Infectious disease doesn't care why you're unvaccinated | Hacker News Reader

Infectious disease doesn't care why you're unvaccinated

sciencebasedmedicine.org

211 pointsRockyMcNuts227 comments

> Most people have not lived in a time of plagues or remember their effects. Most people do not read history or look at the morbidity and mortality of vaccine-preventable illnesses in the third world.

This is another great example of why people need to be taught actual history, not the version censored "for their young minds". The people who change curricula and edit textbooks to remove the unpleasant memories, or forward an agenda, do a disservice to everyone[1].

[1] http://www.huffingtonpost.com/2010/03/14/backstory-how-the-t...

I think people's own minds provide some of that effect. Firstly, secretly wondering if the numbers aren't being exaggerated for effect and that sort of thinking. Secondly, it's difficult to really wrap your head around a disease that killed a third of the population. It's so ridiculous it's hard to fathom.

Polio existed in the US within the memories of many people still alive.

Sure, but polio was virtually eliminated in America by 1980, and how old were today's non-vaccinating parents in 1980? Or 1953, for that matter- the year of the last polio outbreak?

The age gaps are large, but I remember my grandmother being debilitated by polio. She wore leg braces most of her life and had trouble moving around the few years I knew her (she passed in the 1980s).

There is no need to have witnessed polio directly to have a sense of the awful potential it carries. The whole idea of people living attached to ventilators should be enough for any quasi rational individual.

Well, 2 things:

1) At this point polio survivors really are pretty rare

2) Since polio is now a kind of historical gremlin ,you don't learn to fear it. Even if you meet people scarred by it, you have practically zero risk of contracting it.

Re polio: read "Splendid Solution: Jonas Salk and the Conquest of Polio", it tells the story of the fear that polio inspired and the public health efforts--including taking sick children away from their parents, forcibly if necessary--that it occasioned. Although not as widespread as the flu, polio was far more feared because of its seeming random occurrence and often debilitating effects on even its survivors.

I'm not one to call things miracles. But if I were, the progress of anti-microbials in the century to the 1950s would be the one. Vaccines, sulpha drugs, antibiotics... it's interesting that this wave of science-driven discovery is given such short shrift among the tech community, it has certainly (alright, arguably) made a greater difference to our species than any other thing we've done.

There are people still alive today that lived through the Spanish Flu. They are pretty damn old today and they were young then, but there are many more people alive today that lost immediate family members to it and many more that lost extended family members to it. That shit wiped out something like 5% of the world.

Yet even in this thread we see people who seem to think that flus are a laughing matter.

I hate that. The spanish flu killed my great grandfather at 28 years of age right of the boat and people tell me "flu vaccine is bs. Vaccines are bs. Flu is a bunch of shit. I'll do fine against any flu.". I don't know. The ignorance bothers me. Most of these people haven't even heard of the Spanish flu much less know it killed around 50 million people including plenty who were very fit, young, and healthy.

I am 40. I know only one person who had polio (as a child); a teacher of mine from my high school. I also saw an iron lung once, but it wasn't in use.

The sad thing is, one of the worst pandemics in human history is fairly recent: https://en.wikipedia.org/wiki/1918_flu_pandemic

There are (a few) people alive today who remember it.

It killed between 1.5 and 3 times as many people as the earlier WWI - but isn't as sexy as war, so hardly anyone studies it (relatively speaking)

Killing about 5% of the entire population of the world about 100 million people, just imagine now with seven billion if a flu outbreak killed 350 million people.

Even people on remote islands in the middle of oceans died from the flu.

That's amazing, that's more than the population of the United States.

> Even people on remote islands in the middle of oceans died from the flu.

Without contact from the outside world?

It was avian based influenza, birds spread it to remote areas of the world.

Also, the pandemic was made worse due to over medicating the sick http://www.sciencedaily.com/releases/2009/10/091002132346.ht...

I hadn't heard about this so I looked up the primary reference[1]. I'm not sure that high aspirin regimens (the overmedication you're referring to) would explain the high mortality of the flu outside the U.S.

Further, the author of the study cautions that this is a correlation that could be important given our changed understanding of aspirin toxicity and not a proven finding.

[1] http://cid.oxfordjournals.org/content/49/9/1405

Hell, it killed around as many people as WWII, including the Holocaust (wikipedia estimates for WWII being >60million, and estimates for the Spanish flu being 50-100million.)

Numbers that big become very difficult to actually fathom in a meaningful way.

That's about a 1/4th the US population. Wow!

I saw a kid with polio deformed legs a few months ago. Something that I have never seen while the immunization calendar was state mandated and I was young.

I have also never seen a case of autism.

In a few years we will have outbreak of something preventable. I just feel poor for all the kids that had real reasons not to get the shots.

A friend of mine after very bad Hodgkin was with compromised immune system for 10 years. He was constantly sick and popping antibiotics like tic-tacs. If the herd immunity was not so strong he would have been dead.

The stuff we vaccinate against is not harmless.

I would also recommend Ben Goldacre's "bad science" where he makes one of the best analysis of the MMR scare insanity and its origins and development. It is mostly the media's fault.

in a few years there will be an outbreak of something preventable

There's an outbreak of preventable childhood measles in England at this very moment

I think it's south Wales that copped the worst of it. 1,219 cases of measles, 88 hospitalisations and one death.

http://www.bbc.co.uk/news/uk-wales-23168519

National newspapers are very much involved. Journalists like to present two sides of the story as equal rivals for "balance", even when one side is science and the other is paranoid quackery. When it comes to public health, this is a disaster.

A family from my region went on a trip to Wales and both kids contracted measles and were sick when they returned. When the children were young the parents never had them vaccinated and now they're sick.

It was just sheer luck this happened when school was out, the school system here doesn't require kids to be vaccinated as most places in Canada require.

It's so easy for a stupid thing to escalate into a world-wide event all because of a few anti-vaccination idiots.

Same thing in the Netherlands. No surprise: all in the Bible Belt.

This is a map of the Dutch Bible Belt: http://en.wikipedia.org/wiki/Bible_Belt_%28Netherlands%29 , and this is a map of the epidemic: http://www.nrc.nl/wp-content/uploads/2013/06/ANP-23877900-56...

And just for clarity: these are areas with a low population density.

At least in the US, my impression is that vaccination refusal is more common among left-wing anti-corporate types than among fundamentalist Christians. It thrives any time there are non-rational beliefs, but it doesn't seem to be too picky about which kind.

One of the current big US measles outbreaks is church-related: http://www.npr.org/2013/09/01/217746942/texas-megachurch-at-...

My anecdotal experience among anti-vaccination people I've known is that they're only weakly correlated with religion or politics--leaning slightly left but still all over the map.

It is a conspiracy thing. Left or right wing conspiracy-minded people adopt it. Some people replace vaccines with "faith healing", others replace it with new-age shit.

That makes sense. All of the above run strong in the rather new-agey community I grew up in.

Try lack of trust, or distrust in authority, it sounds better than conspiracy. Some replace vaccines with fear of disease, and anger at the lack of a trustworthy gov't.

And possibly rumors of additives to vaccines (adjuvant - Squalene, Mercury, etc.)

I have been made aware anecdotally how may times profit is chosen over safety when critical decisions are made... It has lead me to question some decision makers about the actual priorities for their decisions...

20-ish cases is not what I would call a big outbreak. Some of those affected in Texas had received vaccinations, but for whatever reason[1], weren't protected.

[1] I guess they had either neglected to get a booster, were not scheduled to receive the full series of shots, or the vaccine's efficacy isn't what it is claimed to be.

>My anecdotal experience among anti-vaccination people I've known is that they're only weakly correlated with religion or politics

Here is another anec-data point for you. I'm not anti-vaccine, but I am more skeptical / cautious than most (we selectively decline / delay vaccinations). I am also Atheist. My impression is that the skepticism is rooted more in lack of trust in authorities, than religion.

Well ... it is simple math. If the vaccine is effective 95% (pretty good on its own) and you come in contact with 10 sick people you have a good 40% chance to catch it.

That is the whole things with vaccines - the herd immunity is as important in protection as the vaccine itself. It is virtuous positive feedback loop.

This is the part most people don't get, on either side. You're vaccinated? Not a magic bullet, you rely on others around you. Not vaccinated? You're putting others in danger, not just yourself.

A vaccine doesn't have to get anywhere near 100% protection to be effective - it just has to drop the viral coefficient below 1.

> we selectively decline / delay vaccinations

Interested to hear your justification for declining / delaying vaccine's, but not considering yourself anti-vaccine.

>Interested to hear your justification for declining / delaying vaccine

I'm interested to hear why a five minute old infant is at risk of contracting Hep-B. Our kids will get Hep-B before they start school. Even if one of our kids did contract Hep-B, it is pretty unlikely that they will be able to give it to your children.

Rota-virus vaccine was suspended by the FDA temporarily,[1] We opted to decline this one even after the suspension was lifted considering seriousness of intussusception[2][3] compared the very low incidence of death or serious injury by rota-virus infection in the US. Even though the suspension wasn't related to the earlier intussusception problem, I considered the incident sign of poor QC and/or a lack of respect for the FDA by the manufacturer. We would probably reconsider if we had plans for international travel with the children, even though our oldest has probably been exposed/infected. (a fun story!) (It sure would be nice if antibody testing were cheap and widely available).

Seasonal Influenza - Declined based on personal negative experience and systematic reviews of vaccine efficacy[4][5]. Every single seasonal influenza vaccine I have taken has resulted in a miserable two-week flu-like state. I have never had a case of the flu as that was as unpleasant as my reaction to the vaccine. I understand most people are not affected so negatively by the vaccine. After reading the Cochrane reviews on the subject, I am inclined to believe that the seasonal Influenza vaccine is an unnecessary and rarely useful product.

Not that I need to worry about it yet, but Cervarix and especially Gardasil seem to have low efficacy WRT to the (possible) risks of the vaccine, especially considering the prognosis for those that contract cervical cancer (women rarely die of cervical cancer). I also find Merck's relationship over the matter with my state's idiot Governor particularly aggravating.

So, basically, if the risk of contracting and or having the illness is low, and if it doesn't needlessly endanger others (like MMR refusal for school-aged children) then I am going to take a good hard look at whether we really need the vaccine.

>not considering yourself anti-vaccine.

Anti-vaccine means you don't allow yourself or your children to be vaccinated. Our children do receive most vaccines at the scheduled time. We have opted to delay or forgo a few vaccines. Lumping people into two opposing factions has had a very negative effect on the debate, as it tends to do in a debate on any subject.

[1] http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedP...

[2] https://www.ncbi.nlm.nih.gov/pubmed/22293889

[3] http://www.fda.gov/BiologicsBloodVaccines/Vaccines/Questions...

[4] 'Flu vaccine doesn't help elderly' http://www.ncbi.nlm.nih.gov/pubmed/20166072

[5] Please read the author's conclusions for this one. 'Vaccines for preventing influenza in healthy adults.' http://www.ncbi.nlm.nih.gov/pubmed/20614424

"I'm interested to hear why a five minute old infant is at risk of contracting Hep-B. "

Because a baby whose mother is infected with Hep-B can be infected at birth, it's estimated that only 50% of the pregnant women who have Hep-B are identified, and babies can get Hep-B from other family members and caregivers.

See http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf for the full details, but here are two relevant passages:

> Even with improvements in the management of pregnant women, only approximately 50% of expected births to HBsAg-positive women are identified (on the basis of application of racial/ ethnic-specific HBsAg prevalence estimates to U.S. natality data) for case management, which maximizes timely delivery of postexposure immunoprophylaxis (11; CDC, unpublished data, 2004). The need for proper management of women without prenatal care, including HBsAg testing at the time of admission for delivery and administration of the first dose of vaccine to infants <12 hours of birth, is underscored by the higher prevalence of HBsAg seropositivity among these women than among women who are screened prenatally (12). Even when maternal HBsAg testing does occur, certain infants of HBsAg-positive mothers do not receive postexposure immunoprophylaxis because of testing errors and lapses in reporting of test results (13), and infants of women with unknown HBsAg status at the time of delivery often do not receive a birth dose of vaccine (14).

> Children who are not infected at birth remain at risk from long-term interpersonal contact with their infected mothers. In one study, 38% of infants who were born to HBsAg-positive mothers and who were not infected perinatally became infected by age 4 years (64). In addition, children living with any chronically infected persons are at risk for becoming infected through percutaneous or mucosal exposures to blood or infectious body fluids (e.g., sharing a toothbrush, contact with exudates from dermatologic lesions, contact with HBsAg-contaminated surfaces). HBV transmission rates to susceptible household contacts of chronically infected persons have varied (range: 14%–60%) (65,66). High rates of infection also have been reported among unvaccinated long-term residents of institutions for the mentally handicapped (67,68), and, in rare instances, person-to-person transmission has been reported in child care settings (69,70).

Also, the vaccine is made from virus capsid protein expressed in Baker's yeast. There's no infectious material at all, making it a very safe vaccine. (Unlike the earlier Hep-B vaccine which had a danger of including viral DNA should something go wrong during purification.)

>Because a baby whose mother is infected with Hep-B

Well, we didn't elect to deliver in the back room of a whorehouse, or under a tree on the prairie. We went to one of the best hospitals in the country, where blood tests are done in advance of delivery, where these things are discussed and planned as part of the pre-natal pregnancy care.

Wife and I are both vaccinated, and apparently Hep-B negative. I have to make sure my kids aren't raped by Hep-B positive child-rapists, which is sadly too common.

> There's no infectious material at all, making it a very safe vaccine.

You keep missing something from my posts. I don't doubt the science behind vaccines. You don't need to convince me that vaccines are practically a modern miracle. I lack confidence in manufacturers, and in fairness of the NVIC.

The document I linked you to, "Recommendations of the Advisory Committee on Immunization Practices (ACIP)", does not base its decisions on the number of childhood rapes by people with Hep-B, nor on the "number of babies delivered in the back room of a whorehouse." Why do you believe those are critical factors in the decision?

You seem to think that Hep-B is only spread through sex and drug use, and from the mother through childbirth. This is incorrect. For example, one of the citations in the above report was to http://www.ncbi.nlm.nih.gov/pubmed/2626287 . It seems some 30% of Hep-B infections come from unknown sources.

> We investigated two situations involving hepatitis B virus exposure among children in day care. In the first a 4-year-old boy who attended a day care center developed acute hepatitis B; another child at the center, who had a history of aggressive behavior (biting/scratching), was subsequently found to be a hepatitis B carrier. No other source of infection among family and other contacts was identified and no other persons at the center became infected.

Before the vaccine, some 24,000 children got Hep-C each year. That's down about 90%.

As to the "very safe vaccine", nothing in that last line was meant to imply that you needed any sort of religious faith in vaccines nor that you doubted the science. It was meant to explain why failures by the manufacturer are less likely to lead to severe adverse effects than with the older vaccine. This is an engineering consideration and not a science one.

The previous vaccine was only "safe", and not "very safe." The older vaccine started with blood serum from people who had Hep-B, and purified it so only Hep-B proteins remained. This has a risk of infection should something go wrong in the purification process so that the full virus - or other viruses - somehow get through. This sort of failure would be very risky for newborns.

But the current vaccine, which is based on a genetically modified form of Baker's yeast, does not come from human sources. Since human viruses aren't in the source material, they can't enter the vaccine. There can still be other failure modes, but the most fatal - introduction of virulent particles directly into a newborn baby - can't happen through a process failure during vaccine manufacturing.

Think also of the oral polio virus. This uses an attenuated virus, that is, a mutant form of the polio virus which infects the child, but doesn't cause the symptoms. The child's immune system produces the same antibodies at it would the wild-type virus, which provides immunity. The problem is, the attenuated virus mutates in the body, and it can mutate towards a form which is deadly. This happens about once every 750,000 cases.

Again, this is not the type in the modern Hep-B vaccine - there is no infectious material at all - making it safer than oral polio virus. That's why I said Hep-B is "very safe."

>The previous vaccine was only "safe", and not "very safe." The older vaccine started with blood serum from people who had Hep-B, and purified it so only Hep-B proteins remained. This has a risk of infection should something go wrong in the purification process so that the full virus - or other viruses - somehow get through. This sort of failure would be very risky for newborns.

>But the current vaccine, which is based on a genetically modified form of Baker's yeast, does not come from human sources. Since human viruses aren't in the source material, they can't enter the vaccine. There can still be other failure modes, but the most fatal - introduction of virulent particles directly into a newborn baby - can't happen through a process failure during vaccine manufacturing.

That is interesting and reassuring to learn. Thanks, I will also pass it on to Mrs. Fnord.

Thank you for the candid and well-cited response!

> So, basically, if the risk of contracting and or having the illness is low, and if it doesn't needlessly endanger others (like MMR refusal for school-aged children) then I am going to take a good hard look at whether we really need the vaccine.

But there-in lies why I would label you anti-vaccine. If the risk of disease is relatively low, you decline vaccine's - regardless of whether or not they are safe (e.g. " Gardasil seem to have low efficacy WRT to the (possible) risks of the vaccine").

> Anti-vaccine means you don't allow yourself or your children to be vaccinated.

To me, and most medical professionals, Anti-vaccine means you default to declining a vaccine, which you seem to do, despite no evidence of harm from the vaccine, and good evidence for safety.

Vaccines don't work 100% of the time. That's why you shoot for herd immunity.

Vaccines aren't to keep individuals from getting sick; they're to prevent outbreaks and pandemics.

That they prevent most people who receive them from getting sick is an added benefit.

>That they prevent most people who receive them from getting sick is an added benefit.

You'll have a lot better luck selling vaccines to people if they provide a direct benefit.

I'm not a salesman.

I guess I need to dig deeper with that case, but 20 symptomatic cases is probably linked to many others exposed and needing monitoring and prophylactic care[1]. So maybe not big, but not tiny either.

[1] for example, this case that happened in my old town had 3 symptomatic, but 175 or so others needing treatment: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a3.htm

And I totally get the skepticism of authorities thing. I only developed what trust in medical authorities I have after doing prepress work on a lot of medical textbooks and getting more familiar with the literature. Frankly most of us don't have a chance of keeping up with the state of the field when even professionals can barely keep up.

Did the antivaccination craze reach the UK too?

It started in the UK: https://en.wikipedia.org/wiki/Andrew_Wakefield

We had our very own, home-grown craze!

http://en.wikipedia.org/wiki/Andrew_Wakefield

Yaaay!

+1 for Bad Science, that book is amazing! Not only in this respect; it covers many topics really, really well. Everyone should have read it.

Bad Pharma too, also by Goldacre.

His blog (http://www.badscience.net) is also very good and he writes for the Guardian.

> I have also never seen a case of autism.

Not sure where you live.

There are two kids with autism on my block. Both young boys. Autism is a common disease where I live in the midwest. We have 3 large organizations that only work with Autistic kids.

My wife and I have 3 kids and vaccinate them selectively on our own schedule. We vaccinate our kids for the same things that we received as children, nothing more and nothing less.

> The stuff we vaccinate against is not harmless.

Our medical system wants to vaccinate for everything now, chicken pox etc.

Why not vaccinate for chickenpox? Helps reduce chance of scarring and reduces the chance for shingles. When I was a kid I gave chicken pox to my mom who got super sick. It would have been nice to have a vaccine back then.

http://en.wikipedia.org/wiki/Varicella_vaccine

I'm surprised at the number of comments on a tech site showing fear of technology.

As an adult who had shingles, allow me to add that you definitely do not want shingles and it is not as benign as most of us remember childhood chicken pox as.

It isn't so much a fear of technology, as a distrust of the authorities. Like the author said, some of it has a rational basis, and some does not. I know vaccines usually work, and are mostly safe. I remain very skeptical though for several reasons including: The difficulty of proving vaccine injury, and inadequate remedies. The business incentives caused by the NVCIA[1] (no fault vaccine court). Personal experience with doctors, pediatricians, and other medical professionals. The lack of credible statistics for vaccine adverse reactions.

It is nearly impossible to find authorities on the subject who can calmly and rationally explain the risks and benefits, and help you evaluate the risk properly. It is also nearly impossible to find objective impartial information from any source. The "debate" on the subject is very polarized. Skepticism is often treated as heresy or idiocy.

We still vaccinate our children, but not for everything[2], and not always on schedule.

[1] https://en.wikipedia.org/wiki/National_Childhood_Vaccine_Inj...

[2] We delayed the HEP-B at birth and opted not to take the rotavirus vaccine.

HEP-B is one of the vaccines that a person can take anytime. (It is actually combined A+B 3 shot IIRC). HEP-B is transmitted by bodily fluid exchange so the real danger kicks during puberty. But it is extremely virulent sadly.

>HEP-B is transmitted by bodily fluid exchange so the real danger kicks during puberty.

Right, we determined the risk of contracting Hep-B was very low for infants. The other risk factors are blood transfusions, medical malpractice. They will get it before they start school. There is also very low chance for an infected infant/toddler to spread Hep-B so, no ethical worries there, unlike MMR.

If your kids happen get chickenpox naturally in their childhood, they'll likely be safe. However, if they get when they grow up, it could easily be fatal.

I don't know why there is an increase of autism in your area, or even if there really is an increase. But vaccines are a red herring.

I had a friend in college who used to talk about how she almost died as a kid due to complications of chicken pox. She was very vocally thrilled when the vaccine was announced.

I meant that there weren't kids in my surrounding (consisting of a couple of thousand kids) with the kind of mental problems(symptoms) while growing up and having very strict immunization schedule.

Of course in the 80s in Eastern Europe some things were just considered being a kid that I suppose will give you today some diagnosis.

Was chicken pox or mumps the one that boils your testicles if you get is as an adult?

Mumps.

Honestly, how many times does the link between vaccines and autism have to be disproven before people get it?

On the other hand, there is a direct link between not being vaccinated and getting sick. Probably why they want to vaccinate against everything. Even chicken pox can cause more severe disease like shingles [1].

You wouldn't want your kids riding in a car with only the safety features that existed when you were a child. Why would you do the same for their health?

[1] http://en.wikipedia.org/wiki/Herpes_zoster

>Honestly, how many times does the link between vaccines and autism have to be disproven before people get it?

Honestly, there are many possible adverse reactions, and honestly, I want to see lots of good data. I know it may be costly, I don't care. I want to see the little bumps and dips in the plots of efficacy and safety for various vaccines. I want continuous quality control. I want it published publicly where the incidences of vaccine related injury were investigated, a cause found, and a problem corrected. I don't question the science or the public benefit of vaccination. I question whether the safety of vaccines as they are manufactured, transported, and stored is as advertised.

This is from the product insert for DTaP, note it cannot be considered conclusive, because the data collection methodology is crap. Would the manufacturer or FDA allow autism to be in the following list if either could conclusively exclude it? Honestly, I hope these guys have it right[1]. I think it would be fantastic if the solution were so simple.

"Adverse events reported during post-approval use of Tripedia vaccine include idiopathic thrombocytopenic purpura, SIDS, anaphylactic reaction, cellulitis, autism, convulsion/grand mal convulsion, encephalopathy, hypotonia, neuropathy, somnolence and apnea. Events were included in this list because of the seriousness or frequency of reporting. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequencies or to establish a causal relationship to components of Tripedia vaccine."

source: http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines...

[1] http://www.bmj.com/rapid-response/2011/10/30/iodine-deficien...

"I know it may be costly, I don't care."

This is all part of the cost/benefit analysis. How much do we need to spend in order to say that the data is good enough to use?

"I want it published publicly where the incidences of vaccine related injury were investigated, a cause found, and a problem corrected."

It is published publicly. Download the entire data set yourself. It's available at http://vaers.hhs.gov/data/index in CSV format and through the CDC WONDER on-line tool at http://wonder.cdc.gov/vaers.html .

Make sure to read the big warning messages. It's not possible to establish a cause from this data.

> More than 10 million vaccines per year are given to children less than 1 year old, usually between 2 and 6 months of age. At this age, infants are at greatest risk for certain medical adverse events, including high fevers, seizures, and sudden infant death syndrome (SIDS). Some infants will experience these medical events shortly after a vaccination by coincidence.

> These coincidences make it difficult to know whether a particular adverse event resulted from a medical condition or from a vaccination. Therefore, vaccine providers are encouraged to report all adverse events following vaccination, whether or not they believe the vaccination was the cause.

How much money and time should we spend to determine a causal relationship? More importantly, what do we do when we don't have those resources?

This is all part of the cost/benefit analysis.

"it cannot be considered conclusive, because the data collection methodology is crap. Would the manufacturer or FDA allow autism to be in the following list if either could conclusively exclude it?"

You have misunderstood the list. It's a complete list of serious and uncommonly high occurrences. They are not allowed to exclude autism. More importantly, if they excluded something only to find that it shouldn't have been excluded, then they can be sued.

Chicken pox is not harmless. It kills adults, and if you get it as a child you can get shingles as an adult which is debilitating.

Vaccinating on your own schedule is dumb. Do you have a MD? Did you develop the vaccine? Trust the experts.

Skipping vaccines is dumb. Science and medicine make progress. To put this in HN terms: this is like saying I'm going to build my startup's website using DOS and XTs, because that's what existed when I was a kid. It's a dumb idea.

If there's a vaccine available: get it. There is no scientific reason not to. Skipping vaccinations means your an irresponsible parent and member of society.

This is a weird one. I got shingles about two years ago (when I was 37). It was pretty horrible. My boss who sat in the next office from me got it within two weeks of when I got it, which is a pretty odd coincidence.

When I talked to my doctor about all of this, her hypothesis was that there was probably some other virus which weakened our immune systems to the point where the dormant chicken pox virus could get out and travel up the nerve endings and break out. Her thinking was that as a result of kids getting vaccinated, we're actually not exposed to the virus a lot any more. She felt that as a result shingles was becoming more prevalent in adults because you're not generating as many antibodies.

Through all of this, my daughter who was three at the time, also broke out in slight bumps on her legs. She had been vaccinated against the chicken pox, so the bumps went away and never developed into anything like a full blown case. I remember when I was a kid and got the chicken pox it was pretty horrible.

My point is really that there are side effects to everything. I haven't seen a study of whether shingles is on the rise, so I don't know if my boss and I were just unlucky. My preference is to still vaccinate, but really I'd love to see that particular virus wiped off of the planet.

I agree on the last - From what I have read, boys are now strongly recommended to be vaccinated against human pappillomavirus to address potential throat cancer... Due to oral sex with infected females?

http://www.cbsnews.com/8301-504763_162-20125260-10391704/hum...

As well as plans/experiments for vaccines against smoking, alcohol consumption... I don't think vaccines are what I thought they were any more. Viruses are not the main target for some of these...

http://www.ncbi.nlm.nih.gov/pubmed/22895958

http://science.slashdot.org/story/13/02/15/184232/alcoholism...

So yes, we are being conditioned to be vaccinated against everything. Unfortunately, this is a profitable business for some, creating a feedback loop with questionable motives...

>I have also never seen a case of autism.

What? You can't tell just by looking at someone if they have autism. You must have some sort of preconceived notions of what autism looks like. For example, here is two people in my family with autism (they are identical twins)

http://i.imgur.com/9PP5O6T.jpg http://i.imgur.com/aedlKYR.jpg

Rather than saying something incredibly ignorant like "I've never seen it," why don't we use science?

http://www.sciencedirect.com/science/article/pii/S0140673699...

http://jama.jamanetwork.com/article.aspx?articleid=197365

http://www.nejm.org/doi/full/10.1056/NEJMoa021134

Those are just some peer reviewed scientific publications disproving any association between autism and vaccines. If you aren't looking at real facts, you are just as bad as the anti-vacciners.

NOW, lets talk about how this got started.

The association was started by one study authored by Andrew Wakefield and published in The Lancet. Andrew Wakfield had serious conflicts of interests and it was later found he was paid money by British trial lawyers to prove the vaccine was dangerous so the lawyers could get rich suing. Hundreds of thousands of pounds we are talking. It was found he had manipulated evidence and broken other ethical codes to publish that paper in The Lancet.

The Lancet paper was partially retracted in 2004 and fully retracted in 2010, and Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010 and was struck off the Medical Register, meaning he could no longer practice medicine.

http://en.wikipedia.org/wiki/MMR_vaccine_controversy

http://en.wikipedia.org/wiki/Andrew_Wakefield

I think he simply meant that he's never met someone with autism, in his experience.

The point to that being that, if vaccines do cause autism, he should have met someone with autism. The fact that he didn't seems to argue against the hypothesis that vaccines do cause autism.

My point, how does the grandparent know he's never met someone with autism? Autism isn't always a visible disease. The faces of autism are the faces of everyday people. My guess is they have meet or seen an autistic person, and didn't know they were autistic because they have some kind of preconceived notion of what an autistic person looks or sounds like or acts like. Look at the pictures I posted above of my two autistic family members, if you were to see them out and about, would you think "there's some autistic kids?" Well, they aren't kids anymore, they are in their early 20s.

You're reading a lot into "seen" here. FYI, it's often used to mean "observed" or "known" generally, not necessarily in a visual or superficial sense. When addressing an argument about the supposed autism risk of vaccines, both prevalence and severity matter. If the severity of the effect is so low that these individuals do not present as autistic during normal interaction, then the risks of vaccination compared to the risks of measles/polio/etc. could be considered low despite high prevalence (which as far as anyone knows is not the case anyway).

BTW, are you aware what impression people might gain from the the vehemence and narrow focus (missing the broader point) of your response, in a discussion of anything related to the autism spectrum? Maybe you should work on reining in that behaviour instead of indulging it.

> The faces of autism are the faces of everyday people.

My oldest son has an ASD. I'm very familiar with the idea that those with a form of autism are not those who simply "look autistic".

>The fact that he didn't seems to argue against the hypothesis that vaccines do cause autism.

It does no such thing.

Please note first that I am pro-vaccination.

Vaccinations are a risk, which are designed to mitigate another (larger) risk. With this in mind, we shouldn't look at vaccines uncritically.

The article points out that Japanese vaccinations were withdrawn because they were believed to be causing aseptic meningitis - it's a shame that no numbers are mentioned on that side of the coin.

The comparative risk of vaccination ought to be regularly and properly assessed, e.g. https://www.ncbi.nlm.nih.gov/pubmed/8096942

"it's a shame that no numbers are mentioned on that side of the coin"

Here you go: "The rates of virologically confirmed aseptic meningitis per 10,000 recipients were 16.6, 11.6, 3.2 and 0 for the standard MMR, Takeda MMR, Kitasato MMR and Biken MMR vaccines, respectively." There were 38,203 recipients, and the vaccines "were arbitrarily given".

Source is "Adverse events associated with MMR vaccines in Japan", http://www.ncbi.nlm.nih.gov/pubmed/8741307 .

Shouldn't there be a _lot_ of very good data about this in the general case, not just for widely recognized anomalous events? I suspect adverse reactions are under-reported. A recent experience does nothing to dissuade me from that notion. (I know, confirmation bias). But the sheer number of vaccinations that take place would provide some very good data. Of course, that data would also probably show at least some occasional quality control problems with vaccines. No matter how much I may respect the science behind vaccination, I refuse to simply have faith that there are never any QC problems with the mass production of vaccines (or any product for that matter).

Our youngest developed a _very_ bad cough in the days/weeks after receiving the DTaP. We called the pediatrician who gave us the standard advice, to monitor the baby and bring her in if it worsened. We later did take the baby in for the cough. The doctor began dissuading us from the idea that it was Pertussis or related to the vaccination, before seeing the baby, and despite local news reports indicating a local increase in Pertussis cases[1]. The doctor had a look at the baby, and told us again it probably wasn't Pertussis, everything was normal (except the cough and low grade fever), ran a blood test for Influenza (tests confirmed that it wasn't Influenza), and told us to use a humidifier. I asked what the procedure (WRT both treatment and reporting) would be if it had been a possible or suspected vaccine adverse reaction. The doctor said they had _never_ had any reportable cases of vaccine adverse reaction and indicated a general lack of knowledge of adverse event reporting requirements. The clinic where this occurred was right across the street from the hospital that baby was born in, in the Medical Center in Houston, Texas, and is part of a large and well respected practice. Considering the number of patients that clinic has (it is a busy practice, with several clinics), even considering the low expected rate of serious adverse vaccination events, it is not possible that this clinic has never had a reportable event, and very unlikely that there were no serious adverse events. Baby might not have had Pertussis and baby is fine now. But, the experience turned my skepticism into a lack of confidence, at least with that particular clinic.

[1] http://www.chron.com/news/houston-texas/article/Whooping-cou...

Umm, what makes you think there isn't a lot of very good data? Start with http://www.cdc.gov/vaccines/vac-gen/side-effects.htm#dtap . I linked to DTaP but there are many others on that page.

To report a problem, go to http://vaers.hhs.gov/index , which is the Vaccine Adverse Event Reporting System.

Did you get any paperwork about the immunization? There should have been a flyer or handout like http://www.cdc.gov/vaccines/hcp/vis/vis-statements/dtap.pdf . This has information both about VAERS, as well as about the National Vaccine Injury Compensation Program.

The "ap" in DTaP vaccine means "acellular Pertussis", which means it uses antigens of the pertussis pathogen rather than whole cells. There should be no infectious material that could cause a bad cough a week later. (It also has fewer side-effects than, but is also less effective than the whole cell vaccine.)

I read that newspaper article you mentioned. It said "Infants under 2 months of age are at the highest risk, accounting for five of Texas' [six] deaths this year" and "80 percent of those were children under 2 months old, who are too young to be vaccinated against the disease."

This is a very different situation than what you are describing, where a cough starts a week after the vaccination. I don't think you can make the inference that it's a side-effect of the vaccination itself based on that article.

The article points out that the new vaccine formulation doesn't seem to be as effective for as long as the old one. What's likely happening is that adults whose immunity has worn off are acting as carriers for the disease, and infecting babies and children who haven't received any immunization for the disease.

This is probably one of the reasons that the Td immunization (DTaP is for children) recommends "All adults should get a booster dose of Td every 10 years."

(While it doesn't confer a life-long immunity, the goal is to prevent pertussis in children; they have the highest risk of death if infected.)

I don't know what to say to you, other than that I, some anonymous person on the internet, agrees with your doctor that "it probably wasn't Pertussis."

> "even considering the low expected rate of serious adverse vaccination events, it is not possible that this clinic has never had a reportable event"

There are different styles of reporting. First off, 25% of the children who receive the DTaP vaccine get a fever, 25% get redness or swelling where the shot was given, and 25% get soreness or tenderness where the shot was given. Your doctor has almost certainly seen those side effects.

But they aren't reported because they are expected. Again, they should be in the handout you got as part of the information about immunization. No doctor is going to report such mild problems.

Then there are the "moderate problems", like seizure, non-stop crying, and a fever of over 105°F. These occur in less than 1:1000 children, which means there should have been a couple of children in your clinic who have had these reactions.

However, it's up to the doctor to decide if this is severe enough to report. The VAERS guideline include "clinically significant adverse health events following vaccination", "vaccination error [that] may pose a safety risk", "or that the error would be preventable with public health action or education" but "accepts all reports."

These moderate problems are likely not 'significant adverse.' The severe cases seem to happen in 1:1 million cases or rarer for the vaccinations I looked at. Even across all of the vaccinations, it's unlikely that your doctor's office would have had that happen to one of their patients.

So, that's one style of reporting. Another style occurs when they get the above statistics in the first place. In that case, they enroll doctors into the program, and have the doctors report all problems that arise after the vaccination. This can be compared to a baseline reference from children who haven't yet had the vaccine. (Eg, the three weeks before the vaccine compared to the three weeks after.) That's used to weed out coincidental correlations. After all, kids do get sick even with vaccines.

This second style of reporting is what's used to list the known risks of the vaccine, with the first style of reporting use to get information about the very rare cases.

What should the doctor have done to improve your sense of confidence? Run a test for pertussis even though your child didn't have the symptoms for the disease? Make a report even though it wasn't a severe adverse effect? The information you wanted - what to do if there was a severe affect - should have been information you already had. I'm somewhat surprised that the staff didn't know that, since I (an anonymous stranger on the internet) knew it existed, but I also only know your side of the story.

>Umm, what makes you think there isn't a lot of very good data?

Because there isn't. Good data on vaccine outcomes would mean that blood samples would be taken and used to assess the effectiveness of vaccines. Good data would require a follow-up tests post vaccination. Good data means I'd get a report in the mail, and maybe every once in a while the report might say to come and get another X because the test indicates that the last X vaccination was ineffective. Thanks, I've been all over the FDA's and the CDC's websites.

>To report a problem, go to http://vaers.hhs.gov/index , which is the Vaccine Adverse Event Reporting System.

Yes, VAERS is voluntary reporting system that is sporadically used by practitioners, and may also be filled with reports from randoms, some of which may be junk. It has some value, it is better than nothing; but, we certainly aren't going to draw many conclusions from it. I was very dissatisfied with baby's first pediatrician for failing to mention VAERS when I asked, as anyone should be.

>Did you get any paperwork about the immunization?

Of course, parents are showered with CDC pamphlets; and showered with them again every time you tick a box on forms that say your child isn't up to date on ALL vaccinations.

>There should be no infectious material that could cause a bad cough a week later.

I know there shouldn't! I described an experience as I remembered it. I did not draw a conclusion, I cannot. I do not have my own immunology lab. But, neither can I dismiss the possibility that the cough was related to the vaccination (maybe baby was exposed in the waiting room). Nobody else should draw a conclusion from a secondhand anecdote, either. Baby could have been exposed several other ways, either to Pertussis or something else.

>I don't know what to say to you, other than that I, some anonymous person on the internet, agrees with your doctor that "it probably wasn't Pertussis."

Nor do I know what to say to you other than, you're probably right. You'll probably always be right because both Pertussis infection, and vaccine adverse reactions are fortunately rare.

I didn't ask the ped to make a VAERS report over the visit. I asked what would happen in the event of a serious problem, following a vaccination. If you're my child's pediatrician, and your response to my question indicates a lack of knowledge, or possible willingness to mislead me for your own convenience; then you probably aren't going to be my child's pediatrician much longer.

> The severe cases seem to happen in 1:1 million cases or rarer for the vaccinations I looked at. Even across all of the vaccinations, it's unlikely that your doctor's office would have had that happen to one of their patients.

Unless death is the only thing you qualify as serious, you are mistaken. Even with the shabby state of data collection, and the even shabbier state of medical studies, severe adverse reactions are evidently more common than 1:1e6. Look at pretty much any vaccine label for evidence to support that. I haven't access to our former ped's books, but I would expect them to have given tens maybe hundreds of thousands of vaccinations per decade as a conservative estimate. Consider the number of vaccines recommended by the CDC schedule http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch...

>What should the doctor have done to improve your sense of confidence? Run a test for pertussis even though your child didn't have the symptoms for the disease?

The child did have the symptoms of the disease[1][2].

Additionally, as I stated, about that time, there was a "Massive Pertussis (fear mongering) Outbreak" in the news, with periodic reporting and shaming of vaccine refuseniks. Yes, absolutely, the ped. should have run a test. But the main thing that any ped. can do to inspire confidence is not to be dismissive of parents' concerns or questions. If instead of waving more CDC pamphlets at us, she had mentioned VAERS, or anything resembling even a vague and non-specific something like VAERS she would probably still be our ped.

Is it not enough that I vaccinate my kids for infectious diseases, despite my suspicions that all may not be right in the world of vaccines[3], but you expect me to do so with unreserved faith in the manufacturers of vaccines, and the government?

[1] http://www.cdc.gov/pertussis/about/signs-symptoms.html

[2] Pertussis symptoms are quite like the symptoms of Influenza, and many other childhood ailments.

[3] I don't question the science of immunology or epidemiology. I question the claim that in practice, vaccines are manufactured, distributed, and administered with a near miraculous failure rate.

Yes, we have different definitions of "good data."

"Good data" for me is enough to establish if there's a public health need. "Good data" for you is much, much higher.

"the test indicates that the last X vaccination was ineffective"

And perhaps impossible. Do these tests even exist? In the various papers I read, there are tests for given antibodies, but the only hard numbers I saw are the infection rates. What's the false positive/false negative rate for these tests? How much do they cost? Who should pay for them, and what's the effective benefit?

Also, the test doesn't need to be 100% effective in everyone in order to be useful. That's the logic behind herd immunity.

"Look at pretty much any vaccine label for evidence to support that."

I did look at the Vaccine Information Statements for several vaccines. I pointed you to one as well.

DTaP: Severe Problems: 1) Serious allergic reaction (less than 1 out of a million doses), 2) Several other severe problems have been reported after DTaP vaccine ... These are so rare it is hard to tell if they are caused by the vaccine.

Hepatitis B: Severe Problems: Severe problems are extremely rare. Severe allergic reactions are believed to occur about once in 1.1 million doses.

MMR: Severe problems: 1) Serious allergic reaction (less than 1 out of a million doses), 2) Several other severe problems have been reported after a child gets MMR vaccine ... These are so rare that it is hard to tell whether they are caused by the vaccine.

Then there's the ones that don't even have numbers, which I assume puts it in the "greater than 1 in a million" probability.

Meningococcal: Severe problems: Serious allergic reactions, within a few minutes to a few hours of the shot, are very rare.

Pneumococcal Conjugate (PCV13): Life-threatening allergic reactions from any vaccine are very rare.

Haemophilus Influenzae Type b (Hib): The risk of Hib vaccine causing serious harm or death is extremely small

Since I couldn't find one with < 1e6 probability of severe problems, perhaps you can point it out to me?

If your clinic has done 100,000 shots, then that's still under a 10% probability that any of their patients have had a problem. But the math doesn't work out as simple as that. If someone isn't allergic to DTaP the first time then that person likely isn't allergic to it the next 4 times. I estimate more like a 2% rate.

> there was a "Massive Pertussis (fear mongering) Outbreak"

Which was an outbreak mostly among those who have not been vaccinated. Your child had been vaccinated. (Well, you didn't say if this was after the 2 month, 4 month, or 6 month shot. If it started the day after the 2 month shot then the immunization wouldn't have started being effective. I don't have enough data to go on.)

> the main thing that any ped. can do to inspire confidence is not to be dismissive of parents' concerns or questions

Agreed. You have every right to make that decision. It is a proper one.

My argument is that your demands on the quality of the information you expect - personalized tests after every vaccination, for example - is not possible. It's expensive, even if feasible, and the major benefit seems to be that it makes people like you more confident.

But that data will also have vague and uncertain parts. It won't be a simple statement of "the last vaccine did not provide enough immunization" but "the number of antibodies is 10% lower than the recommended level. This may increase the risk that your child will be infected in the future by between 1% and 15% compared to full immunization. Enough other children have been immunized so the overall probability is very low, unless <list of circumstances>. Should you wish a booster shot, please contact your physician."

You complained about "waving more CDC pamphlets at us" -- interpretation of this additional data leads to still more CDC pamphlets.

"I question the claim that in practice, vaccines are manufactured, distributed, and administered with a near miraculous failure rate."

Why do you think it's 'near miraculous' any more than having potable fresh water come out of your tap? A clean water supply has probably saved more lives than all the vaccinations ever done in the US. We bathe in drinking water!

The vaccines which have the higher failure rates, like anthrax, aren't part of the normal schedule. The allergic reaction rate to the anthrax vaccine is ">100,000" so 10x higher than those children get.

The yellow fever vaccine lists "Severe allergic reaction to a vaccine component (about 1 person in 55,000)" and "Severe nervous system reaction (about 1 person in 125,000)" and "Life-threatening severe illness with organ failure (about 1 person in 250,000). More than half the people who suffer this side effect die." That's much higher than anything I saw on any of the childhood vaccines.

Let's look at some less successful vaccines.

The RTS,S malaria vaccine only reduced the chance of infection in children by 31%, which it lower than the 50% that the researchers had hoped for, and much lower than the 90+% from the best childhood vaccines.

The RV 144 HIV vaccine is estimated to be 31.2% effective, but "there is no more than a 71 percent chance that the vaccine was effective at preventing HIV." There are of course many AIDS vaccines which just plain didn't work.

The attenuated form of the polio vaccine would sometimes revert to a more virulent form, which caused vaccine-induced polio in about 1 in 750,000 cases. The US switched to the less effective inactivated form, because those rare polio cases aren't worth the advantage.

And so on.

The first vaccine was for smallpox in 1796. The first compulsory vaccine law was in England in 1853. The rabies vaccine was in 1885. The first polio vaccine in 1955. There's a lot of work behind that "near miraculous failure rate." Why are you so astonished?

For that matter, there are failure rates, just not at the level where you're looking. People get the wrong shots, last year "160,000 doses of the Novartis vaccine, Agrippal, [were] recalled after 'particles' were found in the vials", and this year Merck recalled "1 lot [27,000 vials] of Recombivax HB hepatitis B vaccine (adult formulation, 10 μg/mL) because some of the vials may be cracked."

And so on.

Why does any of this require you have "unreserved faith in the manufacturers of vaccines, and the government", any more than you have faith in the builders of your car, the maintainers of the traffic lights, or the pilots and builders of the plane you fly?

For a start "Good data" is data from independent sources, not merely clinical trial data provided by manufacturers. The need to collect "Good Data" doesn't stop after the clinical trial ends because there are many opportunities to screw up between the end of clinical trials and mass vaccination.

>what's the effective benefit?

It closes the loop. Researchers and manufacturers get data with which to improve their products. Patients get more confidence in the products they are administered. Increased confidence means more vaccinated people, and better herd immunity.

>Which was an outbreak mostly among those who have not been vaccinated.

It was also mostly fear mongering, and there were a fraction of those who contracted Pertussis who were vaccinated. Ped's shouldn't be surprised if this sort of thing biases the opinions of worried parents. I think baby's cough happened after the first or second of the series. Can't remember exactly, doesn't really matter. Baby is doing fine.

>Why do you think it's 'near miraculous' any more than having potable fresh water come out of your tap?

Because manufacturing and distributing pharmaceuticals is more complicated than digging a hole, pumping water through sand filters and adding Chlorine, a task that is routinely accomplished by people without even a high school education.

> A clean water supply has probably saved more lives than all the vaccinations ever done in the US.

Yes, I know, isn't it great? But vaccines often get the credit.

>We bathe in drinking water!

The significance of this isn't lost on me. I have visited developing countries, and lived in China, where tap water is usually not considered safe to drink.

>My argument is that your demands on the quality of the information you expect - personalized tests after every vaccination, for example - is not possible. It's expensive, even if feasible, and the major benefit seems to be that it makes people like you more confident.

It probably is too expensive to achieve 100% testing, that's a high bar. Continuous sampling? I think it not too big a challenge or too expensive. I'd bet that some people would even pay extra for it if they had too.

>the major benefit seems to be that it makes people like you more confident.

Do you want herd immunity or don't you? It's not as though I am the last doubter.

>But that data will also have vague and uncertain parts. It won't be a simple statement of "the last vaccine did not provide enough immunization" but "the number of antibodies is 10% lower than the recommended level. This may increase the risk that your child will be infected in the future by between 1% and 15% compared to full immunization. Enough other children have been immunized so the overall probability is very low, unless <list of circumstances>. Should you wish a booster shot, please contact your physician."

We need some meeting place between the raw data in .csv vs "Just Take, All The Vaccines" Maybe I'd trust Nate Silver to tell me, if he showed me some pretty charts. It needs to be understandable by a lay-person.

>You complained about "waving more CDC pamphlets at us"

Well, obviously, they aren't effective on everyone. Why would more of them be more effective?

>For that matter, there are failure rates, just not at the level where you're looking. People get the wrong shots, last year "160,000 doses of the Novartis vaccine, Agrippal, [were] recalled after 'particles' were found in the vials", and this year Merck recalled "1 lot [27,000 vials] of Recombivax HB hepatitis B vaccine (adult formulation, 10 μg/mL) because some of the vials may be cracked."

No, that's exactly the sort of thing that worries me. And no amount of historical safety data can prevent a mishap like those you mentioned from occurring.

>Why does any of this require you have "unreserved faith in the manufacturers of vaccines, and the government", any more than you have faith in the builders of your car, the maintainers of the traffic lights, or the pilots and builders of the plane you fly?

Cars are not a great example, I can choose not to buy a crappy car because they performed poorly in crash tests. Planes are a little better, and you know what? I don't really want to ride in a 787 until they fix those batteries, and I can choose not to fly Northwest because of their maintenance problems (well before they went under). But in general, I am mostly unimpressed with the FAA. But, I have very small latitude WRT my choices of vaccines. A gov't agency purposefully crashes example cars to prove their safety, it is unethical to try the same thing with people. But neither the FDA nor the CDC appear to take much interest in providing better oversight. I expect more. Sorry if you think it is too expensive or not worth it. I don't agree.

Your wording is one of the reasons people skip on vaccinations.

> Vaccinations are a risk, which are designed to mitigate another (larger) risk.

People don't understand risks, the lottery is one excellent example of people that don't understand basic probability. The difference between 1 in 10.000 chance of death vs 1 in 1.000.000 of sickness is huge, but when presented to most people the risk seems the same (very small).

> Your wording is one of the reasons people skip on vaccinations.

Unfortunately, my choice of wording is not the problem... you are welcome to restate what I said, if you like.

In the case of vaccinations, it is economically rational to skip a vaccination (from a selfish point of view) - you receive the majority of the benefit from herd immunity and don't have to take the risk of the vaccination.

The fact that people almost always do choose to take vaccinations shows that we humans have a good altruism and excellent appreciation of the consequences in wider society. I don't think policy should undermine that by disguising the mathematical truth of the situation.

In most cases, we trust that people can judge their own risks. Every medicine has a list of side-effects with their possible risk attached. Vaccinations should really be no different.

(We can argue about your lottery example another time - there are several rational reasons to play)

The effectiveness of vaccines rely on 'herd immunity', that is: you need more than 90% of a population immunised to stop a disease spreading (as vaccines are never 100% effective)(also varies according to vaccine types/adjuvants and disease contagiousness)

So by not vaccinating your self/dependents you are actually extremely selfish as you are benefiting from herd immunity whilst at the same time avoiding the (small) side reactions each vaccine may have. This is one of the most selfish things you could ever do.

From my research, people who avoid vaccines are usually afraid of (big) side reactions, like infertility or autism.

Oh, those are "big" (as in, serious, though rare; or serious, but doesn't fucking happen...) but do you know what is bigger? Somebody who could not get immunized dying because you refused to get immunized.

That is why it is selfish. Incredibly selfish.

If one was forced to immunize their child, that child then dies from a reaction to that vaccine. Is that the "unselfish" act? You might of well have said it's against your "morals". Your full of it, might as well say we should cull the autistic kids from the herd, you know to protect the herd.

Vaccines save millions of live. If, in your personal system of morality, the veeery slight chance that your child will die takes priority over the benefit vaccines present to society, then while you are entitled to that viewpoint, I have the right to call you a selfish monster who embodies much that is wrong with modern society.

Furthermore, neither autistic kids nor eugenics have fuck all to do with vaccinations. Quit peddling this bullshit.

Your comment made absolutely no sense whatsoever.

Yep, which would be valid except there is no scientific basis for those.

Here is an in-browser demonstration of herd immunity[1], which I think shows the importance pretty well. It was posted on HN before[2].

[1] http://op12no2.me/toys/herd/index.php?scenario=intro

[2] https://news.ycombinator.com/item?id=5190234

Worse, some people can't get certain vaccines, due to health/immune issues. They actually need herd immunity to stay alive. By refusing to get vaccinated, you're putting already sick people at risk.

Like me, I'm allergic to most vaccines. So I can't have them, and require herd immunity to keep me OK. Thankfully I've been fine thus far.

I am pro vaccination for anything that has sufficient maturity (high proof of action/low enough risk).

For the sake of the point, I'll just put out that vaccination is for the good of the community, but this community might not fully commit to support members who react badly to vaccines.

I don't refer to direct health concerns if something goes bad, but on the long term effects when there is some disability left. You'll vaccinate your kid to protect others as well, but if his lever doesn't stand it and became diabethic, you'll have a hard time finding schools that will provide assistance towards kids with special needs.

If a vaccine has a 1% chance of going awry, commiting to do what it takes to support the 1% "unlucky" ones would help a lot lowering the resistance toward vaccines.

In a conversation like this, it's important to discount hypothetical risks. Vaccination has been around for a long time. Hypothetically, there could be one with a 40% risk of long-term disability. But there isn't.

Show me an example of disability caused by vaccination (they exist), complete with a percentage estimate of how many people will suffer. Then we can talk about the associated costs.

I think you are looking at this from a statistical point of view, where you balance the risk for the group and what might happen to one person. I understand this point.

What I am saying is that from an individual point of view, people won't react the same if you tell them:

A - "Your kid has a 1 in 800 million have it bad, it should be OK but if it's not, tough luck, you deal with it"

B - "Your kid has a really small chance to suffer from it, but it's for the group. If it goes bad the group will do everything to support you and your kid"

I'd really wish it would more of the B pattern, and that everyone would be on the same page, not fearing to have to mildly go through hell if they hit the vaccine lottery. You talk about associated costs, I think some of the people refusing vaccines feel that the main cost (and that not just financial cost) in case of failure will be on them, not on the general population. You can agree or disagree, but that's a point of view that is too often overlooked I think.

'''B - "Your kid has a really small chance to suffer from it, but it's for the group. If it goes bad the group will do everything to support you and your kid'''

To be fair, that's why the National Childhood Vaccine Injury Act was passed, though there are limitations:

> to be eligible to file a claim, the effects of the person’s injury must have: 1) lasted for more than 6 months after the vaccine was given; or 2) resulted in a hospital stay and surgery; or 3) resulted in death.

For examples, if you get the measles vaccine and within 4 hours go into anaphylactic shock, then it's presumed to be caused by the vaccine. If in the month after getting the chicken pox vaccine you start suffering from chronic arthritis, then again it's presumed that the vaccine caused the condition.

In those cases you can be paid (quoting from http://www.hrsa.gov/vaccinecompensation/84521booklet.pdf ):

• a reasonable amount for past and future nonreimbursable medical, custodial care, and rehabilitation costs, and related expenses (There is no limit on the amount a person with an injury may be paid for these types of expenses. Payments are based on your vaccine injury needs.);

• up to $250,000 for actual and projected pain and suffering;

• lost earnings; and/or

• reasonable lawyers’ fees and other legal costs or legal costs, not fees, of petitioners representing themselves, if your claim was filed on a reasonable basis and in good faith.

Good points. I would just add two things. First, as you say, the percentage you need to reach herd immunity depends on a lot of factors. Broadly speaking, the vaccination coverage you need is 1 - 1/R0, where R0 is the basic reproductive number of the disease (http://en.wikipedia.org/wiki/Basic_reproduction_number). For diseases like measles, where the estimated R0 is above 10, you need at least 90% vaccinated, perhaps even more; for other diseases it may be lower.

Second, even if you reach herd immunity, it is a concept that completely relies on a random vaccination distribution. Say your R0 is 10, and you have attained a vaccination coverage of 90%, you may still get lots of outbreaks, because the 10% that are unvaccinated may not be randomly distributed. Indeed, it's becoming quite clear that in almost all cases unvaccinated people are clustered. This is why you get these sporadic outbreaks in under-vaccinated communities.

We (some of my colleagues at the Center for Infectious Disease Dynamics and I) are doing a MOOC this fall on exactly these topics: https://www.coursera.org/course/epidemics

I love this argument, "reality doesn't care". I often have semi-arguments with family members when they tell me that they "believe" that X is true or Y is false when it comes to medical or scientific stuff. Then I tediously argue that science is not a matter of beliefs but facts, but that doesn't really hit home because some random guy on a random website wrote something they wanted to hear.

I thought about forwarding this cool article but then realized that, just like reality doesn't care about us, there's a category of people who doesn't really care about reality.

The nice thing about reality is that it continues to exist regardless if you believe in it or not.

The thing is, what we perceive as reality might be wrong sometimes. Fortunately the scientific method is a pretty good algorithm whose purpose is to expose it whether we like the answer or not. Our species doesn't know everything yet, and we're limited by the capabilities of our bodies, knowledge, technology, and other things.

Many people like to create a worldview in their heads which they become comfortable with. That's fine, but trouble arises when it's challenged and they fail to question or adjust it. Those who stubbornly defend against, dismiss, or demonize contradictory evidence significantly increase their probability of being wrong. A great technique to avoid this trap is to ask yourself, and answer, the following question for any subject, no matter how uncomfortable or taboo:

What facts or evidence would it take for you to stop believing in what you currently believe?

It's an excellent self-check, and a tool no open minded person should be without.

> science is not a matter of beliefs but facts

Is it? There is a lot of shoddy science that is done, and a lot of things that were accepted as scientific fact only to be overturned. Just because something is accepted by the medical community (for example) doesn't mean that it's necessarily a fact. </devils_advocate>

Yes, I think we should all be vaccinated, as the powers that be confidently tell us.

And as a consumer of medicine, I observe that doctors are equally confident when they really don't know what they're talking about, and when their opinions aren't substantiated by science. (The command to wear padded running shoes, for instance.)

And I know that the CIA organized a fake "vaccination drive" to get Osama bin Laden.

So I understand why people who might not have a scientific education choose not to believe the vaccination story they're given by their government.

Saying it louder and more often won't help.

> The command to wear padded running shoes, for instance.

Physio's I've spoken to describe the pros and cons of both (barefoot, and padded) and let me decide. What command are you referring to?

Barefoot versus padded is a false dilemma. There are non padded shoes.

The fake vaccination drive is going to do a lot of harm to the efforts of help organizations. Especially muslims showed in the past and present that they can hold a self-damaging grudge for a long time...

In India for example, a lot of Muslims still believe almost any medical treatment by the government, especially contraception, can lead to sterilization. To be fair, there was a time in India when, especially Muslims, were sterilized against their will. This was a crime against humanity in my opinion, but the lack of trust is still damaging them.

So as to not provide any more baseless evidence against vaccines under the guise of impartial reasoning, the CIA led vaccination drive actually did provide vaccines in a poorly developed region, but the data collected led to the capture of Bin Laden.

In and of itself, the vaccination drive wasn't some sort of hoax, and it had legitimate doctors and results. It had just been co-opted by the CIA for covert intelligence gathering.

That doesn't actually make it better. The point is that we want people in those communities to be able to trust that the doctors who come to their door don't have an ulterior motive. It's not a question of whether the vaccines are real (though faking that would of course have been far worse).

It was a hoax. You need multiple doses of the vaccine over a span of months for it to work. They didn't do that.

http://www.scientificamerican.com/article.cfm?id=how-cia-fak...

The misguided vaccine program in Pakistan was started in a poor neighborhood of Abbottabad, no doubt to give it an air of legitimacy. Yet after the first in a standard series of three hepatitis B shots was given, the effort was abandoned so that the team could move to bin Laden's wealthier community.

And I know that the CIA organized a fake "vaccination drive" to get Osama bin Laden.

I had not heard of that until now, but that will be incredibly damaging to vaccination efforts in developing countries (where vaccination is most effective).

Why don't you give your source for said CIA "drive" the same level of distrust as the FDA and your doctors? Or are you a primary source?

I know the Internet can seem overwhelming at times.

Here you go: http://lmgtfy.com/?q=cia+fake+vaccination+osama

Ignoring the question. I asked why you didn't give those sources the same level of apprehension. I'm familiar with the situation you snarkily linked to.

I've been thinking about "Herd immunity" a lot recently, but not with respect to /biology/. The concept that if we easily become overpowered by a threat if do not maintain an active defence against it is true in most political issues, too[1].

In the current NSA drama, for example, we are fortunate enough to HAVE a "vaccine" against many of the problems: encryption. It's not always something that can be used (just like vaccines), but if those are rare enough most of the abuse-of-power problems wouldn't even be attempted.

When a certain critical mass of people start skipping that protection, a tempting target is created and the problems com back, often much faster than expected. If I could just think of a clever epithet similar to "antivaxxers" to use when referring to someone who think they can skip encryption because "they aren't doing anything wrong" ("won't get $DISEASE").

[1]: insert traditional speculation about meme-vs-gene here

I've had the fun experience of debating with anti-vaccine people. Outside of the religious 'god will protect us' line, which I can't really argue with as it's a matter of faith, the vaccines cause autism line keeps coming up.

Unfortunately for us a condition that we don't really understand is far more prevalent than the side-effects of preventable diseases. I've never met anyone who's experienced post-polio syndrome or given birth to a child with congenital rubella. Alas I had measles myself, but I was too young to have been vaccinated.

This coupled with our odd perception of risk leads to people abandoning something that demonstrably saves lives because of the minor risk of side-effects. Having done some minor work with autistic children it's certainly not as bad or as certain as the documented outcomes of disease.

I don't think much will change people's minds until the diseases return, but I will be keeping up on the pro-vaccination side.

The folks who skip out on vaccination are (consciously or not) doing one or both of the following:

1) Counting on the herd immunity provided by everyone else to keep them safe

2) Pretending that the diseases which are being vaccinated against "really weren't all that bad" or maybe "didn't happen often"

Y'all are totally overlooking that there is a broad swath of the population that is intelligently selecting vaccinations based on current research indicating which vaccines pass the cost/benefit test. Not all vaccines are created equal--including some that are intended to solve for the same thing. And all too many who blab their opinion on pro-vaccine or anti-vaccine do so with a minimum of research and evidence to support their opinion.

Here I hear a lot of pro-vaccine chest pounding. Sure there are anti-vaccine myths just as their are pro-vaccine myths. Some vaccines provide almost no benefit and entail fairly significant risks.

As in most things, vaccination is not an all or nothing proposition and it's a fallacy to suggest it is.

No, we are not overlooking that. Some of us have looked into the evidence and figured out that people who convince themselves that they are "intelligently selecting vaccinations" are in fact making poor choices.

What do you say to someone making poor choices when you know their choices are poor, and they are so convinced they are right that they won't listen?

Can you show me a "almost no benefit" vaccine that has "significant risks" that is currently in use?

> Here I hear a lot of pro-vaccine chest pounding.

You say that as you pound your chest about "informed opinion" without providing any information... so it's just (uninformed) opinion (right now).

> Sure there are anti-vaccine myths just as their are pro-vaccine myths. Some vaccines provide almost no benefit and entail fairly significant risks.

Can you provide some examples (three or four would be ok, that should count as "some") of these vaccines, backing your results with real, reputable research?

Y'all are totally overlooking that there is a broad swath of the population that is intelligently selecting vaccinations based on current research

I disagree; the people I've encountered who claim to be making this kind of selection are not doing it based on current research. They're doing it based on (often slightly hysterical) websites, niche talk shows, celebrity opinion and op-ed pieces designed to sell newspapers. Doing it based on current research would require a great deal more effort, knowledge and time.

Pretty much all the data points I've ever seen used by such people have been false, and little more than excuses for their irrational choices.

>current research indicating which vaccines pass the cost/benefit test.

Citation needed, and also important to share if you really believe that unicorns like this exist.

>As in most things, vaccination is not an all or nothing proposition and it's a fallacy to suggest it is.

No, it's a fallacy to expect that the right answer must always be in the middle of two sides of an argument. The Law of Averages isn't really a law, it's a mistake.

The paper saying that the MMR vaccine causes autism (which is where the whole concept came from) was fraudulent, so it's not just "well, a side effect is better than the disease", it's total misguidance.

Also, here's an amusing Penn & Teller clip that shares your view. https://www.youtube.com/watch?v=RfdZTZQvuCo

Depending on the decease this side-effect IS the better alternative. It's better to have 1 autism then 100 dead people. Unless you can know in advance who will develop side-effect, they should take their changes with dead.

Read up on the fraudulent research of ex-Dr. Andrew Wakefield.

There is no as in zero, none, zilch, nada evidence that vaccines is in any way related to autism.

The reason why people still believe in a connection (apart from Wakefield's fraud) is that often when an infant gets the first shot this is about at the time when the first autism symptoms show.

I'm not claiming that there are never bad side effects of vaccines (very rare) but autism is most certainly not one of them.

If nothing else, Wakefield has been a great example of the cost of scientific fraud. As a science major, I've had Wakefield drilled into me; befrauding a paper for money/fame/whatever leads to public opinion preventing herd immunity many years down the line, and indirectly, loss of lives. It's unbelievable.

In the end, though, the fact is that if you require informed consent, some people won't.

The question really is whether we go around battering people for their own good by poking them with needles or whether we respect the decisions regarding medical consent, whether those are right or wrong.

Why would God protect from the measles but not the autism? (And I say this as a Christian who believes in healing) Yet while 'vaccine denialism' is often associated with the Religious Right, it's certainly not a prerequisite, because you can certainly find the same sentiments among the all-natural anti-GMO fringe Left, and before we had stories about Texas mega churches we had stories about affluent Californians[1]

[1]http://scienceblogs.com/insolence/2010/08/26/vaccine-exempti...

Why would God protect from the measles but not the autism?

That's a wonderful line.

Well, when your mind is made up you can explain anything - perhaps the autism is a punishment for not trusting in the original protection, etc, etc

Indeed. If you want talk to them with their terms, you might have better luck with "God helps those who help themselves", though I doubt that will work in practice either.

Sure, but it's not like they're consistently anti-medicine, happily 'helping themselves' to cancer treatments and the rest (well, except for the oddly named Christian Science sect, but not the broader Bachmann-style evangelicals that are found overlapping with the anti-vaccine movement these days). It's almost like existing biases helped them succumb to the original fraud and helped them get stuck in it, so now they just truly believe that most medicine helps but vaccines cause autism. Fortunately it doesn't seem to be spreading across evangelicals as a whole.

And I say this as a Christian who believes in healing

Forgive me if I come across as rude. I'd love to hear your answer to, "Why won't God heal amputees?"

I'm not trying to score points or anything. I'm genuinely curious about your answer. Despite our different beliefs, I'm glad we share so much common ground on the issue of vaccination.

That's a legitimate question, and I don't pretend to have an answer. I believe God has healed in numerous cases that defy explanation by placebo, misdiagnosis, or other means, but that tells me little about why he has not done so in others. I could come up with theological theories, but none, at least presently, that I would expect others to find satisfactory. It is also, I admit, not a question I have specifically spent much time considering or investigating, - - though I acknowledge its difficult implication.

Fair enough. I used amputees in my example because they were the most obvious, but there are plenty of afflictions that prayer never cures: Down syndrome, spina bifida, cleft palate, Tay-Sachs, dwarfism, etc.

I hope some day that you have a satisfying answer to this question.

> Outside of the religious 'god will protect us' line, which I can't really argue with as it's a matter of faith

"God hasn't protected people of your faith historically, why do you think he's going to start now?"

it sure didn't protect the original Apostles (if Foxe's Book of Martyrs is to be believed).

Personally, I've seen a lot more vaccination refusal among left-wing anti-corporate types than among the devoutly religious. That may be a function of my usual peer group, but to solve this problem it's going to be important to recognize how widespread it can be.

The last big outbreak of polio in the US was among the Amish, in the 1970s.

Historically, members of Christian Science have been against vaccinations (and other forms of medical treatment) since the Compulsory Vaccination Act in England in 1855. See http://en.wikipedia.org/wiki/Christian_Science#Avoidance_of_... .

The notion that we can secure ourselves from disease through immunization is clearly valid for the subset of known treatable diseases.

With pure untamed conjecture, I suspect, however, that the behavioural and psychological effects of the greater population's immunity to such diseases serve primarily to reinforce the modern 'medical miracle' that may, longer term, in fact leave us in a state of reduced immune performance and an 'immune monoculture', due to unnatural lifestyles and living environments, relaxed psychology, and a lack of exposure within the general population to the range of natural challengers that we once had.

Vaccines do the precise opposite of what you just wrote - they expose you to huge numbers of viral particles ramping up your immune system so a state of enhanced immunity performance.

When you travel to foreign countries, you tend to take a number of vaccines just so that your body is ready to fight off the endemic diseases that are prevalent in the region you are traveling to.

Vaccines do the precise opposite of what you just wrote...

Yes, but only for one specific disease.

I believe your parent was arguing that vaccines facilitate travel and that globalisation is anathema to monoculture. So vaccines indirectly attack the monoculture which you both think is a risk to our civilisation.

I wasn't - but I really like the point you are making. It had never occurred to me that the globalization of of travel is the antitheses of monoculture disease pools - But it's true - the Flu in China last year, quickly becomes a worldwide phenomenon six-nine months later.

That wasn't really my point so much as an attempt to clarify. In all likelihood globalisation at best buys time against the monoculture issue. If and when that hits, with globalisation, it will be commensurately larger than it would have been otherwise.

There is also other side of vaccination when pharma industry pushes untested and ineffective serum. Mostly it is for viruses (hint: virus mutates too fast and vaccination is practically useless).

Great example is bird/pig flu, serum was untested and used only thanks to massive hype. More people died from vaccination than actual flu. And best part are doctors which refused to have themselves vaccinated :-)

disclaimer: I am well educated and my children got full vaccination.

Knowing some of the details on vaccination, I can't agree. There is profit to be made in vaccines, sure. But it's hardly the same as in patented drugs. Competition is usually harder.

I wouldn't call the bird/pig flu story hype. There was a wide consensus that these viruses were a threat and might have the potential for a pandemic. It killed a lot of people, and as far as I remember it had a higher mortality rate than most flus. So the threat was real.

Now we know the virus probably didn't have the potential. In hindsight. I hope the next time there is a preventable pandemic threat people don't trump up the anti-pharma rhetoric and say "last time it wasn't so bad, was it?"

> There is profit to be made in vaccines, sure. But it's hardly the same as in patented drugs.

But there is also good chance to convince government to buy huge quantities.

Flu kills and becomes pandemic nearly every year. Bird/pig flu was just a bad year.

There are more effective measures to fight flu. For example closing schools for couple of weeks. Also employers should allow tele-commuting during flu seasons.

Exactly the kind of attitude which can hurt people. Even kill them.

Yes, and someone who thinks that NSA is spying on him is tinfoil-hat.

Actually last year, most people who thought the NSA was spying on everyone, were in fact highly vulnerable to all sorts of conspiracy theories. There just was no evidence.

Today, with all the data we have on incompetence and failure in most intelligence agencies, we can still have some hope...

Echolon is widely known since 1980ies, "spying on everyone" is just question how filters were set. And "all the data on incompetence and failure" you have now are just a few PowerPoint slides and speculations. I would say NSA is actually very competent.

And checking basic facts != conspiracy theories.

Nah, that's a poor argument. The medical industry would make more money if they let the people get sick so they need to be hospitalized for weeks or even, in the case of some polio victims, need to be in an iron lung for the rest of their lives.

(In Ontario, for example, a cost-benefit analysis shows that a universal free influenza inoculation program reduces costs of the medical system; see http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj... .)

I can turn the argument around: companies don't want people to get vaccinated so they can sell more expensive palliative care. Why would a hospital want to get less business if more people are vaccinated and so don't need their services?

If a given argument predicts X and it predicts not-X, then it's a poor argument. This appeal to the profit motive is a poor argument.

> The medical industry would make more money

There is strong competition in medical industry. One company sells vaccine, some others sells medicine and hospital equipment.

In theory maybe. The data suggests that the same companies are providing vaccines and drugs.

Competition in the US Health System certainly doesn't do a good enough job at driving costs down...

I don't like to use these strong words, but I do find it dangerous and reckless when people with nearly no medical knowledge want to reason against proven methods on the basis of costs and the hatred of "evil, profit seeking companies".

If mistakes were made it's up to the medical establishment to judge about and avoid them in the future. Anticapitalists should not play a role in that.

I don't believe what I'm reading here: You suggest that the medical industry is more or less a monopoly / oligopoly with lack of competition and at he same time barf at people dependent on that system to keep out of the discussion? Maybe you (or I) missed a sarcasm tag ... Otherwise it might be the place to remind you that the medical industry does not operate on a free market because sick people mostly don't have much to choose from. I cannot imagine why the profit seeking aspect of that industry should not be questuined and/or observed?

Your retort is baseless since I didn't say anything of the nonsense you are trying to make me say.

There is an economic aspect to health care. I am accusing those who want to make recommendations on (extremely weak) economic grounds without any medical and scientific reasoning.

Baseless anticapitalist conspiracy theories should not play a role in healthcare.

>just a bad year.

1918 was just a bad year, too.

https://en.wikipedia.org/wiki/1918_flu_pandemic

>It infected 500 million people across the world, including remote Pacific islands and the Arctic, and killed 50 to 100 million of them—3 to 5 percent of the world's population at the time—making it one of the deadliest natural disasters in human history.

The DOD mandates flu vaccination every year for their servicemembers (who can't simply "take a couple of weeks off"). It does indeed usually significantly decrease the incidence of flu infection.

If it didn't the DOD would probably find some better way to spend that money, like buying a missile or something. :P

[citation needed]

Edit: I was doing academic influenza drug discovery research at the height of the H5N1 threat. 59% morality rate [1] is no "hype". Your generalization of viruses mutating "too fast" is a false clause. Vaccination against influenza isn't "useless", it's actually effective [2].

[1]: http://www.who.int/influenza/human_animal_interface/EN_GIP_2...

[2]: https://www.landesbioscience.com/article/19917/full_text/#lo...

Q8: Is a vaccine available to prevent human infection with H5N1avian influenza?

Candidate vaccines to prevent H5N1 infection have been developed, but they are not ready for widespread use.

http://www.who.int/influenza/human_animal_interface/avian_in...

How do you know that bird/pig flu wouldn't have had more severe impact if it wasn't for the vaccinations?

Large part of population was not vaccinated. Also some countries did not provide vaccination at all. Dead were mostly related to overall fitness rather than some magic virus.

Last year the flu vaccine was only about 35% effective in my area and the world didn't end. In a normal year you're in no danger from the flu unless your pulmonary or immune systems are compromised.

Of course that's not true every year.

The seasonal flu isn't like H1N1, the latter put some young healthy people under so bad that they had to be hospitalized for weeks and needed equipment to breathe.

Those who suffer that bad from the seasonal flu are very old, very young or have a very weakened immune system.

> In a normal year you're in no danger from the flu unless your pulmonary or immune systems are compromised.

As the parent of twins born three months early, that sort of attitude is distressing. Vaccination protects more than just the person vaccinated.

Don't misread me. I'm not saying people shouldn't get vaccinated. All I'm saying is we have a pretty good idea what a "normal" non-vaccinated flu season looks like.

Of course getting vaccinated is the right thing to do, even if it's only partially effective. My dad has emphysema, so I know where you're coming from.

I had a family friend die of the common flu. He was in his early 50's and otherwise completely healthy. Just got the flu and died. It was so sad...

We also know that healthy children and teens without any known risk factors die from the flu

Austin’s case is not unusual, according to a new Centers for Disease Control and Prevention study released Thursday. In fact, 43 percent American children who died from flu were perfectly healthy beforehand, CDC researchers found. While conditions such as cerebral palsy and asthma can make flu especially dangerous for a child, there’s no way to tell which children will become seriously ill or even die from seasonal flu, the researchers warn.

http://www.nbcnews.com/id/49465633/ns/health-cold_and_flu/t/...

> Combined with a little luck (nothing quite as beneficial as being a white, middle class male in the US) you might have a reasonably healthy health.

Hard to take an article seriously that starts out like that. On every axis mentioned there, there is a significantly healthier alternative group (and all but one - the alternative to middle class - are large).

Personally I recommend keeping vaccine exemptions but not encourage people to use them.

There is no reason to have a vaccine exemption unless there is a legitimate health reason (allergic reaction, etc.).

You have spoken, all interactions within biological sciences are decided. Thanks for that.

If you have valid, replicatable evidence where vaccines cause harm, I'm all ears.

But if you're going to rely on anecdotal evidence, GTFO. I'm tired of hearing people not vaccinating their children and causing public health issues because they believe they're more informed than the CDC.

Here's an example where vaccines cause harm: http://www.cbc.ca/news/canada/british-columbia/story/2012/09...

By and large though, vaccines are amazing. Just the fact that we have a vaccine which can protect against influenza is pretty fantastic. Life unfortunately always throws you spanners, so even though I think the people who live in the vaccine autism universe are bat shit crazy, it's still good to have people taking both sides of the issue. This is despite how freaking frustrating it can be when one side is arguing with opinion and the other is arguing with facts.

Both sides of the issue with evidence. Yours is the first I've read here. Most people, most discussions involving vaccinations don't come close to sensibility.

Well it's still possible to be pro-vaccine in general but against a specific vaccine that does not hold up its end of the risk/reward bargain.

There aren't simply two sides where 1 is always pro-vaccine and the other is always quoting Wakefield.

Absolutely. I wasn't trying to paint it as a black and white argument at all, and in fact, quite the contrary.

The people who are against vaccinations are mostly idiots, however, scientists are not infallible. Sometimes they lapse into politics too.

By "allergic reaction", I assume the g'parent poster did not mean only an allergy to the virus particles or fragments in the vaccine, but also included an allergy to the other components of the given formulation.

Some people have an egg allergy. Some vaccines are made using chicken embryos, the vaccine includes some of the egg protein, and some people are allergic even to this slight amount.

For an overview you can start with http://en.wikipedia.org/wiki/Egg_allergy#Vaccine_hazard

The journal citations are easily accessible.

First, these allergies are quite rare. "Estimates of true allergic, or immediate hypersensitivity, reactions to routine vaccines range from 1 per 50000 doses for diphtheria-tetanus-pertussis to approximately 1 per 500000 to 1000000 doses for most other vaccines." says http://www.ncbi.nlm.nih.gov/pubmed/20349363 .

There are protocols for those with egg allergies, so most (95%) don't have a severe reaction to at least the flu vaccine: http://www.ncbi.nlm.nih.gov/pubmed/20368312

Another possible source of allergies is gelatin: "[The researchers] suggested that previous receipt by these patients of diphtheria-tetanus-acellular pertussis vaccines with trace amounts of gelatin was responsible for the sensitization," leading to an analysis which suggests that "Almost one fourth of patients with reported anaphylaxis after MMR seem to have hypersensitivity to gelatin in the vaccine." http://www.ncbi.nlm.nih.gov/pubmed/12456938

Those were the allergies I was referring to in my original post. Thank you for providing not only the relevant info, but also the corresponding Wikipedia and Pubmed links.

Just as long as the people who remain unvaccinated stay away from me, out of schools, the workplace, and other contact I agree with you. Everyone has the right to be vaccine free, but they don't have the right to be a disease vector and harm others.

In much the same way it's considered (very) rude to sneeze or cough in someone's face, it's also socially inappropriate to not be vaccinated.

In the first world, we don't actually understand how horrible it was prior to vaccines, (horrible doesn't begin to describe it) - so we think that being vaccinated is optional.

I recommend quarantining these people in their own communities and refusing public assistance when they inevitably get outbreaks of preventable disease.

It is not a bad idea by a long shot, but the ethical dilemma comes up when you consider the children that will be unwillingly involved.

Denying the adults treatment is one thing, but denying the children treatment because of the decisions their parents made is no more acceptable than allowing that parent to deny lifesaving treatment for a child.

And allowing parents to deny their children vaccine that may save their health and life and health and life of other children is all fine?

If we allow for that we might also refuse treatment alltogether and lift ban on female genital mutilation when we are at that.

> And allowing parents to deny their children vaccine that may save their health and life and health and life of other children is all fine?

Well I would say no. I am in favor of giving all children vaccines, with or without the approval of the parents.

As I said, the ethical problems are around the children. If adults want to opt themselves out, then I am perfectly cool with quarantining them in colonies and refusing them medical treatment. However they should not be permitted to drag their children along in such madness.

What happened to sciencebasedmedicine.org?

Does anyone else see an auto-generated placeholder spam page linking to "Naturopathic Nutrition", "Faith Healing", and "Homeopathic Treatment" when they go there?

Way to miss the point. This is so much bigger than just vaccines, encompassing distrust of authorities, misunderstandings about the existence of god, etc.

But sure lets focus on vaccines.

> This is so much bigger than just vaccines, encompassing distrust of authorities, misunderstandings about the existence of god, etc.

If you get a horrible strain of the flu, very little of that will matter. Living to see tomorrow will matter.

I'd rather think his point is precisely that: distrust of authority, misunderstanding about the existence of god are just distractions from reality, and the wrong tools to face it. When disease=reality hits, he says, vaccines are the right weapon.

That's the whole point of the article. Distrust, misunderstandings, God are not bigger, because they are virtual, they are not part of physical reality, and reality doesn't care about why you ignore it. It will kill you all the same for whatever reasons.

That's why we need to focus on vaccines.

Way to miss the point of the article.

>...misunderstandings about the existence of god...

What does that mean, exactly? Do you know something the rest of us don't?

It's interesting (scary) to see all the anti-biotic resistant diseases on the rise. I wonder how long until the diseases vaccinated against evolve enough to bypass the antibodies produced by the vaccine?

Spend some time in the autism community, as a parent of a child with autism, and meet other parents of children with autism, and you might have a different opinion about whether children can be vaccine injured after you hear the same stories over and over again.

http://en.wikipedia.org/wiki/Confirmation_bias

Thanks for the non sequitur.

Man, I wish I could down-vote this idiotic comment.

Changes in the brains of infants who later developed Autism have been observed before those infants ever received their vaccinations.

You're not actually disagreeing with my point, but I'm not going to engage in a conversation that begins with an ad hominem.

> "Changes in the brains of infants who later developed Autism have been observed before those infants ever received their vaccinations."

I'd love a citation, if you have one.

(Disclaimer: I am pro-vaccination, and the father of an autistic child. I'm interested in the "changes in the brain" thing, not the "link with vaccines" thing.)

From another parent of a child with autism, I have two things to say:

1) it's clear from the science that vaccines do not cause autism. Autism becomes noticeable about the same age as vaccination, but its causes are earlier.

2) refusing to vaccinate simply means that you put your autistic child and mine at risk of other diseases.

Get educated and stop doing the wrong thing.

I didn't say vaccines cause autism, but thanks for regurgitating the usual non-conversation at me.

If you would like to discuss the idea that vaccines can pull the trigger on particular children who are born with a loaded gun, then maybe we can have a constructive conversation.

I guess you didn't actually say "vaccines cause autism". You merely spoke about the stories you hear about vaccines in the autism community, and suggested that everyone else would change their mind if only they had the same experience -- without any clarification as to what you actually meant that is different from the usual "vaccines cause autism" tripe.

Do not blame others for misunderstanding when you communicate badly (see also http://xkcd.com/169/ ). If you want to have a "constructive conversation", start by communicating better. Explain what you mean, instead of getting angry at people for not guessing what you mean.

> I didn't say vaccines cause autism

Then you're incapable of having an adult conversation.

> If you would like to discuss the idea that vaccines can pull the trigger twaddle twaddle whine

Provide evidence that they can and we'll think about it. Note that evidence comes in the form of peer-reviewed journals, not mommy-blogs written by people who still think Wakefield qualifies as a human being.

I am not against vaccines, it saves lives, but sometimes i have the feeling we may not get sick anymore, with all proposals for inefficient vaccines against benign affections. Sadly both camps (pro and anti vaccines) have too extreme positions to have a constructive debate.

I do not understand the downvotes here,especially with no argumentation. It only illustrates my opinion: people have too extreme opinion on the subject. I maintain that being unconditionally pro or anti vaccines is a bad approach.

Vaccines save lives. Millions of lives. Pro-vaccine is not an extreme position, it is the sane position.

I downvoted you because I think you are presenting a false compromise. An "argument to moderation": http://en.wikipedia.org/wiki/Argument_to_moderation

A lack of moderated opinions is hurting a lot these days. Read my answer to dalke, because I would like ask you the same question: Would you be for mandating vaccines against rota-viruses in high-income countries?

I don't have the expertise to make that call, and neither I suspect do you. I am comfortable with the CDC making that call.

Moderated positions should not be your priority. Rather factually correct and defensible positions should be.

Looking at the facts lead me to a moderate position.

I let you feel confortable following the cdc, i prefer to keep a critical mind, though i agree it is hard for non experts like us to get good and objective information.

>Looking at the facts lead me to a moderate position.

Mention them, rather than "moderation", and people may not downvote you.

I listed an example about the rotavirus in my subsequent comments, but here's another one mentioned by Patrick_devine in the comments: http://www.cbc.ca/news/canada/british-columbia/story/2012/09...

This illustrates that the precautionary principle[1] might sometimes be forgotten or be put on the background.

[1] http://en.wikipedia.org/wiki/Precautionary_principle

That's a random fact, but not evidence in support of your thesis, which is that the currently accepted set of vaccines should be evaluated for their costs and benefits by individuals.

The evidence that individuals are better equipped and are less biased than the current scientific establishment to evaluate the costs and benefits of a particular vaccine is the evidence I'm looking for. The evidence that vaccine X was crappy is not. Evidence of people trying to get a new vaccine into the market or required for children is definitely not.

You ask for facts, I give an example of what I mean but then you reject it as random and needing evidence of a thesis I never formulated....

As for your second paragraph, the scientific establishment can be very wrong. Example: 20 years ago the scientific establishment rejected the idea of exoplanets. Today, there are hundreds catalogued. Although I had no facts to support my view, the consensus felt just wrong to me. I just think there might other be cases where the scientific consensus just feels wrong, a good reason to keep a critical mind!

"20 years ago the scientific establishment rejected the idea of exoplanets"

What?! No, they didn't. The Drake equation even had a term, f_p, for the fraction of those stars that have planets.

Drake's 1961 shot-in-the-dark estimate for f_p was 0.2-0.5 (one fifth to one half of all stars formed will have planets).

Sagan and Drake were believers in the principle of mediocrity, which says that "the Earth is a typical rocky planet in a typical planetary system, located in a non-exceptional region of a common barred-spiral galaxy." (Quote from Wikipedia.)

Others were believers in the Rare Earth hypothesis, yes, but there definitely wasn't the consensus rejection of the idea of exoplanets. The consensus was more that we don't have the information to stay one way or the other.

There are plenty of examples of when the scientific establishment was very wrong. Geologists didn't accept Wegener's theory of continental drift for many decades, and it wasn't until the 1980s that Warren and Marshall showed that most stomach ulcers and gastritis were caused by H. pylori infection, instead of the then-consensus view that they were caused by stress or spicy food.

"...you feel confortable following the cdc, i prefer to keep a critical mind..."

* Do you have information that is not available to the CDC?

* Do you have evidence that the CDC is biased in a fashion that prevents it from being suitably "critical"?

* Did I have information showing that the NSA was accessing private data stored at big providers like Google, MS, Apple, etc? No.

* Was I right to have kept a critical mind regarding storing data in the cloud? Yes

So in response to your comment, I'm not saying the CDC is not to be trusted or biased. I'm just saying keeping a critical mind is a must.

The factors are not the same in the two comparisons.

It's people who develop these vaccines. These people have friends and family, with children. These children will be vaccinated. Why would they want to place these children at too high of a risk?

If your thesis is true, then you would expect that the children or grandchildren of pharmaceutical researchers are less likely to be inoculated. Do you think that's the case? Do you have any evidence for that?

(Personal anecdote: I once met a woman who worked at Glaxo-Wellcome, back before they became GSK. Once the chicken pox vaccine was available, she immediately got her daughter inoculated.)

There are many public health organizations besides the CDC. There's the WHO, and the public health organizations of different countries. The EU, for example, also has a very extensive set of requirements and oversight. So you can also look towards the UK, or Australia, to see what they think. (I picked English speaking countries to make it easier on you.)

There are significant differences between the CDC and NSA: 1) the NSA is institutionally secretive, while public health research is not, 2) the NSA staff are less likely to have an adverse effect by the NSA accessing their private data than the public at large, and 3) other espionage organizations, who are in the position of finding out what the NSA does, are also secretive and not likely to publish that information to the public.

I assume you considered these differences as part of your critical analysis. Why did you think they aren't significant?

Writing, as you did in the grandparent post,

but sometimes i have the feeling we may not get sick anymore

may not need any more response than a downvote. Perhaps if you were more explicit about what you mean, your comment would be better received.

This formulation was not very good, I agree. Thanks for the constructive comment. What I meant is that some push for overly-broad vaccination when the benefits/risks ratio is too small. Just like rotavirus vaccination in high-income countries like I mentioned in two other comments clarifying my initial post.

You have made an implication, without basis, that the immunization policies in the US are "unconditionally pro", or at least that the people here are "unconditionally pro."

This is not the case. Read any of the CDC, NIH, or WHO history of vaccinations and you'll see the reasons for the decisions. You'll see the numbers of how much it costs to vaccinate, how much it costs to treat, the likelihood of disease, the likelihood of death, and the effect of side-effects. You'll see research to reduce those side-effects, like improved treatment methods for those with egg allergies.

You'll see treatment policies change over time. The polio vaccine in the US use to be the more effective Sabin vaccine, which used attenuated vaccine strains that occasionally mutated to a more virulent form that gave 144 known cases of vaccine-associated paralytic polio (VAPP) between 1980 and 1999.

Since polio doesn't exist in the US, we switched to the deactivated form in 2000. This isn't as effective, which is why there's now one more shot in the vaccination series, but the old treatment, if continued, would have been deadlier.

There has always been a policy to allow people to opt out of vaccines, usually for religious reasons. (The last outbreak in the US was among Amish groups. The virus came from the Netherlands.) A reason why is because there will always be resistance to any mandate, and vaccines don't require 100% coverage to be effective in a population. It's better to let a few not be vaccinated than to use the indiscriminate and blunt threat of government intervention against them.

This means the CDC and others have to be very cautions and sensitive. For example, even though there's no evidence that mercury preservatives in vaccines cause side effects, you'll see that the vaccines were reformulated to remove thimerosal. The general policy is to minimize objections to the process, and not to force people to comply.

This is absolutely not an "unconditionally pro" policy, so you are downvoted because you're speaking out of ignorance and a blithe appeal, as jlgreco rightly points out, to an argument to moderation.

> You have made an implication, without basis, that the > immunization policies in the US are "unconditionally pro", > or at least that the people here are "unconditionally pro."

You have interpreted this. Read my comment without considering me as anti-vaccines and maybe you'll understand you over-reacted....

My reflection was about pushing administration of vaccines against for example stomach ulcers (vaccine in development) or rotaviruses in developed countries. Would you be for mandating, in high-income countries, the administration of a vaccine against rotaviruses knowing their efficiency is only 45%? Rotavirus is evaluated at 1% of children deaths in these countries [1] (from CDC, a source you mention yourself). Will you also push for a vaccine for the 99 other percent?

[1] http://wwwnc.cdc.gov/eid/article/9/5/02-0562_article.htm

"Read my comment without considering me as anti-vaccines"

I didn't regard you as such in the first place. I regarded you as making the incorrect appeal to argument by moderation.

Now you have switched the topic, from the implication that the US health policy and/or supporters in this forum are "unconditionally pro" vaccination, to a question about a specific vaccine and disease.

I do not wish to discuss this new topic.

I don't understand why you think I'm discussing US policy... It seems we don't understand each other and ending our discussion is indeed the best option.

I never said you were talking directly about US policy. I both times used the word "implication." You say there are two camps. I point out that the majority view, which includes the views of the CDC and WHO, and described in their publications, is in neither of those camps that you proposed.

Specifically, you say "Sadly both camps (pro and anti vaccines) have too extreme positions to have a constructive debate."

The US health policy is decidedly pro vaccine. Therefore, I can use it an exemplar to determine if it has "extreme views" which are "too extreme positions to have a constructive debate."

I then showed that there is a lot of debate and cost/benefit analysis on the use of different vaccines, including a change in the vaccination policies over time as conditions change. Nothing about the debate looks "extreme".

Therefore either you don't understand the majority view or you are using an very different reference frame than the others on this forum, without explaining the context shift.

That's the likely source of the downvotes that you complained about.

Now I understand your reasoning. Stating there are two camps with no one in-between was maybe indeed too... extreme. I meant to say that there are a lot of people with strong opinions, and few with a balanced view acknowledging there are both risks and benefits.

I disagree. From what I can tell, there are a lot of people with strong opinions based on a balanced view acknowledging both the risks and benefits. And their opinion is in general favor of mass immunization.

You have only to go to the CDC, or the WHO, and read their reports. Every single Vaccine Information Statement from the CDC says "A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions." They also list the risks, and describe if there are groups of people who specifically should or should not be immunized.

Where then is this large camp of people with strong view for vaccination but who do not acknowledge that there are risks? Because to me it sounds like it's a hypothetical construct based on the assumption that there must be people who are equal but opposite to the anti-vaxxers, when as far as I can tell, such a pro-vaccination group is at best small and with little influence.

Can you point me to their web sites or other literature?

I know a pregnant woman trying to get information about which vaccines to administrate to her future baby. She either get as answer "do them all as there's absolutely no risk' or 'vaccines are bad'. So it's not an organised group publishing position papers as you asked. But she has a very hard time to get explanations of the implications of not administrating a vaccine against usually benign affections.

Also, I just found this article mentioning that the cdc used children as guinea pigs for a new vaccine. Of course i am not sure it is true but it makes me suspicious and distrustful. How could i believe them blindly as some commenters seem to do if they do such covert operations?

> She either get as answer 'do them all as there's absolutely no risk' or 'vaccines are bad'."

She's supposed to receive a handout from the CDC describing the known risks. That required by law, I believe. These handouts say, over and over, that there's always a risk, that there are common mild side-effects (redness or soreness where the shot was injected, for example), and that the severe side effects are extremely rare, as in larger than 1:1,000,000. It's hard even to know if some of the side effects are due to the vaccine or not.

The handout she gets is supposed to tell her where to report severe side effects, and tell her about the fund that's set up to pay money to those who have severe side effects.

But the side-effects are so rare that it falls into the background noise. It's hard to even think about odds this low, which is the reasoning behind the "micromort"; see http://en.wikipedia.org/wiki/Micromort . A risk of 1:1,000,000 is about the same as traveling 6 minutes by canoe, or 250 miles by car.

This is so low that most people say "no risk" rather than enumerate all the low-probability ways you could die.

> the cdc used children as guinea pigs for a new vaccine

I don't know how the paper defines "guinea pig." The answer is both 'yes' and 'no', depending on how you want to interpret it. If "guinea pig" means "children used as a subject for a medical test", then the answer is certainly "yes."

There's a point between "we think this is a possible vaccine" and "this vaccine is effective." At some point you need to inoculate children and see if the vaccine works. In this respect, those children are indeed guinea pigs.

But if by "guinea pig" you mean there's no knowledge of what the risks are, or even that the test is going on, then there's a long story.

Earlier in our history we would test physically and mentally disabled children in institutions (see Koprowski's work on the polio vaccine), or people in jails (see Southam's experiments with HeLa cells), or simply not tell them what was going on (see the Tuskegee syphilis experiment).

This is unethical, though it took a long time to establish and require those ethical standards. Human testing requires oversight by an institutional review board, and informed consent from the test subjects.

There's all sort of problems related to what "informed" means. Obviously, children cannot grant informed consent, so their parents are used as proxies to make the decision. Even then, it's hard to know if the parents have all the information they need to make a decision.

It gets even worse with overseas testing. There have been many attempts at coming up with a malaria vaccine. One such is RTS,S (or Mosquirix). You can read about the ethics behind the test http://www.nejm.org/doi/suppl/10.1056/NEJMoa1208394/suppl_fi... . There are several pages detailing what they did to maintain good ethics:

- follow international and local standards for testing

- get independent local doctors to provide oversight

- have community meetings, and meetings with local leaders

- discuss the goals and methods with the parents, including the use of an impartial witness for illiterate parents

and more. For example, we know that bed nets are effective at reducing malaria, so all of the children who volunteered for the trial - even if they weren't accepted - got insecticide treated bednets.

So yes, those 6537 infants are guinea pigs. We don't know of a better way to find out if a candidate vaccine works.

Would you be for mandating, in high-income countries, the administration of a vaccine against rotaviruses knowing their efficiency is only 45%? Rotavirus is evaluated at 1% of children deaths in these countries [1] (from CDC, a source you mention yourself). Will you also push for a vaccine for the 99 other percent?

Where to start with this?

45% is a pretty low effectiveness rate. I'd prefer to see it higher, but nevertheless 45% success should improve herd immunity, right?

Rotavirus is evaluated at 1% of children deaths in these countries

If that is correct, then that is a HUGE death rate. Anything to reduce that seems sensible.

Will you also push for a vaccine for the 99 other percent?

Well.. can you predict in advance which are the 1% who are going to die? If you can then vaccinate them! If not then it would seem sensible to vaccinate everyone to develop her immunity. That will (a) directly decrease the death rate by making some who would have died immune, and (b) indirectly decrease the death rate by making it less likely to be transmitted.

Edit: Reading a bit, I believe your numbers are incorrect - or at least the way you have phrased it. 1% may be the rate in developing countries, but it isn't in developed countries.

The Wikipedia article on Rotavirus[1] makes the vaccine seem pretty compelling: In Mexico, which in 2006 was among the first countries in the world to introduce rotavirus vaccine, diarrhoeal disease death rates dropped during the 2009 rotavirus season by more than 65 percent among children age two and under.....In the United States, rotavirus vaccination since 2006 has led to drops in rotavirus-related hospitalizations by as much as 86 percent. The vaccines may also have prevented illness in non-vaccinated children by limiting the number of circulating infections.

So yes, in my opinion - based on 10 minutes of research only - it should be mandatory.

[1] http://en.wikipedia.org/wiki/Rotavirus#Prevention

Just to be sure we agree: it is 1% of deaths, not of children. Maybe the efforts should focus on bigger death causes of children. My opinion of course.

Your example talks about mexico, which is not a high income country, and the US, which has amongst the worst life expectancy amongst developed countries....

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