Rethinking Vaccination through Eula Biss’s On Immunity

Last week we explored the weird and wonderful world of eighteenth-century inoculation pamphlets and the stories they contain, trying to puzzle out how it was that this experimental technique in the 1720s galvanized thinking around the functioning of what we today refer to as the immune system.

I’ve struggled somewhat with this week’s blog because of a worry it will come across as overly book reviewish, largely because I have so much admiration for Biss’s style and find her accessible approach to a complex subject infinitely compelling. So maybe I’ll get the review parts out of the way before taking a deep dive into the substance of On Immunity : An Inoculation (Graywolf Press 2014). The work assumes a deeply personal approach to storytelling that gives us access to how the history, philosophy, and ethics of vaccination inform our contemporary understanding of immunity. There is a graceful mingling of science and the humanities in these pages that, in addition to the author’s own candid voice, incorporate the views of immunologists, philosophers, friends, and most prominently, her own physician father. In this respect, this is also a book about relationships, about love—chiefly maternal and filial—and vulnerability. It is also a book about bodies—maternal, infant, and social—that, without giving over too much to didacticism, probes our collective responsibilities to one another while exploring the embedded meanings of “munity”: duty, service, etc. This is a meandering work that often lightly deals with specific subjects (environmental toxins, AIDS, capitalism, blood donation, autism, social Darwinism, etc.) before returning to explore them in more depth at interludes in the storytelling. There is a lightness to the touch in the short chapters of this book that belies the weight of the concerns it addresses: questions rendered still more urgent in the midst of COVID-19.

Biss’s anxieties as a new mother during the 2009 H1N1 pandemic drive her investigation into the science and ethics of vaccination. As an expectant mother myself in the fall of that year, I can relate to a sense of mounting panic as pregnant women (considered an at-risk population due to disproportionately high rates of hospitalization and intensive-care admission)  were ushered to the front of the line for a vaccine that public health authorities were not yet able to assure did not pass through the placenta. My own plunge into the scientific literature circulating at the time mirrored that of Biss, whose book in many ways feels intimate and uncannily familiar. However, I wonder how its rather privileged and relentlessly maternal perspective reads to someone without these experiences. Although the book acknowledges class privilege (especially in its discussion of the HIB vaccine and racial injustice) and takes up social inequity at numerous points in its chapters, lingering residues of privilege adhere to discussions of medical paternalism (captured especially in the voice of her father standing in for medical authority) that the author identifies as preferable to the consumer-based model driving medical practice in the United States, without adequately considering alternatives. Moreover, as a book that centres maternal anxiety in its attempt to acknowledge concerns in a non-judgmental and compassionate way, its scope may be limited. As such, the focus may also circumscribe Biss’s power to reach beyond the specific concerns of overwhelmed mothers to address the broader issues the book endeavours to position as ones that concern all of us sharing space in our neighbourhoods, local communities and cities.

But I may be reverting to review mode, so for the purposes of our course, I would like to flag  the following statement as carrying special relevance: “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 whle they draw resources from the other 99 percent” (95). In 2020 the Occupy movement has given way to urgent protests of racial injustice and colonial structures, but in the midst of the COVID-19 pandemic, we find ourselves confronting the same resistance, not just to a future vaccine, but to mask-wearing more generally (as discussed in an earlier blog). Scientists and public health authorities the world over are actively appealing to a sense of collective responsibility that contradicts the individualist ethos (that Biss captures so evocatively in the Dracula motif that weaves the various strands of her discussion together) that has contoured our thinking in the West since the eighteenth century. As Biss writes, Enlightenment philosophy conditions us to believe “we inhabit only one body contained entirely within the boundaries of our skin” and as such “celebrate[s] the individual in both mind and body” (125). Despite posing issues for cis women who often “make other bodies” and are divisible and not as readily contained, this thinking prevents the majority of us from acknowledging that “our bodies may belong to us, but we ourselves belong to a greater body composed of many bodies..” (126). Our own sense of bodily sovereignty resists the logic of vaccines that “impose a particular order on [the immune system” with the result that “we resist vaccination in part because we want to rule ourselves” (127). Does accepting vaccination involve giving up a little of that sovereignty, retraining ourselves to think beyond the constructs that inform medical understanding and opening ourselves up to our shared immunity, to an acknowledgment that “an illusion of independence” (124) drives how we look at the self in relation to others?

Any attempt to adjust our mindsets encounters obstacles erected by language, as we’ve discussed already in the course. Immunologists find themselves in the position of using expressions that other scientists, like physicists or chemists, are not called upon to invoke: memory, recognition, self, etc. Interrogating metaphor in the tradition of Susan Sontag and Emily Martin (and George Orwell), Biss teases out the military and defensive metaphors that have become so naturalized in immunology that many scientists take them as a given. Efforts to counter this thinking by demonstrating how vaccines “tutor” the immune system, or analogies relating to eating and digestion,  are difficult to accept given widespread and unquestioning acceptance of combative language to describe immunity.  But, as Biss writes, “Stale metaphors reproduce stale thinking. Mixed metaphors confuse. And metaphors flow in two directions—thinking about one thing in terms of another can illuminate or obscure both. If our sense of bodily vulnerability and pollute our politics, then our sense of political powerlessness must inform how we treat our bodies” (128). There are multiple levels of metaphor here: the first dealing with immunity itself, that (and we will explore this idea in more depth next week when we get into the work of Ed Cohen) originated in the “context of law to describe an exemption from service or duty to the state. Immunity came to mean freedom from disease as well as freedom from service in the late nineteenth century, after states began requiring vaccination. In a peculiar collision of meanings, the exemption from immunity made possible by the conscience clause was a kind of immunity in itself. And allowing oneself to remain vulnerable to disease remains a legal privilege today” (121).  COVID-19 has magnified these disparities in our society; parades by gun-wielding, MAGA hat-wearing anti-maskers down Target aisles and displays on the steps of capitol buildings showcase how some bodies circulate more freely and with more impunity than others. These same individuals may opt out of vaccination, leaving herd immunity a burden for other populations to assume, like the African American communities subjected to compulsory immunization at gunpoint in 1898 (42).   Read through this legal lens, immunity is a fraught proposition, with certain persons enjoying illegal immunity at the expense of the bodily immunity of others.

The language of the “natural” plays a crucial role in cementing these social divisions. As certain parents disdain the chemical composition of vaccines, they endeavour instead to boost their children’s immune systems through natural means or claim a native “robustness” that may be implicitly tied to white supremacism.  As the anthropologist, Emily Martin, questions,  “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?”  (quoted in Biss). Biss troubles the division between the natural and artificial the vaccine hesitant invoke to support their arguments. Preferring “natural” inoculation through direct exposure (chicken pox parties are taken over by so-called COVID parties in today’s world), these individuals affirm yet another binary (in addition to self/nonself) that structures our thinking. But are vaccines themselves inherently unnatural, or do they, as Biss insists, occupy a “liminal place between humans and nature”? The borrowed image of the “mowed field” in this context invites us to visualize the peculiar functioning of vaccination that “depends on a natural response of the body” and invites “the immune system to produce its own protection”  As the eminently quotable Biss writes, “The most unnatural aspect of vaccination is that it does not, when all goes well, introduce disease or produce illness” (65). At any rate, as she acknowledges elsewhere (invoking Donna Haraway), we are all cyborgs rather than the wholly natural beings posited by vaccine hesitant discourse.

The second level of metaphoricity Biss references informs how we look at the “immune system” as  “a metaphor for the prevailing sense of the vulnerability of the human individual in a hostile world” (Michal Fitzpatrick, quoted in Biss 133). As Emily Martin notes, this construct that took hold in the 1970s (not so very long ago!) is actually indebted to “systems thinking” that should in theory encourage us to think relationally, in this context considering in what way the body is a complex system linked to other complex systems. The drama of the immune system is read in terms of self/non-self distinctions that ironically overlook how our adaptive immune system presumably borrowed its “essential technology from the DNA of a virus.”  In her closing chapters, Biss attempts to find a way out of this conundrum through recourse to other theories like Polly Matzinger’s “Danger Model.” In her work in the 1990s, Matzinger posited that the “task of the immune system…is not to detect nonself, but to detect danger. Self can be dangerous, as immunologies have observed, and nonself can be harmless” (160). This model encourages us to think in a more complex way about threat, recognizing that microbes and germs outside us are not equally dangerous and not even necessarily as problematic as things that are within ourselves (we’ll discuss this in more depth when we look at auto-immunity in several weeks). Acknowledging that there is no “outside” of metaphorical thinking, Biss leaves us with new metaphors to consider: “Our bodies are not war machines that attack everything foreign and unfamiliar, this metaphor suggests, but gardens where, under the right conditions, we live in balance with many other organisms. In the garden of the body, we look inward and find not self, but other” (162). Ultimately, she writes, ”immunity is a shared space—a garden we tend together” (163). This concept is more conducive to the aims of public health and may in fact foster the kind of attitude so needed in the midst of a pandemic.

A virus that preys (no escaping metaphor) particularly on senior and medically vulnerable communities, COVID-19 elicits different anxieties than the pandemic that initiates Biss’s exploration of vaccination in the context of children’s bodies and maternal fears. But her book remains relevant in interrogating how language distorts our understanding of the immune system. Biss also gives us crucial strategies for overcoming anxiety and addressing the concerns of others in a way that does not dismiss or belittle them. In this sense, she offers the more “compassionate messaging” that Julia Marcus of Harvard has been calling for, as well as foregrounding the communication issues that public health authorities are finally beginning to acknowledge. Those who decline vaccination are often nostalgic for a preindustrial nature they read as inherently benevolent. Deconstructing this misconception is a crucial first step in countering the binary thinking that pits the natural against the artificial, and the private against the public, and dispelling the illusion that we are independent, closed systems.

Questions to consider:

Why does Eula Biss subtitle her book “An Inoculation”? In what sense and how is she endeavouring to inoculate her readers?

What is the overarching importance of the Dracula motif in the text?