The anti-vaccination movement is not a new phenomenon, but its tenacity relies upon the short memories of the public. While some have condemned those who choose not to vaccinate their children as “backsliding into medieval ignorance” (Hiltzik 2014), it is also critical to consider the ideological tensions that drive an individual or a community’s decision not to protect their children from harmful pathogens and to contextualize historical precedents that demonstrate the strain between personal liberties and the protection of public health.
When Edward Jenner first proposed an inoculation for smallpox—based off of newly emergency theories about how diseases are spread and the connection between milkmaids’ immunity to the illness—the public erupted in panic, fearing that the newly introduced vaccination, containing a live culture from cows, would mangle their bodies and deform them into half-bovine creatures (Green 2015). The ultimate success of Jenner’s treatment helped to convince the public of the efficacy of vaccination, but doctors also faced the challenge of communicating complex scientific theories and principles to the public, in a way that had to be neither patronizing nor alienating. Scientific discourses and theories are not necessarily accessible or easily digestible to the general public. For many years the widespread use of vaccinations has relied upon the success of eradicating once pernicious and deadly diseases, like polio, to convince the public, perhaps without comprehensive or convincing public education programs about why and how the vaccinations have been working.
Less than 100 years ago, there was also a much greater fear of disease. The Influenza Epidemic of 1919 reportedly killed more people than World War I, wiping out huge swaths of the American population. Measles killed innumerable children. Fear of disease and the promise of protection offered by inoculation may have combined to vest doctors and scientists with public trust in vaccinations, despite unclear understandings behind the biological mechanisms that inform the intervention. Fortunately, or, perhaps, unfortunately, we live in a time when the threat of disease in the Western world is distant. David A. Grimes writes, “Apathy derives from naiveté; many parents of young children today did not live through the ‘bad old days’ before immunization. Vaccination has become a victim of its own success, and our nation has become complacent as a result. An entire generation of Americans has grown up unaware of the danger of measles” (2015). We have forgotten how recently diseases that could not be tamed or controlled threatened our lives. We live in the aftermath of an extensive and successful multi-sectoral public health intervention that has improved food and water standards, attempted to sanitize urban spaces and ushered in an era of hearty herd immunity. But we also live in a time of suspicion—scientists and doctors are not the well-trusted experts they once were. Many Americans are disaffected by biomedicine or the callous attitudes of the public health system, instead turning to traditional or homeopathic remedies that represent more sensitive, holistic approaches to their health needs. Some Americans may also be blinkered by the normalization of health privileges—it is easy not to fear death or disease when you have easy access healthy food, clean water, a social environment that creates positive conditions for health to, and quality health care facilities that you can afford to use if alternative remedies fail.
This is not the case throughout the rest of the world, especially in communities so impoverished that their immune systems cannot adequately fight off relatively benign sicknesses. In America, we are all considered “experts” of our own health, but are not necessarily equipped with the critical tools to tell apart medicine from quackery. We value anecdotes over statistics, the triumph of the individual over the sanitized data and hypotheses of biomedicine. Vanessa Wamsley consulted, “Dr. Kristin Hendrix, a professor of pediatrics at the Indiana University School of Medicine, researches how parents make decisions about their children’s healthcare, including vaccinations. ‘It’s a combination of pretty complex psychological factors,’ Hendrix says. ‘Some folks are very predisposed to trust information about others’ personal experience’” (2014). Within this complicated context of dis-ease, it should not be surprising that Andrew Wakefield’s 1998 Lancet article connecting MMR vaccinations with autism trigged a wave of hysteria. The article touched a visceral nerve, validating confirmation biases and further entrenching mistrust of government mandated medicine. Seth Mnookin’s book The Panic Virus (2012) provides a comprehensive analysis of the scientific, social and discursive debate that emerged from the paper. Within the age of personalized medicine and without adequate mechanisms to launch a convincing public health education offensive that was comprehensive without being pedantic, we began to lose our herd immunity. And from the wake of the latest measles outbreak in California emerges what may be a familiar debate between the responsibility of the state to protect the public’s health and the sanctity of personal choice.
In the early part of the 20th century, Mary Mallon served as a cook for well to do families in New York City. A single, Irish immigrant woman, Mallon’s choices and opportunities for employment were limited. Perhaps due to her aberrant independence, she was a spit fire by nature, private and self-possessed. She may seem typical in a city full of immigrants clawing after the American Dream, were it not for the other part of her identity that remained hidden until the state of New York intervened—she was a healthy carrier of typhoid. Otherwise known as Typhoid Mary, Mary Mallon was initially accosted by public health officials in 1907 when they traced a recent typhoid outbreak to her. As a cook, her profession lent itself to quick yet discrete transmission of the disease. Mary claimed to be entirely healthy, with no symptoms of the illness, and denied the claims that she was a healthy carrier. When she refused the state’s request to discontinued her profession as a cook, she was arrested as a menace to public health and removed to North Brother Island, where she would no longer “contaminate” the upper crust elite of NYC society.
She was eventually released in 1910, under the condition that she find other work apart from cooking, but was equipped with minimal assistance and few other marketable skills to find steady employment. She was eventually discovered under a false name in the kitchen of a family, likely out of desperation for income and the dogged belief that she was not ill, especially considering that she demonstrated no symptoms of typhoid. Previously portrayed to the public as a somewhat sympathetic, if misguided character, the media quickly turned on her, labeling her as a mistress of death knowingly brewing disease in the houses where she worked. Newspapers painted her as a heartless villain who wished to infect those around her. Infuriated by the violation of the terms of her release, New York decided to use Typhoid Mary to set an example. In 1915, they permanently removed her to North Brother Island, where she would live out the rest of her life.
Like the contemporary anti-vaccination community, Mary Mallon did not trust the doctors or public health officials who told her that she carried typhoid. As Judith Walzer Leavitt points out in her book Typhoid Mary: Captive to the Public’s Health (1996), Mallon’s clinical status represented an ideological schism between public health officials and the infected individual: “[Mary Mallon] insisted she was not sick and had never been sick with typhoid fever. She used her personal knowledge about her own body to argue that since she had no disease symptoms she could not menace anyone else’s health. She did not want to be treated like someone who was sick when she felt healthy and vigorous, and was in fact leading a productive life when she was taken” (86). Her personal experience and bodily knowledge clashed with those of the scientific community, positing alternative approaches to health. Her vexed condition as a menace to public health was further inflamed by the mistrust of immigrants at the turn of the 20th century. Leavitt also indicates that Mallon’s gender worked against her: “Health officials viewed women carriers of typhoid fever as more dangerous than men in part because cooking, an activity that provided one of the easiest routes of bacilli transmission, was a traditional female activity” (1996: 97). Mallon’s health can therefore be understood as both a biological and a social condition, galvanizing a series of public outcries and institutional responses that also expose belief systems intertwined with health. During the time of Mary’s arrest and removal, the American populace compelled the government to protect public health, a mandate that necessarily involved dictating social order. “In the early twentieth century the law spoke with a single voice and a simple guideline: public health authorities had the medical ability and the legal authority to define a public health menace, regardless of due process or the curtailment of an individual’s liberty and regardless of consistency. The judges were willing to give health departments the power to discriminate among carriers and decide which healthy people who carried pathogenic bacteria in their bodies were to go free and which were to be detained” (Leavitt 1996, 95). The health of the population (particularly the wealthy population) of New York was therefore elevated above the civil liberties of Mary Mallon.
As a healthy carrier of typhoid, Mallon jeopardized the health of those around her, not unlike how the anti-vaccination movement is undermining herd immunity and endangering the lives of those who are either too young to be immunized or the immunocompromised, such as citizens in developing, impoverished countries, unwittingly exposed to carriers through the tourism industry. The United States is not without its own health problems, which means that individuals and families who don’t have access to quality and affordable health care may also be in danger. Mary Mallon was demonized for her actions, and as the measles (declared eliminated in the US in 2000) escalate in numbers and severity, certain members of the public are beginning to treat anti-vaccination as a threat to public health as well. Conor Friedersdorf has made the point that condemning the actions of a group will only solidify their anger and further entrench their actions, especially considering that, “the vast majority [of anti-vaccination parents and proponents] are not, in fact, especially selfish people, and characterizing them as such just feeds into their mistaken belief system” (2015). Mary Mallon’s public health experience transcended the personal into a popular metaphor, one that highlights the perils of conflicting ideological frameworks surrounding health and the compromises that must be made to avert health crises. Biomedicine, though founded upon empirical evidence, also represents an ideology about the body and healing that may be incommensurate with personalized notions about illness.
We are quickly reaching a crossroads when the US government will be faced with a similar dilemma the state of New York confronted in 1907. As Leavitt so cannily writes, ““Because the road from and to the past is a two-way street, we must be alert to how the realities of the present have an impact on how we construct and reconstruct the past […] If we are aware of our present sensitivities, they can help rather than hinder our understanding of history, just as history can help us comprehend our options in the present” (1996, 5). What do we value as a nation—radical individualism or national prosperity and heath? How are our understandings of health shaped by personal biases that are also related to privilege, race, and gender? Are there instances in which public health triumphs over personal liberty?
CDC (2015). “Frequently Asked Questions About the Measles in the U.S.” http://www.cdc.gov/measles/about/faqs.html
Friedersdorf, Conor (2015). “Should Anti-Vaxers Be Shamed Or Persuaded?” The Atlantic. http://www.theatlantic.com/politics/archive/2015/02/should-anti-vaxxers-be-shamed-or-persuaded/385109/
Green, Matthew (2015). “The Feverish Roots of Today’s Anti-Vaccination Movement.” The Lowdown. http://blogs.kqed.org/lowdown/2015/02/15/the-feverish-roots-of-todays-anti-vaccine-movement/
Grimes, David A. (2015). “Deniers of Science: The Anti-Vaccination and Anti-Abortion Movements.” The Huffington Post. http://www.huffingtonpost.com/david-a-grimes/deniers-of-science-the-an_b_6471684.html
Hiltzik, Michael (2014). “The anti-vaccination movement drives measles to a 20-year record high.” LA Times. http://www.latimes.com/business/hiltzik/la-fi-mh-measles-20140530-column.html
Leavitt, Judith Walzer (1996). Typhoid Mary: Captive to the Public’s Health. Boston, Massachusetts: Beacon Press.
Mnookin, Seth (2012). The Panic Virus: The True Story Behind the Vaccine-Autism Controversy. New York: Simon & Schuster Paperbacks.
Wakefield, Andrew et al. (1998). “Retracted: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” The Lancet, Vol. 315, No. 9103. pp. 637-641. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2897%2911096-0/abstract
Wamsley, Vanessa (2014). “The Psychology of Anti-Vaxers: How Story Trumps Science.” The Atlantic. http://www.theatlantic.com/health/archive/2014/10/how-anti-vaccine-fear-takes-hold/381355/