11 ms·

The Unforgiving Math That Stops Epidemics

113 points by nature24 9y ago

smallnamespace 9y ago
The math makes it clear why giving everyone absolute freedom to choose whether to immunize or not doesn't work very well. If everyone else is immunized to the point where there is significant herd immunity, but immunization has a low but non-zero cost (e.g. feeling crappy for a few days), then the rational selfish action is to be a free rider and not immunize. However, if everyone did that, then herd immunity can collapse down to a level where there is no herd immunity; people rationally choose to immunize only to protect themselves. However, given that immunizations aren't perfect shields, in that scenario, even immunized individuals will be at risk to infections spreading through the population.
- lr4444lr 9y ago
  Worth noting in the article (quoted out of order for emphasis): "Determining the R0 of a particular microbe is a matter of more than academic interest. If you know how many secondary cases to expect from each infected person, you can figure out the level of herd immunity needed in the population to keep the microbe from spreading. This is calculated by taking the reciprocal of R0 and subtracting it from 1. For measles, with an R0 of 12 to 18, you need somewhere between 92 percent (1 – 1/12) and 95 percent (1 – 1/18) of the population to have effective immunity to keep the virus from spreading. For flu, it’s much lower — only around 50 percent. And yet we rarely attain even that level of immunity with vaccination. ... The calculated R0 of the West African Ebola outbreak was found to be around 2 in a 2014 publication, similar to the R0 computed for the 1918 influenza pandemic based on historical data. " All of you ladies and gents who blow off your annual flu vaccine because "you just don't seem to ever catch it" - you're just lucky. It's only a matter of time with modern travel and climate change until another virulent strain hits.
  - luke0016 9y ago
    > All of you ladies and gents who blow off your annual flu vaccine because "you just don't seem to ever catch it" - you're just lucky. It's only a matter of time with modern travel and climate change until another virulent strain hits. Even if you do get the vaccine, there's no guarantee that it will actually include your new virulent strain. The flu vaccine is more involved (and uncertain) than others because influenza has a high mutation rate. It's a bit of a guessing game each year as to which strains should be included, and new ones crop up all the time.
    - exhilaration 9y ago
      Even if you do get the vaccine, there's no guarantee that it will actually include your new virulent strain. True, for reference look at this table from the CDC: https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm https://www.cdc.gov/flu/professionals/vaccination/effectiven... 2011-12: 47% vaccine effectiveness 2012-13: 49% vaccine effectiveness 2013-14: 52% vaccine effectiveness 2014-15: 19% vaccine effectiveness 2015-16: 48% vaccine effectiveness 2016-17: 42% vaccine effectiveness But I still get my flu shot every year, better to be 40-50% protected than 0%.
      - lr4444lr 9y ago
        Are you sure the R0 of the original article isn't determined accounting for the fact of vaccine ineffectiveness?
        exhilaration 9y ago
        I don't know, corrections are welcome!
        btilly 9y ago
        The R0 of the original article is determined on the assumption that nobody is immunized at all. Vaccine ineffectiveness is the odds that when you are potentially infected by a wild flu, the virus that you encounter was one that you were vaccinated against. Vaccines are more effective when they correctly predict what varieties of flu will be circulating. But the more effective the immunization program, the more the ones that they predicted become and the less effective the vaccine becomes. However we all benefit because less flu is in the environment.
  - learc83 9y ago
    >All of you ladies and gents who blow off your annual flu vaccine because "you just don't seem to ever catch it" - you're just lucky That's not true. There is a significant portion of the population who are resistant to the flu. I'm 34 and I've never had the flu. None of my 3 siblings, nor my mom (who's 55) have either. This is despite never getting a flu shot, and spending several years riding public transit. It's well documented that many people just don't become symptomatic or even contagious. A study in 2011 infected 17 people with live active flu virus, and only half developed any symptoms at all. Furthermore, it's likely that people with this immune response never develop the viral load necessary to easily spread the virus.
    - AlexandrB 9y ago
      > A study in 2011 infected 17 people with live active flu virus, and only half developed any symptoms at all. That's fascinating. Do you have a link to the study?
      - learc83 9y ago
        I can't find a link to it with a quick google search, but I remember it was done at the University of Michigan if you want to search further.
    - ashark 9y ago
      From about ages 12-21 or 22 I caught nothing. I consistently had a ~36hr period of very slight sniffles about once a year, and nothing else at all. Never bothered with flu shot, took no precautions, ate absolute garbage. Then I started having 2-3 serious illnesses—very bad colds, the flu, sinus infections (I'd never had either of those last two)—every single year, and my nose is a little bit stuffy 100% of the time. 360 days a year, before, I couldn't blow my nose at all even if I wanted to—nothing would come out—but now I can a couple times a day, every day, when not actually sick. Aging sucks and/or HGH is a hell of a drug.
      - learc83 9y ago
        Sounds like you have allergy problems, or maybe a deviated septum, or something else causing sinus infections. That's definitely not just a result of being over the ripe old age of 22.
  - sushisource 9y ago
    All in support of parent comment, though. I don't get the flu shot because I've had it once in about 10 years, and I hate getting shots. Sure, call me selfish, but it's just not worth it for me. Now, if I have to go get it, or pay a $200 fine or something - yeah, I'll suck it up and go do it.
    - naasking 9y ago
      > Now, if I have to go get it, or pay a $200 fine or something - yeah, I'll suck it up and go do it. In an ideal world, all those who opt out should have to pay the medical expenses of those who get sick. Not vaccinating is the same sort of negative externality as environmental pollution. Rather than making it a fine, a high opt-out fee could cover it without the stigma of "breaking the law".
      - riot504 9y ago
        I don't get the shot and never will. Under your logic all those who eat fast food for lunch everyday and don't exercise should have to pay extra for medical insurance for not taking care of themselves.
        CDRdude 9y ago
        I think they should pay more. However, it is harder to track than a yearly checkbox for if they had a flu shot.
        osteele 9y ago
        What is the analogy between being too young or immunocompromised to receive the vaccine, and having poor diet and exercise habits?
        kbenson 9y ago
        Some locations do charge a "health tax"[1] on certain food types and/or quantities of food. There are many ways to incentive/disincentivize behavior. 1: https://en.m.wikipedia.org/wiki/Fat_tax https://en.m.wikipedia.org/wiki/Fat_tax
  - revelation 9y ago
    "Flu shots" are an unique American silliness and seem to do more damage than good for the vaccinations we actually want people to have.
    - geomark 9y ago
      That's a strange notion. I live in Southeast Asia and flu shots are routine here, even offered by schools to students.
      - tom_mellior 9y ago
        I've also had employers in different EU countries offer flu shots.
- ouid 9y ago
  We are sexual reproducers, and as such, we require other people to further our biological goals. This means that the health of our herd has a direct effect on our own adaptiveness. Don't speculate about biological motives with the "rationality" defined by economics. They are different terms.
- orf 9y ago
  That's why a lot of things, like liberterianism (optional taxes) and communism don't work in practice.. Edit: I mean everyone thinking "well someone else will do it, I dont have to", specifically regarding to paying taxes or contributing to society.
  - astrodust 9y ago
    It's because a portion of humans are just dicks and ruin it for everyone else, so we need systems that clamp down on dickish behaviour so it doesn't wreck everything.
    - rlanday 9y ago
      Everyone is a “dick” given the right set of incentives.
    - civilian 9y ago
      The _really difficult_ trick is building systems that won't get corrupted by the dickheads.
      - astrodust 9y ago
        Precisely why making social network sites like Facebook and Reddit is really hard.
        civilian 9y ago
        I mean, I agree that this rule applies to everything. But I'm more worried about the organizations that have a monopoly on force, not on social networks.
  - wonderwonder 9y ago
    In this case would communism not actually be a positive? If the communist government decided everyone has to get vaccinated it seems the problem would be solved. Not an advocate of communism as a whole but it is an interesting mention that it would if applied by an aggressive state actor go a long way towards eliminating certain diseases assuming it has the financial resources.
- samlevine 9y ago
  We can apply Kant's categorical imperative to lots of stuff. Some people don't want to have children. If everyone chose to not have children the human race would face extinction. This does not imply that we must (or more importantly, can from a moral perspective) force people who do not want children to have them anymore that it implies that forcing people who do not want flu shots is the right thing to do.
  - danharaj 9y ago
    In one case we are talking about the wellbeing of other actual human beings, in the second, the abstract concept of the human race. Seems like a bait and switch to me.
- hannob 9y ago
  > If everyone else is immunized to the point where there is significant herd immunity, but immunization has a low but non-zero cost (e.g. feeling crappy for a few days), then the rational selfish action is to be a free rider and not immunize. Except that's not really how it is. There's still a very non-negligible risk to catch any of a number of vaccine-preventable diseases. People die from measles on a regular basis. You can in theory imagine a situation where this is different, but realistically Vaccines totally make sense even from a very egoistic perspective.
- ThrustVectoring 9y ago
  So subsidize it. I mean, that's what subsidies are for - to convince people to do things that are in the public interest.
  - AlexandrB 9y ago
    In Canada flu shots are free. It's pretty great - I catch the flu easily and I've managed to avoid getting sick the last few seasons possibly thanks to getting the shot.
    - vanjoe 9y ago
      Pretty sure they are only free for at risk people/ health care workers. At least that is true in BC. http://immunizebc.ca/diseases-vaccinations/influenza http://immunizebc.ca/diseases-vaccinations/influenza Healthcare is a provincial responsibility in Canada
- pasquinelli 9y ago
  i don't know why you claim it's rational to be a free rider with one breath and in the next explain how it isn't rational. only considering immediate considerations and immediate consequences doesn't have to be what rationality is. only considering your own self and your own interests doesn't have to be what rationality is. rationality is a nebulous term and i see people far to often use the word to refer to stupid selfishness and short sightedness. if people tend to do something because it's easier for them but that will come the long way round and bite them, and a lot of other people, in the end then that's a demonstration of a failure of human to be rational.
  - smallnamespace 9y ago
    You're absolutely right that the word 'rational' is so overloaded that it can be nearly meaningless -- that's why I qualified it with 'selfish'. We do need to draw distinctions between consequences that are immediately faced by the decisionmaker, vs. the long-term consequences to the group. Note that even if you do care about the long-term consequences to the group, it may still be narrowly rational to decide not to immunize. After all, your own individual decision is only going to have a tiny impact on whether herd immunity persists in your community, but will have a much greater impact on yourself. This is the same logic over why companies pollute, people litter, fishermen overfish -- there is a 'commons problem' where people collectively benefit from collaboration, but selfish individuals can benefit by defecting and free-riding. If one can't see how selfish behavior may appear rational, then it becomes very difficult to figure out how to structure norms and incentives to encourage group cooperation.
- PostOnce 9y ago
  "it doesn't work very well" for the purpose of ensuring the absolute optimal immunity, but it does work very well for ensuring the absolute optimal individual liberty. I vaccinate, always, and I am hopeful that other people will too, but I absolutely do not want to force people to do what everyone else thinks is best for them, because then, where does it stop? How far might we go in the pursuit of perfect immunity? Some contagions have no vaccine, will we require masks at all times? Will we criminalize handshakes? At some point, the benefit of immunity is outweighed by what you have to pay for it. I guess I sound like an antivaxxer here. I probably sound like a Nazi elsewhere. All I am though, is pro-liberty.
  - lotsofpulp 9y ago
    Except we live in a world with others, and some of our actions affect others. It's a nice sound bite to say you're "pro-liberty" or freedom or whatever nonsense, but I'm sure you're not "pro-liberty" when it comes to performing obscene acts in public where your children can see them. Issues in life are not simple binary choices. We have to think about balancing individual goals, societal goals, national goals, and global goals. I'm of the opinion that we should err on the side of individual liberty, but when the evidence is so overwhelmingly positive to be pro vaccine, then obvoiously we might have to re-arrange our priorities.
suneilp 9y ago
So now, what am I supposed to think of all those claims that the flu vaccine is essentially a step or two behind nature. Then, for me, I worry about the adjuncts and other stuff added to the standard vaccines as I have autoimmune problems. There are alternative vaccines that are available but I don't remember their efficacy. So I refuse taking vaccines unless absolutely necessary until I see viable alternatives without aluminum, any kind of mercury, and so on.
- apsec112 9y ago
  These fears are based on bad science. The alleged "toxins" in vaccines are either present in microscopic quantities - micrograms or less - or were simply never there in the first place. It's like worrying about "sugar being bad for you" - which it is, in large enough amounts - because a single grain of table sugar got into your cereal. Details: https://sciencebasedmedicine.org/toxic-myths-about-vaccines/ https://sciencebasedmedicine.org/toxic-myths-about-vaccines/
  - suneilp 9y ago
    That page was interesting. Yet, I keep seeing conflicting reports stating that the removal of thimerosal from vaccines to be exaggerated, etc.
- jfoutz 9y ago
  I can't imagine how difficult it would be to be that sensitive to aluminum. I handle so many aluminum objects every day, it seems impossible i wouldn't consume some tiny amount daily, accidentally. Not to mention baking powder and cheese.
favorited 9y ago
Anyone interested in these topics should look into the books "The Hot Zone" (about the first filovirus outbreaks, including Ebola) and "The Demon in the Freezer" (about several biological agents, most notably Smallpox, and their potential for use in warfare). "The Demon in the Freezer" goes into the story of the eradication of Smallpox in the natural world, and talks a lot about containment of viral breakouts as well as the role of vaccination.
mayneack 9y ago
I've always wondered why the flu shot wasn't 100% free even without insurance. It wouldn't surprise me if one insurance company (or a collective of companies) could lower their net payout by increasing the number of total vaccinated people. A one day clinic recently that I went to only charged $30 for uninsured people.
- toss1 9y ago
  It would not surprise me if the math actually worked out that it would be best to pay people $5 or something to get the shot. It's be especially good if the payout was perhaps $2 to get it but $5 if more than 50% of the pop in an area got the shot. Maybe manageable with an Etherium contract?
  - mayneack 9y ago
    Yeah, I guess instead of rolling the dice on herd immunity by subsidizing everyone. they could just offer monetary incentives for their customers.
- gizmo686 9y ago
  Why would it benifit an insurance company? In effect, they would simply be subsidizing people who are not their customers (either because they are uninsured, or insured by a different company). Therefore, the insurance company would not see any reduction in payout. Further, in effect insurane companies do pay their customers to get the flue shot, because they pay full price for the shot, but some distributors (like CVS) offer a discount on unrelated purchases for getting the shot. I think the solution here is government provided shots. Even without going to full government healthcare, vaccinations seems to fall well withing the CDC's perview. And, due to the herd immunity factor, there is a general societal interest in people getting vacinated (beyond the costs on society of a person getting sick).
  - jakobegger 9y ago
    I think the logic goes like this: 1) Insurance company has customers that don't get vaccinated 2) Insurance company pays for vaccinations of uninsured people 3) Uninsured people don't get sick 4) Uninsured people don't infect their unvaccinated customers 5) Insurance company has lower payouts because their customers don't get sick as much From a financial point of view, this probably only makes sense if the cost of the vaccine is significantly lower than the cost of care of someone who catches the flu.
deepsun 9y ago
Article doesn't mention that flu shots are always against previous year virus, not current. Developing a vaccine is a time consuming process (even one year is already a huge achievement). So I'm still not convinced about flu shots. Other vaccines, like measles, are clear win, of course.
- doitLP 9y ago
  Huge point. I agree. The flu virus has mutated over loads of generations before it arrives again (it circles the globe with the seasons). The vaccine is a total crap shoot.
  - geomark 9y ago
    More like a coin flip since it's about 50% effective.
- AlexandrB 9y ago
  As another comment pointed out the effectiveness hovers around 50% - which is better than ~0% from doing nothing. And there's no cost if you live in glorious socialist Canada. America's crazy healthcare system alters this calculus of course.
- onychomys 9y ago
  That's not true, and it's not true in a totally fascinating way. The flu shot is aimed towards a projected virus, based in part on last year's viruses, but also on a host of other things. The nitty-gritty on it can be highly technical (and highly interesting, if you're into that sort of thing!), but here's a nice overview that should give the lay-person a broad idea of how it's done: https://www.cdc.gov/flu/professionals/laboratory/genetic-characterization.htm https://www.cdc.gov/flu/professionals/laboratory/genetic-cha...
ryanpcmcquen 9y ago
Great article. They did themselves a bit of a disservice referencing the Flu shot though. It is the most ineffective vaccine used in America. This would be more convincing to those against vaccination if they had just left it out of the discussion.
sunstone 9y ago
This all makes sense except perhaps for the flu. Only about 30% of people that come down with "flu like symptoms" actually have the flu. On the other hand the effective of flu vaccines can vary widely from year to year. This is because it takes months to make all the doses that are needed so the vaccine make up, which changes every year, has to be estimated in the advance. The actual prevalent flu though can change significantly by the time flu season starts. The upshot is that the public doesn't necessarily perceive the benefit of the shot because a) they might get what they think is the flu (but isn't) and b) they might get a variant of flu that was not adequately covered by the vaccine. Obviously a more universal flu vaccine would help out a lot.
vanderZwan 9y ago
This was all over the news when it was discovered, but for those who missed it: measles vaccination protects against other illnesses too, because the measles causes your immune system to "forget" previously learned immune responses to other pathogens[0]. I wonder if this applies more broadly: if you're already immune to one disease, it would be reasonable to expect that your body has more energy left to fight any unknown diseases it comes across. [0] https://www.newscientist.com/article/dn27481-measles-leaves-you-vulnerable-to-a-host-of-deadly-diseases/ https://www.newscientist.com/article/dn27481-measles-leaves-...
ashwinpp 9y ago
I have a counterpoint for discussion against taking the flu vaccine based on the facts we know, and a two independent assumptions I make. We know that influenza is different from other viruses because 1) There are many strains of influenza, it has a high mutation rate 2) Flu vaccines are based on a forecast of likely strains and typically cover only at most 50% of the strains in a given year [1] Now let us make the following assumption - Actual flu infection boosts immunity after recovery from the infection compared to vaccination (perhaps an analogy would be how muscle recovery happens after microtears after a strength training workout with heavier weights). In which case, one might conclude - Since a stronger immune response is great against a fast mutating virus and around 50% of strains are not covered by vaccines anyways, that the benefit of boosting immune response against future infections (beyond the current year) outweighs cost of getting infected and is a better choice than getting immunized against 50% of the strains with increased chances of getting flu due to the other 50% anyways Assumption 2 - Getting exposed, but not infected by flu, increases the number of strains one's body is immune to. Something sort of like vaccination, but without taking the vaccines themselves. For the purpose of modelling, let us also make the assumptions that all strains arise and propagate independently. That is the strains not covered by vaccination expose the same number of people unaffected by herd immunity, while the strains covered by the vaccination face herd immunity. Now consider the strains covered by the vaccine, whose spread is reduced due to herd immunity. It is great for everyone vaccinated against the strains, but for people not vaccinated against it, it prevents exposure from and hence immunity. This might be a case where the utility of vaccination decreases for non-vaccinated individuals instead of increasing (herd immunity) as a function of the fraction of vaccinated population. In other words, the more people vaccinated for flu, the less likely an non-vaccinated person is to get exposed, the less likely is he/she to develop immunity towards those strains naturally. Thus this would prevent population level immunity from arising, where it would have arisen naturally. Note that in this scenario, one might question that in the natural course of events, a certain percentage of population will develop immunity anyways and hence become equivalent to the scenario where some part of the population is vaccinated. However there are three major differences. First is that there is a certain delay between getting infected, spreading to others and gaining immunity. Thus for the same percentage of immune population, there might be larger population exposed in the natural course of events. Second is that many individuals might get infected, transmit and immunized to a strain without getting infected, thus such an individual gets all the benefits of vaccination, but might help others get exposed and immunized to a strain. And third that vaccination is more aligned with socio-economic factors while infection less so. To conclude, if any of the two assumptions I state are true, then we should perhaps not blindly apply the same logic that applies to other viruses for which we have vaccinations. [1] https://news.ycombinator.com/item?id=15562258 https://news.ycombinator.com/item?id=15562258
mitchtbaum 9y ago
If humans are so afraid of strangers with needles, then why not turn our efforts to environmental tools for microbe management?
awful 9y ago
The 1918 flu pandemic killed what, 5% of the world population? The next predicted pandemic is to be much worse IIRC. Chief Justice Roberts called the simple efficiency gap math "gobbledygook"; is he, or is he not, willing to say the same about this math? what if push comes to shove and has to force America the free individual to be inoculated, saving the herd? This simple thought experiment highlights we are all connected, there is only the illusion of individual liberty because the herd would never intentionally let you kill it off.
aaron695 9y ago
> They’re about achieving a collective resistance to disease that goes beyond individual well-being We don't get the flue vaccine for herd immunity and never have. I've never heard this argument from health departments or doctors. This article seems to be confusing issues. If the flue vaccine does help others they need to start publicizing that if it's true. If they are trying for heard immunity they also need to publicize that. I don't watch ads but if people can link to any that claim this I'd be interested. If it was true then the vaccine sellers would be shouting it from the roof tops I would think.

113 points by nature24 9y ago

The math makes it clear why giving everyone absolute freedom to choose whether to immunize or not doesn't work very well. If everyone else is immunized to the point where there is significant herd immunity, but immunization has a low but non-zero cost (e.g. feeling crappy for a few days), then the rational selfish action is to be a free rider and not immunize. However, if everyone did that, then herd immunity can collapse down to a level where there is no herd immunity; people rationally choose to immunize only to protect themselves. However, given that immunizations aren't perfect shields, in that scenario, even immunized individuals will be at risk to infections spreading through the population.

lr4444lr 9y ago
Worth noting in the article (quoted out of order for emphasis): "Determining the R0 of a particular microbe is a matter of more than academic interest. If you know how many secondary cases to expect from each infected person, you can figure out the level of herd immunity needed in the population to keep the microbe from spreading. This is calculated by taking the reciprocal of R0 and subtracting it from 1. For measles, with an R0 of 12 to 18, you need somewhere between 92 percent (1 – 1/12) and 95 percent (1 – 1/18) of the population to have effective immunity to keep the virus from spreading. For flu, it’s much lower — only around 50 percent. And yet we rarely attain even that level of immunity with vaccination. ... The calculated R0 of the West African Ebola outbreak was found to be around 2 in a 2014 publication, similar to the R0 computed for the 1918 influenza pandemic based on historical data. " All of you ladies and gents who blow off your annual flu vaccine because "you just don't seem to ever catch it" - you're just lucky. It's only a matter of time with modern travel and climate change until another virulent strain hits.
- luke0016 9y ago
  > All of you ladies and gents who blow off your annual flu vaccine because "you just don't seem to ever catch it" - you're just lucky. It's only a matter of time with modern travel and climate change until another virulent strain hits. Even if you do get the vaccine, there's no guarantee that it will actually include your new virulent strain. The flu vaccine is more involved (and uncertain) than others because influenza has a high mutation rate. It's a bit of a guessing game each year as to which strains should be included, and new ones crop up all the time.
  - exhilaration 9y ago
    Even if you do get the vaccine, there's no guarantee that it will actually include your new virulent strain. True, for reference look at this table from the CDC: https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm https://www.cdc.gov/flu/professionals/vaccination/effectiven... 2011-12: 47% vaccine effectiveness 2012-13: 49% vaccine effectiveness 2013-14: 52% vaccine effectiveness 2014-15: 19% vaccine effectiveness 2015-16: 48% vaccine effectiveness 2016-17: 42% vaccine effectiveness But I still get my flu shot every year, better to be 40-50% protected than 0%.
    - lr4444lr 9y ago
      Are you sure the R0 of the original article isn't determined accounting for the fact of vaccine ineffectiveness?
      - exhilaration 9y ago
        I don't know, corrections are welcome!
      - btilly 9y ago
        The R0 of the original article is determined on the assumption that nobody is immunized at all. Vaccine ineffectiveness is the odds that when you are potentially infected by a wild flu, the virus that you encounter was one that you were vaccinated against. Vaccines are more effective when they correctly predict what varieties of flu will be circulating. But the more effective the immunization program, the more the ones that they predicted become and the less effective the vaccine becomes. However we all benefit because less flu is in the environment.
- learc83 9y ago
  >All of you ladies and gents who blow off your annual flu vaccine because "you just don't seem to ever catch it" - you're just lucky That's not true. There is a significant portion of the population who are resistant to the flu. I'm 34 and I've never had the flu. None of my 3 siblings, nor my mom (who's 55) have either. This is despite never getting a flu shot, and spending several years riding public transit. It's well documented that many people just don't become symptomatic or even contagious. A study in 2011 infected 17 people with live active flu virus, and only half developed any symptoms at all. Furthermore, it's likely that people with this immune response never develop the viral load necessary to easily spread the virus.
  - AlexandrB 9y ago
    > A study in 2011 infected 17 people with live active flu virus, and only half developed any symptoms at all. That's fascinating. Do you have a link to the study?
    - learc83 9y ago
      I can't find a link to it with a quick google search, but I remember it was done at the University of Michigan if you want to search further.
  - ashark 9y ago
    From about ages 12-21 or 22 I caught nothing. I consistently had a ~36hr period of very slight sniffles about once a year, and nothing else at all. Never bothered with flu shot, took no precautions, ate absolute garbage. Then I started having 2-3 serious illnesses—very bad colds, the flu, sinus infections (I'd never had either of those last two)—every single year, and my nose is a little bit stuffy 100% of the time. 360 days a year, before, I couldn't blow my nose at all even if I wanted to—nothing would come out—but now I can a couple times a day, every day, when not actually sick. Aging sucks and/or HGH is a hell of a drug.
    - learc83 9y ago
      Sounds like you have allergy problems, or maybe a deviated septum, or something else causing sinus infections. That's definitely not just a result of being over the ripe old age of 22.
- sushisource 9y ago
  All in support of parent comment, though. I don't get the flu shot because I've had it once in about 10 years, and I hate getting shots. Sure, call me selfish, but it's just not worth it for me. Now, if I have to go get it, or pay a $200 fine or something - yeah, I'll suck it up and go do it.
  - naasking 9y ago
    > Now, if I have to go get it, or pay a $200 fine or something - yeah, I'll suck it up and go do it. In an ideal world, all those who opt out should have to pay the medical expenses of those who get sick. Not vaccinating is the same sort of negative externality as environmental pollution. Rather than making it a fine, a high opt-out fee could cover it without the stigma of "breaking the law".
    - riot504 9y ago
      I don't get the shot and never will. Under your logic all those who eat fast food for lunch everyday and don't exercise should have to pay extra for medical insurance for not taking care of themselves.
      - CDRdude 9y ago
        I think they should pay more. However, it is harder to track than a yearly checkbox for if they had a flu shot.
      - osteele 9y ago
        What is the analogy between being too young or immunocompromised to receive the vaccine, and having poor diet and exercise habits?
      - kbenson 9y ago
        Some locations do charge a "health tax"[1] on certain food types and/or quantities of food. There are many ways to incentive/disincentivize behavior. 1: https://en.m.wikipedia.org/wiki/Fat_tax https://en.m.wikipedia.org/wiki/Fat_tax
- revelation 9y ago
  "Flu shots" are an unique American silliness and seem to do more damage than good for the vaccinations we actually want people to have.
  - geomark 9y ago
    That's a strange notion. I live in Southeast Asia and flu shots are routine here, even offered by schools to students.
    - tom_mellior 9y ago
      I've also had employers in different EU countries offer flu shots.
ouid 9y ago
We are sexual reproducers, and as such, we require other people to further our biological goals. This means that the health of our herd has a direct effect on our own adaptiveness. Don't speculate about biological motives with the "rationality" defined by economics. They are different terms.
orf 9y ago
That's why a lot of things, like liberterianism (optional taxes) and communism don't work in practice.. Edit: I mean everyone thinking "well someone else will do it, I dont have to", specifically regarding to paying taxes or contributing to society.
- astrodust 9y ago
  It's because a portion of humans are just dicks and ruin it for everyone else, so we need systems that clamp down on dickish behaviour so it doesn't wreck everything.
  - rlanday 9y ago
    Everyone is a “dick” given the right set of incentives.
  - civilian 9y ago
    The _really difficult_ trick is building systems that won't get corrupted by the dickheads.
    - astrodust 9y ago
      Precisely why making social network sites like Facebook and Reddit is really hard.
      - civilian 9y ago
        I mean, I agree that this rule applies to everything. But I'm more worried about the organizations that have a monopoly on force, not on social networks.
- wonderwonder 9y ago
  In this case would communism not actually be a positive? If the communist government decided everyone has to get vaccinated it seems the problem would be solved. Not an advocate of communism as a whole but it is an interesting mention that it would if applied by an aggressive state actor go a long way towards eliminating certain diseases assuming it has the financial resources.
samlevine 9y ago
We can apply Kant's categorical imperative to lots of stuff. Some people don't want to have children. If everyone chose to not have children the human race would face extinction. This does not imply that we must (or more importantly, can from a moral perspective) force people who do not want children to have them anymore that it implies that forcing people who do not want flu shots is the right thing to do.
- danharaj 9y ago
  In one case we are talking about the wellbeing of other actual human beings, in the second, the abstract concept of the human race. Seems like a bait and switch to me.
hannob 9y ago
> If everyone else is immunized to the point where there is significant herd immunity, but immunization has a low but non-zero cost (e.g. feeling crappy for a few days), then the rational selfish action is to be a free rider and not immunize. Except that's not really how it is. There's still a very non-negligible risk to catch any of a number of vaccine-preventable diseases. People die from measles on a regular basis. You can in theory imagine a situation where this is different, but realistically Vaccines totally make sense even from a very egoistic perspective.
ThrustVectoring 9y ago
So subsidize it. I mean, that's what subsidies are for - to convince people to do things that are in the public interest.
- AlexandrB 9y ago
  In Canada flu shots are free. It's pretty great - I catch the flu easily and I've managed to avoid getting sick the last few seasons possibly thanks to getting the shot.
  - vanjoe 9y ago
    Pretty sure they are only free for at risk people/ health care workers. At least that is true in BC. http://immunizebc.ca/diseases-vaccinations/influenza http://immunizebc.ca/diseases-vaccinations/influenza Healthcare is a provincial responsibility in Canada
pasquinelli 9y ago
i don't know why you claim it's rational to be a free rider with one breath and in the next explain how it isn't rational. only considering immediate considerations and immediate consequences doesn't have to be what rationality is. only considering your own self and your own interests doesn't have to be what rationality is. rationality is a nebulous term and i see people far to often use the word to refer to stupid selfishness and short sightedness. if people tend to do something because it's easier for them but that will come the long way round and bite them, and a lot of other people, in the end then that's a demonstration of a failure of human to be rational.
- smallnamespace 9y ago
  You're absolutely right that the word 'rational' is so overloaded that it can be nearly meaningless -- that's why I qualified it with 'selfish'. We do need to draw distinctions between consequences that are immediately faced by the decisionmaker, vs. the long-term consequences to the group. Note that even if you do care about the long-term consequences to the group, it may still be narrowly rational to decide not to immunize. After all, your own individual decision is only going to have a tiny impact on whether herd immunity persists in your community, but will have a much greater impact on yourself. This is the same logic over why companies pollute, people litter, fishermen overfish -- there is a 'commons problem' where people collectively benefit from collaboration, but selfish individuals can benefit by defecting and free-riding. If one can't see how selfish behavior may appear rational, then it becomes very difficult to figure out how to structure norms and incentives to encourage group cooperation.
PostOnce 9y ago
"it doesn't work very well" for the purpose of ensuring the absolute optimal immunity, but it does work very well for ensuring the absolute optimal individual liberty. I vaccinate, always, and I am hopeful that other people will too, but I absolutely do not want to force people to do what everyone else thinks is best for them, because then, where does it stop? How far might we go in the pursuit of perfect immunity? Some contagions have no vaccine, will we require masks at all times? Will we criminalize handshakes? At some point, the benefit of immunity is outweighed by what you have to pay for it. I guess I sound like an antivaxxer here. I probably sound like a Nazi elsewhere. All I am though, is pro-liberty.
- lotsofpulp 9y ago
  Except we live in a world with others, and some of our actions affect others. It's a nice sound bite to say you're "pro-liberty" or freedom or whatever nonsense, but I'm sure you're not "pro-liberty" when it comes to performing obscene acts in public where your children can see them. Issues in life are not simple binary choices. We have to think about balancing individual goals, societal goals, national goals, and global goals. I'm of the opinion that we should err on the side of individual liberty, but when the evidence is so overwhelmingly positive to be pro vaccine, then obvoiously we might have to re-arrange our priorities.

suneilp 9y ago

So now, what am I supposed to think of all those claims that the flu vaccine is essentially a step or two behind nature. Then, for me, I worry about the adjuncts and other stuff added to the standard vaccines as I have autoimmune problems. There are alternative vaccines that are available but I don't remember their efficacy. So I refuse taking vaccines unless absolutely necessary until I see viable alternatives without aluminum, any kind of mercury, and so on.

apsec112 9y ago
These fears are based on bad science. The alleged "toxins" in vaccines are either present in microscopic quantities - micrograms or less - or were simply never there in the first place. It's like worrying about "sugar being bad for you" - which it is, in large enough amounts - because a single grain of table sugar got into your cereal. Details: https://sciencebasedmedicine.org/toxic-myths-about-vaccines/ https://sciencebasedmedicine.org/toxic-myths-about-vaccines/
- suneilp 9y ago
  That page was interesting. Yet, I keep seeing conflicting reports stating that the removal of thimerosal from vaccines to be exaggerated, etc.
jfoutz 9y ago
I can't imagine how difficult it would be to be that sensitive to aluminum. I handle so many aluminum objects every day, it seems impossible i wouldn't consume some tiny amount daily, accidentally. Not to mention baking powder and cheese.

favorited 9y ago

Anyone interested in these topics should look into the books "The Hot Zone" (about the first filovirus outbreaks, including Ebola) and "The Demon in the Freezer" (about several biological agents, most notably Smallpox, and their potential for use in warfare). "The Demon in the Freezer" goes into the story of the eradication of Smallpox in the natural world, and talks a lot about containment of viral breakouts as well as the role of vaccination.

mayneack 9y ago

I've always wondered why the flu shot wasn't 100% free even without insurance. It wouldn't surprise me if one insurance company (or a collective of companies) could lower their net payout by increasing the number of total vaccinated people. A one day clinic recently that I went to only charged $30 for uninsured people.

toss1 9y ago
It would not surprise me if the math actually worked out that it would be best to pay people $5 or something to get the shot. It's be especially good if the payout was perhaps $2 to get it but $5 if more than 50% of the pop in an area got the shot. Maybe manageable with an Etherium contract?
- mayneack 9y ago
  Yeah, I guess instead of rolling the dice on herd immunity by subsidizing everyone. they could just offer monetary incentives for their customers.
gizmo686 9y ago
Why would it benifit an insurance company? In effect, they would simply be subsidizing people who are not their customers (either because they are uninsured, or insured by a different company). Therefore, the insurance company would not see any reduction in payout. Further, in effect insurane companies do pay their customers to get the flue shot, because they pay full price for the shot, but some distributors (like CVS) offer a discount on unrelated purchases for getting the shot. I think the solution here is government provided shots. Even without going to full government healthcare, vaccinations seems to fall well withing the CDC's perview. And, due to the herd immunity factor, there is a general societal interest in people getting vacinated (beyond the costs on society of a person getting sick).
- jakobegger 9y ago
  I think the logic goes like this: 1) Insurance company has customers that don't get vaccinated 2) Insurance company pays for vaccinations of uninsured people 3) Uninsured people don't get sick 4) Uninsured people don't infect their unvaccinated customers 5) Insurance company has lower payouts because their customers don't get sick as much From a financial point of view, this probably only makes sense if the cost of the vaccine is significantly lower than the cost of care of someone who catches the flu.

deepsun 9y ago

Article doesn't mention that flu shots are always against previous year virus, not current. Developing a vaccine is a time consuming process (even one year is already a huge achievement). So I'm still not convinced about flu shots. Other vaccines, like measles, are clear win, of course.

doitLP 9y ago
Huge point. I agree. The flu virus has mutated over loads of generations before it arrives again (it circles the globe with the seasons). The vaccine is a total crap shoot.
- geomark 9y ago
  More like a coin flip since it's about 50% effective.
AlexandrB 9y ago
As another comment pointed out the effectiveness hovers around 50% - which is better than ~0% from doing nothing. And there's no cost if you live in glorious socialist Canada. America's crazy healthcare system alters this calculus of course.
onychomys 9y ago
That's not true, and it's not true in a totally fascinating way. The flu shot is aimed towards a projected virus, based in part on last year's viruses, but also on a host of other things. The nitty-gritty on it can be highly technical (and highly interesting, if you're into that sort of thing!), but here's a nice overview that should give the lay-person a broad idea of how it's done: https://www.cdc.gov/flu/professionals/laboratory/genetic-characterization.htm https://www.cdc.gov/flu/professionals/laboratory/genetic-cha...

ryanpcmcquen 9y ago

Great article. They did themselves a bit of a disservice referencing the Flu shot though. It is the most ineffective vaccine used in America. This would be more convincing to those against vaccination if they had just left it out of the discussion.

sunstone 9y ago

This all makes sense except perhaps for the flu. Only about 30% of people that come down with "flu like symptoms" actually have the flu. On the other hand the effective of flu vaccines can vary widely from year to year. This is because it takes months to make all the doses that are needed so the vaccine make up, which changes every year, has to be estimated in the advance. The actual prevalent flu though can change significantly by the time flu season starts. The upshot is that the public doesn't necessarily perceive the benefit of the shot because a) they might get what they think is the flu (but isn't) and b) they might get a variant of flu that was not adequately covered by the vaccine. Obviously a more universal flu vaccine would help out a lot.

vanderZwan 9y ago

This was all over the news when it was discovered, but for those who missed it: measles vaccination protects against other illnesses too, because the measles causes your immune system to "forget" previously learned immune responses to other pathogens[0]. I wonder if this applies more broadly: if you're already immune to one disease, it would be reasonable to expect that your body has more energy left to fight any unknown diseases it comes across. [0] https://www.newscientist.com/article/dn27481-measles-leaves-you-vulnerable-to-a-host-of-deadly-diseases/ https://www.newscientist.com/article/dn27481-measles-leaves-...

ashwinpp 9y ago

I have a counterpoint for discussion against taking the flu vaccine based on the facts we know, and a two independent assumptions I make. We know that influenza is different from other viruses because 1) There are many strains of influenza, it has a high mutation rate 2) Flu vaccines are based on a forecast of likely strains and typically cover only at most 50% of the strains in a given year [1] Now let us make the following assumption - Actual flu infection boosts immunity after recovery from the infection compared to vaccination (perhaps an analogy would be how muscle recovery happens after microtears after a strength training workout with heavier weights). In which case, one might conclude - Since a stronger immune response is great against a fast mutating virus and around 50% of strains are not covered by vaccines anyways, that the benefit of boosting immune response against future infections (beyond the current year) outweighs cost of getting infected and is a better choice than getting immunized against 50% of the strains with increased chances of getting flu due to the other 50% anyways Assumption 2 - Getting exposed, but not infected by flu, increases the number of strains one's body is immune to. Something sort of like vaccination, but without taking the vaccines themselves. For the purpose of modelling, let us also make the assumptions that all strains arise and propagate independently. That is the strains not covered by vaccination expose the same number of people unaffected by herd immunity, while the strains covered by the vaccination face herd immunity. Now consider the strains covered by the vaccine, whose spread is reduced due to herd immunity. It is great for everyone vaccinated against the strains, but for people not vaccinated against it, it prevents exposure from and hence immunity. This might be a case where the utility of vaccination decreases for non-vaccinated individuals instead of increasing (herd immunity) as a function of the fraction of vaccinated population. In other words, the more people vaccinated for flu, the less likely an non-vaccinated person is to get exposed, the less likely is he/she to develop immunity towards those strains naturally. Thus this would prevent population level immunity from arising, where it would have arisen naturally. Note that in this scenario, one might question that in the natural course of events, a certain percentage of population will develop immunity anyways and hence become equivalent to the scenario where some part of the population is vaccinated. However there are three major differences. First is that there is a certain delay between getting infected, spreading to others and gaining immunity. Thus for the same percentage of immune population, there might be larger population exposed in the natural course of events. Second is that many individuals might get infected, transmit and immunized to a strain without getting infected, thus such an individual gets all the benefits of vaccination, but might help others get exposed and immunized to a strain. And third that vaccination is more aligned with socio-economic factors while infection less so. To conclude, if any of the two assumptions I state are true, then we should perhaps not blindly apply the same logic that applies to other viruses for which we have vaccinations. [1] https://news.ycombinator.com/item?id=15562258 https://news.ycombinator.com/item?id=15562258

mitchtbaum 9y ago

If humans are so afraid of strangers with needles, then why not turn our efforts to environmental tools for microbe management?

awful 9y ago

The 1918 flu pandemic killed what, 5% of the world population? The next predicted pandemic is to be much worse IIRC. Chief Justice Roberts called the simple efficiency gap math "gobbledygook"; is he, or is he not, willing to say the same about this math? what if push comes to shove and has to force America the free individual to be inoculated, saving the herd? This simple thought experiment highlights we are all connected, there is only the illusion of individual liberty because the herd would never intentionally let you kill it off.

aaron695 9y ago

> They’re about achieving a collective resistance to disease that goes beyond individual well-being We don't get the flue vaccine for herd immunity and never have. I've never heard this argument from health departments or doctors. This article seems to be confusing issues. If the flue vaccine does help others they need to start publicizing that if it's true. If they are trying for heard immunity they also need to publicize that. I don't watch ads but if people can link to any that claim this I'd be interested. If it was true then the vaccine sellers would be shouting it from the roof tops I would think.