Standing AFFIRM: Gun Ownership is Not a Disease, but Gun Violence is Like Rabies : Emergency Medicine News

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Standing AFFIRM

Standing AFFIRM

Gun Ownership is Not a Disease, but Gun Violence is Like Rabies

Haselden, Laura MD; Barsotti, Christopher MD

doi: 10.1097/01.EEM.0000898192.38474.a0
    gun violence, gun ownership, injury prevention

    Comparing gun misuse, violence, and injury prevention initiatives with other public health successes like vehicles, tobacco, and viruses like HIV is logically inconsistent and stigmatizes the majority of gun owners.

    Gun misuse and violence continue in our society, and injury prevention initiatives attempt to provide solutions to what is now being recognized as a public health problem. But more than 99 percent of responsible gun owners do not engage in violence (EMN. 2022;44[9]:9;, and this population is an essential and natural ally in our attempts to make the presence of firearms in society safer.

    Talking about gun violence in these terms fails to recognize the overwhelming preponderance of responsible gun owners who share our goals of safety, who hold strong beliefs about their rights and responsibilities to have guns, and who we must engage to reduce the harms associated with guns.

    Gun owners recognize—where we might not—that access to guns is not a disease and the owners are not the ill ones to be treated. The intent to commit violence with guns is the disease, and interventions and analogies must acknowledge this.

    No single public health analogy works for understanding firearm injury prevention, so we must explore alternate disease models to develop a functional and practical approach. Acknowledging that perpetrating gun violence is a statistically rare disease with high morbidity and mortality allows us to draw lessons from other rare but highly fatal diseases and tailor our interventions to those at risk of having that disease.

    Gun Violence and Rabies

    Some public health advocates have referred to guns as a vector of disease in the same way they might discuss a virus as an agent transmitting illness. This suggests an infectious quality inherent in gun ownership, effectively stigmatizing all gun owners as though they transmit violence by their mere existence.

    The disease is not device possession but rather using that device for intentional harm, and the component of virology that applies is that people may be put at risk of acquiring the disease from factors outside of their control.

    Perpetrators of firearm injury, whether self-directed or interpersonal, often develop the disease of intentional violence from exposure to adverse social determinants of health, prior trauma, and structural violence, among other harmful external variables. Hurt people hurt people.

    Perpetrators of the most extreme forms of interpersonal violence—mass shootings—commonly have suicidal and homicidal ideation (J Threat Assessment Management. 2021;8[4]:125), and the source victim often dies along with the secondary victims he “infects.” The rabid nature of this form of violence invites the analogy of another rare and highly fatal disease among humans: rabies. Even the etymology applies: La rabbia means anger in Italian.

    Avoiding Failure

    Rabies, while infectious, is generally transmitted through violent, direct physical contact—bites. The presence and proximity of animal reservoirs put humans at risk of infection and death analogous to geographic hot zones of firearm injury. We have established upstream health systems for preventing harm from rabies because of its high mortality: We vaccinate the animals closest to us to minimize their risk of infection and transmission, and we seek post-exposure prophylaxis to prevent the disease when we are bitten by an animal.

    We do not take a blanket approach of removing or containing all organisms that could transmit this fatal infection. And because we recognize and value the importance of noninfected animals, pet owners understand their responsibility to maintain the safety of their animals. Community health systems have protocols for characterizing and minimizing risk from animals when exposure or abnormal behavior is reported. Nor do we vaccinate all humans for rabies, which would pose high costs and potential adverse effects. Instead, we can safely and effectively vaccinate only those at increased risk (i.e., ring vaccination).

    We can address gun violence as a public health crisis while still recognizing its rare prevalence among gun owners, just as we have approached other rare but highly fatal diseases with profound success. Rabies has been effectively eradicated in humans because of community education and targeted interventions to those at risk without eliminating those vectors that potentially transmit illness. Efficient community education of risks, protective factors, and effective therapies for those rare individuals in periods of increased risk appear to be a practical approach to mitigate harms from gun violence as well.

    Meaningfully reducing the public health effects of gun violence means we must acknowledge the extent to which responsible gun owners will need to engage and collaborate with health experts. Stigmatizing these stakeholders by treating gun ownership as a disease or an infection virtually guarantees our failure. Appreciating the intent to commit harm with a firearm as a rare, specific disease that affects a very small subset of gun owners allows us to engage and target our interventions more meaningfully and where they will have the most effect.

    Dr. Haseldenis an emergency physician in the Washington, DC, region and the acting communications fellow at the AFFIRM Institute, a program dedicated to reducing firearm injuries in the United States through health-based, nonpartisan approaches. Follow her on Twitter@HaseldenMD. Dr. Barsottiis the program director of AFFIRM at the Aspen Institute. He is also a community practice emergency physician at Berkshire Medical Center in Pittsfield, MA, and a certified 4-H youth rifle safety instructor. Read his past columns at, and follow him on Twitter@ChrisBarsottiMD. Find more information about AFFIRM at, and follow the foundation on Twitter@ResearchAFFIRM.

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