A health worker administers the polio vaccine to children in Yemen. Photo: Reuters
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How immunity became a political issue: Eula Bliss’s timely study of disease and vaccination

With "anti-vaxxers" dominating the headlines, Biss's new book is a thoughtful examination of how people feel about vaccines.

On Immunity: an Inoculation
Eula Biss
Fitzcarraldo Editions, 216pp, £12.99

In recent news, no one is immune from: making mistakes, random acts of violence, heartbreak, or our intention to thwart attacks against us. The metaphorical use of the word “immunity” (originally a legal, then a medical term) is, it seems, a temptation to which few writers are immune. At the same time, biological immunity (or the lack of it) is on our minds as carriers of the latest potential pandemic virus hop around international airports, or ebola vaccination trials begin in Africa. And for the worried rich who believe the misinfor­mation put about by “anti-vaxxers”, immunity from disease is to be weighed against the supposed risk of worse disease from the act of vaccination. Fear of the MMR vaccine, for example, is being blamed for the current outbreaks of measles in the US and Germany.

The word “vaccination” comes from “vacca”, the Latin for cow. (It was the country doctor Edward Jenner who successfully used cowpox to inoculate patients against smallpox in the late 18th century.) Notional cows crop up, too, in the widely used phrase “herd immunity”, one of those buried metaphors that Eula Biss regularly stops to unearth throughout this beautifully written essay. “The very expression herd immunity suggests that we are cattle, waiting, perhaps, to be sent to slaughter,” she writes. “If we were to exchange the metaphor of the herd for a hive, perhaps the concept of shared immunity might be more appealing.” And as bees and human beings signal to one another, so immunologists speak of immune cells within us communicating, interpreting and remembering. Biss even writes at one point of “cells that swallow pathogens and then display pieces of them for other cells to see”, as though our cells have tiny eyes.

This book is partly a fruitful archaeology of ideas about immunity – which sometimes seem to be metaphor all the way down – and partly a memoir: the subject took on visceral importance for the author once she gave birth to a son who turned out to have severe allergies. She was also surprised to find that many of her fellow intelligent, middle-class mothers believed all kinds of nonsense about vaccination. It’s true that vaccination can in rare cases, Biss points out, lead to complications such as fever (in people with weakened immune systems) or allergic reaction (in those with severe allergies). But the question of whether, say, MMR causes autism, as Andrew Wakefield suggested in 1998, is “not . . . the subject of any ongoing scientific debate”.

Herd or hive immunity, Biss insists, is a political issue, and riven with problems of class and power. Because herd immunity needs only the majority of a population to be inoculated to thwart the spread of disease, the unvaccinated children of the superstitious rich get a free ride from the vaccinated many. There is even a North American phenomenon of “chicken pox parties”, in which parents actively try to get their children to catch a disease that can later lead to the agonising nerve pain of shingles.

This long after Wakefield, it is still a surprisingly popular paranoid belief that vaccination is a harmful scam. Biss concludes, more in sorrow than in anger: “That so many of us find it entirely plausible that a vast network of researchers and health officials and doctors worldwide would wilfully harm children for money is evidence of what capitalism is really taking from us . . . When we begin to see the pressures of capitalism as innate laws of human motivation, when we begin to believe that everyone is owned, then we are truly impoverished.”

Another aspect of the paranoid mindset is the frequent dismissal of public-health responses to potential new pandemics as “fear-mongering”. The H1N1 “swine flu” did not go, as it were, supernova, but it still killed, as Biss reports, between 150,000 and 575,000 people – mostly in poor countries, thus enabling western cynics to pretend that nothing much had happened. “The complaint that preventive measures against the flu were out of proportion to the threat strikes me as better applied to our military action in Iraq,” she comments drily. Meanwhile the latest ONS figures suggest that ordinary flu was the cause of 7,000 excess deaths in Britain during a two-week period in January. Perhaps “flu” makes the disease seem too domesticated and trivial, and we should revert to “influenza”.

As there is no such condition as immunity from everything – whether influenza or the slings and arrows of outrageous fortune – so, too, there is no such thing as the global eradication of infectious disease. The future holds increasing antibiotic resistance and the certainty that some mutable virus will cause a pandemic on the scale of the 1918 Spanish flu, which killed between 3 and 5 per cent of the world’s population. In this context, immunity is also a problem of capitalism, specifically one of failing incentives: “Older vaccines make considerably less money than new vaccines,” Biss writes, “and vaccine production has not proved profitable enough to keep many companies from leaving the business over the past thirty years.”

Part of the suspicion of vaccination (among those who don’t have more serious things such as malaria to worry about) is a fantasy of bodily purity, Biss argues persuasively. Historically, the spread of disease was once explained by reference to “filth” – which was accurate enough in its way, although there was as yet no germ theory to explain why sewage and the like transmitted illness. Now, we worry instead about “toxins”. Scientists know that toxicity is all about the dose (drinking too much water will kill you) but the wider cultural chat becomes fixated on invisible molecular threats, “toxins”, that threaten to compromise the sanctity of our bodies – bodies that contain more bacterial cells than human ones. (And we go about “ritually sanitising our hands” with antibacterial liquids, though Biss points out that studies have found they are “no more effective at reducing bacteria” than ordinary soap.)

The notional purity of our physical engineering is also presumably the idea behind the argument that mitochondrial transfer amounts to “tampering with our DNA”. But other things have long been tampering with it already. “A rather surprising amount of the human genome,” Biss notes, “is made up of debris from ancient viral infections.”

The unscientific, New Agey fantasy of “detoxing” is one of purging undesirable chemical immigrants. Metaphors of border protection and war are routinely used, too, to describe the workings of the “immune system” itself (which is another metaphor, Biss points out, and of surprisingly recent vintage: the phrase was coined in 1967). It turns out that the barrier between such metaphors and the outside world is intriguingly permeable. How we think about micro-organisms that might enter our bodies affects how we think about human beings who might enter our countries. One study showed, Biss reports, that “people who had read about harmful bacteria were later more likely . . . to express both concern about bodily contamination and negative opinions on immigration”. On the other hand, people who had been vaccinated against the H1N1 flu “expressed less prejudice against immigrants” than those who hadn’t.

In some way, then, immunity from illness confers a measure of immunity from hatred – perhaps simply because the first eases fear. It is not clear whether the converse is true: whether stoking fear of immigration causes people to feel physically more sick. Perhaps, as the general election approaches, someone will try to find out.

This article first appeared in the 13 February 2015 issue of the New Statesman, Assad vs Isis

Marc Brenner
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Carey Mulligan is oddly unemotional in Dennis Kelly’s powerful new play, Girls & Boys

If you intend to see Girls & Boys, don’t read this review.

If you intend to see Girls & Boys, then you should do two things. First, come back to this review: it’s a production best seen with no preconceptions. Second: have a child.

Still here? Good, because there is no way to discuss this play without spoiling its big reveal. It opens with Carey Mulligan centre stage, in orange shirt and red trousers, against set designer Es Devlin’s boxy backdrop of purest cyan. It’s a palette favoured by Hollywood posters, because the contrast is so striking. (Van Gogh once used it on a still life of crabs.) Mulligan’s unnamed narrator tells us how she met her husband, who is only ever “he”. Her monologue starts off funny – “Paris? Call that a world city? It’s Leeds with wider streets” – and sexually frank, but it’s also cleverly disconcerting.

She met him in an Easyjet queue and “took an instant dislike to the man”. Why? Because he was obliviously buried in a book – or because of his interaction with two models, who tried to queuejump by feigning sexual interest to stand next to him? (“And he’s just like, well of course… but I get to sleep with one of you, right?”) One of the models snottily tells him that she would never sleep with a Normal like him, and he acknowledges the truth of this. Then he calls them “bitches” for playing with his feelings, makes a chivalrous speech about the transcendence of loving sex, and suggests that sleeping with them would be “necrophilia… wanking into a pretty dress”. The temptation is to cheer – he put those stuck-up cows in their place! – and I wondered if my disquiet was evidence I’ve gone full Millie Tant. (Beware men who think there are some women to whom it’s OK to be sexist.)

But no. The husband is indeed a wrong ‘un. Mulligan’s monologues are interspersed with role-plays against another pure-cyan set; a living room, with details – a sippy cup, a blanket – again picked out in orange. She chides her children, Leanne and Danny, talking to the empty air about their petty squabbles. And then, halfway through the 90-minute running time, comes the punch: “I know they’re not here by the way. My children… I know they’re dead.” My mind went instantly to a routine by Louis CK. “A woman saying yes to a date with a man is literally insane,” the comedian says. “Globally and historically, we’re the number one cause of injury and mayhem to women. If you’re a guy, imagine you could only date a half-bear-half-lion.”

The narrator’s story, of a relationship going sour, is achingly familiar. Her burgeoning career, and growing confidence; the failure of his business, and his consequent loss of status. She asks for a divorce. He tells her: “There will never come a time when you have my kids and I don’t.” One night, he sweet-talks his way past the babysitter and twists a knife into little Danny’s heart, guiding it in with his thumbnail, before stabbing Leanne eight times. (Mulligan marks each wound on her body.) He tries to kill himself.

My friends with kids tell me that giving birth rewired them, leaving them reluctant to watch any drama with children in peril. To me, Mulligan seemed oddly unemotional in recounting these horrors; but perhaps a parent’s imagination would supply all the horror required.

Is it a coincidence that this play had its premiere at the Royal Court, where artistic director Vicky Featherstone has led the theatre world’s response to a reckoning with sexual harassment? Her code of conduct outlines potentially abusive behaviour, from the obvious – “physical force or threat of force, for sexual action” – to the situational: “staring, meaningful glances”. Yet Dennis Kelly’s script, which depicts one poison drop of sexism blossoming into a manifestation of the most extreme masculine rage, shows how difficult such behaviour is to police. When should the narrator have seen the danger? How can women sort the good from the bad?

In an industry convulsed by a feminist reckoning, I was left wondering if a female playwright would have dared to write lines as starkly confrontational as the narrator’s conclusion: “We didn’t create society for men. We created it to stop men.”

Girls & Boys runs until 17 March.

Helen Lewis is deputy editor of the New Statesman. She regularly appears on BBC Radio 4’s Week in Westminster and the News Quiz, and BBC1’s Sunday Politics. 

This article first appeared in the 22 February 2018 issue of the New Statesman, Sunni vs Shia