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Europeans have an ironic history with vaccines

Human Rights court rule that compulsory vaccinations could be necessary in democratic societies stretches back more than a century.

When the European Court of Human Rights (ECHR) in Strasbourg ruled last Thursday that compulsory vaccinations could be necessary in democratic societies, it was just the latest chapter in a saga that stretches back more than a century.

Mankind’s first-ever vaccine, a breakthrough in the fight against deadly smallpox in the 19th century, was made compulsory in some European countries, yet proved controversial even then.

The issue touches on the deepest fundamentals of society: a confluence of the state and its citizens with the concern for and control over one’s own body.

The ECHR ruling, the culmination of years of legal battles over a Czech law requiring vaccination of schoolchildren, comes at a crucial time as the world faces a new scourge: Covid-19.

In its ruling, the ECHR said compulsory vaccines required by Czech health authorities are in the “best interests” of children. “The objective has to be that every child is protected against serious diseases, through vaccination or by virtue of herd immunity,” said the high court.

Under Czech law, children must be vaccinated against nine diseases including diphtheria, tetanus, whooping cough, hepatitis B and measles. The case was brought by families that had been fined or whose children had been refused access to a nursery for failing to comply with vaccination requirements.

In arguing for vaccinations, lawyers for the Czech health authority plumbed the question of what legal and moral obligations individuals have to their fellow citizens. “The more parents refuse to vaccinate, the greater the risk that diseases will spread,” they argued. “The plaintiffs benefit from the fact that others bear the burden of the responsibility for the health of the population.”

Vaccination and resulting immunity, first discovered by English country physician Edward Jenner, are considered among the greatest achievements in the history of medical science and public health. Jenner found that milkmaids appeared to be immune from smallpox because they had been infected with a non-lethal strain, the related cowpox virus. He then developed a process based on cowpox that could eradicate one of the most dreaded diseases of its day. The affliction had a mortality rate of 30 per cent and left the majority of survivors covered with deep pockmarks, including on their face. Eventually, fancy ladies flocked to Parisian salons filled with cows so they could be directly infected, or vaccinated, with the cowpox strain.

Yet when England and Germany moved to require vaccination with the new medical miracle, the push-back was surprising.

Medical historian Malte Thiessen told broadcaster Deutsche Welle that vaccines have always been political in Germany. “Inoculation has always been about more than just the jab. It’s also about a worldview,” he said. An imperial German vaccination law was put in force in 1874 after widespread smallpox infections across Europe killed tens of thousands of people in Prussia. While many willingly complied with the mandate, the “Lebensreform”, or life reform, movement gained adherents who instead advocated natural ways of strengthening the body such as sunshine or special diets. An association opposing compulsory vaccination soon had 300,000 members.

For them, vaccines were the “devil’s tool”, Thiessen said. “Something artificial, chemical getting injected into the body. That helps explain the huge opposition to vaccines in Germany’s alternative circles until today.”

In Victorian England, a similar movement took shape after the government passed a series of laws making vaccination against smallpox compulsory. Many citizens and healthcare professionals supported the initiative, but anti-vaccination feelings grew, reaching full force in the 1890s with the formation of a group called the National Anti-Vaccination League that organised protests and produced its own publications to promote anti-vaccine views.

Ultimately, the movement became too popular to ignore and the government made it possible for people to opt-out of vaccination.

One of the great historical ironies is that France, birthplace of Louis Pasteur, is perhaps the most vaccination-sceptical country in the world. Though the numbers have risen in recent weeks, previous polls showed that fewer than half of French citizens polled would take the new vaccines developed to fight Covid-19. Among his renowned achievements, Pasteur developed the first “attenuated vaccine” in the late 19th century. Using infected rabbits, he produced the first rabies vaccine.

A 2019 global survey by the non-profit organisation Wellcome and the Vaccine Confidence Project found that “the richer a country is and the more economically developed it is, the less confidence people tend to have in vaccines”, said Imran Khan, spokesman for the Wellcome Trust.

Many blame conspiracy theories shared over social media for high vaccine scepticism in wealthier countries, but the elderly were already reluctant in Europe. Figures from 2019 show just 35 per cent of those over 65 got a common flu shot compared to 85 per cent in Korea and 72 per cent in the UK.

A survey by Nature found that people reporting high levels of trust in government were more likely to accept a vaccine.

“It comes down to the fact that globally, vaccines are highly regulated by government, recommended by government, sometimes required by government,” said Dr Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. “If you have any issues with government, you’ll think twice before you accept a vaccine that they decided on.”

But countervailing that is another phenomenon: vaccination envy. “I admit it. I have vaccine envy,” wrote Dr Robert H. Shmerling, senior faculty editor at Harvard Health Publishing. “It’s that feeling of jealousy, disappointment, or resentment you feel when someone else gets the vaccine for Covid-19 — and you can’t.”

It just shows the diversity of the human race. When an issue affects the entire planet, the spectrum of opinions, feelings and actions is enormous.

Although the recent ruling by the ECHR does not mean European countries can or will force people to be vaccinated for Covid-19, acceptance levels are rising. They might not admit it, but even sceptics might be feeling a tinge of envy — and are quietly planning to get in the queue.

Jon Van Housen and Mariella Radaelli are journalists based in Milan