Reading “On Immunity” During a Measles Outbreak

Eula Biss's book on anti-vaccine sentiment helped me learn how to talk to the people I would otherwise blame

Syringe

In the days after I gave birth to my daughter, Washington state’s worst measles outbreak in decades made headlines. Two hundred fifty miles removed from the outbreak’s epicenter in Vancouver, Wash., I rocked my sleeping newborn while reading about the emerging public health crisis. Since my daughter cannot receive the MMR vaccine until her first birthday, she relies on herd immunity. As the number of confirmed measles cases rose from 36 to 55 to 71, the Google searches I relied on to assuage my first-time mom, postpartum anxieties assumed a more ominous tenor. In addition to researching cradle cap and milk supply, I began to seek information about Koplik spots and maternal antibodies.

Facts did not comfort me. More information just made my fear more real, and I found it just as frightening that other parents choose not to vaccinate when faced with the same facts. Nothing frightened me more than the fact the measles virus can contaminate an airspace for up to two hours in the wake of an infected person. The few times my husband and I ventured out in public with our newborn, the air chilled me, as if I could sense the presence of every sneeze and cough haunting the space. I felt like the older woman I gaped at on the bus in the days prior to giving birth, the woman who wore a surgical mask, latex gloves, and a plastic bag over her head and mumbled incessantly about chemtrails. I had never before had reason to fear the air.

“What will we do with our fear? This strikes me as the central question of both citizenship and motherhood,” Eula Biss writes. I was thinking about fear at three weeks postpartum, when I rose from the couch during my daughter’s nap to search my bookshelves for Biss’s On Immunity: An Inoculation. Several years earlier, when motherhood was still a theoretical and far-off state, I read On Immunity simply for the prose, for the way Biss blends research and criticism with personal experience, for Biss’s careful examination of immunity through the lenses of history, medicine, literature, economics, myth, and metaphor. The second time I read On Immunity, it was for Biss’s perspective on fear, for how she argues compellingly for vaccination without deriding parents who want to make informed choices and are fearful of harming their children. After all, even as I feared how other people’s decisions could put my infant’s wellbeing at risk, if there was one thing I now understood it was the overpowering desire to protect one’s child.

As the measles outbreak persisted in Washington state and cases surged elsewhere in the United States, I struggled with how to respond to the vaccine hesitancy that circulated among some of my friends and family. A relative who visited my newborn asked if we planned to vaccinate and described how their grandchild contracted a respiratory virus after receiving their four-month shots—an anecdote offered as evidence for the dubious claim that vaccinations can overload a child’s immune system. Still newly postpartum, I was either too anxious, or too exhausted, to muster a counterargument. Even though I affirmed our intent to vaccinate—in fact my efforts to confer immunity began with the Tdap and influenza vaccines I received while my daughter was in utero—I felt relieved when the conversation moved on to other matters. After the visit, I was troubled by how the topic of vaccination threatened to divide us even as we sat together on the sofa in my living room cooing over my daughter, and I was troubled by my timid response. Later, I would ask our pediatrician for advice about limiting our daughter’s contact with unvaccinated or undervaccinated children without being perceived as hyper-vigilant or damaging relationships with parents and children we care deeply about. “If you need to blame someone,” she said, “blame me.”

Only weeks before I had taught conversational inquiry as a form of argument to my first-year college writing students, but now I could barely remember the version of myself who emphasized the importance of making specific, arguable claims, gesturing to examples displayed on the screen behind me all the while breathing through Braxton Hicks contractions and carefully positioning myself to avoid the digital projector’s bright light and the exaggerated shadow of my protruding belly it would cast. After giving birth, I remained certain my husband and I would vaccinate our daughter, but I couldn’t quite figure out how we’d reached that conclusion, how to explain it without falling back on the social media rejoinder, “because science.”

The pages of On Immunity welcomed me into conversations about motherhood that were new to me, conversations that felt risky.

It’s not just that I lacked the energy in the weeks after childbirth to marshal facts and research findings to support vaccination. I also didn’t know how to disagree productively with other parents, especially from my position as an inexperienced new parent. During pregnancy, I had learned to speak cautiously about the decisions we were making, even when I felt confident in those decisions, because I was loath to imply criticism of other parents. The pages of On Immunity welcomed me into conversations about motherhood that were new to me, conversations that felt risky. During Biss’s son’s infancy, the 2009 H1N1 influenza pandemic and the ensuing vaccination campaign prompted mothers to debate the merits of the flu vaccine. Rather than censure these conversations for what they might reveal about our regard for science or rationality, Biss dedicates her book to other mothers, and to her own mother, and in an endnote writes, “In a culture that relishes pitting women against each other in ‘mommy wars,’ I feel compelled to leave some traces on the page of another kind of argument. This is a productive, necessary argument—an argument that does not reduce us, as the diminutive mommy implies and that does not resemble war.”

While Biss acknowledges the decision to vaccinate is not exclusively the purview of mothers, her decision to write directly to mothers is a nod to how her conversation partners have “helped [her] understand how expansive the questions raised by mothering really are.” I came to On Immunity for confirmation of my beliefs about vaccination, but found something more: the company of another mother’s mind at work, troubling the false dichotomy between public and private spheres. Just as Biss counts Rachel Carson and Susan Sontag among the mothers with whom she is conversant, so in Biss I found a much-needed companion. I recognized myself in her descriptions of life with a newborn: in her obsessive note-taking of nursing and sleeping times, in the way her hearing became so attuned to the sound of her baby crying that she perceived phantom wailing in the sound of jets flying overhead, in the monsters she imagined creeping at the windows during night feedings, in the compulsion to lie awake listening to her baby breathe. In those wakeful nights of early motherhood, I reached for On Immunity because I didn’t know how to protect my child from the decisions of other parents and the politicians who seized on vaccination as a wedge issue by framing it as an attack on individual liberty. Biss expanded my view of parenting, helping me to see how mothering is an act of citizenship, how the decisions I make for my child have consequences that reach far beyond the walls of our home.

Re-reading On Immunity during the current measles outbreak made me feel less alone in my fears about motherhood and citizenship. In her book, Biss demonstrates how our metaphors for vaccination—as well as our metaphors for the conversations we have about vaccination—can affirm or deny our interdependence, that is, the connections between our bodies and our body politic. In Biss, I found a model for how to talk with other mothers, how to become a more trustworthy conversation partner, even and especially when I am afraid. Learning how to disagree productively strikes me as essential both for being a mother and for being a citizen of the world.

When we are afraid, it’s much simpler to think in terms of familiar binaries—good and bad, natural and unnatural, public and private, us and them.

When we are afraid, it’s much simpler to think in terms of familiar binaries—good and bad, natural and unnatural, public and private, us and them. Biss sets out to disrupt these dualisms and in doing so, demonstrates the debate about vaccination has to do with nothing less than what it means to be human. For example, Biss’s response to parents who would prefer their children to develop “natural” immunity includes both an argument for our kinship with animals and machines based on Donna Haraway’s Cyborg Manifesto as well as an accounting for how the term “natural” favors the perspective of Euro-American colonizers and slavers—in other words, those responsible for bringing epidemic diseases like smallpox, malaria, and measles to the Western Hemisphere in the first place. This is a move Biss makes frequently throughout her book, demonstrating how the personal is political, making the point that “the natural body meets the body politic in the act of vaccination, where a single needle penetrates both.”

Vaccine hesitancy and fake news are words that do not appear in the pages of On Immunity, which was published in 2014, but Biss seems to anticipate the current measles outbreak as well as the viral misinformation that poisons our public discourse. “The fact that the press is an unreliable source of information was one of the refrains of my conversations with other mothers, along with the fact that the government is inept, and that big pharmaceutical companies are corrupting medicine,” writes Biss, reflecting on the 2009 H1N1 influenza pandemic. “I agreed with all these concerns, but I was disturbed by the worldview they suggested: nobody can be trusted. It was not a good season for trust.” When I read this now, as a mother and a citizen, I wonder: when has it ever been a good season for trust?

I spent the third trimester of my pregnancy discussing trust with my college writing students. As they evaluated sources for their research projects, we engaged the questions social media scholar Danah Boyd asks in her article, “Did Media Literacy Backfire?” As Boyd points out, teens seeking information about sexual health online, the conspiracy theorists behind #Pizzagate, and even parents who choose not to vaccinate are doing what teachers like me have taught them: “to question the information they’re receiving and find out the truth for themselves.” In their eagerness to demonstrate critical thinking, my students were often too quick to dismiss a source as biased simply because the writer constructed an evidence-based argument. They could critique sources, but they were inexperienced at assent. In other words, they did not know what to do with a source they deemed trustworthy.

Motherhood, as I discovered, requires many of the same research skills I wanted my college writing students to develop. Motherhood often means working from incomplete data and contradictory advice from experts and other parents to make decisions about every aspect of my child’s care, decisions whose stakes, because of my love for my child, feel staggeringly consequential. Like my college students, it means doing this work while transitioning into a new identity with new responsibilities, all while sleep-deprived. And it requires the discernment to recognize when it is appropriate to trust information sourced from others. Ultimately, Boyd makes a compelling case for assent: “I believe that information intermediaries are important, that honed expertise matters, and that no one can ever be fully informed. As a result, I have long believed that we have to outsource certain matters and to trust others to do right by us as individuals and society as a whole. This is what it means to live in a democracy, but, more importantly, it’s what it means to live in a society.”

Researchers recently released the results of a large study that offers further evidence the MMR vaccine does not increase the risk of autism. The same day, while scrolling through my news feed, I happened upon a post from a friend who in the years since we last interacted had become a mother and decided not to vaccinate. She posted a link to an article that questioned the study’s findings and admonished her followers to read studies for themselves and to fact check the articles they read and share. In the comments that followed on this post and subsequent posts, several other parents quoted from the CDC and NIH websites in their arguments against vaccination. How do we talk together about matters of import, especially when we don’t agree on what constitutes a fact? More than statistically significant results, these parents seemed to want what no study can provide: absolute certainty.

But what I can’t stop thinking about is the woman who made plain her fears by posting an image to the comments section that I can only describe as propaganda, a photograph that calls to mind a pietà, in that it depicts an adult child wearing a diaper cradled in the lap of his mother. The caption reads: “The herd who expects you to vaccinate your child will abandon, mock and ridicule you once you’ve made that sacrifice and injured your child on their behalf. And then they will expect you to do it again.” I reacted first to the image’s ableism, and then with sadness over the worldview the caption espoused, a worldview in which no one can be trusted. What does it mean to this woman, I wondered, to live in society?

“Belonging and not belonging is a common theme of children’s books, and maybe of childhood itself,” Biss realizes while reading to her son. These stories are about the kind of “us versus them” thinking that has come to characterize our public life. If vaccination is about who we understand ourselves to be as humans, it is also about who we are, or who we could be, to each other. The borders that separate our bodies are neither fixed nor impermeable, and our immunity to vaccine-preventable illnesses depends on each other.

When faced with uncertainty, I believe that trust can soften the fear.

Reading Biss renewed my conviction that as mothers and citizens we need to have productive, necessary arguments about vaccination and other matters of concern, conversations that demand better metaphors than warfare. Conversations like the series of hours-long living room sessions hosted by oncology nurse Blima Marcus, a member of Brooklyn’s ultra-Orthodox community. Marcus invited mothers to gather to discuss their fears about vaccinations. She listened to and validated their concerns even as she responded with evidence-based arguments. As a community member, she was able to address the underlying fears that made the ultra-Orthodox women more susceptible to anti-vaccination arguments while also connecting her arguments for vaccination to their values. In order to have these kinds of conversations, we need to cultivate trust. When faced with uncertainty, I believe that trust can soften the fear that forces us to extremes of dogmatic or cynical thinking.

At my daughter’s two-month well-child visit, I thought about the advice Biss’s father, a pediatrician, offered her. To seek medical care, he said, “You’re going to have to trust someone.” So it was trust I was thinking about as my husband and I cradled our daughter, leaning over the examination table while a nurse administered the rotavirus vaccine by compressing its oral applicator. A few drops of clear liquid dribbled like milk from the corner of our daughter’s mouth, but she consumed most of the dosage and the nurse seemed satisfied. Next, the nurse injected our daughter’s left thigh with the first of three shots, which in all would include the pneumococcal, DTaP, Hib, polio, and hepatitis B vaccines. I watched pain register on our daughter’s face. As she squirmed on the table’s thin paper, our ministrations were part restraint and part comfort. With calm efficiency, the nurse applied shiny, holographic band-aids. I dressed our daughter in her onesie, settled her into the car seat, and by the time we exited the waiting room she had stopped crying and fallen asleep.

Late that night, while washing my hands, something gleaming caught my eye in the bathroom mirror. There on my still-soft, postpartum belly, just to the right of my fading linea nigra, a third of my daughter’s band-aid was stuck to my skin. Like The Rainbow Fish who found happiness in sharing his beauty with the school of fish to which he belonged, my daughter’s bandage had rubbed off on me, a sparkle, a shimmering scale. As I peeled it off, I thought about all my daughter and I have shared, about how my daughter and I belong to each other and to all the other others with whom we share public space, and recalled Biss’s words, “The boundaries between our bodies begin to dissolve here.”

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