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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.

in Vaccinating Britain
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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.

in Vaccinating Britain
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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.

in Vaccinating Britain
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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 Vaccinating Britain
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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.

in Vaccinating Britain
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Mass vaccination and the public since the Second World War

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.

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This conclusion presents some closing thoughts on concepts discussed in the preceding chapters of this book. The book emphasises how the interconnectedness that has been at the heart of the voyages continued to matter far beyond the time that people spent at sea. It shows that medical knowledge and authority was never a given, and convicts and emigrants actively invested in and shaped the meanings and outcomes of voyages. On an individual level, these voyages were a stepping-stone through a career that might combine service in a British hospital, on a West African patrol, or in an Australian prison. Surgeons' ideas and actions reflected broader assumptions of class and gender, as well as an ethos of nineteenth-century naval medicine as it sought authority and status, particularly under the leadership of William Burnett at the Admiralty.

in Health, medicine, and the sea
Quarantine and the colony

The history of quarantine stations is a history of what it meant to make the transition from emigrant to immigrant, and it is never just about disease. In a period that lasted 150 years, from 1832 to 1984, thirteen thousand people were quarantined at Sydney's North Head for diseases including typhus, smallpox, plague, cholera, and measles. Compared to diseases such as cholera, smallpox, and yellow fever, typhus has played a minor role in the history of modern quarantine. In a politicised and factious atmosphere, the significance of quarantined immigrants reverberated beyond the medical debates of the quarantine station. As news of the cholera outbreaks in Britain reached New South Wales, the colonial government passed its own quarantine legislation in 1832. As the colonial economy of New South Wales entered the depression of the 1840s, the British government suspended its schemes of emigrant assistance.

in Health, medicine, and the sea

This chapter dwells in the tropics, where the experience of calms reinforced and extended preconceptions about the coast of West Africa across the space of the sea. It explores the ways in which passengers used an eclectic range of corporeal, scientific, cultural, medical, and colonial frameworks to evaluate their encounter with the maritime environment. The chapter shows that understandings of health were not just related to being at sea, but also to constant movement through the different regions, environments, and climates of the oceans. In order to understand how medical experience and knowledge evolved over the time and distance of the voyage, it is crucial to appreciate how constant movement through distinct regional maritime climates affected travellers' knowledge of health and illness. Of all these regions, the Atlantic tropics perhaps most define the environmental experience of voyaging to Australia.

in Health, medicine, and the sea
Australian Voyages, c. 1815-1860

During the nineteenth century, over 1.5 million migrants set sail from the British Isles to begin new lives in the Australian colonies. This book follows these people on a fascinating journey around half the globe to give a rich account of the creation of lay and professional medical knowledge in an ever-changing maritime environment. It shows how voyages to Australia partook of colonialism. On leaving the ports, estuaries, and harbours of Britain and Ireland, ships' captains negotiated the adverse winds of the English Channel and the Irish Sea before steering into the Atlantic and heading south-by-south west across the heavy swells of the Bay of Biscay. The book dwells in the tropics, where the experience of calms reinforced and extended preconceptions about the coast of West Africa. It discusses convicts, showing how scurvy became resurgent as British prison committees steadily reduced prison dietary rations during the 1820s and 1830s. Despite their frustrations, the isolation of the ocean and the vulnerability of convicts' bodies offered surgeons an invaluable opportunity for medical experimentation during the 1840s. The book also shows how a series of questions about authority, class, gender, and social status mediated medical relationships as the pressures of the voyage accumulated. Themes of mistrust, cooperation, and coercion emerged in many different ways during the voyage. Australia, where, as emigrants became immigrants, the uncertainties of government responsibility combined with a poisonous political atmosphere to raise questions about eligibility and the conditions of admittance to their new colonial society.