Little Rock   A friend and comrade made the simple, but totally correct, observation that the weaknesses in the political positions from both the right and left, Democrats and Republicans, is that they were both arguing over insurance, when the American people only care about healthcare.  Nowhere is this more obvious than when you consider the public health and the not uncontroversial, but universal, consensus on the community priority of immunization.

To get a better understanding of this issue I talked to Heather Mercer, the executive director of the Arkansas Immunization Action Coalition on “Wade’s World.”  Her nonprofit pulls together various organizations to try to pull the immunization rates up in her state.  On immunizations that are required for school attendance on the old standbys where doses are one-and-done for typhoid, diphtheria, and the like, the rates are 91% and 89%, which are pretty good.  Talking to Mercer, the story gets worse from there.

Part of the problem is that in 20 of the 75 counties in Arkansas when it comes to Medicaid recipients on the expanded terms of the Affordable Care Act, the only access to immunizations is at the public health department’s one location on the county.  For lower income families challenged by multiple appointments and distances to access there’s a big, fat escape hatch provided by the state of Arkansas.  Families simply need to fill out a one-page form saying that they have a medical, philosophical or religious objection to the immunization, and wham-bam, no problem, come on to school, and cross your fingers and pray you stay healthy.

For the critical HPV vaccination, which is not yet mandatory in Arkansas, but where the goal is an 80% vaccination rate by 2020, the current rate is only 35% for girls and 33% for boys.  HPV is transmitted through skin-on-skin contact, which means we’re talking about S-E-X usually.  It contributes to cervical cancer in women and some pretty bad health consequences for men as well, including oral cancer.  HPV requires two doses if taken under the age of 15 and three doses if over 15, and to make the mountain even higher, the doses have to be taken within rigid timelines.

Advocating for more access to immunization and assuring the implementation of programs to achieve public health security is a big job, so I asked Mercer about her coalition.  They had not been around long and in fact had to shut down for lack of money several years ago and reorganized in the last several years thanks to a two-year only grant from a foundation.  The foundation resources allowed Mercer to be hired and allowed the coalition to ask for applications for local physicians in underserved areas to access grants of up to $1000 to allow them to buy refrigerators or freezers to hold the vaccines, since many argue that is the barrier to their providing the service, despite how specious that argument sounds.  What happens when the grant ends?  The answer was not exactly hopes and prayers but close enough.

This is where the ideological health care delivery system breaks down.  Clearly, immunizations are a public health need and a public health responsibility, but the public, meaning the state, is not paying to get the job done by either funding the coalition or even more appropriately giving public health offices the resources and support to provide the service, and, if necessary, bring the immunizations to the public.  Conservatives argue that private, religious, and philanthropic resources can pick up the slack, rather than taxpayers, but there isn’t enough of that money in Arkansas or most other places to fill the gaps on services that the government should provide.  The default becomes the increasing potential of a public health breakdown threatening entire communities.

Politicians have to realize that they need to step up.  Hope and prayer is not a plan for healthcare.