There’s a claim running around the anti-vaccination circles that measles vaccination didn’t do anything because the disease had already dropped by 95% (or 98%) before vaccination was introduced. That claim is false, of course, and I don’t really expect that debunking it will make any difference, but here it is anyway.
I’m not going to dignifiy the claim with a link. The author shows a chart with measles incidence dramatically dropping in the early 1900s, and offers a list of references for the chart. That chart is a flat lie; the references he cites don’t show numbers that bear any relation to the chart he has made up. I encourage anyone who sees that to check out the references he links — clearly, he’s assuming that people are gullible enough to believe his claim without checking. Also, of course, I encourage people to check my data. I’ve taken my numbers from publically-accessible source (thanks to Google Books) and they’re from publications that preceded the vaccine, so there can’t be any claim that the numbers were manipulated by vaccine propnents. (Unless, of course, the international vaccine conspiracy also has time machines and a vast transdimensional publishing and replacement arm.)
The post-vaccine data I’ve already shown, and I’ll repeat it here. This is measles in the US, after 1950. (Click for a larger version.) You can easily see where the vaccine was introduced.
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| Measles incidence and deaths in the USA, after 1950 |
The anti-vaccine claim is that by 1950 measles had already dropped by 95%. But public health data are available back to at least 1912, and there’s no support for that claim. Here are the data from the US census (PDF link; measles incidence, expressed as rate per 100,000 population):
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| Measles cases in the US, 1912-1997 |
The specific antivaccine claim is made for the UK. Fortunately, again, death rates for England and Wales are well documented back into the 19th century. Here’s what happened to death rates for measles from 1838 to 1937 in the UK (pre-vaccine, obviously). This is taken from the Annual report of the Registrar-General for England and Wales, Volume 70 By Great Britain. General Register Office (the data up to 1890), from the Parliamentary papers, Volume 13 By Great Britain. Parliament. House of Commons (to 1920), and the 1937 data are from a text entitled “Anomalies and curiosities of medicine” By George Milbry Gould. (I believe measles stopped being a reportable disease in the UK in 1921, and that’s why the Parliamentary reports stopped including it.)
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| Measles deaths in the UK, 1838-1937 |
Obviously, there’s no 95% drop. Measles deaths were pretty much constant for over 100 years, until the vaccine was introduced. (EDIT: This is wrong. I meant to write “measles incidence has been pretty much constant … ” not death. Measles death rate did in fact drop, in some places rather markedly, in the first 50 years of the 20th century (see my long answer to Peter in the comments below for reasons). The extent of the reduction in death rate (ie. frequency of deaths per case of measles) was very dependent on region — today it’s still 1900-level or so in third-world countries, for example — and depended heavily on nutrition and sanitation. But the death rate had pretty much plateaued by the early 1950s, and it wasn’t until vaccination spectacularly reduced the incidence and took the deaths away with that. Nevertheless the death rate drop was nowhere near the 95% claimed by antivaccine loons, as the charts here show. Check the original sources.)
One important point is that measles is very much an epidemic disease. It sweeps across a country (in standing waves that originate from cities), and then drops drastically until a new population of susceptible children are born. That means if you want to fake your data you could draw from peaks and valleys of an epidemic and make it show whatever you want. Here’s a more detailed illustration of measles — weekly number of cases — in England and Wales (from Benjamin Bolker at hte University of Florida, who compiled these from public reports):
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| Weekly measles cases in England and Wales |
As I say, I don’t really expect this to convince the loons, but I know there are lots of people who are not loons, but who may be puzzled (or fooled) by the loons’ lies. Don’t take anyone’s word; check the original references.
Your data on measles certainly support you.
I wonder if you have a wider view on this issue (with respect to other infections).
Evidently, the view that rising wealth – via nutrition and hygienic living conditions – greatly outdid all medical interventions in altering death rates from infection, was promoted particularly by one McKeown during the 1950s-80s. He published journal articles and a couple books.
If you believe this author, McKeown’s views are no longer much accepted at all:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447153
There are other essays on the topic out there.
Somewhere in my education – not necessarily in school, but in fact I think it was – I encountered and absorbed this McKeown thesis, presented more or less as fact.
McKeown was a physician whose historical work corresponded to a polemical position in favor of greater preventive care and “humanism” in medicine and less “technocratic” use of specific interventions.
I looked up vaccine loonery in wikipedia for 20 seconds just to see how old it was. Apparently it goes way back, drawing in early times on austere theological notions that disease was a divine punishment for sin.
A number of diseases I’ve looked at don’t seem to fit the McKeown picture well at all, just like measles doesn’t. The one exception I’ve seen so far is TB. If the wikipedia article on BCG can be believed, the latter was not “widely” used until after WWII (the very time of the advent of streptomycin, PAS, and before long isoniazid). In any case it was not used in man at all until 1921. Yet the sprawling TB plummet lasting decades came long before, as shown by these Danish data blessed by the CDC:
http://www.cdc.gov/ncidod/eid/vol8no7/01-0482-G1.htm
I certainly can’t say that quarantine alone couldn’t have produced this, but it sure was one hell of a change.
Eric — I’ve commented on the decline in Tb previously, here. One possibility is that the poorhouse institution inadvertantly acted as a quarantine mechanism for Tb patients and had a lot to do with the decline in incidence. The papers I reference make that argument, anyway.
For nonscientist readers who might not get this from the context, I should add that I’m 98% sure that McKeown and friends were not actually against vaccines. (I’ve never heard of even one serious person who supports that view.) He merely thought the changes in living standards caused by the industrial revolution were significantly more important than vaccines were. And, again, even that much is probably much more false than true.
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I’m writing as a reader sympathetic to your main point about showing the effectiveness of vaccines. In fact, I came across your blog while doing research to try to persuade a beloved relative to vaccinate her kids. I have no scientific or statistical training and am wading into this completely as a layman.
Anyway, what I wanted to ask you about was this: What do you make of this chart, from a UK NHS site, that pretty clearly shows that while reports of measles cases fell dramatically following the vaccine, measles deaths HAD fallen from more than 1000 in 1941 to around 100 (? hard to tell from scale) in the mid-1960s, just before the vaccine.
When I show this to my beloved relative, she will certainly point out to me that UK NHS data prove that measles deaths fell by more than 90% before the introduction of the vaccine.
How would you advise that I respond to her?
Here is the link:
http://www.hpa.nhs.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733756107
Hi, Peter. It’s a good question. It’s strictly a question of mortality rates, as you can see from the case numbers — the number of cases of measles remained fairly constant (accounting for epidemics) while the per-case mortality dropped precipitously. It started well before 1941, probably in the 1920s or so. The same thing happened in the US, rather earlier than in the UK.
By far the most important reason was nutrition. Childhood nutrition (and childhood quality of life) really started to improve around the turn of the century, and nutrition is an enormous factor determining measles survival. This is still hugely relevant today; measles case-mortality rates in Africa are much higher than in the US or UK, for example, and nutrition status is the major predictor. American children in general had better nutrition than British, and that helps account for the earlier drop in measles mortality in the US.
Another reason was better nursing care — or, more accurately, getting rid of actively harmful nursing care. Blood-letting and similarly drastic “treatments” accounted for a fair number of childhood deaths in the early 20th century. Sanitation — reducing exposure to other diseases — was another important factor; measles is a potent immune-suppressive disease and many measles deaths are due to secondary infections, so reducing exposure to bacteria and other viruses was literally a life-saver. And, though I don’t have real evidence of this, I think a more formal approach to quarantine probably was important as well. That shifted the age of exposure up a little by protecting the youngest children, and it was mainly the very youngest children who died of measles. (it’s also argued that other factors caused measles to increasingly infect a slightly older population, including reduced family size and so on.)
It’s important to note, though, that while the death rate did drop it had pretty much plateaued in the early 1950s — there was little or no further improvement in death rate for a decade before the vaccine was introduced, after which there was another precipitous drop in deaths that paralleled, this time, the drop in case number.
I don’t think anyone argues that vaccines alone have been the cause for all diseases and all death reduction — I’ve tried to make that point in this blog several times, especially when talking about tuberculosis. Sanitation, nutrition, antibiotics, and quality of care are all parts of the story. But if you follow through measles death rates in multiple countries — I’ve shown data for China, Finland, Burkina Fasso, Mali, and Togo, as well as the US and the UK, introducing the vaccine at different times — measles vaccination has led to a rapid and dramatic drop in measles cases and in measles deaths.