We’ve Been Here Before…..

Last week’s post by Lesley Henderson on the contemporary anti-vaccination movement’s use of social media, Charlie Davison takes a look at the history of the battle between Public Health and the ‘Anti-Vaxxers’, and finds that things haven’t changed much in over a century….

In 1896 the long awaited Royal Commission Report on Vaccination finally appeared. In those days the big issue was smallpox. In spite of the development of Edward Jenner’s original experiments into a comprehensive Public Health programme, the UK and other developed countries were facing a major smallpox threat. The problem was that there were a large number (too large from a technical Public Health point of view) of people in the population who were so wary of vaccination technology that they were declining vaccination and refusing to present their children for injections.

A cartoon from a December 1894 anti-vaccination publication

Although the 1840s saw the establishment of a legal obligation to take part in the vaccination programme, and an attendant regime of fines and prison sentences, this had little impact on the culture of defiance which was strong, deep and, if anything, growing. A fact borne out by the astonishingly large attendance at the 1885 mass rally against vaccination that brought an estimated 100,000 citizens onto the streets of Leicester, and included representatives from anti-vaccination groups drawn from across the entire country.

The Royal Commission, however, also dropped a bombshell whose shockwaves continue to reverberate down the years. The state policy of compulsion on the individual was found to be misguided and inappropriate. The Commission’s recommendation (swiftly accepted by government) was that any citizen should be allowed to decline vaccination for themselves and also on behalf of their children. The Commission’s view was that they should be able to do this on the grounds of their own beliefs and their own ethical codes. In Victorian language, this was known as ‘objection based on conscience’. The concept of the conscientious objector entered British law in this context, even though its more famous cultural and political impacts turned out to be connected to a different state enterprise altogether – the waging of war.

One of the striking aspects of the 19th-century vaccination debate is that (at least!) two of its main elements are still alive and kicking over a century further down the road. First is a fear of the contamination of previously healthy bodies by the introduction of extraneous and dangerous material. Second is a concentration on the individual experiences and personal stories of people who have been killed or harmed by vaccination.

In terms of the first point on the contamination of bodies. The use of poisonous or ‘disgusting’ materials in the preparation of vaccines was a major element in the Victorian movement. At the Leicester demonstration, one banner read “From Horse Grease, Calf Lymph and the Local Government Board – Good Lord Protect Us!”. A speaker told the crowd that they had the right to live with: “Pure blood – and no adulteration”. A Belgian delegation’s banner was inscribed (in French) “Neither penalties nor prison can prevent vaccine being a poison”. All of these sentiments can be easily found in the discourse of contemporary anti-vaccination movements.

The use of individual stories of vaccine damage and bodily contamination to counter (and outweigh) the accumulation of impersonal scientific evidence was a major feature of the 1890’s hearings of the Royal Commission. The evidence from a “monumental mason of Gloucester” whose twelfth child was “never so well or so strong after vaccination” was reported in the British Medical Journal along with the weary observation that “there were many witnesses of this kind”. In the modern world, this element of anti-vax arguments is particularly strong. The collective stories of individual campaigners and organised groups ensure that the concept of ‘vaccine damage’ is a conspicuous and constant element of public argument and debate. In the contemporary world, social media platforms are playing a major role in bringing this element to the fore.

In terms of the second point, the ‘conscientious objection’. This issue is also very much alive, but the removal of compulsion in the 1890s has been superseded in Britain by more modern arguments and laws relating to the State’s responsibility to look out for the interests of children and take on an over-riding responsibility for their wellbeing. Individual acts of ‘vaccine refusal’ can thus find their way to court and compulsion has been, to a certain extent, reintroduced. In other European countries, particularly France and Italy, recent sharp rises in measles cases have brought compulsory vaccination to the top of the political agenda.

 A very interesting take on contemporary conscientious objection to vaccination and the ethics of the responsibility of an individual towards the collective is presented by ethicists Clarke, Giubilini and Walker in the journal Bioethics (open access). Their examination of how conscientious objection to military service has been dealt with by legal systems provides a glimpse of a system that could allow an ‘opt-out’ system to work, as long as those against vaccination are as prepared to suffer for their cause as their pacifist counterparts have always been. Their argument is that ‘conscientious objection’ has been allowable by states in the context of a culture of reciprocity. In this kind of ethical landscape individuals desiring to opt out of a collective endeavour are required to give something (collectively judged to be commensurate) in return or in substitution, such as volunteering to becoming a stretcher bearer or medical orderly on the battlefield. In the absence of an acceptable and workable exchange, objectors may have to accept sanctions such as fines or loss of rights. One problem with this kind of approach could be that many objectors to vaccination (and other Public Health endeavours) base their opposition on political ideologies of ‘libertarianism’ and a generalised antipathy towards state-organised collective action. In common with their nineteenth-century forebears, an acceptance that they are out-of-step with a generalised public good is unlikely to be offered meekly.