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Straine-On-Success — Return Of The Vaccine Wars

Published on February 25, 2015

VaccinationThe Return Of The Vaccine Wars
The controversy over vaccines is as old as vaccination itself.

When Edward Jenner, a brilliant English country doctor, discovered the vaccine for smallpox in 1796, he faced as much criticism as praise. Ministers thundered against tampering with the Lord’s grand design. The economist Thomas Malthus worried that vaccines would lead to dangerous population increases. The very idea of injecting animal matter into the human body struck many as dangerous and repulsive. Cartoons appeared showing cows’ horns sprouting from the heads of recently vaccinated children.

The current measles outbreak, with more than 140 cases so far, has created a firestorm that may not disappear when this particular crisis ebbs. Last week, New York University Medical School bioethicist Arthur Caplan compared doctors who oppose vaccination to “Holocaust deniers” and demanded that their medical licenses be revoked. Some pediatricians said they would no longer treat the children of vaccine resisters. In response, Barbara Loe Fisher, founder of the National Vaccine Information Center, an antivaccine group, accused the mainstream media of creating a phony crisis to serve the interests of big government and the “massive Pharma-led lobby.”

The vaccine wars in America have been particularly contentious because they involve our most basic rights (personal liberty, religious freedom) and deepest suspicions (government intrusion, rule by elites). Historians generally trace the antivaccine movement to a number of 19th-century groups, including religious activists, radical libertarians and health faddists, who insisted that Jenner’s vaccine actually caused smallpox. Like some current movement activists, these early leaders had a personal story to tell, claiming that a vaccine had harmed or even killed someone close to them, most often a child. Indeed, their most visible symbol was the smiling but entirely limp Raggedy Ann doll created by a popular cartoonist for his daughter, who had fallen ill and would later die, he believed, from a smallpox shot she received without his permission.

The issue came to a head in 1905 in the vitally important Supreme Court case of Jacobson v. Massachusetts. As America industrialized, state legislatures passed numerous measures to protect the “public good.” There were laws abolishing child labor, requiring safety inspections in factories and restricting the hours a woman could work outside the home. In Massachusetts, the legislature gave towns the authority to require vaccination “when necessary for public health or safety,” such as the smallpox epidemic then sweeping the state.

Cambridge quickly put an ordinance in place requiring its residents to get the smallpox shot or pay a $5 fine. Henning Jacobson, a minister, refused both options, claiming the ordinance violated his Fourteenth Amendment right to liberty. The U.S. Supreme Court strongly disagreed. A “well-ordered society” must be able to enforce “reasonable regulations” in responding to “an epidemic disease which threatens the safety of its members,” wrote Justice John Marshall Harlan. While the Constitution protected against tyranny, it didn’t afford “an absolute right in each person to be, in all times and in all circumstances, wholly free from restraint.”

Justice Harlan’s opinion would prevail for much of the 20th century. In 1915, New York City health officers used the logic of Jacobson to quarantine an Irish cook whose patrons kept turning up dead from typhoid fever. When Mary Mallon, or Typhoid Mary, refused to change professions, she was exiled to a barren island in Manhattan’s East River, where she spent the remaining 23 years of her life. Seven decades later, New York forcibly isolated tuberculosis victims who refused treatment, using Jacobson.

There were times when this logic went awry. In Buck v. Bell, an egregious 1927 decision, the Supreme Court specifically used Jacobson to uphold Virginia’s policy of forcibly sterilizing the “feebleminded,” ruling that “the principle sustaining compulsory vaccination [could also] cover cutting the fallopian tubes.” In most instances, though, the true meaning of Jacobson prevailed: The state could—and must—exercise its police powers to protect the public’s health.

In 1905, only the smallpox vaccine existed to fight infectious disease. Others appeared in time: a vaccine for polio in the 1950s; vaccines for measles, mumps and rubella in the 1960s—the list growing by the year. Guided by Jacobson, all 50 states put laws in place by 1980 requiring the mandatory vaccination of school children for most of these diseases. Exceptions were made for medical and certain nonmedical reasons, such as religious conviction, though few used them at the time.

People complied because vaccines worked. New polio cases disappeared in the U.S., and smallpox was eradicated world-wide. In a typical year before the measles vaccine was licensed in 1962, more than half a million American children would come down with the disease, 48,000 would require hospitalization, and 450 would die. Thirty-five years later, the number of annual measles cases had dipped below 100.

The revival of the antivaccine movement in the 1990s had less to do with fears of personal liberties being deprived than with claims of a link between vaccines and various afflictions, especially autism. It hardly mattered that study after study would refute this junk science. Spurred on by the Internet, talk radio and other outlets, these discredited claims gained credence through repetition. Many parents now had second thoughts. Why vaccinate against diseases that rarely, if ever, occurred? Why take any chance at all? In an odd way, vaccines had done their job too well. They had erased the evidence of why they’re always needed.

In a reversal of Jacobson, politicians began to back away from the notion that community protection trumped individual choice. In the 2008 presidential campaign, both Barack Obama and John McCain remained safely neutral on the bogus health scare surrounding vaccination. State legislatures passed laws allowing vaccine exemptions for philosophical reasons—a loophole so vast that almost anyone living in Oregon or Vermont could opt out for himself or his children.

Vaccination rates dropped, in some areas falling below the level of herd immunity needed to control a contagious disease (generally between 85% to 95%). Studies show that most of the outbreaks occur in states where exemptions are easiest to get and where clusters of unvaccinated children gather.

For now, the consequences of vaccine resistance are on full display. Politicians have walked back the sort of comments about free choice and alleged vaccine dangers that were barely controversial only months before. Bills to toughen school vaccination standards are cropping up across the country.

How long this momentum will last is the key question. Vaccination requires one to take an extremely small risk to ensure a safer future for all members of the community. To refuse it, and to live selfishly off the herd immunity of others, is both dangerous and unfair. Vaccination isn’t meant as coercion but rather as a nod to the public good, and that message is again being heard.

—Prof. Oshinsky is a member of the history department at New York University and director of the Division of Medical Humanities at the NYU School of Medicine. His book “Polio: An American Story” won the 2006 Pulitzer Prize for history.

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