Right, we can't stop ALL imports, just like we can't vaccinate EVERY local child. I'd suspect fairly simple measures, like requiring shots in a time-effective fashion as a condition of a visa, would stop at least 90% of that 80% though.
So, I ran the numbers. Here they are for the individual vaccines CDPH tracks: DTP 92.4%, Polio 93.1%, MMR 92.6%, HepB 94.9%, Varicella 95.5%. These are numbers for the incoming 2014 kindergarten class. That 90% number is kids that are up-to-date on all five.
The real elephant in the room is conditional enrollees. They make up 6.8%. Like PBE kids, it's not clear if they are vaccinated or not. There simply aren't records for these kids. If school districts would grow a set and not let these kids enter school, that would be far more effective than SB277 (bill in the OP article). The conflict is most conditional enrollees are in underprivileged areas where getting a kid to school is considered a victory. If we start throwing them out of school, equal access to education becomes an issue.
Your point about making vaccines more available and publicized I agree with completely.
Conditional enrollees has the same issue regarding geographic concentration. Because of this alone, I still find targeting PBEs a near complete waste of time. According to CDPH data, about 118 schools (out of 7464) have a PBE rate >=30%, representing 0.4% of incoming kindergartners. 388 schools have a conditional enrollment rate >=30%, representing 2.4% of incoming kindergartners (3x and 6x of PBE respectively). Getting all the PBE schools counts for something, but very little.
I certainly recognize that SB277 has benefits to public health. I just hope people realize that those benefits are really, really, really small and the hit to civil liberties and public education that we're taking to get those benefits is not.
There is a downside. "Stupid" parents will pull their kids from school. Do you really want "anti-science" parents home-schooling?
There's another downside. This particular bill puts the entire onus of enforcement on the school districts. That means they have three choices: accept unvaccinated kids conditionally, expel students or administer the shots. The first option naturally defeats the entire purpose of the bill. Either remaining option costs the school districts. They get federal money based on how many kids are actually in attendance and they don't currently have to administer the shots on any kind of scale this bill demands. That means that less education money is spent on education.
I'd love to hold society to the standard that no child should have to risk death due to parental stupidity. That's just not California. If you really want to uphold this ideal, you'll have to crusade for myriad causes, including gun control, obesity-fighting measures, tighter distribution of driver's licenses, promotion of breastfeeding, etc, etc. On the list of annual deaths in California caused by parental stupidity, lack of vaccination is near the bottom of the list.
Are you talking about CA SB277? It doesn't have any criminal component at all, even for schools and parents that willfully disobey it. It doesn't have any enforcement mechanism. In fact, they gutted the mandatory reporting of individual schools' vaccine rates from the bill because that would cost the state money and force it to go through an extra committee.
I'm saying I'm against this law because its public health impact is very small. As stated before, you'll increase the immunization rate optimistically from 90% to 93% and more realistically from 92% to 93%. For that small of an improvement, it becomes important to ask what the downsides are. Again, if we were going from 0% to 93%, then, by all means, pass the bill. But that's not the situation.
California's kids are already at 90% full immunization. When you already are more or less fireproof, why fireproof more?
If you want to come into the country, get your shots some safe amount of time ahead of traveling. Visas will not be granted unless. Simple. I'm sure there's a similar mechanism for returning citizens as well. I certainly wouldn't immunize at the time of entry, if that's what you're implying, as nice a straw man as that makes.
Again, over 80% of measles outbreaks in the U.S. in recent years originated from outside the United States. With this law, you get a slight increase in coverage (from 91% to 93%) of the other 20%, so optimistically, you're reducing outbreaks by 0.2%. Why bother when there's an huge, gigantic 80% chunk there for the taking?
To explain the 91%, about 3% of kids have a personal belief exemption (PBE). This law only targets them. It disappears the PBE. A PBE could mean a kid has no vaccines, it could mean they have all but one. So, I'm approximating that of the vaccines you'd want kids to have, PBE kids actually have about a third of them. The actual number is probably much higher and could be extracted from the cdph.ca.gov website. And, just for completeness, the other 7% of unvaccinated kids are not addressed by this law at all.
Ah, but there's a subtlety. MMR is given in two rounds. The first confers over 90% effectiveness and the second, well, there's not much room to grow, is there? Under the proposed law, deciding against that second shot because 90% already confers "good health" would exclude you from private and public education (yes, private too).
Many vaccines are given in multiple rounds. They have similar issues.
And, really, do kindergartners need to be vaccinated against STDs? Really? Hep B is in the proposed law. Religion isn't even the principal reason to decide against that one.
Being against this law is not about being against vaccines. You need to look at the incremental benefit of capturing the Personal Belief Exemptions (PBE). It's very small, 2.7% of kids. Contrast that with about 7% conditionally enrolled (that basically means, there's no paperwork, but they get to go to school anyway). In other words, immunization rates will go from 90% to 93% with this law.
The benefit is actually not even that great. You need a PBE even if you're only opting out of one vaccination. So it's more like going from 91.5% to 93%. For that incremental benefit, it's worth asking whether things like what's the rate of kids that will simply not go to school and is this worth our freedom. Obviously, if this law meant going from 0% to 93%, then it's a no-brainer; but that's not what this law is about.
There's a serious flaw here. Those 2.2B doses were not administered to 2.2B distinct individuals. I'd venture to guess it's more like 150M distinct individuals. So, we're looking at about 1 in 100,000 experience an adverse reaction.
While the death rate of measles is about 3 per 1000 (actually I think it's closer to 1, but I'll let it slide), what's the rate of contracting measles under the status quo in the U.S.? Let's take 2014 data as a worst-case, 668 cases. That's about 1 in 500,000. So, the chance of dying from measles in the status quo is about 1 in 150M. That's only for a single year, so multiply by 80 to cover a lifetime, 1 in 2M or so.
So, you're about 20x more likely to get an adverse reaction from a vaccine than die from measles. OK, maybe death is worse than "adverse reaction" on average. All I'm asking is what is the benefit of this specific law? It's not like not passing it means suddenly no one in California ever gets vaccinated.
This specific law does not allow any choice except vaccinate or home school. This law is not restricted to public schools.
So, that Disneyland "outbreak" where no one died...this law would have prevented 2 of the cases. When the benefit is so minimal, religious freedom is a valid concern. If the benefit were all of the cases preventable by vaccines ever, of course, it's a no-brainer. But when the status quo has resulted in 0 deaths in the last 10 years from measles, what exactly is the benefit of a stronger law? The rates of all the other diseases on this law's list have similarly low incidence in California.
Mostly it's through the ingredients. Vaccines use pig and cow parts, not to mention aborted fetuses. Many religions are against ingesting these. Some are not anti-vax at all, they just don't want the one that has pig parts.
If it's everyone else, as you say, why does this law completely ignore the conditionally enrolled? There are at least twice as many, if not three times, as there are using the Personal Belief Exemption.
The problem is this law isn't very effective. Personal belief exemptions (PBE) only comprise 2.7% of children. Another 7% are conditionally enrolled. That basically means they promise to turn in records eventually, but basically never do. That's the other problem with this law: there is no enforcement clause. In fact, to get it past the appropriations committee, they intentionally left it out so that the State itself would not be responsible for enforcement. This leaves the schools themselves to enforce with their already-stretched budgets.
In California, where the law in question was passed, shots are not free. The actual law is not a very effective way to immunize, as it doesn't capture the largest population of unvaccinated schoolkids, the conditionally enrolled. It also does nothing to address the transmission of disease from international travel, which is the source of most vaccine-preventable outbreaks in the United States.
First off, SB277, the law in question, affects private schools too. Only home schooling would allow one to not vaccinate their child.
Second, this specific law has many non-contagious diseases on it. Tetanus is one, diphtheria is another. To me, the most egregious over-reach is Hep B. Why on earth should someone need a vaccination against that for kindergarten? The complete irony is that California has a separate law that protects the rights of kids who actually have Hep B to be publicly schooled. So, an actual carrier is allowed in, but a non-carrier who isn't vaccinated isn't.
Have you looked at the conditional enrollment data for California schools? Infectious disease also doesn't pay attention to whether you signed a "Personal Belief Exemption" form, so why is there so much obsession over it? Twice as many kids are conditionally enrolled as are attending with a signed PBE form.
however, the broader point is most instances of a vaccine-preventable disease in the u.s. is due to international travel (sorry, don't have time to look up the links right now, but they're out there; over 80% for measles iirc). so maybe it's not south and central america. who cares? shouldn't we be more focused on citizens who travel abroad and incoming visitors?
I realize I'm going to be attacked for this (maybe not, it's already 5 days old). Add that anyone searching for my name will see I'm vegan too and think I'm double-crazy and I should just not make this comment, but here it goes anyway.
Vaccines are good. Yes. They have prevented a lot of disease and saved lots of lives. Yes. Yet no one can explain to me why we need this bill.
1) Most cases of diseases on the vaccination schedule appearing in the U.S. come from travel to foreign lands (there are sources, I'm too lazy, use Google), 80% or so for measles, if I'm not mistaken. Why is this law so important while foreign travel is completely ignored? Okay, fine, do both, whatever, but the actual impact of this bill is going to be pretty small (point 2 below feeds this as well).
2) What of our current vaccine practices is failing so badly that requires this law? Vaccine rates are currently pretty darn high in California. Should we really sacrifice an education for underprivileged children for this relatively minor threat? Deaths from measles is at exactly 0 for the last 10 years. I think the status quo is okay, at least as far as school-aged children are concerned.
3) Yes, underprivileged children are the ones who will suffer. Everyone bandies about the personal belief exemption and Jenny McCarthy (McCarthyism irony?), but if you look at the California state data, conditional enrollees are the biggest unvaccinated population, twice that of personal belief. Conditional enrollees are ones who haven't provided records, but swear they will (but usually don't). Where are these conditional enrollees concentrated? In underprivileged areas (see http://www.cdph.ca.gov/program... for data, though you'll need to know your california neighborhoods to make sense of the info), at least that's the case in Los Angeles County. Malibu isn't the problem; south, central and east L.A. are. And if you think this law will actually make those conditional enrollees get vaccinated to go to school, you don't know Angelenos, at least not the ones I know who are underprivileged.
Also, I'm surprised that such an open-source happy community isn't requesting that government-required vaccines be open-sourced. If the government is going to force something upon me, I'd at least like to know the profit motive is removed. Senator Pan's most relied-upon person during all the hearings has been a paid Merck lobbyist after all. If this is really about public health, make Mr. Rotavirus-vaccine charge less than $500 a pop or at least discover there's a good reason it's so expensive.
so, i don't mean to weigh in on the value of doing this. okay, i will, but i agree that it's a bad idea. however, to really get this right, isn't there a temperature component? i know it works in the space-based system's favor, though i've not run the calculation to see how much.
also, on your blog post, if you take away the tracker on the ground-based system, does it just scale down by 1/sqrt(2)?
i don't think this is true at all. scanning radio waves seems just as viable a means as any other to me. my point is that we need to wait for far more than a few decades of silence before the statement "seti is a failure" should even enter our thinking. there may be a civilization making identical radios to our's right now and maybe they have been for as long as we have. but if they're 1,000 light years away (not very far in interstellar terms), decades of silence is the expected result.
Going off on a tangent here, while I echo your sentiment that people should be free to support whatever distributed computing project they want, I'm not sure people realize that SETI has basically already failed. They've covered their entire spectrum numerous times, and have been listening for decades without finding anything. The entire project operates off the assumption that interstellar communication of another intelligent life form would occur over radio waves.
well, the seti@home project may be in disarray, but it's a bit early to say that seti (search for extra-terrestrial intelligence) in general has failed, isn't it? a few decades of silence from potential civilizations that may potentially be thousands, millions or even billions of light years away can hardly be construed as strong evidence.
then her philosophy really is too simple, as i suspect your understanding of the vegan community is.
There's no such thing as a 'philosophy of the vegan community' - there are millions of individuals each with their own ideas.
i'm not sure why "philosophy of the vegan community" is in quotes. i never put those words next to each other in that order.
i agree with you. there are lots of ideas. any that removes carrots from consumption on philosophical grounds is not representative of even a small portion of vegans.
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Right, we can't stop ALL imports, just like we can't vaccinate EVERY local child. I'd suspect fairly simple measures, like requiring shots in a time-effective fashion as a condition of a visa, would stop at least 90% of that 80% though.
So, I ran the numbers. Here they are for the individual vaccines CDPH tracks: DTP 92.4%, Polio 93.1%, MMR 92.6%, HepB 94.9%, Varicella 95.5%. These are numbers for the incoming 2014 kindergarten class. That 90% number is kids that are up-to-date on all five.
The real elephant in the room is conditional enrollees. They make up 6.8%. Like PBE kids, it's not clear if they are vaccinated or not. There simply aren't records for these kids. If school districts would grow a set and not let these kids enter school, that would be far more effective than SB277 (bill in the OP article). The conflict is most conditional enrollees are in underprivileged areas where getting a kid to school is considered a victory. If we start throwing them out of school, equal access to education becomes an issue.
Your point about making vaccines more available and publicized I agree with completely.
Conditional enrollees has the same issue regarding geographic concentration. Because of this alone, I still find targeting PBEs a near complete waste of time. According to CDPH data, about 118 schools (out of 7464) have a PBE rate >=30%, representing 0.4% of incoming kindergartners. 388 schools have a conditional enrollment rate >=30%, representing 2.4% of incoming kindergartners (3x and 6x of PBE respectively). Getting all the PBE schools counts for something, but very little.
I certainly recognize that SB277 has benefits to public health. I just hope people realize that those benefits are really, really, really small and the hit to civil liberties and public education that we're taking to get those benefits is not.
There is a downside. "Stupid" parents will pull their kids from school. Do you really want "anti-science" parents home-schooling?
There's another downside. This particular bill puts the entire onus of enforcement on the school districts. That means they have three choices: accept unvaccinated kids conditionally, expel students or administer the shots. The first option naturally defeats the entire purpose of the bill. Either remaining option costs the school districts. They get federal money based on how many kids are actually in attendance and they don't currently have to administer the shots on any kind of scale this bill demands. That means that less education money is spent on education.
I'd love to hold society to the standard that no child should have to risk death due to parental stupidity. That's just not California. If you really want to uphold this ideal, you'll have to crusade for myriad causes, including gun control, obesity-fighting measures, tighter distribution of driver's licenses, promotion of breastfeeding, etc, etc. On the list of annual deaths in California caused by parental stupidity, lack of vaccination is near the bottom of the list.
Are you talking about CA SB277? It doesn't have any criminal component at all, even for schools and parents that willfully disobey it. It doesn't have any enforcement mechanism. In fact, they gutted the mandatory reporting of individual schools' vaccine rates from the bill because that would cost the state money and force it to go through an extra committee.
I'm saying I'm against this law because its public health impact is very small. As stated before, you'll increase the immunization rate optimistically from 90% to 93% and more realistically from 92% to 93%. For that small of an improvement, it becomes important to ask what the downsides are. Again, if we were going from 0% to 93%, then, by all means, pass the bill. But that's not the situation.
California's kids are already at 90% full immunization. When you already are more or less fireproof, why fireproof more?
If you want to come into the country, get your shots some safe amount of time ahead of traveling. Visas will not be granted unless. Simple. I'm sure there's a similar mechanism for returning citizens as well. I certainly wouldn't immunize at the time of entry, if that's what you're implying, as nice a straw man as that makes.
Again, over 80% of measles outbreaks in the U.S. in recent years originated from outside the United States. With this law, you get a slight increase in coverage (from 91% to 93%) of the other 20%, so optimistically, you're reducing outbreaks by 0.2%. Why bother when there's an huge, gigantic 80% chunk there for the taking?
To explain the 91%, about 3% of kids have a personal belief exemption (PBE). This law only targets them. It disappears the PBE. A PBE could mean a kid has no vaccines, it could mean they have all but one. So, I'm approximating that of the vaccines you'd want kids to have, PBE kids actually have about a third of them. The actual number is probably much higher and could be extracted from the cdph.ca.gov website. And, just for completeness, the other 7% of unvaccinated kids are not addressed by this law at all.
Ah, but there's a subtlety. MMR is given in two rounds. The first confers over 90% effectiveness and the second, well, there's not much room to grow, is there? Under the proposed law, deciding against that second shot because 90% already confers "good health" would exclude you from private and public education (yes, private too).
Many vaccines are given in multiple rounds. They have similar issues.
And, really, do kindergartners need to be vaccinated against STDs? Really? Hep B is in the proposed law. Religion isn't even the principal reason to decide against that one.
Being against this law is not about being against vaccines. You need to look at the incremental benefit of capturing the Personal Belief Exemptions (PBE). It's very small, 2.7% of kids. Contrast that with about 7% conditionally enrolled (that basically means, there's no paperwork, but they get to go to school anyway). In other words, immunization rates will go from 90% to 93% with this law.
The benefit is actually not even that great. You need a PBE even if you're only opting out of one vaccination. So it's more like going from 91.5% to 93%. For that incremental benefit, it's worth asking whether things like what's the rate of kids that will simply not go to school and is this worth our freedom. Obviously, if this law meant going from 0% to 93%, then it's a no-brainer; but that's not what this law is about.
There's a serious flaw here. Those 2.2B doses were not administered to 2.2B distinct individuals. I'd venture to guess it's more like 150M distinct individuals. So, we're looking at about 1 in 100,000 experience an adverse reaction.
While the death rate of measles is about 3 per 1000 (actually I think it's closer to 1, but I'll let it slide), what's the rate of contracting measles under the status quo in the U.S.? Let's take 2014 data as a worst-case, 668 cases. That's about 1 in 500,000. So, the chance of dying from measles in the status quo is about 1 in 150M. That's only for a single year, so multiply by 80 to cover a lifetime, 1 in 2M or so.
So, you're about 20x more likely to get an adverse reaction from a vaccine than die from measles. OK, maybe death is worse than "adverse reaction" on average. All I'm asking is what is the benefit of this specific law? It's not like not passing it means suddenly no one in California ever gets vaccinated.
This specific law does not allow any choice except vaccinate or home school. This law is not restricted to public schools.
So, that Disneyland "outbreak" where no one died...this law would have prevented 2 of the cases. When the benefit is so minimal, religious freedom is a valid concern. If the benefit were all of the cases preventable by vaccines ever, of course, it's a no-brainer. But when the status quo has resulted in 0 deaths in the last 10 years from measles, what exactly is the benefit of a stronger law? The rates of all the other diseases on this law's list have similarly low incidence in California.
So why does this specific law target belief, but not the actual population of unvaccinated children, conditional enrollees?
Mostly it's through the ingredients. Vaccines use pig and cow parts, not to mention aborted fetuses. Many religions are against ingesting these. Some are not anti-vax at all, they just don't want the one that has pig parts.
Wrong. This specific law, SB277, does not restrict itself to public schools. It also affects private schools.
If it's everyone else, as you say, why does this law completely ignore the conditionally enrolled? There are at least twice as many, if not three times, as there are using the Personal Belief Exemption.
Private schools are not exempt from this law.
The problem is this law isn't very effective. Personal belief exemptions (PBE) only comprise 2.7% of children. Another 7% are conditionally enrolled. That basically means they promise to turn in records eventually, but basically never do. That's the other problem with this law: there is no enforcement clause. In fact, to get it past the appropriations committee, they intentionally left it out so that the State itself would not be responsible for enforcement. This leaves the schools themselves to enforce with their already-stretched budgets.
In California, where the law in question was passed, shots are not free. The actual law is not a very effective way to immunize, as it doesn't capture the largest population of unvaccinated schoolkids, the conditionally enrolled. It also does nothing to address the transmission of disease from international travel, which is the source of most vaccine-preventable outbreaks in the United States.
First off, SB277, the law in question, affects private schools too. Only home schooling would allow one to not vaccinate their child.
Second, this specific law has many non-contagious diseases on it. Tetanus is one, diphtheria is another. To me, the most egregious over-reach is Hep B. Why on earth should someone need a vaccination against that for kindergarten? The complete irony is that California has a separate law that protects the rights of kids who actually have Hep B to be publicly schooled. So, an actual carrier is allowed in, but a non-carrier who isn't vaccinated isn't.
This is not the law that OP is talking about. SB277 affects private schools too.
Have you looked at the conditional enrollment data for California schools? Infectious disease also doesn't pay attention to whether you signed a "Personal Belief Exemption" form, so why is there so much obsession over it? Twice as many kids are conditionally enrolled as are attending with a signed PBE form.
+1. We can't vaccinate people against stupidity, but we can keep their kids from suffering for it.
Or throw their kids out of school. Whichever.
however, the broader point is most instances of a vaccine-preventable disease in the u.s. is due to international travel (sorry, don't have time to look up the links right now, but they're out there; over 80% for measles iirc). so maybe it's not south and central america. who cares? shouldn't we be more focused on citizens who travel abroad and incoming visitors?
I realize I'm going to be attacked for this (maybe not, it's already 5 days old). Add that anyone searching for my name will see I'm vegan too and think I'm double-crazy and I should just not make this comment, but here it goes anyway.
Vaccines are good. Yes. They have prevented a lot of disease and saved lots of lives. Yes. Yet no one can explain to me why we need this bill.
1) Most cases of diseases on the vaccination schedule appearing in the U.S. come from travel to foreign lands (there are sources, I'm too lazy, use Google), 80% or so for measles, if I'm not mistaken. Why is this law so important while foreign travel is completely ignored? Okay, fine, do both, whatever, but the actual impact of this bill is going to be pretty small (point 2 below feeds this as well).
2) What of our current vaccine practices is failing so badly that requires this law? Vaccine rates are currently pretty darn high in California. Should we really sacrifice an education for underprivileged children for this relatively minor threat? Deaths from measles is at exactly 0 for the last 10 years. I think the status quo is okay, at least as far as school-aged children are concerned.
3) Yes, underprivileged children are the ones who will suffer. Everyone bandies about the personal belief exemption and Jenny McCarthy (McCarthyism irony?), but if you look at the California state data, conditional enrollees are the biggest unvaccinated population, twice that of personal belief. Conditional enrollees are ones who haven't provided records, but swear they will (but usually don't). Where are these conditional enrollees concentrated? In underprivileged areas (see http://www.cdph.ca.gov/program... for data, though you'll need to know your california neighborhoods to make sense of the info), at least that's the case in Los Angeles County. Malibu isn't the problem; south, central and east L.A. are. And if you think this law will actually make those conditional enrollees get vaccinated to go to school, you don't know Angelenos, at least not the ones I know who are underprivileged.
Also, I'm surprised that such an open-source happy community isn't requesting that government-required vaccines be open-sourced. If the government is going to force something upon me, I'd at least like to know the profit motive is removed. Senator Pan's most relied-upon person during all the hearings has been a paid Merck lobbyist after all. If this is really about public health, make Mr. Rotavirus-vaccine charge less than $500 a pop or at least discover there's a good reason it's so expensive.
so, i don't mean to weigh in on the value of doing this. okay, i will, but i agree that it's a bad idea. however, to really get this right, isn't there a temperature component? i know it works in the space-based system's favor, though i've not run the calculation to see how much.
also, on your blog post, if you take away the tracker on the ground-based system, does it just scale down by 1/sqrt(2)?
i don't think this is true at all. scanning radio waves seems just as viable a means as any other to me. my point is that we need to wait for far more than a few decades of silence before the statement "seti is a failure" should even enter our thinking. there may be a civilization making identical radios to our's right now and maybe they have been for as long as we have. but if they're 1,000 light years away (not very far in interstellar terms), decades of silence is the expected result.
Going off on a tangent here, while I echo your sentiment that people should be free to support whatever distributed computing project they want, I'm not sure people realize that SETI has basically already failed. They've covered their entire spectrum numerous times, and have been listening for decades without finding anything. The entire project operates off the assumption that interstellar communication of another intelligent life form would occur over radio waves.
well, the seti@home project may be in disarray, but it's a bit early to say that seti (search for extra-terrestrial intelligence) in general has failed, isn't it? a few decades of silence from potential civilizations that may potentially be thousands, millions or even billions of light years away can hardly be construed as strong evidence.
then her philosophy really is too simple, as i suspect your understanding of the vegan community is.
There's no such thing as a 'philosophy of the vegan community' - there are millions of individuals each with their own ideas.
i'm not sure why "philosophy of the vegan community" is in quotes. i never put those words next to each other in that order.
i agree with you. there are lots of ideas. any that removes carrots from consumption on philosophical grounds is not representative of even a small portion of vegans.