Pox_ An American History - Michael Willrich [113]
The old rhetoric of the vaccination argument had lost its persuasive powers, even for some of the measure’s strongest supporters. Cost-benefit arguments were not enough. Vaccination was a political measure, ordered for the most benevolent of purposes. But vaccine was a commercial product, and like all such wares, its success depended upon the confidence of consumers. Public confidence in the market—and thus in the measure—had collapsed. Vaccination itself was, as one New York physician observed, “at a crisis.” And that crisis exposed to all the fundamental contradiction characterizing the procedure: the government compelled vaccination, but it would not vouch for vaccine.70
Dr. Theobald Smith, a scientist with the Massachusetts Board of Health, was one of the growing number of officials and physicians who demanded reform in 1902. “Without the specific protection given by vaccination, small-pox cannot be efficiently controlled and suppressed,” Smith said. “The acceptance of this proposition by the medical profession and the State creates the responsibility of supplying as pure and efficient vaccine virus as can be made under present conditions.”71
The vaccine crisis seemed to require a new role for the state in controlling production. But what sort of control? Like their European social-democratic counterparts, progressive reformers in the United States insisted that certain areas of life were too precious to leave entirely to the unregulated market. This call for a sort of decommodification—to replace capitalist price with government discipline—was a common thread running through a great many otherwise disparate reform causes, from the movement for public ownership of streetcars to the campaign to ban child labor. The disasters in St. Louis and Camden convinced many physicians and health officials that vaccine production had been left to the free market for too long. “The lesson we have principally to learn from these catastrophes,” said Dr. Dalton of New York, “is the necessity of eliminating commercialism from matters pertaining to public health.”72
The professional debate centered on two options. The first was for states to manufacture their own vaccines, in effect socializing the industry (as Japan had done in 1896). Eugene A. Darling, director of the Cambridge, Massachusetts, Bacteriological Laboratory, noted the ethical clarity in this approach. He said, “The State compels the child to be vaccinated, and should furnish the lymph for the operation, guaranteed to be pure and efficient.” The other option was to bring commercial vaccine makers under the discipline of a new regime of licensing and inspection. Since vaccines were an interstate business, most supporters of regulation called for the involvement of the federal government. This, too, was a bold idea: the federal government did not regulate drugs or biologics manufactured in the United States. (Since 1848, federal law had banned the importation of adulterated or spurious drugs, but that law did not touch domestic manufactures.) The entire professional debate took place in the context of rising antivaccination sentiment. In early February, the Massachusetts legislature held hearings on a bill to repeal the state’s compulsory vaccination law. The committee heard an emotional appeal from the mother of Annie Caswell, a five-year-old Cambridge girl who had died the previous month from tetanus after vaccination. The bill failed. But that effort and others like it helped keep the vaccine purity question before the press.73
The idea of government production, which American Medicine dismissed as “almost out of the question,” met with powerful opposition from vaccine makers