In fact, parents have been objecting to vaccines since the British government passed the Vaccination Act of 1840. That law made it compulsory for infants to be vaccinated against smallpox during their first three months. In 1867, the law was expanded to require mandatory vaccination of all children up to age 14. Parents could be fined if they didn’t comply — and put in prison if they couldn’t pay the fines.
Anti-vaccination groups immediately formed. “At first, many local authorizes did not enforce the fines, but by 1871, the law was changed to punish officials if they did not enforce the requirement,” writes Earl. “The working class was outraged at the imposition of fines. Activists raised an outcry, claiming the government was infringing on citizens’ private affairs and decisions.”
Anti-vaccination pamphlets, articles and books were published. People took to the street in angry protests, some of which became violent.
A lot of misinformation was circulated. Before the smallpox vaccine had been developed, about 4,000 people died from that disease each year in London alone. But the people who opposed universal vaccination — which included the prominent British biologist Alfred Russel Wallace — claimed those numbers were grossly inflated.
Wallace also claimed that the smallpox vaccine was ineffective and caused unnecessary deaths.
And, indeed, smallpox innoculation was not entirely without risk. Some people did become ill after receiving the vaccine, which was sometimes contaminated in those early days with bacteria and other pathogens.
Crossing ‘the pond’
Anti-vaccination activity was not confined to Britain, of course. It spread to other European cities, including Stockholm, Sweden, where by 1872 vaccination rates had fallen to just over 40 percent, according to a 2002 article in BMJ (formerly known as British Medical Journal).
Stockholm residents quickly changed their mind about vaccinations, however, when a major smallpox epidemic swept the city in 1874.
The 1870s also saw the emergence of anti-vaccination activity in the United States. Ironically, the smallpox vaccine’s success was one of the reasons some Americans became skeptical about its benefits, as the authors of the BMJ article explain:
Widespread vaccination in the early part of the century had contained smallpox outbreaks, and vaccination fell into disuse. However, in the 1870s, the disease became epidemic owing to the susceptibility of the population. As states attempted to enforce existing vaccination laws or pass new ones, vigorous anti-vaccination movements arose. … Using pamphlets, court battles, and vigorous fights on the floors of state legislatures, the anti-vaccinationists succeeded in repealing compulsory vaccination laws in California, Illinois, Indiana, Minnesota, Utah, West Virginia, and Wisconsin. A continual battle was waged between public health authorities and anti-vaccinationists, with the anti-vaccinationists battling vaccination in the courts and instigating riots in Montreal and Milwaukee.
Anti-vaccination activists also won a major victory in Britain.
“The British government introduced a key concept in 1898: A “conscientious objector” exemption,” writes Earl. “The clause allowed parents to opt out of compulsory vaccination as long as they acknowledged they understood the choice. Similar to today’s religious exemptions in 47 U.S. states and the personal belief exemptions in 18 states, according to the National Conference of State Legislatures, the parents signed paperwork certifying that they knew and accepted the risks associated with not vaccinating.”
Then and now
Although the anti-vaccination movement of the late-19th and early-20th centuries shares some characteristics with today’s movement, it was also quite different in at least one important way.
“Modern vaccination activists come from a different world than those in the 19th century,” writes Earl. “While anti-vaxers today are largely upper middle class, the crowd opposing vaccination in the 19th century was largely composed of lower- and working-class British citizens.”
Still, as the authors of the BMJ article point out, the beliefs of people opposed to vaccines “have remained remarkably constant over the better part of two centuries. The movement encompasses a wide range of individuals, from a few who express conspiracy theories, to educated, well informed consumers of health care, who often have a complex rationale for their beliefs.”
Opposition to immunization, which began with the smallpox vaccine all those decades ago, “has not ceased, and probably never will,” they add. “From this realization arises a difficult issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society, whereas a heavy handed approach can threaten the values of individual liberty and freedom of expression that we cherish. This creative tension will not leave us and cannot be cured by force alone.”
A remarkable achievement
Thankfully, the often-angry opposition to the smallpox vaccine did not stop public health officials from their efforts to eradicate that disfiguring and deadly disease, which many experts believe may have killed more people than any other infectious disease in history.
Smallpox is no longer a health threat — a remarkable public health achievement that is almost entirely the result of worldwide immunization efforts.
The last case of smallpox was reported in 1977.
You can read Earl’s article on The Atlantic’s website. You can also read the BMJ article in full through the U.S. National Library of Medicine’s website.