
The toll of the anti-vaccination movement, in one devastating graphic - DanBC
http://touch.latimes.com/#section/-1/article/p2p-78971408/
======
jen_h
The issue is not black and white - and laying the entire issue at the feet of
non-vaccinated is blatant propaganda. For example, the recent whooping cough
outbreaks are due to the fact that the newer (safer!) acellular vaccines are
just not as effective as the older (less safe) vaccines. Vaccinated
populations are falling victim to whooping cough, as the current vaccines are
not long-lasting enough. Reuters published a pretty good explanation of the
issue in August of last year: [http://www.reuters.com/article/2013/08/01/us-
whooping-cough-...](http://www.reuters.com/article/2013/08/01/us-whooping-
cough-booster-idUSBRE9700XK20130801)

tl;dr: We need a new vaccine. Tilting at small populations of anti-vaxxers may
feel satisfying, but it is ultimately counterproductive, especially in this
case.

~~~
pit
Thanks for explaining that. I wasn't sure why it it would matter to Kid #1 if
Kid #2 had the mumps, as long as Kid #1 was vaccinated.

~~~
rz2k
What was explained?

The understanding of the effects of vaccinating kid #1 isn't all about kid #1
being immune to the infection. Instead it is that kid #1 is x% less
susceptible to contracting the infection if exposed.

So you might wonder, how could Small Pox be much extinct if the vaccine is
only about 95% effective, and how have we wiped out an enormous number of
diseases that caused immense suffering in the 20th century using vaccines that
were not 100% effective in protecting the vaccinated from infection on an
individual level?

The lesson is that common sense can be a terrible guide for even the roughest
approximations of the dynamics of a system. Dispersion models explain the
limits to how far water will trickle down through soil or the conditions under
which wild fires will burn themselves out. The models for infectious diseases
involve variables for the likelihood of transmission, mortality rates, how
long you're contagious until you show symptoms, the percentage of population
that is susceptible etc.

While even common sense will tell you that the best way to avoid a disease is
to avoid contact, it might not tell you that vaccinating populations is
largely about reducing exposure. Assume our hypothetical situation has kids
one through eight living on a street and they only play with their immediate
neighbor. Then let's assume that the kids have a natural resistance of 20%,
but 60% if they are vaccinated. If kid #8 has the disease, what is kid #1's
risk of _exposure_ if everyone is vaccinated vs no one is vaccinated?

(1-20%)^6 = 26%

(1-60%)^6 = 0.4%

I think those numbers are astonishing and beat the tar out of what common
sense has to say. Of course more realistic models would show many more links
between nodes as well as lower transmission rates, but differences of even a
hundredth of a percent in a population of 320 million is 32 thousand people.

The conversation begins with: "The issue is not black and white — and laying
the entire issue at the feet of non-vaccinated is blatant propaganda." If
we're going to use extreme language, then it is "blatantly wrong" to say it is
"blatant propaganda". The portion of people who defect from or cooperate with
vaccination programs _does_ matter. It isn't much of a problem if there is one
Jenny McCarthy, but it becomes a problem if she advocates on behalf of
defection to everyone else in her playgroup, or worse to other parents around
the country.

While it is a good instinct to assume that issues aren't simple, it is
tempting to see issues as having "two sides" and that the middle ground must
be reasonable. I don't understand why newer/safer vaccines being less
effective is being presented as a middle ground. If the "two sides" are not
vaccinating and vaccinating, then this argument would not be in between the
two, but instead it should be an argument that is more extreme than a mere
decision to vaccinate. And yet, I think it serves to create uncertainty
instead, and ultimately fewer vaccinations and lower resistance in the
population.

~~~
pit
> What was explained?

As Fomite pointed out, partial immunity. If the vaccines aren't 100%
effective, then yeah, we definitely want more people to get them.

------
barrkel
This should be an animation or something, perhaps with corresponding graph of
anti-vaccination media mentions, in order for it to actually be devastating.

As it is, I have no idea what measles rates were like 10 or 20 years ago. I
have to research that myself, which makes it less than devastating.

So, for example, this graphic is somewhat more devastating:

[http://news.bbcimg.co.uk/media/images/67218000/gif/_67218108...](http://news.bbcimg.co.uk/media/images/67218000/gif/_67218108_measles_464.gif)

~~~
Shish2k
Personally I find this one the most convincing

[https://31.media.tumblr.com/8a705761bae7a2f6b682c668cf409fb1...](https://31.media.tumblr.com/8a705761bae7a2f6b682c668cf409fb1/tumblr_inline_myoxzltjpA1qhvklt.jpg)

(With "<90% vaccination coverage" and "highly religious" having an almost 1:1
correlation...)

~~~
vfclists
Hmmmm. Very interesting.

------
nathan_long
Doctors I know say that it's almost exclusively educated people who decline
vaccines. Uneducated people generally defer to the doctor's opinion.

I think this is a lesson we should all take care to note: be humble. Knowing
something doesn't mean we know everything, and it can hurt us to think so.

~~~
pmorici
On the other hand; If the field of medicine is anything like engineering and
computer science I'd rather chance my own opinion over trusting the advice of
a random doctor w/o supporting reasoning. I've been given obviously crappy
advice by way to many doctors over the years to just "take their word for it"
because they have an MD next to their name.

~~~
TwoBit
You trust your own engineering opinion over that of an expert professional
engineer? The doofus who used to own my house was one of those kinds of people
and I am still paying for it.

~~~
pmorici
You're missing the point. There are a lot of engineers out there who claim to
be "expert professionals" and may even have the credentials on paper but when
it comes down too it aren't competent. This is evidenced by the large number
of posts on HN dedicated to finding and hiring good engineers.

People seem to assume that all doctors are roughly equal, or at least meet
some baseline level of competency. I'm saying based on my experience in the
engineering world and my first hand experience with doctors I don't believe
that. So I'm saying that just taking someones word for it because they are a
doctor is naive. I've lost track of the number of times I've been told totally
nonsensical things by doctors that were just not sound advice which I
confirmed by seeking another doctor's opinion and in some cases because what
they told me to do made me sicker.

~~~
nathan_long
I'm sorry you've had bad experiences, and I'm sure you're very smart. But do
consider: imagine you're building software for a doctor and he/she disagrees
with your choice of database/programming language.

You might not say it, but you'd probably think, "really? You probably don't
know a function from a hole in the ground."

Personally, I can't tell you what all of my organs do, much less what can go
wrong with them, much less how that should be treated. __I 'm sure there are
incompetent doctors, but I doubt there are many less competent at medicine
than I am. __

------
joosters
Actual graphic at:
[http://www.cfr.org/interactives/GH_Vaccine_Map/#map](http://www.cfr.org/interactives/GH_Vaccine_Map/#map)

~~~
fractalsea
Only have to click through three other websites to get to it.

~~~
joosters
LA Times, reporting on the reporting of reporting of news.

Hacker news, reporting on the reporting of reporting of reporting of news.

------
devandstuff
Dr. Anne Schuchat, the director of the CDC’s National Center for Immunization
and Respiratory Diseases:

“Better diagnosis and reporting of whooping cough may be contributing to the
increased numbers, along with the fact that the disease tends to peak and wane
in cycles. It does not appear that anti-vaccination sentiment among parents
has contributed…”

------
wonderzombie
As someone who's about to become a parent (on the order of weeks now), this
drives me up a fucking wall.

My instinct is generally towards politeness[0] so it goes against my nature to
get up in people's faces. But I'm wondering if I need to take a hard line on
vaccination when it comes to who I allow to spend time with my kid.

[0]: See
[http://www.math.uh.edu/~tomforde/hquotes.html](http://www.math.uh.edu/~tomforde/hquotes.html),
the quote on p247.

~~~
purephase
I'm struggling with the same right now. I'm not sure how to bring it up yet,
but while my daughter is vaccinated, I would prefer to limit her exposure to
non-vaccinated children.

------
jostmey
It is sad. Vaccines are one of the few truly amazing technologies in medicine.
Vaccines are both cheap, effective, and most importantly safe. Where else in
medicine is this true?

------
josefresco
Everyone is pro-vaccine until you have to jam 3 or 4 vaccines into your own
child seemingly every doctors visit and sometimes have to suffer through a
"sickness" (but let's not call it that) post shot reaction. I'm not
speculating here, just speaking from experience as a parent of two children
who knows and speaks with parents of other young children. We're not anti-
vaccine but I'm not dancing into the Dr. office with my kids to get it done.

~~~
joosters
Why isn't that anti-vaccine?

~~~
Sharlin
Because being for something, at the same time recognizing there are also
downsides, is not being against something.

------
kokey
If I understand it correctly, this isn't based on true stats but instead
heavily depends on numbers through news reports. I would be tempted to say
that's almost as unscientific as the reasons the anti-vaccination crowd uses.

~~~
pmr_
I spend some time playing with the original map and the references for data
points I examined more closely always were papers published in journals. This
might not be the case for all data points that have been used and I wasn't
able to find a comprehensive list of references. It's definitely better than
just news reports though.

------
213424355352255
"The lesson of all this is that vaccination is not an individual choice to be
made by a parent for his or her own offspring. It's a public health issue,
because the diseases contracted by unvaccinated children are a threat to the
community."

Unvaccinated children who contract a disease are only a threat to other
unvaccinated children, who are generally unvaccinated by choice. Not sure why
this is a public health issue.

~~~
DanBC
Sadly you are wrong. Not all vaccinated children will be protected. Herd
immunity keeps even those people safe. When people do not vaccinate they
destroy herd immunity, meaning that unvaccinated and vaccinated but vulnerable
children are at risk.

~~~
devandstuff
Since they're finding out more and more that immunity from various vaccines
wane faster than thought, why aren't adults who aren't fully up-to-date on
their boosters figured into the "herd immunity" argument? I have yet to get a
serious response on this anywhere I've brought it up.

~~~
Fomite
They are, which is why there are, for example, very well developed campaigns
to get college students caught up on their vaccines, and vaccination campaigns
for certain groups at higher risk of either complications from the disease, or
passing it on to others (for example, parents, and expectant mothers for
certain vaccines).

~~~
devandstuff
Interesting. I have not seen this. Nor have I seen any vitriol whatsoever
directed at these equally important members of the "herd."

------
masklinn
Q: playing with
[http://www.cfr.org/interactives/GH_Vaccine_Map/#map](http://www.cfr.org/interactives/GH_Vaccine_Map/#map)
there seems to be pretty significant Measles presence in Europe although
(aside from the UK) I'm not aware of any specific anti-vaccination movement
and there's no whooping cough and only localised mumps (greece, a pair of
outbreaks in Germany, the Netherlands or the iberic peninsula) and rubella
(Poland, Romania) clusters. For instance, aside from (the significant) 15000
cases of mumps France is completely free of vaccine-preventable outbreaks. So
are Italy, Switzerland or Belgium.

Given mumps is endemic in much of the developing world, especially northern
india, pakistan and sub-saharan africa, could the measles outbreak in much of
europe be in (unvaccinated and potentially partially contaminated) immigrant
communities rather than a specific anti-vaccination movements?

~~~
Fomite
Mumps is a disease of childhood in places where it's endemic and prevalent,
which would suggest most immigrant communities would not actually be the
source, though for very small clusters, small ethnic or religious communities
(not necessarily foreign ones - the Dutch outbreaks for example are just
religious groups) can be the source.

As for some of the other countries in Europe, while there's less of a vocal
anti-vaxx movement, the vaccination rate in the Swiss has been dropping for
the better part of a decade now.

------
sdoowpilihp
I am alarmed by how difficult it is to get a consensus on this matter that
should be able to be put to rest via empirical data. As a side effect
impotence in regard to rationally approaching the vaccination issue, we have
people with a lot of power on both sides, saying the exact opposite thing,
which hints at a far more systemic issue with the way that some people seem to
approach problems today. Are we incapable of having rational approaches to
real and lethal issues in the world? I worry about where else in our national
psyche this type of thought process has leaked into...

------
Pxtl
Something tells me that Jenny McCarthy hasn't made a huge impact on Africa.

~~~
Fomite
That may not be true, and actively isn't true for other parts of the
developing world.

I rather vividly remember a presentation given by PAHO a couple years ago on
their rubella control efforts in South America, and how frustrating it was to
have outbreaks kicked off by import cases from wealthier European and North
American countries.

------
yaright13
This is based on a report by the Council on Foreign Relations. Members
include:

Bank of America Merrill Lynch, Chevron Corporation, Exxon Mobil Corporation,
The Goldman Sachs Group, Inc., JPMorgan Chase & Co., McKinsey & Company, Inc.,
Bridgewater Associates, LP, Kingdon Capital Management, Kohlberg Kravis
Roberts & Co...... and the list goes on.

[http://i.cfr.org/content/about/annual_report/ar_2012/AR2012_...](http://i.cfr.org/content/about/annual_report/ar_2012/AR2012_for_Web.pdf)

------
wil421
Quit submitting mobile versions of articles.

~~~
DanBC
There's no easy way to verify the URL if I'm using a mobile device.

What's the disadvantage of the mobile site on a desktop?

~~~
67726e
> There's no easy way to verify the URL if I'm using a mobile device.

The URL typically contains a token that would indicate it. In this case, the
URL is "touch." but you also typically see "m." or "mobile."

> What's the disadvantage of the mobile site on a desktop?

Depends on the site. In the case of LA Times, it works very well. Other sites
have a bad Mobile -> Desktop experience just like they have a poor Desktop ->
Mobile experience.

Either way, I don't give a damn. I'm just playing Devil's Advocate.

------
tokenadult
Rolling back to the original source

[http://www.cfr.org/interactives/GH_Vaccine_Map/#map](http://www.cfr.org/interactives/GH_Vaccine_Map/#map)

here is remarkably problematic. It's good that this graphic has a lot of
uptake and spread around the Internet, but I had to go back through a chain of
about four repostings to find the map as it started out. The team at the
producers of the original map should study more usability for Web display of
data as they prepare to share this important message.

~~~
thaumasiotes
The link you post is the third link appearing in the article, it's prominently
featured in the first paragraph, and the map is directly attributed to it in
the text. I have a hard time imagining how finding it could be less
problematic. Did I misunderstand your comment?

------
eliteraspberrie
One of the saddest developments of 2013 was the polio outbreak in Syria. [1]
It's even more disheartening considering that part of the world pioneered
vaccination. [2]

[1]
[http://www.who.int/csr/don/2013_10_29/en/index.html](http://www.who.int/csr/don/2013_10_29/en/index.html)

[2] [http://royalsociety.org/exhibitions/arabick-
roots/smallpox/](http://royalsociety.org/exhibitions/arabick-roots/smallpox/)

------
maxerickson
Does anybody know offhand what the standing practice for MMR vaccination is in
Europe/Eastern Europe?

Seems to be a lot more mumps and rubella there, especially Eastern Europe.

~~~
kjjw
Used to be offered in schools in the UK, probably still is. There was huge
media coverage of the faux science that fingered MMR specifically for a link
with Autism, which resulted in a large backlash and calls for alternatives. I
forget if the government caved or not.

~~~
kjjw
Oh, and it was the usual culprits: right-leaning press, both the reactionary,
hateful kind (Daily Mail), and those that should know better (Telegraph.) And
of course there was the undertone of anti-big-government there.

People tell me I should not worry about the Daily Mail. They can print all
they like, what's the harm? Well, here it is.

------
codezero
Do any of the source links provided in the circles work? Almost all of them
are 404 or non-responsive servers.

Also, it looks like some of the bubbles are duplicates, one is 4000 in
California, then one from a few months later is 5000 and it looks like the
5000 is a report that just adds 1000 more to the previous report, but it's
counted as two separate things.

------
josefresco
Whole bunch of editorializing in this "news" article. Is this the "opinion"
section of the LA Times?

------
raintrees
The click through from the LA Times:
[http://theincidentaleconomist.com/wordpress/vaccine-
preventa...](http://theincidentaleconomist.com/wordpress/vaccine-preventable-
outbreaks-are-real/)

------
J_Darnley
What? This page is blank except for the LA Times header.

------
vfclists
Who takes a report by the right wing genocidal maniacs of the Council for
Foreign Relations seriously?

The fact that they are endorsing the MMR vaccine is probably good reason not
to take it all.

------
leterter
Vaccine does have some pretty heavy side effects though. The worst being an
evolutionary pressure against stable virus, leading them to evolve towards
instability, causing future virus to be much more severe (as in HIV like)

~~~
Fomite
Vaccine escape, which is the phenomena you're talking about, is extremely
rare, and as far as I'm aware has never been observed in most vaccine
preventable diseases.

The exception is perhaps influenza, but that's mainly because the flu vaccine
is one of the few "moving target" viruses we have a vaccine against.

~~~
leterter
We are seeing it with HIV.

~~~
Fomite
HIV, which is admittedly another "moving target", isn't that way because of
artificial selective pressure because of vaccines.

It's because RNA transcription doesn't have error checking.

Nor does an unstable antigen profile (ala HIV or influenza) necessarily imply
more severe disease.

------
iterationx
Government loves you and wants you to take your medicine.

~~~
kjjw
Get out more.

------
MarcusBrutus
Whenever I read the words "herd immunity" my eyes roll over. It sure feels
good to be a free loader every once in a while. And let's not forget that
medicine is not engineering or mathematics. I 've met quite a few doctors and
my impression is that their average IQ does not compare very favorably with
that of coders or engineers. And let's not forget that the medical profession
has a very long history of suppressing inconvenient truths or adopting a
condescending attitude towards anyone who dare challenge their authority. Plus
when I pay a "doctor", I expect him to advise me what's best for me, in my
narrow little case, not what's best for the society as a whole. But then again
I suppose that if the Government wants me to take those shots it must be for
my own good, right? I mean, who am I to decide what chemicals and "weak"
viruses get injected into my own body?

~~~
Fomite
Herd immunity is something can be relatively easily shown with mathematics.

A huge amount of research into how vaccines are deployed is, and is done by,
people with skill in applied mathematics.

~~~
MarcusBrutus
Herd immunity is a "tragedy of the commons" type of game. Case closed. Unless
you can prove that a rational actor would chose in his own self-interest to
cooperate in which case you might get considered for a Nobel prize in
economics.

~~~
Fomite
Whether or not we can _achieve_ herd immunity is a tragedy of the commons type
game, though it's hardly "case closed" \- I know several researchers working
in that particular area. The _existence_ of herd immunity is a relatively easy
calculus problem.

