In Victorian England, nearly a century after the physician Edward Jenner had shown that exposure to the cowpox virus, or vaccinia, conferred immunity to smallpox, vaccination against smallpox was both a life-saving public health measure and a source of immense controversy. Vaccination was compulsory; parents were required to have their children immunized by three months of age or face fines that escalated as long as they refused to do so. Parents organized against the requirement, forming anti-vaccinationist societies, the largest of which was the National Anti-Compulsory Vaccination League, to promote their cause. They founded their own newspapers, circulating tales of sickened and disfigured children injured by vaccination, complete with shocking photographs, through the national media. Protestors organized mass demonstrations and challenged the law in the courts, banding together to pay the fines and court costs of parents who could not afford them. Without such helps, a family’s goods could be auctioned off and parents jailed until debts were paid—the consequences of opposition were not minor.
In many ways, the history of compulsory smallpox vaccination echoes present-day vaccination controversies. Then, as now, the vaccination debate raised vital questions: what are the limits to the claims a state, acting in the name of the public good, can make on an individual and his or her body? When are individuals justified in resisting these claims, and what intellectual, spiritual, and moral resources can a person draw on in support of his or her resistance? What, ultimately, should be the role of science and medicine in a free society?
In Victorian England, opposition to vaccination had a lot to do with how the vaccine was administered. As described by Nadja Durbach in her book Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907, vaccination piggybacked on the Poor Law which, in the Victorian era, tried to discourage poverty by forcing the indigent into workhouses in which families were broken up, personal belongs taken away, and children and parents forced to work long hours of brutal physical labor. The same officials who administered the laws that ushered the poor into the workhouses oversaw the provision of free, public vaccination. For middle and working class parents, vaccination thus seemed to carry with it with it the social stigma of accepting welfare. They also feared that it was a short step from vaccination to the workhouse.
The vaccine helped to reduce the incidence of smallpox, a deadly, endemic disease. But it was also often unsafe and unsanitary, and those on the lower end of the socioeconomic spectrum bore the heaviest risk of harm here, as well. Those without means to pay a private doctor to vaccinate their children were forced to go to the public vaccinators, where the vaccine was administered “arm-to-arm.” A vaccinator scratched cuts into an infant’s arm and scraped “lymph,” i.e. pus, into the cuts. The lymph was taken directly from the blisters that had formed on the arm of another child who had been vaccinated the previous week. Initially, there was no way to reliably store vaccine, and the authorities deemed this method the most efficient way to ensure that there was a consistent supply of vaccine available. Parents who refused to bring their babies to serve as a source of vaccine for another child were subject to fines, just like those who refused to be vaccinated in the first place. The middle class and upper classes, because they obtained their vaccinations privately, were able to avoid having their children serve as vaccine factories. The poor were not so lucky.
Objectors rightly believed that vaccination made them sick. In the best-case scenario, the vaccine conferred immunity to the disease and caused some swelling of the arm and fever. But the vaccine could also provoke full-blown cases of smallpox. Additionally, with little attention paid to hygiene as vaccine was passed from arm to arm, other diseases could be spread with it. Syphilis was particularly feared. Depending on the skill of the vaccinator and the quality of the lymph used, the vaccine could also be ineffective in preventing smallpox.
Health and safety objections to vaccination were grounded in broader religious, spiritual, and medical frameworks. Anti-vaccination was particularly associated with religious nonconformists (generally, Protestant Christians who did not support the state-sponsored Anglican Church). Some believed that it was folly to think that humans could circumvent God’s will through vaccination. Others believed that all that God had made was good, and even smallpox must serve a purpose. Others abhorred the mixing of human and animal that occurred when lymph ultimately derived from cows was introduced into the human body: for these individuals, as Durbach observes, vaccination was the “mark of the beast.” (Ironically, from a modern perspective, some evolutionists abhorred vaccination for somewhat similar reasons, worrying that the mixing of animal and human caused the human species to degenerate, or regress, to a lower form of life.) Resistors, connecting the spiritual and the medical, argued that vaccination caused disease because it violated their spiritual precepts.
Opposition to vaccination tapped into the holistic, naturopathic preoccupations of the day, as well. The modern industrial era, with its packed, filthy cities and its sped-up tempo, was making people sick. The vaccine was part of that unnatural modern world; of course it caused disease. Much better to eat a healthy diet, get lots of fresh air, avoid introducing unnatural or foreign substances into the body, and clean up your house and your city. Much better to avoid physicians and their vaccine altogether.
Though medical and public health authorities looked down upon vaccination opponents and their claims, opposition had the effect of making vaccination better. As the historian Peter Baldwin writes in Contagion and the State in Europe, 1830-1930, over time the British government responded to anti-vaccinators’ concerns by taking measures to make vaccination safer and more effective. They came to require more stringent training and licensing procedures for those who administered vaccines. They also moved away from the “arm-to-arm” method, switching instead to lymph taken directly from cows and stored in glycerin, which acted as a mild bactericide, helping to prevent other diseases from being transmitted along with the vaccine. Ultimately, in 1907 the English government made vaccination non-compulsory, allowing parents to obtain certificates testifying that upon careful consideration they conscientiously objected to the vaccination of their children. (This is the origin of the modern category of the “conscientious objector.”) Once vaccination was no longer compulsory, vaccination rates plunged, as did membership in the National Anti-Compulsory Vaccination League. But smallpox remained under control—the disease was on the decline in England, and careful quarantine procedures ensured that cases that arrived from foreign shores did not lead to epidemics.
A lot has changed in the century-plus since the conscientious objector exemption was written into British law. Vaccines are used to prevent the spread of many more diseases. Though not risk-free, they are vastly safer; other diseases are much less likely to be unwittingly transmitted with them, and the side effects of vaccination are relatively mild (usually restricted to a fever or a little soreness at the vaccination site). In the U.S., although children are generally required to be up-to-date on their vaccines before they can begin school, parents can exempt them if they so choose. In some states, parents are required to justify their exemption on religious grounds; in others, a conscientious objection to vaccination is all that’s necessary. Vaccines are more humanely administered, often, though not always, in the privacy of a doctor’s office. Though physical compulsion was used abroad as recently as the 1970s, during the global campaign to eradicate smallpox, poor children were not made to serve as reservoirs of vaccine material for others. There’s also a national reporting system for adverse events that may have been caused by vaccination, so that vaccine injuries can be tracked and vaccines recalled, if necessary. The federal government, in the form of the CDC and the FDA, recognizes that vaccines can cause significant harm, however rarely, and has taken steps to minimize that harm.
Yet vaccination is still fraught with controversy. Latter-day anti-vaccination activists echo many of the concerns, as well as the tactics, of their nineteenth-century antecedents. Certain spiritual and religious communities object to it as part of an overall rejection of medical treatment in favor of the healing powers of prayer and faith. Such groups include everyone from faith healers in Philadelphia (among whom a 1990-1991 measles outbreak lead to the death of 9 children) to the followers of Maharishi Mahesh Yogi in Fairfield, Iowa, where a 2006 outbreak required the quarantine of roughly 1,000 people, as described by Arthur Allen in his book Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver.
Modern anti-vaccinators raise health and safety claims, too. As in the nineteenth century, such objections to vaccination are frequently rooted in spiritual beliefs about health, healing, and human development. Sometimes modern anti-vaccinators’ beliefs can be directly traced to those of the earlier generation of vaccine resistors. In the United States, for example, opposition to vaccination sometimes overlaps with Waldorf educational philosophies. The Waldorf educational approach, developed in the early twentieth century by the Austrian mystic Rudolph Steiner, is part of an overall spiritual and philosophical framework according to which illness is believed to strengthen both body and spirit. According to Allen, twenty-first century resistors building on Steiner’s philosophy cast this claim in modern scientific language, saying that suffering through diseases is the only way to really develop one’s immune system. Many anti-vaccinators are not simply anti-science; rather, they selectively incorporate mainstream scientific knowledge into their belief systems.
Most famously in recent decades, British physician Andrew Wakefield linked autism to the combined vaccine for measles, mumps, and rubella. This connection has been definitively disproved (and Wakefield’s research shown to be fraudulent), yet it persists. Celebrities have taken up opposition to vaccination as a cause and used their fame to amplify the spread of misinformation and fear. Jenny McCarthy, the most famous of modern antivaccinators, continued to perpetuate the connection between autism and vaccines after it was disproven, questioning the scientific research that showed it to be false. Concerned parents can find each other on the Internet, where they discuss their fears, dissect the science, and promote their movement, much as nineteenth-century anti-vaccinators started newspapers and wrote books.
This activism has had sobering effects. In the U.K., measles vaccination rates dropped from 90 percent to 80 percent after the research linking vaccines to autism was published in 1998. In the U.S., measles cases are now at a 20-year high, with almost all cases being the product of unvaccinated individuals—most of whom have rejected vaccination for religious, philosophical, or personal reasons, rather than medical necessity—bringing the disease home after travel to parts of the world where it is endemic. The prevalence of whooping cough, or pertussis, which can be fatal for infants, has also tracked with anti-vaccination scares. (Though, in this case, the scientific issues are somewhat more complicated; individuals who reject the pertussis vaccine for themselves and their children do not bear all the blame for recent outbreaks. The immunity conferred by the acellular form of the pertussis vaccine, which uses only fragments of the pertussis bacterium, fades over time, requiring booster shots. But researchers only discovered this fact after the acellular vaccine replaced the whole cell variety in the 1990s.)
Opposition to vaccination, especially when it’s based on fears and misinformation, is frustrating. But it’s also understandable. Tellingly, such opposition is the province of no one group (religious or otherwise). Vaccination occupies a sensitive spot in the science-society interface, inside a square formed by a parent, a doctor, a baby, and the state, which still insists (though less firmly) on vaccination as a precondition for participation in civil society. Opposition to vaccination is driven by the fear and uncertainty that attends all things, the raising of children especially. In the service of protecting those we love most, we seek to understand; we seek to control. When things go wrong, we long for someone—or something—to blame. And scientists and doctors can’t always answer all the questions that we have about the effect that any vaccine, or any medicine, will have on a given individual. Given these pressures, it seems unlikely that anti-vaccination movements will ever be permanently tamed.
Even if it were possible to put an end to opposition to vaccines, it’s not clear that this would be a good thing. In nineteenth-century England, the anti-vaccination movement helped to drive a political and scientific process through which smallpox vaccination was made safer and more effective. Furthermore, no public policy—not even one grounded in thorough scientific research undertaken by those with the best of intentions—is exempt from political opposition. This is true even when that opposition defends itself with bad science or no science at all. It’s especially true when public policy impinges on an individual’s charge over her own body and the bodies in her care.
We can, and should, do our best to counter fear and misinformation with the evidence that vaccination is safe and effective. Yet we should also remember that the history of vaccination as the triumph of humanity over disease is not just a history of heroic doctors, intrepid scientists, and public health officials; it’s also a history of concerned parents, anti-science spiritualists, and conscientious objectors.
Elizabeth Yale is an historian of science and adjunct assistant professor at The University of Iowa Center for the Book.