RAINA MACINTYRE Vaccine Nation. Reviewed by Braham Dabscheck

Professor Raina MacIntyre was a prominent voice during Covid. Now she fears the backlash against vaccination will have devastating effects.

 We dodged a bullet – or did we? The panic created by Covid-19 has (apparently) gone away. Somehow or other policy-makers and the medical profession found a way to protect most of us from the devastating effects of the virus. As epidemiologist Raina MacIntyre says, the pandemic was the first time since smallpox that ‘we have seen mass vaccination’. But we are not in a post Covid-19 world. The virus is still with us, and in a more insidious way has the potential for devastating long-term effects on public health. MacIntyre is concerned that the benefits provided by vaccinations are being undone by negative reaction to the public health policies that tackled Covid-19.

Globally, including in Australia, public health suffered a blow during the Covid-19 pandemic, with any mention of public health measures to reduce disease and disability being met with resistance by politicians and many in the community. The lockdowns of 2020, which comprised a few months or less of the whole year in most communities, have become conflated with any kind of public health measure. So instead of being strong and confident, public health messaging has become timid and apologetic, with health departments issuing messages like ‘be kind to people who wear a mask’. The implication in that message is that the community has a right to be aggressively opposed to visible public health measures and that authorities should plead for the safety of mask-wearers. We now risk losing the gains of the last two centuries in a post-truth era embraced by the community and medical experts alike.

MacIntyre points out that over 90 per cent of resources in healthcare are devoted to acute care, with only a small fraction allocated to prevention, of which vaccines are an important part. Vaccination is designed to protect people from diseases which may affect them in the future. Before 1800, only half of all babies reached their first birthday. In most countries today, that figure is 99 per cent; even in poorer nations the survival rate is 90 per cent or more.

In the first half of Vaccine Nation MacIntyre provides a history of diseases, the emergence of vaccines, and the different ways they operate. She also explains the protocols for developing vaccines, and important procedures for their delivery – such as the training of staff, the transportation and storage of vaccines – and the rigorous monitoring of vaccines after they have been developed to ensure that they do not have unacceptable levels of side effects.

The book examines issues associated with such things as ‘herd immunity’, compulsion versus persuasion as a means to increase vaccination rates (she favours persuasion, especially if overall vaccination rates are high), and mass versus targeted vaccination (if a virus has a long incubation period, targeted vaccination of contacts can be used to eradicate the virus). She emphasises how vaccines, by eliminating diseases, provide protection against other health problems such as cancer and cardiovascular disease, thereby reducing the need to allocate resources to acute care.

 MacIntyre is also concerned by the different vaccination rates between the young and the old, or what she refers to more generally as ‘vaccine equity’. Children have high rates of vaccination, over 90 per cent; the aged have lower rates, between 60 and 70 per cent. She advocates increased vaccination for the aged, especially against influenza, as it increases overall health, reducing cardiovascular, cancer and other problems, thereby enhancing longevity. With the backlash against Covid-19 measures, MacIntyre is concerned about low vaccination rates for the elderly, particularly in nursing homes. She is a strong supporter of increased vaccination because of its positive preventive effects with resultant saving of scarce financial sources.

The second half of Vaccine Nation focuses on problems inherent within the medical profession and the post Covid-19 attacks on public health. In a chapter entitled ‘The Dark Underbelly of Medicine and Global Health’, she points to inequities and problems of colonialism and racism in the production of research. She refers to an article that claimed The Lancet, a leading medical journal:

‘legitimised and continues to promote specific types of knowers, knowledge, perspectives, and interpretations in health and medicine’ … how the journal promoted people from wealthy, privileged and usually white or Western backgrounds as the ultimate knowers of truth … vast imbalances of power exist between privileged researchers and organisations from high-income countries and the subjects they study in low-income countries … Many vaccine and drug trials are conducted in low or middle-income countries, but the benefits and availability are seen first in high-income countries.

Further, MacIntyre argues:

With personal experience of racism in medicine and academia, I see global health through a different lens. I see the opportunism, the exploitation and the personal profit gained on the backs of disempowered people. Global health and pandemics are especially ripe for the exploitation of the vulnerable because these fields offer more opportunities for privileged people to swan around as saviours among vulnerable people to advance their own careers.

Following the backlash against public health measures, governments have declared the pandemic is over and relaxed many of the controls, such as mask wearing, social isolation and the need for vaccination and boosters. The efficacy of Covid-19 vaccination wanes after three to six months, which would suggest a need for boosters every six months. In Australia, from the beginning it was decided that children should not be given vaccines, and an age limit was placed on boosters. Six-monthly boosters should presumably be mandatory in aged care. But Covid-19 vaccination rates (and vaccinations for other diseases) have declined as we have returned to something called normal.

This is an issue of major concern to MacIntyre. She can see a major health crisis looming in the future where those who have had COVID are likely to experience long-term health problems.

Privately, many doctors and health leaders bemoan falling vaccination rates and stay silent while anti-vaxxers claim the stage, free to make whatever outlandish anti-vaccine claims they wish …  [We are] trapped in a dystopian, global-scale conspiracy of silence … Within this silence, the stage is free for anti-vaxxers, snake oil salesmen and people with other agendas to get out their megaphones and flood the world with disinformation because governments are unwilling to challenge them.

She is also concerned with the rise of revisionist or fake science. She refers to bullying attacks by people opposed to the use of vaccines (and provides examples of hate mail she has received from anti-vaxxers), junk studies being published in reputable journals (which says something very alarming about editorial standards in such journals), the emergence of junk and predatory journals, and junk conferences all banging the anti-vaxxer drum. So much fake science flooding the scene increases the likelihood of policy decisions that will have long-term negative effects on public health.

Finally, she expresses concern about developments within the medical profession concerning Covid and the need for vaccines. She refers to examples in both America and the United Kingdom where doctors have embraced anti-vaccination rhetoric, and haven’t been disciplined for doing so. Worse, governments make poor appointments (she uses the term ‘cronyism’) to policy committees dealing with viruses, pandemics and vaccines.

Clinicians and basic scientists were driving policy on expert committees, and public health experts were absent, resulting in a bumbling, learn-as-you-go public health response. In the US, a radiologist was put in charge of the US pandemic response … Guidelines in many countries still do not reflect airborne transmission. No aerosol scientists or engineers who understand the transmission of respiratory viruses and the movement of aerosols were on the WHO committee in the first few years of the pandemic, and their expertise was not sought until years later.

Vaccine Nation is both a wake-up call and a response to the attacks being mounted on public health. Raina MacIntyre provides a blueprint for how to take on such attacks and provides a clear overview of the role vaccines have played in enhancing public health and well-being. Hopefully, her book will strengthen the resolve of scientists, the medical profession and policy-makers to resist those opposed to vaccines as a public policy instrument. The alternative is too dreadful to contemplate.

Raina MacIntyre Vaccine Nation: Science, reason and the threat to 200 years of progress NewSouth 2025 PB 256pp $34.99

Braham Dabscheck is a Senior Fellow at the Melbourne Law School at the University of Melbourne who writes on industrial relations, sport and other things. He published a review of a book entitled Cricket Ball: The heart of the game (it is a wonderful book). Since then he has regularly been asked to participate in cardiology journals and conferences ‘due to his expertise in the area’.

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Tags: Covid-19, public health policy, Raina | MacIntyre, vaccination