By David Leonhardt
Nearly 60 million American adults — or about one of out every four — remain unvaccinated against Covid-19. They have made an irrational choice that exposes them to severe illness. But they have also made a choice with a long historical tradition.
In his State of the Union address on Tuesday, President Biden declared, “We will never give up on vaccinating more Americans.” And Biden is right that a continued vaccination campaign can do a lot of good, given that a large majority of Covid deaths and hospitalizations are still occurring among the unvaccinated and unboosted. The question, of course, is what arguments might win over any vaccine skeptics at this point.
Today, I want to use history — with some help from the filmmaker Ken Burns — to answer that question.
A West African pioneer
The original American advocate for inoculation against severe disease was arguably an enslaved man named Onesimus. Before being forcibly brought to Boston, Onesimus seems to have lived in West Africa, where inoculation was a common practice. There, he had been deliberately infected with a small amount of smallpox to make him immune from a more severe version.
In Boston, Onesimus told his owner, Cotton Mather, about the practice. Mather was among the colonies’ most prominent religious leaders in the 1720s. He was also keenly interested in science, as Burns told me when we spoke recently. Today, science and religion are often considered antithetical, Burns noted, but past religious leaders were scientific pioneers.
When smallpox began spreading in Boston in the 1720s, Mather campaigned for residents to be inoculated — and was met with fierce criticism and even an attempt to bomb his home. Some Bostonians argued that inoculation violated God’s will. Others, including doctors, argued that it was folklore that would do more harm than good.
These arguments were powerful because inoculation was so counterintuitive. Mather was claiming that people could avoid getting sick … by getting sick.
Modern vaccination is somewhat less counterintuitive, because drugs can now teach the immune system to respond to a deadly virus, without having to use small amounts of an actual virus. But vaccination is still a strange notion. It involves the injection of a mysterious cocktail of foreign substances into the human body.
That’s why nearly every new vaccine — even the life-changing polio vaccine — has had its skeptics. The skepticism has increased in recent decades, as Americans have become less trusting of institutions and experts, as Elena Conis, a medical historian, has written.
Historically, the two most effective responses to vaccine skepticism have been government mandates and relentless, calm persuasion. But broad Covid-vaccine mandates are probably unrealistic in the U.S. today, thanks to a combination of a Supreme Court ruling and widescale public opposition. Persuasion will probably have to do most of the work.
Persuasion tends to require taking seriously the concerns of skeptics and creating opportunities for doctors, nurses, relatives, friends and other trusted people to explain why vaccination can be counterintuitive and yet lifesaving. “As a doctor, I was always trained you never give up on people — you show up,” Dr. Vivek Murthy, the surgeon general, told me yesterday. “You build trust by listening to people, helping them feel they’re respected and valued.”
In Mather’s time, one such evangelist for inoculation was Benjamin Franklin. Along with several other founders — including George Washington, John Adams and Thomas Jefferson — Franklin himself was persuaded. Yet he still had a tragic relationship with smallpox inoculation.
As the disease was sweeping through Philadelphia in 1736, he and his wife, Deborah, initially decided not to inoculate their 4-year-old son Francis, known as Franky. The boy was sick with a cold and the Franklins worried that his body would not be able to handle the side effects of inoculation. Soon, though, Franky contracted smallpox and died.
“This is the great tragedy of Franklin’s life,” Burns told me. “Deborah and Benjamin Franklin were just beset by this mistake they made even though it was completely understandable.” (Burns has just posted a six-minute “extra” film clip about Franky and inoculation, and it’s powerful. Next month, PBS will air Burns’s new documentary, “Benjamin Franklin.”)
When rumors spread in Philadelphia that Franky had died from the inoculation rather than the disease itself, Franklin took the painful step of writing the true story in his newspaper, The Pennsylvania Gazette. In the years that followed, he tried to persuade others to avoid his family’s fate.
“Surely parents will no longer refuse to accept and thankfully use a discovery God in his mercy has been pleased to bless mankind with,” Franklin wrote, in a pro-inoculation pamphlet. “For the loss of one in 10 thereby is not merely the loss of so many persons, but the accumulated loss of all the children and children’s children the deceased might have had, multiplied by successive generations.”
In the U.S. today, the death toll from Covid has exceeded 950,000, and many of those deaths occurred after vaccines were available. It is a tragic pattern that’s consistent with history: Vaccination tends to be both counterintuitive and highly effective.
Credit: New York Times Morning Letter