First, some preempting of some potential and probable responses:
- Yes, I do have children.
- Yes, they are fully vaccinated for their age.
- No, they have not suffered any side effects other than mild fever shortly after the vaccinations.
- No, they are not autistic.
- Yes, I do know an autistic child.
- No, the autism was not caused by vaccines.
- No, I do not work for any government, Big Pharma organisation, health insurance provider or health care provider.
- Yes, my wife does work as a medical assistant at an obstetrics clinic.
- No, vaccines do not cause autism.
- No, mercury does not cause autism.
- No, Thimerasol does not cause autism.
- No, the vaccine schedule does not cause autism.
- Yes, if you don't vaccinate your child you are an idiot (unless there's a medical reason).
OK. With that out of the way let's move on to why I found the response patterns more interesting than the question of mandatory vaccines. I found the responses more interesting because they seemed to fall into one of just a few different categories - sure there was different phrasing, but generally speaking there was not a great deal of variation in the types of response objecting to mandatory vaccination.
- It's the government and do we want the government telling us what we must do when vaccinating or not vaccinating our children, and anyway government is sometimes incompetent or wrong.
- You probably don't have kids because if you did you would not want the government telling you that they must have injections, so you are only saying yes because you don't have kids.
- Slippery slope, slippery slope!
- Parents have a right to choose how to raise and medicate their children.
- Vaccines don't fix everything.
- Vaccines aren't safe, they cause autism etc.
Now, I haven't read the more recent responses so maybe there is a new type that I've missed that doesn't fit into these categories, but generally speaking these are the types I saw as I read through the comments (some more common than others). In addressing these categories hopefully I'll address first, what is wrong with them as objections to compulsory vaccination and second, why I think compulsory vaccinations are needed.
1. It's the government
No, it isn't.
It is, in fact, the entire science based medical community who think vaccinations should be given to children. The government would merely be acting on the current medical understanding of the overwhelming benefit of vaccinations. Let's get this quite clear:
Government does not recommend vaccination - the medical community does.
In this case (compulsory vaccination) government is merely the best placed institution to ensure complete coverage of a population and so government would have to be responsible for compliance.
This response is largely, I believe, down to the hysterical overreaction some people have to governments. As soon as they hear the word government they believe that anything attached to it must be wrong. Well, in this case, it isn't.
Part of a government's responsibility and purpose is to protect citizens from each other when that is necessary. That would mean protecting the "not currently vaccinated" or the "unable to be vaccinated" from the "children whose idiot parents won't have them vaccinated". That means either seperating the "children whose idiot parents won't have them vaccinated" from the rest permanently, or vaccinating those children. Which is better?
Let me make this quite clear again:
It is the government's duty to ensure that my unintentionally unvaccinated child (too young, not medically able to receive vaccines) is protected from your intentionally unvaccinated child (because you're an idiot).
Now, just because government is incompetent or has been wrong or lied about things before does not mean they should not be behind this. Remember - it is not the government who recommends vaccination, it is the science based medical community. Just because government can't ensure that all drivers are insured does not mean they shouldn't be behind a program to ensure that all children are vaccinated. What kind of argument is that? "We can't guarantee this other thing 100% so why bother trying this totally seperate thing at all?"
That's exactly like saying that just because car manufacturers can't make cars that ensure nobody dies in car crashes means they shouldn't bother trying to make them safe at all.
Not to mention the fact that this flatly contradicts the fear of government omnipotence that is sometimes part of this objection anyway - can the government control everything or not?
I don't care that the government might not be able to ensure absolute and total 100% vaccination - I still want it to try so that children don't die.
2. You probably don't have kids
Wrong.
I do.
More importantly though, this has absolutely bugger all to do with whether or not someone thinks vaccinations should be compulsory or not. This is nothing more than Jenny McCarthy's (I think it was her anyway) silly argument that mothers know best so screw the copious amounts of scientific evidence.
I think vaccinations should be compulsory because I have kids. I think vaccinations should be compulsory based on the scientific evidence of their effectiveness at combating disease. I think vaccines should be compulsory because they save lives.
This objection (and I did only see it once to be fair) is an epic fail.
3. Slippery slope
In order for someone to argue that compulsory vaccination is the top of a slippery slope they have to show why it is the top of a slippery slope and they have to show a causal mechanism that connects what they think is at the top and what they think is at the bottom.
Simply saying "Well what next? One day compulsory vaccinations the next implanted ID chips with in built locator beacons that transmit your thoughts is what." is not acceptable. This is not the slippery slope argument but the slippery slope fallacy.
Go on tell us. What is compulsory vaccination the top of the slippery slope to and why? Show your working.
4. Parents have a right to choose
To choose what? How their kids might die?
What, exactly, about the parent's right to choose how their child is medicated or vaccinated overrides the child's right to life? The child's right to be free of certain illnesses where that is possible?
What, exactly, makes a parent's uninformed ignorance more important than a child's life?
Remember this, vaccinations are given to children who are too young to decide for themselves. Where this is the case parents are expected to make the decision in the best interests of the child. When a parent is not able to make that decision responsibly, the government steps in (that is why we have laws and organisations to protect children after all people). People make uninformed choices about vaccines because of scaremongering, ignorance and just plain old stupidity. The choice to not vaccinate your child is not a responsible one. It is not in the best interests of the child.
You have a right as a parent to be uninformed, ignorant and stupid. You don't have the right to inflict the consequences of those things on your children. You do not have the right to endanger your children's lives.
You don't have a right as a parent to choose to expose my children to illnesses because you chose not to vaccinate your child.
The government has a duty to protect those citizens who cannot protect themselves and who others will not protect through their negligence. In this case, that may be your children. Tough. Stop being an idiot then.
5. Vaccines don't fix everything
So what?
Are you really going to argue that because vaccines don't fix everything we should not try to ensure they are given to everybody because of the things they do prevent (fix, in the terminology of the objection)?
Airbags don't prevent all deaths in car crashes either, does that mean they shouldn't be compulsory in new cars?
6. Vaccines aren't safe
Yes, they really are.
A very small proportion of people have adverse reactions to vaccinations. Yes, tragically some reactions are fatal or debilitating and as a parent my heart aches for people who lose children this way, I can't possibly imagine how devastating that is.
Hopefully as medical science improves and vaccines with it we will be able to identify those at risk of adverse reactions and tailor the vaccination schedule and types to them. The scientific community is already looking at ways to make individually targeted medicines, similar advances in vaccination technology may reduce the chance of allergic reaction.
The potential consequences of adverse side effects are vastly outweighed by the benefits of vaccination right now however. More children die or become severely ill or debilitated from vaccine preventable illness around the world than will die or be injured by vaccine side effects. The risk of not vaccinating is far greater than the risk of vaccinating.
And no, autism is not caused by vaccines. The evidence is overwhelmingly against the hypothesis that vaccines or their ingredients cause autism. I am not going to link every study and paper that shows this - do your own research and do it somewhere other than Generation Rescue and other quack sites. Somewhere like, oh I don't know, real scientific and medical journals.
Just because there is a very small possibility of harm caused by vaccines does not mean they should not be compulsory. Airbags in cars can kill too.
So that's that
I find none of these objections compelling or convincing given the benefits of compulsory vaccination for everybody.
Now as to caveats - clearly vaccination should not be compulsory for those who are medically at risk from them, either through known health issues or because of suffering an adverse reaction to a previous vaccine.
I do not believe we should allow religious exemptions to vaccination. With vaccination you are not simply risking your own child. Why should my child of a different or no religion be put at risk because of your religion? Your right to practise your religious beliefs ends at the point where they conflict with my child's right to good health and their right to be unaffected by your religion.
Further to that, I think that we should stop allowing people to use their religion as an excuse to mistreat their children and deny them potentially life saving medication or health care. Religion is not a free pass for child abuse. Denying children proper medical care is child abuse.
Religion is not an excuse for being an unreasonable, uniformed, uneducated ignorant prick. It might be the reason, but it isn't an excuse.
The long and the short of it is this:
If you're going out in public it is the governments duty, for the protection of others, to ensure that you are vaccinated.
That's what government is supposed to do - protect us.
@ Jimmy
ReplyDeleteSince I represent about a third of the bulk of text on Phil's comment thread for that particular post, I'm kind of surprised and disappointed that you don't address the point I'm making on his thread.
This leads me to believe that you're lumping what I'm saying with the "It's the Government" people, and that's not what I'm saying over there at all.
> Just because the government can't ensure
> that all drivers are insured does not
> mean that they shouldn't be behind a
> program to ensure that all children are
> vaccinated.
Absolutely. The fact that the government can't ensure that all drivers are insured just illustrates that it can be difficult for the government to effectively solve some problems. Mandatory vaccination may or may not also fall under this category of problem.
In my analysis (over at Phil's place), I think I've pretty much covered why it's a bad assignment of resources to try and solve this problem using legislation. You may disagree with me, like Scenario Dave and justcorbly do, but if you do I'd like to see an analysis of why I'm wrong (particularly because they're not providing that analysis either, and I'm actually interested to see if anyone has a credible counterargument).
The real question is efficacy. From a societal standpoint, we have lots of mechanisms to solve problems. We have regulatory bodies. We have free market forces. We have established rights. We have scientific research. We have a police force, and the implied enforcement of legislation via violence. Societal problems, however, are usually extremely complex, and require careful application of a combination of these mechanisms to solve the problem *effectively*.
All of these mechanism have costs. There are lots of externalized non-economic costs, which is the big argument of the average "anti-Government" commenters on Phil's thread... the idea that forcing people to do something imposes on their liberty. I personally think this argument (in this particular discussion) is weak sauce... those people have a point, but in the greater view everything we do in society is a tradeoff between individual liberties and communal goods, so the question of how we should lean in this particular issue is interesting only from a philosophical standpoint.
My problem is that it costs too much for the benefit we get out of it. Moreover, the costs that are born are going to be disproportionately assigned to the people who are already doing what we want, as a society, or are unable to do what we want for justifiable reasons.
We're looking at 90% of the community who vaccinate and somewhere between 0.5% and 5% who can't vaccinate because of immune system compromise or allergies or some other medically justifiable reason. Therefore, any mechanism we use to *force* people to vaccinate is going to require that 90.5-95% of people to pay, in time and money, to prove that they're already doing what we want them to do... just so that we can force the remaining 5% to do what we want them to do. Since we can't catch everybody via audit, we're still going to get people refusing vaccinations, so the net value of the entire program is that it catches some low hanging fruit in the anti-vax crowd and it catches 1-10% of the higher hanging fruit via audit.
This is *not* a good way to spend money. It makes much, much more sense to take all the funds that you would dump in such a program (again, this is a giant pile of $$$, see my comment thread at Phil's place), and use that money to provide basic health care and nutrition for the uninsured poor. We'll boost herd immunity better that way than we will by spending all that money to force a few thousand idiots to change their minds.
There is, at least in Georgia, a certain mechanism whereby government requirements for vaccination is enforceable. It is in the elementary school registration process.
ReplyDeleteTo enter kindergarten, a child must have receieved an up-to-date schedule of vaccinations including Hep, TB, measles and others.
Unfortunately, all too often school registrars are the ones charged with making sure that children entering the school are vaccinated. These registrars are rarely medically trained and are often not able to access the state databse of childrens vaccination records.
I would suggest that EVERY concerned parent, upon registering their child for school, ask to see the policy of the school for ensuring that all the children with whom their precious offspring will soon be mixing is immunized.
I asked at my own child's school and suggest to everyone I talk to about this, that they do the same. I guarantee you WILL be suprised at the lack of urgency about this issue.
It is not a matter of parental choice, it is a matter of PUBLIC HEALTH. If your child wishes to attend a PUBLIC school, then your child needs to achieve the required standard of PUBLIC health.
To my mind there are three reasons not to immuize your child:
1. You are ignorant, lazy, stupid or apathetic
2. You have religious reaasons not to immunize (see point #1)
3. You believe that the minute risk of an adverse reaction to an immunization outweighs the risk that your child poses to those too young to have yet been immuized. In which case, see #1.
Padraig:
ReplyDeleteFirstly I think it seems that you assume we would need an entirely new department or mechanism established to monitor vaccinations - we wouldn't. As Mark pointed out many daycares require you to prove your kids are vaccinated. Simply put, with relatively little expenditure we can ensure people are vaccinated - to go to daycare, public or private school, public or private university - you must show you are current with vaccinations. Want a drivers licence or social security number? Show you are current with your vaccinations.
In short, the mechanisms to monitor this could be put in place quickly, easily and cheaply.
We're looking at 90% of the community who vaccinate and somewhere between 0.5% and 5% who can't vaccinate because of immune system compromise or allergies or some other medically justifiable reason.
Where do you get your figures from? They seem very optimistic:
MMR uptake in UK as low as 85-78%
or:
MMR immunisation rates fell as low as 62% in parts of London
From PubMed:
Measles and UK vaccination levels
From the BMA:
MMR Vaccine
This article makes it clear the WHO recommends 95% coverage, but that this isn't being achieved. Community immunity is achieved at 92-95% coverage. Uptake in England in 2007-2008 was only 85%. Some primary care trusts in the UK reported lass than 80% uptake.
I should also note that the BMA are actually not in favour of compulsory vaccinations (largely on a parents rights ticket it seems from a quick read through of one of their publications). Incidentally, I also found from reading the BMA's publication on childhood immunisation that MMR IS semi-compulsory in the USA (if you want to go to school) - so there ARE mechanisms in place already for helping monitor this.
Therefore, any mechanism we use to *force* people to vaccinate is going to require that 90.5-95% of people to pay, in time and money, to prove that they're already doing what we want them to do... just so that we can force the remaining 5% to do what we want them to do.
Have to pay what? To whom? They already have to anyway for at least MMR and several other infectious diseases.
Since we can't catch everybody via audit, we're still going to get people refusing vaccinations, so the net value of the entire program is that it catches some low hanging fruit in the anti-vax crowd and it catches 1-10% of the higher hanging fruit via audit.
If I accepted your figures, and I don't, then you might have a case, but we could be talking about catching as many as 40% of the low and high hanging fruit in some areas.
This is *not* a good way to spend money.
If we accept your inaccurate figures.
use that money to provide basic health care and nutrition for the uninsured poor. We'll boost herd immunity better that way than we will by spending all that money to force a few thousand idiots to change their minds.
No, we won't. Herd immunity to measles is not improved by people simply having a better diet. And we are not talking about a few thousand idiots, we are talking about millions in large countries.
Now, if you are really worried about cost, if you think that spending the money on compulsory vaccinations is not cost effective or worthwhile answer me this - how much do epidemics cost us? How did Swine Flu do for the world economy? (and yes I know there was no swine flu vaccine - the point was to highlight the potential cost of an infectious disease outbreak). Businesses closed, international travel suspended, human lives lost, health care systems brought to their knees, quarantine.
If you want to complain about the cost of the vaccination program, you have to compare it to the potential cost of falling vaccination levels.
> Where do you get your figures from?
ReplyDeleteThe CDC. Sorry, I was talking about the U.S. case, not the U.K.
With a vaccination rate dipping more drastically there, and the number of children to cover being ~ 1/6th of U.S. numbers, you're looking at a much smaller amount of money.
> If we accept your inaccurate figures
Dear sir, I build IT systems for a living, and have since 1995 as a primary job function. I also am a graduate student in IS, in the particular field of disaster response and crisis management. I reiterate what I said over at Phil's blog: my numbers are certainly inaccurate, and they're inaccurate well on the side of under-estimation.
However, don't take my word for it. Start reading about administrative costs for governmental programs. Realize that most of *those* reports include only direct costs; those things that are attributable to the bureaucracy itself. Yes, they are going to include labor costs for people who are already hired to do something else... this is standard budgetary practice. If someone already has a job, and you give them something else to do, they still need to spend time doing it, and *not* doing something else that you want them to do (or you overwork them, a common complaint in the U.S. educational system if not the U.K., or you have to hire more people).
Lots of the other costs, like, say, having someone who *can't* immunize their children prove it to your auditing process, aren't included in those sorts of reports and they represent hours of frustration and lost time.
> And we are not talking about a few
> thousand idiots
Yes, we are. You need to re-examine the numbers. With the exception of countries that don't have anything resembling a major medical system to begin with, most countries have widespread vaccinations. The under-vaccinated crowd is *not* millions of people. Do the math.
> Herd immunity is not improved by people
> simply having a better diet.
Yes and no. You're correct, it's not "herd immunity", that was poor phrasing on my part... what I meant was that the overall effect on the chance of outbreak does when you're talking about the actual poor and malnourished. Your susceptibility to disease is greatly enhanced if you don't have basic hygiene. Don't confuse me with an anti-vaxxer, I know very well how effective vaccines are and I think it's stupid for people to not take them... but if a third of your unvaccinated population is also destitute and poorly fed, giving them sanitary facilities and food *will* reduce the chance of pandemic.
> How much do epidemics cost us... business
> closed, international travel suspended...
And, ah, all of those consequences (which in many, many cases were exacerbated by public panic, not practical thread)... would not have happened if we had a vaccine.
Let me rephrase. I agree with Phil's science. I agree that it's stupid for people not to vaccinate. I think people like us should make every effort to encourage people to vaccination.
I still don't think it's a good thing to hand over to the government. If you disagree with my numbers, show me why I'm wrong. Show me some sort of analysis that shows that my costs are unreasonable. Tell me *why* you think it's so much cheaper than I think it is, rather than, "I don't accept your numbers".
Evidence is all; you have to agree with that proposition or you're not a scientist, and you've got no business telling people that *they* have to accept the evidence that vaccinations work, because you don't apply the same level of rigor to your own positions :)
Note: This will have to be in two parts because of the Blogger limit of 4,096 characters in a comment.
ReplyDeletePadraig:
You say you get your figures from the CDC. Where at the CDC - give us a link or citation.
Here is the link from the CDC that I used and if you think this shows 90% vaccination coverage you are very much mistaken.
Immunization coverage in the USA
For instance, taking the NIS figures for children for 07/08 and looking at estimated vaccination coverage for individual vaccines and selected vaccination series for children between 19 and 35 months the figures fall between 93.0% and 68.1% with a 95% confidence level (and using only the national average).
For coverage levels for HepB at birth to 3 days of age figures range from 46.5% to 54.0%.
For certain vaccines at 3 months of age 93.2% to 55.3%.
For certain vaccines at 13 months of age from 95.0% to 53.5%.
For teens (13-17) for different individual vaccinations the figures range from 91.7% to 25.1% (although this latter is for HPV so not entirely fair to include).
You really don't want me to quote the adult figures if you think the CDC says 90% coverage.
Where, exactly does your 90% figure come from? Citation please.
Dear sir, I build IT systems for a living, and have since 1995 as a primary job function. I also am a graduate student in IS, in the particular field of disaster response and crisis management. I reiterate what I said over at Phil's blog: my numbers are certainly inaccurate, and they're inaccurate well on the side of under-estimation.
Nice attempt at an argument from authority. Also meaningless. Do you want me to add my own? Or would that have no bearing on whether or not the figures which you made up are worth arguing over?
I am sure you would like to go a few rounds over your figures but I am not going to - I am not going to argue with someone who uses figures he made up to prove his argument when they apparently can't even get the actual figures from the source they claim to be citing correct.
Your figures aren't simply inaccurate (I was referring to your 90% coverage claim by the way) they are fictional, and I note that you had a habit of throwing out figures in that argument that you apparently had not researched (for instance repeated claims that vaccination was at least above 80%). I note also that you provide no citations but ask other people to do so. Why are you exempt?
Furthmore, your fictional figures are meaningless without a comparison to the cost of not vaccinating, which you don't give. What figure would you put on the human cost for instance?
Padraig:
ReplyDeleteYes, they are going to include labor costs for people who are already hired to do something else... this is standard budgetary practice. If someone already has a job, and you give them something else to do, they still need to spend time doing it, and *not* doing something else that you want them to do
Which completely ignores the point that Mark and I made - there are already people (particularly within the school system) whose job it is to ensure vaccination coverage in children admitted to schools - it is already part of their job to do this, they do not have to drop something else to perform the task.
Lots of the other costs, like, say, having someone who *can't* immunize their children prove it to your auditing process,
Actually, this is very simple. I have to take both of my kids to a doctors appointment tomorrow for the doctor to sign a form from the daycare to show vaccination levels - if the kids couldn't be vaccinated the doctor could provide documentation of this. The kids get a physical, the doc signs the paper, the daycare can check its authenticity very easily.
Yes, we are. You need to re-examine the numbers.
No, we are not. It is not me who needs to check his figures. For instance, the number of children under 5 by July 2008 was actually 21,005,852 according to the US Census Bureau. Between 5 and 9 20,065,249. Between 10 and 14 20,054,627. Between 15 and 19 21,514,358. Considerably more than your 8,000,000 wouldn't you say?
The under-vaccinated crowd is *not* millions of people. Do the math.
It's painfully obvious who needs to redo the numbers here I am afraid.
And, ah, all of those consequences (which in many, many cases were exacerbated by public panic, not practical thread)... would not have happened if we had a vaccine.
Sorry, you appear to have missed my point. The point in bring up swine flu was that you do not appear to have considered the cost of an epidemic or pandemic because of poor vaccination rates - you put a lot of work into your fictional figures to show that compulsory vaccination is costly - but those figures are meaningless without a comparison to the cost of a pandemic - and yes that includes the actual dangers and costs as well as the percieved dangers and costs.
Show me some sort of analysis that shows that my costs are unreasonable.
They are made up, that's why they are unreasonable. I would not expect you to dispute some figures I made up, for you to expect others to do so for you is dishonest at best.
Evidence is all; you have to agree with that proposition or you're not a scientist, and you've got no business telling people that *they* have to accept the evidence that vaccinations work, because you don't apply the same level of rigor to your own positions
I'd say given your abuse of the statistics and numbers this is a clear case of the pot calling the kettle black. What part of making up the numbers counts as scientific evidence for an argument?
Here's a good article about unvaccinated free riders that is also relevant to the discussion at hand:
ReplyDeleteUnvaccinated free-riders
Jimmy:
ReplyDeleteI'll post my reply over on Phil's blog; the inability to use copy and paste in your comment box is driving me nuts :)
Padraig:
ReplyDeleteYou can use copy and paste. What industry did you say you worked in?
I have no problem copying from the original post, subsequent comments or this comment box, and then pasting them into the comment box.
> You can use copy and paste.
ReplyDeleteAh; it works in IE 8, but not in Firefox, at least with NoScript installed and enabled. I thought this was your configuration, as I haven't had this problem on other Blogspot blogs.
> What industry did you say you worked in?
No need to be snide.
> I would not expect you to dispute some
> figures I made up, for you to expect
> others to do so for you is dishonest
> at best.
No, it's not, it's proper argumentation.
See, Phil said, "I think we should do this." I'm saying, "I challenge your assertion, here's a chicken-scratch analysis of why I think this is too expensive."
I'm not making the claim (we should do this), Phil is (and you are, since you're backing him). That means it behooves you to convince *me* that you're right, not the other way around. If I was the one making the policy change suggestion, the roles would be reversed, absolutely.
Sure, I readily agree that my analysis lacks rigor; it doesn't need rigor. I readily accept that I might be wrong. Now it's up to you to explain to *me* why it's cheaper than I think it is (and, to another extent, why spending any money on this at all when we can spend it constructively elsewhere is a good idea). You don't get to dismiss my objection and therefore state that your policy is the correct one, because you are the one making the claim to begin with :)
> For instance, the number of children
ReplyDelete> under 5 by July 2008 was actually
> 21,005,852 according to the US
> Census Bureau.
I can't find my original source for the 8 million figure (as I recall, it was a percentage figure and I reverse-engineered the 8 million out of the U.S. population), but I see no reason to argue with this number.
That said, we've both been unclear on this particular part of the overall argument: the under-vaccination problem is both a matter of people not getting vaccinations due to funding problems (they can't afford the health care to begin with), medical reasons (they won't get the vaccination in any event), and people who object for religious or non-religious reasons.
I can't find an actual stated figure for the last after a half-hour of trying, but the closest I come is this (http://health.msn.com/health-topics/vaccinations/articlepage.aspx?cp-documentid=100213272#) which pegs the nationwide exception rate (ie, those people who opt-out any reason) at lower than 3% (of course, reading this article leads me to believe that there's lots of idiots in certain smaller communities. 60% rates in some states is ridiculously low, and makes me wonder about the wisdom of vacationing in Montana... but that's not precisely apropos) FTA:
"Nationwide, the percentage of parents who are opting out of some or all of the required vaccinations is quite low, with nonmedical exemption rates lower than 3 percent, even in states that offer an easy way to opt out due to personal beliefs."
Their source isn't cited directly, so I don't have supreme confidence in how accurate that is, but 3% of 21 million is 630,000... which jibes with my earlier flawed estimate of 640,000, coincidentally enough. Not millions, in any event. Of course, I was only looking at a subpopulation of small children.
You do crack 2 million if you include everybody under the age of 19, with ~80 million total, 3% is 2.4 million. Neither of us was doing bad math, we were just looking at different sets of the population.
Now, of course, that doesn't mean that there aren't unvaccinated people who *will* take vaccinations but don't have access to them for whatever reason. Whatever the age range, these people make up the vast majority of the unvaccinated population, it appears, no?
So again, isn't it better to spend money giving those people vaccinations and giving them better access to healthcare? Buying and distributing free vaccinations to those who *want* them, but either can't afford them or don't realize that they're behind in their schedule is spending money directly on the problem.
One thing you might want to keep in mind, Padraig; the stats you're looking at are for the US overall. However, from what I've read, a lot of this occurs in pockets; since most places aren't pockets, the overall average is still high.
ReplyDelete(If this doesn't have the relevance that I think it does at the moment to the discussion, I blame caffiene-induced sleep deprivation!)
No, that's a valid point, King.
ReplyDeleteVaccination rates *are* critically low in some states (http://www.cbsnews.com/stories/2007/08/30/health/webmd/main3221902.shtml), but I still haven't found a reference that differentiates between "people who choose not to vaccinate" and "those who simply don't, for whatever reason".
FTA:
West Virginia: 68.4 percent
Alaska: 67.3 percent
Montana: 65.6 percent
Wyoming: 63.5 percent
Nebraska: 59.5 percent
Those are some pretty scarily low numbers. However, I'll go out on a limb and state that trying to make vaccinations mandatory in Montana will fail miserably (I go there regularly and you saw more Ron Paul for President signs that you did McCain signs prior to the last election - libertarianism is alive and well in Montana). I'd guess that Alaska and Wyoming would also fall in that categorization (I don't know enough about the political makeup of West Virginia or Nebraska to hazard a reasonable guess). The practical consequence there is that the whole conversation about whether or not it's an effective way to spend money is moot; it simply is not going to happen.
I also don't know how many of those are due to factors that are correctable via other venues. I don't know if those states, for example, have a disproportionate number of people unvaccinated due to healthcare access or poverty, both of which are better served by actually giving them access to care than dictating what they ought to be doing.
As for the crazy woo communities in California, for example, who don't vaccinate although they're relatively affluent college educated professionals who are overly enamored with nature, well, they're a problem too. Most of *them* aren't stupid, they just have a large woo factory feeding them woo, and they don't have enough access to real data.
But tackling homeopathy and "natural remedies" is a different topic. Now, if you want to talk about making the 68 billion dollar supplemental market meet FDA regulations for medical claims, I'm all on board with that sort of governmental enforcement of public health. There's a large swath of people who have fallen for the "Big Pharma controls the FDA" baloney who for some reason don't apply any sort of critical thinking to "Big Holistic Remedy Peddlers" (ie, Snake Oil Salesmen), in spite of the fact that the snake oil market outperforms the vaccination market by a huge margin.
Come to think of it, if you want to make it easy for people whose children die because they're exposed to a disease through an unvaccinated carrier to sue people like Jenny McCarthy for encouraging negligence without evidence, I'm okay with that venue, too.
Whoops, sorry for any confusion from that last. I run Firefox as my default browser, and my wife's running session meant that when I ran IE to post to this blog, she took the credit (or blame) for my post.
ReplyDeleteThat last one above is mine.
Padraig:
ReplyDeleteNo need to be snide.
Well, you're not the only one starting to lose his temper. However, that wasn't necessary so I apologise.
No, it's not, it's proper argumentation.
I'm sorry, but it is not. You used figures you had misinterpreted or that were just plain wrong, then made up some more figures, then came on to this blog and said "Hey, no one has analyzed my figures and they show that compulsory vaccinations are not worth the cost." They do nothing of the sort because they were made up! You don't get to make up some figures that you can't jutify and then expect them to prove your point if no one responds because they don't want to get drawn into picking apart figures pulled out of the air at random.
I'm not going to analyze figures that are made up with no justification - whether they are over estimated or under estimated.
You don't get to dismiss my objection and therefore state that your policy is the correct one, because you are the one making the claim to begin with
I have not declared my argument is correct.
I agree wholeheartedly that it is up to Phil or I to convince you - however, disproving some figures that you made up is not going to be the way to do it, and cost alone is not a satisfactory measurement of whether something should be done or not. What would your approach have said about the Apollo program for instance?
Furthermore - I have certainly never said this would be cheap, it will be expensive so I am not going to argue that there is a cheap way to do this because there isn't. What I said was that since many of the mechanisms are in place and already in use this would be cheaper than you think since you seem to assume we are doing this from scratch.
I gave you just a small sample of what was wrong with your figures and instead of admitting that this seriously undermines them you simply fell back on "OK, I oversimplified, but I did say they weren't rigorous." You were off by 72,000,000+ for the number of children in the vaccination age groups! So why exactly should I take them seriously and spend time refuting them?
The point that I have continually made and that you haven't yet addressed is that mechanisms for this are already in place - people are already doing this. We are not talking about inventing something from scratch.
MMR is semi-compulsory if you want to send your kid to a public school. Today I took my kids to the doctor to get their physical and proof of immunization - it was very easy to get from the doctor, but you do have to visit the surgery - one sheet of paper signed by a physician or nurse practioner that contains proof of immunization and a section to be signed for exemption (and at least for this daycare nothing but a physician or nurse practitioner will do). I don't know how they audit this or even if they do yet - but mechanisms are already in place for this process to continue or be implemented more stringently.
Cost of the physical and immunization records was $15 each (through health insurance, but I am not going to get into how I think the USA should have socialised medical care anyway - that's an entirely different can of worms to open).
OK, in looking for sources for exemption rates I've come across further figures that suggests part of the problem is that, as you say, we've been talking about certain different sets of figures and using them differently. Also, it seems neither of us has been completely aware of just to what scale vaccinations are actually already mandatory.
ReplyDeleteAs the links at the end of this comment will show, kindergarten age kids are largely being vaccinated at or around 95% coverage rates (in something like 75% of states). This is becuase vaccinations are already mandatory for children going to public schools and enrolling in kindergarten.
What is needed here then is an improvement in those states missing the 95% target, and then studies into whether 95% can be improved on without incurring unrealistic cost - this latter point is what you have been arguing obviously.
So again, isn't it better to spend money giving those people vaccinations and giving them better access to healthcare?
Clearly it is beneficial to spend money helping these people get access to the vaccinations - and that can be part of making vaccines mandatory at all ages and improving monitoring of this.
I want to make my position absolutely clear - I think mandatory vaccination at all ages could be expensive (even though for kindergarten age this is in place) and it should go hand in hand with restructuring of healthcare (certainly in the USA). However, I disagree that cost should be the sole consideration in making vaccines mandatory at all ages.
I also do not think the program should simply be a case of enforcement of vaccination, but should go hand in hand with education on the benefits of vaccination and a drive to ensure that vaccinations reach those who don't get them simply because of cost.
I'll respond to the comments you made on Phil's blog over there.
Ok, some sources for immunization and exemptions. Note that the Institute for Vaccine safety states that it is already law in every US state that children are vaccinated before attending school.
Vaccine safety and exemption laws
MSNBC article on vaccination exemption rates using CDC figures
School entry immunization report - this is an excellent source, breaks numbers down by state and exemptions are seperated into medical, philosophical and religious. You can break numbers down in a large number of ways here.
Then check this out:
Vaccination coverage among children in kindergarten
The report shows that vaccination rates amongst children in kindergarten are much higher than in pre-kindergarten children. The difference? Vaccination is mandatory for entry into kindergarten.
Really we are arguing about something that is already happening and working! The key now is removing non-medical exemptions; the morality of allowing free-riders; how we make vaccinations available to those who can't afford it; and making pre-kindergarten and teenage vaccinations mandatory - since these are the ages where vaccination rates drop significantly below 95%.
I think that with the removal of non-medical exemptions and a drive to make vaccinations available to those who can't afford it you are likely to get as close to 100% coverage (at kindergarten age) as you are going to.
> I have not declared that my argument is
ReplyDelete> correct.
I confess I've never seen this response before in an online discussion.
You don't have to refute my numbers; again (like I said on Phil's blog), they're not intended as an argument, per se. They were merely to illustrate the sorts of costs that one must include in an analysis... a framework, if you will, for people who may argue that it *isn't* expensive to plug numbers *into*.
> The point that I have continually made and
> that you haven't yet addressed is that
> mechanisms for this are already in place -
> people are already doing this. We are not
> talking about inventing something from
> scratch.
Well, that's what I was trying to get at on my comment #165 over at Phil's. I don't really know *what* it is that you're proposing, so I don't really know what of the mechanisms actually are already in place. There's a big difference between "mandatory vaccinations of school-age children in public school" and "mandatory vaccinations of everyone without established medical reasons to opt-out". Getting pre-schoolage children requires an entirely new mechanism. Getting private school age children requires a new mechanism. Extending out into homeschoolers requires another. Covering dropouts yet another. Once you get into trying to cover adults, it gets crazy.
Never mind that the mechanisms that are already in place are of (as yet) unproven merit. I don't know how much they've changed the vaccination schedule adoption, do you? I'll admit I haven't researched it.
Anywho, *my* main point (that you actually haven't addressed either) is that overall audit mechanisms are by their nature effectively very inefficient. Attach *any* dollar figure per headcount in the U.S. (with a population of 80 million schoolage children or the greater population of 306 million overall), and you get a substantial amount of money. All of this money is going towards auditing a behavior that the majority already follow, so the money spent auditing them is competely wasted. It doesn't matter if you're talking about $1 a head (considering postage is almost $0.40 a pop, this is crazily small), it's still a lot of money, relative to what we *do* spend money on.
I would rather give that money to cancer research, or subsidizing health care for the undercovered, or anything that is actually directly constructive than spend it checking to see if people have had their shots.
Personally, I think it would be much more effective for a grassroots following to just start suing people that don't vaccinate when their children get sick.
Sorry, cross-posted. I'll take a look at your stuff later today, thanks for finding the citations...
ReplyDelete> The report shows that vaccination
ReplyDelete> rates amongst children in kindergarten
> are much higher than in pre-kindergarten
> children. The difference? Vaccination
> is mandatory for entry into kindergarten.
This is a factor that I had admittedly not considered, and it is a pretty telling bit of evidence to indicate that it's pretty likely that the status quo is fairly effective, simply for the low-hanging fruit aspect... apparently the number of people who have no objection to vaccination (but are somewhat lazy) is pretty significant :)
Now, that said, I don't know that changing the status quo to *add* more requirements is going to be very much more beneficial. Trying to nab the home schoolers or extending your audit to cover adults is still very likely to be way more expensive than its worth... the first because they're less likely to be lazy and more likely to be opposed to vaccination (if they're not vaccinating already), and both groups simply because there's no easy mechanism.
All that aside, *many* of the objections I have go away if you're considering it part and parcel with an overall socialized medicine program. You don't have much of a problem with many of these factors (some of them are vastly simplified over the status quo, in fact) if you're putting everyone on a nationwide socialized medicine program (which, by the way, I cautiously support).
But that's a whole 'nuther kettle of worms entirely.
Padraig:
ReplyDeleteI've responded over at Phil's and agree that as this goes on we seem to be edging in the same direction so there probably won't be much more to add here.
Just a few responses:
I confess I've never seen this response before in an online discussion.
Not a surprise I'm sure! I tend to try and avoid assuming my position is correct (and always try to avoid declaring it correct) unless I have overwhelming evidence in my favour - and you make some very good and powerful points that still need examination on my part. The issue I have is that I don't find the expense of compulsory vaccination a compelling argument against it - but then I am not a member of an administration that would have to try and implement it!
You don't have to refute my numbers; again (like I said on Phil's blog), they're not intended as an argument, per se.
Understood.
Anywho, *my* main point (that you actually haven't addressed either) is that overall audit mechanisms are by their nature effectively very inefficient.
Apologies. Yes, I agree that overall audit mechanisms are inefficient (I used to work for the UK's Post Office and write software for financial institutions - you'll get no argument from me). My point was that much of this is already in place and is effective at achieiving the target (95% in 75% of states shows something is being done correctly). I concede the point that we do not know how efficiently this is being done though.
All of this money is going towards auditing a behavior that the majority already follow, so the money spent auditing them is competely wasted.
After looking at the figures I am not sure you can make this assertion - the majority follow it at kindergarten age, before and after they do not necessarily and the numbers seeking exemptions are rising - figures from the CDC show this, and figures from the UK certainly show that many people do not vaccinate.
Personally, I think it would be much more effective for a grassroots following to just start suing people that don't vaccinate when their children get sick.
That is, in my opinion, a splendid idea - we should promote this idea at every chance possible!
I think I would have to agree with you that trying to catch home schoolers and those opposed to vaccination would likely be more expense than it is worth - the problem becomes if more and more people start choosing to not vaccinate before and after that age, as well as those who take so called philosophical or religious exemptions. Figures do suggest that trend is likely in the future - but the evidence is not conclusive yet.
I am not sure I would want to wait and find out.
Too bad we can't just see it as helping the gene pool - stupid people breeding, you know? But they endanger all of us. Maybe we could locate an island and put them all there - Anti-Vax Island.
ReplyDeleteThat might do it...
you sir, are a major dickhead. you may make some valid points about the need for vaccines but you can't just go around calling people who don't have their children immunised idiots. Just because they have different views to you doesn't mean they're wrong and you're immediately right. I, for one have never had an injection and have never been ill and I use alternative medicine. The reason for this is because a relative died because of a vaccination when we were younger. You say 'if you don't like having your beliefs or assumptions questioned , you might as well piss off now.' I am questioning your beliefs and I think I can pretty much guarantee that you're not going to like it. I'm sorry to say but you seem to be very small-minded and fixed in your ideas. You need to think about other points of view other than your own every once in a while maybe.
ReplyDeleteI re-posted so my comment was not deleted due to it being under 'anonymous'.
Dear oh dear.
ReplyDeleteyou can't just go around calling people who don't have their children immunised idiots.
Yes I can, just like you can go around calling people, and I quote, 'a major dickhead'. They have a name for people like you - hypocrite.
But let me ask you this - what would you call someone who knowingly and willingly endangers their children and the children of other people? I'd say idiot is not enough, maybe I was in a better mood when I wrote that originally.
Here's what people like you don't get. When you don't immunise your children it isn't just your children you put at risk, you put at risk every child who is too young to have been immunised. You put at risk every child who has a medical reason for not being immunised. Short of it is if you don't immunise your child when there is no reason not to, you're an idiot.
Just because they have different views to you doesn't mean they're wrong and you're immediately right.
It isn't about different viewpoints, its about preventing potentially life threatening illnesses or choosing not to. If you can't understand that you might as well bugger off now.
I, for one have never had an injection and have never been ill and I use alternative medicine.
Going to stick my neck out here and call bullshit. Never, in your whole life, been ill? No cold, flu, stomach bug, food poisoning, runny nose, sore throat, cough, ear ache, pink eye etc etc. Nothing?
But lets assume you've never had an illness that's prevented by an immunisation, and you've never had an immunisation. It wouldn't be because of pricking yourself with needles or drinking magic water that you have escaped, it would almost certainly be because of herd immunity. Its because other people have been responsible enough to have themselves and their children immunised so you haven't been exposed to the illness.
In short, you rely on other people taking the potential risks of immunisation so you don't have to. You're a social leech.
The reason for this is because a relative died because of a vaccination when we were younger.
I'm sorry you lost a relative but was it medically confirmed it was due to the vaccination? If so, then its a personal tragedy for your family but also an extremely rare occurrence.
I'm sure you know people who have either been killed or injured in a car accident, but you still drive or travel in cars don't you? You are vastly more likely to die in a car wreck than from an immunisation. So, by your own logic, you should stop using vehicles to travel.
I am questioning your beliefs and I think I can pretty much guarantee that you're not going to like it.
You questioned nothing, you called me a major dickhead and then said I can't call people names, then made some bullshit claims. Where do you question my beliefs?
I'm sorry to say but you seem to be very small-minded and fixed in your ideas.
Pot, meet kettle.
You need to think about other points of view other than your own every once in a while maybe.
OH yeah, its not like I have a blog where every post I make is examining other peoples ideas and points of view or anything. Maybe I should do that.
Go and promote childhood illness somewhere else quack.