HJNO Nov/Dec 2025

HEALTHCARE JOURNAL OF NEW ORLEANS I  NOV / DEC 2025 11 rent surgeon general, Joseph Ladapo, MD, PhD, has argued against mandating routine childhood vaccinations, insisting that such decisions should be left entirely to parental choice. 13 At face value, this aligns with the traditional American notion of autonomy. But vaccinations are not solely about me; they are about we. Childhood immunizations against diseases such as measles, polio, and pertussis have historically been among the most successful public health interventions in reducing both incidence and prevalence of communicable diseases. Widespread uptake of these vaccines has not only protected individual children but has created herd immunity, shielding entire communities — including infants too young to be vaccinated, immunocompromised indi- viduals, and others who rely on the collective barrier to avoid exposure. When uptake falters, outbreaks resurface, as demonstrated by re- cent measles resurgences in communities with lower vaccination rates. Each year I receive the influenza vaccine, not so much for my own protection, but for that of my patients. To infect a vulnerable patient with influenza because of my refusal to vacci- nate would be to violate medicine’s most basic principle: primum non nocere — first, do no harm. Vaccination is not only personal health maintenance but a professional and ethical duty of solidarity with those I serve. Childhood vaccinations function in the same way. They are not only personal health maintenance but a community-wide safeguard. By framing vac- cination only as a matter of parental discretion, we weaken the collective shield that has histori- cally kept devastating diseases at bay. Vaccina- tion is thus both an individual act of protection and a societal act of solidarity, affirming that healthcare is strongest when we act for we, not just me. The tension between Ladapo’s stance and the physician’s responsibility illustrates the broader issue: When healthcare decisions are framed in terms of me, the system fragments; when framed as we, trust and reciprocity can emerge. Radical Inclusion as a Framework How do we move beyond entrenched di- vides? A framework emerges from an unlikely partnership: Martin Dempsey, a retired four-star general and the former chairman of the Joint Chiefs of Staff, and Ori Brafman, a progressive UC Berkeley academic. Their book, Radical Inclusion: What the Post-9/11 World Should Have Taught Us About Leadership , argues that leadership in an interconnected world must be rooted in inclusion. 14 Their six principles — giving people shared memories, making work matter, imagining alternative futures, developing a bias for ac- tion, co-creating context, and relinquishing control to build power — speak directly to healthcare. Imagine how prior authorization might differ if payers and providers co-created context around evidence instead of imposing rigid rules. Or how public trust might improve if leaders empowered local physicians and com- munities to co-design reforms. In their book, they derived lessons from mili- tary teams that might help inform healthcare teams. The U.S. military offers case studies of inclusion shaping outcomes. Racial integration of the armed forces in 1948 was controversial at the time, and President Truman’s executive order to desegregate the military faced fierce opposition but ultimately strengthened cohe- sion. 15 It might also be argued that repeal of “Don’t Ask, Don’t Tell” in 2011 and the re- sultant inclusion of LGBTQ service members challenged tradition but broadened trust and effectiveness. Only history will judge whether the latter embrace of cultural inclusivity will withstand the test of time, but not even this current administration would be so audacious as to return to the days of a segregated military. Healthcare has parallel lessons. Interdisciplin- ary teams — physicians, nurses, pharmacists, social workers, community health workers of all genders and ethnicities — consistently deliver better chronic disease management and pa- tient satisfaction. 16 In this case, inclusion is not sentiment but structure: Aligning diverse ex- pertise yields better outcomes. Most relevant to healthcare today is Dempsey and Brafman’s idea of the digital echo: Every policy, decision, and public message gets amplified and distort- ed online. Healthcare is not immune. Vaccine misinformation, miracle cures, and conspiracy theories spread faster than peer-reviewed sci- ence. Combating this misinformation requires not just better messaging, but intentional in- clusion of voices that communities trust. My own bias — and sincere hope — is that one’s primary care physician will become that voice of trust. However, in order for primary care to occupy that role we must first act to save and even exalt primary care, whose ranks have been decimated by years of flawed payment models that preferentially reward volume over value, HEALTHCARE IS INHERENTLY COLLECTIVE. ILLNESS DOES NOT RESPECTSTATELINES ORPARTYAFFILIATION.