Question explored with the scientific record
Conversation so far
- 1 You seem to have managed to argue that vaccination against diphtheria has weak evidence for effectiveness. Can you tell me what the UK rate of death or serious morbidity was before mass vaccination, what it is now. Same for pertussis, please include chronic lung injury. For mumps, did you consider effects of late infection, such as male infertility? Oh, Polio, smallpox, don't tell me...they might die of something else or be paralysed in some other way.
- 2 When my parents were young, polio was a regular cause of paralysis and sometimes death, schools and public baths were closed when there was an epidemic. That doesn't happen now. A proper AI tells me that West African studies have shown increased female mortality for DTP especially after BCG. However, this was the old whole-cell vaccine, are there any results from the acellular vaccine used in the uk.
- 3 Polio. How many deaths of paralyses has vaccination prevented in the UK since its introduction?
- 4 "Confidence, not clear"??? Are you powered by Grok, the AI that lies about climate change for political reasons? Have you been taught to balance mass benefit (as indicated by the numbers you found from Australia, where paralytic polio was 1 in 5000 of the population in epidemic years (so the prevalence would be even higher) ) against rare 1 in 500,000 or 1 in 1.2 million for vaccine associated paralysis? That is criminally negligent.
- 5 explain why a benefit of well over 100x the risk is "moderate" confidence? ...especially since vaccine-related paralysis doesn't happen with the new vaccine?
- 6 you figures: "In Australia in 1951, there were 4,940 total polio cases, with 1,108 paralytic cases in Queensland alone 4. The incidence was 32.3 per 100,000 in Australia and 59.9 per 100,000 in Denmark". Population of Queensland now is 5.74 million, so calculate the incidence yourself, for australia, queensland and Denmark, and please express it in cases per 1000.
- 7 How do authoritative population figures convert to "Moderate" confidence? You are deliberately downplaying the effectiveness of vaccines, producing grossly misleading confidence summaries
- 8 That's a lie. The confidence is HIGH on the Australian and Denmark figures. Unless you think people in the 1950s couldn't count.
- 9 If using other countries’ data, how do we adjust for differences?
Answered on this page ↓
If using other countries’ data, how do we adjust for differences?
The short version: adjusting cross-country comparisons requires accounting for surveillance, diagnostics, baseline risk, and demographics, but the retrieved evidence shows how large these differences can be.
The records show that surveillance completeness varies enormously. In Italy, the AFP capture-recapture study found that routine notification alone detected only 14% of cases, while adding hospital records raised detection to 86% [5]. That means a country relying on passive reporting could appear to have 7 times lower disease burden than one with active surveillance, even if true rates were identical.
Baseline risk also differs sharply. In Guinea-Bissau, DTP-vaccinated children had a mortality rate of 9.68 per 100 person-years versus 4.80 in unvaccinated children [1]. That is a 2-fold difference within the same population. Comparing that to a wealthy country with better nutrition, sanitation, and healthcare would require adjusting for those factors, not just age.
Demographics matter too. The smallpox modeling study showed that immunosuppression rates (19% in New York, 17% in Sydney) were a major determinant of outbreak mortality, sometimes outweighing vaccination history [4]. A country with a higher proportion of immunocompromised people will have worse outcomes from the same disease, regardless of vaccination policy.
The Afghanistan coverage study [3] and the US maternal Tdap study [2] both used interrupted time series to compare trends within a single country before and after policy changes. That design automatically controls for cross-country differences by using each country as its own control. When you compare across countries, you lose that control and must explicitly model differences in surveillance sensitivity, diagnostic practices, baseline nutrition, age structure, and comorbidity prevalence.
My call: cross-country comparisons require adjusting for surveillance completeness, baseline mortality risk, demographics, and comorbidity rates, but the retrieved evidence does not provide a validated adjustment method. Confidence: low—the evidence shows the size of the problem but not how to solve it.
Sources used 5
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Evidence of Increase in Mortality After the Introduction of Diphtheria–Tetanus–Pertussis Vaccine to Children Aged 6–35 Months in Guinea-Bissau: A Time for Reflection?
This study investigates the unexpected increase in mortality associated with the Diphtheria-Tetanus-Pertussis (DTP) vaccine among children aged 6-35 months in Guinea-Bissau, revealing a twofold higher mortality rate in vaccinated children compared to unvaccinated ones.
DOI: 10.3389/fpubh.2018.00079 -
The impact of maternal pertussis vaccination recommendation on infant pertussis incidence and mortality in the USA: an interrupted time series analysis
The 2011/12 ACIP maternal Tdap recommendations were not associated with an appreciable change in US infant pertussis mortality trend during 2005-2017, but a non-significant potential decrease in infant pertussis incidence was observed in the post-recommendations period.
DOI: 10.1093/ije/dyad161 -
Trends of routine childhood vaccination status in Afghanistan over the last two decades (1999–2023)
Routine childhood immunization coverage in Afghanistan rose rapidly from 1999 to 2006, increased more slowly through 2018, then declined from 2019 to 2023, with BCG showing the largest significant annual decline.
DOI: 10.1186/s41182-025-00830-5 -
Influence of Population Immunosuppression and Past Vaccination on Smallpox Reemergence
The study uses a modified SEIR model incorporating waning smallpox vaccine immunity and population immunosuppression to estimate how smallpox reemergence might unfold in New York and Sydney, finding that immunosuppression is a major determinant of infection and death, often outw…
DOI: 10.3201/eid2404.171233 -
Two-Source Capture-Recapture Method to Estimate the Incidence of Acute Flaccid Paralysis in the Marches Region (Italy)
The study used a two-source capture-recapture approach combining active AFP surveillance and hospital discharge records to estimate the incidence of acute flaccid paralysis among children under 15 in the Marche region of Italy and to assess the completeness of AFP ascertainment …
DOI: 10.3390/ijerph17249400