Citing government overreach, Louisiana won't promote vaccination, surgeons general say

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The Louisiana Department of Health (LDH) will no longer encourage mass vaccination, the state attorney general and his deputy said yesterday in a news release and on social media, alarming health experts amid a growing measles outbreak in neighboring Texas.

And LDH has banned vaccine events and ordered staff not to promote vaccination, New Orleans Public Radio (NOPR) reported today, citing an internal memo to staff yesterday, the same day as the confirmation of vaccine critic Robert F. Kennedy, Jr, as secretary of the US Department of Health and Human Services.

In December, NOPR reported that LDH employees had been instructed not to produce news releases, presentations, or social media posts urging vaccination against COVID-19, flu, or mpox.

'Offense against personal autonomy'

"Government should admit the limitations of its role in people’s lives and pull back its tentacles from the practice of medicine," Ralph Abraham, DVM, MD, and Wyche Coleman III, MD, said in yesterday's release. Restoring public trust, they said, "requires returning medical decisions to the doctor-patient relationship, where informed, personalized care is guided by compassion and expertise rather than blanket government mandates."

Abraham is a veterinarian, physician, and was a Republican US representative for Louisiana's fifth congressional district from 2015 to 2021. He made a failed bid for governor in 2019. Coleman is an ophthalmologist who practices in Shreveport.

The statement noted that for much of last century, public health has worked to fill the gaps in the "broken" US healthcare system by providing guidance, information, and recommendations. "But when we get it wrong and overreach, the harm is often irreparable," it said, calling the US Centers for Disease Control and Prevention (CDC) recommendation that 6-month-old children receive COVID-19 vaccinations "woefully out of touch with reality and with most parents."

"Trust is built over years and lost in seconds, and we’re still rebuilding from the COVID missteps," namely the vaccine mandates that constituted an "offense against personal autonomy that will take years to overcome," they said.

'Not a reason to eschew the value of vaccines'

Paul Offit, MD, director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphia, called the logic of the surgeons general statement on vaccines "tortured."

"They say 'here we had mandated vaccines for COVID, and there were things we didn't know about COVID because, as with everything, we learn as we go. But we still mandated vaccines when there were things we still didn't know; therefore, we can't trust the people who made those decisions, and we shouldn't have mass vaccine campaigns ever again.'"

I'm really worried about measles especially, because it's the most infectious disease—period. And it's going to seek out those who aren't vaccinated.

Paul Offit, MD

Offit said the move is very concerning for public health. For example, Texas's measles outbreak is now at 48 cases. "What if it spreads into Louisiana?" he asked. "Are we just going to say 'do what you want?'"

"I'm really worried about measles especially, because it's the most infectious disease—period," he said. "And it's going to seek out those who aren't vaccinated."

Governments first became involved in public health for the exclusive purpose of controlling infectious diseases, Amesh Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security and adjunct assistant professor at the Bloomberg School of Public Health, told CIDRAP News.

"The Louisiana Surgeon General and Deputy Surgeon General—neither of whom are infectious disease physicians—evade that fact and construct a false alternative describing vaccines as 'a zero sum' game and misrepresent liability protections that apply to vaccine manufacturers," he said.

He was referring to Abraham and Coleman's statements that "Medical decision-making is a zero-sum game: when outside forces get involved, patient autonomy is sacrificed" and that vaccine manufacturers are exempt from liability for any harms they cause.

Adalja said that he agrees that vaccine recommendations should be as nuanced as possible and not one-size-fits-all, "that they have not always met that metric is not a reason to eschew the value of vaccines for both individuals and the societies in which they reside."

Solution will come down to 'usual hard work'

Rather than vaccines, Louisiana is focusing on promoting make-up disease screenings, treatment of substance abuse and mental illness, stemming chronic disease rates, and reducing maternal and infant death rates in the state, which it acknowledges are some of the worst in the country, the news release said. It provided no details on how the state will address these concerns.

"As a nation, we must recognize that there is no miracle pill for the major population health problems we face," Abraham and Coleman wrote. "The solution to increased spending and declining outcomes in our country is unlikely to come in the form of a pill or a shot. Much of the solution will likely come down to the usual hard work of improving diet, increasing exercise, and making better lifestyle choices."

In a February 12 Facebook post, Abraham warned the people of Louisiana that eating "party trays of fried chicken and seafood or mini muffulettas, king cakes and sugary daiquiris" during Mardi Gras is not healthy. Six people "liked" the post.