As the Center for American Progress’ Sam Fulwood III aptly pointed out in his recent analysis of the impact of the economic downturn in communities of color, there’s an old saying that also applies when we’re talking about health outcomes: “When white folks catch a cold, black folks catch pneumonia.”
And with the concerns of urban communities already less heard and less addressed in general, it’s crucial that science and data dictate vaccination policy—not politics. So when our leaders make misguided and misinformed statements outside their space of expertise, it can undermine medical professionals who are trying to save lives.
Of course, that may not be the first thing on the minds of Republican presidential aspirants like Gov. Chris Christie of New Jersey and Sen. Rand Paul of Kentucky, who made irresponsible assertions this week that it’s OK for parents to choose to ignore the science when it comes to decisions about the vaccination of their children. While Christie quickly backpedaled on his statements after a firestorm of public criticism, Paul—who is a physician—doubled down, stating that vaccines were to blame for “profound mental disorders” such as autism. This is simply not true.
These scientifically baseless assertions can lead to profoundly dangerous public health policy, particularly in communities of color. The ramifications for many African Americans and other minority groups are greater than for those who have better access to quality health care—as has been shown—even as the Affordable Care Act takes shape. These concerns are primary in densely populated urban centers or metropolitan areas, where communities of color are disproportionately concentrated.
As The Guardian’s health editor Sarah Boseley correctly points out, infectious diseases “spread horrifyingly fast in cities.” This was one major reason why, during my time as chief health officer of Washington, D.C., we instituted an ambitious citywide emergency school immunization campaign in 2002 upon finding 21,000 public school students who had not been vaccinated to meet established standards. This was considered one of the largest immunization drives in U.S. history, and within just eight weeks we experienced a 99 percent success rate.
There was no conversation about choice, simply a conversation about how we could best protect the nearly 600,000 residents in the nation’s capital and the tens of millions of people from across the world who visit each year. And at that time we were extremely sensitive about contagions and the spread of lethal infections, especially in the immediate wake of managing the country’s first bioterrorism attack.
What’s significant to note here is that we did this in a city that had, at the time, a majority-black population (more than 56 percent) and a public school population that is overwhelmingly African American.
In describing these communities, we frequently use the term “underserved.” But in reality, communities of color in highly populated metro areas are highly underresourced. This makes these communities much more vulnerable to major epidemics, including measles. The need for surge capacity and an adequate emergency health care response is critical.
Measles is actually much more contagious than another disease that recently grabbed headlines, Ebola. Which makes the current political “debate” peculiar. Elected officials like Christie didn’t hesitate to quarantine medical staff returning from fighting the disease in West Africa but appear somewhat nonchalant about fast-infecting measles. More alarming, and what some political leaders won’t say, is that diseases like measles will spread faster in cities.
That will put people of color, especially African Americans, in the direct line of epidemiological fire, since nearly 20 of the largest cities in 13 states have black populations of 50 percent or higher.
The last major outbreak of measles in the United States erupted less than 25 years ago. More than 56,000 Americans were infected, including 11,000 nationwide who were hospitalized and, sadly, 123 reported fatalities. And as the Centers for Disease Control and Prevention later found, a disproportionate share of those infected were “inner-city, American Indian, Hispanic, non-Hispanic black and low-income children aged five years [or younger] who had not been vaccinated.” In fact, the CDC discovered that “[r]acial/ethnic minority children were at three to 16 times greater risk for measles than were non-Hispanic white children.”
This risk disparity is of particular concern to public health professionals and planners, and it was a main driver behind the federal government’s creation of the Childhood Immunization Initiative in 1993.
For those who advocate for “choice,” it’s not an urban issue, but it is an example of mostly more affluent individuals imposing their preference on underresourced and vulnerable populations of color—which means, ultimately, that they are transferring the risk.
Dr. Ivan Walks is the former chief health officer for the District of Columbia. He is also founder and CEO of Ivan Walks & Associates. Follow him on Twitter.