‘Vaccinating Britain’: Book Review

Georgia Haire reviews Vaccinating Britain: Mass vaccination and the public since the Second World War (Manchester University Press, 2019) by Gareth Millward.

Throughout the post-war period, the British public actively accepted, even demanded, vaccines and the establishment of vaccination programmes, to the extent that the routine immunisation of children soon became, and has remained, the status quo in Britain. Vaccinating Britain tells the story of how our vaccination programmes have come to be regarded as so ordinary. Using the themes of apathy, nationhood, demand, risk, and hesitancy across five chapters, Gareth Millward utilises specific case studies to highlight the ways in which the public, experts, and governments have interacted and shaped public health throughout the post-war period.

In the first part of the book, Millward explores the development and evolution of the vaccine programme in post-war Britain and uses three case studies to establish Britain’s vaccine narrative. Chapter 1 uses the diphtheria immunisation programme to discuss how the subjective concept of ‘apathy’ was used by health authorities to explain a decline in immunisation take-up in the 1950s and how it was combatted through publicity campaigns and communications, both locally and nationally.

Chapter 2 looks at the relationship between nationhood and vaccination, specifically in regard to the smallpox vaccine. In the post-war period, smallpox vaccination was framed as a tool to defend the British nation from foreign contagion. Here, Britain was both a body to be protected and part of an international community (p. 102). Routine smallpox vaccination ended in 1971, and so this chapter also presents an example of the difficulties in removing a firmly established public health measure, despite the lower uptake outside of localised outbreaks. Ultimately, and uniquely, this vaccination programme was shut down at a time when the WHO Smallpox Eradication Programme was intensifying in other areas of the world (p.100).

In chapter 3, the issue of demand is examined. Millward uses the polio vaccine programme to explore public demand for health and welfare protections from the government and, more specifically, the demand for a coordinated routine immunisation campaign (p.114). Here, we see how the government managed  the supply  of the polio vaccine which, much to the government’s chagrin, was dictated by fluctuating uptake throughout the 1960s,  whilst also dealing with broader demands for the option of the vaccine whenever the public wanted it; demand, Millward states, was a very difficult beast to tame (p.136).

Vaccination against polio. Colour lithograph, ca. 1960. Credit – Wellcome Collection.

The second part of Vaccinating Britain deals with vaccination crises within a mature system of mass immunisation. Chapter 4 deals with the pertussis crisis of the 1970s, when some doctors questioned the safety of the whooping cough vaccine, claiming it would cause brain damage in young children (p.150). This example highlights how risk, both in terms of receiving or not receiving a vaccination, was negotiated by both the public and health authorities. Furthermore, this chapter shows how the public expected the state to protect citizens, but also sought assurances that they would be protected against state actions.

Finally, chapter 5 explores the MMR controversy of the late 1990s and early 2000s and its impact on public confidence in this particular routine vaccination. Millward challenges popular conceptions of the anti-vaccine sentiment during this period, which resulted in only a relatively mild drop in the vaccination rate throughout the crisis. However, the crisis lives on as cautionary tale for public health workers who, in the face of growing mistrust of political authorities and the rise of online anti-vaccination activity, must remain vigilant against the spread of misinformation, particularly as even small changes in the vaccine’s uptake can have dire consequences (p.204). A drop in the uptake of the MMR vaccine in the early 2000s in Swansea, reportedly created a ‘vulnerable age group’ who were more susceptible to infection.[1] The dangers of this droppage were seen during Swansea’s 2012/2013 measles epidemic, in which 1,200 people fell ill, 88 were hospitalised, and one person died. At the time of the epidemic, the Guardian reported: ‘A row that started in late 1998 and continued well into the new century is now having its consequences’.[2] As Millward highlights, during the Swansea epidemic, there were large queues outside doctors’ offices as parents sought to have their children vaccinated against measles (p. 203).

Wellcome polio vaccine. Credit – Wellcome Collection.

Comforting in the light of recent media stories about ever-growing anti-vaccination sentiments, Vaccinating Britain conveys the normality and ordinariness of vaccines and the modern vaccination programme in Britain. As Millward explains, our current system has not been imposed upon us. Vaccines are something the British public has demanded of its government and fellow citizens throughout the post-war period, creating the conditions for this normalcy. Furthermore, Vaccinating Britain stresses the fluid attitudes of parents and the wider British public throughout the post-war period. As is shown across all five chapters, the public’s behaviour toward vaccines have differed across time, and their feelings towards specific vaccines have changed at specific times (p. 204).  Throughout the latter half of the twentieth century, enthusiasm for certain vaccines could ebb and flow depending on a variety of factors. But all the while, wholesale belief in the entire vaccination programme never truly wavered. Although we may face, or soon face, new crises, the events outlined within Vaccinating Britain suggest these too shall pass (p.232).

Although the book focuses on routine childhood immunisation some similarities can be drawn with our current situation: the mass vaccination of British adults against COVID-19. Or rather, these comparisons can only be expected whilst reading this book during a global pandemic. No doubt that there will be many future explorations of the public health response to this pandemic within academic scholarship, but Millward’s book provides an important framework in which to consider the implementation of this novel vaccine, as well as public, national, and international responses to both individual prophylactics, as well as the overall progress of the mass vaccination of the population. In this context, apathy, nationhood, demand, risk, and hesitancy, are wholly relevant themes in which to contextualise current expectations and attitudes towards the COVID-19 vaccination programme.

Record-type hypodermic syringe, London, England, 1930-1960. Science Museum, London.

In the UK, we have seen the public express desires and demands for the implementation of a vaccine programme to combat COVID-19 and aid a return to ‘normality’; concerns voiced about ‘vaccine nationalism’ after rows about shortfalls in supply in the EU, as well as calls to share doses across the globe; and witnessed anxieties over the safety of the vaccine play out across the media, social media, and in personal interactions. Most acutely, perhaps, we’ve seen much worry over vaccine hesitancy among the British population, as well as ‘anti-vaxxers’, and how such groups might threaten the success of this current vaccination programme. As Millward argues elsewhere, public health is a victim of its own success, as aiming for eradication, rather than reduction or prevention, changes the parameters of the anti-vaccination problem.[3] Such framing perhaps overstates the issue of hesitancy, particularly at a time when confidence and uptake in the vaccine is high.

With startling precision, Millward traces the history of Britain’s firmly established childhood immunisation programme, giving masterful consideration to the many actors involved. The significance of this achievement is not overlooked within the book, neither is the role of the public in shaping public health authorities’ priorities or considerations, or the various concerns that have required tending over the course of the post-war period. Despite the book’s focus on ‘the mundane business of established immunisation programmes’ (p. 5), Vaccinating Britain makes for a fascinating and hugely enjoyable read. Millward expertly weaves together these seemingly disparate vaccine histories to address the larger story of how the public and health authorities moulded our relationship to routine immunisation throughout the latter half of the twentieth century. The book offers further avenues for scholarly exploration of vaccination programmes – both the controversial and the seemingly banal. Most importantly, Vaccinating Britain allows us to closely consider our own attitudes towards the most ordinary aspects of our individual and public healthcare.

[1] BBC News, ‘Swansea measles epidemic: Worries over MMR uptake after outbreak’, 10 July 2013, https://www.bbc.co.uk/news/uk-wales-politics-23244628 [Accessed 28 April 2021]

[2] James Meikle, ‘Measles outbreak sees ‘missing generation’ queuing for MMR jab’, The Guardian, 17 April 2013, https://www.theguardian.com/society/2013/apr/17/measles-outbreak-mmr-jab [Accessed 28 April 2021]

[3] Gareth Millward, ‘VACCINE HESITANCY IS A 21ST-CENTURY PHENOMENON’, Perspectives on History, 16 April 2021, https://www.historians.org/publications-and-directories/perspectives-on-history/april-2021/vaccine-hesitancy-is-a-21st-century-phenomenon-why-moving-from-prevention-to-eradication-changes-the-scale-of-the-anti-vaccination-problem, [Accessed 28 April 2021]

References

BBC News. ‘Swansea measles epidemic: Worries over MMR uptake after outbreak’. 10 July 2013. https://www.bbc.co.uk/news/uk-wales-politics-23244628 [Accessed 28 April 2021]

Meikle, James. ‘Measles outbreak sees ‘missing generation’ queuing for MMR jab’. The Guardian. 17 April 2013. https://www.theguardian.com/society/2013/apr/17/measles-outbreak-mmr-jab [Accessed 28 April 2021]

Millward, Gareth. ‘VACCINE HESITANCY IS A 21ST-CENTURY PHENOMENON’, Perspectives on History, 16 April 2021. https://www.historians.org/publications-and-directories/perspectives-on-history/april-2021/vaccine-hesitancy-is-a-21st-century-phenomenon-why-moving-from-prevention-to-eradication-changes-the-scale-of-the-anti-vaccination-problem, [Accessed 28 April 2021]

Georgia Haire is a PhD candidate at the University of Kent where she is researching false teeth and oral health in mid-twentieth century Britain.

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