Thursday, March 15, 2007

It's For the Children

I once worked with a young lady that had never had chickenpox — until the disease nearly killed her at age 26. Chickenpox has varying severity among the population, but it is generally worse the later in life it is contracted. Not long after this event, a vaccine was developed that protects against the disease. This vaccine could have saved my coworker from the severe illness and expensive treatment she endured.

But vaccines are expensive to develop. And the best way turn a profit from a vaccine is to make its use general among the population. And the best way to do that is to get states to require it for children attending public schools. This has been a tried and true marketing strategy for drug companies for a long time now.

But we used to only vaccinate children for serious diseases that killed or maimed people. How grateful we are for vaccines for polio, smallpox, mumps, measles, Pertussis, and even tetanus, etc. Prior to the introduction of vaccines, these diseases were responsible for a significant number of deaths and cases of permanent health problems.

But chickenpox isn’t like that. Prior to vaccination becoming general, there were fewer than 100 deaths per year from the disease, with about 4 million cases per year. That’s a death rate of less than 0.04%. Most of those deaths were among adults. And while a few people experienced some permanent scarring, it was relatively minor and largely did not impact quality of life. In other words, the disease is a relatively mild disease, especially for children.

The ideal use of the chickenpox vaccine is for adults that have not naturally contracted the disease. But, since the development of the vaccine, drug company lobbyists have been successful in getting 41 states to require the vaccine in schoolchildren. My oldest three children contracted the disease naturally. My youngest two have been vaccinated for it.

Why did we allow this vaccine to become required for children? I believe that this has little to do with the welfare of the children. Instead, it has more to do with the changes in marriage practices and in adult employment. With the explosion of single-parent homes and the expansion of mothers of young children working full time, most young children have all of their available parents working. They are left to hired caregivers while their parents earn money. When having a built-in caregiver was more common, chickenpox was an inconvenience. But today it means the loss of a couple of weeks of income.

The length of the vaccine’s effectiveness has always been a question. Such is always the case when a new vaccine is introduced, until sufficient time has passed for experience to show the answer. A recent study shows that the vaccine begins to lose effectiveness after a few years. Conveniently for drug makers, this means that children need a booster shot between the ages of four and six. Although they still don’t know how effective the vaccine remains as children pass into adulthood, it is probably a good idea for those that have not had the disease to get booster shots as adolescents and as adults. Perhaps booster shots will be needed throughout life.

Although it was quite predictable, an unintended side effect of requiring children to be vaccinated for chickenpox is that the older children that have contracted the disease (as vaccine effectiveness has waned) have much more serious symptoms. Many young adults just getting out on their own neglect their own vaccinations. I predict that as our vaccinated children become adults we will see an expansion of the disease among young adults and that symptoms will be far more serious, even life threatening for some. Don’t be surprised a few years from now when there are far more than 100 deaths per year from chickenpox. I’m no medical expert or epidemiologist, but this seems to be a common sense forecast.

We should keep all of this in mind as we debate any governmental infringement on personal liberties. We should keep it in mind as we debate requiring schoolgirls to be vaccinated for cervical cancer. And we should definitely keep this in mind anytime anyone waves around the oldie but goodie claim that a regulation is primarily for the benefit of the children. If we had truly been concerned about the welfare of the children, we would have refused to require them to be vaccinated for chickenpox.


Democracy Lover said...

It's hard to know whether the story of the chickenpox vaccine's loss of potency has any relation to the HPV vaccine. The stories of the polio or smallpox vaccines might be more pertinent.

I have to wonder, however, why it is you are speculating about this since immunology is rather far afield from your usual blog posts.

That One Guy said...

here's the thing... I'm all about making this discussion about the medical implications of a particular vaccine...

But that's not the story. At all. The real story is that there are MANY who are calling for a BAN on this vaccine, or are wanting it to not be a "we want all the children to have this vaccine as part of the usual vaccination process", because they are calling it a vaccination against a Sexually Transmitted Disease.

What the HELL??

This virus is the precursor to CERVICAL CANCER, people. get the vaccination (pending it's medical/immunology consequences, of course).

It's stunning to me that people fear that getting the vaccine is somehow admitting to the reality of your child's sexual promiscuity.

Gimme a break, people.

This isn't a "sex-ed" issue, it's a medical one.

Bob said...

Well, you've definitely made me take a second look at the issue....



y-intercept said...

I agree with ReachUpward that we are rolling out this vaccine all wrong. When you roll out a vaccine incorrectly all you get is a worse form of the disease.

The problem I see is that we are only giving the vaccine to girls, when it is the guys who are the carriers. Infected men are as much part of the problem as infected women. If we are to eradicate this disease, then we need policies that address both sides of the sexual equation. Just giving it to girls will create a large population in which the virus will quickly mutate. If the theory of evolution is correct, how the virus will mutate is unknown.

I suspect that there are some religious kooks who believe that Cervical Cancer is God's punishment for bad girls; However, I think we should give people the benefit of the doubt. Hinting that ReachUpward's motivation for writing this post is just religious bigotry is an unwarranted ad hominem attack.

(As for punishing naughty girls. If you know any, you can send them my way, and I will spank them.)

Reach Upward said...

I'm rather surprised that most comments here deal with the HPV vaccine. I merely intoned it as a side note. I did not even state my position on that issue.

I felt that I was intoning for great caution whenever we consider any action where government infrignes on personal liberties. I believe that the government-knows-best model has frequently been proven to cause more problems that it cures. I used the chickenpox vaccine example to illustrate the kinds of problems we cause when our deliberations are shoddy.

However, I do not believe that government should never infringe on individual liberties. There are obviously cases where this is warranted. I simply believe that given the propensity of government intervention to produce unwanted side effects, we should move forward with great caution whenever considering any governmental policy that will infringe on personal liberties.

And it doesn't hurt to follow the money trail in the deliberations either.

That One Guy said...

"Y" - let me be clear that I have not, and do not, attack Reach here, or in any other post... "I'm a lover, not a fighter"...

I was simply making the point that the HPV vaccine is being sold to us in the wrong way... The thought of also vaccinating the known carriers of the virus (males) is a great thought, and should be explored.

Vaccinations are a touchy subject with many people, particularly for the reasons outlined in the original post. As with all other vaccinations, their effects will be borne out a long time from now. I don't imagine the makers/supporters of the chickenpox vaccine foresaw the difficulties now arrising from its use. But they are there now.

A difficult issue, to be sure. Add to that the sexual implications of the HPV debate, and you have a beehive ready for the kick-fest.

That's all. Reach knows I'm not calling him out on this issue, and I never posted anything here that was meant to be an ad hominem attack. If that was conveyed, I do apologize.

y-intercept said...


The last paragraph included a link to an HPV article. In standard academic structured writing, the conclusion is often where people state their position. The last paragraph is also the natural place for discussion to begin.

So while it is odd that the discussion focused on HPV and not chickenpox, one can make the case that your post was about trying to equate the two HPV vaccine.

I hate to a admit it but DL was correct to wonder if equating the Chicken Pox vaccine to HPV vaccine was appropriate.

Blog writing is weird. What happens with me is that something peeks my interest. I start writing a post with a link to that resource. I then make some off hand comments.

A casual reader is likely to misunderstand the offhand comments as a judgment or conclusion. I really can't fault them when offhand comments get mixed up with the point of the post.

As for the statement about individual rights: This is something where I would disagree. The use of vaccinations, antibiotics and even quarantines are areas of public concern that go beyond the needs of the individual. In a quarantine, you deny fundamental rights to a innocent person who has a contagious disease. This is done to protect the rights of others.

Antibiotics and vaccines are given with the purpose of controlling infectious agents that use the human population as a host. Again, this is an area that demands public debate and public health policy.

Interestingly, I think it is an area with an important moral dimension. Often people take vaccines specifically to protect the health of the people around them. For example, Nurses in old folks homes get a flu shot to reduce the chance that they will become a vector ... not just for their personal health.

Anyone who takes antibiotics has a moral obligation to take the whole prescription to reduce their contribution to the mutation of the vector.

Although I am a free marketeer, I concede that infectious disease is an area that requires public health policies.

In conclusion: the first post was correct in questioning connections; the second really came off as an attack; the fourth post is obviously from some sort of perv.

Reach Upward said...

Kevin, I agree that there are both moral and public safety reasons for infringing on personal rights. Vaccines for many infectious diseases work best when a high percentage of the public receives the vaccine. I obviously buy into it, as all of my children have received every scheduled vaccine on schedule.

I have reread my original post, and I now understand how readers felt that I was equating the HPV vaccine with the chickenpox vaccine experience, although; that was not my intention.

I still maintiain, however, that as important as public health issues are, the chickenpox experience demonstrates that it is wise to approach these matters with a great degree of caution. Decisions should be made with calm and deliberate reasoning. It is important that we consider the most correct and proper usage of the proposed solution. We did not do that in the chickenpox debate. Legislators were warned up front, but the lobbyists won out.

y-intercept said...

I had to read your post twice to figure out the connection between what you wrote and the comments.

One of the things we are taught in modern education is to always look for a hidden motive in what people write. The problem with looking for hidden motives in everything is that such "critical thinking" gradual erode our ability to communicate.