Isaacs details the worst consequences of vaccine-preventable diseases – now rare events in countries like Australia where vaccines are widely used. These case studies serve as a lucid counterbalance to his careful coverage of the history of vaccine hesitancy and dissent. For example, the book illustrates how the first organised anti-vaccination movement began in England, just 150 years after Voltaire’s visit, in response to compulsory vaccine legislation. By then, in the late nineteenth century, smallpox vaccines were safer and more effective than ever, yet many early sceptics were willing to be imprisoned rather than vaccinate their children. This eventually led to the first exemptions to vaccine requirements, and these historical events make Isaacs’s book especially timely. Nowadays, in many wealthy countries, the increasing number of parents opting not to vaccinate their children has led to outbreaks of infections not seen for decades, and to the spread of harmful diseases to others.

At the social level, Isaacs emphasises that vaccinating one individual also protects others. The immunity of mothers protects their children, that of children protects their classmates, and so on. The book gives a sensitive account of the ethical issues raised by vaccination, including what Isaacs refers to as ‘altruistic vaccination’, that is, the moral reasons individuals have to be vaccinated in order to avoid spreading disease to others. This is particularly important for diseases whose most severe effects are confined to certain groups. For example, girls are vaccinated against mumps largely to prevent the virus from spreading to boys and causing male infertility, while males are vaccinated against human papillomavirus largely to prevent cervical cancer in women. Yet the same altruistic reasons apply to infections that pose risks to all people in more equal measure, such as measles or hepatitis B. Isaacs provides an illuminating account of how these moral considerations matter for individual children and parents as well as for public health.

'Enforcing the Vaccination Laws', a photo from 1907 regarding vaccinations in Croydon, London (photograph via Vaccine Common Sense)

Isaacs traces not only the triumphs but also the tragedies, false starts, and controversial moments in the history of vaccines – from John Keats, whose poetic genius was cut short by tuberculosis; to Louis Pasteur, a brilliant man whose vaccine experiments were sometimes more lucky than rigorous; to frauds who have made false claims about the risks of vaccines. The book is also candid about cases where accidental contamination of vaccine batches with dangerous microbes resulted in harm, and provides a compelling argument for transparency and truthfulness in vaccine research and policy.

Defeating the Ministers of Death weaves together lively anecdotes, historical research, and scientific analysis to tell the tale of vaccination over the last three hundred years. While global health advocates still strive to extend the benefit of vaccines to the world’s most vulnerable populations, those in wealthy countries can easily forget that infectious diseases strike back as soon as key prevention measures like vaccines begin to lapse.

Isaacs brings the history of vaccination to life – from the courage and conceits of early vaccine pioneers to the marvel that children can now avoid what were previously inevitable diseases. Infectious diseases and the benefits of vaccines are shared between people, and Isaacs eloquently captures the many characters in his narrative, evoking moments of humour, hubris, and humility. These moments in history are still relevant today, in the complex contemporary landscape of views about vaccines and the pharmaceutical companies that produce them. It is not so long ago that Jonas Salk was asked why he never patented his polio vaccine, replying that its benefits belonged to all people, and famously adding: ‘There is no patent. Could you patent the sun?’