TThe culture of public health and medicine is based on open discussion where different perspectives are considered to improve patient care and health. This process relies on psychological safety, so individuals feel free and safe to speak up and openly disagree. Collectively, these elements create a culture of justice that improves systems and organizations and is widely implemented in health care settings across the country.
However, in the face of politicized anti-science and anti-expert sentiment and attacks, we need to ask whether a culture of justice is being limited in public health. Following a series of legislative and policy changes in Florida that impact academic institutions, medical care, and public health, medical and public health professionals are now required to discuss infectious disease control practices related to COVID-19 and, now, measles. We see that open dialogue by the house is receding.
On January 3, 2024, in sharp disagreement with the CDC, FDA, and medical and public health experts, Dr. Joseph Ladapo, the state's Surgeon General, announced that the COVID-19 mRNA It advised everyone to avoid vaccines. This concept is clearly in contrast to ample scientific data showing that these vaccines do not alter a person's genes, even if they contain trace amounts of his DNA associated with vaccine production. be. This announcement comes despite the fact that on September 13, 2023, 25% of deaths from COVID-19 occurred in people under 65. The announcement followed an announcement recommending people not to get vaccinated against viral infections. He recommended that young adult men avoid the vaccine due to concerns about myocarditis. However, this risk of myocarditis is very rare, and the risk of myocarditis after COVID-19 infection is much higher than after vaccination.
These announcements prompted widespread national criticism of these Florida-specific policies. In contrast, the response from Florida's medical and public health community to these controversial recommendations, whether in support or opposition, has been muted. This lukewarm response compares to the first few years of the pandemic, when Florida health care providers, medical schools, and public health experts often commented publicly on the state's COVID-19 mitigation efforts and vaccination policies. are in contrast.
There is currently a measles outbreak at an elementary school in South Florida. Dr. Ladapo, who is not the county health officer, said children at high risk of contracting measles can attend school despite the possibility of contagious disease, leaving the decision to their parents. Although we are in the early stages of this epidemic, the response from Florida's medical community has been limited to a small number of practitioners, while his recommendations have sparked a similar outcry nationally. We are observing the situation.
Measles is a highly contagious virus that can travel long distances and remain in the air for many hours, making it five to 10 times more contagious than COVID-19. Unvaccinated people have a very high chance of contracting the virus, which can cause encephalitis, pneumonia, and hearing loss.
Childhood measles vaccination rates are below critical levels in many regions of the United States, reflecting anti-vaccine and anti-science activities that have become part of the political agenda. Not surprisingly, measles cases have recently increased in the United States. The medical community overwhelmingly supports childhood vaccinations, but this is drowned out by policies that weaken vaccination requirements and misinformation that undermines confidence in vaccines.
Measles outbreaks can be controlled by early postexposure vaccination measures and by isolating unvaccinated exposed individuals for 21 days, which spans the incubation period. This recommendation is based on the fact that people with measles may be contagious for several days before symptoms appear. Although more than 90% of the population in some regions of the United States may have received measles vaccination, many unvaccinated and medically infected individuals remain independent of local vaccination rates. , are at high risk if exposed to measles.
Three weeks is a long time for a child to be absent from school. But as we move through the pandemic, tools to facilitate distance learning have become widely available, and schools have adopted them. If parents are worried about being able to control the spread of infection, it makes sense to keep their children out of school. The school, which had previously reported high vaccination rates, reported that nearly 20% of students were absent in the days following the outbreak. Rather than allowing children who may have measles to attend school, was it considered that emphasizing that standard measles control policies were followed might increase attendance? ?
We need to ask what has happened over the past year to stop the dissemination of views that are contrary to national policy. Is there self-censorship or external censorship? Has there been opposition from within the Florida Department of Health to these recent recommendations by Dr. Ladapo? This may lie in reviewing recent legislation or state actions that may be hesitating to raise funds.
First, a law was passed that allows faculty members at state universities to have their terms revoked, meaning that faculty members in stable positions can be fired. University of Florida faculty said the policy limits the freedom of experts to speak publicly for fear of retaliation.
Third, states regulate hospital funding and reimbursement rates for Medicaid patient care. Therefore, administrators at universities, medical schools, and hospitals may be concerned about faculty members making public statements or clashing with political leaders.
Fourth, states decide what can and cannot be taught in K-12 schools and public universities, something that has been unheard of in universities in the past. Recently, the Florida Governor's Commission banned sociology from the university system's core curriculum. For example, considering that the most popular majors at the University of Florida are psychology and biological sciences, which are foundational to sociology, asking whether national policy is in the best interest of students There is a need.
Fifth, healthcare providers are currently embroiled in a culture war. Medical institutions are also being investigated for health-related issues at the state and national level.
We now look at what happens when policies threaten the ability of medical professionals, academic experts, medical societies, and public health workers to speak up. Public debate about important public health state policies fades.
Florida used to have one of the highest COVID-19 vaccination rates for people 65 and older in the U.S., and one of the lowest per capita COVID-19 death rates, ranking 29th. was ranked.th In contrast, Florida currently has one of the lowest rates of COVID-19 booster vaccinations in the United States, ranking eighth.th Number of deaths due to new coronavirus infection per person. Florida is currently experiencing a severe measles outbreak, and standard precautions are not being taken to allow potentially infected children to return to school.
Given the high vaccination rate of 97% in the outbreak area, this outbreak will likely be contained. But what happens if measles enters a school or community where vaccination rates are low and standard public health measures must be followed?
Do we really want to limit discussion of infectious disease control policies? We have learned the clear benefits of a culture that considers diverse perspectives in medicine and public health.