The anti-vaxxers have been around as long as the vaccines

So what do Kanye West, Piers Corbyn and David Icke all have in common? Anti-vax, anti-lockdown, alien conspiracies… Yes, of course, all of that but, putting aside the obvious, it’s a pretty nailed-on certainty that had any of them been around back in the late 18th century they wouldn’t have reckoned much to Edward Jenner.

Jenner was, of course, the “father of immunology”; the English doctor who created the world’s first vaccine two-and-a-quarter centuries ago. And as the world is set to roll out one or more new vaccinations for Covid-19 it is worth noting that the kind of scepticism Icke and his ilk have been propagating has a long history. Jenner himself was all too aware of its effects.

The Gloucestershire doctor had noticed that people who had contracted the cowpox virus seemed to be immune to smallpox – outbreaks of which were common in Jenner’s time and killed a fifth of those who caught it. So Jenner collected pus from cowpox pustules and injected them into an eight-year-old boy, James Phipps. Later he twice exposed Phipps to the smallpox virus and found no infection. It was one of medical science’s great breakthroughs. Others had been aware of the protective nature of smallpox but Jenner was the first to create a specific vaccine (which he named after the Latin word for cow: vacca).

Vaccines would eventually go on to supplant the previous technique of variolation, which required subjects to be exposed to a small amount of the actual live disease. This, for obvious reasons, was far more risky and sometimes fatal in previously healthy participants. It was eventually outlawed in 1840. Leaving aside the ethics regarding the use of a child to prove his hypothesis, Jenner’s work was eventually recognised by the government which, in the same 1840 act, provided free vaccinations for the poor. Millions had been dying in Europe for centuries, now there was a way to stop it.

Just like now, the success or otherwise of Jenner’s discovery depended on uptake. Without a certain percentage of the population being immune, the disease cannot go into effective abeyance. Which leads to the ethically questionable practice of compulsory vaccination, eventually introduced in Britain in 1853 for infants under three months and 14 years later to all children under 14.

It was not necessarily a popular initiative, for then as now there were those who didn’t want anything to do with Jenner, vaccines or modern medicine. Today’s anti-vaccination, or anti-vax, movement has long and very deep roots.

On a basic level you can see a glimmer of rationality – let’s face it, Jenner was scraping goo from the blisters of cowpox sufferers and injecting it into people. It’s not something you’d sign up to without good reason. But beyond that, irrationality took hold, much of it using arguments we see today, even though the vaccine had been proven to be safe. Opposition to vaccination has existed for as long as vaccination itself and, like today, had varied rationales.

Just as the MMR scandal, perpetuated by disgraced British doctor Andrew Wakefield – who in the late 1990s spread the false assertion that the Measles, Mumps and Rubella vaccine could induce Crohn’s disease and autism – caused such a stir among the anti-vax movement and acted as a persuasive recruiting sergeant through rumour and unease, it was the much the same in Jenner’s day even without the questionable benefit of social media. 

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Wakefield was struck off the medical register in the UK for refusing to retract his claims and for unethical research practices, but he still retains a huge following. Naysayers, it seems, will always have an audience. As we have become aware over the past four years with the pronouncements from Donald Trump, demonstrable evidence (or a lack of it) will not necessarily win over a rather large section of society.

Distrust of mainstream medicine and the ever-present malaise of the general anti-science zeitgeist was as prevalent then as it is fashionable now, driven by factors we’d recognise today, but also other concerns. 

As now, many people disputed whether the vaccine worked, citing better sanitation as a cause for reduced infection, or the fact that there was no obvious transmission from person to person – arguments frequently used by anti-vaccination campaigners today. Germ theory – microscopic organisms as the vectors of disease – would not be generally accepted until a century after Jenner, and it was still widely believed that miasma – or bad air – caused illness. Some anti-vaxxers today cling to the notion that a virus cannot kill humans because it is so small and we are so big.

Once a belief, however demonstrably false it can be shown to be, is embedded in a significant swathe of the population it is difficult, if not impossible, to dispel – just look at the fallout from this year’s US presidential election. Despite no evidence, a large section of the population believes that Trump was defrauded out of office. 

Many years ago, science weekly New Scientist reported the story of a purported new-age practitioner who had incorporated healing crystals into the matrix of his computer server. Anybody logging on to the internet via a particular IP address would have access to the ameliorating power within. 

Thousands said they had benefited, reporting recoveries from any number of medical conditions and improvements in their professional lives, their relationships and general wellbeing. Except there was no crystal computer server, the owner had made it up to prove how simple it was to convince adherents. 

Yet many of those who believed they had prospered, refused to accept this. So determined were they to cling to their convictions, even with 100 per cent proof of being hoodwinked they were unshakable. They either accused the individual of not being the original disseminator of the story, or that he’d been threatened into his about-turn by practitioners of mainstream medicine.

Innate scepticism of evidence is, of course, just one strand to the anti-vax argument. Another is the infringement of civil liberties: just how far should the authorities go in enforcing medical procedures for the greater good? The aforementioned Piers Corbyn and like-minded libertarians believe the state should have no part in enforcing lockdown or compulsory vaccination for coronavirus. It is almost certain that in modern Britain the latter will not be mandatory. But that was not the case post-Jenner.

Compulsory smallpox vaccinations backed by fines led to the growth of anti-vaccination leagues and in some cases rioting, the city of Leicester being a particularly radical anti-enforcement hotspot. This led to the “Leicester Method” of isolation of smallpox victims, disinfection of the individuals’ homes and sometimes destruction of their belongings as an alternative to vaccination. It was track, trace, isolate in early form. And it was more popular with some than vaccination.

In the 1800s people were becoming educated, literate and increasingly aware of their status and rights: Chartists, working-class activists and trade unionists were all linked to what was considered their libertarian right to refuse vaccination. This was the era of laissez-faire economics and the growth of free trade in the dawning industrial revolution and many of those working in mines and factories believed that vaccinations were a means of keeping them working harder and longer. 

Medical historian Kristin Hussey of the Royal College of Physicians points out that “people were asking questions about rights, especially working-class rights. There was a sense the upper-classes were trying to move into an area of people’s private lives, their health, which had not been governed before. There was distrust.”

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As with the common theme of the past few years in world politics, the ruling classes and government “elites” were seen to be forcing their will on the private lives of individuals. When, on occasion, the newly introduced vaccine failed to work as it should or, rarely, had fatal side-effects, moral panic and opposition grew. 

Satirical cartoons showed vaccinated babies sprouting cows’ heads. Leicester resident George Bamford had his three eldest children vaccinated but after one died, he refused to vaccinate his fourth. He was fined 10 shillings but won widespread popular support. Posters read: “Better a felon’s cell than a poisoned babe” while effigies of Jenner were burned on bonfires and his statue removed from Trafalgar Square. 

“This libertarian movement against vaccination has been a constant theme from Jenner through the mid-1800s and is still a key factor today,” says Heidi Larson, founding director of the Vaccine Confidence Project (VCP), based at the London School of Hygiene and Tropical Medicine.

Playwright and political polemicist George Bernard Shaw was a latter-day convert to the cause, having caught smallpox even though he had been inoculated and describing vaccines as a “filthy piece of witchcraft”. Pamphlets denounced vaccines. How many people would happily accept inoculation after reading “Horrors of Vaccination: the fallacies and evils”? Of course, the downside of the success of the anti-vaccination arguments meant that smallpox regularly returned. Shades of the return of measles following the MMR scandal.

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“The UK lost its World Health Organisation-monitored measles elimination status last year,” says Larson. This means measles is now transmitting between people in the UK whereas as before it was suppressed. For the MMR or any measles vaccination to successfully suppress the disease it requires coverage of about 95 per cent.

 “It took a long time to recover from Wakefield and the MMR scandal where measles vaccination dropped off dramatically,” says Larson. “But it’s still wobbling. The UK had regained its status in 2017 but lost it again last year.”

And then there was religion. In Jenner’s day many believed evil spirits or Satan caused illness, not pathogens, and that these could only be drawn out by clergy or other “healers” from herbalists to exorcists. 

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A similar situation exists today. “Toxins”, mostly unnamed and unidentified, are often held culpable for any number of maladies and cures are offered from detox diets to reflexology to realigning chakras. But simply replace the word toxin with evil spirit and we are looking at much the same phenomenon. It’s easy to see how the anti-vax movement can hold firm in a febrile atmosphere where science is misunderstood or actively believed to be damaging. 

How many mad scientists appear in horror movies? Far more than positive fictional images. Jenner was similarly disparaged and the power of state religion at that time meant that it was by far his most vocal and implacable foe.

Smallpox was sent by God, posited the church. He would choose who would live and die, not some doctor from the Gloucestershire countryside. Others said that injecting humans with material from an animal was an “unchristian abomination” in much the same way some religious groups today object to organ or blood transplants. Vaccination was tantamount to witchcraft. Others, even less charitably, believed smallpox and other diseases were sent by God to kill the children of the feckless poor because they were a burden on society.

Perhaps the most dispiriting assaults on Jenner came from within his own profession. In the main this was driven by protectionism: surgeons practising variolation suddenly saw their income under threat, as did those promoting even less efficacious cures such as leeches or purgatives and those who believed pricking smallpox pustules with silver needles would release the pathosis. 

Many wrote articles declaring vaccination was dangerous. It caused cancer, tuberculosis and syphilis they proclaimed. The belief even took hold that vaccination could turn children into cows – famously lampooned by cartoonist James Gillray in The Cow Pock,  which shows a room of people sprouting cattle-like features as Jenner injects them. 

One farmer burnt alive his entire herd of cattle because he believed they were communicating with his wife, imploring her to have their children vaccinated which, he believed, contradicted religious teaching. And it echoes through to today. “Rumours were circulating on the internet that the Oxford Covid vaccine that uses a chimpanzee virus as its base would turn your child into a chimp,” bemoans Larson.

Even those physicians of a more scholarly bent found it hard to obtain cowpox matter, especially those living in major cities, and it often became contaminated when transported leading some to declare it more dangerous than smallpox contagion. In a few cases they had a point, although it wasn’t vaccination that was killing some patients but the unsterile conditions – long before germ theory was understood – in which injections were prepared. 

Farmyards, from which cowpox samples often had to be taken, were never likely to be the most hygienic of areas. As Alun Anderson, former editor of New Scientist,  has written: “In 2004 New Scientist reported that some polio vaccines made in the Soviet Union had been contaminated with simian virus from monkeys which could potentially cause cancer. It didn’t mean all vaccines were hazardous, just that batch. Yet it had happened once before in the US and such incidents erode trust.” 

Likewise other diseases could be transferred from patient to patient by using the same needle more than once. This did not mean, of course, that the vaccination itself was unsafe but as with modern-day anti-vax movements, circumstantial evidence was enough to convince any cynics.

A belief, with no foundation in fact, that vaccines “overload” a child’s immune system is frequently cited today. Measles cases have risen even in areas of the world where full vaccination is available, often driven by well-meaning, educated but scientifically nescient parents whose belief in lifestyles based on “natural or traditional healing” (the worldwide market for which is now approaching $300 billion) and inherent distrust of science creates unintended repercussions. 

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Routine vaccinations for under-fives are falling in developed countries – and once below that 90-95 per cent figure the general population begins to lose the fabled herd immunity we heard so much about in the early days of the Covid pandemic.

But today – as back in Jenner’s day and the decades after his death – even reasonable people, those who support vaccination and mainstream medicine, would rarely endorse enforced vaccination. In the second half of the 19th century you could divide Europe into nations that had made vaccination mandatory, such as Britain, which were down to about two deaths per million people from smallpox each year and those that hadn’t, such as the Netherlands, which had more than 4,000 deaths per million people each year. 

But even so, a Royal Commission in 1896 – exactly a century after Jenner injected James Phipps – recommended the government should cease making it compulsory although it acknowledged the smallpox vaccine was effective and safe. Two years later a “conscientious objector” clause was introduced allowing parents to opt out of vaccinating their children.

 Compulsory vaccination itself was finally abolished in 1948. And today the Royal College of Paediatrics believes compulsory vaccination, even in a pandemic, would be counterproductive and lead to scepticism even as the WHO has declared “vaccine hesitancy” to be one of the top 10 risks to global health.

“Some nations require children to be vaccinated before they attend school, usually to protect others,” says Larson. “But in adults it’s difficult to make vaccination mandatory and the UK is particularly cautious because of the anti-vaccination leagues of the 1800s. In any case the UK’s system, as we have seen throughout the pandemic, would almost certainly be incapable of introducing a mandatory programme.”

So how do we “encourage” those who believe vaccinations inject government-controlled, Bill Gates-built nanobots into our bloodstreams to be vaccinated? The same people who back in Jenner’s day believed that an injection would turn their child into cattle? We can’t, of course, but education is the key.

“The VCP has just launched an initiative called ‘Convince’,” says Larson. “We want to develop understanding and literacy around Covid and other vaccines. We want to make the information relevant to ordinary people and their concerns rather than passed down from health authorities. Social media moves quickly and we need to react in real time to address fears and myths rather than reacting when apocryphal stories have already taken hold. A lot of the problem stems from the fact that science by its nature is uncertain, but people want certainty. The language of science can be cryptic but the messaging needs to be clearer. 

"A lot of it is delivered by policy makers and politicians and, like the general public, they too find much of the output from scientists difficult to comprehend. And they have constituents who don’t understand vaccines or are outright opposed to them. Surrounded by different opinions they will often hedge their bets and make poor calls. We must spell out the evidence to them in simple, basic and clear terms. In the past there were some terrible diseases and it was clear why we needed vaccines. Today we live longer and healthier and the need for vaccines seems less obvious to the general public, even though they are still important. That needs to be made clearer.” 

And as Anderson adds: “Reports of the constant failings, legally and ethically, of many people in the employ of industries such as energy, tobacco, food and pharmaceuticals destroy public trust. It has made it easy to convince the public that everyone is conspiring to harm us, rather than working for the public good. Mistakes and poor controls by pharmaceutical companies must be stopped if they are to regain trust.”

And should science, while continually asserting it is based only on the genuine evidence collected,  be more attentive to people’s fears rather than dismissing them as witless? 

Maybe there would be common ground. In July 1999, leading medical organisations recommended that mercury-containing thimerosal, a component used in small amounts in vaccines, should be phased out. There was no clear-cut evidence it was in any way harmful but anecdotal stories once again linked it to autism. Whether this was a wise decision is an argument yet to be fully played out, but it showed a willingness from medicine to either engage or to succumb, depending on which side of the fence you are sitting. “There is nothing wrong with the precautionary principle as long as we make it clear we are doing it for that reason alone,” says Larson.

No vaccine is, of course, 100 per cent safe, nor 100 per cent effective in all cases: they can have side effects and negative long-term consequences we have yet to discover. But these are the reasons they are tested before release. 

The myth that vaccinated people have more disease than the unvaccinated is simply that, a myth – a widespread one among anti-vax campaigners but a myth nonetheless. A small proportion will catch the disease they are vaccinated against but that is because, as we have seen with the recent Covid trials producing success rates of around 90-95 per cent, no vaccine is fully effective for everybody. 

Anderson offers his own solution. “Back in Jenner’s time one of the supporters of vaccination offered to pay the funeral costs of any anti-vaxxers who would come forward and be exposed to a person with smallpox. No one took up the offer. The same option should perhaps be extended to everyone who sees Covid-19 as no worse than flu or a hoax. I suspect the result would be the same,” he says sardonically.

In 1978, thanks in large part to Jenner’s work and the large-scale vaccination programmes that followed, the WHO (itself the subject of Trumpian and other conspiracy theories throughout the current pandemic) announced smallpox eradicated – the only human disease so declared (two specimens remain in laboratories should the need to study them further arise). 

It is estimated that Jenner has saved somewhere in the region of 530 million lives, possibly more than any other person in history. Yet still the anti-vax offensive rumbles on. A recent poll in the UK suggested that as many as four in 10 people might opt out of taking a Covid vaccine, while figures for some other developed nations are even higher. It is a paradox of the human condition that in an era where medicine is deemed safer and more successful than ever, some people will still prefer to put their faith in healing crystals.

Owen Gower, the manager of Dr Jenner's House, Museum and Garden in Berkeley, Gloucestershire, told the BBC that “Jenner's legacy is a world where we do not have to live in fear of horrific infectious diseases”. Yet still we do and, in many circumstances, apparently out of choice.