Eula Biss’ ‘On Immunity’

I first read excerpts of Biss’ On Immunity in Salon months ago. I was finally able to get it from my local library 2 weeks ago.  It is a slim book, so I read it quickly in about 2 days, but it is a beautiful, profound book.  It is a mother’s and a literature professor’s exploration of vaccination and an analysis of the terms used, arguments made and history. Biss appears to be pro-vaccination, but the book is full of vivid personal moments, and she manages to straddle the difficult area of highlighting parental concerns (her own and others) and using evidence and anecdote to respond. She doesn’t preach; she explores and explains and comes at it from a mother’s point of view which is disarming.

Honestly, I don’t even know how to review this book.  I kept it past the two-week checkout window so I could re-read it and post on it.  It is a beautiful, intelligent book, and I highly recommend it, especially in light of the measles outbreak and latest reports of mumps as well.

I am pro-vaccine.  Daniel is fully vaccinated, and I believe that vaccines are a public health miracle.  We are fortunate that we have never had to experience a polio outbreak or smallpox epidemic with little hope for a cure.  Maybe it is because I’ve read way too many biographies of historical figures, but I cannot think of vaccines as anything but good.

But. I felt nervous when Daniel needed to receive the dreaded “MMR” vaccine. He received it on time, but I closely monitored him.  I agree that these decisions are difficult, especially when it is your tiny, fresh new baby who is being poked.  I get it. I get how easy and comforting it is to think if only you can feed you child the best, safest food; provide the safest, most enriching environment, you can somehow stave off disease of all types, ranging from the flu to cancer. What we forget or don’t want to think about is that we are all irrevocably tied to our environment and all the good and bad things in it. We have far less control than we think, including over our own bodies.  As The Emperor of All Maladies (a book I had read already and one that Biss references) points out, cancer is us.

I don’t think I can do justice to this book in a review, so I’m going to post some quotes that stood out to me.

When I search now for a synonym for ‘protect,’ my thesaurus suggests, after ‘shield’ and ‘shelter’ and ‘secure,’ one final option: ‘inoculate.’ This was the question, when my son was born – would I inoculate him? As I understood it then, this was not a question of whether I would protect him so much as it was a question of whether inoculation was a risk worth taking. (p. 7)

The very expression ‘herd immunity’ suggests that we are cattle, waiting, perhaps to be sent to slaughter. And it invites an unfortunate association with the term ‘herd mentality,’ a stamped toward stupidity. The herd, we assume, is foolish.  Those of us who eschew the herd mentality tend to prefer a frontier mentality in which we imagine our bodies as isolated homesteads that we tend ether well or badly. The health of the homestead next to ours does not affect us, this thinking suggests, so long as ours is well tended. (p. 20-21)

When I ask the pediatrician what the purpose of the hep B vaccine was, he answered, ‘that’s a very good question,’ in a tone that I understood to mean this was a question he relished answering.  Hep B was a vaccine for the inner city, he told me, designed to protect the babies of drug addicts and prostitutes.  It was not something, he assured me, that people like me needed to worry about. (p. 23-24)

The brief that public health measures are not intended for people like us is widely held by many people like me.  Public health, we assume, is for people with less – less education, less healthy habits, less access to quality health care, less time and money. (p. 24)

One of the mysteries of hep B immunization is that vaccinating only ‘high risk’ groups, which was the original public health strategy, did not bring down rates of infection…But rates of hep B infection remained unchanged until the vaccine was recommended for all newborns a decade later.  Only mass vaccination brought down the rates of infection and it has now virtually eliminated the disease in children. (p. 25)

When the last nationwide smallpox epidemic began in 1898, some people believed that whites were not susceptible to the disease…And when smallpox arrived in Middlesboro, Kentucky, everyone in the black section of town who resisted vaccination was vaccinated at gunpoint. These campaigns did not limit the spread of the disease, but all the risk of vaccination…was absorbed by the most vulnerable groups. The poor were enlisted in the protection of the privileged. (p. 25-26)

If it was meaningful then for the poor to assert that they were not purely dangerous, I suspect it might be just as meaningful now for the rest of us to accept that we are not purely vulnerable. The middle class may be ‘threatened,’ but we are still, just by virtue of having bodies, dangerous. (p. 27)

In a study that invited people to compare various causes of death, Slovic found that people tended to believe that accidents cause more deaths than disease and that homicide causes more deaths than suicide, when the opposite is true in both cases. (p. 37)

‘Intuitive toxicology’ is the term that Slovic uses for the way most people assess the risk of chemicals…For toxicologists, ‘the does makes the poison.’ Any substance can be toxic in excess. Water, for instance, is lethal to humans in very high doses…But most people prefer to think of substances as either safe or dangerous, regardless of the does. And we extend this thinking to exposure, in that we regard any exposure to chemicals, no matter how brief or limited, as harmful. (p. 38)

Allowing children to develop immunity to contagious diseases ‘naturally,’ without vaccination, is appealing to some of us. Much of that appeal depends on the belief that vaccines are inherently unnatural…Vaccination is a kind of domestication of a wild thing, in that it involves our ability to harness a virus and break it like a horse, but its action depends on the natural response of the body to the effects of that once-wild thing. (p. 41)

The idea that toxins, rather than filth or germs, are the root cause of most maladies is a popular theory of disease among people like me. (p. 73)

As for mercury, a child will almost certainly get more mercury exposure from her immediate environment than from vaccination. This is true, too, of the aluminum that is often used as an adjuvant in vaccines to intensify the immune response.  Aluminum is in a lot of things, including fruits and cereals as well as, again, breast milk. Our breast milk, it turns out, is as polluted as our environment at large. Laboratory analysis of breast milk has detected paint thinners, dry-cleaning fluids, flame retardants, pesticides and rocket fuel. (p. 74)

Though toxin is now often used to refer to man-made chemicals, the most precise meaning of the term is still reserved for biologically produced poisons.(p. 74)

Immunity is a public space. And it can be occupied by those who choose not to carry immunity. For some of the mothers I know, a refusal to vaccinate falls under a broader resistance to capitalism. But refusing immunity as a form of civil disobedience bears an unsettling resemblance to the very structure the Occupy movement seeks to disrupt – a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent. (p. 95)

Paternalism has fallen out of favor in medicine, just as the approach to fathering that depends on absolute authority no longer dominates parenting. But how we should care for other people remains a questions. (p. 98).

Autonomy is usually imagined as the alternative to paternalism. But in what is sometimes called the “restaurant model” of medicine, the paternalism of doctors has been replaced by the consumerism of patients…And the doctor, who was a father in the paternalistic model, is now a waiter. (p. 99)

Once you are infected with chicken pox, the varicella virus never leaves your body. It lives in your nerve roots and must be kept at bay by your immune system for the rest of your life. (p. 115).

We used to live among wild things, mountain lions on the ridge and fires raging on the prairie. There were dangers….It is difficult to imagine any type of chicken pox, with its distinctive rash described as a ‘dew drop on a rose petal,’ as sinister. And it is hard not to suspect, when the two types of chicken pox virus are termed the wild type and the vaccine virus, that the wild type might be superior. (p.115-116)

The natural body meets the body politic in the act of vaccination, where a single needle penetrates both. The capacity of some vaccines to generate a collective immunity superior to the individual immunity produced by those same vaccines suggests that the politic has not only a body, but also an immune system capable of protecting it as a whole. (p. 126)

The anxieties generated by the AIDS epidemic have bled into our attitudes toward vaccination. Needles, as we learned from AIDS, can spread disease. The needle itself has become ‘dirty.’ AIDS reveals that our immune systems are vulnerable to sabotage and can be permanently disabled. (p. 136)

AIDS education taught us the importance of protecting our bodies from contact with other bodies, and this seems to have bred another kind of insularity, a preoccupation with the integrity of the individual immune system. Building, boosting and supplementing one’s personal immune system is a kind of cultural obsession of the moment. I know mothers who believe this is a viable substitute for vaccination, and who understand themselves as raising children with superior immune systems. (p. 137)

Biss’ On Immunity is truly an amazing book. I think I’ve read it three times now, and its study of the language used in vaccine discussions has taught me so much. I urge everyone to read it.

 

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12 comments

  1. Thanks for the review! Immunization is one of those things I haven’t thought about because I haven’t had to, but it feels complicated and overwhelming. Glad to have a go-to read.

  2. Sounds like my kind of book! From the excerpts, I can appreciate the tone she used and the fact that she questioned what some people do automatically because they’re told to. I struggled with whether or not to vaccinate. My worry isn’t about autism but rather what we don’t know about the impact they have on us, what we aren’t capable of discovering yet. Still, we chose to immunize our children. The risks of not outweigh the risk of the vaccines themselves.

  3. Really interesting! I’m adding this to my library hold list. Thank you for sharing.
    At the heart of the vaccine debate I truly believe that parents are doing what they think is best for their children, on both sides, which I think is what makes having a dialogue about vaccines so difficult as it becomes emotionally charged for all involved.

  4. Sounds like an interesting book. I have a slight reservation abut these kinds of books about vaccination, though. I appreciate that the overall tone of the book is pro-vaccine and I especially like how much emphasis it seems to place on autonomy and “being informed.” The problem with being “well-informed” is that there are different places to find information and they all have different levels of validity – how do people know what to believe and what not to believe. As a physician, it is hard to stand back and watch patients make “bad decisions” in the name of something they read/heard somewhere else that is misinformation. In one way it is good that patients have more choice and the paternalistic attitude towards physicians has changed. But, the reason it has changed, I think, has more to do with a loss of respect for the knowledge, training, and education of the physician rather than a push for autonomy. There are some really bad, horrible doctors out there (Dr. Wakefield being one) but they are greatly outnumbered by doctors who care deeply about ensuring the best outcomes for their patients.

    1. I really think you’d like the book. Biss’ dad is a doctor & quoted throughout. What she does well that I may not have conveyed is acknowledging that maternal fear we feel as we strive to protect our babies and then using evidence and science to defuse it. She tackles many of your concerns, how they came to be & why they are problematic. She doesn’t waffle at all. If I were a physician, I would be infuriated at a patient making bad choices willingly despite science to the contrary.

      1. I always think it’s interesting when the thought is that it’s maternal to be afraid of vaccines rather than the diseases. Maybe I’ve had more experience with vaccine-preventable diseases than most since my neighbor growing up was about 40% paralyzed by polio and I had a pet die of tetanus, but to me, it was scary to have to wait to get the girls fully vaccinated. I wanted to protect them and the small discomfort of immunizing was so tiny compared to the risks of the diseases that it was no decision at all to me. I get that the language of “herd immunity” puts people off, especially now that so few people spend time with a herd and that we are so sure we need to be individuals in America who are totally free to do whatever we want. Have you read “The Panic Virus” by Seth Mnookin? It’s about the history of vaccines and the anti-vaccine movement and is very interesting (the half I’ve heard is anyway, I was too lazy to figure out where we left off to finish listening myself).

      2. I have read The Panic Virus & loved it!!! That’s what I liked about Biss. She didn’t outright dismiss the anti-vaxxers but used their language to figure out the root cause and history of that train of thought.

  5. I think we felt nervous getting our kids the MMR vaccine because of the publicity that followed Jenny McCarthy. My in-laws were talking to me about a world you and I never lived in, where people had 6 or 8 kids and 3 or 4 of them died in childhood. I think that our generation growing up in a country where children don’t have to fear polio has given us a false sense of security and an unhealthy sense of entitlement.

  6. Sounds like a fascinating book. I accidentally landed on a PBS episode of NOVA this week that was all about this topic. I realize, as others have said, that humans are very nonrational about the risks we are and are not willing to take on. Vaccines are prominent in this discussion, as are balancing free-ranging vs protection and other spectrums (spectra?) parents plot themselves on so often as we try to raise our kids the best we can.

    Thanks for the book tip.

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