Dr. Frances Houghton

‘So many people accept without question the dogmatic opinion and fantastic claims of the patent medicine vendor, ignorant quacks, or even film stars, in preference to the guarded statements of scientists and the experimental evidence which shows that [these] claims and opinions have no foundation in fact…’[1]

In 1943, the exasperated Medical Director General (MDG) of Britain’s Royal Navy (RN) noted that rumour and disinformation were causing considerable damage to the health of the Service. Securing collective health in the Navy by preventing the spread of infectious disease was vital to the successful prosecution of Britain’s war effort, yet the RN repeatedly found itself confronting the challenges of those who undermined its medical experts’ best endeavours. This post examines the Navy’s efforts to counter ‘anti-vaxxers’ during the Second World War and considers the significance of this little-known history.

Reflecting on the Ebola outbreak that tore through West Africa between 2014-16, Rob Boddice argues that ‘historians’ contributions to contemporary vaccine debates are… strikingly relevant, especially when focusing on the nature of anti-vaccinism.’ [2] Historians have traced cycles of fear and resistance to vaccination right back to 1796 when Edward Jenner developed the first vaccine for smallpox. Successive compulsory vaccination legislation throughout the nineteenth century mobilised and crystallised anti-vaccination movements, whilst resistance to British vaccination policy also underpins histories of colonial medicine and imperial subjugation. [3] Some of the perpetual anxieties that surrounded vaccine confidence sprang from clear abuses of domestic and imperial state and medical power, poor medical hygiene, concerns about lost labour productivity and earnings, and social stigmatisation of vaccination. Amid this longer and broader history, the Second World War helps us to understand how wartime medical experts came under ‘friendly’ fire for attempting to control epidemics in the armed forces. The following discussion of this takes its cue from medical historian Paula Larsson, reserving the term ‘anti-vaxxers’ for the figureheads of anti-vaccination movements, who mobilised others against vaccination and whose activities included the distribution of disinformation. As we see, the challenges that these Second World War ‘anti-vaxxers’ posed to the Navy’s medical expertise offer a useful window upon the tenacious cycles of fear, doubt, ignorance, and suspicion surrounding modern vaccination.

In February 1941, a row blew up in the House of Commons between William Leach, a Labour MP who was concerned about inoculation practices in the Navy, and AV Alexander, First Lord of the Admiralty. Having studied pre-war statistics on the health of the RN in 1932, 1934, and 1935, Leach insisted that these reports established that inoculated seamen in the early 1940s were subject to significantly greater risks of contracting and dying from typhoid fever (also known as enteric fever) than uninoculated men. Of the 13 cases of typhoid fever reported across the three years mentioned, 11 men had been inoculated. Of the 11 who had been vaccinated against typhoid, 2 were fatal cases. Leach claimed this proved that in the Navy during the early war years, ‘the great majority of the cases of typhoid fever are in the inoculated class and also the bulk of the deaths.’[4] Although Leach’s figures can, at best, be described as decidedly scanty, for the Navy, problems in challenging his views arose from incomplete record-keeping. The First Lord was forced to fudge his response with some rather clumsy guesswork based on Army records of vaccinated servicemen. The Naval MDG, however, gave the entire matter short shrift, noting that Leach’s claims were grounded in ‘false reasoning’ and woefully limited clinical evidence.[5]

Aside from demonstrating the eternal wisdom of keeping an institution’s statistical and record-keeping ducks in a row, there was a much deeper significance to this spat. Fundamentally, Leach’s concerns were connected to a widespread rumour that the RN routinely withheld shore leave from unvaccinated men. He sought to use what he viewed as the Navy’s ‘entire misconception’ of the above facts to prevent so-called ‘unfair deprivation’ of shore leave on foreign stations. Actually, vaccination was not compulsory in the wartime RN (nor in its sister Services). Men were entitled to refuse vaccination or re-vaccination on conscientious grounds without being subject to punishment or penalty for their decision. Nevertheless, official regulations did caution that men who refused vaccination were not to be allowed to land in ports where there was a risk of exposure to diseases such as smallpox. From the Navy’s perspective, this was simply a sensible precaution to safeguard the entire shipboard community.

In the eyes of the National Anti-Vaccination League (NAVL), however, the wartime Navy were engaging in sinister efforts to deprive people who were fearful of vaccines of their rightful liberty. The NAVL originated as the Anti-Compulsory Vaccination League in 1866, and its Secretary, Lily Loat, was a prominent anti-vaccination activist of long-standing. Picking up the threads of Leach’s challenge, Loat forwarded to the Admiralty a resolution passed at the League’s annual Conference in May 1941 which formally censured the First Lord for listening to the advice of his medical experts. The NAVL also warned that they deplored the Navy’s practice of rejecting unvaccinated recruits for the Fleet Air Arm (FAA). This charge left the Navy a little puzzled; the Medical Department were only aware of one case in which a direct entry officer cadet undergoing pilot training for the FAA had refused vaccination, and he was given the option of selecting another branch of naval service instead. Overall, argued the RN, this was an unusual case, and the decision to stop the man’s pilot training was very much in his own interests since overseas flying personnel might be forced to land in endemic areas that posed high risk of contracting infectious disease.

These debates spilled over into wider accusations from the League that the RN and the other Services were infringing ‘the right of the people to safeguard their health’. Given that ‘liberty’ was ‘in eclipse over so much of the world’, warned Loat, it was more needful than ever to stand up against a ‘medical dictatorship’. The NAVL did not restrict its anti-vaccination activism to the armed forces, objecting also to the proposed establishment of a State Medical Service on the basis that it would ‘limit freedom of ideas’ and be ‘grossly unfair’ to people who objected to compulsory taxation to pay for medical doctrines to which they were opposed (ie., vaccination). [6] Throughout the rest of the war, the NAVL broadcast these ideas through their newsletter, The Vaccination Inquirer and Health Review. This provided a public platform from which to distribute challenges to military and civilian vaccination policies, in addition to publicising cases where it believed the Services had wronged conscientious objectors to vaccination.

So what can we take away from all this? Not least, the wartime fight to protect the collective health of the RN underscored the imperative of keeping meticulous medical records; a couple of years into the war, the Navy began to overhaul and modernise its systems of medical record-keeping. The Navy’s problems also demonstrate the importance of being able to counter ‘dogmatic opinion and fantastic claims’ with clear, well-explained facts and anecdotal reassurance about misleading stories in a febrile climate of anxieties about medical intervention. This history also highlights that the voices of anti-vaccinationists who challenged leading medical authorities remained surprisingly prominent in wartime British public and political spheres.

As our world marks the grim first anniversary of a year in which pandemic has ravaged the globe, in Britain the ghosts of the Second World War seem to touch our lives more than ever. Partly, of course, the 75^th commemorative anniversaries of VE Day and VJ Day provided moments of much-needed distraction from the troubles of the present, but seemingly endless attempts to interpret the present crisis through a lens of the mystical ‘spirit’ of the wartime nation have also managed to frame the Battle of Covid-19 as an offshoot of that great ‘People’s War’ of eight decades ago. To me, as a historian, it is surely significant that even in the midst of the Second World War, we can identify the same fear-drenched language, the same anxious concerns about bodily and personal freedom from state intervention, the same heightened emotional responses to vaccination, and the same vitriol directed against top medical experts as we are currently witnessing in our own generations’ efforts to combat Covid-19. Perhaps, then, one of the more useful legacies of the Second World War in Britain might be to help broaden popular awareness of how ‘anti-vaxx’ discourses and methods threatened even the nation’s ‘finest’ hours – and to encourage reflection about how this might help to overcome the challenges that lie ahead in Britain’s public health endeavours in 2021.

Notes

[1] The National Archives (TNA), ADM 261/4, ‘Malaria Prevention: A Problem of Discipline’

[2] Rob Boddice, ‘Vaccination, Fear and Historical Relevance’, History Compass, 14:2 (2016), 71-78 (71).

[3] Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907 (Durham, NC: Duke University Press, 2005); Deborah Brunton, The Politics of Vaccination: Practice and Policy in England, Wales, Ireland, and Scotland, 1800-1874 (Rochester, NY: University of Rochester Press, 2008); David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth Century India (Berkeley: University of California Press,1993); Sanjoy Bhattacharya, Mark Harrison, and Michael Worboys, Fractured States: Smallpox, Public Health and Vaccination Policy in British India, 1800-1947 (London: Sangam Books Limited, 2005); Niels Brimnes, ‘Variolation, Vaccination and Popular Resistance in Early Colonial South India’, Medical History, 48:2 (2004), 199-228.

[4] TNA ADM 1/15661, ‘Vaccination and Inoculation of R.N. Personnel’

[5] Ibid.

[6] TNA ADM 1/15661, ‘Resolutions passed at Annual Conference of the National Anti-Vaccination League’, 22 May 1941.