On the surface, it might seem that a narrative is just a way of describing the practical reality of disease and vaccination. But narratives are more than descriptions: they affect the way people process information, create meaning and develop values, and this affects reality.
[Jacob] Heller traces the vaccine narrative through four case studies: diphtheria toxin-antitoxin, rubella, pertussis and HIV/AIDS. He examines the history and politics in each case, showing how the vaccine narrative developed and how it impacted on the politics of health. Here is what he identifies as the vaccine master narrative, in its standard form.
The cultural narrative of vaccines tells the story of a deadly disease that exerts a terrible toll in human suffering and death. Heroic researchers, working altruistically, marshal the forces of modern science to develop a simple intervention to ready the body’s own defenses: a vaccine. Properly prepared, we can defend ourselves, just as our science demonstrates human mastery of death. Through the application of a simple, safe, and effective shot, we protect ourselves and set the disease on the road to oblivion. Our compliance with mass vaccination policies is a moral obligation that protects each one of us at the same time that we contribute to our common goal of eradicating disease. Our compliance is morally right, practically easy, and both scientifically and politically progressive. By explicit extension, those who oppose, refuse, or resist vaccination are ignorant, anti-science, and a threat to the public health. They, too, are part of the story — the “bad guys” who try to subvert our attempts to win the war, but whose plans are doomed to failure. [The Vaccine Narrative (Nashville, TN: Vanderbilt University Press, 2008), p. 22]
This narrative has surprising power over thought and behaviour. The trouble with it, according to Heller, is that it distorts history and can lead public health promoters astray.
The classic example of a disease fitting the narrative is polio. It is portrayed as a deadly disease that can affect anyone without warning. Then along came the brilliant and selfless polio pioneers Jonas Salk and Albert Sabin whose vaccines protected the population. However, Heller says, this misrepresents the realities of polio. It did indeed have terrible impacts on many of those afflicted, but most cases were mild, causing no long-lasting disabilities. Other infectious diseases were more deadly and debilitating but did not receive the attention given to polio. Because the polio story, as told following the standard vaccine narrative, is so moving and convincing, it is regularly used to justify vaccines for other diseases.
– Vaccination Panic in Australia (2018), pp. 254-5
In countries such as Australia, Japan, Sweden and the US, many vaccines are standard, for example those for polio, measles and pertussis. Their governments are usually responsive to advice from the World Health Organisation. However, there are some differences between the recommendations offered by national governments. For example, in the US there are quite a few more vaccinations recommended than in Sweden. The question is, why?
One explanation is that the risk of certain infectious diseases is greater in some countries than others. Another explanation is that the results of cost-benefit calculations are different depending on factors such as the cost of disease and the cost of vaccines. To my knowledge, no one has carried out a comprehensive analysis of the reasons for differences in national vaccination recommendations.
For me, there is a strange pattern in the differences. The number of recommended vaccines tends to be greater in countries with the least government commitment to welfare. The United States is the most striking example, having no national health insurance and a weak and patchy welfare net that leaves many of those who are poor or disadvantaged with little protection. In contrast, Sweden has a longstanding national health insurance scheme, unemployment payments and other welfare features. US opponents of national health insurance have long labelled it “socialised medicine.”
Why, then, is there such a strong push for more vaccines, and for more government coercion for taking them, in the US compared to Sweden? This is counterintuitive, given that in other spheres emphasis on individual rights and opposition to government intervention is very strong in the US.
[…]
Decades ago, I studied the fluoridation debate: the controversy over whether to add fluorides to public water supplies in order to reduce the incidence of tooth decay in children. I wrote to officials in dozens of countries asking about government policies on fluoridation. At the time, fluoridation was widely used only in a few countries, including Australia, Canada, New Zealand, Singapore and the US. In most of Western Europe, there was little or no fluoridation, though there had been significant debates in many countries, including strong support from most dental professions.1
Fluoridation raises some of the same issues as vaccination. It provides a collective benefit — fluoride gets to nearly everyone in the community, regardless of income or access to dental services — but is seen by opponents as a violation of individual rights. Writing about fluoridation, I could only speculate as to why it had become entrenched in only a few countries, and those countries — mostly the English-speaking ones — were where the rhetoric of free choice was greatest and where government welfare systems were least comprehensive. I suggested that fluoridation was advocated more strongly in places where the dental profession was more autonomous of the state.
I do not have an explanation for national differences in vaccination recommendations, but mention this as a possible topic for study that will give greater insight into the dynamics of vaccination debates in different parts of the world. It may help explain the extreme features of the Australian vaccination struggle.
– Ibid., pp. 266-9