The World Today
12 June 2015 , Volume 71, Number 3

On Immunity – an Inoculation
Eula Biss 
Fitzcarraldo Editions, £12.99


Claire Munoz Parry is Manager of the Centre on Global Health Security at Chatham House


In 1998 The Lancet published a research paper by Andrew Wakefield that linked the measles, mumps and rubella (MMR) vaccine to autism. As Eula Biss points out, Wakefield’s paper was hardly conclusive: it said that the association between the MMR vaccine and the behavioural syndrome that included symptoms of autism could not be proved and more research was needed, yet it still caused a dramatic drop in vaccination rates. Since then, study after study has failed to find a link between the MMR vaccine and autism and the General Medical Council has ruled that Wakefield acted ‘dishonestly and irresponsibly’ in his research.

Despite such reassurance, many parents continue not to have their children vaccinated. The issue is still live as shown by news from Australia, where parents who refuse to vaccinate their children will be denied childcare tax rebates and welfare. In the US a measles outbreak has occured after  some of the children who fell ill had not been vaccinated against the disease. 

On Immunity is an essay on the history of inoculation and vaccination, the ethical questions surrounding them, the interdependence of our actions (in a world where not vaccinating one child can expose others to risk, no one can pretend to live in isolation), toxicity and a fair amount of philosophy on the stresses our immune systems are exposed to through them. Biss’s book is captivatingly written and will appeal to those concerned with the safety of vaccines, as well as those interested in the space between science and morality. 
She investigates the main beliefs and publications on this topic, both scientifically sound ones and the many online articles rejecting vaccination. Biss points out that in some cases the anti-vaccine campaigners use only the original version of an article, leaving out later retractions on the allegations of toxicity and side effects.

The conspiracy theories that doctors and pharmaceutical companies are part of a worldwide Machiavellian plot are easily challenged, but there are also more serious publications. The Vaccination Book, by Dr Robert Sears, is a prime example. It offers two clear courses of action for parents who fear both vaccines and infectious diseases. One is to only vaccinate for those diseases that Dr Sears deems most important, the other is to vaccinate according to the standard schedule, but to spread the process out over eight years. 

The first approach leaves children susceptible to infections such as hepatitis B, polio, measles, mumps and rubella, while the second is open to criticism in that there is no evidence, beyond Sears’s speculation, that spacing vaccination minimizes the incidence of side effects. 

Addressing the claim that the number of vaccines given to children today is excessive, Biss points out that ‘a single dose of the smallpox vaccine that our parents received presented a greater challenge to the immune system than the total challenge presented by all 26 immunizations for 14 diseases now given to children over the course of two years’. 

George Washington, himself a survivor of smallpox, struggled with the decision of enforcing smallpox inoculation – a predecessor of vaccination – on his soldiers. It was only when rumours spread of a British plan to use smallpox as a form of biological warfare that  he decided to go ahead. 

In the early 20th century, when smallpox was claiming fewer lives due to the appearance of the less virulent strain called variola minor, armed anti-vaccination mobs in the US drove vaccinators away. Even today health workers are murdered for trying to administer polio vaccines in Pakistan and Nigeria. 

These stories illustrate the battle waged now and then around vaccination. However, too often, Biss brings up vampires, and more specifically Dracula, as a metaphor for the disease, at the risk of detracting from the serious nature of the topic. On Immunity is written from the perspective of an anxious mother faced with determining the use and possible harm of vaccines. Throughout the book the author’s belief in science shines through. Biss manages to stick to the evidence and, sensibly, lands on the right side.