Saturday, November 27, 2010

Murderous Middle class Marin Mommies

Marin county ranks #2 in California for pertussis (whooping cough), with 123 cases per 100,000. The illness has reached epidemic levels in California, with 5600 cases and 10 deaths. The disease is completely preventable with the dtap vaccine. However, bourgeois parents in Marin often choose to forego the vaccine out of irrational fears about the safety of vaccines (and the assumption that enough other parents will vaccinate their children to protect their unvaccinated kids through herd immunity). Many are also skipping the vaccine for measles, a disease that once killed 3000 children annually.

In San Francisco, and many other counties, the majority of those stricken with the illness are Spanish speaking immigrants. The assumption of medical professionals is that there is an outreach problem in terms of educating the immigrant population. There has also been a dramatic jump in adult infections due to the fact that the vaccine wears off over time and adults rarely get boosters. The high infection rate in Marin, however, is primarily among white middle class children.

What’s most troubling about the anti-vaccine hysteria is the utter disregard for everyone else’s safety. It is understandable that parents would want to protect their children from perceived threats. But in the case of vaccines, not only is the perceived threat irrational and exaggerated, but the consequences of foregoing vaccines are that everyone’s risk level goes up proportionately to the number of people who are not vaccinated. 

Herd immunity occurs when 80-90% of the population is vaccinated (depending on the pathogen). Once a threshold of vaccination has been reached, it is virtually impossible for the pathogen to establish a foothold in the population, thus protecting the minority that has not been vaccinated. Some studies have indicated that being unvaccinated in a highly vaccinated population is far better protection than being vaccinated in a poorly vaccinated population. Therefore, a selfish and self-entitled parent might assume that his or her child is safe, even if the child is unvaccinated. The problem is that if too many parents make this assumption, the threshold is not met and herd immunity does NOT occur and their child is at an increased risk of contracting a potentially deadly disease. Worse, everyone’s children are at an increased risk.

The anti-vaccine movement is dominated by wing nuts and extremists who use fear and misinformation to intimidate opponents and to recruit new adherents. Amy Wallace, author of Epidemic of Fear, and Paul Offit, coinventor of the rotovirus vaccine (a drug that could save thousands of children’s lives), were recently sued for $1 million dollars by Barbara Loe Arthur of the National Vaccine Information Center (NVIC) for liable. Fortunately, the lawsuit was thrown out. Robert F. Kennedy Jr. called Offit a “biostitute,” while actor, Jim Carey, calls him a profiteer. One man even threatened to murder him under the mistaken assumption that this would somehow save innocent children’s lives.

Why so much sturm und drang over an award winning scientist who has created a life-saving medication? Autism is a terrible disease. It scares the hell out of new parents who are understandably desperate to find a causative factor they can blame. Offit has infuriated anti-vaccination activists by publishing well-researched data refuting their bogus claims, including the one linking autism to vaccines. Numerous studies have shown that there is no link between vaccines and autism. The illness is typically diagnosed in children between the ages of 12 and 24 months, the same ages in which they are receiving common childhood vaccinations. The correlation however, is purely coincidental. Thimerisal, a mercury-containing preservative, has not been used in children’s vaccines for over ten years, yet autism rates have continued to climb in that same time period. Likewise, vaccines have been incorrectly linked to Guillain-Barre syndrome, after several people contracted this tragic auto-immune condition coincidentally after receiving swine flu vaccines in the 1970s. (Guillain-Barre is extremely rare, occurring in only one to two out of every 500,000 people. The cases in the 1970s did occur after flu vaccinations, but were still within the normal range).

Anti-vaccination advocates also blame Big-Pharma for sacrificing their children’s safety for profits. This fear is based on a long history of pharmaceutical companies distorting data, providing false claims of safety, and massively promoting dangerous products in order to boost profits (e.g., Vioxx, Fen-Phen, Accutane, DES, Thalidomide). While drug companies have been making fortunes from drugs like Lipitor, Nexium, Prozac, and Viagra, most have been getting out of the vaccine market, as profits are low compared to the blockbusters, and liability is high, particularly for newer vaccines, like influenza, which must be reformulated each year. If anything, the profit motive has increased our risk of contracting preventable diseases by limiting availability (See Mike Davis, Monster at the Door, for how this relates to influenza).

Many parents believe that too many vaccines overwhelm a child’s immune system. There is no science to back up this claim. However, a newborn may not have a strong enough immune system to develop immunity when vaccinated, so the hepatitis vaccine that hospitals offer the day after a child is born may not be effective. Also, parents can choose to space out the vaccinations to allow their children to recover in between vaccinations (many do cause minor side effects like muscle pain or cold symptoms). Some parents also believe that vaccines increase the risk of diabetes, but this is based on the flawed research of a single discredited scientist. The overwhelming scientific consensus is that there is no connection.

Vaccines save lives. Consider the smallpox vaccine, which has eradicated this deadly disease throughout the world, or the polio vaccine, which has eliminated this potentially deadly or disabling disease throughout most of the world. Avoiding vaccines for your child not only increases your child’s risk of contracting a deadly disease, but increases the risk for everyone else, too. There are also other costs associated with non-vaccination. Diseases like whooping cough, for example, which tend to kill mostly infants, can cause older children to miss weeks of school, potentially causing them to fail and have to repeat a year of classes. Parents may be forced to skip weeks of work to care for sick children (or themselves, if they catch the disease). Buying into pseudoscientific quackery and snake oils will not prevent or cure autism.


  1. What you say is sad but true. The other day I encountered a woman who told me that if everyone else vaccinates their kids then her kids wont get whooping cough. Too many americans don't understand how epidemics spread.

  2. Sad and frustrating that someone would be so selfish.

  3. How sad,and completely preventable.

  4. "Some studies have indicated that being unvaccinated in a highly vaccinated population is far better protection than being vaccinated in a poorly vaccinated population."

    I know I have read this before somewhere and there were even links to original data, but I don't seem to find it anymore. I would be very interested in these studies; could You give some more information? Hope You still see this comment - a little bit late :-).

  5. Hi Tanja,

    thanks for the response. I don't have the studies handy, but a Pub Med search might do it for you. I believe the most famous study was done in Netherlands.

    The basic idea is that no vaccine confers immunity to 100% of recipients, so even with 100% vaccination rates, there will always be a few who don't pick up immunity. However, if 80% of a population is immunized, then you reach a threshold where it is so rare for anyone to get infected that the non-immune never get exposed and therefore do not get sick.

    The big problem is that if people deliberately refuse to get vaccinated, trusting that everyone else will, you never reach that 80% threshold and lots of people remain at risk.

  6. Thanks!
    I actually spend some time in the Pubmed, but didn't find anything which looked directly this question, I mean compared the risks.
    I know it's quite reasonable thougt, if You think of the "infectious pressure" one might get in an epidemic, and since protective immunity is never absolute You get infected easier if there is high infectious pressure. I think I saw a study of the chickenpox vaccine some time ago which found that the efficacy in an epidemic (in a population with low vaccine coverage) was quite low (like 20% or something), alhough the efficacy against severe disease was high (maybe 80-90%). Quite depressing for me, since it is not included in our vaccine schedule here in Finland, but I got it for our children (I know the vaccine coverage is very low, most of the parents don't know it is available & it's quite expensive. And then there are those who think chickenpox is "nothing" and it's better to have the disese...).
    I just would like to see if someone has run the risk numbers and really compared, and as I said I know I read this before and there were somekind of links also, but I didn't check then and now I don't find them, ARGH :-)!
    I'd quess that it depends also of the disease - for tetanus this doesn't really hold but for measels, pertussis etc. it makes sense.
    I would just love to ask someone who denys herd immunity effect that how would he explain this if there is no such thing than herd immunity ;-).

    (Sorry for possible misspellings & weird language - as said I'm Finnish)

  7. Hi Tanja,

    Anyone who has had shingles would not call chickenpox trivial and the chickenpox vaccine does prevent shingles. Also, as a teacher, absenteeism is a major cause of poor academic achievement. Considering that chickenpox could keep a kid out of school for more than a week, especially if it is a teen, I would consider it a serious problem, even if not particularly deadly.

    By the way, we hear a lot about your school system here. The corporate raiders who are trying to privatize our schools like to hold Finland up as a model of perfection (you have much better academic outcomes than we do) without acknowledging the differences in childhood poverty and social investments between our two countries.

    I'm curious what you think of your school system and what you've heard about ours?

  8. Interesting question!
    First, I’m no expert in education systems, my background is in biosciences like bacteria and diseases and that stuff, so I’ll have to comment based on my own experiences (I went to school at the 80’s) and what I’ve heard on the news etc.

    The fact that we have succeeded in PISA tests (and maybe in some other similar comparisons?) is discussed in the media quite extensively after every test, and several reasons for the results are given. Like, we do have quite “fair” school system, meaning that it doesn’t really matter if You come from a rich or poor family, everyone goes to same public schools, so the background differences are “balanced” at least a little bit. You don’t have to pay for anything, not for the material, not for the food, not for the health care in schools, or for the possible expeditions etc. Private schools are very rare, and they are not allowed to “make money” (=collect school fees), but instead they also rely on public support and donations, and they have to follow the common curriculum (except for the international language schools). So I would say that schools are very similar to each other – neither lousy ones nor outstanding ones. I don’t have a good idea of the situation in the US but I have understood that there is quite big difference between public schools and private ones, and it can be really expensive to put Your kid in a private one, is this right? And since the country is huge, I would guess that there are not that “stringent” regulations about the curriculum (I mean different rules in different states)?

    Also I would guess that the gap between the wealthy and the poor is not that big in Finland than it might be in some other countries, like in the US. Although, it has been said during the last 5-10 years that the polarization has grown in Finland; the income differences between poor and rich is bigger and there are more and more children living in real poverty. So this is maybe changing for the worse.
    Also, the teachers are said to be well-educated (university level) compared to many other countries, but I have no idea what is the situation there?

    I think there are many reasons for our success, but one question is also what do these comparisons really measure? Do they measure real learning, or only “repeat what You are told” learning ;-P. I’ve heart complaining about that; the PISA test measures only repeating and not real learning, and the Finnish school is criticized for producing students who are really not interested in using their brains, they just memorize everything and forget it after a test… Well, I don’t know if that’s the case really, but maybe something to think about. I know that the class size is getting bigger and bigger and no matter how good the teacher is (s)he cannot teach a class of 35+ students properly, IMO.

    But I don’t really get why someone would think privatizing schools would compare to the situation in Finland since we have basically only public schools??? Where would the money for those schools come from?

    And, BTW, I have also heard that Finland does not do that well when the focus is on the “feelings”, I mean students don’t enjoy being in schools, there is much mental health problems among children etc., so even if the learning results are good (at least in some tests) there still seems to be problems.

    So, I think that our system is good but it could be better (with more money, of course, education does not come for free). I would be against privatizing schools in here, I think education should be paid with tax-money, and should be free for everyone. OK, private schools could also be paid with tax-money, but I’m not sure how well the “who will do this for less money” kind of thinking sits with education (not well in my opinion).

    A long answer, hah...

  9. A long answer, but very interesting. Thanks.

    I'm not sure we do any better here at getting kids to think for themselves or to like being in school. Both are very challenging problems.