DEALING RATIONALLY WITH VACCINE CONCERNS AND TREATMENT DECISIONS
Christopher Ebbe, Ph.D. 9-25
While a large majority of Americans and parents still think that vaccines for their children are important, there has been an increase in the number of people who have doubts, particularly about the safety of vaccines. The debates over vaccination and lockdown policies during the COVID epidemic weakened the faith of a considerable number of people in the government’s recommendations and concerns for safety. Many fewer than before believe that flu and COVID vaccines are important for themselves or for their children.
These differences of opinion are augmented by a previously existing and continuing trend in medicine toward “patient-driven care,” in which patients are not supposed to simply take doctors’ recommendations unthinkingly but are expected to learn about their illnesses and be the essential decision-makers about their care. One way to put vaccine use on a different footing (as well as patient decisions about their own care generally) would be to provide people with needed information about their options and then expect people to make their own decisions, instead of relying only on trust in a doctor’s recommendations. If parents knew the risks of serious side effects of a vaccine (e.g., if one child out of 400,000 needed hospitalization after this vaccination, due to the vaccine, and one other child died) as well as the risks of a child not getting the vaccine (e.g., one out of 100 children who do not get the vaccine will contract the illness, (like mumps) and of those who do get mumps, 1 out of 100 will have life-threatening symptoms), then they could weigh the various risks and make their decisions.
Up to now, parents haven’t known how much to trust a doctor who says that “the vaccine is safe,” because they know that for a few children it didn’t turn out to be safe. So, the conception of an individual about how safe is “safe” would be very important. Doctors in general might have a different perception of safety than parents. With this added information about probabilities, parents would then be responsible for the care outcome, based on their thoughts and feelings about the various risks (although we would recognize that any single case could be out of the statistical expectation due to unusual characteristics of the patient (for example, pre-existing conditions), since statistical expectations are long-term expectations for a large population).
Some parents would of course prefer to trust the doctor and not have to be responsible themselves, but a system of providing the needed information would solve the issue of parents not wanting to be forced to have children vaccinated by law or regulation. Some parents and patients would, of course, continue to simply trust the doctor’s recommendation rather than think about the risks and gains themselves. Many people would use some combination of the doctor’s recommendation and their own evaluation of the various risks involved.
For infectious diseases, there is risk of an infected person infecting others without the knowledge of either person. The downside of not requiring children going to school to be vaccinated, for example, is that if some children were not vaccinated, then we would have to tolerate a higher level of illness among children and some larger but perhaps still small, number of children would die—fewer from the vaccination itself because fewer children were being vaccinated but more from the greater number of children who get the disease either because they were not vaccinated or because they were vaccinated but it wasn’t sufficient to prevent the illness. Parents who chose not to vaccinate children would also need to deal with the moral question of what responsibility they have for children and adults who get the disease from children who have not been vaccinated. (Much of the uncertainty currently and part of the justification for not having children vaccinated is that we don’t know currently which infected child had done the infecting. If we could use DNA to identify the child who caused the infection in another person, more parents would be having their children vaccinated!)
There would be a bit of a challenge in determining the levels of the various risks described here, since there could be data from poorly done research that differed from the “official” version from a government agency, but this could be dealt with through research transparency, so that errors in research design and calculations could be exposed and evaluated by a reasonably diverse and objective panel.
The information needed by parents and by patients for each illness and vaccine would be—
1. the symptoms of the illness and the treatments for the illness
2. the probability of hospitalization or death from the illness, and the side effects, probability of hospitalization or death, and probability of cure from each treatment
In the case of vaccination—
3. the probability of a vaccinated person (age ___) being hospitalized or dying due to the vaccine itself
4. the probability of a person becoming infected under current conditions if he/she is not vaccinated (citing the overall percentages of persons who are currently vaccinated)
5. the probability of a vaccinated person becoming infected under current conditions
6. the probability of an infected person being hospitalized or dying if they have or have not been vaccinated
7. the probability of a vaccinated person becoming infected if half the relevant population were vaccinated and half were not
8. the probability of a non-vaccinated person becoming infected if half the relevant population were vaccinated and half were not
9. the probability of an infected person infecting at least one other person under current conditions
10. the probability of an infected person infecting at least one other person if half the relevant population were vaccinated and half were not
The assumptions needed in order to create these probabilities would be spelled out for parents and patients. Questions 9 and 10 are intended to give a person a sense of what the size of their contributions to public health/ill health might be, assuming that half the relevant population will choose not to vaccinate.
This set of questions presumes that there are no “carriers” of the illness (who are infected but not symptomatic). “Probability” can be understood as the same as the odds of winning a bet. A difficulty of adopting this approach in general to patient-directed care is that many people have difficulty grasping the meaning of percentages and probabilities. This could be dealt with by a pamphlet explaining percentages and probabilities and by ensuring that all students in high school gain an understanding of percentages and probabilities as applied to practical situations.
An example (the numbers cited here are for example only and are not based on data)–
2. The probability of your child (age___) being hospitalized or dying due to receiving the vaccine is 1 in 400,000.
3. The probability of your child (age___) becoming infected with COVID-19 under current conditions if he/she is not vaccinated is 1 in 250 (0.4 percent).
4. The probability of your child becoming infected if vaccinated is 1 in 1000 (0.1 percent).
5. The probability of an infected person who has been vaccinated (age___) being hospitalized or dying from this infection is 1 in 10,000. The probability of an infected person who has not been vaccinated being hospitalized or dying from this infection is 1 in 7,000
6. The probability of a vaccinated person (age___) becoming infected if half of the total population were vaccinated and half were not is 1 in 900.
7. The probability of a non-vaccinated person (age___) becoming infected if half of the total population were vaccinated and half were not is 1 in 200.
8. The probability of an infected person infecting at least one other person under current conditions is 1 in 4.
9. The probability of an infected person infecting at least one other person if half the relevant population were vaccinated and half were not is 1 in 3.5.
Given these figures, a parent who was uncertain about vaccinating a child for COVID-19 could reasonably conclude that (a) the chance of the child being hospitalized or dying due to the vaccine itself is very low, (b) the chance of being hospitalized or dying from the illness is very low but that that chance could be lowered even a bit more through vaccination. The chances of infecting someone else are much higher, so whether any of the people around this child were particularly at risk would be important.
The same pattern of statistics could be used for other illnesses as well as vaccinations, as in this example.
1. The symptoms of malaria are….
The probability of being hospitalized or dying from malaria if
infected is …
The probability of complete recovery from malaria is…
2. There are shots (not a vaccine specifically for malaria) that work to prevent this infection.
The possible side effects of these shots are….
The probability of being hospitalized or dying from these shots
themselves is 1 in …..
3. The number of persons last year who contracted malaria after visiting a designated infection area was 250 (out of 2400 people who visited a designated infection area) (10.4 percent). Thirty percent of people who visited a designated infection area took pre-trip preventive measures, and 70 percent did not.
4. The probability of contracting malaria when visiting areas designated as having high infection rates is 1 in …. if you have taken no preventive measures.
5. The probability of contracting malaria when visiting areas designated as having high infection rates is 1 in … if you have taken preventive measures.
6. The various treatments for malaria are—
a. …….
The possible side effects of this treatment are ….
The probability of being hospitalized or dying from this treatment
itself are 1 in ….
The probability of cure resulting from this treatment is 1 in ….
b. ……
.
,
,
6. The probability of an infected person infecting at least one other person is 1 in ….
There are no doubt some in the medical community who have already thought of this informational scheme, and it is hoped that the community as a whole will now discuss the scheme seriously.
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