A counterexample

I think the reason for the difference may be because Europeans and others view publicly funded education as more of a ‘right’. The US ‘individual liberty’ line can be perfectly well interpreted as the liberty not to enter public education if you have a problem with the rules. Countries with more committment to a welfare state may be more uneasy about children being denied education because their parents are unwilling to vaccinate them.

Immigration. When you have a lot of immigrants coming in from a lot of different places you need an effective system of vaccination.

It’s actually even more startling than you think, given that public education in the US is mostly a locally governed affair. I don’t think there’s any Federal mandate here, though I could be wrong. So, it looks like all those school board members who think the world was created 5000 years ago are also insisting that all children get vaccinated.

For example, it’s impossible for a child to attend school without up-to-date vaccination records (at least that was my experience when I lived there).

First, not all states require all childhood illness vaccines, such as mumps.
Second, virtually all states with requirement laws have exemption laws that are, in most instances, very lax. One can claim a religious or deeply held belief against the MMR vaccine and go to public school without the vaccine.

Slocum: On your comment, I googled ‘vaccine creationist’ and the result was pretty interesting. Creationists take some pride in being, generally, pro-vaccine. Point for you.

A lot of private schools are religiously affiliated. I am not aware of any Christian sect that opposes vaccination. Almost no private schools are associated with the sort of nutty, vaguely left-wing, “Big Pharma is poisoning us,” “vaccines aren’t natural, man” ideology that leads people to eschew vaccines. (The public schools in a few places, like Berkeley, might be.) So theory accords with my experience, which is that private schools are quite strict about vaccination.

Alar and BGH caused reasonably big scares in the US.

Yeah, the libertarian/welfare state distinction I made earlier is rubbish. The reason’s really in the history:

(1) Both Europe and the US did have mandatory vaccination laws against smallpox in the nineteenth century, when the only vaccine was smallpox vaccine. These laws applied to everyone – not just kids in public education.

(2) There were really fierce struggles against these laws about 1900. Repealling them was one of the defining moments in English public health. In the UK the issue’s been more or less closed ever since.

(3) But the US went the other way. The laws for adults were declared constitutional, and so were those for school kids. The number of states with mandatory laws over time are interesting too.

1905 – 11 states.
1963 – 20 states.
1970 – 29 states.
1999 – 47 states.

Lots of new vaccines have came into play during the twentieth century. The big reason for the expansion is the advent of polio/measles vaccines roughly 1955-1965. And the push to use then afterwards (the post-1970 growth is directly due the US measles elimination campaign of that time). So the difference is that in the UK the issue was taken off the table politically in about 1900 – way before all the modern vaccines were invented – and just wasn’t an option on the table. But it was kept in play politically in the US, and so laws were expanded and strengthened as new vaccines were invented during the c20.

Last sentence of comment 16 should read “personal” instead of “public”

For example, it’s impossible for a child to attend school without up-to-date vaccination records

A good friend of mine has basically no vaccinations because (1) her parents went through a fringe homeopathy phase and just refused to innoculate their kids, and (2) she was home-schooled. So even though she has a decent-paying job, a degree from an Ivy League university, a driver’s license, a passport, has traveled outside the country with relative ease, etc., she and her sisters haven’t really been innoculated against anything, aside from whatever seasonal flu vaccines they’ve gotten from year to year. I’ve no idea how common this type of situation is, or how else you can get around getting vaccinated, but it’s at least anecdotal evidence that holes exist in the system.

1) Regarding Christian sects against vaccination, google “polio” and “Amish”.

2) I would guess the European objection to mandatory vaccination is related to the European obsession with GM foods in some ways.

Part of what’s going on here is that the center of gravity of those who are worried about compulsory vaccination is on the left, while the typical American government-haters are on the right. The stereotypical homeopathic hippie (my apologies to anyone with health concerns about vaccination, I’m sterotyping to talk about the social dynamics) who doesn’t want to vaccinate their kids doesn’t pick up support from moderate leftists, because moderate leftists like and trust gov’t-run public health programs. And they don’t get support from anti-gov’t types, because anti-gov’t types hate hippies. So they exist, but they’re very isolated.

In agreement with #24, I recall reading that there have been recent outbreaks of one of the childhood diseases in Boulder, CO, apparently owing to alternative-medicine-lovin’ folks being so opposed to vaccinations. But I am too lazy to look up the details.

Purely anecdotal, but most of the anti-vax people I know are evangelical religious types who are definitely not left-wing. Fear tends to be their driving motivator – they homeschool their kids because they are afraid that their children might get exposed to people or ideas they do not approve; they fear that the drug companies or the government are injecting their children with poison, so they don’t vaccinate. Couple that with a lack of healthy skepticism or critical thinking skills, and they refuse vaccinations.

The story Nik tells in 16 is pretty fascinating.

Well, as another anecdote/data point, I went to a very small, religious private school in a very conservative part of Louisiana, and we were still required to get vaccines. Growing up, I didn’t know of anyone who *didn’t* get vaccines, and that was including a lot of the various evangelical groups (pentecostals, southern baptists, charismatics, etc.) and a lot of homeschooled kids.

“You’re better off when you’re not vaccinated and everyone else is.”

Well, so long as you don’t plan to do much travelling.

Uhh, John you’ve got me confused. While the US has, by global standards, a “stringent and effective” system, what you “would have expected” is also true – and the system is growing progressively less stringent and effective.

As a parent with kids in school, I come across vaccination resisters/free-riders all the time. Some are loony right, others are loony left, and others are simple idiots driven by paranoia. Living where I do, I personally know the parents responsible for two cases in the “Midwest outbreak.” One case is the result of typical loony left / CA-Style individualism-live-for-ever-on-macrobiotics selfishness/anti-social behavior. Basically, ANY risk – other thatn the risks of getting mumps apparently – is simply too great for their little princess. Besides, as I heard them describe it long before the outbreak, because so many people are vaccinated, the risk of getting Disease A is really not a great concern! When little princess got the mumps, they told everyone that she had the flu until the social pressure got so great – or perhaps they were ratted out? – that they eventually contacted the school with the truth. The second case was the result of parental stupidity: “we read on the web that vaccinations will turn our little Johnny into an autistic or spastic.” They didn’t have much to say one way or the other when little Johnny came down with the mumps, but at least they didn’t try to hide it!

The bottom line is that the public health system in the US is becoming a real joke, with a multitude of “opt outs” and “special conditions” open to any sociopath with an itch to scratch. God help us if the Bird Flu every blows up as some fear…

“You’re better off when you’re not vaccinated and everyone else is.”

So, that works to a point. Unlike with taxes, immunity in the herd can’t be raised to compensate for free riders. The herd effect is an important part of how a vaccine works to protect a population. A vaccine is not fully protective for one individual, it is fully protective iff the whole population is immunized.

Random replies on random points.

Harry B,
In most states, private schools (including religious schools) have to comply with the vaccination laws, unless exempted; I know that’s the case in Tennessee.

M Gordon,
To my knowledge, the Plain People (of whom the Amish are a subset) don’t oppose vaccinations, but are substantially less likely to be vaccinated than the general public. Some parents believe vaccination is dangerous, often because of trial-lawyer anti-vaccine material, which circulates and is not discredited due to general lack of knowledge. But the most common reason is simple poverty. The Plain People (of whom the Amish are a subset) generally refuse to deal with the government more than can be avoided; they thus won’t use public clinics, viewing them as an optional government benefit. (They generally avoid farm subsidy programs for the same reason.) They rarely have insurance, due to both their employment and their religious convictions. And they are generally poor—I have known many families of 10 with annual incomes of

I got an email alert on this from my university’s health department. There are about 600 cases reported in Iowa, of which a substantial portion apparently had up-to-date MMR’s. So the problem here appears to be efficacy not penetration.

Well, I’m horrified at how lax other anglo countries are about vaccines. A UK doctor I respect a lot looked me in the eye and said that there was no vaccine for chicken pox. When I said that we’ve had them for fifteen or twenty years, the doc looked away and mumbled something about how folks in the US were into that sort of thing. I do know some ‘granola’ types here who had their kids get the MMR as three separate injections – the sensible response to the first reports of a link to autism. The UK didn’t allow that (stupid, stupid approach to public health; a little more flexibility might have kept 95% or more actually protected).

Google News’ top hit for “mumps vaccine effectiveness” (Mayo clinic) says:

It’s important to remember that the vaccine isn’t 100-percent effective in preventing a mumps infection. One dose of the vaccien is 80-percent to 85-percent effective, and a second dose raises the vaccine’s effectiveness to about 90-percent.

Yeah, I’d thought the Iowa mumps outbreak might be due to anti-vaxers, but the statistics cited by various people over on ScienceBlogs seem to imply that it isn’t: Iowa has pretty good vaccine coverage. Nor is this an unusual strain of mumps; it’s just that the vaccine is only about 90-95% effective or so, and that’s enough to get outbreaks of a few hundred infected people in dense places like schools, once you introduce an infected individual.

I guess in my post above I should have specified “American anti-vaxers”.

Interesting that Latin American countries have done so much better than Europe.

I would say that the main reason these vaccination programs enjoy public support is the widespread conviction that they work fantastically well, and that the risks are far outweighed by the benefits. It is not hard to coerce people into doing something that prudence clearly requires anyway.

I suspect the US polio experience was the crucial factor in the formation of these public attitudes. The US has endured several devastating polio epidemics that killed or crippled thousands of people. Even as late as the 1950’s, there were over 20,000 cases of polio a year. People of my parents’ generation have often impressed upon me how the country was periodically gripped by sheer terror from a polio outbreak, with people afraid to send their kids to school. For a disease that was so devastating just a couple of generations ago to be reduced to the point of virtual eradication, with fewer than 10 cases a year, was such an obvious and complete victory that only a fool could question the efficacy of the vaccination program.

We also had a very popular president who was a victim of polio. That may have helped to spur interest in polio eradication, and the sense of triumph that accompanied success. And as another poster mentioned, the fact that the two main figures in the development of the vaccine were American scientists may have added an element of national pride to the mix.

These days, getting your children vaccinated against the major childhood diseases is for most American parents one of the customary rituals of child rearing, and an unchallenged cornerstone of being a “good parent” – along with getting braces for their teeth, teaching them not to talk to strangers and making sure they have nice clothes to wear to school. Failure to vaccinate them would generally be seen as a sign of ignorance, gross negligence and low breeding.

I wonder if the American education system has something to do with the support for mandatory vaccination as well. Despite the vaunted US love of liberty and private sector economics, most American children are educated in a clearly socialized sector of the economy – the education sector. Since parents send their kids to school with a lot of kids from various different economic and social classes, they have a strong incentive to focus on public health measures in the schools.

Just to confuse me, the most anti-vac parent I know does send her children to a private school; where she is not the only anti-vac parent; but it’s a German school (in the US) so all these kids and their families fly through international hubs all the time. I worry.

As an american parent I thought I’d just weigh in with my experience. I think several things are at work here–as people have noted kids have to display proof of immunization to go to public school. They also often have to display it to get into summer camps and private schools. One reason given to parents is to protect pregnant teachers/parents from contact with kids who get rubella. That reason was given to *me* when I protested (some) vaccines on enrolling my child in private pre-school.

Because the rules are pretty general its hard to opt out of the system without a huge amount of work. Americans are paranoid but lazy, fearful of the loss of their “rights” but also unwilling to buck the crowd. Without a vocal anti-immunization movement to back them most parents simply take the easier route and give the kid the vaccine.

There has been a periodic anti-vaccine movement here due to fears of thimeserol/autism but it seems to have been snuffed out or never fully gotten off the ground–I do attribute that to the power of big pharma and the interests arrayed against it, and the ambiguity of the science as well as the atomization of the parent community/american society generally.

But all this flies out the window when it comes to the HPV vaccine–there a well organized, religiously inspired, utterly loony, grassroots movement has sprung up which uses the rhetoric of children’s rights/anti-vaccine language to prevent the incorporation of a vaccine which they see as dangerous to their moral worldview that sex *should* potentially be punished with death.Although their main concern is not the health effects of the vaccine in question they use that language. Although their main concern is not children’s rights they use that language. Their main concern is to prevent both boys and girls from being vaccinated against potentially fatal HPV because removing one potential harmful side effect of unprotected sexual contact removes one potential rhetorical strategy for the far right sexual moralists. In other words, if they can’t tell young girls that sex leads to death, they don’t think they can make the case for abstinence before marriage.

But that goes to another point a poster made up above–that you are probably safe if everyone else is vaccinated and you aren’t, so long as you don’t travel. That is a very, very, naieve view of the world today. Diseases travel *to you* and your children in the form of recent unvaccinated immigrants. You don’t have to travel to some kind of slum–its not a “class issue” in the sense that your class protects you from contact with “those” people. Au contraire, class is a vector of disease since the people we routinely hire to bus our tables in restaurants, cook the food we eat outside of the home, and bathe our children at home are generally of a lower class than ourselves. The idea that we can isolate ourselves from disease by “not travelling” or by “Not interacting with other non vaccinated classes of people” is naieve.

aimai

I don’t know, I don’t think your typical waitors, babysitters and people you bump into at an airport are likely to be unvaccinated. It’s the class division on a global scale: people who fly airplanes and, eat/work at restaurants, live/work in houses vs. people who never been to an airport, never talked on a telephone, never seen a refrigerator. Unless you are a humanitarian worker of some kind, you’re unlikely to meet any of these people at the places you live, work and travel.

Also, I have to object to stereotyping parents who refuse vaccination as hippies (in 24 in 47). My mother is a medical doctor, specialist, atheist, not a hippie by any stretch of imagination, and one of the most rational people I know – OK? As far as I remember she refused many vaccination when I was a kid. Yes, it is ‘free riding’, but as we discussed in another thread people do things for their children that could be reasonably classified as unethical all the time and it’s often socially acceptable too. It’s just the human nature.

Dan Kervick I think has it mostly right. But I’ve never been anywhere (up and down the west coast, admittedly) where you couldn’t prevent your child from taking vaccines if you had the persistence. However, there is quite a bit of pressure to take them, so you really do have to have the persistence.
Public schools by law have to educate; ultimately, they cannot simply edumacate the vaccinated no matter what they want. If the parent holds out, they will win down the line.
If anyone has a cite of a case in which a school refused to edumacate a child because of no vaccination and was backed up by the courts, I’d love to read about it. It would be rare, I suspect.
Mind you, I’m not talking about the right of the schools to enforce a policy of vaccinations; I’m talking about the cases in which a public school refuses to educate a student due solely to the lack of a vaccination even after the parent has jumped through all the hoops.

Yes Vivian; on the other hand, they were still vaccinating against smallpox when I was a kid, and at that time your child was much more likely to die from the vaccination than the desease itself. If you’re a medical professional, you’ll try to figure the odds and do what’s best for your child, obviously.

hey fcc, I’m in MA too. This thing about the updated forms, and not accepting faxed forms, and wanting the doctor to provide a new form on the school form–or the doctor refusing to computerize the damn system and having to personally handwrite a new form every year is *&&^%$ insane. I’ve never resorted to faking it but I have organized my daughter’s “yearly exam” so that the form I already have is good through some part of the year and I don’t have to panic. By the time the form “expires” I no longer need it.

aimai

PS. I wasn’t arguing against the multiple vaccinations, only making a bemused comment.