Vaccination regression

HIS REPUTATION will never recover from that unfortunate business in Salem, but Cotton Mather deserves some recognition for his place in American medical history. He was the anti-vaccination movement's first target.

The scene was Boston in 1721. Beginning in April, a smallpox epidemic spread from a ship anchored in the harbor; over the course of a year, it killed more than 840 people. (Here I'm drawing on Kenneth Silverman's excellent The Life and Times of Cotton Mather, winner of the Pulitzer Prize for biography in 1985.) In the course of his pastoral duties, Mather preached the necessary funeral sermons, but he was also a corresponding member of the Royal Society of London for Improving Natural Knowledge. The Puritan cleric had been keenly interested in medical issues for many years before the epidemic hit. He knew of a treatment, discussed in the Society's journal, in which a little of the juice from an infected person's pustule was scratched into the skin of someone healthy. It warded off the disease itself, somehow. The patient might fall ill for a short while, but would be spared the more virulent sort of infection.

Two months into the epidemic, Mather prepared a memorandum on the technique to circulate among area doctors, one of whom decided to go ahead with a trial run on three human guinea pigs. All survived the experiment, and in a remarkable show of confidence, Mather had his son Samuel inoculated. (Mather himself had contracted smallpox in 1678, so was already immune.)

News of the procedure and its success became public just as the epidemic was going from worrying to critical, but not many Bostonians found the developments encouraging. The whole idea seemed absurd and dangerous. One newspaper mocked the few supporters of inoculation for giving in to something "like the Infatuation Thirty Years ago, after several had fallen Victims to the mistaken notions of Dr. M----r and other clerics concerning Witchcraft."

Still more unkind was the person or persons responsible for trying to bomb Mather's house. It failed to go off, but the accompanying note made the motive clear: "You dog, damn you, I'll inoculate you with this...."

THE COLONIAL era falls outside the purview of Vaccine Nation: America's Changing Relationship with Vaccination (University of Chicago Press) by Elena Conis, an assistant professor of history at Emory University, who focuses mainly on the 20th century, especially its last four decades. The scene changed drastically since Mather's day. Knowledge lagged behind technique: pioneering though early vaccination advocates were, they had no sound basis for understanding how inoculation worked. And the "natural philosophy" of Mather's era was nowhere near as institutionalized or authoritative as its successor, the sciences, grew in the 19th century.

By the point at which Vaccine Nation picks up the story--with John F. Kennedy announcing what would become the Vaccination Assistance Act of 1962--both the nation-state and the field of biomedical research were enormous and powerful, and linked up in ways that Conis charts in detail. "If the stories herein reveal just one thing," she writes, "it is that we have never vaccinated for strictly medical reasons. Vaccination was, and is, thoroughly infused with our politics, our social values, and our cultural norms."

Be that as it may, the strictly medical reasons were compelling enough. The Act of 1962 was a push to make the Salk vaccine--which between 1955 and 1961 had reduced the number of new polio cases from 30,000 to under 900--available to all children. This seems like progress of a straightforward and verifiable sort, with the legislation being simply the next step toward eradicating the disease entirely. (As, indeed, it effectively did.)

But in Conis's account, the fact that JFK announced his support for a vaccination program on the anniversary of Franklin Delano Roosevelt's death was more than a savvy bit of framing. The reference to FDR, "the nation's most famous polio victim and survivor," also "invoked the kind of bold, progressive Democrat [JFK] intended to be." It positioned his administration as sharing something with "the nation's impressive biomedical enterprise and its recent victory against a disease that had gripped Americans with fear in the 1940s and 1950s."

It was technocratic liberalism at its most confident--a peak moment for the belief that scientific expertise might be combined with far-sighted government to generate change for the common good. And it's all pretty much downhill from there: Vaccine Nation is, in large part, the story of an unraveling idea of progress. True, scientists developed new vaccines against measles, diphtheria, rubella and other diseases. But at the same time, the role of federal power in generating "public awareness and acknowledgement of a set of health threats worth avoiding" came into question. So did public trust in the authority of medical science and practice.

THE EROSION was, in either case, a drawn-out process. A couple of instances from Conis's narrative will have to suffice as examples. One was the campaign against mumps. The military lost billions of man-hours to the highly contagious disease in the course of the two world wars. But a vaccine against mumps developed in the 1940s was left on the shelf when peace came. Mumps went back to being treated as a childhood ailment, rather than a disease with an associated cost.

But the postwar baby boom created a new market of parents susceptible to warnings about the possible (if very rare) long-term side-effects of getting mumps in childhood. Messages about the responsibility to immunize the kids were targeted at mothers in particular, stressing that the possible danger from contracting mumps made prevention more urgent than statistics could ever measure.

The logic of that appeal--"Why risk a danger that you can actively avoid?"--applied in principle to any disease for which a vaccine could be manufactured, and by the 1970s, early childhood meant having a cocktail of them shot into the arm on a regular basis. Then came the great swine flu scare of '76. The government warned of an impending crisis, stockpiled a vaccine for it, and began immunizing people – especially the elderly, who faced the greatest risk.

The epidemic never hit, but the vaccine itself proved fatal to a number of people and may have been the cause of serious medical problems for many more. All of this occurred during the last months of Gerald Ford's administration, though it has somehow become associated with the Carter years. There is no historical basis for the link, but it has the ring of truthiness. The whole debacle seemed to refute JFK's vision of science and the state leading the march to a safer and healthier future.

THE LARGELY unquestioned confidence in vaccination was perhaps a victim of its own success. Insofar as nearly everyone was immunized against several diseases, any number of people suffering from a medical problem could well believe that the shots had somehow caused it or made them susceptible. And in some cases there were grounds for the suspicion. There were also cases of inoculation inducing the disease it was supposed to prevent, as well as allergic reactions to substances in the vaccine.

But Conis sees the rise of an anti-vaccination mood less as direct response to specific problems than as a byproduct of countercultural movements. Feminists challenged the medical profession's unilateral claim of authority, and some women took the injunction to protect children by immunizing them and turned it on its head. If they were responsible for avoiding the risk, however slight, of preventable childhood illnesses, then they were equally responsible for avoiding the dangers, however unlikely, posed by vaccines.

Another strain of anti-vaccinationist thinking was an offshoot of environmental awareness. While industrial society polluted the air and water, heedless of the effects, medicine was pumping chemicals and biological agents into the smaller ecosystem of the human body.

Similar concerns had been expressed by opponents of vaccination in the late 19th and early 20th centuries--though without much long-term effect, particularly given the effectiveness of immunization in preventing (even obliterating) once-terrifying diseases. Conis depicts anti-vaccinationists of more recent times as more effective and better-established.

Besides the feminist and ecological critiques, there is the confluence of anti-government politics and new media. Supporters of vaccination once downplayed the issue of side effects, but it's an area that demands--and is receiving--serious medical investigation.

In places, Vaccine Nation suggests that the critics and opponents have made points worthy of debate, or at least raised serious concerns. And that may be true. It would almost have to be, the real question being one of degree.

But even with that conceded, many of the arguments the author cites are...well, to be nice about it, unpersuasive. "DISEASE IS NOT SOMETHING TO BE CURED," says one vintage anti-vaccinationist tract revived in the 1980s. "IT IS A CURE." The cause for illness? "Excess poisons, waste matters, and incompatible food"--but not, most emphatically, germs.

"Did you know," asks another figure Conis quotes, "that when immunity to disease is acquired naturally, the possibility of reinfection is only 3.2 percent? If the immunity comes from a vaccination, the chance of reinfection is 80 percent." In a footnote, Conis indicates that the source of these fascinating statistics "is unclear." That much, I bet, is true.

Poor old Cotton Mather's thinking combined superstition and enlightened reason. They can and do mix. But not in a statement such as "DISEASE IS NOT SOMETHING TO BE CURED. IT IS A CURE." The good reverend would dismiss that as little more than ignorance and magical thinking--and rightly so.

First published at Inside Higher Ed.