View source for Medicine:Vaccine controversies

[[File:The cow pock.jpg |thumb |300px |James Gillray, ''The Cow-Pock—or—the Wonderful Effects of the New Inoculation!'' (1802)]]
{{Alternative medicine sidebar|conspiracy}}
'''Vaccine controversies''' have occurred since almost 80 years before the terms [[Biology:Vaccine|vaccine]] and [[Biology:Vaccination|vaccination]] were introduced, and continue to this day. Despite [[Philosophy:Scientific consensus|scientific consensus]] that recommended vaccines are safe and effective,<ref>{{Cite web |url=https://www.vaccines.gov/basics/safety/index.html |title=Vaccines.gov |last=Services |first=U.S. Department of Health and Human |website=www.vaccines.gov |language=en-us |access-date=2018-08-05}}</ref> unsubstantiated scares regarding their safety still occur, resulting in [[Medicine:Outbreak|outbreak]]s and deaths from vaccine-preventable diseases.<ref>{{cite web |url=http://www.childrenshospital.org/centers-and-services/division-of-infectious-diseases/faq-resurgence-of-measles |title=Frequently Asked Questions (FAQ) |website=Boston Children's Hospital |accessdate=February 11, 2014 |archiveurl=https://web.archive.org/web/20131017113035/http://www.childrenshospital.org/centers-and-services/division-of-infectious-diseases/faq-resurgence-of-measles |archivedate=October 17, 2013}}</ref><ref>{{cite journal |last1=Phadke |first1=Varun K. |last2=Bednarczyk |first2=Robert A. |last3=Salmon |first3=Daniel A. |last4=Omer |first4=Saad B. |title=Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States |journal=JAMA |date=15 March 2016 |volume=315 |issue=11 |pages=1149–1158 |doi=10.1001/jama.2016.1353 |pmid=26978210 |pmc=5007135}}</ref><ref name="wolfesharp" /><ref name=AgeOld>{{cite journal |vauthors=Poland GA, Jacobson RM |title=The Age-Old Struggle against the Antivaccinationists |journal=N Engl J Med |volume=364 |issue=2 |pages=97–99 |date=January 13, 2011 |pmid=21226573 |doi=10.1056/NEJMp1010594 }}</ref><ref>{{cite news |author=Wallace A |title=An epidemic of fear: how panicked parents skipping shots endangers us all |work=Wired |date=2009-10-19 |url=https://www.wired.com/magazine/2009/10/ff_waronscience/all/1 |accessdate=2009-10-21 }}</ref><ref>{{cite journal |vauthors=Poland G, Jacobson R |title=Understanding those who do not understand: a brief review of the anti-vaccine movement |journal=Vaccine |volume=19 |issue=17–19 |pages=2440–2445 |year=2001 |pmid=11257375 |doi=10.1016/S0264-410X(00)00469-2}}</ref> Another source of controversy is whether mandatory vaccination violates [[Philosophy:Civil liberties|civil liberties]] or reduces public trust in vaccination.<ref name="wolfesharp" /><ref>{{cite web|url=https://www.mystatesman.com/news/state--regional-govt--politics/civil-liberties-center-vaccination-debate-texas/lWzq91qhSyAKcY8MiaWnYM/|title='Civil liberties' at center of vaccination debate in Texas|last=Chang|first=Julie|website=myStatesman|publisher=Austin American-Statesman|date=12 July 2017}}</ref><ref>{{cite web|url=https://www.nytimes.com/roomfordebate/2014/03/23/making-vaccination-mandatory-for-all-children/in-britain-vaccinate-with-persuasion-not-coercion|title=In Britain, Vaccinate With Persuasion, not Coercion|date=23 March 2014|website={{wipe|The New York Times}}|last1=Elliman|first1=David|last2=Bedford|first2=Helen}}</ref>

==Variolation==
[[File:GAVI Global Alliance Save Childrens Lives pledging conference (5827417113).jpg |thumb |Campaigners in [[Place:London|London]] for expanded vaccination in the developing world]]
Early attempts to prevent smallpox involved deliberate [[Biology:Inoculation|inoculation]] with the disease in hopes that a mild case would confer immunity. Originally called inoculation, this technique was later called [[Biology:Variolation|variolation]] to avoid confusion with cowpox inoculation ([[Biology:Vaccination|vaccination]]) when that was introduced by Edward Jenner. Although variolation had a long history in China and India, it was first used in North America and England in 1721. [[Biography:Cotton Mather|Reverend Cotton Mather]] introduced variolation to Boston, Massachusetts, during the 1721 smallpox epidemic.<ref name="VaccineControversy">{{cite book |last=Allen |first=Arthur |title=Vaccine: The Controversial Story of Medicine's Greatest Lifesaver |year=2007 |publisher=W. W. Norton & Company, Inc. |location=New York, NY |isbn=978-0-393-05911-3 |pages=25–36}}</ref> Despite strong opposition in the community,<ref name="Early"/> Mather convinced Dr. Zabdiel Boylston to try it. Boylston first experimented on his 6-year-old son, his slave, and his slave's son; each subject contracted the disease and was sick for several days, until the sickness vanished<!-- is "miraculously vanished" a direct quote? --> and they were "no longer gravely ill".<ref name="VaccineControversy" /> Boylston went on to variolate thousands of Massachusetts residents, and many places were named for him in gratitude as a result. [[Biography:Lady Mary Wortley Montagu|Lady Mary Wortley Montagu]] introduced variolation to England. She had seen it used in Turkey and, in 1718, had her son successfully variolated in Constantinople under the supervision of Dr. Charles Maitland. When she returned to England in 1721, she had her daughter variolated by Maitland. This aroused considerable interest, and Sir Hans Sloane organized the variolation of some inmates in Newgate Prison. These were successful, and after a further short trial in 1722, two daughters of Caroline of Ansbach Princess of Wales were variolated without mishap. With this royal approval, the procedure became common when smallpox epidemics threatened.<ref name=williams>{{cite book |last=Williams |first=Gareth |title=Angel Of Death; the story of smallpox |year=2010 |publisher=Palgrave Macmillan |location=Basingstoke, UK |isbn=978 0 230 27471 6 |pages=87–94}}</ref>

[[Medicine:Vaccination and religion|Religious arguments against inoculation]] were soon advanced. For example, in a 1772 sermon entitled "The Dangerous and Sinful Practice of Inoculation", the English theologian Reverend Edmund Massey argued that diseases are sent by God to punish sin and that any attempt to prevent smallpox via inoculation is a "diabolical operation".<ref name="Early" /> It was customary at the time for popular preachers to publish sermons, which reached a wide audience. This was the case with Massey, whose sermon reached North America, where there was early religious opposition, particularly by John Williams. A greater source of opposition there was Dr. William Douglass, a medical graduate of Edinburgh University and a Fellow of the Royal Society, who had settled in Boston.<ref name=williams/>{{rp |114–122}}

==Smallpox vaccination==

After Edward Jenner introduced the [[Medicine:Smallpox vaccine|smallpox vaccine]] in 1798, variolation declined and was banned in some countries.<ref>{{cite journal |last=Bazin |first=Hervé |title=A brief history of the prevention of infectious diseases by immunisations |journal=Comparative Immunology, Microbiology and Infectious Diseases |date=October 1, 2003 |volume=26 |issue=5–6 |pages=293–308 |doi=10.1016/S0147-9571(03)00016-X |pmid=12818618}}</ref><ref>{{cite journal |author=Ellner P |title=Smallpox: gone but not forgotten |journal=Infection |volume=26 |issue=5 |pages=263–269 |year=1998 |pmid=9795781 |doi=10.1007/BF02962244 }}</ref>[[File:Edward Jenner2.jpg |thumb|Edward Jenner]] As with variolation, there was some religious opposition to vaccination, although this was balanced to some extent by support from clergymen, such as Reverend Robert Ferryman, a friend of Jenner's, and Rowland Hill,<ref name=williams/>{{rp |221}} who not only preached in its favour but also performed vaccination themselves. There was also opposition from some variolators who saw the loss of a lucrative monopoly. William Rowley published illustrations of deformities allegedly produced by vaccination, lampooned in James Gillray's famous caricature depicted on this page, and Benjamin Moseley likened cowpox to [[Medicine:Syphilis|syphilis]], starting a controversy that would last into the 20th century.<ref name=williams/>{{rp |203–205}}

There was legitimate concern from supporters of vaccination about its safety and efficacy, but this was overshadowed by general condemnation, particularly when legislation started to introduce compulsory vaccination. The reason for this was that vaccination was introduced before laboratory methods were developed to control its production and account for its failures.<ref name=baxby2001>{{cite book |last=Baxby |first=Derrick |title=Smallpox Vaccine, Ahead of its Time |year=2001 |publisher=the Jenner Museum |location=Berkeley, UK |isbn=0 9528695 1 9 |pages=12–21}}</ref> Vaccine was maintained initially through arm-to-arm transfer and later through production on the skin of animals, and bacteriological sterility was impossible. Further, identification methods for potential pathogens were not available until the late 19th to early 20th century. Diseases later shown to be caused by contaminated vaccine included [[Medicine:Erysipelas|erysipelas]], [[Medicine:Tuberculosis|tuberculosis]], [[Medicine:Tetanus|tetanus]], and syphilis. This last, though rare—estimated at 750 cases in 100 million vaccinations<ref name=bazin2000>{{cite book |last=Bazin |first=Hervé |title=The Eradication of Smallpox |year=2000 |publisher=Academic Press |location=London |isbn=0 12 083475 8 |page=122}}</ref>—attracted particular attention. Much later, Dr. Charles Creighton, a leading medical opponent of vaccination, claimed that the vaccine itself was a cause of syphilis and devoted a book to the subject.<ref name=creighton>{{cite book |last=Creighton |first=Charles |title=The Natural History of Cowpox and Vaccinal Syphilis |year=1887 |publisher=Cassell |location=London}}</ref> As cases of smallpox started to occur in those who had been vaccinated earlier, supporters of vaccination pointed out that these were usually very mild and occurred years after the vaccination. In turn, opponents of vaccination pointed out that this contradicted Jenner's belief that vaccination conferred complete protection.<ref name=baxby2001/>{{rp |17–21}} The views of opponents of vaccination that it was both dangerous and ineffective led to the development of determined anti-vaccination movements in England when legislation was introduced to make vaccination compulsory.<ref name=williamson>{{cite book |last=Williamson |first=Stanley |title=The Vaccination Controversy; the rise, reign and decline of compulsory vaccination |year=2007 |publisher=Liverpool University Press |location=Liverpool |isbn=9781846310867}}</ref>

===England===
Because of its greater risks, [[Biology:Variolation|variolation]] was banned in England by the 1840 [[Biology:Vaccination Act|Vaccination Act]], which also introduced free voluntary vaccination for infants. Thereafter Parliament passed successive acts to enact and enforce compulsory vaccination.<ref name=porter>{{cite journal |last=Porter |first=Dorothy |author2=Porter, Roy |title=The Politics of Prevention; anti-vaccinationism and public health in nineteenth-century England |journal=Med. Hist. |year=1988 |volume=32 |issue=3 |pages=231–252 |doi=10.1017/s0025727300048225	 |pmid=3063903 |pmc=1139881}}</ref> The 1853 act introduced compulsory vaccination, with fines for non-compliance and imprisonment for non-payment. The 1867 act extended the age requirement to 14 years and introduced repeated fines for repeated refusal for the same child. Initially, vaccination regulations were organised by the local Poor Law Guardians, and in towns where there was strong opposition to vaccination, sympathetic Guardians were elected who did not pursue prosecutions. This was changed by the 1871 act, which required Guardians to act. This significantly changed the relationship between the government and the public, and organized protests increased.<ref name=porter/> In Keighley, Yorkshire, in 1876 the Guardians were arrested and briefly imprisoned in York Castle, prompting large demonstrations in support of the "Keighley Seven".<ref name=williamson/>{{rp |108–109}} The protest movements crossed social boundaries. The financial burden of fines fell hardest on the working class, who would provide the largest numbers at public demonstrations.<ref>{{cite journal |last=Durbach |first=Nadjya |title=They might as well brand us; working-class resistance to compulsory vaccination in Victorian England |journal=Soc. Hist. Med. |year=2000 |volume=13 |issue=1 |pages=45–63 |doi=10.1093/shm/13.1.45 |pmid=11624425}}</ref> Societies and publications were organized by the middle classes, and support came from celebrities such as [[Biography:George Bernard Shaw|George Bernard Shaw]] and [[Biography:Alfred Russel Wallace|Alfred Russel Wallace]], doctors such as Charles Creighton and Edgar Crookshank, and parliamentarians such as Jacob Bright and James Allanson Picton.<ref name=porter/> By 1885, with over 3,000 prosecutions pending in Leicester, a mass rally there was attended by over 20,000 protesters.<ref name=baxby1999>{{cite journal |last=Baxby |first=Derrick |title=The End of Smallpox |journal=History Today |year=1999 |volume=49 |pages=14–16}}</ref>

Under increasing pressure, the government appointed a Royal Commission on Vaccination in 1889, which issued six reports between 1892 and 1896, with a detailed summary in 1898.<ref>{{cite book |last=(Royal Commission) |title=Vaccination and its Results; a Report based on the Evidence taken by the Royal Commission |year=1898 |publisher=New Sydenham Society |location=London}}</ref> Its recommendations were incorporated into the 1898 Vaccination Act, which still required compulsory vaccination but allowed exemption on the grounds of conscientious objection on presentation of a certificate signed by two magistrates.<ref name="wolfesharp">{{cite journal |vauthors=Wolfe R, Sharp L |title=Anti-vaccinationists past and present |journal=BMJ |volume=325 |issue=7361 |pages=430–432 |year=2002 |pmid=12193361 |doi=10.1136/bmj.325.7361.430 |pmc=1123944 }}</ref><ref name="porter" /> These were not easy to obtain in towns where magistrates supported compulsory vaccination, and after continued protests, a further act in 1907 allowed exemption on a simple signed declaration.<ref name="baxby1999" /> Although this solved the immediate problem, the compulsory vaccination acts remained legally enforceable, and determined opponents lobbied for their repeal. No Compulsory Vaccination was one of the demands of the 1900 Labour Party General Election Manifesto.<ref>{{cite web |title=Labour Party Manifesto 1900 |url=https://suacs.wordpress.com/2014/04/20/labour-party-manifesto-1900/ |website=Voice of Anti-Capitalism in Guildford |accessdate=July 2, 2015}}</ref> This was done as a matter of routine when the National Health Service was introduced in 1948, with "almost negligible" opposition from supporters of compulsory vaccination.<ref name="millard1948">{{cite journal |last=Millard |first=C. Killick |title=The End of Compulsory Vaccination |journal=Br. Med. J. |year=1948 |volume=2 |issue=4589 |pages=1073–1075 |doi=10.1136/bmj.2.4589.1073 |pmid=18121624 |pmc=2092290}}</ref>

Vaccination in Wales was covered by English legislation, but the Scottish legal system was separate. Vaccination was not made compulsory there until 1863, and conscientious objection was allowed after vigorous protest only in 1907.<ref name="baxby2001" />{{rp |10–11}}

In the late 19th century, the city of Leicester in the UK received much attention because of the way smallpox was managed there. There was particularly strong opposition to compulsory vaccination, and medical authorities had to work within this framework. They developed a system that did not use vaccination but was based on the notification of cases, the strict isolation of patients and contacts, and the provision of isolation hospitals.<ref>{{cite book |last1=Mooney |first1=Graham |title=Intrusive Interventions: Public Health, Domestic Space, and Infectious Disease Surveillance in England, 1840–1914 |date=2015 |publisher=University of Rochester Press |location=Rochester, NY |isbn=9781580465274 |url=http://www.urpress.com/store/viewItem.asp?idProduct=14810 |accessdate=2 April 2016}}</ref> This proved successful but required acceptance of compulsory isolation rather than vaccination. C. Killick Millard, initially a supporter of compulsory vaccination, was appointed [[Medicine:Medical Officer of Health|Medical Officer of Health]] in 1901. He moderated his views on compulsion but encouraged contacts and his staff to accept vaccination. This approach, developed initially due to overwhelming opposition to government policy, became known as the Leicester Method.<ref name="millard1948" /><ref name="fraser">{{cite journal |last=Fraser |first=Stuart M.F. |title=Leicester and Smallpox: the Leicester Method |journal=Med. Hist. |year=1980 |volume=24 |issue=3 |pages=315–332 |doi=10.1017/s0025727300040345 |pmid=6997656 |pmc=1082657}}</ref> In time it became generally accepted as the most appropriate way to deal with smallpox outbreaks and was listed as one of the "important events in the history of smallpox control" by those most involved in the [[Organization:World Health Organization|World Health Organization]]'s successful [[Medicine:Smallpox|Smallpox]] Eradication Campaign. The final stages of the campaign, generally referred to as "surveillance containment", owed much to the Leicester method.<ref>{{cite book |last=Fenner |first=Frank |title=Smallpox and its Eradication |year=1988 |publisher=World Health Organization |location=Geneva |isbn=92 4 156110 6 |pages=247, 275 |author2=Henderson, D.A. |author3=Arita, I. |author4=Jezek, Z. |author5=Ladnyi, I.D. }}</ref><ref>{{cite book |last=Henderson |first=Donald, A. |title=Smallpox; the death of a disease |year=2009 |publisher=Prometheus Books |location=Amherst, N.Y. |isbn=978 1 59102 722 5 |pages=90–92}}</ref>

===United States===
In the US, President Thomas Jefferson took a close interest in vaccination, alongside Dr. Waterhouse, chief physician at Boston. Jefferson encouraged the development of ways to transport vaccine material through the Southern states, which included measures to avoid damage by heat, a leading cause of ineffective batches. [[Medicine:Smallpox|Smallpox]] outbreaks were contained by the latter half of the 19th century, a development widely attributed to the vaccination of a large portion of the population. Vaccination rates fell after this decline in smallpox cases, and the disease again became epidemic in the late 19th century (see [[Medicine:Smallpox|Smallpox]]).<ref>{{vcite book |editor=Plotkin SA, Orenstein WA |title=Vaccines |author=Henderson DA, Moss B |url=https://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=vacc |chapter=Public health |chapterurl=https://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=vacc&part=A45 |edition=3rd |publishers=W. B. Saunders |location=Philadelphia |isbn=0-7216-7443-7 |date=1999 }}</ref>

After an 1879 visit to New York by prominent British anti-vaccinationist William Tebb, The Anti-Vaccination Society of America was founded.<ref>{{cite journal |author1=Robert M. Wolfe |author2=Lisa K Sharp |title=Anti-vaccinationists past and present |date=August 24, 2002 |quote=In 1879, after a visit to New York by William Tebb, the leading British anti-vaccinationist, the Anti-Vaccination Society of America was founded. Subsequently, the New England Anti-Compulsory Vaccination League was formed in 1882 and the Anti-Vaccination League of New York City in 1885. |pmc=1123944 |pmid=12193361 |volume=325 |issue=7361 |pages=430–432 |doi=10.1136/bmj.325.7361.430 |journal=BMJ}}</ref><ref name=history>{{cite news |url=http://www.historyofvaccines.org/content/articles/history-anti-vaccination-movements |title=History of Anti-vaccination Movements |date=March 8, 2012 |accessdate=2015-02-11 |quote=The Anti Vaccination Society of America was founded in 1879, following a visit to America by leading British anti-vaccinationist William Tebb. Two other leagues, the New England Anti Compulsory Vaccination League (1882) and the Anti-Vaccination League of New York City (1885) followed. ... |publisher=College of Physicians of Philadelphia }}</ref> The New England Anti-Compulsory Vaccination League formed in 1882, and the Anti-Vaccination League of New York City in 1885.<ref name=history/> Tactics in the US largely followed those used in England.<ref>{{cite journal |last=Kaufman |first=M. |title=The American Anti-vaccinionationists and their Arguments |journal=Bull. Hist. Med. |year=1967 |volume=41 |issue=5 |pages=463–478 |pmid=4865041}}</ref> Vaccination in the US was regulated by individual states, in which there followed a progression of compulsion, opposition, and repeal similar to that in England.<ref>{{cite book |last=Hopkins |first=Donald R. |title=The Greatest Killer; smallpox in history |year=2002 |publisher=University of Chicago Press |location=Chicago |isbn=978-0226351667 |pages=83–84}}</ref> Although generally organized on a state-by-state basis, the vaccination controversy reached the US Supreme Court in 1905. There, in the case of [[Biology:Jacobson v. Massachusetts|Jacobson v. Massachusetts]], the court ruled that states have the authority to require vaccination against smallpox during a smallpox epidemic.<ref>{{cite journal | pmc= 1449224 | pmid=15798113 | doi=10.2105/AJPH.2004.055160 | volume=95 | issue=4 | title=Jacobson v Massachusetts: it's not your great-great-grandfather's public health law | year=2005 | journal=Am J Public Health | pages=581–590 | author=Mariner WK, Annas GJ, Glantz LH}}</ref>

John Pitcairn, the wealthy founder of the Pittsburgh Plate Glass Company (now [[Company:PPG Industries|PPG Industries]]), emerged as a major financier and leader of the American anti-vaccination movement. On March 5, 1907, in Harrisburg, Pennsylvania, he delivered an address to the Committee on Public Health and Sanitation of the Pennsylvania General Assembly criticizing vaccination.<ref name="vaccination_address">{{cite book |author=Pitcairn J |title=Vaccination |publisher=Anti-Vaccination League of Pennsylvania |year=1907 |url=https://archive.org/details/vaccination00pitcgoog |oclc=454411147 }}</ref> He later sponsored the National Anti-Vaccination Conference, which, held in Philadelphia in October 1908, led to the creation of The Anti-Vaccination League of America. When the league organized later that month, members chose Pitcairn as their first president.<ref name="Horrors">{{cite book |author=Higgins CM |title=Horrors of Vaccination Exposed and Illustrated |chapter=Life sketch of John Pitcairn by a Philadelphia friend |pages=73–75 |location=Brooklyn, NY |publisher=C. M. Higgins |year=1920 |url=https://archive.org/details/horrorsvaccinat00higggoog |oclc=447437840 }}</ref>

On December 1, 1911, Pitcairn was appointed by Pennsylvania Governor John K. Tener to the Pennsylvania State Vaccination Commission, and subsequently authored a detailed report strongly opposing the commission's conclusions.<ref name="Horrors" /> He remained a staunch opponent of vaccination until his death in 1916.

===Brazil===
In November 1904, in response to years of inadequate sanitation and disease, followed by a poorly explained public health campaign led by the renowned Brazilian public health official Oswaldo Cruz, citizens and military cadets in Rio de Janeiro arose in a ''Revolta da Vacina'', or [[Biology:Vaccine Revolt|Vaccine Revolt]]. Riots broke out on the day a vaccination law took effect; vaccination symbolized the most feared and most tangible aspect of a public health plan that included other features, such as urban renewal, that many had opposed for years.<ref>{{cite journal |journal=J Lat Am Stud |year=1989 |volume=21 |issue=2 |pages=241–266 |title='Living worse and costing more': resistance and riot in Rio de Janeiro, 1890–1917 |author=Meade T |doi=10.1017/S0022216X00014784}}</ref>

==Later vaccines and antitoxins==

Opposition to smallpox vaccination continued into the 20th century and was joined by controversy over new vaccines and the introduction of [[Biology:Antitoxin|antitoxin]] treatment for [[Medicine:Diphtheria|diphtheria]]. Injection of horse serum into humans as used in antitoxin can cause [[Medicine:Hypersensitivity|hypersensitivity]], commonly referred to as serum sickness. Moreover, the continued production of smallpox vaccine in animals and the production of antitoxins in horses prompted anti-vivisectionists to oppose vaccination.<ref>Ciok, Amy E. "Horses and the diphtheria antitoxin."&nbsp;''Academic Medicine''&nbsp;75.4 (2000): 396.</ref>

Diphtheria antitoxin was serum from horses that had been immunized against diphtheria, and was used to treat human cases by providing [[Biology:Passive immunity|passive immunity]]. In 1901, antitoxin from a horse named [[Medicine:Jim (horse)|Jim]] was contaminated with [[Medicine:Tetanus|tetanus]] and killed 13 children in St Louis, Missouri. This incident, together with nine deaths from tetanus from contaminated smallpox vaccine in Camden, New Jersey, led directly and quickly to the passing of the [[Medicine:Biologics Control Act|Biologics Control Act]] in 1902.<ref>{{cite journal |last=Lilienfield |first=D.E. |title=The First Pharmacoepidemiologic Investigations: national drug safety policy in the United States, 1901–1902 |journal=Perspect. Biol. Med. |year=2008 |volume=51 |issue=2 |pages=188–98 |pmid=18453724 |doi=10.1353/pbm.0.0010}}</ref>

[[Biography:Robert Koch|Robert Koch]] developed [[Chemistry:Tuberculin|tuberculin]] in 1890. Inoculated into individuals who have had [[Medicine:Tuberculosis|tuberculosis]], it produces a [[Medicine:Hypersensitivity|hypersensitivity]] reaction, and is still used to detect those who have been infected. However, Koch used tuberculin as a vaccine. This caused serious reactions and deaths in individuals whose latent tuberculosis was reactivated by the tuberculin.<ref>{{cite book |last=Gradman |first=Christopher |title=Laboratory Disease; Robert Koch's medical bacteriology |year=2009 |publisher=Johns Hopkins University Press |location=Baltimore |isbn=978 0 8018 9313 1 |pages=133–6}}</ref> This was a major setback for supporters of new vaccines.<ref name=baxby2001/>{{rp |30–31}} Such incidents and others ensured that any untoward results concerning vaccination and related procedures received continued publicity, which grew as the number of new procedures increased.<ref>Brock, Thomas.&nbsp;''Robert Koch: A life in medicine and bacteriology.''&nbsp;ASM Press: Washington DC, 1999. Print.</ref>

In 1955, in a tragedy known as the [[Biology:Cutter incident|Cutter incident]], [[Organization:Cutter Laboratories|Cutter Laboratories]] produced 120,000 doses of the Salk polio vaccine that inadvertently contained some live polio virus along with inactivated virus. This vaccine caused 40,000 cases of polio, 53 cases of paralysis, and five deaths. The disease spread through the recipients' families, creating a polio epidemic that led to a further 113 cases of paralytic polio and another five deaths. It was one of the worst pharmaceutical disasters in US history.<ref>{{Cite journal |title=The Cutter Incident, 50 Years Later |date=April 7, 2005 |last=Offit |first=Paul A |journal=New England Journal of Medicine |volume=352 |pages=1411–2 |doi=10.1056/NEJMp048180 |pmid=15814877 |issue=14}}</ref>

Later 20th-century events included the 1982 broadcast of ''DPT: Vaccine Roulette'', which sparked debate over the [[Medicine:DPT vaccine|DPT vaccine]],<ref>{{cite news |title=Scientist: autism paper had catastrophic effects |publisher=NPR |date=2010-02-07 |url=https://www.npr.org/templates/story/story.php?storyId=123472234 }}</ref> and the 1998 publication of a fraudulent academic article by [[Biography:Andrew Wakefield|Andrew Wakefield]]<ref name=Goldacre-2008>{{cite news |title=The MMR hoax |author=Goldacre B |work=The Guardian |date=August 30, 2008 |accessdate=2008-08-30 |url=https://www.theguardian.com/society/2008/aug/30/mmr.health.media |archiveurl=http://www.badscience.net/2008/08/the-medias-mmr-hoax/ |archivedate=August 30, 2008 |location=London}}</ref> which sparked the [[Social:MMR vaccine controversy|MMR vaccine controversy]]. Also recently, the [[Medicine:HPV vaccine|HPV vaccine]] has become controversial due to concerns that it may encourage promiscuity when given to 11- and 12-year-old girls.<ref>{{cite web |url=https://www.npr.org/2011/09/19/140543977/hpv-vaccine-the-science-behind-the-controversy |title=HPV Vaccine: The Science Behind The Controversy |publisher=NPR |date=September 19, 2011 |accessdate=September 30, 2015 |author=Knox, Richard}}</ref><ref>{{cite journal |last1=Chatterjee |first1=Archana |last2=O’Keefe |first2=Catherine |title=Current controversies in the USA regarding vaccine safety |journal=Expert Review of Vaccines |date=May 2010 |volume=9 |issue=5 |pages=497–502 |doi=10.1586/erv.10.36|pmid=20450324 }}</ref>

Arguments against vaccines in the 21st century are often similar to those of 19th-century anti-vaccinationists.<ref name="wolfesharp" />

Studies done during 2008–2010s suggest that higher education levels and socioecomonic status of parents were associated with lower completion rates for vaccination.<ref>{{cite journal |last1=Pearce |first1=Anna |last2=Law |first2=Catherine |last3=Elliman |first3=David |last4=Cole |first4=Tim J. |last5=Bedford |first5=Helen |title=Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study |journal=BMJ (Clinical Research Ed.) |date=5 April 2008 |volume=336 |issue=7647 |pages=754–757 |doi=10.1136/bmj.39489.590671.25 |pmid=18309964 |pmc=2287222}}</ref><ref>{{cite journal |last1=Yang |first1=Y. Tony |last2=Delamater |first2=Paul L. |last3=Leslie |first3=Timothy F. |last4=Mello |first4=Michelle M. |title=Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California |journal=American Journal of Public Health |date=1 January 2016 |volume=106 |issue=1 |pages=172–177 |doi=10.2105/AJPH.2015.302926 |pmid=26562114  |pmc=4695929 }}</ref><ref>{{cite journal |last1=Ogilvie |first1=Gina |last2=Anderson |first2=Maureen |last3=Marra |first3=Fawziah |last4=McNeil |first4=Shelly |last5=Pielak |first5=Karen |last6=Dawar |first6=Meena |last7=McIvor |first7=Marilyn |last8=Ehlen |first8=Thomas |last9=Dobson |first9=Simon |last10=Money |first10=Deborah |last11=Patrick |first11=David M. |last12=Naus |first12=Monika |title=A Population-Based Evaluation of a Publicly Funded, School-Based HPV Vaccine Program in British Columbia, Canada: Parental Factors Associated with HPV Vaccine Receipt |journal=PLOS Medicine |date=4 May 2010 |volume=7 |issue=5 |pages=e1000270 |doi=10.1371/journal.pmed.1000270 |pmid=20454567 |pmc=2864299 }}</ref><ref>{{cite journal |last1=Amit Aharon |first1=Anat |last2=Nehama |first2=Haim |last3=Rishpon |first3=Shmuel |last4=Baron-Epel |first4=Orna |title=Parents with high levels of communicative and critical health literacy are less likely to vaccinate their children |journal=Patient Education and Counseling |date=21 November 2016 |doi=10.1016/j.pec.2016.11.016 |pmid=27914735 |volume=100 |issue=4 |pages=768–775}}</ref><ref>{{cite journal |last1=Kim |first1=Sam S. |last2=Frimpong |first2=Jemima A. |last3=Rivers |first3=Patrick A. |last4=Kronenfeld |first4=Jennie J. |title=Effects of Maternal and Provider Characteristics on Up-to-Date Immunization Status of Children Aged 19 to 35 Months |journal=American Journal of Public Health |date=22 January 2017 |volume=97 |issue=2 |pages=259–266 |doi=10.2105/AJPH.2005.076661 |pmc=1781415 |pmid=17194865}}</ref>

==Effectiveness==
[[File:Rubella-us-1966-93-cdc.gif |thumb|350px |right |Rubella fell sharply when universal immunization was introduced. CDC.]]

Scientific evidence for the effectiveness of large-scale vaccination campaigns is well established.<ref>{{Cite journal |last=Christenson |first=Brith |last2=Lundbergh |first2=Per |last3=Hedlund |first3=Jonas |last4=Örtqvist |first4=Åke |date=2001-03-31 |title=Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study |url=http://thelancet.com/journals/lancet/article/PIIS0140-6736(00)04237-9/abstract |journal=The Lancet |language=English |volume=357 |issue=9261 |pages=1008–1011 |doi=10.1016/S0140-6736(00)04237-9  |pmid=11293594 }}</ref> Vaccination campaigns helped eradicate [[Medicine:Smallpox|smallpox]], which once killed as many as one in seven children in [[Earth:Europe|Europe]],<ref name="Fenner">{{cite book |author=Fenner F, Henderson DA, Arita I, Ježek Z, Ladnyi, ID |url=http://whqlibdoc.who.int/smallpox/9241561106.pdf |accessdate=2007-09-04 |format=PDF |title=Smallpox and its Eradication |publisher=World Health Organization |location=Geneva |year=1988 |isbn=978-92-4-156110-5}}</ref> and have nearly [[Medicine:Poliomyelitis eradication|eradicated polio]].<ref>{{Cite book |journal=Curr Top Microbiol Immunol |year=2006 |volume=304 |pages=195–220 |title=Mass vaccination campaigns for polio eradication: an essential strategy for success |vauthors=Sutter RW, Maher C |pmid=16989271 |doi=10.1007/3-540-36583-4_11 |series=Current Topics in Microbiology and Immunology |isbn=978-3-540-29382-8}}</ref> As a more modest example, infections caused by ''[[Biology:Haemophilus influenzae|Haemophilus influenzae]]'', a major cause of bacterial meningitis and other serious diseases in children, have decreased by over 99% in the US since the introduction of a vaccine in 1988.<ref>{{cite journal |author=Centers for Disease Control and Prevention (CDC) |title=Progress toward elimination of ''Haemophilus influenzae'' type b invasive disease among infants and children—United States, 1998–2000 |journal=MMWR Morb Mortal Wkly Rep |volume=51 |issue=11 |pages=234–7 |year=2002 |pmid=11925021 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5111a4.htm}}</ref> It is estimated that full vaccination, from birth to adolescence, of all US children born in a given year would save 33,000 lives and prevent 14 million infections.<ref>{{cite news |author=Park A |url=http://www.time.com/time/health/article/0,8599,1808438-1,00.html |title=How safe are vaccines? |work={{wipe|Time (magazine)}} |date=2008-05-21}}</ref>

Some argue that these reductions in infectious disease are a result of improved sanitation and hygiene (rather than vaccination), or that these diseases were already in decline before the introduction of specific vaccines. These claims are not supported by scientific data; the incidence of vaccine-preventable diseases tended to fluctuate over time until the introduction of specific vaccines, at which point the incidence dropped to near zero. A Centers for Disease Control website aimed at countering common misconceptions about vaccines argued, "Are we expected to believe that better sanitation caused incidence of each disease to drop, just at the time a vaccine for that disease was introduced?"<ref name="CDC: common misconceptions">{{cite web |url=https://www.cdc.gov/vaccines/vac-gen/6mishome.htm |title=Some common misconceptions about vaccination and how to respond to them |publisher=National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention |accessdate=September 28, 2012 |archiveurl=https://web.archive.org/web/20150120055820/http://www.cdc.gov/vaccines/vac-gen/6mishome.htm |archivedate=January 20, 2015 }}</ref>

Other critics argue that the immunity granted by vaccines is only temporary and requires boosters, whereas those who survive the disease become permanently immune.<ref name="wolfesharp" /> As discussed below, the philosophies of some alternative medicine practitioners are incompatible with the idea that vaccines are effective.<ref name="Ernst" />

===Population health===
[[File:Charlotte Cleverley-Bisman.jpg |thumb|Charlotte Cleverley-Bisman, who had all four limbs partially amputated aged seven months due to meningococcal disease.<ref>{{cite web |last1=Wane |first1=Joanna |title=The case for vaccination |url=http://www.biocsl.co.nz/docs/957/642/NorthSouth_case-for-accination.pdf |website=North & South |accessdate=July 3, 2015}}</ref> More widespread vaccination can protect children like Cleverley-Bisman, who are too young to vaccinate, from catching the disease through development of herd immunity..<ref name=pmid21427399 >{{cite journal|last1=Fine|first1=P.|last2=Eames|first2=K.|last3=Heymann|first3=D. L.|date=1 April 2011|title="Herd immunity": A rough guide|url=http://cid.oxfordjournals.org/content/52/7/911.full|journal=Clinical Infectious Diseases|volume=52|issue=7|pages=911–16|doi=10.1093/cid/cir007|pmid=21427399}}</ref>]]
Incomplete vaccine coverage increases the risk of disease for the entire population, including those who have been vaccinated, because it reduces [[Medicine:Herd immunity|herd immunity]]. For example, the measles vaccine is given to children between the ages of 9 and 12 months, and the short window between the disappearance of maternal antibody (before which the vaccine often fails to [[Biology:Seroconversion|seroconvert]]) and natural infection means that vaccinated children are frequently still vulnerable. Herd immunity lessens this vulnerability if all the children are vaccinated. Increasing herd immunity during an outbreak or risk of outbreak is perhaps the most widely accepted justification for mass vaccination. Mass vaccination also helps to increase coverage rapidly, thus obtaining herd immunity, when a new vaccine is introduced.<ref>{{Cite book |vauthors=Heymann DL, Aylward RB |title=Mass vaccination: when and why |journal=Curr Top Microbiol Immunol |volume=304 |pages=1–16 |year=2006 |pmid=16989261 |doi=10.1007/3-540-36583-4_1 |series=Current Topics in Microbiology and Immunology |isbn=978-3-540-29382-8 }}</ref>

Herd immunity also decreases risk to people who have a compromised immune system. Some people who have a compromised immune system cannot get certain vaccines and thus are at increased risk if those around them are not vaccinated for those diseases. If the immunocompromised person is surrounded by people who have not been vaccinated and have the disease, that person will likely contract the disease. The outcome for people with compromised immune systems who subsequently get infected is often worse than that of the general population. Herd immunity decreases this risk.<ref>{{cite web |url=https://www.cdc.gov/features/ReasonsToVaccinate |title=Immunization |publisher=}}</ref>

===Cost-effectiveness===

Commonly used vaccines are a cost-effective and preventive way of promoting health, compared to the treatment of acute or chronic disease. In the US during the year 2001, routine childhood immunizations against seven diseases were estimated to save over $40 billion per birth-year cohort in overall social costs, including $10 billion in direct health costs, and the societal benefit-cost ratio for these vaccinations was estimated to be 16.5.<ref>{{cite journal |vauthors=Zhou F, Santoli J, Messonnier ML, et al. |title=Economic evaluation of the 7-vaccine routine childhood immunization schedule in the United States, 2001 |journal=Arch Pediatr Adolesc Med |volume=159 |issue=12 |pages=1136–44 |year=2005 |pmid=16330737 |url=http://archpedi.ama-assn.org/cgi/content/full/159/12/1136 |doi=10.1001/archpedi.159.12.1136}}</ref>

===Necessity===

If a vaccination program successfully reduces the disease threat, it may reduce the perceived risk of disease as cultural memories of the effects of that disease fade. At this point, parents may feel they have nothing to lose by not vaccinating their children.<ref>{{cite journal |journal=Am J Epidemiol |year=1986 |volume=124 |issue=6 |pages=1012–20 |title=Individual versus public priorities in the determination of optimal vaccination policies |vauthors=Fine PE, Clarkson JA |pmid=3096132 }}</ref> If enough people hope to become free-riders, gaining the benefits of [[Medicine:Herd immunity|herd immunity]] without vaccination, vaccination levels may drop to a level where herd immunity is ineffective.<ref>{{cite journal |last1=Buttenheim |first1=AM |last2=Asch |first2=DA |title=Making vaccine refusal less of a free ride |journal=Human Vaccines & Immunotherapeutics |date=December 2013 |volume=9 |issue=12 |pages=2674–5 |pmid=24088616 |doi=10.4161/hv.26676 |pmc=4162060}}</ref>

==Events following reductions in vaccination==

In several countries, reductions in the use of some vaccines were followed by increases in the diseases' morbidity and mortality.<ref name="Gangarosa_pertussis" /><ref name="Allen_herd" /> According to the Centers for Disease Control and Prevention, continued high levels of vaccine coverage are necessary to prevent resurgence of diseases that have been nearly eliminated.<ref name="CDC_stop">{{cite web |url=https://www.cdc.gov/vaccines/vac-gen/whatifstop.htm |title=What would happen if we stopped vaccinations? |accessdate=2008-04-25 |date=2007-06-12 |publisher=Centers for Disease Control and Prevention }}</ref> Pertussis remains a major health problem in developing countries, where mass vaccination is not practiced; the World Health Organization estimates it caused 294,000 deaths in 2002.<ref>{{cite book |chapter=Pertussis |title=Epidemiology and Prevention of Vaccine-Preventable Diseases |veditors=Atkinson W, Hamborsky J, McIntyre L, Wolfe S |author=Centers for Disease Control and Prevention |location=Washington, DC |publisher=Public Health Foundation |year=2007 |chapterurl=https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf |isbn=978-0-01-706605-3}}</ref>

===Stockholm, smallpox (1873–74)===

An anti-vaccination campaign motivated by religious objections, concerns about effectiveness, and concerns about individual rights led to the vaccination rate in Stockholm dropping to just over 40%, compared to about 90% elsewhere in Sweden. A major smallpox [[Medicine:Epidemic|epidemic]] began there in 1873. It led to a rise in vaccine uptake and an end of the epidemic.<ref>{{cite journal |journal=Soc Hist Med |year=1992 |volume=5 |issue=3 |pages=369–88 |title=The right to die? Anti-vaccination activity and the 1874 smallpox epidemic in Stockholm |vauthors=Nelson MC, Rogers J |pmid=11645870 |doi=10.1093/shm/5.3.369}}</ref>

[[File:Diphtheria vaccination poster.jpg |thumb |upright |In a postwar poster the Ministry of Health urged British residents to immunize children against diphtheria.]]

===Vietnam===
During the Vietnam War, vaccination was necessary for soldiers to fight overseas. Because disease follows soldiers, they had to receive vaccines preventing cholera, influenza, measles, meningococcal, plague, poliovirus, smallpox, tetanus, diphtheria, typhoid, typhus, and yellow fever. However, the diseases mainly prevalent in Vietnam at this time were measles and polio. After arriving in Vietnam, the United States Military conducted the "Military Public Health Assistance Project".<ref>{{Cite journal |title=Immunization to Protect the US Armed Forces: Heritage, Current Practice, and Prospects |url=http://epirev.oxfordjournals.org/content/28/1/3 |journal=Epidemiologic Reviews |date=2006-08-01  |pmid=16763072 |pages=3–26 |volume=28 |issue=1 |doi=10.1093/epirev/mxj003 |first=John D. |last=Grabenstein |first2=Phillip R. |last2=Pittman |first3=John T. |last3=Greenwood |first4=Renata J. M. |last4=Engler}}</ref> This public health program was a joint United States Military and Government of Vietnam concept to create or expand public medical facilities throughout South Vietnam.<ref>{{Cite web |title=The Night the Viet Cong Stopped the War |url=http://www.historynet.com/the-night-the-viet-cong-stopped-the-war.htm |website=History Net: Where History Comes Alive – World & US History Online |accessdate=18 November 2015|language=en-US|date=17 March 2011|last=Worthington|first=Bob}}</ref> Local villages in Vietnam were inoculated. The United States military screened patients, dispensed medication, distributed clothing and food, and even passed out propaganda such as comic books.<ref>{{Cite book|url=https://www.worldcat.org/oclc/774064073|title=Tunku Abdul Rahman Putra Al-Haj|last=Putra.|first=Al-Haj, Tunku Abdul Rahman|date=2008|publisher=Institute of Diplomacy and Foreign Relations (IDFR), Ministry of Foreign Affairs|others=Malaysia. Ministry of Foreign Affairs. Institute of Diplomacy and Foreign Relations (IDFR)|isbn=9789832220268|location=Kuala Lumpur|oclc=774064073}}</ref>

===UK, pertussis (1970s–80s)===

In a 1974 report ascribing 36 reactions to whooping cough (pertussis) vaccine, a prominent public-health academic claimed that the vaccine was only marginally effective and questioned whether its benefits outweigh its risks, and extended television and press coverage caused a scare. Vaccine uptake in the UK decreased from 81% to 31%, and pertussis epidemics followed, leading to the deaths of some children. Mainstream medical opinion continued to support the effectiveness and safety of the vaccine; public confidence was restored after the publication of a national reassessment of vaccine efficacy. Vaccine uptake then increased to levels above 90%, and disease incidence declined dramatically.<ref name="Gangarosa_pertussis">{{cite journal |journal=Lancet |year=1998 |volume=351 |issue=9099 |pages=356–61 |title=Impact of anti-vaccine movements on pertussis control: the untold story |vauthors=Gangarosa EJ, Galazka AM, Wolfe CR, et al. |doi=10.1016/S0140-6736(97)04334-1 |pmid=9652634}}</ref>

===Sweden, pertussis (1979–96)===

In the vaccination moratorium period that occurred when Sweden suspended vaccination against whooping cough (pertussis) from 1979 to 1996, 60% of the country's children contracted the disease before the age of 10; close medical monitoring kept the death rate from whooping cough at about one per year.<ref name="Allen_herd">{{cite journal |author=Allen A |title=Bucking the herd |journal=The Atlantic |year=2002 |volume=290 |issue=2 |pages=40–2 |url=http://immunize.org/exemptions/allen.htm |accessdate=2007-11-07}}</ref>

===Netherlands, measles (1999–2000)===

<!-- I'm uncertain whether religious behaviour is in the same category - this is more like a control experiment (as sometimes demanded by anti-vaccinationists) If we define a-v as actively trying to stop others being vaccinated this group probably falls outside it, and therefore should move to the vaccination article AKM -->
An outbreak at a religious community and school in the Netherlands resulted in 3 deaths and 68 hospitalizations among 2,961 cases.<ref name="auto">{{cite journal |title=Measles outbreak—Netherlands, April 1999 – January 2000 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4914a2.htm |journal=MMWR Morb Mortal Wkly Rep |author=Centers for Disease Control and Prevention |year=2000 |volume=49 |issue=14 |pages=299–303 |pmid=10825086}}</ref> The population in the several provinces affected had a high level of immunization, with the exception of [[Medicine:Vaccination and religion|one of the religious denominations]], which traditionally does not accept vaccination. 95 percent of those who contracted measels were unvaccinated.<ref name="auto"/>

===UK and Ireland, measles (2000)===

As a result of the [[Social:MMR vaccine controversy|MMR vaccine controversy]], vaccination rates dropped sharply in the United Kingdom after 1996.<ref name="Pepys">{{cite journal |journal=Clin Med |year=2007 |volume=7 |issue=6 |pages=562–78 |title=Science and serendipity |author=Pepys MB |pmid=18193704 |doi=10.7861/clinmedicine.7-6-562}}</ref> From late 1999 until the summer of 2000, there was a [[Medicine:Measles|measles]] outbreak in North Dublin, Ireland. At the time, the national immunization level had fallen below 80%, and in part of North Dublin the level was around 60%. There were more than 100 hospital admissions from over 300 cases. Three children died and several more were gravely ill, some requiring mechanical ventilation to recover.<ref>Ireland measles outbreak:
* {{cite news |title=Measles outbreak feared |date=May 30, 2000 |publisher=BBC News |url=http://news.bbc.co.uk/2/hi/health/769381.stm }}
* {{cite journal |vauthors=McBrien J, Murphy J, Gill D, Cronin M, O'Donovan C, Cafferkey M |title=Measles outbreak in Dublin, 2000 |journal=Pediatr Infect Dis J |volume=22 |issue=7 |pages=580–4 |year=2003 |pmid=12867830 |doi=10.1097/00006454-200307000-00002}}</ref>

===Nigeria, polio, measles, diphtheria (2001–)===

In the early first decade of the 21st century, conservative religious leaders in northern Nigeria, suspicious of [[Medicine:Medicine|Western medicine]], advised their followers not to have their children vaccinated with oral polio vaccine. The boycott was endorsed by the governor of Kano State, and immunization was suspended for several months. Subsequently, polio reappeared in a dozen formerly polio-free neighbors of Nigeria, and genetic tests showed the virus was the same one that originated in northern Nigeria. Nigeria had become a net exporter of the polio virus to its African neighbors. People in the northern states were also reported to be wary of other vaccinations, and Nigeria reported over 20,000 measles cases and nearly 600 deaths from measles from January through March 2005.<ref name="Clements">{{cite journal |journal=Curr Drug Saf |volume=1 |issue=1 |year=2006 |pages=117–9 |title=How vaccine safety can become political – the example of polio in Nigeria |vauthors=Clements CJ, Greenough P, Shull D |url=http://bentham.org/cds/samples/cds1-1/Clements.pdf |format=PDF |doi=10.2174/157488606775252575 |pmid=18690921 |access-date=July 28, 2007 |archive-url=https://web.archive.org/web/20070928030913/http://bentham.org/cds/samples/cds1-1/Clements.pdf |archive-date=September 28, 2007 |dead-url=yes |df=mdy-all }}</ref> In 2006, Nigeria accounted for over half of all new polio cases worldwide.<ref>{{cite web |title=Wild poliovirus 2000–2008 |date=2008-02-05 |url=http://www.polioeradication.org/content/general/casecount.pdf |format=PDF |publisher=Global Polio Eradication Initiative |accessdate=2008-02-11 |archiveurl=https://web.archive.org/web/20070927204139/http://www.polioeradication.org/content/general/casecount.pdf <!-- Bot retrieved archive --> |archivedate=2007-09-27}}</ref> Outbreaks continued thereafter; for example, at least 200 children died in a late-2007 measles outbreak in Borno State.<ref>{{cite news |title='Hundreds' dead in measles outbreak |agency=IRIN |date=2007-12-14 |url=http://irinnews.org/Report.aspx?ReportId=75883 |accessdate=2008-02-10}}</ref>

===Indiana, United States, measles (2005)===

A 2005 measles outbreak in the US state of {{wipe|Indiana}} was attributed to parents who had refused to have their children vaccinated.<ref name="parker">{{cite journal |vauthors=Parker A, Staggs W, Dayan G, et al. |title=Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States |journal=N Engl J Med |volume=355 |issue=5 |pages=447–55 |year=2006 |pmid=16885548 |doi=10.1056/NEJMoa060775}}</ref>

===United States, measles (2013–)===

In 2000, measles was declared eliminated from the United States because internal transmission had been interrupted for one year; remaining reported cases were due to importation.<ref>{{cite web |url=https://www.cdc.gov/measles/about/faqs.html |title=Frequently Asked Questions about Measles in U.S |publisher=Centers for Disease Control and Prevention }}</ref>

The Centers for Disease Control and Prevention (CDC) reported that the three biggest outbreaks of measles in 2013 were attributed to clusters of people who were unvaccinated due to their philosophical or religious beliefs. As of August 2013, three pockets of outbreak—New York City, North Carolina, and Texas—contributed to 64% of the 159 cases of measles reported in 16 states.<ref>{{cite news |title=CDC: Vaccine "philosophical differences" driving up U.S. measles rates |author=Jaslow, Ryan |url=http://www.cbsnews.com/8301-204_162-57602677/cdc-vaccine-philosophical-differences-driving-up-u.s-measles-rates/ |publisher=CBS News |date=September 12, 2013 |accessdate=September 19, 2013}}</ref><ref>{{cite journal |last1=Centers for Disease Control and Prevention |title=National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months – United States, 2012 |journal=Morbidity and Mortality Weekly Report |volume=62 |issue=36 |pages=741–3 |date=September 13, 2013 |pmid=24025754 |pmc=4585572 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a1.htm}}</ref>

The number of cases in 2014 quadrupled to 644,<ref>{{cite news |vauthors=Rañoa R, Zarracina J |title=The spread of Disneyland measles outbreak |newspaper=Los Angeles Times |date=January 15, 2015 |url=http://www.latimes.com/visuals/graphics/la-me-g-spread-of-disneyland-measles-outbreak-20150113-htmlstory.html}}</ref> including transmission by unvaccinated visitors to Disneyland in California.<ref name=Alazraki11>{{cite news |author=Alazraki M |title=The Autism Vaccine Fraud: Dr. Wakefield's Costly Lie to Society |newspaper=DailyFinance, AOL Money & Finance |date=January 12, 2011 |url=http://www.dailyfinance.com/2011/01/12/autism-vaccine-fraud-wakefield-cost-money-deaths/ |access-date=October 18, 2011 |archive-url=https://web.archive.org/web/20111027104603/http://www.dailyfinance.com/2011/01/12/autism-vaccine-fraud-wakefield-cost-money-deaths/ |archive-date=October 27, 2011 |dead-url=yes |df=mdy-all }}</ref><ref>{{cite news |title=Measles outbreak worsens in US after unvaccinated woman visits Disneyland |url=https://www.theguardian.com/us-news/2015/jan/14/measles-outbreak-spreads-unvaccinated-woman-disneyland |accessdate=June 1, 2015 |date=January 19, 2015|website={{wipe|The Guardian}}|last=Glenza|first=Jessica}}</ref> Some 97% of cases in the first half of the year were confirmed to be due directly or indirectly to importation (the remainder were unknown), and 49% from the Philippines. 165 of the 288 victims (57%) during that time were confirmed to be unvaccinated by choice; 30 (10%) were confirmed to have been vaccinated.<ref name="cdc2014a">{{cite journal |authors=Gastañaduy PA, Redd SB, Fiebelkorn AP, Rota JS, Rota PA, Bellini WJ, Seward JF, Wallace GS |title=Measles — United States, January 1 – May 23, 2014 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=63 |issue=22 |pages=496–9 |year=2014 |pmid=24898167 |pmc=5779360 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6322a4.htm?s_cid=mm6322a4_w}}</ref> The final count of measles in 2014 was 668 cases in 27 states.<ref name=CDCdata>{{cite web |url=https://www.cdc.gov/measles/cases-outbreaks.html |title=Measles Cases and Outbreaks |author=CDC |publisher=CDC |date=June 30, 2015 |accessdate=July 2, 2015}}</ref>

From January 1 to June 26, 2015, 178 people from 24 states and the District of Columbia were reported to have measles. Most of these cases (117 cases [66%]) were part of a large multi-state outbreak linked to Disneyland in California, continued from 2014. Analysis by the CDC scientists showed that the measles virus type in this outbreak (B3) was identical to the virus type that caused the large measles outbreak in the Philippines in 2014.<ref name=CDCdata/> On July 2, 2015, the first confirmed death from measles in 12 years was recorded. An immunocompromised woman in Washington State was infected and later died of [[Medicine:Pneumonia|pneumonia]] due to measles.<ref>{{cite web |url=http://www.doh.wa.gov/Newsroom/2015NewsReleases/15119WAMeaslesRelatedDeath |title=Measles led to death of Clallam Co. woman; first in US in a dozen years |author=Press Release |publisher=Washington Department of Health |date=July 2, 2015}}</ref>

In spring 2017, a measles outbreak occurred in Minnesota. As of June 16, 78 cases of measles had been confirmed in the state, 71  were unvaccinated and 65 were Somali-Americans.<ref>{{cite web|url=http://www.health.state.mn.us/divs/idepc/diseases/measles/|title=Measles - Minnesota Dept. of Health|website=www.health.state.mn.us}}</ref><ref>{{cite web|url=https://www.washingtonpost.com/national/health-science/imams-in-us-take-on-the-anti-vaccine-movement-during-ramadan/2017/05/26/8660edc6-41ad-11e7-8c25-44d09ff5a4a8_story.html|title=Measles outbreak in Minnesota surpasses last year's total for the entire country|first=Lena H.|last=Sun|date=June 1, 2017|website={{wipe|The Washington Post}}}}</ref><ref>{{Cite web|url=http://www.cnn.com/2017/05/08/health/measles-minnesota-somali-anti-vaccine-bn/index.html|title=Anti-vaccine groups blamed in Minnesota measles outbreak|first=Jacqueline|last=Howard|website=CNN|access-date=26 May 2017|date=8 May 2017}}</ref><ref name=":3">{{Cite news|url=https://www.newscientist.com/article/mg23431253-200-minnesota-measles-outbreak-follows-antivaccination-campaign/|title=Minnesota measles outbreak follows anti-vaccination campaign|work=New Scientist|access-date=26 May 2017|date=10 May 2017|issue=3125|language=en-US|publication-date=13 May 2017}}</ref><ref name=":1">{{Cite news|url=https://www.npr.org/sections/health-shots/2017/05/03/526723028/autism-fears-fueling-minnesotas-measles-outbreak|title=Unfounded Autism Fears Are Fueling Minnesota's Measles Outbreak|work=NPR.org|access-date=26 May 2017|language=en|date=3 May 2017|last=Zdechlik|first=Mark}}</ref> The outbreak has been attributed to low vaccination rates among Somali-American children, which can be traced back to 2008, when Somali parents expressed concerns about disproportionately high numbers of Somali preschoolers in special education classes who were receiving services for autism spectrum disorder. Around this time, [[Biography:Andrew Wakefield|Andrew Wakefield]]  visited Minneapolis, teaming up with vaccine-skeptical groups to raise concerns about the MMR vaccine.<ref>{{cite web|url=https://www.npr.org/sections/health-shots/2017/05/03/526595475/understanding-the-history-behind-communities-vaccine-fears|title=Understanding The History Behind Communities' Vaccine Fears|website=NPR|date=3 May 2017|last=Sohn|first=Emily}}</ref> Multiple studies have shown no connection between the [[Medicine:MMR vaccine|MMR vaccine]] and [[Medicine:Autism|autism]].<ref>{{cite journal|url=https://academic.oup.com/cid/article/48/4/456/284219/Vaccines-and-Autism-A-Tale-of-Shifting-Hypotheses|title=Vaccines and Autism: A Tale of Shifting Hypotheses|first1=Jeffrey S.|last1=Gerber|first2=Paul A.|last2=Offit|date=February 15, 2009|journal=Clinical Infectious Diseases|volume=48|issue=4|pages=456–461|doi=10.1086/596476|pmid=19128068|pmc=2908388}}</ref>

===Wales, measles (2013–)===

In 2013, an outbreak of measles occurred in the Welsh city of Swansea. One death was reported.<ref name=over/> Some estimates indicate that while MMR uptake for two-year-olds was at 94% in Wales in 1995, it had fallen to as low as 67.5% in Swansea by 2003, meaning the region had a "vulnerable" age group.<ref>{{cite web |url=https://www.bbc.com/news/uk-wales-politics-23244628 |title=Swansea measles epidemic: Worries over MMR uptake after outbreak |publisher=BBC News |date=July 10, 2013 |accessdate=October 8, 2014}}</ref> This has been linked to the [[Social:MMR vaccine controversy|MMR vaccine controversy]], which caused a significant number of parents to fear allowing their children to receive the MMR vaccine.<ref name="over">{{cite web |url=https://www.bbc.com/news/uk-wales-23168519 |title=Swansea measles epidemic officially over |publisher=BBC News |date=July 3, 2013 |accessdate=October 8, 2014 |quote=Large numbers of children in the 10–18 age group were not given the MMR vaccine as babies, the result of a scare that caused panic among parents. It followed research by Dr Andrew Wakefield in the late 1990s that linked the vaccine with autism and bowel disease. His report, which was published in The Lancet medical journal, was later discredited, with health officials insisting the vaccine was completely safe.}}</ref>  5 June 2017 saw a new measles outbreak in Wales, at Lliswerry High School in the town of Newport.<ref>{{cite web|url=https://www.bbc.co.uk/news/uk-wales-south-east-wales-40366937|title=600 children get MMR jab after measles outbreak in Newport|publisher=BBC|date=22 June 2017}}</ref>

===United States, tetanus===

Most cases of pediatric [[Medicine:Tetanus|tetanus]] in the U.S. occur in unvaccinated children.<ref>{{cite journal |vauthors=Fair E, Murphy TV, Golaz A, Wharton M |title=Philosophic objection to vaccination as a risk for tetanus among children younger than 15 years |journal=Pediatrics |volume=109 |issue=1 |pages=e2 |year=2002 |pmid=11773570 |url=http://pediatrics.aappublications.org/cgi/content/full/109/1/e2 |doi=10.1542/peds.109.1.e2}}</ref>

=== Romania (2016–present) ===
[[File:Ovidiu Covaciu ESC2017.webm|thumb|Ovidiu Covaciu on how the Romanian antivaccine movement threatens Europe (2017).]]
As of September 2017, a measles epidemic was ongoing across Europe, especially Eastern Europe. In Romania, there were about 9300 cases of measles, and 34 people – all of whom were unvaccinated – had died of measles.<ref name="Covaciu">{{Cite web |url=https://www.youtube.com/watch?v=wFpAiHCQ85g |title=How the Romanian anti-vaccine movement threatens Europe |author=Ovidiu Covaciu |website=European Skeptics Congress |publisher=European Council of Skeptical Organisations |date=5 November 2017 |accessdate=6 November 2017}}</ref> This was preceded by a 2008 controversy regarding the HPV vaccine. In 2012, doctor Christa Todea-Gross published a free downloadable book online, this book contained misinformation about vaccination from abroad translated into Romanian, which significantly stimulated the growth of the anti-vaccine movement.<ref name="Covaciu"/> The government of Romania officially declared a measles epidemic in September 2016, and started an information campaign to encourage parents to have their children vaccinated. By February 2017, however, the stockpile of MMR vaccines was depleted, and doctors were overburdened. Around April, the vaccine stockpile had been restored, but by May 2017, the death toll had risen to 25.<ref name="Covaciu"/>

==Safety==
Few deny the vast improvements vaccination has made to public health; a more common concern is their safety.<ref name="LancetID">{{cite journal |journal=Lancet Infect Dis |year=2007 |volume=7 |issue=4 |page=235 |title=Tackling negative perceptions towards vaccination |doi=10.1016/S1473-3099(07)70057-9 |pmid=17376373 |author=<!-- unsigned editorial --> |url=http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2807%2970057-9/fulltext}}</ref> As with any medical treatment, there is a potential for vaccines to cause serious complications, such as severe allergic reactions,<ref>{{cite web |url=https://www.cdc.gov/vaccines/vac-gen/side-effects.htm#mmr |title=Possible Side-effects from Vaccines |accessdate=January 3, 2014 |publisher=Centers for Disease Control and Prevention |date=August 26, 2013}}</ref> but unlike most other medical interventions, vaccines are given to healthy people and so a higher standard of safety is expected.<ref>{{cite journal |title=Vaccine Safety: Current and Future Challenges |date=July 1998 |url=https://www.utoronto.ca/virology/mby480/VaccineSafe/VaccineSafe.htm |last=Chen |first=Robert T. |journal=Pediatric Annals |accessdate=January 3, 2014 |issue=7 |volume=27 |last2=Hibbs |first2=Beth}}</ref> While serious complications from vaccinations are possible, they are extremely rare and much less common than similar risks from the diseases they prevent.<ref name="CDC: common misconceptions" /> As the success of immunization programs increases and the incidence of disease decreases, public attention shifts away from the risks of disease to the risk of vaccination,<ref name="BH">{{cite journal |journal=Current Opinion in Infectious Diseases |year=2007 |volume=20 |issue=3 |pages=237–246 |title=Adverse events following immunization: perception and evidence |vauthors=Bonhoeffer J, Heininger U |doi=10.1097/QCO.0b013e32811ebfb0 |pmid=17471032 |url=http://lib.ajaums.ac.ir/booklist/955899.pdf}}</ref> and it becomes challenging for health authorities to preserve public support for vaccination programs.<ref>{{cite journal |author=Mooney C |title=Why does the vaccine/autism controversy live on? |journal=Discover |url=http://discovermagazine.com/2009/jun/06-why-does-vaccine-autism-controversy-live-on |date=June 2009 }}</ref>

Concerns about immunization safety often follow a pattern. First, some investigators suggest that a medical condition of increasing prevalence or unknown cause is an adverse effect of vaccination. The initial study and subsequent studies by the same group have inadequate methodology – typically a poorly controlled or uncontrolled [[Medicine:Case series|case series]]. A premature announcement is made about the alleged adverse effect, resonating with individuals suffering from the condition, and underestimating the potential harm of forgoing vaccination to those whom the vaccine could protect. Other groups attempt to replicate the initial study but fail to get the same results. Finally, it takes several years to regain public confidence in the vaccine.<ref name="BH" /> Adverse effects ascribed to vaccines typically have an unknown origin, an increasing [[Medicine:Incidence (epidemiology)|incidence]], some [[Medicine:Biological plausibility|biological plausibility]], occurrences close to the time of vaccination, and dreaded outcomes.<ref>{{vcite journal |author=Leask J, Chapman S, Cooper Robbins SC |title='All manner of ills': The features of serious diseases attributed to vaccination |journal=Vaccine |year=2009 |pmid=19879997 |doi=10.1016/j.vaccine.2009.10.042 }}</ref> In almost all cases, the public health effect is limited by cultural boundaries: English speakers worry about one vaccine causing autism, while French speakers worry about another vaccine causing multiple sclerosis, and Nigerians worry that a third vaccine causes infertility.<ref>{{cite book |last=Goldacre |first=Ben |title=Bad Science |year=2009 |publisher=Fourth Estate |location=London |isbn=9780007284870 |pages=292–294}}</ref>

===Autism controversies===

There is no evidence that vaccines cause [[Medicine:Autism|autism]] despite popular press and media linking the two.<ref name="BH" /><ref>{{cite news |url=https://www.theguardian.com/society/2010/feb/02/lancet-retracts-mmr-paper |title=Lancet retracts 'utterly false' MMR paper |last=Boseley |first=Sarah |date=February 2, 2010  |work=The Guardian |accessdate=February 2, 2010}}</ref><ref>{{cite journal |last=Taylor |first=Luke E. |author2=Swerdfeger, Amy L. |author3=Eslick, Guy D. |title=Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies |journal=Vaccine |doi=10.1016/j.vaccine.2014.04.085 |pmid=24814559 |volume=32 |issue=29 |date=June 2014 |pages=3623–3629}}</ref> Despite this, anti-vaccine activism continues. A developing tactic appears to be the "promotion of irrelevant research [as] an active aggregation of several questionable or peripherally related research studies in an attempt to justify the science underlying a questionable claim."<ref>{{cite journal |last1=Foster |first1=Craig A. |last2=Ortiz |first2=Sarenna M. |title=Vaccines, Autism, and the Promotion of Irrelevant Research: A Science-Pseudoscience Analysis |journal=[[Unsolved:Skeptical Inquirer|Skeptical Inquirer]] |date=2017 |volume=41 |issue=3 |pages=44-48 |url=https://web.archive.org/web/20181006204019/https://www.csicop.org/si/show/vaccines_autism_and_the_promotion_of_irrelevant_research_a_science-pseudosc |accessdate=6 October 2018}}</ref>


====Thiomersal====
{{Main |Chemistry:Thiomersal controversy}}
[[Chemistry:Thiomersal|Thiomersal]] (spelled "thimerosal" in the US) is an [[Chemistry:Antifungal|antifungal]] preservative used in small amounts in some multi-dose vaccines (where the same vial is opened and used for multiple patients) to prevent contamination of the vaccine.<ref name=Baker>{{cite journal |journal=Am J Public Health |year=2008 |title=Mercury, Vaccines, and Autism: One Controversy, Three Histories |author=Baker JP |doi=10.2105/AJPH.2007.113159 |pmid=18172138 |volume=98 |issue=2 |pages=244–253 |pmc=2376879}}</ref> Despite thiomersal's efficacy, the use of thiomersal is controversial because it contains [[Chemistry:Mercury (element)|mercury]]. As a result, in 1999, the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) asked vaccine makers to remove [[Chemistry:Thiomersal|thiomersal]] from vaccines as quickly as possible on the [[Precautionary principle|precautionary principle]]. Thiomersal is now absent from all common US and European vaccines, except for some preparations of [[Medicine:Influenza vaccine|influenza vaccine]].<ref name="Offit">{{cite journal |journal=N Engl J Med |year=2007 |volume=357 |issue=13 |pages=1278–1279 |title=Thimerosal and vaccines – a cautionary tale |author=Offit PA |doi=10.1056/NEJMp078187 |pmid=17898096 |url=http://content.nejm.org/cgi/content/full/357/13/1278}}</ref> (Trace amounts remain in some vaccines due to production processes, at an approximate maximum of 1 microgramme, around 15% of the average daily mercury intake in the US for adults and 2.5% of the daily level considered tolerable by the [[Organization:World Health Organization|WHO]].<ref>{{cite web |url=http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228 |title=Vaccine Safety & Availability – Thimerosal in Vaccines |publisher=}}</ref><ref>{{Cite journal |vauthors=Bose-O'Reilly S, McCarty KM, Steckling N, Lettmeier B |title=Mercury Exposure and Children's Health |journal=Current Problems in Pediatric and Adolescent Health Care |pmc=3096006 |pmid=20816346 |doi=10.1016/j.cppeds.2010.07.002 |volume=40 |issue=8 |year=2010 |pages=186–215}}</ref>) The action sparked concern that thiomersal could have been responsible for autism.<ref name="Offit" /> The idea is now considered disproven, as incidence rates for autism increased steadily even after thiomersal was removed from childhood vaccines.<ref name="Gerber" /> Currently there is no accepted scientific evidence that exposure to thiomersal is a factor in causing autism.<ref>{{cite journal |journal=Can J Neurol Sci |year=2006 |volume=33 |issue=4 |pages=341–346 |title=Immunizations and autism: a review of the literature |vauthors=Doja A, Roberts W |pmid=17168158 |doi=10.1017/s031716710000528x}}</ref> Since 2000, parents in the United States have pursued legal compensation from a federal fund arguing that thiomersal caused autism in their children.<ref name="Sugarman">{{cite journal |journal=N Engl J Med |year=2007 |volume=357 |issue=13 |pages=1275–1277 |title=Cases in vaccine court – legal battles over vaccines and autism |author=Sugarman SD |pmid=17898095 |url=http://content.nejm.org/cgi/content/full/357/13/1275 |doi=10.1056/NEJMp078168}}</ref> A 2004 Institute of Medicine (IOM) committee favored rejecting any causal relationship between thiomersal-containing vaccines and autism.<ref name="ISRC">{{cite book |author=Immunization Safety Review Committee |title=Immunization Safety Review: Vaccines and Autism |publisher=The National Academies Press |year=2004 |isbn=978-0-309-09237-1 |url=http://www.nap.edu/catalog.php?record_id=10997 }}</ref>

====MMR vaccine====
{{Main |Social:MMR vaccine controversy}}

In the UK, the [[Medicine:MMR vaccine|MMR vaccine]] was the subject of controversy after the publication in ''The Lancet'' of a 1998 paper by [[Biography:Andrew Wakefield|Andrew Wakefield]] and others reporting case histories of 12 children mostly with [[Medicine:Autism spectrum|autism spectrum disorders]] with onset soon after administration of the vaccine.<ref>{{cite journal |title=Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children |journal=Lancet |volume=351 |issue=9103 |pages=637–641 |year=1998 |doi=10.1016/S0140-6736(97)11096-0 |pmid=9500320 |url=http://briandeer.com/mmr/lancet-paper.htm |accessdate=2007-09-05 |vauthors=Wakefield A, Murch S, Anthony A, et al. |authorlink1=Andrew Wakefield }}{{Retracted paper |intentional=yes}}</ref> At a 1998 press conference, Wakefield suggested that giving children the vaccines in three separate doses would be safer than a single vaccination. This suggestion was not supported by the paper, and several subsequent peer-reviewed studies have failed to show any association between the vaccine and autism.<ref name="NHS">{{cite web |title=MMR vaccine |url=https://www.nhs.uk/conditions/vaccinations/mmr-vaccine/ |accessdate=4 July 2018 |year=2015|author=National Health Service}}</ref> It later emerged that Wakefield had received funding from litigants against vaccine manufacturers and that he had not informed colleagues or medical authorities of his [[Philosophy:Conflict of interest|conflict of interest]];<ref>{{cite news |author=Deer B |title=Revealed: MMR research scandal |work=The Sunday Times |date=2004-02-22 |url=http://www.timesonline.co.uk/tol/news/uk/health/article1027603.ece |accessdate=2007-09-23}}</ref> had this been known, publication in ''The Lancet'' would not have taken place in the way that it did.<ref>{{cite journal |journal=Lancet |year=2004 |volume=363 |issue=9411 |pages=747–749 |title=The lessons of MMR |author=Horton R |doi=10.1016/S0140-6736(04)15714-0 |pmid=15016482}}</ref> Wakefield has been heavily criticized on scientific grounds and for triggering a decline in vaccination rates<ref>{{cite news |url=http://news.bbc.co.uk/2/hi/health/5118166.stm |publisher=BBC News |title=Doctors issue plea over MMR jab |date=2006-06-26 |accessdate=2007-11-23}}</ref> (vaccination rates in the UK dropped to 80% in the years following the study),<ref name=Alazraki11/> as well as on ethical grounds for the way the research was conducted.<ref name="paid_children">{{cite news |url=http://news.bbc.co.uk/2/hi/health/6289166.stm |title=MMR scare doctor 'paid children' |publisher=BBC News |date=2007-07-16 }}</ref> In 2004, the MMR-and-autism interpretation of the paper was formally retracted by 10 of Wakefield's 12 coauthors,<ref>{{cite journal |vauthors=Murch SH, Anthony A, Casson DH et al. |title=Retraction of an interpretation |journal=Lancet |volume=363 |issue=9411 |page=750 |year=2004 |pmid=15016483 |doi=10.1016/S0140-6736(04)15715-2}}</ref> and in 2010 ''The Lancet''{{'}}s editors fully retracted the paper.<ref>{{cite journal |title=Retraction – Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children |journal=Lancet |volume=375 |issue=9713 |page=445 |date=February 2010 |pmid=20137807 |doi=10.1016/S0140-6736(10)60175-4 |laysource=BBC News |laydate=2010-02-02 |laysummary=http://news.bbc.co.uk/2/low/health/8493753.stm |last1=The Editors Of The Lancet }}</ref> Wakefield was struck off the UK medical register, with a statement identifying deliberate falsification in the research published in ''The Lancet'',<ref name=gmc-uk_Wakefield_SPM>{{cite web |url=http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf |format=PDF |title=General Medical Council, Fitness to Practise Panel Hearing, 24 May 2010, Andrew Wakefield, Determination of Serious Professional Misconduct |accessdate=September 18, 2011 |publisher=General Medical Council |deadurl=yes |archiveurl=https://web.archive.org/web/20130512115524/http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf |archivedate=May 12, 2013 }}</ref> and is barred from practising medicine in the UK.<ref name=MeikleBoseley>{{cite news |url=https://www.theguardian.com/society/2010/may/24/mmr-doctor-andrew-wakefield-struck-off |title=MMR row doctor Andrew Wakefield struck off register |newspaper=The Guardian |date=May 24, 2010 |accessdate=May 24, 2010 |location=London |last1=Meikle |first1=James |first2=Sarah |last2=Boseley |archiveurl=https://web.archive.org/web/20100527003931/http://www.guardian.co.uk/society/2010/may/24/mmr-doctor-andrew-wakefield-struck-off |archivedate=May 27, 2010 |deadurl=no}}</ref>

The CDC,<ref>{{cite web |title=Concerns about autism |publisher=Centers for Disease Control and Prevention |url=http://cdc.gov/vaccinesafety/Concerns/Autism/Index.html |date=2010-01-15 }}</ref> the IOM of the National Academy of Sciences,<ref name="ISRC" /> and the UK National Health Service<ref>[http://www.mmrthefacts.nhs.uk/ MMR Fact Sheet] {{Webarchive|url=https://web.archive.org/web/20070615000359/http://www.mmrthefacts.nhs.uk/ |date=June 15, 2007 }}, from the {{wipe|United Kingdom}} National Health Service. Retrieved June 13, 2007.</ref> have all concluded that there is no evidence of a link between the MMR vaccine and autism. A systematic review by the [[Cochrane Library]] concluded that there is no credible link between the MMR vaccine and autism, that MMR has prevented diseases that still carry a heavy burden of death and complications, that the lack of confidence in MMR has damaged public health, and that the design and reporting of safety outcomes in MMR vaccine studies are largely inadequate.<ref name="pmid22336803">{{cite journal |author=Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C |title=Vaccines for measles, mumps and rubella in children |journal=Cochrane Database Syst Rev |volume=2 |issue=2 |pages=CD004407 |year=2012 |pmid=22336803 |doi=10.1002/14651858.CD004407.pub3 |editor1-last=Demicheli |editor1-first=Vittorio}}</ref>

In 2009, ''The Sunday Times'' reported that Wakefield had manipulated patient data and misreported results in his 1998 paper, creating the appearance of a link with autism.<ref>{{cite news |url=http://www.timesonline.co.uk/tol/life_and_style/health/article5683671.ece |title=MMR doctor Andrew Wakefield fixed data on autism |author=Deer B |work=Sunday Times |date=2009-02-08 |accessdate=2009-02-09}}</ref> A 2011 article in the ''British Medical Journal'' described how the data in the study had been falsified by Wakefield so that it would arrive at a predetermined conclusion.<ref>{{cite journal |title=How the case against the MMR vaccine was fixed |author=Deer B |journal=BMJ |year=2011 |volume=342 |pages=c5347 |url=http://www.bmj.com/content/342/bmj.c5347.full |doi=10.1136/bmj.c5347 |pmid=21209059}}</ref> An accompanying editorial in the same journal described Wakefield's work as an "elaborate [[Finance:Fraud|fraud]]" that led to lower vaccination rates, putting hundreds of thousands of children at risk and diverting energy and money away from research into the true cause of autism.<ref>{{cite journal |year=2011 |doi=10.1136/bmj.c7452 |pages=c7452 |volume=342 |title=Wakefield's article linking MMR vaccine and autism was fraudulent |vauthors=Godlee F, Smith J, Marcovitch H |journal=BMJ |url=http://www.bmj.com/content/342/bmj.c7452.full |pmid=21209060}}</ref>

A special court convened in the United States to review claims under the [[Medicine:Vaccine court|National Vaccine Injury Compensation Program]] ruled on February 12, 2009 that parents of autistic children are not entitled to compensation in their contention that certain vaccines caused autism in their children.<ref>Vaccine court and autism:
* {{cite news |url=http://www.cnn.com/2009/HEALTH/02/12/autism.vaccines/index.html?iref=allsearch |title=Vaccine didn't cause autism, court rules |date=2009-02-12 |publisher=CNN |accessdate=2009-02-12}}
* {{cite court |litigants=Theresa Cedillo and Michael Cedillo, as parents and natural guardians of Michelle Cedillo vs. Secretary of Health and Human Services |vol=98-916V |court=United States Court of Federal Claims |date=2009-02-12 |url=ftp://autism.uscfc.uscourts.gov/autism/vaccine/Hastings-Cedillo.pdf }}</ref>

==="Vaccine overload"===

"Vaccine overload", a non-medical term, is the notion that giving many vaccines at once may overwhelm or weaken a child's immature immune system and lead to adverse effects.<ref name="Hilton" /> Despite scientific evidence that strongly contradicts this idea,<ref name="Gerber" /> some parents of autistic children believe that vaccine overload causes autism.<ref>{{cite news |author=Hurst L |title=Vaccine phobia runs deep |work=Toronto Star |date=2009-10-30 |url=https://www.thestar.com/news/article/718829 |accessdate=2009-11-04 }}</ref> The resulting controversy has caused many parents to delay or avoid immunizing their children.<ref name="Hilton">{{cite journal |vauthors=Hilton S, Petticrew M, Hunt K |title='Combined vaccines are like a sudden onslaught to the body's immune system': parental concerns about vaccine 'overload' and 'immune-vulnerability' |journal=Vaccine |volume=24 |issue=20 |pages=4321–7 |year=2006 |pmid=16581162 |doi=10.1016/j.vaccine.2006.03.003 }}</ref> Such parental misperceptions are major obstacles towards immunization of children.<ref>{{cite journal |title=An internet-based survey on parental attitudes towards immunization |author=Heininger U |journal=Vaccine |year=2006 |volume=24 |issue=37–39 |pages=6351–6355 |pmid=16784799 |doi=10.1016/j.vaccine.2006.05.029 }}</ref>

The concept of vaccine overload is flawed on several levels.<ref name="Gerber" /> Despite the increase in the number of vaccines over recent decades, improvements in vaccine design have reduced the immunologic load from vaccines; the total number of immunological components in the 14 vaccines administered to US children in 2009 is less than 10% of what it was in the 7 vaccines given in 1980.<ref name="Gerber">{{cite journal |vauthors=Gerber JS, Offit PA |title=Vaccines and Autism: A Tale of Shifting Hypotheses |journal=Clin Infect Dis |volume=48 |issue=4 |pages=456–461 |year=2009 |pmid=19128068 |pmc=2908388 |doi=10.1086/596476 |laysummary=https://web.archive.org/web/20110225143641/http://www.idsociety.org/Content.aspx?id=13336 |laysource=IDSA |laydate=2009-01-30}}</ref> A study published in 2013 found no correlation between autism and the [[Biology:Antigen|antigen]] number in the vaccines the children were administered up to the age of two. Of the 1,008 children in the study, one quarter of those diagnosed with autism were born between 1994 and 1999, when the routine vaccine schedule could contain more than 3,000 antigens (in a single shot of [[Medicine:DTP vaccine|DTP vaccine]]). The vaccine schedule in 2012 contains several more vaccines, but the number of antigens the child is exposed to by the age of two is 315.<ref>{{cite web |url=https://www.forbes.com/sites/emilywillingham/2013/03/29/vaccines-not-linked-to-autism-again/ |title=Vaccines Not Linked To Autism. Again |author=Willingham, Emily |website={{wipe|Forbes}} |date=March 29, 2013 |accessdate=April 4, 2013}}</ref><ref>{{cite journal |last1=DeStefano |first1=Frank |authorlink=Frank DeStefano |last2=Price |first2=Cristofer |last3=Weintraub |first3=Eric |title=Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism |journal=Journal of Pediatrics |date=April 1, 2013 |doi=10.1016/j.jpeds.2013.02.001 |pmid=23545349 |url=http://www.jpeds.com/webfiles/images/journals/ympd/JPEDSDeStefano.pdf |accessdate=April 4, 2013 |volume=163 |issue=2 |pages=561–567|citeseerx=10.1.1.371.2592 }}</ref> Vaccines pose a very small immunologic load compared to the pathogens naturally encountered by a child in a typical year;<ref name="Gerber" /> common childhood conditions such as fevers and [[Medicine:Otitis media|middle-ear infections]] pose a much greater challenge to the immune system than vaccines,<ref>Immune challenges:
* {{cite journal |title=Branhamella catarrhalis: epidemiology, surface antigenic structure, and immune response |journal=Microbiol Rev |year=1996 |pages=267–279 |volume=60 |issue=2 |author=Murphy TF |pmid=8801433 |pmc=239443 |url=http://iai.asm.org/cgi/reprint/9/6/1028.pdf |format=PDF }}
* {{cite journal |title=Immune Response to Acute Otitis Media in Children I. Serotypes Isolated and Serum and Middle Ear Fluid Antibody in Pneumococcal Otitis Media |vauthors=Sloyer JL, Howie VM, Ploussard JH, Ammann AJ, Austrian R, Johnston RB |journal=Infect Immun |year=1974 |pages=1028–1032 |volume=9 |issue=6 |pmid=4151506 |pmc=414928 |url=http://iai.asm.org/cgi/reprint/9/6/1028.pdf |format=PDF}}</ref> and studies have shown that vaccinations, even multiple concurrent vaccinations, do not weaken the immune system<ref name="Gerber" /> or compromise overall immunity.<ref>Vaccine burden:
* {{cite journal |vauthors=Miller E, Andrews N, Waight P, Taylor B |title=Bacterial infections, immune overload, and MMR vaccine |journal=Arch Dis Child |volume=88 |issue=3 |pages=222–223 |year=2003 |pmid=12598383 |pmc=1719482 |doi=10.1136/adc.88.3.222}}
* {{cite journal |vauthors=Hviid A, Wohlfahrt J, Stellfeld M, Melbye M |title=Childhood vaccination and nontargeted infectious disease hospitalization |journal=JAMA |volume=294 |issue=6 |pages=699–705 |year=2005 |pmid=16091572 |doi=10.1001/jama.294.6.699}}</ref> The lack of evidence supporting the vaccine overload hypothesis, combined with these findings directly contradicting it, has led to the conclusion that currently recommended vaccine programs do not "overload" or weaken the immune system.<ref name="BH" /><ref>Vaccine schedules and "overload":
* {{cite journal |vauthors=Gregson AL, Edelman R |title=Does antigenic overload exist? The role of multiple immunizations in infants |journal=Immunol Allergy Clin North Am |volume=23 |issue=4 |pages=649–664 |year=2003 |pmid=14753385 |doi=10.1016/S0889-8561(03)00097-3}}
* {{cite journal |vauthors=Offit PA, Quarles J, Gerber MA, et al. |title=Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system? |journal=Pediatrics |volume=109 |issue=1 |pages=124–129 |year=2002 |pmid=11773551 |doi=10.1542/peds.109.1.124 |url=http://pediatrics.aappublications.org/cgi/content/full/109/1/124}}</ref><ref name="Schneeweiss" />

Any experiment based on withholding vaccines from children has been considered unethical,<ref>{{Cite journal |last1=Deen |first1=J. L. |last2=Clemens |first2=J. D. |doi=10.1038/nrd2159 |title=Issues in the design and implementation of vaccine trials in less developed countries |journal=Nature Reviews Drug Discovery |volume=5 |issue=11 |pages=932–940 |year=2006 |pmid=17080029 }}</ref> and observational studies would likely be [[Confounding|confounded]] by differences in the health care-seeking behaviours of under-vaccinated children. Thus, no study directly comparing rates of autism in vaccinated and unvaccinated children has been done. However, the concept of vaccine overload is biologically implausible, vaccinated and unvaccinated children have the same immune response to non-vaccine-related infections, and autism is not an immune-mediated disease, so claims that vaccines could cause it by overloading the immune system go against current knowledge of the [[Medicine:Pathogenesis|pathogenesis]] of autism. As such, the idea that vaccines cause autism has been effectively dismissed by the weight of current evidence.<ref name="Gerber" />

===Prenatal infection===

There is evidence that [[Medicine:Schizophrenia|schizophrenia]] is associated with prenatal exposure to [[Medicine:Rubella|rubella]], [[Medicine:Influenza|influenza]], and [[Medicine:Toxoplasmosis|toxoplasmosis]] infection. For example, one study found a sevenfold increased risk of schizophrenia when mothers were exposed to influenza in the first trimester of gestation. This may have public health implications, as strategies for preventing infection include vaccination, simple hygiene, and, in the case of toxoplasmosis, antibiotics.<ref>{{cite journal |vauthors=Fineberg AM, Ellman LM |title=Inflammatory cytokines and neurological and neurocognitive alterations in the course of schizophrenia |journal=Biol. Psychiatry |volume=73 |issue=10 |pages=951–966 |date=May 2013 |pmid=23414821 |doi=10.1016/j.biopsych.2013.01.001 |pmc=3641168}}</ref> Based on studies in animal models, theoretical concerns have been raised about a possible link between schizophrenia and maternal immune response activated by virus antigens; a 2009 review concluded that there was insufficient evidence to recommend routine use of [[Medicine:Influenza vaccine|trivalent influenza vaccine]] during the first trimester of pregnancy, but that the vaccine was still recommended outside the first trimester and in special circumstances such as pandemics or in women with certain other conditions.<ref>{{cite journal |vauthors=Skowronski DM, De Serres G |title=Is routine influenza immunization warranted in early pregnancy? |journal=Vaccine |volume=27 |issue=35 |pages=4754–4770 |year=2009 |pmid=19515466 |doi=10.1016/j.vaccine.2009.03.079 }}</ref> The CDC's Advisory Committee on Immunization Practices, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians all recommend routine flu shots for pregnant women, for several reasons:<ref name="ACIP2007" />
* their risk for serious influenza-related medical complications during the last two trimesters;
* their greater rates for flu-related hospitalizations compared to non-pregnant women;
* the possible transfer of maternal anti-influenza antibodies to children, protecting the children from the flu; and
* several studies that found no harm to pregnant women or their children from the vaccinations.

Despite this recommendation, only 16% of healthy pregnant US women surveyed in 2005 had been vaccinated against the flu.<ref name="ACIP2007">{{cite journal |journal=MMWR Recomm Rep |year=2007 |volume=56 |issue=RR–6 |pages=1–54 |title=Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm |pmid=17625497 |vauthors=Fiore AE, Shay DK, Haber P, Iskander JK, Uyeki TM, Mootrey G, Bresee JS, Cox NJ, ((Advisory Committee on Immunization Practices)), ((Centers for Disease Control and Prevention)) }}</ref>

===Aluminium===

[[Chemistry:Aluminium|Aluminium]] compounds are used as [[Biology:Immunologic adjuvant|immunologic adjuvant]]s to increase the effectiveness of many vaccines. The aluminium in vaccines simulates or causes small amounts of tissue damage, driving the body to respond more powerfully to what it sees as a serious infection and promoting the development of a lasting immune response.<ref name="Baylor" /><ref>{{cite journal |author=Leslie M |year=2013 |title=Solution to Vaccine Mystery Starts to Crystallize |journal=Science |volume=341 |issue=6141 |pages=26–27 |doi=10.1126/science.341.6141.26 |pmid=23828925 }}</ref> In some cases these compounds have been associated with redness, itching, and low-grade fever,<ref name="Baylor">{{Cite journal |doi=10.1016/S0264-410X(02)00166-4 |title=Aluminum salts in vaccines–US perspective |first3=P. |last3=Richman |first2=W. |year=2002 |last2=Egan |last1=Baylor |first1=N. |journal=Vaccine |volume=20 |pages=S18–x20 |pmid=12184360}}</ref> but the use of aluminium in vaccines has not been associated with serious adverse events.<ref name="Francois" /> In some cases, aluminium-containing vaccines are associated with [[Unsolved:Macrophagic myofasciitis|macrophagic myofasciitis]] (MMF), localized microscopic [[Medicine:Lesion|lesion]]s containing aluminium salts that persist for up to 8 years. However, recent case-controlled studies have found no specific clinical symptoms in individuals with biopsies showing MMF, and there is no evidence that aluminium-containing vaccines are a serious health risk or justify changes to immunization practice.<ref name="Francois">{{Cite journal |doi=10.1097/01.inf.0000183853.16113.a6 |title=Vaccine Safety Controversies and the Future of Vaccination Programs |year=2005 |last1=François |first1=G. |last2=Duclos |first10=P. |first2=P. |last3=Margolis |first3=H. |last4=Lavanchy |first4=D. |last10=Van Damme |last5=Siegrist |first5=C. A. |last6=Meheus |first6=A. ? |last7=Lambert |first7=P. H. |last8=Emiroğlu |first8=N. |last9=Badur |first9=S. |displayauthors=3 |journal=The Pediatric Infectious Disease Journal |volume=24 |pages=953–961 |pmid=16282928 |issue=11}}</ref>

===Anthrax vaccines===
When the U.S. military began requiring its troops to receive the [[Social:Anthrax vaccine|anthrax vaccine]], multiple US military troops refused to do so, which led to threats of military courts martial.<ref>{{cite journal |last1=Poland |first1=Gregory A. |last2=Jacobson |first2=Robert M. |last3=Ovsyannikova |first3=Inna G. |title=Trends affecting the future of vaccine development and delivery: The role of demographics, regulatory science, the anti-vaccine movement, and vaccinomics |journal=Vaccine |date=26 May 2009 |volume=27 |issue=25–26 |pages=3240–3244 |doi=10.1016/j.vaccine.2009.01.069 |pmid=19200833 |pmc=2693340}}</ref>

===Swine flu vaccine===
During the 2009 flu pandemic, significant controversy broke out regarding whether the [[Medicine:2009 flu pandemic vaccine|2009 H1N1 flu vaccine]] was safe in, among other countries, {{wipe|France}}. Numerous different French groups publicly criticized the vaccine as potentially dangerous.<ref>{{cite journal |last1=Ward |first1=JK |title=Rethinking the antivaccine movement concept: A case study of public criticism of the swine flu vaccine's safety in France |journal=Social Science & Medicine |date=June 2016 |volume=159 |pages=48–57 |doi=10.1016/j.socscimed.2016.05.003 |pmid=27173740}}</ref>

===Other safety concerns===

Other safety concerns about vaccines have been published on the Internet, in informal meetings, in books, and at symposia. These include hypotheses that vaccination can cause [[Medicine:Sudden infant death syndrome|sudden infant death syndrome]], epileptic seizures, [[Medicine:Allergy|allergies]], multiple sclerosis, and [[Medicine:Autoimmune disease|autoimmune disease]]s such as [[Medicine:Diabetes mellitus type 1|type 1 diabetes]], as well as hypotheses that vaccinations can transmit [[Medicine:Bovine spongiform encephalopathy|bovine spongiform encephalopathy]], [[Biology:Hepatitis C virus|hepatitis C virus]], and [[Biology:HIV|HIV]]. These hypotheses have been investigated, with the conclusion that currently used vaccines meet high safety standards and that criticism of vaccine safety in the popular press is not justified.<ref name="Schneeweiss">{{cite journal |journal=Dtsch Arztebl Int |year=2008 |volume=105 |issue=34–5 |pages=590–595 |title=Vaccination Safety Update |vauthors=Schneeweiss B, Pfleiderer M, Keller-Stanislawski B |doi=10.3238/arztebl.2008.0590 |pmid=19471677 |pmc=2680557 }}</ref> Large well-controlled epidemiologic studies have been conducted and the results do not support the hypothesis that vaccines cause chronic diseases. Furthermore, some vaccines are probably more likely to prevent or modify than cause or exacerbate autoimmune diseases.<ref>{{cite journal |author=Offit Paul A., Hackett Charles J. |year=2003 |title=Addressing Parents' Concerns: Do Vaccines Cause Allergic or Autoimmune Diseases? |url=http://pediatrics.aappublications.org/content/111/3/653 |journal=Pediatrics |volume=111 |issue=3 |pages=653–659 |doi=10.1542/peds.111.3.653 }}</ref>

==Individual liberty==
{{Further |Medicine:Vaccination policy}}
Compulsory vaccination policies have been controversial as long as they have existed, with opponents of mandatory vaccinations arguing that governments should not infringe on an individual's freedom to make medical decisions for themselves or their children, while proponents of compulsory vaccination cite the well documented public health benefits of vaccination<ref name="wolfesharp" /><ref>{{cite journal |journal=Am J Public Health |year=2005 |volume=95 |issue=4 |pages=571–576 |title=Manifold Restraints: Liberty, Public Health, and the Legacy of Jacobson v Massachusetts |vauthors=Colgrove J, Bayer R |doi=10.2105/AJPH.2004.055145 |pmid=15798111 |url=http://ajph.aphapublications.org/cgi/content/full/95/4/571 |pmc=1449222 }}</ref> In the United States, mandatory vaccination laws sometimes provoke opposition from members of anti-government or libertarian factions, who express concern for what they view as the intrusion of the government into their private lives.<ref name="wolfesharp" /> Others argue that, for compulsory vaccination to effectively prevent disease, there must be not only available vaccines and a population willing to immunize, but also sufficient ability to decline vaccination on grounds of personal belief.<ref>{{cite journal |author=Salmon Daniel A |title=Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future |journal=The Lancet |volume=367 |issue=9508 |pages=436–442 |doi=10.1016/s0140-6736(06)68144-0 |display-authors=0 |year=2006 |pmid=16458770}}</ref>

Vaccination involves complicated ethical issues, as unvaccinated individuals may spread disease to people with weaker immune systems, such as young children and the elderly, and to individuals in whom the vaccine has not been effective. For this reason, even where not required by law some schools and doctors' surgeries have prohibited parents with unvaccinated children from enrolling.<ref>{{cite web |title=Should Pediatricians Refuse Unvaccinated Kids? |url=http://live.huffingtonpost.com/r/segment/should-pediatricians-refuse-unvaccinated-kids/53285f162b8c2a24f700070f |website=The Huffington Post |accessdate=July 4, 2015}}</ref><ref>{{cite web |last1=Bachai |first1=Sabrina |title=NYC Schools Are Now Allowed To Ban Unvaccinated Kids, Rules Federal Judge |url=http://www.medicaldaily.com/nyc-schools-are-now-allowed-ban-unvaccinated-kids-rules-federal-judge-289614 |website=Medical Daily |accessdate=4 July 2015|date=24 June 2014}}</ref> However, mandatory vaccination raises ethical issues regarding parental rights and [[Philosophy:Informed consent|informed consent]].<ref>{{cite web|url=http://www.who.int/bulletin/volumes/91/4/12-113480/en/|title=Ethical considerations for vaccination programmes in acute humanitarian emergencies|website=[[Organization:World Health Organization|World Health Organization]]|first1=Keymanthri|last1=Moodley|first2=Kate|last2=Hardie|first3=Michael J.|last3=Selgelid|first4=Ronald J.|last4=Waldman|first5=Peter|last5=Strebel|first6=Helen|last6=Rees|author-link6=Helen Rees|first7=David N.|last7=Durrheim|date=7 February 2013}}</ref>

==Religion==
{{Main |Medicine:Vaccination and religion}}

Vaccination has been opposed on religious grounds ever since it was introduced. Some Christian opponents argued, when vaccination was first becoming widespread, that if God had decreed that someone should die of smallpox, it would be a sin to thwart God's will via vaccination.<ref name="Early">
Early religious opposition:
* {{cite book |chapter=Theological opposition to inoculation, vaccination, and the use of anæsthetics |title=A History of the Warfare of Science with Theology in Christendom |author=White AD |location=New York |publisher=Appleton |year=1896 |chapterurl=http://abob.libs.uga.edu/bobk/whitem10.html }}
* {{cite journal |author=Bazin H |title=The ethics of vaccine usage in society: lessons from the past |journal=Endeavour |volume=25 |issue=3 |pages=104–108 |year=2001 |pmid=11725304 |doi=10.1016/S0160-9327(00)01376-4}}
* {{cite journal |journal=Stem Cell Rev |year=2005 |volume=1 |issue=4 |pages=345–76 |title=Ethics in the trenches: a multifaceted analysis of the stem cell debate |author=Noble M |doi=10.1385/SCR:1:4:345 |pmid=17142878|citeseerx=10.1.1.465.2410 }}</ref> Religious opposition continues to the present day, on various grounds, raising ethical difficulties when the number of unvaccinated children threatens harm to the entire population.<ref name="May">{{cite journal |journal=Hum Vaccin |year=2005 |volume=1 |issue=1 |pages=12–15 |title=Free-riding, fairness and the rights of minority groups in exemption from mandatory childhood vaccination |vauthors=May T, Silverman RD |pmid=17038833 |doi=10.4161/hv.1.1.1425}}</ref> Many governments allow parents to opt out of their children's otherwise mandatory vaccinations for religious reasons; some parents falsely claim religious beliefs to get vaccination exemptions.<ref>{{cite news |url=https://www.usatoday.com/news/nation/2007-10-17-19819928_x.htm |date=2007-10-17 |accessdate=2007-11-24 |author=LeBlanc S |title=Parents use religion to avoid vaccines |work=USA Today}}</ref>

The Haredi burqa sect in Israel opposed vaccinations and medical treatments on moral grounds, which led to the death of at least one baby from untreated influenza.<ref name="baby">{{cite web |url=http://failedmessiah.typepad.com/failed_messiahcom/2013/02/haredi-burka-cult-family-flees-after-baby-dies-from-alleged-neglect-123.html |title=Haredi Burka Cult Family Flees After Baby Dies From Alleged Neglect|website=FailedMessiah.com|date=10 February 2013|last=Rosenberg|first=Shmarya|access-date=29 August 2018}}</ref>

Among early Hasidic leaders, Rabbi Nachman of Breslov (1772–1810) was known for his criticism of the doctors and medical treatments of his day. However, when the first vaccines were successfully introduced, he stated: "Every parent should have his children vaccinated within the first three months of life. Failure to do so is tantamount to murder. Even if they live far from the city and have to travel during the great winter cold, they should have the child vaccinated before three months."<ref>Avaneha Barzel p.31 #34</ref>

In the United States, there are currently only three states (Mississippi, West Virginia, and California) that do not provide exemptions based on religious beliefs.<ref>{{cite web|url=http://vaccines.procon.org/view.resource.php?resourceID=003597|title=State Vaccination Exemptions for Children Entering Public Schools - Vaccines - ProCon.org|website=vaccines.procon.org}}</ref>

The cell cultures of some viral vaccines, and the virus of the [[Medicine:Rubella|rubella]] vaccine,<ref name="pmid3890107">{{cite journal |vauthors=Plotkin SA, Buser F |title=History of RA27/3 rubella vaccine |journal=Reviews of Infectious Diseases |volume=7 Suppl 1 |issue=|pages=S77–78 |year=1985 |pmid=3890107 |doi=10.1093/clinids/7.supplement_1.s77|url=}}</ref> are derived from tissues taken from therapeutic abortions performed in the 1960s, leading to moral questions. For example, the [[Philosophy:Principle of double effect|principle of double effect]], originated by [[Biography:Thomas Aquinas|Thomas Aquinas]], holds that actions with both good and bad consequences are morally acceptable in specific circumstances, and the question is how this principle applies to vaccination.<ref>{{cite journal |url=http://www.immunizationinfo.org/files/nnii/files/Moral_Considerations_With_Certain_Viral_Vaccines.pdf |format=PDF |title=Moral considerations with certain viral vaccines |author=Grabenstein JD |journal=Christ Pharm |volume=2 |issue=2 |pages=3–6 |year=1999 |accessdate=2009-05-11 |archive-url=https://web.archive.org/web/20110718001330/http://www.immunizationinfo.org/files/nnii/files/Moral_Considerations_With_Certain_Viral_Vaccines.pdf |archive-date=July 18, 2011 |dead-url=yes |df=mdy-all }}</ref> The Vatican Curia has expressed concern about the rubella vaccine's embryonic cell origin, saying that Catholics have "a grave responsibility to use alternative vaccines and to make a conscientious objection with regard to those which have moral problems."<ref name="Vatican">{{cite journal |author=Pontifical Academy for Life |title=Moral reflections on vaccines prepared from cells derived from aborted human foetuses |year=2005 |journal=Medicina e Morale |url=http://www.academiavita.org/template.jsp?sez=Documenti&pag=testo/vacc/vacc&lang=english |accessdate=2008-12-03 |archiveurl=https://web.archive.org/web/20060507072740/http://www.academiavita.org/template.jsp?sez=Documenti&pag=testo%2Fvacc%2Fvacc&lang=english |archivedate=May 7, 2006 |dead-url=yes |df=mdy-all }}</ref> The Vatican concluded that until an alternative becomes available, it is acceptable for Catholics to use the existing vaccine, writing, "This is an unjust alternative choice, which must be eliminated as soon as possible."<ref name="Vatican" /> In the US, some parents claim fake religious exemptions when their real motivation for avoiding vaccines is supposed safety concerns.<ref name="cbs-fake">{{Cite news |url=https://www.cbsnews.com/news/parents-fake-religion-to-avoid-vaccines/ |title=Parents Fake Religion To Avoid Vaccines |date=17 October 2007 |website=CBS News|agency=AP}}</ref>

==Alternative medicine==
{{Alternative medicine sidebar}}
Many forms of [[Medicine:Alternative medicine|alternative medicine]] are based on philosophies that oppose vaccination (including [[Biology:Germ theory denialism|germ theory denialism]]) and have practitioners who voice their opposition. These include some elements of the [[Unsolved:Chiropractic|chiropractic]] community, some [[Unsolved:Homeopathy|homeopaths]], and [[Unsolved:Naturopathy|naturopaths]].<ref name="Ernst">{{cite journal |journal=Vaccine |year=2001 |volume=20 |issue=Suppl 1 |pages=S89–93 |title=Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination |author=Ernst E |doi=10.1016/S0264-410X(01)00290-0 |pmid=11587822}}</ref> The reasons for this negative vaccination view are complicated and rest at least in part on the early philosophies that shaped the foundation of these groups.<ref name="Ernst" />

===Chiropractic===
{{Globalize/North America |section |date=March 2016}}

Historically, [[Unsolved:Chiropractic|chiropractic]] strongly opposed vaccination based on its belief that all diseases were traceable to causes in the spine and therefore could not be affected by vaccines. Daniel D. Palmer (1845–1913), the founder of chiropractic, wrote: "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison."<ref name="Busse" /> Vaccination remains controversial within the profession.<ref name="Campbell" /> Most chiropractic writings on vaccination focus on its negative aspects;<ref name="Busse" /> A 1995 survey of US chiropractors found that about one third believed there was no scientific proof that immunization prevents disease.<ref name="Campbell">{{cite journal |journal=Pediatrics |year=2000 |volume=105 |issue=4 |pages=e43 |title=Chiropractors and vaccination: a historical perspective |vauthors=Campbell JB, Busse JW, Injeyan HS |pmid=10742364 |url=http://pediatrics.aappublications.org/cgi/content/full/105/4/e43 |doi=10.1542/peds.105.4.e43}}</ref> While the Canadian Chiropractic Association supports vaccination,<ref name="Busse">{{cite journal |journal=J Manipulative Physiol Ther |year=2005 |volume=28 |issue=5 |pages=367–373 |title=Chiropractic antivaccination arguments |vauthors=Busse JW, Morgan L, Campbell JB |doi=10.1016/j.jmpt.2005.04.011 |pmid=15965414 |url=http://jmptonline.org/article/S0161-4754(05)00111-9/fulltext}}</ref> a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% advised against, vaccinations for patients or for their children.<ref>{{cite journal |vauthors=Russell ML, Injeyan HS, Verhoef MJ, Eliasziw M |title=Beliefs and behaviours: understanding chiropractors and immunization |journal=Vaccine |volume=23 |issue=3 |pages=372–379 |year=2004 |pmid=15530683 |doi=10.1016/j.vaccine.2004.05.027}}</ref>

Although most chiropractic colleges try to teach about vaccination in a manner consistent with scientific evidence, several have faculty who seem to stress negative views.<ref name="Campbell" /> A survey of a 1999–2000 cross-section of students of Canadian Memorial Chiropractic College (CMCC), which does not formally teach anti-vaccination views, reported that fourth-year students opposed vaccination more strongly than did first-year students, with 29.4% of fourth-year students opposing vaccination.<ref>{{cite journal |journal=Vaccine |year=2008 |volume=26 |issue=49 |pages=6237–6242 |title=Attitudes towards vaccination among chiropractic and naturopathic students |vauthors=Busse JW, Wilson K, Campbell JB |doi=10.1016/j.vaccine.2008.07.020 |pmid=18674581}}</ref> A follow-up study on 2011–12 CMCC students found that pro-vaccination attitudes heavily predominated. Students reported support rates ranging from 84% to 90%. One of the study's authors proposed the change in attitude to be due to the lack of the previous influence of a "subgroup of some charismatic students who were enrolled at CMCC at the time, students who championed the Palmer postulates that advocated against the use of vaccination".<ref>{{cite journal |journal=J Can Chiropr Assoc |year=2013 |volume=57 |issue=3 |pages=214–220 |title=Attitudes toward vaccination: A cross-sectional survey of students at the Canadian Memorial Chiropractic College |author=Lameris M, Schmidt C, Gleberzon B, Ogrady J |pmc=3743647 |pmid=23997247 |last2=Schmidt |last3=Gleberzon |last4=Ogrady }}</ref>

====Policy positions====

The American Chiropractic Association and the International Chiropractic Association support individual exemptions to compulsory vaccination laws.<ref name="Campbell"/> In March 2015, the Oregon Chiropractic Association invited [[Biography:Andrew Wakefield|Andrew Wakefield]], chief author of a [[Social:MMR vaccine controversy|fraudulent research paper]], to testify against Senate Bill 442,<ref name=Yoo>{{Citation |last=Yoo |first=Saerom |date=February 24, 2015 |title=Vaccine researcher Wakefield to testify in Oregon |work=Statesman Journal |url=http://www.statesmanjournal.com/story/news/health/2015/02/24/andrew-wakefield-vaccine-oregon/23967797/ |accessdate=March 3, 2015 }}</ref> "a bill that would eliminate nonmedical exemptions from Oregon's school immunization law".<ref name=Yoo_canceled>{{Citation |last=Yoo |first=Saerom |date=February 26, 2015 |title=Meeting on vaccine mandate bill canceled |work=Statesman Journal |url=http://www.statesmanjournal.com/story/news/health/2015/02/25/meeting-vaccine-mandate-bill-canceled/24020213/ |accessdate=March 3, 2015 }}</ref> The California Chiropractic Association lobbied against a 2015 bill ending belief exemptions for vaccines. They had also opposed a 2012 bill related to vaccination exemptions.<ref name=Mason>
{{Citation 
 |last=Mason |first=Melanie |date=March 5, 2015 
 |title=Chiropractors lobby against bill ending belief exemptions for vaccines 
 |work={{wipe|Los Angeles Times}} 
 |url=http://www.latimes.com/local/political/la-me-pc-vaccine-bill-chiropractors-20150305-story.html |accessdate=March 6, 2015 
}}
</ref>

===Homeopathy===
Several surveys have shown that some practitioners of [[Unsolved:Homeopathy|homeopathy]], particularly homeopaths without any medical training, advise patients against vaccination.<ref>{{cite journal |vauthors=Schmidt K, Ernst E |title=MMR vaccination advice over the Internet |journal=Vaccine |volume=21 |issue=11–12 |pages=1044–1047 |year=2003 |pmid=12559777 |doi=10.1016/S0264-410X(02)00628-X}}</ref> For example, a survey of registered homeopaths in Austria found that only 28% considered immunization an important preventive measure, and 83% of homeopaths surveyed in Sydney, Australia, did not recommend vaccination.<ref name="Ernst" /> Many practitioners of [[Unsolved:Naturopathy|naturopathy]] also oppose vaccination.<ref name="Ernst" />

[[Unsolved:Homeopathy|Homeopathic]] "vaccines" (nosodes) are ineffective because they do not contain any active ingredients and thus do not stimulate the immune system. They can be dangerous if they take the place of effective treatments.<ref name="SciMed">{{cite web |title=Homeopathic Vaccines |last=Crislip |first=Mark |date=November 5, 2010 |url=http://www.sciencebasedmedicine.org/?p=8003}}</ref> Some medical organizations have taken action against nosodes. In Canada, the labeling of homeopathic nosodes require the statement: "This product is neither a vaccine nor an alternative to vaccination."<ref name="StopNosodes">{{cite web |title=Nosode Use in Canada |author=Stop Nosodes/Bad Science Watch |date=August 2015 |url=http://www.stopnosodes.org/the-problem/the-extent-of-nosode-use-in-canada/}}</ref>

==Financial motives==
[[Medicine:Alternative medicine|Alternative medicine]] proponents gain from promoting vaccine conspiracy theories through the sale of ineffective and expensive medications, supplements, and procedures such as [[Unsolved:Chelation therapy|chelation therapy]] and [[Medicine:Hyperbaric medicine|hyperbaric oxygen therapy]], sold as able to cure the 'damage' caused by vaccines.<ref>{{cite book |format=PDF |author=Kerr MA |chapter=Movement impact |pages=194–203 |title=The Autism Spectrum Disorders / vaccine link debate: a health social movement |year=2009 |publisher=University of Pittsburgh |url=http://etd.library.pitt.edu/ETD/available/etd-04302009-115908/unrestricted/Kerr_FINAL.pdf |accessdate=2010-02-25 |archiveurl=https://web.archive.org/web/20110718173710/http://etd.library.pitt.edu/ETD/available/etd-04302009-115908/unrestricted/Kerr_FINAL.pdf |archivedate=July 18, 2011}}</ref> Homeopaths in particular gain through the promotion of water injections or 'nosodes' that they allege have a 'natural' vaccine-like effect.<ref>{{cite web |last1=Weeks |first1=Carly |title=Health experts question lack of crackdown on 'homeopathic vaccines' |url=https://www.theglobeandmail.com/news/national/health-experts-question-lack-of-crackdown-on-homeopathic-vaccines/article23019800/ |website=The Globe and Mail |accessdate=July 4, 2015}}</ref> Additional bodies with a vested interest in promoting the "unsafeness" of vaccines may include lawyers and legal groups organizing court cases and class action lawsuits against vaccine providers. Conversely, alternative medicine providers have accused the vaccine industry of misrepresenting the safety and effectiveness of vaccines, covering up and suppressing information, and influencing health policy decisions for financial gain.<ref name="wolfesharp" />

In the late 20th century, vaccines were a product with low [[Finance:Profit margin|profit margin]]s,<ref name="Sheridan" /> and the number of companies involved in vaccine manufacture declined. In addition to low profits and liability risks, manufacturers complained about low prices paid for vaccines by the CDC and other US government agencies.<ref>{{cite book |author=Allen A |year=2007 |title=Vaccine: the Controversial Story of Medicine's Greatest Lifesafer |chapter=Epilogue: our best shots |pages=421–442 |publisher=W. W. Norton |isbn=978-0-393-05911-3}}</ref> In the early 21st century, the vaccine market greatly improved with the approval of the vaccine [[Medicine:Pneumococcal conjugate vaccine|Prevnar]], along with a small number of other high-priced blockbuster vaccines, such as [[Biology:Gardasil|Gardasil]] and Pediarix, which each had sales revenues of over $1 billion in 2008.<ref name="Sheridan">{{cite journal |author=Sheridan C |title=Vaccine market boosters |journal=Nat Biotechnol |volume=27 |issue=6 |pages=499–501 |year=2009 |pmid=19513043 |doi=10.1038/nbt0609-499 }}</ref>

==War==
[[File:"The White Man's Burden" Judge 1899.png |thumb |upright=1.3 |Judge's cartoon of Rudyard Kipling's famous poem "The White Man's Burden" published in 1899. The poem's philosophy quickly was utilized to explain/justify the United States response to annexation of the Philippines. The United States used the "white man's burden" as an argument for imperial control of the Philippines and Puerto Rico on the basis of moral necessity to ensure the spread of civility and modernity.]]
The United States has a very complex history with [[Medicine:Vaccination policy|compulsory vaccination]], particularly in enforcing compulsory vaccinations both domestically and abroad to protect American soldiers during times of war. There are hundreds of thousands of examples of soldier deaths that were not the result of combat wounds, but were instead from disease.<ref name=":0">{{Cite book |title=Pox: An American History |last=Willrich |first=Michael |publisher=Penguin Group |year=2010 |isbn=9781101476222 |location=New York, New York |pages=117–165}}</ref> Among wars with high death tolls from disease is the Civil War where an estimated 620,000 soldiers died from disease. American soldiers in other countries have spread diseases that ultimately disrupted entire societies and healthcare systems with famine and poverty.<ref name=":0" />

===Spanish–American War===
The Spanish–American War began in April 1898 and ended in August 1898. During this time the United States gained control of Cuba, Puerto Rico, and the Philippines from Spain. As a military police power and as colonizers the United States took a very hands-on approach in administering healthcare particularly vaccinations to natives during the invasion and conquest of these countries.<ref name=":0" /> Although the Spanish–American War occurred during the era of [[Biology:Germ theory of disease|"bacteriological revolution"]] where knowledge of disease was bolstered by [[Biology:Germ theory of disease|germ theory]], more than half of the soldier casualties in this war were from disease.<ref name=":0" /> Unknowingly, American soldiers acted as agents of disease transmission, fostering bacteria in their haphazardly made camps. These soldiers invaded Cuba, Puerto Rico, and the Philippines and connected parts of these countries that had never before been connected due to the countries sparse nature thereby beginning epidemics.<ref name=":0" /> The mobility of American soldiers around these countries encouraged a newfound mobility of disease that quickly infected natives.

Military personnel used Rudyard's Kipling's poem "The White Man's Burden" to explain their imperialistic actions in Cuba, the Philippines, and Puerto Rico and the need for the United States to help the "dark-skinned Barbarians"<ref name=":0" /> reach modern sanitary standards. American actions abroad before, during, and after the war emphasized a need for proper sanitation habits especially on behalf of the natives. Natives who refuse to oblige with American health standards and procedures risked fines or imprisonment.<ref name=":0" /> One penalty in Puerto Rico included a $10 fine for a failure to vaccinate and an additional $5 fine for any day you continue to be unvaccinated, refusal to pay resulted in ten or more days of imprisonment. If entire villages refused the army's current sanitation policy at any given time they risked being burnt to the ground in order to preserve the health and safety of soldiers from endemic smallpox and yellow fever.<ref name=":0" /> Vaccines were forcibly administered to the Puerto Ricans, Cubans, and Filipinos. Military personnel in Puerto Rico provided Public Health services that culminated in military orders that mandated vaccinations for children before they were six months old, as well as a general vaccination order.<ref name=":0" /> By the end of 1899 in Puerto Rico alone the U.S. military and other hired native vaccinators called ''practicantes'', vaccinated an estimated 860,000 natives in a five-month period. This period began the United States' movement toward an expansion of medical practices that included "tropical medicine" in an attempt to protect the lives of soldiers abroad.<ref name=":0" />
{{Clear}}

==Information warfare==

An analysis of [[Company:Twitter#Tweets|tweets]] from July 2014 through September 2017 revealed an active campaign on [[Company:Twitter|Twitter]] by the [[Organization:Internet Research Agency|Internet Research Agency]] (IRA), a Russian [[Social:Troll farm|troll farm]] accused of interference in the 2016 U.S. elections, to sow discord about the safety of vaccines.<ref name=WeaponizedHealthCommunication>{{Cite journal|title=Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate|journal=American Journal of Public Health|volume=108|issue=10|pages=1378–1384|last1=Broniatowski|first1=David A.|last2=Jamison|first2=Amelia M.|last3=Qi|first3=SiHua|last4=AlKulaib|first4=Lulwah|last5=Chen|first5=Tao|last6=Benton|first6=Adrian|last7=Quinn|first7=Sandra C.|last8=Dredze|first8=Mark|date=23 August 2018|doi=10.2105/AJPH.2018.304567|pmid=30138075}}</ref><ref>{{cite web|title=Russian trolls 'spreading discord' over vaccine safety online|url=https://www.theguardian.com/society/2018/aug/23/russian-trolls-spread-vaccine-misinformation-on-twitter|website={{wipe|The Guardian}}|date=23 August 2018|access-date=23 August 2018|last=Glenza|first=Jessica}}</ref> The campaign used sophisticated Twitter bots to amplify highly polarizing pro-vaccine and anti-vaccine messages, containing the hashtag #VaccinateUS, posted by IRA trolls.<ref name=WeaponizedHealthCommunication />

==References==
{{reflist}}

==Further reading==
{{refbegin}}
* {{cite book |author=Largent, Mark A. |title=Vaccine: The Debate in Modern America |publisher=Johns Hopkins University Press |year=2012 |isbn=978-1421406077 }}
* {{cite journal |vauthors=Bedford H, Elliman D |title=Concerns about immunisation |journal=BMJ |volume=320 |issue=7229 |pages=240–243 |year=2000 |pmid=10642238 |pmc=1117437 |doi=10.1136/bmj.320.7229.240 }}
* {{cite journal |vauthors=Davies P, Chapman S, Leask J |title=Antivaccination activists on the world wide web |journal=Arch Dis Child |volume=87 |issue=1 |pages=22–25 |year=2002 |pmid=12089115 |pmc=1751143 |doi=10.1136/adc.87.1.22 }}
* {{cite journal |vauthors=Elliman D, Bedford H |title=''MMR: Science and Fiction''. Exploring the Vaccine Crisis; ''MMR and Autism: What Parents Need to Know'' |journal=BMJ |year=2004 |volume=329 |issue=7473 |page=1049 |doi=10.1136/bmj.329.7473.1049 |pmc=524574 }}
* {{cite web |author=Friedlander E |title=The anti-immunization activists: a pattern of deception |url=http://www.pathguy.com/antiimmu.htm |year=2007 |accessdate=2007-11-13}}
* {{cite journal |vauthors=Hanratty B, Holt T, Duffell E, Patterson W, Ramsay M, White J, Jin L, Litton P |title=UK measles outbreak in non-immune anthroposophic communities: the implications for the elimination of measles from Europe |journal=Epidemiol Infect |volume=125 |issue=2 |pages=377–383 |year=2000 |pmid=11117961 |doi=10.1017/S0950268899004525 |pmc=2869610}}
* {{cite book |title=Your Baby's Best Shot: Why Vaccines Are Safe and Save Lives |publisher=Rowman & Littlefield Publishers |year=2012 |isbn=978-1442215788 |last=Herlihy |first=Stacy Mintzer |last2=Hagood |first2=E. Allison |last3=Offit |first3=Paul A. |authorlink3=Paul A. Offit}}
* {{cite journal |last=Miller |first=C. L. |title=Deaths from measles in England and Wales, 1970–83 |journal=Br Med J (Clin Res Ed) |volume=290 |issue=6466 |pages=443–444 |year=1985 |pmid=3918622 |pmc=1417782 |doi=10.1136/bmj.290.6466.443}}
* {{cite book |vauthors=Myers MG, Pineda D |title=Do Vaccines Cause That?! A Guide for Evaluating Vaccine Safety Concerns |publisher=Immunizations for Public Health (i4ph) |location=Galveston, TX |year=2008 |isbn=978-0-9769027-1-3 }}
* {{cite journal |author=Naono, Atsuko, |title=Vaccination Propaganda: The Politics of Communicating Colonial Medicine in Nineteenth-Century Burma |journal=SOAS Bulletin of Burma Research |volume=4 |issue=1 |pages=30–44 |year=2006 |url=https://archive.org/download/VaccinationPropagandaThePoliticsOfCommunicatingColonialMedicineIn/4.1naono.pdf}}
* {{cite book |author=Offit, Paul A. |year=2008 |title=Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure |publisher=Columbia University Press |isbn=978-0-231-14636-4|title-link=Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure }}
* {{cite book |author=Offit, Paul A. |year=2012 |title=Deadly Choices: How the Anti-Vaccine Movement Threatens Us All |isbn=978-0465029624 |publisher=Basic Books}}
* {{cite journal |vauthors=Orenstein W, Hinman A |title=The immunization system in the United States – the role of school immunization laws |journal=Vaccine |volume=17 Suppl 3 |pages=S19–24 |year=1999 |pmid=10559531 |doi=10.1016/S0264-410X(99)00290-X}}
* {{cite journal |author=Spier R |title=Ethical aspects of vaccines and vaccination |journal=Vaccine |volume=16 |issue=19 |pages=1788–1794 |year=1998 |pmid=9795382 |doi=10.1016/S0264-410X(98)00169-8}}
* {{cite journal |author=Vermeersch E |title=Individual rights versus societal duties |journal=Vaccine |volume=17 |issue=Suppl 3 |pages=S14–17 |year=1999 |pmid=10627239 |doi=10.1016/s0264-410x(99)00289-3 }}
* {{cite journal |vauthors=Wolfe RM, Sharp LK, Lipsky MS |title=Content and design attributes of antivaccination web sites |journal=JAMA |volume=287 |issue=24 |pages=3245–3248 |year=2002 |pmid=12076221 |url=http://jama.ama-assn.org/cgi/content/full/287/24/3245 |doi=10.1001/jama.287.24.3245}}
* {{cite web |title=Six common misconceptions about immunization |url=http://www.who.int/immunization_safety/aefi/immunization_misconceptions/en/ |date=February 16, 2006 |publisher=World Health Organization |accessdate=2006-11-02}}
* Lewandowsky et al. Anti-Vax Psychology Study Report – {{cite news |author=Mooney, Chris |title=If You Distrust Vaccines, You're More Likely to Think NASA Faked the Moon Landings |url=https://www.motherjones.com/environment/2013/10/vaccine-denial-conspiracy-theories-gmos-climate |date=October 2, 2013 |publisher=''Mother Jones'' |accessdate=2016-02-02}}
{{refend}}

==External links==
* {{dmoz |Society/Issues/Health/Vaccination |Vaccination}}
* {{cite web |title=Immunizations, vaccines and biologicals |publisher=[[Organization:World Health Organization|World Health Organization]] |url=http://www.who.int/immunization/en/ }}
* {{cite web |title=Vaccines & immunizations |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/vaccines/ }}
* {{cite serial |series=Frontline |title=The Vaccine War |url=https://www.pbs.org/wgbh/pages/frontline/vaccines/ |network=PBS |date=April 27, 2010 }}

{{Vaccines}}

{{DEFAULTSORT:Vaccine Controversy}}
[[Category:Vaccine controversies| ]]

{{Sourceattribution|Vaccine controversies|1}}