Category Archives: Guest blog

At least one Congressman is being reasonable about Syrian refugees

In response to an online petition, Dr. Amy Hagopian, our Section’s Nominations Committee Chair, received the below thoughtful reply from her Congressman, Adam Smith (D-WA). The petition asked that U.S. welcome refugees from Syria, despite opposition from xenophobic governors around the country. Here’s a link to a petition YOU can sign!


Dear Amy,

Thank you for contacting me with your concerns regarding the situation in Syria. I appreciate hearing your thoughts on this important issue.

The civil war in Syria is a highly complex struggle between Bashar al-Assad’s authoritarian regime and the fragmented groups that oppose it. As the conflict in Syria has become more violent and protracted, radical elements that directly and seriously threaten our and our allies’ security have become more powerful. It has also become an enormous humanitarian catastrophe. Since the unrest and violence began in 2011, the number of Syrians seeking refuge in neighboring countries or Europe has increased above 4 million. The United Nations Refugee Agency reports that 12.2 million people inside Syria have been affected by the conflict, with nearly 7.6 million displaced internally.

The tragic terrorist attacks in Paris have complicated the situation even further. Our number one priority must be protecting the United States and the American people from terrorist attacks. In the strongest possible terms, I condemn the cowardly attacks in Paris and send my deepest sympathies to the victims. I also welcome the French government’s increased efforts to combat terrorists in Syria. It is important that as we fight terrorism, we must stay true to the values enshrined in our Constitution, remember that we are a nation of immigrants, and not let terrorist groups define or change who we are.

Amidst the conflict, radical groups – like Jabhat al Nusra and the Islamic State of Iraq and Syria (ISIS) – have established safe havens and where, they have attracted substantial financial resources. The strongest and most violent group, ISIS, has continued a campaign of terror and has launched violent and deadly attacks in Northern and Western Iraq. ISIS victories over the Iraqi armed forces have made them a real and dangerous threat to the government in Baghdad and the region. Additionally, the civil war in Syria has attracted a large number of foreign fighters, including from Europe, many of whom are fighting with forces affiliated with ISIS or al Qaeda. As we have seen, these foreign fighters may eventually return to their home countries or go to others where their new combat skills and increased radicalization can be used to subvert other governments.

The civil war in Syria has devolved into a protracted conflict that is dangerously destabilizing. The increasing flows of refugees to neighboring countries place a real strain on already over-burdened public services. Sectarian tensions are on the rise and can lead to further displacement of refugees as host communities become increasingly frustrated with the length of their stay. The humanitarian crisis is quickly shifting from being a consequence of the Syrian conflict to being a potential driver of conflict itself, threatening regional stability. Additionally, the increased activity of Hezbollah, the Iranian-allied militia within Lebanon, and its involvement in the Syrian conflict has escalated tensions between Lebanon and Israel, presenting a great security risk.

The United States has not turned a blind eye to the hurt and suffering of the Syrian people and has been the largest contributor of humanitarian assistance to the crisis, providing over $4.1 billion between Fiscal Years 2012 and 2015. These funds have been used to provide critical, lifesaving services for internally displaced populations within Syria and refugees in neighboring countries, including Jordan, Iraq, Lebanon, Turkey, and Egypt. Channeled through United Nations (UN) agencies and non-governmental organizations, U.S. emergency assistance provides Syrian families with food, medical care and supplies, shelter, and funding for water, sanitation, and hygiene projects.

Due to the worsening refugee situation and immediate need for increased assistance, on July 31, 2015, the U.S. Agency of International Development (USAID) announced an additional $65 million in emergency food assistance. These funds are for the UN World Food Program (WFP), which serves approximately 4 million people inside Syria and 1.6 million refugees in neighboring countries every month.

To help address the refugee crisis, I have taken a number of steps. I supported increased funding for refugee-related program in Fiscal Year 2016 so that resettlement agencies have the resources necessary to help these refugees. I believe that helping our partners in the region and European allies cope with this stressful and destabilizing situation is in our national interest and ultimately helps keep this crisis from devolving into further chaos. I also joined a letter to Secretary of State John Kerry and Secretary of Homeland Security Johnson asking them to increase the number of people eligible to apply for refugee status. I have also called for the Department of State and Homeland Security (DHS) to improve coordination of the lengthy security check process for those applying for asylum, as well as informing families when some but not all of their members have been cleared. Finally, I have joined other members in advocating for the U.S. to increase the number of refugees we are admitting through our resettlement program from 70,000 to 85,000 per year.

To date, of the millions of law-abiding Syrian refugees, less than 1,800 have been resettled in the United States. Applicants for refugee status are held to the highest level of security screening through which we evaluate travelers or immigrants to the United States. If as a result of the security process, U.S. security agencies cannot verify details of a potential refugee’s story to that agency’s satisfaction, that individual cannot enter the United States. I will continue to pursue ways to make sure our vetting process is effective, without unduly burdening bona fide refugees fleeing the terrible situation in Syria and Iraq.

To be very clear, the United States thoroughly vets all refugees. Refugees are subjected to an in-depth interagency vetting process that includes health checks, verifications of biometric information to confirm identity, and multiple layers of biographical and background checks. Moreover, applicants get interviewed in-person. Members of the interagency team includes the FBI’s Terrorist Screening Center, the State Department, DHS, the National Counterterrorism Center, and the Department of Defense. The background check process takes between 18-24 months, happens before an application is approved; and occurs long before a refugee would be able to enter the United States.

The American SAFE Act of 2015, H.R. 4038, which was brought to the House floor for a vote by House Republicans on November 19, 2015, would effectively shut down resettlement of refugees from the Syria and Iraq region. It is wrong to deny asylum to refugees on the basis of inaccurate assumptions, fear, and prejudice, and that is why I voted against it. We must continue to stand strong as an international community and remember that refugees are fleeing terrible conditions and persecution. As we move forward, let us unite to use the tools at our disposal – diplomatic, military, intelligence, and development – to defeat extremism and the terrorism it breeds.

I have also heard several concerns regarding U.S. military involvement in Syria. I am acutely aware of the great cost we incur in both blood and treasure when we ask our men and women in uniform to secure our interests abroad. I share your concerns about becoming militarily involved in another costly conflict in the Middle East. Any consideration of the use of U.S. military force is not one to be taken lightly – especially considering our experiences in Iraq and Afghanistan and the limited ability to affect certain outcomes in those countries. Ultimately, this is a fight between the Syrian people about who will control the future of their country.

The best way to protect ourselves and our allies in the region from the chaos in Syria is by building the Syrian moderate opposition’s capacity so they can stand their ground and fight this war. There is no easy way to identify those elements in the opposition that we can work with, although we have some developed some local allies, such as the Iraqi and Syrian Kurds and some local Sunni allies and are working to identify additional such forces that we can support. By helping those who are fighting ISIL, the U.S. can ensure moderate elements have a chance at playing a role in the creation of an inclusive transitional government, if a peace deal were to be reached in the future.

Due to the extremely concerning developments in Syria and Iraq, the President has taken a number of actions. First, the United States has conducted literally thousands of airstrikes intended to degrade ISIS in Syria and Iraq, reduce their ability to raise money, and to support the local allies we have identified. We are also currently retraining and equipping a number of brigades in the Iraqi Army and Congress has provided over $1 billion for this process. The President also decided that training and equipping moderate elements of the opposition was necessary in Syria. On June 26, 2014, he requested $500 million as part of a supplement to the budget request known as “overseas contingency operations.” These funds would be used to train and equip vetted elements of the Syrian armed opposition to help then fight against the Assad regime. As you may know, this training program did not meet expectations nor objectives and the training portion has been suspended. Since that time, however, the approach has transitioned to equipping moderate elements in hopes of empowering them in this fluid situation, and the President has announced that fewer than 50 U.S. Special Forces will be deployed to Syria to help accomplish this goal. I will continue to monitor developments in the region, understanding that there are always risks involved in conflict and I do not take them lightly.

Moreover, I support the Obama Administration’s diplomatic efforts to find a political solution to the situation in Syria that respects the rights of people. While those efforts have not yet produced any sort of agreement that would lead to an end of the war in Syria, I believe that it is helpful to have the major international countries that are involved in the conflict in Syria discussing possible ways to bring about a political transition and end to the civil war. Hopefully, such a course forward would also address the underlying causes of the refugee crisis. Until a solution can be found, we must continue to help those seeking refuge. We cannot let what happened in Paris cloud our judgement, drive policy or destroy the fabric of what America stands for. We need to be strong and smart to fight terrorism. If we turn our backs on refugees, then we risk making ISIS stronger.

Again, thank you for contacting me with your concerns regarding these important issues.. Rest assured that I will closely follow the continuing developments as they arise. Should you have any additional questions or concerns, please do not hesitate to contact me again.

Sincerely,

Adam Smith
Member of Congress

Guest Blog: The DevelopmentXChange Pitch Competition

Guest Blogger: Amanda Hirsch


Saving Lives at Birth, along with the U.S. Agency for International Development (USAID), hosted DevelopmentXChange, the fifth annual pitch competition held by the partnership to call upon innovators from around to identify and scale up groundbreaking prevention and treatment approaches for pregnant women and newborns in poor, hard-to-reach communities.

Fifty-three finalists from the pool of innovators joined this year’s DevelopmentXChange in Washington, DC to participate in the final stage of the competition. They gathered to actively network their ideas with innovators, investors and partners, display their innovations in an open Marketplace, and compete for grants to make their innovations reality.

Amongst the 53 finalists, the first to present was a representative of the Pumani by 3rd Stone Design. Half of premature babies struggle to breath upon birth. This product expands upon the existing Bubble Continuous Positive Airway (bCPAP) technologies that are commonly used in the developed world to treat neonates with compromised respiratory systems by maintaining positive airway pressure during breathing, preventing airway collapse and improving oxygenation.

The Pumani, named after the Malawian term for “breathe restfully,” is as cheaper, easily-transportable version of the original bCPAP. The Pumani is currently being used by 700 clinical staff in 40 hospitals in Malawi and surrounding African countires. 2,000 patients have been treated with 170 Pumani devices to date and have seen survival rates of 64.6% with usage compared to rates of 23.5% from the use of oxygen alone. Creators of the Pumani hope to receive sufficient funds to manufacture hundreds more devices and to develop a sales and distribution team.

Next, innovators of Emory University pitched their Skin Immunization Microneedle Patch. Each year 1.5 million babies and children die of vaccine-preventable diseases. Low socioeconomic status, little-to-no access to healthcare facilities to receive vaccinations, and difficulty transporting and storing vaccines to remote and rural populations have severely impacted vaccination rates in hard-to-reach communities.

The vaccination patch, a small square covered in microneedles that will vaccinate a subject against one or multiple diseases within minutes is proposed to be the solution to this problem. The Skin Immunization Microneedle patch can be stored in unfavorable elements, transported easily, requires minimal storage space, and eliminates the burden of biohazard sharps. So far, the patch has successfully provoked immune responses to H1N1 and tetanus. Innovators of the Emory University team wish for funding to begin conducting human studies for the patch.

Third, innovators from the University of Toronto sought to address iron deficiency in pregnant women, particularly in Southeast Asia. Iron deficiency causes 150,000 maternal deaths each year. To address this problem, the Toronto teamed proposed food fortification- to fortify tea with iron. Tea was chosen to be fortified because it is the sole product that is universally purchased across Southeast Asia. People from all walks of life- rich, poor, urban, rural, must go to purchase tea.

Mimicking the iron fortification of salt which has cured one million people of anemia, it was proposed that iron be microencapsulated into tea that can be processed in the body. Innovators of the iron-fortified tea seek funds to work on managing the taste, distribution, and exploration of their product.

The remaining of the 53 innovators also presented at the DevelopmentXChange pitch competition. To learn more about the innovators, products, competition, and organization, visit http://www.savinglivesatbirth.net.


twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.

Guest Blog: Research, Data and the Risk of Inaction

Guest Blogger: Amanda Hirsch


Research and data are a necessity to execute public health agendas – to identify populations in need, pinpoint existing gaps in healthcare systems, and to track and monitor progress. Data collection exists to ensure these necessary details are documented and not forgotten as every person, health affliction, and need is logged as a number, a figure, a statistic.

Data collection, although crucial, can also become highly counter-productive as this, a vast collection of numerated people and needs, can cause these people and needs to become just that – numbers.

Dr. Binagwaho highlighted the experience of West Africa during the recent Ebola epidemic, one in which the identities of thousands of individuals were lost to the tool most necessary for successful public health interventions.

When the faces and stories of West Africa became blended together through numbers and statistics, the potency of the cause and the intervention became lost. Data can allow people to disappear as their identities take-on a range of figures that highlight their poverty, poor health outcomes, and perceived failures therefore undermining their humanity, discouraging action and perhaps encouraging inaction by those that cannot see the direction nor the importance of the aid that is necessary.

Inaction, when these figures display what appears to be a hopeless and trodden population, is lethal to the real-life humans that the numbers account for.

The Rwandan Experience

In honor of David E. Barmes, renowned public health dentist and epidemiologist, the National Institute of Health (NIH) in Bethesda, Maryland hosted the annual Barmes Global Health lecture featuring Rwandan Minister of Health Dr. Agnes Binagwaho on “Medical Research and Capacity Building: The Experience of Rwanda.”

As the sole presenter, Dr. Binagwaho spoke upon her experience as a physician, researcher, and government health official in her native Rwanda and the country’s substantial improvements in public health following the Rwandan genocide of 1994 that took the lives of over 500,000 citizens.

In need of rapid and effective reconstruction efforts after the end of the civil war, the country was pushed to reinvent its public health systems and infrastructure to make Rwanda a stronger and healthier country than it had ever been before.

Since the genocide, Rwanda, a country smaller than most American states with a population of slightly over ten million, has achieved health outcomes for its people that far surpass those of many developed nations. After reconstructive efforts, the under-five mortality in Rwanda decreased by three-quarters, life expectancy nearly doubled, vaccination rates skyrocketed to 90% for vaccines such as HPV for both young boys and girls, and over 90% of Rwandans acquired health insurance coverage.

“Rwanda is a clear example of what is now possible in sub-Saharan Africa”- Dr. Agnes Binagwaho

How were such great achievements accomplished? An emphasis on resilience- a concept that requires not only a strengthening of health systems, but a focus on strengthening the backbone of those health systems as well- the people.

Research and data collection were key to Rwanda’s reconstruction efforts. In Rwanda, Binagwaho explained that public health workers used this research and data to the population’s advantage, maintaining a scientific and moral responsibility to the people, leaving no one behind and holding research to a new standard: an impact- focused standard that would not allow for inactivity.

The people maintain culture, infrastructure, morale, and economic wellbeing. When the people are healthy and stable, the benefits to the country are immense. According to Dr. Binagwaho Rwanda recognized this connection, encouraging  vast vaccination campaigns, emphasis on maternal and child health, and a reach for universal health coverage to protect the country’s most valuable asset. In turn, Rwanda experienced substantial economic growth, social rest, and improved population health- a feat that would not have been accomplished had the needs of the people not been put first.

You can hear Dr. Agnes Binagwaho’s presentation at the NIH here.


twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.

Guest Blog: Sepsis – A Neglected Global Killer (CUGH)

Guest Blogger: Amanda Hirsch


Sepsis can be caused by any serious infection that leads to multi-organ dysfunction. Diseases that most commonly lead to sepsis infection are pneumonia, TB, HIV/AIDS, dengue, diarrheal diseases, etc. Multi organ dysfunction can lead to death if not recognized and treated early.

Every year, approximately 30 million cases of sepsis are documented. However, it is speculated that the 30 million known cases only comprise a portion of the actual incidence of sepsis each year. Recognition and documentation of sepsis cases is lacking and the exact global burden of sepsis remains unknown.

Many deaths that occur due to sepsis are attributed to the original disease. For example, if a patient succumbs to sepsis after contracting pneumonia, their cause of death will likely be recorded as pneumonia. Secondly, late mortality from sepsis contributes to its underreporting. Many sepsis infections occur after a patient is discharged from the hospital. Yet, very few patients return to seek help for their rapidly advanced infection, resulting in a mortality due to sepsis.

The highest burden of sepsis infections occurs especially in low income countries. The lack of resilient health systems, little public education and awareness, costs of healthcare, long distances to healthcare facilities, and poor transportation all make it difficult for individuals to seek and receive care for sepsis. Also in poor countries, low immunization rates, low coverage for citizens, high levels of disease co-morbidity, unprepared or undertrained healthcare workers, a low emphasis on preventative services, few new drugs for tropical diseases circling through the market, and the export of healthcare staff make sepsis significantly more of a threat.

This underrepresentation of sepsis and lacking preparedness and recognition in the healthcare world has pushed members of organizations such as the Global Sepsis Alliance to call for help- bringing public awareness to the unacceptably high current incidence of morbidity and mortality from sepsis, asserting that something must be done.

To curb the incidence of sepsis, a multi-faceted approach is needed. This approach, according to Dr. Ron Daniels includes the following:

  • Vaccinations
  • Strict hygiene
  • Early recognition
  • Aggressive treatment
  • Rational us of antimicrobials
  • Innovations in care
  • Knowledge translation
  • Capacity building
  • Advocacy

On the topic of advocacy, Dr. Daniels spoke of turning sepsis into a political movement of sorts, putting a face and a name to the infection and what it includes. The public must be educated on the signs and symptoms, the media must spread the word, and governments must allow for more data to be collected, support more funding for sepsis research and treatment, and use their power and platform to make sepsis a priority on both the national and international political arenas.


twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.

The Severity of Racial Health Inequities

Guest Blogger: Tiffany Gilliam


African American women are more likely to succumb to negative health outcomes than any other race or ethnicity. Health inequities are classified as the differences in health status between one disadvantaged population and a group of advantaged. Numerous social determinants of health are related to health inequities, such as:

  • Socioeconomic status
  • Education
  • Age
  • Sex
  • Race and ethnicity
  • Lack of access to quality healthcare

These factors also increase the risk of cardiovascular disease, high blood pressure, diabetes, strokes and healthcare inequity. Nearly 50,000 African American women die each year from cardiovascular diseases. There is a significant gap in life expectancy for African American women compared to white women.

Research has shown that larger populations, like those found in metropolises, correlate to wider gaps in life expectancy. The county of Philadelphia is one of the most racially diverse counties in the United States. That same county contains one of the most racially segregated cities in terms of access to quality healthcare and positive health outcomes. The Philadelphia population is estimated at 1,560,006 residents: 44.2 per cent of which are African American. A recent study conducted by the University of Pennsylvania examined the patient ratio to primary care physician (PCP) in low socioeconomic neighborhoods. The study revealed a PCP ratio of 3,000:1  in underserved areas of Philadelphia. Given this PCP a question is raised regarding the level of care provided to patients. The patient to primary care physician ratio is high due to several reasons such as shortage of primary care physicians, increased amount of Affordable Care Act-covered patients, and the high density of elderly and chronically ill in underserved areas.

In a recent conversation with Sheila, my esthetician, she stated a previous diagnosis of ovarian cancer. The physician immediately advised a treatment of chemotherapy, without any willingness to answer questions or provide additional information.

Before that treatment occurred, however, Sheila received a second opinion from another physician, which revealed that she suffered from endometriosis, not ovarian cancer. After this conversation, numerous questions were raised.  How many other African American women were misdiagnosed and treated for illnesses they did not have? Why was it so difficult for the doctor to make an accurate diagnosis? How often are doctors encouraging participatory medicine when interacting with patients?

How can public health clinicians improve negative health outcomes amongst underserved African American women populations? It is crucial that health polices are created to enforce the overall well-being of African American women of disadvantaged populations. Health policies that promote affordable education, employment opportunities, and adequate accessible health promotion programs are needed in order to improve fair and equal treatment, along with disease prevention and detection.


 Tiffany Gilliam is a first year masters student in Public Health at La Salle University, with a focus in Maternal and Child Health, Social and Behavior Sciences and Health Equity. Her academic interest includes Global Health, Reproductive and Sexual Health and Public Health Policy. For the past three years, Tiffany has worked as a Behavioral Health Worker at Northeast Treatment Center, providing coping strategies, social skills, methods to reduce impulsive behavior at school to children with Attention Hyperactivity Deficit Disorder (ADHD), Oppositional Defiant Disorder (ODD)/Conduct Disorder and Mood Disorder.

Guest Blog: Second Annual Global Social Service Workforce Alliance Symposium at the US Institute of Peace

Guest Blogger: Amanda Hirsch


The SSW symposium provided a forum for practitioners, government representatives, academics, and other experts from around the world to discuss current efforts (3) being undertaken internationally to expand the social service systems for the health and safety of children and families. The presentation was broken into three parts, each part discussing one component of the stride to strengthen the social service workforce.

  1. Planning: Dr. Jini Roby, a professor in the Department of Social Work of Brigham Young University along with Ms. Joyce Nakuta, Deputy Director of the Namibia Ministry of Gender Equality and Child Welfare spoke on the topic of planning the social service workforce. Planning the workforce, they agreed, “takes a system”- a calculated outline of each potential worker and their respective responsibility. To be most effective, social service must work on a network basis from workers on the ground (ie child health workers who raise and mentor orphaned children) to policy makers that have the capacity to encourage funding of child health worker training programs- all positions are necessary for the job to effectively get done.
  2. Robin Sakina Mama, Dean of Monmouth University School of Social Work and Ms. Zenuella Sagantha Thumbadoo, Deputy Director of National Association of Child Care Workers, South Africa discussed developing the social work force. This component of the process deals with educating and training social service workers. Dr. Robin Sakina Mamma spoke about the issue of certification and degrees. Today, many countries in need of social service work are left at a disadvantage because they lack existing institutions that provide proper degrees for social work or do not yet have a place in  the workforce for professional social workers. With that, many do not receive enough of an education in social work to be effective and many do not have a chance to practice and/or use their degrees in their home countries of need.
  3. Natia Partskhaladze of UNICEF and the Georgian Association of Social Works discussed the issue of supporting the workforce. Dr Partskhaladze spoke about worrisome recruitment and retention rates that are particularly high in developing countries, such as her home country of Georgia. The social work profession was non-existent in Georgia as of fifteen years ago. After establishing a study program and professional network for social work in the year 2000, an organization of social workers has since been formed. Centered on retention and development, the organization strives to keep social workers in the workforce while encouraging Georgians to get involved in the field of social work through the development of academic and professional programs and support groups. This organization of social workers now boasts 600 members, making Georgia an example of what committed recruitment and retention efforts can do to create or revive a supply of social workers within a country in need.

In her opening remarks Deputy of the Child Protection Section of UNICEF, Dr. Karin Heissler, noted that social work uses data and lessons learned in order to make decisions about the social service workforce and influence policy- a concept that is very familiar in public health.

Public health is entirely driven by data and “lessons learned”- both are at the base of nearly all interventions and both are necessary when public health professionals must have a voice at the community or policy levels.

The process of “planning the workforce” described is similar to the process of planning an intervention in public health. Both require assessing an issue; anticipating the immediate, medium, and long-term needs to be addressed; and creating a system with which to achieve a goal at all anticipated levels.


twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.

Disney, measles, and parents’ choice not to vaccinate: Who’s to blame?

Guest bloggers: Brittany Seymour and Rebekah Getman

The recent challenges surrounding childhood vaccinations in the United States have received notable attention in both popular and scientific press, illustrating a spectrum of parental concerns and resultant attitudes ranging from vaccine hesitancy to outright refusal. The current measles outbreak traced to Disneyland has contributed to the highest number of US measles cases in fifteen years and resulted in the Centers for Disease Control and Prevention’s release of an official CDC Health Advisory in January this year. Over half of the individuals who have come down with the illness are unvaccinated; of those, more than 80% are old enough to receive the MMR vaccine but have not, leading many states to reevaluate their personal belief exemption policies. Unsurprisingly, this now multi-state outbreak has reignited the emotional debate over vaccine safety, efficacy, and policy in mainstream and social media. While vaccinations are likely one of the most prominent health debates in the United States right now, health officials are increasingly battling unfounded controversy regarding several of public health’s greatest achievements.  The field that is tasked with controlling global disease epidemics is now up against what have been dubbed “digital pandemics:” the far-reaching, rapid spread of unrestricted, scientifically inaccurate health information across the Internet through social networks.

Researchers at Harvard University recently studied this phenomenon over another common public health intervention: community water fluoridation. A lobby to end fluoridation pushes on in communities across America, despite more than 3,000 studies confirming its safety and benefits. The researchers’ findings indicate that, similar to the anti-vaccination community, a small but vocal and very tightly knit network is driving the anti-fluoridation lobby. A well-known social theory describes individuals in the world as connected by six degrees of separation, and Facebook’s one billion users are four degrees separated; the study found that individuals in the anti-fluoride community are separated by a mere two degrees. Often, highly connected networks develop a strict set of norms and values, and any person or information in violation of those norms, such as scientifically accurate pro-fluoride information, will be quickly rejected, making rational discourse nearly impossible. The researchers also traced online social conversations about fluoride through the network. Members of the anti-fluoride network frequently shared and cited scientific studies to back their arguments; however, in more than two-thirds of conversations, the actual study cited was buried two or three links away from the online discussion, or was not reachable at all. This is concerning because, under these circumstances, the risk of evidence becoming misrepresented or misinterpreted likely increases with each link that takes readers further away from the source.

The researchers’ findings support the theory that highly connected social networks, and not science or evidence, are driving digital pandemics of health information on openly accessible Internet sites. In the digital information age, scientific fact is only one piece of the complex health decision-making process. When capable, intelligent parents encounter the sea of voices online while researching how to make optimal decisions for their children’s health, of course they become concerned with what surfaces to the top of their Google search. The Harvard study suggests that perhaps we need to stop blaming parents for choosing not to vaccinate their children or for lobbying to end fluoridation in their communities, an approach that only alienates parents with questions and shuts down dialogue. Moreover, corrective scientific information inserted into existing social communities without respect for norms and values, even if in response to misinformation, runs the risk of insulting those not readily convinced solely by the prevailing science, an ultimately detrimental approach.  Rather, additional research is needed to discover new, social health communication strategies that are more inclusive and acknowledge social networks’ differing belief systems. Digital pandemics are a part of our current, connected reality. Rather than fight against this trend (which may prove impossible), public health communication approaches must empower and partner with parents so that the voices of expertise, evidence, and experience are the ones they trust, and share within their networks, once again.

Getman HeadshotRebekah Getman is the Senior Program Manager for Education at the Harvard Global Health Institute, tasked with creating and implementing multi-disciplinary curriculum for students that supplements their in-classroom learning. These curricula combine global health knowledge with other disciplines to provide students with a broad lens through which to study and assess global health interventions.

SeymourHeadshotBrittany Seymour is an Assistant Professor of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine’s Department of Oral Health Policy and Epidemiology and the Inaugural Harvard Global Health Institute Fellow. Her research includes interdisciplinary global health curriculum development and pedagogy, capacity strengthening for oral health delivery systems in resource-challenged regions, and digital information transfer and impacts on health.