Six Reason to Question Vaccinations

[kellyb]

The simple fact is, if you are vaccinated, you are almost certain never to catch the thing you are vaccinated against, regardless of who else has been vaccinated.

That's a rather sweeping statement, Cuddles.
It doesn't hold true for several of the vaccines. For some of them, yes...others, not at all.

 

[Ivor the Engineer]

I'm still not seeing it.

Let's say there is a vaccine given to 2 year-olds that reduces the risk of contracting a disease by 50%.

The risk of an individual contracting the disease each year they are not vaccinated is 10%.

Thus the risk of the one vaccinated individual contracting the disease is 10% * 50% = 5% per year.

It takes about 29 years for an unvaccinated person to have a 95% chance of contracting the disease. (1-0.1)^29 < 0.05.

It takes 59 years for the vaccinated person to have a 95% chance of contracting the disease. (1-(0.5*0.1))^59 < 0.05.

Thus the vaccine has only delayed the time before infection. Though as Cuddles pointed out, if the expected delay is much greater than a human lifespan, the vaccine could be considered to provide significant protection, all other things being equal.

I guess if you're defining "works" only as complete elimination or eradicaton of a pathogen in a community.

Or as the elimination of epidemics. This does not usually require 100% vaccine coverage, though.

 

[kellyb]

Let's say there is a vaccine given to 2 year-olds that reduces the risk of contracting a disease by 50%.

The risk of an individual contracting the disease each year they are not vaccinated is 10%.

Thus the risk of the one vaccinated individual contracting the disease is 10% * 50% = 5% per year.

It takes about 29 years for an unvaccinated person to have a 95% chance of contracting the disease. (1-0.1)^29 < 0.05.

It takes 59 years for the vaccinated person to have a 95% chance of contracting the disease. (1-(0.5*0.1))^59 < 0.05.

Vaccines don't work like that, though.
That is the way circumcision as a STD preventive works, but vaccines are totally different.

Ok...there are two different flavors of a "50% effective" vaccine.
1) a vaccines which seroconverts 50% of the people who get it with one dose
2) a vaccine that reduced the symptoms/severity of the disease by 50%

Then there are mixtures of the two, but that's a lesser effect, so nevermind that for now.

With a vaccine that seroconverts (effective seroconversion, to make it simple) 50% of people with one dose...let's assume it's an endemic childhood disease, and the average age of infection is age 5. Assuming vaccine uptake is low and the disease is still endemic, by age 10, your odds of having caught the disease (as in, got sick from the disease) are 50/50. Either way, you'll be immune (if you lived to tell the tale.) You either ran into the disease, the vaccine "worked" and you never got sick, and your immunity was "boosted" from the exposure...or the vaccine just failed, you caught the disease, and now you're immune from having had the disease. Either way, you'll probably be immune by age 10ish.

Make sense?

ETA:
And every time you run into the disease from there on out, you usually just become more and more immune (or if your immunity had started to wane, you're back to just "thoroughly immune"), without ever experiencing any symptoms and without passing the pathogen to someone else.
Your odds of eventually catching it don't go up as you get older unless mass vaccination has changed the average age of infection.

 

[Ivor the Engineer]

Vaccines don't work like that, though.
That is the way circumcision as a STD preventive works, but vaccines are totally different.

Ok...there are two different flavors of a "50% effective" vaccine.
1) a vaccines which seroconverts 50% of the people who get it with one dose
2) a vaccine that reduced the symptoms/severity of the disease by 50%

Then there are mixtures of the two, but that's a lesser effect, so nevermind that for now.

With a vaccine that seroconverts (effective seroconversion, to make it simple) 50% of people with one dose...let's assume it's an endemic childhood disease, and the average age of infection is age 5. Assuming vaccine uptake is low and the disease is still endemic, by age 10, your odds of having caught the disease (as in, got sick from the disease) are 50/50. Either way, you'll be immune (if you lived to tell the tale.) You either ran into the disease, the vaccine "worked" and you never got sick, and your immunity was "boosted" from the exposure...or the vaccine just failed, you caught the disease, and now you're immune from having had the disease. Either way, you'll probably be immune by age 10ish.

Make sense?

ETA:
And every time you run into the disease from there on out, you usually just become more and more immune (or if your immunity had started to wane, you're back to just "thoroughly immune"), without ever experiencing any symptoms and without passing the pathogen to someone else.
Your odds of eventually catching it don't go up as you get older unless mass vaccination has changed the average age of infection.

Yes, that makes perfect sense.

The significance of the protection provided by vaccination still has to be balanced against the likely outcome of not being vaccinated. This includes the risk of contracting the disease in the first place and the severity of the disease if you do contract it. Many vaccinations do not provide significant protection at an individual level when this is taken into account. Only when the number of people vaccinated is multiplied up to population level does the number of lives saved become significant.

For example, measles has a death or serious complication rate of 2 per 1000 in the developed world. Thus you need to vaccinate about 500 people to save one of them from dying or being seriously ill.

 

[Phytotherapist]

I'm busy in the field of laboratory and clinical research trying to develop a vaccine against the quackery epidemic(s). I'm afraid for those who already contracted this highly contagious infection, active immunisation may not act quickly enough.

 

[Skeptic Ginger]

No, they are an individual health issue.

If you get a vaccination, then it shouldn't matter to your health whether or not your neighbor gets his vaccination.

Yes, it can matter. For some people the vaccines don't work. Those folks rely on others being immune. This is especially true for infants whose vaccines are not yet completed.

 

[Skeptic Ginger]

I agree with the spirit here, but just one, small caveat comes to mind. There is a definite, usually very small, chance that a vaccination can go wrong, usually by stirring up some sort of nascent allergic reaction. Vaccines are, by necessity, very complex organic molecules, and those that are created naturally (as with chicken eggs) rather than synthesized do contain lots of other proteins in microscopic amounts, so there is always the chance of a reaction. The winning rationale is that the mortality rates of those things which the vaccine conquers always are higher. Getting a vaccination is always a high-stakes, low-probability gamble. As stated above, the real target of a vaccine program is the general public, not any one individual.

You are instructed to observe a vaccinated person for allergic reaction for a short period afterwards, are you not?...

No, it isn't necessary. I only make people wait if they have actually allergies to the vaccine components.


This is really bizarre logic. I realize it is common logic, so no offense but it is bizarre nonetheless.

Do you have the same qualms about eating food? Gee, there are rare allergic reactions and there are all sorts of chemicals in there. What about driving or riding in a car? How about when you breathe the highway fumes that pour into your car's air vent? Shouldn't you be afraid of scraping that margarine container with a knife? Surely you are scraping some of the chemicals from the sides of the soft plastic with your metal knife.

For whatever reason, the extremely rare risk of a vaccine over the much more common and serious risk of the actual infection is perceived in a distorted way compared to most of the other risk benefit decisions we make in our lives. You choose to take the risk of driving because the benefit is worth it. Yet with a vaccine which has an almost unheard of risk and a well documented benefit, there is this silly psychological assessment that you are somehow taking a risk you may regret. Nonsense!

In thirty years of nursing, of which the last 18 included giving thousands (literally) of vaccinations every year, and during another year much earlier, I worked at a public health clinic giving vaccinations all day, I haven't ever seen an allergic reaction to a vaccine. Yet I have seen severe allergic reactions to peanuts, shell fish and antibiotics.

One of the first patients I took care of in nursing school was a 21 yr old girl in a coma with liver failure from hepatitis B. She died a few days later. I was 21. I also took care of a 6 yr old patient in a permanent coma from measles. One of my boyfriends in college had a leg damaged by polio. Why aren't people afraid of these infections? That is what people should be afraid of, not the vaccinations which protect them. It's like the foolish belief a seat belt is going to trap you in a car accident when the real risk is not using it.

 

[Skeptic Ginger]

The way vaccination is sold to individuals at the moment is often by misleading them into thinking being vaccinated will protect them directly by a significant amount.

It displays a certain level of contempt for people to think they are too selfish and/or stupid to be persuaded by an honest argument for vaccination, which would highlight the benefits to the community over the individual.

Nonsense! You just don't believe the risks of the infections. I practice evidence based medicine and I promote evidence based medicine. And I always use information that is as accurate as I can find when discussing risk and benefits of vaccines with people.

It is a fact people die and are disabled from these infections and the vaccines are thousands of times less risky. If you want to interpret that as a scare tactic then what do you base your claim on?

 

[Skeptic Ginger]

If only one person has been vaccinated in a population, anything less than 100% immunity merely extends the expected time before they get infected.

Realistically, vaccination only "works" if enough of the population get vaccinated. The lower the efficacy of the vaccine, the more people in the population need to be vaccinated for it to have a significant effect.

These are both false statements. In the first case, partial immunity usually means you still get infected, but the disease is modified and you are less likely to get a severe form.

In the second case, many people get 100% immunity from their individual vaccination.

Then there are those vaccines that are pretty useless for prevention, such as the BCG, though supposedly this does reduce the risk of complications if you do contract TB.

And we don't give BCG vaccine to everyone, now do we? Why not if we are just pushing vaccines on people with scare tactics and lies? Could it be because the risk benefit is used to determine who the vaccine will actually benefit? Wow! Isn't that a contradiction to your conspiracy theory?

 

[Skeptic Ginger]

What I said

Read Linda's post for a more detailed explanation....

Linda was referring to odds. She wasn't talking about individual responses.

 

[Ivor the Engineer]

<snip>

And we don't give BCG vaccine to everyone, now do we?

<snip>

It was standard in the UK when I was at school. I think there may have been a phasing out during the 90's.

 

[Skeptic Ginger]

No. When we say the vaccine works less than 100%, it means that you have, say, a 99% chance of the vaccine making you 100% immune, not that it has a 100% chance of making you 99% immune. Even if your interpretation were correct, your conclusion is still wrong, or at least misleading. If being vaccinated means it will take an average of 200 years of exposure to infected people to catch it myself, instead of 5 years without the vaccination, how can you possibly argue that is not protection? The simple fact is, if you are vaccinated, you are almost certain never to catch the thing you are vaccinated against, regardless of who else has been vaccinated.

It differs by vaccine. Live vaccines tend to be all or none with failure rates meaning # of people not getting immunity. Hepatitis B vaccine and tetanus are the same, though with a few people, hepatitis B infection can occur after their vaccine immunity wanes but no disease develops and we still consider them protected. Influenza vaccine, because the virus' genetic changes gradually make the virus unrecognized by the immune system and because we vaccinate a lot of people with weaker immune responses (mainly the elderly) tends to have varied responses and some people get a milder infection rather than no infection.

The BCG vaccine has between 70-80% effectiveness and lasts for around 15 years. Please actually do some research and stop coming out with such nonsense.

He actually wasn't that far off. BCG prevents TB meningitis but not necessarily TB infection. So it is most useful in young children with high levels of exposure. They are most likely to get TB invading the nervous system and it is rapidly fatal when that occurs.

TB infection merely means you have a positive TB skin test and a chance of developing active TB disease in the future. 90% of those infected will never develop disease. So the fact BCG prevents some of those infected cases from becoming disease cases is still very useful. People who don't understand what is meant by not preventing TB infection but preventing TB disease as Ivor seems to be wrongly concluding don't get the idea behind using BCG vaccine. So in that respect, you are correct and Ivor isn't.

 

[Skeptic Ginger]

It was standard in the UK when I was at school. I think there may have been a phasing out during the 90's.

And TB was occurring at a much higher rate then, as it still is in much of the world. As the rates went down, BCG is given less often. We still use it here in certain circumstances. If you have a child who you cannot remove from a home where the parent has active TB disease, once in a rare while you give BCG to the child.

 

[Skeptic Ginger]

....

For example, measles has a death or serious complication rate of 2 per 1000 in the developed world. Thus you need to vaccinate about 500 people to save one of them from dying or being seriously ill.

A darn good trade off, don't you think? Saving a life with every 500 doses of vaccine? Surely you aren't suggesting that life wasn't worth it? Are you suggesting the parents should gamble on their children's lives with those odds?

 

[Ivor the Engineer]

Nonsense! You just don't believe the risks of the infections. I practice evidence based medicine and I promote evidence based medicine. And I always use information that is as accurate as I can find when discussing risk and benefits of vaccines with people.

It is a fact people die and are disabled from these infections and the vaccines are thousands of times less risky. If you want to interpret that as a scare tactic then what do you base your claim on?

My claim is that many vaccinations, at an individual level, provide excellent protection against unlikely to be serious and/or unlikely to contract infections. It is only when the number of people vaccinated is increased to many thousands does the number of serious complications and deaths avoided become significant.

What appears to get lost when promoting the benefits of vaccination is the absolute risk of serious complications, which is often small to very small for an individual.

 

[Ivor the Engineer]

A darn good trade off, don't you think? Saving a life with every 500 doses of vaccine? Surely you aren't suggesting that life wasn't worth it? Are you suggesting the parents should gamble on their children's lives with those odds?

From a public health point of view it makes sense. From an individual point of view, it's less clear cut. The child has a 99.8% chance of being unharmed by measles and will be immune after recovering from the infection.

Do parents in the US have to pay for the vaccinations directly? If so, how much does it cost?

 

[kellyb]

From a public health point of view it makes sense. From an individual point of view, it's less clear cut. The child has a 99.8% chance of being unharmed by measles and will be immune after recovering from the infection.

All factors considered, (incidence, case/fatality, complications, etc) measles is probably the "deadliest" of the diseases we vaccinate for. The only situation in which one can say the individual benefit is definitely higher for the non-vaccinated is an unvaccinated individual in a community with a high level of immunity. What's a lot more complicated are diseases like Hepatitis A, (mandatory in many US states). HepA is usually completely asymptomatic in toddlers, but we vaccinate them to protect adults, since toddlers are considered the "spreaders". And HepA isn't even usually very serious in adults, either, unless you're in end-stage renal failure already when you catch it.

Do parents in the US have to pay for the vaccinations directly? If so, how much does it cost?

Most of the "basic", older vaccines can be gotten at the local health department for free. The newer ones can be quite expensive. The HPV vaccine is about $400, for example.

 

[Skeptic Ginger]

From a public health point of view it makes sense. From an individual point of view, it's less clear cut. The child has a 99.8% chance of being unharmed by measles and will be immune after recovering from the infection.

Do parents in the US have to pay for the vaccinations directly? If so, how much does it cost?

The problem with this analysis is you fail to consider the weight of those potential consequences of disease when you construct your rationale.

If your child had a 0.2% annual or even lifetime risk of dying from an infection and you could prevent it with a vaccine that carried a 0.00002% risk of death*, not many parents are going to say, well, 0.2% risk is pretty low, guess I'll take my chances. When the consequences are so devastating, 'rare' becomes proportionately less relevant.



*The actual vaccine risks are lower but I'll use that figure to avoid the argument of fear-mongering.

 

[Skeptic Ginger]

All factors considered, (incidence, case/fatality, complications, etc) measles is probably the "deadliest" of the diseases we vaccinate for. The only situation in which one can say the individual benefit is definitely higher for the non-vaccinated is an unvaccinated individual in a community with a high level of immunity. What's a lot more complicated are diseases like Hepatitis A, (mandatory in many US states). HepA is usually completely asymptomatic in toddlers, but we vaccinate them to protect adults, since toddlers are considered the "spreaders". And HepA isn't even usually very serious in adults, either, unless you're in end-stage renal failure already when you catch it.

If you only count fatalities Hep A accounts for a small number every year. But if you consider other consequences such as 6 months off work recuperating, then hep A can be a devastating disease.

Most of the "basic", older vaccines can be gotten at the local health department for free. The newer ones can be quite expensive. The HPV vaccine is about $400, for example.

Are you unaware of the Vaccines for Children Program?

The HPV vaccine was Adopted and Effective: June 29, 2006. In other words it is covered.

 

[kellyb]

If you only count fatalities Hep A accounts for a small number every year. But if you consider other consequences such as 6 months off work recuperating, then hep A can be a devastating disease.

What are the chances that the toddler being vaccinated will be devestated by hepA, though? The chances are one in ____?

Are you unaware of the Vaccines for Children Program?

The HPV vaccine was Adopted and Effective: June 29, 2006. In other words it is covered.

It doesn't cover the new ones. I don't think anyone can get free Gardasil anywhere, for example.
ETA:
Actually...I take that last part back.
A quick google search says the situation is in the process of changing.
It's still an issue sometimes, though.

http://content.hamptonroads.com/story.cfm?story=131314&ran=78441&tref=rss

http://www.statesman.com/news/content/region/legislature/stories/06/26/0626hpv.html

http://www.kff.org/womenshealth/upload/7602.pdf

Financing
The 3-dose HPV vaccine is expensive, costing $120 per injection
($360 for entire series). Many, but not all, private and public sector
payors will cover the vaccine, but policies about who will be
covered and what amount will be paid are still being determined.
Private Insurance
• Most girls and women in the target age group for the HPV
vaccine have private insurance. However, one in ten (12%)
girls ages 9 to 18 and three in ten (29%) women 19 to 26 are
uninsured (Figure 1).
• Private insurers typically follow ACIP guidelines and are likely
to cover the vaccine. Several major insurers have already
begun covering the vaccine in at least some of their plans.