In Sickness and In Health: Reading ‘On Immunity’

Book cover of On Immunity: An Inoculation by Eula Biss features a Reubens painting, Achilles Dipped In The River Styx. Baby being held by one leg and dipped in river up to navel.

When you are pregnant in Austria, you receive a booklet called the Mutter-Kind Pass (Mother-Child pass) which records all the exams during pregnancy, details of the birth and forms for mandated doctor visits including the immunization schedule for the first 2 years. As a mother I found it an incredibly useful and reassuring thing to have since it kept so much information in one place. It also saved me from having to think too much about what needed to be done. I’m a rule follower so the document hit my compliance sweet spot.

Looking back, I can say that the document provides an effective public health nudge to parents. For every encounter with physicians from pregnancy through the first two years, there’s a place to collect and track a slice of family health information. While I was able to see myself as a beneficiary of sound public health policy, through my compliance I also became an agent of public health. Few of us think of public health until there’s a crisis.

Author Eula Biss invites us to  accompany her on a journey to understand the interplay between health, immunity, disease and society. On Immunity: An Inoculation was published in 2014. In it Biss asks readers to consider how we arrive at and think about public health, particularly in response to disease prevention through immunization. To follow her lead in 2021 through this multifaceted and complex set of topics in the midst of a global pandemic feels like a lifeline I didn’t realize I needed.

COVID-19 has put us all on notice: We are interdependent. Public health is a shared endeavor. Individual actions hold consequences for the community with or without direct intention. That so many folks choose their personal privilege to publicly shop, dine, socialize, etc. over the opportunity to make their communities safer for everyone by putting those activities on hold tells us a lot about the trouble we are already in. Capitalist consumerism (and its destructive toll) seems determined to have the last word; sooner rather than later.

Eula Biss raises questions in these connected essays that offer us dry ground in an informational swampland. How are we related to each other in health and illness? Who is responsible for the health of the community? Which metaphors do we use to talk about immunity and how do they inform our actions? What does it mean as a parent to protect our children? I found myself both unsettled and sobered through these explorations. In each chapter we learn precisely how deeply these questions and their answers overlap and intersect. Biss consistently acknowledges the dark, the murky, the foreboding and the promising.

In considering the nature of risk perception drawing on research by Cass Sunstein, she notes

“…risk perception may not be about quantifiable risk as much as it is about immeasurable fear. Our fears are informed by history and economics, by social power and stigma, by myths and nightmares. And as with other strongly held beliefs, our fears are dear to us.” (p. 37)

I’ve been thinking about this quote ever since reading it the first time. Yes, our fears are dear to us. In an age where disinformation can take hold in the popular imagination faster and more fervently than ever, those dear fears mutate into an arsenal of potentially deadly actions (or inaction) that can hold communities hostage. We are living this reality right now as anti-maskers continue to assert their right to put themselves and others at risk of infection. The fear: that their rights (power) are being removed or curtailed. The threat of illness (to themselves or others) is not permitted to enter the discussion. Fear can make us do outrageous things. Our positional sense of power will influence our sense of appropriate measures we can and should take to counter those fears. In a different context I wonder about how the most entitled among us may respond when they feel threatened: call the police, demand protection, escalate violence, claim immunity

Biss raises the question “What will we do with our fear?” (p. 152) And I have to acknowledge that it very much depends on who you are and where the fear is coming from. Throughout the book, she bears witness to the ways in which race, class and gender impact who is most often in a position to decide how medical care will be administered and whose health will be prioritized in the face of contagious and other forms of disease. Eula Biss does not allow readers to dwell solely in the realm of well educated middle class whiteness from which she hails. She shows us other times, places and circumstances and how these connect to a present day health care system which still caters to privilege.

On Immunity is a work of tremendous care and nuance. Where we might be inclined to jump to conclusions, Biss offers us earnest words of caution. In describing the tendency of anti-vax adherents to buy into shaky research, she suggests that they

“…are not guilty of ignorance or science denial so much as they are guilty of using weak science as it has always been used – to lend false credibility to an idea that we want to believe for other reasons.

Believing that vaccination causes devastating diseases allows us to tell ourselves a story we already know: what heals can harm and the sum of science is not always progress.” (p. 70)

Her use of “we” is instructive. Underscoring the interconnectedness of individuals, communities and societies, she reminds us that “we are protected not so much by our own skin, but by what is beyond it. The boundaries between our bodies begin to dissolve here…Those of us who draw on collective immunity owe our health to our neighbors.” (p. 20)

Biss refuses to cast us in our anticipated roles. She resists painting sides with a broad brush. On the contrary, she uses detail from immunology, the history of medicine, vampire literature, and personal experience as a parent and daughter to provide us multiple ideas which both contribute to and complicate our understanding of disease and society. In the end, we are still in the swamp but perhaps better able to appreciate all the ways we are also of the swamp that we create on the daily.

The pandemic has not yet left us. As the vaccine rollout reaches larger numbers we can begin to hope for better days, safe in the company of friends and family. Some of us have learned more than our fair share about the limits of a society running on unchecked capitalism and worker disposability. The weight of our losses will bear down on us longer than we can imagine. Given the socio-historical moment I am grateful to have spent time with this exceptional writing. I step away mindful of my role in supporting public health and also wary of the faith I have to place in others to keep society afloat. The more I know, the more I fret. Thanks to Eula Biss my fretting at least has a home away from home.

On Immunity: An Inoculation by Eula Biss, Graywolf Press (2014).