We have made remarkable progress in global disease prevention.
We have developed a vaccine to eliminate COVID 19.
We have an effective “cure” for AIDS.
We have eradicated childhood diseases including measles, whooping cough, chickenpox, polio, and mumps.
But we haven’t.
Because of the last mile.
The last mile is the term health officials use to describe bringing prevention treatment to the population. And it has always been its Achilles heel. COVID-19 is a good example, we have the “magic bullet,” but it is unlikely that we will ever eliminate COVID-19.
If everyone had taken the first COVID-19 vaccines, the disease would be in our rear view mirror. But since many refused to be vaccinated and it was unavailable to the young, it is probably too late. Unvaccinated people will continue to be a breeding ground for new mutations of the virus. Vaccines will be playing catchup for the foreseeable future. For those of us who try to protect society by doing the right thing and getting our vaccinations, it is a hard pill to swallow. And in our frustration and anger, we jump to judgement. The last mile, so close.
There is a resurgence in heretofore eliminated childhood diseases. Recent research (2019) identifies the availability of nonmedical exemptions (NME) for vaccinations as the culprit. Measles (rubeola) is a highly contagious, vaccine-preventable illness. Since 2014, an illness once eliminated has been reappearing due to low vaccination rates. Mumps has found its way onto college campuses (even Loyola University in Maryland), Patient Zero has consistently been identified as an unvaccinated student. Whooping cough infected 9,000 students in California, the source—an unvaccinated student. Chickenpox has reappeared, once again, the source—unvaccinated students.
While there are some religious exemptions, most parents choose not to vaccinate their children because of misinformation or fear. Many parents who request an exemption cling to the repudiated belief that vaccines cause autism. Others feel that as long as other parents are doing it, they didn’t need to expose their own children. And finally, there are anti-vaxers who are simply misinformed.
Sitting on the school board it was hard to listen to parents’ pleas to not immunize their child, knowing that I vaccinated my child for the good of the community.
HIV/AIDS has a similar pattern, but for different reasons. In the 80’s, HIV/AIDS was the number one killer of young people, more than suicide, more than accidents, more than drug overdoses. Dedicated scientists spent billions of dollars to bring us a type of cure. Not the vaccination they had hoped for, but an innovative way to prevent the spread of the disease, using a two-pronged approach.
Decades of research revealed that the HIV/AIDS virus mutated so rapidly that a vaccine virtually impossible. So, they decided to attack HIV/AIDS using a novel methodology aimed at two populations: the infected and the uninfected, at-risk population. Much like the malaria drugs that we take when we go overseas, PReP is a medication developed by scientists to prevent those at risk from contracting the HIV/AIDS virus. Scientists also developed medications for those infected with HIV/AIDS (called TasP) that reduced the virus load to “undetectable,” so that infected people could not transmit the virus.
But then came the last mile.
Early on, public health officials recognized that many people with HIV/AIDS lived on the margins of society. Sex workers, drug users, the mentally ill, homeless, low education, the abused, and closeted or untested LBGTQ individuals were key transmitters of the disease. And how the states addressed the last mile appears to be about judgement.
In San Francisco, health workers went on the streets searching for infected and at-risk individuals to offer them tests and medication. They provided free health care and HIV/AIDS medications. Subsequently, (before COVID 19) new HIV/AIDS infections dropped substantially.
A NOVA documentary covered the rise of HIV/AIDS in southeastern states. A handful of states in the south are responsible for 50% of all new HIV/AIDS cases nationally. Ten percent of these residents have no access to healthcare, healthcare insurance, or financial assistance, despite the prohibitive cost of HIV/AIDS medicines ($2,000 per month). Some Federal assistance is available, but in those states with large Christian populations that preach “morality,” there is little aid to those who are vulnerable. I suspect that the reason for this is judgement.
People who live on the margins of society can be challenging. But these dedicated healthcare professionals are able to care for them wholly without judgement. They understand that they cannot know the issues that many face and it is unkind to judge them.
Our rush to judgement is not surprising. In my church, I was raised on judgement. I was told by my tantes (German for aunt) that Missouri Synod Lutherans were the only ones who would go to heaven. How lucky was I, I thought, that my parents chose the one church that would get me to heaven, if I was good. Score! (Although, I still feared that every thunderstorm was God returning to send me to hell for whatever transgressions a little kid might have committed.)
As an adult, I remember listening to a sermon by a priest in my Episcopal church (by joining the Episcopal church, I guess that I gave up on heaven) reminding us that the Bible makes it clear, it is God’s job to judge, not ours. “After all,” he said. “You can get some time back in your busy day if you leave the judging job to God.”
I admire those who don’t judge, those who aren’t detoured by the roadblocks in the last mile. They are our hope for eradicating diseases.
As for me, I keep trying.
Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.