PDF Summary:Dissolving Illusions, by Suzanne Humphries and Roman Bystrianyk

Most people credit vaccines with eliminating deadly diseases and saving millions of lives. But in Dissolving Illusions, Suzanne Humphries and Roman Bystrianyk challenge this narrative. They argue that mortality rates from infectious diseases like measles, smallpox, and diphtheria were already declining dramatically before vaccines were introduced—due to improvements in sanitation, nutrition, and living conditions rather than medical interventions.

Humphries and Bystrianyk examine historical data on disease mortality, sanitation reforms, and nutritional factors that strengthened immune function. They question whether vaccines deserve credit for reducing deaths from infectious diseases and raise concerns about their limitations and potential adverse effects. This guide explores their arguments about what actually drove the decline in disease mortality and examines their perspective on the role vaccines played—or didn't play—in improving public health.

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Malnutrition weakens the body's cellular immune reactions, worsening the impact of measles exposure or infection. When the body battles any infection, particularly measles, various processes drain vitamin A reserves. Contracting measles and receiving high-dose measles vaccines can hinder cell-mediated immunity partly due to the reduction of vitamin A. Some of that reduction is due to the body’s epithelial cells using it, while another part results from rapid turnover of immune cells. Other mechanisms that may be responsible probably involve the sequestration of vitamin A. Inadequate levels of vitamin A, caused by poor diet or malnutrition, increase the likelihood of even worse results.

(Shortform note: While vitamin A depletion may play a role in measles-related immune suppression, research suggests that the primary driver is the virus’s direct impact on immune memory cells. Mina et al. (2015) found that measles virus infection induces a prolonged form of ‘immune amnesia’ by depleting preexisting protective immune memory cells, thereby increasing susceptibility to and mortality from a wide range of other infectious diseases for several years after the acute illness. This effect is distinct from and more profound than the temporary immune suppression caused by vitamin A depletion or sequestration.)

It's recognized that secondary infections can cause death in measles cases; however, this is mainly because of vitamin deficiencies, which lead to a reduction in cellular immune responses. Cellular immune reactions are deeply suppressed when measles is present. Lymphocyte mitogenic factor and specific T cell populations are known to be inhibited during a measles infection.

(Shortform note: While vitamin deficiencies can exacerbate measles, researchers have found that most deaths from secondary infections are due to the measles virus itself. In a study, researchers found that the measles virus can wipe out up to 73% of a person’s antibodies, which are proteins that help the immune system fight off infections.)

Vaccine Limitations and Historical Narratives

Next, we will discuss the effectiveness of vaccines in reducing disease mortality, along with their mechanisms, limitations, and potential adverse effects.

Challenging Vaccine-Centric Narratives of Reduced Incidence

Humphries and Bystrianyk question the effectiveness of vaccines in lowering disease mortality. They argue that vaccines had little to no effect on the reduction of deaths from diseases caused by infections, and the idea that vaccines are what led to the dramatic drop in deaths is fundamentally false. In their view, the life-saving benefits of vaccines are overstated, and the dangers are downplayed or ignored. The authors claim that the idea that vaccines played a key role in transforming our world from a nightmare of disease to the present day is not supported by evidence.

(Shortform note: André et al. argue that vaccines played a major role in reducing deaths from infectious diseases. In a review published in a World Health Organization journal, they state that “vaccination has greatly reduced the burden of infectious diseases; only clean water, almost certainly, has had a greater effect on mortality and the growth of the human population.” The authors argue that the widespread use of vaccines has been a major driver of the modern decline in deaths from vaccine-preventable infections.)

They argue that the smallpox vaccination was unnecessary and resulted in unnecessary pain and fatalities, yet it's still upheld as the exemplary vaccine to promote vaccine faith today. They also claim that fatalities due to measles fell by over 98% before the vaccine's introduction, and fatalities from pertussis decreased by more than 90% before the debut of the DTP vaccine. Additionally, they state that overall child mortality remained unchanged during decades of smallpox vaccination and that children's mortality rate stayed the same until around 1880. They add that the infant mortality rate rose when vaccination laws were stringent and vaccination was widespread. The authors note that while it seemed fatalities decreased after vaccines were introduced, fatalities from other causes rose, and the child mortality rate overall was the same.

(Shortform note: If people decide that the smallpox, measles, and pertussis vaccines are unnecessary, this could lead to serious problems. For example, when people forgo the measles vaccine, outbreaks and fatalities increase. In 2019, the US experienced the highest number of measles cases since 1992, with 1,282 cases reported. The majority of these cases were among unvaccinated individuals, and 10% of those infected required hospitalization. Similarly, when people forgo the pertussis vaccine, outbreaks and fatalities increase. In 2012, the US saw the highest number of pertussis cases since 1955, with over 48,000 cases reported. Infants too young to be vaccinated are particularly vulnerable, with 20 deaths reported in 2012, most of them in infants under three months old.)

During the first few decades of the 1900s, living conditions were much better, and many diseases that had been fatal for children in prior decades were less deadly. Most vaccines and other medical interventions appeared much later and were only minor players compared to all other interventions that took place.

(Shortform note: In Deadly Choices, medical historian Paul Offit argues that vaccines and other medical interventions were more than “minor players” in reducing childhood deaths. He says that once sanitation and nutrition had improved, vaccines and other medical advances became the main drivers of further reductions in childhood deaths. He explains that vaccines against diseases like diphtheria, polio, and measles led to dramatic declines in deaths from those diseases.)

In Leicester, after the 1872 outbreak, vaccination levels and smallpox deaths declined. Child death rates fell after 1885 as vaccination levels significantly decreased. The authors claim that for decades, stringent vaccination laws had no impact on extending children's life expectancy at any age. They add that since Leicester stopped vaccinating infants 62 years ago, just 53 people have died from smallpox, and over the last four decades, there have only been two deaths. From 1933 to 1946, a span of 14 years, only 28 people died among approximately 40 million residents, and none of the deceased were infants under a year old. In 1948, mandatory vaccines ceased in England, and the long-running Leicester experiment had shown considerable success.

(Shortform note: The World Health Organization (WHO) authors of Smallpox and its Eradication offer a starkly different perspective on England’s smallpox history. They argue that the introduction of compulsory vaccination in the latter half of the nineteenth century led to a marked decline in smallpox incidence and mortality. They note that as vaccination coverage increased, large epidemics disappeared, and cases became concentrated among the unvaccinated. The authors emphasize that it was the widespread, compulsory vaccination that brought the disease under control, not the abandonment of such measures. This interpretation directly contradicts the Leicester narrative, highlighting the deep divide in how public health experts interpret the same historical data.)

The authors claim that in Leicester, the majority of infants weren't vaccinated. While some school children contracted smallpox, there were no significant outbreaks. In 1910, Dr. Millard asserted that vaccinating infants played a significantly lesser role in curbing the transmission of smallpox than most thought, and that the unvaccinated weren't a threat to public health. In 1893, Professor E. M. Crookshank expressed his view that once smallpox is managed, the vaccine will become obsolete and merely of historical interest.

(Shortform note: In Bodily Matters, historian Nadja Durbach uses Leicester’s public health records and debates to argue that the city’s experience doesn’t support the anti-vaccination narrative presented here. Durbach argues that later anti-vaccinationists misrepresented Leicester’s public health strategy as proof that sanitary measures alone could control smallpox, when in fact the city used a combination of tactics, including selective vaccination and revaccination. She explains that this oversimplification turned a complex public health approach into a misleading story of successful resistance.)

In 1980, Stuart M. Fraser noted the success of the Leicester approach, saying that Leicester is an example where strategies besides complete dependence on vaccination were implemented successfully to eradicate the disease from the community. The authors explain that quickly notifying, isolating, and placing contacts in quarantine proved especially effective for managing and curbing smallpox.

(Shortform note: Many public health experts disagree with the idea that the Leicester approach can eradicate smallpox. In Smallpox and its Eradication, Fenner and colleagues argue that vaccination was essential for eliminating smallpox, and that measures like isolation and quarantine were only supportive tools. They maintain that widespread vaccination was necessary to create and maintain population immunity, and that isolation and quarantine alone couldn’t achieve eradication.)

In 1948, Dr. Millard elaborated on why he thought contemporary medical professionals were mistaken. The central issue was a cycle of pro-vaccine beliefs that reinforced themselves. Medical officials frequently employed charts to illustrate that the enforcement of vaccination was connected to a decline in smallpox mortality. However, the authors argue that these diagrams were problematic. They assert that the seeming link was likely coincidental since smallpox mortality kept falling even as vaccinations declined. They add that other factors must have contributed to the dramatic decrease in smallpox mortality starting in the early 19th century and that vaccination has been credited more than it deserves.

(Shortform note: The authors’ claim that the link between vaccination enforcement and smallpox mortality was coincidental is questionable. In Smallpox and its Eradication, the authors present evidence that when vaccination programs lapsed, smallpox deaths increased, even when sanitation remained stable. This suggests that the relationship between vaccination and smallpox mortality was more than just a coincidence.)

Next, we will present evidence of declining mortality before widespread immunization, along with alternative explanations for the decrease in infectious diseases.

Proof of Reduced Deaths Before Mass Vaccination

Humphries and Bystrianyk claim that mortality rates for diseases like measles, scarlet fever, and diphtheria were declining before vaccines were introduced. For example, in the 1800s, measles outbreaks happened biannually in the U.S. and England, and up to 20% of children who contracted the disease died. In the 1930s, the likelihood of dying from measles fell to 1–2 percent. By 1968, when the vaccine became available, mortality had decreased by 99.96% in England from its highest point. In the US, the mortality rate for measles had decreased by over 98% from its peak before the vaccine was introduced in 1963.

(Shortform note: The authors’ arguments about the decline in mortality rates for diseases like measles, scarlet fever, and diphtheria before the introduction of vaccines align with the “McKeown thesis,” a controversial theory in historical demography. In his 1976 book The Role of Medicine, British physician and epidemiologist Thomas McKeown argued that the decline in mortality from infectious diseases in the 19th and early 20th centuries was primarily due to improved living standards, nutrition, and sanitation, rather than medical interventions like vaccines and antibiotics. McKeown’s thesis was based on his analysis of long-term mortality data, which showed that most of the decline in deaths from infectious diseases occurred before the widespread use of medical treatments. He argued that rising living standards, particularly improved nutrition, played the most significant role in reducing mortality. He also acknowledged the importance of better hygiene and environmental changes that reduced exposure to infection.)

In 1963, no deaths in Massachusetts were linked to measles. In Washington State, measles mortality had been gradually declining for years, and by 1963, it was 0.3 per 100,000. In 1963, no measles-related deaths happened in certain New England states. In the entire New England region, measles was linked to just five deaths. Asthma caused 56 times more deaths, accidents led to 935 times more, motor vehicle accidents caused 323 times more, other accidents resulted in 612 times more, and heart disease led to 9,560 times more deaths.

(Shortform note: In Calculated Risks, Gerd Gigerenzer argues that risk information only becomes understandable when it is put into a transparent reference class: instead of presenting isolated figures or relative risks, one should use absolute risks or natural frequencies and, where appropriate, compare them with familiar causes of death or everyday hazards on the same time scale, so that people can judge the size of a risk in relation to other risks and make informed decisions rather than be swayed by decontextualized numbers. This approach helps people avoid being misled by relative risks or isolated statistics and instead make informed decisions based on a clear understanding of the actual magnitude of a risk.)

In 1960, the US population was 180,671,000, and the official number of measles deaths was 380, resulting in a measles mortality rate of 0.24 per 100,000. In 1960, England and Wales reported only 2.4% of childhood measles cases, and mortality decreased to 0.030%. Humphries and Bystrianyk add that, at the start of the 1900s, those who got scarlet fever were 95% less likely to die than the previous century. The mortality rate had reached zero by the mid-20th century. For pertussis, mortality rates had dropped by over 99% when the vaccine was introduced. Regarding diphtheria, child mortality rates decreased roughly 87% between 1894 and 1920. In America, deaths from diphtheria declined 98% from 1900 until the DTP vaccine became available in the mid-1940s. They assert that better living conditions, rather than vaccines, were responsible for starting the drop in disease mortality.

Vaccines and the Decline in Measles Mortality

While the authors argue that better living conditions, rather than vaccines, were responsible for starting the drop in disease mortality, this may not be the case in all contexts. For example, in many low-income countries, the introduction of mass vaccination campaigns in the early 2000s led to a sharp decline in measles deaths, even though sanitation and nutrition remained poor. A 2012 research article by epidemiologists found that between 2000 and 2010, global measles deaths dropped by 74%, from 535,300 to 139,300. The researchers attribute this decline to increased vaccination coverage, particularly in Africa and Southeast Asia. They note that in 2000, only 72% of children worldwide received the first dose of the measles vaccine, but by 2010, this had increased to 85%. The researchers argue that this increase in vaccination coverage was the primary driver of the decline in measles deaths, rather than improvements in living conditions.

Alternative Explanations for Infectious Disease Decline

Humphries and Bystrianyk argue that improved sanitation contributed to the reduction of contagious illnesses. By the start of the 20th century, it was acknowledged that sanitation had succeeded in conquering smallpox where vaccination had not. Vaccination for smallpox was decreasing, yet the disease was vanishing as a significant danger. Smallpox fatalities dropped from 20% in 1895 to 0.26% in 1908. The authors attribute this decline to the disease's natural lifecycle and the reality that smallpox had stopped being a natural illness for the country.

(Shortform note: The authors’ statement that smallpox had “stopped being a natural illness for the country” is somewhat unclear. In modern epidemiological terms, this would mean that the disease had been eliminated from the country, but not eradicated. In Smallpox and its Eradication, Frank Fenner explains that elimination means that the disease is no longer endemic in a country, but sporadic cases may still occur. Eradication, on the other hand, means that the disease has been completely wiped out worldwide.)

Starting in the late nineteenth century, immunization rates decreased and stayed low until mandatory vaccinations were halted in England in 1948. Vaccinations persisted from 1948, when the U.S. experienced its final smallpox death, until 1963, leading to around 5,000 avoidable hospitalizations linked to vaccines. Starting in the latter half of the 1800s and continuing into the 1900s, deaths from infectious diseases declined. By the late 1800s, it was clear that better sanitation was significantly combating bacterial illnesses like typhus and typhoid, even without vaccines.

(Shortform note: In the late 19th century, England saw a significant decline in vaccination rates due to public opposition to compulsory smallpox vaccination. The Vaccination Act of 1898 introduced a conscientious objection clause, allowing parents to opt out of vaccinating their children. This change came after widespread protests and the formation of anti-vaccination leagues, which argued that mandatory vaccination infringed on personal liberties and could cause harm. The 1907 Vaccination Act further relaxed requirements, making it easier for parents to obtain exemption certificates.)

In England, deaths from fever, typhus, and typhoid fever fell from 1,228 per million in 1838 to 137 for typhoid and only three for typhus per million in 1892. The authors credit this remarkable preservation of lives to town cleanups, water purification, and the installation of effective sewers. By the start of the 1940s, typhoid fatalities were extremely uncommon. Between 1900 and 1943, typhoid and paratyphoid deaths—already much lower by the late 19th century—fell by another 98%.

(Shortform note: The authors don’t explain how these measures reduced deaths from fever, typhus, and typhoid fever. Typhoid fever is caused by the bacterium Salmonella typhi, which is spread through contaminated food and water. Typhus is caused by the bacterium Rickettsia prowazekii, which is spread by lice. In the crowded towns of England, these pathogens could easily spread from person to person through contaminated water and food. By separating human waste from drinking water and improving overall cleanliness, these measures broke the chain of transmission.)

The authors add that deaths from diseases that were once tragically commonplace—like scarlet fever, rubella, pertussis, varicella, and diphtheria—dropped considerably. It's suggested that the public health movement contributed to reducing death rates from diarrhea and enteritis from 20.4 per 100,000 people in 1930 to 4.6 per 100,000 people in 1940. Improvements in hygiene practices, such as milk pasteurization, enhanced food refrigeration, purifying water supplies, along with overall increased living standards, are the primary factors behind this advancement.

The Role of Oral Rehydration Solution in Reducing Deaths From Diarrhea

While the authors suggest that improved hygiene practices and living standards were the primary factors behind the reduction in deaths from diarrhea and enteritis, researchers have found that in many low- and middle-income countries, the decline in child deaths from diarrhea was primarily due to the introduction and widespread use of oral rehydration solution (ORS) and improved clinical case management. For example, a study in Bangladesh showed that between 1980 and 2000, child deaths from diarrhea dropped by 90%, largely due to the use of ORS, even though improvements in water and sanitation were modest.

Vaccine Mechanisms, Limitations, and Negative Consequences

Humphries and Bystrianyk argue that inoculations have limitations and potential adverse effects. The authors say that immunization doesn't always confer immunity for a lifetime, and their effectiveness can wane over time, requiring multiple doses. Additionally, vaccines may have unintended consequences, such as suppressing the immune system or causing other health issues. The authors express concern that the long-term effects of widespread immunization are not fully understood and that epidemics might be more frequent moving forward.

(Shortform note: The authors’ claim that the long-term effects of widespread immunization are not fully understood and that epidemics might be more frequent moving forward has been criticized. In 2013, the National Academies of Sciences, Engineering, and Medicine (then the Institute of Medicine) published a report titled The Childhood Immunization Schedule and Safety, which reviewed the safety of the recommended childhood immunization schedule in the United States.)