Indiana, That Bastion of Public Health

It’s not a secret that Donald Trump offered the Vice President nomination slot to John Kasich, telling Kasich that he would be the VP but be in charge of domestic policy and other things. In essence, Trump would be a figurehead, probably raking in the cash and other benefits of being in power while letting the VP do all the dirty work. When Kasich declined, Trump picked Indiana Governor Mike Pence.

Mike. Pence.

Governor Mike Pence took office as governor in January 2013. Almost immediately, he worked with the Legislature there to de-fund Planned Parenthood. (It was something that the previous governor had tried to do as well, in all fairness. It must be a tradition, or something.) Their efforts failed, but the damage was done.

Slowly and steadily, funding for Planned Parenthood was diminished. It wasn’t eliminated, because they really couldn’t take away all the money. But it was diminished. The time then came when the one clinic serving Scott County, Indiana, had to close. It never provided abortion services, just to be clear.

In January of 2015, epidemiologists at the Indiana State Department of Health (ISDH) noticed that 11 cases of HIV had been newly diagnosed in the southeast part of the state. (Scott County is just north of Louisville, Kentucky, in a rural part of Indiana.) Previously, only 5 cases a year had been diagnosed there, on average. The fact that all the cases shared a similar place of residence and had similar exposure histories (IV drug use) raised alerts. By April, 135 cases had been identified.

You can read all about it in the Morbidity and Mortality Weekly Report of the outbreak.

For many years before the outbreak, Indiana had outlawed needle exchange programs. So needles were hard to come by. Then the opiate epidemic arrived, and people were addicted to pain medication. When pain medication became hard to get, they turned to heroin. The heroin needed to be injected, so they got needles from somewhere. Then they started sharing those needles… And the outbreak began.

In March, when he was told what was going on, Gov. Pence called up advisors and wondered what to do (my emphasis in bold):

“Much as Tim Kaine, the Democratic vice-presidential candidate, had to wrestle with his deeply felt opposition to capital punishment in a death penalty state, allowing 11 executions when he was Virginia’s governor, the H.I.V. outbreak forced Mr. Pence to balance strong beliefs against ground-level reality: an epidemic that was growing more dire by the day.

In recent interviews, local, state and federal health officials said Mr. Pence initially held firm. So as they struggled to contain the spread of H.I.V., the officials embarked on a behind-the-scenes effort over several weeks to persuade him to change his mind, using political pressure, research and pleas for help from this remote, poor community.

On March 23, more than two months after the outbreak was detected, Mr. Pence said he was going to go home and pray on it. He spoke to the sheriff the next night.

Two days later, he issued an executive order allowing syringes to be distributed in Scott County.”

Thank God — literally, since Gov. Pence had to pray about this — that he opted to do the right thing.

That NY Times article goes on to talk about how people up and down the public health and policy structure within Indiana were conflicted about needle exchanges. Some of them, including Gov. Pence, believed that giving IV drug users needles was the ethical/moral/practical equivalent of enabling their drug use. (Federal legislation making it illegal to use needles and syringes for other than “legal” administration of drugs was supported by Gov. Pence when was in the House of Representatives.)

Because, you know, making something illegal totally eliminates it from our society.

Thankfully, enough reasonable people reached Gov. Pence, and he issued the executive order for the needle exchange in Scott County (and nearby places seeing that outbreak happening to their people). Sometime later, the Indiana Legislature passed a bill to reverse the prohibition on needle exchange programs, instead regulating them closely. However, that regulation comes with some interesting caveats:

  • First, the local health official declares an emergency because an HIV or Hepatitis C outbreak is happening.
  • Then, the local government accepts the declaration and asks for public health officials to proceed.
  • Finally, the state health secretary declares the emergency and the programs are propped up. This declaration is re-visited yearly.

In other words, the horse has to be out of the barn before a commission of people ask that a door be built.

You will probably think that this is a political attack on Gov. Pence and his possible handling of public health should he and the misogynist orange phlegm specimen lost in the back of a lab workbench for 70 years win the election coming in November. You might even call for me to make a similar evaluation of Tim Kaine’s public health record in Virginia. And this would be fine… If there is some thing out there telling me that Tim Kaine took some weird decision with regards to public health. He really hasn’t (kind of). He’s vanilla like that with regards to it.

But Mike Pence? The guy even had an op-ed telling us that smoking doesn’t cause cancer and certainly doesn’t kill. Maybe we should pray he doesn’t have anything to decide as VP when it comes to public health? I know I will.


You get the point.

1 Comments on “Indiana, That Bastion of Public Health”

  1. Pingback: Portugal, That Bastion of Public Health – Epidemiological

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