Low Vaccination Rates Are Caused By Inadequate Public Health Systems, Not By Anti-Vaxxers

There is a really crappy New York Times op-ed entitled “How the Anti-Vaxxers Are Winning” circulating at the moment (it’s such a great click-bait headline! Good job New York Times editors!).

It claims that “It’s looking as if 2017 could become the year when the anti-vaccination movement gains ascendancy in the United States,” but the only pieces of evidence it actually gives for that are that Robert Kennedy claims he was asked by Trump to be on an anti-vaxxer commision, and that there is an anti-vax documentary. Then it goes on to present some CDC data in confusing and misleading ways, while skipping over all of the data that shows that vaccination rates are steadily increasing and that the overwhelming majority of failure to vaccinate is caused by poverty and busyness, not anti-vaxxers.

It targets the wrong problem and ignores the real problem (as well as engaging in pointless scare-mongering). Anti-vaxxers are wrong and selfish, but the reason for low vaccination rates is overwhelmingly an inadequate public health system. Look at Texas in the two maps in the article: more than 33% of toddlers haven’t gotten the full sequence of vaccines, but only 2-5% of toddlers are unvaccinated for anti-vaxxer reasons.

More directly, here is the CDC report on vaccination rates: Note three things:

  1. for each vaccine individually, vaccination rate is > 90%, generally the safe level for herd immunity;
  2. the complete 7 vaccination rate has risen steadily for the last 7 years (through 2014, but nothing in the NYTimes op-ed cites more recent data);
  3. the main group that is inadequately vaccinated is poor people.

The two minute hate at anti-vaxxers is fun (and who doesn’t hate anti-vaxxers?), but it masks the real problems and the real success of vaccination programs in the US.

(Oh, and in good vaccine news, Britain, which really did suffer a huge wave of anti-vaxxers in the 00’s is now back to greater than 9 out of 10 rates for MMR vaccines.)

This entry posted in Uncategorized. Bookmark the permalink. 

9 Responses to Low Vaccination Rates Are Caused By Inadequate Public Health Systems, Not By Anti-Vaxxers

  1. 1
    Sarah says:

    This was very informative – thank you, Charles. I hadn’t realized we were doing better than 70% for complete vaccinations and better than 90% on some individual vaccinations. For some reason, I thought it was much lower.

  2. 2
    Charles S says:

    Hi Sarah,

    Are you in the San Francisco area or am I confusing you with a different infrequent Alas commentor? I think San Francisco has some areas of high anti-vaxxer exemptions and some areas of poor public health compliance, so your impression might be biased by coverage of local issues.

    Of course, those local issues of non-vaccination can be really important. An overall 91% rate is still a problem if it includes areas of <66% compliance. I found an interesting NYTimes infographic for California. In both SF and LA, there are small areas where wealthy anti-vaxxers create kindergartens with <66% measles vaccination rates, and much larger areas where poorer neighborhoods have 92% vaccination.

    So local non-compliance, either from inadequate public health or anti-vaxxer tendencies, are a potential problem. An outbreak from abroad (say, the Philippines or Europe) has the potential to spread in those local pockets of under-vaccination, but it doesn’t have much potential to break out from those pockets, since most schools have sufficient vaccination rates. That seems like about what we saw with the Disneyland outbreak in 2014-2015. It kept going for months, but it only infected 110 people in California, almost all of whom hadn’t been vaccinated or had undocumented vaccination status, 29 of whom were anti-vaxxers, and only 34 people were infected by contact with a known infected person.

    The Ohio Amish outbreak of 2014 showed what happens when an outbreak happens in a seriously under-vaccinated community. Even there, only a small percentage of the community was infected (<1%), and the outbreak failed to spread outside of the specific community.

    Just because it is my other vaccination hobby horse, I'll also mention that the whooping cough outbreaks of 2010 and 2014 were mostly driven by the poor effectiveness of the modern acellualr Pertussis vaccine (the 'aP' in 'TDaP'), which both only works for a few years and also allows people to later become asymptomatic carriers when exposed to the disease [edited based on MJJ’s later below, because the original phrasing was very misleading], and not by refusal to vaccinate by anti-Vaxxers. The anti-Vaxxers’ kids got hit hard by those outbreaks (which was their parents’ fault), but the outbreak was mostly spread by asymptomatic carriers to kids whose vaccination had worn off.

    Of course, the use of acellular Pertussis vaccines instead of whole cell vaccines is entirely the fault of the anti-vaxxers. Whole cell pertussis vaccine is nasty stuff, causing temporarily debilitating pain and high fevers, but it doesn’t cause brain damage or kill you, unlike whooping cough, which kills 20 babies a year in the US. Infant infection rates have roughly doubled since anti-vaxxers forced the replacement of whole cell Pertussis vaccines, so I suppose we can fairly say anti-vaxxers are responsible for half those deaths.

    Okay, reading through all of that right now, I guess I should change the direction of my hobby horse on whooping cough.

  3. 3
    Ruchama says:

    I’ll also mention that the whooping cough outbreaks of 2010 and 2014

    I got whooping cough in 2006, I think. I’d last been vaccinated against it in 1990. I’d been working at a summer program for middle school kids, and during the last week of the program, a lot of kids were getting sick and coughing. A week or so later, after I got home, I started coughing. I went to the doctor and got diagnosed and got antibiotics, but the cough didn’t totally go away until a few months later. That cough is scary — it feels like your lungs stop working, and you can’t take a breath. Even as an adult, knowing that I’d be able to breathe if I just waited a few seconds, it was hard not to panic. I can’t imagine how terrifying that would be for a little kid who doesn’t understand.

  4. 4
    MJJ says:

    Charles S: Here is the link to the article on acellular pertussis vaccine. You forgot a “>”.

    Also, to be clear, when you say:

    the whooping cough outbreaks of 2010 and 2014 were mostly driven by the poor effectiveness of the modern acellualr Pertussis vaccine (the ‘aP’ in ‘TDaP’), which both only works for a few years and also turns some people into asymptomatic carriers,

    you mean that it allows people to later become asymptomatic carriers when exposed to the disease, not that they become asymptomatic carriers from the vaccine itself (I was confused at first, trying to figure out how a acellular vaccine could cause an infection).

  5. 5
    Charles S says:

    MJJ, Thanks. Yes, definitely. I’ll fix that phrasing in my comment.

  6. 6
    Ampersand says:

    You forgot a “>”.

    Fixed!

  7. 7
    h says:

    I agree that the title is misleading, but the author–a pediatrician–does state that vaccination rates have been going up. The impression I got from the piece is that the guy is trying to do two things.

    (1) He’s worried about the possibility of resources being diverted from meaningful studies to hearing and investigations called for by misinformed anti-vaxxers, and he’s going on the offensive.
    (2) He wants to assure parents and soon-to-be parents that vaccinating children is safer than the alternative–partly so they’ll vaccinate their kids and partly so they won’t support or undertake any anti-vaccination efforts.

    I’m sure the guy, an instructor at Baylor, is aware of and concerned by a link between poverty and lack of vaccination; but this is just an op-ed, not a grant application or letter to the legislature, so I don’t think the absence of this or that fact is indicative of an intention to mislead.

  8. 8
    Sarah says:

    Charles, I could be that person you’re thinking of – I don’t live in the Bay Area now, but I did until a few years ago, and I might have mentioned it at some point. Either way, I think you’re right: my perception of overall vaccination rates probably was influenced by the local rate.

    I just looked at the NYT infographic you linked to and it’s interesting: the place I live now, the LA/Orange County metro area, is also a hot-spot of low vaccination rates – or cold-spot of regular vaccination rates? – which the article describes as linked to wealthy white demographics. I had thought low vaccination rates were a rural thing, but apparently in SoCal it’s the urban areas that are a problem. Go figure.

    Anyway, this was all very informative, so thanks for the additional info.

  9. 9
    Ruchama says:

    which the article describes as linked to wealthy white demographics. I had thought low vaccination rates were a rural thing, but apparently in SoCal it’s the urban areas that are a problem. Go figure.

    Yeah — back-to-nature types who don’t want to put “chemicals” in their kids’ bodies. I’ve encountered many of them through vegan groups. I saw one study that looked at it on the level of individual schools, and the Waldorf schools tended to have an absurd number of unvaccinated kids, along with a couple of other similar types. (Which irritates me, because that sort of hippie-ish parenting is probably what I’ll end up doing once I have kids, but I don’t want my hypothetical future kids hanging out with tons of unvaccinated kids.)

Leave a Reply

Your email address will not be published. Required fields are marked *