Vaccine policy was brought into focus last week when the Centers for Disease Control and Prevention’s advisory committee revised its recommendations on the COVID-19 booster and the combined MMRV vaccine. This development is part of a long history of debate over immunization in the United States, shaped by cultural and political issues across different eras.
Elena Conis, a professor of journalism and history at UC Berkeley, has explored these changes in her book “Vaccine Nation: America’s Changing Relationship With Immunization.” The book details how various vaccines—from polio to HPV—were received by the public depending on their historical context. For example, President John F. Kennedy approved significant federal funding for vaccination during a period marked by high trust in science and concerns about national health amid the Cold War. Similarly, decisions about infant hepatitis B vaccination in the 1990s were influenced by fears surrounding AIDS and immigration.
Conis explained that attitudes toward vaccination have shifted alongside government policies. “From the middle of the 19th century to the end of it, U.S. cities and states started to create more boards of health, many of which were imbued with the power to require the vaccination of their local populations. For several decades, these laws and regulations were enforced sporadically and unevenly. By the turn of the 20th century, there were boards of health with this authority across the U.S. Smallpox was also spreading at an alarming rate. So there were more and more clashes at the local level as these boards of health attempted to enforce mandatory vaccination in the context of a growing anti-vaccine movement,” said Conis.
She highlighted a major turning point: “In 1905, the U.S. Supreme Court ruled that states have the authority to enforce compulsory vaccination if it is in the interest of public health, and importantly, if it doesn’t cause any harm to individuals. But that Supreme Court ruling ended up galvanizing anti-vaccine groups even more.”
Conis described a recurring pattern: “There’s a rough pattern: The more vaccines and the more force used to encourage or require vaccination’s widespread adoption, the more resistance we see in the population.” After California rolled back compulsory vaccination in 1921 due to public opposition, officials began focusing on persuasion rather than mandates.
This approach changed during efforts to combat polio. The release of a polio vaccine in 1954 led to broad public demand for both access and government oversight regarding safety. Federal involvement increased under Presidents Kennedy and Johnson.
Research findings from subsequent decades demonstrated that mandates reduced disease rates among children; as Conis stated: “Research on vaccine-preventable diseases made it increasingly apparent that where there were vaccine mandates, there was much less disease.” By 1980 all states required schoolchildren to be vaccinated according to recommended schedules—a policy shift followed by renewed skepticism toward vaccines that continues today.
Debate over government roles has persisted since smallpox vaccinations began in America in the late 1700s. According to Conis: “Since the first vaccine against smallpox was developed in the late 1790s, there have been debates about…who should get vaccinated against what and when.” Resistance often increases with greater use or enforcement of vaccines.
Throughout history Americans cited religious beliefs or concerns about bodily autonomy as reasons for refusing vaccines; others raised risks associated with early methods like smallpox inoculation using infected material from animals or people—sometimes resulting in transmission of other diseases such as syphilis.
Anti-vaccination arguments drew support from varied social movements—including abolitionists—and later incorporated rhetoric from environmentalism, women’s rights advocacy, patient rights campaigns, and consumer activism beginning in the 1970s.
While libertarian ideas remain influential among contemporary skeptics, Conis noted connections between modern opposition movements and earlier liberal causes as well.
Media channels have always played a role spreading opinions on vaccines; however today’s polarized information environment intensifies divisions between opposing viewpoints online. As Conis observed: “Depending on your individual media habits…you’re going to see one set of ideas about vaccines presented…or you’ll see a completely different set….the vast majority…are becoming more entrenched…and less able to understand…people who think differently from us.”
This interview has been condensed and edited for clarity.
