Below, Thomas Levenson shares five key insights from his new book, A Pox on Fools: The True Believers, Grifters, and Cynics Who Convinced Us to Reject Vaccines.
Thomas is a professor of science writing at MIT. He is the author of several books, including So Very Small, Money for Nothing, and Einstein in Berlin. He has also made 10 feature-length documentaries, for which he has won numerous awards.
What’s the big idea?
Vaccines work because we agree to protect not only ourselves but one another, making them one of the greatest expressions of collective responsibility ever devised. The danger is that their success has erased our memory of the diseases they conquered, leaving us vulnerable to misinformation and the return of preventable tragedy.
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1. Vaccines are kindness in a syringe.
None of the characters in the first passage of my book has a name. They were all anonymized (rightly so) as participants in an early-stage clinical trial. 108 healthy adults had agreed to allow researchers to inject them with a new compound that hadn’t been tried on humans before.
12 went first—guinea pigs willing to risk unanticipated consequences. They and the other study participants then stuck with it through a lengthy nine-month protocol, all to test a candidate vaccine to protect against human immunodeficiency virus, or HIV, the pathogen that causes AIDS. Those unnamed, unknown volunteers lent their bodies and time to a project that could potentially save millions of others from a scourge that no one in this original cohort was facing themselves.
Such courage shoots through the long history of vaccination. That group of people willing to put themselves on the line to help humans they will never meet remind us that the story of vaccines is a tale of kindness—and of one of the best of human qualities: a willingness to take a chance in the hope of defeating persistent and deadly foes.
2. Not all vaccine hesitation is created equal.
Some people in the anti-vaccine world are in it for the money, power, and clout they can gain from pushing repeatedly debunked claims about the hazards of vaccines. But over the long history of vaccine development, some fears were not crazy. In one of the most significant incidents, there was a brief period in the 19th century when the first versions of the smallpox vaccine accidentally transmitted syphilis rather than the benign cowpox virus that conferred immunity to smallpox. Those incidents were rare, but one is too many if it happens to you.
News of such cases outraged and terrified many people, and some of the responses to those fears were not particularly helpful to the pro-vaccine cause. Some defenders then, and still today, argued that the obvious overwhelming benefits of the smallpox vaccine as a shield against one of the most terrifying killers of the day justified ignoring those alarmed by the small but real risk of a loathsome, deadly disease. In the end, such easy dismissals led to anger among those afraid of the new procedure—and those grievances sparked riots in the streets.
“Some of the responses to those fears were not particularly helpful to the pro-vaccine cause.”
If people are concerned about a shot—even if it’s just the worry produced by all the noise from anti-vaccine voices—it doesn’t work to fall back on the (valid) cost-benefit statistics of vaccination. Instead, it’s vital to identify the roots of someone’s hesitation and tell the whole story—way back to syphilis and smallpox, if necessary—to address the fear behind the fear: a deeply human concern about sticking some invisible and potent substance into one’s body.
3. It’s crucial—and difficult—to remember a past beyond lived experience.
Modern anti-vaccine activists are as adamant as their 19th-century predecessors about the allegedly fatal dangers of vaccines. For example, before Robert F. Kennedy became Health and Human Services Secretary, he asserted that kids “get the shot, that night they have a fever…and three months later their brain is gone.”
Kennedy was wrong, of course. The alleged connection between vaccines and brain injury has been repeatedly debunked and modern vaccines are the safest medical procedures available today. But when Kennedy and his allies assert that vaccines are terribly dangerous and riskier than any conceivable benefit they might convey, that sense of danger can come to seem plausible—because of what we no longer recall.
Before vaccines existed, one in three kids would die of a fever before the age of five. It was routine for parents to bury one or more of their children. But with the steady expansion of vaccines for previously unchecked diseases in the 20th century, childhood infectious illnesses in rich countries have been almost completely defeated. A single kid’s death from measles is so rare that when one does happen, it makes national news.
“Modern vaccines are the safest medical procedures available today.”
That triumph has made it easy for opponents to claim that a shot is far more dangerous than any seemingly negligible threat posed by some invisible microbe. That false narrative is persuasive only because the genuine and vast peril posed by pathogenic viruses and bacteria has been defeated by vaccines. Such amnesia defines the job for the historian. Memory is not automatic. It must be cultivated, sought out.
4. When we forget what our grandparents knew about infectious disease, tragedy follows.
In 1857, a senior British doctor, Sir John Simon, defended vaccine mandates when he wrote that vaccine opponents were prepared to risk allowing “unconscious infants to become the prey of a fatal and mutilative disease.” Then, unleashing the most memorable phrase in the history of vaccination, he named the crime thus committed: “It was this liberty of omissional infanticide which the law took courage to check.”
“Omissional infanticide”—murder, with the lethal weapon being inaction: the withholding of the procedure that could have saved babies from dying from a preventable disease. What’s frustrating, terrifying, and tragic about what Simon said nearly two centuries ago is that his indictment still holds. As I write this, news has broken of infants dying in the U.S. from Vitamin K deficiency bleeding disorder (VKDB). About one in 250 babies is at risk of the malady, and the resulting deaths are wholly avoidable.
It’s standard practice to give newborns an injection of vitamin K right after they’ve made their entrance. But increasingly, American parents are rejecting that shot. It’s not a vaccine—the immune system isn’t involved—but because a needle is involved, this utterly benign bit of prophylaxis has been swept up in the cacophony of anti-vax misinformation. Parents become persuaded that they’re avoiding an unnecessary medical procedure and then expose their children to potentially fatal harm.
“This utterly benign bit of prophylaxis has been swept up in the cacophony of anti-vax misinformation.”
The same thing happens when people reject the standard—and transformative—suite of vaccines against the once ubiquitous and often lethal suite of childhood diseases: diphtheria, pertussis, measles, and the rest. Omissional infanticide, indeed.
5. Vaccination and the kind of people we want to be.
Our choices about vaccination hold up a mirror to who we are or want to be, as individuals and a society. Every decision to vaccinate begins with self-interest; the calculation that the benefit of avoiding an illness or the worst of an infection outweighs the slight risks of getting a shot.
We bare our arms because the prospect of a sore shoulder is worth it to avoid an encounter with anything from COVID to mumps to yellow fever or measles. That’s the “profit” we gain in thinking of a vaccination as a purely private transaction.
But another way to understand our choices recognizes the possibility of both generosity and individual gain. Seen that way, vaccines against the common endemic diseases confer a benefit that is shared with everyone around us. At the population level, a high enough vaccine rate stops infectious diseases cold by making it impossible for a single case to spread into an epidemic. Sitting still for each of the jabs on the recommended list gives our neighbors an amount of security that none of us can secure for ourselves alone.
To be against vaccination is to isolate oneself, to be alone, and to reject the ties that could bind one to others. You, me, all of us don’t have to live that way. Recognizing the gift inherent in the choice to vaccinate demonstrates that there is another way to be: in the company of others, mindful of ourselves as they each are of themselves, and generous to them as they are to us.
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