Anti-vaxx sentiment is as old as the smallpox vaccine but modern parental refusal began in the early 1900s. Do you know what the trigger was?
Vaccine refusals are as old as our first vaccine, the one against smallpox. But let's talk about more recent history. When I first went into private practice in 1979, I had a few blissful years when I didn't spend much time talking about vaccines with parents. Parents just accepted the fact that vaccine benefits outweighed any risks and went along with the expert recommendations. Have times ever changed!
Most people, whether lay or medically trained, would probably say the rise of the modern antivaccine movement in the US began with concerns about links between vaccines and autism-a fear fueled first in the early 1990s by the presence of mercury in vaccines (since removed) and perpetuated soon after by publication in the Lancet in 1998 of Andrew Wakefield’s now discredited research that purported an association between the MMR vaccine and autism.
But that was far from the beginning-in fact about 20 years after the true start of antivaccine activism.
The combination DTP vaccine was first licensed for use in the United States in 1949 and parents were delighted since at that time all were familiar with the dangers of whooping cough in infants. But as early as the 1930s there were concerns over the whole cell pertussis vaccine , when it was a single-component vaccine. Nevertheless, when I started practicing pediatrics in 1979, no parent refused any of the recommended vaccines (OPV, DTP, and MMR in the first 6 years of life).
In the mid 1970’s reports of permanent neurologic damage following DTP administration in Japan and Great Britain raised concern in those countries. In 1975, the death of 2 infants in Japan within 24 hours of receipt of the DTP vaccine led the Japanese government to halt the use of the vaccine. In 1979, 13,000 cases and 40 deaths occurred during a pertussis epidemic in Japan. The development and use of an acellular vaccine by Japanese scientists led to a turnaround in that country. Great Britain saw a similar surge in cases and deaths from pertussis as parents refused to let their infants receive the DTP vaccine.
I would argue that the antivaccine movement in the United States took root in 1982 after the airing of a television “documentary” titled “DTP: Vaccine Roulette.” The show looked at the risks and benefits of the DTP vaccine with the implication that the vaccine was more dangerous than the disease on whole. That was when I first encountered push back from parents on recommended vaccines.
Vaccines and the Law
Physicians in the US, unlike many of our British counterparts, continued to support the use of the DTP vaccine and vaccine rates did not decrease as steeply in the US as they had in Japan and England. Several things did change, however. One was the amount of time I now had to spend talking to parents about the vaccine. The more important change in the US overall was the surge in vaccine-related lawsuits. From 1978 to 1981 about 2 cases a year had been filed against DTP manufacturing companies for alleged damage following vaccine administration. In 1986, 225 cases were filed, a one-hundred-fold increase. In 1984 two of the three manufacturers distributing DTP in the US market dropped out citing these liability concerns. The subsequent shortage of DTP vaccine that year led to withholding the 18-month and 5-year DTP doses.
Congress (still functional in that era) stepped in and passed the National Childhood Vaccine Injury Compensation Act of 1986 (enacted in1988) which led to a no-fault compensation program with an immediate drop in DTP liability suits from 118 in 1988 to 18 in 1991. The NIH made finding a new pertussis vaccine a priority and funded both foreign and domestic clinical trials with acellular vaccines. In 1991, two acellular pertussis vaccines (DTaP) were approved for use in children but only for the 4th and 5th doses since the FDA still wanted more efficacy data in infants. In 1996 approval was given for the primary series as well. I have not had a parent voice specific concerns over the DTaP vaccine since then.
Talking about vaccines to worried parents has become a little like the “Whack-a-Mole” arcade game where a mole head pops up to be smacked down with a soft hammer only to have another head pop up out of a different hole. A vaccine concern arises, gets addressed, and then another pops up taking years to clear up. Mercury and the MMR-autism concerns have all but disappeared. The newest parent vaccine worry I deal with is the “I want to spread the vaccines out” craze. But the old whole cell DTP vaccine was the first mole to pop his head up in this modern era.
Fine A. Diphtheria, tetanus, and acellular pertussis (DTaP): A case study. Background paper prepared for the Committee on the Evaluation of Vaccine Purchase Financing in the United States. April 2003; Institute of Medicine Division of Healthcare Services.
Baker JP. The pertussis vaccine controversy in Great Britain, 1974–1986.Vaccine. 2003;21:4003–4010.
CDC. Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 1997; 46(RR-7);1-25.