1. Public Health Liberty vs Compulsion
Gareth Millward

2. Public Health Liberty vs Compulsion
Use the case study of smallpox vaccination
Freedom from the state
Freedom from disease
Which publics does public health protect?
Edward Jenner’s Lancet, Science Museum, London. From Wellcome Images CC-BY

3. James Colgrove, State of Immunity: The Politics of Vaccination in Twentieth-century America (Berkeley, 2006), p. 17.

4. Public Health Liberty vs Compulsion
Variolation in C18th Britain
Vaccination in C19th Britain
Immigration in C20th Britain
Eradication in C20th India
Edward Jenner’s Lancet, Science Museum, London. From Wellcome Images CC-BY

5. Smallpox
Estimated cause of 15% of all deaths in epidemic years during C18th. Mostly in children
A cure was never found
Control and eradication the only defence
Japanese medical text on Smallpox, c From Wellcome Images CC-BY

6. Variolation
By putting a small amount of smallpox into the body, patient gets a mild case and life-long immunity
Practiced in India and China since antiquity
“Inoculation” popularised in West by Lady Montagu.
Two thorns used for smallpox inoculation, Palestine, 1921.
Science Museum. From Wellcome Images CC-BY

7. Variolation
Safer than no protection – but still dangerous. Death rate of 1-2%!
Difficult to “prove” it worked.
Largely a “private” rather than “public” health procedure
Lady Mary Montagu, Stipple engraving by W. Greatbach, 1844, after C. F. Zincke. From Wellcome Images CC-BY

8. Vaccination
By putting cowpox into the body, patient gets very mild case of cowpox and limited immunity from smallpox
Popularised by Edward Jenner using C18/19 scientific networks
The hand of Sarah Nelmes in Jenner’s account of vaccination.
From Wellcome Images CC-BY

9. Vaccination Much safer than variolation
Modern statistical techniques and nation state enthusiasm leads to widespread adoption
Compulsory in many European countries by mid-C19
E.E. Hillemacher, Edward Jenner vaccinating a boy (1884). From Wellcome Images CC-BY

10. Vaccination Compulsory vaccination is resisted
Some local authorities seek alternatives – see the “Leicester Method”
UK effectively ends compulsion in 1897, fully in 1948
J. Gilray, The cow-pock - or - the wonderful effects of the new inoculation! (1802)
From Wellcome Images CC-BY

12. Commonwealth Immigration Bill
Smallpox eradicated in UK in 1930s
Some cases after this, all traced to importation from abroad
Seen as “one of those things” in the 1940s/50s…
1950s Ministry of Health poster. The National Archives, INF 13/292, photograph by Alex Mold.

13. Commonwealth Immigration Bill
Outbreak in 1961/62 coincides with political tension over “coloured” immigration
Importation from Pakistan
Vaccination imposed on travellers
Michael Cummings, Daily Express (17 January 1962). From British Cartoon Archive © Express Syndication.

15. WHO Smallpox Eradication Programme
Smallpox declining worldwide over C20
WHO in 1950s decides to commit to full eradication
Biggest focus on sub-Saharan Africa and South Asia
Plaque at the London School of Hygiene and Tropical Medicine. Personal photograph.

16. WHO Smallpox Eradication Programme
Close international co-operation, even (especially!) between USA and USSR
Eradicated in the wild in 1977 – declaration 1980
Imposed on post-colonial nations
1960s WHO smallpox reward poster by René Gauch. From Wellcome Images CC-BY

17. Conclusions / Questions
Who gets to decide what is in “our best interests”?
Parents?
Doctors?
The state?
Majority rule?
“Advanced” nations?
Protest placard outside the Houses of Parliament from the Vaccine Awareness Network. From vaccineriskawareness.com.