Conscience, religious tolerance and public health

The 1898 UK Vaccination act was the first law to include an explicit “conscientious objection” clause. It was a pragmatic solution, reconciling the mounting scientific evidence regarding the efficacy of smallpox vaccination, and the fierce objection of lay-persons and non-mainstream healthcare providers to the imposition of medical procedures on the free citizens of England. The debate about vaccination was about benefits, risks, and medical theory. The risks were substantial; at least one in a hundred children died or got seriously ill from vaccine complications – usually bacterial infection (A. Allen, Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver). If an outbreak of smallpox did not pass through one’s town, the risk might well have outweighed the benefit.

While vaccinators merely accepted medical advice and the evidence from the immunity of vaccinated children to the pox, anti-vaccinators tended to represent broader perspectives about the good and healthy life, most notably vegetarianism, antivivisection, and feminist causes. Indeed, key actors in the debate had no medical or scientific background. They represented worldviews. Objectors voiced their position in terms of civil rights and protection from “medical monopolies” profiting from vaccination.

People long accepted the imposition of quarantine and other policing measures on those who were sick with contagious diseases. Such practices were justified by the Biblical laws concerning lepers. However, compulsory vaccination (first introduced in the USA and Napoleonic Europe) created three disturbing precedents. First, whereas former practices did not touch patients’ bodies, vaccination was an invasive and repulsive intervention. Second, vaccination targeted the healthy, innocent and vulnerable babies. The offense was aggravated by the administration of vaccination by law officers, thus stigmatizing the working classes who could not afford private healthcare. Third, vaccination was universal, thus treating everybody as sickly people in need of forced, invasive, and risky treatment. Aside from these precedents, laws in the 1870s were enacted and enforced to penalize individuals who refused to be vaccinated.

In the 1880s, The Royal Commission on vaccination, however, issued a few reports criticizing the harsh penalties system and the safety issues associated with public vaccinations. The Commission acknowledged the need for universal vaccination, but it also acknowledged the futility of mass enforcement. Working class dissenters became martyrs following repeated fining and arrests. Without saying so, the “conscientious clause” introduced a public instrument from the dawn of religious toleration in a non-religious controversy. The Peace of Westphalia established the notion of a state religion, on one hand, and the right of the family head to educate his family according to his religious conviction. When the spirit of Westphalia was brought to UK with the Glorious Revolution, non-Anglicans obtained the freedom of religion as “dissenters.” In 1695, Common Law exempted Quakers from testifying under Oath and the 1757 Militia Act accommodated Quakers’ pacifism. The 1870, Elementary Education Act saw to it that no child shall be obliged to participate in religious activities contrary to his or her parents’ wishes. In a similar vein, the 1898 Vaccination Act created a structure, which contained a default obligation and a legally recognized right to register as a dissenter. Albeit, there is no religious prohibition on vaccination. The 1898 Vaccination Act demedicalized the controversy and clad it in religious habits. But dissenters reasoned that if the law recognized “theological convictions,” it should as well respect “medical convictions” (N. Durbach, Bodily Matters: The Anti Vaccination Movement in England, 1853-1907). The conscientious declaration was neither about one’s creeds nor about one’s allegiance to a dissenting medical school, but about a personal conviction on a factual matter, that vaccination is harmful to the child.

Today, many years after the successful eradication of smallpox, and the introduction of many other vaccinations, the official recognition of anti-vaccination as a matter of religious freedom looms large over the public sphere. Then and now, anti-vaccinators are almost always affiliated with broader alternative practices, such as the medical doctor and homeopath Thomas Cowan, who writes about the “wisdom of nature” (T. Cowan, Vaccines, Autoimmunity and the Changing Nature of Childhood Disease). Newman protested that mandatory vaccination forbids “perfect health,” and “to forbid perfect health is a tyrannical wickedness just as much as to forbid chastity or sobriety” (F. W. Newman, “The Political Side of the Vaccination System” [1874]).

Even though neither side in the vaccination debate invoked religious teachings and traditions, the secular opposition to vaccination cast itself in a religious language, with key words such as “perfection” and “purity.” It expressed religiosity not religion through their zeal and sincere conviction, and their preaching rather than deliberative style of campaigning. The anti-vaccine propaganda with religious fervor mixed medical facts (such as criticism of medical literature, published safety issues) with socio-political issues (such as the financial interests of Big Pharma) and metaphysical propositions (e.g. the inherent goodness of nature and natural childhood infections). The struggle assumed the shape of resistance to oppression of religious practice and preaching. For example, the London Society for the Abolition of Compulsory Vaccination (est. 1880) was established with the objects of revocation of the vaccination act and the “diffusion of knowledge concerning vaccination” (“Vaccination Facts and Problems,” A special issue of the British Medical Journal, July 5th, 1902, p. 50). The Israeli non-for-profit anti vaccine association (est. 2015) flags the slogan “The right to informed and rational choice” (בחירה מושכלת).

The early opposition to the vaccination act maintained that no conscientious person would approve of vaccination. But the dissenters were not fighting against vaccination; they fought forced vaccination. They engaged themselves in the public debate about vaccination policy but rejected critical discussion of personal choice in vaccination. Because such a choice is a “conscientious matter,” it was entitled to respect as such, they argued. Moreover, while in a democracy, the minority is not offended by the majority’s act of legislation, the dissenters represented forced vaccination as a horrible offense against one’s most cherished possession – his or her conscience.

In the 19th century, anti-vaccination had strong class and gender tones. Working class people who feared modern medicine, and mothers who fought for gentle methods of care and against experimenting on human beings. In the 21st century, mothers’ personal testimonies about their children who were harmed by vaccination fuel the anti-vaxxers’ argument. For mothers like Jenny McCarthy, her own unique personal knowledge of her son Evan is the overriding evidence for the causal link between the vaccine he had received and the autism he later developed. Her best-seller book’s title Louder than Words exemplifies the dissenters’ recourse to Protestant, Evangelical epistemology of personal spiritual experience at the expense of scientific discourse. The egalitarian and de-centered nature of social media help boosting the anti-vaccine talk as a secular, dissenting religion that lashes criticism at the mainstream “establishment,” the flaws in its science and the alleged corruption of its actors, while demanding respect for consciences and the immunity religious conscience enjoys in the public arena.

Even though the vaccination debate has nothing to do with religion, the public colored it with religious tones, and opted for policy inspired by the evolving culture of religious toleration and respect for individual conscience. After this move in the direction of post-reformation European culture took shape, public health turned medieval. With the discovery of herd immunity in the 1930s, it became apparent that the common good in terms of public health and the health of the most vulnerable (those who cannot tolerate vaccination) depends on mass cooperation, not on individualized conscientious choices. The style of personal religiosity encourages personal choice at the expense of centralized authority and professional paternalism. However, if society does not find a breakthrough ahead of the paradigms of post-reformation religious toleration, the risk for the vulnerable and possibly for society will keep growing.