By Alberto Giubilini
(Cross-posted from the TORCH Medical Humanities blogpost)
It was a pleasure to host Professor Elena Conis (UC Berkeley) to deliver the inaugural lecture of the Medical Humanities program “Immunity and the Humanities”, supported by the Uehiro Oxford Institute.
Elena Conis is one of the most prominent historians of medicine and the author, among other things, of Vaccine Nation. America’s Changing Relationship with Immunization (University of Chicago Press, 2016). The book provides an engaging historical illustration of the main idea behind our MedHum program, namely, as she writes, that “vaccines have never been merely medical, but always infused with politics, social values, and cultural norms”. In her lecture, Prof. Conis guided the audience through the societal and political tensions that, historically, vaccines exemplified and often contributed to.
One would be tempted to think there is one, straightforward explanation for why vaccines have historically enjoyed this societal and cultural status. Yet, what the lecture suggested – to me at least – is that the search for “the” factor that renders vaccines special compared to most other medical technologies might overlook the complexity of the phenomenon.
For example, it might seem straightforward to think that the historical association of vaccines and mandatory vaccination explains the tensions around them. However, as Prof. Conis explained, for large part of their history, vaccines were only sporadically made mandatory, especially in the early days. Yet, societal and scientific tensions accompanied them from the beginning. The first “vaccine” – Edward Jenner’s inoculation with cowpox to protect from smallpox – was introduced as an alternative to the well-established, though less safe, practice of variolation, the purposeful infection of small doses of smallpox itself to confer immunity. This challenge to the status quo was also a challenge to the societal and scientific acceptance of the new practice. But even after vaccines became the established immunization technology, societal tensions, expectations, and polarizations around them did not diminish. They merely shifted their focus onto other underlying cultural, societal, and scientific dynamics.
For instance, Prof Conis explained that, while vaccines were for 150 years almost exclusively associated with smallpox prevention, the 20th Century saw a proliferation of new vaccines. By mid-century, vaccination increasingly targeted children. And as more vaccines were introduced in the middle of the 20th Century in conjunction with antibiotics, expectations of disease eradication became inflated with unprecedented optimism.
It is perhaps partly because of expectations around their public health impact that the focus of vaccine discourse has shifted between the individual and the collective over the course of vaccination’s history. To the extent that the latter became more pervasive over time, the justification for vaccination-based public health policies grew stronger. Gradually, vaccines stopped being only a matter of individual health and became also, if not predominantly, a matter of public health. Traditionally, public health is the remit of government intervention. Thus, vaccine discourse intersected broader cultural and societal phenomena of resistance to different types of authority and establishment, from governments to “the” science to pharmaceutical companies. It’s no surprise, then, that resistance to vaccines often found expression in the various countermovements of the 20th century, such as the feminist revolution, disability rights advocacy, anti-capitalistic resistance.
As someone working in public health ethics, I have found these historical considerations particularly illuminating. It is relatively easy for those working in my field to make a straightforward argument for why vaccines should or should not be mandatory, or what forms mandates should or should not take. But to the extent that these arguments presuppose contested tradeoffs among values, we tend to forget that the relative weight of the conflicting values depends, at least in part, on cultural contexts and historical developments.
For instance, we could perceive as logically strong an argument in favour of vaccine mandates based on a duty to fairly contribute to the public good of herd immunity. However, such fairness-based arguments need to assume that a duty of fairness prevails over a right to bodily autonomy. While this is plausible, the opposite take is not implausible, either. Across cultural contexts and historical moments, reasons for prioritizing individualistic or collectivist values might differ. My colleagues in philosophy might shudder at the relativistic undertones of this consideration. However, to the extent that fairness and autonomy are both fundamental, widely shared values, it is hard to see how the reason for prioritizing one over the other can be based on philosophical reflection alone. The cultural meaning and broader societal implications of each of these two values in different contexts can provide reasons for why one or the other should be prioritized at different times and in different places.
The discourse is, of course, way more complex than this sketch can convey, both in the historical and the ethical dimension. These brief considerations are simply meant to illustrate how the type of historical reflection that Prof Conis’ work promotes can be relevant to understanding not only the history, but indeed the current ethics and politics of vaccination.
As the range of diseases targeted by vaccines expands, including non-infectious and non-contagious ones (such as cancer), the complexities of vaccine discourse will only multiply. Perhaps there is some scope for historians, philosophers, and other humanities scholars to contribute to a better understanding and better handling of this phenomenon. One of the goals of the “Immunity and Humanities” program is precisely that of exploring interdisciplinary, humanities-based approaches to public health issues. In light of this, I could not think of a better way of kicking off the program than Prof. Conis’ lecture. More academic and public engagement events are being prepared, and I invite you all to keep an eye on the Medical Humanities website for updates.