On Immunity: An Inoculation by Eula Biss

Hardcover, 216 pages
Publisher: Fitzcarraldo (September 2014)
Language: English
Selected by Tank

Eula Biss’s book-length essay, On Immunity, comes hot on the heels of worldwide controversy about vaccinations and the various risks (or non-risks) involved. One of the New York Times Book Review’s top books of 2014, On Immunity has recently been published in the UK by Fitzcarraldo Editions. Biss takes a practical and intellectual look at our collective fear of disease, seeing with the eyes of both a terrified new mother and a radical thinker. On Immunity is equally concerned with sociology, biology and the clear argument that the science checks out.


My father has a scar on his left arm from his smallpox vaccination more than half a century ago. That vaccine is responsible for the worldwide eradication of smallpox, with the last case of natural infection occurring in the year I was born. Three years later, in 1980, the disease that had killed more people in the 20th century than all that century’s wars was officially declared gone from earth.

The smallpox virus now exists only in two laboratories, one in the United States and the other in Russia. Beginning shortly after the eradication of smallpox, the World Health Organization set a number of deadlines for the destruction of these stores, but neither country complied. In a 2011 discussion of the matter, the United States argued for more time with the virus so that a better vaccine could be developed, just to be safe. Smallpox has now ceased to be a disease and is only a potential weapon. And even if the last stores are destroyed, it may remain a weapon. There is plenty we do not know about smallpox, including why it is such a virulent disease, but we know enough, in theory, to resurrect it in a laboratory. “Our knowledge,” Carl Zimmer observes, “gives the virus its own kind of immortality.”

Thirty years after routine vaccination for smallpox ceased in the United States, the government asked researchers at the University of Iowa to test the remaining stores of the vaccine for efficacy. This was in the long moment after 9/11 when every potential terrorist attack was anticipated, including the use of smallpox as a biological weapon. The smallpox vaccine proved to be effective even after having been stored for decades and diluted to increase the supply. But the results of the vaccine trial, says Patricia Winokur, director of the university’s vaccine research and education unit, were “unacceptable by today’s standards”. A third of the people who received the vaccine suffered serious fevers or rashes and were sick, in some cases, for several days.

That vaccine eliminated smallpox, but it remains far more dangerous than any vaccine currently on our childhood schedule. The risk of death after vaccination against smallpox, according to one estimate, is about one in a million. And the risk of hospitalisation is about one in 100,000. Many of the children in my father’s generation took that risk. They were the generation of the polio pioneers, the 650,000 children from all over the country who were volunteered by their parents to test the first polio vaccine. This was after Jonas Salk1 had tested the vaccine on himself and his own three boys. I have seen pictures of the polio pioneers, schoolchildren just slightly older than my son, standing in lines with their shirtsleeves rolled up, grinning for the camera.

“They were afraid of polio and of the bomb,” Jane Smith writes of their parents, “and they tended to think of them in the same terms, as sudden forces that would attack without warning and destroy their own and their children’s lives.” The polio pioneers were born in the wake of Hiroshima, to parents who had, in many cases, been enlisted into wartime service. The forms they signed to give permission for their children to receive the experimental vaccine did not ask for their consent, but allowed them to “request” to be part of the trial. It is hard to imagine parents now making that request. While we routinely call for more vaccine testing, and more human trials, the unspoken assumption is that we do not intend our children to be the subjects of those trials.


[1] In 1955, when news of a successful vaccine for polio was made public, Salk was hailed as a hero. In his final years, Salk tried unsuccessfully to develop a vaccine for HIV.

  • On Immunity