9.4 Lessons from history
Bellaby, P. (2003) ‘Communication and miscommunication of risk: understanding UK parents' attitudes to combined MMR vaccination’, British Medical Journal, 327, 27 September 2003, pp. 725–28. Reproduced by permission from the BMJ Publishing Group; Mary Evans Picture Library Ltd; P A Photos.
Yet there is a history to compulsory vaccination of infants in Britain that is an object lesson for today. From its Introduction in law in 1853, compulsory smallpox vaccination for infants provoked vigorous opposition, not only from middle class radical liberals, but also from working class movements.13 It was not until 1898 that conscientious objection was allowed, but this followed progressive decline in compliance with vaccination law from about 1889. From then on, Britain differed from most countries, including the United States and Germany, in not relying on compulsory vaccination in order to control smallpox.
A comparison of vaccination policy and its effects on population health in England and in Prussia and Imperial Germany from 1835 to 1914 suggests that compulsory vaccination led to an earlier downturn in smallpox in Germany. However, by the end of the period, both countries had controlled the disease.14 This was partly attributable to disease surveillance and containment in Britain, but was also due to another factor, which contributed to Britain's success with many childhood diseases at the turn of the 20th century. This was active engagement with the public at local level in health improvement.15 By the late 19th century, the liberal middle classes were encouraging the “deserving poor” to change their lifestyles by face to face engagement in their homes, schools, and neighbourhoods.16 At the same time, they might provide an example of domestic management and hygiene to the many women servants in middle class homes who would later rear their own children in working class areas.