For the last several years I’ve taken a flu shot, for the simple reason that I don’t want to get the flu. But I hadn’t given much thought to the ethical choice that I was making for myself and for others who would encounter me during the flu season, until I read Eula Biss’s provocatively welcoming On Immunity.
The book has been widely reviewed, and Biss rightly praised for her careful handling of the scientific literature and medical history, her creative readings of Voltaire and the novel Dracula, and her imminently empathetic approach, all of which I second. There’s not a lot to say about the book that hasn’t already been said elsewhere, except what I’ve gained personally from the reading.
What I find most interesting about On Immunity is the author’s own story, the way an unexpected situation led her to dig into the science and the history and the philosophy, ultimately leading her to change her own mind about vaccination. She doesn’t frame the book around her story—it’s more of a series of tightly-related essays—but flashes of her story are revealed in her reflections, and they imbue her conclusions with a winsomeness not found in many discussions on this topic.
Biss is a middle-class American mom, with friends of the vaccinating and non-vaccinating kind, a mom with the relative good fortune of having some time and resources to devote to pondering the purity of her water, her air, and the toys in her playroom. Before the birth of her son, she planned to exercise her right to forego the standard vaccination schedule, for many of the reasons shared by other non-vaccinating parents. But complications during his birth required her to receive a blood transfusion, which meant that by the time she put him to her breast for the first time, her cells were already no longer their own.
But had they ever been?
This realization that her breast milk, while produced by her body, was being aided in this production by the foreign material she had received from an unknown donor, pushed her to start vetting some of her assumptions about what was in and out of her control, not just as a mom but as a human being.
“Our breast milk, it turns out, is as polluted as our environment at large,” she writes. She quotes from a report that “if human milk were sold at the local Piggly Wiggly, some stock would exceed federal food-safety levels for DDT residues and PCBs.”
These facts are not an argument for or against breastfeeding (or vaccinating, for that matter) but a simple, irrefutable statement that “natural” and “pure” are not synonymous, as she once thought they were. The notion that we are pure at birth—or that our state at birth is even somehow preferable to maintain—may be a lovely idea, but it’s a fallacy.
We are no cleaner, even at birth, than our environment at large. We are all already polluted. We have more microorganisms in our guts than we have cells in our bodies—we are crawling with bacteria and we are full of chemicals. We are, in other words, continuous with everything here on earth. Including, and especially, each other.
It’s this continuity between bodies—this permeable state that we think of as a border that is anything but—that draws out the incredibly important ethical problems of vaccination.
Thanks to today’s Ebola-saturated media, we’re well aware of how vulnerable we are, but many of us in the so-called first world forget that we are also, as Biss writes, “just by virtue of having bodies, dangerous.” We’re vulnerable and dangerous. Applying this to myself is uncomfortable, but Biss challenges me to do it.
When I get a flu shot to protect myself against the flu, I’m thinking of myself from a position of vulnerability: because I come in contact with people who might have the flu, I am susceptible to getting the flu, and therefore must protect myself from it. But I’m not thinking of myself from a position of contagion: that when I come into contact with people, I unknowingly might be carrying the flu to them. This realization puts the responsibility on me, because the person to whom I transmit the virus may have taken a precaution (a flu shot), may have opted not to take a precaution (their choice), or may have impaired immunity (not their choice) who could suffer greatly as a result of my choice. This is sobering.
While Biss digs into a number of studies and reports that have played significant roles in the internet debates and celebrity shouting matches, she makes it clear that the conversation should not be about taking one “side” over another. Instead, it should be an agreement between all parties to choose to understand the complexity of our relationships to others and our environment. And then take these relationships seriously.
“Debates over vaccination,” she says, “are often cast as debates over the integrity of science, though they could just as easily be understood as conversations about power.” And herein lies the heart of the matter.
The power of fear: “We do not tend to be afraid of the things that are most likely to harm us” (like the cars and bicycles we ride and the alcohol we drink and how much sitting we do), but paranoia is a contagion that “knows some things well and others poorly.”
The power of government: “We resist vaccination in part because we want to rule ourselves.” But biology is not a democracy.
The power of information: It’s a reality of the human condition that we tend to seek out sources that will “lend false credibility to an idea that we want to believe for other reasons.”
The power of community: “Immunity is a public space. And it can be occupied by those who choose not to carry immunity.”
Ultimately, it’s about the power of conscience.
One of the mercies of immunity produced by vaccination is that a small number of people can forgo vaccination without putting themselves or others at greatly increased risk. But the exact number of people this might be—the threshold at which herd immunity is lost and the risk of disease rises dramatically for both the vaccinated and the unvaccinated—varies depending on the disease and the vaccine and the population in question. We know the threshold, in many cases, only after we’ve exceeded it. And so this puts the conscientious objector in the precarious position of potentially contributing to an epidemic. Here we may suffer what economists call moral hazard, a tendency to take unwise risks when we are protected by insurance. Our laws allow for some people to exempt themselves from vaccination, for reasons medical or religious or philosophical. But deciding for ourselves whether we ought to be among that number is indeed a matter of conscience.
For me, the significance of Biss’s contribution to the conversation is the clarity with which she knocks down illusions of independence and raises the moral questions of vaccination: If you’re in a position to put yourself (or your children) before the rest of your community, should you? Would you make the same choice if you were extremely poor? Had a compromised immune system? Had no access to health care?
In the end, Biss decides for herself that it is morally wrong to put the burden of inoculation on others, and has her son vaccinated. Many of Biss’s friends tell her they can’t in good conscience do the same. But when she asks one friend how she would feel if her non-vaccinated child led to another child’s death, her friend admits she’s never thought about that. Biss doesn’t try to change her friend’s mind, but she does insist how vital it is for this woman to thoughtfully consider the question and come to an answer that can she can live with.
This book is as much for people who don’t understand why a parent might choose not to vaccinate a child as it is for parents who are not vaccinating their kids. It’s slim but weighty, thoughtful but not sentimental. It forced me, as much as I like to think of myself as a loner, to grapple with what it means to be simultaneously vulnerable and dangerous, one small part of a larger organism with which I am, for better or worse, interdependent.
NOTE: Periodically, we will be reintroducing relevant book reviews from our previous blog, The Discarded Image.