Whenever we discuss vaccines and vaccine hesitancy, thanks to Andrew Wakefield the one vaccine that almost always comes up is the MMR, which is the combined measles-mumps-rubella vaccine. In 1998, Wakefield published a case series of cherry-picked patients in which he strongly inferred that the MMR vaccine was associated with autism and “autistic enterocolitis.” Of course, even the way Wakefield spun it, this wasn’t enough evidence to link the MMR vaccine to autism, which is no doubt why Wakefield never explicitly said that it did in the paper describing his case series. My guess has always been that the peer reviewers wouldn’t let him. However, outside of the scientific literature, unconstrained by peer reviewers, Wakefield was not nearly so shy about explicitly linking the MMR to autism. As a result, MMR uptake plummeted in the UK, and measles returned to become endemic again, after having been declared eliminated before. We now know Wakefield is a fraud, thanks to Brian Deer’s excellent investigative work, but the damage was done, and MMR uptake still hasn’t returned to pre-scare levels.
Unfortunately, measles is still in the news, even in the US, where the predominant mode of antivaccine fear mongering has not been about MMR, at least not the way it was in the UK in the wake of Wakefield’s case series. Most recently, there was what has become known as the Disneyland measles outbreak, in which an outbreak centered at Disneyland resulted in mini-outbreaks throughout the country. And, yes, the unvaccinated played a major role.
Not as well known are some previous measles outbreaks. One of these occurred in Ohio in 2014 and was traced to unvaccinated Amish men who traveled to the Phillippines, where measles is endemic. In fact, it’s bad there. with the World Health Organization having confirmed 21,403 cases of measles and 110 measles-associated deaths. This brings us to a study that appeared today in The New England Journal of Medicine (NEJM) that examined this particular outbreak, A Measles Outbreak in an Underimmunized Amish Community in Ohio. It’s more of a narrative than a study in that it’s a descriptive study of what happened, including the efforts used to contain the outbreak once it was identified, noting in the introduction:
When measles outbreaks occur in a region in which measles has been eliminated, they occur in clusters of unvaccinated persons, including those in religious communities. The Amish, a Christian sect descended from the Swiss Anabaptists, practice group solidarity and rejection of modern conveniences. Although the Amish Church does not specifically prohibit vaccination, the personal and cultural beliefs of the Amish limit participation in preventive health care, which results in low immunization rates16-19 and an increased risk of vaccine-preventable diseases. During measles outbreaks, the infection can spread unchecked among community members, which subsequently places susceptible persons in the general population at risk. Such outbreaks afford a unique opportunity to measure the ways in which high baseline immunity in a population and targeted public health responses contribute to the prevention of measles epidemics.
During the outbreak, which lasted from March to July 2014, there were 573 suspected cases of measles investigated, of which 190 (33%) were ruled out, which resulted in 383 confirmed cases. The authors note that this outbreak occurred in one of the largest Amish settlements in the US, with over 32,000 people. It was centered in Holmes County but quickly spread to neighboring counties. The overall age distribution showed that 26% of the cases occurred among children from 5-17 years of age and 48% among young adults 18-39 years of age—at least until the halfway point of the outbreak. After that, the rates changed to 52% and 25%, respectively. Early on in the outbreak, the transmission setting for 38% of the cases was church, and for 48% was home; later in the outbreak, these rates changed to 5% and 90%, respectively. Public places where lots of people gather are fantastic incubators to get an outbreak started.
Here’s where vaccination status comes in:
Before the outbreak, 340 case patients (89%) were unvaccinated As part of the public health response, 106 case patients (28%) received the MMR vaccine; of these, 16 (15%) received the vaccine before assumed exposure. No case patients received immune globulin as prophylaxis after exposure.
In 2014 in the general population in Ohio, vaccination coverage with at least one dose or at least two doses of MMR among young children and adolescents was 95.6% and 88.2%, respectively, and coverage with at least two doses of MMR among children in kindergarten was 91.9%.33 On the basis of data collected from the affected households, coverage with at least a single dose of MMR vaccine in this community was estimated to be at least 14% before the outbreak.
And there’s why the outbreak was able to spread so fast. MMR uptake among this Amish community was far below what was required to provide herd immunity. The exact percentage vaccinated necessary to maintain herd immunity depends on several factors. It’s not necessary to go into them here, but suffice to say that for a disease as highly contagious as measles in general vaccine uptake greater than 90% of the population is needed. Thus, this outbreak demonstrates how, in a state where vaccine uptake is very high there can still be a large outbreak. All it takes is a pocket of people with low vaccine uptake, like the Amish in Ohio. This is illustrated in a video that accompanies the article that’s well worth watching.
The article also details the public health response. This included containment interventions conducted according to CDC guidelines. These included enhanced surveillance, meetings with bishops and local health department personnel to encourage reporting, to emphasize the importance of vaccination, and to inform patients about the availability of testing. News of the outbreak spread rapidly through word-of-mouth, as well as by stories in the local Amish newspapers. Alerts were sent to health care providers. The jack-booted thugs from the CDC public health advisors from the CDC (sorry, dealing with antivaccine loons for so long sometimes causes me to lapse into their jargon) assisted local health officials in their investigation, and door-to-door case finding was conducted in areas where underreporting was suspected.
There there was a mass vaccination campaign:
During 120 free vaccination clinic sessions, 12,229 doses of MMR vaccine were administered to 10,644 persons; 6461 of the persons who received at least one dose (61%) were 5 to 39 years of age (Table 3 and Figure 3FIGURE 3). Case patients were isolated until they were no longer infectious (4 days after the onset of rash), and nonimmune persons who were exposed to measles were voluntarily quarantined at home and followed for the development of symptoms until beyond the maximum incubation period (21 days). The church-related entity that organized the charitable work in the Philippines adopted pretravel immunization measures for subsequent volunteers.
These are the sorts of things public health officials have to do once an outbreak starts. Preventing an outbreak is, obviously, far more desirable. One notes that persuading the population to vaccinate, even in the case of an outbreak. Fortunately, this time around the community involved was less resistant to vaccination than during past outbreaks and was very cooperative:
A few notable features of the outbreak revealed important characteristics of the affected community. First, the degree of opposition to immunization was less strenuous than it was in previous outbreaks among the Amish, in which vaccination was refused. In addition, infectious and exposed persons were willing to limit attendance at church gatherings, weddings, and other events, which may explain the changes in age distribution and exposure setting during the outbreak; initial transmission seemed to occur more often among adults, whereas subsequent transmission occurred more often among younger age groups once measles was introduced into households. Second, the rate of hospitalization due to measles was lower among the Amish (approximately 3%) than in the general U.S. population (approximately 20%), which may reflect differences in health-seeking behavior and the cost of medical care, because the Amish tend to be uninsured. Third, measles attack rates were 1.5 to 1.9 times as high among persons younger than 40 years of age as among those 40 to 54 years of age, which suggests that older age groups had previous natural immunity; this finding is consistent with reported measles outbreaks in Ohio in the late 1980s. The fact that no case patients were 55 years of age or older supports the statement in official recommendations that persons born before 1957 have presumptive evidence of measles immunity. Fourth, although we had expected lower attack rates among children younger than 1 year of age because of transfer of maternal antibodies, unvaccinated mothers had a high probability of remaining susceptible through early adulthood because of the low background incidence of measles in an area in which measles has been eliminated, which therefore diminished any potential transfer of protective antibodies to their neonates.
In other words, when measles isn’t around in the population, you can’t count on maternal antibodies transferred to the baby protecting against measles. All of this brings us to the conclusion:
This evaluation illustrates the way in which a clustering of persons who do not routinely vaccinate against measles can result in an accumulation of susceptible persons and can subsequently create a niche of sustained measles transmission. Since the outbreak, local health departments have continued to promote and offer vaccination. Although acceptance of vaccination among some of the Amish has generally improved, the demand for immunization has varied by county, and efforts to ascertain and to improve coverage in this and other Amish communities are needed. We highlight the importance of early recognition of measles and suggest that prompt initiation of control measures ahead of the epidemic curve may be key to limiting the spread of measles. Effective strategies rely on community commitment through engagement of local leaders, isolation of infectious persons, quarantine of those exposed, and vaccination of susceptible persons. The single best means of containment of measles, however, is maintenance of high initial levels of measles immunity in the population.
Let’s repeat that again: The best means of containment of measles is the maintenance of high initial levels of measles immunity in the population—through vaccination.
The question then becomes: How to maintain that high level of vaccination. To this end, there was also a Perspective article by James Colgrove, PhD, MPH entitled Vaccine Refusal Revisited — The Limits of Public Health Persuasion and Coercion. This is an article that explicitly addresses the difficult issues around how far the government should go to require vaccination. Colgrove starts his article that coercion as a strategy in public health goes way back, citing examples from the 19th century of compulsory smallpox vaccination laws that covered both children and adults. These laws included penalties that ranged from exclusion from school for unvaccinated children and fines or quarantine for adults who refused vaccination. These laws worked, too, and, contrary to what you will hear from antivaccinationists, their constitutionality was consistently upheld in numerous court challenges that ultimately made it to the Supreme Court, where the 1905 Supreme Court case of Jacobson v. Massachusetts also affirmed their constitutionality.
As time went on, persuasion became as important, if not more so, than coercion:
The use of coercion has always raised concerns about state intrusions on individual liberty and the scope of parental control over child-rearing. Compulsory vaccination laws in the 19th century typically contained no explicit opt-out provisions. Today, all states offer medical exemptions, and almost all offer religious or philosophical exemptions. Nevertheless, even a law with an opt-out provision may exert a coercive effect, to the extent that the availability of the exemption may be limited and conditional and the consequence of the law is to make the choice to withhold vaccination more difficult (if only marginally so) for the parent. These laws continue to be the target of antivaccination activism.
That’s an understatement. Fast forward 110 years, to when SB 277 was passed in California. Passed in the wake of the Disneyland measles outbreak, it’s a law that fully took effect this school year and eliminated non-medical exemptions to school vaccine requirements. Given how easy nonmedical exemptions were to obtain in California, it was a not unreasonable measure to take. Unfortunately, although other states have tried to pass similar laws since, no other state has succeeded. In any case, resistance to SB 277 has been fierce, with demonstrations, but also disturbingly lots of Nazi imagery comparing the law to the Holocaust and the unvaccinated to Jews, complete with some even making badges patterned after the yellow Star of David badges Jews were forced to wear to identify themselves in the Third Reich and conquered territories.
Colgrove points out that today public health officials are working on both persuasion and coercive approaches, but mostly persuasion. He notes that social scientists are working to develop a much more nuanced understanding of the phenomenon of vaccine hesitancy, which actually encompasses a wide range of behaviors that range from reluctance to vaccinate to suspicion of some vaccines but not others to wanting to delay vaccines to full-out antivaccine wingnuts like the crew at Age of Autism or The Drinking Thinking Moms’ Revolution. Of course, one thing that I tend to think that social scientists do too much of is trying to craft strategies to reach antivaccinationists. Don’t get me wrong. Reaching the vaccine-hesitant is important. Many, if not most, of them can be reached with the right message. Trying to reach the hard core antivaccine wingnuts is what I like to call a long run for a short slide, a lot of effort for not much chance of a return.
Where I do agree with Colgrove is that neither coercion nor persuasion is sufficient. Noting that even the best-crafted persuasive appeals can’t achieve the near-universal vaccine uptake needed to protect the population against a disease as contagious as measles, he concludes:
Both persuasion and coercion are necessary, and neither is sufficient. Laws serve as a critical safety net as well as a powerful symbolic statement of proimmunization social norms. Education and persuasion are needed to maintain public understanding of the value of vaccines and trust in health professionals, both of which are essential to securing compliance with laws. The melding of the two approaches — along with ensuring a stable, accessible, and affordable supply of vaccines for everyone who needs them — is the central challenge for vaccine policymakers. As has been the case since the 19th century, effectiveness, efficiency, ethics, and political acceptability all need to be balanced in a careful calculus.
Figuring out what the proper balance is and how to achieve that calculus is more difficult now than it was in the 19th century or even the 20th century. Thanks to the Internet and social media, antivaccine forces, which were relegated to using pamphlets and speeches, can reach millions or billions. They can forge like-minded virtual communities of individuals imbibing the same self-reinforcing misinformation, immune to correction. That is the unique challenge of the 21st century in maintaining high vaccine uptake.
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Maternally-conferred measles immunity is over-rated. Even wild-type maternal antibodies last, at best six months and not infallible.
The online ease with which "how-tos" for filling out non-medical exemption forms can be found and completed has hurt vaccination rates, especially when those "how-tos" are found on searches that land vaccine-hesitant parents to sites like the NVIC, who seem to have themselves planted firmly as the top result of all vaccine exemption searches.
I shake my head daily that its taking more and more of these outbreaks to convince people to vaccinate. Anti-vaccinationists, however, are unshakable in their stupidity and will do the darndest to take every outbreak and misrepresent it as some sort of "vaccine failure" when in fact every one of these outbreaks-- be it the Amish in Ohio or the 125 cases due to the "Disneyland" outbreak--are due to low vaccination rates.
OT grumble: iIf NEJM is going to let the main article be free to view, they could also at least let the perspective article by Dr. Colgrove be as well--but of course they didn't.
You mentioned that they are using the Star of David forced on the Jews to allow easy identification of them. As a public health matter, I kind of support the idea. Instead I propose a large pointed cap that says "**DANGER** I may present a health-risk to the un-vaccinated and immune compromised. My parents are morons that want to risk my life and others to vaccine preventable diseases"
Yes it is unfair that the child has to pay for the idiocy of the parents, but that is life.
Hmmm. How about this proposal?
Rather than deny unvaccinated children from going to school at all, establish a herd-immunity quota. If, for instance, measles has a herd-immunity level of 95%, any given school is allowed to admit 5% unvaccinated children.
Now set up a priority system. Medical exemptions get first dibs (tiered based on seriousness of the exemption); religious second dibs; "I just don't wanna" are at the back of the line. Use a lottery to break ties.
The benefits:
* It seriously dilutes complaints about coercion, and thus would be easier for people on the fence to swallow. "Nobody's coercing you - if you don't want to get vaccinated, get in one of those exemption slots."
* Thanks to the existence of school districts, it will geographically scatter anti-vax parents. Anti-vax parents will find themselves the only ones espousing their views in any given community, diluting their influence when everybody else disagrees with them. This as opposed to the current situation, where anti-vax parents tend to congregate together, and the more concentrated they are the more influence they can have on the uninitiated.
* This geographic scattering also lessens the chances of a non-school-centered outbreak.
* When the slots are already filled by medical exemptions, you are starkly presenting the would-be anti-vaxxer with the consequences of their actions: "If we let you do this, you are putting the whole community at risk of measles."
* It provides a teachable moment for parents who don't fully understand vaccination, herd immunity, and the dangers of long-gone, supposedly-non-serious diseases: "There are certain kids in the neighborhood who will unquestionably die if they get the measles, and by vaccinating your kid you are helping to save them *and* protect your own kid."
* It lets schools tell anti-vax parents explicitly: You don't want to vaccinate your kids and just rely on herd immunity? Well, sorry, I think the kid who has cancer should be let into school instead. Don't like it? Go and tell the kid who has cancer that you think you should have the right to infect him. Don't want to? Then quit complaining and vaccinate your damn kid, or quit complaining and go to a different school.
* It might also help curtail the fake medical exemption black market. First, it appeals directly to the parent: Do you really want to be the kind of monster who kicks the kid who has cancer out of school? Then, if that doesn't work, the public shame factor. You just know the parents of the kid who has cancer will be informed of who replaced them and why, and then your face will be on the local news: "Cancer patient John Smith can't go to school because Bob Jones bought his kid a fake medical exemption! The full interview at 11."
Sure, when I think about this more seriously I can see a million different ways such a policy could backfire, but I think it has a certain poetry to it. Maybe if I think about it more I can plug some of the holes.
@3: "I may present a health-risk to the un-vaccinated and immune compromised."
It's a health risk for the vaccinated too. Vaccines aren't perfect. Don't let the anti-vax people use the argument "well if you are vaxed then you shouldn't care if I'm not". They use this argument repeatedly, and disingenuously, since most have been told why it's wrong 10 times, but just keep on saying it.
@5: You are indeed correct that vaccines arn't 100% effective. Putting all the caveats and information on the cap would probably reduce the impact. That or lead to accusations of assault as you spin the child around to read it all. :-)
@4: Your idea probably run into the same issue as my cap. Personal privacy generally out-weighs public health. HIPPA etc.
Rather than deny unvaccinated children from going to school at all, establish a herd-immunity quota. If, for instance, measles has a herd-immunity level of 95%, any given school is allowed to admit 5% unvaccinated children.
We already know vaccines are not 100% effective. Why endanger other children needlessly for some stupid parents' behavior.
Apart from privacy concerns, there is also the objection that current Federal law (ADA) requires school districts to accommodate all students within their borders who have medical exemptions. I'll grant that it's unlikely in large school districts for the fraction of students affected to exceed the herd immunity threshold (absent the sort of fraud that certain California pediatricians are alleged to be committing), but it could easily happen in a smaller school district. Say that a certain district typically has 30 students per class year, and in a given year there happen to be twins who both have a medical exemption. This would violate your limit (the vaccination rate would be only 93%), but it's definitely unfair to the parents if they have to send one (and only one) of their kids to some other school district that may be several miles or more away.
I have heard the quota idea before, and have some issues with it.
A. The 95% threshold doesn't really consider vaccine failure.
B. Among parents who don't vaccinate, there are parents who will vaccinate in the face of mandates, and parents who won't. A quota system won't distinguish. So we may have parents who would otherwise vaccinate not vaccinating because they got a slot on the quota - and kids still kept out of school if extremist parents did not get a slot on the quota.
I don't think the state should be complicit and getting parents who would vaccinate absent a quota not to vaccinate.
I also want to plus Dr. James Cosgrove's wonderful, thorough book, State of Immunity, on the history of the politics around vaccines in the U.S..
@jrkrideau, Dorit: The limit can easily be set according to the effective immunity rate provided by the vaccine.
@Eric: The limit would be per-school, not per-year, but your point is taken. For such extreme cases, we can decide that medical exemptions count toward the quota but are not limited by it (in which case we'd do away with the tiered medical exceptions thing).
Regarding medical privacy concerns - how do schools *currently* recognize medical exemptions? Don't they need to be told about the issue?
@Dorit Force all parents to submit their request for an exemption in advance, to a centralized database rather to a specific school district. The exemptions will then be allocated out; a parent who isn't militant about anti-vaxxing wouldn't want to risk being allocated to a distant district.
Yerushalmi: "The exemptions will then be allocated out; ..."
And there will be those who can find a bureaucrat who can slip them in for a price.
You are making it too complex, which always leaves room for under the table deals. Sorry, unless they have a real medical contraindication, they should just keep their special snowflakes out of public schoo.
@Yerushalmi:
You can stop at the word "quota". My immediate response is NO. South Africa has considerable experience with the use of quotas for various things. The bottom line: quotas reduce everything to a numbers game.
I can not support such an idea, no matter how well intended.
Can I make a request that we stop with this? The fact that they like to get together and have wine is really irrelevant to the veracity (or lack thereof) of their comments and beliefs.
They need to know that the student has a medical exemption. They do not need to know what medical condition justifies the exemption. This is another reason not to go with your tiered system: there is no way to enforce it.
And as Chris@12 points out, your proposed system can and will be gamed.
Which is why I favor the system in place in California, Mississippi, and West Virginia: No nonmedical exemptions allowed. That's the closest we can come to a perfectly fair system. There will still be some people who try to obtain dubious medical exemptions, as we are seeing in California. We also see cases of parents trying to get a special education determination for their special snowflakes, because the law requires special education students to get particular attention. So we have authorities audit the records to cut down on the number of fraudulent medical exemptions.
There may be a better way to balance herd immunity with privacy concerns and providing schooling to those who, through no fault of their own, cannot or should not be vaccinated. But I don't see that better way. We take the risk of an outbreak in a school with an unusually large fraction of medical exemptions because we have to--the alternatives are worse. We do not take the risk of outbreaks in schools with large fractions of "philosophical" or "religious" exemptions (BTW, no religious sect of significant size that I am aware of has an official position against vaccines), because we don't have to--there are better ways.
@ Chris Hickie:
I feel ya', Chris. Many's the time Orac links an article that appears to deal with public health issues that are important NOW, I click, and find the darn thing is hidden behind a paywall. And I'm not talking research papers reporting results of a scientific study, but essays like Colgrove's.
Most recently, there was Turner and Knoepfler's article on the promotional efforts of sketchy stem cell clinics (excuse any redundancy there) -- Orac rightly complained that the authors didn't name names, but worse, the mere consumers like me who are, duhh, the target of this sales hype can't access the warnings detailing the dubious sales techniques and why/how they're not kosher with the science.
I'm extremely skeptical about how 'social scientists' tend to understand questions of ideology and persuasion, and what I've seen of vax-persuasion efforts from the medical science community strikes me as mostly clueless and inept. So, with the power of coersion limited within a liberal democracy, if persuasion is the primary means at the disposal of public health officials to prevent future outbreaks, I fear they won't be good enough at it to get the job done. Actually, what Orac noted about "a more nuanced understanding of vaccine hesitancy" composed of "a wide range of behaviors" is encouraging, and seems to suggest TPTB may not waste time on the hard-core AoA/TMR crowd. On the other hand, the reference to a range of behaviors could be a red flag. So Orac's aside spurned my curiosity... But, NOOO. Paywall!!
I take what you're saying about NEJM, but I don't fault the journals as much as I do the authors. If you have something important and timely to say, forget adding another journal publication to your CV, put social responsibility ahead of reputation polishing, and publish the damn thing someplace the relevant public can get to it, will take notice of i, and spread the word around..
@Chris: You can use a Gale–Shapley algorithm to eliminate any human interference, just like the NRMP.
@Eric: I've already done away with the tiers in a previous response, but you are correct that if they were still there one would either have a privacy issue or a doctoral trust issue.
--------
@Everyone:
There is a certain level of hostility I am seeing in some of the responses, so I want to repeat this sentence from my original post:
Sure, when I think about this more seriously I can see a million different ways such a policy could backfire, but I think it has a certain poetry to it.
One of the objections raised here in fact was among said million ways. I had even already started typing in "That's one of the million ways", but thought of a solution before I could finish. (That speaks ill of the strength of the objection, not of my typing speed.)
So I politely request that people stop treating this as an official stance that I have taken, and treat this more as the let's-see-where-this-takes-us thought experiment that it was intended to be.
Coercion, persuasion and education. Whether it is formal or informal, social media or whatever, there is a huge need for education on the miracle of vaccination. Nobody I talk to has any idea of the history of these diseases and what a scourge they were. They see Mercola write things like measles is nothing, all I remember is spending a week in bed reading comics. These diseases have become distant and forgotten, which is good, but we need to be reminded strongly how we got here and how quickly we can go back.
@Yerushalmi: I fail to see how a quota would eliminate complaints about coercion. Aside from that, distinguishing religious and philosophical exemptions is constitutionally problematic.
@ Todd W:
I'm not entirely sure if I totally agree BUT right, there are so many other points based upon which we can poke fun at/ insult them.
Let me suggest a few:
- they spread misinformation about vaccination and health
- they pretend expertise that merely exists in their own imaginations and nowhere else
- they posture as 'cool people' ( that one is truly unforgivable)
- they self-promote their own (bad) books
- they raise money to help other parents off autistic kids buy woo
- they manage the preceding actions by posing as a charity
( aren't there US laws?- btw- other woo-meisters do this as well- some whilst some politicise their sites)
- they worship AJW
- they hate Orac and company ( and the likeminded)
- they use alcohol as an excuse to go off the deepend and proselytise their woo-mongering and mutually enable each others' unrealistic ideas and self- evaluations
I can think of many much better uses of alcohol. many of which I have personally experienced and found efficacious.
-
OF autistic kids
Maybe I missed it, but I would have hoped that the "A Measles Outbreak in an Underimmunized Amish Community in Ohio" would have addressed the cost of controlling the outbreak.
I know that other outbreaks have been costly to contain.
Don't forget ignoring corrections to absolute howlers (I'm thinking back to the Hahnemann memorial item) or, in the alternative, getting really pissy in response and then ignoring them.
As far as censorious asshattery goes,* TMR way outpaces AoA.
* Yes, I'm taking the phrase out of its proper context – it's their litter box, after all.
Narad, I do recall their (in)famous post about Dr @sshat by Mac Neill.
( she seems to have gone off the radar both @ TMR and Fearless Parent- which may be limping off into the sunset @ PRN.fm and elsewhere-
she wrote the most seething posts and then took herself off anti-deprerssion meds-
NO NO NO I am not illness-shaming her but merely reporting what shewrote herself - I'm not sure who could replace her... erm.. wit)
The ( so-called) Professor O'toole may still be their editor/ website runner and thus, responsible for various atrocities beside her own posts. And that's saying quite a lot.
TMR's merry wives may be viewed in videos posted at the websites for Autism One 2015/ 2016. They did panels about recovery etc. There's quite a few which enables us to view them and their manners of both thinking and revolution.
Also videos at TMR.
@Anthony: It wouldn't eliminate complaints about coercion from the people already inclined to make those complaints under the current system, no. But currently the complaints can only be countered by a vague pointing at the general concept of herd immunity. Tie it to a quota system, and every single anti-vaxxer complaining about coercion will in effect be talking about a specific ill person they want kicked out of the quota on their behalf, or they will be trying to explain why they're so special that they deserve to be the one who brings the percent of immune people from above the safe level to below it.
The idea was not to eliminate the complaints, but to expose them as the scientifically illiterate and entitled whining that they are.
@Anthony
I forgot to mention - your point about religious vs. philosophical being unconstitutional is a very good one. So scrap that distinction. Oh well. (This house of cards I've built is looking more and more unstable... :) )
I'd suggest relaxing about it. People have different styles of just kicking ideas around.
Do you think that they care? In their worldview, they are the special, enlightened, deserving ones. Do you really think that they will feel shame and/or embarrassment over that?
They don't now, and they won't.
Hence my reference to "The Drinking Thinking Moms' Revolution," except that in retrospect I think that perhaps I should have put the strikethrough on the word Thinking.
And I didn't even mention their wholesale embrace of medical marijuana for autism. :-)
The WA DOH just released a statement concerning vaccination rates in WA .In part: The state recorded increased rates over last year for nine out of 10 vaccines and met national targets for several of those. In addition, the state surpassed its own goal of 72.6 percent completing the full childhood series of vaccines; our rate this year was just over 77 percent.
I think even 77% is to low of a goal, let alone 72.6%.
Good for them. Is that supposed to be a bad thing?
# 11 and later posts Yersalemi
@jrkrideau, Dorit: The limit can easily be set according to the effective immunity rate provided by the vaccine.
You miss the point. There is no reason to cater to philosophical or religious objections. There are good reasons to cater to medical exemptions.
If parents have such objections to vaccinations no one is forcing them to send their children to a public school. Let them home school or find a private school that does not require vaccinations. This last alternative will encourage togetherness among the pupils as they share in the measles epidemic.
I wouldn't use the word "catering". That implies that I think such objections are legitimate, which I don't (while I have significant sympathies for religious concerns, I don't think those should ever override human life).
Right now, objections to coercion are one of the strongest weapons in the anti-vaxxer arsenal, particularly on the political right. I'm theorizing that, if we remove the coercion on the individual level and put it on the community level instead, it becomes a far less powerful rallying cry. No individual person would feel like they're being coerced, because they're effectively choosing, for themselves, whether to vaccinate or seek an exemption (in their local district or, if the quota is full, a neighboring one). So the coercion is depersonalized, spread across society, and therefore less acutely felt.
I'm also theorizing that, counterintuitively, providing limited exceptions would actually improve vaccination rates. Fence-sitters will be faced with the knowledge that there are specific sick individuals in their community whom they will be harming with their decision, while anti-vax fanatics will be isolated and embarrassed because their deleterious effects on society as a whole will be thrown into sharp relief.
Obviously one or both theories could be wrong, which is precisely why I am presenting and thinking through the exercise. But I'm not going into this with the goal of catering to anti-vaxxers. Much the opposite; I'm going into this with the goal of exposing their selfishness to their neighbors and forcing them to face the consequences of their actions in the form of being shunned by same.
Clarification: By "such objections" I of course am referring only to the religious, philosophical, and pseudoscientific objections. Obviously true medical exemptions are legitimate.
@ #30 (Orac) But dude...DUDE...I smoke weed everyday and I don't have autism. Coincidence? Or EVIDENCE? I also don't have cancer...Yet another coincidence? Or MORE EVIDENCE?!
I'm just joshin'. That is ridiculous.
Rich: I don't think 72.6% is terrible for completing the full childhood series. I didn't see the report so I don't know how they are accounting for children who have not yet aged through the system. Is is possible that some of the remaining 23% are 'mostly' vaccinated?
And are the medical exemptions included in the 23%? Or recent immigrants, who might just be behind schedule but are catching up?
I totally agree that 77% is still too low, and there are some high-risk pockets (darn hippies on the islands). But an upward trend is way better than a downward trend!
JustaTech,
I only saw the PR release on the WA DOH website. DOH didn't have a link to WA specific report only the full CDC (at least that I could find) and didn't want to take the time to go through the CDC report.
I agree that an upward trend is way better than a downward.
It is not only the hippies in the islands but all the far right anti everything parents that also causing problems.
@34 Yerushalmi
But there is no compulsion in any country I am aware of. Exclusion yes but no compulsion.
OT but it is a vaccination thread.
In a discussion on PZ Myers blog that morphed from how horrible Thursdays are into getting a flu vaccine we find jjaybee stating I refuse to get a flu shot, because I don’t want to get adult onset autism. Jenny McCarthy has saved my life more than once, you know.
I'm still laughing.
Just curious. How many of the unvaccinated Amish who got the measles died?
@Yerushalmi:
As I elucidated above, shame won't work on them. They believe that they are the enlightened, special people. In fact, ostracism by the "little people" may be viewed by them as a badge of honour.
A bit OT, but, as use of naturopaths appears to be linked to anti-vax ideas, here's another one for the "yeahbut alternative meds don't do any harm!" collection:
https://www.theguardian.com/lifeandstyle/2016/oct/07/doctors-warn-over-…
jrk @40
Seriously, someone claimed adult-onset autism? The stupid it burns...
I have wondered many times how much some of these eejits know about autism (see also the berk who was citing mouse behaviour studies round here the other week)...
@ImaSkeptic, The mortality rate is far less important than the morbidity. The real question is how many got sick (answered pretty well), how many suffered secondary conditions as a result of the 16-24 month immune suppression effects, and how many suffered long term disabilities.
As mentioned above, the costs to contain vs the costs to prevent are shockingly out of balance.
#44 Murmur
Seriously, someone claimed adult-onset autism? The stupid it burns…
"Seriously"? No of course not. You missed the level of sarcasm in the comment. I still am laughing.
Edit: For 'sarcasm' read 'disdain'.'
re Orac @ #30..
These revolting moms give drinking a bad name.
As I mentioned previously, there are so many better uses for alcohol than it serving as a launching pad for a stream of unmitigated woo and self-aggrandisement.
- Interestingly enough, many, if not most, woo-meisters discourage its use altogether- it is after all a poison. Two I survey claim not to have touched the stuff EVER!
In their lives!
But TMR - and at least one of AoA's editors- drink wine.
So they are inconsistent in their acceptance of alt med ideas about what is healthy.
I think that they confuse what they feel from alcohol- reduction of stress, euphoria, self-acceptance, solidarity with likeminded folk**- as validation
that their bad ideas are realistic.
I can assure you that ingesting alcohol has never resulting In my acceptance of bad ideas. Ideas are at those times the last thing on my mind.
One of TMR's own- Tex- started an effort to legalise marihuana in Texas.
** as a civically minded individual, I should point out that parents like the Moms who have received a dx of ASD for their children might be suffering from disappointment, shock and possibly estrangement from their peers ( their kids may not attend local school or partake in average childhood activities). They feel isolated and devastated and seek out help through the internet or facebook ( where TMR was born -btw-).
There they find likeminded mothers who also blame SBM for their woes and encourage woo-ful ideas about the causation and cure of ASDs.
Thus, they enter a club where their problem becomes a mark of distinction. They join the revolution as brave freedom fighters in solidarity with others. A few write books and lecture others. It's called Secondary Gain- or making lemonade.
@ Rich Bly:
It never fails to amaze me that 'hippies; and the 'far right anti everything' folks can agree on anything.
Too bad it's on the nonsensical .
jrk @ 47 & 48
I have often found that my own habitual sarcasm and mild irony do not transfer well to a text-based medium, so I'd missed it in that comment...That and I have heard far too much eejitcy and numptiness emanating from certain quarters, why,in another tab just over there (<------) I have open a piece about electro-sensitivity...
None yet but many infants were infected which increases their risk of SSPE, a 100% fatal complication of measles infection. Three percent of patients were hospitalised which in Amish country means quite serious given their reluctance to seek healthcare outside their communities. Death isn't the only endpoint worth avoiding.
Just curious. How many of the unvaccinated Amish who got the measles died?
Anything less than death is ok with you?
I suppose the rush to get vaccinated also helped minimize the odds of mortality in the most vulnerable.
@Yerushalmi: Your quota system ignores the fact that not being vaccinated is a health risk for the children in question. We shouldn't be in the position of enabling parents to endanger their children due to their own ignorance and ability to qualify for any quota.
Sometimes I think that "mandatory" has a different meaning in the US. For example, on the radio today there was a piece on the mandatory evacuation order for part of Florida (for the hurricane) and then the sheriff was saying that for anyone who didn't evacuate, there would be a curfew.
If the evacuation was mandatory, why would there still be non-responders in the area who need a curfew? That doesn't seem like a very mandatory evacuation.
The next time someone tries to tell me that vaccines are mandatory, I'll say they're as mandatory as evacuating from a hurricane.
I hereby humbly offer my 'objective' reading of “The Drinking Thinking Moms’ Revolution,” as a professional semiotician and one who is ambivalent about the use of the construction and thus has 'no dog in this fight'.
Where Todd errs, I think, is taking 'Drinking' as a literal reference to "the fact that they like to get together and have wine." In the usage at hand, 'Drinking' is a snarky substitution for 'Thinking', and thus defined in opposition to the meaning implied in the original usage. That is, more than anything, it's an assertion that the TMRs are not actually characterized by 'Thinking'i as a quality. The fact that Orac strikes out 'Drinking' not 'Thinking' adds more force to the snark. via mock politesse. It means he actually considers 'Drinking Moms' the appropriate term but is deferring to their chosen name out of overtly mock politesse, a smack-down at the fragile sensitivity common among AVs.
As a substitute for 'Thinking' with only a single consonant changed, 'Drinking' is clearly wordplay, which puts it more in the realm of the figurative than of the literal. It's quite common for 'drinking' to be use to invoke the connotations of 'drunk', which are quite commonly applied not to reference actually alcoholics, but anyone (or even any thing) acting or speaking erratically, incomprehensibly, un-thinkingly, even if no alcohol use is involved or the subjects do not actually drink.
The long-term context of Orac's blogging persona also works against a literal meaning of 'Drinking' as he's clearly employing it as a pejorative for the Moms, and regular readers here will know he has no generic objections to the consumption of alcohol. ;-)
While, as a pejorative, 'Drinking Moms' is clearly ad hominem, in the usage “The Drinking Thinking Moms’ Revolution,” it's much less a 'first strike' at the persons than a negation of the inherent claim of condescending personal superiority in their choice of 'Thinking Moms' as a moniker. The emphasis, again, is on the substitution, not the meaning of the substituted term. 'Thinking moms? Umm, I don't think so.'
We might still argue that the snark of this negation is 'getting down into the gutter' by mirroring the heat of AV rhetoric, or that arguments for 'science' should just not go to question of personal authority or integrity at all, and focus exclusively on "the veracity (or lack thereof) of comments and beliefs". However, the contradictions between "insolence" and the dispassionate 'objective' standards of scientific inquiry and 'skepticism' (as defined by Brian Dunning: "the process of applying reason and critical thinking to determine validity") are a defining feature of this blog, manifesting themselves (sometimes quite awkwardly) in the majority of posts, and comments as well. Thus, a choice to "stop with" just this particular manifestation of Insolence would be hard to justify on the sort of general principles we've been considering.
More pragmatic principles might be applied, though. E.g. we could argue the 'joke' is worn out, overplayed, and stale at this point, or that this specific bit of Insolence is a poor strategic choice for undermining TMR rhetoric for the target audience, and some other still-highly Insolent bon mot might be more effective... (Offered merely as examples, not my views; and I have no alternative Insolent thing to suggest...)
@11 Yerushalmi
Short version: a quota system would be problematic because many schools would have effective immunization rates well below the population-level efficacy rate of the vaccine due to random effects alone.
Long version:
There are a couple of complications involved in setting quotas based on efficacy of the vaccine. The obvious one is not everyone receives the same form of a vaccine: for example, students of foreign origin might have received a completely different set of vaccines on a different schedule than native-born students, and figuring these in (even assuming data is available and comparable) would be a pain.
The second complication is even more problematic and unavoidable: the actual take rate of a vaccine in any given sample (for instance, all the students in a certain elementary school) is a random variable following an approximately binomial distribution. This means that some samples will have take rates lower than the efficacy rate of the vaccine.
The natural questions to ask next is "how much lower than efficacy rate?" and "how often?" I played around with the parameters of binomial distribution a bit. Assuming that the efficacy rate of measles vaccine is 97% and we need 95% take rate for herd immunity, a school of 300 students would have a 2% chance of falling below that 95% requirement due to chance alone (this probability would be higher for smaller schools and lower for larger schools). If a school only needs a 90% take rate, then the chance of falling below the herd immunity threshold in the same school of 300 goes down to 3 out of a billion.
The above model is just about the most optimistic take possible on the problem. We assumed that there were no medical exemptions, which would have required take rate to be higher in the rest of the sample to maintain herd immunity. We assumed that whether each student develops immunity to measles is independent of every other student, which is probably not the case in reality (some students may be related by blood, while others may have received vaccines from the same lot). Finally, students may associate in smaller groups, forming subpopulations that are more susceptible to random effects by virtue of their size.
All in all, I think we need as many people vaccinated as possible to avoid having pockets of susceptibility.
At meetings where the Dean of Freshmen at the college where I taught discussed advising the frosh with the faculty assigned to that task, she always joked, 'They're freshmen. They don't know anything [about how the college actually functions]. So they think "required" means they actually have to do it.'
Which is to say, the mere existence of a mandate is a different thing than the means, if any, employed to enforce compliance. Examples typically cited by dictionary definitions of 'mandatory' include things like seat belt laws, yet people drive unbuckled all the time without getting ticketed. Other mandates established by law go without any meaningful enforcement at all. (Motorists drive 66MPH without fear.) People may still cringe at low-enforcement mandates if they feel the policy is unfair, since the existence of the mandate brings the potential of negative consequences for non-compliance, even if that has never happened yet. They may also complain about the rhetorical/ideological effect of a mandate they consider unjust -- as their behavior may be stigmatized resulting in informal interpersonal de facto consequences rather than de jure ones.
So if an AV whines about 'vaccine mandates', first of all they're conflating the written requirement with some non-extant regime of fascistic enforcement. Second, of course, they're distorting what the mandate of SB277 actually is: a requirement for healthy children to be admitted to accredited schools, not something everyone has to submit to regardless.
I think the most significant consequence of SB277 is exactly its rhetorical/ideological effect. No matter how vigorously it's enforced, it thoroughly de-legitimates the AV position by removing the de jure 'personal belief exemption'. I also think the AVs understand this, and are trying to Godwin SB277 to claim some legitimacy for being scofflaws or obtaining bogus medical exemptions, whether or not they're successful (fat chance) in getting the law repealed or rejected by the courts.
@ Sadmar
As a long-term reader, my perception/remembrance of the context of this "drinking" joke is that it started as a way to say "you don't know what you are talking about", as follow:
The first time Orac used it, it was when reporting on a discussion the TMR have published on the net; in it, a number of Thinking Moms had congregated IRL and were bemoaning the presence of all these neurotoxins in vaccines (alu, formol, the usual), all the while indulging in some nice wine.
Orac - or some readers - pointed out that, as neurotoxins go, ethanol is a very potent one, especially on the developing fetus.
(trivia - early september, I saw in the news that fetal alcohol syndrome is still A Thing, with awareness/prevention campaigns kicking off, both in Canada and in France)
In short, this "drinking" joke was actually a retort on the line of:
"You wouldn't be able to recognize a neurotoxin, even if you were drinking it. Which you do."
Or as you said: "Thinking? I don't think so"
I'm not as uncomfortable as Todd with the repetition of this joke, but I'm aware I have the original context in memory. So I can see how more recent readers may get the joke the wrong way.
But as you said, this is Orac's blog, and the tone is set on Insolence.
In other news.....
Today our friend, Dan Olmsted** at AoA writes of the
" latest outrages of the mainstream media"..
that is, how could a newspaper writer discuss VAXXED! without mentioning Thompson?- the gentleman in question only writes about AJW.
" This is the stuff of madness"
" This is lousy, rotten, no good reporting"
" When I worked at a daily newspaper, we took our readers very seriously ( at AOA we do this too)"
I leave his comments today in light of recent developments in the NEWS news ( that is, sex, lies and videotape, overnight):
for over a year the media has been rather tame in its criticism of Mr Trump ( with exceptions who are- of course- the ones I follow). Fortunately, more recently a few intrepid souls have descended into the deep muck of his life history to unearth various disgusting artifacts of interpersonal warfare and derision of those he imagines are beneath him because of race, ethnicity, gender, socioeconomic class etc.
Of course, it took years fro the mainstream to discover the motivation and MO of AJW - again probably because there is an intrepid soul or two around willing to descend into the muck to find data and reality.***
Trump once called the media - IIRC- "the scum of the earth"
Interesting choice of words there.
Of course my own travels around the swampy ruins of the internet necessitate a good, strong pair of boots and a strong constitution. As I've often noted: someone has to do it- why not me? So far, I seem to be no worse for the wear.****
** I hope that Dan doesn't get angry at me... again
***don't they say that the lotus ( enlightenment) grows out of the mud?)
**** and yes, I'll continue to insult the TMs- or DMs- because they deserve criticism because they mislead vulnerable parents by arrogating expertise they don't really possess.
I should clarify:
VAXXED! is really about AJW - not Thompson- the so-called Thompson story is just another means for Andy to attempt to get attention. It's all about Andy- and it's always been.
Yes, Pumpkin Spice Putin (it's so much more precise than "Hitler") does so dearly love to throw out the "mainstream media" dogwhistles to his alt-right supporters.
Still waiting.
Don't make me drag you through the woods.
The meaning of this idiom is opaque to me.
It's a Kleps reference. I can do a different version later, but my neighbor just broke a big honking mirror-in-frame that her grandson and I have to get rid of, and K.'s coming over for some dinner in a bit.
@ #33
"Let them home school or find a private school that does not require vaccinations."
Almost all states' immunization laws apply to private schools as well as public. About half the states exempt homeschoolers, as they don't classify them as schools.
@ JP:
Pumpkin Spice Putin....
Ha ha.
Wasn't that song on the same album as "Karma Chameleon?
-btw- isn't it true that most ( or many) names that end in *IN*
are indeed Russian ( and some others originally from Yiddish)?
( And yes, I know I know that both *Stalin* and Lenin* were pseudos for a Georgian name and Ulyanov respectively.)
I had an odd conversation the other day about name endings like the Armenian *IAN* and Finnish *EN* thus the Russian *IN* came up.
S I decided to "ask an expert" i.e. you.
" my neighbor just broke a honking big mirror-..."
Oh boy. My cat did something similar several years ago when he ran ( flew?) into an antique mirror in a mahogany frame that may have actually been worth something. It was sitting on a bureau - not hung on a wall ( seriously, do you really things that I hang things on walls? )
it involved cleanup of what appeared to be nearly powdered glass and tiny shards of glass - I wonder how he managed that.
I contemplated the seven years of bad luck predicted by the Stevie Wonder song but they never occurred. Unless if you count the crash of '08-'09.
do you really THINK that I hang things
Yah, I've done it too. I have a big dresser that was part of a matched set from when my grandmother worked for Sears (my dad has the other dresser and bureau). Big dresser, big mirror. Very hard to get mounted because of the weight.
Before I got to the task after a move, it was propped against a wall, and slowly but surely, gravity won out over friction.
For your collective amusement:
yesterday and today, Mikey ( Natural News) has been furiously typing ( 3 posts!) in support of his presidential choice.
If he approves of this guy and disapproves of Orac...
well, I'll leave the conclusion to readers.
^ Oh, right... Maynard Ferguson's mirror, photographed at Millbrook.
It should be noted that I visited Millbrook many years after its heyday where I observed the manor gardens and antique shops but I didn't ingest any you-know-what.
Wealthy folk and semi-celebrities have taken over the place - it's not the same.
most ( or many) names that end in *IN* are indeed Russian
Rin-Tin-Tin was German (or from Alsace), I believe.
I believe Tintin is Belgian. I'm not sure about Raspu-Tin-Tin.
Rumpelstiltskin / Rumpelstilzschen was clearly an Estonian pretending to be a Russian.
-btw- isn’t it true that most ( or many) names that end in *IN*
are indeed Russian ( and some others originally from Yiddish)?
( And yes, I know I know that both *Stalin* and Lenin* were pseudos for a Georgian name and Ulyanov respectively.)
Yah, either Russian or sometimes Serbian or Bulgarian. It's roughly equivalent to the English "ine," so Lenin was "Leonine," Stalin was "man of steel," Putin is Mr. Path, Rasputin was Mr. Crossroads.
It does show up in Russian Jewish surnames, like Levine, but not via Yiddish - though I imagine some surnames might be Yiddish words with the suffix attached.
^ "Levine" is actually one of the few specifically Jewish surnames in Russia, though; mostly they're of Slavic origin like other Russian surnames. Sokol (falcon), Pasternak (turnip), Popik (Ukrainian, "little priest"), etc.
The other names which can be called specifically Jewish are patronymics like Naumovich and Berkovich.
^ Which doesn't prevent Russians from fixating on Yiddish-origin surnames like Shvarts and Rubenshtein, though, when it comes to anti-Semitic stereotypes.
@ JP:
I knew that you would know more about it than I do!
I do know something about how to anglicise Russian and Jewish names but I shan't go into that here. Long story.
And.... the revolution isn't going all that well.
^ Via CIDRAP.
Can't believe that we have to debate whether its ok to mandate medieval chemical injections.
@Cypher,
What are you talking about?
No one is arguing for mandating variolation. Vaccines are a very modern development.
Try reading the Birth of the Modern by Paul Johnson for a little historical perspective.
And here I thought there were no "medieval chemical injections" only ingested and topical.
And, since water and salt have been know since before medieval times, does that mean we should not be giving saline IV's to hospital patients?
Giving? Hell noes! Charge them out the derriere for it.
Cypher, what is your sure fire proven way to prevent measles, mumps and rubella in the 21st century. Just provide us the PubMed indexed papers from qualified reputable researchers that is much much much better than the MMR II approved for use in the USA in 1978.
By the way, I was alive in 1978 and truthfully tell you that there were real hospitals, antibiotics and the washing of hands. While the fashions were questionable, they were not "medieval."