Drugs & Medication

After the introduction of vaccination in 1796, the first anti-vaccination society was formed in 1798. In the 19th and early 20th centuries, various organizations declared their opposition to vaccination. Until Pasteur and Lister demonstrated the basis of infection and how to prevent it, vaccinations were as dangerous as other surgical treatments of the time. The view of the British government throughout was that vaccination was safer than variolation, and this is not generally disputed; variolation was safer than random infection with smallpox, but potentially spread smallpox infection itself.

The medical community overwhelmingly supports vaccination as an effective and safe way to prevent the spread and reduce the impact of infectious illnesses. Public health advocates overwhelmingly consider that the benefit to the public justifies mandatory programs.

Contents 1 Timeline 1.1 Arguments against vaccination 2 Consequences of success 3 Events following reductions in vaccination 3.1 UK: DPT 1970s-80s 3.2 The Netherlands: measles (1999-2000) 3.3 Ireland: measles (2000) 4 Anti-vaccinationist material 4.1 Section references 5 Anti-vaccination organisations 5.1 Historical 5.1.1 Aims and results of the early movements 5.2 Current 5.3 General 6 The state 7 Anti-vaccinationist assertions 7.1 No benefit 7.2 50% 7.3 90% 7.4 In on-line responses 8 Attacks on a broad front 8.1 Science 8.2 Doctors' behaviour 8.3 Cell-lines 8.4 Thiomersal 8.5 Effect on public morality 9 Publications 9.1 Historical 9.2 Recent 9.3 Websites in opposition to anti-vaccinationists 10 Notes 11 References

Timeline

After the work of Edward Jenner, vaccination became widespread in the United Kingdom in the early 1800s.[1] Variolation, which had preceded vaccination, was banned in 1840 because of its greater risks. Public policy and successive Vaccination Acts first encouraged vaccination and then made it mandatory, with the highest penalty for refusal being a prison sentence. This was a significant change in the relationship between the British state and its citizens, and there was a public backlash. Initially this was focused against compulsory vaccination, and later included arguments that vaccination was dangerous and ineffective.

In the USA, President Thomas Jefferson took a close interest in vaccination, alongside Dr Waterhouse, chief physician at Boston. Jefferson encouraged the development of ways to transport vaccine material through the Southern states, which included measures to avoid damage by heat, a leading cause of ineffective batches. Smallpox outbreaks were contained by the latter half of the 19th century, a development widely attributed to vaccination of a large portion of the population[2]. Vaccination rates fell after this decline in smallpox cases, and the disease again became epidemic in the 1870s.

Anti-vaccination activity increased again in the USA in the late 19th century. After a visit to New York in 1879 by William Tebb, a prominent British anti-vaccinationist, the Anti-Vaccination Society of America was founded. The New England Anti-Compulsory Vaccination League was formed in 1882, and the Anti-Vaccination League of New York City in 1885.

Arguments against vaccination

The first arguments against vaccination were theological.^[3] Some anti-vaccinationists still base their stance against vaccination with reference to the Bible.^[4]

In a 2002 paper in the British Medical Journal, two medical historians suggest that the arguments made against the safety and effectiveness of vaccines in the 21st century are similar to those of the early anti-vaccinationists.[5] Another author in the JRSM(2005) describes the differences between contemporary anti-vaccination campaigns and those before 1907.^[6]

Anti-vaccinationists argue that:

• Large smallpox epidemics have occurred in highly vaccinated populations, presenting figures from 1905 in the Philippines. Historians note that the Philippine-American War between 1899 and 1913 caused major disruptions to medical facilities, which were noted to damage the effectiveness of vaccines.
• 90% of the decline in infectious disease incidence occurred before the application of specific vaccines.

Even before Pasteur's work on the nature of infection, there was evidence that contagions spread from person to person, even though microscopes were not yet available and the nature of the contagion (microorganisms) could not be elucidated. Subsequently, as demonstrated by Ignaz Semmelweis, Joseph Lister and others, the knowledge that there were specific modes of cross-infection and that these could be avoided diffused through the population. One argument presented by some modern anti-vaccinationists (e.g. Whale.to) is that Pasteur's theory was incorrect and Antoine Bechamp's germ theory^[7] better represented the transmission of disease. This view is not widespread, but is not criticised on anti-vaccinationist websites. This view of the genesis of disease provided no rationale for sterilising instruments, and an overlap in those decades between anti-vaccinationist thinking and Bechampist potentially contributed to deaths from infection and cross-infection.

Infection as a complication of vaccination is almost absent in the 20th century in developed countries, but in developing countries re-use of needles has contributed to the spread of HIV. There is an overlap in anti-vaccinationist thought, with the denial both of HIV as the unique causative organism of AIDS and with denial that viruses cause disease. (Viral and bacterial DNA is listed as a dangerous constituent of vaccines by some authors without disagreement visible, from other anti-vaccinationists). These arguments oppose conventional medical arguments that favour expensive public health precautions against HIV infection.

Consequences of success

Success in opposing vaccination, or a particular vaccination, will be reflected in a reduction in use of all or specific vaccinations. If a vaccine is beneficial, then such success will lead to harm; if a vaccine is harmful, then such success will lead to benefit.

The arguments over which of these occurred were considerable even in the 19th century with only a single vaccination to consider - smallpox. After the Royal Commission, which reported in considerable detail, the Royal Statistical Society devoted a meeting to considering the statistical aspects of the argument. The Royal Commission concluded that smallpox vaccination was effective.

From 1796 to 1905, large changes in English society added to the difficulties of analysis. In later periods, changes in hygiene and sanitation have been much less dramatic, and thus the confounding factors are less around the introduction of measles, rubella and Haemophilus B vaccinations.

Events following reductions in vaccination

In several countries since 1960, reductions in the use of some vaccines were followed by increases in the diseases' morbidity and mortality.

It has been suggested that, because the death and illness rate is so low in most first world countries, there is no need for vaccination. This could be interpreted to mean that when a public health measure is effective, it should be discontinued.

In the absence of assertions that contracting infectious diseases is either a necessary part of development, or confers specific benefits apart from specific (to that disease) immunity, it is commonly accepted that surveillance for infectious disease and isolation of individuals contracting an infectious disease are cornerstones of public health policy[1]. In the 19th century, the city of Leicester in the UK achieved a high level of isolation of smallpox cases and great reduction in spread compared to other areas. The mainstay of Leicester's approach to conquering smallpox was to decline vaccination and put their public funds into sanitary improvements. Bigg's account of the public health procedures in Leicester, presented as evidence to the Royal Commission, refers to erysipelas, an infection of the superficial tissues which was a complication of any surgical procedure.

A component of current-day anti-vaccinationist argument is against the medical establishment . This renders those convinced more likely to avoid reporting illness, and weakens the tracing and control of infection . An imported measles case in Iowa [2] is one illustration of the problem this might cause.

UK: DPT 1970s-80s

In the 1970's and 1980's there was a campaign (in which the newspaper The Sunday Times was particularly involved) against the use of the Diphtheria, Pertussis and Tetanus (DPT) "triple jab" vaccine. This lead to a decline in public confidence and an increase in cases of pertussis (whooping cough) and the subsequent death of some children. The scare ended in the UK after a March 1988 ruling in the High Court in London that, on the balance of probabilities, the vaccine did not cause permanent neurological damage [3]. A similar pattern was thought to occur in the 1990's with the MMR vaccine causing autism; the single study this was based on has now been discredited.

The Netherlands: measles (1999-2000)

An outbreak at a religious community and school in The Netherlands illustrates the effect of measles in an unvaccinated population.^[8] The population in the several provinces affected had a high level of immunisation with the exception of one of the religious denominations who traditionally do not accept vaccination. The three measles-related deaths and 68 hospitalizations that occurred among 2961 cases in the Netherlands demonstrate that measles can be severe and may result in death even in industrialized countries.

Ireland: measles (2000)

From late 1999 until the summer of 2000, there was a measles outbreak in North Dublin, Ireland. At the time, the national immunisation level had fallen below 80%, and in part 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.^[9],[10]

Anti-vaccinationist material

Anti-vaccination writings on the Internet are characterised by a number of differences from medical and scientific literature.^[5] These include:

• Promiscuous copying and reduplication.^[11]
• Tendency to be without corrections, even when an initial report is shown to be false (e.g. Donnegan and Schreiber references below). See also absent correction
• Deficiency of references to allow readers, should they wish, to check sources.^[12]
• Personal attacks on individual doctors.
• Dishonest or fallacious arguments.^[13]
• The sites show a high degree of interlinkage.^[11]

There is a considerable overlap with homeopathy and various conspiracy theories, and a subset of the material shades into the appearance of psychosis.[14] An example, which vaccinationists say is dishonest, is the dismissal of immunisation by some critics because it has not eliminated any disease. In 1979 the World Health Organisation (WHO) announced that smallpox had been eradicated; WHO described a huge effort involving many people and various public health strategies, of which immunisation was an important one. Anti-vaccinationists present this as an assertion that the result came solely by vaccination, and then assert that instead it came about solely by historical force.

Over each time period, infectious disease mortality has been falling for all common diseases (UK Office for National Statistics); anti-vaccinationists argue that this is because of improvements in nutrition and living conditions, not because of immunisation.

Section references

• UToronto.ca (pdf) - 'Public opponents of vaccination: a case study", Julie Leask, Peter McIntyre, National Centre for Immunization Research & Surveillance, University of Sydney
• Vaccine, vol 21, p 4700-4703 (2003) PMID 14585678 ]
• [4].
• [5]
• [6]
• [7]
• www.vaclib.org/basic/crusade.htm Yurko (attacks Jenner, makes various assertions) reprinted from Crusador Magazine.
• www.mercola.com/2001/may/5/vaccination_jenner.htm Hadwen MD "Truth" 1923 (on Jenner - nothing approaching a medical qualification; fraudulent research on cuckoo ...

Anti-vaccination organisations

Historical

Aims and results of the early movements

In Massachusetts, the argument continued from that about variolation, with a minority religious view strongly put that others should eschew immunisation and accept the smallpox that God sent. Cotton Mather and other leaders favoured efforts to prevent disease.

In the USA, the Commonwealth of Massachusetts was the first to make vaccination mandatory, in 1908[8]. In the UK, vaccination was provided free from 1840 under the Vaccination Act. In 1873, a further Vaccination Act made vaccination compulsory. Resistance to compulsion grew, and in 1885, after riots in Leicester, a Royal Commission sat and reported 7 years later, recommending the abolition of cumulative penalties. This was accomplished in the 1898 Act, which also introduced a conscience clause, allowing parents who did not believe that vaccination was efficacious or safe to obtain exemption. This extended the concept of the "conscientious objector" in English law. The aims of the protesters and organisations had thus been achieved in 1898.

Name	Started	Finished	Location	Unique Proposition / Notes
Anti-vaccination Society	1798		Boston USA	Against the will of God
Anti-Compulsory Vaccination League	1866	1880 (segue)		Mr. R. B. Gibbs (d. 1871) started it . Revived 1876, President: Rev. W. Hume-Rothery
the Anti-Vaccination Society of America	1879
New England Anti-Compulsory Vaccination League	1882
Anti-Vaccination League of New York City	1885
London Society for the Abolition of Compulsory Vaccination	1880	1896 (segue)	Victoria Street, Westminster, London	Secretary: Mr William Young. Adopted The Vaccination Inquirer established 1879 William Tebb as the organ of the Society. Published: 14 "Vaccination Tracts" 1877 - completed by Dr Garth Wilkinson in 1879. 1879, "Vaccination Tracts" 1882 THE FABLE OF THE SMALL-POX HOSPITAL NURSES SAVED FROM SMALL-POX BY RE-VACCINATION April 1883 to March 1884, The Vaccination Inquirer Vol V (book) The movement grew  and the London Society soon became national so reformed as ...
National Anti-Vaccination League	1896 (Feb)	before 1970?	England	objectives:— repeal of the Vaccination Acts; disestablishment and disendowment of vaccination; abolition of all regulations in regard to vaccination as conditions of employment in State Departments or of admission to Educational or other Institutions. Added in 1921:— vindication of the legitimate freedom of the subject in matters of medical treatment.

An organisation with a general anti-vaccination view but other more significant characteristics was the Nazi party.^[15]

Current

Name	Started	Finished	Location	Membership	Unique Proposition / Notes
Vaccination Liberation (USA)	Contemporary				Website: www.vaclib.org
VRAN (Canada)					Website: www.vran.org
AVN (Australia)					Website: www.avn.org.au

Since the reversion from compulsory immunisation in the UK, opposition has continued at a lower level. After 1993, several national organisations appeared on the Web. Continuity with the older organisations is not apparent.

Opposition could no longer focus on the right to determine what is done to one's children, and therefore the primary arguments against vaccination changed. Focus transferred to arguments that immunisation did not have an effect; that it had a negative, rather than beneficial effect; or that although immunisation had a beneficial effect in the short term, any benefit may be negated by long term negative consequences.

These changes have resulted in arguments based upon hypotheses that are susceptible to disproof rather than philosophical questions of the relationship of individuals to state or deity.

General

The historian Nadja Durbach ^[6] notes that in the early 19th century, the anti-vaccination movement drew members from across a wide range of society. Fitzpatrick reviewing it adds that in recent years, it has been reduced to a predominantly middle-class phenomenon.

The state

"Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of a medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this realisation 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." BMJ

Most states in the USA require immunization, or obtaining exemption, before enrolment in public school. Exemptions are typically for people who have compromised immune systems, allergies to the components used in vaccinations or strongly-held objections. The American Academy of Pediatrics considers parental waivers of immunization a form of child abuse and neglect.

Anti-vaccinationist organisations publicise the procedure for obtaining exemption.

Immunizations are often compulsory for military enlistment.[9]

Anti-vaccinationist assertions

Many assertions are replicated in several websites and repeated by individuals who have been categorised as anti-vaccinationist. Peter Morrell, a part time academic in England, describes one set. They are generally presented as individual propositions, rather than a nesting set of propositions ; this contrasts with scientific argument where classification and consolidation are fundamental 

No benefit

Some anti-vaccinationists offering alternative medical practices assert that there has never been any benefit to public health from vaccination[16]. Similarly they assert that all the reduction of communicable diseases which were rampant in conditions where overcrowding, poor sanitation, almost non-existent hygiene and a yearly period of very restricted diet existed, are reduced because of changes in conditions excepting vaccination .

50%

As in:

• "50% of deaths occur in vaccinated children"  with the implication that there is an even chance regardless of immunisation, and that the immunised population is identical to the unimmunised .
• "50% of deaths occur in children below the age of vaccination"  with the implication that they would not be protected by personal immunisation, and therefore not protected at all . Herd immunity is not mentioned.

90%

A recurring argument is that a 90% (eg 99.4% for measles in England and Wales from 1901/2 averaged) reduction in a specific disease occurred between two dates, the latter just before introduction of vaccination or immunisation against that disease, and that therefore any subsequent reduction is due to the same forces of history, and none of it is because of vaccination.

(See also vaccine controversy)

In on-line responses

Responses to papers or reports of scientific or political enquiry in the BMJ attract responses repeatedly deploying characteristic arguments in characteristic fashion from a small population of frequent responders [10]. Mainstream doctors regard these arguments as having been refuted.

Attacks on a broad front

Science

Assertions that immunisation cannot work because the theory on which it works is incorrect have been made .

Doctors' behaviour

In 2006 immunisation of medical, nursing and paramedical staff in the UK national health service is believed to be complete .

Cell-lines

A reluctance to use (viral) vaccines derived from human cell-lines is a definite principled objection. Secular ethical, humanist and mainstream religious views generally do not reject them. The element of presentation of the argument, in terms of absolutes and the evil of those preparing the vaccines distinguishes arguments from an anti-vaccinationist stance from the discussion of proportionate benefit and harm in a continuum of ethics.

Thiomersal

Thiomersal is being phased out (already in some European countries) and the USA is following. Recently, largely in the USA, it has been suggested that the organic mercury content of thiomersal in child vaccines might contribute to autism.[17][18] The 2004 Institute of Medicine panel favoured rejecting any causal relationship between thiomersal-containing vaccines and autism. The interests in this are vested, for example, governments wishing public health policies to proceed, pharmaceutical companies preferring not to pay huge damages, and (in the absence of no-fault compensation) large monetary gains for successful litigants and their counsel. Anti-vaccination sites publicise the assertions of danger more prominently than these findings , or the fact that thiomersal has recently (eg Oct 2004 in the UK) been removed from many vaccines for use in the Western world (but not the third world).

Effect on public morality

In the USA, some conservative Christian groups, for instance the Family Research Council, have opposed mandatory vaccination for diseases that are typically spread via sexual contact (e.g. Hepatitis and HPV). They believe that the possibility of disease serves as a deterrent against risky sexual contact, and that removing the possibility of disease would have the unintended side effect of encouraging risky sexual contact, particularly among teenagers.^[19]

Publications

Historical

• 1884 Compulsory Vaccination in England by William Tebb
  1885 The Story of a Great Delusion by William White
  1898 Vaccination A Delusion by Alfred Russel Wallace
  1936 The Case Against Vaccination by M. Beddow Bayly M.R.C.S., L.R.C.P.
  1951 The Truth About Vaccination and Immunization by Lily Loat
  1957 The Poisoned Needle by Eleanor McBean

Recent

• 1990 Universal Immunization: Miracle or Masterful Mirage by Dr. Raymond Obomsawin
  1993 Vaccination: 100 years of orthodox research shows that vaccines represent an assault on the immune system by Viera Scheibner. ISBN 064615124
  2000 Behavioural Problems in Childhood by Viera Scheibner. ISBN 0-9578007-0-3
  2004 The Vaccination Nonsense by Dr. med. Gerhard Buchwald ISBN 3-8334-2508-3

Websites in opposition to anti-vaccinationists

• The Anti-Immunization Activists: A Pattern of Deception - Ed Friedlander, MD
• Issues in Immunization - Lon Morgan, DC
• Misconceptions about Immunization - Stephen Barrett, MD
• Chiropractors and Vaccination: A Historical Perspective - James B. Campbell, PhD; Jason W. Busse, DC, MSc; and H. Stephen Injeyan, DC, PhD
• Chiropractors and Immunization - Stephen Barrett, MD
• Natural experiments in medicine - Ganfyd
• Compare the Risks: Disease vs. Immunization - King County Public Health Dept.
• Six Common Misconceptions about Vaccination and how to respond to them - CDC
• What Would Happen If We Stopped Vaccinations? - CDC

Notes

References