On Vaccines, Incentives, Open Data and Public Policy

I know. Some mom coming out in favor of vaccines shouldn’t be breaking news. There’s nothing edgy about siding with most parents, nearly all the world’s governments and the vast majority of medical researchers and practitioners. But more of us need to do it.

And so begins JJ Keith – reknown blogger of all things parenting (I’m told) – titled I’m Coming Out… as Pro-Vaccine in the Huffington Post. Two days after getting published the piece has received a staggering 35,000+ facebook “likes” (a number, I suspect, that dwarfs the total likes of every “formal” public policy piece written in the last 48 hours combined – of course her’s IS a piece about public policy). And, it is a wonderfully written piece – filled with a dark sense of humour and concern that the topic deserves.

Keith’s main point is that more parents need to come out in favour of vaccines. That the central problem with the anti-vaccine movements is that they are loud and the rest of… well… are not. And I agree. It would be great if more of us stood up and talked about the importance of vaccines and engaged in this so called debate. Indeed, it may be the best of a number of not so great public policy options.

I’d love to think that there are simple policy measures that could fix what is, quite frankly, a matter of life and death. Requiring parents to produce proof of vaccination when entering their kids in public school feels like an obvious option. Greater transparency into vaccination rates in schools could also potentially spur parents to select schools that are “safer” from a health perspective. But not all those incentives in either case always push in the right direction.

So first, why does this matter?

When parents fail to vaccinate their children they don’t just put their own kids at risk of contracting measles, polio and other terrible diseases. Sadly, they put at risk newborns (who cannot be vaccinated) and – more critically – a chunk of the population who legitimately cannot be vaccinated or interestingly, who do get vaccinated but for whom the vaccination does not work.

This is why epidemiologists refer to “herd immunity” (it’s always nice when discussing public policy to refer to humanity as a “herd”). Since vaccines don’t work on everyone, enough people need to be vaccinated to prevent the disease from spreading reliably. The percentages required is usually north of 80% or 90% although I’m sure it varies a little based on the communicability of the disease.

Thus, what we actually have here is a free rider problem. If everyone vaccinates, then a few people opting out are probably safe if “the herd” remains sufficiently immune to the diseases. But drop below 80% and suddenly a tipping point is reached and things can get scary. Very scary. Frighteningly, there are whole (small) schools districts in California that fall below 50% immunized. And there are normal sized school districts that sit in the 60% and 70% range.

Indeed, thanks to the California Department of Public Health (CDPH), I was able to download the vaccination rates for every preschool in the state and poke through the raw assessment data myself (Sidenote: Dear CDPH administrators, please format your excel spreadsheets without merging title columns that make it impossible for users to sort the data, super frustrating). Shockingly two preschools, Kolbe Academy in Napa and the Waldorf School of Santa Barbara, had a zero kids – that is not one child – with all the required vaccines. Moreover, at Kolbe every single kid had a personal (not medical) exemption while at the Waldorf all but two had personal exemptions (meaning there parents didn’t want their kids to have vaccines) and the other two had simple not gotten around to it. Indeed at least 230 preschools in the state had kids with “personal exemptions” from vaccines that caused total immunization rates to fall below 80%.

These preschools are, in essence time bombs.

And some have already gone off! Just Googling “Whoop Cough Waldorf” (a chain of preschools that seems to dominate my poor immunization list) revealed a story about The East Bay Waldorf School – where only 44% of students are immunized – that had to be shut down by the local health authority because of an outbreak of Whooping Cough which is… easily prevent by a vaccine.

So a simple solution would be to require all kids who go to public schools to be vaccinated. This however, is already the rule in places like Santa Clara, and it while in part effective, it also drives  all the non-immunized kids into the same private schools, further diminishing the herd immunization effect and creating an ideal breeding ground for a dangerous disease.

Disturbingly, this is only desirable insofar as having a few outbreaks in schools like this cause parents to rethink their approach. But this is a terrible, terrible price to pay. It recently happened in Texas where a church that preached a deep skepticism of medicine and vaccines suffered a measles outbreak. Luckily no one died, but the church very quickly set up vaccination stations on its site. It is amazing how quickly one returns to fold of science and medicine once kids start contracting fatal diseases.

I also wouldn’t be surprised me if someone, using the data from the California Dept of Public Heath website created an web application that did a risk assessment of every school based on a number of factors of which vaccination rates would loom large. On the one hand it might cause parents to demand that other kids who attend the school also be vaccinated. On the flip side it might just accelerate the divisions between the anti-immunization camp and everyone else, creating even more dense clusters of schools where non of the kids are immunized.

In the end, short of a series of minor epidemics where enough kids die to scare non-conforming parents into getting their kids immunized, I fear that JJ Keith is doing the best possible thing: trying to build a coalition that will confront those spreading misinformation about vaccinations. Indeed, maybe a good first step would be organizing a boycott of Jenny McCarthy – a celebrity and “The View” co-hostess who has been one of the worst offenders in spreading misinformation about vaccines. Maybe we could call schools where more than 20% of the kids are not immunized because of their parents personal preference “McCarthy Schools.” And every time there is a measles breakout we can label it a “McCarthy Outbreaks” or worse, a “McCarthy death.” It’s strong language, but society maybe need to get tough to rebuild the social pressure needed to stomp out this problem… the other tools at our disposal are not, I fear, that strong.

2 thoughts on “On Vaccines, Incentives, Open Data and Public Policy

  1. jencloss

    There’s a problem in general with science communication. Scientists aren’t given the stage or the means to share their findings and even when they do, the public doesn’t really understand that it isn’t just some guy spouting his opinion, but peer-reviewed, statistically relevant information. Proponents of the anti-vax choice like to say they’ve done their research, but I highly doubt they are reviewing the types of articles and studies that use actual unbiased science, because if they were they would surely be coming to a different conclusion.


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