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[Eagle_eye]

Totally depends. Right now in the United States, it is reasonable to predict about 1 death from measles per 20 years, total. And we are WAY below endemic levels.

And you want to know why? Because almost everyone gets vaccinated. Prior to the advent of vaccination, measles killed thousands upon thousands of people a year, just like plenty of other diseases that are close to being eradicated now. The fact that one person can surf off of herd immunity doesn't mean that things will still work out if everyone does it.

As for the moral issue, complain about your bodily autonomy all you want, it doesn't change the fact that you're, on average, causing people to die, and that is absolutely unacceptable.

Plus, in the long run, even a vaccine that actually did kill people would cause vastly fewer deaths, because they have the potential to actually wipe diseases out entirely. There's a reason no one gets smallpox vaccines anymore.

[Gentlefish]

Hitler

Pack up folks, thread is done.

On a more serious note, on issues of national health in response to communicable disease, absolutely the individual should be subordinate to society. There's risk for everything, and we do a lot of risky things with very little benefits. Vaccines are low-risk, very high benefit. If everyone sucked up their "Oh but I want to be different" and just took the shots, then we wouldn't be having this thread because there wouldn't be measles.

[BFEL]

Hitler

Pack up folks, thread is done

Yeah yeah, bad taste I know, but there is something...fascist about Mr. Cthulu's argument. I mean fascism is basically "individuals don't matter, only the group"... that's pretty much the exact definition.

[Cthulhu]

Sorry, it didn't even occur to me that my viewpoint might end up somewhere under the umbrella of a scary sounding word.

I'll give myself the requisite spankings right away.

[GavJ]

Totally depends. Right now in the United States, it is reasonable to predict about 1 death from measles per 20 years, total. And we are WAY below endemic levels.

And you want to know why? Because almost everyone gets vaccinated.

Yes, obviously, of course that's why it's so low. I'm aware of this, and I'm explicitly taking it into account in what I'm saying.

The thing is, 100% and 0% vaccination are not the only logical possible targets. It may very well be the case that a permanent sustained 80% vaccination rate, or something, may in fact be ideal for a given disease, which perfectly weighs not allowing it to take hold at a self-sustaining rate and the risks of those who contract the disease (but almost never die) against an ideally minimal usage of drugs that might have dangerous side effects and might also kill people. Or almost any other number instead.

Think of it as two rubber bands tied to a pencil, one is probably stronger than the other, but it might be either one. Where the pencil naturally ends up staying still representing an ideal vaccination rate, minimizing overall deaths from the combined sum of the disease and the vaccine together.

Your concern and citation of old <1960s statistics only really makes sense in response to a person advocating 0% vaccination rate. Which is NOT what I'm doing. I am by definition advocating minimizing total deaths overall. Which may or may not correspond with current policy.

Personally I disagree with the American notion that an individual has the right to make personal decisions that jeopardize the group as a whole.  As George Costanza says, we live in a society, or at least we purport to.

The main point of the thread is that mathematically, it is impossible for you to KNOW what is best for the whole society. It MIGHT be better for everyone to vaccinate more than we are now. It MIGHT be better for society to vaccinate somewhat less (almost certainly not 0 though!)

So even if this is your philosophy, it doesn't matter, because you don't know which of the two decisions actually does jeopardize the whole in the first place.

[TamerVirus]

Hey, Hitler vaccinated himself with the barrel of a gun.

So it cant be all bad, right?

[Leafsnail]

Totally depends. Right now in the United States, it is reasonable to predict about 1 death from measles per 20 years, total. And we are WAY below endemic levels.

Since all you really need to do is have everybody in the world below endemic levels for a pretty rapid eradication, we may be overdoing it, yet not really helping out the world any more than we would be otherwise.

This is wrong, due to anti-vaxers the vaccination rate has dropped and measles is enjoying a resurgence in the US once again.  You really need to push fucking hard to get the required percentage vaccinated all over the country.
http://www.nbcnews.com/health/health-news/measles-cases-surge-u-s-fueled-unvaccinated-travelers-n88196

It all depends on the death rate from vaccination, which we don't know. I strongly suspect it's higher than 1 per 20 years though. If so, then we would want to scale back to some lower level of vaccination (not 0%! Likely not even close to 0%!), as long as it is simultaneously above the risk/benefit equilibrium AND well below endemic rates.

We don't know the death rate from vaccination because it is so incredibly fucking small.  I am not prepared to jeopardize a disease elimination program just to possibly prevent an event so incredibly rare we've never even observed it.

And again I'm pointing out that the necessary rate of vaccination for herd immunity is a matter of epidemiology, not some kind of unsolvable cosmic mystery.  Measles is a very contagious disease and it's thought that a population needs to have over 95% coverage in order to prevent outbreaks:
http://rsif.royalsocietypublishing.org/content/early/2010/04/13/rsif.2010.0086.full
Note that the measles vaccine is not 100% effective, so that pushes the required coverage even higher.  Basically we need as much coverage as possible.

So yeah, that's actually a good addendum to the theory, I admit.  We should seek to achieve EITHER equilibrium risk/benefit, OR some safety buffer below endemic levels, whichever one = a higher vaccination rate out of those two considerations. In order to save the most lives while we wait for other areas of the world like Africa to catch up and the disease to go bye bye.

So in other words more people in the US need to be vaccinated to prevent outbreaks like the ones that are currently happening (which will get worse if people continue to not vaccinate their children).

And you want to know why? Because almost everyone gets vaccinated. Prior to the advent of vaccination, measles killed thousands upon thousands of people a year, just like plenty of other diseases that are close to being eradicated now.

Correction: measles still kills thousands upon thousands every year in countries with inadequate vaccination coverage.

Yeah yeah, bad taste I know, but there is something...fascist about Mr. Cthulu's argument. I mean fascism is basically "individuals don't matter, only the group"... that's pretty much the exact definition.

No it isn't at all, and I think saying so basically amounts to a pro-Nazi statement.  How did the massacre of 6 million Jews benefit their group as a whole?  It's almost like fascism is actually defined by extreme authoritarianism and nationalism

[Leafsnail]

The main point of the thread is that mathematically, it is impossible for you to KNOW what is best for the whole society. It MIGHT be better for everyone to vaccinate more than we are now. It MIGHT be better for society to vaccinate somewhat less (almost certainly not 0 though!)

You've done nothing to demonstrate that it's "impossible to know", you've only shown that you don't know the science required to calculate the critical coverage level and can't be bothered to look it up.

e: in addition, I'd point out that if it's an unknown then surely it's safest to make our vaccination rate as high as possible to prevent outbreaks

[BFEL]

It's almost like fascism is actually defined by extreme authoritarianism and nationalism

Isn't it? I mean unless I'm horribly mistaken that IS what it is defined by.

Sorry, it didn't even occur to me that my viewpoint might end up somewhere under the umbrella of a scary sounding word.

Well, I'm a self-described Anarchist, so I guess I can relate there
I guess I should probably drop this before it goes places... its already a substantial derail, wouldn't want full on passenger casualties XD

[GavJ]

This is wrong, due to anti-vaxers the vaccination rate has dropped and measles is enjoying a resurgence in the US once again.

No actually i just looked up the up to date numbers earlier tonight and calculated this brand new spanking fresh. It is 100 cases per year for the last 10 years on average (which to my eye looked an appropriate range due to high variability year to year).

If you're gonna trust NBC in their choice of dramatic terms like "surge" without actually looking up the real numbers, then you need to work on your media consumption habits, IMO. I'd be surprised if I could get through any network news story without hearing "resurge" "explosion" "plague" etc. at least 10 times, even if it were about stuffed animals.

As they point out, the number so far is 129 in the US, which is a modest difference from recent years and well within the variance rate from recently.

We don't know the death rate from vaccination because it is so incredibly fucking small.

 
Just like the death rate from measles.
Even at 1960's death rates for those with the disease, 100 people recent average = about 1 death per 20 years, just like I said. That is "incredibly fucking small"

By comparison, the number of people mauled to death by cougars is about 10x higher http://en.wikipedia.org/wiki/List_of_fatal_cougar_attacks_in_North_America

(Curiously though I don't see anybody flipping out online about how we need to make a "strong push" in this country to eliminate the looming cougar threat)

And again I'm pointing out that the necessary rate of vaccination for herd immunity is a matter of epidemiology, not some kind of unsolvable cosmic mystery.

 
I agree. The exact shape and size of the blue curve in my graph is probably entirely solvable by epidemiologists, if they chose to do so. What is not known is the red line, and you need both to determine an optimal policy.

Measles is a very contagious disease and it's thought that a population needs to have over 95% coverage in order to prevent outbreaks

Preventing outbreaks =/= preventing endemic self-sustainability.
The outbreaks are fueled by imported carriers from other endemic countries, and if/when all countries are below endemic rates at once, it should die out. That's the threshold that matters long term, not just "any outbreaks ever"

Also, please note that I at no point suggested our vaccination rate is currently too high. I said it MIGHT be too high, depending on information nobody knows. It MIGHT also be too low. "We do not have the data" is in no way the same thing as "omg stop vaccinating!"

So in other words more people in the US need to be vaccinated to prevent outbreaks like the ones that are currently happening (which will get worse if people continue to not vaccinate their children).

Yes, if "stopping all outbreaks" was the correct goal.

But it isn't the correct goal. The correct goal is "minimizing total number of deaths."

If eliminating an outbreak that has a 5% chance of killing a single person or something would require enough extra vaccinations that you would kill 3 people with them, then vaccinating more would be the incorrect choice in that situation. It would save more lives in that example to intentionally allow that level of outbreaks to continue occurring, or in fact to even slightly lower vaccinations until the number of deaths from either choice is equally low.

I have no idea if that's actually the case, versus whether the vaccines have a lower chance currently of killing than the outbreak. Neither do you. That's the point. Nobody does.

You've done nothing to demonstrate that it's "impossible to know", you've only shown that you don't know the science required to calculate the critical coverage level and can't be bothered to look it up.

I know how to look it up. But since it's not the number the matters, I have no reason to. I don't think this term means what you think it means.

[BFEL]

I...just realized the relevance of GavJ's avatar to this conversation XD

[GavJ]

I...just realized the relevance of GavJ's avatar to this conversation XD

Totally! No current vaccine for dysentary, guys!

It helps though not to swallow lungfuls of dirty river water because your asshole parents tried to ford a 30 foot river for fun.

[GavJ]

Now, that equation alone is almost hilariously wrong. For one, you're forgetting the timeframe here- chance over what period? Immediate? Over 5 years? The risk of having a seizure as a result of a severe reaction the vaccine is vastly different to the benefit of not risking a serious disease during a brief, immunocompromised state later in life. Your equation doesn't take that into account, and fails quite hard on that alone.

1) If you want to add in time scaling factors, go for it. Since that equation was never actually USED in that level of detail the rest of the thread at all, though (due to the death rate simplification which is frankly necessary unless you want to do your dissertation on this), it won't really matter and seems pretty pedantic.

2) There's very little studying done of long term antibody titers in general for most types of vaccines over very long periods of time to assess their continued viability, even for normal healthy people. And I've never seen any study of that for immunocompromised people who acquire their condition sometimes later after an earlier vaccine. Do you actually know that a previous vaccine would even hold in a newly immunocompromised individual? Including one decades later? If we don't know these things for sure, then no amount of math-ing is going to properly account for them anyway, which would just be yet another layer of unknowns and suggest the true answers are even further out of reach than previously expected.  Or do you have cites?

Yes, you said the premise is of death/life, but for something like measles, death isn't even half of the issue here. By reducing to the issue of the life/death type, you miss half of your first equation- risk. Death is a risk, but so are many, many other consequences to measles.

Vaccines have these same non-death complications as well, which I also left out of the risk side of the equation. So what? Unless you have good reason to assume that for measles, complications:death is a much higher ratio than it is for vaccines, it's not a big deal.

If you want to go in and calculate 50 billion random little side effect risks of eczema and all that crap for both measles and vaccines for measles, be my guest, though. It's all going to end up being a collossal waste of time when you finish with the disease side and then realize that the only risk studies on the other side that even mention things like that are clinical trials that have stupidly low subject populations (none of the meta studies are going to go into vaccine cause eczema on the other side of things. Remember, most of these studies don't even look at death rates! like 80+% of them look EXCLUSIVELY at autism)

As a result, you would be better off looking at vaccination statistics for particular areas such as school districts to know the exact risk; which, by the way, is significantly higher.

Edit: Okay let's be extreme on this and pretend people ONLY get measles in school district areas. How many people is that? Probably well over half. Let's say half though, I'll be generous. You've now adjusted to at most 1/30,000,000 instead of 1/60,000,000 lifetime, for the specific half of people living in school districts (that's also implicitly, unrealistically assuming that people never move in or out of school districts, because if they do you're back to blending the population up again. Conservative assumption #4)

You still have about 2 orders of magnitude to go before you would be in range of meta studies even if they were perfect causal experiments looking at precisely what you wanted them to (lol).

[Jelle]

Assuming the math is all correct (to tired to propperly analyze), and the mathematical models you're using accurately approximates reality I suppose you have a point. I can certainly follow the general reasoning.
One not so very mathmetical counter argument though is, given you sacrifice self authority over your one's body for the health of all, that you'd be forcing a certain percentage of the population to get vaccinated and not the other. A policy like that can not be considered 'fair' if you value an equal society.

[10ebbor10]

On a side note, maybe we should try to run a risk/reward analysis on our risk reward analysis.

Presumably, danger (if there is any) of vaccines scale linearly as the population that is vaccinated increases.

The danger of the disease however, does not. It scales relatively slowly, until suddenly the herd immunity is no longer sufficiently and you cause an epidemic.

So it might be better to err on the side of caution.