On Immunity: An Inoculation

by Eula Biss

Public health, we assume, is for people with less—less education, less-healthy habits, less access to quality health care, less time and money. I have heard mothers of my class suggest, for instance, that the standard childhood immunization schedule groups together multiple shots because poor mothers will not visit the doctor frequently enough to get the twenty-six recommended shots separately. No matter that any mother, myself included, might find so many visits daunting. That, we seem to be saying of the standard schedule, is for people like them.

One of the mysteries of hep B immunization is that vaccinating only “high risk” groups, which was the original public health strategy, did not bring down rates of infection. When the vaccine was introduced in 1981, it was recommended for prisoners, health care workers, gay men, and IV drug users. But rates of hep B infection remained unchanged until the vaccine was recommended for all newborns a decade later. Only mass vaccination brought down the rates of infection, and it has now virtually eliminated the disease in children.

Vaccination, like slavery, raises some pressing questions about one’s rights to one’s own body. But as the historian Nadja Durbach has noted, antivaccinators were often more interested in abolition as a metaphor for individual liberty than they were in the cause as a shared purpose.

It was not in the recklessly selfless spirit of John Brown, who was hanged with his sons for their doomed effort to free slaves, that white workers resisted vaccination. “Anti-vaccinators were quick to draw on the political, emotive, or rhetorical value of the slave, or of the colonized African,” Durbach writes of the movement in Britain. “They were quicker still to claim that the suffering of white English citizens took precedence over that of the oppressed elsewhere.”

vaccine resisters saw their bodies “not as potentially contagious and thus dangerous to the social body, but as highly vulnerable to contamination and violation.” Their bodies were, of course, both contagious and vulnerable. But in a time and place where the bodies of the poor were seen as a liability to public health, as dangerous to others, it fell to the poor to articulate their vulnerability. If it was meaningful then for the poor to assert that they were not purely dangerous, I suspect it might be just as meaningful now for the rest of us to accept that we are not purely vulnerable. The middle class may be “threatened,” but we are still, just by virtue of having bodies, dangerous.

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.

A rather surprising amount of the human genome is made up of debris from ancient viral infections. Some of that genetic material does nothing, so far as we know, some can trigger cancer under certain conditions, and some has become essential to our survival. The cells that form the outer layer of the placenta for a human fetus bind to each other using a gene that originated, long ago, from a virus. Though many viruses cannot reproduce without us, we ourselves could not reproduce without what we have taken from them.

many of the complications associated with vaccines are also caused by the natural infections those vaccines are designed to prevent. Natural infections of measles, mumps, chicken pox, and influenza can all cause encephalitis, a swelling of the brain. We do not know what the base rate of encephalitis would be in a population with no disease and no vaccination against disease. But we do know that 1 in about every 1,000 cases of measles leads to encephalitis, and that encephalitis has been reported after vaccination in about 1 out of every 3 million doses of the MMR (measles-mumps-rubella) vaccine. This incidence is so rare that researchers have been unable to definitely determine whether or not encephalitis is caused by the vaccine.

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.

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

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.

Milkmaids in eighteenth-century England had faces unblemished by smallpox. Nobody knew why, but anyone could see it was true. Nearly everyone in England at that time got smallpox and many of those who survived bore the scars of the disease on their faces. Folk knowledge held that if a milkmaid milked a cow blistered with cowpox and developed some blisters on her hands, she would not contract smallpox even while nursing victims of an epidemic.

His paper speculated that the MMR vaccine might be linked to a behavioral syndrome that included symptoms of autism. While the publicity around Wakefield’s paper precipitated a dramatic drop in vaccination against measles, the paper itself concluded, “We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described,” and the primary finding was that more research was needed. Over the next decade, study after study would fail to find a link between the MMR vaccine and autism, and even researchers sympathetic to Wakefield’s hypothesis were unable to replicate his work. In 2004, an investigative journalist discovered that Wakefield had been paid for his research by a lawyer preparing a lawsuit against a vaccine manufacturer.

I was alive, and gratefully so, but I felt entirely undead. Nitroglycerine was injected into me during the surgery that repaired my uterus. “The same thing that’s used in bombs,” my midwife reported.

The groups that opposed the exemption, as global health researchers would observe in Pediatrics, were all nongovernmental groups like SafeMinds from high-income countries where vaccination rates would not be affected by a ban on thimerosal. 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.

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.

“This is an important vaccine from a public health standpoint,” he writes of the hep B vaccine, “but it’s not as critical from an individual point of view.” In order for this to make sense, one must believe that individuals are not part of the public.

Infants are exposed to an onslaught of bacteria the moment they leave the womb, even before they exit the birth canal. Any infant who does not live in a bubble is likely to find the everyday work of fighting off infection more taxing than processing weakened antigens from multiple immunizations.

“It’s hurtful,” Offit says of the persistent suggestion that his research has been driven by profit. He also finds it somewhat laughable. “Who ever goes into science,” he asks, “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!” He would have made a much better salary, he observes, if he had gone into private practice as a pediatrician after medical school rather than going into research.

The hep B vaccine is often used to illustrate the absurdity of a public health system that would vaccinate a newborn baby against a sexually transmitted disease. “Why target two and a half million innocent newborns and children?” Barbara Loe Fisher asks of the hep B vaccine. The implication behind the word innocent is that only those who are not innocent need protection from disease. All of us who grew up during the AIDS epidemic were exposed to the idea that AIDS was a punishment for homosexuality, promiscuity, and addiction. But if disease is a punishment for anything, it is only a punishment for being alive.

In the fall of 2009, at the height of the H1N1 flu pandemic, a group of researchers began testing their hypothesis that people who feel protected from disease might also be protected from feeling prejudice. The study looked at two groups of people, one vaccinated against the flu and the other not vaccinated. After both groups were asked to read an article exaggerating the threat posed by the flu, the vaccinated people expressed less prejudice against immigrants than the unvaccinated people.

the fact that US vaccines did not contain squalene, she said, had been disputed elsewhere: In 1997, a series of stories in Insight on the News magazine suggested that Gulf War syndrome might be linked to the presence of squalene, among other things, in the anthrax vaccine. There was no squalene added to the anthrax vaccine, according to the FDA and the Department of Defense, but some laboratory tests were able to detect minuscule traces of the substance. In a test conducted by the FDA, researchers suspected that the source of these traces was the people doing the testing. “Because of the difficulty of removing squalene-containing fingerprint oils from laboratory glassware,” they explained, “it is hard to know whether the squalene is truly present in some lots of the vaccine or is introduced by the testing process itself.”

Human papillomavirus is the most common sexually transmitted disease in the United States and the world, and it is the sole cause of cervical cancer. The CDC’s 2006 recommendation that all girls should be vaccinated against HPV at age eleven or twelve led to widely reported concerns that the vaccine itself would encourage teenagers to become sexually active. A 2012 study published in Pediatrics, “Sexual Activity-Related Outcomes after Human Papillomavirus Vaccination of 11- to 12-Year-Olds,” found that promiscuity was not one of the side effects of the vaccine. Page 16

The term herd immunity was first used in 1923, by researchers investigating bacterial infections in mice. The concept itself had been recognized much earlier, though its implications were not fully appreciated until widespread vaccination revealed that, for example, immunizing less than 90 percent of a population against diphtheria could reduce the incidence of disease by 99.99 percent. “That indirect protection occurs is obvious, both in logic and in observation,” the epidemiologist Paul Fine notes in his review of the literature on herd immunity, “Herd Immunity: History, Theory, Practice.” He goes on to explain that apparent exceptions to herd immunity do not refute the general principle, but only reveal that herd immunity can be fragile in certain circumstances.

number of friends had offered his name when I asked for a recommendation, and so had my midwife, who referred to him as “left of center”: We had already abandoned my son’s first pediatrician for a new doctor by the time it occurred to me that the first pediatrician had been recommended to me almost solely because he did not ask his patients to follow the standard immunization schedule. It was this that defined him as “left of center,” though his attitudes struck me as more typical of right-wing politics.