Public health up for debateFeb 19, 2020
What happens at the Colorado State Legislature, in session for 120 days from January 8 to May 6, is critical for public health in the state. There are numerous bills under consideration that relate to public health issues: tobacco products, substance use disorders, behavioral and mental health, guns, and immunization, for example. The Colorado Public Health Association is tracking bills as well.
Public Health Day at the Capitol, an annual event organized by the Colorado Public Health Association in collaboration with the Colorado School of Public Health, fell on February 12 this year. It was well attended by students, faculty and alumni from the school and by the public, and afforded an opportunity to hear from and meet with legislators and to watch the legislative session. At the kick-off event, guidance on interacting with legislators was provided (easily summarized: know what your point is, and say it quickly and directly), and we heard from two legislators at some length: Rep. Perry Will, R-House District 57 (sponsor of the Colorectal Cancer Screening Bill, member of the Health & Insurance and Rural Affairs & Agriculture Committees) and Sen. Dennis Hisey, R-District 2 (former Board of Health member in El Paso county, member of the Appropriations and Transportation & Energy Committees). And heard, cameo but instructive comments from Rep. Richard Holtorf, R-House District 64, member of the Public Health Care & Human Services and Rural Affairs & Agriculture Committees) and Sen. Rachel Zenzinger, D-District 19 (member of the Appropriations, Joint Budget, and Statutory Revision Committees).
Rep. Will spoke passionately about sponsoring HB20—1103 which ensures needed screening for colorectal cancer. Personal connections count in his passion; he described learning about the need for the bill from his cousin, Andi Dwyer—a member of our staff and director of the Colorado Cancer Screening Program in the CU Cancer Center. I have made many trips to state legislatures—Santa Fe while at the University of New Mexico, and Annapolis while at the Johns Hopkins Bloomberg School of Public Health. Often the questions become personal; don’t be surprised. Passive smoking and the need for clean indoor air legislation was a frequent topic in the 1980s. My presentations on this topic, drawing on science and the 1986 Surgeon General’s report, were often followed by such questions as: “Doc, I want to ask about my grandchildren; their mother smokes. Is her smoking harmful to them?” Answering the question gave the opportunity to bring home the message from my fact-based testimony.
Sen. Hisey spoke about the various bills on vaccination, which may be simply described as either promoting vaccination or supporting those viewing vaccination as a parental/personal decision. He offered an opinion that leaned towards parental choice in decision-making, leading away from governmental authoritarianism in requiring vaccination for all, except those with a necessary medical exemption. For those viewing vaccination as one of our most powerful public health tools, how should a conversation with Sen. Hisey proceed? Communication in public health needs to acknowledge the pluralism of opinions, while delivering what we know with the right tone.
And, we do know much about vaccination, which dates back at least two centuries to Edward Jenner and the cowpox vaccination for smallpox. Some of us who are old enough have a scar from a smallpox vaccination on our arms. That highly fatal disease was eliminated by vaccination in a campaign led by D.A. Henderson, subsequently Dean of the Johns Hopkins School of Hygiene and Public Health. The approach of “ring vaccination” was used, vaccinating all of those living around the location where a smallpox case had been identified. The strategy might have been unsuccessful had it lacked cooperation from all to establish a buffer of immunity that could not be penetrated.
Some of us remember our childhoods when we lacked the key vaccines that protect us now. During epidemic polio, our parents isolated us and movie theaters and public swimming pools were out-of-bounds. Some friends had braces and weakness as an aftermath of polio and the Drinker respirator or “iron lung” maintained the lives of those paralyzed. And now, polio eradication is possible, although slowed by geopolitical complications. As the new coronavirus (now named Coronavirus Disease 19 or COVID-19) epidemic surges, vaccine development and the timing for a new vaccine are under hopeful discussion. In the setting of a pandemic of a disease with a high case-fatality rate, would there be vaccine hesitancy?
Back to the 2020 legislative session. Learn about what is happening and track the bills that are important to public health. Write in support of those that are important for you and for public health in Colorado. Track those who support particular bills and those who do not. Here are a few that may be informative: HB-1001, Nicotine Product Regulation and SB-163, School Entry Immunization. Remember that legislative sessions are in progress across all states.
And, for the latest on COVID-19, major medical journals are providing access to relevant articles. Go to The Lancet and the New England Journal of Medicine and, of course, the CDC. The New York Times is providing dynamic coverage that reaches internationally, while the interactive web-based dashboard hosted by Johns Hopkins University offers a visual representation of reported cases across the world in real-time.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health