Infectious Diseases, Vaccinations, Responsibility, and Irresponsibility

A single person contracted an infectious disease in Switzerland sometime during the week before January 15th. Within 10 days, new cases of the disease had been identified in San DIego. Less than two weeks later, the disease was known to have spread to Honolulu. People exposed to the disease are known to have attended a performance of Cirque du Soleil and a major sporting event. This isn't a Tom Clancy novel or a Homeland Security exercise, and the illness in question isn't some obscure new infectious disease. It's measles.

If you're wondering how a disease for which there is a very safe and very effective vaccine managed to travel so far, so fast, it's very simple. Vaccines only work if they are actually administered. In Switzerland, there's no requirement that schoolchildren be vaccinated. In California, vaccination is "required" before children attend school, but parents are permitted to opt out of that "requirement" for religious or "personal" reasons.

The person who contracted measles in Switzerland is an unvaccinated 7-year old. That person spread the disease to two (also unvaccinated) siblings. Between them, they managed to infect two other (unvaccinated) students who attend school with them. When the parents took the first patient to the doctor, four other children who were waiting at the office were exposed to, and contracted, measles. When they returned to the same office, they exposed a total of sixty other people (although it's not yet clear how many of them may have actually contracted the disease).

One of the children who was initially exposed at the doctor's office flew to Honolulu during a period when he or she was contagious, potentially exposing up to 250 more people on the airplane and an unknown number of people who were at the gate area of the airport during the three hours that the family was waiting for their flight. Another of the children exposed at the doctor is a 10-month old. Apparently, the parents of both of these children are big believers in the benefits of early childhood development, because a day care center and a swim school have had to temporarily close their programs for children under one year old.

All of this brings us to the subject of responsibility.

This entire measles outbreak has a single cause: the decision that two parents made to not vaccinate their children. I do not know why they made that choice - it might have been because they're afraid that there's a link between measles and autism, it might be because they have religious objections, it might be for some reason comprehensible only to them - but that doesn't really matter. The key here is that these parents decided that they would not vaccinate their children. As a result of this decision, three of their children got sick. Unfortunately, the consequences of their bad decision did not stop there.

Some of the other parents involved also share some of the blame for the consequences that their children have suffered. Two of the children who attend school with the index case have become sick, and 17 others were quarantined at home because they were not vaccinated, missing three weeks of school in the process. I have a great deal of sympathy for those children, but none at all for their parents. They (almost certainly) made the same bad decision as the first set of parents, and any missed work or other inconvenience that they suffer is entirely earned. Unfortunately, the consequences of the bad decision didn't stop there, either.

Two of the children who contracted the disease were under one year old. Children don't normally get their first measles vaccination before their first birthday. They are sick. Both have been hospitalized for multiple nights. In addition to the worry that goes along with a sick baby, their parents are dealing with expense and inconvenience because somebody else didn't bother having their children vaccinated. And the bad decision consequences keep on rolling.

The infants who are sick both attended programs with other infants. Those infants weren't vaccinated, either. They're quarantined, and the programs they attend are temporarily closed. A lot of parents are now dealing with the worry that their children will get sick, and many of them are also dealing with the additional expense and inconvenience that comes with the need to make other child care arrangements or miss work. In the mean time, the programs involved are losing income. None of these parents or businesses has done anything wrong. They're simply suffering the consequences of someone else's selfish, stupid behavior.

This entire situation is a perfect example of why vaccination opt-out laws are so friggin' stupid. Parents who decline to vaccinate their children aren't just putting their own kids at risk, which is bad enough, but they're also putting other children at risk, which is inexcusable. What makes it worse is that many of the parents involved make that choice content in the knowledge that measles, mumps, polio, and the other diseases involved are rare, and there's very little risk that their precious darlings are going to actually get sick. Why? Because other parents have taken the (very, very slight) risks that come with vaccinating their children.

(Minor update: Janet pointed out to me that Tara and DrugMonkey blogged this case earlier - which I somehow managed to miss. DrugMonkey's post is particularly worth reading - it's a much more eloquent rant than I managed. The comment sections for both are also worth a hit.)

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why vaccination opt-out laws are so friggin' stupid.

OK ... but what's the right approach? It's easy to fulminate against shortsighted and selfish parents (which they are), but's what's the answer? Keeping the kids out of school won't work; they'll infect people at the mall. Fine the parents? Probably won't work either. Have the police forcibly take the kids to a vaccination clinic?

By Scott Belyea (not verified) on 21 Feb 2008 #permalink

Keeping kids out of school won't keep them from getting infected, or from infecting others, true. But I've got a hunch that the inconvenience that would come with having to homeschool would probably be enough to get a lot of the idiots to vaccinate.

How about this: if I fail to vaccinate my kid (other than for valid medical reasons), and he/she gets sick, and infects your kid who is vaccinated (or has a valid medical exemption), then you can sue my ass for any and all expenses and damages you incur as a result: examinations, medications, inconvenience, pain and distress, hospitalization, long-term disability.....

It's called "taking responsibility for your choices".

(No, I'm not entirely serious; but I'm getting tired of hearing about this idiocy).

if I fail to vaccinate my kid (other than for valid medical reasons), and he/she gets sick, and infects your kid who is vaccinated (or has a valid medical exemption), then you can sue my ass
Only... if my kid is vaccinated, they shouldn't pick up the disease at all.
But if your 7 year old who should have BEEN vaccinated infects MY 1 year old who wouldn't be yet, and MY 1 year old DIES because of your choice...

Only... if my kid is vaccinated, they shouldn't pick up the disease at all.

Vaccination is not immunity. It's resistance. Hopefully it would provide your child with enough resistance to not become infected, but there's no guarantee. That's why the anti-immunization crowd is such a danger.

What do you think about the cases of unvaccinated children being infected by a immunodeficient child who had been vaccinated with live polio? Who's responsible in this case? The penny pinching Bill Gates' foundation, who did not want to spend the extra money for a safer vaccine?

William Wallace:

Nice deflection attempt. Why were those kids not vaccinated? Was the immunodeficient child's condition know beforehand? What to you have against the Bill and Melinda Gates Foundation? Do you have a reference for this or are you making it up?

I've got a hunch that the inconvenience that would come with having to homeschool would probably be enough to get a lot of the idiots to vaccinate.

I think it would, but if and only if your local authority with jurisdiction over such things would set standards for homeschooling (as in, students of such an age have to have a demonstrated competency in these subjects at this level or better, not so much as in what to teach or how to teach it) and enforce them. Otherwise, what you're doing would be creating a cohort of essentially uneducated second-generation idiots who create a lot of social costs for everyone else once they hit adulthood and don't have any documentable skills. (Ignorance is a disease with consequenses too.)

I think a lot of parents, particularly of the "syncretin" type, would give up on homeschooling pretty fast (in favour of the minor inconvenience of vaccination) if they realised they actually had to be accountable to someone for it, and couldn't just teach Bible stories, woo, and how to colour inside the lines -- especially once the costs in terms of time, money, and effort became apparent.

By Interrobang (not verified) on 25 Feb 2008 #permalink