健康和医学学者们把预防接种形容为二十世纪公共健康领域最伟大的十大贡献之一。但是，对于预防接种的反对也由来已久，久到可能和疫苗存在的时间一样长。（事实上，在牛痘免疫接种前实践就已经在质疑声之中了）。

爱德华•詹纳的牛痘试验证实了，一个孩子注射了牛痘淋巴液，可以保护孩子免于感染天花。在十九世纪初期，天花疫苗的预防接种逐渐普及。詹纳的发现在他的时代无疑是伟大的，但他们却很快遭受了公众的批判。质疑的理论多种多样，这包括了卫生的，宗教的，科学的以及政治上的反对。

对于一些家长来说，天花的预防接种本身就导致了恐惧和抗议。它需要在孩子的胳膊上刻痕并且注射来自已经免疫过天花一周的人痘中的淋巴液。一些反对者，包括一些当地的牧师，认为疫苗来自于动物，因此接种疫苗是“异教”的。而另外一些的反对疫苗接种者，他们对于天花疫苗的不满，反映了公众对于医药以及詹纳对于疾病传播的观点的不信任。一些怀疑者声称，天花是大气中的腐败分子所导致的，因此他们对于疫苗效果提出质疑。

最后，很多人反对预防接种，因为他们认为它侵犯了他们的个人权利。随着政府制定强制性疫苗政策，这种紧张局面进一步恶化。1853年的预防接种法案要求，对三个月的婴儿强制接种疫苗，到1867年的法案已经把年龄扩大达到了14岁，并增加了对拒绝接种疫苗的惩罚。这样的法规立刻招来了很多公民的不满和反对，他们认为他们自己有权处理他们自己以及孩子的身体健康的权利。在这样的强制法律之下，反对预防接种联盟和反对强制预防接种联盟产生，并且无数的反对预防接种的期刊涌现。

莱斯特镇是反预防接种运动的温床并且是许多次反对预防接种集会的聚集地。当地报纸是这样描绘集会的细节的：“前面有旗帜开道，一个护卫队形成了，队伍护卫着一个年轻的妈妈和两个男人，这三个人已经下定决心把自己送进警局接受监禁，因为他们孩子的预防接种。。。这三个人被无数的人簇拥着。。。三声真诚的欢呼送给他们，当他们进入警局，他们将成为其中的新鲜血液“。1885年的莱斯特示威游行是最著名的反对预防接种示威游行之一，有8到10万的预防接种反对者策划并上演了一场精心准备的游行，游行中有很多的旗帜，一口孩子的棺材，还有一座詹纳的雕像。

直到十九世纪末，天花在美国的爆发，这导致了疫苗接种运动以及相关的反对疫苗活动。在英国反对预防接种者威廉泰伯访问美国之后，美国的反对预防接种学会于1879年成立。另外两个组织，新英格兰反对强制接种联盟（1882）和纽约反对预防接种联盟（1885）年也相应成立。在几个州，包括加利福尼亚州，伊利诺斯州，和威斯康星州，美国反对预防接种者们展开了法庭战争，要求废除预防接种法案。

反对疫苗接种的观点和预防接种争论并不只限于过去。在二十世纪七十年代中期，一场关于DTP免疫安全的国际争论在欧洲，亚洲，澳大利亚和北美爆发。

DTP疫苗争论之后25年，英格兰再次成为反对预防接种据点，这次针对的是MMR疫苗。1998年，英国医生安德烈维克菲尔提出进一步调查肠道疾病，自闭症和麻腮风疫苗之间可能的关系。几年之后，维克菲尔声称在投入使用之前，疫苗没有经过充分的验证。接下来，媒体抓住了这些故事，引发了公众对于疫苗安全的恐惧和混乱。

与此同时，曾经率先刊登了维克菲尔的研究成果的《柳叶刀》杂志，宣称在2004年不应该发表他的论文。英国的医学委员会，一个独立医生监管机构，发现维克菲尔本人在此事存在“严重的利益冲突”。他曾经收受一个法律委员会的酬劳来寻找证据来支持一起诉讼，而诉讼中的父母确信疫苗对他们的孩子造成了伤害。2010年，在英国医学委员会在几个领域对维克菲尔进行了惩罚之后，《柳叶刀》杂志也正式撤回这篇文章。维克菲尔在英国被吊销了医学执照，不再可以从事医学工作。2011年1月BMJ发表了记者布兰迪尔报道的一系列报道，有明确的证据显示维克菲尔通过伪造数据进行了科学欺诈，并且他希望通过他调查的几个方面实现最终的财务获利。

硫柳汞，一种含有汞成分的用于疫苗的防腐剂，也曾经成为了免疫接种和自闭症争论的焦点。虽然并没有清晰的科学证据证明疫苗中小量的硫柳汞会造成伤害，1999年7月，美国公共卫生和医学组织以及疫苗生产厂商还是达成如下共识：为了防范未然，硫柳汞的含量应该在疫苗中进一步减少甚至消除。2001年，药品免疫安全审查委员会发表报道声称，没有足够的证据证明或者反驳，硫柳汞在儿童疫苗中会引起自闭症，过敏性注意力分散，或者语言障碍。委员会在进一步更新的一些报道称“更倾向于不支持硫柳汞疫苗与自闭症之间存在因果关系”。即使在这样的情况下，一些研究者仍在继续不断的研究硫柳汞和自闭症之间可能的关联。今天，硫柳汞，除了在一些多剂量流感疫苗中可能还作为防腐剂有一些使用，在大多数儿童疫苗之中已经不复存在。

原文文献：History of Anti-vaccination Movements

Health and medical scholars have describedvaccination as one of the top ten achievements of public health in the 20thcentury.[1] Yet, opposition to vaccination hasexisted as long as vaccination itself[2] (indeed, thepre-vaccination practice of variolation came under criticism as well: see this timeline entry for details). Critics of vaccinationhave taken a variety of positions, including opposition to the smallpox vaccinein England and the United States in the mid to late 1800s, and the resultinganti-vaccination leagues; as well as more recent vaccination controversies suchas those surrounding the safety and efficacy of the diphtheria, tetanus, andpertussis (DTP) immunization, the measles, mumps, and rubella (MMR) vaccine,and the use of a mercury-containing preservative called thimerosal.

Smallpox and the Anti-vaccination Leaguesin England

Widespread smallpox vaccination began inthe early 1800s, following Edward Jenner’s cowpox experiments, in which heshowed that he could protect a child from smallpox if he infected him or her withlymph from a cowpox blister. Jenner’s ideas were novel for his time, however,and they were met with immediate public criticism. The rationale for thiscriticism varied, and included sanitary, religious, scientific, and politicalobjections.

For some parents, the smallpox vaccinationitself induced fear and protest. It included scoring the flesh on a child’sarm, and inserting lymph from the blister of a person who had been vaccinatedabout a week earlier. Some objectors, including the local clergy, believed thatthe vaccine was “unchristian” because it came from an animal.[3] For other anti-vaccinators, theirdiscontent with the smallpox vaccine reflected their general distrust inmedicine and in Jenner’s ideas about disease spread. Suspicious of thevaccine’s efficacy, some skeptics alleged that smallpox resulted from decayingmatter in the atmosphere.[4] Lastly, many people objected tovaccination because they believed it violated their personal liberty, a tensionthat worsened as the government developed mandatory vaccine policies. [3]

The Vaccination Act of 1853 orderedmandatory vaccination for infants up to 3 months old, and the Act of 1867extended this age requirement to 14 years, adding penalties for vaccinerefusal. The laws were met with immediate resistance from citizens who demandedthe right to control their bodies and those of their children.[3] The Anti Vaccination League and theAnti-Compulsory Vaccination League formed in response to the mandatory laws,and numerous anti-vaccination journals sprang up.[2]

The town of Leicester was a particularhotbed of anti vaccine activity and the site of many anti-vaccine rallies. Thelocal paper described the details of a rally: “An escort was formed, precededby a banner, to escort a young mother and two men, all of whom had resolved togive themselves up to the police and undergo imprisonment in preference tohaving their children vaccinated…The three were attended by a numerouscrowd…three hearty cheers were given for them, which were renewed withincreased vigor as they entered the doors of the police cells.”[5] The Leicester Demonstration March of1885 was one of the most notorious anti-vaccination demonstrations. There,80,000-100,000 anti-vaccinators led an elaborate march, complete with banners,a child’s coffin, and an effigy of Jenner.[3]

Such demonstrations and general vaccineopposition lead to the development of a commission designed to studyvaccination. In 1896 the commission ruled that vaccination protected againstsmallpox, but suggested removing penalties for failure to vaccinate. TheVaccination Act of 1898 removed penalties and included a “conscientiousobjector” clause, so that parents who did not believe in vaccination’s safetyor efficacy could obtain an exemption certificate.[2]

Smallpox and the Anti-vaccination Leaguesin the United States

Toward the end of the 19th century, smallpox outbreaks in theUnited States led to vaccine campaigns and related anti-vaccine activity. TheAnti Vaccination Society of America was founded in 1879, following a visit toAmerica by leading British anti-vaccinationist William Tebb. Two other leagues,the New England Anti Compulsory Vaccination League (1882) and theAnti-vaccination League of New York City (1885) followed. The Americananti-vaccinationists waged court battles to repeal vaccination laws in severalstates including California, Illinois, and Wisconsin.[2]

In 1902, following a smallpox outbreak,the board of health of the city of Cambridge, Massachusetts, mandated all cityresidents to be vaccinated against smallpox. City resident Henning Jacobsonrefused vaccination on the grounds that the law violated his right to care forhis own body how he knew best. In turn, the city filed criminal charges againsthim. After losing his court battle locally, Jacobson appealed to the U.S.Supreme Court. In 1905 the Court found in the state’s favor, ruling that thestate could enact compulsory laws to protect the public in the event of acommunicable disease. This was the first U.S. Supreme Court case concerning thepower of states in public health law. [6],[7]

The Diphtheria, Tetanus, and Pertussis(DTP) Vaccine Controversy

Anti-vaccination positions and vaccinationcontroversies are not limited to the past. In the mid 1970s, an internationalcontroversy over the safety of the DTP immunization erupted in Europe, Asia,Australia, and North America. In the United Kingdom (UK), opposition resultedin response to a report from the Great Ormond Street Hospital for Sick Childrenin London, alleging that 36 children suffered neurological conditions followingDTP immunization.[8] Television documentaries andnewspaper reports drew public attention to the controversy. An advocacy group,The Association of Parents of Vaccine Damaged Children (APVDC), also piquedpublic interest in the potential risks and consequences of DTP.

In response to decreased vaccination ratesand three major epidemics of whooping cough (pertussis), the Joint Commissionon Vaccination and Immunization (JCVI), an independent expert advisorycommittee in the UK, confirmed the safety of the immunization. Nonetheless,public confusion continued, in part because of diverse opinions within themedical profession. For example, surveys of medical providers in the UK in thelate 1970s found that they were reluctant to recommend the immunization to allpatients.[9] Additionally, an outspoken physicianand vaccine opponent, Gordon Stewart, published a series of case reportslinking neurological disorders to DTP, sparking additional debate. In response,the JCVI launched the National Childhood Encephalopathy Study (NCES). The studyidentified every child between 2 and 36 months hospitalized in the UK forneurological illness, and assessed whether or not the immunization was associatedwith increased risk. NCES results indicated that the risk was very low, andthis data lent support to a national pro-immunization campaign.[10] Members of the APVDC continued toargue in court for recognition and compensation, but were denied both due tothe lack of evidence linking the DTP immunization with harm.

The U.S. controversy began with mediaattention on the alleged risks of DTP. A 1982 documentary,DPT: Vaccination Roulette, described allegedadverse reactions to the immunization and minimized the benefits.[11] Similarly, a 1991 book titled A Shot in the Dark outlined potential risks.[12] As in the UK, concerned and angryparents formed victim advocacy groups, but the counter response from medicalorganizations, like the Academy of Pediatrics and the Centers for DiseaseControl and Prevention, was stronger in the United States.[9] Although the media storm instigatedseveral lawsuits against vaccine manufacturers, increased vaccine prices, andcaused some companies to stop making DTP,[13] the overall controversy affectedimmunization rates less than in the UK.

The Measles, Mumps, and Rubella (MMR)Vaccine Controversy

Nearly 25 years after the DTP controversy,England was again the site of anti-vaccination activity, this time regardingthe MMR vaccine.

In 1998, British doctor Andrew Wakefieldrecommended further investigation of a possible relationship between boweldisease, autism, and the MMR vaccine.[14] A few years later, Wakefield allegedthe vaccine was not properly tested before being put into use.[15] The media seized these stories,igniting public fear and confusion over the safety of the vaccine.[16] The Lancet,the journal that originally published Wakefield’s work, stated in 2004 that itshould not have published the paper.[17] The General Medical Council, anindependent regulator for doctors in the UK, found that Wakefield had a “fatalconflict of interest.” He had been paid by a law board to find out if there wasevidence to support a litigation case by parents who believed that the vaccinehad harmed their children. In 2010, the Lancet formallyretracted the paper after the British General Medical Council ruled againstWakefield in several areas. Wakefield was struck from the medical register inGreat Britain and may no longer practice medicine there. In January 2011, theBMJ published a series of reports by journalist Brian Deer outlining evidencethat Wakefield had committed scientific fraud by falsifying data and also thatWakefield hoped to financially profit from his investigations in several ways.[18]

A large number of research studies havebeen conducted to assess the safety of the MMR vaccine, and none of them hasfound a link between the vaccine and autism.[19]

“Green Our Vaccines”

Thimerosal, a mercury containing compoundused as a preservative in vaccines,[20] has also been the center of a vaccinationand autism controversy. Although there is no clear scientific evidencethat small amounts of thimerosal in vaccines cause harm, in July 1999, leadingU.S. public health and medical organizations and vaccine manufacturers agreedthat thimerosal should be reduced or eliminated from vaccines as aprecautionary measure.[20] In 2001, The Institute of Medicine’sImmunization Safety Review Committee issued a report concluding that there wasnot enough evidence to prove or disprove claimsthat thimerosal in childhood vaccines causes autism, attention deficithypersensitivity disorder, or speech or language delay.[21] A more recent report by thecommittee “favors rejection of a causal relationship betweenthimerosal-containing vaccines and autism.”[22] Even with this finding, someresearchers continue to study the possible links between thimerosal and autism.[23] Today, thimerosal is no longer usedin most childhood vaccines, though some forms of influenza vaccine available inmulti-dose vials may contain the preservative.[24]

Despite scientific evidence, concerns overthimerosal have led to a public “Green Our Vaccines” campaign, a movement toremove “toxins” from vaccines, for fear that these substances lead to autism.Celebrity Jenny McCarthy, her advocacy group Generation Rescue, and theorganization Talk about Curing Autism (TACA) have spearheaded these efforts.[25]

In Conclusion

Although the time periods have changed,the emotions and deep-rooted beliefs—whether philosophical, political, orspiritual—that underlie vaccine opposition have remained relatively consistentsince Edward Jenner introduced vaccination.

Last update 18 Dec 2014

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文章来自：The history of vaccines