Tag: costs

Vaccines and Homeschooling Myths

Do many parents homeschool their kids because they don’t want to get them vaccinated and comply with vaccination laws?

Vaccines and Homeschooling Myths

Opponents to a vaccine law in California that removed personal belief vaccine exemptions, SB277, claimed that it would lead all children currently receiving personal belief exemptions to leave those schools and become homeschoolers.

One problem with this idea is that even though 32 states don’t allow personal belief vaccine exemptions, avoiding vaccines laws is not a top reason for why most parents choose to homeschool their kids.

“Parents cite a number of different reasons for choosing to homeschool, including concerns about the school environment and desires to provide religious/moral instruction.15 In fact, a Department of Education study says that 38.4 percent of respondents claim they are homeschooling for religious reasons,16 while Christopher Klicka suggests in his book, The Right to Home School, that it is closer to 85 percent.”

Khalili et al on Off the grid: vaccinations among homeschooled children

Instead, most parents homeschool because of:

  • academic reasons – thinking they can provide a better education for their kids at home and dissatisfaction with public or private school
  • family reasons – such as a child with special needs, not being able to get into the right school, transportation issues, or simply wanting more family time
  • religious reasons – including providing religious instruction at home
  • social reasons – including negative social activity and exposures at public and private schools

The availability of virtual education, cyber schools, and charter homeschools has likely also been a factor in some parents choosing to homeschool their kids.

What about vaccines?

In one article, Homeschooling parents’ practices and beliefs about childhood immunizations, only five parents (4%) included a desire not to vaccinate children as a reason for homeschooling.

Also, homeschooling rates are about the same in every state, just over 3% of students. A few outliers include Delaware (2.1%), North Carolina (7.7%), Pennsylvania (1.1%), West Virginia (4.6%), and Wisconsin (1.6%).

Of these states, only West Virginia doesn’t allow non-medical exemptions. But neither does Mississippi, which has very average homeschooling rates (3%).

Are Anti-vaxxers Turning to Homeschooling?

If anti-vaxxers are truly turning to homeschooling to avoid getting their kids vaccinated, we might have expected to see it happen in 2015, when California passed SB 277. That law eliminated non-medical vaccine exemptions and has been in effect since the 2016-2017 school year.

Orange County was the site of several large measles outbreaks before SB 277 took effect.
Orange County was the site of several large measles outbreaks before SB 277 took effect.

Although California is dealing with fake medical exemptions, there has not been a lot of evidence that many folks are homeschooling, leaving schools, or leaving the state after SB277 because they now have had to vaccinate and protect their kids.

“The law, however, does not apply to children who are home-schooled, a loophole that parents seem to be increasingly exploiting. Over the past three years, the number of kindergartners who were home-schooled and did not have their shots quadrupled, according to a Times analysis of state data.”

Parents who won’t vaccinate their kids turning to home-schooling in California, data show

While there were more homeschoolers last year in California (3%), the rise in homeschooling in California is also being seen in many states without new vaccine laws.

“Home-schooling mothers were concerned about SB-277 but did not report that it was directly impacting their children, their vaccine decisions, or reason to home school.”

McDonald et al on Exploring California’s new law eliminating personal belief exemptions to childhood vaccines and vaccine decision-making among homeschooling mothers in California

And, according to the Los Angeles Times, only “1.2% of the state’s kindergartners were home-schooled and unvaccinated in the last school year.”

The Homeschool Vaccine Loophole

It is also important to note that many states already have laws requiring homeschooled students to be vaccinated!

So yes, it is correct to say that the parents who are switching to homeschooling to avoid vaccinating and protecting their kids are exploiting a loophole.

“Submit proof of vaccination and receipt of any health services or examinations as required by law.”

Home Schooling in Tennessee

Interestingly, North Carolina, with one of the highest rates of homeschoolers, requires that homeschooled children be vaccinated.

Is being able to homeschool without vaccines a loophole that will have to be closed?

“And though most of their schooling may take place at home, many are part of programs that meet several times a week with other students. If one contracted a disease such as measles, they could still spread it at the park, or the grocery store, or anywhere they come into contact with other people, said Dr. James Cherry, a UCLA expert on pediatric infectious diseases.”

Parents who won’t vaccinate their kids turning to home-schooling in California, data show

It will likely depend if we end up seeing outbreaks among clusters of unvaccinated homeschoolers…

“During the six weeks after the gathering, a total of 34 cases of measles were confirmed. Of the patients with confirmed measles, 94 percent were unvaccinated, 88 percent were less than 20 years of age, and 9 percent were hospitalized. Of the 28 patients who were 5 to 19 years of age, 71 percent were home-schooled. “

Parker et al on Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States.

Few people will remember the 2005 measles outbreak in Indiana that occurred mostly among intentionally unvaccinated homeschoolers and cost over $167,000 to contain. At the time, it was “the largest documented outbreak of measles in the United States since 1996.”

And it is likely that few people know about the two unvaccinated homeschooled kids in Oklahoma who got tetanus in 2012, including an 8-year-old who was in the ICU for 18 days…

What to Know About Vaccines and Homeschooling

Parents who homeschool their kids should get their kids vaccinated and protected on time and on schedule and follow all of the other AAP recommendations for preventative health care.

More on Vaccines and Homeschooling Myths

What is the Natural Immunity Model?

It’s becoming a little clearer why some folks think it is safe to not vaccinate their kids, leaving them at risk to get vaccine-preventable diseases.

Who's calling the measles outbreaks a national emergency?
Who’s calling the measles outbreaks a national emergency?

Their idea of a natural immunity model of getting disease simply involves hiding in the herd and any outbreaks they trigger magically stopping.

What is the Natural Immunity Model?

Bob Sears thinks he has exposed some big news, that not everyone who gets measles dies.

Fortunately, that’s very true and something folks have always known.

With a death rate of about 1 in 1000 cases, you wouldn’t expect to have had any deaths after just 50 or 60 cases. But you never know. It’s not like every 1000th case dies. It could be the second case, the 562nd, or the 3043rd.

The hospitalization rates work the same way. They are statistical averages of what typically happens when people get measles.

That’s why measles was once called a “harmless killer.” It is often harmless, if you call having a high fever and feeling miserable for a week harmless, but it is sometimes a killer.

So is what we are seeing in Washington “what an outbreak looks like with the natural immunity model,” when no one is vaccinated and protected?

Of course not!

In a natural immunity model, up to 90% of the people who are exposed to someone with measles get sick!

In the pre-vaccine era, everyone got measles. That's the natural immunity model.
In the pre-vaccine era, everyone got measles. That’s the natural immunity model.

In a natural immunity model, everyone gets measles.

Not everyone survives having measles though.

Remember, the last measles death in the United States was during a 2015 outbreak in Washington. A immunocompromised women got caught up in an outbreak of mostly unvaccinated people, got measles, and died.

That’s the natural immunity model.

This family didn't have a choice about their son getting sick - he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.
This family didn’t have a choice about their son getting sick – he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.

Not having a choice about getting measles.

That’s the natural immunity model.

Worry about your child with leukemia after an exposure to measles…

That’s the natural immunity model.

“Well, what does this mean? Much like the outbreak in 2014 in a large Amish community (around 400 cases), and the recent NY outbreak in an orthodox Jewish community (around 100 cases), these types of outbreaks are centralized and self-limiting—which means they don’t spread like wildfire. These cases are also almost exclusively in communities who are CHOOSING not to be vaccinated. In other words, they are not random people “victimized” by measles. #dontfeelsorryforthem”

Melissa Floyd

Do anti-vaccine folks really think that these outbreaks are self-limiting? That they just stop on their own?

Do they not understand that the only thing that keeps them from “spreading like wildfire” is the intensive work of the local and state health departments, efforts to get folks vaccinated, and quarantines?

The Disneyland measles outbreak, for example, was hardly centralized or self-limited. It spread to Arizona, Nebraska, Utah, Colorado, Washington, Oregon, Mexico, and Canada.

And like many other large outbreaks, it cost millions of dollars to contain.

“Measles outbreaks can be very costly to communities, a new report suggests. For example, the 2013 measles outbreak in New York City cost the city’s health department nearly $395,000 and more than 10,000 personnel hours, according to a report in JAMA Pediatrics. And there were other non-monetary costs, including the loss of a pregnancy, researchers reported.”

Measles outbreaks come with serious consequences

That hardly sounds like something that is harmless or self-limited.

“Now, the ACIP is preparing to add a 3rd dose for all college-age students to try to stop adults from getting and spreading measles—THAT’S how common adults cases are. Yet in Washington, there were only three??”

Melissa Floyd

Not only is there no call for a third dose of MMR to help stop the spread of measles, the CDC actually says a third dose isn’t necessary.

“In the event that a HCP who has 2 documented doses of MMR vaccine is tested serologically and determined to have negative or equivocal measles titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of measles immunity.”

Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Any talk about a third dose of MMR has to do with outbreaks of mumps…

“Is this all a coincidence my friends? Is the panic generated because of motive rather than data? In other words, could the media actually be encouraged to shift public beliefs on an issue to help pass legislation with a vested interest? #HerdImmunityDoesntApplyToVaccines”

Melissa Floyd

It’s not a coincidence that we are seeing so much anti-vaccine measles panic and propaganda these days. Outbreaks always bring it out.

Why?

It becomes harder to justify your decision to leave your kids unvaccinated and unprotected when you actually start to see that intentionally unvaccinated kids are getting sick.

More on the Natural Immunity Model

Vaccines Statistics and Numbers

To help you get better educated about vaccines, it can help to learn some vaccine statistics and some other numbers behind vaccines.

Vaccine Court payouts come from an excise tax and are not taxpayer dollars...
Vaccine Court payouts come from an excise tax and are not taxpayer dollars…

Including the numbers that anti-vaccine folks throw around.

Vaccine Statistics

For all of the talk of some folks delaying or skipping vaccines, do you know how many vaccines are given each day?

According to the CDC, from 2006 to 2017, at least 3,454,269,356 doses of vaccines were distributed in the United States. These are the vaccines that are covered by the National Vaccine Injury Compensation Program, such as DTaP, MMR, Hepatitis A and B, HPV, and flu, etc.

That’s over 287 million doses each year!

The WHO reports that 85% of infants around the world receive vaccines against DTP, polio, measles, and hepatitis B.
The WHO reports that 85% of infants around the world receive vaccines against DTP, polio, measles, and hepatitis B.

How about worldwide?

That’s harder to know, but consider that the World Health Organization reports that 85% of infants worldwide, or almost 100 million infants, get at least:

  • 3 doses of DTP
  • 3 doses of hepatitis B
  • at least one doses of measles
  • 3 doses of polio

Plus, an increasing number are getting vaccines to protect them against Hib, pneumococcal disease, rotavirus, HPV, meningitis A, mumps, rubella, tetanus, and yellow fever.

“UNICEF supplies vaccines reaching 45 per cent of the world’s children under five years old as part of its commitment to improving child survival.”

How many vaccine doses are we talking about?

A lot. UNICEF alone buys 2.8 billion doses of vaccines each year! Those vaccines are then distributed to children in over 100 countries.

Vaccine-Preventable Disease Statistics

As impressive as the number of vaccines that are given each year are the numbers about what happens when we give vaccines:

  • there are 2 to 3 million fewer deaths in the world each year because people are vaccinated and protected
  • in the Unites States, every $1 spent on vaccines provides $3 in direct benefits and up to $10 in benefits if you include societal costs
  • in developing countries, every $1 spent on vaccines provides $16 in direct benefits, but that goes up to $44 when you take “into account the broader economic impact of illness”
  • for children born in the United States during “1994–2013, routine childhood immunization was estimated to prevent 322 million illnesses (averaging 4.1 illnesses per child) and 21 million hospitalizations (0.27 per child) over the course of their lifetimes and avert 732,000 premature deaths from vaccine-preventable illnesses,” and it also “will potentially avert $402 billion in direct costs and $1.5 trillion in societal costs because of illnesses prevented”
  • only two countries continue to have wild polio – Afghanistan and Pakistan – and together, they only had 21 cases in 2017

Still, only one vaccine-preventable disease, smallpox, has been eradicated.

And worldwide, more than 3 million people still die from vaccine-preventable diseases every year, many of them young children.

Other Vaccine Numbers

There are some other numbers about vaccines and vaccine-preventable diseases folks should know:

  • the number of pediatricians who got a $3 million vaccine bonus – zero
  • the number of doses of vaccines kids get today – 69 72 54 doses (including yearly flu shots) by age 18
  • the number of vaccines that contain antifreeze as an ingredient – zero
  • the number of vaccines that contain peanut oil as an ingredient – zero
  • the number of studies that link vaccines to autism – zero
  • the number of diseases that homeopathic vaccines can prevent – zero
  • the number of anti-vaccine sites that mention any benefits of vaccines – zero
  • the number of VAERS reports that are thought to be unrelated to a vaccine – 53%
  • the number of VAERS reports that are thought to be definitely caused by a vaccine – 3%
  • the number of definite VAERS reports that were serious – 1% (anaphylaxis)
  • the number of myths about vaccines that can scare you away from vaccinating and protecting your kids – 100s
  • the number of measles outbreaks that have been caused by a vaccine strain – zero
  • how long you have to stay in quarantine if you are unvaccinated and are exposed to someone with measles – at least 21 days
  • the number of new vaccines in the pipeline300

And yes, $4,060,857,713.42 has been paid by the Vaccine Court for 6,355 compensated claims for vaccine injuries since 1989, during which time billions of doses of vaccines were given.

“This means that for every 1 million doses of vaccine that were distributed, 1 individual was compensated.”

Vaccine Injury Compensation Data

And many of those claims were simply settled.

Vaccines work. Vaccines are safe. Vaccines are necessary.

Get vaccinated and protected.

What’s the biggest number you should be thinking about? Way too many people are still getting and dying from vaccine-preventable diseases.

What to Know About Vaccine Statistics

Although more work needs to be done to protect more people, vaccine statistics clearly show that vaccines work and that they are safe and necessary.

More on Vaccines Statistics

Updated February 2, 2019

The Value and Cost Savings of Getting Vaccinated

We often hear a lot about the benefits of vaccines.

Even the schools were closed in San Antonio when polio came to Texas in 1946.
How much would it cost to close all of the schools in a big city today?

Well, most of us do.

But can getting vaccinated really help save us money?

Cost Savings of Getting Vaccinated

Vaccines are expensive, so it probably doesn’t make a lot of sense to many people that saving money is one of the big benefits of getting vaccinated.

That’s just because vaccines work so well.

“Analyses showed that routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively.”

Zhou et al on Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009

Few of us remember the pre-vaccine era when there were polio and diphtheria hospitals and “pest houses” at the edge of town.

We don’t remember when outbreaks of vaccine-preventable diseases would close schools and these diseases were more deadly, not because they were more severe, but simply because they were more common.

Costs Associated With Getting Sick

If we don’t remember these diseases and outbreaks, we certainly don’t remember how much it cost to control and treat them.

We should though.

Just look at how much it costs to control the recent measles outbreaks that continue to plague us.

“The estimated total number of personnel hours for the 16 outbreaks ranged from 42,635 to 83,133 and the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

Ortega-Sanchez on The economic burden of sixteen measles outbreaks on United States public health departments in 2011

Not including the direct costs for outpatient visits and inpatient care, recent outbreaks have cost anywhere from $3,000 to $50,000 per case to contain. Why the difference? Localized outbreaks, like in a church group or among a single family, will be easier and less expensive to contain, as they will likely involve fewer contacts to track down to see if they were exposed and are already vaccinated.

Again, these costs don’t include the costs of going to your doctor or the ER because your child is sick, getting hospitalized, or lab tests, etc.

It also doesn’t include the costs associated with living under quarantine, which is happening in many of the recent outbreaks.

Getting sick is expensive.

How much is a liver transplant?

How much does it cost to treat someone with cervical cancer?

How much does it take to care for a child with congenital rubella syndrome?

How do anti-vax folks usually counter this important message?

They typically say that taking care of a vaccine-injured child is expensive too. While that can be true, the problem is with their idea of what constitutes a vaccine injury. While vaccines are not 100% safe and they can rarely cause serious or even life-threatening reactions, most of what they describe as vaccine-induced diseases, from autism to SIDS, are not actually associated with vaccines.

The Value of Vaccination

So yes, getting vaccinated is cost effective.

“Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines.”

Luyten et al on The Social Value Of Vaccination Programs: Beyond Cost- Effectiveness

The value of getting vaccinated goes way beyond saving money though.

Most of the ways this has been studied in the past still leaves out a lot of important things, including:

  • increased productivity later in life following vaccination
  • improved cognitive and educational outcomes
  • community-level health gains through herd effects
  • prevention of antibiotic resistance
  • vaccination-related benefits to macroeconomic factors and political stability
  • furthering moral, social, and ethical aims

Why are these important?

“Vaccination has greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better. Paradoxically, a vociferous antivaccine lobby thrives today in spite of the undeniable success of vaccination programmes against formerly fearsome diseases that are now rare in developed countries.”

Andre et al on Vaccination greatly reduces disease, disability, death and inequity worldwide

If you are making a decision to get vaccinated vs. trying to hide in the herd, you want to have all of the information about the benefits of vaccines, not just about the risks, or what you might think are risks.

Vaccines Are Expensive

Although getting vaccinated is certainly cost-effective, that doesn’t erase the fact that vaccines are expensive.

If they weren’t so expensive, then we likely still wouldn’t have so many deaths from vaccine-preventable diseases in the developing world, where the problem is access to vaccines, not vaccine-hesitant parents.

“We conclude that the vaccination portion of the business model for primary care pediatric practices that serve private-pay patients results in little or no profit from vaccine delivery. When losses from vaccinating publicly insured children are included, most practices lose money.”

Coleman on Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices

Parents should also be aware that vaccines are expensive for the average pediatrician too, who no matter what anti-vax folks may claim about bonuses, aren’t making much or any money on vaccinating kids.

And because vaccines work, pediatricians also don’t make as much money when vaccinated kids don’t get diarrhea and dehydration that is prevented by the rotavirus vaccine, recurrent ear infections that are prevented by Prevnar, or a high fever from measles, etc., all things that would typically trigger one or more office visits.

It should be clear that the only reason that pediatricians “push vaccines” is because they are one of the greatest achievements in public health.

A great achievement at a great value.

What to Know About the Cost Savings of Getting Vaccinated

There is no question that there is great value in getting fully vaccinated on time and that getting immunized is a very cost effective way to keep kids healthy.

More on the Cost Savings of Getting Vaccinated