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"It took more time than it should have for them to be put in isolation"
March 20, 2014 11:48 AM   Subscribe

In the past weeks, there have been 20 confirmed cases of the measles in New York. After being virtually "eradicated" in the United States in 2000, 2013 saw 189 cases reported. The most recent outbreak seems to have spread due to "failure of medical workers to recognize the disease quickly enough and to quarantine patients so they would not infect others." And via Slate: "I’m a Pediatrician. Should I Treat All Kids, or Just the Vaccinated Ones?"
posted by roomthreeseventeen (232 comments total) 25 users marked this as a favorite

 
Would you expect Drs to recognize a disease that's been virtually eliminated ?

(that said, given the rash, you'd think that would ring a bell, vs more non-specific symptoms of fever, malaise, etc But would small pox be recognized any more ? )
posted by k5.user at 11:52 AM on March 20


My mom is a nurse in a pediatric office and I feel horrible for doctors / nurses who have to deal with the anti-vaccine parents.
posted by glaucon at 12:02 PM on March 20 [16 favorites]


would small pox be recognized any more?

Yes. It's...distinctive. Don't google "smallpox" for pictures. Once you've seen it you will never forget it. You will want to forget it.

The vaccinators of The Order of the Bifurcated Needle did more for humanity than any group in human history.
posted by justsomebodythatyouusedtoknow at 12:08 PM on March 20 [17 favorites]


Wait.. This is 2 out of 20 whose parents declined vaccinations. Out of the 11 adults, only 3 could prove with records they had been vaccinated, but shit, I've been vaccinated, but it would be hard to prove it. I don't remember my pediatrician's name. So it doesn't mean that the other 8 adults haven't been vaccinated, just that they didn't have records stating so.

So is this a consequence of non-vaccinations or a super measles?
posted by Debaser626 at 12:08 PM on March 20 [2 favorites]


It's theoretically relatively difficult to get a religious exemption, with schools being authorized to require additional documentation and reject it if they think it is inadequate. There are no philosophical exemptions. In New York City, it looks like some serious work is required and religious objections have been rejected.

If this can happen in a city where school age children almost always have to be vaccinated, it terrifies me to think what will happen if it hits a region with looser standards.
posted by Hactar at 12:08 PM on March 20 [3 favorites]


I'm still a little confused about whether adults need a measles booster-- I don't think I do, but there is a helpful guide to the vaccine and schedules here.
posted by jetlagaddict at 12:14 PM on March 20 [2 favorites]


Failure of medical workers to recognize the disease? Really? It seems more like rank ignorance borderong on denial. Doctors don't see a lot of things on a regular basis, but are expected to be able to make a diagnosis all the same. Measles are way easier to recognize than most cancers.

Where are the trial attorneys? A few million dollar awards would solve this problem faster than anything else.
posted by three blind mice at 12:16 PM on March 20 [5 favorites]


I don't remember my pediatrician's name. So it doesn't mean that the other 8 adults haven't been vaccinated, just that they didn't have records stating so.

Here's an additional layer to the problem, those of us born in the early sixties were vaccinated with a strain that petered out. When I re-enrolled in college in 2000, they took my blood to scan for titers, found none, and I was re-vaccinated.

The weird thing was I did have my records. I had a little card given to new parents by Lederle for the purpose of writing down the vaccination type and date on the card, and the time for the booster shot.

So, I'm protected, but I'll be Husbunny isn't.
posted by Ruthless Bunny at 12:17 PM on March 20 [4 favorites]


According to the CDC, 5% of children who receive two doses of the MMR vaccine are not protected from measles. Getting vaccinated yourself gets you to 95% -- we need herd immunity and a high rate of vaccination in your community to get to 100%.
posted by telegraph at 12:20 PM on March 20 [27 favorites]


I don't know what we can do about these people. They are immune to logic, reason, and pleas of civic duty. Anti-vaccination is a religion for them.
posted by Justinian at 12:24 PM on March 20 [29 favorites]


I actually know someone who's against vaccines. She thinks they're a scam, and cause disease or something. But she's a perfectly nice, seemingly reasonable person. I was shocked, and terrified.
posted by bleep at 12:28 PM on March 20 [5 favorites]


I surmise that the vast majority of small children I know socially are not vaccinated - my circles have far more than their fair share of anti-vaxxers, which depresses me. But I've gotten into so many arguments where I am the lone person saying "food cooked in the microwave is safe" and so on and everyone looks at me like I'm either a dupe or history's greatest monster that I just don't want to touch anything which can be framed as "Frowner wants us to subject our children to the medical-industrial complex". I think I'll be getting that second measles shot in the next couple of weeks just to be on the safe side.
posted by Frowner at 12:29 PM on March 20 [37 favorites]


Failure of medical workers to recognize the disease? Really?

In their defense, it's not like the doctors stand at the door of the hospital (although I hear they're screening in the emergency rooms now). You come in, you get your paperwork, you sit down- how long does it take before you see a member of the medical staff?
posted by ThePinkSuperhero at 12:31 PM on March 20 [3 favorites]


Fuck it. I'm not a medical professional and am not bound by any medical ethics. Give me some needles and a good address book and I'll take care of this.
posted by Bunny Ultramod at 12:33 PM on March 20 [74 favorites]


Failure of medical workers to recognize the disease? Really? It seems more like rank ignorance borderong on denial. Doctors don't see a lot of things on a regular basis, but are expected to be able to make a diagnosis all the same. Measles are way easier to recognize than most cancers.

I am not a doctor, nor have I ever had the measles. But from what I've read, it does seem like the first signs of the measles are pretty generic--fever, coughing, conjunctivitis, days before the characteristic rash appears.

I'm wondering if a patient was brought into a doctor's office, prior to an outbreak of the rash, would it be reasonable to suspect measles, since it's a disease that's been effectively eliminated?
posted by inertia at 12:34 PM on March 20 [3 favorites]


I live in a state which recently had a whooping cough outbreak, and I have a two year old and her unborn sister, and I really am starting to think drones with vaccination-filled blowdarts might be the best solution.
posted by selfnoise at 12:36 PM on March 20 [40 favorites]


since it's a disease that's been effectively eliminated?

Not as effectively as we thought.
posted by yoink at 12:36 PM on March 20 [1 favorite]


My husband had the measles in the early 1950s. His parents just thought he was sick with flu until he finally presented with the rash and almost died.
posted by roomthreeseventeen at 12:37 PM on March 20


The "failure of medical workers to recognize the disease quickly enough and to quarantine patients" sounds like a bad waiting room system.
Kids are really really good at picking up all sorts of bacteria and viruses when they go to kindergarden. Mine brought home a few different variants of the Norovirus in one winter season, poor thing. Well, there was a particularly nasty one going around and she was in an awful state so I decided that I needed to take her to the doctor. As soon as I entered the waiting room there were signs describing her symptoms and stating "if you child has these symptoms, go to the room on the left". Yes, that's right, we weren't allowed to wait in the same room as anyone else! Pretty clever, huh? That sign changed with whatever bug or virus was going about, and the waiting room on the left is always there for quarantine. Why isn't this a system everywhere?
posted by dabitch at 12:39 PM on March 20 [7 favorites]


As already pointed out in this thread, the measles present like the flu at the start. Flu-like symptoms wait in the room on the left......
posted by dabitch at 12:41 PM on March 20 [2 favorites]


Vigilante vaccination. I like it.
posted by oceanjesse at 12:42 PM on March 20 [4 favorites]


Comparable with the Swansea epidemic last year, brought about by the anti-MMR bullshit in the 1990s.
posted by GallonOfAlan at 12:45 PM on March 20 [1 favorite]


I can't believe NYC has only seen 20 confirmed cases so far. We're all so close together! Riding the same trains all day every day.
posted by ThePinkSuperhero at 12:47 PM on March 20 [2 favorites]


Give me some needles and a good address book and I'll take care of this.


Let me use a blowgun and I'm in
posted by Fists O'Fury at 12:47 PM on March 20 [6 favorites]


A pediatrician's office next to my dentist's office has two entrances -- one for kids getting non-contagious medical, one for sick kids. I like that solution, wish my regular doctor and the local clinic had something similar. Just because I twisted my ankle doesn't mean I really want to be exposed to every germ and virus making the rounds.
posted by Blackanvil at 12:49 PM on March 20 [1 favorite]


Vaccinations do not last a lifetime. The CDC publishes a re-vacc schedule.

As for the monsters who don't vaccinate their children: it's child abuse, plain and simple.

It's also a distinct and real threat to our society, and it should be the law that children be vaccinated. If we can make JWs accept transfusions for their children, we can make idiot parents vaccinate their little plague rats.

Make Vaccination the Law.
posted by five fresh fish at 12:49 PM on March 20 [49 favorites]


I live in a state which recently had a whooping cough outbreak

We've got a baby on the way sometime in the next few days and it turns out that NY mandates that hospitals offer pertussis boosters to any adults who might be in frequent contact with the newborn. You don't have to take it, but they have to offer it. Won't stop the loonies from refusing, but at least it makes it easy for the rest of us.
posted by uncleozzy at 12:50 PM on March 20


Yeah, for reals: get re-vaccinated for Whooping Cough, people. I got it in 2010 and it sucked major donkey balls (thanks anti-vax losers!). The CDC even recommends it for adults.
posted by gsh at 12:51 PM on March 20 [2 favorites]


Make Vaccination the Law.

I don't see how that could ever be legally justified in the US
posted by MisantropicPainforest at 12:52 PM on March 20 [3 favorites]


...I really am starting to think drones with vaccination-filled blowdarts might be the best solution.

But if everyone gets drone-vaccinated ahead of time, how will we find the next Osama Bin Laden when we need to?
posted by XMLicious at 12:53 PM on March 20


Vaccinate the water supply.
posted by Apocryphon at 12:54 PM on March 20


Anectotally...When I was a kid way back in the early 60's, it wasn't unusual, when a child in the neighborhood came down with measles or chicken pox, for mothers to send their healthy kids down to the sick kids' house to hang-out and play with the kid. The idea, of course, was to get their kids sick so as to develop resistance.

So...Question...Do the anti-vaxers practice this "natural" inoculation?
posted by Thorzdad at 12:55 PM on March 20 [3 favorites]


My pediatrician had a two waiting room system as well--a well care and a sick care waiting room. However, the health department recommends that anyone with measles be put into isolation--not just lumped into a room with other sick people with all sorts of different illnesses.
posted by inertia at 12:56 PM on March 20


Also my coworker had whooping cough recently--I should probably go get myself a booster.
posted by inertia at 12:57 PM on March 20


So...Question...Do the anti-vaxers practice this "natural" inoculation?

Yes they do. They do chicken pox parties and there also exist Web sites where you can get sputum from sick kids mailed to you in order to infect your own. Yup.
posted by killdevil at 1:00 PM on March 20 [3 favorites]


For what it's worth, the pertussis booster is usually teamed with diptheria and tetanus, so if you're as accident-prone as I am, you may have had one in the last ten years.
posted by uncleozzy at 1:01 PM on March 20 [2 favorites]


Thorzdad, I don't think measles work the same as chicken pox, where you are usually immune once you've had it. I've heard of the parties as well, but only for chicken pox.
posted by soelo at 1:02 PM on March 20 [1 favorite]


If you take a look at this map of measles outbreaks last year, it's interesting and not suprising that most of the outbreaks tied to non-religious communities were in, mmm, 'progressive' parts of the country - San Francisco, Denver, LA, Portland, Seattle.

I mean, I love Portland, but last I checked something like 80% of kids in charter schools weren't vaccinated.
posted by Lutoslawski at 1:02 PM on March 20 [2 favorites]


and there also exist Web sites where you can get sputum from sick kids mailed to you in order to infect your own

or if you just have a collection
posted by FAMOUS MONSTER at 1:02 PM on March 20 [33 favorites]


I don't see how that could ever be legally justified in the US

See the recent redefinition of the word "imminent" for NSA purposes. Vaccination is basically the same thing as quarantine, once things that happen years before the outbreak of an epidemic / public emergency can count as imminent!
posted by XMLicious at 1:04 PM on March 20


soelo, I've had the chicken pox twice. Once when I was three and once when I was seventeen, after having the chicken pox vaccination.
posted by roomthreeseventeen at 1:04 PM on March 20


get re-vaccinated for Whooping Cough, people.

Usually it comes for free when you get your tetanus booster.
posted by jeather at 1:05 PM on March 20


soelo, I've had the chicken pox twice. Once when I was three and once when I was seventeen, after having the chicken pox vaccination.

Me too!

The second time was horrible. They aren't kidding when they say it's worse for older people.
posted by winna at 1:05 PM on March 20 [1 favorite]


The second time was horrible. They aren't kidding when they say it's worse for older people.

Yeah, I think some people are just prone to getting it a second time, even with vaccination. The second time was awful for me as well. I had chicken pox everywhere, including in my ear. I still have pretty bad scarring.
posted by roomthreeseventeen at 1:07 PM on March 20


They do chicken pox parties and there also exist Web sites where you can get sputum from sick kids mailed to you in order to infect your own.

How is intentionally making your child sick not child abuse?
posted by inertia at 1:08 PM on March 20 [6 favorites]


Because its no different than giving your kid medicine when they are sick that may upset their stomach
posted by MisantropicPainforest at 1:09 PM on March 20 [4 favorites]


"If you take a look at this map of measles outbreaks last year, it's interesting and not suprising that most of the outbreaks tied to non-religious communities were in, mmm, 'progressive' parts of the country - San Francisco, Denver, LA, Portland, Seattle."

Is this really a liberal thing? The one guy I know on Facebook who doesn't believe in vaccinations is a libertarian. There are pretty big pockets of libertarians in the "progressive" Northwest.
posted by ChuckRamone at 1:10 PM on March 20


>last I checked something like 80% of kids in charter schools weren't vaccinated.

80%?!?!?!?!?!?!?!?!??!!??!?!?!!?!
posted by ghostbikes at 1:11 PM on March 20 [12 favorites]


I actually really enjoyed having the chicken pox. A week off from school with lots of popsicles and movies? Well worth the pain! That was also the week I first saw ET.
posted by Lutoslawski at 1:11 PM on March 20


I don't know what we can do about these people.

I do: vaccinate their kids against their will.

They are immune to logic, reason, and pleas of civic duty.

They are indeed. So just use force.

I don't see how that could ever be legally justified in the US

States could easily require all their residents to be vaccinated under their general police power. They wouldn't need to pay much attention to religious claims since it would be a clearly neutral law of general application, and the circumstances where your religion excuses you from obedience to such a law are very small.

The feds could probably require it by relating it to the interstate travel or something like that.
posted by ROU_Xenophobe at 1:12 PM on March 20 [3 favorites]


80%?!?!?!?!?!?!?!?!??!!??!?!?!!?!

Felt like I should probably cite this. I feel like I've seen more recent numbers with rates >80%, but even these stats from 08-09 have Cedarwood Waldorf at 78% exempt and Portland Waldorf at 64% exempt.
posted by Lutoslawski at 1:15 PM on March 20 [9 favorites]


Right, I said "usually". The reason for the parties is the high number of people who only get it once and the parents wanting to control when they get it. This was popular before the vaccines came out, but it is still practiced. I am not endorsing it, btw, just explaining the pre-vax rationale.

I was 9 my one and only time. I am glad I got it then because otherwise the assumption was that I had it in utero. I doubt that is even possible, but that was the family theory until I got it for real. Is 9 even that old to get it for the first time?

My main point was to ask if measles was ever seen as a "have it once and probably be immune forever" thing like chicken pox was. I've never heard that before.
posted by soelo at 1:15 PM on March 20


I think chicken pox parties were fairly common before the vaccine. Not in the sense that parents would mail it to each other to inject, but that if one kid on the block had it, all the other kids would be sent to play with that child so that they would get it as young people, too.
posted by roomthreeseventeen at 1:17 PM on March 20 [2 favorites]


I don't know what we can do about these people.

As a purely practical matter, I'd like to see a higher level of restrictions on school, employment and volunteer activities, particularly those which are funded by tax dollars.

Unvaxed kids can't go to schools. Work and volunteer participation are restricted for unvaxed adults (e.g. can't work with kids or in nursing homes, can't volunteer for youth, elderly or at-risk population services). No use of public facilities for adults or kids, like pools or health clubs. Allowable heath coverage costs go up to cover higher risk factors.

Ideally, you'd want to exclude any carrier of disease from contact with others, and make them bear the increased risk and thus monetary costs of choosing to not vaccinate.
posted by bonehead at 1:18 PM on March 20 [33 favorites]


Unvaxed kids can't go to schools.

Unless they have a medical waiver.
posted by jeather at 1:22 PM on March 20 [10 favorites]


Thorzdad, I don't think measles work the same as chicken pox, where you are usually immune once you've had it.

You can only get measles (well, each of the two kinds) once. After you've had it you usually have lifetime immunity. I think the rationale for having healthy kids play with infected kids (not, I think, that it was ever all that common a practice) was that it was better for kids to get these diseases as children than to get them as adults. In general that wasn't a totally irrational idea.

States could easily require all their residents to be vaccinated under their general police power.


Perhaps, but I think you'd be hard pressed to make the case that such a massive imposition of state power was justified by the actual harms that one is seeking to prevent. Prior to the widespread use of the measles vaccine, measles caused approx 400-500 deaths per year in the US. It's certainly tragically stupid that people choose to subject their own and other people's children to such an easily preventable risk, but it's still, in fact, a very, very small risk (especially because you're talking about mitigating the marginal increased risk caused by parents who refuse to vaccinate their children, not about whether or not to have any children vaccinated at all).
posted by yoink at 1:22 PM on March 20 [5 favorites]


My mom is a nurse in a pediatric office and I feel horrible for doctors / nurses who have to deal with the anti-vaccine parents.

My pediatrician has come up with his solution: if you don't want to vaccinate your kids that's fine, but he just can't be your doctor anymore.

No more arguing with parents, no more worries about silent carriers infecting others (and unvaccinated babies) in the waiting rooms. He's just capital-d Done with dealing with it.

But that also got me thinking. Doctors that band together and say "no anti-vaxxers" will lead to doctors that will welcome that crowd, concentrating them all in one place. That can't be good either.
posted by JoeZydeco at 1:23 PM on March 20 [9 favorites]


I don't think it's true that sending people with flu-like symptoms into a separate waiting room would be effective as a "quarantine." First, it's the tail end of flu season. Lots of people are going to end up in that waiting room, all of them exposed if it turns out that one of them has the measles. Second, as cited in the article, people can be infected by droplets that remain in the air two hours after the infected person leaves the room. Even if you walk down a short hallway to get to the emergency room, or through a doorway vestibule, you could be exposed if somebody with measles came through there an hour ago.

Quarantine means masks and a room to yourself that is specially cleaned between each visitor, and it means that somebody has to put you in there from the moment you arrive at the hospital or clinic. I find it really amazing that they're having security guards screen for symptoms. To me that seems way outside their scope of practice (given that they're not even medical professionals at all), but it might be the only way to catch these cases early enough to prevent it spreading.

Maybe we just need to make everyone put on a mask from the moment they exit their car, and put them all into individual, negative-air-pressure cubbies to wait to be seen. Someplace that can be sealed and heated to 1000 degrees between patients.
posted by vytae at 1:27 PM on March 20


Actually, one I'd really like to see, but can't see how you could actually do it: restriction on use of buses, trains and airplanes. My wife was never so sick as when she had to take public transit to work in the winter time. She's started commuting by car largely to stop her chronic sinus infections. It's worked pretty well.
posted by bonehead at 1:27 PM on March 20 [5 favorites]


If you are unsure about your own immunity, you can get a blood test done. Whether insurance will pay is a completely separate issue.

Every time one of these outbreaks occur, I get nervous and frustrated with the anti-vaccine contingent. As I stated in a previous thread, I have a documented allergy to the MMR vaccine and can not get the booster. A significant outbreak in my area would mean yet another blood test (the 4th since I was 17) to check my immunity. If it is too low, I would have to remain in isolation until the outbreak was over. I have a healthy immune system and can work from home. I can't even begin to imagine the inconvenience for someone with a compromised immune system who is required to show up every day or end up unemployed.
posted by theBigRedKittyPurrs at 1:28 PM on March 20 [15 favorites]


MisantropicPainforest: "Make Vaccination the Law.

I don't see how that could ever be legally justified in the US
"

I don't see how searches without warrants could be justified, or locking prisoners up indefinitely without trial could be, or hoovering up the collective data of all the communications in transit could be, but, well... here we are!
posted by symbioid at 1:29 PM on March 20 [9 favorites]


Regarding Chicken Pox Parties, they were definitely a popular thing in the UK at one point. The disease is much nastier in adults than in children, so without a vaccine it makes sense to ensure that your kid catches it young.

Interestingly, the NHS doesn't routinely vaccinate against chicken pox. There's evidence that being vaccinated (as opposed to catching the disease young) increases your chances of developing shingles later in life,* and presumably someone in the NHS (well, probably in NICE) has done a load of stats and decided that kids getting chicken pox is less of a problem than adults getting shingles.

I actually know someone who's against vaccines. She thinks they're a scam, and cause disease or something.

I've met a disturbing number of anti-vaccine people. My mum is a primary school teacher, and meets many more. Lovely people, often very smart and well-informed about the world, and utterly convinced that vaccines are some combination of unnatural**, ineffective, dangerous, and, in more than one instance, actually some kind of timed-release pathogen cocktail designed to make you sick at whatever intervals through your life are most profitable to drug companies.

In many cases I'm pretty sure it's a full-blown faith position. You're too smart to be fooled by Big Pharma, taking a natural and holistic approach to health, and more independent-minded than most. Believing feels good. And, as the saying goes, you can't reason someone into a position that they didn't reason themselves into.

With that said, there are also plenty of perfectly well-meaning and open-minded people who have been taught a lot of bullshit about vaccines, and made decisions that are perfectly rational within that context. If you don't have the education or time to really get into it, one "health expert" with a white coat and a TV slot sounds pretty much like any other, and how much can we vilify people who had the misfortune to believe the wrong one? We should definitely go after the fuckers who make a living peddling the lies, of course.

*IIRC, it's something to do with developing Th1 vs Th2-mediated immune response: making white blood cells that kill infected cells vs. making white blood cells that pump antibodies into your bloodstream to mop up free-floating virus. It's a long time since I read about it, though.
**Totally unscientifically, my impression is that the more strongly someone argues it's unnatural, the greater the chance that they're at the hippie-ish end of the spectrum and either smoke or take recreational drugs made from and cut with god-only-knows-what. It's a weird blind spot for some people.

posted by metaBugs at 1:34 PM on March 20 [5 favorites]


According to wikipedia, measles still manages to kill 1/300 kids these days (3/1000).

It's not just measles, though. Those same kids aren't being vaccinated against mumps and rubella, both of which cause a 30% miscarriage rate in pregnant women, and have about the same rate of damaging men's and women's gonads. Rubella also cause awful birth defects in those fetuses it doesn't kill. Note that pregnant women are likely to be in contact with children, unlike us childfree types.

If you want to be a citizen in our society, you have to vaccinate. Don't like it, shove off to the Taliban-controlled territories.
posted by five fresh fish at 1:34 PM on March 20 [4 favorites]


I got shingles and man does that suck. I no longer think chicken pox is a harmless illness. I've had chronic pain for the past few years since I had shingles. At first I thought the chicken pox vaccine was silly and seemed optional because everyone gets chicken pox right?! My wee one most def got his chicken pox vaccine.

But I really don't think we need everyone to have this virus hanging out in your nerves waiting to infect people during times of stress or low immunity or whatever reason. Bleh. Seriously painful and there is not much they can do for shingle neuralgia which apparently can last a lifetime (though mine has subdued slightly over the past few years)

But I am going to have to go with yoink on this. Especially when you consider child deaths from car accidents and the implications for other legislation on human behaviors that pose an even greater risk to child welfare that the state currently is not forcing compliance about. (Though I'm not opposed to some such regulations I just just think without being willing to start with the things that pose even greater risk it strikes me as very politically and emotionally loaded attempt at use of state control to enforce social norms rather than a legitimate desire that safety should become more important than freedom in just this one aspect of life as opposed to others.) What I think they need to do is make a "natural" vaccine, targeted to people who like "holistic health" that is essentially the same but with nicer sounded adjuvants-- like coconut oil or something trending (not saying that would work, just you know, something more marketable to the target crowd).... and market it to the naturapathic docs and explain it in silly woo terms to the homeopaths... this is homeopathy and it works on atomic essence and stuff... like.. uh ... loooove... and we diluted it for sures.

See? Problem solved. A lot of people are worried about the aluminum and other ingredients that go along with the vaccine more than the vaccine so at least for that crowd it would probably be a good sell. I can see it now "Vaccines! Now with a hint of natural lemon essence"
posted by xarnop at 1:37 PM on March 20 [2 favorites]


If someone ever invents a sprayable vaccine and time-travel, we're going to save a lot of lives!
posted by blue_beetle at 1:38 PM on March 20


I think it is going to take quite a tragic situation to change the unserious way this topic is presented in US (and UK) media as just another issue with "two sides."

You may not believe in science, but reality believes in you.
posted by spitbull at 1:41 PM on March 20 [41 favorites]


I think in a number of places once there has been an outbreak if you have measles you are supposed to STAY HOME and let the medical care come to you.
posted by jeather at 1:41 PM on March 20 [1 favorite]


Felt like I should probably cite this. I feel like I've seen more recent numbers with rates >80%, but even these stats from 08-09 have Cedarwood Waldorf at 78% exempt and Portland Waldorf at 64% exempt.

The highest in my town (which is sort of Portland-ish) was 55% at a Waldorf school.

The overall rate was 7.4% for incoming kindergarteners, the private school rate was 18.5%.
posted by madajb at 1:42 PM on March 20


I know, as I say, lots of anti-vaxxers. Nice people, engaged in the community, smart, creative. Generally people who have had a lot of bad run-ins with the medical establishment or the law or both - people who have been treated very unfairly by large bureaucracies, who have had difficulty accessing quality medical care so they associate doctors with people who patronize you, ignore your symptoms and either misdiagnose you or withhold things like pain pills because the poors are just drug-seekers. "Caught between the doctor and the magistrate" would be a good description. Basically people who have very, very good reason to be deeply skeptical about "for your own good" legislation and social practices who also often haven't received a very good scientific education due to attending lousy schools. They're people I like a lot because they are rightly skeptical of a lot of bad stuff, but they're still wrong about vaccines.
posted by Frowner at 1:43 PM on March 20 [33 favorites]


You're too smart to be fooled by Big Pharma, taking a natural and holistic approach to health, and more independent-minded than most.

This is what I keep hearing from moms around here. They've "done a lot of reading" and they don't trust anything mainstream. A lot of them are also really into using essential oils as medical treatment and avoiding doctors as much as possible. Because they're more "educated". There is absolutely no reasoning with them, they just feel persecuted for their beliefs and pity for your poor, toxic, vaccinated children. It's very much like a religious belief.
posted by waterlily at 1:45 PM on March 20 [9 favorites]


Perhaps, but I think you'd be hard pressed to make the case that such a massive imposition of state power was justified by the actual harms that one is seeking to prevent.

It would only need to pass a rational purpose test, which sloppily just means

(1) A valid goal that isn't itself forbidden by the Constitution
(2) A means of reaching that goal that isn't clearly and obviously nonsensical
posted by ROU_Xenophobe at 1:45 PM on March 20


five fresh fish: "mumps and rubella, both of which cause a 30% miscarriage rate in pregnant women, and have about the same rate of damaging men's and women's gonads"

A middle-aged relative of mine is sterile because of the mumps when they were 3 years-old.
posted by wcfields at 1:46 PM on March 20


My wife was never so sick as when she had to take public transit to work in the winter time.

Uggghhhhh, yes. I cannot even begin to count how many uncovered coughs I heard on the train this winter. Ugly bags of mostly diseased water.
posted by Steely-eyed Missile Man at 1:49 PM on March 20 [6 favorites]


MetaFilter: Ugly bags of mostly diseased water.
posted by one more dead town's last parade at 1:53 PM on March 20 [24 favorites]


The CDC has a schedule for adult immunizations, too. We can all do our part.

I recently had a mild case of shingles at 38 yrs old. Even my mild case made my skin feel like it was on fire. This and a cervical cancer scare in my 20's has made me a fervent vaccine advocate.
posted by Foam Pants at 1:53 PM on March 20 [7 favorites]


1. I have a cousin who wouldn't vaccinate her two kids. (They're probably ~17 and ~22 now.) She wasn't a conservative -- she was a hippy-dippy liberal and a wack job. I don't know what her specific beliefs regarding vaccinations were, but I do know that her two kids never went to school. Like, in their lives, they never went to school. They were theoretically "homeschooled," except my cousin didn't give them a curriculum as much as an education on how to deal with hard knocks. The older one ended up getting pregnant at 15, and the younger one will almost certainly end up in jail at some point in his life, because he's already been caught racking up thousands of dollars on relatives' credit cards. (They declined to press charges; I have no idea why.)

I'm not drawing any causal link to vaccinations (or lack of) and teen pregnancy or criminal potential. Just saying that my cousin is a bad parent, and not solely because of her stance on vaccinations, and her kids have suffered greatly for it and will continue to suffer for the rest of their lives. (But hey, she's also committed elder abuse against her mom, so she's really just kind of shitty all around.)

2. I have a high school classmate who has adopted three special needs kids. The first one "developed" autism after his first round of vaccines, and then "regressed further" into autism after his second vaccines. Despite knowingly adopting an infant with known health issues from a developing country, she's convinced that the vaccines caused his autism. (She has a blog about it which is fairly popular among the anti-vax crowd, and which is how I know her stance.) It's impossible somehow for her to recognize that maybe this infant was going to develop autism anyway, and that it could have been coexisting/comorbid with his other health problems, but that he didn't show the signs as a babe in arms. She is convinced -- likely by the religious community to which she belongs -- that the vaccines did it.

Conclusion: People are weird and baffling and sometimes you can't educate them out of that, either because of The Crazy (as in my cousin's case) or The Word of the Congregation (as in my classmate's). And that sucks for the rest of us.

3. I've never had the chicken pox and am terrified of contracting it as an adult. However, my dad also never had it, nor did two of his sisters. I almost feel like we should be part of a study, because it appears that we have some sort of immunity to the virus. (Knock on fucking wood, because I don't want it.)
posted by mudpuppie at 2:07 PM on March 20 [5 favorites]


Failure of medical workers to recognize the disease? Really? It seems more like rank ignorance borderong on denial. Doctors don't see a lot of things on a regular basis, but are expected to be able to make a diagnosis all the same. Measles are way easier to recognize than most cancers.

posted by three blind mice at 3:16 PM on March 20


You're kidding, right? Measles was practically eliminated in the US; I'm not even sure med school students are being taught about it beyond a passing mention in class (though given recent outbreaks, that may be changing).

I keep hearing anecdotal stories about measles being diagnosed in kids by concerned grandmas, great-grandmas, elderly aunties, and the like--women who are old enough to remember what it looked like. I know one guy who, when he came down with whooping cough a few years back, was sitting in the hospital when one of the doctor's brought a bunch of med students so they could hear that distinctive, rib-cracking cough.

The downside of eradication is that people forget. Oh, sure, the textbooks and the medical records remember. But the actual experience of seeing the symptoms arise in a child? That knowledge slides away quickly. A number of people have already forgotten the horrible things that measles and rubella and whooping cough can do to both kids and adults; that's why they fear vaccines more.

I did my part. After a thread on Metafilter about yet more anti-vax nonsense, I called my doctor's office and got the TDAP booster shot. I am not going down because of these idiots.

3. I've never had the chicken pox and am terrified of contracting it as an adult. However, my dad also never had it, nor did two of his sisters. I almost feel like we should be part of a study, because it appears that we have some sort of immunity to the virus. (Knock on fucking wood, because I don't want it.)
posted by mudpuppie at 5:07 PM on March 20


My dad was the same way--all three of us kids had it, but he didn't. My mom (a former nurse) was terrified for him, because she knew how much harder chicken pox is on adults.

Bees and mosquitoes never bothered Daddy, either. Lucky SOB.
posted by magstheaxe at 2:17 PM on March 20 [14 favorites]


Ben Goldacre is a British Epidemiologist, author, broadcaster, campaigner, medical doctor and academic. His book bad science is highly recommended.
He says sensible thing in an interesting way, here's an interesting blog post - How vaccine scares respect local cultural boundaries: http://www.badscience.net/2013/04/how-vaccine-scares-respect-local-cultural-boundaries/
posted by Drew Glass at 2:19 PM on March 20 [3 favorites]


If someone ever invents a sprayable vaccine and time-travel, we're going to save a lot of lives! go extinct in a spasm of retroactive genocides

FTFY
posted by The Tensor at 2:19 PM on March 20 [8 favorites]


The feds could probably require it by relating it to the interstate travel or something like that.

More likely this would be a solid constitutional basis against this being mandated at the state level.
posted by Navelgazer at 2:21 PM on March 20


he didn't show the signs as a babe in arms
The onset of symptoms/signs is usually delayed and most ASD kids have typical development for months. I can see how it would be easier to accept a non-environmental cause if you knew about it as soon as they were born than if it seemed to develop months down the road. So, like anything so deeply personal, I think some compassion needs to be exercised towards non-believers. However, the harm they can do to others (esp. their own kids) is very real and needs to take precedence.
posted by soelo at 2:24 PM on March 20 [3 favorites]


I don't understand your comment. Are you implying that anti-vaxxers are primarily Republicans? Or what?

Yea really. Growing up mostly homeschooled, and going to a bunch of homeschool groups/resource centers/etc i associate antivaxers strongly with middle class neo-hippies.

In fact, i never again saw more of them in one place.

The other group seems to be also of the left wing laws-off-my-body group who are even more affluent, but send their kids to private school.

Sluffing this one off on republicans seems fairly irrelevant. Most of the truthers about this are in the mid to upper socioeconomic echelons and are cut from the same cloth as the gluten free fad types.
posted by emptythought at 2:25 PM on March 20 [5 favorites]


I would like to see a Venn diagram of the parents who don't vaccinate their children and the parents who are afraid of unlikely things such as playground deaths, kidnappings and so on, as seen in this earlier thread.
posted by chavenet at 2:26 PM on March 20 [2 favorites]


My incredibly stupid, stupid idiot former brother-in-law was an anti vax religious fanatic home schooler who had eight (eight!) kids because he also didn't believe in contraception. Surprise: Here comes Satan -- I mean, Whooping Cough-- and every one of those kids was in misery. Eight for eight.

What an asshole.

Needless to say, things got a little heavy, so he left the family to pursue his music career. Real prince of a guy.
posted by silkyd at 2:30 PM on March 20 [9 favorites]


Don't like it, shove off to the Taliban-controlled territories.

It's worth remembering that eliminating smallpox required going everywhere. The smallpox hunters knew that long term 100% 3rd world coverage would be impossible, so unless smallpox was driven to complete extinction it would someday spread out of and be everywhere again.

Afghanistan, rural Pakistan and Somalia were among the last holdouts for endemic smallpox. I remember hearing about one vaccinator who was captured by warlords and insisted on the right to vaccinate his captors' families, eventually getting permission to sweep through the whole region. The smallpox hunters were big damn heroes.
posted by justsomebodythatyouusedtoknow at 2:45 PM on March 20 [78 favorites]


> I don't know what we can do about these people. They are immune to logic, reason, and pleas of civic duty.

CTRL+C

This comment will come in handy for many threads, thank you.
posted by The Card Cheat at 2:51 PM on March 20 [4 favorites]


I feel public school systems and pediatricians ought to require anti-vaxxers to spend an entire day wandering through an old graveyard filled with the headstones of child after child after child killed by measles, diphtheria, whooping cough, polio, etc. Maybe that might cause the urgency to sink in to at least a few of their heads.
posted by scody at 2:52 PM on March 20 [7 favorites]


I want to read more about smallpox hunters! They do sound like heroes. Any good books to check out of the library?

My mother-in-law has a compromised immune system. I was privileged to have never had to consider vaccinations deeply before I met her. It was just like "yeah, yeah, sure, shots." Since she became part of my life, I get very angry at the unnecessary peril visited upon our society (and especially upon vulnerable people) by the ignorance of the anti-vaccination movement.
posted by erlking at 2:53 PM on March 20 [5 favorites]


If we can mandate car seat, seat belt and helmet use, I don't understand why we can't mandate vaccination.
posted by desjardins at 2:57 PM on March 20 [16 favorites]


The smallpox hunters were big damn heroes.

Pakistan's polio workers targeted for killing - There's some pretty damn inspiring stuff going on amongst the Polio vaccination volunteers at the moment, too. Tremendous bravery, and self-sacrifice that's occasionally all too literal.
posted by metaBugs at 3:00 PM on March 20 [25 favorites]


If we can mandate car seat, seat belt and helmet use, I don't understand why we can't mandate vaccination.

Well, that is a state-by-state thing first. And more importantly, driving or riding in a car is a privilege (just like we can deny someone a drivers license).

Vaccinating _everyone_ means there would not be a way to avoid it, the way there is with seatbelts (dont ride in a car). Even with the ACA, there was an opt-out method (pay the tax). And that was just about getting health insurance, not a shot.

So we can require for certain activities (like going to school), but there will always have to be exceptions made (at the very least for medical reasons, and probably for religious reasons -- which gives determined parents a way out).
posted by wildcrdj at 3:02 PM on March 20


Because you don't have a constitutional right to drive a car or ride a bike on the street? I mean, I am on Team Vaccine Blowout here, but people freak out about fluoridated water. Mandated drug injections would not go over well.

On a personal note, I felt so bad for my daughter's pediatrician when he tried to obliquely bring up vaccination at her first appointment. Explaining that Mrs. Penguin and I had spent the drive over making fun of Jenny McCarthy did a lot to set him at ease. But I can't imagine how many anti vaxxers he must deal with.
posted by Elementary Penguin at 3:03 PM on March 20 [3 favorites]


Smallpox hunters sound like some of the most badass people ever to walk the face of the earth. I didn't even think about the implications in the third world. (Typical US-centric shortsightedness, I suppose.) Thank you for giving me something new and awesome to learn more about!
posted by dogheart at 3:05 PM on March 20 [3 favorites]


I don't have much to do with the world of children and parents, so I (naively? hopefully?) assumed anti-vaxxers were a tiny % of the population, a lunatic fringe. It's very distressing to hear how relatively common it is.
posted by erlking at 3:05 PM on March 20 [2 favorites]


killdevil: " Yes they do. They do chicken pox parties and there also exist Web sites where you can get sputum from sick kids mailed to you in order to infect your own. Yup."

In case it's not immediately obvious to anyone reading this, it's illegal to send chicken pox-infected sputum through the mail.

I had chicken pox two years ago. A colleague suggested buying a gross of jolly ranchers I could lick. Said he'd advertise them on Craigslist and make a fortune.

No, it didn't happen.

winna: " The second time was horrible. They aren't kidding when they say it's worse for older people."

They were everywhere (and I mean EVERYWHERE) and they burned. They didn't itch. It was a total nightmare. Misery.

Two years later, I'm still dealing with scarring on my bronchii and a few other places. Getting chicken pox as an adult SUCKS.
posted by zarq at 3:07 PM on March 20 [3 favorites]


If we can mandate car seat, seat belt and helmet use, I don't understand why we can't mandate vaccination.

Deaths from car accidents are many orders of magnitude more probable than deaths from measles, chickenpox etc. And forcing someone to have something injected into their body is a much greater invasion of privacy than requiring someone to wear a seatbelt or a helmet only on those occasions when they choose either to drive a car or to ride a motorbike.

Absolutely everyone ought to get their kids vaccinated, no doubt, but I find it a little odd that Mefites who are usually such deontological sticklers for the limited right of the state to intrude into our personal affairs (see any discussion here of abortion or domestic spying) are apparently so unattached to any right to privacy and to control over one's body when it comes to vaccination.
posted by yoink at 3:09 PM on March 20 [8 favorites]


I was really on the fence about vaccinating my first child against pertussis. REALLY on the fence. Why? Well, I'd never been vaxed against pertussis, because of a belief when I was born in the UK that people who had a family history of seizure disorders shouldn't get vaccinated. (My paternal grandmother had seizures.) When my younger brother was vaccinated in the US (without my mother's consent, btw; the doctor sent her to go get the nurse to do some paperwork and vaccinated him while she was gone), his temperature shot up to about 105 and change before turning around and coming back down. In discussing it with my husband, who also had a history of childhood seizures, I learned that he had had the same reaction as my brother. With bad reactions on both sides of the family, it seemed like there were some good reasons to exercise caution.

then my doctor pointed out three things:

1. They use a different vaccine now that doesn't cause those fevers
2. Even if my daughter did spike a fever, 105 isn't damaging in an infant -- scary, sure, but not damaging
3. The county we live in was enjoying a pertussis outbreak at the time

and lo! My mind was changed! We vaccinated her against pertussis, as well as all the other routine vaccinations which we had already been planning on giving her.

I tell this story to illustrate what an actual productive conversation about vaccination looks like. There are some good situations for parents to have concerns about vaccines in; family history, compromised immune systems, neurological disorders, or egg allergies (which frankly are the suckiest thing of all, because it's not the vaccine itself that's a problem, just the medium they're cultured in). But those are concerns that are specific to the person being vaccinated, not the process as a whole -- and frankly, the existence of those concerns is the reason WHY everyone else needs to be vaccinated.

There's a kid in my son's preschool classroom who can't be vaccinated because she's medically fragile and has essentially no immune system. It sucks, and her parents are scared a lot. They also practice responsible self-quarantine, for their own safety as well as the safety of everyone else, after every known or suspected exposure to illness. It means she misses a lot of school, and that sucks, but not as much as a measles outbreak.
posted by KathrynT at 3:10 PM on March 20 [28 favorites]


I want to read more about smallpox hunters! They do sound like heroes. Any good books to check out of the library?

The story of the end of smallpox has so much human and dramatic gold in it that I really think Hollywood should give it the full big-budget action-adventure-drama treatment.

The Apollo program inspired a lot of movies. But Apollo happened in the world spotlight, while eradicating smallpox happened quietly out of sight, though eradicating smallpox is a magnificent human adventure and achievement of the same scale. For drama, it's untapped gold.
posted by anonymisc at 3:10 PM on March 20 [12 favorites]


If vaccines were mandatory, where would that leave children who are legitimately allergic to vaccine ingredients?
posted by Hermione Granger at 3:11 PM on March 20 [1 favorite]


uncleozzy: "We've got a baby on the way sometime in the next few days and it turns out that NY mandates that hospitals offer pertussis boosters to any adults who might be in frequent contact with the newborn. You don't have to take it, but they have to offer it. "

My local Walgreens had on the marquee outside for Father's Day last year when we had a pertussis outbreak: "Dads! Get your DTaP booster this year for Father's Day! Your kids will thank you!" In states where pharmacists can give routine vaccines, it's SO EASY to get your boosters! In my state, pharmacies now do it free and THEY submit to insurance for the reimbursement (it used to be you paid and sent in the paperwork), and the state provides some kind of incentive to the pharmacies for that to make it even easier and more widespread and have as little paperwork as possible on the recipient end. I'm not sure if they do MMR for adults, but they do DPT and flu and shingles boosters, I know. It's also now routine and required prenatal care in my state to counsel the parents about vaccine boosters for common childhood diseases.

ChuckRamone: "Is this really a liberal thing? The one guy I know on Facebook who doesn't believe in vaccinations is a libertarian. "

There is a strain of crunchy-granola parenting, typically populated by liberals, that has a lot of anti-vaxxers in it. There are more religious non-vaxxers than secular non-vaxxers in my area, statistics say, but all the ones that I PERSONALLY know are liberals in the attachment parenting community (which I am too, more or less, depending on how one defines attachment parenting; this isn't a ding on APs). There is definitely a natural healing! crystals! earth mother! strain of anti-vaxxers.
posted by Eyebrows McGee at 3:12 PM on March 20 [3 favorites]


It's behind a paywall, but here's a terrific New Yorker piece by Atul Gawande about the polio vaccination "mop up" efforts in the developing world. It's also in his collection Better: A Surgeon's Notes on Performance.
posted by telegraph at 3:13 PM on March 20 [7 favorites]


I find it a little odd that Mefites who are usually such deontological sticklers for the limited right of the state to intrude into our personal affairs (see any discussion here of abortion or domestic spying) are apparently so unattached to any right to privacy and to control over one's body when it comes to vaccination.

That's the thing, though. Your child's body is not your property to do with as you please.

Sure, you have legal custodianship of your kids, but that doesn't give you the right to, say, toss one out the car window when it's being a brat, nor does it give you the right to let one die of a treatable disease because your religion tells you to.
posted by Atom Eyes at 3:19 PM on March 20 [16 favorites]


I find it a little odd that Mefites who are usually such deontological sticklers for the limited right of the state to intrude into our personal affairs (see any discussion here of abortion or domestic spying) are apparently so unattached to any right to privacy and to control over one's body when it comes to vaccination.

I'm certainly not for forcing people to get vaccinated. I'm for requiring vaccination status or a medical exemption in order to use some public services (public schools, by which I mean any school funded by the government, which I suspect includes charters), but there are other options to public schools if you have a religious or philosophical objection to vaccination. (Your child, of course, cannot possibly have this kind of objection.)

We force people in certain job categories to get vaccinated, too, and I don't think many people find this objectionable.
posted by jeather at 3:20 PM on March 20 [3 favorites]


If vaccines were mandatory, where would that leave children who are legitimately allergic to vaccine ingredients? Social pariahs?
They are actually part of the argument in favor of mandating because of herd immunity. They (and the other small percentage of children whose vaccines were ineffective) would benefit from reduced exposure.
posted by soelo at 3:22 PM on March 20 [23 favorites]


'm for requiring vaccination status or a medical exemption in order to use some public services (public schools, by which I mean any school funded by the government, which I suspect includes charters), but there are other options to public schools if you have a religious or philosophical objection to vaccination.

One of the fiercest, shittiest arguments I ever got in online was with a woman who proudly boasted about how she lied about her kids' vaccination status so they could go to the daycare she wanted them to go to, despite the fact that they had a mandatory vaccination policy. Just thinking about it now makes me see red.
posted by KathrynT at 3:24 PM on March 20 [12 favorites]


As an immigrant going through the U.S. green card hoops at the moment I find it hilarious that I have to go to specially certified doctors selected by la migra for a physical exam and immunization check and updates. Not that i think it is a bad policy. I'm Canadian and had to have my shots to even go to school. My mother also survived polio as a child. I fully support herd immunity. It's just that this 'precaution' is coming almost 2 years after I was let into the U.S. Also my wife has spent 6 years total living in the U.S. without any immunization check until now.
posted by srboisvert at 3:25 PM on March 20 [1 favorite]


Sure, you have legal custodianship of your kids, but that doesn't give you the right to, say, toss one out the car window when it's being a brat, nor does it give you the right to let one die of a treatable disease because your religion tells you to.

But it is clearly absurd to equate not getting vaccinated for a disease that is, in the vast majority of cases, not fatal with refusing to provide treatment when a child is dying of a disease they have already contracted. Those are simply not equivalent situations.

Again (just to be clear), I think the parent who makes the choice not to get their child vaccinated is making a foolish and uninformed choice. But the increased risk to the child's life and wellbeing is well below that of many, many other choices we would not hesitate to allow that parent to make: allowing the child to take up skiing or horse riding, for example. If this is a question about "what is the risk threshold at which the state has to step in and take away the parent's right to make decisions on behalf of their child" then I think you'll struggle to make the case that measles, pertussis or smallpox (or even all three combined) crosses that threshold unless you want a whole host of other decisions taken out of parents' hands on the same basis.

I do think it's reasonable for school systems to demand that children be vaccinated (clearly you greatly raise the risk of transmission when you're cooping a bunch of children up in a series of rooms all day)--and that leaves parents with strong feelings on this matter the option of home schooling or private schooling. But to make this an actual state law? That seems intrusive in a way that just can't be justified on the facts. The most important battles in civil rights can be about preserving people's rights to make bad decisions as well as preserving their rights to do things of which we approve.
posted by yoink at 3:28 PM on March 20 [3 favorites]


Here's my suggestion for dealing with anti-vax parents in the United States:

Every person who receives a vaccination pays 75 cents per dose (so $2.25 for a triple-dose like MMR) into the National Vaccine Injury Compensation Program (NVICP). Because vaccination is SO important for public health but does have measurable risks, the government created a special program that removes vaccinations, from the most part, from the expensive system of tort liability and puts it in a special no-fault liability system. If you develop one of the known complications of a particular vaccine, you are paid out of the NVICP fund, without even having to prove your complication came from the vaccine specifically. (If you develop an unknown complication, you can go through a court-like process to request compensation.) As vaccines overall get safer, the cost-per-dose paid to NVICP falls; if vaccines get more dangerous, it rises. All victims are compensated appropriately (and have rights of appeal) so that we can get the great public health good of vaccinations while paying recompense to the small number of people who will, inevitably, suffer the rare side effects.

Now, we will remove children with medical exemptions from this question (although the medical exemption will now have to be approved by a state medical official, not just a drive-through doc who hands out medical exemptions for anything). They're among the people who need protection! If we want, they can pay the 75-cent excise tax on their medical exemption per dose. So leaving aside that group:

I propose that anyone, for any reason may pursue a Certificate of Non-Vaccination and to do so, they will pay into the Vaccine-Preventable Illness Compensation Fund. This fund will cover ALL of the costs of ALL vaccine-preventable diseases -- all medical care for all patients, all governmental costs for intervention to prevent an epidemic, reasonable compensation for time and inconvenience and lost work for workers/parents who are subject to quarantine, and reasonable compensation for long-term injuries or deaths, exactly the way that the NVICP does for people injured by vaccines. Part of the problem is that the cost of vaccine injuries is borne by those who vaccinate for the good of public health, while the cost of failing to vaccinate is borne by taxpayers generally, so what we need to do is shift the cost of failing to vaccinate on to those who refuse to vaccinate.

So a couple of years ago I worked this out for California, which has pretty good vaccination statistics and had recently had a measles epidemic (2008 maybe?). I looked at the CDC's estimates of the costs of medical care for all the patients under the age of 18, the costs to the state government for controlling the epidemic, and I threw in a reasonable (small) compensation amount for the two (I think) children who died based on lawsuits for wrongful death in other sorts of cases. Then I divided that total number by California's estimate of the total number of unvaccinated children in the state of California, to work out what it costs the state of California per unvaccinated child in the case of a very small measles outbreak.

You'll be happy to know that you could acquire a Certificate of Non-Vaccination for Measles for the low, low price of $10,000 per skipped measles dose.

Give parents the choice. Vaccinate their children and pay the 75-cent excise towards the total cost of the injuries caused by vaccines, or let them skip vaccinations and pay the $10,000 excise towards the total cost of injuries caused by vaccine-preventable diseases. It will probably help them make more appropriate risk assessments, and of course the cost of the vaccine vs. the certification will rise and fall with the risk of vaccinating vs. not vaccinating. If, in fact, skipping vaccinations is as safe as claimed, that cost will fall dramatically! Let the free market solve the problem by shifting the costs onto the appropriate people.
posted by Eyebrows McGee at 3:29 PM on March 20 [94 favorites]


If we can mandate car seat, seat belt and helmet use, I don't understand why we can't mandate vaccination.

We're talking about piercing the skin and injecting foreign substances into a person.

The ability to refuse that (for oneself, we can talk about minors later) is just about the first and most fundamental criterion for whether one is living in a free country.

Unvaxed kids should not be allowed in school, for damn sure, and no religious exemptions or any of that nonsense. And the decision to go without the shots should be prima facie indication that the state should consider taking custody of a child. But now that we're done venting about this obscene situation, we can stop talking about vaccinating by force.
posted by ocschwar at 3:34 PM on March 20 [6 favorites]


My daughter had her 18 month immunisation shot on Wednesday. As we both watched that needle slide into her chubby innocent upper arm all I could think was thank god.
posted by Wantok at 3:36 PM on March 20 [18 favorites]


So a couple of years ago I worked this out for California, which has pretty good vaccination statistics and had recently had a measles epidemic (2008 maybe?). I looked at the CDC's estimates of the costs of medical care for all the patients under the age of 18, the costs to the state government for controlling the epidemic, and I threw in a reasonable (small) compensation amount for the two (I think) children who died based on lawsuits for wrongful death in other sorts of cases. Then I divided that total number by California's estimate of the total number of unvaccinated children in the state of California, to work out what it costs the state of California per unvaccinated child in the case of a very small measles outbreak.

You'll be happy to know that you could acquire a Certificate of Non-Vaccination for Measles for the low, low price of $10,000 per skipped measles dose.


Something like this might not be an unreasonable approach. There's a flaw in your calculation, though. For one thing you're taking a year in which there was a measles outbreak. Surely you couldn't set the fee by the worst year in recent memory? You'd have to set the fee according to the annual average. Secondly, your calculation isn't separating out those who are unvaccinated by choice and those who have some legitimate medical exemption. You'd need to work out a "total increased financial burden" figure of some kind that exempted the costs which would have to be borne in any case arising from the 'legitimately' unvaccinated. All of which might well bring the fee down to a reasonable level where you couldn't argue that it imposed an unfair burden on parents opting not to have their children vaccinated but would probably create a strong enough incentive to get many who currently don't vaccinate to opt in.

I like it.
posted by yoink at 3:37 PM on March 20 [2 favorites]


yoink: "Something like this might not be an unreasonable approach. There's a flaw in your calculation, though. For one thing you're taking a year in which there was a measles outbreak. Surely you couldn't set the fee by the worst year in recent memory? You'd have to set the fee according to the annual average. Secondly, your calculation isn't separating out those who are unvaccinated by choice and those who have some legitimate medical exemption."

Yeah, these are good point. It was a "small" epidemic (of 11 cases) -- there were larger outbreaks in other states but their childhood vaccine data wasn't as good, and you'd also have issues of adult vaccination rates. I tried to be very conservative with the costs, though, and artificially DEFLATE them by making very conservative assumptions as to what I included in costs. And yeah, California doesn't break out unvaccinated by choice from medical exemptions. It was just a quick back-of-the-envelope calculation ... but I think that's all just basically an actuarial problem once you decide on the regime you're going to pursue! It's certainly a solvable problem by epidemiologists and people like that; they could for-sure put a number on it based on, say, a 10-year average to start with.
posted by Eyebrows McGee at 3:46 PM on March 20 [1 favorite]


Wait i'm confused, anti vaccination by law people.

If you're required by law to have your kid in school until they're 16 or end up in truancy court and potential CPS type stuff, and you're required to vaccinate to be in school and they rarely grant the wavers... aren't we already there?

Where is the system breaking? how are these people squeaking by it? am i missing something?
posted by emptythought at 3:47 PM on March 20 [1 favorite]



If you're required by law to have your kid in school until they're 16 or end up in truancy court and potential CPS type stuff, and you're required to vaccinate to be in school and they rarely grant the wavers... aren't we already there?


You're required to have your kid educated. Private schools and home schooling are legal options in this country. So no, we're not quite there.

Now, as bad as foregoing vaccination is, as in, sufficiently bad to be grounds for a CPS investigation, it is not so bad that the child would be safer in foster care. (And thus no, children should not be removed just because they're unvaxxed, IMHO)
posted by ocschwar at 3:54 PM on March 20 [3 favorites]


I think that the state should do the minimum of forced medical treatment, and that forced vaccination sounds like a real slippery-slope situation. I think that the more forced medical treatment becomes normalized, the more likely it is to be used against vulnerable populations - it's not as though medical treatment hasn't been used abusively in the past. Also, even threatening that kind of law would lead to a lot of ugliness (and expense) in the courts.

Instead, I'd suggest more of a hearts/minds approach - community clinics, outreach, education through the schools, more and better media coverage in venues likely to be read by the hippie crowd. Outreach to key people in Waldorf and co-op movements. Pair it with a social-justice oriented well-baby program that goes out into the community to work with low income families.

Consider this: in any situation, there's the hard core who will never be on your side, but there's also a lot of people who could go either way. Those are the people to reach out to - change the language around vaccinations, educate better, do more community work - and you can isolate the hard core.
posted by Frowner at 3:54 PM on March 20 [2 favorites]


they rarely grant the wavers

Only public schools require vaccinations, and the waivers are not only granted rarely. It differs by state; in my state, you just have to sign a piece of paper that says essentially "We didn't vaccinate on purpose."

As we both watched that needle slide into her chubby innocent upper arm all I could think was thank god.

My son is very susceptible to croup. He's been to the emergency room for it 5 times, and he's three. One of these was particularly bad; I waited to long to go, and he stopped breathing in the car on the way to the hospital. He started again before we got there, but it was the scariest twenty-seven seconds of my entire life. When I got to the ER, I didn't even park, I just bolted out of the car, grabbed him out of his carseat, and sprinted through the doors. His breathing was so bad that the nurses heard us from triage and came RUNNING out to meet us, snatched him out of my arms, body-checked the doors to the ER open, and got an oxygen mask on him before either of us could even speak. As they got an O2 sensor on his tiny toe and stripped him naked to monitor his chest retractions, one of them turned to me with a look of terrified intensity in her eyes and said:

"Is he up to date on all his vaccinations? INCLUDING PERTUSSIS?!"

I said "YES! Yes he is, yes he is fully vaccinated, he has had all his vaccines on time and on schedule."

She sagged with relief. I will remember that forever. My kid was on the gurney, wires and sensors and masks on him, his chest and neck sucking in around and between his ribs and collarbones with every breath, his lips purpling. . . and she was relieved, because this was not the worst possible case.

Thank god indeed.
posted by KathrynT at 3:56 PM on March 20 [102 favorites]


Well, you know, Europe is having a tough time with their eradication efforts, and that's where last year's outbreak came from.

Probably best to figure out why they're having a bad time before we start equipping domestic drones with dart guns.
posted by RobotVoodooPower at 3:57 PM on March 20 [1 favorite]


I'm for requiring vaccination status or a medical exemption in order to use some public services (public schools, by which I mean any school funded by the government, which I suspect includes charters), but there are other options to public schools if you have a religious or philosophical objection to vaccination.

Only public schools require vaccinations,

I don't know the law for all 50 States, but in both NY and CA the vaccination law applies to all schools public, private, and religious.

If you have a religious objection to vaccination you can get an exemption in NY, but not for a personal or philosophical objection. You can also get a medical exemption with a letter from a doctor.

I expect that a fair number of religious exemptions are used by people who perjure themselves on the forms.

(Personally, I think getting vaccinated is a moral imperative. )
posted by Jahaza at 4:02 PM on March 20 [1 favorite]


Why We Immunize:

Teeny tiny headstones.

This is the piece that turned me from a laid-back, casually pro-vaccination but "why get a flu shot when I never get the flu" person into a "TDAP booster NOW please, when can I get my next flu shot?" person.

I'm still not convinced the flu shots are doing ME much good - but I feel a lot better knowing that I'm not as likely to unwittingly spread disease around to everyone else.
posted by kristi at 4:08 PM on March 20 [23 favorites]


emptythought: "they rarely grant the wavers... aren't we already there?"

In a lot of states the exemption is as easy as "I don't really feel like it" and they're like "PHILOSOPHICAL EXEMPTION GRANTED!" Religious exemptions are also pretty routinely granted to "religions" whose sole purpose is to dodge government regulations like this one.

Secondly, yeah, private schools and homeschooling can be way to avoid vaccination but those children are often involved in clubs and extracurriculars and whatnot with other children.

For me as a parent, the scariest thing was parents of 1-to-5-year-olds who weren't in school yet but were in various mommy-and-me classes which typically do not have vaccine policies, and among the highest-risk groups are children too young to be vaccinated. I dropped out of a "gymboree" type class when I found out the mom of one of the 4-year-olds was bringing her totally unvaccinated child to classes that included infants who hadn't had their first DTaP yet (2 months) and babies who weren't big enough for MMR (12 months). This was during a local pertussis outbreak and two infants DIED in my area and she bragged she wouldn't quarantine her special little snowflake even if she thought he was sick because people "are just too worried about these minor childhood diseases!" and "Why should HE have to stay home just because other people are giving in to government hysteria?" How on earth do I protect my children against insane people like that? Do I just quarantine my infants until they're a year old? And then quarantine my older children every time I have a younger baby? (Many infants are exposed by an older sibling who WAS properly vaccinated but the vaccine didn't "take" fully, and the sibling was exposed to an unvaccinated child with the disease.)

Pertussis is a horrible, slow, gasping, painful death for an infant that takes several days. Ask any pediatrician you like; most either become enraged or cry talking about a tiny patient they lost to a preventable disease.
posted by Eyebrows McGee at 4:09 PM on March 20 [33 favorites]


You know what scares me? Besides pertussis and tetanus, the other component of that vaccine is diphtheria. The fatality rate for diphtheria is about 5 to 10% for older children and adults. For young children, it's 20%. You want a horror show, just wait until the vaccination rates drop low enough that diphtheria comes back to town.
posted by Mary Ellen Carter at 4:12 PM on March 20 [7 favorites]


There is a strain of crunchy-granola parenting, typically populated by liberals, that has a lot of anti-vaxxers in it.

I'm sure you recall this irresponsible article that made the rage-rounds late last year. No surprise Adele also does not believe in vaccination or any sort of modern, peer-reviewed medicine what so ever.
posted by MiltonRandKalman at 4:14 PM on March 20 [1 favorite]


How on earth do I protect my children against insane people like that?

I don't know. A friend isn't bringing her child to see its great-grandparents in France in part because at less than 9 months the measles vaccine is useless (at 9 months you would still need to also get the normal vaccines later, but it would hold you for a bit) and they live in a heavily non-vaccinating area.

She also told me that the current thinking is that lots of people got polio, but few of them had bad reactions to it (like most of the other childhood diseases), not that few people got polio but the bad reactions were common, which surprised me.
posted by jeather at 4:15 PM on March 20


The up side of all of this is that I have been reminded that tetanus booster shots are a thing and I now have it on my calendar to call and make an appointment for that tomorrow. I'm only, er, about ten years late.
posted by Sequence at 4:28 PM on March 20


my mother had polio as a kid. She is about 4' 10" tall in a family where the average is well over a foot taller than that. She also needs two leg braces and a cane to walk.

The vaccine was new but around when she was a kid. But huzah for US healthcare her family was poor as hell so no vaccines for them.
posted by Riemann at 4:36 PM on March 20 [3 favorites]


Sadly, all these measles cases now mean we'll get rerun of this story in 10-20 years, only more tragic, when several adolescents and young adults begin to sicken and then die from SSPE, one of the more fatal measles sequelae.
posted by meehawl at 4:38 PM on March 20 [4 favorites]


three blind mice: "Doctors don't see a lot of things on a regular basis, but are expected to be able to make a diagnosis all the same."

For the first 24-48 hours, it just looks like any other acute viral illness. Most people will just say "flu". The rash is just a post-acute, already-have-been contagious cosmetic addition.
posted by meehawl at 4:42 PM on March 20 [1 favorite]


Lutoslawski: "I actually really enjoyed having the chicken pox. A week off from school with lots of popsicles and movies? Well worth the pain!"

It might seem like a bargain, except when and if you develop zoster inflammation, aka shingles. I've seen people lose vision because of this. Or people with post-herpetic neuralgia, which is like having your nerve endings scraped with broken glass. One memorable case had got it right across their groin and genital sex had become basically agonizing. Shingles is not fun, and it can easily be avoided by vaccination.
posted by meehawl at 4:50 PM on March 20 [3 favorites]


jeather: "She also told me that the current thinking is that lots of people got polio, but few of them had bad reactions to it (like most of the other childhood diseases), not that few people got polio but the bad reactions were common, which surprised me."

People should remember that when UMichigan announced the Salk vaccine was safe and effective, churchbells rang across the United States in celebration, people wept in the streets, and it was gigantic-headline front page news worldwide.

It's interesting to ask people who were children or parents in the 1950s or 1960s about the polio vaccine, because a lot of the children remember the mass-vaccinations and how they didn't really understand what it was about but they got that it was like THE MOST IMPORTANT THING EVER, and people who were parents -- well, my grandmother got weepy until the end of her life talking about her children being finally safe from polio. In the 40s and 50s it wasn't totally clear how polio was transmitted and what was dangerous, so kids used to be banned from swimming pools (for example) by terrified parents during outbreaks.

My mother just can't believe they vaccinate against rotavirus now. She shakes her head in amazement that they can now prevent an infantile disease that is rarely deadly in the First World, but is SUPER-MISERABLE, and she went through God knows how many cases of it with four children, and her grandchildren get not just vaccines but ORAL vaccines that don't even require shots! Thanks Paul Offit! It's a measurable improvement in parenting and childhood health in just the 30 years between my birth and my first child's birth.

And yeah, MMR (measles-mumps-rubella) isn't given in the U.S. until 12 months because it doesn't work on small infants, which is why it's so crucially important that bigger kids and adults who have contact with babies get vaccinated and be up-to-date on their vaccines, to limit exposure for infants and help protect them via herd immunity. If you are one of the first people in your peer group to start having babies and your friends ask, "What can we do to help?" a good answer is, "Make sure your vaccinations are up to date, because the baby can't get vaccinated for DPT until 2 months and MMR until 12 months!" People do, willingly and happily! And it's good for THEM as well as for the babies! I'm sure this is one of the reasons they're doing so much prenatal education about vaccinations for pregnant women, because pregnant women (and their partners) apply so much peer pressure to their childless friends to get their boosters for the baby's sake.
posted by Eyebrows McGee at 4:58 PM on March 20 [25 favorites]


But the increased risk to the child's life and wellbeing is well below that of many, many other choices we would not hesitate to allow that parent to make: allowing the child to take up skiing or horse riding, for example.

It's not only parents making choices for their children, it's also parents making choices for other people's children. My cousin has some very adorable toddlers, but it wouldn't be cool at all if I were to take them skiing or horseback riding without her parental approval, and I especially don't think she'd be on board with me exposing them to potentially deadly pathogens.

The most important battles in civil rights can be about preserving people's rights to make bad decisions as well as preserving their rights to do things of which we approve.

Making bad decisions that negatively impact the health and well being of others has never been a civil right.
posted by RonButNotStupid at 4:59 PM on March 20 [22 favorites]


metaBugs: "There's evidence that being vaccinated (as opposed to catching the disease young) increases your chances of developing shingles later in life"

Extraordinary claims demand extraordinary evidence. You have derived an incorrect assumption from limited evidence.

The decision not to vaccinate the young population against zoster involves a trade-off with the older population. The theory is that if you allow occasional mild, sporadic outbreaks of zoster in the population, you give older adults harbouring the virus in their nerve endings occasional "booster" infections that are hopefully mild and do not proceed to the runaway inflammation of shingles. You assume that most of the younger kids who catch the disease will survive without much morbidity or mortality, and you assume that at some future date you're going to turn around and vaccinate the entire adult cohort.

You can reduce the probability of shingles with the live attenuated vaccine virus. The solution would be to also embark on a massive vaccination of cohorts of older adults with Zostavax or similar, to reduce the probability of shingles outbreaks. But older people have much lower total QALYs, so from a public health perspective, you can model a curve where it's more cost effective to not vaccinate (at a cost of watching kids get chickenpox). The tradeoff becomes a complicated s-curve. The NHS recently decided to start covering people for zoster vaccines at 79 and older, which is pretty sucky really.
posted by meehawl at 5:06 PM on March 20 [6 favorites]


I got a tetanus booster the other day and the doctor explicitly said that the CDC did not recommend pertussis boosters for all adults, only for adults around newborns. This did not agree with what I had read on the CDC website earlier, but I wasn't really confident enough to follow up with 'no, you're wrong' - sounds like I should have.

My mother had polio, and until recently she was only crippled in one leg for her entire life, needing a full leg brace. Now she's got post polio syndrome and is no longer able to drive even her modified vehicle and it looks like by the end of the year she'll be in a wheelchair. If I ever found out a friend of mine was not vaccinating their kids that would be the messy, nasty end to that friendship.
posted by the agents of KAOS at 5:10 PM on March 20 [3 favorites]


Dialogue between 4-year-old Mini McGee and Eyebrows:
"Shots are great. They hurt a lot, they don't hurt a little."
"Is it okay that they hurt a lot?"
"Yes."
"Why?"
"I know that my immune system wakes up to eat them! If you sneeze on me with a bad virus and my immune system wakes up and goes in to get it so I don't get sick!"
"What else should people know about shots?"
"I'm brave when I get shots! I'm braver than you! I squish my fingers so hard!"
"Should I tell my internet people anything else about shots?"
"I LOVE TO SNUGGLE TO GIVE YOUR IMMUNE SYSTEM A YUMMY GERM TO EAT!"

You heard it here first, folks: snuggle to give your immune system yummy germs to eat.
posted by Eyebrows McGee at 5:13 PM on March 20 [89 favorites]


I am totally going to start squishing my fingers hard when I need to be brave. You tell the small mini McGee that advice is wise and good!
posted by winna at 5:20 PM on March 20 [6 favorites]


I want to put that on a poster, Eyebrows. That conversation reminds me of this kid.
posted by ocherdraco at 5:21 PM on March 20 [1 favorite]


Instead of shingles, you could also get systemic herpes, which isn't any fun either. My mouth was so sore I could barely swallow water for 10 days, and I was quite ill.

The smallpox hunters were big damn heroes.

Talk about complications. From the Al Jazeera article:
After news emerged that the US' Central Intelligence Agency employed a doctor to run a fake hepatitis B vaccination programme in an effort to find Osama bin Laden, conspiracy theories about health workers' activities have abounded - such as claims that vaccinators mark houses to be targeted by US drones. Polio workers have been accused of being CIA operatives, and the campaign has suffered incalculable damage.
posted by sneebler at 5:38 PM on March 20 [2 favorites]


Where are the trial attorneys? A few million dollar awards would solve this problem faster than anything else.

Suing doctors isn't the answer to everything. And it seems especially vicious to sue doctors over measles outbreaks, given that they're often caused by people who essentially say screw you to medical science.
posted by lesbiassparrow at 5:55 PM on March 20 [4 favorites]


I don't think there's any precedent but I think the intel clowns FUCKING WITH POLIO ERADICATION should be tallied up on the list of crimes against humanity that will never be prosecuted.

I don't know any of these shitheads to do this, but this is cannot be received as acceptable behavior in polite society. It's drunk driving. Smoking crack and shouting anti-Semitic slurs on the playground. Tossing lit smokes into a bone-dry pine forest. Not allowed. Enforce this.
posted by save alive nothing that breatheth at 6:13 PM on March 20 [31 favorites]


"I'm brave when I get shots! I'm braver than you! I squish my fingers so hard!"

The muscle tension is what's making the shot painful. Learning to relax is the key to a painless shot.
posted by five fresh fish at 6:23 PM on March 20 [3 favorites]


"Vaccines! Now with a hint of natural lemon essence"

My mom is a nurse at a pediatric's office and often works the phone line. Their office has a hard and fast, must-vax policy. It took the partners a few years to come around to that policy, thinking it would be better to keep a family in the practice and attempt to gently educate them over several visits. But yeah that turned out to not work so well, and the risks to their other patients were so great that they dumped a few existing families and refused any new non-vax families.*

Anyhow, as for the "organic coconut-oil infused vaccines" natural branded vaccines (which, to be clear, don't exist)? Yeah, my mom has had several parents call and ask if they used "the vaccines with TOXINS!!! Or the good vaccines?"

A few of my favorite "crazy anti-vax" calls, in no particular order:
  • The doula who called to say that the new parents were coming in for a vitamin K shot and PKU test in a few days and they would not be getting any other vaccines or tests. (A PKU is administered at birth and reported to public health agencies, which they have no means to do at this office, and I guess a vitamin K shot was cool because it has the word "vitamin" in it?)
  • The mom who was convinced that she could get her kid seen at this practice even though she was anti-vax because "an anti-vax website" listed one of their doctors. (The doctor's name was the equivalent of John Doe). When she wouldn't believe the lowly nurse, she insisted on speaking to Dr. Doe, who said basically vaccinate or GTFO and get my name off that damned website and hung up on her.
  • The expecting-mom who was trying to decide if she was going to go the no-vax route because all of her friends were doing it.
*an interesting bit of cognitive dissonance is to be found in the "slow-vax" crowd. They believe vaccines are good, they prevent disease! But, all at once are somehow bad! So, they ask for individual vaccines instead of the combo MMR/TDaP. There was a time when they would see families with "alternate vaccination schedules" but they've tightened it down to the AAP schedule or bust.
posted by fontophilic at 6:24 PM on March 20 [4 favorites]


I think the idea is that the immune system just gets plumb tuckered out fighting the vaccine dose and too many at once is stressful. While I have no medical training I do not think it works that way for the nearly-always harmless doses given by vaccine.
posted by save alive nothing that breatheth at 6:36 PM on March 20


It doesn't work that way because your body is always fighting everything all the time anyway. Unless you're the bubble-boy, your environment is throwing nasties at you all. the. time.
posted by five fresh fish at 6:40 PM on March 20 [8 favorites]



I'm still a little confused about whether adults need a measles booster-- I don't think I do, but there is a helpful guide to the vaccine and schedules here.


I haven't read the whole thread, but I just wanted to address this: yes, you need a booster. You need a booster for almost everything. Vaccines wear off. I'm a nurse and I had to have 15 million boosters to be in a facility because almost everything wears off. Get a MMR booster. Get a DPT booster because pertussis has come back big time and if you haven't had a booster since you were a kid, you can get it. You really don't want to. There are outbreaks all over for that these days.

Think of it this way, would you rather get rubella and find out you're pregnant or just get a shot now that kind of hurts? (MMRs hurt.)

I could be way more inflammatory about this, but all I want to do is support herd immunity and keep everyone safe.
posted by syncope at 6:41 PM on March 20 [7 favorites]


I actually know someone who's against vaccines. She thinks they're a scam, and cause disease or something. But she's a perfectly nice, seemingly reasonable person. I was shocked, and terrified.

I learned recently that my old college roommate - an otherwise smart and rational person - believes that vaccines are a government conspiracy to infect the population with experimental diseases to develop biological weapons. I thought she was joking. She wasn't. I couldn't talk to her for weeks after that!

(Her kids are vaxed, though, because our public schools here require it, and she didn't want to homeschool. And her husband thinks her looney conspiracy theory is dangerous.
posted by MissySedai at 6:50 PM on March 20


Yeah, for reals: get re-vaccinated for Whooping Cough, people. I got it in 2010 and it sucked major donkey balls (thanks anti-vax losers!). The CDC even recommends it for adults.

I got it in 2002. I was in bed for an entire month, finally dragging myself up and around because Christmas, and things had to be done. I was still coughing in March, and it took another 6 or 8 weeks before I felt relatively okay again.

I spent a good part of this afternoon reading through an anti-vax site (thanks, old friends on Facebook, for your informative status updates) where I learned that measles is "a relatively mild viral illness (disease) that God created for us to contract naturally, which served a greater purpose ... to pass protective antibodies to our babies". Also, it's only kids who are poor and malnourished who actually suffer any genuine ill-effects, or death, from measles, so everything's fine for upper and middle-class Americans. I seriously don't even know where to start to argue with these people.
posted by jokeefe at 7:16 PM on March 20 [4 favorites]


There's a special kind of magical thinking that leads you to conclude that because previously-dangerous illnesses are no longer a big deal, that means you can stop doing the things that made them go away.

Anyway, guess I won't be taking my kiddos uptown any time soon.
posted by snickerdoodle at 7:22 PM on March 20 [1 favorite]


The expecting-mom who was trying to decide if she was going to go the no-vax route because all of her friends were doing it.

Wow. This will not end well.
posted by running order squabble fest at 7:26 PM on March 20 [1 favorite]


k5.user: Would you expect Drs to recognize a disease that's been virtually eliminated ?
(that said, given the rash, you'd think that would ring a bell, vs more non-specific symptoms of fever, malaise, etc But would small pox be recognized any more ? )

justsomebodythatyouusedtoknow: Yes. It's...distinctive. Don't google "smallpox" for pictures. Once you've seen it you will never forget it. You will want to forget it.


Worth noting: the smallpox exanthem is so distinctive that casefinders for the World Health Organization used photo cards (here - warning, gross and sad) in their house-to-house surveillance work the way cops ask around with a picture of a suspect. (The end result was different, of course - the goal was "ring vaccination", i.e. vaccinating everyone who might have been in contact with a case as part of the eradication effort.)

It doesn't surprise me at all that providers don't know firsthand what measles looks like. "Koplik's spots" are the pathognomic sign of the prodrome, but you have to look inside the mouth with bright light, which no one is going to do as routine waiting-room screening. Any kid presenting with a rash should be isolated as a matter of course, but a lot of doctor's offices don't do it.
posted by gingerest at 7:31 PM on March 20 [1 favorite]


We just had the 2 week pediatrician wellness checkup on our newborn. She was born in a birth cottage. We're kinda hippy nutty crunchy people. We recycle. We're using cloth diapers. We're breastfeeding (and so glad things are going well). We drive an antique VW Beetle and a Toyota Yaris. She's been vegetarian for umpteen years and I've cut out meat for the last few months unless it's a dish a friend or family member has made for me.

I'm anxiously waiting for the vaccinations to begin. Bring them on.

The needles can't come soon enough.
posted by RolandOfEld at 8:25 PM on March 20 [12 favorites]


I feel like a broken record, always coming in to these vaccination threads to say the same thing: vaccination is for your child and for everyone elses children. Non-vaccinators are the epitome of selfishness. My daughter was diagnosed with cancer at age 20 months and had six months of chemo which wiped out her immune system. She went about two years with no vaccinations and an uncertain ability to fight off infection. She survived in no small part because there is enough herd immunity to mean she didn't come in contact with measles, or pertussis, or mumps. She's the quintessential kid who could not be vaccinated and whose life depended on others doing their duty to society. Now she is five and you're damn straight we had her vaccinated as soon as we were advised she could handle it.

It's not about putting your own kid in danger by taking her on a car ride. It's about putting my kid in danger so you can prove your dubious point of libertarian principle or indulge your antiscience delusions. I'm not opening your car and removing your seatbelts or your child seats and you'd be none too happy if I did. Well, maybe you think there's no such thing as society, but I do.
posted by Rumple at 8:57 PM on March 20 [43 favorites]


The up side of all of this is that I have been reminded that tetanus booster shots are a thing and I now have it on my calendar to call and make an appointment for that tomorrow.

My GP took some staples out of my head earlier this week, but before she did so, she verified that my tetanus shots were up to date (last done in 2007, because many tiny cuts and scrapes from GARDENING, people.)

So as an adult who got my polio and smallpox shots as a kid and got measles and chicken pox the old-fashioned way because we didn't have the vaccine back then, what booster shots should I ask my GP about next time? (I already get my flu shots annually, thanks.)
posted by maudlin at 9:48 PM on March 20


You can only get measles (well, each of the two kinds) once. After you've had it you usually have lifetime immunity. I think the rationale for having healthy kids play with infected kids (not, I think, that it was ever all that common a practice) was that it was better for kids to get these diseases as children than to get them as adults.--yoink

I grew up in the early 60s and everyone in our suburban neighborhood did this. They didn't have vaccines for a lot of these diseases yet, and there were always stories going around about a pregnant woman getting the measles and losing her baby. At least in my experience, it was a pretty common thing. So I was guaranteed to get all these diseases, though somehow I never caught the mumps.

I don't think people realize that whether or not parents did this, most people caught all these diseases back then. There was no herd immunity. I'm no doctor, but given my memory of getting these diseases, I'd be willing to bet that getting sick causes a million times more problems (not to mention death) than getting the vaccine. Yet without the vaccines, that's where we would be. You wouldn't even have a choice, you'd just catch the diseases like everyone else.

With the vaccine we do have a choice, of whether or not we are contributing to the spread of the diseases.
posted by eye of newt at 9:50 PM on March 20


I can definitely say that in Portland there are a lot of liberal-minded people who are anti-vaxx, just as much as there are people who believe putting crystals into your plant beds will make your plans grow better, or other such nonsense.

Remember, this is a place that had a massively well-funded and organized campaign that continually used misinformation to push anti-fluoridation, and it won.
posted by gucci mane at 9:53 PM on March 20 [2 favorites]


My mother's rational for sending us to play with the kid on the block with chicken pox (my bestie and her brother) was she'd rather all seven of us have it and get it over with.

Turns out it didn't take with me. So, while all my siblings are covered in a horrible rash, my mother made a slight slit in my skin and rubbed sibling puss into it. Still no chicken pox.

Turns out I have a rare immunity. My body doesn't react to it at all, as if it's inert. Somehow, I lucked out and am immune to the whole zoster family (yay, no herpes!). About once a decade, I get a doc that doesn't believe me and has to test again. So far, five of five tests still say I'm immune.

Unfortunately, my two kids didn't inherit my rarity; my girls had it bad (pre-vax availability) And their Dad got it at the same time, for his first time. He nearly died.
posted by _paegan_ at 10:01 PM on March 20


I suspect it'll take a decade or so if having lots of dead kids before the pendulum swings back. Humans just don't learn from history. Pisses me off.
posted by five fresh fish at 10:34 PM on March 20 [6 favorites]


Certainly, showy displays of contempt for a group is the best way to turn them from error. Also, we can be absolutely sure of what people with odd opinions think based on our off the cuff interactions with them.

I've pretty much decided that when you think difficult people are irredeemably irrational the chief reason is your own solace, entertainment and aggrandizement. Yet it is in fact pretty easy to see how chains of rational decision making lead to erroneous conclusions. It's why so many intelligent people are libertarians, despite it being a demonstrably stupid political philosophy.

Some of you act as if there would never be a reason to doubt mainstream medicine, but this is not true--women and members of other marginalized groups who are aware of systemic discrimination in medical care may have no reason to doubt science, but many reasons to doubt institutions. They may be inclined to listen to their personal networks and exercise caution, since this works in other spheres. They may be especially cautious of initiatives that resemble the one size fits all hegemonic actions that disguise supremacist, harmful policies in other areas. This strategy, which succeeds in other contexts, fails in this situation--vaccines work.

For example, women often have to closely control their own health care in the face of medical intervention that treats male bodies as the default, and has a history of accepting some screwed up things in sexual and reproductive health. Asking many women to trust their kids to the system just a short time after being immersed in literature about how doctors can really screw up their pregnancy and maybe fighting with a medical professionals through childbirth itself is probably unrealistic without some sane outreach strategy.

Through this all we have quackery, of course, which gets stronger the worse access to real care is.

So in vaccination we are talking about a public health initiative that works, but is a failure at responding to the real relationships people have with medical treatment. Its rational, mistaken opponents have no way to make the right decisions seem right in the context of other rational positions that have helped them before. And now that pro-vaccination culture has been taken up as a grating, arrogant sub-identity within modern scientism, that relationship isn't going to improve, though I'm sure it'll help make people who got their shots feel really smart.
posted by mobunited at 11:05 PM on March 20 [17 favorites]


Unless you have information that contradicts the recent study that shows anti-vaxxers won't change their mind regardless the approach taken to inform and persuade them, it's safe to say that "a grating, arrogant sub-identity within modern scientism" is no better or worse than any kill-em-with-kindness approach you might advocate.

These people will return us to an era of literal decimation, where children are slaughtered by the score, and debilitating birth defects await those parents (un?)fortunate enough to not miscarry.

Choosing to not vaccinate is a monstrous act of violence against society. Grating arrogance is going to be comparatively milquetoast as herd immunity is lost and we are forced to treat these people as child abusers.

What they want can not be tolerated. They are irrational, ignorant, selfish people who must be stopped.
posted by five fresh fish at 12:33 AM on March 21 [7 favorites]


My rant detracts from my main point to you, which is that arrogant or sweet, it does not matter in the slightest: these people have a religious conviction and nothing will change their mind.

So you go ahead and be sweet. It's ineffective. Me, I'm going to continue to aggressively agitate for the law to stomp all over them. The law won't be nice, but it will be effective.
posted by five fresh fish at 12:44 AM on March 21 [1 favorite]


meehawl - The decision not to vaccinate the young population against zoster involves a trade-off with the older population. The theory is that if you allow occasional mild, sporadic outbreaks of zoster in the population, you give older adults harbouring the virus in their nerve endings occasional "booster" infections that are hopefully mild and do not proceed to the runaway inflammation of shingles.

Yep, it looks like I misunderstood or misremembered what I had been told on the subject. Your explanation squares exactly with what I've had a chance to read this morning. Thanks for the correction!
posted by metaBugs at 2:39 AM on March 21 [1 favorite]


"We're talking about piercing the skin and injecting foreign substances into a person.

The ability to refuse that (for oneself, we can talk about minors later) is just about the first and most fundamental criterion for whether one is living in a free country.
"
If we intend to live in community with each other, there absolutely must be basic practical limits to how much our individual rights to autonomy interfere with public health. For example, while city dwellers have an otherwise absolute right to the privacy and sanctity of their homes absent a hell of a lot of due process and good reason, they do not have a right to keep firefighters from invading their homes, ripping them apart with axes, or drowning them with water or chemicals as part of efforts to prevent fires from spreading. The bare communal necessities of firefighting and epidemic control can absolutely require ways to set aside otherwise inviolate rights to personal integrity when there ends up being no other way. Currently, the public health need for the vaccination of free loaders is no where near this dire, but infectious disease doesn't care about your civil rights any more than fire does. The importance of civil liberties in the event of the more dire kinds of possible public health emergencies is an important conversation to have.

We really have no idea how bad it would get if some one let The Demon out of the freezer, but there were cataloged strongly contagious strains of flat-type smallpox that were vicious enough for the virulence rate to approach 100%. The Soviets also spent a considerable amount of effort to weaponize smallpox in a variety of different ways. Smallpox is already naturally explosively contagious, virus particles in the mouth spit out as its host talks, and a single particle of smallpox can be enough to get you sick. It especially loves children. After exposure then nothing happens for 8 to fifteen days, you feel fine, there isn't the barest hint of illness, but you can still be infectious. The virus then crashes into your system like a ton of bricks, there is a massive fever, vomiting, and general incapacitation as little red spots begin to appear. Those spots then expand into bumps, or pustules, and keep growing with pus until the pressure becomes so great that your skin splits open, through all of the sub-layers, and the pus leaks out and forms hard scabs, filled with more pus. Its like being flayed alive by a thousand tiny knives. Your entire body becomes completely encased in the delicate scabs that result, while they continue to grow and split in the most painful way imaginable. Your eyes squeeze shut from the scabs on your eyelids and while you become barely able to breathe, you remain conscious, fully alert and lucid to everything that is happening to you. If you survive, the scabs eventually fall off on their own, but if you don't there really isn't a consensus on how death happens if you don't. The best answer is probably a little of everything, between your fluids leaking out of your skin like a burn victim, your lungs slowly ceasing to function as they get clogged with pus and sores, and just the unimaginable horror, loneliness and pain of the whole ordeal.

Unlike the time before the 18th and 19th centuries, we have no population of exposed survivors granting the herd some measure of immunity, and the vaccine was never designed to last the forty years it has been since anyone has been exposed to smallpox antigens in meaningful numbers. We are totally vulnerable in every respect except for our ability to mount a public health response, and even that is somewhat uncertain, front line responders are no longer routinely vaccinated and we haven't really had a meaningful test of what we can do in a long time. There are hopefully somewhere around 7 million doses worth of vaccine left in the four boxes in Lancaster Pennsylvania that hold the United States' supply, which could only hope to be enough to provide ring vaccination for a short period of time. For that to work, the CDC would need to be able to assemble everyone exposed to every known case of the outbreak and vaccinate them, whether they wanted to be vaccinated or not. Private property would need to be seized in order to house the sick and reduce pressure on hospitals, roadblocks assembled to prevent people in exposed areas from traveling, and those roadblocks would need to be real in a way none of us are prepared for.

The 1972 outbreak of smallpox in Yugoslavia is illustrative of just how important civil defense infrastructure and an ability to bypass civil liberties could be in containing the worst of what is out there. We also don't really have a very successful history with this kind of thing. If it ever happens to us, practitioners of woo would be all over the internet and Oprah with their own cures and theories with no one to stop them, armed libertarians would have no interest in their own good much less the public good, and Oath Keepers in the military would behave unpredictably. Would you panic? Find a gun? Comply with orders even if they didn't really make sense to you?

There are very real influenza scenarios that involve >50% global mortality, half of everyone you know and everyone you don't know dying in a single flu season. A tragedy that would dwarf all of the great wars of the twentieth century combined by an order of magnitude in a matter of months. Civil liberties would be among the least of our concerns, there are monsters lurking in our biology more terrible than the worst of tyrants.
posted by Blasdelb at 4:47 AM on March 21 [59 favorites]


"I think the idea is that the immune system just gets plumb tuckered out fighting the vaccine dose and too many at once is stressful. While I have no medical training I do not think it works that way for the nearly-always harmless doses given by vaccine."
This is really common across the internet but it reflects a fundamental misunderstanding of how the human immune system works and what its challenges are.

Our adaptive immune systems work in a really cool way that should, in theory, protect us from an infinite number of potential pathogens but has a few significant drawbacks. As the white blood cells that mediate the adaptive immune response get made they each are born with a completely new antibody through a very randomized process that has a very specific and very random shape on the business end that could, in theory, bind to anything.1 These antibodies are how our bodies recognize foreign invaders that have some means of evading our innate immune systems, and in theory there are enough white blood cells running around our bodies that one of them will have an antibody that will be effective. One white blood cell though is not enough to meaningfully fight off an infection, and so whenever a mature white blood cell encounters something that triggers its antibody it immediately races back to a lymph node and starts dividing like crazy to make enough cells to eliminate the infection. Then, once the infection is cleared, almost all of the new clones of the effective will trigger themselves for death to make room for new white blood cells. One of the big draw backs to the fantastically complex process that is the adaptive immune system is how long it takes to get going, so a significant portion of them will change in such a way as to protect themselves from degradation and remain as a reservoir of memory cells waiting in case the infection ever comes back such that the process has a big head start the second time. This is the biggest reason why when people get sick with infections they then get better as well as why people don't tend to get sick from the same thing twice.

I can sort of see the logic in assuming that this process is all pretty stressful, and that maybe babies would have a hard time dealing with it, but you've got to understand that the moment that the child leaves the sterile uterus their immune system is suddenly surrounded by the functionally infinite number of antigens present on the 100 trillion bacteria found in the human gut and on human skin. The infant immune system is amazingly robust, the how of it all is truly beautiful if you've got the stomach for learning all of the four letter acronyms you've got to memorize to learn it, and the effort required for it to learn from the 14 vaccines delivered in 26 doses as infants is absolutely piddlyshit compared to the stress from learning the contents of a single sneeze. At the same time the benefits are amazing, instead of having to learn from a thing that is trying to kill it, the infant immune system gets to learn from target practice on something that is dead in the water or better yet a inert piece that happens to be the weak spot for the whole damn thing.

1One of the big problems with that strategy though is what happens when the antibody recognizes something that is actually us or for what ever reason actually belongs in us and shouldn't be attacked. Our bodies deal with this by immediately killing all of the white blood cells that are born with an antibody that recognizes a target within the first few weeks of being created, the idea is that if it sees something that quickly its probably something that should be there. Auto-immune disorders are what happens when this system fails for a variety of reasons and our immune cells start attacking things that are us.
posted by Blasdelb at 5:31 AM on March 21 [34 favorites]


"Pertussis is a horrible, slow, gasping, painful death for an infant that takes several days. Ask any pediatrician you like; most either become enraged or cry talking about a tiny patient they lost to a preventable disease."
If any of you really want a visceral understanding of why the pertussis vaccine is important, watch this video. That whoop terrifies me to the point where I can't finish watching it and I don't even have kids. That this entirely preventable disease is not only extant but common enough that we should all need to be able to recognize that sound is a disgusting display of the failings inherent to the human condition.
posted by Blasdelb at 6:00 AM on March 21 [4 favorites]


*an interesting bit of cognitive dissonance is to be found in the "slow-vax" crowd. They believe vaccines are good, they prevent disease! But, all at once are somehow bad! So, they ask for individual vaccines instead of the combo MMR/TDaP. There was a time when they would see families with "alternate vaccination schedules" but they've tightened it down to the AAP schedule or bust.
we did this with my daughter (following the schedule from dr sears).

for me, i see the value in vaccines. children today also seem to get a lot more vaccines than i did in my youth (30+ yr ago), and a lot more together. given that this is all about building immunity, and we don't really, really understand the complexity of the immune system (witness the rise of autoimmune disorders), not pounding the body with a bunch of things all at once made sense to me.
posted by osi at 6:02 AM on March 21 [1 favorite]


The sheer stupidity, and the way anti-vaxxers embrace stupidity and ignorance just chaps my ass something fierce.

Chicken pox parties - exposing your child to disease, on purpose: There's an effective vaccine. Many people who have chicken pox will later develop shingles, which is terribly painful, sometimes debilitating. If you do this to your child, it's abuse. There's a vaccine for shingles, but it's far, far better not to have chicken pox in the 1st place.

Vaccines. There are kids who can't get vaccinated due to fragile immune systems, and vaccines don't take in a small percentage of people. We need to have reliable herd immunity to protect those people, and to get rid of these diseases that are really awful. Measles, mumps, rubella, diptheria, whooping cough, Hib, Hepatitis A & B - these are real diseases. Yeah we survived them, except the people who didn't, or who were badly damaged by them. I grew up knowing someone my age who was blind due to her Mom having German measles. My stepfather had polio, had some lasting disability, then that fucker polio came back and he had post polio syndrome late in life.

There's a very small risk of harm from vaccinations. Everybody has to take that risk, so that everybody is safe. You want your kid to be the one who doesn't take the risk, but still gets protected by herd immunity. That makes you a selfish asshole. We all suck it up, do the right thing, take the risk, and protect the kid who had cancer or some other illness.

You know what's tragic? Not having vaccines available. We had a student from China, family was highly placed and privileged, access to good health care. But this young man, born in @ 1970, had had polio. Not because his parents chose not to vaccinate, but because it wasn't available. I remember how thrilled and grateful parents were to have polio vaccine become available, so their kids would be safe, so they didn't have to be terrified of polio.

The anti-vaxxers, specifically the reprehensible Jenny McCarthy, malign public health doctors. Everything I've learned about people in public health has shown me a remarkable community of professionals who are committed to the public good.

anti-vaxxers won't change their mind regardless the approach taken to inform and persuade them Irresponsible assholes like McCarthy have created an environment of acceptance for not vaccinating. Respond to every anti-vaxxer with disapproval, write to ABC to tell them it's appalling that they employ Ms. McCarthy as if she were a reasonable person, be vocal in your community. You may not change the mind of the anti-vaxxer on facebook, but you may affect the people who friend and follow that person.
posted by theora55 at 6:06 AM on March 21


children today also seem to get a lot more vaccines than i did in my youth (30+ yr ago)

I have never really understood that argument. There are more vaccines today because science is constantly growing and getting better. Diseases are also changing over time. 30+ years ago we also couldn't Skype with grandparents across the country, we didn't have iPads and Netflix. Heck, 30+ years ago we didn't even have cell phones. I would be more concerned if we didn't have more vaccines today than in the 70s because the pace of scientific research moves so fast.

My son gets every vaccine available on the recommended schedule. I mean, he's been sick with various colds all winter and that's miserable enough, why wouldn't I want to give him the chance to avoid all physical ailments we possibly can avoid for him? There are plenty of ways for kids to get sick naturally that aren't preventable, I'm not going to deny him the opportunity to live as pleasantly and healthily as possible because medicine today is different from when I was a kid.
posted by banjo_and_the_pork at 6:17 AM on March 21 [8 favorites]


"we did this with my daughter (following the schedule from dr sears).

for me, i see the value in vaccines. children today also seem to get a lot more vaccines than i did in my youth (30+ yr ago), and a lot more together. given that this is all about building immunity, and we don't really, really understand the complexity of the immune system (witness the rise of autoimmune disorders), not pounding the body with a bunch of things all at once made sense to me."
Children get a lot more vaccines all at once today primarily because we both have a lot more safe and effective vaccines to give and because we know it to be safe to do so. There really is a lot that we do understand about the immune system but Dr. Sears is not an immunologist and has the understanding of immunology of a man who makes a lot of money understanding it in a certain way. His book communicates very very basic errors that I would expect my undergrads to be able to point out, this is not an authoritative source of information.

Whenever a child is exposed to a new antigen, a molecular shape that can be recognized by the immune system, they can go through the whole process I described above. The sheer amount of exposures that babies just handle like champs is truly astounding, and while each vaccine component is certainly going to be fundamentally new to almost any baby, so is almost everything they encounter. How much stress each exposure to something new causes is entirely dependent on factors that we know very well and can manipulate easily in vaccines. For example, when your innate immune system sees one of a small set of very specific patterns embedded into our DNA that are associated only with pathogens in combination with something new, our immune system goes into overdrive, which can sometimes be dangerous. So, even though I could use these patterns in my lab to vaccinate rabbits for research purposes, no one would ever think to use them in human vaccines despite the fact that using them would make vaccines incredibly cheap and effective. Especially with infant vaccines, they are formulated to cause such a trivial amount of stress that the vast vast majority of babies notice nothing beyond the prick. The idea is just to make sure that the hundred or so most important antigens to have antibodies premade against are a part of the trillions and trillions that go through their systems on a daily basis.
posted by Blasdelb at 6:20 AM on March 21 [23 favorites]


not pounding the body with a bunch of things all at once made sense to me.

Well you aren't a doctor or a scientist studying the human body, are you?

Sorry but the root problem here is gnosticism. The idea that you can know complex stuff, just by thinking about it for a teeny tiny bit, and arrive at a correct conclusion that contradicts the millions of hours of technical and scientific expertise amassed by a community of people whose singular goal is to advance knowledge, is just pure fucking hubris.
posted by MisantropicPainforest at 6:23 AM on March 21 [29 favorites]


Also, thanks for speaking up osi, I know its got to be hard raising concerns in a forum filled with people calling for the children of anyone communicating doubts about vaccine recommendations to be taken away. I had to take more graduate level immunology for scientists, which is slightly different and even more ridiculous than the kind they make doctors learn, and epidemiology back in the day than I'd have liked and I'd love to have a chance to finally put it to some productive use if you have any questions.
posted by Blasdelb at 6:29 AM on March 21 [14 favorites]


Was any of this a thing in the days before Wakefield? I get that science works by making mistakes, but the guy seems to have been wilfully damaging humanity with his actions, not pursuing honest science.
posted by bonaldi at 7:00 AM on March 21


(just to be clear, my kid is fully vaccinated)
Sorry but the root problem here is gnosticism. The idea that you can know complex stuff, just by thinking about it for a teeny tiny bit, and arrive at a correct conclusion that contradicts the millions of hours of technical and scientific expertise amassed by a community of people whose singular goal is to advance knowledge, is just pure fucking hubris.
.. it is a constant challenge for parents to act perfectly rationally when undertaking complex decisions that affect their kids.

thank you Blasdelb.

omitted from my prior message is controlling variables. when you give a kid multiple shots at once, and there is some sort of side effect, what was the cause? how does a parent isolate the variables to determine causation?

yes, children are exposed to lots of pathogens. most of which are outside of a parent's control. but some aren't. it's about the minuscule portion of babies that might see something beyond a prick. that might be your kid. if you're giving them 5 pricks at once, which one caused a problem? if you spaced them out, does that not make it easier to isolate?
posted by osi at 7:00 AM on March 21 [2 favorites]


We force people in certain job categories to get vaccinated, too, and I don't think many people find this objectionable.

I resemble that remark. I was actually worried when it took more than two weeks in my case. Four shots, four different things that I either have to handle directly in the hood or indirectly in case someone didn't wash and autoclave their culture bottles well enough.
posted by Slackermagee at 7:05 AM on March 21


Many people who have chicken pox will later develop shingles, which is terribly painful, sometimes debilitating. If you do this to your child, it's abuse.

I wonder if you're aware that people who have had the chicken pox vaccine can also develop shingles later in life, and that some people lose the vaccine-derived immunity in as little as five years.
posted by Behemoth at 7:34 AM on March 21 [2 favorites]


.. it is a constant challenge for parents to act perfectly rationally when undertaking complex decisions that affect their kids.

I don't think anyone is demanding perfect rationality. Its not like there is an ambiguity among the scientific/medical community regarding the safety and risks/rewards of vaccines.
posted by MisantropicPainforest at 7:35 AM on March 21 [3 favorites]


"omitted from my prior message is controlling variables. when you give a kid multiple shots at once, and there is some sort of side effect, what was the cause? how does a parent isolate the variables to determine causation?

yes, children are exposed to lots of pathogens. most of which are outside of a parent's control. but some aren't. it's about the minuscule portion of babies that might see something beyond a prick. that might be your kid. if you're giving them 5 pricks at once, which one caused a problem? if you spaced them out, does that not make it easier to isolate?"
This is actually a really cool question with a relatively straightforward answer. While each each of the combined vaccines on the schedule were primarily tested for efficacy together, each of the components have been tested for safety both individually and together. Thus for example in the MMR vaccine we know that the side effects we do see tend to come from the measles component rather than the mumps or rubella components. While each of the components do have varying levels of safety and efficacy, they each absolutely incontrovertibly worthwhile (barring indicators that pediatricians are trained to screen for) and become safest and most effective at the same time, making it pointless to jab a baby three times in three miss-able annoying appointments rather than just once.

Really though, this seems to be a question of diagnostics, which gets really tricky really fast in non-intuitive ways. On a patient level, knowing why something happens is only really useful when there is something you can do with the information. For example, a parent or pediatrician knowing whether a fever was caused by the mumps or measels component isn't really relevant to the procedures they would follow to address the fever. The answer to that kind of question is only really relevant to the old suspender wearing guys who have been at the business of solving the puzzle of what exactly the optimal regime is for decades, and they already know and have already included the information into their calculations.

The scientific literature on vaccines is very deep and the most relevant papers for each of the components of the MMR individually would probably be from the late 60s to early 70s, but I'd be happy to rustle them up for you if you'd like.
posted by Blasdelb at 7:54 AM on March 21 [12 favorites]


for me, i see the value in vaccines. children today also seem to get a lot more vaccines than i did in my youth (30+ yr ago), and a lot more together.

This is a purely emotional argument, I was a college student in the mid-2000s, and many, many of my female friends had HPV. I interned at my campus health clinic, and the NPs there could not believe the amount of women with HPV they were diagnosing. Many of my friends had surgeries, and the mother of a friend of mine recently passed away from cervical cancer (sadly, she had not seen an ob/gyn since the last 1970s until her cancer was diagnosed).

I can't even tell you how thrilled I was to get my first dose of the HPV vaccine. It was exciting when it came out, to think that people younger than me will probably never have to worry about the shit that many people my age and older went through--or at least not nearly as much, since I know that the vaccine does not protect against all strains.
posted by inertia at 8:32 AM on March 21 [4 favorites]


Dr. Sears is not an immunologist and has the understanding of immunology of a man who makes a lot of money understanding it in a certain way

I'm amazed by the number of perfectly reasonable people who have recommended the Sears books to me. I threw out my copy of the Baby Book when I got to the part about how I should take out loans to stay home with my baby of I couldn't afford not to work.

Anyway, you're sadly wrong about the younger Sears never treating measles. Patient 0 in the 2009 California outbreak was actually his patient.
posted by snickerdoodle at 8:45 AM on March 21 [6 favorites]


If we intend to live in community with each other, there absolutely must be basic practical limits to how much our individual rights to autonomy interfere with public health.

Which is why we require schoolchildren and health workers to get vaccinated. Social pressures were enough to get this job done in the United States up until 1998. We can get back to getting these diseases under control and en route to extinction without resorting to forcible vaccination.
posted by ocschwar at 8:51 AM on March 21


Chicken pox parties - exposing your child to disease, on purpose: There's an effective vaccine. Many people who have chicken pox will later develop shingles, which is terribly painful, sometimes debilitating. If you do this to your child, it's abuse. There's a vaccine for shingles, but it's far, far better not to have chicken pox in the 1st place.

This piece of misinformation has been repeated way too many times in this thread. Vaccinated people can also develop Shingles. It's just a disease that can develop in someone who has been exposed to the Chicken Pox virus.

The benefit of the vaccine over direct exposure to the virus is that you don't have to suffer through actual Chicken Pox as a kid, but that's it. Exposing your kid to the virus was a sensible way to deal with it before there was a vaccine, since it meant you were less likely to suffer the disease as an adult and generally it's easier as a child. Now there's a vaccine, so you don't even have to go through it as a child. But Shingles is still a risk, whether you've been vaccinated or had the disease. If you've never had Chicken Pox & you remain unvaccinated, you risk having Chicken Pox as an adult rather than risking Shingles.
posted by mdn at 8:56 AM on March 21 [2 favorites]


"Anyway, you're sadly wrong about the younger Sears never treating measles."

Wait, someone in the thread has claimed that Sears has never interacted with measles?
posted by Blasdelb at 8:58 AM on March 21 [1 favorite]


Yeah, I don't recall Blasdelb saying anything like that, although the This American Life episode that I'm now listening to via the article snickerdoodle linked to is quite interesting.
posted by XMLicious at 9:07 AM on March 21


If we intend to live in community with each other, there absolutely must be basic practical limits to how much our individual rights to autonomy interfere with public health.

Absolutely. But this will always be a matter of balancing rights against the risks we're trying to mitigate (as, indeed, is the case with the practical limits we accept to all fundamental rights--the old, "fire in a crowded theater," saw). But that means neither side has a magic, unanswerable argument. You can't simply say "universal vaccination will save some lives, therefore there is no rational objection" any more than you can say "I have a right over my own bodily integrity, therefore you cannot force me to accept vaccination no matter what." We have to ask, in each case, how many deaths will be avoided, how big a difference would there be between a voluntary vaccination program, an incentivized vaccination program and a mandatory vaccination program etc.

If smallpox were sweeping the nation, then heck yeah, I'd say "to hell with your right to privacy, it's time for everyone to get vaccinated." The massively high risk clearly counts as something that makes individual protestations about their rights to determine what is and is not placed in their bodies irrelevant. But we're not talking about smallpox outbreaks here. We're talking about childhood diseases that are very, very rarely fatal. In such cases, while it is as plain as day to me that anyone making the choice not to get themselves or their children vaccinated is making the wrong choice, it is not clear to me that the damage caused is sufficiently great to justify the extraordinary violence done to people's individual rights of privacy and self-determination that give them the right to make that bad decision.
posted by yoink at 9:11 AM on March 21 [1 favorite]


Sorry, should have been clearer. People (myself included) have said that people downplay the illnesses because they haven't witnessed them first hand. In Sears' case, it's not true at all.
posted by snickerdoodle at 9:40 AM on March 21 [2 favorites]


mdn: "Vaccinated people can also develop Shingles. It's just a disease that can develop in someone who has been exposed to the Chicken Pox virus. "

While it's true that there's a nonzero chance of someone vaccinated with the VZV vaccine developing shingles, the risk of reactivation is much lower than infection with wildtype VZV. The Oka/Merck virus used has been attenuated by passage through human lung, guinea pig and diploid fetal cultures. It's a fundamentally confused virus, ill-prepared to reactivate after the long-haul dormancy phase in human nerve endings. It's not as confused as BCG, but then it doesn't exhibit the same variable, contingent efficacy.
posted by meehawl at 10:52 AM on March 21 [5 favorites]


We're talking about childhood diseases that are very, very rarely fatal

We're talking about measles, right? In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide... In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. Two years later, measles was responsible for the deaths of half the population of Honduras.

This is the "you're not wet, so you don't need that umbrella" argument. The only reason we think of these diseases as minor is the massive effort undertaken to vaccinate enough people to establish herd immunity. You're proposing that we wait for the inevitable wave of fatalities and disabilities among the elderly, young, and immunocompromised before we take things seriously again? It's already starting to happen in anti-vax communities.
posted by 0xFCAF at 11:23 AM on March 21 [12 favorites]


This is the "you're not wet, so you don't need that umbrella" argument. The only reason we think of these diseases as minor is the massive effort undertaken to vaccinate enough people to establish herd immunity. You're proposing that we wait for the inevitable wave of fatalities and disabilities among the elderly, young, and immunocompromised before we take things seriously again? It's already starting to happen in anti-vax communities.

Huh? Yoink's link was to the CDC (and specifically called "What Would Happen If We Stopped Vaccinations?"), which said: "Before measles immunization was available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963" (bolding in original). Now the US population was smaller then, so 450 probably extrapolates to something like 800 today. It's a reasonable debate what sort of intrusions of personal liberty are worth preventing 800 deaths a year, plus other disabilities and such, and I definitely support vaccination rules for schools and the like, but we shouldn't exaggerate the harm just because it's the right side of the argument either.
posted by dsfan at 11:58 AM on March 21 [1 favorite]


But measles isn't the only issue-- take pertussis, for example:
Before the whooping cough vaccine, about 8,000 people in the U.S. died each year from the disease. Today, because of the DTaP vaccine, this number has dropped to fewer than 40.


The CDC goes on to note that "from 2000 through 2012, there were 255 deaths from whooping cough reported in the U.S." And that's just deaths-- pertussis, as several people have noted, causes enormous pain and debilitation for those infected, often lasting for months. This is of special meaning to me, because I was allergic to the first pertussis shot given to infants and it was not recommended that we try the later editions, so I fully rely on herd immunity in a state that now periodically has pertussis outbreaks. I work with college students, elementary children, and their parents.

It doesn't look like rubella used to kill a lot of people, but here's what it does do:
as many as 85 out of 100 babies born to mothers who had rubella in the first 3 months of her pregnancy will have a birth defect...Before the MMR vaccine, more than 50,000 people in the U.S. got rubella each year.
I don't think that every person should be inoculated for everything with no exceptions, since I in fact am up to date on everything but pertussis. But the reality is that these are not harmless diseases with no lasting repercussions to anyone but to the parents of the, what, hundreds of children we'd be willing to sacrifice to spare one the needle?
posted by jetlagaddict at 12:13 PM on March 21 [6 favorites]


I remember my smallpox vaccination-- how painful the blister was, how I was not allowed to touch it as it healed; everyone of my age still carries the scar, a nickel-sized pucker on the upper arm. I also remember how happy and relieved my mother seemed as the vaccine was applied to the scrape on my skin. Vaccines are one of the miracles of the modern world, one of the few things we as human beings have done in concert to make our lives easier and lessen suffering. It's maddening to see this tossed away, and the sheer ignorance is grating.
posted by jokeefe at 12:54 PM on March 21 [9 favorites]


The pertussis Wikipedia article cites a 2012 report saying
The worldwide incidence of whooping cough (pertussis) has been estimated at 48.5 million cases and nearly 295,000 deaths per year. In low-income countries, the case-fatality rate among infants may be as high as 4%.
in a source also cited in The Lancet Respiratory Medicine.

I'm just not sure how many times you should put "very" before "rarely fatal", if indeed at all, when talking about the sorts of diseases with a fatality rate above 1.5% on a worldwide scale even in 2012. It's not exactly lottery odds. Like, being an astronaut is rarely fatal—per Wikipedia again, "About two percent of the manned launch/reentry attempts have killed their crew"—but we wouldn't consider it insignificant if retail store cashiers suddenly had the same degree of fatal occupational hazard.

The issue is preventing epidemiological events in which even a fraction of a percent fatality rate ends up being a not-inconsiderable number of adults and children dying. This doesn't seem entirely like the sort of medical ethics situations where you're discussing what you can do to someone for the sake of their own health without their consent, nor something like eugenics and forced sterilizations where the benefit is some shaky logic comparing the potential value or happiness of one class of people who don't exist yet to a supposedly-better class of people who also don't exist yet.

Certainly the standard of evidence for compelling even a minimally-invasive or minimally-disruptive medical procedure, to mitigate the consequences for others of the risks that person takes (or in this case their parents take), should be incredibly high. But in the 21st century, with this particular medical precaution and the well-quantified risks to other real, existing people of not using it, it appears as though such a standard of evidence (for the technology in general, maybe not for specific vaccines) has been met.

The imposition of requiring that people be exposed to vaccines does not seem any greater (and indeed seems less onerous) than the part of the social contract where we don't have any choice but be exposed to all kinds of poisons and carcinogens that have ended up in the environment for the sake of Progress and The Common Good. There's definitely the Clockwork Orange question of what you can do to someone to mitigate future risks to others but this isn't a matter of strapping someone down in a torture device to re-shape their personality and eliminate inherent tendencies judged to be anti-social: it's giving them some shots when they're too young to remember which prevents them from doing something—serving as a disease vector—that doesn't involve any volition anyway. They can still grow up to become industrialists and polluters (via both consumer waste and industrial waste) and exercise all those rights we hold most dear.

Until, at least, we figure out how to give kids a similarly-scientifically-validated injection that prevents them from polluting for the rest of their lives or ensures that any pollution they release only affects them.
posted by XMLicious at 1:33 PM on March 21 [4 favorites]


Any easily-preventable child death is too many. We're not talking about extreme measures, or about adults that have made concious choices to put themselves in harms way. The law makes special exceptions and rules around children, and I don't see how this should be any different.

The people that are anti-vax aren't just against MMR, they're against the concept of vaccinations. If we stopped vaccinations in general, it's conceivable that we could see hundreds of millions of deaths world-wide in a short period of time. That's not just wrong, it's monstrous.
posted by blue_beetle at 1:42 PM on March 21 [2 favorites]


Yeah, I kind of come down on the side of enforced vaccination for everyone, no religious exemption, the only way you can get out of it is actual documented medical reasoning--as mentioned in the personal experiences of people in this thread.

When you're old enough to make your own medical decisions, you can... no, sorry, still mandatory.

Your right to your bodily integrity stops right about where it starts affecting everyone else's health.

Alternatively, I'd be okay with letting people refuse vaccination as long as they then go live on an island. One-way trip only.
posted by feckless fecal fear mongering at 1:51 PM on March 21


Here's another analogy that occurs to me: by allowing aircraft to exist in our civilization we're forcibly exposing everyone to some infinitesimal non-zero chance that an airplane will crash into your house and kill your entire family, and this is acceptable for a variety of reasons including the fact that people in injurious situations can be rescued by helicopter, patients can be medflighted to more effective care, and organs to be transplanted can reach the people who need them fast enough. With modern medical technology and statistical quality control, the risks from receiving vaccines appear to also be infinitesimal, in exchange for an even more substantial benefit to everyone.

(Well arguably more substantial, but I'd think it's at least as valuable as having aircraft and is less lethal than going without, given than when nearly all the aircraft were grounded on 9/11 the consequences appeared to primarily be economic.)
posted by XMLicious at 2:06 PM on March 21


Heartbreaking.
posted by five fresh fish at 2:50 PM on March 21




I'm just not sure how many times you should put "very" before "rarely fatal", if indeed at all, when talking about the sorts of diseases with a fatality rate above 1.5% on a worldwide scale

There's a reason you're rushing off for worldwide statistics rather than confining yourself to statistics in the US (the country the FPP is about). All these diseases kill many more people in third world countries where treatment is harder to access and populations are generally less healthy. But from a policymaker's perspective in the US, the worldwide death rate is utterly irrelevant. The question is "how many deaths will we actually prevent in this country by changing the laws of this country?" To answer that question honestly you can't suddenly pretend that every child who contracts measles in the US because of a parent opting not to get their child vaccinated will be flown to a third world country for treatment.

In the relevant country and given the relevant circumstances it remains true that despite the fact that parents who choose not to vaccinate are making a foolish and ill-informed decision, they are also making one that is extremely unlikely to threaten the life of their child. The route to sound social policy does not pass by way of lying about the actual risks you're trying to confront.
posted by yoink at 6:02 PM on March 21 [1 favorite]


Here's another analogy that occurs to me: by allowing aircraft to exist in our civilization we're forcibly exposing everyone to some infinitesimal non-zero chance that an airplane will crash into your house and kill your entire family, and this is acceptable for a variety of reasons including the fact that people in injurious situations can be rescued by helicopter, patients can be medflighted to more effective care, and organs to be transplanted can reach the people who need them fast enough. With modern medical technology and statistical quality control, the risks from receiving vaccines appear to also be infinitesimal, in exchange for an even more substantial benefit to everyone.

That's funny--I thought you were going to go in exactly the opposite direction with that analogy. We allow people to exercise the freedom of choosing to fly light planes recreationally. We do this knowing that there is a non-zero risk to themselves and to others of death and injury. This serves no vital social purpose whatsoever, but we consider it a basic human good to be allowed to pursue a variety of recreational activities and forms of free expression and self-actualization even when it involves some risk to the lives and well-being of others. Similarly, people who do not wish to take a vaccine have the right to make that bad choice even though it presents some risk to their own and others' lives and well-being.
posted by yoink at 6:08 PM on March 21 [1 favorite]


A piece by another pediatrician: Thanks to Anti-Vaxxers, Mumps Are Back. What’s Next?
posted by homunculus at 6:27 PM on March 21


In the relevant country and given the relevant circumstances it remains true that despite the fact that parents who choose not to vaccinate are making a foolish and ill-informed decision, they are also making one that is extremely unlikely to threaten the life of their child.

You seem to be completely ignoring what I said above: I'm not proposing that mandatory vaccinations would be justified because of a danger parents would cause for their own child but because they'd be contributing to a public health risk, like you might if you improperly dispose of human waste (i.e. dump a chamber pot out the window onto the sidewalk) or human remains. There could easily be flaws in my ethical reasoning above—if I were king of the world I certainly wouldn't enact mandatory vaccination without considerable scrutiny of the reasoning supporting it—but what you say there isn't a criticism of my argument.

The reason I cited those statistics is because that's what it says in the first paragraph of the pertussis Wikipedia article, not as some sort of devious lying rhetorical gambit. By all means, present the fatality rate you expect would result in the U.S. from the sort of epidemic outbreaks I'm talking about, or from epidemics that would be caused by introducing open sewers, so that we can compare.

I don't know much about epidemiology but I assume that since more and more of the population will be unvaccinated as anti-vaxxers continue having children, this will increase the speed and severity of epidemics, so I suppose that such figures would need to be calculated against the particular year the epidemic occurs as well.

Flying light planes is a highly regulated and controlled activity: you can't just do it in any fashion you want and there are mandatory safety measures involved with the plane itself, the act of flying on any particular occasion, the operation of airports, and an extensive national aviation infrastructure. If you think that taking the risk of flying light planes is a valid analogy for taking the risk of contributing to a public health disaster, I'm saying that refraining from vaccination and hence furnishing an epidemiological vector for pertussis is like intentionally flying a plane in some way involving a safety risk that is yearly likely to kill some third party one out of a thousand times or one out of five thousand times, whatever fatality rate you think applies rather than the global fatality rate for pertussis, which I agree is not directly comparable to the risk of causing an epidemic.
posted by XMLicious at 8:13 PM on March 21 [2 favorites]


I had to take more graduate level immunology for scientists, which is slightly different and even more ridiculous than the kind they make doctors learn, and epidemiology back in the day than I'd have liked and I'd love to have a chance to finally put it to some productive use if you have any questions.

I'm late to this party, but if you ever check back, Blasdelb, and just because you offered... what's your take on this article (and others scattered around PubMed) suggesting the potential for long-term toxicity and possible autoimmunity resulting from the aluminum adjuvants in infant vaccines?

Scienceblog kind of rips apart the methodology of one of the authors' other adjuvant studies (although he hurts his own case somewhat, imho, with his hysterical and dogmatic tone, and his parting indignation that those authors might actually dare to design an experiment to test their hypothesis empirically); but even if these specific investigators do have crap methodology and poor evidence, I'm more interested in the mechanism being proposed. Do immune effects from aluminum adjuvants seem at all plausible to you? I'm sure they're probably well-tested for immediate toxicity, but are there also rigorous ways of looking for subtler long-term effects as well?
posted by Bardolph at 8:27 PM on March 21 [2 favorites]


Arguing that a minute quantify of aluminum is required to create a biological effect on the body that will alter one's physical system positively for life is inconsistent with refusing to consider that a minute quantity of a substance could negatively effect one's physical system for life. If a minute quantity is capable of such a huge positive effect it only follows logic and safety concern to consider it could also have other negative effects. Actual quality research about it is one thing but arguments about how it's not even worth researching the long term effects are concerning to me.
posted by xarnop at 5:43 AM on March 22


With literally *billions* of doses administered over *decades* now, even the most infintesimal effects are going to show themselves. Thousands upon thousand of studies and meta-studies. Vaccinations are the most-analyzed medical intervention ever.

But all the results, all the studies, all the proof in the world will never be enough, because anti-vax is a religious cult. Faith and woo are immune to reason.
posted by five fresh fish at 8:28 AM on March 22 [9 favorites]


Here is a link to a PDF of that paper hosted on an antivaxx website that undoubtedly doesn't have the rights to it. Reading that link wouldn't incur any liability, even theoretical, on your part but if anyone would like a legitimately obtained copy of this or any other research related to the topic please feel free to memail me with the paper you want, an email address I can send a PDF to, and a promise not to distribute that PDF further.

So I just spent my lunch break going through this carefully and I guess I don't know what I was expecting, but it was something at least more reasonable than this paper coming from a journal that looks as respectable as this one does. More or less all papers start out and sometimes end with a significant amount of absurd or irrelevant hand waving, its part of good writing, but at some stage (ideally less than a paragraph or two in) the bullshit is supposed to stop when you get to the foundation of the points you're really trying to make. This paper never really gets there, keeping the kind of fluffy unrooted tone that is at least really hard to interact with in a serious way throughout. There are also a bunch of aspects of this paper I'm not really that familiar with so I ended up needing to hunt down a bunch of its references to really be able to asses what the authors were talking about, and I ended up finding that it relies pretty heavily on references that were written by these two authors and both this one and those pretty heavily on papers that have either been been retracted due to fraud or definitively debunked. Following the more dramatic statements in the paper to their original foundations, the ones not rooted in clear misconduct or 'error' ended up with me finding myself reading papers that either had much more complex things to say or just something else entirely. Both of these things represent a clear abuse of the trust inherent to academic communications and publishing misconduct. There we also a bunch of really hyperbolic statements that they really really needed a citation for, or an argument to back them up, with but were just thrown out there like they were common knowledge, or I guess received gospel, and an awful lot of actually relevant but inconvenient things I was able to find with a second on google scholar that they don't cite. That doesn't even get into the shell games the paper plays with calling two thousand fold different concentrations of Al adjuvants both 'high'. This is well past the point where one of my old and lovably grumpy East German colleagues would throw up his hands and declare that the authors should just be dragged out and shot to be done with them, and reading this paper was indeed really frustrating like digging for gold in an outhouse, but enough of my complaining, lets get to the argument they try to make.

Leaving aside the toxicological arguments that the two authors primarily try to make in another paper (connected there somehow to autism) and the various bits of other peoples' work that they misrepresent, the main case that they're trying to make ends up being a pretty deeply theoretical one. They point out, as if no one had ever thought of it before, that giving animals massive doses of Al, or other much stronger adjuvants, can cause auto-immune disorders (ASIA) - especially if you do it over and over. To do it they neglect to mention the huge body of work very precisely defining these effects, particularly for Al, and try to play a shell game equating multiple antigens with multiple adjuvants. Even then, as they note, enough Al is not enough to cause ASIA as it naturally prompts the immune system down a pathways that is not harmful to freak out towards. To cause problems you also need to push the immune system down an alternate pathway which can be done with various specific adulterants that can come from the processes involved in making vaccines. What they then don't mention is how really fucking aware of this everyone involved in vaccines for the last 40 fucking years has been or the truly fantastical levels of purity and QC required of vaccines to test for these specific adulterants, using the same molecular tools our immune system would to detect them.

The last portion though is really whats most damning about it, where they cite a handful of safety studies in humans, that they then take pot shots at in a table, with very limited goals building on solid previous work and present them as if the foundations they're built on don't exist and then attack them for it as if they represent the sum total of vaccine safety work. The paper either isn't aware, or doesn't want to be aware of the older safety data in humans that originally demonstrated Al adjuvants as safe, it doesn't even bother interrogating it. Even then though, there is newer epidemiological data that makes all of this bullshit entirely pointless. Here a study done on the registry of every single child born in Denmark between January 1991 and December 1998 that was published a decade ago and that kept track of vaccine compliance as well as auto-immune disorder and autism spectrum disorder occurrence data. They ended up with 537,303 children in the cohort (representing 2,129,864 person-years), 440,655 (82.0 percent) of whom had received the MMR vaccine. This is the kind of statistical power capable of detect even extraordinarily tiny effects and there is absolutely nothing to be found that we didn't already know would be there, and its the same with various other studies of super-large data sets from around the world that have come out since.

I guess this leaves me with one more question, why are two ophthalmologists - eye doctors, publishing this paper on what they at least imagine to be immunology? If you google their names it seem they both have a very long history of making news by seizing on anything - no matter how absurd or inconsistent with the other things they seize on - that might criticize vaccinology. These guys are bullshit artists who've figured out how profitable and rewarding it can be to tell people what they want to hear regardless of how true it is.
posted by Blasdelb at 9:53 AM on March 22 [11 favorites]


why are two ophthalmologists - eye doctors, publishing this paper on what they at least imagine to be immunology?

Investigating climate change deniers has taught me to be extremely skeptical of scientists who publish outside their field. This looks like more of the same.
posted by KathrynT at 9:59 AM on March 22 [2 favorites]


Ophthalmologists are very multi-talented.
posted by Behemoth at 12:30 PM on March 22 [3 favorites]


Anti-vaxers seems to be a very American phenomena. What's the reason for outbreaks of measles in France and in Sweden?
posted by dabitch at 5:34 PM on March 22


Anti-vaxers seems to be a very American phenomena. What's the reason for outbreaks of measles in France and in Sweden?

Anti-vaxers are, regrettably, to be found far and wide and not just in the US. I think I've met more in the UK than anywhere else.
posted by lesbiassparrow at 5:59 PM on March 22


Anti-vaxers and vaccine delayers here in Canada. What really scares me is those I've talked to say they've done "research" and believe they're making an informed decision.
posted by betsybetsy at 6:29 PM on March 22 [1 favorite]


I'd say it's more of a very western thing. In addition to the UK and canada as already mentioned I've heard of them in Australia, and even Germany iirc and other European countries.
posted by emptythought at 7:28 PM on March 22


So when my step-cousins had chicken pox, we went over to their house. My 11 year old self did not get it.

When my sister got chicken pox, and my brother, and my step-father, I went to visit them, and my 17 year old self did not get it.

Like a bolt from the blue out of nowhere, my 27 year old self got it.

Now, after reading all this, I'm fucking terrified of shingles. Thanks, MetaFilter. Really.
posted by Katemonkey at 9:23 AM on March 23


Thanks, Blasdelb!! MeMailing you a question re: sources.
posted by Bardolph at 4:04 AM on March 24 [1 favorite]


xarnop: "Actual quality research about it is one thing but arguments about how it's not even worth researching the long term effects are concerning to me."
There are indeed unfortunately an awful lot of science enthusiasts with a lot less understanding of scientific philosophy or process that they think they've got who can be awfully loud. While there is a lot of non-intuitive weirdness to constructing questions that are capable of giving us useful answers, both in terms of the why and the how those questions are constructed, being willing to meaningfully engage with the questions people ask is really incredibly important to intellectual credibility. I was actually pretty excited to read this paper when Bardolph linked it because while I've heard arguments about Al adjuvants over and over again, and if true would be incredibly important, I had never really engaged with on a really solid level before. Reading it I was pretty disappointed in how banally dishonest and poorly constructed it turned out to be, though in the end I guess thats a good thing.
posted by Blasdelb at 7:23 AM on March 24 [2 favorites]


My anecdata regarding school-required vaccinations:
A few years ago, I was a data manger for a public charter school in Minnesota and, as required, I got vaccination data on every student in my school, including some waivers, which parents needed to get from a doctor. I had to call and send letters threatening to not allow students to attend school if we didn't get the information and I didn't allow transfer students whose vaccine information hadn't arrived to start school. This was all approved by the principal, of course, because we were just following the law.

We didn't have a registered nurse on staff, as we were a small school, so a couple of months into the year, a visiting nurse came in to check out how we did things: incident reports, cleaning the sick room, methods for administering medication, etc. She asked about our vaccination data and was astonished that we had data on 100% of the students. She did the thing where she asked me several times in different ways because she thought we were misunderstanding one another. This is apparently something she had never seen before. When she called a few weeks later to see if we had come up with any questions or needed a follow-up visit, she even mentioned it, like, "oh, yeah, you were that really weird school that had all the data."

(School data management has, sadly, proven to be the thing I have done in my life that I am the best at, so I totally believe that I could do a thing no one else did because it is in this one area and I am so damned good at bureaucracy.)

If her reaction was accurate, I don't think that the public school admission carrot/stick is terribly effective. It's also problematic because schools are reimbursed for students only after they start physically attending (at least in MN), so there is an incentive to allow kids in and assume that you'll eventually get proof of vaccination. Once kids are in, it's easy to end up letting missing registration materials go.
posted by MsDaniB at 7:26 AM on March 24 [3 favorites]


"I don't think that the public school admission carrot/stick is terribly effective. It's also problematic because schools are reimbursed for students only after they start physically attending (at least in MN), so there is an incentive to allow kids in and assume that you'll eventually get proof of vaccination."

In my large urban district, kids lack proof of vaccination (or paperwork for the exemption) for a few major reasons:
1) They have not been vaccinated because they are on medicaid and must go to public health for the vaccines and their parent(s) have to take time off work to get them there and there are buses and whatnot and it is a hassle
2) They have been vaccinated, but are in an unstable housing situation, casual caregiver situation (being passed among family members as parents travel to follow work or go to jail or whatever), or are entering or exiting foster care
3) They have probably been vaccinated, but their parents are in the subset of parents who cannot find their child's birth certificate, can't totally remember the kid's exact birthday, aren't sure who their pediatrician is, and definitely have no idea where vaccine records are. (This is a very small subset but they are an outsize headache because the state definitely doesn't like it when you have basically no records of your child's existence.)

None of these situations is particularly improved by NOT having the child in school. We have an October 1 deadline for vaccination, and MOST of the parents in groups 1 and 2 are able to get it sorted out by then, sometimes with a lot of hand-holding by school officials. But we typically don't enforce the "vaccinate, paperwork, or GTFO" rule unless an actual vaccine-preventable disease starts circulating (typically pertussis). We just send increasingly-sternly-worded letters and make grumpy phone calls and our "community coordinator" eventually shows up at your door to talk to you about it and so forth.

Relatedly, don't schedule your kid for doctors' appointments in August (when all the responsible-but-last-minute parents go for school physicals and shots) or September (when all the irresponsible parents go for physicals and shots). It is always packed.
posted by Eyebrows McGee at 10:16 AM on March 24 [4 favorites]




I don't think that the public school admission carrot/stick is terribly effective.

I don't know about its effectiveness on a large scale, but I was vaccinated only because of that stick. My mom tried delaying and everything else she could do to get around the rule. She finally caved when they convinced her that they really wouldn't let us into the school without vaccinations. Missed out on Hep B because that one was optional (done in school in grade 7-8 but required parental consent). Same thing for all my siblings.

So I'm all in favour of maintaining the requirement, although I'm not sure how to solve the problem of parents/etc misplacing records. A lot of that stuff is going electronic now so maybe at some point the doctors will be able to send confirmation to the schools directly.
posted by randomnity at 2:42 PM on March 24 [1 favorite]


I was vaccinated only because of that stick.

You know, I posted and then went to bed, but I was thinking that I was probably wrong about that. For most parents, it's probably a good reminder, especially for the post-infancy shots. I'm glad to see that it worked for a parent trying to avoid vaccinating, in your case.

Regarding records, the childhood vaccines need to be proven to schools pretty shortly after they are given, so that helps keep them. Doctors often do send the confirmation directly to schools, you get them with other school records when a kid transfers, and Minnesota has a vaccine database (that not all doctor's offices participate in, but it helps) that schools and doctors can access.
posted by MsDaniB at 3:09 PM on March 24 [1 favorite]


In my large urban district, kids lack proof of vaccination (or paperwork for the exemption) for a few major reasons:

Can't your district allocate some of the $750,000 it spends on football to bringing in a doctor for two days in September, which would solve at least problem 1 you list? And is there anything bad about kids getting these vaccines twice? If not, then you could solve sets 2 and 3 at the same time by just vaccinating everyone without paperwork.
posted by the agents of KAOS at 11:33 AM on March 28


the agents of KAOS: "Can't your district allocate some of the $750,000 it spends on football to bringing in a doctor for two days in September, which would solve at least problem 1 you list?"

We actually spend considerably more than $750,000 a year -- around $4 million* yearly -- operating six full-service year-round health clinics in six of our neediest schools, though they are staffed by nurse practitioners and APNs rather than MDs. But they are part of a nearby hospital system and have access to the full hospital staff. They do indeed vaccinate large numbers of children. The treatment numbers for last year were something like 40,000 office visits serving around 8,000 different students or family members (family members can also receive some treatment).

But parents still have to give consent to get their children vaccinated. We can't just stick children with needles willy-nilly.

Documentation's not an unfixable problem, I was just sharing why districts don't typically have 100% documentation. We have student mobility rates well above 50% in some of our schools (that is, half the student body moves into or out of the school during the school year) ... even if you get 100% of the students documented at the beginning of the year, they're constantly moving around. Some states have a central vaccine registry, which my state does not, and I feel like that would help a LOT even if it were voluntary (there is one for providers to exchange medical records relating to vaccination, but not for patients to access their own, and providers aren't required to use it, it's optional). We still use grey cardstock half-sheets from the county department of health and every six months or so I have a freak-out when I have to find MY kids' cardstock sheets to take to the pediatrician and get updated, and I am pretty responsible about that kind of thing. It's just too easy to lose track.

*The funding stream is considerably more complicated than that for football, involving a combination of Medicaid, federal grants, state grants, local tax dollars, in-kind donations, earmarked county funds, etc., but I don't think you actually wanted to know about what it costs to run that sort of program, I assume that was just a snark about how too much is spent on football.
posted by Eyebrows McGee at 12:30 PM on March 28 [6 favorites]






" We can't just stick children with needles willy-nilly."

Aye, though the way Sweden's vaccination law recently changed it seemed to open the door for exactly that. In other Swedish news, the Pandemrix flu vaccine that 59% of the population took has been linked to an increase in Narcolepsy cases. WHO info. I refused to take the vaccine, and didn't allow it for my daughter either which was a great social stigma as people saw me as anti-vax and therefore nutso. (I'm not. I was anti THAT vax).
posted by dabitch at 8:55 AM on April 5


But parents still have to give consent to get their children vaccinated. We can't just stick children with needles willy-nilly.

Yes we can, and yes we should.
posted by feckless fecal fear mongering at 10:07 AM on April 5


Yes we can, and yes we should.

As someone who is VIOLENTLY pro-vax, no we can't. There are real reasons why some people can't get vaccines. Allergies to the components, compromised immune systems -- none of my children can get live-virus vaccines (aka Flumist) because my husband is immunocompromised. I am all for disallowing bullshit religious and philosophical exemptions, but the medical exemptions are real, and eliminating parental consent requirements basically guarantees that some poor harried school nurse who is only talking to the 5 year old in her care and doesn't know about the kid's baby sister in the NICU or grandmother caregiver or whatever will make a mistake that could have deadly consequences.
posted by KathrynT at 10:42 AM on April 5 [4 favorites]


Obviously actual verified by science medical exemptions are fine.

It's every other single exemption that needs to be burned right before sticking the kid.
posted by feckless fecal fear mongering at 10:58 AM on April 5


"I am all for disallowing bullshit religious and philosophical exemptions, but the medical exemptions are real, and eliminating parental consent requirements basically guarantees that some poor harried school nurse who is only talking to the 5 year old in her care and doesn't know about the kid's baby sister in the NICU or grandmother caregiver or whatever will make a mistake that could have deadly consequences."
Seriously, vaccines are as safe as they are only because of our ability to screen for contraindications in the people receiving them in proper settings when they are administered by people with the training to discern them as well as the ability to respond appropriately in the rare events that things go wrong in the context of vaccine schedules that indicate potential harm before it happens. As much as I appreciate the enthusiasm upthread, running around and just sticking kids would result in a lot of dead kids and actually good reasons to oppose vaccination.
posted by Blasdelb at 1:40 PM on April 5 [1 favorite]




uh.. wow. just.. wow... quote from here
"The CDC is looking at it for the larger population. It's like when you go to war. You know a certain amount of civilians are going to die. It's sad, but that's part of war. I have to weigh the pros and cons for my child."
posted by dabitch at 4:19 PM on April 5


So other people's children who get sick are acceptable collateral damage? How lovely.
posted by homunculus at 5:17 PM on April 5


It's weird, because the same person is quoted saying "Catching whooping cough means two weeks of treatment, antibiotics, high doses of vitamin C", which suggests that she actually doesn't think it's particularly dangerous, certainly not a war.
posted by jeather at 5:41 PM on April 5


Here's whole quote:
"Catching whooping cough means two weeks of treatment, antibiotics, high doses of vitamin C. But if my child has an adverse reaction to the DPT vaccine, that can mean lifelong brain damage."

She's ignoring the adverse reactions to catching whooping cough, which for infants can include pneumonia (20%), encephalopathy (0.3%), seizures (1%), failure to thrive, and death (1%).

Oh that's right--it's all just part of the war she's waging.
posted by eye of newt at 11:44 AM on April 6






"It seemed that her vaccine-given immunity had waned."

They said this about the outbreak in France a couple of years ago (some newsreport on TV I can't link)... I got a booster shot that fall.
posted by dabitch at 1:12 PM on April 14


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