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The Darkish Days Earlier than Vaccines

Medically reviewed by Barbara Dehn, RN, MS, NP, FAANP, NCMP

Emmi Herman was only five years old when her older sister was hospitalized with measles encephalitis, a rare condition that causes the brain to swell. It was 1960 and the vaccine that could have prevented her 9-year-old sister from getting sick was three years away.

After five weeks in the hospital, barely escaping death, Herman’s sister came home – but she wasn’t the same. The measles virus injured her brain and caused permanent damage. Herman’s sister has struggled with the effects of this damage her entire life.

When a Disneyland measles outbreak was linked to vaccine denial in 2014-2015, Herman felt compelled to share her sister’s story. “I just couldn’t believe that people, especially parents and privileged caregivers, chose not to vaccinate,” Herman told HealthyWomen. She wants people on the fence about vaccinations to understand the serious threat that preventable diseases like measles pose to our health.

Herman’s story is important because it gives face to something that often feels abstract. Just as it is hard to fathom the world before antibiotics were invented, it can also be difficult to imagine what life was like before vaccinations when a simple cut could kill you. Diseases effectively eradicated in the United States were nightmares.

So much disease: life before vaccines

Before the measles vaccine was developed in 1963, major epidemics of the disease occurred every two or three years. Every year, more than 2.6 million people died from measles until vaccination against the disease spread.

Another disease that we are vaccinating against is polio, which mostly affects children under five. It can lead to paralysis within a few hours and leads to death in 5 to 10% of the paralyzed. In the early 1950s, polio caused over 15,000 cases of paralysis each year. After the introduction of polio vaccines in 1955 and 1963, the number of cases fell rapidly. The United States has been polio-free since 1979 and the disease is nearly eradicated worldwide.

Even vaccines that only reduce the severity of a given disease, rather than prevent it, have huge public health implications. Before the flu vaccine became widely available in 1945, pandemic influenza was a common, fatal event. One of them, the 1918 flu pandemic, caused over 20 million deaths worldwide between 1918 and 1919.

In the 2018-2019 season alone, the flu vaccine prevented approximately 4.4 million influenza cases, 2.3 million influenza-associated doctor visits, 58,000 influenza-associated hospitalizations, and 3,500 influenza-associated deaths.

Community immunity

As the world waits for a vaccine against COVID-19, the vaccination debate continues to heat up. Despite extensive evidence that vaccines are safe and save lives, more and more people are choosing not to get themselves or their children vaccinated. The number of parents who refuse to vaccinate their children entering kindergarten has increased every year for the past three years.

Although some say the decision not to vaccinate is a personal choice, vaccination rates actually affect the entire population. This is due to herd immunity. Herd immunity, also known as community immunity, is achieved when a disease cannot spread from person to person, as a high percentage of people in the community are immune to the disease either from vaccinations or from previous infection.

An integral part of herd immunity is the protection it provides to vulnerable members of the community, such as those who cannot be vaccinated because of their age or health. So vaccination protects those who cannot.

Falling vaccination rates, devastating consequences

If vaccination rates fall below what is necessary to maintain herd immunity, the consequences can be devastating. In the United States, 1,249 cases of measles were reported between January 1 and October 1, 2019 – a disease declared eradicated in the United States in 2000. Of these reported cases, 89% were in patients who were not vaccinated or had an unknown vaccination status. Around 10% of measles patients had to be hospitalized.

The 2019 measles outbreak began with import, in which an unvaccinated person visits an area with a high disease rate, becomes infected and brings the disease back to their home area. If the infected person returns to an area with high vaccination rates, the disease can be easily contained.

However, in close communities with a high percentage of unvaccinated people, the virus spreads quickly. “It’s like wildfire,” said Barbara Dehn, a nurse and member of HealthyWomen’s Women’s Health Advisory Board.

This is especially devastating to the most vulnerable members of this community. “The people who are immunocompromised, the children who are receiving chemotherapy – these people are at high risk,” Dehn said.

Recognition of our vulnerability

We are fortunate to live in a time when scientists have found a way to cure or prevent so many dangerous diseases. But vaccines can only work when we get them, and the recent measles resurgence is a stark reminder that diseases believed to be eradicated can return.

Dehn, who is a volunteer in sub-Saharan Africa, has watched the devastating effects of preventable diseases, including three cases of tetanus-related tetanus. “In sub-Saharan Africa, mothers and babies stand in line for hours to get their children vaccinated because they saw children die from these preventable diseases,” she said. “It’s very, very real to her.”

While most of us will never experience the horrors of tetanus, Dehn sees the COVID-19 pandemic as a reminder of how susceptible we are to disease. “We are all vulnerable to these invisible microbes that can harm us. We forget – we live in a plastic-wrapped world so we don’t think this is a real threat to us,” she said.

“Then COVID-19 comes and reminds us that we are still fragile people and that we must take good care of our bodies and do our best to protect ourselves and our families.”

Vaccines are one of the best ways to do this.

This resource was created with the assistance of Merck & Pfizer.

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