Debates over public health and personal liberty can seem utterly of the moment in response to new and evolving threats -- an outbreak of measles at Disneyland this year triggered California politicians to put the law forward. And remember when the scary specter of Ebola triggered some politicians to implement mandatory quarantines for physicians and nurses who traveled to Africa to treat Ebola patients -- over the objections of public health experts?
But a flashback to our nascent nation in the summer of 1776 -- when liberty was pretty much the topic of the day -- can reveal just how long the debate over government health policies has been running, and how the meaning of "freedom" has changed when it comes to access to preventive medicine. In Boston, the first Independence Day was preceded by inoculation day, when the Massachusetts general court abolished a ban on inoculating people against small pox. Only people who wanted to be inoculated or had already had the disease were allowed in the city. To leave the city before the inoculation period had ended, people needed the permission of a doctor or judge.
"They posted guards at the entry to the towns. ...When the Declaration of Independence was first read in Boston, Abigail Adams was there with a whole bunch of people who were sick with smallpox," said Andrew Wehrman, a history professor at Central Michigan University.
Two years earlier, 20 men in Marblehead brought torches and tar to burn down a new hospital -- not because of corporate fascists who were forcing them to get vaccines, but to protest the high-cost system that was shutting the poor out from access to small pox inoculations.
In his forthcoming book, The Contagion of Liberty, Wehrman recounts how the expansion of inoculation was intertwined with the American Revolution itself. The freedom to inoculate was happily received in Boston, he wrote:
"Ezekiel Price, a court official and insurance broker, declared, 'Liberty is given for to inoculate for the small-pox; many begin upon it this afternoon.' Hannah Winthrop, the wife of Harvard mathematics professor John Winthrop, described the scene: 'Boston has given up its Fears of an invasion & is busily employd in Communicating the Infection. ... Men Women & children eagerly crowding to inoculate is I think as modish as running away from the Troops of a barbarous George was the last year.'"
The scientific consensus on the value of vaccines is clear: they are the medical innovation that – after clean water and hygiene – is one of the biggest boons to public health in human history. But strict laws such as California's (Mississippi and West Virginia have similar ones) can seem to some like an authoritarian scheme that threatens carefully guarded personal liberties. Even public health experts who unequivocally think that vaccination needs to be more widespread are unsure whether despite good intentions, the new law could backfire and have the unintended consequence of strengthening the anti-vaccination movement.
“It may galvanize those parents who are sitting on the fence and unsure to be against vaccines,” said Daniel Salmon, deputy director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health. “If you look at the anti-vaccine groups in this country they’re actually pretty small. They’re loud, but they’re small. My concern is there are a lot of parents that have concerns, and my concern is it’s going to push [those] people in the wrong direction.”
If anything, history teaches us that debates over public health and liberty predate government as we know it and are likely to rage on -- although no one expects any hospitals to be burnt down in 2015.
Instead of mandatory vaccinations, Wehrman said U.S. medicine has largely been guided by an idea he traced to an influential medical textbook called Domestic Medicine, in which public health policies help reinforce "custom, which was the strongest of all laws. If you didn’t vaccinate, there would be enough pressure on you. Ostracism from the community would be enough."
At the least, the situation in California might be seen as an experiment -- when custom breaks down and outbreaks occur, what is the best solution? Will a strict new law mean more children will be vaccinated and measles declines, or will the anti-vaccine movement gain strength?