Beyond the Golden Age: Rethinking the History of the Anti-Vaccination Movement Since 1970

[Note: This following was presented on April 18, 2015 at the annual meeting of the Organization of American Historians in St. Louis. As a note of appreciation to S-USIH for sponsoring my panel, I am happy to reproduce it here. Advance apologies for the length (note the handy print button at the bottom of the post!). I hope, nevertheless, that you find it rewarding. I received nice comments from my panel chair, Matthew Osborn, but would love more feedback here. – TL]
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In chronicling the long history of vaccination and the anti-vaccination movement in the United States, investigative journalist Arthur Allen observed that “the Golden Age of public acceptance for vaccination” began late in World War II and during the Cold War. In that period, which lasted until around 1980, collective fears about foreign aggression coalesced into a need for collective security. The common good trumped individualism and ideology in order to build up the United States’ “immunological commons.” Allen argues that, in Cold War America, a “new spirit of compliance” resulted from “militarization” and “heightened public trust in medicine and its genuine advances.” That trust negated the need for compulsion and coercion. The fear of biological warfare, instigated by the U.S.S.R., also added a sense of necessity to that trust. Indeed, as historian Kendall Hoyt noted in her 2012 book Long Shot, “bugs [have often] played a larger role than bullets” in military history. Whatever the source, disease is the more traditional and long-running security threat to humanity.[1] Vaccination, then, provided some sense of safety in a wartime world full of human hazards. These factors created a unique “golden age” narrative for vaccination—an age against which subsequent narratives of vaccination and anti-vaccination movements have been measured.[2]

But this essay is not about that period. The focus here is on the recent anti-vaccination movement—about how it has been portrayed and theorized in the limited historiography on the subject. If acceptance of, and resistance to, science (and mathematical risk) has been a kind of totem in these narratives, and in other journalistic accounts of vaccinations and the anti-vaccination movement, then I propose that the taboo is intellectual history and the history of ideas. How so? While larger ideas and intellectuals factor into Allen’s and Hoyt’s narratives, a more thorough exploration of themes and topics like individualism, liberalism, “the market,” neoliberalism, libertarianism, paranoia, emotion, democracy, citizenship, culture, and, last but not least, anti-intellectualism might create a richer narrative and deeper understanding of the persistence of the anti-vaccination movement. A robust consideration of intellectual history and the history of ideas, in terms of theory and practice, will provide a sense of the persistence and longue durée of the anti-vaccination movement.

Main Currents Since World War II

Hoyt and Allen provide concerned parties with differing reasons for the eventual breakdown in consensus that undergirded the “golden age” of the vaccination in America. They also locate that breakdown in slightly different eras. Hoyt observed that “approximately eighty new diseases have emerged or reemerged since 1970 in response to…evolutionary pressures” such as “population growth, climate change, and expanding travel and trade patterns,” not to mention “the widespread use and misuse of antibiotics and antivirals.”[3] To Hoyt, it appears that globalization and the rise of a free-market ideology have recreated an imperative to understand now the golden era passed. These are what I am tentatively labeling ‘external factors’.

Allen, however, locates the passing of the golden age in a series of internal factors that came together in the 1980s (though he acknowledges that “angst began” in the 1970s).[4] I see three prominent points in his narrative. The first is endemic to the vaccine industry itself, and began, ironically, in the golden age: problems with government oversight and regulation of the vaccine industry. Issues came to light right after the April 1955 celebration of the success of Jonas Salk’s polio vaccine trial. The Cutter-Wyeth production problems helped instigate oversight by the National Institutes of Health. These problems led scientists, such as the virologist and pediatrician C. Henry Kempe, to push for both better vaccine safety and widespread vaccination. Kempe’s concern for the safety of vaccines and vaccine injury did not overshadow his sense of the greater good.[5] Even while regulation improved during the 1960s, it would continue to be an occasional problem through the 1980s.

Second, increased vaccination created a victim-of-its-own-success problem. The increased regulation and safety of vaccines as the 1960s progressed led to more compulsory vaccination laws (in 1969, 24 states had none, but by 1977 that number was reduced to 2). Both Presidents Lyndon Johnson and Jimmy Carter pushed programs that created financial incentives for states to set vaccination laws, usually linked to school enrollment. By 1980 all 50 states had school immunization requirements, extending down in some cases to preschoolers. But Allen notes that these requirements did not activate parental resistance; they were “acceptable to most parents” in that they made vaccination “a priority for people.”[6] Even so, the disappearance of disease made the problems of diseases like polio, measles, rubella, mumps, and pertussis (i.e. whooping cough) less visible to parents. Vaccinations, then, might become a victim of their own successes; prevention might seem worse than the disease to less discerning parents.

Lastly, a proper consideration for vaccine injury never occurred during the golden age. During the 1950s, 1960s, and 1970s, scientists never truly acknowledged or attempted to understand why patient injuries occurred. The focus was on vaccine expansion because, relatively speaking, injury risks were relatively small. Allen argues that, until the 1980s, authorities had not “systematically look[ed] for, or correct[ed], damages caused by vaccines.” There were no “smoking guns, but [also]…no system in place to look for them.” In 1978 the Centers for Disease Control created the “Monitoring System for Adverse Effects Following Immunization,” but participation was voluntary and the office was small. A compensation program was even authorized after the so-called “swine flu fiasco” of 1976. But that program remained in a study stage until the mid-1980s, even while countries (e.g. Japan, Hungary, West Germany) created their own compensation programs.[7]

Taken together, it seems that Allen, for the most part, attributes the rise of an organized anti-vaccination movement in the United States to internal problems in the production and consumption of medicine. While outside factors are mentioned, causation is located primarily in the failures of physicians, scientists, public health figures, and the vaccine industry. The health establishment is the scapegoat for antivaccers. The larger context feeds the successes of Allen’s “golden age” for vaccination, but his consideration of context diminishes in relation to antivaccer movement. The main characters in the latter are ideologues, kooks, and frustrated parents of children with either known or suspected vaccine injuries. And these singular, quirky, irrational figures (i.e. poor scientific thinkers) are the scapegoats of the medical establishment. Again, the focus is on the producers and consumers of vaccines and medicine (i.e. vaccination).

While Hoyt nods to larger contextual factors (i.e. “evolutionary pressures”) her book focuses on the decline of innovation, or failures of development, in the vaccine research establishment. Hoyt’s empirical evidence derives from corporate, military, and government scientists—a sort of military-industrial research complex. The book’s thesis is that innovation rates were high in the 1940s and 1950s, when “economic incentives, firm capabilities, and the stock of technological knowledge/opportunities were weaker”—and conversely that innovation was low in the 1980s and 1990s when “market-based theories of innovation” were highest.[8] The narrative is focused on vaccines, not vaccination.

This essay intends to push the boundaries of narratives like Allen’s, Hoyt’s, and others by looking at vaccination and the anti-vaccination movement in the context of intellectual and cultural history. Intellectual and cultural history offer alternative theoretical underpinnings, as well as different subtopics for integration. Deeper exploration in both areas might foster more fulsome dialogue with the anti-vaccination movement.

Antivaccer Sensibilities

In thinking about the larger context and larger issues facing vaccination, both in the U.S. and around the world, Allen quotes Bill Foege, former CDC director, as saying: “If you tangle with culture, culture will always win.”[9] Foege was referring to culture in an anthropological sense—i.e. to native cultures and resistance to global immunization campaigns in the third world. But we can stretch his invocation of ‘culture’ to encompass what I will call an “antivaccer sensibility,” inclusive of emotional and rational factors marshaled for resistance. Allen himself notes that vaccination has been “a cultural line in the sand”—a “political choice” in what others would call the Culture Wars of the last decades of the twentieth century.[10]

What do I mean by an “antivaccer sensibility”? This is where thinking like an intellectual historian adds both high and low elements to the history of anti-vaccinationism. Pondering the notion of an antivaccer sensibility (AVS) allows one to more fully inhabit the antivaccer community, from the ground level. But it also integrates disparate AVS strains. An AVS encompasses “perception and feeling, the terms and forms in [or with] which objects were conceived, experienced, and represented”—in the past and present. It is inclusive, using the words of Dan Wickberg, of “the emotional, intellectual, aesthetic, and moral dispositions of the persons” implicated in a great books sensibility. For those inclined, an AVS is a “capacious” way of seeing health and wellness, both now and historically.[11] It is sometimes imaginative (springing from a certain structure of experience), and at other times concrete; it can be conscious and unconscious. The adherent uses an AVS to comprehend the surrounding social, culture, and intellectual environs, local or global.

The definite article ‘an’ in ‘an antivaccer sensibility’ is important. There is no one, or singular, sensibility. But some common traits emerge historically. And positing an AVS helps one understand the antivaccers as a community, instead of as discrete, individualistic resisters of the state. Reason and rationality are important to some antivaccers, but it they are, obviously, not necessarily dominant. Wickberg reminded readers of William James’ notion of “the sentiment of rationality” (outlined in an 1882 essay), which implies reason, even without the same rising above emotion and attitudes. An AVS might require rationality and reason without believing that logic and syllogisms must dominate. I am also sympathetic to James’ distinction (again, folded into the sensibility discussion by Wickberg) between “tender” and “tough”-minded thinkers, as outlined in Pragmatism (1907). Antivaccers can approach the world ‘tenderly’, meaning in a rationalistic fashion through principles and ideologies. That world can also be seen through ‘tough’ eyes—factually, empirically, and scientifically.[12]

I think a sincere effort to fully explicate antivaccer sensibilities would lead to more sympathy and empathy with adherents. This putting-one’s-self-in-their-shoes might lead to some antivaccers to recognize valid points made by the pro-vaccination side of the debate. A deeper understanding of, and sympathy with, the varieties of AVS might also lead to more intense scrutiny of the capitalistic underpinnings of American healthcare—which many attribute to health disparities in the United States.

René Girard

Thinking again more theoretically—or philosophically or theologically—about the antivaccination movement and antivaccer sensibilities led me to consider the work of René Girard. Girard’s La Violence et Le Sacré might serve as an integrative narrative structure in relation to closed circles of both vaccination proponents and antivaccers.[13] Their rivalry, in Girard’s terms, is mimetic. They possess a common object of desire, wellness. But they approach wellness, of course, differently. Public health officials, physicians, and evidence-based practitioners of medicine use a “reductionist” scientific approach to wellness. Medical authority, for them and provaccers by default, rests on accumulated knowledge obtained by small experiments over time. But an AVS approach to wellness might favor larger, unorthodox, “holistic” principles that still use a language of rigor (i.e. if not mainline science, their science is at least mimetic, as Michael Gordin has argued of all non-standard scientific endeavors).[14] As Allen notes: “For diseases where there is neither a cure nor an explanation—for example, autism—‘holism’ holds its ground.” When there are “gray zones of unknown risk and cause,” then “holistic approaches” are “more comforting.” If alternative medical practitioners abide by absolute principles, they also make meaning “central” to their practices, which comfort the afflicted.[15]

Returning to Girard, both vaccine proponents and antivaccers see each other as doing violence to innocents. They also do violence to each other by scapegoating the other. Both sides see the other as an obstacle to wellness. Their respective senses of injustice drive their causes. Both likely experience some catharsis, via schadenfreude, perversely, when the other group experiences a setback (which means that harm was done to someone). To summarize, Girard’s philosophical-theological narrative structure helps the reader and scholar see deeper commonalities and differences, on the road, hopefully, to a useful reconciliation that would benefit children and society as a whole.

Anti-Intellectualism

A deeper and longer look at anti-intellectualism might reveal, or underscore, the deepest and most persistent traits of corners of the antivaccer movement. This approach carries some risk in terms of present-day wellness and justice if all antivaccers feel lumped together and are alienated. For instance, Susan Jacoby’s 2008 book, The Age of American Unreason, treats antivaccers with broad, dismissive strokes. Jacoby describes the anti-vaccination movement has “rife” with “junk science,” “junk thought,” and “conspiracy theories.” By focusing on the writing and thought of Barbara Loe Fisher, a long-time, strident anti-vaccination activist (also covered extensively in Allen’s book), one is left with the impression that all anti-vaccination thinking and antivaccer sensibilities are the same as Fisher’s.[16] So the pluralistic/splitter approach to AVS(es) might allow for an analysis of anti-intellectualism that holds the attention of more readers.

In terms of anti-intellectualism, Allen gets at some of these traits in his 2007 book, but does not systematically reinforce the continuities, and broader contextual connections, in his historical thinking. Allen successfully teases out antivaccer traits from the eighteenth, nineteenth, and early twentieth centuries that help one understand deep currents of antivaccer thought. For instance, resistance to Cotton Mather’s variolation-inoculation technique (first used in 1721), especially from William Douglas, set a path of thinking that persists in later antivaccers. Douglas disputed Mather’s statistics, used singular examples of adverse reactions to undermine the general positives, charged that variolation would cause long-term health problems that were then hidden, and claimed that moral principles could not allow for variolation. When Edward Jenner’s cowpox poison/vaccination technique was published in 1798, an American practitioner, Benjamin Waterhouse, Harvard’s first professor of pharmacy, attempted to profit from his technique in American via demanding “exclusive rights” for distribution—foreshadowing later antivaccer skepticism about vaccines and profit-seeking. Around this time there arose problems with sterilization, with reduced or eliminated the efficacy of the vaccine. “Critics,” Allen wrote,” exaggerated the failures of vaccines.” The inability to explain the process in detail caused wider skepticism about the vaccine’s effectiveness, or even fear. All of these factors came together such that, by the turn of the nineteenth century, vaccination could provoke “organized opposition, even social movements against it.”[17]

By the turn of the twentieth century other objections would be added, and other traits would emerge among antivaccers—all of which would be reproduced and reasserted later (and are still in existence). In his 1901 book, Vaccination a Delusion, Lord Alfred Russel Wallace (in the context of smallpox vaccinations) decried the system of vaccine distribution, asserted that the gravity of smallpox was exaggerated, claimed that sanitary reforms had done the work claimed by vaccines, argued that vaccination weakened the body’s overall constitution (and actually caused smallpox in those receiving the inoculation), and, finally, asserted that the scientific experiments were inadequate to prove the effectiveness of vaccination because the control groups were to small (i.e. people wouldn’t have contracted the disease anyway). Again, all of these arguments have been reproduced in recent years. Using the work of Michael Shermer (Borderlands of Science, 2001), Allen attributes to Wallace a “heretic personality” that revels in maverick-ness. These types readily take on “anti-establishment points of view” and seek to overturn “established theories.”[18]

These traits fit in what I call an antivaccination sensibility because they are a mix of emotion and reason. They are scientific and reactive, reactionary and measured. The antivaccer point of view can be rigorous and complex as much as flippant and simple.

Antivaccer sensibilities overlap with traditional historical literature on anti-intellectualism (as opposed to traditional reason and rationality) in terms of conspiracy theories, paranoia, and resentment of expertise. Jacoby gets to these topics when she argues that antivaccer “conspiracy theories [are] tied both to the right wing’s distrust of government and the left’s distrust of traditional medicine.”[19] On the resentment of expertise, Jacoby’s thinking moves in greater coordination with the man who inspired her book, Richard Hofstadter. She connects that line of thinking with Allen’s golden age in vaccination and science:

The virulent outbreak of anti-rationalism in late twentieth-century America is also rooted in a much older, nonpolitical tendency in American thought—a chronic suspicion of experts that dovetails with the folk belief in the superior wisdom of ordinary people. Ironically but perhaps predictably, the upsurge in mistrust of expert authority followed several decades in which public deference to scientific and technological authority, a deference so great that it was sometimes exaggerated and misplaced, stood at an all-time high.[20]

In speaking of the suspicions of ordinary people, Jacoby is now moving the conversation toward equality and democracy.

Hofstadter located the tension between expertise, politics, and democracy in the Jacksonian era. Hofstadter continues: “In the original American populist dream, the omnicompetence of the common man was fundamental and indispensable. It was believed that he could, without much special preparation, pursue the professions and run the government.” Now, however, he asserted in 1963, “trained intelligence has come to be recognized as a force of overwhelming importance.” As a result, “what used to be a jocular and usually benign ridicule of intellect and formal training has turned into a malign resentment of the intellectual in his capacity as expert.” Experts are now “fiercely resented because he is needed too much. …Intellect is resented as a form of power or privilege.”[21] Although over 50 years old now, Hofstadter’s work still resonates in an age of resentment toward government experts and, in relation to vaccination, toward the expertise of medical researchers. It seems clear, from recent stories about the anti-vaccination movement, that medical expertise has been devalued enough that vulnerable populations are no longer protected from disease by achievable herd immunity.

Conclusion

And now we are to it. Bringing intellectual history, the history of ideas, and deeper cultural-intellectual history theory into the story of the antivaccination movement, and antivaccer sensibilities, allows the historian, scholar, and analyst to discuss biggest ideas possible in American history: democracy, modernity, and power. The links are direct and firm. The story is no longer just about the production and consumption of medicine—although the structure of capitalism, or democratic capitalism, does indeed matter. But the story about vaccination is now also a proxy for inequality, disempowerment, inclusivity, community, citizenship, and individual and communal perceptions of the good life. These larger themes and topics direct greater respect toward discrete parts of the anti-vaccination movement, even while the greater good is also intimately linked with that movement’s place in American history.

When I dreamed up this paper, I thought it would be about the movement, directly, since roughly 1998 (the year Andrew Wakefield’s faulty, retracted MMR-autism study appeared in The Lancet).[22] I thought I’d be writing a paper about anti-intellectual celebrity liberalism. In the end, however, it became a call for writing about the anti-vaccination movement, as it has existed since the late 1970s and early 1980s, as something more than just a quirky set of resistors and ideologues in relation to mainline science and medicine. The movement needs to be approached more holistically and integratively—as a group whose assumptions and predispositions are fundamentally mainstream and American. They need a more sophisticated theoretical treatment that puts readers in antivaccer minds. In sum, they need a bottom-up, history of thought style treatment that gives the movement with whatever respect is deserved.

I say this despite my fundamental opposition to non-medical exemptions from vaccination. The only way that exemption culture will be minimized is if their pivotal, populist assumptions—i.e. skepticism, anti-capitalism, anti-elitism, anti-statist libertarianism, desire for holistic treatment—are dealt with directly. If you see the deeper currents in that list, you’ll also see why the movement transcends left and right politics.

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Notes

[1] Arthur Allen, Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver (New York: W.W. Norton & Company, 2007), 16, 119, 159, 442; Kendall Hoyt, Long Shot: Vaccines for National Defense (Cambridge, MA: Harvard University Press, 2012), 2, 253n1.
[2] Other books and articles that organize that periodize vaccination and anti-vaccination similarly: Eula Biss, On Immunity: An Inoculation (Minneapolis: Graywolf Press, 2014); Paul A. Offit, Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases (New York: HarperCollins, 2007); Paul A. Offit, Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (New York: Basic Books, 2012); Peter Doherty, “Why Measles Continues to Plague Us.” History News Network, February 4, 2015, http://historynewsnetwork.org/article/158410; Michaeleen Doucleff, “How Vaccine Fears Fueled The Resurgence Of Preventable Diseases?” Shots: Health News from NPR, January 25, 2014. In this paper I have chosen, for several reasons, to not utilize the work of Paul Offit, specifically his book Deadly Choices. First, Offit is a physician who both researches and actively promotes vaccination. As such, he has been accused of conflicts of interest. Second, not only does he promote vaccination, but he is outspoken and controversial. Citing his work invites more heat than light. Thirdly, as a physician, his work on the history of medicine is not in touch with the kind of intellectual history work I’m promoting in this paper. Because of this, I’ve chosen to rest my background narrative on other works (e.g. Allen, Hoyt). In a larger, more comprehensive work I would explicitly deal with Offit’s writing.
[3] Hoyt, 3.
[4] Allen, 16.
[5] Allen, 197-99, 202, 218.
[6] Allen, 240, 244-47.
[7] Allen, 231, 257-59, 262-63.
[8] Hoyt, 2, 4.
[9] Allen, 440.
[10] Allen, 360. I use ‘sensibility’ in the fashion that it was explored by Daniel Wickberg in “What Is the History of Sensibilities? On Cultural Histories, Old and New,” American Historical Review 112, no. 3 (June 2007): 661–84.
[11] Wickberg, 662, 664-65, 669, 675. I conceived of these AVS elements similarly in another essay on the history of the great books idea: Tim Lacy, “A Great Books Sensibility, Part I: Theory,” U.S. Intellectual History Blog, March 20, 2014.
[12] Wickberg, 671, 676-77.
[13] René Girard. Girard’s La Violence et Le Sacré, trans. Patrick Gregory (Baltimore: The Johns Hopkins University Press, 1977); Cynthia Haven, “History Is a Test. Mankind Is Failing It,” Stanford Magazine, August 2009; 1. Gabriel Andrade, “Rene Girard (1923-),” Internet Encyclopedia of Philosophy, accessed March 12, 2015. Girard’s book is based on Freud’s Totem and Taboo in a mimetic context.
[14] Michael D. Gordin, The Pseudoscience Wars: Immanuel Velikovsky and the Birth of the Modern Fringe (Chicago: University of Chicago Press, 2012), 202-203.
[15] Allen, 336-37.
[16] Susan Jacoby, The Age of American Unreason (New York: Vintage Books, 2008), 219-222.
[17] Allen, 33-36, 46-52, 56-7.
[18] Allen, 66-68. See Michael Shermer, The Borderlands of Science: Where Sense Meets Nonsense (New York: Oxford University Press, 2001).
[19] Jacoby, 219.
[20] Jacoby, 217.
[21] Richard Hofstadter, Anti-Intellectualism in American Life (New York: Alfred A. Knopf-Vintage, 1963), 14, 34.
[22] AJ Wakefield, “RETRACTED: Ileal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children,” The Lancet 351, no. 9103 (February 1998): 637–41.