Perspective: Preventable DiseaseWhat the Measles Epidemic Really Says about America

Published 15 July 2019

The critic Susan Sontag observed that disease can serve as a metaphor—a reflection of the society through which it travels. Now, a virus is offering insights into the country’s psychic and civic condition. Two decades ago, measles was declared eliminated in the U.S. Yet in the first five months of this year, the Centers for Disease Control and Prevention recorded 1,000 cases—more than occurred from 2000 to 2010. Three cultural conditions have contributed to the resurgence of measles in the United States. One is historical forgetting: contemporary America suffers from a dangerous lack of historical memory. The second is diminished trust in government. As distrust of government has grown, so too has distrust of vaccines. The third is a population that suffers from overconfidence in its own amateur knowledge. This third condition is especially dangerous: It’s one thing to Google a food to see whether it’s healthy. It’s quite another to dismiss decades of studies on the benefits of vaccines because you’ve watched a couple of YouTube videos.

In two essays, “Illness as Metaphor” in 1978 and “AIDS and Its Metaphors” in 1988, the critic Susan Sontag observed that you can learn a lot about a society from the metaphors it uses to describe disease. She also suggested that disease itself can serve as a metaphor—a reflection of the society through which it travels. Now, a virus is offering insights into the country’s psychic and civic condition. Two decades ago, measles was declared eliminated in the U.S. Yet in the first five months of this year, the Centers for Disease Control and Prevention recorded 1,000 cases—more than occurred from 2000 to 2010.

Peter Beinart writes in The Atlantic that three cultural conditions have contributed to the resurgence of measles in the United States. One is historical forgetting: contemporary America suffers from a dangerous lack of historical memory. Most of the parents who are today skipping or delaying their children’s combined measles, mumps, and rubella (MMR) vaccine don’t remember life with measles, much less that it used to kill more children than drowning does today. The second is diminished trust in government. As distrust of government has grown, so too has distrust of vaccines. Studies found that distrust of government was correlated with distrust of vaccines among both Republicans and Democrats. Indeed, the best predictor of someone’s view of vaccines is not their political ideology, but their trust in government and their openness to conspiracy theories.

Beinart writes that declining vaccination rates not only reflect a great forgetting and a diminished trust in government. There is a third cultural condition contributing to the decline of vaccination rates:

Declining vaccination rates…also reveal a population that suffers from overconfidence in its own amateur knowledge. In her book Calling the Shots: Why Parents Reject Vaccines, the University of Colorado at Denver’s Jennifer Reich notes that starting in the 1970s, alternative-health movements “repositioned expertise as residing within the individual.” This ethos has grown dramatically in the internet age, so much so that “in arenas as diverse as medicine, mental health, law, education, business, and food, self-help or do-it-yourself movements encourage individuals to reject expert advice or follow it selectively.” Autodidacticism can be valuable. But it’s one thing to Google a food to see whether it’s healthy. It’s quite another to dismiss decades of studies on the benefits of vaccines because you’ve watched a couple of YouTube videos. In an interview, Reich told me that some anti-vaccine activists describe themselves as “researchers,” thus equating their scouring of the internet on behalf of their families with the work of scientists who publish in peer-reviewed journals.