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AMA Policy on Immunization Exemptions
State Rights, Parental Decisions, and Vaccine Exemptions
Availability and Impact of 9-Valent HPV Vaccine
Please, Nurse, May I Have Some Plague Vaccine?
Today's blog post is by Robert D. Hicks, PhD, Director, Mütter Museum/Historical Medical Library
Instead of a teething ring, I had a passport. Between a military father and diplomatic step-father, my family moved every year or two or three to exotic places, from Taiwan to the Philippines to Ecuador. Tucked into my passport was another essential travel document, the International Certificates of Vaccination issued by the federal government, a yellow-paper catalog of inoculations with separate pages for smallpox, yellow fever, and cholera. When traveling during the 1950s and 1960s, before computerized databases, immigration officials examined my passport in one hand, the dog-eared vaccination record in the other. Reviewing the vaccination record now, I still derive the same satisfaction that I experienced as a school kid in reading my vaccination history—which we kids called our “shot records”--as a chronology of health accomplishment, a medical report card. A visit to the doctor before taking a trip became so routine that I ceased to fear needle punctures. Rather, I looked forward to having the administering physician sign and return my vaccination record. Having a purple-ink stamp to certify the credentials of the administering doctor seemed particularly important: I could point to “American Embassy, Quito, Ecuador” or “CAPT[ain] M[edical] C[orps] US N[avy] to my non-traveling schoolmates with particular pride. I had been somewhere. I had taken risks of contracting exotic diseases. I was an explorer.
My parents—and the health officials who routinely examined me—ensured that I understood what vaccinations were for and how they worked. I knew that I was taking into my body small amounts of the very diseases I would be armed against. Living in environments where I was cautioned against drinking the water, I was aware at an early age how bacteria and viruses worked, and how to take precautions against very specific local parasites. In a military environment, doctors would emphasize the soldierly attributes of getting vaccinated to stiffen the resolve of a young kid. Sometimes, though, doctors or nurses were a bit casual and, to my sensibilities, rough in administering vaccinations. I still recall the two gamma globulin injections I received in 1966: both injections, which were intended to boost my immunity to many disease threats at a time when I had trouble coping with living in Quito because of its 9300-foot altitude, caused me pain. Both were injected into the buttocks: I limped for days. These injections appear in the shot record under “Other immunizations,” a tour of vaccine history. To my schoolboy mind, these vaccines did not match a reality in the United States. Injections for typhus, tetanus, and typhoid were necessary, I was assured, but I did not know why. These names denoted vague and distant demons, but when traveling abroad I was aware that these diseases lurked in many places. My four polio injections were no mystery, however: I grew up with schoolmates in leg braces.
Entries in the vaccination record cease around 1970: shortly thereafter, no one wanted to see, and no one annotated my shot record. It became an artifact of another era. By the time it became obsolete, I had studied biology and had learned a great deal more about diseases. The passport records the one time when I had requested a vaccination. In 1966, having just studied about the Black Death and having just seen an old Richard Widmark/Jack Palance film from 1950, Panic in the Streets, I became anxious about bubonic plague. In the film, Widmark portrays a Public Health Service doctor who recognizes an outbreak of plague in a U.S. city and tries to do something about it when the disease victims also happen to be active and dangerous criminals. After hearing that Ecuador’s coastal region had experienced some plague cases, I headed to the embassy nurse and requested a plague vaccination. After she got past her dumbfounded expression, the nurse explained to me that she had vaccine on hand for emergencies but that she could not recall any mass inoculation of embassy workers against plague. I insisted, and I well remember the side-effects of that first injection: a very, very sore arm. I soldiered on, nevertheless, and returned for the required two boosters at intervals of six months. And I transformed this experience into an A paper in my English class.