On Immunity: An Inoculation

by Eula Biss

A child cannot be kept from his fate, though this does not stop the gods themselves from trying.

Immunity is a myth, these stories suggest, and no mortal can ever be made invulnerable. The truth of this was much easier for me to grasp before I became a mother. My son’s birth brought with it an exaggerated sense of both my own power and my own powerlessness. I found myself bargaining with fate so frequently that my husband and I made a game of it, asking each other what disease we would give our child for prevention against another—a parody of the impossible decisions of parenthood. When my son was an infant, I would hear many variations of “All that matters is that he is safe.” I would wonder whether that was, indeed, all that mattered nearly as often as I would wonder if I could keep him safe. I was certain that I did not have the power to protect him from his fate, whatever it might be.

I would not let my child be cursed by my own carelessness or cupidity.

Some of the mothers I knew did not like the tone of this article. They found it insulting for the same reason I found it reassuring—it did not acknowledge any good reason for doubt.

A trust—in the sense of a valuable asset placed in the care of someone to whom it does not ultimately belong—captures, more or less, my understanding of what it is to have a child.

Plumbing most any word will reveal what Emerson called “fossil poetry,” metaphors submerged below the surface of our current usage. Fathom, a means of measuring the depth of the ocean, now means understand because its literal origin, using outstretched arms to measure cloth from fingertip to fingertip, was once used as a metaphor for grasping an idea.

Now our vaccines are, if all is well, sterile. Some contain preservatives to prevent the growth of bacteria. So now it is, in the activist Jenny McCarthy’s words, “the frickin’ mercury, the ether, the aluminum, the antifreeze” that we fear in our vaccines. Our witches’ brew is chemical. There is not actually any ether or antifreeze in vaccines, but these substances speak to anxieties about our industrial world. They evoke the chemicals on which we now blame our bad health, and the pollutants that now threaten our environment.

Victorian vampires, like Victorian doctors, were associated not just with corruption of the blood, but also with economic corruption. Having virtually invented a paid profession and being almost exclusively available to the rich, doctors were suspect to the working class.

Dracula arrives in England just as a new disease might arrive, on a boat. He summons hoards of rats, and his infective evil spreads from the first woman he bites to the children she feeds on, unwittingly, at night. What makes Dracula particularly terrifying, and what takes the plot of the story so long to resolve, is that he is a monster whose monstrosity is contagious. Germ theory was widely accepted by 1897, when Dracula was published, but only after having been ridiculed earlier in the century.

When we watched the sun set over the river where we lived he described Rayleigh scattering, the removal of the shorter wavelengths of light by the atmosphere that results in reddish clouds and grass that looks more intensely green at dusk.

I was not raised in the Church and I never took communion, so I was not reminded of Jesus offering his blood that we all might live when my father spoke of the universal donor. But I believed, even then, that we owe each other our bodies.

When he taught me to drive, he gave me this advice from his own father: you are responsible not just for the car you are driving, but also for the car ahead of you and the car behind you.

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.

Any given vaccine can fail to produce immunity in an individual, and some vaccines, like the influenza vaccine, are less effective than others. But when enough people are vaccinated with even a relatively ineffective vaccine, viruses have trouble moving from host to host and cease to spread, sparing both the unvaccinated and those in whom vaccination has not produced immunity. This is why the chances of contracting measles can be higher for a vaccinated person living in a largely unvaccinated community than they are for an unvaccinated person living in a largely vaccinated community.

antivaccinators were often more interested in abolition as a metaphor for individual liberty than they were in the cause as a shared purpose.

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.

There is some truth, now, to the idea that public health is not strictly for people like me, but it is through us, literally through our bodies, that certain public health measures are enacted.

Without exposure to germs, we now know, a child’s immune system is prone to dysfunction. In 1989, the immunologist David Strachan proposed that having older siblings, belonging to a large family, and living in an environment that was not overly sanitized might help protect children from developing asthma and allergies. This “hygiene hypothesis” suggested that it was possible to be too clean and too free of disease. As the hygiene hypothesis took hold, scientists searched for one particular childhood disease that might prevent allergies, but this thinking gave way to the understanding that the overall diversity of germs in our environment is probably more important.

Of all the varieties of germs, viruses may be the most vexing. They are mysterious creatures, parasitic and vampiric by nature. They are not exactly inanimate, but viruses are not, strictly speaking, alive. They do not eat, do not grow, and generally do not live in the manner that other living things live. Viruses must enter and inhabit a living cell in order to reproduce, or to do much of anything. On their own, they are little more than minuscule bits of inert genetic material, so small that they cannot be seen by an ordinary microscope. Once inside another cell, viruses use that cell’s body to make more of themselves. The metaphor of a factory is often used to describe how viruses work—they enter a cell and force its equipment to produce thousands more viruses. But viruses strike me as more supernatural than industrial—they are zombies, or body snatchers, or vampires.

Our own adaptive immune system, the branch of our immune system that develops long-lasting immunity, is thought to have borrowed its essential technology from the DNA of a virus.

Fears of vaccines do not seem easily quieted by an abundance of expert risk-benefit analyses assuring us that the good they do is far greater than the harm.

The injection of any type of vaccine can produce fainting and muscle pain caused not by the vaccine, but by the act of injection itself.

What vaccines do not cause, the report explained, is significantly harder to establish than what they do cause. While a substantial amount of evidence is acceptable as proof that an event does and can happen, there is never enough evidence to prove that an event cannot happen.

“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.

In a study that invited people to compare various causes of death, Slovic found that people tended to believe that accidents cause more deaths than disease and that homicide causes more deaths than suicide, when the opposite is true in both cases. In another study, people significantly overestimated the fatality rates of highly publicized or dramatic dangers like cancer or tornadoes. One could interpret this, as Sunstein does, to mean that most people are just wrong about risk. But risk perception may not be about quantifiable risk so much as it is about immeasurable fear.

When we encounter information that contradicts our beliefs, as Slovic found in one of his studies, we tend to doubt the information, not ourselves.

We sleep with our babies because the benefits, as we see them, outweigh the risks. The birth of my son, which posed a greater risk to my health than I anticipated when I became pregnant, gave me a new appreciation for the idea that there are some risks worth taking. “Having children,” a friend with grown children reminds me, “is the greatest risk you can take.”

We are locking our doors and pulling our children out of public school and buying guns and ritually sanitizing our hands to allay a wide range of fears, most of which are essentially fears of other people.

Any substance can be toxic in excess. Water, for instance, is lethal to humans in very high doses, and overhydration killed a runner in the 2002 Boston Marathon. But most people prefer to think of substances as either safe or dangerous, regardless of the dose. And we extend this thinking to exposure, in that we regard any exposure to chemicals, no matter how brief or limited, as harmful.

We seem to believe, against all evidence, that nature is entirely benevolent.

What natural has come to mean to us in the context of medicine is pure and safe and benign. But the use of natural as a synonym for good is almost certainly a product of our profound alienation from the natural world.

The wild and the domestic now often seem isolated values, estranged from one another. And yet these are not exclusive polarities like good and evil. There can be continuity between them, and there must be.”

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.

I hung up the phone and fell asleep with my face on a pile of articles about herd immunity. I woke to find that a fragment of print had been transferred to my cheek. It spelled “munity,” from the Latin munis for service or duty. “Munity is what you are really writing about,” a colleague would say to me months later, “not immunity.” This struck me as true, though I was writing about both.

All of us who have been vaccinated are cyborgs, the cyborg scholar Chris Hables Gray suggests. Our bodies have been programmed to respond to disease, and modified by technologically altered viruses. As a cyborg and a nursing mother, I join my modified body to a breast pump, a modern mechanism, to provide my child with the most primitive food. On my bicycle, I am part human and part machine, a collaboration that exposes me to injury. Our technology both extends and endangers us. Good or bad, it is part of us, and this is no more unnatural than it is natural.

Every day with a child, I have discovered, is a kind of time travel. I cast my mind ahead with each decision I make, wondering what I might be giving or taking from my child in the future.

According to the Catholic Church’s official guide for witch hunters, midwives belonged to the class of good witches who healed and did not harm, but this made them no less witches.

Wise women were themselves susceptible to superstition, but as far back as the early middle ages they used ergot to speed contractions and belladonna to prevent miscarriage. Saint Hildegarde of Bingen cataloged the healing properties of 213 medicinal plants, and women lay healers knew of recipes for effective painkillers and anti-inflammatories at a time when physicians were still writing prayers on the jaws of their patients to heal toothaches. Benjamin Rush, one of the fathers of American medicine, bled his patients to, as Barbara Ehrenreich and Deirdre English put it, “Transylvanian excesses.” In the late eighteenth and early nineteenth century, patients were bled to a faint, dosed with mercury, and blistered with mustard plasters. While medical schools excluded women from formal medical education, physicians competed, sometimes aggressively, with their informal practice in the home.

The pressures of the marketplace, Ehrenreich and English suggest, led to the practice of “heroic” medicine, which relied heavily on dangerous therapies like bleeding. The purpose of heroic medicine was not so much to heal the patient as it was to produce some measurable, and ideally dramatic, effect for which the patient could be billed. Dr. Rush, for one, was accused of killing more patients than he cured.

As childbirth moved into hospitals, the maternal death rate rose dramatically. Childbed fever, as puerperal sepsis was called, was spread by doctors who did not wash their hands between exams. But doctors blamed it on tight petticoats, fretting, and bad morals.

In 2004, an investigative journalist discovered that Wakefield had been paid for his research by a lawyer preparing a lawsuit against a vaccine manufacturer. And in 2007, Britain’s General Medical Council launched an investigation into Wakefield’s ethics that concluded with the decision that his conduct was “irresponsible and dishonest,” that he had subjected children to unnecessary invasive procedures, and that he had “repeatedly breached fundamental principles of research medicine.”

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.

Where it is not built on social domination, science can be liberating.

The idea that toxins, rather than filth or germs, are the root cause of most maladies is a popular theory of disease among people like me. The toxins that concern us range from pesticide residue to high fructose corn syrup, and particularly suspect substances include the bisphenol A lining our tin cans, the phthalates in our shampoos, and the chlorinated Tris in our couches and mattresses.

As long as a child takes only breast milk, I discovered, one can enjoy the illusion of a closed system, a body that is not yet in dialogue with the impurities of farm and factory. Caught up in the romance of the untainted body, I remember feeling agony when my son drank water for the first time. “Unclean! Unclean!” my mind screamed.

Formaldehyde is in automobile exhaust and cigarette smoke, as well as paper bags and paper towels, and it is released by gas stoves and open fireplaces. Many vaccines contain traces of the formaldehyde used to inactivate viruses, and this can be alarming to those of us who associate formaldehyde with dead frogs in glass jars. Large concentrations are indeed toxic, but formaldehyde is a product of our bodies, essential to our metabolism, and the amount of formaldehyde already circulating in our systems is considerably greater than the amount we receive through vaccination. As for mercury, a child will almost certainly get more mercury exposure from her immediate environment than from vaccination. This is true, too, of the aluminum that is often used as an adjuvant in vaccines to intensify the immune response. Aluminum is in a lot of things, including fruits and cereals as well as, again, breast milk. Our breast milk, it turns out, is as polluted as our environment at large. Laboratory analysis of breast milk has detected paint thinners, dry-cleaning fluids, flame retardants, pesticides, and rocket fuel. “Most of these chemicals are found in microscopic amounts,” the journalist Florence Williams notes, “but if human milk were sold at the local Piggly Wiggly, some stock would exceed federal food-safety levels for DDT residues and PCBs.”

If we do not yet know exactly what the presence of a vast range of chemicals in umbilical cord blood and breast milk might mean for the future of our children’s health, we do at least know that 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.

My pregnancy, like every pregnancy, had primed me for the understanding that my body was not mine alone and that its boundaries were more porous than I had ever been led to believe. It was not an idea that came easily, and I was dismayed by how many of the metaphors that occurred to me when I was pregnant were metaphors of political violence—invasion, occupation, and colonization. But during the birth, when the violence to my body was greatest, I was most aware not of the ugliness of a body’s dependence on other bodies, but of the beauty of it. Everything that happened to me in the hospital after my son’s delivery, even things I understand now as cold or brutal, I experienced at that time as aglow with humanity. Alarms were sounded for me, doctors rushed to me, bags of blood were rigged for me, ice chips were held to my lips. Human hands were in me and in everything that touched me—in the nitroglycerine, in the machines that monitored my breathing, in the blood that wasn’t mine.

Power, of course, is vampiric. We enjoy it only because someone else does not. Power is what philosophers would call a positional good, meaning that its value is determined by how much of it one has in comparison to other people. Privilege, too, is a positional good, and some have argued that health is as well. Our vampires, whatever else they are, remain a reminder that our bodies are penetrable. A reminder that we feed off of each other, that we need each other to live. Our vampires reflect both our terrible appetites and our agonized restraint. When our vampires struggle with their need for blood, they give us a way of thinking about what we ask of each other in order to live.

MY FATHER HAS A SCAR on his left arm from his smallpox vaccination more than half a century ago. That vaccine is responsible for the worldwide eradication of smallpox, with the last case of natural infection occurring in the year I was born. Three years later, in 1980, the disease that had killed more people in the twentieth century than all that century’s wars was officially declared gone from Earth.