Vaccination in Older Adults: Erasure, Barriers, and Hesitancy (Part Two)

By Patricia Harte-Maxwell

Looking to the beginnings of variolation in England reveals that children were already regarded as the center of immunization – a product, I suggest, of smallpox  – and that objection also already existed. Charles Maitland, in Mr Maitland’s Account of Inoculating the Small Pox from 1722, recounts variolation cases dealing mainly with children to assuage fears and prove “that this whole Practice, prudently manag’d, is always Safe and Useful, and the Issue ever Certain and Salutary” (Maitland 33). Normalizing variolation started with a child and his mother, “the Ambassador’s ingenious Lady . . . was so thoroughly convinced of the Safety of it, She resolv’d to submit her only Son to it, a very hopeful Boy of about Six Years of Age,” (7) as proof of the process’s ability to protect children from an infection with high mortality and “the young Gentleman was quickly in a Condition to go Abroad with Safety” (8). So successful is the variolation that the same lady, Lady Mary Wortley Montagu,  arranges for her daughter to then be treated as well. The effectiveness of variolation is proven on the bodies of children and the reasoning is framed by Maitland’s account as an act of motherly love and protectiveness. The use of children in Maitland’s study was practical also because a majority of people contracted smallpox at a young age – leading to many survivors having immunity as adults – consequently many children died as a direct result of infection. Additionally, children and the death of children are used by Maitland to appeal to readers’ emotions: “He had formerly lost some Children in a very malignant kind of the Small Pox, and therefore desired me to lose no Time to ingraft the only Son he had left,” (11) but this example also suggests that smallpox was conceived as a direct threat to the future and legacy of a whole family via the lives of children, not merely as a concern of one individual’s life or well-being.

Maitland did not only variolate children, however; several adults imprisoned as criminals also underwent variolation in the course of his study (21-26).  This detail relates to the idea of autonomy and suggests that variolation, now vaccination, in England and English-speaking territories was constructed early on as a non-autonomous – but not cruel or malicious – practice. Variolation being performed on children has been maintained in some respects through the centuries as both a practical concern from an immunological standpoint and as tradition.

There is, likewise, a political dimension to the focus on children in vaccination: the Politics of the Child. Citing the works of Lauren Berlant and Lee Edelman, Alison Kafer writes that “struggle [using Politics of the Child] becomes no longer about rights or justice or desire or autonomy but about the future of ‘our’ children” (28) which relies on ideas of reproductive futurities that, for Kafer’s article on queer/crip time, “buttress able-bodied/able-minded heteronormativity” (29) and the life-timeline of such normativity. The Politics of the Child asks one to work to the betterment of an imagined child “to be more healthy, more active, stronger and smarter . . . to do everything in [one’s] power to make that happen” (29) which makes the Politics of the Child flexible in use by both or multiple sides of controversies but also still follows a path that assumes one type of life and the existence of one group of people – a future people, the children yet to be. As Kafer explains, “a politics based in futurity leads easily to an ethics of endless deferral,” (29) a continuous bet on and investment in tomorrow rather than repairs, solutions, or acceptance today. Vaccination does not clearly conform to the Politics of the Child: On one hand, vaccination as a preventive medical treatment is obviously highly concerned with the future of the one and the many; on the other hand, vaccination does not bank on a separate imaginary future person, rather vaccination as a process always deals with the body that exists and lives here and now and relays a least some benefit to that existing person. Conceptualized as a material process vaccination occurs in terms of the body here and now, a body for whom vaccination is always a consideration in the moment because only the present, like the body in which biological immunity is structured within and as part of, is tangible. The political dimension of however of vaccination is fraught with complications deriving from imaginings of immunization occurring not with/within bodies present here and now but with bodies projected into the incorporeal, unknowable future – phantom bodies, at one alive and not-alive.

As early as Mr Maitland’s account, vaccination was recognized for the future it enables : “. . . a plain and honest Account of the Truth of Facts; both to prevent, if possible, any one’s being impos’d upon . . . or fear’s from the Practice of it for the future” (Maitland 1). According to Maitland, parents who had lost many children placed the future of their families in the variolation of the last child, specifically the last male child that would continue the family name and inherit any family assets. Furthermore, the children that Maitland variolated were of well-off families, Ambassadors and wealthy persons who had the economic and/or social capital to be variolated by the surgeon. Vaccinations, then and now, are a tool to build the future because vaccination allows an insurance of who will, or will not, be a part of that future.