How The 'Pox' Epidemic Changed Vaccination Rules.

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How The 'Pox' Epidemic Changed Vaccination Rules

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

The current controversy over childhood vaccinations and their possible side
effects pales in comparison to the vaccine wars at the turn of the 20th
century, according to my guest, Michael Willrich.

His new book "Pox" is about the smallpox epidemic in the early 1900s, when many
people were afraid to be vaccinated and public health officials and policemen
forced thousands of Americans to be vaccinated against their will, sometimes at
gunpoint.

Those public health officials needed to stop the spread of this deadly disease,
but the way they went about it raised civil liberties questions that ended up
in the Supreme Court.

Smallpox killed 300 million people in the 20th century. That's more than all of
the wars in that century combined. As a result of the vaccine's success, the
World Health Organization declared the disease officially eradicated in 1980.

Michael Willrich is an associate professor of history at Brandeis University.

Michael Willrich, welcome to FRESH AIR. Why did you want to write about
smallpox vaccinations at the turn of the 20th century?

Professor MICHAEL WILLRICH (History, Brandeis University; Author, "Pox: An
American History"): Well, I was collecting material for a book on civil
liberties during the period. This - I was writing this, just beginning this
project not long after 9/11, and I think like many Americans, I was thinking a
great deal about problems of national security and individual liberty and the
clash between them.

So I set out to write this book on civil liberties, and as I was gathering
material, I came across this small item in the New York Times that just
absolutely sparked my curiosity.

It was about a vaccination raid on a set of tenements in Little Italy, New
York. This was the Little Italy that was on the Upper East Side, in Italian
Harlem. And this occurred right about February, 1901.

And a crew of vaccinators and police from the city, about 250 men in all,
arrived on the scene of these tenements in the middle of the night and set
about vaccinating everyone they could find, knocking on doors, breaking them
down if necessary.

And people started running. So there were scenes of policemen holding down men
in their night robes while vaccinators began their work on their arms, and
inspectors were going room to room looking for children with smallpox. And when
they found them, they were literally tearing babes from their mothers' arms to
take them to the city pest house.

And I just became fascinated by this episode. What did it mean for a big city
government at the dawn of the 20th century to be battling an epidemic disease
in this way? What did it mean for American notions of liberty?

GROSS: And how to balance the good of society with the liberty of the
individual.

Prof. WILLRICH: That's exactly right. I mean, I just had the sense when I came
across this very short article of having my hands on a - I don't know, a shard
of glass from a broken stained glass window and just having no real idea of
what the big picture looked like. And that really got me started on this
project.

GROSS: At the same time, were you seeing parallels to the controversies around
vaccinations today?

Prof. WILLRICH: Always. Throughout this entire project there were resonances
for me with the vaccine controversy today that really increased in intensity as
I was working on this project. And I began this project around 2003, and at the
time, I think, according to the CDC, it was something like, you know, 22
percent of American parents of young children were refusing one or more
vaccines for their children.

And five years later, as I started to, you know, write the project up into a
book, five years later that number had - the percentage had nearly doubled, to
about 40 percent of all Americans.

So vaccine today, the vaccine controversy today is one of the most important
public health crises we face in America. But these controversies today just
simply pale in comparison to the vaccine wars of the turn of the 20th century.

GROSS: So let's talk about those vaccine wars at the turn of the 20th century.
But let's start by talking about smallpox itself. People aren't really familiar
with smallpox anymore. It's a disease, fortunately, that we seem to have
eradicated. So I'm going to ask you to describe the symptoms of smallpox and
why it was so deadly.

Prof. WILLRICH: So smallpox was caused by a virus, the variola virus. And it's
spread from person to person, usually through saliva, for a sneeze or a cough,
and it had an incubation period of about 12 to 14 days. And after that period,
people would experience the onset of a very high fever.

And for a couple of days that fever would subside and people would feel better.
They'd start to feel ready to go back to work or back to school. But that's
when they were just becoming their most contagious, at their most contagious
state. And lesions started to form in their throat and then eventually on the
skin.

And smallpox was famous for its horrific rash that doctors from the period
called the eruption. People would suffer through this growing and spreading
rash for a period of two or three full weeks, and along the way usually about a
third of all people infected with smallpox would die, usually from acute
respiratory failure.

And for the most part, most people who survived a bout with smallpox were
severely scarred for life, on their faces most commonly. So even someone who
had survived a battle with this loathsome disease bore its marks on their face
for the rest of their lives.

GROSS: Now, the epidemic that you write about at the turn of the 20th century
was a less lethal strain of smallpox that didn't kill as many people.

Prof. WILLRICH: Yes, it's a - part of the medical mystery of this book and this
epidemic was that it was the first time that a new strain of smallpox, that is
now described as variola minor, first appeared.

And this strain of smallpox, instead of killing 30 percent of its victims, only
killed about one percent, which was a remarkably - remarkably attenuated form
of the disease.

And the problem was that medical officials understood this to be smallpox, and
they had no - they couldn't tell when this mild form of smallpox would turn
into or revert back to the deadly form of smallpox that everybody feared.

And during this same wave of milder epidemics, epidemics of the classic type of
smallpox were breaking out in American cities across the country. In New York,
730 people died. In New Orleans, 500 people died. In Boston, 270 people died.
In Philadelphia, 400 people died from the disease.

So you have a real kind of perfect storm of factors to create a vaccination
controversy: a milder form of the disease that is lowering people's sense of
risk, of suffering from smallpox, and at the same time a strong belief among
health officials and epidemiologists that this disease had to be brought under
check by swift vaccination of the population or else it could turn into
something truly horrific.

GROSS: So what was the vaccination for smallpox like at the turn of the
century, the period that you document, compared to what it became later, as
scientists learned more about immunization?

Prof. WILLRICH: Sure, well, we think about vaccination today as a shot
delivered in the antiseptic environment of a trusted pediatrician's office. But
a century ago, the smallpox vaccine involved someone taking a hold of your arm,
scraping the outer layer of the skin with a sharp blade, a lancet or a needle,
usually drawing a little bit of blood, and then dabbing on some of the virus
material, the vaccine material, which was a live vaccinia virus that had been
harvested literally from sores on the underside of infected calves.

So as you can imagine, people faced with the prospect of being vaccinated had
all kinds of images in their head as they did so. Vaccines a century ago were
far less safe than they are today.

GROSS: And you're talking about how people today have an image of getting the
vaccine in a trusted doctor's office. What were some of the places that
vaccines were administered at the turn of the century, during the smallpox
epidemic?

Prof. WILLRICH: Well, especially for the poor, vaccine was a very public event.
It often took place in the public schools, on factory floors. Sometimes when
employers had agreed with public health officials to get their entire workforce
vaccinated, they would have the doctors sitting at the desk as the workers came
by to collect their pay envelopes at the end of the week. And the agreement was
if you want to come back next week, you're going to get vaccinated right now.

GROSS: Really, outside of the coercive aspect of what you're describing, it
doesn't sound that different from today. Like flu shots are given at
workplaces. I was immunized against polio and I forget what else in school. I
guess maybe it was just polio. You know, drugstores give flu vaccines now. So
it has become something that you get outside of your doctor's office. I just
thought I'd get that in.

(Soundbite of laughter)

Prof. WILLRICH: Sure, no, I think that's true. Consider this aspect of the
environment that's so different today. You know, 110 years ago, vaccination was
compelled by the state. There's a law - there were laws on the books compelling
vaccination.

But there was no effort taken by the government to ensure that vaccines on the
market were safe and effective. We live in a very different environment today,
where there are extensive regulations governing the entire vaccine industry.
And there's a system of compensation in place for people who are adversely
affected by vaccines, that small number of people.

GROSS: So people had a reason to be afraid of vaccines at the turn of the 20th
century because there was no oversight. There was no licensing of the
pharmaceutical companies. So you really didn't know what you were getting.

Prof. WILLRICH: Well, vaccines were this marvelous product of the stable and
the laboratory. Vaccines were produced literally by infecting cows with
vaccinia virus, waiting for these sores to arise in their bellies, and then
harvesting the pus coming out of those sores. And that is the essential vaccine
product of the turn-of-the-century period.

GROSS: And since one of the - like in New York, for instance, public health
workers, accompanied by police, would raid tenements and forcibly vaccinate
people - and I imagine some of the immigrants were just terrified. A lot of
them probably didn't even speak English. And here are these people forcing them
to get inoculated. It must have been a pretty frightening experience.

Prof. WILLRICH: This is exactly right. I mean, you sense the terror in the
documents as you read about people fleeing the scene of these vaccination raids
that took place in the middle of the night in, say, in New York, in the city's
crowdest(ph) and poorest immigrant neighborhoods.

And you had immigrants who had recently arrived from Europe, had often been
fleeing very repressive regimes back in Europe, seeking liberty and asylum in
the United States. And in their experience, a state official pounding on the
door in the middle of the night could have meant anything from, you know, being
conscripted into the army to being dragged off to prison.

And so given the language barriers, given the differences in political
traditions and the like, there was no reason to assume that these health
officials and police entering the tenements in the middle of the night were
there for benign purposes.

GROSS: If you're just joining us, my guest is Michael Willrich. He's the author
of a new book, "Pox: An American History." We'll talk more after we take a
short break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Michael Willrich. His new book,
"Pox: An American History," is about the smallpox epidemic in America at the
turn of the 20th century and the balance between protecting society through
vaccinations, often forced vaccinations, and civil liberties issues.

Now, you write that in parts of the South, smallpox was considered a disease
that black people got. Why?

Prof. WILLRICH: Well, when variola minor, the new, milder form of smallpox,
first started spreading through the South, it was documented first among
African-American populations. This is a period of a very high level of racial
segregation in the South.

So it's conceivable that, in fact, smallpox was spreading first more rapidly
among one sector of the population, particularly a sector that had been
completely neglected by the medical profession, a sector of the population that
was malnourished and thus more susceptible to disease.

And the distinctive response in the South to the spread of this disease was: As
long as it was confined solely to African-Americans or appeared to be, public
health officials paid it very little mind. It was only when they concluded that
uh-oh, this disease might spread across the color line, that they started to
take action. And they usually started that action by rounding up blacks and
getting them vaccinated.

GROSS: Forcibly?

Prof. WILLRICH: Often by force. In fact, there's one episode that really stands
out in my mind, in Middlesboro, Kentucky, when the police and a group of
vaccinators went into this African-American section of town, rounded up people
outside this home, handcuffed the men and women and vaccinated them at
gunpoint, as if that wasn't all quite redundant. But it's a shocking scene and
very much at odds with our, you know, sort of dearly-held notions of American
liberty.

GROSS: You write that the Kentucky Board of Health in 1898 made it mandatory to
travel with a certificate saying that you'd been inoculated. Tell us about
that.

Prof. WILLRICH: It's a remarkable thing. I mean, the - many health officials,
not just in the South, viewed a vaccination scar on the upper arm as a kind of
passport to - that people should be required to have in order to enter a
workplace or a school or any kind of public area.

But in the South, during this wave of epidemics in Kentucky, the health board
actually came up with this order that blacks traveling through Kentucky needed
to have a document or have a vaccination scar on their arms in order to be – in
order to move about. And it really - it was, I think, a very harsh blow against
the people whose right to travel freely had been so dearly bought just a few
decades before in the Civil War.

GROSS: What about white people? Did they need a certificate?

Prof. WILLRICH: No, not - no, not at all to the same extent. In fact, this
health measure singled out African-Americans.

GROSS: So another example of the conflict between inoculating people for the
greater good, to protect society, and then violating civil liberties in order
to do it.

Prof. WILLRICH: Absolutely, yes.

GROSS: So you say that the vaccine program, the vaccination program, is what
spread federal power in the South during this period.

Prof. WILLRICH: Yeah, it's quite remarkable. I mean, the - today we associate
public health with government at every level, from the local to the state to
the federal level of government. But according to the sort of American
constitutional traditions, this form of governmental action was largely a
matter of local and state concern.

During the smallpox epidemics at the turn of the century, as one sort of
Southern community after another proved defenseless against this disease, had a
lot of difficulty sort of managing the disease, many called upon a federal
health agency, the U.S. Marine Hospital Service, to provide help.

And the service sent down a number of surgeons through the South who became
smallpox experts, and they'd go from town to town, advising local communities
how to stamp out the disease. This really is, I think, a very important moment
of transition in which the federal government becomes much more involved in
everyday health measures in the South.

GROSS: Now, in a lot of places, if you did contract smallpox, you were
quarantined in a place that became known as a pest house. Would you describe
what the pest houses were?

Prof. WILLRICH: The pest house was the most dreaded of American political
institutions. In a place like New York, the pest house would have to be quite
large. The pest house is an isolation hospital. And so in a place like New York
they would set up a pest house for smallpox patients on an island, North
Brother Island, up by Riker's Island, on the East River, completely isolated
from the rest of the community.

But in most smaller places around America, a pest house would be just simply a
ramshackle house on the edge of town that the local authorities had taken over
for this purpose. And people would be literally dragged there against their
will.

In the most poignant scenes - some of the most poignant scenes in the book are
when mothers are fighting with health officials to keep their children in their
own homes rather than have them be taken off to a pest house, because people at
the time rightly associated pest houses with death. That's where someone was
taken to die.

GROSS: And the only treatment you could get there was to ease symptoms, because
there certainly wasn't a cure for smallpox.

Prof. WILLRICH: No cure for smallpox and really very little effective treatment
to bring the symptoms in check. So in fact the instincts of these mothers who
were fighting to keep a hold of their sick children and keep them in their
home, the instinct wasn't such a bad one.

Studies have shown that people with smallpox, particularly in developing
countries - the United States at the turn of the century was very much of a
developing country - particularly in a developing country with poor hospital
facilities, people often had a better chance of survival if they were taken
care of by loved ones in their own home.

GROSS: My guest, Michael Willrich, will be back in the second half of the show.
His new book is called "Pox: An American History." I'm Terry Gross and this is
FRESH AIR.

This is FRESH AIR. I’m Terry Gross, back with Michael Willrich, author of the
new book “Pox: An American History.” It’s about the smallpox epidemic in the
U.S. at the turn of the 20th century and the conflicts between public health
officials, who were trying to vaccinate the population to prevent the spread of
the disease, and the people who refused to be vaccinated or allow their
children to be vaccinated. Willrich is an associate professor of history at
Brandeis University.

Let’s talk about the anti-vaccinationists. There was an anti-vaccination
movement. What did the movement stand for and was it aligned to other causes as
well?

Prof. WILLRICH: These people were remarkable. You know, the whole world of
people who were resisting vaccination during this period, the organized hard
core anti-vaccinationists were just a small segment but they were very vocal.
They conceived of themselves as part of a transatlantic movement dedicated to
protecting individual liberty against the encroachment of a Leviathan state.
They had produced some marvelously interesting publications that were filled
with both some - the gory details of vaccination but also with principled
claims for personal liberty. And some of the arguments that they make about
liberty are arguments that we associate more with the much later movement for
reproductive rights and family privacy in the late 20th century.

In fact, these early 20th century anti-vaccinationists are already arguing that
the liberty protected by the U.S. Constitution included a right to bodily
integrity, to medical liberty and to freedom of choice in the area of health.

GROSS: Well, the battle between people who took the individual liberty argument
against vaccinations and the government who took the greater good mandatory
vaccination argument came to a head in a Supreme Court decision. Tell us about
that decision.

Prof. WILLRICH: Well, this was a – so there was a wave of litigation at the
local, state and the federal levels but it did come to into a head in 1905 in
Supreme Court’s decision in Jacobson versus Massachusetts. Jacobson was a
Swedish immigrant minister in the city of Cambridge, where Harvard is located,
and during an outbreak, a very serious outbreak of smallpox in 1902, Jacobson
was one of the handful of people who refused to comply with the city's
vaccination order. When he explained why he said he had been vaccinated as a
child and had made him very sick; that when his young son was vaccinated
against smallpox he too was made very sick, and that he knew many more cases
like this.

And so he refused to be vaccinated. He was found guilty in a local police
court. He appealed, he appealed, he appealed and it made it all the way up to
the U.S. Supreme Court. And in that decision the Supreme Court upheld the right
of a state like Massachusetts to order its citizens to be vaccinated during an
epidemic of smallpox - upheld that measure as a collective right of the state
to protect the people from a disease that imperiled the population.

But at the same time, the Court recognized certain limitations on that power -
that this power of health policing was not absolute, it was not total, that
there was in fact a sphere of individual liberty that needed to be recognized.
That measures like this needed to be reasonable and that someone who could make
a legitimate claim that a vaccine posed a particular risk to them because of
their family history or their medical history...

GROSS: Or their religious beliefs.

Prof. WILLRICH: Well, the Supreme Court in fact did not recognize religious
arguments as a legitimate defense against vaccination during this period.

GROSS: Oh, okay.

Prof. WILLRICH: Although many, including Christian Scientists, wanted exactly
such an exemption. The most important exemption created in this decision was,
or an implied exemption that for a person for whom vaccine posed a particular
health risk. So if you look at our laws today, the compulsory vaccination laws
in the books now, particularly that apply to school children, I think 48 of the
American states now have religious exemptions. Everyplace will recognize that
someone who can get a doctor's certificate that vaccines pose a particular harm
to them, everyplace recognizes that that’s a legitimate excuse against
vaccination. Some states are even now recognizing conscientious objectors,
people whose beliefs not necessarily beliefs, tell them that vaccination is
unconscionable.

GROSS: Now the Supreme Court decision also said you couldn't forcibly vaccinate
somebody.

Prof. WILLRICH: Yes. This happened actually at the state level, in the Supreme
Judicial Court of Massachusetts, one of the most storied courts in American
history. That court in its decision said as an aside - even as it upheld the
right of the state government to order vaccination - that, of course, it would
be unconstitutional and sort of beyond the pale for health officials to
forcibly vaccinate anyone. That's not within their power. And I think that this
was really a shout out to the Boston health authorities who were employing
forcible vaccination all the time in the poorest neighborhoods in the city.

GROSS: So was the epidemic at the turn of the 20th century the last smallpox
epidemic in the United States?

Prof. WILLRICH: For many of these communities it in fact was the last epidemic;
for Boston, for New York. But no, there were still isolated epidemics of
smallpox outbreaks, affected places like Detroit in the 1920s. And this new
form, the milder form of smallpox sort of had a relatively low-level incidence
throughout the first half of the 20th century, due to the fact that so many
people were still refusing to get vaccinated against it. 1949 was the last
reported case of smallpox in the United States. And by 1972, the government had
decided that it was time to stop mandatory vaccination against smallpox
because, you know, every year a few people would die from the vaccine.

GROSS: Now, it's through mandatory vaccinations that smallpox ended not only in
the United States but around the world.

Prof. WILLRICH: That was a very big part of the story was it was not the only
part of the story. Smallpox was not destroyed through universal vaccination -
that is getting everybody across the globe vaccinated. But it was destroyed by
targeted vaccination in a smallpox-infected regions of the country and the
world carried out by an international team during the decades of the '60s and
the '70s.

GROSS: So in 1980, the World Health Assembly declared that the world and all
its people had won freedom from smallpox. It recommended that countries
discontinue smallpox vaccinations. But smallpox remained alive in research labs
in the CDC in the United States and in labs in the USSR. And, as you point out,
after the Cold War, the West was able to verify that the USSR had weapons grade
smallpox. In other words, it had weaponized smallpox, which is a pretty
frightening thought. So do you know where that stands now, like what’s left of
that?

Prof. WILLRICH: I don't think anyone knows exactly where it stands. The big
concern, of course, is that some of that former Soviet smallpox might have
ended up in the hands of other countries. In fact, this was one of the - was
part of the conversation leading up to the Iraq War in 2003 - was a concern
stated by the Bush administration that Saddam Hussein had weaponized smallpox,
which turned out, of course, not to be true.

GROSS: So if smallpox is ever used as a weapon do have vaccine stockpile?

Prof. WILLRICH: Yes, we do. I believe we in fact have enough smallpox vaccine
in our stockpile in the United States for every American, every person within
the country's borders to receive the vaccine. And, in fact, the vaccine not
only prevents people from becoming infected with smallpox, it also if taken
within a few days after infection can cause there to be a much milder form of
the disease.

GROSS: My guest is Michael Willrich. His new book “Pox” is about the smallpox
epidemic in the U.S. in the early 1900s.

We’ll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you’re just joining us, my guest is Michael Willrich. He’s the author
of the new book “Pox: An American History,” and it’s about the smallpox
epidemic in the United States at the turn of the 20th century and the conflict
between mandatory vaccination laws and people who didn't want to get vaccinated
because they were afraid of the vaccine and thought it was a violation of their
civil liberties.

Let’s fast forward to today when vaccines remain really controversial. And tell
us some of the objections that a lot of, for instance, parents raise today
about getting their children vaccinated with all the vaccines that are
recommended.

Prof. WILLRICH: Well, the anti-vaccination movement of our own times really
took off after the publication of a report in 1998 by the British medical
journal The Lancet, that purported or suggested that there might be a link
between autism - which was very much on the rise in the U.S. and the U.K. -
between autism and vaccination, particularly the MMR vaccine.

GROSS: That’s, yeah, measles, mumps, rubella.

Prof. WILLRICH: Yes, the measles, mumps and rubella vaccine - one of the most
common childhood vaccines. This paper was thoroughly discredited and debunked.
But the idea that vaccines might somehow be the cause of autism stuck in the
public mind. And so according to some of the most recent studies something like
one-fifth of all American parents believe that vaccines cause autism. This is
simply not true, but it's a powerful association in the public mind.

GROSS: Well, the research paper that you cited by Andrew Wakefield connecting
vaccines, the MMR vaccine with autism, that was published in 1998. And I think
it was only in the past year that The Lancet, where it was first published,
withdrew the study that he was, he is no longer allowed to practice medicine in
England. The editor of The Lancet, which first published his article said that
the research was based not on bad science but on a deliberate fraud. So, but...

Prof. WILLRICH: So just if I...

GROSS: Go ahead, correct me.

(Soundbite of laughter)

Prof. WILLRICH: I just want to correct you a little bit on that, so.

GROSS: Yeah, go ahead.

Prof. WILLRICH: The Lancet retracted the study, I believe it was maybe back in
2005. What happened very recently is that the British Medical Journal, which is
another leading medical journal out of Britain, published a long-term sort of
investigative report about the original Wakefield study that concluded that
Wakefield had in fact at the time that he produced this study was on the, was
receiving payment from a lawyer involved in a suit against a vaccine
manufacturer. So that's what led the British Medical Journal to make the
statement that this was not just about bad science, it was about fraud.

GROSS: So now that that Andrew Wakefield study connecting the MMR vaccine to
autism has been discredited and he can no longer even practice medicine in
England, is there a, you know, a concerted effort in the United States, an
organized campaign to get the word out that that study was totally study was
totally discredited?

Prof. WILLRICH: I think that the public health community in the U.S. could do
much more with this moment. I think this is the time for redoubling their
efforts to spread the good word about vaccines and also have a candid public
discussion about the risks and benefits of vaccines. There's no more opportune
moment than the present to launch a new publicity campaign around vaccines.

GROSS: You seem to see both sides in the story of at turn of the century, the
people who were afraid of vaccines and the government who felt like everybody
had to be vaccinated to protect the larger population; that it was essential to
get people vaccinated. So do you see both sides in the controversy today?

Prof. WILLRICH: To this extent. It concerns me whenever I hear health officials
or journalists characterize parents who are afraid of vaccines today as simply
ignorant or anti-scientific denialists, right, that paint - I just think that's
too broad a brush to paint these people and their concerns with.

Parents, we have to accept the fact and realize that parents, like the health
officials, have the best interest of their children in mind. They understand
those interests in different terms. They have these newborn infants they are
responsible for, they have this intimate bond with, and to see them receive one
shot after another to protect them against diseases that the parents don't see
as present anyway is something kind of unnatural about this as important as it
is and certainly counterintuitive.

So I think it's very important that health officials and members of the public
health community at large never forget that this is the challenge of science in
a democracy. It's a process of continuous education and education that has to
be very candid and honest about the relative risks and the benefits of
vaccines, and that this is their job as members of the public health community,
and it's a job that's never going to go away.

GROSS: May I ask if you have children?

Prof. WILLRICH: I do. Yes.

GROSS: And did you have concerns about their vaccinations?

Prof. WILLRICH: You know, I was one of those parents who when the doctors let
us leave the hospital with our first child about 12 years ago, I couldn't
believe that they were letting us drive off with that...

(Soundbite of laughter)

Prof. WILLRICH: ...precious human infant. My wife and I both took the
vaccination instructions very, very seriously and we got our children
vaccinated for everything that they were supposed to be vaccinated for. But I
will tell you I have one story that may shed some light, or for me shed some
light on parents’ fears about vaccines.

My son Max, when shortly after he was born, he was I think about five months,
six months old, got the rotavirus vaccine. This was a new vaccine to protect
children against a very serious disease. It had broken out in Houston where we
were living at the time. So I said, of course, get him, let’s get him the
vaccine. He took the vaccine and within a number of weeks he started to develop
this horrible sort of abdominal pain and was in great sort of distress and we
were so concerned about him.

We finally took him to the emergency room, where he was diagnosed with and
treated for a condition called intussusception, which involves the intestine
literally telescoping in on itself. It's extremely dangerous and very, very
painful. So they were able to resolve this problem, he was almost instantly
better. And the next morning as I wake up in the hospital bedroom next to my
son in his little hospital crib, someone brings me a copy of The New York Times
and look, and there on the front page is a story, rotavirus vaccine pulled from
the market because it causes in one in 10,000 cases intussusception.

So I feel people's concerns very much. But I, you know, there's a new rotavirus
vaccine back on the market today. It's safer. They have timed it better so they
give it to kids a little bit earlier. This problem has been resolved. But I'll
tell you, it's no fun being, having your kid be the one in 10,000 cases who
feels the very serious side effects of a vaccine.

GROSS: So I'm wondering what your thoughts are today about the need for
mandatory vaccination.

Prof. WILLRICH: I think we can just say that vaccines work by giving a virus no
place to go, essentially. Viruses spread in human populations from person to
person and if you have a vast majority of a community vaccinated, protected
against that virus, the virus will simply never be able to have a toehold in a
community and spread from there. So universal vaccination to the extent that it
can be achieved seems like a very laudable public health goal to me.

There’s a very important concept of herd immunity that says that in any
community there are bound to be people who cannot get vaccine because – certain
vaccine because it poses a health risk to them individually. There are also
some people for whom the vaccine just simply won't work, who won't be protected
from the disease against a vaccine. So it's important to get the entire
community vaccinated in order that everybody can be protected and that a virus
cannot successfully spread in a local population.

But people - and this I think may go for Americans more than just about any
other people in the world - people don't like to think of themselves as members
of a herd, and that's the real dilemma for public health today.

GROSS: Well, I want to thank you so much for talking with us.

Prof. WILLRICH: Oh, it's been my pleasure.

GROSS: Michael Willrich is the author of the new book “Pox: An American
History.” You can read an excerpt on our website, freshair.npr.org.

Coming up, Maureen Corrigan reviews “Please Look After Mom," a novel that's
been a bestseller in South Korea and has just been published here.

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'Please Look After Mom': A Guilt Trip To The Big City

TERRY GROSS, host:

Our book critic Maureen Corrigan has a review of “Please Look After Mom,” a
best-selling novel in South Korea that has been translated into English and was
just published here. The title piqued Maureen's curiosity. But after reading
the book she wonders if something was lost in the cultural translation.

MAUREEN CORRIGAN: Mama Mia, who knew that the Koreans could outstrip the Jews
and Italians when it comes to being plagued by mother guilt.

How else to explain why “Please Look After Mom,” a new novel by Korean novelist
Kyung-sook Shin, has already sold over one-million copies in her native South
Korea? This literary phenom is scheduled to be published in 22 other countries
and has just come out here. The back cover of the American edition, brought out
by Knopf, is filled with blurbs by heavyweights like Gary Shteyngart and
Edwidge Danticat. They, too, must share a weakness for melodramas about
maternal self-sacrifice, although “Please Look After Mom” out sniffles even
those immortal weepies of the Western canon, Stella Dallas and Mildred Pierce.

To give it its due, Shin's novel, which was translated from the Korean by Chi-
Young Kim, is marked by a wistful tone and by some precisely-rendered scenes of
emotional disconnect between a mother and the adult children who've grown apart
from her. But the weird fascination of “Please Look After Mom” is its message -
completely alien to our own therapeutic culture - that if one's mother is
miserable, it is indeed, the fault of her husband and her ungrateful children.

As an American reader indoctrinated in resolute messages about boundaries and
taking responsibility - I kept waiting for irony; a comic twist in the plot; a
reprieve for the breast-beating children. It wasn't until the end of the novel,
when Shin rolled out the mother of all maternal suffering images,
Michelangelo's “Pieta” - that I understood I was stranded in a Korean soap
opera decked out as serious literary fiction.

The pretext of “Please Look After Mom” is that an elderly, illiterate woman is
separated from her distracted husband in the central train station in Seoul and
goes missing. Her four adult children distribute fliers and roam the city
searching for her, but are tormented by regret that none of them went to the
train station in the first place to meet their country bumpkin parents. That
goes double for the eldest son, a wealthy businessman who was indulging in a
sauna during his parents' arrival time and, extra especially, for the eldest
daughter, a successful novelist, who was off having her ego inflated at the
Beijing Book Fair.

Shin presents her reproachful tale through different narrative perspectives,
the most labored of which is a God-like second-person voice. Here, that voice
hectors the novelist daughter for her crimes of inattention...

After you'd left home for the city, you'd always talked to Mom as if you were
angry at her. You talked back to her saying, what do you know, Mom? Even when
you had to take a plane because your book was being published in another
country, or you had to go abroad for a seminar, when she asked, why are you
going there? You stiffly replied, because I have business to take care of.

Did you catch the anti-city, anti-modernist, anti-feminist messages in that
passage? The lost mother clearly stands for values that are fading from Korean
culture as industrialization and urbanization triumph. Her life, which we
glimpse in flashbacks, has been one long ordeal since her marriage at age 17,
yet mom has retained her simple humanity. We readers know this because we're
told that Mom secretly donated money for years to an orphanage and only asked
in return that a worker there read aloud to her the books written by her cold-
hearted novelist daughter.

If there's a literary genre in Korean that translates into manipulative sob
sister melodrama, “Please Look After Mom” is surely its reigning queen. I'm
mystified as to why this guilt-laden morality tale has become such a sensation
in Korea and why a literary house like Knopf would embrace it. Although, since
women are the biggest audience for literary fiction, “Please Look After Mom”
must be anticipated to be a book club hit in this country. But why wallow in
cross-cultural self-pity, ladies?

Having just read Patti Smith's award-winning memoir, “Just Kids,” for the
second time, I'd urge you to pick instead her empowering female adventure tale
about getting lost in the city. Smith will get your book club up on its feet
and pumping its collective fists in the air, rather than knocking back the wine
and reaching for the cheap consolations of kimchee-scented Kleenex fiction.

GROSS: Maureen Corrigan teaches literature at Georgetown University. She
reviewed “Please Look After Mom” by Korean novelist Kyung-sook Shin. You can
read an excerpt on our website, freshair.npr.org, where you can also download
podcasts of our show.

(Soundbite of music)

GROSS: I'm Terry Gross.

(Soundbite of music)

GROSS: On the next FRESH AIR, journalist Dexter Filkins talks about the
uprising in Yemen and his experiences reporting from there. Filkins’ article
“After the Uprising: Can Protesters Find A Path Between Dictatorship And
Anarchy,” is published in the current edition of The New Yorker. Join us.
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