September 11, 2019

1: The Greatest Killers

Did vaccines cause the dramatic drop in mortality from history's greatest killers?

1: The Greatest Killers

In this episode, Andrew Wakefield discusses the timelines of when vaccines were introduced, and compares these to other non-vaccination diseases.


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So for the last 25 or so years, I've studied the possible infectious origins of disease, and specifically as a gastroenterologist, inflammatory bowel disease, Crohn's disease and ulcerative colitis. And in this series of lectures is therefore very much a personal perspective, for which I bear full responsibility. And it goes without saying that my perspective is not one that is shared by everyone. Perspective is something that I will be discussing in some detail as we move through this series, but my perspective is one based, as my experience has been, upon clinical observation and how that observation has raised certain questions that lent themselves to scientific analysis. It's also, sadly, a reflection on how that analysis and the line of logical scientific inquiry that followed was deemed unacceptable, and was terminated, and its inferences, right or wrong, never adequately addressed.

Ultimately, it's a story of medical science in crisis, a crisis in a discipline that should be objective, iterative, self-correcting and unemotional. A science that should serve the health of people and not that of special interests. Perception is crucial and we come to the father of modern microbiology, Louis Pasteur, working in France. Pasteur himself developed vaccines for diptheria, cholera, rabies, anthrax, yellow fever, plague and tuberculosis. These were variously successful. His perception at the time, one shared by the CDC currently, is that this is man against microbe and he wrote, "If it is a terrifying thought, that life is at the mercy of the multiplication of these minute bodies, it is a consoling hope that science will not always remain powerless before such enemies."

The CDC, sharing that perception, wrote of Pasteur, "He had established beyond doubt that a solid immunity could be brought about without endangering the life or health of the vaccinated person." And that is something that we will explore. Further, "immunization has become as a general law of nature." A very bold statement. Only the future will reveal its full significance in the realm of human economy. So the question, is the certainty that vaccines are one of the greatest achievements of all time justified by the evidence?

Let's go back into history again and look at the great killers. The great killers, the ten leading causes of death in 1850, for example, in the United Kingdom and in the US, included tuberculosis, dysentery, cholera, malaria, typhoid fever, pneumonia, diptheria, scarlet fever, meningitis and whooping cough. Now, two of those, pneumonia and meningitis, are not a specific infectious agent, so we'll put those to one side for the moment. Let's separate the remaining diseases into those for which a vaccine has been produced, one that has been in widespread use as a tool of public health and those for which there's never been a vaccine of that description. Those that for which there is, is tuberculosis, diptheria, and whooping cough, or pertussis. Those which there's not, dysentery, cholera, malaria, typhoid fever and scarlet fever. And let's look at the history of those diseases.

Well, here is the mortality from dysentery and typhoid, infections for which there has never been a vaccine. And you can see that there has been a dramatic decline in the mortality from this disease shown here per 100,000 of the population in the United States over the years, from 1900 onwards. And here we can see there's graphically again deaths per 100,000 in the United States and England from a different source.

In the next slide we see malaria death rates worldwide in the bold blue line, showing again a dramatic fall in mortality from malaria, albeit that there's an upswing at the end. This is a disease for which there has never been a successful vaccination. Here we see scarlet fever mortality rates in the United States and in England over the centuries. Death rates per 100,000; again, this same dramatic decline in mortality.

Let's look at those diseases now for which a vaccine is available, starting with tuberculosis. Here we see the deaths in children from tuberculosis in England and Wales, starting with a dramatic decline at the beginning of the 20th century and achieving very, very low levels by 1970. Here we see United Kingdom deaths from tuberculosis of all ages, and it shows this dramatic decline long in advance of the BCG vaccine for tuberculosis coming available. In the next slide we see the same pattern in the United States of America where a vaccine against tuberculosis has never been in routine widespread use. This cannot be ascribed to the benefits of vaccination.

Here you see a similar image for whooping cough, UK deaths per 100,000. You can see again dramatic decline in mortality in advance of the vaccine being introduced in the 1950s. Again, exactly the same pattern in the United States of America. Here we see diptheria in the United States and England on the same graph and the blue arrows indicating the point at which the vaccine was introduced, exactly the same pattern of mortality from these infectious diseases.

So the observation that requires explanation is the shape of the mortality curves is the same whether or not there was a vaccine for that particular disease. Was this decline in mortality due to vaccines? Did the downward trend start with vaccination? No. Could vaccination have accounted for the majority of the decline in mortality? No. What would have happened if we'd never vaccinated? We don't know. This question and the questions of where we stand with other less serious infectious disease will be addressed in the next lecture.