This chapter introduces the historiography of the British welfare state, vaccination and public health, and sets out the book’s structure. It argues that while much attention has been given to the various controversies in British vaccination policy, this obscures the long periods of relative calm. Even during crises, most parents continued to vaccinate their children with individual vaccines and, overall, take-up has increased markedly since the 1940s. The chapter therefore reframes the debate to ask why vaccination became normalised during the post-war period, and draws attention to the role of the public as a receiver and forger of public health priorities. This question is then explored through the following five chapters, examining five key themes – apathy, nation, demand, risk and hesitancy. The first three themes are covered in Part I of the book, showing how the modern vaccination programme became established. Part II details the pertussis and measles-mumps-rubella (MMR) vaccine crises and how they exposed the limits of public support for vaccination and the welfare state.
This chapter examines the twenty-first-century public health concept of hesitancy by placing it in a wider historical context. Hesitancy as an analytical category was developed by social scientists and adopted by the World Health Organization and other nations to explain the numerous vaccine crises that had occurred worldwide over previous decades. In Britain between 1998 and 2004 a significant drop in measles-mumps-rubella vaccine (MMR) take-up followed a series of media stories that it might cause autism. Initially, the government sought to refute this through a typical education campaign but was forced to adopt new strategies of risk communication. The internet had become an important tool for vaccine sceptics to spread doubt and for uncertain parents to seek information. Although the vaccination rate eventually recovered, many of the criticisms of the government and the vaccine during this period reflected deeper anxieties on the part of the public regarding the motives and competence of medical and political authorities in the 1990s and early 2000s. The MMR crisis was a product of a particular historical moment, and the construction of hesitancy that followed is coloured by this.
Part II begins with an examination of what the pertussis (whooping cough) vaccine crisis of the 1970s tells us about risk. The management of risk was an integral part of post-war public health and, indeed, of modern nation-states. The risks associated with infectious disease for both the state and individuals had to be weighed against the risks associated with specific vaccines. In the 1970s, reports that the pertussis vaccine might cause brain damage in some children resulted in a significant drop in take-up. A campaign for social security payments for children suffering from vaccine injury was successful, showing how the vaccination programme was tied to wider political concerns within the welfare state during a period of financial retrenchment. These debates are contrasted with those over the provision of rubella vaccine to girls and young women, where voluntary organisations demanded that the government should provide many more resources to the programme.
This chapter focuses on the example of the inactivated poliomyelitis vaccine (IPV) programme in the 1950s and early 1960s to show how the public expressed demand for vaccination services. On the one hand, the government struggled to raise the registration rate for the vaccine to target levels. On the other hand, parents and the media became increasingly frustrated over a series of supply crises. Some of these were caused by an inability or unwillingness to import American vaccine to cover shortfalls in production by British pharmaceutical companies. Others were caused by surges in demand, such as the rush by young adults to get the vaccine following the death of professional footballer Jeff Hall. Thus, demand was a major problem for the British government. Demanding parents could force policy responses (such as a commitment to import more vaccine). Surges in demand could stress the system to breaking point. But a lack of demand also threatened the Ministry of Health’s wider public health goals. The supply issues were only fully resolved after the introduction of the oral polio vaccine (OPV) in 1962.
In this chapter the decline of the routine smallpox vaccination programme is used to examine the theme of nation. While smallpox had been eliminated from Britain in the 1930s, occasional importations by air and sea showed the vulnerability of the nation to external public health threats. Moreover, since the disease often came from postcolonial Commonwealth nations – notably India and Pakistan – racialised views of threats to public health became more common during periods of anxiety about immigration and Britain’s place within the international community. The government attempted to combat declining vaccination rates through publicity campaigns, but struggled to convince the public to comply with its guidance. The public was not anti-vaccination, as shown by the demand for vaccination as a form of epidemic control when outbreaks occurred. However, by showing little enthusiasm for vaccination, coupled with the declining statistical and emotional threat of the disease during the 1960s, the British public helped to create the conditions for the removal of routine childhood smallpox vaccination in 1971 – years before the disease’s official eradication and before other European nations followed suit.
Vaccinating Britain investigates the relationship between the British public and vaccination policy since 1945. It is the first book to examine British vaccination policy across the post-war period and covers a range of vaccines, providing valuable context and insight for those interested in historical or present-day public health policy debates. Drawing on government documents, newspapers, internet archives and medical texts it shows how the modern vaccination system became established and how the public played a key role in its formation. British parents came to accept vaccination as a safe, effective and cost-efficient preventative measure. But occasional crises showed that faith in the system was tied to contemporary concerns about the medical profession, the power of the state and attitudes to individual vaccines. Thus, at times the British public demanded more comprehensive vaccination coverage from the welfare state; at others they eschewed specific vaccines that they thought were dangerous or unnecessary. Moreover, they did not always act uniformly, with “the public” capable of expressing contradictory demands that were often at odds with official policy. This case study of Britain’s vaccination system provides insight into the relationship between the British public and the welfare state, as well as contributing to the historiography of public health and medicine.
To set the scene for the rest of the book, this chapter discusses the evolving discourses of the rural and the urban, the exploitation of this discourse by some political parties, and the rise of the heritage industry. It then proceeds to survey the literature, in both anthropology and geography, on north European immigration into rural Western Europe: who these people are, when they arrived, what effects have they had on the social, economic, and political life of the places they chose to settle in. Since this material is relatively scanty, I have also relied on material within popular travelogues. I then discuss, in a similar manner, the nature and consequence of labour migration from North Africa and Eastern Europe to these areas. I conclude by considering the roles anthropologists can play today in today’s countrysides, in the development of rural life and the formulation of rural policy.
In the last three decades the anthropology of Western Europe has become almost exclusively an anthropology of urban life. The anthropology of rural life in Western Europe has been progressively neglected. Yet, just because cities concentrate people who continue to produce new and unexpected forms of social organization does not mean rurality becomes the emptying home of a tired traditionalism. Far from it. Since the city is only defined by opposition to the countryside, and since rural movements have urban effects, we cannot ignore the changes taking place in hamlets, villages, and rural towns throughout Western Europe. They are a integral part and parcel of life in Europe today. The key aim of this book is to redress this academic imbalance, by examining some of the central changes in the rural zones of contemporary Western Europe. In particular, most contributors look at the newcomers to these areas and the rainbow variety of effects they are having. The ‘alternative’ in our title is to be understood broadly. The contributors are not just looking at the self-proclaimed alternatives (hippies, New Agers, back-to-nature types, etc.) but at labour migrants from outside Western Europe and affluent resettlers as well. Members of all these groups are, in their own way, contributing towards the construction of a non-traditional countryside. All of them help to maintain life in rural areas which would otherwise be emptying of residents.
Collinson did fieldwork in Donegal, northwest Ireland, on relations between indigenes and incomers. He found that incomers, acting in groups in liaison with some locals, tended to be more prepared to seek EU rural-stimulation grants and so acted as motors of rural change. These groups had a different vision of the environment to that held by community development groups, staffed wholly by denizens, and by local councils. He is thus able to argue that the historical neglect of environmental concerns in the overall development agenda in Ireland is socially grounded at local levels, with all the consequences that entails.
‘Locals’ and ‘Moroccans’ in the Sainte-Foy-Bordeaux vineyards
Based on fieldwork among North African workers in the Bordeaux wine growing area of rural France, Crenn documents the relationship between locals and long established transnational groups. The size, generational differences and perception by locals, of these North African workers has changed over time, with new expectations. Despite integration in industry and social life over several decades, this group remain marginal. Crenn demonstrates that established long-term labour migrants are best viewed as transnationals, who creatively and selectively interpret their everyday practice to justify both their visions of themselves as North Africans and as active participants in French life. By creating their own food network, for instance, they can see themselves as comparable to, while different from, their French neighbours.