It’s a meticulously researched work and a depressingly necessary history, as recent reports coming from tony neighborhoods in Los Angeles, where there’s a whooping cough outbreak (Beverly Hills and Santa Monica), show vaccination rates that are as low as vaccination rates in South Sudan. Other scary ideas? In a major study, confirmation bias proves that people who are anti-vaccinations literally cannot be talked out of their position. Despite the fact that Biss’ searching for answers and relationships between what we think vaccination is and how it affects our community can, at points, take on the tone of your most concerned, worried, living-in-a-Park Slope Brooklyn brownstone mother (the book takes itself seriously and studiously and it’s exhausting), On Immunity is an important work of public health scholarship, a passionate and strongly argued argument that vaccinations are a duty and a service to our fellow humans.
While On Immunity may not quite be the book to wield at the Thanksgiving table when you’re arguing with your cousin who’s an anti-vaxxer — metaphors may not convince them — there’s still a plethora of fascinating ideas and insights that Biss brings to the table regarding the battleground of the human body. Here are five of the most potent:
1) Herd Immunity: Biss says that mass vaccination can be far more effective than individual vaccination through the principle of herd immunity. “The boundaries between our bodies begin to dissolve here… those of us who draw on collective immunity owe our health to our neighbors.” We have resistance to the idea of herd immunity as we don’t want to be compared to cows, but if we thought about our cooperation as more along the lines of hive immunity, or the wisdom of honeybees, perhaps we’d be more interested in community, as opposed to the lone wolf American individual, a loaded metaphor these days.
2) Variolation: The practice of infecting someone with a mild case of smallpox to protect them from illness went from China and India to England, and it came to America from Africa. Puritan minister Cotton Mather, in Salem Witch-era Massachusetts, learned about it from his Libyan slave, and when he convinced a local doctor to inoculate his remaining family and several hundred people, Mather would go on to say that variolation was a gift from God. It was an unpopular sentiment and someone threw a firebomb in his window as a response.
3) Vampires: The birth of Biss’ son required a blood transfusion, an operation that gave the writer visions of vampires. For her, the idea of vampire bloodsuckers related quite a bit to the life-saving trauma of her son’s birth. Reading about vampires, however, there’s the idea that “If you want to understand a cultural moment, you have to look at their vampires.” In this case, Biss felt like what vampires mean now is that “they give us a way of thinking about what we ask of each other in order to live.”
4) Ethics and Morality: Biss discusses whether vaccination is moral and ethical with her sister, an ethics professor at a Jesuit college. Biss’ sister discusses the tricky morality of personal and public conscience; i.e., what may be wrong to you, may be right in the public good. She follows this note with a story about how a small number of people can forgo vaccination without upping the public risk; but we see the threshold after we play with the line. “The health of our bodies always depends on choices other people are making,” her sister says. “The point is there’s an illusion of independence.”
5) Immune System: What we think of as “the immune system” can actually be seen as a metaphor for our body’s collective workings. It makes us feel empowered — we control our machines! — but powerless — what can we do when the machine is broken? It’s analogous to our representative democracy in that manner. And yet, because we think of our body as a complex system, one that we are arguably in control of, we bear the weight and guilt when it breaks down.