Book Review: On Immunity: An Inoculation by Eula Biss

on immunityI read Eula Biss’s On Immunity: An Inoculation straight after finishing The Body Economic by David Stuckler and Sanjay Basu, as I was on a bit of a public health kick, and this came as a contrast to the previous book. In juxtaposition to the work of the economist Stuckler and medic Basu, which takes a more data driven and emotionally removed approach to public health, Biss’s account of vaccination from historical, political and personal perspectives cuts to the essence of medicine as a discipline founded upon and often driven by emotion, inevitable for a discipline which deals with bodies and minds which feel.

Biss’s book can be described as a medical humanities work, but as she explores in the book, the dichotomy between a medical and a humanistic understanding is undermined by the topic of vaccination. The act of vaccination is both a profoundly personal one when the needle breaks my skin or my child’s skin, but a public act done at the behest of the government for the good of others and all. As Biss writes, “The natural body meets the body politic in the act of vaccination, where a single needle penetrates both.” Biss explores the tension between the body natural and politics by her choice of form of the work. On Immunity is a book-length personal essay on a subject matter which is typically given the impersonal treatment of Stuckler and Basu, the peer reviewed scientific article and the governmental report. As someone with a scientific interest in disease and healthcare, I have some hesitancy with science-related works drawing on the authors feelings, as this can often be irrelevant to the narrative and misrepresent the reality of the phenomena as understood by science, producing both bad writing and bad science.

Biss does none of this, as  the feelings, prejudices and social relations of all in society influence the decision to vaccine or to refuse vaccination, and therefore the herd immunity of the entire population, rich or poor.

Biss is a non-fiction writer and academic, and approaches the topic of immunity from the perspective of a new mother navigating the minefield of information and misinformation around vaccination to make the best decision for her child and her community, including those of different ethnic and socio-economic statuses to her. Biss acknowledges from the outset the great privileged involved in her ability to take this decision, as a white middle-class woman. She writes that, during the last US-wide smallpox epidemic of 1898, everyone in the black-section of Middlesboro, Kentucky who resisted vaccination was vaccinated at gunpoint, “the poor were enlisted in the protection of the privileged.” Historically, resisting vaccination was an act of political resistance for many racially and economically oppressed people to combat state control in which their bodies were used for the benefit of the privileged, and thus was seen as continuous with exploitative systems such as slavery.

This leads to the fundamental issue of vaccination, the compromise and tension between desire for autonomy in personal healthcare and the health of the community, as if the person can be separated from the public.This issue was present in the 19th century vaccination programs and continues today, and though the theme of autonomy continues the politics of the situation is flipped. Since Andrew Wakefield’s publication of his now redacted study linking MMR vaccines to an autism-like disorder, there has been a wave of vaccine refusal amongst overwhelmingly middle-class white parents in the UK and USA, a demographic which Biss lies within, and Biss does have considerable, maybe excessive, sympathy for vaccine refusers as they are her friends and has previously slipped into this thinking. For many middle-class vaccine refusers, vaccines are seen as not for their children, but rather for ‘risk groups’ such as those in poverty, and to pollute their children with what Jenny McCartney terms “the frickin’ mercury.” Vaccine refusal is a bid for autonomy for your family, a pioneer attitude to health. I suggest that this is the extension of the neoliberal idea of the individual extended to health, but this concept falls down when faced with infectious diseases which are diseases of communities, and therefore require a community-based effort to counter them.

Biss writes of vaccination as a way of understanding ourselves in relation to others simultaneous in medical and social terms, as she writes, “We are protected not so much by our own skin, but by what is beyond it. The boundaries between our bodies begin to dissolve here. […] Those of us who draw on collective immunity owe our health to our neighbors.” From this, I draw that vaccine refusal is a symptom of our alienated, individualistic neo-liberal politics, but to ensure health of everyone we must trust in others as our social and bodily boundaries begin to “dissolve” in the face of infectious disease.





Book Review: The Body Economic by David Stuckler and Sanjay Basu

the body economicThough I’m really a biologist, I have been nurturing an interest in medicine for a while now, especially public health and epidemiology, more as a social concern than an academic interest. I am also a socialist and a Labour Party member (though through gritted teeth at the moment). Therefore, Stuckler and Basu’s book on the public health consequences of austerity appealed to me from its place on a shelf in my public library both on political and medical grounds, and they fuse these disciplines well to formulate the rarest of things, an evidence based economic argument.

My government has been pursuing austerity measures since 2010 (though God knows how long this will continue with Brexit-related chaos). This means that the government’s spending in areas such as social security payments and public services have been reduced, with particular severe reductions in the number of disabled people receiving government welfare payments. The government claims that this was done in order to reduce the government’s deficit, so that foreign investors gain confidence in the British economy and invest in it, growing the economy. So, it is argued, for the good of the future economy, citizens must be inconvenienced in the present. However, things are not so simple as this. Stuckler and Basu present data supporting the economic arguments against austerity; that as government spending creates economic growth principally by paying people so they have more money to buy things, cutting government spending reduces growth. This line of argument is nothing new, but Stuckler and Basu go beyond this line of argument by calling into question the idea that economic growth should be the supreme value of a government, for which everything else must be sacrificed. Rather, we say “We’ll always have our health” for a reason.

Many on the left have an instinctual repulsion against austerity measures, not because they know the consequences to be detrimental, but rather because allocating resources towards rebuilding the economic system rather than helping people is seen as inherently inhumane. “People Before Profit” has been written on a thousand placards across the land. This argument can be criticized by conservatives as over-emotional and unrealistically short-term, the state must be cut back to ensure future prosperity. Aye, there’s the rub.

Basu and Stuckler summarise studies (many of which they have been involved with) suggesting that, whilst economic recession often leads to better health outcomes for a population (largely due to lack of money leading to lower cigarette and alcohol consumption in most cases), a government responding to a recession of a similar magnitude in a similar situation with austerity (for example, in the US states which eschewed Roosevelt’s New Deal Policy) will have a lower life expectancy and a greater burden of disease than populations whose government responded to recession by stimulating the economy by spending more on public projects as seen in the comparable US states which embraced the New Deal. They detail many different examples of this situation occuring, from the high suicide rates in Russia following the collapse of communism and the adoption of radical austerity measures, or “Shock Treatment”, leaving whole villages and towns depleted of men compared to the “unshocked” Belarus. As a biologist interested in the ecology of disease, the fact of the book had to be the tracing of an unusually high number of West Nile Virus cases in Bakersfield, California in 2007 to the subprime mortgage crisis. This is because West Nile Virus is transmitted to human by the Culex mosquito, which lays its eggs in water. 2007 was a drought in Bakersfield, so there shouldn’t have been a low incidence of West Nile Virus, as the Culex population would be lower. However, as many homes were abandoned due to foreclosure after the homeowners could not keep up with their mortgage payments, the swimming pools of these houses were given over to nature, and to the mosquitos. The mosquito population boomed using the foreclosured swimming pools as nurseries, and more people got sick. From an epidemiological standpoint I find it fascinating that disease outbreaks can be traced to such unconventional sources as abandoned swimming pools. It shows how all environments are on a knife edge, and if altered due to ecological or economic reasons, disease can proliferate.

Therefore, Basu and Stuckler show simultaneously that austerity is bad for the economy and bad for health, but by doing so they turn on its head the principle behind austerity. I take from this book that governments proposing austerity as a way of economic recovery irregardless of the evidence provided by economists such as Basu and Stuckler are pursuing a harmful neoliberal ideology rather than good policy to the benefit of the citizens. I am lead to ask, what is a government for? My government seems to acting for what it thinks is the good of the economy, so places the well-being of its citizens in jeopardy by cutting welfare payments and chipping away at the NHS. This is utterly perverse, as to value the economy over the health of citizens is fundamentally undemocratic. A government that acts for the good of the people should do all it can it maximise their health and wellbeing in a financial, social and psychological sense based on sound evidence. A government that ignores such evidence in pursuit of ideology is fundamentally inhumane.