A new book offers the best available critique of vaccination orthodoxy. 

(This is a long review. To skip the preliminaries, go to “Turtles enter the fray.”)

The vaccination debate

In 2010, I began writing about the vaccination debate — the public debate over the benefits, risks, ethics and politics of vaccines. This was long before Covid-19, so nearly all the debate was about childhood vaccines for diseases like polio, measles, diphtheria, and tetanus.

            I came to this issue having previously written about disputes over nuclear power, pesticides, fluoridation, nuclear winter and the origin of AIDS. In the field of science and technology studies or STS, these are called scientific controversies. They typically involve striking disagreements between both scientists and laypeople, and aren’t just about science. They also involve disagreements over ethics, decision-making and values such as freedom.

            In studying the vaccination issue, my purpose is not to take a side but to understand the dynamics of the controversy, including the players, their moves and claims. I also have another purpose, which I’ll come to.

            There are remarkable similarities between different scientific controversies. They typically pit a powerful establishment, supported by governments or corporations and most experts, against citizen opponents, backed by a small number of dissident experts. This at least is the configuration in debates over nuclear power, pesticides, fluoridation, genetically modified organisms, microwaves — and vaccination. There are two important exceptions, where most experts oppose a powerful establishment: smoking and climate change.

            In every controversy, it is possible to examine public campaigning and expert scientific commentary. In public campaigning, it is common to find mistakes, exaggeration, misunderstandings and misinformation. However, judging what is a mistake is not always easy, because partisans on one side or the other may challenge what seems like an obvious statement or assumption. For example, I refer to the “vaccination debate” but some proponents say there is no debate and any disagreement with vaccination is misinformed or worse.

            Before proceeding, I had better explain my own position. I do not have strong views in favour of or opposed to vaccination. As noted, my interest in the issue is as a social scientist, to learn about the way the debate proceeds. My other interest in the issue is to defend free speech on controversial social issues. I believe in the value of open dialogue, discussion and debate. If vaccines are highly beneficial and extremely safe, criticism should be welcomed so that it can be clearly and accurately countered. If vaccines have shortcomings, criticism is valuable for highlighting them, hopefully leading to better products and practices.

Writing about the vaccination debate

I started writing articles about the vaccination debate, in particular about a most amazing attack on an Australian vaccine-critical group. By doing this, I came under attack myself. This was wonderful! As a social scientist studying a public scientific controversy, it is often difficult to obtain first-hand information. Social researchers usually rely on published materials, interviews and surveys, but remain separate from the action. I didn’t just have a front-row seat: I was on the playing field. Some others were treating me like a player.

            In writing scholarly articles, I gradually developed a standard way of introducing the vaccination debate in a few words. Here’s one example, from 2012:

Vaccination against infectious diseases is supported by medical professions worldwide (Andre, et al., 2008; Offit and Bell, 2003), and in most countries there is a standard set of vaccinations given to children. In the face of this medical orthodoxy, a small number of citizens’ groups and professionals present a contrary position, arguing that the benefits of vaccination have been overestimated and that there are significant risks to individuals and society, with recorded cases of seriously affected children (Habakus and Holland, 2011; Halvorsen, 2007).

You can see that for the vaccination-positive view, I gave two references, and likewise for the vaccine-critical view. In each case, I wanted to give solid, credible references. Reflecting on how I proceeded, my implicit criteria were that the source should be comprehensive, reasoned, authoritative and readable.

• Comprehensive: the source needs to address all or most of the vaccines and the scientific and medical issues in the debate.
• Reasoned: evidence and arguments should be presented in a careful, logical, systematic way.
• Authoritative: the authors and the content should be credible.
• Readable: the writing should be understandable by non-experts.

It’s hard to satisfy all these criteria. For example, there is a vast quantity of vaccination-positive materials in scientific and medical journals, but most of it is specialised (not comprehensive) and aimed at experts (not readable).

Vaccination-positive sources

For the case for vaccination, the book by Paul A. Offit and Louis M. Bell was an ideal reference. Titled Vaccines: What You Should Know, it is aimed at a general audience, covers the full gamut of vaccines and comes across as informative. Paul Offit is a doctor and professor and a prominent advocate of vaccination, and Louis Bell is also a doctor. Some of Offit’s other works include bitter attacks against critics, but Vaccines does not enter this territory.

            A correspondent alerted me to an article by F. E. Andre and eleven co-authors. It is titled “Vaccination greatly reduces disease, disability, death and inequity worldwide,” and published in the Bulletin of the World Health Organization. The title alone suggests the article’s aim to be comprehensive, and the authors are a slew of experts in the field. It scores less on readability.

            Later I cited another source: Vaccines. The seventh edition of 2018 is edited by Stanley A. Plotkin, Walter A. Orenstein, Paul A. Offit and Kathryn Edwards. This is a massive text, aimed at specialists. It is definitely comprehensive, and the editors have high status in the field. It is factual rather than overtly partisan but is not bedtime reading for non-experts. It is good for pointing to the vast quantity of research supporting vaccination.

            No doubt there are other good sources. These were the ones I found most useful. My purpose was to point to credible material supportive of vaccination. I guessed that few readers would bother to look up any of these sources, but they needed to know they existed.

Vaccine-critical sources

To show the existence of a dispute over vaccination at the level of science, I wanted to cite sources that had some parallels with the vaccination-positive ones. That means ones that are comprehensive, reasoned, authoritative and readable. At this point, it is useful to note a crucial asymmetry in the debate. Because nearly all scientific and medical authorities support government vaccination policies and practices, it is unlikely there will be any authoritative critics, because to be a critic is to become a target of attacks on credibility.

            You’ll note that I’ve avoided using the term “anti-vaccination.” It is misleading, and in the shortened form “anti-vax” has been turned into a term of denigration. Anyone who deviates from the official vaccination position may be called an anti-vaxxer. This includes parents who space out their children’s vaccines or choose some vaccines but not others. It includes researchers who raise any questions or reservations about vaccination. To call someone “anti-vax” suggests they are opposed to all vaccines, which is misleading. Therefore, I avoid the label “anti-vaccination” for both its imprecision and its derogatory connotations. Although “pro-vaccination” does not have negative connotations, I’ve also avoided it.

            For vaccine-critical sources, I found a book by Richard Halvorsen titled The Truth about Vaccines.

Halvorsen is a doctor who researched the issues himself. Halvorsen is not opposed to vaccines — he gives them. But he wanted to find out the full story, and so addresses both the history of vaccination and each vaccine in turn, focusing on Britain and its policies and experiences. He provides lots of references. His message is to be aware and consider the evidence, not to make a knee-jerk decision either way. Halvorsen’s book, now in its fourth edition titled Vaccines: Making the Right Choice for Your Child, is comprehensive, reasoned and readable. It somewhat lacks authority in that he is not an established researcher in a relevant field such as virology or epidemiology.

            Another useful critical source is Vaccine Epidemic, edited by Louise Kuo Habakus and Mary Holland. It covers a wide range of issues, ranging from law and ethics to the politics of science. However, compared with Halvorsen’s book, much less of Vaccine Epidemic addresses the scientific evidence about vaccination.

            In 2018, a comprehensive critique of vaccination was published: Mateja Cernic’s Ideological Constructs of Vaccination. It is a revised and expanded version of her PhD thesis at the School of Advanced Social Studies in Slovenia. The book is an intriguing combination of massive documentation and strong statements. It includes a treatment of social aspects of medicine and vaccination, covering discourses, ideologies, representations of vaccination critics, power and abuses of power by medical and state authorities. The longest chapter is a challenge to the orthodox view about the effectiveness and safety of vaccination, covering infectious disease mortality rates, the immune system, adverse events, safety and efficacy studies, contamination of vaccines, monitoring of adverse events, and herd immunity. This would seem to be a powerful challenge, yet it has received little attention, perhaps in part because it is not so easy to read, and the author is a sociologist, someone outside the medical establishment.

Turtles enter the fray

Being on the lookout for good sources on the pros and cons of vaccination, I obtained a copy of a book published in 2022 titled Turtles All the Way Down. The title, at first glance, sounds peculiar. The subtitle is more revealing: Vaccine Science and Myth. For convenience, I will refer to it as Turtles.

            The book arrived with plenty of advance publicity. It was published in 2019 in Israel, in Hebrew, and made a splash. I read that it had received a positive review in an Israeli medical journal, a review written by Ety Elisha and Natti Ronel. Well, well. I knew them: we were collaborating, along with two others, on a paper about suppression of critics of official views about Covid-19. It’s a small world.

            An unusual aspect of Turtles is that its authors are anonymous. They chose not to reveal their identities to avoid ad hominem attacks. Also, if they worked within the health system, they could be subject to reprisals in their careers. That’s exactly what I had been studying for the past decade concerning vaccination, and even longer for other scientific controversies. Remaining anonymous makes a lot of sense to me. Indeed, it’s what I recommend for whistleblowers, whenever possible. The authors call themselves The Turtles Team or TTT.

            Turtles is a frontal attack on the assumption that the standard childhood vaccination programme is both safe and effective. This assumption is at the core of the vaccination paradigm, the framework that guides thinking and research in the area.

            To illustrate the contrast between TTT’s analysis and the official position on vaccination, I found a short article that nicely articulates the orthodox view, an article you can read yourself. Titled “Simply put: vaccination saves lives,” it was published in 2017 in PNAS, the Proceedings of the National Academy of Science, a prestigious long-standing US scientific journal. The authors are Walter Orenstein and Rafi Ahmed, both from Emory University. Orenstein, from the Department of Medicine, is also one of the four co-editors of the text Vaccines, which I mentioned earlier as an authoritative source for the vaccination-positive view. I will refer to Orenstein and Ahmed’s article to highlight assumptions and emphases in the orthodox position on vaccination, the position challenged by the Turtles Team.

Safety

Let’s start with safety. Orenstein and Ahmed do not explicitly discuss adverse events caused by vaccination, but instead implicitly dismiss them by countering concerns that vaccines cause autism. Perhaps their assumption is that if the autism claims don’t stand up, less well-known ones won’t either.

            A prime claim in Turtles is that the safety of standard vaccines has never been established, indeed that assumptions or claims about safety have no foundation. How could this be? TTT begin by examining the vaccine approval process and the randomised controlled trials that are required, clearly and carefully explaining what’s involved. In phase 3 trials, there are two groups of children. One group is given the vaccine, let’s say a vaccine for chickenpox, and the other group is given a placebo: they are injected with a passive or neutral substance. No one, including the researchers and the children, is supposed to know which children get the vaccine and which get the placebo. When testing for safety, the numbers of adverse events — including seizures, breathing difficulties, allergic reactions, paralysis, severe illness and death — in each group are noted. If the frequency of adverse events in the vaccine group is not much higher than the frequency of adverse events in the placebo group then, after other factors are taken into account, the vaccine is assessed to be safe.

            The problem, TTT say, is that the placebos in phase 3 trials of childhood vaccines, before they are licensed for use, are not inert. The researchers doing the safety studies could have used a saline solution for the placebo, but instead they use other vaccines. This would be fine if the other vaccine had been shown to be totally safe but, according to TTT, no vaccines have been tested against inert placebos, and hence the clinical trials don’t actually show how safe the vaccine is. This is a striking claim, and also a daring one given that a single counterexample, a single study, might undermine it. A safer claim by TTT would be that despite extensive searching, they have not discovered a phase 3 trial of a vaccine against an inert placebo.

            Note that TTT don’t make a detailed claim about the rate of adverse events. They just say the clinical trials haven’t shown vaccines to be safe. As they put it, “The true rate of adverse events of routine childhood vaccines is virtually unknown; therefore, there is no scientific basis for claiming they’re safe.” (p. 66)

Undone science

Clinical trials are only one way to examine the safety of vaccines. Another possibility is to undertake biological and physiological research into adverse events. TTT examine studies in this area, or rather their absence. Their conclusion is that the generous funders of vaccine research — there is a vast amount of research in the field — seem remarkably averse to adverse-events research into diagnoses, causal mechanisms, individual susceptibilities, and therapies. By not undertaking studies to better understand damage from vaccination programmes, it remains possible to say vaccination is safe.

            David Hess, an anthropologist and sociologist at Vanderbilt University, and my friend and collaborator, introduced the idea of undone science. This refers to research that could be done, and furthermore that citizen activists say should be done, but which is neither funded nor carried out because the findings might be unwelcome to powerful groups with vested interests. There are many examples, especially on environmental and health topics. For example, the sweetener mannitol may have benefits for treating Parkinson’s disease, but because mannitol cannot be patented, companies didn’t want to research it.

            TTT do not refer to Hess’s analysis of undone science. The team sticks to scientific and medical sources and does not engage with social-science writings. Nevertheless, the team’s examination fits the picture of undone science perfectly.

            What about the reporting of vaccine adverse events? Anyone following this issue will soon hear about VAERS, the Vaccine Adverse Event Reporting System, where harmful side effects of vaccines can be reported. If there aren’t many reports, that should indicate that vaccines are safe. But, according to TTT, there’s a problem, actually several problems. Although reporting of cases of many infectious diseases is mandatory, when it comes to potential adverse events from vaccines, reporting is voluntary, and doctors are not compensated for making them. Furthermore, many doctors are reluctant to make reports, telling patients that their conditions could not be due to vaccines but are just a coincidence. This suggests considerable underreporting. Some estimates are that only one in ten, or one in a hundred, adverse events are reported.

            So why not improve the rate and quality of reporting to determine how accurate VAERS actually is? There was a study to show how this could be done but the CDC — Centers for Disease Control and Prevention, the US body charged with vaccination recommendations — stopped engaging with the researchers, without explaining why. TTT argue that the CDC has shown no interest in improving VAERS.

            TTT’s next target is epidemiological studies showing a low rate of adverse events. Imagine collecting data from a large population about the incidence of a particular condition, let’s say high blood pressure. Then collect data about people’s ages, incomes, diets and anything else you can think of that might be relevant. By looking for statistical relations between the health condition and other factors, you might be able to notice, for example, that people’s blood pressure gets higher as they get older, or that it’s higher for people who eat lots of meat, or whatever. These are correlations, but they don’t prove causation. Maybe people who eat lots of meat get less exercise: it could be that lack of exercise is the main factor responsible for high blood pressure. Or it could be the salt in the meat dishes. You can see this gets quite complicated.

            TTT provide a primer on epidemiology, explaining the basic ideas clearly and simply. They then offer a damning indictment of epidemiological studies about vaccine safety, arguing they are designed to show no correlations between vaccines and adverse events. This is serious. TTT closely examine five major studies. Based on their examination, they suggest the studies are biased by design or execution, using defective research methods, relying on unsubstantiated data, omitting essential data, making meaningless calculations, dismissing unwelcome findings and exaggerating the significance of the findings.

            Remember that Orenstein and Ahmed in their article “Simply put: vaccination saves lives” did not explicitly mention adverse events caused by vaccines, but implicitly dealt with them by dismissing a study by Andrew Wakefield and 12 collaborators about the possible connection between the MMR triple vaccine and autism. One of the epidemiological studies often cited as showing there is no such connection is by Madsen and colleagues. This is one of the “doctored” studies that TTT analyse, showing systematic shortcomings.

More undone science

TTT next examine what they call “the studies that will never be done.” An obvious way to investigate the overall safety of the entire vaccination schedule is to compare the health of two groups of children that are as similar as possible except in one respect: one group receives all recommended childhood vaccines and the other group receives no vaccines at all. Simple! Such a study would gather all the benefits and risks of vaccines, the benefits from reduced incidence of infectious disease and the risks from adverse events, and anything else, including beneficial or harmful effects not normally considered. A study like this showing the benefits of vaccination would be a powerful way to encourage parents to have their children vaccinated. But, perhaps surprisingly, such a study has never been undertaken by medical authorities. (There are some small studies by vaccine critics showing unvaccinated children have better health.)

            This is the most striking example of undone science in the vaccination arena. A plausible reason is that proponents are afraid the results might not support vaccination, or not support it as much as they hope. TTT go further, suggesting that the CDC has the data and therefore comparative studies may have been quietly done but never published because the results do not support vaccination. This is speculative. Another explanation derives from the vaccination paradigm: proponents operate within a framework that assumes vaccines are vital for health.

Historian-of-science Thomas Kuhn introduced the idea of scientific paradigms

Given this belief, there is no need for further studies to see whether vaccines are beneficial. In fact, publicity about doing such studies might generate alarm, by making people think there is some reason to doubt the vaccination programme. Within the assumptions of the paradigm, this is a reasonable concern. However, it does mean that critics can continue to point to the absence of definitive studies showing that the net benefits of receiving all recommended childhood vaccines are greater than having no vaccines at all.

            I’ve referred to the “vaccination schedule.” In guidelines for childhood vaccination, there are targets for particular vaccines at specific ages, for example, in the US, hepatitis B at birth, one month and six months. The schedule is another target in Turtles. For example, in the usual schedule, several vaccines are given in a single visit. Some parents prefer to space out the vaccines. Is there sound evidence for the safety of giving multiple vaccines at the same time? TTT say no.

A vaccination schedule

            Given TTT’s sustained critique of assumptions about vaccine safety, does this mean that vaccines are unsafe? This depends on what exactly is meant by unsafe. Despite statements that “vaccines are safe,” careful vaccination advocates always acknowledge adverse events, but say they are extremely rare. What TTT have done is show that the research behind the claim that risks are extremely low is simply not there. They show that research about adverse events is either flawed or not done at all. But what if studies were carried out to accurately determine the rate and significance of adverse events? One possibility would be that the adverse events would be shockingly frequent, validating the worst fears of vaccine critics. But another possibility is that harmful effects would be modest, perhaps higher than ones currently acknowledged but not high enough to outweigh benefits. TTT may have shown that the science of vaccine safety lacks foundations, but they haven’t attempted to show what the science would say if it did have a solid foundation. By the nature of undone science, no one can know for sure. But we do know who is resisting doing definitive studies.

Benefits

In the usual slogan of “Vaccination saves lives,” the benefits are assumed to outweigh the risks. There is a sleight of hand here in referring to “vaccination” rather than individual vaccines. It is quite possible that a group of vaccines reduces the death rate but some specific vaccines cause more harm than benefit.

            Orenstein and Ahmed’s opening sentence is “Few measures in public health can compare with the impact of vaccines.” The Turtles Team challenges this claim. They provide figures showing that deaths and illnesses from infectious diseases were in rapid decline before mass vaccination was introduced, and argue that most of the decline in these diseases was due to other measures that improved public health, including clean water, good diet, better hygiene and a higher material standard of living.

            Orenstein and Ahmed provide a table showing the decline in annual morbidity (ill health) for vaccine-preventable diseases. It shows, for example, that measles morbidity declined by more than 99%. From what? Their base figure is the “20th Century annual morbidity” which they compare to reported cases in 2016. What they don’t provide is a comparison of morbidity before and after the introduction of mass vaccination. See below for more on this.

            These arguments are not new. They were presented, most prominently, by Thomas McKeown, and have been cited repeatedly by vaccine critics. Despite this, vaccine proponents seldom mention these arguments. Orenstein and Ahmed certainly do not. I wish vaccine advocates would provide a cogent rebuttal of the work of McKeown and others who question the scale of the benefits of vaccination. So far as the public debate is concerned, this might be called an “undone refutation.”

            You can see that the slogan “vaccination saves lives” is suspect if the benefits have been exaggerated and the harms undercounted. But TTT are not finished. There is one more important claim to address.

Herd immunity

Proponents argue that being vaccinated primes the immune system, reducing the risk of catching the targeted disease. They also argue that when most people have vaccine-induced immunity, others — including people who can’t be vaccinated — are also protected. For a virus to spread, it needs to encounter susceptible hosts: others who can be infected. If most people are immune to the virus, the disease outbreak will die out. This process protects the whole population, the “herd,” a collective benefit from sufficiently high levels of immunity in the community.

            Vaccine proponents make a big deal about herd immunity. It provides a moral imperative to be vaccinated and to promote vaccination, including through mandates. Orenstein and Ahmed devote a considerable portion of their short article to herd immunity, complete with a colourful diagram.

They write that herd immunity “provides the rationale for interventions to achieve high population immunity” including “mandates for immunization requirements for attending school.”

            For years I’ve read the arguments for and against herd immunity. Vaccine proponents almost invariably raise it, sometimes at such length that people gain the false impression that the main benefit of receiving a vaccine is not to yourself but to others. The result of this impression is that vaccination is sold, and often perceived, as altruistic, which means those who question vaccination, or are not vaccinated, can be painted as selfish.

            I wondered why herd immunity plays such a high profile in arguments for vaccination but analogous concepts are less prominent concerning other public health interventions. By analogous concept, I mean the idea that health-related behaviours benefiting the individual can also benefit others in the community. The example I find most compelling concerns alcohol. Not drinking alcohol benefits one’s own health by reducing the risk of cirrhosis of the liver, pancreatitis, cancer and other maladies (partially counteracted by a few health benefits). Not drinking also reduces the harm to others caused by drunk driving and domestic violence. A community with less drinking is a healthier and safer community. There is more to be said about the pros and cons of alcohol, and I’m not making an argument for prohibition or abstention. The point is that the collective-benefit argument does not play such a big role in alcohol debates.

            Turning to writing by vaccine critics, it’s possible to find critiques of herd immunity, with arguments that it doesn’t exist or is irrelevant.

            So is herd immunity the most wonderful thing since sliced bread, or fake news? I don’t remember seeing an intermediate view — until reading Turtles. TTT systematically examine the evidence for and against herd immunity for each of 14 vaccines, from tetanus to measles. They conclude that, with sufficient coverage, five of them may confer herd immunity, whereas the others probably will not, or that their protection is not relevant or beneficial to children. It was refreshing to encounter an analysis that independently follows the evidence and doesn’t end up purely in one of the two warring camps.

Remember that Orenstein and Ahmed provided figures showing the measles vaccine reduced disease morbidity by over 99%. TTT agree that the vaccine reduced morbidity through herd immunity, though perhaps not by this percentage. Some vaccine critics may find this assessment unwelcome.

            TTT’s analysis shows the value of making careful assessments of different vaccines, each one with specific considerations and complications. Rather than follow Orenstein and Ahmed in saying “vaccination saves lives,” the question should be whether specific vaccines save lives, and beyond this who benefits and who suffers harm.

            To question vaccine-induced herd immunity is to question the rationale for coercive means to promote vaccination, for example requirements for attending school. Even for vaccines providing herd immunity, an assessment of the overall benefit needs to take into account harmful side effects. As TTT put it, “in the absence of solid evidence for a positive net benefit for individual vaccines, as well as the totality of childhood vaccination programs, there is no moral justification for mandating vaccination, or enforcing it in any other way.” (p. 367)

Polio

In 1990, I began studying the debate over the origin of AIDS. In particular, I became interested in the hypothesis that AIDS could have started as a result of contaminated oral polio vaccines used in central Africa in the late 1950s. Even if this hypothesis is correct, it says nothing about the safety of today’s vaccines, so the origin-of-AIDS debate is not relevant to the arguments in Turtles. Anyway, in the course of studying the polio-vaccine theory of the origin of AIDS, I read various studies of polio, including dissident views about its cause. One of those dissident views is that many or most cases of what we call poliomyelitis, a serious paralytic disease, are due to exposure to pesticides.

            Polio has long had a high profile, first as a disease to be feared and then as one of the great triumphs of vaccine research. In the 1950s, Jonas Salk developed a vaccine that was injected. Then Albert Sabin developed an oral vaccine, typically taken with a sugar cube. I vaguely remember having this vaccine when I was in primary school. The struggle to eradicate polio is one of the longest-running sagas in vaccination lore. As you can imagine, the idea that pesticides are the main cause is not likely to receive a warm welcome from the medical establishment.

            Turtles provides the clearest exposition of this idea that I’ve encountered. In a long chapter, TTT systematically lay out a series of open questions and contradictions in the official story about polio, presenting the standard view and an alternative explanation based on pesticide exposure. For example, they ask “Why did most of the early polio outbreaks occur in sparsely populated rural areas rather than in the large and crowded metropolitan areas?” The standard view about polio, which assumes the contagious spread of the poliovirus, cannot explain this. The alternative view gives this explanation: “Farming communities were the first to be poisoned by the use of toxic pesticides.” All up, TTT list 19 mysteries not explained by the standard view but apparently explained by pesticides being the primary factor in paralytic polio.

DDT spraying in the 1950s

            TTT’s arguments about polio are not essential to their overall critique of the risks and benefits of childhood vaccines, so their polio chapter might be thought of as a provocative supplement, an extra way of showing the limitations of establishment explanations. Without trying to get to the bottom of the polio story, my thought was “I’d really like to see vaccination proponents offer their views about each of these 19 apparent mysteries.”

What next?

In the late 1980s, I made an intensive study of the fluoridation controversy, and came to the conclusion that nothing would resolve the controversy in the short term. No matter what new evidence and new arguments are introduced, partisans on each side maintain their positions. This sort of polarised scientific controversy can be likened to a clash of paradigms, with adherents to each side seeing the world through assumptions almost impervious to new evidence. Contrary information is treated as anomalous, and supportive evidence is intertwined with assumptions about ethics and appropriate methods of decision-making.

            Why should the vaccination controversy be any different? I don’t expect Turtles to turn the tide. However, it will undoubtedly be a potent tool for vaccine critics.

            During the 1980s, US pro-fluoridationists discussed whether to engage in debates with anti-fluoridationists. Those who said yes thought that debates provided an opportunity to show the superiority of the arguments for fluoridation. Those who said no feared that engaging in debates gave anti-fluoridationists too much credibility. In essence, debating meant accepting that there was something worth debating. But there was a problem with refusing to debate: it seemed arrogant, which could hurt the cause. The debate about debating was never resolved.

Water fluoridation debate in Portland, Oregon

            These same considerations are present in the vaccination debate. My guess is that vaccination proponents will studiously avoid engaging with the arguments in Turtles. It is certainly possible that they could counter some of TTT’s arguments but, alas, we will probably never know, because proponents are in the ascendant, having cemented childhood vaccinations as an unquestioned good and stigmatised the slightest reservation or criticism.

            This is a sad state of affairs. There are a great many people who would benefit from an open debate, without ad hominem attacks, with respect for contrary views. Such a debate might lead to some backing down from vaccine mandates and more tolerance for selective vaccination and even non-vaccination. On the other hand, the debate might lead to a more solid basis for the benefits of some vaccines.

            “Debate” is the wrong word. There needs to be deliberation, a calm, rational discussion with the aim of reaching an agreed position, the sort of process used in citizens’ juries to look at all manner of contentious issues. In such a jury, a group of randomly selected citizens addresses a carefully specified issue by weighing up available evidence and reaching collectively-agreed recommendations. But allowing citizens to have input via deliberative processes is unlikely while experts and authorities are in full control.

            However, even deliberation would not be enough, because of undone science. There is too much research that needs to be carried out, too much evidence that needs to be collected, before judgements about vaccination can be put on a solid basis.

Conclusion

Of available critiques of vaccination orthodoxy, I think Turtles is the best yet. It exposes systematic weaknesses in studying the harmful effects of vaccines and challenges the usual claims about the benefits of vaccines for the individual and the community. The book has all the features I look for.

• Comprehensive: it covers the central scientific and medical issues in the debate.
• Reasoned: evidence and arguments are presented in a careful, logical, systematic way.
• Authoritative: the authors, though anonymous, show their knowledge through their grasp of research and through comprehensive citations to medical research.
• Readable: the writing is remarkably clear, and occasionally high-spirited.

            Two predictions. First, vaccination advocates will try to ignore the book. They are unlikely to engage with the book’s contents, though they might complain about the authors’ anonymity. Second, Turtles won’t end the dispute, which is likely to continue for decades.

Turtles was written before Covid and does not address Covid vaccines. Yet Covid is an important factor in the vaccination debate, because Covid vaccine mandates, and adverse events from Covid vaccines, disturbed large numbers of people, leading some to protest publicly. Concern about and opposition to Covid vaccines led to greater questioning of other vaccines. For those who are energised by concerns about Covid vaccines, Turtles is the ideal source for learning about the evidence and arguments.

Although arguments seldom resolve scientific controversies, events sometimes make a big difference. In the debate over nuclear power, the accidents at Three Mile Island, Chernobyl and Fukushima had immense impacts, serving to discredit the technology. In the vaccination debate, a major vaccine disaster could play a similar role. The full story of the impact of Covid vaccines is yet to play out, but it is reasonable to say that when promoters endorse a vaccine that is widely seen as disastrous, they jeopardise the rest of the vaccination programme. So perhaps my prediction about the continuation of the debate is off the mark. Time will tell!

            There’s much more to be said about Turtles. But enough from me, for now. You can form your own view, let me know what you think and, after you’ve read the book, contact The Turtles Team at the email address given in their book.

A different turtles team

Brian Martin

bmartin@uow.edu.au

For valuable feedback, I thank Steven Bartlett, Lyn Carson, Jungmin Choi, Kevin Dew, Bob Dildine, Kelly Gates, Anneleis Humphries, Olga Kuchinskaya, Julia LeMonde, Natti Ronel, Wendy Varney, Qinqing Xu and others who prefer to remain anonymous. None of them necessarily agrees with the views expressed in this review or by The Turtles Team.