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Vaccine Nation

America’s Changing Relationship with Immunization

With employers offering free flu shots and pharmacies expanding into one-stop shops to prevent everything from shingles to tetanus, vaccines are ubiquitous in contemporary life. The past fifty years have witnessed an enormous upsurge in vaccines and immunization in the United States: American children now receive more vaccines than any previous generation, and laws requiring their immunization against a litany of diseases are standard. Yet, while vaccination rates have soared and cases of preventable infections have plummeted, an increasingly vocal cross section of Americans have questioned the safety and necessity of vaccines. In Vaccine Nation, Elena Conis explores this complicated history and its consequences for personal and public health.

Vaccine Nation opens in the 1960s, when government scientists—triumphant following successes combating polio and smallpox—considered how the country might deploy new vaccines against what they called the “milder” diseases, including measles, mumps, and rubella. In the years that followed, Conis reveals, vaccines fundamentally changed how medical professionals, policy administrators, and ordinary Americans came to perceive the diseases they were designed to prevent. She brings this history up to the present with an insightful look at the past decade’s controversy over the implementation of the Gardasil vaccine for HPV, which sparked extensive debate because of its focus on adolescent girls and young women. Through this and other examples, Conis demonstrates how the acceptance of vaccines and vaccination policies has been as contingent on political and social concerns as on scientific findings.

By setting the complex story of American vaccination within the country’s broader history, Vaccine Nation goes beyond the simple story of the triumph of science over disease and provides a new and perceptive account of the role of politics and social forces in medicine.


“This is a fascinating account of how routine childhood immunization came to be both a public health success story and a source of bitter controversy. Conis untangles these seemingly contradictory trends and provides a probing analysis of the ways that American culture and politics have influenced how we think about vaccines. Engagingly written and filled with surprising insights, this book is an invaluable guide to one of the most critically important areas of modern medicine. Everyone with a stake in our immunization system—which is to say, all of us—should care about the story Conis has to tell.”

James Colgrove, author of State of Immunity: The Politics of Vaccination in Twentieth-Century America

“An original and illuminating analysis of the relationship of vaccination, public health, and American society since 1960. Vaccine Nation is especially strong on the vaccine policies of presidential administrations and on the relationship between vaccine politics and social movements such as environmentalism and feminism. Conis’s clear and lively writing style makes the book a pleasure to read.”

Beatrix Hoffman, author of Health Care for Some

“This comprehensive social history of childhood vaccination in the United States since the 1960s is written in clear, engaging, and always intelligent prose. As Conis wends her way through a field notorious for partisan pleading and other intellectual landmines, she convinces us of both the power of vaccination to save us from disease and the sincerity of the often well-intentioned people who question its adherents’ tendency to oversell their product.”

Michael Bliss, author of The Making of Modern Medicine

“In the 1960s afterglow of broad success in defeating polio and smallpox, the US public embraced vaccination. Yet by 2009, debate was raging over its risks, even as some 90% of toddlers were being vaccinated against a raft of diseases. Historian Elena Conis analyses the shifts in official and public thinking on immunization as initiatives by presidents from John F. Kennedy onwards drove waves of mass vaccination. As she reveals, each new vaccine has prompted a radical reevaluation of the disease it targeted.”


“No book on vaccination can ignore the rise of vaccine-safety and anti-vaccination movements. Conis brings out their complexities in the United States with great skill. . . . This is a fine social history of an ongoing story.”

Times Higher Education

“Conis has produced a strikingly honest, fair-minded, and informed chronicle of the vaccine controversy in the United States.  She illuminates issues that others have obfuscated, and she opens up discussions that some have tried to shut down.  She understands that vaccine policy is determined not solely by objective science, but also by politics, profits, prejudices, and bureaucratic imperatives. . . . Conis provides that historical context in rich and illuminating detail, and in crystal clear prose that any lay reader can follow.”

Age of Autism

“How do some people in a country that rejoiced in vaccines for killers like polio wind up wary of them? Emory University historian Elena Conis goes sleuthing in her book, Vaccine Nation: America's Changing Relationship with Immunization, finding answers in science, politics, and shifting cultural standards about how we vaccinate and what our doubts are. At a moment when, as Conis says, children’s participation in public life depends on their immunization status, she favors a nuanced view of our complicated relationship with ‘the jab.’”

Los Angeles Times

“With Vaccine Nation, Conis explores the history of vaccines in our country, exploring the many reasons (medical, societal, political, financial) why their use has become so widespread. Conis also spends a fair amount of time discussing the many legitimate reasons why people from all walks of life are sometimes skeptical of vaccines, covering heavy metals in the ingredient lists, safety concerns over testing, and vaccine injuries. With its extensive list of sources, Vaccine Nation is a surprisingly balanced history of this controversial topic.”

San Francisco Book Review

“Conis presents a detailed, step-by-step historical account, beginning in the 1960s, based on an extensive literature review of all the events.  This includes social, economic, political, and commercial aspects as well as issues such as poverty, sex, government, drug companies, the women’s movement, society’s perception of disease, and more.  These all contributed to the still-current controversy over the safety and medical value of vaccination, which started with the introduction of the polio vaccine. . . . Highly recommended.”


2015 Arthur J. Viseltear Prize

American Public Health Association

"An insightful account of immunization policies and practices in the United States through the last few decades of the twentieth century. Many books on vaccines and immunizations reproduce a boundless faith in the possibilities of this public health technology. As one would expect from a professional historian, Conis develops a more complex argument in Vaccine Nation."


Table of Contents


Part I
1. Kennedy’s Vaccination Assistance Act
2. Polio, Measles, and the “Dirty Disease Gang”
3. How Serious Is Mumps?

Part II
4. Carter’s Childhood Immunization Initiative
5. A Mother’s Responsibility
6. Tampering with Nature

Part III
7. Clinton’s Vaccines for Children Program
8. Sex, Drugs, and Hepatitis B
9. Vaccine Risks and the New Media
10. Sex, Girls, and HPV


Appendix: The Science and Regulation of Vaccines

Selected Bibliography


Choice Magazine: CHOICE Outstanding Academic Title Awards

American Public Health Association: Viseltear Award

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