The Vaccination Wars

Michael Willrich
Mike Lovett
Michael Willrich

Widespread childhood vaccination is one of the great public-health triumphs of the last century. It eradicated smallpox, and brought other dreaded diseases like polio and measles to record-low numbers. In fact, according to the Centers for Disease Control and Prevention, immunization ranks first on the top-10 list of the 20th century’s public-health achievements.

Yet the perceived perils of vaccination have escalated dramatically over the past two decades, initially fanned by the now thoroughly debunked claim that some vaccines can cause autism. In a recent outbreak of anti-vaccination sentiment, opponents protested a California bill requiring schoolchildren to be vaccinated and eliminating a “personal belief” exemption that allowed unvaccinated children to attend school. The legislation passed in June, six months after a measles outbreak at Disneyland quickly spread and sickened nearly 150 (most of whom were not vaccinated) in the U.S. alone.

The idea of inoculation has always inspired fear and hope, says Michael Willrich, the Leff Families Professor of History at Brandeis and the author of “Pox: An American History” (Penguin, 2011), which examines how the government’s discriminatory enforcement of compulsory smallpox vaccination at the turn of the 20th century ignited a civil liberties struggle even as the measures eventually snuffed out the disease.

“When you make something mandatory, and that something is mysterious to people, as vaccines certainly are, it elevates the perception of risk,” says Willrich. “Parents are naturally anxious about their young children’s health, and even 225 years after Edward Jenner introduced the concept of vaccination, it’s still hard to get your head around it.”

After the first successful polio vaccine was introduced in the 1950s, states began to mandate a growing list of childhood vaccinations. Today, 16 vaccinations (many individual vaccines include multiple doses) are given between birth and age 18.

All 50 states have some form of mandatory vaccinations, but almost every state allows a medical or religious exemption. About 20 states have recast that exemption as a broadly conceived “personal belief,” enabling parents to skirt vaccination requirements for vague philosophical reasons, says Willrich.

“However, we’re still very vulnerable to these diseases, as the recent Disneyland outbreak proves,” he says. Some states, like California, have ended or narrowed the personal belief exemption.

The anti-vaccination movement of the early 20th century drew momentum from that era’s version of personal exemption laws. Then, as now, personal freedom collided with the societal benefit of mass vaccination. Then, as now, parents spearheaded the opposition.

But while today’s anti-vaxxers are mostly middle- and upper-class parents living in affluent communities, their counterparts at the turn of the last century were poor — and powerless.

At the time, authorities had broad power to regulate individual liberties in the interest of the general welfare. Wherever crowded conditions could easily spread contagion — schools, workplaces, public transit — officials could use legal coercion and sometimes even physical force to vaccinate in the name of checking an epidemic. Public-health officials focused on working-class neighborhoods in urban immigrant and African-American communities.

“Public-health authority was exercised in a very coercive manner that sometimes involved violence and people being vaccinated against their will by force, if you can imagine it,” says Willrich.

Yet authorities did nothing to regulate the vaccine industry. “Commercial manufacturers of dubious quality were producing vaccines that might be ineffective, impure or dangerous,” says Willrich.

Over the past century, however, the risks of vaccination have all but vanished. With no scientific data to support the modern anti-vaccine movement, today’s debate is purely philosophical and political. Even presidential hopefuls are offering libertarian arguments against mandatory childhood immunization. That never would have happened a century ago, says Willrich: “There’s no way Teddy Roosevelt would have come out and said vaccines were a bad idea.”

While parents continue the debate, voluntarily unvaccinated children pose a potentially deadly risk to children unable to tolerate vaccines because of their medical condition. “Do parents really want to be responsible for that?” Willrich asks.