Vaccinated America is frustrated with the unvaccinated. Stories regularly go viral about covid-19 patients sending messages of regret and contrition about their vaccination hesitancy. Accounts also come from burned-out health-care workers, remorseful loved ones, even funeral directors and embalmers — all desperately, even angrily, begging the vaccine-skeptical to reconsider.

A prominent subset of stories and social media chatter is specifically focused on the sufferings of anti-maskers, anti-vaxxers, QAnon influencers, conservative politicians and numerous right-wing talk radio personalities (some notorious for having celebrated AIDS deaths). Many of these discussions adopt a tone that goes beyond the feeling of schadenfreude. They seem to ask: What if the unvaccinated cannot be persuaded? Will hospitalizations and deaths accomplish what reasoning, encouraging, pleading, bribing, shaming and mandating cannot?

These and other questions demand urgent reflection, since policymakers and health providers are confronting distressing choices around crisis standards of care. How might pent-up frustration and anger influence assessments for medical rationing? What are the ethics of expecting the disease itself to sway the vaccine holdouts?

SARS-CoV-2 may be a novel virus, but these quandaries, including frustration at the stubbornly unvaccinated, are not new. Vaccine resisters in the 19th century significantly stymied public health efforts, and the anger felt by health officials shaped their responses — not always for the best.

When Victorians talked about vaccination they meant immunization for smallpox, a deadly and often disfiguring viral disease. Britain introduced compulsory infant vaccination in 1853, significantly suppressing the prevalence and visibility of smallpox.

But anti-vaccination then exploded as a movement, churning out popular literature that challenged vaccine efficacy and warned of injuries to children. Fueled by resentment toward the fines and jail sentences used to compel compliance, Victorian anti-vaccine sentiment took hold in clusters in places such as the English towns of Leicester, Gloucester and Keighley.

The doggedness of anti-vaccine fervor frustrated vaccine proponents, who worried that it raised the threat of epidemics. A key figure was John C. McVail, health officer for the Scottish town of Kilmarnock. His 1887 “Vaccination Vindicated” provided a meticulous response to the claims of the leading vaccine opponents, delivered in a snarky style not unlike some social media posts today. McVail recognized the difference between anti-vaccine ideologues and the merely vaccine-hesitant, but above all he was worn down by the sheer magnitude of misinformation he had to repeatedly debunk.