I have posted my comments on the issue, and I think you should, too. Given the reforms happening across Europe right now, this debate is timely and critically important. You can read the current debate thread at:

http://www.debatingeurope.eu/2011/11/14/what-should-european-healthcare-look-like/

As you have no doubt noticed, the blog has been inactive recently.  This is because I have been focusing my efforts elsewhere, but also because I have realized that the ghtech site is not doing as much as it could to help global health.

When I first set up this site, I was using it as a learning tool for myself, both to learn about site maintenance and blogging as well as about global health.  Now that I’ve been at it a while, it has come time to repurpose the ghtech site to make it more useful to people working in global health.  This redesign will remove parts of the site and add new parts, with particular emphasis on the following:

• Tools for global health, including web/communication tools and analysis tools
• Forums for experts in global health technology to gather and share thoughts about their work, present challenges, and hopefully get solutions from other members of the forum
• Blog from experts in the field, highlighting recent work and its applicability to global health and technology

I have already begun this redesign, and I expect the full process to take several months.  If you would like to help with this process, become a site co-owner, or have suggestions about how to make the ghtech site better, please don’t hesitate to contact me at:

I thank you for your patience.

Here’s the main point: although there are side effects to vaccines, these side effects are vastly more rare and vastly less serious than the disease the vaccines prevent. And, there’s an important corollary to this point that the Seattle Weekly did a great job of mentioning: herd immunity. If someone does not want to immunize their children, that should be their choice. But what about the child of the family without access to services, or the child of the parents who don’t know to vaccinate? Now they are vulnerable because the Refuser hasn’t vaccinated his children. Herd immunity protects unvaccinated people by vaccinating everyone else, but it doesn’t work unless a certain fraction (usually quite high) of the population is vaccinated! For polio, as I mentioned in a previous post, this percentage is upwards of 85%, and for measles, the percentage of people that need to be vaccinated to protect everyone is as high as 94%. So, even a few Refusers can compromise an entire vaccination program. This, it seems to me, is selfish. I know Refusers are simply trying to protect their children, and this is admirable. But, are they really protecting their children, and is this ethical if it comes at the expense of other peoples’ children? I vote no.

Public health as a discipline was a long time in coming on this planet, and I for one refuse to let the Refusers compromise the amazing advances the field has made. Who reading this post has had polio? Measles? Mumps? Were you vaccinated for these diseases? Do you have autism? I myself had pertussis as a child, and chicken pox, but these are now both vaccine-preventable. I did not have polio, measles, mumps, rubella, or tetanus.

Here’s a suggestion that meets the needs of the Refusers as well as the rest of the population of the planet: you may refuse to vaccinate yourself or your children, but then you will be subject to travel restrictions for the rest of your life so that you do not endanger anyone else who may not be vaccinated. This way, at least the only people who will die of these diseases will have an explanation as to why they are dying. I leave you with some pictures of vaccine-preventable illnesses, noting that these people may be dead as a result of their illnesses. Judge for yourself.

A man with an atrophied leg as a result of polio. Photo from Centers for Disease Control and Prevention (#134).

A boy with diptheria in Vietnam has a pacemaker to keep him alive. Photo copyright Science Photo Library (M935/0102).

A boy with rubella. Photo by US Centers for Disease Control and Prevention.

A child with measles. Of the children with measles in this ward when this photo was taken, several died. Photo by Julian Harneis.

I just watched Bruce Aylward’s TED talk, and it was an amazing display of how new technologies are enabling humanity to meet the most difficult of challenges, the eradication of all three types of the polio virus from the face of the earth. There has been an active debate of late about whether polio eradication is the right thing to do, or even possible to do. This was due in part to a resurgence of polio cases and outbreaks across the world in recent years. However, Dr. Aylward says in his talk that not eradicating polio stands as “a stark reminder that we are failing, as a society, to reach children with the most basic of services”. In this, and the quote at the title of this post, he makes a convincing Rawlsian argument that polio eradication is both just and fair, and that due to the way that such eradication is being attempted, it also serves as a marker of how all childrens’ access to essential medicines is progressing. A huge army of volunteers hikes to the most remote places on the planet, through heat, extreme cold, and war zones, to administer two drops of oral vaccine to every single child. This is the only way to eradicate the virus, and to accomplish this would mean that we can access every child on the planet. Indeed, these same volunteers often bundle many health care services into every visit, including other vaccines, malaria bed nets, and vitamin drops. But how to ensure that every single child is vaccinated? This is where technology is playing a huge role. Satellite imaging provides new views of where the children and the infections are (remote villages, slums, and other areas not on other maps), and GIS sensors given to the volunteers track where they go. Overlaying these two technologies allows teams to see that every street has been walked down, every village visited, and hopefully every child vaccinated. In his talk, he also presented a graph depicting polio cases over time, and showed with digital geographic accuracy that for the first time in history this year, no new polio paralyses have been detected in the two most problematic Indian states, Bihar and Uttar Pradesh. All in all, a tour de force for the eradicationists, and a death knell for the “let’s control it” argument.

One point not covered in the TED talk but worth noting is the effect of herd immunity in eradication of polio. Given that only 95% of vaccinated individuals develop immunity to polio (i.e., 5% vaccination failure rate), there will always be at least 5% of the population that is susceptible to polio. However, it has been estimated that herd immunity will protect these susceptible individuals if between 80 and 86% of all people are immune. So, it is important not only to get the vaccination rate as high as possible, but to keep it there forever.

I think this effort is amazing. Every child on the planet getting the same vaccine, now and forever. Although two other diseases have been eradicated from the planet, smallpox and rinderpest, neither of these involved the scale of the polio effort due to the endemic countries affected and the number of susceptible individuals in these countries. Surely this is the first time in history a global disease eradication of this magnitude has been attempted, and if successful, it will open a new chapter in humanity’s ability care for itself.

There is an abundance of evidence now (and has been for decades) that a vegetarian diet is not only better for individual health, but also better for global sustainability.  And yet, those of us vegetarians know that we count for, at most, 10% of the population of developed countries like the US or Canada.  The result of that statistic is that the numbers of animals killed for food every year are staggering.   Figure 1 shows the annual meat consumption per capita in kg/person.  Although even the poorest countries in the world have some level of meat consumption, in the G20 countries the numbers are far higher.

Figure 1. Annual meat consumption per capita. From www.chartsbin.com

Worse, as formerly developing countries become economic powerhouses, the meat consumption there is rising dramatically.  Meat consumption, despite the suffering to people and other animals it causes, is a sign of wealth and privilege.  This places it outside of the realm of logic and in the realm of emotion, making the changing of attitudes very difficult.

One of my favorite books on vegetarianism is A Vegetarian Sourcebook by Keith Akers, which you can get for free here.  Akers dedicates three chapters to an in-depth discussion of the role of vegetarianism and its history across the major world religions, two chapters to the philosophy of vegetarianism, and one chapter to vegetarian ethics specifically, comprising in all a third of his book.  Reading these chapters gives a clear view of how the originators of the world’s religions thought about meat consumption, and that even back then, when meat consumption involved a far different process and costs, there was significant debate on the subject.  My view:  the problem is that diet is tightly linked to views about destiny.  If you accept the view that humans are “supposed” to eat animals, or that certain animals are “born to become food”, then you are rejecting any other possible outcomes, and you are frozen in your thinking.  The simple facts as I see them now (and I spent 22 years eating meat before I switched) are these:  (1) the planet will not sustain the level of meat consumption we currently have, (2) meat consumption is not necessary for human survival or prosperity, and (3) lowering meat consumption improves individual and thus global health.

It’s your choice about what to do, but you’d better decide fast.