Deadly Choices: How the Anti-Vaccine Movement Threatens Us All - Paul A. Offit (2010)

Chapter 7. Past Is Prologue

History, despite its wrenching pain, cannot be unlived; but, if faced with courage, need not be lived again.

MAYA ANGELOU

In a sense, Barbara Loe Fisher has been around for a hundred and fifty years. That’s because the anti-vaccine movement didn’t start with the pertussis vaccine in the 1970s. It started with the smallpox vaccine in the 1850s. Remarkably, every aspect of the modern antivaccine movement—every slogan, message, fear, and consequence—has its origin in the past. But in contrast to the modern-day movement, the final outcome of the first anti-vaccine movement is known—and remains a painful, unheeded lesson in how the rights of the individual can trump the good of society.

The first vaccine prevented a disease that killed more people than any other: smallpox. The disease would start benignly with fever, headache, nausea, and backache—symptoms common to many infectious diseases. The symptoms that would follow, however, were unmistakable. The face, trunk, and limbs erupted in pus-filled blisters that smelled like rotting flesh—blisters so painful that victims felt like their skin was on fire. Worse: smallpox was highly contagious, spread easily by coughing, sneezing, or even talking. As a consequence, smallpox infected almost everyone. Pregnant women suffered miscarriages, young children had stunted growth, many were permanently blinded, and all were left with horribly disfiguring scars. One in three victims died from the disease.

“The smallpox was always present,” wrote a British historian in 1800, “filling the churchyard with corpses, tormenting with constant fears all whom it had not yet stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of a betrothed maiden objects of horror to the lover.”

Smallpox killed more people than the Black Death and all the wars of the twentieth century combined; about five hundred million people died from the disease. And it changed the course of history. The virus claimed the lives of Queen Mary II of England, King Louis I of Spain, Tsar Peter II of Russia, Queen Ulrika Eleonora of Sweden, and King Louis XV of France. In Austria, eleven members of the Hapsburg dynasty died of smallpox, as did rulers in Japan, Thailand, Sri Lanka, Ethiopia, and Myanmar. When European settlers brought smallpox to North America, they reduced the native population of seventy million to six hundred thousand. No disease was more feared, more destructive, or more loathsome than smallpox.

In 1796, Edward Jenner invented a vaccine that eliminated smallpox from the face of the earth. The idea for how to make it wasn’t his.

Jenner was a country doctor working in the hamlet of Berkeley, Gloucestershire, in southern England. In 1770, a milkmaid noticed that when she milked cows with blisters on their udders—and suffered the same blisters on her hands—she was protected against smallpox during the epidemics that periodically swept across the English countryside. She confided her theory to Jenner, who, after observing the same phenomenon, decided to test it. On May 14, 1796, Jenner took fluid from a blister of another milkmaid named Sarah Nelmes. Then he injected it under the skin of James Phipps, the eight-year-old son of a local laborer. After a few days, Phipps developed a small, pus-filled blister that eventually fell off. To test the milkmaid’s theory, on July 1, 1796, Jenner injected Phipps with pus taken from someone with smallpox; Phipps survived. In a let-ter to a friend, Jenner wrote, “But now listen to the most delightful part of my story. The boy has since been inoculated for the Smallpox which, as I ventured to predict, produced no effect. I shall now pursue my Experiments with redoubled ardor.”

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Edward Jenner inoculates his young son with smallpox vaccine. (Courtesy of Time & Life Pictures/Getty Images.)

Two years later, in 1798—after many similar experiments—Jenner published his observations in a monograph titled Inquiry into the Causes and Effects of the Variolae Vaccinae. (The term vaccination is derived from the Latin vaccinae, meaning “of the cow.”) Jenner’s vaccine spread through England with remarkable speed, reaching Leeds, Durham, Chester, York, Hull, Birmingham, Nottingham, Liverpool, Plymouth, Bradford, and Manchester as well as many smaller towns. Within two years, his monograph had been translated into several languages and vaccination had spread to France, Germany, Spain, Austria, Hungary, Scandinavia, and the United States. Universally accepted by all classes, between 1810 and 1820 Jenner’s vaccine halved the number of deaths from smallpox.

Then British government officials did something that launched a movement that has never ended. They required vaccination.

The first pleas for compulsory vaccination came from a relatively unknown medical society. In 1850, a group of prominent British physicians founded the Epidemiological Society of London; their goal was to evaluate epidemic diseases under the “light of modern science.” Like all physicians in medical societies, they had intellectual interests. But unlike those in other societies, they were also political. Society members wanted to influence the state to take a greater role in public health: “to communicate with the government and legislature on matters connected with the prevention of epidemic disease.” And no disease interested them more than smallpox. Society physicians reasoned that the best way to protect the public from the ravages of smallpox was to require vaccination. So they lobbied the British Parliament for a compulsory vaccination act.

On February 15, 1853, the “Bill to Further Extend and Make Compulsory the Practice of Vaccination” was introduced in the House of Lords. The bill required all children to be vaccinated by six months of age; parents who failed to comply could be fined or imprisoned. Passage of the bill was ensured by an outbreak that, from the standpoint of the society’s physicians, couldn’t have come at a better time. Between 1810 and 1850, deaths from smallpox were in a slow, steady decline. But in 1852—the year before the bill was introduced—smallpox deaths in England and Wales increased from four thousand to seven thousand and in London from five hundred to a thousand. As a consequence, the bill passed easily and parents lined up to vaccinate their children. The rush to vaccinate didn’t last long. When parents realized that compulsory vaccination wasn’t enforced, vaccination rates fell. As a consequence, the vaccination act of 1853, described by one historian as “a damp squib,” had limited impact.

The lesson learned in 1853 resulted in a tougher law. This time the government wasn’t going to look away when parents chose not to vaccinate their children. The new act, passed in 1867, clearly defined how vaccination would be enforced and who would do the enforcing. First, medical officers would issue a warning to parents who didn’t have a certificate proving vaccination. If the warning was ignored, officers took parents to court, where they faced a stiff fine plus court costs. Because the law targeted the poor—considered less likely to vaccinate their children due to “ignorance and prejudice”—many parents couldn’t afford the fines. If parents couldn’t or wouldn’t pay, their family assets were seized and sold at public auction. And if enough money couldn’t be raised from these sales, one of the parents (usually the father) could be jailed for up to two weeks. The compulsory vaccine act of 1867 also overturned a court ruling in 1863 that only one penalty could be levied for failure to vaccinate. Now, the cycle of fines, public auctions, and imprisonment could occur again and again.

Compulsory vaccination spawned the first anti-vaccine movement. In 1866, Richard Butler Gibbs co-founded the Anti-Compulsory Vaccination League (ACVL) with his brother George and his cousin John Gibbs. By 1879, the league had a hundred branches and ten thousand members. By 1900, British citizens had formed another two hundred anti-vaccination leagues. Gibbs urged citizens to protest vaccination as an act of patriotism. “Stay then the hand of the vaccinator,” he wrote. “Join us in waging war against a practice fraught with such an amount of disease and death. Let Britannia put her foot on this iniquitous destroying, death-producing interference with nature’s laws and crush it out.”

Anti-vaccine activists produced hundreds of thousands of handbills, posters, pamphlets, and photographs decrying the horror of vaccination and the motives of those who enforced it. In 1881, they published the Vaccination Vampire, which likened doctors to vampires who “hovered over the pregnant woman who waited in the shadow of its wings” and to “raven[s] perched on [pregnant] sheep, waiting to pluck out and devour the eyes of newborn lambs.” Other images were even more dramatic. Anti-vaccine activists declared that vaccination “offer[ed] up annually an indefinite number of human sacrifices to propitiate an imaginary Devil,” and they compared it to “some savage African tribe that every week sacrificed to an idol two children to guard against smallpox.”

The contents of Jenner’s vaccine also came under fire. Anti-vaccine activists claimed that it contained the “poison of adders, the blood, entrails, and excretions of bats, toads and suckling whelps” and that it transformed a healthy child into “a scrofulous, idiotic ape, a hideous foul-skinned cripple: a diseased burlesque on mankind.” Using gothic images, propagandists distributed pictures of vaccinated children turning into minotaurs, hydra-headed monsters, dragons, the incubus, and Frankenstein.

The rallying point of the movement came at public auctions, where the possessions of those who refused to pay fines were sold. Protests took many forms. In 1889, a Mr. Cockcroft plastered a dresser and clothes wringer with anti-vaccine literature, making them unfit for sale. One protester in Charlbury screwed a table to the floor, claiming that it “grew there and we built the house around it.” Because local supporters invariably purchased the furniture and gave it back to the owner, auctions became a joke at the expense of the government.

Public auctions were also a site of violence. In 1887, more than sixty uniformed and plainclothes police fought their way through a mob of angry citizens, broke into the house of a noncompliant resident, and took his furniture. The auctioneer, who was pelted with stones and eggs, required police protection. Auctioneers became increasingly harder to find.

Anti-vaccine rallies took other forms. Mothers staged mock funerals featuring small white coffins symbolizing the death of a child. In 1885, a parade of women marched across London: “There was a brass band playing appropriate music, an open hearse with the child’s coffin, a number of mourning coaches filled with women in black, and a banner inscribed ‘In Memory of 1,000 Children Who Died This Year Through Vaccination.’” Protesters also paraded in front of the House of Commons, played Chopin’s Death March, and carried banners declaring “Murdered by Compulsory Vaccination.”

To resist vaccination, mothers hid their children. In 1872, a Leeds woman explained that when the vaccine inspector “comes into the neighborhood, we shut our doors, pull down the blinds, and go upstairs until he’s gone; that’s how we trick him.” One father advised, “When the vaccination inspector calls round ‘seeking whom he may devour,’ raise a hue and cry after him, cry shame on him, and both you and your neighbors hoot him out of the neighborhood; drive the wolf from the door and let the authorities know that mothers are mothers still, and that it is a mother’s duty to protect her child.”

Although more than a hundred and fifty years separate the first antivaccine movement from today’s, the two share remarkably similar beliefs and practices—some are so striking that it’s as if nineteenth-century England has sprung to life in twenty-first-century America.

Doctors are evil: In response to the vaccination act of 1853, John Gibbs (who later co-founded the Anti-Compulsory Vaccination League) wrote Our Medical Liberties. “Who could receive with cordiality and respect the Doctor of Physic who should burglariously thunder at the door,” he wrote, “armed with scab and lancet, feloniously threatening to assault the inmates therewith, and, no matter how loudly he should protest that he was bent upon a mission of mercy, who could avoid suspecting that his real objects are power and gain.”

On November 5, 2006, Barbara Loe Fisher, in an article titled “Doctors Want Power to Kill Disabled Babies,” echoed the writings of John Gibbs: “The tragic consequences of allowing one small group of individuals in society—those who choose to become medical doctors (M.D.’s) or scientists (Ph.D.’s)—to make life and death decisions for others [are] that they can become drunk with power and end up exploiting people. Those elitists who would force people to take medical risks or even kill people in the name of the greater good of society cannot and should not be trusted. If the birthing rooms and newborn nurseries of the world become killing fields and those who practice science and medicine become the executioners, then it will be a very short time before nursing homes, doctors’ offices, and public-health clinics are legally allowed to stock lethal injections.”

Public rallies: Anti-vaccine rallies peppered the English countryside for much of the late 1800s. The most dramatic—and the one that garnered more media attention than any other—took place in Leicester in 1885. Organizers made travel arrangements for a hundred thousand people to attend; as a consequence, it was the largest rally of its kind. Actors entertained protesters by playing “doctors riding cows and holding on by the tail, and mothers at upper windows clasping their infants, while policemen were trying to commit a legal burglary at the keyhole in the street below.” The highlight of the show was an effigy of Edward Jenner, hanged, decapitated, and taken to the local police station for arraignment.

The spirit of the Leicester rally—a rally described at the time as “a perfect carnival of public merriment,” can be found in today’s anti-vaccine protests. In June 2006, organizers staged a rally in front of the CDC in Atlanta. People carried signs and children wore T-shirts bearing anti-vaccine slogans; many dressed in costumes, such as prison outfits. It was like a scene out of Monty Hall’s television game show, Let’s Make a Deal—except for the angry, threatening undertone. Protesters with megaphones screamed epithets at CDC employees as they drove through the crowd on their way to work. Others carried placards with pictures of Walter Orenstein, former director of the CDC’s National Immunization Program, and Marie McCormick, chairman of the Institute of Medicine’s committee to evaluate vaccine safety. Mimicking the defacement of Edward Jenner’s effigy, both images were circled in red, a crude slash across their faces, above the word TERRORIST in bold, black lettering.

Paranoia: In the days following passage of the vaccination act of 1853, anti-vaccine activists likened government officials meeting in a late-night parliamentary session to a coven of witches preparing destruction: “In a dark midnight hour, when evil spirits were abroad, when nearly all slept save a few doctors, who were rather awake, whose dictum and nostrum carried the night, this Act was passed, this deed was done. It was a deed worthy of the night, dark as the night.”

In 2007, Barbara Loe Fisher described an anti-vaccine rally at a Maryland courthouse: “I talked with a mother hundreds of yards from the front of the Courthouse door. I was about twelve inches inside a row of large cement balls that apparently were erected as a barrier to prevent terrorist attacks. I did not know I wasn’t supposed to be talking with this Mom inside the barrier. All of a sudden, out of the corner of my eye I saw an armed guard with a dog emerge from the Courthouse and walk toward us. I got a sick feeling in the pit of my stomach. It was the dread that any citizen of any country in any century has ever felt when an armed guard with a dog starts advancing. As if we were common criminals or terrorists, he yelled and gestured for us to move behind the stones. We moved without a word. And the sick feeling in the pit of my stomach told me we were being shown the power of the State wielded by that armed guard with the dog, just as parents inside the Courthouse were being shown the power of the State wielded by doctors with syringes.”

The popular notion of extreme coercion by public health officials took yet another form. Following the vaccination act of 1867, colorful accounts abounded of parents watching helplessly as their children were taken away and vaccinated without their consent. Actually, it never happened. Although the act of 1867 talked tough, in practice—apart from the occasional property auction—it didn’t act tough. The system literally paid vaccinators to listen to parents’ concerns. Some vaccinators bribed parents with beer, baked goods, money, and medicine. Others were perfectly willing to cater to the parents’ desire to have the child vaccinated in the home, instead of having to suffer the indignity of a public-vaccine station. Still, rumors that children were taken away and vaccinated persisted. And they persist today.

On October 14, 1999, Jane Orient, a prominent anti-vaccine spokesperson in Tucson, Arizona, appeared on ABC’s Nightline with Ted Koppel. Orient had just finished likening vaccines to scientific experiments in Nazi Germany. Koppel responded: “Dr. Orient, you raised before that sort of dramatic analogy to the Nuremberg Laws, in which people were required to undergo medical procedures against their will. It’s a horrible analogy, and I’m sure you are aware of just how horrible it is. Do you really think that’s an appropriate one?” Orient didn’t back down. “Yes, I do,” she said, “because I think that the CDC is not being honest with people. They are saying these vaccines are safe and to save the world from hepatitis B you have to be vaccinated. If parents want to refuse consent, they may be threatened with having their children taken away from them.” Koppel, at a loss for words, turned to Dr. Sam Katz, a professor of pediatrics and infectious diseases expert at Duke University School of Medicine. “Address if you would, though, what Dr. Orient said about if parents refuse,” asked Koppel, “[namely] that the child would be taken away from them, because I’ve never heard of that.” Katz responded: “There’s no such event that’s ever been recorded to my knowledge or that I’ve ever heard from anyone else. That’s just not true.” Orient held her ground. “I have heard of cases,” she said. “Well, I have heard of cases of parents.” Pressed again, Orient refused to elaborate.

False claims of vaccine harm: In 1802, James Gillray penned a cartoon that captured the spirit of the time. Titled “The Cow-Pock or the Wonderful Effects of the New Inoculation,” it featured Edward Jenner standing among a group of people, a needle in hand, ignoring the horror around him. Jenner’s vaccine had apparently turned people into cows; they bore horns, had snouts, or suffered small cows growing like tumors out of their mouths, arms, faces, and ears. Looking at this cartoon two hundred years later, one would assume that Gillray was merely representing the public’s concern about the source and purity of Jenner’s vaccine. But he wasn’t. People were actually scared they were going to turn into cows. In the early 1800s, “those opposed to the new practice of vaccination had reported terrible side effects such as the ox-faced boy or children who ran about on all fours, bellowed, coughed, and squinted like cows.” In 1890, at a meeting of the British Medical Association, one speaker produced a child whom he claimed was “covered with horn-like excrescences, which had resulted from vaccination.” In 1891, a father said he resisted vaccination because “it is well known that the bulls go mad every seven years, and that the cows make them mad.” He reasoned that because cows were used to make vaccine, “the madhouses [were] full of vaccinated children.” During an epidemic of smallpox in Gloucester in 1895, some parents refused vaccination because they were unwilling to have “a beast be put into their children” for fear that it would cause them to “low and browse in the field.”

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Cartoonist James Gillray depicts the fear of British citizens in 1804 that Jenner’s smallpox vaccine could turn people into cows. (Courtesy of Time & Life Pictures/Getty Images.)

Other false notions about vaccines were common. George Gibbs, co-founder of the Anti-Compulsory Vaccination League, claimed that it was “statistically demonstrated that Vaccination causes very many more deaths than, even in the worst of times, result from Small-Pox.” The National Anti-Compulsory Vaccination League Occasional Circular reported that a child became “spotted over the whole of the body with black, hairy marks ... as in the negro”; vaccination, according to some, was turning white children into black children. In Westminster, a father tried to exempt his children from vaccination, claiming that it caused diphtheria. Similarly, in New York City in 1916, residents claimed that smallpox vaccine caused polio. Ironically, both the bacterium that causes diphtheria and the virus that causes polio had already been identified at the time these claims were made.

Today’s fears of vaccines are far more sophisticated than those of the past. But their biological underpinnings are about the same. It makes as much sense to say that the MMR vaccine causes autism as to say that the smallpox vaccine turns children into cows. The only difference is that today’s claims are couched in scientific jargon, so they sound better. During the Omnibus Autism Proceeding, fringe doctors and scientists claimed that thimerosal weakened the immune system, allowing measles vaccine virus to damage the intestine. Because the intestine was now leaky, brain-damaging proteins could enter the bloodstream and cause autism. These hypotheses sound perfectly feasible, except that not a single aspect of them is correct.

It isn’t hard to make even the most preposterous claim seem reasonable. If anti-vaccine activists from the nineteenth century were alive today they would no doubt provide a far more sophisticated rationale for their smallpox-turns-people-into-cows contention. For instance, they could claim that smallpox vaccine is made from the fluid of cow blisters that invariably contain cow DNA. If one injected cow DNA into children, they might argue, it is possible that in a small group of the genetically susceptible children the DNA could incorporate itself into the nucleus of some cells. Cow DNA, which contains the blueprint for making cows, could then take over the cellular machinery, causing small, but noticeable, cow-like features. Were this even remotely possible—given the number of hamburgers containing cow DNA consumed every year, and the fact that small fragments of ingested DNA probably enter the body—we would all be cows by now.

Vaccines are unnatural: A persistent theme of those who opposed vaccination in the nineteenth century was that “parental, conjugal, and domestic rights [include] the right to be pure and unpolluted.” The best way to avoid smallpox, argued a Midland anti-vaccinator, was to keep “the blood pure, the bowels regular, and the skin clean.” Pure blood was the key. And smallpox vaccine, taken from the lymph of a cow, only made the blood impure.

The sentiment that vaccines contain blood poisons was also expressed on June 4, 2008, during a “Green Our Vaccines” rally in Washington, D.C., led by celebrity anti-vaccine activists Jenny McCarthy and Jim Carrey. “The ingredients,” said McCarthy, “like the frickin’ mercury, the ether, the aluminum, the anti-freeze, need to be removed immediately, after we saw the devastating effects [they had] on our children.”

Rejection of the germ theory: In 1796, when Edward Jenner showed that fluid taken from the blisters of cows protected against smallpox, many didn’t believe it. Their disbelief is understandable. Jenner’s observation was pure phenomenology, occurring eighty years before the discovery of germs—he had no way to explain why it worked.

One of the first to successfully advance the germ theory was Robert Koch, a German physician. In 1877, Koch showed that a specific bacterium, now called Bacillus anthracis, caused anthrax. Then he discovered the bacteria that caused tuberculosis and cholera. By 1900, researchers had found the cause of more than twenty different infections. Koch’s observations allowed researchers to explain why Jenner’s vaccine worked: infection with cowpox virus protected against disease caused by human smallpox virus. Anti-vaccine activists refused to believe it. Their disbelief was shared by a group of practitioners who, like them, dismissed the scientific advances of the time.

The medical marketplace in nineteenth-century England was broad and diverse, including disciplines that were based on scientific principles, known as allopathic medicine, and those that weren’t, known as heteropathic medicine. Heteropathic practices included hydropathy, which claimed the curative power of bathing; homeopathy, which offered medicines that were so dilute there wasn’t a single molecule of the active ingredient remaining; and mesmerism, which argued in part that diseases could be treated with magnets. Heteropaths were angry that allopaths had convinced the government to compel a medical practice they didn’t offer, seeing compulsory vaccination as allopathic medicine harnessing authority for financial gain.

Anti-vaccine activists joined forces with heteropaths to vigorously denounce the germ theory. One activist argued, “We are being frightened to death by microbes. It is germs, germs, germs everywhere. Must one give up shaking hands, kissing, eating, and drinking? With all the germs ever-present, it is a wonder that any of us are alive at all.” Another prominent anti-vaccine activist said, “This infection scare is a sham, fostered, if not got up originally by doctors as a means of raising their own importance and tightening their grasp on the throat of the [nation].” Perhaps the harshest critic of the germ theory was the president of the National Anti-Vaccination League. In 1893, he wondered whether “infection [by germs was] merely a theoretical bogey, worked to frighten laymen, and diverting attention from the real enemy of the human race: dirt.”

Surprisingly, the notion that the germ theory was ill-founded isn’t dead. It’s alive and well among chiropractors, who often distribute literature warning of the dangers of vaccines and offer a safe haven for parents frightened by them.

Chiropractic traces its roots to a mesmerist in Iowa. In 1895, Daniel D. Palmer claimed to have made a startling discovery. One of his patients, Harvey Lillard, who had been deaf for seventeen years, wasn’t responding to Palmer’s magnets. Then Palmer noticed a lump on the back of Lillard’s neck. “An examination showed a vertebra racked from its normal position,” Palmer recalled. “I reasoned that if that vertebra was replaced, the man’s hearing should be restored. With this object in view, a half-hour’s talk persuaded Mr. Lillard to allow me to replace it. I racked it into position by using the spinous process as a lever and soon the man could hear as before.” It was a miracle—a miracle that would have made infinitely more sense if the cochlear nerve, responsible for sending nerve impulses from the ear to the brain, actually passed through the neck. Nevertheless, Palmer was convinced and a new method for treating disease—chiropractic—was born. Based on Palmer’s observation, chiropractors believe that diseases are caused by an imbalance of the flow of energy from the brain, which could be cured by manipulating the spine.

At the time of Palmer’s observation, Robert Koch and others were well on their way to proving the germ theory of disease. Palmer didn’t believe it. Nor did his son Bartlett Joshua (B. J.), who became a dominant figure among his fellow chiropractors, all of whom had trained at Daniel Palmer’s school for chiropractors in Davenport. B. J. Palmer eschewed the germ theory, writing, “Chiropractors had found in every disease that is supposed to be contagious, a cause in the spine. If we had one hundred cases of smallpox, I can prove to you where, in one, you will find a subluxation [misalignment of the spine] and you will find the same condition in the other ninety-nine. I adjust one and return his functions to normal. There is no contagious disease. There is no infection.”

Because chiropractors didn’t believe the germ theory of infection, they didn’t believe in vaccination. Why bother? They could simply treat diseases like smallpox by manipulating the spine. That chiropractors rejected the germ theory at its birth isn’t surprising; that some reject it today—given the impact of vaccines and antibiotics—is.

As of 2010, about a hundred thousand chiropractors were practicing in the United States.

The lure of alternative medicine: In nineteenth-century England, alternative medicine was attractive because it was much less invasive, much gentler, much more humane, caring. No surgeries, no harsh medicines, no grim prognoses. And the explanations for how alternative therapies worked were easy to understand. Water and magnets treated diseases.

Alternative medicine is attractive today for the same reasons. A perfect example is autism: a disorder for which mainstream medicine hasn’t found a cause or cure. Practitioners of alternative medicine, on the other hand, claim both. Fringe doctors argue that autism is caused by vaccines and can be treated with hyperbaric oxygen, anti-fungal medications, and creams that rid the body of mercury. Good science gets shoved to the side, in part, because it’s hard to understand. For example, in 2009, researchers published a paper in Nature, one of the world’s premier scientific journals. They found that some children with autism spectrum disorder had a defect in genes that made proteins on the surface of brain cells called neural cell adhesion molecules. The specific proteins, cadherin 9 and cadherin 10, help brain cells communicate with each other. Unfortunately, conceptualizing how problems with cadherin 9 and 10 could cause autism is much more difficult than laying the blame on vaccines; even worse, it doesn’t offer immediate hope for prevention or cure. It is in such a setting that alternative medicines thrive.

Fear of medical advances: Although the germ theory explained why Jenner’s vaccine worked, a hundred years would pass before researchers figured out how it worked. In 1891, Elie Metchnikoff, a Russian microbiologist and pathologist, showed that certain cells in the bloodstream could kill germs. He called them white corpuscles, leukocytes, or phagocytes. Anti-vaccine activists refused to believe Metchnikoff’s discovery. Walter Hadwin, a pharmaceutical chemist and one of the anti-vaccine movement’s greatest orators, mocked Metchnikoff’s findings. On November 1, 1907, more than fifteen years after the establishment of the theory of specific immunity and thirty years after proof of the germ theory (and one year before Metchnikoff won the Nobel Prize in Medicine), Hadwin likened Metchnikoff’s immune cells to “Thames policemen [that supposedly went] rollicking round, gobbling up the disease germs and thus extinguishing the imaginary source of the disease.”

The inability to accept scientific advances, the desire to protect outdated, disproved theories, and the rejection of new technology weren’t unique to anti-vaccine activists. Perhaps nineteenth-century England’s best example of the fear of science occurred in 1818 with the publication of a book by a twenty-one-year-old author named Mary Shelley: Frankenstein. Shelley was inspired in part by the work of the Italian physicist Luigi Galvani, who showed that if he stimulated the nerve of a dead frog with an electrical current, the frog’s leg would twitch. In Shelley’s book, Dr. Victor Frankenstein uses electricity (in the form of lightning) to bring the dead back to life. But Frankenstein’s monster would eventually break free, terrorizing the community. Shelley’s message was clear. Science was powerful but dangerous.

Today’s fears of new technology are no different. When the human papillomavirus (HPV) vaccine was first made available in the United States in June 2006, anti-vaccine activists targeted it for elimination. This was in part a response to the relatively new method used to make it: recombinant DNA technology. To make HPV vaccine, researchers took the gene responsible for the surface protein of the virus, known as the L1 protein, inserted it into a small circular piece of DNA, known as a plasmid, and put the plasmid inside yeast cells (specifically, common baker’s yeast). When the yeast cells reproduced themselves, they also made large quantities of the HPV L1 protein, as instructed by the plasmid inside them. The L1 protein, which then assembles itself into a structure that looks just like the virus, is used as a vaccine. The same process is employed by one vaccine maker to make four different L1 proteins representing four different strains of HPV. This means that the vaccine contained only four viral proteins. (In contrast, Jenner’s smallpox vaccine contained at least two hundred different viral proteins, plus the contaminating proteins in cow lymph.)

By using a technology that produced only one critical viral protein under highly sterile conditions, the science of vaccine making had advanced well beyond the days of harvesting cow blisters. Antivaccine activists, however, were unimpressed, claiming that the HPV vaccine caused strokes, blood clots, heart attacks, paralysis, seizures, and chronic fatigue syndrome. The notion that a single viral protein could do all this—when the whole natural replicating virus can’t do any of it—was illogical. And although we might dismiss anti-vaccine activists in the mid-1800s who claimed that vaccination transformed some healthy children into oxen destined to graze on all fours and go mad, the biological bases of those claims are as logical as claims against HPV vaccine today.

Vaccines are an act against God: Anti-vaccine protesters saw vaccines not only as an act against nature but as an act against God, frequently using biblical references to make their point. “Like the mother of Moses,” proclaimed one anti-vaccine activist, “I have ‘hid’ my little one. Hers was in danger from the execution of a senseless and murderous law; mine now is; but no ark of bulrushes would avail me, and there is no Pharaoh’s daughter to interpose.” Referring to the slaughter of the newborns under King Herod, activists likened the consequences of compulsory vaccine acts to children being slaughtered by “Herodian decree.”

Activists described vaccination as a perversion of the Christian sacraments, which were supposed to secure the safety of children, not put them in harm’s way. Vaccination was “unchristian,” a type of “devil worship” that transformed a child into an “anti-Christ.” In a pamphlet titled Jenner or Christ? the author described vaccination as the “most outrageous blasphemy against God [and] against Nature.” Mary Hume-Rothery, a prominent anti-vaccine activist in the 1880s, argued that vaccination fulfilled the apocalyptic prophesy in Revelations 16:2 that warned, “Foul and evil sores came upon the men who bore the mark of the beast.” To Hume-Rothery, vaccination scars were the mark of the devil.

The spirit of Mary Hume-Rothery is alive today in Debi Vinnedge, founder of Children of God for Life in Largo, Florida. Vinnedge is angry that two human cell strains—which could be used to make vaccines for the next several centuries—were obtained from voluntary abortions in the early 1960s. These cell lines are used to make vaccines for rubella, chickenpox, hepatitis A, and rabies. Vinnedge refuses to accept a product made using cells from an abortion, an act worthy of excommunication. “Casually accepting the use of aborted fetal cell lines in medical treatments has been a blatant disgrace to humanity,” she has said, “a despicable sullying of the value and dignity of human life, and has lent credibility to the gross commercialization of aborted babies, ripped from their mother’s womb so that someone could turn a profit. We must not become slaves to the Culture of Death. Using aborted babies as products to help those children fortunate enough to not have their lives snuffed out pre-birth is akin to the most vile form of cannibalism imaginable. Yet we are asked to accept it for every polite reason except one that begs the question: ‘What kind of a civilization have we really progressed to when we can find no better way to protect ourselves than by using the remains of murdered children?’” Vinnedge has lobbied the Vatican’s Pontifical Academy for Life without success—the Vatican arguing that vaccines using cell lines originally obtained from elective abortions promote the greater good by preventing life-threatening infections. (Ironically, because natural rubella infections during pregnancy led to thousands of spontaneous abortions every year, the rubella vaccine, like the Catholic Church, has prevented many abortions.)

Mass-marketing: Anti-vaccine activists in Victorian England took advantage of an increasingly print-oriented society. They produced hundreds of different handbills and pamphlets; engaged in letter-writing campaigns to local and national newspapers; distributed several periodicals throughout England and Wales; hung posters in shop-windows to encourage citizens to talk about the dangers of vaccines; and produced grotesque, graphic photographs of children supposedly harmed by vaccination, perhaps the most disturbing of which was a child suffering from cancer of the eye. The editor of the British Medical Journal, Ernest Hart, lamented the success of the antivaccine message. “[Anti-vaccine activists have] an extremely energetic system of distributing tracts, inflammatory postcards, grotesquely drawn envelopes, and other means of disseminating their views.” On the other hand, those who were promoting the value of vaccines didn’t offer “an accessible antidote to these productions.”

Today’s methods of mass communication include national television programs, Web logs, YouTube, and Twitter. Through these outlets anti-vaccine activists have been able to get their message to millions of people quickly and cheaply. And they’re much better at it than public health officials, doctors, and scientists. Rahul Parikh, a pediatrician in Walnut Creek, California, offered a lament in 2008 that echoed the words of Ernest Hart a hundred and fifty years earlier. In an editorial titled “Fighting for the Reputation of Vaccines,” Parikh wrote, “Anti-vaccine groups are well organized and passionate. They have used popular settings such as Oprah and Larry King Live to make strong emotional appeals and get parents to think twice about having their children vaccinated. People, logical or not, do not forget this kind of emotional prowess. On the other hand, our medical and scientific experts counter with accurate evidence and citations of studies, which do not resonate with many parents. Dispassionate messages are not sticky. Gut-wrenching stories ... are. It is time we change.”

Although the anti-vaccine movement in the mid-1800s is similar to today’s, certain differences are striking.

Rich versus poor: Laws compelling vaccination in nineteenth-century England were directed against the poor. Authorities believed that the working class, because it was less educated, would be more likely to fear vaccines and less likely to get them. As a consequence, resistance to vaccination sprang up in working-class neighborhoods in East and South London as well as in heavily industrialized towns such as Manchester, Sheffield, and Liverpool. Resisters were primarily journeymen laborers, artisans, factory workers, and small shopkeepers—groups most likely to suffer the public humiliation of vaccine stations.

Today, on the other hand, resistance to vaccines is found in the upper-middle class among parents who are college- and graduate-school-educated, likely to use the Internet to make healthcare decisions, and fully believing that they, too, can become experts in an information age. The problem, however, lies in how they obtain their expertise. Magazine and newspaper articles and the Internet often provide information that is misleading and unnecessarily frightening. And it’s not hard to find like-minded people on the Internet, no matter how small the group or how outlandish the belief.

Lawyers: Unlike anti-vaccine protesters in Victorian England, some of today’s anti-vaccine activists find a pot of gold at the end of the injury-compensation-program rainbow. Fear of pertussis vaccine in the 1980s led to millions of dollars in awards and settlements. As a consequence, anti-vaccine organizations now work hand-in-glove with personal-injury lawyers, many of whom sit on their advisory boards and help them prepare pamphlets that warn of the dangers of vaccines and describe how to collect money. For example, a press release by Barbara Loe Fisher’s National Vaccine Information Center quotes Michael Kerensky, a lawyer from one of the most powerful product-liability law firms in the United States. At the end of the press release is this statement: “In cooperation with the National Vaccine Information Center, Kerensky has developed an educational pamphlet about the National Vaccine Compensation Fund. To request a copy call 1-800-245-0249.” Fisher’s Web site provides direct links to sixteen personal-injury law firms.

Marketing strategy: Protesters in nineteenth-century England had no trouble labeling themselves anti-vaccine. Indeed, most organized anti-vaccine groups included the word anti-vaccination in their names. Today, however, anti-vaccine activists go out of their way to claim that they are not anti-vaccine; they’re pro-vaccine. They just want vaccines to be safer. This is a much softer, less radical, more tolerable message, allowing them greater access to the media. However, because anti-vaccine activists today define safe as free from side effects such as autism, learning disabilities, attention deficit disorder, multiple sclerosis, diabetes, strokes, heart attacks, and blood clots—conditions that aren’t caused by vaccines—safer vaccines, using their definition, can never be made.

In 1898, the British government finally gave in, appeasing angry citizens by passing a conscientious-objection law. People who didn’t want to get a vaccine didn’t have to. (The term conscientious objector , born of England’s anti-vaccine movement, was later applied to those who refused to fight in World War I and subsequent wars.) Within a year, the government issued more than two hundred thousand certificates of conscientious objection. By the late 1890s, vaccination rates had plummeted. In Leicester 80 percent of babies were unvaccinated; in Bedfordshire, 79 percent; in Northamptonshire, 69 percent; in Nottinghamshire, 50 percent; and in Derbyshire, 48 percent. Anti-vaccine forces in England had won the day. In Ireland and Scotland, on the other hand, no such movement existed. No anti-vaccine groups were formed, no anti-vaccine pamphlets were produced, and citizens readily accepted vaccination. While vaccination rates in England fell, those in Scotland and Ireland rose. As a result, England became Europe’s epicenter of smallpox disease and death.

For anti-vaccine activists in England, the freedom to choose had become the freedom to die from that choice. As in nineteenth-century England, the battle to eliminate vaccine mandates in twenty-first-century America would also be fought in legislatures and court-rooms. And the results would be all too similar.