PARENTAL NARRATIVES OF VACCINATION PRACTICES 
IN THE STATE OF OREGON 
 
 
 
 
 
 
 
 
by 
ZOE CAMERON 
 
 
 
 
 
 
 
 
 
 
A THESIS 
 
Presented to the Department of Human Physiology  
and the Robert D. Clark Honors College  
in partial fulfillment of the requirements for the degree of  
Bachelor of Science 
 
June 2019 
 
 
 
 
 
An Abstract of the Thesis of 
Zoe Cameron for the degree of Bachelor of Science 
in the Department of Human Physiology to be taken June 2019 
 
 
Title:  Parental Narratives of Vaccination Practices in the State of Oregon 
 
 
 
Approved: _______________________________________ 
 
Professor Melissa Graboyes 
 
 
 
 
 
In public health, vaccines are widely regarded as the most effective protection method 
against communicable diseases and are credited with greatly reducing incidence of 
diseases and their serious effects. That being said, there is a growing community of 
individuals who continually question the safety and efficacy of vaccines and 
subsequently choose to not vaccinate their children and instead claim non-medical 
exemption. In the state of Oregon, the 2017-2018 K-12 non-medical exemption rate was 
4%, compared to the national average of 2%. Thus, as a means of exploring this 
complex issue, three interviews were conducted with parents who live in Oregon, do not 
vaccinate their children and claim non-medical exemption. These interviews were 
analyzed through an interdisciplinary approach, combining historical and social 
contexts and perspectives as a means of better understanding the drivers of vaccine 
refusal. It was found that in interviews with this subset of parents, there were three main 
themes which emerged: historical similarities of arguments against vaccination during 
the 1800s and the present; feelings of little to no of autonomy due to mandated, 
compulsory vaccination; and distrust of government and pharmaceutical companies.  
 
 
 
ii 
 
 
 
Acknowledgements 
First and foremost, I would like to thank Dr. Melissa Graboyes for her 
mentorship, guidance and continued support over the past three years and especially 
during this thesis process. I’d like to thank her for introducing me to public and global 
health and providing me with the opportunity to be part of her research group. Thank 
you for your interdisciplinary expertise, attention to detail and patience – they have not 
gone unnoticed in the slightest. I would also like to thank Dr. Mary Wood and Dr. Clare 
Evans for being my second and third readers. Thank you for not only serving on my 
committee but for your support, advice and feedback throughout this process.  
In addition, I would like to thank Dr. Judith Raiskin for connecting me to Dr. 
Evans and for supporting me this year in both the classroom and my public health 
endeavors. I would also like to thank Dr. Patrick Luedtke for his extensive public health 
expertise in our multiple conversations regarding vaccination practices in Lane County 
– without him, I would not have thought to choose this topic.  
Lastly, I would like to thank Dr. Barbara Mossberg, who has supported me, 
cheered me on and pushed me to find my inner Genius the past four years both in the 
Honors College and abroad. I am forever grateful for her dedication to my education 
and encouraging me to pursue all my interests, no matter how different they may be. 
To my friends and family, your support has been instrumental not only during 
this process, but the past four years. Without you, I would not be where I am today. 
Thank you.  
 
 
 
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Table of Contents 
 
Chapter One 1 
Introduction 1 
Literature Review: Defining Vaccine Hesitancy and Refusal 6 
Literature Review: Exploring Arguments Against Vaccination 9 
Methods 13 
Roots of the Contemporary Anti-Vaccination Movement in the United States 16 
Chapter Two 23 
Historical Similarities in Arguments Against Vaccination Past and Present 23 
Chapter 3 40 
Vaccine Compliance: Exploring the Freedom of Choice 40 
Chapter Four 48 
Examining Vaccine Distrust: Profit, Safety and Bias 48 
Chapter Five 58 
Conclusions and Recommendations 58 
Appendix A 62 
List of Interview Questions – adapted from World Health Organization 
Vaccine Hesitancy Survey 62 
Bibliography 63 
 
  
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List of Figures  
 
Figure 1.1 Herd Immunity 21 
Figure 2.1 “The Cow Pock” by James Gillray, 1802 36 
 Figure 2.2 “Vaccination” by Charles Williams, 1807 38 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
v 
 
 
 
List of Tables  
 
Table 1.1 Top ten Oregon counties with highest non-medical exemptions 2017-2018 3 
Table 1.2 State of Oregon K-12 Vaccination Data 2017-2018 4 
Table 1.3 Lane County, Oregon K-12 Vaccination Data 2017-2018 5 
Table 1.4 Categorical comparison of vaccine hesitancy and refusal 8 
Table 1.5 Reasons against vaccination 10 
Table 1.6 Seven common arguments against vaccination 11 
Table 1.7 Comparison of parent attitudes per chapter in vaccine refusal 16 
Table 1.8 Benefits of vaccine use on disease, disease severity and protection 19 
Table 2.1 Vaccine excipient and media summary - CDC, 2018 30 
Table 3.1 Shows two official United States Supreme Court cases and their major 
holdings from 1905-1922 46 
Table 4.1 Reactions to various vaccines 49 
Table 4.2 Programs established by the National Vaccine Injury Act, United States 1986
 52 
 
 
 
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Chapter One 
Introduction 
In January and March 2019, Clark and Rockland counties in Washington and 
New York States each declared a state of emergency (Lambert, 2019; NBC New York, 
2019). The culprit? Measles. 
 Measles, also known as rubeola, is both a communicable and vaccine-
preventable disease characterized by fever, cough, runny nose and a systemic rash. It is 
highly contagious and spreads through coughing and sneezing. Though it was declared 
eradicated in the United States in 2000 by the Centers for Disease Control and 
Protection (CDC), as of April 2019, 704 confirmed cases of measles were reported to 
the CDC from 22 states (Centers for Disease Control and Prevention, 2019). According 
to the CDC, while these outbreaks were linked to those who have brought measles back 
from other countries--Israel and Ukraine, for example, who were experiencing large 
outbreaks--many of those who contracted the disease were those who had not received a 
dose of the MMR (measles, mumps, rubella) vaccine. In Rockland County of New York 
alone, 79.7% of those with measles did not receive a dose of the MMR vaccine, as 
opposed to the 5.2% with measles who received at least one dose (Rockland County, 
2019).  
 So why the state of emergency? And why fuss over one disease? 
 Vaccines are considered the “gold standard” preventative measure in public 
health against communicable diseases. Communicable diseases, or infectious diseases, 
are “caused by microorganisms such as bacteria, viruses, parasites and fungi that can be 
 
 
 
 
spread directly or indirectly from one person to another” (World Health Organization, 
2017). A vaccine preventable disease (VPD) is a disease that can be prevented with a 
vaccine (Centers for Disease Control and Prevention, n.d.-c). According to the CDC, a 
vaccine is a “product that stimulates a person’s immune system to produce immunity to 
a specific disease, protecting the person from that disease.” Vaccines can be introduced 
via injection, or in some cases (i.e. the flu), a nasal spray.  
 Immunity, however, is defined as protection from an infectious disease. This 
makes it so that people can be exposed to the disease without getting infected. The 
terms “vaccination” and “immunization” are the processes of introducing vaccines to 
produce immunity against an infectious disease for an individual and are used 
interchangeably (Centers for Disease Control and Prevention, n.d.-a).In the case of the 
measles, the MMR vaccine is used as the preventative measure. 
 Though public health and the medical community advocate for vaccines as the 
best preventative measure against communicable diseases, the safety and efficacy of 
vaccines is continually debated amongst a growing population of individuals globally in 
what is called the “anti-vaccination movement” in the United States. This population, 
which consists primarily of parents, can be viewed as a spectrum: on one end of the 
spectrum are the “vaccine-hesitant,” which according to the World Health Organization 
Strategic Advisory Group of Experts (SAGE), refers to “delay in acceptance or 
approval of vaccines despite availability of vaccination services.” On the other end of 
the spectrum, however, are the “vaccine rejectors” who reject vaccination completely 
(Dubé et al., 2013). From the 2014-2015 measles outbreak in Disneyland to the most 
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recent measles outbreaks in Washington and New York, anti-vaccine populations have 
been increasingly the subject of the media and under intense scrutiny. 
In Oregon, children grades K-12 must receive a series of vaccines to attend 
school (Oregon Health Authority, 2017). It does not matter if this school is private, 
alternative, public or a charter school—they must all comply with the government-
mandated, required vaccinations. By February 20th of each school year, parents must 
comply to the vaccination requirements for their children or claim medical or non-
medical exemption, otherwise children will be sent home and unable to attend school.  
 In the 2017-2018 school year, the state of Oregon’s non-medical vaccine 
exemption rate was at 4% for grades K-12, compared to the national average of 2% 
(Mellerson et al., 2018; Oregon Health Authority, 2019). Locally, in Lane County 
alone, the non-medical exemption rate for grades K-12 was similar to that of the state 
average at 5%, earning a spot in the top ten Oregon counties with the highest number of 
non-medical exemptions. 
Table 1.1 Top ten Oregon counties with highest non-medical exemptions 2017-2018 
 
Table 1.1 Shows the top ten Oregon counties with the highest K-12 non-medical 
exemption rates, 2017-2018 (Oregon Health Authority, 2018) 
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Figure 1.1 Map of the state of Oregon and its counties 
Figure 1.1 Shows a map of the state of Oregon and its counties; starred counties 
indicate top ten counties with highest K-12 non-medical exemptions 2017-2018 (see 
Table 1.1) (University of Alabama, n.d.) 
Table 1.2 State of Oregon K-12 Vaccination Data 2017-2018 
 
Percent of K-12 aged Number of K-12 aged school 
school children in children in Oregon 
Oregon (%) 
Non-medical 4 15,498 
exemptions 
Medical exemptions 0 780 
Table 1.2 Shows Oregon K-12 vaccination data from 2017-2018 taken from 1,797 
schools with a total enrollment of 604,725; 127 schools displayed no data, for 10 
students or less were enrolled (Oregon Health Authority, 2018) 
4 
 
 
 
Table 1.3 Lane County, Oregon K-12 Vaccination Data 2017-2018 
 
Percent of K-12 aged school Number of K-12 aged 
children in Lane County, school children in Lane 
Oregon (%) County, Oregon 
Non-medical 5 1,376 
exemptions 
Medical 0 28 
exemptions 
Table 1.3 Shows Lane County K-12 vaccination data from 2017-2018 taken from 159 
schools with a total enrollment of 46,405; 12 schools displayed no data, for 10 students 
or less were enrolled (Oregon Health Authority, 2018) 
I approached this topic wondering, why does Oregon have such a high rate of 
non-medical exemptions? What are the main drivers and motivators which influence 
parents who choose to not vaccinate their children? Though I do not have the data to 
answer these questions, this thesis presents a small amount of evidence about the 
current vaccination climate within a subset of Oregon parents. 
This thesis analyzes parental narratives from interviews with 3 Oregon parents 
who choose to not vaccinate their children by relying on a non-medical exemption. 
From these interviews, I discuss and highlight three main themes: the similarities of 
arguments against vaccination from the 1800s in the United States and England today; 
parents’ contemporary distrust of government and pharmaceutical companies; and 
parents’ concerns about limits to their autonomy due to mandatory, compulsory 
vaccination. This thesis takes an interdisciplinary approach with secondary historical 
materials and analyses of 3 interviews.   
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Literature Review: Defining Vaccine Hesitancy and Refusal 
When speaking about the anti-vaccination movement, it is important to 
understand those involved. By categorizing the motivations and drivers of refusal 
amongst parents, one can better understand the factors which influence the decision-
making process as to whether or not one vaccinates their children. That being said, it is 
difficult to broadly categorize these groups of parents for the arguments against 
vaccination are widely varied and diverse.  
According to the World Health Organization Strategic Advisory Group of 
Experts (SAGE), vaccine hesitancy refers to the “delay in acceptance or approval of 
vaccines despite availability of vaccination services,” for “vaccine hesitancy is complex 
and context specific varying across time, place and vaccines. It includes factors such as 
complacency, convenience and confidence.” While the WHO suggests that these 
determinants be assessed in a systematic manner to “explore the individual, group and 
contextual influences,” researchers Eve Dubé and Caroline Laberge in the review titled 
“Vaccine hesitancy: an overview” claim that vaccine hesitancy models proposing 
acceptance or refusal are difficult to use, for despite the growing number of articles 
referring to vaccine hesitancy, “there are some discrepancies among publications about 
what exactly falls under the umbrella of ‘vaccine hesitancy’” (Dubé et al., 2013). Dubé 
and contributors claim that because these models are often rooted in “individual 
studies” and “complex interaction of social, cultural, political and personal factors in 
vaccine decision,” it is difficult to have a “clear picture of the range of possible attitudes 
about vaccination.”  
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 That being said, past studies have categorized vaccine refusal as a dichotomous 
phenomenon, where parents are either “for” or “against” vaccination (McIntosh, Janda, 
Ehrich, Pettoello-Mantovani, & Somekh, 2016; Poland & Jacobson, 2001). However, 
other researchers claim that vaccine refusal should be viewed as a spectrum, for several 
factors influence parents’ decision-making and attitudes surrounding vaccination 
practices (Gust et al., 2005). In the study “Immunization attitudes and beliefs among 
parents: beyond a dichotomous perspective,” Gust and collaborators identify five types 
of parental attitudes regarding vaccination from parent responses to 44 questions 
involving beliefs in vaccination safety, involvement in health issues, family and friend 
influences on vaccination, etc. These include the “immunization advocates” and “go 
alongs to get alongs,” who strongly agreed immunizations are necessary; the “health 
advocates,” who only slightly agreed that immunizations are necessary and remained 
neutral to the serious immunization side effects; the “fence sitters,” who only slightly 
agreed that vaccines are necessary and safe; and the “worrieds,” who slightly disagreed 
vaccines are necessary and disagreed that vaccines are safe.  
 This same categorization method can be seen in another study, titled 
“Qualitative Analysis of Mothers’ Decision-Making About Vaccines for Infants: the 
Importance of Trust,” where Benin and collaborators investigate the decision-making 
process of vaccinating infants by addressing attitudes to vaccination, knowledge about 
vaccination and decision-making. It was found that the participants could also be 
categorized, this time into four groups: the “acceptors,” who accepted vaccination; the 
“vaccine-hesitant,” who accepted vaccination but had significant concerns about 
vaccinating their infants; the “late vaccinators,” who purposely delayed vaccinating or 
7 
 
 
 
chose only some vaccines; and the “rejectors,” who completely rejected vaccination 
(Benin, Wisler-Scher, Colson, Shapiro, & Holmboe, 2006; Dubé et al., 2013). 
Table 1.4 Categorical comparison of vaccine hesitancy and refusal 
Study/Researchers Categories 
Gust et al., 2005 1. Immunization advocates 
2. Go alongs to get alongs 
3. Health advocates 
4. Fence sitters 
5. Worrieds  
Benin et al., 2006 1. Acceptors  
2. Vaccine-hesitant  
3. Late vaccinators 
4. Rejectors  
Table 1.4 Gives a comparison between the categories of vaccine hesitancy and refusal 
from studies by Benin et al., 2006 and Gust et al., 2005 
 Because existing studies have been largely quantitative or based on hypothetical 
decision-making about vaccination, they may not have adequately assessed the specific 
range of attitudes parents use when deciding to vaccinate their child (Benin et al., 2006; 
Gellin, Maibach, & Marcuse, 2000; Robison et al., 2003). According to Benin and 
researchers, a qualitative study is best for evaluating parental attitudes for “qualitative 
research provides a framework for describing social phenomena,” such as 
comprehension and behaviors that are “based on complex beliefs that may be difficult 
to measure in a standardized quantitative manner.” Similar methodology can be seen in 
the World Health Organization’s survey titled “Determinants of vaccine hesitancy,” 
which aims for an in-depth understanding of the issues that drive vaccine hesitancy 
around the globe. In this thesis, a qualitative model is used to explore the attitudes and 
beliefs held by Oregonian parents against vaccination. While it combines some 
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quantitative data to illustrate the vaccination rates throughout both Lane County and the 
State, the main driver of this thesis is qualitative data. Thus, by utilizing a qualitative 
model to evaluate the social, historical, economic and individual influences, perhaps 
researchers may better understand the complexity that is vaccine hesitancy. 
 
Literature Review: Exploring Arguments Against Vaccination 
As rates of vaccine refusal increase among a growing population, it is important 
to investigate the reasoning behind it. For research purposes, they can be categorized 
into broad categories in an attempt to better understand the motivations of each parent. 
That being said, no two arguments are alike, nor are two parents’ reasoning alike. Thus, 
when reading through arguments that are either for or against vaccination, one should 
consider the spectrum of “vaccine hesitant” parents that may be included within each 
argument.  
 According to a study titled “Exploring the Reasons Behind Parental Refusal of 
Vaccines,” researchers McKee and Bohannon propose four reasons against vaccination. 
These consist of religious reasons, personal beliefs or philosophical reasons, safety 
concerns and desire for additional education, where they argue that the greatest reason 
parents refuse vaccines is due to safety concerns, most of which are based on 
“information these parents have discovered in the media or received from 
acquaintances” (McKee & Bohannon, 2016). McKee and Bohannon also note that 
within each of these subsets, there exists a “spectrum of compliance with vaccination, 
including delaying vaccinations, only refusing certain ones, or refusing immunizations 
completely” (McKee & Bohannon, 2016).  
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Table 1.5 Reasons against vaccination 
McKee et al, 1. Religious reasons 
2016 2. Personal beliefs or philosophical reasons 
3. Safety concerns 
4. Desire for additional education 
Table 1.5 Gives reasons against vaccination from the study titled “Exploring the 
Reasons Behind Parental Refusal of Vaccines” (McKee & Bohannon, 2016) 
 At a more local level, in a study titled “What Ashland Parents Told Us About 
Vaccines and Religious Exemptions,” researchers from the State of Oregon 
Immunization Program created a Community Vaccine Survey (CVS) to better 
understand Ashland parents’ perceived risks and benefits of immunization, “the sources 
of information that parents depend upon, and how these may lead parents to consider a 
religious exemption to school immunization requirements for their children.” Like 
McKee and Bohannon, the majority of these arguments included concerns around 
vaccine safety, vaccine schedules and vaccine efficacy, with one parent claiming they 
would “trust vaccine recommendations more if they didn’t push immunizing 2-month-
olds” (Robison et al., 2003). Unlike McKee and Bohannon, however, this study argues 
that the decision to not vaccinate is based on “a balance between perceived risk and 
perceived benefit from vaccination,” which emphasizes parents’ belief (or lack thereof) 
in vaccine safety. 
 In a review titled “Vaccine Rejection and Hesitancy: A Review and Call to 
Action,” Smith also cites common arguments against vaccination, however they argue 
that most objections are “cached in language that makes them highly palatable to 
parents and difficult for scientists to object to,” with terms such as “informed consent,” 
10 
 
 
 
“health freedom,” and “vaccine safety.” The arguments referenced are included in the 
following table: 
Table 1.6 Seven common arguments against vaccination 
Argument Vaccines are “toxic” and contain antifreeze, mercury, ether, aluminum, 
1 human aborted fetal tissue, antibiotics and other dangerous chemicals 
that can lead to autism and an assortment of chronic health conditions 
Argument Vaccines are a tool of “Big Pharma;” individuals who promote them are 
2 merely profiting off of harm to children and/or paid off by 
pharmaceutical companies 
Argument A child’s immune system is too immature to handle vaccines; they are 
3 given “too many, too soon” and the immune system gets 
“overwhelmed,” leading to autism and an assortment of chronic health 
conditions 
Argument “Natural immunity is better;” most vaccine-preventable diseases are 
4 harmless to most children, and natural exposure provides more long-
lasting immunity 
Argument Vaccines have never been tested in a true “vaccinated vs. unvaccinated” 
5 study; the vaccines in the current schedule have never been tested 
collectively 
Argument Diseases declined on their own due to improved hygiene and sanitation 
6 
Argument Vaccines “shed;” therefore, cases of vaccine-preventable diseases in the 
7 population are driven by the vaccinated, not unvaccinated 
 Table 1.6 Shows seven common arguments against vaccination according to the review 
titled “Vaccine Rejection and Hesitancy: A Review and Call to Action;” adapted from 
Hausman et al, 2014; Kata, 2012; Kata, 2010; and Smith, 2016 
Smith summarizes in the article that many of these arguments are due to one of 
three components: distrust in medical science, distrust of the pharmaceutical companies 
which manufacture the vaccines and the overwhelming of the immune system. She 
claims that arguments against medical science are those which emphasize the harms and 
risks associated with the ingredients in vaccines, such as aluminum and thimerosal 
11 
 
 
 
(Smith, 2017). Arguments against pharmaceutical companies, however (also known as 
“Big Pharma”), are concerned with the profit-driven motives of pharmaceuticals and 
associated physicians that could potentially benefit as well, while arguments against 
vaccines due to their effects on the immune system stem from concerns for “vaccine 
overload” on the immune system and advocate for natural immunity instead (Smith, 
2017). Smith argues that while these arguments have “been used for well over a 
century,” they are “recycled and updated to better reflect the modern science landscape 
and language,” which could possibly explain the historical similarity and continuity of 
arguments against vaccination across time.  
 Similar to Smith, in the study titled “‘Poisonous, Filthy, Loathsome, Damnable 
Stuff’: The Rhetorical Ecology of Vaccination Concern,” researchers Hausman, 
Ghebremichael, Hayek and Mack explore arguments against vaccination, however they 
do so through rhetorical analysis, arguing that a rhetorical approach “offers a way to 
understand how discourses are engaged and mobilized for particular purposes in 
historical context.” This is done by investigating why certain arguments are “persuasive 
to particular people at discrete points in time, how persuasiveness might continue across 
historical periods, and how discourses circulate and change as they are applied to new 
circumstances” (Hausman, Ghebremichael, Hayek, & Mack, 2014). Like Smith and 
McKee and Bohannon, this study provides a qualitative basis for arguments against 
vaccination in the 21st century. Unlike the two studies, however, this study pinpoints 
where certain arguments fit in within historical context and framework and the 
implications of each argument for the future (Hausman et al., 2014). 
 
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Methods  
Initial recruitment of subjects began in December 2018, a month shy of the 
January 2019 measles outbreak in Clark County, Washington. Before the outbreak, 
seven parents who either I contacted or reached out to me via Facebook Messenger 
expressed great interest in participating in the study. During and after the outbreak, 
however, many parents declined to participate. Parent A, who participated in this study, 
reached out to their social circle to gather interest. When no one returned their 
messages, they explained to me that it was possible that parents were fearful their words 
would be used against them or the research itself was biased or subjective to those who 
supported vaccines. Ultimately, 3 parents agreed to participate (1 in person and 2 via 
email) and it is these interviews that provide the basis for this thesis. This project was 
reviewed and approved by the University of Oregon IRB as protocol 11012018.001. I 
focused my attention on the Eugene Waldorf School and the Eugene Village School, the 
two schools with the highest non-medical exemption rates in Lane County, which I 
determined by publicly available data (Oregon Health Authority, 2019). I contacted 
both school administrations with thorough explanations regarding the background and 
goals of the project. I also contacted Facebook groups such as the “Vaccine Friendly 
Plan,” “Oregonians Against Mandatory Vaccinations,” “Oregonians for Vaccine Truth 
and Healthcare Choice,” and “Oregonians for Medical Freedom” and shared my project 
description, seeking participation.  
Seven subjects were recruited by January 2019. When the measles outbreak 
made news and gained attention from the media, four of those parents declined to 
participate in the study. An amendment was then submitted to the University of Oregon 
13 
 
 
 
IRB and the study was opened up to the state of Oregon, where subjects were contacted 
solely through Facebook with the option of doing interviews in person or via email. One 
subject was interviewed in person at a Eugene coffeeshop and signed a written consent 
form. Their answers were audio recorded on an iPhone 6S and transcribed by myself. 
Two subjects were interviewed via email and the subject electronically signed a consent 
form.  
Interview questions were drawn from a list of 54 questions adapted from a 
World Health Organization (WHO) sample survey titled “Vaccination Hesitancy” listed 
in Appendix A. The questions were developed by the WHO to “better understand the 
drivers of vaccine hesitancy in specific settings or around vaccines - specifically or in 
general” (SAGE Working Group on Vaccine Hesitancy, 2013).The survey consists of 
three sections, categorized by the type of influence. The first section, titled “Contextual 
Influences,” focuses on influences arising due to “historic, socio-cultural, 
environmental, health system/institutional, economic or political factors;” the second 
section, titled “Individual and Group Influences,” focuses on influences arising due to 
“personal perception of the vaccine or influences of the social/peer environment;” and 
the third section, titled “Vaccine/Vaccination Issues,” focuses on issues “directly related 
to vaccine or vaccination” (SAGE Working Group on Vaccine Hesitancy, 2013). 
Out of the 54 questions, 17 were copied and/or modified and used for 
interviews; however, they were not organized in the same manner as the WHO survey. 
The first half of questions were organized to learn the subjects’ background, their 
vaccine knowledge and entities they trusted or did not trust. The second half then used 
this foundation of beliefs to explore their overarching beliefs about vaccines, those who 
14 
 
 
 
make them and those who enforce them. Questions omitted from this interview were 
excluded based on their redundancy; those included were either modified as a 
combination of two questions or left out altogether. At the end of the research process, 1 
interview was conducted in person; the last 2 were collected via email.  
Three semi-structured interviews were collected for this study where the key 
themes from the interviews were analyzed with an interdisciplinary approach. Each 
chapter explores one of three arguments, each seeking to connect the content to 
historical themes. Chapter two introduces the anti-vaccination movement in the United 
States and provides contextual and historical evidence of similarities of anti-vaccine 
arguments in American and British society during both the 1800s and the present. 
Chapter three focuses on parental concerns surrounding feelings of limited autonomy, 
and chapter four focuses on parental concerns regarding distrust of government and the 
pharmaceutical industry.   
Throughout this thesis, parents from each interview will be referred to as Parent 
A, Parent B and Parent C. To maintain anonymity and privacy, demographics such as 
names, age, occupation, education level, location, ethnicity and number of children 
were not collected. However, the following table helps to describe the personalities of 
each parent and their main attitudes surrounding vaccines for each chapter: 
 
 
 
 
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Table 1.7 Comparison of parent attitudes per chapter in vaccine refusal 
Parent In person Sex Lack of autonomy Distrust of 
interview government/Big 
or email? Pharma/medical 
A In person Female Large advocate for medical Concerned with “blindly 
freedom and freedom of trusting” the government; 
choice; believes that each believes that government 
individual should make their organizations making 
own decisions based on their decisions based on 
“own genetics, religion, “outside influences” and 
intuition, [and] philosophical “financial interests” 
beliefs” 
B Email Female Unconcerned with the Distrusts the government 
medical choices of others, but and “inappropriate 
bothersome when vaccination relationships” between 
practices are imposed upon government agencies and 
them; feels people are “being pharmaceutical 
brainwashed to get companies; believes that 
vaccinated” the government is “not an 
unbiased player in the 
vaccine game” 
C Email Female Believes that the choice to Believes that the 
refuse vaccination, like any “government is not 
medical procedure, is a “basic making any efforts to 
human right;” concerned with bring safe products to 
lack of honesty in market” for “they are not 
communicating the harms of doing mandatory safety 
vaccines studies, they carry all the 
liability”  
 
Roots of the Contemporary Anti-Vaccination Movement in the United States 
 In 1998, British enterologist Andrew Wakefield and his colleagues published a 
study in the Lancet claiming there was a purported link between the measles, mumps 
and rubella (MMR) vaccine and autism (Godlee, Smith, & Marcovitch, 2011). The 
Lancet, founded in 1823 by Thomas Wakley as a means of “[making] science widely 
available so that medicine can serve, and transform society, and positively impact the 
16 
 
 
 
lives of people,” has since served as the second-oldest medical journal and a reputable, 
trusted source of information (The Lancet, 2019). Thus, after the Wakefield study was 
published, it made its rounds among the general public and medical community and 
caused a monumental stir. For example, in Britain, vaccination rates dropped to 80%; in 
America, celebrities such as Jenny McCarthy endorsed these fears, suggesting that her 
son’s autism diagnosis at 2 ½ stemmed from a series of required vaccinations (Frontline 
& Public Broadcasting Station, 2015; Godlee et al., 2011). If they had not already, this 
caused some parents to either question or refuse vaccination, fearful their child may 
either develop autism or suffer from chronic side effects and issues stemming from 
vaccines (Stern & Markel, 2005).  
 In 2014, Dr. Erik Kodish, a medical ethicist from the Cleveland Clinic wrote in 
the Washington Post, saying that “The anti-vaccination movement is a relatively new 
one that has taken hold over the past decade. Started by a small community of parents, it 
is based on myths that have been perpetuated by the power of the Internet and 
endorsements from celebrities” (Hausman et al., 2014). The idea that the 21st century 
anti-vaccination movement is relatively new—new, meaning within the last thirty 
years—continues to crop up among those attitudes and preconceived notions in regard 
to public health. Especially with the rise of the Internet and social media platforms such 
as Facebook and YouTube, the widespread, rapid dissemination of information is 
prominent now more than ever. And yet, despite influences such as media, celebrities 
and a study such as Wakefield’s, the anti-vaccination movement is not new; arguments 
against vaccination predate modern arguments by at least 200 years, if not more. So 
long as vaccines have existed, so has its opposition. However, to better understand this 
17 
 
 
 
issue, it is important to examine each side—more specifically, those views of the pro-
vaccine community and those of the anti-vaccine community. While the following 
section presents the various pro-vaccine views, the rest of this thesis will focus on those 
views of the anti-vaccine community. 
Vaccines were initially developed as a means of protection against the recurring 
smallpox epidemics in England and the United States (Stern & Markel, 2005). While 
“vaccine” here refers to the vaccine developed by Edward Jenner based on his findings 
with smallpox immunity, similar practices called “inoculation” were practiced in Africa 
and Asia as early as the 1600s and served as the precedent to the modern vaccine 
(Herbert, 1975). Today, vaccines are the “gold standard” in public health as a means of 
protecting large communities against communicable diseases. According to researchers 
Andre et al at the World Health Organization, “vaccine safety gets more public attention 
than vaccine effectiveness” and they assert that “a comprehensive vaccination program 
is a cornerstone of good public health and will reduce inequities and poverty” (Andre et 
al., 2008). In their study titled “Vaccination greatly reduces disease, disability, death 
and inequity worldwide,” Andre et al discuss the various vaccine benefits against 
disease, disease severity and vaccine protection, claiming that “the best way in the long 
term is to refute wrong allegations at the earliest opportunity by providing scientifically 
valid data.” Thus, as an attempt to fully articulate the extent to which they believe 
vaccines have aided society, these benefits are outlined in the following table: 
 
 
 
18 
 
 
 
Table 1.8 Benefits of vaccine use on disease, disease severity and protection 
Benefit How it has benefited 
Eradication of disease Unless an environmental reservoir exists, an eradicated 
pathogen cannot emerge (i.e. smallpox), allowing 
vaccination to be discontinued as a preventative 
measure 
Elimination of disease With the use of vaccine, diseases can be eliminated 
locally without global eradication of the causative 
microorganism; for example, elimination of measles 
from United States in 2000 
Control of mortality, Vaccines may protect those if administered before 
morbidity and exposure and help prevent 6 million deaths annually 
complications worldwide 
Mitigation of disease Disease may occur in previously vaccinated 
severity individuals; however, secondary infections are usually 
milder than in the non-vaccinated individual 
Prevention of infection Some vaccines protect against infection (i.e. hepatitis 
A) and are referred to as “sterilizing immunity”  
Protection of Vaccination of certain percentage of population 
unvaccinated population protects unvaccinated individuals 
Table 1.8 Discusses the several vaccine benefits researchers Andre et al have proposed; 
these benefits form the basis of many pro-vaccine arguments (Andre et al., 2008) 
A large concern in the pro-vaccine vs. anti-vaccine debate is the last vaccine 
benefit, which involves the protection of unvaccinated populations. To ensure immunity 
amongst a population, a certain percentage of the community must be vaccinated. 
Certain diseases, depending on their contagion level, require different percentages of 
the population to be vaccinated. Thus, the more contagious the disease, the higher the 
percentage of the population needs to be vaccinated. For instance, in the case of 
measles, 90-95% of people must be vaccinated to ensure protection (Oxford Vaccine 
Group, 2016). This concept, also known as “herd immunity,” is used to protect not only 
19 
 
 
 
those who are vaccinated, but those who cannot be vaccinated due to immunodeficiency 
disorders such as HIV/AIDS, or those with cancer and undergoing chemotherapy. These 
people are at the highest risk for disease and rely heavily upon the rest of the population 
to be vaccinated so as to ensure their safety and protection, for their immune systems 
cannot withstand vaccines (Oxford Vaccine Group, 2016).   
 The following figure was taken from the Oxford Vaccine Group and given as a 
visual representation of this concept. There are two panels which represent a vaccinated 
population and an unvaccinated population. Each circle represents a person; those 
highlighted in red represent those persons that are immunodeficient, whereas those 
highlighted in green represent those that are vaccinated. Those that are highlighted in 
orange represent persons who carry disease and infect others with it, regardless of 
whether or not they present symptoms. In the unvaccinated population, once the orange 
reaches a red, immunodeficient circle, the disease can severely affect the individual and 
cause them to get very sick or even die. In the vaccinated population, however, once the 
orange reaches a green vaccinated circle, that person is protected and does not pass on 
the disease. Though the figure only shows a small representation of a population, it 
should be noted that for herd immunity to work, a certain percentage of people must be 
vaccinated.  
20 
 
 
 
Figure 1.1 Herd Immunity 
 
Figure 1.1 Shows the representation of herd immunity in both vaccinated and 
unvaccinated populations. Each circle represents a person; orange circles represent 
those who have been infected by disease and pass it on; red circles represent those who 
are immunodeficient and green circles represent those who are vaccinated; yellow 
circles represent those protected by the green vaccinated people (Oxford Vaccine 
Group, 2016) 
Because herd immunity relies on a certain percentage of the population to be 
vaccinated, those individuals who vaccinate can be especially critical of those 
individuals who choose not to, especially when it comes to their children. Pro-vaccine 
parents accuse anti-vaccine parents of child negligence, while those in the medical 
community become increasingly frustrated with anti-vaccine parents who refuse 
vaccines or request a different schedule (Hausman et al., 2014). In an attempt to combat 
the growing movement, various studies have been conducted as a means of 
simultaneously addressing the misconceptions of vaccination while encouraging anti-
vaccine parents to vaccinate, but to no such avail (Jarrett, Wilson, O’Leary, 
21 
 
 
 
Eckersberger, & Larson, 2015; Nyhan, Reifler, Richey, & Freed, 2014; Smith, 2017). 
Instead of increasing vaccination rates, these pro-vaccine messages and campaigns have 
an opposite effect where anti-vaccine parents become increasingly frustrated and 
isolated for their choices.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Chapter Two  
Historical Similarities in Arguments Against Vaccination Past and Present 
 This chapter explores the arguments against vaccination in the 1800s and the 
present, specifically within the United States and Britain. Prior historical research 
demonstrates that many of the arguments from the 18th and 19th centuries are very 
much similar to those seen today. It is also important to note that three hundred years of 
arguments against vaccination presents a large range of varying ideas, opinions and 
attitudes that are difficult to neatly categorize. Thus, this section is one example of  
historical themes and attitudes regarding vaccination in the 1800s. 
In 1706 colonial America, the Atlantic Slave Trade was in full swing and 
smallpox frequented the region in epidemic form (Herbert, 1975). Smallpox, caused by 
the Variola virus, is a communicable disease characterized by systemic rash of small, 
red sores and fever (Centers for Disease Control and Prevention, 2016a). Because there 
is no treatment for smallpox, a person may easily contract the disease and die. Thus, as 
smallpox continued to ravage the Atlantic Coast, people struggled to find methods to 
tame the disease. Though there were very few preventative measures, some were 
fortunate enough to overcome the disease and were left with the scars as reminder. 
Many, however, were not so lucky and lost their lives in the process (Herbert, 1975).  
In the same year, scientist, physician and Reverend Cotton Mather of Boston, 
Massachusetts was given a slave whom he named Onesimus. Like many slave-owners 
of the time, Mather inquired if Onesimus had smallpox, to which Onesimus replied that 
yes, he had and explained to Mather the phenomenon known as inoculation—or in other 
23 
 
 
 
words, the process of “transferring smallpox artificially from someone infected with the 
disease to someone who is not but hopes thereby to contract a mild case and subsequent 
immunity.” Mather later recorded this experience in his “Sentiments on the Small Pox 
Inoculated,” where he wrote: 
And then told me, he had undergone an Operation, which had given him 
something of the Small-Pox & would forever praeserve him from it; 
adding that it was often used among the Guramantese, & whoever had 
the Courage to use it, was forever free from the fear of Contagion 
(Herbert, 1975).  
His curiosity piqued, Mather’s interest prompted further investigation in 
smallpox inoculation, leading him to similar cases in which other slaves in the area also 
exhibited immunity to smallpox (Herbert, 1975). When another smallpox epidemic hit 
Boston in 1721, Mather was prepared to use his smallpox inoculation knowledge and 
further urged the colonies to adopt this method of prevention. Though the epidemic of 
1721 affected over 6,000 of the 11,000 citizens and took the lives of 850, it was 
Mather’s use of inoculation he learned from Onesimus that was one of the first well-
documented, widespread use of inoculation to combat the epidemic (Niederhuber, 
2014). 
Despite attempts to control the disease, Mather’s inoculation campaign 
prompted public criticism and opposition from the medical community. At the forefront 
of the anti-inoculation movement was Dr. William Douglass, one of the only men who 
actually held a medical degree in Boston and opposed Mather’s method based on  
religious reasons (Niederhuber, 2014). Douglass argued that inoculation “violated 
divine law” by “inflicting harm on innocent people” while also arguing that inoculation 
24 
 
 
 
was untested and based on folklore, for unchecked use of inoculation would ultimately 
quicken the spread of disease rather than contain it (Niederhuber, 2014).  
Though these events took place mid-eighteenth century, the arguments against 
inoculation foreshadow those against vaccination today. In a 2017 review titled 
“Vaccine Rejection and Hesitancy: A Review and Call To Action,” Smith cites seven 
different contemporary arguments against vaccination (Chapter I, Table 1.6). 
Arguments from the review include: vaccines pose increased risk due to and contain 
toxic, harmful ingredients, such as aluminum and thimerosal; natural immunity is better, 
for “most vaccine-preventable diseases are harmless to most children, and natural 
exposure provides more long-lasting immunity;” and diseases declined not as a result of 
vaccinations, but as a result of improved hygiene and sanitation (Smith, 2017).  
To better understand how Parents A, B and C viewed vaccination, they were 
asked if they believed there are other, better ways to prevent vaccine-preventable 
diseases than a vaccine. Each parent said yes. “Absolutely 100% there are better ways,” 
said Parent B:  
In addition to researching each vaccine, I have also researched every 
disease there is a vaccine for, how it is contracted, the percent chance of 
a healthy person in the US getting the disease, the positive attributes that 
come about from getting the disease, the negative attributes to getting the 
disease, how many people in the US have died from the disease, and 
what western and natural treatments are indicated for prevention and 
treatment of the disease. 
Parent C shared they prefer "Homeopathy, better hygiene, plumbing and water 
infrastructure, prevent social scales that reduce homelessness and refuse,” while Parent 
A “[thought] there are wonderful ways to stay healthy, yeah.  
25 
 
 
 
Sanitation, um, healthy eating, clean water, um [another pause to think], 
plumbing, those—those things have, uh, greatly reduced diseases. Hand 
washing, I’m a big fan of that and yeah, just, um, and definitely, I 
definitely use herbs and you know, natural medicines and salts and stay 
healthy in an alternative way… I have a lot of medical practitioners and 
that sort of thing that don't just go with you know, every vaccine's great 
and everybody should get every vaccine, and they you know, they 
challenge different aspects of that.  
While these arguments are similar to those referenced by Smith, they also echo 
those arguments made by the first anti-vaccinationists from the 1800s. When the 
vaccine was first introduced to the United States at the turn of the 19th century, the 
population had suffered multiple smallpox epidemics which caused serious health and 
economic consequences. In 1809, Massachusetts passed the first U.S. compulsory 
vaccination law, which required smallpox vaccination to be administered to the entire 
population (Omer, Salmon, Orenstein, deHart, & Halsey, 2009). From 1802 to 1840, 
smallpox vaccine use became increasingly widespread. As similar legislation passed in 
other states, it was not long until opposition emerged and prompted repeated court cases 
concerning the legality of compulsory vaccination laws. States such as California, 
Illinois, Indiana, Minnesota, Utah, West Virginia and Wisconsin repealed all 
compulsory laws and similar campaigns ensued in Massachusetts, Rhode Island and 
Pennsylvania. From the 1850s to 1870s, anti-vaccine campaigns headed by “irregular 
physicians” and “unorthodox medical theories” led to the decreased use of vaccines, to 
the point where in 1870, smallpox re-emerged and several smallpox epidemics 
subsequently followed (Omer et al., 2009).  
In 1879, following another bout of several epidemics, anti-vaccination 
campaigns evolved into organizational form; leading British anti-vaccinationist William 
Tebb established the Anti-Vaccination Society of America, which led to the formation 
26 
 
 
 
of the New England Anti-Compulsory Vaccination League in 1882 and the Anti-
Vaccination League of New York City in 1885 (Wolfe & Sharp, 2002). Instead of the 
Internet or social media, anti-vaccinationists spread their information by passing out 
pamphlets and holding live demonstrations. At the time, the circulated arguments 
against vaccination included that vaccination did not aid the prevention of smallpox; 
vaccines were unsafe due to “accidents of vaccination;” sanitation should take 
precedence over vaccinations; and that botanical and natural remedies should be used 
instead of vaccines (Kaufman, 1967).  
Fast forward approximately two hundred years. When examining Parents A, B 
and C’s responses, it is evident there is a correlation between their present-day 
arguments to those of the original anti-vaccinationists. In addition to each parent 
agreeing there are other, better ways in preventing vaccine-preventable diseases, each 
parent believed in the practice of alternative and natural medicine as well as alternative 
ways of staying healthy, such as homeopathy, hand-washing, better hygiene and 
improved sanitation practices. In Parent B’s case, for example, they:  
[trusted that] the history of vaccination and that the deadliest diseases 
were not eradicated by vaccinations but by increased sanitation practices. 
Vaccinations are getting so much credit for removing disease from 
society when in actuality, it was the clean water coming in and the 
disease ridden sewage going away that has done the most for society. 
Instead of vaccinations as preventative treatment in disease transmission, Parent B 
believed that sanitation was the key factor in ridding disease from society. While this 
suggests that vaccines were ineffective, it also suggests that bacteria and viruses were 
merely a result of poor hygiene and infrastructure—that by improving only these two 
aspects of society, diseases were essentially washed out with the water itself.  
27 
 
 
 
Though vaccination practices contributed to the decreased incidence of smallpox 
in the 1800s, some individuals noticed a link between the ill health of the working 
population and their living conditions compared to those of the middle and upper 
classes. In May 1842, British social reformer Edwin Chadwick published “A Report on 
the Sanitary Condition of the Labouring Population and on the Means of Its 
Improvement,” which provided a thorough account of the “condition of the labouring 
classes, in respect to their residences and the habits which influence their health.” In this 
report, Chadwick provided descriptions of the overcrowded, poorly ventilated and 
incomplete sewage systems of the labouring class villages and their correlation to 
disease, including testimonies from those medical officers of the villages. In addition, 
Chadwick compared the quality of life in different classes of the community and cited 
evidence of certain preventative measures, such as increased sanitation, which raised 
the standard of health and chances of life. He wrote: 
On viewing the evidence, which shows that in most situations higher 
chances of life belong to the middle and higher classes of the population, 
an impression may be created that the higher standards of health are 
essentially connected with expensive modes of living… The experience 
of the effects of sanitary measures in banishing spontaneous disease from 
crowded prisons, offers further evidence of the health obtainable by 
simple means, under circumstances still more unfavourable (Chadwick, 
1842). 
It was found that despite living in “unfavourable” conditions, increased sanitation 
measures were not impossible to accomplish. In fact, after examining the poor, disease-
ridden conditions of the imprisoned populations in England, national attention was 
brought to the issue and “the evils of prison management [were] removed” (Chadwick, 
1842). Thus as a result, prison conditions improved tremendously and disease incidence 
decreased, as acknowledged by “the medical practitioners, who [were] well acquainted 
28 
 
 
 
with the general state of health of the population surrounding the prisons concur in 
vouching to the fact, upon their own knowledge, that the health of the prisoners [was] in 
general much higher than the health almost of any part of the surrounding population” 
(Chadwick, 1842).  
 Chadwick’s report was integral to the development of public health, for not only 
did he issue thorough evidence of living conditions in London, he was able to recognize 
the link between sanitation and population health while providing suggestions as to how 
public systems may implement simple changes to better the health of their citizens. 
These same principles can be seen present day, where sanitary and hygiene measures 
have greatly reduced incidence of disease, such as hand-washing, hand-sanitizing and 
improved plumbing and infrastructure. Thus, it can be argued that Parent B does raise a 
valid point in that increased sanitation practices have helped to greatly reduce incidence 
of disease.  
 When asked about the main, overarching attitudes surrounding vaccines, Parent 
B and Parent C both mentioned concerns regarding the ingredients in vaccines. “Most 
inactivated vaccines contain aluminum adjuvants. Safety of injected aluminum is 
assumed but not proven,” wrote Parent C, who cited a research article which examined 
aluminum hydroxide injections and their effects on motor neurons (Shaw & Petrik, 
2009). Parent B wrote that “Vaccines contain ingredients known by the FDA to be toxic 
to humans. Other ingredients are sourced from bacterial cultures grown on petri dishes 
that contain glyphosate (AKA Round-Up). Round-Up has been found in the vaccine 
supply and no work is being done to eradicate it.” In addition, Parent B later mentioned 
that “I consider eating and paying bills more important than injecting a poorly 
29 
 
 
 
researched liquid that contains more aluminum and formaldehyde into myself than the 
FDA thinks is safe."  
 As seen in Table 1.6 from Chapter 1, these arguments and concerns are similar 
to those cited by Smith, which states that “Vaccines are toxic and contain harmful 
ingredients...which can lead to an assortment of chronic health conditions” (Smith, 
2017). Like the previous sanitation argument from Parent B, the concerns of Parent B 
and Parent C are valid, for there are varying ingredients included in vaccines today. 
According to the CDC, the current ingredients added to vaccines “are added for a 
specific purpose” and include the following: 
Table 2.1 Vaccine excipient and media summary - CDC, 2018 
Excipient/Media Purpose Example 
Preservatives To prevent contamination Thimerosal  
Adjuvants To help stimulate a stronger Aluminum salts 
immune response 
Stabilizers To keep vaccine potent during Sugars or gelatin 
transportation and storage 
Cell culture materials Used to grow vaccine antigens Egg protein, various 
culture media 
Inactivating Used to kill viruses or inactivate Formaldehyde  
ingredients toxins 
Antibiotics Used to prevent contamination by Neomycin  
bacteria 
Table 2.1 Shows the vaccine excipients and media added to vaccines for specific 
purposes, updated by the CDC in October 2018; cell culture materials, inactivating 
ingredients and antibiotics are “residual trace amounts of materials that were used 
during the manufacturing process and removed” (Centers for Disease Control and 
Prevention, 2018b) 
30 
 
 
 
 Compared to those vaccines from the 18th and 19th centuries, which included 
only the virulent matter from smallpox lesions, current vaccines include more 
ingredients which cultivates concern amongst parents in regards to the safety and risk of 
injecting certain matter into their children. These concerns, though valid, are not new—
rather, they date back to the creation of the vaccine in 1796.  
While Jenner may not have been the first to vaccinate against smallpox, he was 
the first to scientifically and systematically report his findings in his text titled “Inquiry 
into the Causes and Effects of the Variolae Vaccine” (Stern & Markel, 2005). Jenner, a 
country doctor living in Berkeley, England, formulated this vaccine concept based on 
his observations of the local milkmaids in his town: visible pustules on the dairy maids’ 
arms from cowpox provided them immunity from the smallpox outbreaks that 
frequented the area. These observations served as scientific justification for one of the 
world’s first controlled clinical trials, where Jenner conducted a series of experiments in 
which he demonstrated the use of live infection from pustules and scabs from those 
infected with cowpox conferred immunity to smallpox. In 1796, Jenner presented these 
findings in his text to the Royal Society of London which consisted of twelve 
experiments and sixteen additional case histories which detailed his success with 
vaccinations (Kaufman, 1967; Stern & Markel, 2005).  
Unlike Mather, the amount of public opposition to Jenner’s methods was 
relatively minimal. Because the amount of smallpox vaccine in circulation was so small, 
it is suggested that lack of opposition early on was due in part to the haphazard 
geographical spread of the vaccine, for its circulation was “determined largely by 
personal contacts and private interests” (Rusnock, 2016). Thus, vaccines were not 
31 
 
 
 
mandatory nor were they endorsed by the government; rather, they were heavily 
promoted by Jenner himself, who traveled from Berkeley to London to recruit 
vaccination volunteers but with no such luck (Riedel, 2005). It wasn’t until aristocrats 
and reputable individuals—such as London surgeon Henry Cline—began promoting 
and recommending vaccines that vaccines were popularized in England. By 1800, 
vaccination practices had reached most of Europe and as many as 100,000 had been 
vaccinated (Stern & Markel, 2005). Despite his increasingly limited supply, Jenner 
continued to send samples of his vaccinations to those who requested them. One of 
these doctors included Dr. John Haygarth of Bath, who in 1800 sent some of Jenner’s 
materials to Dr. Benjamin Waterhouse of Harvard University. The vaccine was 
subsequently introduced to New England and gained support from Thomas Jefferson, 
where Jefferson appointed Waterhouse as vaccine agent in the National Vaccine 
Institute, “an organization set up to implement a national vaccine program in the United 
States” (Riedel, 2005).  
Despite advances in the spread of vaccination, there were still those who 
opposed Jenner and his vaccination methods. Vaccination was not made a mandatory 
practice in England until 1853, thus many of the fears surrounding vaccines in the 
1800s were rooted in the potential risks and harms associated with the procedure. 
Among these individuals were members of the clergy, who critiqued Jenner’s methods 
by claiming that “inoculating someone with pus from a diseased animal was not only 
revolting but blasphemous” (Green, 2019). When Britain passed their Vaccination Act 
of 1853, they did so with the stipulation that should parents object or refuse to vaccinate 
their infant within zero to three months of life, they were “liable to a fine or 
32 
 
 
 
imprisonment” (Wolfe & Sharp, 2002). As a result, several parents were imprisoned 
and opposition grew in several forms: riots occurred Ipswich, Henley, Mitford and other 
towns; books and journals were published, which included The Anti-Vaccinator 
founded in 1869, the National Anti-Compulsory Vaccination Reporter found in 1874 
and the Vaccine Inquirer of 1879; cartoon propaganda became a popular method of 
critique, where British artists both critiqued and satirized public and political fears and 
the inherent evils of vaccination (see Figures 2.1-2.2). In 1885, a massive vaccination 
demonstration in Leicester attracted the attention of 100,000 people, causing the anti-
vaccine movement to gain serious momentum and the attention from the Royal 
Commission, where it eventually sat for seven years “collecting testimonies from 
opponents and supporters of vaccination” (Wolfe & Sharp, 2002). In 1896, the 
commission’s report concluded that “vaccination protected against smallpox” but “as a 
gesture to the anti-vaccinationists it recommended the abolition of cumulative 
penalties” (Wolfe & Sharp, 2002).  
Such opposition to Jenner’s methods can be seen in the cartoons of Charles 
Williams and James Gillray, who produced illustrations arguing against vaccination 
practices, as seen in the following figures, Figure 2.1 and Figure 2.2. These two images 
were taken from the Wellcome Collection online archive and were chosen based on 
their visual demonstration of the first wave of 1800s public opposition in response to 
vaccination in Britain. Though they were not the only two cartoons produced at this 
time—several were produced and circulated not only in England, but France as well—
they are effective in communicating the initial fears individuals experienced in the early 
1800s. While textual evidence is an integral component to understanding the rhetoric 
33 
 
 
 
and reasoning of the anti-vaccination movement, visual imagery is important as well, 
for it expresses vaccine concerns in a manner that text and journals cannot.  
Figure 2.1 was illustrated by James Gillray, a British caricaturist and printmaker 
known for his satirical critiques of British and social life (Sherry, 2019).The image, 
titled “The Cow Pock” was published in London in 1802 and depicts a crowded scene 
with Edward Jenner vaccinating patients, where patients sprout cow heads from 
vaccination sites on various parts of their bodies. Those patients being vaccinated seem 
to include individuals not only from the middle and upper classes, but also those of the 
lower class, as seen by the dark-haired man in the tattered clothing in the front right, 
suggesting that not only the rich are subjected to the “evils” of vaccines but the poor as 
well. At the far right of the cartoon, what appears to be a pregnant woman sprouts a cow 
head from both her mouth and under her skirt, which could suggest that vaccination 
with foreign substance causes birth defects. To her left, a man with his hands raised 
sprouts horns from his forehead, almost resembling a devil-like appearance. In front of 
the horned man is another man with tattered clothing and a cow head sprouting from 
both his right arm and right buttock with a horrified expression on his face. A milkmaid 
can be seen in the center of the cartoon, representing the country milkmaids which 
Jenner originally gained his vaccine inspiration from, and to her left is Jenner himself, 
vaccinating her right arm with what appears to be a lancet, his face expressionless in 
contrast to her shocked one. To Jenner’s right is a short man in a blue pea coat holding a 
container of vaccine material labeled “Vaccine Pock Not From Cow,” and in his right 
pocket holds a pamphlet titled “Benefits of the Vaccine.” Behind the milkmaid, there 
are two men and one woman: the man on the right has his hands up and faces Jenner, a 
34 
 
 
 
cow head sprouting from his face; the woman to his left also has a cow head sprouting 
from her right eye and has a concerned look on her face; and the man to her left appears 
angry, with his right hand clenched and sprouting a cow head from his left ear. To the 
left of Jenner are roughly six men and women, each with visible smallpox on their face 
and bodies, lining up and crowded in a doorway and being forced to drink from a 
bucket labeled “opening mixture.” The man who ladles the mixture into each patient’s 
mouth holds the same remote, emotionless expression of that as Jenner, while those 
who await the drink appear terribly sick and perplexed.  
When looking at the cartoon in its entirety, one can see from left to right the 
transformation of smallpox patients into cows themselves, symbolizing the fear of 
intrusion and the introduction of unknown material to the body. The crowded nature of 
this cartoon possibly alludes to fears of mass damage, that should several people be 
vaccinated, Jenner would inflict suffering on society as a whole with his harmful 
vaccine ingredients. This fear of vaccine ingredients can be seen in the bucket labeled 
“Vaccine Pock Not From Cow,” which suggests that by forcibly subjecting the body to 
an unnatural substance, vaccines significantly harm or betray the body. Moreover, the 
depiction of Jenner as robotic and expressionless suggests a lack of sympathy or no 
regard for a person’s feelings or personal boundaries—that nothing else matters than 
pushing his vaccine agenda to the masses. It could be argued here that such lack of 
sympathy was possibly foreshadowing of the concerns surrounding autonomy that 
would come with mandatory, compulsory vaccination roughly fifty years after the 
publication of this cartoon.  
35 
 
 
 
Figure 2.1 “The Cow Pock” by James Gillray, 1802 
Figure 2.1 “The Cow Pock” by James Gillray, 1802; satirical cartoon depicting Edward 
Jenner vaccinating smallpox patients and cow heads sprouting from vaccination sites 
(Wellcome Collection, n.d.-b) 
These same themes of fear and intrusion can be seen in Figure 2.2, a sketch 
titled “Vaccination” by Charles Williams in London in 1807, which depicts vaccination 
as a large, carnivorous beast. In the center of the cartoon is a large, brutish monster that 
is being fed fresh infants by three men with horns and tails. The monster, after 
consuming its meal, then excretes the infants where they tumble onto the ground as 
beasts themselves—half cow, half infant, complete with horns and tails. A man on the 
right, who also has horns and a tail, shovels the newly transformed creatures into a 
wagon while the other men continue to dump fresh infants into the mouth of the 
creature. This creature, given the name “Pandora’s Box,” suffers from several oozing 
pustules, each marking a different affliction; from left to right it reads “pestilence,” 
36 
 
 
 
“plague,” “leprosy,” and “fetid ulcers.” In the background, there is a small group of 
armed men that cower in the distance, each with an initial of the disease they are 
arguably meant to attack on their shields, though the horned and tailed men pay them no 
attention.  
This sketch criticizes vaccination and its effects, implying vaccines are these 
mutilation agents which manipulate the inherent qualities of human beings and turn 
them into satanic, hellish creatures, as depicted by the horns on both the infants and the 
men feeding the creature. Further, by naming the beast “Pandora’s Box,” Williams 
emphasizes the forbidden nature of vaccines, as if vaccinations tamper with the good 
and evil of the world and are capable of unleashing the latter. Though both of these 
images represent vaccination in a separate manner, they both seem to illustrate these 
themes of fear and intrusion—fear of the foreign, contamination and intrusion of one’s 
body and autonomy.  
37 
 
 
 
 
Figure 2.2 “Vaccination” by Charles Williams, 1807 
 
Figure 2.2 “Vaccination” by Charles Williams, 1807. Sketch depicts a monster named 
“Pandora’s Box” being fed human infants and excreting them with horns, symbolizing 
the negative effects of vaccination (Wellcome Collection, n.d.-a) 
 Figures 2.1-2.2 from 1802 and 1807 echo the same fears of Parents B and C, 
where vaccine ingredients posed potential harms and risks to individuals’ bodies. 
Whether it was intrusion, invasiveness, contamination of vaccine material or the sheer 
unknown of vaccination as a practice, many of these concerns continue into the present. 
According to the study titled “‘Poisonous, Filthy, Loathsome, Damnable Stuff:’ The 
Rhetorical Ecology of Vaccination Concern,” Hausman and researchers argue that “the 
rhetorical ecology that articulates contamination concern through discourses of disgust 
38 
 
 
 
and danger and links the two remains a persistent thread,” for “contemporary vaccine 
concern is permeated by a sense of uncertainty about the advances of modern medicine, 
especially concerning the side effects of drugs that must be accommodated as part of 
treatment.” Despite advances in modern medicine, opposition to vaccines remain, as 
there are many of the same concerns in both the 1800s and the present.  
 
 
 
 
 
 
 
 
39 
 
 
 
Chapter 3  
 Vaccine Compliance: Exploring the Freedom of Choice 
 This chapter explores United States and Britain compulsory vaccine laws and 
their effects on vaccine compliance in anti-vaccine parents by examining the history of 
government-mandated vaccination and its subsequent opposition. Topics that emerged 
in all the interviews include self-governance, “medical freedom,” “informed consent,” 
and power of choice (or lack thereof). I group and analyze these themes found in 
interviews with Parents A, B and C in accordance with historical patterns and similar 
themes found in secondary sources.   
In the United States, there are no federal or national laws that determine which 
vaccinations are required, thus it is the responsibility of each state to develop and 
implement vaccine and immunization requirements into their legislature (Centers for 
Disease Control and Prevention, 2017). For schools, these laws are especially important 
for they determine which children can and cannot attend. In Oregon, children are 
required to receive vaccines which protect against diphtheria, tetanus, pertussis 
(whooping cough), polio, varicella (chicken pox), measles, mumps, rubella, hepatitis B, 
hepatitis A, and haemophilus influenzae type B (Oregon Health Authority, n.d.-b). Each 
family has until February 20th (also known as Exclusion Day) to comply with these 
requirements or their child will be sent home from school. In order for their child to 
return to school, families must provide one of the following: updated immunization 
record including all mandatory vaccinations, or, proof of either medical or non-medical 
exemption. That being said, whether parents choose to claim any type of exemption, 
40 
 
 
 
during the certification process they must be made aware of the fact that their child may 
be excluded from school in the event of an outbreak and that the exemption may not be 
recognized (Centers for Disease Control and Prevention, 2016b).  
All states and the District of Columbia in the United States allow for medical 
exemption, and all but two states—West Virginia and Mississippi—offer non-medical 
exemptions (Mellerson et al., 2018). A medical exemption is allowed when a child has a 
medical condition that prevents them from receiving a vaccine, such as an 
immunocompromised patient (i.e. HIV/AIDS) or a patient undergoing chemotherapy. 
There are two kinds of medical exemptions: temporary and permanent. A temporary 
medical exemption is given an expiration date after which the child must receive the 
vaccine; a permanent medical exemption does not require for a child to ever receive the 
vaccine.  
A non-medical exemption is claimed when a parent has religious or 
philosophical reasons against vaccinations. If a family chooses to claim a non-medical 
exemption for their child, they must become certified in an online training module, or, 
they must have a primary care provider sign off or indicate that the family has discussed 
with them thoroughly the risks and benefits of vaccination (Oregon Health Authority, 
n.d.-a).   
Despite parents having the choice to claim non-medical exemption for their 
children, they still face social and medical scrutiny when it comes to their choices. All 
three parents I interviewed had claimed non-medical exemption and chose to not 
vaccinate their children and I was interested in whether or not they faced social 
implications for their decisions. Thus, I asked each parent if they feel social pressure to 
41 
 
 
 
vaccinate their children, to which Parents A and C replied, yes. “I'm a strong believer 
and advocate for medical freedom,” Parent A said. 
I think everyone needs to make their own medical choices based on their 
own genetics, religion, intuition, philosophical beliefs and based on their 
own, you know health, and you know—who they are as a soul, and as an 
individual, and I support person's right to choose a vaccination, but I 
don't really think it should be pushed on, you know, like, people 
shouldn't be—have to, get their rights taken away from them if they don't 
choose the same medical care as everyone else or the person next to 
them. 
Whereas Parent C wrote,  
Vaccination is a medical procedure with very serious risks. The choice to 
refuse any medical procedure is a basic human right. Philosophical 
exemptions encompass scientific, religious, and medical concerns. 
Medical exemptions are difficult to obtain and often one must suffer a 
reaction first to qualify. There are valid reasons that are scientifically 
evidence based to decline vaccinations, regardless of an individual’s 
genetic predisposition to injury. Which my daughters have… 
Here, Parents A and C argued the importance of one’s freedom to make their 
own, informed medical decisions in the best of their interests. Regardless of whether or 
not it was vaccination, they were concerned with the choice, rather than the type of 
treatment, procedure, etc. This desire emphasizes the importance of both autonomy and 
control—that rather than some governing body or medical practitioner mandating or 
requiring a certain policy or procedure, people should have the right to decide yes or no. 
Instead of forcibly being required to comply with certain regulations, individuals’ 
autonomy should be acknowledged rather than disregarded, for disregard of one’s 
autonomy could lead to feelings of isolation or abandonment. While this belief 
prioritizes the individual over society as a whole, it questions whether or not scientific 
justification holds any value in the face of mandatory vaccination. If vaccines are 
42 
 
 
 
scientifically researched and evidence-based, why can’t scientific evidence be used as a 
means of defending one’s decision against vaccinations?   
Parents A and C’s arguments for medical freedom are not new. Though 
exemptions for vaccination exist today, early compulsory vaccination laws did not 
permit the option of choice. Instead, compulsory laws mandated that each parent 
vaccinate their child, regardless of their views. When the United States first began to 
impose compulsory immunizations in the early 1800s, many who refused vaccination 
did so based on one of two rationale: vaccination was an unwanted governmental 
interference with human autonomy and liberty, and, there were valid scientific 
objections about vaccine effectiveness (Hodge & Gostin, 2002).  
 According to the article “School Vaccination Requirements: Historical, Social 
and Legal Perspectives,” Hodge and Gostin claim that these fears were “attributable in 
part to overly aggressive public health practices and general public distrust of public 
health objectives,” citing the public health vaccination programs in response to the 
several smallpox outbreaks throughout the 1800s. In addition to the introduction of a 
relatively new medical procedure, citizens were required to comply despite concerns or 
distrust. More often than not, individuals were vaccinated anyway with or without their 
consent and forcibly injected (Hodge & Gostin, 2002). For example, in 1895, the New 
York Times published a report titled “$1,500 For Forced Vaccination,” in which a man 
named Emil Schaefer won a lawsuit against a public health official who forcibly 
vaccinated him in a night raid. As Hodge recounts: 
The police were frequently called upon to protect the vaccinators, and 
midnight raids were made by the vaccinators and the police, and people 
were vaccinated whether they submitted or objected.... Dr. Henry L. 
43 
 
 
 
Schelling visited [Schaefer's] house April 27, 1894, and said he had 
come to vaccinate the family. Schaefer objected, and said he was 
suffering with a tumor on the brain, and thought it would be dangerous to 
be vaccinated. According to Schaefer's story, Dr. Schelling seized him 
by the arm, and exclaimed: 'You shall be vaccinated, if I die for it'” 
(Hodge & Gostin, 2002). 
In Oregon and most of the United States today, the penalty for not vaccinating 
children is their exclusion from attending school and even so, parents have the choice to 
claim exemption as a means of circumventing this requirement. That being said, there 
still exists the fear of government and medical infringement upon one’s rights, resulting 
in feelings of little to no autonomy, as seen in statements made by Parents A and C. 
Until recently, these fears were mitigated with the choice for non-medical exemption; 
however, with recent events such as the 2019 measles outbreak, the costs of non-
vaccination have risen. In April 2019, Mayor Bill de Blasio declared a public health 
emergency in New York City, requiring that “unvaccinated individuals living in 
Williamsburg, Brooklyn receive the measles vaccine” or else they would receive a city-
issued violation and fine of $1,000 for those who did not comply (Pager & Mays, 2019). 
This requirement, though confined to the limits of Brooklyn and New York, mirrors 
those of the very first compulsory laws and raises the question of whether or not these 
cumulative penalties are specific to this measles outbreak, how they are or will continue 
to be enforced, or if they will remain as part of immunization requirements.  
This demanding nature of vaccination requirements continually frustrates Parent 
B, who when asked about who they trust the least for vaccine information, wrote, 
 We allow the makers of vaccines to tell us how great they are and they 
are screaming it so loudly, smart people just don't realize they are not 
being told the Truth. People want them to work so badly they are willing 
to get the jab and bully others to do so. 
44 
 
 
 
In this statement, Parent B presents a distinct us vs. them mentality—us being 
the public and them being the vaccine manufacturers. Though the specific “we” 
population the subject refers to is unknown, it reads as if there is a power imbalance 
between the groups, where the “makers of vaccines” have access to different 
information and choose to withhold some greater “Truth” that should be shared with the 
us population. Parent B seems not only fearful of them, the vaccine manufacturers, but 
that individuals capable of making good, well-thought out decisions are somehow being 
manipulated without even realizing it and further recruited into the them category—that 
being, supporters of vaccine manufacturers. Like Parents A and C, Parent B seems to 
experience feelings of infringement; however, these feelings concern the general 
population in regard to a threat to their autonomy. Instead of vaccination being a choice, 
it is as though Parent B feels that the public has been conditioned to believe that 
vaccination is the only way to prevent disease—which, in some ways, we have, 
specifically with the evolution of compulsory laws and their collective acceptance in 
society.   
The original 1809 Massachusetts compulsory law was not settled until its 
constitutionality was upheld in 1905 in the landmark case, Jacobson v. Massachusetts, 
where the U.S. Supreme Court “endorsed the rights of states to pass and enforce 
compulsory vaccination laws” and has since “served as the foundation for public health 
laws,” including those required for school (Omer et al., 2009). In 1922, it was found in 
the Zucht v. King case that school immunization requirements were constitutional and 
did not infringe upon rights of liberty, and further, “upheld mandatory vaccinations as a 
contingency for school admission” (Torre-Fennell, 2013). In 1969, 17 states passed 
45 
 
 
 
laws which required children to be vaccinated against measles before entering school in 
efforts to control the high prevalence of measles in the United States (Omer et al., 
2009). In addition to the 17, 12 states “legally mandated requirements for vaccination 
against all six diseases for which immunization was carried out at the time,” and 
throughout the 1970s, state and local health officials worked to enforce immunization 
laws by excluding students from school who did not have the required vaccinations to 
attend, which helped control the number of outbreaks but received much backlash. By 
the early 1980s, all 50 states had immunization requirements, for efforts by public 
health and other immunization advocates resulted in the enforcement of immunization 
requirements for all vaccines (Omer et al., 2009). These official cases and their holdings 
can be seen in the following Table 3.1, which were “decided by the United States 
Supreme Court and federal and state courts concerning governmental vaccination 
policies” (Hodge & Gostin, 2002): 
Table 3.1 Shows two official United States Supreme Court cases and their major 
holdings from 1905-1922  
Year Case Major Holdings 
1905 Jacobson v. The City of Cambridge may require its citizens 
Massachusetts to be vaccinated for smallpox provided certain protections for the individual are 
accommodated consistent with liberty 
principles under the Due Process Clause. 
 
1922 Zucht v. King States may delegate to a municipality the 
power to order vaccination and the 
municipality may then give broad discretion to 
the board of health to apply and enforce the 
regulation. 
 
Table 3.1 Shows the two previously discussed United States Supreme Court cases from 
1905 and 1922 with their major holdings (Hodge & Gostin, 2002) 
46 
 
 
 
  Because vaccines have become so widely accepted and ingrained in society by 
public health and medical communities, it is difficult to imagine a society without 
them—which is perhaps why Parent B raises the question as to whether or not the 
public is blindly accepting vaccination due to their prolonged presence in government 
and medical practice. With instances such as the continued measles outbreak in 2019, 
we are encouraged as a society to think about how to draw the boundary between public 
safety and constitutional freedoms, and whether or not pre-existing legislation is truly 
effective amongst populations such as the anti-vaccine community.  
 
  
  
  
 
 
 
47 
 
 
 
Chapter Four  
Examining Vaccine Distrust: Profit, Safety and Bias 
This chapter explores the possible drivers and motivators of parental distrust 
toward entities involved in the processing, manufacturing and regulating of vaccinations 
and vaccination programs. From these interviews, there appear to be two main drivers 
which fuel Parent A, B and C’s concerns. These concerns include vaccine safety, and 
the compromised relationships between government, pharmaceutical companies and the 
medical community. Similar to chapters two and three, I will present the concerns 
expressed by each parent and provide current systemic or historical context which could 
possibly contribute to these feelings of distrust.  
In public health, vaccines are widely regarded as the most effective protection 
method against communicable diseases and are credited with greatly reducing incidence 
of diseases and their serious effects. That being said, there are some side effects and 
risks involved when it comes to vaccination, which are listed in the table below and 
cover side effects from the following vaccines: chickenpox (varicella), DTaP 
(diphtheria, tetanus and pertussis), haemophilus influenzae B, hepatitis A and B, human 
papilloma virus (HPV), influenza virus, MMR (measles, mumps, rubella), 
meningococcal, polio virus, pneumococcal, rotavirus and tuberculosis (Seattle 
Children’s Hospital, 2019). 
 
 
 
48 
 
 
 
Table 4.1 Reactions to various vaccines  
Symptom Description 
Local Shot sites can have swelling, pain and redness. Most 
reactions often, symptoms develop 24 hours after shot and last 
3-5 days. With DTaP, symptoms can last up to 7 
days. 
Fever Fever with most vaccines begins within 24 hours 
after shot and lasts 1 to 2 days. 
Delayed With MMR and chickenpox shots, fever and rash 
reactions can occur but these symptoms start later, within 1 
and 4 weeks. 
Anaphylaxis Severe allergic reactions are rare, but can occur with 
any vaccine and start within two hours. 
Table 4.1 Shows the different symptoms of vaccine reactions to various vaccines – 
adopted from Seattle Children’s Hospital (Seattle Children’s Hospital, 2019) 
 As a means of monitoring vaccine safety, the CDC and FDA established a vaccine 
monitoring system called “Vaccine Adverse Event Reporting System” (VAERS), which 
serves as “an early warning system to detect possible safety issues with U.S. vaccines” 
by “collecting information about adverse events that occur after vaccination” (Centers 
for Disease Control and Prevention, 2015). This database was created in 1990 in 
response to the 1986 National Childhood Vaccine Injury Act (NCVIA) and allows 
doctors, nurses, vaccine manufacturers and the general public to submit a report in the 
event of any health problems occurring after vaccination (Centers for Disease Control 
and Prevention, 2015).  
49 
 
 
 
 When initial recruitment of subjects began, I was pointed several times in the 
direction of the VAERS website as a reference for vaccine safety. More often than not, 
it was found that the risks and harms associated with vaccine safety outweighed 
concerns regarding vaccine efficacy. When asked about if they thought that vaccine 
benefits outweigh the risks, Parent A said:  
Well, that is my biggest concern I think, is that—is that the risks are 
underreported? And the risks are you know, they suppress that 
information. I don't know if you're familiar with the CDC, HHS, 
department of HHS, asked Harvard to do a study about vaccine risks and 
how many were actually reported. And Harvard came up with one 
percent, or actually reported and the federal government, since you 
know, since late 1980s have paid out 4 billion dollars in vaccine 
damages. So if that's just one percent? And that's just the payouts, you 
know, so I am worried that the risks of vaccination are underreported, 
not really understood. 
Parent A was concerned with not only vaccine injury, but that the risks have been 
under-reported and the agencies involved are inaccurate or untrustworthy. As an agency 
involved in vaccine risk and injury, whether it be government or medical, there is little 
to no room for error or mistakes. When individuals such as Parent A are concerned that 
these risks fail to be mitigated or that their reporting is inaccurate, it cultivates a sense 
of distrust, or potentially, skepticism. If the risks are under-reported, then the agencies 
involved could potentially be withholding important information which could 
negatively impact those seeking vaccination.  
 Parent A was not the only one concerned with vaccine risk and injury. At the 
conclusion of each interview, I asked parents what their overarching views were 
regarding vaccines as an opportunity to share anything they felt they had forgot to 
mention earlier in the interview. While Parent C did not necessarily express concern in 
vaccine risks being under-reported, they did explain their concerns with how risks were 
50 
 
 
 
conveyed at the public health level based on personal experience. This involved the 
concern that the agencies involved in vaccination development and production withhold 
important vaccine information or fail to maintain transparency in the associated risks 
with vaccination. Thus, in response, Parent C wrote:  
I used to work in public health for several years, the training I received 
for answering phone calls regarding vaccine safety was straight from 
Paul Offit’s training of public health nurses in this country. None of it 
was accurate in conveying the risks of the medical procedure instead I 
was trained on marketing points from pharmaceutical companies. 
 When examining these two statements, there are two perceived issues at play: 
the first being, that the harms and risks of vaccination are underreported; the second 
being, that these risks are disregarded as a means of promoting the pharmaceutical 
industry’s marketing agenda. No monitoring system is perfect; because the VAER 
system operates and relies on self-reporting, it is possible that the harms and adverse 
effects of vaccines are underreported. The CDC acknowledges this too, citing certain 
limitations to the VAER system which include the “rate of reports may increase in 
response to media attention and increased public awareness” and that it “is not possible 
to use VAERS data to calculate how often an adverse reaction occurs in a population” 
(Centers for Disease Control and Prevention, 2015). The VAER system is simply a 
government run, CDC surveillance system which publicly presents vaccine data. From a 
marketing perspective, however, it is plausible to share certain pieces of information 
and withhold some as a means of selling product. There is a delicate union between the 
business aspect of pharmaceuticals versus maintaining their clinical integrity. Thus, 
should conflict arise between the two sides, those individuals who are on the receiving 
end—those receiving the vaccines—are entitled to questioning the product.  
51 
 
 
 
 In the early 1980s, major legislative reform in the United States revolved around 
liability for injuries resulting from the use of vaccines. Like Parents A and C, some 
individuals grew increasingly weary of vaccinations to the point where vaccine 
manufacturers saw an increase in vaccine-induced injuries. In turn, manufacturers 
claimed that “substantial tort costs would discourage research and innovation,” to which 
consumer groups argued that “it was morally wrong to make parents prove that 
manufacturers were at fault” before “obtaining compensation for vaccine-induced 
injuries” (Hodge & Gostin, 2002). Thus, as a result of these complaints from 1982-
1986, United States Congress established the National Vaccine Injury Act which 
established four different programs seen in Table 4.2 below: 
Table 4.2 Programs established by the National Vaccine Injury Act, United States 1986 
Program Purpose 
The National Responsible for most aspects of vaccine policy; examples 
Vaccine Program include research, development, safety and efficacy testing, 
etc. 
The Vaccine Injury Compensates persons who suffer from vaccine-induced 
Compensation injuries according to values set in the Vaccine Injury Table; 
Program highly controversial, for nearly three-fourths of cases have 
been dismissed 
The Vaccine Requires health care providers and manufacturers to report 
Adverse Events adverse events from vaccines 
Reporting System 
The Vaccine Requires all health care providers to give parents 
Information System standardized, written information before administering 
certain vaccines 
Table 4.2 Shows the four different programs established in 1986 by the National 
Vaccine Injury Act as a means of mitigating vaccine manufacturer liability in response 
to increased vaccine-injury lawsuits (Hodge & Gostin, 2002). 
52 
 
 
 
Despite such measures to accommodate the varying range of parental belief 
systems, parents continue to either question their trust in these programs, or, do not trust 
them altogether. In these interviews, I was particularly interested in where parents 
placed their trust when it came to vaccines. Thus, I asked each parent who they trusted 
the most and who they trusted the least for information regarding vaccines. When asked 
who they trusted the least for information regarding vaccines, Parent A said:  
I am concerned about blindly trusting the government. I don't do that. I 
feel like the level of corruption and, and self-preservation… The, you 
know, the CDC's own scientists who've come forward talking about 
concerns, so I don't like following orders of people who are following 
orders and people who are following orders. When I talked to Lane 
County Public Health, they said they're following Oregon Health 
Authority orders, and when I talked to Oregon Health Authority, they 
said they're taking orders from the CDC, right? So, I don't just kind of 
blindly follow with it, what everyone says to do, because just simply 
cause someone's just saying to do it, so I kind of trust my own self, I 
guess, to gather my own information. 
In addition to Parent A’s concerns regarding vaccine safety, they also expressed 
concern in their trusting of the government—specifically, “blindly” trusting and going 
along with it “just simply cause someone’s just saying to do it.” Though this statement 
reads as though there are feelings of isolation from the government, Parent A has sought 
out this sense of individualism or even liberation from the constraints of authority. 
Perhaps they fear that the government is working in the interest of benefitting 
themselves rather than the good of the people; or, perhaps they fear government took 
advantage of them. Nonetheless, though it is unknown what specific event caused 
Parent A to lose their trust in the government, it has tasked them with the responsibility 
of “gathering [their] own information,” and making their medical decisions based on 
their own needs. 
53 
 
 
 
According to the article titled “‘Poisonous, Filthy, Loathsome, Damnable Stuff: 
The Rhetorical Ecology of Vaccine Concern,” this sense of individualism is a relatively 
recent development in the social context of the United States. As the era of paternalistic 
medicine waned in the late 1900s, patient-centered decision-making emerged as more 
parents became more involved in the matters of their healthcare (Hausman et al., 2014). 
That being said, with the requirement of compulsory vaccination looming over 
individuals’ heads, it could be argued that vaccination remains one of the current areas 
of medicine in which both the government and medical community retain this 
paternalistic mindset.  
As parents become more involved in their healthcare decisions, the more they 
learn about the systems and organizations they are dealing with as well as their 
relationships with one another. In the realm of vaccination, these systems include 
government organizations such as the FDA and CDC, pharmaceutical companies and 
medical professionals, where “significant concerns about corrupt relationships between 
recommended medical treatments and pharmaceutical companies have emerged in 
recent years” (Hausman et al., 2014). In the case of Parent B, the relationships between 
these organizations were most troublesome, specifically those between the CDC and the 
pharmaceutical company, Merck. “I don't trust the people who make the vaccines, I 
don't trust anyone that holds patents on vaccines (the CDC holds patents on vaccines). I 
don't trust because the companies who are going to profit from the product are doing the 
research,” they wrote. 
First I read that research, saw how crappy it was, and then discovered the 
pharmaceutical companies have a super cozy relationship with the only 
organization that comes between them and their customer base… Take 
54 
 
 
 
the CDC's Director Julie Gerberding for example. She worked as director 
for the CDC from 2002 to 2009 and then, in 2009 went from directing 
the CDC to being the president of Merck's vaccines division.  That is an 
unacceptable relationship in my opinion. We need unbiased leaders at 
the Center for Disease Control and not a family-like relationship. The 
CDC is charged with approving or denying products based on the 
research done by the company that wants the product approved… We 
need unbiased leaders at the Center for Disease Control and not a family-
like relationship. 
 Like Parents A and C, Parent B questioned those with control of regulation and 
manufacturing of vaccines. However, unlike Parents A and C, Parent B was more 
concerned with the close nature of the relationships between government and 
pharmaceutical companies. From this compromised relationship, their concerns were 
rooted in worry about how these relationships influence vaccine recommendations for 
the public good. They were concerned that rather than making decisions in the best 
interests of the public, this relationship relies on profit and motivations for money 
instead.   
By the time a new vaccine hits the market, it has already undergone several 
phases of clinical trials and testing before being added to the United States 
recommended immunization schedule. According to the CDC, the FDA sets rules for 
three phases of clinical trials which work to ensure the safety of the volunteers. 
Researchers from the FDA and CDC test vaccines on adults first, transitioning from 20-
100 volunteers to hundreds or thousands of volunteers, testing the vaccine’s safety and 
efficacy. If the vaccine becomes approved and licensed by the FDA, the Advisory 
Committee on Immunization Practices (ACIP) carefully reviews the product based on 
the available data from clinical trials or other research studies and continues to monitor 
the safety of the vaccine, even after its routine use (Centers for Disease Control and 
55 
 
 
 
Prevention, 2018a). Parent B’s need for “unbiased leaders” emphasizes certain feelings 
of exploitation and fear that these organizations, rather than manufacturing products 
meant to improve health, produce poorly-researched medical treatments which pose 
more harm than good in hopes of driving up profit margins. Not only are these fears 
reminiscent of those previously discussed regarding vaccine safety, they also indicate 
trust issues with the bureaucracy of the vaccine manufacturing process itself.  
 Take, for instance, the 2006 controversy over the human papillomavirus (HPV) 
vaccine, Gardasil. After its licensure in 2006, many states worked to incorporate the 
HPV vaccine as part of the required immunizations for middle school, sparking 
opposition from religious conservatives who regarded the vaccine as the “promiscuity 
vaccine” (Colgrove, Abiola, & Mello, 2010). Though it had been proposed in twenty 
four states, the bill was either been abandoned or stalled; it wasn’t until 2007 that the 
situation became “politically explosive,” after Texas Governor Rick Perry “bypassed 
the legislature and issued an executive order” which made the vaccine mandatory for 
girls entering the sixth grade. Because Texas was a conservative state with a steadily 
increasing anti-vaccine community, this executive order was quite unusual. Perry was 
subsequently accused of being influenced by a Merck lobbyist, and ultimately, the 
tensions over vaccine policy “pitted physicians against parents and advocacy groups 
against vaccine manufacturers,” and “skeptics bemoaned the influence of business 
marketing and the power of the state over its citizens” (Colgrove et al., 2010). By the 
time Merck emerged on the other side of the controversy, it was perceived poorly by the 
public; parents who participated in a study by sociologist Jennifer Reich viewed the 
“HPV vaccine development, review, and market process as corrupted by the politics and 
56 
 
 
 
through lobbying efforts funded by pharmaceutical companies” and negatively affected 
their trust in the science behind the research process (Hausman et al., 2014).  
 It is difficult to neatly categorize the various drivers of distrust when it comes to 
vaccines and their development and manufacturing process. Significant concerns 
regarding the overly close relationships and their ability to jeopardize neutral regulation 
between pharmaceutical companies and government organizations such as the FDA and 
CDC will continue to exist so long as vaccines do. With controversies such as the 2006 
Gardasil controversy, which provide evidence of pharmaceutical lobbying and its 
political influence, these fears will be present and perpetuated in society. While it is 
important to remember these events, it is also important to rebuild trust with the anti-
vaccination community—not as a means of increasing vaccination rates, but as a means 
of establishing open and trusted communication.  
 
 
 
 
 
 
 
 
57 
 
 
 
Chapter Five  
Conclusions and Recommendations  
As a result of the 2019 measles outbreak, those who opt out of vaccination and 
their communities have been under extended scrutiny by media and their peers. When 
Mayor Bill de Blasio declared a public health emergency and required that citizens of 
Williamsburg, Brooklyn get vaccinated or face $1,000 fine, certain historical themes 
were reintroduced into the modern anti-vaccination movement—specifically, those of 
government infringement upon personal autonomy.  
Essentially, all mandatory vaccinations and their enforcement are paternalistic. 
This mindset is rooted in the notions of public health’s mission to ensure population 
health at both the state and national level. In the case of vaccinations, public health 
mandates their use as a means of preventing communicable diseases based on the 
precedent set by the 1905 United States Supreme Court Case Jacobson v. 
Massachusetts, which deemed mandatory vaccination constitutional at the state level 
(Hodge & Gostin, 2002). As a result, each state is responsible for reinforcing their own 
vaccination laws, whether it be through government or police forces. Though parents 
are now given the choice to opt out of vaccination and claim exemption, in the event of 
an outbreak such as the measles outbreak, that exemption is essentially disregarded by 
public health (Centers for Disease Control and Prevention, n.d.-b). This may exacerbate 
feelings of little to no autonomy, and further, isolate anti-vaccination communities to 
the point where they may not feel safe or valued as members of the greater population. 
58 
 
 
 
With events such as the 2019 measles outbreak, we are given the opportunity to 
better understand the possible motives of those who refuse vaccines. By listening 
carefully to vaccine hesitant parents, we are able to learn about their specific concerns, 
whether it be vaccine risk and harms, the close relationships between government and 
pharmaceutical companies, or lack of medical freedom. These concerns, which 
influence this subset of parents’ decisions, provide a small glimpse into the possible 
challenges these parents face when it comes to their choice to not vaccinate.  
That being said, there are certain limitations with a topic this complex. For this 
thesis specifically, the main limitations faced were the lack of subjects interviewed, 
geographical constraints and the time frame in which the research needed to be 
completed. Because I had roughly six months to collect and analyze interviews and 
write this thesis, I was limited in my subject pool. Thus, as a result of working with a 
limited population, interview data could not be generalized to a broader subset of other 
like-minded individuals. Instead, analyses were limited to each individual parents’ 
beliefs and the similarities drawn between them. Ideally, a larger subset of parents 
would be interviewed and specific to the local population in Lane County, for I was 
initially interested in the local vaccination climate and its high rate of non-medical 
exemptions. In addition to a smaller subject pool, I was limited in my historical 
analyses. Based on readings of secondary sources, I knew the two cartoons by Charles 
Williams and James Gillray fit into a wider pattern of critique. However, there were no 
other primary sources or historical data about how vaccines were widely understood or 
accepted historically. If I were to recreate this project, I would like to look into archival 
material specific to the New England and United Kingdom regions to better understand 
59 
 
 
 
the public response to vaccinations or how they were understood. In addition, I would 
like to dedicate more time in recruiting subjects locally as a means of finding patterns or 
similarities in vaccination attitudes and beliefs specific to the area.   
Not only is vaccine hesitancy a widely debated topic, it is a relevant one. While 
the timing of this project coincided with the 2019 measles outbreak, I was able to 
witness a health crisis in real-time and follow its subsequent outbreak measures, which 
included Mayor de Blasio’s vaccine mandate in New York City. With measles cases 
mounting to over 700 in the past five months, the need to mitigate the threat of disease 
was heavily pressed on by public health departments and their vaccination agendas 
(Centers for Disease Control and Prevention, 2019). In addition, distrust of 
pharmaceutical companies skyrocketed as a result of the recent 2019 conviction of Insys 
Therapeutics’ founder John N. Kapoor, who was found guilty of bribing medical 
doctors to prescribe opioids in high doses (Richer, 2019). With events such as these that 
fuel distrust in government, pharmaceuticals and the medical community, it becomes 
increasingly difficult to convince others of vaccination and continues to reinforce 
historical patterns in the contemporary anti-vaccination movement. 
The topic of vaccine hesitancy and refusal is complex, for it integrates social, 
historical, cultural and individual attitudes. So long as vaccines exist, its opposition will 
subsequently follow. By historically situating contemporary arguments amongst their 
predecessors, perhaps the drivers behind modern vaccine refusal might be better 
understood. From these interviews, it is apparent that those who choose to not vaccinate 
will not change their minds and it is ineffective to convince them otherwise. In addition, 
it can be argued that narrative and anecdotal evidence are just as important as empirical 
60 
 
 
 
evidence. Thus, from interviews with this subset of parents, I have concluded there are 
two components which help influence their decisions to not vaccinate. These include 
distrust of government and pharmaceutical companies, as well as feelings of little to no 
autonomy in the face of mandatory vaccination. Instead of attempting to increase 
vaccination rates or alter the mindset of those who do not choose vaccination, we must 
work on mending the trust and relationships between those who do not vaccinate and 
the corresponding agencies involved in vaccination by not only carefully listening, but 
acknowledging what they have to say.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
61 
 
 
 
Appendix A 
List of Interview Questions – adapted from World Health Organization Vaccine 
Hesitancy Survey 
 
1. What is your definition of a vaccine? 
2. Can you give a brief description of how you believe a vaccine works? 
3. What is the most common information source you turn to for information about 
vaccines? 
4. Who do you trust the most for information? Who do you trust the least? 
5. Do you trust the vaccine advice your main health care provider gives you? Has your 
best interests at heart? 
6. Have you yourself ever been vaccinated? 
7. Did your parents ever get vaccinated? Did you have any discussions growing up 
surrounding vaccines? 
8. Do you believe that there are other (better) ways to prevent vaccine preventable 
diseases than with a vaccine? 
9. Do you think that vaccine benefits, in general, are larger than their risks? 
10. Do you know anyone who has a child who has had a serious reaction to a vaccine? 
11. Are most people you know being vaccinated/are getting their children vaccinated? 
12. Do you feel social pressure to get vaccinated? 
13. Do you consider other activities (going to the market, work, etc.) more important 
than getting a vaccine? 
14. Is access to immunization easy for you? Convenient in location? Is the process of 
being immunized welcoming? 
15. Do you trust that your government is making decisions in your best interest with 
respect to what vaccines are provided? 
16. Do you trust the motives of the pharmaceutical industry? 
17. What are your main attitudes surrounding vaccines? 
 
 
62 
 
 
 
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