This week, the states of Washington, Oregon and California announced they’ve developed an alliance to work together on issues related to vaccines and other public health issues. They say they can no longer trust the guidance they receive from federal health agencies.
It’s a turbulent time for an institution once considered among the most trustworthy in the U.S., but COVID changed that, says Washington Health Secretary Dennis Worsham, who visited Spokane this week.
This interview lightly edited for length and clarity.
Dennis Worsham: Public health, prior to that, has always been a trusted voice. You would oftentimes hear things like, we're going to use the public health approach, even if it wasn't a public health department doing that. I think COVID became very politicized. And of course, when politics get in the middle of science, it becomes, you start to lose trust from certain constituents based on the affiliations politically. So I feel we've got some rebuilding to do from COVID. I think there's some trust that we need to rebuild. I think that's really going to be sitting down and having conversations with people in the community.
Doug Nadvornick: So what's the message then, that you convey during meetings like this to rebuild that trust?
DW: I think it's important to understand where there is not trust, so when we have that is then be able to come back and have the conversations around, what is our public health approach? What is the science we use? What are the voices we listen to in making those areas? And so people understand how we make informed decisions that are really rooted in long, traditional public health practices as well as medical practices.
DN: Where do you think public health has made mistakes during this time?
DW: I think we've taken for granted that public health was the trusted voice and we didn't have to slow down and always explain our whys. And COVID was tough because you're responding to a situation in real time. You have people who are dying. You have hospitals that are over capacity and you have schools that are struggling and teachers who don't want to come back to school and parents who are concerned about sending their kids to school. I think we just kept moving forward with our policies and our recommendations and I think we should have probably had enough conversation in there to bring people along. I think that that's the part that we have to do now is slow down and talk more about the whys of what we do.
DN: Now, trust is a two-way thing. Do you have trust now in the federal public health officials now that the new administration is in?
DW: Yeah, it's a really good question and it's really tough. Right now, the way that the public health system works in our country is we have a federal agency, CDC, who has really played that part for many, many years. Then you have a state agency, like a state Department of Health. Then you have your local health departments that are really in the ground providing those services. Those systems have been very tightly aligned in practice and in science and recommendations about what really is best practices and best health. And we have seen through this last administration some ideology coming in.
I read the terms by former CDC directors on both sides that have served for both Republicans and Democrats of calling the weaponizing of CDC and when that begins to happen, we have to be careful about where we go and what information we're looking and making sure it aligns with what we're seeing from other trusted entities in looking at science review.
DN: So when former CDC directors, do get out and have that strong message, how do you, as somebody who has to work within the system, deal with that message? Do you try to step back and say, that's going too far? Or how do you work your way in the middle there?
DW: I'm learning this. I'll be honest. And it's tough.
You know, I take my role really responsibly with, I'm entrusted with the health of all Washington people and knowing that we have people with different political affiliations. And so I do have to step back and say, one, where are we getting our information and to make our best decisions? And then to be able to explain to people why we're making the decisions based on a thing. A really classic example of that is the Academy of Pediatrics. They have been giving vaccine recommendations for over 80 years in this country. And they have helped inform and shape what vaccines kids should be receiving in order to have optimal health, stay in school, continue their learning, and keep them healthy. We're having to pivot a bit and look to those type of affiliations and services because we trust that they are really doing a science rigor and it's not tied to a political decision on what a recommendation should look like.
DN: We've heard a lot from your office regarding vaccines and getting people's confidence up about vaccines, kids are going back to school and all that. Are people listening to that? Or are people going away from the vaccines and saying, you know, I'm not sure that I trust you because for various reasons?
DW: Yeah, we have seen a slight decline in some of our vaccine uptake among kids in particular. We certainly saw it through both our flu and our COVID vaccines this past year. We have seen an increase in disease and a decrease in the vaccines. Yes, so I'm concerned about that.
As you know, measles was a hot topic last year. We had a number of measles cases throughout our country. Most we've seen in quite some time. We've had three deaths, the first time we've had deaths in over a decade. Herd humidity should be really about 92% of kids should be vaccinated with MMRs and we're down around 90%. We're close, but not enough that I'm comfortable with. And so I think that our message is shifting a bit.
We're going to continue to put the guidance out what we think is the best practice in good health based on what the science is telling us. And we're gonna really encourage parents to have those conversations with their healthcare providers about their kids' health and make those best decisions in those environments because I do think people are gonna have to go to other places. We can start with the guidance, but to go to places where they have trusted voices and medical providers we know historically have been that for families.
DN: On the other hand, are we overreacting to this a little bit? On our side of the mountains, there were a couple of cases of exposures and measles cases in North Idaho. Our local public health department was saying there may have been an exposure at one of our hospitals. But as I think back in my life, kids have died from measles. We've had lots of cases of measles. Are we overreacting about one or two cases of measles and exposures?
DW: Well, I can answer that a couple ways. So first of all, what our goal is in public health is really to interrupt transmission and prevent the further spread of transmission. So our job is when you have a potential exposure of somebody is you want to get them isolated as quickly.
Measles in particular is a highly contagious disease. If I had measles and left the room, that virus would live in this space for a couple hours. And it's highly contagious. A lot of suffering can happen in that disease model, even death, potentially death in those areas. It's rare, but it does happen. And so we do take it serious is that we don't want that to continue to spread through areas.
When you look at the economic impact of those areas, pulling kids out of schools and learning environments, it's costly. For public health to do a measles investigation, it's about $140,000 per case. So it's like a lot of time and money that goes into interrupting these transmissions, getting people the appropriate boosters that they need if they haven't had their vaccines. So it's a costly endeavor and we're trying to prevent that as best we can, both the suffering and the cost impact to stopping the transmission.
