The Age-Old Struggle against the Antivaccinationists

[Zeno Swijtink]

Perspective
The Age-Old Struggle against the Antivaccinationists
Gregory A. Poland, M.D., and Robert M. Jacobson, M.D.
N Engl J Med 2011; 364:97-99January 13, 2011

ArticleReferences

Since the introduction of the first vaccine, there has been opposition to vaccination. In the 19th century, despite clear evidence of benefit, routine inoculation with cowpox to protect people against smallpox was hindered by a burgeoning antivaccination movement. The result was ongoing smallpox outbreaks and needless deaths. In 1910, Sir William Osler publicly expressed his frustration with the irrationality of the antivaccinationists by offering to take 10 vaccinated and 10 unvaccinated people with him into the next severe smallpox epidemic, to care for the latter when they inevitably succumbed to the disease, and ultimately to arrange for the funerals of those among them who would die (see the Medical Notes section of the Dec. 22, 1910, issue of the Journal). A century later, smallpox has been eradicated through vaccination, but we are still contending with antivaccinationists.

The Cow Pock — or — the Wonderful Effects of the New Inoculation.

Since the 18th century, fear and mistrust have arisen every time a new vaccine has been introduced. Antivaccine thinking receded in importance between the 1940s and the early 1980s because of three trends: a boom in vaccine science, discovery, and manufacture; public awareness of widespread outbreaks of infectious diseases (measles, mumps, rubella, pertussis, polio, and others) and the desire to protect children from these highly prevalent ills; and a baby boom, accompanied by increasing levels of education and wealth. These events led to public acceptance of vaccines and their use, which resulted in significant decreases in disease outbreaks, illnesses, and deaths. This golden age was relatively short-lived, however. With fewer highly visible outbreaks of infectious disease threatening the public, more vaccines being developed and added to the vaccine schedule, and the media permitting widespread dissemination of poor science and anecdotal claims of harm from vaccines, antivaccine thinking began flourishing once again in the 1970s.1

Little has changed since that time, although now the antivaccinationists' media of choice are typically television and the Internet, including its social media outlets, which are used to sway public opinion and distract attention from scientific evidence. A 1982 television program on diphtheria–pertussis–tetanus (DPT) vaccination entitled “DPT: Vaccine Roulette” led to a national debate on the use of the vaccine, focused on a litany of unproven claims against it. Many countries dropped their programs of universal DPT vaccination in the face of public protests after a period in which pertussis had been well controlled through vaccination2 — the public had become complacent about the risks of the disease and focused on adverse events purportedly associated with vaccination. Countries that dropped routine pertussis vaccination in the 1970s and 1980s then suffered 10 to 100 times the pertussis incidence of countries that maintained high immunization rates; ultimately, the countries that had eliminated their pertussis vaccination programs reinstated them.2 In the United States, vaccine manufacturers faced an onslaught of lawsuits, which led the majority of them to cease vaccine production. These losses prompted the development of new programs, such as the Vaccine Injury Compensation Program (VICP), in an attempt to keep manufacturers in the U.S. market.

The 1998 publication of an article, recently retracted by the Lancet, by Wakefield et al.3 created a worldwide controversy over the measles–mumps–rubella (MMR) vaccine by claiming that it played a causative role in autism. This claim led to decreased use of MMR vaccine in Britain, Ireland, the United States, and other countries. Ireland, in particular, experienced measles outbreaks in which there were more than 300 cases, 100 hospitalizations, and 3 deaths.4

Today, the spectrum of antivaccinationists ranges from people who are simply ignorant about science (or “innumerate” — unable to understand and incorporate concepts of risk and probability into science-grounded decision making) to a radical fringe element who use deliberate mistruths, intimidation, falsified data, and threats of violence in efforts to prevent the use of vaccines and to silence critics. Antivaccinationists tend toward complete mistrust of government and manufacturers, conspiratorial thinking, denialism, low cognitive complexity in thinking patterns, reasoning flaws, and a habit of substituting emotional anecdotes for data.5 Their efforts have had disruptive and costly effects, including damage to individual and community well-being from outbreaks of previously controlled diseases, withdrawal of vaccine manufacturers from the market, compromising of national security (in the case of anthrax and smallpox vaccines), and lost productivity.2

The H1N1 influenza pandemic of 2009 and 2010 revealed a strong public fear of vaccination, stoked by antivaccinationists. In the United States, 70 million doses of vaccine were wasted, although there was no evidence of harm from vaccination. Meanwhile, even though more than a dozen studies have demonstrated an absence of harm from MMR vaccination, Wakefield and his supporters continue to steer the public away from the vaccine. As a result, a generation of parents and their children have grown up afraid of vaccines, and the resulting outbreaks of measles and mumps have damaged and destroyed young lives. The reemergence of other previously controlled diseases has led to hospitalizations, missed days of school and work, medical complications, societal disruptions, and deaths. The worst pertussis outbreaks in the past 50 years are now occurring in California, where 10 deaths have already been reported among infants and young children.

In the face of such a legacy, what can we do to hasten the funeral of antivaccination campaigns? First, we must continue to fund and publish high-quality studies to investigate concerns about vaccine safety. Second, we must maintain, if not improve, monitoring programs, such as the Vaccine Adverse Events Reporting System (VAERS) and the Clinical Immunization Safety Assessment Network, to ensure coverage of real but rare adverse events that may be related to vaccination, and we should expand the VAERS to make compensation available to anyone, regardless of age, who is legitimately injured by a vaccine. Third, we must teach health care professionals, parents, and patients how to counter antivaccinationists' false and injurious claims. The scientific method must inform evidence-based decision making and a numerate society if good public policy decisions are to be made and the public health held safe. Syncretism between the scientific method and unorthodox medicine can be dangerous.

Fourth, we must enhance public education and public persuasion. Patients and parents are seeking to balance risks and benefits. This process must start with increasing scientific literacy at all levels of education. In addition, public–private partnerships of scientists and physicians could be developed to make accurate vaccine information accessible to the public in multiple languages, on a range of reading levels, and through various media. We must counter misinformation where it is transmitted and consider using legal remedies when appropriate.

The diseases that we now seek to prevent with vaccination pose far less risk to antivaccinationists than smallpox did through the early 1900s. Unfortunately, this means that they can continue to disseminate false science without much personal risk, while putting children, the elderly, and the frail in harm's way. We can propose no Oslerian challenge to demonstrate our point but have instead a story of science and contrasting worldviews: on the one hand, a long history of stunning triumphs, such as the eradication of smallpox and control of many epidemic diseases that had previously maimed and killed millions of people; on the other hand, the reality that none of the antivaccinationists' claims of widespread injury from vaccines have withstood the tests of time and science. We believe that antivaccinationists have done significant harm to the public health. Ultimately, society must recognize that science is not a democracy in which the side with the most votes or the loudest voices gets to decide what is right.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

SOURCE INFORMATION

From the Mayo Clinic Vaccine Research Group (G.A.P., R.M.J.), the Department of Medicine (G.A.P.), and the Department of Pediatric and Adolescent Medicine (G.A.P., R.M.J.), Mayo Clinic, Rochester, MN.

[sharingwisdom]

https://www.cyberclass.net/smallpoxvaccine.htm
History of Smallpox
Excerpt

While Jenner is universally venerated today as mankind's deliverer from the scourge of infectious disease in probably 99% of references, a little different version of Jenner's rise to fame and wealth is summarized in Miller's book Immunizations, p 24. [9] Other sources from Jenner's own contemporaries who were less than enchanted with his idea of variolation appear throughout Anderson's The Facts Against Compulsory Vaccination, [7] the writings of Walter Hadwen, [5] and the very thorough research by Alfred Russell Wallace. [6]


From these writers we can learn a few details that most edited modern drafts of this story omit, such as:

• the utter lack of science underlying Jenner's original claim of immunity from vaccines

• the number of deaths and disfiguring cases his experiments brought to those unsuspecting patients who were unfortunate enough to be talked into trying Jenner's injections during those early years.

Even from the beginning, after inoculating his very first patient - 8 year old James Phipps - Jenner absurdly maintained that his injections were conferring lifetime immunity:

"...what renders the cowpox virus so extremely singular is that the person who has been thus affected is for ever after secure from the infection of the smallpox."
- Jenner, 1797, cited in H.B. Anderson [7]

Reality Check
Many of Jenner's own contemporaries were shocked at how easily the scientific community was taken in by this auteur. Perusing the work of Walter Hadwen MD, [5] celebrated English surgeon, author, and medical scholar of 100 years ago, we find a version of the Jenner story that is not so set in bronze as most of what we read today. Hadwen points out a few cracks in Jenner's pedestal:

Jenner was no physician. He never passed a medical exam in his life, completed any course of medical study, or received a diploma from any medical school.

Jenner bought his medical degree for £15 from St Andrew's College in Scotland, which he never attended
(Hume, p 174 [17], also Hadwen [14])

Jenner "tested" his theory on one patient, and then immediately claimed that he had "immunized" the patient against smallpox for life. Jenner also claimed that the vaccine would work universally. That's it! No controlled clinical trials, no years of research, nothing! One patient!

With no proof whatsoever, and a sample size of one, Jenner tricked the entire medical profession, then and now, into pretending that cowpox was smallpox in cows - a total scientific inaccuracy. And then he sold the idea that his vaccine was the cure. [5, 14]

Wheel Of Fortune
Not long after his "breakthrough," Jenner's repeated petitions to the House of Commons struck gold. It finally dawned on the English government how millions of pounds sterling could be moved around by passing a law making the new smallpox vaccine compulsory. Jenner was promptly awarded the enormous sum of £30,000 by British Parliament and suddenly this uneducated poseur was a revered scientist! (Wallace [6])

Two Different Diseases
Legitimate scientists of Jenner's day decried the smallpox vaccine from the start. Bechamp, Hadwen, Wallace, and others thought it appalling that the most basic facts concerning the distinction between cowpox and smallpox were simply never discussed. If the original axioms of vaccination were true, how could one disease vector immunize against a completely separate disease? This was the question that was never asked, and is still ignored today.

Watch closely: the two diseases - cowpox and smallpox - are completely distinct conditions. Hadwen explains:
"What is cow-pox? It is a disease which occurs on the teats of cows; it only occurs when they are in milk; only in one part of the body, and naturally only in the female animal; it results in an ugly chancre; and is not infectious.
Small-pox, on the other hand, is not limited to the female sex as is cow-pox, nor to one portion of the body; it presents different physical signs, and, furthermore, is tremendously infectious, and the course and symptoms of the two diseases are totally different. Therefore there is no analogy between the two." [5]

Hadwen wrote this 100 years ago, but his objections are still valid. Doing a taxonomic check today in a standard index of viruses from a National Institutes of Health database [21] readily points out that cowpox is caused by a virus called Orthopox vaccinia and smallpox is caused by a virus called Orthopox variola. These two viruses have different sizes, genetic sequences, and characteristics. To pretend that cows get a version of smallpox called cowpox is bizarre enough - but then to say that people who get the same disease are immune to smallpox is simply fantasy.

Did The Original Vaccine Work?
By 1853, Parliament began passing laws to make the untested vaccine compulsory throughout the British empire. Other countries of Europe followed suit.

Once the economic implications of compulsory vaccinations were realized, few dared to disagree. Then as now, the media were controlled by the vaccine manufacturers and the government, who stood to make huge money from the sale of these spurious vaccines.

Hadwen put it like this:
"... so strong is the effect of authority, custom, and endowment, and so prone are people to save themselves the trouble of personal investigation by the simple process of accepting the decisions of "the majority" ... When once an error is accepted by a profession corporately and endowed by Government, to uproot it becomes a herculean task." [14]

And this is how mass immunizations get started. Once the money machine started rolling, doctors who questioned the research were ignored. Despite the lack of scientific validation and hundreds of thousands of documented vaccine deaths, compulsory smallpox vaccination lasted for 120 years! The US was the last holdout, finally giving it up in 1971.

Alfred Russell Wallace offers abundant proof how vaccine statistics were manipulated in England during the 1800s - the who and the why of it. After a thorough presentation charting actual deaths throughout the UK and the Continent from smallpox and from the vaccine, Wallace concludes that smallpox vaccine

"...has actually increased susceptibility to the disease. ... the conclusion is in every case the same: that vaccination is a gigantic delusion; that it has never saved a single life; but that it has been the cause of so much disease, so many deaths, such a vast amount of utterly needless and altogether undeserved suffering, that it will be classed by the coming generation among the greatest errors of an ignorant and prejudiced age, and its penal enforcement the foulest blot on the generally beneficent course of legislation during our century."
- Alfred R. Wallace, Chapter VI 1898 [6]

Slow Learners
What most people don't know is that just after the US began vaccinating for smallpox (1902) England stopped. By 1907 England finally got the message: no more compulsory smallpox vaccination. Holland, same thing in 1928. Australia - 1925 (Anderson, p 10) [7]

How long did it take the US to figure it out? We finally stopped in 1971, the last holdout in the world.

The low ebb of the infectious diseases arrived in the 1970s. From 1950 to 1970, zero cases of smallpox were reported in the U.S. After several years passed, however, there are now a few cases of smallpox, but they only occur among the ranks of the vaccinated! (Scheibner) [23]

What's important to notice is that smallpox vaccination in the U.S. persisted another 30 years after the disease was at an incidence of practically zero. Again, the only source of death from smallpox in the U.S. for 30 years was from the vaccine itself. (Mendelsohn, p 232, World Book, 1994) [24, 25]

Even though smallpox vaccination became mandatory in the US after 1902, what is less commonly known is that by 1929, all states but nine no longer made it compulsory. Reason: too many deaths and complications. (H.B. Anderson, p 2) [7]

Most Americans Can't Receive Smallpox Vaccine

A major blow to the best laid plans of the New Vaccinators came on 10 Sept 02 with the Reuters article [1] about the CDC announcing how the new smallpox vaccine is not to be recommended for:

• HIV people - anyone on immunosuppressive drugs - anyone with eczema

The CDC quoted a new study in the Journal of Allergy and Clinical Immunology, describing reactions that include blindness, scarring, and death. [31] So the vaccine is therefore contraindicated in all these cases, according to the CDC.

Eczema patients alone comprise half the US population. AIDS patients and those on immunosuppressive drugs add another significant proportion to the group of those who shouldn't be vaccinated.

Perspective
The Age-Old Struggle against the Antivaccinationists
Gregory A. Poland, M.D., and Robert M. Jacobson, M.D..