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

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.

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

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:

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?

• This seems to suggest that being seriously ill is OK so long as you do not die – Henry Aug 27 '17 at 16:00
• 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 7:26
• 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 3:30
• @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 at 22:38

# 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 and 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:

• 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 a whole bunch of vital statistics here which go as far back as 1900. This PDF (for 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

year            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 here):

[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:

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

• 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. – user36688 Aug 28 '17 at 22:43
• 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 7 '18 at 3:06
• @Laurel 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 7 '18 at 3:26
• "There is currently no vaccine for Scarlet Fever, so it's pretty irrelevant here." It's not irrelevant. It makes for a good control. – fredsbend Feb 19 at 17:31
• 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. – fredsbend Feb 19 at 17:38

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.

• 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 8:54
• @DrakaSAN It's from CDC. The page is moved, but it's also available at for instance sciencebasedmedicine.org/… – liftarn Aug 28 '17 at 8:59
• @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
• @Jordy the point is exactly to debunk the decorrelation argument, not to prove causality – Guiroux Jul 17 '18 at 9:51

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).

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.

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