The ethics of mandatory participation in vaccine trials

Mandatory vaccination is a reality in many countries including in Australia where members of the military, students of mainstream medicine and employees at hospitals in NSW have no option but to accept vaccines or lose their jobs. The AVN is absolutely opposed to forced vaccination because vaccines are neither 100% safe nor is it 100% effective and therefore, it is not the government’s right to insist that people be vaccinated or vaccinate their children if they don’t think it is in their best interest. No government has the right to force a citizen to accept something that may make them ill or even kill them.

Even more chilling however is the idea of mandating that someone participate in a trial of an experimental vaccine. Making someone become a guinea pig or offer up their child for that purpose without the right to say no goes against everything our democratic government should stand for and the idea that a journal of medical ‘ethics’ could even suggest such as thing as a possibility is shocking. To read the original article, reproduced here for the purpose of research and critiquing, please click here.

In recent decades there has been a distressing decline in the numbers of healthy volunteers who participate in clinical trials, a decline that has the potential to become a key rate-limiting factor in vaccine development. …As a result, the risks of developing a health intervention that would benefit the whole population are carried disproportionately by some of society’s most poor and vulnerable. This is a situation few would judge to be fair or ethical.

It really is amazing how “ethics” works in medicine. It isn’t right that one group of people is poisoned so to fix the problem we need to ensure that more groups of people are poisoned to even out the burden. When the people during the French Revolution called for equality did they really mean it to be applied this way?

Compulsory involvement in vaccine studies is one alternative solution that is not as outlandish as it might seem on first consideration.

That’s the problem. There are plenty in the medical profession who wouldn’t consider this to be outlandish. And it is why we should be truly frightened.

Mandatory involvement in vaccine trials is therefore perhaps more akin to military conscription, a policy operating today in 66 countries. In both conscription and obligatory trial participation, individuals have little or no choice regarding involvement and face inherent risks over which they have no control, all for the greater good of society.

Yes. It is more akin to military conscription than organ donation. It is akin to something else too. Slavery.

Indeed I think it would be good to compare mandatory vaccination to both these ideas. Firstly, they are all justified as necessary evils for a greater good – the need to break a few eggs to make an omelette. Secondly, none of them ever actually produce the omelette.

The justification for conscription is that you can have more people fighting for your cause then you otherwise would which should help in the defence of a nation (I will be kind here and assume that conscripts will be used for this purpose even though for the most part historically they are used in aggressive pursuits rather than defensive ones). However, there is a fundamental problem. People who are conscripted don’t actually want to be there. How can you trust a soldier who would rather be smoking weed or diving under the nearest cover in order to protect himself from getting shot than he would to brave enemy fire and haul several wounded men to safety? Such people are more of a liability than they are a help and it was the great economist Milton Friedman who pointed this out (although many had no doubt made a similar argument previously). Conscription doesn’t work because while you can force people to take a plane to some faraway country you can’t force them to care about the cause – or their fellow soldiers. Of course that is not to say that all conscripts are terrible soldiers but they are – all else equal – vastly less reliable than those who want to be there.

So conscription sounds like it should work for the greater good but it simply doesn’t.

Slavery has also been justified as being necessary for the economic development of a country. The reasoning was that even though it wasn’t particularly fair on the slaves there was simply no choice for a developing economy. The simple economic argument is that slaves do work for a below market wage and hence you can “extract” more production without having to place a financial burden on employers. But, just like conscription, the argument was based on a false premise. Slaves only have an incentive to avoid getting beaten and so the work they will do will be only at this level – not a skerrick more. Generally speaking they can’t be promoted or rewarded with more money so they just do the bare minimum and never take any initiative nor do they have any means or incentive to save and invest in productive capital themselves or attempt any sort of entrepreneurship. Why would they? Consequently, slavery actually reduces production all else equal.

Obviously some people gain from slavery (ie slaveholders) but the majority of people lose (when you take into account the welfare of the slaves themselves). The economy as a whole does more poorly then if the workers are free.

Ideas that are justified “for the greater good” invariably only mean the greater good of scoundrels and this is precisely what we would get with mandatory vaccination. The assumption is that vaccines are effective and acceptably safe. Just like the assumption was that conscripts would care about fighting people they had never met in South-East Asia or that slaves would have just as much incentive to work as free labourers. All of these assumptions are wrong. But it is no accident. Sure those who believe in vaccinations – just like those who believe in slavery – do genuinely believe they are in the right, but their beliefs are inextricably linked to their own self-interest. They believe in vaccinations because it is in their best interests to do so. There is no point providing them with counter-arguments because you are asking them to recognise that not only is their pay-packet unjustified but their actions unconscionable.

As ever, then, the debate boils down to a consideration of the “greater good” or the “lesser evil.” A key consideration is the risk benefit ratio—risk to the individual volunteer balanced against the benefit to society. Society is unlikely to accept compulsory recruitment to a trial for a vaccine against the common cold if the vaccine causes severe complications in vaccinees. Increase the severity of the disease in question, however, and compulsory recruitment becomes a more palatable option.

An odd wording really. Almost as though the authors wish for the disease to be more severe so their dream of compulsory vaccination can become a reality. But that is probably just the paranoid in me.

In 2009, initial speculation regarding the H1N1 “swine flu” pandemic set mortality estimates high. In Mexico where the outbreak started, authorities closed public and private facilities [11], putting the interests of society above those of the individual. Although millions of people were infected worldwide, mortality rates were quickly revised downwards [12], and a successful vaccine mass-produced [13]. But consider if this had not been the case.

You got that? The only reason that H1N1 didn’t kill billions of people was because of the heroic efforts of the medical authorities and the glories of coercive government action. It wasn’t because the whole thing was completely overblown and these same authorities were simply scaremongering to offload some vaccines and play out their totalitarian fantasies.

The fundamental principles of medical ethics—beneficence, nonmaleficence, respect for autonomy, and justice—are, as always, conflicted on this issue.

They are the fundamental principles of medical ethics? Well I was way off then.

Justice would reason for the fair treatment of all, supporting mandatory enrollment to help ensure that the risks of developing an intervention that could benefit all are equally borne by all.

No. Justice would state that those who seek to profit from these concoctions and especially those who seek to force them upon us should be the sole people to be the test subjects. There is no need for case controlled trials or any sort of statistical shenanigans All that has to happen is for someone to show that even in extremis there is no way these concoctions could hurt anybody. The obvious first cab off the rank could be the mandatory vaccination guru Paul Offit. He claims that 100,000 vaccines given to a child in a single day would be a walk in the park so one can only presume he can’t wait for the honour of proving this to us himself. Those who believe in vaccine safety but make slightly less grandiose claims should at the very least take a weight-adjusted dose of the entire infant vaccination schedule of their respective countries.

But they won’t. Just like slavery advocates were never slaves themselves or conscription advocates generally keep their own sons out of harm’s way those who justify their actions by referencing some greater good are invariably cowards and hypocrites.

Respect for autonomy, on the other hand, would recognize and maintain the right of individuals to self-determination and their corresponding right to refuse a medical intervention. The Universal Declaration of Human Rights upholds the rights, dignity, and freedom of individuals and the need to protect people from “arbitrary interference” [14]—principles that would inevitably be compromised by mandatory enrollment in vaccine trials. Health services depend absolutely on the public’s confidence and trust—compromising on respect for autonomy would undermine this fundamental premise and launch us on a precarious slippery slope that may be difficult to climb back up.

Well I guess we should be thankful for small mercies that at least the authors haven’t gone all the way down the rabbit hole.

A more palatable and realistic option is a policy of “mandated choice.” In this case individuals would be required by law to state in advance their willingness to participate in vaccine trials [15]. The advantage of this system is that it could identify a large cohort of willing volunteers from which participants could be recruited rapidly without jeopardizing individual autonomy. It would encourage an open, noncoercive philosophy for tackling societal challenges without compromising individual freedom or public trust in the health care system.

Ostensibly this is probably a reasonable suggestion. However, it is unlikely to work out in such a benign manner. As I have said, vaccine creators and proponents are the obvious candidates but they are all hypocrites and cowards. So if even they refuse to partake why should anybody tie themselves in like that without a massive incentive to do so? Obviously such a proposal would, initially, go nowhere and hence, lead to a call for the government to provide ‘incentives’ to people to participate. Now, again this could be my paranoia, but I suspect that this is exactly what the authors expect to happen – that the government would make people an offer they couldn’t refuse to be part of the guinea pig group. Of course, this would just lead us back to the old problem: if the government were to entice people with say extra welfare payments we would still be getting much the same socio-economic group of volunteers as we do currently and which the authors say troubles them so.

In short, the only likely effect of this proposal is that trials would be funded by taxpayers rather than pharmaceutical companies. And, this may well be the paranoid in me again, but I strongly suspect that this is precisely where the authors want this to go.

But perhaps most importantly, as a society we need to evaluate our perception of vaccination. Any successful vaccine program by its very nature takes a once-feared illness out of the public eye.

That is actually true in a sense. The definition of “success” for a vaccine is when the disease is relabelled and even though the number of people who suffer from the same symptoms stays the same (or increases) the original disease label is taken from the public eye to be replaced with a bunch of new conditions or increases in others. The only exceptions to this are things like influenza for which even the epidemiological evidence doesn’t show a protective benefit from vaccination – and still the doctors tell us to take them! Remember what I said previously about how it doesn’t matter what data you show them – even if it is their own? They will never accept that their pay-packets are unjustified, let alone that their actions are unconscionable.

This means that the benefits of immunization become forgotten while side effects in small numbers of individuals fill the headlines. It is all too easy for sensationalist and unfounded stories such as that claiming a link between the MMR (measles-mumps-rubella) vaccine and autism [16] to instead take root in society’s collective psyche.

Note the hypocrisy. Suggesting that we should split the MMR up before further research is done is “sensationalist” but claiming the whole world needed to take a poorly tested vaccine (H1N1) because a few unrelated people suffered flu-like symptoms is calm, rational policy-making.

Ultimately such a crucial public health intervention as vaccine development may become devalued—and only revalued once a drop in vaccination rates leads to resurgence of severe disease.

We can only hope! I don’t know why they are so concerned though – manufacturing panic is their greatest talent. Well, other than the sheer chutzpah to turn around and accuse us of ‘scaremongering’ – they certainly have that in spades too.

Perhaps lessons can also be learned from organ donation, where apathy and ignorance may be as much to blame for low donation rates as conscientious objection. If a concerted effort were made to increase public awareness of the success of vaccination, the potential of novel vaccines to improve global health drastically, and the important contribution that individuals can make by volunteering for studies, perhaps mandatory enrollment would not even need to be consider

Yes I suppose. One thing I have always noticed about vaccinations is that very few people have ever heard about them or their astonishing success rates. Clearly more children need to be told about them at school and government websites need to stop downplaying their benefits and the media need to be more one-sided when they are covering the risks vs the benefits…. I’m sorry, but do we live in the same world? Who the hell hasn’t been brainwashed from the day they were born about the miracle of vaccines? I remember in 3rd grade sticking 50 cent coins (it might have been 20 cents) on to a board at school because each one of those coins was going to save a child from measles apparently. I can’t imagine my upbringing was significantly different in that respect to anybody else’s.

The thing is though, that there are a significant and growing group of people on this planet who have been able to recover from this brainwashing. It isn’t easy of course. Most people find it extremely difficult to imagine that something they have been taught from the day they are born and backed by very serious government appointed experts who are particularly adept at using big esoteric words could possibly be wrong. It usually starts from making an observation that the great minds of the medical world swore was only a one in a zillion shot ie a severe reaction after a vaccine. But for many it branches out into reading about the completely farcical data that the so-called vaccine miracle is predicated on.

Indeed, it is probably the fact that the vaccine data is so appalling that holds it all together. Joseph Goebbels famously said that the bigger the lie the more credible it will be. Nobody ever thinks that somebody (particularly somebody in authority) would deny the bleeding obvious so the massive lies, ironically, go by with the least scrutiny. The type of evidence used to demonstrate the efficacy and safety of vaccines wouldn’t be acceptable to a Year 10 maths student if it was used to support anything other than this most sacred of cows.

For example, how do they get away with not using real placebos in their safety trials but other vaccines? How do they get away with ignoring the fact that deaths due to infectious disease had all but disappeared from Western countries long before vaccines for those diseases had been invented let alone become widely used? How do they get away with using notification data in place of incidence data? How do they get away with claiming that “you never see any more polio victims” when, according to government data, rates of physical disability have actually risen since the polio vaccine? How do they get away with claiming that the diphtheria and pertussis vaccines are worth their weight in gold when hospitalisations due to respiratory conditions are a dime a dozen despite a near universal vaccination rate? How do they get away with claiming that these toxoid vaccines will promote herd immunity when they don’t even aim to prevent the bacteria? How did they get away with claiming that small pox was eradicated when no mere mortal could have possibly known such a thing? How do they get away with multiplying a completely made up number (rates of measles deaths in developing countries) with another completely made up number (efficacy of vaccine in preventing measles deaths) by a real number (number of measles vaccines given) and use this to “prove” that the measles vaccine saves millions of lives? It truly is extraordinary the extent of the fraud. But the majority of people find it almost impossible to believe that so many intelligent and respected people could get it oh so wrong. After all, if it is obvious to us vaccine critics, then surely it must be obvious to the experts who must have subsequently given adequate explanations for them right? Now if only someone could find these damned explanations.

Article review by Punter

Measles deaths in Africa

The following article is by Greg Beattie, author of Vaccination: A Parent’s Dilemma and the more recent Fooling Ourselves on the Fundamental Value of Vaccines. This information and the graphs included are excerpted from Mr Beattie’s latest book. It demonstrates very clearly that a true sceptic will not necessarily believe in headlines such as “Measles deaths in Africa plunge by 91%” without seeing the proof of those claims. Question everything – accept nothing at face value – that is the credo of the true sceptic.

Man is a credulous animal, and must believe something; in the absence of good grounds for belief, he will be satisfied with bad ones.
Bertrand Russell

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0.450–0.499 0.400–0.449 0.350–0.399 0.300–0.349 under 0.300 n/a (Photo credit: Wikipedia)

If you are not one to follow the news, you may have missed it. Others will have undoubtedly seen a stream of good-news stories over the past five years, such as:

Measles Deaths In Africa Plunge By 91%[1],[2]

There have been many versions on the theme; the percentage rates have changed over time. However, the bodies of the stories leave us in no doubt as to the reason for their headlines. Here are some direct quotes:

In a rare public health success story on the world’s most beleaguered continent, Africa has slashed deaths from measles by 91 per cent since 2000 thanks to an immunization drive.

An ambitious global immunization drive has cut measles deaths…

Measles deaths in Africa have fallen as child vaccination rates have risen.

These stories represent a modern-day version of the belief that vaccines vanquished the killer diseases of the past. There is something deeply disturbing about the stories, and it is not immediately apparent. The fact is: no-one knows how many people died of measles in Africa. No-one! Not last year and not ten years ago.

I will repeat that. No-one knows how many measles deaths have occurred in Africa. So, where did these figures come from? I will explain that in this blog. In a nutshell, they were calculated on a spreadsheet, using a formula. You may be surprised when you see how simple the method was.

We all believe these stories, because we have no reason to doubt them. The only people who would have questioned them were those who were aware that the deaths had not been counted. One of these was World Health Organisation (WHO) head of Health Evidence and Statistics, who reprimanded the authors of the original report (on which the stories were based) in an editorial published in the Bulletin of the WHO, as I will discuss shortly. Unfortunately, by then the train was already runaway. The stories had taken off virally through the worldwide media.

Overview

First, an overview of the formula. The authors looked at it this way: for every million vaccines given out, we hope to save ‘X’ lives. From that premise, we simply count how many million vaccines we gave out, and multiply that by ‘X’ to calculate how many lives (we think) we have saved. That is how the figures were arrived at.

The stories and the formula are both products of a deep belief in the power of vaccines. We think the stories report facts, but instead they report hopes.

The nuts and bolts

Hardly any of the willing participants in spreading the stories bothered to check where the figures came from, and what they meant. That was possibly understandable. Why would we need to check them? After all, they were produced by experts: respected researchers, and reputable organisations such as UNICEF, American Red Cross, United Nations Foundation, and the World Health Organisation.

However, I did check them. I checked because I knew the developing world wasn’t collecting cause of death data that could provide such figures[3]. In fact, it is currently estimated that only 25 million of the 60 million deaths that occur each year are even registered, let alone have reliable cause-of-death information[4]. Sub-Saharan Africa, where a large proportion of measles deaths are thought to occur, still had an estimated death registration of only around 10%[5] in 2006, and virtually no reliable cause-of-death data. Even sample demographic surveys, although considered accurate, were not collecting cause-of-death data that allowed for these figures to be reported. Simply put, this was not real data: the figures had to be estimates.

I was curious as to how the estimates were arrived at, so I traced back to the source—an article in The Lancet, written by a team from the Measles Initiative[6]. After reading the article, I realised the reports were not measles deaths at all. They were planning estimates, or predictions. In other words, they represented outcomes that the Measles Initiative had hoped to achieve, through conducting vaccination programs.

Don’t get me wrong. We all know that planning and predicting are very useful, even necessary activities, but it is obvious they are not the same as measuring outcomes.

The title of the original report from the Measles Initiative reads, “Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study.[7] The authors took one and a half pages to explain how natural history modelling applied here. I will simplify it in about ten lines. I realise that in doing so, some may accuse me of editorial vandalism, however I assure you what follows captures the essence of the method. The rest is detail. If you are interested in confirming this, I urge you to read the original article for that detail. Here we go… the formula at the heart of the stories:

My interpretation of the Measles Natural History Modelling Study

  1. Open a blank spreadsheet
  2. Enter population data for each year from 2000 to 2006
  3. Enter measles vaccine coverage for each of the years also
  4. Assume all people develop measles if not vaccinated
  5. Assume vaccination prevents 85-95% of measles cases
  6. Calculate how many measles cases were ‘prevented’ each year (using the above figures)
  7. Calculate how many measles deaths were ‘prevented’ each year (using historical case-fatality ratios)

There, simple. As you can see, this is a typical approach if we are modelling,for predictive purposes. Using a spreadsheet to predict outcomes of various plans helps us set targets, and develop strategies. When it comes to evaluating the result of our plan however we need to go out into the field, and measure what happened. We must never simply return to the same spreadsheet. But this is precisely what the Measles Initiative team did. And the publishing world swallowed it—hook, line and sinker.

As mentioned earlier, WHO Health Evidence and Statistics head, Dr Kenji Shibuya, saw the problem with this method. Writing editorially in the Bulletin of the WHO, under the title “Decide monitoring strategies before setting targets”, Shibuya had this to say[8]:

Unfortunately, the MDG[9] monitoring process relies heavily on predicted statistics.

…the assessment of a recent change in measles mortality from vaccination is mostly based on statistics predicted from a set of covariates… It is understandable that estimating causes of death over time is a difficult task. However, that is no reason for us to avoid measuring it when we can also measure the quantity of interest directly; otherwise the global health community would continue to monitor progress on a spreadsheet with limited empirical basis. This is simply not acceptable. [emphasis mine]

This mismatch was created partly by the demand for more timely statistics …and partly by a lack of data and effective measurement strategies among statistics producers. Users must be realistic, as annual data on representative cause-specific mortality are difficult to obtain without complete civil registration or sample registration systems

If such data are needed, the global health community must seek indicators that are valid, reliable and comparable, and must invest in data collection (e.g. adjusting facility-based data by using other representative data sources).

Regardless of new disease-specific initiatives or the broader WHO Strategic Objectives, the key is to focus on a small set of relevant indicators for which well defined strategies for monitoring progress are available. Only by doing so will the global health community be able to show what works and what fails.

In simple terms, Shibuya was saying:

  • We know it is difficult to estimate measles deaths, but
  • You should have tried, because you attracted a lot of interest
  • Instead, you simply went back to the same spreadsheet you used to make the plan—and that is unacceptable!
  • If you want to make a claim about your results, you need to measure the outcomes and collect valid data
  • Until you do, you cannot say whether your plan ‘worked’

Unfortunately, by the time Shibuya’s editorial was published, the media had already been trumpeting the stories for more than a year, because the Measles Initiative announced its news to a waiting media before subjecting it to peer-review. So, without scientific scrutiny, the stories were unleashed into a world hungry for good news, especially concerning the developing world. The result… the reports were welcomed, accepted, and regurgitated to a degree where official scrutiny now seems to have the effect of a drop in a bucket.

The question of who was responsible for this miscarriage of publishing justice plagued me for a while. Was it the architects of the original report? Or was it the robotic section of our media (that part that exists because of a lack of funds for employing real journalists) who spread the message virally to every corner of the globe, without checking it?

One quote which really stands out in the stories is from former director of the United States Centers for Disease Control (CDC).

“The clear message from this achievement is that the strategy works,” said CDC director Dr. Julie Gerberding

What strategy works? Is she talking about modelling on a spreadsheet? Or, using the predictions in place of real outcomes? More recent reports from the Measles Initiative indicate the team are continuing with this deceptive approach. In their latest report[10] it is estimated 12.7 million deaths were averted between 2000-2008. All were calculated on their spreadsheet, and all were attributed to vaccination, for the simple reason that it was the only variable on the spreadsheet that was under their control. And still there is no scrutiny of the claims. Furthermore, the authors make no effort to clarify in the public mind that the figures are nothing but planning estimates.

No proof

Supporters of vaccination might argue that this does not prove vaccines are of no use. I agree. In fact,let me say it first: none of this provides any evidence whatsoever of the value of vaccination. That is the crux of the matter. The media stories have trumpeted the success of the plan, and given us all a pat on the back for making it happen. But the stories are fabrications. The only aspect of them which is factual is that which tells us vaccination rates have increased.

Some ‘real’ good-news?

General mortality rates in Africa are going down. That means deaths from all causes are reducing. How do we know this? Because an inter-agency group, led by UNICEF and WHO, has been evaluating demographic survey data in countries that do not have adequate death registration data. These surveys have been going on for more than 50 years. One of the reasons they do this is to monitor trends in mortality; particularly infant, and under-five mortality.

Although the health burden in developing countries is inequitably high, there is reason to be positive when we view these trends. Deaths are declining and, according to the best available estimates, have been steadily doing so for a considerable time; well over 50 years.

One of the most useful indicators of a country’s health transition is its under-5 mortality rate: that is, the death rate for children below five years old. The best estimates available for Africa show a steady decline in under-5 mortality rate, of around 1.8% per year, since 1950[11]. Figure 1 shows this decline from 1960 onward[12]. It also shows the infant mortality rate[13]. Both are plotted as averages of all countries in the WHO region of Africa.

Figure 1. Child mortality, Africa

This graph may appear complex, but it is not difficult to read. The two thick lines running horizontally through the graph are the infant (the lower blue line) and under-5 (the upper black line) mortality rates per 1000 from 1960 to 2009. The handful of finer lines which commence in 1980, at a low point, and shoot upward over the following decade, represent the introduction of the various vaccines. The vertical scale on the right side of the graph shows the rate at which children were vaccinated with each of these shots.

The primary purpose of this graph (as well as that in Figure 2) is to deliver the real good-news. We see a slowly, but steadily improving situation. Death rates for infants and young children are declining. I decided to add the extra lines (for vaccines) to illustrate that they appear to have had no impact on the declining childhood mortality rates; at least, not a positive impact. If they were as useful as we have been led to believe, these vaccines (covering seven illnesses) would surely have resulted in a sharp downward deviation from the established trend. As we can see, this did not occur.

In Africa, the vaccines were introduced at the start of the 1980s and, within a decade, reached more than half the children. The only effect observable in the mortality rates, is a slowing of the downward trend. In other words, if anything were to be drawn from this, it would be that the introduction of the vaccines was counter-productive. One could argue that the later increase in vaccine coverage (after the year 2000) was followed by a return to the same decline observed prior to the vaccines. However, that does not line up. The return to the prior decline predates it, by around five years.

With both interpretations we are splitting hairs. Since we are discussing an intervention that has been marketed as a modern miracle, we should see a marked effect on the trend. We don’t.

The WHO region of Africa (also referred to as sub-Saharan Africa) is where a substantial portion of the world’s poor-health burden is thought to exist. The country that is believed to share the majority of worldwide child mortality burden with sub-Saharan Africa is India, in the WHO south-east Asia region. Together, the African and South-east Asian regions were thought in 1999 to bear 85% of the world’s measles deaths[14]. Figure 2 shows India’s declining infant and under-5 mortality rates, over the past 50 years. Again, the introduction of various vaccines is also shown.

Figure 2. Child mortality, India

And again, vaccines do not appear to have contributed. Mortality rates simply continued their steady decline. We commenced mass vaccination (for seven illnesses) from the late 1980s but there was no visible impact on the child mortality trends.

In a nutshell, what happened in the developed world is still happening in the yet-to-finish-developing world, only it started later, and is taking longer. The processes of providing clean water, good nourishment, adequate housing, education and employment, freedom from poverty, as well as proper care of the sick, have been on-going in poor countries.

I would have loved to go back further in time with these graphs but unfortunately I was not able to locate the data. I did uncover one graph in an issue of the Bulletin of the WHO, showing the under-5 mortality rate in sub-Saharan Africa to be an estimated 350 in 1950[15]. It subsequently dropped to around 175 by 1980, before vaccines figured. It continued dropping, though slower, to 129 by 2008[16].

The decline represents a substantial health transition, and a lot of lives saved. When cause-of-death data improves, or at least some genuine effort is made to establish credible estimates of measles deaths, it will undoubtedly be found they are dropping as well. Why wouldn’t they? This is good news, and all praise needs to be directed at the architects and supporters of the international activities that are helping to achieve improvements in the real determinants of health. In the midst of all the hype, I trust we will not swallow attempts to give the credit to vaccines… again.

I am not confident, however. I feel this is simply history repeating itself. Deaths from infectious disease will reach an acceptable “low” in developing countries, at some point in time. And although this will probably be due to a range of improvements in poverty, sanitation, nutrition and education, I feel vaccines will be given the credit. To support the claim, numerous pieces of evidence will be paraded, such as:

Measles Deaths In Africa Plunge By 91%

We need to purge these pieces of “evidence” if we are to have rational discussion. The public have a right to know that these reports are based on fabricated figures.  Otherwise, the relative importance of vaccines in future health policy will be further exaggerated.


[1]    Medical News Today 30Nov 2007; http://www.medicalnewstoday.com/articles/90237.php

[2]    UNICEF Joint press release; http://www.unicef.org/media/media_41969.html

[3]    Jaffar et al. Effects of misclassification of causes of death on the power of a trial to assess the efficacy of a pneumococcal conjugate vaccine in The Gambia; International Journal of Epidemiology 2003;32:430-436 http://ije.oxfordjournals.org/cgi/content/full/32/3/430

[4]    Save lives by counting the dead; An interview with Prof Prabhat Jha, Bulletin of the World Health Organisation 2010;88:171–172

[5]    Counting the dead is essential for health: Bull WHO Volume 84, Number 3, March 2006, 161-256 http://www.who.int/bulletin/volumes/84/3/interview0306/en/index.html

[6]    Launched in 2001, the Measles Initiative is an international partnership committed to reducing measles deaths worldwide, and led by the American Red Cross, CDC, UNICEF, United Nations Foundation, and WHO. Additional information available at http://www.measlesinitiative.org

[7]    Wolfson et al. Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study; Lancet 2007; 369: 191–200 Available from http://www.measlesinitiative.org/mi-files/Reports/Measles%20Mortality%20Reduction/Global/Wolfson%20Lancet2007_Measles_Mortality_Reduction.pdf

[8]    Kenji Shibuya. Decide monitoring strategies before setting targets; Bulletin of the World Health Organization June 2007, 85 (6) http://www.who.int/bulletin/volumes/85/6/07-042887/en/index.html

[9]    MDG – Millennium Development Goals, to be discussed shortly in this chapter.

[10]  Dabbagh et al. Global Measles Mortality, 2000–2008; Morbidity & Mortality Weekly Report. 2009;58(47):1321-1326 http://www.medscape.com/viewarticle/714345

[11]  Garenne & Gakusi. Health transitions in sub-Saharan Africa: overview of mortality trends in children under five years old (1950-2000);  Bull WHO June 2006, 84(6) p472 http://www.who.int/bulletin/volumes/84/6/470.pdf

[12]  If you perform a ‘google’ search for ‘infant mortality rate’ or ‘under-5 mortality rate’ you will locate a google service that provides most of this data. It is downloadable in spreadsheet form by clicking on the ‘More info’ link.  http://data.worldbank.org/indicator/SH.DYN.MORT/countries/1W-US?display=graph :Vaccine coverage data is available from the WHO website http://www.childinfo.org/files/Immunization_Summary_2008_r6.pdf

[13]  Infant mortality rate is “under-1 year of age” mortality rate.

[15]  Garenne & Gakusi. Health transitions in sub-Saharan Africa: overview of mortality trends in children under five years old (1950-2000);  Bull WHO June 2006, 84(6) p472 http://www.who.int/bulletin/volumes/84/6/470.pdf