The word “vaccine” is to a dinner party what the word “fire” is to an elevator: Both scenarios inspire fear that blocks out rationality. The general public has rudimentary knowledge of fire however, we know how they happen and what to do. Vaccinations are, Eula Biss explains in “On Immunity,” largely misunderstood. Biss draws on mythology, literature, historical record, her experiences as a new mother, science and philosophy to explain where this misunderstanding originates. According to Biss, the language and metaphors used to conceptualize modern medicine; the evolving nature of the science of vaccination; the political and social history of vaccination; and a false sense of individualism all lead to misunderstandings about vaccination.
We cannot underestimate the power of the language used to discuss vaccines. Biss cites James Geary’s “I is Other,” “Our bodies prime our metaphors and our metaphors prime how we think and act.” We draw from a military lexicon to discuss medicine and vaccinations, we receive a “shot” or “jab” from the doctor. The metaphors we associate with such an action are overwhelmingly fearful: violence, violation, pollution. The reaction? The lexicon provided by alternative medicine draws us in—cleanse, detoxify, supplement—without understanding the word “natural” has value because our modern lives are so far removed from wildness to begin with.
“The wild and the domestic now often seem isolated values, estranged from one another,” Biss quotes Wendell Berry, “there can be continuity between them, and there must be.” The language we use to discuss vaccinations causes a rift in our understanding: We conceptualize vaccines as “synthetic” and as bad for our bodies. Biss, armed with Berry and Geary, demonstrates that the public’s understanding of vaccines is largely misshaped by the erroneous belief that the word “natural” means “better.”
Biss draws on mythology, showing how myths unconsciously reinforce the fear built into conversations about vaccinations: Thetis dipped Achilles in the River Styx but she failed to fully inoculate Achilles. In fact, the illusion of inoculation and Achille’s resulting arrogance contributed to his death. Vaccines promise a protection that doesn’t necessarily lead to hubris, but many fear might lead to death by illness or other fatal reaction. The failure of Thestis to fully protect her son reinforces the idea that the risks of inoculation (or vaccination) are greater than the risks of not acting.
Vaccination is an evolving science which is largely misinterpreted and allows misinformation. Biss traces the history of vaccinations. She explains what a virus is, how they work and why vaccinations are effective. She discusses the potential side effects of vaccines as well as the news events that shape our fears. Her conclusions are fascinating: The term “milk maid” originated from the 1770s when a farmer in England discovered the pus from sores on the udders of cows protected milkmaids from smallpox. This was more than one-hundred years before the discovery of penicillin. Despite a history stretching back hundreds of years, much is still unknown about viruses, vaccines and how the two work together.
As scientists’ understanding of vaccination grows, the public’s understanding of vaccinations seem to shrink. We cannot unring the bells, Biss writes “when we engage with science we are in Wonderland.” In 1999 the FDA asked that vaccines discontinue the use of thimerosal ( a mercury derived preservative used in vaccines since the 1930s) until scientists conducted further research. By 2002, every childhood vaccine except multidose vaccines were free of the preservative. Thimerosal contains ethyl mercury, which further research found had no connection with the neurotoxic effects of methyl mercury. Thimerosal makes multi-dose vaccines possible, making cost-effective, less-wasteful vaccines that do not require refrigeration. There are places, Biss writes, where a ban on thimerosal would equal a ban on vaccinations against diphtheria, pertussis, hep B and tetanus: “Wealthier countries have the luxury of entertaining fears the rest of the world cannot afford.”
Vaccination has a difficult social history, plagued by prejudice and fear. Biss draws on the observation of Michael Merry, “The prevention of risk is often used to justify a coercive use of power.” At one time the U.S. believed vaccinating “high risk groups” would bring down infection rates. Biss cites Susan Sontag, “The concept of a ‘risk group’ revives the archaic idea of a tainted community that illness has judged.” In the late 1890s during the last nationwide smallpox epidemic—when vaccinations could led to infection with tetanus and other diseases—every African American in Middlesboro, Kentucky who resisted vaccination was vaccinated at gun point. “The poor were enlisted in the protection of the privileged,” Biss writes. The us versus them mentality reinforced by mythology and metaphors in literature, combined with humans’ inability to correctly asses risk led to vaccinations as an abuse of power.
Biss explores the long military history of disease and vaccinations. George Washington, under threat of biological warfare from Britain, ordered the variolation of all new recruits (the much safer vaccine was not discovered for over another one hundred years). After 9-11, the U.S. government feared the use of smallpox as a biological weapon. Nigerians in 2003 feared polio vaccinations were part of a Western plot to sterilize Muslim children. When the U.S. used a fake hep B vaccine campaign (administering only one of the three doses for immunity) to gather DNA evidence to verify bin Laden’s location, a Taliban leader in Northern Pakistan responded with a ban on polio vaccination in his region until the U.S. stopped drone strikes. The fear of vaccination as a weapon affects very small parts of the world’s population, the very parts that can least afford to go without vaccination, Biss explains. “If vaccines can be conscripted into acts of war, it can still be instrumental in works of love.”
Vaccinations are also mis-conceptualized as a political statement. Britain’s 1853 Compulsory Vaccination Act led to the creation of a conscientious objector: a person whose conscience prevented them from inoculating their children. This trend of believing our conscience exempts us from vaccinations continues today. Biss writes about a joke her friend made, Occupy Immunity, at the height of the Wall Street embargo. “For some of the mothers I know,” Biss writes “a refusal to vaccinate falls under a broader resistance to capitalism.” The problem, Biss argues, is that a refusal of immunity in the name 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.”
Biss continually points to the inaccurate “sense of self” as a factor in vaccination’s tumultuous social history and the unrealistic conceptualization of vaccination as a political statement. Enlightenment brought the contemporary idea that we inhabit only one body, replacing previously held beliefs about the body politic—the Greek idea that “both the citizen and the city were bodies within bodies,” Biss writes. This idea of the individual leads to private morality and the unrealistic expectation that we can make special exemptions for ourselves. “Morality can’t be fully private,” Biss said, just as social responsibility is not private. Biss argues that we don’t own our bodies and our bodies are not independent. “The health of our bodies always depends on the choices other people are making.”
Biss introduces the concept of herd immunity early in her discussion, consistently returning to this idea to impress the importance of vaccinations. “Think of vaccination as a kind of banking of immunity,” she said. When enough people are vaccinated, even ineffectively, viruses struggle to move between hosts and stop spreading, sparing both the vaccinated and unvaccinated from disease. This is herd immunity. Immunity is “a common trust as much as it is a private account. Those of us who draw on immunity owe our health to our neighbors.” Those of us who are unvaccinated are protected by the bodies around us. “We are protected not so much by our own skin, but by what is beyond it.” Thinking of ourselves as individuals exempt from the greater needs of the group is bad for our own health, bad for the health of other living in our region, and a risk to the population of humans on a larger scale. “Immunity is a public space,” Biss writes, “And it can be occupied by those who choose not to carry immunity.”
Biss approaches vaccination from the perspective of a first-time mother skeptical of vaccinations and modern medicine. Her research led her to the side of vaccination. She mixes historical fact with her experiences as a mother, conversations with friends, and modern news events in an entertaining and informative way. Sometimes she seems to tout her own horn a little too loudly, maybe injecting too much of herself into the narrative. However, this may be the most entertaining aspect of the book for some readers. Over all this is a beautifully written, well-researched piece on what is meant by becoming a responsible, contributing member of our society. Ultimately, Biss argues, vaccinations are an act of love.