Vaccines

A great post on why people are backing away from life-saving vaccines:

Why would parents refuse to vaccinate their children against dangerous diseases? Many are skeptical of modern science and medicine in general. (And it is true that most vaccines carry exceedingly tiny—but real—risks of serious illness or even death.) But I think most are responding to the widespread belief that vaccines are linked to autism. Recent studies have soundly disspelled that notion. And a simple glance at health statistics shows that autism cases continued to rise even after thimerosal, the mercury-based preservative widely blamed for the supposed autism link, was largely phased out of U.S. vaccines by 2001.

Nevertheless, these unsubstantiated fears have led some people to say that getting vaccinated should be a matter of individual choice: If you want to be protected, just get yourself and your children vaccinated.

Only it’s not that easy. While the measles vaccine protects virtually everyone who is inoculated, not all vaccines have the same rate of success. But even if a vaccine is effective for only 70, 80 or 90 percent of those who take it, the other 30, 20 or 10 percent who don’t get the full benefit of the vaccine are usually still not at risk. That’s because most of the people around the partially protected are immune, so the disease can’t sustain transmission long enough to spread.

But when people decide to forgo vaccination, they threaten the entire system. They increase their own risk and the risk of those in the community, including babies too young to be vaccinated and people with immune systems impaired by disease or chemotherapy. They are also free-riding on the willingness of others to get vaccinated, which makes a decision to avoid vaccines out of fear or personal belief a lot safer.

Of course it is the very success of modern vaccines that makes this complacency possible. In previous generations, when epidemic disease swept through schools and neighborhoods, it was easy to persuade parents that the small risks associated with vaccination were worth it. When those epidemics stopped—because of widespread vaccinations—it became easy to forget that we still live in a dangerous world. It happens all the time: University of Tennessee law professor Gregory Stein examined the relation between building codes and accidents since the infamous 1911 Triangle Shirtwaist factory fire in New York and discovered a pattern: accident followed by a period of tightened regulations, followed by a gradual slackening of oversight until the next accident. It often takes a dramatic event to focus our minds.

The problem is that modern society requires constant, not episodic, attention to keep it running. In his book The Escape from Hunger and Premature Death 1700–2100 Nobel Prize–winning historian Robert Fogel notes the incredible improvement in the lives of ordinary people since 1700 as a result of modern sanitation, agriculture and public health. It takes steady work to keep water clean, prevent the spread of contagious disease and ensure an adequate food supply. As long as things go well, there’s a tendency to take these conditions for granted and treat them as a given. But they’re not: As Fogel notes, they represent a dramatic departure from the normal state of human existence over history, in which people typically lived nasty, sickly and short lives.

This departure didn’t happen on its own, and things don’t stay better on their own. Keeping a society functioning requires a lot of behind-the-scenes work by people who don’t usually get a lot of attention—sanitation engineers, utility linemen, public health nurses, farmers, agricultural chemists and so on. Because the efforts of these workers are often undramatic, they are underappreciated and frequently underfunded. Politicians like to cut ribbons on new bridges or schools, but there’s no fanfare for the everyday maintenance that keeps the bridges standing and the schools working. As a result, critical parts of society are quietly decaying, victims of complacency or of active neglect. (See PM’s special report on the nation’s infrastructure, “Rebuilding America”) It’s not just vaccinations or bridges, either. A few years ago, I attended an Environmental Protection Agency Science Advisory Board meeting, and the water-treatment discussion was enough to make me think about switching to beer.

Human civilization is like an iceberg. 90% of what keeps us afloat isn’t seen. It just happens in the daily lives of the hundreds of millions of people doing their best.

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