What’s past is prologue

In the summer of 1854, London faced a devastating cholera outbreak in the Soho area. At that time, the dominant belief was that diseases arose from miasmas—foul air emitted by decomposing matter. People thought cholera was contracted by inhaling these vapors from sewage, unaware that the true culprit lurked in their drinking water.

John Snow, a physician, embarked on a mission to understand the disease's spread. He meticulously documented cases of cholera, noting where and when they occurred, and discerned a clear pattern: the source of the illness was the water from the Broad Street pump.

With solid evidence, Snow partnered with Rev. Henry Whitehead to advocate for the closure of the Broad Street pump. Initially, their claims were met with skepticism; the authorities were reluctant to act against established scientific beliefs and risk depriving the community of essential water access. They feared that the proposed solution might be more harmful than the disease itself—a sentiment that may resonate with today's challenges.

After considerable discussion, the authorities finally agreed to remove the pump handle, leading to a swift decline in the outbreak. While there is debate regarding whether the pump closure directly caused the decrease in cases, it is undeniable that the water was contaminated, and restricting access to it saved lives.

Though Rev. Whitehead believed illness was a divine act, Snow maintained a scientific approach, attributing the outbreak to a waterborne pathogen. Despite their differing views, they united in their mission to save lives, employing nothing but maps and interviews to intervene amid public skepticism.

John Snow passed away in 1858, and in 1866, London faced another cholera outbreak. Armed with knowledge gained from working with Snow, Rev. Whitehead took action to manage the crisis. Seventeen years later, Robert Koch identified the cholera bacterium, and scientists in Paris began work on a vaccine.

“Will you defeat them? Your demons, and all the non-believers? The plans that they have made?” — My Chemical Romance, Welcome To The Black Parade

Public health in the United States has always been intertwined with politics, a system established from the outset. While experts provide advice, ultimately, decisions are made by elected officials, influenced by public perception and the interests of campaign financiers.

During the late 1970s and early 1980s, the HIV-AIDS crisis was in full swing. At the time, the prevailing notion was that the disease predominantly affected men who have sex with men. Public health officials assured the public that heterosexual individuals were at no risk, despite knowing the virus could be transmitted through blood. This misinformation was perpetuated by officials from the Reagan administration and echoed by the media, despite their probing inquiries.

This lack of action resulted in countless individuals contracting HIV, believing they were safe due to their sexual orientation. Additionally, children with bleeding disorders received contaminated blood products because donors often concealed their risk factors. The ban on blood donations from LGBTQ+ individuals persists, yet many epidemiologists continue to urge the FDA to revise their policies, as testing methods have improved and treatment options are now available.

Despite these challenges, public health professionals remained dedicated to combating the epidemic. Pharmaceutical researchers continued to develop anti-retroviral therapies, and virologists and immunologists persisted in their search for a vaccine. Although funding was sometimes withdrawn due to misguided political or social pressures, those committed to defeating HIV refused to give up.

Consider this: the HIV pandemic has lasted over 40 years, and many who began working on it still strive for solutions. Their unwavering dedication exemplifies the spirit of public health advocates throughout history.

You Are Not Alone

When reflecting on what causes our anxiety and frustration, we often find that these issues are beyond our control. From protests disrupting cities in Canada to the spread of misinformation by anti-vaccine advocates, these challenges can feel overwhelming.

However, our response and our ability to unite against these adversities are within our control. Public health consists of countless individuals, each supported by friends and family ready to assist. For instance, when a man traveled from Mexico to New York City with smallpox, the city's residents rallied to get vaccinated. Similarly, when Jonas Salk introduced the polio vaccine, parents patiently stood in line to protect their children. More recently, during the rollout of the COVID-19 vaccine, a significant portion of the U.S. population eagerly participated.

Currently, Alabama has the lowest vaccination rate in the country at 49.8%. Given the state's recent voting patterns, it appears that many conservative individuals are choosing to get vaccinated. However, it’s essential to recognize that viewing this situation through a lens of fear overlooks the reality that many are choosing science and health. States like Vermont and Florida demonstrate that vaccination debates are more about noise than substance.

The anti-vaccine movement thrives on creating feelings of isolation and despair. They may be loud, but they are a minority, often misrepresenting the scientific community. The majority of scientists support vaccination and public health initiatives.

Public Health Rises

In a previous post, I expressed concerns about the current state of public health, feeling disheartened by the challenges we face. Yet, conversing with students, colleagues, and friends shifted my perspective. My students are brimming with optimism and creativity, ready to tackle the issues ahead.

I am fortunate to know remarkable individuals—from philanthropists aiming to prevent future pandemics to advocates working tirelessly behind the scenes to avert crises. I collaborate with dedicated professionals in my local health department, academic institutions, and professional organizations, all of whom possess the knowledge and resilience to confront any challenge posed by skeptics and shortsighted politicians.

Did you think we would endure years of education and training only to concede to those who prioritize profit over people? Did you truly believe we would abandon our mission of saving lives?

If so, you don’t understand public servants very well.

So, bring your best arguments, science deniers; we’re ready to intervene... once again.

Cut to a diverse group of public health workers, healthcare providers, scientists, and community members, all poised to make a difference.

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Thank you!

René F. Najera, MPH, DrPH, is a public health doctor, epidemiologist, amateur photographer, running/cycling/swimming enthusiast, husband, father, and "all-around great guy." You can find him working as an epidemiologist at a local health department in Virginia, enjoying tacos at a local taquería, or teaching at a university in northern Virginia as an adjunct in the Department of Global and Community Health. All opinions expressed in this blog post are his own and do not necessarily reflect the views of his employers, friends, family, or acquaintances.