Anti-vaxxer thought is nothing new.

The legs of a patient suffering from poliomyelitis, a disease which is now nearly eradicated due to vaccinations. Source: Historical Medical Library of the College of Physicians of Philadelphia.

Vaccines entered the medical sphere in 1796, when Edward Jenner used material from a cowpox lesion to innoculate an 8 year old subject. Ethics aside, the child was protected from the deadly smallpox virus due to his immune system being exposed to the mild, closely-related cowpox. Following further experimentation and refinement, the vaccine (vacca means cow in Latin) was born.

Within 200 years, smallpox was eradicated by a global vaccine drive, and several other diseases, from polio to measles, have been eliminated in many countries and reduced considerably in others. Vaccines have been one of the greatest public health accomplishments of the 20th century, but they have been met with repeated resistance.

Birth of the anti-vaccine movement

In 1840, the United Kingdom made vaccines for smallpox freely available to the poor, and by 1867 vaccination was mandatory with ‘cumulative penalties’ for non-compliant parents. Although there was some anti-vaccine sentiment prior to the 1867 legislation, the encroachment of the state in the name of public health resulted in the formation of several anti-vaccine journals and mass protests, with childhood vaccination rates plummeting to 3% in Leicester. The anti-vaccine mood spread to other parts of Europe, resulting in a major smallpox epidemic in Stockholm. The British government, under pressure from anti-vaccinationists, institued a royal commission to investigate vaccine effictiveness. The commission came out in favour of vaccines, but allowed for parents to conscientiously object against vaccination in the future.

Victorian era artwork warning of the dangers posed by vaccines. Source: Historical Medical Library of the College of Physicians of Philadelphia.

Continuation in the 20th century

Although anti-vaccine sentiment was still prevalent in the early 20th century, by 1940 the movement was much diminished due to several reasons:

  1. Vast improvements in vaccine development and research.
  2. Increases in public awareness of disease outbreaks (including polio, measles, rubella and others), along with the desire to protect children from future epidemics.
  3. Increased levels of scientific literacy alongside a post-war baby-boom.
  4. Public acceptance of vaccines resulting in publicised decreases in disease rates, reaffirming the necessity of vaccine use.

The above resulted in a period of wide-scale vaccine promotion between 1940 and 1970, within which disease occurence dropped signficantly. However, the golden-age of public opinion regarding vaccines was short-lived. With decreases in disease threats to the public, similar to that of the diminished presence of smallpox in late 19th century Europe, anti-vaccine sentiment began to rise once more.

The DTP controversy

Figure: Whooping cough (Pertussis) notifications and deaths in England and Wales, 1940–1998. Source: J.P. Baker (2003).

The Diphtheria-Tetanus-Pertussis (DTP) combined vaccine was widely used from the 1950’s, with the aim of preventing disease caused by the three bacterial pathogens in its name. Whooping cough (pertussis) is a respiratory disease which is potentially deadly to infants and young children. In the UK, cases of whooping cough dropped from over 100 000 per annum in the 1940’s to a few thousand in the early 1970’s (see Figure above), with similar trends observed in other countries which actively utilised the vaccine.

The DTP vaccine had remained relatively unchanged from the 1940’s, raising concerns over the vaccine’s safety. In 1974, a paper was published in the UK detailing the cases of 36 children with neurological illness that, the authors believed, was caused by the DTP vaccine. A media frenzy ensued, and vaccination rates plummeted in the face of growing public uncertainty. Vaccine opposition spread to many other countries, facilitating whooping cough outbreaks in the UK, Sweden and Japan, among others —eventually resulting in a return to vaccine use. Although the claims against the DTP vaccine weren’t completely unfounded (there was a very low risk found), the controversy was the first taster of mass media coverage of anecdotal evidence and sensationalised research.

The 90’s and beyond: a movement grows

Centre: Andrew Wakefield, co-author of a retracted 1998 paper linking the MMR vaccine to autism. Source: Newsweek

It was in 1998, following the publication of a paper linking the Measles Mumps and Rubella (MMR) vaccine to autism, that media-fuelled anti-vaccine fervour rose once again. Although the paper was later retracted by The Lancet, due to major flaws and the finding that Andrew Wakefield (an author on the paper) had vested financial interest in the autism-MMR link (read more about the investigation here), the damage to public opinion was complete. A new anti-vaccine era had begun.

On top of the vaccine-autism theory (which has been thoroughly debunked), several other vaccine concerns and theories have since proliferated:

  1. Thimerosal, an anti-bacterial preservative used in multidose vaccines, was thought by anti-vaccine campaigners to contribute to the vaccine-autism link, due to its mercury content. However, thimerosal breaks down into 50% ethylmercury (not hazardous methylmercury); and although there was no basis to the claims, the FDA phased out thimerosal use in many vaccines, further fuelling conspiracy theories.
  2. Aluminum salts are utilised in vaccines as adjuvants (for a stronger immune response). Due to the well documented toxic nature of aluminum, campaigners highlighted it as a toxic substance. However, it is utilised in extremely low amounts, well below the established safe limits.
  3. Many campaigners believe that global disease reduction is due to greater levels of public hygiene, and that vaccines are an unnecesary arm of a grand government conspiracy. This is simply false, with much research showing the efficacy of vaccine use, not to mention historical precedent. Other debunked theories include the risks of vaccines outweighing the benefit and the overloading of the immune system, which you can read about here.

So where do vaccines stand today?

Donald Trump, now president of the United States, has repeatedly tweeted against vaccines.

Anti-vaccine campaigners, known widely as anti-vaxxers, are no longer confined to the fringes of society. From Donald Trump’s lacklustre scientific grasp to Robert De Niro’s vaccine-skeptic push; we find ourselves in a period of pseudoscientific prevalence amongst societal elites. Furthermore, a string of scientists have joined the anti-vaccine fray. Funded by private foundations, they produce questionable scientific papers along an anti-vaccine theme.

With declining rates of vaccine use in the United States, whooping cough (amongst other preventable diseases) has made a comeback as history appears to be repeating itself once more.

The historical role of scientific critique

The anti-vaccine movement has resulted in the repeated study of vaccine safety, including unanticipated secondary effects; which has, rather than working against vaccines, added to the backing of their use. However, this has mostly been superfluous; and the consequences of not vaccinating has been severe. Critique is always important, but it should be done in a manner which doesn’t result in unfounded outcry and panic — for it is the youngest in our society who end up paying the price.

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Further reading:

An informative piece on the reasoning flaws behind the anti-vaccine movement.

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