Vaccination is routine in Britain. A rite of passage for parents and children that is “the done thing” in an advanced economy. Last year, a resurgence in measles generated some headlines and soul-searching. But for most people it was a public health programme which about as interesting as the sewage system.
And then came Covid.
Since we all now (apparently) need to be experts here’s four things you might not know about vaccines and vaccination from Dr Gareth Millward from the Centre for the History of Medicine at the University of Warwick.
1. Immunisation is really old
Immunisation actually occurred long before we may think. In ancient China and India healers used small amounts of smallpox to generate a mild case of the disease, which would (hopefully) produce life-long immunity.
The technique – variolation – was not for the faint of heart. Some used the pus from a “pock”, rubbed into a cut on the patient’s arm. Others would grind up the scabs and blow them up a patient’s nose using a large straw.
The procedure was unsafe by modern standards. An estimated two per cent of inoculations resulted in full-blown smallpox. But given the fatality rate of the “natural” disease could be around 40-50 per cent, this was a relative risk many were willing to take.
Immunisation became much safer after experiments using cowpox rather than smallpox. This new practice – vaccination – spread widely after Edward Jenner demonstrated its effectiveness in the late-nineteenth century.
2. Covid won’t be the first time we’ve tried to mass vaccinate adults in Britain
Of course, we have the annual ‘flu vaccine. Travellers to certain countries are asked to vaccinate against conditions like yellow fever. But we don’t tend to routinely vaccinate adults. Covid will be different.
Usually, new vaccines go to children. Most vaccine-preventable diseases are less dangerous to adults. And if the vaccine can provide life-long immunity, it makes sense to get it as early as possible.
With Covid, children are the least at-risk. That’s why the Joint Committee on Vaccination and Immunisation has recommended we start with the oldest in the population first.
Polio was also a killer of adults. Although children were more likely to get the disease and develop long-term complications like paralysis, young adults were more likely to die if they contracted it. When the new vaccine had been given to most kids in the late 1950s, therefore, the government asked Britain’s teenagers and twentysomethings to register themselves for the jab.
The Ministry of Health found it difficult to convince healthy young people to vaccinate. Local Medical Officers tried all sorts of things. In Bristol, the authorities ran an ‘injections-while-you-dance’ campaign, where ‘dance records [were] interrupted for propaganda announcements’.
The rates of vaccination among this demographic only improved appreciably after Jeff Hall, the England right back, died after a match. Football fans across the country realised the severity of the disease and registered in large numbers. So much so, some areas even ran out of the vaccine.
3. Being wary of new vaccines is nothing new
A lot has been written about anti-vaccinationism in the nineteenth century against compulsory smallpox vaccination. Today, some question how safe and effective Covid vaccines can be given how quickly they were developed.
In the 1940s, similar concerns were raised about diphtheria. The government wanted to immunise children during the Second World War. It feared the cramped conditions of air raid shelters would incubate the disease.
Campaigners, building on the legacy of their nineteenth-century forebearers, attacked this new vaccine as ineffective and unsafe. The British Union for the Abolition of Vivisection objected to the use of horses in the manufacturing process, taking out large billboards across the country.
Despite the War, these groups were allowed to dissent. The government preferred “education and persuasion” over compulsion and censorship. The vaccine soon proved its worth as infection rates dropped dramatically. Vaccinated people who did catch the disease were twenty times less likely to die.
This success meant that when the new National Health Service began on 5 July 1948, the government explicitly made vaccination voluntary, not compulsory.
4. Fear of one vaccine doesn’t mean people fear all vaccines
Vaccination scares are rare in Britain. Only two have gained much traction since the Second World War: one over whooping cough (pertussis) in the 1970s; and the other over MMR at the turn of the millennium.
In both cases, the rates of vaccination dropped significantly – but only for the specific vaccines at the heart of the controversies. In the 1970s, there were some reports that the whole-cell pertussis vaccine might cause brain damage. Investigation found these fears to be exaggerated, but it did result in the creation of the Vaccine Damage Payments Scheme. The current pertussis vaccine is of a different, even safer type.
In the late 1990s, a single research paper suggested a possible corelation between a specific type of autism and MMR. A lack of knowledge about autism combined with a concerted media campaign by Andrew Wakefield cast doubt over the vaccine’s safety. This research was criticised at the time, with no evidence that MMR caused autism. Wakefield was subsequently struck off the medical register for his unethical research conduct.
In the wake of the thalidomide scandal (for whooping cough) and “mad cow disease” (for MMR), it was understandable why people could be hesitant. Remarkably, however, the rates of vaccination against other diseases did not drop significantly.
This suggests that people might have doubts over specific vaccines. But, historically, the British public has trusted vaccination as a concept.
14 December 2020
Dr Gareth Millward is a Wellcome Research Fellow at the University of Warwick. He leads the post doctoral research project Sick Note Britain, about medical certification and its representation in Britain since the Second World War.
He is an expert on the history of vaccination policy since the Second World War.
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