U.S. vaccine policies, to all appearances, are based on assumptions about cost effectiveness, safety, and public health needs. Analysis of the peer review health professions’ discourse about rubella vaccine between 1941 and 1999 challenges this view. There were four justifications for the development of the vaccine: (1) cost-benefit projections about vaccine use versus anticipated birth defects; (2) the desire to prevent “fetal wastage” by vaccinating women; (3) a professional imperative to ensure healthy babies; and (4) a bias among vocal vaccine advocates against “unnecessary” abortion. The role of a fifth consideration, the “cultural provenance” of vaccines for American medicine, though not recognized by participants as part of the decision-making process presented in the literature, is hypothesized. Evidence published in 1991 substantiating the adverse effects of rubella vaccine for women highlights researchers’ earlier assumptions about women’s willingness to incur personal risk to prevent potential birth defects. The fetal rights movement (since 1980) establishes a language to help understand the social and scientific justifications for American rubella vaccine policies.



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