Future Tense

The Fable of the Sick Anti-Vaxxer

In the early 20th century, a famous anti-vaxxer exposed himself to smallpox. What happened next offers a COVID cautionary tale.

A screen advertising transit rewards for COVID-19 vaccination above the entrance to a subway station
New York City on July 18. Daniel Slim/AFP via Getty Images

A parishioner of Los Angeles’ Hillsong Church dies of COVID-19 after making anti-vax jokes on Facebook and Instagram, some of which were posted from his hospital bed; after his death, the founder of the church tells CNN that vaccines are a “personal decision.” A Nashville radio host who had voiced skepticism about the COVID vaccine gets the disease and, after suffering from COVID-related pneumonia, goes on a ventilator; his brother tells the media, “If he had to do it over again, he would be more adamantly pro-vaccination.” Another pastor, from Texas, speaks publicly about his regret at not getting vaccinated before getting COVID and going to the intensive care unit: “I recognized that I had been a bit cavalier.”

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This was a week for these kinds of stories to circulate, as the delta variant has surged and it became clear that, as the Centers for Disease Control and Prevention’s Dr. Rochelle Walensky said at the White House, “this is becoming a pandemic of the unvaccinated.” These stories, which I’ve come to think of as Fables of the Sick Anti-Vaxxer, are familiar from past battles over vaccination. There’s a 1975 poster, created by the World Health Organization in service of worldwide childhood vaccination campaigns, that epitomizes health authorities’ belief in the power of this kind of morality tale. The poster features two mothers, one who vaccinates her baby, one who doesn’t. After an epidemic strikes, sparing the vaccinated baby, the vaccine-hesitant mother, standing over a little bed, begs the health worker: “Is it too late to vaccinate?” The health worker, walking away, says (harshly!) “Yes, it is!” as the mother weeps over the little bed.

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Andrea Kitta, who studies vaccination folklore, suggests that the fable has diverse social functions. It cements the in-group of the vaccinated, providing the vaccinated reader with confirmation that their choice was the right one. Jonathan Berman, author of Anti-Vaxxers: How to Challenge a Misinformed Movement, said that the fable allows the vaccinated some “choice-supportive bias/post-purchase rationalization,” pointing out that “people will look up reviews of cars they’ve already bought or vacation destinations they’ve already been to because they want to reassure themselves that they made the right choice”—this may be similar. It’s also delicious for vaccinated people to see the unvaccinated finally realizing that they were wrong and being forced to acknowledge a shared reality—something that’s been hard to come by in the Trump years. Kitta told me about a meme she saw recently that embellished on the saying “You can’t fix stupid” with a picture of the coronavirus, next to a speech bubble: “Well, I can!” (“Kind of a rough one there,” Kitta added.)

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There’s often a certain meanness to the circulation of these stories. Responses to a tweet about a 31-year-old anti-vax father on a ventilator in Missouri saying goodbye to his 6-year-old son were unsympathetic­­—even though this story, like many others, featured the man’s avowed desire to get the vaccine if he recovers. “They should be sent home with a religious book of their choice,” one replier said. “If only there were scientific evidence at how bad this virus is and what it can do to you…oh wait,” another snarked. “Here is how much I am concerned for someone that had 18 MONTHS of warnings, plus a chance for the vaccine: I really want tacos,” another joked.

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But what about any onlookers among the hesitant? Might these stories be serving a different function for them? A media circus from the American smallpox outbreaks of the early 20th century is an object lesson in the way this fable does, and doesn’t, convince anyone to change their position on vaccination. During this time, many people resisted compulsory vaccination against smallpox, because they were (justifiably, in some cases) afraid of the quality of the vaccines, unwilling to miss the week of work to suffer through the vaccine reaction, resistant to government compulsion, or all three. As historian Michael Willrich points out, this was a period where newspapers often featured Fables of the Sick Anti-Vaxxer. The New York Times reported on one such death by writing that the person in question had “died of the disease he defied,” and editorialized, when an epidemic broke out among anti-vaccinationists in Zion City, Illinois, in 1904: “There is likely to be an excellent, though rather dangerous, opportunity to see what can be done with a disease of that sort by the exercise of ‘faith.’ ”

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Newspaper illustration of doctors from the board of health going door to door to vaccinate people. The headline warns that those who refuse will be brought to court.
From the Boston Globe, Jan. 28, 1902. Boston Globe
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The center of the most memorable media frenzy of this type was Immanuel Pfeiffer. In retelling his story, I am relying on an account of it in Karen Walloch’s book The Antivaccine Heresy. Pfeiffer was a burr in the side of Boston’s public health authorities. He ran a magazine, Our Home Rights, that railed against compulsory vaccination (while advancing other Progressive Era causes like pacifism and vegetarianism), and he spoke on the topic in “every public forum he could find,” as Walloch writes. Pfeiffer was publicity-stunt-friendly, having fasted for weeks on two occasions as a way to attract people to his medical practice. He had a medical license, but participated in many fringe-y practices, like using hypnotism on his patients and “treating” people by mail.

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Annoyed to death by Pfeiffer as smallpox hit the city, Samuel Holmes Durgin, the chairman of the Boston Board of Health, dared the doctor to expose himself to smallpox, unvaccinated. Durgin had said publicly of Pfeiffer: “I have no patience with those who say vaccination is useless and harmful. … I wish the smallpox would get into their ranks instead of among innocent people.” In early 1902, Durgin invited “the adult and leading members of the anti-vaccinationists” to “a grand opportunity” to test their beliefs publicly by inspecting sick patients personally. Pfeiffer said he’d do it. He visited a smallpox isolation hospital on Gallops Island and examined patients during a tour, then slipped away, taking public transportation home, and attending a public meeting at a church.

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Thirteen days later, just about the amount of time it takes to incubate a case of smallpox, Pfeiffer vanished from public view. Durgin, questioned by reporters about whether his bet had been ill-advised, defended himself by saying that he had assigned a policeman to tail Pfeiffer and make sure that if he got smallpox, he wouldn’t come in contact with the public. The press was on the case, and police detectives were dispatched to find him. When health authorities finally located him, at his family farm in Bedford, Massachusetts, Pfeiffer’s smallpox was, according to the doctor assigned to examine him, “fully developed.”

The press, Walloch writes, “exploded with articles and editorials about his illness.” The story made it into the New York Times, the Boston Globe, and many medical journals. “The victim of his own folly and professional vanity,” the Boston Herald editorialized under the front-page headline “Anti-Vaccinationist May Not Live.” This was an excellent story, and the health authorities knew it; one, Pfeiffer said, even tried to take a picture of his face, covered in pustules, presumably with the intention of getting it to the press. (His physician intervened.)

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And yes—Pfeiffer lived. Not only that, he refused even to acknowledge that the experience had been a negative one, saying “the disease of smallpox, dreadful as it is said to be, never caused me pain for one minute.” And he still wouldn’t admit that vaccines worked. He said that the reason he got the disease wasn’t because he was unvaccinated, but because he was “immensely overworked” and exhausted. He even refused to acknowledge that his neighbors were angry at him for going through with the stunt, instead saying that they were only mad that the vaccines they rushed out to get upon learning that he had smallpox had made them sick.

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And so even this extreme example of the Fable of the Sick Anti-Vaxxer didn’t seem to have the effect authorities thought it would. The day after this fable hit the press, the health department made a vaccination sweep through Boston and “met with but little objection”; “the case of Dr. Pfeiffer had helped their cause immediately.” Medical journals argued that the case had been an “object lesson” that had helped the cause of vaccination. But when the vaccinators went back to knocking on doors a couple of weeks later, after the public learned about Pfeiffer’s survival, they had less luck. And other anti-vaccinationists refused to acknowledge this episode as a blow to their cause, saying that this was just one anecdote, that Durgin should have been more careful, and that the childhood vaccination Pfeiffer had 60 years prior meant that he actually was immunized, and therefore his illness was proof that vaccination didn’t work. In the end, Walloch argues, the episode was not quite the magic bullet of persuasion that Durgin hoped for. Even the anti-vaxxer’s sickness meant different things to different people.

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In his book, Berman categorizes anti-anti-vaccination persuasion tactics in three ways: “reactive” (think mean-spirited arguments with anti-vaxxers); “information-deficit” (dumping info on people); and “community-based” (tactics that demonstrate that other people around anti-vaxxers are vaccinating, “taking into consideration their self-identity and values”). These lessons, taken from research done around vaccination drives conducted in service of childhood vaccines, may or may not translate to our current situation. But I think it’s clear that these new fables will only be as useful as we let them. It’s difficult to be kind, when our fragile hopes for some post-pandemic normalcy seem to be falling apart due to other people’s refusal to get vaccinated. But the Fable of the Sick Anti-Vaxxer—a story aimed at the hesitant, from somebody who once thought as they did—may work best when we, the vaccinated, just let it sit, and resist the temptation to gloat.

Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.

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