United Kingdom: The Road to Vaccine Compulsion

“[Jacob Bright, House of Commons Committee] Q: Then you approve of putting men into prison if they will not be vaccinated contrary to their own belief of the advantages of vaccination?

[John Simon] A: I should not myself put it quite in that way. I should regret very much that a person were imprisoned on account of his refusal to have his child vaccinated; it would be to me personally, if I were a magistrate, a very painful necessity to have to send a man to prison under cut circumstances; but he is not sent to prison for not having his child vaccinated: he is sent to prison for not obeying the law of his country; and if the judgment of Parliament, the final judgment of the Legislature, is not to be binding on crotchety people in this matter, so immensely important as it is for the public health, no law can be binding.” (Williamson, 2007, p. 168)

The origins of compulsory smallpox vaccination in the United Kingdom can be traced back to the times of Edward Jenner, when he and his supporters in the College of Physicians urged the government to support their new, life-saving treatment. Indeed, Jenner once secured an audience with then-Prime Minister Spencer Perceval. Perceval, however, was not receptive, much to Jenner's chagrin, as foreign powers were perfectly willing to make vaccination compulsory: Bavaria did so in 1807, Denmark in 1810, and Russia in 1812. Beyond political obstinacy, Jenner's efforts to promote vaccination were also frustrated by the preferences of the common people: the average Brit was more familiar with variolation than vaccination and did not understand why they should switch over to this new-fangled practice.

Gressenhall Workhouse

2009 photo by Evelyn Simak of Gressenhall Workhouse in Norfolk county in the United Kingdom

Government efforts to promote or regulate smallpox vaccination would not begin until 1840 when it was proposed that the management of vaccination be delegated to local Boards of Poor Law Guardians (authorities that administered relief for the poor). Such a scheme would help appoint qualified vaccinators to every borough in Britain, provide vaccines to the most needy, and help create a register of immunized citizens. However, critics contended that connecting vaccination-- already viewed with suspicion by that average lower-class citizen-- to the much-hated Poor Law guardians and their wretched workhouses would do little to actually increase vaccination rates. Indeed, in the parish of St. George the Martyr in south London, the Poor Law guardians mandated all vaccinations take place in the workhouse itself; the year after this change was made, vaccination rates in the parish plummeted by 96%. The Vaccination Act of 1840, passed shortly after these proposals were made, would not connect vaccination to workhouses, but it would make free vaccination the duty of Poor Law Commissioners and also render the less-effective practice of variolation illegal.

With efforts to make vaccines more available not measurably improving vaccination rates, some began to consider employing government power to make citizens get vaccinated. Medical officials bemoaned British political apathy towards public health, the abysmal pay of government vaccinators, and difficulties working with Poor Law guardians; they looked with envy at Continental affairs, where Austrian police officers had the authority to take unvaccinated people to clinics and French marriage licenses required a vaccination certificate. Their lobbying ultimately resulted in the Vaccination Act of 1853, but what little forms of compulsion existed in this law applied only to people born in England and Wales (immigrants and the rest of the United Kingdom were exempt) and nobody was authorized to enforce it, rendering penalties for non-vaccination irrelevant.

19th century vaccination certificate

A smallpox vaccination certificate issued to 5-year-old Sarah Grovner on December 2, 1817

Proponents of vaccination also sought to improve the quality of the vaccination system itself. Advocates were scandalized by the poor quality of vaccination at public facilities, with the most incompetent vaccinators not only failing to immunize the majority of their patients, but also leaving their patients with unsightly scars. Parents could also complicate the procedure: some wanted the vaccine inoculum to come from a specific source (e.g., the arm of a person they personally knew) and others expected some sort of compensation from the vaccinator, believing they were doing the doctor a service by letting them vaccinate their children. Some parents may have asked for compensation because of the significant time investment vaccination required: going through the whole process required two full trips to a vaccination station, a not-insignificant investment for working parents. Although some vaccination advocates tried to adapt vaccination procedures to fit the realities of working-class life, these reform-minded men were typically well-to-do and ignorant of the burdens their systems could impose on the less fortunate.

Smallpox poster 1851

1851 poster from Liverpool warning of a new outbreak of smallpox in the parish and urging parents to vaccinate their children at the indicated times and places

Efforts to compel citizens to vaccinate their children finally grew teeth with the passage of the Vaccination Act of 1867, which enabled Poor Law guardians to report non-vaccinated children to a justice of the peace, who would, in turn, summon the child's parents and, if the child was deemed healthy and had not already contracted smallpox, mandate the parents vaccinate their child by a specific date or face a fine of up to twenty shillings (approximately 5 days' wages). What was particularly controversial about this new law was the proposal parents would be fined toties quoties for failing to vaccinate their child  (i.e., they could be fined repeatedly until the child had been vaccinated). Anti-vaccinationists objected to this system that would effectively burden them with financial penalties or, if they failed to pay up, jail time until they complied with the state's wishes, and they argued that no amount of punishment would get them to accept a procedure they thought dangerous. Such arguments initially moved legislators to cap fines at two per unvaccinated child, but Viscount Redesdale in the House of Lords strenuously objected to such a provision, believing it would inhibit vaccination efforts. Thus, the prosecution cap never made it into law, which very likely made disputes over compulsion all the more embittered in the coming decades.