Little Shot of Horrors

On Immunity: An Inoculation Eula Biss. Graywolf Press. Hardcover, 216 pages. $24

The poet and essayist Eula Biss first became interested in vaccination, the subject of her book On Immunity: An Inoculation, as a new mother taken aback by the anxieties her son’s birth provoked. When her son was born—in 2009, the same year that the H1N1 flu became pandemic—Biss “crossed over into a new realm in which I was no longer fearless.” She began worrying about lead paint on the walls and the hexavalent chromium in her water. She slept with a baby monitor beside her. As she puts it, “I wanted to hear him breathing. I understood that this was an absurd indulgence but it was one I could not resist.” Danger seemed to be everywhere, and “immeasurable fear” permeated her conversations with other upper-middle-class mothers. Fear of what, you ask? Of their children being polluted and contaminated by the chemicals and excesses around us; of losing control; of not being able to protect their children from harm.

But a main locus of fear was vaccination, the very mechanism that is supposed to protect our young from a long list of once-common, sometimes deadly diseases. Over the past fifteen or so years, vaccination rates in parts of Britain and the US have dropped, and many Americans continue to be convinced that vaccination causes autism, despite overwhelming evidence that it does not. And so Biss began to ask herself the crucial question of why so many had come to believe “vaccination to be more monstrous than disease.”

Deftly interweaving personal history, cultural analysis, science journalism, and literary criticism, On Immunity investigates vaccination from many angles—as the mechanism that protects us from disease, a metaphor for our wish for invulnerability, a social good, and a class-based privilege. Biss bases much of her argument on medical research, but she also looks to Bram Stoker’s Dracula and Greek myths (such as Achilles being dipped in the River Styx) to gain insight into our deep-seated yearning for protection. The author, whose last book, Notes from No Man’s Land, won a 2010 National Book Critics Circle Award, has been compared to Joan Didion, and the reasons are obvious here. Like Didion she has a gift for coming at her subjects from all sides, in unsentimental, lyrical prose: “To prepare her children for the hazards of life,” she says, “my own mother read Grimms’ fairy tales aloud to us every night before bed. I do not remember the brutality for which those tales are famous as vividly as I remember their magic—the golden pears growing in the castle garden. . . . But it did not escape my notice, as a child, that the parents in those tales have a maddening habit of making bad gambles with their children’s lives.”

Biss thinks not vaccinating is also a kind of bad gamble, albeit one with a long history. In the mid-twentieth century, most people embraced vaccines—it was a “golden age” when patients, awed by huge advances in science, acquiesced to medical authority. But for the most part, vaccines have elicited distrust, a fear of infection, and a concern that we humans are meddling with what the gods might want left alone.

The earliest form of inoculation—which originated in China in the fifteenth century—was a smallpox preventive measure known as variolation, in which scabs or pus from an infected person were rubbed into scratches in the skin of a healthy person, or inhaled through the nose. Variolation used a live virus, and was far more dangerous than today’s vaccines, but it appeared to be highly effective at preventing deaths. In the late eighteenth century, a farmer who’d had cowpox “used a darning needle to drive pus from a cow into the arms of his wife and two small boys”; the wife got sick, but the boys never contracted the related smallpox, and soon afterward “vaccination” (vacca means “cow” in Latin) became a prevalent practice.

Nonetheless, many in the seventeenth and eighteenth centuries contested the use of variolation and vaccines, which became a divisive topic of pamphlets, sermons, and public debate. An incensed Voltaire claimed that “twenty thousand persons whom the smallpox swept away at Paris in 1723 [c]ould have been alive at this time.” In 1721, when Cotton Mather—who’d lost his wife and three children to measles—“began preaching that variolation was a gift from God,” Biss tells us, the sentiment was “so unpopular that a firebomb was thrown through his window.” Introducing disease to the healthy was seen as a way of trafficking in impurity: In the nineteenth century, vaccination scars were often referred to as “the mark of the beast,” and one Anglican archbishop called vaccination an “abominable mixture of corruption.”

In the 1990s, these old fears resurged when parents, alarmed by rising rates of autism, began desperately looking for answers. The idea that vaccines were making children sick was an irony that fit a growing sense, among certain Americans, of having overreached, having put too much midcentury faith in science. In 1998, the prestigious medical journal Lancet published a study, which it subsequently retracted, by the British gastroenterologist Andrew Wakefield speculating that the MMR vaccine might be linked to autism. Wakefield, it turned out, had manipulated data and falsified time lines, and in 2007 he lost his medical license. Yet the idea was contagious—so much so that anti-vaxxers continue to believe that Wakefield has been unfairly silenced.

The quest to blame autism on vaccines has proved tenacious. Over the course of the twentieth century, doctors and researchers began floating the idea that thimerosal, the mercury product used as a preservative in some vaccines, increased a child’s chances of developing autism, a fear that, in 1999, led the American Academy of Pediatrics to suggest that the FDA remove thimerosal from childhood vaccines. But even though thimerosal was removed from most vaccines in 2001, autism rates have continued to increase dramatically. And, as Biss reminds us, a “committee of eighteen medical experts took two years . . . to examine 12,000 peer-reviewed articles” on vaccine side effects for the Institute of Medicine; they found that vaccines are safe, relatively speaking. Yet studies suggest that 25 percent of Americans (and many in Britain) still believe that vaccines can cause autism. As a result, MMR vaccine rates have dipped, dropping as low as 80 percent in Britain, even as disease rises. Over the past year, measles infections in the US dramatically increased, and a whooping-cough outbreak recently reached epic proportions in California.

Because the vaccination debate is so polarized, it’s tough to write a nuanced book about it. Yet in On Immunity Biss manages, to some degree, to do exactly that, finding common ground with that vast group of parents (and many chronically ill patients) in the middle, who believe vaccinations are necessary yet aren’t sure if today’s vaccination schedule—which typically has babies receiving nearly thirty vaccinations by the age of two—is safe for everyone. After all, while upper-middle-class fears may seem free-floating and indulgent, they are not exactly groundless—autoimmune diseases are rising at what one leading researcher described to me as “epidemic” rates, as are allergies. We still don’t know entirely why. Biss’s ability to get past the us-versus-them standoff is one of her great strengths. She is staunchly pro-vaccination, yet she recognizes the inherent oddness of vaccines: They are protection from contaminations, but also possibly contaminations themselves—savior and killer all wrapped up in one. She writes as someone disenchanted with American capitalism in its most excessive guises, a person who can understand the feeling that vaccines represent a hubristic technological interference with the “natural” processes of the human body, a person who is alive to the possibility that immune dysregulation may be more complex than our current medical system accounts for.

But if Biss can understand such skepticism, she also recognizes the problems of consistently acting on it. Assuming that science is always less than scientific leads to skewed risk assessments and causes us to forget the real issue at stake: the collective good. It’s here that Biss is at her sharpest. Even if a particular vaccine might pose a risk to an individual child—for example, there is a small chance that a child will develop an adverse reaction, such as a seizure caused by fever—vaccination is imperative for children as a whole, and for the larger community. Those who choose not to vaccinate are relying on the rest of us to do so—our immunity is what enables their children to survive without getting sick, a phenomenon known as “herd immunity.” The unvaccinated pose a real risk to those who can’t be vaccinated, like babies, the elderly, and the immune-suppressed. What’s more, there’s an uncomfortable element of class privilege at work: Unvaccinated children tend to be white and upper middle class, whereas the “undervaccinated” children among us—those who haven’t gotten their follow-up shots—tend to be black children of single mothers who have recently crossed state lines. As Biss reminds us, the middle-class body is not merely “threatened” but also threatening. “Even the little bodies of children, which our time encourages us to imagine as absolutely vulnerable,” she notes, “are dangerous in their ability to spread disease.” Public health, Biss realizes, is not just “for people like me, but it is through us, literally through our bodies, that certain public health measures are enacted.”

Ironically, the current wellspring of anti-vaccination sentiment is a yardstick for just how effective vaccinations really are. It’s hard to imagine that throngs of upper-middle-class parents would be shrugging off or delaying vaccinations if their children were routinely contracting, say, polio, or measles, which killed 164,000 children around the world in 2008, primarily in countries where vaccination is less common than in the US. In the past, polio and whooping-cough vaccinations were demonstrably more dangerous than they are today, yet parents—well aware of the devastating alternatives—lined up for them. Today those dangers seem remote. And so instead of the old plagues, we fear chemical toxins that we ourselves (via corporations) put in the environment, minimizing the dangers of infectious disease as we focus on what we ourselves have spoiled. Yet it’s not the case that the old “natural” world was a safer and prettier place to live. The diseases that kill us are natural; plenty of chemicals that don’t kill us are man-made. And those diseases took a particular toll on the very young. Wandering in a nineteenth-century graveyard, Biss notes that there are no graves of babies. Her father suggests that they likely didn’t have their own markers, because so many died.

Meghan O’Rourke is at work on a book about the mysterious rise of chronic illness in the United States. She is the author of The Long Goodbye (Riverhead, 2011), an investigation of grieving, and the poetry collections Once (2011) and Halflife (2007; both Norton).