Back in 2010, a somewhat well-known anti-vaccine activist claimed that he and his followers were “in the early to middle stages of bringing the U.S. vaccine program to its knees.” Yet here we are, in 2020, and children in the United States are still being protected from vaccine-preventable diseases. Yes, 2019 was a record year for measles, and that in itself is a harbinger of worse things to come if vaccine refusal is not brought under control.

Let us conduct a thought experiment and think about a world without vaccines. No, not a world where vaccines never happened, but a world where we do away with vaccination. If vaccines had never existed to begin with, we probably would not be in the current situation that we find ourselves in right now, where we have passed 7.6 billion people on the planet. Fewer people translates to less productivity, less advancement. Medical technologies may have progressed to keep people alive in the most acute presentations of vaccine-preventable diseases. But what would happen if tomorrow morning all vaccines ceased to exist.

As a species, we probably would be alright, especially those of us lucky enough to live in a developed nation and with access to healthcare. Adults who have been exposed to childhood diseases — or vaccinated against them — would probably be okay. As cases of vaccine-preventable diseases climb in the next few years, their immunity would be boosted, and they would not fall victim to things like measles or chickenpox. The problem in the first few years would be influenza and pneumonia in the older populations.

Japan learned this the hard way a few years ago when they stopped immunizing their children against influenza. This caused children there to share influenza among each other and bring it home to their parents and grandparents. By some estimates, that policy resulted in an excess of tens of thousands of deaths each year from influenza complications. The theory is that vaccinating children triggered community immunity.

Currently, outbreaks of chickenpox are being reported at the border in the refugee camps and the detention centers holding detainees from Central America and Mexico. Unlike the United States, chickenpox is not routinely given in those countries, though it is available in Mexico if a parent requests it. (Immigrant children are more likely to be immunized against other childhood diseases than American-born children, according to the World Health Organization.) If children in the United States stopped being vaccinated against chickenpox, those imported cases would trigger outbreaks here.

Contrary to popular opinion, chickenpox can trigger potentially deadly complications. In the first few years without vaccines, we would see those outbreaks grow in number and size. Periodically thereafter, we would have outbreaks of chickenpox in which most children would survive but many would develop complications. Parents would also have to stay home to care for their children, so the economy would take a hit.

Over the course of several years, diseases like mumps and measles would also come roaring back and establish themselves in periodic waves of disease. In 1960, just a few years before the measles vaccine was licensed, the United States had about half a million reported cases, with 500 to 1,000 deaths. The population then was about 180 million residents. Today, we have over 320 million residents. All things being equal, we would probably see close to a million yearly cases of measles, and well over 1,000 deaths. Currently, thankfully, we have not had a measles death in some time in the United States. In Samoa, in only a few months after measles vaccination rates dropped below community immunity levels, a massive measles epidemic claimed the lives of dozens of children and sent hundreds to the hospital.

Pharmaceutical companies would make massive profits as more and more children would need to be hospitalized and given supportive care for things like encephalitis and pneumonia. Antibiotics given for secondary bacterial infections would eventually stop working as the bacteria would adapt to the antibiotics. New antibiotics would have to be developed and patented, bringing in billions of dollars to private companies and leaving those without means at the mercy of diseases.

Finally, and perhaps most terrifyingly, an accidental or intentional release of smallpox would go unchecked. There are no antivirals for smallpox, and it is highly contagious. Between one third and one half of the people who contract it would die, and they would be infectious before they even showed outward signs of the disease. Those who survived would be scarred or disfigured. After a few years, like with other diseases, periodic epidemics of smallpox would start to go around the world.

While the effects of a complete cessation of immunization programs would not be felt immediately, it would only be a matter of months before the first few outbreaks of vaccine-preventable diseases would start to be reported. After a few months or years of the first larger outbreaks, the diseases would become endemic, established and happening in periodic waves. Those without the means to access and/or pay for healthcare would be the most impacted at first. After a while, even those with the means would be affected as antibiotics would no longer work effectively (same for antivirals).

As a species, humans would survive, but not without millions of cases of diseases and hundreds of thousands (or millions) of excess deaths. Vulnerable populations the world over would feel the effects of a diminished population and work force. People would begin to migrate at greater rates to seek medical care. All indicators from the pre-vaccine era, combined with the current realities of worldwide travel and population levels, tell us that the world would be turned upside down without vaccines.

Let’s hope we never find out.

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