Vaccination: A Vexatious History

Friday, 16th of September 2016

The Lancet, Volume 387, No. 10032, p1988–1989, 14 May 2016

Perspectives

Vaccination: a vexatious history

Mark Honigsbaum

An unanticipated effect of the success of mass immunisation campaigns in western countries, no less than in Asia and the global south, is the more that vaccines have reduced the incidence of formerly deadly childhood diseases, the harder it becomes to convince parents that it is necessary for their own child to be vaccinated. This is particularly the case with a new generation of parents too young to have experienced measles or mumps for themselves, never mind diseases such as polio that cast a shadow over their grandparents´ childhoods. Instead, it is the remote and unproven risks of vaccination that keep parents awake at night, not the fact that about one in every 1000 cases of measles results in encephalitis.

As a new exhibition at the Hunterian Museum, Vaccination: Medicine and the Masses, reminds us, there is nothing new about these concerns. Ever since Edward Jenner lanced a milkmaid infected with cowpox and introduced the pustulent material into the arm of a healthy young boy in 1796, thereby inducing protection against the related smallpox virus, vaccination has proved a fertile ground for fear-mongers. In Jenner´s day it was the fear of contamination with animal matter, hence the cows shown sprouting from the heads of vaccinated patients in James Gillray´s famous 1802 engraving, The Cow-Pock-or-the Wonderful Effects of the New Inoculation! or George Cruikshank´s similar 1812 satirisation of the practice in The Cowpox Tragedy. By the 1880s, following the passage in 1853 of the compulsory vaccination act in the UK, it was the growing suspicion of medical profiteering and resentment about the assault on personal liberty, hence the postcards distributed by Victorian anti-vaxxers depicting John Bull in medical fetters.

Gillray´s image does not feature in the exhibition but John Bull´s and Cruikshank´s do, as does a striking engraving dating from 1885 of The Vaccine Upas Tree. Well known to Victorians familiar with the poetry of Erasmus Darwin and Alexander Pushkin, the upas tree was the source of a poison used in Javanese arrowheads and had long been mythologised as a tree of death. Here, its roots are shown sucking the “young life blood of the nation” as fruits labelled “syphilis”, “scrofula”, and “cancer” dangle menacingly from its branches.

The Cowpox Tragedy (1812) by George Cruikshank

Hunterian Museum, at the Royal College of Surgeons

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A different exhibition might have explored these anti-scientist sentiments more deeply, or why it is that in other historical periods and contexts, such as pre-revolutionary New England, vaccination was championed by religious zealots such as Cotton Mather, while it was the Boston medical establishment that railed against the “devilish invention”. Unfortunately, the Qvist Gallery is too small to allow more than a cursory examination of this rich metaphorical subject. Instead, the curatorial team from the Hunterian Museum and Oxford´s Constructing Scientific Communities project offer a twin-track approach, focusing, on the one hand, on the story of the global eradication of smallpox and, on the other, on opposition to the “tyranny” of compulsory vaccination.

Before visiting the Qvist Gallery, I had no idea that Leicester in the 19th century had been such a hot-bed of anti-vax sentiment or that shortly after the act´s passage angry townspeople had hung an effigy of Jenner in the city centre, much less that Leicester suffered an outbreak of smallpox as recently as 1904. Even 50 years later, the scarred faces of these survivors would have served to remind people of the pox´s horrors. Perhaps that is why in 1951 the Ministry of Health issued a film,Surprise Attack, warning of the dangers of ignoring official vaccination advice starring a young girl supposedly infected with smallpox from a rag doll her father had bought on a trip to the “east”.

Today, of course, smallpox, which was eradicated in 1979, no longer has the same power to instil fear and dread. Instead, it is new diseases like Ebola virus disease and Zika virus that are more likely to lead to demands for vaccines. Indeed, knowing that your baby might be born with microcephaly, one doubts that any woman considering pregnancy in Recife, or some other city in South America where Zika is endemic, would opt to reject a vaccine against the disease, were one on offer. Yet in affluent countries, some middle-class parents play Russian roulette with their children´s health, as evidenced by recent outbreaks of measles in California and other US states that followed visits by unvaccinated school children to a Disney theme park in Orange County. Meanwhile, in Afghanistan and Pakistan suspicions about the motives of international vaccination teams have fuelled community resistance to polio immunisation, jeopardising efforts to interrupt the transmission of wild polio viruses and eradicate the disease worldwide. It is tempting to view this resistance as the product of conspiracy theories and low levels of scientific literacy but, as this exhibition shows, it was not that long ago that Britons were prone to similar suspicions. Nor should we assume that the evident benefits of vaccination have resulted in higher levels of scientific understanding.

Perhaps, it all goes back to Jenner´s cowpox vaccine and the unfortunate expression herd immunity. If the collective term for the protection conferred by vaccines was less redolent of association with massed brutes perhaps the middle classes might find the idea more appealing.

Vaccination: Medicine and the Masses

Cowan´s vaccination shield, on loan from Dr Jenner´s House, Museum and Garden