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Pox: An American History ( )

How The 'Pox' Epidemic Changed Vaccination Rules

Apr 5, 2011 (Fresh Air from WHYY)

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Michael Willrich is an associate professor of history at Brandeis University. He is also the author of City of Courts and contributes regularly to The Washington Monthly and City Paper.

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Historian Michael Willrich was planning to write a book about civil liberties in the aftermath of Sept. 11 when he stumbled across an article from The New York Times archives. It was about a 1901 smallpox vaccination raid in New York — when 250 men arrived at a Little Italy tenement house in the middle of the night and set about vaccinating everyone they could find.

"There were scenes of policemen holding down men in their night robes while vaccinators began their work on their arms," Willrich tells Fresh Air's Terry Gross. "Inspectors were going room to room looking for children with smallpox. And when they found them, they were literally tearing babes from their mothers' arms to take them to the city pesthouse [which housed smallpox victims.]"

The vaccination raid was not an isolated incident. As the smallpox epidemic swept across the country, New York and Boston policemen conducted several raids and health officials across the country ordered mandatory vaccinations in schools, factories and on railroads. In Pox: An American History, Willrich details how the smallpox epidemic of 1898-1904 had far-reaching implications for public health officials — as well as Americans concerned about their own civil liberties.

"110 years ago, vaccination was compelled by the state," he says. "But there no effort taken by the government to ensure that vaccines on the market were safe and effective. We live in a very different environment today where there are extensive regulations governing the entire vaccine industry."

At the turn of the 20th century, explains Willrich, there were little to no regulations governing the pharmaceutical industry. Many people were forced to receive the vaccine — most of the time against their will.

"There was one episode in Middlesboro, Ky., where the police and a group of vaccinators went into this African-American section of town, rounded up people outside this home, handcuffed the men and women and vaccinated them at gunpoint," says Willrich. "It's a shocking scene and very much at odds with our daily-held notions of American liberty."

People infected with small pox would also be quarantined against their will in large isolation hospitals called pest houses.

"People would literally dragged there against their will," he says. "Some of the most poignant scenes are when mothers are fighting with health officials to keep their children in their own homes rather than have them be taken off to a pesthouse. People at the time rightly associated pest houses with death. That's where someone was taken to die."

Resistance To Vaccinations

From the very start of the organized vaccination campaign against smallpox, there was public resistance, says Willrich. The battle between the government and the vocal anti-vaccinators came to a head in a landmark 1902 Supreme Court decision, where the Supreme Court upheld the right of a state to order a vaccination for its population during an epidemic to protect the people from a devastating disease.

"But at the same time, the Court recognized certain limitations on that power — that this power of health policing was no absolute and was not total and there was a sphere of individual liberty that needed to be recognized," says Willrich. "Measures like this needed to be reasonable and someone who could make a legitimate claim that a vaccine posed a particular risk to them because of their family history or medical history [would not have to be vaccinated.]"

In addition, the Supreme Judicial Court of Massachusetts stipulated that a state couldn't forcibly vaccinate its population.

"[They said,] 'Of course, it would be unconstitutional and go beyond the pale for health officials to forcibly vaccinate anyone because that's not within their power,'" says Willrich. "And I think that's really a shoutout to the Boston health authorities who were employing forcible vaccination all the time in the poorest neighborhoods in the city."

Because so many refused to get vaccinated, there were isolated incidents of smallpox outbreaks in the United States until 1949, says Willrich. It wasn't until 1972 that the U.S. government decided to stop mandatory vaccination against smallpox, in part because the disease had been largely eradicated.

The Current Anti-Vaccine Controversy

In 1998, the British medical journal The Lancet published a report by Dr. Andrew Wakefield that suggested that there might be a link between autism and the measles, mumps and rubella (MMR) vaccine.

"This paper was thoroughly discredited and debunked but the idea that vaccines might somehow be the cause of autism stuck," says Willrich. "And so, according to some of the most recent studies, something like one-fifth of all American parents believe that vaccines cause autism. This is simply not true. But it's a powerful association in the public mind."

Wakefield is no longer allowed to practice medicine in England and The Lancet withdrew the study in 2010. In January, 2011, the British Medical Journal said that the study wasn't just wrong — it was "a deliberate fraud" that altered key facts to support the link between vaccinations and autism.

Even though the study was discredited, many people continue to believe the link between vaccinations and autism, says Willrich.

"[In 2003,] according to the CDC, there was something like 22 percent of American parents of young children were refusing one or more vaccines for their children," he says. "Five years later, that percentage had nearly doubled to about 40 percent of all Americans. So the vaccine controversy today is one of the most important public health crises we face in America."

And, he says, public health officials can and should do more to inform the public that the American Academy of Pediatrics, the American Medical Association and the CDC all believe that vaccines are safe.

"I think this is the time for doubling their efforts to spread the good word about vaccines and also have a candid public discussion about the risks and benefits," he says. "There's no more opportune moment than the present to launch a new publicity campaign around vaccines. ... Viruses spread in human populations from person to person and if you have a vast majority of a community vaccinated against that virus, the virus will simply never have a toehold in that community."

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