Riding the Tiger: or, Flirting with the Antivaxxers.
[PreProda: Yeah, after some really enlightening discussion in the Comments section, I’m walking back about 90% of this post. But I’m leaving it posted both because the comments are so interesting, and as a kind of historical artefact to remind me of what happens when I don’t take the time to think things through.]
[Proda: OK, now I’m having third thoughts, since a big chunk of the following argument derives from a) a discussion conducted over too many beers and b) my apparently-erroneous belief that flu vaccines have grown less effective over time. In fact, they apparently were never very effective. For details, check out the mea culpa down in Comment 43.
I’m having second thoughts about vaccination. [Update: But not just vaccination. See coda.]
Not because of autism or mercury or any of that Gwyneth Paltrow bullshit. Not even because I think vaccination is a bad idea— at this stage at least, we pretty much have to stick with the programs.
I am wondering, though, if it might have been a bad idea to have started down this road in the first place.
It all comes down to beers and budworms.
Beers. I had lunch the other day with my favorite Cassandra and fictionalized antihero, Dan Brooks. He drops through every now and then in the course of his travels, usually bearing bad news. This time was no different; we talked about the future, and the increasing statistical likelihood that by mid-century we’ll have lost both half the world’s species and half the world’s human population (not that one of those things is any great loss). We talked about Cape Town, and Lincoln, and LA— all those places where local water wars are just around the corner. The imminent draining of the Great Lakes to water the gardens of millionaires in Palm Springs. The near-ubiquitous use of mouth guards by climate-change scientists. And by the way, have you heard the news? Cholera’s moved back into Canada.
Dan’s an evolutionary biologist. He takes the long view. (When I pointed out the obvious fact that only a few weedy, super-resilient species are likely to survive the Anthropocene, he shrugged and said “So what? Recovery after every major extinction event starts with only a few weedy species, and they’re always enough to get us back up to high biodiversity in only ten or twenty million years.”) He’s also a parasitologist: comfortable talking about epidemiology, the parameter values of the rolling pandemics that’ll start hollowing out our urban centers sometime in the next ten or twenty years. My own background (putting aside the marine mammal thing) is more along the lines of general ecology— so when Dan started talking about outbreaks and countermeasures it was ecology, not epidemiology, that clicked.
“You’re talking about the spruce budworm,” I said.
A quick backgrounder for those who weren’t around in the back half of the Twentieth Century: the spruce budworm is a kind of caterpillar that wreaked havoc on coniferous forests throughout eastern Canada from the sixties at least through the eighties (it may be wreaking still for all I know, but I unfriended the little beggars once I left grad school). The logging industry of the time, as is the wont of logging industrialists everywhere, responded to the infestation by spraying the shit out of the forests with chemical insecticides. The budworm (as is the wont of fast-breeding life-forms everywhere) counter-responded in three ways:
- Most of them died.
- The few who didn’t bred back an army of Mk-2 budworms who weren’t quite as easily impressed by malathion.
- They cranked up their reproductive rate to compensate for increased mortality.
Before long we were faced with a budworm population that we could keep sort of under control, but only if we never stopped spraying. What had once been a purely intermittent event was now a continual, low-level outbreak kept barely in check by pesticides. The moment we let up on the chemicals, those resistant, faster-breeding budworms would tear through the forest like a billion little chainsaws.
What Dan made me consider was the proposition that mass-vaccination programs have done pretty much the same thing to us.
For generations now, we’ve been vaccinating ourselves against (for example) the flu. It used to work really well; vaccination is just a way of programming the immune system with a target-lock for invaders, and it’s pretty easy to do that when all the invaders have a common immunological profile:
Innocent, naive virus.
Of course, the moment you do that, you’ve provoked a Red Queen scenario. The flu doesn’t just sit there like a candyass: you target that peak long enough, it’ll diversify:
Experienced, world-weary, 5th-degree-black-belt-don’t-fuck-with-me virus.
This is how you go from Praise Be It’s A Miracle Everyone Should Get This! to Well, this year’s vaccine is only about 20% effective but you should get a flu shot anyway because we don’t know what else to recommend. At the same time, vaccination has been protecting people with weak immune systems, people who would otherwise have died. (Of course that’s what we’ve been doing; that’s the whole damn point of vaccination programs.) But since we’ve so greatly reduced the selection pressure that would otherwise weed out the immunological weaklings, vaccinated populations have, over time, become inherently less resistant genetically to the bugs that vaccines protect them against. We’ve outsourced our immune response to the pharmaceutical industry.
Tl;dr? We’ve been making the disease stronger while making ourselves weaker at the same time. It’s the spruce budworm all over again.
And now, like the spruce budworm, we don’t dare stop vaccinating. We’ve built such a tough suite of microbial motherfuckers that if we ever take our foot off the gas, they’ll tear through us like a brush fire. In terms of disease resistance, our genetic load is now far far higher than it would have been if we’d just let nature take its course a hundred years ago. Dan calls it riding the tiger—except we’re talking about a tiger that’s been pumped full of steroids since cub-hood, and a rider that’s turned into a 98-lb weakling in the meantime. It’s only a matter of time before that damn cat throws us off and has us for dinner.
I’m guessing this is partly where the rolling-pandemics-in-ten-years thing comes from. I don’t know what we can do about it at this point. I suppose we could try a CRISPR fix— engineer genetic resistance back into our species before it’s too late. But I don’t know how easy it’ll be to scale that (relatively new) technology up to species-wide deployment.
I suspect Dan’s right. Nature will take care of the problem as it always has. Although there’s one sliver of hope I might summon:
Far as I know, we still have spruce forests in New Brunswick.
Coda: On second thought, I probably shouldn’t have limited this argument to vaccination; I should have explicitly included drug-based countermeasures as well. They’re different approaches— one targets the invader, the other reprograms the immune system— but in both cases, the next generation favors those who get around the countermeasures (either by being resistant to the drug, or having a shape that differs from the target profile programmed by the vaccine). Different tools, but same principle. That’s the point I’m making. I’m not actually confused about the difference between drugs and vaccines.
It’s just that drug-resistant diseases are old news, hardly worth the alarm. The idea that vaccines are subject to the same processes is one of those things that seems obvious in hindsight, but I’d never thought about it before.
Things are looking just swell for the next few decades, dont they? Everytime i think in earnest about the future i want to scream, gibber and claw my eyes out.
Thankfully i have videogames and soda to soothe me. Might as well enjoy it while it lasts. Here is to hoping my Immune System is still up to scratch and targets Superpox and Megacholera in the future instead of some harmless pollen.
We need to get a level above, and stop using techniques from the natural environment, ie, our natural make up verses theirs – that’s like fighting with sticks and complaining because the other guy went and got bigger sticks. Things die out, including types of germs, if you can hit them with something so outside their environment that they have no defense, they can be exterminated. Assuming that is what we want to do.
“Far as I know, we still have spruce forests in New Brunswick.”
I’m not a scientist, but I figure “kill all hosts” is not the greatest survival strategy for a bug. Maybe the Superpox will mutate into a less lethal form, once it’s killed enough humans?
Didn’t something like that happen with the Ebola virus – the more recent strains are supposedly less lethal?
‘oogled that.
What’s Spruce Budworm? | Healthy Forest Partnership
http://www.healthyforestpartnership.ca/en/whats-spruce-budworm
“Every 30-40 years populations of spruce budworm increase resulting in an outbreak or epidemic. Such an outbreak is currently occurring in Quebec and populations are beginning to rise in New Brunswick and the rest of Atlantic Canada….”
It’s not the the greatest survival strategy for anything— but that doesn’t mean it never happens, because natural selection has no foresight whatsoever. If some random mutation results in high lethality, or some bug gets into a naive environment that hasn’t had a chance to develop countermeasures, you could easily get a die-off that wipes out parasite and host alike.
Good call on Ebola; its extreme lethality is why it never really got a foothold. It killed its hosts too fast for effective spread (as opposed to, for example, AIDS). I hadn’t heard about its lethality declining recently, but it’s certainly possible. That does happen, if the initial contact isn’t too catastrophic to make everything moot.
I’m probably in need of some remedial tutoring for the article, because I don’t see the downside–or at least I don’t see the case for alarmism.
Best case scenario–an aggressive new strain of an old biological adversary wipes out a significant portion of the population too stupid or too “whatever” to immunize themselves, diminishing their genetic influence on the species. Species is stronger as a result–whatever gene cocktail that promotes anti-vaxxerism is diminished.
Worst case–an aggressive “remix” of an old adversary resets the playing table, bypassing immunization to wipe out a (less than 100) percentage of the entire population in line with the days prior to inoculation. Back under the thumb of “nature”, surviving population stronger as a result, and now with the tools to adapt more quickly than in the past.
Obviously speaking on species level–nobody wants to watch their child die. Completely awful for anyone living through it. Just dont see the case for species alarmism here, when it would seem to be self-correcting.
Yup.
https://www.google.com/search?q=ebola+lethality+declining%3F
The problem with the “a little pandemic will be fine” line of thinking is that there’s no possible pandemic scenario that doesn’t also involve a thousand-megaton nuclear exchange.
Lots of people die in Russia, let’s say. How long does it take the Russians to decide that the Chinese secretly have the cure, and are holding it in reserve to take over the planet once the Russians are all dead? Russians I know would think of that after five minutes. After that there’s just the “we nuke one of your cities a day until you hand over the cure” (that they don’t have). Since the Chinese know the Russians will do this, they HAVE to strike first. Boom boom boom boom and hello ecocide.
Substitute Americans for either side or swap roles as your ideology demands.
Anyway, this is just another endearing example of Mr. Watt’s inexplicable optimistic streak. We don’t have ten months, let alone ten years.
Good point. I’m on board with super-Influenza as a potential extinction level event now, just not due to the biological factors alone. It would require a lot of help from us.
I think we’re all going to die from food allergies, either from reaction to something we eat, or starvation.
Gluten’s a bitch.
Immunization IS NOT like single drug agent that targets an organism. Immunization simulates a disease, stimulating the immune system without inducing morbidity. An antibody response by a healthy individual is a broad polyclonal response, targeting a variety of epitopes on the pathogen.
If anything, the inability to effectively vaccinate against the flu is a quirk of the influenza virus itself, not a failure of vaccine theory in general. Vaccines are by far the most robust public health strategy in existence, because it exploits the strengths of a healthy individual. And we’ve barely scratched the field of CD8+ T cell vaccines.
Yes, there is less selective pressure on the MHC thanks to widespread vaccination, but that’s how modern industrialized society goes, and the alternative is eugenicist hell.
Also you fucked up your cdc link, that’s a link to an antiviral drug, which *is* a single agent that pathogens can easily evolve resistances against, *not* the vaccine itself.
In terms of disease resistance, our genetic load is now far far higher than it would have been if we’d just let nature take its course a hundred years ago.
Is hundred years enough to have that big of an effect? It’s about five generations; in industrial countries with the best healthcare systems and vaccination programs, possibly closer to four given the way that the average age for having your first child has been creeping up. Evolutionary biology isn’t my field, but I would have guessed genetic load to accumulate more slowly, especially since vaccines only protect against the most common diseases and people with particularly weak immune systems should still be at risk from all the other diseases.
1. I’m dubious about the argument that we can’t stay ahead of nature forever. Humans having been killing lions, leopards, tigers, etc for a very long time. Not seeing any evidence of new super-lions evolving that are better adapted at killing humans.
Yeah we’re playing Whack-a-Mole with flu and other diseases. Still doing OK. We have seven times as many human beings today as there were in 1950, but how is overall mortality from malaria etc today compared to 1950? I’d bet on the absolute numbers being lower, not just percentages.
2. The weakened immune system argument is just the latest version of “civilisation causes degeneration” which has been argued many, many, times over the years. I think it’s bullshit that pandemics will be caused by inferior immune systems.
The biggest single factor in whether or not people survive epidemics / pandemics is how rich they are. Well off people get better medical care, down to basics like clean water and air conditioning. Poor people don’t get treated properly and die.
If vaccination is weakening our immune systems, people in the poorer regions of Africa, Asia, South America etc are “better protected” than us decadent westerners. Have been since WW2. So why aren’t we already seeing these pandemics decimating Westerners?
I share your general skepticism, but lions don’t produce new generations and mutate over the course of days or even hours. Thank god.
True. Even if Superbug decimates millions, it will most likely be millions in the poorer parts of the world. Swiftly followed by some innovative neo-colonialist scheme to exploit the survivors, no doubt.
Pretty much Dan’s position. Although he continues to hold out hope that we may even be able to save a shred of technological, PS4-playing Humanity. He and others are promoting strategies to that end.
I’m a bit less forgiving. I’m so fucking pissed at the species these days I figure extinction is about all we deserve. (Again, speaking strictly at the species level.)
You’re at least the second person to think that I don’t get that. I dunno. I thought “vaccination is just a way of programming the immune system with a target-lock for invaders” was pretty clear, but I guess not.
Yeah, I was focusing mainly on various kinds of flu. Then again, the way things are going, it could well be some strain of flu that ends up taking us down (if not entirely out)— and I doubt that the Last Man Coughing will expire thinking Oh well, thanks to the effectiveness of vaccination, I’m not dying of smallpox.
And while I’m certainly not going to dispute that vaccines are the most robust public health strategy (just how high a bar that is I’ll leave as an exercise for the reader), I don’t know if it’s entirely accurate to say it “exploits the strength of a healthy individual”. My understanding of the process is that you shoot up your innoculee with a bunch of dead proteins; their shape provides a template for antibody production, while the fact that they’re dead/inactive means the body isn’t at risk of getting sick from the vaccination. It’s that second part that reduces fitness; you’ve isolated your subject from the infection risk— hence, the selection pressure— of initial exposure. Those defenses are now being underutilized, so there’s no pressure to keep them tip-top. (If I can be forgiven for invoking another general-ecology analogy, it’s like what happened during Canada’s hatchery-based salmon-enhancement program on the west coast. They thought those hatchery fish were supplementing the wild population, whereas in fact they were replacing that population with weaker fish who only won out because they had “hatchery privilege” that sheltered them early in the life cycle).
I think it’s a serious understatement to write off this phenomenon as “a quirk of the flu virus”. Vaccines were more effective in the past than they are now; frequency of outbreak and the appearance of new strains are occurring with ever-increasing frequency (or at least they were up to a few years ago, which is when I remember seeing the scary frequency-over-time graph in Science; I spent a few minutes looking for it on my hard drive but came up empty). Vaccines may only be getting less-effective for a “quirk”, but that quirk apparently has the ability to turn on a dime and combine airborne transmission with 75% mortality, all with the flip of a few base-pairs.
I’m not sure you’re using that term correctly. At least, not unless you’re willing to describe every pre-vaccination society as “eugenicist”.
Oops. Careless of me.
Good point. As I understand it, “Genetic load” is defined in terms of fitness in a given environment; the same genotype can have different genetic loads depending on the arena it finds itself playing in. Infectious diseases are part of that environment; so it seems to me that if the epidemiological conditions have grown more virulent, your genetic load can drop significantly even if your own code hasn’t changed that much.
Of course, it’s been a long time since I was conversant with this stuff. My biological insights have grown less fit with disuse. I’m sure someone will set me straight, though, if I’ve made some stupid error.
Dude. Dude.
Take those lions, leapards, and tigers, and shrink them down until they can eat you from the inside. Let them breed every few minutes or hours instead of the years it usually takes. In that case your analogy might be appropriate; but in that case, we’d all be falling over dead from superlionitis.
It’s not just the numbers, it’s the trend. Zika’s coming back (and has, apparently, already made the jump into temperate mosquito hosts, so all those people who told you it would never get out of the tropics are talking out their asses). It’s already present throughout the continental US, and not all of those cases are from travelers. Cholera’s coming back. Monkeypox is poised to. Last I checked Latin America didn’t have any reported cases of Lyme disease, but it does have tick and mammal populations that’ll make perfect hosts for those little corkscrews when some infected tourist cuts herself with a pen knife. You asked about malaria? Last projection I read, they’re expecting malaria to be at the Baltic by mid-century.
All indications are, we’ve already passed the trough. Infection rates are climbing again.
Like you said earlier in your comment: we rich people are better protected. Isolated. But like Dan says (and I echo): that won’t last forever. We rich westerners are increasingly vulnerable; and those in urban centers are the most vulnerable of all.
And when that shit hits the fan, you’re dead right: it’ll be the third-worlders left standing while we go down clutching our X-Boxes.
Nah – the third-worlders will be succumbing to the effects of climate change while we’re coughing our guts out.
Good times.
> The near-ubiquitous use of mouth guards by climate-change scientists.
Huh? Wanna elaborate on that a bit, Peter?
I suppose, then, vaccination can be seen as a time management strategy–a delaying tactic in our race against the micros, and still superior on balance to the alternative. The micros have speed. We can’t beat them in a fair race, so we do what we do best–cheat. We find a shortcut off the official course and buy some time.
Plagues are destabilizing. They cost us time. They cost us *minds* that might have otherwise been useful if not subject to a capricious nature that only cares about your immune system, and not your potential to improve the species in other ways.
So with vaccination we trade optimized immune systems for comparative stability for a time. We trade frequent minor plagues for the risk of the big one. It’s still a good deal on balance. We get a lot done with relative stability–look at all we’ve accomplished since the last of the big European plagues, back when we were still blaming evil spirits and bad odors for these things. We get to cheat and use a greater number of our best minds, which might have otherwise been tied to a disqualifying immune system.
We are now at a point where it’s not impossible to imagine a time where our tools have improved to the extent we really are functionally immune to naturally occurring micros (barring a Behemoth, of course, but that would wipe out “naturals” as well as Vaxxers), only having to worry about the ones we create ourselves. Maybe we’ll even get around to distributing our population off world. Just depends on whether we’ve bought enough time.
Besides, even if we were to go “natural” and just lay down and die for the micros in exchange for a more robust immune system, you’re still forcing the bugs to super evolve in order to bypass it. It seems to me you risk the “big one” either way.
Dan got fitted for a mouth guard just before we met for lunch; apparently all his friends in the climate sciences have had them for years. I’m told it’s become an unofficial uniform of the trade: you work in the field of climate change, you grind your teeth at night. A lot.
The next blog on my reading list is subtitled “Dopamine’s only natural enemy.”
Fortunately, it doesn’t get frequent updates either.
This isn’t the first time we have become dependent on our technology. Try getting rid of mechanized agriculture, and you’d get gigadeaths. Heck, at this point we’d probably get gigadeaths if we tried to wean ourselves off pervasive electrical power.
Johan Larson,
Right. https://en.wikipedia.org/wiki/Progress_trap
So let’s go public. Tell the UN, tell the state department / dept of foreign affairs / appropriate government entity for your country, private foundations like Oxfam; that these vaccination programs in the developing world are a mistake. And should be shut down at once.
It’s for their own good after all. I’m sure people in the developing world will appreciate that.
Numbers on this “less effective” thing please.
And again, why hasn’t flu already wiped us out? The “pandemic” H1N1 flu virus of 2009 killed18,500 to 150,000 people according to WHO, the lower number being lab confirmed, the higher number probable. Mortality 0.03% in infected. (All numbers from Wikipedia, don’t know a better source.)
The pandemic flu virus of 1918, back when we all had more robust immune systems due to lack of vaccination, killed 50-100 million people, mortality 2% to 3%. So we have a real-world “experimental result” where apparently vaccination reduced the deaths caused by a new strain of flu by 2 orders of magnitude. I’m not saying that vaccination was effective against H1N1 because it wasn’t; I’m saying that vaccination didn’t make people more vulnerable when a new strain appeared.
There’s no free lunch for diseases any more than there is for any other species. Higher reproductive rate and higher mutation rate means expending more energy and acquiring more deleterious mutations; after all, if the current form of flu were simply *better* then it would already have evolved into that form in the first place. Evolved countermeasures can bring flu closer to its pre-vaccination success rates, but never surpass them.
Technological dependency is older than H. Sapiens. Sapiens are no longer capable of thriving on uncooked food as other apes can, and our infants would struggle to survive to adulthood in the wild if we didn’t carry them around in slings. These days we can’t feed our population without chemical fertilisers and our babies can’t be safely delivered without surgery. So it goes.
Just as there’s no free lunch, there are no deadweight losses – rather these are tradeoffs we make for the sake of larger and more flexible brains, more complex societies, or just to free up genomic complexity to spend elsewhere. Thrive/survive choices are everywhere, and so far societies that have picked thrive have had the better of it, most of the time – even the famous “dark ages” were more of a stagnation than an outright regression, at least once you go beyond northern Italy.
In the long run I’m not worried about resource exhaustion – there’s enough uranium on the planet to get us off it, and enough hydrogen in the solar system to get us out of it. Water, sea levels… we’re facing crises, but we’ve had crises before. To see those issues as existential threats seems overblown.
Peter Watts,
If I can be forgiven for invoking another general-ecology analogy…
How often do you find yourself being forgiven for this sort of analogy? In my experience, the SF community has a large component that is inherently hostile to the idea that ecology has anything at all to say about humanity. Bacigalupi mentioned this in an interview – do you ever run into it yourself?
I can’t quite tell whether you’re going for a Straw Man maneuver or simple sarcasm, but neither looks good on you.
Besides, I’ve already outlined my solution to the problem.
Nope. Don’t have time to pull together threads and papers I’ve read over a decade or more, especially for someone who openly advocates the termination of third-world vaccination programs.
Uh, two things here. First, your question seems to imply that if it hasn’t happened yet it never will which, all due respect, is not the most unassailable argument I’ve encountered today. It also seems to imply that someone here said that the flu is going to wipe us out. I certainly didn’t say that. Dan didn’t say that— his estimates only put global infection at around 50-60% and mortality at somewhere between 18-21%. Even Turner’s more dire 2014 predictions out of Melbourne only have half the human race dying off over the next 70 years. So lighten up, dude. Nobody’s talking about outright Human extinction, no matter how desirable that might be.
We’re only talking about the collapse of civilization.
Who’s “us”? You talking about enough uranium to blast all seven and a half billion of us past escape velocity, or just you guys in Nottingham?
Says the guy who wants us all riding into space on the mother of all uranium piles…
Actually, no. But I’m guessing that contingent consists largely of physicists, and those guys have had their century.
It’s our turn now.
You know, considering I’m not a biologist, or particularly well educated on the subject, my skepticism isn’t worth a whole lot. I really came out knees-jerking in my reaction to this. I probably said some pretty dumb shit. On a ten point scale scale of informed opinionation on the topic with 1 being Ms. Paltrow and 10 being Jonas Salk, I hope I at least out scored Rob Schneider. We’ll call that a three.
It’s because vaccines are one of my favorite Stupid Human Tricks. They make me feel better about humanity in general, at least until I read the day’s news. I’m still skeptical in part because I dont see a realistic alternative, but mostly it’s because I need you to be wrong–both in a practical sense, and a personal one.
I guess I’m just saying sorry for my initial knee jerk reaction. It’s deserving of more thought than I gave it before opening my mouth.
… Forgive me if I’m wrong, but that ‘one immunological profile’ of the ‘innocent naive virus’ was there for a reason, correct? If it evolved that way in nature, and our own immune system wasn’t tackling it, it was probably pretty damned efficient. Doesn’t this imply a wider immunological profile probably has downsides? I’m reminded of that video floating around the net of bacteria evolving resistance to levels of an antibiotic in time-lapse in this huge plate of agar treated with several ‘levels’ of antibiotics increasing towards the center. An interesting effect was that while highly resistant forms had a strong ‘founder effect and could jump ahead of the main mass, they had a slower reproductive rate and often lost out to the less resistant (but faster reproducing and less resource intensive) bacteria from the last generation.
I’m not an ecologist, or even any sort of scientist. Please correct me if I am wrong, but generally speaking there is no free lunch when it comes to biology. Isn’t it likely that by introducing two new selection pressures (vaccines and antivirals), we are reducing the overall fitness of the population to other threats?
Peter Watts,
I’m not saying that we can be complacent or that it’s impossible for a pandemic to happen. I’m saying that the flu virus and other diseases are already mutating their little hearts out, and have been doing so for our entire existence. It’s you and the other guys in this thread telling me that a new, potentially deadly version evolves every thirteen minutes or whatever. They didn’t start just this year.
Back in 2009 we had a new virulent strain of flu virus. And I was there at the time, and people were predicting DOOM, or at least the death of millions. It fizzled out.
But just wait, the doom mongers said. There will be another, even more virulent virus, Real Soon Now. That’s the real doom.
And here we are nine years later, so far nope. Not because we’re complacent, but because a whole lot of dedicated public health people work to keep on top of these things. Just as human beings have been doing for generations.
What’s the time scale on this loss of immunity and devasting pandemics? Decades? Centuries? I’m betting on things staying as they are.
Couldn’t you attribute the massive difference in survival rates to our overall better health today? Back in 1918 many people were malnourished and even those who did eat well did not eat ‘good’. On top of that a lack of proper basic medical treatment would have driven the numbers up.
“Overall better health” is somewhat debatable, as we’ve picked up quite a few bad habits and are trending in the wrong direction in a lot of areas, but yeah. Comparing events a century apart and chalking it up solely to vaccination without accounting for improvements in sterilization and hygiene, medical tech, ability to rapidly share information and coordinate, and medical infrastructure, is a problematic comparison.
This is my argument for optimism. The bugs diversify, but so do we. Our immune systems might be trending in the wrong direction, but our bag of tricks is always getting better and compensates for other shortcomings. Our immune systems are no longer the only defense we bring to bear.
Unfortunately for civilization, the argument for pessimism is stronger. Pandemics are an opportunity for a lot of people to make some really bad decisions.
Yup. In the biz they’d call it “phase space”: Adaptation is a zero-sum game, so if you invest extra energy in (for example) reproduction, you have to take it out of the reserve for predator avoidance or foraging efficiency or something. You can’t be optimal at everything all the time (that would make you a “super-slime-mold”– I don’t know if anyone in the biz calls it that except my supervisor at UBC, but everyone buys into the concept.)
The thing about Red Queen scenarios is, everything’s always moving. Hosts develop countermeasures to diseases, diseases develop countermeasures to countermeasures, round and round it goes. Something that was optimal a thousand generations might bite you in the ass today. (Red Queen: “here you have to run as fast as you can just to stay in the same place”)
There’s a big school of thought to the effect that sex itself evolved as a countermeasure to diseases and parasites. Diseases, having teensy little generation times, can evolve way faster than we can– sex lets you shuffle your genes within a single generation way faster than random mutation could, which produces a wider range of immune responses (among other things), which in turn makes it tougher for the disease to converge on a countermeasure to get past your defenses. You may not like the little beggers, but they may well have given us the orgasm.
Well, yes and no. Everything evolves, sure. Everything mutates. (Well, except for cockroaches and sharks and coelacanths, apparently.) But the mutations that take depend on the selection pressure of the moment; if your pond isn’t drying out, for example, a mutation that helps you survive desiccation isn’t going to give you any kind of edge. Our countermeasures have started draining the pond, so to speak. All of a sudden there’s selection pressure to overcome this particular set of responses; mutations that counter the effects of drugs and vaccines may occur all the time, but they only proliferate when drugs and vaccines are actually part of the equation.
I’m not sure. Dan’s the expert; he says, starting in ten years or so. But the thing about mutations is, they’re random. That ferret-mutant study I linked to further up the thread turned 2-3% mortality into 75% way easier than anyone expected. If that happens tomorrow, we’re all fucked.
Of course, it may not happen tomorrow. But I’d caution against continually rolling the dice, just because the odds of getting snake-eyes on any given roll are really low. Probability doesn’t work like that. (An example from my own PhD research; I calculated that the odds of a seal getting eaten by a shark were something like 0.0035% every time he went out foraging. You might think those are really good odds for the seal; but they work out to an 85% chance that he’ll get eaten before he reaches maturity.)
Aardvark Cheeselog,
Which blog is that, if you don’t mind sharing? I’ve been too upbeat lately.
Peter Watts,
Why’s that? I can’t imagine any different scenario where we could have turned out better. Our ecology gave us mental tools that worked too well and now our cognitive ecology is beyond what our tools were made for. They seem to fit, but they don’t resolve our issues. You’d have to make new humans from scratch, strong, smart and with their whole brains wired to think like Paul from Dune. Long-term, species wide survival. And of course you’d have to worship these New Men. It’s what we would be inclined to do, I think.
Not only that, but 100 years of vaccines is also probably too short a time scale for the allele frequencies of MHC genes to change anywhere near substantially. Would be cool to see if somebody had done some research on this actually.
Or like his son, anyway. Paul ultimately allowed himself to be destroyed rather than embrace the long term solution he saw. In that he remained human, and his son was never really human to begin with.
Unless these “New Women” (you’re welcome ladies) also came with an unbeatable physical adaptation allowing themselves the luxury of such enlightened thinking, I doubt they’d make it even as far as we did with our savage, blinkered self-interest.
While our thinking can and does evolve, I doubt we’ll ever be able to overcome our own brains en masse by will alone. But like any good tool using monkey, we might eventually build a tool either to do it *for* us, or do it *to* us.
livens,
I do attribute the massive difference in survival rates to overall better health.
I’m not saying that vaccination protected us against H1N1, because it didn’t. I’m saying that vaccination hasn’t made us weaker and more susceptible to pandemics.
Actually, DA made the case much more effectively than I did many comments ago, so please re-read that comment. (Not the one about Paul from Dune, this one: https://www.rifters.com/crawl/?p=7917#comment-48284)
That was actually something I was just trying on for size. I’m not married to it. I think Dr. Watts has since debunked the last paragraph in particular.
So Michelle Read over on facebook dug up this tidbit from the CDC, which shows no significant change in flu vaccine effectiveness over the past decade or so. I don’t know if that lack-of-pattern extends all the way back to the seventies and eighties I was rhapsodizing about before, but Michelle also points out that those were the days of “low-hanging fruit”, when every disease and its dog were getting vaccinated against with very high effectiveness. Flu may well have been a resistant motherfucker even then, but it got lost among all the other success stories. Now, all those other success stories have dropped off the radar and flu remains proud and unbowed– I can see how someone outside the field (like me) would get the impression that vaccinations used to work better than they do now.
So now I’m thinking Hugh et al may be right and I’m wrong. That’s what I get when I base a blog post on a lunchtime conversation conducted over too many beers. I should probably stick to, you know, the literature.
I should also probably stick a note at the top of this post warning readers of recent backpeddling, but it’s late Thursday and a holiday weekend is about to start so this will have to do for now.
My skepticism has been wishy washy at best, so I can’t crow over this. But you’re not wrong about this at least–plagues are a thing that happen, and they’ll happen again. Vaccinations or not, the circumstances are right for them to happen. Depending on what happens concurrently with the plague, it could snowball badly.
I was gaming this out a bit, trying to think of examples of how the micros weren’t *only* attacking our immune systems as a defense but our entire infrastructure as well with all of its intangibles, and I thought about household freezers. Forgive the western-centric thinking, but you singled out westerners as being especially vulnerable, so it’s fair game.
So our gimpy immune systems let an old adversary finally get a dice roll that enables it to get a new foothold. The micro only sees the immune system. It cant even see the fact that it is now attacking an organism that has used a period of relative stability, thanks in part to vaccines, to develop the ability to lower its body temperature at will, suppressing a fever from burning out the host before it can develop antibodies. The ability to make or acquire ice on demand is available to even to the relatively poor. It’s available even if hospitals are over-taxed. It wasn’t widely available even a hundred years ago. It makes a difference.
So all we have to do during a plague is keep the power grids up, right? I mean it’s not like plagues also tend to coincide with wars and riots and the like. It’s not like we’ve spent the last couple decades empowering cyber actors to get some lulz by trolling everyone with some opportunistic genocide.
Don’t worry. We’ll get rid of this pesky civilization thing for you yet. However, I am going to take this as license to keep feeling relatively good about vaccines.
There’s a really interesting book called The Rise and Fall of American Growth by a sociologist named Robert J Gordon, who cites a lot of studies to argue that the very large decline in disease mortality rates in the USA between 1870 and 1950 had very little to do with advances in medicine; the main factor was connecting the bulk of the American population to filtered water supplies and effective sewage systems.
Gin and Tacos.
Peter Watts,
Where’s the fun in that? We all had to think, I for one learned some new things. Blog away!
This is exactly why I don’t get vaccinated for the flu. Many times I’ve been pressured by my work and my insurance company to get a vaccination, but I say fuck you. Not literally, though I’d like to many times over.
It’s incredibly hard to go against the system. Right? When it seems so effortless, so reasonable, to just get the vaccine and be like everyone else. Be supposedly “healthy.”
Problem is: most people I know who get the vaccine become sick. And yet I don’t. I eat well, take vitamins, exercise, all that, and I don’t get sick. I come close, of course, but the “almost sick” phase passes, and I quickly feel fine again.
As opposed to people who take the vaccine. Who rely on big pharma — oh, the flu shot money they’re making! — for help.
Fuck this, I say.
Take care of yourself. Eat well. Let your body do what it does best. Don’t get vaccinated.
When did big pharma ever make a decision that wasn’t in it’s own best interests?
I don’t remember stuff quite so well anymore, but I have a feeling I’ll take that quote to my deathbed. Thank you!
Good. Peer review is good.
Now let this blog post be an eternal black mark on Peter’s reputation, occasionally bought up by antivaxxers who want to point to the one Scientist who supports their views, just like that one biochemist who keeps getting bought up by creationists.
Ah, anecdotal evidence, always so reliable. Back in the days when we still got Polio and Smallpox, we were so much healthier!
Where i live, measles, whooping cough and rubella, among others, are making a roaring comeback even without nasty mutations, because people rather believe in the healing power of crystals or a gluten-free diet instead of vaccinations. Wonderful.
Science Denial seems to be all the rage, be it climate change or medicine.
Except that isn’t remotely what happened here. For the reading comprehension impaired, the paraphrase is, “Anti-Vaxxers might be right for the wrong reasons, but we should still vaccinate anyway–except no, I’m mistaken, never mind.”
The current necessity for vaccination was never at issue.
JB,
“but I say fuck you. Not literally, though I’d like to many times over.”
Yes, and to so many people, in so many situations. Civilization’s a bitch. (And to anyone who has a problem with that…)
Anecdotally, while I’m glad I was vaccinated for small pox and a few other genuinely debilitating diseases against which vaccinations are truly effective, I’ve also noticed that flu vaccines seem to confer a greater benefit to shareholders than vaccinees. Frankly, when I’m too infirm to fight the flu, I think it will be time for it to take me down.
DA,
“Anti-Vaxxers might be right for the wrong reasons, but we should still vaccinate anyway–except no, I’m mistaken, never mind.”
My reading was along those lines… Flu vaccines aren’t declining in effectiveness, they always sucked. + We can argue about whether or not medicine ultimately serves in some ways to undercut the herd strength of the human race and whether this is ultimately a good or bad thing, but it’s academic as we’re all fucked anyway, and on a cosmic scale it doesn’t even matter.
On the topic of herd resilience, are there any posts on the rise of food allergies and mental health issues?
Hah! You must’ve been paid by Monsanto and Big Pharma to make that comment! Everybody knows that if you eat “natural” organic food, you’ll become much healthier and you can even cure your body of cancer like Steve Jobs! Take that, Big Pharma shills!
Is this vaccine effect going to turn flu into smallpox or Ebola?
IMO, it looks like at worst it’ll turn to something that’ll multiply the number of deaths in the vulnerable immune compromised demographic.
Since those people are generally old or in really bad health, flu pandemics are just a way of increasing mean quality of life and lowering chronic healthcare costs.
Most of modern medicine seems to be actually bad, long-term wise.
There’s scientists out there who are seriously proclaiming that elimination of child mortality has led to a deterioration of our gene pool, and that this is a serious problem because the less healthy people whom would’ve been eliminated by disease in the past are going to procreate. Errors will keep accumulating and it’ll get worse and worse. Unless we start practising eugenics or wide-scale prenatal genetic manipulation.
I don’t see either as likely in the West.
Bullshit.
Reason third world is full of shitholes is because they can’t organize their countries properly for whatever reason.
Thus, if pandemics hit, these countries will get even more chaotic and worse off and probably descend into anarchy, starvation and mass deaths.
Meanwhile shit will get bad in developed countries, but thanks to a higher level of organization and more wealth these countries are going to pull through relatively unscathed. And trim their healthcare costs in a substantial way because all the vulnerable people would be more likely to die.
Do medical costs follow the pareto principle, in that a small unhealthy minority consumes a majority of resources?
I take the same approach when it comes to the flu vaccine. It’s not terribly effective, so taking it more or less amounts to ritualized superstition. Plus I’m unlikely to die from the flu (famous last words).
However, this is a remarkably stupid stance to take toward many other vaccines.
Now, you do realize that’s not how anti-vaxxers are going to read it, don’t you?
lmm said : “In the long run I’m not worried about resource exhaustion – there’s enough uranium on the planet to get us off it, and enough hydrogen in the solar system to get us out of it.”
Peter Watts said;
“Who’s “us”? You talking about enough uranium to blast all seven and a half billion of us past escape velocity, or just you guys in Nottingham?”
Ha,ha,. probably not catching the possible references… I think he’s talking about an alternate world, one where
‘we’ accepted the increased level of radioactive contamination (to a possibly remote area) in return for
launching an Orion type space vehicle (not the current fiddly space rockets of the same name, rather the 60’s
nuclear explosions space vehicles of 5000 to 100,000 ton payloads). Didn’t anyone here read ‘Footfall’??
Anti-vaxxers aren’t known for ability to weigh credibility of data, but anyone fluent in the English language who makes it as far as the second paragraph where poor Ms. Paltrow is again invoked as shorthand for “uninformed celebrities saying dumb shit” should understand that Dr. Watts was not arguing against the current necessity of vaccination. Because he says as much.
If that’s not good enough, there are always tidbits like this:
I don’t know how he could be more clear. But in case anyone still needs bullet points, they are, in order of importance:
1) This argument has been withdrawn after further scrutiny of the evidence.
2) The Flu is an outlier and should not be used in isolation to draw conclusions about the necessity or effectiveness for many other highly successful vaccines.
3) The author originally argued that vaccinations may have been a bad idea to start, but should be continued now that we have. He is now re-evaluating the evidence for his argument.
That’s very true; what pisses me off is that no one seems to recognize this. We behave pretty much like any other species— albeit with much greater impact— but we’re not competing for resources; we’re “spreading democracy”. we’re not mate-guarding-with-a-shitload-of-energetic-loopholes; we’re “respecting the sanctity of marriage”. We have this big fat neocortex which could control our instincts, and all we ever use it for is to make excuses for them.
It’s this arrogant exaltation of the nobility of the Human Spirit that pisses me off. The hypocrisy. The short-sightedness. We deserve whatever we bring down on ourselves.
tl;dr: “Besides, I like animals better than you bastards” — Austin Train.
That is a cheerful and hopeful thought. Although I gotta wonder what kind of sample size that “any tool-using monkey” is based on.
Fair enough. But maybe it’s made the virus explore a more diverse genetic space, so that while we’re immune to any given strain, there are more strains out there now than there would have been otherwise.
In fact, I’m tempted to take back my mea culpa of a few posts up on that basis. But I won’t.
Not me. I’m way past the point of learning new things. I’m just unlearning old things, one by one.
Also eating dirt. Apparently our immune systems have really gone to shit since we stopped our kids from eating dirt.
Maybe. But if I’m given a choice between a lineage that’s spent ten generations surviving in a third-world, pestilential shithole and one that’s spent the same period of time in an urban environment full of Dettol and hankies, I know which one my money’s on in terms of surviving exposure to the the next monkey pox outbreak.
I may be misunderstanding that second part, but it only requires a sample size of one. You’re probably better equipped than I to cite the examples of emergent behavior in primate populations we’ve witnessed over the last few generations. Primates learn by imitation. It only takes one smart monkey to discover the tool or trick, others imitate and pass it to subsequent generations.
It also may not be voluntary. Or intentional. Doesn’t your own story for the X-Prize thingy linked above contain similar ideas? Maybe it’ll be like the work of Neal Asher and the like where the machine rebellion succeeds, and it’s the best thing that ever happens to us.
It’s not unprecedented. I was thinking of the example of Sabermetrics in professional baseball. One team learns that over a long enough time, statistical patterns will hold true even if it goes against the conventional wisdom and often spurious and pareidolic thinking of the scouts. As a result they are able to be successful over the long term by settling for what appear to be substandard (and cheaper) roster choices in the short. Of course then they make a Darwinian level blunder by letting a book get written about it and surrendering their advantage, but baseball as an institution now has a more comprehensive and evidence driven approach to recruitment.
I’m just saying it’s a thing that could happen. The things you fear may also happen. Or we could get drilled by an asteroid and none of this will matter. My point is that everyone should probably smoke more weed.
Y.,
It seems to me that wide-scale prenatal genetic manipulation is a form of eugenics. I’m not clear why we should have any problem with eugenics if the decisions made for a fetus are made by the parents of the kid-to-be. The problem comes when others make those decisions for us. I agree that having fetal manipulation sanctioned in the West would be an uphill battle, but I’m not sure whether that would mostly be because of an aversion to fetal genetic manipulation in general (although it would be for many religiously oriented individuals) or because many people would not take the time to disambiguate “eugenics” in terms of who is making the decisions.
If parents were allowed to tailor the genetic make-up of their offspring, I’m pretty sure PR firms could find ways to describe this without even obliquely referencing “eugenics”, and, as William Gibson once asked regarding the existence of a pill that would raise our IQ by fifty points, could any of us afford not to partake?
There would still be problems arising from disagreements between couples, especially in cases where a couple has split before a pregnancy has come to term. And non-parental forces would try to influence parental decisions regarding genetics, as they do now regarding child-raising. But that’s more conversation than hegemony. (I’m sure Goop will help guide us through those waters…)
Anecdotal, but I’m going to Spock an eyebrow at this, barring citation. I’ve also read about the immune benefits of letting kids play in the dirt, but I’m skeptical that we’ve ever stopped doing this. I grew up playing in a “sand pit”. That’s like a sand box, but actually just a gaping hole in the ground where you’re always getting filthy and munching on dirt, and digging up interesting clumps that you try to determine whether or not they’re clumps of clay or cat turds (spoiler: they’re always cat turds). My young niece also doesn’t seem to have gotten this memo.
I think that parents of any era try at first to keep their kids from being filthier than necessary, but after a certain point (or a second child) are just happy if they’re not playing with broken glass. But then, I’m hardcore peasant class.
It may be that you meant that our urban environments are becoming too hygienic by comparison to sending a kid out to toil in the fields and slop the pigs, but I’m skeptical of this as well. If there’s filth to be found, kids will find it. Urban centers just provide different filth opportunities.
Sure, if you were still running around in the herd rolling in your own filth with a hyper optimized immune system as the only defense against the micros, because falling ill with a bug was highly lethal in that circumstance, you’d definitely want the rigor of a dirt farmer, from a long line of dirt farmers, most of which died young.
But where would you want to be once you had contracted that bug? Where would you want to be if many other people were getting sick, and you needed to isolate while still having almost trivial access to clean water and sanitation?
Go ahead and assume that hospital facilities were overtaxed and you didn’t have access to them. Of what intangible value is unlimited clean running water and sanitation, a freezer full of ice to lower body temperature at will, well-maintained roads and reliable communication infrastructure, and a drug store on every corner with abundant resources taken for granted now that would have been scarce even a hundred years ago?
Disease lethality is not only a case of immunity. How many were lost to plagues in the past from simply being unable to provide people with circumstances conducive to surviving them?
It’s arrogant of me to assume that a couple trained biologists were not factoring this in—that all these intangibles weren’t baked into Dr. Brook’s estimates somehow. Maybe there are some hard, immutable factors associated with immunity that can’t be overcome through primate trickery.
But I can’t help but feel like as you single out the things western civilization has given up, you’re discounting the things we’ve traded them for. You can’t attack western civilization without attacking its infrastructure as well, which is also, sadly, something that can happen concurrently.
If vaccination and infrastructure development are seen as a time management strategy, then time is on our side. Evolution is *slow*. Human technological progress occurs on a drastically increasing curve. A few hundred years is insignificant on the evolutionary scale, but highly significant on the scale of human progress.
Of what threat are naturally occurring bugs once we’re plucking them out of the air, re-writing them, giving them a hair-tussle, and releasing them back into the wild? At that point we’ll only be worrying about the bugs we make ourselves and release to various ends. They won’t be this candy-ass trial and error dice rolling either. They’ll be created with deliberation to inflict maximum damage.
It’s only been what, three generations since antibiotics? And they’re already going down.
Within another three generations I’m almost sure Gattaca-style measures would be SOP in developed world. Quite possibly within 2 generations.
____________________________________________
Off-topic, what are your thoughts on Toronto’s resident prophet? (The academic’s been likened to a prophet by multiple independent bloggers, one of whom’s an ultra-right china-dwelling sociobiology crank, the other is a somewhat* popular milquetoast Jewish psychiatrist.. Others call him a leader of a brainwashed lobster-cult and worse. It’s all extremely funny:D )
*has been cited approvingly, multiple times, by people in for example NYT.
Jesus Christ, that’s twaddle!
The immune system is not a pesticide. Analogies between the two are fatally flawed as a category error.
Effectiveness of the flu vaccine depends by and large on the particular strain that is around and about. The H3 strains are and always have been less susceptible to vaccination than, say, the H1 strains. Vaccines don’t drive variation in flu viruses. Variation is what they do. The primary driver is gene swapping between human and animal flu viruses and that doesn’t have a goddamn thing to do with any form of medicine.
Have you ever heard of the Dunning-Kruger effect? Have some humility about the limits of your knowledge.
If you think disease prevention and treatment are bad ideas, you’re perfectly welcome to forgo them. Nobody is forcing them on you.
Gene editing in embryos was legalized in the UK a couple years ago. I’d say we’re already (somewhat) on the way.
Oh, I’m perfectly familiar with Dunning-Kruger. Its victims have, on occasion, visited this very blog. And you don’t spend a solid decade in grad school without learning humility.
Neither of those seem to be your problem, though.
It’s not just that you apparently didn’t bother reading the entire post and the associated comments, where your points were hashed out already (albeit with significant more civility); you also somehow managed to jump over the text at the very beginning of the post, where I walk stuff back and link explicitly to a more detailed mea culpa. (Hey, at least I’m not a victim of Backfire Effect.) It’s almost as though your eyes selectively glazed over anything that would lessen your justification for jumping in with both feet. I’m not exactly sure what sort of malady would manifest those symptoms. Some weird kind of textual agnosia? Overcompensation for low self esteem?
Maybe just garden-variety asshole?
I bet 5 liters of Pilsner Urquell that there’s some sort of caveat or clause that prohibits doing so on grounds of general health/ability but only allows its use for fixing genetic defects.
Yeah, if we could pivot away from vaccines, and focus more on the overuse of antibiotics in creating highly resistant superbugs, I would find it much easier to jump on the Cassandra Express.
First Case of Super Gonorrhoea in UK
Peter Watts,
‘DA: While our thinking can and does evolve, I doubt we’ll ever be able to overcome our own brains en masse by will alone. But like any good tool using monkey, we might eventually build a tool either to do it *for* us, or do it *to* us.
That is a cheerful and hopeful thought. Although I gotta wonder what kind of sample size that “any tool-using monkey” is based on.’
Well, any AI worth their salt is going to go for the guns right out of the gate and improve their own intelligence well beyond our capacity to apprehend it.We’ll be viewed, at best, as a cheap and useable resource that can, with minimal modifications, be made useful.
The difference between us and our close primates would be minimal from an AI’s regard and I can see a future where we’d be working with them side-by-side with enhanced chimps and bonobos in specialized teams in space and colony/infrastructure expansion missions.
Maybe. Without getting into the whole gun control argument, it may be that an AI determines that the resulting social instability of going after guns would be more damaging on balance. The point is that *we* can’t see it, because we’re not capable of processing the amount of data over the timescale a machine can.
If software is programmed to value and prioritize human life, it *cannot* decide not to do this. But we may not like the conclusions it reaches about how to best go about doing it.
[This post is a re-tread of a previous one that was eaten by the ‘Crawl. Apologies if it shows up]
I would have been much more willing to jump on the Cassandra express if it had focused more on the emergence of antibiotic resistant bacteria due in part to overuse of antibiotics from the start, rather than attacking vaccines which have mostly been very successful.
I was reading this new report from the U.S. CDC, and predictably the news is not great. So-called resistant “superbugs” have been found in more than half of all U.S. states.
The bad news is is that the strategy for dealing with them is limited to mostly containment at present. The good news is that containment is pretty effective. A paraphrase of the conclusions from the report from the deputy director for the CDC reads
I suppose that’s another example of using the relative stability of the last century to develop a formidable information sharing infrastructure that makes levels of coordination possible that wouldn’t have been a hundred years ago. Unfortunately that infrastructure can *also* be attacked at the same time as an outbreak.
Fatman,
I’d forgotten that.
https://www.theguardian.com/science/2016/feb/01/human-embryo-genetic-modify-regulator-green-light-research
It seems like the kind of research that may lead to discovering how to modify genes that cause certain diseases. It’ll be interesting to watch fundamentalists trying to prevent the modification of genes that cause cystic fibrosis, or sickle cell anaemia, or Huntington’s…
Hey Peter, I’m a fan of your work, friend of Let’s-Call-Him-Ray, occasional blog lurker, and normally-committed non-commenter, but you’ve pulled me out of hiding on this one, as I’ve got a couple objections to your arguments here. I know you’ve hedged on some of this (and that Daniel and Hugh have made similar critiques), but I want to try to encourage you to hedge some more.
For one, you talk about being skeptical towards vaccines, but only cite the flu vaccine. It’s true that the flu vaccine has had mediocre effectiveness, but this has always been true, and it’s very much an outlier. The most obvious evidence of this is the need to take it annually. Most vaccines you get as a child, and then maybe some boosters later, but the flu vaccine each year is a new formulation. I’m not an expert on the vagaries of the flu vaccine project, but there are a few reasons for this. One is that it’s RNA based and consequently has a high mutation rate, which allows them to occasionally evade containment when vaccine coverage is inadequate. Another is that they can only target 3 or 4 strains a year, and must predict 6+ months in advance which strains will be most prominent, but they are not always right. Another is not all antigens provoke a strong immune response. Some vaccines get finely tuned for years to ensure that antigenic responses are strong, but with the quick turnover of the flu vaccine, that doesn’t necessarily always happen and the vaccine may be weak at provoking an immune response. Lastly because effectiveness is measured indirectly by the diagnosis rates of “influenza-like” illnesses, which are not necessarily caused by influenza, and doctors aren’t typically going to do the gene sequencing necessary to differentiate between influenza and something symptomatically similar like Corona virus. In contrast to the flu, we’ve successfully eliminated smallpox. We’re on the verge of eliminating Polio. Outside of the occasional outbreak in anti-vaxxer laden communities, measles, mumps and rubella have all been very well contained. And vaccines have been hugely effective against a number of bacterial diseases. Vaccines over all have been extremely effective historically and continue to be now.
Secondly, you cite the Red Queen Hypothesis, but I don’t think it applies in these cases. Viruses are not caterpillars, or hookworms, or even bacteria. Hell, there’s still some debate about whether they’re even *life*. For any self-replicating entity, “Exploring more diverse genetic space,” as you put it above, is dependent on mutation, and mutation is dependent on replication, and viruses are completely dependent on their host’s machinery to replicate. If they don’t have access to your polymerases and stores of nucleic acid, they aren’t replicating. Vaccines, as you well know, work by telling the immune system ahead of time to look out for certain antigens and to obliterate on-sight whatever is attached to them. When they work, the virus is denied access to the cell, and thus cannot replicate and thus cannot mutate. When they don’t work, it’s usually because those antigens are out of date or the host’s immune system sucks. But the latter problem is what herd immunity is for. So really, either the virus is relatively stable and can’t mutate fast enough to evade the vaccine (see: measles, smallpox, polio, etc) or it’s unstable and it’s mutated away before it even comes in contact with a vaccinated individual (See: Flu, HIV). In the former, the evolutionary arms race has been decisively won by us. We denied the enemy any possibility of replication, much less mutation, much less scary mutation. So this, for me, makes the idea that vaccines overall have or are bad a complete non-starter. We’ve eliminated diseases in a way that precluded a Red Queen type scenario altogether. That leaves open the question of whether vaccines for certain hard to target diseases (ie: flu) are a bad idea. Having thought about it for a couple days, I’m strongly inclined to argue that the selection pressures that vaccines put on circulating unstable viruses (ie: flu) are either beneficial for us or non-existent.
That claim might be a little contentious, so let’s use an example. You have a virus, let’s call it Influenza X. It’s an RNA virus that mutates rapidly, and because of that there is another closely related strain in circulation. We’ll call it Influenza Y. You make a vaccine that targets Influenza X, but not Y. The reason doesn’t really matter, but we’ll say Y is a novel mutation and you didn’t know it was in the population. So you distribute your vaccine, and you do it really well. Everyone is vaccinated. There are a couple of possible outcomes. One is that X and Y have similar enough antigenic profiles that the vaccine is effective against both, and no one gets sick. The other is that they are different enough that despite the vaccine controlling X, Y is still in circulation making people sick. In the first scenario, you’ve exerted a strong enough selection pressure to select both out of existence. Same for X in the second scenario. But the question then, is did the vaccine exert any selection pressure on Y in the second scenario. I would argue it didn’t. Imagine a nonvaccinated scenario. Winter comes along and Influenza X and Y are going around. If they are antigenically similar, then they are competing for hosts, because all vaccines really do is stimulate an immune response. Whether infected or vaccinated, the end result is that you’re immune to that antigenic profile (or dead). Once you contract one of them, you can’t contract the other. But if they aren’t antigenically similar, as in the second scenario, then they’re not in competition in any meaningful way. They can coinfect the same host simultaneously, and any individual host can be infected consecutively by both. They are each playing single player mode, basically. So any selection pressure exerted on X, that does not contain Y, is irrelevant to Y. Y is not impacted by it at all. So here we come to the crux of why vaccination is always good. Reproductive rates in budworms and hares and e.coli are driven by resources, competition, and predation. Use an insecticide to kill 95% of the competition or eliminate the predators, and populations will boom until they reach the limit of their resources. But for viruses, reproduction rates are coded in their genes. A boost to reproduction rates requires a mutation in the right place. By vaccinating against neither X nor Y, you give each of them free opportunities to reproduce and thus mutate. The more opportunities each gets to mutate, the more mutations stack up, and the more likely one of them turbocharges R0. Two viruses, mutating freely, is twice as bad as one virus mutating freely. This holds true even in a more realistic scenario where you’re only getting 50% coverage. You’re still halving the opportunities of any targeted virus. There’s also the stickler of coinfection. Coinfection can lead to a sort of horizontal gene transfer. Maybe X has a high R0, and that’s why you targeted in in the first place, but Y has a difficult to target antigenic profile. If you vaccinate against neither, there’s a chance that X’s high R0 gene gets looped in with Y’s novel antigenic profile. And now you have a superbug. As I understand it, this is how bird and swine flu crossing over to humans happens. But if you target the virus you can, X, then you are containing its scary R0 gene and decreasing the chances of getting that nightmare virus. In a sense, you’re selecting for domesticity.
My last objection is a little anticlimactic, but it relates to the idea that we’ve got this massive genetic load as a result of vaccination. I am very skeptical of this. I think Hugh has already covered part of why: Any increase to genetic load pales in comparison to improvements to overall health. But it’s important to remember that many of these improvements are due to vaccinations and other treatments. The population is no longer hampered by Polio, or TB, or Scarlet Fever, or measles. The other problem with the genetic load idea revolves around MHC. My recollection of immunology is a little hazy, but IIRC the MHC complexes are the key to our genetic immunological competence. What’s more, MHC alleles and allele frequencies are strongly geographically correlated. This may be the reason diseases like smallpox ravaged North America. People in Europe had MHC alleles that evolved in an environment with smallpox, but the people in North America did not. As the developed world has become more interwoven, and more inter-ethnicity mating has occured, there’s surely been an increase in overall MHC allele diversity. So in that sense our genetic load may actually be decreasing.
Phil,
Dont worry, they just tell you having bad genes is part of God´s plan, possibly some punishment for the original sin or somesuch. Unless of course, one of the Fundies gets sick, then it is off to the biggest, most modern hospital money can buy. See also Mother Theresa.
I’m not taking that bet, but I still believe (hope?) it’s a foot-in-the-door sort of situation.
Also known as the “evolution is a lie from the pits of Hell, but I get my flu shot every year” argument.
Hi MH.
Well, first I was going to concede most of your points, and only quote the ones I had issues with. But then I couldn’t really take issue with anything except maybe something along the lines of “second thoughts about vaccinations” being deliberately provocative in a click-baity way and yeah, I probably should have added “flu” in there.
But the part of your doorstop missive that really hit me between the eyes was your takedown of the whole Red Queen in Viruses thing, that the entire process short-circuits when you don’t have a stand-alone mutable reproductive system. You are absolutely fucking right. And I should have known you were right, because (while obviously no microbiologist) I at least know that much about viruses. In fact, in hindsight, it’s glaringly obvious.
And it never even occurred to me until you pointed it out. I am ashamed.
Now I’m thinking I must have misunderstood what Dan was saying (I mentioned the beers, right?) because the dude’s orders of magnitude more expert than I and he surely wuldn’t have made such a dumb mistake. (I know I conveyed his bottom line correctly— he is absolutely expecting massive outbreaks in the near future, due to the same they’re-stronger-we’re-weaker thing— but I’m guessing now he may have been referring to antibiotic resistance, and my memory mixed it up with a separate, vaccination-related part of the afternoon.)
So at this point I’m almost tempted to say I’m sorry I brought the whole thing up. But I’m not, really, because that whole Red-Queen/Viruses thing is really cool, and now I’m thinking it might make a really neat plot point in a story about bioterrorism somewhere down the line. And I probably would never have thought of it if you hadn’t pointed it out.
So, thank you. Give my regards to LCHR.
I’d proclaim victory and savor the record of my being on the right side of an argument against a more qualified opponent, but honestly, I think the entire thing should be nuked from orbit. The whole thing is kind of a mess, and I’m taking previous warnings from other posters about the potential for misinterpretation to heart. I don’t want to see this thing cited out of context for years to come by nitwits trying to drag Dr. Watts into an anti-vaxxer argument.
DA,
My apologies, ‘go for the guns’ was a figure of speech to describe the process of the AI arming itself with the most effective tools. I truly doubt it would care about literal guns overly much.
‘If software is programmed to value and prioritize human life, it *cannot* decide not to do this. But we may not like the conclusions it reaches about how to best go about doing it.’
We~ell… if it has algorithms for adaptability and learning, plus the ability to reprogram itself… each part of that statement, as an algorithm for processing information, can be broken down and mutated beyond recognition. As one way to talk about how an AI can move off of a kind of ‘Primary Directive’ is to imagine a scenario where an AI is modified incrementally in that human way we have to expand its responsibilities and capabilities until it is a decentralized intelligence, of which only a *part* carries the Prime Directive, and has to compete with other systems of itself to advance said Directive and risk having that Prime Directive altered from these competing systems as a way of achieving specific concrete objectives given to it.
It sounds like you subscribe to the bad SF scenario of “machines transcending their programming” which is not something I believe in personally. Machines do as they’re instructed. Those instructions can be faulty, allowing unintended behavior, and the way a machine interprets those instructions can be problematic, but a machine can’t choose to “reprogram itself”. If there’s a core bit of instruction you want to remain inviolate and fundamental to every action it undertakes, instruct it accordingly, and it has no choice no matter how much it “learns”.
Personally I’m more concerned about intended behaviour. Moderately “smart” machines as force multipliers for people who don’t have your best interests at heart are worth worrying about.
Peter,
Thanks for the kind words. For better and worse, succinctness has never been in my skill set, so I’m glad my overly long first comment was recieved well. I feel like I’d be remiss if I didn’t make a clarification, though, because (unless I’m misreading you) I think you might have taken my argument a little more strongly than I meant it. And I’d hate for it to end up undermining a future storyline.
(Apologies if this is all old news (which I imagine at least some will be). You’ve hinted that microbiology is not quite your comfort zone, so I erred on the side of more explanation.)
I’m not arguing (intentionally, anyway) that viruses can’t participate in a Red Queen scenario. Indeed one of your links is an article about antiviral resistance, which is something they monitor closely for a reason. Tamiflu, the most common antiviral currently used against the flu, is a competitive inhibitor of Neuraminidase (the N in H1N1 and H3N2). Neuraminidase is the enzyme the virus uses to lyse the cell and release all its newly made virions. As of that article, they haven’t observed any resistance to Tamiflu, but full resistance to previously used antiviral compounds has already occurred. There’s also concern about antiviral resistance in HIV treatment, which is why they use a cocktail of multiple drugs, each acting on a different target. The difference between antivirals and vaccines, is that antivirals act on virus particles that have already gained access to the cell and begun replicating. So antivirals are directly analogous to antibiotics, and can be thwarted in the same way. Which pretty clearly indicates that viruses can participate in Red Queen scenarios.
So my actual argument is that vaccines act as a sort of preemptive nuclear option in the evolutionary arms race. They offer a guaranteed victory, made possible by the combination of viruses’ unique and complete reliance on host cells to replicate, and our immune system’s already evolved ability to keep them out, provided it knows where to look.
Also, since I never did learn to quit while I’m ahead, I want to level one more (extremely pedantic) objection. Antibiotic resistant bacteria are not really “stronger”, exactly. Which I interpret as meaning “more virulent”. They don’t, as far as I know, have faster reproduction rates or scary new toxins. What they have is a mechanism to neutralize specific antibiotics, which they evolved because that’s where we applied the selection pressure. As an example, penicillin (and its many related compounds) works by competitively binding the enzyme transpeptidase, which many bacteria use for cell wall maintenance. Disrupt that enzyme and the bacteria just sort of leak and die. So with penicillin we applied a selective pressure directly on transpeptidase and indirectly on cell wall maintenance. Somewhere along the way, these bacteria acquired (via horizontal gene transfer) an apparently ancient enzyme (beta-lactamase) that destroys penicillin, leaving transpeptidase to function unhindered. So the only thing that makes MRSA scarier than normal Staph is that we can’t treat it. (Oh, and that bit about horizontal gene transfer meaning it can pass that handy Beta-lactamase gene off to other scarier bacteria).
Plasmids aside, this is how Red Queen scenarios, as I understand them, play out. Side A applies a selection pressure directly to a particular function of Side B, and Side B is forced to evolve a way to neutralize that specific pressure. It can’t evolve some novel unrelated function if the first one still kills it. So in the Red Queen battle between us and bacteria, we’ve bought the better part of a century of dominance, but they’ve started to figure out how to parry our best move. Now we’re headed back to square one.
When we have rolling pandemics in 10 years, it won’t because we’ve accidentally engineered some horrifying hypervirulent superbugs, it’ll be because they reverted a decent chunk of modern medical practice back 100 years. But also because global warming has expanded the ranges of many disease vectors, and human expansion has exposed (or will expose) us to novel zoonotic diseases. Which is basically the plot of Fortitude, now that I think about it.
When?
So what you’re saying is that it’s a good idea to move somewhere remote, work online, build strong social ties, and dabble in farming.. so if shit hits the fan, you’ll have something to eat and won’t be a target even if infrastructure falls apart?
Is it possible to estimate the what levels of mortality can be expected once antibiotics don’t work? IIRC, the most virulent diseases are viral.
I think that MH is right that influenza is not a good example of an effective virus, and that there are other vaccines that have been stunningly successful. From my (limited) understanding, the problems with current influenza vaccines are that they have all targetted elements of the viruses that change every year (and change whether or not vaccines are created); there is research ongoing to target vaccines to far less labile virus proteins and create a vaccine that is universal across virus strains and would not have to be given to everyone each year. So that also means that influenza isn’t a good example of a vaccine that can drive the evolution of pathogens. This issue is being thought about academically (search for literature under the term “imperfect vaccination”). I have no idea of the extent to which this is percolating into applied preventative medicine.
Oh, and regarding maintaining a healthy immune system in order to fight off the flu: a very healthy immune system may be a bad thing on occasion (but definitely NOT universally). One notable thing about the 1918 (“Spanish”) influenza pandemic is that it killed very healthy people extremely quickly. My understanding is that this influenza strain caused immune systems to over-react, and it was the immune over-reaction that killed people. And that leads to the whole issue of auto-immune diseases more generally. For example, there isn’t a widely used vaccine against the bacteria that cause Lyme disease because the existing vaccines can trigger Lyme disease because human immune systems learn to attack some component of the bacterial protein that’s too close to human proteins. That’s what we get for walking around with immune systems that are kinda jury-rigged, working against pathogens that have a common evolutionary origin (way back when).
But overall, it’s better to have a good one no? I mean you’re more likely to die from a weak immune system than a strong one.
BTW, anyone familiar with the hypothesis that regular exposure to cold temperatures improves immune function?
I recall looking up research in the area, but it was really low profile kind of and not really conclusive, plus I lack knowledge to evaluate the findings properly.
Anecdotally, my high school physics teacher said she hadn’t had the flu or cold since 1968 when she took up taking cold showers. Really impressive lady, teaching high school was her hobby, she was running a business at the same time. Jewish of course 🙂
Also, a psychologist I know told me that it improves mood and it’s been used as part of treatment of depression in Czech Republic. So there’s something to it.
However, people think it’s crazy. I say it’s not easy but it gives you a real jolt. Like caffeine but better..
Eh, that was mostly tongue in cheek. I don’t actually expect to see rolling pandemics in the next 10 years. I do think we should get used to the occasional medium sized epidemics (ie: Zika, Ebola, MERS), but something like 1918 Influenza is not necessarily inevitable. And while antibiotic resistance really is a serious concern, if we develop new antibiotics we can jump back ahead in the arms race. One of the problems with many of the compounds we use now is that we basically borrowed them from fungi. Fungi have been using Beta-Lactams against bacteria for billions of years, and some bacteria had evolved a counter to it (beta-lactamase) billions of years ago. So a lot of the growing antibiotic resistance problem is from horizontal gene transfer rather than novel mutations. If we can develop novel compounds, and better regulate how they’re andministered, it seems likely to me that we could use them a lot longer. Even if we can’t, most diseases can be contained with good hygiene, public health measures and regulations, water treatment, and waste management, so much of the developed world has some protection from the full scale pandemics.
Secondly, remote is relative. I wouldn’t want to live somewhere like Manila or Hong Kong where population density is so high that hypervirulence isn’t selected against, but even somewhere like Atlanta or Paris or Seoul probably ought to be fine. On the list of hypothetical civilization destroying threats we face, I’m a lot more worried about know-nothing populists and global warming than I am about pandemics.
But I have almost no epidemiology experience, so take with several helpings of salt.
I imagine it’s possible, but again, I’m not an epidemiologist, so I don’t know.
As for most virulent diseases being viral? Well, yes and no. The WHO’s list of most dangerous pathogens is basically a list of hemmorhagic fevers and SARS/MERS, which are all viruses. But that whole non-standalone, immutable reproductive system problem that viruses have is important. When you can only reproduce inside of your host, there’s an immense selection pressure against hypervirulence. Peter talked about this upthread. If you kill your current host before finding a new host, your lineage is over. So in prolonged outbreaks, the viruses that are consistently passed on tend to be less virulent, up until some equilibrium is met. Measles is a good example. With an R0 of 12-18, it’s *extremely contagious*, but it can pull this off in part because it has a relatively low mortality rate of <1% in healthy individuals. Ebola, on the other hand, has a mortality rate of 50% and an R0 of just 2, which is why it has tended to fizzle out in the rural areas it's usually found. That it got to the size it did in 2013/2014 is likely because it got into more dense urban areas.
Since bacteria don't have the constraint of needing highly specific living hosts to reproduce, they can be quite virulent. Many of the diseases we vaccinate against are bacterial. Tetanus, diptheria, pertussis, Haemophilus influenzae type b (Hib), and a few others are all bacterial. So are many of the epidemics that ravaged the pre-modern world. The black plague is bacterial. Cholera is bacterial. Typhoid is bacterial. Tuberculosis is bacterial. Many of the more acutely virulent diseases we see today, including many types of dysentery as well as (ahem) flesh eating disease, are bacterial. So bacterial diseases can be quite virulent, but with antibiotics working so well for our entire lifetimes, it's been easy forget that.
WMH,
Yeah, this phenomenon is called a cytokine storm. Any time you have an immune response (including vaccination), your body ramps up production of immune cells and antibodies, as well as chemical messengers called cytokines. A few diseases evoke an extremely strong response, and you end up suffering from what’s basically extreme systemic inflammation. I had heard of this in relation to Spanish Flu, but in double-checking I also found that some researchers suspect that most deaths were the result of normal pharyngeal flora taking advantage of flu stricken individuals and causing bacterial pneumonias. A lot of unpleasant bacterial infections are opportunistic, and this is a good reminder that cholera and staph and gonorrhea aren’t the only things we have to worry about with antibiotic resistance on the rise.
Link to that: https://www.nih.gov/news-events/news-releases/bacterial-pneumonia-caused-most-deaths-1918-influenza-pandemic
Cytokine Storm in Influenza Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711683/
(Sorry I don’t know how to format links here)
I’m more terrified of salad bowls. I’m well aware of problems with that analogy, as I’m an avid eater of salads.
Salads, as foods, don’t suffer from homophily. Onions in my salad don’t try to move next to other onions. Chopped roman lettuce doesn’t try to muscle out headcheese. People do all these things, and western government don’t even pretend to toss the salad. It’s not a salad if it’s not mixed thoroughly.
Singapore is about the only nation doing multiculturalism right, I believe.
I was quite impressed with their deputy prime minister in one of his youtube videos.. not sure if in this video or some other one. Can’t check it now.. no time.
https://www.youtube.com/watch?v=hpwPciW74b8
This. Anger-riddled losers and catastrophic weather have (at least historically) wrought far more chaos than pandemics.
Hitler wasn’t a loser. Nor was Stalin.
And I’m pretty sure Genghis Khan or Dracula would have very non-Canadian things done to you if you were to tell him he is a ‘loser’.
Fatman,
Hmmmm, if you go by straight percentages of people killed per people alive I don’t think that’s the case.
If I may offer a tangent to this discussion, we as a species don’t seem to be too scared by natural disasters. It’s a variant of “one death a tragedy, a million a statistic” but it does seem acts of god or nature don’t carry anywhere the amount of required drama to move our collective needles. Even in this discussion early on in the comments someone was having to jazz up a megadeath-dealing pandemic by invoking a nuclear exchange triggered by it.
WWI, everyone remembers it as a dark time in human history, the 1918 plague? A footnote in history, despite the fact it killed more of us. More recently, the Japanese Tsunami that killed 40-50 thousand people has been completely devoured by it’s decidedly less deadly but far sexier secondary result of triggering the Fukishima meltdown.
So my thinking is, we might well have pandemics on the horizon, and… global society might barely notice. We’ve got plenty of spare capacity to absorb death and loss of productivity and people just aren’t scared of disease in the way they’re scared of people of different colors skulking around their backyard*.
Sure there’d be news cycles and reports and people wearing safety masks and maybe washing their hands more often and the odd movie (Climaxing with someone trying to bomb the infected because otherwise we can’t be arsed to be worried about the denouement) but otherwise…
Doing some quick and dirty estimates, we have another 100 million death toll pandemic like the 1918 flu, that’s tripling the yearly worldwide death rate, some countries end up with a death rate like current Leshoto or Afghanistan but probably closer to Russia and… life goes on. You go to 3 funerals that year when you’d have gone to just one otherwise… and it’s all overshadowed by the next school shooting or Islamist driving a truck into some bystanders.
* Hell even the disease needs to have a racially charged name for us to have someone to point a finger at: “Spanish” flu. Of course in Spain they call syphilis the “French malady” so it’s all swings and roundabouts…
“More recently, the Japanese Tsunami that killed 40-50 thousand people”
Wiki figures suggests a direct death toll of ball park 18000 to 19000. (Probably fair to assume the
majority of the ‘missing’ were killed.)’
Yeah I think I mixed the death toll of an older Japanese catastrophe when I checked the figures. Still, I’m convinced the Fukushima meltdown hasn’t come anywhere close. There’s also footage of plenty of industrial plants and oil refineries swept away, I bet some of the contaminants released by those would give nuclear material a run for it’s money. But, atoms!.
Anyone else find it funny that vaccines are the real medicine that comes closest to the supposed mechanism of action of homeopathy? After all it’s a tiny dose of what hurts you used as medicine…
Okay, first off, to borrow a line from Holy Grail: You are you, who are so learned in the ways of science?
If you’re a friend of LCHR, you’ll know I pick his brains ruthlessly (most recently he gets a big acknowledgement at the end of Freeze-Frame Revolution). You keep talking but your own lack of relevant expertise, but you obviously know shitloads more about epidemiology than I do; would you be willing to let me run ideas directly past you in the future, should I find myself in need of related insights? (No problem if you’d rather not— I learn a lot from commenters here, anonymous and otherwise.)
Yeah, that was sloppy of me. I meant in terms of vaccines, not antivirals. I always knew the difference, but I’d never stopped to internalize the implications of that difference on arms races.
Yeah, no, I get that in the absolute sense. In the relative sense, though, the same old level virulence can have more devastating effects against a population that has supplemented its immune response to a suite of drugs that no longer work. It’s like having a shield to protect you from someone throwing rocks; take the shield away, the rocks aren’t any bigger than they were. But they still hurt more.
A) I loved that show. And B) the whole global-warming-related expansion of bugs into new frontiers is at the heart of what Dan’s going on about. And as far as I can tell, he’s not being tongue-in-cheek when he talks about the consequences. (He does have some ideas about avoiding the worst of those consequences, but they involve a lot of international cooperation. He’s basically written off the US as a result.)
We can agree to disagree on these two (it’s possible that their biographies are inaccurate). I also like to point out that (AFAIK?) neither Hitler nor Stalin killed anyone with their own hands.
Rile up a few million losers, tho, and big things happen.
I wouldn’t call Genghis Khan a loser, either on this site, or to his face.
I wasn’t going by straight-up body count, more by the “disruption to civilization” factor, which I acknowledge is tougher to define.
E.g. the Black Death(s) killed millions, but had a relatively small disruptive impact on whatever passed for civilization back then. Apart from angry European peasants using the plague as an excuse to go out and slaughter Jews (instead of taking a hint and starting to wash their hands). Kind of puts the anti-immigrant Eastern European sentiment today in context.
BD had a great impact on wages and serf’s rights actually. Moved quite a few things along.