Now that the book is out and actually selling a few copies here and there, I’ve been trying to decide what the next major writing project should be. The easy answer is a second volume of The Accidental Plague Diaries. The published book only goes up through this January and I’ve continued to write routinely about Covid and its effects on our society over the last nine months. By the end of the year, I should have more than enough material for The Accidental Plague Diaries: Volume Two, or The Second Year, or Delta Dawn or whatever I would decide to call it. I’m not sure if that’s the best idea or not. Sequels not called The Empire Strikes Back rarely live up to the promise of the original work. I thought tonight I’d take a look at why antivaccination is such a thing and why it’s so much more prevalent in the US than in most of the rest of the world.
There’s nothing new about the willful flouting of public health dicta by certain segments of American society. There’s a strong independent streak in the national character that flows out of the individualism of Western philosophical thought and the enlightenment; the idea that the individual is the natural building block of society and that each unique individual is to be celebrated for his or her differences is central to our governance, our economy, and our sense of self understanding. A couple of other fundamental precepts come with this. One is the idea of bodily autonomy. That our bodies belong wholly and totally to ourselves and that no one has the right to tell us what to do with them against our conscience. Of course, we have all sorts of laws and customs that subvert this. Technically, our bodies no longer belong to ourselves or our heirs after our death. For reasons of public health, laws exist in every state making the body technically property of the state so that the state can proscribe what can and cannot be done with it postmortem. You’re not allowed to plant your mother under your geraniums or expose your hated brother in law on the wheel for the elements and the neighbors to gawk at even though these would have been considered perfectly normal behaviors in times past. Then there’s the penal system under whose care bodily autonomy is strongly limited, laws limiting reproductive capability, rules regarding sexual mores based on consanguinity and chronological age and, of course, all the political thought of the social contract that your rights stop when your actions impinge on my rights. But this idea, which is basic to medical ethics, is what allows us a Jehovah’s witness to refuse blood products, prevents agents of the state from forcing us to donate blood or tissue, or lets us forego aggressive care at the end of life with a do not resuscitate order. It also makes it easy for competent adults to refuse a vaccine which would benefit themselves and society as a whole. They need not have any reason for it beyond a simple declaration of no. A second is that if we are all different, that there must be ways of ordering us and, given the way humans categorize and find patterns, even in randomness, that there must be a hierarchy among humans with some of greater and some of lesser worth.
Vaccine mandates and vaccine refusal are as old as the country. In the early 18th century, a West African slave of Cotton Mather, Onsemus, introduced him to the practice of his tribe of inoculating themselves with small doses of smallpox to build immunity to the disease. When a smallpox outbreak hit Boston in 1721, Cotton Mather convinced Boston physicians to try the technique. Records from the time showed that the mortality rate in the inoculated population was 2% compared to 15% in uninoculated individuals. There was some push for more widespread use of the technique, but a number of newspapers were critical, including that run by the brothers Franklin – James and Benjamin. Some years later in 1736, after Benjamin had relocated to Philadelphia, there was a smallpox outbreak in that city and Ben refused to allow his family to be inoculated. His four year old son caught the disease and died. Ben Franklin quickly shifted his position to pro-inoculation and deeply regretted the decision that cost his son his life. In 1777, George Washington mandated smallpox inoculation for the Continental Army as he was losing more troops to disease than to battle. I’m sure there was negative reaction to this decision but as it was a time of war with very real consequences should the war be lost, most of them were muted and not made much of by the writers of the day.
All of this, of course, took place in a very different society. Pandemic illness and death were part of the natural order. Everyone saw young healthy people sicken and die from diseases that would easily be cured today such as an infected wound, pneumonia, or complications of childbirth. Men died young in agricultural or industrial accidents. From early childhood, people grew to understand that the world could be a dark and dangerous place and that simple misadventure could be fatal. For modern generations, raised in a world of antibiotics, globalism, all volunteer military, and innumerable workplace safety standards, bad has been safely removed from most of our lives for decades. When pandemic illness struck this past year, as it always has, it struck a population with a lack of coping mechanisms and understanding about the nature of illness and death. It’s not something that happens to people like them, so they need not take it seriously. They need not toe the line regarding public health rules. They can safely question expertise from the cocoon of their own thinking and develop their own alternative theories given their ability to access vast quantities of information via the internet – although they may not understand or interpret what they find correctly. Alexander Pope put it best when he wrote ‘A little learning is a dangerous thing…’
Humans, when confronted with realities that do not conform to their expectations or experience tend to develop elaborate rationalizations and alternatives that fit comfortably within their own world view. I went to a play this weekend, a one woman monologue based on Joan Didion’s books chronicling her personal experiences with illness, grief, and loss. She entitled her work ‘The Year of Magical Thinking’ as she tries to explain her lack of rationality as the sudden death of her husband and the serious illness of her daughter hit her life nearly simultaneously. I had read the book some years ago. It was a favorite of Tommy’s. He had seen the play in New York with Vanessa Redgrave and the material really spoke to him. His early adult life coincided with the early wave of the HIV epidemic and he was very involved in the Birmingham gay community’s mobilization to face both the needs of the sufferers and the indifference of the general populace. I can’t remember why I didn’t go to the play with him. I think it was on a trip he made to New York on his own for some reason or maybe it was one we made together, and I had a meeting or something I had to go to that afternoon. It all escapes me now. Anyway, as I was watching the performance, I could not help but draw parallels between the magical thinking of Joan Didion in the face of great calamity and the magical thinking of segments of American society when it comes to pandemic response, jettisoning hundreds of years of carefully gathered data and medical facts which tell us how to respond to pandemic disease in favor of praying for divine intervention or trusting the quick cures of charlatans.
Social media has certainly played a role in the spread of fringe ideas. I regard social media as a tool and, like any tool, it can be used either constructively or destructively. A hammer has no moral value in and of itself. It can be wielded with careful intent to help create something lasting or beautiful or it can just as easily be used in a malicious fashion to maim or to kill. Facebook is the same way. You can use it to connect and build community and share positive things, or you can use it to argue and sow divisiveness and discord. One of the great appeals of social media is its ability to allow isolated members of outcast and minority groups to find each other, create community and build a social infrastructure. This can be a positive and comforting thing, but it also means that all kinds of communities can coalesce, including some whose purpose is spreading a gospel far outside of usual mainstream thought. Social media gives a platform and a megaphone allowing ideas that would once never have made it past a couple of people exchanging letters to infiltrate large groups and begin changing the terms of public discourse. Once an idea is out there in the zeitgeist, the famed Overton window can start shifting, both left and right making it harder and harder for society to find the common ground in the middle and the compromise that’s necessary for civil social function. We’re certainly seeing this in our politics and the result is a congress that can barely pass legislation and is no longer attending to the business of the general public.
Elected officials, of course, are no longer really responsive to their constituents, especially on the national level. They are responsive to those who fund their increasingly expensive reelection campaigns. The general public, of course, does not have the resources to set up PACs and funnel multi-millions to campaign coffers so politicians now cater to the large corporations and the wealthy individuals who do. The general tilt of these funders is towards protection of their perquisites and assets so legislation such as tax cuts becomes more popular than legislation that might benefit the majority of the citizenry. The upper middle and professional classes have been coopted into supporting this agenda by the replacement of the traditional defined benefit pension plan with the IRA and the 401K. This particular slight of hand has millions of voters supporting an economic agenda that’s better for the stock market, in which their future is heavily invested, rather than one which might, over time, provide them with more tangible benefits in terms of more robust social and health programs. The conflicts in society that this has put in place have been good for business. Conflict stokes fear and anger and keeps people tuning in to media, clicking on web links, buying books with political themes, and loading themselves up with merchandise that identifies them as team red or team blue. Politics has moved from a realm of serious thinkers and policy wonks to just another field of celebrity infotainment where elected officials jockey with each other for camera time or press mentions, adhering to the age old idea of there’s no such thing as bad publicity.
A political system that is no longer terribly interested in the people’s business leaves a vacuum for other interests to move in and take care of things that need to be seen to. They are often economic in nature and this has certainly applied to the American health care system. I have written at length in the past about the morphing of our health care system into a health care industry over the last half century with a completely new set of rules guiding how it works, not ones pertaining to the saving of lives and general health of the citizenry, but rules ensuring that profit is generated and flows upwards to the owners of the various components of the industry. Most Americans are fairly happy with their doctors and other health care providers on a one on one basis. We’re well educated, try to uphold our oaths to our patients and profession, and in general are reasonable communicators. At the same time, most Americans recognize that the health care system is no longer serving them the way it once did. Their doctors are all of a sudden ‘out of network’. They receive enormous surprise bills for simple emergency visits. They feel like they have very little control over the shape of their health care once they enter a hospital. All of this has fed a distrust of the system in general and has helped undermine confidence in medical expertise, particularly when it’s coming from ‘the system’ rather than from an individual provider with whom a relationship has been built. Add to this the systemic racism of American society which manifests itself in health care as it does elsewhere (not to mention such things as the Tuskegee experiments which occurred within living memory, not ending until 1972), the unfamiliarity of most providers, who come from middle and upper middle class backgrounds, with the realities of life on the lower end of the socio-economic scale, and the tendency for more and more healthcare to be handled algorithmically rather than individually, and you get a perfect storm for a patient base to become alienated from the system that’s supposed to care for it.
When you start putting all of this together, you start to see that a reaction against public health measures and vaccine mandates was probably inevitable and that the issue is not that we as Americans don’t want to be safe from pandemic disease but that we have built social structures over the last half century that make it nigh on impossible for us to be safe from pandemic disease. Can this be fixed? It’s not going to be easy. It’s going to take a lot of work. It’s going to take unified messages from government and media sources which means eliminating the dichotomies and conflicts on which so much of the marketplace is based, potentially reducing profits. It’s going to require Americans having access to health care in a form that they recognize with individuals with whom they can form relationships and develop trust, meaning we’re going to have to shift the system from one that rewards specialty care to one that rewards primary care. It’s going to require schools that teach critical thinking and how to analyze presented information to understand what it is, what it really says, and what the motivations are of the source which presents it, not schools that are focused on teaching to the standardized test. It won’t be easy, but nothing worth achieving ever is.