When I spoke with the essayist Eula Biss last month, Ebola was killing people in West Africa. Protesters across the country were condemning reactionary violence by white cops who felt threatened by black men. Republicans had swept midterm elections, assisted by ads about terrorists crossing the U.S.-Mexico border, the imminent threat from ISIS, and the dangers of Ebola.
In short, fear was in the air. And fear wasn't the only epidemic underway. Pertussis, also known as whooping cough, was spreading in Michigan, probably because of parents who, fearing vaccines, had chosen not to immunize their children against a sometimes fatal, entirely preventable infection.
In short, it was a good time to speak with Biss, whose brilliant, elliptical new book on anti-vaccination sentiment, "On Immunity," came out last September. "On Immunity" charts the tangle of anxiety, misconception, privilege and metaphor that surrounds opposition to vaccination. Part memoir, part cultural criticism and part science journalism, it is an elegant reflection on a very contemporary flavor of fear.
Over the phone, Biss spoke with Salon about action movies, race, fear, violence and vaccination.
What is immunity? There's the medical definition, of course, but I feel like you're aiming at something a little different.
That's true. Immunity in its political sense—which is actually much older than the [medical] sense that we use—means being exempt from punishment, or exempt from duty under a certain law. I was interested in thinking about how refusal of vaccination is a kind of political immunity. There's a cultural expectation that everyone will be immunized, in part to protect the entire population. When people refuse that expectation, they're indulging in a certain kind of political or social immunity.
You point out that people who oppose vaccination tend to be wealthier, whiter and more educated than the population at large. Why does this kind of social (but not medical) immunity hold a particular attraction for this demographic group?
I should say that there are a few different demographics that tend not to vaccinate.
I think there's a lot going on there, actually. Maybe the largest component is the kind of thinking that attends privilege. What I mean is a pattern of thought that's been developed over a long period of time.
One of the favorite narratives [of privilege] is that we've just worked harder, so we deserve more. But there's another narrative. It has to do with vulnerability, and that's a narrative that I first started thinking about and noticing when I was writing about race. It justifies certain ways of wielding privilege, on the argument that the person who is privileged is actually not powerful but very, very vulnerable and needing protection, and that the people who are dangerous are the people who are less privileged. There's a story line that runs something like this: vaccination may be OK for some people, but my child is uniquely vulnerable. My child is actually too vulnerable to receive this preventative medicine, and therefore I'm going to opt out of this public health initiative to spare my child this risk.
Which ends up penalizing people who do vaccinate.
It means that all of the risks of vaccination are carried by the people who are participating. In the end, the perception for people who are forgoing vaccination is that they're having the best of both worlds. The child is protected [because it’s surrounded by immunized children], but the child does not have to be exposed to any of the risks of vaccination. The problem with that thinking is that it's only true as long as [community-wide] immunity holds. In some areas immunity has been eroded so much that the child who's not vaccinated is now actually more vulnerable to the complications of infectious diseases.
We have life expectancies our ancestors could only have dreamed of, and yet we still experience these intense public health panics. It can feel as if there’s been an intensification of fear in our society, even though we’re safer than ever before.
There's a physician who writes about this—I think his name is Michael Fitzpatrick—who says that statistically we are safer and healthier and less exposed to dangerous chemicals than ever before, but our psychology does not seem to reflect that. We seem to be more frightened than we've ever been.
I was particularly interested in looking at the places, internationally, where there's a fear of vaccination. That happens internationally in countries like Nigeria and Pakistan. It wasn't all that hard for me to understand why people were feeling suspicious of vaccination. There's a lot of political instability, there's a lot of inconsistency in medical care, there's a lot of corruption. In the case of Pakistan, the CIA actually used a fake vaccination campaign to try to locate Osama bin Laden, so now vaccination is associated with espionage.
In comparison, we have relatively more economic stability, relatively better controls on our pharmaceuticals, relatively better government oversight, and relatively better healthcare in general, with more access for more people—but we still have problems. Part of what's going on behind the resistance to vaccination here is a response to problems in all those areas: It's a response to corruption in pharmaceutical companies; a response to problems in the way our government regulates and oversees things that have an impact on our health; problems with unequal access to medical care.
The healthcare system is large and confusing. To what extent does anti-vaccination sentiment involve individuals trying to reckon with these enormous systems that are just so hard for us to comprehend?
I think there are many, many facets to this question, and I think that is one facet. In some cases, lack of information and lack of understanding is compounded by the fact that vaccination works quite differently from other medical interventions. Just because you understand something else, like how stitches or aspirin work, it doesn't mean you'll understand vaccination in great detail without having it explained to you.
One of the shortcomings of our medical system is that doctors have very little time with their patients. There isn't really the time for a doctor to sit down and carefully explain to you how the vaccines are working, what each of the different diseases are that your child is being vaccinated against, why those diseases are of concern, who they're of concern to, and basically the whole public health strategy or justification behind mass vaccination.
When it comes to anti-vaxxers, science communicators and journalists have usually responded with a tide of data—and plenty of derision. You’re unusual, in that you’re being empathetic, and trying to understand the sources of vaccination fear. Is that ever difficult? Where does that empathy come from?
Part of it comes from having inhabited that position. When I started working on this book, I did decline the first immunization on my child's childhood schedule for hep B. Even though I myself wasn't vaccinating, I had plans to vaccinate. At the same time, I had this idea that people who didn't vaccinate at all were ignorant and simply didn't have access to the information that would convince them to vaccinate.
The more I talked with other mothers—many of them incredibly well-educated, some of them scientists—the less I felt that to be true. That's part of why my book doesn't go really heavily in terms of information. In many ways, I'm not convinced that it's about information. I think in many cases the true reason for avoiding vaccination is not medical. It's social or historical or political in nature.
A lot of socially expressed fears reveal deeper anxieties. I’m thinking, for example, of the way that Ebola quickly became tied up with political campaigns and anti-immigration rhetoric.
I was very interested in the nurse in Maine who violated her quarantine [after returning from West Africa]. One of the points she kept making was that this is a politically motivated quarantine, this is not being imposed for medical reasons.
Suddenly people had what felt like a good excuse to act on racist impulses—maybe a sublimated desire to just keep “those people” out. Suddenly there seemed to be a good excuse to take that sublimated desire and act on it, and say, "Aha, finally! Finally we have a good reason to just keep black people out."
So do we need little armies of Eula Bisses walking around, helping to inoculate citizens against epidemics of fear? How should we respond to these sublimated desires when they come up?
I do think the shouting-at-each-other tactic is hugely unproductive, and you see that around vaccination. Whatever your posture, whatever your attitude or argument, I do think that the important thing is for people to call an action what it is. That's the nurse [quarantined in Maine] saying this is political, not medical. That's for the rest of us to say that we see racist assumptions at work about this.
Reading your book, I kept thinking of the novelist Marilynne Robinson, who told the New York Times Magazine in October that "Fear has, this moment, a respectability I've never seen in my life."
Yeah, I read that too.
What kind of anti-fear language does our society have right now? Obviously, there are cases when fear is justified. But do we have a way to criticize other people’s fears?
While I was writing this book, I was noticing all the places where we celebrate fear culturally. I was watching a movie where a man's daughter gets kidnapped in France [ed: “Taken”]. The whole rest of this movie is the hero running around blowing up buildings in France. In the pursuit of protecting this one person, his daughter, he kills many, many people. The movie is assuming that we're willing to suspend the moral laws that would make those actions crimes because fear for his daughter’s life justifies the whole thing.
It's a situation where fear is celebrated and used as a justification for all types of violent actions.
I think you see a version of the same thing in places that are more highbrow and intellectual. If you don't approach your subject from a paranoid posture, the risk is that you'll be seen as naive and complacent, as someone who is kind of playing the fool to institutions of power. I felt that pressure very much as I was writing on this subject.
Those are ways of talking about fear that celebrate it, but your question was really the opposite. You asked how do we talk about fear in a way that exposes how dangerous it is to us socially.
I think some of that is happening right now. I saw it bubbling up around Trayvon Martin. In that case, there's actually legal support for the idea that if you feel afraid, you can kill someone. There are obviously a lot of people in this country who are uncomfortable with that. How afraid do you have to be before it's OK for you to kill someone? Some people feel a killing fear as soon as they see a black person, so that clearly is not morally admissible or something that we can culturally support.
We need to start thinking about how we treat our fears. Part of my inspiration for writing the book about vaccination was writing the book about race, which was where I started to understand fear as potentially violent and hostile to other people.
It's really hard to imagine the president getting up, FDR-style, and saying that one major danger of, say, ISIS is what our fear of ISIS will lead us to do.
We had that rhetoric once, right? “The only thing we have to fear is fear itself”—but we have shifted from that to “we have everything to be afraid of” and “we are terribly vulnerable.” You're right, it's very hard to imagine a president getting up and talking about how damaging the fear of terrorism has been to us, culturally and politically, and how much it's horribly undermined us. Looking at torture and all the other things that have been done in the name of counterterrorism, it's really quite disturbing what we've done in the name of our own fear.
As you point out in your book, there’s often a gender component to our discussions of science and risk. Especially with vaccination, it can feel as if the medical establishment is sort of mansplaining vaccination to mothers. Is there a better way to critique the idea of mother knows best?
Power is gendered, so even if we're talking about a female doctor talking to a father, there can still be that sense of mansplaining, because you have someone speaking from a position of authority and power to someone who is subject to that authority and power.
There are different kinds of knowing interacting in that space, in the interaction between a parent and a doctor. Both parties need the knowledge that the other parties hold. I try to do this in my interactions with my son's pediatrician. My knowledge is the observations I've made of my son's behavior, his symptoms, his diet. The doctor is also bringing a kind of knowledge that the parent doesn't necessarily have access to. I think some people approach their encounters with a doctor as a kind of competition between different kinds of knowledge—the doctor telling you this but I observe that—and I think that could be reframed as “the doctor saying this and I've observed that,” and making sense of the contradiction together.
When it comes to science-and-society issues, talking about multiple forms of knowledge is not always a popular approach.
I thought this a lot when I was reading popular literature about vaccination. I often thought of the kind of sexist assumption that doctors are cold and calculated and all they care about is numbers, and that the real warmth and humanity and knowledge of humans comes from parents, specifically mothers.
When I was doing my research, I became less and less convinced that that was true, in part because there is another kind of knowledge now that is often exclusively held by doctors because of the success of vaccination. Very, very few of the people I know of my generation have seen a child suffer from most of the diseases we vaccinate against. Very few people have seen a child suffer from measles; very few people I know have seen a child suffer from meningitis.
One of the things I found in interviewing pediatricians, immunologists and infectious disease experts is how emotional they became when they talked about the children they treated for these very serious infectious diseases that were preventable by vaccination. I spoke to an immunologist who became tearful when he was talking about a child he saw die from influenza. People who have seen that happen are deeply affected by it, and that's not about facts and figures but about real experience.