Among the smaller of many striking lessons in Eula Biss’s elegant, intense essay on immunity is this: the phrase “conscientious objector”, now so intimately attached to those who refused to fight in the Great War, was first used decades earlier to describe individuals who would not let themselves or their families be vaccinated against infectious disease. Resisting state efforts at universal smallpox protection, American anti-vaccinators likened their campaign to the struggle to end slavery, while in Britain they invoked the cause of Home Rule for Ireland. As Biss notes, these seemingly atavistic souls were also early opponents of expanding police powers, and civil unrest was not unknown.
A century and a half ago “conscience” was the spiritual, moral defence against which medicine, bureaucracy and law conceded they had no licence or power. If the “vaccine riots” of the late 19th century seem today like outbursts of primitive unreason, consider that, even as I write, legislators in California are fighting to overturn the right of citizens to claim “personal belief” as a defence against measles shots, and that Tony Abbott, the prime minister of Australia, has announced a “no jab, no pay” policy that will stop welfare payments to parents who refuse to vaccinate their children. Hard-held convictions may still trump the common medical good.
A decade and a half after a supposed link between MMR and autism was first fraudulently bruited in the UK, you might think the new vaccine wars should have been won. But it seems that, like certain other wars, such controversies can no longer die. Their vampiric originators simply furl themselves in conspiracy theory and run their cargoes of ignorance and fear aground on different shores – in this case, the United States and the internet.
Medical paranoia
On Immunity
is a well-timed riposte to the present rash of “anti-vax” hysteria, touching also on the medical paranoia foisted on pregnant women in the West and the profitable nonscience behind anti-bacterial soaps, hand sanitisers and detox diets. Which constellation of topics ought to suggest that Biss is no credulous cheerleader for state, commerce or the medical profession. Ambiguity is precisely her theme; despite herself, she shares many or most of the fears she diagnoses in others.
Biss writes brilliantly about the swelling sense of vulnerability that came with her own pregnancy and the birth of her son. The baby was healthy, but Biss suffered an inverted uterus and bled everywhere – later, her husband describes the lapping sound of the blood, and a midwife says: “You’ve had a lot of people’s hands in you.” Her impression is that the world has turned leaky and porous, her body and her son’s subject at any moment to infinitesimal or even violent invasion. The child is allergic to cow’s milk, but his mother baulks too when he first drinks water, a voice in her head screaming “unclean!”.
Her supersensitive imagination takes on a Gothic cast; as she pushes his stroller through a sunny cemetery he reaches out to a sad little statue above a Victorian grave: “Did I worry my son would catch death if he touched the marble boy?”
Soon she has bigger things to fret about, with implications not just for Biss and her boy but also for the fragile network of organic and social relations that keeps them whole and healthy. When the time comes for her son to be vaccinated, her doctor explains the range of jabs and diseases, which includes hepatitis B – this one, he says, is really reserved for “the inner city”. By which he means black people. Never mind that hep B is one of those infections that refused to decline until a universal – not racially or geographically or economically targeted – vaccine programme was put in place. Biss remarks: “The belief that public health measures are not intended for people like us is widely held by people like me.” She finds herself surrounded by middle-class parents possessed by a curious amalgam of fanciful terror and undaunted exceptionalism – they truly believe they’re justified in keeping their kids inviolate, because after all the others have been vaccinated, so their own are safe twice over: from the disease itself and from its cure.
At the core of this renewed belief – or is it unbelief? – is a primitive-sounding but very modern idea of purity. The terror of “toxins” is a fear precisely of what is almost not there at all, whether it’s the minute amounts of mercury or formaldehyde in certain vaccines, or the vaguely defined “chemicals” in our food or cosmetics. If such fears have usurped earlier ones regarding infection itself, it is because vaccinations have made many diseases vanish in the West, and collective memory now struggles to recall the horrors of polio, let alone smallpox.
There is a kind of arrogance, a biomedical “presentism”, involved here: we imagine we’re historically beyond certain threats, just as some of us like to think race or class will inoculate us against low-born diseases.
Public sphere
And in recent years, Biss argues, such attitudes have got mixed up with perfectly rational fears of government and big business, to the point that when it comes to health and medicine, worried individuals distrust the whole public sphere, the very idea of community. The result, as with the recent measles outbreak in California, can be a ruinous undermining of collective or herd immunity.
Biss is as much alert to the metaphors at work in present attitudes to immunisation as she is to the medical controversies. (In fact at times they amount to the same thing; as she points out, the notion of an immune system is itself a metaphor.) Her book is troubled throughout by the foreign, invasive figure of Dracula; she dreams of vampires in the days after her son’s birth. Bram Stoker’s novel, she says, is very obviously a story about the threat of disease, but it’s more precisely about the ways information travels regarding that disease: all those diaries, letters, telegraphs and typewriters.
On Immunity too is in part a study of the way medical legends travel in the age of information.
"The body is not a battlefield," wrote Susan Sontag in her 1988 essay AIDS and Its Metaphors. She had in mind, as in her earlier Illness as Metaphor, the way we traduce the reality of disease with figures and symbols, whether alarming or comforting.
On Immunity has the force and lucidity of Sontag's assault on myth and pseudoscience, but it's written out of a more uncertain personal and political predicament. Where Sontag wished to burn away the fog of euphemism that surrounded her own experience of cancer, Biss knows that in the case of immunity, metaphor is impossible to displace. She is writing about diseases (and cures) that involve us with the bodies of other people, that remind us we are never ourselves, entire and alone.
Brian Dillon's The Great Explosion will be published by Penguin Ireland in May. He teaches critical writing at the Royal College of Art, in London
