Vaccine: The Debate in Modern America by Mark A. Largent, and: Values and Vaccine Refusal: Hard Questions in Ethics, Epistemology, and Health Care by Mark Navin (review)

Over the last twenty years or so, vaccines have developed as one of the standard examples of major public scientific controversies, alongside climate change and genetically modified foods. This public contention has attracted scholarly attention, and the current review examines two recent attempts at such scholarly intervention. While both books have their limitations, I recommend both to anyone interested in a sophisticated introduction to the vaccine controversy. Specifically, the first substantive chapter of each book would be an excellent set of readings for one-session discussion of the controversy in a bioethics class or science communication workshop.

Mark Largent’s Vaccine: The Debate in Modern America was published in 2012 by Johns Hopkins University Press (Largent 2012). Largent is a historian of science at Michigan State University, and most of the book takes the form of historical narratives of some key figures or moments in the development of the vaccine controversy. Mark Navin is a political philosopher at Oakland University in Auburn, Michigan, and so his Values and Vaccine Refusal—published in 2016 by Routledge—focuses on a more abstract analysis of arguments (Navin 2016). Both books are broadly accessible. While Largent’s book was published a few years ago, the two books work well together; thus the current, joint review.

Before getting into the details, let me introduce some terminology and provide a brief overview of the state of the vaccine controversy and vaccine compliance. Following Navin, vaccine denial is a denial of mainstream medical beliefs about the safety and efficacy of vaccines, while vaccine refusal is the behavior of refusing routine childhood vaccinations. That is, roughly, denial is a matter of belief while refusal is a matter of behavior. Public health officials often focus on vaccine compliance, which is simply the logical negation of refusal, viz., accepting all routine childhood vaccinations; or on vaccine coverage, which is the percentage of a population (often children in kindergarten) who have received recommended vaccinations. Largent focuses on vaccine hesitancy, which refers primarily to (subjective) doubt about vaccine safety and efficacy, and so secondarily the prudence of vaccine compliance or refusal. The difference between vaccine denial and hesitancy is the difference between [End Page e-10] confident rejection and uncertainty. Vaccine hesitant or denialist parents will often have more or less specific and well-articulated vaccine concerns. These concerns can be narrowly understood as reasons to doubt the safety or efficacy of vaccines, or they can be understood more broadly as reasons to doubt the all-things-considered prudence of vaccine compliance. The possibility that vaccines can cause autism is a widespread vaccine concern, despite being thoroughly rejected by the mainstream medical community.

Popular media coverage of the controversy often gives an oversimplified impression of a rapid, widespread drop in vaccine coverage. Nationally, coverage rates for four major, longstanding immunizations (MMR, DTP/ DTaP, polio, and HepB) have remained steady since 2000, at around 90% or more of preschool children (Centers for Disease Control and Prevention 2015). Coverage is lower for immunizations that have been added to the recommendation list more recently, such as rotavirus and HepA, but even here the national trends are towards increased coverage over time. By contrast, there is more variance at the state and county level (Ernst and Jacobs 2012), including some state-level increases in personal or philosophical exemption rates since the 1990s (Omer et al. 2012; Richards et al. 2013). Some epidemiological research has shown that vaccine refusal tends to occur in geographical clusters (Lieu et al. 2015), such as Ashland, Oregon, and parts of the Bay Area in California. Such vaccine refusal clusters have been associated with preventable disease outbreaks, such as an outbreak of measles in San Diego in 2008 (Sugerman et al. 2010); although other outbreaks, such as outbreaks of pertussis, appear to be due to “waning immunity” rather than vaccine refusal patterns (Phadke et...