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Vaccines work. Period.

Over my blogging “career,” which now stretches back nearly nine years, and my hobby before that of engaging in online “debates” on Usenet newsgroups back before 2004, I developed an interest in the antivaccine movement. Antivaccinationism, “antivax,” or whatever you want to call it, represents a particularly insidious and dangerous form of quackery because it doesn’t just endanger the children whose parents don’t vaccinate them. It also endangers children who are vaccinated, because vaccines are not 100% effective. The best vaccines have effectiveness rates in the 90%-plus range, but that still leaves somewhere up to 10% of children unprotected. Worse, because herd immunity requires in general approximately 90% of the population and above to be vaccinated against a vaccine-preventable disease to put the damper on outbreaks, it doesn’t take much of a degradation of vaccination rates to put a population in danger of outbreaks. That’s why, even though overall vaccine uptake is high in the US, we still see outbreaks, because there are areas with pockets of nonvaccinators and antivaccinationists who drive vaccine uptake down to dangerous levels. We’ve seen this in California and elsewhere. Other countries have observed even more dramatic examples, the most well-known being the way that fear of the MMR vaccine stoked by Andrew Wakefield’s bad science and the fear mongering of the British press led MMR uptake to plummet. The result? Measles came roaring back in the UK and Europe, from having been considered under control in the 1990s to being endemic again by 2008.

As much as I get chastised by concern trolls for saying this, to antivaccinationists it really is all about the vaccines. Always. They blame autism, other neurodevelopmental conditions, and a wide variety of chronic diseases on vaccines, without evidence that there is even a correlation. They even falsely blame sudden infant death syndrome (SIDS) on vaccines, even though there is no evidence of an association and, indeed, existing evidence suggests that vaccines likely have a protective effect against SIDS more than anything else. No matter what happens, no matter what the evidence says, antivaccinationists will always find a way to blame bad things on vaccines, even going so far as to claim at times that shaken baby syndrome is a misdiagnosis for vaccine injury.

One thing, however, that is often forgotten, is that they also do their utmost to downplay the beneficial effects of vaccines. One such tactic is for antivaccinationists to claim that the pertussis vaccine doesn’t work because we are seeing resurgences of pertussis even in the face of high vaccine uptake. For example, another common trope is what I like to refer to as the “vaccines didn’t save us” or the “vaccines don’t work” gambit, in which it is pointed out that the introduction of vaccines doesn’t correlate tightly with drops in mortality from various diseases. Julian Whitaker even used this gambit when he debated Steve Novella. The fundamental flaw in this trope neglects the contribution of better medical care to the survival of more victims of disease, which decreased mortality. If you look at graphs of disease incidence you will see a profound and powerful effect of the introduction of vaccines on specific vaccine-preventable diseases. In other words, vaccines work.

Over the Thanksgiving long weekend here in the US, there appeared a study that simply emphasizes once again that vaccines work. More importantly, it estimates how well they work. I’ve frequently said that vaccines are the medical intervention that have saved more lives than any other, and this study by investigators at the University of Pittsburgh’s graduate school of public health, published on Thanksgiving Day in the New England Journal of Medicine (NEJM) and showing up on the news the day before provides yet more evidence to support my assertion. In one way, it’s a shame that it was published over a long holiday weekend here in the US, where it was unlikely to garner as much attention as it normally might have at another time. On the other hand, it was Thanksgiving, and if there is anything we should be thankful for it’s that so few children die of vaccine-preventable diseases anymore. This study simply underlines this.

What the authors did was a massive undertaking that involved going back over case reports from before and after times when specific vaccines became commercially available. Boiled down to its essence, the study examined these reports and came up with estimates for cases of a disease prevented based on the drop in cases after the vaccine for that disease came into widespread use, and they did it all the way back to 1888. From the Methods section of the paper:

In an effort to overcome these limitations, we digitized all weekly surveillance reports of nationally notifiable diseases for U.S. cities and states published between 1888 and 2011. This data set, which we have made publicly available (www.tycho.pitt.edu), consists of 87,950,807 reported individual cases, each localized in space and time. We used these data to derive a quantitative history of disease reduction in the United States over the past century, focusing particularly on the effect of vaccination programs.

We obtained all tables containing weekly surveillance data on nationally notifiable diseases that were published between 1888 and 2011 in the Morbidity and Mortality Weekly Report and its precursor journals from various online and hard-copy sources.21-24 We digitized all data available in tabular format that listed etiologically defined cases or deaths according to week for locations in the United States. Reported counts (weekly tallies) of cases or deaths and the reporting locations, periods, and diseases were extracted from these data and standardized. Then we selected eight vaccine-preventable contagious diseases for more detailed analysis and computed weekly incidence rates, deriving a quantitative history of each disease.

We estimated the number of cases that have been prevented since the introduction of vaccines for seven of the eight diseases. (Since there were no data from the era before the introduction of the smallpox vaccine in 1800, we could not quantify the number of smallpox cases that were prevented by the vaccine.) We estimated the numbers of cases of polio, measles, rubella, mumps, hepatitis A, diphtheria, and pertussis that were prevented by vaccines by subtracting the reported number of weekly cases after the introduction of vaccines from a simulated counterfactual number of cases that would have occurred in the absence of vaccination, assuming that there were no other changes that would have affected incidence rates. We used the year of vaccine licensure as the cutoff year to separate the prevaccine period from the vaccination period. Counterfactual numbers were estimated by multiplying the median weekly incidence rate from prevaccine years with population estimates for vaccination years.

Yes, you read that right: nearly 88 million reported individual cases. The New York Times news report on the study points out that this massive digitization of data was performed by Digital Divide Data, described as “a social enterprise that provides jobs and technology training to young people in Cambodia, Laos and Kenya.” However, getting the data digitized and organized into spreadsheets was only the first step. Massive databases and spreadsheets are not particularly useful if they aren’t in a form that can be queried to answer research questions. The data thus had to be standardized and sorted in order to allow for that. Once that was done, the investigators were able to conclude since 1924:

Assuming that the difference between incidence rates before and after vaccine licensure for these diseases was attributable solely to vaccination programs, we estimated that a total of 103.1 million cases of these contagious diseases have been prevented since 1924 on the basis of median weekly prevaccine incidence rates. Estimates based on the 10th and 90th percentile of weekly prevaccine incidence rates were 72.3 million and 147.8 million cases, respectively. Of those hypothetical cases, approximately 26 million were prevented in the past decade. Sensitivity analyses that used different methods for imputing missing data and for simulating counterfactual cases resulted in estimates ranging from about 75 million to 106 million prevented cases. The number of cases that were prevented per disease depended on the incidence rate before vaccination and the duration of the vaccination program.

If you delve into the paper, you’ll find a really cool interactive graphic about disease elimination in the US, specifically hepatitis A, measles, mumps, pertussis, polio, rubella, and smallpox. As you move your cursor to different points of the graph, different facts and statistics pop up. You can look at state level data. If you click on different lines indicating when a specific vaccine was first licensed, all the other lines representing the other diseases disappear, and you see the data only for that disease. For instance, if you look at when the measles vaccine was first licensed in 1963, you’ll see a brief blip upward in measles incidence well within the range of random variation followed by a drop to almost zero by 1968, a mere five years after the vaccine was licensed. The pertussis vaccine took a bit longer; after it was licensed in 1948 it took around 8 years before the disease incidence hit bottom. Particularly cool is a set of graphs in Figure 2 that show snapshots of disease elimination in the US for different diseases and the entire country divided up into ten different areas. It’s particularly striking and an effective way of demonstrating the effect of vaccines on infectious disease:

VaccinesWork

The investigators were very conservative about their assumptions, as well. The authors point out in the discussion that their estimate of number of cases of diseases prevented is probably an underestimate. The reasons include an inability to include all vaccine-preventable diseases and to correct for underreporting of cases. They note that the underreporting rate was higher in the era before specific vaccines came into use and that they don’t always have the detailed historical demographic data, such as birth rates and age-specific disease incidence rates, that would enable them to make such adjustments. Unfortunately, such data are only available for a small number of locations and for limited periods of time.

One weakness of the study is that the authors could not examine death rates in nearly as much detail as they could study incidence. They could only estimate the effect of various vaccines on death rates. Hence, they did not report death rates in the NEJM article because, according to the NYT article, death certificate data became sufficiently reliable and consistent only in the 1960s. They could, however, make a reasonable estimate of three or four million deaths prevented based on the known mortality rates of the diseases studied in the database.

The real accomplishment of this project is not so much the first publication, but rather the open-source Project Tycho™ database, named after Danish scientist Tycho Brahe (1546—1601), who was known for his detailed astronomical and planetary observations. The reason for choosing Tycho Brahe becomes obvious if you know that Tycho could not use all of his data during his lifetime. However, his assistant Johannes Kepler (1571-1630) used his data to derive the laws of planetary motion. As the authors put it:

Similarly, this project aims to advance the availability of large scale public health data to the worldwide community to accelerate advancements in scientific discovery and technological progress.

And:

The database contains three levels of data. Level 1 data were the basis of the NEJM article, and “include different types of counts that have been standardized into a common format for a specific analysis published recently in the NEJM.” Level 2 data are defined thusly:

Level 2 data only includes counts that have been reported in a common format, e.g. diseases reported for a one week period and without disease subcategories. These data can be used immediately for analysis, includes a wide range of diseases and locations but this level does not include data that have not been standardized yet.

While Level 3 data are defined:

Level 3 data include all the different types of counts ever reported. Although this is the most complete data, the large number of different counts requires extensive standardization and various judgment calls before they can be used for analysis.

All of these data are broken down into diseases, states, and cities, as well as time periods. Level 1 data include eight diseases, 50 states and 122 cities from 1916-2009; Level 2, 47 diseases, 50 states, 1,287 cities from 1888-2013; and Level 3, 56 diseases, 72 disease subcategories, 3,000 cities, etc. from 1888-2013. Any investigator can establish an account to look at Level 1 and Level 2 data, although the University of Pittsburgh won’t give out Level 3 data to anyone, because the database contains “substantial number of counts for which the disease name, time period, or location has not yet been identified from contextual information.” To get an idea of the power of this database, it’s useful to take a look at a couple of short videos:

And:

As you can see, this is a fantastic resource that is likely only to get better with time as raw data are curated, organized, and put into a form that can be mined for correlations. Epidemiologists, vaccinologists, and infectious disease researchers will be able to use this resource to ask questions and look at historical comparisons in a way that they haven’t been able to do before because of the difficulty in reconstructing old disease patterns. No wonder the Bill and Melinda Gates Foundation funded this work!

There is one concern I have about the project, although it does not in any way outweigh the potential usefulness of this database. That concern derives from what I know of bad science generated by antivaccinationists. I can easily see antivaccine “scientists” mining this database in ways to look for correlations to support their agenda, particularly if they get their hands on the raw data, which, according to the authors, needs a lot of cleaning:

These data have not been filtered or standardized and cannot be used for analysis. These data include a large variety of data counts and often varying types of information. In this level, multiple types of data counts are often available for one location, disease, and week. In some cases, different counts provide conflicting information on a location and disease. The use of data from this level requires extensive knowledge of the historical U.S. disease surveillance system and data digitization and quality control procedures. We continue to standardize data and will include newly standardized data in the level 2 data section of this website at regular intervals. These level 3 data are provided for those that are interested in contributing to the data standardization process.

Can you imagine what Jake Crosby might do with such a data set? Or Mark and David Geier? Just take what they’ve tried to do with the VAERS database and the Vaccine Safety Datalink and put it on steroids. I rather expect that various antivaccine “scientists” have already registered accounts for Project Tycho™ and are furiously mining ever smaller slices of data trying to see if they can “prove” that vaccines don’t work or linking their work with other databases to try to correlate vaccine uptake with autism.

Still, any database can be abused, as can any scientific tool. If the database is truly open source, then its creators are obligated to provide access to everyone who requests it. The benefits of such a resource far outweigh the risk that Jake Crosby, Mark Geier, Gary Goldman, or other epidemiologist wannabes might use it to produce nonsense. Besides, the correlations between the introduction of various vaccines and plunges in the incidence of the diseases being vaccinated against are so robust that I doubt the antivaccinationists can do any real serious harm, other than producing studies to use to preach to the choir with. Meanwhile, real scientists will be using the database to do real science and ask important questions about infectious disease and how it can be prevented with vaccines.

Posted in: Epidemiology, Public Health, Vaccines

Leave a Comment (134) ↓

134 thoughts on “Vaccines work. Period.

  1. Jann Bellamy says:

    A report from Modern Healthcare on Nov. 30th discusses the resurgence of vaccine-preventable diseases. http://www.modernhealthcare.com/article/20131130/MAGAZINE/311309983/rise-in-measles-and-other-infectious-diseases-has-u-s-public-health

    An incident from the report demonstrating the damage one infected person can do:

    “A Swiss woman who had been traveling in Mexico arrived at a Tucson, Ariz., emergency room with symptoms that included a rash and difficulty breathing. Two days passed before she was diagnosed with measles and placed in isolation. By that time, she had transmitted the disease to another woman who was in the emergency department at the same time. That woman then passed the measles infection to a hospital staffer who had not been vaccinated, as well as to an 11-month-old child who was too young to get vaccinated. In all, 14 confirmed cases and 363 suspected cases resulted from the Swiss traveler’s case of measles. Of the confirmed cases, seven people got the disease while in the care of two hospitals for other medical conditions. A 2011 study in the Journal of Infectious Diseases calculated the cost of the hospitals’ responses to the 2008 outbreak at more than $799,000.”

    1. Chris Hickie says:

      As a pediatrician practicing then (and now) in Tucson, it was very worrisome knowing that measles was in Tucson and spreading. The county health department declared a health emergency and set up multiple vaccination clinics. We also vaccinated infants 6-12 mos age with the MMR vaccine (which you wouldn’t do normally, but you can do during an outbreak). I felt like we dodged a bullet on that one. Now, unfortunately, there is a whooping cough outbreak in my practice area (http://azstarnet.com/news/local/education/vail-continues-to-see-whooping-cough/article_756ebf08-b473-5b3d-a4c0-0a4df9c19a7a.html) that is due to the decline in vaccination rates I have seen since setting up practice here.

      It’s very sad to think we may have to learn the same lessons all over again about how awful these diseases are and how truly effective vaccines are–especially when everyone is vaccinated–at preventing these diseases.

      Thank you for today’s article, David. Vaccines do indeed work. Period.

      1. Kathy says:

        Yes, we may have to learn all over again. Like with wars, there never is a war to end all wars. Young mothers today haven’t actually experienced things like whooping cough themselves, so they minimize them in their minds. They hear about them but, hey, it can’t have been as bad as all that?

        I emailed my mother last night to check which vaccinations I’d had as a baby, and this was her comment, “Whooping cough, diphtheria and measles. They killed babies very easily.” That’s the comment of someone who was there and saw it happen to people she knew.

        She also insisted on getting me vaccinated for polio, despite the opposition of her mother-in-law, who lived with them and who was a Christian Science convert. And who was a very hard-faced old dame I can tell you. Tough for a young wife to stand her ground against her … all credit that she did.

      2. doug says:

        “herd immunity” has NOTHING….let me repeat….NOTHING to do with vaccinations. Please leave the clinic for a few hours and reacquaint yourself with this terminology.

        Saying things like “vaccines work” is such a ridiculous statement on so many levels.

        1. Chris says:

          Explain exactly, with references, how the research and statistical analysis discussed in above article is flawed. You seem to be big on claims but short on data.

          When you are done with that tell us why the following census data shows that the incidence of measles fell in the USA by 90% between 1960 and 1970. Do not mention mortality, any other country nor any other decade.

          From http://www.census.gov/prod/99pubs/99statab/sec31.pdf
          Year…. Rate per 100000 of measles
          1912 . . . 310.0
          1920 . . . 480.5
          1925 . . . 194.3
          1930 . . . 340.8
          1935 . . . 584.6
          1940 . . . 220.7
          1945 . . . 110.2
          1950 . . . 210.1
          1955 . . . 337.9
          1960 . . . 245.4
          1965 . . . 135.1
          1970 . . . . 23.2
          1975 . . . . 11.3
          1980 . . . . . 5.9
          1985 . . . . . 1.2
          1990 . . . . .11.2
          1991 . . . . . .3.8
          1992 . . . . . .0.9
          1993 . . . . . .0.1
          1994 . . . . . .0.4
          1995 . . . . . .0.1
          1996 . . . . . .0.2
          1997 . . . . . . 0.1

    2. Greg says:

      The study supposed that all else was equal before and after vaccine introduction, which according to you, it was not, as treatments were advancing to the point where the disease was already on the decline. I could be wrong here, but it seems to me that without accounting for advances in medical treatment, it makes it rather difficult to pinpoint cases that could have occurred but didn’t due to medical treatment as opposed to cases that were prevented through vaccination.

      1. Greg says:

        the previous reply is in the wrong spot – it was meant as a general reply to the article and not the post by Jann Bellamy

        1. Lawrence says:

          Why am I not surprised that an anti-vax individual can’t tell the difference between mortality and incidence rates……..and better yet, has no idea that there are no “preventative” treatments for things like Measles besides vaccination.

          1. Greg says:

            So I misinterpreted what I read… OMG!

          2. AnObservingParty says:

            I think this is a different Greg, not our friend from the not-so-secret-other-blog.

      2. Old_skeptic says:

        You can tell the difference.

        In almost all instances, medical treatment does not prevent the occurrence or spread of vaccine-preventable diseases. Instead, it improves the outcome for those who do become ill.

        Therefore, medical treatment would not affect the number of cases of disease in most instances.

      3. windriven says:

        So what precisely is your point, Greg? We aren’t clairvoyant.

        It drives me band-edge when commenters pop these enigmatic little potshots.

        “[B]ut it seems to me that without accounting for advances in medical treatment, it makes it rather difficult to pinpoint cases that could have occurred but didn’t due to medical treatment as opposed to cases that were prevented through vaccination.”

        Treatment does not equal prevention. Aggressive treatment may limit the number of healthy individuals exposed to the vector and it would certainly impact the mortality rate. But it does not prevent. And treatment is WAAAAAY more expensive than prevention.

        Imagine a world without smallpox vaccine or polio vaccine. Would the incidence rate be the same as it was in 1900? No. Would there still be outbreaks of smallpox and polio? Yes. So are you quibbling about the number of cases prevented?

        Does it make a big difference to you if it was 60 million or 75 million or 100 million?

      4. AnObservingParty says:

        I’m confused as to what diseases you think could be prevented by
        “medical treatment.” Several times Dr. Gorski has pointed out that while medical advances may have reduced overall mortality from the disease, it does NOT reduce incidence of infection.

        What medical treatments would prevent the spread of an airborne disease such as measles, aside from vaccination? Even with the “medical treatments” of today, measles mortality is still 1-2/1000. Or pertussis? I think you misunderstand the entire point of what this study showed (incidence of disease) and really, how pathogens spread and the practices put in to prevent them.

        However, it should be noted that despite decent hygiene and sewage diversion/treatment programs, polio was still rampant until vaccination. that has also been addressed in these blogs.

        1. Greg says:

          Yes, I misunderstood the point of the study.

      5. Young CC Prof says:

        Medical treatment does not prevent the measles any more than it prevents colds. Measles is unbelievably contagious, more so than most colds, look into the matter. In Europe, declining vaccination rates have led to massive epidemics.

        In the 1950s, pretty much all of the baby boomer children caught it. (Official records have only 500,000 cases per year, but the true number was probably a couple million. Again, almost all the children, entire classrooms at once, and medicine did nothing to prevent it.)

        However, luckily for those children, most of them were properly nourished, and they did have medical care, including penicillin to treat secondary infections. That’s why only about 500 died each year. (And roughly 1,000 suffered substantial permanent harm such as brain damage.) Still, they got sick and it was not a trivial illness for any of them. Many were desperately sick.

        Polio, same deal. By the 1950s, the iron lung and penicillin to hold off pneumonia could keep the victims alive long enough to fight off the virus, but many many thousands of people went through hell and were left with permanent nerve damage.

        Medical treatment prevents death when you are already sick. Vaccines prevent sickness in the first place. I know which I’d prefer.

      6. Harriet Hall says:

        We have seen many instances of diseases returning when vaccination rates dropped and subsiding again when vaccination rates improved. Also of adjacent African countries where the disease rate was much lower in the country with higher vaccination rates. Those “natural experiments” control for the effects of medical care and hygiene, which presumably did not change.

      7. WilliamLawrenceUtridge says:

        You might have a germ of a point, but we could look at it this way:

        Deaths due to currently-vaccine-preventable diseases were going down due to improved medical treatments, both in general, and in specific. So, to take an extreme example, people were no longer dying of polio, instead they were put in iron lungs for the rest of their lives. So yeah, fewer people died of these diseases, and you can’t necessarily say the vaccine reduced death rates.

        However, vaccines prevented incidence. So, to take the same extreme example, people were no longer put in iron lungs for the rest of their lives. Instead, they never got polio.

        Do you really think it’s better to get polio, or measles, or smallpox, or pertussis, and not die but instead spend weeks in misery, or in the hospital or (in the case of polio), the rest of your life staring at the same spot in the ceiling? Often at a cost of tens of thousands of dollars, minimum? Versus, say, a shot costing $15 that causes you a few days aches and low-grade fever but means you never get any of these diseases?

        Sure, maybe vaccines didn’t drop the death rates by much (though this is a questionable argument that only applies in areas with first-world hospital care and the money to pay for treatment), but they sure as hell saved a ton of money and even more misery.

        I don’t know about you, but I’d rather my kid got a single shot rather than a month in the intensive care unit. But maybe I’m crazy.

    3. le mec says:

      This brings up an interesting point – if one can person can be targeted for causing a vaccine preventable outbreak, then could said person be liable for damages through a lawsuit? If herd immunity is requires participation of the entire group, and certain folks who choose not to vaccinate put the rest of the group at risk, then punishment could be levied against those for endangering the rest of the group. So, perhaps a lawsuit would then be a game changer, and it wouldn’t necessarily be a class action – the life insurance company of a hospital worker that dies of measles, the insurer for a medical clinic. What if a legal precedent is set that not being vaccinated and constantly being around children, the elderly or the infirm is gross negligence (or more terrifyingly found to be acceptable).

      1. Tallise says:

        I’m not sure if you can sue someone for exercising their medical autonomy. In medical ethics it’s one of the number one concepts drilled into your head relating to informed concent / patient rights. You could perhaps have ordered topical education for those who cause damages based on I’ll informed medical decisions. I doubt anything more could come from something like this, given the medical ethics laws and concepts valued in the united states.

        1. windriven says:

          @Tallise

          “I’m not sure if you can sue someone for exercising their medical autonomy”

          I don’t think the issue is medical autonomy. A person who is HIV positive can be prosecuted for having unprotected sex if they don’t inform their lover. A person, using similar logic, could reasonably considered culpable for refusing immunization but continuing to socialize with groups unaware of their non-immunized status.

          If a daycare worker refused pertussis vaccination but continued to work with small children and sparked an outbreak I would characterize that as depraved indifference. The same person, working from home as a freelance writer who had incidental contact with others might not.

          1. Tim's Neighbor says:

            There would certainly be a case for negligence here, as has been established with some people being held responsible in civil courts. It’d be boring to go into the legal details/standards and I’m still a newbie to law, but if I could make a semi-decent argument for it, someone smarter and more experienced than I definitely could. I think a lawsuit like that could be justified.

  2. Miles Cannon says:

    For me, all I have to do is go to Google or Bing images to see what some diseases do, e.g., smallpox, etc., to know I rather gamble with a vaccine than not

  3. LDM says:

    The incidence plots are so amazing and detailed. I’m glad you shared them since I don’t have access to the study itself.

    Looking at the black histograms, it appears the incidence is cyclical for all but Hep A and Pertussis. It makes sense to me that diseases would come in cycles (like flu does), so I’m wondering what makes these two different.

  4. AnObservingParty says:

    An aside that isn’t really a constructive comment: those data are absolutely beautiful. Really awe-inspiring, that mankind was able to accomplishment that. One of those diseases we’ve completely eradicated. Amazing.

    Now, how long until an anti-vaxxer tries to warp it? Although, I don’t know how well their “epidemic” numbers would fit in with the lowest levels of the diseases–indicating the population has hit probably maximum uptake without really delving deeper into the numbers. Specifically the diseases for the one vaccine they continue to try to blame.

    1. Lawrence says:

      My apologies to Greg – based on dealing with with other Greg, my patience is somewhat limited.

      1. AnObservingParty says:

        I thought it was him at first too, sorry to Greg! I hope we answered your questions.

        1. Greg says:

          No worries – I’m not so easily offended. Yes, you clarified things for me. David’s posts are quite lengthy so I try to read them quickly – next time I will read more carefully.

          1. Chris says:

            That is why it takes me a while, since I usually read them in small bits over the day.

  5. Matt Carey says:

    I consider 100 million to be a very conservative number. (and note this is only an estimate for the US)

    Consider that today most of the population of the US has not had the measles. Nor Rubella, Mumps, pertussis, etc.. Diseases which were so common in the past that everyone would eventually catch them.

    About 400M people in the US. Say 1/2 were born post vaccine. Heck, say 1/4. The lack of measles alone should result in over 100M fewer infections. Then add Rubella, Mumps, etc..

  6. Chris Hickie says:

    Here’s a great piece by Dr. Roy Benaroch, a fellow pediatrician, illustrating wonderfully the insanity of the anti-vaccine crowd (well, at least those who aren’t foaming at the mouth anti-vaccine): http://pediatricinsider.wordpress.com/2013/12/02/does-it-make-sense-to-use-car-safety-seats-only-sometimes-or-only-when-children-are-older/

    1. Greg says:

      Great analogy! But you know there’s always going to be doubters. I’m beginning to believe anti-vaxxers and conspiracy theorists are one and the same – there seems to be a lot of overlap in their mentalities.

  7. andrew says:

    http://www.nvic.org/nvic-archives/conflicts-of-interest.aspx

    When you own the information, you can make it say anything you want. Do you know how much research the FDA does on vaccines? None. The FDA reviews existing research. Who does the research? Who do you think?
    I am not suggesting all vaccines are bad, or that all pharmaceutical companies are evil, but what assurances do we have that ethical standards are maintained when there are billions of dollars at stake?
    Additionally, there are still no long term studies to say that the current recommended vaccine schedule is safe. I’m talking the total sum of all vaccines, not the studies that look at them individually. That’s because no one with money wants to find out.

    1. Lawrence says:

      @Andrew – actually, pretty much nothing you just stated is true….I’m heading up to Dinner, but I believe the others here will point out just how wrong you are….

    2. Chris says:

      Wow. Just wow.

      Please explain why we should care what the National Vaccine (mis)Information Center has to say. They have a reputation of leaving out data that they don’t like.

      If you have evidence that is contrary to the paper that this article is about, please present the PubMed indexed study by a reputable

    3. Chris says:

      Oh my word! That document is over a decade old! Dr. Offit has not been on the ACIP for ages. Talk about more lies of omission.

      Oh, and more about NVIC:
      http://www.harpocratesspeaks.com/2013/03/nvic-know-omissions.html

      Also, again, it has absolutely nothing to do with the paper that this article is about.

    4. AnObservingParty says:

      Long-term effects of what, exactly? Which sums of which elements of which vaccines? I’d say, the number of antigens, full-cell organisms, elements, and compounds we come into contact with every day of our lives that make up vaccines–some of which we even produce inside our bodies ourselves, in much higher amounts, oh my! :O–is evidence that the sum of the minute anything in vaccines, except in very, very rare cases of immediate adverse event (anaphylaxis, etc) is enough to show no long-term affects that can be attributed to vaccines. The only difference is very few of those things we come into contact with provide immunity, and those that do, require dangerous sickness to get there.

      And ah, the 14 year old document with Rotashield. Which was caught. Rather quickly. The system in place works for what it is supposed to! If causation is there, it will be found.

    5. WilliamLawrenceUtridge says:

      Well, in this case one can look towards anecdotal experience for a lesson. Ask yourself this question Andrew – who do you know with smallpox scars? When smallpox was endemic, the scars of smallpox were ubiquitous.

      Do you know why milkmaids were traditionally the plebian temptresses of yesteryear? It’s because cows got cowpox, a smallpox-like infection that would infect the teats of cows and from their the hands of milkmaids. Their hands were scarred, but because cowpox protected against smallpox, their faces remained smooth and unblemished. So much so, it became a staple of the literature at the time.

      And while the current schedule hasn’t been compared against any other schedule, the individual vaccines have had both long and short term safety studies conducted. Further research as driven down the number of infective particles found in each vaccine through the use of adjuvants, to the point that in some cases you are getting as few as seven viral particles per shot (compared to the billions upon billions of whole viruses if you were genuinely infected). Why would the current schedule, with orders of magnitude reduced exposure to infectious particles, be more dangerous than getting the individual diseases? And why would you think there is a better schedule out there? Is it because you’re a follower of that idiot, Sears? Why do you think the current schedule, drafted by dozens of world-renowned experts in specific diseases, pediatric immunology, vaccinations and epidemiology, is anything but the best we could come up with given current knowledge?

      And why would you quote the notoriously antivaccination organization of NVIC seriously? Their entire mandate is about exaggerating the risks of vaccination and minimizing the benefits, why do you consider them credible? They aren’t interested in a fair assessment of vaccination, they just want to criticize.

  8. Max says:

    “One such tactic is for antivaccinationists to claim that the pertussis vaccine doesn’t work because we are seeing resurgences of pertussis even in the face of high vaccine uptake.”

    Paul Offit attributed the resurgences of pertussis to a newer less effective vaccine. He said the vaccine that was developed in the 40′s had some 3000 antigens including both the bacteria and its toxins, but it caused scary though temporary side effects. The newer vaccine has only 8 or so antigens, causes fewer side effects, but wears off in 10 years and requires booster shots.
    http://www.pointofinquiry.org/paul_offit_md_-_do_you_believe_in_magic_the_sense_and_nonsense_of_alternati/

    1. Vicki says:

      Possibly fewer than ten: the intake questionnaire when I saw a new doctor a couple of weeks ago asked if I had had a DTaP booster in the last five years, and “if not, would you like to help prevent the spread of pertussis?” Having had mine four years ago, I didn’t pursue it, but I suspect I won’t be waiting until 2019 for my next booster.

    2. Young CC Prof says:

      Five years. My obstetrician says everyone who’s going to be around little babies should have a booster within the past five years, and the data from the California epidemics seems to bear that out.

      The obstetrician also says, “Now why can’t we bring back the old whole-cell one, at least for older children and adults.” She’s probably right.

  9. Max says:

    What are all the actual side-effects of vaccines?

    Ever heard of Shoulder Injuries Related to Vaccine Administration (SIRVA)?
    http://www.jabfm.org/content/25/6/919.full

    Seen the Vaccine injury table?
    http://www.hrsa.gov/vaccinecompensation/vaccinetable.html
    Encephalopathy 5-15 days after the MMR vaccine? Chronic arthritis 7-42 days after vaccines containing rubella virus?

    One more
    http://www.iom.edu/~/media/Files/Report%20Files/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality/summary2.pdf
    “Disseminated varicella infection with subsequent infection resulting in pneumonia,
    meningitis, or hepatitis” from the chickenpox vaccine?

    Narcolepsy from European H1N1 flu vaccine?
    http://www.cdc.gov/vaccinesafety/Concerns/h1n1_narcolepsy_pandemrix.html

    1. Harriet Hall says:

      If you think we are not all well aware that vaccines can have side effects, you are badly mistaken. Steven Novella even wrote about the narcolepsy question here: http://www.sciencebasedmedicine.org/tag/narcolepsy/

      This article was about the benefits of vaccines, not about the side effects, the magnitude of which pale into insignificance beside the magnitude of the benefits.

    2. Chris says:

      Interesting you should cite the table injuries of the National Vaccine Injury Compensation Program. Now exactly how many have been compensated. Goes to the NVICP Statistics page, looks at the bottom of the second table, and see a total since 1988 of less than 3500 claims have been compensated. And that includes the fact that symptoms described on the page you posted are pretty much automatically paid due to being in a certain time range, even though there may be another reason.

      So that 3500 is what percentage of the number of vaccines given in the USA in the last twenty five years? Well, about four million kids are born each year, so that is about a hundred million kids born, with at least 80% getting about twenty vaccines. Now tell us what 3500 divided by that number is? Is it big or is it small?

      Also, if you other evidence that a vaccine on the present American pediatric schedule causes more than the disease, please feel free to post the PubMed indexed study by a reputable qualified researcher showing the relative risk.

      For instance tell us if “Disseminated varicella infection with subsequent infection resulting in pneumonia, meningitis, or hepatitis” happens more often with the vaccine or the actual wild virus. Provide the reference with the actual numbers, not a summery saying there is just a relationship.

      1. Chris says:

        Screwed up one word: “more often with the vaccine than the actual wild virus.”

        So just give us the data that the vaccines cause more problems than the diseases. Tell us exactly why we should not prevent the diseases.

      2. AnObservingParty says:

        I wonder how many of those awards were for individuals who ended up having Dravet syndrome, instead of injury from the pertussis vaccine, as it was later discovered to be. I honestly have never seen numbers.

        1. Chris says:

          I am sure some of the earlier ones were. The criteria for table awards have been modified over the years with new research. I believe this was the reason for the Bruesewitz v. Wyeth, inc. case.

  10. davdoodles says:

    One bit of good news coming out of Australia is that the disingenuously mis-named “Australian Vaccination Network” has lost its appeal against a government order that it must change its name, as it is it is misleading and deceptive.

    http://www.skeptics.com.au/latest/news/avn-told-to-change-its-name/

    Of course, they haven’t done so yet. Maybe it’s becuase they can’t think of a name which both (i) reflects their real mission, and (ii) doesn’t contain the phrase “Scumbag Turd Lowlife Fearmongering Lying Enemies of Humanity”

    I have a suggestion: they can call themselves “Shills for Big IronLung, Inc”.
    .

    1. windriven says:

      “they can call themselves “Shills for Big IronLung, Inc”.”

      No, I prefer the original “Scumbag Turd Lowlife Fearmongering Lying Enemies of Humanity”. But we have to change it up to give it a catchy acronym. The ‘ST’ at the beginning is good but then the ‘L’ is problematic. ‘R’ would be better. Or ‘U’: Unscientific. ‘P’. Phony. Idiotic. Maybe ‘D’.

      Scumbag Turd Unscientific Phony Idiotic Douchebags or STUPID for short. Works for me.

    2. Young CC Prof says:

      Australian Anti-Vaccination Network. They could redesign their logo real easy.

      1. Chris says:

        My thought it would be a syringe with a red slash through it.

        Plus they could just change their name to part of the slogan they put on shirts they sell “Love them. Protect them. Never inject them.” So it would work if they became the “Never Inject Group”, or NIG.

        It would be much better than being confused with the Adult Video News or Network (um, yeah, I made a mistake by putting “AVN” into Google).

        1. Lawrence says:

          @Chris – yeah, it was a “mistake” wink, wink….

  11. Randall says:

    Jonas Salk or Jenny McCarthy.
    Whom to believe?

  12. DayneATC says:

    To anyone willing to confront…
    I happen to be perusing facebook pages for antivaccine groups. I ran across the “Vaccine Skeptic Society”. The admin loves to speculate and pontificate about research, but mostly post quotes from “vax fanatics” as an attempt to demonize or present pro-vaxxers as dumb. I don’t feel competent enough to spark a debate or discussion because I’m a lowly athletic trainer with a love and appreciation or science and evidence-based info. It would be amazing to see any of you post on that page.

    1. Chris says:

      Sorry, I can’t help because I don’t do Facebook.

      Though I have managed to acquire some “questions that the antivax will not answer.”

      I have used one on this very thread about the NVICP only compensating fewer than 3500 claims in the past twenty five years.

      In the last couple of days I have employed some here, which include the cost of vaccine versus disease, what increase in autism was caused by the USA introducing a MMR vaccine in 1975, and what vaccine in the present American pediatric schedule is only available with thimerosal.

      Then when there are those who want to claim that vaccines did not reduce disease I pull this one. It is amazing how they try to wiggle out of that one. Yes, the rate of death from measles was reduced before the measles, but that was because of some serious and expensive medical intervention. One of the major killers from measles is pneumonia, but if you can hook someone up to a ventilator it improve the chance of survival. Still, the better way would be to avoid getting pneumonia in the first place.

    2. Flower says:

      Yea, and I found this other site of shills for the iron lung et al – run by MDs who reckon that vaccines are unsafe and unnecessary:

      http://www.vaccinationcouncil.org/about/

      1. Chris says:

        Yeah, they decided to change their name. Those guys are well known here:
        http://www.sciencebasedmedicine.org/medical-voices-always-in-error-never-in-doubt/

      2. DayneATC says:

        Thanks, I’m well aware of the various sites and organizations that use the term “vaccination” to push an agenda.

    3. DayneATC says:

      I should make it known that the infamous radio host from Autism One, infowars, and natural news, Curt Linderman Sr, frequents the Vaccine Skeptic Society facebook page. He has called me a “dumbass” and other names already.

  13. PMoran says:

    “This article was about the benefits of vaccines, not about the side effects, the magnitude of which pale into insignificance beside the magnitude of the benefits.”

    Agreed, in the main. We do, however, have a special responsibility to ensure vaccines are safe because they are given to perfectly healthy children who are often at little personal risk under present conditions in developed countries.

    Vaccines thus involve a very different cost/risk/benefit template to that which applies to the medical treatment of sick individuals. There is even an extra component: benefits that apply to other members of the public, or to the public generally, such as sparing it the substantial costs of dealing with epidemic illnesses. .

    Because of that personal autonomy has its limits in the matter. Society can and would use almost any legal compulsion in any extreme event.

    The other side to this coin, however, is that the public has the right to be as inquiring as it likes as to the safety of vaccines. They are entitled to be sure that obvious biases and commercial interests are not moulding the information that they are being supplied with regarding vaccines. This requires openness, trust — not being too abruptly dismissive or impatient with such queries.

    This is why so-called “concern trolls” are a little bothered by attempts to dismiss vaccine safety matters as the devious ploy of a lumpen “anti-vaccinationism”. Many of those involved in vaccine safety issues never held an anti-vax thought until someone close them seemed to have been harmed by a vaccine. We may be convinced that vaccines are “sufficiently” safe but experience shows that it is not OUR conviction that counts when mothers are asked to vaccinate their children against threats that are unfamiliar to them.

    1. David Gorski says:

      This is why so-called “concern trolls” are a little bothered by attempts to dismiss vaccine safety matters as the devious ploy of a lumpen “anti-vaccinationism”. Many of those involved in vaccine safety issues never held an anti-vax thought until someone close them seemed to have been harmed by a vaccine.

      Please provide a specific example of this or how those of us here who write about vaccines don’t understand the difference between parents with concerns and antivaccinationists. You made the assertion. Please supply an example.

    2. WilliamLawrenceUtridge says:

      Pete, the day you can come up with a test that will verify which children will ever be at risk of getting a vaccine preventable disease during their lifetime, you might have a point. Until then, universal vaccination is the best and safest way to protect children and the adults they become. That or disease extinction.

  14. Home says:

    Like any medicine, properly tested and researched , it will work great. But many vaccines are a best guess, poorly tested, and a big money maker. Anyone who disputes that vaccines are effective is a fool. As is anyone who takes any vaccine as a “cure” without researching how long it has been around, and it’s side effects. Vaccines have grown from a medicine to a profit driven market.

    1. Chris says:

      “But many vaccines are a best guess, poorly tested, and a big money maker”

      Do tell, which ones are those? Tell us how much the USA would save in medical costs if we stopped vaccinating for measles and pertussis, or even Hib. Come up with some real numbers, much like the following:

      Arch Pediatr Adolesc Med. 2005;159:1136-1144.
      Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001

      J Infect Dis. 2004 May 1;189 Suppl 1:S131-45.
      An economic analysis of the current universal 2-dose measles-mumps-rubella vaccination program in the United States.

    2. AnObservingParty says:

      Which vaccines are “best guesses?”

      Please also provide the cost analysis of treatment for a vaccine-preventable illness vs. the vaccine. Also, if you’re going to run large numbers, be sure you use rates from when the disease was common, as the only reason it’s not common now is due to vaccines. Nobody says vaccines are a cure, in fact, vaccines exist so we don’t need a cure. You don’t need a cure for something you can prevent.

      Or, to your entire note, [citation needed]

    3. WilliamLawrenceUtridge says:

      Vaccines are a happy medium – they do generate some profit for the companies, because they are low-cost preparations that are given to many, many people. The actual profit is pretty low though, something like 2% of the income of the companies that produce them. But the public benefits because these vaccines are sold for little cost as well. For a mere couple hundred dollars, you can essentially eliminate the risk of your child dying of the world’s most dangerous diseases. That’s amazing! How can you object to that? How can you claim “companies make a profit” as a bad thing, particularly when vaccines themselves are almost a form of corporate public service? Well-regulated companies produce products for the benefits of their customers (and in this case, society) and the free market ensures they do so at a low cost.

      Vaccines are an example of the market and government regulation actually working.

      Unless you’d like to watch helplessly while your child slowly chokes to death, turning blue, gasping for air, coughing so hard they vomit, unable to feed, surrounded by tubes and supplementary oxygen that does nothing to ease their suffering or prevent their death.

      You’re the fool, and the consequences of your foolishness is the deaths of children. Vaccines are tested heavily before they are licensed, and monitored afterwards. The vaccine schedule changes in response to new evidence (witness the switch from whole-cell pertussis vaccine to the current accellular pertussis vaccine due to concerns about intussusception). They are continually tested in new variations to reduce the number of antigens, in combinations that reduce the number of shots, and for new diseases. They are amazing, astonishing, life-giving things that you should be grateful for. Unless you want to go back to the good old days of having ten kids so two will survive? Why do you like dead babies so much? Do you eat them?

  15. Dave says:

    Referable to the profit aspect of vaccines, I would like to point out that the pharmaceutical industry would make a ton more money from treating the enormous number of diseases that the vaccines prevent than by having people get the one (or few) time doses of the vaccines to prevent these diseases. I think most public health leaders feel that vaccination is generally very cost-effective. Example: It’s a lot cheaper to prevent hepatitis B with a hep B vaccine than to manage end-stage liver disease or a hepatoma if a patient develops a chronic infection with this virus. Not to mention better for the patient.

    Funny, some of the same people who think the vaccine market is only profit driven with no other benefit also think that cures for some diseases are being suppressed because of the profit in treating those diseases.

  16. Gloria says:

    Has anyone researched David Gorski? Ties to pharma money, lots of it. Amazing what we can write when we have a so called ‘medical reputation’, which I can respect; but we must also be open-minded and do our own research.

    1. Chris says:

      So, Gloria, what about the authors of the paper this article is about? What do you say to their finances, and profit motives? Come on, go to a medical school library and get a copy of that paper. Then tell us what is so bad about preventing diseases.

      Would you have been happier if those cases of diphtheria, tetanus, mumps, measles, polio, etc had never been prevented? Are you cool with about five hundred American kids dying each year from measles?

    2. DayneATC says:

      It’s always interesting to me how conspiracy theorists will put a small amount of effort into finding that someone they disagree with is profiteering or a shill, but put zero effort into “researching” their own proponents and gurus.

      “oh but they’re just funding their website and research” by selling supplements, books, documentaries, diet plans, “secrets”….
      Yep, judging by their lifestyle and housing, it sure seems like that money is going toward “research” and their practice. *sarcasm*

      I guess individual profiteering makes one immune to nepharious activity. That takes being an employee or a proponent of a product or service provided by a corporation. If you call yourself “independent”, you can do whatever you want and nobody seems to care….except for people actually paying attention.

    3. AnObservingParty says:

      I’m sorry, I just find this question hilarious, especially considering Dr. Gorski has a pretty standard following of readers, who have been reading for awhile.

    4. WilliamLawrenceUtridge says:

      Translation: Because I can’t muster any real objections to Dr. Gorski’s analysis, or the data he cites, I’m going to try to discount the whole article by attacking his character.

      Response: You’re using an intellectually lazy rationalization to justify discounting information you don’t like. At worst, Dr. Gorski’s ties are to cancer treatment, since that’s his specialty. He has, as far as I can tell, no publications that involve vaccination, they’re all about cancer (except one from 1976 that involves audiometry?) but you probably knew that, because you probably know what pubmed is, don’t you? Consider the fact that the people and places you get these accusations from might not be the most trustworthy of sources. They might have their own biases, such as the money and glory they get by disparaging vaccines. Maybe you should do your own research, and be open-minded to the fact that vaccines work and you, and your children, will never have to worry about smallpox because of it. Science says you’re welcome.

  17. George Locke says:

    …assuming that there were no other changes that would have affected incidence rates.

    Assuming that the difference between incidence rates before and after vaccine licensure for these diseases was attributable solely to vaccination programs…

    Are these really safe assumptions? I can see effects that would increase or decrease incidence rates dramatically over such a long timeframe, namely population density and sanitation.

    1. AnObservingParty says:

      1) How would improvements in sanitation prevent airborne/respiratory diseases such as measles? That means its mode of transmission is breathing the same air.
      2) Every one of those, save polio and Hep B, have that same manner of transmission. How was the sanitation in 1950s America? Didn’t stop the polio epidemics…

      1. Lawrence says:

        Given the conditions in most of the developing world (particularly around sanitation and the massive population densities of many of those countries), I can’t imagine what the infectious disease profile would look like today without vaccines….it is too horrible to imagine.

        1. AnObservingParty says:

          The fact that these conversations even exist is purely because we live in countries like the US, Britain, etc. Go to a developing nation and ask them.

    2. Harriet Hall says:

      As I pointed out before, there have been many natural experiments showing that disease rates rise when the vaccination rate drops and drop when the vaccination rates rise in countries and periods where factors like population density and sanitation do not change. And they look at “incidence rates”- numbers per 100,000 population, rather than at “incidence” – number of cases in the entire population.

      1. George Locke says:

        I’m not doubting that vaccines are effective. I’m asking whether these numerical estimates are meaningful. Holding factors besides vaccination constant while vaccination rates change speaks to the former and not the latter.

        1. Chris says:

          Give examples so that we can understand you. Provide a disease, a time period and changes in population/sanitation/etc. that show that effect.

          Along with the papers I provided on the drop in vaccination in the former Soviet Union states, Japan and other countries, you can try these two sources for data:

          (huge pdf) http://www.census.gov/prod/99pubs/99statab/sec31.pdf

          and: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/g/cases&deaths.PDF

    3. Chris says:

      “I can see effects that would increase or decrease incidence rates dramatically over such a long timeframe, namely population density and sanitation.”

      What about these incidences:

      Diphtheria in the former Soviet Union: reemergence of a pandemic disease.:

      In the 1990s, a massive epidemic throughout the Newly Independent States of the former Soviet Union marked the reemergence of epidemic diphtheria in industrialized countries. Diphtheria had been well controlled in the Soviet Union for more than 2 decades after universal childhood immunization was initiated in the late 1950s (Figure 1). Although all of the Newly Independent States were affected, three quarters of the more than 140,000 cases (Table 1) and two thirds of the more than 4,000 deaths reported since 1990 (1-3) were reported by the Russian Federation.

      Impact of anti-vaccine movements on pertussis control: the untold story:

      After two infants died within 24 h of receiving DTP, the Ministry of Health and Welfare eliminated whole-cell pertussis vaccine altogether. They later allowed it only for children older than 2 years. Pertussis coverage for infants fell from nearly 80% in 1974 to 10% in 1976. A pertussis epidemic occurred in 1979 with more than 13 000 cases and 41 deaths.

      Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan:

      In Japan, measles vaccine coverage has remained low, and either small or moderate outbreaks have occurred repeatedly in communities. According to an infectious disease surveillance (2000), total measles cases were estimated to be from 180,000 to 210,000, and total deaths were estimated to be 88 [11,12]. Measles cases are most frequently observed among non-immunized children, particularly between 12 to 24 months.

      Now please explain how sanitation effects air borne pathogens discussed in these papers.

      1. NorrisL says:

        A very simple answer. Vaccinate your children and keep them off the freeway. This was a quote that I borrowed from a local GP earlier this year in a pro/anti vaccine argument conducted in the local newspaper. We won by the way. Defeated the local “geomancer” whatever that may be.
        My brother is a GP and he gave me stats on the numbers of cases of vaccine preventable disease before vaccine was available and after it was available. In almost every case the stats went from large numbers to zero.
        So, once more, vaccinate your children and keep them off the freeway!
        Maybe we should put the geomancer on the freeway so that he can get a taste of what it is like to be left in a dangerous situation. But would that pass an ethics committee?

    4. David Gorski says:

      Over the short term, I’d say they are safe assumptions. When a disease incidence plummets within five years after the introduction of a vaccine, it’s unlikely that anything else that could cause such a drop happened, particularly for diseases that are endemic.

      1. George Locke says:

        Right, but we’re talking about sock parisons between 1888 and the modern day. I’m just asking whether the assumption of constant incidence rates across such a timespan amounts to a spherical cow in the model.

        Given the number of cranks who frequent the comments section, I might have made pains to indicate that I’m not doubting the overall conclusion that vaccines have saved millions. All I’m saying is that if you’re trying to ask how many millions, an assumption that nothing changes in transmission rates over more than a century seems dubious. How sensitive are transmission rates to living conditions? I’d just like to see some support for this assumption.

        1. windriven says:

          “I’m just asking whether the assumption of constant incidence rates across such a timespan amounts to a spherical cow in the model.”

          Possibly. So what?

          “Assuming that the difference between incidence rates before and after vaccine licensure for these diseases was attributable solely to vaccination programs,”

          The article was not claiming that 103,482,116 lives were saved not including fetuses which would have succumbed in the wombs of their dying mothers. A scientific report doesn’t have to have the specific answer to every variable but it does have to note important assumptions that were made. The authors did that.

          I don’t think I am alone in wondering what your actual issue is. Do you believe the lives saved estimated to be wrong enough to alter the general conclusion? Are you just quibbling?

        2. WilliamLawrenceUtridge says:

          Purely in terms of signal-to-noise, the fact that the rates of each of these diseases dropped to almost zero within a small number of years after the introduction of the vaccine seems pretty reasonable back-of-the-envelope proof to me.

          You might try reading the original paper too, see what they say about confounds.

  18. Flower says:

    Vaccines work. Period?

    A Cochrane review showed that reliable evidence on influenza vaccines (as an example) is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies (http://www.ncbi.nlm.nih.gov/pubmed/20614424).

    Period.

    I note you deleted my earlier comment, a response to someone else’s comment above.
    It shows that the manipulation and censorial methods evident in the pharma-funded medical literature is continued here.

    1. windriven says:

      Flower, are you evil or just stupid? I hate to frame the question in such blunt terms but there seem no other alternatives.

      Influenza vaccine is fiendishly difficult because the virus mutates rapidly and because so many variants exist at any given time. Still, even with low effectiveness as vaccines go, influenza vaccination makes a significant dent in morbidity and mortality.

      But let’s talk measles and polio and rubella and other diseases that we vaccinate against. Look at the horror unfolding in Syria where polio vaccination has been disrupted by civil war and a disease all but unknown there in the recent past has come charging back. The efficacy of vaccination against these diseases is disputed only by the delusional and the sociopathic.

    2. AnObservingParty says:

      The problems with Jefferson and his conclusions have been discussed widely, both here and the not-so-secret other blog. You are free to use the search button.

      Also, one can hardly compare the influenza virus to viruses such as measles, polio, etc. Influenza is a rare duck, and interestingly, wasn’t one of the vaccines looked at in the study, possibly because of its unique nature. Nobody has ever said the flu vaccine is perfect, but it’s the best we have right now.

      The viruses discussed in this study, and this blog by Dr. Gorski? The ones rapid antivaxxers claim weren’t affected by vaccine programs? Take a look at the pretty pictures above. Vaccines work. PERIOD.

      Nice try, though.

      1. AnObservingParty says:

        *rabid* Me no spell so well.

    3. Chris says:

      “I note you deleted my earlier comment, a response to someone else’s comment above.”

      So who did you respond to? I see your comment after DayneATC . I responded, but all of my comments go into moderation automatically. It is a glitch in the system.

    4. mousethatroared says:

      Flower “I note you deleted my earlier comment, a response to someone else’s comment above.
      It shows that the manipulation and censorial methods evident in the pharma-funded medical literature is continued here.”

      Everyone who comments here for any length of time learns that the comment system is buggy. I have posted pro-SBM comments that disappear in moderation too. It’s not a plot and it’s not personal. That should be reasonably clear by the number of anti- SBM comment that DO appear in these threads.

      1. Sawyer says:

        As much as it annoys me, I’m beginning to love the buggy commenting system, for it has lead to an amazing ironic twist. Disappearing comments never fails to bring out insane levels of paranoia from the conspiracy theorists, thus allowing me to filter out their nonsense from the legitimate comments. The glitches may be completely random, but are extremely effective at allowing me to “censor” out the nuts anyway.

        Or maybe the SBM administrators are so devious that the randomly delete comments, knowing that this will happen. It’s conspiracies all the way down!

    5. WilliamLawrenceUtridge says:

      Hi Flower, back again I see. It is well-known that the influenza vaccine has a number of challenges that other vaccines do not. It mutates on a regular basis, the two main proteins, the hemagglutinin and neuraminidase that make up the protein coat of the virus, provide more than 100 variations of the same species, and the vaccine must be tuned to each seasonal variation. We still don’t have a universal influenza vaccine that protects against all strains – so it’s more like vaccinating against 100 different diseases than it is vaccinating against one. It’s also not helped by the low uptake of influenza vaccines which prevents herd immunity from kicking in.

      There is no “period” here, vaccination is not an all-or-nothing response. It’s complicated, each disease is different, each vaccine is different, each variation of each vaccine is different, and each has good and bad points. Your cartoon version of “if one vaccine isn’t perfect, all are failures” argument is a reflection of your own ignorance, not the reality of biology, immunology and epidemiology.

      Read a book. I recommend The Great Influenza by John Barry, and Vaccines by Arthur Allen. You could also look into why the claims about the Cochrane reviews are as much about Tom Jefferson’s personal spin as they are the actual data.

  19. Cath of Canberra says:

    Have you seen this one?

    http://www.biomedcentral.com/1741-7015/11/227
    Conclusion: A population-based HPV vaccination program in schools significantly reduced cervical abnormalities for vaccinated women within five years of implementation, with the greatest vaccine effectiveness observed for the youngest women.

  20. NorrisL says:

    I also meant to ask how the anti- vaccinationists explain away the eradication of smallpox. Also in my field (veterinarian) we have eradicated rinderpest, a serious disease of cattle in Africa. Polio should have been eradicated by now if not for the evil work of the Taliban in preventing their own people from being vaccinated. They are doing this not because they are anti vaccines, but because they just don’t want the west to help the people of Pakistan and Aghanistan.

    1. Harriet Hall says:

      One explanation I was given is that smallpox has not been eradicated; cases are still occurring and are being mis-diagnosed as chickenpox!

    2. Greg says:

      Another explanation I’ve read is that it is still exists – as another strain – monkeypox.

      1. Lawrence says:

        Yes, the old Monkey-Pox excuse….even though we can see that the two diseases may be genetically related, but they certainly aren’t the same disease….

  21. windriven says:

    Here’s a link from today, December 5, for all the dufi who don’t think vaccinations work:

    http://ca.news.yahoo.com/spike-u-measles-cases-shows-disease-still-threat-173041279.html

  22. Peter James Moran says:

    “All I’m saying is that if you’re trying to ask how many millions, an assumption that nothing changes in transmission rates over more than a century seems dubious. How sensitive are transmission rates to living conditions? ”

    Apart from the obvious sanitation and public health measures regarding personal hygiene, food and water supply?

    We can be pretty sure any other change in transmissibility is negligible, since similarly transmitted “colds and flus” and a few enteric infections remain as easily transmitted as they ever were, given the opportunity.

  23. Bob says:

    Hi there, I Just found this site today after seeing an unbelievable amount of anger directed at a few magazines/sites that have posted pro-vaccine stories on Facebook. Salon, Slate, The Atlantic, Upworthy, etc, all seem (I think?) to be relatively left, liberal, progressive, whateveryou’dliketocallit, but the comments under recent articles about vaccination are shockingly anti-vaccine. I don’t mean to try to put this issue on the political spectrum, but I just assumed that vaccines were a more progressively done thing… And I sort of thought that once Jenny M was debunked all was well and proper again with the world, but it doesn’t seem like it if Facebook comments are any real sample…

    Anyway, I’m glad I found this site and I’m wondering if anyone here has seen and/or debunked the writings on insidevaccines.com? It’s one of many sites I found while poking around today and they are obviously linked with lawyers who sue pharma companies for a living, they do seem to have some convincing ideas around some of the numbers. I’m not trying to stir or promote. I’m not affiliated with anyone; I’m a Canadian teacher just poking around out of interest. I fully believe that the pros of vaccinations heavily outweigh any cons. I’m very very skeptical about pretty everything there is to be skeptical about, but I just thought some of the writing on the site seemed… definitely over my head to refute. Thoughts?

    Thanks and keep up the good thinking!!

    Actually, this is the article I read that I thought looked… umm? plausible?

    http://insidevaccines.com/wordpress/2008/06/16/where-do-they-find-these-scary-statistics/

    1. Chris says:

      Let’s start with the last sentence in that article:
      “What would happen if we stopped vaccinating infants against diphtheria? Stay tuned”

      That was effectively answered in the 1990s when the USSR ceased to be, so did they ever mention it? To repeat what I said earlier in this thread, from Diphtheria in the former Soviet Union: reemergence of a pandemic disease.:

      In the 1990s, a massive epidemic throughout the Newly Independent States of the former Soviet Union marked the reemergence of epidemic diphtheria in industrialized countries. Diphtheria had been well controlled in the Soviet Union for more than 2 decades after universal childhood immunization was initiated in the late 1950s (Figure 1). Although all of the Newly Independent States were affected, three quarters of the more than 140,000 cases (Table 1) and two thirds of the more than 4,000 deaths reported since 1990 (1-3) were reported by the Russian Federation.

      And, no, insidevaccines is not trustworthy. They have a habit of cherry picking, as you can see in this exchange.

      Note in that article they are focusing on mortality, and not morbidity. They are ignoring that medical advances, and very expensive hospital care, were preventing the deaths. But not preventing the diseases. Even when more lived, many were still permanently disabled.

      That is a very common trope used by the anti-vax folks, and is mentioned in the above article. Go back up and read this paragraph, and click on the links in it:

      For example, another common trope is what I like to refer to as the “vaccines didn’t save us” or the “vaccines don’t work” gambit, in which it is pointed out that the introduction of vaccines don’t correlate tightly with drops in mortality from various diseases. Julian Whitaker even used this gambit when he debated Steve Novella. The fundamental flaw in this trope neglects the contribution of better medical care to the survival of more victims of disease, which decreased mortality. If you look at graphs of disease incidence you will see a profound and powerful effect of the introduction of vaccines on specific vaccine-preventable diseases. In other words, vaccines work.

    2. Chris says:

      By the, a search on the InsideVaccines website shows that they never addressed the 1990s diphtheria epidemic in the former Soviet Union states. Not even a mention of how the epidemic was stopped, effective vaccination programs. See Successful Control of Epidemic Diphtheria in the States of the Former Union of Soviet Socialist Republics: Lessons Learned.

    3. Sawyer says:

      I want to personally thank you for leaving this comment. I’ve been really bummed out by the incredible number of cranks that have shown up here over the past several months, and it’s refreshing to discover new people that are interested in real science and medicine. We hope you’ll stick around.

      I also don’t know enough to tear apart the link you gave, but I can tell you what the general problem is. Insidevaccines does not understand the fundamental concept of a public health expert. When someone from the CDC goes on television, their job is actually NOT to present the highest-quality, extremely complicated, boring statistics that you find in a journal paper, and then explain the strength and weaknesses of every study they cite. If they did that every single viewer would change the channel. Their job is to summarize years of careful research and quickly get central concepts of medicine across to the public. The CDC is not perfect, but they do a pretty damn good job.

      Complaining that one of the metrics they presented in a television program isn’t the PERFECT metric for judging vaccines is bonkers. It’s sort of like complaining that your dentist didn’t explain nuclear fission well enough to you, so therefore you shouldn’t wear the lead shield during your mouth x-ray.

  24. brett says:

    I guess we should just start genetically modifying humans with the vaccines inside us already when we are born right? Oh, wait that wouldnt make any money…..you guys all sound like evil pricks.

    1. WilliamLawrenceUtridge says:

      Brett, please tell me, what’s so great about children dying of pertussis?

      Who is more evil, the people who say “vaccines are imperfect, but they are the best means we have to prevent people, particularly children, from dying of preventable diseases”, or “I’m not going to vaccinate my children because I think there might be a tiny, tiny risk to them, and I don’t care if that means my child ends up getting sick, or making someone else sick, or re-introducing a disease into an area where it has been eradicated”.

      You know where doctors and drug companies could make tons of money? Treating the complications of vaccine-preventable diseases. Funny how instead there is so much emphasis placed on the much cheaper option of vaccination.

      Incidentally, there is already a process in place to genetically modify humans in the face of disease – it’s called natural selection, the population-level selective die-off of those most vulnerable to diseases. It’s the reason why smallpox killed off so many of the original inhabitants of the Americas – Europeans had been through hundreds of cycles of pandemic smallpox, ratcheting up the resistance of the population and the lethality of the disease a little more each time.

    2. Dave says:

      Vaccines use our own genetic ability to form antibodies against foriegn antigens. There’s no genetic modification here.

      Vaccines are developed to prevent people from getting horrible, potentially lethal or debilitating diseases. I’ve met a few people who have had polio – they were confined to wheelchairs. And I’ve seen people die horrible deaths from endstage liver disease and hepatomas from hepatitis B, a vaccine-preventable disease. How in the world can you construe wanting to prevent this type of thing as “evil”? This is the craziest comment I’ve ever seen, and there have been a few whoppers on this blog.

  25. Erwin Alber says:

    Thanks for this piece of blatant vaccination propaganda! It in my opinion doesn’t change the fact that vaccination is an organised criminal enterprise dressed up as disease prevention.

    http://www.vaccinationinformationnetwork.com/do-vaccines-save-lives-what-infectious-disease-mortality-graphs-show/

    Here is some information parents need to make an informed choice but the authorities don’t want them to know:
    http://www.vaccinationinformationnetwork.com/to-vaccinate-or-not/

    1. David Gorski says:

      Silly man. That is one of the most intellectually dishonest and transparent of antivaccine tropes:

      http://www.sciencebasedmedicine.org/vaccines-didnt-save-us-intellectual-dishonesty-at-its-most-naked/

    2. Chris says:

      Great testimony from the World’s Worst Person!

      He is also intellectually bankrupt for claiming a badly hand drawn fake line on a graph was actually factual just because he wanted to believe in it.

      From the first link on how some regard Erwin “Worst Person in the World” Alber:

      I just wanted to do this quick post so we can keep in mind the type of sociopath held in high regard by the anti-vaccination movement. Alber is welcome on all anti-vaccination fora, and is seen as some kind of guru, being the magnet for crankery that he is. Alber has also been called “a friend of the AVN”, by Meryl Dorey. He even appeared on crank internet radio, last week.

  26. windriven says:

    Erwin, you don’t have the tinfoil wrapped tight enough! Brain eating bacteria have been beamed into what passes for your brain by dark forces controlled by The Illuminati. The only thing that can save you is a skinny double hazelnut frappucino latte enema and emergency mercury chelation therapy. Hurry before its too late!!!

  27. Keating Willcox says:

    You make a straw man by saying that either we take all vaccines or none…There seems to be a considerable question about the science, and because big pharma is so vitriolic and hateful, their actual science appears flawed…see.
    http://www.thelibertybeacon.com/2013/06/21/new-published-study-verifies-andrew-wakefields-research-on-autism-again-mmr-vaccine-causes-autism/

    When the lawsuits and damages start coming in, bi Pharma can no longer depend on haters to prove their science. No, as the science comes in ( I love your comments that there has been no increase in autism. Are you for real?) you will have a big job to do. As far as Autism is concerned, there is solid evidence that mercury and other chemicals are very dangerous and very likely contributors to autism as well as other problems.

    By the way, Wakefield research has been verified in several studies. Your response? crickets.

    Whose the real scientist now?

    1. windriven says:

      @Keating Willcox

      1. The Liberty Beacon is the house organ of the lunatic fringe, not a reliable source of information.
      2. The National Vaccine Injury Compensation Program is a ‘no fault’ system that compensates correlation, not causation.
      3. Wakefield’s research has not been verified in “several studies” in any meaningful scientific publication and it certainly isn’t verified by the PLOS article linked in the Beacon story.
      4. Not to be a dick but ‘whose’ is the possessive form of who. You apparently meant ‘who’s', viz. Who’s the real scientist now? And the answer remains: not Andrew Wakefield.

      1. Chris says:

        “3. Wakefield’s research has not been verified in “several studies” in any meaningful scientific publication and it certainly isn’t verified by the PLOS article linked in the Beacon story.”

        It has no mention of the MMR vaccine, and includes a friend of Wakefield.

        And I hope my other comment comes out of moderation and is not in the ether, since it did not show up with I refreshed this page. Le sigh.

    2. Chris says:

      Oh, come on! You mean that I am not even allowed to post two links anymore?

      I don’t even get a “comment in moderation” message, the post just disappears.

    3. Dave says:

      I would encourage you to read the investigative journalism articles published in the British Medical Journal concerning the 1998 Lancet article published by Wakefield and retracted some years later. This can be accessed by typing in http://www.bmj.com and entering “Wakefield” in the search box. In essence, the paper was fraudulent. None of the reported cases in the journal correlated with the actual medical record of those cases. The journalist goes on to describe Wakefield’s involvement with a lawyer filing suit against MMR manufacturers and his plans to get rich after discrediting the MMR vaccine. It details the patents he filed to do so and his plans therof. It is quite illuminating reading, although there are a series of articles and it is lengthy reading. Note the investigator was outside the medical hierarchy.

    4. Chris says:

      Okay, maybe the third time will work. I am also going to do two, so to only have one link each.

      Mr. Willcox said: “There seems to be a considerable question about the science, and because big pharma is so vitriolic and hateful, their actual science appears flawed…see.”

      Okay, look at the papers list in Vaccine Safety: Examine the Evidence, and tell us precisely which pharmaceutical companies paid for each study. Be specific, and directly quote the section of the Conflict of Interest or affiliations that note the funding.

      He continues: “As far as Autism is concerned, there is solid evidence that mercury and other chemicals are very dangerous and very likely contributors to autism as well as other problems. ”

      Citation needed. And by citation we mean a PubMed indexed study by a qualified reputable researcher. By qualified, we mean the appropriate education and related experience. This means that no papers written by lawyers, journalists, computer scientists and geologists. By reputable, we mean those who have not been stripped of their right to practice medicine.

    5. Chris says:

      AAAAArgh! Will someone please put up the link at JustTheVax that shows that Wakefield was not independently replicated. I have tried four times, and it just goes off into the ether.

      And I really wanted to say the response is more like cicadas than crickets.

      Le sigh.

    6. WilliamLawrenceUtridge says:

      Which studies have verified Wakefield’s research, can you produce links? Because there’s a good chance that these studies have been discussed here previously and shown to be flawed.

      Not to mention – science doesn’t rely on “magic bullet” studies, it relies on the convergence of evidence. Only pseudoscientists cherry-pick single, questionable and equivocal studies and claim that they offer definitive answers (and then stop conducting studies).

      It’s a bit like shooting a basketball, then stopping when you sink one and proclaiming a 100% success rate.

      1. Chris says:

        Okay, I have been trying to post a blog link that went through the list of the studies that they claim verified Wakefield. For the fifth time, it just disappeared.

        It is at the “JustTheVax” blog, which is the “Science-Based Vaccine Information from Catherina and Science Mom.” The is article titled “Still no independent confirmation of Wakefield’s claims”… just search for it.

        Please find it and post it for me, since wordpress hates me today.

        1. Sorry you’ve been having trouble posting that link, Chris. Don’t know what’s going on with that, but I’m sure it’s just WordPress glitchiness (not a moderation thing). We have seen a lot of this kind of problem in the last year, and most of it is actually or effectively impossible to troubleshoot, too many layers of technology, some we don’t have any control of (not even in principle, let alone in practice). That is, even if we had the resources to chase all the bugs, some of them are caused by external resources/services.

          Anyway, thanks to WLU for getting the link posted one way or another!

          1. Chris says:

            Thanks. WordPress was glitchy on another site yesterday.

            Could be worse, it blocked my access to Doubtful News for almost a year. I literally had to go find free public WiFi (library, coffee shop, etc.) to read it.

    1. Chris says:

      By the way, the conclusion is that:

      Non-human primates are not perfect analogs to real humans.

      The vaccine does prevent many symptoms (like coughing), and the bacteria is eventually cleared out.

      Even though the bacteria was still present in the throat, not coughing the bacteria out is a good thing even if it is still in it. Because if you don’t cough, you don’t spread it as much.

      This is yet another reason to push for better community immunity by vaccinating everybody, especially young teens and adults with the Tdap.

      And, finally, my own interpretation not mentioned by that podcast: ignore anything from Natural News. Enough said.

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