“One might suppose that the popular prejudice against vaccination had died out by this time,” one writer complains. It sounds like a lament from today, but in fact, it’s from 1875. Anti-vaxxers may seem like a product of our fake-news, health-hysteria modern times, but the fear that propels these skeptics is as old as the vaccine itself. How has modern medicine not shaken generations’ worth of suspicion and fear? We go back to look at two pivotal moments — the birth of the vaccine and a 1905 Supreme Court case — to understand what still motivates the anti-vaxxers of today.
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Jason Feifer: This is Pessimists Archive. I'm Jason Feifer. In the year 1900, Massachusetts was introduced to a local man that they would be hearing quite a lot about in the coming years. His name was Dr. Immanuel Pfeiffer, on March 3rd, 1900, a story appears in the Boston daily globe, headlined "Experimental Fasting". And then it goes on to report that.
Voice Clip (Boston Daily Globe): Dr.Immanuel Pfeiffer of the city announces that in a week or so, he will begin a series of fasts. The first one to be for a period of 21 days, this will be followed by longer periods until he reaches what he believes is the limit of human power to go without food of any kind, which he holds to be 60. He will do this to emphasize his conviction, that people eat too much for their wellbeing and to study the effects of fasting on the mind.
Jason Feifer: Whether any of that is true or what even happened with the fast. I just can't tell, but six months later on June 22nd, 1900, this advertisement appeared in the Boston daily globe.
Voice Clip (New York Times): Wonderful, but true are the records of cures performed by a Immanuel Pfeiffer, MD, the renowned natural healer and apostle of health, who in March of this year, fasted for 21 days in the interest of science. He successfully treats all kinds of chronic diseases by the simple laying on of hands after having been pronounced incurable by regular physicians.
Jason Feifer: Ah, so we learned two things here. One, that whole thing about fasting up to 60 days was a lot of big talk. Two, Immanuel Pfeiffer was a quack who understood the power of a publicity stunt. Now let's set aside Dr. Pfeiffer for a moment, and let me tell you about what happens roughly one year later. In May of 1901, smallpox breaks out in Boston. By that fall, the city's board of health pulls together a plan, which basically goes like this quarantine everyone with smallpox, either in a hospital or in a facility on nearby Gallup's island and encourage everyone locally to get vaccinated. By the end of the year, about 400,000 people are vaccinated, but it isn't enough to stop the crisis. The efforts are being hampered by a group of very, very vocal anti-vaxxers who are claiming that vaccinations are dangerous and don't work and that nobody can tell them what to do. So in November of 1901, the chairman of the Boston Hoard of Health just has had enough of this. He throws down the gauntlet and issues. The following challenge,
Voice Clip (New York Times): "If there are among the adult and leading members of the antivaccinationist. Any who would like an opportunity to show the people, their sincerity and what they profess. I will make arrangements by which that belief may be tested and the effects of such exhibition of faith by exposure to smallpox, without vaccination be made clear."
Jason Feifer: In other words, "Hey, anti-vaxxer do you think vaccinations are pointless, then come expose yourself to smallpox and let's see what happens." Boom, perhaps unsurprisingly, nobody steps forward. The Hoard of Health, figuring that their point had been made soon begins a program of mandatory vaccinations. Physicians would go door to door throughout the city offering smallpox vaccinations. Nobody will be physically pinned down for a vaccine, but if somebody does say no, there'll be fined $5, which is about $100 in today's dollars and might be subjected to 15 days in jail, which ain't nothing. Mandatory vaccines begin in December, then the next month in January of 1902, a man steps forward to take up the Board of Health challenge.
Jason Feifer: He is not vaccinated. He doesn't believe in vaccinations and he will willingly expose himself to smallpox. In fact, he wants to tour the Gallup's Island smallpox facility, where all the sick people were shipped off to. Who is this man? This brave, possibly insane, man. Who's willing to risk his life to make a point. You guessed it. His name is Immanuel Pfeiffer and the Board of Health says, sure, we'll give you a tour. Come on right this way.
Jason Feifer: Okay. Before we go any further, let's talk present day for a moment. What this episode is about, currently we're in, I think it's fair to say a boom time for anti-vaxxers. Although there is absolute medical consensus that vaccines are safe and save lives. I just can't stress that enough. Donald Trump has embraced long discredited theories, linking vaccines to autism. Measles has repeatedly broken out among unvaccinated people in Minnesota. There was even an anti-vaccine March in Washington. All of this is of course troubling, globally vaccines prevent the deaths of about 2.5 million children every year. Here's a doctor on Jimmy Kimmel venting about this.
Voice Clip (Jimmy Kimmel): Hey, remember that time you got polio? No you don't because your parents got you vaccinate.
Jason Feifer: This is not a science show. So I will leave making the case to other more qualified people. I just hope you're making the right choice. At Pessimists Archive, we look back at the origins of fears of innovation to the moment something new is introduced so that we can try to understand where a fear came from and why it continues. That is what we're doing today. Throughout this episode, by the way, our archival materials are being read by my old pal, Mike Darling, the managing editor of Vice's new site about medical science and health, it's called Tonic. They describe it as real wellness advice for imperfect humans. Which is pretty perfect for our subject today because the history of vaccinations is very much a history of real wellness and imperfect humans, and so is the fight we still must endure about it. Anti-vaccine actually fits really neatly among every other fear we've covered on this show, which is to say it repeats itself across time.
Jason Feifer: We may say now, like I cannot believe that we're still arguing about this subject, but they were saying the exact same thing more than 100 years ago. In 1875, in the New York times under the headline and absurd prejudice, a writer opens by saying, "one might suppose that the popular prejudice against vaccination had died out by this time, considering that it has been practiced for nearly a century". That was in again 1875. So let's go back further and then work our way forward. Smallpox has terrorized humanity for thousands of years, possibly tens of thousands of years.
Jason Feifer: Egyptian, Pharaoh Ramses the fifth who died in 1156 BCE appears to have had it. The disease is an absolute horror with fluid filled blisters across people's entire bodies and fever and pain and vomiting. The more common form of the disease had a mortality rate of 30%. By the 17 hundreds in Europe, about 400,000 people were dying annually of smallpox and one third of the survivors went blind. For much of this time. People didn't have a great understanding of how the body worked or how to develop medical cures, but they did realize that if someone survived smallpox, they didn't get it again. So that led to a process called inoculation, which basically meant intentionally infect people with.
Karie Youngdahl: The idea was to use a soar from a person with a very mild case of the disease. Then you would use the liquid from that sore or in certain places, they would dry the scab from the soar and then pulverize the scab and use it as a powder to either make into a paste to scratch into someone's arm or even in, in some places to inhale. So you could inhale the scab powder.
Jason Feifer: So hey, aren't you glad you're alive today. Instead of in the days when they were inhaling scab powder, this is Karie Youngdahl, the director of the History of Vaccines project at the college of physicians at Philadelphia. The hope, Youngdahl says was that some version of this horror show would give a patient only a little bit of smallpox. Something that yes would make them sick, but not too sick and their body would be able to fight it off, but this was not exactly a controlled medical procedure. It came with all sorts of risks.
Karie Youngdahl: Maybe the infection you thought that was a small infection on one person. It turned into a bad infection. So you were actually transmitting a more virulent form of smallpox.
Jason Feifer: The fatality rate with inoculations was around one to three percent, which when you're putting your life on the line is a pretty big risk. Here you develop your antiknockers and it doesn't really roll off the tongue. Anyway, I think it's fair to say that they had legitimate reason for concern. Although still, debate raged at the time, because yes, one to three percent fatality rate is scary, but on the whole, it was a far better way to immunize. A large portion of a population.
Karie Youngdahl: There was objections. Clergy members who thought that it was interfering in God's will that only God should have the power to decide who lived and who died. There were people who just thought it was unsafe and unknown. Cotton Mather was attacked verbally. His house was attacked with people, by people who objected to the practice. So yeah, certainly people were scared of it and didn't want to see it happen, but it was effective if it didn't kill you.
Jason Feifer: Cotton Mather, being the person who introduced inoculations to the American colonies in the 1720s. No less a thinker than the philosopher Voltaire even weighed in on this. When England took up inoculations, while much of Europe criticized it. Here's Voltaire in 1773,
Voice Clip (Voltaire): The English on their side call the rest of Europe, unnatural and cowardly. Unnatural and leaving their children exposed to almost certain death by smallpox and cowardly, in fearing to give their children a trifling matter of pain for a purpose so noble and so evidently useful.
Jason Feifer: But in 1796, something happened that would change the world. An English physician named Edward Jenner realized that when someone survived, cowpox a lesser version of smallpox. They become immune to smallpox. So he found a young dairy maid with cowpox named Sarah Nelmes. He took some matter from one of her lesions and basically injected it into an eight year old boy. The boy got sick for a bit and then recovered and then was proven to be immune to smallpox. The Latin word for cow is vacca and cowpox is Vaccinia, so Jenner named his procedure The Vaccination. For this, Jenner is considered the inventor of the vaccine. Although, to be honest, I was a little confused by this point, because it seems like what Jenner did was just do an inoculation with a somewhat different disease. Youngdahl says that's true, Jenner hadn't invented what we now know of as a vaccine. So much as he just introduced the basic concept that science would then build upon.
Karie Youngdahl: It was this idea of altering the material, introducing it in a different way. So he didn't just take whatever smallpox matter he could find. He found something that was similar, but not as deadly.
Jason Feifer: He found a verifiably weaker version of the disease. He studied it, he published his results and therefore he introduced a process. Governments quickly embraced Jenner's vaccine and understood that if they could get entire populations vaccinated, a disease could effectively be wiped out. In 1806, Thomas Jefferson even wrote a letter to Edward Jenner that said, "future generations will know by history only that this loathsome disease has existed". In 1840, the British government made vaccinations free, and then in 1853 made vaccines mandatory. The story here of course is not a steady March towards universal acceptance of vaccinations. Anti-vaxxers were quickly answering the call. Here's from an 1856 book called More Words on Vaccination.
Voice Clip (New York Times): Do you really believe that you can successfully combat dirt with dirt? Risum teneatis.
Jason Feifer: Reisum teneatis, basically being the Latin version of LOL, so uppity slang. In 1866, the anti-compulsory vaccination league was founded in the UK. In America three years later, the New York times ran a story called "Is Vaccination Dangerous?". It went on.
Voice Clip (New York Times): Everybody Knows of cases where vaccinated persons have been attacked with smallpox. Thus, the principle of vaccination is becoming more unpopular than it was even when Jenner first recommended it.
Jason Feifer: In 1876, there were even anti-vax riots in England. Seven local elected representatives in a town called Keighley had run on an anti-vaccine platform. Then once an office refused to enforce the mandatory vaccines that were the law of the land. That landed them in prison in York Castle. That in turn brought out what the times of London called "a dense mob with so menacing and appearance, that it was soon evident that a rescue of the prisoners was intended". This sets the stage for what happens in Massachusetts in the early nineteen hundreds. Let's actually give these anti-vaxxers the benefit of the doubt because they were living in very different times than ours today.
George Annus: The quality of vaccination in the early nineteen hundreds. So it was far inferior to what it is today. So there's probably no doubt that there were people who had bad reactions and that it wasn't well explained by the people vaccinating them.
Jason Feifer: This is George Annus, our guide through the early nineteen hundreds.
George Annus: I'm George Annus. I'm the director of the Center for Health Law, Ethics and Human rights at Boston University School of Public Health. I've written widely on issues of public health and bioethics.
Jason Feifer: Annus says that back then the vaccines were not the only thing we did not know a lot about. Medical science wasn't clear on the difference between a bacteria and a virus. There were a lot of theories about what caused disease, but we didn't know about germs.
George Annus: You know, there was an old saying that night. It wasn't until 1910, that a random patient going to a random hospital had better than 50% chance of profiting from the hospitalization.
Jason Feifer: That old saying, it feels like it could have been a little snappier, but you get the point. Before 1910, if you go to a hospital, you have only a 50/50 chance of walking out of there healthier than you walked in. This creates a really interesting, terrifying tension for someone living during this time.
Jason Feifer: There is global evidence that vaccines are reducing incidences of terrible disease. Yet doctors aren't especially well-trusted and smallpox is still breaking out. Everyone knows that medicine is basically the Siri of its time, which is, you know, like it works, but not really. So, that's the setting and now let's advance to 1902. Smallpox breaks out in Cambridge, the city next to Boston, and much like Boston, Cambridge announces mandatory vaccines. Doctors will go door to door. If you refuse the vaccine, you're fined $5, again, $100 in today's. People generally complied, but then doctors came to the door of Henning Jacobson, a Lutheran preacher. Who said that one of his children had been harmed by a vaccine and so no, he would not be vaccinated. He refused.
George Annus: I think he could have paid the fine, but he didn't want to. He really, really didn't want to be vaccinated. So he did refuse and the city could have let them along, but they didn't.
Jason Feifer: Cambridge find Jacobson the $5. Jacobson refused to pay. Cambridge didn't back down and prosecuted him. Now the budding anti-vaxxer movement had a trial case on its hands. One that had hoped would result in a court striking down mandatory vaccination programs. An organization stepped forward to fund Jacobson's legal battle, and we were off to the races. First, there was a trial where a judge quickly finds Jacobson guilty, which was no surprise to anybody. Massachusetts law said the guy had to be vaccinated and he refused. So, guilty.
George Annus: And then he appealed and it went first to the Massachusetts Supreme Judicial Court, which had our name for a Supreme court.
Jason Feifer: After that, it went straight to the Supreme Court of the United States of America, fast track to the big game. That's just how they rolled in those days.
George Annus: His argument was that he had a right to bodily integrity, which encompassed a freedom to refuse to have his body invaded by a vaccine or by needles or by any other force at the liberty interest of individuals was to stand up against the government force. That was a pretty good argument. That was a violation of fundamental rights of American citizens to be vaccinated without their consent.
Jason Feifer: It's an argument anti-vaxxer is still used today, but Jacobson couldn't produce any actual evidence showing that vaccines were harmful or even ineffective, much like say recent court cases, gay marriage. There was no actual hard evidence about the harm being caused. It was really more of an abstract personal argument. You know, something about this just doesn't feel right. Massachusetts made a compelling counter argument that "yes, we as a nation believe in and protect individual Liberty, but that can't come at the cost of the expense of an imminent threat to the whole".
George Annus: When the entire community is at very serious risk, the state can for self-defense and to prevent large numbers of people from being killed, can order reasonable interventions like vaccination to be given to everybody.
Jason Feifer: In 1905, the court made its ruling in a seven to two vote, it sided with Massachusetts. All states could now mandate vaccines. If the safety of everyone was at risk. Justice John Marshall Harlan wrote that liberty is not "an absolute right in each person to be in all times and in all circumstances, wholly free from restraint". Although, he did make an exception for people who would be harmed by a vaccine, and here's the money quote.
Voice Clip (Justice John Marshall Harlan): There is of course, a sphere within which the individual may assert the supremacy of his own will and rightfully dispute the authority of any human government, especially of any free government existing under a written constitution. But it is equally true that every well-ordered society charged with the duty of conserving the safety of its members, the rights of that individual in respect of his Liberty may at times under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations as the safety of the general public may demand.
Jason Feifer: Interestingly, this decision did not make giant news at the time. That could be because it came out the same week as Lochner versus New York, which found that laws couldn't limit the number of hours that employees are forced to work. That ruling was a big deal and of course was later overturned, which is why I say airplane pilots are now only allowed to fly eight hours during a 24 hour period.
Jason Feifer: Jacobson versus Massachusetts did have a steady ripple effect across the nation. More states followed Massachusetts has lead enacting mandatory vaccine laws and the anti-vax movement became even more organized and shifted its focus to children. Then some states began mandating that children be vaccinated if they wanted to attend public school, which led to its own Supreme court case. In 1922, the court sided with the states again. That's more or less how we ended up where we are today.
Jason Feifer: A state can't physically force someone to get a vaccine, but it can deny their children's access to public education because of it. And because Jacobson versus Massachusetts carved out exceptions for people who felt they'd be harmed by vaccines, anti-vaxxers have been pushing to make those exceptions as big and flexible as possible. Many states now allow exceptions for people who don't want to get vaccinated, whether it's for religious reasons or philosophical reasons and minor court squabbles continued to test these boundaries. So that was Jacobson, after the case, he went back to life as a pastor. If he kept up his activism, I can't find much evidence of it. Although the New York times did run a short obit when he died at age 74 in 1930, it doesn't even reference the Supreme court case. It just says he was the founder and pastor of his church for 37 years. What happened to that other anti-vaxxer Immanuel Pfeiffer, who, when we last left, him had just volunteered to walk the smallpox hospital without being vaccinated. Well, this is a tale of two headlines. So here's the first from the New York Times, February 9th, 1902.
Voice Clip (New York Times): "Exposed to smallpox Boston doctor who oppose vaccination now has the disease and probably will die!"
Jason Feifer: Actual headline right there. Pfeiffer went to the island, then came back to Boston, developed smallpox and decided to hail a cab and take it to his home in the nearby town of Bedford. That might be kind of head slapping like nutty to us. You know who this news was not amusing to the cab driver who no joke opened his newspaper that Sunday read about Pfeiffer and realize holy crap, that guy was in my car. He quickly made his way to a hospital where he and his entire family was vaccinated. Then his car and home were disinfected.
Jason Feifer: Meanwhile, scandals erupted everywhere. The Board of Health was accused of endangering the public by letting Pfeiffer go through with this crazy stunt. The town of Bedford began exploring legal options against Pfeiffer for potentially spreading smallpox around. Pfeiffer even sent his children to school, risking the lives of every one of their classmates. Now comes the second headline in this tale of two headlines. It ran just a month later on March 10th, 1902. Can you guess what it's going to be? You know what, I'm just going to cut you off. You are wrong.
Voice Clip (New York Times): "Dr. Pfeiffer recovering antivaccinationist convalescent after smallpox with his views on the disease unchanged".
Jason Feifer: The dude covered! His son Immanuel Jr. took a victory lap for his dad and the press issuing this statement. "Dr. Pfeiffer is as strongly opposed as ever to vaccination. Nothing has happened to change my own views on the subject, and I am as earnest as my father in opposition to vaccination".
Jason Feifer: Dr. Pfeiffer would go on to live decades longer, which just, I mean, right, there is almost nothing worse in the world than seeing someone wrong. Feel vindicated. It makes us who feel in the right suddenly feel a little less right. The world is just not as straightforward as we wished it was. It is full of randomness. It's full of chance. That is a hard thing to be reminded of. And yet I'd propose that this is actually the perfect ending for Dr. Pfeiffer's story. It fits so neatly into the past 100 years and more of debate over vaccination. To help explain that I want to play you this bit of tape from my conversation with Professor Annus, we were talking about what it would take to convince anti-vaxxers that they're wrong. He said,
George Annus: I actually had long conversations with, of the anti-vax people, because many of them had experiences with their children where they seem to change radically right after they get vaccinated and ultimately were diagnosed as autistic. You can tell them that the vaccination had nothing to do with it, and scientists can tell them that it was coincidental. That it happens. But was a causative?
George Annus: You're not going to convince many mothers have experienced that with their children. That's true. You know, it was very much like Jacobson himself. We weren't going to convince, he was convinced that there was something wrong with the vaccine and saw a lot of these parents were totally convinced.
Jason Feifer: This is what carries through the past 100 years of vaccination debate. It's what carries through back to when Edward Jenner developed a vaccine, and on past that. People base their fears, their knowledge, their deeply rooted beliefs in what they personally experience, or at least what feels personal.
Jason Feifer: It's hard to value any information over what you've seen with your own eyes. Even if what you saw was the product of random chance. Even if what you saw was a misinterpretation of reality. Because when a man is told that he needs to be vaccinated and in response, he basically bathes himself in a disease, catches it and then survives. How do you tell that man, that he's wrong? Even if he is wrong, even if every expert people who have devoted their entire lives and careers to a subject, all tell him he's wrong. Even if, had he done it all over again, that same stunt would have put him in a grave. Even if he may have gotten other people sick in the process, nobody could yell or shame or make fun of Immanuel Pfeiffer enough for him to doubt what he himself lived through.
Jason Feifer: Why even try, I mean, yeah, it's tempting and emotionally satisfying to knock the guy, but it doesn't serve the greater good because the greater good is vaccinations. So, that just leaves us with a question. The riddle to this problem that's lasted hundreds of years. How do you convince someone to believe something other than what they think they experienced themselves, solve that and we're all cured.
Jason Feifer: And that's our episode. Hey, special announcement. I have a second podcast as you may or may not know. My day job is as editor and chief of Entrepreneur Magazine. I just launched a new weekly show for the mag called Problem Solvers. In each episode, I explore how an entrepreneur solved an unexpected problem in their business. It's insightful. It's useful. It's so endlessly fascinating to hear entrepreneurs talk about their failures, please check it out wherever you get your podcasts, just search Problem Solvers. For this episode of Pessimists Archive, of course we have plenty of people to thank again. Our archival reader was Mike Darling of Tonic, which is Vice's awesome new health site. Check it at out at tonic.vice.com. Our theme music is by Casper Baby Pants, and you can find more at babypantsmusic.com. Thanks again to the experts I interviewed for this show, George Annus of Boston University and Karie Youngdahl, the Director of the History of Vaccines project at the College of Physicians at Philadelphia, where you can get more information on vaccines at historyofvaccine.org.
Jason Feifer: Thanks also to Stephan Rydall for his History of the Jenner Vaccine in the Baylor university medical center proceedings, hot reading material there, which I relied upon for this episode and to Roberto Scalese who helped me access some Boston history research. Thanks also to the folks at timeline.com, where we run aCcompanying articles for our episodes. You can find links to everyone's work as well as other articles referenced in this episode at our show page, which is pessimists.co. Pessimists.co.
Jason Feifer: Hey, if you like this podcast, please, please, please, please do us a favor. Subscribe to the show, wherever you get your podcasts and leave us a review on iTunes, which I am swearing to you helps us reach a larger audience. I just cannot stress that enough. We also have an awesome Twitter feed you'll want to follow it's @pessimistsarc, P E S S I M I S T S A R C, where we're posting a regular stream of pessimists through history. You can also get in touch with us at firstname.lastname@example.org. Pessimists Archive was created by Louis Anslow, our producers, this episode where Louie and Jennifer Ritter, and we were edited by Chris Cornelis. My name is Jason Feifer. I'm a very much not Immanuel Pfeiffer. Thanks for listening and we'll see you in the near future.
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