The issue is not black and white - and laying the entire issue at the feet of non-vaccinated is blatant propaganda. For example, the recent whooping cough outbreaks are due to the fact that the newer (safer!) acellular vaccines are just not as effective as the older (less safe) vaccines. Vaccinated populations are falling victim to whooping cough, as the current vaccines are not long-lasting enough. Reuters published a pretty good explanation of the issue in August of last year: http://www.reuters.com/article/2013/08/01/us-whooping-cough-...
tl;dr: We need a new vaccine. Tilting at small populations of anti-vaxxers may feel satisfying, but it is ultimately counterproductive, especially in this case.
Ultimately unvaccinated people put the whole community at risk by reducing herd immunity. For pertussis the threshold is over 90% for prevention assuming that 100% of the population is immunized. If 10% are not immunized then your already behind for a disease with high transmission rates.
the recent whooping cough outbreaks are due to the fact that the newer (safer!) acellular vaccines are just not as effective as the older (less safe) vaccines
You have one historical fact misreported there. It is clear that the current acellular vaccines were adopted because of safety concerns about former cellular pertussis vaccines. What's actually NOT clear is whether those safety concerns really necessitated changing the vaccine formula. It appears that anti-vaccine activists may have exaggerated the risk profile of cellular vaccines and understated their effectiveness while campaigning to reduce vaccine use in general.
Billions of dollars aren't spent to modify a vaccine just to mollify a small community of questioners, who weren't even that great in number at the time of conversion. If anything, it would benefit the vaccine makers - fewer side effects to impede sales, and more sales because more boosters are needed (though I doubt there's anything that nefarious at play in this specific case).
Thanks for the link, but that study was very soon after the change and ignores the issue of whether vaccine effectiveness was the same (as history appears to be showing it was not). And that is the point. A small reduction of minor reported adverse effects for a large reduction of immunization effectiveness is usually not counted as a good trade-off by epidemiologists.
The understanding of the effects of vaccinating kid #1 isn't all about kid #1 being immune to the infection. Instead it is that kid #1 is x% less susceptible to contracting the infection if exposed.
So you might wonder, how could Small Pox be much extinct if the vaccine is only about 95% effective, and how have we wiped out an enormous number of diseases that caused immense suffering in the 20th century using vaccines that were not 100% effective in protecting the vaccinated from infection on an individual level?
The lesson is that common sense can be a terrible guide for even the roughest approximations of the dynamics of a system. Dispersion models explain the limits to how far water will trickle down through soil or the conditions under which wild fires will burn themselves out. The models for infectious diseases involve variables for the likelihood of transmission, mortality rates, how long you're contagious until you show symptoms, the percentage of population that is susceptible etc.
While even common sense will tell you that the best way to avoid a disease is to avoid contact, it might not tell you that vaccinating populations is largely about reducing exposure. Assume our hypothetical situation has kids one through eight living on a street and they only play with their immediate neighbor. Then let's assume that the kids have a natural resistance of 20%, but 60% if they are vaccinated. If kid #8 has the disease, what is kid #1's risk of exposure if everyone is vaccinated vs no one is vaccinated?
(1-20%)^6 = 26%
(1-60%)^6 = 0.4%
I think those numbers are astonishing and beat the tar out of what common sense has to say. Of course more realistic models would show many more links between nodes as well as lower transmission rates, but differences of even a hundredth of a percent in a population of 320 million is 32 thousand people.
The conversation begins with: "The issue is not black and white — and laying the entire issue at the feet of non-vaccinated is blatant propaganda." If we're going to use extreme language, then it is "blatantly wrong" to say it is "blatant propaganda". The portion of people who defect from or cooperate with vaccination programs does matter. It isn't much of a problem if there is one Jenny McCarthy, but it becomes a problem if she advocates on behalf of defection to everyone else in her playgroup, or worse to other parents around the country.
While it is a good instinct to assume that issues aren't simple, it is tempting to see issues as having "two sides" and that the middle ground must be reasonable. I don't understand why newer/safer vaccines being less effective is being presented as a middle ground. If the "two sides" are not vaccinating and vaccinating, then this argument would not be in between the two, but instead it should be an argument that is more extreme than a mere decision to vaccinate. And yet, I think it serves to create uncertainty instead, and ultimately fewer vaccinations and lower resistance in the population.
I remember reading somewhere that some of the whooping cough in the States was actually being transmitted by the vaccine itself in some cases - but Google isn't returning any unbiased search results right now on that one.
That is an extraordinary claim. Does someone else have a source to back that up? This argument would appear to vindicate the antivax movement, at least vis a vis whooping cough. That would be a shocking development.
The most reputable source I could find that touches on pertussis vaccinations and disease spread is http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/uc..., particularly this part: This research suggests that although individuals immunized with an acellular pertussis vaccine may be protected from disease, they may still become infected with the bacteria without always getting sick and are able to spread infection to others, including young infants who are susceptible to pertussis disease.
The study, conducted on animals, does not, however, suggest that the vaccine increases rate of disease spread, rather that vaccinated individuals can serve as unaffected and unsuspecting nodes of transmission. This can happen with the acellular type of vaccine, not the whole-cell.
Here we go - it's another strain one can still be colonized by, not pertussis, but parapertussis: http://www.cidd.psu.edu/research/synopses/acellular-vaccine-... ("An acellular whooping cough vaccine actually enhances the colonization of Bordetella parapertussis in mice; pointing towards a rise in B. parapertussis incidence resulting from acellular vaccination, which may have contributed to the observed increase in whooping cough over the last decade.")
tl;dr: "We missed a spot." Which is going to happen. I don't think it validates being anti-every-vaccine, but it does validate asking questions and furthering research (and ceasing the vilification of the population that does ask questions!).
Without commenting either way on the veracity of the GP comment's claim, it sounds like you're asserting something on the basis of your own bias, here, too.
EDIT: particularly so, given the follow-ups to your comment's sibling, citing animal studies demonstrating exactly the thing claimed: that even vaccinated individuals can transmit the disease.
actually being transmitted by the vaccine (claimed in the post in question) and that even vaccinated individuals can transmit the disease are very different things.
This should be an animation or something, perhaps with corresponding graph of anti-vaccination media mentions, in order for it to actually be devastating.
As it is, I have no idea what measles rates were like 10 or 20 years ago. I have to research that myself, which makes it less than devastating.
So, for example, this graphic is somewhat more devastating:
Your graph is better; the other one only provides enough info to deduce "omg! Circles!"
More devastating would be to know how many are actually dying of measles/pertussis. I can't find any legitimate, non-anti-vax sources talking about that, except the WHO, who says that measles deaths declined 71% worldwide between 2000 and 2011, (anti-devestating! Hooray!) and also that 95% of measles deaths occur in low-income countries. Hmm.
Doctors I know say that it's almost exclusively educated people who decline vaccines. Uneducated people generally defer to the doctor's opinion.
I think this is a lesson we should all take care to note: be humble. Knowing something doesn't mean we know everything, and it can hurt us to think so.
On the other hand; If the field of medicine is anything like engineering and computer science I'd rather chance my own opinion over trusting the advice of a random doctor w/o supporting reasoning. I've been given obviously crappy advice by way to many doctors over the years to just "take their word for it" because they have an MD next to their name.
You trust your own engineering opinion over that of an expert professional engineer? The doofus who used to own my house was one of those kinds of people and I am still paying for it.
You're missing the point. There are a lot of engineers out there who claim to be "expert professionals" and may even have the credentials on paper but when it comes down too it aren't competent. This is evidenced by the large number of posts on HN dedicated to finding and hiring good engineers.
People seem to assume that all doctors are roughly equal, or at least meet some baseline level of competency. I'm saying based on my experience in the engineering world and my first hand experience with doctors I don't believe that. So I'm saying that just taking someones word for it because they are a doctor is naive. I've lost track of the number of times I've been told totally nonsensical things by doctors that were just not sound advice which I confirmed by seeking another doctor's opinion and in some cases because what they told me to do made me sicker.
I'm sorry you've had bad experiences, and I'm sure you're very smart. But do consider: imagine you're building software for a doctor and he/she disagrees with your choice of database/programming language.
You might not say it, but you'd probably think, "really? You probably don't know a function from a hole in the ground."
Personally, I can't tell you what all of my organs do, much less what can go wrong with them, much less how that should be treated. I'm sure there are incompetent doctors, but I doubt there are many less competent at medicine than I am.
Yes, when a single doctor tells you something it is worthwhile seeking more advice and more information. Nasking "whT happens if we jist watch and wait?" Is also a great question to ask.
Luckily this isn't relevant to vaccinations because we're not relying on what one person says, but on an accumulated body of research.
Sure, don't trust the advice of any one doctor; that's alright. With vaccines though, you're deciding not to trust the advice of pretty much every doctor.
I'm not really talking about vaccines in particular but even those aren't as cut and dry as you imply. Take a look at the common MMR vaccine. In 2005 they introduced MMRV which is the traditional MMR plus the addition of a chickenpox vaccine. The WHO recommends MMRV but US health officials don't express a preference one way or another. The side effects of each are different. So clearly there is some ambiguity there. If a doctor recommended one over the other I would want to know what his reasoning was before taking his word for it.
Vaccination for varicella is tricky - if you're going to vaccinate against it, you need to vaccinate hard. It's a great working example of what's known as the "Paradox of Moderate Infection Control" - getting a handle on it just a little bit will cause worse outcomes than if you did nothing at all.
The WHO then, making recommendations for the entire world, logically favors a single "Do it and be done" shot that piggybacks on their incredibly intensive campaigns for MMR vaccination.
In the U.S., a varicella vaccine is a co-occuring part of the recommended vaccine schedule. It's a question of one shot or two, and managing slightly worse side effects for the MMRV vaccine, and thus absolutely sensical to leave it to the clinician and parent to discuss, because the likelihood of the child getting one and never getting the other is quite low, it's just a question of how.
Vaccine schedules are, just so we're clear, not set by "a random doctor w/o supporting reasoning".
They're done by panels of doctors who are experts in that field, and the supporting reasoning is extensive and the result of many, many peer-reviewed studies.
> If the field of medicine is anything like engineering and computer science I'd rather chance my own opinion over trusting the advice of a random doctor
I'd certainly trust a random doctor's medical opinion over a random programmer's (my own). And I think a doctor should trust a random programmer's opinion about software over his/her own.
In both cases, the solution is to find a reputable practitioner, not substitute an untrained opinion for a trained one.
You should trust expert opinion, unless you are expert in given area. To understand medicine you need many years of hard study. Several articles from wikipeida is not enough.
What you are alluding to sounds like it may have it's roots in the Dunning-Kruger effect. I can't seem to find it in the article, but I seem to recall there was also some research done that found people that were considered highly skilled in one area tended to over estimate their skill in many other areas. Anecdotally speaking, I can confidently say that as programmers, we love to do just this!
If anyone knows the research I am referring to, I'd love to look at it again.
Dr. Anne Schuchat, the director of the CDC’s National Center for Immunization and Respiratory Diseases:
“Better diagnosis and reporting of whooping cough may be contributing to the increased numbers, along with the fact that the disease tends to peak and wane in cycles. It does not appear that anti-vaccination sentiment among parents has contributed…”
As someone who's about to become a parent (on the order of weeks now), this drives me up a fucking wall.
My instinct is generally towards politeness[0] so it goes against my nature to get up in people's faces. But I'm wondering if I need to take a hard line on vaccination when it comes to who I allow to spend time with my kid.
I'm struggling with the same right now. I'm not sure how to bring it up yet, but while my daughter is vaccinated, I would prefer to limit her exposure to non-vaccinated children.
It is sad. Vaccines are one of the few truly amazing technologies in medicine. Vaccines are both cheap, effective, and most importantly safe. Where else in medicine is this true?
Everyone is pro-vaccine until you have to jam 3 or 4 vaccines into your own child seemingly every doctors visit and sometimes have to suffer through a "sickness" (but let's not call it that) post shot reaction. I'm not speculating here, just speaking from experience as a parent of two children who knows and speaks with parents of other young children. We're not anti-vaccine but I'm not dancing into the Dr. office with my kids to get it done.
It most certainly is unpleasant, for the parent and for the child. One thing that helps is to keep it mind what the alternative is - having your child actually getting the disease.
One of my middle school classmates (from India) had leg deformities from polio, and could not walk without the help of crutches. He couldn't participate in most school activities, and was teased often. I wasn't able to find out why he wasn't vaccinated, but he was from a wealthy family so we always assumed they were in the anti-vaccination camp. Can you imagine being in his place? He has to suffer for his entire life because of a dumb decision that his parents made.
BTW I realize that polio vaccination does not require painful injections, but just pointing out that there are severe downsides to not vaccinating your child. Most certainly severe than a few jabs.
I'm a parent, I have a sibling who is a parent, and friends with kids. I don't know a parent who wasn't aware that there are side effects to vaccination; any time a doctor does anything to your infant, you're going to be asking questions and they're going to be overcommunicating, and a mild fever after vaccination is an extremely common side effect.
I'm definitely dancing to the Dr's office with my kids to get them vaccinated (when scheduled). There are a lot of vaccines early on, which makes sense, because little kids are highly vulnerable. It eases up as they get older; it's been years since either of my kids got jabbed.
I dance into my pediatricians office to get my kids vaccinated.
Then we get some shots.
Then we do another dance, which has an accompanying song entitled "I just extended you lifespan!"
We also talk about how we're going to get more vaccinations before our next trip because the India has crazy mosquitos and Costa Rica could have bad water.
Vaccinations are wondrous. It isn't that much work to get your expectations to match.
Kids get sick all the time anyway, and almost nothing is directly attributable to vaccine administration. I thought I was really lucky when my household had a healthy stretch between last July and mid-December. That may have been record since my son was born 5 years ago and my daughter 3.
I don't get it. So if things are not fun we don't do them?
Is someone claiming they love to dance to the doctor to see their child in pain?
I have a newborn. He has been upset, in pain, and sick in his first 6 months - we always try to do what is best for him, our family, his health, and public health. Dancing or allowing his discomfort to heavily bias our decisions never even remotely occurred to us.
Most of the scheduled vaccines end around 5 years old other than those you take to go into certain parts of the world. There's a booster every so often but those are infrequent.
Most kids just cry for a bit and get a sore arm, a statistically small percent get a true adverse reaction. It's simply not worth the risk to not vaccinate.
If I understand it correctly, this isn't based on true stats but instead heavily depends on numbers through news reports. I would be tempted to say that's almost as unscientific as the reasons the anti-vaccination crowd uses.
I spend some time playing with the original map and the references for data points I examined more closely always were papers published in journals. This might not be the case for all data points that have been used and I wasn't able to find a comprehensive list of references. It's definitely better than just news reports though.
"The lesson of all this is that vaccination is not an individual choice to be made by a parent for his or her own offspring. It's a public health issue, because the diseases contracted by unvaccinated children are a threat to the community."
Unvaccinated children who contract a disease are only a threat to other unvaccinated children, who are generally unvaccinated by choice. Not sure why this is a public health issue.
Sadly you are wrong. Not all vaccinated children will be protected. Herd immunity keeps even those people safe. When people do not vaccinate they destroy herd immunity, meaning that unvaccinated and vaccinated but vulnerable children are at risk.
My understanding is that the pertussis vaccine, by its nature, does not prevent infection at all. It inures you to the pertussis toxin, causing you to experience milder or no symptoms when you do get infected.
But I must be wrong, because they push for people to handle babies to get the vaccine - wouldn't it be better for those people to feel sick, stay home, and not handle babies when they're infected?
Help me understand.
Since they're finding out more and more that immunity from various vaccines wane faster than thought, why aren't adults who aren't fully up-to-date on their boosters figured into the "herd immunity" argument? I have yet to get a serious response on this anywhere I've brought it up.
They are, which is why there are, for example, very well developed campaigns to get college students caught up on their vaccines, and vaccination campaigns for certain groups at higher risk of either complications from the disease, or passing it on to others (for example, parents, and expectant mothers for certain vaccines).
Vaccines are not force fields that prevent you from contracting a disease. They just lower your chances considerably. So an unvaccinated child can infect vaccinated children.
Vaccinating "eradicates" disease in that it lowers the overall chance of transmission to the point where the disease can't effectively spread. A bunch of unvaccinated kids raises that overall chance back up and can cause outbreaks.
There are many unvaccinated people who are not unvaccinated by choice, such as children who are too young to be vaccinated, and people who are allergic to the vaccine.
Q: playing with http://www.cfr.org/interactives/GH_Vaccine_Map/#map there seems to be pretty significant Measles presence in Europe although (aside from the UK) I'm not aware of any specific anti-vaccination movement and there's no whooping cough and only localised mumps (greece, a pair of outbreaks in Germany, the Netherlands or the iberic peninsula) and rubella (Poland, Romania) clusters. For instance, aside from (the significant) 15000 cases of mumps France is completely free of vaccine-preventable outbreaks. So are Italy, Switzerland or Belgium.
Given mumps is endemic in much of the developing world, especially northern india, pakistan and sub-saharan africa, could the measles outbreak in much of europe be in (unvaccinated and potentially partially contaminated) immigrant communities rather than a specific anti-vaccination movements?
Mumps is a disease of childhood in places where it's endemic and prevalent, which would suggest most immigrant communities would not actually be the source, though for very small clusters, small ethnic or religious communities (not necessarily foreign ones - the Dutch outbreaks for example are just religious groups) can be the source.
As for some of the other countries in Europe, while there's less of a vocal anti-vaxx movement, the vaccination rate in the Swiss has been dropping for the better part of a decade now.
According to the CDC, 90% of measles cases in the US originate from outside the country. In other words, the disease spreads by people travelling. Outbreaks in Europe are probably caused by vacationing Europeans, rather than immigrants.
I am alarmed by how difficult it is to get a consensus on this matter that should be able to be put to rest via empirical data. As a side effect impotence in regard to rationally approaching the vaccination issue, we have people with a lot of power on both sides, saying the exact opposite thing, which hints at a far more systemic issue with the way that some people seem to approach problems today. Are we incapable of having rational approaches to real and lethal issues in the world? I worry about where else in our national psyche this type of thought process has leaked into...
That may not be true, and actively isn't true for other parts of the developing world.
I rather vividly remember a presentation given by PAHO a couple years ago on their rubella control efforts in South America, and how frustrating it was to have outbreaks kicked off by import cases from wealthier European and North American countries.
This is based on a report by the Council on Foreign Relations. Members include:
Bank of America Merrill Lynch, Chevron Corporation, Exxon Mobil Corporation, The Goldman Sachs Group, Inc., JPMorgan Chase & Co., McKinsey & Company, Inc., Bridgewater Associates, LP, Kingdon Capital Management, Kohlberg Kravis Roberts & Co...... and the list goes on.
> There's no easy way to verify the URL if I'm using a mobile device.
The URL typically contains a token that would indicate it. In this case, the URL is "touch." but you also typically see "m." or "mobile."
> What's the disadvantage of the mobile site on a desktop?
Depends on the site. In the case of LA Times, it works very well. Other sites have a bad Mobile -> Desktop experience just like they have a poor Desktop -> Mobile experience.
Either way, I don't give a damn. I'm just playing Devil's Advocate.
As said below their would be a difference in the subdomain.
The only difference is with the LA Times is it turned out decent looking. This is the second mobile site I clicked on today and the other one was horrible for desktop.
here is remarkably problematic. It's good that this graphic has a lot of uptake and spread around the Internet, but I had to go back through a chain of about four repostings to find the map as it started out. The team at the producers of the original map should study more usability for Web display of data as they prepare to share this important message.
The link you post is the third link appearing in the article, it's prominently featured in the first paragraph, and the map is directly attributed to it in the text. I have a hard time imagining how finding it could be less problematic. Did I misunderstand your comment?
One of the saddest developments of 2013 was the polio outbreak in Syria. [1] It's even more disheartening considering that part of the world pioneered vaccination. [2]
Used to be offered in schools in the UK, probably still is. There was huge media coverage of the faux science that fingered MMR specifically for a link with Autism, which resulted in a large backlash and calls for alternatives. I forget if the government caved or not.
Oh, and it was the usual culprits: right-leaning press, both the reactionary, hateful kind (Daily Mail), and those that should know better (Telegraph.) And of course there was the undertone of anti-big-government there.
People tell me I should not worry about the Daily Mail. They can print all they like, what's the harm? Well, here it is.
Do any of the source links provided in the circles work? Almost all of them are 404 or non-responsive servers.
Also, it looks like some of the bubbles are duplicates, one is 4000 in California, then one from a few months later is 5000 and it looks like the 5000 is a report that just adds 1000 more to the previous report, but it's counted as two separate things.
Vaccine does have some pretty heavy side effects though. The worst being an evolutionary pressure against stable virus, leading them to evolve towards instability, causing future virus to be much more severe (as in HIV like)
Vaccine escape, which is the phenomena you're talking about, is extremely rare, and as far as I'm aware has never been observed in most vaccine preventable diseases.
The exception is perhaps influenza, but that's mainly because the flu vaccine is one of the few "moving target" viruses we have a vaccine against.
Whenever I read the words "herd immunity" my eyes roll over.
It sure feels good to be a free loader every once in a while. And let's not forget that medicine is not engineering or mathematics. I 've met quite a few doctors and my impression is that their average IQ does not compare very favorably with that of coders or engineers. And let's not forget that the medical profession has a very long history of suppressing inconvenient truths or adopting a condescending attitude towards anyone who dare challenge their authority. Plus when I pay a "doctor", I expect him to advise me what's best for me, in my narrow little case, not what's best for the society as a whole. But then again I suppose that if the Government wants me to take those shots it must be for my own good, right? I mean, who am I to decide what chemicals and "weak" viruses get injected into my own body?
An old riddle asks what you call the guy who graduated last in his medical class: doctor, what else?
But anybody licensed to practice has spent a lot more time studying medicine that your average coder or engineer. Among the matters they have studied is the current best understanding of vaccines. It isn't the guy last in his class who's coming up with the recommendations that the others follow. And what's best for you in your narrow little case is very likely most of the time what's best for the "herd".
Herd immunity is a "tragedy of the commons" type of game. Case closed. Unless you can prove that a rational actor would chose in his own self-interest to cooperate in which case you might get considered for a Nobel prize in economics.
Whether or not we can achieve herd immunity is a tragedy of the commons type game, though it's hardly "case closed" - I know several researchers working in that particular area. The existence of herd immunity is a relatively easy calculus problem.
I've met quite a few doctors and my impression is that their average IQ does not compare very favorably with that of coders or engineers.
You have undoubtedly met fewer doctors and fewer coders and engineers than I have. (I'm older than most people on HN.) Anyway, IQ is not the relevant issue. The issue is specific training and clinical experience. For equal IQ scores, I will ask engineers to solve my engineering problems, and doctors to diagnose and treat my diseases. If each professional has passed the required training course and has continued in practice with a license with good reputation, I don't need to ask IQ scores before I seek a doctor or seek a coder. What's important is getting the work done right, and doctors have better background for doing medical work than engineers or coders.
tl;dr: We need a new vaccine. Tilting at small populations of anti-vaxxers may feel satisfying, but it is ultimately counterproductive, especially in this case.