On Immunity : An Inoculation (9781555973278) (14 page)

From the advent of the conscience clause until now, the
Oxford English Dictionary
has consistently defined
conscience
primarily in terms of right and wrong. “The sense of right and wrong as regards things for which one is responsible” now appears in its first definition. The next six definitions mention ethical values, justice, equity, correct judgments, scruple, knowledge, insight, and God, with feelings and heart entering into the eighth and ninth definitions, along with the notations “now rare” and “obsolete.”

George Washington, a survivor of smallpox, wrestled with the question of whether or not to require inoculation for revolutionary soldiers long before vaccination became a question of conscience. In 1775, roughly a third of the Continental Army fell ill to smallpox while laying siege to Quebec. They were eventually forced to retreat in the first battlefield defeat of this country’s history. The deadliest smallpox epidemic the colonies had seen was in the process of taking 100,000 lives, but smallpox was endemic in England and most of the British soldiers were immune, having survived it as children. This was before the invention of vaccination, and Washington was reluctant to subject his troops to variolation, which had known dangers and was illegal in some of the colonies. Several times, he ordered inoculation and then withdrew the order days later. Finally, with rumors in the air of a British plan to spread smallpox as a form of biological warfare, Washington definitively ordered the inoculation of all new recruits.

If we owe the existence of this nation in some part to compulsory inoculation, we also owe some of its present character to the resistance against compulsory vaccination. Early vaccine refusers were among the first to make legal challenges to the growing reach of police power in the United States. We have them to thank for the fact that we can no longer be vaccinated at gunpoint, and perhaps also for the fact that women cannot be denied abortions. Some pivotal reproductive rights cases in the 1970s cited as their precedent
Jacobson v. Massachusetts
, a 1905 Supreme Court case in which a minister defended his refusal of vaccination on the grounds that a previous vaccination had damaged his health. But this case has also been used as a precedent for defending warrantless searches and the detainment of US citizens. The ruling in
Jacobson
was an effort to balance the interests of the collective and the power of the state against the rights of the individual. It upheld compulsory vaccination laws, but required that states offer exemptions for individuals who might be subject to injustice and oppression under those laws.

The United States has never had a federal compulsory vaccination law. In the early twentieth century some states had compulsory laws, but two-thirds of the states did not, and a couple states had laws against compulsion. In some school districts, children were—as they are now—required to be vaccinated in order to attend public school, but this requirement was often loosely enforced. A third of the school children in Greenville, Pennsylvania, for example, were granted medical exemptions from vaccination.

The only vaccine routinely recommended at that time was the smallpox vaccine, which had serious side effects and was frequently contaminated with bacteria. A new, milder strain of smallpox appeared in this country around the turn of the century and
Variola minor
, as it is now known, was killing only around 1 percent of the people who contracted it, as opposed to the 30 percent who typically died from
Variola major.
With smallpox taking fewer lives, unorganized opposition to vaccination became an antivaccination movement led by activists like Lora Little, who offered empowering advice: “Be your own doctor. Run your own machine.” In some places, armed mobs drove vaccinators away. “Vaccination riots,” the journalist Arthur Allen writes, “were not at all uncommon.”

Long before the term
immunity
was used in the context of disease, it was used in the context of law to describe an exemption from service or duty to the state.
Immunity
came to mean freedom from disease as well as freedom from service in the late nineteenth century, after states began requiring vaccination. In a peculiar collision of meanings, the exemption from immunity made possible by the conscience clause was a kind of immunity in itself. And allowing oneself to remain vulnerable to disease remains a legal privilege today.

Dictionaries aside, what it means to have a conscience may be no more clear to us now than it was in 1898. We do recognize when it is lacking—
she has no conscience
, we say. But what exactly is missing? I put this question to my sister, who teaches ethics at a Jesuit college and is a member of the North American Kant Society. “It’s tricky,” she says. “In the eighteenth century, Kant wrote that we have a duty to ourselves to examine our conscience. This implies that it’s not transparent, that it must be scrutinized and deciphered. Kant thought of conscience as an inner judge and used the metaphor of a courtroom to explain its operation. In the courtroom of conscience, the self is both judge and judged.”

I ask her if this means our conscience emerges from thought and is a product of our minds. “It’s an evolving concept,” she says. “It may have once been more closely associated with the emotions, but we still say we
feel a pang of conscience
—it involves a unity of thought and feeling.” Kant, she tells me, called the inner judge a “scrutinizer of hearts.”

“The part that’s tricky,” my sister says, “is how you discern between a sense of discomfort and what your conscience is telling you.” This question remains with me, and I am disturbed by the possibility that I could mistake the call of my conscience for something else. I ask a former professor of mine, a novelist who teaches the Old Testament as literature, how one recognizes one’s own conscience. She looks at me sternly and says, “It’s a very distinct feeling. I don’t think one’s conscience is easily confused with any other feeling.”

“Morality can’t be fully private,” my sister tells me, “for many of the same reasons that a language can’t be fully private. You can’t be intelligible only to yourself. But thinking of the conscience as a private sense of right and wrong suggests that our collective understandings of justice can be insufficient. An individual might resist flaws in the dominant moral code and thus create the possibility for reform—there are all sorts of historical examples of this. But another way to think about the conscience is as an inner voice that keeps your actions in line with publicly defendable moral standards. It reforms you.”

One of the mercies of immunity produced by vaccination is that a small number of people can forgo vaccination without putting themselves or others at greatly increased risk. But the exact number of people this might be—the threshold at which herd immunity is lost and the risk of disease rises dramatically for both the vaccinated and the unvaccinated—varies depending on the disease and the vaccine and the population in question. We know the threshold, in many cases, only after we’ve exceeded it. And so this puts the conscientious objector in the precarious position of potentially contributing to an epidemic. Here we may suffer what economists call
moral hazard
, a tendency to take unwise risks when we are protected by insurance. Our laws allow for some people to exempt themselves from vaccination, for reasons medical or religious or philosophical. But deciding for ourselves whether we ought to be among that number is indeed a matter of conscience.

In a section of
The Vaccine Book
titled “Is it your social responsibility to vaccinate your kids?” Dr. Bob asks, “Can we fault parents for putting their own child’s health ahead of that of the kids around him?” This is meant to be a rhetorical question, but Dr. Bob’s implied answer is not mine. In another section of the book, Dr. Bob writes of his advice to parents who fear the MMR vaccine, “I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the disease increase significantly.”

I do not need to consult an ethicist to determine that there is something wrong there, but my sister clarifies my discomfort. “The problem is in making a special exemption just for yourself,” she says. This reminds her of a way of thinking proposed by the philosopher John Rawls: Imagine that you do not know what position you are going to hold in society—rich, poor, educated, insured, no access to health care, infant, adult, HIV positive, healthy immune system, etc.—but that you are aware of the full range of possibilities. What you would want in that situation is a policy that is going to be equally just no matter what position you end up in.

“Consider relationships of dependence,” my sister suggests. “You don’t own your body—that’s not what we are, our bodies aren’t independent. The health of our bodies always depends on choices other people are making.” She falters for a moment here, and is at a loss for words, which is rare for her. “I don’t even know how to talk about this,” she says. “The point is there’s an illusion of independence.”

O
N BECOMING QUEEN in 1558, Elizabeth I spoke of inhabiting two bodies: “I am but one body naturally considered, though by His permission a body politic to govern.” She drew this idea from medieval political theology, but the notion of a body politic was already ancient then. The Greeks imagined the body politic as an organism, itself alive and part of a greater cosmic organism—both the citizen and the city were bodies within bodies.

Our contemporary belief that we inhabit only one body contained entirely within the boundaries of our skin emerged from Enlightenment thinking, which celebrated the individual in both mind and body. But what defined an individual remained somewhat elusive. By the end of the Age of Enlightenment, the body of a slave was allowed to represent only three-fifths of a person. Some people remained parts of a whole while others enjoyed the novel illusion of being whole unto themselves.

In response to a 1912 definition of biological individuality as the quality of being “rendered non-functional if cut in half,” Donna Haraway observes that this requirement of indivisibility is problematic for both worms and women. “That, of course,” Haraway writes, “is why women have had so much trouble counting as individuals in modern Western discourses. Their personal, bounded individuality is compromised by their bodies’ troubling talent for making other bodies, whose individuality can take precedence over their own, even while the little bodies are fully contained.” One of our functions, as women, is to be divided.

When my son asks me about his belly button, I describe the near-mythological umbilical cord that once connected us. I point to my belly button and tell him that all of us were once contained within another body on which our lives depended. Even a three-year-old, who is still wholly dependent on me but already accustomed to thinking of himself as independent, finds this perplexing. Speaking from a moment just before the Enlightenment, Queen Elizabeth expressed a paradox that eludes us to this day—our bodies may belong to us, but we ourselves belong to a greater body composed of many bodies. We are, bodily, both independent and dependent.

The natural body meets the body politic in the act of vaccination, where a single needle penetrates both. The capacity of some vaccines to generate a collective immunity superior to the individual immunity produced by those same vaccines suggests that the politic has not only a body, but also an immune system capable of protecting it as a whole. Some of us assume that what is good for the body politic cannot be good for the body natural—that the interests of these bodies must be at odds. But the work of epidemiologists and immunologists and even mathematicians often suggests otherwise. All sorts of risk-benefit analyses and models of herd immunity tend to produce the conclusion that vaccination benefits the individual as well as the public. When Harvard researchers recently used game theory to build a mathematical model of vaccination behavior during an influenza epidemic, they found that even “a population of self-interested people can defeat an epidemic.” No altruism is required.

Vaccines are regulated, recommended, and distributed by the state—there is a very literal relationship between government and vaccination. But there is a metaphoric relationship too. Vaccines govern the immune system, in the sense that they impose a particular order on it. British antivaccinators in the nineteenth century compared their movement to the Irish Home Rule movement, conflating the governance of a country with the governance of a body. We resist vaccination in part because we want to rule ourselves.

Attitudes toward the state easily translate into attitudes toward vaccination, in part because the body is such a ready metaphor for the nation. The state has a head, of course, and the government has arms, with which it can overreach its power. In
I Is an Other
, James Geary writes of an experiment designed to study the effects of using the body as a metaphor for the nation. Researchers invited two groups of people to read an article about US history that used bodily metaphors—the nation experienced a “growth spurt” and worked to “digest” innovations. Before reading this article, one of the groups was also asked to read an article describing airborne bacteria as harmful. Researchers found that the group of people who had read about harmful bacteria were later more likely than the people who had not to express both concern about bodily contamination and negative opinions on immigration, though the article about US history had not mentioned immigration. Without having the metaphor explicitly established for them, those people gravitated toward thinking of immigrants as bacteria, invasively contaminating the body of the nation. Where two issues are metaphorically linked, the researchers concluded, manipulating a person’s attitude toward one can affect how she thinks about the other.

“If thought corrupts language,” George Orwell famously suggested, “language can also corrupt thought.” Stale metaphors reproduce stale thinking. Mixed metaphors confuse. And metaphors flow in two directions—thinking about one thing in terms of another can illuminate or obscure both. If our sense of bodily vulnerability can pollute our politics, then our sense of political powerlessness must inform how we treat our bodies.