Peter Hobbins reviews Raina MacIntyre’s Vaccine Nation: Science, Reason and the Threat to 200 Years of Progress (NewSouth Publishing, 2025).
Pandemics are not rational affairs. Transforming a ‘pandemic’ into a ‘panic’ seemingly takes little more than deleting three letters. Cultural and emotional shifts can be similarly rapid. Yet as we have re-learned in the 2020s, living through a pandemic also generates prolonged cognitive and political sequelae.
In Vaccine Nation, world-leading Australian epidemiologist Raina MacIntyre mounts a spirited defence of immunisation in the aftermath of the Covid-19 crisis. It is a response to falling immunisation rates – not only against Covid (technically Severe Acute Respiratory Syndrome Covariant 2, or SARS-CoV-2), but also other high-profile diseases such as influenza. Prior to the current pandemic, Australia boasted impressively high uptake rates for preventive jabs. Indeed, in 2018–19 there was considerable media opprobrium amidst reports of drastically falling measles vaccination rates in Samoa, with an attendant rise in infections.
So why would Australians turn their backs on ‘200 years of progress’, as the book’s subtitle argues? As MacIntyre outlines, there is overwhelming epidemiological evidence that immunisation not only reduces the risk of disease transmission, but also ameliorates many consequences of infection across the populace. These assertions hold true for a variety of bacterial and viral infections, even those that rapidly mutate, such as Covid and flu. And just to be upfront: I have had both my Covid booster and annual influenza shots this year. Since then I’ve already caught a mild case of Covid – my second – but so far I’m dodging the flu.
Perhaps this is part of the problem. Immunisation is never 100 per cent protective. The nature of infectious diseases and vaccines, and of human biology and behaviour, mitigates against any iron-clad guarantees. But in the decades prior to 2020, we came very close to universal protection against a wide range of maladies. As MacIntyre observes, such success can breed complacency, at both individual and communal levels. It can also foster a sense of nihilism when vaccines don’t reach the impossible 100 per cent benchmark. She therefore rails against ‘how quickly people lose hope about vaccines when the development of highly efficacious vaccines in less than a year after SARS-CoV-2 emerged is a miracle’ (120).
MacIntyre spends less time, however, asking why the majority still believe in vaccines. This may seem a fatuous point: her career has focused on garnering and disseminating empirical evidence of their efficacy. But we are told that many things are good for us, whether abstaining from alcohol or brushing our teeth twice daily. Some recommendations we accept; some we flaunt. Immunisation choices aren’t always evidence-based, either. Both Nancy Cushing and I have investigated vaccines hastily developed during the 1918–19 influenza pandemic. We were amazed that fully one-quarter of the New South Wales population agreed to be immunised despite a lack of supporting evidence. In fact, that vaccine was technically ‘wrong’ – targeted to bacteria rather than the responsible virus – so why were so many people willing to accept it? Was that a ‘good’ or ‘bad’ outcome for immunisation?
This is where historical case studies can inflect contemporary public health policy, as Ben Huf and Holly Mclean demonstrated in their 2020 report on prior pandemics for the Victorian Parliament. The blurb for Vaccine Nation states that immunisation ‘is arguably the greatest public health achievement in history’. This contention has been debated for decades by medical historians, pointing to basic sanitary measures such as clean domestic water supply and effective sewerage systems. Hand-washing in healthcare settings is another. None of this is to deny that immunisation has been a positive development; a bigger historical question is why it succeeded in particular moments – especially after setbacks.
Vaccine Nation is rather taciturn when it comes to such difficulties. A few of the more infamous cases of vaccine failure or contamination are brushed over quickly. However, historians have demonstrated that negative impacts – even discredited associations such as the purported link between measles-mumps-rubella (MMR) vaccination and escalating diagnoses of autism – may create visceral and sustained animosity. While Australia was declared measles-free in 2014 and our current vaccination rate is 93.4 per cent of under-5s, cases contracted overseas could begin to spread if that figure falls. A growing number of cases around the country is currently animating experts to urge MMR vaccination for unprotected children and adults.
But for many in the community, science isn’t the point. The very nature of vaccines is that even where population-level evidence is overwhelming, it is difficult to prove that an individual was protected by immunisation. For those of us who believe in vaccination, it is effectively an article of faith. On the other hand, adverse associations such as side-effects can rapidly gain cultural and regulatory traction. Faith then flows in an alternate direction.
‘Individuals have every right to hold whatever beliefs they choose, however erroneous or dangerous those beliefs might be’, MacIntyre remarks. ‘It’s a different matter when those individuals force their beliefs on innocent, dependent children, or, if unvaccinated, they get infected and infect another person who then suffers serious consequences’ (68). Such rhetoric is polarising, as are statements such as ‘mass, unopposed brainwashing against vaccines post-COVID has affected everyone, healthcare professionals included’ (215). This is not the substance of the book, but it is indicative of the tone. If you are not among the faithful, it is more likely to castigate than to convert you. Historical case studies, from Leicester in England to Montreal in Canada, suggest that sometimes a middle-ground approach can achieve similar public health ends. These have included instances of self-imposed isolation or quarantine, as well as community care, where vaccination was opposed on libertarian grounds.
Vaccine Nation is written in a lively style that includes many personal anecdotes, including MacIntyre’s experiences as a doctor, woman, parent, and person of colour. She is deeply committed both to scientific rigour and to equity in preventive healthcare – primarily immunisation. The book would, however, have benefited from a more thoroughgoing edit, especially to winnow out repetitive references to select statistics and homilies, such as the recent fall in influenza vaccination rates in Australians over 65 years old. An index would also have been welcome, particularly for marshalling evidence. Nevertheless, this is an engaging snapshot of a historic technology on the verge of … well, we are waiting to see.