From the Magazine — January 2, 2013, 10:05 am

The Class Politics of Vaccination

“Debates over vaccination, then as now, were often cast as debates over the integrity of science, though they could just as easily be understood as conversations about power.”

The following is an excerpt from “Sentimental Medicine” by Eula Biss, in the January 2013 issue of Harper’s Magazine. Subscribers can read the full story here.
 

Schoolchildren wait in line for immunization shots at a child health station in New York City, 1944. Courtesy Portrait of America Collection, Library of Congress

The belief that public-health measures are not intended for people like us is widely held by people like me. Public health, we assume, is for people with less — less education, less healthy habits, less access to quality health care, less time and money. I’ve heard mothers of my class suggest, for instance, that the standard childhood vaccination schedule groups together multiple shots because poor mothers can’t visit the doctor frequently enough to get the twenty-six recommended shots separately. (No matter that many mothers, myself included, might find so many visits daunting.) That, we seem to be saying of the standard schedule, is for people like them.

When the last nationwide smallpox epidemic began in 1898, some people believed that whites were not susceptible to the disease. It was called “nigger itch” or, where it was associated with immigrants, “Italian itch” or “Mexican bump.” When smallpox broke out in New York City, police officers were sent to help enforce the vaccination of Italian and Irish immigrants in the tenements. And when smallpox arrived in Middlesboro, Kentucky, everyone in the black section of town who resisted immunization was vaccinated at gunpoint. These campaigns did limit the spread of the disease, but most of the risk of vaccination, which at that time could lead to infection with other diseases, was absorbed by the most vulnerable. The poor were forced into the service of the privileged.

Debates over vaccination, then as now, were often cast as debates over the integrity of science, though they could just as easily be understood as conversations about power. The working-class people who resisted England’s 1853 provision of free, mandatory vaccination were concerned, in part, for their own liberty. Faced with fines, imprisonment, and the seizure of their property if they did not vaccinate their infants, they sometimes compared their predicament to slavery. In her history of that antivaccination movement, Nadja Durbach returns often to the idea that the resisters saw their bodies “not as potentially contagious and thus dangerous to the social body, but as highly vulnerable to contamination and violation.” Their bodies were, of course, both vulnerable and contagious. But in a time and place where the bodies of the poor were seen as a source of disease, as dangerous to others, it fell to the poor to articulate that they were also vulnerable.

If it was meaningful then for the poor to assert that they were not purely dangerous, I suspect it might be just as meaningful now for the rest of us to accept that we are not purely vulnerable. The middle class may be “threatened,” but we are still, just by virtue of having bodies, dangerous. Even the little bodies of children, which nearly all the thinking common to our time encourages us to imagine as absolutely vulnerable, are dangerous in their ability to spread disease. Think of the unvaccinated boy in San Diego, for instance, who returned from a trip to Switzerland with a case of measles that infected his two siblings, five schoolmates, and four children in his doctor’s waiting room. Three of these children were infants too young to be vaccinated, and one of them had to be hospitalized.

Unvaccinated children, according to a 2004 analysis of CDC data, are more likely than undervaccinated children to be white and to live in households with an income of $75,000 or more — like my child. Their mothers are more likely to be, like me, married and college-educated. Undervaccinated children, meaning children who have received some but not all of their recommended immunizations, are more likely to be black, to have younger, unmarried mothers, and to live in poverty.

“Vaccination works,” my father, a doctor, tells me, “by enlisting a majority in the protection of a minority.” He means the minority of the population that is particularly vulnerable to a disease. The elderly, in the case of influenza. Newborns, in the case of pertussis. Pregnant women, in the case of rubella. When relatively wealthy white women choose to vaccinate our children, we may also be participating in the protection of poor black children whose single mothers have not, as a result of circumstance rather than choice, fully vaccinated them. This is a radical inversion of the historical approach to vaccination, which was once just another form of bodily servitude extracted from the poor for the benefit of the privileged. There is some truth now to the idea that public health is not strictly for people like me, but it is through us — literally through our bodies — that public health is maintained.

Subscribers can read the rest of “Sentimental Medicine” here. You can subscribe for only $19.97 per year here.
 
Share
Single Page

More from Eula Biss:

From the January 2013 issue

Sentimental Medicine

Why we still fear vaccines

Perspective December 27, 2012, 9:00 am

On Vampire Capitalism and the Fear of Inoculation

Why efforts to contain disease are often seen as conspiracies to sell vaccines

Get access to 168 years of
Harper’s for only $45.99

United States Canada

CATEGORIES

THE CURRENT ISSUE

October 2018

Checkpoint Nation

= Subscribers only.
Sign in here.
Subscribe here.

view Table Content

FEATURED ON HARPERS.ORG

Article
Checkpoint Nation·

= Subscribers only.
Sign in here.
Subscribe here.

Laura Sandoval threaded her way through idling taxis and men selling bottles of water toward the entrance of the Cordova International Bridge, which links Ciudad Juárez, Mexico, to El Paso, Texas. Earlier that day, a bright Saturday in December 2012, Sandoval had crossed over to Juárez to console a friend whose wife had recently died. She had brought him a few items he had requested—eye drops, the chimichangas from Allsup’s he liked—and now that her care package had been delivered, she was in a hurry to get back to the Texas side, where she’d left her car. She had a three-hour drive to reach home, in the mountains in New Mexico, and she hated driving in the dark.

Sandoval took her place in the long line of people waiting to have their passports checked by US Customs and Border Protection (CBP). When it was her turn, she handed her American passport to a customs officer and smiled amicably, waiting for him to wave her through. But the officer said she had been randomly selected for additional screening. Sandoval was led to a secondary inspection area nearby, where two more officers patted her down. Another walked toward her with a drug-sniffing dog, which grew agitated as it came closer, barking and then circling her legs. Because the dog had “alerted,” the officer said, Sandoval would now have to undergo another inspection.

Checkpoint on I-35 near Encinal, Texas (detail) © Gabriella Demczuk
Article
The Printed Word in Peril·

= Subscribers only.
Sign in here.
Subscribe here.

In February, at an event at the 92nd Street Y’s Unterberg Poetry Center in New York, while sharing the stage with my fellow British writer Martin Amis and discussing the impact of screen-based reading and bidirectional digital media on the Republic of Letters, I threw this query out to an audience that I estimate was about three hundred strong: “Have any of you been reading anything by Norman Mailer in the past year?” After a while, one hand went up, then another tentatively semi-elevated. Frankly I was surprised it was that many. Of course, there are good reasons why Mailer in particular should suffer posthumous obscurity with such alacrity: his brand of male essentialist braggadocio is arguably extraneous in the age of Trump, Weinstein, and fourth-wave feminism. Moreover, Mailer’s brilliance, such as it was, seemed, even at the time he wrote, to be sparks struck by a steely intellect against the tortuous rocks of a particular age, even though he labored tirelessly to the very end, principally as the booster of his own reputation.

It’s also true that, as J. G. Ballard sagely remarked, for a writer, death is always a career move, and for most of us the move is a demotion, as we’re simultaneously lowered into the grave and our works into the dustbin. But having noted all of the above, it remains the case that Mailer’s death coincided with another far greater extinction: that of the literary milieu in which he’d come to prominence and been sustained for decades. It’s a milieu that I hesitate to identify entirely with what’s understood by the ringing phrase “the Republic of Letters,” even though the overlap between the two was once great indeed; and I cannot be alone in wondering what will remain of the latter once the former, which not long ago seemed so very solid, has melted into air.

What I do feel isolated in—if not entirely alone in—is my determination, as a novelist, essayist, and journalist, not to rage against the dying of literature’s light, although it’s surprising how little of this there is, but merely to examine the great technological discontinuity of our era, as we pivot from the wave to the particle, the fractal to the fungible, and the mechanical to the computable. I first began consciously responding, as a literary practitioner, to the manifold impacts of ­BDDM in the early 2000s—although, being the age I am, I have been feeling its effects throughout my working life—and I first started to write and speak publicly about it around a decade ago. Initially I had the impression I was being heard out, if reluctantly, but as the years have passed, my attempts to limn the shape of this epochal transformation have been met increasingly with outrage, and even abuse, in particular from my fellow writers.

As for my attempts to express the impact of the screen on the page, on the actual pages of literary novels, I now understand that these were altogether irrelevant to the requirement of the age that everything be easier, faster, and slicker in order to compel the attention of screen viewers. It strikes me that we’re now suffering collectively from a “tyranny of the virtual,” since we find ourselves unable to look away from the screens that mediate not just print but, increasingly, reality itself.

Photograph (detail) by Ellen Cantor from her Prior Pleasures series © The artist. Courtesy dnj Gallery, Santa Monica, California
Article
Nothing but Gifts·

= Subscribers only.
Sign in here.
Subscribe here.

If necessity is the stern but respectable mother of invention, then perhaps desperation is the derelict father of subterfuge. That was certainly the case when I moved to Seattle in 1979.

Though I’d lived there twice during the previous five years, I wasn’t prepared for the economic boom I found upon this latest arrival. Not only had rent increased sharply in all but the most destitute neighborhoods, landlords now routinely demanded first, last, and a hefty security deposit, which meant I was short by about fifty percent. Over the first week or so, I watched with mounting anxiety as food, gas, and lodging expenses reduced the meager half I did have to a severely deficient third. To make matters even more nerve-racking, I was relocating with my nine-year-old son, Ezra. More than my well-being was at stake.

A veteran of cold, solitary starts in strange cities, I knew our best hope wasn’t the classifieds, and certainly not an agency, but the serendipity of the streets—handmade for rent signs, crowded bulletin boards in laundromats and corner grocery stores, passersby on the sidewalk; I had to exploit every opportunity that might present itself, no matter how oblique or improbable. In Eastlake, at the edge of Lake Union between downtown Seattle and the University District, I spied a shabby but vacant one-story house on the corner of a block that was obviously undergoing transition—overgrown lots and foundation remnants where other houses once stood—and that had at least one permanent feature most right-minded people would find forbidding: an elevated section of Interstate 5 just across the street, attended by the incessant roar of cars and trucks. The house needed a new roof, a couple of coats of paint, and, judging by what Ezra and I could detect during a furtive inspection, major repair work inside, including replacing damaged plaster-and-lath walls with sheetrock. All of this, from my standpoint, meant that I might have found a solution to my dilemma.

The next step was locating the owner, a roundabout process that eventually required a trip to the tax assessor’s office. I called the person listed on the rolls and made an appointment. Then came the moment of truth, or, more precisely, untruth, when dire circumstance begot strategic deception. I’d never renovated so much as a closet, but that didn’t stop me from declaring confidently that I possessed both the skills and the willingness to restore the entire place to a presentable—and, therefore, rentable—state in exchange for being able to live there for free, with the length of stay to be determined as work progressed. To my immense relief, the pretense was well received. Indeed, the owner also seemed relieved, if a bit surprised, that he’d have seemingly trustworthy tenants; homeless people who camped beneath the freeway, he explained, had repeatedly broken into the house and used it for all manner of depravity. Telling myself that inspired charlatanry is superior to mundane trespassing—especially this instance of charlatanry, which would yield some actual good—I accepted the keys from my new landlord.

Photograph (detail) © Larry Towell/Magnum Photos
Article
Among Britain’s Anti-Semites·

= Subscribers only.
Sign in here.
Subscribe here.

This is the story of how the institutions of British Jewry went to war with Jeremy Corbyn, the leader of the Labour Party. Corbyn is another feather in the wind of populism and a fragmentation of the old consensus and politesse. He was elected to the leadership by the party membership in 2015, and no one was more surprised than he. Between 1997 and 2010, Corbyn voted against his own party 428 times. He existed as an ideal, a rebuke to the Blairite leadership, and the only wise man on a ship of fools. His schtick is that of a weary, kindly, socialist Father Christmas, dragged from his vegetable patch to create a utopia almost against his will. But in 2015 the ideal became, reluctantly, flesh. Satirists mock him as Jesus Christ, and this is apt. But only just. He courts sainthood, and if you are very cynical you might say that, like Christ, he shows Jews what they should be. He once sat on the floor of a crowded train, though he was offered a first-class seat, possibly as a private act of penance to those who had, at one time or another, had no seat on a train.

When Corbyn became leader of the Labour Party, the British media, who are used to punching socialists, crawled over his record and found much to alarm the tiny Jewish community of 260,000. Corbyn called Hez­bollah “friends” and said Hamas, also his “friends,” were devoted “to long-term peace and social justice.” (He later said he regretted using that language.) He invited the Islamist leader Raed Salah, who has accused Jews of killing Christian children to drink their blood, to Parliament, and opposed his extradition. Corbyn is also a patron of the Palestine Solidarity Campaign and a former chair of Stop the War, at whose rallies they chant, “From the river to the sea / Palestine will be free.” (There is no rhyme for what will happen to the Jewish population in this paradise.) He was an early supporter of the Boycott, Divestment, and Sanctions (BDS) movement and its global campaign to delegitimize Israel and, through the right of return for Palestinians, end its existence as a Jewish state. (His office now maintains that he does not support BDS. The official Labour Party position is for a two-state solution.) In the most recent general election, only 13 percent of British Jews intended to vote Labour.

Corbyn freed something. The scandals bloomed, swiftly. In 2016 Naz Shah, Labour MP for Bradford West, was suspended from the party for sharing a Facebook post that suggested Israel be relocated to the United States. She apologized publicly, was reinstated, and is now a shadow women and equalities minister. Ken Livingstone, the former mayor of London and a political supporter of Corbyn, appeared on the radio to defend Shah and said, “When Hitler won his election in 1932, his policy then was that Jews should be moved to Israel. He was supporting Zionism before he went mad and ended up killing six million Jews.” For this comment, Livingstone was suspended from the party.

A protest against anti-Semitism in the Labour Party in Parliament Square, London, March 26, 2018 (detail) © Yui Mok/PA Images/Getty Images

Chance that a country to which the U.S. sells arms is cited by Amnesty International for torturing its citizens:

1 in 2

A newly discovered lemur (Avahi cleesei) was named after the comedian John Cleese.

Kavanaugh is confirmed; Earth’s governments are given 12 years to get climate change under control; Bansky trolls Sotheby’s

Subscribe to the Weekly Review newsletter. Don’t worry, we won’t sell your email address!

HARPER’S FINEST

Happiness Is a Worn Gun

By

Illustration by Stan Fellows

Illustration by Stan Fellows

“Nowadays, most states let just about anybody who wants a concealed-handgun permit have one; in seventeen states, you don’t even have to be a resident. Nobody knows exactly how many Americans carry guns, because not all states release their numbers, and even if they did, not all permit holders carry all the time. But it’s safe to assume that as many as 6 million Americans are walking around with firearms under their clothes.”

Subscribe Today