The World Health Organization defines vaccine as “a biological preparation that improves immunity to a particular disease… and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.”[1] The preparation of microorganisms revolutionized the prevention of numerous diseases. Vaccines are the reason smallpox, polio, and many other diseases no longer affect nations that widely implemented vaccination measures. However, an issue of rights to one’s own body arises from modern mandatory vaccination laws. As we will discuss later, Foucault’s theory of biopower[2] plays an integral role when dissecting the intricacies of mandatory vaccination laws. First, we will go into depth regarding the history of vaccination and the production of the first vaccines.
The history of vaccination cannot be told without first diving into the subject of inoculation. To inoculate means “to introduce immunologically active material (such as antibody or antigen) into especially in order to treat or prevent disease.”[3] The earliest signs of inoculation originate from 10th century China, but the first explicit reference to inoculation was found in a 16th century document from China.[4] The idea of intentionally infecting the body eventually formed the basis for vaccines.
Edward Jenner, known as the “father of immunology,” was a pioneer who developed the first vaccine, a vaccine for smallpox.[5] During the late 1760’s, Edward Jenner learned of dairy workers in Rural England who almost never were afflicted with smallpox because they had already overcome a biologically similar disease, known as cowpox. After studying this phenomenon for almost two more decades, in 1796, Jenner used the pus from a person infected with cowpox and scratched it into the arm of a healthy eight-year-old boy. A few weeks later, Jenner inoculated the child with smallpox, observing that the child did not develop smallpox at any point afterwards.[6] Jenner continued his research and expanded his studies, determining that the vaccine was safe for adults and children.[7] Ultimately, the practice of inoculation was outlawed in England in 1840, due to vaccination, by way of cowpox, being much safer.[8]
In the 1880’s, Louis Pasteur developed new vaccinations for chicken cholera and anthrax, which kick started the second generation of vaccine production. During the 20th century, vaccines were produced to counteract measles, mumps, and polio, including many others. These diseases would normally be life-altering, affecting the ill throughout their lives, and cutting many of them short. Amongst the various microbiologists producing vaccines during this time, Maurice Hilleman stands out due to his incomparable productivity. Hilleman was responsible for the creation of over 30 vaccines, and of the fourteen vaccines most frequently given to children in the western world, Hilleman developed eight of them.[9] Although there were frequent advances and development of vaccines, there are still many diseases for which there are not vaccines.[10]
Vaccines face an economic impediment in addition to technological obstacles. Many diseases that most need a vaccine produced are predominant in poor countries. Companies are not incentivized to produce vaccines for those diseases because there is little potential for a profit. Even in wealthier countries, profits are relatively low. Many vaccines are produced through public funding from governments, universities, and non-profit organizations.[11]
Figure 1, above, provides a visual overview of vaccine production for certain diseases. The timeline spans from early 20th century to early 21st century and demonstrates the astonishing rate of vaccine production. Vaccine production sped up to an unprecedented degree during the 20th century.
In the early 20th century, many countries passed compulsory vaccination laws as well, to help eradicate many diseases.[12] While this was to reduce singular incidents of disease, it also worked because of the idea of herd immunity. Herd immunity indirectly protects people of certain population because other members of the population are immunized to the disease. If a large percentage of a population is immunized to a disease, and a few members are infected, the outbreak of the disease would be contained because a majority of people who come into contact with the diseased would already be immune. Because most people are not infected with the disease, there are few chances for the disease to spread and it is unlikely that the diseased would come into contact with those who are not vaccinated, as demonstrated by Figure 2.[13] This theory has it’s drawbacks, however. Herd immunity is prone to the “free-rider” problem. While many people in the community would willing vaccinate themselves, so as to avoid any personal costs or risks, some would choose to avoid any consequences from the vaccinations and rely upon herd immunity to protect them from disease instead. Herd immunity falls apart when there is not a critical mass of members who have been vaccinated and exposes those who might be medically unable to receive a vaccination, like the elderly, those with allergies, or those with severe chronic conditions.[14]
While the idea of vaccinations seems unimpeachable, many take issue when vaccinations become compulsory. As of now, there is no federal vaccination law in the US, but all fifty states require children to be vaccinated for diphtheria, tetanus, and measles, among others.[15] All fifty states allow for medical exemptions (where one might not be able to handle the vaccination due to medical reasons), forty-seven allow for religious exemptions (where one believes that vaccinations go against one’s religious beliefs), and seventeen allow for philosophical exemptions (where one does not believe in vaccinations in general).[16] Some countries have more strict vaccination laws, such as Slovenia, where children must be vaccinated for nine different diseases before they begin school.[17] When thinking about mandatory vaccination laws using Foucault’s theory of biopower, one frames the issue of vaccination entirely as a form of control over one’s body.[18] The process through which vaccinations are achieved demonstrates the state’s control over one’s body, even though the end result is beneficial. That is to say, a state’s control over a body could be entirely positive, such as the broad improvement of health brought through vaccines, but it is still demonstrable loss of control. This loss of control can manifest itself in children and young adults as a form of medicalization. Foucault might say that even if one believes in vaccines, and programs behind them, making vaccines mandatory through the state is demonstrable loss of one’s own biopower.[19] One’s vaccination status can come to define who a person is and how they are allowed to interact with society, such as not being able to attend school with other children in their community without first being vaccinated.[20] Ultimately, vaccinations have generally been beneficial to the health of societies, but recent laws concerning vaccinations bring about a theoretical discussion regarding control over one’s own body.
[1] WHO | Vaccines. (n.d.). Retrieved March 1, 2018, from http://www.who.int/topics/vaccines/en/
[2] Foucault, M. (1976). The History of Sexuality. New York, NY: Vintage Books
[3] Definition of INOCULATE. (n.d.). Retrieved February 16, 2018, from https://www.merriam-webster.com/dictionary/inoculate
[4] Needham, J., & Gwei-Djen, L. (2000). Science and Civilisation in China: Volume 6, Biology and Biological Technology, Part 6, Medicine p. 134. Cambridge University Press.
[5] BBC – History – Edward Jenner. (n.d.). Retrieved March 2, 2018, from http://www.bbc.co.uk/history/historic_figures/jenner_edward.shtml
[6] Dunn, P. M. (1996). Dr Edward Jenner (1749-1823) of Berkeley, and vaccination against smallpox. Archives of Disease in Childhood – Fetal and Neonatal Edition, 74(1), F77–F78. https://doi.org/10.1136/fn.74.1.F77
[7] Baxby, D. (1999). Edward Jenner’s Inquiry; a bicentenary analysis. Vaccine, 17(4), 301–307. https://doi.org/10.1016/S0264-410X(98)00207-2
[8] Didgeon, J. A. (1963). Development of Smallpox Vaccine in England in the Eighteenth and Nineteenth Centuries. Br Med J, 1(5342), 1367–1372. https://doi.org/10.1136/bmj.1.5342.1367
[9] Maurice Hilleman. (2005, April 13). Retrieved from http://www.telegraph.co.uk/news/obituaries/1487746/Maurice-Hilleman.html
[10] Baarda, B. I., & Sikora, A. E. (2015). Proteomics of Neisseria gonorrhoeae: the treasure hunt for countermeasures against an old disease. Frontiers in Microbiology, 6. https://doi.org/10.3389/fmicb.2015.01190
[11] Olesen, O. F., Lonnroth, A., & Mulligan, B. (2009). Human vaccine research in the European Union. Vaccine, 27(5), 640–645. https://doi.org/10.1016/j.vaccine.2008.11.064
[12] Stern, A. M., & Markel, H. (2005). The History Of Vaccines And Immunization: Familiar Patterns, New Challenges. Health Affairs, 24(3), 611–621. https://doi.org/10.1377/hlthaff.24.3.611
[13] Fine, P., Eames, K., & Heymann, D. L. (2011). “Herd Immunity”: A Rough Guide. Clinical Infectious Diseases, 52(7), 911–916. https://doi.org/10.1093/cid/cir007
[14] Fu, F., Rosenbloom, D. I., Wang, L., & Nowak, M. A. (2011). Imitation dynamics of vaccination behaviour on social networks. Proceedings of the Royal Society of London B: Biological Sciences, 278(1702), 42–49. https://doi.org/10.1098/rspb.2010.1107
[15] State Vaccination Exemptions for Children Entering Public Schools – Vaccines – ProCon.org. (n.d.). Retrieved February 17, 2018, from https://vaccines.procon.org/view.resource.php?resourceID=003597
[16] State Vaccination Exemptions for Children Entering Public Schools – Vaccines – ProCon.org. (n.d.). Retrieved February 17, 2018, from https://vaccines.procon.org/view.resource.php?resourceID=003597
[17] Walkinshaw, E. (2011). Mandatory vaccinations: The international landscape. CMAJ : Canadian Medical Association Journal, 183(16), e1167–e1168. https://doi.org/10.1503/cmaj.109-3993
[18] Foucault, M. (1976). The History of Sexuality. New York, NY: Vintage Books
[19] White, M. D. (2014). Pros, cons, and ethics of HPV vaccine in teens—Why such controversy? Translational Andrology and Urology, 3(4), 429–434. https://doi.org/10.3978/j.issn.2223-4683.2014.11.02
[20] Engels, K. S. (2016). Biopower, Normalization, and HPV: A Foucauldian Analysis of the HPV Vaccine Controversy. Journal of Medical Humanities, 37(3), 299–312. https://doi.org/10.1007/s10912-015-9361-5
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