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The Nation Can't Afford Further Backsliding on Public Health

Proven measures to protect health such as vaccines and even fluoridation are under increasing threat. Misinformation must be combated with facts about the way these interventions save lives.

Even as vaccination rates for traditional childhood diseases are declining, some states are easing school-entry requirements.
Christina House/TNS
Vaccines. Water fluoridation. Quarantines and isolation. These are critical public health strategies with a proven track record of preventing disease. In fact, they are recognized as effective, with vaccines and water fluoridation cited among the 10 great public health achievements of the 20th century, contributing to dramatic improvements in health and life expectancy in the United States. But thanks in part to a recent barrage of misinformation, declining trust in science and government, and even intentional disinformation that was accelerated by the polarization of the COVID-19 pandemic, these vital prevention strategies are now plagued with public perception issues.

These issues add to longstanding public health challenges of chronic lack of investment and sense of urgency to protect against threats that, when they are under control, go unnoticed. With the extreme right’s politicization of medicine overlaying these challenges, we’re in danger of moving backward on public health. That’s why it’s imperative to reflect on the historic public health improvements these strategies have spearheaded and continue building support for the public health authorities that enable them.

Take the case of state childhood vaccination laws. State laws generally require certain types of routine childhood vaccinations against diseases including measles, polio and tetanus for school entry. These laws exist because they help maintain high vaccination coverage rates, and vaccines are one of the most low-cost and effective strategies known to prevent disease and prolong life. However, rates of routine vaccination for preventable diseases among kindergarteners have been dropping since the 2020-2021 school year and remain below the 95 percent target level needed to prevent community spread.

These lower vaccination rates increase the risk of outbreaks of highly contagious diseases, as we’ve seen with measles cases this year and polio in 2022. As of March 21, there have been 64 confirmed measles cases across 17 states or jurisdictions in 2024 — more cases than were reported for all of 2023. The outbreaks include a center for new migrants in Chicago and an elementary school in Florida, where the state’s surgeon general failed to recommend vaccines and left the decision to families about whether to keep unvaccinated children home, as experts and the CDC advise. Alarmingly, in July 2022, New York reported that a man in Rockland County had contracted the first known case of polio in the U.S. since 2013. The man, paralyzed as a result of his infection, was not vaccinated.

Despite the risks associated with insufficient vaccination levels, proposed laws in some states would relax rather than strengthen vaccine requirements. In West Virginia — a state that had one of the most comprehensive vaccination requirements for more than 30 years, and had among the highest school vaccination rates in the country for decades — the state Legislature recently voted to exempt students who attend private schools or public schools remotely from state vaccination requirements. Mississippi, another former childhood vaccination leader, recently permitted new vaccine exemptions for religious reasons following a lawsuit funded by a leading source of vaccine disinformation. Tennessee passed a law last year allowing only birth parents and legal guardians, not foster parents or other caregivers, to provide vaccination consent. On Monday, the Tennessee Legislature voted to eliminate requirements for flu and whooping cough vaccinations for adoptive and foster families.

Apart from threats to routine childhood vaccinations, we’re also seeing backsliding against water fluoridation. Tooth decay — the most common chronic disease among children 6 to 19 years old — is a preventable disease. Water fluoridation laws have existed for decades because they reduce tooth decay without requiring anyone to adopt new behaviors, and those laws benefit all community members. Yet disinformation on water fluoridation has flourished. Research in 2022 found that Instagram posts with claims about toxicity of fluoridated water are “frequently motivated by financial interests.” Recent bills in Georgia and Kentucky, under the guise of local control, would reduce the state’s authority to regulate water fluoridation and make local water fluoridation programs optional.

Finally, public health leaders face broad challenges to their expertise and decision-making during emergencies. Over the first two years of the COVID-19 pandemic, as science about the virus and the guidance based on that science evolved in real time, more than 40 percent of all public health executives reported feeling bullied, threatened or harassed by people opposing health measures, while over half had their public health expertise challenged or undermined.

Recently, states have been introducing and enacting laws that threaten emergency response based on personal and political ideology; in some cases, lobbyists with corporate interests are drafting legislation and circulating it nationally with the intent of limiting state public health authority. In 2021 and 2022, 43 states enacted nearly 200 new laws that modified emergency health authority, limiting the power of public health officials. As recent examples, South Carolina and Kansas have considered bills in 2024 that would revoke their state health agency’s authority to order quarantines, an effective strategy known to prevent disease transmission.

Vaccinations, water fluoridation and public health scientists’ ability to curb the spread of infectious diseases are only a few of the many public health policies that have improved health and life expectancy in America. Coming out of a pandemic that led to more than 1 million deaths in its first 30 months is not the time to retreat from effective public health strategies.

Building and restoring trust in science and public health — an effort aided by engaging communities and leaders, making data transparent, communicating clearly and acknowledging missteps — is increasingly critical to ensure new laws won’t restrict the lifesaving measures that may be needed when our next crisis inevitably hits.

Jill Rosenthal is the director of public health policy at the Center for American Progress.

Governing’s opinion columns reflect the views of their authors and not necessarily those of Governing’s editors or management.
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