Welcome back to the Daily Dose and MedHum Mondays! Today, we review Eula Biss’s 2014 book, On Immunity: An Inoculation. Reboot Reviewer Anna Clutterbuck-Cook provides an insightful look at this work, and at the intersection of bodies, selves, and rights that makes up the debate over immunization. As presented recently on the Dittrick Medical History Museum blog, the drive toward vaccination was originally driven by community responsibility–and perhaps, now more than ever, that should be our focus.
Biss, Eula. On Immunity: An Inoculation (Graywolf Press, 2014)
Reviewed by Anna Clutterbuck-Cook
Recently, in preparation for a different book review, I read Alice Dreger’s One of Us: Conjoined Twins and the Future of Normal (Harvard U.P., 2004) in which the author encourages us to question the Western preoccupation with bodily autonomy as the prerequisite to a fully realized self. By centering the voices of conjoined twins, who almost universally understand their physical inter-relatedness as compatible with their individual senses of self, Dreger challenges singletons to question why physical autonomy has such a privileged place in modern political and medical cultures. What can conjoined persons teach us about what it means to be human?
I thought of Dreger’s work while reading essayist Eula Biss’ haunting On Immunity: An Inoculation (Graywolf Press, 2014). Like Dreger, Biss pushes us to reconsider our conception of individual bodies in relation to other bodies. In response to modern debates about the safety and efficacy of vaccination, On Immunity empathetically explores the anxieties of those who question inoculation — while ultimately challenging all of us to reframe the question in terms of community responsibility rather than individual safety.
Spurred by her personal experience weighing the pros and cons of vaccination for an infant son prone to allergic reactions and chronic sinus infections, Biss explores the history and science of immunity — and specifically of the human quest for immunity through vaccination. “It was not a good season for trust,” she writes of the first months of her son’s life — a time when the other mothers around her spoke bitterly of government ineptitude, media manipulation, and business interests compromising all sources of information. Like the women chronicled in Emily Matchar’s Homeward Bound (Simon & Schuster, 2013), the new mothers in Biss’ community struggle with questions of expertise and evidence — who can be trusted, and what type of evidence is good enough?
Biss offers no easy answers. Instead, she troubles our individualistic approach to immunity, challenging us to consider the possibility that we inoculate not primarily to protect ourselves but rather to protect the other. “Our bodies may belong to us, but we ourselves belong to a greater body composed of many bodies. We are, bodily, both independent and dependent,” she reminds us (126). While we may have the legal right to refuse inoculation for ourselves or our children, Biss argues that we may have an ethical responsibility to place the safety of more vulnerable bodies — infants, the elderly, those with compromised immune systems — ahead of that right.
On Inoculation is an incisive critique of the very American individualism that bolsters the case against vaccination despite the medical consensus on the safety and efficacy of inoculation as a tool for prevention of infection at the population level. The American discourse around vaccination has, Biss argues, too often been framed in terms of protection for the vaccinated — protecting the body from being invaded by impurity rather than protecting others from the impurities we may harbor. (After all, who among us would like to imagine our bodies as carriers of death rather than vulnerable to it?). Too often, “we” don’t need to rely on vaccination precisely because we imagine never intermingling our bodies with “them” — let alone imagining “we” might be the vector, not the victim, of disease. The discourses and practices around vaccination, as Biss points out, too often map the fault lines of class, geography, race, and health. To recognize ourselves (or our children) as candidates for inoculation is to recognize that we are, inexorably, part of a body politic within which we can both harm and be harmed.
Questions of bodily autonomy and physical purity are also deeply feminist concerns. As Biss reminds us, pregnant and nursing bodies — like conjoined bodies — trouble our Enlightenment notions of independence, vulnerability, and personhood. The classical liberal self is imagined as a self-reliant being, and thus threatened or compromised by the introduction of ill-health and interdependence — disease threatens not only our well-being but our very ability to be counted as persons, as citizens. To acknowledge ourselves as vulnerable, therefore, is to acknowledge our selfhood may be at risk.
One way to confront such a threat is to retreat into radical self-sufficiency (“it was not a good season for trust”) — but another would be to question the usefulness of that liberal model, and consider whom it serves and doesn’t serve; whom that model leaves vulnerable — and whether we are comfortable with a world that conceives of personhood in those terms. It is this latter approach that Biss tends toward in On Immunity, though she provides no clear path forward. Instead, her capacious and empathetic exploration of the history and culture of vaccination prompts us all toward deeper reflection.