#mandatory immunization

[AL: My friend Gord D. wrote this, a draft essay based on research he has been conducting into smallpox epidemics and anti-vaccination campaigns in early 20th century Kingston, Ontario.  This research happens to link up with Ghostbusters in some unusual ways, too. Rest assured, similar struggles over public health, with anti-vaccinationists mobilizing the same arguments, took place across Canada] “When a smallpox epidemic hit Kingston in 1908, the biggest anti-vaxxer in town was Dan Aykroyd's great grandfather, Samuel Aykroyd. He was head of the local Anti-Vaccinationist League which was set up earlier in the century, and did everything in his power to sow distrust of the public health authorities. He claimed compulsory vaccination was a scam and that local doctors were making money off of it. Meanwhile, he was also a dentist who advised that the best way to fend off any disease, including contagious ones like smallpox, was to stay healthy and the best way to do that was to have your teeth looked after. He went so far as to say that dental care was the key to "immunity." Although he once admitted that vaccines worked "empirically", Aykroyd had a "philosophical" objection to curing disease through the administration of disease, however diminished. (He was wrong about the dangers of vaccines and right about the importance of dental health. But Canadians don't get universal dental care. At the time, they didn't have universal healthcare either, and vaccines were not free.) The smallpox epidemic had started in April, 1908, was thought to have been staunched (through contact tracing, spot vaccination, and quarantine) by August, then returned with a vengeance in the fall with the opening of schools. It wasn't until November, however, when the provincial health officer warned city officials that Kingston would be isolated, quarantined as a whole from the rest of Ontario, unless firm public health measures were taken, that the local Board of Trade and the Board of Education took the advice of the Board of Health and okayed compulsory vaccination, and the mayor issued a proclamation to that effect. The anti-vaxxers went on to win the municipal elections in January of 1909. By March, almost a year after the first wave of smallpox, they had reversed the vaccination mandate. Four members of the Kingston Board of Health resigned in protest. But by then the vaccination campaign had taken effect, and smallpox receded. Vaccines worked; and it was known at the time that they worked best after revaccination within 7-10 years of the first "scratch". Ten years later, in the middle of the devastating Spanish flu pandemic in 1918-1919, Kingston suffered another outbreak of smallpox. The city was faced with the same quandary again. (It was a recurring cycle of 7-10 years. Kingston was struck by a smallpox epidemic in 1901 as well.) And Samuel Aykroyd? From 1901 to 1921, he regularly published letters to the local Kingston paper, the Daily British Whig about the loss of personal liberties resulting when public health measures like vaccination were mandated. 

“Is this Russia? Is this China?” he asked. 

[AL: I’ve attached a copy of one such letter from February 24, 1912, in which he makes Sinophobic comments and defends ‘British liberties.’] By the 1920s, Aykroyd was seriously invested in the occult, and had a live-in medium. His experiments in the field of spiritualism inspired his children and grandchildren, especially Dan Aykroyd, who seriously believed in all of it and took those ideas to help launch the Ghostbusters franchise. Samuel Aykroyd believed in ghosts but he never believed in vaccines. According to the Canadian Museum of Healthcare:

Twentieth century smallpox incidence in Canada reached a peak of 3,300 cases in 1927, but fell sharply to zero by the mid-1940s.

“The last endemic case of smallpox in Canada occurred in 1946, but before widespread vaccination, smallpox outbreaks were common. Smallpox was a self-limiting, deadly disease caused by the variola major and variola minor viruses. It spread through respiratory droplets, and infection of the sebaceous glands produced pustules that would burst, leaving scar tissue pockmarks in 65%–80% of patients. The case fatality rate was about 15% in unvaccinated and unvariolated people who became sick with smallpox. Those who survived developed immunity.

In March 1885, a conductor of the Grand Trunk Railway arrived in Montréal carrying smallpox, which soon spread through the city.6 Subsequent vaccination efforts did not unfold smoothly. Several cases of erysipelas after vaccination, likely caused by unsanitary conditions, led health officials to believe that a bad batch of vaccines was being used. This led to a suspension of the vaccination program for 3 months, starting in May 1885. People opposed to the vaccination spread word that the smallpox vaccine was dangerous and pulled down warning signs that public health workers posted to the homes of people who were diagnosed with smallpox. In poor, predominantly French-speaking areas of the city, the disease flourished; contemporary English-speaking editorials blamed the living conditions of slums occupied by the poor, ignoring the uneven and often poor quality of the vaccination program. Over the summer, the epidemic became worse.

By Sept. 2, 1885, the Board of Health in Montréal believed that there were about 2000 cases of smallpox present in the city. By Sept. 28, some experts were estimating 4000 cases. By late September, sanitary police began to forcibly remove people from housing conditions that made isolation impossible, often using harsh tactics, isolating the poor from housing and social support. On Sept. 28, the Board of Health announced that vaccination was to be made compulsory. In response, a “howling mob” surrounded the East End Branch Health Office that evening and “wrecked” the building.6 Protestors were as concerned with matters of identity as with vaccination, shouting phrases like, “Hurrah for the French-Canadians; Montréal is no longer for the English nor Irish.”7

Constables gathered, but were driven away by the mob. The crowd travelled through the city, smashing windows of pharmacies that sold vaccines and of the homes of health officers. Antivaccine protesters smashed all the windows in the Central Police Station. The Chief of Police was stabbed and stoned, though he survived. Rioters fired at police, and police escalated their tactics in an attempt to disperse the mob. They armed themselves with rifles and bayonets, firing above the heads of the crowd. Finally, they began clubbing the rioters, causing them to break into groups that continued the destruction of property, damaging various buildings.

The next day, officials worried that more violence would occur. Although the Board of Health was ambivalent about resorting to force, 1400 armed military men gathered at the city hall and patrolled the city. Sanitary police were issued revolvers. The Board of Health blamed the riots on lies told by vaccine opponents — that vaccine administrators would enter women’s bedrooms and tie children down to be vaccinated. No further major violence occurred. Whether the display of force was effective, or the crowd had ceased interest in rioting, or simply was not organized, is unclear. For the most part, the riot resulted only in property damage.

In the 5-week period ending on Oct. 31, 1391, people died of smallpox in Montréal. Of those, 1286 were French-speaking and about 90% were children under 10 years. Ultimately, the outbreak resulted in at least 19 905 cases and 5964 deaths in the province of Quebec, with 3259 of these deaths in Montréal alone.8

The outcome of the riot was neither capitulation to the demands of antivaccine activists, nor a heavy-handed enforcement of policy. Rather, after this epidemic, the opposition to vaccination shifted to courtrooms and activist leagues. Ontario passed a Vaccination Act in 1887, which required that “parents must have their children vaccinated against smallpox within three months of birth and re-vaccinated when necessary every seven years.” It allowed cities to issue vaccination orders in the event of a smallpox outbreak, and allowed school boards to demand that students provide a vaccination certificate.9 The Anti-Vaccination League of Canada emerged in 1900, in part a reaction to the Vaccination Act, modelling its rhetoric and methods on British antivaccine groups. The British Anti-Compulsory Vaccination League had been founded in 1867, and in 1885 had its own (peaceful) march in Leicester with an estimated 100 000 attendees.10

Arguments from antivaccine campaigners invoked concerns about individual liberties and fears that the risk of vaccination might exceed the benefits. At the time, smallpox vaccines used lymph taken from cowpox pustules on cows or infected humans, and vaccines could become contaminated and cause secondary infections.11 Vaccine opponents wondered why some people became sick despite being vaccinated.12 Among physicians, theoretical questions swirled around how vaccination worked, and many wondered if cowpox, used to make vaccines, was caused by the same virus as smallpox.13

Notably for physicians today, it was not scientific uncertainty alone that allowed antivaccine campaigners to effectively push back against public health laws. In 1906, 2 decades after the Montréal riots, the Anti-Vaccination League of Canada succeeded in convincing the Toronto Department of Health to remove a vaccination requirement from schools. Antivaccine activists framed their opposition in terms of social class and personal autonomy. Alexander Ross, one of the founders of the League, wrote in 1888, “It is the poor wives and children of laboring men; it is the clerks in the stores and operatives in factories and workshops; it is the workingmen and women that are threatened and driven by the hirelings of the infamous compulsory vaccination law.”14 Opposition to smallpox vaccination, whether expressed by angry crowds or constrained to courtrooms, communicated discomfort with a shift in power over a personal health decision.”

- from Jonathan M. Berman, “When antivaccine sentiment turned violent: the Montréal Vaccine Riot of 1885.” Canadian Medical Association Journal. April 6, 2021.

Anti-vaccinationists also observed a class bias in the administration of vaccination. The League charged that vaccination was being administered unevenly, as working-class children and immigrants were being forced to comply with measures that middle- and upper-class citizens managed to avoid. As evidence, the League offered the example of an immigrant who was forced to have a vaccination on board ship prior to his arrival in Canada, because he was traveling in the steerage section. The man developed huge sores as a result of the vaccination and was unable to work to support his family. The League demanded to know why some people were able to avoid such measures, simply because they had paid a higher rate of passage.

A similar charge had been made by Dr. Alexander M. Ross, founder of the Toronto Anti-Compulsory Vaccination League, in 1888. In an 1885 letter to the Toronto News written during the Montreal smallpox epidemic, Ross claimed:

Compulsory vaccination is never attempted on the so-called better classes. It is the poor wives and children of laboring men; it is the clerks in the stores and operatives in factories and workshops; it is the workingmen and women that are threatened and driven by the hirelings of the infamous compulsory vaccination law.

Consistency of enforcement remained a problem, however, and in 1887, in an effort to both codify and extend existing practices in the wake of the Montreal smallpox epidemic of 1885-86, the Ontario government passed the Vaccination Act. The Act stipulated that parents must have their children vaccinated against smallpox within three months of birth and re-vaccinated when necessary every seven years. The Act also empowered a municipality to make a general vaccination order in the face of an outbreak of smallpox. Finally, the law empowered local school boards to pass a by-law demanding that each pupil provide a vaccination certificate.

It was in response to one such by-law, passed by the Toronto Board of Education in 1894, that the first organized opposition to vaccination in Ontario appeared On 18 January 1900, the Anti-Vaccination League of Canada was formed. Modeled on the British anti-vaccinationists, and using much of their "argumentation, methods and publication," the Anti-Vaccination League set out to secure the repeal of all compulsory vaccination legislation. It is important to recognize that during these years opposition to compulsory vaccination was effectively a mass movement. 

At the height of the controversy, the issue was featured in Toronto newspapers on a daily basis. While actual membership in the League may have numbered only in the hundreds, thousands more supported their efforts, attending rallies, and signing petitions. Included among its members and supporters were politicians, workers, homeopaths, small businessmen, and even a few doctors.  The issue clearly struck a responsive chord in the hearts of many Canadians of the day.

After an initial failure shortly after its formation to force the Toronto Board of Education to rescind its by-law, the League returned to the Board in 1906. At the 1 March meeting, the Anti-Vaccination League presented a petition of some five thousand names demanding the repeal of the compulsory vaccination by-law. One trustee, sympathetic to the group, demanded that "the arbitrary pollution of children's bodies in Toronto with animal matter be abandoned." By a vote of ten to two, the Board agreed to remove the requirement of a vaccination certificate for school entry.

The controversy raged in the pages of Toronto papers throughout the month of March, as the League attempted to overturn provincial vaccination legislation as well. Like their counterparts in the United States and Great Britain, the anti-vaccinationists offered a number of medical arguments to support their case, maintaining that sanitation, hygiene, and the isolation of smallpox victims were the best weapons against the disease. They alleged that public health officials used vaccination as a "ploy to avoid [more expensive] sanitary measures." Challenging the statistical and medical evidence offered by health officials, the anti-vaccinationists spoke of the poor quality of the vaccine and the unhygienic conditions of its administration, both of which, they alleged, frequently led to secondary infections and even death. The League passionately demanded:

Has any civilized Government moral sanction for compelling wholesale inoculation of a filthy and highly dangerous disease upon its healthy subjects, professedly for the purpose of preventing the incidence of another disease which not one in a thousand of them may ever take and which does not, in these days, lay one per cent of those who do take it?

In light of the disorganized, unsupervised conditions under which vaccinations had been administered in the late nineteenth century, such a challenge may well have had some validity. As Heather MacDougall noted in her recent history of the Toronto Department of Health:

The lymph that was used to immunize the individual was occasionally contaminated with streptococcal or other organisms, and quite frequently inactive. The ivory points which were used to scarify the patient's upper arm were not always cleaned from person to person. Of equal importance was the tendency of recently vaccinated people to contaminate their wounds through ineffective bandaging or improper cleaning. All these potential hazards led some citizens to avoid vaccination because they were afraid of getting an infection and being unable to work.

By the early part of this century, however, both the quality of the vaccine and the methods of its administration had improved considerably. 

Many people came to oppose vaccination through direct experience with the suffering it had allegedly caused. One letter to the Toronto Daily Star, written by someone who claimed to be a former advocate of vaccination, reported that on a visit to an isolation camp for victims of smallpox, the author "saw not one symptom of suffering." Victims of vaccination apparently did not fare so well:

Never in my life have I witnessed such suffering anywhere as among the little ones through inoculation. Mother after mother [bared]the arms of their little ones to show me the vicious, ulcerous sores, so large a silver half-dollar would drop into them, and deep, nearly to the bone. I am not easily affected, but this made my heart ache, and I shudder to-day when I recall their suffering.

The author's "own (and only) son, who from a babe had never had a sick hour nor missed a meal, was a sufferer, the poison having seriously affected his heart." As a result, the child's health "never reached the stability it had before." Because of these experiences, the author concluded: "It is a law of torture and murder and should never have been on any statute book."