VACCINES--HOW A MILLENNIA-OLD LIFESAVER WAS AND STILL IS CONTROVERSIAL: Part 2

 Anti-vaxxers are nothing new

Opposition to vaccination is not a 20th-21st century phenomenon. It has been prevalent for much longer than many may realize. Here's an intriguing anti-vaccination flyer from 1807 called "The Vaccine Monster," clearly designed to engender feelings of suspicion, disgust and fear.

The Vaccine Monster, 1807 (Image: Wiki Digital Methods)

The text that accompanied this image proclaimed that, "A mighty and horrible monster, with the horns of a bull, the hind of a horse, the jaws of a krakin, the teeth and claws of a tyger, the tail of a cow, all the evils of Pandora's box in his belly, plague, pestilence, leprosy, purple blotches, foetid ulcers, and filthy running sores covering his body . . . has made his appearance in the world, and devores mankind —especially poor helpless infants—not by sores only, or hundreds, or thousands, but by hundreds of thousands." 

Another flyer from 1894 was accompanied by text warning of the dangers of vaccination.

(Image originally from Historical Medical Library of The College
of Physicians of Philadelphia)

Notice the reference to vaccines being poison and not only ineffective, but actually producing death. Most important is this sentence: "Any dogma of a class, medical or religious, that needs the fostering care of legislative enactment to force it upon the people, shows inherent weakness and condemns it at once among all men." It also claims that the smallpox vaccine caused greater mortality than smallpox itself. 

A Supreme Court Case

In Part 1 of this two-part series, we saw how important the smallpox vaccine became as a preventive measure against a grossly disfiguring and highly contagious disease. By 1902, smallpox vaccination was well established in Boston. Nevertheless, the disease stubbornly hung around, and officials took drastic measures. For instance, public health doctors, accompanied by guards, went to the railway yards and forcibly vaccinated “Italians, negroes and other employees.”

In 1902, Cambridge's Board of Health mandated smallpox vaccination for all residents who had not been vaccinated since 1897. But a naturalized Swedish American called Reverend Henning Jacobson refused to take the vaccination, claiming that Sweden's mandatory vaccination when he was six years old had caused him "great and extreme suffering." He was convicted and fined $5, which he refused to pay. 

                                            Henning Jacobson (Image: New England Historical Society)

In a legal brief, Jacobson stated he rejected a law that compelled ". . . a man to offer up his body to pollution and filth and disease," on the basis of the 14th Amendment, which states in part, "No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States."  Of note, Jacobson made dire references to vaccinations ("filth and disease") that echoed those of the 1807 "Vaccine Monster" flyer. The Jacobson case went to the U.S. Supreme Court, which held that individual liberty is not absolute and is subject to the police power of the state. Jacobson lost the case.

But in 1926, a group of health officers who went to Georgetown, DE to vaccinate the townspeople were met by an armed mob led by a retired Army Lieutenant and a city councilman. The "vaccinators" were driven out. If any of the residents of Georgetown were aware of the 1905 Supreme Court ruling, it evidently made no difference to the ire directed against the authorities.

In 1935, two separate polio vaccine trials using killed and attenuated poliovirus resulted in catastrophic morbidity and mortality in many subjects out of the 11,000 total number of people vaccinated. This doesn't say vaccines are bad; rather it emphasizes the absolute importance of conducting careful trials before a large number of people are administered a vaccine. In 1953, Jonas Salk produced an injected vaccine for polio using a killed virus, and in fact he injected his own family members with it. In 1959, Albert Sabin brought out his oral attenuated virus, which was tried out on, strangely enough, Soviet citizens. In modern times, only the inactivated (injected) poliovirus is used in the U.S., while other countries use the oral form. Throughout the 1900s, many of the vaccines with which we've come to be familiar, e.g. mumps, measles, rubella, rabies, diphtheria, pertussis, meningitis, and chickenpox were developed. In 1972, the smallpox vaccine was no longer routinely administered in the U.S. 

The "Case" Against Vaccines

The objections and resistance to vaccination fall into a number of categories:

• Religion: It isn't that multiple Christian denominations like Roman Catholic, Amish, Anglican, Episcopalian, have an official stance against vaccination. They do not. What we see is the individual who believes that "God is more powerful than any virus," or some similar declaration. These people refuse vaccinations on the basis of their faith. All but two US states allow vaccination exemption on the basis of religion.
• Misconceptions: Just as in foregoing centuries, some believe that vaccines actually give a person the disease or even cause death. This is still the case with the annual influenza vaccine. I have personally taken it every year for more than 20 years, but people still swear (including a surprising number of people in health care) that whenever they get the flu shot, they get the flu. It isn't true. There may be a mild local or systemic reaction, but it is not the flu.
• Concerns about adverse effects: In 1998, Andrew Wakefield published a study in the influential British medical journal, The Lancet, claiming to show that the mumps-measles-rubella (MMR) vaccine could be associated with the development of autism in twelve children. What followed was a circus of accusations and conspiracy theories that the manufacturers of the MMR vaccine were hiding the truth about its causing autism. When the cause of a disease is unknown, those affected will readily latch onto any explanation offered, no matter how flawed. Wakefield's paper was deeply flawed, yet it took The Lancet 12 years to officially retract it. However, humans being what they are, a planted seed puts down deep roots and continues to grow unabated.
• Fear of vaccine ingredients: in 1926, Alexander Glenny increased the effectiveness of the diphtheria toxoid by treating it with aluminum salts. Called an adjuvant, this increases the immune response in a subject. Much later, in 1964, the American Academy of Pediatrics recommended aluminum adjuvant in the combination diptheria-tetanus-pertussis (DTP) vaccine. The amount of aluminum salts contained is in fact less than the amount in normal human breast milk, but many people are under the impression that there are pieces of the metal aluminum floating around in the vaccine. Like the MMR vaccine itself, thimerasol, a preservative containing ethyl mercury, was implicated--falsely--to autism. Since 2001, thimerasol hasn't been used in children's vaccines, although it is still used in the adult flu vaccine unless preservative-free vaccine is specifically requested.
• Immune overload: Many parents falsely believe that the multiple immunizations given to children at a single doctor visit is detrimental to a child because their immune system can't handle them all at once.
• Genocidal agent: prevalent in Africa especially is the belief that vaccines are really an attempt by western countries to kill off black Africans. Most recently, this conspiracy theory has been applied to the putatively upcoming Covid vaccine, and of interest is that Bill Gates is central to that plot. But don't scoff at Africans just yet. Since Gates famously predicted a pandemic back in 2015, some Americans also believe that he started the pandemic himself. (Others decry why he shows up on CNN talking about medical issues when he is not a physician.). But guess what? President Barack Obama actually beat Gates to it (at least on YouTube) when he precisely foresaw a global airborne pandemic such as Covid back in 2014.

Individual Liberty

All those above reasons aside, a powerful theme that has run through the anti-vaxxer's cry from way back in the 1800s until the present day is a strong objection to being told what to do by authorities. People go to a physician for a sore throat and demand antibiotics, but being asked to take a vaccine to prevent illness is a different matter. That is an imposition on one's freedoms, as is wearing a mask to prevent spread of Covid. There are emotional, cultural, and ideological objections to vaccination. Conservative people are less likely to accept or recommend vaccination. Donald Trump has used Twitter to perpetuate the long-debunked linkage between autism and vaccines since as far back as March 2012. However, a well-known liberal, Robert F. Kennedy, Jr. also was a vaccine skeptic. 

Suspicion of government and the perception that authorities are trying to take away personal freedoms are often tied to any number of dark conspiracy theories. These are sometimes triggered by signals from sharply partisan individuals with a platform, such as conservative TV and radio hosts, celebrities such as Jenny McCarthy, and leaders such as President Trump, who has cast aspersions on the CDC, for example. The tangle of ideology, politics, and conspiracy theories is complex, and unfortunately it can have negative and dangerous consequences when it comes to vaccines and vaccination. Since the 19th century, we have made tremendous progress in science and technology, but for some, that "Vaccine Monster" of 1807 is still a reality. 

(Addendum: A correction was made to reflect that the Robert Kennedy who is a vaccine skeptic refers to Robert F. Kennedy, Jr.)