Vaccination policy against smallpox, 1835-1914: A comparison of England with Prussia and Imperial Germany
Vaccination policy against smallpox, 1835-1914: A comparison of England with Prussia and Imperial Germany
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DOI：
10.1093/shm/11.1.49
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发表时间：
1998-04-01
影响因子：
0.7
通讯作者：
Hennock, EP
中科院分区：
文献类型：
--
作者：
Hennock, EP
在比较英格兰、普鲁士和德意志帝国的疫苗接种政策时，有三个可识别的阶段。(i)在1870年代以前，普鲁士的医务警察传统使人口的疫苗接种比英国更早被视为国家责任，并提供了适当的行政框架。可以施加的行政压力使普鲁士当局相信，立法强制接种疫苗是不必要的。相比之下，英格兰和威尔士既缺乏医疗警察的传统，也缺乏医疗警察的行政结构。立法（1840年，1853年）免费和普遍的婴儿疫苗接种之后，激进的思想和行政创新。从1875年至1889年，两国都为所有人提供免费和强制性的疫苗接种。在英国，这仅限于婴儿；在德国，包括普鲁士，它包括重新接种儿童疫苗。1889年以后，英国和德国的分歧开始更加尖锐。在英国，疫苗接种率下降，1898年之后，出于良心拒服兵役者被允许不必让他们的孩子接种疫苗。德国保留了强制性疫苗接种，两国的接种率日益分化。英国开始依靠当地的公共卫生管理部门来监测和控制天花，包括对接触者进行选择性接种。尽管存在这些差异，但两国的天花死亡率都急剧下降，尽管德国下降得稍早一些。英国对监视和控制的依赖预示了世界卫生组织在第三世界消灭天花的做法。这表明，德国文献中对高水平大规模疫苗接种重要性的强调或许应该加以修订。
There are three identifiable phases in comparing vaccination policy in England, Prussia, and Imperial Germany. (i) Prior to the 1870s the tradition of medical police in Prussia resulted in the vaccination of the population being treated as a State responsibility earlier than in England and provided an appropriate administrative framework. The administrative pressure that could be exerted persuaded the Prussian authorities that legislation to make vaccination compulsory was unnecessary. In contrast, England and Wales lacked both the tradition and administrative structures of a medical police. Legislation (1840, 1853) for free and universal infant vaccination was followed by radical ideological and administrative innovation. (ii) From 1875 to 1889 both countries provided free and compulsory vaccination for all. In England this was limited to infants; in Germany including Prussia, it included the re-vaccination of children. (iii) After 1889 England and Germany began to diverge more sharply. In England vaccination rates fell and after 1898 conscientious objectors were excused from having to have their children vaccinated. Germany retained compulsory vaccination and rates in the two countries increasingly diverged. England came to rely on the local public health administration for the surveillance and containment of smallpox, including selective vaccination of contacts. Despite these differences smallpox mortality dropped sharply in both countries, although in Germany somewhat earlier. The English reliance on surveillance and containment prefigures that of the WHO in the eradication of smallpox in the Third World. It suggests that the emphasis on the importance of high levels of mass vaccination in the German literature should perhaps be revised.