We mothering vs. me mothering: neoliberalism, paranoia and vaccination

Medical vials and Syringe, Isolated on Blue background

Earlier this week I wrote about the closing of well baby nurseries as an expression of neoliberal philosophy:

Neoliberalism places a premium on individual responsibility and minimizes the value of collective action. We see this in contemporary political philosophies that venerate private industry and derogate goverment support. But we also see its impact in mothering philosophies that place a premium on individual maternal action and ignore the impact of the family and “the village.”

There’s no better example of the triumph of ‘me mothering’ than the anti-vaccination movement.

The closing of hospital well baby nurseries is a paradigmatic expression of neoliberal philosophy. In order to “promote breastfeeding,” new mothers are being forced to room in 24/7 with their newborns. It doesn’t matter that these women are exhausted, in pain and often taking sedating medications. Promoting breastfeeding is considered to be more important and neoliberal philosophy places responsibility squarely on the mother.

In other words, neoliberalism ignores our cultural history of ‘we mothering’ in favor of ‘me mothering.’ For example when lactivists offer breastfeeding “support” they aren’t offering to share women’s mothering burdens; they are hectoring women to assume individual responsibility.

Moreover neoliberalism doesn’t merely pressure women to take on the entire burden of children’s health, wellbeing, brain function and future economic prowess; it actively attempts to discredit the value and possibility of collective action to improve children’s health. Vaccination is the archetypical example of the triumph of ‘we mothering.’ And there’s no better example of the triumph of ‘me mothering’ than the anti-vaccination movement.

Vaccination works through collective action. We cannot vaccinate 100% of the population since some are allergic or immunocompromised and infants are too young for some vaccinations. Vaccination works through herd immunity. Vaccines dramatically reducing the chance that an infected person will encounter an unprotected person.

Imagine that little Ainsley comes in close contact with 10 children per day. Now imagine that Ainsley develops diphtheria. Who is likely to catch diphtheria from Ainsley? If 99% of children are vaccinated and the vaccine is 95% effective, the odds are low that any of the 10 children she comes in contract with could get diphtheria. Thus, the outbreak of diphtheria ends with Ainsley (though it may end poor Ainsley’s life).

Now imagine that only 50% of children are vaccinated against diphtheria. That means that half the children are likely to be susceptible, and therefore diphtheria is almost certain to be transmitted. And since the children who catch diphtheria from Ainsley are going to expose additional children who aren’t vaccinated, the disease begins to spread like wild fire.

The effectiveness of vaccines depends on collective action, precisely the kind of action that is devalued in neoliberal philosophy.

But vaccines have been a spectacular success. How could anyone doubt their efficacy and safety?

To privilege individual over collective action, neoliberalism takes advantage of the paranoid style in American thinking, the belief that bad things are caused by conspiracies. Rather than acknowledge the role of chance, misunderstanding and just plain stupidity in government or industry blunders, the paranoid style leads people to believe that there is no such thing as mistakes, only deliberate, nefarious plots.

An irreducible tiny fraction of children will be harmed by vaccines. Indeed, vaccine consent forms inform parents of the rare risk of brain injury or death. Those afflicted with the paranoid style imagine that pharmaceutical companies deliberately allow injuries that could easily be prevented and have hidden the scale of those injuries. In addition, there are children who suffer from conditions, like autism, whose cause is still unknown. Those afflicted with the paranoid style look for someone to blame and vaccines, because of their ubiquity, are easy to blame.

It is hardly surprising then that neoliberal thinking, which places all responsibility for children’s health and wellbeing on individual parents, has led to the vaccination movement, which venerates individual action, especially action in defiance of authority. From the anti-vaxxer’s viewpoint, ‘we mothering’ has given us vaccine “injuries” and only ‘me mothering’ can prevent them.

Ironically, the same people who are quick to see nefarious economic motives to ‘we mothering’ projects like vaccination, are willfully blind to the economic motives of those who promote ‘me mothering.” Anti-vax is nothing if not a money making enterprise; profits are high because unlike pharmaceutical companies that have to demonstate efficacy and safety, anti-vaxxers simply monetize nonsense — books, websites, supplements, immune “boosters” and detoxes.

Anti-vax flourishes not because children are being injured by vaccines; they aren’t. It flourishes because the neoliberal mothering project derides the possibility of collection action to promote health, lays complete responsibility for child health and wellbeing on individual parents, and promotes a paranoid style of thinking.

Anti-vax advocacy dismisses ‘we mothering’ in favor of ‘me mothering.’ As a result children die, parents arrogantly trumpet ignorance and ‘me mothering’ advocates laugh all the way to the bank.

  • Nick Sanders

    Speaking of “Me Mothering”, this came up in a vaccination group I follow:

    https://www.facebook.com/babynevaeh2017/posts/304626686654416

    36 hours after membranes ruptured before seaking medical attention, refused vit k and antibiotics for the baby, and now the doctor is the evil one for threatening to get CPS involved.

    • Roadstergal

      The comments…!

      • Nick Sanders

        She deletes any that don’t kiss her ass. I know because I got banned after just two comments.

        • Roadstergal

          I see that one sensible comment that was there when I looked earlier is gone now…
          I’m not sure what type of comment creeps me out more:
          -OMG how can those pedophiles do such horrible things when you’re just doing what’s best for your baby because we have seen vaccine damage and it’s real!
          -Just tell them you’re ‘delayed vax’ because that doesn’t freak people out as much as ‘anti-vax.’
          -God bless you and walk with Jesus *crosses and rainbow flags*
          I mean, they’re all horrible, but such different flavors of horrible.

  • StephanieJR

    The thing I don’t understand is, what do these people think about why? Why does Big Pharma want their children to be autistic? It doesn’t make any sense; but then again, sense isn’t their strong point.

  • Steph858

    I must disagree with this article. It implies that anti-vaxxers’ sin is selfishness or, as this article puts it, neoliberalism. This implies that vaccinating one’s children is a matter of public duty, that one ought to vaccinate one’s children lest they infect those who cannot be vaccinated. But even if you ignore public duty concepts like herd immunity, you should still vaccinate your children because the benefits of vaccinating far far outweigh the risks, even on a purely individualistic level.

    This article makes it sound like encouragements to vaccinate your children are in the same category of advice as “Don’t drink and drive,” or, “If you work with food and come down with a stomach bug, take 2 more days’ sick leave than you need to feel better.” That is, advice which is generally sound when it comes to the health of the public at large but which selfish narcissistic sociopaths might ‘logically’ disregard since, to the individual, following that advice would cause much inconvenience and little benefit. Actually, encouraging vaccination is more akin to advice like “Eat your veggies,” or, “Don’t smoke.” Well, it’s like those pieces of advice inasmuch as the individual following them will be the one who benefits. Unlike eating lots of fruit & veg or quitting smoking, however, getting vaccinated requires very little effort.

    • fiftyfifty1

      I disagree. Getting vaccinated does require significant effort and cost: taking off work for 5 doctor visits in the first year alone, the cost of the vaccines themselves, dealing with a potentially uncomfortable and feverish kid after etc. And the benefit to the individual is not guaranteed, especially in a situation where other members of society do their duty. Little Ainsley’s parents can avoid vaccinating her precisely because the other parents (and children) have already paid the price of effort and discomfort, giving Ainsley the free gift of herd protection. Even if there is an outbreak, Ainsley herself is unlikely to pay the ultimate price (although she could). The most likely to pay the price are the vulnerable–people with chronic conditions, immune problems, and the very young.

      • Merrie

        This is true, but I don’t think that there are a lot of people who would otherwise vaccinate who don’t for the primary reason that it’s a hassle.

        • BeatriceC

          I would argue with you on that point. Significant numbers of my students in my inner city middle school, and the elementary schools that fed into it, are under-vaccinated precisely because their parents cannot afford to take the time off work to to take them to the doctor’s office. For most people in poverty, this is more than just a half day. Public transportation systems in most cities are ineffective and take easily 2-4 times as long for travel as a person traveling by car, so a single appointment is an all day affair. Then taking that day off can make the difference between having enough money to pay rent or buy groceries, or having to decide which expense is more important. These children are un- or under vaccinated not because their parents choose not to, but because circumstances don’t allow them to.

          • Merrie

            No, I get that. I meant more that people who identify as opposed to vaccines aren’t doing so because they don’t want the hassle of going to the doctor’s office and get shots. They’re doing so because they disagree with vaccines for some reason. Whereas most of the parents of the kids you describe would presumably be for vaccines if it were easier to get them.

          • fiftyfifty1

            I agree that for anti-vax parents, the hassle factor is not the big motivator. The main motivation is a combination of toxin fears, status symbol, social subgroup conformity etc. Then again, when it’s all said and done, they do get to avoid the hassle, no? No cost, inconvenience or crabby baby…and they get a free ride off of herd immunity anyway. They are users.

          • Merrie

            I do know a lady who’s kind of medium-woo who isn’t really opposed to vaccines, but isn’t really super pro-vax either, but just hasn’t really gotten around to getting all her kids updated since their latest move, so they’re all behind on their vaccines. So there could be some intersection of these two populations as well.

          • fiftyfifty1

            Yes, it could be enough to tip someone over. Ambivalent about vaccines anyway, and then add in the cost, time, crabby baby….

          • demodocus

            I had to delay my daughter’s MMR, but hopefully only for the weekend. Didn’t figure Dr. S and her staff would appreciate a parent vomitting in their office. I feel better now…

          • Amy

            Ehh, some do, some don’t. I know that pretty much all the anti-vaxxers in my area do take their kids to regular “doctor’s” appointments. It’s just that the providers aren’t MDs, or DOs, or PAs, or NPs. Instead, they’re naturopaths or chiropractors. In some of the more woo-laden circles, the ONLY “medical” care the kids are getting are chiropractic adjustments, which the parents (and chiropractors, of course) insist are all that the body needs to keep itself healthy. Well, that and the supplements the chiropractor just conveniently happens to be selling, and of course a diet based on kale and kombucha.

          • Heidi

            I know in middle school, they brought the shots to us free of charge. It is the one thing my super conservative part of Tennessee got right

          • AnnaPDE

            They did that with the drop-on-a-sugar-cube polio vaccine in my German elementary school — late 80ies, so not exactly when polio was still super prevalent. And I remember some kids getting shots at school, too — we had these little consent strips from our parents and all lined up at the school office and a doctor would just basically stick a needle in whoever had “yes” on their slip. I had my shots already so I luckily had a “no”.
            We had the same consent slip/line up outside procedure when the local community bank rep came to give us kids a piggy bank each and explain how our newly opened kids’ accounts worked — imagine how freaked out we all were that now *everyone* had a “yes” on their slip. 🙂

          • Mattie

            Yeh, I was just going to say that, we had a few of our vaccines at school, parents signed the consent form and then we got them done during the school day. We don’t have to pay for any healthcare for children under 16 (or 17 and 18 if in full-time education).

          • FallsAngel

            “parents signed the consent form”
            Therein lies the problem. I’ve done in-school clinics, and between the teachers who forget to hand out the consents and the kids who “forget” to bring them back, it’s a real problem.

          • Mattie

            I mean sure, but it’s still a lot more vaccinated than not. Also I believe forms were collected the day before the actual vaccines so parents who were missing the forms had some time to rectify the situation

          • FallsAngel

            Yes. I’m just saying, it’s a lot of resources. The vaccine has to be transported, etc. If it works for your school, that’s great.

          • Azuran

            Transporting vaccines isn’t that hard. I do it every week when I go to the local shelter.
            They make flu vaccine clinics in public spaces every year. And there are blood donation clinics being done in schools, shopping malls and other non-medical public space every single day.
            Sure, it takes some organization, but it’s actually not that hard. And probably actually saves resources compared to having all those kids take individual appointments to get their shots.

          • FallsAngel

            You’re a vet and were transporting animal vaccines. People vaccines have a higher safety standard.

            I have actually done these types of clinics. You have to be careful with the vaccines. In fact, I sometimes wonder if some of them really survived the trip in a cooler, then the sitting in the cooler for hours, then the return trip to the office. See some of these guidelines:
            http://www.environmental.lsu.edu/vepr/References/Cold%20Chain%20for%20Vaccines.pdf
            ALL inactivated vaccines, includes IIV flu: “Keep cold at 35–46°F (2–8°C) and do not freeze. Place some insulation (e.g., crumpled paper, bubble wrap) between the vaccine boxes and the refrigerated or frozen packs to prevent the inactivated vaccine from directly touching the refrigerated or frozen packs. Put crushed paper in the cooler to keep the vaccines from shifting during transport. During hot weather, keep the insulated container in a cool place (air-conditioned interior of car). Do not leave the vaccine container unattended or in the trunk of a parked car. During cold weather, do not leave the container in an unheated area because vaccine must not freeze. In cold weather, include a freeze indicator in the vaccine container.”

            MMR and rotavirus: Same instructions as inactivated vaccines plus ” refrigerate the diluent in advance to help maintain the cold temperature in the cooler”

            MMRV and Zoster (Shingles): “Transport only the quantity needed in a special freezer unit or in an insulated container with dry ice; clearly mark the vaccine with the date and time it was removed from the original freezer unit. It is extremely important to include a thermometer in the container with the vaccine. If using dry ice, pack the container with enough to ensure the temperature is maintained at 5°F (-15°C) or colder. If dry ice is not available, you may transport VAR (not MMRV or zoster) with frozen packs. If the temperature within the container exceeds 5°F (-15°C) but doesn’t go above 46°F (8°C), the expiration date of the VAR vaccine is reduced to 72 hours. VAR vaccine that has reached temperatures above 46°F (8°C) or has exceeded the 72 hour limit cannot be used. Note: MMRV and zoster vaccines must always be transported with dry ice or in a special freezer unit that can reliably maintain temperatures of 5°F (-15°C) or colder. For this reason, transport of MMRV or zoster to off-site clinics is not advised.” (Emphasis theirs)

            LIve flu (not used in US last year, don’t know yet about this year): Follow package recommendations.

            I know that most people have A/C in their cars now, but I sure wonder about some of those clinics we did years ago! And even now, some cars are not air-conditioned. It can get quite hot here in CO in the summer, 100degrees (F) is not unheard of and 90 degree days are common. Plus most workers have to leave their cars outside in the heat at work.

            As I said, I’ve worked many flu clinics like that at grocery stores, senior centers, etc. They are a LOT of work, and I’ll admit we weren’t even *that* careful with the vaccine. They’re not much done in the US any more, as pharmacists in most states can give shots, and doctor’s offices are encouraged to keep a supply as well.

            I can’t see how it saves any resources. If the parents take them in, it’s on their dime, not the agency’s. I did say if it works for them, fine.

          • FallsAngel

            Add: You are supposed to continuously check the termperature as well.
            “When transporting vaccines, think about how each vaccine was packed when you first received it from the manufacturer or distributor. Use this as a model for how to repack the individual vaccines in order to transport them at their appropriate temperature. Keep a temperature log. Record the temperature during transport and periodically (e.g., at least once each hour) during the entire time the vaccine is kept in the transport container to ensure it remains within the recommended range.”

            Op cit

          • Azuran

            When I personnaly go to the shelther, I use a cooler, because I know exactly how many vaccines of what kind I need beforehand (So I don’t bring any back) and the shelter is 5 minutes away. I could not even use a cooler and I’d still be within the acceptable limit to leave the vaccines a room temperature.
            However, the vets I worked with that did house calls did have an actual fridge in their truck

            I’m not saying it doesn’t require work. But when you have the government behind you who is committed to make in-school vaccine clinics the main way for school aged kids. Those can be done in safely and are extremely effective and overall much more cost effective.

          • FallsAngel

            “I could not even use a cooler and I’d still be within the acceptable limit to leave the vaccines a room temperature.”

            So you see the difference between vet vaccines and people vaccines re: transport?

            I don’t know how you can say these school clinics are more cost-effective. More cost-effective than what? A lot of work means a lot of employee hours, e.g. pay to just pack vaccines and other supplies, travel to the clinic and back, etc. Our health department did not find them cost effective.

          • Azuran

            Our vaccine (and all our medication, actually) have standards just as high, they are not more resistant because they are for dogs and cats. All our vaccine fridge also have special thermometer to make sure they stay in the appropriate 5 degree range.

          • FallsAngel

            OK. Do you take that refrigerator to the shelter? Or do you just transport in a cooler?

          • Mattie

            Yeh, I think it’s national…so all vaccines done to school age children are done in school.

          • Amy Tuteur, MD

            But they’re not anti-vaxxers.

          • fiftyfifty1

            They are not anti-vaxers, but they are unvaccinated all the same. Herd immunity doesn’t care what your reason for not vaccinating is. For the group of willing parents, we need to keep working on reducing barriers. For the anti-vaxers, we need to close the conscientious objections and “religion” loopholes.

          • Roadstergal

            I’ve said it before – if all of the public money spent on woo birth and pushing breastfeeding were instead spent on a few vans with nurses who could travel to low-SES communities and give prenatal care, including vaccines, the overall health benefits would be so much greater.
            They could even go to schools with low-SES students and administer vaccines.
            Hey, how much money did you save by eliminating the newborn nursery, Hospital A? Kick back a bit of that to the community.

          • FallsAngel

            Do be aware that some of this is going on now. This is just one example:https://www.childrensimmunization.org/uploads/School-Based-Immunization-Presentation.pdf
            Many health departments have immunization clinics that are in the neighborhoods.

          • KeeperOfTheBooks

            Problematic though Texas is in many public health areas, I do need to give a shout-out to my state (or at least, my area within the state) for this: one of the biggest hospital/healthcare companies here has several mobile-home type vehicles staffed with nurses which travel around the community, setting up in various locations on given days in order to get both kids and adults vaccinated, usually at no cost to the patients. Duplications are avoided via a state-run vaccine registration program. (Of course, that’s something you can opt out of, so it won’t keep everyone from getting duplicates, but it will prevent many such incidents.)

        • fiftyfifty1

          “I don’t think that there are a lot of people who would otherwise vaccinate who don’t for the primary reason that it’s a hassle.”

          Actually, statistically it’s the #1 reason. When you look at unvaccinated kids nationwide, some of them come from anti-vax families, but even more of them are just behind on their shots. Their parents are not unwilling to vaccinate, but it’s a practical hassle: 5 different vaccination visits in the first 12 months alone. This may be easily done for parents with flexible jobs, maternity leaves, transportation, childcare, sick days etc. But for a lot of poor people, the hassle factor is enough that it doesn’t happen.

          • Daleth

            But for a lot of poor people, the hassle factor is enough that it doesn’t happen.

            I remember getting some shots at school. All the kids waited in line. Why don’t they do this anymore?

          • FallsAngel

            Kids are supposed to be fully vaccinated by age two, with boosters pre-kindergarten. The next vaccines are not due until 7th grade entry. I’m not sure what vaccines people who say this ever got at school. I went to school in the 1950s/60s, and we never got any immunizations at school. We did get TB tests, which may be what you remember.

          • MaineJen

            Wasn’t polio vaccine given at schools? Or would that just have been a community clinic?

          • FallsAngel

            It was given on Sundays at churches and schools-“Sabin Sundays”. http://magazine.uc.edu/issues/0408/on_campus.html If you read the article, you’ll see it was three Sundays in September 1960. So that would be the first dose. I guess you were supposed to get the rest of the series at your doctor’s office. It is possible that some places, the vaccine was also given in schools. But there was a whole country to immunize at the time. These days, it’s just the new infant cohort born every year that is unimmunized. Well, that and the kids of anti-vaxers. But IME, polio is one vaccine many parents want their kids to get, even if they are in general anti-vaccine.

          • poppy72

            Just to butt in, here in Australia, we had it at school PLUS it was available at the TOWN HALL ( community centre )

          • Carolyn the Red

            My husband got all his vaccines at school in Denmark in the early 80s. After he got most of the diseases, which proves the point

          • FallsAngel

            Well, yeah. The most fatalities with pertussis are to kids under 6 months of age. 60% of invasive Hib disease occurred by 12 months of age pre-vaccine, and virtually all kids had some type of Hib infection by age 6. 50% of kids had measles by age 6. Peak age of chickenpox was 3-6 years of age pre-vaccine. I do have documentation of this should you want some links.

          • Carolyn the Red

            Not arguing the timing at all, but he’s the parent of young kids who did get vaccines at school – at the time it was age 7. It’s not impossible other people in this discussion did too.

            That he got all the diseases save smallpox and polio kind of proves the point that the school based vaccine program didn’t work for herd immunity. And our daughter got vaccines against more diseases than he ever did by age 2, which makes us all happy

          • FallsAngel

            Yes, well I was agreeing with you. The time to get most of the vaccines is infancy, or whenever they’re recommended.

          • Azuran

            I had a few shots at school as well. I know I had 3 Shot of Hep B. I’ve had a few others but I don’t really remember what they where (definitely not TB test, I’ve never had that)
            But yea, I received a few vaccines in school.

          • FallsAngel

            Yeah, about 20 years ago I worked some clinics like that. In 1991, Heb B was made a part of the universal infant immunization schedule in the US. In about 1997 (kinda guessing here) the Colorado DOH made Hep B part of the required school immunization program for kindergarten and 7th grade entry. The Ks had mostly had the vaccine, but the incoming 7th graders had not. We did some school clinics to get them started. I remember a boy fainting and falling into a box in this tiny little room they gave me at this mountain school. I don’t think we did it more than the one round. After that, we encouraged them to come to our clinics, which did have evening hours.

          • Daleth

            Preschool, dude.

          • FallsAngel

            Preschool? ROTFL! It is hard enough to give vaccines to school age kids w/o their parents present. Going into a preschool to vaccinate 3 and 4 year olds would be a total zoo!

          • Daleth

            What can I say? I remember standing in line with a bunch of kids to get shots. It was the 70s, man.

          • MaineJen

            “It was the 70s, man” covers a lot of weirdness!

          • “Oh WOW! man!!! You should have seen the size of that needle!!! It was really freaky and… and… and…
            I forgot what I was going to say.
            Hey! Pass that on! Don’t Bogart that, man!”

          • Yes.
            I remember standing in line in 1963 to get the OPV with my mother and sibs at our local high school. I’d already had the IPV back in 1956.
            It was an open air clinic and I’m pretty sure it wasn’t an internal function of the school. I believe the county health department merely used their facilities to stage the OPV vaccination clinic. I never received any vaccines at any school nurses office or as a function of the actual school district. Clinics were only held at school sites for the convenience of the population and the county health department but were not a school program.

          • kfunk937

            The two times I got vaccines at school (OPV & smallpox) were both school functions in the gyms. The school nurse(s) attended along with public health.

            Sigh. Now many schools don’t even have nurses on site, and public health programs are spread even more thin than they always were. Still, it would be nice to offer vaccinations at school. If there were a will, we could find a way.

          • FallsAngel
          • Yeah. I remember a long line. It was a nice warm sunny day. They probably would have moved it into the “special education” building’s cafeteria if it had started to rain. It was so long ago I don’t remember well but considering the time of day and the presence of my mother and sibs I’m betting it was either during summer vacation or a Saturday and was not a clinic during school hours for the school kids per se.

          • FallsAngel

            Therein lies a problem with some of these school-based clincs-duplication of vaccines. Back in those “Glory Days” of OPV, people got vaccines who didn’t really need them, there was virtually no assessment done, no record keeping, adults got it which is now a contraindication, plus many others. (Not picking on you; it seemed like a good place to respond.)

          • I’m not sure what the story is and my parents are long dead so I’ve no one to ask but I know our pediatrician (who actually made house calls back then) was a very impressive and sensible fatherly sort and he probably advised my parents to take advantage of the OPV even if we’d been previously IPV vaccinated. That is just conjecture on my part, but knowing my parents they would not have made that decision in a vacuum and likely consulted him.

            If I’m not mistaken a few years ago Israel had a scare after finding vaccine polio virus in their sewage stream and went on a tear revaccinating kids with OPV and the health rep. explained in the article that it was a good idea to actually get the IPV first to protect against infection and then get the OPV to insure you wouldn’t be a carrier and since you had the IPV you wouldn’t risk VAPP. IIRC it seemed they were pushing for that to become the vaccination protocol: IPV followed by OPV.
            Made sense when I read it.

          • FallsAngel

            My parents did the same thing, took my bro and I to the Sabin Sunday, even though we had had the IPV as well. I specifically remember my father taking the OPV too. I don’t know about my mom. Years later, I remember talking to a co-worker about this and saying maybe that’s how they found out that adults were more likely to get VAPP from it, with so many adults taking it.

            Yes, the IPV/OPV was used in the US for a short time when transitioning to IPV. Then they switched to all IPV.

          • kfunk937

            Did you overlook the second MMR at 4 – 6YO? That one at least seems timed well for catch-up just prior to gradeschool entry.

            As others have already related, I also got OPV at school, with a whole crowd of other kindergarten/first graders, and some older kids transferring in may’ve gotten other vaccines too. (I’m pretty sure I had the IPV as a baby, along with DTP.) That was circa ’65. Then in the early ’70s at a different school in another town, I received the smallpox vaccination. I dunno if I’d missed it, or a previous one hadn’t taken, but I only have the one scar. There were a lot of kids getting vaccinated at school that day. I remember several fainted, even with an airgun/jet injector.

            So maybe it wasn’t as rare as you think.

            I’d like to see more school-based programs, personally. That solves a lot of logistical problems, IMO.

          • FallsAngel

            I did say boosters pre-kindergarten, meaning they’re supposed to have them by kindergarten entry. I do not like school-based clinics without parents. Fainting isn’t cool if the parent isn’t present. It’s not cool any time buy it makes parents suspicious.

            Yes, we had a whole country to immunze against polio when the vaccine first came out.

          • kfunk937

            Yes, I recall you writing about it before. It helped me understand a bit more about the potential obstacles in school-based programs, which struck me as probably solvable, if challenging.

            Not to venture too far off-topic, but I wonder how mobile units would work out? Some Red Cross units use RVs (possibly specially equipped) for blood drives in my area, and I’ve seen mobile health clinics do the same elsewhere (usually for targeted populations). It seems something like that would address some of those issues. Comfy too, albet a bit cozy. However, I’d wager that not too many communities would be willing to pony up—like schools and libraries, it may be seen as unnecessary and/or too expensive and hard to pass funding levies.

          • Jazz Let

            In the UK in some areas we have mobile breast screening trailers that park up in a different GP’s practice every couple of weeks each year and do all their patients who are due a screening. Much easier than going into town which I had to do where I last lived.

          • FallsAngel

            OK, I’m back at my regular computer now. Ironically, I was on a break at a Colorado Children’s Immunization Coalition presentation when I posted the above from my phone.

            I’m not sure what the big advantage to these school based IZ clinics would be. For at least the last 20 years, if not more, the health policy people have been pushing the idea that everyone should have a “medical home”, e.g. a primary care provider such as pediatrician, family practice doc, internal med doc, whatever who would co-ordinate virtually all their health care and do the basics, including immunizations. Public clinics were seen as inferior (by the planners) because they aren’t part of the medical home. Nor would a clinic held at the school be part of a medical home.

            Immunization rates did rise as IZs were included in insurance, so people didn’t have to be sent elsewhere (usually HD) for them. It helps, too, that under the ACA, well child visits are also included free at point of service. There is an advantage to getting everything in one place, rather than a physical here, baby shots there, pre-K shots somewhere else, etc. Plus there is better continuity of care, better record keeping if all in one place. For the uninsured, the VFC program can be used in private offices. It is far better to encourage the care to be given all in one place as much as possible.

            I was just talking to a friend who used to live in New Hampshire. There, the state pays for immunizations for all kids. I believe the poster Kathy said Washington state does the same. I believe there are several other states that do the same. Cost of immunizations is not generally an issue in the US.

            Plus, to reiterate, I have big problems with parents not being present, even with older kids. The consent forms sent home are usually pretty basic. What if they have more questions? What if there is a problem at the clinic.

            Mind you, I’m not talking about school based clinics, which have actual practioners on site, although with a “medical home” a lot of those may become redundant as well. Now when it gets to teens, onsite school based clinics where they can get BC, etc is a good thing, I think.

            Things have changed a lot since I was a very young PHN back in 1970. People of modest means had to go to the well baby clinic for well checks and IZs, and as they got older to the school physical clinics for their annual PEs and IZs, then to some other doctor when they got sick.

            I suppose a mobile van would be OK, but again, I can’t really see a big need for such a service in a community like mine. It might work for underserved areas.

          • kfunk937

            It was of underserved communities, specifically, that I was thinking—they are my primary focus anyway—where some parents will have trouble keeping up with their child’s vaccines due to scheduling or other logistical difficulties. When insurance covers the cost (for now at least… continuation is looking kinda iffy presently) but parent can’t get there, that puts a rock in the road for some kids. Of course, medical homes are good too, but they can’t meet all needs. I think that was the point of the thread.

            Thanks for your thoughts. I always find them informative.

          • FallsAngel

            Well thanks for the kind words. I had an epiphany on this issue once I got away from the computer. I think a lot of people of a certain age (and I’m more of a certain age than many) remember these school clinics fondly. However, health care providers did not stop doing them because they wanted to make it harder for people to get immunizations. They stopped because of the difficulties of doing them. It really is better to get all your care in one place. Of course, I know that doesn’t always work. In fact, my big beef with the ACA is that in most cases, people with insurance can’t go to public clinics any more. They’re supposed to go to the dr, but face it, some people have lost contact with their doctors. They’ve moved, the doc has retired, etc. So it was nice to have the HD around. Maybe some day, it’ll all be perfect.

          • Young CC Prof

            This is why Orac always harps on how important it is to make sure that getting a vaccine exemption for school is as difficult as getting the vaccine. It really does push a number of “hesitant” parents over the line into vaccinating.

      • Another argument, if one were needed, for the dreaded “socialized”health services. In Israel, all vaccinations for children are free at the Tpat Halav (well baby) clinics. Yes it does mean a visit to the clinic, and probably a cranky child that night. But it sure beats nursing a small child who has developed a potentially fatal disease.

      • FallsAngel

        In the US, all ACA compliant insurance, that is virtually ALL insurance available these days, is required to include immunizations and well-child care for FREE at the point of service with no co-pays or charges to deductibles. This includes high-deductible policies, private policies, employer sponsored policies, bronze, silver, platinum, etc. In addition, the Vaccines for Children program provides free vaccines for the uninsured, the underinsured, Medicaid recipients, Native Americans and Alaskan Natives. Some offices do offer very early (7:30 AM) or late afternoon/early evening appointments.

        • Young CC Prof

          Vaccine access is MUCH better than it used to be, although appointments are still potentially challenging for some families, especially poor single parents with crazy work schedules.

          The awful measles outbreak in 1989? A major driver was involuntarily unvaccinated kids, poor kids who couldn’t afford the vaccine or hadn’t gotten around to it. That outbreak led public health authorities to take some steps to improve access.

          • FallsAngel

            Yes, but . . . The major driver was unimmunized toddlers. Some of the research done at the time showed that many of these kids had been to a health care provider at a time between age 1 and the time they got measles, but they weren’t given the vaccine. Many providers had policies at the time that imms could only be given at designated well-child checks (physical exams). So if your kid was in for an ear re-check and was clear, they wouldn’t vaccinate, even if the kid was behind. Also, many providers used inappropriate contraindications, such as mild colds, pt. on antibiotics, etc. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html Plus, many insurances did not pay for immunizations, so patients were sent to health dept. clinics, and many of them never got there.

            That epidemic did change the way immunizations are given. It always seems to take a crisis. That was then.

            This is now. My POV is to try to look at how to get kids vaccinated, not to why they can’t. Many people are not aware that insurance pays for IZs, or that the uninsured can go to the health dept even if they aren’t strictly low income, or that there actually is a clinic nearby, etc.

            Getting your kid vaccinated is a hassle for everyone.

    • Mattie

      Yes, to a person who has never considered not vaccinating. To someone who doesn’t think vaccines are full of toxinz and will cause cancer/autism/death/stupidity then vaccinating becomes an issue of “DUH I don’t want my kid to get a VPD” but anti-vaxxers don’t care about the science, they believe that vaccinating is WORSE than any possible complication of a VPD.

      So, once you’ve tried your best to convince them that they’re wrong, that their science is faulty, and that there prophets are false then what? You throw up your hands and say FINE, do that, it’s your choice, but don’t expect to benefit from the helpful things society can offer, because you’re refusing to partake in the responsibilities of being in that society.

      So then it is more about not driving drunk, or rather, drive drunk if you want, but don’t do it anywhere where other people might be.

    • TheArtistFormerlyKnownAsYoya

      “If you work with food and come down with a stomach bug, take 2 more days’ sick leave than you need to feel better.”

      My, you have a rosy view of the food service industry!

      • Steph858

        Oh, not at all. I’m not under the illusion that this advice is ever actually [i]followed[/i]. Back when I was in college (NB For US readers: In the UK, what you call ‘College’ we call ‘University’; what we call ‘College’ you call ‘Polytechnic’ or ‘Trade School’. I studied Plumbing and Electrics), I earned my living working in a Chicken & Chip shop part-time (evenings and weekends). I came down with a rather nasty stomach bug once; it came on rather suddenly while I was at work. My boss was kind enough to let me take that evening off (though he docked my pay for this).

        There was good news and bad news. Good news: the bug turned out to be a 24-hour thing. Bad news: my boss laughed heartily for a disconcertingly long time when I suggested I might need to take an extra couple of days off to be on the safe side. To be fair, I wasn’t ACTUALLY working with the food; my job was solely to answer the phone (it got that busy during evenings and weekends that this really was a ‘full time’ job). But there was always the distinct possibility that one of the workers who DID work with food might answer the phone I’d had my germy hands all over while I was on a 5-minute break …

        Note that this was a place where most of the workers were ‘off the books’; for half of them there were no records that they had ever so much as set foot in the place, for the other half they’d be down as doing 10 or 15 hours a week when really they did 50. I very much doubt that any National Insurance or Income Tax was paid by on our behalves. Precious little health and safety; I distinctly remember an electrician working live (including exposed wires) on a faulty machine about half a foot away from me while I spoke on the phone. No sick time or holiday pay. And the best bit? I got £4 an hour. More experienced/senior/ longstanding employees got £5. This was at a time when the minimum wage was £7/hr. Many such jobs with similar conditions exist in the food industry, and aside from being exploitative of those working in such conditions, they are a recipe for spreading any stomach bugs workers might contract far and wide among colleagues and customers.

  • Heidi

    I definitely agree. The anti-vaxxers I see have elaborate stuff they do for their child that probably a caretaker isn’t going to be willing to do. They put onions in their socks, or bathe them in essential oils, give a medicine cabinet full of supplements, breast feed until well past toddlerhood because they don’t understand breast milk doesn’t contain anything to prevent VPDs, eat only local organic produce, etc. At some level, I have to think they are scared of these diseases because otherwise, why are they putting in all this time and effort into these elaborate, useless rituals? No one but them can care for the child (so I guess they get to be a martyr, too!). As a parent of a vaccinated child, we save so much time, effort and money and don’t think twice about letting his grandparents keep him over the weekend. He can eat whatever food is available (and not a choking hazard, of course), we don’t try to “boost” his immune system, bath time is for fun and cleaning but not much more and he gets $1 bubbles that are non-toxic instead of essential oils (that in my experience BURN) that can be quite toxic and possibly smell gross .

    • Dr Kitty

      My seven year old daughter has developed a rather expensive Lush habit. Possibly the only child to spend her pocket money on bath bombs.
      So my advice is to keep with the $1 bubbles as long as possible.

      • Heidi

        Oh, those are expensive! My son will probably never know they exist.

        • Charybdis

          My son loves the Dragon’s Egg bath bombs. He showers more now as a 13 year old, but will still take a bath using his LUSH stash once in awhile.

      • MI Dawn

        Oh my…my 26 year old daughter is addicted, too…So far she hadn’t gotten me in the habit. I like baths, but I’m happy to use the cheap-o bubble stuff.

      • Mattie

        If she hasn’t already tried them, then these are good and fractionally cheaper lol https://bombcosmetics.co.uk/bath-blasters

      • AnnaPDE

        Here are some DIY versions: http://www.wikihow.com/Make-Bath-Bombs
        With the main ingredients being baking soda, powdered citric acid (get it from an online chemicals shop, or as coffee machine descaler) and cornstarch, it should be quite a bit cheaper than at Lush, even if you add in the essential oils for scent and one-off investment in moulds. Plus, the process is super simple, so you can walk your daughter through it once, and then she’s busy crafting for some time.

      • Bombshellrisa

        Love those things, the ones with petals that pop out or have some other surprise make me so happy.

      • Charybdis

        Oh, I LOVE LUSH! I was so happy when we got a store here locally, so I didn’t have to use mail order any more. I love Sandstone soap, Ultrabland cleanser, Catastrophe Cosmetic face mask, Silky Underwear powder and I lay in a supply of Snowcake soap every Christmas.
        Although, the choice is a little different here in the US than you guys have in the UK.

    • Platos_Redhaired_Stepchild

      You might want to pass on bubble baths.

      http://jezebel.com/5261280/are-you-a-victim-of-mr-bubble

  • ec

    I urge everyone reading this to get your MMR (and chicken pox) titers checked. I had all my shots as a kid, but found out in my mid-thirties that I wasn’t immune to two of the three MMR diseases. At your next physical, ask your primary care doctor to add the titers to your other bloodwork, then get the booster shots if you need them.

    • Jetske Goslinga

      Even if you’ve had the shot, it’s possible to still have low titers. I had mine done less than 2 years after getting a booster (in the military, we kept up to date with those things) and my titers were still low for Rubella. The Dr. told me there was nothing to do, other than “avoid anyone who has German measles” if I get pregnant. Luckily there hasn’t been a case in Canada since 2005.

      • Kristi Berry Pedler

        Have had 6 documented MMRs since age 18. Still RNI. I have had 3 documented series of the HepB vaccine. When I started at my current hospital, neg titer. In the 1970s, had one of the worst cases of chicken pox the ped had seen (and have scarring all over to remember it). Again, no titer when checked by current hospital, so forced to get the varicella vaccine.

        I rely upon herd immunity! I was exposed to rubella while pregnant & was terrified.

    • Sullivan ThePoop

      I am lucky. I had one MMR in 1972 and have good titers for all three.

    • Dr Kitty

      Given my exposure to chicken pox (close contact with infected kids in order to diagnose the at least 20 times a year) I’m confident in my immunity. I got an MMR booster (third dose) as a med student before my pards rotation, and as my rubella immunity is OK (tested in two pregnancies) I assume it is fine.

      An acquaintance of mine, who was too old to have had MMR as a child, had an adult and very sick patient with measles. He had his titres checked and it turned out he was immune to measles but not mumps or rubella, so he got an MMR.

      If he hadn’t been immune to measles he would have been quarantined and unable to see patients until it was clear he hadn’t caught it from the patient. Which, as a GP in a double-handed practice would have been a disaster both financially and for patient care.

      The adult patient, BTW, had been on public transport at the same time as an unvaccinated child with measles.

      • MI Dawn

        But, but, but… Dr Kitty! Measles is just a minor disease, right? How can an adult be very sick with them? I guess they must not eat organic, drink only pure bottled water, and think good thoughts all day. (gag).

        OK. Can’t think like an anti-vaxxer any more. It makes me sick.

        • Amazed

          He can’t. Be sick, I mean. That’s why my mom’s adult student of today is eager to get measles and all the wonderful benefits it confers. After all, she’s just recovered from a chickenpox. It was a breeze indeed. Just two weeks of being very ill and wishing that she could just die.

          Oh, she doesn’t eat organic either. That must be it. That’s why chickenpox was bad for her, measles would be even worse and she’s be wise to avoid it – she wishes to have avoided the chickenpox as well!

        • Christy

          It had to have been damage from the vaccine he..didn’t…get..Oh! I know, shedding. That’s the ticket!

    • crazy grad mama

      In the US, it’s standard of care to do a rubella titer during pregnancy. Mine was low, so I got an MMR in the hospital after my kid was born. If you’re really on the ball planning to try to conceive, it’s a good idea to have a titer run a few months early so you can get the shot in advance.

      I had chicken pox three(!) times as a child, so I’m feeling pretty good that I’ve built up an immunity there. 🙂

    • Sheven

      I tend to get MMR shots quite often because of laziness and disorganization. I start a new job or volunteer somewhere and they ask when my last shot was. I don’t know and can’t find the paperwork. They send me to get the shot.

    • fiftyfifty1

      “I urge everyone reading this to get your MMR (and chicken pox) titers checked. ”

      Actually please don’t. Instead follow official recommendations which state that as long as you have received all recommended shots, you do not need titres tested except in very specific cases (e.g. rubella with pregnancy).

      The reason is that after many years, titres will often decrease to the point that they are reading “not immune” but in reality, the person is still fully immune. Here is the US, each titre test costs $50-100. If you test for measles, mumps, rubella and varicella, that’s 4 tests. Then add the cost for reimmunization, despite the fact that the person is, in all likelihood, actually immune, just with a low titre. Multiply that by 300 million people.

      A better strategy is just to make sure a person really is up to date on shots. An example is the MMR. When I was a child, the official schedule only required 1 dose. But the schedule has since been revised to require 2 doses. So get that 2nd dose.

      • AnnaPDE

        Does it actually hurt any to get a booster “just in case”? Saves a bunch of money on the tests, plus the discomfort of a blood draw before the shot.

        • fiftyfifty1

          The downside to giving shots above and beyond the official schedule is cost and potential side effects.
          The cost is not inconsequential. Shots, especially live vaccines, are expensive. And they are time consuming. They take enough nursing time that doctors offices typically take a loss on them. And then there are the potential side effects. They are not worse than they are for the regular series, but they do exist– rare allergic reactions etc.

        • FallsAngel

          I’ll give you a different take on it than AnnaPDE. No, it does not hurt to get a booster if you don’t know your immunization status. Your insurance may even pay for it. Check first.

      • Roadstergal

        Yeah, immunology is fun. Long-lived plasma cells make antibodies on an ongoing basis, but memory B and T don’t, so it’s possible to have low titers and still have a robust memory response raring to go. Exposure or a booster will ramp titers back up.
        The cells, of course, are not passed to your kid in utero, so you need circulating antibody in pregnancy…

    • Taysha

      I actually just did. New job, titers are gone. One dose done, one to go

    • MaineJen

      I had to get a titer drawn for chicken pox years ago for work, I’m too old to have been vaccinated but I had it as a child, and luckily the antibodies were still kicking around in there 🙂