My caseworker’s fingernails are several inches long — long enough…
(via flickr user julien harneis)
The Antivax movement, whose members (antivaxers) choose not to give their kids vaccines, seems to be spreading. In 2012, the CDC found that about ten percent of parents had delayed or forgone vaccinations. If exposed to an infectious disease, these unvaccinated kids could be infected with certain kinds of pneumonia, diphtheria, measles, mumps, rubella, whooping cough, tetanus, polio, and the flu, while children who have been immunized would almost never be susceptible to any of these.
Antivaxers have usually read something on the internet that convinced them. This could have been the preaching of Viera Scheibner, who believes children need more diseases. It might be because of a study by Dr. Andrew Wakefield that linked vaccines to autism until his publisher formally retracted it because there wasn’t any link, at all, whatsoever. It could be caused by fears about aluminum and formaldehyde in vaccines, despite these common “adjuvants” not being capable of harming children unless the doses are multiplied to cartoonish levels. Other antivaxers are afraid mercury is in there, which it isn’t, with one easily avoidable exception.
I have another explanation for what drives some antivaxers: Machiavellianism.
(Weirdly ugly Machiavelli bust, via flickr user blu-news.org)
In a peer-reviewed paper from last year, Dr. Cornelia Betsch, et al, wrote that when asking parents if they would vaccinate, fewer turned them down if they guilted them about the societal cost. Conversely, “When a message emphasized individual benefit, vaccination intentions decreased.”
The Centers for Disease Control seem to agree. They had to devise a pamphlet for antivax parents called “If You Choose Not to Vaccinate Your Child, Understand the Risks and Responsibilities.” In it, they reframe the problem of disease in a really fascinating way: they focus on making others aware at all times of your child’s unvaccinated status.
They emphasize the importance of notifying any hospital staff “even when you are under stress,” and they tell you how to inform childcare and school staff of your child’s lack of immunity.
Naturally the CDC has concerns about the child’s health. After all, doctors aren’t expecting any German measles cases today. But “disease control” is in their name. The CDC is concerned with the social cost: unvaccinated kids chipping away at what’s called “herd immunity.”
Herd immunity, also known by the more sing-songy name “community immunity,” is the idea that immunizing everyone is impossible, but the few who aren’t immune to infectious disease are protected by the vast majority of their neighbors who are immune. A person in a crowd, say at Disneyland, carrying asymptomatic mumps is most likely a few steps removed from the nearest person who hasn’t been vaccinated for mumps, so the immune “herd,” protects them.
In economics, an argument could be made that the immune crowd is known as a “common pool resource.” This would only be strictly true under ideal circumstances in which there were widely agreed-upon rules, and some kind of governing body in charge, but many of the principles can be applied, particularly exploitation by actors known in economics as “free riders.”
Herd immunity benefits us all, including free riders, in several ways:
- It reduces the overall risk of catching an infectious disease.
- Through prevention, it reduces the overall monetary cost of medical coverage.
- It reduces the operating costs of federal and local funding for taxpayer-funded programs like medicare and medicaid.
- It prevents visitors from catching or spreading diseases while in the US.
- It lowers the odds of an immunized individual catching an infectious disease because of improper, or unsuccessful inoculation.
The “free ride” approach to immunity is not statistically likely to kill your child, although it could: Taking the CDC’s highest estimates, only maybe 190 or so Americans die per year from vaccine preventable illnesses. But out of perhaps a few million unvaccinated kids, that’s only a handful. The takeaway is this: if you don’t vaccinate your kids in the United States, you’ll probably “get away with it,” if you will, because the herd is immune.
You wouldn’t be so likely to get away with it in someplace like Zimbabwe, where outbreaks of preventable illnesses are happening right now. You would be less afraid of a few atoms of aluminum under your skin, and much more afraid of the typhoid fever that just killed your neighbors.
In other words, vaccination is only a “choice” when the herd is immune. As an extremely lazy person who should not be a parent, I can see myself making this “choice.” For me it would be a “choice” between remembering to take my kids to pediatrician’s appointments, and staying home where the TV is. If there were a school of thought that would let me get on a soapbox about my personal choices when I, say, forgot to go to work, I might go that route. I’m not saying all antivaxers are lazy, but I am saying dangerously lazy parents could pretend to be antivaxers, and they would at least look principled.
Another reason to be a free rider, according to game theory, is “information asymmetry,” the idea that those who know a secret take advantage of those who don’t. Choosing to be a non-immune member of an immune herd means not only avoiding aluminum and formaldehyde, but skipping the real downsides that can — however rarely — come from vaccinations. These can include pain, redness, tenderness or swelling at injection site, fatigue, headache, itching at the injection site, nausea, dizziness or fainting, fever and a mild rash. The perception that you’re avoiding these could make you feel like an insider in a secret club.
Think of it: American kids who get vaccinated are risking all of these minor inconveniences, and your kid can skip all of them, not to mention avoiding the unpleasantness of getting stuck with a needle.
The others must not know all the downsides, right? It couldn’t possibly be that the rest of the herd recognizes that vaccines come from nasty metal needles, and contain irritants and scary sounding chemicals, and hurt for a while, and make you feel whoozy sometimes, and then choose to get them anyway. Not to mention the cost in dollars and cents!
Assuming you vaccinate against diphtheria, whooping cough, polio, both hepatitises, measles, mumps, rubella, viral meningitis, varicella, and buy the controversial new HPV vaccine, Gardasil (and you should), the cost of the drugs can be as much as $700 if you don’t have prescription coverage. The doctor visits, particularly for a course of three injections, can rack up as well. Pretty soon, you’ve spent a thousand dollars on diseases your kid was probably never going to get, sucker.
I could write another blog post on how to save on vaccines (“Varicella,” for $94.14? Are you really scared of your kid getting chickenpox? It’s a rite of passage!), but I don’t want to. Vaccines are one area where savings doesn’t come into the picture. Every vaccine is a technological marvel, and we should all be happy to spend the money for the good of everyone, no matter who we are.