Rivkah I respect his intent and the frustration he experiences but the best of intentions sometimes cause more harms than goods.
Fulfilling his “contract” is best served by expanding his field of vision beyond his waiting room. In the last decade many thousands* (actually tens of thousands) have caught pertussis and measles and mumps outside of traditional providers’ waiting rooms as a consequence of outbreaks that could only occur because of a community failure to meet the herd immunity threshold. To the best of my knowledge not one has occurred from exposure in a traditional provider’s waiting room. The reasons for not meeting a community-wide herd immunity threshold includes the refusers, the delayers, to splitters, and those who intend to vaccinate on time not being up to speed for a variety of reasons many of which can be addressed.
For my curiosity though could you find out for me what he refuses to see? Those “who don’t vaccinate” means different things to different people. Does he mean the complete refusers only, or does he include the delayers and the splitters? Does he kick out those who refuse influenza? Those who refuse or delay HPV? (Last good data was that 25% of FPs don’t even discuss the HPV at the 11 to 12 year old visit.) The current recommendation for HepB is to give the first dose before newborn hospital discharge, just moved to within 24 hours of birth. Does he refuse to see those who fail to comply?
Jack I am really get effing fed up with you saying that I have said things that I have not said.
I am saying “2 No one else is at risk if I don’t vaccinate my kids”? Like hell. Not said not implied. Not true. I have been clearly saying that the exact opposite is true. Those who are not vaccinated and those who are inadequately vaccinated put all the rest of us at risk to the degree that more of us end up suffering for it than “them.” That’s why we healthcare providers have to work to keep community herd immunity levels high as frustrating as that effort may be.
Which is 4. Which is simply not a myth. The significance of that fact is often distorted by anti-vaxxers. Vaccines are highly effective and the attack rate for the vaccinated is a small fraction of the attack rate for those not. The reason for the fact that of the tens of thousands of people impacted by these diseases during outbreaks most have been vaccinated is the relative size of populations. The significance of the fact that most people who get sick during outbreaks are vaccinated is that the harm they do is not borne by their kids alone but impacts the rest of us too. The kids who die of pertussis in outbreaks are most often exposed by previously immunized family members, maybe caught up as adults maybe not, in an outbreak enabled by those who are refusers and those otherwise not up to date. The truth of facts does not depend on who says it and how they distort their significance.
I’ve said “27 Vaccinated kids are the cause of most outbreaks.”?? Absolute bullshit.
29? Yup. That’s fair charge. The facts on the ground demand we do our best to get everyone vaccinated for chickenpox but a concern that many pediatricians had before it came out was the lack of adult natural re-exposure to chickenpox and the booster effect such re-exposure has would increase the rate of shingles in adults who had had natural chickenpox at younger ages and, lo and behold, the rate of shingles in younger adults has increased since. Maybe it is just a coincidence and there are good arguments that it might be. And no question that those vaccinated will themselves be at lower risk of shingles as they get older. But yes I was one of those with that concern and am not yet convinced that the rise is just coincidental.
100% agreed that we need to fight against a resurgence of anti-vax sentiment aided by a sympathetic president. Airily dismissing the problem (which I believe is done by dismissing the kids) is not an acceptable option as tempting as it may be.
*Measles cases with a significant outbreak of 667 in 2014, otherwise fortunately significantly less. That year’s outbreak mostly within an largely unvaccinated Amish community. 188 cases in 2015 across multiple states linked primarily to a Disneyland exposure.
Pertussis, a majority of cases occurring in those vaccinated, with infants, who are at most risk, most commonly exposed by previously vaccinated household members who caught it in the community, running between 10,454 to 48,277 cases a year. Refusers driving it but also failure to fully get adults to keep up with their immunizations. “From 2000 through 2014, there were 277 deaths from whooping cough reported in the United States. Almost all of the deaths (241 of the 277) were babies younger than 3 months of age” again, most if not all catching it from previously vaccinated household members who caught it in the community and may not have even thought of themselves as sick. The risk to those babies was not a few minutes in a standard doctor’s waiting room; it was the community level of protection not being high enough.
Mumps 5,311 cases in the outbreaks of 2016 alone. Most of those impacted also those who have been vaccinated. High herd immunity level is critical.
Fortunately the improvements in the rate of childhood invasive pneumococcal disease (down to 2/100K) and of Hib diseases (decreased 99%) have been stable. Rotavirus has been stably impressive too.