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Below you will find a small sampling of the many Medical Heritage Library resources pertaining to vaccination, including materials that reflect both pro- and anti-vaccination viewpoints. These sources, organized chronologically, trace the history of vaccination from the 18th century through the 1920s. Click on any resource to learn more and explore the full text!

Don’t see quite what you’re looking for? Try searching the Medical Heritage Library for yourself! Another excellent online resource is this interactive timeline of the history of vaccines, made by the College of Physicians of Philadelphia.

J. Jurin, An account of the success of inoculating the small pox… (1724)	E. Jenner, An inquiry into the causes and effects of the variolæ vaccinæ... (1798)	W. Fermor, Reflections on the cow-pox... (1800)
C. R. Aikin, A concise view of all the most important facts... concerning the cow-pox (1801)	E. Jenner, “Instructions for vaccine inoculation” (1801)	J. Birch, Serious reasons for uniformly objecting to the practice of vaccination (1806)
F. S. Stuart, £30,000 for the cow-pox!!! (1807)	J. Conolly, An address to parents on the present state of vaccination in this country... (1822)	H. Edmonston, Observations on cowpox and on the necessity of adopting legislative measures… (1828)
G. S. Gibbs, The evils of vaccination: with a protest against its legal enforcement (1856)	Boston City Physician’s Office, “I transmit to you herewith a supply of fresh Vaccine Lymph…” (1859)	J. Jones, Researches upon “spurious vaccination”… (1867)
E. A. Hart, The truth about vaccination (1880)	E. Robinson, Can disease protect health? Being a reply to Mr. Ernest Hart's pamphlet (1880)	A. von Rózsahegyi, Experiments on Pasteur's protective inoculation against anthrax in Hungary (1882)
J. Pickering, Which? Sanitation and sanatory remedies, or vaccination and the drug treatment? (1892)	W. J. Simpson, Cholera in Calcutta in 1894 and anti-choleraic inoculation (1894)	J. M. Peebles, Vaccination: a curse and a menace to personal liberty (1900)
S. M. Copeman, Modern methods of vaccination and their scientific basis (1903)	W. S. Magill, Memoranda concerning vaccination in the prophylaxis of typhoid fever (1912)	W. M. Haffkine, On prophylactic inoculation against plague and pneumonia (1914)
E. C. Rosenow, Prophylactic inoculation against respiratory infections... (1919)	C. M. Higgins, Horrors of vaccination exposed and illustrated (1920)	L. S. Dudgeon, Bacterial vaccines and their position in therapeutics (1927)

The “Dangerous and Sinful Practice of Inoculation” 

In 1721, London was hit with a smallpox epidemic. In response, Lady Mary Wortley Montagu, wife of the former ambassador to Turkey, had her 2 ½-year-old daughter variolated (inoculated) in front of an audience of physicians and members of the aristocracy, thus introducing the practice to British society. It had long been understood that survivors of smallpox carried life-long immunity: the practice of inoculation introduced smallpox matter directly from one person into the arm of another, generally resulting in a milder case than if one had caught the virus “wild.” 

The experiments of the fashionable aside, inoculation was introduced at a time when popular understandings of the body and disease centered on divine intervention: “Diseases are sent,” preached the Reverend Edmund Massey, “if not for the Trial of our Faith, for the Punishment of our Sins” (p. 10). Therefore, to inoculate oneself or children against disease, was an arrogant refusal of God’s will, and would only lead to eternal punishment. 

Massey’s opposition to the new practice of inoculation was only one of several arguments. Dr. W. Wagstaffe, of the College of Physicians, asserted that inoculation was so far proven effective for cultures who dwell in “a warm Climate, living on a spare diet, and in the lowest manner.” Englishmen, on the other hand, were “the product of the richest Diet,” and therefore an operation that originated in the near East could not be simply transplanted to Britain. Physicians, he asserted, should refrain from practicing it until they had more experience.

Charles Maitland, himself an inoculator, wrote a lengthy pamphlet in which he responded line by line to the arguments put forward by both gentlemen the same year. 

The Discovery of Vaccination

In 1796, Edward Jenner began a series of experiments based on local knowledge that individuals who contracted cowpox in the course of handling livestock were not susceptible to catching smallpox. Jenner first located a number of individuals who had developed cowpox lesions previously – each case detailed in his 1798 pamphlet – and attempted to inoculate them with smallpox. In no case did the disease take. He then took cowpox matter from sores on the had of Sarah Nelmes, and introduced this into the arm of an eight-year-old boy, by making scratches into his skin. The boy was subsequently inoculated with smallpox matter, but it did not take, thus proving cowpox (or vaccinae, from the Latin, vacca, for cow) an effective preventative of smallpox.  

Vaccination: a Moral Imperative

Published four years after Jenner’s discovery, Dr. Lettsom’s plea to parents to have their children vaccinated cited an increase in the mortality rate across Europe from both naturally-occurring cases of smallpox as well as from inoculation. “Parents and guardians of children!” he wrote. “If you allow them to take the Small-pox, and they should die of it, are you not accessory to their deaths? As the Vaccine Inoculation is a certain security against the Small-pox; as it introduces no constitutional disease or blemish, and is never fatal; what apology can you offer for neglecting the means of prevention and security?” Lettsom asserted that it was divine providence that the vaccine had been discovered when it was, and was a means of saving lives, as Christians had been instructed to do.

Organizing to Eradicate Smallpox

Nineteenth-century New Yorkers – and Americans generally – lived in a world with few government-sponsored social welfare programs. Nearly all services for the public welfare were provided by charitable organizations founded and funded by private, usually well-to-do citizens. One such society, the New-York Vaccine Institution, was incorporated in 1844 with the purpose “exterminating” smallpox through vaccination. The Institution provided free vaccines to anyone who visited their clinic, and also supplied the virus to individuals who worked with the public, including missionaries, sea captains, agents for receiving immigrants, and manufacturers, so that they might also vaccinate their clients and employees. 

Notably, the Vaccine Institution was founded in the midst of a massive wave of immigration to the United States from Ireland and what is now Germany; approximately 7.5 million immigrants arrived on the east coast between 1820 and 1870. As stated in the organization’s charter: “a peculiar necessity exists for such an institution in this city, on account of the constant influx of emigrants, and the rapid changes of its population” (p.1). Probably it was this realization that led the Institution to establish its offices and clinic at 369 Broome Street, located in the heart of Manhattan’s densely-populated, predominantly immigrant Lower East Side. 

Normal Progression of a Vaccine Vesicle 

         Dr. Holt’s 1171-page authoritative text on the diseases of childhood featured a substantial section on specific infectious diseases, including: scarlet fever, measles, rubella, mumps, diphtheria, typhoid fever, pertussis, tuberculosis, influenza, chicken pox, and vaccinia-vaccination (inoculation with cowpox). The image above shows examples of typical progression of the vaccination vesicle; in normal progression, the initial wound healed within 3-5 days, with sign that the vaccine took (figure A) appearing on the fifth day. Holt’s textbook includes a number of illustrations and charts and graphs, particularly when a visual would aid in diagnosis – especially useful for differentiating measles and chickenpox, as both febrile diseases cause rash or pustules on the skin. Noticeably absent from this text, however, is information on the diagnosis and treatment of smallpox. Instead, Holt rather extensively covers the process of vaccination and after-care, along with information on complications as well as common injuries (infection with tetanus, the activation of latent tuberculosis) that were known to occur. He was emphatic, however, that in the majority of cases such injuries could have been avoided if sterile lymph were used or if attention was paid to contraindications – children with active eczema rashes or syphilis were not to be vaccinated.

         Holt informs his readers that: “the nature of the protection against smallpox which vaccination affords is even now but imperfectly understood. The fact, however, remains one of the best attested in medical history …It is the imperative duty of the physician to see to it that every young infant is vaccinated” (p. 998). This statement is accompanied by a chart, displaying the annual rates of death per 100,000 from smallpox from three European countries: Prussia and Holland, where vaccination became compulsory in 1874 and 1873, respectively, and Austria, where it had not been made mandatory. 

Against Compulsory Vaccination

Major Boudren vigorously opposed compulsory vaccination in stark language: “The violation of the body of a healthy person and the defilement of the pure blood of a child or adult by pus inoculation as in vaccination, and without their consent, is assault and a crime in the nature of rape” (p.4). Boudren’s reasons for opposing vaccination range from an interpretation of compulsion to the procedure as a violation of individual liberty to alleging that a great many more deaths were caused by the vaccine itself than were killed by smallpox. These are supported by quotes and pieces by more eminent authors and a list of individuals injured or killed by vaccines for the years 1909 and 1910 (67 in total).

         Boudren’s views on the subject can best be understood in the context of the Progressive Era, a time of rapid modernization as well as expansion of government involvement in everyday life. A number of individuals, unnerved by these rapid changes, sought to exert more direct control over government policy and to preserve their own bodily autonomy. Boudren also offers an alternative interpretation of the child welfare rhetoric that upheld compulsory vaccination for school children as necessary to their protection and to the nation’s welfare: rather than protecting children from disease, public health officials were introducing loathsome material into the body of an innocent child. 

In Defense of Vaccination

According to Professor Dock, “many antivaccinationists [in 1907] are both ignorant and fanatic, but more are merely ignorant” (p. 1-2) Dock paid no mind to the arguments put forward by Boudren and others that vaccine itself resulted in injury and death; instead, he addresses the question of whether or not state governments had the authority to enforce vaccination and the benefits of a systematic approach to vaccinating the public. In detailing the various loopholes and oversights across the several states’ laws regarding vaccination, Dock builds an argument typical of the Progressive Era: the problem is not the vaccine itself, it’s how it had been administered. A system whereby vaccines were administered routinely and regularly, documented thoroughly, by well-trained officials, supplied by vaccine manufacturers whose product was overseen by the best experts, could only result in a total abatement of smallpox epidemics and would see no accidental deaths or injuries. 

Smallpox defeated: Vaccination still necessary? 

The last case of smallpox to occur in the United States was in 1949. By 1971, smallpox had been eradicated in North and South America. The following year, based on the advice of the American Academy of Pediatrics as well as that of the Centers for Disease Control, many states ended compulsory smallpox vaccination requirements for school children. This decision was not without attendant controversy, however. Older physicians, who remembered the severity of smallpox and its high (30 to 60 percent) mortality rate, advocated caution and recommended that compulsory vaccines be reinstated. The disease was still present in some areas of the globe, and air travel had raised the specter of an outbreak in an isolated area becoming an instantaneous global epidemic thanks to a single traveler. Additionally, skeptics of the United Nations and of global organizations hypothesized that smallpox eradication efforts could lull the United States and other western powers into a false sense of security, making them susceptible to a biological warfare attack.

In response to such concerns that had been aired in issues of the Virginia Medical Monthly, Robert Jackson, an epidemiologist for the state of Virginia, wrote the above letter to the editor of that journal. Jackson’s letter is an example of a new point in the discussion of risks and vaccines that had been taking place since the early twentieth century: when the threat of a once-dread disease is practically extinct, should the public still be expected to bear the risk of adverse side effects of vaccination? 

Vaccine does not Equal Cure

Founded in 1938 by Franklin D. Roosevelt and his former law partner, Basil O’Connor, the National Foundation for Infantile Paralysis began as a non-profit aimed at funding research on poliomyelitis and providing rehabilitative care to its victims. The organization’s most famous campaign, the March of Dimes – from which the organization eventually took its name – encouraged small donations from all individuals to fund the fight against polio. These funds made possible the development and testing of the first successful vaccine, licensed in 1955.          

  In the wake of the National Foundation’s mass vaccination drives, cases of paralytic polio fell from an average of 15,000 per year, to fewer than one hundred cases annually after 1967. Polio was no longer a major threat to health, however, that assumption forgot about the thousands of individuals who had contracted the disease either before or in the early days of the vaccine’s debut, who were still struggling with the long-term effects of disease. This pamphlet from the National Foundation informed readers that additional funds raised by the March of Dimes would go towards research on improving mechanical breathing aids (such as the iron lung) and assistive mobility devices so that those who survived polio could regain independence and live fuller lives beyond the polio ward. Nevertheless, even the National Foundation for Infantile Paralysis soon realized its efforts would be better spent elsewhere, and in 1958 announced a new focus on chronic diseases and birth defects. 

The Medical Community Responds to the Salk Vaccine Debut

The March of Dimes campaign was not the first fundraising drive to focus on small donors – Christmas Seals Campaigns to raise money for tuberculosis patients beat them to that – but the National Foundation for Infantile Paralysis was unique in its use of marketing strategies to generate large sums and to use those funds to directly fund research on prevention and treatment. Prior to these campaigns in the 1940s, funding for medical research came from three major sources: university research programs, state health departments and the US Public Health Service, and large private donors (for example, the famed Rockefeller Foundation). As the National Foundation was governed by a board of directors and solicited donations from the general public, it was policy to share news of progress directly with the public. According to surveys, at least 90 percent of the American public was familiar with the vaccine before it had been approved, making the polio vaccine one of the first national “medical breakthrough” news stories. 

The NFIP contributed research funding to several scientists working on polio, but two men have received acclaim for development of the two types of vaccine that have been used: Jonas Salk and Albert Sabin. Salk’s research worked on the “killed-virus principle” – that a dead virus would not be able to transmit the disease but would still prompt the body’s immune system to create antibodies. Sabin however, along with many other scientists, believed only a live virus could stimulate the body to produce effective antibodies, and focused on creating a live attenuated vaccine – that is, one that would replicate in the body and provoke an immune response, but be too weak to make the patient ill. Sabin’s live attenuated virus also had the advantage of being administered orally, making it quicker to deliver and painless to the patient. However, Salk’s research was favored by the National Foundation, who sponsored field trials in 1954 and, once the vaccine was licensed by the Department of Health, Education, and Welfare (now the Department of Health & Human Services) in 1955, purchased and distributed the vaccine widely to elementary school children. 

Sabin continued to develop his oral vaccine, and in 1957, approached the Ministry of Health for the Soviet Union to conduct field trials of his formula (field trials in the U.S. would not be possible, as too great a fraction of the population had already been vaccinated with the Salk injected vaccine). The USSR trials were successful, and in 1960, the Sabin Oral Polio Virus was licensed for use in the U.S.  

Doctors Aid in Polio Vaccine Trials 

This article from the Fort Wayne News Sentinel, reprinted in the Journal of the Indiana State Medical Association, reports on Allen County’s participation in the national trials of the Salk vaccine in 1954. Fort Wayne (Allen County, Indiana) was the third largest city in Indiana in 1950, and had an active March of Dimes chapter. The article commends the selfless volunteer service doctors and support staff, who would administer the vaccine to 3,500 second-graders – in a series of three shots – and perform blood test as controls on thousands of first- and third-graders. The control blood tests were used to ascertain the overall presence of polio in the county, through the presence of antibodies that would have been created if the child had had a previous case of polio, and it would determine the number of active, but undetected, cases of polio.  

Maryland State Board of Health Weighs in on Polio Vaccine Trials

This statement by the Maryland State Board of Health captures the attitude of several within the medical profession: cautious optimism, with an emphasis on the cautious. Members of the medical profession expressed some concern that, given all the publicity given to Salk’s research, the general public would start assuming that the vaccine was already complete and available, and, it follows, begin demanding doctors administer a vaccine to their children that did not yet exist. Worse was the unstated scenario: what if the vaccine trials failed and the preparation proved useless? How then might the public react? 

“The National Foundation is running this thing like a soap opera” 

Public health initiatives – and vaccination campaigns in particular – have long been the subject of commentary in state and county medical society journals. This editorial from the Sacramento County Medical Bulletin (republished in a 1955 issue of the Bulletin of the Mahoning County [Ohio] Medical Society) captures a sense of the unprecedented nature of the National Foundation for Infantile Paralysis’s March of Dimes drive to fund research into polio prevention and treatment. Some physicians, however, felt that the foundation had gone around traditional professional authorities to release their results directly to the public, when it should have first been published in a medical journal with the attendant data so that physicians could be the ones to interpret the results to their patients. Dr. Korngold’s discontent with the announcement may have also been inspired by much of the confusion surrounding the debut of Salk’s vaccine. Supplies fell short of demand in the first months of the vaccine drive, and many questioned whether the vaccine ought to be given to other groups in addition to the NFIP’s priority demographic: first- and second-grade school children. 

The Cutter Incident

In the aftermath of the announcement that the polio vaccine worked, manufacturers ramped up production in order to meet supply: the National Foundation was funding distribution of the vaccine free to children in grades one and two, and each child required three shots to achieve full immunity. Supplies of the vaccine were short from the beginning, and to make matters worse, it was revealed on April 25, 1955, that vaccine manufactured by Cutter Laboratories had led some children to develop full cases of polio. This report by Dr. Malcolm H. Merrill, director of the California State Department of Health to the California Medical Association annual meeting, describes how the cases of polio resulting  from the vaccine were discovered by the Board of Health and their instructions to physicians. They immediately informed doctors to stop using the Cutter-manufactured vaccine but to continue use of the others; a week after this meeting, the U.S. Surgeon General suspended the national vaccination program until all six manufacturers’ product could be tested. Merrill specifically notified his colleagues that it was not recommended to administer gamma globulin – a biological product that has been used to stimulate the immune system to fight off disease – to inoculated children, but instead to carefully monitor them for the time and report any cases.  

The Cutter Incident, as it has become known, did lead to several significant reforms, including the new Division of Biologics Standards (now the Division of Biological Standards and Quality Control of the Food and Drug Administration), which is responsible for developing and maintaining products testing standards. 

Sabin Vaccine Drive in Britain

In September 1961, a polio outbreak hit the English port city of Kingston upon Hull. The Hull Health Authority requested the use of the Sabin Oral Vaccine (or OPV), in what became the first mass distribution of the vaccine in Western Europe. Albert Sabin’s vaccine was made from a live attenuated virus that could be administered orally, making distribution faster, simpler, and for those afraid of needles, less stressful. This documentary film is meant to educate public health officials and the general public on the process of performing mass vaccination with the new formula. It shows the process of preserving the oral vaccine for transport, preparing it for distribution, and how the town used public facilities and education campaigns to ensure that over 90 percent of residents were vaccinated. The film ends with a short interview with the head of the vaccination campaign to discuss what lessons his department’s experiences could lend to others. 

Pasteur and his work : from an agricultural and veterinary point of view

Pasteur’s research on microscopic organisms that led to the discovery of the processes of fermentation and pasteurization have been celebrated in the history of medicine and public health, but his work had an impact on the field of agriculture as well. The nineteenth century saw the beginning of the mass movement of people into cities in Europe and the United States. Some city dwellers kept animals – pigs and chickens especially – close at hand in their new homes. Dairies, shepherds, and other animal farmers expanded their stock in order to provide more butter, milk, cheese, wool, and meat for urban dwellers who had to buy these items in the market. The result was that animals were coming more in contact with each other and epidemic diseases in animals devastated larger numbers and affected human beings both directly – as sources of disease to humans – and indirectly, as shortages affected the food supply. Pasteur’s development of vaccines for rabies and anthrax were key developments in stemming epidemics: rabies was frequently transmitted from dog bites to children in cities, and anthrax killed hooved livestock and could make humans sick as well. The above image demonstrates how to effectively inoculate a sheep against anthrax; according to the directions, two men working in this way could vaccinate up to 150 sheep or goats per hour. 

The Preparation of Diphtheria Antitoxin and Prophylactics 

While anti-vaccinationists in the early twentieth century liked to point to the cultivation of cowpox virus in cows and its transmission to humans as a source of contamination and impurities [link to the “What is Vaccine lymph” document in anti-vax docs], scientific authorities in later decades documented processes such as these in order to demonstrate to the public the safety and cleanliness of animal facilities. In this film, produced for British audiences at the end of World War II, we find out first how diphtheria toxins and antitoxins act on the body, then are taken on a tour of a laboratory where the virus is purified and attenuated for use in medicine. The narrator provides details on how frequently and under what conditions the antitoxin is harvested from the horses, to show the reader that everything is done in accordance with the strictest principles of hygiene. Finally, as proof of the safety of this process, statistics on falling diphtheria rates since 1894, when the vaccine was first used, are shown.    

Mobile Vaccine Clinics, c. 1955 

This image, captured in 1955, was published in a 1994 exhibit catalog celebrating nearly 200 years of the United States Public Health Service (USPHS). Originally established by Congress as the Marine Hospital Service in 1798 to assist and quarantine sick and diseased seamen, this federal organization evolved over decades to promote the public’s health both domestically and internationally. In the 1950s, as more vaccines became available for more communicable diseases – notably polio – the PHS took on the duty of distributing vaccines widely, especially in rural areas and populations underserved by doctors. 

The 1962 Vaccine Assistance Act 

This Kennedy Administration policy was passed by Congress in 1962 to provide federal funding for local and state immunization programs. At this time, vaccines were available for diphtheria, poliomyelitis, tetanus, and whooping cough, and national surveys showed that these diseases were most prevalent among preschoolers in impoverished areas, which also had the lowest vaccination rates. Not all doctors agreed, however, on whether a federal program for vaccination assistance was necessary, as evidenced by the following series of medical journal editorials.

Kansas 

The editor of the Journal of the Kansas Medical Society urged his readers to consider the reasons why the bill had been passed before they jumped to conclusions about government interference in the practice of medicine. 

South Carolina 

The editor of the Journal of the South Carolina Medical Association questioned whether mass vaccination was important enough to divert patients from their doctors’ offices to receive them. 

Kentucky 

In Kentucky, the public health department chose to take advantage of federal funds to institute a state-wide immunization program, and kept doctors appraised of what the program would be doing with its funds. 

In 1977, the US Department of Health, Education, and Welfare put out this pamphlet for parents, to inform them of the recommended childhood vaccines and to explain their importance. By the late 1970s, smallpox had been effectively eradicated in the United States, [see smallpox-specific documents] and with the death of such a virulent threat, many parents began to wonder whether the other diseases for which vaccines were available – measles, polio, rubella (German measles), mumps, diphtheria, pertussis (whooping cough), and tetanus – were all that dangerous. In particular, adherents of natural living and the Holistic Health Movement, were convinced that immunity obtained “naturally” – that is, through catching the disease itself in childhood – would more effectively convey lifelong immunity to the disease.

The pamphlet produced by DHEW includes several images of healthy children, but only two pictures at the beginning depict the vaccination process. One shows the more typical syringe injection, but the second introduces a new piece of vaccine technology (shown above). The invention of the jet injector increased the rate at which vaccinations could be distributed: this device could vaccinate up to 1000 people in an hour. Jet injectors worked by using high pressure to force vaccine material under the skin without the use of needles, which though not painless, was relatively less painful than a needle stick, reduced the risks from needle-stick injuries, and was thought to be easier for individuals who feared needles.

Changing notions of risk and disease prevalence in the late 1970s did change how parents and government officials understood vaccine risks and benefits. One event especially gave the public pause when it came to immunizations: the 1976 swine flu “affair.” Reports in early 1976 that an influenza virus similar to the one that caused the 1918 global flu pandemic had stricken soldiers at Fort Dix, New Jersey, prompted President Gerald Ford to announce a national campaign to vaccinate 95 percent of the US population. But the epidemic never came, and to make matters worse, several dozen cases of Guillian-Barré syndrome had occurred among the 40 million people who did receive the vaccine. As part of the public law implementing the vaccine program, Congress had ordered the Secretary of Health, Education, and Welfare to investigate the range of adverse side-effects attributed to various vaccines and the rate at which they occurred, with the goal of determining the potential cost to the government should claims be made against it as a result of vaccine injuries. Later, in 1986, Congress passed the National Vaccine Injury Compensation Program, a no-fault system in which claimants who felt they had suffered adverse effects from a covered vaccine could file a claim against the federal government, thus providing a streamlined alternative to traditional malpractice lawsuits. 

Vaccine-Preventable diseases in Pre-school children

Government attempts to mitigate the risks associated with vaccination – whether through increased surveillance and investigation under the FDA or by the Vaccine Injury Compensation Program – did not automatically result in 100 percent compliance with immunization guidelines for children. This report and plan of action, set out by the Indiana State Department of Health, found that only two-thirds of children under the age of two had been given all of the vaccines deemed appropriate to their age group in 1993. The data generated by their study and the Department of Health’s proposed course of action to bring more families into compliance, is representative of the problems public health officials have faced in trying to ensure compliance with vaccination requirements and what they have felt to be the best course of action in response.

Talking to Patients about New Vaccine Guidelines

In the early 2000s, highly publicized findings – later proven untrue – alleged that a link existed between the MMR vaccine (for measles, mumps, and rubella) and autism. Fearful that this could be true, many parents in the United Kingdom and United States opted to have their children receive the vaccines as single doses (rather than the combined shot), skipped booster shots, or declined to have their children vaccinated at all. In response, many medical professionals tried to address these fears and assure their patients that the vaccines were safe. This issue of Chemist and Druggist, a trade magazine for pharmacists and pharmacy owners in Britain, featured as one of its continuing education modules information on new vaccine guidelines put out by the National Health Service in 2007. The pharmacist is not only educated on what the then-current medical advice was, but is also given a hypothetical scenario in which a client with small children expresses fears about a link between autism and vaccines. By completing the exercise, the pharmacist is meant to learn effective techniques for convincing the patient that it is safer to have her children vaccinated.