Freedom, Rights, and Vaccine Refusal: The History of an Idea

James Colgrove, PhD, MPH; Sara J. Samuel, MPH

Disclosures

Am J Public Health. 2022;112(2):234-241. 

In This Article

Abstract and Introduction

Abstract

We analyzed how activists opposed to vaccination have used arguments related to freedom, liberty, and individual rights in US history. We focused on the period from the 1880s through the 1920s, when the first wave of widespread and sustained antivaccination activism in this country occurred. During this era, activists used the language of liberty and freedom most prominently in opposition to compulsory vaccination laws, which the activists alleged violated their constitutionally protected rights. Critics attacked vaccination with liberty-based arguments even when it was not mandatory, and they used the language of freedom expansively to encompass individuals' freedom to choose their health and medical practices, freedom to raise their children as they saw fit, and freedom from the quasicoercive influence of scientific and medical experts and elite institutions. Evidence suggests that in recent years, vaccine refusal has increasingly been framed as a civil right. We argue that this framing has always lain at the heart of resistance to vaccination and that it may prove consequential for the rollout of COVID-19 vaccines.

Introduction

Organized opposition to vaccination has grown in strength and visibility in the United States over the past two decades because of a complex set of factors, especially the rise of the Internet as a medium for spreading misinformation and connecting likeminded activists. Historically and in the present day, vaccine-critical rhetoric has rested on two principal claims: (1) that vaccination is a dangerous procedure whose risks outweigh its benefits, and (2) that efforts to pressure or compel people to be vaccinated (or to vaccinate their children) violate individual rights.[1] A 2019 study of Facebook posts found that in recent years, arguments related to individual liberty have grown more prominent in antivaccination messaging, with vaccine refusers increasingly framing their choice as a civil right.[2]

In addition to the potential impact of this messaging on routine childhood immunization, the framing of vaccine refusal as an issue of individual liberty has potentially far-reaching implications for the use of vaccines to control the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. One of the most striking aspects of the COVID-19 pandemic in the United States has been the way that some members of the public have rejected public health measures as unacceptable intrusions on personal liberty. Measures designed to protect the common welfare and vulnerable members of the community, such as quarantine orders and recommendations or requirements for wearing face coverings, have repeatedly been met with opposition by small but vocal minorities who claim that public health interventions are a violation of rights by an overreaching and tyrannical government. Antimask protestors and antivaccination activists have presented their resistance to both measures as matters of personal liberty.[3]

"No idea is more fundamental to Americans' sense of themselves as individuals and as a nation than freedom," the historian Eric Foner writes.[4] Freedom is a protean concept, carrying different meanings across successive historical eras and encompassing political, legal, religious, and economic dimensions. Invocations of liberty in the context of vaccination have been similarly multifaceted. Most commonly, the language of liberty and freedom has been used in opposition to compulsory vaccination laws, for which alleged violations of constitutionally protected rights have been at issue. But critics have attacked vaccination with liberty-based arguments even when it was not mandatory. They have used the language of freedom expansively to encompass individuals' freedom to choose their health and medical practices, freedom to raise their children as they saw fit, and freedom from the quasicoercive influence of scientific and medical experts and elite institutions. In all of these cases, freedom-based arguments have been a reaction to the actual or perceived exercise of power, especially (but not only) by government.

We examine how claims related to liberties and rights have been used, substantively and rhetorically, in the arguments of antivaccination activists and organizations. Although there is evidence that this discourse has grown in salience in recent years, we argue that it has lain at the heart of resistance to vaccination since the 19th century. We focus on a five-decade period spanning the 1880s through the 1920s, which encompasses the first widespread and sustained wave of antivaccination activism in the United States. This period produced critical jurisprudence on the scope of liberty in the context of vaccination and other public health interventions, as well as numerous legislative and advocacy battles featuring lines of argument that continue to resonate in the present day.

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