"But the 2003 CDC report states that 152,209 people die from mumps annually in the 20th century and 47,745 from rubella."
Table 13-1 which you post a picture of clearly states 'morbidity'. Morbidity refers to the number of cases of illness, 'mortality' means deaths. Table 13-1 states 152,209 per year were sick of mumps annually in the 3 years ahead of the vaccine licensure (not for the full 20th century, the footnote on this is directly at the bottom of the table you copied). It seems you may be confusing some vocabulary.
More broadly, preventing illness is still important. If you look at the measles in the United States this year, there have been 2012 cases, 'only' 3 deaths, but also 227 (11%) hospitalizations (https://www.cdc.gov/measles/data-research/index.html). If we went back to 500k cases a year, that would be 57k hospitalizations a year. Each hospitalization has an average cost of $14k (https://www.cdc.gov/nchs/hus/topics/hospitalization.htm), so this would cost the country about $800M in direct healthcare costs, and then you'd want to add in costs of lost wages for people who were sick, their caretakers, impact of missed schooling, worse care for people who need to wait longer because beds are taken up with measles, etc. to get the broader impact.
Certainly disease prevention is a good thing, but the disappearance of measles deaths likely implies a decline in disease burden prior to the vaccine as well--much of which has already been trod in the McKeown thesis. This story only focused on mortality, but a subsequent story on metrics like hospitalizations might be worthwhile.
That CDC estimate based on AHA data seems ridiculous on its surface. Will take some time to dig into that estimate, but my guess is they are lumping in all hospital costs divided by number of inpatient stays. A single inpatient hospitalized overnight for the measles should not cost $14k.
The skepticism is warranted, a took a deeper look and the average length of stay is about 4.8 days for a measles case, and in 2016 dollars this translated to ~$7.4k (source: https://pmc.ncbi.nlm.nih.gov/articles/PMC7188204/).
Prior to the introduction of the vaccine, the hospitalization rate for measles was roughly 1% (48k / 4 million). https://www.cdc.gov/measles/about/history.html This is likely on the high end, as the 1950 National Vital Statistics Report noted that cases were likely underreported because measles was such a mild disease: "Certain so-called minor communicable diseases such as measles are poorly reported because a large proportion of the cases are never seen by a physician. The fact that few cases of measles have a fatal termination and because restrictive measures are minimum and no investigation of cases is made, also mitigates against complete reporting." https://www.cdc.gov/nchs/data/vsus/vsus_1950_1.pdf
This was 13 years preceding the introduction of the measles vaccine, at a time when the aforementioned public health measures were still taking effect on infectious disease mortality, so it is likely that hospitalization rates would have continued to decline as nutrition and treatment advanced.
Even at 'only' 48k hospitalizations, at $12k each, that's still $576M in direct costs. Additionally, you may say that nutrition has advanced, but if anything we've become more unhealthy metabolically in the time since, with rates of diabetes and obesity at all-time highs - obesity has tripled in the last 60 years.
"But the 2003 CDC report states that 152,209 people die from mumps annually in the 20th century and 47,745 from rubella."
Table 13-1 which you post a picture of clearly states 'morbidity'. Morbidity refers to the number of cases of illness, 'mortality' means deaths. Table 13-1 states 152,209 per year were sick of mumps annually in the 3 years ahead of the vaccine licensure (not for the full 20th century, the footnote on this is directly at the bottom of the table you copied). It seems you may be confusing some vocabulary.
More broadly, preventing illness is still important. If you look at the measles in the United States this year, there have been 2012 cases, 'only' 3 deaths, but also 227 (11%) hospitalizations (https://www.cdc.gov/measles/data-research/index.html). If we went back to 500k cases a year, that would be 57k hospitalizations a year. Each hospitalization has an average cost of $14k (https://www.cdc.gov/nchs/hus/topics/hospitalization.htm), so this would cost the country about $800M in direct healthcare costs, and then you'd want to add in costs of lost wages for people who were sick, their caretakers, impact of missed schooling, worse care for people who need to wait longer because beds are taken up with measles, etc. to get the broader impact.
Good catch. I have removed that section.
Certainly disease prevention is a good thing, but the disappearance of measles deaths likely implies a decline in disease burden prior to the vaccine as well--much of which has already been trod in the McKeown thesis. This story only focused on mortality, but a subsequent story on metrics like hospitalizations might be worthwhile.
That CDC estimate based on AHA data seems ridiculous on its surface. Will take some time to dig into that estimate, but my guess is they are lumping in all hospital costs divided by number of inpatient stays. A single inpatient hospitalized overnight for the measles should not cost $14k.
The skepticism is warranted, a took a deeper look and the average length of stay is about 4.8 days for a measles case, and in 2016 dollars this translated to ~$7.4k (source: https://pmc.ncbi.nlm.nih.gov/articles/PMC7188204/).
Trying to translate that into 2025 dollars, the average stay at a for-profit hospital (the cheapest) in 2023 was $2500 a night (https://www.beckershospitalreview.com/finance/hospital-expenses-per-inpatient-day-across-50-states-2025/), so multiplied by 4.8 average gives $12k.
Prior to the introduction of the vaccine, the hospitalization rate for measles was roughly 1% (48k / 4 million). https://www.cdc.gov/measles/about/history.html This is likely on the high end, as the 1950 National Vital Statistics Report noted that cases were likely underreported because measles was such a mild disease: "Certain so-called minor communicable diseases such as measles are poorly reported because a large proportion of the cases are never seen by a physician. The fact that few cases of measles have a fatal termination and because restrictive measures are minimum and no investigation of cases is made, also mitigates against complete reporting." https://www.cdc.gov/nchs/data/vsus/vsus_1950_1.pdf
This was 13 years preceding the introduction of the measles vaccine, at a time when the aforementioned public health measures were still taking effect on infectious disease mortality, so it is likely that hospitalization rates would have continued to decline as nutrition and treatment advanced.
Even at 'only' 48k hospitalizations, at $12k each, that's still $576M in direct costs. Additionally, you may say that nutrition has advanced, but if anything we've become more unhealthy metabolically in the time since, with rates of diabetes and obesity at all-time highs - obesity has tripled in the last 60 years.