I’m vaccinated and my kid is vaccinated, but how likely is it that vaccines cause harm? I completely accept that they do lots of good, but is the case for common vaccinations (1) that the benefits greatly outweigh the costs or (2) that the benefits are high and the costs statistically trivial?
Moreover, which vaccines are worth getting? For example, is it worth getting a meningococcal vaccine if you’re not in any of the major risk groups?
Many universities strongly encourage their students to get the meningococcal vaccine (as sleeping in rubbish communal bedding is a risk factor), but for something really rare, even the risk involved in traveling to the clinic to get vaccinated could have more disutility than the protection the vaccine might provide would be worth.
Outside of major risk groups, this vaccine decreases your chances of getting meningococcal disease by some low amount, less than one in a million annually. If you get the disease, there’s a 10% chance of dying and a further 10% chance of being permanently disabled in some severe way. This is less than a tenth of a micromort.
The bacteria that causes meningoccoal disease is ubiquitous (10% of people are carriers), so other benefits of vaccines, such as herd immunity, would require extreme measures to obtain.
Driving causes about 1.5 fatalities per 100 million miles traveled, according to FARS, so this particular vaccine actively averts about as much risk as is involved in driving ten miles a year, which may or may not be worthwhile, but it certainly isn’t a low-hanging fruit in terms of risk aversion.
Anyway, let’s tally it all up:
Meningococcal vaccine utility:
0.00001% lower individual chance of getting meningococcal disease per year (minus 0.1 micromorts/year = at best a few minutes more of expected healthy lifespan, unless we solve the aging problem)
increased herd immunity (negligible due to the nature of this particular disease)
Meningococcal vaccine disutility:
mild discomfort
3 to 5% chance of fever
whatever risk is involved in traveling to the clinic (could be several minutes less of expected healthy lifespan)
whatever time it takes to get the vaccine (a few minutes to over an hour) could be spent doing something else
any undocumented risks that the vaccine itself might have (What are these?)
risk of physician error (What is this for a simple injection?)
Obviously, a lot of this will vary depending on the vaccine and the disease it’s meant to prevent. Some diseases pose higher risk, as do some vaccines. I didn’t get all of the standard vaccinations as a child because I was too severely allergic to some of them.
It might be helpful to do this sort of calculation for every available vaccine, but it’s a bit tedious. I haven’t found anywhere that lists the necessary information in anything resembling a convenient format.
Don’t you need to include the risks of a)being in an undiagnosed high-risk group, and b) developing a condition that puts you in a high-risk group?
Also, in terms of the driving risk, don’t you need to understand that in terms of substitution (I think that is the right term)? In other words, when calculating the driving risk, it becomes complex because time in the car going to the clinic may/very likely will be bundled with other driving (going to the clinic for other services, going to a store afterwards, etc.), so you can only include driving risk for this vaccine if it would not have been substituted for by other driving.
Depending on how the stats are compiled, the risk of being in an undiagnosed high-risk group is included in the risk for the general population.
If you later are in a situation where you will have greater risk, you can often get the vaccine when that situation arises, and probably won’t be any worse off for having waited. Vaccines become less effective as time goes on, so you might have to renew the vaccine when that situation arises anyway.
I am unsure how immune disorders factor into this.
For meningococcal disease, the most volatile risk factor is sleeping in rubbish communal bedding (or living in tropical Africa, or both). In this case, the risk goes from a tenth of a micromort per year up to maybe one micromort per year. Some situations where that might happen may be out of your control, sure. The only plausible non-society-crushing situation I can think of where that might be problematic (i.e. access to the vaccine would decrease) would be if you were to become homeless for lack of money. Feel free to adjust accordingly.
Not currently relevant, but an example of balancing risk and benefit and deciding to stop vaccinating against smallpox.
Wikipedia
There are side effects and risks associated with the smallpox vaccine. In the past, about 1 out of 1,000 people vaccinated for the first time experienced serious, but non-life-threatening, reactions, including toxic or allergic reaction at the site of the vaccination (erythema multiforme), spread of the vaccinia virus to other parts of the body, and to other individuals. Potentially life-threatening reactions occurred in 14 to 500 people out of every 1 million people vaccinated for the first time. Based on past experience, it is estimated that 1 or 2 people in 1 million (0.000198 percent) who receive the vaccine may die as a result, most often the result of postvaccinial encephalitis or severe necrosis in the area of vaccination (called progressive vaccinia).[38]
Given these risks, as smallpox became effectively eradicated and the number of naturally occurring cases fell below the number of vaccine-induced illnesses and deaths, routine childhood vaccination was discontinued in the United States in 1972, and was abandoned in most European countries in the early 1970s.[5][40] Routine vaccination of health care workers was discontinued in the U.S. in 1976, and among military recruits in 1990 (although military personnel deploying to the Middle East and Korea still receive the vaccination.[41]) By 1986, routine vaccination had ceased in all countries.[5] It is now primarily recommended for laboratory workers at risk for occupational exposure.[20]
I’m 30 years old and almost entirely unvaccinated.
I’ve always had poor health, I had lymphoma at age 27, type 1 Diabetes since age 13, all of which suggests poor immune system performance. And anecdotally, when I get sick with common cold etc, I seem to stay sick longer than other people. So I don’t expect my body to be good at fighting off really dangerous disease.
Which vaccines should I get? Most resources either target or assume vaccination of children on a regular schedule.
Yes, and make sure they take into account both what you are likely to contract and how much a weakened immune system affects how you will benefit from said vaccinations. Lymphoma in particular suggests that there’s been a more or less reset of the immune system over the course of treatment… I have no idea if that makes a difference in effectiveness.
I might specifically try to get advice on this from a doctor who was involved in the treatment of your lymphoma, because lymphoma is a cancer of the immune system, so you want advice from someone deeply familiar with the details of your case.
Note that if you have a concurrent immunocompromising condition (e.g., lymphoma), then live vaccines should generally be avoided. This includes the varicella, MMR, and zoster vaccines. Again, your healthcare provider can tell you more.
I’m vaccinated and my kid is vaccinated, but how likely is it that vaccines cause harm? I completely accept that they do lots of good, but is the case for common vaccinations (1) that the benefits greatly outweigh the costs or (2) that the benefits are high and the costs statistically trivial?
Moreover, which vaccines are worth getting? For example, is it worth getting a meningococcal vaccine if you’re not in any of the major risk groups?
Many universities strongly encourage their students to get the meningococcal vaccine (as sleeping in rubbish communal bedding is a risk factor), but for something really rare, even the risk involved in traveling to the clinic to get vaccinated could have more disutility than the protection the vaccine might provide would be worth.
The meningococcal vaccine causes a fever 3% of the time, and a few days of mild to moderate discomfort 60% of the time. If it causes any other problems in healthy people, the CDC hasn’t documented it.
Outside of major risk groups, this vaccine decreases your chances of getting meningococcal disease by some low amount, less than one in a million annually. If you get the disease, there’s a 10% chance of dying and a further 10% chance of being permanently disabled in some severe way. This is less than a tenth of a micromort.
The bacteria that causes meningoccoal disease is ubiquitous (10% of people are carriers), so other benefits of vaccines, such as herd immunity, would require extreme measures to obtain.
Driving causes about 1.5 fatalities per 100 million miles traveled, according to FARS, so this particular vaccine actively averts about as much risk as is involved in driving ten miles a year, which may or may not be worthwhile, but it certainly isn’t a low-hanging fruit in terms of risk aversion.
Anyway, let’s tally it all up:
Meningococcal vaccine utility:
0.00001% lower individual chance of getting meningococcal disease per year (minus 0.1 micromorts/year = at best a few minutes more of expected healthy lifespan, unless we solve the aging problem)
increased herd immunity (negligible due to the nature of this particular disease)
Meningococcal vaccine disutility:
mild discomfort
3 to 5% chance of fever
whatever risk is involved in traveling to the clinic (could be several minutes less of expected healthy lifespan)
whatever time it takes to get the vaccine (a few minutes to over an hour) could be spent doing something else
any undocumented risks that the vaccine itself might have (What are these?)
risk of physician error (What is this for a simple injection?)
Obviously, a lot of this will vary depending on the vaccine and the disease it’s meant to prevent. Some diseases pose higher risk, as do some vaccines. I didn’t get all of the standard vaccinations as a child because I was too severely allergic to some of them.
It might be helpful to do this sort of calculation for every available vaccine, but it’s a bit tedious. I haven’t found anywhere that lists the necessary information in anything resembling a convenient format.
Don’t you need to include the risks of a)being in an undiagnosed high-risk group, and b) developing a condition that puts you in a high-risk group?
Also, in terms of the driving risk, don’t you need to understand that in terms of substitution (I think that is the right term)? In other words, when calculating the driving risk, it becomes complex because time in the car going to the clinic may/very likely will be bundled with other driving (going to the clinic for other services, going to a store afterwards, etc.), so you can only include driving risk for this vaccine if it would not have been substituted for by other driving.
Depending on how the stats are compiled, the risk of being in an undiagnosed high-risk group is included in the risk for the general population.
If you later are in a situation where you will have greater risk, you can often get the vaccine when that situation arises, and probably won’t be any worse off for having waited. Vaccines become less effective as time goes on, so you might have to renew the vaccine when that situation arises anyway.
I am unsure how immune disorders factor into this.
For meningococcal disease, the most volatile risk factor is sleeping in rubbish communal bedding (or living in tropical Africa, or both). In this case, the risk goes from a tenth of a micromort per year up to maybe one micromort per year. Some situations where that might happen may be out of your control, sure. The only plausible non-society-crushing situation I can think of where that might be problematic (i.e. access to the vaccine would decrease) would be if you were to become homeless for lack of money. Feel free to adjust accordingly.
The travel risk is just as you say.
Not currently relevant, but an example of balancing risk and benefit and deciding to stop vaccinating against smallpox. Wikipedia
Given these risks, as smallpox became effectively eradicated and the number of naturally occurring cases fell below the number of vaccine-induced illnesses and deaths, routine childhood vaccination was discontinued in the United States in 1972, and was abandoned in most European countries in the early 1970s.[5][40] Routine vaccination of health care workers was discontinued in the U.S. in 1976, and among military recruits in 1990 (although military personnel deploying to the Middle East and Korea still receive the vaccination.[41]) By 1986, routine vaccination had ceased in all countries.[5] It is now primarily recommended for laboratory workers at risk for occupational exposure.[20]
I’m 30 years old and almost entirely unvaccinated.
I’ve always had poor health, I had lymphoma at age 27, type 1 Diabetes since age 13, all of which suggests poor immune system performance. And anecdotally, when I get sick with common cold etc, I seem to stay sick longer than other people. So I don’t expect my body to be good at fighting off really dangerous disease.
Which vaccines should I get? Most resources either target or assume vaccination of children on a regular schedule.
This seems like the sort of question to which the answer has to be “find a competent medical professional and ask them”.
Yes, and make sure they take into account both what you are likely to contract and how much a weakened immune system affects how you will benefit from said vaccinations. Lymphoma in particular suggests that there’s been a more or less reset of the immune system over the course of treatment… I have no idea if that makes a difference in effectiveness.
I might specifically try to get advice on this from a doctor who was involved in the treatment of your lymphoma, because lymphoma is a cancer of the immune system, so you want advice from someone deeply familiar with the details of your case.
I second gjm’s suggestion to talk to a healthcare professional.
Every year, the CDC updates and publishes their recommended immunization schedule for adults (patient version), which doesn’t assume childhood vaccination. Below, I’ve summarized the parts that are most relevant to you.
Vaccines recommended for adults aged 30 years:
Influenza (annually)
Tdap (with Td booster every 10 years)
Varicella (2 doses)
MMR
Additional vaccines recommended for adults aged 30 years with diabetes:
Zoster
PPSV23
Hepatitis B (3 doses)
Note that if you have a concurrent immunocompromising condition (e.g., lymphoma), then live vaccines should generally be avoided. This includes the varicella, MMR, and zoster vaccines. Again, your healthcare provider can tell you more.
Thanks!
Cost-Benefit analysis of a flu shot