An exploration of the history and issues of the Anti-vaccination movement and why you should get vaccinated
You probably already know what a vaccine is. There is a high chance your parents, recently or way back, have already taken you to a health clinic or doctor’s office to experience the initial dread of a needle and the final phew of satisfaction after the pain was either gone or solely psychological. Maybe you even received a lollipop for being so brave. For some of you, vaccination has been part of your lives for the time being, and it has become a health routine. Every year, you may look at the Yellow Card to check the validation of your vaccines and ask your doctor what to take next. However, for others, immunization is considered a devil in sheep’s clothing. So, with the celebration of both the World Health Day on April 7th and the World Immunization Week on the last week of this month, what is the best course of action if not to discuss one of the most controversial topics of the new century: the ideological battle between anti-vaccination and vaccination?
First, let’s delve into the history of vaccines. Immunization is not a very recent concept to human. There are records from the 7th century relating how Buddhist monks used to drink small quantities of snake venom to lessen the effect of future snake bites in the body. In the 17th century China, the first registration of variolation (immunization using skin or fluids from a contaminated host) occurred when the pus of a person infected with smallpox smeared in an open wound of a patient. After a mild infection was over, the patient acquired a near immunity to the disease. By the turn of the 18th century, this practice had spread to Africa, the Ottoman Empire, Arabia, and later was introduced into the English Royal Society by Lady Mary Wortley Montagu and the Americas by author Cotton Mather. Even if it was dangerous and prone to failure, the variolation was able to at least diminishing smallpox’s fatality rate from 30% to 2-3%.
However, vaccination itself was only developed at the end of the 18th century by doctor Edward Jenner in England. He formed the first vaccine in 1796 after taking pus from a milkmaid’s hand infected with cowpox and transmitting it to an 8-year-old boy called James Phipps through an updated variolation method using a lancet. Even though after two weeks, Jenner infected the boy with smallpox, Phipps did not show any sign of the infection. After conducting twelve more experiments, Jenner published his findings and coined the name vaccine from the Latin word “Vacca” which means cow. With his scientific advancement, the disease was eradicated by 1980. But how did he come up with the idea? Jenner was a country doctor, so he was familiarized with seeing the pus-filled hands of milkmaids (a sign of cowpox), and he was in the first seat of the smallpox epidemics of the time. After observing that handmaid's infected with cowpox were not affected by smallpox, Jenner had his Eureka moment.
And Jenner was only the begging. The person who popularized vaccination was Louis Pasteur. One century later, the scientist reasoned that if smallpox could have a vaccine, why other diseases couldn’t? So he sought to variolate chicken against chicken cholera using a recently harvested colony of bacteria. However, his first trials were unsuccessful as all chicken died from the exposure to the bacteria. That changed in 1879 when his assistant forgot to inject the recently cultured bacteria into the animals. After some time, the bacterias were weekend inside the flask by oxygen, and the colony lost its virulence (toxic properties). Pasteur injected the old culture, and in a result that would change the study of immunization forever, the chicken showed little to no sign of infection. Then, he introduced the new bacteria onto the chicken’s bodies and nothing happened. Louis and his assistant had just invented the process of attenuation, where the old bacteria culture was so week that it taught the body to quickly destroy the infection caused by it. After the discovery, the scientist went to invent a vaccine against anthrax in 1881 and rabies in 1885, the first formally attenuated immunization process for humans and the achievement that made him ultimately famous.
After the chicken cholera vaccination, three new types were created to accompany the live-attenuated version: inactive vaccines, toxoid vaccines, and subunit, recombinant, polysaccharide, and conjugate vaccines. The inactive version uses the killed variant of the germ and is more effective when is given more than once in a smaller interval of time. The toxoid type only employs the toxins of the bacterium, so the body learns how to identify and combat just it and nothing else when the whole pathogen enters the body. And the conjugate form only uses the specific structure of the germ that is dangerous like a protein or a sugar chain.
Nowadays, vaccines are available for a total of 26 diseases listed by WHO and for four that are not listed as the illnesses were either already eradicated (smallpox), not very effective (pulmonary plague) or the vaccines are not available for the general global population (anthrax and Q fever). In total between 2010 and 2015, WHO says vaccines prevented at least 10 million deaths. Each year, vaccines save 2 to 3 million lives. In 2017, 116.2 million people received an immunization. From 1974 to 2017, 5% of people protected against WHO’s Expanded Programme on Immunization six killer disease went up to, on average, 84%. CDC estimates that the vaccination of people born in the last 20 years may prevent the hospitalization of 21 million individuals and 732,000 deaths, and can save $295 billion in direct hospital costs. These numbers speak louder than many words, and it is difficult to deny the positive impact of vaccination on the lives of many. Though this does not mean individuals haven’t doubted the safety and efficacy of immunization.
Enters the anti-vaccination movement, an global campaign with the mission of denouncing the “evils” and “overwhelming” dangers of taking a flu shot (not just the flu, but you get the point). The movement is so very entangled with the vaccination history that the first group dates back to when Edward Jenner invented the first vaccine. Criticism is sure to happen to everyone that creates anything from a poetry book to a simple scientific innovation and later makes it public. No one can please everyone, and even if Jenner was ultimately trying to save lives, people consciously decided to be blind to it out of fear or beliefs. The first reaction was milder as parents were reticent of giving their children the vaccine because the idea of a cure made of contaminated lymph, even if scientifically proven to be viable, seemed so outlandish and weird. And then the church got into the discussion and demonized it. In England in 1772, Reverend Edmund Massey called vaccines “diabolical operations.” In the US, Reverend John Williams made similar remarks, defending the thought that vaccines reduced God’s punishment on humans. Other clergyman believed vaccines were unchristian for being made from animals.
However, the outcry was not widespread until England passed the Vaccination Act of 1853, demanding infants up to 3 months to take the smallpox vaccine and later extended the age to 14 in the 1867 act, adding penalties for not doing so. Many individuals saw the policy as an offense to their civil rights and the personal liberties of their babies, and as an opposing measure, founded the Anti Vaccination League and the Anti-Compulsory Vaccination League. Because of the general opposition to the acts and massive demonstrations in the city of Leicester, a nest for the anti-vaccination movement, the British parliament formed a commission to study the validity of immunization. From their study ruling vaccines as safe, the parliament created the Vaccination Act of 1898, which removed the penalties and gave the possibility of a child not to be vaccinated based on the parent's belief.
Still, England was not alone in the endeavor. Massachusetts passed United State’s first vaccination law in 1855, and as soon as 1879, English anti-vaccine advocate William Tebb formed The Anti-Vaccination Society of America. Shortly after, two more groups were founded. As part of their normal activities, these groups fought battles in court to remove the law in many states including California, New York, and Illinois. Their activism only went down after the city of Cambridge, Massachusetts suffered an outbreak of smallpox in 1902. The health board of the town made vaccination mandatory for every single person, which did not stand well with citizen Jacobson as he argued that the immunization had made both him and his son ill and the mandate was unconstitutional. As a response, Cambridge filed a criminal charge against him. The man appealed for both the Massachusetts court and the US Supreme Court, and he lost both cases, with the latter affirming that any state could create laws for compulsory vaccination. After the anti-vaccination movement suffered this loss, it went low for a couple of years.
In recent years, the anti-vaccination movement has resurfaced a couple of times. The first was in the mid-1970s when the DTP vaccine (diphtheria, tetanus, and pertussis) became official. The prime adverse reaction came from a report from the Great Ormond Street Hospital for Sick Children in London stating that 36 hospitalized children came to be neurologically impaired because of the immunization. Then, an American documentary published in 1982 gave more power to the movement by depicting testimonies from mothers with sick vaccinated kids. Scientists brushed the allegations off by conducting researches that concluded on the dissociation of the vaccines from the neurological issue and by stating that the documentary was biased because it heightened the real risks and left out the benefits of DTP, but many were skeptical of what scientists were saying. And the second time was in 1998 amid the legalization of the MMR vaccine (measles, mumps, rubella). British Doctor Andrew Wakefield released a paper in the journal The Lancelot claiming there could be a relationship between bowel syndrome, autism, and the MMR vaccine. The media felt the story was too good to be left aside and republished it ferociously, boosting the anti-vaccination movement and igniting confusion and fear on the global public. It was only in the 2000s that people discovered Wakefield was bribed by lawyers to find evidence to support a case against the vaccine, ultimately falsifying results and committing scientific fraud. Several scientific studies were conducted in the pursuit of relating said disorders with MMR vaccine and none has found a link.
However, the campaign didn’t get so much traction until the end of the last decade as it can be argued that social media and the influence of celebrities like Jenny McCarthy reignited the fear of vaccination. I pinpoint the beginning of this era to be at the 2007 MTV Oprah show when McCarthy claimed her “mommy instinct” told her that her child had autism because of the MMR vaccines. It was one of the first times a celebrity was outspoken about her views regarding the safety of immunization and because Oprah did not appear to question McCarthy in the validity of her statements and aired the episode, the millions of people that watched it were informed and persuaded by the “possibility” of a vaccine flaw. Jenny later went on to join and lead a foundation called Generation Rescue to treat autism and organize a 2008 rally to protest against mercury in thimerosal preservatives and inside vaccines (even if recent research has found little to no correlation between thimerosal and autism, the claim the vaccines have mercury has become one of the most famous arguments against them). From there on, social media made the spread of fear easier. On Facebook, the so-called “anti-vaxxers” form closed groups of people and demand a verification to accept new members. Inside the groups, misinformation spreads without a person to debate against it. Everyone that enters it has the initial mindset that vaccines are either dangerous or not worth the doubt and the misinformation adds fuel to the misconceptions. And with the spread of fake news in many social media platforms, more people are swayed into doubting the government and experts and believing that vaccination and mandates are again, either a violation of parental beliefs, a hazard to children, or an unconstitutional against civil liberties.
Nowadays, the results of the movement are catastrophic. In 2017, Pediatricians from the American Academy of Pediatrics reported that 87% of parents refused giving vaccines to children, with 76% finding it unnecessary. In 2018, only 37% of adults in the US received an influenza vaccine, which resulted in 80,000 preventable deaths. This hesitancy can be mirrored in the recent measles outbreak, a once eradicated highly contagious disease that is 99.9% preventable by vaccines. We have seen a 30% increase in cases globally. As of the end of February, more than 900 people have died in Madagascar with 68,000 infected, more than almost 200 people perished in the Philippines with 11,500 affected by the disease, Japan has seen 167 cases, and Canada faced 14 incidents of infected people in 2019. Last year, Europe confirmed 83,000 instances of measles and 72 deaths, all entirely preventable. Brazil saw 10,326 cases. The US was hit with the first outbreak since the Disney event in 2014-2015 in December of the last year. Right now, the country is faced with 387 infected children and because of the resurrection of measles, WHO now considers vaccine hesitancy one of the top 10 threats to global health.
The takeaway is: if you encounter any data denouncing vaccines, research to see if it holds up (it probably won’t). Use credible sources like WHO, UN, NIH, Scientific American, Smithsonian and CDC for scientific database and health studies and BBC, The Guardian, NBCNews, CNN, and Washington Post for accredited journalistic articles. Vaccines are not an enemy. They save lives. They prevent illnesses from weakening and killing you and even everybody else around you. By being immunized, a person coming in contact with an infected patient won’t let the disease develop inside them and thus stop it from contaminating others. That is called herd immunity. Vaccines are safe, heavily studied and strongly regulated by governments and scientists. In Brazil, 25 vaccines are free for everyone from low-income families to high-income families.
So, if you talk to your doctor and he tells you it’s time to get vaccinated, it is probably for the better.