Category Archives: Vaccines
There is hope a coronavirus vaccine might be ready by the end of the year. But for it to eliminate COVID-19 a critical mass of people must be vaccinated. And if the protective benefits of a COVID-19 vaccine fall off rapidly (as seems to happen with naturally acquired antibodies) maintaining immunity will require multiple vaccinations. So unless people keep renewing their jabs, the critical mass will decline quickly.
How will politicians ensure critical mass and renewal? For UK prime minister Boris Johnson (who labels those who oppose vaccination as “nuts”) and others, vaccination is a matter of duty. There is a logical case (we know people who have died or suffered badly from COVID-19) and a moral case (to protect others if not yourself).
Yet anti-vaccination sentiment focused on the rights of citizens not to act is clear. A recent poll of 2,000 people across the UK found that 14% would refuse to take a vaccine.
The rights of citizens not to act mean that compulsory vaccination cannot be (and has not been) ruled out. The history of other vaccination programmes, particularly the first truly national campaign against smallpox, shows how difficult the balancing of rights and duties will be.
A disappearing act
The 19th-century invention of vaccination created a new national imperative for the UK to combat endemic smallpox. The risk of dying from smallpox for those who contracted it was substantially higher than that for COVID-19 today. Survivors gained immunity but often at the cost of physical scarring and long-term health problems.
Vaccination and subsequent elimination should have been a no-brainer. Yet local and regional outbreaks persisted across the 19th century.
Governments of this period assumed (sometimes incorrectly) that the middle-classes would realise the value of vaccination. The poor and marginal were different. For them, mass compulsory vaccination awaited.
The result was an explosive atmosphere. Rumours of deaths after vaccination and of the rounding up of the poor like animals generated a sustained popular backlash, with some organising under the umbrella of the National Anti-Vaccination League.
Yet even after vaccination became compulsory in 1853, there were many ways in which, by accident or design, ordinary people citizens avoided the jab. Some people simply disappeared from the records or failed to appear when asked. Those most prone to doing so (those in crowded households or immigrants, for example) were also the groups most susceptible to disease.
Census data consistently undercounts the national population. Undercounting in the 1800s may have missed around 10% of some communities. Even for the 2011 census, around 6.1% of the population is believed to have been missed. Achieving vaccination critical mass is difficult where you do not know the true size of the mass and the most vulnerable are the least detectable.
The poor also “clogged up” the vaccination system. Sometimes they agreed to participate and then did not turn up, a common feature for systems of compulsion where there is no ultimate sanction. On other occasions, as for instance at Keighley in 1882, people would supplement this activity with the sending of anonymous hate mail in an attempt to disrupt the work of local vaccinators.
Fight for their rights
Taking advantage of local tensions was also a useful avoidance technique. “Smallpox riots” in the face of attempts at crude compulsion were frequent and sustained.
Sometimes organised by local agitators, and sometimes spurred on by instances of children dying after vaccination, such unrest varied on a spectrum from small and localised to community-wide and sustained. Riots at Ipswich, Henley, Leicester and Newcastle were particularly notable.
Nor should we forget that vaccination opponents spread rumours about and caricatured vaccines and vaccinators, undermining the credibility of the system in the public imagination. These included one cartoon from the 1880s in which helpless children are shovelled into the mouth of a diseased cow while, at the other end, a doctor portrayed as the devil incarnate shovels dead children excreted by the cow into a cart bound for mass graves.
In July 2020 public figures stand accused of using Twitter to the same effect for COVID-19 vaccination.
Most forcefully, while politicians used the law in order to force vaccination, the law could also be turned against them. Penalties against parents for failing to vaccinate children, introduced in 1853 and strengthened in 1867, were routinely ignored by courts. Compulsory child vaccination was removed in 1898 and the freedom to refuse introduced.
Long-standing opposition to vaccination by some scientists as well as ordinary people crystallised in 1885 with a huge demonstration at Leicester (ironically the recent focus of a British local lockdown). This and ongoing smaller protests across the country forced the government to introduce a Royal Commission to reflect on the whole question of compulsion. The verdict ultimately fell on the side of the rights of the individual.
It is not hard to imagine the 2021 human rights case in which a court must decide on the balance of the legal and collective duty of citizens to get vaccinated against COVID-19 nd the individual right to choose.
Our political and medical elites believe that people will accept moral responsibility: “get vaccinated”. Yet little thought has gone into how a mass vaccination programme works.
We will see some of the lessons of 20th-century vaccination schemes repeated, with public information campaigns and elements of coercion via vaccination programmes in schools and care homes. Nonetheless, the lack of serious credence given to anti-vaccination “nuts” and the resistance that a vaccination programme may generate feels oh so 19th-century.
A recent surge in mumps among young adults in the UK has been linked to the 1998 MMR vaccine scare, when a now-discredited medical paper authored by Andrew Wakefield suggested a connection between the vaccine and the development of autism. The publication of the paper led many parents to refuse the vaccine for their child.
The effect of Wakefield’s paper is still deeply felt. Indeed, every week seems to bring news of an unfolding controversy about vaccination. In the UK an alarming decline in childhood vaccination rates has been recorded. Vaccine scepticism seems to be increasing – a fitting testament to these troubling times, when distrust of science and expertise permeate.
Social media is often pinpointed as part of the problem. The ease with which ideas and information about vaccination are spread on Twitter, Facebook and other platforms is causing concern. As one medical journalist observed in 2019: “Lies spread through social media have helped demonise one of the safest and most effective interventions in the history of medicine.”
Social media has undoubtedly changed the way information about vaccination is engaged with. But the media-driven nature of the debate isn’t actually that new. When vaccination began at the end of the 18th century, it quickly became fodder for commentators.
In the 1790s, the surgeon Edward Jenner had confirmed through a number of experimental procedures on patients that exposure to cowpox pustules – symptoms of a disease of cows’ udders which in humans resembles mild smallpox – could confer immunity to smallpox. Following the publication of his results in 1798, vaccination came into widespread use.
With it came immediate unease and distrust. Satirists like James Gillray capitalised upon rumours that inserting cowpox pustules into the skin might cause one to sprout cow horns, a fear which had its roots in religious and cultural stigma surrounding the pollution of blood with animal matter.
Images like Gillray’s were an early indicator of the ability of vaccination to capture the public imagination in a way few other medical developments would over the ensuing decades. This only intensified in the mid-19th century, when the Compulsory Vaccination Act of 1853 decreed that all babies should be vaccinated. Compulsory vaccination aroused accusations that personal liberty was under threat. In its wake, resistance to vaccination ramped up considerably.
Vaccine hesitancy was amplified by the tumultuous world of print which characterised the Victorian age.
Improved printing technologies and lower prices gave rise to a rapid increase in the number of periodicals and newspapers available. Information was democratised, as cheap papers and periodicals became accessible to women and the working classes. Medical and health issues were mined by journalists for their dramatic content, and tropes of the vaccination debate we see today were given shape by the information revolution of the late 19th century.
Indeed, it was during this time that the polarisation between “pro” and “anti” vaccination camps solidified. Use of the phrase “anti-vaccination” rocketed at the end of the 19th century. Pamphlets and magazines sprung up in opposition to its use, claiming that vaccination was a dangerous, toxic procedure that was being thrust upon society’s most vulnerable citizens: children.
The not so catchily named National Anti-Compulsory-Vaccination Reporter, a magazine which began in 1876, sold hundreds of copies every month. The paper revelled in its radicalism, its opening editorial announcing:
As sound-hearted and enlightened Anti-Vaccinators, it is our bounden duty, and should be our steady and constant aim, to work towards the complete destruction of Medical Despotism.
Meanwhile, humour publications such as Punch and Moonshine skewered organisations like the Anti-Vaccination League for their zealotry and irrationality. In an of age of self-professed scientific medicine, the movement’s association with radical religious beliefs and other non-conforming lifestyle choices, such as vegetarianism and abstinence from alcohol, made it a target for lampoonery.
A polarised debate
Anti-vaccination publications believed they were deliberately excluded from a press that was in the pocket of the state and who sought to suppress the true dangers of vaccination. Publications such as The Times had become the gatekeepers of public opinion – in 1887 the paper claimed to have suffered from “an epidemic of letters about vaccination”. But anti-vaccinators lambasted newspaper editors as “shamelessly unprincipled and venal” for refusing to publish that correspondence which was critical of vaccination.
This is an accusation that has its echoes in conspiracy theories that continue today. The prominent American anti-vaccine organisation Children’s Health Defense has denounced the mainstream media for being under the thumb of Big Pharma and ignoring the voices of those harmed by vaccines.
As this shows, there has always been a potency to the vaccination debate few other medical practices generate. The provocative issue of children’s health at the heart of it, and the tension vaccination evokes between notions of collective responsibility and the freedom to choose what we think best for our bodies has made it an emotive, highly polarised debate that has been brewing since the 19th century. This has always been galvanised by sustained media interest.
But there is a complexity to vaccination that polarisation does not properly unpack. What of, for example, the many people who would not identify as “anti-vax”, but instead form a loose group who are hesitant about vaccines and may delay or choose only some vaccinations?
Social media may amplify division between the two camps, but it builds upon a long history of media outlets constructing it.
But there’s a long history of opposition to childhood vaccination, from when it was introduced in England in 1796 to protect against smallpox. And many of the themes played out more than 200 years ago still resonate today.
For instance, whether childhood vaccination should be compulsory, or whether there should be penalties for not vaccinating, was debated then as it is now.
Throughout the 19th century, anti-vaxxers widely opposed Britain’s compulsory vaccination laws, leading to their effective end in 1907, when it became much easier to be a conscientious objector. Today, the focus in Australia has turned to ‘no jab, no pay’ or ‘no jab, no play’, policies linking childhood vaccination to welfare payments or childcare attendance.
Of course, the methods vaccine objectors use to discuss their position has changed. Today, people share their views on social media, blogs and websites; then, they wrote letters to newspapers for publication, the focus of my research.
Many studies have looked at the role of organised anti-vaccination societies in shaping the vaccination debate. However, “letters to the editor” let us look beyond the inner workings of these societies to show what ordinary people thought about vaccination.
Many of the UK’s larger metropolitan newspapers were wary of publishing letters opposing vaccination, especially those criticising the laws. However, regional newspapers would often publish them.
As part of my research, I looked at more than 1,100 letters to the editor, published in 30 newspapers from south-west England. Here are some of the recurring themes.
Smallpox vaccination a gruesome affair
In 19th century Britain, the only vaccine widely available to the public was against smallpox. Vaccination involved making a series of deep cuts to the arm of the child into which the doctor would insert matter from the wound of a previously vaccinated child.
These open wounds left many children vulnerable to infections, blood poisoning and gangrene. Parents and anti-vaccination campaigners alike described the gruesome scenes that often accompanied the procedure, like this example from the Royal Cornwall Gazette from December 1886:
Some of these poor infants have been borne of pillows for weeks, decaying alive before death ended their sufferings.
Conspiracy theories and vaccine cults
Side-effects were so widespread many parents refused to vaccinate their children. And letters to the editor show they became convinced the medical establishment and the government were aware of the dangers of vaccination.
If this was the case, why was vaccination compulsory? The answer, for many, could be found in a conspiracy theory.
Their letters argued doctors had conned the government into enforcing compulsory vaccination so they could reap the financial benefits. After all, public vaccinators were paid a fee for each child they vaccinated. So people believed compulsory vaccination must have been introduced to maximise doctors’ profits, as this example from the Wiltshire Times in February 1894 shows:
What are the benefits of vaccination? Salaries and bonuses to public vaccinators; these are the benefits; while the individuals who have to endure the operation also have to endure the evils which result from it. Health shattered, lives crippled or destroyed – are these benefits?
Conspiracy theories went further. If doctors knew vaccination could result in infections, then they knew children died from the procedure. As a result, some conspiracy theorists began to argue there was something inherently evil about vaccination. Some saw vaccination as “the mark of the beast”, a ritual perpetuated by a “vaccine cult”. Writing in the Salisbury Times, in December 1903, one critic said:
This is but the prototype of that modern species of doctorcraft, which would have us believe that their highly remunerative invocations of the vaccine god alone avert the utter extermination of the human race by small-pox.
For many, the issue of compulsory vaccination was directly related to the rights of the individual. Just like modern anti-vaccination arguments, many people in the 19th century believed compulsory vaccination laws were an incursion into the rights enjoyed by free citizens.
By submitting to the compulsory vaccination laws, a parent was allowing the government to insert itself into the individual home, and take control of a child’s body, something traditionally protected by the parent. Here’s an example from the Royal Cornwall Gazette in April 1899:
[…] civil and religious liberty must of necessity include the right to protect healthy children from calf-lymph defilement […] trust […] cannot be handed over at the demand of a medical tradesunion, or tamely relinquished at the cool request of some reverend rural justice of the peace.
What can we learn by looking at the past?
If anti-vaccination arguments from the past significantly overlap with those presented by their counterparts today, then we can learn about how to deal with anti-vaccination movements in the future.
Not only can we see compulsory vaccination laws in Australia could, as some researchers say, be problematic, we can use the history of vaccine opposition to better understand why vaccination remains so controversial for some people.