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Eula Biss's inoculation against misinformation about vaccines

In On Immunity, the essayist explores the history and science of vaccination.



The day before their son, Juneau, was born, Eula Biss and her husband, John Bresland, walked to the end of the pier at Rogers Beach, across the street from their apartment on Eastlake Terrace. It was the first warm day of March. Biss was in labor. They knew their lives were about to change dramatically.

"My husband held up a video camera," Biss writes in her new book, On Immunity: An Inoculation, "and asked me to speak to the future, but the sound did not record, so whatever I said has been lost to the past. What remains evident on my face is that I was not afraid. . . .  By the time my son was born late the next day a cold rain was falling and I had crossed over into a new realm in which I was no longer fearless."

Parenthood for Biss began with emergency surgery and a blood transfusion; in a rare complication (one birth in 3,000), her uterus had inverted after delivery. But after the initial fright of waking up in an operating room, "lashed with tubes and wires" with the "sense that I had, indeed, gone down to the banks of the River Styx," all her fears were for Juneau.

After they came home, she filled a notebook with obscure notations tracking the times that he cried, and instead of sleeping, she huddled by the baby monitor at night listening to him breathe. She wanted to protect him from all the dangers of the world. With modern medicine, the best way to do this seemed to be vaccination. But there were so many stories about the damage vaccines could do. "As I understood it then," she writes, "this was not a question of whether I would protect him so much as it was a question of whether inoculation was a risk worth taking." She couldn't stop thinking about fairy tales and myths about parents who, in attempting to save their children, actually end up condemning them to death.

So she started doing research.

Now, five and a half years later, Juneau is a remarkably polite and patient kindergartner with his first pair of lace-up shoes, and Biss's due diligence research on vaccinations has expanded into the book-length essay On Immunity.

Biss is the sort of writer who likes to think her way toward her conclusions. Research, for her, begins with finding the right questions to ask, instead of looking for information to support a position she's already chosen.

"The subject was incredibly expansive," she says now. It's the week before school starts, and she and Juneau are spending an afternoon back at Rogers Beach; although they and Bresland recently moved to Evanston, into quarters that are both larger and closer to Northwestern, where Biss teaches nonfiction writing, they have a powerful nostalgia for Rogers Park. "It became an obsession."

On Immunity
  • On Immunity

Biss is 37, with a calm, thoughtful demeanor, much like the way she writes. Aside from a single college class in physiology, she doesn't have a scientific background; she has an MFA from the University of Iowa in nonfiction writing. ("One of the brave things about Eula as a writer is her confronting of topics she most thinks she's not qualified to write about," says Jeff Shotts, her editor at Graywolf Press.) She began by reading articles online and talking with other mothers, who'd developed impressive technical vocabularies, throwing around terms like "thimerosal" and "squalene." What, she wondered, is squalene? She learned it's an organic compound manufactured in the human liver. A version of it derived from shark-liver oil was used in European flu viruses, but never in the U.S., which made all the hysteria over it pointless. She talked with her father, an old-school physician who told her bluntly that parents who deliberately infected their kids with chicken pox instead of getting them properly vaccinated were idiots. She talked with a pediatrician who'd been recommended to her as "left of center," who assured her that because she and Bresland are white, middle-class professionals who don't live in an inner city, they didn't have to worry about vaccinating Juneau against hepatitis B.

Biss ended up skipping Juneau's first hep B vaccine, not because the doctor told her to, but because she was still uncertain. But his recommendation raised some questions for her that, strangely, related to her previous book, Notes From No Man's Land, a collection of essays about race in America. "I was back in familiar territory," she says, "how one person uses privilege. There are large numbers of people who don't have good access to health care. African-American children are more likely to be undervaccinated. There's poverty. It's a complex web. If I exercise privilege [not to vaccinate], I may not hurt Juneau, but his body serves as a vector for disease."

In On Immunity, Biss draws a distinction between the unvaccinated and the undervaccinated. Undervaccinated children have some of their shots, but not all; their lack of vaccination is not because their parents have decided to take a moral stand but because they simply don't have access to health care. During the pertussis epidemic in California in 2010, caused in part by parents in mostly white, mostly wealthy Marin County who chose not to vaccinate their children (though Biss emphasizes that there were other factors as well), ten babies died. Nine of them were poor Hispanics.

Vaccination has never been legally mandated in the U.S., though during the early 20th century, one-third of the states had compulsory laws. In her research, Biss learned how in 1898, during the last national smallpox outbreak, the black residents of Middlesboro, Kentucky, had been vaccinated at gunpoint. In 1853, Britain made a provision for free, mandatory vaccinations. Some working-class people resisted; they said it limited their personal liberty and compared it to slavery.

Vaccination works because of a concept called herd immunity: as long as a certain percentage of the population is inoculated against a disease, the other, unvaccinated, part will be protected, too. This fascinated Biss. (It was also one of the hardest sections of the book for her to write; an earlier draft, she says, was highly technical and almost entirely mathematical formulas.) Americans usually don't like being part of a herd: "The herd, we assume, is foolish," she writes. Perhaps a better metaphor, she suggests, is a beehive, where the health of each individual bee depends on the health of the hive as a whole.

An "antivaxxer" political cartoon from 1809 - GETTY IMAGES
  • getty images
  • An "antivaxxer" political cartoon from 1809

Inoculation against disease by variolation, the process of deliberately exposing a noninfected person to smallpox, existed for centuries before vaccination—specifically, inoculation by injection of the cowpox virus (which is similar to smallpox, except it doesn't cause disease in humans)—was discovered in the late 18th century. And, Biss discovered, "anti-vaxxers" have been around nearly as long. She found a handbill called The Vaccination Vampire from 1881 that reads like it was written by the spiritual ancestor of Jenny McCarthy, the former Playboy playmate and View host who has stridently—and, it turns out, inaccurately­­—blamed vaccines for her son's autism. It calls vaccinations the "universal pollution," sexual and economic corruption, delivered to "poor babes." (One of the luxuries of living in the 21st century, Biss observes, is that children are practically guaranteed to live into adulthood. In 1900, one in ten wouldn't live past its first birthday.)

It also led Biss to a particularly entertaining research tangent: vampirism, starting with Dracula. (She decided she could skip the Twilight series, but she did watch True Blood.) "There's something different about wanting to live forever," she says. "It's demented. Monsters live forever. I started thinking about the problem of privileging survival above all things."

"I thought, how would I feel if my son gave one of those [underprivileged] kids chicken pox? For him it's not a terrible thing. We have good insurance and easy access to health care. It's a different situation for another family. I didn't want to make the decision for them."—Eula Biss

In the 2012 film Abraham Lincoln: Vampire Hunter, there's a scene where Mary Todd Lincoln begs Lincoln to revive their son, who has just died of a fever. Lincoln refuses. "There's an interesting buried theme," Biss says. "You don't want everlasting life for your child at all costs. It's scary and monstrous. Wanting to survive is reasonable. Wanting your child to be healthy is reasonable." She looks over at Juneau, who is sprawled on the beach, arranging sand and rocks into what he will later explain is a platter of chicken wings. "Privileging your child's health over everything else becomes scary. It's vampirism."

She decided Juneau needed to be fully vaccinated. "It wasn't epiphanous," she says. "It took research and thought. It was a slow dawning." There were no problems, aside from a bad reaction to a flu vaccine; it was a nose squirt and, at the time, they didn't realize Juneau has asthma. He doesn't mind the shots, though. "After the shot, I felt great!" he exclaims before running into the water.

Still, there was one vaccine Biss was wavering on: the one for chicken pox, which hadn't existed when she was growing up in upstate New York in the 1980s. In her experience—middle-class, with a father who was a doctor—having chicken pox had been more of a childhood rite of passage than a serious crisis.

At Howard Playground, where Biss and Juneau used to play when they still lived in Rogers Park, there was a day care for underprivileged children. Biss noticed that the kids there were not getting everything they needed: their clothes were usually wrong for the weather, and they looked smaller than they should have been.

"I thought, how would I feel if my son gave one of those kids chicken pox?" she says. "For him it's not a terrible thing. We have good insurance and easy access to health care. It's a different situation for another family. I didn't want to make the decision for them."

She also learned that chicken pox isn't as harmless as she'd thought: before the vaccine was introduced, 10,000 children had been hospitalized with the disease every year, and of those, 70 had died.

Biss spent some time with scientists learning about the technical aspects of vaccination. "It was exciting and interesting, seeing how people in the sciences think about vaccines," she says. "It's different from laypeople. A common way of thinking about vaccines is that they're taxing or challenging to the body. Parents feel reluctant to get too many at once. Scientists didn't have that anxiety. The immunologist explained it best: we endure so much every day. There are more immunity challenges living life than a vaccine presents. Here at the beach, there's dog poop, everything in the water. It's way more challenging. One bacterium has thousands of immunological components. All the recommended vaccines together have 160."

Naturally, Biss felt obligated to look into the link between the measles-mumps-rubella vaccine and autism, the sticking point for many antivaxxers. The conjecture is based on a 1998 paper in the medical journal the Lancet by a British gastroenterologist named Andrew Wakefield that included a case study of just 12 children and concluded with a note that the study didn't actually prove there was a link between the vaccine and autism. Six years later, a journalist discovered that a lawyer preparing a lawsuit against a vaccine manufacturer had paid for Wakefield's research; his license to practice medicine in Britain was suspended in 2010 after an investigation by the British General Medical Council determined that his research had been unethical and irresponsible. The Lancet retracted the paper later that year.

And still, it's the study people remember, not its afterlife. "All the fears about autism are because we don't understand how to cure or prevent it," Biss says. "It's ripe for fear, anxiety, and irrational decisions. When people say they don't want vaccinations because of their feelings about pharmaceutical companies and drugs, they don't realize a drug is different from a vaccine. It's a different class called biologicals. What vaccines are are living things. It's beautifully elegant. Part of the beauty is harnessing our own immunity system to protect ourselves." (Modern vaccines use attenuated viruses, which is why they don't cause diseases.)

In On Immunity, as she did in Notes From No Man's Land, Biss argues that most people are self-interested, placing their own needs before the general good, because of their fears. "The more vulnerable we feel," she writes, "sadly, the more small-minded we become." Nobody, she points out, is completely isolated from germs or from any other dangers. But are you going to spend the rest of your life avoiding taking your child in the car—or to a public beach?

Biss isn't a polemicist, however. Her voice is cool, though not dispassionate; she relies on facts and reasoning and metaphors to make her points, not overheated rhetoric. Shotts, her editor, compares her to Joan Didion. At one point in the book, a doctor puts her off because he doesn't talk to the press, and Biss is momentarily confused, even though she's writing an article for Harper's. "In my mind," she writes, "I do not write for the press even if my writing is being published by the press. And if the opposite of the press is a poet, then I am both." She didn't conceive either On Immunity or Notes From No Man's Land as books about current affairs; instead, they're about questions that preoccupy her. When reporters called and asked her to comment on the situation last month in Ferguson, Missouri, she declined; she hadn't yet made sense of it.

"She's a writer asking questions for the long term," says Rachel Jamison Webster, a friend and fellow professor at Northwestern who read every draft of On Immunity. "It's a mistake to put work into too timely a moment. She's asking questions that are likely to reverberate."

"She's a citizen-thinker," says Shotts.

Biss herself is more modest: "I shoot for highly informative and aesthetically pleasing on the page. I hope I get to that place as a writer someday, like John McPhee."

She has a poet's gift for compression. (Her first book, 2002's The Balloonists, was a collection of prose poems.) If she'd used all the material she'd gathered, she told Shotts early on, On Immunity would have been an 800-page tome. Instead she sifted through and winnowed it down into 30 short sections. Some are dense, but their brevity keeps them readable. Both Shotts and Webster encouraged her to include her own feelings and experiences about being a mother trying to decide the best thing to do for her child. "It's an intellectual book with facts and ideas," says Webster, "but she hasn't forgotten her heart and why we struggle with questions. We want desperately to protect the people we love."

"I wrote the book I wanted to read when I was an expectant mother," Biss says. Perhaps that's the reason that, in the end, On Immunity is a forgiving book. It has to be: unless enough people band together, immunity doesn't work.

"The way disease moves, it shows our relationships to each other," she says. "We think of community in a limited way. The book exposed to me who is my true community, everyone who shares air, whether we know or like them or even know their name."

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