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14
SMALL-POX AND PUBLIC VACCINATION.
The repeal of the Vaccination Acts and the introduction of a voluntary system was
advocated by one of the large provincial towns during the year, and representations with
this end in view were made to the Ministry of Health. The advocacy was based upon a thesis
which, put briefly, was as follows:—
Endemicity of small-pox remained to the date of compulsory vaccination of infants,
and has since been abolished by that measure. In 1898 and 1907, conscientious objection
and further ease in obtaining exemption were provided for, leading to a fall to 40 per cent.
of vaccinations in infants in 1929.
The fear of sleepy sickness has produced modified technique conferring immunity
which is less in duration and intensity than before. Thus, with an infant vaccination rate
which has dropped to about one-third of the birth-rate, the protection of those vaccinated
is diminished.
The present administration through the Vaccination Officer is costly and cumbrous,
and requires reconsideration. The work is done on voluntary lines, but follows the almost
obsolete " compulsory " routine, which is needlessly complicated.
The replacement of the various notices required and the disabilities the Public Vaccinator
suffers under the present conditions of home vaccinations, by a scheme worked through the
Health Visitors and Welfare Centres (touching three-quarters of the new births) and through
pamphlet (touching the remainder) is suggested. The vaccination would take place at an
infant welfare clinic.
The foreseen advantages are:—
1. As great or even greater efficiency.
2. A saving in cost, estimated at £100,000 for England and Wales.
Legislation would be necessary to repeal the Vaccination Acts and to introduce the
voluntary system.
The following considerations on the subject of retention or abrogation of the Vaccination
Acts present themselves:—
The Vaccination Acts are limited, for all practical purposes, to vaccinations of infants
under two years of age as to the compulsory clauses.
Other vaccinations and re-vaccinations are practised as a general public health measure
under the public health authorities.
The Acts, as at present administered, secure approximately 9 per cent. immunity,
which is a material safeguard, and this especially against foci of infection in schools.
It may be assumed that no further attempts at compulsion are possible in this country,
so that the lessons from the efficacy of extensive compulsion in other countries are only of
educative use by way of popularising vaccination and re-vaccination here.
The Acts secure that, in times of threatened epidemic, there is a Public Vaccinator at
hand. He is not limited by this contract to infant work. The Public Vaccinator, in his
routine, using one definite technique and recording his results, is of use to the government,
in that he teaches students and enables an assessment to be made of the value of batches
of lymph sent out from the central establishment.
The above advantages are at present less in that the technique of vaccination has been
simplified. Any medical practitioner should be familiar with vaccination, as with other
inoculations similar in principle and practice: to this end special schools for the sole teaching
of vaccination are not necessary or advisable; the duty of teaching need not be limited to
those familiar with a technique which is no longer advised, and efficient records can be
kept by any medical man with clerical ability or assistance.
Moreover, the present one-mark vaccination should properly be followed by re-vaccinations,
to ensure immunity through life: this is the end to be arrived at, and it is not promulgated
by Acts dealing with infant vaccination. The machinery of the Vaccination Act is
too complicated to be of use in vaccination of later life. The Vaccination Register was
initiated when the Vaccination Act constituted almost the sole public health activity; now
the Medical Officer of Health has an independent register of all births, and a separate register
for vaccination as one of many health activities seems unnecessary. Vaccination might
well become a matter for advice in the routine of Infant Welfare work, and Public Vaccinators