Health and medicine scholars have described vaccination as one of the top ten achievements of public health in the 20thcentury. Yet, opposition to vaccination has existed as long as vaccination itself(indeed, the pre-vaccination practice of variolation came under criticism as well: seethis timeline entry for details). Critics of vaccination have taken a variety of positions, including opposition to the smallpox vaccine in England and the United States in the mid to late 1800s, and the resulting anti-vaccination leagues; as well as more recent vaccination controversies such as those surrounding the safety and efficacy of the diphtheria, tetanus, and pertussis (DTP) immunization, the measles, mumps, and rubella (MMR) vaccine, and the use of a mercury-containing preservative called thimerosal.
Smallpox and the Anti-vaccination Leagues in England
Widespread smallpox vaccination began in the early 1800s, following Edward Jenner’s cowpox experiments, in which he showed that he could protect a child from smallpox if he infected him or her with lymph from a cowpox blister. Jenner’s ideas were novel for his time, however, and they were met with immediate public criticism. The rationale for this criticism varied, and included sanitary, religious, scientific, and political objections.
For some parents, the smallpox vaccination itself induced fear and protest. It included scoring the flesh on a child’s arm, and inserting lymph from the blister of a person who had been vaccinated about a week earlier. Some objectors, including the local clergy, believed that the vaccine was “unchristian” because it came from an animal. For other anti-vaccinators, their discontent with the smallpox vaccine reflected their general distrust in medicine and in Jenner’s ideas about disease spread. Suspicious of the vaccine’s efficacy, some skeptics alleged that smallpox resulted from decaying matter in the atmosphere. Lastly, many people objected to vaccination because they believed it violated their personal liberty, a tension that worsened as the government developed mandatory vaccine policies. 
The Vaccination Act of 1853 ordered mandatory vaccination for infants up to 3 months old, and the Act of 1867 extended this age requirement to 14 years, adding penalties for vaccine refusal. The laws were met with immediate resistance from citizens who demanded the right to control their bodies and those of their children. The Anti Vaccination League and the Anti-Compulsory Vaccination League formed in response to the mandatory laws, and numerous anti-vaccination journals sprang up.
The town of Leicester was a particular hotbed of anti vaccine activity and the site of many anti-vaccine rallies. The local paper described the details of a rally: “An escort was formed, preceded by a banner, to escort a young mother and two men, all of whom had resolved to give themselves up to the police and undergo imprisonment in preference to having their children vaccinated…The three were attended by a numerous crowd…three hearty cheers were given for them, which were renewed with increased vigor as they entered the doors of the police cells.”The Leicester Demonstration March of 1885 was one of the most notorious anti-vaccination demonstrations. There, 80,000-100,000 anti-vaccinators led an elaborate march, complete with banners, a child’s coffin, and an effigy of Jenner.
Such demonstrations and general vaccine opposition lead to the development of a commission designed to study vaccination. In 1896 the commission ruled that vaccination protected against smallpox, but suggested removing penalties for failure to vaccinate. The Vaccination Act of 1898 removed penalties and included a “conscientious objector” clause, so that parents who did not believe in vaccination’s safety or efficacy could obtain an exemption certificate.
Smallpox and the Anti-vaccination Leagues in the United States
Toward the end of the 19th century, smallpox outbreaks in the United States led to vaccine campaigns and related anti-vaccine activity. The Anti Vaccination Society of America was founded in 1879, following a visit to America by leading British anti-vaccinationist William Tebb. Two other leagues, the New England Anti Compulsory Vaccination League (1882) and the Anti-vaccination League of New York City (1885) followed. The American anti-vaccinationists waged court battles to repeal vaccination laws in several states including California, Illinois, and Wisconsin.
In 1902, following a smallpox outbreak, the board of health of the city of Cambridge, Massachusetts, mandated all city residents to be vaccinated against smallpox. City resident Henning Jacobson refused vaccination on the grounds that the law violated his right to care for his own body how he knew best. In turn, the city filed criminal charges against him. After losing his court battle locally, Jacobson appealed to the U.S. Supreme Court. In 1905 the Court found in the state’s favor, ruling that the state could enact compulsory laws to protect the public in the event of a communicable disease. This was the first U.S. Supreme Court case concerning the power of states in public health law. ,
The Diphtheria, Tetanus, and Pertussis (DTP) Vaccine Controversy
Anti-vaccination positions and vaccination controversies are not limited to the past. In the mid 1970s, an international controversy over the safety of the DTP immunization erupted in Europe, Asia, Australia, and North America. In the United Kingdom (UK), opposition resulted in response to a report from the Great Ormond Street Hospital for Sick Children in London, alleging that 36 children suffered neurological conditions following DTP immunization.Television documentaries and newspaper reports drew public attention to the controversy. An advocacy group, The Association of Parents of Vaccine Damaged Children (APVDC), also piqued public interest in the potential risks and consequences of DTP.
In response to decreased vaccination rates and three major epidemics of whooping cough (pertussis), the Joint Commission on Vaccination and Immunization (JCVI), an independent expert advisory committee in the UK, confirmed the safety of the immunization. Nonetheless, public confusion continued, in part because of diverse opinions within the medical profession. For example, surveys of medical providers in the UK in the late 1970s found that they were reluctant to recommend the immunization to all patients. Additionally, an outspoken physician and vaccine opponent, Gordon Stewart, published a series of case reports linking neurological disorders to DTP, sparking additional debate. In response, the JCVI launched the National Childhood Encephalopathy Study (NCES). The study identified every child between 2 and 36 months hospitalized in the UK for neurological illness, and assessed whether or not the immunization was associated with increased risk. NCES results indicated that the risk was very low, and this data lent support to a national pro-immunization campaign. Members of the APVDC continued to argue in court for recognition and compensation, but were denied both due to the lack of evidence linking the DTP immunization with harm.
The U.S. controversy began with media attention on the alleged risks of DTP. A 1982 documentary, DPT: Vaccination Roulette, described alleged adverse reactions to the immunization and minimized the benefits. Similarly, a 1991 book titled A Shot in the Darkoutlined potential risks. As in the UK, concerned and angry parents formed victim advocacy groups, but the counter response from medical organizations, like the Academy of Pediatrics and the Centers for Disease Control and Prevention, was stronger in the United States.Although the media storm instigated several lawsuits against vaccine manufacturers, increased vaccine prices, and caused some companies to stop making DTP, the overall controversy affected immunization rates less than in the UK.
The Measles, Mumps, and Rubella (MMR) Vaccine Controversy
Nearly 25 years after the DTP controversy, England was again the site of anti-vaccination activity, this time regarding the MMR vaccine.
In 1998, British doctor Andrew Wakefield recommended further investigation of a possible relationship between bowel disease, autism, and the MMR vaccine. A few years later, Wakefield alleged the vaccine was not properly tested before being put into use. The media seized these stories, igniting public fear and confusion over the safety of the vaccine. TheLancet, the journal that originally published Wakefield’s work, stated in 2004 that it should not have published the paper. The General Medical Council, an independent regulator for doctors in the UK, found that Wakefield had a “fatal conflict of interest.” He had been paid by a law board to find out if there was evidence to support a litigation case by parents who believed that the vaccine had harmed their children. In 2010, the Lancet formally retracted the paper after the British General Medical Council ruled against Wakefield in several areas. Wakefield was struck from the medical register in Great Britain and may no longer practice medicine there. In January 2011, the BMJ published a series of reports by journalist Brian Deer outlining evidence that Wakefield had committed scientific fraud by falsifying data and also that Wakefield hoped to financially profit from his investigations in several ways.
A large number of research studies have been conducted to assess the safety of the MMR vaccine, and none of them has found a link between the vaccine and autism.
“Green Our Vaccines”
Thimerosal, a mercury containing compound used as a preservative in vaccines, has also been the center of a vaccination and autism controversy. Although there is no clear scientific evidence that small amounts of thimerosal in vaccines cause harm, in July 1999, leading U.S. public health and medical organizations and vaccine manufacturers agreed that thimerosal should be reduced or eliminated from vaccines as a precautionary measure. In 2001, The Institute of Medicine’s Immunization Safety Review Committee issued a report concluding that there was not enough evidence to prove or disprove claims that thimerosal in childhood vaccines causes autism, attention deficit hypersensitivity disorder, or speech or language delay. A more recent report by the committee “favors rejection of a causal relationship between thimerosal-containing vaccines and autism.” Even with this finding, some researchers continue to study the possible links between thimerosal and autism.
Despite scientific evidence, concerns over thimerosal have led to a public “Green Our Vaccines” campaign, a movement to remove “toxins” from vaccines, for fear that these substances lead to autism. Celebrity Jenny McCarthy, her advocacy group Generation Rescue, and the organization Talk about Curing Autism (TACA) have spearheaded these efforts.
Although the time periods have changed, the emotions and deep-rooted beliefs—whether philosophical, political, or spiritual—that underlie vaccine opposition have remained relatively consistent since Edward Jenner introduced vaccination.
- Centers for Disease Control and Prevention (CDC). Ten great public health achievements -- United States, 1900-1999. MMWR. Atlanta, GA: Centers for Disease Control and Prevention (CDC); 1999;48 (12):241-243. Accessed April 25, 2010.
- Wolfe RM, Sharpe LK. Anti-vaccinationists past and present. BMJ. 2002d;325:430-432.
- Durbach N. They might as well brand us: Working class resistance to compulsory vaccination in Victorian England. The Society for the Social History of Medicine. 2000;13:45-62.
- Porter D, Porter R. The politics of prevention: Anti-vaccination and public health in 19th century England. Medical History. 1988;32:231-252.
- Williamson S. Anti-vaccination leagues. Archives of Diseases in Childhood. 1984;59:1195-1196.
- Gostin L. Jacobson vs. Massachusetts at 100 years: Police powers and civil liberties in tension. AJPH. 2005;95:576-581.
- Albert M, Ostheimer KG, Breman JG. The last smallpox epidemic in Boston and the vaccination controversy. N Engl J Med. 2001;344:
- Kulenkampff M, Schwartzman JS, Wilson J. Neurological complications of pertussis inoculation. Arch Dis Child. 1974;49:46-49.
- Baker J. The pertussis vaccine controversy in Great Britain, 1974-1986. Vaccine. 2003;21:4003-4011.
- Miller DL, Ross EM. National childhood encephalopathy study: An interim report. Br Med J. 1978;2:992–993.
- WRC-TV, (Washington, D.C.). DPT : Vaccine Roulette. [Film]; 1982.
- Coulter H, Fisher BL. A Shot in the Dark. New York: Penguin Group; 1991
- Gangarosa EJ, Galazka AM, Wolfe CR, Phillips, L. M. Gangarosa, R. E., Miller E, Chen RT. Impact of anti-vaccine movements on pertussis control: The untold story. The Lancet. 1998;351:356-361.
- Wakefield A. Measles, mumps, and rubella vaccine: Through a dark glass, darkly. Adverse drug reactions and toxicological reviews. 2001;19:265-283.
- Wakefield A, Murch SA, A., Linnell J, Casson D, Malik M. Ileal-lymphoid-nodular hyperplasia, non specific colitis, and pervasive developmental disorder in children. The Lancet. 1998;351:637-641.
- Hackett AJ. Risk, its perception and the media: The MMR controversy. Community Practitioner. 2008;81:22-25
- BBC News. Lead researcher defends MMR study. BBC News. Sunday, 22 February, 2004. Accessed May 10, 2010.
- Deer B. How the case against the MMR vaccine was fixed. BMJ 2011;342:c5347. Accessed January 11, 2011. Deer B. How the vaccine was meant to make money. BMJ 2011;342:c5258. Accessed January 11, 2011. Godlee F, Smith J, Marcovitch H. Wakefield's article linking MMR vaccine and autism was fraudulent. BMJ 2011;342:c7452. Accessed January 11, 2011.
- Stratton K, Gable A, Shetty P, McCormick M. Immunization safety review: Measles-mumps-rubella vaccine and autism. Washington, DC: Institute of Medicine, National Academies Press; 2001. Accessed May 10, 2010.
- Centers for Disease Control and Prevention (CDC). Information about Thimerosal. Accessed April 25, 2010.
- Institute of Medicine (IOM). Immunization safety review: Thimerosal - containing vaccines and neurodevelopmental disorders. Washington, DC: National Academies Press; 2001. Accessed May 10, 2010.
- Institute of Medicine (IOM). Immunization safety review: Vaccines and autism. Washington, DC: National Academies Press; 2004. 2010.
- Centers for Disease Control and Prevention (CDC). Vaccine Safety Datalink (VSD) Project Priority Studies. Accessed May 10, 2010.
- Kluger J. Jenny McCarthy on autism and vaccines. Time Magazine. 2009. Accessed May 10, 2010.