A response to this article in which Tim Jack explains how his child with Leukemia was exposed to measles. He lashes out at parents who do not vaccinate their children.

Tim,

First of all, I would like to say that I am very sorry to hear of your child’s leukemia and recent visit to the hospital after being exposed to measles. At times like these it is really easy to lash out at others, trying to assign blame. If there is a car accident, people might blame car manufacturers, or the other driver, or God, anything. Attributing blame helps people make sense of the tragedy in life. But we should caution ourselves before trying to export our frustrations.

Myself, I too have a child with leukemia, T-ALL. He is not in the low risk category either. I write this from the hospital as he has been admitted with an unknown fever. You know the drill. We might be there for a week or more waiting for the fever to subside. Your child shuts down. He is unable to sleep, being awaken by nurses through each night. The food is terrible, and the schedule destroys your own life as well as the lives of your other children. It is not a pretty picture. I understand your frustration.

Do I blame the little girl who coughed on my youngest son, straight in his face? Do I blame the church Sunday school for allowing sick children to attend? Do I blame my other children for possibly bringing it home? Do I blame the parents of the sick children to whom my children were exposed? Before assigning blame, we should step back, clear our minds of prejudices, and take account of the situation.

So why should we be hesitant to assign blame? When we usually think of negligent actions, one factor has to be probabilities. Yeah, a car crash involving someone who was playing a Gameboy is probably negligent. The odds that his behavior would directly increase the immediate harms to other people are apparent. People generally cannot play Gameboy while giving attention to their environment. But what if he were, instead, swerving as not to hit a child. This crash might be his fault, but people could understand he was facing tradeoffs and made an executive decision. No one would “blame” him. In the latter scenario, who is going to assign blame to the driver? In short, the resulting consequences have to be probable and mitigating factors have to be considered.

Additionally, there should be some sort of direct link. Hitler blamed “the Jews” for all the ills of Germany. An entire group is being blamed, although that group is made up of a diverse group of people, living in varied situations, who may or may not have ties to the economy. Plus, there were other people in power who had even more control over the economy who were not Jewish. By what means can a reasonable person attribute a failing economy to “the Jews”?

When someone labels all non-vaccinating parents as evil, they are lumping in the South Dakota rural farmers with Miami metro socialites. The risk factors are vastly different for these two groups. In fact, the least vaccinated people group in the US is in the US Virgin Islands, where there has been no deadly outbreaks that I am aware. Vaccinated people carry disease as well. Certain children are too young to have had certain vaccinations. Animals carry disease. The blame for transmission becomes very hazy when we realize that there is no direct link.

Take the following scenario: A vaccinated man travels to a third world country. He is a photographer and wants to take pictures of a measles outbreak. He then flies back to the United States where an infant is exposed to him on a plane. The infant travels to Disneyland and infects an unvaccinated boy. That boy travels to Arizona and exposes a child who cannot get vaccinated. Who is to blame? Should it be the first person for engaging in risky activity? Maybe it is the parents of the baby for traveling when unvaccinated? Is it Disneyland for not screening for disease in a popular destination? Is it the unvaccinated kids’ parents for not vaccinating? But what if they were the 2% for which the vaccination would not have worked anyways, is it still their fault? Maybe it is the parents of the last child. After all, they took no precautions that could have avoided the infection. After all, they could have dressed their child in a full HAZMAT suit every day. Every time we leave our house, certainly we assume some sort of risk on our own volition. When bad things happen, sometimes there is no blame that can be given.

What this tells us is that not only does an action have to be negligent, without mitigating factors, but it also has to be attributable. Only then can we assign blame. Do you believe parents who do not vaccinate meet those requirements?

Let us take measles, because that is the most common scare tactic and your child with Leukemia was exposed to it. Let us assume 1500 cases of measles from 2004-2014. This is my estimation from the CDC chart, and I graciously include stats from the Amish outbreak (it is an outlier stat that does not represent normal American communities). The US population is 316 million. I will put these two numbers next to each other for scale.

316,000,000
– – – – 1,500

Running the rough numbers places the chance of getting measles (over a ten year period) at 1 in 210,066. This is rough math, but it gives us an idea of how rare measles actually is. A few things to note, the risk for vaccinated children would be less and the risk for unvaccinated children would be more. How much less and how much more? It is hard to know without more detailed statistics. Controlling for living conditions would prove even less risk on normal Americans, considering the outlier Amish data point skewing the results. In any case, a normal unvaccinated child has almost no chance of contracting measles.

The statistics I just quoted are all about just contracting measles, not even about death. No one dies of measles these days. Even if there were a few deaths in the coming years, the probability of death is almost nonexistent. Considering these statistics, and considering that the pro-vaccine crowd uses measles as their default example, maybe we should also cast a skeptical eye against the benefits of other vaccines which are preventing much less scary diseases. After all, if the pro-vaccine crowd is using Motte and Bailey logic, your Motte has to at least be a little defensible.

So pretend that in 2004 a parent had a baby. A doctor walks up to the parent with a vial of the measles vaccine.
Doctor: “If you do not inject this into your baby, then she will have a 1 in 210,000 chance of catching measles (with zero percent chance of death) between now and age ten.”
Parent: “Will my kid infect others?”
Doctor: “That 1 in 210,000 includes the infected others.”
Parent: “Well, what happens to that 1 in 210,000?”
Doctor: “Six to 20 percent of the people who get the disease will get an ear infection, diarrhea, or even pneumonia. One out of 1,000 people with measles will develop inflammation of the brain, and about one out of 1000 will die [although rates of death may be lower in the US]”.
Parent: “So, 210,000 times 1000 is 210,000,000. By not getting the vaccine my child has a 1 in 210,000,000 chance at inflammation of the brain or dying.”
Doctor: “Your math checks out.”
Parent: “What else is in the vial and how will that affect my baby?”
Doctor: “All sorts of stuff are in there and we do not have data controlling for life differentials between those who have and have not gotten this shot. I guess it would be useful if we had twin studies or anything, really.”
Parent: “My friend tells me that their own child changed behavior dramatically after the shot.”
Doctor: “Probably a liar.”

So what is a rational parent to do? Not give the child the vaccine: A 1 in 210,000 chance of getting something that definitely will not kill the kid. Or give the child the vaccine: with a slim possibly of resetting their child mentally or giving some other effect that might be hard to observe (such as a decrease in IQ). Rational people can disagree. In what other area of life would someone decry someone else for not taking action to prevent a 1 in 210,000 occurrence? Would that one individual taking that action skew those statistics even a little?

What should definitely not happen in the measles hypothetical is that the decision be referred to third parties who have less stake in the lives of the children then the children’s parents. This includes doctors and politicians, who both thrive on hubris and lack basic skills in cost-benefit analysis.

As Economist Bryan Caplan has shown, even dentists are highly irrational. Can dentists quantify the benefit between brushing once per day versus twice? Do dentists know how many average teeth are saved by flossing daily? Dentists show us pictures of the extreme examples to scare us. But in doing so they are not being realistic and revealing their very myopic agenda. In their private isolated world, there are no tradeoffs. Any expenditure of time, resources and comfort are worth a healthy mouth. But even expending all those resources does not lead the average person saving their teeth. As Bryan Caplan notes, people lose teeth regardless of hygiene. The question becomes: what is the optimal amount of resources to invest in teeth maintenance. Even knowing the statistics, rational people can come to opposing views.

If the pro-vaccination side is really worried about science, they should be attempting to encourage a transparent discussion about marginal harms. They should give meaningful numbers to help parents make informed decisions. Pointing to an outbreak of 100 cases in a nation of 316 million people is ignorant scare mongering. They should, instead, focus on answering some very basic risk assessment questions: What are the risks of an unvaccinated child dying due to a vaccine preventable disease? What are the risks of a vaccinated child dying due to a vaccine preventable disease? What are the relative numbers for being “seriously harmed”? ***Note that I am not asking for “what percent of children are unvaccinated who are seriously harmed by a preventable disease”. That would be a useless statistic for weighing the merits of vaccination.***

Maybe, being a pediatrician, you can tell us some very basic information. What is the probability of serious harm to an average child if the parents wait until that child is five to vaccinate? What about if the parents wait until the child is 10? 15? 20? Never vaccinate? Again, I am not asking “what percent of infected kids are unvaccinated”, that statistic is useless in deciding to vaccinate my own children. It tells me nothing about the relative risks that my own child faces. The question is: what will vaccination do for me now, today, with my child. Once that information becomes available, it could be added to the cost-benefit analysis. Note: just the mere presence of a perceived harm should not inform our activities. It is only when that is weighed against all other factors should action be taken.

Tim, both you and I won the reverse lottery of having our child contract leukemia. It is a rare event and it distorts our perspectives on the likelihood of rare events. But let us entertain a hypothetical. My child with leukemia was up-to-date on his vaccinations at time of diagnosis and not much is known about cancer’s causes. Pretend they found out vaccinations are the cause. How would that affect your perception of the parents you decry? Would they still be irresponsible or would you be the irresponsible one? Would that change your decision to vaccinate if you were to do it all again? On one hand, not many children get cancer, so the risk of vaccinations (in this hypothetical) is still low. On the other hand, not getting vaccinated might increase risks of being harmed by disease.

Life is full of tradeoffs. Different people have different value sets and weigh various risks differently. All the parents who choose not to vaccinate believe the risk of harms by vaccinations outweigh the risks of being hurt by not being vaccinated. Plenty of these parents chose to take a very cautious route of waiting until their children has developed more (a delayed schedule) before they inject them with unknown substances. To this day, I have not seen response as to why this is not a viable alternative.

Tim, please stop blaming others for non-attributable events. Your child was exposed by a different child. I am sure those parents were making a rational decision in their lives when they chose not to vaccinate. They did not ask to get the disease, and if they got it from a vaccinated individual they should have no recourse to blame their ills on the entire vaccinated population, much less the airline industry, Disneyland, or even third world counties. Sometimes things just happen. We need to deal with it like we deal with the leukemia, stay grateful for life and take it one day at a time.

Thank you,

Chris Fisher

PS: I need to make this very clear. I am not against vaccinating, even young babies. Both sides of the vaccine debate vastly overestimate relative harms. Your child will probably suffer no ills by being vaccinated. Your child will also probably suffer no ills by not being vaccinated. People like to irrationally fear monger.