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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

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.

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.