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History and anti-vaccination anxiety

[ 69 ] January 23, 2011 |

So The Times ran an op-ed the other day about the history of anti-vaccination fears. The piece was written by Michael Willrich, a very good historian of the progressive era whose forthcoming book on the early 20th century smallpox eradication program will be coming out in late March.  The majority of the article is quite interesting, but in other respects it’s a fine example of why history doesn’t always offer useful guidance for confronting the difficulties of the present.

Willrich’s entry-level argument — that opponents of vaccination predate the fraudulent and scientifically invalidated work of Andrew Wakefield — won’t surprise anyone who’s spent more than a few minutes studying the history of medicine and public health. More specifically, he notes that well into the 20th century, vaccination opponents frequently had perfectly sensible reasons to be wary of public officials whose enthusiasm for fighting infectious disease was often matched by their loathing of workers, immigrants and racial minorities. When I teach this history, in fact, I usually argue that vaccination opponents are entitled to a pass if they (a) lived prior to the widespread acceptance of germ theory, or (b) were part of an economic and/or ethnic stratum routinely scapegoated by sanitary reformers.  As Arthur Allen’s book describes in great detail, the history of smallpox vaccination in late 19th and early 20th century did indeed stray into some dubious civil libertarian ground, and the health risks associated with the smallpox jab — though unquestionably preferable to the virus itself — weren’t negligible.  (There was, for example, a significant risk that vaccine recipients would be infected with tetanus bacilli.)

But none of this historical detail, correct though it is, has much relevance to the issue laid out by the paper’s headline writers (“Why parents fear the needle”).  Put quite simply, only the most recent species of the anti-vaccination movement — beginning with the DTP scare of the 1980s, continuing through Wakefield’s MMR fraud, and more metastasizing over the last decade into a whole array of hysterical claims about the preservatives and adjuvants in nearly every shot on the market  — have emphasized children as the focal point of risk.  The health of children certainly mattered in previous eras of anti-vaccination hostility, but they weren’t the overriding focus.  And it’s worth pointing out that many of the perceived risks for children and adults a hundred years ago — like tetanus infections — were very real and abundantly documented, unlike the chimera of autism that has served as the basis for anti-vaccine science fiction for the past dozen years or so.

Moreover, contemporary vaccination opponents have little room to argue (as Willrich’s historical subject might have) that contemporary vaccination schedules represent a violation of civil liberties or accentuate patterns of racial, ethic or class chauvinism.  In most states, the exemption laws are quite generous and acknowledge all sorts of religious kookery as well as secular, scientific illiteracy as legitimate grounds for parents to avoid vaccinations and heighten the risk that their children and communities will be exposed to preventable, deadly illnesses.  So here again, the smallpox struggle during the era of Teddy Roosevelt really doesn’t offer much guidance to the current debate.

The larger problem with Willrich’s argument, though, is his recommendation that vaccine advocates look to their progressive era forebears and “reclaim the town square with a candid national conversation about the real risks of vaccines.”  Perhaps I’m less optimistic than I should be that the American public will actually listen to informed public health advocates who faithfully represent the scientific consensus on vaccine safety and efficacy.  But clearly, Willrich doesn’t waste much of his time debating vaccination opponents or reading their literature.  Otherwise, he’d understand that initiating a conversation about the “real” and “minuscule” risks of vaccination will quickly run up against a wall of assertions about the “real” and “inevitable” afflictions lurking in every dose of Pediarix.  Advocates will have to explain why, if the risks are so minimal, the packaging inserts for commercially available vaccines all warn of horrifying potential complications (with no reference to their statistical unlikelihood); or they’ll have to explain why the Vaccine Adverse Event Reporting System exists in the first place if vaccines are so uncontroversially “safe.”  There are, of course, strong and convincing responses to both of these detours among many others, but I can attest from personal experience at least that most vaccine delayers/refusers don’t give a shit about the history of VAERS or about why product inserts are written the way they are.  For some people, terms like “febrile seizures” trip all the circuit breakers simultaneously, after which point you might as well be offering advice to your cat.

In the end, the unfortunate historical reality is that the best argument for smallpox vaccination was always an epidemic of smallpox itself — not an earnest spokesperson for science-based public health.  I certainly hope I’m wrong, but I count myself among those who doubt that America’s growing vaccine complacency will shift without a major public health catastrophe.  But if we have to wait until pertussis or measles is as common as smallpox was a century ago, there won’t be much reason to celebrate our collective enlightenment.

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  1. [...] This post was mentioned on Twitter by Chuck Betley, LG&M. LG&M said: History and Anti-vax Anxiety http://bit.ly/fob8a2 [...]

  2. fluffytuna says:

    I grew up and was of the right age when the polio vaccines were developed (50′s). I clearly remember the should we or shouldn’t we fight, and the essentially competing vaccines (Salk and Sabin). Polio was a serious issue and just about everyone knew someone who had been affected. But the horror stories spread about the vaccines were plain scary. Lots of parents opted their kids out, and some really paid. And you sort of had to jump through legal hoops to authorize your kid(s) getting either vaccine. I did, and with no ill effects, and many of my friends didn’t, fortunately with no ill effects. It was a big deal in the mid-50s.

  3. Landru says:

    I agree, except to note that in my experience, cats are better listeners than people who actually try to claim, in serious debate, that vaccines contain antifreeze and aborted fetuses.

  4. WrongfulDeath says:

    I, too, remember the terror of Polio and the vaccines that were offered up. However, what I don’t remember was widespread opposition. At the end, they lined us up for the sugar cube and in the public schools…..and we were glad to get it.

    That being said, I still don’t understand the rise of vaccines for serious, but less dangerous childhood diseases such as measles. Parents used to encourage little Johnnie to play with infected Mikey during the summer.

    Now, no one has any immunity at all from measles. Is trying to protect from every known childhood disease really that smart in the long run?

    • DrDick says:

      Is there anything that you actually know and understand? Everyone who has been vaccinated against a disease is immune. That is what vaccines do, which is to create immunity by giving you a low dose (or dead virus) infection to stimulate your immune system.

    • SeanH says:

      Parents used to encourage little Johnnie to play with infected Mikey during the summer.

      And what’s a couple hundred thousand infant deaths between friends? Vaccination programmes decreased global measles deaths by 78% between 2000 and 2008.

    • Jeremy says:

      As far as I know (not being a doctor or health expert), the vaccine gives you lifetime immunity from measles, so today people who have had the vaccine DO in fact have immunity.

      Not to mention, combined vaccines like MMR are much more ideal from any standpoint — easier to coordinate than individual vaccines, and less hazardous if you think preservatives make your kid autistic.

      • DrDick says:

        I have a background in historical demography and have some knowledge of this. All modern vaccines work by injecting a weakened or dead virus into the person to produce a mild (generally unnoticed) infection which spurs the immune system and creates immunity. While we used to think this was lifetime immunity, we now realize that it weakens over time (the degree and timing varies between individuals) and lack of additional exposure, so that boosters may be required in later life.

        The original smallpox vaccine actually infected patients with cow pox, from which smallpox evolved, a cattle disease that humans can catch, but which is fairly mild, like a bad cold. This is why it is called “vaccination” (vacca = cow).

    • Malaclypse says:

      Parents used to encourage little Johnnie to play with infected Mikey during the summer.

      You know, WD is a lot more entertaining if you read everything he writes in the voice of Abe Simpson.

    • Anonymous says:

      “I still don’t understand the rise of vaccines for serious, but less dangerous childhood diseases such as measles. Parents used to encourage little Johnnie to play with infected Mikey during the summer.”

      No that’s chicken pox, with the belief that childhood chicke pox exposure immunizes the person from contacting (more dangerous) chicken pox during adulthood, or shingles.

      • davenoon says:

        Right. And the chicken pox vax is a more recent addition to the stable, so now there’s no good reason for these infectious disease parties — though I know plenty of people who do them, because they’d apparently rather do it the “natural” way and expose their kids to the potential complications of the disease…

        • DrDick says:

          Both sets of vaccines (there are actually separate vaccines for measles and rubella or German measles) were developed during my lifetime and I have had all three diseases as the vaccines were not available to me. They are very serious diseases and come with a variety of sometimes very serious complications (including death). From personal experience, I would call deliberately giving your child any of these when safe and effective vaccines are readily available child abuse.

        • DocAmazing says:

          And expose immune-compromised members of the community to the likelihood of catching the disease, which can kill them in spectacularly horrible ways. (“Immune-compromised” in this case includes people with HIV,but also includes transplant patients, people on long-term steroid therapy–like asthmatics–or other immune-suppressant meds, the elderly, and those with other ilnesses. Chickenpox in the wrong patient is no joke.)

    • DocAmazing says:

      serious, but less dangerous childhood diseases such as measles

      “Less dangerous”? In countries where measles vaccination is poorly practiced, it is a fairly common cause of childhood mortality. Look up “subacute sclerosing panencephalitis”, a condition caused by measles that makes mad cow disease look salubrious. Rubella was a very common cause of miscarriage and of congenital deafness until vaccination held it off.

      WrongfulDeath, you are in this case well-named. You appear to advocate for an idea–”let ‘em develop their immunity naturally”–that would result in large numbers of preventable deaths annually.

      • DrDick says:

        As an ethnohistorian who specializes in Indians of the SE US, I would point out that measles killed literally millions of Native Americans over 3 centuries, including one epidemic among one of the Timucua groups near modern Orlando that killed 10,000 people in six months.

  5. DrDick says:

    There is no arguing with the willfully ignorant. Sadly this is just part of a larger anti-science movement by people who do not understand and therefor fear science, aggravated by the fact that science often contradicts their deeply held beliefs or threatens their livelihoods in some way. You see it in the anti-evolution campaigns, global warming opposition, and the rise of alternative medicine quackery.

  6. WrongfulDeath says:

    This is great!

    Personal attacks instead of discussion may satisfy a need to hate on your perceived enemies, but it does little other than expose the attacker for the jackass he is.

    The truth is Polio was virtually unknown before the 19th century when we tried to shelter everyone from everything. People had an immunity to the virus already because of incremental exposure. Now, they have none and a breakout would be huge. That is the road we are going down with lesser diseases.

    I see your point of view. I just want you to acknowledge this negative aspect of mass vaccinations.

    And guess who was against today’s vaccines? It wasn’t the mainstream. It was the wack-0 screaming left and guess what they offed up as evidence? It wasn’t the more reasoned stuff you have just mentioned. It was the fraudulent studies trashed by the British Medical Journal (among others). They didn’t want to look too deep…….just rage.

    The political issue is more interesting than the other aspects of all of this. It applies to other issues where the shallow rage as well.

    • Malaclypse says:

      Now, they have none and a breakout would be huge. That is the road we are going down with lesser diseases.

      I see your point of view. I just want you to acknowledge this negative aspect of mass vaccinations.

      Under your insane theory, vaccines reduce immunity and lead to mass epidemics. Okay, I acknowledge that you are absolutely pig-ignorant on a variety of topics.

      • DrDick says:

        That would include the history of the 19th century and public health, as we did not start “to shelter everyone from everything” until the late 20th century and no capacity to do so for anything other than smallpox before the 20th century, when other vaccines were developed along with antibiotics. Might have something to do with why life expectancy was 40 years in the US in 1900 or why millions died of the Spanish flu in 1918. I have yet to find a topic on which WS is not abysmally ignorant, though I do hope there is something.

    • Polio was virtually unknown before the 19th century when we tried to shelter everyone from everything.

      Bullshit. A lot of diseases were specifically identified in the 18th and 19th centuries that have existed since the earliest days of humanity, and a lot of diseases became survivable in the 19th and 20th centuries that previously had been more or less death sentences, and a lot of communicable diseases became more obviously dangerous with intensive urbanization of the 18th through 20th centuries.

      Facts: bad for ideologues.

      • DrDick says:

        WD also seems ignorant of the fact that new diseases often appear (AIDS, SARS, Avian influenza, or Ebola ring a bell?), especially as population density increases. Probably does not understand or believe in evolution either.

      • It is a rather “Tree Falls in Forest” approach to medical science, isn’t it? “If several million people in 14th cen. Europe drop dead of the Black Plague and people believed it was caused by stars, earthquakes, angry God and/or Jews, does that mean Y. pestis didn’t exist until the 19th cen.?”

    • davenoon says:

      And guess who was against today’s vaccines? It wasn’t the mainstream. It was the wack-0 screaming left…

      I may write a longer post about this later, but this claim simply isn’t true. Unless you count Robert Kennedy as “the left,” anti-vaccination doesn’t easily fit easily on a left-right continuum; it’s politically polymorphous. Wakefield, for example, has increasingly been embraced (to his delight, in fact) by evangelical protestant opponents of vaccines…

    • The truth is Polio was virtually unknown before the 19th century when we tried to shelter everyone from everything. People had an immunity to the virus already because of incremental exposure. Now, they have none and a breakout would be huge. That is the road we are going down with lesser diseases.

      You are historically incorrect. Polio was not “virtually unknown” prior to the 19th century – we have evidence of polio dating back to ancient Egypt. There was a lack of polio epidemics, but it shouldn’t be a surprise that polio epidemics emerged during the historical transition to urbanization which greatly increased the frequency of many kinds of epidemics, and the development of modern medicine which regularized the reporting of disease outbreaks that would have been previously lumped under a generic “plague.”

      Vaccination had nothing to do with this, as we had no polio vaccine until the 1950s. The lack of a vaccine did not stop mass epidemics in the 1890s-1940s, the largest of which in 1952 affected 58,000 people in the U.S. Following the spread of the vaccine, there were only 1124 cases worldwide in 2004.

      Vaccines work. Full stop.

    • hv says:

      Personal attacks instead of discussion may satisfy a need to hate on your perceived enemies…

      You flatter yourself.

      • strategichamlet says:

        Longer WrongfulDeath: “We went into a camp to inoculate some children. We left the camp after we had inoculated the children for polio, and this old man came running after us and he was crying. He couldn’t see. We went back there, and they had come and hacked off every inoculated arm. There they were in a pile. A pile of little arms. And I remember… I… I… I cried, I wept like some grandmother. I wanted to tear my teeth out; I didn’t know what I wanted to do! And I want to remember it. I never want to forget it… I never want to forget. And then I realized… like I was shot… like I was shot with a diamond… a diamond bullet right through my forehead. And I thought, my God… the genius of that! The genius!”

    • mpowell says:

      This is the internet and rudeness is the norm. And if you’re wondering, sure people around here enjoy making fun of you. But there was plenty of engagement with your points. You still seem to be unaware of the fact that vaccines provide immunity to disease. I’m almost curious to know what you think they do if not this. It does suggest an almost total lack of even low level reason.

  7. In the end, the unfortunate historical reality is that the best argument for smallpox vaccination was always an epidemic of smallpox itself

    Just ignore the people crying “If only they’d made the vaccines safer, none of this would have happened!”

  8. Perhaps I’m less optimistic than I should be that the American public will actually listen to informed public health advocates who faithfully represent the scientific consensus on vaccine safety and efficacy.

    You may be right, but sometimes open debate and discussion is all, or almost all, we have.

    I think that one obstacle to more people getting vaccines, aside from the “free ridership” problems and the alleged problems of discomfort about certain specific vaccines (I probably would not like to undergo an anthrax vaccine right now), is the fact that some vaccines are compulsory (with, of course, the many qualifications and generous exemptions that davenoon mentions).

    The fact that the state requires/mandates people to get (some) vaccines probably adds more grist to the mill of antivaccinationists’ arguments. Their pseudo-science is indeed pseudo, and the risks are greatly outweighed by the benefits. But when the argument is “take these vaccines by order of the state” rather than “here are the benefits and here are the harms,” antivaccinationists can claim, with more (but not much more) than zero plausibility, that the battle of ideas has been lost by the provaccinationists and they must resort to coercion.

    I’m not sure what the solution is, and maybe at the end of the day the answer is, indeed, to make vaccines even more compulsory (e.g., by narrowing the exemptions).

    • DocAmazing says:

      I deal with a lot of vaccine-shy parents. Very few are rabid Jenny McCarthy types; most have a vague sense of unease, stoked by some facts (a bad batch of DPT vaccine did cause some kids in the UK to go deaf in the ’80s, anthrax vaccine is pretty gnarly) and some bad information (the MMR-autism “link”, mercury/thimerosal in vaccines). All of this would be less of an issue, however, if there weren’t a pervasive distrust of the pharmaceutical industry. That distrust is well-deserved: after Vioxx and Fen-Phen and revelations about manipulated and suppressed research and the casual buying-off of doctors [here I confess that I'm no saint; I've eaten drug-company-sponsored lunches and written with ComVax-logo pens], trusting drug companies to manufacture and market a thing that is going to be injected into your infant child is indeed a leap of faith.

      I spend quite a while with parents going over immunization schedules and adjusting them to suit. Some parents feel that too many vaccines at once is an undue insult to the immune system (I call this the “immune overload hypothesis”), though there is no data to support this and plenty to argue otherwise. Hey, we can give two vaccines per visit in two visits rather than four vaccines in one visit (if your insurer will allow it) if that gets the job done.

      Addressing the fear of vaccines does rely on realistic discussions of infectious disease and public health, but it also relies on Big Pharma admitting that they’ve fucked up grievously in the past and that they’re committed to transparency now. That may take some doing.

      • DrDick says:

        Good points and an honest appraisal of important issues. I think it goes beyond a justified, if overblown, lack of faith in Big Pharma, to a larger distrust of science in general. I think a lot of this comes from an exaggerated belief in the power science to immediately solve all problems (contributed to by corporate interests and some scientists, as well as a really bad science press corps) and accompanying disillusionment when it does not always work out.

        • DocAmazing says:

          Woo also plays a role; a lot of folks in my part o’ the world are fans of “alternative medicine” (I hate that phrase: if it works, it’s medicine), and strongly suspect that we allopathic types are withholding information on the efficacy of other treatment modalities, and that affects the view of immunization, as well. Again, there is a grain of truth to all of this: drug companies don’t market stuff they have no patent on, and create obstacles to those medicines reaching the market (for example, there’s a lot of stuff about the efficacy of ibogaine for treating opiate withdrawal, but large-scale studies aren’t being funded, because those who Hold The Pursestrings have nothing to gain); as a result,that free-floating distrust is stoked still further.

          • DrDick says:

            I recently encountered a bit of that regarding colchicine for my gout. Price went from $10 to $500 for three months. I am no fan of Big Pharma either, but I trust science and the existing science says most of that stuff does no good (though some has not been investigated yet) and some is actively harmful. From a medical standpoint, however, there is nothing wrong with a little help from the placebo effect, as long as they are also doing what they need to.

            • Hanspeter says:

              I can get 5g of 95% pure colchicine for $222.90, though you probably don’t want it given that it apparently comes with 10% ethyl acetate and chloroform in the solvent fraction. Damn FDA purity requirements.

  9. Paul Orwin says:

    Many good points here, especially once people stopped arguing with the troll. We’ve started vaccinating against a lot of things – chicken pox, pneumococcal meningitis/pneumonia/ear infection, rotavirus, hepatitis, hpv, etc. All of these are good vaccines (from what I know = not a physician), but progressively we move from diseases everyone knows/fears to things people have heard of but maybe weren’t too worried about to things they didn’t know about. This changes the perceived risk/reward calculation (note that the perceived risk is the big issue, since the real risk is vanishingly small). You also get the “I don’t care what the odds are, if it happens to my child” which is, of course, an impossible argument. So I think Dave (Noon) is essentially correct that it will require substantial outbreaks (like the current pertussis outbreak in CA) to make people understand the risks and adjust their perceptions. However, I have to say that I think advocacy can shift the equilibrium, which might have the effect of reducing the size of outbreak that is convincing. This would have the very important effect of saving lives…

    Finally, this should be seen as evidence that our population desperately needs decent science and math education, so they can understand these topics (as our troll is pointing out unwittingly).

    • Joe says:

      how useful, for those who might know, has the chicken pox vaccine been? Growing up when it wasn’t around, I was not aware of some pressing need for it, though I guess it’s helpful and maybe in a few cases prevents serious problems.

  10. mds says:

    “reclaim the town square with a candid national conversation about the real risks of vaccines.”

    Does anyone know where the portal to Willrich’s alternate earth is located? ‘Cause I’m ready to move on from a town square in which violent ignoramuses and well-paid liars are still spewing horseshit about “death panels.”

  11. Linkmeister says:

    Tangential observation: for the first time in my memory, my local Safeway is advertising that it will offer shingles vaccinations this weekend.

    This astonishes me. I hadn’t thought that shingles had made it into the general knowledge pool yet.

    (I had my vaccine for it several months ago, since I was on the cusp of turning 60 and had had chicken pox as a kid.)

  12. wiley says:

    It should not be forgotten that the article linking vaccinations with autism was published in a respected medical journal. When admonishing people for not trusting medical science, remember that part of the problem with the vaccine/autism link is that people were trusting medical science.

    • idlemind says:

      Actually, Wiley, the Wakefield Lancet article only made oblique references to autism in his case series. The “research” focused on gastrointestinal symptoms for which it had (what we now know to be at least partially fabricated) data. It was Wakefield’s activities in the media apart from the article that led to the vax scare (though he and others certainly used the article to pump up people’s fears).

      My understanding is that a single case series with N = 12 is, on its own, quite weak as evidence. If more (and better) studies had followed confirming his findings, then a scientific foundation would have been established — but that never happened. Rather, much better studies were done with none of the effects Wakefield claimed confirmed.

      • davenoon says:

        I’ve written about this before, but the Lancet’s decision to publish was quite controversial at the time, and the editors published an accompanying editorial that was intended to — but did not actually — dampen the public reception and media interpretation of the original article.

        One of Brian Deer’s findings in the BMJ was that Wakefield was offered funding by the Royal Free Hospital (his employer at the time) to actually *do* controlled follow-up studies with more cases. But Wakefield — because he knew it was fraudulent work — refused, making bizarre claims about “academic freedom” to justify his reluctance to do actual academic work.

  13. wiley says:

    In the sad that after 12 years of public education category, many people have the idea that they if don’t have symptoms, they don’t have the disease and so don’t have the germs and can’t transmit it. Likewise, they assume that if they avoid people with symptoms, then they avoid the disease. We’ve all heard people say “I don’t have any germs” when something is going around. I correct people when they say that and inform them that they probably do have the germs, just not enough to overwhelm their immune systems.

  14. WrongfulDeath says:

    As discussed, the Wack-0′s promoted all of this. How stupid is this?

    ENJOY

    http://www.dailykos.com/story/2007/9/14/05116/9498

    Thu Sep 13, 2007 at 10:24:49 PM PST

    The first ever study comparing vaccinated to unvaccinated children was completed with startling results.

    Vaccines Caused Autism
    Vaccines Caused Asthma
    Vaccines Caused ADHD

    The study was privated funded and conducted through an independent research firm. 11,817 households with 17,674 children were interviewed.

    This is important to note as this is the first ever study of its kind. All other studies on autism and vaccines only studied a changed variable, such as removing the MMR shot, or reducing the mercury in vaccines.

    What is most significant is Congresswoman Carolyn Maloney introduced a bill to do just this study last year. The CDC discarded the idea and instead a bill for $1 billion for autism treatment was approved. The idea was “don’t do the study, just try some other things with this money.” Now, a privately funded study, costing only $200,000, argues very powerfully that vaccines cause autism.

    • DocAmazing says:

      Right. After no fewer than four studies–quite large and well-done ones–failed to find any vaccine-autism link, this on-the-cheap, n=some-number-greater-than-my-kid’s-birthday party study will change everything.

      I’m trying to figure out if you’re arguing that bad effects from vaccines have been studied too little, or that only Kossack weirdos think that bad effects from vaccines have been studied too little.

      On second thought, don’t tell me.

      • (the other) Davis says:

        Don’t you see? One dude on the Kos site promoted the anti-vaccine nonsense some three years ago, therefore liberals are responsible for the anti-vaccine movement. Quod erat demonstradum, noli urinare contra ventum, ictory-vay.

    • hv says:

      The beauty is that the study can be conducted with rigor relatively easily. All you have to do is compare the autism rates among these kids to the general public.

      While I am very receptive to simple caveperson arguments based on almanac-caliber demographics, let’s not start calling them “studies.” What are you controlling for?

  15. WrongfulDeath says:

    So, how much promotion have you seen by conservatives?

    Hmmmmmmm…..?

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