Vaccines and Third World Countries

by Hilary Butler

2007

PART 1

“Well Hilary”, said the voice at the end of the phone, “that is such an outstanding achievement, you can’t argue with that, surely?!” 

This person had just read out figures from an article[1] which stated that vaccination had slashed the death rate from measles 91% since 2000, and that death rates worldwide had fallen from an “estimated” 757,000 to 242,000 (68%) in 6 years.  That quote came from the “Measles Initiative”.  So does this[2] quote: 

Why children die of measles
Measles is a leading killer of children in many developing countries for several reasons. Children are already compromised with poor living conditions, they are infected at very young ages when their immune systems are not strong, malnutrition is rampant in many homes, and many families do not have access to medical care to treat measles and its complications. Measles, itself, does not kill children. Instead, complications from measles attack the child’s already weak immune system. Measles attacks the body, inside and out. It is similar to HIV in the sense that when it knocks down the immune system, the child becomes susceptible to the myriad of diseases that fester in poor living conditions.

 The CDC Director in USA, Dr Julie Gerberding was quoted as saying, "The clear message from this achievement is that the strategy works."

I agree.  It has worked.  The measles vaccine works.  Or … was it … “just” the measles vaccine?

It comes as no surprise that this was given international exposure at a time when many people world wide are questioning vaccination, and when people like Dr Julie Gerberding are trying to rope dissidents in with “sound-bite” messages, which focus tightly on vaccines and little else.

The first question that needs to be asked is whether or not this news item is the whole truth.  Not just a “bit” of the truth, but the whole truth.

To understand the real picture surrounding the third world, vaccines and other relevant factors, there’s a lot of other things which need to be taken into account, not the “full stop” at the end of the chapter.

First, the article.  It’s a very lousy piece of journalism, even on the surface, since on the one hand we are told that world wide, measles deaths were reduced now to 10 million a year, and on the other hand, we are told that in India last year 178,000 million people died of measles.  I was a little surprised that India had a population of 178,000 million people, let alone an annual measles total that astonishing.  Perhaps the 178,000 million insertion was caused by blindness while typing up a rush job. 

If the journalist concerned was so slack about basic fact-checking such as this, what else might be a mistake in this article?  What has she failed to check out?  Has she just done a quick slam dunk job, faithfully repeating enticing sound bites from a bundle of press-releases? Has she looked at anything else, other than the agenda WHO, and CDC in USA want her to take from the papers they dumped on her desk?

Bit-piece reportage like this never tells the whole story.  The first question to ask is how did this 92 percent drop occur?  Just a vaccine?

Back in 2,000, measles cases in Africa were “estimated”.  As in, “we think” there are about…. So in 2000 the WHO implemented a system of laboratories[3] specifically to properly diagnose measles.  Yes, you heard that right. 

Africa is a country which doesn’t have enough power to light one roomed medical centres at night, so mother’s babies[4] die in childbirth.  And sometimes mothers die too.

Africa is a country where if you have malnutrition and have a serious bacterial infection, chances are you won’t have access to antibiotics, so you will die. 

Africa is a country where women don’t have access to pap smears, so they are far more likely to get, and die from, cervical cancer than anyone in the developed world.  At least, so the argument goes as to why they need the new Gardasil vaccine. 

Africa is a country where to get a glass of clean water, if you are poor, is nigh on impossible[5] and where  “child death rate something like seven times the Kenyan average because of water-related infectious disease - mostly diarrhea”  is the result.

Africa is a country where if you are poor, and you want to find decent food, you will be struggling. 

Africa is a place where many people can’t afford shoes, and the injuries to feet[6] is a major, untalked-about cause of death.

Africa is that place where ethnic cleansing goes on, and the western world is powerless to do anything.

Africa is that place where Mugabe lives; a man content to starve his people to death, not realizing that in the eyes of the world he’s rapidly becoming a tame version of Idi Amin.

Do you want me to continue with all the possible “Africa is…” statements of fact?

Yet, if we believe this WHO document here,[7] a network of laboratories was set up where all measles cases were tested to make sure they are measles.  This data is now where WHO gets its figures from. 

Confirmed cases by blood tests is a far cry from the 2000 crystal ball gazing that went on seven years ago. 

I’d like to know if every measles case in Africa in all countries gets seen, and blood tested?  What sort of a mammoth exercise would that be?  WHO complains that one-day vaccine programmes are a major strain on logistics, money and energy[8], so what about day in, day out taking of blood samples and analysing the results? 

Do these people trudge through all the back blocks of nowhere?  In a country where basic health services are sporadically inefficient at best, how are we supposed to believe that “every single measles case” is both found, and blood tested?  Where do the workers and massive dollars come from to fund this network of laboratories?  How is it that “this” can be done, yet other very basic medical services from a potential list a mile long, like rehydration for diarrhoea or zinc supplements to help stem diarrhoea, can’t be set up?

I cannot imagine that the many variables that make Africa what it is would allow for the funding and testing of even 20% of measles cases, let alone 100%.  It defies commonsense and logic.  But if it is happening, and the expense of basic health care, that’s a crime. If this is truly accurate, then, is this “new and improved” method of data collation the reason why measles figures have dropped? Maybe they don’t “find” very many, but instead of guessing, the labs word is the last word?

On 17 April, 1997, I received from England, a small news item which has no date or publication on it, but it’s so impressive, it’s worth quoting in full. 

London (Europe Today). – “97.5% of the times that British doctors diagnose measles they are wrong”, says a publication of the Public Health Laboratory service.  The mistake being made by National health GP’s was found when the services tested the saliva of more than 12,000 children who had been diagnosed as having measles.  Roger Buttery, an adviser on transmissible diseases at the Cambridge and Huntingdon Health Department, said that the majority of doctors “say they can recognise measles a mile off, but we now know that this illness occurs only in 2.5% of the cases.”  Butter says that doctors classify as measles, many other viruses that also cause spots.  He found eight different viruses during the survey in East Anglia.  One of them, parvovirus, gives symptoms similar to German measles.  The reason for the high rate of error puzzled Buttery. “Doctors are neither vague nor careless,” he said.  The solution is to defer the diagnosis until more detailed information can be got.  There are 5,000 to 6,000 cases of measles registered each year in the United Kingdom, but these findings now call most of them into doubt.”

 A quick search on internet revealed a later report by the same laboratory showing that the most common viruses causing “morbilliform rash” in the UK [9]are “parvovirus B19; group A streptococcus; human herpesvirus type 6; enterovirus; adenovirus, and group C streptococcus.”

So tell me.  Did African medical workers before the year 2000 have some special way to know the difference between the viruses above, (and possibly others they have, that England doesn’t), and measles?

Another thing.  Does this mean that all historical data for England and other western countries, and Africa, are guestimates based on an unknown mix of a minimum of seven viruses, of which one might be measles?

How might this fact alone affect the accuracy of the WHO report above?

Earlier this year, Georgina Newman, the New Zealand representative of Unicef, wrote a somewhat randomly thought-out newspaper piece[10] on measles in Africa.  Parts of it raise interesting questions.  She said: 

"Just two doses of an inexpensive, safe, and available measles vaccine can prevent most, if not all, measles deaths."

Just as an aside here.  If you wanted your child to have a single measles vaccine, you would be told it was NOT[11] safe, it was very expensive and to use the MMR instead. So the single measles vaccine is safe for malnourished African children, but not safe for Western children.  Smells fishy to me.

Let us progress further down Georgina Newman’s literary vein.  We are told that : 

“Survivors are often left with lifelong disabilities including blindness and brain damage.”

One of the world’s most provaccine doctors, Dr Hinman wrote this[12] for Healthline: “more effective use of measles vaccine and administration of Vitamin A could prevent most of the deaths from measles.”

What’s this about vitamin A, you ask?

In 1997, an ophthalmologist wrote[13] an editorial in the British Medical Journal in which he pointed out that vitamin A deficiency was a major cause of morbidity and mortality, and “the single most important cause of blindness in children in developing countries, and it is entirely preventable.”

At the same time, one of the world’s experts[14] of vitamin A in measles reported that in Africa, four trials of vitamin A in children admitted to hospital with severe measles, had reduced dramatically all clinical responses with mortality dropping by 50%.  He stated that the drop was because vitamin A corrected an underlying vitamin A deficiency by up-regulating the immune system. This finding was replicated by another study, and reported[15] in a New Zealand Medical Journal:  

“Serum retinol levels were subnormal in 92 per cent.  Mortality and morbidity were significantly reduced among vitamin A recipients.  12 children died, 10 of whom were randomized to placebo.  Pneumonia which was responsible for 10 of the 12 deaths lasted twice as long in the placebo group and diarrhea one-third longer.  Duration of hospitalization was decreased by one-third in vitamin A recipients.  An adverse outcome such as prolonged pneumonia or diarrhoea, was half as likely to occur in the vitamin A treated group.”

By 1999, WHO was ready to act, and we look at this 2001 WHO report[16] where we see that: “In 1999, adding vitamin A supplementation to polio national immunization days is estimated to have saved 242,000 lives.”

Not that this finding is anything new.  In 1982, a doctor in Tanzania, who was looking at blindness in children, pointed out[17] that “The clinical picture in malnourished measles patients is very typical and entirely similar to that of diseases children suffering from severe vitamin A deficiency, i.e. xerophthalmia”.  i.e. blindness.  He pointed out that, “well nourished children, however, only rarely develop complicated measles and they do not have bad corneal lesions.”  They took 59 children who had blindness as a “result of measles” and put them on 100,000 units of vitamin A every day, for a week.  The eye lesions started to dissipate, and by two weeks, all 59 children, with or without corneal scars, had healed. 

So tell me.  What causes the blindness?  The measles, or a fundamental vitamin A malnutrition?

The answer is pretty simple, because ANY person who is vitamin A deficient is going to have major problems with any infectious diseases, because the immune system requires vitamin A to work properly, as well as other vital nutrients vitamin A deficient people also won't have..

And why was it that Georgina said that survivors of measles were left blind?  Isn’t that a totally unnecessary outcome?  Or was it emotional blackmail?

To give you an idea how long it takes for doctors to get the Vitamin A message, the very first medical article I found about measles being treated effectively with Vitamin A is:

 Ellison JB., “Intensive vitamin therapy in measles.” BMJ 1932;2: 708 – 711. 

Lest you think this is only a developed world issue, it is not. 

Studies in America[18],[19], and New Zealand [20] have found children who have measles often have third world micronutrient levels, and the recommendations in both countries since 2001 have been that all children with measles be given vitamin A.

 So I ask you two questions:  Why, 75 years later, is Gerberding only wanting you to know that the measles vaccine works to reduce deaths? 

Don’t you wonder what might have been, for Africa and the developed world as well, had doctors taken their heads out of the sand and administered vitamin A from 1932 onwards?

Ah, but the catch with that was they wouldn’t have had all those deaths and complications from pre-1996, to wave in front of your nose and say,[21] in a nutshell, you need the vaccine because there is NOTHING we can do to help you if your child gets measles.  The messages that “you need the vaccine” and “there is nothing we can do for you” were both lies. For whatever reason, the medical profession chose to ignore decades of literature on vitamin A. 

But let us return to Georgina Newman[22] again, who says, “In cramped, insanitary places like refugee camps, measles can kill a child in less than five hours….poor immunization systems in developing countries are the main reason for high numbers of deaths from measles.” 

Now we are starting to see more of the picture.  Cramped unsanitary places….

She also relates a story of a Bangladeshi mother, who when her child got measles the doctor prescribed paracetamol, which reduced the fever and rash, and then a few days later the child died.

Georgina says this tragedy should never had happened had Hossain been vaccinated. 

The real tragedy is that paracetamol should never have been prescribed, and vitamin A should have been given for a week.  But I will deal with paracetamol in another chapter.

The blame for the problem, must always be that people don’t use vaccines.  The praise for the solution in death reduction must always go to vaccine.

The common sense, simple things may be given a little sentence tucked somewhere at the end, almost like an irrelevant afterthought.  You need to ask yourself why this is always the way it is.

But there is something else that needs to be considered in all this, and it’s something no-one ever talks about.  Because … it’s pretty scary.

Part 2.

“Dr Anyon.  Hmm… I don’t know him,” I mused, 19 years ago, as I read a Newspaper article.[1]  This doctor had some pretty interesting things to say.  He wrote about vaccination in third world countries, and how these vaccines would save 11 million children every year.  But the wording alerted me to the fact that something different was going to come;

“It sounds a very desirable objective. And one of which humankind should be proud, if achieved.”

He talked about our medical services and how we tidied up coronary arteries and how much we took for granted, but then he changed tack again;

“It makes you wonder about the future of the 11 million children “saved” each year around this world.  What are we letting them in for with our efforts?  Will the so-called benefits of Western civilization (for that’s how we judge it all) really turn out to be benefits in the long run?

These simple questions are troubling indeed… let’s remember that while the immediate objectives are sometimes fine, the long-term results may be somewhat different.

No, I’m not advocating non-immunization.  Just wondering about what kind of a life we will provide for these children.  Presumably, it will be immediately better than the current or immediately anticipated one, but it may yet turn out to be a poor legacy from us to them.  The 20th century can and will bequeath all sorts of things to the 21st century.  Giving these children the chance to survive in our world may not, at the risk of being unduly morbid, turn out to be the big bonus we would like.”

Depressing words indeed.  But it opened a channel in my mind, and from that day on, I became an ardent gatherer of information on Africa, and as I processed it all, wondered just what the results might be. 

Then, when Professor Horrobin’s book, “Science is God” was in the library toss-out bin, I grabbed it and was instantly riveted.  He was a doctor from Nairobi, so it was inevitable that he would have something to say about Africa, and so he did.[2]   I don’t agree with all of it, but the whole context is a very good analysis of the situation when he wrote it:

It is arguable that medical research is the most destructive and least controllable weapon ever let loose upon mankind.  Before modern medicine and public health arrived on the scene, most societies had achieved some form of equilibrium.  Birth rates and death rates balanced out, each man could know that his skills would not be rendered redundant by rapid change, and there were no threats other than those of war and disease to which man had become adapted over thousands of years.  I am not suggesting that in those societies the lot of the individual was idyllic.  Especially in terms of personal comfort, it quite obviously was not.  But there was a stability, a sense of being part of the cycle of life, which hardly exists today except in isolated rural communities.  Too, because of the relatively high death rate, young men in any field had a reasonable chance of achieving real responsibility at an early age without waiting over long for the shoes of the departed.  They were thus less likely to become frustrated and disillusioned.  And then came modern medicine and public health.  The death rate fell precipitously and the population rose correspondingly. In Europe, although the condition of the industrial poor was miserable, the population explosion did not lead to disaster.  Agriculture advanced with medicine and managed to keep pace with the food needs of the people.  Industry was at a state when mechanization was primitive and enormous numbers of people were required to man the great new factories.  Those not absorbed in this way could always emigrate to the new developments of America, of South Africa, or of Australia.  Our ability to feed and to employ people was therefore not hopelessly outstripped by the falling death rate. We seem to think that this can happen again in Africa, in Asia and in South America.  But we are living in a fool’s paradise.  We have reaped all the advantages of modern medicine and have escaped most of the disadvantages.  But we may be handing on to less fortunate peoples a terrible legacy, a true kiss of death.

Medicine, for the underdeveloped countries is relatively cheap.  It is also emotionally attractive and draws many dedicated souls and large sums of conscience money.  The establishment of industries to give employment, and of advanced agricultural methods to supply food are not so emotionally attractive and draw much less support.  Even those industries which are developed tend to be highly mechanized and to employ relatively few well-paid individuals.  The masses of young people now growing up, given life by our medical aid, have no work to do and no food to eat.  They are too numerous to be accommodated within the framework of traditional society, and that society has been shattered.  Especially dangerous is the massive unemployment amongst the relatively educated who gaze with hungry eyes on the fortunate few who receive what are comparatively enormous salaries.  No wonder that the men with power and influence feel that they must hang on whatever the cost or they will go to the wall.  Unless we do something about the balance between medicines, on the one hand, and agriculture and technology on the other, the situation will become impossible to control.  The next hundred years will then see starvation, inhumanity and war on a scale which dwarfs anything that has happened before.  Is that what the believers in medical research want?  Is it not conceivable that had they not opened Pandora’s box, the state of the world might have been better in fifty year’s time, than it is going to be?  I do not know, but the matter is at least arguable.

“Unfortunately the experience of those who have tried to keep agriculture and technology advancing at the same rate as medicine has not been happy.  In theory it is the right answer, but in practice it does not seem to work.  This is mainly because the medical measures required to bring about a dramatic reduction in the death rate are simple and cheap.  In contrast, the development of advanced agriculture and technology is complex and expensive and requires highly trained people.  In any case, even if agriculture and technology do advance, there must be a theoretical upper limit to the amount of food that can be produced on this planet.  In contrast, short of starvation or war, there seems no reason why the population should not go on expanding indefinitely.  Research into industrial food production can only postpone the disaster, it cannot prevent it happening.  This means that the only real hope is for medicine to devote itself as energetically to restricting birth as it has in the past to defying death.  Only in this way can a reasonable, permanent population balance be achieved.”

Horrobin neglects to comment on political and ethnic instability, but then, when he wrote that there was at least a veneer of civility about existence in Africa.

What do the African people think today?  How do they feel about the Western version of “help”?  It turns out that Professor Horrobin was partly right.  Year after year, I have cut out a huge collection of articles from aid agencies with headings like “10.5m young children dying from preventable illnesses[3].”  With comments from the Western world like “How much longer will impoverished parents have to bury the children they love?” and Norwegian Prime Minister recognizing the injustice that “all Norwegian infants are immunized, but very few children are in parts of Asia and Africa.” Which appear to imply that vaccines will fix everything.

I thought of Horrobin’s predictions as I read this woman’s words to UK Independent reporter, Cahal Milmo[4]: 

“Ms Dima said: "The aid came too late for us. We were provided with livestock feed. But there were no animals to give it to. They were already dead. Yes, we have survived. But because we have lost our source of income, we can no longer send our children to school. It has been a terrible time. We must make a living from small things, firewood, wild crops. We have lost people and animals. We are proud; we have no wish to live off others. But now we are a marginalized people. Perhaps it is better for the men who have gone."

She, and others, described to him terrible governmental decisions which were leading to fierce armed clashes between the tribes. Overseas observers said this was Addis Ababa, using the situation to try to divide and rule, and take over tribal areas. The tribes of around 10 million people, have been the focus of either persecution or being ignored for a long time, because the governments want to stop them using both land and water. Milmo wrote how people viewed life, after the western aid agencies had left and the people had to try to sort it out themselves:

Jamdesa Mole said: "Why should we believe anything the outside world tells us? Without cows you cannot have meat or milk, you cannot get married or have children. You cannot even plough a field. We have lost our birthright."

As to the aid agencies.  What did they have to say to Milmo?”

One senior executive of an international agency based in the Ethiopian capital, Addis Ababa, said: "We know what we want to do, we know how we can do it but there is a wrong-headed bureaucracy in international aid that stops things being done in a timely fashion to prevent disasters like the drought."

Care UK, Living on the Edge, did a study which found that 120 million people in sub-Saharan Africa, needlessly face a permanent state of humanitarian emergency. Their study found:

 "the international community's response too often centres around food aid [and] generally speaking the response to emergencies is too late, too brief, inappropriate and inadequate".

As Horrobin would have said, “they have got the cart before the horse.”

What are the answers to this?  I think that just as in the UK in the 1800s, when the rich had to cough up to provide sanitation and clean water for all, the same applies now.  But how?  It has to be done the right way in each country.  People like Mohammed Yunus[5], who received the 2006 Nobel Peace prize has the right idea for his area.  As Justin Huggler from the UK Independent tells it:

In 1976, he started by lending the cash he had in his pocket, the equivalent of £14, to a group of 42 women in a Bangladeshi village. That worked out at 34p each. With the money, they bought the materials to start a business, some making chairs, others pots. They paid him back in full.

Today, Dr Yunus' Grameen Bank has lent more than £2.9bn. His methods have been copied in more than 50 countries, and similar loans are believed to have reached more than 100 million of the poorest people worldwide. The rate of loans which are paid back to the Grameen Bank is a staggering 98.45 per cent - a recovery rate most commercial banks would love to be able to emulate. And this is in a bank that is 94 per cent owned by its borrowers, is still run on an entirely philanthropic basis, but is completely self-funding.

The rest of the article deserves to be read as well.  Mohammed Yunus exemplifies philanthropy and working at grass roots at its best. 

Philanthropy at its worst, is guilt money throwing billions of dollars into the pockets of western health corporations and vaccine manufacturer’s pockets, under the illusions that vaccines will solve the deaths.  Vaccine and drug solutions alone, leave the basic problems which cause ill-health in the first place, on the fringes, while inflating multi billionaire’s share portfolios containing the companies the money was donated to, so that even more can be thrown at the wrong side of the equation.

Add into the mix, “climate change”.  In the article[6] called 'The Most Effective Vaccine against Child Death in Africa is a Glass of Clean Water', Kevin Watkins talked about what would happen if climate change hits Africa as predicted.  People will have less water, hotter temperatures, more evaporation and a 25% further reduction in income.

Apart from any solutions for Africa, in Africa, if the western world is to help sort out Africa’s problems, the biggest need is to sort out our own communities, get our priorities right, and work out how we are going to live to give the best legacy to future generations, if there are to be any.  We have a huge battle on our hands if this is to happen, and you can guarantee that neither corporations, or governments will like the answers one little bit.

When people focus on which parts of the medical profession have opened a “Pandora’s Box”, and the consequences of those on the whole world, not just the unintended legacy for Africa and other countries like them, rather than quick-fix sound-bites from WHO, and Bill Gates, then some real answers for everyone might percolate out of the mud.