Exactly one year ago, I began to search my bookshelves for Daniel Defoe’s A Journal of the Plague Year. By the time I remembered that I had returned it to the library, the library was closed, and so was my child’s school, and we seemed to be living through a new adaptation of that novel. In 1665, Defoe’s narrator wanders the empty streets of London, where quarantines and curfews have been imposed. He tracks the rising and falling numbers reported by the weekly bills of mortality and witnesses a mass burial.
All this now feels eerily current, but I first read that book to learn about what life was like before the advent of vaccination. A Journal of the Plague Year was published in 1722, long before germ theory was validated. Defoe’s narrator mentions a curious rumour that disease might be caused by tiny dragons visible only through the lens of a microscope. He then dismisses that possibility as fanciful and highly improbable.
A Planet of Viruses, Carl Zimmer’s slim collection of essays, offers an edifying tour of the improbable world of viruses, which is also our world. The strategies our bodies have devised for survival are endlessly matched by viruses, with their uncanny intelligence for evolution. Over the past year, their ability to reinvent themselves has heightened the suspense around developing new vaccines against Covid-19. Patenting the Sun, Jane S Smith’s lively account of the first vaccine against polio, offers a heartening history of success. Smith herself was among the millions of American children who were volunteered by their parents to be the test subjects for that programme.
New viruses require new vaccines, but vaccines are not a new technology – they predate penicillin, and X-ray machines, and most of the advances of modern medicine. Scepticism of vaccines is as old as vaccines themselves. In Bodily Matters: The Anti-Vaccination Movement in England 1853-1907, Nadja Durbach details widespread refusal to take part in the government-mandated campaign to eradicate smallpox. Some fears from that time seem comical now, such as the belief that vaccination could cause a person to grow horns. But other concerns remain familiar – fear of bodily pollution, suspicion of both doctors and the medical system, and opposition to the government’s role in public health.
The anti-vaccine pamphlets of that time compared doctors to vampires, but the vampire hunters in Bram Stoker’s Dracula include two doctors who “sterilize” the count’s coffins so that he cannot rest in them. Germ theory was widely accepted by 1897, when Dracula was published, and the drama of the novel is driven by contagion. Dracula’s bite infects his victims, making them vampires too. In this particular horror story, disease, not vaccination, is terrifying.
The smallpox inoculation was more dangerous than any modern vaccine, but it is no longer in use because it wiped out the disease. In theory, other infectious diseases could be eradicated as well, though vaccine refusal has recently led to outbreaks around the world. In the US, well-educated white women are among the demographic groups most likely to refuse vaccines for their children.
Reasons for this can be found in For Her Own Good: Two Centuries of the Experts’ Advice to Women by Barbara Ehrenreich and Deirdre English , which explores the fraught history of women’s health and illuminates why some women might be reluctant to accept expert advice on vaccination.
By contrast, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A Washington offers context for the lack of trust some black people feel in the US towards a medical system that has continually failed to offer them the same standard of care as that received by white patients. These books are not specifically about vaccination, but they illuminate the longstanding inequities that damage public trust. If we want to restore trust and promote widespread vaccination, we will have to address these inequities.