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Despite overwhelming evidence to the contrary, roughly one in
five Americans believes that vaccines cause autism, a disturbing fact that will
probably hold true even after the publication this month, in a British medical
journal, of a report thoroughly debunking the 1998 paper that began the
vaccine-autism scare. That’s because the public’s underlying fear of vaccines
goes much deeper than a single paper.

The evidence against the original article and its author, a British
medical researcher named Andrew Wakefield, is damning. Among other things, he
is said to have received payment for his research from a lawyer involved in a
suit against a vaccine manufacturer; in response, Britain’s General Medical
Council struck him from the medical register last May.

But public fear of vaccines did not originate with Wakefield’s
paper. Vaccines have had to fight against public scepticism from the beginning.
In 1802, after Edward Jenner published his first results claiming that scratching
cowpox pus into the arms of healthy children could protect them against
smallpox, a political cartoon appeared showing newly vaccinated people with
hooves and horns.

Nevertheless, during the 19th century vaccines became central
to public-health efforts in England, Europe and the Americas Such a move didn’t
sit comfortably with many people, who saw mandatory vaccinations as an invasion
of their personal liberty. An anti-vaccine movement began to build and, though
vilified by the mainstream medical profession, soon boasted a substantial
popular base and several prominent supporters, including Frederick Douglass,
Leo Tolstoy and George Bernard Shaw, who called vaccinations “a peculiarly
filthy piece of witchcraft.” In America, popular opposition peaked during the
smallpox epidemic at the turn of the 20th century. Health officials ordered
vaccinations in public schools, in factories and on the nation’s railroads;
club-wielding New York City policemen enforced vaccinations in crowded
immigrant tenements, while Texas Rangers and the United States Cavalry provided
muscle for vaccinators along the Mexican border.

Public resistance was immediate, from riots and school strikes
to lobbying and a groundswell of litigation that eventually reached the Supreme
Court.

But the opposition reflected complex attitudes toward medicine
and the government. Many African-Americans, long neglected or mistreated by the
white medical profession, doubted the vaccinators’ motives. Christian
Scientists protested the laws as an assault on religious liberty. And workers
feared, with good reason, that vaccines would inflame their arms and cost them
several days’ wages.

Understandably, advocates for universal immunisation then and
now have tended to see only the harm done by their critics. But in retrospect,
such wariness was justified: at the time, health officials ordered vaccinations
without ensuring the vaccines were safe and effective.

Public confidence in vaccines collapsed in the fall of 1901
when newspapers linked the deaths of nine schoolchildren in Camden, New Jersey
USA, to a commercial vaccine allegedly tainted with tetanus. In St. Louis, 13
more schoolchildren died of tetanus after treatment with the diphtheria
antitoxin.

Seeking to restore confidence after the deaths in Camden and
St. Louis, Congress enacted the Biologics Control Act of 1902, establishing the
first federal regulation of the nation’s growing vaccine industry. Confronted
with numerous anti-vaccination lawsuits, state and federal courts established
new standards that balanced public health and civil liberties.

Most important, popular resistance taught government officials
that when it comes to public health, education can be more effective than brute
force. By mid-century, awareness efforts had proven critical to the polio and
smallpox vaccination efforts, both of which were huge successes.

One would think such education efforts would no longer be
necessary. Still, according to a 2010 C.D.C. report, 40 percent of American
parents with young children have delayed or refused one or more vaccines for
their child. That’s in part because vaccines have been so successful that any
risk associated with their use, however statistically small, takes on an
elevated significance.

It also doesn’t help that, thanks to the Internet, a bottomless
archive of misinformation, including Wakefield’s debunked work, is just a few
keystrokes away.

Health officials often get frustrated with public
misconceptions about vaccines but that’s no way to run a health system. Our
public health leaders would do far better to adopt the strategy used by one
forward-thinking federal health official from the early 20th century, C.P.
Wertenbaker of the Public Health and Marine-Hospital Service.

© 2011 The New York Times