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Vaccination Laws: What the Rest of the U.S. Can Learn from Appalachia

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Lacey Walter, of Kennewick, Wash., holds a sign that reads "Vaccines, the more you know, the more you No!" as she takes part in a rally held in opposition to a proposed bill that would remove parents' ability to claim a philosophical exemption to opt their school-age children out of the combined measles, mumps and rubella vaccine, Friday, Feb. 8, 2019, at the Capitol in Olympia, Wash. Amid a measles outbreak that has sickened people in Washington state and Oregon, lawmakers earlier Friday heard public testimony on the bill. Photo: Ted S. Warren/AP Photo

For decades, two Appalachian states have been national leaders in an unexpected area: vaccinating children against contagious diseases.

In 2000, measles was eliminated as a major public health threat in the United States. But because measles still exists in other countries, it’s occasionally brought here. And as American parents opted out of vaccines for their children in larger numbers, outbreaks have crept up in places where high numbers of people remain unvaccinated.

Now, less than six weeks into 2019, 84 cases of measles have been confirmed in 11 different states. Fifty-five of those cases are in Washington state, where health officials have declared a state of emergency. As states like Washington evaluate how best to move forward, they may be surprised to find themselves looking to another part of the country for help: Appalachia.

West Virginia and Mississippi are not generally considered leaders in public health. Dangerous professions, high poverty rates, rough terrain, water contamination and pollution have left much of Appalachia struggling with rates of cancer, addiction, overdose and premature mortality higher than the rest of the country. On many health metrics, West Virginia and Mississippi rank towards the bottom. But when it comes to inoculating schoolchildren against dangerous diseases like measles, polio and whooping cough, they are consistently the best in the country.

At a time when other states are struggling to contain outbreaks of preventable diseases, Mississippi and West Virginia have been national leaders in preventing these outbreaks altogether. Why? Because Mississippi and West Virginia have the strongest vaccination laws in the United States.

Vaccines and Their Efficacy

The efficacy of some medical procedures can be debated. Vaccines are not among them.

Vaccines protect people in two ways. First, they protect the individuals who receive them, by inoculating them. Second, when vaccines are successfully administered to a large percentage of the population, a herd immunity develops. Herd immunity protects the people who truly can’t get vaccinated, like infants not yet old enough or people undergoing chemotherapy. When a high enough percentage of the population has been inoculated, herd immunity protects those more vulnerable members of our society.

Vaccines are largely considered one of the greatest public health discoveries of modern history. The CDC estimates that vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born since 1994. The World Health Organization credits vaccines with preventing 2-3 million deaths every year from a variety of diseases, reducing measles mortality by 84 percent and bringing us closer than ever to eradicating polio worldwide. Vaccinations have already entirely eradicated smallpox and rinderpest.

Vaccines are safe and medical science has proven that the most recent argument against them–that they cause autism–is false. This false claim can be traced back to one, now discredited, paper, by a man named Andrew Wakefield. In 1998, Wakefield and his colleagues made headlines worldwide when they published a paper arguing that vaccines caused autism. Eventually, the paper would be retracted and Wakefield and his colleagues would be found guilty of ethical violations, scientific misrepresentations and deliberate fraud; but by that time, the damage had already been done and has had a lasting global impact.

People around the world continue to contract preventable diseases, sometimes because of lies about the safety of vaccines. In a tragic 2015 case, a Spanish boy named Pau died of diptheria after his parents refused to have him vaccinated. Pau’s parents later said they felt they had been “tricked,” had not been properly informed about vaccines, and felt tremendous guilt over the death of their son.

Mississippi and West Virginia: Leaders for Decades

Mississippi’s vaccine mandate is the result of a 1979 decision from its highest court, Brown v. Stone. A father challenged Mississippi’s mandatory vaccination law, which allowed religious exemptions if “an officer of a church of a recognized denomination” signed off on it for the parent. He argued the law violated his First Amendment rights by requiring him to be a member of a denomination in order to claim the exemption. In a stunning turn, the court didn’t simply reject the father’s objection—it eliminated all religious exemptions. As the court stated:

“The exception, which would provide for the exemption of children of parents whose religious beliefs conflict with the immunization requirements, would discriminate against the great majority of children whose parents have no such religious convictions. To give it effect would result in a violation of the Fourteenth Amendment to the United States Constitution which provides that no state shall make any law denying to any person within its jurisdiction the equal protection of the laws, in that it would require the great body of school children to be vaccinated and at the same time expose them to the hazard of associating in school with children exempted under the religious exemption who had not been immunized as required by the statute.”

West Virginia’s strict vaccination laws were created by the legislature, not the judiciary, and first appeared in 1872. The state’s laws have  never allowed for a nonmedical exemption.

Despite the documented success of their laws, the debate on whether to weaken them  continues in both states. Year after year, politicians introduce bills that would allow religious or personal belief exemptions–and this year is no exception. To date, however, every proposal to relax Mississippi’s or West Virginia’s vaccination laws has failed, perhaps, in part, because of the overwhelming proof that strict vaccination laws work.

Models for the Rest of the Country

West Virginia and Mississippi took two different paths, but ended with similar results: the highest vaccination rates in the country.

For the most recent school year, 99.4 percent of incoming kindergarteners in Mississippi and 98.4 percent in West Virginia were inoculated against measles, mumps and rubella (MMR). The national average is 94.3 percent. Doctors estimate that between 90 and 95 percent of a population must be inoculated for the MMR vaccine to be effective.

Far away from Appalachia and Mississippi’s nearly universal vaccination rate is Clark County, Washington. Washington has some of the most relaxed vaccination laws in the country, allowing both a religious exemption and a “personal belief” exemption. Clark County is in the southwest corner of the state, near Portland, Oregon. Only 76 percent of Clark County kindergarteners were fully immunized for the 2017 – 2018 school year.  Only 84 percent had received the MMR vaccine. Clark County is home to 53 of the 55 measles cases reported in Washington this year. At least thirty-four of the sick are children under the age of 10.

In 2015, a measles outbreak originating at Disneyland in southern California resulted in 147 cases of measles spread across eight states and two other countries. Later that year, California changed its laws and joined Mississippi and West Virginia in eliminating religious exemptions to vaccines. In response to the current measles outbreak, lawmakers in Washington have proposed removing their personal belief exemption.

At a time when several parts of the country are dealing with outbreaks of a disease that was almost eradicated, more states would do well to look towards Appalachia for two examples to follow. West Virginia and Mississippi are leading the country in protecting our children from preventable diseases. In the midst of this public health crisis, the rest of the country should look to West Virginia and Mississippi as models of what strong vaccination policies can accomplish.

Jamie Lynn Crofts is a constitutional and civil rights attorney in Charleston, West Virginia. She is a graduate of Northwestern University School of Law, a former federal judicial law clerk, and previously worked as the Legal Director for the ACLU of West Virginia.

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Commentary: Immunizing Against Our Culture of Contempt

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In his first inaugural address in March of 1861, Abraham Lincoln said, "We are not enemies, but friends. We must not be enemies," and he invoked "the better angels of our nature." Photo: Wikipedia

Today’s public discourse is a petri dish for breeding disgust for people with whom we disagree. Debates about healthcare issues affecting rural America are no exception.

From the left’s “basket of deplorables” to the right’s “send her back,” our public and private spaces have become infected with a culture of contempt. On too many days, I feel I am in a country I barely recognize. I don’t know if conservatives and liberals equally engage in contempt of the other, only that I hear too much of it from both sides.

Tim Size

I take little comfort when individuals say it’s not so bad, that we were more divided during the Civil War. As savage as those days were, Abraham Lincoln knew we could and must do better.

“Though passion may have strained, it must not break our bonds of affection. The mystic chords of memory, stretching from every battlefield and patriot grave to every living heart and hearthstone all over this broad land, will yet swell the chorus of the Union when again touched, as surely they will be, by the better angels of our nature.”

Even while coming of age in the riot-torn ’60s, my evangelically conservative family would encourage me “to hate the sin but love the sinner.” And not dissimilarly, at the same time, the left made an icon of a Vietnam War protestor placing a carnation into the barrel of a soldier’s rifle.

From Fox News to MSNBC, our airwaves are filled with voices competing to be the loudest and the most adept at ridiculing their opponents. The dominant narrative is not to address ideas but to reduce those with whom who we don’t agree to a position beneath contempt. Once we allow ourselves to hold someone in contempt, all that the best of our culture teaches us about how we are to relate and support each other goes out the window.

I have taken heart from individuals who have begun to name this problem and suggest solutions, such as Arthur Brooks, long-time president of a conservative think tank, as he wrote about “Our Culture of Contempt” in a recent issue of The New York Times: “What we need is not to disagree less, but to disagree better. And that starts when you turn away the rhetorical dope peddlers–the powerful people on your own side who are profiting from the culture of contempt. As satisfying as it can feel to hear that your foes are irredeemable, stupid and deviant, remember: When you find yourself hating something, someone is making money or winning elections or getting more famous and powerful.”

If we are to reverse our country’s slide into increasingly entrenched and divided camps, we need to relearn how to productively talk about our differences instead of attacking the character, motive and personal attributes of the “other side.”

Brooks goes on to say that “each of us can make a commitment never to treat others with contempt, even if we believe they deserve it. This might sound like a call for magnanimity, but it is just as much an appeal to self-interest. Contempt makes persuasion impossible – no one has ever been hated into agreement–so its expression is either petty self-indulgence or cheap virtue signaling, neither of which wins converts.”

For those of us working in health care, contempt is not theoretical. We seem increasingly less able to make progress on important issues as the rhetoric heats up and the attacks get more personal. Here are a few examples of current health care issues that seem too often to be dominated by attacks on those who hold an opposing opinion rather than the opinion itself.

  • Advanced Practice Registered Nurse Collaboration
  • Family Planning
  • Federal Dollars for Medicaid Expansion
  • Medicare for All
  • Race and Geography in Health Disparities
  • Vaccination and Anti-vaxxers

While I know that I have and still can readily discount those who disagree with me on each of these issues, I have renewed my commitment to keep my advocacy based on the facts and our organization’s aspirations, not on trying to tear down those who might disagree. Will you join me in this quest?

Tim Size is executive director of the Rural Wisconsin Health Cooperative.

This article was originally published by the Daily Yonder.

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How Organized Labor Can Reverse Decades of Decline

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A union miner at the rally for pension protection. Photo: Aaron Payne, Ohio Valley ReSource

Collective bargaining has long been one of organized labor’s most attractive selling points.

In its simplest form, collective bargaining involves an organized body of employees negotiating wages and other conditions of employment. In other words, unions are saying: Join us, and we’ll bargain with your boss for better pay.

Unfortunately, traditional collective bargaining is no longer an effective strategy for labor union growth. That’s because employers and many states have made it incredibly hard for workers to form a union, which is necessary for workers to bargain collectively.

My own research suggests unions should pursue alternative ways to organize, such as by focusing on more forceful worker advocacy and offering benefits like health care. Doing so would help unions swell in size, putting them in a stronger position to secure and defend the collective bargaining rights that helped build America’s middle class.

Why unions still matter

Unions reached their pinnacle in the mid-1950s when a third of American workers belonged to one. Today, that figure stands at just 10.5 percent.

A big part of the problem is that employers have used heavy-handed legal and managerial tactics to block organizing and the elections necessary to form a union. And more than half of U.S. states have passed so-called right to work laws, which allow workers at a unionized company to avoid paying dues.

The stakes of this challenge are high – not just for unions but for most workers in the U.S. That’s because weaker unions correlate with lower wages, reduced benefits and greater economic inequality.

Millions stand to gain from a strengthened labor movement, from Uber and Lyft drivers in the gig economy to low-wage employees in retail and hospitality. And surveys show nearly half of nonunion workers in the U.S. say they would join one if they could.

I believe there are three models traditional unions could pursue to add members without relying on workplace certification and collective bargaining.

Advocating for workers

One approach is to build on the success of worker advocacy groups like Fight for $15 and the National Domestic Workers Alliance.

Fight for $15, for example, played a leading role advocating increases in the minimum wage in several states, most recently Connecticut, while the National Domestic Workers Alliance helped secure the passage of the domestic workers bill of rights in New York.

What they all have in common is that they engage in protests and strikes to call public attention to the plight of exploited workers while advocating for economic and social justice. Unions, which used to engage in more of this kind of activism, need to recapture some of that militant spirit.

Establishing minimum standards

A second model involves pushing employers to agree to a minimum set of standards for benefits and pay to provide workers.

The Writers Guild of America, which represent screenwriters and others in television, theater and Hollywood, exemplify this model. For example, they establish minimum levels of compensation for specific jobs and duties and then require members – both employers and workers – to adhere to them. It’s a collective bargaining agreement with a potentially much wider reach.

That’s because these agreements are negotiated with employers but also cover independent contractors who sign on as well. Their strength comes from the aggressive organizing and advocacy plus the strategic importance of the workers they represent, which puts pressure on employers to take part and meet the minimum standards.

Other unions could expand this approach to encourage workers throughout industries that have little or no labor representation to join their ranks as affiliated members, which should pressure employers to follow suit.

Unions peaked in the 1950s. Photo: AP Photo/Sam Myers

Unions with benefits

Another approach involves focusing on offering special benefits to independent workers in exchange for fees.

Some labor groups already do this, but the workers would benefit from unions combining their collective power to offer more heavily discounted goods and services, such as health care, disability benefits and legal representation.

For example, although the 375,000-strong Freelancers Union can’t negotiate over pay, it offers independent contractors these sorts of discounted benefits. Instead of charging dues, it charges fees for its benefits, essentially operating as its own insurance company. It also advocates for public policy changes that safeguard freelancers from exploitation, such as New York’s Freelance Wage Protection Act of 2010.

This model is probably the approach most likely to succeed in attracting large numbers of new members. The growing gig economy and low-wage industries like fast food are two areas that could receive benefits from these types of collective entities.

The endgame

Ideally, unions would embrace all three of these models, offering discounted benefits to any worker interested in signing on, fighting for minimum standards across industries and putting worker advocacy front and center. By broadening the ways in which workers can join and what they offer, unions will become stronger and closer to the people and communities that they are meant to represent.

But by no means are these models meant to supplant organized labor’s traditional collective bargaining role. My point is that unions should break the straightjacket fixation on traditional bargaining and use alternative models as intermediate steps to the ultimate goal of unionizing more workplaces in order to negotiate collective bargaining agreements on behalf of workers.

To get there, though, unions must mobilize a critical mass of workers. Only then will they break the dynamic of labor’s decline.

[ Deep knowledge, daily. Sign up for The Conversation’s newsletter. ]

Marick Masters, Professor of Business and Adjunct Professor of Political Science, Wayne State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Why Do So Many Rural Americans Feel Politics is Pointless?

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Of Jennifer Silva’s sample of 108 working-class people, over two-thirds didn’t even vote in the 2016 election. Photo: AP Photo/Keith Srakocic

In sociologist Jennifer Silva’s first book, “Coming Up Short,” she interviewed working-class young adults in Lowell, Mass., and Richmond, Virginia.

Most had a tough time earning decent wages. Many felt like they were in a perpetual state of limbo, unable to reach the traditional markers of adulthood: job, marriage, house and kids. But Silva was surprised to learn that many blamed themselves for their situations and believed that relying on others could only result in disappointment.

After the book was published, it bothered Silva that she never pressed her subjects further on their politics to see how they might be connected to their worldview.

Jennifer Silva. Bucknell

Now, in a new book, “We’re Still Here: Pain and Politics in the Heart of America,” she has made working-class politics her focus.

Beginning in May 2015, Silva started conducting interviews in a once-thriving coal town in central Pennsylvania, which she calls “Coal Brook.” The timing was prescient: A month after she began her research, Donald Trump descended the escalator at Trump Tower and announced his candidacy for president.

Silva spent over a year interviewing townspeople. She gained their trust, forged relationships and spent time in their homes and at community meetings. After years of declining prospects under both political parties, some of the townspeople she interviewed were drawn to Trump’s anti-establishment message. But for most, their politics had devolved into an abyss of cynicism that couldn’t even be penetrated by a politician who promised to “fix” everything.

In an interview, which has been edited for length and clarity, Silva describes a community that is racially diverse, hardworking and politically aware. But its residents are also deeply distrustful and shoulder immense amounts of pain and alienation.


Can you talk a little bit about what inspired you to study working-class Americans?

I was the first person in my family to graduate from college, and I experienced some self-doubt and discomfort when I tried to integrate into the world of academia.

In my position between two worlds – growing up with more working-class roots, and then building a professional middle-class life – I would cringe whenever I saw upper-middle-class people treat working-class people with casual condescension or indifference. It sometimes seemed like the very colleagues who most loudly proclaimed their commitment to social justice were the ones treating the administrative assistant like their personal secretary or complaining about the cost of their housekeeper. It made me really skeptical of whether people’s stated political beliefs were even a good predictor of how they treat people with less power and status.

What was the hardest part of the research?

Getting people to open up to me. I wasn’t from the area. This is the kind of place where if you knock on someone’s door, they’re not going to let you in. I started off talking to white people. I’d go to football games and addiction meetings to try to meet people, and I was able to get to be known as “so-and-so’s friend.” Then I realized I wanted to have a non-white group in my book, because there’s been an increase in Latino and black people in the area. So I had to find out how to get this population to trust me because the white population and the minority population don’t overlap very much.

You spent months conducting interviews. Then the election happened, and Trump won. All of a sudden, there was a lot of interest in the very sort of community you had just spent time in. What’s your take on the ensuing media coverage of these small towns?

It seemed like there was one dominant story: older white men, angry and in pain, were feeling bad about not having jobs and blaming racial minorities or foreigners.

And an element of that certainly emerged in my research. But the overall picture was just so much more complex. One of the things that was very striking to me was how much distrust there was. Among everyone I interviewed – white, Latino and black – there was a fierce distrust and hatred of politicians, a suspicion that politicians and big business were basically working together to take away the American Dream. Everyone was very critical of inequality.

So it wasn’t this idea of “dumb white people voting for billionaires because they don’t understand it’s against their interests.” Almost everyone was aware that the system is rigged against poor people. They blamed politicians for refusing to raise wages to a level people can live on. Many wanted higher taxes to support education. I heard a lot of that, across all of the different groups, and I didn’t read a lot of that in the articles about these communities.

You interviewed 108 people and only 37 of them actually voted, with 26 voting for Trump. Of the 41 black or Latino people you spoke with, only four voted. So to me, one of the major stories wasn’t necessarily support for Trump. It was a refusal to participate in politics altogether.

Two-thirds of the sample were nonvoters. They knew the election was happening but they just viewed political participation as pointless. They thought of it as a joke. And they said, “Look at what’s happened in my lifetime, it doesn’t really matter who’s been president.”

One of the critiques I heard a lot was that everything’s about money now. If you have money, your life is good. You can buy anything. But if you don’t have money, the system is stacked against you. I heard that from old white men. I heard that from young black women. And it was interesting, because it’s not untrue, right? If you kill someone and you’re rich you’re more likely to get off.

So I think for them it was almost like, “Well, if we participate, we’re just playing along and pretending. But we’re not naive. We know already that politicians are bought off by corporations. No one actually cares about us.”

There’s that great story in the book where you showed up to an interview wearing your “I voted” sticker.

He laughed at me! Like, “Why would you vote? Are you crazy?”

And yet of those who voted, Trump did emerge as the clear favorite.

Well, Trump and Bernie Sanders. But Sanders wasn’t an option in the end. The general take on Trump was, “We like Trump’s personality, we like his aggressiveness, we like how he doesn’t care about the rules.” And then they liked Bernie Sanders for his authenticity and his heart. But for many who even ended up voting for Trump, they still didn’t think it would matter if they voted.

Where does this disillusionment come from?

There’s a sense of betrayal by a number of social institutions – education, the workplace, the military – all of these things that they thought they could trust, but, for one reason or another, ended up disappointing them.

So they turned inward. No one was really looking for external collective strategies changing the world. Many wanted to simply prove that they didn’t have to rely on other people. There was this sense that any kind of redemption is only going to come out of your own efforts. And then you’ll see some blame other people who don’t seem to support themselves.

Before and after the 2016 election, J.D. Vance, with the publication of his memoir, “Hillbilly Elegy,” was held up in the mainstream media as an oracle for dispossessed rural Americans. But in your book, you vehemently disagree with his worldview.

Vance seemed to look at other people in his community and think that the reason they were suffering was because of their own choices – that they weren’t really strong enough to face the truth about themselves, that they had to stop blaming the government and corporations and actually take responsibility.

And that just wasn’t the story that I heard. I heard a lot of self-blame and a lot of people who wanted to take responsibility for their own fate. There was a lot of soul searching and a lot of pain. Vance makes it seem like everyone just needs to be like him – a lone hero who escapes his difficult past on his own. It’s not that simple or easy.

Can the pain people feel be used as a bridge to bring people together? That’s how I end my book. And I saw signs of it. Families suffering from addiction were coming together and wondering, how can we change the ways that doctors prescribe medicine? Or how can we challenge pharmaceutical companies to stop making these medications that get our children addicted? Can we get the police to help addicts instead of arresting them?

That sounds like the stirrings of political mobilization. But what’s the biggest obstacle that’s preventing working-class voters from organizing en masse?

I think that it’s the absence of what you could call “mediating institutions.” The people in my book have a lot of critical and smart ideas. But they don’t have a lot of ways to actually connect their individual voices. So they don’t have a church group or a club that they would join that would then give them political tools or a louder voice. And I don’t even know if they would join one if these did exist, because of their distrust of institutions. So it just ends up being turned inward rather than outward.

Within academia, what are some of the most common misconceptions you encounter when it comes to working-class politics?

I have heard some liberal academics talk about how self-defeating and misinformed working-class white people are. They seem to believe that if these people just knew the facts, they would change their votes immediately. Or they dismiss all working-class white people as angry and racist.

The working-class people I met were often radically critical of inequality and deeply skeptical about whether we live in a meritocracy. It was important to me to show that the people in my book of all races are creative and thoughtful – that they arrive at their positions by piecing together their histories and experiences in meaningful ways.

Sometimes these ways are destructive and divisive, and sometimes they have the potential to be transformative and healing.

[You’re smart and curious about the world. So are The Conversation’s authors and editors. You can read us daily by subscribing to our newsletter.]

Nick Lehr, Arts + Culture Editor, The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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