Wednesday, April 23, 2014

Vaccinations

Why is this a debate?

We know that vaccines just plain work for their intended purpose (80% efficacy for Chicken Pox, right around 100% for the others, including elimination of truly awful diseases like Polio). So what's the other side of the debate that drives all the heat and emotion? 

It's my understanding that the autism question has been asked and answered as not related by repeated studies since the initial falsified study. The toxicity of the preservatives has been studied by WHO, FDA, and Institute of Medicine and found to not pose a safety risk, and Autism Spectrum Disorder (ASD) rates have continued to rise since use of the suspected culprit (thiomersal / thimerosal) ceased. We know the Wakefield/Lancet/McCarthy thing has been refuted a few times now. We know that an army of acronyms have subsequently searched for a connection and found none.

I reviewed the side effects for MMR/MMRV, DTaP, Polio, Meningococcal, Varicella, and a couple others at the CDC's website, and I didn't see one that outweighed either statistically or otherwise, the benefit of not contracting the target ailment. So while I can appreciate the fear of the unknown in anything, including vaccines, I have trouble seeing how the benefit of 100% protection against highly contagious and life-threatening diseases that pose individual AND public safety risk wouldn't every time outweigh the possibility that there is some as yet unidentified problem with the prevention mechanism. 

Am I missing the other side completely? Is there another dimension of risk that the collective health establishment is hiding from us beyond the listed side effects? I'm asking about this in the context of today, after the understandable concerns from 10-15 years ago have been studied and addressed. I'm asking why there is a Measles outbreak in Canada, where that disease was eradicated 20 years ago. I'm asking why we're hearing of Mumps cases in the US where it was eradicated years ago. I get why we're hearing of Polio in war-torn countries like Iraq and Syria where basic medical care took a back seat to dodging artillery, but Measles in Vancouver where MMR is free? 

I've heard the arguments about skipping childhood vaccinations being a "personal choice." I've heard the arguments that the anti-vaccine community should be left alone as they intend no harm to anyone.  

The problem is the logic. It's not just a personal choice -- that decision affects other people. There are people who cannot get vaccines either because their immune systems are compromised or because they are simply too young (most doctors won't give MMR until a child is at least 12 months old). Those vulnerable groups count on others to be inoculated to create herd immunity / inoculation by proxy. 

The problem I have with the "well-intended" argument is that nobody of sound mind has the "intent" to do harm with communicable disease. Whether one group "intends" to harm the other is scientifically irrelevant. Intent isn't a vector, and lack of intent isn't an inoculation. I can intend to not give my next cold to my wife, but that intent and $2.50 will get me a cup of coffee and nothing more. 

I can find statistics on the efficacy of MMR and company. The numbers tell a story for me. I am still open to understanding the other side of the debate, but I'd like to see some numbers. I have trouble with nebulous assertions around unknown risk of undefined nature when compared to published facts (admittedly sourced through google, so feel free to correct). On the Pro-MMR side, let's just take the first "M" where I have seen: Near 100% immunity against a disease with a 90% infection rate and a 0.3% mortality rate in the US, closer to 20-30% in developing world. On the Anti-MMR side, I saw one citation of life-threatening reactions in <0.0001% of vaccinations. That's a .27% bad-outcome chance vs. a 0.0001% bad-outcome chance. No contest.

We all agree that the preservatives of 15 years ago have been both removed and shown as non-toxic and that the ASD connection is a fallacy, so that's not an issue and will be no longer discussed. 

There are also less severe reactions to both the disease and the vaccine that should be considered. For example, 1-in-6 (18%) chance of fever after vaccine vs 1-in-1 (100%) chance of fever after infection. 1-in-20 (5%) chance of mild rash after vaccine, 1-in-1 (100%) chance of rash after infection. 1-in-3000 (0.033%) chance of single-event seizure after vaccine, vs 1-in-20 (5%) chance of pneumonia after infection and 1-in-1000 (0.1%) chance of encephalitis (which can cause convulsions, brain damage, etc.). Are there other numbers I'm not considering?

With those types of numbers, the only case in which a parent would feel better off skipping vaccines is if they somehow believed their child was more likely to be the 1 in 100,000 than to be 1 in 2,700, and while math skills aren't what they used to be in North America, I still have a hard time believing there are too many parents who would make that mistake.  

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