Part II of this book signifies a shift in emphasis for the British vaccination programme. Some of this was due to maturity. By the 1970s, many of the fundamental questions about which vaccines to include and whether the state had a role in protecting the British public had been answered. Citizens had come to accept vaccination for themselves and demand it of others. Other changes were due to political and historical circumstances. Whereas MOHs had played a key role in the administration of immunisation from the 1940s to the 1960s, these
advisers in the government. Faith in vaccination still relied upon the moral and political authority of the scientific and administrative communities that vouched for the safety and efficacy of both the vaccines themselves and the mass immunisation programmes that underpinned them. In the aftermath of the thalidomide or BSE crises, or during major political debates about the viability and future of the welfare state, such authority was dented. Experiences with these crises led to a reappraisal of how vaccinators communicated with the public, producing a greater academic
British population. Parents were placed under more extensive surveillance by local health authorities, allowing better follow-up, more convenient appointments and more successful vaccinations. Yet the nature of those reforms stored up potential political dilemmas that came to the fore during the MMR crisis. The chapter then goes on to describe the chronology of the crisis and explain the role of the major players. Focusing primarily on the years 1998 to 2004, it shows how and why the case against MMR was made by its opponents. This leads to a discussion of the main
the public. Moreover, through investigating how vaccination policy changed in post-war Britain we begin to understand the fluid and changing role of the public in the practice of public health.
Vaccination in history
When the story of post-war vaccination is told by public health advocates, it is usually one of progress. 16 This is said to occur on both a scientific basis (the discovery of new techniques leading to the development of new vaccines) and a political one (the development of various administrative and
occurred throughout the period, not always successfully, as this chapter will demonstrate. The second context of demand was more subjective. The public in general believed that the government ought to provide polio vaccination to its people. Universal polio vaccination was a symbol of a modern, rational state. Politically, therefore, the vaccination programme was created and expanded not entirely due to administrative or epidemiological measurement, but on what various branches of government believed would be popular with the wider public. Similarly, there was nothing
was a problem, authorities were at no great pains to stress it. Indeed, they saw parents’ enthusiasm as a sign that modern preventative health care would be seen as a civic duty – states would be obliged to provide services, and good citizens would actively use them. 13 While the British political classes had committed to the social rights of a comprehensive welfare state based on the war-time Beveridge Report, they also came to expect certain behaviours in return. 14 These trends were common in the West during the twentieth century, and accelerated after 1945
international vaccination and public health campaigns was making smallpox an ever-decreasing threat; but taking decisions about when the risk of disease had fallen below the risks posed by the vaccine itself proved to be a political and scientific minefield. Moreover, smallpox may have receded as a quotidian threat to British residents by the post-war period – but in the 1950s and 1960s a series of imported cases from abroad showed that the country was still at risk from foreign contagion.
Smallpox is a unique example of an infant vaccination programme that was shut down in