You can call them ‘cynical spreaders.’ But the COVID-19 flouters are following a trail blazed in debates over vaccines, milk safety and seatbelts

Some flout social-distancing advice at Cherry Beach dance parties and others cheer passing cars at protests, waving signs comparing masks to mind control.

As the back-to-school season looms with fears of a second wave of the pandemic, a recent Angus Reid survey indicates that while most Canadians are following all or most advice to help prevent the spread of COVID-19, there is a skeptical cohort that defies guidance on group size, bubbles, handwashing, distancing and masks.

The polling company labelled them cynical spreaders." They are more likely to be young, more likely to live in the western part of the country, more likely to believe that current restrictions go too far.

While cynical spreaders" are in the minority, their reaction to public-health advice and rules is far from original.

The annals of Canadian public-health history are filled with stories of skeptics, cynics and people who value individual freedom above all. A 1931 editorial in the Canadian Public Health Journal noted that resistance was practically tradition: It has always been" that bitterly opposed ideas are ultimately accepted as being in the best interests of all concerned," it read, citing fiercely contested changes like compulsory school attendance, child labour laws and vaccination.

The author, Dr. John T. Phair, who would later become the chief medical officer of health for Ontario, wrote his editorial during the debate about milk pasteurization in the 1930s. Many people opposed the plan to make milk safer, and Phair was frustrated by what he saw as political unwillingness to act on good public-health advice. While he reasoned that much of the opposition could be chalked up to ignorance, selfishness or misinformation, it seemed to him that it mostly came down to the inherent dislike of the Anglo-Saxon to all measures which are designed to restrict his right to personal choice."

In the midst of the Great Depression, Ontario Premier Mitch Hepburn visited a tuberculosis ward at Toronto's Hospital for Sick Children, where many children were sick because of milk. (The children were from regions outside Toronto, where milk wasn't pasteurized.) Hepburn was told that if pasteurization was enforced across Ontario the spread of tuberculosis could be drastically checked." It seemed like a worthy goal, so Hepburn set out to regulate milk across the province.

How hard could it be?

Hepburn was a farmer from St. Thomas, Ont., before he entered politics so he likely knew the mess he was walking into. Hepburn was a populist - charismatic, bombastic, controversial. Soon after he entered politics as a federal backbencher, he became one to watch in Ottawa. By 1934, he was elected the Liberal premier of Ontario, at 37 years old.

The province he oversaw was going through major changes. The influenza pandemic of 1918, which killed around 50,000 Canadians, had led to the creation of the federal department of health in 1919. With more statistics being gathered, alarming trends were emerging. Infant mortality was going through the roof" by the end of the 1920s and into the 1930s, says Dr. Aleck Ostry, a professor emeritus at the University of Victoria who also served as the Canada Research Chair in social determinants of health.

With significant population losses in the Great War and the 1918 pandemic, this was a big worry, Ostry says. There was an anti-immigration thrust to the concern, he says - fears that if native-born Canadians" couldn't safely produce children, then the country would need more immigration. Meanwhile, more Canadians were continuing to move to the city, and farmers were working hard to feed crowded urban centres, shipping large volumes of milk by train.

Many dairies pasteurized their milk, but not all. Regulations came from the municipal level, and there was a patchwork across the province. In his biography of Hepburn, historian John T. Saywell writes that while around 85 per cent of milk in Ontario was pasteurized by 1937, smaller-scale dairy farmers made noisy opposition." Making sure milk could be safely transported on a large scale was a key concern, Ostry says.

If you don't pasteurize you're going to kill people in the cities with this poisonous milk you're sending," he says. So a lot of governments, marketing boards and producers were in favour of pasteurization, but the small farmers, sure, they saw this as kind of a plot by the big boys to shake them out of the market."

By the 1930s, Toronto already required pasteurization, thanks to the work of crusading medical officer of health Charles Hastings during the war.

According to the Museum of Health Care at Kingston, by 1900, 15 per cent of tuberculosis cases could be traced to dairy products, and doctors were trying to find ways to reduce that.

Through the late 1920s and early 1930s, there were a series of typhoid epidemics traced to milk-borne infection in different Canadian communities. In 1927, a typhoid outbreak caused by milk killed more than 500 in Montreal and caused thousands more to be sick. Montreal had a pasteurization bylaw, but it wasn't enforced, according to the Canadian Public Health Association. At the height of the scare, the U.S. government imposed an embargo on milk and cream originating anywhere close to that city.

Pasteurization was heralded as the safeguard. If you heated and cooled the milk to a certain temperature, you could kill any germs with the heat to prevent milk-borne illness.

It sounded like the ideal fix, but it rankled many.

Some farmers and consumers thought that raw milk was simply healthier. Many bristled with the government interference in their operations, calling it an unwarranted invasion of personal liberties." Some forecasted economic ruin in the purchase of equipment, which was no small expense during the Depression.

As Hepburn was building toward the pasteurization vote at Queen's Park in 1938, he was due to give a speech at the Ontario Agricultural Council winter meeting. Tension was high.

The premier told the crowd that prejudice against science would not stand. No matter how much they were against it, he promised that pasteurization would be a reality.

We don't like to do anything because we must," one farmer told the Globe and Mail.

But by the end of the meeting, the council voted to supported Hepburn's effort by a narrow margin.

It was a hard and sometimes lonely road," for the premier, the Globe would later write. Men who were his friends became his enemies. He was assailed and reviled."

At Queen's Park, wearing his wide-lapelled suits and pocket squares, he gave fiery speeches about death and disease and name-dropped the Dionne quintuplets as exclusive consumers of pasteurized milk. He asked his allies to hold firm. He knew they were being chewed out on street corners back home.

Why people are notifying me verbally or by letter every day that they will never vote for me again unless we change the law," Hepburn said. Well I don't mind that sort of talk. The government is going to stand pat ... in two or three years we'll have far fewer deaths than we unfortunately are having at the present time."

By the end of 1938, the bill had passed. Pasteurization was mandatory, but would be phased in for rural areas over the coming years. Anger lingered. After the bill passed, Hepburn was at an Elgin County Liberal association meeting, defending his actions by telling horrifying" stories of children infected with bovine tuberculosis.

Hepburn recognized a farmer who opposed the change in the back of the room. Since he was from the riding, the premier knew the crowd and remembered that two of the man's seven children had died.

They died of bovine tuberculosis, didn't they? They drank milk from your own cows and died?"

The Globe noted that the premier was incredulous. His voice rose as he asked his next question.

What kind of man are you?"

In the aftermath of mandatory pasteurization, ministry health statistics showed the changes Hepburn had hoped for - major declines in typhoid fever mortality and other milk-borne illness.

Despite this, a poll in the 1940s reported that 42 per cent of Canadians didn't have any issues with raw milk. One man wrote a letter to the editor in 1941 calling pasteurization Ontario's contribution toward the destruction of the rights of man."

Doctors at the Hospital for Sick Children just shook their heads: Those who object to pasteurization or do not appreciate its values are without scientific information," said Dr. Alan Brown.

On their website, the Dairy Farmers of Ontario call pasteurization one of the most beneficial and cost-effective measures to protect the health of the consumer." Many people didn't see that bigger picture back in the 1930s and 1940s, says Christopher Rutty, a Dalla Lana School of Public Health professor and public-health historian.

It was a similar story with the smallpox vaccine. The vaccine had been around since the late 18th century, and by the early 1930s, many had become indifferent.

It's kind of typical for the whole vaccine hesitancy issue," Rutty says. It's pretty clear historically that they work, but then new generations of parents grow up not seeing the diseases and have no real connection to them."

In 1932, a smallpox outbreak became a flashpoint of frustration for Vancouver officials.

By the time the spread was contained, 17 people were dead, according to a 1933 study published in the Canadian Public Health Journal.

In one family of conscientious vaccine objectors, seven died, including the parents. Three of their children, vaccinated in school, did not catch the disease, and there was not one case of smallpox among anyone who had been vaccinated within the last 15 years. (Of the 17 dead, one had been vaccinated 36 years previously.)

During the outbreak and its aftermath, 50,000 people in Vancouver were vaccinated as public-health officials waged a publicity battle with anti-vaccinationists" who protested in public, bought advertisements in the newspaper and invited the city's medical health officer to a debate.

He refused. There was simply nothing to debate he said, instead inviting them to visit smallpox wards with him to see how their immunity held up. (There were no takers on this offer," the Canadian Public Health Journal noted.)

Germ theory and laboratory medicine were still new concepts for many people, and those ideas hadn't percolated" into society, Rutty says. There were pockets of resistance and even today we have some of that."

Another big public-health fight captured headlines in the 1960s, as cities across Canada debated adding fluoride to their water, a measure widely supported by many dental associations and public-health officials as a way to prevent tooth decay regardless of socioeconomic status.

Fluoride is a naturally occurring mineral, and adjusting fluoride to an optimal level in community water supplies is associated with a 25 to 30 per cent reduction in tooth decay," the Canadian government wrote in a 2017 report. Figures like these are far less than the two-thirds reductions" that public-health promoters promised in the 1960s, historian Catherine Carstairs wrote in her article on the fluoridation debate in the American Journal of Public Health.

Fluoridation was not universally supported by the medical community during those early debates, Carstairs wrote. Some were not convinced that it was the right solution. Many people saw it as a thinly veiled intrusion into cherished civil liberties," Toronto's director of dental health services wrote in 1960. (Toronto's water has been fluoridated since 1963.)

As the debate raged, one Canadian dentist told a royal commission that pure water" groups were scaring people with dire tales" that had no basis in science and spreading alarmist literature.

While fluoridation is supported by many health organizations, including Health Canada, (the U.S. Centers for Disease Control calls it one of the 10 great public health achievements of the 20th century") the debate remains active in many communities, with fluoridation rates varying across the country, and some cities like Calgary choosing to stop the practice.

In 2011, Toronto held an extensive review and reaffirmed its position. The Medical Officer of Health concluded that none of the submitted materials contain information that would warrant further investigation of the safety and effectiveness of community water fluoridation in Toronto," a city statement reads.

Although water fluoridation undoubtedly did improve the dental health of many children in the 1960s and 1970s, fluoride proponents were perhaps too hasty in declaring that community water fluoridation was the best (or only) solution for dental decay," Carstairs writes, adding that a less fractious debate might have encouraged a more open discussion" about harms and benefits.

Back in the 1960s, the debate had come to the point where it was either a poison or a panacea, Rutty says, which made the matter difficult to resolve. He sees similarities in the discussion about masks and vaccines.

We have broader concerns that people have that are not necessarily grounded in any real science," he says. They are just grounded on fears or conspiracy theories that are amplified through social media and everything else, so it's difficult to resolve these things."

Another big public-health battle came in the 1970s with automobile safety. With death tolls on the roads mounting, Premier Bill Davis and his Progressive Conservative government announced that seatbelts would soon be mandatory in Ontario.

The letters to the editor poured in to the Star calling the proposed policy Big Brother" dictatorship, unfair, unsafe, and a dangerous precedent." Most were incredulous that the government would interfere in their daily habits.

If someone is willing to risk being hurt or killed because he does not wear a seatbelt, it is his own business," one person wrote.

Stories in the Toronto papers noted that even Davis's own backbenchers resented the interference, and some argued that not wearing a seatbelt was safer, referencing Oslo Villeneuve, the Glengarry MPP who claimed his life had been saved by not wearing a seatbelt. In the mid-1970s, about 15 per cent of Ontarians wore seatbelts, and the government estimated that if 75 to 80 per cent buckled up, hundreds of lives would be saved each year, and millions in health costs avoided.

Aware of a certain lack of citizen enthusiasm," the government spent money on an education program, and then made it law in 1976. The first person charged on day one of the new regime was Eric Biggins of Meaford, who chose a jail term over a $23 fine.

Biggins has since died, but his wife Marjorie Biggins, now 96, said her husband was making a point about loss of freedom. For many years, people wrote supportive letters to her husband, who continued his crusade and even had the car outfitted with Buckle up yours" stickers.

In 1986, he told the Edmonton Journal that he wasn't against seatbelts so much as he was against mandatory enforcement. The police say they are only doing their job, and I say that's what the Germans said in '39."

He was a staunch Yorkshireman ... you know, a sort of Churchill type," Marjorie says. Eric wouldn't change his mind because he believed in what he believed."

The government didn't change their mind either. In 2014, the province estimated that more than 9,000 lives had been saved by seatbelts. Recent statistics show that 96 per cent of Ontarians buckle up regularly.

COVID-19 is a new and evolving public-health crisis where understanding is constantly changing, Rutty says. Just like pasteurization, local perspectives guide reaction to issues like masks, distancing, school policies. In the U.S., the response has been even more fragmented.

Because it's a whole new situation," he says, we have to be careful not to blame people."

Canadians have historically had more trust in government than the U.S., he says. We also have more government support and better access to health care, Aleck Ostry says.

The ability of people in the states to deal with these harsh public-health lockdowns is much less," Ostry says, and people suffer in a real way economically in ways we don't in Canada. That's part of the reason why there is so much tension in the states."

No matter the situation or the solution, resistance to change has long been a challenge for public-health officials. In his 1931 editorial, Dr. J.T. Phair wrote that the remedy was an educational programme as persistent as its opposition, directed at the leaders of public opinion."

Christopher Rutty believes history can help. We live in a very present culture," he says, so having examples of hard-won public health measures that clearly worked is important.

He has written extensively on the history of public health in Canada, as well as the history of vaccines.

It's hard to argue the whole vaccine issue in the absence of understanding history," he says. When you understand the history, it kind of melts away the resistance."

Katie Daubs is a Star reporter and feature writer based in Toronto. Follow her on Twitter: @kdaubs