Unsure about vaccinations? Try reading "Deadly Choices"

[arkestra]

I got Whooping Cough recently at age 43, what fun. Apparently vaccine immunity for WC wears off after a few decades. It was as ill as I have ever been and I was pretty much out of action for 3 months. There has been an increase of WC cases recently in the SW of England, where I live. I could rant at anti -vaccine campaigners, but what would be the point? I am more concerned that the people who are unsure have access to a clear statement of the pro-vaccine position.

So can I suggest that anyone who is unsure about vaccination reads "Deadly Choices" on the pro-vaccine front even if they read nothing else?

I just had my early summer ruined. But babies get killed by this kind of thing. I totally get why people find vaccines icky and unsettling, there are hard wired ways we intuitively think about our bodies that foster that kind of reaction. So just read this book if you're on the fence OK? It would be nice if lots of other 40-somethings don't irritate everyone else with their wheezing and self-pity

(Gets back off soapbox)

No, you don't have to, but it's hypocritical not to. I'm not talking about routine checking, I'm talking about people who call others "socially irresponsible" being "socially irresponsible" themselves in the same way. How rude to call me a lost cause because you're wrong.

what would it cost to regularly test most of the population? I'm not arguing for that, just for people not to be hypocritical and tell others to make sure they're immune when they may not be themselves

what percentage of immunised people lose their immunity? you can find this out per vaccine - but it does wane, and you're not sure if you're one of them

is it cheaper just to get everyone to have boosters every few years, then? I'm not arguing for that - you can if you like

would that be harmful to them? you would have to weigh the harm to adults against the harm to babies - obviously

given lifestyle changes from toddler to adult, are the people we're checking actually at the same risk of contracting these illnesses as they were as infants? generally they're at higher risk of complications. "We're not check anyone. Just get yourself checked if you're going to consider others socially irresponsible over immunity

are they still as likely to transmit them widely? they're just as likely to transmit them as a child

Actually i don't think you know what a straw man is tbh, because this isn't one. HTH.

Perhaps I can help you out. A strawman would be if I was arguing against something people haven't said, and that I made up in order to score an easy point (perhaps because it would be very absurd, and an impossible position to maintain). People are saying it's selfish not to ensure immunity by vaccinating. I am arguing that it must therefore be selfish not to make sure your own immunity is up to date.

Now if I made it up that people weren't telling others to make sure of their and their children's immunity, and argued against that, that would be a straw man.

But - I haven't called you socially irresponsible. I don't think you're actually thinking within the parameters of social responsibility, tbh.

So, if I've understood you correctly, it's not that you want routine testing of immunity status because you think it'd be a good way of reducing the transmission of nasty illnesses? We're agreed that it wouldn't be in anyway effective in that respect?

You'd just like anyone who concurs with the unremarkable mainstream belief that routine immunisation is a generally good idea to get their own immunity tested, before expressing that opinion, because otherwise you think they are being 'hypocritical'?

At this point I'm inclined to concede that yours is indeed not a straw argument.

We're going to have to downgrade it to total silage I'm afraid.

What you want to achieve by herd immunity is stopping epidemics.

To achieve this, you concentrate resources on (a) the most vulnerable and (b) the most likely vectors of infection.

In both cases, children are high on the list (the mixing that goes on in schools draws a more diverse group of people together than adult workplaces).

So vaccinating children is the sensible place to concentrate priorities.

If it turned out that you were still getting outbreaks because of waning immunity in adults then booster shots for all would be the fallback, individual testing is far too expensive.

So:

1. children should be vaccinated because they are most vulnerable and most likely to spread infection

2. adults should not be checked regularly en masse for waning immunity because it's too expensive a way of achieving the desired end (of high levels of herd immunity)

3. there is a possible case for giving adults booster shots en masse but I presume that this too has been considered by public health policy makers and is also viewed as not cost-effective.

Therefore people would ideally vaccinate their kids to schedule. And adults don't need to check their immunity in order to think that childhood vaccination works, and to wish justifiably that people would do it!

Seems a simple argument to those on the pro-vaccine side of the fence but it does rely on trusting the judgement of public health policy makers.

If one instead assumes that a primary driver of public health policy is the financial interests of the vaccine industry (coupled with arrogance, groupthink and out-of-control confirmation bias in the medical profession) then one will see things quite differently. I wonder if that's the underlying assumption here?

Even the pro-vaccine end admit medicine is not perfect. Peptic ulcer treatment is the classic modern story of a mistaken orthodoxy prevailing for decades. But ultimately I trust the prevailing orthodoxy because there is no prevailing evidence to the contrary that I've seen so far. I will read Wakefield though.

People checking their immunity is simply not going to work. They are not going to do it unless there is an outbreak of a disease. I don't see how NHS can afford to run a programme of testing and so you would have to pay. Herd immunity is much more cost effective.

And for a reasonably concise overview of herd immunity see here: m.cid.oxfordjournals.org/content/52/7/911.full

They even mention the freeloader problem.

Their take on waning immunity is you need better initial coverage and/or boosters. Not individual testing of immunity levels in adults.

Just wanted to say this after reading the OP. WC vaccine immunity wanes after a few years, not a few decades. Some studies have shown it starts to wane in as little as 12 months. There is no chance of achieving herd immunity with a vaccine that wanes after such a short period of time. HTH

Somebody always says smallpox. As if that means the MMR and other vaccines don't damage children. As you say - it's a bit more complex than just saying "smallpox".

No it's not. It really is that simple, vaccination can wipe a disease off the face of the earth.

How many children have been vaccine damaged by smallpox vaccine in the last 10 years? Zero. Zilch. None.

That's because children are no longer vaccinated, they don't need to be because they will only ever encounter small pox in a lab if they choose certain careers.

We (I mean the population of the world) are close to the same situation with polio.

Oh dear oh dear. It really has to be spelt out doesn't it.

You haven't ravenak - at least I don't think you have. But the OP has used the word selfish and is blaming her own illness on people who haven't vaccinated. You just sort of interrupted, which is fine, but why assume my comments are directed at you?

"So, if I've understood you correctly, it's not that you want routine testing of immunity status because you think it'd be a good way of reducing the transmission of nasty illnesses?" I have no idea why you think I said this this. I haven't said anything like it at all. I haven't mentioned routine testing, or discussed the value of herd immunity or the effectiveness of mass vaccination. In fact, this IS s straw man. You sort of imagined I'd said it in order to argue against it. Do you see now what a straw man is?

Children are not the most vulnerable to complications, and a woman in her forties is more likely to spread infection than an 8 week old baby.

Exotic: People checking their immunity is simply not going to work.

Of course it works. they check, are they immune? If no, get a vaccination.

They are not going to do it unless there is an outbreak of a disease.
Well then they can piss off lecturing others about getting their kids vaccinated.

I don't see how NHS can afford to run a programme of testing and so you would have to pay. Meh.

Arkestra: children should be vaccinated because they are most vulnerable and most likely to spread infection wrong

"adults should not be checked regularly en masse for waning immunity" who said they should? - straw man

There are more poor points in your post Arkestra, I will respond later.

Bumbly: the CDC agrees, especially re the newer acellular vaccine. See here: www.cdc.gov/pertussis/about/faqs.html

"Since pertussis spreads so easily and vaccine protection decreases over time, we can't rely on herd immunity to protect everyone."

Their recommendation is for more adult booster shots.

Obviously this does not mean that herd protection is completely irrelevant. But certainly "herd protection" seems more applicable a term than "herd immunity". I think the former term is gaining currency in the vaccine community for exactly this reason.

I got my lines muddled up - Arkestra you said this:

children should be vaccinated because they are most vulnerable and most likely to spread infection

and it's absolutely wrong

Children are not the most vulnerable to complications, and a woman in her forties is more likely to spread infection than an 8 week old baby.

Moral being that one can have a nuanced view on how strong herd immunity/protection effects are but still think childhood vaccination makes it pretty obviously less likely that WC has outbreaks.

Crumbled: you are not actually responding to the points I made. If you start doing so then dialogue will resume kids ARE infection vectors. When there's a flu epidemic, the first thing that gets closed are the schools.

Happy to respond further but only if you give evidence of understanding what I write.

Sassh "No it's not." - Yes it is, actually. For example google AFP and polio in India. But you might want to keep thinking it's simple, so you probably don't want to.

I have responded directly to the points you made arkestra -

I don't care if you're immune or not. Check, boost, vaccinate, not my business. But you make other people's immunity your business. So if you are going to call people selfish for not making sure they're immune - it's not a one way street. You have to make sure you're immune. Capisce? It's hypocritical not too. Now that is simple.

I didn't call anyone selfish for not vaccinating - look back through my posts - this is the kind of thing I mean Crumbled.

A dialogue is where you get 2 people communicating, responding to each others points. That is not what is happening in our case.

As it happens I think most people who don't get their kids vaccinated are not selfish. Just wrong in their beliefs. There are a very few people who agree with herd protection as a concept and consciously free-ride. But they are a very small minority of vaccine refusers.

I still reserve the right to believe that vaccine refusers are wrong, and that their actions have a negative impact on public health. But I don't think they lack integrity. It's just not a useful way to proceed, to assume that people disagree with oneself because they are somehow wicked. In the long run we're all trying to do the right thing.

Crumbled: one more thing. It was actually you who called me selfish.

I have, numerous times in this thread, said that I don't think that people's moral worth is the problem.

For what it's worth, my default model of people's motives is "No matter how it seems, everyone is trying to do the right thing".

I recommend it to you as I think your mental image of pro-vax people is getting in the way of understanding what they are saying and is also - as per my first point - hindering an accurate recollection of the discussion, as you try and force your memories of what people have said into slots that don't fit them very well

No - it was Nickelbabe saying selfish - you just think people should get their children vaccinated so as not to put other babies at risk. I assume then you think putting other babies at risk is not selfish fair enough

Well now we've cleared that up - you accept that as your own immunity is unclear, you have no right to advise others to vaccinate ?

It's not about moral worth - it's about you having NO right to advise, expect, or lecture people about herd immunity when your own is in doubt.

Yes - I did absolutely call you selfish (in response to Nickelbabe calling me selfish) for expecting babies to get vaccinated so that you don't have a summer ruined. I'm afraid I'll have to stand by that.

arkestra, I'm glad they agree with me but boosting adult immunity isn't going to help much either if the majority of children and teenagers are not immune. Also, if you accept that herd immunity isn't going to be achieved then what is the point in vaccinating adults again anyway? WC is usually not as serious in adults and frequently goes undetected (allowing it to spread more easily)

I think that people who are wrong about this are putting other people at risk, babies among them, yes. I just don't think they are doing it for selfish motives. I think they are, rather, mistaken in their beliefs.

You think I am selfish because you're not really basing your judgement on anything I have actually written. If you read the OP you will see that I do explicitly say that my cough is of minor importance compared to the health of babies. So, once again, my words do not actually bear the construction that you have put on them.

Much of the time I don't think you are responding to what I am writing at all!

I think you have an image of someone judging you as morally deficient and are responding to that instead. You are constantly misinterpreting my words but that's OK. I am not taking it personally because this is not really aimed at me.

Bumbley: the CDC say the herd protection effect is partial but that's not the same thing as saying that they think it's useless. Just that herd protection is not sufficient by itself, ar least on current evidence.

Agree that Pertussis is often mild in adults and possibly massively undiagnosed. The idea behind their program is to protect the vulnerable and they seem pretty clear-eyed and realistic about current issues with waning immunity.

Is there a particular part of the CDC stuff that you disagree with?

UK Govt Green Book Pertussis chapter (24) more relevant: www.gov.uk/government/uploads/system/uploads/attachment_data/file/147976/Green-Book-Chapter-24-dh_125944.pdf

Clearly the priority is to safeguard infants under 6 months of age. If vaccine uptake rates in the target population are high, this also (as the graphs show) brings the overall incidence down.

So the primary purpose is keeping infants safe, and if this is done there is the side benefit of lower cases overall. I'm happy with that. Am clear that no such thing as 100% herd immunity is achievable for Pertussis - but you don't need that for vaccination to be beneficial overall.

arkestra, a certain proportion of the population need to be immune in order for herd immunity to exist. That article you linked to seemed pretty clear that it doesn't exist at the moment. You cant have 'partial' herd immunity. You either have a high enough proportion of immune people to prevent the spread of the disease or you don't.

Considering that you have already acknowledged that WC in adults (and older children) is often undiagnosed, I'm not sure how accurate those graphs are.