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Public HealthLiberty vs Compulsion - warwick.ac.uk

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Public HealthLiberty vs Compulsion
Gareth Millwardg.millward@warwick.ac.uk
Public HealthLiberty vs Compulsion
Use the case study of smallpox vaccinationFreedom from the stateFreedom from diseaseWhich publics does publichealth protect?
Edward Jenner’s Lancet, Science Museum, London.FromWellcomeImagesCC-BY
JamesColgrove,State of Immunity: The Politics of Vaccination in Twentieth-century America(Berkeley, 2006), p. 17.
Public HealthLiberty vs Compulsion
Variolation in C18th BritainVaccination in C19th BritainImmigration in C20th BritainEradication in C20th India
Edward Jenner’s Lancet, Science Museum, London.FromWellcomeImagesCC-BY
Smallpox
Estimated cause of 15% of all deaths in epidemic years during C18th. Mostly in childrenA cure was never foundControl and eradication the only defence
Japanese medical text on Smallpox, c. 1720.FromWellcomeImagesCC-BY
Variolation
By putting a small amount of smallpox into the body, patient gets a mild case and life-long immunityPracticed in India and China since antiquity“Inoculation” popularised in West by Lady Montagu.
Two thorns used for smallpox inoculation, Palestine, 1921.Science Museum. FromWellcomeImagesCC-BY
Variolation
Safer than no protection – but still dangerous. Death rate of 1-2%!Difficult to “prove” it worked.Largely a “private” rather than “public” health procedure
Lady Mary Montagu, Stipple engraving by W.Greatbach, 1844, after C. F.Zincke. FromWellcomeImagesCC-BY
Vaccination
By putting cowpox into the body, patient gets very mild case of cowpox andlimitedimmunity from smallpoxPopularised by Edward Jenner using C18/19 scientific networks
The hand of SarahNelmesin Jenner’s account of vaccination.FromWellcomeImagesCC-BY
Vaccination
Much safer than variolationModern statistical techniques and nation state enthusiasm leads to widespread adoptionCompulsory in many European countries by mid-C19
E.E.Hillemacher, Edward Jenner vaccinating a boy (1884). FromWellcomeImagesCC-BY
Vaccination
Compulsory vaccination is resistedSome local authorities seek alternatives – see the “Leicester Method”UK effectively ends compulsion in 1897, fully in 1948
J.Gilray, The cow-pock - or - the wonderful effects of the new inoculation! (1802)FromWellcomeImagesCC-BY
Commonwealth Immigration Bill
Smallpox eradicated in UK in 1930sSome cases after this, all traced to importation from abroadSeen as “one of those things” in the 1940s/50s…
1950s Ministry of Health poster. The National Archives, INF 13/292, photograph by Alex Mold.
Commonwealth Immigration Bill
Outbreak in 1961/62 coincides with political tension over “coloured” immigrationImportation from PakistanVaccination imposed on travellers
Michael Cummings, Daily Express (17 January 1962). FromBritish Cartoon Archive© Express Syndication.
WHO Smallpox Eradication Programme
Smallpox declining worldwide over C20WHO in 1950s decides to commit to full eradicationBiggest focus on sub-Saharan Africa and South Asia
Plaque at the London School of Hygiene and Tropical Medicine. Personal photograph.
WHO Smallpox Eradication Programme
Close international co-operation, even (especially!) between USA and USSREradicated in the wild in 1977 – declaration 1980Imposed on post-colonial nations
1960s WHO smallpox reward poster by RenéGauch. FromWellcomeImagesCC-BY
Conclusions / Questions
Who gets to decide what is in “our best interests”?Parents?Doctors?The state?Majority rule?“Advanced” nations?
Protest placard outside the Houses of Parliament from the Vaccine Awareness Network. Fromvaccineriskawareness.com.

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Public HealthLiberty vs Compulsion - warwick.ac.uk