Ever since the vaccines for COVID-19 became available, the public health data has been very clear. Vaccines prevent serious disease and death, while the unvaccinated suffer more serious disease, higher rates of hospitalization and higher mortality. Nearly a year has passed since vaccines have been available and nearly 64% of the population has been fully vaccinated. From those who’ve chosen to remain unvaccinated — not counting those who are too young to be eligible — you will hear a number of different reasons for their decision, including personal choice or concerns about the vaccines not being well tested. But underlying all of these reasons is most likely a lack of understanding about public health, and a breakdown in the chain of trust in our society.
Defining public health can be difficult, as it is a broad field. Simply put, it is what we do to prevent disease, prolong life and promote physical health. At the minimum, it includes keeping water safe to drink, food safe to eat and the population free from infectious disease.
Public health is related to, but different from, what most of think of as medicine. Medical care focuses on individual patients and physicians treating those who are ill. With public health the “patient” is the community or even the whole country. There is a strong science component in public health and lots of data collection and analysis. But there is also an important governmental component, as federal, state and local governments must carry through on the recommendations of public health experts.
Our understanding of disease and consequent measures taken by the government to promote public health have been highly successful throughout history. During the 19th century, life expectancy was only around 50 years old. Tuberculosis, smallpox and typhoid were common causes of death before the age of 25. Since implementing strong public health measures, the average life span in this country has increased by decades, to 79 years in 2019. Most of us receive vaccinations during childhood that keep us safe from measles, chickenpox, rubella, pertussis and number of other infectious diseases. We get vaccinated in adult years, as well, for tetanus, shingles, pertussis and bacterial pneumonia. Good public health measures save lives and decrease medical costs.
Given the proven success of public health measures, where did things go wrong with COVID? The crisis is real, with more than 900,000 Americans dying of COVID, yet only two-thirds of this country fully vaccinated.
As an educator, I think the great success story of public health needs to be taught and celebrated, maybe in a high school curriculum, just as we teach other aspects of history. It offers an excellent example of how we have been able to balance the needs of the community with the emphasis on individual freedom in this country. No one lost their freedom by being vaccinated against polio; it guaranteed them freedom from a crippling infection.
Inherent to the success of public health programs is trust: trust that the scientists working on these issues are rigorous and unbiased in their studies; trust that government officials in implementing the public health measures are balancing all the needs in the community, while keeping people safe. We have a long history of accomplishments in this area, but all of us need to be reminded, occasionally, that our lifestyles, longevity and freedoms are largely due to public health measures. We also need to better reach parts of our society who have not always shared in this success.
If we can find a way to educate the next generation with a better understanding of public health, and empower them to ask good questions, we will generate even wider acceptance of public health measures and perhaps avoid another aversion to vaccination in the future.
George Delahunty (email@example.com) is professor emeritus at Goucher College and co-founder of the school’s Post-Bac Premedical Program and Public Health minor.