“I saw myself as writing for a certain kind of optimism”: In Converstion With Eula Biss
Eula Biss, National Book Critics Circle Award-winning author of Notes from No Man’s Land, turns her focus to a cultural and personal examination of vaccination for her latest book, On Immunity: An Inoculation (Graywolf Press). Biss took the time to share her thoughts with Late Night Interview about the writing process, the complex politics and cultural differences surrounding immunization, and topics she might be interested in exploring in the future.
NICHOLE L. REBER: At what point in your research and writing about a subject do you determine you have a book?
EULA BISS: Usually fairly late in the process. The Balloonists began as notes for the “real” book I thought I was writing at the time, and I had written most of it before I began to think of it as a book in its own right. I had written about two thirds of the essays in Notes from No Man’s Land before I saw the potential for them to become a collection of essays about race. And I initially thought On Immunity would be a much shorter essay. As the work unfolded, I quickly understood that it would need to be longer than I had anticipated. But I was still surprised, when I finished, by how long of an essay it turned out to be. It’s a short book, but it’s the longest continuous work I’ve ever written.
NR: You dug up some fantastic research on vaccinating newborns against Hep B, stating, “Like human papillomavirus and a number of other viruses, hep B is a carcinogen, and it is most likely to cause cancer in people who contract it when they are young.” This reminded me of certain Republican politicians on the national stage who disagreed with vaccinating young women against HPV. Did your research lead you to a sense of the general public’s stance on the vaccine against HPV?
EB: I don’t think there is one stance on HPV shared by the general public. That’s part of why the HPV discussion is so difficult and confusing. Many parents have already vaccinated their children against HPV, but there is also fairly widespread reluctance to follow the HPV vaccination recommendations. I can think of at least five different mothers I’ve spoken with who have five different reasons for delaying or refusing the vaccine. Some people don’t like the idea of vaccinating children before they are sexually active, though this is when the vaccine is likely to be most effective. Some people don’t think the vaccine is worthwhile, despite evidence that vaccinating every 12 year-old girl in the United States could prevent about 1,300 deaths every year. Some people are afraid of the potential side effects of the vaccine, and these fears are stoked by unsubstantiated or exaggerated reports of side effects – one of my neighbors, for instance, was reluctant to vaccinate her son because another neighbor of ours had told her that she had heard that it made girls in Australia infertile. That concern was new to me, so I looked into it and found that the origin of that fear was a single individual – a girl with unexplained infertility whose doctor had forwarded her case for further study. For some people, (and this might include the Republicans you mention, as well as some of the Democrats I know), the actual efficacy or side effects of the vaccine are irrelevant because the vaccine has become emblematic of the encroachment of the state on the rights of the individual and refusing the vaccine is a way to assert one’s individual rights or express one’s opposition to the government.
NR: In On Immunity you broach the subject of allergies, leading the reader to the concept of the “hygiene hypothesis.” The hypothesis suggests, “it was possible to be too clean and too free of disease.” I find cleanliness appealing but that does not mean I don’t suffer cognitive dissonance over it. I find the bottle of anti-bacterial hand wipes at the entrance to the supermarket, the post office, and elsewhere to be disturbing. However, I admit to being taken aback when a British man I met in Peru said upon meeting me, “Ah, the country that loves its hygiene.” Considering the seeming growth of allergies, especially among children, I wondered why you didn’t go into more detail about allergies.
EB: Allergies are an enormous subject, worthy of their own book — a colleague of mine has already suggested a sequel! My exploration of immunity demanded that I write about allergies, particularly the hygiene hypothesis, which is sometimes misconstrued as a reason not to vaccinate, but the form of On Immunity limited how far I could venture into the subject. This book, which makes frequent forays into related subjects but consistently circles back to its central concern, did not allow me extended tangents. And that is probably for the best, as almost every subject I touched strikes me as worthy of an extended tangent – the use of DDT to control malaria in Africa, the murders of Lady Health Workers in Pakistan, the politics of smallpox, the nuances of influenza, the intricacies of toxicology, the mysteries of risk assessment, the legacy of paternalism, etc. This book is written in thirty short sections, each of which could – if this was a different book – be expanded considerably. But that would make for a huge, sprawling book, and I wouldn’t be the right writer for it.
I drew some inspiration for On Immunity from Candide by Voltaire, which is also written in thirty short sections. I was interested in Candide in part because Voltaire was writing against a certain kind of optimism, and I saw myself as writing for a certain kind of optimism. Candide is a bawdy, fast-paced tour of world history that ranges from the Lisbon earthquake and the Inquisition to the Jesuits in Buenos Aires and back to Paris and then Constantinople. One could say that slavery in the Americas deserved more than a few sentences in Candide, but that would be missing the point.
NR: The concept of “fading immunity” and the susceptibility of a vaccinated person who is surrounded by those carrying a disease to be vulnerable to vaccine failure, particularly intrigued me. “We are protected not so much by our own skin, but by what is beyond it. The boundaries between our bodies begin to dissolve there,” you wrote. “Those of us who draw on collective immunity owe our health to our neighbors.” Can you elucidate us with an example of fading immunity?
EB: Our current pertussis vaccine, the acellular pertussis vaccine, produces fewer fevers and side effects than the whole-cell pertussis vaccine that it replaced in the 1990s, but it may also produce an immunity that fades more quickly. (All immunity against pertussis tends to fade with time — neither natural infection with pertussis nor vaccination can be relied on to produce lifelong immunity.) People who were vaccinated as infants may no longer be immune to pertussis as older children or when they themselves become parents. Pertussis is most dangerous for newborns, but fading immunity is significant because adult caregivers and siblings are the people most likely to transmit pertussis to a child who is too young to be vaccinated. There is evidence that fading immunity, along with vaccine refusal, contributed to the 2010 pertussis epidemic in California that killed ten infants.
Fading immunity, or the tendency of the immunity produced by some vaccines to fade over time, is just one reason why a vaccinated person who is surrounded by unvaccinated people could be vulnerable to disease – another reason is vaccine failure, in which the individual’s immune system does not mount a robust enough response to the vaccine to produce immunity. Some vaccines have higher rates of failure than others, but in all cases it is the individual’s immune system, not the vaccine, that produces the antibodies necessary for lasting immunity. High percentages of unvaccinated people who create reservoirs for disease are dangerous not just for vaccinated people with fading immunity or vaccine failure, but also for people with immune systems that have been compromised by AIDS or many types of cancer.
NR: You mentioned researcher Eve Sedgwick’s concept of a “strong theory” in which a wide-ranging, reductive theory displaces other ways of thinking. Otherwise stated, paranoia often passes for intelligence. You also addressed this, though from a different perspective, in Notes: “Fear is accepted, even among the best-educated people in this country… as a kind of intelligence.” We might think of germs as an American example in this case. Did you find yourself enacting different—or more or fewer— measures against germs while or after writing this book?
EB: Yes, I began washing my hands much more regularly – not, I like to think, in a paranoid way (ha!), but in a way that reflected both my newfound respect for germs and my growing awareness of how effective hand washing can be in controlling the spread of disease. At the same time that I began washing my hands more often, I also became more dedicated to avoiding products that kill germs, rather than simply wash them away. Antibacterial soaps are no more effective at reducing germs than regular soaps, and killing germs indiscriminately can be unhealthy for both us and our environment. My research prompted me to ask my son’s preschool to stop using hand soap that contained triclosan, an antimicrobial agent. It took some time, but they did eventually change soaps. In that case, I was not concerned about the direct effects of triclosan on my son’s health so much as I was concerned about the effects of triclosan on the environment after it had been washed down the drain. Of course, a healthier environment is going to be better for my son in the long run.
NR: Speaking of the strong theory, I would so love to see your next book be about America’s obsession with safety. Any ideas what your next book will be?
EB: Both fear and personal safety, which is often used to justify fear, have come up in my last two books and I certainly have more to say about safety, particularly now that my son is getting older and even more fond of danger. (He told me recently that he really wants to go sky diving – he is five!) I don’t at all know what my next book will be. I have a few projects in mind – a collection of portraits of artists that interest me like Dr. Seuss, Margaret Leng Tan, and Weird Al Yankovic is one idea. I would like to return to writing shorter essays for a while before I tackle another book, but sometimes a book emerges from an essay, as I learned from On Immunity.
NR: Finally, if you could give three pieces of advice for nonfiction book-length writers, what advice would you give? What is one thing you’d tell writers not to do?
EB: This is an oddly hard question for me to answer, considering that teaching nonfiction writing is my day job. But one of the things that teaching has taught me is that there is very little advice that is applicable to every writer. And the more I learn about writing, the less confident I am giving blanket advice. Long ago I read something by Anne Carson in which she mentioned that what she is trying to do in her writing is avoid boring herself. That is a suggestion I frequently make to my students – try not to bore yourself.
Find a copy of On Immunity: An Inoculation on Indiebound
Eula Biss is the author of three books: On Immunity: An Inoculation, Notes from No Man’s Land: American Essays, and The Balloonists. Her work has been supported by a Guggenheim Fellowship, a Howard Foundation Fellowship, an NEA Literature Fellowship, and a Jaffe Writers’ Award. She holds a B.A. in nonfiction writing from Hampshire College and a M.F.A. in nonfiction writing from the University of Iowa. Her essays have recently appeared in The Best American Nonrequired Reading and the Touchstone Anthology of Contemporary Nonfiction as well as in The Believer, Gulf Coast, Denver Quarterly, Third Coast, and Harper’s. Eula Biss and John Bresland are the Chicago-based band STET Everything.
After dozens of moves around the country and the world, Nichole L. Reber has gone back to the Midwest, where the people are pasty, the vowels are sharp, and the Victorians still stand.