measles in africa, vaccination africa, measles

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. It was originally published on the REAL Australian Sceptics blog and bears repeating.

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

Africa, measles africa, vaccination africa
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-newsstories 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 causesare 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

Vaccine Autism cover-up?

A whistle-blower seems to have come out about The Center for Disease Control and Prevention (CDC) conducting scientific fraud and cover-up over the relationship between vaccines and autism. It states that risk factors for association between the MMR vaccineand autism are being under 3 years old, being a boy, and being of African descent.

MMR coverup

Will this report turn out to be true? If so I wonder why our health authorities in Australia haven’t been active in ensuring that the link hasn’t been ruled out? Time will tell.

News Epoch Times, Green Med Info, Natural News. Original research article link.

Marketing based medicine: how bad is it? – On Line Opinion – 7/7/2014

It should be the scandal of the century. It potentially affects the health of almost everyone. Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of Marketing Based Medicine, as psychiatrist Dr Peter Parry terms it, hasnt as yet generated the kind of universal outrage one might expect.

If you bought a new car and there was only a one in twelve chance that it would work properly, how would you feel? And what if there was a one in three chance that it was downright dangerous? Faced by these sorts of statistics, most consumers would be furious. And yet according to an articlein the ‘Journal of Law, Medicine and Ethics’, entitled ‘Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs’ this may well be the state of affairs with pharmaceutical products.. The “…..proportion of new products with clinical advantages seems to have moved from about 1 in 8 down to 1 in 12, while the proportion with serious harms has gone up from 1 in 5 towards 1 in 3 .…..”

Strangely a public outcry seems slow coming.

via Marketing based medicine: how bad is it? – On Line Opinion – 7/7/2014.

Another Doctor Testifies: ‘HPV Vaccine Does Not Protect Against Cancer’ | Truthstream Media

HPV Doesn't ProtectHPV is different from all other vaccines. It is not a vaccination against cervical cancer but against a virus that in some cases causes a premalignant condition, and in a small number of cases, a malignancy. In a year in Israel, there are 180 cases of cervical cancer, and half [of those with the disease] die of it. [This] is a rate of five per 100,000 residents – the lowest rate of cervical cancer in the world. One would have thus have to vaccinate 20,000 girls to prevent one case.” [emphasis added]

Another Doctor Testifies: ‘HPV Vaccine Does Not Protect Against Cancer’ | Truthstream Media.

UK Government Laments Tamiflu Secrets | The Scientist Magazine®

tamiflu fullNow let me get this straight…The UK Government spent more than $700 million purchasing and recommending Tamiflu to all of its citizens and now, they are complaining that the drug companies withheld information from them so they didn’t know about the safety or effectiveness of the drug prior to buying it. I don’t know about you, but if our governments spend our money on drugs and vaccines BEFORE knowing this information, they should be put in jail for stealing at the very least – gross negligence as well. This is why the AVN has been saying that governments need to do their own testing of all vaccines and drugs prior to licensure. It is the necessary due diligence and without that, we have a situation that we currently see where adverse reactions to drugs and vaccines is now close to the number one cause of death in just about every developed country in the world.

“Despite the UK government stockpiling £424 million ($694.3 million) worth of the antiviral medication Tamiflu, doctors and researchers are unable tp make informed decisions about its use because of a lack of public data on the drug’s safety and efficacy, according to the Public Accounts Committee of Parliament.

“Committee member Richard Bacon, who is a member of parliament, told the BBC: “The full results of clinical trials are being routinely and legally withheld from doctors and researchers by the manufacturers of medicines.” On top of that, the committee had “extreme concern” that positive trial results were more likely to be published than negative ones, Bacon said.”

Click the link below to read the full story.

UK Government Laments Tamiflu Secrets | The Scientist Magazine®.

BBC News – Lack of drug data ‘extreme concern’

Lack of evidenceThe lack of data on the effectiveness of medicines available to doctors and researchers is “of extreme concern” say a group of MPs.

The Public Accounts Committee is calling for all data on drugs being prescribed in the UK to be made available.

It also says the government spent £424m stockpiling the antiviral Tamiflu despite a lack of agreement on how effective the drug is.

Campaigners called for “urgent action”.

BBC News – Lack of drug data ‘extreme concern’.

Vaccines to prevent influenza in healthy adults | Cochrane Summaries

Flu ShotWhy are governments around the world still recommending influenza vaccinations across the board when the largest retrospective study of the vaccine found that:

“100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalised or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited..”

How many billions of dollars need to be wasted? How many innocent lives must be lost or ruined before governments decide that their health policies regarding this vaccine are not based on science?

Vaccines to prevent influenza in healthy adults | Cochrane Summaries.

Top 10 Retractions of 2013 | The Scientist Magazine®

17971851_sEvery year, hundreds of articles are retracted from peer-reviewed scientific journals due to fraud or error. Most of them don’t get the media attention that the Wakefield et al article from 1998 garnered (though that was not a fraudulent article. It was a fraudulent attempt by the General Medical Council in the UK to stifle the vaccination debate), but they really should. Because a significant percentage of all medical and scientific research will eventually be proven wrong – or fraudulent. Yet when this happens, it is rare for government to change their policies or doctors to change their practices. Just one more reason why the expression caveat emptor – or let the buyer beware – applies to medicine and science.

It’s been difficult to keep up with all of the retractions in the scientific literature this year, as it has been since we started our blog Retraction Watch in 2010. At the time of this writing, with a few weeks to go in 2013, there have been 511, according to Thomson Scientific’s Web of Knowledge. Here is our top 10 list for the year, in no particular order, based on the response of our readers and other “scientific” factors, such as whether we liked the story:

Top 10 Retractions of 2013 | The Scientist Magazine®.