Cover art for episode 5.

Communities of Contagion

Today, we explore how community can be a source of mutual contagion, as well as mutual support, with Eula Biss, the author of four books, including Notes from No Man's Land and On Immunity: An Inoculation. This conversation was originally recorded in 2015, when California had recently removed exemptions for vaccinations, and Portland had just voted no on adding fluoride to city water for the fourth time.

Show Notes

Eula Biss is the author of four books, most recently Having and Being Had. Her book On Immunity was named one of the Ten Best Books of 2014 by the New York Times Book Review, and Notes from No Man’s Land won the National Book Critics Circle award for criticism in 2009. Her work has recently appeared in the Guardian, the Paris Review, Freeman’s, The Believer, and The New Yorker.


Adam Davis: Welcome to The Detour, a show about people and ideas. I'm Adam Davis.

Do you remember what, and maybe whether, before all this, you thought about immunity and community? Did you think about immunity at all? What do you owe to other people on the bus, to the neighbors’ kids that come up to say hi, or to your partner, or your partner's parent, when your actions impact each of them? What do they owe you? What do we owe each other as citizens?

Today, we explore how community can be a source of mutual contagion, as well as mutual support, with Eula Biss, the author of four books, including Notes from No Man's Land and On Immunity: An Inoculation.

You'll notice throughout this conversation that Eula repeatedly mentions how much she doesn't know. The COVID-19 pandemic has been an ongoing dunk in what we don't know. This episode might reveal things you don't know. This conversation happened seven years ago. At the time, California had removed exemptions for vaccinations, and Portland had just voted no on fluoride for the fourth time.

The passage of time has changed how this conversation feels and will change it again.

Now, the first thing I want to say is a big Portland welcome to Eula Biss. The most recent book is On Immunity. And as we've been thinking about the broad theme of justice this year, immunity seemed like it might fit under that broad theme. And in preparation for this, I was reading this and also a previous book, Notes from No Man’s Land. And there's an essay in there where you talk about a doll of yours from when you were a kid. And we can talk more about the doll as we go, but your mother has kept the doll, and you fairly recently, it sounds like at least six years ago, saw the doll and noticed that parts of it had faded, but that it had pockmarks from where you had, as a kid, given it shots. So I thought I might start just by asking you, do you remember what you were doing giving that doll shots, or what you were trying to get done?

Eula Biss: Yeah, I did give that doll, that was the center of an essay in No Man's Land, immunizations as a child. My father is a physician. And he actually did quite a bit of medical care on us as children. We, we didn't go to the doctor a whole lot. You know, we went once a year for our exams, and otherwise, we weren't there a whole lot.

I have memories of immunizing my doll, but also of giving faux medical care to my little sister too. I guess it was already written into my interactions with my dolls and my siblings, that this is part of what people do for each other. This is part of that caring relationship.

Adam: And then it seems like the kind of occasion for diving deeper in there was in a way, your relationship with your son.

Eula Yeah. Yeah. I was actually, I was pregnant when I started thinking about this. And then it intensified when I actually had the child, but I was, I was already doing some of the research that became this book when I was pregnant. And, you know, I was naive enough when I started doing this research to think, um, because I'm fairly facile with research, and I even teach research in one of my classes at Northwestern, I thought, I'll do a couple evenings of reading, and I'll just solve this problem and figure out whether I vaccinate him or not. And I'll get this taken care of pretty quickly. And that's how little I really understood the scope of this question—and the politics of vaccination. I really wasn't that familiar with it when I started my reading. And so, it ended up being five years that I spent doing that research.

Adam Davis: And is that because it was difficult to make the decision about whether or not, or how, to vaccinate your son? Or is it because it opened up other questions?

Eula Biss: No, the decision happened much more quickly than the rest of the thinking that unfolded.

So yeah, I started with a very practical question. Do I vaccinate this kid, and do I vaccinate him on schedule? And by the time he was born, I hadn't finished answering that question, and he didn't get the first vaccine on the childhood schedule, at that moment. He later got it. I caught him up when he was two months old, and I vaccinated him on schedule.

And I answered that question for myself relatively quickly. So it took me three or four months to answer that question. But in the process of answering that practical question, you know, what do I do? It opened all of these philosophical questions for me. And many of them were questions that felt like they were at the heart of parenting. You know, like this, this question of: how do you care for someone who can't care for themselves, and what kind of responsibility do we hold when we make decisions for people who can't make decisions for themselves? And that was one of the big questions, but also, you know, I started thinking about what do we owe each other as citizens? What’s kind of incumbent on me as a person with a body who interacts with other bodies constantly? What are my responsibilities as a citizen? And somehow these questions of citizenship all arrived at the same time as questions of parenthood and motherhood—they were all knitted together for me. And I think that there's some obvious reasons for that. And then some reasons that remain mysterious to me.

Adam Davis: Easy to be a citizen and a parent at the same time?

Eula Biss: No, you know, not necessarily. Especially in, you know, our contemporary parenting climate, I think, doesn't necessarily encourage us to think of ourselves as citizen parents. I think it's in some ways a climate that encourages an insularity and a pulling in, and this idea that you can create your own little society within the walls of your home, and that your kind of domain ends there and that your responsibilities end there. And I think that that's a potentially destructive way of thinking—and dangerous to the community.

Adam Davis: So, I don't want to lose. In a way, you’re moving quickly past the decision about your son, what you said, the practical decision. I wonder, like how do you decide that relatively quickly, in three or four months?

Eula Biss: That’s a great question. Yes. So I'd been doing a ton of reading. But what really decided the question for me was the realization of how little I knew. And for me, it takes a while researching a subject before the full proportions of how little you know hit you. You know? So for me, it took several months before I realized, whoa, I don't know anything about this. And I think the moment, I can actually pinpoint the moment. I think there's a lot of situations in my own thinking where there's no epiphany, but there was a somewhat epiphanous moment where, I had the—the vaccine that I declined when my son was born was the Hep B vaccine, that's given to most newborns within twelve hours of birth. And there's a number of reasons why that vaccine is given within twelve hours of birth. I didn't know any of them at the time that I declined them. But one of the reasons is that when infants acquire Hep B, the person they're most likely to acquire it from is their own mother.

And the mother can be a carrier of Hep B without showing any symptoms, without her knowledge. And so that's one of the reasons it's given more or less immediately, because the most common way an infant gets it is actually passing through the birth canal. That's how they get Hep B. And then there's a number of risk groups for Hep B, and they're pretty diverse risk groups. So being Asian American is a risk group, having had a blood transfusion is a risk group, having had a tattoo before a certain year is a risk group. So there's all these disparate risk groups. Before my son was born, I went to the pediatrician that we had selected for him. And I said, why does he need this Hep B shot?

And he said, Oh, um, you know, that's not for people like you, that's for prostitutes and drug users. You don't need to worry about that one. And what dismayed me after the fact was that I walked out of that office and thought, okay, great. I'm not going to do that one. I didn't actually interrogate that interaction and think, wow, he didn't even ask me whether I was a prostitute or not before he told me, you know. Like he had no idea I wasn't a sex worker, but he decided that I didn't need the Hep B vaccine without, you know—basically he just looked at me and thought that he had the information he needed to tell me not to use that vaccine. This is a long answer, but there's a process that leads to an epiphany.

And so when my son was born, I'd had a very healthy pregnancy. I'd considered giving birth at home. In Illinois, it's really inconvenient to give birth at home. You have to jump through a lot of hoops, and a lot of midwives can't attend births at home in Illinois. It's just legally tricky.

So I wasn't committed enough to giving birth at home to actually do it. So I had a midwife birth in a hospital, but a low-risk healthy pregnancy and had a very, very rare complication right after my son was born and lost half the blood in my body very, very quickly, within ten minutes, and was rushed to surgery and given a blood transfusion because I was having difficulty breathing.

And it was a very intensely scary moment for me, for my husband, for my midwife, who described herself as traumatized. I thought, if you're traumatized, what am I? And I got this blood transfusion that, to me, felt like it saved my life. And months passed. And there was a day when my son was napping, and I was reading about infectious diseases—that's what I did for the first whole six months of his life, was read about infectious diseases. And so I was in my Hep B moment, and I was reading about how people acquire Hep B. And I read the part about how getting a blood transfusion puts you in a risk group. And I thought, oh, I gave birth, and I entered a risk group immediately. And I could have exposed my son, who I chose not to vaccinate. And all of these kinds of realizations came tumbling into my mind at once. You know, and at that moment, I didn't even know that that hadn't happened because, you know, Hep B can be hard to detect. You can have it for a long time without showing symptoms Though, you know, I should say, while I'm saying this, that I was looking at the numbers, the chances of getting Hep B from a blood transfusion are incredibly tiny. I think it's one in 200,000 or something like that. The complication that happened in childbirth for me was described to me as very, very, very rare. And it was one in 300—one in 3000 is the incidence of that. So, one in 3000 is something we consider very rare. One in 200,000 is much, much rarer. So I knew that in all probability that probably hadn't happened. But it still, that was the moment where I thought, there's so many things I didn't consider when I made that decision.

When I made that decision not to vaccinate him, I didn't think about how my health might change, for instance, and how my health changing might endanger his health. And that set us, you know, it was less about me feeling scared for my son's well-being than me feeling suddenly deeply humbled by the number of factors that I hadn't considered. And immediately after that moment, I decided that I was going to follow the schedule. And if only because I wanted people who had considered many more factors than I had considered to be the ones in charge of this decision.

Adam Davis: So, risk factors. This is an interesting phrase, and it's an interesting thing to think about, and it gets a whole lot more interesting once there are kids around that, as you say, you're responsible for. We’re right now, as we sit here, we’re engaged in many things that are pretty risky, like sitting, which is not a joke.

Eula Biss: No, it's really dangerous. And drinking.

Adam Davis: And I wonder how people got here. How many, how many people drove? And did people ride bikes? I wonder what, so what do you think about risk and the risks we look at and the risks we just take without paying attention?

Eula Biss: Yeah. Yeah. So that was one of the most interesting parts of the research that I did for this book was learning about risk perception, which I'd never read anything about before. And hadn't really even thought about before. One of the, you know, revelations of reading about risk perception is that we're really terrible at assessing risk, like we, meaning human beings. We're terrible at it, and, for lots of reasons, but there's some mistakes that we tend to all make. So, for instance, things that are familiar to us, we tend to see as not very risky just by virtue of their familiarity. So, driving, for instance, and sitting. Two things that are pretty likely to cause you harm, and in different ways, but that most of us are going to be unwilling to see as highly risky. Even though we all know the statistics around driving. We all know intellectually that it’s probably the most dangerous thing we do, but it doesn't feel in our hearts scary or dangerous. And so, you know, unfamiliar things, we're much more willing to see as dangerous, even if statistically they're really unlikely to cause us harm.

So learning this, you know, I read this material about risk perception, and then I started to think about my own thinking about risk and what I considered risky and what risks I willingly engaged in. And at the time I was bicycling my son back and forth to his preschool. And so, I carried him on the back of my bicycle, the three miles or so to his preschool and back.

And I think also around that time, the results of a 2007 census were analyzed and released. And the number one most dangerous consumer product from that census was bicycles. So, involved in more accidents than any other product. And I realized that I, you know, very willingly engaged in this risky activity pretty much every day, which was bicycling with my son.

And I thought about, you know, why am I so worried about things that have negligible, tiny risks attached to them? You know, statistically minute risk. Like why do I allow myself to worry while my infant is crawling across the grass in the park, that he might be picking up traces of some chemical that was used to treat that grass. And that those traces might bioaccumulate over the next 40 years and caused him cancer when he's, you know, 45 or something—like, that's a minuscule and semi-insane train of thought when you're carrying your infant on your bicycle every single day, several times a day. And so, it, it made me, you know, it put me in touch with the inconsistencies in my own thinking and my own attitudes and in the way that I was living my life.

So as I commuted back and forth to my son's preschool and Northwestern, where I teach, those commutes became this kind of meditative place for me to think about risk and vulnerability. And, you know, one of the things I would think about is why am I doing this? And I think this is probably similar for a lot of people who bicycle around. I like it. Like that was my most honest answer was, I'm doing this risky thing because I like it. I enjoy it. And I have no more, like, no higher reason, really, you know, I could build, I could say, you know, it's more environmentally conscious, you know, and I want to teach my son certain things about being out in the world and being outside. I could build a lot of infrastructure around it, but the real reason was I just liked to live this way. And when I set that against my own concerns around vaccination, you know, thinking about these statistically small but real risks that attend vaccination. And how concerned I was with these small risks, even though I knew from all my research, there were real, compelling, moral reasons to engage in it. Reasons that were really in alignment with some of my most dearly held values.

And I thought, so here's this risky activity, bicycling, that I do just because I like it. And here's this much more statistically safe activity that I'm scared to do, even though it's really supporting things that I think are deeply important.

Adam Davis: So that makes me think again about what your—what that pediatrician said. You’re not in one of those risk groups. It sounds like now you're saying, well, there's, there's at least a couple of ways to answer that. Although I wonder which one, if either, would be persuasive. You've talked some about the first one, which is actually, ‘I'm in more risk groups than you might know, or I could be.’ But the second one that you're just pointing to now seems to be a moral response. And I guess I wonder what you mean.

Eula Biss: As I was learning more about how vaccines work, and why, for instance, we encourage 100% of the population to vaccinate themselves, I learned that—and this was very surprising to me, I didn't know about herd immunity, I didn't know how most vaccines work. I learned that with most vaccines, and this isn't true of every single one. So, it's for the most part, not true of the tetanus vaccine, but for most vaccines, a majority of the population is being vaccinated to protect a certain vulnerable minority. An example is pertussis. Pertussis is not a serious disease for many adults, though I have a friend who got it as an adult and broke a rib coughing. It can be an unpleasant disease for adults, for sure. But it's a very dangerous disease for infants, especially infants under one. So, a huge number of people—the majority of people are not under the age of one—get vaccinated in order to protect that one vulnerable minority. Same for rubella. So rubella is not a very serious disease in most cases, but it's an incredibly serious disease for an unborn baby.

So a huge number of birth defects, before we started vaccinating against rubella, were caused by rubella infections in pregnant women. So we vaccinate the herd to protect the pregnant women and their unborn fetuses. And I could kind of go on and on. This is, for almost every disease, especially influenza is another one. Influenza, it changes from year to year, but in most years, the seasonal flu is most dangerous to the elderly. That particular age group is also the age group in which the vaccine is least effective. So part of the reason that we have this recommendation for pretty much everyone to get a flu vaccine is because if everyone does it, we can all together protect the elderly who are among us.

So when I learned this, I started thinking, number one, this is incredible, because there are very few situations in our society that I can think of where the majority is called upon to take a bodily risk to protect a minority. We do, you know, this is a foundational kind of American ideal, right, is protecting a minority, but we're not usually called upon to give something up to protect a minority.

And to me, that felt extraordinarily important. And when I learned this, I thought, yes, I want to participate in that. I believe wholeheartedly in a majority giving something up, giving up some of their safety or comfort, in order to protect a more vulnerable minority.

Adam Davis: A majority being called upon to give something up to protect the minority. It sounds, to me, it sounds compelling. And then I also wonder the way you put it. That argument is hard for me to see how many ways I do or don't do that in my life. So I just wonder, are we explicitly called upon to vaccinate because it's for the good of the minority, or how does it function, that argument?

Eula Biss: You know, I'm actually exaggerating a little bit there—or I'm not exaggerating, I'm doing the other bad thing, which is distorting a little bit. There's all this, you know, computer modeling and other high math that goes into looking at vaccination and how it's affecting populations. But the finding of a lot of this complicated math is that it's not wholly altruistic, what we do when we vaccinate. In almost every case, there's a benefit to the individual as well. So, for instance, influenza’s a good example, right? In part, because it's pretty unpredictable. We know that the elderly are especially susceptible to bad cases of influenza and have really high rates of dying from influenza. But people who are 30 die of influenza too. People who are six die of influenza. Teenagers die of influenza. Babies die of influenza.

So it's not against your interest to be vaccinated, but you are participating in a system that's not expressly, you know, if you're, say, me, if you're 38 and basically healthy, the encouragement to be vaccinated against the flu is not just for me. My doctor definitely has my interest in mind when she recommends that, you know, she asked me a bunch of questions and one of them is, you know, what do you do? And I say, I teach at a large university, and her next recommendation is, you should get vaccinated against the flu. And she's definitely thinking about my health when she recommends that. But the thing that I started thinking about when I finally started accepting my flu vaccinations, which was only after I started doing this research, was my interaction with my grandparents, and you know, how often I come to see them, and how I could very easily bring influenza to my grandparents, and how much I don't want to be a disease vector. So, I think both of those things are going on. It's a distortion, that's the word I was looking for, to say that we're only involved in protecting a minority, but both things are happening.

When I was thinking through this question of which diseases will I vaccinate against and which ones won't I, one disease that I thought I'd feel very comfortable allowing my son to get was chickenpox. In part because all four children in my family had chickenpox, you know, I remember it vividly, and I didn't think it would be a terrible thing for him to get chickenpox. And not too long after I was thinking that through, my son and I were playing on a playground where we play very frequently, that was shared, this playground was shared, by a daycare center for underprivileged youth. So, the people who worked at the daycare center were all volunteers, and the children were children who came from very poor families. And it was very obvious that they lacked for a variety of things. Some of the children were really underweight for their age. Some of the children weren't talking, and they were old enough to be talking. Some of the children, just, their clothes were inadequate. And, you know, so it was obvious to see that these kids didn't have everything they needed and probably didn't have the greatest access to health care either.

And that's one of the inequalities in our country that I think has to be factored into this conversation, is the fact that we have unequal access to health care in this country. And as I played on this playground with these kids, I thought about how I would feel if my son gave one of these kids—or all of them—chickenpox. And I realized that I would be really uncomfortable with that, and that I was fine making the decision about chickenpox for my son, but that I didn't want to be making that decision for somebody else.

Adam Davis: So that sounds, uh, I mean, I don't think you used the word privilege, but it seems like that's the idea you’re talking about.

Eula Biss: For sure, I was thinking about my relative privilege, and it was almost painful—and this happened many times, we’d shared this playground with this group of children many times. And it was almost painful for me to see how much my son had compared to how little some of these other children had, how robust his health seemed in comparison to their health.

And I did, I thought about all the many layers of privilege, you know, part of it was money, nutrition, education. But there was also just that pure, like, access. You know, there's this large demographic of people who avoid some or all vaccines that is my demographic. So fairly well-educated, middle-class White women who are older and married. And then there's another demographic that doesn't get vaccinated, and it's for different reasons. And that demographic tends to be poor Black children whose mothers are single, unmarried, and they've been in some unstable circumstances. So, they've recently moved. They don't have contact with a health care provider, and they're just kind of slipping through the cracks. They're not getting vaccinated because there's a lot going on in their lives and their parents' lives, and they don't have a consistent health care provider.

You know, the end result looks the same, which is under-vaccination or not being vaccinated, but the way you get there is really different. And one of those is a manifestation of privilege and, you know, you get to make a decision not to do this in part because you know that if your child gets measles, you can be at the doctor instantaneously. If it's a $14,000 hospital bill, you can probably pay it. And you're leaning on your privilege to make that decision.

Adam Davis: You're listening to The Detour by Oregon Humanities. I'm Adam Davis, and today, we're speaking with author Eula Biss on immunity.

Eula Biss: I guess to go back to the bicycle, maybe—this is easier for me to think about sometimes in terms of metaphor, and bicycling has also given me a great metaphor for thinking about bodily vulnerability and just being in the road and feeling vulnerable in the road on my bike has given me many opportunities to think about what it's like to be on the less privileged end of things. So I kind of think of the road as a spectrum of privilege, where the cars have most of the power and privilege, and then there are bikes, and there are pedestrians, and you also have a spectrum of vulnerabilities. So, pedestrians are very vulnerable, and so are people on bikes, and people in cars are less vulnerable in terms of what happens if there's a collision between these different groups of people who use the road.

One of the most enduring lessons that I've learned on my bike is the bad things that can happen if you get consumed with attention for your own vulnerability. So, when I first moved to New York City, and I was riding in the city, which I wasn't used to, because I didn't grow up there. And I was commuting through Chinatown, which is very busy, I was acutely aware of my own vulnerability in the road. And I was always watching. I was always aware of who was around me, what vehicle was near me. And one day I was zipping through Chinatown, and I ran a yellow light. And, um, but it was all clear. I checked for cars. I knew I wasn't going to get hit, but I ran the yellow light, and the light changed while I was in it, and a pedestrian stepped off the curb, and I hit him really hard. We knocked each other out, mutually knocked each other out. And it was a horrific moment for me. I hurt him quite badly. I realized that it was in part because I'd been so consumed with the sense of my own vulnerability and watching only for cars that I'd forgotten that I was also a dangerous presence for pedestrians, and that a person on a bike can really hurt someone who’s on foot.

And I think that this can happen in all kinds of situations of privilege. I even see it happen when I get behind the wheel of a car. I spend all this time on my bike, and then I get into a car, and suddenly my mindset changes. And I think this is one of the features of privilege is there's—actually, I was reading, today, John Rawls, and he calls it "the veil of ignorance." And it’s incredible how even just stepping into a car, the veil of ignorance can come down. And I suddenly see myself being less aware when I'm in a car.

Adam Davis: I mean, the car, well, a couple of things, I guess. One, you mentioned that your father, when you were growing up, said, when you're driving, you're not just responsible for your own car. You're responsible also for the car in front of you and the car behind you.

Eula Biss: Which is why I can't drive now. It’s paralyzing.

Adam Davis: —paralyzing. That's where I was headed. This is going to seem roundabout and it may be roundabout, so I apologize in advance, but thinking about the biking, and I, too, used to live in Chicago and then moved out here, and riding a bike is such a different experience here, because in Chicago, you know what the terms are. Everybody's just trying to get where they're going as fast as they can, and screw you if you're in the way.

Eula Biss: Yeah.

Adam Davis: And you come to know how to ride in that. And then I get out to Portland, and people stop, and they look around, and they tell you to go first, and it feels really dangerous.

This is not meant to be a comment about biking. It's meant to be a question about privilege, uh, which is, it seems unlikely that most of us will walk through the world thinking first about how we might negatively affect other people. So I guess I wonder about that as a way of thinking, in the world, as a way of thinking about privilege, and how it should affect our movement through the world.

Eula Biss: I think that this is part of what the term consciousness-raising means, right? Where I do think, I think of the kind of consciousness that I have on a bicycle now as a split-consciousness, where I'm aware of my own vulnerability, but I'm also aware of the vulnerability of, say, a pedestrian, and I think that both of those things are necessary. And that doesn't mean that I have to ride with only a pedestrian in mind, right? Or stop where there's no stop sign, you know, because a pedestrian is there. That actually does get dangerous. You know, I've had these interactions too, where someone will try to wave me through a stop sign or something, and I think, No, these rules are here to keep us all safe. If everyone just stops at the stop sign when they're supposed to, we're all cool. But as soon as people start to get waved through, then we get confused, and then I'm going through because you waved me, but that guy didn't see you wave me, and so that guy hits me and, you know. There is a reason why these rules are here.

And this is part of why we depend on sound social policy. You know, so we don't have to go through the world constantly trying to figure out what the people who are less vulnerable than us, or more vulnerable than us, need from us. We need social policy that has thought that through already. I was mentioning to you earlier that I was rereading John Rawls, “Justice as Fairness.” And he's got this idea that has an odd term, it's called the original position, right? And the original position is, it's almost like a test for social policy. To figure out whether this policy is fair or just, you think about how it would affect people who are in really disparate positions.

So you have to think of this policy not only as the person that you are but as a person that you could be if you don't know who you're going to be born as. So how do I feel about this policy if I'm someone who's HIV-positive? How do I feel about this policy if I'm someone who's being treated for cancer and has a suppressed immune system? How do I feel about this policy if I'm a single mother who works two jobs, and I don't have any health care for my children? How do I feel about this policy if you're over the age of 70, or if you're under the age of two? So, this is kind of a test—is this policy favoring one powerful group, one privileged group? And is it really serving that group? Or is this a policy that's serving everyone, and does that make it a fair policy? And I think what we need to strive for, and this goes beyond individual interaction is, you know, this is like effective traffic laws, right, is social policy that is just.

Adam Davis: Looking at what's going on in many states right now, around the country, the trend seems to be in the other direction. Where there are, the laws, the social policy seems to be moving toward more room for exemptions, less mandatory vaccination. And I guess I wonder, first, why you think that is, and, second, how that feels.

Eula Biss: It's partly a result of us seeing some of those contingencies when the measles epidemic happens. So one of the very, um, highly publicized cases was a family who had a child who was being treated for cancer, and his immune system was suppressed, and it wasn't safe for him to go to school, because he had too many classmates who were unvaccinated, and if he caught measles within a suppressed immune system, it would be disastrous.

I think that gave people an opportunity to project into another position in society and think, what would I want if that was my kid, if I was in that situation, what would I want? And I think part of why that isn't happening in some other places is that we've got a lot of emphasis culturally on our individual vulnerability, and the people who tend to be the loudest are the people who are privileged.

So, like me, upper middle class, White, well-educated, and really concerned about the risks that our child is subjected to through vaccination. And that's the butt that we're trying to cover. Another part of my research for writing On Immunity that really hit home for me, in an emotional way, was thinking about who my community of contagion was. So, and I realized that that wasn't necessarily what I thought of as my community. I'm a writer, and I tend to think sometimes of my community as other writers, which is a really far-flung community. And most of those people are not people that I'm going to give pertussis to, if I get pertussis, because we hardly ever see each other.

But I realized I had a little bit of, I think, what some people call medical student syndrome. When I spent quite a long time reading about infectious diseases, it was actually after two or three years of this, that I thought I had pertussis, and it's true, my symptoms were consistent with pertussis, and it was pertussis season, which, you know, cases peak in warm weather. It was August. And I'd had a cough for over two weeks, which is one of the defining characteristics of pertussis. And this is one of the tricky things with pertussis and another reason why we vaccinate against pertussis: no one gets diagnosed with pertussis until they've been coughing for over two weeks.

So that two-week span that you've been coughing is a span of contagion, right? Where you can, in that period, it looks like just a bad cold. And you only begin to have the suspicion that it might be something more than a bad cold after you've been coughing on people for two weeks. And so, I had actually, I did have this bad cold that made me cough for a month actually. But I, after coughing for two weeks, I started to feel nervous, and I felt nervous, in part, because for the first couple of days I was sick, I had stayed home. But then the only symptom I had was a cough. And I'd been doing a lot of things, and I'd been taking my child to daycare, for instance. And at his preschool, he was three years old, which meant that a whole lot of mothers around me had just had their second child.

So, there were all these newborn babies there in the hallway of the preschool when I was dropping my son off, and I was, you know, breathing air on them and coughing near them. And I thought about how many of those babies, I didn't even know their parents' names, you know. I was just crossing paths with them. If I gave their kids pertussis, I might even never know that I gave their kids pertussis.

And then I started thinking about all the other people that I touched during a day, and that I came close enough to, to cough on. And I thought about the librarians where I write in the public library. I thought about the other people who use the public library, which includes a lot of homeless people. I thought about the people that, the cashiers at the grocery store, where I had been going. And I realized that I had this, like, immense web around me, of people—many of them, I didn't even know them. I wouldn't necessarily think of them as my community, but they were part of this community of contagion.

And that became for me, you know, a somewhat terrifying idea. Like, I could have given this disease if I had it, which I didn't, it turns out, to anyone. But it also, you know, as I continued to ponder it, it also became a beautiful idea to me. It became an occasion for me to understand my true community and how many interactions I was having with people every day. And for me, the awareness of the reach and stretch of that web was very beautiful.

Adam Davis: As I've been reading and rereading some of your essays, I've had this story, a William Carlos Williams story. So again, another generalist in a way, a doctor, but also a poet. And the story, “The Use of Force.” I don't know if anyone knows that story. It's this very short story about a doctor going to pay a house visit to a young girl, whose parents suspect she may have diphtheria. So, it's a public health question. They need to know both for her own good and for the good of the community in which she lives. And the girl does not want the throat culture, the swabs, that she's fighting it like crazy.

And the doctor, whose head, we get to see what he's thinking, he kind of falls in love with her resistance to his trying to do what he kind of knows is right. And, I guess the question I want to ask is related to what you said earlier about why we ride bikes, because we like it. And something you said too about how this is one case where the government sort of gets in our body in some invasive way. There's something about the image and the experience of vaccination, uh, that feels like, you know what? It runs against self-rule. And if I'm in charge of myself, I can say what I want about what goes into and doesn't go into my body. And I wonder sort of, the last thing I want to ask before opening it up about that kind of, uh, it's not a solid argument, but it seems to me it's a strong feeling.

Eula Biss: Yeah. Yeah, no, that's a great question. And that was one of the big struggles for me as I was writing this book, I didn't know what I was going to end up saying or thinking. At a certain point, I began to discover it, and I was deeply disappointed that what I was saying was, follow the rules? You know, like not only did that strike me as, you know, a sad conclusion, but it also seems like a totally unsexy book that I'd never be able to sell. You know, like, uh, I thought really, really hard. And what I came up with was, ‘Do what you're told.’ But part of that struggle was also, you know, about my deep respect for people who muster the courage to resist, and to resist government oppression, to resist social oppression, and to even sometimes just resist the mainstream, not in a political way, but to live differently. And that, to me, being around people who do that has been incredibly vital to my own thinking in life. And I have tremendous respect for that position. And so, it was a struggle for me to think about, you know, what am I saying to a person who has, you know, spent a lifetime in resistance and has given up all the things that you give up when you live a life that's in resistance to the mainstream?

And I guess two things came out of that long struggle for me, one of them was seeing, you know, the way I thought about it when I was writing was, opting out of opting out is not the same as opting in. And I do believe that. And I think that I vaccinate for reasons that are very different than the reasons that some other people vaccinate. I vaccinate out of reasons that feel very political to me. And that do feel essentially connected to some traditions of resistance. Even though what I'm doing is not actively resisting a government recommendation. But the other thing that came out of this, that I think is, is maybe even more important, is a respect for the fact that we really owe a lot to vaccine safety advocates, right? People who've, for instance, there's a father whose child, this was only about a decade ago, his child developed complications from the polio vaccine that we were using at the time, which was the Sabin vaccine. And about twelve children a year were developing these sorts of complications, and he petitioned the government, and he said, there's a safer vaccine, it’s the Salk vaccine, we should be using this vaccine. And that's the vaccine my son received. We made a change. The policy was changed, and that's twelve people a year who aren't going to be paralyzed because an activist worked for that change.

Adam Davis: And that distinction you make between vaccine safety activists and anti-vaccine activists feels like a huge distinction that was confused in my head.

Eula Biss: Yeah. And I do think it's, sometimes the boundaries get blurry, and sometimes there are people who are doing both, which gets confusing, but I do think it's more or less, you know, distinct activities. It's one thing to say, No, I don't want anything to do with this. And it's another thing to say, here’s this one particular thing that I know could be safer. Here's what we need to do to make that happen. And I'm going to argue my case and, you know, in front of all the people who need to hear it until it changes. And he's not the only person who has done that, and who, you know, whose work we all have benefited from. Part of what gets lost in this, the way this conversation is kind of stratified into pro and con, is some of the nuances in there, and this, the important work of people who are, you know, trying to advocate for better products, right? Better vaccines. Some of that gets drowned out in the pro and con conversation.

Adam Davis: What I'd like to do is I guess I want to invite, we have a microphone over here in the dark that will soon be kind of lit up, and I want to invite questions. And while people come up with questions, I guess I would ask everyone to join me in a preliminary thank you for helping us start to think through these things.

Audience member: I appreciate your comments regarding those who are concerned about vaccine safety and vaccine safety advocates, and your previous comments about race and privilege, as well as distrust of government sort of tie into the question that I have for you. Just yesterday morning at the House of Representatives, Congressman Posey addressed the issue of research and scientific integrity. And he pointed out that he's received documents from Dr. William Thompson, who's a CDC researcher who, along with four other researchers in 2004, published a study on an autism case study involving MMR vaccine, and as part of their protocol, when they set up that study, they set up certain parameters regarding race. And when they reviewed the results they found, there were some statistically significant results regarding race. And the four of them got together and purposely dumped documents into a garbage can and did not report those results in the race, in the study that was published. Congressman Posey has called for an investigation study of the CDC, and into the, uh, allegations made by the whistleblower. Isn't it a great concern that the study, the science that we're getting isn't trustworthy?

Eula Biss: Well, science might not be trustworthy, but I don't think that's the best example of it, because in that particular case, what's going on is a manipulation of the data. You know, in the time when I was researching this really intensively, stories would appear periodically that were, um, stories where some new finding was being suggested. And sometimes it was an alarming new finding, and on closer inspection, it was a manipulation of the data. So, one of the, and this is one of those situations, which I have read about this and have looked into this. And this is where, if you crunch the numbers in a certain way, it can suggest that Black children had a higher chance of developing autism following vaccination.

There's a lot of numerical manipulation going on there. And there's some, I've seen some fairly good breakdowns of how that manipulation is happening. Another example was, and this still comes up fairly frequently, was something that was presented as a new finding about the U.S. having the highest infant mortality rate in the world, or of any developed country. And this being linked to vaccinations in some way. The problem with that, that was also a statistical manipulation. So, what was going on there is the U.S. happens to measure our infant mortality rate in a different way than almost every other developed country, in that we count every child who was born at any number of weeks gestation, any child who is born with any signs of life, as a live birth.

And so, a lot of countries don't count as a live birth, a baby who's born before a certain number of weeks of gestation, even if that baby lives. They're not counted as a live birth, it doesn't go into their numbers. They also don't tend to count as live birth, a baby who has only, say, one sign of life. And so, we're really measuring infant mortality in a different way than, say, Germany is. And so, if you compare our infant mortality to Germany's, it can appear at first blush to be remarkably higher. And that, that seems concerning. If you then look at where those numbers are coming from, and why one is higher than another, the alarming aspect disappears. And that's the same thing that I found in the story that you're bringing up about this suggestion that, that Black children had a higher incidence of autism. This was really a numerical manipulation that doesn't, once I looked at it quite closely, cause me any sense of alone.

Adam Davis: What do we owe the people we live among? And what should we be able to expect and possibly even demand from them? What kind of responsibility do we hold when we make decisions for people who can't make decisions for themselves? How do we live with uncertainty? How do we change our minds?

You can find a link to our full conversation with Eula in our show notes, along with suggestions of her work, picked by our staff, at You can support the show by subscribing wherever you get your podcasts, or by sharing it with a friend; we'd be really grateful. The Detour is made possible by the National Endowment for the Humanities.

I'm Adam Davis. Our producer is Keiren Bond, our editor and engineer is Dave Friedlander. Thanks to Ben Waterhouse, Alexandra Powell Bugden, and Karina Briski for all their work. Thanks for being with us. See you next time.


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