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Sunday, February 15, 2015

The useful functions of vaccine deniers

I was born into a unique generation in the history of mankind. My generation in the US was the first generation which grew up with almost no fears of infectious disease. The polio epidemic, which raged in its worst form immediately prior to my birth, was reigned in by the miracle of the Salk and Sabin vaccines. The antibiotic era began immediately before and one remarkable agent after another was brought to market in my childhood. While there were a number of childhood diseases which I had to weather (measles, mumps, and varicella), the terrifying scourges were for the most part vanquished.

For the next few decades, we became increasingly complacent about vaccination and these diseases which became of interest mostly because of historical interest. The memory of polio, whooping cough, diphtheria, measles, and chickpox became increasingly distant. Yes, if you cut yourself and appeared for acute care you received a tetanus shot, almost like some sort of religious ritual. Throw some salt over your left shoulder or say gesundheit when someone sneezes or coughs. No one gets those diseases anymore, do they?

The general public had increasingly fewer and fewer reference points to judge the need for vaccinations. The generations which experienced infantile paralysis or other less harrowing childhood diseases are dying off and the reality of such diseases have become nothing but distant echos. It is not at all surprising that skeptical voices have emerged. While I believe that these voices as relating to vaccine issues are barking up the wrong tree, I also believe it is important to cultivate skeptical voices. Expert classes tend to become increasingly insulated and self serving over time and the skeptical voices are important to provide feedback from broader, non-expert audiences who ultimately the experts must answer to.

An experiment has been done. The subjects unfortunately were the children of parents who were skeptical of the value of the measles vaccine. The results were the re-emergence of isolated pockets measles. The feedback is if you don't vaccinate your children they are at higher risk of getting sick. The news has been widely broadcasted. There is value in this. One could argue that children should not suffer the consequences of bad judgements of their parents. That however can never be avoided and the risks of striving to use the power of the state to reach those utopian goals will result in much more harm than could ever be perpetrated by the isolated bad judgement of selected parents.

Those of us who make bad decisions (which is all of us sometime) can serve useful functions when the unfortunate circumstances which befall us become apparent to those around us. We can but should not  insulate people from the consequences of their bad decisions. Bad outcomes provide the feedback that tells us that we should not have done specific things. In the case of the parents who make unwise decisions regarding vaccination, we should not be timid about pointing out the errors. However, we also should not deploy tyrannical approaches in an attempt to reign in all sorts of bad judgements. It won't work and it runs the real risk of putting power into the hands of people and entities which want to run peoples lives.

I envision there will always be an ebb and flow when it comes to compliance with vaccination. As we are more successful with vaccine adoption the rates of disease will go down, but over the time the rates of complacency will go up, resulting in lower vaccination rates and resurgence of disease. It should be self correcting except for places such the Swat Valley. It may be unfortunate but the voices of science cannot fight complacency nearly as effectively as the predictable resurgence of disease in a complacent population.