AbstractThis article, based on an analysis of English language medical literature on mumps' manifestation in men, women and children from the late eighteenth to the early twentieth century, examines the role of gender in shaping conceptualisations of mumps' severity and medical significance. Over time, gendered social roles undermined the medical notion of mumps as a severe disease of women while elevating mumps' reputation as a severe and significant disease of men, eventually casting the disease as a threat to masculinity. When the modern mumps vaccine was commercialised in the 1960s, its development built on a long history of gendered conceptualisations of mumps and its use cast children as safeguards of a legacy of masculine citizenship defined by military activity and fatherhood.
The modern era of vaccination was heralded with the licensure of the first 2 measles vaccines in 1963. This new era was distinct from the preceding era of vaccination for 4 main reasons. First, federal leadership in support of immunization at the local level grew. Second, immunization proponents championed the required vaccination of children as the best means of ensuring a protected population. Third, immunization proponents championed the idea that mass vaccination would not only help manage infectious diseases but also eradicate them. Fourth, the focus of local and federally supported immunization initiatives began to extend to the "mild" and "moderate" diseases of childhood (eg, measles), so-called because they were seen as less severe than previous targets of mass vaccination, such as smallpox, polio, and diphtheria. This article follows the history of measles to explore immunization successes and challenges in this modern era, because measles was the first of the mild and moderate diseases to become the target of a federally supported eradication-through-vaccination campaign, one that relied heavily on the preemptive, required vaccination of children. Its story thus epitomizes the range of political, epidemiological, cultural, and communications challenges to mass immunization in the modern era of vaccination.
In the decade following hepatitis B vaccine's 1981 approval, U.S. health officials issued evolving guidelines on who should receive the vaccine: first, gay men, injection drug users, and healthcare workers; later, hepatitis B-positive women's children; and later still, all newborns. States laws that mandated the vaccine for all children were quietly accepted in the 1990s; in the 2000s, however, popular anti-vaccine sentiment targeted the shot as an emblem of immunization policy excesses. Shifting attitudes toward the vaccine in this period were informed by hepatitis B's changing popular image, legible in textual and visual representations of the infection from the 1980s through the 1990s. Notably, the outbreak of AIDS, the advent of genetically engineered pharmaceuticals, and a Democratic push for health reform shaped and reshaped hepatitis B's public image. Hepatitis B thus became, in turn, an AIDS-like scourge; proof of a new era of pharmaceuticals; a threat from which all American children had a right to be protected; and a cancer-causing infection spread by teenage lifestyles. The metamorphosis of the infection's image was reflected in evolving policy recommendations regarding who should receive the vaccine in the 1980s, and was key to securing broad uptake of the vaccine in the 1990s.
In two centuries of vaccination in the U.S., the last five decades constituted a unique era. American children received more vaccines than any previous generation, and laws requiring their immunization against a litany of diseases became common. Vaccination rates soared, preventable infections plummeted, and popular acceptance of vaccines remained strong--even as an increasingly vocal cross-section of Americans questioned the safety and necessity of vaccines and the wisdom of related policies. This dissertation examines how and why, between the 1960s and 2000s, Americans came to accept the state-mandated vaccination of all children against a growing number of infections despite the growing prominence of vaccine doubts. I argue that vaccines and vaccine policies fundamentally changed the ways health experts and lay Americans perceived the diseases they were designed to prevent. Second, I demonstrate that vaccination policies and their acceptance throughout this period were as contingent on political, social, and cultural concerns as they were on scientific findings. Thirdly, I show how, as new vaccine policies took shape, feminism, environmentalism, and other social movements laid challenge to scientific and governmental authority, with profound--but previously overlooked--implications for how Americans perceived vaccination. Finally, I argue that the relationship between vaccination beliefs and political ideology is more complex than historians have heretofore asserted, for selective and blanket vaccination doubts at the end of the twentieth century were as informed by leftist critiques of capitalism and social hegemonies as by traditional American libertarian ethics. This work draws on a diverse set of sources, including presidential archives; government agency records and publications; popular and scientific print media; television broadcasts; newsletters; internet archives; documents and publications at chiropractic libraries; and the personal files of vaccine scientists and critics. It contributes to the histories of disease, women, the environment, and health politics, as well as the sociology of social movements. By placing public health knowledge in historical context, this dissertation illuminates the many meanings of vaccination that lay between that of gold-standard disease preventive and hotly contested enterprise at the end of the twentieth century and the beginning of the twenty-first.
Language used to describe measles in the press has altered significantly over the last sixty years, a shift that reflects changing perceptions of the disease within the medical community as well as broader changes in public health discourse. California, one of the most populous U.S. states and seat of the 2015 measles outbreak originating at Disneyland, presents an opportunity for observing these changes. This article offers a longitudinal case study of five decades of measles news coverage by the Los Angeles Times and the San Francisco Chronicle, which represented two of the largest news markets in California when the measles vaccine was released, in 1963, and during the 2015 outbreak. Measles reporting during this period displays patterns pointing to an active role for journalists in shaping public understanding of health and medical matters, especially as they recede from public memory, through the employment of available and circulating political and cultural frames. Moreover, journalistic frames in this period of reporting incorporated presentist descriptions of the disease, which imposed present values on the medical past, and which were constructed of decontextualized historical references that supported prevailing contemporary notions of the disease. Framing and the tendency toward presentism, in the context of shifting public health discourse, had the effect of communicating an increasingly severe sounding disease over time, and of shifting blame for that disease's spread from nature to government to individuals. Journalistic framing and causal stories have much power to shape public understanding of medical matters as they recede from public memory.
