Balancing unreason: vaccine myths and metaphors
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Is
any medical procedure more misunderstood or charged with anxiety than
vaccination? “We have more microorganisms in our guts”, observes Eula
Biss, “than we have cells in our bodies—we are crawling with bacteria
and we are full of chemicals”. Yet, to judge by the popularity of
anti-vaccination forums, increasing numbers of people believe that
introducing an attenuated virus into one's bloodstream to kick start a
life-saving immune response is unnatural and dangerous.
Is
this because viruses, like vampires, occupy a nether world between the
living and the dead? Or do our fears have more to do with the act of
vaccination itself—the “scarring” of flesh and the “violation” of what
we imagine to be pristine bodily spaces? All of these ideas and more,
suggests Biss in On Immunity: An Inoculation. As she shows in
her elegant and ruminative take on vaccination, inoculation—from the
Latin word for graft or implant—draws on a surprisingly diverse range of
metaphors. These metaphors evoke different anxieties in different
contexts, from fears of racial “contamination” and sexual “violence”, to
anxieties about environmental “pollutants” and our absorption into the
“herd”.
This is hardly surprising given the way that our
bodies prime our metaphors and metaphors govern the way we think and
act. What is surprising and demands more explanation, Biss argues, is
the persistence of these fears in the face of overwhelming scientific
evidence that vaccination is a boon to health and for the most part
safe. From fears that three-in-one vaccines will “overtax” children's
immune systems, making them more susceptible to asthma and allergies, to
anxieties about the “neurotoxicity” of thimerosal, these anxieties are
more prevalent today than ever. How else to explain the way in which
Andrew Wakefield's now discredited theory about the link between
measles-mumps-rubella (MMR) vaccination and autism was taken up with
such enthusiasm by the chattering classes or the popularity of
anti-vaccination sentiments in states like California, currently the
site of a growing measles outbreak?
One of the strengths
of Biss's thought-provoking book is that as a member of these soi-disant
classes and a mother herself, she does not shirk these questions but
confronts them head on. Indeed, her angst-ridden reflections on
inoculation are borne out of her own, seemingly innocuous conversations
with other Chicago mothers shortly after the birth of her son in the
spring of 2009. That was when a new, potentially deadly strain of H1N1
influenza (swine flu) began spreading across the USA from Mexico,
leading to urgent calls for Americans to immunise their children. But
for every public health pronouncement assuring Biss the H1N1 influenza
vaccine is safe, there is a mother on hand with an anecdote of how her
child screamed all night after the jab. Worried about making the wrong
choice, Biss finds herself caught in a shadow zone “in which all that is
known about disease is weighted against all that is unknown about
vaccines”.
The problem, Biss thinks, is that “people like
us”, by which she means white, college-educated middle-class American
women, do not think of public health as something that operates in and
through their bodies. They instinctively recoil from the concept of
“herd immunity”, imagining that vaccination is only a matter for the
poor and the underprivileged, when exactly the reverse is true.
Thankfully, Biss's father, a doctor who acts as the voice of authorial
reason, is on hand to put his daughter, and the reader, straight.
“‘Vaccination works’, my father explains, ‘by enlisting a majority in
protection of a minority’. He means the minority of the population that
is particularly vulnerable to a given disease.”
Indeed,
while recognising that for some mothers the refusal to submit to
vaccination is a form of protest against Big Pharma, Biss suggests it is
a particularly retrogressive protest that ends up penalising those
least able to protect themselves. “Unvaccinated children”, Biss writes,
“are more likely to be white, to have an older married mother with a
college education, and to live in a household with an income of $75 000
or more—like my child… Undervaccinated children…are more likely to be
black, to have a younger unmarried mother, to have moved across state
lines, to live in poverty.”
Biss's conclusion is that
although it is only natural for mothers to want to shield their children
from harm, absolute immunity is a myth. It does not matter how many
times Thetis dips Achilles in the River Styx, the spot where she held
his heel will always be vulnerable. Biss also gives a master class in
parsing statistics. Yes, one in 3 million children who receive the MMR
jab may develop encephalitis but the association is so miniscule as to
be statistically worthless. By contrast, in the days before measles
vaccination one in 1000 children who contracted measles developed
encephalitis—and some ended up paralysed.
That is the
true moral hazard invited by the anti-vaccination crowd. The problem is
that the intuitive judgments “people like us” make about such dangers no
longer bear much resemblance to the real risks.
