When I was an undergraduate at Johns Hopkins University, I had only a dim awareness of the measles outbreak then raging through Baltimore. I was fully vaccinated, spent most of my time on campus, and lived in university housing among mostly white, middle and upper-middle class students, who were also fully vaccinated. Measles, for me, was a remote thing, despite its proximity. It didn’t happen to anyone I knew.
But too many children in Baltimore were not so fortunate. This highly contagious and serious disease sickened around 500 area residents, mostly children, and caused a third of them to wind up in the hospital. Across the nation, thousands of people were afflicted during that outbreak and 41 died.
A majority of victims in Baltimore were poor and African American or Hispanic. Vulnerable to barriers like cost and healthcare access, they were unvaccinated—or under-vaccinated—not by choice but by circumstances.
Overcoming social privilege through science-based policies
Today, as the Disneyland measles outbreak continues to unfold, the demographics have changed somewhat. Many white, educated, affluent parents are choosing not to vaccinate their children. However, individuals under-vaccinated by circumstances still tend to be poor and black, placed at greater risk of preventable illness by the decisions of others.
The choice not to vaccinate, often framed in terms of individual liberties, is not just a personal one. It’s infused with privilege and has consequences for those who have less freedom to choose—not only those who have difficulty accessing healthcare but children who are too young to be vaccinated and people with compromised immune systems.
In the wake of the Baltimore outbreak during my college years, both the city and the State of Maryland made important policy changes that improved access to immunizations and empowered residents to protect themselves and their communities through science-driven interventions. Clinics added extra hours; walk-in appointments were permitted; a pre-vaccination physical exam was no longer required; and vaccines were offered free of charge.
But will these measures be enough to keep Baltimore measles free?
Baltimore statement on childhood vaccination
Along with public engagement efforts, Baltimore’s policies have paid off over time. As the current Baltimore City health commissioner, Dr. Leana S. Wen, put it in a public statement this week, “For the last ten years, our city has seen zero measles infections. Zero hospitalizations. Zero permanent injuries. Zero deaths.”
Dr. Wen made her remarks at a symposium I attended organized by the Johns Hopkins School of Public Health. Sitting in an auditorium at my alma mater hearing Dr. Wen speak made me proud of my school and the city I once called home, but I also keenly appreciated how much my perspective during that outbreak in my college years had been shaped by social privilege as much as by the success of vaccines. I didn’t worry about measles because, unlike the kids in nearby neighborhoods, my parents—and the parents of my friends and the parents of their friends—had easy access to medical care. They had us vaccinated as children and, in doing so, created a level of protection against disease in our communities that was unprecedented in human history.
Yet it is this unprecedented freedom from diseases once a scourge to humanity that has created a different and dangerous kind of privileged perspective—a distortion of risks that rejects science for sickness and places the personal freedom to chance disease above the public will to stay well.
Balancing individual liberties with safeguards to protect the common good has always been a challenge for our democracy, even as science has advanced and policy has worked hard to keep pace. From the audience, I felt the passion—and compassion—in Dr. Wen’s voice as she tried to navigate this complexity. “Baltimore is not an island,” she cautioned, reminding us of the precariousness of her city’s success:
“Despite consensus among doctors and scientists that vaccines are safe and effective, there have been increasing numbers of parents who have chosen not to vaccinate their children. In 2014, there were 644 cases of measles across 27 states.
“The recent outbreak that began at Disneyland is spreading among unvaccinated children. As a result, parents of children who are not able to be vaccinated, such as those under one year of age and those with weakened immune systems, are fearful of illness and complications. The Disneyland outbreak raises the real risk that measles may come roaring back.
“We have come too far to let that happen …. “
Baltimore is not an island
Even as initiatives like Baltimore’s have helped to democratize access to vaccines and reduce racial and ethnic disparities in immunization rates, rising personal belief exemptions across many states mean that we can no longer count on community immunity (the discovery of Arthur Hedrich, another Baltimorean and Johns Hopkins scientist) to safeguard the vulnerable groups Dr. Wen mentioned. To sustain community immunity, localities, states, and the federal government must work together.
Baltimore—its science-based policies and high vaccination rates notwithstanding—cannot maintain its freedom from measles forever, as long as other localities lack stronger safeguards to stop the spread of this preventable disease.
In retrospect, even though I attended college steeped in the culture of Hopkins’ highly regarded achievements in science and medicine, I now recognize that as a student I took my health and my freedom from diseases like measles for granted. Are we not doing the same thing today when we fear vaccines more than the diseases they have prevented so many of us from ever having suffered? Are we not taking both science and democracy for granted if we pretend that privilege equals personal freedom and knowledge carries no responsibility to act on behalf of the public good?