| This dissertation is a historical analysis of how public health and medical professionals over the course of the twentieth century made vaccination a widely accepted component of the American health care system. I address a set of broad empirical and theoretical questions. What strategies have health professionals used to gain public acceptance of vaccines? How have they resolved, philosophically and pragmatically, the tension between individual rights and community needs? Under what circumstances have they used the recourse to legal compulsion? How did various segments of the public react to specific vaccines and to the concept of immunization more generally? What social, political and legal factors have shaped policy making? What have been the most significant determinants of consensus, discord and controversy in vaccination policy?; The twentieth century began with a sweeping affirmation of legal authority to compel vaccination in the 1905 case of Jacobson v. Massachusetts . But the decision did not exert a determinative influence on the practice that lay at the heart of the case. For the next sixty years, vaccination policy relied primarily on persuasive measures. The preference for persuasion was rooted partly in respect for the principles of liberty and autonomy that have occupied such a central position in American civic and political life. Equally important were pragmatic reasons. Laws enforced through schools would distract from efforts to protect infants, health officials believed; attempts to force adults would provoke potentially violent resistance. The most notable feature of the persuasive efforts was the self-conscious adoption of the tools of advertising and public relations to "sell" the public on the importance of immunization. The sea change in the stance of health professionals toward the use of compulsion came in the late 1960s, when an ideological commitment to the eradication of infectious disease sparked a national push to enact laws requiring vaccination before children could attend school. Throughout the twentieth century, social and political factors, as much as science and epidemiology, shaped the decision-making of health officials whose mission was to achieve high levels of vaccination coverage. |
