Anti-Science

San Diego measles outbreak

Three children in San Diego have been diagnosed with measles. They are all siblings and two of them attend the same charter school. None of them were vaccinated against measles.

Ten percent of the charter school’s 380 students were not vaccinated. The figure for most schools in San Diego County is 1 percent to 2 percent, said Jennifer Gorman of the San Diego district’s nursing and wellness program. The statewide average is about 1.5 percent, according to the California Department of Public Health.

And another quote:

The three infections announced yesterday were defined as the first reported outbreak since 1991. An outbreak involves two or more cases from a single source.

I feel terrible for the children and angry at the parents. Just the other day I was talking with a nurse friend about what it will take to get people to stop being taken in by the anti-vaccination rhetoric. She mentioned that it would take something serious, like measles, to make an impact. I just hope that no one has to die in order for a change to happen.

Amanda

Amanda is a science grad student in Boston whose favorite pastimes are having friendly debates and running amok.

Related Articles

114 Comments

  1. I can't even have this argument with my non-vaccing friends any more, because they just get too upset. It's frustrating to me that people can (usually) "get away" with not vaccinating on the backs of everyone else who does. I generally have sort of a live-and-let-live attitude about it (and I'm sort of uneasy about mandated vaccines for generally non-lethal diseases like chicken pox or HPV), but I sometimes wonder if the risk of catching these diseases is completely comprehended by those who don't or won't vaccinate. I think for some of the people I know who don't, it's the idea that their actions could harm their child (because, despite the fact that it's treated as routine, some children DO have adverse reactions to vaccines), vs. theoretical harm based on some outside cause (i.e. the disease, which they can see as "not their fault"). And now I feel like I'm not making sense. But it's really sad that this happened, though not surprising if epidemiology has taught us anything (and apparently it hasn't).

  2. I am bemused that these same parents who did not vaccinate their children are looking to science-based medicine to help those children now.

    Certainly that is the right thing to do, but it should have been done from the start of their lives, not now that they are suffering. It would be great to think they would learn something from the care and successful treatment, but I fear that's unlikely at best.

  3. Before my sister became pregnant, she was initially very dubious about the benefits of vaccination. Though we never discussed it in depth, she was concerned about the purported link between certain vaccines and autism.

    But she is trained as an occupational therapist, and during her grad school and intern work she saw a lot of what modern health care does. By the time she was pregnant with her son, my nephew, she was quite ready to commit to having him vaccinated, and she has followed through.

    She remains fascinated with autism, and now has a partner and clinic where they help autistic children. But she considers the autism-vaccine link tenuous at best.

  4. Having known a lot of anti-vax folks quite well, there are numerous objections to vaccinating besides just the autism one. There's the fear of adverse reaction (which does happen) which can include everything from very mild reaction to allergic reaction to death. My understanding (and I am not a doctor, epidemiologist, or immunologist) is that the risk of this is small compared to the risks of disease exposure. Personally, I look at vaccinating myself and my kid as sort of a civic duty, like voting, though I do think some pediatricians have a tendency to pooh-pooh parents concerns about vaccines rather than using it as a "teachable moment."

    Anyway, moving on, vegans object to vaccines that are cultured in chicken embryos or contain any animal products whatsoever. Some religious folks object to vaccines on the grounds that some of them are cultured/grown (I don't know the correct scientific term, someone help me out here) using aborted fetal tissue, which I never was able to conclusively figure out the veracity of.

    So, there's more than just the autism scare floating around out there in the anti-vax community. I actually know several people who feel it must be bad for a child's immune system to administer so many vaccines in such a short time, and so have put their children on a delayed vaccine schedule. I have much less of a problem with this.

  5. There's a very broad "religious exemption" policy for vaccines. All you have to do is author a letter with the proper language, and BINGO! you can enroll your child sans vaccinations. The protocol varies from state to state.

  6. As an RN, it breaks my heart to read this today, although I am not shocked. As a community health nurse, I worry about my patients that are elderly or have depressed immune systems being unnecessarily exposed to sick children in their communities as well. It is a challenge for these people to fight off the common cold, much less measles. Sigh. Get well soon, kids. I hope medicine won't fail you the way your parents did.

  7. I think the vaccine that people commonly object to because it uses aborted fetal tissue is the rubella vaccine which is made from a virus that is cultured using a cell line created from an aborted fetus. I am not too sure if all modern rubella vaccines need to be cultured using this medium or if any additional cell lines have been needed since the creation of the original one.

    There seems to be some good news in that the rubella vaccine seems "Vatican approved" until some alternative to fetal tissue can be found.

  8. I'm only alive today because I was vaccinated as a child against pertussis. I know this for a fact.

    Because it hits so close to home, I find this quite a sobering thought. Needless to say, my kids are very much up-to-date with their vaccinations.

  9. I see the anti-vax crowd as being grossly ignorant of even recent history. It wasn't so very long ago that families in frontier times HAD to be large, just to have a decent chance of having any kids left to grow up to be adults!

    During my genealogy phase, I noted with dismay how many families in my own ancestral line had multiple children dying of diseases that we now have the luxury of being immunized against. What infuriates me most is the risk to my own children that these fools create by weakening the herd immunity concept!

    A pox on them!

  10. This is really bad news,

    Innocent children, in harms way, over this foolishness.

    Why?

    Because some has been playboy bunny had to get back on TV somehow; (and eating her boogers didnt' work anymore). She got the coveted media attention with her dumb ass book and screw the children, as far as she's concerned.

    Am I alone in wanting to run out and strangle Jenny McCarthy? (Hell, Jim Carey too, the fool hasn't been funny since the Nineties, if then…and I hear he's quite supportive of her nonesense about vaccines).

    All the damage these idiots cause and not a backwords glance at the people they've hurt.

    Based upon that, I'm guessing that they'd be voting a straight Republican ticket.

    I'm just sayin'…

    rod

  11. flygrrl wrote:

    Having known a lot of anti-vax folks quite well, there are numerous objections to vaccinating besides just the autism one. There’s the fear of adverse reaction (which does happen) which can include everything from very mild reaction to allergic reaction to death. My understanding (and I am not a doctor, epidemiologist, or immunologist) is that the risk of this is small compared to the risks of disease exposure.

    Would you be able to reduce the odds of dying from complications even further if you could do some allergy tests on the kids before giving them vaccines, so you'd know which ones to avoid for safety, or substitute with a less common variant?

  12. Would you be able to reduce the odds of dying from complications even further if you could do some allergy tests on the kids before giving them vaccines, so you’d know which ones to avoid for safety, or substitute with a less common variant?

    I don't know the answer to that… sometimes you know what kids are allergic to at that age (the usual vaccination schedule has most childhood vaccines being given before the age of 2 years) and sometimes you don't. I think egg allergy is the one most often contraindicating some vaccines, but there are other more obscure things people can be allergic to without knowing it that aren't in the standard RAST battery you'd give a child for screening if you had, for instance, a family history of food allergies.

  13. flygrrl – What makes me the most angry is what you mentioned about doctors letting "teachable moments" pass by. General ignorance in the public – while unpalatable – can be forgiven (not everybody knows everything abotu everything), but the lesson about vaccines is so simple, it astounds me that it isn't shouted from the rooftops:

    VACCINATIONS ELIMINATED POLIO.

    Trump that, woos. Also, the idea that something "must" be bad for you is the most ridiculous kind of arrogance. Read research, interpret it however you like, but don't presume that your gut somehow acts as a truth detector more effectively than experimentation and analysis. Just don't.

  14. Yeah, w_nightshade; it seems like what a lot of parents (myself included) would LOVE, is to go to the pediatrician and say "I heard such-and-such a report; can this harm my child? I'm concerned" and have the pediatrician say back, not "Oh, don't be stupid, you have to do this" but "I understand that you would never want to harm your child, and there's a lot of scary information out there, but here's what the research says, and here's why this is important." For some of my friends who have chosen to go the more "woo-woo" route with their children's health care (which I don't agree with) I often think it has as much to do with being treated with respect by medical personnel as it does what they're actually saying. Which is too bad. Maybe they ought to make health care professionals go through a Dale Carnegie course or something.

  15. Too right, flygrrl. My wife has mild hypochondria (she is aware she has it), so she is always wary of visiting a doctor for fear of casual dismissal. She has no problem being told she is fine, as long as the doctor takes the time to explain how he knows that. We are very fortunate that our GP is a very nice man, who understands both her worries in general, and our worries as parents.

    I suspect part of the problem is that there are many who would not want (or even be insulted by) a lesson from their doctor, whatever form it took. In my experience, the more ignorant the person, the more likely they will be to assume they know everything worth knowing. *sigh*

  16. I wonder if docters sometimes have those "helpdesk" moments where theyve just heard the same stupid question for the umpteenth time and just lose patience, opting for the "No, yoyu'll be allright" answer instead of giving the whole explanation again. Or even more likely, giving the whole explanation, sufficiently dumbed down (or so you thought), only to get blank stares anyway.

    There is a limit to everyone's friendliness.

  17. Mmmmm… I don't buy that as an excuse. I worked in first line tech support – I have seen the limit of human patience. And when part of your job is to help a customer, you don't cross that line. period. Do all the venting you need to do between visits, but don't drop the customer in the kacky because you are a little frustrated.

  18. Yeah, what people don't understand is that vaccinations aren't about you, they are about society as a whole. For herd vaccination to work, about 95% of "the heard" needs to be vaccinated, depending on the efficacy of the vaccine. When you don't vaccinate yourself or your children, it's not just you or your children who may get sick, you will pass the virus on to other people who DID get vaccinated, and that is not fair. But, people are selfish and don't think about others.

  19. I think some people *do* understand the herd immunity thing, and reason that as long as practically everyone else gets vaccinated, they could avoid taking any vaccination risk, however slight, and no doubt feel vindicated if their child avoids the diseases due to what everyone else does, but maybe find someone else to blame for their choice (the manufacturers for not making 'nicer' vaccines?) if their kid gets sick.

  20. So, it's essentially the Prisoner's Dilemma, then.

    Actually, I have an even simpler theory, and it's based on several converging pieces of evidence: The United States, as a whole, doesn't understand a single damn thing about public health.

    If your otherwise fine nation really understood public health, then like every other developed country in the world, then most of these elementary mistakes wouldn't be made.

    If a government-managed insurance provider had to pay for treatment of these mostly preventable diseases, for example, vaccination would be a no-brainer.

    Similarly, nobody would encourage "abstinence-only sex education" if the authorities had to pay for pregnancy and STD treatment when it didn't work.

    And like every non-Catholic developed country in the world, there probably wouldn't even be a so-called "abortion debate". "So-called" because there really isn't any "debate"; just a stagnation between the "right of choice" frame vs the "right to life" frame. This so-called issue is really a no-brainer if you understand it as really being about the right of access to health care.

    Hell, there probably wouldn't even be a "war on drugs" if people recognised drug abuse as a public health issue rather than a law enforcement issue.

  21. What?

    In the UK, we *don't* require vaccination to be done, and the state *does* pay for problems arising from non-vaccination.

    How would a 'government-managed insurance provider' be better equipped to enforce vaccination than a state health service?

  22. PH, I didn't say "require" or "enforce". You can't force people to undergo medical treatment except in limited circumstances. All you can do is make it attractive, easy and relatively cheap (or free if you genuinely couldn't otherwise afford it).

    As I understand the specific situation in the UK, that's pretty much what happens. New parents are given literature on vaccination explaining everything, as well as reminders. Vaccination is also free to low-income families (and a bunch of other people in a similar situation) and subsidised for everyone else.

  23. "I’m only alive today because I was vaccinated as a child against pertussis. I know this for a fact."

    Pseudonym – Why exactly? How can you be certain that you would have caught pertussis and that it would have been fatal? In case you're wondering, I'm 100% "pro-vac" (my five-year-old was vaccinated last week). I'm just curious.

  24. In the UK, all the childhood vaccinations are free, as are some adult vaccines (flu for the elderly or immune-suppressed, flu for poultry workers, rabies for bat handlers, some vaccines for travellers)

    http://www.nhsdirect.nhs.uk/articles/article.aspx

    Still, whatever the balance between state and private health insurance, the cost/benefit figures for vaccination can mean it's a no-brainer for both kinds of funder.

    However, if one was being completely unfeeling, one might suggest that once rough herd immunity is approached, the cost/benefit figures for the remaining unimmunised start to become less wonderfully good.

    If it wasn't for the fact that it's not the parents making decisions who are generally going to get ill, having a few people unimmunised, and having the odd little outbreak doesn't cost a great deal, and can be useful for stopping most people from becoming complacent.

  25. crster:

    The pertussis vaccine doesn't confer long-term immunity. In fact, if you've been vaccinated, you can still catch it, though it does much less damage.

    That's what happened to me. Not enough kids my age were vaccinated, and as a result, I caught it at age two. I was quite sick for a couple of weeks, and it did some permanent damage to my respiratory tract. I still have a terrible cough that appears when irritated.

    Everything taken together, I'm as certain as I can be that if I hadn't been vaccinated, I wouldn't be here.

  26. My son has some bizarre allergies, and we have a family history of adverse reactions to vaccines which was swaying me towards not vaccinating… and then shortly before my son was due for his first shot my friend's baby had a near fatal reaction to a vaccine right in the doctor's office. I'll tell you what, I take the measles with gratitude over what I watched my friend go through. That child was damaged for life.

    Meanwhile, I'm wondering what a.real.girl // was talking about when she said:

    "I am bemused that these same parents who did not vaccinate their children are looking to science-based medicine to help those children now. ..It would be great to think they would learn something from the care and successful treatment"

    Measles is a virus, like the flu, and there is no treatment besides getting rest , drinking fluids, and taking immune-boosting foods or supplements. And I hope I misinterpreted JennY who says she's a RN and hopes medicine doesn't fail these families. If she's talking about medicine for measles, I hope she's never my RN!

    I don't know why they assume these families are seeking treatment, in fact they're not. Measles is a reportable disease which means you're supposed to contact the doctor to get diagnosed and tested to prevent the spread of the disease. And also it's nice to know that your child has lifelong immunity (which the vaccine can't promise).

    Of course, as a parent I suffer every time I watch my children uncomfortable with illness, which thankfully isn't very often. But this experience of measles has been no worse than the time they had the flu. A few days of cold symptoms, one day of fever and tiredness, one day and restless night of a really uncomfortable rash (not as bad as poison oak though!!), and then getting better. The hardest thing, honestly, was that my other child didn't get sick and it was difficult to attend to one who wanted to wrestle and go for bike rides, while the other wanted someone by his side constantly, dispensing water and tissues and oatmeal baths.

  27. My grandmother got german measles while she was pregnant. As a result, I grew up with an aunt who was deaf, mentally retarded, and below average height.

    My grandmother was also unable to have additional children–sterility is a common side effect in adults.

    If you think measles are harmless, you're deluding yourself.

  28. One thing, though: somedaynevercomes (and the family thereof) is clearly one of those very few for whom certain vaccines are probably not a good idea.

    The rest of us have no such excuse. Indeed, we have the responsibility to ensure herd immunity for the tiny minority who cannot be vaccinated for legitimate medical reasons.

  29. I'm so sorry bug girl about your aunt. German measles is a different disease from the current one to which I referred, and you're right, not harmless. Ironically, unless you're pregnant it has very mild symptoms, but for mothers the chance of birth defects, etc is high.

    Before we judge, why consider who "the rest of us" are? I agree that the majority of "the herd" seems not to have significant problems with vaccines. But on the spectrum of humans we have those on one end who are harmed by diseases, and those on the other end who are harmed by vaccines. Unfortunately as someone else pointed out, it's difficult to tell which end of the spectrum you or your children will fall on, and it's heartbreaking if you make a mistake. I believe each parent needs to make an informed decision thats best for their situation. I do know that one of those recent measles cases involved a child who had extremely adverse and scary reactions to their first round of vaccines. Yet people on these chat pages are so quick to jump up and make assumptions that the parent is selfish (which is the kindest of the accusations I have come across). That parent has a right to be selfish if her child's life is in danger! I don't know why the first family didn't vaccinate, but they seem like intelligent people who made an informed choice and I respect their decision. There is incredible pressure to vaccinate in this country, and even though my family has clear and alarming contraindications, I have still experienced a lot of flak and been yelled at by complete strangers. If parents decided not to vaccinate despite the overwhelming pressure, I trust that they based their decision on strong and convincing evidence.

  30. "But this experience of measles has been no worse than the time they had the flu. A few days of cold symptoms, one day of fever and tiredness, one day and restless night of a really uncomfortable rash "

    Someday, how was your child diagnosed with measles? The infection you describe does NOT sound like measles. True, it can start with a few days of cold symptoms, but then there are usually 4 or more days of fevers to 104, and a severe rash that is not itchy, and eyes that are so bloodshot they sometimes bleed. During the last large break out in San Diego in the 90's, there were 900 cases and 3 children died.

  31. It's quite understandable that someone could look at the current risks and decide their child might be better off unvaccinated, especially when/where disease prevalence is very low due to the existence and use of vaccines.

    However, it's also equally understandable that a government can look at the overall risks and possibly choose to enforce or strongly encourage vaccination if it appears to be in the best interests of the people overall.

    Fundamentally, for anyone thinking about the issue, choosing not to vaccinate is a decision undeniably made hugely easier if one lives somewhere where almost everyone else does vaccinate.

    The funny thing is when the issue comes up, people choosing not to vaccinate rarely if ever seem to describe that fairly fundamental point as part of their reasoning.

    Surely the way to assess risk is via statistics, not anecdote.

    I had chickenpox as an adult, and it wasn't too unpleasant *for me*, but if I had to assess the merits of vaccination, what happened to me, or a friend, or a friend's friend wouldn't be relevant, especially since my experience doesn't do anything other than confirm what's accepted by everyone – apart from maybe some unpleasantness at the time, most of the 'childhood' diseases don't really harm most of the people catching them them.

  32. The health department sent a nurse out who took a urine sample and throat culture, and they also did the blood tests. I spoke extensively with the health department nurse assigned to our case, as well as my doctor. My older child had every symptom– the sores in the mouth, the red eyes, cough, runny nose, earache, fever and characteristic rash… the sores didn't bother him, the red eyes and mild earache only lasted a couple days, and he only had one day of fever at 103.2. The rash came on slowly, was very mild for 4 days, obvious the next day and severe for 2 days, then began to fade away. Overall the symptoms lasted about a week with just the two really rough days. My kids have never had a fever more than one day for any illness. I let it runs its course, it kills the bad guys and they've always been fine the next day. The really weird part of all this, is that yesterday it was determined that my younger son also had the measles, but his case was so mild we initially dismissed it. He never got past the mild rash and mild cold symptoms stage. The doctor explained that this is common in families, just as with chicken pox, one child might have 200 pox and another 4. We believe the younger child was exposed to a non-documented case last year and probably developed some immunity which helped him fight the disease more efficiently. The difficulty with diagnosis these days is that most doctors don't see the measles anymore, but like any disease, it varies among individuals. My two children and "case #4" followed the same pattern. They were all in the same classroom as the index child who was only in school a few hours when he was contagious, so they were all exposed on the same day and their illness progressed together. It worked out well for child care trades! Ironically, because of the time it takes the lab to process test results, by tomorrow when the next scary press release comes out about the "new cases," my kids will both be well and back in school.

  33. I think with most diseases, the risk of problems developing as a result of a vaccine ar much smaller than the risk of problems arising as a result of the disease. Perhaps that isn't really obvious in a one-on-one basis (i.e. the risk of serious consequences once you have contracted the disease) but you also have to consider the reduction of the risk of contracting the disease in the first place because everyone else is vaccinating their children.

    I'm pretty sure somedaynevercomes is very glad that everyone else has vaccinated their kids against all kinds of childhood diseases, thereby drastically reducing the risks of her unvaccinated kids contracting them.

  34. The United States, as a whole, doesn’t understand a single damn thing about public health.

    If your otherwise fine nation really understood public health, then like every other developed country in the world, then most of these elementary mistakes wouldn’t be made.

    right, right. "developed country". Like perhaps:

    Only nine still have a measles vaccination coverage of under 90 per cent: Switzerland, Britain, Belgium, Cyprus, France, Greece, Ireland, Italy and Malta.

  35. Ehm, drugmonkey, those are statistics for EUROPE. What did you possibly hope to prove with those with regards to vaccination rates in North America?

    I'm sure if you broke down measles vaccination rates on a state by state basis, you'd find at least a few severely lacking as well.

    But, … as far as I can tell, the lower in rates in Europe are due to people using "alternative medicine", so they're not weaseling out of vaccination for "philosophical reasons", the law probably considers them OK, even if science doesn't.

  36. I'm not sure how much 'alternatives' have to do with it.

    At least in the UK, the recent dip in vaccination rates seems essentially to be down to the MMR scare (assisted by certain newspapers more interested in panic than journalism) and the relative lack of disease deaths and disabilities (or publicity for same) in recent years.

  37. What's traditional home-vaccination?

    I tried googling, but it basically seems to basically throw up links about vaccinating pets, and a few about outreach programs getting underimmunised children up-to-date with vaccinations.

    The mental imagery the phrase throws up is a little odd – some kind of cross between Little House On The Prairie and The Addams Family.

  38. The outbreak is spreading, as could probably have been predicted:

    (My first time coding a link here, let's see if it works!)

    The bit that scares me is the four babies so far who are thought to have been infected in a doctor's office. See, babies under a year are unprotected (the vaccination is first given at a year, presumably for some good medical reason). And I have a 3.5-month-old baby.

    Before I became a mom, I was vaguely aware of the anti-vax movement, and I thought it was a bad idea, but now my reaction is much more visceral: these people are risking MY BABY'S LIFE.

    Not abstractly, either. I don't live in SD, but I'm sure there are many flights daily from there to here.

    So basically, I wish the media would do some more careful educating of the public.

  39. I have been told (and I certainly hope not erroneously), that if you have been vaccinated and you are breastfeeding, that you actually do confer some protection upon your infant for some period of time (disclaimer: not to be considered as medical advice, and I do not remember the specifics). It's certainly not to be considered a substitute for vaccination, but in an otherwise healthy infant helps resistance. I hope that a side effect of this outbreak (and I certainly wouldn't wish disease on anyone's child) is that some people's eyes are opened a bit to the fact that these diseases are not gone.

  40. Oh yes, breastfeeding (which I'm doing) does give the baby some protection. Which is comforting for me!

    How much protection, exactly, I'm not sure … a quick-and-dirty search of the American Academy of Pediatrics site turned up this article containing the relevant assertion:

    "maternal antibodies offer limited immunologic protection when compared with protection afforded by an infant’s active immune response."

    So my baby's still better off if the older children around him are immunized, I think.

  41. A great source of info an questions like yours, Alice, is the Center For Disease Control (CDC) website. I've been perusing it a lot lately, as you can imagine. Here's what I found regarding babies:

    "Why is MMR vaccine given after the first birthday?

    Most infants born in the United States will receive passive protection against measles, mumps, and rubella in the form of antibodies from their mothers. These antibodies can destroy the vaccine virus if they are present when the vaccine is administered and cause it to be ineffective. By 12 months of age, almost all infants have lost this passive protection."

    As you can see there is a quite practical reason why babies aren't vaccinated– it doesn't work. There is no mention of breastfeeding, the immunity seems to be there regardless. Of course nursing does confer additional immunity…

  42. Thanks for the tip, somedaynevercomes, and for the info!

    Though from the fact that several babies seem to have been infected in the SD outbreak, I'd guess the immunity passed on from the mom isn't as strong as that which older kids get from vaccines.

  43. clue it up exarch. the original comment suggested the US was making a mistake in under-vaccination that is unlike “every other developed country”. I listed a few such that have worse vacc rates than the US. anti-vacc nutz are not unique to the US.

    and the people here are weaseling out for all kinds of reasons including traditional home-vaccination strategies.

  44. OK, just to be clear on something: I'm not claiming that the reason why there's a measles outbreak in the US is "the reason" why the US doesn't understand public health.

    (Beware anyone who claims they know "the reason" behind anything. The world is usually more complicated than they think.)

    But I do believe that there's a pattern here. The US (and I don't necessarily mean the CDC; I mean the legislators and the public) really does have no conception of public health.

  45. Interestingly, Alice in W., I came across something today which suggests that this passive immunity protection is strongest when the mother actually HAD the disease– vaxed mom's don't give their babies as much protection as mom's who have true immunity from having the disease themselves. Also, the baby who is possibly infected (only one and not confirmed) was close to a year old, so perhaps their passive immunity had already worn off. Your baby is younger, so I expect would have more protection, especially if you are also nursing.

  46. There is an excellent book out there about vaccines and the history of vaccines by Arthur Allen (I know, his name sounds like a coporation doesn't it?) called Vaccines: The Controversial Story of Medicine's Greatest Lifesaver.

    Somedaynevercomes is corrent, the passive immunity that vaccinated moms pass on to their children is not as strong as moms who have had measles. I would also tend to agree with her, that families that have histories of severe reactions to vaccines have every right to be concerned. Chickenpox can be dangerous to an adult, but for the most part as kids it's not terrible (but yes I do realise there do get to be some pretty miserable cases out there). Personally, I think the HPV vaccine is wonderful, but no I don't think it should be mandated. I also think that the Hep B vaccine should be held till the children are older, 13 would be good, but that doesn't have to be mandated either. (and somewherenevercomes, I think JennY was using medicine to refer to the general health care industry, hospitals, doctors, nurses, not medications)

    That being said, the general attitude is growing that vaccines are unneccessary and do more harm than good. Does anyone bother to look at infant mortality rates any more? Yes, there are some diseases which, in mild cases, might be considered a nuisance disease (basically that the only reason we vaccinate is so parents don't have to miss work), but not everyone is a mild case! Measles (both german/ruebella and regular measles) KILLS. Mumps can kills and at the very least cause neurological damage! Whooping cough (pertussis) is extremly dangerous for small children. These kids cough so hard they turn blue and have have periods of suffication, or cough so hard they can herniate their diaphrams. As someone else mentioned, polio has been eradicated, a disease that was not nearly as prevelant or deadly as measles or the flu ever was, but had the nasty side effect of paralising people and leaving all their pain receptors intact, turning the human body into it's own perfect torture device. And does anyone really want to forego a tentanus vaccination? Personally, I know muscle cramps are back enough, I don't want to experience the one that breaks my back.

    Maybe we do vaccinate to early, or stack to many vaccines in the same time or shot. You can opt out or choose to follow a more spread out vaccination program (frankly I think the Canadian one makes more sense than the Americans). However, we have reached a point where we have gone to far to be able to go back. If the herd immunity decreases, or we stop vaccianting all together, some of these diseases we thought were dead and gone or only "mild inconviences" are going to come ripping back through.

  47. There are about 76 outcomes possible as a result of contracting a preventable disease. They range from headache through rectal prolapse and lifelong spasticity to slow and painful death.

    There are about a dozen outcomes possible as a result of reaction to an immunization. They range from fever to death.

    To be informed about the desirability of immunizing your child against any disease means that you have to know the probability of each one of all those adverse outcomes. How likely is it that your child will die as a result of getting the mumps vaccination? Almost zero. That he will become sterile as a result of getting mumps? About one in 10,000.

    So, to be able to determine whether it is more likely your child will benefit from the immunizations or survive the illnesses whole, you have to know approximately 1,800 factors.

    And when you know the odds, no matter what the choice you make, you have to remember that they are still odds. They might be very much in your child's favor, but your choice just might be irrelevant, given the odds.

    On the other hand, if you make a choice based on incomplete information, you just might have chosen against insuperable odds, and your child loses.

  48. Personally, I think that there are serious problems (ethical and practical) related to basing enforcement or penalties on what could happen to other people.

    For a start, proving a trail of infection would be rather difficult much of the time.

    Also, if the parents of an unvaccinated child were liable if the child caught and passed on a disease, presumably the same logic should make parents quarantine their children (and adults quarantine themselves) whenever they have any kind of infectious disease for fear that they might get sued.

    Generally speaking, I think it's better to argue that being vaccinated is, on average, beneficial to the vaccinated.

    Suggesting that group benefit should be a major part of someone's individual decision-making does seem to be close to suggesting that the selfish reasons are insufficient – that the risk to the individual outweighs the personal benefit, which does seem to be what some nonvaccinating parents fear may be the case.

  49. PH, In California we have to carry liability auto insurance based on what might happen to other people and/or property as a result of our actions.

    The CDC seemed to be able to find the child who contracted measles in Europe and spread it to the children in San Diego. The CDC/health departments were able to located the family and the other children who may be at risk at the charter school.

    And I was writing about the spreading of PREVENTABLE infectious diseases–not the common cold.

    Many of the reasons for not vaccinating are selfish–they are depending on the fact that the majority of the population is vaccinated, keeping their unvaccinated children safe. Like you said above, many won't cite this as a reason for making the decision to not vaccinate easier.

    The U.S., and California especially, are very litigious, and I think something else has to be done to protect the infants who are too young to be vaccinated, the elderly, and the immune-suppressed or compromised from VERY preventable, and perhaps even deadly, diseases. Because as you mentioned above simply arguing "that being vaccinated is, on average, beneficial" doesn't seem to be working.

    Sadly parents need to be held accountable, and the only thing that seems to work is financial accountability. For example, truancy used to be a huge problem in our local school district. When the school and courts starting requiring the parents to show up for hearings (having to miss work) and penalized them with fees and tickets, guess what? Truancy rates dropped significantly.

    Just some ideas…

  50. Unfortunately, there is no reasoning with, or changing the beliefs of, the non-vaccinating parents. So, they need to be hit where it hurts. Why not pass laws requiring these parents to carry medical LIABILITY insurance. Since their children are at risk of spreading preventable, communicable diseases, they should have to pay for the medical treatment of the others they infect. Also, I wonder if any lawsuits can come from this. Meaning, for example, my four-month-old daughter is too young for the measles vaccine, and I am outraged at the possiblilty she could contract it because of another parent’s selfish ignorance. I was thinking, if this were to happen. Would there be grounds to sue the initial carrier’s parents for neglect, endangerment, damages, medical bills, etc…Like the lawsuits filed by people suing previous sexual partners for transmitting HIV. I realize the non-vaccinating parents aren’t knowingly spreading disease or withholding disease status, but their lifestyle (like travelling abroad) and choice to not vaccinate leaves their child at high-risk of contracting and spreading miserable diseases that can be fatal. Just a thought…

  51. Ah, here's how to deal with it: The family refuses to immunize, their health care provider (allopath, homeopath, faith healer, shaman, whatever) levies a $50 "prevention tax" on them. The provider keeps half and sends the other half in to the Centers for Disease Control.

    A provider who refuses to levy the tax faces no penalty– until one of his patients comes down with a preventable disease, at which time the authorities come down on him like they were Homeland Security and he looked like he was vaguely Middle Eastern. He then gets fined for not having forwarded half the levied tax for each child and immunizable adult in his practice. Or her practice, to be even-handed.

    The ones who maintain their discipline magically prevents diphtheria, etc., will put their money where their mouth is.

    Providers who have collected and forwarded the tax are of course operating within the law, even if their patients get sick.

  52. PH, there doesn’t seem to be much consistency in your response threads. The only thing you do seem to consistently do is denounce and find flaws in others’ suggestions to the problems and health risks the unimmunized pose on society without offering any alternative solutions other than make vaccination “attractive”.

    It’s not right for a few to avoid vaccination risks because the majority of the population is vaccinated, essentially keeping their children safe. I’m not sure if you have any children. But can you imagine if your infant contracted a disease which would be completely eradicated in the United States if all who could be were vaccinated (which can be very lethal in infants). I would be incensed if my baby, and I am close enough to San Diego that this last epidemic scared me, were to contract, suffer, and possibly die because someone didn’t vaccinate his/her child because of unproven theory. It is NOT theory that these immunization-preventable diseases are highly contagious. It is NOT theory that many of the immunization-preventable diseases are deadly in infants. What gives people the right to pose such a health risk to the defenseless?

    I didn’t state that liability health insurance was an answer it was an idea. SOMETHING more effective needs to be done. You stated in a previous post, “it’s also equally understandable that a government can look at the overall risks and possibly choose to enforce or strongly encourage vaccination if it appears to be in the best interests of the people overall..” So, perhaps instead of medical liability insurance, there could be stronger legislation requiring vaccines. Or, maybe the insurance providers shouldn’t cover the unvaccinated through state or employer-subsidized insurance plans. They should have to obtain the more expensive, individual coverage. Medical and life insurers can deny coverage for a plethora of reasons: coverage can be denied to those who participate in undesirable “high-risk” activities such as drug use, recent tattoos, or having had too many previous sexual partners. Insurance providers also deny coverage for pre-existing conditions. Why can’t an “unimmunized status” be considered a pre-existing condition? This group is definitely at a higher risk of contracting diseases. Then, perhaps a percentage of the higher rates and deductibles the unimmunized pay can go toward the public vaccine clinics that service the uninsured and low-income.

    “and having the odd little outbreak doesn’t cost a great deal” There was nothing odd or little about the San Diego measles outbreak in 1990, with over 900 cases resulting in 3 deaths.

  53. Fundamentally it seems to be very dangerous territory to argue that the benefit of the immune-suppressed, elderly, etc, is sufficient reason for someone to be expected to get themselves or their child vaccinated.

    As a simple case, take HPV.
    Even though reducing HPV transmission is definitely seriously beneficial to women, until/unless it can be shown that vaccinating males would be on-average beneficial for them, it’s ethically tricky to argue that vaccination should be in any way required for males.
    If the HPV vaccine were shown to be effectively harmless or better for males, should that make any male not getting vaccinated liable if they unknowingly caught and passed on HPV?

    The CDC seemed to be able to find the child who contracted measles in Europe and spread it to the children in San Diego. The CDC/health departments were able to located the family and the other children who may be at risk at the charter school.

    In that case, it would seem that the other children infected were infected as a result of not having been immunised. Presumably, even in your liability scenario, their parents shouldn’t be allowed to sue anyone for making the same decision they did.

    When I got rubella and chicken pox as an adult, I have no idea who I could have caught them from, since I wasn’t aware of anyone else who had them – I presumably caught them from some random stranger in the street or a store, a week or more before symptoms started to show.
    I imagine that that’d tend to be the way that many elderly or immune-compromised people would catch diseases from unimmunised children. In that scenario, what should the authorities do – demand that local doctors hand over information on patients in order that someone can be found to be legally blamed?
    It’s one thing to try to track down disease transmission on a no-fault basis to stop the spread, but rather a different thing to be chasing up a long line of cascading liabilities.

    Except in the case of deliberate infection of others, I think that liability and infection don’t really go together.

  54. One of the best ways of effecting a change in behavior is to provide a reward. The single biggest change in smoking levels in New York City was when the cost of a pack of cigarettes went over $5. That was a negative reward.

    A large part of the reward parents feel they are getting by refusing to vaccinate is the sense of doing the best for their child. I think that reward would largely be overpowered by the negative reward of having to shell out $50 for every immunization they refused.

    The provider who levied it on them would be rewarded by getting half. The other half, as would be explained to the parents, would go into the fund for controlling the spread of an epidemic– after all, in San Diego, thirty health workers were put on overtime to get it under control. My guess is that represented a minimum of $5000 a day and probably $150,000 total.

    Many parents would abandon their hostility toward immunizations by reasoning that they would rather knuckle under AND have their child protected as well, rather than pay into a fund that had to correct some other parents' damfoolishness. Others would grumble and pay, but I think immunization rates in general would go above 98% nationwide, versus the 85% that prevails currently.

  55. On the liability side, even if it could be implemented without opening a huge legal can of worms, it doesn’t seem likely to work as a great deterrent to someone genuinely (if misguidedly) worried their child could be damaged by a vaccine, since any cost would only seem likely to arise in the case that their child got infected and traceably passed the disease on to someone else, who then became damaged as a result, (and who wasn’t themselves unimmunized by choice or parental choice).
    In a situation where disease outbreaks are rare and small, and the probability of someone being damaged in any given outbreak is low, the risk of suffering loss as a result of not having your child vaccinated is itself low.
    If disease outbreaks were more common and larger, to the extent that the liability risk might seem greater, then it would seem likely that even the apparent ‘selfish’ risk/benefit balance would shift such that fewer people would avoid vaccination anyway.

    What gives people the right to pose such a health risk to the defenseless?

    Basically because they’re an individual deciding something for themselves (or for someone in their charge), not for the benefit of random other people. There is still a real issue of autonomy involved when it’s suggested that people should undergo a medical intervention for some other person’s benefit, even if the intervention was demonstrably low-risk.

    The cynical politician’s aim is to avoid having large outbreaks that they can be blamed for. As long as there aren’t large outbreaks happening, the likely gain from being tougher is small, possibly nonexistent. Even if there was a larger and more serious outbreak, it’s still easy for the government to point the finger at the anti-vaccination crowd, and maybe then bring in some tougher measures, increasing encouragement for vaccination or enforcing penalties for nonvaccination.

    There was nothing odd or little about the San Diego measles outbreak in 1990, with over 900 cases resulting in 3 deaths.

    Unfortunately, from a national perspective, an outbreak 18 years ago that resulted in less deaths than many road accidents really could be considered as small.
    It’s likely to be seen as small by people looking at anecdotal evidence of claims of vaccine harm from numerous parents.
    How large would an outbreak have to be for it to become the natural response in any discussion where someone was arguing against the use of vaccines – the kind of thing that any journalist would be guaranteed to bring up over and over?

    Insurance is certainly a potential lever, but with insurance companies, unless they’re somehow required to withdraw cover from the unvaccinated, as long as the risk of epidemics is small, their potential savings don’t seem likely to be great.
    Would they have to distinguish between those unvaccinated out of choice, and those unvaccinated for medical reasons?
    Even then, if someone is convinced they’re acting in the best interests of their child, they may choose to pay more insurance or have worse cover.
    If people are being misinformed, properly informing them would seem to be the thing to do, but I wonder what the best way is.
    Chances are, a storyline in a medical drama would probably have more impact than a government information campaign.

  56. I suppose it come down to what the various subsets of belief are amongst those not getting their children vaccinated.

    How many are irrationally anti-vaccine to the extent that even if it could be clearly demonstrated that their child would be better off vaccinated, they'd still be against it?

    How many are being more rational and not perceiving a huge current risk from either vaccination or nonvaccination, being rather likelier to be amenable to having their mind changed.

    How many are just misinformed?

    Certainly, if there's misinformation around, some steps to correct it might help, if they aren't already being taken. If myths are being spread, is there any attempt to counter them at the point of opt-out, with the current best scientific knowledge set out in a clear and unarguably honest fashion, with people available to talk to if someone wants more information?

  57. Well, to respond to the last comments by both idios and PH, I have lots of (again, anecdotal) experience with the anti-vax crowd. "Science" is unlikely to sway them since many are convinced there is a government/big pharma conspiracy to cover up the truth about vaccines. Likewise, any sort of tax or higher insurance premium is likely to further make them feel like the persecuted underdogs being punished for running afoul of "public health."

    I think it will have to be more of a grass roots effort. There was just an article by Dr. William Sears in La Leche League's bi-monthly magazine on vaccines; while I wish he had been a little less even handed in dealing with "both sides" of the vaccine issue, he did come down on the side of being pro-vaccination, even if it is on a delayed schedule. Dr. Sears is someone people in the anti-vax communities I've known really listen to, so I was heartened to read the article.

    So I think it's getting people who are influential in the alternative parenting scene convinced. If Mothering Magazine ran an article debunking the anti-vax movement, you'd see changes, I guarantee it.

  58. People might grumble about being persecuted when they have to fork over $50 for adhering to their beliefs, but imposing such a burden will move the argument away from whether or not immunizations are bad for their children to the argument about having to pay for the expense of curtailing an epidemic brought on by an unvaccinated child– the original vector– and sustained by other unvaccinated children, one of whom could be theirs.

    You have to shift the grounds of debate in order to bring them around. Their primary motivation is to be the best possible parents in the world, and the more insecure they are about being good parents, the more resistant they are to changing their values.

    By shifting the argument to focus on what happens independently of their choice to immunize– you don't have to bring their child into it at all– you give them the opportunity to change their behavior without causing them to lose face or lose a healthy child.

    Getting them to change on the basis of positive rewards is a lot more labor-intensive. You'd be talking about the epi equivalent of Jehovah's Witnesses or Mormon missionaries, visiting time after time, discussing, probing for the weak points, coaxing, affirming and eventually converting. For a lot of us, life isn't that long!

  59. PH wrote:

    … as long as the risk of epidemics is small, their potential savings don’t seem likely to be great.

    This is the very heart of the issue though, isn't it?

    The one thing that a decent vaccination strategy is accomplishing is the reduction of outbreaks, and the trivialization of "epidemics" to such small scale events that they barely stay in the news for more than a few days.

    For what it's worth though, we have plenty of evidence of what being sick would be like if there was no such thing as vaccination. We need but look back a good hundred years to see how entire populations where practically wiped out by measles, chicken pocks or rubella. The slightly more recent bird-flu outbreaks certainly illustrated how quickly things can go from bad to really, really fucked up.

    Getting people to put two and two together shouldn't be that hard. But my guess is they just keep getting the same scare stories about bad vaccination reactions shoveled into their heads by people who probably haven't got a clue what they're talking about. I'd say the real crime here is non-medical personnel giving out medical advice. And that ranges from vaccination bull-crap to homeopathy, acupuncture and plenty of other supposedly "alternative" medicine.

    Make people pay for this. Make anyone who gives bad medical advice that results in injury or death liable. Not just doctors who are doing their job and trying their damnest to cure people. And use a current medical manual to determine what constitutes "bad". Anything that's not medically proven or part of a study is going to be a risk then.

    Americans like lawsuits, don't they? So fix it with lawsuits. Not getting cured by homeopathy? Just sue that fucker and put him out of business.

    When the alt-med crowd has no one left to listen to, the only place they can get their medical advice will be sure to have reliable info.

  60. Problem is, a newspaper putting forward a one-sided case based on a few anecdotes couldn't be called 'medical advice' by any meaningful sense of the phrase, but can do possibly rather more harm than an alt-med practitioner who's already largely preaching to the converted.

    It's tricky to sue a journalist for being ignorant or biased, and concerned parents with an autistic kid probably make good copy even if there's no evidence that their kid or any other was damaged by vaccinations.

    On the other hand, interviewing the parents of someone provably damaged by a disease doesn't have that nice frisson of 'conspiracy'. It's sad, but shit happens, or it's God's Mysterious Will, or whatever, but there's no corporation to subtly cast aspersions at.

  61. A few principles underlying this situation:

    1. Parents always want to do right by their children.

    2. Parents usually like feeling empowered.

    3. Parents feel empowered when they are able to choose among options for their children.

    4. Parents do not feel empowered when they feel they are being pressured to change their choice.

    5. Parents will choose differently when they find a good reason to do so. Attacking their present choice is never a good reason.

    6. Parents are influenced in their decisions by the cost involved.

    7. A threat in the future is not as menacing as a present threat to the wallet.

    So, here's what can be done: Establish an epidemic control fund in the Centers for Disease Control, a fund meant to defray those extraordinary expenses of stopping outbreaks. Publicize the fact that the work is to protect unimmunized children– the statistics will show they are the ones who get sick, and case histories will show that some of them are killed or crippled forever.

    Charge parents who refuse immunizations a $50 fee, NOT to encourage them to change their mind, but to provide funding to protect their child against an outbreak of that disease.

    Parents who refuse to immunize their child will have the choice of standing by their principles and paying the fee because it will protect their child, or the choice of re-thinking their position.

    Now, how do you think parents would act in a situation like the above?

    For purposes of this argument, let's leave out the role of the providers. If you want, we can discuss that next.

  62. However it was spun, I think a lot of people would see any charge as a fine for non-vaccination intended to push them to change their choice, not some kind of contribution to a fund.

    5. Parents will choose differently when they find a good reason to do so. Attacking their present choice is never a good reason.

    If they're basing their choice on misinformation, the misinformation could be challenged without the parents feeling they're being attacked.

  63. I don't think the providers should even be involved at all. Except maybe to exempt people from contributing to the anti-vax fund after they got their shots.

    Just make it a mandatory kind of "insurance" for unvaccinated people only. An annual contribution to be paid per unvaccinated person, with the fund used for financing outbreaks, or reducing the cost of vaccinations. Make the contribution the same cost as the vaccinations themselves.

    I don't know if your health care refunds the expenses of those kinds of things, but they would definitely NOT refund the contribution to the anti-vax fund, meaning vaccination would actually become the cheaper alternative.

  64. PH, misinformation is most effectively marketed by appealing to as basic a level in the brain as can be addressed. The limbic system, which operates almost purely on reflex, is the most basic there is. To implant reactions in that system, you use fear or desire. When misinformation is presented in such a way, it is easy to assimilate and very difficult to dislodge, since you would have to present an even more emotionally powerful message (public health types are rarely allowed to use such tactics, since governments which do so are usually totalitarian). So, trying to overcome misinformation by sweet reason could be done, but it would be far too labor-intensive to be practical under government funding.

  65. Exarch, it seems to me that the health care provider is the "control point" through which everything has to flow: he/she provides information, education, inspiration to prevent illness and restorative care in case of illness.

    Without using health care providers, how would a system have to be set up to identify non-immunizers, the number of times each of their children has avoided an immunization (allowing credit for the immunizations some of them might have had), collecting the tax and enforcing cases of non-payment? If you can come up with a system that's simpler than having the MD or chiropractor explain there's a $25 administration fee for giving the immunization or a $50 fee for not giving it, it would certainly be worth putting in place.

  66. I don't see how you can easily frame legislation such that some alt-med practitioner who doesn't give immunisations is put under any obligation to participate.

    If someone avoids taking their children to proper doctors and only visits people who have nothing to gain from helping administer a charging system, you'd need some other mechanism to extract charges.

    Fundamentally, if you want to increase vaccination rates, you need to find out what reasoning the different subgroups of non-vaccinators are using, and direct initial efforts to the subgroups which seem the cheapest/easiest to change the mind of.

  67. PH, this wouldn't obligate the practitioner to give the shots; in fact, by collecting the fee, the practitioner protects him/herself from the legal consequences.

    I have dabbled enough in the preventive care field to know that the first duty of a health care clinic of any sort is to stay in business. This is why so many practitioners will participate in multi-agency health efforts– in exchange for their signatures on various forms, they get a fee of $10, $20 or $50.

    This is why the "epidemic curtailment" fee would be split. A provider, even though vehemently opposed to immunizations, would rationalize his/her participation in the program by saying it was government mandated and therefore he/she has to do it. And they'd take the $25. They'd object to the clause which penalizes them for not collecting the fee– but that's only if it's one of their patients that gets sick. Given the choice between making omney and making more money, they'd choose the latter, 99 times out of a hundred.

    Okay– now let's say you're a reflexologist who preaches "no immunizations" to all your families, because you know that foot therapy can cure everything. The state examining board informs you that all care providers– of which you are one– are now required to screen their pediatric patients for immunization status and collect a $50 fee for every child found lacking those which should have been administered most recently (i.e., a 20-month-old should have had the 18-month series).

    You have 300 children among the families in your practice. Advising them that you have to collect an 'epidemic fund' fee of $50 will earn you between $7,500 and $10,000 a year. (Infants receive immunizations about five times in the first year of life, which would be $125 for you.) What would you feel like doing?

    As for using reason, you might want to check out the anti-fluoridation scene– There are people who quite simply are willing to terrify people into believing them. Unless you happen to be an emotionally healthy and reasonably intelligent individual, you will come away from those sites vowing never to let fluoride in your town's water.

    But– you're the health care provider. How would you handle the situation?

  68. Okay– now let’s say you’re a reflexologist who preaches “no immunizations” to all your families, because you know that foot therapy can cure everything. The state examining board informs you that all care providers– of which you are one– are now required to screen their pediatric patients for immunization status and collect a $50 fee for every child found lacking those which should have been administered most recently (i.e., a 20-month-old should have had the 18-month series).

    Idios, I've got two questions on this. First, which healthcare provider is responsible for collecting? Suppose you take your child to a GP, a Chiro, and a Reflexologist. Would the parent have to carry around a receipt showing that they've paid?

    Also, another flaw with this plan is when to administer the fee. The "recommended vaccine schedule" is just that – recommended, and there are alternative schedules out there. Some of the scheduling and vaccine combos are set up for the convenience of providers and record keeping, not so much because those are the best times to be vaccinated.

    I don't think your basic premise is a bad one, but maybe it's something that could be applied when a child enters school (hey, there's an idea–have the schools be the ones to collect and split the fee!) since that's when unvaccinated status is both more of a public health issue and it's when it gets checked/enforced most strongly. That doesn't help with homeschooled children, of course, but just a thought.

  69. I think for this to work properly, you'd have to simply make it some sort of tax. Precisely why it would be a good idea to make it the exact same cost as a vaccination.

    Doctors can then provide vaccinations free of charge and recover the expense from "the outbreak fund™", health care providers who don't vaccinate don't have to do anyting. People who vaccinate get a vaccine, people who are anti-vax get nothing in return for the added expense. I'd say that almost balances out.

  70. Flygrrl, itr would be a first come, first served: The provider who first notices the child has either missed a scheduled iz or is due one at present would be the one to present the bill. the parent would have a receipt to include with the child's records (just as other parents carry around the iz record for their kids) to prove to the next provider that they had paid into the fund.

    Since there are a given number of iz's no matter what the intervals of administration, the parent would only have so much wiggle room. For example, he or she would be compelled to face the fact that now the child was due for HepB #2, there would have to be a settlement for dealing with the lack of HepB #1.

    As for deferring the whole thing until the start of school, as you point out, the home-schoolers would be completely missed (and that's 75% of Evangelical families!). And I think there would be a fair amount of resistance from the health care providers who would be missing out on some signficant revenue. (My child's provider had 5,000 children, representing about $120,000 over a fiveyear preschool period. I'd sure like to see our schools get that sort of money!)

  71. Exarch, it's clear you're not a Republican! Impose a tax?!?!?! (just kidding). But there would be a lot of resistance to that.

    The fee actually is a form of taxation, and people are going to argue that position, but to out and out call it one invites death for any political career you might have planned!

    Believe it or not, most pediatric vaccines are already free, provided by the Federal government. Providers can't charge for them, but they are allowed to charge for administering them. (In my son's time, it was about $25.)

    In my state, 100% of the children are covered either by private insurance or state or Medicaid funding. The providers are flummoxed enough by the present three layers of paperwork and would not take kindly to having another layer added to the load. They would be happy, however, to forward half of a new fee source, since the paperwork would definitely be simpler (see SiCKO" to see about the fights over "denial of service").

    And of course, since the idea is to reduce the expense of epidemiological crisis work, it can't be done by letting the anti-iz families simply slide by. They might change their behavior (and probably will) when they are faced with a choice of getting their child immunized (in my state, free) and paying $50 to the epi control fund.

  72. One downside would seem to be that for people who don't go t0 alt-med providers (including Evangelicals?), having a system which was effectively a per-missed-vaccination tax which was collected on visits to a doctor might result in some parents being reluctant and/or slow to seek medical help when they really should do.

    That's not to say that there isn't a good case for asking/expecting nonvaccinators to help fund the vaccination of other people, from which they demonstrably benefit.

    The difficulty the practical one of avoiding doing things which could push some people to make worse choices for their children.

  73. Yes, PH, some parents would be reluctant, but they would use one of two strategies: they would either "doctor-hop" (which is what abusive parents do), switching from one doctor to another, or they would limit their child's visits to crisis care only, in emergency rooms.

    However, the number would be far fewer than the 15% of families that are at present unimmunized. My guess is that it would be about 2 to 3 percent.

    Most parents who don't believe in immunizations are good parents and want to be good parents; they would not shirk a petty confrontations with their children's doctor. It would give them a substantial reason for re-thinking their stand on immunizations.

  74. Let health insurance companies charge 2x for individuals not 100% up on their medically recommended vaccinations. If a vaccination isn't medically recommended, then not having it doesn't invoke the higher payment option.

    If you lied about your vaccination status to your health insurance company they get to cancel your coverage retroactively (with no refund)and you get charged with fraud.

  75. Good idea, Daedalus2u, except that its complexity is problematic. The most effective processes are the ones that have the most immediate feedback. The paperwork lag involved in this proposal would dilute the intended effect that would be present in a face-to-face situation. Which is more effective, having your doctor explain your alternatives, or getting a letter from your insurance company? I think the personal element is much stronger.

    A subsidiary problem is that insurance companies only cover about 60% of the population, which means that a lot of people wouldn't be motivated by the threat of an insurance rate hike or loss of insurance.

    But I do think that the companies would absolutely love to make money off the 100% surcharge and the cancellation of policies– you have seen "SiCKO," haven't you?

  76. What's the general score in the US with health insurance and children – ie how much is it a case of children having specific cover paid for one way or another by parents, how much is a case of children having automatic cover as a result of employer-provided or parent-funded insurance of the parent?

  77. Essentially, the problem boils down to this:

    You want people to pay for not having done something, and you want them to do this thing in order to avoid having to pay.

    I don't se why calling it a tax would be a bad thing. Don't like the tax? Easy, just get vaccinated and you're exempted. But if you didn't get vaccinated, you're looking at an annual tax that quickly adds up.

    If people in the US really hate taxes as much as idios suggests, I'd say that is the strongest emotion to work with right there. Which do you hate more: taxes or vaccines? You only get to choose one to avoid …

  78. That's a whole different topic, PH! I'd have to do some reading up on it, but there's nothing stopping you from doing the same– Obviously, Wikipedia's entries on heatlh coverage are a good start, and the US Census actually has understandable information about who is covered and how. In general, the kids who aren't covered are the ones whose parents have an income high enough to make them ineleigible for SCHIP and Medicaid-funded programs, but too low to afford insurance– the upper lower class and the lower middle class

  79. It's not a whole different topic.

    If children are covered for free under state insurance, or for free as part of an employer's insurance, it'd be harder to make daedalus2u's 'more expensive insurance for unvaccinated kids' idea work.

    Do any insurance companies have exclusions for the effects of diseases that children have (by choice) not been vaccinated against?

    Would such exclusions be currently legal?

  80. Children are only covered "for free" because that is how the health insurance is priced. A family policy covers everyone in the whole family. If everyone in the whole family had to have all their vaccinations current otherwise the health insurance was 2x, that would include adults and children.

    The coverage may be "for free" to the employee, it certainly is not to the employer. If the employer had to pay 2x, they would gladly pass along the 1x even if 1x remained "for free" due to collective bargining agreements.

    This might not solve the whole problem of unvaccinated children, but it is a start.

    I disagre that the non-immediacy of 2x insurance costs would reduce the effectiveness. Depending on the insurance plan, every pay day some amount is taken out and shows up on the pay stub. Every month a new bill arrives. That is many more "learning moments" than doctors visits where 15 minutes of explanation costs a lot more than the vaccine does.

    Once a few insurance companies did this, it could snowball if a few MDs decided that a health insurance company that didn't do this was behaving unethically and warrented a surcharge.

    I don't think that any insurance companies do have exclusions for diseases the could have been vaccinated for but were not. I don't think such exclusions would be legal under current law. It would be similar to self-inflicted adult diseases, cancer from smoking, liver failure from alcohol consumption, obesity. I think it would be especially difficult to make the argument for children.

    Children might have a legal case to sue their parents for neglect, but that would be difficult if the parent was still the legal guardian.

  81. Presumably,if/when children are covered for free, that's at least partly down to them being seen as a low risk.

    I suspect that many doctors might also wonder about the ethics of inflating insurance costs far beyond the marginal cost resulting from a child not being immunised.

  82. Remember, when it comes to enforcement/legal action, in many places it's difficult to override a guardian's wishes even where those wishes involve withholding likely life-saving treatment for a child who is acutely ill.

    In the case of vaccinations, even if rates were low enough for the childhood diseases to be endemic, most would still be pretty a low risk on a per-person basis.

  83. PH, the marginal cost to who? If herd immunity is reduced such that an epidemic spreads, there could be many thousands of cases to deal with, not just the one unvaccinated person. Who compensates the individuals who can't get vaccinated because of real medical issues, or because they are too young?

    Insurance costs are already inflated beyond the marginal cost. That inflation is called profit. Everything that is sold has a price that is inflated beyond the marginal cost of providing that good or service. In the case of a 2x multiplier for non-vaccine use, either people will be vaccinated, or will accept the 2x multiplier. In that case the 2x multiplier is what the non-vaccinators are willing to pay to be non-vaccinated.

    Children are "low risk" to insurance companies because they don't get that many serious diseases that require large medical expenses. Some of that is due to vaccines.

  84. If the argument is an economic one, the marginal cost to the insurer is derived from their best guess as to the probability of someone catching a disease (based on current/recent vaccination rates), and how expensive it's likely to be if they do catch one.

    Insurance costs are already inflated beyond the marginal cost. That inflation is called profit. Everything that is sold has a price that is inflated beyond the marginal cost of providing that good or service.

    And companies that inflate their prices too far lose out in business to others, except when operating in some explicitly or implicitly anticompetitive environment.

    Who compensates the individuals who can’t get vaccinated because of real medical issues, or because they are too young?

    That seems to be a rather large can of worms.

    If you're looking at a blame-based approach to infectious diseases, or to medicine in general, I assume you're not counting people who are immune-compromised due to choices they made amongst those deserving of compensation?

  85. w_nightshade shows one example of what works for a lot of parents– the motivational power of a sticker. Daedalus2u and PH talk about structural adjustments.

    What seems to be missing is a grasp of where the non-immunizing parents are coming from. Solutions offered to an uninterested party are not going to be effective. Anybody care to offer an insight as to where these uninterested parties are coming from?

  86. I thought I gave a little insight as to where these people are coming from. Here's my honest opinion, having had conversations/arguments with many of them… they are mostly well-educated, stay-at-home moms. They are good parents, but perhaps like to have a feeling of empowerment/expertise and thrill in finding fault with "the establishment" in terms of medicine. There's a lot of good evidence that what the medical community has been doing for years in terms of childbirth practices, breastfeeding support, etc. is actually detrimental to the health of women and children in some ways (though that is really changing), and these parents see the "evils" of vaccination as a logical extension of this. They look at things like thalidomide, and conclude that the government has a vested interest in covering up true harm done by doctors and the pharmaceutical companies. They also find this anti-establishment stance as a way to bond and find common ground with other parents. It's a very strong community of people, who seek each other out and reinforce their prejudices and belief system at every opportunity. They are highly suspicious of arguments from authority (authority meaning mainstream pediatric and CDC advice) about their children's health.

    That's all the insight I can offer, but having known roughly a couple dozen parents who are in this camp in the last five years, I'm not really sure what will motivate. It certainly isn't governmental pressure. It's probably more grassroots sorts of organizations/figures being convinced and spreading the message because that's who these parents turn to (Mothering Magazine, La Leche Leage – a group that has no stance on vaccination officially, but among members you'll find a lot of sympathy for the anti-vax cause, Dr. Sears, etc.)

  87. Virtually all of the anti-vax parents are anti-vax because they are delusional. They have bought into a delusional world view of Big Pharma and CDC conspiracies to poison children to save a few pennies. People who are spreading those lies about mercury, thimerosal, vaccines and autism in particular are doing so to profit off the ignorance of those that are being duped. It is exactly like the situation in Nigeria where so called "leaders" told people the polio vaccine was designed to sterilize people.

    http://www.bmj.com/cgi/content/full/328/7438/485

    It is exactly the same mindset that the anti-vaxers have. You can't reason a person out of a belief they didn't arrive at by reason. The belief that polio vaccine is a plot to sterilize children was made up solely to increase the political power of those expressing it. That is exactly what the anti-vax proponents are doing.

    Anti-vax sentiments are being pushed by CAM practitioners because they get more business that way. Trash real medicine so people don't trust it and where are they going to go when they get sick? To CAM. Tell enough gullible and naive people that magic water is better than a vaccine and some will believe it.

    Wakefield put out his fraudulent report about measles, because he was hired by lawyers suing the vaccine manufacturers. Wakefield has made a lot of money defrauding anti-vax parents, and in the process has hurt a lot of children. Children have died because of the hysteria he whipped up.

    PH, the marginal cost isn't linear. It may stay linear as the number of unvaccinated increase until the number exceeds the threshold necessary for an epidemic to propagate. The cost of an epidemic might be a billion dollars. Do you charge that "marginal" cost to the single individual who put the unvaccinated population over the epidemic threshold?

    Orac has a lot of stuff on anti-vax over at Respectful Insolence.

  88. PH, the marginal cost isn’t linear.

    Evidently, but it's currently low, and if an insurance company could recalculate premiums on a yearly basis, they'd be able to track all but the most rapid drop in vaccination rates.

    If an argument was meant to be an economic one from their point of view, it can only take their likely exposure into account.

    in the UK

    If virtually all non-vaccinating parents were really delusional, I'm not sure how easy it would be to price them out of their delusions.

    Personally, I wouldn't be surprised to find a significant number of nonvaccinating parents weren't conspiracy theorists, but were just trying to balance a few emotive arguments of MMR-autism linkers against a currently low perceived risk of not being vaccinated, maybe with the human (if illogical) tendency to be more scared of bad outcomes from doing something than bad outcomes from not doing something.

    Presumably, as the numbers of nonvaccinating parents rise, better and better information should become available regarding the statistics of vaccinating or nonvaccinating and the relation to autism, etc.

    If there is no causal linkage, that should become increasingly obvious and hard to deny over time.

  89. Personally, I wouldn’t be surprised to find a significant number of nonvaccinating parents weren’t conspiracy theorists, but were just trying to balance a few emotive arguments of MMR-autism linkers against a currently low perceived risk of not being vaccinated, maybe with the human (if illogical) tendency to be more scared of bad outcomes from doing something than bad outcomes from not doing something.

    PH, I would say that this is a very accurate summation of all but the most militant anti-vax parents I have known. In fact, I was once leaning this way myself, but as I did more and more research I realized that most of the arguments against vaccination were crap. But it is terrifying, when you have an infant, to think that you could make a choice that would harm your child. So in that sense, the unknown consequences of inaction sometimes seem better than taking responsibility for the (supposedly) "known" risks of action (even though if you're thinking rationally you realize you have to take responsibility for any consequences of inaction as well…)

  90. It already is completely obvious that there is no linkage between thimerosal and autism. Thimerosal has been out of children's vaccines for years now and there has been no decline at all in the rate of autism. Not even a blip in the curve. The proponents of the (wrong) "mercury causes autism" idea (not a hypothesis because it is inconsistent with much that is well known) are now moving the "goal posts". Blaming other components in vaccines, blaming mercury from China, blaming anything they can to save face and continue to sell their harmful chelation treatments. Orac has a lot on this with many links to other blogs. The autism hub has a lot of blogs about this too, with links to the literature.

    It is not a close call. There is no evidence that supports a vaccine-autism link. None. There is no evidence to support the idea that autism is caused by toxins of any kind. The most consistent symptom of the autism spectrum is larger brains with more neurons. How does a "toxin" cause a larger brain?

  91. It already is completely obvious that there is no linkage between thimerosal and autism.

    So that's not an issue in anyone's decision-making unless they're underinformed.

    The proponents of the (wrong) “mercury causes autism” idea (not a hypothesis because it is inconsistent with much that is well known) are now moving the “goal posts”.

    To be fair, mercury was only ever just one suggested mechanism to explain a perceived vaccine/autism link (based on anecdotal cases of apparent temporal correlation).

    Many autism scare stories don't seem to depend much/at all on the use of mercury, and that's been the case at least since Wakefield started doing his thing.

    By far the best way to demonstrate a lack of overall correlation seems to be to look at large numbers of vaccinated and unvaccinated children in one country at the same time, since that does get rid of various possible confounding factors (changing/different diagnostic criteria, alleged environmental factors, etc)

  92. By far the best way to demonstrate a lack of overall correlation seems to be to look at large numbers of vaccinated and unvaccinated children in one country at the same time, since that does get rid of various possible confounding factors (changing/different diagnostic criteria, alleged environmental factors, etc)

    I had actually heard several anti-vax people point to a study done among the Amish in the US showing a virtual lack of autism as proof that there is a link. Some of the problems with that being a) it was a telephone survey b) Being such an isolated community we don't know if autism is underdiagnosed in the population and c) from what I understand there is a strong genetic component to autism, and being such a small and interrelated population it might not be surprising to find a much lower instance than in the population at large.

  93. There haven't been any well done studies of ASD prevalence in the Amish communities.

    What was done wasn't a survey per se, I think it was just the "impression" that a water treatment salesman got from his experience in trying to market to that community.

    http://www.kevinleitch.co.uk/wp/?p=352

    There are also confounding factors in the Amish community. For the most part many of them do vaccinate. They also don't use electricity, and so they don't bathe as frequently as non-Amish do. That is (according to my research) an extremely important factor in the severity of autism symptoms. The bacteria I am working with (which I discuss on my blog in the context of ASDs) are easily washed off by bathing and they don't come back if bathing is continued every few days.

    There has been a lot on autism and the Amish in the blogosphere, at Respectful Insolence and at others. There is no actual data to support 1 that the Amish don't vaccinate, and 2, that there is no autism among the Amish, or 3, that there is any causal relationship between vaccines and autism.

    The measles vaccine never had thimersal in it.

  94. Thanks for the info, daedalus2u! That is really fascinating… and the kind of thing you don't hear in the anti-vax community. It just seems like these [anti] anecdotes get repeated, weighed just as heavily as actual evidence, and passed from one person to another on authority (and people get VERY emotional talking about this stuff). I'm sorry if I just repeated the "Amish Study" story in an uninformed way. I know repeating hearsay, even in an attempt to dispel it, can be a bad thing…

  95. You might want to check out this blog for some better information on homebirth.

    http://homebirthdebate.blogspot.com/

    There is a gigantic amount of wrong stuff out there on home birth being "safer" than a hospital birth. It simply isn't, and there is no data that says otherwise. The author of the blog has a “reputation” among home birth advocates. There was a serious push to have her blog voted to be the "worst blog on the internet". My experience of her is that she is knowledgeable and suitably skeptical and always backs up her opinions with facts and logic and links to the relevant papers in reliable literature which she critically evaluates.

    Don't be sorry, as skeptics we are all here to learn from each other. Very few of us can be expert at everything ;). The key to being a real expert is to know your limits and not exceed them.

  96. Well, leave it to you guys to undermine my last remaining holdout anti-establishment view. :)

    I think that there are valid criticisms of how many (not all; mine was fantastic) hospitals deal with women and sharing of information and supporting things like breastfeeding. Not that that justifies misleading people or ignoring evidence to hold on to a strongly held belief. And I certainly don't want to get into the whole homebirth thing here… ugh. I've already had a public flogging on that topic that I'm not about to repeat. :)

    Live and learn.

  97. I don't dispute that a successful home birth may be more emotionally satisfying that a successful hospital birth.

    As a father the two most important things for me were the health of my child and my child's mother (not in any particular order). Everything else is so far down the list that I have trouble considering it.

    My mother was an RN CNM who did deliver babies out in the backwoods of Kentucky in Frontier Nursing. All of her children were delivered in a hospital. I don't think she would have ever considered a home birth were a hospital birth available.

    I agree that there can be difficulties associated with stress and agency in hospital births. My children's mother (now ex) did have some with our first child. I don't know how best to deal with those issues.

  98. daedalus,

    My wonderful hospital birth experience was actually with a CNM and a staff doula. The midwives group was part of the hospital staff, and you could choose to see them rather than an OB provided you were considered healthy enough. For us it was the best of both worlds. I think that model is a good start (though with a mindset much like those who are opposed to vaccines, many in the homebirth community see this model as a "front" for a medicalized birth that co-opts the midwife model. I see it as a legitimate attempt to provide a different model where women can be more involved partners in more individualized maternal care, though with all the modern medicine and backup care you could need if things do go wrong).

  99. I came across this blog, while searching for something else as it related to a measles outbreak a few years ago in another developing country, and finally got through everyone’s posts. Very entertaining reads! I think people in favor of cumpulsory vaccination need to be completely aware of the fact that disease outbreak has been demonstrated in 100% vaccinated populations of the herd. In the case of measles, it has been published that when vaccination rates rise to certain levels that measles in fact becomes a disease of the vaccinated:

    http://archinte.ama-assn.org/cgi/content/abstract/154/16/1815

    I am actually very much in favor of the original concept behind inoculation, but when the mad scientist took over – that’s where I have far too many questions that I can’t seem to get any answers to. My issues relate to lack of testing for carcinogenicity and genotoxicity. Many commerical viral vaccines are cultured on foreign cells, and are permitted to have up to 100,000,000 functional lengths of DNA in a SINGLE vaccine dose. In 1983, kids got 10 now they get 36. In addition to the foreign cells, in order for the virus to survive it needs to be nurtured – this is commonly done with calf serum (media), also not tested for its own contamination ie: pestivirus etc… Then you have the issue of immortal cells, which have no limits on how many times they can divide (the very nature of cancerous cells)… It feels like a huge genetic experiment with unknown consequence, we’re just history in the making.

    Mortality from childhood diseases were declining well before the introduction of the vaccine, in some cases mortality rates decreased by 90-95%. Granted, this doesn’t address disease incidence – but I’ve not been able to find any reasonable data to measure, so I stick with mortality rates.

    When you research the term herd immunity, it will take you back to the early 1900s where it was used when the phenomenon occurred among cattle. As the disease spread through the herd, the cattle mounted an immune response naturally and drove out the disease. I don’t understand applying this term to society, considering the immunity that is conferred by a vaccine is artificial – and one dimensional. Stimulating the humoral immune response indeed creates antibodies, but disease outbreaks occur in vaccinated people – so that means very little.

    http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11587808&dopt=Abstract

    Anyway, I didn’t come here to stir up a brew haha. I respect everyone’s decision with regard to vaccination. I don’t have an irrational fear of disease though, so I’m perfectly fine being around whoever in whatever state. I just want people to realize that there is an underlying safety issue that has FAR from been addressed, and who knows what the consequence may be.

    So, for now – I think I’ll be passing on the bovine DNA into my genetic heritage until I know a bit more.

    Cheers.

  100. Unherdof, herd immunity refers to the phenomenon whereby the unimmunized child is protected from the contagious child by a wall of immunized people who do not become vectors for the disease. Next, people who have been immunized and then get the disease have a much milder form of it. Four years ago, I got the flu after having gotten the shot– it lasted a day, and I was ambulatory and functional the entire time. A friend of mine who got the flu when he was living by himself was so ill he had to crawl around the apartment .

    “Mortality rates were declining” ignores a couple of facts: 1) They declined precipitously after the introduction of vaccines; you would have needed millions more dead babies and kids to happen before arriving at a population with a naturally-induced level equal to that produced by immunizations. And 2) Mortality rates aren’t the only thing to measure by; you have to look into side effects, such as rates of measles-induced meningitis cases of lifelong palsy or polio-induced paraplegia.

    I think the reason you can’t find the answers you want to the issues of carcinogenecity and genotoxicity is that there is no data that suggests there is a link. Researchers for years have been looking at possible causes for cancer; I can’t imagine that they would have failed to latch onto a possible link that might earn them an award in the field of science. Look at how much mileage has been generated with the unproven yet undead autism/merthiosol or fluoride/brain cancer flapdoodles.

    With hundreds if not thousands of would-be Nobel Laureates looking for their particular brass ring in biomedicine, it’s inconceivable that absolutely everyone has overlooked the possibilities of carcinogenicity and genotoxicity. I think you can safely turn your attention to other fields of investigation. Good luck in letting go of this one..

  101. That was not the original context of the term, is’t been retrofitted. I don’t disagree that people who are vaccinated get a milder form of disease, but they still get it. I think it’s a bit misleading for the circulars to state they are 90% effective, when they clearly only demonstrated antibody production NOT disease prevention [for ethical reasons I realize this will never occur, I find that a bit too convenient].

    The pharmaceutical industry is publicly traded, it is certainly conceivable that interests can prohibit research into areas of vaccine safety.

    Why would someone overlook the possibility of mutagenesis when the production protocol allows for what it does? 10(8) foreign cell source DNA lengths in a single vaccine dose… wow, just wow.

    BVD has been isolated in 20% of the commercially available calf serum (PMID 1655059). And then there’s nanobacteria, to which more than 80% of calf serum contains. This pleomorphic bacteria escapes most filtering processes, and a human variety of this pathogen has been associated with many neurodegenerative diseases. The medical literature also documents cross contamination of cell lines, so I find it rather convenient it is not tested for carcinogenicity when everything else under the sun is…

    I’m sorry, but the burden of proof is not on me.

    Cheers

  102. Unherdof, there are people out there who will say, “Why give our kid the shot when Unherdof says he’s probably going to get the disease anyway?” I know that’s not what you probably mean, but you are helping some really handicapped people remove their offspring from the gene pool. Maybe you should get a ribbon for that service!)

    Don’t underestimate the difference between the full-blown disease and the better-resisted one; that’s why they are in a milder form.

    And it sounds as though you’re in a prime position to find some funding and investigate it yourself. There’s probably some money floating around out there that can be put at your service. Good luck.

  103. Hmmm. I thought I replied, lemme try again. I do understand the difference, however – it’s hardly been scientifically demonstrated and most of the surveillance reports involve only “questionnaires” so that’s barely a clinical diagnosis. In most cases, it’s those with the most memory cells that fare the best and there is no evidence that vaccines are responsible for their production, in fact there is more that the cell mediated response stimulates the same immunological memory. Anyhoo,

    as far as investigation… I would think that’s the responsibility of the vaccine maker before rendering the product 100% safe and effective, but that’s just me. I’ll leave the last word to you,

    Cheers

  104. Nope, I’ll have to leave you with the last word “Memory cells” is something I haven’t heard of with immumizations; it sounds like a level deeper than I’ve plumbed.

    And if, like me, you don’t have the gift of charming foundations out of moolah, I guess we’ll have to leave it up to the manufacturers and their regulators.

Leave a Reply

Close