Herd Immunity and Compulsory Immunization

GWB was a ringer to check who is paying attention.

Post 21

Monday, February 2, 2009 - 8:11am

There is also the issue of compulsion. Compulsion is a nice word for "guy with a gun willing to kill you over the issue". Is that what you'd be willing to take this to? I haven't formed my full opinion yet here, just want to hear thoughts.

Post 22

Monday, February 2, 2009 - 8:25am

Is there a point in justifiable compulsory immunization? I would say it's justified when there's an encroaching plague just getting started, in which individual businesses and persons (and the courts) can decide to quite literally cut off people who haven't gotten the minimum necessary immunization against such a plague. Not because of some greater good, but because of the fact that every one has the moral right to ensure their own survival, then ensuring that my own body doesn't become infested with a virus or bacteria that can end my life is just an extension of that moral right.

And I don't see how anyone can argue it otherwise, because if the person who is unimmunized goes about in public willfully has done so with the intended (maybe unintended, not sure) consequence of harming person and property (indirectly), thus their actions are really no different than the actions of a person who goes about breaking people's stuff un/intentionally, and said person in both cases would have to pay for the losses (of people's lives and people's property).

Post 23

Monday, February 2, 2009 - 8:27am

Well, let's see, a man regulated by law, pointing a gun at people walking around spreading viruses, or a man walking around leaving small pox (30% mortality) in his wake?

Is it the fact that viruses are invisible that makes this such a difficult issue?

My coughing on you is an initiation of force.

Post 24

Monday, February 2, 2009 - 8:46am

Ted, I don't think anyone is arguing against quarantining those who have contagious diseases like smallpox.

The more challenging issue involves the "preventative compulsion" of immunization of people under the conditions of no immediate or impending threat.

Smallpox vaccines have been discontinued since 1980:

There is no accepted medical indication for smallpox vaccination except to protect individuals from acquiring smallpox. For a small number of individuals working with smallpox virus in controlled laboratory environments vaccination remains important. However, for the vast majority of travelers the risk of complication secondary to smallpox vaccination is greater than the risk of acquiring smallpox. Hospital employees, of course, should not receive routine smallpox vaccinations.

I have trouble believing that people in a free country would not swarm in large numbers for vaccinations (see Jon's flu post earlier in this thread) regardless of mandates.

But, yes, those who spread disease casually need to be quarantined to prevent their trespasses of infection to others.

Post 25

Monday, February 2, 2009 - 8:55am

Regarding vaccines and autism, I don't agree that the negative ("no causal link") has been 'proven.'

Vaccines do more good than harm, but that doesn't mean that they are harmless. Nuclear bombs do more good than harm, too -- when used according to the directions ("don't use too close to home", etc). :-) Here's a blurb from a place:

Autism has been characterized as a behavioral disorder since it was first described by Leo Kanner in 1943. The number of autistic children has increased over the last decade. The incidence of autism was 1 in 10000 before the 1970s and has steadily increased to 1 in 150 in 2008 with a male:female predominance of 4:1. The cause of this epidemic has remained unknown, but several hypotheses have been studied. Many of these suggest an environmental trigger ...

Apparently, autism is growing by bounds and leaps. So let's not throw babies out with dirty vaccines ... No, that's not quite right ... er, dirty bathwater! There's a great, new immunoexitotoxicity hypothesis out there which may help us to get normal kids -- and help kids get back to normal (assuming that normal is good).

Ed

Source:
http://www.ncbi.nlm.nih.gov/pubmed/19043939

Post 26

Monday, February 2, 2009 - 8:56am

It has been stated in previous forums that some regulation is completely unnecessary, such as building codes. The argument being that any builder who desires to remain in business will produce a superior building for reasons of reputation and increased business. Why is enlightened self interest deemed sufficient to keep a contractor from building something that will cave in and kill you, but it somehow isn't powerful enough to motivate someone to maintain a responsible immune status, knowing that refusal to do so will result in being ostracized from most of society. A building collapse that kills or cripples 100 people is deemed an avoidable problem without recourse to force, but a disease that kills or cripples 100 people isn't? How is immunological negligence different than any other kind of negligence? Its acknowledged in nearly every other scenario that enlightened self interest should be enough to prevent the willfully stupid or irresponsible. Is it because viruses are invisible that self interest is deemed insufficient?

Post 27

Monday, February 2, 2009 - 9:09am

Ed, has the actual number of autism cases increased or just the number of diagnoses (diagnosis inflation)?

Ryan, one key difference involves being able to point to culpable parties constructing a building (easier) versus being able to point to a particular spreader of a disease (harder). However, in both cases, a lack of regulations does not mean necessarily an epidemic of bad buildings or deadly diseases. As I said, I still find the "compulsion" aspect of the equation questionable. People who want good buildings or good immunity have a positive obligation to inform themselves and then act accordingly.

Post 28

Monday, February 2, 2009 - 9:13am

This is a solution in search of a problem.

Let me argue in the strongest terms.

Ah, so in the name of political freedom, the more desirable state is to have 30% of the country locked up in quarantine, by force as necessary, rather than to have 99% of the people immunized ahead of time, by threat of force, if necessary?

Sorry, it is only the perceptual bound mentality that allows this.

In a neighborhood where bears roam, we require people to keep their meat locked up and put away. We don't say that after the bear comes we will use force, but not before.

As for smallpox, it's a friggin example. I assumed everyone here knew they don't need to vaccinate for it nowadays. People our age were among the last to get that shot - a triumph of mandatory vaccination campaigns. The eradication of smallpox is a hard example to argue against.

Measles, mumps, diphtheria, they all kill. Vaccines provide only partial immunity. So, even if I do get vaccinated, if my neighbor doesn't, he can still get the disease and pass it on to me. And the nature of the phenomenon is such that it is only after he has already become infectious that we know he has the illness. Prior restraint is the only way that actually saves lives in such cases. We simply require people to get vaccinated ahead of time since that is the best way to deal with a plague - to prevent it.

The political mechanism? What's really wrong with the current mechanism, other than a potential ideological complaint? I am all for voluntary. (Indeed, I expect there must be at least five published doctoral theses on this by libertarian Poli-Sci majors.) But I am not interested in throwing the baby out with the bathwater. The bathwater we have right now is hardly objectionable.

After you let me know specifically what is wrong, we can see if it can be ameliorated. But I will not act like some unshaven conspiracy theorist, and go into a panic over the current "disastrous" widespread violation of people's rights that we have now, until someone can point at the actual disastrous effects. I can point to prior disasters before vaccination. Let's see some post vaccination disasters.

Post 29

Monday, February 2, 2009 - 9:39am

The CDC has an entire page about this here:

In most states, a parent must bring written proof of a child's immunizations from the health provider or clinic at the time of school registration. If a required vaccination has not been obtained, and there is no health condition or religious objection preventing immunization, the child must receive the vaccinations before school entry. You can find out what the requirements are in your state through a link provided at the end of this section.

So the states allow for parental religious objections.

I am forced to assume the states have these laws because they control the schools, but I will let this slide.

There are no legally mandated vaccinations for adults, except for persons entering military service. The National Immunization Program does recommend certain immunizations for adults, depending on age, occupation, and other circumstances, but these immunizations are not required by law. For example, adults may seek immunization for protection against seasonal illnesses, such as influenza and pneumococcal diseases; specific diseases that may be related to work exposure or personal interests (handlers of animals may be concerned about rabies); or upon potential exposure to a specific disease (such as rabies after an animal bite, or tetanus after sustaining a wound).

So adults do not have to take immunizations.

This all sounds within the bounds of reason to me.

I think the law is more lax than Ted would like!

I am not "looking for a problem" but did want to discuss this topic for clarification.

Post 30

Monday, February 2, 2009 - 10:18am

Luke, you're right-on that there is diagnosis-inflation in autism. It is extreme, but I would not want to claim that it accounts for all or most of the inflation. Nowadays, a kid whose parents thought he was normal, but who doesn't socialize at school to the teacher's satisfaction can be "diagnosed" as autistic!

This sort of thing happens in psychiatry off and on. "Schizophrenia" was grossly inflated a couple of decades ago. It is a scientific nightmare, because generalizations about prognosis and trials of meds are polluted by false positives. However, what diagnosis a patient gets controls what insurance payments will be made!

I have met several people with a child who seemed fine for the first year or 18 months, then regressed or failed to develop. They thought vaccinations were to blame. It is hard to accept the reality of your baby's suddenly becoming what a really autistic child is. For many people it completely overturns their lives, and they feel they face an unending nightmare existence from then on. Many divorces occur over this. Dads bail.

Post 31

Monday, February 2, 2009 - 10:27am

Maybe, instead of forcing needles into people, public places could be made off-limits to anyone not wearing an immunization ID--this in an epidemic emergency. Can't drive or even walk on the roads without it. Jailed if you are found without it, (or if it is fake) fined, put in quarantine until health is proved--part of the penalty could be getting innoculated!
That seems to make communicable health optionable, but necessary to going into public spaces, which is where communicable health matters.

Post 32

Monday, February 2, 2009 - 11:02am

Yikes, Mindy! I don't want to wear an immunization ID, tagged like a cow. It's certain to clash with my shoes. Besides, it'd probably be easy for the infected to forge. Let's make the unimmunized wear a big scarlet letter "U" instead. :-)

Incidentally, quarantining almost never works. First, by the time a disease presents, it's too late. Second, many people with the disease will hide because they don't want to go into quarantine.

I'm with Ted on this if I understand him correctly. It's not "compulsion" in any sinister sense to compel people to stay within the reasonable bounds of their rights.

Jordan

Post 33

Monday, February 2, 2009 - 11:21am

Based on the CDC site mentioned in my last post, it appears that the current system of non-compulsion of adults and tentative compulsion of children in state schools works well enough.

Post 34

Monday, February 2, 2009 - 11:47am

Jordan,
I have to take exception to your statement, "It's not 'compulsion' in any sinister sense..." as overthrowing the whole philosophic use of principles in ethics and politics!
If we had a benevolent monarch, he would probably reason exactly that way as he assigned people to jobs that needed doing.

P.S. Do you mind carrying a driver's license?

(Edited by Mindy Newton on 2/02, 11:50am)

Post 35

Monday, February 2, 2009 - 11:49am

Why would you be afraid to be asked to prove your immunological competence on demand? How exactly is that more invasive than a driver's license?
Ted, I'm going to devil's advocate you here. Where did you gather your 30% quarantined hypothetical? Where did you gather your 99% vaccinated ahead of time. The data I could find online suggested 60-93% at best, depending on state. I think you've gotten wrapped around the efficacy of vaccination argument. Vaccines work. I don't know anyone that is disputing that. I'm asking why vaccination is different than the huge number of issues that objectivist thinking states would be handled without government intervention. The law pretty much already allows exemption for the main reasons a person could conceivable decline vaccination anyway. So why would you expect vaccination numbers to go down? If your position is that we need compulsory enforcement in this one area, doesn't that throw everything else into question. If I'm too damn stupid to wipe my own immunological ass, how the hell can I be trusted to operate a vehicle, own a firearm, provide for my own children, build anything for the purpose of trade that has any value at all, or act responsibly in any situation. If I can't be trusted with something this basic then any other kind of gov't intervention seems like a matter of degree. The vaccine evaders are already evading. I'm not seeing how a freer society could possibly do any worse, especially given that compulsory health issues are now totally hijacked by special interests. Save a few million with smallpox if the right people are at the helm, kill a few million with malaria if the wrong ones decide DDT is too risky.

Post 36

Monday, February 2, 2009 - 12:18pm

I was just thinking that the term "herd immunity" is a rather nice metaphor for Objectivism.

Post 37

Monday, February 2, 2009 - 12:20pm

Luke,

That's a good point about "diagnosis inflation."

There's diagnostic sensitivity and specificity. I'd assume that the diagnostic sensitivity has gone up (more folks "caught" with autism now than before) but without a concommittant [?] rise in diagnostic specificity (successful differentiation of autism from other abnormalities). This would result in an irrelevant spike in autism cases (along with an extra-irrelevant spike in diagnoses). However, even conservatively factoring in the spike -- say, with a fudge factor of 10 -- leaves several new autism cases unexplained.

Genes haven't changed, so it's likely that the environment has.

Let's assume a 10-fold increase in autism diagnoses resulting simply from us being extra-sensitive toward spotting it in kids (no actual increase in autism incidence, just us finding 10 times as many cases which were overlooked before). Now, if 35-40 years ago, the incidence was 1 case per 10,000; then we'd expect to see a jump in cases (due to "diagnosis inflation") up to 1 case per 1,000 (because that's 10 times more diagnoses than before). But actual incidence (1 case per 150) is still almost 7 times higher than that.

It would seem that diagnosis inflation, while real, does not explain a great proportion (perhaps half or more) of all of the new incidences that we see today but which we didn't 35-40 years ago.

I think that dairy and grain sensitivities are drivers for somewhere around half of all cases of autism (perhaps more). It's an educated guess. Vaccines may play a part, too -- but it'd be difficult to say. It's not because the question hasn't been looked at. It gets looked at all the time.

Ask yourself why a question would get repeatedly looked at like vaccines are. Sit down, relax, and ponder why it is that a question like that would keep coming up -- even though it's been answered.

Ed
(Edited by Ed Thompson on 2/02, 12:22pm)

Post 38

Monday, February 2, 2009 - 1:06pm

Luke, I asked you what was wrong with the current law, and you respond that you think the current law is more lax than I would like. So, I think maybe you have a reading comprehension problem.

Ryan, those numbers were simply stipulated for the sake of argument. Sti-pu-lated. Why not ask me why I mentioned smallpox, when we don't immunize for that any more? (Woops, some one else already did.) Would the argument be any different if I said 3% of people forcibly quarantined and 90% vaccinated by law? I didn't think so.

Listen, people. One of the important parts of arguing is you have to actually try to understand what the other person is saying. It's kind of silly to assume that I'm some sort of innoculation fetishist who gets his jollies from watching forcible vaccinations.

I just don't want you sneezing on me.

(Edited by Ted Keer on 2/02, 1:14pm)

Post 39

Monday, February 2, 2009 - 2:09pm