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Comment: Re:Higher immunization rates in South America than (Score 1) 545

by e_hu_man (#49747625) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:Military service can be mandatory, can cause ha (Score 1) 545

by e_hu_man (#49747265) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:Military service can be mandatory, can cause ha (Score 1) 545

by e_hu_man (#49739325) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:Higher immunization rates in South America than (Score 1) 545

by e_hu_man (#49739217) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:Religious Freedom (Score 1) 545

by e_hu_man (#49733765) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:Military service can be mandatory, can cause ha (Score 1) 545

by e_hu_man (#49733739) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:Military service can be mandatory, can cause ha (Score 1) 545

by e_hu_man (#49733717) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:Religious freedom vs public health (Score 1) 545

by e_hu_man (#49733663) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:finally, some responsibility (Score 1) 545

by e_hu_man (#49733595) Attached to: California Senate Approves School Vaccine Bill
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.

Comment: Re:Charged only if actually negligent (Score 1) 545

by e_hu_man (#49733575) Attached to: California Senate Approves School Vaccine Bill
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.

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