The long history of the anti-vaccination movement

The Disneyland measles outbreak is now believed to have affected over 100 people in 14 states. Health officials in Toronto say six people in the city are infected with the virus, and the question of whether parents should have the right to opt out of immunizing their children became a political football in the U.S. this week. For some historical perspective, Brent speaks to Karie Youngdahl, Director of The History of Vaccines project for The College of Physicians of Philadelphia about what we can learn from the long history of anti-vaccination movements.

Tell me about the first immunization against smallpox, about a 150 years ago, what was the process and how did it work?

Right, so this was Edward Jenner's famous invention. He had observed and many milkmaids had observed that they had beautiful clear skin and they never got smallpox, and they believed that this was because they had been exposed to cowpox, which was a disease that caused these sores on cows' udders. So Jenner built on that observation by taking matter from a cowpox sore on a milkmaid's hand and scratching that into the arm of a young boy. He watched the boy get a little bit ill, not very ill, and then a few weeks later he challenged him with live smallpox virus by scratching that into his arm. The boy did not get smallpox, he did not take ill, and that was Jenner's success, and that quickly spread around the world.

So it was successful but it didn't sound like a very appetizing process. What lead to the opposition to this smallpox vaccine?

Well, for one thing, it was kind of a scary procedure. You were taking matter from a sore on a cow and scratching it into a person.There were a lot of clergy people who objected to this. First of all, they said you're involving yourself with these cows, and you're polluting the body with this cowpox matter. Second of all, you're subverting God's will. It should be God who decides who gets ill and who suffers and who doesn't, and so you're interfering in that process. There was that, but there was this aspect of introducing animal matter into the human body, and somehow that had some aspect of devilry, maybe it was the mark of the beast. The smallpox vaccine scar was a pretty big scar, it was pretty significant, so there were some allusions to that in the literature of the time. There's also a great caricature done by Gillray who's a famous caricaturist, and he's depicting this vaccine clinic, you see these people with cow parts coming out of their faces after they've been vaccinated, and then on the wall is a little portrait of a golden calf, so it's the idol - smallpox vaccine - is being idolized. There was a lot of that imagery going around at the time.

So it was actually connected to very famous taboos in the Bible, but did people believe that there was a risk to them in taking tissue from a cow and putting it in their own body?

Sure, I think they believed that, especially in the very early years, the 1800s. It was a really new concept, a scary concept, and there was no understanding of the germ theory of disease. They were taking this step and they didn't really know why it worked. It was a very strange concept. Do you think that primal fear of immunization that you just described, do you think that on some level that continues today? I do, because I read a lot of the anti-vaccine literature and they talk a lot about the ingredients of vaccines and they tend to demonize them. There's aluminum in some vaccines as an adjuvant and that sounds scary because it's a metal. We know that there was a scare around the mercury-based preservative that was used in vaccines, so they tend to pick apart these little tiny ingredients and magnify the scariness of the names.

Where did these protests manifest? Where were the biggest anti-vaccination protests at the time?

Those didn't really emerge until the middle of the 19th century when smallpox vaccination became compulsory. That was really the flashpoint for a lot of the reaction and the violence. Along with those compulsory vaccination laws came fines if you didn't get your infant vaccinated, or jail if you refused to pay the fine. People objected to that. It was a pretty heavy-handed enforcement at times, especially in times of epidemics. There were these riots. They happened a lot in Leicester, England. Leicester, England was a real hotbed of anti-vaccination thinking. There was one in Montreal in 1885 in reaction to some mandatory vaccination laws that were being enforced by the board of health.There were thousands of people rioting in the streets of Montreal. They would attack the Board of Health, they threw rocks through their windows, they went to the Health Commissioner's house and threw rocks threw in his windows. They burned houses and they had hand-to-hand combat with police in the streets, and that was thousands and thousands of people. There was also a rally in Leicester in England in 1885. This was a peaceful rally, but reports say there 100,000 people marching in a parade. They had an effigy of Edward Jenner. They had children's coffins in this parade. They went to the town hall, they had speakers. That's a lot of people - 100,000 people protesting compulsory vaccination.

What do you think it was that motivated all of those people to behave in that public manner?

It really was the compulsory aspect of the vaccination law - the fact that the government was telling people they had to take an action that they perceived to have some risk, and they objected to that. I think we see a lot of reaction like that today around government policies in some areas.

What did the protests do to public health policy both in Europe and in North America?

In England it changed policy. There really weren't any exemptions to the vaccination laws up until the late 1890. At that point there was been so much protest and so many people speaking out about the compulsory nature and the fact that you couldn't get around it, that they introduced an exemption clause into the vaccination act of 1898 in England, and that introduced the term 'conscientious objector' to the English language. We often associated that with people who didn't want to serve as soldiers in wars, but it really arose with smallpox vaccinations, so they affected public policy change.

Here in Canada, we've had calls to tighten up immunization requirements. And in the United States you've had Rand Paul and Chris Christie and other politicians making some controversial comments about opting out of vaccination. Historically, what have been the arguments for allowing people to opt out of the process?

Well, there's certainly always been this religious aspect to allowing people to opt out. The Christian Scientists lobbied, throughout the early 20th century and mid-20th for religious exemptions to vaccination. There's a pretty strong sense of religious communities reacting to those requirements. In the '70s was when we saw this personal belief exemption taking hold, or the philosophical exemption taking hold, in the United States. You didn't have to have a religious objection, you could just have a moral objection or a philosophical exemption that would allow you to opt out. Let's talk about measles now because we're seeing increasing numbers of measles cases here in Canada, and I want to know if this has happened before.

Has measles made a comeback even though it's been almost wiped out due to vaccinations?

It has. The vaccine was introduced here in the states in 1963. Uptake was increasing every year, but around 1988-89 there was a big epidemic of measles across the United States that lasted for about three years. There were tens of thousands of cases, and I believe there was 123 deaths from measles in that period. Here in Philadelphia, where I live, there were nine deaths in one year. It was a pretty serious epidemic and it drew a lot of attention to the need to enforce school vaccination requirements and enforce the MMR booster which had just been added to the schedule for kids who are just entering kindergarten.

Do you think that people have lost sight of the importance of immunization because they don't think of these diseases as a real threat, because they lose sight of things that happened as recently as 1989? Is immunization a victim of its own success?

Absolutely. I've heard that term used before and I think it's true, because we as humans are not very good at risk assessment and if we don't perceive a risk we will not take action to prevent it happening in the future. There was a big smallpox scare in New York in the late '40s - 1947, I believe. One man, a traveller, came with smallpox, and spread the disease to a couple people around him. Six or seven million people were vaccinated in New York because of just a few cases. People will take action when they perceive an imminent risk.

Do you think that risk is being perceived right now pertaining to measles? Do you think that people are going to be vaccinated because measles seem real again?

I do think that happening. I read today in the newspaper that certain preschools in L.A. have seen their vaccine acceptance rate 10, 20, 30 per cent just in the past month because parents know that measles is circulating and they want to protect their kids.

For much more detail, please see The History of Immunization website.