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  (Source: Gizmodo)
Anti-vaxxers suggest it's their "freedom" to not vaccinate, even if it lowers the herd immunity killing and maiming children

The state of California made headlines over the holiday season when many young vacation goers contracted the measles virus, a rare illness in modern America.  The outbreak was ultimately traced to an unvaccinated child visiting the tourist attraction.  

The virus subsequently spread to several others states including Arizona and Michigan.  Of the 50-some children that were infected as of February more than half were unvaccinated.  But what has Californian public health officials and many parents particularly concerned is the fact that some of those infected had received the MMR (measles, mumps, and rubella) vaccine.

I. California Moves to Protect the Herd

Largely in reaction to that pox on the nation's most populous state, the state's legislature proposed SB 277, a bill which would strike the "personal beliefs" exemption from the state's school vaccination laws.  This week the bill moved a step closer to passing -- but not without some rancorous outcry.

Under the new format parents would be effectively compelled to vaccinate their children unless they could demonstrate the child had already been exposed to the disease in question (and had developed natural immunity) or that there was a compelling medical risk to vaccination (e.g. a child who was immunocompromised during cancer treatment would be one such probable exemption).

The State Senate bill -- proposed Feb. 19 -- is largely split along party lines.  Democrats -- who control roughly two-thirds of California's State Senate and House -- were the bill's main backers.  Of the 25 Democratic state senators roughly half (12, to be precise) cosponsored the bill.  Of the 14 Republican senators only one -- Sen. Jeff Stone of Temecula, Calif. -- sponsored the bill (conspiracy theorists are quick to note that Stone is a pharmacist).  That's an anemic 7 percent sponsorship from the Californian assembly's Republican minority.

Some might wonder why the bill exists in the first place.  Why does it matter what other parents might do?

The answer lies in vaccination programs strongest weapon -- herd immunity.  Vaccination, it turns out, is an imperfect art.  For every 100 children that are vaccinated -- several may never develop immunity.  However, even the unimmune rarely contract the diseases vaccinated against when the vaccination is sufficiently high, as the majority's immunity precludes the pathways of infection which might otherwise expose the vacinated, but unimmune.  This is known as herd immunity.

Ideally researchers want to achieve 95 percent vaccination rates in order to ensure a large enough immune majority to offer herd immunity.  In many parts of the country a mixture of education efforts on the part of doctors, government legislation, and a legacy of public awareness have helped the medical community reach that target.

herd immunity graphic
Herd immunity -- vaccines' secret weapon. [Image Source: Wikimedia Commons]

According to the 2012 National Immunization Survey (NIS) 90 percent of children ages 19 to 35 months had all their recommended vaccines, and only 1 percent had no vaccinations at all.

MMR vaccinations are typically given at around 12 months with a second booster when the child reaches school age (at 4-5 years old).  The booster increases the likelihood of acquiring immunity.  In parts of the country MMR vaccination rates are as high as 94-98 percent of young school age children.

But California is a glaring exception.  In some parts of the state, like Berkley vaccination rates are as low as 81.45 percent. And much like the diseases that are now making a comeback, the Golden State's anti-vaccination sentiment is spreading to other states.

II. The Lingering Stench of Former Doctor Andrew Wakefield

The anti-vaccine movement simmered quietly in the 80s and 90s, but was largely dismissed by most in the mainstream given its unilateral rejection by the scientific community.  But the situation shifted after a fame and fortune seeking medical doctor in the UK -- Dr. Andrew Wakefield -- published a headline grabbing study in 1998.  Dr. Wakefield's paper claimed that vaccines were linked to autism.  The claim was incendiary due to both rising rates of reported autism and the lack of clarity of the causes of the syndrome.  Prior studies had linked the condition to the age of parents but otherwise there was little to explain the rising rates of the disease.

Could vaccines be to blame?  Some weren't willing to wait to find out.  This was precisely the development they were looking for.  After spending so long lurking in the shadowy periphery so-called "anti-vaxxers" -- those who attack vaccination on various poorly sourced grounds -- finally had what appeared to be solid science to justify the pseudoscience beliefs they had held.

In a classic case of confirmation bias, the anti-vaxxer contingent became increasingly vocal.  J. B. Handley, co-founder of Generation Rescue (an anti-vaccination group), commented:

To our community [the anti-vaxxer movement], Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one.

One prominent support of Wakefield's work was actress Jenny McCarthy -- who may or may not have an autistic child (she now admits her child might not be autistic) -- took to the talk show circuit "educating" parents on the supposed perils of vaccination and their reported link to autism.

Unfortunately, science moves at a more deliberate pace.  It took a decade to investigate Dr. Wakefield's claims, but after thorough examination a disturbing picture emerged.  There was no sign of the symptoms that Dr. Wakefield had describes; systems that supposed showed a link between autism and vaccines.  And investigative journalists filled in the rest of the blanks -- Dr. Wakefield was serving as an advisor to a group of attorneys looking to file lawsuits against the vaccine makers.  And in a truly wild twist, Dr. Wakefield had actually filed for intellectual property protections on an alternative MMR vaccine which might have made him a very rich man had his research survived and led to the elimination of the current formulation.

And soon these troubling signs would give way to full blown disaster for Dr. Wakefield after hs employees began to one by one come forward and admit that he had pressured them to fake results in one of the twentieth century's most glaring and egregious cases of academic fraud in the field of medicine.

But even as the papers were retracted, it became clear to doctors in the U.S. and the UK that the cat was out of the bag.  The new legion of vaccine fearful largely ignored Dr. Wakefield's exposure as a fraud, or in many cases cynically suggested that the debunking was due to some sort of vast conspiracy to suppress their cause.

III. Statistics Showcase Flaws in Anti-Vaccine Arguments

Opponents of vaccination were now emboldened to hunt for some sort of evidence to strengthen their argument in the wake of the Wakefield controversy.  One such argument seized upon were statistics on allergic reactions that can occur in vaccinated children and occasionally carry severe complications.

Medical professionals were well aware of this issue because it's relatively predictable.  The MMR vaccine is formulated using chicken eggs.  And a small number of children are allergic to eggs.  This problem is by no means unique.  A small number of children are allergic to virtually any naturally derive antibiotic.  Like allergic reactions to common antibiotics like penicillin, egg allergy-induced reactions to vaccines are relatively uncommon and rarely life threatening.  But in an exceedingly small amount of cases they are.

In the past 3 decades U.S. health records indicate 45 children (ages 17 or younger) have died from vaccination.  While that works out to only 1-2 deaths per year out of millions of children vaccinated, to anti-vaxxers it's a compelling excuse to say no.

But there's a deadly flaw in that logic.  It weighs the risk of vaccinating with a blind eye to the reward -- immunity from deadly disesase.  Measles, for example was once a top killer claiming 400-500 childrens' lives per year [source] in the U.S. until the measles vaccine was developed in the 1960s.  Given that the U.S. population has more than doubled since that time, it could be concluded that without vaccination, the disease would likely be claiming around 1,000 American childrens' lives per year.

Vaccinations
[Image Source: inserm.fr]

In other words, while there's a tiny risk of dying from an allergic reaction to a drug as a child, by reducing the risk of infection vaccines effectively decrease the likelihood of your child dying by at least two orders of magnitude (a "99 percent" or more reduction).

And yet many would willfully reverse that benefit and allow these preventable deaths.  In California, a bizarre twist has been seen.  While it is the Democrats leading the charge to mandate vaccination in the state legislature, it is the liberal so-called "hippie contingent" -- mostly aging Baby Boomers -- who are galvanizing opposition to the measure.

IV. Liberals, Religious Right Find Common Enemy in Science

In Berkley, a hyper-liberal hotbed of hippie culture and new age thought, the constinuency is rebelling against the measure.  Gizmodo's Sarah Zhang documented the furor that arose at a local town hall meeting after one city council member had proposed sending a letter in support of SB 277.  That led to a massive crowd of anti-vaccine protesters at the town hall meeting on the topic.

Stunned, Berkley Mayor Tom Bates, tried desperately to convince the protesters to leave calmly, stating, "Most people really don’t think [the letter is] significant."

Berkley protest
Some in California claim it's their "religious right" not to vaccinate, even if their decision endangers others. [Image Source: Gizmodo]

At an hour of public comment, 6 citizens voiced support for the bill, but their view was drowned out by the anti-vaxxer majority which included 30 citizens speaking out against the measure.

Common threads among the protesters, according to Gizmodo, included a vague insinuation that medical doctors were only pushing vaccines for profit.  One particularly bold commenter even claimed Cuba's medical system was superior to America's as it requires less vaccinations.

Another common claim was that the law was unecessary.  Statewide the vaccination rate is at 89.4 percent.  That's a little low, but still sufficient to do a decent job at providing herd immunity.

The flaw in that argument is ironically Berkley itself, as the city is one of several pockets with much lower vaccination rates.  In Berkley only 81.45 percent of children are vaccinated -- and at some small private schools like the Berkeley Rose School, more than three-quarters of children are unvaccinated.  That's right, incredibly (and frightningly) the majority of kids at some schools in this hotbed of anti-vaxxer protests are unvaccinated.  Suffice it to say in Berkley the herd immunity which may be a bit under the weather in California at large, is flat out dead in the hippie haven.

Antivaxxers
Anti-vaxxers clashed with a small contingent of pro-science medical school students at a local town hall meeting in Berkley. [Image Source: Gizmodo]

The Californian city's fear of vaccines has created strange bedfellows.  Liberal new age shamans are consorting with evangelical Christian faith healers.  After spending so many decades despising each other, some on California's far left and right are finding ground in a common enemy -- medical science.

The diverse coalition of the fearful's most persistent argument is that the choice of not vaccinating is "a human right" or "a freedom".  One protester's sign read:

My parents call the shots, not politicians.

Of course that attack angle ignores that the bill still allows room for medical professionals to adjust treatment with the boundaries of reasonable science.  The bill solely prohibits scientifically baseless requests for exemption on the grounds of "religious" or "philosophical" freedoms.

Berkley
Protesters voice their animus in Berkley. [Image Source: Gizmodo]

SB 277 is not without precedent.  Legislation has long held that it is illegal for a reckless few to put the majority at an undue medical risk.  A classic example is drunk driving laws, which prohibit the population from consuming alcohol and then getting behind the wheel.

Drunk driving laws quite commonly force innebriated citizens to pursue alternative transportation or overnight accomodations when drinking outside their home.  And yet few are complaining about the government robbing them of their "freedom" to drunk drive.

V. When Your "Freedom" Kills or Cripples Others It's Time for Change

SB 277 looks likely to pass, given the large legislative majority in California.  This week the  the state Senate Health Committee approved the bill, moving it formally to the Senate floor, where it likely awaits a vote later this month.  If all goes smoothly the law may be in place as early as next month.

But if the bill's backers find their constituency growing too rebellious, it's entirely possible that the measure might be sunk.  Similar bills in two liberal northwestern states -- Oregon and Washington -- were proposed by Democratic majorities in the states' legislatures, but were sunk in mid-March amidst fears of a backlash amongst liberal voters.

As imperfect as the bill may be, it's important to bear in mind that it preserves medically reasonable exemptions.  As for the 2.67 percent of Californians who refuse to vaccinate their children on the grounds of "religious belief" exemptions, they may not like being forced to vaccinate, but aside from legislative compulsion there's no clear free market solution given the pressing public health risk.

One potential supplement -- or perhaps alternative -- to laws mandating vaccination would be to pass laws increasing financial liability for parents if a parent willfully chooses not to vaccinate and their child contracts an preventable disease as a result and infects others who did vaccinate.

Currently there's no clear cut way to sue an anti-vaxxer parent in most states, even if it's clear -- medically speaking -- that their gross negligence harmed your child.  Calling in the lawyers might seem an overeaction, but once you see the affects of these diseases few would argue that it might be justifiable.

Don't believe it?  Take the USA Today report on one such case in Oklahoma where one parent's rash decision robbed another child of their future.  The story describes:

Jeremiah Mitchell, 10, plays Xbox with no hands, writes with a pencil strapped to what remains of his arms and prefers eating pizza because it's one of the few foods he can hold.

Four years ago, doctors working to rid his body of meningitis amputated both his arms and legs as well as parts of his eyelids, jaw and ears. At the time, Jeremiah, then 6, was a kindergartner in Oologah-Talala Public Schools in Oklahoma. An outbreak of meningitis in the school system killed two children and infected five others, including Jeremiah.

In 12 hours, Jeremiah went from being a child who loved climbing trees and riding his bicycle in the mud to being in a coma, says his mother, Michaela Mitchell, 42, of Tulsa. He spent 14 days unconscious in the hospital as parts of his body became blackened and burned-looking from t?he disease.

"He came out with all his limbs cut off and wrapped up like a mummy — I fainted," Mitchell says. "We cried for a long time."

Jeremiah wasn't vaccinated against meningitis because at his age his school didn't require it, Mitchell says. CDC suggests all 11- or 12-year-olds get the vaccine and receive a booster shot at 16. And though his family did everything according to medical recommendations, Jeremiah was exposed because someone brought the disease into their community.

If one parent's decision to defy science and act in a willfully negligent manner cripples another parent's child legal liability should be a right.  Sadly, for families like the Mitchells, there's little legal recourse under today's laws.

Jeremiah Mitchell
Jeremiah Mitchell lost his limbs and was brain damaged after he caught viral menigitis from a classmate whose parents refused to vaccinate on account of their "personal beliefs".
[Image Source: USA Today/YouTube]

Forcing the defiantly self-destructive legions of anti-vaccination critics may be an imperfect solution, but time is running out to find a better one.

In Calif. Democratic Sen. Richard Pan was adamant that California would not bow to cries of pseudoscience -- even if those cries happened to come his party's own base.  He commented:

I have confidence in my colleagues.  When they have the science and the truth about why we need this to protect public safety and stop preventable diseases, we will prevail.

If they can, they will likely save lives.  But sadly those lives may come at the cost of some officials' political futures, thanks to the public's stewing mixture of fearfulness, paranoia, gullibility, and ignorance.

Sources: The Sacramento Bee, Gizmodo





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