Measles, Skepticism, Science, and Real Conservatism
In the ongoing debate among conservatives over vaccination programs -- in which case the measles are often used as a case study by both sides -- two distinct issues are getting muddled: (1) whether or not the government should have vaccination programs (either mandatory or optional); and (2) whether or not vaccination programs have been successful.
The first question is one of policy and ideology, and lies outside of the fundamental science. The answer is one of values and philosophy. Nothing more, nothing less. The latter question is indeed one of science, and the data is unequivocal on this front. Vaccination programs for measles have been successful.
Do we need better vaccines? Of course. We always have, and we always will. The movement to improve the safety and efficacy of all products -- be they in the field of public health or elsewhere -- will continue. That isn't the real issue at play.
A track record of success in the arena of measles vaccination programs would involve a reduction in the overall mortality and complications rates of the disease when compared to the likely counter-factual world of not having vaccination programs. As I have already shown on this subject, the data is clear. Look at the time trends for mortality and incidence rates of measles in the United States in the pre- and post-vaccine era from this previous article, and then try to rationally argue that the measles vaccination program wasn't a success. It is impossible.
Is the measles vaccination program perfect? By no means. But I have seen absolutely no credible evidence presented to date that the benefits of the measles vaccination program do not overwhelmingly outweigh any and all drawbacks from the program. None whatsoever.
In the 1950s and early 1960s, immediately before the implementation of measles vaccination programs, the number of measles cases ranged from 300,000 to 800,000 per year, with about 350 to 700 deaths annually from the disease and each year "48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness." These rates were approximately constant in the decade prior to vaccine implementation. Within a few years of the measles vaccine being rolled out, the number of measles deaths in the USA dropped to just 24. By the 1980s, the number of measles deaths was down into the low single digits. In 1993, 1994, 1998, 2002, 2004, 2006, and 2007, there were zero deaths from measles in the United States, with all other years since 1993 only having either one or two deaths. No deaths have been reported since 2005.
So in the 15 years before the measles vaccine was implemented, we saw no declining trend in the number of measles deaths, and in the 15 years after the measles vaccine the number of deaths was down more than 95 percent. Nope, nothing to see here. Everyone just move along and pretend the measles vaccination program wasn't a huge success.
Is measles making a comeback? In 2011, there were 212 cases in the United States, 189 in 2012, and the first half of 2014 has seen 514. As the CDC notes, "this is the highest number of cases since measles elimination was documented in the U.S. in 2000." And here is the following sentence by the CDC: "The majority of the people who got measles are unvaccinated." Oops. That's not convenient for the vaccine truthers, is it? Still, it appears there has not been a measles death in the United States since the single one in 2005.
This perfectly illustrates the success of the measles vaccination program, not its failure. From about 500 deaths per year in the pre-vaccine era of the 1950s and early 1960s down to not a single measles death reported over the last decade, even though the population size has doubled since the pre-vaccine era. From about 500,000 cases per year in the pre-vaccine era down to averaging less than 100 per year during the 2000s. Nothing to see here. Everyone just move along and pretend the measles vaccination program wasn't a huge success.
And then the anti-vaccination hysteria began. Commensurate with the choice by many to drop out of the vaccination program was a modest increase in the number of measles cases during the past few years. If you want cause-and-effect, there it is. Rather than prove the case against the measles vaccination program, it proves the case for it. Let's call that an inconvenient truth, especially when you consider that the measles vaccination program has been such a success over the past half-century that we are now very concerned over possibly having even one more measles death in the United States (whereby there used be many hundreds per year, with tens of thousands of hospitalizations and thousands of serious, permanent complications annually), and where we also now consider it a public health crisis that upwards of 1,000 people in the USA may contract the measles this year (versus half a million cases per year in the pre-vaccine era when the population size was half the current level).
Some vaccine skeptics cite fatality rates from measles over time as support for their skepticism. This is gibberish. Fatality rates from measles are calculated by taking the number of people who died from the measles and dividing it by the number of measles cases. In the decade-and-a-half before measles vaccinations, the measles fatality rate was about 0.1 percent, meaning that one out of every thousand individuals who contracted the disease died from it, and there was no decline in the fatality rate over this period.
You could argue the fatality rate for measles has actually increased after vaccination programs were implemented. Between 1998 and 2007, the fatality rate was 0.7 percent, or seven-fold higher than in the pre-vaccine era. Granted, in five of these ten years the fatality rate was zero -- a level never before seen in American history. But this higher fatality rate only means something if you are practicing pseudo-science.
The only statistic of relevance to the success or failure of vaccination programs is the mortality rate -- namely, the number of deaths from the measles divided by the total population. To show the absurdity of the fatality rate statistic being used against vaccination programs, consider the following hypothetical example. Imagine if in the pre-vaccine era, some disease led to 100,000 cases and 1,000 deaths per year in a population of 1,000,000 people. The fatality rate is 1 percent, and the mortality rate is 0.1 percent. Then a vaccine is developed and a mass vaccination program is implemented. In the post-vaccine era, there are now 100 cases and 10 deaths per year in the same population size of 1,000,000. The fatality rate is now 10 percent, isn't it? But the mortality rate is now down to 0.001 percent, a massive decline of two orders of magnitude.
Using the vaccine skeptics' reasoning, we'd look at these results and conclude the vaccination program was a failure because not only did the fatality rate not decline, it actually went up. What logical nonsense. Once again, if you want to assess the efficacy of a vaccination program -- which is primarily intended to prevent the acquisition of a disease -- you consider only mortality rates, not fatality rates. If conservatives cannot see the obvious reasons for this, then so be it.
Freedom of thought is a basic right. You can ignore math if you want, and some conservatives appear to be doing this.
Thus, the real damage to the conservative movement comes with those that equate skepticism over climate change hysteria to skepticism over the success of vaccination programs. All of us can readily go to the publicly available climate datasets from various local, state, national, and international organizations, download the data ourselves and analyze it using common statistical approaches, and come to the rational conclusion that there is a major disconnect between the alarmist predictions and recent trends. In a number of cases -- as I have repeatedly shown on this site and elsewhere -- the data analyses by the alarmists have been incorrect.
Compare this to the historical data on the measles. No matter which way I look at the data from an independent, objective position, I see absolutely no evidence to contradict claims by the health sciences establishment -- and especially the CDC -- that the measles vaccination program has been very successful. And I have seen absolutely no rigorous evidence by the vaccine truthers to contradict the establishment position. None whatsoever.
This is in stark contrast to the topic of climate alarmism, whereby the so-called "skeptics" have adduced a large body of knowledge that contradicts many of the alarmists' positions. So far. Time will be the final arbiter on the topic of anthropogenic climate change. Over time, the skeptics may be proven right, or the alarmists may be proven right, or the truth may lie somewhere in the middle. That is how science works.
Time has proven the supporters of measles vaccination programs correct. That is how science works.
Real conservatism is at a dangerous crossroads. Some science skepticism is healthy, other science skepticism is anti-intellectual nonsense. At present, skepticism over climate alarmism is healthy. Skepticism over the well-documented success of vaccination programs is not.
Some vaccine skeptics invoke the name of Ronald Reagan during their efforts. Indeed, let us look at what this great conservative had to say specifically on the topic of vaccination programs, and I provide the following quote directly from "The Public Papers of President Ronald W. Reagan" available online at the Ronald Reagan Presidential Library in Reagan's "Proclamation 5733 -- National Adult Immunization Awareness Week, 1987":
"By the President of the United States of America
We have good reason to set aside a week to remind ourselves of the benefits of adult immunization: The lives of many adults could be saved each year by inoculation with vaccines readily available and approved by the United States Food and Drug Administration. Vaccination against infectious diseases saves lives and lowers health care costs as well, as the Surgeon General has repeatedly reminded our Nation.
Many adults needlessly become victims of diseases that vaccination prevents. Influenza and pneumonia kill more than 70,000 adult Americans each year, in part because approximately 80 percent of people at high risk for influenza-related complications have not been vaccinated. Estimates are that more than 200,000 cases of hepatitis B occur in the United States every year, yet 70 percent of those who should be protected remain unimmunized. Between 10 and 15 percent of women of childbearing age -- more than 11 million women -- are unprotected against rubella. As many as seven million adults born after 1956 remain susceptible to measles, and the majority of Americans over 60 are not protected from tetanus and diphtheria.
In recognition of the importance of adult immunization and the benefits of public awareness, the Congress, by Senate Joint Resolution 168, has designated the week beginning October 25, 1987, as 'National Adult Immunization Awareness Week' and authorized and requested the President to issue a proclamation in observance of this occasion.
Now, Therefore, I, Ronald Reagan, President of the United States of America, do hereby proclaim the week beginning October 25, 1987, as National Adult Immunization Awareness Week. I call upon all government agencies and the people of the United States to observe this week with appropriate activities.
In Witness Whereof, I have hereunto set my hand this twenty-eighth day of October, in the year of our Lord nineteen hundred and eighty-seven, and of the Independence of the United States of America the two hundred and twelfth.
Reagan wasn't anti-science. He was skeptical of many government programs, but not all of them. He was skeptical of some clearly flawed and politicized science, but he did not reject science. Even in the mid-1980s, the evidence for the overwhelming net benefits of mass vaccination programs was clear. A quarter-century later, the evidence is even more undeniable.
Throwing out the science baby with the climate hysteria bathwater is irresponsible conservatism, and nicely illustrates why Reagan -- a clearly pro-science real conservative -- won the two largest back-to-back electoral majorities in American history, and why the conservative movement has floundered since the Gipper. The increasing infestation of anti-science nonsense among conservatives since Reagan left office is itself a disease that needs to be eliminated.