United Kingdom: The Discontents of Compulsory Vaccination
“Smallpox was not a ‘filth disease’ and did not ‘cause’ erysipelas, but when it is recalled that children less than three months old were routinely being sent away from crowded vaccination stations with open wounds in their arms, to be tended in often vile conditions by parents ignorant through no fault of their own of the most elementary notions of hygiene or proper care in the case of illness, it is perhaps not to be wondered at that deaths occurred, and that conscientious and better-informed parents could be driven to protest against legislation compelling them to submit their children to surgery in conditions that no legislator or civil servant would have accepted for his own family.” (Williamson, 2007, p. 221)
Emanuel Swedenborg
Portrait of Emanuel Swedenborg holding his book Apocalypse Revealed, painted in 1766 by Per Krafft the Elder
A man self-administering hydrotherapy, sitting outside in a barrel
Colored lithograph of a man performing hydrotherapy on himself; the lettering reads "Cure for a fever. Sit in the water but let the spout run on your head till you feel better."
Resistance to compulsory smallpox vaccination in Great Britain arose almost immediately after the Vaccination Act of 1853 was passed. Although the objections of anti-vaccinators were not monolithic, certain tropes recurred through their work: medical compulsion was an assault on individual liberty, vaccination was dangerous, and alternative medical practices were a better avenue for treatment. One of the first to write against compulsory vaccination, John Gibbs, considered hydrotherapy as an alternative to vaccination and asserted that compulsory vaccination obliterated parental rights and threatened to spread diseases like syphilis. The post hoc ergo propter hoc fallacy (i.e., the belief that if something follows an event, it must be because of that event) was particularly prevalent among anti-vaccinationists. Rev. William Hume-Rothery, for instance, published a running list of children who died sometime after being vaccinated, assuming their suffering must be due to vaccination and not some other medical condition. The influence of Swedish mystic Emanuel Swedenborg, who believed that each globule of blood was invested with spiritual significance, is also present in many anti-vaccinationist tracts in their deep concern about blood contamination.
One group of anti-vaccinators consisted of doctors who objected to the science used to justify vaccination. To an extent, this was unsurprising, as Edward Jenner himself did not fully understand how vaccination worked, seeing as he and his contemporaries lacked modern knowledge about the functioning of the immune system. In this light, the treatment of some of these vaccine skeptics was a bit unfair: Edgar Crookshank, a professor of comparative pathology and bacteriology at King's College, was furiously condemned by his professional colleagues until he retracted his claim that vaccine inoculum was actually derived from smallpox, not cowpox, and therefore not as safe as believed. Other physicians were less reasoned in their claims. Charles Creighton claimed there was no connection between cowpox and smallpox; instead, cowpox was related to the great pox (i.e., syphilis) through the "unconscious memory" of disease, and Jenner was a charlatan cosplaying as a healer.
Vaccination
An anti-vaccination cartoon from 1802 showing Edward Jenner and other vaccinators feeding infants to a monster while a team of vaccine skeptics descend from a Temple of Fame wielding swords inscribed with the word "Truth" and monogrammed shields
Another series of objections to compulsory vaccination centered on the stiff penalties imposed on parents who did not vaccinate their children. The Vaccination Act of 1871, responding to concerns that boards of guardians were too hesitant to pursue prosecution against non-compliant parents, appointed vaccination officers whose specific duty was to ensure compliance in their jurisdiction. Unfortunately, the new regime may have shifted too far in the direction of law enforcement: even proponents of vaccine compulsion were disturbed by reports of working fathers being thrown in jail for a couple of weeks because extenuating circumstances prevented them from vaccinating their children in a timely manner. Such draconian punishment increased public sympathy for opponents of compulsory vaccination, particularly in the city of Leicester, which boasted an anti-establishment streak.
The quality of public vaccination clinics was another obstacle to vaccination campaigns. A plethora of issues imperiled the health of poor Britons seeking vaccination at substandard clinics: vaccinations given to ill infants, the reuse of (sometimes rusty) lancets, and overcrowded waiting rooms. Anti-vaccinationists seized on the weakness of the public vaccination system, with Dr. W. J. Collins of the Royal College of Surgeons arguing that public vaccination was impractical and parents ought to decide for their families whether these potential hazards were worth the promises of vaccination.
Anti-vaccinationists' tendency to ignore the potential for reform to focus instead on the negative consequences of vaccination was seen again amidst a syphilis outbreak in 1871. That year the Medical Department of the Privy Council became aware of a series of incidents in which children developed syphilis shortly after being vaccinated against smallpox. Although an investigation by surgeon Jonathan Hutchinson determined that the syphilis cases were attributable to either congenital syphilis and vaccinators failing to follow rules regarding the collection of blood-- the outbreak had nothing to do with contaminated lymph or anything else pertaining to vaccination in and of itself-- anti-vaccinationists seized on the incident to make apocalyptic pronouncements about the threat of widespread infection. Ultimately, the outbreak motivated the transition away from arm-to-arm vaccine transmission: guaranteeing no blood would be collected with vaccine lymph was too difficult, so animal lymph was used more frequently in vaccines. Although legislation to promote the use of animal-based lymph failed, the National Vaccine Establishment independently worked to create a stable system of calf-to-calf vaccination to ensure that there was a stable supply of cowpox lymph that could supplant arm-to-arm human vaccination.
Gloucester smallpox epidemic, 1896: William Allen
Photography by H.C.F. of smallpox patient William Allen in Gloucester, where the last major British outbreak of smallpox occurred in 1896
The anti-vaccinationists would never obtain the total repudiation of vaccination they sought, but the Vaccinations Acts would lose ground over the years. In 1889, the Home Secretary, under pressure from anti-vaccination lobbying, called a royal commission to consider the efficacy of vaccination and the need for medical reforms after a smallpox epidemic arose in Sheffield despite high vaccination rates. The commission was critical of the punishments used against non-vaccinating families-- namely, repeated fines for noncompliance and jail sentences for parents who were unable or unwilling to pay the fines-- and their final report called for parents who could demonstrate a conscientious objection to vaccination should be exempt from the vaccination mandate. The Vaccination Act of 1898 largely followed the recommendations of the royal commission while maintaining the vaccine mandate, all against the ironic backdrop of the last major smallpox outbreak in Britain being snuffed out in Gloucester with the aid of increased enforcement of vaccination compulsion. New legislation in 1907 made filing a conscientious objection easier: no longer did parents have to convince a magistrate that their objection was legitimate. In 1946, legislation that created the National Health Service nullified the Vaccination Acts, officially ending compulsory smallpox vaccination in the United Kingdom.
"Care must be taken to discriminate between what can be done by legislation for the people, and what can only be accomplished by themselves individually and swayed by the slow progress of opinion." -- William Farr, 5th Report of the Registrar General, 1843 (Williamson, p. 215)