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History and anti-vaccination anxiety

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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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