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Changes in the law passed in permitted the authorities to enforce vaccination more efficiently. The law allowed the repeated prosecution of parents who failed to have their child vaccinated. The Act authorized the appointment of vaccination officers, whose task it was to identify cases of noncompliance. In , in response to widespread public resistance, Parliament appointed a Royal Commission to draft recommendations to reform the system. The Commission published its conclusions in It suggested allowing conscientious objection, an exemption which passed into law in The first vaccination act mainly incited resistance from heterodox medical practitioners who were forced out of business.

Large-scale popular resistance began after the Act with its threat of coercive cumulative penalties. The social and political diversity of the British antivaccination movement is vividly described by Durbach Just considering the details of the vaccination practice of the midth century does much to make many criticisms understandable.

MMR: risk, choice, chance | British Medical Bulletin | Oxford Academic

For instance, the widespread arm-to-arm vaccination, used until , carried substantial risks, and the instruments used 14 could contribute to severe adverse reactions. Furthermore, many antivaccinationists appealed, like their opponents, to enlightenment values and expertly used quantitative arguments.

Wallace himself apparently did not hold strong opinions about vaccination until the mids. He had received a vaccination as a young man before he left for South America, and all 3 of his children were vaccinated as well. Wallace was recruited some time in to the antivaccination movement through the efforts of his fellow spiritualist William Tebb — , a radical liberal who in had cofounded the London Society for the Abolition of Compulsory Vaccination.

These metaphysical foundations led him to a holistic view of health; he was convinced that smallpox was a contagious disease, but he also was certain that differences in susceptibility caused by nutritional or sanitary deficiencies played a major role in the epidemiology of the disease. Despite his strong metaphysical commitments, Wallace, however, always remained a devoted empiricist and was among the first to use a statistics-based critique of a public health problem.

In works such as Vaccination Proved Useless and Dangerous or Vaccination a Delusion, Its Penal Enforcement a Crime , Wallace mounted his attack on several claims: 1 that death from smallpox was lower for vaccinated than for unvaccinated populations; 2 , that the attack rate was lower for vaccinated populations: and 3 that vaccination alleviates the clinical symptoms of smallpox. Both provaccinationists and antivaccinationists relied heavily on time series of smallpox mortality rate data, which showed a general decline over the 19th century overlaid by several smaller epidemic peaks and the large pandemic peak of — Their conclusions from these data differed according to the way these data were subdivided into periods For example, if it were assumed that vaccination rates increased in , when cumulative penalties were introduced and fewer dared to challenge the vaccination law, and not in , when the smallpox pandemic accelerated, then the rate of decline of smallpox mortality rates was lower when vaccination was more prevalent.

Wallace concluded from his analysis that smallpox mortality rates increased with vaccination coverage, whereas his opponents concluded the exact opposite. Wallace argued that the problem of determining vaccination status was serious and undermined the claims of his opponents. Additionally, epidemiologic data for vaccination status were seriously incomplete.

I almost died of measles when I was 17. Why are anti-vaxxers making the news again?

Furthermore, if a person contracted the disease shortly after a vaccination, it was often entirely unclear if the patient should be categorized as vaccinated or unvaccinated. Provaccinationists argued that the error introduced by this ambiguity was most likely to be random and thus would not affect the estimate of the efficiency of the vaccine. In contrast, Wallace believed that doctors would have been more willing to report a death from smallpox in an unvaccinated patient and that this led to a serious bias and an overestimation of vaccine efficiency.

He was convinced that susceptibility to the disease of smallpox was not distributed equally across social classes. Weakened, poor persons living in squalor were in his opinion less likely to get vaccinated. At the same time they would have higher smallpox mortality rates because their living conditions made them more susceptible to the disease. This demonstrated to Wallace that factors other than vaccination must have played a major role. The numerical arguments used by Wallace and his opponents were based on an actuarial type of statistics, i. Inferential statistics that could be more helpful in identifying potential causes did not yet exist.

The statistical approach to the vaccination debate used by Wallace and his opponents could simply not resolve the issue of vaccine efficiency; thus, each side was free to choose the interpretation that suited its needs best. However, despite its indecisive outcome, the debate was a major step in defining what kind of evidence was needed It is also unjustified to portray the debate as a controversy of science versus antiscience because the boundaries between orthodox and heterodox science we are certain of today were far less apparent in the Victorian era What the scope and methods of science were or should be were topics still to be settled.

It is thus unwarranted to portray the 19th-century antivaccination campaigners generally as blindly religious, misguided, or irrational cranks. This judgment certainly does not apply to Alfred Russel Wallace. Wallace was modern, but he represented an alternative version of modernity, a version that has been sidelined in historiography until recently but has lately been acknowledged as a central cultural feature of the late 19th century Movements such as spiritualism were not resurrections of ancient traditions but used interpretations of the most recent natural science, such as experimental psychology, evolutionary biology, and astronomy 20 , or electromagnetism Some, like Wallace, also contested the social role that emerging professional sciences should play.

Wallace strongly favored a natural science that also addressed moral, political, social, and metaphysical concerns, and with this inclination he ran against the tide that was more concerned with developing a barrier between politics and disinterested, objective science.

In the case of vaccination, Wallace argued that liberty and science need to be taken into account, but that liberty is far more important than science. Wallace only appears to have been such a heretical figure if a large portion of the social, political, and intellectual reality of Victorian and Edwardian England is blotted out of the picture.

To argue that, then as now, the controversies are between religiously motivated, irrational eccentrics and rational, disinterested science is historically inaccurate and distracts from substantial differences in social, political, and economic context between then and now. The Victorian vaccination legislation was part of an unfair, thoroughly class-based, coercive, and disciplinary healthcare and justice system: poor, working-class persons were subjected to the full force of the law while better-off persons were provided with safer vaccines and could easily avoid punishment if they did not comply.

The National Health Service, established in , was planned to bring more social justice to health care. The new health system no longer was stigmatizing and coercive. The development has not stopped there: today, there is an increasingly strong emphasis on individual choice and involvement in decision making in the healthcare system in Great Britain.


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Patients have become customers. The contemporary vaccination controversy has to be seen against the opportunities and challenges offered within this new environment. It has become evident that population-based risk assessments of vaccine safety often fail to convince in this new context Parents instead evince a clinical, individual-based attitude when assessing the risks of vaccination—their own children are often judged not to be average.

In Great Britain, such attitudes are reinforced by the recent developments, mentioned above, in the healthcare system that encourage choice and autonomy and also by individualized perspectives concerning parenting and child development. Such a clinical perspective of parents can, however, cut both ways. The individually witnessed causal relationship between therapy and recovery in the case of tetanus and diphtheria was instrumental in the widespread public acceptance of immunization A similar mechanism is at play in the contemporary controversies: perceived causal relationships between vaccination and the appearance of complications undermine the claims that vaccines are generally safe.

This analysis also illustrates that contemporary vaccination controversies take place in specific historical contexts. Colgrove 22 depicts in detail how vaccination became an accepted public health intervention in the United States and what factors have fueled and influenced historical and contemporary controversies. For example, compared with most countries in Europe, the risk of costly litigation for pharmaceutical companies in the United States is much higher and the role of the state is seen as far more restricted.

This specific background influences forms of provaccination and antivaccination campaigning, but it also needs to be taken into account that the increasing availability of Internet resources accessible from everywhere may contribute to making the arguments and the debate more uniform across the globe. Modern vaccines save lives. But worries surrounding vaccination need to be taken seriously. And the lessons taught by history are, as usual, complex. As pointed out forcefully by Leach and Fairhead 10 , vaccine delivery systems must suit social, cultural, and political realities.

Paternalistic and coercive attitudes were harmful in the 19th century and are even less appropriate in the 21st century. Dr Weber is a biologist working in the fields of public health and consumer protection. He also publishes regularly in the history of science and has a particular research interest in the history of evolutionary biology. Suggested citation for this article : Weber TP. Alfred Russel Wallace and the antivaccination movement in Victorian England. Emerg Infect Dis [serial on the Internet] April [ date cited ]. National Center for Biotechnology Information , U.

Journal List Emerg Infect Dis v. Emerg Infect Dis. Thomas P. Author information Copyright and License information Disclaimer. Rather there are many opinions based on very different views and theories of the world. The same goes for refusing it, even against the advice of doctors. Another aspect of this cultural transformation is related to feminism.

To many second-wave feminists, it was the duty of women to wrest control of their own health issues from a medical profession dominated by males. By the late s, Conis points out, some applied this idea to vaccines. Barbara Loe Fisher, in particular, was spurred into action by the documentary; she helped form organizations critical of vaccination and, as mentioned above, coauthored the book DPT: A Shot in the Dark with Harris Coulter.

Alfred Russel Wallace and the Antivaccination Movement in Victorian England

They can be so damn patronizing. You know, pat the little mother on the head and tell her to calm down. But too extreme of a reaction against medical paternalism can be unhelpful; the belief that mothers know what could hurt their children better than a condescending physician can be taken too far. The late Robert S. The legitimacy of medical paternalism has always depended in large part on the superior expertise and knowledge of physicians. Courtesy Oprah. Oz Show — have also given a platform to critics making medically misleading claims about vaccines.

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Unsurprisingly, the Internet has given many activists a place to share information and ideas and to reinforce their beliefs about vaccines. Vaccine opposition has also been stoked by the rise of environmentalism, with its focus on the ideas of the balance of nature and the dangers of technological interventions.

It produces all the chemicals one will ever need to be healthy The wisdom that created our bodies is far superior to the finite mind of all the scientists in the world. Sometimes vaccine critics point to other substances that have been widely used but that have been shown to harm health, including toxins in cigarettes and pesticides. Is it not possible that vaccines might be just as dangerous?

A t the heart of the opposition to vaccines is the fear that they will harm children. For parents, this can mean a lifetime of intensive, round-the-clock monitoring of their children, or even the purchase of a child-sized coffin. One boy, Sam, after receiving his DPT vaccine, reportedly began to cry and subsequently went silent.

It turns out he had akinetic seizures and alternating hemiparesis. Imagine the horror of parents in discovering their once perfectly healthy child like this. They also inserted a tracheotomy and feeding tube because she could no longer breathe or eat on her own. So are vaccines safe, or do they harm children? In medicine, as in the rest of life, safety is a relative term.

Medical interventions always pose some risk to the patient, but risks can be justified by medical benefits. For the purposes of both good medical practice and public health, all that needs to be shown is that the risks of side effects from vaccines are outweighed by the benefits of the protection that vaccines provide. Historically, many inoculations and vaccines resulted in serious side effects. A fraction of patients died from smallpox contracted through variolation, and scarring from variolation was common.

But variolation saved more lives than it harmed, and variolated patients fared better than those who acquired smallpox naturally.

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For instance, in Boston in the s — before Jenner popularized vaccination — a patient who was inoculated with smallpox had a roughly 1 or 2 percent chance of dying from the disease contracted during the procedure. But a patient who acquired the disease naturally, without inoculation, had a much higher likelihood of dying: between 10 and 33 percent. Vaccination in the nineteenth century usually involved using material from individuals who had been infected by cowpox, but these individuals sometimes carried other diseases that could be passed to the vaccinated patients — as happened to dozens of children in Italy in the s, who developed syphilis from vaccinations and died.

In the s, some of the biggest vaccine producers were found to have distributed in Philadelphia needles contaminated with bacteria. In , cases of tetanus, some deadly, were found to be caused by contaminated diphtheria vaccines. Even well into the twentieth century, incidents involving vaccines sometimes gave rise to serious side effects. As Dr. Paul Offit describes the incident in his book Vaccinated ,.

Today, thanks to vaccination, the disease has been eradicated from the United States and nearly eradicated around the world. Even though vaccines continue to grow safer over time, they undoubtedly still have some side effects, as is also true of antibiotics, surgical procedures, and blood pressure medication. Sometimes, the medium in which a vaccine has been cultured can cause problems; people who are severely allergic to eggs are not allowed to take some forms of the flu vaccine since they contain egg products that can cause a severe allergic reaction.

Other vaccine side effects can include soreness, redness, itching, bleeding, or swelling at the injection site. Studies have shown that the MMR vaccine causes a small increased risk for febrile seizures — convulsions and unconsciousness associated with high body temperature. But febrile seizures are short and relatively benign, and they naturally occur in 2 to 4 percent of all children under the age of five in the United States and Europe.

Thus while febrile seizures are terrifying to watch, they are rare side effects of the MMR vaccine and are usually harmless. Furthermore, vaccines actually prevent some diseases that cause febrile seizures. As noted above, one of the chief safety concerns raised by vaccine opponents is that increased vaccination rates beginning in the s may have contributed to the sharp rise in autism diagnoses over the past several decades.

Fewer than 1 in 3, children were diagnosed with autism in the s; today that figure is around 1 in The causes of this rise are still unclear, but better autism screening has surely contributed to the higher rates of diagnosis.


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  • Vaccine opponents, however, claim that vaccines are to blame: more children are getting vaccinated than in the past, and more doses of more kinds of vaccines are being administered the CDC currently recommends vaccination against sixteen diseases for children. Most often, fingers have been pointed at the MMR vaccine, since the symptoms of autism tend to emerge at roughly the same time that children receive it — between ages 1 and 2.

    Much of the concern over vaccines and autism can be linked to the discredited research of Andrew Wakefield, who claimed in a now-retracted paper that the MMR vaccine may contribute to gastrointestinal inflammation that may result in autism. The presence of the mercury-containing compound thimerosal in vaccines has also been proposed as cause of autism , since exposure to mercury is known to have neurotoxic effects. Given the attention these claims have received, it is worth taking the time to summarize a few of the many studies that have shown there to be no meaningful link between vaccines and autism:.

    The researchers used a major database of U. What makes this paper so interesting is that the combined MMR vaccine was phased out in Japan in , so that none of the children born in the last four years studied to received that vaccine. They were given separate vaccines instead of the combined vaccine.

    The study compared neuropsychological outcomes which include measures of speech and language, verbal memory, motor coordination, general intellectual functioning, and others in children who received recommended vaccines on schedule and children who delayed having these vaccines or did not have these vaccines at all. The researchers did find evidence of some associations between vaccines and adverse events: the rotavirus vaccine can be linked to intussusception a dangerous and sometimes deadly intestinal pathology , and MMR vaccine can be linked to febrile seizures.

    The evidence overwhelmingly shows that there is no link between the MMR vaccine specifically, or several vaccines taken together during childhood, and the development of autism. More studies will be done, of course — good science and good medicine demand no less. B ut why does the safety of vaccines matter so much to us on a policymaking level? Why not let parents decide if they should vaccinate their children? Surely, some say, this is an individual and not a public-policy decision. In truth, however, the public has a stake in vaccination rates because vaccines affect not only the health of the individuals vaccinated but of the community as a whole.

    If fewer people can catch the disease, then fewer people can spread it, so even people who are not vaccinated are less likely to contract the disease if those around them are protected. The proportion of the community that needs to be individually immune to a disease in order to provide herd immunity is higher for diseases that are more contagious.

    So for pertussis, a highly contagious disease, 92 to 94 percent of the community must be immune in order to protect those who are not immune, while for the flu, which is less contagious, herd immunity is achieved with 50 to 75 percent of the population. For measles, the disease that has most recently been in the news, 83 to 94 percent of a population must be individually immune to confer herd immunity. Because vaccination does not always guarantee complete immunity to disease, however, vaccination rates need to be higher than these theoretical immunity rates in order to secure herd immunity.

    As an example of the dangers of low vaccination rates we can look to California. Rates like these help us account for a sporadic reemergence of the virus in the United States over the past decade: there were measles cases in , cases in , and cases in the first eight months of In the recent outbreak centered at Disneyland in late and early , residents of California were infected with measles. These are troubling reemergences of a disease that, before being curbed by vaccination, used to kill hundreds of Americans every year and infect millions.

    The evidence behind herd immunity is not just anecdotal.

    It is scientific and robust, just as it is for the relative safety of vaccines. Because the parents of unvaccinated children tend to live together in communities with low vaccination rates, the risk increases for each unvaccinated child, including both those who have specific medical reasons for not being vaccinated as well as those whose parents refuse vaccination out of a more general sense of concern.

    Admittedly, herd immunity does not always work. There are instances in which a population with widespread vaccine coverage can still see outbreaks of a disease. In Quebec City, Canada in , there was an outbreak of more than seven hundred cases of measles in a population vaccinated at about the same level as most of North America more than 90 percent of the people had received the full two doses of the measles vaccine.

    O ver the years, vaccine policy has been shaped by both real and perceived risks, as both government and the medical establishment have reacted to concerns from the public and the companies that make vaccines. Given that vaccines do carry some small degree of unavoidable risk, any company that manufactures vaccines could face lawsuits filed by patients who were harmed — or who at least believed themselves to be harmed — by the vaccines.

    Such litigation could be costly, perhaps even bankrupting the vaccine makers. To prevent such a scenario, nineteen countries have established mechanisms for compensating victims and families accidentally harmed by vaccines. The U. And so in , Congress passed and President Reagan signed legislation creating the National Vaccine Injury Compensation Program , colloquially known as the vaccine court even though it is not a true judicial body.

    Ever since, nearly all substantial U. Money collected from an excise tax on each dose of a vaccine is used to compensate the plaintiffs whose claims are approved by the program. This means that various adverse events not proven to be caused by vaccines are compensated for by the court, including Sudden Infant Death Syndrome, Attention Deficit Disorder, and epilepsy. Critics of vaccination sometimes complain that by protecting vaccine manufacturers from liability, this program removes a crucial incentive — the cost of lawsuits — to make vaccines as safe as possible.

    This is a legitimate concern, and it is one reason that the U. One is called the Vaccine Adverse Event Reporting System VAERS , which anyone, including those lacking scientific or medical expertise, can use to report adverse side effects from vaccines. Unlike VAERS, which focuses on adverse reactions and to which anyone can contribute, VSD collects all vaccine-related data from nine big health care providers around the country. This pool of data allows the CDC, as well as outside researchers, to track the safety and efficacy of new vaccines and to follow up on complaints raised through VAERS.

    For example, in the CDC and the American Academy of Pediatrics found via the research of John Salamone a concerned parent whose son had been injured by a polio vaccine that the Sabin vaccine had a small risk of causing polio. The virus in the vaccine was live and in very rare cases was not weakened enough, causing debilitating disease.

    Another example of improvements in vaccine safety came in , when the CDC recommended switching from one vaccine for pertussis to another. In countries with a higher incidence of whooping cough infections and poorer quality health care, the more effective vaccine can certainly be worth the slightly greater risks. In the United States, where vaccination has already dramatically reduced cases of pertussis, a less effective but slightly safer vaccine may make more sense. Some government vaccine recommendations switch rapidly. In , the CDC recommended the universal use of a vaccine against rotavirus, an infection that causes diarrhea.

    However, the vaccine was soon found to cause an increased number of cases of the intestinal disorder intussusception among children. In response to this risk, the CDC withdrew its recommendation in and the company producing the vaccine took it off the market.

    Yet another example of government action to deal with vaccine-safety concerns involves thimerosal, the additive that some vaccine critics long believed was associated with autism. It had been used since the s as a preservative to ensure that vaccines were not contaminated with bacteria. Thimerosal contains ethyl mercury, which is not the same as methyl mercury, the mercury compound found in the environment that is known to accumulate in the brain and cause long-term health problems.

    Methyl mercury is actively transported across the blood-brain barrier while ethyl mercury is not, so ethyl mercury is much less likely to cause neurotoxicity. Nonetheless, despite the lack of evidence of harm, the CDC discontinued the use of thimerosal in vaccines in These examples of action to improve the safety of vaccines show that the medical community and the U.

    But critics still question the wisdom of vaccine policy. They sometimes point out that the U. However, actual vaccine requirements are almost entirely a matter for state and local governments and usually linked to school enrollment rather than the federal government, and not all states have vaccine mandates against all the diseases listed by the CDC. Like many other countries, the United States relies on technical advisors to guide national policy and make recommendations on vaccination schedules. And contrary to the claims of vaccine critics that extensive vaccination recommendations in the United States are evidence of corruption, the U.

    The history of vaccines contains clear cases of risks and injuries.

    But time and again, physicians, scientists, and the government have changed vaccines and vaccine policy to make vaccines safer. Sometimes, as in the case of the removal of thimerosal from vaccines, changes were even made to allay relatively unsubstantiated but widely felt concerns. Nonetheless, vaccine advocates should continue to acknowledge the minor risks posed by vaccines and the need for ongoing research to identify and mitigate even small hazards. W e know that vaccination has saved millions of lives. In the United States alone, it has prevented over million cases of polio, measles, rubella, mumps, hepatitis A, diphtheria, and pertussis since , according to a recent estimate.

    And we know that unvaccinated people are at a higher risk of infection and put others around them at a higher risk of infection. We should remember, too, that anti-vaccination sentiment in the United States is not as strong as media coverage sometimes makes it seem. According to a recent CDC survey , vaccine coverage remains very high, with roughly 95 percent of children receiving the recommended doses of some of the most important combination vaccines. The geographic concentration in particular communities of people refusing to vaccinate leaves those communities at a higher risk of outbreaks, but vaccine-preventable diseases are thankfully very rare in the United States; the chances for an American child to contract measles remains extremely low.