Vaccine policy has been a topic of public debate in the United States for more than a century, with each era’s social and political context shaping attitudes toward immunization. The recent decision by the Centers for Disease Control and Prevention’s vaccine guidance committee to adjust recommendations for the COVID-19 booster and MMRV shot is part of a long history of government involvement in vaccination.
Elena Conis, professor of journalism and history at UC Berkeley, explored these developments in her book “Vaccine Nation: America’s Changing Relationship With Immunization.” She traces how federal policies and public perceptions have evolved alongside medical advances. For example, she notes that President John F. Kennedy’s support for federal vaccination funding occurred during a period when trust in science was high and national health was seen as critical during the Cold War.
Conis explains that from the mid-19th century, local boards of health gained authority to require vaccinations, but enforcement varied widely. “From the middle of the 19th century to the end of it, U.S. cities and states started to create more boards of health, many of which were imbued with the power to require the vaccination of their local populations. For several decades, these laws and regulations were enforced sporadically and unevenly. By the turn of the 20th century, there were boards of health with this authority across the U.S. Smallpox was also spreading at an alarming rate. So there were more and more clashes at the local level as these boards of health attempted to enforce mandatory vaccination in the context of a growing anti-vaccine movement,” said Conis.
A pivotal moment came in 1905 when the U.S. Supreme Court upheld states’ rights to enforce compulsory vaccination if it served public health interests without harming individuals. However, this ruling energized anti-vaccine groups further. “There’s a rough pattern: The more vaccines and the more force used to encourage or require vaccination’s widespread adoption, the more resistance we see in the population,” Conis observed.
Following California’s repeal of compulsory vaccination laws in 1921, public health officials shifted focus from mandates to persuasion until demand surged again during polio outbreaks in the 1950s. “When the polio vaccine came out in 1954, the U.S. public responded by saying they really wanted the vaccine, and they wanted the government involved to make sure everybody had access to it and it was safe,” said Conis.
Research linking vaccine mandates with lower disease rates led all states by 1980 to require children be vaccinated before starting school—a move followed by renewed skepticism about vaccines that persists today.
Since smallpox inoculation began in late 18th-century America, debates have continued over government roles versus individual choice regarding vaccines. Opposition has often drawn on arguments about personal liberty—sometimes influenced by European thinkers—and concerns about religious beliefs or risks associated with early vaccines.
“But people with anti-vaccine views in the 19th century also circulated two other arguments. One was that vaccination was anti-religion…The other was a risk-based argument,” said Conis.
Throughout history, both liberal groups such as abolitionists or child safety advocates and those aligned with libertarian ideals have supported vaccine opposition at different times.
Media has always played a role in spreading views on vaccines; however, digital platforms now allow information—including misinformation—to circulate faster than ever before. “Depending on your individual media habits, you’re going to see one set of ideas about vaccines presented to you over and over in your news feeds or social media, or you’ll see a completely different set,” Conis noted.
She concluded that increasing polarization makes understanding opposing perspectives on vaccination increasingly difficult.
