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A counterexample

April 21st, 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 Keating government (IIRC) passed responsibility to the states, but now seems 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?

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  1. April 21st, 2006 at 16:54 | #1

    What are the prevailing attitudes of american parents of home-schooled children toward immunisation/compulsory vaccination?

    And what proportion of American children are home schooled? Compared to European/Australian children?

  2. SJ
    April 21st, 2006 at 17:07 | #2

    I think your general expectation is faulty.

    The immunization rate in the US is around 80%

    Immunization rate exceeds federal goals

    Nearly 81% of American babies get all their recommended vaccinations before age 3, a record high, health officials said Tuesday.

    Immunization rates have risen steadily. As a result, some of the diseases that once raged across the country, such as measles, rubella and polio, no longer occur naturally in the USA, says pediatrician Stephen Cochi, acting director of the Centers for Disease Control and Prevention’s National Immunization Program.

    Cochi says that for the first time, the immunization rate for toddlers exceeds the goal of 80% set by Healthy People 2010, a federal program designed to improve health nationwide through several strategies, such as boosting vaccination rates.

    However, in the UK, where the “health scare” about measles vaccination occurred, the vaccination rate is about the same

    MMR immunisation rate falls again

    Uptake of the measles, mumps and rubella vaccine in England has fallen yet again, official figures show.

    Statistics for April 2003 to March 2004 showed 80% of two-year-olds had been given the MMR jab, down from 82% in 2002 to 2003.

  3. SJ
    April 21st, 2006 at 17:14 | #3

    Fixed link to the BBC story above.

    The conclusion one could draw is that countries with compulsory vaccination schemes have higher vaccination rates than countries with voluntary schemes. That’s not really a counterexample of anything, though.

  4. SJ
    April 21st, 2006 at 22:31 | #4

    John, there’s an implication about vaccination rates in Germany in the article you cited.

    The Microbes Are Back

    An outbreak of mumps currently sweeping Germany has received far less attention than the Midwest spate of cases, mainly because mumps, measles, and other vaccine-preventable diseases are still routine in Germany and other European countries where vaccination is not mandatory and frequently ignored. The Nietzschean sentiment that sickness makes one stronger is still prevalent in Germany, and kids there are often brought together for “measles parties” so they can get the more definitive immunity that actually catching the unpleasant disease provides.

    But the implication about vaccination rates is just BS

    Measles outbreak in Germany; docs may be at fault

    FRANKFURT, Apr 09 (Reuters Health) – Doctors opposed to vaccinating children against measles might be at least partly responsible for a measles epidemic in southern Germany, according to a regional division of AOK, one of Germany’s largest public health insurance groups.

    The measles outbreak has struck the district of Coburg in the German state of Bavaria. The district has a population of less than 100,000, but more than 1,000 people, mostly children, have contracted measles since November…

    Martin Eulitz, spokesman for the KBV, told Reuters Health that leadership of the KBV was strongly in favor of the MMR vaccines, and encouraged all members to give the vaccines.

    However, he said that German law does not require doctors to give the vaccines…

    In the Coburg district, 76% of children have been vaccinated, which compares with a rate of 88% in the whole state of Bavaria, he said.

    So it looks like my statement that “The conclusion one could draw is that countries with compulsory vaccination schemes have higher vaccination rates than countries with voluntary schemes” doesn’t stand up.

    I don’t think that any sensible conclusions may be drawn from your cited article.

  5. rd
    April 22nd, 2006 at 00:20 | #5

    I’ve had children at both Australian and US schools.

    More than most other countries, it is unwise to generalise about the US from a small sample. Anyway, my experience in the District of Columbia is there is no mechanism for enforcement before school, but the requirement for a vaccination certificate from a doctor is strictly required at both public and private schools. It’s required for summer camps too. From what I understand, it’s compulsory to supply the form but you can still avoid vaccinations if you can convince your doctor that you really don’t want to do them. The end-result is that not having vaccinations is not an oversight or because of convenience.

    Since it’s a scheme run by the DC Government, they just go through the motions of collecting bits of paper that look right. I suspect a form signed as Dr Ronald McDonald or George Washington mightn’t get queried.

  6. avaroo
    April 22nd, 2006 at 08:33 | #6

    “More than most other countries, it is unwise to generalise about the US from a small sample. ”

    This gets my vote for the understatement of the year.

    “From what I understand, it’s compulsory to supply the form but you can still avoid vaccinations if you can convince your doctor that you really don’t want to do them. ”

    I’ve never heard of this in the US and have not only been through public school here but also have children in public school in the US. The point isn’t the form, it’s the vaccination.

  7. avaroo
    April 22nd, 2006 at 08:41 | #7

    I don’t recall ever hearing about vaccination “scares” in the US. The British experience of numerous people refusing vaccines wouldn’t be common here in the US. Who wouldn’t want their children vaccinated against such diseases as mumps, measles, chicken pox, etc? I understand that some Brits even purposely expose their children to some common childhood diseases to “get it over with”. I believe this would strike the average American as extremely odd and unscientific.

    It’s difficult in the US, to control for young people entering the country as part of a family of illegal immigrants. Since vaccination is usually staged, with vaccines required at specific grades, such as 1st, 4th, 6th, etc., if you have a young person enter the country and enroll in school in 10th grade, their vaccination records might not be checked as American kids are pretty well through the vaccine schedule by that time. I think it’s likely that children actually born in the US have higher rates of vaccination than children who enter the US in their teenage years but it would interesting to know if that is actually true.

  8. April 22nd, 2006 at 12:39 | #8

    Actually, in a country with high vaccination rates (and thus herd immunity), if there is any well founded doubt about the safety of vaccination itself (as in Britain – government “reassurances” do not remove well founded doubt), why, the best thing for any one family is to avoid vaccination. I routinely refused free flu shots at work for this reason. Of course, there is a Tragedy of the Commons mechanism here; you want everybody else‘s children to be vaccinated, for the benefit of your own.

  9. wilful
    April 24th, 2006 at 09:25 | #9

    I understand that some Brits even purposely expose their children to some common childhood diseases to “get it over with�. I believe this would strike the average American as extremely odd and unscientific.

    It was the central plot of a Simpsons episode, so I don’t think it could be that unamerican.

  10. wilful
    April 24th, 2006 at 09:26 | #10

    Of course, there is a Tragedy of the Commons mechanism here; you want everybody else’s children to be vaccinated, for the benefit of your own.

    PM Lawrence, that’s not a tragedy of the commons, that’s you being a selfish git.

  11. avaroo
    April 24th, 2006 at 09:37 | #11

    “It was the central plot of a Simpsons episode, so I don’t think it could be that unamerican. ”

    Wrong. The Simpsons are considered quite peculair in the US. In fact, that’s the point of the Simpsons. No one would consider them “normal”.

    Of course, it may indeed be that there has been a movement in the US to expose children to diseases easily vaccinated against and that no one has ever heard about it. Doesn’t make sense to me, but…..

  12. JP
    April 24th, 2006 at 09:55 | #12

    I wonder how much Australia’s success in this area is due to the fact that this Government made 20% of the Maternity Allowance payable as a lump sum (currently $222) for children who are fully immunised at the age of 18-24 months. I believe you can still claim this for unimmunised children if you declare yourself a conscientious objector, but it seems that in the end this is an uncommon reason for non-immunisation.

  13. April 24th, 2006 at 11:16 | #13

    This is slightly off topic but quite interesting none the less:-

    http://www.smh.com.au/news/science/wallabys-milk-beats-super-bugs/2006/04/23/1145730809352.html

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