We all know the scene: a cold, sterile room; sleeve rolled up to expose the soft flesh of the forearm or shoulder; the smell of iodine; the sight of the alarming circle-covered-by-throwing-star shape that denotes biohazardous waste—“sharps.” And we all know that there are few things more invasive than a needle piercing our skin, injecting a mysterious concoction of virus and chemicals into our flesh. We fear them viscerally for their violation of our bodies and intellectually for the chemicals they contain.
In “On Immunity,” Eula Biss, award-winning author of “Notes from No Man’s Land,” examines this instinctive alarm by mining metaphor, literature, history, and our own collective psychology to try to understand the anti-vaccination movement. The book is, at heart, about fear and what it does to our choices. The thread that ties all of Biss’ thoughts and stories together, and the motivation for her research, is the birth of her first child. Her anxious, new-mother perspective allows Biss to empathize with the feelings of the anti-vaccination parents she talks to, and adds another dimension to the unease surrounding vaccination.
Though not a mother, I came to the book with two relevant perspectives: that of a bookseller (full disclosure, I work at Politics and Prose in Washington, D.C., where Biss will be reading) and that of a master’s of public health graduate. I admit, I was nervous starting the book. The bookseller in me wondered if Biss could possibly match the complex genius of “Notes from No Man’s Land,” which paired meditations on gentrification and race with an analysis of “Little House on the Prairie.” And the public-health student in me demanded: What if Biss concludes that vaccination is dangerous? What if her scientific arguments are shaky? Instead, throughout the book, Biss is thorough, reasonable, and eloquent; she lays out the history and the studies of vaccines with such calm logic and empathy that, despite the fact that by the end she is clearly advocating for childhood vaccination, the overall picture is astonishingly balanced for such a sensitive and controversial topic.
Biss begins each short, easily digestible chapter with a quote or memory (“My father has a scar on his left arm from his smallpox vaccine more than half a century ago”). There is an element of personal-essay-style meditation to the book; however, Biss takes the discussion much further than her own experience. She explores the tension between bodily independence and dependence that comes from living in a community; the public resistance that flares up most strongly when society feels forced to vaccinate; and ideas of what is natural and what is not in our environment and our medicine. The book is packed with scientific studies and rich with references to Greek myth and vampires.
Though Biss has said that she did not anticipate writing about vampires when she began, they skulk throughout the book, serving as a metaphor for many aspects of the discussion—from vaccinators (early Victorian England) to disease (Bram Stoker’s “Dracula”) to Biss’ own experience of early motherhood. The connection of virus and vampire makes sense, given that both are contagious and not quite alive. The vampire is historically a symbol of social power, and is today—with our sparkly, morally tortured blood-suckers—often used as a symbol of the give and take of life, the demands one being must make on another to survive. Biss connects this balance to the “herd immunity” property of vaccines, which means that for many, a vaccination will serve to protect those around them more than themselves. Or, put another way, lack of vaccination will put those around them at more risk than they are themselves.
This paradox becomes clear—and more frightening than the vampires which haunt the book—in Biss’ discussion of Andrew Wakefield’s debunked 1998 study linking the MMR vaccine and autism and Robert Sears’ (aka Dr. Bob) “The Vaccine Book,” where he argues that “this is an important vaccine from a public health standpoint, but it’s not as critical from an individual point of view,” which, as she points out, could only make sense if individuals are not part of the public.
“On Immunity” is not the work of a specialist . As narrator, Biss recounts her own research process and her discoveries about health, disease, and vaccines, so any higher-level information is explained as Biss herself comes to understand it. “When protective impulses are unregulated, they can be as dangerous as they are necessary,” she writes of the immune system, deftly connecting the immune response to the default reaction of many to vaccination.
But, as important as the arguments are the characters who voice and embody them. There’s Paul Offit, author of “Autism’s False Prophets,” who replies to the suggestion that his research into vaccines is driven by profit with, “Who . . . goes into science thinking, ‘God, if I could just figure out which of these two viral surface proteins evoke neutralizing antibodies, I’ll be rich beyond my wildest dreams!’” And Biss’ own doctor-father’s frank and often sardonic advice guides Biss’ actions for her own son.
Outside of our domestic discussions of vaccinations, autism, and even government mind control, this book is especially timely considering the active controversy over treatments for the Ebola virus epidemic that is currently ravaging west Africa. In a rare public-health situation, Ebola is a disease with high mortality and virulence, but with no approved treatment aside from the management of symptoms. An experimental vaccine does exist, and health workers, the WHO, and global-health policymakers are all arguing over whether it should be used without the usual trials and, if so, who should receive it. Perhaps they too should be reading “On Immunity.”
The choice to vaccinate or not to vaccinate should not be taken lightly, and we could all stand to know more about the arguments. “On Immunity” will change the way you think about your health and the health of those around you—from your own children to the global community.