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IMMUNISATION AND VACCINATION
Introduction
On the day on which the National Health Service came into existence in 1948, the
Public Vaccinator and the Vaccination Officer, who had for many years been responsible
for carrying out the provisions of the Vaccination Acts, disappeared from the scene.
Thereafter the compulsion associated with the Vaccination Acts was replaced by the
persuasion which had proved so successful in the national diphtheria immunisation
campaign.
Before the National Health Service Act, 1946
Vaccination
against
small-pox
Before the National Health Service Act, 1946, vaccination against smallpox had been
governed by the Vaccination Acts, 1867-1907. Under these Acts public vaccinators
were appointed to carry out the vaccinations, and vaccination officers were given the
duty of bringing proceedings against parents who neglected to have their child vaccinated.
The administration of the Acts was originally in the hands of the boards of
guardians, but in London after 1929 it passed to the metropolitan borough councils.
The Vaccination Acts provided that no proceedings should be brought against parents
who made a declaration that they conscientiously believed that vaccination would
damage the health of their child. Increasing use was made of conscientious objection
so that whereas in 1908 the ratio between vaccinations and births in England and Wales
had been 63 per cent., by 1939 it had fallen to 34 per cent. The purpose of the Vaccination
Acts was being defeated and a serious breach made in the national defences against
disease. When the national diphtheria immunisation campaign began, on a voluntary
basis, in 1940 its general acceptance was in such striking contrast to the low acceptance
rate of vaccination against smallpox that the opportunity was taken in the National
Health Service Act, 1946, to repeal the largely ineffective Vaccination Acts. As will be
seen later the effect of the removal of compulsion in London has been to reverse the
trend of previous years.
Diphtheria
immunisation
The first metropolitan borough to provide facilities for diphtheria immunisation
was Holborn, and in this borough a clinic for the purpose was opened in 1922. Westminster
and Camberwell followed four years later and, by 1929, fourteen boroughs
had opened clinics. From 1922 onwards immunisation was carried out on the staff of
the fever hospitals of the Metropolitan Asylums Board and on an increasing scale among
the children in the residential schools at that time administered by the boards of
guardians. From 1930 the fever hospitals and the residential schools came under the
control of the London County Council and the diphtheria prophylactic in use throughout
the service was formol toxoid prepared in the Council's Belmont laboratories. When
in 1940 the national diphtheria immunisation campaign was launched, the Council made
arrangements for immunisation of children in the schools to supplement the work
carried out by the metropolitan boroughs on children under the age of 5 years and the
prophylactic in general use at the beginning of this campaign was the Council's formol
toxoid.
Up to the end of 1946 the proportion of children under 5 years of age who had
been immunised against diphtheria varied from 28 per cent. in one borough to 68 per
cent. in another (compared with an estimated 5.3 per cent. for the County as a whole
in 1937), the borough figures for the 5 to 14 years age group varying between 20 per
cent. and 86 per cent.
The virtual
abolition of
diphtheria
The achievement of diphtheria immunisation in virtually eliminating the disease
from the community has passed into history. It is essential for the present to continue
with immunisation and it is therefore necessary for us to be on our guard against the
activities of those who seek to cast doubts on its value. An argument against immunisation
which is being used widely at present is that diphtheria incidence and mortality
were diminishing before the national immunisation campaign began, that the subsequent
fall was merely a continuation of this secular trend, and that similar trends have taken
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