On Immunity: An Inoculation by Eula Biss (review)

In On Immunity: An Inoculation, essayist and author Eula Biss has given academics and clinicians interested in the public’s skepticism of vaccines, and of science skepticism more generally, a fresh look at what drives these phenomena. Despite public health’s continued success in maintaining high rates of coverage for vaccines across the United States, recent measles, mumps, and rubella outbreaks in the U.S. (and globally for that matter) have harmed lives and indicate cracks in the vaccine uptake façade. From a public health perspective, it’s all hands on deck to make sure vaccine coverage stays high. Biss’s outsiders’ view of these issues offers bioethicists, public health practitioners, and physicians much to consider as we address ongoing challenges to vaccination.

Do not read On Immunity expecting a scholarly analysis of the state of vaccine refusal and resistance. The book is instead part self-reflection (how Biss samples but rejects anti-vaccine sentiments), part observation (the ways vaccines both capture and reflect popular understanding and anxiety about the body, about germs, and about medicine more generally) and part research (into the history of anti-vaccine thought as well as its contemporary impact).

Throughout the book, Biss’s physician father acts as sort of a scientific straight man, laying out both the joys and challenges of medical and scientific practice. In one of these moments, Biss recalls how her father taught her about blood types, and about how both he and she were universal donors. With type O negative blood, Biss would come to understand her universal donor status “more as an ethic than as a medical concept” (18). This belief in a communitarian ethic runs throughout the book. “If we imagine the action of a vaccine not just in terms of how it affects a single body,” Biss writes, “but also in terms of how it affects the collective body of a community, it is fair to think of vaccination as a kind of banking of immunity.” “Contributions to this bank are donations to those who cannot or will not be protected by their own immunity,” she concludes (19).

For those of us who spend time considering vaccine policy, these are obvious points, as are the conclusions to be drawn from them. But what [End Page E-1] Biss offers its academic readers is a less jargon-filled and stilted way to talk about the importance and fear of vaccines, and thus provides some insight into what we might do to shore up vaccine coverage. One suggestion Biss has is to abandon the term “herd immunity.” In her analysis, it is a negative metaphor, one that “suggests we are cattle, waiting, perhaps, to be sent to slaughter.” “And it invites,” she continues, “an association with the term herd mentality, a stampede towards stupidity.” In its place, Biss suggests the concept of “shared immunity,” rooting the metaphor instead on natural examples like the cooperation of honeybees and collective problem solving. If the herd assumes we are foolish, the notion of shared immunity roots the nature of vaccine coverage in cooperation (21).

Some have read On Immunity as a weak embrace of anti-vaccinationism, if only to have the reader take a taste of it, understand its essence, and be “inoculated” against its impact (Oppenheimer 2014). But I read this book differently. In fact, this is less a vaccine-world Rashamon, and more of an opportunity for scholars and policymakers to view the challenges and mindset of anti-vaccine thought, through the eyes of a sympathetic yet disapproving observer.

Biss’s chapter on how popular misunderstandings of toxicity have seeped into anti-vaccine thought, for example, is especially relevant as policy makers and ethicists consider how to respond to the threats to herd or shared immunity. Fears of toxicity, which she acknowledges is a loosely defined idea in the public’s mind, can at once refer to the ingredients in vaccines, the accumulation of vaccines in the body, or environmental exposures more generally. Biss argues that such references to toxicity by both anti-vaccine boosters and the Gwyneth Paltrow...