We've Been Here Before: Learning from Historical Responses to Epidemics

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As we close the month of June, the United States also closes out the 5th month of COVID response in this country—and we’re not even close to done with this pandemic. In these 5 months, we’ve learned a lot about the SARS-CoV-2 virus which causes COVID-19 and about ourselves. During these months, epidemiologists (like me) have watched in horror as our efforts to control the spread of the disease have been thwarted—sometimes, it seems, intentionally—by people in power. It’s been shocking and heartbreaking to watch case counts here in the United States plateau only to spike again. It’s been particularly agonising watching Nations like the Yakama and Navajo be so consistently denied the resources they need to protect their communities.

As of 28 June 2020, there have been 4,933,972 cases of COVID reported in the Americas region. Of those, 2,452,048 have been reported in the United States. This means that 49.70% of cases occurring in the Western Hemisphere occurred in the United States. For comparison, the population of the United States makes up 33.18% of the population of the Americas Region. This means we have 49.70% of the cases and despite making up just 33.18% of the population. Even without taking into account that the United States as a large, wealthy country should have some of the lowest communicable disease numbers, this discrepancy is shocking.

Something is clearly wrong here and the course needs to be corrected. It’s not impossible to break the chain of transmission, but it takes hard work and plenty of bravery on the part of elected officials. Thankfully, history is littered with success stories when humans have controlled the spread of diseases. For some of these lessons, we don’t even have to look back farther than a half century.

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Season’s Greetings: Welcome to Influenza Season

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The air is crisp, the days are shortening, Starbucks is hocking their pumpkin spice creations, and I see people sneezing into their hands everywhere I go. Although we often think of there being only four seasons, many cultures recognise more than just those four. In Bangladesh, there are 6 in total and autumn is broken into shorotkal (early autumn) and hemontokal (late autumn). For public health practitioners, we also acknowledge a special season: Influenza Season.

Public Health measures the calendar year broken into what we call CDC or Morbidity and Mortality Weekly Report (MMWR) weeks. They run Sunday-Saturday and Week 1 begins the first Sunday of each year. Influenza Season (in the Northern Hemisphere) is generally considered to be between Week 40 (around the first week of October) through Week 20 (the end of May).

Unfortunately, just as cold, dry air makes our noses more hospitable to the virus entering our bodies and and poorer weather keeps us indoors, school also begins and large numbers of children spend whole days sneezing on each other and refusing to wash their hands. It’s an annual recipe for disaster.

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Medicines and Vaccines Part 3: Is it the Water or the Vaccines?

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In this last part of our medicines and vaccines series, we’re going to talk about how vaccines work and how we know they do. I know that vaccines are a contentious topic and I want to start by acknowledging that sometimes delaying or forgoing a vaccine is the evidence-based decision. If someone is pregnant, they shouldn’t have the varicella (chickenpox) vaccine. A child with leukemia probably shouldn’t get the measles, mumps, and rubella (MMR) vaccine. Those conditions which make vaccines temporarily or permanently unsafe for an individual are, thankfully, very, very rare. For most humans, following the CDC vaccine schedule is safe and will provide both them and their contacts with protection against those diseases.

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Medicines and Vaccines Part 2: Bringing Essential Medicines to Market

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In our last piece, we talked about the pharmaceutical development pipeline and how some drugs are repurposed from other medicines, rather than being discovered as a new medicine completely. In this post I’ll talk about what that pipeline looks like for antibiotics and vaccines, two of the most important types of medicines that we have. 

Vaccines and antibiotics, like all medications, are very expensive to produce (as we discussed in Part 1), but they can’t be sold for the same high prices as nonessential (think Viagra) medications. This creates a problem for the development pipeline: how can companies afford to take risks on new development for products that won’t cover the cost of producing them? The answer was surprising for me when I first started studying public health. 

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Medicines and Vaccines Part 1: The Pharmaceutical Pipeline

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I often hear people express concern that pharmaceutical companies (Big Pharma) are making a killing on medications and vaccines and fear that we can’t trust them because of it. I also feel a lot of discomfort with pharmaceutical companies skyrocketing the prices for products like daraprim and epi pens. Drugs are really, really, really expensive to make and somebody has to foot the cost for developing them, but we also have people dying because they can’t afford the basic medications they need to live. There has to be a better way, but it’s hard to know what to think when the process is so mysterious. This piece is the first in a 3 part series on how medicines and vaccines are made and what they do. We won’t be able to cover every aspect of it because 1. that’s the stuff of dissertations and 2. I honestly don’t know all of it, but we’ll go through an overview of how the very basics.

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Vaccine Hesitancy: A Case for Compassion

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The purpose of writing this isn’t to shame parents who are vaccine hesitant or vaccine resistant or even to convince you with data. The purpose isn't to make anyone feel like they don't love their children enough or somehow aren't smart enough to be parents. Or, honestly, to make you think that I think those things. The point of writing this is to speak to the parents who are frustrated and frightened by the declining immunisation rates in places like Vashon Island in Washington State, who are worried when they see a notice come home that there’s been an outbreak of a vaccine-preventable disease in their child’s school. It’s scary for parents whose children are potentially exposed and school exclusions, while effective, can cause frustration in affected communities. 

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