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On to today's history behind the headlines...
America's vaccine debates echo centuries-old tensions over trust and authority.
When federal vaccine guidance changed this summer, Americans faced competing recommendations from different authorities.
The resulting debates over expertise, government oversight, and personal choice mirror conflicts that began in colonial North America. The first American vaccine controversy split communities and sparked the same fundamental questions we're wrestling with today.
🖼️ The Big Picture
What's Happening: Federal health agencies have revised vaccine policies under new leadership. Health Secretary Robert F. Kennedy Jr. reconstituted the CDC's vaccine advisory committee with new appointees and narrowed COVID vaccine recommendations to high-risk populations.[1] Several states have responded by developing independent vaccine guidance, with medical organizations like the American Academy of Pediatrics maintaining their own recommendations.[2]
⚠️ Why It Matters: Americans now receive different vaccine guidance from federal agencies, state governments, and major medical organizations. This creates multiple sources of medical advice where there was previously more unified messaging, requiring families to navigate competing recommendations.
📜 What History Reveals: These dynamics mirror America's first major vaccine controversy in the 1720s, when communities split over smallpox inoculation. The debates revealed enduring tensions between institutional authority, scientific evidence, and public trust that continue to shape American attitudes toward medical interventions.
🔍 Historical Deep Dive
The Boston Smallpox Crisis, 1721
In 1721, Boston faced a devastating smallpox outbreak. Cotton Mather, a prominent Puritan minister, learned about inoculation from his enslaved African, Onesimus, who described the African practice.
Inoculation is different from vaccination. Inoculation involves introducing a pathogen, like smallpox, under the skin to deliberately induce a mild infection that will create immunity and hopefully prevent severe illness. Vaccination introduces a weakened, killed, or modified form of a pathogen to spur someone’s immune system to create full or partial immunity to that pathogen.[3]
Cotton Mather sent a personal letter to Dr. Zabdiel Boylston (John Adams’ maternal great-uncle) to explain what he learned from Onesimus and what he had found through individual study. Impressed with the information and research Mather offered, Boylston agreed to try inoculation.
Cotton Mather by Peter Pelham, 1727
Bostonians divided over the procedure.
Critics gathered outside Mather’s home, and one person threw an explosive device through his window (it failed to detonate).[4] The controversy revealed two sides competing for authority during the outbreak:
Traditional physicians who opposed the practice.
Men like Mather and Boylston, who argued for it based on research and religious conviction.
The Boston smallpox controversy of 1721 established a pattern that continues to the present day: Scientific innovation meets public resistance —> Experts disagree among themselves about the innovation —> The public is left to determine which medical and scientific authorities they should trust.
Setting Precedent, 1777
In 1777, the young United States faced an even larger smallpox threat: George Washington’s decision to inoculate the Continental Army. Smallpox posed a severe threat to the Continental Army. Many of the army’s young recruits hailed from regions that offered them little prior exposure to the disease. During the 1775/1776 Siege of Boston, Washington witnessed how smallpox decimated his fighting force by killing soldiers and rendering them unfit for duty.
So in February 1777, while in winter quarters, Washington ordered the systematic inoculation of his army. The decision caused distress among civilians. Those near the Army’s winter quarters in Pennsylvania and New Jersey worried the disease might infect their towns too. Those who lived in more distant areas feared for the lives of their fighting men. The procedure had a 2%-3% fatality rate among healthy people. But Washington’s gambit worked. Inoculating his soldiers created immunity and eliminated the threat that the Continental Army would be too sick and depleted from smallpox to fight.[5]
Washington’s actions also established a precedent for American government leaders to make population-wide health interventions during periods of emergency.
Dr. Edward Jenner, by John Raphael Smith, 18th century.
From Inoculation to Vaccination, 1796
In 1796, English physician Edward Jenner developed the smallpox vaccine.
Unlike the process of inoculation, where doctors placed the pus from a person with a live, but mild case of smallpox under a healthy person’s skin, Jenner injected the much milder cowpox virus to trigger a person’s immunity to smallpox.
By the early 1800s, Jenner's safer cowpox vaccine had largely replaced dangerous smallpox inoculation. Cities like Philadelphia established vaccine programs with distribution centers and door-to-door outreach.[6]
Yet participation remained inconsistent due to varying levels of public trust, religious concerns, and skepticism about government health programs.
Why vaccine debates persist
Today's disagreements between federal, state, and medical authorities over vaccines reflect fundamental tensions in American federalism.
Through the Tenth Amendment, the Constitution grants states significant authority over public health, while federal agencies provide national coordination and expertise.[7]
When these levels of government offer differing guidance, citizens must choose which authority to follow.
Historical evidence suggests that scientific data alone do not determine public acceptance of medical interventions. Trust in institutions, personal experience, and community norms significantly influence individual decisions.
When established authorities provide conflicting guidance—as occurred in 1721 and again today—people often rely on familiar social networks and ideological frameworks to navigate uncertainty.
Vaccines represent both medical tools and symbols of broader debates about expertise, autonomy, and social responsibility.
How societies distribute them, who provides recommendations, and which populations receive priority access reflect deeper values that have shaped American culture since colonial times.
💬 Final Thought
Cotton Mather defended inoculation by arguing that divine providence gave humans reason to discover medical advances.
His opponents claimed that deliberately causing disease violated natural and religious law.
Three centuries later, Americans continue to debate. When experts disagree and institutions offer conflicting guidance, how should individuals and communities make decisions about medical interventions?
🎧 Go Deeper
Explore the fascinating history of vaccines and public health controversies with these episodes of Ben Franklin's World:
From Inoculation to Vaccination, Part 1 Episode 301 Discover how early Americans lived with smallpox and developed the world's first immunization procedure, featuring the dramatic story of Cotton Mather's inoculation controversy in 1721.
From Inoculation to Vaccination, Part 2 Episode 302 Learn how Edward Jenner's observations led to the creation of the first vaccine and how early Americans navigated the transition from dangerous inoculation to safer vaccination.
Yellow Fever in the Early American Republic Episode 174 Investigate how yellow fever outbreaks tested science, society, and government responses in early Philadelphia, showing how disease shaped politics and public health policies.
Yellow Fever, Immunity, and Early New Orleans Episode 316 Explore how immunity to yellow fever became a form of social and economic capital in early New Orleans, revealing how disease and immunity shaped class, race, and opportunity in early America.
Everyday People of the American Revolution Episode 325 Examine how ordinary Americans made life-and-death decisions during the Revolution, including choices about medical treatments and public health measures like Washington's army inoculation.
💬 What Do You Think?
History tells us who we are and how we came to be who we are.
What do you think today's vaccine debates reveal about American values and our relationship with institutional authority?
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P.S. Something New For History Lovers
You may recall in early August, I mentioned launching something special. That project is the History Explorers Club: an online community where curious minds explore early American history together and alongside actual historians.
Last night's highlight: Members voted to explore food history this month, so historian Marie Pellisier Tansi joined us for our first live historian event to discuss election cakes and the famous "Mammoth Cheese" that Cheshire, Massachusetts, sent to President Thomas Jefferson in 1801. The Q&A afterward was incredible!
A Monument that is a full-size replica of the Cheshire, MA cheese press, courtesy of Marie Pellissier Tansi
Our Founding Members are helping shape the Club into something truly special. And I'm having fun working with their ideas to build a living community where history lovers connect with each other and with professional historians through live events, workshops, and discussions. No history degree required, just curiosity about early America.
Want in? I'm reopening membership in mid-January. Join the waitlist to be first to know when doors open.
The History Explorers Club, where curious minds explore the past--together.
[6] Martin Kaufman, "The American Anti-Vaccinationists and Their Arguments," Bulletin of the History of Medicine 41, no. 5 (September-October 1967): 463-478. Ben Franklin's World, "Episode 301: From Inoculation to Vaccination, Part 1," April 27, 2021, accessed September 11, 2025, https://www.benfranklinsworld.com/301; Ben Franklin’s World, “Episode 302: From Inoculation to Vaccination, Part 2,” May 11, 2021, accessed September 11, 2025, https://www.benfranklinsworld.com/302. [7] United States, "Tenth Amendment," United States Constitution, 1787, National Constitution Center, accessed September 11, 2025, https://constitutioncenter.org/the-constitution/amendments/amendment-x.
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