On Immunity: An Inoculation

by Eula Biss

If we imagine the action of a vaccine not just in terms of how it affects a single body, but also in terms of how it affects the collective body of a community, it is fair to think of vaccination as a kind of banking of immunity. Contributions to this bank are donations to those who cannot or will not be protected by their own immunity. This is the principle of herd immunity, and it is through herd immunity that mass vaccination becomes far more effective than individual vaccination.

Unvaccinated children, a 2004 analysis of CDC data reveals, are more likely to be white, to have an older married mother with a college education, and to live in a household with an income of $75,000 or more—like my child. Unvaccinated children also tend to be clustered in the same areas, raising the probability that they will contract a disease that can then be passed, once it is in circulation, to undervaccinated children. Undervaccinated children, meaning children who have received some but not all of their recommended immunizations, are more likely to be black, to have a younger unmarried mother, to have moved across state lines, and to live in poverty.

“Perceptions of risk—the intuitive judgments that people make about the hazards of their world,” the historian Michael Willrich observes, “can be stubbornly resistant to the evidence of experts.” We do not tend to be afraid of the things that are most likely to harm us. We drive around in cars, a lot. We drink alcohol, we ride bicycles, we sit too much. And we harbor anxiety about things that, statistically speaking, pose us little danger. We fear sharks, while mosquitoes are, in terms of sheer numbers of lives lost, probably the most dangerous creature on earth.

Our fears are informed by history and economics, by social power and stigma, by myths and nightmares.

many people regard natural chemicals as inherently less harmful than man-made chemicals. We seem to believe, against all evidence, that nature is entirely benevolent.

Vaccination is a kind of domestication of a wild thing, in that it involves our ability to harness a virus and break it like a horse, but its action depends on the natural response of the body to the effects of that once-wild thing.

Those who went on to use Wakefield’s inconclusive work to support the notion that vaccines cause autism are not guilty of ignorance or science denial so much as they are guilty of using weak science as it has always been used—to lend false credibility to an idea that we want to believe for other reasons.

Wealthier countries have the luxury of entertaining fears the rest of the world cannot afford.

Immunity is a public space. And it can be occupied by those who choose not to carry immunity. For some of the mothers I know, a refusal to vaccinate falls under a broader resistance to capitalism. But refusing immunity as a form 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.

We are justified in feeling threatened by the unlimited expansion of industry, and we are justified in fearing that our interests are secondary to corporate interests. But refusal of vaccination undermines a system that is not actually typical of capitalism. It is a system in which both the burdens and the benefits are shared across the entire population. Vaccination allows us to use the products of capitalism for purposes that are counter to the pressures of capital.

Our cynicism may be justified, but it is also sad. That so many of us find it entirely plausible that a vast network of researchers and health officials and doctors worldwide would willfully harm children for money is evidence of what capitalism is really taking from us. Capitalism has already impoverished the working people who generate wealth for others. And capitalism has already impoverished us culturally, robbing unmarketable art of its value. But when we begin to see the pressures of capitalism as innate laws of human motivation, when we begin to believe that everyone is owned, then we are truly impoverished.

The extra time and trouble required to follow Dr. Bob’s alternative schedule are hard to justify unless the dangers of contracting infectious diseases early in life are minimized and the dangers of vaccinating early in life are exaggerated. Much of The Vaccine Book is devoted to this minimization and exaggeration. Tetanus is not a disease that affects infants, according to Dr. Bob, Hib disease is rare, and measles is not that bad. He does not mention that tetanus kills hundreds of thousands of babies in the developing world every year, that most children will encounter the bacteria that causes Hib disease within the first two years of their lives, and that measles has killed more children than any other disease in history.

“The problem is in making a special exemption just for yourself,” she says. This reminds her of a way of thinking proposed by the philosopher John Rawls: Imagine that you do not know what position you are going to hold in society—rich, poor, educated, insured, no access to health care, infant, adult, HIV positive, healthy immune system, etc.—but that you are aware of the full range of possibilities. What you would want in that situation is a policy that is going to be equally just no matter what position you end up in.

EVERYONE WHO IS BORN holds dual citizenship, in the kingdom of the well and in the kingdom of the sick,” Susan Sontag wrote in her introduction to Illness as Metaphor. “Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”

“Is the immune system at the heart of a new incarnation of social Darwinism that allows people of different ‘quality’ to be distinguished from each other?” asks the anthropologist Emily Martin. She believes the answer may be yes. Some of the people in her study expressed what she calls “immune machismo,” saying, for instance, that their immune systems “kick ass.” One person suggested, in Martin’s words, that “people without a good living standard need vaccines, whereas vaccines would only clog up the more refined systems of middle-class or upper-class people.”

In the years since I became pregnant with my son, I have read about studies suggesting a link between autism and a family’s proximity to a freeway, the mother’s use of antidepressants, the father’s age at conception, and the mother’s infection with influenza during pregnancy. But none of these have enjoyed the kind of press devoted to one small, inconclusive study that suggested a link between vaccination and autism.

During the Black Death that killed more than half the population of Europe in the fourteenth century, rioters burned Jews alive under the auspices of public health. Hundreds of Jewish communities were destroyed in response to accounts of an imagined conspiracy against Christians. These accounts were extracted from Jews who confessed under torture to spreading the plague by poisoning wells. Bram Stoker’s rendering of Count Dracula, with a prominent nose and piles of gold and vague origins in Eastern Europe, suggests that he is intended to be read as a Jew. To make that explicit, Bela Lugosi’s Dracula wore a Star of David.

As the American Medical Association recently observed, the ban on gay men giving blood, which was instituted in 1983, seems to have outlasted its medical prudence and is now merely discriminatory.