A Man With a Gun – A Man With a Sneeze

Why should I read this:
The recent measles outbreak has been in the news a lot the last few weeks. Just about every single news outlet and blog in the country has written on the topic. My degree is specifically “human biology”, so I have strong opinions about how public health and disease should be treated. Whether I am preaching to the choir, or you are still certain that you should have personal choice in the matter,  read along and we will go over some of the talking points.


The Story:

Imagine a man with a gun. Not a soldier or an action hero, just imagine a normal man with a gun.
Imagine that man walking through a crowded public space. Imagine him walking casually, calm and unassuming.
Imagine him harboring no I’ll will against his fellow man.
Imagine that man casually drawing his gun as he walks, and firing. He fires with no particular target in mind, he doesn’t even seem to realize what he’s doing.

Imagine the bullets hit someone 90% of the time and imagine that the people in the crowd don’t immediately realize what’s happening.

Some who are hit are maimed. Some who are hit will die.

We as a society don’t allow this type of wantonly deadly behavior. We don’t deem it acceptable to endanger others in this way.

This next part is obvious. Infectious disease. Just how dangerous are “curable” infectious diseases? We have a tendency to believe, in this day and age, in the impotence of the diseases that killed our less medically literate ancestors.

Having never seen the ravages of endemic measles or polio, it is easy to forget that they are far more dangerous and cruel than simple firearms. One of the deadliest mass shootings in U.S. history occurred at Virginia Tech in 2007. Thirty two people were killed when a student with a gun went on a rampage. Epidemics and pandemics, however, are orders of magnitude deadlier. Remember that before the introduction of vaccines for diseases like measles and polio, these were pandemic diseases. They killed a few percent of the global population every year.

A man (or more often a child) walking through a crowded public place with an active measles infection can expose thousands of people. The virus takes root in about 90% of those who are not immune. Of them, given only basic care, about 10% will die. In a society like ours, with advanced medical care, around 1% will die. Most of the dead will be infants, children, and those with other health conditions.

Let’s think this out in real world terms so it is easier to understand.

Imagine a man with measles. Not a sick looking man, not a walking corpse, just imagine a normal man out with his family.

Imagine that man walking through a crowded public space. Imagine him walking casually, calm and unassuming. Imagine him harboring no ill will against his fellow man.

Imagine that man coughing as he walks, or sneezing into his hands. He does this with no particular target in mind, he doesn’t even seem to realize what he is doing.

Imagine tiny respiratory droplets hanging in the air, floating on the same breeze that rustles a nearby girl’s dress. The same air that cools a passing family. The same air gulped by a crying baby.

Every puff of exhaled air, every surface touched by our patient zero will be infectious. It will have a chance to infect anyone who breaths the air or touches the same surface.

None of his victims know the danger they are in. Some who are infected will be maimed. Some who are infected will die.

This isn’t even the most insidious property of a disease. The true horror is the geometric expansion of vectors. Not only does our patient zero infect and maim or even kill innocent people, but he also transforms them. Every breath of air they take, every surface they touch, become just as deadly as his.

Without protection, measles will infect 90-95% of a human population. This was once the case in the United States. It was expected that you would contract measles in your childhood. It was expected that some children would die. How many prayers were uttered, pleading to a silent god, that he might spare a parent’s dying child? How much suffering was endured by humankind for those countless generations? How must it feel to watch your child slip away, powerless to provide the relief they so desperately need?

These are questions that most of us cannot begin to fully answer, but I think that we can at least empathize with those people who can.

Through all that fear and misery, scientists dedicated their lives to better understanding disease. Scientists like Antonie Philips van Leeuwenhoek, who invented the microscope and ushered in the new study of microbiology. Scientists like Louis Pasteur, who helped to prove and spread understanding of the germ theory of disease. Scientists like Martinus Beijerinck, who described an infectious agent smaller than bacteria and named them virus. Scientists like Wendell Stanley, who took the first images of a virus using an electron microscope. Scientists like Jon Enders, Thomas Weller and Fredrick Robbins, who grew polio virus in cultured human embryo cells. Scientists like Jonas Salk, who developed the safe and effective polio vaccine. Scientists like these and countless others who’s names the public never knew. They were an army, dedicated to removing the veil of mystery that surrounds disease. They were men and women, they were fathers and mothers and sons and daughters. They were the ones who finally gave desperate parents the power to save their children.

They did this because disease affects us all. Rich and poor, black and white, theist and atheist. The polio vaccine could have made Jonas Salk one of the richest men in the world had he chosen to patent and sell it. Jonas Salk speaks to the humanity in us all when, after being asked about the patent on polio vaccine, he said, “There is no patent. Could you patent the sun?”

The vaccines for polio and for measles have eradicated the diseases from our population. Polio has been gone for more than 30 years, and indigenous measles was eliminated in the year 2000. The effectiveness of vaccination cannot be questioned by any rational person.

http://jid.oxfordjournals.org/content/189/Supplement_1/S1/F1.expansion.html
Reported US measles incidence, 1950–2001. *, First initiative was termed “eradication.”

Apathy toward those who choose not to vaccinate is common in my experience. I often hear people remark that if they want to be sick we should let them, or more morbidly they suggest that natural selection will remove their “anti-vaccination genes” from the pool. This type of indifference is unrealistic for several reasons, the most important being that vaccines are not 100% effective. You may have received the mumps, measles, and rubella vaccine as a child. You may think you are protected from mumps, measles, and rubella. You may be right. But, vaccines do not always induce antibody formation. A quick survey of my coworkers revealed two people who show no antibody titre for measles even after repeated vaccination. That means they are not immune at all. It also means that if they do become infected, they run the risk of not being able to effectively clear the disease. They could very easily die as a result of a measles infection.When we look at the objective numbers, we find that the success rate of the vaccine is around 95 to 98%.This is why it is important to vaccinate every single person.

Actively choosing not to vaccinate implies that the lives of the 2-5% who have tried and are unable to protect themselves are unimportant to you, and should be sacrificed in the name of your personal freedom. A price which I believe is unquestionably monstrous to ask others to pay for you.

This effort applies to all vaccines, including your annual influenza vaccination. Nowhere do I encounter more selfish behavior regarding health, than I do when talking to people about influenza vaccinations. People insist that they never get sick. People insist that the vaccines make them sick. People insist that the vaccines don’t work. In the end, most people finally admit that they are just too lazy to go get one.

Viri like influenza are unstable. They change rapidly, and we have to try to alter our vaccines to match whenever it changes. Thankfully, flu can’t mutate outside a host. This means that the more people who are vaccinated, the smaller the chance is for the virus to mutate again. It’s just like gambling, every person who has influenza is another chance for the virus to mutate — that’s the key. Fewer infected people, smaller chance for the virus to mutate. The moment the virus wins the mutation jackpot, all the flu shots people got no longer matter.

On a more human note, influenza kills people. The exact numbers are difficult to tease out, but at minimum several thousand Americans die each year. At its worst around 49,000 men, women, and children die in the United States each year from seasonal flu. There is a lot of confusion about these numbers in the public, so I highly recommend reading the linked CDC article above.

A big part of this problem is how lightly people treat diseases like “seasonal flu”. You the reader are almost certainly apathetic about the “seasonal flu”. Could a disease sound any less bothersome? You just read that it kills thousands of people a year in our country alone. The Ebola epidemic has killed somewhere between 15,000 and 25,000 people. Objectively less that Influenza routinely does, but you are lying if you weren’t even a little worried about Ebola in the United States. Would you get an Ebola vaccine if you could? Why don’t more people get flu vaccine? Why is there such a disconnect?You, like most humans, have a hard time conceptualizing the reality of that magnitude of loss. Empathizing with a single victim is easy, that’t why we get so interested in news about a single murder or a rape case. It is one person harming another. We can internalize that type of suffering and that kind of direct threat to the individual. Think about the news covering people dying in the Ukraine or Syria, and you gloss over. If we can get so upset over a single victim, an entire war ought to emotionally cripple us, but it doesn’t. We completely fail to empathize with the suffering of those people, just as we fail to empathize with the suffering of the people dying from seasonal flu.

In 2013, the CDC reported that “An early look at this season’s reports [regarding pediatric deaths from Flu] indicates that about 90 percent occurred in children who had not received a flu vaccination this season.” This is a great highlight that shows how much more common serious complications are in patients who do not vaccinate. This statistic does not rely on the effectiveness of the vaccine, it just illustrates that nine times out of ten a child who died from flu had not been vaccinated. Is that number a bit misleading? It could be. We need to remember that the vaccination rates are phenomenally low. Further investigation of that year’s vaccine shows that it was 60% effective against the circulating strains. Or, if you got the flu shot, you had a 60% likelihood of avoiding a hospitalization for that year’s influenza. This lends a bit more weight to the previous statistic regarding pediatric deaths, because we know that the vaccine did help to prevent complications. I suspect that with universal vaccination, the pediatric deaths in vaccinated and un-vaccinated children would have been much more closely matched to the effectiveness rating of the vaccine.

We know that influenza kills people, and that it is highly contagious. Why should healthy people still be vaccinated? The answer is: to protect those who are likely to encounter complications. You may be twenty years old and healthy, but what if you pass the virus along to someones aging parent? What if you pass it along to an infant too young to be vaccinated? What if you pass the flu, a respiratory virus, to someone with asthma or COPD or cystic fibrosis? You stand a very real chance of killing them. There is no difference between what you do each flu season, and the measles patient zero described above. You are consciously choosing to become a danger to the public.Educating the population about the science behind vaccines is paramount in eradicating preventable disease. As many people are well aware, due to the anti-vaccine movement in this country, we are experiencing a resurgence of formerly eradicated illnesses.

Measles, mumps, rubella, polio, whooping cough, and chicken pox are all on the rise, and all 100% preventable thanks to safe effective vaccines.

I know that it sounds very “anti-freedom” to suggest mandatory vaccinations, but I cannot fathom how this would not be passed into law if one were to put it to a vote. An unvaccinated person, adult or child, is a direct threat to the health and safety of every single other person in that society. There is no question about it, the damaging and costly effects of epidemics on civilizations is apparent, and the human suffering is not possible to quantify.

It is difficult to for me understand how anyone who consciously opts out of vaccinations, can honestly think of themselves as a decent and moral individual. Knowing the suffering that they are undoubtedly causing, but still insistent on a patently unreasonable, ruthless, and selfish course of action. I am continually astonished at just how many people there are who still look me directly in the eye and admit that they are too lazy to go out and get vaccinated. People who are admitting flat out that they simply do not care about the lives they may extinguish, because it would very slightly inconvenience them. It bothers me deeply to look back and see nothing sinister in them, to know that these are not psychopaths, these are completely normal people. Completely normal people.This is why we need to embrace mandatory vaccinations. Not because there are crazy people out there not vaccinating their kids, but because even the completely normal people cannot muster the empathy or responsibility to get their vaccinations.

I believe that we as a species can overcome that selfish nature. I believe that we can create a better world for everyone by growing our collective knowledge and understanding of the universe. I believe that we as humans have that capacity. It’s why I dedicate my time to scientific pursuits and trying to communicate as much science as I can to the people around me. In the hope that I can contribute even a small stitch in the ever expanding tapestry of how our universe works.

A final quote from Jonas Salk for you to consider. It is one that I walk over every day on my way to work, and every day it reminds me that we are responsible for creating the future we hope for. 

 

References:
http://www.cdc.gov/measles/cases-outbreaks.html
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115a1.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5933a1.htm
http://www.cdc.gov/flu/spotlights/children-flu-deaths.htm
http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html
http://jid.oxfordjournals.org/content/189/Supplement_1/S1.long

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