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.