In September 1798 a self-published book with an outlandish premise was about to change the world. At first sight, “An Inquiry into the Cowpox” looked more like a piece of vanity publishing than one of the greatest landmarks in the history of medicine. Its author, a doctor called Edward Jenner, was largely unknown outside rural Gloucestershire.
In a 75-page illustrated manual, Jenner explained how people could protect themselves from smallpox – a horrific brute of a disease that killed one person in 12 and left many survivors scarred for life – by inoculating themselves with cowpox, an obscure disease that affected cattle. This extraordinary process was to be known as vaccination, from the Latin for cow.
The “Inquiry” was an instant sensation. Within a few years, vaccination became mainstream medical practice in Britain, Europe and North America, while the King of Spain sent it as a “divine gift” to all the Spanish colonies. By the time Jenner died in 1823, millions had come to regard him as a hero. His admirers included Native Americans, the Empress of Russia (who sent him a diamond ring out of gratitude), and Napoleon, who “could refuse this man nothing” even though France and England were at war. In 1881 Louis Pasteur proposed that the term “vaccination” should be used for any kind of inoculation.
But not everyone thought Jenner was a saint. In 1858 Prince Albert unveiled a statue to Jenner in Trafalgar Square, amid much pomp and circumstance. There was such an outcry that two years later the statue was carted away to a lower-key resting place in Kensington Gardens. Jenner’s earliest and most vocal opponents had been men of the church, who reasoned that smallpox was a God-given fact of life and death. If the Almighty had decided that someone would be smitten by smallpox, then any attempt to subvert this divine intention was blasphemy. Vaccination was also bestial, because humans were being poisoned with disgusting stuff from an animal. Even religious people subscribed to the view that smallpox was a force for good because it tended to cull the children of the poor: if vaccination were allowed to take hold, society would quickly be overrun by the lower classes.
Doctors were also quick to clamber onto the anti-vaccination bandwagon. Many were making a tidy income from useless but lucrative “cures” for smallpox, like leeches, purgatives or silver needles to release the mayonnaise-like pus from the thousands of pustules that studded the patient’s skin. To them, Jenner’s “Inquiry” was an existential threat that had to be neutralised at all costs. Lurid reports of the dangers of vaccination began to appear in medical journals and the popular press. Writing as “Dr Squirrel”, one physician claimed that vaccination could transmit bovine traits: affected children bellowed, ran around on all fours and, if the medical artist could be believed, developed distinctly cow-like facial features. Astonishingly, the belief that vaccination could turn children into cattle took hold in England – a mass delusion that was lampooned by the cartoonist James Gillray.
Less fanciful hazards of vaccination were alleged to include tuberculosis, madness, blood poisoning, cancer and syphilis. An extensive list was laid out in “Crimes of the Cowpox Ring” (1906) by Lora C. Little, a fiery American activist and “natural” therapist. Little used her newspaper the Liberator to attack vaccination (as well as big business, sugar and the enforced castration of male sex offenders). She was convinced that vaccination was a cynical scam, foisted on the public by a conspiracy between doctors, vaccine manufacturers and government officials. “Crimes of the Cowpox Ring” contained over 300 graphic cases of serious and often fatal illnesses, which she believed were caused by vaccination. Case no. 275 was a young man with a torso-sized tumour apparently growing out of his vaccination site, while Case no. 30 was her own son who died (of diphtheria) at the age of seven, shortly after being dragged out of his classroom and forcibly vaccinated.
Supporters of vaccination pointed out that these cases – although tragic – could not definitively be blamed on vaccination. Unfortunately, there were some painful truths in the anti-vaccinationists’ claims. Vaccination could cause blood poisoning; this was not intuitive in the age before germ theory but is no surprise to us today, as cowpox pus was harvested under far from sterile conditions and often harboured farmyard bacteria. The link was reluctantly acknowledged by the coroner during the inquest on a 15-year-old girl who died of blood poisoning in 1865: “I can attribute the death to nothing but vaccination.” Syphilis could be spread by the common practice of first vaccinating a baby in a community, and then using the fluid from the baby’s vaccine blister to inoculate all the other children. Congenital syphilis, picked up by the fetus in utero, often went undetected in babies and was easily passed on by inoculation – as was clearly demonstrated by several outbreaks of syphilis following vaccination.
How did the pro-vaccination brigade respond to evidence that vaccination could be risky? In a word, badly. The 500 doctors who signed a letter to the Times denying that vaccination could spread syphilis were either liars or inexcusably ignorant about the clusters of syphilis reported in newly vaccinated children. Jenner himself may have caused the death by blood poisoning of one of his young guinea pigs; the “Inquiry” glossed over the inconvenient fact that the boy was carried off by a “contagious fever” shortly after being vaccinated. Jenner was convinced that his discovery was perfect and insisted that a single vaccination in infancy provided lifelong protection. His diktat became standard practice in England, even after other countries introduced re-vaccination in early adult life because it was clear that immunity wore off and that people who had been vaccinated only once could still catch smallpox.
The reasonable belief among the public that pro-vaccinationists had played down the risks of vaccination explains why England’s experiments with compulsory vaccination were such a disaster. From the middle of the 19th century, parents who refused to have their children inoculated against smallpox were fined or sent to prison. The legislation was both cackhanded and callous. One young mother drowned herself and her baby son rather than risk the horrors of vaccination. Around England, copies of the Vaccination Acts were publicly burnt, with whole towns turning out to celebrate the release of those imprisoned for flouting the law. There was a flood of recruits for the anti-vaccination movement. One notable convert was George Bernard Shaw, who had caught smallpox despite being vaccinated, and who described vaccination as “a peculiarly filthy piece of witchcraft”. The Acts were finally repealed in 1909, after a Royal Commission failed to reach a unanimous verdict about the wisdom or otherwise of vaccination. The sorry episode provides an important lesson for anyone who believes that compulsory vaccination is the answer to the collapse of public confidence in the MMR vaccine.
In British-ruled India, the authorities were so hellbent on mass-vaccination that they resorted to fraud. When devout Hindus refused to be injected with cow products, the impasse was broken by the lucky discovery of an ancient Sanskrit text which showed that, incredibly, Hindu physicians had discovered vaccination centuries earlier. It was only after the vaccination campaign was safely under way that the truth was revealed: the “ancient” manuscript had been forged in a hotel room in Madras by the British Museum’s expert in Sanskrit. Can such a “pious fraud” be excused because ultimately it did good?
Since the dawn of vaccination there has been a war of disinformation, propagated by both sides. The anti-vaccinationists have lied, bent statistics, invented scare stories and buried facts that undermine their case. They have committed crimes against medicine, science and humanity, and exposed millions to the dangers of preventable infections. The other side may be guilty of far less heinous crimes, but it is not blame-free. The evangelistic desire to spread the benefits of vaccines as widely as possible led pro-vaccinationists to play down the risks, giving fuel to arguments against vaccination. Jenner’s invention has saved countless lives, but the bloody-mindedness of him and his followers ended up creating a culture of mistrust that lingers to this day.