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[Helgoland]

Nope, first individuum still has that 30% benefit. For any serious disease that's too large to be ignored.

[Reelya]

not true, because there could be a disease where the vaccine is as bad as 40% of the disease.

if the vaccine saves you 30% of the time but kills you 40% of the time, you wouldn't get it.

But if everyone gets it then the effects of the disease become zero (because the disease was previously in equilibrium within the population and the additional immunity cause it to spiral to nothing over repeated cycles), vs 40% as bad effects from the vaccine, which is a 60% benefit.

[andrea]

40% mortality rate for a vaccine is an absolute disaster. Immunizing , say, the US with such a vaccine you would kill more than 120 million people. Aquiring herd immunity might not help as much as merely thinning the population.

numbers aside, mortality rate for vaccines are usually so low that the equilibrium point is bound to be quite high, except probably for diseases that aren't that bad anyway ( like a vaccine for the common cold taken by young healthy people)

[Reelya]

That was just a number I pulled out of thin air. Maybe it's 0.04% death from the vaccine vs preventing death 0.03% of the time from the disease.

The point is that if only you are vaccinated, your net chance of dying is higher. But if other people are vaccinated too, your risk falls. So the highest point of personal benefit is not at zero immunization, it's in the middle, and no amount of individual selfish choice will get the ball rolling, because everyone is making the same calculation as everyone else that if they are the first to get immunized, then they increase their risk, not decrease it.

But it's not hard to see that the more OTHER people being vaccinated there are, your protection increases regardless of whether you got the vaccine.

In fact, since the chance of dying from the vaccine is constant, 0.04% and the amount of protection afforded personally by the vaccine is never greater than 0.03%, and actually decreases as more other people get vaccinated which reduces your risk of contracting the disease, it is clear that at every stage it makes sense personally NOT to get vaccinated. And if we allowed everyone to "rationally" choose their personal best interests then vaccination would plummet to zero.

[Helgoland]

not true, because there could be a disease where the vaccine is as bad as 40% of the disease.

if the vaccine saves you 30% of the time but kills you 40% of the time, you wouldn't get it.

But if everyone gets it then the effects of the disease become zero (because the disease was previously in equilibrium within the population and the additional immunity cause it to spiral to nothing over repeated cycles), vs 40% as bad effects from the vaccine, which is a 60% benefit.

Only if you assume certain infection, which would - again - make that first vaccination benefitial.

Maybe more interesting: What if we had a 'vaccine' that didn't stop the disease, but still prevented it from spreading? It's at least a bit plausible for something like AIDS...

[Reelya]

you don't have to assume "certain" infection, just that the chance of dying from infection is lower than the chance of dying from the vaccine. There's nowhere in my analysis above that assumed 100% infection rates.

it's clear that other people being vaccinated reduces your chance of infection in the first place.

The bulk of your protection could come from other people's vaccinations. And in that case, then anyone looking "rationally" at their own vaccination would decide not to get it. Remember in the scenario above, the vaccine is deadly 0.04% of the time, and even at most the vaccine - personally - prevents death 0.03% of the time.

If lots of other people are vaccinated, that could massively reduce your exposure to the virus, but then the logic goes "well my exposure is half now because most other people are vaccinated, but that means my personal shot of vaccine is only reducing my risk by 0.015% rather than 0.03% and I still have the 0.04% risk that the vaccine is harmful - therefore me, personally having the vaccine makes even less sense now".

So, in these sorts of situations, there is no "equilibrium" point, because it's always better to try and offload the responsibility for being vaccinated onto everyone else and reduce your risk from the vaccination itself.

===

Look. I'm clearly not arguing against vaccination here. I'm just saying the "personal choice" model doesn't work. It's a group thing, and that's why it's about public policy. You're not just affecting yourself by choosing not to be vaccinated.

[GavJ]

Oh also @Shinotsa

...otherwise it would simply be antigen which we are exposed to all the time

An additional thing wrong with this comment is that you're ignoring the real possibility that the vaccine program might cause mroe antigen exposure than it prevents at a certain point. Take measles for example again. The flaw with your logic regarding this disease is that most people are absolutely not actually "exposed all the time" to measles antigen. (Yes I realize that's because of vaccines. Which doesn't matter for this argument, since here I'm only going to be talking about staying at 90% coverage versus going to 100%)

In the US we have about 100 cases a year on average. I'd guess that's maybe 5,000 people exposed significantly (the other 4900 naturally fought it off or were successfully vaccinated).

Currently we have 90% coverage. What if we were to bump that up to 100%? Well, BEST case scenario of course would be 0 wild exposure (which ignores international travelers, but let's say we also shut down our airports Madagascar style for sake of argument).

But 10% more people would be getting vaccines, i.e. 30,000,000 more people are exposed to antigen over their lifetimes which = 30,000,000 / 78 = 385,000 a year.

...

So you'd be preventing 5,000 antigen exposures per year in exchange for creating 385,000 antigen exposures per year! Now, but you say "Ah those are inactivated antigens though, they are less likely to cause symptoms!"

Less likely, sure. But are they 385 / 5 = 77x or more lower likelihood of causing symptoms?  Maybe, maybe not.  If not, then the vaccine program going from 90% to 100% might very possibly INCREASE overall measles symptoms and sickness from measles antigens alone (including potentially even the deadly measles symptoms like encephalitis), even ignoring everything else in my previous post.

So, personal choice fails as the explanatory mechanism for the first person getting immunized. It only makes sense if everyone does it.

If a vaccine is 30% effective, and you're the first person who gets one, you are 30% less likely to get sick. That's clearly a personal selfish benefit.  You are acting as if herd immunity is the ONLY factor, and it's absolutely not. It's just one factor. Direct protection is another that will often actually be more important, both selfishly and to society.

Btw my graph in the OP wasn't actually based on personal selfish benefits anyway. See surrounding text in section 5.

[scrdest]

Just to make sure, you do realize that the vaccine does not need to include the actual virus anymore, attenuated, activated or otherwise? Sure, we cannot apply this to all viruses, and measles vaccine used commonly is attenuated, for instance, but we're not limiting ourselves to any single virus.

[GavJ]

Just to make sure, you do realize that the vaccine does not need to include the actual virus anymore, attenuated, activated or otherwise? Sure, we cannot apply this to all viruses, and measles vaccine used commonly is attenuated, for instance, but we're not limiting ourselves to any single virus.

It doesn't necessarily take the actual virus to cause symptoms and complications.

For example, some vaccines use toxin byproducts as the antigen (mostly bacterial vaccines), or something like a toxin with one of the hydroxy groups switched out with a hydrogen or whatever. Might not have any actual cells in it, but if the toxin is actually the thing that would have caused most of the problems in the actual disease, that might not matter -- you could still see the same symptoms from a vaccine using a weaker version of the toxin.

Even if you only use tiny artificial fragments of similar shapes as a virus, you could potentially risk a subset of symptoms too.



But yes, as technology advances, that particular issue might become less of a concern.

[Reelya]

If a vaccine is 30% effective, and you're the first person who gets one, you are 30% less likely to get sick. That's clearly a personal selfish benefit.  You are acting as if herd immunity is the ONLY factor, and it's absolutely not. It's just one factor. Direct protection is another that will often actually be more important, both selfishly and to society.

No, I did actually specify this in a concrete way. It's only better to be the first to get vaccinated if the "30% risk reduction" is greater in magnitude than the risk factor of the vaccine. But herd immunity can kick in to take the overall protection above the vaccine's risk level. That's in no way saying herd immunity is the "only factor" or any other bullshit. I'm calling straw man on that.

It's just not guaranteed that maximum protection is afforded to the first person getting a vaccine, nor is it even guaranteed that this first-level protection is greater than the risk of the vaccine itself. But the total combined protection from personal AND "herd" immunity, which just means having less infectious people around you could be greater than the vaccine risk.

That's just saying that there is no guarantee that the equilibrium point is greater than zero unless you're dealing with 100% effective vaccines. It's not difficult to come up with scenarios where leaving it to individual choice always leads to the worst outcome.

[scrdest]

Just to make sure, you do realize that the vaccine does not need to include the actual virus anymore, attenuated, activated or otherwise? Sure, we cannot apply this to all viruses, and measles vaccine used commonly is attenuated, for instance, but we're not limiting ourselves to any single virus.

It doesn't necessarily take the actual virus to cause symptoms and complications.

For example, some vaccines use toxin byproducts as the antigen (mostly bacterial vaccines), or something like a toxin with one of the hydroxyl groups switched out with a hydrogen or whatever. Might not have any actual cells in it, but if the toxin is actually the thing that would have caused most of the problems in the actual disease, that might not matter -- you could still see the same symptoms from a vaccine using a weaker version of the toxin.

Even if you only use tiny artificial fragments of similar shapes as a virus, you could potentially risk a subset of symptoms too.



But yes, as technology advances, that particular issue might become less of a concern.

My bad, I really need to go sleep after this post, my phrasing is getting progressively worse.

Yeah, I've been specifically meaning using viral protein subunits. These do not produce the viral infection symptoms in themselves, seeing as they lack... well, the rest of the viral infection apparatus, effectively being stripped to the parts recognizable as an antigen.

As such, the only damage it produces in itself is autoimmune, and you cannot really factor in that kind of autoimmune response, because that's for the most part a shit happens kinda thing, until major improvements in genetic diagnostics and therapy are made at least.

Of course, there's also the additives, but those are a separate issue.

[GavJ]

http://www.cbsnews.com/news/gardasil-researcher-speaks-out/

I'm not presenting this article as proof/data for anything. But it bring up an important rhetorical point I didn't address much before:

Duration of immune protection is sometimes simply not well known for many vaccines, or if it's a brand new vaccine might purposefully not be measured for long enough to be certain about medium to long term outcomes, because they simply don't want to wait that long until release of the product. This may or may not be a reasonable decision, but it's a factor that has not been mentioned much yet, and adds extra uncertainty.  For instance if 1/5th of vaccines turn out to wear off after like 5 years, then that means all vaccines in general have to be maybe 10% more effective than otherwise in your risk/benefit estimates, to offset the possibility of them being very short term "duds." or what have you.

______________________

Also, regarding Gardicil: girls who get the vaccine are now in some places by policy NOT getting pap smears anymore. I don't think this is CDC endorsed or anything, but people have told me their gynecologists have specifically recommended this line of action. This is super dangerous, because pap smears can reveal all sorts of cancers that are not cause by HPV, and so now they are at risk from dying of those cancers too. This silly policy decision alone could potentially undo whatever good the vaccine does.

Now, of course you could simply market the vaccine and NOT add on that policy / tell patients the right thing, and avoid this risk. It's not like that policy is inherently packaged along with the vaccine.

But this still embodies a usually intangible factor of culture -- people starting to put too much faith in vaccines and being sloppier in other ways as a result, such that it can undercut the benefits. Regardless of how much we continue to vaccinate more or less or the same, addressing some of the silly cultural trends surrounding it is an important thing to do in the meantime.

No, I did actually specify this in a concrete way. It's only better to be the first to get vaccinated if the "30% risk reduction" is greater in magnitude than the risk factor of the vaccine. But herd immunity can kick in to take the overall protection above the vaccine's risk level.

No, herd immunity is there from the VERY FIRST vaccine.  That first dude not getting sick = one less dude that every other person he knows (hundreds of them) are now exposed to.

In fact, the strength of the herd immunity effect is higher with that first dude than it is with any subsequent dude. Because the second guy who gets vaccinated in the same community? He provides that same lack of exposure risk to all his people he knows as well... MINUS ONE - the first vaccinated person.

So his herd immunity contribution is actually slightly less than the first guy's.  And so on.



(In actuality since not everybody knows everybody in the country, it is just flat at first in the graph, until at least a couple people are vaccinated in every community. Which as you can see, I actually took into account in the drawing, actually!)

As such, the only damage it produces in itself is autoimmune, and you cannot really factor in that kind of autoimmune response, because that's for the most part a shit happens kinda thing

...Except autoimmune "shit doesn't happen", if there's no vaccine at all. So the autoimmune threat still needs to be factored in, however small.

[Shazbot]

The whole premise is flawed. "2014 America" is not a vacuum-sealed bubble, and the diseases vaccines prevent are being brought in to the country constantly through immigration and travel. The entire argument falls apart from there.

http://www.newsmax.com/Newsmax-Tv/border-crisis-health-threat/2014/07/14/id/582623/

If we have 90% measles or TB coverage and then active carriers are scattered across the country's school systems, that's 10% of population at risk. Its just not acceptable. If you want to use the public schools, you have to be immunized against childhood killers. If you want to travel between the US and other countries, you have to be vaccinated according to both parties visa laws. If you want to get free health care, you have to take preventative measures for cost saving or your care could be denied.

Of course if you don't want free healthcare, public schools or unlawful immigration, well. I'm in a daydream about that.

[Reelya]

We're talking about that first individual's decision to get the vaccine, for personal gain.

Herd immunity for other people doesn't come into that persons decision making. So you're getting even more mixed up and off-topic now. We assume that this person doesn't give a shit about benefits that do not accrue to themselves.

If you're now saying the first person to get immunized must take into account the benefit their imminuzation gives to people who are not themselves, then that actually throws your entire concept of equilibrium based on personal choice / personal risk levels into doubt.

If you're NOT saying that the first person needs to take into account of the net effects his immunzation has on the rest of the population, then you need to explain how it's a relevant point to bring up in regards to my example. As far as I can see, it's completely irrelevant to my argument.

[GavJ]

The whole premise is flawed. "2014 America" is not a vacuum-sealed bubble, and the diseases vaccines prevent are being brought in to the country constantly through immigration and travel. The entire argument falls apart from there.

Every day that passes, you change the point of reference.  On january first, 2015, the reference point for decision would be 2015 America.

I am not suggesting it is a permanent reference point we should use forever. I'm saying that the best logical reference point for policy on Sep 4, 2014, is the situation on the ground locally on Sep 4, 2014. I'm not sure how this is remotely controversial. (Keeping in mind that I've agreed several times you should also keep one eye toward the vague future by making sure you're outside of endemic levels for eventual eradication, mind you)

We're talking about that first individual's decision to get the vaccine, for personal gain.

No... I've been talking ever since the very first post in the thread about BOTH personal AND society's gain from that first person getting the vaccine.  Go read the first post, it's pretty explicitly about both perspectives.

Both the first person and society both gain from that first vaccine. The individual only gains from his own personal protection. Society gains in two ways immediately: from that guy's personal protection (he's more likely to stay at work, etc.), and also from there being one less person who is going to expose other citizens (the herd immunity benefit).

As more people get vaccinated, both the individuals and the society gain less with each new vaccination.  The individuals have less risk of disease due to the other already vaccinated people, so their personal benefit goes down.  And for society, the benefit also goes down, for two reasons: that next guy's vaccine is less likely to be needed to keep him at work, and also, there are fewer people prevented from exposure due to his vaccination than with the earlier people who were vaccinated (the herd immunity effect offers smaller marginal gains with each new vaccine administered).

the two curves (individual and society) may have different slopes, but both are monotonically decreasing with % of country vaccinated, because ALL marginal benefits involved decrease gradually for ALL parties with higher and higher vaccination rates.