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[Shinotsa]

I'd like to point out that post-marketing studies can and have had samples of 60 million, and that I still haven't heard a practical, ethical way to enforce a strict percentage based vaccination policy.

[GavJ]

did you actually read the article I posted?

Yes, and their definition of "community" seemed obviously not inclusive of highly clustery places like America. Notice they define the term in the context of islands and cities, i.e. places where people are fairly homogenously networked proximity to one another for transferring viruses relatively freely within the community. They even go so far as to contrast this to "heterogenous methods" a section or two later.

Even more importantly, where exactly did you got the idea that 300,000,000 is "too big for a community" or above the threshold, even if it is a valid community?

The only numbers cited in the article for community size are "~250,000 to 500,000 in an unvaccinated population" and they go out of their way to mention that "Routine vaccination... would increase the community size needed to sustain measles transmission."

Nowhere else do they provide any numbers, even rough guesses, about how much vaccination will increase the critical community size, making it impossible for you to know whether 300,000,000 is above or below the "increased community size" threshold for a 90% vaccinated population, without additional sources (please cite if you have them).  You seem to have just pulled this "fact" out of your hat.

Finally, the authors do not disagree with any of the items from my list of things that herd immunity thresholds assume that I posted earlier. Yes, they discuss more specific and detailed alternative variables than the basic reproduction ratio, however these more detailed variables are not what is being used when you look up the commonly published numbers by the CDC, etc.  The CDC tables use simple (R0-1)/R0 to get their herd immunity thresholds. NOT the "effective reproduction ratio" or similar things described in the study you linked. Nor does that study offer readers any easily available ways to quantitatively apply the more advanced concepts it describes.

So it's wonderful and all that people at some point have thought more deeply about it, but that doesn't actually help us here to determine anything nor does it make the herd immunity thresholds any more useful for the thread.

I still haven't heard a practical, ethical way to enforce a strict percentage based vaccination policy.

I went into fairly explicit detail about an example that should be easy to extend to other similar situations. I don't know what else you want. In case you missed it:

Spoiler (click to show/hide)

As an example of a reasonable law, for instance you might be able to say (after having enough data to find the optimal rate for sure):

a) "If federally published vaccine coverage is below the target level, and has been for over 1 continuous month, then you can be denied new insurance coverage for [that disease or known symptoms/complications thereof]  for that person until either vaccinated or the rate hits target levels"

b) "If federally published vaccine coverage is at or above the target level, and has been for over 1 continuous month, then if you get vaccinated at that time, you can be denied new insurance coverage for that person for [whatever the huge studies identified as the types of vaccine reactions relevant] until the rate falls below again or ___ amount of time passes (expected period of time for most of adverse reactions)."

c) "If it changed threshold in the last month, there's a grace period and you can't be denied on these grounds"

d) "Regular existing exemptions [blah blah, e.g. medical contraindication] apply."

e) "Pharmacies/doctors can allow vaccination at any time it is available, but must legally update you on the current status, i.e. (a) vs. (b) vs. (c) above, when you come in, prior to vaccinating" and give you a receipt to that effect, etc.

(This would act as a strong incentive to keep the rate near target by the way, which responds further to one of the questions from earlier about how you enforce a specific number)

I also mentioned simple reporting of the numbers, and already explained why poor or illiterate people are NOT disproportionately disadvantaged by that, since if you are at the equilibrium point, it is equally dangerous to vaccinate or not, so they're no worse off than anybody else.

[Leafsnail]

The paper considers all of the factors you list in detail and still advises that you need to get to the critical vaccination rate, p_c, if you want to eliminate measles.  It also states explicitly that any p_c value below 90% is impossible.  Those two alone defeat your argument: if there were a significantly lower vaccination level that could prevent endemics in a population as large as 300,000,000 they would say so.  As it is I suspect the difference between p_c and "the level at which epidemics usually die out stochastically in a very large population" is so tiny that it's barely even worth making the distinction, and since this thorough and well-researched article seems to make a similar assumption the onus is on you to demonstrate otherwise.

Also your policy proposal is absolutely absurd, it would result in a wild see-sawing of vaccination levels every month that would leave young people vulnerable.  Do you really think that deliberately staying in the danger zone half the time is a good idea?  At least a raffle system would be enforceable (although it would make your patient choice argument pretty hilarious).

[TinFoilTopHat]

Now I know this is a fallacy and no argument to cease vaccinations amongst the entire general population, but I PERSONALLY seem to have a shitty trait that runs in my family causing us to get terrible illnesses upon being vaccinated. My mother, for example, was diagnosed with Lupus soon after receiving her college vaccinations, which were administered in two sets one week apart, and my brother, soon after receiving a chicken pox vaccination, got a terrible case of chicken pox, having them all across his body and on the inside of his eyelids, so my personal policy is no vaccinations.

[Neonivek]

Now I know this is a fallacy and no argument to cease vaccinations amongst the entire general population, but I PERSONALLY seem to have a shitty trait that runs in my family causing us to get terrible illnesses upon being vaccinated. My mother, for example, was diagnosed with Lupus soon after receiving her college vaccinations, which were administered in two sets one week apart, and my brother, soon after receiving a chicken pox vaccination, got a terrible case of chicken pox, having them all across his body and on the inside of his eyelids, so my personal policy is no vaccinations.

Unfortunately that is just flat out bad luck.

[Leafsnail]

How old was your brother at the time?  Most kids get chicken pox at some point, and it's really safer if they do than for them to get it in adulthood (vaccinations for it are pretty rare though).

I'd need more information to know about the lupus case, but I think most of the time it would be a matter of the vaccine exposing the condition rather than causing it.

[Neonivek]

Sadly enough it can actually take a week or two before vaccines kick in. (Flu shot I believe takes a week)

[GavJ]

The paper considers all of the factors you list in detail

?? Sorry not trying to be a douche about this, but can you provide quotes please? I simply do not see what you're talking about, let alone "in detail." The four things I mentioned before:

a) All of the math I see is from the point of view of the very first person infected in a given location. Just not seeing any mention of susceptible population lowering as a result of some neighbors already being sick during an outbreak.
b) Natural immunity: The only place this is mentioned is one sentence where they are saying that they DON'T account for it.
c) I see mediocre discussion of active government interventions. They mention passive database surveillance, and they mention actively trying to get new students coming to school to be vaccinated. They do not mention various other dynamic measures like quarantines, drug stockpiles, or extra manpower to active outbreak areas, etc. that push the effective R below the theoretical R0
d) I see no mention of how often people stay home or go to work or other self measures and education-dependent variables as being even considered here, let alone how or in detail.

It also states explicitly that any pc value below 90% is impossible.

Yes,
...with a single dose, whereas we give two,
...if delayed until your 2nd birthday, which we don't do,
...using the highest of of the R0s predicted for England (which is way higher than the ONLY value listed for North America, 18 vs. 12.5),
...still ignoring all four of the parameters I listed earlier in terms of spreading variables, until I see quotes attesting otherwise (with the one exception of briefly mentioned new student vaccination)
...and even after all that, this conclusion still was only meant to refer to the one highest risk subsection of a heteregeneous population, not the entire population.

if there were a significantly lower vaccination level that could prevent endemics in a population as large as 300,000,000 they would say so.

Or... they don't know or don't have sufficient data... You don't just say random shit you suspect might be true in a peer reviewed journal article!! Not mentioning something therefore means nothing other than not having hard evidence of it.

As it is I suspect the difference between pc and "the level at which epidemics usually die out stochastically in a very large population" is so tiny that it's barely even worth making the distinction, and since this thorough and well-researched article seems to make a similar assumption the onus is on you to demonstrate otherwise.

I'm sorry, I didn't realize we were dealing with something as serious as your suspicion of what somebody else's suspicion might be about some unpublished numbers. I take it all back.

Also your policy proposal is absolutely absurd, it would result in a wild see-sawing of vaccination levels every month that would leave young people vulnerable.  Do you really think that deliberately staying in the danger zone half the time is a good idea?  At least a raffle system would be enforceable (although it would make your patient choice argument pretty hilarious).

1)  am not a professional congressman. Me failing to foresee and account for every possible snag in a congressional bill that I designed in 15 minutes as a rough example does not == "the idea would never work!"

2) I'm not sure I understand your prediction anyway. "wild see-sawing" ?  Why? People have a personal incentive to remain near the optimal point for their own health outcomes, not just because the government said so. They shouldn't want to see saw, so why would they? A tiny bit of seesawing simply due to logistics, that should be all.

3) Regardless, you could just add things like "Also, if we are within 0.5% of the target, it's just grace period for everyone" to avoid trivial see sawing around the exact value, if you're really concerned about that.

4) I have no idea what you're talking about with raffles or danger zones.  If the nation is almost right at the equilibrium point, then you shouldn't give a crap if you get vaccinated or not, because it's defined as the point at which the risks from the disease and from the vaccine are equal, so you should be completely ambivalent either way.

5) Also, if it is a little bit high, then you're safer not getting vaccinated, and if it's a little bit low, then you're safer getting vaccinated, so the natural incentive already should push people to self correct whenever they aren't ambivalent / right on the dot.

^

Note that this is assuming the possible scenario where risk/benefit equilibrium is higher than the endemic rate (i.e. assuming vaccines are relatively very safe).

I'd need more information to know about the lupus case, but I think most of the time it would be a matter of the vaccine exposing the condition rather than causing it.

Yeah, you and every rheumatologist in the world. Doctors know almost zilch about lupus. It might be just like you say. It might also plausibly be from vaccines sometimes. It might be from a specific microbe that lives in bad cabbage for all we really know about that disease in any detail.

[Shinotsa]

People have an incentive to exercise, go to the dentist, and get regular physicals for their own health. Doing something for your own health is not enough of an incentive for it to get done. The odds are so low for either condition that it wouldn't make a difference anyhow. Think, how long would it take for the information on vaccinations to get back to the country's reporting system, seeing as how EMRs are not standardized nor kept on a national system? Every hospital/small clinic would need to devote time to reporting numbers, or a national system would need to be made to collect these numbers.

This plan is both remarkably impractical and is a response not to a threat, but to the slim chance that in an unknown there may be a threat. The millions it would cost to set up a regulatory program against this possible threat and enforce it would realistically save somewhere between 0 and 500 people a year, with zero being a very strong possibility. The upper end is the aforementioned 1/60,000 risk of death from a vaccine (used in one of the dozens of previous arguments), which I still feel is a very exaggerated estimate of actual risk, multiplied by the 10% of the population that would not have to be vaccinated.

tl;dr - Spending millions to fix something that ain't broke is mad stupid, yo.

[GavJ]

People have an incentive to exercise, go to the dentist, and get regular physicals for their own health. Doing something for your own health is not enough of an incentive for it to get done.

Except that we already know that 90% of people in the U.S. are willing to get a vaccine for health. So yes, actually apparently it is enough of an incentive, up to at least 90%. 

If it's above that, then my toy law example would essentially be no different than current business as usual until/when the rate was reached, so what are you worried about?

The millions it would cost to set up a regulatory program against this possible threat and enforce it would realistically save somewhere between 0 and 500 people a year, with zero being a very strong possibility.

-You don't know how strong the possibility is between those values.
-We already spend money to enforce (records for school enrollment based on vaccines etc.), this is not brand new investment.
-A lot of people on this thread, presumably you included, are gung-ho about increasing vaccination another 10%, aren't you? To save about 1/20th of a life a year extra? Vaccinating another 385,000 people a year ALSO would cost millions, since government heavily subsidized vaccine deployment. So you already want to invest many millions on single lives. Why so frugal all of the sudden in this hypothetical example?

[Leafsnail]

I think there's a difference between "spending millions to help eradicate a disease" and "spending millions to help risk the disease returning"

[GavJ]

I think there's a difference between "spending millions to help eradicate a disease" and "spending millions to help risk the disease returning"

Assuming that a 95%-100% or something rate is necessary for eradication, you're gonna have another couple decades or something before you get India and Africa ready to approach those levels. In the meantime, eradication is off the table anyway, so why spend millions NOW before it is even possible, versus coasting along at 90% until they're ready?

The only reason is if you want to spend those dollars to save those one or two lives that might die in the meantime. And I respect that. Because it's the same motivation I'm working from, and the same willingness to spend a few million dollars to save even several lives.

You don't have to disagree about every little thing, you know. It's pretty obvious we are all cut from the same cloth in this particular respect.

[Morrigi]

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.

[Shinotsa]

-A lot of people on this thread, presumably you included, are gung-ho about increasing vaccination another 10%, aren't you? To save about 1/20th of a life a year extra? Vaccinating another 385,000 people a year ALSO would cost millions, since government heavily subsidized vaccine deployment. So you already want to invest many millions on single lives. Why so frugal all of the sudden in this hypothetical example?

Why are you assuming my point of view? That's pretty poor form to argue against a position that I don't even endorse. I think that the current system addresses your concerns sufficiently without increasing anything. The 90-95% vaccination rate that we already have is above the herd immunity for all of the diseases vaccinated against as well as all those we can reasonably predict.

Also - we have vaccine distribution set up already, sure, but we don't have the monitoring infrastructure and, quite honestly, there's far too much wrong with the healthcare system as is to be spending millions saving a handful of people from a potential threat.

Finally, 90% of people are vaccinated due to requirements to benefit from public services, not for the good of their own health. If we switch from requiring it for school to a "do it for your own good" approach then compliance rates will significantly drop, if studies on compliance have any predictive power of course.

[Neonivek]

I live in a place where high vaccine coverage is... well... assumed.

It is unusual to me to hear of severe gaps in vaccine coverage.

Then again getting my flu shot was as easy as going for a refill of my asthma medication and them saying "yeah you want a flu shot?"