Victoria, Australia government wants to stop free pertussis vaccines

By Phil Plait | May 29, 2012 12:38 pm

[Note: Although I think it's clear in the text below, I changed the title of this post to reflect the fact that it's the Victorian government doing this, not the Federal Australian government.]

In Australia, pertussis — whooping cough — is at epidemic levels. There were over 38,000 cases last year, and it’s killed eight babies since 2008. Despite this, the Health Minister of Victoria wants to cut a program that provides free pertussis vaccines for caregivers and parents of babies. He claims (under advice of a panel of experts) that it isn’t providing sufficient clinical results, but many doctors are concerned what this will do to the already too-high rates of infection.

Even if the results aren’t as good as hoped, it would make sense to fund this program until infection rates are down, at least to where they were before the epidemic.

Toni McCaffery — the mother of Dana McCaffery, one of those eight infants killed by pertussis — has created a petition to continue the program. If you live in Australia, I urge you to read it and sign it if you choose.

And please, please talk to your board-certified doctor and see if you need a shot or a booster.

Why? Because of this, and this, and dammit, because of this.

As long as antivaxxers spread their thin gruel of nonsense, as long as people think it’s OK to get a religious exemption from a life-saving vaccination, as long as people aren’t even aware that as adults they need to keep up with their TDAP booster shots (as I wasn’t), then I will continue to write about this.

As long as babies are dying, I’ll continue to write about this. Let’s hope I can stop very, very soon.


Related Posts:

- Followup: Antivaxxers, airlines, and ailments
- UPDATE: partial Complete success with American Airlines!
- Whooping cough outbreak in Boulder
- Stop antivaxxers. Now.

Comments (68)

  1. Gus Snarp

    I wish there were more promotion of adults getting boosters. You’ve done a great job of mentioning that almost as much as you mention making sure kids get vaccinated, but we need a global campaign promoting pertussis boosters. When I asked my doctor for mine he was very happy about it. With increasing numbers of parents avoiding vaccination, it becomes ever more important for adults to get their boosters in an effort to support herd immunity. That a government would aim to cut this program is unconscionable.

  2. Greg

    Part of supporting Science-Based Medicine is accepting scientific results even when they show something you don’t like. And in this case, “programs for parents did not work well because they were difficult to implement and did not protect babies from other unvaccinated adults they would come into contact with.” (Jodie McVernon, deputy director of Melbourne University’s vaccine and immunisation research group)

    They’re not saying vaccination is a poor idea, they’re saying this is not an effective use of monetary resources.

    And no refuting the conclusion by guessing about problems with their methodology; that’s a total antivaxxer tactic. Evidence or GTFO.

  3. Brendon

    I wholeheartedly agree that antivaxxers are damaging humanity. Being an Aussie ex-pat, it sickens me to see this kind of BS getting serious play at any level of Australian government. (Note “sickens”, not “surprises”.)

    …but I just have to pick this nit. If the government of, oh I dunno, Tennessee did something stupid, would you say, oh I dunno, “U.S. legislature boldly sets the science clocks back 150 years”?

    Might I suggest “Victorian state government of Australia wants…”, instead? More accurate, more educational, and it doesn’t nark pedantic smart-arses like me!

  4. Nick

    It should be noticed that this is the Victorian State Government, not the Federal Australian Government. The Federal Government is centre-left , and the Victorian government is the competing centre-right party.

    More interestingly, the Victorian government is currently on a knife edge of being thrown out. They won office by 45 seats to 43, and one of their members Geoff Shaw is currently being investigated for misuse of government assets.

    Geoff Shaw won his seat by 1090 votes, and if he is forced to resign a by-election may result in the house becoming deadlocked or the opposition taking power, and the Victorian Government will fall. [1] (Amusingly, it is very similar to what is happening on the Federal level, just with the parties reversed.)

    Basically, this is no time for the Victorian government to be making enemies. A publicity campaign showing the insanity of this decision could easily reverse this course.

    [1] Or cause a constitutional crisis – see http://blogs.abc.net.au/antonygreen/2012/05/is-an-early-election-possible-in-victorias-fixed-term-parliament.html

  5. Mike

    Antivaxxers == Morons

  6. Daniel J. Andrews

    There are days, like today, when I just want to say “F*** it” and let the whole human race go to hell. Not because I really want that, but because I’m tired of the short-sightedness in our political systems, of what appears to be rampant stupidity, of the promotion of ignorance as a virtue. I get discouraged and want to just withdraw from society and enjoy what we still have left without having to worry about what will happen to it.

    Then I read something like your latest post here, and it is so full of passion about doing the right thing, to keep on fighting because the causes are worthwhile. It makes me ashamed that I want to give up. But it also inspires me to keep on speaking out, to keep on fighting, to help keep educating others.

    Thank you, Phil. Today you have inspired me, and you have encouraged me. You’ve done so in the past too, but today when I was feeling like things were pretty hopeless this is an especially welcome inspiration. Indeed, a very heart-felt thank you.

  7. MKS

    Phil,

    maybe you should start a kickstarter for a Concentration Camp for anti-Vaxxers? you might make a lot of money *waggles eyebrows*

  8. Mark

    The way this article is written implies that the Victorian government is anti vaccination. This isn’t true, many people are elligible for free vaccinations. It is simply the case that Victoria has a large deficit budget and cuts are being made across the board. When that happens department have to choose what to cut. They have a report showing that they aren’t getting value for money from this program and they choose to put the responsibility for vaccination into the hands of the individual rather than being sponsored by the state. People need to take responsibility for their own health. It takes a huge leap of ignorance to turn this into an alarmist view that the government is anti vaccination.

  9. This makes me really ashamed to be a Victorian. Idiots.

  10. @MKS

    Not a funny joke.

    @Phil

    This popped up in my google alerts, and my first thought was, “WTF?” Offering free vaccines is a good thing, and should not be defunded. How they go about offering it is something that could be looked at and refined as necessary, but nixing the program altogether? Yeah, the program won’t stop other adults that come in contact from spreading pertussis, but that doesn’t mean that preventing the primary caregivers from spreading it should be scrapped.

    The whole adults needing pertussis boosters thing really didn’t seem like a major issue until several years ago. Heck, I think it wasn’t even until 2007, if memory serves, that an adult pertussis booster was approved. The recommended booster for adults was simply the Td, I guess because pertussis wasn’t really seen as a major issue for adults. Then we find out that a lot of infant cases are actually spread by adults, rather than other children. It’s easy to educate and enforce a childhood immunization program; much harder to get adults to keep on top of their vaccinations.

    After my post last week and Orac’s post on parents giving bleach to their autistic children, I was ready to throw my hands up in despair. But, thanks to friends and posts like this one, I’m ready to get back into the fray.

  11. Mark

    @Todd W

    I’m glad you want to get back into the fray. Maybe you can campaign to get more funding from a limited budget spent on funding extra free health care here in Victoria. But before you do that, maybe you could look at the state of the public health care system here and the long waiting lists for essential health care. We don’t have an infinite pool of money, so if you fund this program then something else doesn’t get funded. Like for example reducing the increasingly long time for cancer patients to be able to get a biopsy. People are dying because although they know they have cancer they can’t get a biopsy and start treatment. So what do we do – make it so that primary care givers have to spend a few dollars so that they can get a booster shot, or require someone to spend tens of thousands of dollars to go into the private health care and get treated quickly?

    I’m glad you are willing to make these kind of life and death decisions so rapidly. So get back into that fray and campaign for your favorite cause without a care in the world for the consequences of your actions.

  12. Charlie Foxtrot

    Signed.
    Idiot conservative government looking to cut spending wherever possible. They also recently managed to drive nearly all the nurses in the state to the brink of tendering their resignations over nurse-to-patient ratios and use of barely certified ‘nurse assistants’.
    Looking forward to the next election…

  13. ginckgo

    Two points:

    The sharp rise in pertussis cases is apparently due to a new strain of the bacterium that is not covered by the vaccine (in addition, I recall hearing that years ago it was decided to change the vaccine from one that covers a broad range of strains, to one that only covers the most common ones). So the increase in infections is less due to dropping vaccination rates.

    The State Government of Victoria is abysmally anti-science. Almost from day one they have made decisions that are counter the scientific consensus (like letting cattle graze in the High Country, supposedly to reduce bush fire fuel – when it’s been shown that they avoid just that type of undergrowth and go for the plants that need protection).

  14. Grimbold

    Signed. Thanks for letting me know about this, Phil.

  15. Uranium Willy

    Is this a case of antivaxxers or just a case of saving money. You should distinguish between the two. From what I could tell this had nothing to do with antivaxxers, if you have problems with the reasons for their decision, then fine tell us, but don’t bundle this in with antivaxxers if it is not. If this is antivaxxers and it is just hiding behind something else, then you need to tell us how this is happening. I not trying ti say anything about whether their reason for dropping this vaccination is right or not, I don’t know, yet I should know after reading your article. In general I am a big fan of your blog.

  16. I know you fortunate astronomers do not need to understand the concept of triage, having unlimited resources and such, but this is not an antivaxxer issue; it is a matter of assigning resources where they will do the most good (nor is it the case that in matters medical Australian conservative parties are somehow stupid teapartiers; the convention here is that expert advice is followed by all parties).

    If the cost of the adult pertussis vaccines is not merited by the benefits of the vaccine, and this is a scientific issue, not a political one, then using those resources for a better and more effective medical intervention (such as infant pertussis?) is a rational choice. While I object to much of this government, being a Victorian and all, this is not, I think, such an issue.

  17. Uranium Willy

    “MKS Says:
    Phil,
    maybe you should start a kickstarter for a Concentration Camp for anti-Vaxxers? you might make a lot of money *waggles eyebrows*”
    Translation
    I don’t have a valid rational position and so I am going to try and connect your position to hitler.
    Oh crap my tinfoil hat is failing, I’m going to have to purge myself of the illuminati control signal by ranting in front of my bathroom mirror for a couple of hours. YOU CAN’T CONTROL ME, I AM NOT A SHEEPLE.

  18. Messier Tidy Upper

    Petition signed – now up to 1,045 signatures out of the 1,500 sought already. Shared this on facebook too. Thanks for sharing – haven’t heard about it before reading it here – & keep up the good work on this fight, BA.

    One area where I’ve always thought Australia is far ahead of the USA has been in our health sector and services such as the Medicare safety net for all. Never would have expected anything like this to happen in my country – not even in Victoria!

  19. Barnesm

    I haven’t been able to find the cost benefit analysis that was used to advise the government that the vaccine shouldn’t be subsided so I do wonder how the analysis was set up and if its a case tht its not effective becuase it didn’t achieve sufficent levels for herd immunity or up date was great than expected I the targeted areas, or the number of people developing pertussis was unchanged from befor the introduction to after the introduction of the program.

    I would hope that who ever had constructed the analysis was savy enough to pick up all the complexities of such health program. I fear however that the study may have been fairly skewed with a result to justify cutting a program by a government that during its turm has been focussed on cutting public expenditure.

    Failing to get immunizations up to the nessacary level to provide herd immunity isn’t a reason to drop a program, its a reason to try harder.

  20. @ ^ Barnesm : “Failing to get immunizations up to the nessacary level to provide herd immunity isn’t a reason to drop a program, its a reason to try harder.”

    This! Seconded by me.

    @7. MKS :

    Phil, maybe you should start a kickstarter for a Concentration Camp for anti-Vaxxers? you might make a lot of money *waggles eyebrows*

    Not sure if you are Poe joking or a serious Conspiracy theorist, MKS but either way, nope not funny and not good.

    I’d like to see anti-vaxxers eductaed and prevented from harming others. This does NOT mean I – or I think anyone else -wants to see them put in concentration camps or mistreated. Other than being hit with a clue stick – metaphorically – that is.

    @8. Mark :

    The way this article is written implies that the Victorian government is anti vaccination. This isn’t true, many people are elligible for free vaccinations. It is simply the case that Victoria has a large deficit budget and cuts are being made across the board. When that happens department have to choose what to cut.

    Then they have chosen ..poorly. :-(

    (To quote the Knight in ‘Indiana Jones & the Last Crusade. linked to my name here.)

    There are plenty of good ways money can be saved – starting with politicians salaries & maybe reducing their number – this ain’t one of them!

    They have a report showing that they aren’t getting value for money from this program and they choose to put the responsibility for vaccination into the hands of the individual rather than being sponsored by the state. People need to take responsibility for their own health. It takes a huge leap of ignorance to turn this into an alarmist view that the government is anti vaccination.

    Not that huge a leap and I don’t think the BA is ignorant of reality here.

    Yes, people need to take some responsibility for themselves – of course they do – but this is an issue where we need to be encourgaing people to get vaccinated and that includes making it cost less preferably nothing but time and asking. Because, ultimately this helps everyone’s interests and saves lives. Making the vaccine cost something when people are already worried about their finances is an extra obstacle to getting that necessary herd immunity that we can all well do without.

  21. ColinW

    Watch for something similar in Queensland, where a centre-right and somewhat fundamentalist influenced State Government has been elected and is de-funding all sorts of things. They have already dismantled the main AIDS & safe sex education organisation, and it would not surprise me to see some vaccination & other free health services go as well.

    These statistics make me ashamed to be an Australian. Meryl Dorey and her kind have a lot to answer for.

    As a thinking, caring Australian, all I can say is “I’m sorry”.

  22. flip

    As one of the Victorians here… signed the petition! And of course I’ll be getting my boosters soon. Here there’s very little done by way of encouraging adults to get boosters, so I’m not surprised that there’s little benefit seen from providing them. If no one knows to get it, then no one’s going to.

    In actual fact, the last few doctors I’ve seen I’ve mentioned to them that I wanted to get a booster and no one ever followed up… I wonder if the local docs need reminding too.

    @8 Mark

    In general I agree with you that programs need to be re-evaluated over time to see its effectiveness. However, there are many people who can’t afford boosters or vaccines for children, and appreciate being able to go to a free clinic and obtain them. I am one of those people. My way of taking responsibility for my health is either: become sick or make other people sick because I can’t afford a trip to the doctor; or get a free/subsidised booster. Which would you prefer I do?

    @16 John

    The issue is that vaccines require boosters. Which means you need to get them as an adult. Effectiveness of the vaccine is also dependent on herd immunity. Barnesm has a great point about trying harder.

  23. @Mark

    I understand fully that there are limited resources. Yes, tough decisions need to be made, but that also includes examining how a program is implemented. If what flip says holds for the majority of the state, then the problem with the program may not necessarily be that offering free vaccines is ineffective at controlling the epidemic, but rather that the problem is a matter of education. Unfortunately, we don’t have the report that the Health Minister based his decision on, so we can’t see just what the problems were.

    There are a lot of factors at play, but if at all possible, primary caregivers should be able to receive free (or at the very least, low-cost) vaccines to create a cocooning effect around their children. A partial shield is better than not at all, especially considering the increased cost of treating the disease when it spreads, since it costs far more to track, treat and contain outbreaks than it does to prevent them.

  24. Satan Claws

    Does anyone know if antivaxxers also abstain from taking other medicine? (Cough syrup, pills, …) In other words: where exactly do they draw the line, or why might it make sense (in their minds) to oppose vaccination but (possibly) not other medicine?

  25. DennyMo

    Something of a tangent, to be sure, but:

    BA said: As long as babies are dying, I’ll continue to write about this.

    A lot of anti-abortion activists feel the same way about their subject.

    Some anti-vaxxers are merely concerned that vaccines cause illness. Others take it a huge step further and believe the pro-vax “forces” are just part of a plot to program/subjugate the sheeple of the world.

    Similarly, many pro-abortion folks think that the pro-life activists are all about subjugating women, while the pro-lifers see themselves as rescuing babies from murder.

    IMO, the gap in definitions and perceptions is a much greater source of conflict than the actual differences of the their positions.

  26. flip

    @22 Todd

    I will gladly admit I don’t pay attention to any vaccine campaigning. But then I can’t recall a single TV ad or any other publicity on booster shots for adults. It’s only due to my introduction via this blog that I’ve even made enquiries about getting them for myself; certainly there are regular clinics provided by my local council to provide boosters (and vaccines for children), but again, I’d not known about it til I went looking for that info.

    So I don’t know if my experience is all that representative. It’s just my impression that there isn’t much campaigning done. Certainly since leaving school, the only time boosters came up was when I mentioned them to my doctor recently – so about a decade has gone past with no doctor mentioning it (and this is even with me being potentially sick from pertussis. I wasn’t, but you’d think at that point a doctor would say “hey, let’s update your vaccines seeing as how you might have had it”)

    @23 Satan Claws

    There are lots of reasons, but the biggest one it seems is the false association between vaccines and autism. You can find plenty of info about if you just look for it: Science Based Medicine (the blog) and Respectful Insolence are good places to start. As for accepting some medicine and not others, well, a lot of them are into CAM (complementary and alternative medicine) so it isn’t surprising they’ll reject whole swathes of science based medicine, or some but not all of it.

  27. Greg

    Given that there are limited resources available for health care, does it not make sense that the public service should monitor and evaluate the benefit returned from investment? That’s what happened here: the monitors have reported that the free vaccines for caregivers program is not an effective use of funds. Cancelling it frees them up to offer a program that offers a greater benefit; perhaps subsidized vaccines for all, or a vaccination education campaign or drive.

    The readers of this column have no evidence that free caregiver vaccines are a better use of that money than a different program. Evidence or GTFO.

  28. @Greg

    Evidence or GTFO.

    Agreed, though not in the way you may think. The Health Minister should release the evidence supporting the decision. Right now, all we have are reports and hearsay that the program isn’t working as they would like. So, as Greg says, the ministry should present its evidence so we can make an informed critique or decision, or they should GTFO.

  29. Gary Ansorge

    This entire discussion is a classic example of “Penny wise and pound foolish”. So, a tdap vaccine might cost the state $10.00 per person, while treating a child sick with pertussis might cost $10,000 to 20,000. I guess it’s alright then to not spend that money on vaccines for 1000 people, because it just doesn’t matter how many fully formed and functional humans might get sick and die. After all, they’re out of their mothers bodies now. No need for society to care for them at all.

    Of course, the powers that be may have missed the point that skipping vaccines for those 10,000 people could decrease your GDP by a substantial margin as even the adults get sick. Then where will you get the money to keep your society running?

    Governments are run by idiots. The smart people become scientists and engineers.

    …hmmm, maybe we SHOULD be running for political office??? Naw! Then I’d have to actually be around idiots…

    Gary 7

  30. Greg

    @Todd W.
    Except that I believe that the program supporters are those with the weaker argument and thus responsible for the burden of evidence. Even if Melbourne University did produce their evidence, criticizing their methodology is not a basis for a reversal of the decision; that’s the CAM way: “Oh, their study wasn’t up to my standards, therefore I don’t have to consider its conclusions.”

    You have to produce evidence of your own to counteract that, and superior evidence at that. And right now, the supporters have nothing more than, “more vaccinations are better.” But what you need is evidence that providing caregivers free vaccinations is an effective use of resources, and better than the alternative uses of resources.

    @Gary Ansorge
    No, the entire article is lacking the necessary information to make the rational choice. You are correct is saying one basis of comparison is the cost of treating a case of pertussis. But the other side is how much this program spends to *prevent* one case of pertussis, and that includes the cost of the vaccine, the cost of administering the vaccine, of ensuring it only goes to caregivers, etc. And then you need to compare it to the cost of other ways of preventing pertussis infections.

  31. bbmcrae

    @20. Messier Tidy Upper -

    I think MKS is probably a conspiracy theorist because he Capitalizes random Words unnecessarily in the style of Disorganized thinkers. He’s also thinks the Holocaust is hilarious, apparently.

    Signed. Thanks for the watchdogging, Phil.

  32. @Greg

    The program is in place. A move is being made to end the program. The justification is that the program is not producing “the required result”, whatever that may be. The onus is on the one moving to end the program to justify the change.

    If you happen to have a link to the evidence supporting the change in policy, by all means, present it. It may well be that the evidence does support the change, but we are not being presented with the evidence. If it is sound, show us!

  33. James

    Can’t we simply stick all the anti-vaxxers on an island and drop off some blankets coated with small pox? ;)

    BTW: ANYONE can sign the petition that Ms. McCaffery created on Change.org, not just Australians!!

  34. Greg

    @Todd
    No, that’s crap reasoning. CAM education is in place at universities, therefore it’s the onus of opponents to show that CAM is crap? The onus is not a function of who got there first. The onus is *always* to provide evidence to support your side of the argument. And right now, all you’ve got is, “more vaccinations are better.” You’ve got *absolutely nothing* to show effectiveness or relative effectiveness, both in absolute and per dollar terms.

    Here’s what I’ve got: http://www.news.com.au/breaking-news/new-strain-of-whooping-cough-emerging/story-e6frfku0-1226306167913. Salient points: A team of scientists led by the University of NSW found the emerging whooping cough strain was responsible for 84 per cent of cases since 2008, when the current epidemic started. … Prof Lan said the current vaccine was effective against most forms of whooping cough, but a new strategy was needed combat the ongoing epidemic.

    “The vaccine is still the best way to reduce transmission of the disease and reduce cases, but it appears to be less effective against the new strain and immunity wanes more rapidly,” he said in a statement.

    There’s the evidence that the strategy needs to be changed. What have you got?

  35. My comments weren’t even making it into moderation for some reason.

    At any rate, Greg. We have a new strain of pertussis that is arising and is not covered by the vaccine. The evidence you present indicates that a new strategy is needed for the new strain. It is not evidence that the program should be scrapped entirely, which is what the Health Minister proposes.

    We can reasonably expect that, if caregiver immunization rates decline as a result of the defunding of the program, we will see an increase in the number of pertussis cases caused by the strains that are covered by the vaccine.

    I can fully accept that the program may need to be altered. But, again, the minister is proposing ending the program completely, with nothing to fill the gap between the current system and whatever will eventually address things more effectively.

    When I get some more time, I’ll try to post a comment I lost earlier that has some back-of-the-envelope calculations on costs.

  36. @Greg

    BTW, your CAM analogy is flawed. CAM, in nearly all cases, has such low prior plausibility as to be, for all intents and purposes, impossible. There is seldom any legitimate question regarding whether or not it works, and the requirement of rather extraordinary evidence puts the onus firmly on the part of the CAM proponent.

    In the present case, there are valid questions on both side of the program as to efficacy. On the pro side, we have a great deal of prior evidence that the pertussis vaccine works quite well to reduce the incidence of disease. On the con side, we have evidence of a new strain accounting for a majority of the current cases. There is legitimate question, therefore, whether continuing the program is wise or cost effective. An added element to this is that the reason we are seeing a majority of cases being caused by a novel strain of pertussis is that the strains covered by the vaccine are not occurring because of the vaccine. It is entirely reasonable, therefore, to ask the Minister to support the decision with evidence that not only is the program ineffective with regard to the current dominant strains, but also that it is not needed to prevent infections caused by the strains covered by the vaccine.

  37. Greg

    @Todd
    Of course my CAM analogy is flawed: the science outweighs the “I was here first” argument. So thank you for proving your own argument false. See what I did there?

    Your second paragraph is a variant on, “teach the controversy.” In it, you attempt to portray both sides of the argument as reasonable, and therefore both worthy of consideration. The only problem is that your side has no evidence to support it.

    Actually, the best evidence seems to come from the petition, which quotes the results of the analysis. From the petition: “to prevent a death, 83,333 to 262,388 parents would need a booster. This may cost up to $200,000 per year of life a baby gains (QALY).”

    These are *terrible* numbers. Considering that most fatalities will be infants, that puts the cost to save a life at up to $16.2M (average Australian 81.5-year life span). In fact, after quoting these numbers, the petition doesn’t even bother to contest the obvious lack of cost effectiveness. It simply moves into the emotional argument: “Have you calculated the impact of losing a child for each family?”

    The fact that it will save lives is not enough. It needs to be good at saving lives. And this program is not.

  38. Wzrd1

    It’s interesting that a non-peer reviewed report is touted as reason to cancel an inexpensive program that prevents infectious disease.
    As Victoria seems to wish to spread infectious disease, perhaps the US should restrict entry of anyone from Australia (as it’s not feasible to screen for exposure to Victorians).
    Indeed, we should have long ago closed our borders to those nations with rampant epidemic infectious diseases that are preventable, as many, many measles cases were imported to the US from many nations where measles is epidemic!
    Perhaps THEN, those laggard nations will then fix their problems.
    Of course, I’m also for quarantining anyone who refuses to vaccinate, save the few who CANNOT vaccinate for health/age reasons. It was done in the past for TB, it can again be implemented for the safety of the majority of the populace.

  39. @Greg

    I’ll try to recreate the post I lost when I have more time. Suffice to say that, worst-case-scenario, every infant born is exposed to pertussis, the resulting expected hospitalizations alone would amount to over $700 million. If half are exposed, the costs are about $300 million. Now, that is for an average 5-day stay with zero complications (e.g., no ECMO) and does not account for the cost of antibiotic treatments, prophylaxis to other potential exposed individuals, lost days of work or funeral expenses for the resulting deaths (116 worst-case scenario, 58 for the 50% scenario).

    Again, I’ll try to flesh this out later on when I have a bit more time to redo the calculations and type it up.

  40. Greg

    @Wzrd1
    The report you refer to is not a scientific paper; it doesn’t address clinical effectiveness. It’s from a governmental board that assesses cost-effectiveness of phamaceutical treatments. It would, for example, evaluate whether the newest and greatest cancer drug was worth the money, or delivered poor years-added per dollar.

    That’s what they did here: they calculated what it would cost per year of life saved. And the numbers for this program are atrocious.

    @Todd
    Now you’re presenting a false dilemma. The choice isn’t between keeping this program and immunizing nobody. Australia administers free pertussis vaccines at 2, 4, and 6 months, 4 years, and 15-17 years. Your “worst case scenario” numbers are irrelevant.

    Face it. There’s a government body that knows what it’s doing, and it has showed that the free vaccines for parents program is cost ineffective based on the best available data. You are not going to be able to mount a scientifically justified argument against that.

    If you want to lobby for something, lobby for inclusion of a new pertussis booster for all adults over the age of 20 in the National Immunization Program.

  41. @Greg

    Regarding your flawed CAM analogy, you compound your error by building a straw man (i.e., that I was arguing that simply because the program was in place, the onus was on those calling for its dissolution, absent any other factors). The pertussis vaccine is effective at preventing infection by those strains included in its formulation. As such, there is sufficient reason to accept, barring contrary evidence, that a program providing free immunizations to caregivers would reduce the incidence of pertussis among families of newborns and that it is cost-effective (more on this below).

    Again, your “teach the controversy” analogy is flawed for the same reasons that your CAM analogy was flawed. You assume that the two sides are unequal (that one is robustly supported by evidence and the other has none). That is not true. As I mentioned above, the scientific consensus shows that pertussis vaccine is effective at preventing infection and that it is a cost-effective means of doing so. No evidence has yet been presented that the program in Victoria is cost ineffective. That is what I am asking for.

    The choice isn’t between keeping this program and immunizing nobody.

    Now you’re arguing against a straw man. I never made that argument. Yes, children are still able to receive free immunizations, but infants are still quite vulnerable before the series is complete. During that time, their caregiver may pass along an infection to them, for which they are not fully protected.

    it has showed that the free vaccines for parents program is cost ineffective based on the best available data

    Wrong. They have asserted that such is the case, but they have not shown it.

    lobby for inclusion of a new pertussis booster for all adults over the age of 20 in the National Immunization Program.

    I would heartily support that, actually, as well as improved education of adults on the necessity of boosters.

    Now, to the numbers that I tried to post earlier but lost. Many of the sources used are via the post I made up at #30. Because I used U.S. data for that analysis, I’ll continue that here.

    Victoria had 72,491 births in 2011.
    Infection rate of pertussis: ~80%
    Hospitalization rate in children: ~69%
    Hospitalization length of stay: ~5 days
    Death rate in infants: ~.14%
    Hospitalization cost/day (no complications): ~US$3,750
    Cost of Tdap for adults (CDC cost): US$26.53/dose

    In a worst case scenario, where all infants born are exposed to infection, there will be about 57,993 infants that develop pertussis. We would expect about 40,015 hospitalizations and 81 deaths. The cost of complication-free hospitalization (e.g., no ECMO needed) would amount to somewhere around US$750,281,250.

    If that number is reduced to only half of the infants being exposed, we’d have 36,246 cases of pertussis in infants, 25,010 hospitalizations, 51 deaths and the complication-free hospitalization cost would total around US$468,937,500.

    Even if only 10% of the infants were exposed to pertussis, we would still see 5,799 infections, about 4,001 hospitalizations and 8 deaths. Hospitalization costs would be around US$75,018,750.

    For the sake of argument, let’s assume that each of those births was a single birth to different families, and that each family consisted of two caregivers. That means we would have 144,982 adults that would be eligible to receive the vaccine for free under the government’s program. The total cost to give each of them a booster would be US$3,846,372.46.

    Now, I admit that these calculations are rather simplistic, as they do not account for the novel strain of pertussis, administration costs and so on. They also do not account for other costs associated with infection, like antibiotic treatment, hospitalization with complications or funeral expenses. Nor do my calculations account for increased costs since 2009, when I first gathered the data. The point is clear, though, that prevention is significantly cheaper than treating.

    You should also consider that the reason that the majority of cases are a novel strain is that the vaccine-prevented strains are, well, being prevented. The fact that the vaccine does not prevent the novel strain is not a valid argument for discontinuing the program.

    The health minister argues that the program should be defunded, effectively ending it. The proposal is not to put something more effective in its place, but simply to take it away. That leaves a void which will, quite likely, lead to a decrease in vaccine uptake, meaning lower herd immunity, meaning potential increase in cases and increased burdens on the medical system.

    As I said, the program may not be perfect and could be altered in some way to make it more effective. Development of an improved vaccine that includes the newer strain(s) should also be encouraged. But I’ve yet to see a valid argument made for discontinuing the program completely. In the absence of evidence, it is rather short-sighted to support the move, especially considering that removal of the program could actually result in greater expenses.

  42. flip

    @31 Greg

    And then you need to compare it to the cost of other ways of preventing pertussis infections.

    What are these other ways?

    @35 Greg

    “The vaccine is still the best way to reduce transmission of the disease and reduce cases, but it appears to be less effective against the new strain and immunity wanes more rapidly,” he said in a statement

    Funny, that statement suggests to me that because immunity wanes faster, we need more people getting booster shots. I agree with you that the program probably needs tweaking, but I don’t see any major reason why it needs to go altogether.

    @41 Greg

    If you want to lobby for something, lobby for inclusion of a new pertussis booster for all adults over the age of 20 in the National Immunization Program.

    Why can’t we do both? (Lobby for a new booster *and* lobby for this program to be kept) I wouldn’t expect to get both, but I would expect to keep pressure on the government to ensure some form of improvements to be made in regards to booster shot programs.

  43. Greg

    @Todd
    No, your numbers are the straw man. You’re concocting a situation for which you have no evidence that it’s even plausible (since it didn’t exist before the free parent program), and using it as justification for your assertion that the program needs to be preserved. Your numbers speak to justifcation for a National Immunization Program (which they already have), and say nothing about the effectiveness of a free parental booster program.

    The two sides *are* unequal. One side has a proven methodology, research, and numbers showing that the free parent immunizations are likely a horrendous waste of money in terms of dollars spent per year saved. On the other side is a guy with no evidence to support effectiveness, cost-related or otherwise, doing napkin math for a problem that doesn’t exist.

    I’m done with you. It’s obvious that you’re an ideologue unable to accept scientific work that contradicts your world view. The evidence shows that it’s a waste of money. You reject that finding because it isn’t what you want, and respond with poor logic, irrelevant statistics, cost estimates for a problem that isn’t under discussion (complete lack of immunization), and a conspicuous vacuum of evidence that actually supports the program. It’s all very antivaxxer, really.

    @flip
    While it is not my job to craft NSW’s strategy to combat the pertussis epidemic, I could suggest the following approaches to be evaluated: subsidizing vaccines for everyone; a marketing campaign for everyone to get a booster shot; subsidizing research into a vaccine that is more effective against the new strain.

    Just because the current vaccine is the best possible weapon, doesn’t mean that it’s being targeted or paid for efficiently. For example, what if research showed that a nurse mentioning the vaccine to newborn parents would get equivalent numbers to buy it? And from the report comments, there are too many available infection people for the parental program to be effective. So halve the subsidy to 50% and double the target pool. Or whatever. Free to parents is not the only way.

    You can do both, but the research shows that the parent program is a waste of money. If you love wastes of money for ideological reasons, by all means support it. But if you like evaluation of drug programs to determine whether they save lives and are an effective use of limited government funds, then accept the board findings, reject the petition, and lobby for an effective response to the epidemic.

  44. Nigel Depledge

    Greg (35) said:

    @Todd
    No, that’s crap reasoning. CAM education is in place at universities, therefore it’s the onus of opponents to show that CAM is crap?

    What the hell does CAM have to do with a vaccination programme?

    As it happens, though, it’s pretty easy to show that most forms of CAM are, indeed, crap. For example, homeopathy has never performed better than a placebo in a controlled, double-blind clinical trial.

    OTOH, you are ignoring the point, and trying to argue by analogy.

    The onus is not a function of who got there first. The onus is *always* to provide evidence to support your side of the argument.

    Ideally, yes.

    However, things are the way they are, and change is what people notice. If we’re going to change something, maybe we should make sure that we actually are changing it for the better, based on real data.

    To provide you with an example, I don’t think paracetamol (acetaminophen in the USA) has ever been tested in a controlled, double-blind trial. According to your line of reasoning, it should be withdrawn from sale instantly, until someone has bothered to acquire the data to prove that it works.

    And right now, all you’ve got is, “more vaccinations are better.”

    Yes. Did you have a point?

    You’ve got *absolutely nothing* to show effectiveness or relative effectiveness, both in absolute and per dollar terms.

    So what? Unless the guys who are cancelling the free supply of vaccines can supply data to show that the free vaccines are ineffective, it makes most sense to continue them. Have you never heard of the precautionary principle?

  45. Doug

    Phil,

    On the subject of antivaxxers, I wonder if you’ve seen this:

    http://jennymccarthybodycount.com/Jenny_McCarthy_Body_Count/Home.html

  46. @Greg

    The evidence shows that it’s a waste of money.

    So show it! That’s what I am asking to see. Based on everything we know about pertussis, the vaccine and epidemic management, the vaccine is the most effective means of preventing its spread. I demonstrated that there is sufficient reason to believe that a program giving free pertussis boosters to primary caregivers of newborns is cost-effective, based on actual facts. You have presented nothing in support of scrapping the program. The closest you came was evidence suggesting that the program should be altered in some manner.

    To recap, here is what the Health Minister is proposing: scrap the free vaccines for primary caregivers and put nothing else in its place.

    Here is what the Health Minister is not proposing: alter the free vaccine program; replace the free vaccine program with X; complement the free vaccine program with Y.

    I’m arguing against what the Health Minister is actually proposing, based on the fact that there is no evidence that has been presented supporting that action. Again, I am perfectly amenable to changing my position, if the evidence is presented and actually warrants it.

    Now, to quote you, evidence or GTFO. Enough of your argument by assertion, hearsay and caricatures of my actual position. Show me the data.

  47. Greg

    @Nigel
    re. The CAM analogy. Earlier in the thread, Todd stated:
    “The onus is on the one moving to end the program to justify the change.”

    The CAM analogy was intended to show the falsehood of that statement. I believe the onus of proof is on the people with the crappier evidence. In this case, I think it’s Todd.

    However, within the context of this government process, the onus is very clear. Submitters have to demonstrate evidence that the submitted regimen (drug + indication) will actually do what they say it will. And according to the report, the submitter submitted no evidence regarding the regimen preventing subclinical infections in adults, nor preventing infections in infants.

    Here is the essence of the science: you don’t get to assume clinical efficacy if you haven’t provided evidence for it. They don’t approve drug regimens because “it makes sense” or they’re already in place. They approve them based on whether there’s evidence to support them. There’s the precautionary principle for you.

  48. @Greg

    Wow! You actually provided something in the way of evidence. Congratulations on doing something more than merely asserting your case as true. I’ll take a look at it more closely when I have some time to digest it and evaluate it. Thanks for finally stepping up.

  49. Greg

    The … exchange between me and Todd illustrates something I’ve been thinking about for some time. Todd wanted the opportunity to “evaluate” the PBAC report. The problem is, even if Todd is able to competently evaluate it, not everyone who has a vaccine opinion will be. We can’t all be experts in everything we need to make decisions about.Even with two undergraduate astrophysics courses behind me, I can’t competently evaluate the astronomy that Phil throws at me; I suspect there are very few who are his peers.

    So what’s really needed is not for everyone to demand the evidence and evaluate it for themselves, though that can work in rare cases. What’s needed is a methodology for expert evaluation. The important thing for us is that we choose people who have a track record of making well informed and reasoned decisions, rather than decisions that agree with ours.

    This, I believe is the crux of my objection to Todd. I believe he needs to show that he can produce a better informed and reasoned conclusion than the PBAC, a science-based government body that’s been around 1954. And that’s a pretty tall order.

  50. Nigel Depledge

    Greg (49) said:

    @Nigel
    re. The CAM analogy. Earlier in the thread, Todd stated:
    “The onus is on the one moving to end the program to justify the change.”

    The CAM analogy was intended to show the falsehood of that statement. I believe the onus of proof is on the people with the crappier evidence. In this case, I think it’s Todd.

    Yes, this is what you said earlier.

    However, this is merely an assertion. You have not demonstrated it.

    For example, we have bucketloads of evidence that vaccination in general prevents the spread of diseases. You have not addressed this. You seem to be ignoring it.

    IIUC, what you seem to be saying is that this specific programme was set up in the first place with no evidentiary support that it would do what was claimed.

    OK, that may well be an issue, but it is a separate one from the requirement to show evidence that it isn’t cost-effective. The claim wasn’t “we will cancel this because it was set up without evidentiary support”; the claim was “we will cancel this because it isn’t cost-effective”. Therefore, there is a need to support that claim.

    However, within the context of this government process, the onus is very clear. Submitters have to demonstrate evidence that the submitted regimen (drug + indication) will actually do what they say it will.

    Yet you claim that this programme was set up without such evidence.

    This is inconsistent. Surely the vaccine itself had evidence from clinical trials that it was effective before it was approved. I would be immensely surprised if this were not the case. Thus, your claim that there is “no evidence at all” to support the continuation of this vaccination programme is starting to look thin.

    If we narrow the context, and look only at this specific application of the vaccine (i.e. free provision of the vaccine to parents and carers), there might have been no specific trial to look into this, but that does not necessarily render the more general evidence inapplicable. Yet the implication from your comments is that it does.

    And according to the report, the submitter submitted no evidence regarding the regimen preventing subclinical infections in adults, nor preventing infections in infants.

    Yeah, good luck with getting that trial through the ethics board. Maybe there was a good reason that this specific programme did not get the evidence that you seem to feel is critical to its continuation.

    To the best of my (far-from-exhaustive-but-not trivial) knowledge, placebo-controlled drug trials involving infants are simply not carried out. Anywhere.

    As far as I am aware, nearly all drugs administered to infants have their doses and applications based on a mixture of extrapolation from trials in adults and post-introduction data collection.

    Here is the essence of the science: you don’t get to assume clinical efficacy if you haven’t provided evidence for it.

    Except that, in the real world, this happens all the time.

    They don’t approve drug regimens because “it makes sense” or they’re already in place. They approve them based on whether there’s evidence to support them. There’s the precautionary principle for you.

    If we were talking about a brand-new, untried intervention, you would be correct.

    But we are talking about a vaccine that has been shown to provide at least some level of immunity in the majority of patients. We are talking about giving this vaccine to those most closely involved in the care of people too young to be immunised. The precauttionary principle is clearly in favour of applying the vaccine. At worst, it doesn’t work very well, and you’ve wasted some money. At best, you have saved the lives of some infants.

    Now, it could well be that your argument is correct and that it isn’t cost effective, but you were not (until you provided that link in #48) supporting your contention with any evidence. Instead you were claiming that it should be discontinued because this specific use of the proven vaccine had not been tested. But your contention was carelessly brushing aside the ethical difficulty in acquiring the specific evidence that you deem so critical. Drugs regulators frequently have to make decisions like this : to allow (or not) a different use of a drug in a circumstance where a rigorous trial of that regimen is either ethically untenable or would introduce delays to treatment that bring about unnecessary suffering.

  51. Greg

    @Nigel
    The report states that this is the first time that this regimen has been submitted. That means that it has never been approved by the PBAC. While I don’t know for sure, I can suggest a possible way this situation came to be.

    The health system of Australia was looking for a way to stem the tide of the pertussis outbreak, and someone suggested this cocooning strategy. It seemed plausible, and the risks seemed low, since the booster would be being administered to those who could have received it already. so they said, “We’ll start up the program, submit it to the PBAC, and long term implementation will depend on their ruling.”

    But the PBAC said, “insufficent evidence of efficacy and cost effectiveness.” And that’s the end of that.

  52. Here is an interesting video inlight of the pertussis outbreaks worldwide: public health experts in San Diego are using text-message reminders to increase the immunization rate among 1-year-olds:

    http://sandiegobiotechnology.com/topics/4083/amid-u-s-pertussis-outbreak-san-diego-battling-whooping-cough-with-text-messages/

  53. @Greg

    Okay, so we have a program that was started in 2009. The document you provided was an application by Sanofi-Aventis to get Adacel, specifically, added to the National Immunisation Program with an indication as a booster dose for parents of newborns where there is no evidence of a booster within the previous 10 years.

    The primary finding of the PBAC with regard to that application is that Sanofi-Aventis did not provide sufficient evidence to support the addition of Adacel to the NIP for the indication.

    This particular document does not address the question at hand for several reasons:

    1) The application only focuses on a single pertussis vaccine. There are others available, which could be covered by free vaccine for parents program.
    2) The application seeks addition to the National Immunisation Program, not subsidization within the state of Victoria. The program in Victoria is, apparently, run separately from the NIP. Thus a decision not to include Adacel in the NIP does not necessarily preclude the separate states from covering it.
    3) The finding of the PBAC was that Sanofi-Aventis did not clearly establish the cost-effectiveness of the vaccine with regard to inclusion in the NIP. It was not a finding that providing the vaccine free to parents of newborns was cost ineffective.

    There is evidence to suggest that cocooning can be a cost-effective means of reducing the risk of pertussis in newborns. (I’m not including links, so I don’t get caught in the spam filter, but plug the PMIDs into PubMed to find the original sources.) For example:

    Coudeville et al. (2009) “Adult vaccination strategies for the control of pertussis in the United States: an economic evaluation including the dynamic population effects” (PMID 19606227).

    In 2007, the Global Pertussis Initiative recommended cocooning strategies and including pertussis boosters in countries where it was feasible to do so, also stating that, ideally, universal adult pertussis immunization would be best:

    Forsyth et al. (2007) “Prevention of pertussis: recommendations derived from the second Global Pertussis Initiative roundtable meeting” (PMID 17280745)

    In the U.S., the CDC’s Advisory Committee on Immunization Practices concluded in 2011 that cocooning strategies alone may not provide sufficient protection to newborns, but firmly supported immunizing close contacts of newborns:

    Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months — Advisory Committee on Immunization Practices (ACIP), 2011 (PMID 22012116)

    Other papers that I came across suggested similar things, that while programs providing boosters for parents may be difficult to implement and that, on their own, may not provide sufficient protection, immunizing adult close contacts of infants was still highly recommended, particularly when done in concert with other programs to reduce pertussis.

    Now, back to the matter at hand. The Health Minister in Victoria claimed that it was not worth funding the program because “it does not get the clinical result required”. Now, no mention has been made of exactly what clinical results are required, nor has there been any evidence showing that the program is cost ineffective. The program has also been supported by the Australian Medical Association and physicians who regularly see new pertussis cases coming into their practices.

    From what I have seen thus far, there is ample evidence to suggest that the program can help but may need to be altered or combined with other strategies. No evidence has been presented showing that the program should be scrapped entirely, with nothing else put in its place, nor that the program is, in actuality, cost ineffective.

    If Mr. Davis is going to argue that the program is cost-ineffective (i.e., “not worth funding”), then he needs to show that that is the case.

    @Nigel

    Placebo-controlled studies in children can be done, but there are a number of caveats, such as that known effective alternatives cannot be withheld if they are available. Placebo-controlled trials in children are generally only allowed if there are no other already-approved treatments available and the aim is to determine whether a novel drug or device is effective.

    As to doing a formal study of whether or not a cocooning program would be effective at reducing the risk of pertussis in newborns, a large-scale, prospective population study would be needed. Given the scale and scope, governmental agencies would be in the prime position to conduct (and fund) such studies, rather than leaving it to smaller organizations.

  54. Greg

    @Todd
    Hey, I’m not the one you need to convince. I have no power in Australia. Write to the PBAC and tell them that they’re doing it wrong and that they need to prove to the submitter that the regimens are not cost effective and not efficacious, as opposed to the other way around.

  55. Paul in Sweden

    Slightly off TOPIC: Phil, Would you be so kind as to share with us(ME) your thoughts and understanding regarding the narcolepsy Scandinavian Pandremrix vaccine issue. Is it bogus? Thanks in advance -Paul

  56. Greg

    @Paul in Sweden
    Try contacting Phil directly at The Bad Astronomer “at” gmail “dot” com. I think the odds are better than hoping he’s reading this thread.

    @Todd & Nigel
    I think there are three different conversations taking place.

    1) Sanofi-Aventis has asserted a scientific hypothesis to PBAC: “Adacel is effective and cost-effective in preventing infant clinical pertussis infections when administered to both parents of the infants if they have not had boosters within 10 years.”

    PBAC replied, you have not supplied sufficient evidence to prove that hypothesis. In particular, while you have evidence that Adacel is effective at preventing clinical infections in the immunized, you have not shown that it is effective in reducing transmission rates, nor what the effects on the herd immunity of the infant’s environment are.

    2) I believe Todd is making the argument, “The cocooning strategy is the most reasonable known direct approach to minimizing the pertussis risk to infants.” And, with the exception of his napkin math cost effectiveness analysis, I think he’s made a pretty good case. Unfortunately, no-one is having this discussion with him (well, maybe Nigel). I’m interested in 1, and the health minister is in 3 (and using 1 to inform 3).

    3) I think the NSW Health Minister is addressing some variant of the question, “How do I best spend my budget to attack the pertussis epidemic in NSW?” It’s distinct from 2 in that it’s intimately concerned with available resources, and more broadly scoped.

  57. Greg

    @Todd
    I would like to tweak two points from your analysis of the PBAC finding.

    1. You say that this finding was only about Adacel, and other vaccines are available. While technically true, the finding also says that Boostrix was rejected in July 2011.

    2. You say, “It was not a finding that providing the vaccine free to parents of newborns was cost ineffective.” Also technically true, but what they did find was that according to the submitter’s provided evidence, Adacel had a (highly uncertain) ICER of $45K-$75K, and that this would likely increase (get worse for the submitter) as better evidence was provided. The claim was rejected partially because of this highly uncertain ICER.

  58. flip

    I’m confused: is Greg arguing that the program should be gotten rid of based on lack of efficacy within this *specific* instance, or is he arguing that vaccines themselves haven’t shown any efficacy, therefore this program is based on assumption only? Is he arguing only over cost effectiveness, or medical effectiveness? Is he arguing that herd immunity is only an assumption?

    I will leave the report he provided for others who are better equipped at understanding them; ie Todd and Nigel. Who as always say things better than I could.

  59. Paul in Sweden

    @58. Greg Says:

    Good advice. I rarely send Phil email because I don’t want to disturb him and in this case I thought my question sort of fit in the tread. I really don’t know on this one. In Sweden/Finland they are really talking this narcolepsy Pandremrix vaccine issue. I tend not to believe. tc -Paul

  60. Greg

    @flip
    I’m less interested in the funding question because i) I think it’s a policy question rather than a strict scientific one; and ii) a reasoned approach to health budget allocations requires far more information than is available to us thread bloggers. There’s a reason NSW has an entire ministry dedicated to figuring out such things.

    However, if you’re actually interested in my opinion about the defunding, I think that the PBAC and the NSW Health Ministry have demonstrated a consistent and science-based approach to their decision making, and that we should be more trusting of their process. That is, I see no evidence of a Meryl Dorey plot here; at worst some prioritization disputes.

  61. flip

    Actually Greg I’m more interested in you answering my questions directly. None of what you wrote specifically addresses my point:

    Are you arguing about this because you think vaccines have not been proven to be efficacious (and therefore the program needs to be stopped)?

    Or are you arguing about this because you think that while vaccines have evidence of efficacy, in this particular case, the program is not doing enough to show efficacy?

  62. Greg

    It doesn’t matter what I think; it matters what can be shown through evidence. And in this case, PBAC found and I accept that the submitter did not show that giving free boosters to parents was either i) effective at preventing infections in infants; nor ii) cost effective in doing so. As such, I believe i) PBAC was justified in not recommending inclusion of that regime; ii) that the NSW Health Minister was justified in following that finding and discontinuing the program.

    If this is still insufficient, let me know.

  63. flip

    Still confused. Given that my questions were really ‘yes/no’ answers required, I’m going to stop participating in this discussion. You’re a little too vague for my liking. All you had to do was say “I support vaccines in general, because the evidence shows they have efficacy and are cost-effective, but in this particular case, the program isn’t working and needs to be stopped”. I still have no idea whether you have an overall problem with vaccines, or if you’re just arguing about this specific program.

    Considering you could have easily answered my questions in clear terms, I’m going to move on to other discussions.

  64. Nigel Depledge

    @ Greg (53) -
    Well, that seems to answer most of my objections. Thanks for setting things straight.

  65. Looks like NSW government is not going to up and cut the program completely. Starting July 1, pertussis vaccines will be provided free to new mothers within the first two weeks after giving birth. Dads will, it seems, have to pay out of pocket. This program will “continue until more definitive evidence becomes available about the effectiveness of vaccinating adults to protect new babies”.

  66. Greg

    @flip(65)
    I considered telling you the answer, but I’ve decided not to. It’s irrelevant. Using my pro- or anti-vaccine stance as a factor in this discussion is either an appeal to authority or an ad hominem argument (depending on your stance); both are logically invalid. You don’t get to discuss me, only the substance of my arguments (see 64).

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