Anti-Vaccination Follies
Lasse Andersen
24 Sep. 2020
V
accination is easily one of the greatest medical achievements in the history of public health, constituting a safe and effective way to mitigate and prevent the spread of infectious diseases. Ever since Edward Jenner decided to test the veracity of the rumour that milkmaids who had contracted cow-pox were protected against small-pox, millions of people have been saved from the threat of infection from one of those numerous nasty diseases that have plagued mankind for millennia, and which until fairly recently constituted the main cause of death. However, in spite of the impressive track record of mass-immunisation schemes, an increasing number of people, influenced by what they watch and read online, are now questioning the necessity and safety of vaccines to the extent that they choose to delay or forgo vaccination of their children. Already, this has had devastating consequences. Since the millennium, the global uptake rate of a number of vaccines have been dropping to increasingly dangerous levels, causing old diseases such as measles, mumps and rubella to regain a foothold in Europe and America especially. In the first half of 2018, for instance, more than 40.000 new cases of measles were reported across Europe, an extraordinary increase from the 16.000 reported in the whole of 2017.
The Vaccination Monster
Etching by C. Williams (1802?) demonstrating the beastliness of Edward Jenner’s new way of preventing small-pox. Wellcome Collection.
In January 2019, the severity of the problem was recognised by the WHO, which felt compelled to add ‘vaccine hesitancy’ to its list of the ten most serious threats to global health. Alarmingly, combating and preventing the spread of disinformation has now become a vital part of global disease control - perhaps becoming as vital as the production and distribution of vaccines themselves. And with the emergence of COVID-19, which the WHO declared a pandemic just one year after sounding the alarm about vaccine hesitancy, the urgency of addressing this growing problem has only been enhanced. Within the next year or two, once an effective vaccine has been developed for COVID-19, the world will embark upon what must be the largest global immunisation campaign in history. Its success will depend on the extent to which enough people are willing to let themselves and their children be vaccinated.
Perhaps the only positive thing to say about the growth of vaccine hesitancy is that we have been here before. Anti-vaccination sentiments are, in fact, as old as the vaccine itself. In spite of this, the phenomenon is still very poorly understood, and it is not until this past decade that medical establishments and journals have begun to take it extremely serious. Historians, too, have been rather slow to engage with the phenomenon. While the 19th century opposition to the Contagious Diseases Acts has been the subject of numerous studies, only a few historians have seriously grappled with the fact that Britain, aside from being the birthplace of Edward Jenner and his vaccine, was also home to the first major anti-vaccination movement in history; a movement that became so popular in the 1870s and 1880s that whole cities succumbed to its cause and eventually forced the government to modify its vaccination policy.
Although our present predicament is different, not least due to the enormous influence and near ubiquity of social media, the history of why the vaccine was so vehemently opposed in 19th century Britain nonetheless holds some valuable lessons for today.
Vaccination Lancet
London, England. 1869-1900. Science Museum, London.
In the early 19th century; in that period known (accurately) as the heroic age of medicine, the procedure of vaccination did not simply involve, as it does today, a small prick with a needle. When administering the small-pox vaccine, medical practitioners used a lancet to cut deep lines into the flesh on the arm of a baby, often in multiple places, into which they would then smear infected lymph matter from a diseased calf (vaccination: from vacca = cow). This intermixing of human and animal blood, not to speak of the sheer brutality of the practice, caused many parents to reject it out of a visceral sense of disgust, often influenced by religious notions of man’s distinctness from animals. The journalist William Cobbett, for instance, rejected Jenner’s invention merely on the basis of its ‘beastliness’. ‘There are some things more hideous than death,’ he argued. Many parents much preferred to continue the older method of inoculation, also known as variolation, whereby children were simply infected with small-pox matter from a sick person. However, this method of inoculation, which was often done by a trusted family member, was highly dangerous, since it lacked the main feature of vaccination, which was to be non-contagious and much less risky to the individual. Faced with this persistent resistance to change, the British government decided to outlaw the old method in 1840 while simultaneously rendering vaccination free to all citizens. Unfortunately, however, the efficacy of this policy was significantly undermined by the decision to administer the free vaccines through the existing poor law system; a decision which effectively made sure that vaccination would carry a stigma of poverty for all the families that could not afford to hire a private doctor. As a result, the uptake did not increase sufficiently and compulsory measures had to be introduced. In 1853, The Compulsory Vaccination Act was passed and it immediately infuriated people so much that riots broke out in many towns all over England. In London, The Anti-Vaccination League was founded by John Gibbs, a well-known hydropathic healer and vegetarian campaigner, who thereby inaugurated what would become a more than fifty year struggle to regain the ‘medical liberties’ of parents over their children. In a pamphlet from 1854, he wrote:
The Compulsory Vaccination Act, while dishonouring science, invades in the most odious, tyrannical, and, speaking as a Briton, unexampled manner the liberty of the subject, and the sanctity of the home; unspeakably degrades the free-born Briton not only in depriving him of liberty of choice in a personal matter, but even in denying him the possession of reason…
For Gibbs, the problem was not simply the “beastly” origin of the lymph matter, which he objected to as a vegetarian, but in particular the fact that the medical establishment, by colluding with the government in this way, had acquired state sanction of a practice whose efficacy, safety and scientific status had not yet been sufficiently established in his opinion. At the time, the cause of infectious disease was poorly understood and the case for vaccination was almost exclusively empirical; that is, based on statistics. It was not until the end of the century that the so-called miasmic theory of disease, to which almost all anti-vaccinationists adhered, was permanently pushed aside by the germ theory. This is important to keep in mind because the political argument for compulsive vaccination depends on the truth of the claim that individuals are the locus of contagion.
The Anti-Vaccination Folly
Excerpt from The Weekly Times. Feb 5, 1871. The British Library.
After the publication of On Liberty in 1859, John Stuart Mill’s utilitarian ‘harm principle’ quickly became a common reference point among pro-vaccinationists, yet the principle only gave state officials licence to interfere with individuals insofar as they constituted a potential harm to other people. To the adherents of the miasmic theory, however, the cause of disease was to be found outside individuals; i.e. in the environment or, more specifically, in the insanitary conditions of urban working class areas. As Alfred Russel Wallace, one of the leaders of the Anti-Vaccination Movement, expressed it, infectious diseases were the “self-created scurges of civilised humanity”. Being a radical liberal, Wallace believed that a comprehensive land reform was badly needed in order to counteract the pressure of urbanisation and raise the standard of living for landless urban labourers. For this reason, he saw compulsory vaccination as not only wrong but as a policy that targeted the wrong class in society. What was needed to keep the people healthy was not enforced vaccination but better housing, better sanitation and better nutrition, all of which required the freeing up of urban and rural space occupied by the aristocracy, who were the real enemies of public health.
Aside from disagreements about the cause of disease, one of the most frequent objections to compulsory vaccination was directed towards its pecuniary aspects. Firstly, the fact that the medical establishment had an economic interest in the procedure rendered their expertise questionable in the eye of many anti-vaccinationists, and it meant that the medical statistics documenting the safety of the vaccine were often distrusted. In particular, doctors and poor law guardians had an incentive, so it was believed, to underreport mortalities resulting from vaccination, which meant that the debate often revolved around facts and numbers rather than opinions. Secondly, in a desperate effort to make people comply, the government decided in 1871 to enforce cumulative penalties on parents who refused to have their children vaccinated against small-pox. This was widely perceived as a brazen attempt to raise money on the backs of babies. What is more, in order to save money, Victorian vaccinators often used lymph from recently vaccinated babies instead of the cow-pox lymph provided by the National Vaccine Establishment, which meant that infants who had undergone vaccination had to be brought back eight days later and be used to vaccinate other babies. From 1871, a fine of up to 20 shillings could be imposed on those parents who refused to allow this so-called “arm-to-arm” procedure to take place. As the historian Nadja Durbach has pointed out in her excellent book Bodily Matters (2004, p. 3), children were at this point not only the recipients of vaccine matter, they were also its incubators. Needless to say, this did not tend to go down well with parents, who feared - among other things - that other diseases such as syphilis would be transmitted to their healthy babies. The result was that many parents chose to go to prison rather than pay their fines, thus becoming martyrs for the cause, and local anti-vaccination leagues were often quick to raise money to reimburse parents of penalties incurred.
Given the harsh nature of the procedure and the general lack of knowledge about infectious diseases; given the novelty of compulsory health legislation and the stark political measures used to enforce compliance among the people, it is perhaps not surprising that the anti-vaccination movement thrived to such an extraordinary degree in the 1870s and 1880s. A flurry of pamphlets emerged in this period, many of which with a distinct conspiratorial tone, and journals such as the Anti-Vaccinator (1869) and the Vaccination Inquirer (1879) took up the ideological fight against the medical orthodoxies of The Lancet and The British Medical Journal. In 1885, the matter came to a head when more than twenty thousand people gathered for an anti-vaccination rally in the city of Leicester, which by that point had become the capital of anti-vaccination sentiment in England. Unable to ignore the pressure for reform, a royal commission was created to investigate the grievances, hearing testimonies from Wallace and a number of other prominent individuals both for and against vaccination. After years of deliberation, the government decided in 1898 to adjust its policy, making arm-to-arm vaccination illegal, removing the cumulative penalties on parents and, lastly, introducing the concept of “conscientious objector” into the English law books. Parents who opposed vaccination could now - with more or less ease - be granted exemption from vaccination. As a result, the anti-vaccination movement gradually declined, weakened by its own victory against compulsion.
One of the first lessons that can be drawn from this today is that reservations about vaccines are highly context dependent and most often vaccine specific. The mid-Victorian spirit of individualism and self-help certainly influenced the movement and its leaders, and the specifics of the small-pox vaccine - how it was produced and administered - undoubtedly played a huge role in generating opposition. However, the striking thing about the Victorian example is how much of the opposition was generated by mistakes of policy. What it illustrates is that compulsory measures, even mild measures designed to render vaccination convenient and free, can backfire extraordinarily if the policy is too ham-handed or culturally insensitive. Thankfully, using penalties to enforce compliance is now something that has largely been abandoned, with modern health authorities instead relying more and more on positive forms of encouragement combined with various elements of “liberal paternalism”, also known as nudging. What the Victorian example also demonstrates, moreover, is that at its core, vaccine hesitancy is about knowledge and trust. The utilitarian case for vaccination is only convincing if people understand contagion from the point of view of society as a whole and are willing to trust authorities and experts with the health of their children. In this regard, there are some striking differences between then and now.
Whereas it is true, as is often pointed out, that anti-vaccinationists almost invariably have been informed by alternative forms of medicine (A. R. Wallace, for instance, was influenced by the holistic idea of harmonia naturae, which chimed badly with the germ theory of disease.), it seems anachronistic and unfair to compare the Victorian anti-vaccinationists with their modern-day successors given that orthodox medicine has improved so much in the intervening period - both in theory and practice. Whereas the miasmic theory of disease had an air of plausibility, and was rooted in a genuine concern for the living conditions of the poor, the modern anti-vaccination movement includes a hodgepodge of ideas that are either thoroughly discredited, such as the idea that vaccines cause autism in children, or blatantly absurd, such as the idea that Wi-FI networks are responsible for infections. Moreover, anti-vaccination sentiments today are often shown to be the product of a kind of privileged complacency; a complacency that ironically is made possible by the very success of mass-vaccination schemes. In the Victorian period, however, the anti-vaccination movement was not only rooted in the anxieties of mostly working-class parents, people were also much more aware of the threat of childhood disease and the consequences of their choice to forgo vaccination. The prevalence of disease and death makes the decisions of Victorian parents hard to compare with those of the 21st century developed world, who also face neither financial ruin nor prison-time on account of their actions.
This, however, points towards the somewhat uplifting possibility that vaccine hesitancy might be a fickler phenomenon in modern times, enabled mostly by ignorance about vaccines and about the diseases which they protect against. Presumably, then, it could be educated away and, if it comes to it, be expected to wither away quickly once the consequences of large-scale non-vaccination become apparent. There are a few well-known examples of this from history, most notably Stockholm in the 1870s, where complacency and anti-vaccination ideas imported from Britain briefly influenced enough people to reduce the uptake rate of the small-pox vaccine only for it to go up again promptly when a major epidemic hit the city in 1874. However, although wrong ideas might be less deep-seeded today, they are certainly more frequently and easily reinforced. The advent of social media is perhaps the biggest single explanation for the growth of vaccine hesitancy since the millennium. Never in the history of human communication has so much disinformation been spread to so many people by so few individuals. A study from 2019 found that the majority of anti-vaccination ads on Facebook are funded by just two American organisations, one of which is led by Robert F. Kennedy Jr., the nephew of the US President, who recently addressed a large anti-lockdown demonstration in Berlin with the words: “Today Berlin is once again a front against totalitarianism… And that is why I’m proud to say, ‘Ich bin ein Berliner’.”
With the advent of the COVID-19 crisis, one might suspect that anti-vaccine ideas might find less traction among people who should be looking towards a vaccine as a saviour from further deaths and lock-downs, but so far this seems not to be the case. A study of one thousand New Yorkers during the hight of its local epidemic surge in late April found that almost 20% were either opposed or hesitant towards receiving an eventual vaccine. Moreover, a staggering 65% agreed with the statement that ‘the spread of and response to the COVID-19 pandemic is influenced by powerful but hidden groups.’ Recent demonstrations in London, Edinburgh and other UK cities show that this kind of conspiratorial thinking is not confined to America. Mixed in with anti-mask and anti-lockdown protestors, the anti-vaccination movement now seems to have merged into a larger and more general conspiratorial denial of the danger (or even reality) of the pandemic. Not only does this raise concerns about the potential success of a future COVID-19 vaccine, which requires at least 70% of the population to be vaccinated, it also marks yet another difference with the Victorian movement, which generally looked to tough measures of isolation and quarantining as the necessary alternative to vaccination in the event of an epidemic. In the absence of a vaccine, such a regime has now been forced on us for quite some time, but the growth of doubt and disinformation about the vaccine - even before one has been developed - risks prolonging the need for such measures for much longer than otherwise necessary.
Lasse Andersen is a PhD candidate at the Institute of Intellectual History, University of St Andrews.
