It is often assumed that the ‘anti-vax’ movement began with Andrew Wakefield, and ‘that autism study’, or former Playboy model Jenny McCarthy’s claims that her son’s autism was caused by vaccination.

But did these two events really cause tens of thousands of parents to begin questioning vaccines and getting embroiled in bitter skirmishes on social media? Personally, I had never heard of Andrew Wakefield, or Jenny McCarthy, when I first began to delve into the vaccine subject, in early 2010.

Opposition to vaccination is not a new phenomenon – for as long as there have been vaccines, there has been fierce opposition. Originally focused in England, that opposition really gained momentum when the Compulsory Vaccination Act was passed in Victorian England, in 1853.

The main pockets of opposition to compulsory vaccination were among the working class, and the clergy, who believed it was ‘un-Christian’ to inject people with animal products [1].

The original Vaccination Act in 1840 had provided free vaccination for the poor, to be administered by the Poor Law guardians. This law, however, was a failure, as the “lower and uneducated classes” did not take up the offer of free vaccination [1].

The Compulsory Vaccination Act of 1853 went a lot further – it ordered all babies up to 3 months old be vaccinated ( to be administered by Poor Law Guardians), and in 1867, this was extended up to 14 years of age, and penalties for non-compliance were introduced.

Doctors were encouraged to report non-vaccinators to the authorities, by “financial inducements for compliance and penalties for failure”. While the 1853 Act had introduced one-off fines or imprisonment, the 1867 Act increased this, to continuous and cumulative penalties, so that parent’s found guilty of default could be fined continuously, with increasing prison sentences, until their child reached 14 years of age [2].

(As an interesting side-note here, the vaccination laws were not the only incursions of the state during this time, at the expense of personal liberty, and private bodily autonomy. The Contagious Diseases Acts of 1864, 1866, and 1869, required that any woman suspected of prostitution was to be medically inspected for venereal disease. If deemed to be infectious, she was confined in hospital for treatment, with or without her consent. The Notification of Infectious Diseases Acts in 1889 and 1899 required that all contagious diseases – except tuberculosis, which is rather odd, since it was a major killer at the time – be reported to the local medical officer, who could then forcibly remove the patient to hospital, whether they consented or not [1].

Meanwhile, the vaccination laws were tightened yet again in 1871 (ironically, the same year that a large smallpox epidemic raged across Europe and England – a testament to how ‘effective’ the compulsory laws had been?), making it compulsory for all local authorities to hire Vaccination Officers [2].

In response to these increasingly draconian measures, the Anti-Vaccination League was formed in England, and a number of anti-vaccine journals sprang up, which “included the Anti-Vaccinator (founded 1869), the National Anti-Compulsory Vaccination Reporter (1874), and the Vaccination Inquirer (1879)”.

A number of other writings and pamphlets were distributed widely – for example, 200,000 copies of an open letter titled ‘Current Fallacies About Vaccination’, written by Leicester Member of Parliament, P Taylor, were distributed in 1883 [2].

The vaccination process was painful and inconvenient, for both parents and children alike. The vaccinator used a lancet (a surgical knife with sharp, double-edged blade) to cut lines into the flesh in a scored pattern. This was usually done in several different places on the arm. Vaccine lymph was then smeared into the cuts. Infants then had to be brought back eight days later, to have the lymph (pus!) harvested from their blisters, which was then used on waiting infants [1].

Following the strict 1871 amendments to the law, parents could even be fined 20 shillings for refusing to allow the pus to be collected from their children’s blisters, to be used for public vaccination [1].

By this point, severe and sometimes fatal reactions to the vaccine were being reported, and doubts began to grow about how effective the vaccine really was [3].

The town of Leicester was a particular hot-bed of anti-vaccine activity, with many marches and rallies, demanding repeal of the law, and advocating other measures of containment, such as isolation of the infected. Up to 100,000 people attended these rallies [4].

The unrest and opposition continued for two decades, and an estimated 6000 prosecutions were carried out, in the town of Leicester alone [3].

The following excerpts from the Leicester Mercury bears witness to the deep convictions held by those who refused to submit to the mandatory measures:

“‘George Banford had a child born in 1868. It was vaccinated and after the operation the child was covered with sores, and it was some considerable time before it was able to leave the house. Again Mr. Banford complied with the law in 1870. This child was vaccinated by Dr. Sloane in the belief that by going to him they would get pure matter. In that case erysipelas set in, and the child was on a bed of sickness for some time. In the third case the child was born in 1872, and soon after vaccination erysipelas set in and it took such a bad course that at the expiration of 14 days the child died“.

Mr Banford was fined 10 shillings, with the option of seven days imprisonment, for refusing to subject his fourth child to the vaccine [5].

And again…‘By about 7.30 a goodly number of anti-vaccinators were present, and an escort was formed, preceded by a banner, to accompany a young mother and two men, all of whom had resolved to give themselves up to the police and undergo imprisonment in preference to having their children vaccinated. The utmost sympathy was expressed for the poor woman, who bore up bravely, and although seeming to feel her position expressed her determination to go to prison again and again rather than give her child over to the “tender mercies” of a public vaccinator. The three were attended by a numerous crowd and in Gallowtreegate three hearty cheers were given for them, which were renewed with increased vigour as they entered the doors of the police cells [6]”.

Eventually, there were so many refusers in the town of Leicester, that some local magistrates and politicians declared their support for parental rights, and encouraged their peers to do the same [3].

The law was finally relaxed in 1898. New laws were passed, allowing for conscientious objection of vaccination [7]. By the end of that same year, more than 200,000 certificates of conscientious objection had been issued, most among the working class, and many were women. [1]

Meanwhile in the United States, smallpox outbreaks in the late 1800’s led to vaccine campaigns, and subsequent opposition in the formation of The Anti-Vaccination Society of America in 1879, followed by the New England Anti Compulsory Vaccination League in 1882, and the Anti Vaccination League of New York City in 1885 [4].

The homeless and the itinerate were blamed for spreading smallpox, and in 1901, the Boston Board of Health ordered ‘virus squads’ to force-vaccinate men staying in cheap boarding rooms [8].

Following a smallpox outbreak in 1902, the Cambridge Board of Health in Massachusetts mandated vaccination for all city residents. This led to possibly the most important, and controversial, judicial decision regarding public health.

One man, Henning Jacobson refused to comply with the mandate, on the grounds that it violated his right to care for his own body as he saw fit. The city filed criminal charges against him, which he fought, and lost, in court. He appealed to the US Supreme Court, who ruled in the State’s favour in 1905, prioritising public health over individual liberty [9].

The ‘anti-vaxxers’ have never gone away in the intervening years, though sometimes they have been more vocal than others, such as in the 1970’s, when there was controversy throughout Europe, North America and Britain, about the safety and potential side effects of the diptheria-tetanus-pertussis vaccine [10].

In 1998, the vaccination argument came to the public attention again, with Andrew Wakefield’s case series published in the Lancet. Although the report was looking at a link between autistic disorders and bowel dysfunction, it mentioned in its conclusion that a number of parents believed their child’s symptoms began after MMR vaccination [11]. The authors felt this potential link deserved more investigation…

The furore and the fall-out are still ongoing. Wakefield was found guilty of failing to get proper ethics approval for the study, and he and a fellow investigator were subsequently ‘struck off’. Wakefield’s fellow investigator later challenged the decision, and won [12]. And while a number of researchers later confirmed the original findings, of bowel dysfunction in autistic children [13-16], Wakefield’s reputation and career have been left in tatters – the subject of mockery and derision.

Anybody who confesses to have doubts about the safety of efficacy of vaccines, as a general rule, get a taste of the same scorn and derision that Andrew Wakefield has received.

Even in the era of smallpox vaccination, the media tended to portray anti-vaxxers in a less-than-flattering light. At that time, the media referred to the debate as a “conflict between intelligence and ignorance, civilization and barbarism [9].

So, are anti-vaxxers really anti-science?

Not according to science.

In 2007, Kim et al analysed vaccination records of 11,680 children from 19 to 35 months of age, to evaluate maternal characteristics that might influence whether the child was fully vaccinated, or not.

They discovered that mothers with tertiary degrees and high incomes were the least likely to fully vaccinate their children, while mothers in poor minority families without high school diplomas were the most likely to fully vaccinate their children [17].

Similarly, a study in 2008 that investigated the attitudes and beliefs of parents who decided to opt out of childhood vaccine mandates, found that they valued scientific knowledge, were adept at collecting and processing information on vaccines…and had little trust in the medical community [18].

In 2017, the Australian Institute of Health and Welfare released their latest figures on vaccination rates. The national average was 93% of children fully vaccinated, yet in Sydney’s upmarket (ie. Highly educated, high income-earning professionals) inner suburbs and northern beaches, as few as 70% of children under 5 were fully vaccinated [19].

The same story was repeated in Melbourne, with the wealthiest – and by association, better educated – suburbs having the lowest vaccination rates. There was an ironic, and rather telling, opening paragraph in The Age, when reporting these figures: “Four of the wealthiest, healthiest suburbs of Melbourne have the worst child vaccination rates in the state [20]

Statistics gathered from Canada tell a similar story – a higher percentage of anti-vaxxers hold university degrees, compared to the national average [21].

It appears that doctors and paediatric specialists are not always in agreement with current vaccine practice either – at least, not when it comes to their own children: “Ten percent of paediatricians and 21% of paediatric specialists claim they would not follow [CDC] recommendations for future progeny. Despite their education, physicians in this study expressed concern over the safety of vaccines [22]”.

With the vaccine schedule becoming increasingly crowded, and governments moving towards compulsory vaccination, the anti-vaccination movement is again gathering momentum. Increasing numbers of parents are delaying, declining, or opting for alternative vaccine schedules [23-24].

Around the world, as vaccine scepticism is on the rise, history looks set to repeat, as governments are becoming increasingly more forceful in trying to curb the sentiment. Time will tell how this round will play out…

References:

[1] Durbach, N. They might as well brand us: Working class resistance to compulsory vaccination in Victorian England. The Society for the Social History of Medicine, 2000, 13:45-62.

[2] Porter D, Porter R. The politics of prevention: anti-vaccinationism and public health in nineteenth-century England. Med Hist. 1988;32(3):231-52.

[3] Williamson S. Anti-vaccination leagues: One hundred years ago, Arch Dis Child, 1984, 59: 1195-1196.

[4] Wolfe, R.M., Sharpe, L.K. Anti-vaccinationists past and present. BMJ. 2002d;325:430-432.

[5] Leicester Mercury, 10th March, 1884.

[6] Leicester Mercury, 10th June, 1884.

[7] Wohl A. Endangered Lives: Public Health in Victorian Britain, 1984, Methuen, London, pp. 134-135.

[8] ] Albert, M., Ostheimer, K.G., Breman, J.G. The last smallpox epidemic in Boston and the vaccination controversy. N Engl J Med. 2001;344: 375-379.

[9] Gostin, L. Jacobson vs. Massachusetts at 100 years: Police powers and civil liberties in tension. AJPH. 2005;95:576-581.

[10] Baker, J. The pertussis vaccine controversy in Great Britain, 1974-1986. Vaccine. 2003;21:4003-4011.

[11] Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive development disorder in children, Lancet, 1998, 3519103): 637-641.

[12] Professor John Walker Smith vs General Medical Council [2012] EWHC 503, http://www.eastwoodslaw.co.uk/wp-content/uploads/2013/03/Walker-Smith.pdf. Accessed September, 2017.

[13] Horvath K, Medeiros L, Rabszlyn A, et al. High prevalence of gastrointestinal symptoms in children with autistic spectrum disorder (ASD). J Pediatr Gastroenterol Nutr 2000, 31:S174.

[14] Horvath K and Perman JA. Autistic disorder and gastrointestinal disease, Current Opinion in Pediatrics 2002, 14:583-587

[15] Ashwood P, Anthony A, Torrente F, Wakefield AJ. Spontaneous mucosal lymphocyte cytokine profiles in children with regressive autism and gastrointestinal symptoms: Mucosal immune activation and reduced counter regulatory interleukin-10. Journal of Clinical Immunology. 2004:24:664-673.

[16] Torrente F, Anthony A, Heuschkel RB, et al. Focal-enhanced gastritis in regressive autism with features distinct from Crohn’s and helicobacter pylori gastritis. Am. J Gastroenterol. 2004;4:598-605.

[17] Kim SS, Frimpong JA, et al. Effects of maternal and provider characteristics on up-to-date immunization status of children aged 19-35 months. Am J Public Health, 2007, 97(2): 259-266.

[18] Gullion JS, Henry L, Gullion G. Deciding to opt out of childhood vaccination mandates. Public Health Nurs, 2008, 25(5): 401-408.

[19] Aubusson K, Butt C, Sydney postcode has Australia’s worst vaccination rate for five year old children, Sydney Morning Herald, 8th June, 2017.

[20] Butt C, Spooner R, Melbourne vaccination data: immunisation rates not improving in wealthy inner-city suburbs, The Age, 7th June, 2017.

[21] Chai C, Who are the anti-vaxxers in Canada? New poll profiles resistant group, Global News, 9th March, 2015.

[22] Martin, M. and Badalyan, V, Vaccination practices among physicians and their children. Open Journal of Pediatrics, 2012, 2:228-235.

[23] McCauley MM, Kennedy A, Basket M, Sheedy K. Exploring the choice to refuse or delay vaccines: a national survey of parents of 6- through 23-month olds, Acad Pediatr, 2012, 125): 375-383.

[24] Robison SG, Groom H, Young C. Frequency of alternative immunization schedule use in a metropolitan area, Pediatrics, 2012, 1301): 31-38.

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