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On Immunity: An Inoculation
Graywolf Press, $24 (cloth)
After my daughter was born, whenever I heard about parents who refused vaccines, I’d feel a flare of hostility. Not because I couldn’t relate to them—as an easily spooked new mom, I could relate all too well. No mother is thrilled to see a needle jabbed into her child. It hardly helps to know that the needle contains a substance derived from a disease-causing agent. Even leaving aside the debunked autism claims, the visceral reality of vaccination runs counter to every parental instinct.
But I had decided to trust the experts and not think about it too much. My daughter’s blue immunization book was fully up to date. Hearing about parents who opted out reminded me of my unease. Their existence was also an implicit rebuke; thinking of them put me on the defensive. They would, I imagined, deem me a bad mother, negligent and misinformed. I all but wanted to shout, “I know you are but what am I” at my hypothetical anti-vaxxer adversaries.
In On Immunity, Eula Biss’s quietly impassioned new book, the author evinces no such hostility (and considerably more maturity). She does attribute one pitch-perfect line to her father, a doctor who serves as the wry voice of reason in the book. Biss is groping for words to explain the phenomenon of chicken pox parties as alternatives to vaccinations. “I say, ‘Some people want their children to get chicken pox because,’ and pause to think of the best reason to give a doctor. ‘They’re idiots,’ my father supplies.”
Biss goes on to write, “I do not think they are idiots. But I do think they may be indulging in a variety of preindustrial nostalgia that I too find seductive.” This conclusion—tactful, discerning, self-implicating—is characteristic of her book as a whole. In her understated way, she ends up building a case against the anti-vaccination movement that is more damning than either her father’s or mine.
But the book is about much more than shots and mumps. It contains elements of memoir—Biss relates her child’s unexpectedly difficult birth, after which she lost two liters of blood and received an emergency transfusion from generous strangers. For the most part, though, it is meditative rather than narrative: paragraphs slip from science to philosophy to Greek myth to vampires. At only 200-odd short pages, On Immunity probes a slew of big ideas, from the fiction of purity to the failure of government. All feed into the fundamental question: how to be a humane, non-insane parent circa 2014.
In lesser hands, tackling so many themes could result in a mess. But Biss is able to pull it off, thanks to her intellectual poise and her lucid, frequently aphoristic prose. “A trust—in the sense of a valuable asset placed in the care of someone to whom it does not ultimately belong—captures, more or less, my understanding of what it is to have a child.” “Those of us who draw on collective immunity owe our health to our neighbors.” “As with other strongly held beliefs, our fears are dear to us.” “We do not know alone.”
Biss, an acclaimed Chicago-based essayist, probably shares certain traits with many of her readers: she is a highly educated, married, middle-class mother. As she notes, her demographic is the one most likely to voluntarily forego childhood vaccinations. Though the book’s tone is far from that of a manifesto, it is intended in part to persuade her audience to vaccinate. Though unlikely to convert Jenny McCarthy disciples, it very well could win over people who have heard vague rumors and are unsure what to think.
Biss is not only reassuring her audience that vaccination is safe; she’s arguing that it is a moral imperative. Vaccines are at the crux of her inquiry because they epitomize the way our personal decisions can either help or harm each other. She exposes the unsavory element in the anti-vaccine movement, identifying a feeling in some quarters of being somehow exempt—call it too posh for shots.
One of my most haunting fears is that in trying to protect my child, I’ll harm her.
While pregnant, Biss visits a doctor who assures her that the hepatitis B vaccine is not something that “people like me needed to worry about,” but rather for the children of drug users and prostitutes. Later, Biss’s research reveals that, for reasons that are poorly understood, limiting vaccinations to at-risk populations did not curb the hep B epidemic; only mass vaccination did. “The belief that public health measures are not intended for people like us is widely held by many people like me,” she writes.
The most egregious embodiment of this view is Robert Seares, or Dr. Bob, a famous physician who functions as the book’s villain. “Vaccines don’t cause autism,” he writes, “except when they do.” The hep B vaccine “is an important vaccine from a public health standpoint, but it is not as critical from an individual point of view.” Biss’s deadpan retort: “In order for this to make sense, one must believe that individuals are not part of the public.” And then, Dr. Bob’s most stunning advice: though he indulges his patients’ fears about the measles, mumps, rubella (MMR) vaccine, he writes, “I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the disease increase significantly.” One of Dr. Bob’s patients, it turns out, was a child who sparked a measles outbreak in 2008.
Anti-vaccine hysteria has its roots in a cluster of impulses, and Biss explores how those impulses play out more broadly. One is an ethos that reflexively prizes the “natural,” which, Biss notes, could only arise because of our lack of intimacy with the natural world. Among today’s mothers, suspicion of the “unnatural” often takes the form of fears of toxic chemicals. Tens of thousands of unregulated industrial chemicals are on the market—in pesticides, in plastic, in pots and pans, in furniture. In this context, for a mother, the world can become a strange kind of minefield. The most ordinary household products suddenly take on a sinister cast. During pregnancy, I started apprehensively scrutinizing shampoo labels, some of which boasted that they didn’t contain ingredients I hadn’t known I was supposed to be worried about.
This feeling is dramatized at the beginning of one chapter, when Biss calls her husband in tears, crying that they need a new mattress, because of the toxic chemicals that may be lurking in their son’s crib. As Biss implies, such gestures are attempts to exert control over an uncontrollable world. They are superstitious; you tell yourself that if you follow certain rules—buy organic produce, wooden toys, glass bottles—you can keep your child safe and pure.
As our exposure to industrial chemicals has increased, so has our exposure to information, some accurate, some not so much. Biss discusses the falsehoods that circulate online: a Salon article on vaccines was corrected, then removed, and yet the original version remained on other sites. Though misinformation is surely a major problem, the more interesting question, to me, is whether we also suffer from an overload of accurate information. Hyper-awareness of hazards can be its own kind of toxin.
Biss concludes, “We are all already polluted . . . . We are, in other words, continuous with everything here on earth. Including, and especially, each other.” This realization can be liberating. But what exactly does it imply? Should we give up even trying to shelter our children from threats in the environment? If we recognize, as Biss does, that it is a luxury “to feel threatened by the invisible,” does that mean that fretting about BPA is an elitist indulgence? Not exactly. But trying to cordon off our children from the world around them is both ethically dubious and ultimately futile. The only viable response is to try to repair that world.
• • •
When Biss calls her husband in tears about the mattress, the Deepwater Horizon oil spill is underway. “‘If our government,’ I cried to my husband, ‘can’t keep phthalates out of my baby’s bedroom and parabens out of his lotion, and 210 million gallons of crude oil and 1.84 million gallons of dispersant out of the Gulf of Mexico, for the love of God, then what is it good for?’” This bitter disappointment in government is another component of the fear that defines contemporary American parenthood.
It is not just that we can’t count on our government to protect us; nor can we expect it to support us. Though Biss doesn’t delve into this dimension, the much-lamented lack of policies to support children and families—subsidized child care, paid family leave, and so on—all contribute to a sense among parents that we are on our own. The middle class doesn’t need these policies so desperately, but their absence fosters a climate in which the norm is to fend for ourselves, eroding the very idea of a public.
Compared with previous generations, fewer of us can look to a higher authority, either. Biss invokes God figuratively in her outcry to her husband, but otherwise He doesn’t come up much. In this way, too, we secular liberals are on our own. We can’t expect God to protect our children; equally important, we can’t take solace from the conviction that what does happen is God’s will. Whatever happens is on us. Biss demonstrates this burden when she learns that her son has allergies; she asks the doctor what she had done to cause the allergies. “The possibility that I was not to blame did not initially occur to me,” she writes.
For all of these reasons, many Americans feel the emotional burdens of parenthood acutely. One of my most haunting fears is that in trying to protect my child, I’ll harm her: that her sunscreen, say, will turn out to be toxic. Resistance to vaccination is a dramatic manifestation of this kind of fear. We are terrified of making the wrong move, and nothing could be more painful than the belief that you did something to hurt your child. The fear is related to the notion that the natural is preferable to the unnatural. The natural just happens, which makes it easier to accept; the unnatural requires human intervention. What if that intervention goes awry?
And yet our children are in fact safer and healthier than ever by most measures, suggesting that we’ve gotten more right than wrong (and reminding us that our government, despite its flaws, has in fact accomplished a great deal). In her research, Biss discovers that one out of every ten children born in 1900 died less than a year after birth. “I would read this in a report on vaccine side effects, which concluded its brief historical overview with the observation that now ‘children are expected to survive to adulthood,’” Biss writes drily.
To be a parent today in the United States, Biss writes, is to be in a position of “empowered powerlessness.” Here she is quoting the anthropologist Emily Martin, who describes “the paradox of feeling responsible for everything and powerless at the same time.” Biss comes to the conclusion, “As mothers, we must somehow square our power with our powerlessness.”
Parenthood might also be described as “selfish selflessness.” For the first time, probably, you care about someone else more than yourself, are willing to make sacrifices you’d never consider for anyone else. But the object of this generosity is not random—it is a person who is seen as a kind of extension of you. And too often, we seem to feel that this self-abnegation absolves us of responsibility to others. “Can we fault parents for putting their own child’s health ahead of that of the kids around him?” Dr. Bob asks. “This is meant to be a rhetorical question,” Biss writes, but Dr. Bob’s implied answer is “not mine.”
Biss, by her account, has friends who chose not to vaccinate their children. Writing this book, then, strikes me as a courageous act. It is not easy to criticize the parenting choices of our friends. But parenting culture, now so crippled by fear, needs to change, and it can. Biss’s book is, in part, an attempt to effect that change. And any parent can contribute by behaving in the way her book suggests. Precisely because we are so sensitive to judgment about our parenting choices, and because we are so bewildered, we tend to follow social cues, often for the worse but sometimes for the better. Not only viruses, after all, are contagious.
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