer, infants, diabetes, heart disease, kidney disease and stroke. Personal choices indeed account for some of these ailments, but all are exacerbated when medical help is out of reach. 

Public health experts say Abraham’s apparent retreat from mass vaccination events will only add to these problems in a state with the second-highest poverty rate, 18.9%, in the country. Several studies have affirmed the link between poverty and poor health outcomes.

It could also impact one area where Louisiana is in the middle of the pack – influenza and pneumonia deaths. You’ll recall Abraham provided Louisiana health care workers with a rather flimsy opt-out for any employer flu vaccine requirements, revealing his lack of support for a  widely accepted preventative health practice. 

When Republican Gov. Jeff Landry made Abraham the state’s first surgeon general a year ago, public health advocates met the announcement with skepticism. The governor has long made clear his disdain for decisions his Democrat predecessor, John Bel Edwards, made during the COVID-19 pandemic.   

Dating back to his time as attorney general, Landry has repeated disinformation on the coronavirus and the public health response. Right after his LDH appointment, Abraham echoed the political messaging of his boss. 

“This position was created to reverse the prior trend of bureaucrats creating policy and doctors reacting to it, moving us in a unified way forward,” he said at the time. 

Abraham’s choice to back away from promotion of vaccines with a proven track record of success – some of which have eradicated dangerous diseases such as measles and polio — is the exact opposite of the unified front he seeks with health care providers. 

The reality is he will make their jobs immeasurably more difficult.