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

Question

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:

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

• Was measles vaccine introduced after the disease was under control

• Would measles be no great health risk in the US, even without vaccines?

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?

Answer 1

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.)

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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:
  • The 20th Century Mortality Files, 1901-2000 (I think this is the right one...)
  • Report to The Honourable Sir George Cornwell Lewis...
  • Pearce's Essay on Vaccination

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):

[No graph for whooping cough]

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:

• Graphical proof that vaccines work (with sources)
  • You may need to use Archive.org to view some of the sources, like Appendix E- Pink Book 2015 - Reported Cases.

Here is a chart with lots of diseases:

_{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.}

More

• CDC Pink Book:
  • Measles
  • Pertussis
  • Diphtheria
• CDC: What Would Happen If We Stopped Vaccinations?
• CDC: Achievements in Public Health, 1900-1999: Control of Infectious Diseases

Answer 2

• Cases of measles in the US, 1960-2001, CDC, via Science Based Medicine

  

• "Measles Elimination in Canada", from Journal of Infectious Diseases (2004)

  

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.

Answer 3

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.
Here is a similar diagram for whooping cough

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).

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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.