Diseases like measles disproportionately hurt African American communities

Racism

Diseases like measles disproportionately hurt African American communities.

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.

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.

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.

Anti vaxxers are privileged, although diseases mainly impact people of color.

Vaccines work.

Anti-vaxxers will argue otherwise, but if they’re given airtime, this will degenerate — like most vaccine discourse — into comparative science, misinformation, name-calling, and finally heated charges of baby-killing.

Someone will say all anti-vaxxers should be locked up, and someone else will invoke Hitler. So we’re skipping that part. If you’re interested in reading it, see the comment sections of every vaccine article ever.

Instead, let’s look at the parents who refuse routine childhood vaccinations — and what that means.

There are two categories of kids without a full complement of routine vaccinations. Researchers call the first category the “undervaccinated”: kids who have not received, for one reason or another, their all of their childhood shots. According to ​a study published​ in Pediatrics, these children tend to share several characteristics. Most live near the poverty level, in a central city. Their mothers are unlikely to be married or to have a college degree. And, most tellingly, undervaccinated children tend to be black.

Children without vaccinations, on the other hand, are generally referred to as “free riders”**: kids whose health gets a free ride from the immunity of the vaccinated people surrounding them (i.e. “the herd”). Their parents present a radically different profile from those of the undervaccinated kids. Free riders’ mothers tend to be married and college-educated. Their household income generally averages above $75,000. And those free riders are overwhelmingly white.

Ouch.

“These simple things were pretty difficult to get through,” she says. This doesn’t count the difficulties of making appointments in between full-time work and childcare, not to mention navigating the bureaucracy of Medicaid. These children’s parents may worry about the ramifications of vaccine-preventable disease. But poverty can make it hard to do much about it. When you’re worried about keeping the lights on, the rent paid, and the car running, routine vaxes understandably aren’t high on your priority list.

Instead of vaccinations, free riders’ parents claim other means of keeping their kids healthy. As Public Health professor ​Jennifer Reich argues​, parents of non-vaccinated children believe breastfeeding, superior nutrition, and controlled environments (i.e., not daycare) keep disease at bay.

With the lack of adequate maternity leave and laws to protect mothers’ rights to pump breast milk, nursing in America has become a purview of the privileged mother, whose job — or whose decision to stay home — allows a stable nursing relationship. And despite WIC, SNAP, and other variations of food stamps, access to fresh, healthy food is also often out of reach for the poor, especially those who inhabit so-called food deserts. Finally, working mothers must rely on some kind of childcare, often institutionalized daycare. Undervaccinated children simply don’t have access to the mythical protection free riders’ parents invoke. As one such mother tells Reich, "I think there are some vaccines that maybe some kids, maybe it’s okay for them to have, because maybe their parents. . . aren’t at all educated and . . . so maybe they do need to rely more on outside sources, because that is being done to them.”

Moreover, in general, children living in poverty have more government intervention in their lives. While it varies from state to state, and even social worker to social worker, many WIC recipients are required to produce shot records for their children. Social Services may use a lack of vaccinations as evidence of neglect. And as Reich says, more privileged parents “address experts as consultants and refuse their advice without fear of reprisal, choices less readily available to less privileged families, whose rejection of expert advice more easily results in state intervention, even around vaccination.” A poor black woman refusing to give her kid an MMR shot might not just get the side-eye. She might earn herself a visit from Social Services.

Free riders’ parents also often claim vaccine-preventable diseases are less dangerous than the vaccines themselves, particularly with illnesses like measles. Chicken pox (varicella) is seen as particularly innocuous, partly because most adults remember suffering through it with little more than an itch or two, and partly because of rumors that the vaccine will leave children vulnerable to shingles later in life (it won’t). Whatever the dangers of the diseases, allowing children to catch them costs time and money: time taken off work to care for them, lost wages, and doctors’ bills. It’s more than many parents can afford, especially those without access to family or medical leave. As a rule, poor people don’t throw pox parties.

Basically: It takes money and time to refuse vaccinations. And it’s a lack of that same money and time that often unintentionally keeps parents from fully vaccinating their children.

This has serious public health repercussions. The head of the Sabin Institute for Vaccine Research, Peter Hortez points out that when vaccine rates start to drop, the people who suffer will be “people who live in poor, crowded conditions. So it’s going to affect the poorest people in our country.”

Privileged white people refuse the vaccines in the name of individual freedom.

A drop in vaccination rates poses a danger to us all. But it poses a special danger to those least able to cope with serious illness, and least likely to be (unintentionally) fully vaccinated: minority, city-dwelling children.