Vaccines have accomplished a lot of good over the last century with the eradication of diseases like polio. However, they are not without risks, and many people are raising concerns about the vaccine requirements in place. So how do we balance individual health and autonomy with the good of our communities?
This week on Family Policy Matters, host Traci DeVette Griggs welcomes Dr. Monique Yohanan, a Senior Fellow at the Independent Women’s Forum, to discuss vaccine policy from a perspective that balances parental rights with public health concerns.
The opinions expressed by our guests are their own and do not necessarily represent the opinions or perspectives of NC Family.
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Family Policy Matters
Rethinking Vaccine Policies: Part 1 (with Dr. Monique Yohanan)
TRACI DEVETTE GRIGGS: Thanks for joining us this week for Family Policy Matters. Vaccines. How has such a uniquely powerful medical advancement now become a source of so much controversy? Above all else, of late, vaccines have been a source of increasing distrust on the part of many Americans. So, what to do? A new project from Independent Women’s Forum calls for a recalibration of vaccine policy to help restore trust and truth. Today, we’re joined by Dr. Monique Yohanan, senior fellow at Independent Women’s Forum, to discuss her new paper and documentary “Rethinking Vaccine Policy: Vaccines are Important, But Not Equally Necessary”. Dr. Yohanan is a physician executive and healthcare innovation leader with more than 20 years of experience at the intersection of clinical medicine, technology, and health policy. Dr. Monique Yohanan, welcome to Family Policy Matters.
MONIQUE YOHANAN: Thank you so much for having me. I’m thrilled to be able to be here today and really looking forward to this discussion.
TRACI DEVETTE GRIGGS: Well, thank you for coming because it really is something that we need to be talking about more, and it’s can be tough, right to even broach the subject. But before we get into that, tell us about your organization, Independent Women’s Forum. What is it and why was it formed?
MONIQUE YOHANAN: So Independent Women really comes back to the idea of looking at a different way of approaching feminism. That so much of feminism had been tied up into how the system was rigged against us. And I would say that Independent Women really speaks to what are the great opportunities that we have as women, and what are the things in the system that we need to work together to address? But not really looking things as so much barriers, but as you know, certainly there are some challenges, but that it’s pretty great to be a woman and to be a professional woman, and really looking to advance that in a way that’s frankly respectful, not just of women who are in professional roles outside of the home, but in all of the spheres that women find themselves in throughout their lives.
TRACI DEVETTE GRIGGS: Is vaccine policy a natural fit for your organization to speak out on? And if so, why?
MONIQUE YOHANAN: I do think that vaccine policy is a really natural fit, and in large part because I think we’re looking for areas of respect, and I think in particular women, we do take a lot of the role in terms of managing the health care of our children in families. At least, that’s certainly my experience. And I don’t think that’s just because I’m a physician. And I do think that there is a level of partnership, and frankly, a level of disrespect that I had seen, that I think resonated with some of the other members of our organization, and that really getting back to what’s the role of parents in society, and how can we really be respectful and find ways to advocate for parents, and especially women’s role as parents in the family.
TRACI DEVETTE GRIGGS: When you talk about vaccines, or try to discuss vaccines, it seems like the first thing you would have to do is just bring down the heat. This is a topic that is a trigger to so many people today. It seems like it’s a tough thing to even talk about.
MONIQUE YOHANAN: It really is. And I think trigger is the right way to describe this. And I think when you consider, you know, what makes it triggering, I think that we look at two separate interests, and they’re both really important. But parents and, I would say, healthcare professionals, and in particular, public health leaders, they come at this issue from different points of view. So, from a parent’s point of view, your job, your primary responsibility, your heart really is with your individual child, and you’re thinking about your child and what is going to benefit your child, and how can I be the best advocate for my child? From public health leadership, there’s a different perspective, and that perspective, really, it’s not just about what benefits this individual child, but what benefits society as a whole. But I would go a step further, and this is something I did a Masters of Public Health. And when I was in that training, there was a phrase that was routinely repeated, which is that every issue of public health is first and foremost an issue of social justice. And so, this tension, I think, is in part because you have parents who are thinking about their individual children and how to advocate for them, and you have public health leadership, and it’s not even so much about the millions of children who might be affected medically. It’s about how can vaccine policy, how can public health serve social justice aims? That kind of tension between individual care and individual needs versus public health goals, many of which are really well intended, but are inherently going to lead to a level of friction, I think, is a big part of what underlines some of the issues we have in discussing this.
TRACI DEVETTE GRIGGS: That’s very interesting. I mean, they’re just talking on two different levels and talking past to each other, it sounds like.
MONIQUE YOHANAN: Absolutely.
TRACI DEVETTE GRIGGS: Let’s talk about the current approach to vaccine use and how it translates into policy in the United States, and also how that might compare to other countries.
MONIQUE YOHANAN: Sure, and I think really looking at this from an international perspective, to me, is so important. So, the way I would look at the United States policy, broad strokes, is we take a maximalist approach, and it is a very paternalistic approach. That we start very young, we do vaccines earlier than most of the rest of the world. We give a birth dose of hepatitis B. That’s pretty unique in the world. We also vaccinate against more diseases, not just casually communicable diseases, so a disease like measles that can be spread really easily, but we vaccinate against diseases that are a lot harder to contract, and even against diseases that aren’t necessarily about the population as a whole. So, lots more diseases. For the diseases that we have in common with the rest of the world, we tend to give more shots. So, for example, we give more shots for pertussis. We give more shots for the pneumonia vaccine we give to babies than the other countries in the world do. And then I would also say we have a difference when you add all those things up to, it leads to a big difference in the amount of aluminum that kids get exposed to in the United States. And then finally, in terms of the way they are delivered, we have a focus on mandates that’s relatively unique in the world. Most other countries, there are a couple of exceptions, but most other countries don’t tie getting a vaccine towards the ability for a child to go to daycare, towards the ability of a child to go to go to school. The United States has several vaccines that, when you look across all 50 states, in pretty much all of them, if you don’t get several vaccines, generally 10 or so minimum, by the time you get to school age, you don’t get to go to school. That really is an outlier when you look at this internationally. So, it’s this combination of lots more diseases, lots more shots, giving them a lot earlier, a lot more aluminum exposure, and then, as the way of enforcement, combining it with a mandate. When you put all those things together, I think our policy is very distinct across the world.
TRACI DEVETTE GRIGGS: So, explain why. What was the cause of this?
MONIQUE YOHANAN: Really, when I look back on this, we had a relatively stable policy until about 1986. And in 1986, there was a vaccine shield law that was passed. Now, there were good reasons for that. There were some vaccines that had led to big lawsuits, and people were concerned there were just not going to be vaccines for any of the small number of diseases we vaccinated against them. So, a vaccine shield law was passed that basically said, manufacturers, you’re not going to get sued if you add a vaccine for this. So, we see this in 1986. Now, a manufacturer with a guaranteed market, we have about three and a half million kids born in the United States, who can’t get sued at all. That’s a pretty good incentive to manufacture, to invest in creating new vaccines. But we also saw in the 1980s a change in what people looked at is an approach to using public health. So, and I would tie that back to HIV/AIDS, and a lot of the people who came up, who are now have been the leaders in public health in the last 40 years. They came up during this time of thinking, how can we use our public health interventions to target underserved populations? And you can understand the way that they might think about this, and I think back to some of my mentors and the way they describe having trained in the 80s and what that meant to them. What it meant for the vaccine schedule is you had no ability to get sued at all. You had public health leaders that were looking for ways to actually address more and more risks. They had seen such a horrible travesty from their perspective and how HIV/AIDS had come about. And they said, let’s expand this. And then you put that together with a rise in HMOs and sort of less personalized care, and you could have these sort of quality measures that would say, the way we’re going to be protecting society, the way we can protect the most vulnerable people in society. We can’t fix every problem, but we can give people a shot. So, we can add a shot for hepatitis A, we can add a shot for hepatitis B, we can add shots for sexually transmitted diseases. We can expand the vaccine schedule from what it used to be, because what it used to be was a handful of diseases. It was measles, mumps, rubella, diphtheria, pertussis, diseases that were really easy to spread and diseases that could kill a baby, or they were definitely diseases that could cause severe harm, even if they weren’t fatal. And that was the focus for many years. And then we saw again in the 1980s this expansion, I think, really well intended. But let’s use this universal opportunity. Let’s use the vaccine schedule for something different. And then we started to see little by little, every year or two, we’d have one or two vaccines added to right now, where we’re at is we went from about six in the mid 1980s to about 17 now before a child graduates from high school. So, lots more shots and lots more diseases. But I think it’s this idea of, can we use the policy, not just to get at casually communicable diseases, but can we use it to promote social justice? Again, understandable, but you can see how it grows on itself.
TRACI DEVETTE GRIGGS: Okay, two great answers to my question about how we got here, let’s go back to the first one that you mentioned, and that vaccine shield law, which came about in 1986. And I know, personally, I’ve never heard of that until the last few years. I didn’t realize that these vaccine manufacturers could not be sued. Are we okay to talk about it now and when we talk about it. How should we be talking about it?
MONIQUE YOHANAN: Well, I think the vaccine shield law, again, it accomplishes some things that are really important. You know, when I think about vaccines, if you could sue a manufacturer every time there was a problem with a vaccine, here’s the reality. Even though vaccines are generally pretty safe, think about a disease like measles. One in a million kids are going to get a brain inflammation from the shot. That’s the reality. Actually more kids will actually get a brain inflammation if they get sick with measles, but the shot itself will, one in a million times, actually cause that kind of harm. We have three and a half million kids born every year. That means three or four kids are going to get hurt from a shot. Think about what that looks like in a court. Think about, will manufacturers actually be willing to make a measles vaccine if you have the ability to get sued? So, there is this idea for core vaccines, that it makes a lot of sense. I do think that one of the things that you consider when you look at the vaccine shield law is it’s expanded to all these vaccines that are really for diseases that are pretty uncommon in the United States, like hepatitis B. And why do we need to have the same protections for these much less common diseases? But also tied to it is the compensation. So, we’ve historically limited this as a trade off with the shield law, that the federal government does recognize that some kids might actually get really hurt from a vaccine, so they have this vaccine compensation program. Secretary Kennedy just talked about potentially adding autism to it. And what’s interesting about revisiting that compensation program is right now, unless your child has died or basically has a permanent disability, if your child is really hurt by the vaccine, you’re probably not going to have any kind of recourse. That’s just expected as part of the trade-off for the vaccine. So, I do think the original intent of the vaccine shield law was good. But I think some of the revisiting that Secretary Kennedy has proposed, you know, thinking about other potential harms, that it shouldn’t have to be that a child has to die for a family to have some recourse to a harm from a vaccine. But we really haven’t had an administration willing to revisit that for a long time.
TRACI DEVETTE GRIGGS: We’re just about out of time for this week, but we still have a lot to talk about, so let’s continue this conversation next week with Dr. Monique Yohanan with Independent Women’s Forum on her paper and documentary “Rethinking Vaccine Policy: Vaccines are Important, But Not Equally Necessary. Dr. Yohanan, thank you so much for being with us on Family Policy Matters.
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