The complex roots of vaccine skepticism, from Quebec nationalism to government apathy

When members of the media talk about the roots of vaccine skepticism, the story usually begins in 1998, when the British medical journal The Lancet published a since-discredited article raising the question of a link between the measles, mumps and rubella vaccine and autism. 

But according to historian Heather MacDougall, a University of Waterloo professor who studies the history of medicine and health policy, the roots of vaccine hesitancy in Canada go much further back than that.

She says a surprising mix of forces has shaped parents' fears about vaccines — including the thalidomide crisis, Quebec nationalism, the rise of alternative medicine, second-wave feminism, new parenting philosophies and, perhaps most crucially, government apathy.

Some of the earliest opponents of vaccines objected to the quality and compulsory nature of smallpox immunizations in the 19th century, said MacDougall.

"In the United Kingdom, all babies, as of the legislation of 1853, were supposed to be immunized against smallpox by the time that they were three months old. Certain families in working class areas of the Midlands objected to the point that parents actually went to jail," she told The Sunday Edition's host Michael Enright.

When the measles vaccine was first introduced in 1963, Canadians were on edge. The catastrophic effects of thalidomide had become public knowledge the year before.

"I think it shook their trust in federal regulatory authorities," MacDougall said.

The Quiet Revolution and the 'nouveau Québécois'

Throughout the 1960s, anti-vaccine sentiment flourished in Quebec among some supporters of the Quiet Revolution.

"There is a sort of right-leaning component of the Révolution tranquille that focuses around the creation of a new Québécois individual, who believes in natural health, does not believe in mandatory smallpox vaccination and supports health foods," she said.

A leading figure in that segment of the movement was naturopathic doctor Paul-Émile Chevrefils, who opposed mandatory smallpox vaccination.

Some Francophone second-wave feminists also opposed mandatory vaccinations.

"In the 1970s and the 1980s ... they were very, very firmly trying to encourage the adoption of midwifery in the province of Quebec. They were getting tremendous resistance from the Francophone medical profession," said MacDougall.

"So that then made them fairly skeptical of virtually anything coming from the male-dominated medical establishment. And, of course, one of those items was immunization."

In English Canada, anti-vaccination movements took off in the 1980s, in response to Ontario's 1982 Immunization of School Pupils Act. The newly-formed Committee Against Compulsory Vaccination lobbied to change the act, and in 1984, the provincial government amended it to include exemptions for philosophical and religious reasons.

Lack of political will

MacDougall said the lack of political will for a national immunization schedule and a unified national approach is one of the most significant problems we face. Because of the division of powers, there is currently a patchwork of immunization policies and schedules across the country.

In the 1970s, the federal government tried to create a national measles elimination program, but struggled to get provincial governments on board.

"A lot of that had to do with the fact that the [Pierre] Trudeau government changed the funding formula," she said. "When you basically just turn the money over, without requiring people to explain precisely how they're going to use it, which the provinces objected to ... A province like Saskatchewan doesn't have quite the same kinds of problems as the City of Toronto health department in terms of immunizing its population, but it has other issues that it needs more money for."

In 2003, the Martin government provided funding for a national immunization strategy, to support the introduction of several new childhood vaccines.

But MacDougall said many smaller provinces balked at the plan, "because they weren't convinced that they would be able to continue paying for them after the federal grant ran out."

'A culture … increasingly influenced by celebrity'

When The Lancet published the now-discredited article raising the question of a link between the MMR vaccine and autism, MacDougall said the media immediately picked up the story, and portrayed co-author Andrew Wakefield as "a pioneer making a breakthrough that that no one had ever thought of or seen."

"He's very charismatic. I would describe him as a demagogue, and that is meat and potatoes to a culture which is increasingly influenced by celebrity," she said.

She also believes changing parenting philosophies and family configurations have played a role in the spread of vaccine hesitancy. 

The people who became parents from 2000 onward had the internet … and they also were constantly told that authority was not trustworthy.- Heather MacDougall

"As baby boomer parents, having five kids go down with the measles every couple of weeks meant that, basically, you weren't going out of the house for months on end," she said.

Today, many young parents and doctors have never seen a case of measles.

"The people who became parents from 2000 onward had the internet … and they also were constantly told that authority was not trustworthy — beginning with Watergate, the swine flu, thalidomide and so on."

"At the same time, because families are shrinking in size, children are regarded as fundamentally the centre of parents' existence. I think for a lot of women then, the fear [was] that if they allow their child to have the MMR vaccine and subsequently the child was diagnosed with autism, that it was their fault," said MacDougall.

Reaching "vaccine hesitant" parents

MacDougall believes it's important to draw a distinction between anti-vaxxers — people vehemently opposed to all vaccines — and "vaccine hesitant" parents.

"A vaccine hesitant parent has questions about specific vaccines, and if the health care professional ... giving the shot has the time to talk to them, to find out what the nature of the concern really is, and to reassure them about that, then they probably will get past their hesitancy and agree to the immunization," she said.

In recent years, she's also seen more parents speaking openly to each other about why vaccination is necessary to ensure herd immunity and protect immunocompromised people.

"I think that what we need is for the public health professionals and the media to support the parents who are questioning, by giving them a forum in which they can share their concerns and then receive both expert responses and advice, but also peer-to-peer responses from parents," she said.

Click 'listen' above to hear the interview.