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The Washington State Measles Outbreak (washingtonpost.com)
87 points by WisNorCan 9 days ago | hide | past | web | favorite | 94 comments





Quote from a mom on the fence in the article

“On one side, they make you afraid, and the other side they make you feel stupid, and you get stuck in this middle where you feel beat up by both sides,” she said.

Not trying to be condescending but this frustrates me even more than anti vaxers who have an identity in supporting their idiotic parade.

This woman is sincerely trying to figure out what is best for her child and she couldn’t do it until she had a 2 hour one on one conversation with her doctor. She has no agenda. And she can’t figure it out with honest effort even with the internet. Our society lacks clear trusted authorities on important basic issues. And our citizens lack critical reasoning skills. Why is she so bad at this? serious question. How is our general population so poorly equipped?

I’m glad she did go have that 2 hour conversation, but that feels like the kind of solution we can’t reasonably provide to all people. It shouldn’t require that.


I remember reading an article somewhere by a public health researcher on why parents choose not to vaccinate. The gist of her point was that most parents who choose not to vaccinate their kids believe that they have the financial and other resources to manage the illness in the tiny chance their kids do get it, so they don't think it's worth the "potential downside". I recall the same article also pointing out that the majority of voluntarily unvaccinated kids are in middle/upper class families.

Based on this, I'd attribute the phenomenon to three causes:

1. People have forgotten how bad these diseases can be. Measles will really mess you up, but today's parents were born in the 80's and 90's, they don't remember measles.

2. On the flipside, they do remember scaremongering about autism and mercury. Autism has been especially prevalent in the public memory because we've only recently started to understand it better.

3. Naturopathic/homeopathic remedies have really taken off in the past few years. Humans have a fundamental comformation bias problem. When you want to believe that a remedy is working, you tend to believe that it's working. Humans suck at remembering to consider the null hypothesis.

So my interpretation is that they know that autism is incurable, and they think it's a risk in the single percentage points as a consequence of the mercury in vaccines. However, they know nobody with measles, so they think of it as a zero probability to get a disease like a more serious flu (curable). Who wants to make that tradeoff?

I think that train of thought is so wrong it's not even wrong, but you can't be condescending if you intend to persuade.


I picked up Carl Sagan’s “Demon Haunted World” recently, and it’s all about this question of why certain myths, urban legends, and superstitions, persist. Really worth the read.

He often pointed out the precariousness of living in a world that runs on science, but where few people understand science.

People who know me here know that I’m a big Sagan fan, but seriously — wish we had him around for times like these.


Carl was one of the greats. I was too young to go with him into the darkness of Demon Haunted World, now I’ve seen enough to perhaps take solace and learn how I might combat such demons in my own small world.

> Our society lacks clear trusted authorities on important basic issues.

This is definitely not true of public health issues. Even though some states have dangerously lax rules about claiming exemptions to vaccination requirements, the fact that the requirements exist in any form should be enough of a clue. Or the fact that every doctor and nurse recommends these vaccines, starting before your kid is even born.

If you cannot tell the difference between a professional opinion coming from your doctor, and bullshit coming from an internet troll, then you absolutely should feel stupid. That's the correct response to finding yourself in that kind of situation.

If it takes two hours for your doctor to convince you that you should get your kids vaccinated, then you're being an asshole to your doctor by wasting so much of his time resisting his well-informed professional advice. It should be a two minute conversation, unless the parent and the doctor literally don't speak the same language.


Two doctors in my family. They have stories about how stupid doctors can be, more than one story of a dumb decision by a doctors killing a patient. I see a cardiologist. He didn't know that ecg apps existed, and so made prescriptions based on guesses about what my heart might be doing when it was not being measured. I got an ecg app, and determined my own course of treatment based on what was actually happening.

Doctors don't do differential diagnosis on most issues. They just suggest common approaches. They may be smart and educated, but they don't use their IQ to diagnose most cases. Relying on experts who aren't optimizing their time to utilize their expertise to help you isn't a great idea.

I was sleeping wrong on my elbow, and a doctor suggested a couple of different drugs for my elbow pain without investigating causes at all. I determined the cause pretty easily, and in the process helped several other people with a similar issue.

I'm just saying that you can't rely on the advice of doctors by default. It can kill you.


None of your anecdotes are relevant to preventive medicine. And there's a big difference between second-guessing your doctor's diagnosis using information that your doctor doesn't have, and second-guessing their advice because you just plain don't believe in expertise.

The authority is there, but especially in the past couple of years, people prefer to listen to their own reality.

You know where to put the blame, aren't you? Charlie Sykes told you. The right wing media spent decades on undermining the authority of the mainstream media, as Sykes said, if one of his callers said something blatantly false, he couldn't say any more, look what the New York Times has written because he and the likes of him spent a long time making sure noone believed the NYT any more. This, obviously, doesn't stop at the NYT or even the media. The CDC, well, that's just one voice and how do you know they are right?

Lies, euphemistically called "fake news" elected the current president of the USA, how do you think those people can see the truth any more?


> The right wing media spent decades on undermining the authority of the mainstream media...

And the media didn't deserve it? Dan Rather? The Duke Lacrosse incident? Political donation habits of self described journalists? Media complicity in what should have been a MeToo moment for Bill Clinton in the 90s? Or how long Harvey Weinstein was an open secret? Hannibal Buress breaking the Cosby story? How about the crying wolf about how sexist Mitt Freaking Romney was so that there was no alarm left when a lech like Donald Trump came around?

It's interesting that you use the term "fake news", because besides being a synonym for "lies" on the left, it's used in the alt-right (don't worry, not my camp) to label cherry-picked facts that conform to an existing narrative. Lies of bias and omission, basically.

Mostly, though, to be more severe, the media concentrates on quick narratives, on sound bites, on visuals, and on fresh controversies. And increasingly these days, on reinforcing existing echo chambers. There are so many rumors, anonymous sources, and unverified stories that would have been left to tabloids 20 years ago. There are so many ridiculous articles rehashing twitter arguments in newsprint. And stories about what he-said-about-what-she-said-about-what-they-said.

The media pride themselves on speaking truth to power, but the power they are not willing to speak to is the collective power of their perceived audiences. That goes for nearly all media outlets. They are beholden to remain popular within their respective niches.

If it's not clear, I think there's a tribalism problem in most media organizations, and I think we have them to thank for being a significant contributor to Trump being elected. If people can blame the U.S. for instigating terrorism through its foreign policy, I can blame the media for instigating an ignorant and paranoid public through its pursuit of tribalism over truth.


I made a sloppy job of quoting him, here is the original:

> "There's nobody," he lamented. "Let's say that Donald Trump basically makes whatever you want to say, whatever claim he wants to make. And everybody knows it's a falsehood. The big question of my audience, it is impossible for me to say that, 'By the way, you know it's false.' And they'll say, 'Why? I saw it on Allen B. West.' Or they'll say, 'I saw it on a Facebook page.' And I'll say, 'The New York Times did a fact check.' And they'll say, 'Oh, that's The New York Times. That's bulls---.' There's nobody - you can't go to anybody and say, 'Look, here are the facts.'"

In https://www.businessinsider.com/conservative-media-trump-dru...


My theory? The virulent strain of anti-intellectualism / anti-elitism that has run through American society in the last 20 years. "These fancy educated people in their ivory towers telling me what to do with my children...".

There's a point at which you should simply defer to the critical mass of thousands of people with doctorates in the subject matter, such as about 99.9% of epidemiologists on the planet.


But it begs the question. What's underpinning that as the root cause for what we're now seeing?

My money's mainly on the loss of prestige surrounding the teaching profession, and loss of the elite status of high education. It's simply not valued as it once was, and as a result everyone's 'highly' educated while simultaneously quite poorly educated, at least outside of stuff that is scored on tests. As the parent post says, 'Critical' reasoning/thinking skills are demonstrably lacking.

Reading back what I just wrote, I'm certainly entering 'old man yells at cloud' years of my life it seems :)


I think the reason is the vast change in communication technologies (i.e. the internet) in the last 20 years. People used to mostly be exposed to only the pro-vax side which was available from their doctor, in person. There simply wasn't an efficient avenue for anti-vax sentiment to spread. Now any yahoo with a Facebook account can post their zany ideas. In fact, these technologies are almost tailored to spread the zaniest ideas. People are exposed to these ideas often in social media, making them believe they are also common. This breaks down the barrier which might have previously prevented people from believing in fringe ideas: they are now exposed to them frequently.

As for the 'average citizen', I don't think the general public has EVER really had critical thinking or reasoning skills. I would bet only 5-10% of the population has the scientific literacy skills to really make sense of the statistics and scientific reasoning which so strongly supports vaccination. Without the ability to make sense for themselves, many are left with appeals to emotion or authority for guidance. As authority loses ground in a sea of new voices on social media, only emotion and fear (much of it unfounded) remains.


> "These fancy educated people in their ivory towers telling me what to do with my children...".

I have seen college educated people including those with advanced degrees who just as easily if not more so pedal anti-vaxxing bullshit. No, they are not scientists, but they and their peers would consider themselves intellectuals.

> you should simply defer to the critical mass of thousands of people with doctorates

I noticed a paradox in that people who have doctorates in unrelated fields just as easily decide that they can research on their own and other doctors might just not be as "smart". Unlike flat earth, contrails and other such bullshit, anti-vaxxing does seem to attract educated people as well as uneducated ones.

Even if you read the article, I wouldn't consider Washington state as the epicenter of anti-intellectualism in US. Quite the opposite I would say.


We shouldn’t let someone who doesn’t understand evolution and probability to consider themselves educated. Those concepts should be required to be learned in high school, and not be able to pass without them.

> We shouldn’t let someone who doesn’t understand evolution

Agree yeah. The difficult part is that a lot of these people think they understand evolution. Overall Clark County, WA doesn't seem to be a hotbed of uneducated people, about 30% of adults have college degrees there which is about average for US as well I think. At least it's not as simple as pointing and saying "Ah, look only 5% of people there went to college of course they be anti-intellectual with all the associate risks of following conspiracy theories" but it seems something more complex is happening there.


I've been thinking a lot on the anti-intellectualism lately.

Lower intelligence people are less able to judge whether an idea is sensible on its own merits. Furthermore, they are likely to be outwitted by people with higher intelligence. So their mode of operation becomes to not even attempt judging an idea by its merits, lest they end up fooled. Rather, they judge based solely on the perceived stature of whom the idea is coming from.

The breakdown of our media institutions furthers the problem - rather than presenting an opinionated application of common sense that condemns poor ideas, they've devolved into giving "each side" equal time to obscure their true power of defining what subjects are talked about. So once these memes get out there, they keep circulating as folk wisdom continually re-validated by appearances in mainstream media.


Not to downplay measles, but wait until mumps start spreading. The 10% male infertility rate and enlarged scrotums might change some parents minds.

My wife and I were watching Boardwalk Empire, when in one scene one of the children contracted polio and became permanently paralyzed. My wife was in tears and turned to me to ask how we can make sure the kids don't get it. "Luckily, the kids are vaccinated against that. It's one of the very first shots they get."

Little things like that educate parents. Most of these traumas have disappeared from movies and TVs because we've most eliminated them.


It's a simple fact that vaccines are safe and perhaps the best medical tool we have along with antibiotics to prevent mass death. Only 0.0001% of vaccination doses result in significant complications (roughly 3,800 compensated injuries out of 3.4B doses over ~30y, something like 5,600 total filed injuries [1]). It's also true that they work in part through herd immunity, the concept that if most people are vaccinated, diseases can't spread to those who aren't or can't be.

Still, enough people find this controversial, resorting to conspiracy-minded thinking. It's another example of how science doesn't seem to sink through, and repeating facts doesn't seem to help. Maybe figuring out how to communicate more empathetically through people's perceived values can help [2]. But honestly I'm at a loss, and it's deeply tragic to see so much needless suffering.

[1] https://www.hrsa.gov/vaccine-compensation/data/index.html

[2] https://slate.com/technology/2019/02/antivax-measles-outbrea...


I think the only reason the conspiracy can exist is because of the effectiveness of vaccines - we don't routinely see or know people with the disease anymore.

I read that in poorer countries where vaccines are hard to get and the disease is still common people will travel far distances to get to clinics in order to vaccinate their children.


Spot on.

I'm old enough to recall my patents' relief when I got a polio vaccination. There were multiple children on iron lungs among their age-peer friends.

I grew up in the age of antibiotic supremacy. It's still counterintuitive for me to realize that somebody can now die of a bacterial infection from a scratch.

I hope we don't have to return periodically to the bad old days to convince people of the worth of vaccination.

edit - missing word


This was the case for our grandparents generation as well. When they grew up, kids commonly died of childhood diseases, so when they had kids and vaccines became available, they fucking rushed to have their kids vaccinated, because they had seen the bad effects of the diseases.

I was born in the 1970's, and noone from my generation or younger in the west has really seen the bad effects, noone we knew died of measles or got paralyzed by polio, so we have no fear of the diseases.

And that's why the fears of the anti-vax movement are so strong, there's no counter-balance to them. Everything is a risk, having a vaccine is risky, but if people value the risk of the diseases as 0, of course some people are going to object to the vaccines, because they think it's the bigger risk.


> "having a vaccine is risky"

That risk is for all practical purposes, zero


Yes, but it's not actually zero, even if you remove all the false vaccine side-effects like autism and mercury poisoning. And that's where the irrational fear of vaccines attach itself.

But the actual non-zero risk of death or other horrible side-effects from the diseases, they have nowhere to attach to. We don't get regular stories in the media of kids dying of measles, because we almost eradicated it.

So given this, some parents weigh one risk incorrectly way higher than 0, and the other risk incorrectly at 0, and then they make the rational decision not to vaccinate their kid.

And I think it's important to understand that anti-vax parents actually don't make irrational choices, they make rational choices, but they're made on the grounds of an incorrect and horribly wrong risk analysis.

Hopefully, news stories like this increase the general awareness that measles is a terrible disease, which then can change the risk analysis that people are doing. It just sucks that a bunch of kids have to suffer needlessly because of stupid fearmongering.


There are outliers. My 6th grade best friend's sister died from the "Swine Flu" vaccine in the 70s.

That said, a good parent plays the percentages.


At a certain point, when almost everyone is vaccinated, the odds of having a negative outcome from a vaccine is similar to having a negative outcome from being unvaccinated.

Since we don't "routinely see or know people with the disease" it doesn't take analysis to realize that it may be worth taking vaccine risks into account.

The problem is more of an overlooked "tragedy of the commons", where people who are not vaccinated benefit from the vaccinations of others, until outbreak risks rise too greatly.

That risks from being unvaccinated are low as long as most people get vaccinated, and that vaccines have some risk, makes it a much more difficult decision for some parents than is generally acknowledged.


The conspiracy exists because in order to satisfy their ego, people like to think they know more than they do. At the same time, people will reject a doctor's advice because they know more than the doctor, but then run to the doctor when they get sick. Other than education, I don't know how we can counter this. It's sad that almost everyone I ask doesn't know how evolution works by the time they graduate high school, much less how vaccines work.

got me to learn about the oldest known record of measles symptoms https://en.wikipedia.org/wiki/Muhammad_ibn_Zakariya_al-Razi

Measles is especially pernicious, too.

Not only is having measles deeply unpleasant at best and fatal at worst, surviving it leaves you more susceptible to other knock-on diseases for something like two or three years. Widespread measles vaccinations cratered the measles death rate, obviously, but it also cratered the deaths from pneumonia and the like.

Per [0][1][2], the epidemiological data is suggestive of this -- but sequencing the virus and poking around at its RNA is starting to figure out exactly how sneaky of a thing the virus is.

[0]https://www.npr.org/sections/goatsandsoda/2015/05/07/4049634...

[1]http://science.sciencemag.org/content/348/6235/694.abstract

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997572/


Yes, this is something I was unaware of. Essentially, after getting the measles, you end up needing to be revaccinated for just about everything. Nobody had ever mentioned that.

I was in the Seattle Childrens ER this morning (unrelated issue with my son, hes fine) and chatted with a pediatrician about the outbreak. He said the ER has been inundated with parents bringing (unvaccinated) kids with related symptoms to rule out measles, and STILL refusing to vaccinate at that point. At a certain point public health needs to take priority. Vaccines need to be treated like any other basic norm around health/hygiene that we have societal and legal expectations around.

At some point you should not be able to opt-out of preventing an epidemic. When will we stop coddling the stupid?

This has been all over the local Portland news for weeks.

Here are a few more details (but from memory so I could be slightly off):

About 50 kids in Clark County have come down with measles so far.

49 of kids with measles were unvaccinated.

1 kid with measles received one dose of the vaccine. SOP is for two doses.

No kid that received both doses has contracted measles.

I haven't seen any reports of adults contracting measles.

One vaccine dose is about 93% effective, 2 doses are about 97% effective.

In Washington State (not sure if state as a whole or just Clark County) about 22% of kids aren't vaccinated.

In Oregon about 11% of kids aren't vaccinated.

---

When I was a kid smallpox vaccine was very common and polio vaccine was coming into use. People took vaccination very seriously. Read some history of those two diseases and you will quickly understand why.

In various settings (e.g. family doctor, various school nurses, etc) I probably received 2 doses of injected polio vaccine and 5 doses of oral vaccine. At least that I can remember. The number was probably higher. That's how serious the effort was to prevent polio. One high school teacher (polio victim) needed some metal contraption around his leg to help him walk. I.e. there were visible reminders of how serious polio was.

Smallpox vaccine was easier to keep track of. It left a slight scar on many peoples upper arm. So if you had the scar, it meant you had the vaccine!


When my daughter was born four years ago, the anti-vaccine movement in SF and the north bay was in full swing. Despite living only 40 miles south, she didn’t go to SF for the first time until after she was one.

She went to Budapest at 7 months old. I felt more comfortable taking her to Eastern Europe than San Francisco.


As I was reading, I started thinking, “What if all insurance plans budgeted 45 minutes for a Primary Care Provider visit instead of 15?”

(To be clear, I don’t know if ‘15 minutes’ is hard-codes anywhere, I just know that most appointments I’ve gone to are budgeted that much time.)

I say this, because of the multiple mentions of doctors spending multiple hours talking with patients.

If there was more time budgeted for PCP visits, then there would be time to have these conversations, and maybe address issues (real or perceived) before bad things happen.


It's not a good use of a doctor's time to educate the public about how vaccines work. That is high school biology stuff. And if you didn't learn it in high school, visit the CDC website or watch a Khan Academy video or just try getting your information from somewhere outside an uneducated person's Facebook page.

Your comment has changed several times, so i apologize if my reply is out-of-date!

The CDC web site is good, but a portion of people will say “That’s the Government” and thus be turned off. I don’t like it, but that’s the way it is, so we need to account for that (while working to change it, of course!).

As for Khan Academy, I didn’t know they had videos on this, and that’s cool! But there’s a large population who doesn’t know about it, and so won’t rank its videos any higher than other videos.

I am curious, does Khan Academy advertise on Fox News? I’m not trying to be flippant, I’m just noting that repetition breeds familiarity, and familiarity breeds trust.

Ideally, your PCP would be able to direct you to specific videos, and vouch for their content. But that might result in a conversation, and conversations take time that they don’t have. If Khan Academy was better-known among all segments of the population, then a quick pointer to one of their videos would be better-received!


I think it's the content of the sites that turns people off. I.e., it's not just the messenger, it's the message.

When I see an anti-vax website, I immediately dismiss it as just another anti-vax site.

I imagine when an anti-vax person sees a pro-vaccination site, they feel the same way "Just another pro-vax site, and it's not going to address this serious issue that I saw on the anti-vax site."

I'll accept an "appeal to authority", if I saw an anti-vax doc on the CDC's website, I'd definitely read it (critically). But since the "establishment" is so pro-vax, I suspect that the only authority an anti-vaxxer would accept is someone well known to be against vaccinations.

It might be helpful if some of the parents groups that have been steadfast against vaccinations would reverse course when their children get the measles, but sounds like they are just digging in and dismissing the risk of measles.


The primary care/family doctors I know seem to think that education and proactive counseling is very much a part of their jobs and a good use of their time.

That's true. But what about the people that never do take the time to educate themselves on their own? Could it be worth the extra expense to society to have a (presumably) trusted individual take a bit of time to explain some basic concepts about health?

I don't know the answer, but I do think it is an interesting question.


The problem are the people who do educate themselves and after reading the CDC decide to try and get a "balanced view" and fall down an Internet hole into the antivaxx Upside Down. If they hadn't educated themselves and just done what their pediatrician recommended it wouldn't be a problem.

  decide to try and get a "balanced view"
I think this is myth. Nobody weighs opinions in search of a "balanced view" in other realms of medicine: "treat cancer, yes or no?" "Smoking bad, yes or no?" "Meth bad, yes or no?" "Splint and cast broken bone, yes or no?"

In Germany you typically have two options to get vaccines. Generally recommended vaccines are given by any general doctors. For other vaccines, usually for traveling, you can visit a "tropical institute".

I've had extraordinary good experience with the treatment in those cases. They perform a personalized risk assessment and thoroughly inform about risks of both the vaccination and the disease.


If they trusted the doctor, they would have gotten the vaccine already. I think doctors need to stop seeing people that refuse vaccines (I only visit provider groups whose policy is to refuse unvaccinated people), and also a government initiative to educate people about how a vaccine works and the history of its development, use, and efficacy. And removing any non medical exemptions.

We have thousands of people watching out for terrorist attacks, when the biggest biological threat is our neighbor.


That's a good point. Trust seems to be built on repeated interactions no? Could the doctor spend that time building the trust so that the education sticks?

It's not a good use of a doctor's time to educate the public about how vaccines work.

The idea that a doctor should be removed from general health care concerns seems as poisonous as just about any other other part of the modern American dysfunctional health care system.

A doctor isn't on the top of the health care system merely to provide specialized services. They are there to do exactly this, give the broad public a sense of what science, medicine and general health are. Who else can speak as authoritatively? Especially when you crackpot authorities putting out wholly destructive ideas.


I meant a academic breakdown of how they work. Evolution, probability, herd immunity, history, etc. Doctors are in short supply and if they start acting as one on one teachers for the public, how are they going to have time to treat people.

There are plenty of researchers and PhDs who are subject matter experts on vaccines who can help educate, but I don’t think it’s possible with 1 on 1 interactions.


"Doctors are in short supply and if they start acting as one on one teachers for the public, how are they going to have time to treat people."

Uh, there's no doubt doctors treat people "one on one." A significant part of a doctor's treatment of a person is proscribing a behavior. And human beings being what they are, any wanting to elicit a behavior needs to spend some time educating a person on why they should behave this way.

I'd agree that the standard for how doctors should operate has become something like what you describe - a frenetic technician rather than an educator, counselor and authority along with the technician part. I'd say that's degraded the quality of American health care, along with all the other it's been degraded.


We currently have a 3-year old who's vaccinated and a 5-month old who isn't because she can't be yet.

We also live near the epicenter of this outbreak, and it's enormously irritating how grossly irresponsible both lawmakers and people in the community have been around this issue.

Some of the kids at our eldest's preschool weren't vaccinated, which by proxy put all the families who also have much younger children at much, much higher risk. Thankfully a responsible amount if peer pressure was able to cajole those families to get their kids vaccinated finally.

But, the waves of anti-science BS that we're all wading through are growing in frequency and amplitude, and it's not clear how to ebb it.


The greatest irony is that if an outbreak occurs, the government and public health organizations will somehow be culpable.

“You’re making my kids autistic” will quickly morph into “why did you let my child die?”


"Most of those infected are unvaccinated children under 10, health officials said."

Making it worse, the non-vaccinated group also endangers the vaccinated group! Just because your vaccinated doesn't mean it will work. So now with it spreading, there is %5 odds (or whatever the odds are) you get the virus EVEN IF you are vaccinated.

So even if you are doing the right thing and ARE vaccinated you are still screwed by these non-vaccers.


I’ve heard that a 5 month old child can be vaccinated (it’s just not standard practice) so in a situation where there are serious concerns about infection you are not without options.

This is true with regards to measles. It is also true that babies tend to have some level of immunity for the first year (assuming their mother is), which is why the vaccine isn't given until the 12 month mark.

https://www.nhs.uk/common-health-questions/childrens-health/...


  (assuming their mother is)
Is that conveyed en utero or through the mother's milk? If the latter, that would depend on being breastfed, wouldn't it?

> But, the waves of anti-science BS that we're all wading through are growing in frequency and amplitude, and it's not clear how to ebb it.

have some rich dumbass's kid die of measles.


It is never the child's fault.

it's a horrible horrible thing, and I think anti-vaxxer parents are awful people who are putting their kids lives at risk.

But I think the only way these people will learn is if some kid they know ends up dead because of their selfishness.


> “It shouldn’t be called an outbreak,” Seattle-area mother Bernadette Pajer, a co-founder of the state’s main anti-vaccine group, Informed Choice Washington, said of the measles cases, arguing that the illness has spread only within a small, self-contained group. “I would refer to it as an in-break, within a community.”

This person has a serious lack of understanding about how outbreaks and epidemics work. All it takes is one plane ride, one cough at a public place, and you can infect dozens of people. Even if you infect just two people, this can grow exponentially over a few days, especially given that you are highly contagious four days before symptoms and four days after.

> I would refer to it as an in-break, within a community.

In-break with an unvaccinated community.


I was living in Orange County (CA) when my son was born. It would have been _very_ easy to find a midwife and a pediatrician that were totally fine and all-in on "alternative vaccination schedules." I can't speak for all other metros where this has played out, but I suspect the same is true in many places. Lack of knowledge (or holding on to provably false beliefs) isn't something that physicians are immune to.

I would say those physicians are selling out. I don’t see how one can make it through med school and ignore the mountains of evidence for vaccination.

Seems like a problem that can be totally cured by insurance agencies raising premiums on unvaccinated children.

The ACA (Obamacare) made that illegal in 2010.

I don't know much about this outbreak but in some parts of the world you are required to have your vaccinations up to date if you want access to public services.

Can't that be implemented at a state/local level?


It certainly can, but Washington state has a slight libertarian bent and the current law lets parents opt their kids out of vaccination with a form. Other states are much more strict. The current legislature is considering changing the law in light of current events...

I think it's really weird and sad that this comment and another pro-vaccine comment were downvoted to almost dead within minutes of being posted.

Yeah, though it is bad form to comment on up/downvotes, the voting in this thread is super weird for hacker news. It is putting some other conversations on the site recently in a new light for me, though.

I did not downvote and will not, because the post is phrased as a question. But, I do oppose compulsory vaccination because it harms bodily integrity.

By that criterion, you should support vaccination because as scientific research has shown over and over again, individuals who serve as vectors of disease end up harming the bodily integrities of their communities.

Concern for "bodily integrity" might compelling if abstaining from vaccines didn't harm anyone else, or if the subjects weren't children unable to make informed medical decisions for themselves; obviously neither of those things are true.

I understand your issue here, but at the same time people not getting vaccinated causes significant health risks to me and my family.

Given the risks involved I'm happy for people to be either made to have them or be excluded from society.


The idea of bodily integrity fundamentally makes sense, but in the context of vaccinations and the undeniable benefits to the entirety of society, it should not stand in the way of vaccinations.

Alongside your disapproval of compulsory vaccinations do you approve placing limits on the interactions with society for a non-vaccinated person if there's no medical reason for them not to get vaccinated?


> In fact, health officials say the virus is so contagious that if an unvaccinated person walks through a room two hours after someone with measles has left, there’s a 90 percent chance that an unvaccinated person will get the disease. People can spread measles for four days before the rash appears and for four days after.

Yikes!


Seriously. I'm an infectious disease epidemiologist, and measles is amazingly transmissible.

As an infectious disease epidemiologist, could you elaborate on that? What is it that makes it so contagious?

A couple reasons:

- While it enters via the lungs, the virus emerges in the trachea, which positions it really well to be aerosolized through coughing. This aerosol and droplet transmission is really efficient.

- Measles is relatively stable in the environment, so lingers for a fair amount of time.

- It also appears to have a relatively small infectious dose.

Other highly contagious diseases, like norovirus, share fairly similar properties - you make a lot of virus, it hangs out for awhile, and you don't need to come in contact with much of it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997572/

walrus01 9 days ago [flagged]

Fuck, if only a bunch of clueless helicopter parents hadn't decided that Jenny McCarthy was an authority on vaccine safety, and had listened to the advice of every immunologist and epidemiologist on the planet.

You want to see the result of not vaccinating your children, en masse? Go visit a poor part of Pakistan, where you'll see people still afflicted by polio.


Is there anyone here on HN who reads a story like this and wonders to themselves, even if for a brief moment,

"Hm, the software system I get paid to develop just might be making a situation like this worse..."

Genuinely curious.


Having grown up in the Seattle area (now in SF since after college) I can’t say I’m surprised the Pacific NW is where anti-vaccination parents would cluster to create an epidemic. There’s the right mix of pseudo-intellects, granola hippies, and helicopter parenting to make it all so unsurprising

"'Sad reality': Handful of WA measles outbreak sites are in Russian-speaking communities" https://komonews.com/news/local/sad-reality-handful-of-wa-me...

Antivaxxers are pretty evenly distributed across the ideological spectrum.

There's a cluster of antivaxx sentiment in the Minnesotan Somali community. They're also an autism hot spot, and after that was noticed their fears were fanned by Andrew Wakefield etc.

https://www.statnews.com/2017/05/08/measles-vaccines-somali/


What’s granola hippies?

Pejorative.

In context I’d say they would take magic mushrooms, because they are natural. But they would avoid lsd, because that’s chemicals.

Sorry for the definition by example, can’t think of an obvious definition, but hopefully gets the idea across.


Hippies that eat granola. It’s just used to describe the kind of person that wears Patagonia, goes on weekend hikes in their hiking shoes and cargo pants, buys organic, probably a vegan, and eats granola/trail mix.

Maybe it's because it's taboo to say so, but I haven't even seen it speculated that the rise of these diseases be partly, or even mainly attributed to illegal immigration.

How many anti-vaxxers are there compared to those illegally crossing the border? There's a battery of vaccine requirements for any immigrant[1], but if tens of millions of those living in America skipped that part, it seems like a huge potential source of the problem.

1. https://www.uscis.gov/news/questions-and-answers/vaccination...


You'd think that if illegal immigrants crossing the southern border are bringing in these diseases, we'd see regular outbreaks in cities on both sides of the border instead of in a much more northern known anti-vax enclave?

Even the affected parents are accepting responsibility and calling it an "inbreak" rather than an "outbreak".


According to this World Bank data[1], the measles vaccination rates in the countries that are the top sources [2] of illegal immigration in the US:

* United States: 92% vaccination

* Washington State: 90.6% vaccination

* Mexico (55% of illegal immigrants): 96% vaccination

* El Salvador (6% of illegal immigrants): 85%

* Guatemala (5% of illegal immigrants): 86%

* India (4% of illegal immigrants): 88%

* Honduras (3% of illegal immigrants): 97%

* Philippines (3% of illegal immigrants): 89%

So I’d say that theory is not strongly supported by the evidence. But it’s entirely appropriate to evaluate the possibility, and there could very well be a lower vaccination rate among illegal immigrant populations. Had you phrased your point differently — as a matter of inquiry into the epidemiology — it likely would’ve been received better. Also, your post made no real attempt to quantify the real and well documented phenomenon of philosophical/cultural objections to vaccination among the citizen population in Washington, which is surely relevant!

[1] https://data.worldbank.org/indicator/SH.IMM.MEAS?view=map

[2] https://www.dhs.gov/sites/default/files/publications/Unautho...


Seattle times published data of percentage of unvaccinated children in Seattle schools (https://www.seattletimes.com/seattle-news/data/are-measles-a...).

Each and every school in top 10 is a private school. In Seattle, private schools cost an average of $25k/year. I bet illegal immigrants are not sending their children to the private schools that cost $25k every year when public schools are free.

The top schools is Waldorf which costs $20k/year for grade 1-8 and $25k for 9-12. This fee is only for 9 months of school. This school has 22% unvaccinated children. I bet there are exactly 0 children in this school from illegal immigrant families.


From what has been reported on the news, it's only children that have come down with measles in Washington State. No reports of adults so far.

US schools must accept any and all undocumented immigrant children into K-12 schools. This was a 1982 US Supreme Court ruling. So immigration status shouldn't be a barrier to vaccination for children. https://en.wikipedia.org/wiki/Plyler_v._Doe


That's weird because there has been a whole disinformation campaign pushing exactly that idea, even though it's totally bogus and people in most other countries are grateful as hell for the opportunity to get their kids vaccinated.

Looks like you got downvoted by the usual anti-science politically-correct contingent here on HN, but you’re right to investigate that possibility. Here’s an analysis of the last major outbreak in the early 90s that shows how huge a factor unvaccinated undocumented Hispanics were : https://www.cdc.gov/mmwr/preview/mmwrhtml/00001675.htm

It's a bit ridiculous to call people who downvoted an incorrect and unjustified statement "anti science"

If the original post had contained the link yours does, that would be one thing entirely. Instead, neither post invites discussion (tip: insulting people is a bad way to start a conversation)




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