Abstract
Written in response to the sexist stereotypes of “stupid” mothers waging an anti-science war against the benevolent public health system, Eula Biss’ On Immunity administers a steady dose of nuance into contemporary debates surrounding immunization. Arguing that such debates are as much about society as they are about science, Biss offers a first-hand perspective of the “labyrinthine network of interlocking anxieties” as well as “the proliferation of hypotheses, the minutiae of additives, [and] the diversity of ideologies” that many women encounter throughout pregnancy and child-rearing (p. 23). Blending memoir, literary criticism, history, science writing, and social commentary, On Immunity prompts us to move beyond vaccination to ask important questions about citizenship, morality, the state, and science.
Impeccably researched and argued, On Immunity is a treatise about the beauty and horror of human vulnerability. Beginning with the fateful story of Thetis, Biss describes how the goddess dips her infant son Achilles into the River Styx to confer immortality. Taking a cue from Susan Sontag (1978), Biss uses this as metaphor for her genealogy of immunity. Demonstrating that neither vaccines nor their refusal are contemporary phenomena, she traces the social history of vaccination to folk medicine of the 18th century. Refusal, she argues, came later, emerging from ideology rather than ignorance. The United Kingdom’s Compulsory Vaccination Act of 1853, for example, catalyzed conscientious objectors suspicious of state administration of health. “We resist vaccination,” Biss argues, “because we want to rule ourselves” (p. 127). Citing historian Nadja Durbach’s (2005) argument that resistors drew upon the rhetoric of abolition as metaphor for individual liberty over solidarity with the oppressed, Biss identifies a similar theme in contemporary positions. Using the Occupy movement as metaphor, she argues that “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 while they draw resources from the other 99 percent” (p. 95).
Highlighting the privilege embedded in refusal, Biss’ ultimate argument is a moral one. Although she uses scientific evidence to explain herd immunity (p. 19), it is her embodied rhetoric that persuades. When her son’s birth causes a rare uterine inversion that makes her the recipient of an emergency blood transfusion, Biss describes her dependency not as monstrous but as beautifully human: “human hands were in me and in everything that touched me—in the nitroglycerine, in the machines that monitored my breathing, in the blood that wasn’t mine” (p. 81). Realizing that “my body was not mine alone and that its boundaries were more porous than I had been led to believe” (p. 81), she suggests that the distinction between the individual and the collective is false. Biss argues for communal responsibility and regard for the other, suggesting that “however we choose to think of the social body, we are each other’s environment. Immunity is a shared space—a garden we tend together” (p. 163).
Although this moral argument may frustrate those hungry for scientific “facts,” On Immunity ignites questions sure to complicate any hardline position. Given the historic abuses of science that have coerced, marginalized, and persecuted othered bodies (i.e. forced sterilization, the pathologization of homosexuality, eugenics), why do some of us so uncritically defend it? If we agree that community health should preside over individual rights, how do we balance this with the need to protect informed consent and the right to self-determination? These strike me as important questions, not only for immunization but also for other public health issues such as childhood obesity or infectious diseases like Zika fever.
Something I found challenging was Biss’ rationalist view of modern science. Critiquing the Wakefield Lancet study as an example of “weak science” (p. 71) while praising the “good” science of the Institute of Medicine (p. 143), Biss suggests that the morality of science can be determined by its intention and use. When we limit our view to “‘bad science’ as the problem, and not science-as-usual” (Harding, 1986: 25), we preclude the possibility of asking how we can radically reform it instead.
I say this because On Immunity represents a valuable contribution to public health, affirming the importance of the humanities in enhancing public understanding of these debates. While writing this review, for example, I stumbled across a pro-vaccination campaign deriding anti-vaccine celebrity spokespeople as “airheads.” Incensed at their suggestion that mothers who refuse vaccinations are “stupid,” I challenged them. To my surprise, a representative replied that although they understood that people’s fears and concerns came from a position of care and love, “science is not a democracy.” “That,” I responded, “is precisely the problem.”