Sunday, March 13, 2011

My Vaccine Rant

I complain all the time about the Pioneer Press's, the most annoying newspaper site in the world, because its content is removed after just one month. It always made me particularly sad that Ed Lotterman's Real World Economics columns weren't permanently accessible.

Well, I just found out that Lotterman posts his columns to his own website. Hurray! Thanks, Ed. Wish I'd realized this sooner.

Today's column applied economic theory to the declining vaccination rate among children, a topic near to my heart. Lotterman describes the herd immunity that occurs when the vast preponderance of people are vaccinated. In those circumstances, it doesn't matter much if a few people aren't immunized.

But just as we hear about those clich├ęs about game theory and the tragedy of the commons, there's an incentive for people to each think they can be the one who gets to ride for free. Lotterman writes:

This leads to what logic professors call a fallacy of composition, of assuming that what is true for an individual is necessarily true for a group. Any one individual may be better off by "free-riding" and not getting vaccinated. But if every one avoids vaccination, society as a whole will be much worse off because dangerous diseases will spread throughout the population.
And this is just the type of circumstance when government intervention is called for.
Economists agree that when all the costs and benefits of some product or service are borne by the person deciding to consume it or not, there is no need for government to act.... But when others are affected, society is worse off if government does not act....

Educating everyone in basic literacy and numeracy has enormous spillover benefits for society in the form of economic productivity.... I think government should both subsidize vaccination and "encourage" it...
Some people who resist vaccines say they aren't against them on principle, they just think there are too many given too quickly. The poor kids, goes this line of thought. Their little immature immune systems just can't keep up! Dr. Mark Crislip, writing on Science-Based Medicine, explores the illogic of that viewpoint:
From my perspective the paltry quantity of antigens children receive with the vaccine schedule are, when compared to the enormity of antigens in the environment, a rounding error. We are awash in bacteria, fungi, viruses and an enormous number of environmental organisms. I think of each of us like Pig-Pen, but instead of dirt, we are in a cloud of micro-organisms....
You've heard about the clean world hypothesis, right? Kids whose parents try to keep them in a clean bubble are more likely to get asthma, among other things:
In the [New England Journal of Medicine] study they surveyed the bedding and dust for microorganisms in the environment of children who live on farms and those that live in an urban environment. They did both microbiology counts and molecular methods to evaluate the number of organisms in the environment.

Kids on farms live in a haze of bacteria and fungi at levels far higher than their urban counterparts and to their benefit....
According to the NEJM study, the farm kids had significantly lower levels of asthma and atopy (extreme allergies). Crislip continues:
The world is a crowded place at the level of the microorganism and we have evolved to respond to that crowding from birth. Not just respond, but we need to be exposed to these antigens....

One would wonder if vaccines, in our ever so clean modern environment, could not only protect against the plagues of the past, but be a surrogate for our former environmental exposure to microbial squalor?
And then he cites a study that found vaccinated kids had lower rates of asthma and atopy.

Obviously, vaccinations need their own PR campaign, or perhaps a brainless celebrity like Jenny McCarthy to get them onto the home page of the Huffington Post once a week or so.

Or maybe vaccinations could be more successfully legislated. How to could our government go about requiring vaccines? Schools are supposed to require their use, but it's way too easy to get out of it by objecting, plus many anti-vaxers home school.

There was news recently of a group of doctors in Denver who announced to their patients that unvaccinated children would not be allowed to wait in the waiting room, because they endangered other patients. They caught a lot of flak about it.

Cory Doctorow on recently threw out this idea: Parents who won't vaccinate their children should pay higher insurance premiums. The 231 comments on the post included things like this: "Wow, Cory, I wouldn't have taken you for the big brother type. I'll take the risk of disease over the risk of having the government dictate my medical treatments any day."

I'm afraid the most effective way to get almost everyone to vaccinate is for us all to watch a bunch of kids be killed or maimed by an infectious disease that could have been prevented with immunization. I know that's pretty terrible even to think of. But it might happen, at the rate we're going with vaccination rates in this country.


Linda Myers said...

Interesting comments. Thanks for posting this.

Barbara said...

Of the 10 deaths in California last fall from whooping cough, several were infants too young to vaccinate. Infants MUST count on the herd immunity, and the herd failed to immunize itself. I'm guessing that 10 deaths is not yet enough for strong intervention.

I wouldn't mind the anti-vaxers home-schooling their children, if they would KEEP THEM HOME, or at least away from infants, or pregnant women, or the elderly, or...etc.

My kid got every vaccination going, and pretty much ate dirt for several years, and he still has asthma. But at least he's still alive, and he isn't going to kill some poor infant by walking around contagious with measles or whooping cough before the symptoms show.

Rant on.