Review by Lisette E. Torres, TERC, Email: lisette_torres@terc.edu
Keywords: medicine, autism
In the current chaos and controversy around COVID-19 and its variants, mask mandates, and vaccination, Vaccine Rhetorics stands out as a timely addition to the literature and sociopolitical arena. Though I am sure the author, Heidi Yoston Lawrence, did not foresee her book being published during a global pandemic. Her insightful critical analysis of the discourses and rhetorical arguments provided by medical professionals, policymakers, and patients about vaccination illuminates our current situation related to COVID and explains why vaccine skepticism remains an intractable problem in the United States. The 133-page book is accessible and an interesting read, particularly for undergraduate students who are curious about and want to understand the reasoning behind the polarization around vaccination.
I appreciated Lawrence’s transparency around her positionality as a “vaccinating parent and a pro-vaccine adult” (p. xi) in the preface. She shares her own personal story about a vaccine decision she made related to her child as an example of how these decisions change over time with experiences. Despite her personal stance on vaccination, Lawrence provides a balanced account of the rhetorical arguments, which ultimately aligns well with her recommendation at the end of the book for taking an open stance to rhetorically informed persuasion, “making space for dissent, opportunities for deliberation, and mitigating exigencies that shape debate” (p. 120). She models what it means to meet people where they are avoiding deficit orientations with the goal of “seek[ing] to understand” (p. 131) rather than to persuade.
Throughout the book, Lawrence argues for a “material rhetorical approach” to controversies in science and medicine. This requires viewing the material world as having agency that can generate rhetorics and discourses that may be modified. Lawrence argues that it is critical for us to understand material exigencies, which are “imperfection[s], marked by urgency, created by the material operation of vaccines” (p. 119) and that “demand discursive response” (p. 14). This, in turn, allows you to identify the spaces in which discourse alone will not be enough to sway people so that you can generate new “spaces where vaccinations can be discussed in a less contentious way, and opening those spaces to true deliberation” (p. 123). To elaborate on the material rhetorical approach and its utility, Lawrence uses findings from her research as well as analysis of national and regional conversations around certain diseases and vaccination (e.g., polio, smallpox, measles, flu) to identify four material exigencies of vaccine controversy – disease, eradication, injury, and the unknown.
The exigency of disease is something that many of us should be familiar with in this current pandemic moment; it creates an urgency in vaccine rhetoric “through the power that vaccines have to alter bodies, systems of disease response, social spaces and who gets to inhabit them, and disease itself” (p. 33). We have witnessed the emphasis on the importance of vaccination in COVID-19 conversations around herd immunity because the vaccine is most effective when the maximum number of people possible in the community are vaccinated. What Lawrence also demonstrates is that vaccines function as a way for doctors to run their practices; they “assist with differential diagnosis, reduce the chances of secondary complications among patients who contract vaccine-preventable disease, and limit the use of antibiotics” (p. 36). However, using findings from her interviews with medical professionals, she illustrates that we often do not consider that the best way to respond to disease will depend on a doctor’s specialty and the local context related to the disease.
Lawrence does an excellent job with explaining the history of the theory of herd immunity and exemptions to vaccine mandates (e.g., smallpox – Jacobson v. Massachusetts (1905)) to discuss the exigency of eradication. Using the measles outbreak at Disneyland in 2017 as a case study, she shows how eradication discourse constrains how we respond to preventable disease. She writes that the material exigence of eradication “sets an expectation that incidents of vaccine-preventable disease are unacceptable, as are any measures that jeopardize the possibility of eradication” (p. 73). This results in the only appropriate response being compulsory vaccine mandates.
Later in Vaccine Rhetorics, Lawrence addresses the material exigency of injury often articulated by parents and patients to argue against vaccination. These rhetorical arguments involve the use of narratives and vaccine injury videos to visually demonstrate the before-and-after of vaccination, where the individual who is harmed by the contents of the vaccine is highlighted in “confessional form”? (p. 87). Lawrence contends that parents and patients, through video testimonials, can “interrogate dominant notions about what constitutes vaccine-related risks, valid forms of evidence, and the role of professional and scientific knowledge in decisions about vaccine mandates” (p. 76). She believes that these narratives are persuasive in that they empower parents and patients and provide a physical demonstration of injury as opposed to the potential, ambiguous benefits of vaccination for an individual.
The last portion of the book examines the exigency of the unknown. Based on interviews with patients who are considering getting a flu vaccine, Lawrence notes that participants in her study who were skeptical about or did not take the flu vaccine questioned its benefit as well as the potential long-term harm that they could experience in the future. They also were less likely to get the vaccine if they believed that they had another, more reliable way to keep themselves healthy. Lawrence writes, “in a context of uncertainty, we can see how patients may perceive disease as certainty, not uncertainty, so choosing disease is actually a process of choosing a certain course of action rather than the uncertain process of vaccinating” (p. 116). Thus, there are a variety of reasons why individuals may be hesitant to vaccinate.
Vaccine Rhetorics is an informative read. Lawrence does a nice job of summarizing her argument and presenting future directions for rhetoric researchers in health and medicine at the end of her book. She notes the importance of intercultural communication and culture playing roles in the persuasiveness of messages; however, it is disappointing that she did not delve into this area in her own work. Most of the book is written in color-evasive language, and she neglects to mention the real visceral distrust communities of color have of medical professionals and vaccines due to a history of oppression, exploitation, and violence visited upon them by science. Relatedly, there is no discussion of the role of health insurance, citizen status, disability, or class in the ability to access vaccines, let alone make a decision about whether or not to vaccinate.
This review was published as part of Disability Studies Quarterly, Spring/Summer 2022.
Beginning with Volume 36, Issue No. 4 (2016), Disability Studies Quarterly is published under a Creative Commons Attribution-NonCommercial-NoDerivatives license unless otherwise indicated.
Disability Studies Quarterly is published by The Ohio State University Libraries in partnership with the Society for Disability Studies.