Vaccine refusal: it ain’t nothing new

imgres-1I’ve been fascinated by vaccine refusal for a long time, but for whatever reason I had never thought much about its history–at least not stretching back more than a few decades.

Perhaps it shouldn’t be surprising, but turns out that powerful anti-vaccine sentiment has been around for a long time! I just finished Pox: An American History by Michael Willrich, which explores the anti-smallpox vaccine movement during the last major epidemic in the US. Around the year 1900, smallpox emerged from the American South, where it had been festering, and started rampaging across the country, sparking epidemics in major cities like New York and Boston.

Desperate public health officials imposed mandatory vaccine drives. When people didn’t want to be vaccinated–and a lot didn’t–they risked being fined, thrown in jail, or physically restrained while somebody gave them the vaccination. Of course, vaccination laws were applied very differently depending on whether someone was wealthy or poor. In New York’s tenements, brute squads literally chased down and vaccinated every person they could find, breaking down doors and tearing children out of the arms of their mothers. The same was not true on Park Avenue.

All kinds of people joined anti-vaccine societies around the country. Celebrities weighed in too, although at that time people like Mark Twain and Williams James were voicing anti-vaccine sentiments. A little different from today, when anti-vaccine stars tend to be people like Jenny McCarthy and  Jim Carrey. It’s also striking how little the reasons for vaccine refusal have changed in 100+ years. Parents then were primarily concerned about their children’s safety. They cited all sorts of cases in which vaccines had been followed by death or terrible illness. Many believed that it was better to risk smallpox (especially in its milder variola minor form) than to receive the vaccine.

Of course then they had a point. People had very real reasons to worry about vaccine safety. Although local governments could compel people to be vaccinated, they could not guarantee the safety of the vaccines being administered. In the early days, when people were vaccinated with material from the lesions of another vaccinated person, the risk of some unwanted pathogen being transmitted alongside the vaccine virus was significant. In a particularly awful example from 19th century Italy, 63 children were vaccinated with infectious material taken from an infant who appeared to be healthy. Forty-four of those kids developed syphilis. Some also infected their mothers and nurses. And keep in mind this was before we had antibiotics–when syphilis often proved a death sentence.

Later, cows were used to produce the smallpox vaccine, which really helped ramp up production. It also meant that anyone with a cow and access to some virus could join the vaccine business–small, filthy operations were literally operating out of backyards in places like Brooklyn. There simply was no quality control or regulation.

Not surprisingly, vaccines at that time were often horribly contaminated. The vaccine site often became infected. A man or woman might lose days or weeks of work due to their inability to use the vaccinated arm–and the family that depended on them would suffer. That was sort of a best-case scenario, though. A number of children died of tetanus or other infections after vaccination. You can imagine how that stoked fear of the vaccine! It also horrified many of the doctors who unwittingly administered tainted vaccines and saw their patients suffer the results. Eventually, the attention these cases drew to the lack of quality control in vaccine production would revolutionize the way vaccines were produced, and quality control would become one of the industry’s major concerns. The government would also eventually recognize that it had a responsibility to regulate vaccine production and care for people harmed by vaccines.

The book also draws attention to a major divide in the medical community that was emerging at the time. Homeopaths and other alternative medicine practitioners were very active in the anti-vaccine movement. At the same time, allopaths were coming out strong in favor of vaccination and consolidating their hold over the medical profession. This is another source of tension that seems to have changed very little during the last century.

Willrich gives a sympathetic portrayal of the very real conflicts posed by mandatory vaccination as he follows the outcomes of court cases challenging mandatory vaccination laws. What are the rights of the individual weighed against the many? Especially when the risk of bodily harm to the individual is real? It’s interesting that a lot of passionate vaccine critics then were also active in the women’s rights and civil rights movements of the day. He makes a good case that society’s struggles with vaccine refusal have helped shape our understanding of civil rights. It’s a fascinating book, definitely worth a read!

Syphilis: Then and Now (Or What I’ve Been Doing For the Last 10 Years)

syphilisAn article about our work called Syphilis: Then and Now appeared in this month’s edition of The Scientist.

In it, Molly Zuckerman (U. Mississippi), George Armelagos (Emory U.), and I describe the work we’ve done together on the origins of syphilis. This was a great opportunity to look back at the last ten years, weaving together many different strands of research to figure out what exactly we have learned.

We talk about all the different approaches we’ve employed to try and learn more about the past of T. pallidum, the bacterium that causes syphilis, as well as the lesser-known non-sexually transmitted diseases, yaws and bejel. Looking at old bones in dusty basements? Building a phylogeny with T. pallidum samples collected from all over the world, including remote Amazonian villages? Getting to the bottom of a gruesome disease that causes wild baboons’ genitals to drop off? We’ve done it all! (With a lot of help from other people, of course.)

I will always feel incredibly lucky that I got to carry out my dream dissertation project. Every research project has its highs and lows, but throughout my PhD research I marveled that somebody was paying me to do what I would have gladly done for free. I will also be forever grateful that I had the privilege to work with so many amazing scientists. Thinking back on all this work was a really pleasant endeavor.

Writing this article also forced us to think about the future of this line of research. As we make clear in the article, although our work has shed some new light on the centuries-old debate about syphilis’s origins, there are plenty of questions left. As our ability to obtain whole genome sequences from even poor-quality samples improves, I’m really looking forward to seeing what we learn. The history of this bacterium is just as fascinating to me now as it was when I began my work.

Anyway, writing this article was a lot of fun–and if you are interested in the history of infectious diseases, I hope you will check it out!

And thanks to the folks at The Scientist, especially Jef Akst, for the chance to share our work. It was a pleasure to work with them on this.