Recently I’ve been prone to thinking that things are looking bleak for vaccination, that wonder of science which is estimated to have saved 154 million lives since 1974. There’s the global increase in incidences of vaccine-preventable diseases (the much-reported surge in measles cases, yes, but also pertussis, diphtheria, polio in Gaza, and, in Africa, meningitis and yellow fever) and the declining vaccination rates that have fuelled this. There are the cuts to public health spending and overseas aid that are disrupting vaccination programmes and which will only serve to further prevent people from receiving these lifesaving interventions. And, although I am keen to emphasise that this is not just about anti-vaccination activists, we have to acknowledge that the appointment of an anti-vaccine US health secretary is scary (and Robert F. Kennedy Jr.’s actions since taking office have done nothing to alleviate this concern, from cutting $500 million worth of grants into mRNA vaccine research to calling for a medical journal to retract a paper showing there are no health risks in using aluminium in vaccines, and that’s just this month).
It’s easy to imagine that these are, as they say, ‘unprecedented times’. But, as someone who’s spent a large chunk of my working life dealing with the history of vaccination, I can tell you we’ve been here before. Vaccination has, from its very beginnings, suffered this same mixture of apathy, poor execution, and outright hostility.
In 1805, just nine years after Edward Jenner’s first vaccination using the disease cowpox to protect against the feared smallpox, Dr William Rowley published Cow-pox inoculation no security against small-pox infection. In this pamphlet he railed against “the effects of the diseases of brute beasts incorporated into the human constitution” and reported a fellow doctor’s observation of the face of a young patient which, shortly after vaccination, “seemed to be in a state of transforming, and assuming the visage of a cow.” That medic was Dr Benjamin Moseley who had, in 1804, published a Treatise on the lues bovilla, or, cow pox, a deliberately provocative title that falsely linked cowpox with syphilis. Rowley and Moseley were not to be the last medical practitioners to publish spurious claims about vaccination.
Resistance was also found outside of the medical profession. As early as 1800, Jenner received a report of vaccinated individuals in Hadleigh, Suffolk being attacked with stones if they left their houses. Later, as compulsory vaccination started to be introduced around the world, opposition grew and became more organised. In 1885 an anti-vaccination rally in Leicester attracted, according to contemporary reports, some 80,000 to 100,000 people and an effigy of Edward Jenner was subjected to a mock execution. That same year, in Montréal, a riot occurred when smallpox vaccination was made compulsory in the city in response to an outbreak.
And yet, when Jenner’s friend wrote to him outlining his concerns about the likely impact of early anti-vaccination activism, the pioneering doctor’s response was buoyant. “Why should we fix our eyes on this spot only?” He then listed places around the world where vaccination was thriving: Europe, America, India, and Sri Lanka (Ceylon, as Jenner knew it) where Jenner was pleased to share a report of 30,000 people being vaccinated.
In Hope In The Dark, Rebecca Solnit describes hope as “an embrace of the essential unknowability of the world, of the breaks with the present, the surprises.” We are encouraged in this through study of history, of the significant changes in society, of the progressive victories brought about through activism. Here we take the broader perspective, like I think Jenner did.
In this vein, the history of vaccination gives me cause for hope. In 1802 Jenner predicted that “the annihilation of the small-pox, the most dreadful scourge of the human species, must be the final result of this practice.” Less than two centuries later, in 1980, the World Health Organisation did indeed declare that smallpox had been eradicated, the result of an international campaign of vaccination.
That’s not to say that the current path of vaccination is not troubling and distressing. Indeed, as Solnit notes, “hope doesn’t mean denying these realities… grief and hope can co-exist”.
Smallpox was eradicated despite anti-vaccination sentiment. Despite the kind of indifference that led the Thornbury Medical Officer of Health to write in 1952, “I think it is also relevant to mention the low figure of vaccination against Smallpox in the County as a whole, and especially in this District, which contains the home town of Jenner”. Despite seemingly overwhelming logistical and resourcing challenges. Despite the world being overshadowed by the Cold War, and indeed only because the USSR made the case that they continued to have smallpox outbreaks notwithstanding their strict border procedures and successful vaccination programme (surely a lesson for today’s ‘country-first’ politicians?).
The eradication of smallpox is one of the great triumphs of vaccination and public health. In 184 years, humanity was able to wipe out a disease that had haunted us for thousands of years. But it’s not the only one.
The first vaccine against polio was licensed in 1955 in the US. That year there were 28,985 cases of the disease in the country and 1,043 deaths. By 1957 there were 5,485 cases and 221 deaths. By 1965, only ten years after the start of the nationwide vaccination campaign, the number of cases in the US had reduced to 61. This in spite of confidence being rocked by the Cutter Incident, in which 40,000 children contracted polio from a defective batch of the vaccine just weeks after the first vaccinations. In 1988, when the WHO commenced a global campaign to eradicate polio, there were an estimated 350,000 cases of wild poliovirus worldwide. Last year, there were 99. Wild poliovirus has gone from being endemic in 125 countries to 2. Throughout this initiative, health professionals have had to contend with distrust and misinformation that has led to the halting of the campaign in various communities and the very real risks posed to vaccination workers.
The fight against diphtheria is another work in progress. In the 1930s it was a leading cause of child death in England and Wales. In 1942, when routine vaccination was introduced, there were 41,404 cases of the disease in England and Wales, with 1,827 deaths. By 1950 there were just 962 cases and 49 deaths. In 2024, 85% of children worldwide received the necessary three doses of diphtheria, tetanus and pertussis (DTP) vaccine, up from 72% at the turn of the millennium. Look how far we have come.
New innovations are further changing the ways in which we can imagine vaccination. We now have vaccines that can protect against cancer; in the UK the HPV vaccine has been responsible for a nearly 90% reduction in cervical cancer in those who have been vaccinated. And of course there are the huge advances in technology that allowed vaccines against COVID-19 to be available just months after the first case of the disease. In the first year of the vaccination programme alone, COVID-19 vaccines were estimated to have prevented 19.8 million deaths worldwide. Now, 13.64 billion doses of COVID-19 vaccine have been administered around the world despite issues around equitable access, misinformation spread on social media, and activists disrupting vaccination programmes.
These achievements were only possible through the actions of countless individuals (and Solnit reminds us that “hope and action feed each other”). For Edward Jenner his hope led to a commitment to free access to vaccination, long hours spent writing to correspondents throughout the world, and work building trust amongst members of his community. More recently, I think of the 100,000 volunteers who supported the rollout of the COVID-19 vaccine in England, of health officials in Khyber Pakhtunkhwa province, Pakistan, who have set themselves the ambitious target of vaccinating 90% of children aged under two against twelve diseases by 2027 (vaccination rates in the province currently stand at 55%), and of Khadija Maalim, a Somali social media influencer whose TikTok videos challenge misinformation being spread by groups like Al-Shabaab. I also think of the US state officials who are successfully contesting RFK Jr.’s health grant cuts in court, the CDC leaders who have resigned in protest at the Trump administration’s approach to vaccine policy and misinformation, and the staff who gathered to applaud them for doing so.
We must remember that the majority of people still support vaccination (a study this year found that 85% of UK parents believe that vaccines are safe, an increase from 84% in 2023). And that even in those countries where support for vaccination isn’t as strong, a high proportion of children are still receiving the necessary vaccines (in Latvia in 2023, 46% of people disagreed that vaccines were safe and yet 98% of children received the full course of DTP vaccines). It’s also worth pointing out that, against the backdrop of the US measles outbreak, more people in Texas and New Mexico got their MMR vaccination than in the same period last year.
Where will hope take us today? A few years ago, I attended a panel discussion in which Professor Helen Bedford, a leading authority on childhood vaccination, declared “we need some more noisy pro-vaccine activism”. She was right. The anti-vaccination movement is organised; we must be too. Let’s talk more about vaccination, tell stories about the way it has changed the world for the better, of the lives saved. Let’s give space for our vaccine hesitant friends and relatives to talk about their concerns, pointing them to trusted sources of information. Let’s badger our elected representatives to ensure they are holding our governments to account in supporting science and providing proper funding to do the things we known that work, both at home and abroad: vaccines delivered where people are in ways that are convenient for them to access, opportunities for people to have conversations with community health workers, education in schools and throughout life. And let’s challenge individualistic and nationalistic understandings of human health, to remind people that, in the words of Eula Biss, “immunity is a shared space – a garden we tend together.”
