Tag: outbreaks

Diphtheria in Canada

A lot of people were surprised by the news of a case of diphtheria in Canada this past week.

Some folks were quick to blame the anti-vaccine movement, assuming it was in an unvaccinated child.

News soon came that the child was vaccinated!

“I’ve always been on top of that, I’m a firm believer in immunizations.”

Mother of 10-year-old with diphtheria

What happened next?

Anti-vaccine folks began using the fact that he was vaccinated, but still developed diphtheria, as some kind of proof that vaccines don’t work.

The Case of Diphtheria in Canada

They are wrong.

The diphtheria vaccines have worked very well to control and eliminate diphtheria from Canada, just like it has in the United States.

Diphtheria has become rare since the pre-vaccine era.
Diphtheria has become rare since the pre-vaccine era.

So how did a vaccinated child in Canada get diphtheria?

It’s simple.

He has cutaneous diphtheria, not respiratory diphtheria.

What’s the difference?

“Extensive membrane production and organ damage are caused by local and systemic actions of a potent exotoxin produced by toxigenic strains of C. diphtheriae. A cutaneous form of diphtheria commonly occurs in warmer climates or tropical countries.”

Vaccines Seventh Edition

Cutaneous diphtheria occurs on your skin. It is usually caused by non-toxigenic strains of Corynebacterium diphtheriae.

On the other hand, respiratory diphtheria is usually caused by toxigenic strains of Corynebacterium diphtheriae.

Diphtheria strikes unprotected children.The diphtheria vaccine (the ‘D’ in DTaP and Tdap), a toxoid vaccine, covers toxigenic strains. More specifically, it covers the toxin that is produced by toxigenic strains of Corynebacterium diphtheriae. It is this toxin that produces the pseudomembrane that is characteristic of diphtheria.

It was the formation of this pseudomembrane in a child’s airway that gave diphtheria the nickname of the “strangling angel.”

So why the fuss over this case in Canada? They likely don’t yet know if it is a toxigenic strain. If it is, then it could be a source of respiratory diphtheria.

But remember, even if these kids developed an infection with the toxigenic strain of Corynebacterium diphtheriae, those that are fully vaccinated likely wouldn’t develop respiratory diphtheria. Again, it is the toxin that the bacteria produces that cause the symptoms of diphtheria. The vaccine protects against that toxin.

For example, when an intentionally unvaccinated 6-year-old in Spain was hospitalized with severe diphtheria symptoms a few years ago, although many of his friends also got infected, non of them actually developed symptoms because they were all vaccinated.

Diphtheria Is Still Around

Diphtheria is DeadlyTragically though, especially since diphtheria is still endemic in many countries, we are starting to see occasional lethal cases of diphtheria in many more countries where it was previously under control:

  • at least 7 diphtheria deaths in Venezuela this past year
  • a family that became infected in South Africa in which at least one child died (August 2017)
  • an unvaccinated 3-year-old who died in Belgium (2016)
  • a 22-year-old unvaccinated women who died in Australia (2011)

It is even more tragic that diphtheria is not under control in so many more countries.

In 2016, the WHO reported that there were just over 7,000 cases of diphtheria worldwide. While that is down from the 30,000 cases and 3,000 deaths in 2000, thanks to improved vaccination rates, there is still work to be done.

And as this recent case in Canada shows, diphtheria is still around in many more places than we would like to imagine.

Get educated. Vaccines are necessary.

What to Know About Diphtheria in Canada

The case of cutaneous diphtheria in Canada is a good reminder that vaccines are still necessary.

More on Diphtheria in Canada

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

Polio Survivor Stories

You probably don’t know anyone who ever had polio.

The Last Case of Polio

After all, the United States has been free of polio since 1979. At least that’s when we had the last endemic case or the last case that originated here.

The last case was in 1993. At least that’s when we had the last imported case of polio in the United States.

A 2005 outbreak of vaccine derived poliovirus in 2005 among a group of unvaccinated Amish in Minnesota didn’t cause any symptoms. They had probably been exposed to someone outside the United States that was still shedding after getting an oral polio vaccine, which hadn’t been used in the United States since 2000.

And then there were these following “last cases:”

  • The last case of VAPP that was acquired in the United States – 1999.
  • The last case of VAPP that was acquired outside the United States – 2005 – an unvaccinated 22-year-old U.S. college student who became infected with polio vaccine virus while traveling in Costa Rica in a university-sponsored study-abroad program.

And then there is the final last case of VAPP – 2009 – a patient with a long-standing combined immunodeficiency who was probably infected in the late 1990s, even though she didn’t develop paralysis until years later.

Polio Survivor Stories

Since vaccines work and the United States has essentially been polio free since 1979, it wouldn’t be surprising if you don’t know anyone who ever had polio.

Or do you?

“The doctors told my parents that little could be done for me, so my father prepared for my funeral. Fortunately, I recovered, except for the use of my right hand.”

Archbishop Desmond Tutu on Vaccination’s Lifetime of Blessings

You might not have ever have even heard of anyone who had polio?

Or have you?

A few recent news stories highlight just how common polio used to be in the pre-vaccine era:

  • Mitch McConnell Wouldn’t Meet with the March of Dimes Even Though They Treated His Polio as a Child
  • Joni Mitchell – after the stuff about Morgellons, you can read about how she battled polio as a child

“When Joni turned 10 years old in late 1953, she woke up one morning paralyzed. It was quickly diagnosed and she was shipped to a polio colony in Saskatoon – similar to a leper colony designed to halt the spread of the disease.”

Do you know who else had polio?

Itzhak Perlman, a polio survivor, now works to end polio.
Itzhak Perlman, a polio survivor, now works to end polio.
  • Alan Alda
  • Arthur C. Clarke
  • Francis Ford Coppola – “contracted polio and spent almost a year in bed, his legs paralyzed.”
  • Mia Farrow
  • Frida Kahlo
  • Jack Nicklaus
  • Itzhak Perlman – has needed crutches to walk since he contracted polio at age 4 years
  • David Sanborn
  • Dinah Shore
  • Donald Sutherland
  • Desmond Tutu –
  • Neil Young

Of course, in addition to all of the polio survivor stories, there are stories that aren’t told of the people who didn’t survive polio.

Except when those stories are told too…

For anyone who wants to say that polio is mild or spread other myths about polio, please be sure to read these stories.

What to Know About Polio Survivor Stories

Reading polio stories, from survivors and of those who died, helps reinforce how important it is that we eradicate this vaccine-preventable disease as soon as possible.

More About Polio Survivor Stories

Updated November 24, 2017

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Vaccines are Necessary

We know that vaccines are safe, even if they can have some side effects and risks.

And we know that vaccines work, even if they don’t work 100% of the time.

In fact, vaccines work so well, that they have eliminated or controlled many of the vaccine-preventable diseases that we still get vaccinated against.

Are Vaccines Still Necessary?

So that leaves some people asking themselves – even if the benefits of vaccines far outweigh their risks, are vaccines still necessary?

“So what I did on my schedule is, I took a more logical look at hepatitis B, and I realized that babies have no risk of catching this disease, so let’s not do the hep B vaccine while a baby’s young and small and more vulnerable.”

Dr. Robert W. Sears on Why Partial Vaccinations May Be an Answer

After all, most of us don’t travel to developing countries or do other things to put ourselves or our kids at risk of getting a vaccine-preventable disease, right?

And we probably don’t have conditions that put us at high risk of getting sick either?

So isn’t it safe to just skip or delay many of the shots on the routine immunization schedule?

Shouldn’t some of them just be optional now?

Vaccines Are Necessary

Alternative vaccine schedules? Optional vaccines? No risk of getting diseases? Those are the arguments you will see on many anti-vaccine websites and forums, but they certainly aren’t logical arguments.

“The reason I delay the polio vaccine on my alternative schedule is that we don’t have polio in the United States. We haven’t had it here for over 30 years. We’ve been very fortunate because the vaccination program for polio has been so successful, now we’re reaping the rewards of not having to worry about this disease.”

Dr. Robert W. Sears on Why Partial Vaccinations May Be an Answer

Did you know that an unvaccinated group of Amish children got infected with polio in 2005?

Or that an otherwise healthy, unvaccinated 22-year-old U.S. resident became infected with polio vaccine virus, developing paralytic polio, while traveling in Costa Rica in a university-sponsored study-abroad program in 2005? It turns out that the granddaughter of the host family that she was staying with lived next door and had recently been vaccinated with the OPV vaccine, which does shed, and in this case caused her to develop vaccine-associated paralytic polio.

And did you know that there was a lethal case of vaccine-derived poliomelitis in Minnesota in 2009?

Apparently Dr. Bob didn’t either.

“We know that a disease that is apparently under control can suddenly return, because we have seen it happen, in countries like Japan, Australia, and Sweden. Here is an example from Japan. In 1974, about 80% of Japanese children were getting pertussis (whooping cough) vaccine. That year there were only 393 cases of whooping cough in the entire country, and not a single pertussis-related death. Then immunization rates began to drop, until only about 10% of children were being vaccinated. In 1979, more than 13,000 people got whooping cough and 41 died. When routine vaccination was resumed, the disease numbers dropped again.”

CDC on What Would Happen If We Stopped Vaccinations?

But while polio is now on the brink of elimination, most other vaccine-preventable diseases are not. And that is why we see outbreaks any time vaccination rates drop:

  • measles – in addition to the outbreaks in the United States, there have been much bigger outbreaks across Europe, with much deadlier consequences
  • pertussis – yes, some of our pertussis outbreaks are because of waning immunity and occur in fully vaccinated children, but there were even larger outbreaks in Japan, Sweden, Italy, Ireland, Australia, and other countries in the 1970s and 1980s when immunization rates dropped, cases soared, and children died.
  • diphtheria – few people even know what diphtheria is anymore, but it is still around and causes outbreaks when immunization rates drop.
  • rubella – want to know what happens when you don’t vaccinate for rubella? just look at Japan – they had 14,357 cases of rubella and at least 31 cases of congenital rubella syndrome in 2013.
  • Hib – a 2008 outbreak in Minnesota during a temporary vaccine shortage likely reflected “increasing carriage and transmission affecting those with suboptimal primary series vaccination coverage, or a weakening of herd immunity”
  • tetanus – although tetanus isn’t contagious, we are seeing more cases in kids and pregnant women who aren’t vaccinated, as the bacteria which causes tetanus is present in spores in dirt and dust almost everywhere
  • polio – although polio is now endemic in only three countries, Afghanistan, Nigeria, and Pakistan, there are other countries where outbreaks can still occur, including the DR Congo and Syrian Arab Republic and many other high risk countries. This includes outbreaks of circulating vaccine derived polio virus, which increased this year in non-endemic countries, especially Syria because of years of poor immunization rates because of war.

Vaccines are necessary to avoid these kinds of outbreaks.

What Happens When We Don’t Vaccinate?

It should be very clear that everyone can’t try to hide in the herd.

We know what happens when  too many people don’t vaccinate their kids.

At least those of us who understand herd immunity know what happens…

In Ukraine, for example, there was a “massive epidemic” of diphtheria and other vaccine-preventable diseases in the Newly Independent States of the former Soviet Union in the early 1990s.

“This epidemic, primarily affecting adults in most Newly Independent States of the former Soviet Union, demonstrates that in a modern society diphtheria can still spread explosively and cause extensive illness and death.”

Diphtheria in the Former Soviet Union: Reemergence of a Pandemic Disease

In Ukraine alone, there were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away.

Need a more recent example?

Just look at the tragedy unfolding in Venezuela. In addition to all of the hardships the people are facing, because of a weakened health system, poor surveillance, and a lack of preventative measures, including immunizations, they are seeing a rebound of diphtheria, measles, and other infectious diseases.

After being eliminated in 1992, there have been at least 450 cases of diphtheria in Venezuela since 2016 and at least 7 deaths.

Vaccines are necessary.

Vaccine-preventable diseases will come back if we stop vaccinating our kids.

And tragically, they aren’t yet gone in many parts of the world, even those that are well controlled in more developed countries. That’s why we often say that these diseases are ‘just a plane ride away.’

Just remember that the planes travel both ways. It isn’t just you traveling to high risk areas. Sometimes folks who are sick with vaccine preventable diseases bring them home and start outbreaks.

Get educated. Get vaccinated.

What to Know About Why Vaccines Are Necessary

Until a disease is eradicated, vaccines at herd immunity levels remain necessary to keep it from returning and causing outbreaks.

More About Why Vaccines Are Necessary

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Is the Anti-Vaccine Movement Growing?

Boston Reverend Cotton Mather  actively promoted smallpox inoculation during a local epidemic.
Boston Reverend Cotton Mather actively promoted smallpox inoculation during a local epidemic.

We often have to remind people that the anti-vaccine movement didn’t start with Bob Sears, or Jenny McCarthy, or even with Andy Wakefield.

Did you know that the Reverend Cotton Mather’s house was bombed in Boston in 1721? Well, someone through a bomb through his window. Fortunately, it didn’t go off.

That’s 77 years before Jenner developed his smallpox vaccine!

What was Mather doing?

He had started a smallpox variolation program. He was trying to protect people in Boston from smallpox during one of the most deadly epidemics of the time.

So essentially, the anti-vaccine movement started before we even had real vaccines…

Is the Anti-Vaccine Movement Growing?

You see reports of more and more outbreaks of vaccine-preventable diseases, hear about new vaccine laws and mandates, and depending on who your friends are, may see a lot of anti-vaccine articles and vaccine injury stories getting shared on Facebook.

You have probably even heard about pediatricians firing families who refuse to vaccinate their kids.

So what’s the story?

Is the anti-vaccine movement growing?

Is there a growing resistance among parents to getting their kids vaccinated?

“Parents are taking back the truth. It is my expectation that this crack in the dam will serve to sound an alarm. To wake women up. To show them that they have relinquished their maternal wisdom, and that it is time to wrest it back.”

Kelly Brogan, MD

Is the world finally “waking up to the dangers of vaccines,” like many anti-vaccine experts have been claiming for years and years?

The Anti-Vaccine Movement is not Growing

Many people will likely tell you that the anti-vaccine is in fact growing.

You can read it in their headlines:

  • The worrying rise of the anti-vaccination movement
  • Will 2017 be the year the anti-vaccination movement goes mainstream?
  • Pediatricians calling anti-vaccine movement a growing problem
  • There’s Good Evidence That The Anti-Vaccine Movement Is Growing
  • I was skeptical that the anti-vaccine movement was gaining traction. Not anymore.

But the anti-vaccine movement is not necessarily growing.

The overwhelming majority of parents and adults are fully vaccinated.

What we do have is a very vocal minority of people who do their best to push misinformation and conspiracy theories about vaccines and vaccine dangers, and not surprisingly, they have some new ways to do it. Unfortunately, they use their anti-vaccine talking points to scare vaccine hesitant parents and those who might now be on the fence about vaccines to sometimes delay or skip some vaccines.

Most parents do their research though, don’t jump on the anti-vaccine bandwagon, and know that vaccines work, vaccines are safe, and vaccines are necessary.

The Anti-Vaccine Movement is Changing

A lot about the anti-vaccine movement hasn’t changed over the last 100 plus years.

Many early critics of vaccines were alternative medicine providers, including homeopaths and chiropractors, just like we see today. And like they do today, they argued that vaccines didn’t work, vaccines were dangerous, and that vaccines weren’t even necessary.

alicia-silverstone

The big difference?

Unlike when Lora Little, at the end of the 19th century, had to travel around the country to distribute her anti-vaccine pamphlet, Crimes of the Cowpox Ring, anti-vaccine folks can now just tweet or post messages on Facebook. It is also relatively easy to self-publish an anti-vaccine book and sell it on Amazon, put up your own anti-vaccine website, post videos on YouTube, or even make movies.

“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

Fortunately, all of that is balanced by something they don’t have anymore.

No, it’s not science. That was never on their side.

It’s that the media has caught on to the damage they were doing and isn’t as likely to push vaccine scare stories anymore.

Explaining the Popularity of the Anti-Vaccine Movement

The anti-vaccine movement has always been around and they are likely not going anywhere, whether or not they are growing.

Looking at the history of the anti-vaccine movement, it is clear that they have their ups and downs, times when they are more or less popular, but they are always there.

“By the 1930s… with the improvements in medical practice and the popular acceptance of the state and federal governments’ role in public health, the anti-vaccinationists slowly faded from view, and the movement collapsed.”

Martin Kaufman The American Anti-Vaccinations and Their Arguments

Why so many ups and downs?

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

It is easily explained once you understand the evolution of our immunization programs, which generally occurs in five stages:

  1. pre-vaccine era or stage
  2. increasing coverage stage – as more and more people get vaccinated and protected, you pass a crossover point, where people begin to forget just how bad the diseases really were, and you start to hear stories about “mild measles” and about how polio wasn’t that bad (it usually wasn’t if you didn’t get paralytic polio…)
  3. loss of confidence stage – although vaccine side effects are about the same as they always were, they become a much bigger focus because you don’t see any of the mortality or morbidity from the diseases the vaccines are preventing. It is at this point that the anti-vaccine movement is able to be the most effective.
  4. resumption of confidence stage – after the loss of confidence in stage three leads to a drop in vaccine coverage and more outbreaks of a vaccine-preventable disease, not surprisingly, more people understand that vaccines are in fact necessary and they get vaccinated again. It is at this point that the anti-vaccine movement is the least effective, as we saw after outbreaks of pertussis in the UK in the 1970s and measles more recently. You also see it when there is a report of an outbreak of meningococcal disease on a college campus or a child dying of the flu on the local news, etc.
  5. eradication stage – until we get here, like we did when smallpox was eradicated, the anti-vaccine movement is able to cycle through stages two to four, with ups and downs in their popularity,

So the anti-vaccine movement is able to grow when they have the easiest time convincing you that the risks of vaccines (which are very small) are worse than the risks of the diseases they prevent (which are only small now, in most cases, because we vaccinate to keep these diseases away, but were life-threatening in the pre-vaccine era).

“As vaccine use increases and the incidence of vaccine-preventable diseases is reduced, vaccine-related adverse events become more prominent in vaccination decisions. Even unfounded safety concerns can lead to decreased vaccine acceptance and resurgence of vaccine-preventable diseases, as occurred in the 1970s and 1980s as a public reaction to allegations that the whole-cell pertussis vaccine caused encephalopathy and brain damage. Recent outbreaks of measles, mumps, and pertussis in the United States are important reminders of how immunization delays and refusals can result in resurgences of vaccine-preventable diseases.”

Paul Offit, MD on Vaccine Safety

Fortunately, most parents don’t buy into the propaganda of the anti-vaccine movement and don’t wait for an outbreak to get their kids vaccinated and protected. They understand that you can wait too long.

The bottom line – except for pockets of susceptibles and clusters of unvaccinated kids and adults, most people are vaccinated. If the anti-vaccine does grow, it eventually gets pulled back as more kids get sick.

What to Know about the Growing Anti-Vaccine Movement

Although they may have an easier time reaching more people on Twitter, Facebook, YouTube, and with Amazon, the overwhelming majority of parents vaccinate their kids and aren’t influenced by what some people think is a growing anti-vaccine movement.

More on the Growing Anti-Vaccine Movement

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Hiding in the Herd

The term herd immunity has been used for almost 100 years, since about 1923.

Other terms relating to herd immunity, like ‘hiding in the herd’ and ‘free-riding’ have come into use more recently.

Hiding in the Herd

Some people can get away with hiding in the herd.

Actually, they depend on it.

“Herd immunity is present in a community when such a high percentage of its members have been immunized from a particular disease that the disease cannot gain a foothold in the community. Thus, achieving and maintaining herd immunity protects not only those who have been vaccinated, but also those with compromised or weak immune systems, such as the elderly, babies, and those afflicted with HIV.”

Anthony Ciolli on Mandatory School Vaccinations: The Role of Tort Law

That’s because we don’t need 100% of people to be vaccinated and protected for herd immunity to work.

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions benefit from herd immunity. (CC BY 2.0)

So people who are too young to be vaccinated or fully vaccinated, people who can’t be vaccinated because they were born with an immunodeficiency or get cancer and are on chemotherapy and other true medical exemptions, and even people who are vaccinated but their vaccine didn’t work, can still hope to be protected from vaccine preventable diseases because everyone around them is vaccinated.

These people still get the benefits of herd immunity. Even though they are unvaccinated and susceptible to getting a disease, they probably won’t, because most others in the herd are vaccinated and protected.

But it is not just those people with medical exemptions who try and hide in the herd.

“These numbers have led the National Vaccine Advisory Committee to conclude that religious and philosophical exemptions do not pose a threat to public health.”

T May on Free-riding, fairness and the rights of minority groups in exemption from mandatory childhood vaccination

And that was okay too for a while. It wasn’t that long ago that “free-riding” by those using philosophical or religious exemptions wasn’t a problem, because their numbers were small and herd immunity rates could still be maintained.

Can You Hide in the Herd?

Hiding in the herd can’t work for everyone though.

Surprisingly, Dr. Bob explains that well in his vaccine book that scares parents about toxins in vaccines, while reassuring them that it is okay to space out their child’s vaccines.

“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

Basically, if too many people are trying to hide in the herd and have skipped their vaccines, then we have a breakdown in herd immunity and we start to see the return of many vaccine-preventable diseases.

These aren’t people who can’t be vaccinated though.

They are people who refuse to be vaccinated and intentionally don’t vaccinate their kids.

“In other words, hide in the herd, but do not tell the herd you’re hiding; otherwise, outbreaks will ensue. Sears’ advice was prescient. Recent outbreaks of measles in 15 states, caused by an erosion of herd immunity in communities where parents had chosen not to vaccinate their children, were the largest in the United States since 1996.”

Dr. Paul Offit on The Problem With Dr Bob’s Alternative Vaccine Schedule

And that seems to be exactly what happened as more and more parents have walked into their pediatrician’s offices with a copy of Dr. Bob’s Alternative Vaccine Schedule.

While he predicted that it would “increase vaccination rates in our country,” as most others knew,  they went down instead, and we continue to see more and more clusters of unvaccinated children.

Of course, Dr. Bob didn’t create the modern antivaccine-movement, but the bandwagoning effect he and other “thought influencers in the anti-vaccine movement” have on parents isn’t hard to see. Parents get scared by their anti-vaccine talking points and they go on to scare other parents into not vaccinating and protecting their own kids.

Tragically, the consequences of all of this was predictable too.

“If more parents insist on Sears’ vaccine schedules, then fewer children will be protected, with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases.”

Dr. Paul Offit on The Problem With Dr Bob’s Alternative Vaccine Schedule

More outbreaks of vaccine-preventable diseases.

What to Know About Hiding in the Herd

When too many people try and hide in the herd, it makes it hard to maintain necessary levels of herd immunity, which puts everyone, including medically fragile children and adults, at higher risk for getting a vaccine-preventable disease.

More About Hiding in the Herd

New Vaccine Laws and Mandates

Every good vaccine bill doesn't make it into law.
NY passed a law in 2015 that  eliminated religious exemptions to getting vaccines.

California passed a new vaccine law, SB 277, in 2015.

Most states, including California, already had vaccine mandates though. The difference now is that in California, you need a medical exception to attend school if your kids aren’t vaccinated.

With the passage of SB 277, California joined Mississippi and West Virginia as the only states that do not allow either religious or personal belief vaccine exemptions.

They still aren’t forcing anyone to get vaccinated though.

“The term mandate is somewhat misleading, because there are exceptions — always on medical grounds, frequently on religious grounds, and sometimes on philosophical grounds. Moreover, the thrust of mandates is not to forcibly require vaccination but to predicate eligibility for a service or benefit on adherence to the recommended immunization schedule of vaccination. ”

Y. Tony Yang on Linking Immunization Status and Eligibility for Welfare and Benefits Payments

And in some countries that already have mandates, they aren’t even doing a very good job of making sure that kids even get vaccinated. Many people will be surprised to learn that 14 European countries already mandate one or more vaccines, typically DTP, polio, and MMR.

What’s New in Vaccine Laws

Internationally, the idea of vaccine mandates is a big issue as we continue to see outbreaks of measles in Europe and other areas of the world.

“Parents who vaccinate their children should have confidence that they can take their children to child care without the fear that their children will be at risk of contracting a serious or potentially life-threatening illness because of the conscientious objections of others. ”

Australian Prime Minister Tony Abbott on “No Jab No Pay”

Unlike the Disneyland outbreak in California, the outbreaks in Europe are on a much bigger scale.

And with more cases we see what everyone fears – more deaths.

That’s why we are finally seeing new vaccine laws, including some that mandate vaccines in some other countries, including:

  • Australia – the Australian government began a “No Jab No Pay” plan in 2016 that removed the conscientious objector exemption on children’s vaccination for access to taxpayer funded Child Care Benefits, the Child Care Rebate and the Family Tax Benefit Part A end of year supplement.
  • Estonia – A proposal was put before the Estonian Parliament, the Riigikogu, to make immunizations compulsory.
  • Germany – a new law, if approved (it has already passed the Bundestag or national parliament), will require parents to have a medical consultation before deciding to delay or skip vaccines or they can be fined up to $2,800. Even with the law, in Germany, “vaccinations remain voluntary. But some politicians have suggested that mandatory vaccination is on the way if concerted efforts to encourage vaccinations don’t work.”
  • Italy – the Italian Parliament has given final approval to the Decree-Law Containing Urgent Measures on the Compulsory Vaccination of Children, which makes vaccinations against 12 diseases mandatory for children as a condition of school registration, for both private and public schools.
  • France – is working to expand their list of mandated vaccines to now include protection against 11 diseases instead of just three (diphtheria, tetanus, and polio). All of these vaccines were previously recommended to attend school, but were only voluntary.
  • Romania – a draft Vaccination Law could bring fines to parents who don’t vaccinate their kids and would keep them out of schools. Doctors could be fined too! The draft law is headed to Parliament for debate.

Again, none of these laws mean that anyone is being forced to vaccinate their kids.

Even in the case of vaccine mandates, they are simply requirements to attend daycare or school.

We are also seeing some new vaccine laws in the United States, including changes for the start of the 2017-2018 school year:

  • Indiana – pharmacists can give more vaccines, any vaccine that the CDC recommends, either with a prescription or by protocol for kids over are at least 11 years old and adults
  • Iowa – now requires a meningococcal vaccine for students entering 7th (one dose) and 12th (one or two doses) grades
  • Nevada – now requires a meningococcal vaccine for students entering 7th grade (one dose) and college (a dose after age 16 years)
  • Pennsylvania – unvaccinated students now only have a 5 day grace period at the start of the school year to get vaccinated (it used to be 8 months) before getting expelled from school.

It’s easy to navigate the new laws.

Get educated and get your kids vaccinated. Vaccines are safe, vaccines work, and vaccines are necessary.

What To Know About Vaccine Mandate Laws

Vaccine mandate laws are expanding as we are seeing more outbreaks of vaccine preventable diseases.

More Information on Vaccine Mandate Laws:

Updated August 20, 2017

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