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[Leafsnail]

I'm pretty sure you must be doing this deliberately.  You slice up my posts into tiny pieces and pick up on all kinds of (usually misunderstood) details, but you cut out the key points and ignore them.  For that reason I will once again just state the massive misunderstanding in your position so you can't weasel your way out of acknowledging them.  The only responses you should make to this post are 1) an explanation of why you think this misunderstandings is actually justified or 2) an acknowledgement that you are mistaken.  I will not respond to anything else.

You seem to think that the point at which a treatment and the disease it seeks to prevent kill the same number of people is the "ideal coverage" for that particular treatment.

I won't let you pretend you aren't making this assumption.  You make it here:

Average deaths from measles in the UK 10 year average = 0.9 per year.
At 64 million people, it'd be around 0.8 deaths per year from a smallpox-complications-level vaccine.
Pretty close to break even point.
UK has a 92% coverage rate.

Here you compare the total number of people that would be killed per year by a vaccine (if we are to accept the safety figures for an old vaccine that is clearly a lot more dangerous) to the number of people killed per year by the disease, and suggesting that if these are equal you'd be at a "break even" point, beyond which you should not vaccinate.

This is completely incorrect.  What we are looking for is the point at which there are fewest deaths in total, not the point at which the damage the vaccine is doing and the damage the disease is doing are equal.

My example shows how absurd this notion is: under your "break even point" theory we should leave 3-4 people unvaccinated, so that the disease is allowed to do as much damage as the vaccine.  You deliberately cut out the reason I created this example and attacked it on an irrelevant basis.

The thing is though, I can even demonstrate that your "break even point" idea is nonsense by referring to real-world data.  Let's make our assumptions even more generous: vaccines are actually killing 0.9 people per year, the same number as the disease.  We're already at this point, beyond which we (according to you) should stop vaccinating.

Ok, so the total number of people dying from the vaccine and the disease at 92% coverage is 1.8, that is 0.9 from the vaccine and 0.9 from the disease.

Let's say we increased our vaccination coverage to 100% (this is impossible in practice, but let's say we can).  I think it's fair to say this would eliminate all deaths from measles - it would eradicate the endemic cases and prevent all but the tiniest of outbreaks.  It would also cause more vaccination deaths - we're now vaccinating about 9% more people per year than we were before.  So that would increase the number of people that vaccines are killing per year to 9.8 people.  So if we round up we now have 1 person dying per year due to the vaccine and disease put together (1 + 0 = 1).  This is fewer deaths than under status quo.

This demonstrates that 100% vaccination coverage would be better than what we have now even if we assume we've already reached the "break even point" - in other words, your ideal level is higher than the 92% coverage we got through pushing for universal coverage.  I realize that there is going to be an "optimum level" where the disease is so totally obliterated that we don't need any more vaccinations, but it's likely to be so high that between people with compromised immune systems, babies and anti-vax nuts that we'll never reach it.

Can you see the problem with your assumption now?  100% vaccination coverage would be better than our current level in terms of overall deaths.  What you're failing to realize is that you need to look at the change in risk between different vaccination levels, not just the total risk (unless you're trying to argue that the optimum rate is zero, which I think we've established quite firmly by now is not the case).

[Leafsnail]

My point I was making doesn't require them to actually be planning vaccination of anybody (although incidentally the CDC does have a stockpile of vaccinia pox vaccine on hand for terrorists or something: http://www.bt.cdc.gov/agent/smallpox/vaccination/faq.asp). I was pointing out that at the numbers they cite, if they were to vaccinate as many people as they want to vaccinate for measles (i.e. everybody), they are already admitting that they would predict hundreds of deaths. And 4 deaths a year ongoing.

This is relevant not because I think it would happen, but because it gives us a number for how much safer the measles vaccine would have to be than the smallpox: about 80x safer, for the death rate to equal the likelihood of saving your life from measles. This lends mathematical perspective that has nothing to do with actually administering smallpox vaccines.

This is only a relevant concern if you have a completely non-immune population though.  This isn't true for the thing we were discussing - the measles vaccination program has been going on for years and the current population is already largely immune.  The question is about whether you keep vaccinating kids, and if you want to make the comparison to yearly death rates due to a disease you should use yearly deaths due to vaccinations.  If you're looking at the whole population at once then you should be using the lifetime risk from the disease.

[GavJ]

You seem to think that the point at which a treatment and the disease it seeks to prevent kill the same number of people is the "ideal coverage" for that particular treatment.

MARGINAL benefit = MARGINAL risk vaccine. Or yes, minimal number of deaths, which should be the same thing.

In your example, at 100% coverage the marginal risk of one less vaccination = 1 death. And the marginal benefit = -1/1,000,000th of a death. So obviously, the optimal rate is 100% coverage.

In the UK example, you are correct: I made a math error in that post from thinking through it too quickly. That would imply 100% vaccination as well.





However, this is not guaranteed in all situations. It just happens to be the answer for your aerial disease and for the UK with a smallpox-complications vaccine In the US, we have about 1/90th the deaths from measles per capita than you in the UK does despite almost equal coverages. Presumably due to population density, culture, transit network location, or who knows what. That would be 0.01 deaths per year from measles for one UK's population-worth, or 0.05 people per year (death rate of 1/2000 + 100 cases a year on average = 0.05 deaths/year). 

If we pretend our same imaginary smallpox-like-MMR vaccine is causing 0.9 deaths per UK population, it would be causing ~4.5 deaths per year in the US.

So vaccinating another 10% of the population would = another 0.50 deaths per year, and if that eradicated measles deaths here, it would be saving 0.05 deaths per year

I.e. 10x less additional benefit overall than additional ham compared to status quo.

[Neonivek]

Why are you comparing it to the Smallpox vaccine? The most deadly vaccine possibly ever created?

"So vaccinating another 10% of the population would = another 0.50 deaths per year. and if that eradicated measles deaths here, it would be saving 0.05 deaths per year"

But ignoring that... I checked the real not imaginary math on this... Eradicating Measles death has a near guaranteed elimination of 1 death.

I got this by, checking measles outbreaks.

That is a net gain of .5 of a person.

[GavJ]

Why are you comparing it to the Smallpox vaccine? The most deadly vaccine possibly ever created?

Key word bolded.

It's A somewhat deadly vaccine, which came up purely because of that quote by the CDC about an estimate of its deadliness that I cited for a different reason. I'm not really aware of any studies suggesting that it's the most deadly, though. Or even making many quantitative comparisons at all, really.

It's PROBABLY safer in general than modern vaccines just from an off-the-hip "because modern." But that's not even entirely obvious -- what if adjuvants are actually more deadly in general than the antigens are, and we use a higher ratio of them now, for instance? (virtually zero research has been done on this) Also, if it was more deadly, how much? Enough to make modern ones a non issue? Maybe, maybe not.

[Leafsnail]

I'm glad you've acknowledged that you've been defeated on the UK example.  Now let's move onto the US: you seem to be twisting the numbers as hard as you can.

Firstly, the US has had around 600 cases of measles this year so far, 100 cases per year is not a reasonable estimate.   Also note the worrying trend, which may continue if lower vaccination rates of infants persist (gradually reducing the overall vaccination coverage).

Secondly, 1 death per 2000 cases of measles is a far lower estimate than I've ever seen anywhere.
http://www.cdc.gov/measles/about/complications.html
This suggests a rate of 1 or 2 per 1000.

Thirdly, 0.9 vaccine deaths in the UK was an inflation I made to show that your "break even point" was bullshit.  Even if MMR is as deadly as the smallpox vaccine it would kill less than that.  I have also explained repeatedly why it is very unlikely to be anywhere near this deadly.

[Neonivek]

The only vaccine GavJ I can think of that were more deadly was...

A) The Cowpox scratching (Poor-man's smallpox vaccine)
and
B) The Early Polio Vaccine

It isn't because "Because modern" it is because the environment that pushed all three of these vaccines out the door as fast as possible. They had a much safer polio vaccine in the works while the less credible one was already out.

What made the Smallpox and Polio vaccine possible deadly is not some unknown variable... We know the cause right now. In Polio's case it was because the vaccine required specialized laboratory settings to synthesize and in order to mass produce it they "relaxed" certain safety procedures which ended in a botched batch.

What is interesting about Smallpox is even the dangerous vaccine was far superior to Smallpox... because it was not only pretty deadly but often debilitating.

Leafsnail what are the chances that Measles debilitates you or gives you lifelong problems?

Also Leafsnail why are you doing it like that? Why don't you just compare the amount of deaths to measles RIGHT NOW! to the amount of hypothetical people saved from the vaccine?

[GavJ]

Yes 2014 is a dramatic departure from the last decade of cases. I see it as no more reasonable to go "Oh we're totally gonna have 600 cases a year from now on!" based on one data point than to estimate we will follow the 10 datapoints before that instead.

Secondly, 1 death per 2000 cases of measles is a far lower estimate than I've ever seen anywhere.

In 1964, there were about 500,000 cases of measles in the US.
In 1964, there were about 400 deaths from measles in the US.
i.e. 1/1,250 death rate.

I was guessing about 1/2,000 as a conservative estimate considering we have an extra, you know, 50 years of medical advances... fever reducers, intibation, intensive care, oodles more interventions, etc. plus cell phones to call ambulances anywhere and roads for them to drive on, as well as more paranoia and better sanitation and blah blah.

I have no idea what delusional world the CDC is living in where they estimate we are only HALF as good at saving people's lives from measles as in the 1960s!! Really, wtf? They don't cite which if any of those sources either...?  This is back when tobacco was super good for you!

I have also assumed repeatedly why it is very unlikely to be anywhere near this deadly.

FTFY.

We have virtually no useful reporting system, and virtually no evidence actually testing whether the new general types of formulations used in modern vaccines are safer than the old methods.
Nor does the smallpox antigen being worse than the measles antigen necessarily even matter, because you don't know whether it was mostly the antigen or the preservatives/adjuvants/etc. causing most of the problems back then in the first place.
Your guesses are appreciated, but not the stuff of national policy.

[Neonivek]

Yes 2014 is a dramatic departure from the last decade of cases. I see it as no more reasonable to go "Oh we're totally gonna have 600 cases a year from now on!" based on one data point than to estimate we will follow the 10 datapoints before that instead

Measles goes by cycles. I cannot remember if it is 2 year cycles or 3 year cycles.

Nor does the smallpox antigen being worse than the measles antigen necessarily even matter, because you don't know whether it was mostly the antigen or the preservatives/adjuvants/etc. causing most of the problems back then in the first place.
Your guesses are appreciated, but not the stuff of national policy.

Guesses? People didn't die from the Smallpox vaccine because of a antigen.

The reason I GUESSED it is the most deadly one is because frankly the only competition it has are those two and I am NOT looking up how many botched vaccine cases there were for either of those.

[Shinotsa]

Erm, there is a list of references at the end of that CDC informational page. And I'd honestly trust the CDC a lot more than assumptions made from 50 year old data.

[Mictlantecuhtli]

Your guesses are appreciated, but not the stuff of national policy.

Yeah, I agree with this summary of your position.

[Phmcw]

Your guesses are appreciated, but not the stuff of national policy.

Incredibly ironic since your own reasoning is nothing but guesses.

[GavJ]

Erm, there is a list of references at the end of that CDC informational page.

If you have the free time to entirely read 8 different papers, none of which are probably publicly freely available and require hunting down specific subscribed databases in libraries... all because the CDC is too lazy to put footnote numbers in text, then by all means go for it, and let me know which one it is and we can go from there.

Your guesses are appreciated, but not the stuff of national policy.

Incredibly ironic since your own reasoning is nothing but guesses.

This is absolutely right. I am.
I'm not claiming that "you're guessing and I'm rock solid certain."
no no.

I'm saying "we are all guessing, you me, everyone else. We need to do more research that is required for us not to be guessing anymore."

[Neonivek]

So until we have more research is there enough of a co-relation currently to act upon it?

None of the trails have had fatalities or maimings.

[Insanegame27]

Oh dear god! I was wondering when this silly discussion.
Ima say a few things and yourall gunna listen.
First: No matter whatpeople say, no matter WHO says it, Vaccines DO NOT CAUSE AUTISM
second: even if they did, what would you prefer? a dead kid or an autistic kid?