This was really the problem of the era: The government was requiring people to get vaccinated but not doing anything to regulate the safety of vaccines. This was an incredibly dangerous policy.
How would the authorities enforce this? It seems like in some places, authorities were saying, “Oh, we’re not forcing people to be vaccinated.” But in the news stories you find, it’s people being dragged out of their houses.
Yes! The most dramatic example of this kind of cognitive dissonance was in New York, where public health officials might talk about the fact that there was no compulsory vaccination law in the state of New York. But then there were so-called virus squads—public health people working in tandem with local police, entering tenement districts in the middle of the night, inspecting door to door, looking for sick residents and whether people had evidence of recent successful vaccinations. If they hadn’t been vaccinated, they’d be compelled to be vaccinated on the spot—sometimes using physical force. So there was this disparity between the public message and the reality that could be very dramatic.
But there were also a huge range of inducements. Schoolchildren were pretty routinely required to be vaccinated against smallpox before the start of the school year, but then during epidemics, local health boards could use their police powers to compel adults to be vaccinated as well. In particular settings like industrial workplaces, or places of high concentration of population, health departments would enforce vaccination among the public as a whole. They could say, “You need to do this, in order to keep your job or in order to get a job.” Or, “You need to get vaccinated in order to avoid prosecution for contributing to a delinquency of a minor,” if you didn’t get your kid vaccinated. A wide range of penalties.
You write that the anti-vaccination activists of the time tended to be middle class, maybe people who came into contact with vaccination because they had children. Is it fair to say that working-class people were the ones who were more likely to be compelled to do it?
Publicly mandated vaccination during this time was really carried out in a class-biased way. For example, people arriving in the United States aboard ships—they were much more likely to be inspected, vaccinated on the spot, and quarantined in holding facilities if there had been a case of smallpox aboard their ship if they had traveled in steerage versus in the first-class cabins.
Middle-class and more affluent Americans were much more likely simply to be expected to get the vaccine from their own private physician, but there were very few circumstances where they’d be forced to show their compliance with a vaccine order.