Felicity Mellor on enduring public anxieties
Arthur Allen, Vaccine: the controversial story of medicine’s greatest lifesaver (New York: W.W. Norton, 2007)
An eminent scientist speaks out against vaccination. Public health officials insist that vaccines are safe. The public think otherwise and vaccination rates fall dramatically.
No, this is not 1998. Exactly a century before gastroenterologist Andrew Wakefield raised concerns about a possible link between the MMR vaccine and autism, the British health authorities were grappling with another vaccine revolt.
‘Baby hunters’
In the late nineteenth century, those failing to submit to vaccination faced fines and the workhouse. There were frequent public protests and the ‘baby hunters’, as the vaccinators were known, were pelted with eggs and fruit. Things came to a head in 1898, when parliament met to deliberate the findings of a Royal Commission on the safety and effectiveness of vaccination.
Lord Alfred Wallace, the naturalist who, along with Darwin, had proposed a theory of natural selection, published a pamphlet arguing that smallpox vaccine actually caused the disease. Parliament gave in and passed a new law permitting ‘conscientious objectors’ to be excused vaccination. Over the next fifty years, smallpox vaccination rates fell from 50 per cent to 18 per cent.
Not only science
As journalist Arthur Allen’s fascinating history makes clear, public anxieties about vaccination are as old as the technique itself. Drawing both on original sources and scholarly analyses, Allen shows how vaccination, throughout its history, has been as much a political, social, economic, religious and even military issue, as it has been a scientific one.
A medical intervention in otherwise healthy subjects inevitably raised difficult questions. Should vaccination be compulsory or voluntary? Was mass vaccination always the best strategy, or were policies of containment, quarantine and selective vaccination preferable? How would the elimination of certain diseases from children affect the prevalence and progression of those diseases in the adult population? And – the most fundamental question of all – how could individual risk be weighed against the promise of a social good?
Official denials
Public doubts about the benefits of vaccination were often not helped by technical difficulties with vaccine production or by public health officials’ refusal to acknowledge these difficulties. In Philadelphia in 1901, contaminated smallpox vaccine led to an outbreak of tetanus. Doctors initially denied a link and blamed newspaper scare stories and the victims’ own poor hygiene.
During the second World War, the only major epidemic to afflict the US army was vaccine-linked hepatitis. Sixty-two people died and over twenty thousand were infected. The authorities insisted that the hepatitis was spreading from the civilian population before finally identifying a contaminated yellow-fever vaccine as the source of the epidemic.
A measles vaccine tested in Britain in 1961 caused raging fevers in most of the children it was tested on. In a comment that must have given little reassurance to concerned parents, a US epidemiologist claimed that the importance of measles ‘should not be measured by disability or deaths, but by human values.’ The disease should be eradicated ‘because it is there... and it can be done.’
Modern protestors
Allen reveals the intransigence and arrogance of some vaccinologists, but he also portrays the vaccine protestors of modern-day America as selfish individualists – middle-class mothers who claim that illness is healthy and that vaccination is merely a means for negligent working mothers to avoid having to stay home with their sick children.
Allen also makes clear that it is not a lack of education that prevents parents from vaccinating their children. Indeed, he finds that in Colorado a high concentration of PhDs is a risk factor for whooping cough. In at least one Colorado school, roughly half the children go unvaccinated.
US v. UK
Allen details the occasions on which vaccines have been found to be unsafe, but his account also shows how each such incident prompted more regulation and oversight leading to ever-safer vaccines. His focus is firmly on the history of vaccination in the United States. There, the lack of government intervention in the vaccine market meant that, as regulation and litigation increased, many pharmaceutical companies abandoned vaccine production. Allen concludes that vaccines ‘were square pegs that didn’t fit into the triangular holes of market capitalism.’
From the US perspective, the Wakefield episode was just another blip in a long-running dispute about the link between vaccination and autism. To Allen, the UK offers an example of how vaccination can be better managed. In the UK, he notes, a more sceptical public is more fully vaccinated than in the US, Wakefield’s intervention notwithstanding.
For many British scientists, the Wakefield affair seems to have become a shorthand for media irresponsibility and public gullibility. Anyone tempted to take such a simplistic view of attitudes towards vaccination should read this book.
Dr Felicity Mellor is a Lecturer in Science and Communication at Imperial College London.