5 ms·

>"Even though the vaccine isn't that effective this year, as long as its at least somewhat effective in mitigating transmission, it's worth it" How can you tel

by nonbel 9y ago

>"Even though the vaccine isn't that effective this year, as long as its at least somewhat effective in mitigating transmission, it's worth it" How can you tell if something is "worth it" without considering any costs (side effects, price, time, etc)?

opportune 9y ago
I suppose if it's only 0.001% effective it would not be worth it, but that's really a pedantic nitpick because we know it's not that ineffective. The vaccine this year is about 32% effective against H3N2 in the US and 39% effective overall [0]. That's not amazing but it's definitely "worth it" for a few dollars and 5 minutes at a CVS. [0]https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm https://www.cdc.gov/flu/about/season/flu-season-2017-2018.ht...
- nonbel 9y ago
  Basically your argument is that the costs of getting the vaccine are so negligible they can be ignored? What about side effects? https://www.cdc.gov/flu/protect/vaccine/general.htm https://www.cdc.gov/flu/protect/vaccine/general.htm
  - opportune 9y ago
    Yes, they exist and aren't that common/severe. I mean at the end of the day it's a personal decision and if you're already unhealthy I understand why you wouldn't want to get the side effects. The problem is one of ignorance: people don't even know what herd immunity is and why it's important. In my opinion the side effects pale in comparison to the effects of getting the flu and are not a big "sacrifice" to make whatsoever - but you need to understand the importance of herd immunity to make a truly informed decision I'm not going to continue replying to this conversation because I can sense that it's going to become unproductive
    - nonbel 9y ago
      Ok, but besides my main point (regarding doing a cost benefit analysis), from your comments I doubt you understand herd immunity, and probably should not be attempting to teach others about it... If the virus is too infectious you need very high rates of immunization for it to work. https://en.wikipedia.org/wiki/Basic_reproduction_number https://en.wikipedia.org/wiki/Basic_reproduction_number Most of the time those R0 values assume "well mixed populations" (any one person is just as likely to contact any other person) amongst other things, so don't take them too seriously. However, the basic idea that you don't automatically get herd immunity is simple enough. Eg, just what I found quickly on the topic: >"Whether vaccination of healthcare personnel can lead to a herd effect reducing laboratory-confirmed influenza among patients is still inconclusive. Pooled data from a Cochrane review of 3 cluster randomized controlled trials showed no reduction of laboratory-confirmed influenza (OR 0.86, 95% CI 0.44–1.68; p = 0.66), lower respiratory tract infections, admission to hospital (OR 0.89, 95% CI 0.75–1.06), and deaths from pneumonia (OR 0.82, 95% CI 0.45–1.49) in patients when healthcare personnel were vaccinated [35]. However, given that mathematical models suggest a herd effect [36], more rigorous studies need to be conducted." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/
  - bigtex 9y ago
    Yep, all you have to do is review the government statistics on vaccine injuries to see the list of all the people who got GBS from the flu shot https://www.hrsa.gov/advisorycommittees/childhoodvaccines/Meetings/20171208/doj-presentation.pdf https://www.hrsa.gov/advisorycommittees/childhoodvaccines/Me...
    - nonbel 9y ago
      I wasn't really thinking about GBS, but that is one of the more severe possible (but rare) side effects. Most people (everyone?) feels under the weather for a few days after a flu shot.
- lutorm 9y ago
  All I had to do was take time out of my day to go to the pharmacy, copay with my insurance was $0. Which just makes sense from a financial point of view for the insurance companies, too.
  - nonbel 9y ago
    This gives an inaccurate assessment of the cost. Obviously you are paying for the shot by paying more for insurance (either directly or via taxes or via taxes spent on that rather than some other government service you could take advantage of). My point is that you can't say something "is worth it" without considering both costs AND benefits (I have recently seen friends get so ill they almost got fired because doctors ignored the side effects of prescriptions). Also, costs aren't zero just because they were prepaid or deferred.
    - smileysteve 9y ago
      > Obviously you are paying for the shot by paying more for insurance Wrong calculation. The insurance company is trying to SAVE expenditures of doctors and hospitalizations; therefore, customers getting the flu shot cost the insurer less. Even further for herd immunity (the pt), 1 insured getting the flu shot might reduce 4-8 others from getting the flu.
      - smileysteve 9y ago
        And in the case of workplace or family, are likely covered by the same insurer. There's probably some patient n with diminishing returns for the modern tech workplace, where, if they live alone, commute alone, visit no family, and have no onsites.
      - nonbel 9y ago
        >"The insurance company is trying to SAVE expenditures of doctors and hospitalization" Interesting point (not sure how far down a rabbit hole this can go...), so you are claiming that the introduction of flu shots has reduced insurance costs? Is it even possible to assess this or are there just too many confounds?
apendleton 9y ago
You should consider costs. This tradeoff is a large part of what the field of epidemiology studies. Turns out vaccines don't need to be that effective to be worthwhile, because of the way disease spreads. There's this concept of a "reproduction number" (r-naught) that predicts how many people a given infected person will pass the disease to, based on a combination of the virulence of a disease, how long infected people remain contagious, how much contact people have with each other, etc. The flu often has a value of around 2, meaning the average infected person will infect two others before they're over it. You can use this number to estimate how fast a disease will spread, how likely it is to be successfully contained, or in the case of seasonal diseases, how many people will get it before seasonal societal changes (school getting out, people spending more time outside, etc.) will effectively curtail transmission for the year. Looking at a vaccine on an individual basis, if it's only, say, 50% effective, that sounds pretty awful -- maybe almost not worth the bother. But on a society-wide basis, if every person were vaccinated, that would effectively knock the R0 value from 2 to 1, which is huge. Transmission is exponential: if you infect two people and they infect two people and they infect two people, etc., the total number of infected looks dramatically different than if everybody only infects one person. So in isolation it's only 50%, but societally, with high vaccination rates, there's a huge multiplicative effect that has the potential to dramatically reduce each person's risk of infection if vaccination rates are high enough. And that's still true even if it's even less effective than 50%, and has all sorts of economic and social consequences.
- nonbel 9y ago
  >"The flu often has a value of around 2, meaning the average infected person will infect two others before they're over it." The R0 value refers to the potential for infection (ie in a 100% susceptible population it would be what you wrote). >"But on a society-wide basis, if every person were vaccinated, that would effectively knock the R0 value from 2 to 1, which is huge. Transmission is exponential: if you infect two people and they infect two people and they infect two people, etc., the total number of infected looks dramatically different than if everybody only infects one person." I just wrote a little SIR model and did not see this behavior. Depending on the parameters either 100% of the susceptible population was eventually infected, the infection died out quickly, or, if turnover was high enough (eg birth/death/viral mutation leading to a constant stream of susceptibles), there was a cycle and about the same number of people got infected either way. Do you have a source for this behavior so I can see the details of the model?

by nonbel 9y ago

opportune 9y ago

I suppose if it's only 0.001% effective it would not be worth it, but that's really a pedantic nitpick because we know it's not that ineffective. The vaccine this year is about 32% effective against H3N2 in the US and 39% effective overall [0]. That's not amazing but it's definitely "worth it" for a few dollars and 5 minutes at a CVS. [0]https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm https://www.cdc.gov/flu/about/season/flu-season-2017-2018.ht...

nonbel 9y ago
Basically your argument is that the costs of getting the vaccine are so negligible they can be ignored? What about side effects? https://www.cdc.gov/flu/protect/vaccine/general.htm https://www.cdc.gov/flu/protect/vaccine/general.htm
- opportune 9y ago
  Yes, they exist and aren't that common/severe. I mean at the end of the day it's a personal decision and if you're already unhealthy I understand why you wouldn't want to get the side effects. The problem is one of ignorance: people don't even know what herd immunity is and why it's important. In my opinion the side effects pale in comparison to the effects of getting the flu and are not a big "sacrifice" to make whatsoever - but you need to understand the importance of herd immunity to make a truly informed decision I'm not going to continue replying to this conversation because I can sense that it's going to become unproductive
  - nonbel 9y ago
    Ok, but besides my main point (regarding doing a cost benefit analysis), from your comments I doubt you understand herd immunity, and probably should not be attempting to teach others about it... If the virus is too infectious you need very high rates of immunization for it to work. https://en.wikipedia.org/wiki/Basic_reproduction_number https://en.wikipedia.org/wiki/Basic_reproduction_number Most of the time those R0 values assume "well mixed populations" (any one person is just as likely to contact any other person) amongst other things, so don't take them too seriously. However, the basic idea that you don't automatically get herd immunity is simple enough. Eg, just what I found quickly on the topic: >"Whether vaccination of healthcare personnel can lead to a herd effect reducing laboratory-confirmed influenza among patients is still inconclusive. Pooled data from a Cochrane review of 3 cluster randomized controlled trials showed no reduction of laboratory-confirmed influenza (OR 0.86, 95% CI 0.44–1.68; p = 0.66), lower respiratory tract infections, admission to hospital (OR 0.89, 95% CI 0.75–1.06), and deaths from pneumonia (OR 0.82, 95% CI 0.45–1.49) in patients when healthcare personnel were vaccinated [35]. However, given that mathematical models suggest a herd effect [36], more rigorous studies need to be conducted." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/
- bigtex 9y ago
  Yep, all you have to do is review the government statistics on vaccine injuries to see the list of all the people who got GBS from the flu shot https://www.hrsa.gov/advisorycommittees/childhoodvaccines/Meetings/20171208/doj-presentation.pdf https://www.hrsa.gov/advisorycommittees/childhoodvaccines/Me...
  - nonbel 9y ago
    I wasn't really thinking about GBS, but that is one of the more severe possible (but rare) side effects. Most people (everyone?) feels under the weather for a few days after a flu shot.
lutorm 9y ago
All I had to do was take time out of my day to go to the pharmacy, copay with my insurance was $0. Which just makes sense from a financial point of view for the insurance companies, too.
- nonbel 9y ago
  This gives an inaccurate assessment of the cost. Obviously you are paying for the shot by paying more for insurance (either directly or via taxes or via taxes spent on that rather than some other government service you could take advantage of). My point is that you can't say something "is worth it" without considering both costs AND benefits (I have recently seen friends get so ill they almost got fired because doctors ignored the side effects of prescriptions). Also, costs aren't zero just because they were prepaid or deferred.
  - smileysteve 9y ago
    > Obviously you are paying for the shot by paying more for insurance Wrong calculation. The insurance company is trying to SAVE expenditures of doctors and hospitalizations; therefore, customers getting the flu shot cost the insurer less. Even further for herd immunity (the pt), 1 insured getting the flu shot might reduce 4-8 others from getting the flu.
    - smileysteve 9y ago
      And in the case of workplace or family, are likely covered by the same insurer. There's probably some patient n with diminishing returns for the modern tech workplace, where, if they live alone, commute alone, visit no family, and have no onsites.
    - nonbel 9y ago
      >"The insurance company is trying to SAVE expenditures of doctors and hospitalization" Interesting point (not sure how far down a rabbit hole this can go...), so you are claiming that the introduction of flu shots has reduced insurance costs? Is it even possible to assess this or are there just too many confounds?

apendleton 9y ago

You should consider costs. This tradeoff is a large part of what the field of epidemiology studies. Turns out vaccines don't need to be that effective to be worthwhile, because of the way disease spreads. There's this concept of a "reproduction number" (r-naught) that predicts how many people a given infected person will pass the disease to, based on a combination of the virulence of a disease, how long infected people remain contagious, how much contact people have with each other, etc. The flu often has a value of around 2, meaning the average infected person will infect two others before they're over it. You can use this number to estimate how fast a disease will spread, how likely it is to be successfully contained, or in the case of seasonal diseases, how many people will get it before seasonal societal changes (school getting out, people spending more time outside, etc.) will effectively curtail transmission for the year. Looking at a vaccine on an individual basis, if it's only, say, 50% effective, that sounds pretty awful -- maybe almost not worth the bother. But on a society-wide basis, if every person were vaccinated, that would effectively knock the R0 value from 2 to 1, which is huge. Transmission is exponential: if you infect two people and they infect two people and they infect two people, etc., the total number of infected looks dramatically different than if everybody only infects one person. So in isolation it's only 50%, but societally, with high vaccination rates, there's a huge multiplicative effect that has the potential to dramatically reduce each person's risk of infection if vaccination rates are high enough. And that's still true even if it's even less effective than 50%, and has all sorts of economic and social consequences.

nonbel 9y ago
>"The flu often has a value of around 2, meaning the average infected person will infect two others before they're over it." The R0 value refers to the potential for infection (ie in a 100% susceptible population it would be what you wrote). >"But on a society-wide basis, if every person were vaccinated, that would effectively knock the R0 value from 2 to 1, which is huge. Transmission is exponential: if you infect two people and they infect two people and they infect two people, etc., the total number of infected looks dramatically different than if everybody only infects one person." I just wrote a little SIR model and did not see this behavior. Depending on the parameters either 100% of the susceptible population was eventually infected, the infection died out quickly, or, if turnover was high enough (eg birth/death/viral mutation leading to a constant stream of susceptibles), there was a cycle and about the same number of people got infected either way. Do you have a source for this behavior so I can see the details of the model?