I think the opposite... instead of going through the trouble of making people change their ways (which we know is hard and takes generations) instead we eliminate the root cause. Sounds efficient to me.

That’s because you don’t understand what group A strep is or what it means to eliminate it

Public health tends to prefer the Swiss cheese model of prevention - increased access to antibiotics, trust building in communities, and promoting access to healthcare all occur simultaneously.

But vaccines are very effective.

Public health tends to take the view that access to antibiotics is already too high, not too low.

Not in the example given there.

It is, it's preferable to have no antibiotics than not enough antibiotics. This only creates resistant strains and doesn't heal people.

Is it preferable to have none or enough?

Enough is obviously good, there's plenty of stuff where you need antibiotics to heal. Enough can be bad if abused, since some doctors overprescribe antibiotics for cases where it's not warranted, e.g. a cold. Most colds are viral in any case, so all you're doing is weakening the patient even more. Aside from that there may be severe side-effects, so it's best only to use antibiotics if you know you have a bacterial issue that can be solved with them.

None is preferable to partial treatments, since a partial treatment will create resistant strains and not much else.

Working as an infectious disease epidemiologist in global health, that’s not the take.

The inappropriate use of antibiotics is too high, and simultaneously there are very real issues of access.

Vaccines are sometimes very effective. But against "over 200 known types of strep A, distinguished by their unique M proteins"?

Has there been a vaccine like that?

There’s lots of multi-valent vaccines, the HPV vaccine being a good example. There’s also potential non-M protein targets.

https://www.nature.com/articles/s41541-023-00609-x

In other words, poverty is the real problem.

Ignorance is the problem.

Plenty of wealthy people are taking horse deworming medicine for political purposes.

A mix of both, the poverty creates some of this ignorance by lack of access to education.

That people in the US choose to be ignorant despite having an education happens, but it's rarer than where there is no education.

My mother was educated. She bought into some misinformation and fear-mongering about modern medicine and rejected it entirely. No vaccines no doctors. Mostly it was fine till it wasn’t. I took myself to a doctor as a teen with bad strep. Not our doctor we didn’t have one. just a doctor. No insurance. They could see I was in rough shape. They just diagnosed me with strep (although I already knew that’s what it was) and sent me away with a prescription. I didn’t even realize how weird that was till much later. (That they saw me with no insurance and no previous relationship and no payment)

My sister was in town once years later and my younger brother was in such bad shape she took him to a doctor. She swears to this day he would have died. Again strep.

Misinformation is a big problem. People who buy into it put their kids at risk. When we allow purveyors of nonsense to thrive because “freedoms” we do everyone a disservice.

> Plenty of wealthy people are taking horse deworming medicine for political purposes.

Don’t understand this

This I think https://www.independent.co.uk/news/world/americas/covid-iver...

Though that was a bit 2020. Not sure it still goes on.

They still do. They think it's a magic salve that cures everything, even cancer. Which is sad because for many of them it's probably the only health care they have access to. The way the media reacts to this stuff only makes things sadder.

The “they” being wealthy people? I am skeptical. I know many of them.

People on the margins distrust authority, see themselves as knowing better, and resent the “mainstream” system for different reasons.

Think of the folks who think RFK Jr is some sort of breath of fresh air. Or the people into Gwyneth Paltrow faux “wellness” nonsense and homeopathy.

On the more reactionary side, you have people who idolize the cowboy myth, the 1950s, or interpret freedom as meaning “I don’t pay taxes”.

It’s the same psychological feature, realized through different perceptions.

Interesting. It won the Nobel prize for human applications long before it was considered a veterinary drug so I am still puzzled.

There was a bit of an odd phenomenon in the US where a lot of people went anti vax during covid and in those groups they tended to support using ivermectin instead to treat covid, in spite of the evidence being that vaccines were quite effective at reducing harm and ivermectin wasn't. They tended to be the right wing anti government types, while the dems were mostly in favour of getting everyone to be vaccinated. Most of the ivermectin lot were Trump voters although I don't think he suggested it - he recommended vaccination and in the early days suggested hydroxychloroquine when people still thought that might work.

I'm not american and found it all a bit odd. I mean you'd think with medication you'd follow the scientific evidence for what works rather than political stuff. Maybe social media is to blame?

They estimate about 319,000 more people died in the US that would have happened if everyone just got vaccinated when it was recommended (https://www.npr.org/sections/health-shots/2022/05/13/1098071...)