7 - Towards a National Immunization Programme

Summary

Eight diphtheria related fatalities recorded in Cork city during 1936 brought the total number of such fatalities recorded in the city over the previous four years to 192. Notably, in every child fatality, none had presented for preventive treatment. Of 14,210 children presented for treatment, not one died from diphtheria, even though they endured continuous exposure to an intensive and virulent form of infection. These results attracted both national and international attention, and received positive coverage in the Proceedings of the Royal Society of Medicine in July 1936. The article, submitted by Professor John McLeod of Leeds, confirmed that incidence of diphtheria in Cork city for the twenty-five years to 1936 was ‘one of the highest or absolutely the highest ever recorded in any area […] and three times as high as the worst areas in England and Wales’. Referring to the marked decline in the incidence of diphtheria in Cork, McLeod asserted that the very large proportion of the child population treated may have played a significant part in the decline of diphtheria in the city, which he claimed ‘is today the most completely immunised in Europe’.

In his comprehensive study of anti-diphtheria immunization in England, Wales, Scotland, and Ireland during the years 1929–36, Graham Forbes bolstered McLeod's claims regarding the immunological position of Cork city. Forbes found that, taken as a whole, anti-diphtheria schemes in England, Wales, and Scotland achieved immunization rates representing an average of 5 per cent of the total population, and 22 per cent of the child population.

Forbes highlighted the extraordinary reduction in incidence and mortality achieved in New York and Montreal, major urban centres that achieved immunization rates of 65 per cent, and 50 per cent respectively, amongst their respective child populations. With regard to Britain and Ireland, Forbes found that Cork city alone achieved immunization rates comparable with North America and Canada, accounting for 15 per cent of the total population and 53 per cent of the child population.

More importantly, the high rate of immunity achieved in Cork effected a 96 per cent reduction in diphtheria morbidity and an 87 per cent reduction in diphtheria mortality there.