On Immunity : An Inoculation (9781555973278) (19 page)

If we extend the metaphor of the garden to our social body, we might imagine ourselves as a garden within a garden. The outer garden is no Eden, and no rose garden either. It is as strange and various as the inner garden of our bodies, where we host fungi and viruses and bacteria of both “good” and “bad” dispositions. This garden is unbounded and unkempt, bearing both fruit and thorns. Perhaps we should call it a wilderness. Or perhaps
community
is sufficient. However we choose to think of the social body, we are each other’s environment. Immunity is a shared space—a garden we tend together.

Page 7

In one of its broader senses, the word
inoculate
means “to join or unite.” More narrowly, it means to introduce a germ to the body of a person. Inoculation can include vaccination as well as variolation, intentionally infecting a person with smallpox to induce immunity. I have also seen the word used in a medical journal to describe the practice of putting a baby’s fallen pacifier in one’s own mouth before returning it to the baby—thus introducing one’s own germs to the child.

Page 8

After my son’s birth, I found myself in constant conversation with other mothers and the subject of our conversation was often motherhood itself. These mothers helped me understand how expansive the questions raised by mothering really are. In recognition of the debt my thinking owes to them, I have chosen, throughout this book, to use the word
mothers
in places where I could have used the word
parents.
I am writing to and from the women who complicated the subject of immunization for me. This does not mean that I believe immunization is exclusively of concern to women, but only that I want to address other mothers directly. 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.

Page 10

the fact that US vaccines did not contain squalene, she said, had been disputed elsewhere:
In 1997, a series of stories in
Insight on the News
magazine suggested that Gulf War syndrome might be linked to the presence of squalene, among other things, in the anthrax vaccine. There was no squalene added to the anthrax vaccine, according to the FDA and the Department of Defense, but some laboratory tests were able to detect minuscule traces of the substance. In a test conducted by the FDA, researchers suspected that the source of these traces was the people doing the testing. “Because of the difficulty of removing squalene-containing fingerprint oils from laboratory glassware,” they explained, “it is hard to know whether the squalene is truly present in some lots of the vaccine or is introduced by the testing process itself.”

Page 12

The metaphors I began hearing around vaccination when my son was an infant inspired me to reread Susan Sontag’s essay
Illness as Metaphor.
And then I read, for the first time, the essay she wrote a decade later,
AIDS and Its Metaphors.
“Of course, one cannot think without metaphors,” she reminds us in this essay. Her project in
Illness as Metaphor
, she clarifies, was not to argue against metaphor, but to free cancer of burdensome metaphors that obscured, rather than revealed, truths about that disease.

“The people who get to impose their metaphors on the culture get to define what we consider to be true,” George Lakoff and Mark Johnson write in
Metaphors We Live By.
My thinking about metaphor was informed by their book, and by
I Is an Other: The Secret Life of Metaphor and How It Shapes the Way We See the World
by James Geary. I reread
AIDS and Its Metaphors
many times over the years that I spent working on this book, and I consider Sontag one of the mothers with whom I conversed while I wrote.

Page 13

Human papillomavirus is the most common sexually transmitted disease in the United States and the world, and it is the sole cause of cervical cancer. The CDC’s 2006 recommendation that all girls should be vaccinated against HPV at age eleven or twelve led to widely reported concerns that the vaccine itself would encourage teenagers to become sexually active. A 2012 study published in
Pediatrics
, “Sexual Activity-Related Outcomes after Human Papillomavirus Vaccination of 11- to 12-Year-Olds,” found that promiscuity was not one of the side effects of the vaccine.

Page 16

He then goes on to evoke Mark Twain: “I heard once of an American who so defined faith: ‘that which enables us to
believe things which we know to be untrue’”:
Stoker is paraphrasing Twain’s famous quote, “Faith is believing what you know ain’t so.”

Page 19

The term
herd immunity
was first used in 1923, by researchers investigating bacterial infections in mice. The concept itself had been recognized much earlier, though its implications were not fully appreciated until widespread vaccination revealed that, for example, immunizing less than 90 percent of a population against diphtheria could reduce the incidence of disease by 99.99 percent. “That indirect protection occurs is obvious, both in logic and in observation,” the epidemiologist Paul Fine notes in his review of the literature on herd immunity, “Herd Immunity: History, Theory, Practice.” He goes on to explain that apparent exceptions to herd immunity do not refute the general principle, but only reveal that herd immunity can be fragile in certain circumstances.

Page 23

A number of friends had offered his name when I asked for a recommendation, and so had my midwife, who referred to him as “left of center”:
We had already abandoned my son’s first pediatrician for a new doctor by the time it occurred to me that the first pediatrician had been recommended to me almost solely because he did not ask his patients to follow the standard immunization schedule. It was this that defined him as “left of center,” though his attitudes struck me as more typical of right-wing politics.

Page 25

Unless otherwise noted, all my disease statistics throughout this book were drawn from the CDC or the WHO.

Page 25

Before the vaccine for hep B was introduced, the disease infected 200,000 people a year, and about a million Americans were chronically infected. Rates of hep B infection have declined by 82 percent since the routine vaccination of newborns began in 1991, but somewhere between 800,000 and 1.4 million people in the United States are still chronically infected.

Page 25

The risk of contracting hep B from a blood transfusion is extremely minimal—the Red Cross estimates it at between 1 in 200,000 and 1 in 500,000. While very small, that risk is probably greater than the risk of an infant having a serious allergic reaction to the hep B vaccine—the CDC estimates that risk as about 1 in 1.1 million.

The possibility, however remote, that I could have contracted hep B from a blood transfusion and passed it to my newborn son was alarming when it first occurred to me, but what ultimately disturbed me more was how many factors I had failed to consider when I made the decision not to vaccinate my son. I had not thought of his health in relationship to my health, or the health of our community at large.

Page 25

When the last nationwide smallpox epidemic began in 1898, some people believed that whites were not susceptible to the disease:
A new, milder strain of smallpox was circulating during this epidemic, as Michael Willrich notes in
Pox: An American History
, and it was sometimes confused with chicken pox or taken for a new disease. As a new disease, it was associated with outsiders and immigrants, hence the names “Cuban itch,” “Porto Rico scratch,” “Manila scab,” “Filipino itch,” “Nigger itch,” “Italian itch,” and “Hungarian itch.”

Page 26

Debates over vaccination, then as now, are often cast as debates over the integrity of science, though they could just as easily be understood as conversations about power:
In his history of smallpox at the turn of the century, Michael Willrich suggests that some of America’s efforts toward colonization were made possible, in part, through vaccination. The vaccination campaigns in the Philippines and Puerto Rico were conducted ostensibly for the health of the natives, with this becoming eventually a justification for an ongoing colonial presence, but they also had the effect of making those places safe for colonizers. Vaccination by force was made illegal in the Philippines only after millions of people had been vaccinated by the US military.

Page 26

Britain’s 1853 provision for free, mandatory vaccination:
This compulsory vaccination law, Nadja Durbach notes in her book
Bodily Matters: The Anti-vaccination Movement in England, 1853–1907
, was rarely enforced until 1867, when another vaccination act clarified the penalties for refusing to vaccinate.

Page 27

“Stop Coddling the Super-rich,” the
New York Times
headlined Warren Buffett’s 2011 call for tax reform. Our tax system is just one of the many mechanisms by which we collectively protect the most privileged among us while we neglect the more vulnerable. “These and other blessings are showered upon us by legislators in Washington,” Buffett wrote, “who feel compelled to protect us, much as if we were spotted owls or some other endangered species.”

Page 27

Think of the unvaccinated boy in San Diego, for instance, who returned from a trip to Switzerland in 2008 with a case of measles that infected his two siblings, five schoolmates, and four children in his doctor’s waiting room:
According to a 2010 study published in
Pediatrics
, “Measles Outbreak in a Highly Vaccinated Population, San Diego, 2008: Role of the Intentionally Undervaccinated,” the public-sector cost of containing this outbreak was $124,517. That does not include the $14,458 in medical expenses for the infant who was hospitalized for three days, or the lost wages and other expenses of the families whose unvaccinated children were placed under a twenty-one-day quarantine after exposure. “Despite high community vaccination coverage,” the study concluded, “measles outbreaks can occur among clusters of intentionally undervaccinated children, at major cost to public health agencies, medical systems, and families.”

Page 31

Some of our white blood cells combine and recombine their genetic material like random number generators, shuffling their sequences to create an immense variety of cells capable of recognizing an immense variety of pathogens:
No single person, I learned from the immunologist who explained this “recombinant” process to me, has the genetic material to respond to all diseases, but collectively humans have enough genetic diversity for humankind to survive any disease.

Page 35

A comprehensive report on vaccine “adverse events” was released in 2011 by a committee of eighteen medical experts
who reviewed 12,000 studies of vaccination for the Institute of Medicine:
This report is titled “Adverse Effects of Vaccines: Evidence and Causality” and can be downloaded in full from the Institute of Medicine’s website. The committee examined 158 possible adverse effects of vaccination, but found convincing evidence of only 9 adverse effects, 4 of which were related to contracting chicken pox from the chicken pox vaccine.

Over the two years it took to assess all the scientific evidence available to them, the committee worked without compensation. When I asked the chair of the committee, Ellen Clayton, what motivated them, she responded, “I was going to say the goodness of their hearts, and it’s that too, but the other part is that it’s an opportunity to contribute to policy making in the United States. There’s a strong history of the policy makers around vaccination relying heavily on a series of reports from the Institute of Medicine.”

The Institute of Medicine is an independent, nonprofit research organization whose mission is to help government officials and the public make health care decisions based on reliable information. Its members, medical professionals elected by their peers, donate their time and expertise to the institute’s studies. Members who sit on committees are screened for conflicts of interest and their work is examined by outside experts. In 1986, Congress assigned the task of periodically reviewing the risks of vaccination to the Institute of Medicine. The 2011 report was the result of the twelfth such review, and the largest study to date.

Page 36

The interplay between Paul Slovic and Cass Sunstein in “The Laws of Fear,” Sunstein’s review of Slovic’s book
The Perception of Risk
, is compelling in part because the two are working from the same information, but drawing different conclusions. Slovic is more generous to the average person, and more interested in examining the complex value systems that make the risk assessments of lay people so unlike the risk assessments of experts. Sunstein is less patient, particularly in cases where faulty risk assessments by the general public may lead to increased risk.

Ordinary people, Sunstein observes, tend to make some ordinary errors when thinking about risk. We exaggerate the risk of unfamiliar things, and minimize the risk of familiar things. We also have a tendency, as Slovic found in his studies, to believe that risky things carry little benefit and that beneficial things carry little risk. Our sense that hand sanitizer poses us little risk may inflate how effective we believe it to be. And if we believe that vaccines carry a high risk, we may also tend to believe they are ineffective.

Page 37

Bicycles, the
New York Times
reports, “are involved in more accidents than any other consumer product, but beds rank a close second”:
The information in this article by Sam Roberts, “Who Americans Are and What They Do, in Census Data,” was drawn from the Census Bureau’s 2007 Statistical Abstract of the United States. The raw data contained in the abstract’s tables can be misleading, as Roberts notes: “The table of consumer products involved in injuries does not explain, for example, that one reason nearly as many injuries involve beds as bicycles is that more people use beds.”