Tag: herd immunity

What Percentage of Adults Are up to Date on Their Immunizations?

Are you up to date on your vaccines?

What about everyone else?

What Percentage of Adults Are up to Date on Their Immunizations?

Can you guess why this question comes up so often?

Yup.

There is no plan to force adults to get vaccinated...
There is no plan to force adults to get vaccinated…

It’s about herd immunity.

If most adults aren’t immune because they haven’t been vaccinated or don’t get boosters, then since we aren’t seeing that many outbreaks, herd immunity itself must be a myth.

The thing is though, adults were either born in the pre-vaccine era and likely earned their natural immunity or were born in the vaccine era and are vaccinated and immune.

It is also important to understand that herd immunity is disease specific, so when we talk about herd immunity for measles, it doesn’t matter if everyone has herd immunity levels of protection against hepatitis A or Hib.

And adults do get a few boosters and some vaccines that are only recommended for adults, including the shingles vaccine.

In addition, some vaccines, like Hib and Prevnar, have indirect effects, protecting adults even though they aren’t vaccinated, because vaccinated kids are less likely to become infectious.

But back to the original question, how many adults are up to date on their immunizations?

“While modest gains occurred in vaccination coverage for pneumococcal, Tdap, hepatitis A (persons with chronic liver conditions), herpes zoster, and HPV vaccination, coverage did not improve for other vaccinations and many adults remained unvaccinated with recommended vaccines. “

Vaccination Coverage Among Adults in the United States, National Health Interview Survey, 2016

While most adults are immune to what were once common childhood diseases, like measles and mumps, because they were either vaccinated or had the disease naturally, many could do better with newer vaccines that weren’t available when they were kids.

More on Adult Vaccination Statistics

False Balance About Vaccines at the Chicago Tribune

As more folks are calling out vocal vaccine deniers, many are also learning the role of the media in helping fuel the anti-vaccine movement.

“Whatever you think about Andrew Wakefield, the real villains of the MMR scandal are the media.”

Ben Goldacre on The MMR story that wasn’t

Believe it or not, there likely would not have been a big scare over the DPT vaccine in the 1970s and 80s or concerns about the MMR vaccine if the media hadn’t given so much attention to the anti-vaccine players involved.

False Balance About Vaccines at the Chicago Tribune

Folks in the media have learned their lesson though, right?

“Balance? There is no balance. There is mainstream, superstrong consensus about the value of vaccination, and on the other side … nothing else, since there is no other side. The media have made parents worry about vaccines in a lame effort to provide balance and all points of view.”

Arthur Caplan on There is no other side to the vaccine debate

Well, apparently not all of them…

If you are quoting anti-vaccine activists, then you are doing something wrong...
If you are quoting anti-vaccine activists, then you are doing something wrong…

Why would the Chicago Tribune devote nearly 20% of an article to a parent who is against vaccines, especially without correcting her misinformation?

Why haven’t they learned that spreading this kind of misinformation is what scares parents away from vaccinating and protecting their kids in the first place?

Are vaccinations about parent choice or public safety? That’s the title of the Chicago Tribune article. And maybe that’s why Illinois is among top 5 states for measles as debate heats up, the rest of the title…

How about we give parents a chance to make informed choices without being influenced by propaganda and misinformation?

More on False Balance About Vaccines at the Chicago Tribune

Why Did Anti-Vaccine Folks Applaud Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Wait, what?

Why Did Anti-Vaccine Folks Applaud Rand Paul's Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Anti-vaccine folks actually applauded Rand Paul’s testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Why Did Anti-Vaccine Folks Applaud Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Surprisingly, many of the things he said weren’t anti-vaccine.

I guess they ignored those parts…

  • …given the choice, I do believe that the benefits of most vaccines vastly outweigh the risks.
  • I’m not hear to say don’t vaccinate your kids… if this hearing is for persuasion, I’m all for the persuasion. I vaccinated myself. I vaccinated my kids.
  • For myself and my kids, I believe that the benefits of vaccines greatly outweigh the risks…

So why were they cheering?

Because that’s not all he said…

“Today, instead of persuasion, many governments have taken to mandating a whole host of vaccines, including vaccines for non-lethal diseases.”

Sen Rand Paul

While some vaccine-preventable diseases are more deadly than others, they can all be deadly. From rotavirus and HPV to hepatitis A, these diseases can kill people.

Which vaccine-preventable disease does he think is non-lethal?

“Sometimes these vaccine mandates have run amok. As when the government mandated a rotavirus vaccine that was later recalled because it was causing intestinal blockage in children.”

Sen Rand Paul

That’s an interesting example of “the government” that has run amok…

Which “government” mandated that the original rotavirus vaccine be given to children?

As Senator Paul hopefully understands, the Federal government doesn’t mandate vaccines for anyone. And since it must be given at such a young age, even states don’t actually mandate that the rotavirus vaccine be given to children…

Even today, there are no mandates for the rotavirus vaccine.

If there were, it still wouldn’t mean giving up your Liberty, after all, vaccine mandates don’t mean forced vaccination.

“It is wrong to say that there are no risks to vaccines. Even the government admits that children are sometimes injured by vaccines. Since 1988, over $4 billion has been paid out from the Vaccine Injury Compensation Program. Despite the government admitting to and paying $4 billion for vaccine injuries, no informed consent is used or required when you vaccinate your child. This may be the only medical procedure in today’s medical world where an informed consent is not required. “

Sen Rand Paul

No one says that there are no risks to vaccines. That’s a classic anti-vaccine talking point.

What folks actually say is that vaccines are safe, with few serious risks.

And the $4 billion that Rand Paul and anti-vaccine folks often talk about has been paid out over more than 30 years, during a time that we have given nearly 300 million doses of vaccines each and every year!

But what’s that he said about informed consent?

Why wouldn’t informed consent be given or be required before getting a vaccine?

Of course, parents get informed consent before getting vaccines.

They don’t get informed consent if they decide to skip or delay their child’s vaccines after getting bad information.

“Now proponents of mandatory government vaccination argue that parents who refuse to vaccinate their children risk spreading these diseases to the immunocompromised community. There doesn’t seem to be enough evidence of this happening for it to be recorded as a statistic, but it could happen. But if the fear of this is valid, are we to find that next we will be mandating flu vaccine?”

Sen Rand Paul

Lastly, why didn’t Sen Paul find evidence that intentionally unvaccinated kids are spreading disease to the immunocompromised community?

Maybe he didn’t look…

It happens.

Do we need it to happen more often so that it becomes a large statistic before he and others will advocate that folks get vaccinated to attend school?

Do you understand have a better understand now why anti-vaccine folks were cheering after his testimony?

“If you believe in Liberty, that’s fine, don’t get immunized. But I don’t think that you need to necessarily expose others to disease.”

Sen Bill Cassidy

It should give you a better understanding both of Rand Paul’s ideas and those of the anti-vaccine movement.

More on Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks

Bob Sears on Hiding in the Herd

How do some intentionally unvaccinated kids get away without getting sick?

Mandatory vaccination laws still don't mean forced vaccination.
Mandatory vaccination laws still don’t mean forced vaccination.

How does a pediatrician get away without seeing kids harmed by vaccine-preventable diseases?

Bob Sears on Hiding in the Herd

Most folks know the answer…

“And in my 20 years of pediatric practice, I have never once seen a child seriously harmed by a vaccine-targeted infection. Oh sure, I’ve seen kids get sick. And they all get better. And this is in a practice where most of my patients don’t vaccinate (or don’t anymore after one child suffers). So if anyone should be seeing kids get harmed from infections, it should be me, right? But not even one. “

Bob Sears

There are a few simple reasons that all of Dr. Bob’s intentionally unvaccinated kids all get better when they get sick.

In addition to respiratory problems (think iron lungs), polio causes muscle atrophy.
In addition to respiratory problems (think iron lungs), polio causes muscle atrophy. (CC BY-NC 4.0)

For one thing, vaccine-preventable diseases don’t kill every single person that gets them! Even in the pre-vaccine era, most kids did recover. Tragically though, not all did. And not all did without complications.

That’s why we say that you have to earn your natural immunity.

Even more importantly though, since most other parents vaccinate their kids, his intentionally unvaccinated kids are simply at less risk to get a vaccine-preventable disease.

They are hiding in the herd – free-riding and benefiting from the herd immunity that’s provided by those of us who do vaccinate and protect our kids.

Mostly though, Dr. Bob has been lucky.

185 kids, mostly unvaccinated, died with the flu last year.
185 kids, mostly unvaccinated, died with the flu last year.

And so have his patients.

They are especially lucky that more folks don’t listen to him and instead understand that vaccines are safe, with few risks.

“Here’s the thing…it doesn’t matter if vaccines played a role in reducing the incidence of certain diseases in industrialized nations 60 years ago. Yep, I said it. ***Decades have passed and we’re STILL vaccinating like we are in a developing country and it’s the year 1900.***”

Melissa Floyd

Remember, it wasn’t that long ago that kids were dying from Hib meningititis, Hib epiglotittis, pneumococcal disease, meningococcal disease, hepatitis B, and rotavirus. You don’t have to go back 60 years or all of the way to 1900!

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

And that so many people do get vaccinated is the only thing keeping these diseases from coming back at even higher numbers.

Even Dr. Bob used to know that…

More on Bob Sears on Hiding in the Herd

Del Bigtree on the Government’s Plan to Force Inject Stuff into Your Body

Del Bigtree considers himself to be an expert on vaccines.

Bob Sears doesn't consider media talk show hosts to be expert sources of medical information.
Does Bob consider Del an expert source of medical information?

Either Bob Sears disagrees or he really does think that measles is a deadly epidemic…

Del Bigtree on the Government’s Plan to Force Inject Stuff into Your Body

What makes Del Bigtree an expert on vaccines?

Del’s claim to fame is that he “was an Emmy Award-winning producer on the daytime talk show The Doctors, for six years.”

Del Bigtree shared a Daytime Emmy Award with 27 other producers...

So he shared a Daytime Emmy Award with 27 other producers…

And he produced Andrew Wakefield‘s Vaxxed movie. The whistleblower movie that didn’t actually include the whisteblower…

It sounds like pure anti-vaccine propaganda…

So what did Del have to say in Washington?

“These crowds are gathering all over the nation because we are talking about having the government force inject free citizens. Think about it. Take vaccines out of it. We are going to force inject children of free parents.

Now there are people that are really worried about Donald Trump. He is forcing a wall to be built on the border of this country, but now we are not worried about a forced injection by the government?

If someone worse than Trump, someone more dangerous, more controlling… This person puts in the CDC, the head of the CDC, the head of the FBI, the head of the NIH, the head of the EPA… Do we really want to give the government power over our bodies where we have no say on what it injects into us? This isn’t an issue about vaccines. This is an issue about the last thing we can control in a free country which is our bodies.”

Del Bigtree

Of course, no one is talking about forcing anyone to vaccinate their kids. That’s not what a vaccine mandate to go to school does.

But that’s not all…

Alex Jones Del included a lot of standard anti-vaccine misinformation that we hear over and over again:

He also mentioned his lawsuits against the HHS and FDA which he thinks “proves that none of this science is really there.”

“I actually want my children to have the measles. This is a disease that only affected killed 1 in 500,000 in 1960 before the vaccine ever arrived. You’ll hear 1 in 1,000, that’s a lie. Technically, 1 in 10,000 people who get the disease could die from it. Those are tiny numbers. That’s the same number that autism used to be.”

Del Bigtree

Tiny numbers?

Just remember that in 1960, there were 434 measles deaths in the United States.

And while the great majority of people did indeed survive having measles, it was hardly a walk in the park. Most people describe kids with measles as being miserable, with a high fever for a week, a cough, and other symptoms, which is why they often end up going to the ER several times before they finally get diagnosed.

Which brings me to perhaps the only time I might ever agree with Bob Sears – folks like this should not be considered medical experts!

“But I would think when you have a child with autism, you know, or on the spectrum, you have no reference point. You have no…

I don’t want this to sound wrong, but it’s a little bit more like having a dog or a Doberman or something that you don’t understand how it thinks, you don’t know. I mean, I mean a better figure than animal reference except… you don’t have their brain.

Or you hear about stories of people that bring home of exotic you know of chimpanzee or something where they can’t, and this is not sounding right.”

Del Bigtree

Not about vaccines, and certainly not about autism.

More on Del Bigtree

Dr. Bob Puts the Nail in the Coffin of the Herd Immunity Argument

Dr. Bob Sears, who actually wrote a book about vaccines, seems to think that he and his podcasting sidekick have put the nail in the coffin “of trying to use the herd immunity argument to justify coerced vaccinated.”

Dr. Bob seems to think that herd immunity doesn't apply to vaccines.

The meme he shared even includes the hashtag stating that herd immunity doesn’t apply to vaccines.

Dr. Bob Puts the Nail in the Coffin of the Herd Immunity Argument

While arguing against the idea of herd immunity and for coerced vaccination are common among anti-vaccine folks, neither is true.

Herd immunity is real and no-one is going to force anyone to vaccinate their kids. Vaccine mandates do not mean forced vaccination.

What about the idea that “all vaccines wane within about 2-15 years, leaving vaccinated children & adults unprotected?”

If that were true, then wouldn’t everyone who got sick in latest outbreaks be vaccinated? Why are most folks unvaccinated?

So we are either getting a lot of outbreaks because of waning immunity or your titers are getting boosted because you are getting exposed to so much natural disease. Got it?

While waning immunity is an issue for some vaccines, like mumps and pertussis, the primary and secondary failure rates are still not as bad as Dr. Bob suggests, which is why, in an outbreak, the attack rate of disease is always higher among those who are unvaccinated and unprotected.

The numbers don't always add up correctly when anti-vax folks try to do math.
The numbers don’t always add up correctly when anti-vax folks try to do math.

Is herd immunity the main argument that’s made when experts suggest we need stronger vaccine laws? I always thought the main argument is that folks should just vaccinate and protect their kids, but maintaining herd immunity so that your intentionally unvaccinated kids don’t put everyone else at risk is a good reason too.

Does everyone see the problem with Melissa Floyd’s math? This probably won’t be on the SAT, but you still want to get this right…

Like many others are doing right now, she used state level data. Since many of the folks who don’t vaccinate their kids cluster together in the same communities and schools, the “2% of those filing for exemptions” end up making up 10, 20, or even 30% of some school’s student population.

“This means if you are a primary non-responder, you are walking around every day with a false sense of security, clinically unvaccinated for that particular disease.”

Melissa Floyd

This is the whole point of herd immunity!

Because vaccines aren’t 100% effective, we can walk around all day without actually thinking about it much, hoping that we can rely on the fact that most other people are also vaccinated and protected. That keeps disease out of our community or herd.

The system typically breaks down though, not because vaccines aren’t effective enough, but because too many folks don’t get vaccinated.

“A 2011 article in “Vaccines”, edited by Stanley Plotkin, says, “Much of the early theoretical work on herd immunity assumed that vaccines induced solid immunity against infection…” Theoretical… Assumed…”

Melissa Floyd

She should have read the whole article, or at least used the whole quote…

“Much of the early theoretical work on herd immunity assumed that vaccines induce solid immunity against infection and that populations mix at random, consistent with the simple herd immunity threshold for random vaccination of Vc = (1-1/R0), using the symbol Vc for the critical minimum proportion to be vaccinated (assuming 100% vaccine effectiveness). More recent research has addressed the complexities of imperfect immunity, heterogeneous populations, nonrandom vaccination, and freeloaders.”

Herd Immunity: A Rough Guide

It doesn’t say what she thinks it says…

“Indeed, one might argue that herd immunity, in the final analysis, is about protecting society itself.”

Herd Immunity: A Rough Guide

So why haven’t we eradicated measles like we said we would?

“What’s funny is after the measles vaccine was licensed in 1963, the medical community declared a goal of eradicating measles by 1967. But 1967 came and went and it still wasn’t gone, 1977, 1987, 2000… the dates kept getting pushed, and the result was always the same. Meanwhile they continued to increase the hypothesized “herd immunity threshold”, eventually winding up at the extremely high 95% you hear today. “

Melissa Floyd

That’s actually a good question.

What happened to the previous goals of eliminating measles?

“In 1966, the USA began an effort to eradicate the disease within its own borders. After a series of successes and setbacks, in 2000, 34 years after the initial goal was announced, measles was declared no longer to be endemic in the USA.”

Orenstein et al on Eradicating measles: a feasible goal?

Along the way, we have gone from an estimated 100 million cases and 5.8 million deaths in 1980 and an estimated 44 million cases and 1.1 deaths in 1995 to “just” 7 million cases and 89,780 deaths in 2016.

“Under the Global Vaccine Action Plan, measles and rubella are targeted for elimination in five WHO Regions by 2020.”

Measles

While there is doubt that we can truly eradicate measles with the current vaccine, we can certainly control and eliminate measles if folks stop listening to anti-vaccine propaganda and they get vaccinated and protected.

More on Dr. Bob and His Herd Immunity Arguments

Why Haven’t We Eradicated Measles Already?

The first measles vaccine was developed in 1963.

So why do we still have measles?

Shouldn’t measles be on the list with all of the other eradicated diseases, like smallpox and, well smallpox…

Why Haven’t We Eradicated Measles Already?

Eradicating a disease is not as simple as developing a vaccine.

If it were, a lot of diseases would have been eradicated already.

Hopefully, we will add more to the list of eradicated diseases, but there are some that will never be eradicated. Tetanus, for example, is ubiquitous in soil, so would be nearly impossible to eradicate. Other diseases, like rabies and yellow fever, would be hard to eradicate because they can infect animals or insects.

What about measles?

Anti-vaccine folks do not understand herd immunity.

While there was never a goal to eradicate measles by 1967, we have missed several deadlines to get measles under better control.

What was the first deadline?

“Recent successes in interrupting indigenous transmission of measles virus in the Americas and in the United Kingdom prompted the World Health Organization (WHO), Pan American Health Organization (PAHO), and CDC to convene a meeting in July, 1996 to consider the feasibility of global measles eradication.”

Measles Eradication: Recommendations from a Meeting Cosponsored by the World HealthOrganization, the Pan American Health Organization, and CDC

Folks started talking about measles eradication in 1996.

Before that though, there had been a goal to eliminate measles in the United States.

“An effort is underway to eliminate indigenous measles from the United States; a target date of October 1, 1982 has been set.”

Although we missed that initial target date, we weren’t too far off.

“In 1978, the US Public Health Service initiated a Measles Elimination Program with the goal of eliminating measles from the United States by 1982. The goals of this program included (1) maintenance of high levels of immunity,(2) careful surveillance of disease, and (3) aggressive control of outbreaks. Unfortunately, the program failed, predominantly because of the failure to implement the recommended vaccination strategy and because of vaccine failure. An increase in measles cases was sustained from 1983 through 1991 and was particularly dramatic from 1989 through 1991.”

Poland et al on Failure to Reach the Goal of Measles Elimination

There is also the fact that measles is just so dang contagious!

Improving vaccination rates and a two-dose MMR schedule helped decrease measles rates even further and finally eliminate the endemic spread of measles in the United States in 2000.

What were some other deadlines and goals?

  • In 1989, the World Health Assembly resolved to reduce measles morbidity and mortality by 90% and 95%, respectively, by 1995, compared with disease burden during the prevaccine era.
  • In 1990, the World Summit for Children adopted a goal of vaccinating 90% of children against measles by 2000.
  • Regional measles-elimination goals have been established in the American Region (AMR) by 2000, the European Region (EUR) by 2007, and the Eastern Mediterranean Region (EMR) by 2010.
  • A regional measles-elimination goals have been established in the Western Pacific (WPR) by 2012.
  • In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan with the objective to eliminate measles in four World Health Organization (WHO) regions by 2015 – the Region of the Americas, EUR, EMR, and WPR.
  • Countries in all six WHO regions have adopted goals for measles elimination by 2020.

Obviously, we haven’t hit all of the goals and deadlines on time.

What have we done?

We have tremendously reduced the number of children who get measles and who die with measles. For example, instead of meeting the 2010 goals of decreasing global measles mortality by 90% over 2000 levels, we have decreased it by 74%. The world has gone from an estimated 100 million cases and 5.8 million deaths in 1980 and an estimated 44 million cases and 1.1 million deaths in 1995 to “just” 7 million cases and 89,780 deaths in 2016.

There is still some work to be done though, especially with the uptick in cases and deaths in the last few years.

“Eradication of both measles and rubella is considered to be feasible, beneficial, and more cost-effective than high-level control.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review report: Background and summary

Work that we can still do if everyone makes the commitment to implement their elimination plans.

And folks vaccinate and protect their kids!

What’s the alternative?

To go back to when even more kids got sick and died with measles?

More on Eradicating Measles