Richard H. Hughes, IV, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, authored an article in Health Affairs, titled “Vaccine Politics.”
Following is an excerpt:
In 2006, at age twenty-two, I sat with my bald, scarred head in the office of Paul Halverson, who was the Arkansas State Health Officer at the time. We were both appointees of Gov. Mike Huckabee (R). Back then, before taking the national stage and joining Fox News as a commentator, Huckabee, the chairman of the National Governors Association, had launched Healthy Arkansas and Healthy America initiatives to improve public health outcomes in our state and nation, respectively.
Undertaking his responsibility to educate a young, unqualified board member, Halverson handed me a copy of the seminal 1988 Institute of Medicine report on the future of public health. He then projected onto a screen in his office a diagram, titled “A broad view of population health and the spectrum of possible responses,” from a recent academic article. I had never seen anything quite like it. Circling his pointer over the diagram, Halverson walked me through the lifespan of a hypothetical person, explaining that broad-based public health interventions, such as clean water and vaccines, can head off disease early. When people become vulnerable to disease—say, because of adverse living conditions or an underlying health condition—we must offer them targeted protection through other clinical or public health interventions. If we fail to adequately deploy these interventions, Halverson explained, people get sick. This is where the health care system begins to bear the brunt of missed opportunities: the demands and costs of treating sickness.
I had just started graduate school that year when two unexpected life events converged: my appointment as the youngest-ever member of the Arkansas State Board of Health and a diagnosis with glioblastoma. I underwent a craniotomy to remove a tumor in the right frontal lobe of my brain and narrowly avoided full-brain radiation. A second opinion confirmed that I had been misdiagnosed—I did not have glioblastoma, but a different, rare kind of tumor. The news that I would die in six months’ time had been a false alarm. I came away from that experience with a new sense of purpose and perspective—a definite feeling that I could and should work to improve health outcomes in my home state. The tutorial from Halverson only made the feeling seem more tangible.
I had grown up in rural Arkansas in a small, all-White town, a fifteen-minute drive from the other, predominantly Black side of the county, which sat at the top of the impoverished Mississippi Delta region. I was not yet steeped in concepts such as health equity or social determinants of health, but when Halverson said that someone in rural Phillips County, on the southeastern side of the state, had a life expectancy that was ten years less than someone in more affluent northwest Arkansas, I began to recognize my home county as a microcosm of that greater divide.
My experiences during the next nearly two decades—on the Arkansas State Board of Health; as a public health professional, health lawyer, and professor in Washington, D.C.; and as the vice president of public policy at Moderna during the COVID-19 pandemic—taught me more about the complexities of making evidence-based health policy decisions than I could have imagined that day in Halverson’s office, and of the dangers to human health when politics cloud public health decision making.
