PhD Thesis - ResearchSpace@Auckland - The University of Auckland

My thesis has discussed the introduction and development of various immunisation
programmes in New Zealand since the 1920s, the reasons for the paths taken and the
choices made. It has also explored the responses of the general public and most
specifically parents to those public health initiatives.
One of the most important questions to be considered was how effective overall
immunisation was in doing the job required of it by the New Zealand Health
Department, namely, preventing infectious disease. However, answering such a
question raises several issues as there are a number of other factors which also play
important roles in improving health and longevity. Good nutrition and housing,
suitable sanitation methods and medical advances can all make a significant
contribution to the promotion of health. Coupled with the natural decline in the
severity of infectious disease evident over the twentieth century, assessing the
contribution of a single factor accurately becomes extremely difficult, if not
impossible.
This problem became apparent with the historical debate which was initiated by
Thomas McKeown. His thesis considered the roles of various factors in the decline in
the death rate from infectious disease in the industrialised world. 5 He argued that
nutrition was the most significant reason, however historian Simon Szreter disagreed
and emphasised the importance of sanitation and health education. 6 These assessments
did not include a discussion of immunisation as both McKeown and Szreter agreed
the latter was not important in Britain until after World War Two.
Despite the apparent difficulty in reaching an assessment, it is possible to draw
general conclusions regarding the effectiveness of immunisation in New Zealand.
Before World War Two immunisation in New Zealand was sporadic and its impact
fairly localised. It was not until after the war, when the diphtheria programme was
implemented nationwide and other vaccines, such as pertussis, became available that
immunisation started to make its mark. For immunisation to be effective there has to
5
T. McKeown, The Modern Rise of Population, London, 1976. His research dates from around 1770 to
the present.
6
S. Szreter, ‘The importance of social intervention in Britain, mortality decline c. 1850-1914: a
reinterpretation of the role of public health’, Social History of Medicine, 1988, 1, 1-38.
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