Marco Cáceres di Iorio

Was the Measles Vaccine the Sole Cause of the Decline in Measles?

The Centers for Disease Control and Prevention (CDC) states that, prior to the introduction of the first measles vaccine in the United States in 1963, it had been receiving nearly 500,000 reported cases of measles each year.1 2 3 4 That number is correct if you average the total number of measles cases reported during 1958-1962. The average comes to 503,282 cases annually.4 5 6

The picture looks a lot different, however, if you delete from the equation the year 1958. If you take the measles cases reported during 1959-1962, the annual average comes out to 438,3285 6—or almost 20,000 less than the measles cases reported to the CDC the year after the measles vaccine was introduced in the U.S. The CDC received 406,162 reported cases of measles in 1959; 441,703 in 1960; 423,919 in 1961; and 481,530 in 1962.5 6 It received 385,156 reported cases of measles in 1963 and 458,083 in 1964. This is worth noting because it is often pointed out that after the measles vaccine was introduced the incidence of measles plummeted.

According to a 1992 paper written by Jacqueline Gindler, William Atkinson and Lauri Markowitz in the journal Epidemiologic Reviews:

Following the introduction and widespread use of measles vaccines, measles incidence declined dramatically.4

The impression given here is that the decline was sharp and immediate. Not quite. The dramatic decline in the number of report measles cases occurred in 1965 when they dropped to 261,904, followed by 204, 136 in 1966; 62,705 in 1967; 22, 231 in 1968; and 25,826 in 1969.

“By 1978, the number of reported cases had decreased by almost 95 percent compared with the prevaccine era,” wrote Gindler, Atkinson and Markowitz.4

There is no question that represents a marked decline in reported cases of measles in the U.S. during that period. It is interesting, though, that the declines correlate with other declines occurring in the U.S. population at that time, including a significant decline in birth rates during 1965-1969. For the first time since the end of World War II in 1945, there were less than 20 live births per 1,000 people in the U.S. The birth period for the so-called “Baby Boomer” generation had come to an end. There were many less people being born beginning in 1965 than in each of the previous 20 years.7 8

In 1965, there were a total of 3,760,358 live births in the U.S., compared to 4,027,490 in 1964. That’s 267,132 less American babies. If you compare 1965 to 1957, when the Baby Boomer birth rate hit its peak at 25.3 live births per 1,000 (for a total of 4,308,000 live births), the difference is 547,642 less American babies. That peak birth rate in 1957 may have had something to do with the 763,094 reported cases of measles in 19585 6 7—the peak annual number for the disease in the 1950s.

Live births in the U.S. steadily declined after 1957 to 24.5 per 1,000 in 1958; 24.3 in 1959; 23.7 in 1960; 23.3 in 1961; 22.4 in 1962; 21.7 in 1963; 21.0 in 1964 and 19.4 in 1965. The rates kept dropping throughout the rest of the 1960s and the 1970s when they leveled off at 14.8 in both 1975 and 1976, and they have remained under 17 ever since—mostly under 16.

Is it possible that significant and consistent declines in U.S. birth rates after 1957 were at least a co-factor in the significant and consistent declines in reported measles cases beginning in 1965? Is it possible that there may have been other factors, such as declines in childhood malnutrition as a result of improved government-sponsored nutrition programs for children that helped boost their immunity to infectious diseases and other illnesses?

According to a study by Peter Katona and Judit Katona-Apte in the journal Clinical Infectious Diseases:

Malnutrition is the primary cause of immunodeficiency worldwide, with infants, children, adolescents, and the elderly most affected. There is a strong relationship between malnutrition and infection and infant mortality, because poor nutrition leaves children underweight, weakened, and vulnerable to infections, primarily because of epithelial integrity and inflammation.9

Is it possible that the passage of the Child Nutrition Act (CNA) in 1966 as part of President Lyndon Johnson’s “Great Society” initiative to fight hunger, malnutrition and poverty in the U.S. may have also contributed to the declines in reported measles cases?10 11 Perhaps significantly?

The CNA expanded the U.S. government’s school food aid program.  It “authorized a new pilot breakfast program and a new nonfood assistance program (food preparation and storage equipment) for schools in poor areas” and kept the school lunch and milk subsidy programs that had already been in place since 1946 and 1954 respectively but redirected them toward schools, representing some 9 million children, that had not been able to participate in them because they lacked space for lunchrooms and money to buy equipment for food preparation and storage.12

The stated purpose of the CNA was as follows:

In recognition of the demonstrated relationship between food and good nutrition and the capacity of children to develop and learn, based on the years of cumulative successful experience under the National School Lunch Program with its significant contributions in the field of applied nutrition research, it is hereby declared to be the policy of Congress that these efforts shall be extended, expanded, and strengthened under the authority of the Secretary of Agriculture as a measure to safeguard the health and well-being of the Nation’s children, and to encourage the domestic consumption of agricultural and other foods, by assisting States, through grants-in-aid and other means, to meet more effectively the nutritional needs of our children.10

The idea that measles mass vaccination campaigns initiated in the 1960s were the sole or even the main cause of the declines in reported measles cases during that decade and since is worth a closer examination. The impact of major sociological factors such as diminishing birth rates and improved nutrition for children may have played a much larger role in the decline of measles in the U.S. than is commonly understood.

1 Centers for Disease Control and Prevention. Measles Vaccination.
2 CDC. Measles Data and Statistics. Feb. 16, 2018 (last updated).
3 CDC. Measles Data and Statistics. Feb. 16, 2018 (last updated).
4 Gindler JS, Atkinson WL, Markowitz LE. Update—The United States Measles Epidemic, 1980-1990. Epidemiologic Reviews 1992.
5 Cáceres M. The Story of Measles’ Sharp Decline. The Vaccine Reaction Apr. 12, 2016.
6 CDC. Summary of Notifiable Diseases, United States: 1989Morbidity and Mortality Weekly Report Oct. 5, 1990; 38(54):56-58.
7 Live Births and Birth Rates, by Year.
8 Baby Boomer.
9 Katona P, Katona-Apte J. The Interaction between Nutrition and InfectionClinical Infectious Diseases May 15, 2018;46(10); 1582–1588.
10 Gunderson GW. 
National School Lunch Program (NSLP). United  States Department of Agriculture.
11 Great Society. Wikipedia.
12 School Milk, Lunch Programs Merged in Nutrition Act. CQ Almanac.

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