AMA-Michael Gannon response Part 3-Measles in the Developing World

Today is the third and last post regarding the refusal of Dr Michael Gannon to sit on one of the Q & A Panels at the up-coming VaxXed QLD tour. To date, we have not received any responses from the other public servants invited to likewise answer questions from the public about vaccination. It appears that these individuals are quite happy to try and force everyone to vaccinate and to discriminate against those who choose not to, but when it comes to answering respectful and scientifically-based questions, they won’t participate.

Remember that the original letter from Dr Gannon via his Proxy, Simon Tatz is in black and the AVN’s response is in blue and italics. The exception is the very last section of this response which is an excerpt from Fooling Ourselves on the Fundamental Value of Vaccines – a highly-recommended book by Greg Beattie, former President of the AVN.

These were the 4 invited and again, we would like to ask if you would mind writing to them and sending a copy of your letter to avnenquiries@avn.org.au.

Mr Cameron Dick, Health Minister for QLD
Dr Michael Gannon, President of the Australian Medical Association (AMA)
Dr Bill Boyd, President of the QLD AMA
And Dr Jeannette Young, Chief Medical Officer of QLD

Part 1 of this blog can be found at this link and Part 2 will be accessed by clicking here.

It is important to recognise the qualifications working group responsible for the Australian Academy of Science booklet: Professor Tony Basten, Professor Francis Carbone, Professor Ian Frazer, Professor Patrick Holt, Dr Julie Leask, Professor Peter McIntyre, Professor Terry Nolan and Professor Judith Whitworth. Other experts who reviewed the material include: Professor Ian Gust, Sir Gus Nossal, Professor Fiona Stanley and Professor Robert Williamson. The material in the Science of Immunisation Q & A represents the most accredited expertise  and the AMA absolutely endorses the facts and science on immunisation.

These are appeals to authority and do not indicate that the material contained in this booklet is valid. Many of these experts you cite have strong and concerning financial ties to the same pharmaceutical companies that produce and profit from our burgeoning vaccination schedule.

In fact, a great deal of information in this publication is incorrect and needs to be addressed. Regardless of the source of the data, if it cannot stand up to public scrutiny and relies upon suppression or censorship to maintain its ascendency, it is not worthy of respect.

The world medical profession would stand to gain absolutely nothing from perpetrating the type of conspiracy or frauds that are suggested by some anti-vaxxers. They have far more to gain from pursuing evidence based treatments that prevent children from dying and young adults being confined to serious health problems for the rest of their lives. Doctors save lives, they don’t spend their life involved in worldwide conspiracies aimed at harming the people they care for.

Deaths from vaccine-preventable diseases belong in the history books.

In most cases, deaths from infectious diseases died out long before vaccines were introduced to prevent them.

The medical profession stands to lose a great deal of money and prestige if vaccines were allowed to be openly questioned. The vaccine market is estimated to nearly double in sales – from $32 billion in 2014 to $60 billion by 2020. [1]

Most families would never visit a GP were it not for regular vaccinations. Vaccines are, in fact, the bread and butter of most medical practices and this vested interest could possibly be one reason why the medical profession clings so tightly to its one-size-fits-all vaccination policy.

Most doctors are caring, intelligent, well-educated human beings – just as most parents are. Their relationship needs to be collaborative rather than that of master and servant. We have valid concerns and questions and these pat statements don’t do anything to advance the cause of mutual understanding.

I recommend that you read the World Health Organisation report on measles, which contains the following information:

  • Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
  • In 2015, there were 134 200 measles deaths globally – about 367 deaths every day or 15 deaths every hour.
  • Measles vaccination resulted in a 79% drop in measles deaths between 2000 and 2015 worldwide.
  • In 2015, about 85% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.
  • During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths making measles vaccine one of the best buys in public health.
  • Routine measles vaccinations for children, combined with mass immunization campaigns in countries with low routine coverage, are key public health strategies to reduce global measles deaths. While global measles deaths have decreased by 78 percent worldwide in recent years — from 562 400 deaths in 2000 to 122 000 in 2012 — measles is still common in many developing countries, particularly in parts of Africa and Asia. Indeed, more than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.
  • The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. WHO recommends immunization for all susceptible children and adults for whom measles vaccination is not contraindicated. Reaching all children with 2 doses of measles vaccine, either alone, or in a measles-rubella (MR) or measles-mumps-rubella (MMR) combination, should be the standard for all national immunization programmes.

 In answer to these paragraphs, I’d like to recommend that you and Dr Gannon read the following information which, as opposed to your data, is fully referenced:

This information and the graphs included are excerpted from Mr Greg Beattie’s book, Fooling Ourselves on the Fundamental Value of Vaccines.

Fooling Ourselves on the Fundamental Value of Vaccines (Excerpt)

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

Map of 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-news stories 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.

References

[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.

[14]  MMWR: 1999 / 48(49);1124-1130 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4849a3.htm

[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

[16]  UNICEF; http://www.childinfo.org/mortality.html

 

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2 comments on “AMA-Michael Gannon response Part 3-Measles in the Developing World
  1. Wendy Daniel says:

    Great work from Greg Beattie.
    I look forward to a considered response from Dr Gannon …….

    But I’m not holding my breath ..,

  2. Rixta Francis says:

    Science is not a democratic process. It’s not because the majority agrees on something that it’s true. Besides you can wonder if anyone really agrees that vaccinations are good, or that they just fool themselves and/or others for all kinds of other reasons.

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