In Vaccine Nation, Raina MacIntyre reflects on science, misinformation and the threat to 200 years of progress
- Written by Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia
Raina MacIntyre is one of Australia’s most respected epidemiologists. She was a familiar face and calm voice during the COVID-19 pandemic. So when I was asked to review her new book Vaccine Nation I was delighted to accept.
Review: Vaccine Nation: Science, Reason and the Threat to 200 Years of Progress – Raina MacIntyre (UNSW Press)
Interestingly, MacIntyre initially planned to become a cardiologist, but was drawn instead into infectious diseases and vaccines. Her subsequent career has spanned everything from fieldwork during Australia’s early rollout of the Hib vaccine – which protects against potentially fatal respiratory infections, including meningitis – to advising governments on biosecurity and bioterrorism. Her previous book, Dark Winter, explored pandemic threats and biosecurity.
Vaccine Nation is, in many ways, a natural sequel to that earlier work – though this time, the threats are as much social as they are biological. The book blends a sweeping history of public health with a clear examination of our messy present. It delivers a timely, urgent and often deeply personal account of vaccination’s role in our world.
MacIntyre argues the current anti-vaccination backlash and broader scepticism towards science stem from a complex mix of historical, cultural and political factors, not just from social media.
The cumulative effect is a deeply rooted scepticism that now threatens not only vaccination programs, but the credibility of science and public health more broadly.
Central to this reaction is the trauma and anger generated by the COVID-19 pandemic and its associated public health measures. The book highlights how anger, combined with pandemic fatigue, has been misdirected at public health advocates and scientists. “People deal with loss and grief in different ways,” MacIntyre notes, “but anger is part of this, and public health and people advocating for the prevention of COVID-19 are easy targets for that anger.”
Historical incidents, such as vaccine safety scares and the misuse of vaccination programs for intelligence operations, have “seeded distrust” that anti-vaccine activists continue to exploit. MacIntyre also points to cultural differences. In countries with strong traditions of individualism and low trust in government, such as the United States, anti-vaccine sentiment has found particularly fertile ground.
Importantly, MacIntyre observes that anti-vaccine sentiment has shifted from the fringes to the mainstream, even among some healthcare professionals. This mainstreaming has been fuelled by disparate groups, such as “alternative lifestyle communities and right-wing extremists”, coming together around opposition to COVID-19 vaccines.
The rise of disinformation and pseudoscience, especially via social media, has further muddied the waters. “Presenting facts and figures to the anti-vaccine lobby does not work,” MacIntyre observes. “Anti-vaxxers often use emotive anecdotes of children with complex illnesses or who have died, often with graphic photographs, attributing these tragic cases to vaccination, without any evidence.”
MacIntyre is refreshingly honest about her own missteps. She describes trying and failing to convince a friend to get vaccinated. She reflects on the “move-on mentality” that made public health workers scapegoats during the pandemic. And she doesn’t spare governments, health agencies, or even her own profession from criticism.
An anti-vaccination rally outside the National Press Club of Australia, Canberra, February 1, 2022.
Mick Tsikas/AAP
Reasons for hope
Despite the sometimes bleak outlook – falling vaccination rates, politicised science, rising pseudoscience – MacIntyre remains a passionate advocate for vaccines and for the public’s right to truth. She highlights reasons for hope: the astonishing speed of COVID-19 vaccine development and promising research into vaccines for cancer, heart disease and multiple sclerosis.
MacIntyre’s writing is clear and engaging. She explains complex medical and epidemiological concepts with real-world examples and vivid storytelling. That said, some sections of Vaccine Nation, especially those explaining immunology or epidemiological principles, can get a little technical for general readers. Terms like “immunosenescence” (the decline in the immune system that comes with aging) or “adjuvant” (a drug that increases the effectiveness of other drugs) sometimes appear without enough explanation.
Key themes, such as anti-vaccine sentiment, equity and pandemic preparedness are repeated across chapters. This repetition reinforces the message, but for some readers it may feel slightly excessive.
Vaccine Nation is not just a history of vaccines, nor is it a simple attack on anti-vaxxers. It is a compelling call for science to “reclaim the stage” – to speak clearly, empathetically and honestly in an age of misinformation and distrust.
MacIntyre’s voice is urgent but always calm. Her arguments are passionate, grounded in evidence and driven by a deep commitment to public health. If you want to understand how we got here – and what it will take to rebuild trust in science and vaccines – then Vaccine Nation is essential reading.
As MacIntyre warns: “A new pandemic will occur – the question is when, not if.” Whether we will be ready depends, in large part, on whether we can restore the fragile trust science and public health depend on.
Authors: Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia
