Intended for healthcare professionals

Head To Head Head to Head

Should measles vaccination be compulsory?

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2359 (Published 05 June 2019) Cite this as: BMJ 2019;365:l2359

Response to Noel Thomas: Leicester Smallpox Experience, Not So All-or-None!

The Leicester Method involved quarantining anyone suspected of having smallpox and vaccinating suspected contacts. All those working at the quarantine hospital were vaccinated as well as the guards posted on the roads. This anticipated the ring vaccination approach used by the WHO which ended smallpox, which involves locating cases of smallpox and vaccinating anyone who might have come in contact with them (Wikipedia. Ring Vaccination). Since the only reservoir for smallpox is humans, once the last case was found and those around vaccinated smallpox vaccinations were halted. There are two forms of smallpox, Variola major and Variola minor. The former has average mortality of 30%, while the latter 1%. In addition, variola major causes blindness. The evidence indicates that in the latter half of the 19th Century, Variola minor had become the strain of smallpox in the UK, though the risk from Variola major as long as it existed elsewhere was real.

What did Millard write?

Millard (1904): “I will say at once that I regard it as absolutely proven that the operation of vaccination confers on the individual complete, though temporary, protection against small-pox, and I accept without reservation the finding of the Royal Commission on Vaccination as to the duration of this protection.

It is also accepted, of course, that the protection conferred by vaccination can be renewed from time to time by re-vaccination. Also let it be understood that the ‘Leicester Method’ has never attempted to do entirely without vaccination. Vaccination has always been used to protect the small-pox staff, and such actual ‘contacts’” as were willing to submit to it. . . . In order to place my own personal belief in vaccination as an operation beyond the possibility of question, I have not only had my own two children vaccinated, but I have publicly taken them into the Leicester Small-pox Hospital, and had them photographed there by the bedside of a small-pox patient. This step may not have had much scientific value, but it constituted a useful object lesson, and the photograph obtained has been, I believe, of far more use to me in making converts to vaccination than would have been many pages of vaccination “ literature ” or columns of statistics (page 2).

It is clear that the decrease in small-pox mortality in Leicester cannot be ascribed to systematic vaccination or re-vaccination of its inhabitants. Some of it no doubt may be due to the reduced prevalence of small-pox in the country generally, which in turn may be the result of systematic vaccination, but at the most this can only be a very partial explanation.

I think we may attribute it chiefly to two causes, viz. :
(1) To improved measures for controlling the spread of the disease.
(2) To an alteration in the type of the disease, which, in Leicester at least, has become less virulent (page 4).

Nevertheless, I think we may believe that it has in the past served a most useful purpose in helping to lessen and mitigate the ravages of what undoubtedly was the most dreaded, and rightly dreaded, of all epidemic diseases. . . Even though the value of the institution may to some extent have been over estimated, owing to the whole of the reduction in small-pox mortality which has occurred having been attributed to its agency alone, I still believe that the institution of vaccination has been in the past of immense value to the country. (page 18)

Bearing in mind the mild type of small-pox which has prevailed and still prevails in Leicester (page 20).”

And even in Millard’s 1948 article, he writes: “It is not contended that infant vaccination had no effect in hastening the fall. The extent to which it did so is arguable. It would practically abolish mortality among vaccinated children (page 1074).

should major smallpox again invade this country and ever really get out of hand, we have one trump card to play which we have not got in the case of other epidemic diseases-viz., emergency mass vaccination of the whole population in the affected areas (page 1075).”

Millard admits when Variola major was the prevalent strain, the vaccine saved countless lives and the high vaccination rates around the UK may have reduced the number of cases in Leicester. In addition, a form of ring vaccination was carried out, plus quarantining anyone suspected of being exposed. And the prevalent strain was Variola minor. Even he is aware that as long as Variola major existed in the world, the risk for it returning to the UK existed and mass vaccination would be the best alternative. How would quarantining thousands be accepted/enforced today?

While Variola minor was in the UK and US, variola major ravaged the Third World, killing an estimated 300 million in the 20th Century (Fenner, 1988; Wikipedia. History of smallpox).

As for Thomas reference to Suzanne Humphries book, “Dissolving Illusions,” I am writing several papers refuting much of her book. My first paper focusing on polio contains additional information on smallpox (Harrison, 2018). For more on the Leicester method, see Iannelli, 2016; Porter, 1988.

Despite what Thomas claims, numerous controlled experiments have been and continue to be conducted on vaccines (e.g., Meier, 1972; Gustafsson,1996; Peter, 2009).

Finally, the question of compulsory vaccination. With survival of low and very low birthweight children, autoimmune diseases, and chemotherapy for cancer, today’s population includes many with weakened immune systems. Herd immunity works. In the 1950s, prior to the vaccine, the US experienced up to an estimated one million cases per year. Measles is a highly contagious airborne disease; yet, despite pockets of low vaccinations, in a population double that of the 1950s, the US has had less than 1,000 cases. We live in communities where both rights and responsibilities exist. Education/persuasion is great and continues; but how do we protect the vulnerable if education/persuasion isn’t enough?

References:

Fenner F, Henderson DA, Arita I et al. (1988). Smallpox and its Eradication. World Health Organization. Available at: https://apps.who.int/iris/handle/10665/39485

Gustafsson L, Hallander HO, Olin P et al. (1996 Feb 8). A Controlled Trial of a Two-Component Acellular and Whole-Cell Pertussis Vaccine. New England Journal of Medicine; 334(6). 349-355. Available at: https://www.vaxserve.com/assets/pdf/library/Gustafsson.pdf

Harrison JA (2018 Nov 9). Wrong About Polio: A Review of Suzanne Humphries, MD and Roman Bystrianyk’s “Dissolving Illusions” Part 1. Science-Based Medicine. Available at: https://n1s1t23sxna2acyes3x4cz0h-wpengine.netdna-ssl.com/wp-content/uplo...“Dissolving-Illusions”-long-version.pdf

Iannelli V (2017 May 6). The Leicester Method and Smallpox Eradication. Vaxopedia. Available at: https://vaxopedia.org/2017/05/06/the-leicester-method-and-smallpox-eradi...

Meier P (1972). The Biggest Public Health Experiment Ever: The 1954 Field Trial of the Salk Poliomyelitis Vaccine. Available at: http://www.medicine.mcgill.ca/epidemiology/hanley/c622/salk_trial.pdf

Millard CK (1904 Mar 11). The Leicester Method of Dealing With Small-Pox. Paper read before the incorporated Society of Medical Officers of Health, March 11th, 1904. Available at: https://archive.org/stream/b24765284/b24765284_djvu.txt

Millard CK (1948 Dec 18). End of Compulsory Vaccination. British Medical Journal; 2(4589): 1073-5. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2092290/pdf/brmedj03708-003...

Peter G, Aguado T, Bhutta Z (2009 Mar 17). Detailed Review Paper on Rotavirus Vaccines. To be presented to the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, April 2009. Available at: https://www.who.int/immunization/sage/3_Detailed_Review_Paper_on_Rota_Va...

Porter D, Porter R (1988). The Politics of Prevention: Anti-Vaccinationism and Public Health in Nineteenth-Century England. Medical History; 32: 231-252. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1139881/pdf/medhist00062-00...

Wikipedia (accessed 2019 Jun 14). History of smallpox. Available at: https://en.wikipedia.org/wiki/History_of_smallpox

Wikipedia (accessed 2019 Jun 14). Ring vaccination. Available at: https://en.wikipedia.org/wiki/Ring_vaccination

Competing interests: No competing interests

14 June 2019
Joel A Harrison
Long-Retired Epidemiologist
None
I have NEVER worked for the FDA, NIH, CDC, any pharmaceutical company, nor ever purchased pharmaceutical stocks