Last week, New York Mayor Bill DeBlasio announced extraordinary measures to counter the growing measles outbreak among the ultra-Orthodox Jewish community in Williamsburg, Brooklyn. The decision to declare a health emergency and order mandatory vaccinations of the whole community represents the strongest state response to a mounting public health crisis in decades.
The controversy over measles outbreaks among ultra-Orthodox Jewish communities in New York City and its surrounds has become a flash point amid the growing national controversy over the resurgence of the anti-vaccination movement. Last month, a judge denied the suit of three dozen parents in Rockland County, just north of New York City, to have their unvaccinated children readmitted to the Green Meadow Waldorf school. In the past few weeks, however, parents in Rockland pulled off a partial victory when a judge halted a ban on unvaccinated children being allowed in public places.
With 465 cases of measles reported in over 19 states, state agents elsewhere are taking equally strong actions. Late last month, police in Arizona raided a house with unvaccinated children, removing them from their parents’ care. In 2015, California became the first state to remove exemption clauses from school vaccination laws. The policy has led to a notable uptick in vaccination rates, except in many charter and private schools.
While much of the public debate on the anti-vaxxers centers on their skepticism about the science and safety of vaccination, a deep-seated resentment of state power also courses through the movement. Indeed, it is critical to recognize that much of what fans the flames of the anti-vaccination movement is a vehement defense of parental rights and a rejection of the state’s powers over children.
In that respect, the anti-vaccination movement is just a particularly divisive manifestation of a broader political trend in which parents choose to opt out of public schooling and tangle with authorities over everything from school busing to textbooks. That is why communities with larger and long-standing disputes with the state over schooling, whether it is the ultra-Orthodox Jewish community of Brooklyn, the home-schooling movement or parents more broadly opposed to public schools, end up being the epicenters of anti-vaccination controversies.
In the United States, compulsory vaccination campaigns have targeted children since their inception at the turn of the last century. As smallpox epidemics swept across the country in the late 19th century, city and public health officials first attempted wide-scale vaccination campaigns by tying vaccination requirements to newly enacted compulsory school attendance laws.
It was a sound policy for both medical and administrative reasons. First, as school population swelled in the United States, crowded classrooms, particularly in urban areas, quickly became incubators for the spread of infectious diseases. Second, the growing apparatus of public schools presented a unique site for public health campaigns. Because children were legally defined as dependents, the state possessed more power over children than it did over the adult population. States could not compel adult citizens to submit to vaccination, but they could compel children to attend school and then make vaccination a requirement for entry.
Tying public health campaigns to public schooling was an effective strategy with great reach. By 1915, 20 million children, or one-fifth of the total population of the United States, attended public schools each day under state compulsion. Based on the success of using schools to vaccinate children, public health officials broadened their campaigns. By 1923, 39 states had compulsory school medical examinations in addition to vaccination requirements.
From the outset, however, compulsory vaccination laws pitted some parents against the state. As is true today, the fact that children’s bodies were at play only intensified the stakes. In towns and cities, committed anti-vaccinationists, who opposed the science of vaccination, whipped up public opposition by playing to parents’ fears. Many parents joined their ranks because they resented the idea that the state could strip them of the prerogative to make decisions on their children’s behalf, and came to question the safety of vaccination along the way.
In many respects, the strategies of anti-vaccination activists in the early 20th century presaged much educational activism over the past half-century. In 1911, in the affluent suburbs of northern New Jersey, 350 families in Bergen County avoided vaccinating their children by threatening to move en masse to create a new school district if vaccination requirements were enforced. In Massachusetts, mothers’ leagues worked to create private schools where their children would be exempt from vaccination laws. Around the nation, anti-vaccination networks funded (unsuccessful) legal challenges that demanded that the state provide separate public schools for unvaccinated children.
The resistance to school vaccination laws was also strongest in minority communities that were already wary of the state intervening in religious and familial life. In 1901, the predominantly Mormon population of Utah passed a law that prohibited any state authority from excluding unvaccinated children from schools, with the legislature voting to override a gubernatorial veto. As with the ultra-Orthodox Jewish population at the center of the current controversy, there was no official religious edict against vaccination. Nonetheless, after a long struggle for statehood in which the Mormon practice of polygamy had proved to be a sticking point, many Mormons were suspicious of any intrusive state dictate, particularly with regard to the family and their faith. The problem wasn’t vaccines, it was state power.
Yet despite the parallels between the anti-vaccination movement at the turn of the century and today, anti-vaccination sentiment was not a constant across the 20th century. Indeed, it has ebbed and flowed in tandem with broader public attitudes toward the state. By World War I, as nationalist sentiment swelled, anti-vaccination sentiment waned. It lay relatively dormant throughout the world wars and in the immediate postwar period as public confidence in government soared.
In the late 1960s, however, as public trust in government plummeted because of the Vietnam War, urban crises and Watergate, anti-vaccination activism resurged.
It was no coincidence that the late 20th century also saw battles over schooling explode over questions of desegregation, school prayer and sex education. Like anti-vaccine activists in the early 20th century, furious parents sought to fight back against what they perceived to be state policies forced upon their children that ran contrary to their child’s best interest and offended their personal values and religious beliefs.
Parents flocked to new private schools and began to home-school their children in record numbers. Others sought to carve out exemptions for their children at public schools to enforced state policies such as busing, and fought to overturn prohibitions on school prayer to create public schools that reflected their values.
Schools have long been a highly fraught political battleground, and it is in this broader context of parents struggling to opt out of state policies they opposed with respect to their children’s schooling that the anti-vaccine movement is thriving today.
This context should also shape our approach to addressing the crisis. Certainly, vaccination policies that target children are a necessary and effective strategy as an immediate measure to contain this public health crisis and prevent others. And although compulsory vaccinations that target children make a lot of sense from a public health standpoint, they also risk compounding and entrenching the sentiment and fear of parents underlying the anti-vaccine movement.
We need to fully reckon with the root causes of this sentiment by having a broader conversation about when parents can and can’t opt out of state policies affecting their children. Vaccinating children and preventing outbreaks is only one — albeit crucial — element of a solution. We also must rebuild the faith that parents have in schools and public institutions to do what is best for their children.