"Anti-Vacc-Attack in London": Current Connections

Hey everyone!

After spending a week in London studying the 19th century anti-vaccination movement, I found many connections to current movements. This post is an overview of some of those similarities. 

The London School for Hygiene and Tropical Medicine-
the Vaccine Confidence Project can be found here.
Also notice the names at top- Sir John Simon was in charge of the
1858 Vaccination Act!  

A major reason I was interested in the topic is because of the current implications. The World Health Organization listed "Vaccine Hesitancy" as one of the top ten threats to global health in 2019 (that means it ranks up with Ebola and microbial resistance). The persistent mistrust of vaccines is very interesting to me, especially looking at how that hesitancy differs between time, cultures, and vaccines. I was really lucky to be speak to Clarissa Simas, who works at the Vaccine Confidence Project. With degrees in medical anthropology and psychology, she has done extensive research on HPV vaccine hesitancy in particular. We were able to talk for about an hour, and she emailed me a list of  sources on the biotechnical embrace, medical populism, and current methods on theorizing vaccine refusal. Her reflections on the current state of vaccine hesitancy helped me to understand current concerns, communication strategies, and ways we can learn from the weakness of the 19th century vaccination laws. Understanding the historical legacy of this problem can provide insights into countering it today. 

Concerns

While there was only vaccination for smallpox in the 19th century, now there are 18 approved vaccinations. Between vaccine types, concerns differ. Concerns can also differ between cultures, so it is important to understand the specific context when addressing the fears. Understanding a target population's precise concern can help to approach the conversation about the vaccine in a more thoughtful and effective way. 

In current research, vaccine hesitancy is classified into four main categories: safety, effectiveness, religious, and moral concerns. In the 19th century, smallpox vaccination concerns fell into these categories as well.

Safety Concerns: 

This is the building for the National Autistic Society
They state on their website "The National Autistic
Society is clear that there is no link between autism
and the MMR vaccine."  

The journals are full of personal experiences with illness and death as a result of vaccination. In Mary Hume-Rothery's "150 Reasons for Disobeying the Vaccination Law by Persons Prosecuted Under It",  a majority recount vaccination injuring/ killing a friend, a child, or themselves. Tragic stories of victims, such as Miss Ellen Terry, were also recounted in the journals.  It was interesting how many different medical problems vaccines were blamed for- everything from tooth decay to lunacy to cancer was attributed to vaccination.

There were also large paragraphs about blood-poisoning and rotting flesh, which could be inspired by Gothic literature at the time (such as Frankenstein and Dracula). In fact, there was a pamphlet produced called "The Vaccination Vampire" in which Garth Wilkinson described blood-poisoning.

Today, vaccinations like MMR have "safety concerns" associated with it after Andrew Wakefield's (falsified) study that the vaccine caused autism. Many of the ailments attributed to smallpox were not well understood at the time, and similarly the causes of autism are complex and not well understood today. The focus on the fear of autism, as opposed to the fear of measles/ mumps/ rubella,  is interesting, and perhaps highlights that not having neuro-normative a child is akin to 19th century fears of monsters. (This then begs the question- why? What in our culture needs to change? A way to address MMR vaccine hesitancy could be to make it easier for parents with autistic children to find and afford services, as well as addressing stigma.)

This satirical pamphlet express a fear of government
control over bodies

Effectiveness Concerns: 

Mary Hume-Rothery and others often created large statistical tables to show that the unvaccinated were not more likely to die from smallpox, and that the medical statistics were wrong. As Pasteur's ideas about germ theory came out, he was often attacked. For the Victorian understanding of the body, it didn't make sense to put something unclean into your body to make you healthier.

Today, many people have concerns about the effectiveness of the flu vaccine. Many people either have personal experience ("I got the vaccine but still got the flu") or are skeptical of researchers ability to predict the new strains.

Religious Concerns: 

Religious concerns were prevalent, as many thought it wasn't right to interfere with God's will. May Hume-Rothery called the laws "Devil Worship" and people who were arrested for refusing to vaccinate their children were compared to religious martyrs. Even in the letters abut vaccination from 1803, the author writes "Our little girl we leave in the hands of the Lord who does all things right".

An example of these type of concerns today can be found among Muslim populations, who need to be assured there is no pork product in the vaccine. Another example is refusal of the HPV vaccine because it might "encourage promiscuity" in girls. Because of religious beliefs, people are hesitant about vaccines.

Moral Concerns:

In sophomore tutorial, we discussed modern day questions of bodily
autonomy in museums- I was suprised to see "Body Worlds"
while in London! (Was too scared to go in lol) 

In the 19th century, moral concerns came from the vegetarians who disliked the use of "cow-grease" and others concerned with vaccination not being "natural". Throughout the journals, there were many "healthy habit tips", encouraging exercise, fresh air, a healthy diet, and not smoking or drinking. In this way, the 19th century anti-vaccinators did care quite a bit about their health and were just very careful about what they put into their bodies. 

When someone's identity is founded on them being a "naturalist", it can be difficult to convince them to vaccinate. Today, there are also concerns about vaccination not being natural. For example, there are fears of mercury in vaccines poisoning children. 

Another intersection of 19th century and  modern moral concerns centers around body autonomy. The Contagious Diseases Act of 1864 allowed for the arrest, detention, and invasive examination of any woman that "looked like a prostitute" in order to protect the male soldiers from STIs. (Note- Winston Churchill's mother discreetly fought against this act.) The doctor did not receive the woman's consent. The 1832 Anatomy Act gave poor law guardians power to distribute corpses of dead paupers to anatomical schools for dissection. In this way, even after death, the bodily rights of the poor were not respected. These laws sought to control the bodily autonomy of women and the poor, and the Vaccination Acts were seen to be similar flexes of biopower over vulnerable groups. Today, "my body, my choice" is a common rallying cry for abortion rights, but also as an argument against vaccination. Bodily autonomy continues to be a moral objection, especially for disadvantaged groups.

Communication Strategies

In both 19th century and modern contexts, there are similarities between the methods of spreading information as well as what type of information was being spread. Additionally, the marketing methods of vaccinators experienced problems in both time periods as well.

Spread of Information

This page from the National Anti-Compulsory-Vaccination
Reporter shows the subscriptions received, when meetings
are, and available literature to purchase. 

In many of the 19th century anti-vaccination journals, they spoke of a frustration with "mainstream media" newspapers for not supporting their cause or "showing both sides". (Note- today this focus with "balance" in the media allows for climate change deniers to have an equal platform) To address the lack of support from mainstream media, they created their own journals, circulated their own pamphlets, and held their own conferences. At the end of each issue of the National Anti-Compulsory-Vaccination Reporter, there was a list of "subscribers" who for small fees, could order extra copies to show others. One woman spoke about leaving extra copies in hotels when she traveled. Others spoke about sending the pamphlets to all new mothers and fathers, and many were generated with that target audience in mind. Additionally, there was a great deal of international correspondence, including exchanges with people India, the United States, South Africa, Germany, etc. When the traditional infrastructure refused them, they created their own.

Similarly, anti-vaccination groups of today increasingly utilize their own infrastructures. After the WHO declared vaccine hesitancy a top threat, many social media sites were pressured to censor the spread of misinformation about vaccines, as lives were at stake. While Twitter has done nothing and Facebook are still discussing, Pinterest took steps to remove anti-vaccination activity by limiting searches. (I find it interesting that Pinterest- with predominantly female users- was the first to act.) As these established platforms begin to censor, Clarissa told me that anti-vaccination groups are moving to their own websites. From "arnica.org.uk" to "jabs.org.uk", these websites are in some ways, the modern "National Anti-Compulsory-Vaccination Reporter". Open networks, like "mumsnet.com" are also popular open forums, similar in some ways to the conferences held by the 19th century leagues. The sites, public on the internet, has allowed for even greater international correspondence. Once again, anti-vaccinators created their own methods of sharing information.

This is a scene from "The Worshipers of Whitehall"-
I really enjoy the "...and then everyone clapped" 

Stories

In many of my sources, I found more than just attempted scientific justification. Some of the most entertaining sources I looked at were the anti-vaccination poems, songs, chants, and plays. For example, Worshipers of Whitehall was a six act satirical play that portrayed vaccinators as bumbling, sheep-like "wise-men" who ignored all evidence. Anti-vaccinators, called "Ignorant Fanatics", gave eloquent speeches "and everyone clapped" (direct quote). There were also numerous short stories involving a baby being vaccinated and then the family unit suffering. Speaking to Clarissa, she said there were many similar dramas about the HPV vaccine on YouTube, with crazy plot lines emphasizing horrible side effects and "degenerating morals". These stories are impactful, and difficult for those seeking to restore vaccination confidence to counter. Much like the TSA, no one pays attention to the hard work vaccines do unless something goes wrong. Prevention should be a boring story. However, it is important that in countering anti-vaccination materials, there isn't a sole reliance on logic, and instead there are emotional arguments present as well.

Branding

The British Library!!!! 

The association of the Vaccination Acts with the Contagious Diseases Act contributed to the anti-vaccination movement's alliance with the feminist movement. Passed around the same time, many thought they were directly related. Many considered both of these acts to just be methods of controlling women's bodies. Especially in obstetrics, many women experience a lingering mistrust of medical institutions which then influence their readiness to accept vaccination for their children. Additionally, the association of the poor law guardians with both the Anatomy Act of 1832 and the Vaccination Acts contributed to the branding of both acts as an attack on the poor. The Vaccination Laws were originally run by the Poor Law authorities, and after they saw the disrespect given to the corpses of the poor, they did not trust their motives. Women and disadvantaged groups resist vaccination because of it's marketed associations with these oppressive institutions.

The HPV vaccine similarly influenced biotechical embrace through branding. When the HPV vaccine was first announced, it was marketed to only girls as prevention of an STD. With this branding, some religious cultures refused to let their daughters be vaccinated, as they thought it would be like a "free pass" and make them more promiscuous. Now, the vaccine is being marketed to both boys and girls, and is described to prevent genital warts. Public health officials hope these changes will help increase uptake.

Both of these examples demonstrate the importance of understanding the culture's concerns when preparing communities to receive vaccines. Aligning vaccination with institutions must be done carefully. "Vaccine preparedness" is more than just making sure the science is correct, it's also about appropriate health communication.

Weaknesses of 19th Century Vaccinators

At the Old Operating Theatre Museum, there was a book in which
visitors could write their medical fears.
"Antivaxers" was one of them! 

The strength of the 19th century anti-vaccination movement highlights the weakness of the public health system's approach. Vaccination was forced without a true understanding of why they worked, as germ theory wasn't developed until the late 1800s. Parents weren't allowed to ask questions about the procedures being performed on their infants, because the vaccinators themselves didn't understand. Explaining the science is important for gaining trust. Additionally, the harsh penalties of huge fines or imprisonment became a rallying cry. The journals published weekly lists of the "brave martyrs" who were prosecuted for "just trying to be concerned parents". In part two of Henry Pitman's "Prison Thoughts on Vaccination", he wrote "Part 1 brought me hundreds of sympathetic letters, and two abusive post-cards". (He then proceeds to show how dumb the two "abusive post-cards were.) The harsh penalties were a used by the anti-vaccinators to prove their points. Additionally, the journals are full of examples of vaccinators, judges, and others in positions of power treating women like they were dumb. Many of the women, believing that their role as mother included guardians of their children's health, were upset at the disrespect shown to them. Those opposing them served as threats to their control over the house. A very good example of this can be found in the published letters between a female anti-vaccinator and her male cousin. After sending him a copy of an issue of the "Anti-Vaccinator", he replied that she shouldn't be involved in the movement, as "It would be far better, and more in accordance with feminine modesty, if ladies would attend to their own domestic duties and leave medical questions alone, rather than bring a share of ridicule and disgrace upon their sex." She replied "…you seem to think it is impossible that a woman can know anything and be able to cook at the same time. You are wrong, let me assure you. I ca be as domesticated as you please, and still it does not prevent me from writing on any subject I like…", affirming that she believes her role as a woman is to be involved in the anti-vaccination movement. By calling her dumb and insulting women, the argument was no longer about the science but rather her defending herself and her gender.

Such an amazing experience!!!! 

Understanding these flaws in the 19th century vaccination enforcement provides great insight for today. Even when we disagree strongly with the dangerous actions of anti-vaccinators, attempts to condescend, vilify, or demean them do not help fix the situation. The Vaccine Confidence Project is working on publishing cultural specific guides to help public health departments address specific communities concerns in a more thoughtful way.

Conclusion 

 Working on this research has been an incredible experience. I've learned so much, not just about the 19th century anti-vaccination movement, but also gained a better perspective on how to do this kind of research, as well as make it meaningful for work today. Understanding the historical legacy of issues in our world today is so important. I'm very excited to continue exploring this field and I'm so grateful for this opportunity to travel! Thank you so much to everyone who helped make it possible!