On Immunity: An Inoculation by Eula Biss
I read this book several months before the whole measles thing broke and brought this topic bubbling to the surface. The New York Times had recommended it as one of the 10 best books of 2014 (New York Times, December 4, 2014) and for an avid non-fiction reader such as me, their short blurb made it very appealing.
I read it, found it fascinating, and returned it to the library…and then, a few months later, I bought my own copy as the immunization wars broke out this winter, so I could read again and study it with more concentration.
Note, In this column am limiting my reflections to the wider, more sweeping medical and ethical teachings that Biss brings forward, but it’s important to note that she also provides much hard science on safety, toxins, toxoids, the economics of vaccines, medical ethics, medical quackery and the prevalence of fear over fact. Her treatment ranges from Bram Stoker’s Count Dracula to Rachel Carson’s Silent Spring to the myth of Achilles (the first recorded attempt at immunization).
“Is inoculation a risk worth taking?” Biss asks herself as she contemplates her newborn baby, beginning to see things through her new-parent eyes.
Yes, it involves risk, as do so many (almost all) of the many decisions around parenting—including the decision to have a child at all.
And the real problem with vaccines turns out to be neither thimerosal (target of an earlier completely discredited piece of research which blamed thimerosal in vaccines for autism) or squalene (an ingredient never present in vaccines in America)—it turns out to be squishier things like lack of trust (in the government, in capitalism, in big pharma, in the medical profession), a preference for all things “natural” (including acquiring diseases “naturally,”) a kind of romance with the concept of “purity,” and the eternal life of anything posted on social media.
Biss initiates the topic of immunity with her reading of Kierkegaard and his exegesis of the commandment, “You shall love your neighbor as yourself,” asking the question “who then is one’s neighbor,” and providing Kierkegaard’s answer that “neighbor is what philosophers would call the other.” (p 17) She links this teaching to her childhood learning that her O-negative blood makes her a “universal donor,” which comes with an obligation to donate blood because others’ lives could depend on her willingness to share her blood
The obligation to the other becomes, in her analysis, an obligation to immunize because vaccine for a single body affects the “collective body of a community,” and represents a kind of “banking of immunity. Contributions to this bank are donations to those who cannot or will not be protected by their own immunity. This is the principal of herd immunity, and it is through herd immunity that mass vaccination becomes far more effective than individual vaccination.” (p. 19)
Any given vaccine may vary in its effectiveness and some vaccines are less effective altogether. When enough people are vaccinated, the spread of the virus from person to person slows down and may even stop. “An unvaccinated person is protected by the bodies around her, bodies through which the disease is not circulating. But a vaccinated person surrounded by bodies that host disease is left vulnerable to vaccine failure or fading immunity.” (p. 20) Immunity is a common trust as much as it is an individual choice. Those of us who draw on collective immunity owe our health to our neighbors’ health.
In every community there will be people who are not or cannot be protected by immunizations—they are too young, or immune compromised or on chemo or allergic to components in the vaccine (like eggs). There is a safety net that a community has a responsibility to provide its most vulnerable.
A Jewish view of this complicated tangle, is exemplified by the text Biss brings from her study of the text cited above via Kierkegaard, which we know from the Torah (Leviticus 18:19). I guess it could be interpreted as, “I will love myself by not vaccinating and I won’t compel you to vaccinate either,” (closer to “That which is hateful to you, do not do to others,” as Hillel taught [Babylonian Talmud, Shabbat 31a]) but it turns out that building community requires action rather than passivity and in the face of threat ( measles, mumps, whooping cough, flu and worse) we are obligated to shield one another by using the means at our disposal. This is what the issue looks like when viewed through a Jewish lens.
Biss points out that the words: immunity and community share the Latin root munis meaning service. I have tried to track down this entomological connection without much success but I have found that ‘munis’ is a Latin root meaning to defend, fortify, protect, secure, strengthen. This gives it a clear connection with immunization (that’s what they do) and with community (that’s also what communities do) even if this etymology is more ‘midrash’ than fact.
The injunction to build a parapet (Deuteronomy 22:8) comes to mind here. The commandment to construct a parapet (ma’akeh), a protective fence or barrier around a roof a mitzvah. If you neglect to make your home safe in this way, you actually transgress two commandments: failing to build a parapet, and creating a hazard. It carries the implication that we are obligated to do what we can to prevent foreseeable dangerous situations.
Immunization is a kind of parapet and immunization, like building a parapet, is a moral issue. “morality can’t be fully private,” Biss tells us (p. 123), As an example, she quotes a popular anti-vaccine doctor (known as “Dr. Bob,”) who urges parents to avoid vaccination because it’s OK to put their children’s welfare ahead of that of others, but also advises against sharing their fears with their neighbors “because if too many people avoid the MMR we’ll likely see the disease increase significantly.” (p. 123)
“Immunity is a public space. And it can be occupied by those who choose not to carry immunity.” (p 95). Those who choose not to immunize are “the 1%,” sheltered from risk by the choice of most others to immunize. This is related to the newer “restaurant model of medicine” (p 99) in which the patient has become a customer ordering from the doctor, now a waiter. The doctor serves up what the (privileged) consumer demands, leading to a situation in which “Doctors may be tempted to give patients what we want ven when it is not good for us.” (p 99)
As one of Biss’s reviewers has said, “the book itself is an inoculation against bad science and superstition and a reminder that we owe one another our lives.” (New York Times, December 4, 2014)
Or, as Marjorie Ingall has written, (The Forward, May 4, 2007) “Your right to swing your fist ends where it meets my face, and your right not to vaccinate your child should end where your front door meets the rest of the world.”
Read this book!