On Immunity: An Inoculation

On Immunity: An Inoculation

by Eula Biss

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When Eula Biss became a mother, she stepped into a new world of fear: fear of the government, the medical establishment, the contents of her child's air, food, mattress and vaccines.

In this bold, fascinating book, Biss investigates the metaphors and myths surrounding our conception of immunity, and its implications for the individual and the social body. Weaving her personal experiences with an exploration of classical and contemporary literature, Biss considers what vaccines, and the debate around them, mean for her own child, her immediate community and the wider world.

On Immunity is an inoculation against our fear and a moving account of how we are all interconnected; our bodies and our fates.

Eula Biss is the author of Notes from No Man’s Land, winner of the National Book Critics Circle Award for criticism, and The Balloonists. Her essays have appeared in the Believer and Harper’s Magazine. She teaches at Northwestern University and lives in Chicago.

‘So well written, it’s unbelievable’ Bill Gates

‘It’s fascinating reading, made possible by Biss’ particular blend of scepticism and empathy…Although the book is beautifully written in minimal prose and organised sharply, it is hard to overstate the wealth of information threaded and elaborated throughout its tidy, sturdy structure.’ Saturday Paper

‘Her [Biss] exploration of the history of vaccinating is absorbing.’ Adelaide Advertiser

‘She advances from all sides, like a chess player, drawing on science, myth, literature…What she seems to be suggesting is that knowledge isn’t an inoculation. It doesn’t happen just once. There are things that must be learned and learned again, seen first with the mind and felt later in the body.’ New York Times Book Review

‘This elegant, intelligent and very beautiful book…is elliptical, elusive, neither collection nor narrative exactly but more a set of questions about how we frame our interactions with the world.’ Los Angeles Times

‘The power of Biss’s book stems, in the end, from its subtle insistence on the interrelationship of things—of the mythological and the medical, the private and the public, the natural and the unnatural—and on the idea that one’s relationship with disease and immunity is not distinct from one’s relationship with the world.’ Slate

‘Biss’s project, it turns out, is far grander than a simple explanation of the facts…On Immunity is as much a book about trust as it is a book about vaccines.’ Millions

On Immunity is a history, a personal narrative, ultimately a powerful argument that reads, the whole time, like a poem.’ Guernica

On Immunity casts a spell…There’s drama in watching this smart writer feel her way through this material. She’s a poet, an essayist and a class spy. She reveals herself as believer and apostate, moth and flame.’ New York Times

‘[Biss] brings a sober, erudite, and humane voice to an often overheated debate.’ New Yorker

‘Brightly informative, giving readers a sturdy platform from which to conduct their own research and take personal responsibility.’ STARRED Review, Kirkus

On Immunity needs no topical hook to recommend it, such is its power as a work of literature. Eula Biss is as fine a thinker as she is a stylist.’ Sydney Morning Herald

‘Biss has produced a book that’s like a luxurious quilt, beautiful and comforting…[her] approach is subtle and indirect, circling the subject to illuminate it from different angles.’ Weekend Press

On Immunity is essential reading for anyone genuinely interested in the subject. Pro or con, it will shake up what you think you know.’ Australian

‘Thoughtful and thought provoking.’ Otago Daily Times

‘A lively examination of many of the troubling aspects of how we make decisions for ourselves and our communities…[Biss] dispels myths and delineates our fears. She notes her own fallibilities and transient misconceptions, and through this brisk and readable book enlightens us all.’ On MAS

‘This important book is highly recommended for anyone interested in how vaccination works, its history and current debates… On Immunity richly rewards a casual dip and, indeed, can be sampled in almost any order to experience the beguiling, life-saving world of the immune system and all that surrounds it.’ Australian Book Review

Product Details

ISBN-13: 9781555973278
Publisher: Graywolf Press
Publication date: 09/30/2014
Sold by: Macmillan
Format: NOOK Book
Pages: 216
Sales rank: 141,297
File size: 2 MB

About the Author

Eula Biss is the author of Notes from No Man’s Land, winner of the National Book Critics Circle Award for criticism, and The Balloonists. Her essays have appeared in the Believer and Harper’s Magazine. She teaches at Northwestern University and lives in Chicago.

Read an Excerpt

On Immunity

An Inoculation

By Eula Biss

Graywolf Press

Copyright © 2014 Eula Biss
All rights reserved.
ISBN: 978-1-55597-327-8


The first story I ever heard about immunity was told to me by my father, a doctor, when I was very young. It was the myth of Achilles, whose mother tried to make him immortal. She burned away his mortality with fire, in one telling of the story, and Achilles was left impervious to injury everywhere except his heel, where a poisoned arrow would eventually wound and kill him. In another telling, the infant Achilles was immersed in the River Styx, the river that divides the world from the underworld. His mother held her baby by his heel to dip him in the water, leaving, again, one fatal vulnerability.

When Rubens painted the life of Achilles, the River Styx is where he began. Bats fly across the sky of that painting and the dead ride a ferry in the distance. Achilles dangles from his mother's hand by one plump leg, with his head and shoulders entirely underwater. This is clearly no ordinary bath. The three-headed hound who guards the underworld lies curled at the base of the painting where the baby's body meets the river, as if the baby is being plunged into the beast. Conferring immunity, the painting suggests, is a perilous task.

To prepare her children for the hazards of life, my own mother read Grimms' fairy tales aloud to us every night before bed. I do not remember the brutality for which those tales are famous as vividly as I remember their magic — the golden pears growing in the castle garden, the boy no bigger than a thumb, the twelve brothers who became twelve swans. But it did not escape my notice, as a child, that the parents in those tales have a maddening habit of getting tricked into making bad gambles with their children's lives.

In one story, a man agrees to trade with the devil whatever is standing beyond his mill. He thinks he is giving away his apple tree, but to his dismay he finds his daughter standing beyond the mill. In another story, a woman who has been longing for a child becomes pregnant and craves a plant called Rapunzel that grows in the garden of a wicked enchantress. The woman sends her husband to steal the plant and when he is caught, he promises their future child to the enchantress, who locks the girl away in a tall tower with no door. But maidens locked in towers will let down their hair.

And so it was in the Greek myths my mother read to me later. A king who had heard an ominous prophecy could not keep his daughter childless by locking her in a tower. Zeus visited her in the form of a shower of gold that left her pregnant with a child who later killed the king. When the infant Oedipus, left on a mountainside to die, was saved by a shepherd, he was not saved from the prophecy that foretold he would kill his father and marry his mother. And Thetis, Achilles's mother, could neither burn nor drown his mortality.

A child cannot be kept from his fate, though this does not stop the gods themselves from trying. Achilles's mother, a goddess who married a mortal, heard a prophecy that her son would die young. She made every effort to defy this prophecy, including dressing Achilles as a girl during the Trojan War. After he took up a sword and was discovered to be a boy, his mother asked the god of fire to make a shield for him. This shield was emblazoned with the sun and moon, the earth and ocean, cities at war and peace, fields plowed and reaped — the universe, with all its dualities, was Achilles's shield.

The story my father told me when I was young was not the myth of Achilles, he reminds me now, but another ancient story. As my father relates the plot, I understand why I confused the two. The hero of this story is made immune to injury by bathing in the blood of a dragon. But a leaf clings to his body while he bathes, leaving a small spot on his back where he is unprotected. After having been victorious in many battles, he is killed by one blow to that spot.

Immunity is a myth, these stories suggest, and no mortal can ever be made invulnerable. The truth of this was much easier for me to grasp before I became a mother. My son's birth brought with it an exaggerated sense of both my own power and my own powerlessness. I found myself bargaining with fate so frequently that my husband and I made a game of it, asking each other what disease we would give our child for prevention against another — a parody of the impossible decisions of parenthood.

When my son was an infant, I would hear many variations of "All that matters is that he is safe." I would wonder whether that was, indeed, all that mattered nearly as often as I would wonder if I could keep him safe. I was certain that I did not have the power to protect him from his fate, whatever it might be. But I was determined nonetheless to avoid the bad gambles of the Grimms' tales. I would not let my child be cursed by my own carelessness or cupidity. I would not accidentally say to the devil, You may have what is beyond the mill, only to discover that what is standing beyond the mill is my child.

The day before my son was born was the first warm day of spring. In labor, I walked out to the end of the pier, where the morning sun was breaking up the ice floes on Lake Michigan. My husband held up a video camera 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. During the long labor that followed that sunlit moment I imagined myself swimming in the lake, which became, against my will, a lake of darkness and then a lake of fire and then a lake without a horizon. 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.

That spring, a novel strain of influenza would begin spreading from Mexico to the United States to the rest of the world. I did not register those early reports, as I was too busy listening to my son breathe at night. During the day, I was entirely preoccupied by how much he did or did not nurse, and how much he did or did not sleep. I cannot now decipher the entries I made in a notebook then — long lists of times, some of them only minutes apart. Obscure notations next to the times indicate, I think, waking, sleeping, nursing, and crying. I was searching for a pattern, trying to determine what made my baby cry inconsolably. What made him cry, I would learn much later, was an intolerance to cow's milk. Offending proteins from the milk I drank passed through my milk to him — a possibility that had not occurred to me.

By the end of the summer, the evening news was running footage of people wearing white surgical masks in airports. The novel influenza virus was officially pandemic at that point. Churches were serving holy wafers on toothpicks, and airlines were removing pillows and blankets from their flights. What surprises me now is how unremarkable this seemed to me at the time. It all became part of the landscape of new motherhood, where ordinary objects like pillows and blankets have the power to kill a newborn. Colleges were daily sterilizing every "high-touch" surface, while I was nightly boiling every object my child put in his mouth. It was as if the nation had joined me in the paranoia of infant care. Like many other mothers, I had been informed of a syndrome affecting infants that had no warning signs and no symptoms other than sudden death. Perhaps this is why, despite everything, I do not remember feeling particularly scared of the flu — it was just one concern of many. There was lead paint, I knew, on my walls and hexavalent chromium in my water, and the books I was reading were telling me to run a fan while my baby slept because even stagnant air could suffocate him.

When I search now for a synonym for protect, my thesaurus suggests, after shield and shelter and secure, one final option: inoculate. This was the question, when my son was born — would I inoculate him? As I understood it then, 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. Would I enter into a gamble, like Thetis dipping the infant Achilles into the River Styx?

The mothers I knew began debating whether or not to vaccinate our children against the novel influenza virus long before any vaccine became available to us. We were hearing that what made this particular strain of flu dangerous was that it was new to humans, like the virus that caused the Spanish-flu epidemic of 1918 in which more than 50 million people died. But then we were also hearing that the vaccine had been produced hurriedly and that it might not have been fully tested.

One mother told us that she had miscarried while she was sick with the seasonal flu and, being wary of any flu now, she planned to vaccinate. Another mother said that her child had screamed frighteningly all night following her first vaccination and she would not risk another vaccination of any kind. Every exchange about the new flu vaccine was an extension of the already existing discussion about immunization, in which all that is known of disease is weighed against all that is unknown about vaccines.

As the virus spread, a mother I knew in Florida reported that her entire family had just had the H1N1 flu and it was not any worse than a bad cold. Another mother in Chicago told me that her friend's healthy nineteen-year-old son had suffered a stroke after being hospitalized with the flu. I believed both of these stories, but they told me nothing more than what the Centers for Disease Control and Prevention already seemed to be trying to tell me — the flu could be harmless in some cases and serious in others. Under the circumstances, vaccination began to seem prudent. My baby was just over six months old and I had just returned to work at a large university where the majority of my students would be coughing by the last week of classes.

That fall, the New Yorker ran an article in which Michael Specter noted that influenza is regularly among the top ten causes of death in this country and that even relatively mild pandemics of influenza have killed in the millions. "And, though this H1N1 virus is novel," he wrote, "the vaccine is not. It was made and tested in exactly the same way that flu vaccines are always made and tested." Some of the mothers I knew did not like the tone of this article. They found it insulting for the same reason I found it reassuring — it did not acknowledge any good reason for doubt.

The fact that the press is an unreliable source of information was one of the refrains of my conversations with other mothers, along with the fact that the government is inept, and that big pharmaceutical companies are corrupting medicine. I agreed with all these concerns, but I was disturbed by the worldview they suggested: nobody can be trusted.

It was not a good season for trust. The United States was engaged in two ongoing wars that seemed to be benefiting no one other than military contractors. People were losing their houses and their jobs while the government was bailing out the financial institutions it deemed too big to fail and using taxpayer money to shore up the banks. It did not seem unlikely that our government favored the interests of corporations over the well-being of its citizens.

During the initial aftershocks of the economic crash there was talk of "restoring the public's trust," though even then the emphasis fell more often than not on consumer confidence. I disliked the term consumer confidence, and I bristled every time I was encouraged to trust myself as a mother. I had little confidence, consumer or otherwise, but I tended to believe that confidence was less important than the kind of trust that transcends the self. Even now, years after my son's birth, I remain interested in the precise meaning of trust, particularly in legal and financial terms. A trust — in the sense of a valuable asset placed in the care of someone to whom it does not ultimately belong — captures, more or less, my understanding of what it is to have a child.

By late October, the mothers who were still talking about the flu vaccine were mainly talking about how hard it was to get a child vaccinated. My son had been on a waiting list at his pediatrician's office for over a month. Other mothers were waiting in long lines outside community colleges and public high schools. While we waited, a mother who did not vaccinate her children mentioned that she had heard there was an additive called squalene in the H1N1 vaccine. No, another mother countered, squalene was used in flu vaccines in Europe, but it was not used here. The mother who had originally mentioned squalene was not so sure — the fact that US vaccines did not contain squalene, she said, had been disputed elsewhere. "Where exactly is elsewhere?" one of my friends wondered. What, I wondered, is squalene?

The women with whom I debated the merits of the flu vaccine possessed a technical vocabulary that was entirely unfamiliar to me at the time. They used words like adjuvant and conjugate, and they knew which vaccines were live virus vaccines and which were acellular. They were familiar with the intricacies of the vaccine schedules of other countries, and literate in an array of vaccine additives. Many of them were, like me, writers. And so it is not surprising that I began to hear metaphors behind the technical language and information we traded.

Squalene is found in a great many living things including the human body, where it is manufactured in the liver. It circulates in our blood and is left behind in our fingerprints. Some European flu vaccines do indeed contain squalene from shark liver oil, but squalene has never been added to US-licensed vaccines. Squalene's presence in absence is something like the curious properties of thimerosal, the mercury-based preservative that was removed from every childhood vaccine except multidose flu vaccines by 2002. Well over a decade later, fear of mercury in vaccines persists.

My son finally got his flu vaccination in late November. We didn't know it yet, but the worst of the pandemic was already over — cases of H1N1 influenza had peaked in October. I remember asking the nurse if the vaccine my son was receiving contained thimerosal, but I was asking more out of due diligence than true concern. I already suspected that if there was a problem with vaccines it was not thimerosal, and it was not squalene.

What's that?" was my son's first phrase, and for a long time it was all he could say. As he learned to talk, I learned, in naming the parts of things for him, how often our language reflects our bodies. "We give a chair arms, legs, a seat and a back," writes the poet Marvin Bell, "a cup has its lip / and a bottle its neck." The ability to make and understand basic metaphors of this kind arrives with language, which is itself made of metaphor. Plumbing most any word will reveal what Emerson called "fossil poetry," metaphors submerged below the surface of our current usage. Fathom, a means of measuring the depth of the ocean, now means understand because its literal origin, using outstretched arms to measure cloth from fingertip to fingertip, was once used as a metaphor for grasping an idea.

"Our bodies prime our metaphors," writes James Geary in I Is an Other, his treatise on metaphor, "and our metaphors prime how we think and act." If we source our understanding of the world from our own bodies, it seems inevitable that vaccination would become emblematic: a needle breaks the skin, a sight so profound that it causes some people to faint, and a foreign substance is injected directly into the flesh. The metaphors we find in this gesture are overwhelmingly fearful, and almost always suggest violation, corruption, and pollution.

The British call it a "jab," and Americans, favoring guns, call it a "shot." Either way, vaccination is a violence. And when vaccination is intended to prevent a sexually transmitted disease, it seems to become a sexual violence. In 2011, Republican presidential candidate Michele Bachmann warned of the "ravages" of the vaccine against human papillomavirus and argued that is was wrong "to have innocent little twelve-year-old girls be forced to have a government injection." Her opponent Rick Santorum agreed, adding that no purpose was served by "having little girls innoculated at the force and compulsion of the government." The vaccine, some parents had already complained, was "inappropriate for girls of such a young age," and other parents feared it would encourage promiscuity.

Throughout the nineteenth century, vaccination left a wound that would scar. "The mark of the beast," some feared. In an Anglican archbishop's 1882 sermon, vaccination was akin to an injection of sin, an "abominable mixture of corruption, the lees of human vice, and dregs of venial appetites, that in after life may foam upon the spirit, and develop hell within, and overwhelm the soul."


Excerpted from On Immunity by Eula Biss. Copyright © 2014 Eula Biss. Excerpted by permission of Graywolf Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.


Barnes & Noble Review Interview with Eula Biss

After reading Eula Biss, it can be difficult to follow certain news stories without running them through a Bissian filter. Topic A for Biss, whatever she writes about, the author of three books and a professor at Northwestern University, are the irrational divides that steer how people respond to crises. And in that regard, Biss may be the most relevant essayist going: She's a lyrical epistemologist of dread.

She's accomplished this by taking difficult topics seriously, but with an intellectual flexibility that routinely finds surprising and unlikely connections. In her 2009 essay collection, Notes from No Man's Land, she soberly exposed the racist fears that worm their way into everyday life, lurking everywhere from telephone poles to Little House on the Prairie. In On Immunity: An Inoculation, she does much the same for the scaremongering tactics of anti-vaccination advocates like Jenny McCarthy and Dr. Bob Sears. "Our fears are informed by history and economics, by social power and stigma, by myths and nightmares," Biss writes. But not, she implies, by logic or good science — at least not often enough.

On Immunity was driven by Biss's research into vaccines as she was raising her young son. But though she dives into the squabbling over squalene and other alleged vaccine pollutants, her book encompasses sociology and literature as much as immunology. (As she explains below, Bram Stoker's Dracula becomes a particularly interesting novel when read as an extended allegory on disease and immunity.) And though the book is constructed out of a series of mini- essays, her wanderings never feel off-point or digressive. Indeed, they play into her chief argument that what's been forgotten in the recent vaccine wars is our need for interdependence — that we're connected with each other in ways and to degrees we are often afraid to admit.

"The natural body meets the body politic in the act of vaccination, where a single needle penetrates both," Biss writes. On Immunity argues that we've spent a lot of time selfishly focused on the former — our natural bodies — and not enough on the larger implications of our actions for society at large. Your decision to get that flu shot is more fraught than you already figured. The following is an edited transcript of our conversation. — Mark Athitakis

The Barnes & Noble Review: In the book's endnotes you describe yourself as "an essayist, a citizen thinker," and in the book you resist referring to yourself as a journalist. Why is that distinction important to you?

Eula Biss: There's a lot of essay writing that could pass for journalism, and journalism that could pass for essay. Some of it is just taxonomy. But I wanted to make it clear that I wasn't in this subject just to report, that I was approaching it from what I see as a slightly different tradition — the tradition of the personal essay. One essential element of that tradition is self-scrutiny. There is cultural critique happening in this book, but the cultural critique is emerging out of self-scrutiny. All of the fears that I'm looking at and critiquing are fears that I myself inhabited at one point or another. I was wary in this book of the sense that I was a journalist looking at this from the outside. I wanted to make clear that I was an essayist looking at this from the inside.

BNR: There's an implication that to be a quote-unquote journalist on a topic like vaccination is to be disingenuous. Journalism seeks out a balance, and seeking out a balance is perhaps inappropriate for a subject like this.

EB: Seth Mnookin, in his book The Panic Virus, does a really good job of looking at how journalists, in an effort to maintain the appearance of not having a bias, actually did a lot of damage in terms of spreading misinformation on the subject. Journalists would, for instance, quote a doctor or physician, and then they would go and find someone who had some different opinion about vaccination, and they would quote them as if their opinion held equal weight. This did a lot to spread some information that was just flat-out wrong, some of it distorted, some of it out of context. I think his book made a real difference in the way that this topic is treated by journalists.

I wasn't bringing the expectation of a kind of disinterested observer to this book. I had something at stake, and I wanted it to be clear that I had something at stake, and what exactly it was. In part that was the health and well-being of my child.

BNR: Your subtitle for the book is "An Inoculation." What is it an inoculation against?

EB: The subtitle actually started out as a little joke to myself. I didn't intend for it to remain as the subtitle. But once that subtitle stuck I did start to think of certain aspects of the book that I was uncomfortable with as working like an inoculation works. One of the things I was reluctant to do in this book was repeat fears of vaccination and risk spreading them further, because many of the fears of vaccination that I write about in this book were fears that I didn't know about and didn't have until other mothers shared them with me. I felt a little bit infected by fears I hadn't had before, and I didn't want to participate in doing that more.

So when I started thinking about the book as an inoculation, I saw the possibility that it could work the way a vaccine works. A vaccine introduces a small amount or a tempered version of the virus into the body — just enough to that the body is able to recognize it and deal with it when it encounters it again in the future. So I was thinking that maybe the book would work like this. If I introduced these fears to readers who may not have encountered them yet, perhaps I could introduce them in a way that would better equip those readers to deal with those fears the next time they ran into them.

BNR: It strikes me that the subtitle would be equally appropriate for your previous book, Notes from No Man's Land, since that dealt so heavily with fear of racism and its consequences. Fear is your great theme in a way.

EB: And I didn't see that coming. It was a surprise to me that this book picks up on so many of the themes and preoccupations of the previous book. I thought when I started this that it would be a radically different work. And it is in some ways; there are some formal and stylistic differences. But in terms of the questions it's examining and the ideas that it's engaging with, there's a number of places where it's building on work that I began in Notes from No Man's Land — the question of fear, and what things we do to each other out of fear. That was a major examination in Notes from No Man's Land, and it continued to be, maybe, even more dominant in this book.

But [there's] also the question of social responsibility and the question of what we owe other people. What do we owe the people we share our communities and our country and our society with? That question emerged in Notes from No Man's Land, and it came through even more powerfully in this book. Which is about a lot of things, but in some ways it's about citizenship and what our duties are as citizens.

BNR: Are there differences in the cultural nature of fear when it comes to racism and when it comes to how Americans have looked at vaccination?

EB: I gravitate toward the places where there are similarities. Sometimes they're even quite explicit. I mention in the book that during a smallpox epidemic at the turn of the twentieth century, there were people who believed that only black people carried the disease, and that only blacks should be vaccinated. This was a kind of projecting of their fears onto the bodies of a group that they already feared for other reasons. So there's a kind of overlap — that's a place where racism meets public health attitudes. And there's a common public health attitude that whatever the threat is, it isn't carried by me or someone like me; it's carried by the people I see as others. And what we have to do to control that threat is to manage those others, or to keep away from those others. Maybe one of the most striking differences to me is that we're a little more aware of the fears that we project onto other people out of a kind of racist impulse, and I detect less awareness around the way that fear plays into our attitudes around health.

BNR: It seems almost as if the concept of "herd immunity" [in which a critical mass of inoculated persons helps protect those who aren't] is almost counter to the American ideal. We pride ourselves on being rugged individualists. The suggestion that we all must come together in the name of herd immunity is unpatriotic in a way.

EB: Or it definitely challenges something that is precious to us culturally and historically. Though when I was working on this, a friend of mine who was reading these drafts and who's a poet, Rachel Webster, reminded me that there's an element to herd immunity that is connected to one of the main principles that this country is founded on, which is the idea of minority protection — the majority offering protection to a minority. That goes all the way back to why pilgrims originally came here, right? They were seeking a place where someone could practice a minority religion. Our constitution got built around the idea of minority protection. This is something that challenges the notion of individual rights and individual health and happiness — that we might have to accept some risk as members of the majority to protect members of a minority. But I do think that Rachel was right, that there's a competing philosophy that our country is built on.

BNR: Though there's a part in the book that seems to suggest that there's some erosion of that. You discuss the Polio Pioneers, where 650,000 children were volunteered by their parents in 1954 to test the Salk vaccine. You write, "It is hard to imagine that parents now making that request." What's changed culturally? Why couldn't we have the equivalent of Polio Pioneers now?

EB: Part of this may have to do with that particular postwar moment, when people were still very much feeling a call to duty. I think the sense of duty to your community, duty to your country, duty to those around you — I do think that we have very little of that right now. I don't think it runs strong in our rhetoric or our conversations about who we should be or who we are as a people. That poses some moral and ethical problems.

My sister is a Kant scholar, and one of the things that Kant explored was the concept of duties to yourself and duties to others. This is kind of a fundamental concept in ethics, that you do have duties to others. That doesn't seem to be something that we celebrate or talk about or support or celebrate culturally, right? In that moment, the Polio Pioneers moment, there was a lot of support for the idea that one had duty to one's country, one's fellow humans, and understanding that those duties carried risks. There were things that parents who enlisted their children in the polio trial didn't know. But I'm pretty sure they understood that there was some risk involved.

BNR: You run your discussion of vaccination through a number of fictional filters. You talk about Greek myths, Dracula, [Daniel Defoe's] A Journal of the Plague Year, and some contemporary vampire fiction. Why was vampire fiction the best filter for this?

EB: It's historically related to this subject. When I was researching the Victorian anti-vaccination movement, those activists often used a vampire as a metaphor for the vaccinator. That was my entry point; that's what got me reading Dracula and watching vampire movies and pursuing that fiction further. I wanted to investigate that metaphor. I wanted to see: Is a vampire a good metaphor for the vaccinator?

What I found was interesting and sometimes surprising. Definitely, reading Dracula, I immediately felt that Dracula was intended by Bram Stoker to function as a metaphor. But definitely not as a metaphor for the vaccinator. Dracula was obviously a metaphor for disease.

As I learned more about disease and I learned more about the viruses, I saw all these odd and surprising and eerie similarities between viruses and vampires. Both of them are not, strictly speaking, alive. But they do some of the things that living creatures do. They're both parasitic in that they need the body of a creature that's living in order to reproduce themselves and perpetuate themselves.

And they're both contagious; one of the interesting things about vampires, is that their vampirism is contagious. I also think, and Margot Adler points this out in a really lovely piece she did for NPR about contemporary vampire literature, vampires are a really interesting way to think about social power. The image of a vampire feeding off of someone else's blood is an invitation for us to think about what we ask of each other, and what it means for us to rely on each other's bodies and the ugly side of human interdependence, where we are parasites on other people around us. Though I also think it invites us into thinking about a more beautiful side of human interdependence as well — the idea that we do need each other to live.

BNR: You talk about the words that are connected to vaccination — stick, jab, shot. War metaphors abound, too, and you suggest that this can have a detrimental effect in how we perceive vaccination. If we changed the nomenclature, would it have an effect?

EB: I don't think it would be enough, for instance, to do away with calling it a shot and calling it an inoculation. I think we'd have to shift the whole suite of metaphors that we have and that we use around vaccination.

Most of those metaphors are violent or scary in some way. Even when we're not saying shot or jab, we're associating vaccination with pollution, for instance, and reproducing this idea that the vaccine is a kind of form of bodily pollution. When we talk about herd immunity, we're talkng about suggesting for some people this unpleasant idea of a herd — a stupid group of cows being herded off to slaughter, unthinking masses. Some of it is language, and metaphors do lodge themselves in our language. I don't think it would hurt for us to shift some of the language we use. But what would really help would be for us to use alternative metaphors, or more accurate metaphors.

BNR: At the risk of sounding like a literary agent, who is the audience for this book? Is this discussion of metaphor, however serious and legitimate, going to resonate given the tenor of the discussion that's promoted by the Jenny McCarthys and Donald Trumps and Dr. Bobs?

EB: As an expectant mother who was curious about the subject, I started reading everything I could get my hands on, including all the popular literature. Dr. Bob and everything else. And I was really dissatisfied by both the tone and the scope of most of the literature out there. I thought that it was insulting in terms of the intelligence level it assumed people were bringing to the subject. For instance, I felt deeply insulted by Dr. Bob's book [The Vaccine Book]. The assumption there is that the people reading it are not very intelligent.

And I think there's something really lacking in the conversation. At its worst, I think this conversation can border on being misogynistic. This is rarely made totally explicit, but there is this idea that the people who are making these decisions [about vaccination] are not very smart. The unspoken part is that these people are women. That's part of what I became really dissatisfied with very quickly when I was reading widely on the subject — this sense that I was being talked down to by almost everything that I read. So my project with this book was that I wanted to write the book that I wanted when I was an expectant mother. I wanted to write a book that would assume the intelligence of the reader and not pander, and ask some hard questions and offer possibly difficult or complex problems to the reader.

BNR: Does this book now put you on a public stage? Would you be comfortable debating Dr. Bob?

EB: I would be very uncomfortable debating Dr. Bob, because, still, I'm not an expert in this area. I don't really think that Dr. Bob is, either. But I'm aware of how fragile my grasp is on much of the science and much of the information here, so that I'm very uncomfortable posing or presenting myself as an expert. My husband has joked that he wants to make me a button that says, "I'm an Essayist, Not an Expert." I think the role is different. Part of the role of the essayist is to open questions, to do a thorough examination, to look at how we're thinking about the subject, to do my own hard thinking on a subject. But not necessarily to have total, unassailable expertise in that area. I don't have that, and I'm not at all ashamed to admit I don't have that.

BNR: It might help the conversation if people were more honest about that.

EB: I think so. Writing this book was extremely humbling for me. I had to go outside my comfort area with this book. And the more I learned, the more aware I was of how little I knew. This only became more complex the more I learned. I attended some lectures at the University of Iowa from an immunology professor there. I was sharing with him how overwhelmed I felt by the complexity of it, and he said, "Yeah, well, I hate to tell you this, but what you were just seeing is the most dumbed-down level that we offer. We offer another level for people who are medical students, we have another level for people who are going to go on to become researchers. And we have a final level for people who are really going to be researchers in immunology." I was only getting the barest information, and that alone was incredibly overwhelming.

So I think it would serve us well in this area to have some awareness of what we don't know. I think if you learn a little bit about this subject, it's easy to have opinions, and it's less easy to be comfortable in those opinions when you begin to understand all of the many factors that feed into this. There's personal health, there's epidemiology, there's public health. There are all kinds of different factors here.

BNR: And the rhetorical and metaphorical aspect on top of it. EB: I was definitely taking some cues from Susan Sontag. Her book Illness as Metaphor was a major inspiration for me in terms of looking at the metaphors we use around a subject as a way into looking into problems with how we're thinking. That's not brand new, but for me, when I started examining the metaphors that I myself was applying to vaccination, I realized where a lot of my fears and attitudes were coming from, and I realized they were coming from the metaphors. They weren't actually coming from anything that was real or true about vaccination.

BNR: You write that if we were responding sensibly to things we ought to be afraid of, we ought to be afraid of alcohol, cars, and mosquitoes. Not so much toxins in vaccines.

EB: Most every parent I know has made peace with the fact that their child is going to spend some time in automobiles. And even if you yourself don't own one, there will be buses to school, there will be taxis. That's statistically much, much riskier than a vaccination. But we've made peace with it because this is how we live. And I think we can apply that same attitude to vaccination. We could say that we acknowledge that there's some risk here, but look at how we live today. We live in a society where there are certain diseases we want to prevent, we don't want these to be in circulation. We've decided that it's worth seeing most infants through their first five years of life. This is just something that we have to do, and knowing that there will be side effects, just as we know when we put our child in a car that there could be an accident, and that it wouldn't be our fault, and that it would be a tragedy.

BNR: The book is structured as an assortment of mini-essays. When did you feel these pieces start coming together as a book?

EB: The form of this book was mysterious to me for quite a while. I began thinking that I was writing an essay, and I very quickly realized that I was probably writing a long essay, and as I continued to work it became clear that the long essay was almost certainly a book. But all through that process, the work was being done through this accrual of very short essays. They're not stand-alone essays. I was mystified by that. I didn't quite understand why that was happening, why this form was emerging. I'd expected as I worked that these would all merge together and that I would have one long, continuous essay. I fully expected that would happen, but as I was finishing the book, it wasn't happening; they weren't coming together, they were insisting on being their own distinct sections, but they also weren't fully autonomous.

But I realized that that formal element of the book is a reflection of one of the most important ideas that's in the book, which is that our bodies are to some extent distinct and independent but that we're also intrinsically interdependent. That's how these sections in the book are functioning. They have their own personality, many of them are very personal, some of them are very information-laden, some of them are more historical, some are more contemporary. So they're different from each other. They do to some extent stand alone and read as distinct independent pieces, but they're not independent pieces. They are on a formal level like metaphors for the problem that this book is discussing. That was thrilling and exciting for me to make that discovery — that there actually is a reason why the book is written this way. I didn't understand that until it was almost done, but once I understood it I thought it was important to preserve.

BNR: The sections don't have titles, but as I was reading I scribbled titles for them. A lot of them could be titled along the lines of "On fear of politics," "On fear of community." On fear of X, Y, or Z.

EB: Some of the fears are a reaction to our interdependence. The idea that we're totally interdependent is kind of terrifying. I think that part of what we're resisting when we resist participating in herd immunity or resist participating in public health is the idea that other people's bodies depend on what we're doing with our bodies, and that our bodies depend on what other people are doing with theirs. That can make you feel kind of powerless and out of control. It's scary. It's connected to the issue of fear, but it's also the way out of fear. I think that if you can accept or make peace with the idea that you cannot, solely through your own actions, safeguard your own body, then you can kind of relax into the idea of interdependence.

BNR: Just like stepping into a car.

EB: Right. My sister thinks that traffic laws are a really good metaphor for vaccination. She pointed out that most of us voluntarily stop at stop signs, and we do this for our own safety and for the safety of others around us. And all of us also know that we've probably blown through a couple of stop signs, and we've probably survived that experience. We know we can get away with it every once in a while. But we also have some sense of what would happen if everyone blew the stop signs all the time. If everyone blew the stop signs all the time, what would happen is kind of similar to what would happen if everybody refused to be vaccinated. We'd go from very little contagious disease to having a colossal, chaotic bloom of contagious diseases.

October 1, 2014

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