But there's a deeper point to be made about how the human brain, and society, treats risk:
Of course it is the very success of modern vaccines that makes this complacency possible. In previous generations, when epidemic disease swept through schools and neighborhoods, it was easy to persuade parents that the small risks associated with vaccination were worth it. When those epidemics stopped--because of widespread vaccinations--it became easy to forget that we still live in a dangerous world. It happens all the time: University of Tennessee law professor Gregory Stein examined the relation between building codes and accidents since the infamous 1911 Triangle Shirtwaist factory fire in New York and discovered a pattern: accident followed by a period of tightened regulations, followed by a gradual slackening of oversight until the next accident. It often takes a dramatic event to focus our minds.
The problem is that modern society requires constant, not episodic, attention to keep it running. In his book The Escape from Hunger and Premature Death 1700-2100 Nobel Prize-winning historian Robert Fogel notes the incredible improvement in the lives of ordinary people since 1700 as a result of modern sanitation, agriculture and public health. It takes steady work to keep water clean, prevent the spread of contagious disease and ensure an adequate food supply. As long as things go well, there's a tendency to take these conditions for granted and treat them as a given. But they're not: As Fogel notes, they represent a dramatic departure from the normal state of human existence over history, in which people typically lived nasty, sickly and short lives.
This departure didn't happen on its own, and things don't stay better on their own. Keeping a society functioning requires a lot of behind-the-scenes work by people who don't usually get a lot of attention--sanitation engineers, utility linemen, public health nurses, farmers, agricultural chemists and so on. Because the efforts of these workers are often undramatic, they are underappreciated and frequently underfunded. Politicians like to cut ribbons on new bridges or schools, but there's no fanfare for the everyday maintenance that keeps the bridges standing and the schools working. As a result, critical parts of society are quietly decaying, victims of complacency or of active neglect.
That argument could be made, and perhaps should be made, just as well about financial and regulatory infrastructure. Though I'm not sure that there is any way to prevent 70-year events like the current mess, there are nonetheless decisions that seem lunatic, in retrospect. Why were Goldman, et al, allowed to lever up 30-to-1? Why, for that matter, did they want to? Well, because if you've gone for a long time without any problems, all you can see about the safeguards is that they're costing you money.
The problem is that it simply won't do to say that we ought to be institutionally risk averse. All of these arguments could be applied just as well to gay marriage or abortion law or universal health care, if you lean that way--it's no good just saying that it hasn't hurt Sweden, because the deluge might still await.
Libertarians, conservatives, and progressives all need a better metric for distinguishing between the areas where we're improving on problems, and areas where we're simply eating our institutional and cultural seed corn. Unfortunately, trial and error may turn out to be the best we've got.
I am soooooo 100% on your side regarding vaccines, Megan. (I realize that this isn't really the point of your post, but it felt relevant enough.) And, though my observations don't really count as "evidence," the people who typically refuse vaccines for their kids are exactly the same ones that demand them when there is some kind of public health scare. A couple of years ago there was a shortage of flu vaccine, which was relatively well-publicized, and the people who were most strident in their demands for vaccines were the ones who had never before gotten them for their precious little ones.
On a somewhat related note:
http://bleakonomy.blogspot.com/2009/01/stick-to-what-youre-famous-for.html
if there were polio running around wild then the people taking "personal belief" exemptions would almost all be lining up at the doctor's office. I was in school when the Salk vaccine was invented. It was a magical gift that removed a huge burden of fear and worry from parenting. Jonas Salk became an overnight hero. If you were not around in 1955 you cannot believe the feeling of relief that swept the country.
That's much of the problem, Robert. We now live in an age and country where a great many illnesses have been practically eradicated because of vaccines, and so people presume they are no longer threats. Many are more than happy to piggy-back on the good citizenship of other parents (for it is nothing other than bad citizenship to expect others to assume a risk that you refuse for yourself or your loved ones) with regard to public health.
Libertarians, conservatives, and progressives all need a better metric for distinguishing between the areas where we're improving on problems, and areas where we're simply eating our institutional and cultural seed corn.
Well, a good place to start is: if it only affects you, go ahead. When it starts to affect others, be conservative.
IOW: You want to have a party, and say that you and your same sex partner are "married"? Great. Go for it.
You want to change the way society, or the State, defines marriage? Prove that your change is good.
You want to avoid vaccines? Great. Go for it.
You want to send your kids out to interact with other kids, but not have your kids vaccinated? Sorry, no can do. Threaten yourself all you want. But your unvaccinated child is a threat to others.
IOW, the second you decide you want others to "validate" your choices, you become bound by others desires.
Funny.
A semi-literate libertarian praising the argument of a semi-retarded libertarian that utterly demolishes libertarian first principles.
Like I said. Funny.
I'll just endorse this from Greg Q.
You want to avoid vaccines? Great. Go for it.
You want to send your kids out to interact with other kids, but not have your kids vaccinated? Sorry, no can do. Threaten yourself all you want. But your unvaccinated child is a threat to others.
I don't want anyone to be forcibly vaccinated, or forced to vaccinate their kids. But if don't, sorry, no public buildings for you. No mass transit. No airplane rides.
Oh, that's easy to answer. It's rational behavior because you're risking other peoples' money. Think about it: you're in a business where the sky's the limit for performance bonuses and failure penalty has a hard limit, i.e. you lose your job.
So by conservative stewardship you can get, what, a $25,000 bonus every year and (maybe) keep your job at the end of the bubble. Or you can you can leverage up to your eyeballs, get a couple million dollar bonus every year, and retire when it all hits the fan.
Paulson made $700 million at Goldman Sachs. Could he have done that playing it safe?
What's called for is a healthy dose of humility. We should assume people have a reason for doing something and we should presume that their reason was a good one. Before scrapping a practice, we better understand why it was put into place and that our proposed change really is for the better. That doesn't mean we cannot make positive changes. It just means we should have a lot of respect for the wisdom of those who went before. Two quick examples:
Young bride is asked by her new husband why she's cut off the the end of the roast before putting it into the oven. She says that's the way her mother did it. So they call Mom, who says she learned to do it that way from her mother. So they call Grandma, who says: She cut off the end of the roast so it would fit into her pan. Lesson: Understanding why something was done (Grandma cut off the end of the roast so it would fit into her pan.), it's okay to make an informed change in practice (Quit cutting off the end of the roast).
When I worked in a furniture mill, the mill had a practice of storing it's supply of 55 gallon drums of PVA glue inside the mill. New guy (not me) couldn't understand why valuable shop space was being used to store glue, when the glue was already in water-proof steel drums. So, he moved the glue outside. Did you know PVA glue is ruined if it's allowed to freeze? Neither did new guy. All the joints made with the frozen and then thawed glue failed. The mill lost a lot of time and incurred a lot of expense because new guy assumed he knew more than the men who'd instituted the practice of storing the glue inside the mill.
All of these arguments could be applied just as well to gay marriage or abortion law or universal health care, if you lean that way--it's no good just saying that it hasn't hurt Sweden, because the deluge might still await.
This is completely crazy.
It's perfectly rational not to vaccinate your kids: the fact that almost everyone else does so keeps the risk of contracting (say) pertussis lower than the risk of a severe vaccine reaction. Of course, if enough people apply this logic, you get a large population with no immunity -- bang, pertussis epidemic. How do you avoid this situation? Mandatory immunizations, or at the very least mandatory to attend public school and publicly funded activities like kid's sports.
But isn't the freedom to avoid vaccination more important than a risk of epidemics? I though that's what libertarianism was all about.
When those epidemics stopped--because of widespread vaccinations
I would refer you as usual to these graphs, which show that this assertion is false (at least for measles, but the pattern holds for many other diseases).
The primary drivers of reduced mortality and morbidity from these diseases are improved sanitation and nutrition, along with (probably) less crowding. Vaccine proponents who try to scare people by pretending that a lack of vaccination would result in a return to pre-modern levels of disease are basically lying.
I don't want anyone to be forcibly vaccinated, or forced to vaccinate their kids. But if don't, sorry, no public buildings for you. No mass transit. No airplane rides.
This is kind of silly. If you want to reduce the incidence of disease by restricting individual freedoms, a more logical first step would be to enforce these restrictions on anyone currently manifesting symptoms of an infectious disease (which we currently don't do for most diseases because the risks are small). In any case, if you did quantify the risks of allowing unvaccinated people to run free you would find that they are tiny compared to others we routinely accept in the name of freedom. For example, the excess mortality we accept by not really enforcing highway speed limits.
...accident followed by a period of tightened regulations, followed by a gradual slackening of oversight until the next accident....
...All of these arguments could be applied just as well to gay marriage or abortion law or universal health care, if you lean that way--it's no good just saying that it hasn't hurt Sweden, because the deluge might still await....
I'm not sure I follow;
You take as a given, as do I, the following sequence of occurrences;
1.Things are going great
2.Everyone forgets and relaxes...
3.This causes a change in laws/behavior/practices etc that eventually cause disaster
4.Reforms due to the disaster
5.Back to step 1
This can be compared to gay marriage in the sense that
1. Gays are not allowed to marry ( Everything is great!!!!)
2. Everyone forgets (!!) and relaxes..
3.This causes a change in laws/behavior/practices etc that eventually cause disaster ( Men marrying box turtles! Straight men turning gay causing marriages to break up)
4.Reforms due to the disaster(??)
5. Back to Step 1.
Why were Goldman, et al, allowed to lever up 30-to-1? Why, for that matter, did they want to? Well, because if you've gone for a long time without any problems, all you can see about the safeguards is that they're costing you money.
Goldman, Bear Sterns et al, were allowed to lever up 30:1 because they worked hand in hand with politicians to destroy regulations during steps 1,2 and 3 above. And because it is simply the logical thing to do. As someone mentioned earlier in this thread; why should a CEO maintain a clean balance sheet if doing so will result in earning of only a few million when he could leverage 30/40 times and earn hundreds of millions, perhaps even a billion or two, and when it all comes crumbling down, he'll be retired/retiring/working at the SEC? The logical choice is obvious; leverage as much as you lobbied for and earn a whole lot more. They CEOs, politicians and the rest have become so successful that their mantra of eliminating regulations is now common wisdom.
By the way; the lobbying is ceaseless, from Step 1 to Step 5. Even now, notice how an implied problem is not that everything goes to the crapper again and again, the problem according to Megan McArdle is being "institutionally risk averse" and make a note that we are still in the disaster phase.
why should a CEO maintain a clean balance sheet if doing so will result in earning of only a few million when he could leverage 30/40 times and earn hundreds of millions, perhaps even a billion or two, and when it all comes crumbling down, he'll be retired/retiring/working at the SEC?
This merely raises the relevant question of why the shareholders let the CEO lever it up to 30-to-1. It may be rational to run wild risks other people's money, but that doesn't necessarily mean it's rational to let someone else run wild risks with your money for you.
CEOs are employees, and are subject to contract law. Even if regulations let companies run up massive leverage, the shareholders can write contracts saying that "If leverage risks above 10-to-1, you don't get any bonus" (or whatever other criteria they want to set). Or they can only hire CEOs with a cautious approach historically. Or they can write company constitutions that include that any increase in the leverage ratio must be approved by shareholder vote. After all, it's their money the shareholders are at risk of losing.
Incidentally, anyone know if public companies have been going bust more often than private companies?
"Libertarians, conservatives, and progressives all need a better metric for distinguishing between the areas where we're improving on problems, and areas where we're simply eating our institutional and cultural seed corn."
This is why we need reliable national (and planetary sometime soon) accounts for the capital stock in infrastructures, human capital and (in due course) social capital.
An icidental benefit of the last of these is that valuing social institutions on replacement cost principles will shake up the way liberals, conservatives, progressives and even libertarians think about the institutions in our society.
[I]f you did quantify the risks of allowing unvaccinated people to run free you would find that they are tiny compared to others we routinely accept in the name of freedom.
Bbartog hits the nail on the head. At some vaccination rate in the population, the risk to a marginal member of receiving the vaccine outweighs the risk of contracting the disease. Let's refer to this difference as his risk premium. (I'm not an economist, so forgive me if I butcher the terminology.)
In theory, the risk an unvaccinated person poses to a vaccinated person is non-zero, but whatever it is, should it not be greater than the unvaccinated person's risk premium to justify coercive measures? I don't have the numbers, but it seems that optimum vaccination rate will be less than 100%.
In practice, what's going on here isn't risk management, but herd-think: we've accepted the risk of the vaccine, therefore you must accept the same risk.
A lot of the conversation on vaccines here sounds rather, well, abstract. What's the perspective of the parents out there? I've seen no indication that the prior posts are from anyone with children.
My own experience: my wife and I had our first and only (so far) kid over two years ago. When it came time to vaccinate, we became concerned due to all the new media buzz over vaccines: they'd cause our kid to die, or become extremely sick with the disease they were trying to cure, or they'd give her autism, or whatever. (Adding to the fuel is the fact that my wife's family is heavily into natural medicine.)
So we do our homework, and find a whole slew of publications that say vaccines are a big risk, and a whole other slew of resources that say they aren't. Either way, we're utterly stumped, since neither of us are scientists and have no basis for trusting one side versus another beyond "gee, that sounds good."
This is a very serious issue for a parent. Infant children tend to be cute, warm, and loveable (on the good days, anyway), and the sense of responsibility to one of them can be overwhelming. When faced with a Hobson's choice on a kid's health, that sense of responsibility can be crippling. The deluge of information out there can be additionally crippling--so many people claim to be "experts" in a given field that we have a lot of difficulty judging why one piece of advice is better than the other, particularly since science seems to reverse itself all the time (global warming, anyone?).
We ultimately opted to go with the standard vaccinations. I had an easier time with it, since I was willing to accept that 1) I was vaccinated, and 2) so are most other people, and we're fine. For my wife, it was a lot harder.
On an afternote, though, we discovered that our daughter has food allergies, which some scientists now speculate are tied to vaccination. Milk products give her a runny nose; tree nuts cause her to break out in hives, and we don't know if she'll get worse if she's exposed to nuts in the future. We now carry an epi-pen at all times in case she has a bad reaction.
Did we do our daughter a disservice with the vaccinations? Or did I do her a favor by sparing her from largely rare diseases? I'll never know either way.
But isn't the freedom to avoid vaccination more important than a risk of epidemics?
It's more important until you or your kid gets sick, at which point it becomes much much less important.
This is why we need reliable national (and planetary sometime soon) accounts for the capital stock in infrastructures, human capital
Well we have national data for a lot of countries on infrastructure (go to a country's database, look up National Accounts, and then investment). We also have surveys of education achievement for human capital.
How reliable this is is questionable of course. But we do have the data for a number of countries.
I've seen no indication that the prior posts are from anyone with children.
I don't know that personal experience is all that relevant to the argument, but I have three children (ages 2, 4, and 6) and they are unvaccinated. My wife had a terrible reaction when she was vaccinated and to the extent that such things may have a genetic component we felt the risks were too high. Plus (as I described above) I think the risk of being unvaccinated is low - both individually due to the free-rider effect, but also collectively because most of the reduction in the incidence of these diseases has nothing to do with vaccination.
I don't know that personal experience is all that relevant to the argument, but I have three children (ages 2, 4, and 6) and they are unvaccinated.
Let me clarify my statement so as to not to offend the childless: the positions of parents aren't necessarily relevant to the issue of should/should not vaccinate. They do, however, give insight as to the motivations of why parents choose not to vaccinate. Your own experience is especially enlightening to the latter.
Bbartlog,
I checked the source data re: your measles assertion and let me just say that you are full of s*it. The source data and the chart you provided don't even agree.
"Politicians like to cut ribbons on new bridges or schools, but there's no fanfare for the everyday maintenance that keeps the bridges standing and the schools working. As a result, critical parts of society are quietly decaying, victims of complacency or of active neglect."
As a 10 year Hill veteran, truer words were never spoken. As to regulations, there's little question that no one worries about them when times are good. The press won't cover a hearing on such a boring topic as financial regulation while the good times are rolling, so, no hearings, no bills - not sexy.
bbartblog--first of all, 500 deaths a year from measles, which is what we had pre-vaccines, is not small. Neither are the 40-50 deaths a year occuring TODAY from Pertussis, mostly in infants too young to be vaccinated who get the disease from older unvaccinated siblings, or friends of said siblings. That ignores things like morbidity--the horrific birth defects that result from pregnancy rubella, or the paralysis of polio.
You don't have a right to kill some one else's baby, or for that matter, your own, while free riding.
You missed the other part - if he doesn't lever up he will be fired by his shareholders for subpar performance. They say the markets should be kept in balance by greed and fear. From the CEO on down to the trader and I-Banker greed and fear worked in tandem. Greed to make money and fear that being prudent was the quickest way to get fired.
I'm also thinking that Merrill(founded 1914) Lehman (founded 1850), Bear (founded 1923) all had survived the depression as partnerships, but as public companies, they couldn't survive the lastest financial crisis. I think some thought has to put toward mandating that i-banks must be partnerships, with each partner personally libel for the failure of the firm - down to the last cuff-link - as they used to day...
I checked the source data re: your measles assertion and let me just say that you are full of s*it. The source data and the chart you provided don't even agree.
Spot-checking, I don't see any discrepancies - though the fact that three different figures (deaths, deaths per million, and deaths per hundred thousand) are used at different points might confuse the unwary. Can you be more specific as to what seems to be amiss? I'm also curious whether you think the data on measles mortality is a pure fabrication, since (regardless of any graphing errors) the data quite clearly show a massive drop in measles deaths prior to 1968.
Megan's broader point is pretty accurate. I'm sure we all know of that dangerous intersection that doesn't have a stoplight, and won't have one until someone is killed. There seems to be one of those in every town. Even if you keep issuing warnings about it, eventually people will stop listening to you.
This isn't a particularly new observation, either - it goes back at least to Aesop and the boy who cried wolf. If people think you're either wrong or making stuff up when you first start talking about vaccines, or mortgage regulations, or a dangerous road, they won't listen to you until you either have truly overwhelming evidence or a dramatic demonstration that you're right.
bbartlog,
You don't even know how to read a chart!
http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1619577&pageindex=2
Look at the scale on the left and explain to me what you see and its relevance.
Note: The rate in 1963 when the vaccine was introduced was 0.2 by 1975 it was 0.004 a drop of 99.98%.
first of all, 500 deaths a year from measles, which is what we had pre-vaccines, is not small. Neither are the 40-50 deaths a year occuring TODAY from Pertussis,
2 deaths per million is fairly small though not negligible, and 40-50 per year is definitely a small number. And in addition, I would point out that in order to use the 2 per million figure for measles we would have to assume that whatever forces drove the rate down from 100 per million around 1900 to 2 per million around 1968 *suddenly stopped having any additional effect*, so that all of the subsequent decline can be imputed to vaccination. This does not strike me as a realistic assumption.
You don't have a right to kill some one else's baby, or for that matter, your own, while free riding.
So dramatic. This is one of the recurring problems in arguing with vaccine proponents - they look at a problem involving very small changes in risk, and want to turn it into a morality play about murder.
mostly in infants too young to be vaccinated who get the disease from older unvaccinated siblings
Cite? Not for the first part, I can easily find the evidence that the deaths from pertussis are overwhelmingly among very young unvaccinated infants. But where do you get the information that the source is primarily 'older *unvaccinated* siblings'?
bbartlog,
Again you can't read the chart. The rate after the introduction of the vaccine fell 99.98%.
So yes, I impute a fall of 99.98% almost immediately after the introduction of the vaccine to the vaccine and not improved sanitation.
Your ignorance and innumeracy is staggering...
bbartlog,
You don't even know how to read a chart!
http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1619577&pageindex=2
You claimed that the first charts I linked to were in error (and that I was 'full of shit'). When challenged to back this up, you post *different* charts that I have not referred to and claim that I can't read them? Maybe you could stick to one thing at a time? In any case, the charts you proved do tell the same story as the ones I provided, albeit in log scale rather than linear. The log scale allows us to see a small (in absolute terms) drop in mortality following the vaccine's introduction, which is hidden when a graph with a linear scale is used. On the other hand, the linear scale does a better job of showing the huge drop in mortality prior to the vaccine's introduction. It is worth noting that the log scale still shows a quite steady (and rather linear-looking in a log context) decline in mortality prior to the introduction of the vaccine, and suggests even more strongly that considerable additional reductions would have been achieved even without the vaccine's introduction.
The rate after the introduction of the vaccine fell 99.98%
Looking at the charts you linked to, I can (if I cherrypick start and end endpoints) arrive at a 95% reduction in either overall rate (from say 200 to 10 per 100K population) or else a similar percentage for mortality (again, if I choose my years carefully to take advantage of the spiky nature of the graph).
Your '99.98%' suggests that it is you who have problems with numbers.
Note: The rate in 1963 when the vaccine was introduced was 0.2 by 1975 it was 0.004 a drop of 99.98%.
The rate never reaches 0.004 on the graph you link. 0.004 is the bottom of the graph; the rate in 1975 is 0.009. Of course, even if we accepted your '0.004' it is a 98% reduction, not 99.98%; so you've managed to make two elementary errors in attempting one simple calculation. I think it is time you stopped trying to slam me or anyone else for inability to read graphs.
"I don't want anyone to be forcibly vaccinated, or forced to vaccinate their kids. But if don't, sorry, no public buildings for you. No mass transit. No airplane rides."
Wow - I actually agree with Freddie. I guess this really is the age of the [Oba]Messiah!
The chart I refered to was listed as one of the sources of the site you reffered to me.
To your second point: 99.98% or 95% or 98% the fact remains, a massive +95% decline in the rate of infection after the introduction of the vaccine.
Are you really arguing the without the vaccine the rate of infection would have fallen to statistically zero, as it is now?
"Politicians like to cut ribbons on new bridges or schools, but there's no fanfare for the everyday maintenance that keeps the bridges standing and the schools working. As a result, critical parts of society are quietly decaying, victims of complacency or of active neglect."
Another anecdote: The parent's association board at a high-end private K-8 school in Silicon Valley was asked to rank various proposed spending areas by priority. I put the "building maintenance" item at the top, which no one else did. (Other items were things like higher salaries, more books, more computers, new facilities, ...)
I was the only working engineer in the room, so I was not too surprised. BUT, I was completely unable to convince anyone else of what seemed to me to be a simple proposition: If the boiler breaks, the school shuts down right then and there. They heard me, they nodded their heads, and they made other choices. Sigh...
Are you really arguing the without the vaccine the rate of infection would have fallen to statistically zero, as it is now?
No. The principal driver of reduced mortality appears to be improved outcomes for measles cases, not reduced infection rates. The ratio of cases to deaths changes from about 40 to 1 at the beginning of the 20th century to about 1000 to 1 around 1970, while the decrease in incidence is fairly slight. Looking at information for Germany and the UK 1995 to the present (where they still have some measles) suggests that the odds of death are even lower now, though it is hard to arrive at a statistically significant conclusion due to the very low number of deaths in modern countries. Some of this is due to improved baseline health and nutrition (anemia and malnutrition are both correlated with poor outcomes) and some no doubt due to improvements in treatment. It seems likely that further reductions would be difficult, since looking at some of the cases it appears that the majority of first-world deaths now involve complications like immunodeficiency or other exacerbating factors that present considerable treatment challenges.
A reasonable guess at US incidence and mortality with zero measles vaccination would be 80 per 100,000 annual incidence (~300,000 cases) and 0.04 per 100,000 deaths, with a result of about 15 deaths annually instead of the zero we have now. This assumes a continuation of the slight downward trend in incidence prior to vaccination and an improvement in mortality from one in 1000 to one in 2000.
bbartlog,
I'm not seeing the math...? With 300,000 cases a year and a death rate of 1 in 2000 there would be 150 deaths.
Hah, my turn to have egg on my face. Of course you are right, 300K/2K = 150.
I don't want anyone to be forcibly vaccinated, or forced to vaccinate their kids. But if don't, sorry, no public buildings for you. No mass transit. No airplane rides.
Uh huh. Somehow I suspect that, if we were to tell Freddie that we weren't trying forcibly to convert him to Christianity (or whatever) but that his children would were forbidden to attend public school lest they infect other children with his unbelief, Freddie would suddenly develop a more expansive understanding of the word "forcibly".
Freddie would suddenly develop a more expansive understanding of the word "forcibly".
I doubt it. What Freddie has said is substantially equivalent to saying "I don't support gun control, but you should be barred from shooting into the air." It's a perfectly sensible position, even for a libertarian, which Freddie isn't.
Do what you want with your body, but don't go about posing a threat to others.
bbartlog,
Then how many kids do you assume die every year as a result of the measles vaccine? More than 150?
I don't really have a dog in this fight, but I'm trying to figure out how an unvaccinated person is a threat to a vaccinated one.
I don't really have a dog in this fight, but I'm trying to figure out how an unvaccinated person is a threat to a vaccinated one.
Because sometimes the vaccine doesn't "take," because immunity wears off over time, because populations of inccubators encourage mutations which might not have been included in vaccines, and because some number of people can't be vaccinated, the failure of herd immunity cause by elective non-vaccination poses a threat to the non-elective ones.
It's a perfectly sensible position, even for a libertarian.
Rob, I'm not saying that you're wrong about this, notwithstanding that I still haven't seen a quantification of the risk that unvaccinated people pose to vaccinated people.
My point is only that Freddie advances a sophistical definition of "force" to which he would never submit were it applied to a policy he opposes.
Because [1] sometimes the vaccine doesn't "take," because [2] immunity wears off over time, because [3] populations of inccubators encourage mutations which might not have been included in vaccines, and because [4] some number of people can't be vaccinated, the failure of herd immunity cause by elective non-vaccination poses a threat to the non-elective ones.
So it appears that between groups 1, 2, and 4, above, there remains a core of effectively un-vaccinated people posing a risk primarily to each other, but also some risk to the vaccinated population by incubating mutations. It is this last risk that should be quantified.
I would then ask: to what extent does the marginal electively unvaccinated person increase that risk. I would then ask how that risk compares to the risk of receiving the vaccine. I don't know what these risks actually are, but it seems reasonable to insist that the first risk outweigh the second before resorting to coercive measures.
Very few, I would assume. this report gives at least a ballpark idea of the number of deaths and disabilities imputed to vaccination, though there are arguments to be made both for over- and under- representation in these statistics. Deaths for the MMR vaccine look to be in the low single digits annually.
But in addition to the risk of immediate death we also have to consider the possibility of long-term ill effects, which are poorly captured by existing adverse event reporting mechanisms. Look at this paper, for example. The odds ratio for measles vaccination does not rise to significance because of the smallish sample size (though pertussis vaccination is a different story... but one thing at a time).
But if we accept the estimated odds ratio we see an increase in atopic disorders from 40% to 44%, which would imply over ten million additional cases of atopy if everyone in the US were vaccinated versus no one being vaccinated (for measles). The fact that autoimmune disorders have increased over the same timespan that we have instituted wideranging vaccination, and that plausible mechanisms are proposed for this link (see the paper) lends support to this idea.
In any case, as regards my specific decision and my family:
- my estimate of the odds that my children would die of measles even if everyone stopped vaccinating for it is low (less than the 150 per annum figure would imply). Most people who die of measles in the first world have some complication, or to be more plain were sickly to begin with.
- my estimate of the odds that my children would have an adverse vaccine reaction are higher than what we would assume on the reported statistics, based on the fact that their mother had a severe reaction to vaccination when she was a child.
That said, I think it's unlikely that the US would be better off in totally abandoning measles vaccination (there are other vaccines, notably tetanus and polio, where I think the vaccine should no longer be used). But I do think that *I and my family specifically* would be better off under a no-measles-vaccination-for-anyone policy than under one which forced my children to be vaccinated, which calls the 'free rider' argument into question (though obviously the current situation, where we undergo neither risk, is still better for us than either alternative). The question of who is free riding and who is being forced to shoulder excess risk is quite contingent on what we can know ahead of time about who is likely to have adverse reactions to vaccines and who is likely to actually be killed by measles.
So it appears that between groups 1, 2, and 4, above, there remains a core of effectively un-vaccinated people posing a risk primarily to each other
Groups 1, 2, and 4 are non-electively unvaccinated; to the extent that they are threatened by electively unvaccinated children, that threat is wrongful because they are forced to bear a risk which they did not and could not choose.
I would then ask: to what extent does the marginal electively unvaccinated person increase that risk.
Probably about as much as the marginal tax cheat threatens national security by withholding money than could be used to fund defense. That doesn't justify cheating on your taxes, though.
Just as an amusing aside, my 4-year-old was asked (as part of a game or something): "What do nurses do?" His response: "Stab [his brother, 10 months old] in the leg!"
to what extent does the marginal electively unvaccinated person increase that risk. I would then ask how that risk compares to the risk of receiving the vaccine.
The problem is that this doesn't work, because the marginal risk is decidedly nonlinear. There are threshold effects. To a first approximation (and I know I am oversimplifying), there is a percentage of immunized people that means that any occurrence of the disease is 'damped' and will not spread - and there is a slightly lower percentage that will allow for the disease to increase in the population. Think of critical mass in a nuclear reaction and the role of damping materials and you can get an idea. So if I am the marginal unvaccinated person at 95% vaccine coverage, my decision appears almost costless - it is only when some large number of people do the same thing that we will see the effects.
A more reasonable way of looking at the risk we should be willing to undertake is indeed to ask 'what would happen if everyone refused this vaccine?', and then dividing that consequence amongst everyone involved. This too has problems but is at least a better starting point than what you describe.
bbartlog: I get the non-linear issue. I suppose then that the incentives (or alternatively, "coercive measures") could be ramped up as necessary to produce the optimum level as I have defined it.
Rob: We probably aren't going to agree on this, but I rebel at the idea that you should force me to do something to insulate you from the consequences of your failure to do that very thing.
Otherwise, your analogy to tax-paying seems apropos. But then if taxation were voluntary, it wouldn't really be taxation anymore . . . :-)
We probably aren't going to agree on this, but I rebel at the idea that you should force me to do something to insulate you from the consequences of your failure to do that very thing.
I do no such thing. I seek to force you to do something to insulate me from the consequences of a condition which I did not and could not choose.
Or, to put it another way, I seek to prevent you from avoiding risk (of a bad reaction to the vaccine, for instance) while enjoying the benefits available because others take the risk.
Or, to put it another way, I seek to prevent you from avoiding risk (of a bad reaction to the vaccine, for instance) while enjoying the benefits available because others take the risk.
This is a very different formulation, and one that I admit is psychologically seductive. But it's not really risk management so much as herd-think.
Excellent post, Megan! I disagree with one statement, however:
I'm not sure that there is any way to prevent 70-year events like the current mess...
Not true. There are simple mechanisms to discourage individual borrowers, corporations, and financial institutions from excessive leverage and risk-taking. For example:
1. Prevent under-water mortgages: Mortgage interest is only deductible if the outstanding loan balance is less than 80% of assessed value. Plus: A loan-origination tax equal to 10% of assessed home value, for all loans with less than 20% down, and for all variable-rate/teaser-rate loans.
2. Prevent deep recessions by encouraging individual savings, as personal "insurance" against unemployment. For example, an income-tax rebate of 10% if your liquid net worth exceeds $100K; a rebate of 20% if $200K net worth; a rebate of 30% if $300K net worth. In years where the national unemployment exceeds 8%, you could draw down your net worth and still receive the tax rebate for that year.
3. Insure that corporations can survive severe recessions, by imposing a severe tax on corporations with short-term debt or substantial long-term debt.
4. Prevent fraud and excessive risk-taking in financial institutions (broadly defined): (a) Transparency: financial institutions to publish quarterly, on the web for all to see, a list of all their assets and liabilities. (b) SEC to outsource fraud investigation to private contractors who are paid based on “performance”, defined as evidence of fraud leading to conviction. (c) Minimum 1-year prison terms for all officers of any financial institution that engages in fraud or excessive leverage, or where transparency is incomplete.
Yes, measures like these require a certain degree of moral courage and self-discipline. This is not a "defect" but is in fact a virtue.