On Vaccinations Again

People on the side of The People always ended up disappointed, in any case. They found that The People tended not to be grateful or appreciative or forward-thinking or obedient. The People tended to be small-minded and conservative and not very clever and were even distrustful of cleverness. And so the children of the revolution were faced with the age-old problem: it wasn’t that you had the wrong kind of government, which was obvious, but that you had the wrong kind of people. –Terry Pratchett

It’s time to talk about state vaccination policy again. And by “again,” I mean I’m going to be a bit lazy about it. This time the specific wording of the topic for Public Forum is “Resolved: State mandated administration of childhood vaccinations is justified,” which is a lot simpler than the resolution we had back in 2009. It’s a decent resolution with policy on one side and value on the other: the affirmative should be talking about herd immunity and how it’s not about the individual but rather the diseases that they may be carrying, while the negative will be talking about freedom and autonomy and distrust of elected officials making blanket mandates that would foolishly overwhelm rational self interest.

You’ll note that I don’t advise the negative to go claiming that vaccines cause autism, or that freedom of conscience and/or religion means you don’t have to do any of that “medicine” mumbo-jumbo. Above and beyond the obvious counters to these basic claims — which is what those links are to — there’s a much better claim to make: the frequency of the torch-and-pitchfork crowd making these sorts of claims has undermined the quality of scientific and medical insight available to policymakers. Amy Wallace explains in “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All” (Wired, Nov 2009)

Consider the CDC’s Advisory Committee on Immunization Practices, which reviews new vaccines and administration schedules: Back in the late ’90s and early ’00s, Offit was a member of the panel, along with experts in infectious diseases, virology, microbiology, and immunology. Now the 15-person panel is made up mostly of state epidemiologists and public-health officials… That’s not by accident. According to science journalist Michael Specter, author of the new book Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet and Threatens Our Lives, the controversy surrounding vaccine safety has made lack of expertise a requirement when choosing members of prominent advisory panels on the issue. “It’s shocking,” Specter says. “We live in a country where it’s actually a detriment to be an expert about something.” When expertise is diminished to such an extent, irrationality and fear can run amok.

And this is a problem when capitalism is working the way it’s supposed to: somebody sees a problem to be solved, they invent a solution, they go to sell the solution, and people accuse them of just trying to sell the solution and not solve the problem. This is absurd on a couple of levels, doubly so when applied to vaccines — Offit sums it up in that article: “Vaccines, after all, are given once or twice or three times in a lifetime. Diabetes drugs, neurological drugs, Lipitor, Viagra, even Rogaine — stuff that a large number of people use every day — that’s where the money is.” — especially since there are a plethora of vaccines which aren’t being researched or manufactured (like malaria, if I remember correctly) because the corporate accountants think that they’d be money-losers. But it doesn’t change the fact that noisy voters spread fear, uncertainty, and doubt over the policymaking process until the policymaking process is necessarily compromised. So if you’re thinking that the government is doing something stupid to appease irrational constituents, there’s a goodly chance you’re right.

Beyond that point, teaching people that it’s safe to rely on vaccinations for disease prevention and mitigation reduces the likelihood that people are going to mitigate their risk of disease catching-and-spreading in other ways. Brownlee and Lenzer cover herd behavior in “Does the Vaccine Matter?” (The Atlantic, Nov 2009)

The other possibility, of course, is that we’re relying heavily on vaccines and antivirals that simply don’t work, or don’t work as well as we believe. And as a result, we may be neglecting other, proven measures that could minimize the death rate during pandemics. “Vaccines give us a false sense of security,” says Sumit Majumdar. “When you have a strategy that [everybody thinks] reduces death by 50 percent, it’s pretty hard to invest resources to come up with better remedies.” … In the U.S. … our reliance on vaccination may have the opposite effect: breeding feelings of invulnerability, and leading some people to ignore simple measures like better-than-normal hygiene, staying away from those who are sick, and staying home when they feel ill.

So when we’re talking about people here, we’re seeing two polarities: those that are afraid of the abuse of biopower and are pressuring public policy away from competence, and those that are so confident in the progressive power of science that they forget to take care of themselves in case they’re the unfortunate folks who don’t actually gain immunity from a vaccination. And that’s how we’re going to compromise herd immunity and end up spreading measles. And while the affirmative can claim Wallace’s citation of a 2002 study published in The Journal of Infectious Diseases that

Looking at 3,292 cases of measles in the Netherlands, the study found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because vaccines don’t always take. What does that mean? You can’t minimize your individual risk unless your herd, your friends and neighbors, also buy in.

they can’t claim that a government mandate actually results in public adherence more than government advice, or that the government mandate makes the vaccines more potent. The government mandates that immigration should be managed through legal channels and we can see that the policy there isn’t having the effects that were expected of it. Same deal here: the fringe groups that want to avoid vaccinations will increase their resistance if the government steps up the power of the mandate. Furthermore, if the government gets tied up in immunizations and tracking immunization records, then we can readily guarantee that anybody wanting to avoid the government — illegal immigrants? — will avoid getting immunized to ensure that they’ve got one less point of contact with the government that they fear and/or loathe regardless of how much they may love medical care. So while we love herd immunity, trying to use government mandates and administration — above and beyond recommendations and subsidies — to force the issue is going to compromise herd immunity.

One crucial thing that the negative is going to have to watch out for is how the affirmative defines the “childhood vaccinations,” because there’s a goodly chance that they’ll define it in terms of a status quo which the resolution does not specify. The resolution does not place a limit on vaccinations which can be given in childhood, and it seems reasonable to expect that we will have more vaccines for more diseases which can be administered during childhood, and it is — over time — going to predominantly be those vaccines that need to have their place in public policy justified. Put another way, it is nonsensical to argue over the smallpox vaccine at this point; fait accompli, don’t waste your (plague-bearing) breath. Argue instead over whether future such concerns warrant a big mandate. The negative should be talking about the lack of childhood problems that can be vaccinated against anymore. The affirmative should be able to counter this with an appropriately scary disease that could be solved for with an existing-but-under-deployed vaccine.

Of course, the people that are pressuring public policy away from rationality are helping to ensure the survival and return of dangerous childhood diseases. Dr. Hall writes in “Vaccines and Autism: a Dangerous Manufactroversy

The evidence is in. The scientific community has reached a clear consensus that vaccines don’t cause autism. There is no controversy… There is, however, a manufactroversy — a manufactured controversy — created by junk science, dishonest researchers, professional misconduct, outright fraud, lies, misrepresentations, irresponsible reporting, unfortunate media publicity, poor judgment, celebrities who think they are wiser than the whole of medical science, and a few maverick doctors who ought to know better… [The decline in vaccinations has resulted in the] return of endemic measles in the U.K. and various outbreaks of vaccine-preventable diseases in the U.S. [C]hildren have died. Herd immunity has been lost. The public health consequences are serious and are likely to get worse before they get better…

So there’s the bodies on the flow for the affirmative. Wallace also mentions that

[The manufactroversy] is also, ironically, a product of the era of instant communication and easy access to information. The doubters and deniers are empowered by the Internet (online, nobody knows you’re not a doctor) and helped by the mainstream media, which has an interest in pumping up bad science to create a “debate” where there should be none.

which means that ordinarily rational people might be led to believe dumb ideas. If you’re surprised by this, consider how many people will be voting for the other guy in this November’s election, regardless of who the other guy is. “So while we trust our opponents to not be dumb,” says the affirmative, “because they’re clearly bright enough to distrust the torch-and-pitchfork crowd’s agenda and get their vaccinations voluntarily, we do have concerns that other people might be torch-and-pitchforkers incidentally spreading diseases but looking just like any of us here. And frankly, we’d feel better about our society if people could be forcibly vaccinated against This-itis, That-asum, and the Other-eotis before they had a chance to fail at thinking for themselves. Even accepting that some people will avoid the mandate, we can look to the Netherlands evidence to say that the vaccinated folks will still be better off overall.”

Unfortunately, this plays into the neg position of putting too much faith in vaccinations and paying no attention to preventative measures. Such a counter claim might be rebuffed with observations on the power of positive thinking and evidence on the placebo effect (which interestingly enough can cause harm if harm is expected). That said, I would still lean towards the negative since the affirmative has just mixed the not-yet scientific with the insistence that policy be used to drive science.

April 27 Update: In case it comes up again in the future, we had a local Whooping Cough outbreak and it was found that immunity fades away allowing for retransmission. This may not matter if the infected person isn’t a “super spreader,” a concept worth looking into for the future of disease control and mitigation — see also the SARS outbreak diagram reprinted in Tufte’s Beautiful Evidence. Finally, Donald Trump aligns with the torch-and-pitchfork crowd demonstrating the threat of The Public to Public Policy.