Pox_ An American History - Michael Willrich [198]
The vaccination question a century ago was in important respects markedly different from the current debate. Then the controversy centered on a single vaccine used to fight one horrific infectious disease. Today, healthy children under six routinely receive nearly a dozen separate vaccines, some mandated by state law, all recommended by the CDC, that offer protection against viruses ranging from varicella (chicken pox) to the human papillomavirus. Each of these vaccines raises its own particular issues of safety, parental authority, or even, in the case of the HPV vaccine, sexual mores. Trying to check actual epidemics of smallpox, turn-of-the-century health officials likened their power to the military defense of the nation. Today’s vaccination skirmishes are by comparison a peacetime struggle, mostly fought out in the absence of visible diseases—an absence made possible, in large part, by vaccines. The vaccine politics of the present moment reflect twenty-first-century Americans’ still evolving conceptions of the family, their affective ties to particular local and virtual communities, and their complex views of a modern administrative and welfare state that was still in its infancy a century ago. Antivaccination arguments today often convey an attenuated sense of social responsibility that is all too pervasive in contemporary American culture. Our politics of health must be understood in its own historical context.19
Even so, the long-gone epidemics that swept across the United States over a century ago hold important lessons for us. In our post-9/11 moment, civil libertarians have dusted off the Jacobson decision, finding in that complex opinion a set of useful standards for balancing governmental power and individual rights during a health emergency. The experience of those historical epidemics also underscores the abiding importance of public education and political candor in matters affecting personal health. People care deeply about their bodies. To ask them to accept the risk of bodily harm for the sake of others is at times essential. But the decision to make that request of the people has the greatest prospect of success when it is made with the care and public deliberation worthy of a democratic society.
In a broader sense, the history of America’s turn-of-the-century fight against smallpox cautions us against making reflexive judgments about the innumerable people, the world over, who greet scientific innovation and expert authority with skepticism, resentment, or steadfast resistance. To dismiss so many people as merely ignorant and irrational is worse than intolerant. At a time when the ability of democratic nations to promote the security and health of their citizens depends ever more on science, it is the purest folly. It tells us little about the root causes of ambivalence toward medical science or how to bridge the gap between popular beliefs and the imperatives of preventive medicine. Scientific innovations that in hindsight seem manifestly rational, benign, and inevitable often appear far more problematic to people on the ground. Unthinking scientific triumphalism is no sounder an approach than antiscientific denialism to the social conflict and political contention that are likely to continue to haunt the human quest to make ours a healthier world.
Acknowledgments
Generous fellowships and grants underwrote this project. The Radcliffe