On Vaccinations

It's a fun day when two different Republican presidential candidates get themselves in trouble about science. We've all heard the stories, Rand. That's why there's an issue. The question is not whether there are stories, but what you would advise to parents.

So here's what I think.

1) As a gambling man, I notice that lots and lots of people get these vaccinations, and almost none of them are the source of scary stories. The diseases seem to have much worse outcomes on average. So, a smart gambler takes the vaccine.

2) As an anecdote, I myself have been vaccinated against just about everything, and I'm just fine. I've even had vaccines for anthrax, small pox, and third world diseases that won't come across your desk unless you travel widely.

3) Furthermore, all the medical professionals I know -- including my favorite cousin -- tell me that they are aware of no evidence that these things are dangerous, and strongly recommend administering vaccinations to your children.

4) Meanwhile, not only will you be protecting your child if the vaccination works successfully, you'll be doing a good deed for other parents of other children as well. These things work much better if we all do it.

Now the fun part.

5) As a philosopher, I can tell you that the strongest argument is the argument from gambling. There's a lot of empirical evidence about outcomes. You're placing a wager of a sort, with your child's life and health as the stakes. If you view this as a wager, it's pretty clear what the smart bet is.

All the other arguments are suspect. My anecdote is of no use to you, because anecdotes are not data and your child's body chemistry is not the same as mine. In fact, even if we get to data, you still get no promises. Cabbage is widely administered to the population. Almost no one has any problem with it. My wife happens to be allergic to it. Weird body chemistry things happen all the time.

The appeal to medical professionals and scientists is an appeal to authority, which is an informal fallacy. This is their area of expertise, which makes it less dangerous, but it's still no guarantee of truth. The fact is that the best they can tell you is that they have no evidence, yet, of any connection. That's an argument from ignorance, which is another informal fallacy.

The final argument is an appeal to ethics, but ethics doesn't have a lot of clear objective standards. The only place you find objective standards in ethics is virtue ethics. You can show that courage is objectively a virtue, because no matter what your goals are, being courageous will (always or for the most part, as Aristotle says) help you achieve them. Vaccination is a virtue on this account: always or for the most part, it will lead to the best outcomes for your child. Vaccination is the virtuous thing to do just because it passes the gambler's test.

The ethical argument that you should take the risk to help other peoples' children, however, is suspect. It's not clear that there's a virtue involved in risking your child to save other peoples' children. Any claim that there's any sort of duty to do it is not objective: now we've left virtue ethics for what is called "Deontology," and nobody really agrees about what roots duties. It is not clear to me how you would ground any duty that required a parent to risk their child's life or health for any reason.

So, what should you do? Vaccinate your children. It's virtuous, and it's the smart bet. Don't let anyone tell you that it's not a risk, though, or that you're stupid for worrying about it. There's still a lot we don't know.

UPDATE: Speaking of Republicans seeking the nomination, Dr. Carson is a pediatric surgeon by training and his opinion is to vaccinate.

50 comments:

douglas said...

The post on Christie seemed unfair, as it appeared clear enough to me that he was merely reaffirming parents right to choose, and governments responsibility not to overstep.

Paul is likely to self destruct, even though he is far more savvy than his father.

Cass said...

We vaccinated our kids too, but you're right. There are risks.

In the early 1980s when he was a 1st Lt, he was given flu shots by the Marine Corps. He developed severe pain in his back and shoulder and eventually lost 80% of his nerve function in one major area of the shoulder and quite a bit of the nerve function to his wrist.

This would all be in the line of acceptable risk, if they had not handled it the way they did (pushing a completely ludicrous theory that he had "hurt himself lifting weights" instead of admitting what we now know was really the problem).

For the rest of his career, he had to fight every.single.time they wanted to give him the flu shot. 30+ years later, he still has impaired nerve function in his shoulder and wrists. And it definitely impacted his career - he was non-deployable for nearly a year, during which he built up the other muscles to compensate. To this day, if he doesn't work out, his shoulder blade wings out.

You're exactly right - it's a gamble and the odds favor taking the shot in most cases. Jumping on Christie for saying the obvious is a sign of desperation.

Cass said...

Oops - must have lost part of my comment. The "he" above is the Spousal Unit.

Christopher B said...

I think Ace was right in the first instance on Christie. When you're a bigger waffle on an issue than Obama you've got a problem, and the biggest problem with vaccinations is the idea that they should be optional, like participation in a field trip. I might make a concession for people who have a long standing history of refusal to be vaccinated but not the more recent ones who want to avoid the risk of vaccination while gambling their kids won't be exposed to those diseases because other people are vaccinating their kids.

Vaccination is an instance where your point #4 really is the best argument. The most important part of immunization is the development of 'herd immunity' so that they are few if any populations that can serve as safe harbors in which the disease viruses can survive. If that 'herd immunity' breaks down then vaccination becomes pointless to a degree because vaccinations are not 100% effective. They only boost the bodies ability to fight off the disease. At some point you're faced with the risks of both the vaccination process plus the risk of getting the disease anyway. There is undeniably a risk that a child faces from the vaccination process but I as a parent will willingly take that risk if a sufficient number of other parents join me. It will in the end protect all of our children to a greater degree than if none of us did.

battleblue1 said...

A smart gambler takes the vaccine if the vaccine works. If it doesn't, then the risks outweigh the benefits by far.

25% of a Navy minesweeper crew came down with the flu in 3 days time. Ninety-nine of 102 USS Ardent crew members, 24 of the 25 with ILI symptoms, and 17 of 18 crew members with confirmed influenza A (H3N2) infection had received the 2013–14 influenza vaccine ≥3 months before the outbreak. Vaccinations had been administered at local naval health clinics and at a vaccination fair conducted by Naval Medical Center San Diego. Of the 25 crew members with ILI symptoms, 16 were vaccinated via intradermal injection, eight via intranasal mist, and one had not received vaccination. Sequence analysis of the HA1 portion of the hemagglutinin gene showed 99% homology to typical H3N2 strains circulating in the United States and worldwide during the 2013–14 northern hemisphere influenza season and were found to be antigenically similar to A/Texas/50/2012.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6342a3.htm?s_cid=mm6342a3_e

Since December 2009, mumps incidence has increased in the Netherlands. As of 20 April 2010, 172 cases have been notified on the basis of laboratory confirmation or linkage to a laboratory-confirmed case. Of these, 112 were students, the majority of whom had been vaccinated (81%).
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19554

During August 10-November 23, 1998, 33 confirmed * measles cases were reported to the Anchorage Department of Health and Human Services and the Alaska Department of Health and Social Services (ADHSS). Of these, 26 cases were confirmed by positive rubeola IgM antibody test, and seven met the clinical case definition. This was the largest outbreak of measles in the United States since 1996 (1,2). This report summarizes results of the epidemiologic investigation conducted by ADHSS and underscores the importance of second-dose requirements for measles vaccine.
The 33 case-patients ranged in age from 2 to 28 years (median: 16 years). Twenty-nine case-patients had received at least one dose of measles-containing vaccine (MCV) at or after age 12 months; one person with laboratory-confirmed measles had received two appropriately spaced doses of measles-mumps-rubella vaccine (MMR). No serious complications or deaths were reported.
At the high school where the 17 cases occurred, based on school records, only one of 2186 students had not received at least one dose of MCV before the outbreak; 1057 (49%) had received one dose of MCV, and 1112 (51%) had received two or more doses. Estimated vaccine efficacy for two or more doses of MCV was 100%.
http://www.cdc.gov/mmwr/preview/mmwrhtml/00056144.htm

From January to July 1991, an outbreak of mumps occurred in Maury County, Tennessee. At the primarily affected high school, where 98% of students and all but 1 student with mumps had been vaccinated before the outbreak, 68 mumps cases occurred among 1116 students (attack rate, 6.1%). Students vaccinated before 1988 (the first year mumps vaccination was required for school attendance in Tennessee) may have been at greater risk of mumps than those vaccinated later (65[6.1%] of 1001 vs. 2[2.2%] of 89; risk ratio, 2.9; 95% confidence interval, 0.7-11.6). Of 13 persons with confirmed mumps who underwent serologic testing, 3 lacked IgM antibody in well-timed acute- and convalescent-phase serum specimens. Vaccine failure accounted for a sustained mumps outbreak in a highly vaccinated population. Most mumps cases were attributable to primary vaccine failure. It is possible that waning vaccine-induced immunity also played a role.
http://www.ncbi.nlm.nih.gov/pubmed/8277201?dopt=Abstract

Cass said...

When I was pregnant with my second son, my oldest got sick and they suspected mumps (he had been vaccinated). They tested me and found I had no immunity (I had also been vaccinated) :p

I'm still in favor of most vaccinations, but they're inventing new ones every year and I'm not convinced they should all be mandatory (which I get the impression is what some of the progressives would like).

This strikes me as a very good example of a case where "How much force are we willing to use to ensure compliance" is very relevant.

Anonymous said...

Right now, there is a nation-wide cohort of nurses diligently tracking contacts and thereby tracing the course of the disease. There are also laboratories taking samples, so that strains and contacts can be identified.

Any woman who is pregnant, and comes down with this, will have the information a lawyer would need to identify those who allowed this to happen.

I would sue.

I have a cousin who is an amiable six=year-old who just celebrated his 50th birthday. He has been institutionalized already for many years, and must remain so for the balance of his life.

His mother had a very minor case of the measles.

The threat to unborn children of others is very real, known, and readily foreseeable. Our society imposes a duty to compensate for damage a person does, including what might initially appear to be disproportionate damage due to a given person's enhanced vulnerability.

People who have no ethics can be sued, to enforce an ordinary citizen's right not to be harmed by another.

Valerie

Texan99 said...

The threat of disease to people, especially children and fetuses, is well known. The relative threat of vaccines is not as well known. However, I count myself among the believers in vaccines in most instances.

The hard part about this social dilemma is who should get to balance the risks and rewards. Epidemiology is right up there with national defense as among the areas where I'm most inclined to cede control to a central authority, but then of course I'm never 100% willing, and I always favor a robust debate over what the central authority is pushing, and why. Frankly, its track record, while better than that of many whacked-out anti-science groups, is not always that stellar.

One issue I think is blindingly obvious is that states should be able to exclude unvaccinated kids from public schools, and I don't really care from what fundamental, long-standing, or religious motive the non-vaccination stems. As someone was saying yesterday, "If my kids can't bring peanut butter to school, why should someone else's kids be able to bring measles?"

Grim said...

Christopher B:

I don't think I've seen you around before. Welcome to the Hall.

If argument 4 strikes you as the best argument, it's because you have a system of ethics in which a duty of this sort is (for you) grounded. There are certainly lots of systems like that.

If enough people do, you can get a law passed that makes vaccinations mandatory, and then there's a legal duty even for those who see no ethical duty. What Cass and Tex and others are talking about, and really what Chris Christie is talking about, is whether that is appropriate. Depending on how strongly committed you are to the ethical views that make it plausible to you to declare a duty to risk your child to protect others' children, it may or may not seem appropriate.

BB1:

That's right, vaccines don't always work -- the flu vaccine especially is a real gamble, as the professionals will admit if you ask them.

The gambler's approach still works, though. You multiply the probability of vaccine success by the probability of the expected harm from the vaccine, and judge that against the probability of not contracting a disease multiplied by the expected harm to be avoided.

So if there's a 50% chance the vaccine will work, but it's harmless in almost everyone, then you end up with something close to .5. If the disease is virulent so that there is little chance you will avoid it (as the flu is) and the harm can be severe (as the flu can, especially for the elderly), you end up with something close to 0 on the other side. Clearly the vaccine is a good bet.

Of course, if like Cass' husband you've had it before and you know you've got an issue with it, then the numbers don't work out the same. Now the certainty of having the harm from the vaccine is balanced against an uncertainty of getting the disease; what's really going to be affecting the outcome then is the expected harms (i.e. in terms of severity of harm expected).

As Aristotle says right at the beginning of the Nicomachean Ethics, though, you never get to certainty in ethics or politics. You just get to what is most probable. That's all we can do here.

MikeD said...

This strikes me as a very good example of a case where "How much force are we willing to use to ensure compliance" is very relevant.

Internet hugs to you, lady!

In a move which should surprise no one, I both favor vaccination and believe it would be illegitimate to pass a law mandating it. My personal belief is you are a fool (and a potentially dangerous one who puts others at risk) if you refuse to have your children vaccinated. But I strongly oppose the use of sanctioned force to compel anyone to vaccinate their children.

What I can support (and actually do) is not allowing unvaccinated children to partake in public schools, where their status as health risks (especially in the confined quarters of a school setting) presents an unacceptable burden on the families of those who do vaccinate. If you wish to have your children attend public schools, then you can (and should) be required to provide vaccination records. If not, then you are welcome to either homeschool your child, or enroll them at a private institution that agrees with your philosophies.

battleblue1 said...

What I can support (and actually do) is not allowing unvaccinated children to partake in public schools, where their status as health risks (especially in the confined quarters of a school setting) presents an unacceptable burden on the families of those who do vaccinate.

MikeD, I hear this argument all the time. If we are as confident in vaccines as the doctors say we should be, and you have vaccinated your children, why are you afraid of having unvaccinated children in the same classroom. The vaccine should protect those vaccinated, right? Your argument forces vaccination for everyone who does not have the financial resources/inclination to either homeschool or attend a private school.

No vaccinations => No public school + compulsory attendance laws => Kids truant => Parents arrested/charged => Kids removed from parents custody for failing to educate => Kids vaccinated while in foster care so kids can attend public school

(On a side note, the solution for this is to eliminate school taxes & compulsory attendance laws, but I digress)

I see no legitimate reason why a 15 minute old baby should be vaccinated against Hepatitis B. Hepatitis B infection is transmitted through sexual contact, contact with contaminated blood (for example, through shared needles used for illicit, intravenous drugs), and from mother to child. Hepatitis B is not spread through food, water, or casual contact. If the mother does not have Hep B, then why should a zero day old should be vaccinated.

All this to say, from what I have read, vaccines are not the cure all they are portrayed to be, they are not as effective as most think they are, and they carry not insignificant risks. If polio makes a big comeback in the US/Mexico, then that is the appropriate time to get my children vaccinated against it. Chicken pox? Definitely not.

battleblue1 said...

You multiply the probability of vaccine success by the probability of the expected harm from the vaccine, and judge that against the probability of not contracting a disease multiplied by the expected harm to be avoided.

Grim, I think you and I are closer on this than I thought at first. It is just hard to find the right values to use in the equation (will my child have an adverse reaction to the vaccine) without actually doing the actual harm.

Grim said...

Yeah, that's right. It's a wager. I can know that almost no one proves to be allergic to cabbage, but that doesn't guarantee my wife won't prove to be (as is demonstrated by the facts). Given that she is, will my child prove to be? It seems like the probability is likely to be higher than for the general population, but how much higher?

The argument from mathematics is an analogy, of course, since we can't really calculate the exact odds the way you can in poker. But that's the way you have to approach the problem, I think. And the wager is sometimes pretty high.

Cass, at 5:59 pm still not a robot said...

You know what I've always had a problem with? (I completely understand why they do it, but it strikes me as beyond stupid):

Giving people multiple vaccines at one time.

It struck me as dumb when my boys were small, and again when the Spousal One was a 2nd Lt. and they were shoving vaccines at him faster than a rapid fire tennis ball cannon.

I went to help out when my youngest son and his wife had their first this summer, and was there when my granddaughter had her first shots.

That child is an angel - she rarely cries, but later that night she screamed for quite a while like she was being ax-murdered and then projectile vomited all over Grandma. It was at least 12 hours before she was anything like her usual self. It can't be good for the immune system to be bombarded with 5 *different* bugs at one time, even if they're not live bugs.

FWIW, I don't think it's so much that vaccines are so effective as whether the vaccine failure rate poses a smaller risk than making vaccines completely optional.

I'm pretty much where MikeD is (let people opt out, but if they do so, don't use the law to protect them from the consequences of their freely made decisions). Bad decision almost *always* cost the poor more (they don't have much of cushion against hard times). That's why when you're poor - and we were the first few years we were married - you can't afford to take as many risks.


Internet hugs to you, lady!


Back at you, sir :)

Grim said...

By the way, about the robot thing -- I didn't tell it to do that, and I can't apparently stop it from doing that, but you can just ignore it and the commenting program works fine. The "please prove" is indeed indicative of a request: it's not obligatory, which makes me wonder how useful it is against robots.

douglas said...

Well, turns out this isn't a hypothetical for me. My wife just told me today that the kindergarten class at our school has around a 40% unvaccinated rate (!). Now I'm not hysterical about this, my daughter is vaccinated, and most of the time they work as intended, but ( with some more than others) efficacy varies, and exceptions occur.

I hesitate to legislate the issue, as some people have good reason to be concerned (though there are plenty of morons following Jenny McCarthy), but I agree with Mike that you ought then not be allowed in school. You can either home school, go private, or maybe they can set up a special campus for the un-immunized.

Texan99 said...

What makes the measles controversy especially hard is that dangerous complications from measles are so rare. When it's something like polio, it's a lot easier to get most people to accept the risk/reward ratio.

When I was a kid, my sister got typhoid fever, so everyone on the block had to get vaccinated. The shot was painful, caused a long-lasting painful swelling, and made us all rather sick. Still, we saw what it was like to get full-blown typhoid. Ditto for polio: schoolkids only about five years older than me wore lifelong leg braces from bouts with pre-vaccination polio. We'd all heard about iron lungs. But most of the time measles is inconsequential. It's harder to stay focused on the rare but tragic cases with complications and death, and easier to obsess on questionable reports about rare but scary side-effects from the vaccine itself.

Cass said...

At work, I have given two presentations this month. In the first, I invoked Bastiat's "seen and unseen" to illustrate a similar problem in software development: we don't plan for (or manage well) what we can't readily see.

One of the arguments I see a lot on the libertarian-leaning right is that we should just get rid of X because doing so won't have any adverse effects (or they'll be so minor as to not be worth our notice, especially for people who don't have kids). Which kind of makes me wonder why in the heck X came into being in the first place?

Why did we decide we needed a law regarding X if there was no significant downside to NOT having a law regarding X? And how do we really know what the effect of getting rid of X would be, if we've never lived in a world without X?

History isn't even a terribly good guide here, because public morals and culture today are nothing like they were. The institutions that kept people in line are now weak and ineffectual. Which is why we have so many intrusive laws now - they're just filling the vacuum.

Kind of true of vaccines - these folks have never lived in a world where lots and lots of people do as they want to do (refuse to be vaccinated). So they assume the status quo ante will continue.

FWIW, I'm not arguing that we can never get rid of laws. Plainly, there *are* laws passed in the heat of emotion, or by special interests, that are foolish and wrong. But what has kept me in the conservative camp is a predisposition to caution wrt big public policy changes (especially ones with a time lag for any ill effects to manifest themselves).

Texan99 said...

Re proliferation of laws: To make matters worse, every time we pass a law to remove the consequences of a bad choice, we further weaken the social fabric that discouraged the bad choice. It's not even an institution so much as standing back and letting reality persuade people what a bad choice it is. Then we find ourselves simultaneously passing laws to prohibit the bad choice, and laws to take the natural sting out of the bad choice.

Re blindness to consequences: All social systems have to struggle with free-rider syndrome, and vaccinations are a great example of it. As long as only a few percent of people refuse to get vaccinated, they can take a free ride on the herd immunity and let other people take whatever risk is entailed by the flaws in the vaccine, if any. If enough time passes before the free-riders swamp the system, we lose sight of what things were like before the disease shrank to a minimal presence in the population. Then an epidemic breaks out, and everyone has to remember why we started giving immunizations in the first place, and why a certain level of compliance was important.

Cass said...

To make matters worse, every time we pass a law to remove the consequences of a bad choice, we further weaken the social fabric that discouraged the bad choice.

I think this is true up to a point (IOW, I mostly agree with you!). I think there's a kind of equilibrium point with laws - too few, and the institutions themselves often struggle (or bad/abusive ones proliferate and crowd out the good ones). Too many, and people/institutions become reckless and irresponsible.

What strikes me as so bizarre about this dustup is the suggestion (by the media) that where the balance point lies - or that there even IS an equilibrium point! - is assumed to be beyond debate or discussion.

Of course it's all political opportunism of the "gotcha" variety, because Dems can say the same thing and it's neither SHOCKING!!!! or CRAZY!!!! :p

Grim said...

History isn't even a terribly good guide here, because public morals and culture today are nothing like they were. The institutions that kept people in line are now weak and ineffectual.

Isn't history the guide that lets us see that our present institutions used to function better, though? Any solution aligned with strengthening those institutions is guided by history in that sense.

MikeD said...

MikeD, I hear this argument all the time. If we are as confident in vaccines as the doctors say we should be, and you have vaccinated your children, why are you afraid of having unvaccinated children in the same classroom. The vaccine should protect those vaccinated, right? Your argument forces vaccination for everyone who does not have the financial resources/inclination to either homeschool or attend a private school.

You asked me a question, and I do apologize for not addressing it earlier. Why fear unvaccinated children if mine are vaccinated? Leaving aside that I do not have children, I can still answer that. Because just because I have a school age child who is vaccinated does not mean I don't have an unvaccinated child who is too young to have received the vaccine. Or a wife who may be pregnant. Measles can do abhorrent things to a human fetus. And just because my vaccinated child may be immune to the disease does not mean that they cannot carry it from your unvaccinated child.

Do you propose that it is more reasonable for me to quarantine my child away from him mother or baby sibling in order to keep them safe from germs he acquired from your child than it is for your child to be quarantined away from my family? Do you believe I have a moral obligation to allow my family to be exposed to germs they otherwise would not be exposed to because of your misgivings?

I submit that it may indeed be sad that you cannot afford to send your child to a private school that more accurately reflects your philosophies. But I do not believe that the public has an obligation to subject themselves to diseases because of that. So I do not believe that you have a right to send your child to public schools without one if the community desires to pass a law requiring an up to date vaccination schedule.

As for the cost, homeschooling in indeed an option. If you cannot afford either homeschooling, nor private school, then I suggest that perhaps you are not living within the means required to maintain an expensive philosophy such as anti-vaccination. By the same token, a family that does not have sufficient funds to provide a vegan diet for themselves and their children should not be allowed to bully a school system into providing vegan meal choices to their children at taxpayer expense. Certain lifestyle choices carry a cost. If you cannot afford that lifestyle, do not expect the public to fund it for you.

Cass said...

Isn't history the guide that lets us see that our present institutions used to function better, though?

Sure, if we can agree on what constitutes "better" :p That's easier said than done, because people have different ideas of what "better" looks like. You have often argued that better looks like a system that I would have to give up most of the liberty I now enjoy to return to. That doesn't sound better to me (or, I suspect, to Tex).

Who gets to decide?

But even if I concede the meaning of "better", how does that change things? Yes, some institutions worked "better" under a set of conditions that no longer exist. I'm not sure they actually did, mind you, but I'll accept your premise for the sake of argument.

Perhaps the institutions of the past - like many things - were well suited to conditions then. That doesn't mean they're well suited to current conditions, nor is it possible to return to the past.

So how does the knowledge that under some past system that we can't reproduce today, some things worked better help us? (not saying it doesn't, just posing the question). The current world is the one we need to figure out how to live in.

Grim said...

Well, it sounded like you were saying that the institutions that used to be effective had become weak. One mode of weakening you and Tex were discussing (the use of laws instead of the institutions weakens the institutions). So I didn't think "better" was under contention; it would be better if they were stronger. And the means isn't necessarily contentious either: put more weight on them, and like muscles or bones, these human institutions will grow stronger.

But coming to a judgment like that means looking at history. Not the 14th century, which was nevertheless the height of human civilization -- recent history. My point is that it's only in looking at the past that we are able to make an analysis of that sort.

Texan99 said...

I didn't mean to suggest that relying on laws weakens the extra-legal institutional rules. I was trying to say that passing laws to remove the harsh consequences of flouting the rules (i.e., rules that the institutions formerly enforced) would naturally result in weakening the rules--perhaps far beyond the power of the institutions to enforce--thereby gradually rendering the institution toothless and irrelevant. An example might be welfare for single mothers, which has had effects on marriage and family formation that I suspect we're all familiar with. It's hard to subsidize and to discourage the same thing simultaneously.

If the laws and the institutions are trying to enforce the same rules, I don't expect the institutions to suffer. There's always a role for enforcement of a rule before it rises to the level that would get the judicial system involved.

Grim said...

I think it may also be that taking weight off the institutions weakens them. When you had to go to a church to get help in times of poverty, churches had more influence over mores than they do when the government will cut you a check and you don't have to do anything.

Eric Blair said...

Everybody got vaccinated where I was growing up in the midwest. Nobody got sick from it then.

And even then there was a classmate who had contracted polio before he was vaccinated against it.

But there were no measles or chickenpox outbreaks although occasional cases would happen. But whooping cough? That was something Grandma talked about happening before WWI.

Of course, it doesn't help that hundreds of thousands of illegal aliens, none of which have been vaccinated and have been shown to have various diseases have been allowed in and all over the country. Oh well.

douglas said...

"What makes the measles controversy especially hard is that dangerous complications from measles are so rare. When it's something like polio, it's a lot easier to get most people to accept the risk/reward ratio."

Yeah- we're lucky we got a 'test run' with Measles instead of one of the more fearsome diseases.

"Of course, it doesn't help that hundreds of thousands of illegal aliens, none of which have been vaccinated and have been shown to have various diseases have been allowed in and all over the country. Oh well. "
THIS^^^^^
But we're not allowed to discuss it, are we... lest we be called racist.

Grim said...

I'm pretty sure the counterargument is that we need to let the rest of Latin America come here so we can make sure they get vaccinated. At our county health departments, of course.

Cass said...

"Of course, it doesn't help that hundreds of thousands of illegal aliens, none of which have been vaccinated and have been shown to have various diseases have been allowed in and all over the country. Oh well. "

Do the facts matter here?

The vaccination rates in Mexico and Central America are actually *higher* than they are in the US (for Measles, US = 92%, Mexico and Nicaragua = 99%, Honduras, Guatemala, and El Salvador = 93%). Vaccination rates are pretty much uniformly over 90% in all of North, Central, and South America.

According to the CDC, the primary source of measles outbreaks in the US has actually been unvaccinated Americans returning from places like Vietnam and the Philippines where vaccination rates are lower than they are here.

"The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the United States and spread to others in communities where many people are not vaccinated," said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunizations and Respiratory Diseases. "Many of the clusters in the U.S. began following travel to the Philippines where a large outbreak has been occurring since October 2013."

http://www.cdc.gov/media/releases/2014/p0529-measles.html

Cass said...

I'm pretty sure the counterargument is that we need to let the rest of Latin America come here so we can make sure they get vaccinated. At our county health departments, of course.

Except their vaccination rates are, in most cases, actually higher than ours.

Cass said...

From Canada, which has also been experiencing outbreaks of measles:

There have been 27 cases of measles in Victoria this year, mostly in travellers returning from the Philippines, Bali, Thailand, India and Sri Lanka.
...Dr Lester warned health professionals to be on the lookout for patients with a cough, fever or rash, particularly if they had returned from Asia.


"We have had quite a significant increase in the number of cases of measles here, particularly associated with overseas travel," Dr Lester said.

http://www.heraldsun.com.au/news/victoria/health-officer-warns-tourists-over-measles-outbreaks-in-asia/story-fni0fit3-1226816994477?nk=6d0c693cbeb97a06d66e03810ed308ae

There are plenty of reasons to object to this administration's handing of immigration policy, but so far I've seen precious little actual *evidence* that these illegal immigrants are the source any any of the outbreaks this year, and a TON of evidence to the contrary.

I understand the urge to blame Obama for everything. The guy's a freaking disaster as a President. But the facts ought to matter, here. Otherwise, we're just politicizing everything in sight and lose credibility.

Grim said...

I have a lot of skepticism about numbers from Latin American governments (with a few exceptions). Mexico doesn't have full control of its territory thanks to the cartels, and it's so poor that over the last decades it's exported at least ten million people to the United States, but the government claims that it has met the health needs of essentially everyone in the area of vaccinations? Maybe.

But their record of reporting true figures here is not good.

Grim said...

That said, yes of course in principle the facts should matter. I'm only disputing that the Mexican government's figures are plausible enough to count as "facts."

Cass said...

OK, we can temporarily ignore the inconvenient figures. That doesn't change the fact that epidemiologists have traced the strains in the current outbreaks back to current, widespread outbreaks in Asia, not Central America.

At some point, we have to stop hoping we can blame this on immigration and look at what the actual data is telling us, even if we don't like the answers.

When Canada and several of the major outbreak areas in the US have traced the outbreaks to unvaccinated, legal citizens traveling to infected countries in Asia, and when this phenomenon has been going on for several years now, I find myself unwilling to blindly believe people who keep flogging unproven theories (never even trying to find out the facts).

Sorry, but that doesn't help anyone. I've already conceded that it *could* have happened that way. But there's no evidence that it actually DID, and considerable evidence that it didn't.

Cass said...

Note: I hadn't seen your 12:06 comment before posting the previous one :)

Forgive the heat here, but this is a real pet peeve of mine. I'm more than willing to blame Obama where there's actual evidence that he's to blame, but (as with the stupid rumors of a "purge" of officers in the military) we need to be scrupulous about facts.

Heck, the Marines were talking about post-war drawdowns and the top heavy senior ranks YEARS ago when my husband was at the Pentagon working on the QDR. It's just nuts to try and tie this stuff to the White House absent any evidence.

Nothing wrong with pointing out that - in general - waves of illegal aliens can possibly be a disease vector. Where I get off the bus is when people use studies they obviously didn't even bother to read to "prove" something the studies don't even claim!

/rant

Grim said...

No offense taken.

That doesn't change the fact that epidemiologists have traced the strains in the current outbreaks back to current, widespread outbreaks in Asia, not Central America.

That's right, but it's not quite what I thought we were talking about. What I thought we were talking about was that vaccination is most effective when you have the largest number of vaccinated individuals. So even if they aren't in fact the originating source, the presence of large numbers of unvaccinated individuals dilutes the protections of a community that was otherwise mostly vaccinated.

I don't think we know what the vaccination rate is among the illegal immigrant population, but clearly they are here because they were among the poorest and least well-served of their home country. If a country like Mexico can't actually vaccinate everyone, these are among those who are most likely to have been missed.

Of course they weren't screened for vaccinations when they came (as lawful immigrants are), and of course they manifestly are willing to avoid government rules when convenient (e.g. immigration rules!).

So can we safely assume that 99% of them are vaccinated? I'd say we should assume that it's a huge unknown.

Grim said...

Also, here's a sympathetic article.

Cass said...

I don't know the answer to that question, Grim. And I don't think we should *assume* anything.

My point is that people are assuming things on no evidence. For example, I lost count of the number of blog posts I read a few months back about the enterovirus - all claiming (in exactly the same words, and with NO evidence to back it up) that [unspecified] enterovirus had been running wild in Central America.

One thing we absolutely CAN look at is where large outbreaks of measles have occurred for the past few years (and perhaps more importantly, where they have not occurred).

It might surprise you that Western Europe is one of those places that have had large, repeated outbreaks of measles (France, Italy, Spain). Asia's worse, so's Africa.

There has been an exponential decline in measles in North, Central, and South America over the last few decades. That happened because of several sustained, continent-wide campaigns to immunize children and babies. Clearly, *something* interrupted transmission of measles.

If what we're concerned with is public health, I don't see how it helps to look everywhere but where the data (so far at least) indicates US measles cases are actually coming from.

Cass said...

One more interesting (at least to me) thought: with global travel, the moral question about whether or not to immunize becomes even more pertinent, because it's not just your fellow students and citizens you're putting at risk: it's potentially people in other countries.

Hmmmm.... isn't it progressives who are always lecturing us about being good global citizens? Yet here we have a bunch of privileged Americans behaving with reckless disregard for the potential consequences to those poor kids in 3rd world nations :p

That's a bit schadenfreude-y of me, I know, but I just couldn't resist.

Grim said...

Fair enough. And like I said up top, I've had a lot of vaccinations!

Cass said...

Yeah, the military really gets the whole gamut. I remember when we were in 29 Stumps in the late 90s and there was a big to-do over Saddam Hussein that had everyone preparing to go.

They ordered anthrax shots for the bn. and people were pretty stirred up about it. Fun times :)

douglas said...

Cass, the big flaw in what you're saying is that no one specified Mexican, and Central and South American illegal immigrants- California especially is full of illegals from all over the world with a heavy concentration of Asian/South Pacific illegal immigrants. Also, what Grim said about the Mexican government, who does all they can to prevent backlash against their nationals who are here illegally, as their remittances are as big to the Mexican economy as tourism- to the tune of $8-10 billion/annually. That's pretty good incentive to lie.

I like your suggestion to use the 'good world citizen' angle to promote immunizations. That would work on some people around here (in L.A.).

Texan99 said...

There's quite an interesting libertarian/good-citizen argument going on right now at Megan McArdle's site: http://www.bloombergview.com/articles/2015-02-04/your-right-to-skip-shots-ends-where-my-kid-begins

Cass said...

Cass, the big flaw in what you're saying is that no one specified Mexican, and Central and South American illegal immigrants- California especially is full of illegals from all over the world with a heavy concentration of Asian/South Pacific illegal immigrants.

No one? Then why am I seeing all these references to Central America and kids coming across the southern border? I wrote several posts a few months ago and the articles/posts I cited all were quite clear that they were talking about the wave of kids from central America (they were quite specific, even naming countries).

And pretty much every blog post or article I've read today is chock-full of references to Central America and Mexico.

I understand the you didn't specify the source - that's a fair point and one I'm happy to agree with. But in the comment right after, Grim said this:

I'm pretty sure the counterargument is that we need to let the rest of Latin America come here so we can make sure they get vaccinated. At our county health departments, of course.

Plenty of folks are spreading this rumor, and have been for a while now. But you're not one of them (at least as far as I know).

Cass said...

I like your suggestion to use the 'good world citizen' angle to promote immunizations. That would work on some people around here (in L.A.).

Isn't it weird that people would care more about someone halfway around the world than about people in their own city or town? But there are definitely people like that.

*sigh* :p

Cass said...

One more clarification: I took Grim's comment to be a joke, not "rumor spreading". My observation about rumors was aimed at other articles, posts, and comments I've been reading.

Texan99 said...

At Megan's place they're advocating a marketing blitz featuring free vaccines at Whole Foods, labeled "Free Range All Natural."

Unknown said...

With any law there is appended as "understood" on the end the statement "..or else we will kick down your door and shoot you if we need to in order to make you comply."

While you maye find this shocking, it is indisputable as this is the only tool there is to force compliance. If you disagree, you may ask a certain Mr. Gardner in New York whether he was asked "pretty please: and given sad puppy eyes in order to make him comply on an ordinance against selling loosies.

Or more properly, ask his survivors.

With that in mind, ask yourself if you are willing to go this far to enforce mandatory vaccination. If you are, that's fine, but this is where mandatory (or forbidden) anything may very well end.

Any advocacy of it makes you a part of it.

Grim said...

"Unknown" --

You're making some interesting comments, and this is not in any way intended to run you off, but please pick a handle and stick it at the top or bottom of your comments.

Here is a link to the most recent version of the comments policy, which is nine years old. The original policy has been around for more than ten, I think. It's worked well in keeping the discussions worthwhile.