In May 2019, the British Health Secretary controversially announced that he was considering mandatory measles vaccination for all children. Two years later, there is widespread debate about COVID-19 “vaccine passports” that would effectively make it compulsory to get vaccinated before going to the pub. Proposals like these are very sensitive. Vaccination has been entirely voluntary in the UK since the 1940s, and compulsion was effectively removed by the early 1900s in response to waves of opposition in the 19th century. And you just don’t get between a Briton and the pub.

So why propose such controversial policies? It’s because public health authorities are pushing for universal acceptance of vaccines. Governments, businesses, and the public no longer want to control infectious disease. They have become eradicationists. Protecting the people means removing vaccine-preventable diseases. Anything less is failure.

Despite measles’ return to the UK in 2019, vaccine acceptance is—historically speaking—remarkable. In England, 94.5 percent of children received at least one dose before their fifth birthday in 2018–19. It is now easier to trace people, the measles vaccine requires a much higher rate of acceptance to achieve herd immunity, and vaccines have a longer record of efficacy and safety. High-profile incidents in the United States, such as the 2015 Disneyland outbreak, have shown that vaccination rates below 95 percent can be deadly. COVID-19 is producing similar anxieties. 

In 1945, UK officials were delighted when local authorities achieved a goal of 75 percent diphtheria immunization of preschoolers. But “success” in the 1940s meant reducing diphtheria. Eradication would have been a very welcome side effect; however, it was not the be-all-end-all.

Historians and public health officials can spend all day discussing why certain populations do not vaccinate, the role of partisan party politics, sincerely held moral objections, online disinformation, and other factors. But the focus on “why” obscures a deeper phenomenon: vaccine refusal is a bigger problem for public health professionals today than it was just 30 years ago.