Introduction
In her thought-provoking book "On Immunity: An Inoculation," Eula Biss explores the complex and often contentious topic of vaccination. Drawing from history, mythology, and personal experience, Biss delves into the fears, misconceptions, and cultural attitudes that surround vaccines. She examines why people are so passionate about, misinformed on, and sometimes traumatized by vaccines, while also addressing the question of whether children should be vaccinated.
The book is not just a scientific exploration of vaccines, but a deeply personal and philosophical journey that touches on themes of parenthood, risk, and our relationship with nature and modern medicine. Biss weaves together various narratives and perspectives to create a nuanced and engaging discussion about immunity and our collective health.
Ancient Stories and Parental Fears
Biss begins by drawing parallels between modern parental concerns about vaccination and ancient stories of parents trying to protect their children. These tales often end with unintended consequences, highlighting the difficulty of keeping children safe in an unpredictable world.
The Myth of Achilles
One of the most famous examples is the story of Achilles. His mother, the goddess Thetis, attempts to make him invulnerable by dipping him in the River Styx. However, she holds him by his heel, leaving this one spot vulnerable. Despite her efforts to protect him, including obtaining a magical shield, Achilles ultimately dies when an arrow pierces his heel – the very part his mother's protection missed.
The Tale of Danae
Another myth tells of the King of Argos, who imprisons his daughter Danae in a bronze tower to keep her a virgin. His efforts are futile, as the god Zeus manages to impregnate her by disguising himself as golden rain.
Fairy Tales and Unintended Harm
Fairy tales often feature parents who unwittingly endanger their children while trying to protect them. In "The Girl Without Hands," a miller makes a deal with the devil to bring his family out of poverty, only to discover that he has accidentally traded away his daughter.
These stories resonate with modern parents facing the decision to vaccinate their children. They hope to keep their children safe but fear that their choices might inadvertently cause harm.
The Evolution of Vaccination and Parental Concerns
Biss traces the history of vaccination, highlighting how far the practice has come and why some parents remain wary despite advances in safety.
Early Vaccination Risks
In the 19th century, vaccination methods were crude and sometimes dangerous. The process involved cutting a person's arm and applying pus from another recently vaccinated person's blister. This method could transmit serious diseases like syphilis. In 1901, a contaminated smallpox vaccine killed nine children in Camden, New Jersey, due to tetanus.
Modern Regulation and Lingering Fears
Despite stringent regulations and surveillance by organizations like the Institute of Medicine in the USA, many people remain skeptical of vaccines. Some of the most common concerns include:
Autism and neurological damage: A now-discredited study by Andrew Wakefield in 1998 suggested a link between the MMR vaccine and autism, leading to a sharp decline in measles vaccinations.
Immune system overload: Some parents worry that multiple vaccines might overwhelm or suppress a child's immune system.
Allergic reactions: While extremely rare, some vaccines can cause severe allergic reactions.
Other health concerns: Some people suspect vaccines might cause conditions like asthma, allergies, or multiple sclerosis.
Metaphors and Perceptions of Vaccination
Biss explores how the language and imagery associated with vaccination influence people's attitudes towards it.
Vaccination as Violence
Many people view vaccination as a violent invasion of the body. This perception is reflected in the language used to describe the process – the British call it a "jab," while Americans refer to it as a "shot."
Impurity and Pollution
The act of injecting a foreign substance into the body can be seen as polluting or impure. In the past, some even likened vaccination to an injection of sin.
Sexual Connotations
Some parents express unease about vaccinating young children against sexually transmitted diseases like hepatitis B or HPV, fearing it might promote promiscuity.
Social Identity and Vaccination
Biss examines how social identity and perceptions of "otherness" affect attitudes towards vaccination.
Association with Minority Groups
Historically, certain illnesses have been associated with specific ethnic or social groups. For example, during the last smallpox epidemic in the US, the disease was called "Italian itch" or "Mexican bump."
Privilege and Prevention
Some people avoid certain vaccinations because they don't want to be associated with minority groups or believe that preventive measures aren't necessary for privileged groups.
The Impact of Labeling
The use of terms like "high-risk groups" can reinforce negative stereotypes and discourage people from seeking vaccination.
The Natural vs. Artificial Debate
Biss explores the tension between the perception of vaccines as unnatural and the reality of their biological origins.
The Appeal of "Natural"
In highly industrialized countries, there's a tendency to view "natural" as inherently healthier. This perception can lead people to reject vaccines as artificial intrusions into the body's natural state.
The Biological Nature of Vaccines
Contrary to popular belief, vaccines are classified as biologicals, meaning they have a biological origin rather than being purely chemical compounds.
The Body's Natural Response
Vaccination works by stimulating the body's own immune system to produce antibodies, making it a more natural process than many realize.
Vaccination and Power Dynamics
Biss examines how historical and cultural contexts influence perceptions of vaccination campaigns.
Colonial Legacy
In former colonies, mass vaccination efforts can be viewed as another form of imperialism or Western interference.
Mistrust and Resistance
Some communities, particularly in Muslim-majority countries, have resisted vaccination campaigns due to suspicions of hidden agendas or Western plots.
Misuse of Vaccination Campaigns
The author notes instances where vaccination campaigns have been used for other purposes, such as the CIA's fake campaign in Pakistan to gather intelligence on Osama Bin Laden.
Gender and Medicine
Biss explores how the dominance of male physicians in academic medicine has influenced attitudes towards vaccination, particularly among women who may prefer alternative medicine.
The Language of Immunity
Biss analyzes how the metaphors used to describe the immune system and vaccination shape our understanding and attitudes.
War Metaphors
Both the general public and experts often use war metaphors when discussing the immune system and vaccinations. This militaristic language can be off-putting to some, particularly parents considering vaccinating their children.
The Impact of Metaphors
The author suggests that the use of combative imagery might contribute to vaccine hesitancy, especially among educated parents who are uncomfortable with the idea of their children's bodies being described as battlegrounds.
The Collective Nature of Immunity
Biss emphasizes that vaccination is not just an individual choice but a decision that affects the entire community.
Herd Immunity
When a sufficient portion of a population is vaccinated, it becomes difficult for viruses to spread, protecting both vaccinated and unvaccinated individuals. This concept is known as herd immunity.
Protecting the Vulnerable
Some people, such as very young babies or individuals with compromised immune systems, cannot be vaccinated. They rely on others in the community to be vaccinated for protection.
The Voting Analogy
Biss compares the decision to vaccinate to voting in an election. Individual choices add up to determine the health of the community, which in turn affects everyone.
Weighing the Risks: Vaccines vs. Infections
In the final section of the book, Biss provides a balanced assessment of the risks associated with vaccines compared to the diseases they prevent.
Measles
The risk of encephalitis from measles (1 in 1,000 cases) far outweighs the risk of encephalitis from the MMR vaccine (1 in 3 million vaccinations).
Mumps and Rubella
The MMR vaccine also protects against mumps, which can cause male infertility, and rubella, which can lead to fetal death and serious malformations in pregnant women.
Diphtheria
This potentially fatal disease has a death rate of up to 20% in children, while the risk of a serious allergic reaction to the vaccine is less than 1 in a million.
Chickenpox
Often considered harmless, chickenpox can lead to serious complications. Before the vaccine was introduced, about 10,000 American children were hospitalized annually due to chickenpox, with 70 deaths.
Long-term Effects
The chickenpox virus can remain dormant in the body and later cause painful conditions like shingles. The vaccine virus is much less likely to cause such long-term effects.
Conclusion
In "On Immunity," Eula Biss presents a thoughtful and nuanced exploration of the complex issues surrounding vaccination. She acknowledges the fears and concerns that many parents have while also emphasizing the importance of vaccines for both individual and community health.
By examining the historical, cultural, and psychological factors that influence our attitudes towards vaccination, Biss encourages readers to think critically about their own beliefs and decision-making processes. She highlights the tension between our desire to protect our children and the reality that absolute protection is impossible.
The book doesn't shy away from discussing the real risks associated with vaccines, but it puts these risks into perspective by comparing them to the much greater dangers posed by the diseases they prevent. Biss makes a compelling case for vaccination as an act of social responsibility, emphasizing how individual choices contribute to the overall health of a community.
Throughout the book, Biss weaves together personal anecdotes, scientific research, and cultural analysis to create a rich tapestry of ideas about immunity, risk, and the human body. She challenges readers to consider how their perceptions of nature, purity, and medicine influence their views on vaccination.
Ultimately, "On Immunity" is not just a book about vaccines, but a meditation on parenthood, community, and our relationship with the natural world. It invites readers to consider their place in the larger ecosystem of public health and to make informed decisions based on a holistic understanding of the issues at stake.
By addressing the fears and misconceptions surrounding vaccines while also acknowledging the complexities of the issue, Biss provides a valuable resource for anyone grappling with questions about vaccination. Her balanced and empathetic approach makes the book accessible to readers on all sides of the debate, encouraging open dialogue and critical thinking.
In an era where misinformation about vaccines can spread rapidly, "On Immunity" serves as an important counterpoint, offering a thoughtful and well-researched perspective on this crucial public health issue. It reminds us that our health is interconnected and that the choices we make about vaccination have far-reaching consequences beyond our individual lives.
As we continue to face global health challenges, including the ongoing COVID-19 pandemic, the insights offered in "On Immunity" remain highly relevant. The book provides a framework for understanding and addressing vaccine hesitancy, which has become a significant obstacle in efforts to control infectious diseases worldwide.
Biss's work challenges us to move beyond simplistic pro- or anti-vaccine stances and to engage with the topic in a more nuanced way. She encourages readers to consider the broader context of public health, the history of medicine, and our responsibilities to one another as members of a community.
In the end, "On Immunity" is a call for empathy, critical thinking, and collective action in the face of shared health challenges. It reminds us that while we cannot eliminate all risks, we can make informed choices that benefit not only ourselves and our families but also the wider community. By fostering a deeper understanding of immunity and vaccination, Biss contributes to a more informed and compassionate public discourse on this vital issue.