The Unforgiving Math That Stops Epidemics
quantamagazine.org
quantamagazine.org
If everyone else is immunized to the point where there is significant herd immunity, but immunization has a low but non-zero cost (e.g. feeling crappy for a few days), then the rational selfish action is to be a free rider and not immunize.
However, if everyone did that, then herd immunity can collapse down to a level where there is no herd immunity; people rationally choose to immunize only to protect themselves. However, given that immunizations aren't perfect shields, in that scenario, even immunized individuals will be at risk to infections spreading through the population.
"Determining the R0 of a particular microbe is a matter of more than academic interest. If you know how many secondary cases to expect from each infected person, you can figure out the level of herd immunity needed in the population to keep the microbe from spreading. This is calculated by taking the reciprocal of R0 and subtracting it from 1. For measles, with an R0 of 12 to 18, you need somewhere between 92 percent (1 – 1/12) and 95 percent (1 – 1/18) of the population to have effective immunity to keep the virus from spreading. For flu, it’s much lower — only around 50 percent. And yet we rarely attain even that level of immunity with vaccination. ... The calculated R0 of the West African Ebola outbreak was found to be around 2 in a 2014 publication, similar to the R0 computed for the 1918 influenza pandemic based on historical data. "
All of you ladies and gents who blow off your annual flu vaccine because "you just don't seem to ever catch it" - you're just lucky. It's only a matter of time with modern travel and climate change until another virulent strain hits.
Even if you do get the vaccine, there's no guarantee that it will actually include your new virulent strain. The flu vaccine is more involved (and uncertain) than others because influenza has a high mutation rate. It's a bit of a guessing game each year as to which strains should be included, and new ones crop up all the time.
True, for reference look at this table from the CDC: https://www.cdc.gov/flu/professionals/vaccination/effectiven...
2011-12: 47% vaccine effectiveness
2012-13: 49% vaccine effectiveness
2013-14: 52% vaccine effectiveness
2014-15: 19% vaccine effectiveness
2015-16: 48% vaccine effectiveness
2016-17: 42% vaccine effectiveness
Vaccine ineffectiveness is the odds that when you are potentially infected by a wild flu, the virus that you encounter was one that you were vaccinated against.
Vaccines are more effective when they correctly predict what varieties of flu will be circulating. But the more effective the immunization program, the more the ones that they predicted become and the less effective the vaccine becomes. However we all benefit because less flu is in the environment.
That's not true. There is a significant portion of the population who are resistant to the flu.
I'm 34 and I've never had the flu. None of my 3 siblings, nor my mom (who's 55) have either. This is despite never getting a flu shot, and spending several years riding public transit.
It's well documented that many people just don't become symptomatic or even contagious. A study in 2011 infected 17 people with live active flu virus, and only half developed any symptoms at all. Furthermore, it's likely that people with this immune response never develop the viral load necessary to easily spread the virus.
That's fascinating. Do you have a link to the study?
Then I started having 2-3 serious illnesses—very bad colds, the flu, sinus infections (I'd never had either of those last two)—every single year, and my nose is a little bit stuffy 100% of the time. 360 days a year, before, I couldn't blow my nose at all even if I wanted to—nothing would come out—but now I can a couple times a day, every day, when not actually sick.
Aging sucks and/or HGH is a hell of a drug.
That's definitely not just a result of being over the ripe old age of 22.
After a year of that I had my tonsils out and suddenly I just didn't get sick anymore. I think in the 15 year period since I've maybe been sick twice (and not nearly as heavily).
Sure, call me selfish, but it's just not worth it for me.
Now, if I have to go get it, or pay a $200 fine or something - yeah, I'll suck it up and go do it.
In an ideal world, all those who opt out should have to pay the medical expenses of those who get sick. Not vaccinating is the same sort of negative externality as environmental pollution.
Rather than making it a fine, a high opt-out fee could cover it without the stigma of "breaking the law".
Under your logic all those who eat fast food for lunch everyday and don't exercise should have to pay extra for medical insurance for not taking care of themselves.
Err, that's exactly what happens. Your premiums would definitely be higher if you live a riskier and less healthy lifestyle because you would require more costly health care at a younger age.
And as another poster pointed out, we're now also coming around to the idea of disincentivizing poor food choices for the same reasons, like taxes on sugary drinks.
So this is not "my logic", but in fact the prevailing logic of most people.
Edit: I mean everyone thinking "well someone else will do it, I dont have to", specifically regarding to paying taxes or contributing to society.
Not an advocate of communism as a whole but it is an interesting mention that it would if applied by an aggressive state actor go a long way towards eliminating certain diseases assuming it has the financial resources.
What existing communist communities are you thinking of?
To be clear, it's a critique of what someone else wrote about what he wrote.
> What existing communist communities are you thinking of?
I'm thinking of, for example, cultures that are based on gift economics. The most well known example is the practice of Moka exchange in parts of Papua New Guinea [0]. Other examples abound in anthropology. A light read that specifically tries to outline systems of human existence outside of capitalism is Fragments of an Anarchist Anthropology [1].
But what Marx would have been very familiar with because it had only recently been abolished is the commons that was used by peasants for thousands of years before the early capitalist states completed the process of enclosure which violently converted those common lands into private holdings. Marx actually does a poor job of describing pre-capitalist economies but he didn't need to-- he only needed to analyze them to determine the origins of capital. The concept he came up with is primitive accumulation, which is the process by which the class structure of capitalism originated [2].
The main point I was making is that human systems outside of capitalism exist. Marx doesn't need to make that case. In particular, he doesn't need to explain how to run a communist society in order to demonstrate that such a development proceeds after capitalism. He does this by examining how capitalism reproduces itself, and then he uncovers the contradictions within that reproductive process to predict what will happen when those contradictions become untenable. The main thrust is that capitalism is founded on a system where surplus value is expropriated by the owning class from the working class, and Marx's work is an analysis of how this determines the dynamics of capitalism. In particular, Marx predicts communism is what succeeds capitalism because he expects the resolution of this class conflict to be the abolition of class as a whole and the democratic management of the means of production.
This is a bold thesis, and certainly one that can be attacked. I just had a conversation at lunch about the ways in which Marx's analysis was incomplete or flawed, though he was impressively prescient considering how much mind-boggling technological and societal transformation that has occurred since then.
One needs to also understand that Marx was trying to explain in a scientific way the social unrest of his time. The history books they use in schools, unsurprisingly, undersell just how tumultuous and violent the rise of capitalism was, and how often it was in crisis.
From your link:
> Just as, a dam having been removed, a river will eventually reach the sea somehow, so capitalism having been removed society will eventually reach a perfect state of freedom and cooperation.
This is the same kind of error that is made when people reason about evolution as if it were a volitional process. Marx is describing the long-term behavior of the entire socio-political system. He's not making a deontological argument. His arguments are that the very same mechanisms that reproduce capital day after day lead to its instability and, ultimately, its transformation into a new system that has resolved its inherent contradictions (but it also, that new system will have its own contradictions that are unforeseeable).
> I am starting to think I was previously a little too charitable toward Marx. My objections were of the sort “You didn’t really consider the idea of welfare capitalism with a social safety net” or “communist society is very difficult to implement in principle,” whereas they should have looked more like “You are basically just telling us to destroy all of the institutions that sustain human civilization and trust that what is baaaasically a giant planet-sized ghost will make sure everything works out.”
Well, ok. So, funny enough, the theoretical justifications for the welfare state were based on Marx's theory of historical materialism. Even Marx's critics since his time have had to incorporate historical materialism into their framework, even if they don't admit it in those terms. It's also the case that a historical materialist analysis of society is an epistemological tool which can be used for or against capitalism.
The slatestar dude is pretty decent when he talks about psychology. I think he is an arrogant fool when he so confidently dips his toe into serious philosophy. Like, there are far, far better criticisms of Marx than this. This wouldn't even pass muster for an undergraduate student.
[0] https://en.wikipedia.org/wiki/Moka_exchange
[1] https://libcom.org/library/fragments-anarchist-anthropology
[2] https://en.wikipedia.org/wiki/Primitive_accumulation_of_capi...
In a culture that didn't have the notion of private property, what would a "gift" mean?
1) There was now a class of people that owned most of the resources necessary for a human to survive by their own work.
2) There was now a massive class of landless people who could no longer sustain themselves through their own work of the commons that now needed jobs.
This is the sort of system of property that is strongly associated with capitalism that need not exist in other cultures.
Not in general because the decision often depends on the will of few people in those regimes and those people are not necessarily enlightened as the history prove it.
Yeah possibly. Everyone would be immunized. But then they'd die of hunger waiting in a bread line or in a labor camp somewhere if they said the wrong thing to someone.
At least by school age here is what they did - they'd come to school, call each classroom by age to the nurse's office. They'd be a visiting nurse with a https://en.wikipedia.org/wiki/Jet_injector or vials of oral polio vaccines and you'd be immunized no questions asked. Not even sure if they sent a note to parents or how they even recorded it happened.
So they did that pretty well. Many other things like like economy, freedom of speech, not so much.
Very prevalent. One could argue that it was the reason for the downfall. "Why should I work harder if the corrupt state will just take away my profits and ideas etc. I'll just lay low and let someone else do the work, and still get paid the same amount".
But you gotta give to the devil what belongs to the devil and they provided free government housing, pretty good schools, and basic medical care. Oh and a cool space program and pretty fast industrialization, up until the 60s or so, at least. All the other stuff was rotten and corrupt to the core. It is surprising it even lasted that long.
But, it's a spectrum. It's left it right and a varied distance from authority. You have some libertarian principles. Well, I presume you do.
This does not imply that we must (or more importantly, can from a moral perspective) force people who do not want children to have them anymore that it implies that forcing people who do not want flu shots is the right thing to do.
Except that's not really how it is. There's still a very non-negligible risk to catch any of a number of vaccine-preventable diseases. People die from measles on a regular basis.
You can in theory imagine a situation where this is different, but realistically Vaccines totally make sense even from a very egoistic perspective.
Healthcare is a provincial responsibility in Canada
if people tend to do something because it's easier for them but that will come the long way round and bite them, and a lot of other people, in the end then that's a demonstration of a failure of human to be rational.
We do need to draw distinctions between consequences that are immediately faced by the decisionmaker, vs. the long-term consequences to the group.
Note that even if you do care about the long-term consequences to the group, it may still be narrowly rational to decide not to immunize. After all, your own individual decision is only going to have a tiny impact on whether herd immunity persists in your community, but will have a much greater impact on yourself.
This is the same logic over why companies pollute, people litter, fishermen overfish -- there is a 'commons problem' where people collectively benefit from collaboration, but selfish individuals can benefit by defecting and free-riding.
If one can't see how selfish behavior may appear rational, then it becomes very difficult to figure out how to structure norms and incentives to encourage group cooperation.
How far might we go in the pursuit of perfect immunity? Some contagions have no vaccine, will we require masks at all times? Will we criminalize handshakes? At some point, the benefit of immunity is outweighed by what you have to pay for it.
I guess I sound like an antivaxxer here. I probably sound like a Nazi elsewhere. All I am though, is pro-liberty.
Issues in life are not simple binary choices. We have to think about balancing individual goals, societal goals, national goals, and global goals. I'm of the opinion that we should err on the side of individual liberty, but when the evidence is so overwhelmingly positive to be pro vaccine, then obvoiously we might have to re-arrange our priorities.
It's be especially good if the payout was perhaps $2 to get it but $5 if more than 50% of the pop in an area got the shot. Maybe manageable with an Etherium contract?
Further, in effect insurane companies do pay their customers to get the flue shot, because they pay full price for the shot, but some distributors (like CVS) offer a discount on unrelated purchases for getting the shot.
I think the solution here is government provided shots. Even without going to full government healthcare, vaccinations seems to fall well withing the CDC's perview. And, due to the herd immunity factor, there is a general societal interest in people getting vacinated (beyond the costs on society of a person getting sick).
1) Insurance company has customers that don't get vaccinated
2) Insurance company pays for vaccinations of uninsured people
3) Uninsured people don't get sick
4) Uninsured people don't infect their unvaccinated customers
5) Insurance company has lower payouts because their customers don't get sick as much
From a financial point of view, this probably only makes sense if the cost of the vaccine is significantly lower than the cost of care of someone who catches the flu.
Society wide health improvement schemes like this generally hurt insurance company's profits since their profit and administrative overhead costs are capped to a percentage of the cost of their insurance plans[0]. One of the problems with healthcare in the US is that not many of the players are incentivized to improve costs. Industry wide inefficiency just means the insurance industry's 3% (or whatever) profit margin is larger in absolute terms.
[0]: https://www.healthcare.gov/health-care-law-protections/rate-...
If a statistical fluke or some sort of weird event caused far fewer people to file claims, but the insurance company is already collecting the money from employers and planholders, what would happen?
The upshot is that the public doesn't necessarily perceive the benefit of the shot because a) they might get what they think is the flu (but isn't) and b) they might get a variant of flu that was not adequately covered by the vaccine. Obviously a more universal flu vaccine would help out a lot.
I wonder if this applies more broadly: if you're already immune to one disease, it would be reasonable to expect that your body has more energy left to fight any unknown diseases it comes across.
[0] https://www.newscientist.com/article/dn27481-measles-leaves-...
"The Demon in the Freezer" goes into the story of the eradication of Smallpox in the natural world, and talks a lot about containment of viral breakouts as well as the role of vaccination.
So I'm still not convinced about flu shots. Other vaccines, like measles, are clear win, of course.
https://www.cdc.gov/flu/professionals/laboratory/genetic-cha...
We don't get the flue vaccine for herd immunity and never have. I've never heard this argument from health departments or doctors.
This article seems to be confusing issues.
If the flue vaccine does help others they need to start publicizing that if it's true. If they are trying for heard immunity they also need to publicize that.
I don't watch ads but if people can link to any that claim this I'd be interested. If it was true then the vaccine sellers would be shouting it from the roof tops I would think.
We know that influenza is different from other viruses because 1) There are many strains of influenza, it has a high mutation rate 2) Flu vaccines are based on a forecast of likely strains and typically cover only at most 50% of the strains in a given year [1]
Now let us make the following assumption - Actual flu infection boosts immunity after recovery from the infection compared to vaccination (perhaps an analogy would be how muscle recovery happens after microtears after a strength training workout with heavier weights).
In which case, one might conclude - Since a stronger immune response is great against a fast mutating virus and around 50% of strains are not covered by vaccines anyways, that the benefit of boosting immune response against future infections (beyond the current year) outweighs cost of getting infected and is a better choice than getting immunized against 50% of the strains with increased chances of getting flu due to the other 50% anyways
Assumption 2 - Getting exposed, but not infected by flu, increases the number of strains one's body is immune to. Something sort of like vaccination, but without taking the vaccines themselves.
For the purpose of modelling, let us also make the assumptions that all strains arise and propagate independently. That is the strains not covered by vaccination expose the same number of people unaffected by herd immunity, while the strains covered by the vaccination face herd immunity.
Now consider the strains covered by the vaccine, whose spread is reduced due to herd immunity. It is great for everyone vaccinated against the strains, but for people not vaccinated against it, it prevents exposure from and hence immunity. This might be a case where the utility of vaccination decreases for non-vaccinated individuals instead of increasing (herd immunity) as a function of the fraction of vaccinated population. In other words, the more people vaccinated for flu, the less likely an non-vaccinated person is to get exposed, the less likely is he/she to develop immunity towards those strains naturally. Thus this would prevent population level immunity from arising, where it would have arisen naturally.
Note that in this scenario, one might question that in the natural course of events, a certain percentage of population will develop immunity anyways and hence become equivalent to the scenario where some part of the population is vaccinated. However there are three major differences. First is that there is a certain delay between getting infected, spreading to others and gaining immunity. Thus for the same percentage of immune population, there might be larger population exposed in the natural course of events. Second is that many individuals might get infected, transmit and immunized to a strain without getting infected, thus such an individual gets all the benefits of vaccination, but might help others get exposed and immunized to a strain. And third that vaccination is more aligned with socio-economic factors while infection less so.
To conclude, if any of the two assumptions I state are true, then we should perhaps not blindly apply the same logic that applies to other viruses for which we have vaccinations.
Then, for me, I worry about the adjuncts and other stuff added to the standard vaccines as I have autoimmune problems. There are alternative vaccines that are available but I don't remember their efficacy.
So I refuse taking vaccines unless absolutely necessary until I see viable alternatives without aluminum, any kind of mercury, and so on.