A couple of weeks after I gave birth, wildly exhausted, and still as bloated and wobbly as the Staypuff marshmallow man, I was offered free foot reflexology sessions from a woman who was studying for some kind of school-of-foot-reflexology diploma through the mail. Though I had my doubts about the benefits of reflexology (which proposes that the bottom of your foot is a map to the body and that, if you press on the right spot of the big toe, for example, you can provide relief to your brain), I accepted. If there was any chance that pressing a spot of my foot was going to help me heal from my traumatic 44-hour labor, four hours of pushing, an epidural halfway through, and finally an episiotomy, I would take it. So I agreed to do three sessions in the woman’s house.
The first session was unremarkable, but I felt relief to be out of the house and have a moment to myself. By my next session, my husband was back at work from his paternity leave and I had to bring my newborn with me. While I nursed and had my feet pressed, I found myself surveying the woman’s bookshelves, my eyes landing on a couple of books that appeared to be anti-vaccination titles—one, if I recall correctly, was called The Vaccine Epidemic. I looked at the books and my baby and back at her books. And then I had a silent panic attack. The woman, I’d also learned, had two small children who were off at a preschool. Were they, I wondered, not vaccinated? Would it be rude to ask? Was I putting my newborn at risk by simply being in this woman’s living room?
I didn’t know the answer. But I did know that I was warned from taking my baby out much the first few weeks of his life. I worried that I could have brought him into an environment that was unsafe for him. Despite my earlier agreement to three sessions, I did not return to her house, and I did not tell her it was because I was afraid of her relationship to the books on her shelf or the possibility that she believed their contents.
I was a new mom surrounded by potential epidemics and very real outbreaks (measles had just hit New York City—in one circumstance I had to cancel a meetup with a friend and her baby because she was in the outbreak zone for the measles on Washington Heights). It was at this time in my delicate, anxious, and isolated world, that I was given an advance reading copy of Eula Biss’s On Immunity. I read it in a gulp, bypassing opportunities to sleep during my baby’s naps. I talked about it with other new moms, who also felt it was speaking not just about the health care choices they faced, but about their roles as mothers and caretakers and the isolation of the experience.
Although Biss’s book has exploded because of its investigation on the cultural history of immunization, being chosen this year, among many other accolades, for Mark Zuckerberg’s Facebook book club, “A Year in Books,” it is so much more than a book on a single topic. Most of the reviews for On Immunity focus primarily on the newsworthy angles of vaccination. I came away feeling like most had missed the point. We aren’t just offered a treatise on vaccines. Instead, Biss shows how knotty the issues surrounding motherhood are, explores why women might mistrust the decisions of doctors and health care systems, and demonstrates empathy to mothers who make controversial health case choices for their families. In return, she asks her readers to trust and understand the science of vaccination and the risks of not doing so.
Last October, I ended up speaking with Biss on her book tour and later interviewed her over email (excerpted below). On Thursday, Maris Kreizman has arranged a marathon reading of On Immunity at powerHouse Arena Bookstore in New York City with donations collected for Doctors Without Borders. I signed up to take part. I am doing it not only because it’s the book that made me, in my first year as a mom, feel less alone, but because I believe it’s the book that makes a difference.
The Daily Beast: In On Immunity, you dedicate your work to mothers. What did you discover about the role of mothers in your investigation on vaccines?
Eula Biss: This book emerged out of conversations I had with other mothers after my son was born—I wrote it both to and from those mothers. Talking with them helped me think about the grand scope of the concerns that motherhood encompasses—education, nutrition, health care, environmentalism, philosophy, etc. When I began to research vaccination, my reading reminded me that healing and health care was traditionally women’s work. But after the industrial revolution, as medicine began to emerge as a paid profession, women were systematically excluded from that profession. Women were also, as patients, subjected to the cruelties of early medical practice, which often involved dangerous therapies like blood letting and dosing with mercury.
Many of the women I know are painfully aware of the history of sexism in medicine and are therefore particularly attuned to the sexist undercurrents in the contemporary debate about vaccination. I cringe whenever I hear people who are resistant to vaccination referred to as “stupid” or as unable to understand science, in part because both of those charges echo historical sexist attitudes about the limitations of women’s intelligence. Of course, the parents who make vaccination decisions include both men and women, but this issue is very often cast as a women’s issue… I was interested in taking an issue that was being trivialized as a “women’s issue” and revealing its true complexity and import while preserving my experience of it as a conversation between women.
One of the surprising delights of On Immunity is the amount of vampire history you delve into and the remarkable way you weave it into the history of vaccines, as well as your personal story as a mother. Why did vampires become such a significant metaphor in the book?
I didn’t intend to write about vampires, but in reading about the anti-vaccination movement in Victorian England I learned that the vampire was often used as a metaphor for the vaccinator. I began reading some of the vampire literature of that time, most notably Dracula by Bram Stoker. I found that Dracula was not a metaphor for a vaccinator, but was quite obviously a metaphor for disease. The book also suggests metaphors having to do with immigration and fear of outsiders. When I began to research viruses, I was struck by the similarities between vampires and viruses—they both act like living things but are not, strictly speaking, alive. They can both go into a dormant state for long periods of time. They are both parasitic, in that they need the bodies of other living things to flourish, grow, and reproduce themselves. It isn’t hard to see why Bram Stoker, who wrote Dracula shortly after germ theory was validated, would be tempted to borrow some of the language associated with germs (his vampire hunters “sanitized” Dracula’s coffins so that he could not take refuge in them) to bring his vampire to life.
You don’t spend much time discussing vaccines as a celebrity activist cause, but …you deliver some precise criticism of Dr. Bob Sears and his bestselling The Vaccine Book. What should people know who have heard from other expecting parents about his vaccine schedule recommendations?
Well, I think they should investigate Dr. Bob’s intellectual integrity. When I investigated it, I wasn’t impressed. His style of thought, which is all over the pages of The Vaccine Book, tends to sound good at first but then reveals itself as quite messy on closer examination. I remember being astonished by a passage in the book where Dr. Bob loosely explains how he arrived at his estimate of the frequency of vaccine side effects, an estimate that is much higher than most other estimates. His math violates the laws of algebra and is, when you follow it closely, not math so much as it is guesswork lightly disguised by some numbers. This was not the only place in The Vaccine Book where I felt that my intelligence was being insulted, but it was one of the more audacious. I remember thinking, “Oh, so he thinks his readers can’t do math. Wow.”
You are cautious not to judge all people who choose not to get vaccines. In what circumstances do you feel it might be valid to not participate in immunizations?
Well, I don’t think it’s my place, or any else’s for that matter, to make authoritative pronouncements on what constitutes a valid reason not to vaccinate. I will say that I think there are situations—some of them medical, some of them emotional, some of them political—in which asking a person to participate in vaccination is asking too much. But this has been, historically, a tricky assessment—when magistrates in Victorian England were charged with deciding whether “conscientious objectors” to vaccination were indeed “conscientious” they struggled with what sort of evidence to demand.
There are people whose relationship to our government and our medical system has been damaged irreparably—think of the descendants of the Tuskegee subjects—and there are people who have suffered personal losses that make vaccination emotionally difficult. I’m thinking of a friend whose father died after contracting polio from the polio vaccine she received as an infant, a vaccine we no longer use in this country. After that incident, her mother didn’t vaccinate her against any other diseases (though I should say that she has chosen to be vaccinated as an adult). We can’t compensate her mother’s loss—there is nothing that could compensate that loss—but if she doesn’t want to vaccinate her child after losing her husband, the rest of us can offer that child the protection from disease afforded by herd immunity. We can shelter her. And all of us who have been vaccinated extend that protection to people with medical conditions that prevent them from being able to be safely vaccinated—people undergoing cancer treatment, people with compromised immune systems, people who have had an organ transplant. But if herd immunity is eroded by low vaccination rates, those people become particularly vulnerable. This is why I think the decision not to vaccinate is a true question of conscience. Many of us may have reservations about vaccination, but we need to weigh those reservations against our obligation to the more vulnerable people among us.
What did you intend by subtitling the book An Innoculation?
At first, that subtitle was a joke, and a bit of a wink to Maggie Nelson, who has subtitled books “A Murder” and “A Reckoning.” I included it on one of the drafts that I sent to my editor and his enthusiasm made me reconsider it more seriously. One of the things my editor, Jeff Shotts, and I discussed was my concern about repeating fears of vaccination. As a new mother, I found those fears disruptive and unproductive. I was reluctant to participate in reproducing them. But when I thought about the book as an inoculation, I was able to imagine that it might work like a vaccine: a weakened or attenuated version of the thing that is unwelcome is introduced so that it can be recognized and resisted in the future. And then when I discovered that one of the broadest meanings of “inoculate” is “to join or unite,” I became convinced that it was a very fitting subtitle for the book.
Since your book came out in October, there has been a massive outbreak of Ebola, an outbreak of measles in several states around the country, including a serious one at Disneyland, and tales of measles parties where anti-vaxxer parents have decided to expose their children voluntarily to the disease. Has it felt strange to see how much current events are tracking On Immunity’s investigation of the history of vaccines?
Following the coverage of the measles outbreak has been interesting and, at times, upsetting. In 2010, there was a serious epidemic of pertussis [whopping cough] in California. Over 800 people were hospitalized and 10 babies died. But the media coverage of that epidemic didn’t seem nearly as robust as the coverage of this measles outbreak. I’m sure there are a number of reasons for that—the causes of the pertussis epidemic were more complicated than the causes of the measles outbreak and pertussis could not be blamed on low vaccination rates alone—but I think our national conversation around vaccination is changing. In 2010, I was still seeing a lot of articles that were treating vaccination as an issue of personal choice and/or preference. Now I’m seeing many more articles that are acknowledging that this is an issue of collective action, and an area where we need to try to reach consensus about how best to protect the most vulnerable people among us.
That said, there has also been plenty of sensationalism in the coverage of the measles outbreak, as well as some nastiness against people who don’t vaccinate, which has served as a reminder that the threat of disease can bring out the worst in us. This was also very evident in the way we reacted to Ebola—with fear and racism and a desire to close our borders. The idea that we can isolate ourselves from other people and their problems is a dangerous illusion.