The start of the 1960s was characterized by an optimism about the conquest of infectious disease. New vaccines and new federal resources had led a growing number of experts to predict that vaccine-preventable infections would soon be wiped out for good. But in Sioux City and elsewhere, outbreaks of preventable disease persisted. Health experts who attempted to explain the trend often revived age-old assumptions about the ignorance and disease-breeding proclivities of the poor; these were the very ideas insinuated by the Sioux City investigators’ comments about “skid row” and “transients.” This tendency to hold the poor accountable for outbreaks also reflected a new pattern of disease that emerged over the course of the 60s. With record numbers of middle- and upper-class parents vaccinating their children, preventable infections began to concentrate in new populations. This was particularly true for polio and measles, both targets of federally sponsored vaccination programs that overshadowed diphtheria prevention. In the wake of national immunization efforts, polio, once a middle-class disease, became a disease of the “slums” and, in some areas, of minorities. Measles, which once struck all children, became a disease of the disadvantaged.
The 1960s campaigns against polio and measles took place in the context of a national war on poverty, widespread anxiety about the decline of American cities, and the civil-rights movement; worries about poverty, urban transformation, and race were thus subtly inscribed upon the nation’s efforts to immunize against these infections. The decade was also marked by growing scientific enthusiasm for disease eradication, which inspired a push not just to vaccinate against diseases, but eliminate them entirely.
The decade’s most high-profile vaccination campaigns both shifted their target diseases’ epidemiology—the pattern of who got sick where and when—and provoked changes in the diseases’ popular reputations. Measles-eradication proponents, for instance, urged Americans to see measles not as a familiar part of childhood, but as a fate worse than polio, drawing upon middle-class anxieties about poverty and urban decay as they did so. As one health educator put it, measles-immunization programs needed to highlight the disease’s “dramatic aspects” in order to make Americans fear the disease, for only then would the country stand a chance at wiping out a disease still harbored in its “ghettoes” and “slums.” This approached reinscribed vaccination as a middle-class concern, even as the decade’s social-welfare programs aimed to ensure vaccination’s equitable distribution across class lines.
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In 1959, Surgeon General Leroy Burney penned a letter to health departments across the country, encouraging them to redouble their efforts against polio. “We in the Public Health Service share with you a deep concern that there was more paralytic poliomyelitis in 1958 than in the previous year,” he wrote. When Salk’s polio vaccine was first introduced in 1955, demand for it was so overwhelming, and vaccination rates climbed so quickly, that cases of the disease quickly plummeted. But demand then quickly slackened, noted Burney. And while rates of polio were still far lower than they had been a decade before, the sudden decline in cases showed troubling signs of reversal. There were roughly 5,500 cases in 1957 and close to 6,000 cases in 1958. If health departments didn’t act quickly to halt the trend, things would only get worse because more than half the population under 40 was either unvaccinated or incompletely vaccinated, and close to a third of children under five weren’t protected at all against the disease.