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276 pp Price US$22.95 ISBN 0-8233-3423-2 (p/b)
Durham NC/London: Duke University Press.
Advocates of immunization from the world of public health often illustrate their talks and articles with anti-vaccination cartoons from the nineteenth century. Their theme is that these campaigns and their associated prejudices are always with us, but merely fluctuate in intensity over the years. In the conclusion of her account of the anti-vaccination movement in England, the historian Nadja Durbach endorses the view that 'concerns of parents today echo those of their Victorian ancestors'. Whereas supporters of child immunization programmes regard the views of anti-vaccinationists, past and present, as irrational and potentially damaging to public health, Durbach starts from a benign stance towards contemporary anti-vaccination campaigns—an outlook that leads to a more sympathetic interpretation of the nineteenth century movement than it has previously received. Her final chapter aims to complete the circle by providing historical legitimacy for today's campaigners against MMR and other immunizations.
While Durbach's highly subjective approach may yield some insights into the activities of the campaign and its leading personalities, it risks divorcing the movement's local and particular features from its wider historical context. Thus Durbach begins by dismissing nineteenth century smallpox statistics as 'problematic' and, conceding that 'how well nineteenth century vaccination actually worked is a complicated historical question', makes no further attempt to answer it. No doubt it is true that statistics of efficacy and safety were manipulated by both sides in the controversy. Nevertheless, to discuss the anti-vaccination controversy without providing some basic facts about the epidemiology of smallpox is a radical concession to post-modernist subjectivism.
According to Thomas McKeown, the professor of social medicine now popular among anti-vaccinationists because of his scepticism in the 1970s regarding the contribution of medical interventions towards improving life expectancy in Britain, 'most epidemiologists are agreed that we owe the decline of mortality from smallpox mainly to vaccination'. The technique of inoculation or variolation was widely used around Europe after Queen Caroline submitted her children to this procedure in response to the 'great smallpox scare' of 1721. Following Edward Jenner's promotion of vaccination from the late 1790s—using lymph derived from cowpox instead of smallpox—this practice spread rapidly, in Britain and on the Continent.
By the 1850s, when compulsory vaccination was first introduced in England, smallpox was already in retreat, though it still killed more than 5000 people every year and left many more disfigured with pock-marks. After the Europe-wide epidemic of 1871-2, when the death rate in England rose to more than 10 000, smallpox went into rapid decline: by the 1890s, when the anti-vaccine campaign reached its peak, annual mortality was down to a few hundred. Though Durbach (accurately) describes vaccination as 'an invasive, insanitary and sometimes disfiguring procedure', which in some cases caused blood-borne diseases, infections and gangrene, she says nothing of its benefits (and makes no attempt to quantify the true extent of the adverse reactions). Again, while she focuses on resistance to vaccination, she ignores the public demand for it, particularly in response to epidemics which provoked intense popular fears.
A number of distinctive features of the anti-vaccination movement emerge from Durbach's fascinating account. She reveals the movement's cross-class character: though some of its leading figures were derived from the upper classes, its activists were largely drawn from the lower middle and respectable working classes (women as well as men). The anti-vaccinationists' rejection of government and medical coercion in relation to health reflected a wider suspicion of state intervention in personal and family affairs. Activists were often also religious dissenters, trade unionists and radicals; they were opponents of vivisection, and supporters of temperance, vegetarianism and alternative medicine. As well as being an effective parliamentary lobby, anti-vaccinationism was a militant mass movement, given to carnivalesque demonstrations and riotous protests.
Here the differences between the nineteenth century movement and contemporary anti-vaccination campaigns are more striking than the superficial parallels noted by Durbach. Though today's anti-vaccinationist campaigns get some support from quirky aristocrats, their base of support is almost exclusively middle class. Activists object to particular vaccines (in Britain mainly MMR, in the USA mainly those containing mercury). They have no objection to state intervention in any other area and, though some favour homeopathy or other alternative therapies, many seek to justify their concerns about vaccine safety with reference to mainstream medical science. Indeed some of the most prominent campaigns are careful to point out that they are not 'anti-vaccine' but simply concerned to promote 'informed choice' by parents. However disingenuous this posture may be, it reflects the general defensiveness of current campaigns and the limited scope of their resistance to medical authority. In contrast with the collective campaigns of the past, today's have a strongly individualistic character. Rather than demanding the abandonment of the national immunization programme, they merely request the choice of mercury-free vaccines, or single agents rather than MMR. Campaigns—in reality little more than websites run by a few individuals—provide information (often misleading) and contact details for solicitors pursuing compensation claims for alleged vaccine injuries.
In retrospect, it may be that the anti-vaccination movement deserves the condescension of posterity more than the plaudits of post-modernity offered by Durbach. At least in its resistance to the denial of individual freedom in the compulsory vaccination policy, the nineteenth century movement reflected a libertarian impulse. Today's reactionary and misguided campaigns lack even this redeeming feature.