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[Phmcw]

The problem is that any time you have unvaccinated peoples linked together, you have a potential disaster on your hands (due to the above mentionned complexity of the problem).

IE : 10000 unvaccinated children in a big city : not a big problem. 500 unvaccinated children who are frequent the same faith healer : potential catastrophic outbreak. Any time a group of peoples are not vaccinate you may have an outbreak and significantly endanger their lifes.

In the U.S. (and some other countries), pharmaceutical companies are not legally liable for anything their vaccines do (unlike ANY other drug). You cannot sue them, period.

Not a huge concern : assuming the regulation are followed, the companies are never liable for damage in Europe because that's simply not their job. The health autority make regulation that the company follow and make the product reasonably harmless. Then, continuous surveillance ensure that no side effect stay undetected.

(response to removed post removed)

[PTTG??]

GavJ has said nothing about vaccines that couldn't also be said about sanitation. "It's MY RIGHT to determine where I put my waste! Why CAN'T I crap in my neighbors' water supply? Why does Big Sewage has such reach in municipal governments? I'm just asking questions!"

[GavJ]

IE : 10000 unvaccinated children in a big city : not a big problem. 500 unvaccinated children who are frequent the same faith healer : potential catastrophic outbreak. Any time a group of peoples are not vaccinate you may have an outbreak and significantly endanger their lifes.

Make sure you're not confusing "catastrophic outbreak" with simply "high local percentage of infection."

Because even if all 500 people in a 500 person faith healer community get measles, chances are about 6:1 that not a single person will die anyway.  One sixth of a person dying on average is not what I would exactly call "catastrophic." We definitely do NOT want communities to have 0% vaccination, of course, because we do already know that the MMR vaccine is safer than that outbreak damages at 0% vaccination specifically.  But something isn't "catastrophic" just because it does any amount of net harm.

To be catastrophic, you'd need BOTH a huge population and super super low vaccination rates (like in the 0-30 or 40% range) at the same time, which I'm not aware of happening anywhere in the U.S. so far.

Not a huge concern : assuming the regulation are followed, the companies are never liable for damage in Europe because that's simply not their job. The health autority make regulation that the company follow and make the product reasonably harmless. Then, continuous surveillance ensure that no side effect stay undetected.

The U.S. has a mixed model with minor regulation (clinical trials that are okay, but not as rigorous as European, and insufficiently sized for vaccines since they rely on the model of other drugs for which the subject populations are more reasonable) combined with a lot of the surveillance afterward normally being shunted off to private concern (i.e. lawsuits).

For vaccines, they've removed that safety check, and replaced it with an impotent VAERS database that hardly any doctors use or take seriously.  That's a significant downgrade.

People can still sue in vaccine courts, but:
1) The courts explicitly add disclaimers that any rulings are not to be taken as data for vaccine safety, so they are not supplementing the role of VAERS, unlike lawsuits would be in the private sector,
2) EVen if you win, it's tax payer dollars you get, not corporate dollars, so they still don't care, and it has no effect on vaccine production or usage.
3) You also can't bring class action lawsuits to vaccine court, which obviously cripples the ability for it to serve efficient justice (or for it to help as an alternative surveillance system), because if I have some $200 claim due to a moderate complication, I'm not going to go hire a lawyer and fight in court by myself for months or years. I'm just going to ignore it.

GavJ has said nothing about vaccines that couldn't also be said about sanitation. "It's MY RIGHT to determine where I put my waste! Why CAN'T I crap in my neighbors' water supply? Why does Big Sewage has such reach in municipal governments? I'm just asking questions!"

This is incorrect -- the same cannot be said of sanitation, because unlike vaccines, we DO have sufficient data to prove that taking a crap in the drinking water supply causes harm at or above the levels of benefit that it provides. Unlike vaccines, we aren't talking about life and death situations potentially on both the cost and the benefit sides at once.

What we are talking about in that example is instead something like probably cause hundreds of cases of directly traceable hospitalization, in exchange for the "benefit" of one dude not having to walk an extra 20 feet to a real toilet...

[Phmcw]

But something isn't "catastrophic" just because it does any amount of net harm.

You don't need black plague level pandemia to call something cathastrophic. 500 children with measle count.
The current outbreak in LA count.

But my point was : they don't need to be physically close, just to share a vector of infection IE the faith healer.

For vaccines, they've removed that safety check, and replaced it with an impotent VAERS database that hardly any doctors use or take seriously.  That's a significant downgrade.

Then you need to change those. Anything else is not a solution.

Anyway ethically, you leeching herd immunity. That's profeteering, and to me reprehensible to the point it whould be punished with prison.

[EnigmaticHat]

GavJ has said nothing about vaccines that couldn't also be said about sanitation. "It's MY RIGHT to determine where I put my waste! Why CAN'T I crap in my neighbors' water supply? Why does Big Sewage has such reach in municipal governments? I'm just asking questions!"

This is incorrect -- the same cannot be said of sanitation, because unlike vaccines, we DO have sufficient data to prove that taking a crap in the drinking water supply causes harm at or above the levels of benefit that it provides. Unlike vaccines, we aren't talking about life and death situations potentially on both the cost and the benefit sides at once.

What we are talking about in that example is instead something like probably cause hundreds of cases of directly traceable hospitalization, in exchange for the "benefit" of one dude not having to walk an extra 20 feet to a real toilet...

You addressed the metaphor but not the point that he's making.  You don't just take vaccines for yourself, you take them to protect the people around you.  If you don't vaccinate yourself you could literally kill people, there's really no way around that.

So I guess a better metaphor would be that not taking vaccines is like having unprotected sex when you don't know what diseases you've got.  Except that its kind of worse because at least in that example the other person has to be stupid enough to take a risk, whereas with not taking vaccines the people around you have no warning and some will have no defense (because as others have pointed out, some people can't take vaccines).

Interesting thread. I definitely agree that more large-scale research needs to be done to figure out all effects of vaccines, not just the ones they're looking for. We should know what we're injecting into ourselves and how it affects us.

We... do know what's in vaccines?  Its a weakened or dead version of the disease you want immunity from.

[GavJ]

Anyway ethically, you leeching herd immunity. That's profeteering.

I'm not sure I understand what this means, like as in just technically/grammatically what you're saying. What is "leeching herd immunity" and who is making a profit off of any of my plans?

I'm GUESSING (correct me if wrong) what you mean is freeloading off of vaccinated people, is that right?

If so, no, this plan does not involve unethical freeloading. The "optimal vaccination point" I keep talking about is, by definition, the point at which the risk of harm from the next person getting a vaccine is precisely equal to the risk of harm from the disease if that person doesn't get the vaccine.

Therefore, that person is not freeloading -- when you are exactly at the optimal point, you have no reason to care at all if you're vaccinated or not. Your risk is equal either way. As is anybody else aroud you who is vaccinated or not. You all are benefitting equally from the optimum level of herd immunity, and you're all paying for that benefit equally with the same amount of risk no matter which category you're in.

[Phmcw]

You cannot possibly reach this point because
a) you woldn't have to control how many peoples in your population wouldd be vaccinated but how connected those peoples are
b) you don't know how risky the vaccine is since the risk is neglectible (by neglectible I mean bellow our detection threshold)

[Solymr]

Your optimal vaccination point is bollocks. The risk doesn't depend on the person before getting vaccinated or not, but on a multitude of personal and environmental factors (immune system ready to overreact, proximity to carriers, etc).

It's not possible to calculate a percentage number and then vaccinate random people until you reach that number and expect it to be optimal. The percentage is just the statistical representation of the whole group of individuals put together. You would need to determine each person's multiple factors together to find out the individual risk vs reward and that requires too much resources to be practical.

[GavJ]

You addressed the metaphor but not the point that he's making.  You don't just take vaccines for yourself, you take them to protect the people around you.  If you don't vaccinate yourself you could literally kill people, there's really no way around that.

The analogy is actually just fine, I agree with it as a proper analogy.
As in, the sort of logic you go through to decide if taking a dump in the sewer line is good is the same type of logic you use to decide if more vaccinations are good.

The difference is just in the details of actually plugging in the specific numbers in each case.  In the sanitation example, you have all the numbers you need, and they obviously add up to "not good for society to take a dump in the sewer main"

In the vaccine example, you use the same cost/benefit types of equations, but you don't have all the numbers you need to plug in, so you can't come to the same conclusion.

This is already taking into account the fact that you take vaccines for other people (AND for yourself).  Yes--if you don't vaccinate you can kill people.  And if you encourage people to take more vaccines you can also kill people. I am considering both possible outcomes in competition with each other.

[GavJ]

The risk doesn't depend on the person before getting vaccinated or not, but on a multitude of personal and environmental factors.

I'm not sure I follow you. I don't disagree that of course personal and environmental factors matter.  That's not very helpful though -- if we don't even know HOW MANY people are adversely affected by vaccines with sufficient precision, then we certainly aren't going to know the specific processes by which those (hypothetical) things happen yet... So we can't control for them.

In a potential future when we know all the adverse effects and how they work precisely, then yes, we could screen people for instance to know if they're going to have a reaction ahead of time and thus make the injections almost perfectly safe.  But that's several steps into the future.

In the meantime, we only know about population level things -- and that's precisely what statistics as a science does for us. It allows us to infer things about populations from a sufficiently large sample alone. This will always be inferior to individualized data, but if you don't have that (which we don't because we don't even know what to look for), you have to rely on statistics as a lot better than nothing.

[Reudh]

IE : 10000 unvaccinated children in a big city : not a big problem. 500 unvaccinated children who are frequent the same faith healer : potential catastrophic outbreak. Any time a group of peoples are not vaccinate you may have an outbreak and significantly endanger their lifes.

Make sure you're not confusing "catastrophic outbreak" with simply "high local percentage of infection."

Because even if all 500 people in a 500 person faith healer community get measles, chances are about 6:1 that not a single person will die anyway.  One sixth of a person dying on average is not what I would exactly call "catastrophic." We definitely do NOT want communities to have 0% vaccination, of course, because we do already know that the MMR vaccine is safer than that outbreak damages at 0% vaccination specifically.  But something isn't "catastrophic" just because it does any amount of net harm.

To be catastrophic, you'd need BOTH a huge population and super super low vaccination rates (like in the 0-30 or 40% range) at the same time, which I'm not aware of happening anywhere in the U.S. so far.

Upper class LA communities have vaccination rates on par with developing countries like South Sudan or Chad.
[1]

Immunisation rates in said schools



In this case an immunisation rate <94% puts that community at risk. (The percentages shown is misleading, which is the amount that opted OUT of immunisation, so a 75% school has an immunisation rate of 25% which is most definitely far too low.

[Solymr]

The risk doesn't depend on the person before getting vaccinated or not, but on a multitude of personal and environmental factors.

I'm not sure I follow you. I don't disagree that of course personal and environmental factors matter.  That's not very helpful though -- if we don't even know HOW MANY people are adversely affected by vaccines with sufficient precision, then we certainly aren't going to know the specific processes by which those (hypothetical) things happen yet... So we can't control for them.

In a potential future when we know all the adverse effects and how they work precisely, then yes, we could screen people for instance to know if they're going to have a reaction ahead of time and thus make the injections almost perfectly safe.  But that's several steps into the future.

In the meantime, we only know about population level things -- and that's precisely what statistics as a science does for us. It allows us to infer things about populations from a sufficiently large sample alone. This will always be inferior to individualized data, but if you don't have that (which we don't because we don't even know what to look for), you have to rely on statistics as a lot better than nothing.

What I tried to explain is that 100% vaccination is better than randomly vaccinate people until the "optimal" percentage is reached. Take a hypothetical case of a disease with a vaccine. 10 people at risk of contracting the disease want to get vaccinated, but data shows that 10% of the people vaccinated suffer a worse reaction than the disease itself. The optimal range would be 90%, right? But the person who is going to suffer the reaction isn't random, it depends on its personal factors. So if you vaccinate 9 people and leave 1 without vaccinating, and you don't know which person is the one to suffer the reaction, there's a 90% chance that you leave without vaccinating a person who doesn't suffer a reaction and gets the disease, and the reactive person gets vaccinated and suffers the reaction. That's 2 people who get affected. If you do 100% vaccination the reactive person is sure to have a reaction, but it's the only one to be affected. (This of course assuming that disease infects all of them and vaccine has 100% effectivity.)

So you see, to reduce damage to its minimum while not knowing who it is that gets an adverse reaction it's better to 100% vaccinate and care for the few people that get a reaction instead of trying to vaccinate less and risking having people with disease and people with reactions to take care of.

[Squeegy]

Vaccination seriously isn't optional for your children. Yourself, fine, go ahead and make that stupid decision and put yourself and people who can't get vaccinated in jeopardy. I'd prefer if you "chose" to quarantine yourself from all human interaction too, which would probably be for the betterment of society in general. But "it might have a one in 60 million death rate, we just can't know for sure!" is not a valid reason to prevent your children from being vaccinated. Sorry, not sorry.

e: Also, this is a really utilitarian perspective on vaccination, which, as with most utilitarian arguments, is complete bollocks because it uses arbitrary statistics with no regard to other factors or considerations.

e2: The same argument could be made for voting. Again, feel free not to, we're probably better off.

[Draignean]

Gavj, I disagree with you, but I'm going to do it point by point. I haven't followed all 23 pages of this, but I feel the need to engage based on your first risk vs. reward point.

Right now, just for something simple that everyone likes bashing, we have the flu vaccine. According to the CDC 2013 report, 45% of the current populace (6 mo. and older) is vaccinated. I'm going to ballpark that and say that there are 300 million people in the States and all of them are in right range. Just as an envelope calculation.

So we've got 135e6 people vaccinated each year, and the chances of developing a reaction (not necessarily death) to the flue vaccine is approx 23:20289 (source). So, multiplying the two probabilities, approximately 153e3 people will have reactions each year. But, dear god, the highest estimate of deaths from the flu each year is only 1.6e3! OMIGOD PULL THE NEEDLES OUTTA THE BABBIES THE DOCTORS ARE KILLIN' EVERYBODY!

Wait, sorry, no. Bad math. I forgot to subtract the control group that had vaccine like reactions without actually getting a vaccine. That figure runs at 111e3, (give or take) and so puts the actual vaccine reactions down to 41e3. Now, how many of those vaccine reaction's resulted in death? Hmm. Ah, here it is...

No deaths were observed

We've got an OR of 1.6 with regards to developing Guille Barre syndrome, which is a nasty correlation, but we also have a predicted death suppression of between 47% and 68%.

So, basically it comes down like this. Projections for deaths per year from the flu range from 100 to 1600. Meta-analysis indicates no recorded deaths from vaccine. Vaccine is indicated to have a fair correlation with development of Guille-Barre syndrome. Essentially, this means that your risk-rewards ration is attempting to weigh %death vs. %syndrome, which, since I know of no statistic that allows those two to be correlated, we come down to a debate of philosophy with regards to the flu. Can you weight dead vs notdead? I could debate that, but it ain't science, and it sure as hell wouldn't be mathematical.

Awaiting your reply,
  Draignean

[GavJ]

What I tried to explain is that 100% vaccination is better than randomly vaccinate people until the "optimal" percentage is reached. Take a hypothetical case of a disease with a vaccine. 10 people at risk of contracting the disease want to get vaccinated, but data shows that 10% of the people vaccinated suffer a worse reaction than the disease itself. The optimal range would be 90%, right? But the person who is going to suffer the reaction isn't random, it depends on its personal factors. So if you vaccinate 9 people and leave 1 without vaccinating, and you don't know which person is the one to suffer the reaction, there's a 90% chance that you leave without vaccinating a person who doesn't suffer a reaction and gets the disease, and the reactive person gets vaccinated and suffers the reaction. That's 2 people who get affected. If you do 100% vaccination the reactive person is sure to have a reaction, but it's the only one to be affected. (This of course assuming that disease infects all of them and vaccine has 100% effectivity.)

You're treating disease as a fixed, constant situation. It's not, diseases are dynamic and non-linear, due to herd immunity, so you can't make that assumption that disease affects all of the remainder. Which is actually the reason why optimal rates can be between 0 and 100%

See the graph in the spoiler in my first post in the thread. As vaccination rates change, the benefit of vaccination changes non-linearly. This creates 3 possible scenarios:

1) The vaccine is riskier than the disease at any level of vaccination - 0% is optimal vaccine coverage.
2) The vaccine is safer than the disease at any level of vaccination - 100% is optimal vaccine coverage
3) The vaccine risk is in the middle of the non-linear curve - somewhere in between 0% and 100% is optimal.

So yes 100% optimal rate is possible, but without more data, there's no reason to think it's any more likely than a 90% or 95% or 85% or whatever.

Vaccination seriously isn't optional for your children. Yourself, fine, go ahead and make that stupid decision and put yourself and people who can't get vaccinated in jeopardy.

This assumes out of hand that not vaccinating is a "stupid decision" and the entire point of the thread is demonstrating why we don't actually know that...

The content of your post is therefore equivalent to just writing "nope."  And okay, fine, you disagree, but please justify why for more interesting discussion.

Also, this is a really utilitarian perspective on vaccination, which, as with most utilitarian arguments, is complete bollocks because it uses arbitrary statistics with no regard to other factors or considerations.

I said in my very first post in the thread that there are ethical concerns about treating vaccination as a utilitarian problem. And I have consistently considered and promoted other concepts like deontological protection of bodily integrity. I'm not sure how you're interpreting my posts as the opposite of that. I did CONSIDER the pure utilitarian math for sake of discussion, but that does not necessarily mean I endorse the ethics of the approach of using societal benefit over personal benefit (again, as laid out in the first post)

Gavj, I disagree with you

Except you DIDN'T disagree with me. I laid out a method of math. What I'm advocating is not some blanket conclusion about "raise vaccination!" or "lower vaccination!"  What I'm advocating is an algorithm.

Which you followed, more or less. I.e. you agree with me.

The fact that the result of the algorithm for flu is different than for measles is not surprising. Flu vaccines make more sense than measles vaccines, I am quite happy to admit that. WAY more people die of the flu, and the vaccine coverage is MUCH lower (and thus much easier to infer a valence to whether to increase or not with less data), AND there's a lot more data about the most important strains, because a lot more version of vaccines have been developed for them and close cousin strains.

There are a bunch of problems with a study like that one you posted, but I don't want to get into tedious arguments about them, because I think in THIS case, for flu, the data is sufficient despite those problems to verify that we are helping people with our current vaccination rates (and they they could probably rise quite a good amount and still be data-supported)