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Beach Blanket Bioethics: A Novel Remedy for Vaccination Refusal

American physicians’ growing alarm over parents who opt out of childhood vaccinations mirrors concerns in the UK. In a roundup of news from London, New York Times correspondent Henry Norman notes that a best-selling English novelist has a new title coming out based on the roiling debate there over the safety of vaccines. According to Norman, this “polemical” novel indicts the British government for its recent decision to allow exemptions to vaccination mandates in place in England and Wales since the mid-fifties. In a subsequent article, Norman reports that so many parents were applying for certificates of exemption–43,000 in one northern city alone–that “in a year or two England will be an unvaccinated country.”

Norman filed his reports by cable, not e-mail.  He wrote them in 1898.

In 1853, the House of Commons passed the Compulsory Vaccination Act, which made smallpox vaccination mandatory, and free, in England and Wales. Beginning in 1867, local vaccination officers kept registries of vaccinated children and hauled noncompliant parents into court. Families’ possessions were auctioned to pay fines and court costs. Some parents were imprisoned.

As smallpox rates and public awareness of the disease declined, the class-driven “anti-vaccinationist” resistance strengthened.  Resisters seized on reports of injuries and deaths from infections following vaccination.  Through free-floating applications of germ theory, they portrayed vaccination as an effort by physicians and the state to poison and control citizens’ bodies. To placate the anti-vaccinationists and their political allies, the governing Tories added a “conscience clause” to the Vaccination Act in the summer of 1898, allowing parents to apply to a local magistrate for a certificate of exemption. 

In her superb recent book, Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907, historian Nadja Durbach points out that the anti-vaccinationists called themselves “conscientious objectors,” but did not lobby for the conscience clause. They wanted vaccination to be voluntary, so as not to make anti-vaccinationists into “licensed lawbreakers.” However, they made use of the new penalty-free provision. By year’s end, magistrates had granted more than 200,000 exemptions, concentrated in centers of resistance.

The Tories’ capitulation horrified Conservative-aligned papers and public figures, including H. Rider Haggard. The author of King Solomon’s Mines and dozens of other adventure tales responded by writing a novel, Doctor Therne, published in 1898. In his author’s note, Haggard writes that as a traveler who had seen smallpox firsthand, he felt a duty to alert his readers to the consequences of making vaccination optional.

He does this by setting the novel in the future. The book’s narrator–“James Therne is not my real name”–recalls how, as a struggling young physician, he was rescued by Stephen Strong, a rich shopkeeper and anti-vaccination activist. This “fierce faddist” makes the doctor an offer he can’t refuse: a two-year grant to study vaccine-related injuries. After rationalizing this conflict of interest–Therne knows what kind of results Strong wants–he descends morally as he ascends financially and politically.

Backed by his patron’s fortune, he stands as the “A.V.”-endorsed candidate for Parliament, sealing that deal by promising never to vaccinate his only child. Therne and the “A.V.” cause prevail: the conscience clause is added to the Vaccination Act.  Seventeen years pass. And then a stranger, with a strange illness, comes to town . . . But it’s wrong to spoil plots.Doctor Therne is of more than historical value. Readers interested in the history of medicine and in Victorian popular fiction alike will not be disappointed.

In a memoir published in 1899, Haggard called Doctor Therne “my only novel with a purpose.” He had dedicated it “in all sincerity (but without permission) to the members of the Jenner Society,” and there is ample evidence that the British medical establishment was grateful to him for his public service in writing it. The British Medical Journal carried a long, appreciative review of the novel (“A Vaccination Romance”), between reviews of a German textbook on diphtheria and a French textbook on intestinal obstruction. The BMJ reviewer lauds Haggard for his “mastery of antivaccinationist phraseology,” his “graphic” account of “what epidemic small-pox really is,” and his “great service to the cause of truth against falsehood, of knowledge against ignorance, and of experience against folly and knavery.” 

The Lancet’s similarly glowing review– sandwiched between the Atlas der Syphilis and a 1341-page German-language surgical anthology–observes that while Haggard’s schoolboy fans might give Doctor Therne a miss, its intended readers are parents who “are ready to gamble with the lives of their children and neighbors.”  The Lancet’s reviewer compares Haggard’s accomplishment in making art out of public health to that of Ibsen in An Enemy of the People, which managed to find drama in “the defective drainage of a provincial town.”

The Lancet continued to take a lively interest in the impact of Doctor Therne. A subsequent news item in the journal reported that the executive committee of the Jenner Society had, at its meeting on December 22, 1898, unanimously passed a resolution commending Haggard for his unauthorized dedication and expressing their “warm sympathy” with his efforts to use fiction to engage those “who cannot otherwise be interested in the subject.”

Three years later, The Lancet published excerpts from “an interesting correspondence between the well-known author and a convert whom he has made,” a parent who had renounced his anti-vaccinationist position after reading Doctor Therne.  In his reply to his “convert,” Haggard described a newspaper account of a smallpox outbreak in the town of Ipswich that had killed only the younger children in one family: the older children had been vaccinated, before the conscience clause took effect.

William A.R. Thomson grew up in a family whose story could have turned out like that. In a wonderful posthumously published essay, “Rider Haggard and smallpox,” Thomson, a physician and the longtime compiler of Black’s Medical Dictionary, describes his accidental discovery of Doctor Therne, and his appreciation of Haggard’s efforts to call the reading public’s attention to the consequences of using public health legislation for political ends. Thomson and his older brother were vaccinated, his younger siblings were not, and he was old enough to recall seeing, in shop windows, the same terrifying “A.V” posters Haggard describes in the novel. Thomson also details the impact of the 1898 conscience clause, and of the subsequent 1907 amendment that reduced conscientious objection to a simple declaration: “The vaccination rate crashed,” from 80 percent in 1898 to below 50 percent in 1914 to 34 percent in 1939.

Today, American and British parents who opt out of vaccinating their children may be well-educated proponents of “natural parenting,” not resentful workers.  However, Nadya Durbach and other scholars point out that contemporary anti-vaccination web sites argue the same three points as the Victorian anti-vaccination societies: safety, the rights of parents; the virtues of alternative medicine. Most American parents who refuse vaccines are not morally opposed to vaccines: they are afraid of them.

As soon as English parents could opt out of vaccination without penalty, the majority of children in some English towns went unvaccinated. In the United States today, where 48 states have conscience clauses, more parents opt out in those states where it is relatively easy to get exemptions. Some of these states now have outbreaks of measles that include children whose parents refused vaccination. In Boulder, Co., endemic pertussis, linked to locally high rates of vaccination refusal, is so prevalent that both unvaccinated and vaccinated children regularly come down with this preventable disease.

Rider Haggard could have predicted this.  In fact, he did.


Beach Blanket Bioethics 2008

Published on: August 12, 2008
Published in: Bioethics

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