In 1885, Montreal suffered an outbreak of smallpox that would go on to kill more than 3000 people, which was at the time around 2 per cent of its population. During the outbreak, an eccentric physician known as Dr Alexander Ross circulated a pamphlet urging people to reconsider getting vaccinated against the infectious disease. The pamphlet, which has been preserved by historians and can be read online, states in bold letters “do not be alarmed by the smallpox!”, “thousands have had their health ruined (by vaccination)” and “many children are killed outright!”. This early pamphlet is a masterful example of the key rhetorical devices used by anti-vaxxers, devices still used today, often to great effect.
To be fair, not all of Ross’s concerns were completely unfounded. In the 1800s, vaccination was a much more risky enterprise than it is today, medical instruments were not always sterilised and so vaccination could lead to secondary infections. Leeriness over the smallpox vaccine was not uncommon: the vaccine itself consisted of an “arm-to-arm” process of scraping the flesh and then inserting the fluid from a smallpox blister from a person who had been vaccinated a week earlier. This arm-to-arm process was later replaced by syringes that contained the lymph fluid of cows that had been infected by cowpox.
Notwithstanding some legitimate concerns, the logic of Ross became faulty when he argued that vaccination was riskier than the smallpox disease itself. While vaccination always entails some risk (like any other medical intervention) the risk to health posed by smallpox was much, much higher. Smallpox caused fever and vomiting, mouth ulcers and skin rashes, the rashes would often blister, which would lead to scarring, sometimes blindness, and disfigurement that could last a lifetime. About 30 per cent of people who contracted smallpox would die, including many children and babies. It is only thanks to vaccination that this hideous disease has been eradicated – so much so that we don’t need to vaccinate for it anymore.
Ross was not an isolated figure. In the 1800s several anti-vaccination leagues sprang up in the UK and US specifically in opposition to the smallpox vaccine. These leagues argued that smallpox was not caused by a virus but instead by a lack of sanitation and that vaccination was “un-Christian”.
Others argued that vaccination was an affront to bodily autonomy. Vegetarians also disliked vaccination because it often used lymph material from cows. Victorian-era anti-vaxxers were motivated by two moral concerns: they worried that the “purity” and “wholesome blood” of children would be “poisoned” by vaccination and they also worried that new public health efforts were an exercise of medical tyranny.
Concerns about medical tyranny were inflamed when laws were passed to make vaccination mandatory in England in the mid-1800s. Many of us consider today’s response to the Covid-19 pandemic to be heavy-handed, but governments have long struggled to control the spread of infectious disease and have often used coercive measures. In England during the mid-1800s, if parents did not get their babies vaccinated against smallpox within the first three months of their lives, they risked being thrown into prison.
Yet coercive measures are also known to provoke anger among the populace. In response to compulsory vaccination laws, anti-vaccination sentiments grew. In 1885, the English town of Leicester saw a march of 80,000 to 100,000 anti-vaxxers; they carried banners, a child’s coffin and burned an effigy of Edward Jenner – the famed scientist who had discovered the first smallpox vaccine more than 100 years earlier.
The growing popularity of anti-vaxx sentiment caused the English authorities to wind back their laws that had made vaccination compulsory and parents who refused the smallpox jab hence became known as “conscientious objectors”.
Why does this history matter? It matters because in the fight against Covid, Australia has not yet had to deal squarely with the problem that is vaccine hesitancy and conscientious objection. Because our vaccine rollout has been slow, we still have more demand for the shots than supply. But that will soon change.
This will present us with an ethical dilemma. Gladys Berejiklian has indicated that restrictions might not be lifted in NSW until 80 per cent of eligible adults have been vaccinated. But with an estimated 26 per cent of Australians hesitant to get the vaccine, this may be an impossible target.
We have to accept that we may never reach optimal vaccine coverage. And rather than making vaccination compulsory – which history shows does not work and can even backfire – we may have to learn to live with the reality that a certain proportion of the population would rather risk infection with Covid than be protected from it.
Part of learning to live with Covid will be learning how to live with the reality of anti-vaccination propaganda. When social media companies censor such material, it appears to increase conspiratorial thinking. The realisation that many among the community will refuse the best defence we have against Covid can be challenging, but not much about this pandemic has been easy.
So what can we do? I believe we should respect the decisions of the conscientious objectors. But similarly, the rest of us should not have to live under restrictions to protect this group. Even if they are elderly and have co-existing health problems, we should not consider conscientious objectors to be a “vulnerable” group. If conscientious objectors wish to risk infection with Covid, then they should also live with the responsibility for their choices.
Rather than holding the rest of society hostage to protect a group that willingly refuses to protect themselves, we should respect the choices of conscientious objectors and get on with returning to a life with the freedoms we once enjoyed.