Deadly Choices: How the Anti-Vaccine Movement Threatens Us All

by Paul A. Offit M. D.

  Marketing strategy: Protesters in nineteenth-century England had no trouble labeling themselves anti-vaccine. Indeed, most organized anti-vaccine groups included the word anti-vaccination in their names. Today, however, anti-vaccine activists go out of their way to claim that they are not anti-vaccine; they’re pro-vaccine. They just want vaccines to be safer. This is a much softer, less radical, more tolerable message, allowing them greater access to the media. However, because anti-vaccine activists today define safe as free from side effects such as autism, learning disabilities, attention deficit disorder, multiple sclerosis, diabetes, strokes, heart attacks, and blood clots—conditions that aren’t caused by vaccines—safer vaccines, using their definition, can never be made.

  In 1898, the British government finally gave in, appeasing angry citizens by passing a conscientious-objection law. People who didn’t want to get a vaccine didn’t have to. (The term conscientious objector , born of England’s anti-vaccine movement, was later applied to those who refused to fight in World War I and subsequent wars.) Within a year, the government issued more than two hundred thousand certificates of conscientious objection. By the late 1890s, vaccination rates had plummeted. In Leicester 80 percent of babies were unvaccinated; in Bedfordshire, 79 percent; in Northamptonshire, 69 percent; in Nottinghamshire, 50 percent; and in Derbyshire, 48 percent. Anti-vaccine forces in England had won the day. In Ireland and Scotland, on the other hand, no such movement existed. No anti-vaccine groups were formed, no anti-vaccine pamphlets were produced, and citizens readily accepted vaccination. While vaccination rates in England fell, those in Scotland and Ireland rose. As a result, England became Europe’s epicenter of smallpox disease and death.

  For anti-vaccine activists in England, the freedom to choose had become the freedom to die from that choice. As in nineteenth-century England, the battle to eliminate vaccine mandates in twenty-first-century America would also be fought in legislatures and court-rooms. And the results would be all too similar.

  CHAPTER 8

  Tragedy of the Commons

  Freedom is the recognition of necessity.

  —GEORG WILHELM FRIEDRICH HEGEL

  Parents in nineteenth-century England argued that vaccines were impure or unsafe or an act against nature or God. But their anger wasn’t directed at doctors so much as at government officials who had no right to tell them what to do—no right to tell them what should be injected into their children. To protesters, compulsory vaccination was an intolerable violation of their civil liberties.

  In America, the response to state-mandated vaccines was no different. Indeed, one citizen’s fight went all the way to the Supreme Court. The ruling in that case—called “the most important Supreme Court case in the history of American public health”—has been cited in seventy Supreme Court verdicts and, for more than a century, has determined whether states can force parents to vaccinate their children.

  It started with a Lutheran minister in Massachusetts.

  In May 1899, a case of smallpox occurred in the city of Swamp-scott, twelve miles outside Boston. By summer, several more cases appeared in Everett and Charlestown, just across the Charles River. By 1901, more than two hundred Bostonians had fallen victim to the disease. In response, the Cambridge Board of Health proclaimed: “Whereas, smallpox has been prevalent in this city of Cambridge and has continued to increase; and whereas it is necessary for the speedy extermination of the disease; be it ordered that all inhabitants of the city be vaccinated.” Citizens who refused were fined $5.00. By early 1902, more than 485,000 had been vaccinated. The Boston Daily Globe declared, “There is a greater demand for vaccination in Boston than there is for salvation, even though both are free.” In 1903, when the epidemic ended, smallpox had infected sixteen hundred people and killed almost three hundred. If city health officials hadn’t acted, the toll would have been much greater.

  Not everyone embraced the city’s mandate. On March 15, 1902, Dr. Edwin Spencer visited the home of Henning Jacobson and offered to vaccinate him. Jacobson refused—then he refused to pay the fine.

  Henning Jacobson was born in Sweden in 1856, coming to the United States when he was thirteen years old. In 1882, while a student at a Lutheran college in Minnesota, Jacobson married Hattie Alexander and together they had five children. In 1893, the Church of Sweden Mission Board asked him to found a Lutheran church in Cambridge, Massachusetts. A pious man, charismatic orator, and community organizer, Jacobson was devoted to his congregants; his fundamental belief that God would protect him was at the heart of his refusal to vaccinate.

  In July 1902, Jacobson was tried before a Middlesex county district court. After a jury found him guilty, Jacobson appealed to the county’s superior court, which, in February 1903, upheld the conviction. Undeterred, Jacobson appealed to the state supreme court. This time, two well-known lawyers represented him: Henry Ballard of Vermont and James Pickering, a Harvard-trained lawyer who would later win fame as the oldest U.S. soldier in World War I. Given their fees and his meager pastor’s salary, Jacobson’s choice of Ballard and Pickering was surprising. But Pickering lived only a few blocks from Immanuel Pfeiffer, a leader of Boston’s Anti-Vaccination League. It was Pfeiffer who had convinced Pickering to take the case.

  Pickering and Ballard argued that the state had violated Jacobson’s civil rights: “Can the free citizen of Massachusetts, who is not yet a pagan, not an idolator, be compelled to undergo this rite and to participate in this new—no, revised—form of worship of the Sacred Cow?” Again, Jacobson lost. So he took his case to the highest court in the land. On June 29, 1903, the United States Supreme Court added Jacobson v. Massachusetts to its docket. This time Jacobson chose George Williams, a former congressman from Massachusetts, to represent him. Williams argued that Massachusetts, by requiring vaccination, had violated the Fourteenth Amendment—specifically, that no state could deprive any person of life, liberty, or property without due process of law. Williams’s legal brief stated, “A compulsory vaccination law is unreasonable, arbitrary, and oppressive, and, therefore, hostile to the inherent right of every freeman to care for his own body and health in such a way as to him seems best.” Williams also argued that vaccines were unconscionably dangerous: “We have on our statute book a law that compels ... a man to offer up his body to pollution and filth and disease; that compels him to submit to a barbarous ceremonial of blood-poisoning, and virtually to say to a sick calf, ‘Thou art my savior; in thee I do trust.’”

  Henning Jacobson was at the center of a landmark U.S. Supreme Court ruling on the right of citizens to resist vaccination. (Courtesy of the Evangelical Lutheran Church in America Archives.)

  On February 20, 1905, the Supreme Court—by a vote of 7 to 2—ruled that the right to refuse vaccination wasn’t guaranteed by the U.S. Constitution. Writing for the majority, Justice John Marshall Harlan argued that, in the arena of public health, societal good trumped individual freedom: “The liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right to each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. Society based on the rule that each one is a law unto himself would soon be confronted with disorder and anarchy.” Harlan described the Cambridge Board of Health law compelling vaccination as a “fundamental principle of the social compact that the whole people covenants with each citizen, and each citizen with the whole people.”

  Jacobson v. Massachusetts wasn’t the only time the Supreme Court considered a state’s right to mandate vaccines. Seventeen years later, in 1922, officials from Brackenridge High School in San Antonio, Texas, expelled fifteen-year-old Rosalyn Zucht because her parents refused to vaccinate her. Unlike Boston in the early 1900s, San Antonio wasn’t in the midst of a smallpox epidemic. But that didn’t matter. In a unanimous decision the court ruled that Rosalyn’s expulsion didn’t violate her constitutional rig
hts.

  The rulings in Jacobson and Zucht gave states the right to enforce vaccination. But they didn’t set limits on how far public health officials could go. In some states, for example, parents could be criminally prosecuted. But the event that probably worried antivaccine activists more than any other occurred in New York City in 1909. One health officer involved in the case later said, “There is very little that a Board of Health cannot do in the way of interfering with personal and property rights for the protection of public health.” The officer was referring to the strange case of Mary Mallon.

  Mary Mallon was born in Ireland on September 23, 1869, immigrating as a teenager to the United States, where she became a cook for wealthy New Yorkers. In 1906, Mallon was working on Oyster Point, Long Island, for a New York City banker named Charles Warren. Warren had rented the house on Oyster Point from George Thompson. That summer, six people in Warren’s family were struck down by typhoid fever.

  At the turn of the twentieth century, typhoid fever was a well-recognized problem, infecting as many as thirty-five thousand Americans every year. The disease is caused by the bacterium Salmonella typhi, which at that time regularly contaminated food and water. Typically, victims had fever, headache, and malaise followed by chills, loss of appetite, and a rash on the chest and abdomen. After the rash disappeared, people often got sicker, with severe cramping and weight loss and, in some cases, decreased blood pressure and shock. One in ten died from the disease.

  When Thompson found that half of Warren’s family had contracted typhoid fever, he hired George Soper, a sanitary engineer, to find the source. Soper did his homework, uncovering a series of outbreaks similar to the one on Oyster Point. He found one case in 1900 on Long Island; another in 1901 in New York City; seven in 1902 in Dark Harbor, Maine; four in 1904 among servants in Sands Point, New York; and three in 1906: one in Tuxedo Park, New York, and two on Park Avenue in New York City. All these outbreaks had one thing in common: Mary Mallon was the cook. Twenty-two people had been infected; two had died. When Soper was investigating the outbreaks, Salmonella typhi was known to contaminate food. But when cooks spread the disease, they were always sick as well. Mallon, on the other hand, had no symptoms of the illness. Indeed, Mary Mallon was the first person in North America found to be a healthy carrier of Salmonella typhi.

  After Soper identified Mallon as the likely source of the Warren family outbreak, he wanted to prove it. “I had my first talk with Mary in the kitchen,” he recalled. “I was as diplomatic as possible, but I had to say I suspected her of making people sick and that I wanted specimens of her urine, feces, and blood. It did not take Mary long to react to this suggestion. She seized a carving fork and advanced in my direction.” Eventually, Soper gave up, leaving the task of collecting specimens to Josephine Baker, a New York City public health official. On March 19, 1907, Baker, accompanied by a police officer, visited Mary Mallon. “She came out fighting and swearing,” recalled Baker, “both of which she could do with appalling efficiency and vigor. There was nothing I could do but take her with us. The policeman lifted her into the ambulance and I literally sat on her all the way to the hospital; it was like being in a cage with an angry lion.” Baker took Mallon to the Willard Parker Hospital, then to New York’s receiving unit for contagious diseases. There, microbiologists found that her feces were teeming with typhoid bacilli. Immediately, Baker sent Mallon to North Brother Island in the East River, where she lived in a small bungalow, alone, cooking for herself. Mallon didn’t understand her incarceration. “I never had typhoid in my life,” she said, “and have always been healthy. Why should I be banished like a leper and compelled to live in solitary confinement with only a dog for a companion?” Three years later, health authorities released Mallon after she promised she would no longer work as a cook. The press dubbed her “Typhoid Mary.”

  Mary Mallon (left), “Typhoid Mary,” the first person in the United States identified as a carrier of typhoid bacilli, was confined on North Brother Island from 1907 to 1910 and then from 1915 until her death in 1938. (Courtesy of Bettmann/Corbis.)

  In 1915, an outbreak of typhoid fever occurred at Sloane Maternity Hospital in New York City. Twenty-five doctors, nurses, and hospital staff were infected and two died. Investigators traced the source of the epidemic to Mrs. Brown, a cook who had been employed three months earlier. It didn’t take long for health officials to realize that Mrs. Brown was Mary Mallon. “Whatever rights she once possessed as the innocent victim of an infected condition were now lost,” said George Soper. “She was now a woman who could not claim innocence. She was known willfully and deliberately to have taken desperate chances with human life. She had abused her privilege; she had broken her parole. She was a dangerous character and must be treated accordingly.” On March 26, 1915, state health officials again sent Mary Mallon to North Brother Island, where she remained for the rest of her life, dying of a stroke on November 11, 1938. Mallon had spent twenty-six of her sixty-nine years quarantined as a carrier of Salmonella typhi, never having exhibited a single symptom of the disease.

  American anti-vaccine activists watched what had happened to Mary Mallon—and it scared them. They wondered just how far public health officials would go in their quest to vaccinate children.

  Following the Supreme Court’s decision in Jacobson v. Massachusetts, an editorial appeared in the New York Times: “The contention that compulsory vaccination is an infraction of personal liberty and an unconstitutional interference with the right of the individual to have the smallpox if he wants it, and to communicate it to others, has been ended. [This] should end the useful life of the societies of cranks formed to resist the operation of laws relative to vaccination. Their occupation is gone.” The prediction couldn’t have been more wrong. Anti-vaccine activism in the United States was just getting started.

  In 1894, in response to a smallpox outbreak in Brooklyn, the Board of Health ordered Charles McCauley, his wife, and son to be vaccinated. They refused, the elder McCauley threatening the visiting doctor with a rifle. In response, the McCauleys were quarantined; two policemen stood at their door. The New York Times reported the incident: “They were forbidden to leave the apartment, and the other tenants were warned, under penalty of arrest, not to deliver any messages to them. The grocers, butchers, and bakers in the vicinity were also forbidden to deliver provisions.” The next day, police found a two-foot hole in a closet through which the family had escaped, eventually making it to Hoboken, New Jersey. Three days later, after public health officers convinced the McCauleys they had nothing to fear from the procedure, they surrendered to the Brooklyn police and were vaccinated.

  In the late 1890s, incidents similar to that of the McCauleys spawned anti-vaccine groups like the Brooklyn Compulsory Anti-Vaccination League and the Massachusetts Compulsory Anti-Vaccination Association. Local leagues became national organizations. In 1908, two wealthy businessmen, John Pitcairn and Charles Higgins, founded the Anti-Vaccination League of America, a coalition of many smaller groups. Pitcairn declared, “We have repudiated religious tyranny; we have rejected political tyranny; shall we now submit to medical tyranny?” Pitcairn was the orator; Higgins the pamphleteer, producing Open Your Eyes Wide! (1912), The Crime Against the School Child (1915), Vaccinations and Lockjaw: The Assassins of the Blood (1916), and Horrors of Vaccination Exposed and Illustrated (1920). One of the most active anti-vaccine groups was the Citizens’ Medical Reference Bureau. Founded in New York City in 1919, the group produced the popular pamphlet The Facts Against Compulsory Vaccination: It’s the School and Not the Child That Is Public.

  But of all the anti-vaccine activists at the turn of the century, the most vocal, most passionate, and most irascible was Lora Little, founder of the American Medical Liberty League. Little was moved to action by the death of her son, Kenneth, following a smallpox vaccine. Although the child had actually died from measles and diphtheria, Little was convinced that vaccination was the cause. Like Barbara Loe Fisher, Lora Little believed
that doctors and health officials were all part of a conspiracy to sell vaccines. In her pamphlet, Crimes of the Cowpox Ring, Little sounded themes of antivaccine activists past and future: “The salaries of the public health officials in this country reach the sum of $14,000,000 annually. One important function of the health boards is vaccination. Without smallpox scares their trade would languish. Thousands of doctors in private practice are also beneficiaries in ‘scare’ times. And lastly, the vaccine ‘farmers’ represent a capital of $20,000,000 invested in their foul business.”

  The Raggedy Ann doll was created in part to represent children permanently harmed by vaccines. (Courtesy of Lambert/Getty Images.)

  Anti-vaccine activity in America also produced a popular icon. In 1915, Johnny Gruelle, a cartoonist and illustrator in New York City, watched his daughter, Marcella, die following a smallpox vaccine. Even though the medical report stated that the child had died from a heart defect, Gruelle blamed the vaccine. In his daughter’s memory, he created a doll with red yarn for hair and floppy arms and legs—a symbol of children harmed by vaccines. He called it Raggedy Ann.