GESTIÓN EN SALUD PÚBLICA: BioEdge: How can we curb a world-wide measles outbreak?

domingo, 12 de mayo de 2019

BioEdge: How can we curb a world-wide measles outbreak?

BioEdge: How can we curb a world-wide measles outbreak?

Bioedge

How can we curb a world-wide measles outbreak?

by Michael Cook | 12 May 2019 | 1 comment

The measles epidemic in the United States continues to spread, with officials from the Centers for Disease Control and Prevention predicting that the next cities to see outbreaks will be Chicago, Los Angeles and Miami.

Although CDC officials failed to predict an outbreak in New York City amongst Orthodox Jews, their forecasts, based on counties with low vaccination rates and on proximity to international airports, have been reasonably accurate.

Over the past five years 75% of measles cases have occurred in closely knit communities, like Somalis in Minneapolis, Amish in Ohio and ultra-orthodox Jews in Brooklyn.

In New York City, according to the New York Times, in dozens of schools fewer than 90% of the students were vaccinated in the last school year. Most of these were not ultra-orthodox. (A rate of about 95% is needed to establish “herd immunity.)“Several were Muslim schools, while others were Bible-centered Christian academies. Some were schools that hew to nontraditional philosophies, including the Waldorf education movement, which tends to attract parents who favor alternative medical practices. Some served autistic or special-needs children.”

Many “anti-vaxxers” have been influenced by deregistered British doctor Andrew Wakefield and his discredited theory that the measles-mumps-rubella vaccine causes autism.

The World Health Organization (WHO) says that reported cases of measles rose by 300% in the first three months of 2019, compared to the same period in 2018. At 764 so far in 2019, the number of measles cases in the US is the highest in 25 years.

How can the rates of what the WHO calls “vaccine hesitancy”, “the reluctance or refusal to vaccinate despite the availability of vaccines”, be reduced? This is a urgent question for public health officials.

An article in Slate by two bioethicists from The Hastings Center suggests that public health officials should try to understand parents’ values better rather than trying to bully them into accepting the medical consensus:

although measures to slow the spread of misinformation can be helpful, “myth busting” and appeals for “science-based” policymaking usually are not. They are often just efforts to shut down one’s opponents in a way likely to be deeply threatening and infuriating to them. At best, they ignore what’s most important. While the debaters dwell on facts, what drives them apart are competing values about (for example) personal liberty, political power, human nature, science and technology, the relationships of individuals to society and of humans to the rest of nature, and the weights assigned to different kinds of harms and benefits, and even to uncertainty. Facts inform policy, but values are the basis...
the chief points are to stop haranguing people, to address their interests, and to put values up front. Often, it’s helpful to think about what makes for an effective face-to-face conversation. Instead of treating people as criminals, fools, or misfits, how about listening to their concerns, practicing a little modesty, and recognizing that everyone loves their children? Narratives can play an important role, both as a way of finding out about the other person’s concerns and conveying the importance of vaccination. Putting values up front does not magically make everybody come to affectionate agreement, of course, but it is more respectful of diverse views, it helps clarify the points of disagreement, and it is usually a necessary first step toward compromise.

Michael Cook is editor of BioEdge

In our lead story today we focus on an apparent, and surprising, rift over euthanasia in Belgium. On the one hand the medical association recently issued guidelines which tell doctors to be more cautious about granting euthanasia for psychiatric reasons. On the other, the country’s leading right-to-die association is campaigning vigorously to grant euthanasia to patients with dementia. Apparently, even supporters of the country’s euthanasia law differ on the wisdom of making a liberal law even more liberal.

My feeling, however, for what it's worth, is that Belgium will keep relaxing its 2002 law until it becomes effectively euthanasia on demand. Doctors will become mere suicide enablers.

There may be one way to stop this process, or at least to slow it down. And that is to fire the chairman of the Federal Euthanasia Commission, Dr Wim Distelmans. This gentleman is not only the senior regulator of euthanasia in Belgium. He is also a media star as the chief spokesman for the right to die and one of the main practitioners of euthanasia. In other countries, this would be regarded as an egregious conflict of interest.

A new chairman who is not immersed in the world of Belgian euthanasia politics would be in a better position to identify abuses and refer doctors who fail to comply with the law to the public prosecutor.