Elena Conis’ Vaccine Nation examines the changing perceptions of vaccines in the United States. In the early 1960s, vaccines were held in great confidence by the public, and scientists hoped that vaccines could be used to eradicate common childhood diseases such as mumps and rubella. Yet this optimism soon gave way as critiques of vaccination became increasingly popular. Conis traces the disparate influences of environmentalism, feminism, and cultural politics in creating an anti-vaccination movement
Conis begins the book in the Kennedy Administration after briefly reviewing the successful vaccination campaigns aimed at polio and smallpox. Kennedy and other lawmakers saw federal involvement with the 1962 Vaccination Assistance Act as a cost-effective way to improve public health (20). Vaccination also played into concerns about national security: improving the health of American children was critical at a time when a fifth of applicants to the U.S. military were being rejected (27).
More serious diseases such as polio and smallpox were disappearing or had already been eradicated in the United States, and now federal attention was turned to so-called dirty diseases such as measles. Modern confidence in science was such that many believed these older diseases could and should be eradicated. Conis writes, “Nature was something to be overcome with technological breakthroughs and scientific expertise” (54).
Yet doctors weren’t in lockstep regarding the benefits of vaccines, especially regarding mumps, which was regarded as a harmless and comical disease of childhood. These diseases, once understood as an inescapable fact of childhood, were now targeted because of the damage they could to do a young child’s development (52). Vaccine manufacturers such as Merck expounded on the threat that these diseases could pose, such as the risk of sterility from mumps. Vaccine manufacturers and public health officials pushed the vaccine as part of responsible parenthood, especially after a combined measles, mumps, and rubella vaccine became available. While mumps was never fully eradicated, by 1985 there were just 3,000 cases in the U.S., down by 98% from 1968.
The next major federal push for immunization came during the Carter Administration as the Childhood Immunization Initiative. Rather than relying on the federal government to immunize children, Carter used celebrities, PTAs, corporate leaders, and governors to force states to tighten their vaccination laws combined with parental education campaigns to push vaccination rates up. It was a cost-saving measure that Conis asserts reflected the general philosophy of Carter and his administration, which favored decentralized control over medicine and a reduced federal presence (88).
Carter’s initiative also reflected changing American concerns with healthcare. Health care costs were rising precipitously. In Carter’s view, a major part of the problem was that few Americans seriously tried to prevent serious diseases before they happened. Responsible parents needed to be active in protecting their children with immunization. Pushing vaccination as a way to keep health care costs low was a less-expensive way to tackle the larger problem. Carter’s initiative was the high-water mark of public confidence in vaccination, and by 1980 96% of children were being immunized against measles, mumps, rubella, pertussis, and other diseases. At the same time, several disparate cultural movements posed new challenges to public confidence in vaccination.
Second-wave feminism was one such movement. As caregivers, women traditionally bore the burden of overseeing vaccinations. Yet second-wave feminism challenged the patriarchal nature of medicine by trying to give women agency over women’s health issues (114). Magazines such as Mothering urged women to be cautious with the measles vaccine, for example, because the vaccine could sicken those allergic to eggs. When women expressed concerns about complications from the pertussis vaccine, doctors brushed them aside. The effect was that women increasingly questioned the utility of vaccinations, especially in their role as a responsible parent.
The burgeoning environmental movement also posed a challenge, as environmental concerns clashed with the scientific triumphalism of the 1960s. Even in the nineteenth century, some people had feared that vaccines transmitted poisons or animal matter into the human body (133). Rachel Carson’s Silent Spring ushered in new fears of radiation and heavy metals in the environment, and critics of vaccination would frequently compare vaccines with environmental pollutants. By the early 1990s, authors such as Harris Coulter were proposing that vaccinations were responsible for psychiatric disturbances, including the behavior of serial killer Ted Bundy (148). In the view of environmentalists, nature had an intrinsic value, and it was better to let nature run its course with diseases like the chicken pox.
The hepatitis B vaccine was developed in 1982, largely to immunize health care workers. At that time, the disease barely existed in the public imagination (182). Yet concern about the disease grew throughout the ‘90s, and officials hoped to vaccinate schoolchildren to eradicate the disease. The vaccinations proved to be deeply divisive and set off fears over the vaccines’ safety and the moral imperative to vaccinate children for a disease spread by “adult” behavior.
In the early 2000s, vaccine-safety advocates stoked fears that vaccines were causing autism. While the evidence was widely debunked by scientists, news media seized on one aspect of the story: the misinformed, irrational parent who refused to get their kids vaccinated (223). This perspective greatly oversimplified the debate, Conis argues, by eliminating any discussion around side-effects from vaccination or dealing with barriers created by poverty and the health care system.
The author ends the book with a discussion of the human papillomavirus (HPV) vaccine. HPV went from being a disease that only a few people had heard of to a leading cause of cervical cancer. The vaccine sparked a large debate over the vaccination of school-age girls, ranging from concerns over teenage sexuality to safety concerns as well as intrusion by public health officials. Teenaged girls also had a voice in this discussion, as emerging social media meant that adolescents could offer their own insights.
The book is about two separate but connected narratives: the development of various vaccines and the creation of a public forum in which they can be debated. At the start of the book, scientists and politicians effectively own and control the debate. Some figures on the political fringe question the efficacy or use of vaccines, but their voices are largely discounted. By the end of the book, public opinion is an essential part of policy, and policy is consistently framed around what is “responsible parenthood.” As more voices entered the debate, what exactly made a responsible parent became a heavily debated and divisive topic.
AIDS and the failure to create an AIDS vaccine is strangely absent from this narrative and would have been interesting to use in examining the public attitudes toward vaccination. Much of the book is about the public’s increasing distrust of expert advice. The AIDS epidemic in the 1980s was made worse by a delayed federal response as well as the failure to develop a vaccine, which has fed into popular distrust of public health officials. Nevertheless, this is an interesting and engaging book, one which presents a balanced portrait of debates about vaccines without leaving behind the perspective of scientists and doctors.