Tag: free-riders

Vaccine Analogies and Metaphors

Analogies and metaphors are a good way to explain things, including that vaccines are safe and necessary.

We are sunk if we stop vaccinating.
As the CDC explains, we are sunk if we stop vaccinating.

Here are some of my favorite vaccine analogies and metaphors.

Getting vaccinated is like:

  • applying sunscreen before going to the beach
  • applying insect repellent before going camping in the woods
  • making sure that your kids are wearing a seat belt or sitting in an age-appropriate car seat or booster seat when you get in the car
  • installing anti-virus software on your new computer

When do you put on your seat belt? When you get in the car, before you get in an accident. Just like a vaccine. You get it before you get sick. Yes, some vaccines do work after you have been exposed to an illness, but they don’t work after you are already sick.

There is a problem with these metaphors though; they don’t include the risks to other people.

These do:

  • taking driver’s ed and getting your license before driving
  • taking swimming lessons before going in the water without a life jacket
  • putting your gun in a locked safe
  • putting a fence around your backyard so that no one in your neighborhood can drown in your pool
  • making sure folks don’t text and drive

That’s right.

Vaccination equals protection.

And not just protection for the person getting vaccinated. Being unvaccinated puts others at risk too, as you might start an outbreak.

Getting your kids vaccinated is like taking them to swimming lessons instead of just throwing them in the lake. Either way they can learn to swim and have protection/immunity from drowning. But one method (throwing them in the lake) is much more dangerous than the other.

Analogies can also help explain how vaccines work.

“Vaccines are a like a wanted poster, they just show your body what the bad guys look like, so when faced with them for real you are ready, prepared, and able to stop them before they cause harm.”

Can vaccines overwhelm the immune system?

Are there analogies that explain the idea of free-riders – folks who intentionally don’t vaccinate their kids and attempt to hide in the herd?

“If all my child’s friends are vaccinated, won’t he be protected by herd immunity? Why should I put my child at risk for vaccine reactions if all the other children around him are already immune?

This is like riding in a carpool where everyone contributes each month to pay for gas, repairs and parking. One morning, a new neighbor shows up and says, “I think I’ll ride along with you. But I’m not going to pay, since you’re going downtown anyway and you have an empty seat.” If enough people choose to take a free ride on other children’s immunity, herd immunity will soon disappear.”

Why is herd immunity so important?

And to explain the idea of what some folks consider vaccine injuries.

“I have found that it sometimes helps to give parents an analogy. I ask them the following: If they were to put gas in their car and then later got a flat tire, would that mean putting gas in the car had caused the flat tire? No. The two events were just a coincidence.”

Karen Lewis on What Vaccine Safety Means

What are some good analogies to describe how some anti-vax folks think?

Since that bridge isn’t 100% safe (I Googled that some bridges have collapsed), I’m going to let my kids swim across this river with fast moving water.

Have you heard the bridge analogy?

There are also versions with crocodiles in the water…

In case it’s not clear, in this analogy, walking across the bridge is like getting vaccinated. Swimming across the river is like intentionally not vaccinating your kids.

There are plenty of other good analogies that help to explain the importance of vaccines.

“Clusters of unvaccinated people are like patches of dry grass that, with a single match, can start a wildfire that will burn not only dry material, but sometimes wet as well. The match could be a student who returns from a trip abroad with measles or a train commuter with whooping cough.”

Saad Omer

It’s also important to remember that anyone, even those who are well prepared, can get burned in a wildfire. That’s why the analogy works so well.

“Vaccinating one’s children is like paying taxes. We all have a moral and a legal duty to pay taxes because we have a moral and a legal duty to contribute to the upkeep of our society and to its public goods (e.g., a good public health system, national defence, etc.).”

Vaccine Refusal Is Like Tax Evasion

Why are we concerned about those who are unvaccinated if our own children are fully vaccinated?

“Think of camping as an analogy. If everyone at a campground properly stores their food, bears won’t be enticed to come around. If even one person leaves their food unprotected, it invites bears in to investigate all the campsites for opportunities to eat.”

How does choosing not to immunize affect the community?

These analogies help explain how unvaccinated folks put others at risk.

“Being intentionally unvaccinated against highly contagious diseases is, to carry Holmes’ analogy a bit further, like walking down a street randomly swinging your fists without warning. You may not hit an innocent bystander, but you’ve substantially increased the chances that you will.

One might usefully analogize the risk of disease to a crapshoot. A person’s chance of being infected is, as Dr. Singer acknowledges, a matter of luck. But is it really OK for the unvaccinated to load the dice to increase the odds against other people? If so, by how much?”

Ronald Bailey on Vaccines and the Responsibility To Not Put Others at Risk

Of course, there are plenty of bad vaccine analogies and metaphors that anti-vaccine folks push:

  • getting vaccinated is like rape
  • getting vaccinated is like the Holocaust
  • “genes load the gun but the vaccines pull the trigger”
  • vaccine manufacturers are like tobacco manufacturers
  • I won’t set my child on fire to keep yours warm (this doesn’t work as a vaccine analogy, mostly because there is no benefit to setting your child on fire. Would an anti-vaxxer let their child start a campfire to keep their friends from dying in the cold?)
  • getting a vaccine is like eating a handful of M&Ms out of a big bowl when you know that a few have been poisoned
  • getting a child  vaccinated is like giving 1,000 kids 1,000 cupcakes, telling them to pick one and eat it, knowing that one of the cupcakes is poisoned (it’s maybe like letting a child with a severe peanut allergy choose a cupcake, knowing that there is a one in a million chance that the cupcake he chooses has been made with peanuts…)
  • I want safer cars, but that doesn’t make me anti-car

You understand why the anti-car one is a bad analogy, right? Folks who want safer cars generally still drive and ride in cars!

Have you heard any good or bad analogies or mataphors about vaccines?

More on Vaccine Analogies and Metaphors

The Unvaccinated Child

We know that your unvaccinated child is not healthier than vaccinated children.

And we know that among pediatric flu deaths, most are unvaccinated.

What else do we know about unvaccinated children?

Who’s Who Among Unvaccinated Children

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions have medical exemptions to getting vaccinated and benefit from herd immunity. (CC BY 2.0)

Although it seems like unvaccinated kids all get grouped together, it is important to remember that not all unvaccinated kids are intentionally unvaccinated.

Some are too young to be vaccinated or fully vaccinated, some have medical exemptions, usually to just one or a few vaccines, and sometimes just temporary, and some have skipped or delayed one or more vaccines because of a lack of access to health care.

Whatever the reason, they are all at risk because they are unvaccinated.

The intentionally unvaccinated child poses the bigger risk though, because they tend to cluster together and are more likely to be either completely unvaccinated or to have skipped multiple vaccines. A child with a medical exemption because she is getting chemotherapy, on the other hand, very likely lives with a family who is completely vaccinated and protected. Similarly, a child with an allergy to a vaccine likely isn’t missing multiple vaccines.

Risks to the Unvaccinated Child

Of course, the main risk to the unvaccinated child is that they will get a potentially life-threatening vaccine-preventable disease.

While many vaccine-preventable diseases are no longer endemic in the United States and other developed countries, they have not been eradicated.

People do still get vaccine-preventable diseases in the United States.

And tragically, people do still die of vaccine-preventable diseases in the United States.

Can’t you just hide in the herd, depending on everyone else to be vaccinated and protected to keep these diseases away from your unvaccinated child? While that ends up being what happens most of the time, as there are no real alternatives to getting vaccinated, that strategy doesn’t always work. And it is a gamble that’s not worth taking and won’t keep working if more parents skip or delay getting their kids vaccinated.

Risks of the Unvaccinated Child to Everyone Else

Unvaccinated kids are also a risk to those around them, as they are more likely to get sick with a vaccine-preventable disease, since they have no immunity. No, they are not an instant danger if they don’t actually have a vaccine-preventable disease, but since you can be contagious a few days before you have symptoms, you are not always going to know when your child is sick and a risk to others.

Why does that matter if everyone else is vaccinated and immune?

Well, obviously, everyone else is not vaccinated and immune, including those with medical exemptions and those who are too young to be vaccinated. And since vaccines aren’t perfect, some people who are vaccinated can still get sick.

That’s why it is critical that if your unvaccinated child is sick or was exposed to someone who is sick, you are sure to:

  • notify health professionals about your child’s immunization status before seeking medical attention, as they will likely want to take precautions to keep you from exposing others to very contagious diseases like measles, mumps, and pertussis
  • follow all appropriate quarantine procedures that may have been recommended, which often extends up to 21 days after the last time you were exposed to someone with a vaccine-preventable disease
  • seek medical attention, as these are not mild diseases and they can indeed be life-threatening, even in this age of modern medicine

Hopefully you will think about all of these risks before your unvaccinated child has a chance to sick.

Getting Your Unvaccinated Child Caught Up

Fortunately, many unvaccinated kids do eventually get caught up on their vaccines.

It may be that they had a medical exemption that was just temporary and they are now cleared to get fully vaccinated.

Or they might have had parents who were following a non-standard, parent-selected, delayed protection vaccine schedule, but they have now decided to get caught up to attend daycare or school.

Others get over their fears as they get further educated about vaccines and vaccine myths and decide to get caught up and protected.

Is it ever too late to get vaccinated?

Actually it is.

In addition to the fact that your child might have already gotten sick with a particular vaccine preventable diseases, some vaccines are only given to younger kids.

For example, you have to be less than 15 weeks old to start the rotavirus vaccine. And you should get your final dose before 8 months. That means that if you decide to start catching up your fully unvaccinated infant at 9 months, then you won’t be able to get him vaccinated and protected against rotavirus disease. Similarly, Hib vaccine isn’t usually given to kids who are aged 5 years or older and Prevnar to kids who are aged 6 years or older, unless they are in a  high risk group.

Still, you will be able to get most vaccines. And using combination vaccines, you should be able to decrease the number of individual shots your child needs to get caught up. An accelerated schedule using minimum age intervals is also available if you need to get caught up quickly.

You should especially think about getting quickly caught up if there is an outbreak in your area or if you are thinking about traveling out of the country, as many vaccine-preventable diseases are still endemic in other parts of the world.

What to Know About The Unvaccinated Child

The main things to understand about the unvaccinated child is that they aren’t healthier than other kids, are just at more risk for getting a vaccine preventable disease, and should get caught up on their vaccines as soon as possible.

More on The Unvaccinated Child

10 Reasons You Aren’t Vaccinating Your Kids

Yes, we know.

It’s because you have done your research.

“Many would argue that we have become a culture characterized by intolerance of any risk (particularly of co-mission as opposed to omission), such that when harm does occur someone is to blame.”

Poland et al on Understanding those who do not understand: a brief review of the anti-vaccine movement

But that’s not really why you aren’t vaccinating your kids.

10 Reasons You Aren’t Vaccinating Your Kids

Research has explained the real reasons, most of which happen subconsciously, and they include the following  well known cognitive phenomena:

  1. ambiguity aversion – the idea is that people tend to prefer known risks rather than unknown risks and while you would think that would tend to widely favor getting vaccinated (known, very small risks of a vaccine) vs remaining unprotected (relatively unknown risk of getting a vaccine-preventable disease and coping with possible complications), that’s not how vaccine-hesitant people think. If you are skipping or delaying any vaccines, you are likely to overestimate the risks of vaccines, include ‘risks’ that are not even associated with vaccines, and make getting vaccinated seem like a much bigger and ambiguous risk than it really is. Also, some vaccine-hesitant parents see much more ambiguity in the whole getting vaccinated decision than there really is, mostly because of the false balance in media reporting. There is no ambiguity – experts agree that vaccines are safe and necessary.
  2. anticipatory regret – you might decide to skip or delay a vaccine because you “wouldn’t be able to forgive yourself” if your child had a severe reaction, explaining the anti-vaccine slogan that “You can always get Vaccinated, but you can never get Unvaccinated.” While it is a catchy slogan, it misses the fact that some parents do regret their decision to not vaccinate their kids because they did wait too long and their child did get a vaccine-preventable disease. You can’t always get vaccinated and severe reactions are very rare.
  3. availability heuristic – we think things are likely to happen if we can easily remember them and we are most likely to remember things like vaccine scare stories because we see them all of the time. That doesn’t make them true or mean that they really are common though. Have you seen many of those videos?
  4. bandwagoning – many of us like to jump on the bandwagon – doing what everyone else is doing. So how does bandwagoning fit into vaccine hesitancy, considering that most people vaccinate and protect their kids? Just consider that many of unvaccinated kids we see today are grouped together in “pockets of susceptibles” because their vaccine-hesitant parents are also clustered together in an echo chamber, making it seem like skipping or delaying vaccines is a more popular option than it really is. Also, so much of the vaccine sentiment online is negative, it is easy for it to seem like it is the same in the real world. For example, it has been found that 75% of the vaccine sentiment on Pinterest, 66% of the vaccine sentiment on YouTube, and 30-35% of the vaccine sentiment on Facebook and Twitter is negative! Do your friends and family members vaccinate their kids?
  5. cognitive dissonance – this is the anxiety you get from believing in two things that contradict each other, like if you are afraid to vaccinate your child, but you are just as afraid that if he isn’t vaccinated, then he will get measles. One belief eventually wins out and makes it easier for you to believe anything else that reinforces it, even things that aren’t logical and which are easily disproven. Even if you don’t realize it, and you probably won’t, this is when you begin to use cherry picking, confirmation bias, survivorship bias, etc., and become a Dunning Kruger master.
  6. control – most of us like to be in control, or at least feel like we are in control. Saying no to a vaccine, especially a vaccine that you feel is involuntary (your child needs it to attend daycare or school), may help you feel a little more in control of what may seem like a never ending bombardment of risks facing your child.
  7. explanatory attribution – people like, or even need, to find a meaning for things, such as why kids are autistic, and when you don’t have one, it becomes very easy to make one up or latch onto someone else’s idea of a vaccine injury or vaccine induced disease.
  8. free-riding – while some people are hiding in the herd out of necessity, including those who are too young to be vaccinated and those with medical exemptions, others are free-riders and are benefiting from the fact that most of the rest of us do get vaccinated and do vaccinate our kids.
  9. omission bias – when given the option, some people prefer doing nothing instead of doing something, even if it leads to something much worse happening in the future. Choosing to do nothing, like skipping or delaying your child’s shots, is still a decision though, and if your child or someone else’s child gets sick, your action (by omission) is still the cause and you would still be morally responsible.
  10. optimism bias – some parents are overly optimistic about their ability to protect their intentionally unvaccinated kids from getting a vaccine-preventable disease or even that they can treat them if they do get sick with essential oils, homeopathic remedies, a trip to the chiropractor, or other alternative type treatments. They can’t.

Of course, none of these things would be able to take hold so well without one other thing – fear.

Fear helps these cognitive biases, heuristics, and logical fallacies take hold and change your perception of risk into something that is much different from reality. That’s why some people think that the risks of vaccines are greater than the risks of catching a vaccine-preventable disease or even greater than the risks of having a vaccine-preventable disease.

They aren’t. Vaccines are safe.

immunization-program-stages
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

Again, some people fear vaccines more than they fear the complications of vaccine-preventable diseases. Surprisingly, this effect is well known and has been predicted. If you don’t know or have never seen anyone with a vaccine-preventable disease, like polio, measles, diphtheria, or tetanus, then it’s easy to believe that they really were mild diseases.

They weren’t. And they still aren’t. Vaccines are necessary.

Rotavirus vaccines are associated with a very small risk of intussusception, but that is not a good reason to miss the benefits of this vaccine.
My daughter getting all of her two month vaccines to make sure she was safe and  fully protected. Photo by Vincent Iannelli, MD

But why are some parents so afraid of vaccines that they have panic attacks if they even think about vaccinating their baby? It certainly doesn’t help if you believe one or more of the 100 myths about vaccines that you might see on Facebook, Twitter, Pinterest, and YouTube. Or that you are likely constantly being hit with vaccine scare videos that make it sound like every child has a vaccine injury.

All of that propaganda can make you more susceptible to the cognitive biases that we all have to deal with from time to time, even leading you to believe in the many anti-vaccine conspiracy theories that are always floating around.

But fear shouldn’t be what drives your decision making.

We shouldn’t have to wait for outbreaks for folks to start vaccinating their kids again.

Get educated and understand that vaccines are safe, with few risks and many benefits. Learn to think critically, be more skeptical about the things you see and read about vaccines, and overcome your biases.

What to Know About Why You Aren’t Vaccinating Your Kids

You aren’t vaccinating your kids because something or someone has scared you and a series of cognitive bias are making it hard for you to see the truth that vaccines are safe, necessary, and that they work.

More On Why You Aren’t Vaccinating Your Kids

The Moral Responsibility of the Anti-Vaccine Movement

It shouldn’t be surprising that talk of morality comes up around the issue of vaccines from time to time.

“Scientists and clinicians confront moral and ethical choices daily and often observe a religious faith that helps guide their own personal conduct. Indeed, the religious beliefs of countless historical and contemporary researchers and clinicians have been a source of motivation to help relieve human suffering by means of immunization.”

Grabenstein on What the World’s religions teach, applied to vaccines and immune globulins

It is most often because some vaccines do have a “distant historical association with abortion.”

Even then, the National Catholic Bioethics Center states that:

One is morally free to use the vaccine regardless of its historical association with abortion. The reason is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine. This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.

That seems pretty easy to interpret.

They are saying we are both “morally free” to use these vaccines and that we “have a moral obligation” to get vaccinated.

What about those parents who feel like they shouldn’t have to vaccinate their kids, exposing them to the risks of vaccines, simply to “protect the herd?”

“Putting aside arguments about social good, herd immunity, discouraging free loading and preventing harm to others, vaccinating a child for the child’s sake is not just the right thing to do, but also the only thing to do.”

Ogbogu on Vaccines and the Ethics of Parental Choice

They should understand that:

  • they aren’t vaccinating their kids just to protect levels of herd immunity in the community – they are also providing their own kids with individual levels of immunity and protection, so it is not just about preventing harm to others
  • vaccines are safe, so the risks of getting vaccinated are very low
  • by intentionally not vaccinating their own kids, they are free-riding and benefiting from the fact that most of the rest of us do get vaccinated and do vaccinate our kids

And they should understand that there is no ethical way to defend intentionally skipping or delaying their child’s vaccines, which puts kids who can’t be vaccinated at risk.

“The society of the 21st century, just as many societies and cultures in the history of human civilization, use religion as an excuse for wars, discrimination, and now for vaccination refusal.”

Pelčić on Religious exception for vaccination or religious excuses for avoiding vaccination

Although a few folks haven’t gotten the message, and may even lie to get a fake religious vaccine exemption, most others see it the same way.

“Giving children a healthy start in life, no matter where they are born or the circumstances of their birth, is the moral obligation of every one of us. It is heartbreaking to think that three million children die each year from diseases that we can prevent.”

Nelson Mandela (2002 Vaccine Conference)

Most parents vaccinate their kids because they understand that vaccines are safe, vaccines work, and vaccines are necessary, just as they likely also understand that there is a moral obligation to vaccinate.

“The argument relating to public goods can be added to the harm-to-others arguments. Where a public good, such as herd protection, exists we must take care not to damage it. The need to create and maintain such a good provides an additional reason, should one be needed, to argue in favour of a moral obligation for the traveller to be vaccinated in advance for infectious disease.”

Dawson on What are the moral obligations of the traveller in relation to vaccination?

And if there is a moral obligation to get vaccinated, then what does that say about those who push propaganda that scares parents away from vaccinating and protecting their kids?

“The anti-vaccine argument is wrong in both the scientific and moral sense.”

Sarah Kurchak on Here’s How the Anti-Vaccination Movement Hurts Autistic People

Dr. Vytenis Andriukaitis, the EU Health Commissioner, is the latest to call out those in anti-vaccination movements, who he says have the “moral responsibility” for the death of unvaccinated children.

“I would like to draw attention to the fact that all these movements, which use different arguments, do not understand what they are doing. It would be a shame if the families belonging to this movement were to bury their children, as happened this year in the Member States where children have died of measles.

I would like to invite those who are against the vaccines to visit families, to visit the tombs of the children of those families, and to think what they are doing. I would like to invite all these anti-aging movements to visit the European cemeteries of the nineteenth century, of the eighteenth century, beginning of the twentieth century: they will find many tombs of small children, because there were no vaccines.”

Vytenis Andriukaitis, MD (translated from Italian)

Dr. William Osler's vaccine challenge in his 1911 essay Man's Redemption of Man.
Dr. William Osler’s vaccine challenge in his 1911 essay Man’s Redemption of Man.

This brings to mind another challenge that was made to anti-vaccine activists just over one hundred years ago by Dr. William Osler in his essay Man’s Redemption of Man.

Dr. Osler jokingly proposed a small vaccinated vs unvaccinated study and challenged ten unvaccinated people, including “three anti-vaccination doctors, if they could be found,” to join him in the “next severe epidemic.”

Tragically, Dr. Osler wouldn’t have a hard time finding three anti-vaccination doctors today.

He would have an easy time recognizing their arguments, as they really haven’t changed over the past 100 years.

Neither is the fact that kids are still dying of diseases that are now vaccine-preventable.

What to Know About the Moral Responsibility of the Anti-Vaccine Movement

Many people believe that we have a moral responsibility to protect ourselves, our families, and those around us from vaccine-preventable diseases by getting vaccinated and it is immoral to push misinformation that scares parents away from vaccinating and protecting their kids.

More on the Moral Responsibility of the Anti-Vaccine Movement