Variolation ,
The Cow-PockorThe Wonderful Effects of the New Inoculation! (1802) Early attempts to prevent smallpox involved deliberate
inoculation with the milder form of the disease (Variola Minor) in the expectation that a mild case would confer immunity and avoid Variola Major.
Religious arguments against inoculation were soon advanced. For example, in a 1722 sermon entitled "The Dangerous and Sinful Practice of Inoculation", the English theologian Reverend Edmund Massey argued that diseases are sent by God to punish sin and that any attempt to prevent smallpox via inoculation is a "diabolical operation".
Smallpox vaccination After
Edward Jenner introduced the
smallpox vaccine in 1798, variolation declined and was banned in some countries. As with variolation, there was some religious opposition to vaccination, although this was balanced to some extent by support from clergymen, such as Reverend Robert Ferryman, a friend of Jenner's, and
Rowland Hill, Vaccine was maintained initially through arm-to-arm transfer and later through production on the skin of animals, and bacteriological sterility was impossible. Further, identification methods for potential pathogens were not available until the late 19th to early 20th century. Diseases later shown to be caused by contaminated vaccine included
erysipelas,
tuberculosis,
tetanus, and syphilis. This last, though rareestimated at 750 cases in 100 million vaccinationsattracted particular attention. Much later,
Charles Creighton, a leading medical opponent of vaccination, claimed that the vaccine itself was a cause of syphilis and devoted a book to the subject. As cases of smallpox started to occur in those who had been vaccinated earlier, supporters of vaccination pointed out that these were usually very mild and occurred years after the vaccination. In turn, opponents of vaccination pointed out that this contradicted Jenner's belief that vaccination conferred complete protection.
England File:Diphtheria is Deadly Art.IWMPST14182.jpg|thumb |upright |alt=Poster: DIPHTHERIA is deadly- [depiction of a baby] IMMUNISATION is the safeguard / ASK AT YOUR LOCAL COUNCIL OFFICES OR WELFARE CENTER / Issued by the Ministry of Health and the Central Council for Health Education|In a postwar poster, the
Ministry of Health urged British residents to immunize children against diphtheria. Because of its greater risks,
variolation was banned in England by the
Vaccination Act 1840 (
3 & 4 Vict. c. 29), which also introduced free voluntary vaccination for infants. Thereafter Parliament passed successive acts to enact and enforce compulsory vaccination. The Vaccination Act 1853 (
16 & 17 Vict. c. 100) introduced compulsory vaccination, with fines for non-compliance and imprisonment for non-payment. The Vaccination Act 1867 (
30 & 31 Vict. c. 84) extended the age requirement to 14 years and introduced repeated fines for repeated refusal for the same child. Initially, vaccination regulations were organised by the local
Poor Law Guardians, and in towns where there was strong opposition to vaccination, sympathetic guardians were elected who did not pursue prosecutions. This was changed by the Vaccination Act 1871 (
34 & 35 Vict. c. 98), which required guardians to act. This significantly changed the relationship between the government and the public, and organized protests increased. Societies and publications were organized by the middle classes, and support came from celebrities such as George Bernard Shaw and Alfred Russel Wallace, doctors such as Charles Creighton and
Edgar Crookshank, and parliamentarians such as
Jacob Bright and
James Allanson Picton. Under increasing pressure, the government appointed a Royal Commission on Vaccination in 1889, which issued six reports between 1892 and 1896, with a detailed summary in 1898. Its recommendations were incorporated into the
Vaccination Act 1898 (
61 & 62 Vict. c. 49), which still required compulsory vaccination but allowed exemption on the grounds of conscientious objection on presentation of a certificate signed by two magistrates. This was done as a matter of routine when the
National Health Service was introduced in 1948, with "almost negligible" opposition from supporters of compulsory vaccination. Vaccination in Wales was covered by English legislation, but the
Scottish legal system was separate. Vaccination was not made compulsory there until 1863, and a conscientious objection was allowed after vigorous protest only in 1907. This proved successful but required acceptance of compulsory isolation rather than vaccination.
C. Killick Millard, initially, a supporter of compulsory vaccination was appointed
Medical Officer of Health in 1901. He moderated his views on compulsion but encouraged contacts and his staff to accept vaccination. This approach, developed initially due to overwhelming opposition to government policy, became known as the Leicester Method. In time it became generally accepted as the most appropriate way to deal with smallpox outbreaks and was listed as one of the "important events in the history of smallpox control" by those most involved in the
World Health Organization's successful
Smallpox Eradication Campaign. The final stages of the campaign generally referred to as "surveillance containment", owed much to the Leicester method.
United States After an 1879 visit to New York by prominent British anti-vaccinationist
William Tebb, The Anti-Vaccination Society of America was founded. The New England Anti-Compulsory Vaccination League formed in 1882, and the Anti-Vaccination League of New York City in 1885. Vaccination in the US was regulated by individual states, in which there followed a progression of compulsion, opposition, and repeal similar to that in England. Although generally organized on a state-by-state basis, the vaccination controversy reached the
US Supreme Court in 1905. There, in the case of
Jacobson v. Massachusetts, the court ruled that states have the authority to require vaccination against smallpox during a smallpox epidemic.
John Pitcairn, the wealthy founder of the Pittsburgh Plate Glass Company (now
PPG Industries), emerged as a major financier and leader of the American anti-vaccination movement. On March 5, 1907, in Harrisburg, Pennsylvania, he delivered an address to the Committee on Public Health and Sanitation of the
Pennsylvania General Assembly criticizing vaccination. He later sponsored the National Anti-Vaccination Conference, which, held in Philadelphia in October 1908, led to the creation of The Anti-Vaccination League of America. When the league organized later that month, members chose Pitcairn as their first president. On December 1, 1911, Pitcairn was appointed by Pennsylvania Governor
John K. Tener to the Pennsylvania State Vaccination Commission and subsequently authored a detailed report strongly opposing the commission's conclusions.
Later vaccines and antitoxins Opposition to smallpox vaccination continued into the 20th century and was joined by controversy over new vaccines and the introduction of
antitoxin treatment for
diphtheria. Injection of horse serum into humans as used in antitoxin can cause
hypersensitivity, commonly referred to as
serum sickness. Moreover, the continued production of the smallpox vaccine in animals and the production of antitoxins in horses prompted
anti-vivisectionists to oppose vaccination. Diphtheria antitoxin was serum from horses that had been immunized against diphtheria, and was used to treat human cases by providing
passive immunity. In 1901, antitoxin from a horse named
Jim was contaminated with
tetanus and killed 13 children in
St. Louis, Missouri. This incident, together with nine deaths from tetanus from contaminated smallpox vaccine in
Camden, New Jersey, led directly and quickly to the passing of the
Biologics Control Act in 1902. The
Bundaberg tragedy of 1928 saw a diphtheria antitoxin contaminated with the
Staph. aureus bacterium kill 12 children in
Bundaberg, Australia, resulting in the suspension of local immunisation programs.
Robert Koch developed
tuberculin in 1890. Inoculated into individuals who have had
tuberculosis, it produces a
hypersensitivity reaction and is still used to detect those who have been infected. However, Koch used tuberculin as a vaccine. This caused serious reactions and deaths in individuals whose latent tuberculosis was reactivated by the tuberculin. This was a major setback for supporters of new vaccines. In 1955, in a tragedy known as the
Cutter incident,
Cutter Laboratories produced 120,000 doses of the
Salk polio vaccine that inadvertently contained some live poliovirus along with inactivated virus. This vaccine caused 40,000 cases of polio, 53 cases of paralysis, and five deaths. The disease spread through the recipients' families, creating a polio epidemic that led to a further 113 cases of
paralytic polio and another five deaths. It was one of the worst pharmaceutical disasters in US history. Later 20th-century events included the 1982 broadcast of
DPT: Vaccine Roulette, which sparked debate over the
DPT vaccine, and the 1998 publication of a fraudulent academic article by
Andrew Wakefield which sparked the
MMR vaccine controversy. Also recently, the
HPV vaccine has become controversial due to concerns that it may encourage promiscuity when given to 11- and 12-year-old girls. Arguments against vaccines in the 21st century are often similar to those of 19th-century anti-vaccinationists.
COVID-19 poll showed that 42% said they were very likely to take the vaccine and 25% were fairly likely (67% likely overall); 11% would be very unlikely and 10% fairly unlikely (21% unlikely overall) and 12% are unsure. There have been a number of reasons expressed why people might not wish to take COVID-19 vaccines, such as concerns over safety, self-perception of being "low risk", or questioning the
Pfizer-BioNTech vaccine in particular. 8% of those reluctant to take it say it is because they oppose vaccinations overall; this amounts to just 2% of the British public. A March 2021 NPR/PBS NewsHour/Marist poll found the difference between white and black Americans to be within the margin of error, but 47% of
Trump supporters said they would refuse a COVID-19 vaccine, compared to 30% of all adults. In May 2021, a report titled "Global attitudes towards a COVID-19 vaccine" from the Institute of Global Health Innovation and Imperial College London, which included detailed survey data from March to May 2021 including survey data from 15 countries Australia, Canada, Denmark, France, Germany, Israel, Italy, Japan, Norway, Singapore, South Korea, Spain, Sweden, the UK, and the US. It found that in 13 of the 15 countries more than 50% of people were confident in COVID-19 vaccines. In the UK 87% of survey respondents said they trusted the vaccines, which showed a significant increase in confidence following earlier less reliable polls. The survey also found trust in different vaccine brands varied, with the Pfizer–BioNTech COVID-19 vaccine being the most trusted across all age groups in most countries and particularly the most trusted for under 65s. A January 2022 report from
Time magazine noted that the anti-vaccine movement "has repositioned itself as an opposition to mandates and government overreach." A May 2022 report from
The New York Times noted that "A wave of parents has been radicalized by Covid-era misinformation to reject ordinary childhood immunizations—with potentially lethal consequences." According to the
Centers for Disease Control and Prevention, continued high levels of vaccine coverage are necessary to prevent a resurgence of diseases that have been nearly eliminated. Pertussis remains a major health problem in developing countries, where mass vaccination is not practiced; the World Health Organization estimates it caused 294,000 deaths in 2002. Vaccine hesitancy has contributed to the resurgence of preventable disease. For example, in 2019, the number of measles cases increased by thirty percent worldwide and many cases occurred in countries that had nearly eliminated measles.
UK, pertussis (1970s–80s) In a 1974 report ascribing 36 reactions to
whooping cough (pertussis) vaccine, a prominent public-health academic claimed that the vaccine was only marginally effective and questioned whether its benefits outweigh its risks, and extended television and press coverage caused a scare. Vaccine uptake in the UK decreased from 81% to 31%, and pertussis epidemics followed, leading to the deaths of some children. The mainstream medical opinion continued to support the effectiveness and safety of the vaccine; public confidence was restored after the publication of a national reassessment of vaccine efficacy. Vaccine uptake then increased to levels above 90%, and disease incidence declined dramatically. The population in the several provinces affected had a high level of immunization, with the exception of
one of the religious denominations, which traditionally does not accept vaccination. Ninety-five percent of those who contracted measles were unvaccinated. From late 1999 until the summer of 2000, there was a
measles outbreak in
North Dublin, Ireland. At the time, the national immunization level had fallen below 80%, and in parts of North Dublin the level was around 60%. There were more than 100 hospital admissions from over 300 cases. Three children died and several more were gravely ill, some requiring mechanical ventilation to recover.
Nigeria, polio, measles, diphtheria (2001–) In the early first decade of the 21st century, conservative religious leaders in northern Nigeria, suspicious of
Western medicine, advised their followers not to have their children vaccinated with the oral polio vaccine. The boycott was endorsed by the governor of Kano State, and immunization was suspended for several months. Subsequently, polio reappeared in a dozen formerly polio-free neighbors of Nigeria, and genetic tests showed the virus was the same one that originated in northern Nigeria. Nigeria had become a net exporter of the poliovirus to its African neighbors. People in the northern states were also reported to be wary of other vaccinations, and Nigeria reported over 20,000 measles cases and nearly 600 deaths from measles from January through March 2005. In Northern Nigeria, it is a common belief that vaccination is a strategy created by the westerners to reduce the Northerners' population. As a result of this belief, a large number of Northerners reject vaccination. In 2006, Nigeria accounted for over half of all new polio cases worldwide. Outbreaks continued thereafter; for example, at least 200 children died in a late-2007 measles outbreak in
Borno State.
United States, measles (2005–) In 2000, measles was declared eliminated from the United States because the internal transmission had been interrupted for one year; the remaining reported cases were due to importation. A 2005 measles outbreak in the US state of Indiana was attributed to parents who had refused to have their children vaccinated. The
Centers for Disease Control and Prevention (CDC) reported that the three biggest outbreaks of measles in 2013 were attributed to clusters of people who were unvaccinated due to their philosophical or religious beliefs. As of August 2013, three pockets of outbreakNew York City, North Carolina, and Texascontributed to 64% of the 159 cases of measles reported in 16 states. The number of cases in 2014 quadrupled to 644, including transmission by unvaccinated visitors to Disneyland in California, during the
Disneyland measles outbreak. Some 97% of cases in the first half of the year were confirmed to be due directly or indirectly to importation (the remainder were unknown), and 49% from the Philippines. More than half the patients (165 out of 288, or 57%) during that time were confirmed to be unvaccinated by choice; 30 (10%) were confirmed to have been vaccinated. The final count of measles in 2014 was 668 cases in 27 states. From January 1 to June 26, 2015, 178 people from 24 states and the District of Columbia were reported to have measles. Most of these cases (117 cases [66%]) were part of a large multi-state outbreak linked to Disneyland in California, continued from 2014. Analysis by the CDC scientists showed that the measles virus type in this outbreak (B3) was identical to the virus type that caused the large measles outbreak in the Philippines in 2014. By July 2016, a three-month measles outbreak affecting at least 22 people was spread by unvaccinated employees of the
Eloy, Arizona detention center, an
Immigration and Customs Enforcement (ICE) facility owned by for-profit prison operator
CoreCivic.
Pinal County's health director presumed the outbreak likely originated with a migrant, but detainees had since received vaccinations. However convincing CoreCivic's employees to become vaccinated or demonstrate proof of immunity was much more difficult, he said. In spring 2017, a measles outbreak occurred in Minnesota. As of June 16, 78 cases of measles had been confirmed in the state, 71 were unvaccinated and 65 were Somali-Americans. The outbreak has been attributed to low vaccination rates among Somali-American children, which can be traced back to 2008, when Somali parents began to express concern about disproportionately high numbers of Somali preschoolers in special education classes who were receiving services for autism spectrum disorder. Around the same time, disgraced former doctor
Andrew Wakefield visited Minneapolis, teaming up with anti-vaccine groups to raise concerns that vaccines were the cause of autism, despite the fact that multiple studies have shown no connection between the
MMR vaccine and
autism. In January 2019, Washington state reported
an outbreak of at least 73 confirmed cases of measles, most within
Clark County, which has a higher rate of vaccination exemptions compared to the rest of the state. This led state governor
Jay Inslee to declare a state of emergency, and the state's congress to introduce legislation to disallow vaccination exemption for personal or philosophical reasons.
Wales, measles (2013–) In 2013, an outbreak of measles occurred in the Welsh city of Swansea. One death was reported. Some estimates indicate that while MMR uptake for two-year-olds was at 94% in Wales in 1995, it had fallen to as low as 67.5% in Swansea by 2003, meaning the region had a "vulnerable" age group. This has been linked to the
MMR vaccine controversy, which caused a significant number of parents to fear allowing their children to receive the MMR vaccine.
United States, tetanus Most cases of pediatric
tetanus in the U.S. occur in unvaccinated children. In Oregon, in 2017, an unvaccinated boy had a scalp wound that his parents sutured themselves. Later the boy arrived at a hospital with tetanus. He spent 47 days in the Intensive Care Unit (ICU), and 57 total days in the hospital, for $811,929, not including the cost of airlifting him to the
Oregon Health and Science University,
Doernbecher Children's Hospital, or the subsequent two and a half weeks of inpatient rehabilitation he required. Despite this, his parents declined the administration of subsequent tetanus boosters or other vaccinations.
Romania, measles (2016–present) As of September 2017, a measles epidemic was ongoing across Europe, especially Eastern Europe. In Romania, there were about 9300 cases, and 34 people (all unvaccinated) had died. This was preceded by a 2008 controversy regarding the HPV vaccine. In 2012, doctor Christa Todea-Gross published a free downloadable book online, this book contained misinformation about vaccination from abroad translated into Romanian, which significantly stimulated the growth of the anti-vaccine movement.
Samoa, measles (2019) The 2019 Samoa measles outbreak began in October 2019 and as of December 12, there were 4,995 confirmed cases of measles and 72 deaths, out of a Samoan population of 201,316. A state of emergency was declared on November 17, ordering all schools to be closed, barring children under 17 from public events, and making vaccination mandatory.
UNICEF has sent 110,500 vaccines to Samoa. Tonga and Fiji have also declared states of emergency. The outbreak has been attributed to a sharp drop in
measles vaccination from the previous year, following an incident in 2018 when two infants died shortly after receiving measles vaccinations, which led the country to suspend its measles vaccination program. The reason for the two infants' deaths was incorrect preparation of the vaccine by two nurses who mixed vaccine powder with expired anesthetic. As of November 30, more than 50,000 people were vaccinated by the government of Samoa.
2019–2020 measles outbreaks == See also ==