This month, ITOW project member Dr Sue Hawkins takes the long view on a subject hitting the headlines at the Conservative Party Conference: compulsory vaccination, and the strength of opposition to it.
At the recent Conservative Party Conference, UK Health Secretary Matt Hancock announced he was “looking very seriously” at making vaccination compulsory for state school pupils. In the last year the UK and several other European countries have lost their measles-free status and public health officials blame ‘anti-vaxxers’ for the declining vaccination rate, which has allowed measles once again to regain a foothold. The anti-vaxxers spread their message through social media, urging parents to boycott vaccination of their children using, in extreme cases, aggressive and even frightening language. As one American anti-vaxxer tweeted recently:
If some sick psycho hated kids he might stick razor blades in Halloween candy. If he wanted to go big with spreading his ‘catalogue of horrors’ around he could stick needles with MMR into babies on the threshold of life.
In the US, the anti-vaccination movement has been so successful that public health bodies are once more in fear of measles epidemics, and since summer 2018 the MMR vaccine has been made compulsory in all states for enrollment of children in public (state) schools.
The anti-vaccination movement is not a new phenomenon. It is as old as the practice of vaccination itself, which began in a systematic way in the UK with the Vaccination Act of 1840. Following a major epidemic of smallpox in the late 1830s, the government was forced into action, passing the Act which established a system of free public vaccination against smallpox, to be administered by the Poor Law authorities and funded through the Poor Rate.[i] Although the scheme was open to all, it is unlikely that the better-off deigned to make use of it due to the stigma attached to the Poor Law, opting instead to pay their own medical practitioners to do the deed.
The public were suspicious and the level of vaccination uptake was disappointing. Many Boards of Guardians ignored the order, and many poor people refused to bring their children forward for vaccination. By 1853, after further outbreaks of the disease, it was decided that the only way to ensure all children were vaccinated was to make vaccination compulsory, and a new Act, the 1853 Vaccination Extension Act, was passed. This made it a legal requirement for all children to be vaccinated within three or four months of birth. It also mandated that each vaccinated child should return to the medical officer within eight days of the operation, for inspection and confirmation of the procedure’s success.
Although some recalcitrant parents were paraded through the courts and fined anything up to 20/- for their refusal to co-operate, the law had no real teeth and was often ignored, even by the authorities who were supposed to implement it. An extension to the Act in 1867 made provision for parents to be repeatedly fined for continuing to refuse to have their children “poisoned” in this way, and also provided incentives (by means of threats) for the authorities, who, through laziness or deliberate action, refused to comply with their obligations. By the end of the 1860s, the anti-vaccinators were organising into leagues and committees in order to fight the law, including the influential Anti-Vaccination League founded in Leicester in 1869.
Keighley, a small town in West Yorkshire, had a reputation for being vehemently anti-vaccination. In the mid-1870s seven of its guardians had been sent to gaol for a month for refusing to prosecute parents whose children were not vaccinated, and it was described in the newspapers as “one of the worst vaccinated towns in the UK” (Bradford Daily Telegraph, 2 February 1882). In the same year, an inspector was sent to Keighley to investigate the state of vaccination there. What he found appalled him, and he was particularly shocked by the letter above, which had been sent anonymously to the town’s Vaccination Officer, John Gott. It was just one example, he reported, of the type of “hate mail” John Gott had been receiving.
It is impossible to say who sent the letter. It was written in block capitals, probably to disguise the handwriting, which suggests it could have been a well-known member of the community whose hand would have been recognised. It could even have been one of the Guardians themselves: in addition to being gaoled, at least one had been before the magistrates charged with refusing to have his own children vaccinated. The spelling and vocabulary suggest it was sent by a reasonably literate person, while the scattering of colons and stops (which sometimes seem to indicate sentence breaks but sometimes do not) give the letter a feeling of barely suppressed anger. The language, however, makes that anger very clear. The writer described Gott as a “reptile” and “a mean venomous, skulking toad”, who should be “shot for a nuisance when your flesh drops off your bones”. The writer was prepared to inflict that horrible death him or herself: “You have been nearer your death than you imagine … There is a lot of us that have taken an oath to do for you”.
The letter alluded to several of the common prejudices which existed against vaccination. The references to “blood sucking vampires” and “wading through the blood of innocent children” might refer to the practice of taking fresh lymph from the pustules of vaccinated children for use in future vaccinations, which some parents found objectionable. The letter-writer also cited religious objections, demanding: “Do you think that God almighty has sent us into a world in an unfinished state”. Echoing modern-day anti-vaxxers, who accuse ‘Big Pharma’ of making huge profits from vaccination, the writer accused Gott of doing his job solely for the money: “I hope that every pound you get will sink you a thousand miles farther into hell and heat it ten thousand times hotter”. In fact, Gott earned only £20 a year for his trouble. The letter is delightfully illustrated with images of vile death by several means (a pile of dynamite, a pistol and a dagger), a coffin with Gott’s name on it and finally a medicine bottle containing, presumably, the same “poison” he injected into his child victims. The message is clear!
There is an irony in Gott’s position, though. An Inspector from the Local Government Board interviewed Gott and reported back that his views “as to the necessity of vaccination are apparently not very pronounced … he regards the advantages of the operation from a very lukewarm standpoint”; and in fact his doubts must have been public knowledge as the letter-writer accused Gott of hypocrisy: “You do not believe the cursed system any more than I do”. This is an unusual position for an official whose only purpose was to enforce the law and, curiously, both his predecessors were also described as “violent anti-vaccinators”. The Inspector acknowledged that Gott was labouring under “overwhelming difficulties”, but he was hardly complimentary, describing Gott’s physical appearance as “being of defective physique with a narrow chest”, and as suffering from some pulmonary complaint. Perhaps it is not surprising to find that John Gott, under such stress and abuse, and already ill, died of bronchitis two years later (in 1884) at the relatively young age of 48. An obituary in the Bradford Telegraph described him as “a much-abused official” who was badgered by some guardians for not doing his job aggressively enough, but who was hampered from doing so by the “open hostility of the anti-vaccinators on the Board”.
Strangely, despite the volume of correspondence between Keighley Union officials and the central authorities about the “Vaccination Question”, as it came to be known (you can almost hear the sigh as it was introduced on agendas), there was no contribution from the poor whose children were (or were not) being vaccinated. No complaints of compulsion, or of difficulties in getting their children vaccinated, have been found in the central correspondence files or in any local newspapers. Given the very high numbers of unvaccinated children in Keighley it seems reasonable to assume that the poor joined in the revolt, taking the lead from their social superiors and simply refusing to comply with the law.
By 1898 the Government was relenting (slightly) and introduced “conscientious objection” as a reason for non-compliance. The compulsory element of the law was finally lifted in 1948, and vaccination against smallpox was stopped entirely in 1971, with the World Health Organisation declaring the virus completely eradicated in 1978. That journey from tentative steps towards vaccination, to the complete eradication of smallpox took nearly 150 years. A measles vaccine has been available for only 50 years, so a certain level of nervousness today about a re-emergence of measles epidemics is hardly surprising; and it is not hard to see similarities in argument between 19th century anti-vaccination activism and the modern-day anti-vaxxer outpourings on Twitter.
- [i] It had been possible to vaccinate against small pox since the late 1700s, following William Jenner’s discovery that infection with cow pox, a mild form of the disease, could confer protection against its far more dangerous cousin. But its use was patchy and subject to great cynicism.