Book Review: ‘On Immunity’ by Eula Biss

Combining personal experience with scientific research, Eula Biss examines our relationship with vaccines.

by Kinzy Janssen

As University of Iowa undergrads, my roommate and I worshipped visiting professor Eula Biss from afar. We tried to steal glimpses of her in the English building, and we pestered our mutual friend (who was lucky enough to have her as a teacher) to repeat what our idol had said in class. Biss’s collection of narrative prose poems, The Balloonists, thrilled us with the possibilities of how nonfiction could look (spare on the page!) and what it could sound like (poetry!). That was a decade ago, but it led me to approach On Immunity with a sense of reverence, barely breathing. Out today via Graywolf Press, On Immunity is a book-length essay that combines personal narrative with arguments both scientific and social. I savored it, but in a different way, because it felt at first like the work of another writer. Biss is neither a scientist nor a journalist by training; here she sounds like both. Imagine science writer Mary Roach, then subtract the humor and add mythology, vampires, politics, and metaphor. Yet I soon began to recognize the signature potency of Biss’s sentences, deceptively simple, unflinching, but always wholly earned. At the end of the third chapter, she asks what will become the book’s central question: “Do we believe vaccination to be more monstrous than disease?”

Several events in Biss’s life dovetail toward this question. When Biss gives birth to her first child, a son, her uterus inverts and she must immediately undergo a blood transfusion. This raises her consciousness of both her mortality and her body’s dependency on her community. Biss’s new baby is also placed into her arms at the height of the 2009 H1N1 flu pandemic, exacerbating those newfound feelings of protectiveness and vigilance. “It was as if the nation had joined me in the paranoia of infant care,” she writes, confessing to boiling his toys.

Then came the question: to vaccinate or not to vaccinate? She recalls how the threads of information about vaccination and risk were embroiled in a sticky tangle of what doctors were saying, what other mothers were saying, what her own gut was saying, and what the Centers For Disease Control were saying. The more she read, the stronger the impulse to sort reality from perception grew, until it became more than parental. Yet it is because she begins from a place of vulnerability (new parenthood, traumatic birth) and lack of bias (she claims she only had a 2-year-old’s understanding of germs) that we trust her. The reader has the privilege of following this learning process as she lives it.

Like us, Biss knows the industrialized world lurks with invisible threats, but she is able to wedge distance there and make fun of her own hand-wringing. “I concluded that Tricolsan was destroying our environment and slowly poisoning us all,” she confesses after reading one article about the antimicrobial agent. But she works hard to keep that paranoia at bay, and when she resurfaces from the “research rabbit hole” (like Alice in Wonderland, she “grows and shrinks, believes and doesn’t believe, and swims in her own tears”), her eyes are clear and her voice is steady: We need vaccination. Also, sorry, your immune system doesn’t kick as much ass as you thought.

Biss’s book is a timely one. Recently, accusations against vaccines have been simmering, especially in more affluent communities, where a growing number of “exemptions” have caused a revival of scary (but preventable) diseases. Jenny McCarthy is one of the most famous anti-vaccinators, claiming that they cause autism and contain “frickin’ mercury” and antifreeze. The warnings even circulate within Biss’s own friend group: one of them suggests vaccines are a “profit-driven scheme controlled by pharmaceutical companies.”

Biss picks off these fears one by one, execution style. She does this by citing studies and scientific consensus, yes, but she also places our fears in a broader context. This is where the book shimmers, because the insights are so disarming. For instance, she asks us to upend our fixed view of concepts like “natural.” When Europeans landed on America’s shores, disease wiped out three-quarters of the native population. “Considering this course of events ‘natural’ favors the perspective of the people who subsequently colonized the land,” she writes. And because Americans are still so tied to the mindset of the frontier, we “imagine our bodies as isolated homesteads that we tend either well or badly.” Hence the aversion to vaccines.

And yet, despite the book’s argument, Biss does not shy away from the weighty, often troubled history of mandatory vaccination. She informs us that in 1898, during the last nationwide smallpox epidemic, poor black Kentuckians were enlisted at gunpoint in a vaccination campaign that was intended only to protect rich white folks. And just a few years ago, a door-to-door polio campaign in Pakistan that was conducted by the CIA (in the search for Osama bin Laden) resulted in the killings of vaccinators. Biss pays tribute to an oft-overlooked history, and by extension assures us that she is clear-eyed and informed.

Biss pays tribute to an oft-overlooked history, and by extension assures us that she is clear-eyed and informed.

On Immunity is also an exercise in empathy, no matter which camp the reader falls into. Biss reminds us that most doctors are mothers and fathers, that vaccine inventors have bodies susceptible to disease, and that our children are both vulnerable to disease and dangerous as disease carriers, though we tend to see sickness as a foreign entity. Just look at the names of our diseases – the Spanish flu, the West Nile virus. Smallpox used to be known as the “Italian itch” or the “Mexican bump” and white New Yorkers did not even consider themselves susceptible to it.

As her argument progresses, she hints that the real epidemic in American society is the scourge of “us versus them.” We tend to see ourselves as virtuous individuals struggling against a big, power-hungry government (or big, power-hungry pharmaceutical companies), but this view is at odds with what is actually egalitarian medicine, offering us a way to both protect and be protected. Even vampires emerge as a metaphor for an ever-present “them.” But, she urges, can’t you identify with Edward’s moral dilemma in the Twilight Series? “Us versus them” is an omnipresent theme, becoming almost “meta”: as she writes, Biss works to collapse the boundary between writer and reader by assuring us that our fears are her fears. “We resist vaccination in part because we want to rule ourselves,” Biss writes, and I notice that the perspective here (and throughout the book) is “we.” She can identify with our, ahem, resistance to vaccination. Our misgivings are her misgivings. And eventually, her discovery is our discovery.

Ultimately, Biss likens community health to a garden we must tend together, or to a savings account that we all contribute to and draw from at some point. The book feels less like a vehicle for a pro-vaccine argument and more like a consensus. “We do not know alone,” she warns us about scientific discovery. The same logic applies to her book, which is woven together from a stunning range of sources; I was surprised to see almost 40 pages of citations at the end of the book. As more and more parents refuse vaccination and rates of preventable disease rise, this is our wake-up call, much like Rachel Carson’s Silent Spring (about which we learn some surprising things, including that DDT aversion is one of the reasons so many African children still die of malaria). Biss’s we’re-all-in-this-together plea is full of both hope and warning. I am hopeful if I can put this book into as many hands as possible.

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Kinzy Janssen is the social media editor for The Riveter. You can follow her @KinzyJ.