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The movie Silent Epidemic: The Untold Story of Vaccines presents arguments against vaccination.

One of the arguments is that the alleged benefits of vaccines are actually due to modern health and sanitation.

Nancy Banks is shown saying:

many of the infectious diseases were already 90% reduced when the vaccines were introduced

Sherri J. Tenpenny is shown saying:

illnesses have spiked and been mostly been gone by the time a vaccine was introduced, making the vaccine the hero when in fact the illness was mostly gone before the vaccine came on the horizon

I've often see similar claims paired with a graph like this, from Suzanne Humphries at Dissolving Illusions:

graph of total infectious disease mortality dropping by 1908

A similar issue - restricted to measles - is covered in these questions:

The answers essentially say that measles deaths did drop before vaccines were introduced, but overall cases did not drop dramatically until vaccination programs were widespread.

I haven't seen anything related to claims that it was a broader range of infectious diseases.

Were many vaccine-preventable diseases almost gone before vaccines were introduced?

Oddthinking
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    This seems to suggest that being seriously ill is OK so long as you do not die – Henry Aug 27 '17 at 16:00
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    I don't think the diseases we commonly vaccinate against are much affected by sanitation measures. Measles & influenza, for instance, are spread by airborne transmission from infected people. The diseases that have largely been eliminated by modern sanitation - things like cholera and dysentery - either don't have vaccines, or the vaccines are only given to people travelling to areas with poor sanitation. – jamesqf Aug 27 '17 at 17:48
  • @jamesqf: I'd love to see a quality answer here to bury the existing one rather than pseudo-answers in the comments. Any chance of turning this into a real answer? – Oddthinking Aug 28 '17 at 07:26
  • @oddthinking, isn't this question (currently) off topic? *"Can one make a viable argument that modern health standards make vaccination against infectious diseases unnecessary?"* isn't really challenging a notable claim one has heard or read right? And *"many of the infectious diseases were already 90% reduced"* is too vague to properly verify/debunk I would think. This of course is all IMHO&YMMV. But that raises the question: what makes you say this question on-topic? – Jordy Aug 28 '17 at 07:37
  • @Jordy: You make a point. Let's fix the question, because it *is* a notable claim that the huge savings in lives due to vaccines are actually due to hygiene. I have heard that several times. – Oddthinking Aug 28 '17 at 07:47
  • There are two intermingled claims here. Does hygiene make infections less likely, and did that (and modern medicine) have an effect on mortality rates? Absolutely, I doubt anybody will challenge this. But does that make vaccination unnecessary? (And I doubt raw *mortality* rate is the sole deciding factor here.) – DevSolar Aug 28 '17 at 08:34
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    Or, to put it more simply, you can do a lot to reduce the number of people who get a disease and the number who die from it without a vaccine. Basic sanitation, quarantine, supportive care, and so on all make a big difference and so you see marked reductions in mortality and cases for many illnesses over time. But none of that is at all relevant to the question of how effective vaccines are. – David Schwartz Aug 28 '17 at 09:25
  • @DevSolar: I went to edit it, with the intention of making it about the second claim you highlight, but I realised all the links provided were about the first claim, so that's where it ended up. Perhaps a second question would be warranted, with new notability links? – Oddthinking Aug 28 '17 at 10:50
  • Some counter-arguments to the second graph can be found here https://medium.com/@visualvaccines/why-dr-suzanne-humphries-an-anti-vaccine-activist-is-lying-to-you-about-measles-ce446d0a7e0f – James McLeod Aug 28 '17 at 11:08
  • @Oddthinking: You'd need someone with more expertise, or better research skills, to make my comment into a creditable answer. But one might start, as I did, from knowing what diseases where historically reduced by better sanitation. – jamesqf Aug 28 '17 at 17:23
  • I'm still not happy with this as it doesn't address the implied claim: that vaccines are useless. – Oddthinking Aug 29 '17 at 04:27
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    I find it odd that there is no mention of polio in any of this. Figures I've seen suggest that the Salk and then Sabin vaccines had a very dramatic impact. – Daniel R Hicks Aug 30 '17 at 03:30
  • Eventually, people stop dying from childhood diseases, simply by removing people with the weak genes from the gene pool. This is how humans survived the plague. Now, this solution is probably frowned upon in a modern society... – Per Alexandersson Sep 22 '17 at 10:53
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    @PerAlexandersson The plague still exists and infected individuals still die from it to a significant degree if untreated (70% mortality rate, apparently). It seems treatment is primarily via antibiotics and prevention via hygienic measures (avoiding handling infected organisms, etc.) rather than vaccination. – JAB Feb 18 '19 at 22:38

3 Answers3

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Image from http://vk.ovg.ox.ac.uk/diphtheria

As you can see from the curve the number of cases dropped when vaccinations became available. I don't think hygiene can be the cause here.

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liftarn
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  • To add to DrakaSAN's comment: if genuine, the graph only implies correlation. How do we know *Super-Mega-Germ-Death Hand Sanitizer©* wasn't released in exactly the same year? – Jordy Aug 28 '17 at 08:54
  • @DrakaSAN It's from CDC. The page is moved, but it's also available at for instance https://sciencebasedmedicine.org/vaccines-didnt-save-us-intellectual-dishonesty-at-its-most-naked/ – liftarn Aug 28 '17 at 08:59
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    @Jordy Well, that is tricky, but unless it was introduced in the UK in 1942 and in the US and Canada in the mid 60s that is probably not it. – liftarn Aug 28 '17 at 14:26
  • @SVilcans I agree, the chances of this being merely correlative are diminishing quite fast now that there are more graphs in the answer. – Jordy Aug 28 '17 at 14:36
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    @Jordy the point is exactly to debunk the decorrelation argument, not to prove causality – Guiroux Jul 17 '18 at 09:51
  • @guiroux, my comments were made regarding rev 1. – Jordy Jul 17 '18 at 14:30
  • A section like laurel's "Death rate vs. All cases" would complete this answer. By itself, it's just more graphs to interpret, the same as the question. You need to explain what's different and why it matters. –  Feb 19 '19 at 17:46
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Summary:

The main point of these claims is that the death rate for some diseases was declining before vaccines. While that is true, it misses the fact that even though the death rate was declining, plenty of people (mostly children) were still getting and suffering from these diseases. Vaccines dramatically decreased both the number of total cases, the severity of cases, and also the number of total deaths.

(Another thing worth mentioning, although not directly related to the claim, is that preventing a disease with vaccines means that antibiotics won't be used, and thus antibiotic resistance can't develop.)

There are several problems with your graph: no sources, lumps four diseases in one line (including Scarlet Fever), and only has mortality (except for when they inexplicably include diarrhea...WTF?). So I'm going to address a similar graph, from another antivax site:


Archive Link

  • I think that Scarlet Fever (also called Scarlatina) was included in the graph because it was grouped with diphtheria until 1861. (Or maybe they're trying to trick you.) There is currently no vaccine for Scarlet Fever, so it's pretty irrelevant here.
  • The problem with only looking at the deaths is that for many of these diseases the treatment improved and fewer people died, but they were still getting infected in the first place.
  • While there are...inconvenient...breaks in the graph, the data in the graph seems to be accurate. You can check the sources listed in the image if you want:

Death rate: 19th century

I found a paper that lists some 19th century disease statistics. The data is not as granular as in the graph, nor does it all go back as far as 1838 (and some of the stats cover the gap seen in the graph), but the data that is there matches up with the 19th century part of the graph well. The full paper also lists stats for Scarlet Fever and Smallpox.

Measles mortality rate per 100 000 living: 1838-1910
1838-42 53.9
1847-52 40.3
1856-60 42.5
1866-70 42.8
1876-80 38.5
1886-90 46.8
1896-1900 42.1
1901-5 32.7
1906-10 29.1

Death rate per million from Diphtheria: 1855-1893

[Divide by 10 to get rate per 100,000 as in the image.]
1855 20
1860 261
1865 126
1870 120
1875 142
1880 109
1835 163
1890 179
1893 302

It was classified with scarlet fever until 1861; and because of the uncertainty of diagnosis, any conclusions about it must be speculative.

An antitoxin was discovered in 1894, but, as with all early antitoxins, it had to be administered within the first four days of infection, which is when symptoms are the least evident. However, the mortality did decline from 9 446 deaths in 1894 to 7 661 in 1898. This fall probably relates to the wealthier classes, since the antitoxin was expensive, and not distributed free. It was 1913 before there was an effective diphtheria prophylactic and 1923, before the first safe vaccine was produced.

Whooping cough death rate per 1 000

[Multiply by 100 to get rate per 100,000 as in the image.]
1881-5 0.46
1886-90 0.44
1891-5 0.40
1896-1900 0.36

Anderson, Imogen (1993) The decline of mortality in the nineteenth century: with special reference to three English towns, Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/5687/

Death rate: 20th Century

I already linked to data for the UK/Wales, so I'll cover some US data. The CDC has Vital Statistics of the United States which go as far back as 1900. The PDF Vital Statistics Rates in the United States, 1900-1940 lists how many people per year died from various causes (but I'm only listing some years for three diseases):

Exclusive of stillbirths. By place of occurrence. Rates are the number of deaths per 100,000. Population estimated as of July 1 for 1900-1939 and enumerated as of Apr. 1 1940

1900 1910 1920 1930 1940
Measles 13.3 12.4 18.8 3.2 0.5
Whooping Cough 12.2 11.6 12.5 4.8 2.2
Diphtheria[*] 40.3 21.1 15.3 4.9 1.1

[* includes Croup for years 1900-1920]

And some graphs (from the CDC):

Measles graph 1900-1960

[No graph for whooping cough]

Diphtheria graph 1900-1960

Death rate vs. All cases

Vaccines don't treat diseases; they prevent them. As a result, it's important to look at rates of incidence. If you look at the data, you'll notice that the rate of incidence is pretty high and then gets lowered after the vaccine is introduced. See this good article:

Here is a chart with lots of diseases:

Image of incidence and death rates for various diseases before & after vaccines
Image Source: Our World in Data
These data are taken from Roush and Murphy (2007) – Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. In the Journal of the American Medical Association, 298, 18, 2155–2163.
The same data can be viewed in a table here.

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Laurel
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    I would think a disease without a vaccine like scarlet fever would be nice to include as a control. Perhaps there is a reason scarlet fever is a poor choice for that. –  Aug 28 '17 at 22:43
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    A vaccine for scarlet fever was developed in the 1920s (or was it 30s), but it was not very effective, therefore not in general use, and not of interest after the development of antibiotics to threat the disease. – Andrew Lazarus Feb 07 '18 at 03:06
  • @AndrewLazarus Do you have a source? The [CDC](https://www.cdc.gov/features/scarletfever/index.html) says there is no vaccine, but I guess they wouldn't mention failed vaccines. – Laurel Feb 07 '18 at 03:15
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    @Laurel http://www.newsweek.com/unexplained-outbreak-scarlet-fever-england-724257 mentions the 1924 vaccine in the UK. I'm not sure if it was ever used in the USA. Both my kids got scarlet fever (together). Nasty but antibiotics worked quick. – Andrew Lazarus Feb 07 '18 at 03:26
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    *"There is currently no vaccine for Scarlet Fever, so it's pretty irrelevant here."* It's not irrelevant. It makes for a good control. –  Feb 19 '19 at 17:31
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    I think the "Death rate vs. All cases" is the most important part of this post. It shows why the graph in question is a cherry pick. It should be listed first. –  Feb 19 '19 at 17:38
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    @Andrew The pertussis antibiotic is also extremely effective. A simple and cheap 5 day treatment course. But vaccine use is extremely prevalent (in the so called DTaP). Why would pertussis get this seemingly opposite treatment than scarlet fever did? Perhaps the vaccine was developed long before the antibiotic? –  Feb 19 '19 at 17:42
  • + diarrhea almost certainly means infectious disease and diarrheal causes of mortality, not infectious diseases causing mortality and diarrhea. Also, I think the most obvious counter to the claim is the repeated outbreaks that pop up whenever we stop vaccinating and are traced to an unvaccinated source (see [this biology.SE answer](https://biology.stackexchange.com/a/76104/43480)) discussing US outbreaks, but more dramatically wrt death, pertussis outbreaks in Japan and Sweden in the years after 1979. – De Novo Feb 27 '19 at 22:41
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    @fredsbend If antibiotics work well then there's little reason to bother with a vaccine. it makes a poor control for the same reason that an experiment that used "syphilis deaths" as a control just when they happen to also develop a cure for syphilis. You might use a disease where no vaccine or cure was discovered like varicella up until 1995. – Murphy Mar 01 '19 at 11:58
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I'd like to point out that there are indeed sanitation/hygiene measures that were and are used and that did help to reduce infections with those contagious diseases even before vaccination became available.

E.g. U Ottawa particularly mentions public health measures such as quarantine:

Here is an historical view of deaths due to measles. The decline after the first World War was due to public health measures (case reporting, quarantine, etc) more than immunization. The immunization came in at the very end, as a finale to the prevention story.
measles decline Here is a similar diagram for whooping cough whooping cough decline

quarantine sign from Smithsonian Instituition web site picture source: Smithsonian Institution, http://ids.si.edu/ids/deliveryService?id=NMAH-NMAH2005-11610

Quarantine/isolation

...is a public health/hygiene measure that is still in use, but for those infectious diseases where vaccination is available, it is mostly not necessary any more. And it is certainly neither cheap (consider that measles in the kindergarden of an unvaccinated community may mean that no family member of any kind in that kindergarden group is allowed to leave their house to go to work or even just shopping until it is clear they did not catch measles).

In addition, modern lifestyle (more urban living people, lots of traveling) makes containing diseases by quarantine more difficult, particularly the ones that are highly contagious already before the patient develops clear symptoms.

Note also that somewhat weaker forms, i.e. no full quarantine but measures to keep the patient sufficiently isolated to drastically reduce possibilities for contagion are used e.g. in Germany for whooping cough:

  • (note that immunity against whooping cough doesn't last very long, neither after vaccination nor after an actual infection)

  • Whoever has or is supected to have whooping cough is e.g. not allowed to work (teach, care, supervise, ...) or attend community centers (that would range from kindergarden over schools to elderly care homes etc.) or group activities until a doctor says they are not contagious any more. This also means e.g. that a resident in a nursing home with whooping cough is not allowed to use the community living room, kitchen, etc.

  • (In addition, people in close contact with any person infected with whooping cough receive prophylactic treatment, such as vaccination booster and/or medication)

Or salmonella:

  • kids < 6 years with infectious diarrhea are not allowed to attend community centers (e.g. kindergarden, school)
  • whoever has salmonellosis, is not allowed to prepare food "professionally" (from community center kitchen over restaurants to food industry).

So in fact, there is a bunch of diseases where we do not rely on vaccination (and antibiotics) only, but actually a mix of different measures is taken.

cbeleites unhappy with SX
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