Bob H. Reinhardt: Having the Vaccination Conversation

reinhardt_endWe welcome a guest post by Bob H. Reinhardt, author of The End of a Global Pox: America and the Eradication of Smallpox in the Cold War Era. By the mid-twentieth century, smallpox had vanished from North America and Europe but continued to persist throughout Africa, Asia, and South America. In 1965, the United States joined an international effort to eradicate the disease, and after fifteen years of steady progress, the effort succeeded. Reinhardt demonstrates that the fight against smallpox drew American liberals into new and complex relationships in the global Cold War, as he narrates the history of the only cooperative international effort to successfully eliminate a disease.

In today’s post, Reinhardt recommends that parents and vaccination experts approach vaccination with more holistic perspectives, placing the conversation in the context of past, present, and future.

This article was originally published in Willamette Magazine, Summer 2015, and is republished here with permission.


Parents sometimes hear about “routine childhood vaccinations,” but the current discussion about vaccines is anything but routine. In addition to pediatrician offices, the vaccination conversation is happening in unexpected places: the legislative halls of Oregon, California, and other states trying to stiffen childhood vaccination requirements; Twitter, where author Sherman Alexie invoked Native Americans’ historic experiences with deadly contagious diseases and railed against “superstitious, selfish anti-vaccination ***holes”; and late-night TV, where Jimmy Kimmel joked that parents in Los Angeles are “more scared of gluten than they are of smallpox.” Alexie’s vitriol and Kimmel’s barb invoke the history of smallpox and its eradication, a remarkable story that holds unexpected insights for today.

We are fortunate to live in a world without smallpox, a disease that once wrought terrible horror and death. Although some victims experienced only slight rashes, many more suffered greatly from fever, pustules, and hemorrhagic bleeding. Most people survived the experience with scars and sometimes blindness, but smallpox killed around 25 percent of its victims—an estimated 300 million deaths in the twentieth century. There was and is no cure for smallpox—only a preventative vaccine, which the U.S. Communicable Disease Center (now the Centers for Disease Control and Prevention [CDC]) and the World Health Organization (WHO) used to wipe out the disease in the 1960s and ’70s. In 1980 the World Health Organization officially declared smallpox eradicated—the only human disease (so far) deliberately wiped off the face of the Earth.

Today’s vaccination defenders like to point to smallpox eradication as an example of the importance of vaccination. But they misunderstand how the way we talk about vaccination has changed. Consider the venues for vaccination conversation. During the smallpox eradication program, most of the discussion happened among physicians, public health officials, and scientists—experts talking to experts about the relative benefits and costs of smallpox vaccination. Today, people of varying degrees of expertise and influence exchange ideas about vaccination on Twitter, Facebook, and other forms of social media that provide a soapbox for anyone with Internet access. In addition to presenting scientific papers to their colleagues, experts must now be as adept at Tweeting with laypeople, a challenge that smallpox eradicators did not face.

Today’s vaccination experts face another problem their smallpox eradicator forebears largely avoided: science is no longer widely regarded as infallible. Vaccination skeptics can and do point to a variety of broken promises about the safety of science: DDT pesticide, toxic polychlorinated biphenyls (PCBs) once widely used in manufacturing, and ozone-depleting chlorofluorocarbon compounds (CFCs). Such examples serve as “proof” that experts have been wrong before and might be wrong again, either because the science is incomplete or, more insidiously, because the experts answer to vested interests, like Big Pharma.

This process of questioning scientific authority had already begun during the smallpox eradication effort—Rachel Carson’s exposé of DDT’s hazards came out in 1962—but public health authorities rarely had to defend themselves against charges of ignorance or malfeasance. Today’s vaccination experts should not only understand this new environment of doubt, but also acknowledge that science has, in fact, been wrong. Such humility and honesty could help create a vaccination conversation in which skeptics are willing to listen to well-meaning and well-educated experts.

Vaccination proponents might more directly learn from smallpox eradicators when justifying the importance of vaccination for the wider community. Many skeptics, from vehement “anti-vaxxers” to ambivalent parents, express concern about what vaccines might do to their children. This is completely understandable, which is why pediatricians explain to parents how vaccines protect their children. But protecting one’s own children is not the sole, or even the most important, justification for vaccination.

By vaccinating my child, I prevent her from catching a harmful and potentially deadly disease, such as measles, that could spread to another child, and another, and another and so on. Participants in the smallpox eradication effort understood this fact: we vaccinate for everyone’s children. When officials at the CDC and WHO explained the value of smallpox eradication, they noted that it would save lives and money in the developed world. But smallpox eradication most directly improved lives in less-developed countries—while also benefitting all of humanity, then and into the future.

By thinking not just about my children, but our children, we might evoke that vision of cooperation and sense of responsibility, and move towards a meaningful conversation about vaccination.

Bob H. Reinhardt is executive director of the Willamette Heritage Center in Salem, Oregon. His book The End of a Global Pox: America and the Eradication of Smallpox in the Cold War Era is now available. Follow him on Twitter @bobhreinhardt.