A counterexample

by John Q on April 21, 2006

This report on a recent outbreak of mumps in the US midwest makes the point that the US has a far more stringent and effective system of universal vaccination than most European countries. 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).

Australia dropped the ball on this a decade or so ago when the Federal government passed responsibility to the states, though we now seem to have restored effectively universal vaccination.

All of this is surprising to me. I would have expected that health scares about vaccination would be at least as easy to run up in the US as anywhere else, that objections on the grounds of individual liberty would be taken more seriously in the US than elsewhere, and that the complex patchwork of state and local management of health policy would lead to large gaps.

Is my general expectation wrong, or is there something special about the case of vaccination? Or is thus just an illustration of the fact that every predictive model fails sometimes?



goatchowder 04.21.06 at 3:06 am

Big PHRMA pushes these “mandatory vaccination” bills, and their enforcement. It’s essentially a subsidy to the drug companies, and we know they have huge amounts of money and are eager and willing to bribe Senators, Congresscriters, Governors, Presidents, and anyone they can sink their teeth into.

So of course the USA is “ahead” of other countries in terms of mandatory vaccinations. The suite of vaccinations required of my kindergardener is astounding… we didn’t get shot up like pincushions in my day the way kids do today, and, somehow, we all grew up and were able to reproduce.


nik 04.21.06 at 3:17 am

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.


bad Jim 04.21.06 at 4:01 am

It’s possible that the U.S. is more accepting of vaccination because so much of it was invented here. George Washington immunized his army against smallpox at a time when it was a very dangerous technique. The Salk and Sabin polio vaccines were sources of national pride; I remember watching films about them in elementary school.

My weak suggestion is that it somehow just became part of the culture.


abb1 04.21.06 at 5:34 am

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


dearieme 04.21.06 at 6:20 am

“the U.S. is more accepting of vaccination because so much of it was invented here”: for HEAVEN’S SAKE.


Matt 04.21.06 at 6:42 am

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.


Barry 04.21.06 at 6:49 am

Matt, I’d be surprised if there weren’t federal and state mandates. John, don’t worry about the US; we’ve got large numbers of anti-vax people. Just pop over to Science Blogs and check out ‘Respectful Insolence’.


eudoxis 04.21.06 at 7:05 am

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 04.21.06 at 7:05 am

Big PHRMA pushes these “mandatory vaccination” bills, and their enforcement.

Vaccines are off patent and are a relatively low-profit businesses — to the point where it is sometimes a problem getting drug companies to produce the necessary quantities.

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.

That strikes me as bizarre. Free universal public education has a long history in the U.S. It is true that parents can opt for private and parochial schools or even homeschool their children — IF they can show their children are being adequately educated. Not schooling children at all is not an option (the closest I’ve seen to that, BTW, is on the left with the ‘unschooling’ movement)

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.

I believe these are state-level requirements imposed by state legislatures, so local school boards (or even state school boards) would not be involved. That said, why would you expect creationists to be opposed to vaccinations?

What other ‘counter-intuitive’ facts about the U.S. will CT be startled with in the future? That the constitutional separation of church and state in the U.S. prevents direct state funding of religious schools (unlike the situation in many EU countries)? Or how about the fact that catalytic converters were mandated in the U.S. long before in Europe?


Matt 04.21.06 at 7:23 am

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.


harry b 04.21.06 at 7:24 am

eudoxis is right; these things are regulated (or not) state-by-state, and standard exemption clauses are usually (but not always) written in. Note, though, that the exemptions are standardly about religious conviction, ot individual liberty; unlike in the UK, you can’t get out of it just because you want to be a free-rider; you have to have some religiously based objection to immunization in general.

Also note that the US has a relatively low public school attendance rate. At least 12% attend private schools which will not be touched by these regulations; some number (off the top of my head I don’t know how many, but certainly over a million) are home-schooled. That said, I would guess that the Catholic schools (accounting for at least half of privately educated kids) are sensible and public-spirited about these matters.

The only way to really measure these things is by finding out what proportion of the school-age population is immunized. Lacking data I’d guess its lower in the US and UK than in Northern Europe excluding the UK, higher than in southern europe.

For some reason, there have been no noticeable scares here about MMR, Frankenfoods, BSE, you name it. The religion of technology?


y81 04.21.06 at 7:36 am

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.


John Quiggin 04.21.06 at 7:43 am

“I am not aware of any Christian sect that opposes vaccination.”

How about Christian Science? I don’t know their position, but it seems like they ought to oppose vaccination.


eudoxis 04.21.06 at 7:49 am

Alar and BGH caused reasonably big scares in the US.


Philip Brooks 04.21.06 at 8:07 am

Did the US maybe have a worse polio scare than much of the rest of the world? Having FDR for president might have also further raised polio awareness and made people more open to the idea of vaccinating everyone. Just a thought. I wouldn’t be born for decades yet when all this was going on.


nik 04.21.06 at 8:10 am

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.


rd 04.21.06 at 8:25 am

Peter Baldwin’s study of different responses to AIDS ,Disease and Democracy, makes the point that America favors a preventive rather than curative approach to public health. Thus, the system of actually caring for the sick is patchwork, haphazard and politically divisive. But vast amounts of money are spent on highly organized efforts to find cures, with far more being spent on basic research, even on a per capita basis, than most other industrialized countries. In large part, the effort spent on the latter is meant to spare effort on the former. From this point of view, vaccines are ideal: simple, cost effective and preventive, sparing public action in the long run.

Vaccines were controversial in the early twentieth century, but “public health” was an established exception to Lochner-era constitutional doctrines of public autonomy, so judges mostly gave little trouble.


rd 04.21.06 at 8:33 am

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


Tim 04.21.06 at 8:40 am

Private–including religious–schools, have to make sure their students are vaccinated, too (at least in Illinois and New Jersey).


Iron Lungfish 04.21.06 at 8:43 am

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.


Urinated State of America 04.21.06 at 9:13 am

“George Washington immunized his army against smallpox at a time when it was a very dangerous technique.”

He’d have lost the war if he hadn’t variolated his army. The colonies didn’t have sufficient population density to support endemic smallpox, so most american-born colonists didn’t have resistance from childhood exposure. (This is the reason why Harvard and Yale were founded: colonists sent to Oxford or Cambridge for their education often died from smallpox soon after.)


M. Gordon 04.21.06 at 9:19 am

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.


Cryptic Ned 04.21.06 at 9:20 am

The suite of vaccinations required of my kindergardener is astounding… we didn’t get shot up like pincushions in my day the way kids do today, and, somehow, we all grew up and were able to reproduce.

Except for those who didn’t grow up because they hadn’t been vaccinated and died in disease outbreaks. There are fewer kids like that now.


LizardBreath 04.21.06 at 9:27 am

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.


Ray 04.21.06 at 10:22 am

The battle over mandatory vaccination was over a century before most people had even heard of GM foods, so I can’t quite see a connection between the two. The LRB had a good article on the English anti-vaccination campaigns


Jake 04.21.06 at 11:39 am

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.


Mark 04.21.06 at 11:41 am

How about Christian Science? I don’t know their position, but it seems like they ought to oppose vaccination.

While the church doesn’t, AFAIK, take an official stand these days, most individual CStists don’t get vaccinations except where it’s required by law, and most states have exemptions (from vaccination laws) on the books regarding CS children attending public schools


maurinsky 04.21.06 at 12:07 pm

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.


abb1 04.21.06 at 12:44 pm

Hmm. Christian Science my ass. Listening to you, fellas, one may conclude that one has to be a nutcase to avoid vaccination. Yet in most cases on the individual level it’s no more irrational than, say, tax avoidance. You’re better off when you’re not vaccinated and everyone else is.


joe o 04.21.06 at 12:46 pm

The story Nik tells in 16 is pretty fascinating.


rc 04.21.06 at 12:58 pm

Undervaccinated children appear to be different from unvaccinated children. From this study:

Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding $75 000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children.


MJ Memphis 04.21.06 at 1:04 pm

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.


rc 04.21.06 at 1:04 pm

Crap. I must’ve gotten the tag wrong. The reference in the study above was supposed to be:
Smith, Chu, and Barker, 2004, “Children who have received no vaccines: Who are they and where do they live?”, Pediatrics 114(1:187-195).


MJ Memphis 04.21.06 at 1:05 pm

“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.


abb1 04.21.06 at 1:14 pm

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

Well, fair enough, but still… Even if you’re traveling you’re probably not going to le ventre de Paris kinds of places. It’s probably more of a class thing than geography.


weasel 04.21.06 at 1:21 pm

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…


nick s 04.21.06 at 2:14 pm

The situation in the US — heck, the vaccination requirements for immigrants had my NHS surgery shaking its collective head — makes the debate over administering the HPV vaccine in schools even more interesting.


eudoxis 04.21.06 at 2:14 pm

“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.


MJ Memphis 04.21.06 at 2:46 pm

“The situation in the US —heck, the vaccination requirements for immigrants had my NHS surgery shaking its collective head—makes the debate over administering the HPV vaccine in schools even more interesting”

LOL… my fiancee said she felt like a pincushion after going through the vaccines required for immigration.

As for the HPV vacc situation, that is simple enough to understand, so long as you remember the right-wing xtian mindset… measles, mumps, and rubella are not a divine punishment for sin, so it is ok to vaccinate against them.


SamChevre 04.21.06 at 3:05 pm

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


SamChevre 04.21.06 at 3:08 pm

OK, the comments don’t like the less than sign.

And they (the Plain People) are generally poor—I have known many families of 10 with annual incomes of less than $20,000—and vaccinations are expensive (a full series of infant vaccinations is several hundred dollars).


Alex 04.21.06 at 5:53 pm

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.


LogicGuru 04.21.06 at 7:27 pm

Slightly different take–I think the US has more stringent requirements for vaccination because of Americans’ obsession with hygiene and safety, disinfecting, killing germs, etc. Kids have to be innoculated and sanitized before they can be admitted to public facilities.


vivian 04.21.06 at 8:37 pm

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.


parvati_roma 04.21.06 at 9:00 pm

Writing from Italy – just in case anyone’s still interested in the national-comparison aspects, I found two links that give an idea of the situation here in Italy, and in Europe in general, where it varies a lot from country to country – some vaccinations are compulsory, some optional but not a big ideological issue far as I know?


Matt McIrvin 04.21.06 at 9:24 pm

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.


Jane Galt 04.21.06 at 9:40 pm

That’s the “herd immunity” thing. Not only are vaccines not completely effective, but also their effect for some diseases wane over time, so that for example none of us over the age of 22 are currently immune to measles.

What vaccines do is make it so that there isn’t any population large enough to serve as a reservoir of the disease–which is what schools used to be, with their large populations of unexposed kids happily sneezing on each other and practicing less than optimal bathroom hygeine. So even if some people weren’t immune, the population dynamics are such that any infection quickly burns itself out from lack of new victims.

But once the number of unvaccinated people rises above 10-15%, the disease now has a critical mass. That’s why the UK is now serving as such an excellent reservoir of diseases, thanks to (among other things) the MMR scare. I believe Boulder, Colorado, is apparently becoming another such, thanks to the large number of affluent hippie parents who are afraid of vaccines/happy to free ride on other parents.


Matt McIrvin 04.21.06 at 9:45 pm

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.


Matt McIrvin 04.21.06 at 10:01 pm

…I suppose I could make our libertarian friends happy by suggesting that vaccine coverage is better here because there isn’t decent universal health care. It’s moral hazard, see: why get vaccinated if you know you can see a doctor without a hefty co-pay when you’re sick? On the other hand, the people here who have no health insurance at all are likely to be, as stated above, undervaccinated, so that’s not the whole story.


Dan Kervick 04.21.06 at 10:11 pm

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.


justin 04.22.06 at 1:38 am

From a US perspective, I vote for FEAR. We in the US can be scared into pretty much anything – put the fear of death together with a belief that money can buy anything and bingo, you’ve got vaccination right left and center.


clew 04.22.06 at 1:54 am

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.


stuart 04.22.06 at 4:51 am

You get the impression this is only going to get worse over time, as we move further away from the time when so many of these diseases where commonplace, more and more parents are going to base decisions on whether to immunise their children based on the current situation. This could well lead to entire generations growing up with low rates of vaccination, causing significant outbreaks for years while during this time the rate of vaccination goes back up again as the disease is no longer viewed as only a historical problem.

And of course thats even setting aside the issue of new variants of diseases evolving to sidestep the vaccinations that currently exist, although presumably with existing vaccines for analogues these are only likely to be short term problems in most cases.


aimai 04.22.06 at 6:30 am

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.



Brett Bellmore 04.22.06 at 7:44 am

Vaccination works with American conceptions of liberty, precisely because it isn’t really about protecting the person being vaccinated, it’s about protecting society. Liberty claims are at their strongest when rejecting measures intended to protect YOU, not others. You have the right to run risks to yourself, but far less claim to be entitled to endanger others.


abb1 04.22.06 at 7:56 am

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.


Sharon 04.22.06 at 11:39 am

Hate to spoil the anecdote party, but how about some actual evidence about vaccination rates? To do only a UK/US comparison, the latest NHS immunisation statistics and the US National Immunisation Survey. Yep, US kids are doing better on MMR, but I reckon that’s a short-term UK blip – I’d happily put a bet on the levels soon being back up to where they were in the mid-1990s (over 90%) before the panic.

More than 90% of both US and UK infants are being vaccinated against the same nasties: diphtheria, tetanus, pertussis, polio, Hepatitis B, and haemophilus influenza. The only big difference is that in the UK kids aren’t vaccinated against chicken pox. And that’s probably only because it isn’t routinely available on the NHS.

(Both sets of figures have state/regional breakdowns which contain some interesting features, too. Eg, Londoners would appear to be noticeably more panic-stricken about MMR than the rest of the country. Odd, that.)

So, we might wonder, if governmental policy regimes are so different, why are the outcomes so similar?


ralph 04.22.06 at 3:03 pm

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.


vivian 04.22.06 at 8:32 pm

In the US, my son was due for his MMR at about the time the big UK debate hit on the thimerosal as preservative possible culprit. Thimerosal was phased out of contact lens solution (too irritating) in the early 80’s; why put it into a vaccine? I asked the pediatrician, she said that (1) while there was no link to autism, (2) many object to thimerosal, and (3) they tried to order from companies that didn’t use it. Those vaccines were in demand, sometimes backordered, but the industry as a whole was switching. Now offices often have notices that they use mercury-free vaccines, at least here in sophisticated coastal metropolis-burb.

A national health system could have demanded and gotten such phase-out even quicker. There is no good reason why the UK gov’t didn’t. Seems like the whole ‘patient’s rights’ movement just hasn’t reached the MD’s. “We know best, you idiots comply,” approach. That attitude probably induces a bit less trust.

Abb1 and another commenter are, I think, mistaken. I wouldn’t want to subject my child, or self, to these diseases – even annual flu risks. Whooping cough lasts for months; rubella causes birth defects. Etc. The risk of vaccines is negligible and the pain brief; the risk of getting and suffering from one of these diseases is not negligible. The risk of being the carrier that infects someone with a poor immune system is horrifying.


abb1 04.23.06 at 3:25 am

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.


fcc 04.23.06 at 5:18 am

Based on my experiance in an upper middle class Massachusetts school district, somewhere between 30-35 % of medical records submitted by parents to schools to satisfy vaccination requirements are faked. Don’t get me wrong, the vaccinations are performed, but the documentation requirements to prove it are so onerous and repetitive we parents just start faking it.
Schools require submission of the same records year after year with updated “time stamps” by the primary physician. Around the begining of the school year the group practice we have used reports waiting times of 30 days for an “examination” and has started charging $15 per records request. Multiply this demand by Scouts, Football, Soccer, Field Hockey, Gymnastics class……

So we blow it off, fake the forms. The authorities know the drill and are complicit in the scheme.



aimai 04.23.06 at 12:24 pm

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.



Jean Lepley 04.23.06 at 12:28 pm

“rubella causes birth defects” — yes, when a pregnant woman has the disease. Maybe I’m quibbling here, but I’m struck by the way we now routinely vaccinate against diseases (rubella, mumps, chicken pox) that in my day you wanted your child to encounter because as CHILDHOOD diseases they weren’t devastating at all. I would have been very concerned had my three daughters at one time or another, NOT had German measles (as it was then called) because I knew the effect it could have on an unborn fetus. It mattered that they should get this routine and very mild childhood disease, and it happened without any great effort on my part. Today, of course, it wouldn’t happen. An unvaccinated girl in the midst of a vaccinated “herd” would grow up truly at risk . . .


John Quiggin 04.23.06 at 7:30 pm

Jean, I doubt that immunity by exposure is going to give better coverage than vaccination. I didn’t get chicken pox until I was a young adult and I’ve never had mumps (fortunately, I’m now past the stage of life where the worst of the side effects is a big worry).

And your argument doesn’t apply to measles, which can have terrible side effects on children. If you accept the necessity for measles vaccination, the marginal cost of MMR is essentially zero.


vivian 04.23.06 at 8:22 pm

abb1: I’m also old enough to have a smallpox vaccine scar – easy call back then for my parents, i’ve never second-guessed it. (Would I want to be vaccinated now by the bushies who can’t manage simpler tasks? tougher call.) But sure, all of the parents here are trying to do what’s best for their kids, no slur intended, sorry.


Jean Lepley 04.23.06 at 11:47 pm

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

Comments on this entry are closed.