Vaccination Candy box Images: dreamstimeA significant proportion of Americans believe it is perfectly all right to put other people at risk of the costs and misery of preventable infectious diseases. These people are your friends, neighbors, and fellow citizens who refuse to have themselves or their children vaccinated against contagious diseases.
There would be no argument against allowing people to refuse vaccination if they and their families would suffer alone the consequences of their foolhardiness. It would be their right to forego misery-reducing and life-preserving treatments. But that is not the case in the real world.
The University of Pittsburgh’s Project Tycho database, launched last week, quantifies the prevalence of infectious disease since 1888 in the United States. Drawing on Project Tycho data, a November 28 New England Journal of Medicine article concluded that vaccinations since 1924 until now prevented 103 million cases of polio, measles, rubella, mumps, hepatitis A, diphtheria, and pertussis. While the NEJM article did not calculate the number of deaths avoided as a result of vaccination, one of the study’s authors estimates that number is between three and four million.
People who don’t wish to take responsibility for their contagious microbes will often try to justify their position by noting the fact that the mortality rates of many infectious diseases had declined significantly before vaccines came along. And it is certainly true that a lot of that decline in infectious disease mortality occurred as a result of improved sanitation and water chlorination. A 2004 study by the Harvard University economist David Cutler and the National Bureau of Economic Research economist Grant Miller estimated that the provision of clean water “was responsible for nearly half of the total mortality reduction in major cities, three-quarters of the infant mortality reduction, and nearly two-thirds of the child mortality reduction.” Improved nutrition also reduced mortality rates, enabling infants, children, and adults to fight off diseases that would have more likely killed their malnourished ancestors.
But vaccines have played a substantial role in reducing death rates too. An article in the Journal of the American Medical Association compared the annual average number of cases and resulting deaths of various diseases before the advent of vaccines to those occurring in 2006. Before an effective diphtheria vaccine was developed, for example, there were about 21,000 cases of the disease each year, 1,800 of them leading to death. No cases or deaths from the disease were recorded in 2006. Measles averaged 530,000 cases and 440 deaths per year before the vaccine. In 2006, there were 55 cases and no deaths. Whooping cough saw around 200,000 cases and 4,000 deaths annually. In 2006, there were nearly 16,000 cases and 27 deaths. Polio once averaged around 16,000 cases and 1,900 deaths. No cases were recorded in 2006. The number of Rubella cases dropped from 48,000 to 17, and the number of deaths dropped from 17 to zero.
With the latter disease, the more important measure is the number of babies, born to rubella-infected mothers, who suffered from disease-induced birth defects, such as deafness, cloudy corneas, damaged hearts, and stunted intellects. Some 2,160 infants were afflicted with congenital rubella syndrome as late as 1965. In 2006 it was one.
The risk that infectious diseases will kill innocent bystanders is not the only issue. Sheer misery counts too. The fevers, the sweats, the incessant coughs, the runny noses, the itchy rashes, and the lost days at work must be taken into account, too. And, of course, many people end up in the hospital as a result of infectious disease.
Before a chicken pox vaccine became available, upwards of four million kids got the disease every year, of which 11,000 were hospitalized and 105 died. In 2004, the estimated number cases had dropped to 600,000, resulting in 1,276 hospitalizations and 19 deaths. Before the measles vaccine was introduced in 1962, some 48,000 were hospitalized and 450 died of that infection each year. So far this year there have been 175 cases and three hospitalizations. A 1985 study by Centers for Disease Control and Prevention epidemiologist in the journal Pediatrics estimated that the first 20 years of measles vaccination in the U.S. had prevented 52 million cases, 5,200 deaths, and 17,400 cases of mental retardation.
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