Sceptics who needled doctors into making sure shots

Although millions owe their lives to immunisations, anti-vaccine movements rise up regularly - but their effect is not all bad, writes Ray Spier

As the American Association for the Advancement of Science's annual meeting begins, we talk to the society's outgoing president and survey some hot topics

Vaccines have been at the heart of one of humanity's greatest achievements, the eradication of smallpox in 1979. They have also helped to virtually eliminate deadly diseases such as polio, plague and yellow fever.

Despite these successes, the developed world today faces an active and insistent anti-vaccine movement, which has been prominent in the recent furore in the UK over the purported link between autism and the combined measles, mumps and rubella vaccine.

Such opposition is nothing new. Over the two centuries since Edward Jenner pioneered the use of vaccination to fight smallpox, widespread anti-vaccine movements have waxed and waned at least three times. When the objections of one set of protesters have been met or have faded away, new problems have emerged a few years later.

At first, religion was the problem. In the 1700s, some people sought immunity from smallpox with inoculations of treated material derived from the pustules of patients who were infected with human smallpox. This process, known as variolation, could cause death. Biblical admonitions against suicide were invoked to discourage such efforts at protection.

Quotations from the Bible were also used to warn people against interfering with the punishment schedule of a retributive God, while those who sought or took deliberate measures to prevent or delay their transit to the hereafter were vilified for pre-empting God.

Variolation cut the overall death rate from smallpox, but it was also responsible for many lethal infections. There was room to improve.

On May 14 1796, Jenner inserted fluid from a pustule on the hand of a milkmaid, Sarah Nealmes, into the skin of eight-year-old James Phipps. Over the succeeding weeks, Jenner injected the boy with virulent human smallpox on several occasions without raising any trace of disease. Jenner published his results in 1798, and the century that followed was rampant with medical men and others inoculating citizens with material from pustules that were initially derived from ulcers found on cow nipples. Other inoculations emanated from the pustules of vaccinated humans.

Over the 19th century, vaccinators learnt the techniques that provided protection for the longest time and with the greatest reliability. But there were problems. Protesters complained about a lack of reliability as to whether the vaccine would take, that immunity was short lasting, that other infections such as the "large pox" or syphilis were being transmitted and that some vaccinees were infected with active human smallpox. Towards the end of the century, these issues were largely cleared up by the more controlled production of vaccine material in deliberately infected calves.

Meanwhile, legislation emerged to govern vaccination.

The first vaccination law of 1840 sought to prevent the practice of variolation. A year later, a second law legislated for the free provision of cowpox vaccine to the poor. But the law promulgated in 1853, which made vaccination compulsory for all infants, led to a 50-year campaign against what was considered a draconian intervention.

In 1854, John Gibbs wrote a pioneering 64-page pamphlet, Our Medical Liberties , that stressed the freedom of the individual to be able to refuse the adulteration of a healthy child by offensive material derived from a disease-caused pustule.

Non-compliance with the 1853 law led to the enactment of legislation in 1867 by which parents who refused to vaccinate their children could be fined. This consolidated the anti-vaccine agitators into an organised and vociferous movement. Much of their ire was directed at the peripheral issue of the imprisonment of parents who refused to vaccinate their children and refused to pay the fine of 20 shillings (£45 today). Two years later, the first issue of The Anti-Vaccinator periodical was published.

William and Mary Hume-Rotheray were among the leaders of the battle to rescind the vaccination laws. Their pamphlet of 1877 was a powerful indictment of the laws' intrusive nature. In addition to listing the deficiencies of the vaccines used, the Rotherays introduced the notion that no state had the right to interfere in the relationship between a person's conscience and his or her God. So, in 1898, Parliament passed a law that, for the first time, allowed conscientious objection to be a legal reason to be exempted from vaccination. This took much of the wind out of the sails of the anti-vaccination movement.

The next 75 years were relatively quiet. That is perhaps no surprise given that vaccines were fundamental in helping to eradicate smallpox and to virtually wipe out polio, diphtheria, rubella, whooping cough, measles, yellow fever, tuberculosis, rabies, cholera, plague, tetanus, mumps, meningitis and hepatitis B.

In recent years, however, an anti-vaccination lobby has reappeared. There are several hundred anti-vaccine websites that are supported by numerous publications and journal articles. Here, the charges are that vaccines are not responsible for the decrease in infectious diseases and that some vaccines lead to other diseases - the development of polio vaccines is alleged to have introduced the human immunodeficiency virus (HIV) into the human population, for example.

Each of these cases has been examined closely. So far, the pertussis and hepatitis B vaccines, about which doubts were raised, have been exonerated, and the case against the combined MMR vaccine causing autism is drowning in a sea of contrary evidence. The imputations against the polio vaccine have also been refuted recently.

Notwithstanding the self-correcting nature of the processes that have been, and are being, used to arrive at effective and essentially safe vaccines, the anti-vaccine movement has been instrumental in promoting incremental improvements in the quality of vaccines and the way we use them. Once these have been achieved, the movement goes into hibernation until new correctable deficiencies emerge.

But even if vaccines were to be virtually fault-free in their application, there would still be challenges from anti-progressive movements, and these can only be resolved with the emergence of a universally accepted view of our origins and purpose.

Ray Spier is emeritus professor of science and engineering ethics at the University of Surrey and editor-in-chief of Vaccine . He will speak at the "Public perception of vaccination risks" seminar at the AAAS conference on February 14 at 9am.