Vaccine Controversies Are As Social As They Are Medical

Originally published on November 5, 2014 9:02 am

When essayist Eula Biss was pregnant with her son, she decided she wanted to do just a bit of research into vaccination. "I thought I would do a small amount of research to answer some questions that had come up for me," she tells NPR's Audie Cornish. "And the questions just got bigger the more I learned and the more I read."

In the U.S., vaccination rates are high; for measles, mumps and rubella, the Centers for Disease Control and Prevention estimates that about 90 percent of infants receive vaccinations. The vaccination of children born between 1994 and 2013 will prevent 322 million illnesses, according to the CDC.

But resistance to vaccination has existed nearly as long as vaccination itself. And Biss found that questions about vaccination were also questions about environmentalism, citizenship and trust in the government. Biss traces some of this history in a series of essays called On Immunity: An Inoculation.


Interview Highlights

On finding "middle ground" in a highly politicized issue

In writing this book, I became very wary of the idea of a middle ground. What I saw when I was doing research is that in pursuit of a middle ground, people will kind of split the difference between the two extremes that they're hearing. And I think what's problematic is that people are seeing vaccinating on schedule, on time as an extreme position. So they're splitting the difference between that and the other extreme — which is not vaccinating at all — and doing partial or spaced-out vaccinations. And I'm not actually convinced that that's a viable middle ground.

On "splitting the difference between information and misinformation"

There's a great blog, Science-Based Medicine — and one of the writers on that blog pointed out that when you split the difference between information and misinformation, you still end up with misinformation. So I think there are situations where a middle ground is not desirable. Though I'm the kind of thinker who's very drawn to compromises and to nuances, I think in this particular area, the position that is sometimes seen as extreme — which is vaccinating a child fully and on time — I've come to believe is not an extreme position. I think that protecting children at the age where they're most vulnerable against diseases that are highly contagious is prudent.

On whether the medical community has done enough to educate the public and counter misinformation

I think they're working very hard and I think there are some great minds going at it. But I think that sometimes what the medical community is doing is too limited. And I don't think that's necessarily their fault. They're often addressing medical questions. And I don't think that this debate is always a medical debate — I think it's actually often not a medical debate. I think it's often a social debate. And I think that people's resistance to vaccination isn't going to disappear until we address some of the nonmedical reasons for that resistance and people's discomfort and distrust of the government. That's bigger than what most medical professionals can handle.

On the way distrust of the government affects the way parents view vaccination

This isn't the only country where you see that causing a problem. There are countries where it's a much bigger problem, and those tend to be countries where the political situation is much worse than it is here. Nigeria and Pakistan are two countries that have had a lot of trouble with polio. And part of the reason is that there's a lot of political unrest and people really distrust what the government is doing. That has an effect on people's health and it has an effect on the health of children. And so, this is one more reason for us to be invested in good political systems, because it's a public health concern.

On how to understand the modern anti-vaccination movement

There are so many different reasons people don't vaccinate that I'm not even sure it can be looked at as a cohesive movement. Some people have concerns that are really health-based, and some people are resisting capitalism when they resist vaccination. Some people are resisting what they feel is the corrupt pharmaceutical system and corrupt medical system. So there are all kinds of different angles here, and I do think I came to understand all of them better through this research. And I also came to understand my own reservations better.

On making choices for her own son

Really, the project of this book — it's a social critique, but it started out as a self-critique. I was curious about why I, myself, was reluctant to vaccinate my son. And that did give me some insight into why other people aren't vaccinating. I would prefer for my son to have as little medical care as possible, as little contact with the medical system as possible. I think vaccination is actually one way to try to help ensure that — making sure that he doesn't get something like pneumonia that might mean a hospital stay, where things will be done to him that will make me uncomfortable or that he will be treated in a way that might feel excessive to me. I think the best way for me to keep him out of that system is to engage in this highly effective preventative medicine.

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Transcript

AUDIE CORNISH, HOST:

This is one of those news stories that drives a lot of people crazy. It's a story about vaccines.

STEVE INSKEEP, HOST:

Some parents object to having their kids vaccinated. And since public health can be affected, other parents object to those who object.

CORNISH: In her new book of essays, "On Immunity: An Inoculation," author Eula Biss looks at the history of anti-vaccination movements. She says she believes in giving children the full slate of modern vaccines, but when she had her son, Eula Biss found herself questioning those beliefs.

EULA BISS: I was pregnant with my son, and I'd heard a few things about vaccination. I knew very little, and I thought I would do a small amount of research to answer some questions that had come up for me. And the questions just got bigger the more I learned and the more I read. I was really interested in how vaccination opens into all these other questions of environmentalism, questions of how we relate to our government, questions of citizenship. So long after I had answered my own personal questions, I found myself still really involved in the research.

CORNISH: You also, in writing about these immunization movements in the United States, talk about the ways that this intersects with class and sometimes race. Can you give an example in the U.S. where you saw this?

BISS: I think I saw it first when I was researching the demographics of who does and doesn't vaccinate, but also who does and doesn't die of vaccine-preventable diseases. And one of the statistics that was interesting to me was that there's a group of people who don't vaccinate at all, who tend to be white, middle-class, well-educated and married mothers. And then there's a group of people whose children are under-vaccinated - meaning they haven't received all of their vaccines - and that group of people is more likely to be black, to live below the poverty line, to be a mother who's not married and has recently moved. So this is a group of people who are not vaccinating not because it's a choice or a position that they've taken, but because of the circumstances of their lives. And so this means that this relatively privileged population can end up spreading disease to people who haven't made that choice.

CORNISH: This issue is so highly politicized. And did you come to find any kind of middle ground?

BISS: That's an interesting question, but I actually - in writing this book I became very wary of the idea of the idea of a middle ground. So what I saw when I was doing research is that in pursuit of a middle ground, people will kind of split the difference between the two extremes that they're hearing. And I think what's problematic is that people are seeing vaccinating on schedule, on time, as an extreme position. So they're splitting the difference between that and the other extreme, which is not vaccinating at all, and doing partial or spaced out vaccinations. And I'm not actually convinced that that's a viable middle ground.

CORNISH: Why not?

BISS: Well, there's a great blog - Science-Based Medicine - and one of the writers on that blog pointed out that when you split the difference between information and misinformation, you still end up with misinformation. So I think there are situations where a middle ground is not desirable, though I'm the kind of thinker who's very drawn to compromises and to nuances. I think in this particular area, the position that is sometimes seen as extreme, which is vaccinating a child fully and on time, I've come to believe is not an extreme position. I think that protecting children at the age where they're most vulnerable against diseases that are highly contagious is prudent.

CORNISH: Do you think the medical community has done enough to educate and to counter the information that's out there?

BISS: I think they're working very hard, and I think there's some great minds going at it. But I think that sometimes what the medical community is doing is too limited, and I don't think that's necessarily their fault. I think they're often addressing medical questions, and I don't think that this debate is always a medical debate. I think it's actually often not a medical debate. I think it's often a social debate, and I think that people's resistance to vaccination isn't going to disappear until we address some of the nonmedical reasons for that resistance. And people's discomfort and distrust of the government, that's bigger than what most medical professionals can handle.

CORNISH: By the end of the book, did you have a better sense of what is driving the modern, anti-vaccination movement?

BISS: I think I had a better sense of how very complicated it is and how many different positions there are that feed this modern movement. And I'm not even sure it can be looked at as a cohesive movement. Some people have concerns that are really health-based, and some people are resisting capitalism when they racist vaccination; some people are resisting what they feel is the corrupt pharmaceutical system and corrupt medical system. So there's all kinds of different angles here. And I do think I came to understand all of them better through this research, and I also came to understand my own reservations better.

And really the project of this book - it's a social critique, but it started out as a self-critique. I was curious about why I, myself, was reluctant to vaccinate my son. And that did give me some insight into why other people aren't vaccinating. And I would prefer for my son to have as little contact with the medical system as possible. I think vaccination is actually one way to try to help ensure that, so making sure that he doesn't get something like pneumonia that might mean a hospital stay where things will be done to him that will make me uncomfortable or that he will be treated in a way that might feel excessive to me. I think the best way for me to keep him out of that system is to engage in this highly effective, preventative medicine.

CORNISH: Eula Biss, she's the author of "On Immunity: An Inoculation." Thanks so much for speaking with us.

BISS: Oh, thank you for having me.

CORNISH: This is MORNING EDITION from NPR News. I'm Audie Cornish.

INSKEEP: And I'm Steve Inskeep. Transcript provided by NPR, Copyright NPR.