In 1768 Russia (and most of Europe) faced a devastating smallpox epidemic. They didn’t have vaccines then, but there was knowledge of a forerunner called inoculation (or variolation), where pus is taken from a smallpox patient and injected into the skin of a healthy human to stimulate an immune response –akin to the process triggered by vaccination used today.
Russians were dying en masse, and Empress Catherine wanted to protect her subjects. She could easily have ordered everyone to be variolated (and spared herself the danger, taking advantage of herd immunity). But she had herself and her son inoculated instead -- as an example, the only ruler of the time to do so. [1]
Had President Trump taken to national TV and gotten the COVID jab early on, instead of touting vaccine alternatives, spear-heading politicized anti-vaccine sentiment, and being the first (and only) President on record with anti-vaccine sentiments, quite likely we wouldn’t be talking about vaccine mandates.
Now that loud voices are arguing against vaccine mandates and the results of anti-vax rhetoric is becoming glaringly apparent, we need to figure out how we might effectively persuade the populace to take a jab in a timely fashion. But before getting to the “how” of persuasion, we need to assess the “whether” effective persuasion can even be done.
These inquiries require comparing the cost-benefits of persuasion, a process that is often lengthy, against the perceived autonomy-threatening but swiftly applied and immediately effective mandates. [2] During the time it would take to persuade a significant majority- if indeed it can be done, we must determine what damage can be done by the disease – to people and the public purse -- compared to hypothesized and unproven dangers allegedly associated with mandates.
The key to informed decision-making regarding persuasion vs. mandates is not to proffer hypothetical and conceptual negative possibilities, but to ask if we have hard, scientific research regarding whether persuasion can work when it’s up against a scientific premise already tainted by politics. It turns out that we do - and it’s not pretty. The data clearly contradict the view that persuasion can work in a politicalized context, suggesting that we may have no alternative other than compelling vaccination in those vaccine-averse due to political reasons - which turns out to be a substantial majority (60%) of the vaccine averse.
Looking to the Past: Leadership by Example
The variolation procedure used by Empress Catherine was not nearly as safe as today’s vaccination, and her subjects were scared. The enlightened and prescient Russian Empress was desperate to prevent more deaths (which, at the time, killed between ten and twenty percent of those it afflicted). Resistance to the procedure was rampant, but careful epidemiological records established that survival rates for those inoculated patients were far better than those who got the disease.
Catherine’s story is a great read [3]. The science-literate empress took no chances, recruiting perhaps the most experienced and scientific of the inoculators of the day (someone we used to venerate as an “expert”), Dr. Thomas Dimsdale, to travel from England to perform the procedure. Perhaps of greater significance is the impact she had on her subjects. Her people copied her – and that’s how the majority of Russians survived that epidemic. Wouldn’t it be great if we could do the same thing now: Motivate by example?
Obstacles
True, the resistance Catherine faced wasn’t as great as it is today. The Russians were fairly cloistered from the inoculation-averse French, and the anti-vax movement had not yet mobilized (although, to be sure, anti-inoculators did exist). Only after Edward Jenner perfected vaccination in 1796, almost thirty years later, did the anti-vax movement get its stride. And wouldn’t you know it? That was when intractable resistance kicked in. By the 1800s, vaccination-by-example no longer worked, and laws mandating smallpox vaccination in infants surfaced, enacted in Russia, Denmark, Norway, Bavaria, and Bohemia.
By 1853, England made vaccination mandatory for school children, as did Sweden. In the US, the territories began to realize that children congregating in schools fostered disease transmission. Eventually, all fifty states enacted vaccine mandates for preschool admission. Some exemptions still exist, but they are narrowly construed. And six states have removed all exemptions other than for medical reasons. Yet the postured, speculated, or threatened backlash promised by the anti-mandaters didn’t surface till now.
Terror as a Vaccine Motivator
In the past, we also had abject terror of disease. Turns out this fear is a great motivator. (Interestingly, one principle of the anti-vax movement is to minimize the dangers of COVID, such that realistic fear of contracting the disease is minimized or prevented altogether). Just look at polio. Parents lined their kids up for vaccines. Amid the early phase of the vaccination rollout, Cutter Laboratories released a contaminated vaccine afflicting 40,000 children with polio, leaving ten dead and 200 with paralysis. Parents still lined their kids up for the jab. But we weren’t talking about forcing adults to get jabbed then, just susceptible children. As to getting adults to take the jab, let’s look to history.
More Mandate by Example
In 1947 an American ex-pat named Eugene LeBar traveled from Mexico to New York, exposing potentially thousands to smallpox he had contracted. In less than four weeks, New York vaccinated six million residents. [4] The media helped spur the initiative. The mayor, William O’Dwyer, a Democrat, rolled up his sleeves for the jab, posed for the press, and set an example. The Health Commissioner, Dr. Irving Weinstein, appealed to the populace – by radio – (no fancy glossies, power -points, or dancing muppets needed) in a measured and rational voice. The approach worked.
Motivation by example works. But that was before vaccination was politicized.
What was different in 1947? For one thing, you didn’t have Mayor O’Dwyer’s political opponent trashing vaccination, and no one was touting horse remedies or old-wives concoctions as vaccine alternatives. Nor did you have bots, grifters, or those seeking to compromise national security claiming vaccines do all sorts of nefarious things 24/7 on social media. Can these hard, perhaps impossible, info-challenges, which must be rebutted in real-time to avoid mandates, be overcome?
The problem is much more nuanced than simply a yea or nay to mandating.
“It's just the flu”
As I have written previously, the sectors resisting vaccines differ, each with different motivations and cognitive psychological mechanisms. But one sentiment seems universal: lack of fear of the disease, e.g., COVID, isn’t dangerous. That sentiment runs through the vaccine averse. Mounting data to the contrary goes unheeded.
Before jumping on an anti-mandate bandwagon, it behooves us to evaluate the likelihood of success for persuasion of each of these groups – rather than blanketly attack mandates and champion an across-the- board persuasion-approach.
Next, I will consider the impact of politicization on vaccine resistance before tackling the new dangers COVID is presenting, a critical factor in assessing mandating and vaccine efficacy.
[1] George the V of Britain had his children vaccinated, but he declined.
[2] It should be noted that from a legal standpoint, state-level mandates, with limited exceptions, are legal and, in some cases, preferred or even required, violation of perceived rights and liberties notwithstanding. So said the US Supreme Court in Jacobson v. Mass over 100 years ago.
[3] The Empress and the English Doctor: How Catherine the Great defied a deadly virus by Lucy Ward
[4] For context, It took a year to reach a similar level of population participation in the measles vaccination program in Rockland County compared to three months in New York City, which had enacted a mandate.
