Publisher’s Platform: Hepatitis A and the Food Service Industry: A Case for Universal Vaccination

I read today in the Lancet about the need for universal hepatitis A vaccination for children to prevent what can be a devastating disease. However, under the current US Centers for Disease Control and Prevention (CDC) regime, this safe and effective vaccination has been removed from recommended childhood vaccinations. Another approach that puts politics before public health.

I have spent the better part of three decades in courtrooms, fighting for people who were sickened — sometimes catastrophically — by preventable foodborne illness. I have met families who have lost loved ones to E.coli, SalmonellaAnd Listeria. But few pathogens frustrate me more than hepatitis A, because we’ve had a safe and effective vaccine against this disease since 1995, and we still can’t get it into the arms of the people who need it most.

Hepatitis A is a liver disease that is spread primarily through contaminated food and water, as well as the fecal-oral route. It is, in no uncertain terms, a disease of hygiene and poverty. It thrives where handwashing is inadequate, workers cannot afford to call in sick, and access to health care is limited. This description fits far too many American restaurant workers.

Consider what happens when a single infected restaurant worker handles food before symptoms appear – because hepatitis A is most contagious within two weeks. Before a person feels sick. A single outbreak can expose hundreds or even thousands of customers. I have litigated cases involving fast food chains, buffet restaurants, catered events, and delis. The pattern is always the same: an unvaccinated worker, a hand-washing mistake, and suddenly the local health department is scrambling to offer post-exposure prophylaxis to an entire community. The cost – human, financial and reputational – is enormous.

The economic argument alone should be convincing. A full course of hepatitis A vaccine costs between $100 and $200. A single outbreak investigation, combined with the medical costs of infected customers and the almost certain loss of business for the affected restaurant, can run into the millions. The ensuing trials are costly for everyone. I know, because I classify them.

But this goes beyond economics. Hepatitis A disproportionately affects the most vulnerable: the elderly, people with liver disease, people without housing, and communities with inadequate health infrastructure. When a restaurant worker unknowingly carries the virus, they unwittingly become a bridge between a contagious disease and a public that has no reason to suspect that guacamole is dangerous.

Some states have decided to require hepatitis A vaccination for food handlers. It’s progress, but it’s a patchwork. We need a consistent national standard. Restaurant employers should be required – not just encouraged – to ensure their workers are vaccinated, and they should bear the cost. These are the same companies that take advantage of the public trust. Maintaining that trust is part of the cost of doing business.

I also want to be clear: restaurant workers are not the bad guys here. They often work without sick leave, without health insurance and without anyone explaining to them that a free vaccine could protect them, their families and all the customers they serve. The failure is systemic. It’s up to employers cutting corners, lawmakers resisting mandates, and a chronically under-resourced public health infrastructure.

In the past, we vaccinated children against hepatitis A as part of the standard childhood immunization schedule – and we hope that most still do. However, the question is why we are willing to protect our children, but not the workers who handle their food.

The vaccine exists. The science is established. Epidemics are predictable and preventable. What we lack is the political will to act. I have seen the consequences of this inaction. They are not abstract: they carry names, medical records and, in some cases, headstones.

Vaccinate food service workers. Vaccinate everyone. This is not a radical position. This is simply the logical conclusion of everything we know about this disease. And, by the way, fire RFK Jr. and his anti-vaccination mafia.

Bill Marler is a food safety attorney and managing partner at Marler Clarkthe nation’s leading law firm representing victims of foodborne illness outbreaks. William “Bill” Marler has been an attorney and advocate for food safety since the E. coli Jack-in-the-Box from 1993, recounted in the book, “Poisoned” and in the recent Emmy Award winner Netflix Documentary of the same name. Bill’s work has been featured in the New Yorker, “A bug in the system; » the Seattle Times, “30 years after the deadly E. coli epidemic, Seattle lawyer still fights for food safety; » the Washington Post, “He helped make hamburgers safer. Now he’s battling food poisoning again; » And several others.