“The doctors lied”, Trump tweeted in 2014. Demotix/Andy Katz. All rights reserved.When it comes to public health, suspicions about medical science can do a lot of damage. Deciding not to vaccinate our children, or to ignore public health messages designed to combat epidemics, can have devastating effects on family and fellow citizens. Investigating why such suspicions arise and may even become conspiracy theories is vital in creating strategies to change dissenters’ minds.

As I listened to historian Stephen Mawdsley, a research fellow at Cambridge University and speaker at the CRASSH conference, Suspect Science, describe conspiracy theories about a polio vaccination programme in America in the late 1950s, I was struck by how similar they were to concerns about vaccinations and drug therapies today: the trials of the vaccine were too large to replicate (and therefore verify); they took place behind closed doors; the figures were manipulated; the ingredients were unsafe and the vaccine could be contaminated.

It all sounds very familiar. In early September this year, the NHS rolled out a vaccination programme for babies against Meningitis B, a strain that can cause brain damage, amputation, even death and affects 1,200 victims a year in the UK, many of them under one year old. A lively thread on the online parents forum Mumsnet reveals similar concerns to those described by Mawdsley: vaccines contain ‘germs’ and toxic amounts of aluminium; doctors stand to gain by vaccinating babies but they are ignorant or secretive about possible risks, it’s too new and hasn’t been tested enough. Many Mumsnetters who paid for the Men B vaccine before it became available on the NHS, however, testify to its efficacy and lack of side effects.

A recent report in the Daily Mail tells the story of a young Scottish schoolboy whose parents believe he is now suffering from seizures and narcolepsy (falling asleep constantly) as a result of a flu vaccine administered last year in a government programme for schools. His parents suspect the Scottish government of withholding information about the possible risks, while the government replies that there are no known links between the vaccine and his condition.

Why do some people still harbour the same concerns about medical interventions as were expressed in America in the 1950s?

Even the US Presidential nomination campaign is not immune. Donald Trump’s ‘anti-vax’ proclamations about the MMR vaccine because of suspected links with autism – a result of flawed research by the British doctor Andrew Wakefield – are a hot topic.

Why do some people still harbour the same concerns about medical interventions as were expressed in America in the 1950s? And if history is repeating itself, why haven’t we learned the lessons when the results can be so devastating? Several themes emerged during the CRASSH conference: suspicions about political and financial vested interests; uncertainty and anxiety about the nature of mutating viruses or new strains of bacteria; revulsion at ‘primitive’ living conditions in which disease can flourish, and that reinforce prejudices about race and class.

Useful fictions

Advertisement for the African American HIV/AIDS programme, American Red Cross. Wellcome images/Flickr. Some rights reserved.Take Harriet Washington's devastating critique of the medical abuse of slaves in nineteenth-century America, which, she argues, can help explain why many African Americans today are suspicious of medical interventions and avoid contact with doctors. The medical writer at the University of Nevada explained that it was in the interests of slave owners to believe that Africans did not suffer from diseases such as yellow fever or malaria, even though slaves were dying of them. Or that they did not feel pain when beaten or suffer from heat stroke.

Whether this was a conspiracy, or what Washington describes as “useful fiction”, or down to Victorian ethnographers’ ideas about how Africans were a different, inferior species is debatable. However, what is certain is that the slave owners’ belief that the reason so many slaves suffered from pellagra bolstered assumptions about racial inferiority. They believed the disease, which causes diarrhoea, dermatitis, dementia and even death, spread through the Africans’ dirty, unhygienic habits. Pellagra is in fact, we now know, caused by malnutrition.

It was the turn of the Chinese ‘coolie’ class to be criticised for unwholesomeness when British colonial officials accused them of ‘body dumping’ to avoid stringent public health measures during outbreaks of bubonic plague in Hong Kong in the late nineteenth and early twentieth centuries. This inflamed tensions between the colonial and Chinese authorities, leading to unhelpful accusations and counter accusations as to the causes of the outbreak, as Christos Lynteris, a social anthropologist and researcher at CRASSH explained. ‘Body dumping’ as he pointed out, resonates with tensions over the handling of corpses during the recent outbreak of Ebola in west Africa.

A century later, the same prejudices were at play with the arrival of HIV/AIDS in America, when blacks and gays were blamed for spreading the virus. This in turn was seen as a conspiracy to attack and even eradicate minorities who did not follow white heterosexual codes of sexual conduct.

Harvard researchers estimated that Mbeki’s conspiracy theory cost the lives of 330,000.

The stakes were raised as the AIDS outbreak spread worldwide, and advances in global communications made it easier to trade accusations and counter accusations. In South Africa, when President Thabo Mbeki, an AIDS denialist, refused to sanction the use of antiretroviral drugs, he countered his critics by comparing the "persecution" of HIV/AIDS denialists to the treatment of black people in South Africa during the apartheid era. Harvard researchers estimated that Mbeki’s conspiracy theory cost the lives of 330,000.

The labyrinthine twists and turns in the history of conspiracy theories about the origins of HIV/AIDS from the mid-1980s onwards – including that it was a US bioweapon invented to eliminate unwanted communities, a theory that the KGB were only to happy to promulgate and that is still in circulation today – were outlined in a forensic piece of research by Douglas Selvage that was much admired by his academic peers.

The politicisation of doubts

Vaccination centre 2010. Sanofi Eric Larrayadieu/Flickr. Some rights reserved.The politicisation of debates and doubts around the causes and spread of disease was nothing new, however. Doubts about the efficacy of new polio vaccines, developed in the US and Soviet Union in the 1950s, reflected suspicions about the motives of the two countries during the Cold War era, as Dora Vargha, a historian based at Birkbeck, explained. Although the polio virus had been discovered in 1908, the scale of this global outbreak was unprecedented, with 57,628 reported cases in the US alone in 1952, of which more than 21,000 caused paralysis. The Russians were as eager as anyone to find a cure, but became suspicious when they invited an American doctor to trial in the USSR one of the vaccines under development in the US, and discovered that it had not be trialled on American children. Surely this was a conspiracy to eradicate Russian children?

Cold war hostilities also underpinned doubts about polio vaccination in Hungary, as Vargha pointed out. A programme started there in 1957, only for a massive outbreak to occur two years later. Had the authorities watered down the vaccine to save money? The reason is not clear, but for public health programmes to be effective, there has to be a strong element of trust in the authorities. In the years after the failed Hungarian uprising against Soviet domination in 1956, this was not the case.

Conflicts of interest

H1N1 High Security, Bangkok. Emilio Labrador/Flickr. Some rights reserved.Around the same time that the Chinese coolies of Hong Kong were being subjected to stringent anti-plague measures, the Chinese community in San Francisco was quarantined during a smallpox outbreak in 1900 – much to the dismay of local businessmen and the governor, who were concerned that it would damage commercial interests. The federal bacteriologist, Dr Joseph J Kinyoun, who had identified the smallpox outbreak, became the target of a conspiracy theory that accused him of plotting against the city and even spreading the plague himself. Bacteriology was an emerging and little understood science, and the controversy in California is echoed today by concerns today about ‘biosecurity’. Are terrorists conspiring to wage bio-warfare in our cities, or are governments playing on such fears to justify draconian laws that restrict our civil liberties?

Are terrorists conspiring to wage bio-warfare in our cities, or are governments playing on such fears to justify draconian laws that restrict our civil liberties?

Suspicions around trust and transparency of authorities in managing disease were still alive and kicking as recently as 2009, when an outbreak of a new strain of flu was reported in Mexico. The H1N1 virus rapidly became known as swine flu because it resembled an illness caused in pigs, and as few people were immune, it spread rapidly from country to country. A global pandemic was announced by the World Health Organization (WHO) two months later, prompting a global pandemic of panic. While it is estimated that about 500,000 died worldwide as a result of the outbreak (a relatively but not excessively high number for seasonal flu), on 10 August 2010, the WHO declared the pandemic officially over.

Governments however, had stockpiled supplies of antiviral drugs to help combat the symptoms – to the tune of £400 million in the UK alone. Mark Honigsbaum, a historian based at Queen Mary University London, described accusations that WHO scientists deliberately downgraded the definition of a pandemic in order to hype swine flu. This would benefit manufacturers of antiviral drugs and potential vaccines – in which, it was alleged, some WHO scientists had vested interests. Paul Flynn, a UKIP MEP who wrote a report on the outbreak for the Council of Europe, christened it “the pandemic that never was” and condemned the WHO not only for its lack of transparency over possible conflicts of interest, but also for being too open with the public about the difficulty of dealing with a new and unpredictable virus, thus increasing public alarm. “It might not just be a conspiracy theory,” Flynn said, “it might be a very profitable conspiracy”.

No one doubts that the pharmaceutical industry benefits from the discovery of new diseases or new outbreaks. The revelation that the manufacturers of Tamiflu, one of the antiviral drugs stockpiled during the swine flu outbreak, did not publish data that undermines its effectiveness, helped trigger the All Trials campaign that calls for all past and present clinical trials to be registered and their full methods and summary results reported.

A spoonful of sugar?

Before the NHS. Flickr/Paul Townsend. Some rights reserved.Can suspicious scientific clouds have a silver lining? The All Trials campaign would suggest that they can. The historians who spoke at CRASSH might agree. The conflicts in colonial era Hong Kong over how to manage bubonic plague eventually brought a rapprochement between the British and Chinese, who learned to cooperate over public health measures. Douglas Selvage’s detailed tracking of how conspiracy theories about HIV/AIDS developed from the 1980s onwards prompted a question about whether a pathology of conspiracy theories could be developed to improve our understanding of them, with the theorists acting as vectors of disease, like mosquitoes who transmit suspicion rather than infection. If understanding the reasons why people believe in conspiracy theories makes the authorities better communicators, or reveals unknown lines of questioning or thought, that is a gain, not a loss.

Failure to admit failure can fuel conspiracy theories

While the public longs for hard facts in the midst of health scares, science can’t always offer them. The WHO’s director general, Margaret Chan, was being open and honest when she explained that the H1N1 virus was unpredictable. It can take a long time for scientists to understand the causes of disease and how to contain and prevent it, from pellagra to polio, AIDS to influenza, as the conference demonstrated.

But failure to admit failure can fuel conspiracy theories. And the failure to learn from history could be seen as a kind of conspiracy theory itself, that puts the interests of experts before the needs of the public. What were – and still are – suspicions about the conduct of medical scientists are not necessarily conspiracy theories propagated by paranoid loners on the internet: they may have their roots in experience, history or – in the case of conflicts of interest – contain an element of truth. Perhaps the problem is not so much that the public are ignorant about science, but that scientists don’t understand why the public sometimes thinks the way it does.