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INFECTIOUS
DISEASES

Immunizations

and The Luxury

to Choose

By Travis Bias, DO

he 82-year-old woman lay on her mat, her legs power- not sexually active? And she does not need this shot to attend
T less, looking up at the small group that had come to school?” Gardasil was a difficult sell in the conservative state that

visit her. There were no more treatment options left.
was careful about adopting what government, or anyone for that
The oral liquid morphine we had brought in the small matter, recommended an individual do for the sake of public health.
plastic bottle had blunted her pain. Nonetheless, she would be dead It is now February 2018 and news reports are sounding the alarm
in the coming days. The cervical cancer that was slowly taking her about the strain of influenza making its way around the U.S., causing
life is a notoriously horrible disease if left undetected and untreated, remarkably high rates of hospitalization and death. This disease can
and that is exactly what had happened in this case. be easily prevented by one vaccine each flu season, yet patients de-
We had traveled hours by van along dirt roads to this village with cline this vaccine due to any number of excuses. “Won’t I be sick
a team of health workers from Hospice Africa Uganda, the coun- or sore for several days after?” “I am very careful about what I put
try’s authority on end-of-life care, to visit the woman. She was the in my body.” And the online “anti-vax” echo chamber encourages
second patient of a similar condition I would see that afternoon. this behavior, turning one anecdote of a less-than-desirable reaction
Back home, seeing an 80 year-old woman with advanced cervical into several stories of harm attributed directly to a single shot in
cancer, let alone two in the same day, was exceedingly rare. In high- the arm.
income countries, cervical cancer is a largely treatable disease, es- What a luxury to choose from a menu of technological advances
pecially when caught in the early stages. And it is now preventable to protect one’s health. What a luxury to have an employer or tax-
thanks to Gardasil, a widely accessible vaccine against Human Pa- payer fund these ubiquitous means of preventing disease; whether
pillomavirus (HPV), the infectious agent that causes most cervical it is a vaccine, a blood test, or a basic treatment. High-income soci-
cancers. Physicians and other health care experts recommend the eties have at times taken for granted life-saving resources. All to the
vaccine for all pre-teens in the United States. detriment of their communities. What a luxury.
“If only she had had access to Gardasil,” I thought to myself. Considering the Centers for Disease Control and Prevention’s
Just months earlier I was busy in my private primary care practice list of the top 10 greatest public health feats of the last 100 years,
in Austin, Texas. In one of the richest countries on the planet that we are on an incredible backslide to the year 1899. Measles was de-
spends more on health care per person than anywhere in the world, clared eliminated from the United States in 2000 thanks to wide-
I was putting forth my best effort to explain to a mother why her spread immunization, yet we now have outbreaks at Disneyland and
14-year-old daughter, who had never before had any sexual contact, anticipated future outbreaks due in part to conscientious objectors
needed the series of three shots against HPV. “So this HPV is sex- to the vaccine. Thanks to advancements in water treatment we no
ually-transmitted, and she still needs the vaccine even though she is longer have major outbreaks of diarrheal disease, yet we now have

continued on page 24
22 San Antonio Medicine • May 2018