“A Pox on Fools” Is a Walk Through History That Reminds Us of the Same Three Arguments Made by Anti-Vaccine Forces Since Before Vaccines

This is a review of Thomas Levenson’s book, "A Pox on Fools: The True Believers, Grifters, and Cynics Who Convinced Us to Reject Vaccines." (.)

I read this book twice. The first time as an epidemiologist, checking the numbers and the history against what I teach my graduate students and post on History of Vaccines. The second time as a father, the version of me who once sat up at 2 a.m. with a kid with RSV and consulting my physician assistant wife about what to do next. Both “readers” came away convinced that Thomas Levenson has written a book that the moment demands. It is not a perfect book. No book is. But the book’s central argument is correct, and it is the kind of correct that saves lives.

What the Book Is About

The title makes it sound like a polemic, and parts of it are. But the spine of the book is an argument about history and memory, and it is worth stating plainly because Levenson states it plainly too.

People who reject vaccines, he writes, have made the same three claims for three hundred years. First, that vaccines are unnecessary because a healthy body and a healthy life will protect you on their own, that vaccination is unnatural, and so it is wrong. Second, that vaccines are just plain bad: that they do more harm than the diseases they prevent. Third, that even if they work and even if they are safe, forcing anyone to take one is intolerable, a violation of personal freedom that no government should be allowed to commit. Three claims we see in different forms today in the wellness movement, the “mercury is in vaccines” movement, and the medical freedom movement.

The book gives one chapter to each claim, and the chapters are named exactly that: Wrong, Bad, and Intolerable. A short prologue and a closing chapter, The Choice, frame the whole thing. The structure is the argument. Read it in order, and you watch the case against vaccines get built, brick by brick, the same way its opponents have built it since the 1720s.

Here is the part that matters, and the part I want to dwell on because it is the book's real contribution. Levenson does not pretend that these three arguments were always unreasonable. He gives them their due. In the 18th and 19th centuries, when nobody yet understood why a scratch of cowpox protected you from smallpox, the only way to judge a vaccine was to watch what happened to the people who got one. And observations on vaccination revealed real problems. The early smallpox vaccine, passed arm to arm from one person to the next, sometimes carried syphilis along with it. The first attempts to force vaccination by law arrived while the shots' value was still genuinely in dispute, and while the science was unclear on how it worked and who should get it. That said, the people pushing clean water, clean air, and decent food were not cranks; they were largely right that those things reduce disease.

So the early objections had merit. A reasonable person in 1855 could doubt. That is the foundation Levenson builds on, and it is what makes the book honest rather than smug.

Then Levenson shows what changed. Over two centuries, every one of those real concerns got answered. Germ theory explained the mechanism: microbes cause infectious disease, vaccines train the immune system to recognize them, and no amount of kale will teach your immune system to fight a virus it has never met. 

The arm-to-arm technique that could also spread syphilis was abandoned. Manufacturing got regulated. Boosters fixed the problem of immunity that faded. The science moved; the objections did not. And that is the heart of the book. Today's anti-vaccine movement repeats arguments that were "once-persuasive" but have been settled for a hundred years, stripped of the context that once made them defensible. As Levenson puts it about the great Victorian naturalist Alfred Russel Wallace, who got the science wrong but argued in good faith, and the people repeating Wallace today: "Where Wallace was in error, they deceive — perhaps themselves, certainly their audiences."

That single sentence is the book's thesis. Wallace was wrong. Current anti-vaccine leaders are lying. The difference is the whole story.

When the History Is the Medicine

For a general reader — and Levenson is clearly writing for one, not for epidemiologists like me — the strongest parts of the book are the historical set pieces. They work because they make an abstract risk feel real.

Take, for example, the story of polio. Levenson spends a long stretch on the summer of 1952, the worst polio outbreak in American history: more than 57,000 sick, over 21,000 paralyzed, 3,145 dead, most of them children. He describes parents who came to dread a birthday party or an afternoon at the pool because a week later their kid might spike a fever and stop being able to move their legs. If you have never lived in a world like that — and almost no one reading this has — that paragraph does more work than any statistic. Then he tells the story of the Salk vaccine and the disaster that followed: the Cutter Incident of 1955, when one manufacturer shipped vaccine that still contained live virus and caused roughly 40,000 cases of vaccine-induced polio, 164 cases of permanent paralysis, and 10 deaths.

This is where I, as an epidemiologist, want to applaud loudly. Levenson does not hide the Cutter disaster. He puts it at the center of the book. The worst vaccine catastrophe in American history gets told in full, with a ticking clock: vaccine approved April 12, first paralyzed infant reported April 25, the company's recall telegram sent at 10:38 a.m. on April 27. Forty-eight hours from the first alarm to recall. And then his point: that disaster is exactly why the United States built a serious system of federal vaccine oversight. The committee that grew out of Cutter is, Levenson notes, the direct ancestor of the very advisory panel that Kennedy fired in 2025 and packed with anti-vaccine activists. The system that made vaccines safe is the system being dismantled, using the memory of the era before that system existed.

That is how you argue honestly. You concede the worst case and show what was learned from it. Anyone who has taught outbreak investigation will recognize the move and respect it.

The book is full of these. Lady Mary Wortley Montagu brought inoculation back from Ottoman Turkey and inoculated her own daughter in 1721. Cotton Mather, who learned the practice from an enslaved man named Onesimus, got an incendiary device thrown through his window with a note: "COTTON MATHER, You Dog. Dam you; I'll inoculate you with this, with a Pox to you." The mass anti-vaccine demonstration in Leicester in 1885, where tens of thousands marched, hanged Jenner in effigy, and publicly burned the vaccination laws. The Andrew Wakefield fraud of 1998, of course: twelve children, a press conference instead of real science, and a virologist in the same room banging on the lectern and warning that "children will start dying of measles."

Children did die of measles since... .

How the Book Handles Today's Fights

This is where the book earns its subtitle, and where it will make some readers angry. Levenson does not treat the current vaccine debate as a polite disagreement among reasonable people. He treats it as the reanimation of dead arguments by people who, in his telling, range from sincere to grifting to cynical.

He addresses the live controversies head-on. The false link between the MMR vaccine and autism: he traces it to Wakefield's fraud and to journalist Brian Deer's investigation that exposed the rewritten patient records and the undisclosed money from lawyers preparing lawsuits. The claim that "natural immunity" from catching measles is better than the vaccine: he sets the current version of it next to a naturopath's quote from 1924, and shows that they are nearly the same sentence. 

The COVID and mRNA fights: he gives the numbers — roughly 14 million lives saved worldwide in the first year of COVID vaccination, against the roughly 234,000 Americans who died after refusing the shot in that same period — and he documents current anti-vaccine activists calling the COVID vaccine "the deadliest vaccine ever made." The polio-vaccine-causes-cancer insinuation, the bird flu funding pulled, the half-billion dollars in mRNA research canceled: all of it is here, dated, sourced, and answered.

On the third argument — the Liberty (“Medical Freedom”) argument — Levenson is at his most careful, and I think his most useful. He concedes outright that "the issue of vaccine compulsion has no true-or-false answer. It is, at bottom, a question of values." He does not pretend that whether to mandate a vaccine is a scientific question. It is not. What he argues is that the factual basis for refusing has collapsed, so the liberty claim now has to stand entirely on its own, and that, in its current American form, it has quietly flipped. The 19th-century version defended an individual against state power. The 2024 version uses state power, in the form of a presidential promise not to "give one penny to any school that has a vaccine mandate," to stop other people from protecting their kids. He backs the human cost with a Yale study finding that Republicans suffered roughly half again as many excess deaths from COVID as Democrats. Vaccine refusal, he argues, stopped being a philosophy and became a body count.

And then he does the thing I most wanted him to do. He ends with a child, not a statistic. Renae Archer caught measles in Salford, England, at five months old, too young for the MMR shot, because the vaccination rate around her had fallen too low to protect her. The measles came back years later as subacute sclerosing panencephalitis, which slowly destroyed her brain. She reached her tenth birthday and never saw another. Her mother's words close the case better than any argument: "If there wasn't an outbreak and more kids had their vaccinations, then she wouldn't have got the measles in the first place. And it wouldn't have ultimately ended her life."

I have spent my career explaining herd immunity to people who think it is an abstraction. It is not an abstraction. It is the reason a five-month-old who cannot yet be vaccinated lives or dies. Levenson understands that the math only means something when you can see the kid. As a father, that is the page that stayed with me.

Where the Book Stumbles

Now, allow me to be honest about whether the book is ever hard to follow, and it is, in a few places. None of these are fatal, and most readers will sail past them, but I would be doing the book a disservice to pretend it is seamless.

The "Bad" chapter tries to carry too much at once. In a single stretch, it moves through syphilis-tainted vaccine, the birth of germ theory, three different Pasteur vaccines (chicken cholera, anthrax, rabies), the polio story, the whooping-cough scare of the 1970s, and the Wakefield fraud. Each of these deserves its own breathing room, and a few — the rapid march through Pasteur's experiments in particular — go by fast enough that a reader without a science background may feel hurried along. The chapter sometimes reads like a catalog of cases rather than a single building argument.

The "Wrong" chapter has a softer version of the same problem. Its history of romanticism and naturopathy — Whitman, Thoreau, Muir, then early naturopaths most readers have never heard of — stacks names and quotations quickly, and the jump from 1720s Boston to 19th-century nature-worship is abrupt. The point lands, but the bridge is short.

The biggest structural risk is one Levenson half-admits himself. At one point in the "Intolerable" chapter, he writes that his account has been "one long, penetrating glimpse of the obvious." It is a disarming, honest line. It is also a fair warning. Because the book decides early that the anti-vaccine case is wrong, the later chapters can read like a prosecutor's closing argument rather than an open investigation. For me, and probably for most readers who already accept that vaccines work, that is satisfying. A genuinely undecided reader might wish for a little more room to arrive at the verdict on their own. The conclusion is foregone; the question is whether you mind.

A smaller point: the leap from the 1907 British vaccination law straight to COVID skips nearly a century of how the liberty argument actually evolved, and the Kipling story he uses to illustrate paternalist pro-vaccine thinking is more awkward than illuminating. These are minor.

What I will not fault is the prose. Levenson writes cleanly, and when he tells a story — Cutter, Leicester, Renae Archer — he tells it well. He does not drown the reader in jargon. An interested high-schooler could follow most of this book. That is exactly right for the audience that needs it.

My Verdict

"A Pox on Fools" is a history book disguised as an argument, or even an indictment. And it works on both levels. Its thesis is simple and, I believe, true: the case against vaccines never actually changed; it only lost its excuse. The concerns that were once reasonable have been answered, one by one, for over a century. What remains is repetition without the evidence. And now, repetition with the power of the federal government and global social media algorithms behind it.

As an epidemiologist, I found almost nothing to correct and a great deal I will assign. As a father, I found the one thing public health writing usually lacks: the willingness to remember out loud what the world was like when our children could die of measles, and to insist that we not go back. Levenson's word for what vaccines are is "a gift." After two readings, I cannot think of a better one.

Read it. Then give it to someone who is not sure.

Thomas Levenson, A Pox on Fools: The True Believers, Grifters, and Cynics Who Convinced Us to Reject Vaccines (Random House, 2026). All quotations and figures — including the 1952 polio toll, the Cutter Incident accounting, the Wallace and Renae Archer passages, the COVID-era life-saved and excess-death estimates, and the three-argument structure (Wrong / Bad / Intolerable) — are drawn directly from the text of the book under review.