The measured and compassionate tone Eula Biss uses throughout On Immunity: An
Inoculation seems as if it should inoculate the book against controversy, but its subject matter is likely to land it right in the middle of the vaccination debate. I hope it does. I want it to attract enough attention and readership to become a significant player in that debate, to be honest. It certainly gave me plenty to think about, and I feel the need to express some of those thoughts here.
I’m not quite old enough to remember the polio epidemics, but I’m just about the right age to have been against immunized polio when the vaccine was still fairly new, and I can only imagine how grateful my parents must have been for its existence. My parents were children before most modern vaccines even existed, and while neither of them experienced lingering health complications from measles, mumps, whooping cough, or other formerly common childhood diseases–let alone polio–personally, I’m sure they knew people who did. When that generation became parents themselves and ways to protect their own children from those illnesses became available to them, I suspect the majority of them eagerly seized the opportunity.
Twenty years later, I was a parent myself, and it wouldn’t have even crossed my mind not to get the then-standard childhood immunizations for my son. (I may still have the card with his shot record in a box somewhere.) Granted, this was years before the controversial linkage between the MMR vaccine and autism-spectrum disorders was ever suggested, let alone disproved. People did have concerns about fevers and other potential side effects from shots, but I don’t think I ever encountered a parent in those days who worried enough about them to choose not to vaccinate.
On the other hand, I did meet some parents who wanted more vaccines available to their children; the chicken-pox vaccine wasn’t yet routine in the late 1980s, and I knew a few mothers who hoped it would become available before their kids could come down with the disease. My son did catch chicken pox–along with nearly every other child in his preschool during two weeks in the winter of 1988–but it was his only major childhood illness apart from a few ear infections, and at that young age, it was more of an inconvenience than a serious illness.
While I was reading On Immunity, I came across an interview in The Atlantic with Peter Salk. Salk’s father, Dr. Jonas Salk, developed the polio vaccine, and Jennie Rothenberg Gritz was interested in his thoughts on opposition to vaccines and reliance on “herd immunity.” I pulled some quotes (and added some emphasis):
Rothenberg Gritz: “People have been concerned by the idea that vaccines can cause disease in healthy children.”
Salk: “There are some subtleties to this. With pertussis, for instance, the old vaccine was based on using the whole killed organism. That was very effective, but because there were a whole lot of different kinds of proteins that were all mixed up, there were some side effects. Later on, they developed a so-called acellular pertussis vaccine, where you use purified materials from the bacterium. It doesn’t produce as strong or long-lasting an immune response—people need to have booster shots when they’re adults, for instance. But it doesn’t cause the same side effects.
“When my own son Michael was born 31 years ago, the whole-cell vaccine was still in use. Whooping cough was essentially gone in this country by that time, so from one perspective, why should we take the risk of causing a high fever or other side effects in our own child? I know I certainly thought about this a lot. But I just couldn’t bring myself to take advantage of the good that other people had done by immunizing their kids—to take a free ride, so to speak. Michael did end up developing a fever. But I couldn’t have lived with my decision if we hadn’t given him the vaccine.
Rothenberg Gritz: “Some vaccine opponents argue that as long as children live healthy lifestyles, they can either avoid illnesses like polio or recover quickly and develop ‘natural immunity.’”
Salk: “No. I wouldn’t hesitate to use very strong words about that. Of course it’s a good thing to live a healthy life, to keep the body strong and well-rested. I won’t rule out that it can help to protect against some types of disease. **But when it comes to these organisms that can be very damaging to people, I think it’s wishful thinking to imagine that a healthy lifestyle can protect against infection.
“And what we see is that many diseases are starting to come back. Measles is recurring; whooping cough is recurring. The kids whose parents are choosing not to immunize them are at risk, but so are babies and kids who might not be able to be vaccinated for one reason or another. These kids are no longer having the same benefit of herd immunity. Their level of protection is now eroding.”
Rothenberg Gritz: “Why do you think (this) misinformation has spread so widely?”
Salk: “Part of it is that people have become complacent because these diseases aren’t rampant anymore. During the polio epidemic, people were really frightened. This was a disease they didn’t understand, whose appearance they couldn’t predict, and it had terrible effects on kids. Swimming pools and movie theaters were closed. It’s easy to forget this now. Also, these days, there are a lot of concerns about living naturally and not wanting to be exposed to things that are made in a laboratory.
“But there are probably other forces at work. Back in the 1950s, people really looked to science and medicine as something that would make their lives better. But once the fear of these diseases began to subside, people started looking at other large-scale forces in the world—the Vietnam War, the government, and so on—and wondering, Can we trust large institutions? Can we trust pharmaceutical companies? I think that that’s something that’s driven people also.”
I didn’t start getting annual flu shots until a few years ago, and I still don’t think I’m in a category with particular risk for complications from the flu. But my husband swears by them–the only time he’s had the flu in two decades was the one year he didn’t get a shot–and our health insurance actually offers us a credit if we get the vaccine, so now I do. It’s still less risky than getting the flu.
Every summer, I discover that a few of my blogging friends are participating in writing posts for Blogust. This is a month-long blog campaign in support of the UN Foundation’sShot@Life Campaign, in which blog-post comments and shares lead directly to vaccine donations for children in developing countries:
“A national call to action for a global cause, the campaign rallies the American public, members of Congress, and civil society partners around the fact that together, we can save a child’s life every 20 seconds by expanding access to vaccines. By encouraging Americans to learn about, advocate for, and donate to vaccines, Shot@Life aims to decrease vaccine-preventable childhood deaths and give every child a shot at a healthy life.”
I think what Shot@Life is doing is very important. I’ve supported Blogust in the past, and I expect to do so again in the future. But I have to admit that I struggle to make sense out of the fact that this drive to vaccinate and protect children in poor countries coexists with a movement to stop vaccinating them in developed ones. Do we need to spread “herd immunity” more widely so that more children will be able to take advantage of that instead of taking shots? How is that possibly sustainable when immunity is not genetic?
I know it’s more complex than that, I really do. But even though I wasn’t around in the 1950s, I think I am one of those people Peter Salk mentions–the ones who believe in the potential good of medical science. I recognize the enormous privilege of living in a time and place where many once-devastating childhood diseases either no longer exist or are readily preventable through vaccination. I suppose that means that that choosing not to have one’s children partake in that form of prevention is a privilege too.
