State of Immunity: The Politics of Vaccination in Twentieth-Century America (review)

Vaccination tops the Centers for Disease Control and Prevention's list of the ten great public health achievements of the twentieth century. Indeed, since the early 1900s American society has been transformed by the development, administration, and acceptance of vaccines against diseases such as diphtheria, polio, and measles, just to name a few. In State of Immunity, James Colgrove traces this fascinating and important history, delivering an elegant and original contribution to the history of medicine and to health policy. Although various scholars have addressed facets of the drama of immunization in the United States, usually by focusing on a particular vaccine or disease, Colgrove weaves many threads together to produce an encompassing and nicely paced narrative.

State of Immunity begins in the decades leading up to the U.S. Supreme Court decision Jacobson v. Massachusetts (1905), which upheld the state's right to vaccinate for the common good. Colgrove fleshes out the context and characters behind this landmark case and demonstrates how it and the legal impulse to place the collective before the individual helped to fuel anti-vaccination sentiment, which reached a zenith during the Progressive Era. Colgrove then shows how tides shifted in the 1920s and 1930s as coercive vaccination practices fell out of favor and public health officials turned increasingly to campaigns of persuasion to promote and "sell" immunization. In a chapter devoted to the diphtheria toxin-antitoxin in New York City, Colgrove demonstrates how the rise of education and advertising, in concert with the idealization of the physician as primary care provider, converged to produce a new health ethos in which vaccination eventually became routine. In 1947, overwhelming public faith in vaccines was demonstrated by the massive mobilization of New Yorkers responding to appeals from public health officials to be vaccinated against smallpox, which had recently appeared in the city. In total, 6.35 million people or 80% of the city's residents voluntarily lined up for the procedure, often waiting for hours in the rain.

Throughout the book, Colgrove highlights how a complicated combination of the fears, expectations, and protective instincts of parents has shaped the history of vaccination. Placing children and their families at the center of his analysis, Colgrove delves into the polio campaigns of the 1950s and the "eradictionism" of the 1960s and 1970s, when "faith in the power of vaccination—not just as a method of disease control, but as a force for social melioration—was at its apex" (150). It was during these two decades that the infrastructure supporting immunization expanded significantly in the United States, as vaccines became compulsory for school attendance. In order to encourage immunization among the school-aged population, state and city health departments devised slogans such as "no shots, no school," which they plastered on billboards and publicized in local communities. While in the early 1960s only a handful of states required one or two vaccinations for public school entry, by 1981 immunization for a growing roster of diseases was obligatory in all fifty states.

In the final and most innovative chapters of the book, Colgrove explores what the contemporary regime of mandatory vaccination means for American society. On one hand, vaccination rates are at their highest levels (over 90% for most vaccines), policies to cover low-income children have been markedly expanded, and the United States has achieved "record high levels of public acceptance for routine childhood immunization" (248). On the other hand, opposition to vaccination, or at least to the compulsory administration of particular vaccines, still exists, especially among those parents worried about putative associations between vaccines (such as the combination measles-mumps-rubella vaccine) and developmental disorders like autism. As Colgrove shows, vaccine skeptics, who vary wildly across the political spectrum, have had a powerful impact on immunization policies. For example, in 1986 an alliance between lobbying parents and legislators resulted in the passage of the National Vaccine Injury Act, which in turn established...