I'm Sunil Amrith, interim director of the Mahindra
Humanities Center at Harvard, for another installation
of our series of conversations on COVID-19.
I'm really pleased today to have with me Professor
Michael Willrich, whose [INAUDIBLE] professor
of history at Brandeis and author of Pox,
An American History, which was published back in 2011
and which, it seems, more timely than ever today.
Thank you so much, Michael, for joining us.
Well, thanks for having me.
It's great to be here.
I wonder if you could start by telling us
a little bit about the smallpox epidemic
that swept through the United States
at the very beginning of the 20th century and the course
that that epidemic took.
It was kind of a wave of epidemics, really, that
crested across the United States between 1898 and 1903,
ultimately affecting every state in the union
and most local communities from the South up to Alaska.
And also, there were outbreaks in the US colonial holdings,
possessions in the Philippines and in Puerto Rico.
So it was really the full picture of the United States
during this period.
And it was a really complicated set of epidemics
because some of them were of classic smallpox--
very severe, killing 25% of the people they infected,
the kinds of horrifying experiences
that were known to world history.
And some of them-- many of them, in fact--
were epidemics of a new strain of the virus that has since
been called variola minor to distinguish it
from the classic variola major.
And in this case, the case fatality rates
in local communities could be about 2%,
close to what we're seeing with COVID-19, or even as low as 1%
And so there was a lot of conflict over how
to diagnose these outbreaks.
And this also was one of the contributing factors
to all of the dissension around public health
during these epidemics.
A key argument in the book, of course,
is that this was a pivotal moment
in the history of public health in the US,
especially in terms of compulsory vaccination.
So what was the major legal and legislative shifts
that took place around this epidemic,
with legacies that, of course, continue to this day?
Yeah, so I mean, the power of local governments,
and state governments as well, to respond
to epidemics is part of what's known broadly as the police
power, the power to regulate or interfere
with individual liberty or property rights
in the name of the general welfare.
And public health has always been the strongest case
for this kind of power.
So quarantines, setting up isolation hospitals
and taking people there against their will,
the power to vaccinate people whether they
want to be vaccinated or not--
a whole set of technologies, old and new,
put into service during these epidemics.
How did things change?
Well, there was a mass of litigation
that came from people first at the states and then making
their way up to the federal courts and the Supreme Court,
ultimately, that challenged the right of state
and local governments to carry out compulsory vaccination,
whether as a requirement for children
to enter the public schools or whether it
was a requirement for anyone to leave
their homes during an epidemic.
And ultimately, the Supreme Court
confirmed the decisions of lower courts
that these measures were perfectly constitutional.
And the Supreme Court, in an opinion
that really drew on language from lower courts,
likened these powers to the powers of governments
to protect the people during a military invasion.
And so they said that the individual has no more right
to refuse this order than an individual had the right
to refuse a conscription order.
And so there's a very strong endorsement
of police power given by the Supreme Court,
but also a series of reservations and qualifications
that come in the same decision from 1905, including
a basic premise that these measures must be reasonable,
that they must be a response to actual necessitous
circumstances, and they must be carried out
in a way that really does the least
harm to individual citizens.
One other piece of the legal legacy
of these epidemics that's hugely important
is the development of a system of licensing and regulation
of vaccine production, which did not exist through these years
I'm talking about and which was one of the reasons
that the epidemics were and the public health response was
such a contentious matter.
Because governments were ordering people
to be vaccinated and people had their children
vaccinated, but those same governments did nothing
to ensure that the vaccines on the market
were effective and safe.
So the Biologics Control Act, which
came out of these epidemics, an act of Congress,
was also a hugely important legacy.
There were others, but these are two of the main ones.
One of the very powerful things you do [INAUDIBLE]
is to tell this as a story also of inequality [INAUDIBLE],,
particularly the ways in which immigrants
and African American communities were disproportionately
targeted for police action.
I wonder if you could say a little bit more about that.
Yeah, I mean, it has certainly strong resonances
today with what we're seeing.
First of all, immigrants and African American,
members of the working class generally in American cities,
but also in the rural South, were most vulnerable
to the disease of all the populations because of the way
that they were living in very thickly populated areas,
the way that they were largely neglected
by the medical establishment during normal times.
And then when the outbreaks occurred,
these same communities really were
the first to be targeted for quarantine and compulsory
So you have scenes on the Upper East Side, East Harlem
area of New York in 1901 in the winter of vaccination squads,
these teams of public health officers
and lancet-bearing physicians accompanied
by police with billy clubs going into tenement neighborhoods,
cordoning off blocks, entering the buildings
in the middle of the night, knocking on doors,
inspecting the premises, inspecting people's arms
to see if they had the scar of a recent vaccination--
if they didn't, ordering them to be vaccinated on the spot,
sometimes carrying these out by force.
There were riots.
There were people running, taking to the rooftops,
the whole thing.
But the most poignant moments in these episodes
were when public health officials had to--
or chose to or had to-- take children away,
infected children away from their mothers' arms
and take them off to the pest hospital, which
was in the middle of an island in the East River.
These were scary scenes, and they
were unimaginable in other parts, other more affluent,
wider areas of New York or other communities.
So race was a huge and ideas about race
were a huge animating factor throughout these epidemics.
So this is a story [INAUDIBLE] vaccination, but also
And there are very vivid descriptions
in the book of the pest houses.
What were conditions like in the pest houses?
How were they structured?
What was the experience like to the best of [INAUDIBLE]??
Yes, so I mean, every community during an epidemic
would throw together a pest house, usually,
in the smaller communities, by commandeering a house
at the edge of town and taking it over and then bringing
patients, bringing infected people
from around the community into this place.
In big urban centers like Boston and New York,
these pest houses would frequently
be located in buildings on islands like North Brother
Island in New York or one of the islands
in the harbor of Boston.
And then within them, there was very little
that doctors could do to treat smallpox other
than to try to treat people for discomfort,
try to provide some sort of basic sense of care.
But these spaces were understood to be places
where the poor were taken.
And they were reviled among working class people
in American communities, and they were reviled also
by people, often working class people as well,
in whose communities they would be placed during an emergency.
So there were many episodes I found
during my research of neighborhoods
rising up when a pest house had been put in their midst
and, in fact, tearing it down or burning it down,
sending it aflame--
obviously, driving the people out first.
But these were very, very controversial institutions
of a world gone by.
It reminds me a lot, actually, of the plague epidemic in India
at precisely the same moment in the 1890s
where the plague hospitals were reviled.
And they were reviled not just because of the intrusiveness
that they represented, but also because they
were places which, quite reasonably,
poor people thought they would be sent
to die because not that many people returned from some
of these institutions.
So there was a resonance there which
I certainly was struck by.
And people [INAUDIBLE] taken away from their families,
And in a way, in many of these communities--
and I think in India probably as well, right--
the best chances that infected people had of survival
was being cared for by family members who
would be constantly watching over them
and taking care of them, so yeah.
So another major theme of the book
is, of course, the theme of resistance to vaccination.
And you've already mentioned that briefly
in terms of the litigation.
But what forms did that resistance tale?
Yeah, so it took all kinds of forms--
and this became just a particular obsession for me,
was tracking these out-- but ranging
from organized resistance of groups
that formed anti-vaccination leagues,
had their own literature, not wildly
dissimilar from the anti-vaxxers today.
But from them, there were also groups
of working people who formed organizations,
very temporary organizations, to go down to a town hall
and demand that compulsory vaccination be ceased.
There were also parents who, with their children,
staged school strikes who would either withhold their students
from the schools or take them down to local schools
unvaccinated and demand that they be allowed to matriculate,
to take classes.
In closer quarters or in environments
where there's already a great deal of tension around race
or class, you see these sort of spontaneous riots
occur when the vaccinators show up on the scene.
But some of my favorite examples just
involves everyday subterfuge, like forging
And my favorite of all examples is the forging
of the vaccination scar.
So vaccination produced a distinctive cicatrix,
a nickel-sized scar usually on the arm where
the vaccine was carried out.
And health authorities actually looked for this scar.
They could recognize it.
They could discern how recently it had happened and so on.
And so some folks who wanted to pretend
that they had been vaccinated or that their children had
would take a little bit of nitric acid, quite diluted,
and put it on the skin at this place,
leave it on for about three or four minutes, and dab it off.
And it would leave behind, after a few days, a scar that
looked very much like a recent smallpox scar--
so people literally marking their bodies as forgery, yeah.
And in terms of the arguments they're
using against vaccination, are these arguments
about individual liberty?
Are they about safety?
How did those different factors come together?
Well, so this is one of the things that really, I think,
distinguishes this period, is because they had
so many good arguments to make.
So yes, personal liberty, constitutional liberty,
common law rights, parental rights, masculine rights-- all
of this rights discourse was very much powerfully invoked
during this period against what was a growing state.
But at the same time, there are arguments
about medical liberty, about thought,
about ideas, about freedom of conscience, which
were quite compelling to many observers
at the time in a period in which the regimentation
and regulation of medicine itself
was occurring at a very rapid pace.
Then there were the health concerns, which
were really quite reasonable.
Vaccine was the product of a combination of the stable
and the laboratory.
Vaccines were harvested from the underbellies of calves,
taking vaccinia-- or what previously had been cowpox back
in the day but, in the early 20th century,
would have been vaccinia virus-- from the sores on cows
and sometimes providing some sort of glycerin or some dish
additive in the laboratory that would stabilize it and remove
some of the impurities.
And then next thing you know, it's
being scraped into the arms of little children.
Well, many people had complications associated
with this, ranging from the very typical sore arm
and fever, which would put people out
of work for several days in a time
when there's no workers comp, no system for compensating
laborers who lose their wages temporarily.
Or in the worst cases that occurred,
vaccines became contaminated with tetanus spores.
And so there are episodes such as occurred in Camden in 1901
where children died of post-vaccination tetanus
that was traced to the tetanus itself.
So there are a host of arguments,
ranging from the libertarian to the very practical.
So to turn to our current moment-- and of course,
we're talking to each other from our houses on Zoom.
To turn to the current pandemic, governments, universities,
all of us as citizens are putting a lot of hope
that a vaccine against the coronavirus
will be found in the not-too-distant future.
Reading your book has reinforced to me, of course,
the sense that finding a vaccine is not the end of the story.
And I wonder if you could say a little bit more
about vaccination in society in our moment.
Yeah, I mean, whew.
I think most of us right now are pining for a good vaccine
or, really, for many, many vaccines
that would be effective, produced
in different countries.
But yeah, so I mean, there would need
to be decisions made about how vaccination would be carried
out, under what circumstances, where it would be required,
where it would be voluntary.
I mean, I think that initially, that the general public would
be running to this vaccine rather than away from it,
as was often the case in the early 20th century.
But in the past 15, 20 years, there's
been a rising anti-vaccination movement.
And if these protests out in front of statehouses
are any indication, we can expect that some of those folks
will object to any measure to make this COVID-19
And again, under our laws in the United States,
much has changed in the 20th century
and the early 21st century with the growth
of the federal government, but these are still
going to be state measures.
And so we can expect that there will
be wide variation among the states in terms of how they
carry out vaccination just as there is right now with regard
to social distancing, or there's a real conflict going on,
as you know, among different states.
Michael, thank you so very much for talking to us.
This has been absolutely fascinating.
It's been my pleasure.