Copyright 2011 by Elena Conis ii Acknowledgements Portions of Chapter 6 appeared in the Journal of Medical Humanities 32, no. 2 (2011): 155-166. iii Abstract Calling the Shots: A Social History of Vaccination in the U.S., 1962 – 2008 Elena Conis In two centuries of vaccination in the U.S., the last five decades constituted a unique era. American children received more vaccines than any previous generation, and laws requiring their immunization against a litany of diseases became common. Vaccination rates soared, preventable infections plummeted, and popular acceptance of vaccines remained strong—even as an increasingly vocal cross-section of Americans questioned the safety and necessity of vaccines and the wisdom of related policies. This dissertation examines how and why, between the 1960s and 2000s, Americans came to accept the state–mandated vaccination of all children against a growing number of infections despite the growing prominence of vaccine doubts. I argue that vaccines and vaccine policies fundamentally changed the ways health experts and lay Americans perceived the diseases they were designed to prevent. Second, I demonstrate that vaccination policies and their acceptance throughout this period were as contingent on political, social, and cultural concerns as they were on scientific findings. Thirdly, I show how, as new vaccine policies took shape, feminism, environmentalism, and other social movements laid challenge to scientific and governmental authority, with profound—but previously overlooked—implications for how Americans perceived vaccination. Finally, I argue that the relationship between vaccination beliefs and political ideology is more complex than historians have heretofore asserted, for selective and blanket vaccination doubts at the end of the twentieth century were as informed by leftist critiques of iv capitalism and social hegemonies as by traditional American libertarian ethics. This work draws on a diverse set of sources, including presidential archives; government agency records and publications; popular and scientific print media; television broadcasts; newsletters; internet archives; documents and publications at chiropractic libraries; and the personal files of vaccine scientists and critics. It contributes to the histories of disease, women, the environment, and health politics, as well as the sociology of social movements. By placing public health knowledge in historical context, this dissertation illuminates the many meanings of vaccination that lay between that of gold-standard disease preventive and hotly contested enterprise at the end of the twentieth century and the beginning of the twenty-first. v Table of Contents Introduction 1 Chapter 1 When is One Case Too Many? The Federal Government and Disease Prevention Through Vaccination, 1900-1968 26 Chapter 2 “How Serious Is Mumps?” Vaccination and the Framing of a Childhood Disease 77 Chapter 3 A Shot at Reform Jimmy Carter, Bill Clinton, and the Immunization of Children 121 Chapter 4 A Mother’s Responsibility Women and Vaccine Skepticism 168 Chapter 5 “Something About Tampering with Nature…” Environmental Ethics and Vaccine Resistance 213 Chapter 6 “Do We Really Need Hepatitis B on the Second Day of Life?” Vaccine Acceptance at the End of the Twentieth Century 266 Conclusion 317 vi Introduction Late in 2005, the Boston Globe magazine featured an article about Marjorie and Jared Hansen, a Utah couple who said they had always describe themselves as “very pro- vaccine”—until two of their four children were diagnosed with autism. The diagnosis prompted the Hansens to conduct their own research into autism treatments and theories of causation. In the process, they learned that thimerosal, a mercury-based preservative, had been present in the vaccines their children had received. Thimerosal was removed from vaccines beginning in 1999, and countless studies and scientific reviews failed to turn up evidence of a link between thimerosal and autism. But that didn’t matter to Jared Hansen, a former research chemist who said he was “incensed” when he learned that thimerosal had been in his children’s vaccines, because he recalled treating mercury as carefully as radioactive materials when he was a student. Their faith in official recommendations shaken, the Hansens decided to conduct their own risk-benefit calculations on the recommended vaccines for their children. They concluded that shots against hepatitis B, flu, chicken pox, and pneumococcus weren’t worth getting, since in their assessment the infections either posed little risk to children or were rarely deadly. But they continued to vaccinate their children against other infections, including polio, diphtheria, pertussis, tetanus, measles, rubella, and mumps.1 The author of the article in the Globe, pediatric cardiologist Darshak Sanghavi, condemned the Hansens for committing “an ancient error” by concluding, based on personal experience, that the mercury in vaccines could have caused their children’s 1 Darshak Sanghavi, "The Secret Truth," The Boston Globe Magazine, December 4, 2005, 42. 1 autism. Sanghavi called the Hansens loving, devoted parents, but then accused them of failing to be “truly scientific and objective.” Their case convinced Sanghavi that policies making vaccines mandatory for children were wise, since “sometimes, personal freedom can be a dangerous thing.”2 In a follow-up letter to the editor, Jared Hansen asked that “parents like us” not be summarily dismissed as “unreasonable” and “dangerous,” and listed his own demands of the medical profession: “Your patients are not ‘the herd,’ but individuals. When doctors stop asking ‘Has this child been vaccinated?’ and begin asking ‘Should this child be vaccinated?’ they will again be healers we can trust with the health of our children.”3 The dispute between Sanghavi and the Hansens was emblematic of the polarized debate over vaccination that was increasingly featured on talk shows, magazine covers, and headlines in both the popular and scientific press in the first decade of the twenty- first century. Much as it was popular fodder for the media, this debate also drew scrutiny from both scientists and scholars of the medical humanities.4 But all of this attention has come at the expense of a more nuanced understanding of the myriad factors influencing Americans’ attitudes toward vaccines and vaccine policies. While polarized, the debate over vaccines is not easily defined as one that pits pro-vaccine forces against anti- vaccinators. As the Hansens’ story shows, attitudes and beliefs toward vaccination in 2 Ibid. 3 Jared Hansen, "Letters: Vaccines and Autism," The Boston Globe Magazine, January 1, 2006, 6. 4 Sanghavi’s own article is an illustration of this trend. See also James Colgrove and Ronald Bayer, "Could It Happen Here? Vaccine Risk Controversies and the Specter of Derailment," Health Affairs 24, no. 3 (2005): 729-739; Howard Markel, "Life, Liberty and the Pursuit of Vaccines," New York Times, March 1, 2011, D5; Robert Johnston, "Contemporary Anti-Vaccination Movements in Historical Perspective," in The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America, ed. Robert Johnston (New York: Routledge, 2004), 259-286. 2 modern America are far more complex, involving doctors and health officials who sympathize with skeptical parents to different degrees, and parents (as well as others) who question individual vaccines to varying extents. More importantly, however, this debate is only one small piece of the larger story of vaccines and American culture, politics, and society at the end of the twentieth century and the beginning of the twenty-first. It is this larger story, with all of its complexities and nuances, that this dissertation analyzes, by examining the myriad factors shaping vaccination policies and reception from the 1960s to the early 2000s. This work is driven by two overarching research questions: First, how and why did the universal vaccination of children against a list of diseases ranging in severity become such a widely accepted political, social, and cultural norm in this period? And second, what forces gave rise and shape to the vaccine doubts whose pervasiveness gradually increased in this period? A New Era of Vaccination This dissertation focuses on the social history of vaccination in the U.S. from the 1960s to the early 2000s because, as I argue in the opening chapters, these five decades constituted a unique era in the more than two centuries of vaccination in the U.S. During this time period, the federal government assumed, for the first time, a prominent and authoritative role in the area of vaccination policy and practice. As their authority was consolidated, federal health officials began a push for universal vaccination against what they called the “milder” diseases, including measles, mumps, and rubella—which (in the 1960s at least) were viewed as less severe than polio, smallpox, and diphtheria, the previous targets of mass vaccination campaigns. This push was accomplished largely 3 through the vaccination of children, even when this meant vaccinating children against infections that posed a greater threat to other members of the population (as rubella did to pregnant women, or mumps did to adolescent males and grown men). To a significant extent, the mass vaccination of children was realized through the adoption and strengthening of a patchwork of laws at the state level, which made vaccines mandatory for school enrollment.5 The ease with which such