Wenzel Geissler finds value in different constructions of child wellbeing

To the medically interested anthropologist in the age of expansive connections and global networks, infant vaccinations are fascinating because they connect the largest conceivable levels of scale — international organisations, global charity, and trans-national science — and the most intimate and most fragile and vulnerable relation, that of parent and child. Few other scientific artefacts are more suitable than infant vaccination to explore the shifting engagements between governance, science and local social worlds, or between power, knowledge and bodies.

The weight of Leach and Fairhead's analysis is on the anxieties that vaccination provokes in parents in Brighton, and several sites in The Gambia and Guinea, West Africa.

Leach and Fairhead aim to explore what brings parents to have their children vaccinated, and what prevents them from doing so. And they draw our attention to the fact that the discourses within which these motivations are generated do not simply spring from parents' minds, but are in important ways co-constructed in a dialogue between them and the providers of vaccinations and public health policymakers. 

Brighton and West Africa

The book progresses in two geographically defined parts, first Brighton, shedding light on the MMR scare of the 1990s from different actors' angles, and then Gambia and Guinea, looking at attitudes to routine vaccination, and then at vaccine trials and engagements with these.

Within each chapter, they first of all explore cultures of the body. Second, the social relations, especially among the recipients of vaccination campaigns, and between laypeople and professionals; and third, the larger political frames. This layout makes this informative and rich book accessible to non-anthropologists and will make it popular among medical and public health workers.

Parents' concepts

Among the interesting points of comparison between the African and English study sites are the different construction of child health, on the basis of which parents tend to formulate concerns with vaccination.

While West African parents focus on the strength of the child's blood, which has to be added to and nurtured, English parents seem to draw upon the concept of immunity, as well as the notion of bodily overload.

Moreover, while the West African concerns with vaccination are rooted in rather general assumptions about how all children grow, the English parents studied here seem to consider their own children particularly vulnerable.

Different representations of anxiety

Another interesting difference explored here is that public health discourses about vaccine anxieties differ in Africa and Europe. In Africa, anxiety is attributed to lack of education, traditional beliefs, and local rumours — that is, 'non-modern' features, while in Europe they are attributed to selfishness, emotions, distrust in government and science, and the activity of irresponsible media and activists — rather 'post¬modern' features.

The authors' own observations show that many of these attributes are inappropriate, and that parents' concerns and discussions instead are based on careful consideration of a variety of factors, and on rational thought rather than on ignorance and emotion.

The broader message that one takes away from Leach and Fairhead's presentation of parents' deliberations and debates is the shared rationality on which African and English parents base their decisions, and the profound concern for their children's wellbeing and growth in a world that — for very different reasons — is considered to be threatening. 

Siding with opponents

The book does give much attention to a relatively small group of opponents, especially in the English context, and occasionally it seems to side with them. In those moments one would have wished for a more critical stance towards especially some of the English MMR groups beyond the observation that 'ignorance is often in reality knowledge'. While these groups indubitably create intense bonds of friendship in addition to important knowledge, one wonders, for example, who leads them and who follows, and how knowledge and power are distributed in these new biosocial collectives.

In spite, or rather because of these starting points for further anthropological discussion, Leach and Fairhead have produced a work which must be read not only by medical anthropologists, as well as by anybody interested in the conduct, regulation and ethics of medical policy, intervention, and research. It will also contribute to and stimulate general social anthropological debates about the body and relatedness, as well as about interdisciplinarity, collaboration and comparison.

Dr Wenzel Geissler is a social anthropologist at the London School of Hygiene and Tropical Medicine