Thanks to all those shots in the arm, in the year 2000, measles in the United States was declared eliminated. But now, it’s coming back, with measles cases reported from California to Vermont.

One big reason: across the country in 2023, more families exempted their children from routine immunizations than ever before.

“There’s never been a better time in human history to tackle an infectious disease than today,” said Dr. Howard Markel, a medical historian, retired from the University of Michigan. “There’s so many things we can do, from vaccines to antivirals to antibiotics. And yet, I am dumbfounded by the volume of anti-vax voices.”

History of vaccine hesitancy

Markel says vaccine hesitancy is as old as the United States. In the 1700s, when smallpox was ravaging the colonies, some people were given an early form of immunization called variolation. “You went to a doctor who had this infectious material – dried pus and detritus of smallpox scars and so on,” Markel said. “They would cut you open, make a slice of your arm, and inoculate – ‘put it in’ – your arm. And half of the people got really sick, and some of them died. So, it cost a lot and it was dangerous.”

But the people who recovered were immune.

Benjamin Franklin decided it was too dangerous for his sickly four-year-old son, Franky. “One of Franklin’s great regrets was that he did not get his son inoculated, instilled with smallpox virus, to prevent what ultimately killed him,” Markel said.

In the 1800s, as a much safer smallpox vaccine was developed, many cities and states started requiring smallpox vaccination. At the University of California at Berkeley in 1902, it was mandatory.

Students were up in arms about it, said professor Elena Conis, a medical historian at Berkeley. “And people in town cheered them on.

In 1905, the Supreme Court ruled the government has the authority to require vaccination. “This, importantly, had the effect of energizing a lot of anti-vaccine groups,” said Conis. “And the anti-vaccine groups at the time believed that they were defenders of individual liberty.”

Victory over polio

But by the 1950s, there was one thing that united Americans: their fear of polio. Markel said, “The idea that your child would be paralyzed or, worse, condemned to an iron lung, this giant tank where your head’s sticking out and that’s how you breathe for the rest of your life, that terrified people.”

When Dr. Jonas Salk invented the polio vaccine, he was considered a hero. “The greatest faith probably ever in the American medical-industrial complex was around the 1950s,” said Markel. “And here you had this photogenic Jonas Salk with his wife and his children, and they saved the world.”

The 1950s might be considered the high-water mark of vaccine acceptance. Vaccines were then developed for diseases including measles, mumps, and rubella. As Americans, especially children, got their shots, rates for those diseases plummeted.

But it all ran straight into the counterculture decade of the 1960s. Conis said, “As more and more doctors and public health officials were encouraging people to get vaccinated, or encouraging their children to get vaccinated, people were saying, ‘But hold on: I need to ask questions. What are these vaccines for? Who made them? What’s in them? And why are they necessary? Can you tell me that?'”

The overwhelming medical consensus is that the benefits of vaccines have far outweighed the risks. But an upsurge in the anti-vaccine movement was fueled by a 1998 study in the prestigious British journal The Lancet that falsely linked the measles vaccine with autism.

It took 12 years for the journal to retract the study after concluding the research was fraudulent.

Vaccine advocacy, and dissenting voices

Dr. Peter Hotez has worked for decades to develop vaccines at the Baylor College of Medicine and Texas Children’s Hospital. “If you asked me 40 years ago would I ever have to be defending vaccines like I do now, I’d say you’re crazy,” he said. “Everybody knows the life-saving impact of vaccination.”

One study estimated that by the end of 2022, the COVID vaccine had saved more than three million American lives. And according to Hotez, “We reached that level of 200,000 Americans needlessly dying because they refused the COVID vaccine.”

Hotez entered the public debate as a passionate advocate for vaccines, and become a bit of a lightning-rod, telling an audience at Northwestern University in Chicago, “I’m worried there’s a full-on frontal assault on biomedical science. … When we talk about anti-vaccine, anti-science movements, we call it misinformation or info-demic, as though it’s just some random junk out there on the internet. And it’s not. I want to convince you today that it’s organized, it’s deliberate, it’s politically motivated, and it’s having a devastating impact.”

With public figures like former presidential candidate Robert F. Kennedy Jr. vocalizing vaccine skepticism, Hotez believes politics has turbocharged historical reasons for resisting vaccines. 

Asked why somebody would want somebody else not to be vaccinated, Hotez replied, “It’s a form of political control. And it’s a part of creating another issue to galvanize their base.”

Conis was asked if she were concerned about where vaccines are right now in terms of the public: “What I will say is that I’m not at all surprised. We’ve been here, in some respects, before. Vaccination resistance bubbles up when we use more vaccines, and when we use more of the force of law to encourage or require vaccination. When I hear arguments, and when I hear frustration that people aren’t getting vaccinated – how can they not understand? – my response is, ‘Let’s try to understand their distrust, let’s try to understand their concerns, and let’s take them seriously.'”

But as we try to benefit from the lessons of history, Hotez warns the clock is ticking: “The things that we’re talking about today, like COVID-19, H5N1, they’re the warmup acts. You know, Mother Nature’s not being coy with us, right? She’s telling us, ‘I’m going to throw a major pandemic at you every few years, and you better get ready. And by the way, you better convince your population to accept vaccines. Otherwise, the devastation is going to be unprecedented.'”

      
For more info:

• Medical historian and pediatrician Dr. Howard Markel
• “Origin Story: The Trials of Charles Darwin” by Howard Markel (W.W. Norton & Co.), in Hardcover, eBook and Audio formats, available via Amazon, Barnes & Noble and Bookshop.org
• Elena Conis, historian of medicine, public health, and the environment, University of California, Berkeley
• “Vaccine Nation: America’s Changing Relationship with Immunization” by Elena Conis (University of Chicago Press), in Hardcover, Trade Paperback, eBook and Audio formats, available via Amazon, Barnes & Noble and Bookshop.org
• Dr. Peter Jay Hotez, Baylor College of Medicine and Texas Children’s Hospital
• “The Deadly Rise of Anti-science: A Scientist’s Warning” by Peter J. Hotez (Johns Hopkins University Press), in Hardcover, Trade Paperback and eBook formats, available via Amazon, Barnes & Noble and Bookshop.org

     
Story produced by Alan Golds and Amiel Weisfogel. Editor: Remington Korper. 

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