Diseases had already begun to disappear before vaccines were introduced, because of better hygiene and sanitation. Statements like this (variations include assertions that vaccines had absolutely no effect on disease rates) are very common in anti-vaccine literature, the intent apparently being to suggest that vaccines are not needed. Improved socioeconomic conditions have undoubtedly had an indirect impact on disease. Better nutrition, not to mention the development of antibiotics and other treatments, have increased survival rates among the sick; less crowded living conditions have reduced disease transmission; and lower birth rates have decreased the number of susceptible household contacts. But looking at the actual incidence of disease over the years can leave little doubt of the significant direct impact vaccines have had, even in modern times. Are we expected to believe that better sanitation caused the incidence of each disease to drop, coincidentally, just at the time a vaccine for that disease was introduced? Here are some examples to illustrate this:
Of more immediate interest is the major epidemic of diphtheria now taking place in the former Soviet Union, where low primary immunization rates in children and lack of booster immunizations in adults have resulted in an increase from 839 cases in 1989 to nearly 50,000 cases and 1,700 deaths in 1994, with the number of cases increasing by 2- to 10-fold each year. There have already been at least 20 imported cases in Europe and two cases in U.S. citizens working in the former Soviet Union.
- Invasive disease due to "haemophilus influenzae" type b (Hib), such as meningitis, was prevalent until just a few years ago when conjugate vaccines that can be used in infants (in whom most of the disease was occurring) were finally developed. Since sanitation is no better now than it was in 1990, it is hard to attribute the virtual disappearance of Hib disease in children in recent years to anything but the introduction of routine immunization. Data from reportable disease surveillance systems revealed that from an estimated 2,000 cases a year prior to the availability of vaccine, there are now less than 52 cases per year being reported (with the majority in infants and children who have not been immunized).
- Varicella (chicken pox) can also be used to illustrate the point, since modern sanitation has obviously not prevented cases from occurring each year - with almost all children getting the disease sometime in their childhood, just as they did 20 years ago, or 80 years ago. If diseases were disappearing, we should expect varicella to be disappearing along with the rest of them.
- We can also look at the experiences of several developed countries that let their immunization levels drop. Three countries - Great Britain, Sweden, and Japan - cut back on the use of pertussis vaccine because of fear about the vaccine. The effect was dramatic and immediate. In Great Britain, a drop in pertussis vaccination in 1974 was followed by an epidemic of more than 100,000 cases of pertussis and 36 deaths by 1978. In Japan, around the same time, a drop in vaccination rates from 70% to 20%-40% led to a jump in pertussis from 393 cases and no deaths in 1974 to 13,000 cases and 41 deaths in 1979. In Sweden, the annual incidence rate of pertussis per 100,000 children 0-6 years of age increased from 700 cases in 1981 to 3,200 in 1985.
Of more immediate interest is the major epidemic of diphtheria now taking place in the former Soviet Union, where low primary immunization rates in children and lack of booster immunizations in adults have resulted in an increase from 839 cases in 1989 to nearly 50,000 cases and 1,700 deaths in 1994, with the number of cases increasing by 2- to 10-fold each year. There have already been at least 20 imported cases in Europe and two cases in U.S. citizens working in the former Soviet Union.