[jopsen]

Don't we have vaccines?

I mean sure an outbreak would be pretty horrific. But once the pictures start circulating, I suspect vaccine hesitation would evaporate pretty quickly.

Yes, yes, we should go far to avoid an outbreak, but would it really be so world ending? Wouldn't we just contain it, vaccinate widely and be done with it?

[mynameisvlad]

I'd maybe buy this comment a few years ago.

We are barely able to vaccinate against a global pandemic as it is. Our society would honestly probably crumble if you brought in a really deadly virus like smallpox to the fold.

[throwawaylinux]

Not for lack of people being willing to take the vaccination though.

People look at risks and benefits and generally make their minds up pretty rationally, if you account that not everybody values things exactly the same as you do.

Covid is really not that much of a risk if you're otherwise healthy and the vaccines are not highly effective as the smallpox one is (in fact stated definitions of vaccine had to be revised so it would not be excluded). The absolute risk reduction is just not all that high, and some people are disinclined to jump to getting new therapies without much long term data.

You see the rational behavior play out when you look at vaccinations by age. 98% of people over 65 in the US have had one dose and 86% have had two. Because that's where the risk gets higher. Elderly people are not vastly better educated, smarter, less susceptible to propaganda, or lean toward political ideologies that are more inclined to take it, or have significantly easier access to it.

It's just that they get more benefit from the vaccine and they understand that and act accordingly.

If there was an especially transmissible smallpox epidemic killing 30% of people who contracted it and a vaccine that provided lasting immunity to 95% of people who took it, 99.something% of people would take it I bet.

[ricardobayes]

A comment like this got me banned from reddit, stating I was downplaying the risk of Covid. Not saying covid is not dangerous, it really is, but just looking at numbers even diarrhea kills 10M people yearly. It's just not visible to us in the western world and not picked up by the media.

[throwawaylinux]

A lot of people can't cope with hearing about different peoples' perspectives or learning about new ideas that might contradict their own beliefs. They don't go on the internet to be challenged, they go on it to be comforted and assured that their beliefs are right and that other people believe the same things.

[tzs]

> People look at risks and benefits and generally make their minds up pretty rationally, if you account that not everybody values things exactly the same as you do.

But what about when how they value things is not rational?

Consider for example people who are rejecting COVID vaccines because they believe that they contain luciferase (they don't, BTW, although luciferases were likely used in the development of the vaccines). Why, you might wonder, would someone care about whether or not the vaccines contained bioluminescent enzymes?

I've seen two reasons. (1) somehow the bioluminescent enzymes are supposed to make it so the government can track you, and (2) the name comes from the word "lucifer" when clearly means that the vaccine is the work of or promotes Satan.

If someone truly believes either of those things then arguably it is rational for them to decide that the risks of the vaccine outweigh the benefits, but nevertheless I would not call their overall behavior rational.

Quite a few of the reasons for rejecting COVID vaccination given by people who end up as the subjects of /r/HermanCainAward or /r/CovidAteMyFace posts would apply just as well to smallpox vaccination, and quite a few of those people are in high risk COVID groups or situations.

[throwawaylinux]

I don't know, what about them?

I'm talking about the vast majority of people who are not vaccinated because they just aren't inclined to rush to get new medical treatments of little benefit to them.

Do the stats for the over 65 group honestly not make the situation clear to you? Focusing on the 0.1% lunatic fringe doesn't help your understanding, and it's the reason so many people are utterly baffled by what is easily explainable. Life is not the 20 loudest and most obnoxious twitter accounts.

[wutbrodo]

There are many people who don't make their vaccination decisions out of a mystic adherence to the very concept of a vaccine, but based on what they perceive to be a cost-benefit analysis (with the level of rigor varying wildly, naturally).

Unlike covid, there's no large cohort of the population for which smallpox is a fairly negligible personal risk, and smallpox outbreaks provide much more dramatic and visceral evidence of their harms than covid does (not sure if you've ever seen an image of smallpox).

The lessons of covid vaccine hesitancy are barely applicable to a hypothetical smallpox outbreak.

[mynameisvlad]

Highly disagree. Most people make their vaccination decisions, like most other decisions, based on highly biased information that they have obtained from others around them. There is little "cost-benefit" analysis being done when you aren't actually comparing the real costs and benefits, but rather an extremely skewed interpretation you hear from the bubble you're in.

Given that, regardless of the actual risk or visceral evidence provided, almost anything can be spun as a positive or negative with enough determination, and on the heels of a major anti-vax campaign with Covid, there would be sure to be major overlap between the two were a smallpox outbreak to occur right now.

The first vaccine hesitancy campaign literally was against the smallpox vaccine in Stockholm, so I don't see how you could say that there would be no hesitancy to it. History has already shown that to not be the case over and over again.

[wutbrodo]

> based on highly biased information that they have obtained from others around them. There is little "cost-benefit" analysis being done when you aren't actually comparing the real costs and benefits, but rather an extremely skewed interpretation you hear from the bubble you're in.

You're talking about the quality of the cost-benefit analysis, which I alluded to in my charitably-phrased parenthetical about rigor. That doesn't mean it isn't a cost-benefit analysis, and doesn't make it the same thing as religious adherence to pro- or anti-vaxxing. While some portion of the population engages in this approach, my point is that it's a lot fewer than most people think. That doesn't mean I think the cost-benefit analysis is high-quality, but that modeling these people as dogmatically irrational instead of very bad at being rational is misleading.

In stark contrast to Covid, the nature of smallpox outbreaks makes it so that even an extremely dumb person nominally engaging in cost-benefit analysis would have little trouble making basic inferences about the outcomes faced by people they knew who contracted it vs people they knew who didn't. I got vaccinated because I estimated that my low risk of a bad time after contracting Covid was higher than my low risk of a reaction to the vaccine. If for some reason, I didn't have access to the vaccine, it very likely would not have materially changed my young, healthy, no-comorbidity life.

There's another trivial rebuttal of your hypothesis, outlined in a sibling comment:

> You see the rational behavior play out when you look at vaccinations by age. 98% of people over 65 in the US have had one dose and 86% have had two. Because that's where the risk gets higher. Elderly people are not vastly better educated, smarter, less susceptible to propaganda, or lean toward political ideologies that are more inclined to take it, or have significantly easier access to it.

In your model of most people as not considering the cost-benefit tradeoff of vaccines, how do you explain the significant age disparity?

> The first vaccine hesitancy campaign literally was against the smallpox vaccine in Stockholm

This was _literally the first vaccine for a contagious illness_. You'd have to be irrational _not_ to have some degree of skepticism about being infected with a contagious disease, especially in an era with a population accustomed to a state with infinitely lower capacity and infinitely lower reach into everyday life. A quarter of a millennium later, in a society where the state licenses and ensures our safety in a trillion different publicly-known ways, the reactions of 1750s Swedes could not be less applicable.

Again, the pivotal difference relative to my framing is the approach to vaccines as an all-or-nothing tenet of religious faith, to be rejected with prejudice or embraced with devotion. This is obviously a fairly popular (implicit) perspective on public health, which makes it easy to lose sight that most people do not think like this, even the dumb ones.

> I don't see how you could say that there would be no hesitancy to it.

Kindly don't put words in my mouth. I said that Covid hesitancy is a different enough context that it's not usefully-applicable to a hypothetical future smallpox outbreak.

[crate_barre]

Shows how vain society is. If COVID was a harmless and flu-like, but causes a permanent mole on your nose, then I can promise you everyone would get the vaccine.

[jopsen]

Hehehe, I bet that's true :)

[COGlory]

Covid and smallpox are very, very different.

[blindmute]

Smallpox is actually dangerous, and the smallpox vaccine is like 200 years old. Not even 1% of people would refuse that vaccine in that scenario.

[mynameisvlad]

Once again, two years ago I would have believed it. But considering a sizeable amount of people think that the Covid vaccine "allows governments to track you", "has 5G" or whatever other nonsense has permeated that discourse, I'm not as confident.

Especially if it happened right now with all the controversy around the Covid vaccine, it'd surely be spun as the Covid vaccine in disguise, or the government forcing its way into tracking us all with nanotechnology.

[ricardobayes]

or bird flu. That stuff gets me scared, almost 100% lethality

[tomjen3]

All it takes is one to get away on a subway near an airport. Some of the original vaccine hesitancy was about the smallpox vaccine when it was endemic, so not everyone would take it.