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Cultural anthropologist Prof. Eberhard Wolff and medical historian Prof. Iris Ritzmann have both been studying the history of smallpox vaccination for many years and have done research on anti-vaccination movements in Switzerland and Germany. In this interview, they talk about parallels between then and now.

Interview: Ursula Reis

Do you see similarities between the criticism of smallpox vaccination in the 19th century and today’s sceptics?

Eberhard Wolff: Since the beginning, there have been two main strands of argumentation against vaccination: People had doubts about the effectiveness and were concerned about safety issues. To elaborate a little, they questioned whether the vaccination actually prevents the disease and whether it might not have any unknown harmful side effects. Of course, there were more, but these two main arguments cut across time.

In the individual case, of course, the arguments of vaccination opponents very much depended on the historic situation and the environment. In the late 19th and early 20th centuries, for example, several movements criticizing professional and academic medicine emerged. Most favoured naturopathy and were critical of vaccination. Embedded in this anti-medical milieu of naturopathic associations and animal experiment opponents, the antivax movement began to build its own associations. This cultural situation was still effective in the 1920s when Switzerland was confronted with its last smallpox epidemic.

In the early 19th century, things were different. There were no naturopathic associations. It was rather individuals who were opposed to smallpox vaccination, sceptical doctors or even concerned parents. In Germany, anti-vaccination associations were founded from about 1860 onwards. They published texts critical of vaccination. The movement then became very strong when general compulsory vaccination was introduced in Germany in 1874 – after smallpox epidemics in connection with the Franco-German War.

And in Switzerland?

Iris Ritzmann: It was similar in Switzerland. Vaccination opponents began to organise themselves with the federal vote on the Epidemics Act of 1882 that demanded compulsory vaccination for all citizens. Vaccination laws existed before that, but only on a cantonal level, not nationwide.

It must also be said that the opponents of vaccination were not just cranks. Especially in the early 19th century, without the opponents, it would probably not have been discovered so quickly that the vaccination loses its effectiveness after a while and that revaccination was needed. In many cases, concerned parents made observations, for example that a child’s wound became severely infected. The smallpox vaccination was not without risk. It is still considered dangerous today. One has to imagine that until the end of the 19th century, the vaccine was taken from a purulent pustule and then inoculated into a healthy child. It was common for undesirable side effects to occur. It is therefore not surprising that there was also resistance. This led to the development of the anti-vaccination organisations when the issue became a political one.

It is striking that the Epidemics Act of 1882 was rejected particularly strongly in the Catholic regions. It is assumed that the Catholic population was against vaccination out of religious reservations. Have you found any sources on this?

Eberhard Wolff: That is an interesting question. Such justifications are indeed found again and again among contemporary vaccination advocates, that the population rejects vaccination because they feel the disease is God’s will and the like. I have searched for such sources myself, but have hardly found any. In the meantime, I have come to think that the political and ideological location of the anti-vaccination movement is constantly changing. It often starts with a cultural fracture or a political tension. When compulsory vaccination as a strong governmental pressure is added, this can lead to a crash. Then it is no longer about religious values. In the 1880s, the still young federal state of Switzerland began to centralize. Pressure came from urban, Protestant areas. Catholic cantons were afraid to lose their autonomy.

Iris Ritzmann: Not all the particularly religious communities were opposed to vaccination. Some were also supporters. The said: God has sent us the vaccine. It is a gift.

Eberhard Wolff: For my dissertation, I worked with sources from radical pietists, i.e. a rather strict Protestant movement. You would think that they would reject vaccination with the argument that one should not interfere with God’s plan of salvation. I did not find that to be the case. They said: It does not work and it is dangerous.

The justifications also shift. Sometimes the rejection is more politically motivated, against state intervention. Other times, it is more of an opposition against science based medicine. Such objections were considered backward-looking by the advocates. But naturopathy in particular was an urban-bourgeois phenomenon and saw itself as decidedly progressive. The argumentation then – as now – was complex and sometimes contradictory. Tensions arise when open, critical discussions are no longer possible. This can be observed today with the opponents of coronavirus measures in Switzerland. The fronts are very hardened.

Was it perhaps more for cultural reasons that the rural population dealt differently with diseases or death?

Iris Ritzmann: It is very well possible that in rural areas the distance to the doctors trained in the cities at the universities was a factor. In the 19th century, lay healers in the villages were increasingly no longer allowed to practise. There was, however, a shortage of academically trained rural doctors. However, sources are often lacking on this.

One study I know evaluates court records from a rural area in the 19th century. It is striking that the opposition often comes from mothers. Even in case of the men convicted, they typically argue that they did not want to oppose their wives in this matter! The women usually argued with very tangible reservations. They report, for example, about vaccination damage that had occurred in other families. They say they could not bear the responsibility for such an intervention towards their children.

Finally, I would like to talk about a picture from a publication critical of compulsory vaccination. You see two fighting men defending the Swiss cross against snakes. What do you say to such a combination of anti-vaccination and nationalism?

Eberhard Wolff: You have to see the picture in its historical context. Artistically, the depiction is typical of the time. What effect did the makers of the magazine want to achieve with such iconography? The fight with the snakes refers to Greek mythology and provides a certain dramatization, which was certainly desired for such a signet of a magazine.

Iris Ritzmann: Vaccination is presented as poison. The fight is against compulsory vaccination, which is meant to threathen the Swiss people with poison. The men are thus defending Switzerland against the poisonous snake, which stands as an allegory for compulsory vaccination and the poisoning of the population. The text below demands the free decision to dispose of one’s own body. This historical argumentation is certainly comparable to today’s discussion against compulsory vaccination.

Eberhard Wolff: Today, the Swiss cross in the middle could be interpreted to mean that these people were nationalistic in an exclusionary way. However, contemporaries might have perceived it differently. Perhaps they wanted to show that they were good citizens who defended the values of Switzerland? The anti-vaccination movement was partly conservative, but not only. There was and is also a left-wing anti-vaccination movement.