Why is measles back?

IT'S BACK. Fifteen years after the Centers for Disease Control and Prevention (CDC) declared measles effectively eradicated in the U.S.--a rare victory for public health in our profoundly privatized health care system--we now have a large-scale outbreak that has infected well over 100 people in at least 17 states. That puts the country on a pace to surpass last year's total of 644 cases, itself the highest total since the turn of the century.

Unlike Ebola, which is spread through direct contact with bodily fluids of infected persons, measles can be spread through the air and easily contracted by being in the same proximity as another infected person. Measles can be fatal, but this is true less than 0.2 percent of the time in the U.S. Much more common complications from measles include pneumonia and brain swelling, as well as premature birth for pregnant women.

The point is that a measles outbreak is an important public health matter that should not be taken lightly. Instead many conservative politicians are responding with criminal negligence.

Because a wing of the anti-vaccine movement is made up of conservative Christians, some Republican presidential candidates are clearly more worried about votes in 2016 rather than potentially devastating diseases in 2015.

Kentucky Sen. Rand Paul actively undermined vaccination efforts by validating the thoroughly discredited claim of a connection between vaccinations and autism by referring to "tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines."

Then, of course, there's New Jersey Gov. Chris Christie, a virtual human highlight reel of rank hypocrisy and opportunism. When the subject was quarantining a nurse who was exposed to Ebola but showed no symptoms of having contracted it, Christie initially argued that she should be forced by the state to live in a tent for 21 days, even though public health officials deemed this completely unnecessary.

But when it comes to vaccines, which most public officials agree should be mandatory, Christie argued, "It's more important what you think as a parent than what you think as a public official. I also understand that parents need to have some measure of choice in things as well. So that's the balance that the government has to decide."

THE ANTI-vaccine movement--bolstered by politicians, celebrities like Jenny McCarthy and a sensationalist-driven media--is squarely to blame for the resurgence of measles over the past several years, but it's not alone.

The 2000s have been an era of crisis in health care access, when the uninsured population grew to over 50 million. In 2013, 32 percent of uninsured children under the age of 6 didn't make it to a well-child appointment, whereas this was the case for only 8 percent of insured children. So clearly the extent to which health care reform resolves the health care access question is of some importance in this debate.

For now, however, the need to convince those people influenced by the anti-vaxx movement is the urgent public health question of the day. In particular, there's a need to win the argument in those areas that are specifically undermining what is known as herd immunity--because when this is lost, a critical mass of unvaccinated people can allow a disease to take hold and spread.

In other words, there's a need to break up the small but significant geographically-based pockets of the population where there are very low rates of vaccination.

This will not be easy. The dominant groupings are, on the one hand, small but significant pockets of Christian fundamentalists and other religious-based communities, and, on the other, more affluent liberal communities, particularly centered in northern California.

Anti-vaxx sentiment grew sharply across the board after a 1998 study associated the measles, mumps and rubella vaccine (MMR) with increases in the number of diagnosed cases of autism--and it continued, albeit in a diminished way, long after that study was thoroughly discredited.

There are understandable reasons for the widespread popular anger at the anti-vaxx movement. First, no matter what the nature of the concern about vaccines, opting out of vaccination is a highly individualized response that, in this case, puts thousands of others in very real danger.

Second, the stubborn refusal to grapple with actual evidence--again with very real consequences for other people--undermines the justified concerns many people have about the nature of the relationship between pharmaceutical companies, profit and health care.

In addition, the constant efforts to convince anti-vaxxers by disproving the connection between MMR vaccine and autism over and over again has diverted resources away from researching actual causes of the explosion of Autistic Spectrum Disorder (ASD) rates in the U.S. over the past two decades.

Finally, there is the misguided underlying assumption of many anti-vaxxers that the risk of a child getting autism is worse than of contracting a potentially deadly disease. As Sarah Kurchak--who has ASD--argued in an article titled I'm Autistic, and Believe Me, It's a Lot Better Than Measles, "For starters, we could talk about people on the spectrum like we're better than measles, like we're human, or like we're there at all."

UNFORTUNATELY, THE dominant approach of the mainstream media as well as most of the social media discussion has been to polemically chastise, ridicule and moralize against anti-vaxxers.

In recent weeks, the Internet lit up with articles like "The anti-vaccine movement should be ridiculed, because shame works" and "Anti-vaxxers are stupid and contagious."

Amy Tuteur's "What everybody gets wrong about anti-vaccine parents" attempted to go beyond the "people are just stupid" hypothesis. But the thrust of the Tuteur's explanation--that the anti-vaxx movement is rooted in a triumvirate of American privilege, knee-jerk anti-authoritarianism, and that pesky human desire for empowerment--illuminates more about establishment liberal thinking than it does about the anti-vaxx movement.

This is precisely where the liberal response to anti-vaxxers has the potential to broaden into a more general attack on some left-wing political ideas and principles.

First of all, the privilege argument is a cheap shot, willfully distorting the economic status of Marin County in Northern California, one point of concentration of anti-vaxx sentiment, to paint a distorted picture of how most Americans experience health care. As a pediatric emergency room nurse at a public hospital in the Bronx, I wouldn't say that that most Americans experience health care from a place of privilege.

More importantly, capitalism profoundly distorts scientific research and medical practice. Nowhere is this more apparent that in the historically criminal behavior of the pharmaceutical industry, whose distortion of the scientific method in the name of profits has directly killed hundreds of thousands of people through developing unsafe medications and has left millions more to die by economically denying them needed treatment.

While there is little factual basis for not vaccinating your children because they might get ASD, our starting point has to acknowledge that skepticism about American medical practice is far from irrational.

As for empowerment, the author conflates the ill-fated attempts at individual empowerment by middle-class anti-vaxx parents with the very real need for collective empowerment of the entire working class when it comes to health care information, access and treatment options.

For a time, the polio vaccine used live polio. It turned out this wasn't a good idea. Fealty to the "experts" in government, the pharmaceutical industry and the medical profession doesn't always--or even most of the time--result in the best health care practices.

ACCORDING TO Tuteur, "We have to hit anti-vax parents where they live: in their unmerited sense of superiority."

The emphasis on people's lack of intelligence and ignorance of scientific research--or their supposed excess of privilege, superiority and empowerment--are all horrible places to start when trying to win an argument with real stakes for public health.

"The shaming and the anger and the 'you're dumb' kind of stuff that people are doing isn't working," said educational psychologist Lori Day on CNN. "I think it is making people dig in more, and it seems to me what has to happen is a different type of dialogue that is a little bit more empathetic and more listening and more saying, 'I understand how you feel and that this is scary.'"

But more than dialogue is necessary. The neoliberal restructuring of health care is a key force undermining public health and public health consciousness--with important consequences. In an article in the New Republic comparing attitudes about public health in the U.S. and Sweden, Elizabeth Stoker Bruenig argues that:

The idea that everyone should ultimately be individually responsible for her own health directly animates the idea that there need be no unified, reliable health care system--and those two ideas preclude anything approaching Sweden's trust in health care or society at large. Individualism begets individualist politics, both of which encourage the type of thinking anti-vaccination advocates appear prone to.

In short, the focus on the bad ideas of individuals or small groups lets the system off the hook.

Especially for the left, it's important to understand where some of the misplaced paranoia is rooted, so as to acknowledge the kernel of truth in the anti-vaxx argument. While today it may be a sliver of easily ridiculed pockets of middle-class communities, the major pillars of public health consciousness are eroding among a much larger sections of the population.

We need an approach that validates and further articulates the real contradictions of health and capitalism as a starting point for then understanding where real scientific knowledge can be extracted in the current morass of the profit-driven priorities of health information.

Moreover, we need a movement, led by health care workers and patients, that removes profit out of health care. This means single-payer health care, publicly rather than privately funded health care research, significantly greater regulation, and the expansion of the public health care infrastructure.

Maybe then we can begin to rebuild trust back into a vibrant public health system and a true sense of collective empowerment, which then would undermine the current perception that individual solutions are the only ones on offer.