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Friday, August 16, 2019

Vaccines

I have no particular brief against vaccines. They work, they reduce and eliminate nasty diseases. They are an important tool in the medical arsenal. But, like any tool, vaccines have problems. They aren't completely safe. After all, if vaccines are completely safe, then:
  1. Why does the federal government maintain a National Vaccine Injury Compensation Program which pays out money to, presumably, non-existent victims? Certainly, fiscal conservatives should be trying to shutdown this federal boondoggle, right? So, why don't vaccine supporters rail against this database and these "victim"payouts as the boondoggles they are?
  2. Why does federal law uniquely insulate vaccine manufacturers from all product-related lawsuits, and force taxpayers to provide manufacturers with both complete immunity and with federally-funded, comprehensive insurance against all damage claims?
If vaccines are completely safe, there would be no need for federal law preventing lawsuits, no need for immunity, no need for a database of "victims", no need for payouts. Instead, we have federal laws insulating vaccine manufacturers from having to pay damages, we have a federeal database of victims, and we have a history of payouts to victims listed in the federally managed database.
I can't think of another industry that has this sweet of a deal.
If vaccines are completely safe, why waste federal dollars like this?

Now, whether or not vaccines are dangerous, it is certainly the case that the diseases being vaccinated against are dangerous. For instance, it is perfectly true that measles, although not particularly deadly, can cause injury and death. It is also certainly true that vaccines have wiped out smallpox, are on the verge of wiping out polio, and have greatly ameliorated many childhood diseases like measles, diptheria, pertussis, etc. Many of the childhood diseases are QUITE deadly (e.g., diptheria), and their reduction via vaccine is a boon to mankind.

However, there are also certainly discordant notes. For instance, why are vaccines in the US federally mandated? Japan, for instance, has no mandatory vaccine policy at all. In Japan, failure to vaccinate results in the payment of a small fine, that's it, yet Japanese vaccine compliance is very high. Japan, for instance, has a 97% measles vaccination rate and measles is no longer endemic to Japan. Japan accomplished this without government mandates and without government-funded immunity for vaccine companies. But, the Japanese refusal to implement government mandates results in Westerners writing odd paragraphs like the following: 
"Although many health-related indicators, such as life expectancy and the infant mortality rate show that the health situation in Japan is among the best in the world, there is a large gap between Japan and other developed countries in the use of vaccines to prevent serious infections. For example, the 7-valent pneumococcal conjugate vaccine (PCV) was only recently approved in Japan (October 2009), more than 8 years after its approval in the UK. Many common vaccines, including those for measles, mumps, and rubella (MMR), the inactivated poliovirus vaccine, and combination vaccines, are not yet available in Japan....
[T]he epidemiology of meningococcal meningitis, ...has an incidence of around 1000 cases per year in England and Wales [4], but only around 10–20 cases per year in Japan [5]... Meningococcal vaccines are not available in Japan."

Why does the first sentence begin with "Although"? The entire science article begins with the assumption that Japanese vaccine policies are woefully backward and absurd, because Japan does not have any government mandates regarding vaccines. Yet, if government-mandated vaccines are crucial to stopping the spread of disease, the situation that same article so blithely described above should be literally impossible. Japan has no government mandates, so it should be suffering from an enormous caseload of measles. But it doesn't. Japan is measles-free. This is documented fact. So, why is the US government involved in protecting vaccine manufacturers when the Japanese have shown us that this is not necessary?

We can ask the same question in another way: exactly how dangerous are these diseases when compared to the vaccines we use to fight them? Well, let's take measles as an example. The United States has a population of 330,000,000. There have only been 1282 measles cases in 2019 (and this is a HIGH year). So, the chances of getting measles is currently about 1 in 260,000.

Currently, the chance of even catching measles is lower than the odds of being struck by lightning (1 in 180,746). Once you have contracted the disease, the risk of an adverse measles consequence, like pneumonia, is about 1 in 20. The worst adverse reaction is the least common: only 0.2% of the people who contract measles actually die from measles (and the risk of dying can be cut by 50% if vitamin A supplements are provided). So, which is more dangerous? The measles vaccine or the measles?

To find out, multiply the possibility of catching measles (1 in 260,000) with the possibility of serious adverse reaction (1 in 20) and you have roughly 1 in 5 million chance of suffering an adverse reaction from measles. Compare this to the CDC's estimate of the likelihood of an adverse reaction to the vaccine. According to the CDC, the chance of an adverse vaccine reaction is one in a million. So, here is the paradox: vaccines have worked so well for the general population that a statistician can reasonably argue s/he is five times safer to refuse to vaccinate and risk catching measles than s/he is to get the measles vaccine.
Are anti-vax fears that vaccines will harm or kill their children rational? In many cases, those fears are not rational: many anti-vaxxers fear vaccines on completely irrational, essentially superstitious, grounds. But not always.

We must admit that some of their fears are grounded in facts which the official narrative either seriously underplays or completely dismiss. The facts, indeed, the CDC's own website, demonstrate vaccines are not completely safe. The facts do not support the idea that government-mandated vaccines, and government-funded protection of vaccine companies, are warranted. US vaccine policy does raise valid questions: if vaccines are completely safe, why DO we have government mandates and government immunity for vaccine manufacturing companies? If the individual is duty-bound to bear possibly adverse consequences of the vaccine, from whence comes this duty? When does society have the right to compel an individual to risk personal harm in order to assure a common good?

The anti-vaxxers frequently offer irrational arguments, but the pro-vax arguments aren't fully rational either, at least not from a mathematical perspective. 
Both sides need to acknowledge that the other side has valid points. It is amazing how many people on both sides of the aisle are unwilling to acknowledge that the situation is not necessarily as clear-cut as either side paints it. 

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