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Anti-vaxxers: Vaccines in the age of populism

Published on 06/11/18 at 09:20am

Mistrust of the establishment has fuelled anti-vaccine sentiment in recent years, and adherence has waned as a result. Louis Goss looks into the roots of the anti-vaccine movement and asks what might be done to heal the wound

The French philosopher Voltaire once wrote that: “It is whispered in Christian Europe that the English are mad and maniacs […] mad because they give their children smallpox to prevent their getting it, and maniacs because they cheerfully communicate to their children a certain and terrible illness with the object of preventing an uncertain one.”

In contrast, he noted that “The English on their side say: ‘The other Europeans are cowardly and unnatural: cowardly in that they are afraid of giving a little pain to their children, and unnatural because they expose them to death from smallpox some time in the future.’”

In many ways not much has changed, as to some extent this debate is still going on. While vaccine advocates accuse the so-called ‘anti-vaxxers’ of being mad and superstitious, those opposed to vaccines accuse ‘pro-vaxxers’ of being gullible and misinformed.

Nevertheless the medical establishment has been clear in their advocacy for widespread inoculation. The World Health Organization (WHO) has not only declared that vaccines are both “necessary” and “safe”, but have also suggested that: “The two public health interventions that have had the greatest impact on the world’s health are clean water and vaccines.”

Thus, exactly why this disparity between the medical establishment and large sections of the general public exists is an issue worth exploring. As asked by Voltaire: “What! Aren’t the French fond of life? Do their women not care about their beauty? Indeed we are strange folk! Perhaps in ten years’ time we shall adopt this English method if the priests and doctors permit.”

The history of vaccines

The first recorded instance of the use of vaccines occurred in 10th century China. Supposedly, the inoculation was discovered after a Song Dynasty chancellor of China, Wang Dan, lost his son to the deadly smallpox virus. Having developed the smallpox vaccine more than a millennia ago, the country still boasts high rates of inoculation, with 99% of children receiving vaccines against common infectious diseases. However, the same cannot be said for the societies of Europe and the United States.

It wasn’t until 1796 that Edward Jenner developed the first vaccine to be used in England. Since then, smallpox has been eradicated from every country on Earth, with the last case of smallpox occurring in Somalia in 1977. However, the process through which this eradication was achieved was by no means straightforward or easy.

While anti-vaccine opposition appeared almost immediately after Jenner made his discovery, the first organised anti-vaccine movements arose in reaction to laws, such as the 1853 Compulsory Vaccination Act, which sought to enforce mass immunisation in Victorian era England. 

Blossoming into widespread popularity in the late 19th century, the movement took on the form of working class rebellion, with objectors perceiving themselves as consciously resisting the tyrannical policies of an increasingly interventionist state. At its peak the campaign saw more than 80,000 protestors march in Leicester in 1885, carrying child-sized coffins and burning effigies of Jenner, in defiance of the laws.

The movement also gained the backing of wealthy and influential public figures, such as the businessman and social reformer William Tebb.

Born in Manchester in 1830, Tebb was a pacifist, vegetarian and staunch opponent of slavery. Having become a prominent figure in the abolitionist movement in the 1850s, the wealthy campaigner later chose to devote his energy towards tackling vaccination and later premature burial, from 1869 until his death in 1917.

Believing that mandatory vaccination was deeply unjust, the campaigner wrote in 1884 that: “It has been said of old that there is no deeper injustice than that which is committed in the name of the law, and it may be added, that with perhaps the possible exception of the Fugitive Slave Law of America, there has been no law passed by any English speaking Legislature so unreasonable in its theory, and so hard-hearted in its practice, as the existing Vaccination Law of the British Empire.”

Anti-vaxxers

In many ways the current anti-vaccine movement parallels that of the 19th century. However instead of pamphlets and leaflets, polemical tracts are pontificated via Facebook and Twitter. Nevertheless, themes of resistance to state ‘coercion’ are particularly prominent in both movements’ anti-vaccine discourse. Equivalencies between brutal acts of state oppression and immunisation are apparent in emotionally and politically charged tweets, such as one comparing vaccination to the death sentence: “At least when a cocktail of poisons is injected into a criminal, it is at the end of an appeals process that has dragged on for years. Where is the appeals process for a six-month-old baby that gets the needle?”

In another, immunisation programmes are compared to the crimes of the holocaust: “What could be more evil than herding men, women, children for communal showers and dousing them with poison gas? Herding them by the millions to be inoculated against disease and spraying their blood with toxic vaccines. #vaccineskill #vaccinelies #vaccination #toxic #evil”

Similarly, both anti-vaccine movements share allies, having affiliated themselves with homeopathy and ‘alternative’ medicine.  However, this too shares anti-establishment characteristics. As expanded upon by Nadja Durbach, a historian specialising in the history of the body: “Throughout  the  nineteenth  and  early  twentieth  centuries,  anti-vaccinationists pointed  to the movement's  roots  in  plebeian  forms  of alternative  medicine,  arguing that  the  'general strike'  against orthodox  medicine  had begun  with  the  'lower classes.” In particular, Durbach highlights the way in which working class and anti-establishment resistance takes the form of anti-vaccine sentiment and rebellion against the medical establishment.

However, both movements also appealed to members of the elite. Markedly, along with figures such as William Tebb, the 19th and 20th century anti-vaxxers attracted prominent Irish playwright George Bernard Shaw, a strong advocate for homeopathic medicine and a strong opponent of vaccines, who declared that: “intelligent people do not have their children vaccinated.” Meanwhile, American comedian and political commentator Bill Maher tweeted in 2009: “If u get a swine flu shot ur an idiot,” as he suggested that “I would never get a swine-flu vaccine or any vaccine. I don’t trust the government, especially with my health.” Strikingly, members of the American political classes such as Robert F Kennedy Jr and even President Donald J Trump have also shown support for the anti-vaccine movement.

Yet the anti-vaccine movement still retains its anti-establishment disposition.  Equally in a manner similar to the campaigns of William Tebb, the current anti-vaccine movement also affiliates itself with other popular and arguably more legitimate socio-political campaigns. Notably this socio-political split has drawn the attention of so-called Kremlinbots and Russian internet trolls, who have been revealed to post both pro- and anti-vaccine content, linking both sides of the argument to divisive societal issues such as racism and inequality. For example, one Russian tweet, highlighted in the American Journal of Public Health, reads: “Apparently only the elite get ‘clean’ #vaccines. And what do we, normal ppl, get?! #VaccinateUS.”  Anti-vaccine sentiment also appears alongside an array of hashtags highlighting a range of societal issues from #cronycapitalism to #metoo. Thus in both cases, opposition to immunisation appears to be about much more than just vaccines.

Postmodern medicine

In an article titled ‘Postmodern Medicine’, published in The Lancet journal in 1999, Sir Muir Gray wrote that: “In the modern world, medicine was based on knowledge acquired during training, which was retained during the life of the clinician, and topped up from time to time from sources from which the public were excluded – scientific journals, books, journal clubs, conferences, and libraries. Unfortunately, books on treatment become out-of-date quickly, journals are written primarily for researchers and are too numerous for anyone to master, conferences and journal clubs are ineffective, and the information that can be found exaggerates the benefits. Nevertheless, clinicians had more knowledge than patients, mainly because patients were denied access to knowledge. The worldwide web, the dominant medium of the postmodern world, has blown away the doors and walls of the locked library as efficiently as, but much more quietly than, semtex.”

This is particularly true in relation to the anti-vaccine movement. Above all, anti-vaccine discourse relies on mistrust of the medical establishment, while online ‘experts’, presenting themselves as alternative sources of authority, fill the void left in their place. The internet then provides a platform for these ‘experts’ while allowing them to further fuel mistrust in mainstream medicine.

Thus it could be said that in many ways the anti-vaccine movement is a microcosm of the post-truth world. While the question of whether online platforms are responsible for the content that appears on their sites hit the headlines in recent months after American talk show host and conspiracy theorist Alex Jones was banned from a number of social media platforms, including Youtube, Facebook and Twitter, President Donald Trump has brought the words ‘fake news’ and ‘alt-facts’ into the average person’s lexicon. This has increasingly led towards calls for restrictions to be placed on the ‘freedom’ to publish controversial content on social media platforms online. In particular, this has come in the form of calls for online platforms to take responsibility for the content they host, publish and profit from.

However, according to Gray the answer is not to restrict the public’s access to information, but to instead adapt to the postmodern world. As said by the Oxford University Professor himself: “The Chindits, a famous British task force that fought in the jungle behind the enemy lines, had the motto that the boldest course is the safest: the same motto would suit medicine well as it looks at postmodern society. Medicine must be modern – sceptical, evidence-based, and self-critical – but a self-centred preoccupation with excellent science will be no protection against the criticisms of a well-educated public; openness is the only option.”

Richard Shute, a blockchain consultant at The Pistoia Alliance, a coalition of life science companies, vendors, publishers, and academics, agreed. Although he sought to clarify that he was not in fact an expert on the matter, Shute noted that: “If there is a lack of trust, then the more open and available the research, the science and the documents pertaining to a product are, the  more open they are, and the more easily people can go and look at them, even if they don’t necessarily understand them. If they’re out there and they’re shown to be produced contemporaneously, with caches stored on blockchain, and they’re open so that anybody can read them, it would have to instil more confidence that the government, or the pharmaceutical industry, is open, trustworthy and that they don’t want their reputation damaged.”

He added: “In asking someone to trust that the MMR vaccine is safe, you’re asking a question that requires an individual to go and look at a lot of publications and a lot of scientific opinion, and sometimes those publications have a degree of bias to them. Thus anybody doing science needs to be more open with what they’re doing – both positive and negative results – and how they’ve got there. It requires people to be much more scientifically aware and savvy – often to quite a high level of detail […] but scientists and companies being more open about the work they are doing – both good and bad – is important. And that is happening. It’s happening more and more.”

The backlash against the elites

The Compulsory Vaccination Act of 1853 was the first piece of legislation across the globe, to make immunisation compulsory. The ruling imposed a financial penalty of £1 on those who refused to vaccinate their children. As mentioned above, the ruling met widespread and impassioned resistance. As such, by the beginning of the 20th century, amendments had been made to ensure that so-called ‘conscientious objectors’ – those who were opposed to vaccines – were allowed to choose whether to immunise their children.

Various countries around the world still enforce mandatory vaccination. While Slovenia fines those who fail to vaccinate their children; the Belgian government have retained the right to imprison parents who do not inoculate their children against polio. Similarly, various countries around the world, from the United States to Ukraine, require certificates of vaccination in order for children to be enrolled in public schools.

However, these policies do not necessarily seem to ensure high rates of vaccine adherence. For example, despite policies enforcing immunisation, a 2013 study suggested that just 50% of Ukrainian children are fully immunised against polio, measles and rubella, with many parents procuring falsified certificates of vaccination in order to enrol their children in schools. Even in Slovenia, which is considered to have one of the most aggressive policies enforcing vaccines, adherence to non-mandatory vaccines is remarkably low. While the country boasts more than 95% adherence to mandatory vaccine schedules, just 50% comply when it comes to non-mandatory vaccines such as the one for HPV. 

Equally, mandatory immunisation policies have experienced a transnational backlash, fuelled by mistrust of the establishment, online scepticism and discontent. Strikingly, the populist Five Star movement in Italy, founded by stand-up comedian Beppe Grillo, at one point proposed a ruling which sought to actually make vaccination itself against the law, as reported by British newspaper The Guardian. Citing “the link between vaccinations and specific illnesses such as leukaemia, poisoning, inflammation, immunodepression, inheritable genetic mutations, cancer, autism and allergies”, the Five Star movement was then crucial to the overturning of compulsory vaccination laws earlier this year. The party’s policies and campaigning have however been blamed for the rise in the number of cases of measles over the past few years.

Above all, what defines the Five Star Movement is their opposition to ‘the caste’ or ruling establishment. While this primarily comes in the form of opposition to the ‘political establishment’ and economic elites, increasingly this appears in the form of resistance against medical authority and the pharmaceutical industry. The Italian party’s anti-vaccine sentiment is in large part fuelled by anti-elitism and distrust of the pharmaceutical industry. This trend is however becoming increasingly apparent around the world.

The feeling is evident in a statement from Andrea Liberati, a Five Star official in the Umbria region of central Italy, as quoted by The Guardian: “There is obviously a commercial element to this, and a need for big pharma companies to make money.” As explained by Giovanni Orsina, a professor of politics at Luiss University in Rome: “There is a crisis of trust in all the elites. So if a doctor says ‘you must vaccinate your child’, he’s not seen as someone competent but as someone who gets money from companies that sell vaccines.”

Healing the wound

Anti-vaccine sentiment has existed since the invention of vaccines. As such, we must then ask; what factors allow for the propagation of anti-vaccine discourse, and what fuels the spread of anti-vaccine thought? Both in the 19th century and in the modern day, mistrust of elites, a desire for liberty and autonomy, misinformation and feelings of injustice have encouraged the growth of anti-vaccine movements. However, due to the scale and complexity of these problems, there is not a simple solution. Thus the process of rebuilding trust may be longwinded and deeply disheartening.

Nevertheless it is important not to patronise those who mistrust vaccines, as the perceived condescension and elitism of the medical establishment is in large part responsible for the propagation of anti-vaccine theories. Thus, in healing the wound, the so-called ‘establishment’ must ensure that they are open, transparent and democratic, while above all ensuring that they are institutions worth trusting. This applies to the pharmaceutical industry, doctors and physicians too, who have, along with journalists, politicians, bankers and ‘experts’ in general, fractured public trust.

Louis Goss

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