I read a news story in which a man is dying of Covid-19 in the hospital. He is asked whether he regrets not getting vaccinated and rallies enough to reply, “No, I don’t believe in the vaccine.” So what then does he believe in? Systemic viral infection, suffering, and death? If you don’t believe in vaccination, you don’t believe in modern medicine in toto. You don’t believe in bacteriology, virology, cellular biology, microbiology, or immunology. What then is left to prevent, diagnose, and treat disease? Trump-ish medievalism, mysticism, shamanism, divine intervention?
A study by researchers at Harvard’s Brigham and Women’s Hospital used natural language processing to comb through 5,307 electronic patient records of adult type 2 diabetics living in Massachusetts and followed by their primary care physicians between 2000 and 2014. They found that 43% (2,267) of patients refused to begin insulin therapy when their doctors recommended it. Further, diabetics who declined the recommendation not only had higher blood sugar levels than those who began insulin, but had greater difficulty achieving glycemic control later on.[1] So what do the insulin-declining diabetics believe in? Chronic heart and kidney disease, blindness, and amputation – the all but inevitable sequelae of poorly managed diabetes?
The problem, really an epistemological problem, is that such people apparently have no beliefs at all – unless one imputes to them belief in disease, suffering, and death, and in the case of Covid vaccine resisters, the prerogative to inflict them on others. This is not tantamount to a scientifically specious belief system that unintentionally infects others. During the Yellow Fever epidemic that left Philadelphia in ruins in 1793, Dr. Benjamin Rush, highly acclaimed throughout the newborn nation, set about his curative missions by draining his patients, in successive bleedings, of up to four pints of blood while simultaneously purging them (i.e., causing them to vomit) with copious doses of toxic mercury.
Rush’s “Great Purge,” adopted by his followers, added hundreds, perhaps thousands, to the death toll in Philadelphia alone. But at least Rush’s “system” derived from a belief system. He did in fact find a theoretical rationale for his regimen in an essay by the Virginia physician and mapmaker John Mitchell. Describing yellow fever in Virginia in 1741, Mitchell noted that in yellow fever the “abdominal viscera were filled with blood, and must be cleaned out by immediate evacuation.”[2] Bleeding, of course, was conventional treatment for all manner of disease in 1793, so Mitchell’s recommendation came as no surprise. Taken in conjunction with the system of mercuric purges employed by Dr. Thomas Young during the Revolutionary War, Rush had all the grounding he required for a ruinously misguided campaign that greatly extended recovery time of those it did not kill. But, yes, he had his theory, and he believed in it.
In the early 19th century, Napoleon, sweeping through Europe, conquers the north Italian province of Bolzano, which in 1807 he incorporated into Bavaria. Two years later, when the Bavarian government mandates smallpox vaccination for all residents, the newly absorbed Italians launch an armed revolt, partly because they believed vaccination would inject Protestantism into their Catholic veins.[3]
All right, it is a nonsensical belief, even in 1809, but it is still a belief of sorts. It is epistemically flawed, because it fails to stipulate what exactly makes a substance inherently Protestant in nature; nor does it posit a mechanism of transmission whereby a Protestant essence seeps into liquid smallpox vaccine in the first place. In the realm of ethics, it suggests that the possibility of death pales alongside the certainty of spiritual contamination by a fluid that, however neutral in life-saving potency, is injected by a Protestant hand.
Only slightly less ridiculous to modern ears is the mid-19th-century belief that general anesthesia via ether or chloroform, introduced by James Young Simpson in 1847, must be withheld from women giving birth. The reason? Genesis 3.16 enjoins women to bring forth new life in suffering. Forget that the belief is espoused solely by certain men of the cloth and male physicians,[4] and was based on a highly questionable rendering of the biblical Hebrew. Forget as well that, for Christians, Christ’s death redeemed humankind, relieving women of the need to relive the primal curse. Bear in mind further that the alleged curse would also forbid, inter alia, use of forceps, caesarian operations, and embryotomy. A woman with a contracted pelvis would die undelivered because she is guilty of the sin over which she has no control – that of having a contracted pelvis.[5]
In a secular nation guided by a constitution that asserts everyone’s right to pursue happiness in his or her own pain-free terms, we see the primal curse as archaic misogynist drivel, no less absurd than belief that the Bible, through some preternatural time warp, forbids vaccination. But, hey, it’s a free country, and if a mid-19th-century or early-21st-century man chooses to believe that anesthesia permits men to escape pain whenever possible but women only in male-sanctioned circumstances, so be it. It is a belief.
Now it’s 1878, and the worst yellow fever epidemic in American history is sweeping across the lower Mississippi Valley, taking lives and destroying commerce in New Orleans, Memphis and surrounding cities and towns to which refugees are streaming. The epidemic will reach the Ohio Valley, bringing deadly Yellow Jack to Indiana, Illinois, and Ohio. Koch’s monograph on the bacteriology of sepsis (wound infection) was published that very year, and neither his work nor that of Lister is universally accepted in the American south. Nor would its precepts have counted for much in the face of a viral (not bacterial) invader carried up the Mississippi from Havana.
What can city boards of health do in the face of massive viral infection, suffering, and death? Beyond imposing stringent new sanitary measures, they can quarantine ships arriving in their harbors until all infected crew members have either died or been removed and isolated. This will prevent the newly infected from infecting others and crippling cities still further – assuming, that is, a belief system in which yellow fever is contagious and spread from person to person.
But in 1878 Memphis, where by September the epidemic is claiming 200 lives a day, this “modern” belief is widely contested among the city’s physicians. Some are contagionists, who believe that disease is caused by invisible entities that are transmissible. But others, greater in number, favor the long-held theory that infectious disease results from “miasma” or bad air – air rendered toxic by decaying plant and animal matter in the soil. If you believe miasma causes disease, then you’re hard-pressed to understand how quarantining ships laden with sick people will do anything to control the epidemic.
This was precisely the position of the 32 Memphis physicians who defeated the city council’s plan to institute a quarantine and set up a quarantine station. Quarantine is pointless in the face of bad air. The city’s only recourse, so held the 32, was to alter the “epidemic constitution” of the atmosphere by inundating it with smoke. Canon blasts and blazing barrels of tar up and down city streets – that’s the ticket to altering the atmospheric conditions that create infectious disease.[6]
The miasmic theory of disease retained a medical following throughout the 1870s, after which it disappeared in the wake of bacteriology. But in Memphis in 1878, bad air was still a credible theory in which physicians could plausibly believe. And this matter of reasonable belief – reasonable for a particular time and place – takes us back to the hospitalized Covid patient of 2021 who, with virtually his last breath, defends his decision to remain unvaccinated because he doesn’t believe in the vaccine. What is the knowledge base that sustains his disbelief? There isn’t any. He has no beliefs, informed or otherwise, about bacteriology, virology, cellular biology, or immunology. At best, he has decided to accept what someone equally belief-less has told him about Covid vaccination, whether personally, in print, or over the internet.
It is no different among the 43% of Massachusetts diabetics who, a century after Banting’s and Best’s miraculous discovery, declined insulin therapy when their doctors recommended it. Their disbelief is actually a nonbelief because it is groundless. For some, perhaps, the refusal falls back on a psychological inability to accept that one is diabetic enough to warrant insulin. They resist the perceived stigma of being insulin-dependent diabetics.[7] Here at least the grounds of refusal are intelligible and remediable. An insulin phobia does not sustain real-world belief; it is an impediment to such belief in relation to diabetes and insulin, illness and long-term health, lesser and greater life expectancy.
Back in the present, I read another news story in which two unvaccinated hospital nurses explain to a journalist that they have refused Covid vaccination because the vaccines’ effectiveness is based on “junk data.” Really? Here there is the glimmering of a belief system, since scientific data can be more or less robust, more or less supportive of one or another course of action.
But what exactly makes Covid vaccine data worthless, i.e., junk? And how have these two nurses acquired the expertise in epidemiology, population statistics, and data analysis to pass judgment on data deemed credible and persuasive by scientists at Pfizer, Moderna, Johnson & Johnson, the CDC, and the WHO? And how, pray tell, have they gained access to these data? Like all opponents of vaccine science, they pontificate out of ignorance, as if the mere act of an utterance confers truth-value to what is being uttered. It’s an extreme example of asserting as fact what remains to be demonstrated (argument petitio principii), the legacy of an ex-president who elevated pathological lying to a political art form.
Even the nurses pale alongside the anti-vax protester who is pictured in a news photo holding a sign that reads, “Vaccines Kill.”[8] Whom do they kill and under what circumstances? Does he mean all vaccines are deadly and kill people all the time, or just certain vaccines, such as the Covid vaccine? But what does it matter? The sign holder doesn’t know anything about any vaccines. Does he really believe that everything we know about the history of vaccine science from the time of Jenner is bogus, and that children who once died from smallpox, cholera, yellow fever, diphtheria, pertussis, typhoid, typhus, tetanus, and polio are still dying in droves, now from the vaccines they receive 
to protect them from these infectious diseases during the earliest years of life? Is the demographic fact that, owing to vaccination and other public health measures, life expectancy in the U.S. has increased from 47 in 1900 to 77 in 2021 also based on junk data? In my essay, Anti- vaccinationism, American Style, I provide statistics on the total elimination in the U.S. of smallpox and diphtheria, and virtual elimination of polio. Were my claims also based on junk data? If so, I’d appreciate being directed to the data that belie these facts and demonstrate that, in point of fact, vaccines kill.
Maybe the man with the sign has an acquaintance who got sick from what he believed to be a vaccine? Perhaps someone on his internet chat group heard of someone else who became ill, or allegedly died, after receiving a vaccine. Of course, death can follow vaccination without being caused by it. Do we then assume that the man with the sign and like-minded protesters are well-versed in the difference between causation and correlation in scientific explanation?
We know that for a tiny number of individuals aspirin kills.[9] So why doesn’t the man hold up a sign that reads, “Aspirin Kills.” Here at least, he would be calling attention to a scientific fact that people with GI conditions should be aware of. We know that sugary drinks have been linked to 25,000 deaths in the U.S. each year. Why not a sign, “Soda Kills”? It would at least be based on science. He chooses not to proclaim the lethality of aspirin or soda because he cares no more about aspirin- or soda-related deaths than Covid-related deaths. If he did, then, like the two nurses with their junk data and the Covid patient announcing disbelief in Covid vaccination on his deathbed, he would have to anchor his belief in consensually accepted scientific facts – a belief that someone, anyone, might find believable.
He is no different than other American anti-vaxxers I read about in the paper. They are the epistemological Luddites of our time, intent on wrecking the scientific machinery of disease prevention, despite profound ignorance of vaccine science and its impact on human affairs since the late 18th century. Indeed, they see no need to posit grounds of belief of any kind, since their anger – at Covid, at Big Government, at Big Science, at Big Medicine, at Big Experts – fills the epistemic void. It fuels what they offer in place of the science of disease prevention: the machinery of misinformation that is their stock in trade.
And therein is the source of their impotence. They have fallen into an anti-knowledge black hole, and struggle to fashion an existence out of anger that – to push the anti-matter trope a little further – repels rational thought. Their contrarian charge is small solace for the heightened risks of diseases, suffering, and death they incur, and, far less conscionably, impose on the rest of us.
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[1] N. Hosomura, S. Malmasi, et al., “Decline of Insulin Therapy and Delays in Insulin Initiation in People with Uncontrolled Diabetes Melitus,” Diabetic Med., 34:1599-1602, 2017.
[2] J. M. Powell, Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphian in 1793 (Phila: Univ. of Pennsylvania Press, 1949), 76-78.
[3] My thanks to my friend Marty Meyers for bringing to my attention this event of 1809, as reported by Emma Bubola, “In Italy’s Alps, Traditional Medicine Flourishes, as Does Covid,” New York Times, December 16, 2021.
[4] With reason, wrote Elizabeth Cady Stanton in The Woman’s Bible (1895), “The Bible and the Church have been the greatest stumbling blocks in the way of women’s emancipation.”
[5] For a fulller examination of the 19th-century debate on the use of general anesthesia during childbirth, see Judith Walzer Leavitt Brought to Bed: Childbearing in America, 1750-1950 (NY: OUP, 1986), ch. 5.
[6] On the measures taken to combat the epidemic in Memphis, including the rift between contagionists and noncontagionists physicians, see John H. Ellis, Yellow Fever and Public Health in the New South (Lexington: Univ. Press of Kentucky, 1992), ch. 3.
[7] A. Hussein, A. Mostafa, et al., “The Perceived Barriers to Insulin Therapy among Type 2 Diabetic Patients,” African Health Sciences, 19:1638-1646, 2019.
[8] Now, sadly, we have gone from hand-written “Vaccines Kill” signs to highway billboards, e.g., https://www.kxxv.com/hometown/mclennan-county/a-new-billboard-in-west-claims-vaccines-kill.
[9] Patients prescribed aspirin before developing a GI bleed or perforation are prominent among those killed by aspirin. See A. Lanas, M. A. Perez-Aisa, et al., “A Nationwide Study of Mortality Associated with Hospital Admission and Those Associated with Nonsteroidal Antiinflammatory Drug Use,” Am. J. Gastroenterol., 100:1685-1693, 2005; S. Straube, M. R. Trainer, et al., “Mortality with Upper Gastrointestinal Bleeding and Perforation,” BMC Gastroenterol., 8: 41, 2009.
Medicine, Health, and History 