The global crackdown on parents who refuse vaccines for their kids is on
November 15, 2019 7:42 AM   Subscribe

Countries like Germany and Australia are tired of measles outbreaks — so they're moving to fine anti-vaccine parents. There’s a school of thought that refusing vaccines on behalf of your children amounts to child abuse, and that parents should be punished for their decision. We know vaccines are overwhelmingly safe and effective at preventing the spread of disease, and failing to immunize children can put them (and vulnerable people around them) at tremendous risk of illness or even death when outbreaks occur. Now it seems that Germany, Australia, and a number of other countries are fed up enough with vaccine-refusing parents that they’re experimenting with punitive measures. We haven’t quite reached the level of child abuse charges, but moms and dads in these countries may face fines if they fail to give their kids the recommended shots. In Australia, the directors of schools that let in the unvaccinated kids would be fined, too. This marks a pretty aggressive shift in how we manage vaccine refusers and the costly, deadly outbreaks of diseases like measles and whooping cough they help spark.
But before we start fining anti-vaxxers, there are some much more basic steps the US could take that would improve vaccination rates. And they involve simply making it harder for parents to opt out of routine shots on behalf of their kids.

Vaccines fall under the public health jurisdiction of the states. And there’s currently a lot of variation across the US when it comes to immunization requirements.

Even though all 50 states have legislation requiring vaccines for students entering school, 45 states allow exemptions for people with religious beliefs against immunizations, and 15 states currently grant philosophical exemptions for those opposed to vaccines because of personal or moral beliefs. (The exceptions are Mississippi, California, and West Virginia, and more recently, New York, and Maine, which now have the strictest vaccine laws in the nation, allowing only medical exemptions.)

Perhaps unsurprisingly, the parts of the country that make it easier for people to opt out of their shots tend to have higher rates of ... people opting out of vaccines. So a lax regulatory environment can create space for more parents to refuse vaccines.

That’s why some states have been moving to crack down on this trend — most notably California — which is already seeing success in terms of boosting vaccine coverage rates.

In 2015, another measles outbreak prompted California’s former governor, Jerry Brown, to sign a bill, SB277, that abolished all nonmedical exemptions. And the California experience is instructive for other states that might want to close some of their loopholes.

According to the state health department, the number of kindergarten students in the 2017-2018 school year with all their required vaccines was 95.1 percent — a 4.7 percentage point increase over 2014-2015 and the second highest reported vaccine rate since health authorities started tracking. A recent analysis, published in JAMA, put the opt-out rate at 4.8 percent by 2017.
posted by Homo neanderthalensis (73 comments total) 24 users marked this as a favorite
 
Here's a professor of epidemiology speaking about mandatory vaccinations and the "what about liberty?" question that often arises.

"We need to maximize liberty without infringing on individual choice - you need to consider the freedom to stay away from disease, that parents want to have - parents of children who do get vaccinated . Remember, infectious diseases are infectious - so YOUR behavior impacts MY child's health.

A parent who gets their children vaccinated has as much right to liberty, to freedom from vaccine-preventable diseases, as somebody who has decided to make the other choice on decidedly non-factual information."

posted by entropone at 8:05 AM on November 15, 2019 [16 favorites]


Good. People, including kids, have died because of this nonsense. Enough is enough.
posted by emjaybee at 8:19 AM on November 15, 2019 [18 favorites]


the number of kindergarten students in the 2017-2018 school year with all their required vaccines was 95.1 percent

It's likely a bit higher than that. My kids had all their vaccines but the schools had no records of them, because I lost their cards and changed doctors enough (going back and forth between "work-provided health care" and "state-provided health care") that I had no easy way to prove they'd been vaccinated, and used the "religious exemptions" checkbox.

There is no exemption checkbox anymore, but there are probably schools that accept "they've been vaccinated but I don't have their card right now; I'll... try to contact their doctor in another state from three years ago to get it?"

They are now adults. I have no idea how to deal with vaccination requirements for college. Maybe they just get revaccinated for everything. (If I got a chance to go back to school... I have no idea how to prove I've been vaccinated, either. And 40+ year old records in multiple states would be impossible to track down.)
posted by ErisLordFreedom at 8:33 AM on November 15, 2019 [1 favorite]


My kids had all their vaccines but the schools had no records of them

In the US, many (most? all? I'm not sure) states (and some cities) have a centralized Immunization Registry (or Immunization Information System, IIS), run by the department of health (in California, it's CAIR2 and you can look for other IIS through the CDC). Health care providers (including school nurses) enter records of every shot given into this database, so that the health department can track immunization rates and so that there's a centralized place for individual patient records.

These are designed to address exactly the issues you point out (losing the cards, changing doctors) - kind of like an electronic medical record, but only for vaccines.

While these systems are for use by public health and medical professionals, most allow you to request your child's immunization records (though it's not a quick process - it involves a lot of identify verification).
posted by entropone at 8:39 AM on November 15, 2019 [12 favorites]


I have no idea how to deal with vaccination requirements for college. Maybe they just get revaccinated for everything. (If I got a chance to go back to school... I have no idea how to prove I've been vaccinated, either. And 40+ year old records in multiple states would be impossible to track down.)

There is a simple blood test that can check titers for immunity. When I did a post-grad college course, the college accepted titers as proof of past immunization.
posted by xo at 8:40 AM on November 15, 2019 [24 favorites]


Remember, infectious diseases are infectious - so YOUR behavior impacts MY child's health.

This is especially true of measles, which is extremely infectious and requires a 95% vaccination rate to achieve herd immunity. The US is right on the edge of that.
posted by jedicus at 8:40 AM on November 15, 2019 [8 favorites]


I always hated the term "herd immunity." Few people want to think of themselves as livestock. Let's use "community immunity" or "collective immunity" instead.
posted by entropone at 8:41 AM on November 15, 2019 [32 favorites]


So if parents can sue me for telling their kid to slide into 3rd base, can I sue a parent for allowing their child to bring whooping cough into a school?
How about a school for knowingly exposing my child to an unsafe environment?

Maybe some of the philosophical objections would disappear if people knew they'd be held accountable for the consequences of their decisions.
posted by madajb at 8:44 AM on November 15, 2019 [42 favorites]


I always hated the term "herd immunity." Few people want to think of themselves as livestock. Let's use "community immunity" or "collective immunity" instead.

I mean, I'm only a theoretical vegan, but still, perhaps it's livestock who could stand to benefit if we felt we had more in common with them, perhaps the herd association is a good thing. People probably shouldn't think of themselves or livestock as livestock.
posted by GoblinHoney at 9:15 AM on November 15, 2019 [4 favorites]


I've heard of immunity.

I'll see myself out.
posted by vibratory manner of working at 9:44 AM on November 15, 2019 [17 favorites]


Avoiding the herd immunity phrase is exactly the problem.
People ARE animals and are subject to ALL the things associated with herds.

You only have to look at the difference in the way people behave as individuals and as part of a crowd.
posted by Burn_IT at 9:50 AM on November 15, 2019 [16 favorites]


YOUR behavior impacts MY child's health.

So if parents can sue me for telling their kid to slide into 3rd base, can I sue a parent for allowing their child to bring whooping cough intimidation a school?

I sure hope so. I don't want any (more) children to die because of these fucking morons, but I anticipate the first case of negligent homicide brought to trial is just around the corner.

I hope they win it, too.
posted by tzikeh at 10:00 AM on November 15, 2019 [7 favorites]


...look, I'm as prone to banging the "humans are animals!" drumbeat as the next biologist, but if "community immunity" helps to emphasize the collective aid aspects of vaccination and apply extra social shame on people who opt out, by all means change the damn name. C'mon, guys.

The hell with ideological word choice. What evidence-based initiatives lead to higher vaccination rates? Removing religious exemptions are a great first step. Where do we go next? If we had socialized medical care in the US, it would be easier to provide vaccination clinics in schools themselves, as my Canadian spouse had; that would remove the logistic difficulties for parents and obviate any financial worries. Increasing public discussion by talking about flu shots for adults and openly participating in those is probably helpful, too--normalize the vaccine instead of treating it as a childhood terror, and as a bonus increase collective immunity to the flu viruses. Normalizing adult boosters is probably going to have to happen with the more-popular-as-a-response-to-antivaxxer-concerns killed strains that are now being used anyway; if we can get people talking about that, that's a useful thing too.

Increasing vaccine coverage doesn't need to happen purely as a result of adversarial legal challenges. We should be able to think, as a society, and work out how to ease this transition to improve coverage in ways that don't simply boil down to fear of lawsuits. God knows those are one hell of a double-edged sword.
posted by sciatrix at 10:03 AM on November 15, 2019 [22 favorites]


I also like to think "herd immunity" is a bit of the tip of the hat to Edward Jenner, cows, and the genesis of the smallpox vaccine, which is an important bit of history to raise with anti-vaxxers, i.e., "People used to get horrendously ill and die from smallpox. It was eradicated. By vaccines. Now roll up your fuckin' sleeve."
posted by mandolin conspiracy at 10:03 AM on November 15, 2019 [6 favorites]


Offering free vaccinations at schools, during the first few weeks, would be a great way to increase vaccination rates. Especially if teen kids could get vaccinated without parental consent - have a judge rotate through several schools to give the necessary permissions.
posted by ErisLordFreedom at 10:20 AM on November 15, 2019 [17 favorites]


I always hated the term "herd immunity." Few people want to think of themselves as livestock. Let's use "community immunity" or "collective immunity" instead.

Well, except, the people who don't vaccinate also tend to hate collectivism, so we might want to steer away from that. How about a syringe full of "freedom serum"?
posted by Mayor West at 10:31 AM on November 15, 2019 [23 favorites]


If we used “flock immunity,” we could all pretend we were asshole geese. We pretty much act like it, most days.
posted by GenjiandProust at 10:42 AM on November 15, 2019 [22 favorites]


I would be fine with offering non-medical exemptions for reasons of religion or conscience, as long as the process for claiming the exemption is something more than a checkbox. Gotta make a special to the Official Bureau of Vaccine Exemptions, demonstrate that you have an active, regular and ongoing participation in a religious or other organization of conscience that itself opposes vaccination as a matter of doctrine. Once you show off your attendance records and tithing history and get a signed statement from the Evangelical Church of Science Is Dumb saying you are a member, then you can be granted the exception. Make everyone read some brochures on why vaccines are important first, too.

I'm very, very sure there are church/state reasons why that's a terrible idea, but a lot of things can be dissuaded just by putting an administrative burden on top of them.
posted by jacquilynne at 10:46 AM on November 15, 2019 [6 favorites]


Once you show off your attendance records and tithing history and get a signed statement from the Evangelical Church of Science Is Dumb saying you are a member, then you can be granted the exception. Make everyone read some brochures on why vaccines are important first, too.

....why do you want to give churches who want donations a reason to suddenly claim anti-vax beliefs? Seriously, this would create a whole bunch of money aiming at shady churches where it would be immediately untaxed and go into fuck only knows what.

What reasons of conscience are there to avoid vaccination? What moral reason is there to refuse vaccination?

No. No religious exemptions. They've been too badly abused for way, way too long, and the net effect is to create a massive medical toll on everyone else. I'm absolutely and totally with you on increasing bureaucratic difficulty for avoiding vaccination, but based on what's been going on in California this is way too far gone already.
posted by sciatrix at 10:52 AM on November 15, 2019 [35 favorites]


The US had involuntary household confinement for particular contagious diseases. You could wake up and find official seals on your house or boardinghouse doors and, hey, too bad about your job. Because epidemics are terrifying.

I don’t know what legal basis this was on, or when it stopped, but it always takes me aback in biographies. Much more liberty-curtailing than closing pools and theaters (as the US did longer, during polio outbreaks AFAIK).
posted by clew at 10:53 AM on November 15, 2019 [6 favorites]


changing the word herd to community isn't going to make morons less stupid.
posted by poffin boffin at 11:08 AM on November 15, 2019 [26 favorites]


No, but it might help with people who don't feel strongly either way, but wind up thinking, "I'm not part of a herd! My child is not like a horse or a cow! Individual rights are important to me!"

Switching the common term to "community resistance" (especially, "community resistance to hostile foreign viruses") may help convince conservative parents that this is something they want.
posted by ErisLordFreedom at 11:19 AM on November 15, 2019 [5 favorites]


“What reasons of conscience are there to avoid vaccination? What moral reason is there to refuse vaccination?”

To be fair, some of them contain egg or pork. I’m vegetarian and overlook that for the greater good of not causing a flu outbreak at work, but other people who don’t eat port for religious reasons may be more rigid.
posted by tinkletown at 11:32 AM on November 15, 2019 [1 favorite]


Warsaw recently polled the vaccine state of toddlers in the queue for city-funded daycare (so under the age of 3). Only 80% of them were up on all shots required for their age.

Thankfully, they're now going to introduce a simple "no shots = no city-funded daycare" rule, which may improve things slightly, but the stats are absolutely terrifying. Especially since we have high migration from Ukraine, which has measles all over and a vaccination rate for toddlers ranging from 20 to 56% depending on the disease. (They're working on it too, with free measles vaccinations for adults, but it'll take time.)
posted by I claim sanctuary at 12:02 PM on November 15, 2019 [5 favorites]


sciatrix: it would be easier to provide vaccination clinics in schools themselves, as my Canadian spouse had; that would remove the logistic difficulties for parents and obviate any financial worries.

Wait, you're not telling me that people have to pay for essential vaccinations in the U.S., are you?
posted by clawsoon at 12:12 PM on November 15, 2019 [10 favorites]


I always hated the term "herd immunity." Few people want to think of themselves as livestock. Let's use "community immunity" or "collective immunity" instead.

That seems like a minor, aesthetic issue to be addressed later. No one is refusing to be vaccinated because of how the concept is phrased. You can call it whatever you like and it won't do any good because they don't think that is relevant to them.
posted by Dark Messiah at 12:16 PM on November 15, 2019 [9 favorites]


Wait, you're not telling me that people have to pay for essential vaccinations in the U.S., are you?

In the US, you pay for EVERYTHING medical. (Not sure how to get this across to Canadian and European friends, because... yeah. Everything. No government-provided services at all, except a limited amount for the very poor who have managed to jump through the right hoops, if they have the right kinds of ID and so on.)

Most insurance companies - almost all of them - cover the standard vaccinations. So if you have ACA-compliant health insurance, vaccinations are covered. Before the ACA, a huge number of kids had no insurance. Even now, it's about 5% of kids in the US, almost 4 million children. That's down from 8% in 2010.
posted by ErisLordFreedom at 12:19 PM on November 15, 2019 [32 favorites]


ErisLordFreedom: In the US, you pay for EVERYTHING medical.

I know you know this already, but that's dumb. Stupid. Very stupid. I'm half expecting you to tell me that they don't treat your water supplies, either, because it's a public health issue and therefore you're responsible for putting the chlorine tablets in the water every day. That's how dumb this is.
posted by clawsoon at 12:23 PM on November 15, 2019 [16 favorites]


Only allow religious exemptions where the churches / organized religious groups involved agree to give up their tax-exempt status in exchange to offset the increased medical cost, compensation to victims, and impact to the community AND only where the amount of additional tax revenue that will be collected is expected to be sufficient to cover the cost.

And yes I know it’s never going to happen.
posted by inflatablekiwi at 12:27 PM on November 15, 2019 [6 favorites]


The problem is not religious exemptions. Actual religious groups with objections to vaccines are very rare. The problem is people deciding they don't want vaccines for their kids, and claiming the religious exemption on the grounds that "all of my beliefs are religious," or "my religion believes the parent is the sole decider for a child's health care," which of course is never formally part of a group's statement of beliefs.

It's very hard to get courts in the US to actually question religious beliefs, to require people articulate why a particular practice is part of their religion. It's basically only ever done for minority religions demanding rights that most Christians don't care about - mainstream Christian groups are never required to prove that a particular practice is actually part of their religion. And if it starts being done for this, it's not going to be used only for vaccines, nor only against middle-class white Christian suburbanites.

I don't want any kind of "must belong to X type church to get religious exemptions" restrictions, for this or anything else. Wicca would never have gotten any legal rights if you needed to be a member of a state-recognized church first. A Jewish person should not have to claim membership in a conservative local synagogue for their job to be required to allow them to keep Shabbat. (Yes, basically everyone knows the Jewish religion involves Shabbat. But not every group practices it the same way. I don't want precedents for "you must practice your beliefs with a registered group of X size before you get legal rights.")

I don't want vaccines to be the wedge used to remove the rights minority religions have fought for.
posted by ErisLordFreedom at 12:51 PM on November 15, 2019 [12 favorites]


I know you know this already, but that's dumb. Stupid. Very stupid. I'm half expecting you to tell me that they don't treat your water supplies, either, because it's a public health issue and therefore you're responsible for putting the chlorine tablets in the water every day. That's how dumb this is.

I presume you haven't heard about Flint, Michigan?
posted by zombieflanders at 1:10 PM on November 15, 2019 [20 favorites]


If we used “flock immunity,” we could all pretend we were asshole geese. We pretty much act like it, most days.

Vaccine in the lake!
posted by chadlavi at 1:10 PM on November 15, 2019 [8 favorites]


In the US, you pay for EVERYTHING medical.

Actually, in this instance, it's not the case.
The federally-funded Vaccines For Children Program provides free vaccines to children who aren't otherwise able to get them.

Basically as long as you're under 18 and can find your way to a health care provider in the usa, you can get vaccines without cost.
posted by entropone at 1:14 PM on November 15, 2019 [13 favorites]


In the US, you pay for EVERYTHING medical. (Not sure how to get this across to Canadian and European friends

Many of the vaccines aren't free in Canada (okay, Ontario is all I know, but …) either. Basic preventative ones like measles, tetanus and flu are without charge, but some useful ones can be quite pricey: hepatitis was about $80 (after insurance paid out some) and shingles is around $300 (for which my insurance pays nothing, fml for getting old).
posted by scruss at 1:41 PM on November 15, 2019


> If we had socialized medical care in the US, it would be easier to provide vaccination clinics in schools themselves

We do that for flu shots in my US city -- they set up in the high schools for one or two afternoons each fall. I wish we could do it with more of the standard vaccinations.
posted by The corpse in the library at 1:53 PM on November 15, 2019


Hmm. Maybe a derail, but I'm pretty sure I got some of my vaccines at (my American) elementary school, is that really so unusual?
posted by geegollygosh at 2:24 PM on November 15, 2019 [1 favorite]


The Vaccines for Children program covers eligible children only, which are: Medicaid eligible, uninsured, American Indian or Alaskan Native, or "underinsured," defined as, "you have insurance but it either doesn't cover vaccines, or has a $$ cap and you've already reached it."

It doesn't cover "you technically have insurance but your parents aren't getting you vaccinated because they can't afford the half-day off work + cost of doctor visit copay + cost of vaccine." It also, of course, doesn't cover that half-day or more off work for the parents, even for eligible children. And it only covers kids at all if their parents have done the appropriate set of paperwork rituals, which they may not have, especially if English isn't their first language, they don't have various types of documentation, or they just don't understand how gov't forms work.

The whole medical system setup of "let's not having anyone CHEATING and getting FREE VACCINATIONS" works to dissuade people a lot more than it does to prevent "scammers" who would be skipping out on the cost of vaccines they could otherwise afford.
posted by ErisLordFreedom at 2:28 PM on November 15, 2019 [19 favorites]


As much as I DO strongly believe everyone should be vaccinated, I equally distrust government to dictate what/when/where that should occur. I think individuals should act responsibly, yet have complete bodily autonomy (not just when it comes to immunization - abortion, etc)
posted by blaneyphoto at 3:45 PM on November 15, 2019


Abortion only affects the person having one. Letting people choose not to vaccinate puts all of us at risk of communicable diseases for no reason. They are in no way equivalent.
posted by hydropsyche at 3:58 PM on November 15, 2019 [25 favorites]


Hence involuntary confinement before we had vaccines. It only slowed epidemics and plagues, of course; didn't prevent them.

geegollygosh, I got immunized by a school nurse in a US city in the early 1970s. There were enough poor students at the school that it might have had extra support (back when we did that for a little), or maybe this was the end of the school nurse era for everyone?
posted by clew at 4:08 PM on November 15, 2019


> I'm half expecting you to tell me that they don't treat your water supplies

Not just Flint. About a third of US public water systems at any given time are in violation of EPA regulations.

The mostly small rural communities often simply can't afford to improve them.

Almost everyone I know uses water from their own well in the yard. We're lucky in having both a well and a couple great springs, with no human activity nor farming uphill from our home.
posted by goinWhereTheClimateSuitsMyClothes at 4:08 PM on November 15, 2019 [7 favorites]


, I got immunized by a school nurse in a US city in the early 1970s. There were enough poor students at the school that it might have had extra support (back when we did that for a little), or maybe this was the end of the school nurse era for everyone?

I got at least one vaccination at school.
Not sure what it was, in those days you just lined up and did what the nurse told you to do.

I remember they gave us a little card and we were supposed to check to see if any raised bumps occurred at the injection site.
posted by madajb at 4:44 PM on November 15, 2019 [1 favorite]


*ahem* Canada does not have the moral high ground on water quality.

---

As much as I DO strongly believe everyone should be vaccinated, I equally distrust government to dictate what/when/where that should occur.

Translation for non-Americans: "Though I recognize that government can provide this service in the most efficient, comprehensive manner, I would prefer to leave it up to individuals who may have neither the means nor the inclination to accomplish a task that will only be effective if 95% of them follow through."
posted by klanawa at 4:57 PM on November 15, 2019 [20 favorites]


Whenever I hear anyone mumbling anti-vaccine nonsense, I always get them to watch this classic Penn & Teller video on vaccinations.
posted by kmkrebs at 5:32 PM on November 15, 2019


The problem is not religious exemptions. Actual religious groups with objections to vaccines are very rare.

the entire borough of brooklyn is a plague pit of measles because of religious exemptions
posted by poffin boffin at 6:29 PM on November 15, 2019 [14 favorites]


If we used “flock immunity,” we could all pretend we were asshole geese. We pretty much act like it, most days.

It's a lovely morning in the village, and you are a horrible anti-vaxxer.
posted by solotoro at 6:40 PM on November 15, 2019 [3 favorites]


These perfect assholes won't vaccinate their kids when children, sometimes their own, are literally dying. We could call it Free Kitty-Princess Party Funtime Jabs and they'd still find a reason to avoid it.
posted by XtinaS at 7:00 PM on November 15, 2019 [7 favorites]


the entire borough of brooklyn is a plague pit of measles...

*laughs into my mask stuffed with aromatic herbs*
posted by um at 7:07 PM on November 15, 2019 [6 favorites]


Of course, people being people, the flip side of SB277 is that suddenly there are ... certain ... doctors who will attest to your child needing a medical exemption, provided that you pay large dollars to said doctor. The best part is, you don't even need to actually visit said doctor, you can just mail them the money and get the form back.

...why these individuals (and it is only a handful in the entire state) have not been stripped of their medical license and imprisoned is beyond me. Yes, the wheels of justice grind slow, but for the love of god could they maybe grind at a speed above zero?
posted by aramaic at 8:17 PM on November 15, 2019 [6 favorites]


As much as I DO strongly believe everyone should be vaccinated, I equally distrust government to dictate what/when/where that should occur.

I do wonder when Americans will think it's odd that the entities they're constitutionally guaranteed to have at least some influence over are so much less effective than the entities that are owned by a handful of people who don't have to listen to anyone

and why this doesn't appear to be true in other countries

anyway vaccinate your kids, even the libertarian magicians thought it was a good idea
posted by Merus at 8:30 PM on November 15, 2019 [10 favorites]


Muslim here, I do not eat pork. I had my Zostavax as soon as I was eligiable. Mom had shingles, a couple friends had shingles. There are fatwas allowing Zostavax despite the fact this vaccine contains porcine gelatin. Frankly, I might have gone ahead and had the vaccine anyway fatwa or no fatwa. These people I knew got pretty sick.
Why does Zostavax contain porcine gelatin? Well, there are a shocking number of people who are allergic to beef gelatin . I’m not one of those people. I can apparently have all the beef gelatin I want. People’s allergies can kill them. So they make the vaccine as physically safe as they can for everyone. If you are my age and had chicken pox, as opposed to the vaccine, you need vaccination against shingles.
Many religions which prohibit certain foods will usually have a survival, or medical exemption. Both Judaism and Islam have exemptions for these situations.
posted by Katjusa Roquette at 8:30 PM on November 15, 2019 [36 favorites]


Many minority communities have bad experiences with state-imposed medical treatment and every reason to distrust it. I'm very leery of compulsion, even though I am pro-vaccination. I would far prefer decent outreach and education, along with making it super-easy to do, over coercive measures.
posted by i_am_joe's_spleen at 10:51 PM on November 15, 2019 [4 favorites]


In Australia, local councils conduct vaccination clinics. My recollection is that research has shown the PUBLIC COUNCIL clinics are better at the process of immunisation as
1. the vaccines are fresher
2. the medical staff are specialists dealing regularly with vaccination processes and so better able to assess reactions 3. the worst reactions tend to commence shortly after the vaccination, so being able to stay near the medical staff means that the response is prompt. ie. your child is vaccinated and you stay at the clinic for the next hour or two. Most doctors really don't want you hanging around cluttering up the waiting room.

The introduction of the MEASLES vaccine, in particular, had a much greater reduction in death rates, than the data on deaths from measles would have predicted. We seem to be closer to an explanation

https://www.theguardian.com/science/2019/oct/31/measles-wipes-out-immune-systems-memory-study-finds
posted by Barbara Spitzer at 11:38 PM on November 15, 2019 [4 favorites]


aramaic, from listening to a Behind the Bastards episode, they are cracking down on some of those doctors. Dr. Robert Sears, who wrote his own "lets give your kid a really good chance of getting a communicable disease by delaying vaccines" schedule had to have another doctor sign off on all of his work for 18 months after it was found that he said that a toddler had adverse reactions to vaccines on the say-so of the kid's mother, without taking a medical history or examining the baby.

I would have liked to see him lose his medical license, but being under intense scrutiny for a year and a half is a good start.
posted by Hactar at 12:34 AM on November 16, 2019 [4 favorites]


I don't think we can realistically achieve or expect 100% immunization - but we can aim for community immunity.

I'm pro vaccine, but I do have serious science-focused questions and reservations about autonomy and personal health choices with nearly complete disregard for religious exemptions.

I have direct parental family evidence of a very severe reaction to a flu shot containing thimesoral that put them in a wheel chair for some non-terminal period of time in the order of weeks and left them with a lot of debilitating immune issues, and it may even be some kind of reaction to being previously compromised with what is known as Epstein-Barr, CFS and/or other mononucleosis related immunodeficiency stuff along that axis.

I have had TDAP boosters recently, I'm interested in hepatitis vaccination even though I'm relatively low risk, I would take an HPV vaccine if I was a young adult, and I actually want to partake in flu vaccines because I tend to volunteer with the public and/or work with food in service and so on.

I don't personally catch the flu or even a common cold very often but I know that's not how that works, I can be a carrier and be shedding active virus loads without active flu symptoms.

My doctor asked if I wanted a flu shot but I told her about my family history and allergic reaction and she actively recoiled in a really uncharacteristic way and said "Ok, maybe you shouldn't have flu shots in particular." and she's one of the most pragmatic and evidence-based doctors I've ever had and is very pro-vaccine and basically asks me every visit about getting a flu shot or the hepatitis vaccines, then remembers or reads the family history note.

I wish there was a reliable allergy or reaction test of some kind so that we could aim for maximum vaccination success rates with the least actual damage or ab-reactions to the therapy. It seems like we're getting closer and closer to the point that we could do a personal genome map as well as some kind of allergy scratch test or analysis for additives/preservatives and know with more certainty that a given vaccine therapy will be harmless or well accepted and functional.

So, yeah, I would really like to be getting the flu vaccine every year even with limited personal effectiveness or immunity depending on the actual wild strains, just to help protect the people I try to help. But I don't know if I want to tempt fate and family medical history.

Before I saw this post I was actually thinking about asking my doctor about some kind of possible flu shot allergy test whether it's a scratch test for preservatives in the modern flu shot systems or other.

This issue is extremely complex on multiple levels. Biological, legal, philosophical and even metaphysical or spiritual.

I do know I do not want to live in a world with smallpox, measles, polio, bubonic plague or even tetanus or pertussis and so on - and, now, HPV vaccines and even experimental HIV vaccines and I welcome a world without those as well.

But I'm also pretty sure I don't want to live in a world where vaccines are 100% bright line black and white mandatory without responsibility, culpability or legal liability from the corporate producers of those vaccines because capitalism is often some straight up bullshit and has difficulties sometimes with responsibility or doing the right thing
.
This isn't a religious or genetic engineering fear conspiracy theory thing I'm proposing, but it's that the banality of evil of corporations is often simply the balance of profits over lives and, pardon me, some dirty ratfucker signing off on some bullshit because it means he can buy a yacht or summer home and a couple of mistresses and enjoy themselves for 10-20 years before someone - possibly, maybe - finds out and holds them accountable. As if.

Or even more banal and boring, sometimes we simply make mistakes. As humans, as a species. Our knowledge has grown, changed, and even backtracked.

Here's a current and relevant analogy:

We used to promote fairly liberal antibiotic use, and still do as required with more cauition, but we are now facing bacterial superbugs. And it's more complex than the increase spectrum of anti-bacterials or over-prescription of them It also involves widespread consumer use of anti-bacterial everything from soaps to socks with stuff like triclosan.

And we're finding that bacteria has evolved and started adapting to all of these various therapies and anti-bacterial agents

Why are we assuming that viruses won't adapt or react or fight back at some point in somewhat the same way? I don't see this question generally being raised in an visible way.

Why do we not assume that we don't really know quite enough about what's happening on the genetic level between viruses and their hosts whether it's human or otherwise?

While I'm definitely not a geneticist or molecular biologist, I've been paying attention enough to know some more advanced things about how viruses and general genetic sciences works, how stuff like HPV, HSV, or even HIV invades host biology and alters it permanently, how shingles are a complication of chickenpox and how complicated viruses really are and what they can do to a given host.

And I will ask a rather terrible apocalyptic science fiction grade question - if viruses are often informed by and adapted to the genetic code of their hosts, is there a potential combination of genetic material between engineered or adapted vaccine, vaccinated compromised host and a live, wild virus that either strengthens a given communicable viral strain or creates something entirely new, if only because we don't know what we're doing or how fast something that is alive and more-or-less biologically meets the definitions might adapt or progress in that environment?

Because this is something that already happens in the wild with live viruses and our natural immune systems or the immune systems of our hosts.

And we really haven't had the best track record of knowing what we were doing before we started actually doing it, and viruses and immune system responses and how this all relates - like how we're now learning natural positive bacterial flora may have profound influence on health both physical and mental, how we've been learning for years that our antibiotics have been becoming less and less effective because of evolution and adaptation.

I am pro vaccine, but I really wish we knew a whole lot more about how to apply them with accountability or knowing what is basically high and hard science fiction-grade amounts about genetics to know that they're safe for everyone that are taking them with more reliability and certainty.

Specifically because that knowledge would make it much easier to apply vaccine therapies to us as a collective for our collective health. That knowledge could also make tailored vaccines that offer the most immunity for a patient with the least risk or side effects.

I earnestly wish we knew such vast amounts of science-fiction grade genetics and biology that we could use individually tailored vaccines for each individual patient to provide the best possible individual immunity.

Imagine being able to be immune from the common cold for life? This is probably the genetic technology and knowledge it would take to be able to offer a cure for the common cold and rhinovirus - being able to tailor a rhinovirus vaccine to an individual patient's genome and immune system.

It would take similar knowledge to offer genetic or vaccine-like therapies for allergies, too.

I also think it's telling that I'm hesitant and anxious to hit post on this comment for fear of being wrongfully branded as anti-science or anti-community health and immunity despite the last few paragraphs.

I hope my reputation as being pretty bright and intuitive holds a little weight, here.. I'm super curious and pro-science and intuitively adept. And I have legitimate questions, and they aren't entirely new questions and they also aren't knee-jerk anti-vaxx questions, either.

I am also very much pro-community health and organization and just wish we knew a lot more about individual and community risks.

Somewhat tangentially we need much, much stronger regulation and protection for worker's health rights in particular with food service or professional health services when someone has any hint of a cold, flu or viral or bacterial infection.

We might be able to prevent a whole lot more additional cold/rhinovirus or flu infections and spreads just by affording and allowing service workers to always stay home and not be in contact with the public and also working towards better worker protections and rights in lieu of vaccination therapies.

Seriously, how much of common infectious viral or bacterial disease pathology and vector based on people not being able to afforded or allowed to call in sick to work?

And bringing it back to personal rights and health, how do we preserve individual freedom while achieving community immunity and effective communicable disease and pathological therapies?
posted by loquacious at 1:34 AM on November 16, 2019 [2 favorites]


the entire borough of brooklyn is a plague pit of measles because of religious exemptions

Except, to my understanding, non-vaccination in ultra-Orthodox communities (which is what I assume you're referring to) doesn't actually have to do with religious belief, but rather that isolationist religious communities are particularly vulnerable to anti-vax messaging--people are already distrustful of outsiders and may have limited ability to investigate the issue themselves.
posted by hoyland at 4:08 AM on November 16, 2019 [9 favorites]


Katjusa Roquette: Why does Zostavax contain porcine gelatin? Well, there are a shocking number of people who are allergic to beef gelatin .

Incidentally and tangentially, I believe that was the same reason that insulin was most commonly sourced from pigs in the days before we figured out how to get E. coli to make it. In summary, humans are like pigs.
posted by clawsoon at 5:51 AM on November 16, 2019 [4 favorites]


Lighten up on the damned geese! Even the stupidest meanest goose is nicer than most humans. Flock immunity!
posted by evilDoug at 6:49 AM on November 16, 2019 [2 favorites]


I think individuals should act responsibly, yet have complete bodily autonomy

Which is more important: Requiring responsible behavior, or allowing bodily autonomy?

Normally, we allow irresponsibility for small-scale activities that only affect the individual (e.g. smoking) and disallow it for activities that have a high chance of harming others (e.g. driving recklessly).
posted by ErisLordFreedom at 8:58 AM on November 16, 2019 [7 favorites]


loquacious: The thing is, you sound quite reasonable. But you're raising objections about some stuff we already know the answer to in the same way that anti-vaxxers do. To pick one example...

Why are we assuming that viruses won't adapt or react or fight back at some point in somewhat the same way?

We're not? Scientists and doctors generally aren't stupid. This is an area of research looking for a general solution but, for example, two possible explanations being considered are that vaccines are generally used preventatively while antibiotics are used to treat existing illness and that vaccine-induced immune response targets multiple sites of the virus being attacked while antibiotics tend to attack only a few sites. Are either or both of those explanations the whole picture? Likely not. But what we can say is that viruses don't adapt past immunization at anything like the rate of bacteria evolving in response to antibiotics. We can say that because that's what we observe and we have a very large sample size.

Look, I appreciate this is a complicated and difficult topic but a lot of your comment boils down to "I'm not anti-vax but... [antivax talking points go here]".
posted by Justinian at 9:26 AM on November 16, 2019 [24 favorites]


The flu vaccine given out in UK schools is some sort of spray that contains gelatine. That means my (vegetarian) daughter spends weeks begging us to look for a place that has the jab so she can show that she's already been vaccinated. This year we couldn't find it in time so she just sucked it up and ingested animal flesh to avoid spreading disease.

Her Jewish and Muslim friends avoided the sprays, as I believe there's no guarantee it's not pork gelatine, or possibly a guarantee that it is? I just wish they'd find a way to stop making this an ethical dilemma.
posted by rum-soaked space hobo at 10:17 AM on November 16, 2019 [2 favorites]


A lot of folks can't take the spray flu vaccine, including asthmatics and anyone with immunosuppression. I'm surprised they give it out in the UK schools, honestly. Your rates of childhood asthma must be much lower than here in the US.
posted by hydropsyche at 12:14 PM on November 16, 2019 [1 favorite]


London in particular has something of an asthma epidemic these days, what with all the diesel vehicles on the roads and no Dutch-style "unraveling" of modes to keep them away from where human beings are trying to live their lives. So I'm kind of concerned about the demographic implications of who can receive the inhaler.
posted by rum-soaked space hobo at 1:01 PM on November 16, 2019


In terms of cost in the US, no, you don't have to pay if you have insurance. The ACA mandates that recommended vaccines be covered with no cost to the beneficiary.
Preventive care benefits for adults

All Marketplace health plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

Immunization vaccines for adults — doses, recommended ages, and recommended populations vary:

Diphtheria
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus (HPV)
Influenza (flu shot)
Measles
Meningococcal
Mumps
Pertussis
Pneumococcal
Rubella
Tetanus
Varicella (Chickenpox)

ACA Requirements for Coverage of Preventive Services

Under Section 2713 of the ACA, private health plans must provide coverage for a range of preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services. These requirements apply to all private plans – including individual, small group, large group, and self-insured plans in which employers contract administrative services to a third party payer – with the exception of those plans that maintain “grandfathered” status. In order to have been classified as “grandfathered,” plans must have been in existence prior to March 23, 2010, and cannot make significant changes to their coverage (for example, increasing patient cost-sharing, cutting benefits, or reducing employer contributions). In 2014, 26% of workers covered in employer sponsored plans were still in grandfathered plans, and it is expected that over time almost all plans will lose their grandfathered status.
posted by lazuli at 2:42 PM on November 16, 2019 [2 favorites]


Malaysia gets into conspiracy theory land when it comes to anything that might even have a whiff of pork, but vaccines are pretty common here and you get them at school and no one's complained so far. So I assume they've solved the Halal problem somehow.
posted by divabat at 3:02 PM on November 16, 2019 [2 favorites]


In terms of cost in the US, no, you don't have to pay if you have insurance. The ACA mandates that recommended vaccines be covered with no cost to the beneficiary.

In fact you can get paid to get your vaccine in many places. I, for example, get my flu shot at Pavilions grocery store. 0 cost to me and they give me 10% off my next shopping bill.

Sadly I don't think ahead enough to build up a bulk shop so I can save a bunch and end up, like, buying a snickers bar or something. But a dime is a dime!
posted by Justinian at 3:16 PM on November 16, 2019 [2 favorites]


Sadly I don't think ahead enough to build up a bulk shop so I can save a bunch and end up, like, buying a snickers bar or something. But a dime is a dime!

Pfft, that's an awful prize. Get it at Target or CVS and they give you a $5 gift card. I think I blew most of mine on Twizzlers this round, which definitely made the shot less annoying.
posted by sciatrix at 3:20 PM on November 16, 2019 [2 favorites]


All Marketplace health plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

Remember that in states that didn't expand Medicaid, there are people who are simply uninsurable--too poor to receive the subsidy to buy Marketplace plans, but not eligible for Medicaid, usually because although they are incredibly poor, they do not meet state specific rules. In Georgia, that is 500,000 people, mostly ablebodied adults without children. Yes, most of them are adults (their kids should be eligible for CHIP, called PeachCare in Georgia), but no one is giving those adults any vaccines at all unless they are paying out of pocket with their poverty line income.
posted by hydropsyche at 3:47 PM on November 16, 2019 [11 favorites]


Georgia provides Medicaid to Children ages 6-18 with family income up to 133 percent of the Federal Poverty Level, and to their parent(s) if the household income is no more than 35% of the FPL. (Younger children have higher limits.) A single adult with a child: FPL is $16,910.

However, all the statistics about who's eligible for which coverage are a side issue, here. The point is: All standard insurance covers the standard recommended vaccines. A small but notable percentage of people, including children, don't have any insurance. A larger percentage of those who do, don't have access to the vaccines - if your nearest doctor office is more than half an hour from your home, you may not have the resources to take time off work to get to it for regular vaccinations--if they have a car at all. (One visit for a newborn? Sure. Half a dozen visits over the first year of life? Maybe not.) And there is no nationwide government program to provide vaccines specifically, separate from general health care systems. I don't think there are statewide programs, but various regions may have them.

A sensible approach to the measles outbreaks would be, "free measles booster shots offered at schools and shopping malls during holiday season." Or at airports. But the US has spent a whole lot of time insisting that your health is YOUR PROBLEM rather than an aspect of community welfare that the government should support, so of course they can't just give away "free health care."
posted by ErisLordFreedom at 5:27 PM on November 16, 2019 [2 favorites]


Wait, you're not telling me that people have to pay for essential vaccinations in the U.S., are you?

Some states/counties do have public health clinics where people can get vaccinations at low/no cost, but many fewer of them than when I was a child and open hours and locations have dwindled where they still exist.

When people remembered what it was like before vaccines they were apparently willing to put up with teh Soshulism.
posted by wierdo at 5:36 PM on November 16, 2019 [2 favorites]


Georgia provides Medicaid to Children ages 6-18 with family income up to 133 percent of the Federal Poverty Level, and to their parent(s) if the household income is no more than 35% of the FPL. (Younger children have higher limits.) A single adult with a child: FPL is $16,910.

Yes, that's why I was pointing out that failing to expand Medicaid mostly excludes adults. Adults need vaccines, too, especially an annual flu shot, but also TDAP and MMR boosters, Hepatitis A and B, HPV, and as they get older, shingles and pneumonia. Currently, these adults in Georgia have absolutely no way to access healthcare except through charity clinics that, unsurprisingly, cannot meet demand.
posted by hydropsyche at 4:51 AM on November 17, 2019 [1 favorite]


Justinian: "The thing is, you sound quite reasonable. But you're raising objections about some stuff we already know the answer to in the same way that anti-vaxxers do. ... Look, I appreciate this is a complicated and difficult topic but a lot of your comment boils down to "I'm not anti-vax but... [antivax talking points go here]"
Exactly this kind of disordered black and white thinking is one of the big reasons why there is now a consensus on avoiding the "anti-vaxx" label wherever possible. It is a much better idea to discuss concerns that people raise about vaccines as "vaccine hesitancy," when it needs to be named at all, particularly in the absence of hard-set ideology. Public health is so much more important than the thrill of policing some kind of bullshit pro-vaxx club, and all manner of people have very reasonable concerns about vaccines that get much easier to refute or validate with evidence when we keep our eye on goals that actually matter.
loquacious: "And I will ask a rather terrible apocalyptic science fiction grade question - if viruses are often informed by and adapted to the genetic code of their hosts, is there a potential combination of genetic material between engineered or adapted vaccine, vaccinated compromised host and a live, wild virus that either strengthens a given communicable viral strain or creates something entirely new, if only because we don't know what we're doing or how fast something that is alive and more-or-less biologically meets the definitions might adapt or progress in that environment?"
What a great question!

There are four major types of vaccines: Inactivated vaccines; Subunit, recombinant, polysaccharide, and conjugate vaccines; Toxoid vaccines; Live-attenuated vaccines. This isn't really at all a concern in the first three types as recombination in the wild just mechanically won't work. However, live-attenuated virus vaccines very much could have a chance of recombinating with wild strains, depending on the type of virus that we are talking about, by infecting a cell that is already infected by a wild strain and trading genetic materiel with it. What would come out would indeed be a hybrid that could potentially be a significant concern. Here is a discussion of the current scientific consensus on how this concern needs to be addressed during vaccine development:

Unique Safety Issues Associated with Virus Vectored Vaccines: Potential for and Theoretical Consequences of Recombination with Wild Type Virus Strains
"In 2003 and 2013, the World Health Organization convened informal consultations on characterization and quality aspects of vaccines based on live virus vectors. In the resulting reports, one of several issues raised for future study was the potential for recombination of virus-vectored vaccines with wild type pathogenic virus strains. This paper presents an assessment of this issue formulated by the Brighton Collaboration. To provide an appropriate context for understanding the potential for recombination of virus-vectored vaccines, we review briefly the current status of virus vectored vaccines, mechanisms of recombination between viruses, experience with recombination involving live attenuated vaccines in the field, and concerns raised previously in the literature regarding recombination of virus-vectored vaccines with wild type virus strains. We then present a discussion of the major variables that could influence recombination between a virus-vectored vaccine and circulating wild type virus and the consequences of such recombination, including intrinsic recombination properties of the parent virus used as a vector; sequence relatedness of vector and wild virus; virus host range, pathogenesis and transmission; replication competency of vector in target host; mechanism of vector attenuation; additional factors potentially affecting virulence; and circulation of multiple recombinant vectors in the same target population. Finally, we present some guiding principles for vector design and testing intended to anticipate and mitigate the potential for and consequences of recombination of virus-vectored vaccines with wild type pathogenic virus strains."

Manufacturers in the US and in Europe are also required to demonstrate that the live-attenuated virus vaccines that they produce will not cause harm through this mechanism.
loquacious: "It would take similar knowledge to offer genetic or vaccine-like therapies for allergies, too."
While there is a lot of really cool research looking to translate genomic discoveries into new treatments of allergies to join the more empiric treatments we already have, the point of vaccines is to do the opposite of what these treatments are looking to do. I think explaining how, even if I might have to gloss over a lot, might be helpful.

Our adaptive immune systems work in a really beautiful way that should, in theory, protect us from an infinite number of potential pathogens but has a few significant drawbacks. In general, with notable exceptions, our immune systems have vicious tools that are more than destructive enough to kill the viruses and bacteria that ail us. The big challenges are, generally, recognizing what to kill and doing that as quickly as possible. So we have evolved a gorgeously complex and infinitely adaptive system for identifying foreign entities and targetting them for destruction. As the white blood cells that drive the adaptive immune response get made they each are born with a completely new antibody through a very randomized process that creates a very specific and very random shape on the business end that could, in theory, bind to anything. These antibodies are how our bodies recognize foreign invaders that have evolved 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 against functionally anything. 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 white blood cell will trigger themselves for death to make room for new white blood cells. One of the big drawbacks to the fantastically complex process that is the adaptive immune system is how long it takes to get going, needing cells to divide so much is a significant rate limiter, 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 most common 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. Generating these memory cells to join the library of antigens you already have is the goal of vaccines.

One of the big problems with that strategy though is what happens when the antibody recognizes something that is actually us or for whatever 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 and allergies are what happens when we generate specific kinds of immunity against harmless things. Allergies are what happens when your adaptive immune system learns to target a typically harmless substance in the environment, which can be really dangerous when a system designed to very sensitively target small amounts of invader gets exposed to large amounts of harmless foreign substance and hurts you in its confusion.
posted by Blasdelb at 4:20 PM on November 17, 2019 [12 favorites]


I equally distrust government to dictate what/when/where that should occur.

It's not "the government" - not the shit hacks who grab microphones, take and spend money willy nilly, and make performative nonsense policy. There are a lot of them, so it's normal to be skeptical.

But who's making vaccine policy? Well, the CDC - which is the nation's most trusted federal agency - convenes the Advisory Committee on Immunization Practices. This is made up of a dozen or so medical, public health, and immunization experts - mostly from outside of government. People are nominated by their peers, or apply. They're not political appointees; there are rigorous criteria for even being considered.

The ACIP carefully reviews science and implementation practice in order to develop recommendations. They work in the open - their policies and procedures are all published online, they review science and cite their sources, and they make clear, evidence-based recommendations. These recommendations are accepted by the vast majority of health care providers.

In short, it's not "the government." It's not stuff that gets argued about on cable news, or stuff that gets lawn signs made about it, or social media disinformation campaigns.

It's more or less the gold standard for how policy should be made.

And frankly - when it comes to public health - yeah, that's your government. That's your deep state. Your civil service - your often unionized workforce. People doing careful science out of a deep and abiding commitment to health, wellbeing, and collectivity. People who want policy to be guided by evidence - people who are committed to outcomes, not ideology. People who will never hear "thank you for your service" but are here for you anyway.
posted by entropone at 6:37 PM on November 17, 2019 [15 favorites]


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