Tag: hiding in the herd

Did Bob Sears admit that he doesn’t “waste my breath” talking about the benefits of vaccines?

Have you noticed the bias in the anti-vaccine movement?

His advocacy against vaccines??? And what about his "educational" writings?!?
His advocacy against vaccines??? And what about his “educational” writings?!?

It’s hard to miss…

The Bias in the Anti-Vaccine Movement

Yes, that’s it.

You really only get one side from anti-vaccine folks.

But that’s not all.

In addition to never mentioning the benefits of vaccines, they make you think that:

  • you don’t have to worry about getting measles, chicken pox, and rubella, etc., anymore, because these diseases are rare, forgetting to mention that they are still relatively rare in many countries because most people are vaccinated and protected! When more folks skip or delay their vaccines, as they forget what these diseases are like and they listen to anti-vaccine propaganda, we get outbreaks, especially when they aren’t vaccinated and they travel to places where the diseases are more common!
  • everyone else overlooks the risks, when in fact, the risks of getting vaccinated and protected are just small and all of the so-called vaccine-induced diseases and other things anti-vaccine folks blame on vaccines aren’t real vaccine injuries
  • you don’t have to worry about getting measles, pertussis, or pneumococcal disease, etc., because those diseases are all mild, neglecting to mention that some people do have complications and some die when they catch them
  • if you don’t choose to vaccinate your kids on your own, someone is going to force you to get them vaccinated, overlooking that vaccine mandates don’t actually force anyone to vaccinate their kids – they are just about whether or not intentionally unvaccinated kids should be able to attend school
  • your choice to skip or delay your child’s vaccines won’t affect anyone else, failing to mention that most outbreaks are started by someone who is intentionally not vaccinated
  • if there is a risk, there must be a choice, but with their slogan, they overstate the risks of vaccines, never mention the risks of having the disease, and don’t mention the risk of your child getting other people sick, taking away their choice to keep their kids safe and healthy
  • you can always get vaccinated, but you can never get unvaccinated, neglecting to mention that you can indeed wait too long to vaccinate your kids

The biggest bias though, is not that these folks are against vaccines, but rather that everything they do and say scares parents and makes them feel that they should skip or delay their child’s vaccines, leaving them unprotected and at risk.

Stop listening to them and stop spreading their anti-vaccine propaganda.

More on the Bias in the Anti-Vaccine Movement

What Did Benjamin Franklin Say About Vaccines?

Wait, we had vaccines when Ben Franklin was around?

You can learn what Benjamin Franklin thought about vaccines from his autobiography.
You can learn what Benjamin Franklin thought about vaccines from his autobiography.

That was a long time ago.

What Did Benjamin Franklin Say About Vaccines?

Well, we had variolation

“Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety.”

Benjamin Franklin

The Benjamin Franklin quote many anti-vaccine folks are using these days (do anti-vaccine folks get daily talking points to use?) doesn’t really have anything to do with vaccines though, at least not in the way that they think it does.

“The Franklin quote he nodded to on Tuesday, ironically, means the opposite of what Paul was arguing. When Franklin said, “Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety,” he was opposing the Penn family’s attempt to carve out an exception for themselves from the Pennsylvania General Assembly’s attempt to tax their lands for the collective good of frontier defense. The liberty Franklin was defending was the liberty the rest of us deserve now, too — liberty to choose to protect ourselves.”

Saad B Omer on Rand Paul is wrong: Vaccines are no threat to liberty

It should be clear that Ben Franklin’s quote shouldn’t be used to attack vaccine mandates. If anything, it can be used to attack free-riders and those who skip or delay vaccines and try to hide in the herd!

“It is a quotation that defends the authority of a legislature to govern in the interests of collective security. It means, in context, not quite the opposite of what it’s almost always quoted as saying but much closer to the opposite than to the thing that people think it means.”

Benjamin Wittes onBen Franklin’s Famous ‘Liberty, Safety’ Quote Lost Its Context In 21st Century

Interestingly, Benjamin Franklin did famously talk about vaccines, or at least smallpox variolation.

“In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”

Benjamin Franklin

He got a little temporary safety, avoiding the side effects of variolation, but what were the consequences? What did he lose?

What do you lose when you make decisions about vaccines based on vaccine misinformation?

What do folks like Rand Paul have to gain by speaking out against vaccines?

More on Benjamin Franklin and Vaccines

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

A Legislative Guide to Advocating for Stronger Vaccine Laws

Having to get vaccinated to attend school isn’t a new idea.

In 1827, Boston mandated that all children attending public school must receive the smallpox vaccine.

Believe it or not, it wasn’t until the 1980-81 school year that there were laws in all 50 states mandating that children receive vaccinations before starting school. The smallpox vaccine wasn’t one of them…

A Legislative Guide to Advocating for Stronger Vaccine Laws

Not surprisingly, as vaccines did their job and rates of vaccine-preventable diseases dropped, politicians were able to weaken our vaccine laws.

Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions!

We are now paying the price, with increases of vaccine-preventable diseases among clusters of intentionally unvaccinated children whose parents claim non-medical vaccine exemptions.

And that’s why we are seeing more and more states work to strengthen their vaccine laws.

Legislators who want to combat vaccine exemption abuse should enact laws that make it clear that:

  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence-based medicine – not anecdotes
  • medical exemptions should be reviewed and approved by the State Epidemiologist, Deputy State Epidemiologist, or other designated professionals at the health department
  • religious exemptions, if included at all, should specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • philosophical exemptions, if included at all, should require some degree of education against the myths and misinformation that scares parents away from vaccinating their kids
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • most exemptions are temporary
  • a separate exemption application should be required for each vaccine
  • exemption rates should be tracked at the school level and should be posted on school websites

Getting an exemption shouldn’t be easier than getting vaccinated!

Become an advocate and help get more kids vaccinated. You can also help stop bad vaccine laws from being enacted in your state, including some that would make it even easier to get an exemption.

More on A Legislative Guide to Stronger Vaccine Laws

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

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 Are We Worried About 60,000 Unvaccinated Kids?

In the recent New York Times OpEd, How to Inoculate Against Anti-Vaxxers, the editorial board mentioned the 60,000 children in Texas who “remain wholly unvaccinated thanks in part to an aggressive anti-vaccine lobby.”

“But there’s like 74 million children, so I think that’s a pretty small number. I don’t know why you guys are freaking out about 60,000 really healthy babies running around. Do you know?

Hillary Simpson

Hillary Simpson obviously doesn’t understand how herd immunity works.

Do you?

Why Are We Worried About 60,000 Unvaccinated Kids?

First things first, though.

Just how many unvaccinated kids are there in Texas? How about the United States?

It is actually hard to know exactly.

It's easy to forget, with so much talk about anti-vaxxers these days, but the great majority of parents vaccinate and protect their kids!
It’s easy to forget, with so much talk about anti-vaxxers these days, but the great majority of parents vaccinate and protect their kids!

In Texas, for instance, while only a small percentage of kids get non-medical vaccine exemptions, with about 7 million children in the state (yes, there are 74 million children in the United States, but that’s not how you measure herd immunity), that adds up to a lot of unvaccinated kids.

In addition to about 60,000 unvaccinated kids in school, there are homeschooled children who aren’t vaccinated.

“We’re probably looking at more than 100,000 kids in the state of Texas who are not getting their vaccines.”

Dr. Peter J. Hotez: “A Scary Anti-Science Movement Has Become Very Strong in Texas”

But still, should we be worried about 100,000 unvaccinated kids, when there are 7 million kids in Texas?

Don’t those immunization levels still keep us above herd immunity levels of protection?

Well, they likely would, and this would indeed be less concerning if the unvaccinated children were spread out randomly throughout the entire state. Of course, that’s not what happens and we instead get clusters of unvaccinated children (and adults) in very specific schools, neighborhoods, and even churches.

There are higher numbers of unvaccinated kids in very specific parts of the states, leading to pockets where it is more likely that an outbreak could happen.
There are higher numbers of unvaccinated kids in very specific parts of the states, leading to pockets where it is more likely that an outbreak could happen.

So while it can seem like we have herd immunity levels of protection at the state or city level because of high average vaccination levels, these pockets of susceptibles who are unvaccinated and live in the same neighborhood or go to the same school (where is the Waldorf school in Texas?) can mean that we don’t have herd immunity in those places, leading to outbreaks.

And that’s why we get concerned about 60 to 100,000 unvaccinated children who:

Still, remember that the great majority of parents understand the benefits of vaccines, are not scared by anti-vaccine propaganda, and vaccinate their kids.

In 2015, for example, only 1.3% of children in the United States had received no vaccines by age 24 months. And more than 90% of children completed their primary series of vaccines.

That doesn’t mean that we shouldn’t be concerned about those who don’t, but maybe you should be a little bit more concerned about your decision to not vaccinate your kids.

More on Clusters of Unvaccinated Kids