Thread by @ChrisMasterjohn

Have vaccines saved millions of lives?

The best place to start to answer this question is Thomas McKeown’s 1976 “The Modern Rise of Population.”

As the title suggests, McKeown’s book is not about vaccines so much it is a thesis to explain why the world population dramatically increased beginning in the 1800s.

He first looked at whether this was driven by a reduction in mortality or an increase in fertility.

Mortality declined, so helooked at which specific diseases accounted for the decline.

Then, what could account for those disease mortalities declining.

Chapter 5, “The Medical Contribution,” assesses whether medical interventions were responsible. These include vaccinations.

The following graphs are for UK mortality for each disease, not the incidence of the disease.

This is tuberculosis.

Eradicated in the US with no vaccine, the decline in mortality was almost over before vaccination was introduced in the UK.

This is bronchitis, pneumonia, and the flu. Prior to flu vaccines, it simply shows that drugs were introduced during a decline that started much earlier.

This is whooping cough.

Vaccine introduced when mortality was almost gone.

This is measles.

Mortality practically eradicated by the time the vaccine was introduced.

This is scarlet fever.

Again, no vaccine, but it shows the drugs came in after the mortality was mostly gone.

This is diphtheria.

It does look like the vaccine made the mortality fall more quickly than it was already falling, but it’s also obvious the mortality would have been gone by 1960 with no vaccine had it continued its existing trend.

This is smallpox.

In this case, forced vaccination occurred prior to its peak mortality, and the graph oddly looks like the vaccine could have interrupted the existing decline with an explosion of death.

McKeown was not against vaccines. This can be clearly seen from his comments on the polio vaccine.

In short, he suspected the polio vaccine was extremely effective, but not enough people died of polio to make a meaningful contribution to the overall decline in infectious disease mortality.

Here as his comments on smallpox.

In short, vaccination definitely killed people by infecting them with smallpox, and it was surveillance that ultimately wiped out the disease.

However, in the case of smallpox the availability of a vaccine precedes reliable mortality data, and it is only after forced vaccination started that the mortality spiked, so it could be that the vaccine contributed to the long decline of mortality.

Still, it overlaps with the time period in which mortality from all these other diseases was declining without vaccines.

As I said at the outset, these graphs are for mortality, not incidence.

In the US, measles incidence for example remained high until the vaccine was introduced.

en.m.wikipedia.org/wiki/Measles#/…

However, measles mortality for the US looks like it does in the UK. This graph is noisier than McKeown’s because it is not as smoothed out with averaging so is more erratic due to waves of epidemics.

Now, McKeown was not trying to ask the question of whether vaccines have “saved millions of lives” and he was writing before many vaccines were spread across the world.

I think it is conceivable that in the developing world, vaccines may have been used in circumstances where they did save millions of lives.

For example, McKeown’s thesis was that improvements in quantity, mainly, and to some extent quality, of food, was responsible.

I would emphasize the importance of micronutrients.

The time period of decline corresponds to the use of cod liver oil for tuberculosis, followed by the identification of the fat-soluble vitamins, followed by clinical trials of cod liver oil against measles and other infectious diseases, in which cod liver oil imports to the US… twitter.com/i/web/status/1…

Here is measles.

So, maybe in impoverished countries the vaccines have saved lives that they did not save in the modern West.

I do not know if that is true, but if it is true, the experience of the West shows that vaccines were not needed to save those lives.

In short, it is clear that vaccines were not responsible for more than the most minor, if even that, contribution to the decline of infectious disease mortality in the West.

The claim that “vaccines have saved millions of lives” is misleading and untrue in the way it is typically invoked, and if there is any truth to it at all, it is highly contextual and not a general principle.

End thread.

Post-Script 1 of 2: The role of family planning.

In the following article, I cover Ostry and Frank's 2010 hypothesis that the decline of tuberculosis mortality among adolescents and young adults 1780-1870 was due to improved food availability, but that the decline in infant… twitter.com/i/web/status/1…

Post-Script 2 of 2: The role of cod liver oil.

In the following article, I argue that cod liver oil can explain both the decline in tuberculosis mortality in the 1800s as well as the declines in infant infectious disease mortality in the 1900s:

westonaprice.org/did-cod-liver-…