From Jenner to Wakefield: The long shadow of the anti-vaccination movement

From Jenner to Wakefield:

The long shadow of the anti-vaccination movement

Summary

Professor Gareth Williams

Gareth Williams, professor of medicine, University of Bristol and author of Angel of Death: the story of smallpox

Vaccination has turned out to be one of the greatest of medical technologies, both in terms of the range of diseases that can be prevented and the numbers of lives saved.  Concerted use of Edward Jenner’s original vaccine against smallpox led 30 years ago to the eradication of that disease – the only human infection to be exterminated by mankind and arguably the greatest success yet of preventative medicine.  Yet vaccination has been constantly under attack during the two centuries since Jenner first reported his inoculations against smallpox in 1798. The campaigns targeting smallpox, polio, whooping cough (pertussis) and measles-mumps-rubella (MMR) have been particularly effective in turning public opinion against vaccination.  As a result, several developed countries have recently witnessed resurgences of pertussis and measles – serious childhood diseases that can cause disability and death, and that previously had virtually disappeared.  Their return stands in stark contrast to the situation in the developing world, where for example, 130,000 Indian children die each year from measles because the vaccine is not available.

Why should there be such fierce opposition to a health measure that brings such obvious benefits?  Antagonism to vaccination has come from several quarters, fuelled by motives that range from sincere anxieties about safety to self-interest and the desire to undermine ‘conventional’ medicine and science.  Interestingly, many of the views spread via today’s anti-vaccination websites can be traced back to the professional and public reactions against Jenner’s original inoculations with cowpox.

Some of the earliest objections were religious.  Supported by imaginative interpretations of the Bible, authorities such as John Birch argued that vaccination was bestial and blasphemous.  These sentiments are still propagated today, through ‘Christian’ websites and publications that attack vaccination as ‘ungodly’.  Elsewhere, the power of religious and ideological argument is well illustrated in parts of Nigeria, one of the few regions where polio is still endemic, where polio vaccination has been outlawed as a Western conspiracy designed to sterilise young Muslim men.

Anti-vaccination views have long been expressed by doctors, some of whom have been respected medical authorities.  Some have acted out of genuine concern, while others have been driven by professional jealousy, career advancement or financial gain.  Jenner had to confront medical critics who argued that vaccination against smallpox was unnecessary and dangerous; side-effects which they claimed for smallpox vaccination (and which they published in medical journals) included syphilis, madness and the transformation of children into cattle.  Subsequent claims backed by doctors include the notions that vaccination against polio is unnecessary because polio is caused by environmental toxins rather than a virus.  The most notorious recent example is of Andrew Wakefield who published a paper in the Lancet (1998) claiming that the MMR vaccine caused autism in children.  It has now been shown that this was more than ‘bad’ science, as Wakefield was paid by parents intending to sue the vaccine manufacturers.  As in Jenner’s time, the failure of the medical establishment to confront ‘bad’ science and to act decisively to counter Wakefield’s scientific fraud has helped to perpetuate confusion and has been a gift to those opposed to vaccination.  The damage done by Wakefield, and the resulting return of measles, will take years to undo; meanwhile, Wakefield continues to enjoy the support of anti-vaccination activists around the world.

Attempts to enforce the vaccination of children have always provoked fierce opposition. In the UK, the Vaccination Acts of the 1840s caused public outrage and widespread civil disobedience.  Anti-vaccination tactics included misinformation and the manipulation of statistics; the recruitment of influential figures such as George Bernard Shaw and Alfred Russel Wallace to deliver propaganda; and alignment with other anti-medical causes such as natural healing, chiropractic and anti-vivisection.  This was also the first campaign against the medical establishment to be orchestrated across continents.  Today, the right of the individual to accept or decline treatment continues to be a major plank in the arguments against vaccination.  Such a stance shifts on to others the responsibility for achieving the critical overall level of vaccination that will provide ‘herd’ immunity and protect the community at large – an issue that is neglected or rejected by anti-vaccinationists.

The medical and scientific establishments must share the blame for the continuing existence of anti-vaccination campaigns.  Their response to the anti-vaccinationists has often been defensive, arrogant and inept.  Like the anti-vaccination campaigns themselves, the establishment’s arguments have included misinformation, manipulated statistics and the deliberate cover-up of the shortcomings and complications of vaccination. Indeed, some pro-vaccinationists – beginning with Jenner himself – have trivialised the proven risks of vaccination.  This has helped to undermine public confidence in vaccination and thus sustain the very diseases which they sought to eliminate.

Indeed, the survival of the anti-vaccination lobby in the 21st century is evidence of a catastrophic failure of public confidence in science and mainstream medicine. Vaccination strategies will remain under threat until our public-health campaigns can match the power of the messages which the anti-vaccinationists have refined during the last two centuries, and which they still exploit effectively today.

©Professor Gareth Williams, Gresham College 2011