On Immunity–An Inoculation, Eula Biss. Minneapolis: Graywolf Press, 2014.

Summary: A collection of essays about vaccines, immunity, fears, risks, and related concerns about environmental pollutants and other dangers faced by the human community.

A few caveats at the beginning of this review. One is that this book was published in 2014. So it was not written in the context of our current polemics about vaccines to combat COVID-19. Also, the author is not a scientist but a talented writer who has won a number of literary awards and is currently an Artist in Residence at Northwestern University. She is the daughter of an oncolgist. She is also the mother of a child suffering many allergies.

The essays in this work reflect her background as an academic, writer, child of a doctor, and a mother. It is evident that she extensively researched this work. She explores the history of vaccination from which we learn that the term comes from the Latin name for the cowpox virus, from which the vaccinated developed immunity to smallpox. She explores how the understanding of immunity developed over the years, earlier issues with the safety of vaccination, and contemporary research and reporting systems that confirm the high level of safety and rarity of risks.

She makes an important point that the effectiveness of vaccines isn’t simply for individuals but for the communities within which they live and travel. Vaccines limit or eliminate infections when a large portion of the population is vaccinated. At one point she challenges the flawed reasoning that one doesn’t need to get vaccinated because others are. This only works when very few think that way, and an ethic that you can’t commend universally runs afoul of Kant’s categorical imperative. She observes, “Immunity is a shared space—a garden we tend together.”

But she is also a mom who wants to do the right thing for her child. Her personal concerns lead her to a sympathetic examination of the fears of others, the sources of reports about autism, and various contaminants in vaccines. She both acknowledge the continuing influence of these reports and how extensive research studies have refuted all of them. She explores the question of risk, and how highly unlikely risks, like a rare side effect that may be attributed to a vaccine, and the much more prevalent and often more serious risks of the disease vaccines are meant to prevent. In the end, she comes down on the side of vaccination–but hardly in an unthinking, “sheeple” fashion. She gently challenges being more afraid of inoculation than disease, and the luxury of entertaining fears that most of the world can’t afford.

She considers other chemicals in our environment from triclosan in our liquid soaps to plastics in our foods, drink bottles, and mattresses. She comes to recognize that there is no absolute immunity we can confer on ourselves or our children from all that could render harm. She experiences this herself when she required transfusion after nearly dying from an inverted uterus during childbirth, and has to trust the safety of the blood she is given. She balances this sense of our vulnerability with our amazing immune system, that can handle multiple vaccines at once because it responds to thousands of threats every day. She asks hard questions, reviews research and doesn’t simply accept authority, but also acts on the best evidence of the science.

The book wanders a bit. It is a collection of essays, not strictly a scientific or history piece. But it is also a human piece, rather than a clinical account or research paper. Biss does what we all need to do–listen, ask questions, be the parent, and learn to discern between flawed and reliable information, and make the best decisions one can. In many ways, this may be a helpful read for those with concerns about vaccines. It challenges us to make decisions not from a place of narcissism but enlightened self interest that also considers the common good. It is written from outside the current polemics, but reflects the concerns so many of us have.