Over the last 40 years, much of my work has focused on women’s reproductive health and reducing maternal mortality worldwide. However, during that time I’ve followed with great interest public health developments, including those related to vaccination, in New York state and here in Columbia County, where I’ve lived in Gallatin since 1989. Viewed over time and from a global perspective, I believe there are some key points that are sometimes overlooked in the current discussion of COVID-19 and vaccines here.
The current debate over vaccines in this country and locally is influenced by many political and cultural factors. But one important perspective often seems to be missing from the debate: an historical one. Yet it is important to include history when we evaluate such questions as vaccine safety. All potent medicines have side effects. Many have serious side effects, even if rare. How do we judge the importance of side effects without considering the benefit of the medicine?
By 1980, the United States government was recommending vaccines for eight diseases: diphtheria, pertussis (whooping cough), tetanus, measles, mumps and rubella (German measles), polio and smallpox. (Roush SW et al. JAMA 2007) In the United States in 2005, we could have expected over 10,000 deaths from these eight diseases, based on mortality data from 1936-1945. Instead, there were just 31 deaths from these diseases in the whole country — more than a 99% reduction. How many people know that there were more than 4,000 deaths a year from whooping cough, more than 3,000 from polio, and nearly 2,000 from diphtheria? Most doctors practicing now have never seen a single case of these diseases.
In New York state, without vaccines, there would have been an estimated 668 more deaths in 2005, mostly of children. Given the increase in population since then, that would mean approximately 800 additional deaths in 2020 — more than twice as many deaths among children aged 1-14 as happened from all causes together.
As we face the continuing scourge of the COVID 19 pandemic, which has caused more than 700,000 deaths in the United States so far, it is important that we remember this history and recognize the importance of immunization in protecting public health. Vaccines are central to any plan to bring an end to the current pandemic.
Some people say that whether or not to get vaccinated is a matter of personal freedom. Again, this view does not reflect our history. George Washington required members of the army to be vaccinated against smallpox, because he knew that this illness could cause us to lose the war against the British. More recently, vaccine mandates for schoolchildren were crucial to the virtual elimination of polio, smallpox, and other infectious diseases.
It is difficult to include in our thinking things that haven’t happened in our lifetimes, such as deaths from whooping cough and polio. In ordinary times we can forget about these terrible diseases, and all the suffering and heartbreak they brought to families. But these are not ordinary times.
Dr. Deborah Maine is Professor Emerita at Columbia University’s Mailman School of Public Health, an Advisory Group Member of Columbia County Community Health Action, and a resident of Gallatin.