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Comment by asdkhadsj | Hacker News Reader

Tangent: The headline brings up an interesting thought.. I wonder what anti-vaxx people will do when a new scary virus emerges. Something actively and aggressively flying through the population.

So much of the anti-vaxx mindset is supported by herd immunity. But when a scenario finally happens where herd immunity is compromised.. It'll be interesting to see how the vaccination discussion plays out.

edit: The downvotes must indicate that this is too off-topic, so sorry for the post :). I just had the thought and wanted to see your opinions on it. Appreciated.

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I'm involved in a study of vaccinations. One good thing I'm seeing is that many peds clinics, if you are a pure, down the line anti-vaxxer, will politely ask you to choose another provider.

How does this go, usually? They ask you to choose someone else then decline future appointments?

Have you seen anything similar for urgent-care clinics?

I don't see this in urgent care. I am talking about peds. You bring your newborn in, but start refusing vaccinations. I have spoken in person with over a dozen clinics who categorize themselves as "no-refusal" clinics. They will medically defer, and in some cases allow refusal of STD vaccines. But a person who just doesn't want vaccinations will likely be disenrolled from the register.

That's an interesting moral problem. I don't begrudge those clinics their choice. Maybe they think they're protecting the other patients in the waiting room.

But what would you think of a doctor who declines to treat an alcoholic because the alcoholic persists in his drinking? Does a doctor have a duty to care for people regardless of their actions?

I'm not a doctor, I just study their data. But I think from what I'm hearing, they've made what they think is the most moral choice. Vaccines have very specific age ranges, and if they continue to see a patient without giving them the vaccine, I think they've decided that that interferes with their do no harm.

I agree that pediatric practices refusing service to no-vaxers is the norm in the US.

I've have a few friends who range between full on anti-vax vs being skeptical of one or two, and I’ve heard a few stories.

It seems that a parent asking for their child to not receive one or two of the 20-50 vaccines the pediatrician gives by default has about a 50% chance of being kicked out of the practice. As you said, asking for no vaccines is about a 99% chance.

However, pediatricians have a racket where they will not accept a new child (unless they moved to the area) unless they saw the child within a week of its birth. Thus, when you get kicked out, you are out. You can't see a pediatrician anymore unless you drive 80 miles to sketchy 90's new-age pediatrician in a dingy strip mall, and you can't get any more vaccines unless you go on the correct afternoon of the second week of the month to a government clinic in the part of town with litter and shootings.

This has pushed several people I know into not getting further vaccinations when they were getting 95%.

Maybe it's just our area, and the whole US isn't doesn’t have pediatric practices like this...

I can't say I've actually heard this being a thing in my part of the country. However, you mentioned the following:

> (unless they moved to the area)

Why not just lie and say you just moved to this part of the city/town/state? The only downside is that they'll ask about previous records which could get you caught.

And further, what would be a potential reason for refusing to take care of a patient if you didn't follow them from week 1? I honestly can't think of one besides continuity of care.

I'm guessing it's a malpractice concern. All kinds of things can happen in the first week that aren't visible until a few years later. Who's to blame? The pediatrician who has been taking care of the child for 99% of their life... except for the first critical week...

Not sure I understand. If you're even less likely to be at blame since you weren't even there for those "critical" days, I would imagine there'd be less liability.

"Why not just lie"

Some people care about being truthful. ;)

"What would be a potential reason for refusing to take care of a patient if you didn't follow them from week 1"

It's something like the Apple/Google/Adobe/Intel agreement to not hire each other's engineers. It gives one group more power by making the other party in the relationship have worse options if they leave.

If you leaving your current pediatrician means having no pediatrician at all, then the all of the pediatricians in the town benefit. Each can use it as a threat for compliance, force appointments, or have more room to act in ways that parents/patients don't like.

Is the refusal to care in relation to a parent not wanting their child to be vaccinated, or solely due to not having been the primary care provider since birth?

Edit: I guess my reasoning for this question is based on new guidance from the American Academy of Pediatricians regarding refusal of care to those who refuse childhood immunization. I can't say I agree with that sentiment, and I would also argue that the majority of pediatricians in the US do not refuse care to families who refuse immunization. Why? Because it makes far more sense for a physician to continue to follow up with patients to continue recommending they get immunized. I assure you that most doctors, including pediatricians, don't want kids to die, so most don't refuse care just cause of a family not wanting to vaccinate their kid. It's unfair to a kid that likely doesn't have the competence or capacity to make decisions for themselves. I can't speak towards any pediatrician refusing care, or their reasoning, because I literally have not met one that does.

Edit 2: here is some explanation from the AAP as to when they would recommend dismissal of a family. Note that they specifically note that dismissal should be "a very last resort".

In our town at least, all of the pediatrician practices that I know about, will not accept a child either did not start with them as newborn, or who moved to the town. This is handled by the front desk, before any discussion of care or vaccinations.

At least one pediatrician in our area will also dismiss your child as a patient if you do not schedule something approximating their recommended appointments schedule with them.

I agree 100% with you that refusing to care because of vaccination choices should not be done, and that it does harm the cause of vaccinations. (That's the point I was trying to get across in my original post.)

Hmm, that's weird then. I can see how a pediatrician would stop accepting any new patients, if they are totally booked, but not these criteria.

Healthcare in general in our small city is fairly messed up. I'm glad to hear this kind of thing isn't as widespread as I thought.

They'll double down and blame the government for the ensuing deaths.

It's God's Will until it happens to you.

Maybe this is too off topic for here but I have always wondered why people are so angry at Anti-Vaxx people?

Yes... the compromise our Herd Immunity, but don't they also serve as a "Canary in The Coal Mine", risking their own health so that the human genome can keep battling with and evolving natural defenses against disease?

  risking their own health so that the human genome can keep
  battling with and evolving natural defenses against disease?

Diseases evolve orders of magnitude faster than humans. Giving ourselves a chance to evolve also gives the disease a chance to respond and they will always find ways around our defenses faster than we find defenses. Remember, the usual result of failing to complete a course of antibiotics is a new strain of antibiotic-resistant bacteria. Leaving a reservoir of a disease that we have a vaccine for is far, far more likely to result in a new strain of that disease that can bypass the vaccine.

Additionally... what's the point? Any disease that has a voluntarily unvaccinated population also necessarily has an effective vaccine. The development of a effective vaccine equally necessarily indicates that developing vaccines is easier, faster, and better than attempting to evolve defenses. Why try to go back to evolution at all? The existing vaccine works. If it stops working, make a new one. No need for these ad-hoc primitivist schemes.

Society generally takes a dim view toward people who endanger others through ignorant recklessness.

Because they aren’t the canaries at all. Instead they volunteer their kids (and the kids who interact with their kids) as the canaries.

Furthermore, they risk infecting others who, through no fault of their own, rely on herd immunity. Such as those who due to allergies cannot take a certain vaccination, or who did take it but it was ineffective. Herd immunity protects more than just the ignorant.

Young child affected by leuchemia can't go to school nowadays in Italy, because they risk being infected by anti-vaxxers'child and risk their life

People are angry at them because the herd-immunity they are compromising is the only thing keeping certain members of our population alive and healthy. There are some people who, for various reasons, CANNOT receive vaccinations. Not WILL not, or DO not, but CANNOT. When herd-immunity is compromised it's not just the anti-vaxxers children's lives that are at risk, it's everyone who doesn't GET the choice to vaccinate or not that are more vulnerable to disease since it can now spread through the population more easily.

It’s not just that. Some vaccines are less than 100% effective. When everyone is vaccinated, the disease generally doesn’t spread. When enough people aren’t vaccinated, the disease can spread to some fraction of vaccinated people as well.

Vaccinations are not always effective, nor are they permanent. They are a statistical firebreak against an epidemic. Think of vaccinations like transistors. They are modelled as 1 (vaccinated, won't get sick) or 0 (unvaccinated), but that's not the reality. The reality is very few people have an immunity level of 1.0 (won't get sick) on that scale even after vaccination, and some of those who do seem completely immune are that way because their immune system is particularly good at making a particular disease asymptomatic, not (necessarily) because they were vaccinated.

You can still get infected even if you were vaccinated recently. Many vaccinations lose effectiveness after a decade or two at most. Most adults (who are less affluent/wealthy or who don't travel) don't get re-vaccinated for most things because they're at lower risk. The highest risk is in places like preschool, daycare, grade school and college with lots of people in close proximity, and some poor hygiene mixed in.

And hospitals and doctors offices.

Anti-vaxx parents put everyone else at disproportional risk, because children are a prime infection distribution hub for all kinds of contagious diseases.

Because they are not just risking their own health.

I am not a doctor, but my understanding is there is a small bug significant number of people who cannot get certain vaccines due to e.g. immune system issues. "Herd Immunity" through a highly-immunized population generally protects these people because there are fewer reservoirs for a given disease.

Edit: The reason people are mad at anti-vaxxers: their foolishness directly impacts the welfare of some already unfortunate folks.

Am a PhD, and you are correct. These people are however in the minority, and its important to ensure that people don't use this fact as false justification for not getting vaccinated.

They don't just endanger their own health, they endanger us all. Some people can be carriers but not be symptomatic for a pathogen, so they can be walking around spreading a disease like measles but not even know it. With high herd immunity this is not much of a problem because almost all of the people with whom they come into contact will be vaccinated and not catch the disease before the carrier's body eventually fights it off, but with low herd immunity they become a major problem.

If humanity has not evolved a natural defense to these diseases after thousands of years it is not going to happen by some anti-vaxer volunteering to be an evolutionary petri dish. Actually, now that I think of it, humanity has already evolved a defense against these diseases -- by evolving a big brain it figured out how to develop vaccines...

Anti-vaxxers threaten the lives of not only their own children but the lives of others. There are people that legitimately cannot be vaccinated due to deadly allergies or reactions and the selfish behavior of parents who refuse to vaccinate their children puts them at severe risk. Herd immunity is important to protect people that have no other option and when people compromise it for the sake of perpetuated lies it results in disaster.

My mom is currently going through chemo for cancer. Her immune system is essentially zero despite being fully vaccinated.

You bet I get angry: anti-vaxx people are trying to kill my mom and there is nothing I can do about it.

They're not trying to kill your mom. That may be the effect, but it's not the intent. They're trying to have their kids not be autistic. (You can claim that the evidence doesn't support that as a possibility. But it's still what their intent is.)

That's like saying "I'm trying to make it dark by turning on the lights." You can;'t make excuses for them by saying that, even though they are recklessly endangering other lives, they're doing it under pretenses that are false, so it's ok.

I mean, people who attempt to pray away disease instead of seeking proper care has potentially good intent. But that doesn't make them any less negligent when their child dies as a result.

There’s a research paper out there where people who were prayed for had worse clinical outcomes then the control group.

Someone shooting a gun randomly in the middle of a busy shopping mall might honestly claim they just wanted to hear a loud bang - yet there is no reasonable way to say their actions won't kill someone. Therefore they are trying to kill someone despite their stated intention.

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