Professor Raina MacIntyre was waiting quietly in the emergency department of a busy hospital last year when she overheard a conversation she’ll never forget.
The patient in the cubicle next to hers had been scratched and bitten by his cat but was flatly refusing the tetanus booster his doctor was recommending. Couldn’t he just have some antibiotics and be on his way? The doctor told him that wasn’t necessary and asked why he didn’t want a tetanus shot. “I know 30 people who dropped dead. I don’t want it. I’m not having it,” he said. “Thirty people I know died after getting COVID vaccines.”
Instead of correcting him — instead of explaining that there had been 14 deaths from COVID vaccines in Australia, all before 2022, and 13 of them after the AstraZeneca shot which had since been withdrawn — the doctor gave the man the antibiotics he was demanding, likely only reaffirming his beliefs.
“Privately, many doctors and health leaders bemoan falling vaccination rates and stay silent while anti-vaxxers claim the stage, free to make whatever outlandish … claims they wish,” MacIntyre writes in her new book, Vaccine Nation: Science, reason and the threat to 200 years of progress. “At the same time, many fail to provide the role modelling needed for change, stricken by the same fear as politicians” who avoid speaking about COVID because it is “triggering” for so many people.
That emergency department exchange epitomises the public health challenge the world is now facing, and which MacIntyre, who researches infectious diseases, bioterrorism and vaccines as head of the biosecurity program at the Kirby Institute, examines in Vaccine Nation. In it, she steps through the history of vaccines and the transformative public health benefits they’ve delivered, the rigorous safety and efficacy trials they undergo, the dangerous ways they’ve failed on rare occasions, and how mRNA technology is leading to breakthroughs not just in the fight against infectious diseases but potentially cancer, too.
But Vaccine Nation is also a warning about the acceleration of the anti-vaccination movement during the pandemic and worrying declines in vaccination rates around the world, which MacIntyre links to a broader backlash against science and medicine, including from within the medical profession itself. It is a precarious situation given the looming threat of a bird flu pandemic — one experts fear could be deadlier than SARS-CoV-2 — though it’s already a live and urgent issue, particularly in the US, where a measles outbreak in Texas has infected at least 646 people (most of them unvaccinated) and killed two children.
A catalyst for this backlash, MacIntyre says, were COVID lockdowns, which in Australia were enforced before vaccines were available to prevent the crises unfolding overseas — collapsing health systems, refrigerator trucks full of bodies, mass graves. But lockdowns have become conflated with any kind of public health measure — including face masks and vaccines — as “state-sponsored tools for control” and an attack on personal freedoms. As a result, MacIntyre writes, public health messaging has become “timid and apologetic”, myths and misinformation have flourished unchecked, and “we now risk losing the gains of the last two centuries in a post-truth era embraced by the community and medical experts alike”.
Vaccines are easily taken for granted
Together with improved sanitation, better nutrition, and antibiotics, vaccines have led to significant public health advances that are easily taken for granted. A study published in the Lancet last year estimated that the WHO’s Expanded Program on Immunisation prevented 154 million deaths in the 50 years after its launch in 1974, including 146 million children younger than five and 100 million infants. Vaccinating against measles had the biggest impact, the researchers found, saving some 94 million lives — 60 per cent of the total lives saved.
Until then, infectious diseases were a leading cause of death, particularly among children. The smallpox vaccine against the variola virus led to the disease’s eradication by 1980. But it had previously been one of the world’s deadliest illnesses, with some scientists estimating it killed at least half a billion people just in the last 100 years it was circulating. Before effective vaccines were developed in the 1950s, polio paralysed or killed half a million people every year. And until the first measles shot was rolled out in 1963, major epidemics erupted every couple of years, causing an estimated 2.6 million annual deaths.
Raina MacIntyre’s Vaccine Nation is available from May 1st, 2025. (Supplied: NewSouth Books)
But these gains are now under threat. Australia’s childhood immunisation rates remain relatively high by global standards but fell in 2023 for the third consecutive year, the latest annual immunisation coverage report shows — a concerning trend given rates had generally been increasing prior to the pandemic. COVID and flu vaccination rates have also stuttered, with the latest data showing just 24 per cent of Australians aged 65-74 received a COVID vaccine in the past 12 months and a dramatic decline in the number of people getting the influenza shot last year compared with 2022.
More research is needed to understand exactly what’s driving these shifts: it’s not all about COVID, nor is it all about vaccine hesitancy or anti-vax sentiment — sometimes it’s a simple matter of people not being able to access the vaccines they need. But experts have blamed a misguided fear of COVID vaccines, pandemic-driven vaccine fatigue, a lack of trust in health authorities, and a belief that COVID and influenza aren’t serious infections — maybe not so surprising given, as MacIntyre puts it, the public has been “aggressively force-fed messages” that COVID is over, a “nothingburger”.
MacIntyre also points the finger at doctors, including experts on vaccine advisory committees, some of whom she says have downplayed COVID’s seriousness and fuelled vaccine misinformation. She is scathing, for instance, of Australia’s COVID vaccination policy which, unlike the US, does not recommend vaccinating children unless they are at risk of severe disease, despite large studies finding COVID jabs are safe and effective in children.
“It’s a serious infection; it causes serious complications in a small proportion of kids and on a population level that’s important,” MacIntyre tells ABC News. “It also causes long COVID — and what are we doing to our children, letting them just get repeatedly infected probably several times a year, every year?”
‘I don’t want mRNA in my body!’
In a chapter called “I don’t want mRNA in my body!” — a tongue-in-cheek nod to the fact that mRNA is found naturally in every cell of our bodies — she examines debunked myths and conspiracy theories: that mRNA vaccines contain microchips (they do not), that they’re contaminated with DNA which can alter human DNA (“not supported by any scientific data“) and a monkey virus called SV40 (ditto — plus it’s just not plausible, she says).
Crucially, COVID vaccines saved an estimated 14.4 million lives globally just in the first year after they were rolled out. And the threat of a H5 bird flu pandemic is a key reason we should be thankful for mRNA technology, MacIntyre writes, because it can be used to develop vaccines at “phenomenal speed”.
COVID vaccines saved an estimated 14.4 million lives globally just in the first year after they were rolled out. (Supplied: WA Health)
Still, while the safety of COVID vaccines is well-established, they’re not completely risk free — no vaccine or drug is. A study of more than 99 million vaccinated people from eight countries last year confirmed the findings of previous research that the Pfizer and Moderna mRNA shots increased the risk of myocarditis and pericarditis in rare cases, mostly in young males, but that the risk was much higher with COVID infection. In Australia, as of November 2024, myocarditis was reported in around 10-20 people per 1 million doses of Pfizer vaccines and around 20 people per 1 million doses of Moderna, according to the TGA. It may be of little comfort to people who say they’ve developed other debilitating conditions whose links to COVID vaccines haven’t been studied rigorously — nor recognised by compensation schemes or many doctors — but ultimately the researchers stressed the benefits of vaccination still vastly outweigh the risks.
That’s not to say vaccine programs always go smoothly. In a chapter on vaccine safety MacIntyre explains the strict development process new vaccines undergo and the sophisticated monitoring systems large countries use to track adverse events — this surveillance is used to pick up rare side effects that aren’t identified in clinical trials.
But rollouts have occasionally revealed serious failures. One of the most infamous examples is the Cutter incident of 1955, where 40,000 children in the US contracted polio after receiving the Salk polio vaccine, which had not been properly inactivated by the manufacturer, Cutter Laboratories. It was withdrawn the same month it was launched and the episode triggered an overhaul of federal vaccine safety systems. But dozens were paralysed and five died, MacIntyre writes — “a huge blow to vaccination programs and public confidence in vaccines”.
Tackling the politicisation of public health
Seventy years later, despite the resounding success of COVID vaccines, we’re now grappling with a confidence crisis on a bigger scale, driven by a tangle of factors: the explosion of misinformation online (especially on social media) and the difficulty even medical professionals face sifting fact from fiction; the elevation of vaccine sceptics such as Robert F Kennedy Jr to positions of influence and authority; and what MacIntyre describes as the proliferation of “junk journals” which provide a platform for “anti-vaccination activists” and “pseudoscientific disinformation”. A lack of messaging from governments about COVID’s ongoing health risks — particularly long COVID — and their silence on anti-vax rhetoric, MacIntryre writes, makes the situation even more fraught.
Perhaps one of the most insidious examples of the challenge science now faces is the backlash MacIntyre has copped personally. Earlier in the pandemic, whenever she’d do media interviews, angry, abusive emails from complete strangers would come pouring into her inbox. They blamed her for lockdowns and, in one bizarre example, accused her of promoting masks and vaccines and causing mass deaths as a result. “F— you, Raina. You are just so f—ing useless, like 95 per cent of females with ‘careers’,” one emailer spat.
MacIntyre argues that “risk perception” ultimately drives human behaviour and tolerance for public health measures, vaccines included. (ABC News: Brendan Esposito)
“I’m not sensitive at all because I know what I’m doing,” MacIntyre insists. “I know what I say is based on evidence, on science … and I’m just not bothered by what anyone thinks or says about me. I also don’t want negativity in my life … so if doing interviews is going to bring negativity, I don’t need it, I don’t want the attention.” These days, she says, she’ll do an interview if it’s about a subject she thinks no one else understands the way she does: “If there’s something I can contribute, I would like to. But there’s also the question of, when people are over it, what’s the point in being a talking head out there?”
Still, things can be turned around, she says — especially in Australia, where as far as public health goes, “we’re in a much stronger position than the US or UK”. “I think some public messaging to consolidate the gains we already have is important, so we don’t lose it in the sea of misinformation that will be coming in the near future,” MacIntyre says. “I think the politicisation of public health” — reflected in political leaders’ reluctance to mention COVID, for instance — is something we need to tackle.”
She also supports improving the accessibility of vaccines, and reforming Australia’s Technical Advisory Group on Immunisation (ATAGI) so that the evidence and deliberations behind its recommendations are published — perhaps in the style of the US Advisory Committee on Immunisation (ACIP), whose meetings, documents and rationale are all public. “I think that kind of transparency and open public decision-making would help the vaccine situation in Australia,” MacIntyre says, “and help us protect our strong starting position”.
Other experts have suggested public confidence in vaccines could be bolstered by improving the governance and accessibility of vaccine injury compensation programs (many people who say they were injured by COVID shots have criticised Australia’s now-closed compensation scheme for using an overly-narrow list of eligible medical conditions, claiming the burden of proof was too high and application wait times too long). And in the US, Gregory Poland, the editor of the journal Vaccine, recently argued that the Vaccine Adverse Events Reporting System (VAERS) must be “strengthened” and that large, ongoing studies are needed to help researchers work out who is at increased risk of vaccine injuries and how to reduce that risk.
Perversely, though, it may take people dying from resurgent, vaccine-preventable diseases like measles — or the onset of a bird flu pandemic — to really shift the dial. As MacIntyre writes, “risk perception” ultimately drives human behaviour and tolerance for public health measures, vaccines included. “When people see friends, family and neighbours dying or becoming seriously ill with pandemic influenza,” she writes, “most will avail themselves of any available protective measures”.
