Vaccine Nation: Science, Reason and the Threat to 200 Years of Progress
Vaccine Nation provides authoritative summaries of the preventive value of immunisation against a wide range of illnesses … Given this seemingly incontrovertible evidence, MacIntyre believes that facts will save us.
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Vaccine Nation: Science, Reason and the Threat to 200 Years of Progress
RAINA MACINTYRE | 2025
‘Progress’ is a word you don’t see much in history these days. We historians have been trained to avoid any whiff of Whiggishness – of implying that today’s society is the acme of civilisation. But in certain material senses, our lot is immeasurably better than it once was. Barely 150 years ago, for instance, few Australian families would expect all of their children to reach adulthood.
Vaccination – or more precisely, immunisation – is one of the key technologies that have transformed our life expectancy. Other major factors include clean drinking water, widespread sewerage, adequate nutrition, efficacious pharmaceuticals, preventive healthcare, emergency services and a stunningly effective hospital system. The journey also involved practices that had faded from community consciousness before the COVID-19 pandemic, including quarantine and a personal acknowledgement that the social contract cuts both ways.
Having trained as a medical scientist and later as a medical historian, I have been intrigued for decades by immunisation. I am also a believer (while writing this review I had a booster shot for diphtheria, tetanus and pertussis). Even a century ago, such pathogens were still killing kids on a regular basis; I’ve seen the records in local government infectious diseases registers.
For Raina MacIntyre, a professor of global biosecurity at UNSW, immunisation is the single largest contributor to our near-victory over infectious maladies. While Vaccine Nation is not a historical text, it cites past pandemics as well as contemporary epidemiological evidence to assert this primacy. The book is animated by MacIntyre’s sense of alarm – indeed outrage – that immunisation rates are falling across of our population. In part this decline appears to be consumer choice; it also reflects policy decisions made after a post-COVID backlash against vigorous public health interventions. Indeed, chapter 15 is entitled ‘COVID killed public health’.
‘It is worrying that vaccine experts are adopting the same arguments against COVID vaccines that anti-vaxxers have used since the first vaccine against smallpox’, MacIntyre laments (p. 190). On the one hand, this invocation of history is apt. The introduction of vaccination in 1796 led to an extraordinary, almost evangelical, uptake by medical practitioners and states around the globe, as Michael Bennett has impressively demonstrated. The fervour of this campaign facilitated widespread adoption of vaccination and certainly helped reduce the horrid clinical consequences of smallpox. On the other hand, vaccination pioneered a form of monolithic medicalisation that – perhaps understandably – not everyone welcomed.
Vaccine Nation provides authoritative summaries of the preventive value of immunisation against a wide range of illnesses, not all of them infectious. It addresses the key pandemic challenges of our time – COVID, influenza and severe acute respiratory syndrome – as well as virulent pathogens such as measles, mpox and smallpox. The evolving role of immunisation in averting cancer and heart disease is also outlined, as well as potential impacts on dementia. Given this seemingly incontrovertible evidence, MacIntyre believes that facts will save us.
‘Most arguments against immunisation appeal to the concerns of parents for the health and wellbeing of their children, or in the case of adult vaccination, concerns about their own health’, she insists (p. 63). Historically this assessment was true, although with some important caveats. Early vaccination was a relatively impure process and even today, some immunological agents are still extracted from animal serum. Now-outmoded practices such as reusing syringes or inoculating one patient from the body of another naturally increased the risk of iatrogenic (i.e. health system-induced) transmission of diseases. However unreasonable, fear of such contaminants still lingers.
Many immunisations also made people feel markedly unwell, possibly leaving them with scarring at the inoculation site. Shunning, lying about or even faking vaccinations have all appeared in my archival research. There were also issues with tainting that infamously made some vaccine batches deadly or disabling. Investigating the 1928 ‘Bundaberg Tragedy’ – which left 12 children dead after being injected with contaminated diphtheria toxin-antitoxin – revealed a host of similar calamities previously kept under wraps by health authorities in the 1910s and 1920s. That article has proved to be one of my most-read academic papers.
In short, while today’s immunisation jabs are usually pure, painless and any adverse effects are fleeting, there were many reasons historically why people were either hesitant or outright opposed to vaccination. Given its impact on community attitudes, Vaccine Nation would have benefited from elucidating that back story.
Where the book struggles, moreover, is countering libertarian arguments against compulsion. This is an enduring strand of individual and community resistance to immunisation, founded on spiritual, political or personal principles, rather than science. Sometimes, it’s sheer bloody-mindedness. In other words, facts are not the primary battleground, which troubles MacIntyre to the point of asserting that anti-vaxxers ‘wilfully defy medical advice or shun it altogether, resulting in the suffering and death of babies’ (p. 69). Her gambit may be evidence- based, but it’s also emotive. Whether it will help reverse the decline in voluntary immunisation remains to be judged by … history.
Vaccine Nation is a typical NewSouth book: well-packaged and accurately edited. I found that several anecdotes and fact grabs were repeated; overall the style reads more like a compilation of op-eds rather than a monograph. Nevertheless, the book provides both a timely intervention and touchstone for a profound social issue that will shape how we respond to the next pandemic.
Vaccine Nation: Science, Reason and the Threat to 200 Years of Progress is published by NewSouth Publishing Publishing.
Reviewer: Peter Hobbins, PHA (NSW & ACT)