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|Fig. 1. William Young’s 1886 pamphlet alleging that smallpox vaccinations slaughter and kill. Source: Wellcome Collection. In Public Domain.|
Vaccine misinformation and anti-vaccination conspiracy theories are not new but have acquired a combative energy during the Covid-19 pandemic. Nearly all the arguments now raised against vaccination were known in the late nineteenth-century, and the vaccine objectors’ rhetoric shows striking similarities to that in use today.
Smallpox vaccine opponents: 1850–1930
“Thousands of children are killed annually by vaccination.” – William Young, 1886
Thus began a seventeen-page diatribe against compulsory smallpox vaccination by William Young of London. In a sketchy series of about two dozen collected cases, Young described the association of deaths with cowpox-based vaccinations. The medical details were scant, except for the mention of “blood-poisoning” and illness or death following a vaccination. Young claimed that vaccination, especially if compulsory, had maimed or murdered “thousands.” He asserted that between 1881 and 1883, one child every six days was “directly killed by Cow-pox or Vaccination.” His essay’s emotional tone was loud and accusatory.1 (Fig. 1) In the United States, Thomas Boudren submitted a sixteen-page open letter in 1911 to the Connecticut governor and legislators labeling vaccination as an “assault and a crime in the nature of rape.” His letter’s contents resembled those of Young.2 Other anti-vaccination descriptions were, “Death by vaccination,” “Vaccination murders,” “greatest crime … in this last century,” and “vaccination [is] more fatal than smallpox.”3,4
The core objection to vaccine by these skeptics was the occurrence of death, or morbidity after vaccination or variolation, the latter being the subcutaneous introduction of material in the unaffected from an active pustule of infected persons. Edward Jenner’s (1749–1823) discoveries in 1796 changed the practice of variolation to cowpox-based vaccination; Jenner’s conviction was so strong that in 1789 he inoculated his eighteen-month-old son Edward with swinepox material twice with no adverse effects.5 (Fig. 2) Most deaths occurring within a few weeks after vaccinations had convinced the anti-vaxxers that they were indeed caused by vaccination. Often, the vaccines were administered by ill-trained vaccinators under less-than-hygienic circumstances, resulting in sepsis from multiple bacterial contaminants entering the system. Even in 1899 an insightful report cautioned its readers to remember that “after is not because of.” However, this post hoc ergo propter hoc misattribution of the past persists even today. 3,6
|Fig. 2. Dr. Edward Jenner vaccinating his 18 month old son Edward with swinepox matter in 1789. Source: “The history of inoculation and vaccination for the prevention and treatment of disease.” Lecture memoranda, American medical association, Minneapolis, 1913. In Public Domain. Credit: Courtesy of Science History Institute.|
Quoting out of context
We know little about William Young, but we do know that he cited out of context a few luminaries of that period who held strong views about vaccines. For instance, to support his stance he misquoted Sir James Paget’s statement that vaccines produce “a permanent morbid (though beneficial!) condition of the blood.” He failed to include evidence that Paget was an “unwavering advocate of universal and repeated vaccination.” He had urged moderation before enforcing “rigorous compulsion” because it could “provoke opposition.” Young added insult to injury by gratuitously inserting the parentheses and an exclamation point, which were not part of Paget’s original writing.6 In fact, Paget may have been far-sighted in anticipating the plausibility of “permanent” immune memory, which we now identify as memory T and B cells. This type of context-free quoting had confusing effects, perhaps intended, even in the erudite debates of that period. In 1900–1902 there were heated exchanges between Sir Bernard Shaw and the British Medical Journal in its correspondence section. At the end, even though Shaw had declared that the “old Jennerian claim that infant vaccination protects for life [is] obsolete,” it left open the slight possibility that he may have even supported smallpox vaccination.7 In one of his letters to The Times (of London), he noted that “The death of a single vaccinated person from smallpox does not prove that vaccination is dangerous or useless.”8
Human rabies and other vaccines
Other kinds of misinformation that prevailed then continue today. Anti-vaccine literature revolved around smallpox, and after Pasteur’s discovery of a vaccine against human rabies in 1885, it included that vaccine as well. The vitriol against smallpox vaccination had become an inerasable archetype for succeeding generations, serving as a template even for today’s antivaxxers.
There was even a denial about the very entity of preventable and nearly fatal diseases such as rabies. Human rabies was well recognized, and Pasteur’s rabies vaccine had been available since the mid-1880s. Even prophylactic vaccination after ingestion of infected cow’s milk was in vogue. (Fig. 3) Yet human rabies as a disease was seriously doubted and even denied, much as the current Covid-19 pandemic has been viewed as a “hoax.”9
|Fig. 3. Prophylactic rabies vaccination was not limited to dog or wild animal bites only. Even ingestion of milk from a cow suspected to have contracted rabies, probably from a wild animal bite, warranted vaccination. In this 1933 photograph, a “day laborer” and his family in Oklahoma were receiving anti-rabies serum “after drinking milk from a cow which had rabies.” Source: The Library of Congress. Lee, Russell, 1903–1986, photographer. No known restrictions.|
Even trained and credentialed physicians have contributed to disinformation both in the past and today, with no punitive consequence. An erstwhile, but little known today, exemplar of vaccine misinformation spreaders was William Brady (1880–1972). He was a trained physician from upstate New York and later Beverly Hills, California. His excellent communication skills landed him the first nationally syndicated and popular health advisory newspaper column between 1914 and the 1950s. His long-running column contained much common sense and medical wisdom in its early years. Commencing in the mid-1930s, either because of the emergence of competition from other columnists or overconfidence, he steered into controversy and away from known science and accepted medical practice. His strong advocacy against rabies vaccines, and even outright denial of the existence of human rabies, stirred much opposition, especially from the American Medical Association, medical societies, and medical journals. Notwithstanding, he spread his denials and polemical views through his columns. At age eighty, he finally stopped writing about rabies and his anti-vaccine position by staying silent on the issues. His departures from evidence to controversy, tempered advice to extreme advocacy, and linguistic decency to vituperation are reminiscent of the anti-vaccine and anti-masking positions taken by some physicians during the Covid-19 pandemic.10,11 Similarly, a causal connection between the Measles, Mumps and Rubella (MMR) vaccine and autism does not exist; however, persistent media attention to the once plausible, but now fully discredited, association continues to energize anti-vaccine sentiment among a segment of the public.12
Other irrationalities prevalent then and now
The anti-vaccine discourse included other irrational beliefs such as that vaccines could introduce foreign material or microchips into the body or that they were an external “poison [or] bioplasm” that was capable of “interference with the order of nature.”2 Other narratives included that doctors and public health officials were motivated by “pecuniary interest” and eager to put “money in their pockets.” Smallpox was “not a serious disease” and “the perils of small-pox have been greatly exaggerated.”4,13 “Doctors get the fee and the parents get the corpse,” ridiculed Young about physicians who charged for vaccinations. Brady similarly questioned motivations for public health officials’ advocacy of dog and human rabies vaccinations.
“Invasion of privacy” was another pet objection when it came to the “evils” of vaccine requirements for schoolchildren. “No power on earth would compel [me] to agree to my children’s vaccination,” trumpeted Young and other antivaxxers. Much like the discredited benefits of hydroxychloroquine and ivermectin, the smallpox antivaxxers advocated the use of milk-soaked blankets, linseed oil baths, salts, and “massive disinfection.”4
The roots of vaccine resistance, distrust, and disinformation reach deep, spanning a century and a half.14 From 1802 to 1840, vaccine-induced immunity against smallpox rose while cases fell perceptibly; memories of the vile illness faded. Unorthodox and unhygienic methods and untrained vaccinators entered the scene, and complications followed. This set the stage for vigorous vaccine opposition; anti-vaccine sentiments proliferated until the 1930s. The anemic logic behind vaccine objections hibernated because of the technological advances during the “golden age” of medicine (1930s to 1980s).15 But it found a renewed and growing vitality bestowed by social media and a novel pandemic. An information epidemic, “infodemic,” suffocates us with an overabundance of information, both accurate and otherwise. Newspapers and journals of the past may have functioned as filters, though porous, against the rampant spread of disinformation encountered today.16 The Jennerian vaccine period had a lower literacy rate and fewer and slower media outlets, but they were still capable of spreading misinformation. We may never find a vaccine against the cadre of conspiracists, dissembling doctors, and the gullible public.
- Young W. “Killed by vaccination: a few facts of recent occurrence for the consideration of legislators and others who uphold the useless, cruel, and inhuman law of compulsory vaccination, under cover of which, as has been stated in the House of Commons, children are slaughtered by wholesale.” Compiled by William Young. Wellcome Collection. Published 1886. Accessed February 6, 2022. https://wellcomecollection.org/works/q9dqnjau.
- Boudren T. An Open Letter to the Governor and Members of the General Assembly of Connecticut : Showing the Evils of Compulsory Vaccination and Certain Deaths Caused by the Practice of Cowpoxing. Bridgeport, Conn. : Press of the Farmer Pub. Co.; 1911. Accessed February 12, 2022. http://archive.org/details/39002011128742.med.yale.edu.
- Topics of the Times. New York Times. December 8, 1899:6.
- Kaufman M. “The American Anti-vaccinationists and their Arguments.” Bulletin of the History of Medicine. 1967;41(5):463-478. Kaufman’s review eloquently traces the history of vaccination resistance from circa 1850 to the 1930s.
- Belongia EA, Naleway AL. “Smallpox Vaccine: The Good, the Bad, and the Ugly.” Clin Med Res. 2003;1(2):87-92; Stern AM, Markel H. “The History Of Vaccines And Immunization: Familiar Patterns, New Challenges.” Health Affairs. 2005;24(3):611-621. doi:10.1377/hlthaff.24.3.611; Riedel S. “Edward Jenner and the history of smallpox and vaccination.” Proc (Bayl Univ Med Cent). 2005;18(1):21-25.
- Paget SJ. Lectures on Surgical Pathology: Delivered at the Royal College of Surgeons of England. Lindsay & Blakiston; 1865; Paget J, Paget S, Colt GH, University College LLS, University College LLS. Memoirs and Letters of Sir James Paget [Electronic Resource]. London : Longmans, Green and Co.; 1901. Accessed February 13, 2022. http://archive.org/details/b21290660; Tebb WS. A Century of Vaccination and What It Teaches. Swan Sonnenschein & Co.; 1899.
- Shaw GB. “Mr. Bernard Shaw on Small-Pox Prevention.” Br Med J. 1901;2(2130):1289-1291; “Mr. Bernard Shaw on Vaccination.” Br Med J. 1902; 2 (2181):1283. The intent of the back and forth exchanges between Shaw and the BMJ are difficult to decipher with confidence, especially those of Shaw.
- Shaw B. The Letters of Bernard Shaw to The Times, 1898-1950. Dublin ; Portland, OR : Irish Academic Press; 2007. Accessed February 13, 2022. http://archive.org/details/lettersofbernard0000shaw.
- Hughes JP, Efstratiou A, Komer SR, Baxter LA, Vasiljevic M, Leite AC. “The impact of risk perceptions and belief in conspiracy theories on COVID-19 pandemic-related behaviours.” PLOS ONE. 2022;17(2):e0263716. doi:10.1371/journal.pone.0263716.
- Much of the information about William Brady’s published writings is accessible from newspaper archives, especially the Los Angeles Times, his 1916 and 1962 books, the Journal of The American Medical Association, a few other medical journals, and the “Ancestry Library” web site https://www.ancestrylibrary.com/. The California Digital Newspaper Collection (CDNC) based at the University of California, Riverside <https://cdnc.ucr.edu/> and The Library of Congress “Chronicling America” < https://chroniclingamerica.loc.gov/> are also relevant resources for articles about Brady and his health columns. It is unclear if there are any known biographies about this long-tenured health advice communicator. His two books embed a few of his personal reflections. Also, see the following for specific examples of Brady’s extreme views: Weiner R. “The Doctors: An Historical Overview of Syndicated Columnists, from Dr. William Brady to Dr. George Crane.” American Journalism. 1997;14(3-4):530-538. doi:10.1080/08821127.1997.10731940; Brady W. “Personal Health Service: NOT SO MANY CASES OF HYDROPHOBIA NOW.” Los Angeles Times (1923-1995), September 6, 1934:A4; Brady W. “Here’s to Health!: The Rabies Situation.” Los Angeles Times (1923-1995), March 12, 1938:A5; Brady W. “Brady Lists Findings on Rabies: He Doubts That the Disease Occurs in Human Beings.” Los Angeles Times (1923-1995), January 21, 1955:B2; Brady W. Personal Health; a Doctor Book for Discriminating People. Philadelphia London, W. B. Saunders company; 1916, http://archive.org/details/personalhealtha00bradgoog; Brady W. An 80 Year Old Doctor’s Secrets of Positive Health. Prentice-Hall; 1962.
- Rubin R. “When Physicians Spread Unscientific Information About COVID-19.” JAMA. Published online February 16, 2022. doi:10.1001/jama.2022.1083; Knight V. “Will ‘Dr. Disinformation’ Ever Face the Music?” Kaiser Health News. Published September 22, 2021. Accessed March 7, 2022. https://khn.org/news/article/disinformation-dozen-doctors-covid-misinformation-social-media/; Meltzer CC, Wiggins RH, Mossa-Basha M, et al. “Misleading Public Statements About COVID-19.” Journal of the American College of Radiology. 2021;18(1):6-7. doi:10.1016/j.jacr.2020.10.012.
- Motta M, Stecula D. “Quantifying the effect of Wakefield et al. (1998) on skepticism about MMR vaccine safety in the U.S.” PLOS ONE. 2021;16(8):e0256395. doi:10.1371/journal.pone.0256395.
- Wilder A. “Vaccination a Medical Fallacy.” Publisher not identified, Accessed March 7, 2022. 1875. http://resource.nlm.nih.gov/9715913. Pamphlets, like those of Young, Boudren, or Wilder were unreviewed and unmoderated irregular publications that were neither newspaper essays nor magazine stories. Their contents could be idiosyncratic opinions. Wilder, for instance, claimed that “small-pox will never be eradicated, nor … mitigated in its severity, by vaccination.” These pamphlets could perhaps be viewed as the equivalents of modern day blogs.
- Hausman BL, Ghebremichael M, Hayek P, Mack E. “‘Poisonous, Filthy, Loathsome, Damnable Stuff’: The Rhetorical Ecology of Vaccination Concern.” Yale J Biol Med. 2014;87(4):403-416; Stein RA, Ometa O, Pachtman, Shetty S, Katz A, Popitiu MI, Brotherton R. “Conspiracy theories in the era of COVID‐19: A tale of two pandemics.” Int J Clin Pract. 2021;75(2). doi:10.1111/ijcp.13778.
- O’Mahony S. “After the golden age: what is medicine for?” The Lancet; London. 2019;393(10183):1798-1799. doi:http://dx.doi.org/10.1016/S0140-6736(19)30901-8.
- Bennett WL, Livingston S. “The disinformation order: Disruptive communication and the decline of democratic institutions.” European Journal of Communication. 2018;33(2):122-139. doi:10.1177/0267323118760317.
SATY SATYA-MURTI, MD, FAAN, is a clinical neurologist and health policy consultant. Following retirement, Saty has spent time researching cognitive biases, the social underpinnings of clinical medicine, Progressive Era medicine, and forensic sciences. He enjoys grandparenting, solar cooking, and volunteering.