Why Didn’t Everyone Die with Our 1980s Level of Vaccination Rates?

This is actually a real question that someone recently asked:

“Can someone please explain how we survived the 1980s with vaccination rates well below “herd immunity” thresholds and far fewer vaccines? Why didn’t everyone die?”

J.B. Handley

Mr. Handley even provides a nice chart to give his question some context.

So why didn’t everyone die?

That’s easy.

While vaccine-preventable diseases can be life-threatening, they certainly don’t kill everyone who gets them. They are not 100% fatal. Well, rabies usually is, but not surprisingly, rabies wasn’t on his little chart…

Deaths from Vaccine-Preventable Diseases, 1985

What else does Mr. Handley miss?

“Comparisons between rates obtained from immunization records versus the total sample (records and recall) conducted on data collected between 1979 and 1983 showed that the USIS, which accepted parental recall, underestimated the true vaccination rate in preschoolers by as much as 23% for some antigens.”

Simpson et al on Forty years and four surveys: How does our measuring measure up?

The vaccination rates he is citing were based on a phone survey that wasn’t thought to be very accurate, underestimating true vaccination rates. It was last used in 1985.

While vaccination rates weren’t great at the time, they just weren’t as horrible as he makes it seem, but we still had some deaths from vaccine-preventable diseases. Not as bad as the pre-vaccine era though, when hundreds of people died with measles each year.

Here’s the data from the CDC for 1985:

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/E/reported-cases.pdf

• 23 deaths from tetanus
• 4 deaths from pertussis
• 4 deaths from measles
• 1 death from rubella
• 2 cases of congenital rubella syndrome

Unfortunately, it got worse. This was just before the large measles outbreaks from 1989 to 1991, when 123 people died. During those three years, there were also 28 deaths from pertussis, 6 deaths from mumps, 13 deaths from rubella and 77 cases of congenital rubella syndrome!

But then we learned our lesson and we got kids vaccinated. But most of the problems then were about access to vaccines, not parents who intentionally skipped or delayed vaccines for their kids.

Deaths from non-Vaccine-Preventable Diseases, 1985

Many of the diseases on J.B. Handley’s chart weren’t yet vaccine-preventable in 1985. They were quite deadly though, which is why vaccines were being developed and were eventually added to the schedule to protect our kids from getting them.

But in 1985 (*or in the years before the vaccine was introduced), tragically, the CDC lists:

• 80 deaths from hepatitis A
• 490 deaths from hepatitis B
• 68 deaths from chicken pox
• 219 deaths from Hib meningitis in children and about another 45 deaths from Hib epiglotittis
• at least 200 deaths from pneumococcal disease in children*
• 257 deaths from meningococcal infections
• 20 to 60 deaths each year from rotavirus infections*

Want us to Turn Back the Clock and go back to an immunization plan (the Jenny McCarthy schedule) that didn’t include vaccines against any of these diseases? We would end up back to when kids still died of meningitis, pneumonia, blood infections, severe dehydration, epiglottitis,  Hib, pneumococcal disease, rotavirus, hepatitis A, chicken pox, meningococcal disease, and developed cancer from HPV and hepatitis B infections.

And the answer to Mr. Handley’s question becomes even more obvious.

How did we survive the 1980s with vaccination rates well below “herd immunity” thresholds and far fewer vaccines?

Many people didn’t.

What to Know About Deaths and Vaccination Rates

Poor vaccination rates and fewer vaccines led to more deaths from now vaccine preventable diseases in the mid-1980s.

More on Deaths and Vaccination Rates

• CDC – Vaccine Coverage Levels – United States, 1962-2009
• Study – Forty years and four surveys: How does our measuring measure up?
• CDC – Reported Cases and Deaths from Vaccine Preventable Diseases,
  United States, 1950-2013
• CDC – Summary of notifiable diseases in the United States, 1985
• Study – National trends in Haemophilus influenzae meningitis mortality and hospitalization among children, 1980 through 1991.
• Study – Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States
• Study – Pediatric Invasive Pneumococcal Disease in the United States in the Era of Pneumococcal Conjugate Vaccines
• CDC – Vaccine-Preventable Diseases, Immunizations, and MMWR — 1961–2011
• Survivorship bias
• The return of J. B. Handley
• What Happens When We Don’t Vaccinate?
• Pre-Vaccine Declines in Measles Mortality