Racism, Contagion, and the Dangers We Pose to One Another

In her book “On Immunity: An Inoculation,” from 2014, the essayist Eula Biss examines the varying, complex reasons that many Americans—and people all over the world—distrust vaccines. Biss charts the ways that we have been taught to think about inoculation, as well as the language we use to describe it. She connects the fears that we have about vaccines to larger concerns about the environment and government, and she gives a hearing to the parents who refuse to believe that their children’s health could affect the health of other children. As in much of her work, including an earlier essay collection on racism, “Notes from No Man’s Land,” Biss goes to great lengths to understand different points of view but can be withering about the danger of certain ideas, above all the desire to insure that our bodies and our behavior are “natural.”

With hope rising about the availability of a coronavirus vaccine within the next several months, I recently spoke by phone with Biss, whose latest book, “Having and Being Had,” examines the intersection of consumption and happiness—and her own adventures in home-owning. She explained that “On Immunity” was a “jumping-off point” for her latest work. “The psychology of capitalism is actually robbing us of something,” Biss said. “One of the things we’re being robbed of is our ability to trust other people. We need that in order to keep other people and ourselves safe. It’s really destructive to the social fabric.” During our conversation, which has been edited for length and clarity, we discussed the best way to talk to vaccine skeptics, the connections between racism and contagion, and why she finds something beautiful in the idea of herd immunity.

What is the biggest challenge we face as a society in terms of getting to a place where people feel comfortable taking a vaccine?

I’ve been thinking about this as I watch this whole thing unfold, and I feel like we’re living through the plot of “Jaws” right now. One of the big problems is that the mayor keeps saying everyone should go to the beach, even though we all know there’s a shark in the water. I think once that happens, you’ve broken trust or lost trust. In the book on immunity, I was thinking a lot about the role of trust and how trust is earned and how trust is lost. It was already clear back then, when I was writing in 2010, that there are problems that are specific to places where there’s really low faith in government structures and public infrastructure.

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One of the problems right now that I think we can see coming is that when people don’t have faith in their government and don’t trust their government and don’t feel like decisions are being made in the best interests of people’s health and lives, it’s going to be hard for them to trust a vaccine that the government has had a hand in making or testing or distributing. But we need the government for testing and distributing vaccines. I think we’re setting ourselves up for a bind.

Your book talks about why there is skepticism about vaccines, especially in foreign countries that might be victims of dictatorships or imperialism. But as you also point out, in America, skepticism about vaccines often comes from educated, white, privileged people who you’d think would have generally good reason to be trustful because, broadly speaking, life has been good to them. How do you understand that paradox, if it is one?

I’m not entirely sure it is a paradox. I think there are a number of different things going on there. I think for some people that skepticism of vaccination or resistance to vaccination really is an expression of, or an extension of, a privileged attitude—a sense of “I’m going to let other people take this small risk, and their risk-taking will protect me.” I think that that’s a quintessential thought pattern of the privileged. Let’s let others do the work for us.

That’s not what’s going on with everyone. I think that that’s one of the things that gets lost when we reduce conversations about vaccination to pro and con, and when we think about an anti-vaccine stance as a homogenous position. A lot of the people I talked to when I was working on that book—and most of them were women—were very well educated. Many of them would point to historical events or realities when they talked about their own vaccine skepticism. Some of them pointed to things like the Tuskegee syphilis experiment. That was, for them, a reminder that the government has engaged in medical testing that hasn’t had its citizens’ best interests in mind. Also, people would point to an entire history of misogyny and sexism in medicine and the way in which women’s bodies, knowledge, and professionalism has been marginalized in that space. I think there are many anti-vaccine positions that are coming from awareness.

That doesn’t mean that the smart or socially aware thing to do is not to vaccinate. I think that the suspicions and lack of trust are raised, actually, by a historical awareness—and that the way to address those suspicions and fears is with a really rigorous and transparent system for safeguarding the health of people who are getting vaccines, and to be rigorous and transparent about the way vaccines are tested and monitored.

You wrote in the book that “the metaphors we find in this gesture are overwhelmingly fearful, and almost always suggest violation, corruption and pollution.” You’re talking about getting a vaccine shot. Why is it that the language we use around vaccines is so fraught?

I think, as with everything, that the language exposes. The language is telling. It exposes the things we’re thinking that we’re not saying. We do seem to collectively consider it a violence. When I say we, I’m extending that beyond this country because, as I point out in that passage, the British still use a violent metaphor for this technology. [They call it a “jab.”] I think it’s a window into our subconscious feelings about vaccination—what it is, what it’s doing, what we’re afraid it’s doing. Those fears have been really persistent for well over a century, back into the eighteen-fifties. People had really similar fears of vaccination, fears of the body being permanently polluted or the nature of the person being changed permanently by the vaccine. Back then, the fears would take the shape of being afraid that you would become a cow or grow the horns of a cow if you were vaccinated. The general shape of them is really similar to some of the fears that we have today. For me, it blew this whole project open when I saw my own fears and hesitations around vaccination echoed in the anti-vaccination movement of the eighteen-fifties, which was not only a different time and different context but a whole different vaccine that we don’t even use anymore.

So, then, how should we be talking to people who are skeptical about vaccines? I would say your book is fairly respectful of people with different views but also, at times, cutting about the substance of those views.

I don’t know. I’ll just start by saying that. My project in this book was inspired in part by feeling condescended to as a woman and a mother by a lot of the material that I read about vaccinations when I was pregnant and when I was a new mother. I smelled a strong whiff of misogyny in a lot of the media coverage and even in medical literature. There was an undercurrent—and sometimes it really wasn’t that subtle—of this idea that if only women weren’t so dumb and so bad at understanding science, then this wouldn’t be a problem. My commitment was to write a book that didn’t reproduce or echo any of those misogynist tropes, to write a book in which I directly address other women, with respect for their intelligence and capacity. I do very strongly believe that that’s how any conversation around this should proceed.

I also think there’s a special challenge here and a special opportunity. Vaccination, really, for many diseases, works best not just when a majority of people do it but when everyone does it. It’s one of these few places where we really need to make a consensus decision. I don’t think we have a lot of practice in this majority-rule structure that we’re in of making consensus decisions and of what that requires and what kind of conversation leads to a consensus. I think it’s already pretty obvious that finger-pointing and name-calling and insulting and damning conversation is unlikely to lead to consensus. We do have to find a way to talk about this that will allow us to reach the kind of decision that the technology actually demands. We need everyone to be on board.

Did you hear from people who were skeptical about vaccines who read your book and came away feeling any differently?

I had a couple of close friends and a neighbor mention to me that they had vaccinated their children after reading the book. I was very moved by a conversation I had with a neighbor whom I knew not very well at all. I was working on this book, and we had a little back-and-forth about vaccination. Then I ran into her not long after the book was published, and she stopped me and said that she found out that somebody on her block had a child who was being treated for cancer, and that she had gone out and vaccinated her children immediately because she was so horrified by the possibility that her unvaccinated children could be a danger to this gravely ill child who was now immunocompromised.

I spoke to a number of people, and once they thought about it in those terms, once they were invited to think of their own children as potentially dangerous, which is pretty hard for most people to do—and it’s hard for many of us to think about ourselves as potentially dangerous, too—many of them were much more willing to take a risk to protect other people. I also heard from a lot of people who were unconvinced.

Can you talk more about this idea of seeing your kid as potentially dangerous? I’m not a parent, but people are so used to thinking of their kids as being in danger, and what’s so interesting about all the personal decisions about COVID-19 is that they are not the same as not wearing a seat belt. If you don’t wear a seat belt, you’re putting yourself in danger, but you’re not putting other people in danger.

Yeah. It’s really hard to swing your mind around to that point of view. I think I was primed for it because of the writing I’d done before I worked on this book, about race and whiteness. I’d already been invited through thinking about and writing about whiteness to think of myself in a social setting as potentially dangerous to other people. Racist thought patterns really encourage the opposite, right? This is one of the things that Barry Glassner, who wrote “The Culture of Fear,” pointed out. One of the social groups who are most feared and vilified in our culture, Black men, are actually the most vulnerable and endangered, dying at the highest rates, being incarcerated at the highest rates. We have this tendency to invert reality when we think about danger and vulnerability.

Then, the more I observed my own life, the more it seemed to be true that the people who are the most dangerous in society tend to be the most scared and to see themselves as very vulnerable rather than dangerous. I definitely think this is true of white people, as it is typical to be fearful and consider yourself vulnerable. In working around racism and whiteness, I was consistently challenging myself not to think of myself as inherently vulnerable but rather as inherently dangerous to other people. When I moved into writing about vaccination, I think it was easier for me to make that leap to thinking about both my body and my child’s body as potentially dangerous to the social body, because I’d already done that thinking in terms of race. But it really isn’t easy, especially when you go through this first year of taking care of a being that seems just the epitome of fragility and vulnerability, this being that’s unable to do the most basic things for itself, that needs everything from you. It’s very, very hard to think about that being as anything other than vulnerable.

We also have a cultural tendency to think in either-ors. You’re either dangerous or vulnerable, but really we’re all dangerous and vulnerable both. Vaccination underscores that. Infectious disease in general exposes how we have both capacities. Right now, that’s also being really illuminated for us, because all of us have to walk through our daily paces without symptoms, not knowing whether we’re going to spread a disease to someone else who’s more vulnerable than us or whether we’ll be on the other end of that exchange.

The idea of being sick and then becoming dangerous is a lot easier to get your head around, but the idea of just being a silent carrier is mentally difficult.

Yeah, it is. I also think it’s an excellent exercise for us. I don’t think it’s entirely surprising that, right in this same moment when we’re all being walked through this thought exercise in which we have to understand ourselves as simultaneously dangerous and vulnerable, there’s also a major protest movement going on around police violence and white privilege. It seems to me interconnected beyond the ways in which it’s obviously related, like the coronavirus being, for systemic reasons, more deadly for African-Americans. I also think there’s something deeper going on in terms of people being taught right now how to understand themselves as dangerous to other people.

There’s something similar in what was going on for me when I went from thinking about whiteness to thinking about a disease. Those real immediate dangers are playing out in front of us in terms of daily death tolls. I believe that is contributing to a willingness on the part of some people to consider ways that they’re dangerous beyond disease—racially, culturally, in these ways that are less visible but no less immediate. We also have people losing their lives because of systemic racism. It’s not like it’s less concrete or evident or immediate, but it’s that the relationship to one’s own everyday existence might be harder to trace, less clear. I do think once you start thinking in terms of how am I putting other people at risk, it’s not a huge leap to start thinking about how a system of racial privilege might be protecting you.

The flip side of this, though, is that you also talk in the book about herd immunity and how some people becoming safe can make more of us safe. And you say, “That seems implausible only if we think of our bodies as inherently disconnected from other bodies, which of course we do.” I don’t want to make it sound like you are counselling a herd-immunity strategy right now in 2020, but can you talk about the concept?

Yeah, I personally find herd immunity a really beautiful concept. I worked over and over the chapter where I wrote about herd immunity, because I wanted to find some way of capturing that. In my initial draft of that chapter, it was super-dry. It was all math because herd immunity on the science level is very math-based. You’re figuring out what proportion of the population needs to be immune for everyone to be immune. It’s not a hundred per cent. The people who are carrying immunity are always sheltering people who can’t or won’t carry immunity. For some people, it’s too dangerous to carry immunity. There are people who can’t be vaccinated for medical reasons, and then there are people for whom vaccines wouldn’t be effective.

Sometimes those are the people who are most vulnerable to the disease. Pertussis [whooping cough] is a really good example because the people who are most vulnerable—or most likely to die of pertussis—are under a year old. The idea, the public-health strategy around pertussis vaccination, is that we have everyone else carry immunity to protect the most vulnerable population, which can’t carry their own immunity. That’s one example of how this herd immunity is happening. It’s a sheltering, and not every vaccine works that way. Each disease has a slightly different public-health strategy behind it, but almost always there’s some harnessing of herd immunity.

I guess what I found very beautiful about this concept is it’s an illustration of a social body, a shared body, and that there’s a necessity for really widespread coöperation to protect this social body. There’s even something written into our immune system—and this isn’t directly related to herd immunity, but it’s another illustration of this social body that I find beautiful. It was explained to me by an immunologist at the University of Iowa that our immune system has a component that’s like a random-number generator. One of the things that our immune system is constantly doing is generating antibodies, in kind of random sequence, to diseases we haven’t seen, just in case. This is why one single disease can’t take out the whole human race. There’s always going to be somebody, just by the numbers, who has some ability to resist or fight that disease. Individuals might be vulnerable, but the species is going to be protected by this approach, which I just find beautiful and suggestive.

All of these seem to me to be invitations to think about our relationships to each other differently. That’s why part of what I was up to in that chapter about herd immunity was searching around for metaphors that would be more appealing than the metaphor of a herd. Because a lot of people don’t like to think of themselves as cows. I thought that the problem with the metaphor of the herd is that it suggests that we’re blind followers. That’s why I suggested in that chapter that maybe a better metaphor would be hive immunity, to think about ourselves as bees. The concept is the same; shifting the metaphor doesn’t really substantially change the concept. The idea is that the health of the hive depends on each individual bee’s health, which depends on the health of the hive. The hive as a whole has to be tended to. It’s not enough for each individual bee to just be out for themselves. That’s how bees work, and that’s why they make a good metaphor. They’re really intrinsically coöperative.

A previous version of this piece incorrectly described age restrictions for pertussis vaccination.

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