On Immunity: An Inoculation
My daughter-in-law, who’s a pediatrician at a major teaching hospital, is frustrated by the refusal of growing numbers of families to permit routine vaccination of their children. A decision whose wisdom strikes her and other highly skilled medical professionals as inarguable has been complicated by a flood of misinformation, much of it online and most of it of dubious provenance, that warns parents of scientifically unsubstantiated risks, chiefly autism, that attend these inoculations. Now comes Eula Biss, winner of the 2010 National Book Critics Circle Award for Criticism for her essay collection NOTES FROM NO MAN’S LAND, to shed welcome light on a debate that’s been noteworthy chiefly for the heat generated by these anti-vaccination activists.
ON IMMUNITY is a slim book, a collection of brief, loosely connected meditations exploring, with an economy of language and argument, an impressive array of topics, from the origins of vaccination in late 18th-century England (when the discovery that milkmaids who milked cows infected with cowpox somehow escaped the disease) to the latest medical research on the subject. Although Biss clearly comes down on the pro-immunization side (not without reservations, ones she articulates lucidly), what distinguishes this book from the polemics that mar the controversy is its calm intelligence. Acknowledging that “research is inevitably a rabbit hole,” Biss does an exemplary job marshaling a body of evidence summarized in more than 35 pages of endnotes and an accompanying list of selected sources to support her arguments.
"While the subject matter of ON IMMUNITY, at first glance, may strike some as unappealing, in the hands of an author as thoughtful, wise and honest as Eula Biss, it takes on a significance that reaches far beyond its ostensible subject. How refreshing it would be if more of our public policy debates had such able expositors."
What’s striking about the anti-vaccination movement, manifested in the highly visible campaign led by actress Jenny McCarthy, is that significant numbers of its adherents come from a segment of society --- families with household incomes of $75,000 or more and including an older married mother with a college education --- who seemingly should be persuaded of the merits of vaccination by evidenced-based arguments. If anything, Biss might be faulted for being overly charitable to the vaccine opponents, chiefly those who rely on a discredited 1998 article by British gastroenterologist Andrew Wakefield:
“Those who went on to use Wakefield’s inconclusive work to support the notion that vaccines cause autism are not guilty of ignorance or science denial so much as they are guilty of using weak science as it has always been used --- to lend false credibility to an idea that we want to believe for other reasons.”
Countering that “weak science,” Biss explains, are studies like the 2011 report for the Institute of Medicine that took two years and the work of 18 medical experts from various disciplines to review 12,000 peer-reviewed articles on vaccine side effects. That report supported the “relative safety of vaccines,” as she puts it, recognizing that absolute safety, however desirable, is an unattainable goal.
Biss also artfully deals with a topic that provides one of the subtexts of this controversy --- the tension between individual autonomy and public health. She cites the example of the hep B vaccine, originally used only with “high risk” groups like prisoners, health care workers, gay men and IV drug users, when it was introduced in 1981, without noticeable impact on the spread of the disease. A decade later, after the vaccine was recommended for all newborns, she notes, the rates of infection dropped and the disease now virtually has been eliminated in children. This illustration, along with the concept of “herd immunity” --- the notion that both the inoculated and uninoculated benefit from the decision of sizable numbers of people to vaccinate --- support Biss’s argument that the decision not to vaccinate has consequences far beyond those of the individual who makes it, for “our bodies may belong to us, but we ourselves belong to a greater body composed of many bodies. We are, bodily, both independent and dependent.”
But the narrative thread that personalizes and distinguishes this book from an abstract treatment of the topic is Biss’s status as the mother of a young child, her son born in early 2009, as the H1N1 virus, which killed somewhere between 150,000 and 575,000 people worldwide, entered public consciousness. It was a time when it seemed to her “as if the nation had joined me in the paranoia of infant care,” as she wrestled with the decision whether to inoculate her son against this strain of influenza. That story, along with others about her son’s bout with croup, his allergies or her fears over the chemicals in his crib mattress, reflects the fundamental fear of any parent about keeping her child safe from harm. Citing the myth of Achilles, what Biss calls “the first story I ever heard about immunity” (from her physician father), she recognizes that “a child cannot be kept from his fate, though this does not stop the gods themselves from trying.”
“As mothers,” Biss writes, “we must somehow square our power with our powerlessness. We can protect our children to some extent. But we cannot make them invulnerable any more than we can make ourselves invulnerable.”
While the subject matter of ON IMMUNITY, at first glance, may strike some as unappealing, in the hands of an author as thoughtful, wise and honest as Eula Biss, it takes on a significance that reaches far beyond its ostensible subject. How refreshing it would be if more of our public policy debates had such able expositors.
Reviewed by Harvey Freedenberg on October 3, 2014