The Long History of North American Anti-vaccination Movements

AT THE END OF THE MILLENNIUM, The Simpsons—as always—tapped the pulse of the American nation like no other cultural production. In December 2000 Homer finally discovered the joys of virtual reality, quickly becoming an investigative reporter on the Internet. Our intrepid breadwinner proceeded to uncover a vast conspiracy behind the flu vaccine. This finding put Homer in grave danger. The conspirators, using The Prisoner as their inspiration, took Homer to an island where they placed him under complete isolation, thereby preventing him from spreading The Truth. Yet his kidnappers ultimately did confess. Why, after all, are influenza shots given right before Christmas? Because…they contain a serum that heightens the impulse to shop.1

Nor should I fail to mention that Agent Dana Scully of The X-Files discovered one day, during the course of her duties, the likelihood that some government agency has for decades been tagging all Americans with a special alphanumeric code during their immunizations.2

A jaundiced view of vaccination became a staple of popular culture during the 1990s. Yet real-life concerns about this miracle medical procedure also became, during the same period, intensely political. And to the immunization establishment, anti-vaccination sentiment was—rather is—no laughing matter. For in the last decade, even in just the last half decade, skepticism about vaccinations, and in particular their compulsory nature, has become epidemic in North America.3

Indeed, as I write during the middle of 2003, President Bush, secretary of Health and Human Services Tommy Thompson, and members of the federal medical establishment in Washington, D.C., are as stymied as they have ever been in matters relating to vaccination. Fearing a bioterrorist attack, Thompson promised in late December 2002 to vaccinate half a million health care workers against smallpox within thirty days. A month after the program began, however, less than 1 percent of the targeted subjects had volunteered for the risky immunization, and the figure had not even reached ten percent by July 2003. Before the war with Iraq a former Massachusetts health commissioner commented that the president’s project was “as close to stalled as you can get”; after the war, national security officials feared that the program was “all but dead.” Moreover, powerful voices within the public health elite, as well as among rank-and-file health workers, have effectively—and with few if any consequences—encouraged opposition to official government vaccination policy.4

We should, though, ask: how historic is this massive resistance? Is it truly a phenomenon we have never seen before? On one hand, nothing like it occurred during the midcentury golden decades of vaccines, when immunization became a “sacrament” that received only rare public questioning. On the other hand, opposition to compulsory vaccination runs quite deep in the currents of this continent’s history. We might be surprised by these present-day vaccination reactions. But, looking to the past, we really shouldn’t be.5

The Politics of Healing begins with an essay on anti-vaccination-related issues, and for good reason. Immunization was the focus of intense controversy throughout the nineteenth and early twentieth centuries, galvanizing many concerns about medicine held by unorthodox healers and ordinary people alike. This means that the effective shutting down of current smallpox vaccination efforts has plenty of direct parallels in North American history. The primary purpose of this essay is to make these parallels meaningful by putting current anti-vaccination efforts into historical perspective. First I will briefly outline the scope and scale of earlier anti-vaccination crusades; then I will provide a sketch of the movement that has developed over the last two decades. I seek to highlight both similarities and differences between past and present in terms of medical rhetoric, attitudes toward science, and political ideology. One fundamental difference is immediately apparent: the remarkable legitimacy of latter-day vaccine skeptics in the eyes of the media, parts of the political elite, and even to some extent the medical establishment. When so-called antivaccinationists (and their naming is a crucial part of the story) receive such a high level of respect, intellectual engagement, and at times celebration in the common public culture, this alone justifies our recognition that we live in a historic era in the realm of the politics of healing.

THE LONG HISTORY OF NORTH AMERICAN ANTI-VACCINATION MOVEMENTS

Just as writers for the New York Times and anchors on ABC News have come to admit vaccination skeptics into the acceptable civic landscape, so too have historians finally begun to take anti-vaccinationists seriously. This has not always been the case. As recently as 1991, one historian labeled those who resisted vaccination “the deluded, the misguided, the ignorant, the irrationally fearful.” Yet at least a few scholars now understand that the genuine power of previous crusades against compulsory vaccination demands, if not sympathy, at least a modicum of respect.6

What have we learned from these historians? First, that the roots of resistance reach far down in American soil, playing a role in our very origin stories. The symbolic precursor to today’s struggles is a conflict in colonial Boston in 1721–22, when shopkeepers and artisans used threats of violence against Puritan cleric Cotton Mather. Mather sinned, according to the plebeian portion of the populace, by attempting to introduce into the continent inoculation against smallpox. The result was, in the words of Perry Miller, a “grim struggle” over political and cultural authority throughout New England. In the next century, within the medical ferment of nineteenth-century America, opposition to vaccination itself was even fiercer. Upset about the procedure was rife among free blacks; Frederick Douglass was himself an anti-vaccinationist. Native Americans, Mexican Americans, and a variety of immigrant communities were also at the forefront of resistance. This fit the worldwide pattern, where struggles against vaccination among lowly “subaltern” peo ples—whether in the Philippines, India, or Ghana—were an integral part of the fight against European imperialism.7

Yet displeasure with smallpox vaccination (the only immunization widely available until the early twentieth century) was just as intense within the North American mainstream. Communities from Niagara Falls, New York, to Muncie, Indiana, convulsed with conflict. The western states were the least susceptible to the vaccinators’ appeals. Arizona voters actually outlawed compulsory vaccination in a 1918 popular referendum. Two years earlier, Oregon voters had come within 374 votes of doing the same, with voters in the state’s cultural and political center, Portland, favoring the measure by a 55 to 45 percent margin. The legislatures in California and Washington repealed compulsory vaccination laws in 1911 and in 1919, respectively. As a result, renowned public health official Charles Chapin despaired in 1913 of the United States’ status as “the least vaccinated of any civilized country.” If anything, though, that honor would have gone to Canada ahead of the United States. In early-twentieth-century Toronto, to take just one example, two mayors denounced compulsory vaccination, the school board removed vaccination regulations, and the city council refused to allow city health officials to carry out Ontario’s law requiring vaccination of all citizens.8

Uniting all these laypeople, whether Polish immigrants in Milwaukee or small-business owners in Portland, was a hostility toward the compulsory nature of vaccination. As social scientist Paul Greenough has commented, “The modern state is in a position to demand that its citizens surrender their immune systems as a public duty.”

Anti-vaccinationists, however, refused to accept this increasingly powerful public health idea, often declining to sanction their governments’ compelling of any health measure for the supposed common good.9

Such a sentiment frequently differed little from a primal libertarianism—an extreme individualism that demands that the state always and ever keep its coercive hands off the bodies of the citizenry. Yet frequently the anti-vaccinationists developed a considerably more complex, and indeed more fundamentally democratic, philosophy. In matters of state, for example, anti-vaccinationists such as Portland’s Lora C.Little insisted that the people as a whole were wise enough to vote on scientific policy. Most emphatically, they held that parents had the wisdom to take full charge of the medical affairs of their children. Anti-vaccinationists thus repudiated the cult of the expert blossoming into full flower during the Progressive era. Often they allied themselves as well with advocates of direct democracy, a powerful movement that during the first two decades of the century brought the initiative, referendum, and other electoral reforms to (primarily) the West. In 1913, for instance, Little led a successful campaign to overturn, by popular referendum, Oregon’s new eugenic sterilization law, which would have put to the knife “habitual criminals, moral degenerates and sexual perverts.”10

Many citizen-activists were, in addition, fully anti-vaccinationists, meaning that they objected not just to state coercion, but to vaccines themselves. Anti-vaccinationists pointed—correctly—to the significant risks of the smallpox vaccine, which if contaminated at times transmitted syphilis and other virulent infections; even when free of bacteria it could cause fatal cases of encephalitis.

Also, those who received the vaccination could spread a related infection to close contacts. Protests were only infrequently religious, at least in the public realm, with some objecting to tampering with God’s handiwork in the form of the human body. Much more common were concerns about the poisoning of the blood and the introduction of impurities into an otherwise healthy body. Such thinking frequently flowed from a comprehensive philosophy of natural healing. Lora Little, along with many others, believed that individuals could best heal themselves through close attention to diet, exercise, and right thinking and living. In turn, governments should focus on sanitation. Anti-vaccine activists complained as well about corrupt connections between the state, vaccine manufacturers, and the medical profession. Many of these themes would carry through straight into the twenty-first century.11

All in all, the anti-vaccinationist crusades of the nineteenth and early twentieth centuries were a crucial part of an overall movement for full “medical freedom,” against the tyranny of “state medicine.” What happened to that movement after the 1920s, with the collapse of Lora Little’s Chicago-based American Medical Liberty League, remains mostly a mystery—and a subject very much worthy of study. On the surface, the lack of much overt protest against vaccination fits the dominant model in the history of medicine, which posits a midcentury golden age for orthodox medicine. Still, there are traces that cry out for further examination.

We must first appreciate that, outside of this volume, little—really, almost no—research has been done on mid-twentieth-century movements against orthodox medicine. What we will find when we start exploring this unknown world could be quite surprising. For example, the only sustained work on the subject, Eric Juhnke’s Quacks and Crusaders, reveals the surprising strength of figures such as goat-gland doctor John Brinkley and alternative cancer entrepreneur Harry Hoxsey. In 1932 Brinkley received 240,000 votes when he ran for governor of Kansas. Anti-vaccinationism was an integral part of this world of attempted sexual revitalization and anti-Semitism. Activist Norman Baker decried the “horrors of vaccination” of both children and livestock; Hoxsey in turn warned of the dictatorial power—greater than that of Hitler or Stalin— of the American Medical Association, which sought to vaccinate all children as part of its “medical straitjacket.” The rabidly anti-communist organization American Rally, which staunchly supported Hoxsey, denounced with equal fervor the United Nations and “totalitarian health powers” that sought to inject an untested polio vaccine “in their mad scramble to launch a new money-making empire.” Anti-fluoridationists also carried forth many anti-vaccination ideas during alternative medicine’s supposed years in the wilderness, as Gretchen Ann Reilly’s essay in this volume reveals.12

By no means were the little-known theorists of midcentury anti-vaccination efforts all right-wing extremists. In 1935, Annie Riley Hale penned what turned out to be the most powerful anti-vaccine treatise written between the Wall Street crash and the age of Reagan. Besides presenting a case against immunizations based on a well-developed theory of natural healing, Hale, in The Medical Voodoo, decried “medical experimentation” on “the inmates of jails and orphanages” and castigated the “militarization of medicine” that resulted from increased cooperation between public health authorities and the armed forces. Hale also pointed out that the “rich and powerful” could fend off “medical overlordism” in the form of compulsory vaccination, quarantining, and inspection, but that “the helpless classes” of children, workers, and soldiers could not so easily defend themselves. Arguing for a full “democracy in the healing art” that would allow a genuine choice of different kinds of healers, Hale defended “common-sense reasoning which any lay intelligence can grasp” against the supposed authority of would-be “experts.”13

That said, by the 1950s extreme and conspiratorial anti-communist agitators were apparently at the forefront of anti-vaccination activities. One flyer asked of those behind vaccine “terror”: “The Master Minds, who are they? REDS, seeking our destruction?” Another broadside named the “Unholy Three” as fluoridation, “mental hygiene,” and polio serum. As for the latter, the “vaccine drive is the entering wedge for nation-wide socialized medicine, by the U.S. Public Health Service (heavily infiltrated by Russian-born doctors, according to Congressman Clare Hoffman). In enemy hands it can destroy a whole generation.” The Keep America Committee concluded its screed: “FIGHT COMMUNISTIC WORLD GOVERNMENT by destroying THE UNHOLY THREE!!!” Still, even moderates—including polio vaccine pioneer Albert Sabin—could, and did, question the safety of specific vaccines, especially after the so-called Cutter incident, in which a batch of the new Salk polio vaccine containing live virus caused over 200 cases of polio, with eleven deaths. 14

Recognizing that a strong, and still largely undiscovered, anti-vaccination underground survived in the years from 1930 to 1980 helps us make much more sense of the 1945 statement of leading public health authority Wilson Smillie. Smillie complained that year about how vaccination was still “gradually losing ground. Its enforcement meets with constant opposition from the general public.” Indeed, by the 1930s, four states (Arizona, North Dakota, Minnesota, and Utah) had laws explicitly prohibiting compulsory vaccination, and just nine states and the District of Columbia had compulsory vaccination legislation. The rest of the country effectively rejected coercion—at least most of the time—by leaving the matter to local authorities, who generally acted only during epidemics. Overall, public acceptance for vaccinations became much more solid over the course of the twentieth century. Just as clearly, though, such a strongly rooted tradition of dissent on the vaccine issue by no means simply disappeared.15

THE CURRENT ERA: THE ORIGINS OF DISSATISFIED PARENTS TOGETHER

If it is currently difficult to establish an effective chronology of anti-vaccination activity during the middle of the twentieth century, it is much easier to date the beginnings of the current movement.16 In April 1982, WRC-TV in Washington, D.C. aired a documentary produced by Lea Thompson titled DPT: Vaccine Roulette. Repeated on the Today Show and later the recipient of local Emmy awards, Vaccine Roulette focused on the apparently deadly or life-threatening reactions of children who received the combination diphtheria-pertussis-tetanus (DPT) vaccination. Within a week of the documentary, a group of parents in the Washington area founded Dissatisfied Parents Together (DPT). These citizens, most of whom had children “damaged” by the pertussis component of the DPT vaccine, immediately began to contact federal and state legislators in order to seek official recognition of vaccine dangers, to obtain better information from physicians, and to support the development of a safer vaccine.17

Characterizing themselves as an all-volunteer “grassroots movement,” DPT activists moved into the political arena with stunning speed and considerable success. By May 1982 Paula Hawkins, a Republican senator from Florida, chaired subcommittee hearings where those who testified included DPT co-founder Kathi Williams. At the first public meeting of DPT later that month, influential Democratic congressman Tony Coehlo greeted its members with open arms. From the very beginning, DPT fashioned itself as a group critical of, but willing to cooperate with, the medical mainstream. DPT met right away with representatives of the American Public Health Association, the Food and Drug Administration, and the Centers for Disease Control. The group also initiated talks with the American Academy of Pediatrics (AAP) to discuss the creation of a federal program to compensate families with children who suffered adverse reactions to the pertussis vaccine. “In a remarkable show of agreement,” DPT and the AAP then both testified before the Senate Labor and Human Resources Committee in June 1982, reaching consensus on the need for federal legislation that would not restrict the right of families to sue vaccine manufacturers. AAP spokesman Martin H. Smith even went so far as to praise, in front of Congress, his group’s “extensive and productive discussions with members of…DPT…. We have been impressed by the skill and knowledge of the parents, and frankly we have learned a great deal from them.”18

Although at first DPT worked within the medical establishment, it also without delay displayed a populist orientation toward science. “You don’t need a Ph.D. or an M.D. to understand the medical and scientific literature,” the organization proclaimed. Rather, parents should go to the local hospital or university medical library to investigate what doctors and public health officials would not tell them—or perhaps didn’t even know. DPT frequently supplied to its members accounts of mainstream medical studies, generally ending such reports not with its own lessons but rather with the moral that parents should draw their own conclusions. “We must educate ourselves about vaccines, start asking questions and demanding answers” the group’s first vice president and co-founder, Barbara Loe Fisher, declared in an inaugural editorial. And those associated with the organization made it clear that their views would be potentially unpredictable.

Assuring her audience that “we don’t want to see the return of the kind of pertussis disease that ravaged American households in the early part of the twentieth century,” Fisher refused to be categorized as anti-medicine. “No matter what some may want the public to believe, concerns about the vaccine and the disease are not mutually exclusive.” Rather, a “40-year conspiracy of silence” suppressing the known risks of the pertussis vaccine must come to an end, as citizens “reassert our rights as parents to protect the mental and physical health of our children” and mothers in particular stand up to “intimidat[ion] by physicians.”19

In the four years after its founding, DPT concentrated its political efforts on the creation of a federal vaccine injury compensation system. While eventually successful, the organization found the ways of Washington to be deceptive and ever-changing. The alliance with the American Academy of Pediatrics would fray and then break, while the patronage of conservative senator Orrin Hatch and liberal congressman Henry Waxman would prove fickle but ultimately productive. DPT had a fair amount of political skill at its disposal; president Jeff Schwartz was a lawyer and lobbyist who had worked for the Environmental Protection Agency, as well as for a congressional committee where he drafted amendments to the Clean Air and Safe Drinking Water acts. Yet when up against the power of organized medicine within the government, as well as the clout of pharmaceutical companies, DPT—which had only recently gained its first part-time employee (Kathi Williams) and donated storefront space (from Kathi Williams’ parents’ small business) and which still in the spring of 1984 raised a considerable amount of money at a yard sale—had to accept a painful compromise.20

What DPT wanted was simple. Activists sought a no-fault, nonadversarial system in which parents with vaccine-injured children could go to the government and receive compensation. Opponents such as the AMA and vaccine manufacturers, on the other hand, hoped to get an “exclusive remedy” that would not only strictly limit damage awards from the government but also legally prevent parents from suing for vaccine injuries. They disagreed with DPT in the first place about the relative risks of the pertussis vaccine, but even more they argued that a DPT-style compensation system would drive the cost of vaccine production so high that manufacturers would have to withdraw from the market, causing a severe shortage of vaccines.21

Nevertheless, DPT gained powerful establishment allies. Despite consistent opposition from the Reagan administration, conservatives Paula Hawkins and Orrin Hatch remained sponsors of DPT-inspired legislation, joined by Democrats John Stennis, Ted Kennedy, Jay Rockefeller, and Al Gore. The American College of Physicians and the American Nurses Association joined with the March of Dimes and the Epilepsy Foundation of America to endorse the bill. Yet DPT had to endure many “long and often frustrating struggles” along the way before seeing Ronald Reagan sign into law the National Childhood Vaccine Injury Act of 1986. A multitude of congressional hearings over the course of more than four years, along with a last-minute vigil in front of the White House, proved necessary. As the triumphant but somewhat chastened story in the DPT News put it, “Like David against Goliath, DPT represented essentially powerless vaccine injured victims pitted against three of the most powerful and wealthy segments of our society: the pharmaceutical industry, organized medicine, and the federal government.”22

First along the road to the passage of the 1986 act came the collapse, amid rounds of mutual recrimination, of the “fragile coalition” with the American Academy of Pediatrics. Then Henry Waxman temporarily abandoned DPT after Lederle, one of the primary manufacturers of pertussis vaccine, in 1986 increased the price of its vaccine a staggering 10,000 percent over its cost just four years earlier. Waxman, though, still brought DPT into negotiations over the bill’s future. DPT fought hard, and ultimately successfully, to make sure that the compensation system covered children of all ages. While Waxman was willing to back away from a provision that would have removed children older than four years from the program, he extracted a price from DPT: its agreement to support an amendment that would cover only future unreimbursed medical 

expenses for children injured prior to the bill’s enactment. This was a bitter pill for many activists, who would end up seeing their own vaccine-injured children denied “money for pain and suffering, loss of future earned income, or past medical expenses.”23

The drama was not yet over, however. Although the bill passed unanimously in the Democratic-controlled House, once it reached the Senate its fate was in the hands of key Reagan allies Strom Thurmond and Orrin Hatch. Thurmond, working in cooperation with Attorney General Ed Meese, remained implacable in his opposition. But Hatch was trying hard not to alienate either side. First, he reached a “great compromise” with Waxman that saw the inclusion of the bill in an omnibus health act that, among its provisions, gave pharmaceutical companies authority to export to certain countries drugs that had not yet been approved by the FDA.

Second, Hatch used his political skills to convince the Reagan administration not to veto the bill. He did so through intense private lobbying of Meese, as well as in conjunction with the very public agitation of DPT and its allies. During a press conference Hatch, who had reportedly wept (in private) at the fate of the bill, held aloft a vaccine-injured child, Stacy Scholl, who in turn hugged the Utah senator. Perhaps Hatch realized the power of the social movement that DPT had mobilized; apparently no other measure received so much public comment during the 99th Congress as the vaccine injury bill.24

Although Dissatisfied Parents Together had been caught up in the middle of a serious game of political hardball that it could not control, the organization effectively used its popularity, along with its organizing skills, to score a major political victory. Indeed, the passage of the 1986 National Childhood Vaccine Injury Act was the first time that a movement critical of the vaccine establishment had ever helped enact federal legislation, and for that reason alone the bill’s passage was historic. A not insignificant reason for DPT’s visibility was the publication, in the middle of the fight for the compensation system, of DPT: A Shot in the Dark. Co-authored by Barbara Loe Fisher and prominent homeopath and historian of alternative medicine Harris Coulter, and published by a major New York publishing house, the book alternated between an accessible account of the scientific knowledge about the hazards of the pertussis vaccine and wrenching portraits of children either killed or brain-damaged by the vaccine.25

Coulter and Fisher put front and center the many dangers that they insisted were associated with the pertussis vaccine. Besides the common localized pain and swelling at the site of the shot, reactions ranged from high fever to intense screaming, from brain damage to death. Coulter and Fisher argued that medical authorities had known about these hazards for four decades but had engaged in a “conspiracy of silence” to deny the risk. Indeed, the whole vaccine system was broken, from stem to stern. Vaccines went on the market without proper scientific testing, public health officials who were supposed to be monitoring vaccine safety were caught up in conflicts of interest because of their connection to drug companies, and doctors (who themselves received confusing and conflicting information from vaccine manufacturers and regulators) refused to listen to parents who expressed concerns about their children’s possible susceptibility to vaccine injuries. Furthermore, a safe pertussis vaccine was available, and already in use in Japan, but the American medical establishment refused to even consider developing a safer vaccine.26

Coulter and Fisher also made a case against government medical compulsion, being sure to point out, in the context of renewed Cold War tensions, that western European countries did not compel vaccination but totalitarian Eastern European states did. They foretold a “revolution” in which they envisioned ordinary citizens so well educated in healing matters that medical decision making would become “truly a shared responsibility between parents and doctors.” Parents would then realize that “medicine cannot and should not be legislated.” Still, contesting state mandates was a relatively minor part of Coulter and Fisher’s mission. Rather, replete with heart-rending stories of babies dying hours after their immunizations, DPT: A Shot in the Dark was above all a remarkably effective work in the best muckraking tradition. And the book had a real effect: seasoned vaccine policymaker Sam Katz argued that it “to a real degree threatened the entire immunization program of this country.”27

THE POLITICS OF HEALING Histories of Alternative Medicine in Twentieth-Century North America Robert D.Johnston Editor