Karen Walloch. The Antivaccine Heresy. Rochester: University of Rochester Press, 2015. 400 pp. $125.00 (cloth), ISBN 978-1-58046-537-3.

Reviewed by Julie Adamo (Mount Holyoke College)
Published on H-Disability (April, 2017)
Commissioned by Iain C. Hutchison (University of Glasgow)

In this detailed volume, historian Karen L. Walloch chronicles the history of vaccination in the United States, beginning in the late eighteenth century when British physician Edward Jenner (1749-1823) pioneered the practice and ending with the Supreme Court ruling to uphold compulsory vaccination laws in Jacobsen v. Massachusetts (1905). As smallpox recurrently scourged the United States causing widespread death and disability throughout the nineteenth and early twentieth centuries, vaccination was a defining issue of the time. Highly respected physicians and scholars campaigned tirelessly both in favor of compulsory vaccination and against it alongside mothers, laborers, and everyday people. Drawing from an impressive range of sources including court proceedings, newspapers, pamphlets, government reports, medical records, and medical society archives, Walloch covers both sides of the controversy in great detail.

While the introduction and first chapter of the book provide an overview of the history of smallpox and vaccination in the United States beginning in the eighteenth century, the bulk of The Antivaccine Heresy centers on public and legislative debates around compulsory vaccination in Massachusetts at the turn of the twentieth century. As a hub of medicine and higher education, Massachusetts was a locus for the movements both for and against compulsory vaccination and it was “an early leader in compulsory vaccination legislation and public health organization” (p. 4). Walloch threads several themes throughout the book: tensions between the rising free market of pharmaceutical products and Progressive-era public health professionals who “sought to exert their scientific expertise to promote state control of vaccine production,” debunking the myth that antivaccinationists were uneducated reactionaries who lacked good reason for their concerns, and the influence of an American culture that had a distaste for state interference in personal matters (p. 58). 

Her third chapter recounts the 1901-02 smallpox epidemic that raged through Boston and Cambridge following several decades of relative dormancy. Chapters 4 to 9 detail the history of the antivaccinationist movement in Massachusetts, including examination of the considerable hazards of vaccination that ignited the movement, the ultimate criminal prosecution of several antivaccinationists, and the legislative and political debates surrounding compulsory vaccination.

Walloch concludes by covering the Jacobsen v. Massachusetts Supreme Court case in which Justice John Marshall affirmed the Massachusetts vaccination law. Henning Jacobsen was a Swedish Lutheran pastor who harbored genuine fears about vaccination and was not a “libertarian intent on sticking up for his perceived rights”--a characterization that was commonly applied to antivaccinationists. The case “is a cornerstone of case law that to this day supports broad and sweeping state authority to compel citizens to undergo medical treatment in the interest of public health” and has served as a reference point for courts in support of a variety of health laws, including involuntary sterilization (p. 2).

Throughout the book, Walloch reminds us that many reasonable, literate, and highly respected physicians and scholars opposed vaccination. Furthermore, people had many legitimate reasons to be skeptical about vaccination, as it sometimes led to lost wages by rendering people unable to work for several days or several weeks, left ugly scars, and occasionally resulted in long-term disability or death. Walloch points out that coercion, not persuasion, was the approach of vaccination campaigns and that this approach fueled skepticism of the practice. Many destitute people were forcibly vaccinated. Jacobsen was cited in some cases to validate eugenics laws. Through failing to treat antivaccinationists’ concerns with respect and being overly confident about the safety and efficacy of vaccines, medical authorities not only failed to gain the support of skeptical people, they also continued to ignite the flames of the antivaccinationist movement. Ultimately, Walloch concludes that “antivaccinationists may have lost the court battle but they won the legislative war. The principle of compulsion may remain firmly lodged in constitutional law, but no one dares to truly implement it, making the practice of compulsion for all intents and purposes void” (p. 219). Still today as a result of Jacobsen and the antivaccinationist movement of the eighteenth and nineteenth centuries, there are many loopholes and opt-outs from vaccination that create opportunities for outbreaks. 

Walloch implores today’s physicians to take note of this history as they work to convince parents to vaccinate. She recommends physicians and public health professionals treat patients who express concerns about vaccination with respect, address their concerns honestly, and acknowledge that authorities in the past were overconfident about the safety and efficacy of vaccination.

This fastidiously researched history will be of great use to historians of medicine and public health, physicians, public health professionals, and readers from the general public who are interested in the vaccination debates. The book includes an eighteen-page bibliography, an index, and detailed notes for each chapter, making it an excellent resource for anyone looking to do more in-depth research about any of the issues or events discussed. Additionally, it includes two appendices: Boston Health Department vaccinations from 1872 to 1900, and voting records for Samuel Durgin’s vaccination bill before the Massachusetts State Senate. Illustrations and images, including historical advertisements for vaccine products and other smallpox preventives, posters, pamphlets, portraits, and more contribute helpful context while adding texture to Walloch’s narrative. While the book as a whole can easily be read as a cohesive story, those with interest in a particular event or facet of the vaccination debate will find that individual chapters can also inform a variety of research questions.

The Antivaccine Heresy stands out among the handful of other books on the history of vaccination in the United States in its comprehensive treatment of the subject, its coverage of the topic prior to 1900 and at the turn of the twentieth century, and in the number and variety of resources it draws upon. It is a major accomplishment and a valuable, highly important contribution to the history of medicine and public health, especially in light of the ongoing relevance of the topic and recent surge of scholarly and popular interest in it.

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Citation: Julie Adamo. Review of Walloch, Karen, The Antivaccine Heresy. H-Disability, H-Net Reviews. April, 2017.
URL: http://www.h-net.org/reviews/showrev.php?id=47739

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