Are the unvaccinated entitled, deprived, or just misunderstood? What would be a more effective way of controlling the COVID pandemic—shame or providing healthcare for all? (Or both?)

I talked with Eula Biss, author of On Immunity: An Inoculation, for this week’s Racket podcast. We went deep into the long history of debates over inoculation (debates that started even before the first vaccine was invented!), the power of conversation, and our own experiences vaccinating our respective kids.

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Also discussed in this episode:

“The Unvaccinated May Not Be Who You Think” by Zeynep Tufekci

“Who’s afraid of the vaccine mandate” (The Racket)

Having and Being Had by Eula Biss

Gangsters of Capitalism: Smedley Butler, The Marines, and the Making and Breaking of America’s Empire by Jonathan M. Katz

Historian Farren Yero

Produced by Evan Roberts. Research by Annie Malcolm.

Transcript (may contain errors)

[00:00:00] JONATHAN KATZ: Welcome to The Racket, a newsletter and podcast that asks what's really going on out there. I'm Jonathan M. Katz. A few weeks ago, I wrote a piece at The Racket called Who's Afraid of the Vaccine Mandate in which I discussed the most thought-provoking and enlightening book on vaccines in American culture that I've read "On Immunity" by the essayist Eula Biss, who I'm very pleased to say is joining us here on the show right now. Eula is the author of four books most recently Having and Being Had. She won the National Book Critics Circle Award for criticism. I can't really think of a higher honor than being awarded a prize for criticism by critics. And she also used to teach at Northwestern University—which, and I don't know if this takes the luster off of that particular accolade, but that happens to be my Alma mater— um in the English major in writing. Eula, thanks for being here.

[00:01:15] EULA BISS: Oh, totally. My pleasure. Thanks for having me.

[00:01:18] JONATHAN: So the reason I wanted to talk to you is because, On Immunity is just this incredible deep dive meditation. , and really, I like, I highly recommend it to every, I've been recommending it since like before the pandemic, but especially in this COVID moment, this ongoing COVID moment, um, it's just this incredible meditation on. What vaccines mean, what it means to be, you know, anti-vaccine or pro-vaccine. , and I just, just to get us started, you know, obviously you wrote the book, uh, it came out in 2014, long before COVID , was a thing. What was happening in, in your life? What was happening in, the conversation around vaccines, that set you on the path to write it?

[00:02:04] EULA: Um, well, I started writing this book very shortly after having my first child. , when the question of vaccination was high on my mind. I had just gone through the decision of whether or not to vaccinate my own child. I was in conversation with lots of other parents around me about their vaccination decisions. And I was just, uh, I was really intrigued by some of the philosophical questions around vaccination. the biggest and most pressing one for me was really like the question of parenthood. How do you care for someone who can't care for themselves? You know, this to me felt like a Tremendously difficult question to answer. So I was very aware that I was making decisions for someone who couldn't make their own decisions. , and that's where a lot of the research that, that began the book came from was wanting , to do, , due diligence, I guess.

[00:03:04] JONATHAN: Yeah, I mean, and I think one of the important things to remember that is easy to forget in, in 2021 is that, you know, these arguments over vaccination over vaccine mandates, , have been going on for a very, very long time. Before COVID was even a glimmer in the eye of the horse shoot bat or, or wherever it started.

[00:03:26] EULA: I was actually really surprised when I started doing research to find out how very old these debates are. the first really robust anti-vaccination movement was in England, in the 1850s. So it's, you know, well over 150 years ago, so And there was something about finding that out. That, that also drove me further into the questions around vaccination. I was, I was really intrigued to discover that even though all the technology around vaccination was different in the 1850s, some of the fears around vaccination were the same and it had remained the same. Um, so some of the same things that I heard parents saying to me around 2009, I was seeing quoted in the texts and the pamphlets from the 1850s. So especially. You know, things about, uh, suspicion of state power, you know, and fear of state power, um, or the role of the state and the lives of individuals. but also fears about impurities entering the body and that vaccine back in the 1850s, this is before hollow needles, so people are not getting injections back then. A slit is made in the skin in the 1850s and the vaccine material is rubbed into that slit. So the skin is being broken and something is entering the body. So a lot of the fears people have around vaccination are just visceral responses to the body being penetrated. Right. It's and, and sometimes they're sexualized because there's some sexual nature to that penetration. So that, that comes up again. And again, if you read a lot about fear of vaccination, you'll see sexualized descriptions of vaccination that, you know, compare it to rape in some cases. Soit's definitely the people's sense of integrity of their own body is very, you know, caught up in, in their fears and resistance to vaccination.

[00:05:27] JONATHAN: Some of these conversations go back even before the invention of the first vaccine, they, they, they were happening around inoculation, which was an earlier process where, how did it work? They would cut part of your arm and like put a pustule from somebody who had smallpox into your body. Right.

[00:05:45] EULA: Yeah. So inoculation is the broader category that both vaccination and variolation fall into. And so variolation is the technology that preceded vaccination and it's really, really old it's um, probably thousands of years old. It goes back to, , Eastern medicine. It was practiced in China. It was practiced in India first. Variolation was folk medicine. and this was intentionally giving someone a less severe case of the disease. , so it's different than vaccination in that disease hasn't been. Attenuated in a way that prevents you from actually getting the disease you are in variolation, you're being given the disease. But ideally you're , being given a less severe version of it, you know, a strain that has shown itself to be less deadly. And there's various ways that this was done sometimes scabs from people who had had smallpox were ground up and sniffed through the nose sometimes. , plus was rubbed into a wound on a person, a child. But because variolation was actually giving someone smallpox. It was very dangerous. But it was less dangerous than getting the most deadly strain of smallpox. So for hundreds of years, people looked at this as a better alternative than to just leaving one's child to chance, this is usually done. Variolation was usually done on a child and it was done to try to prevent that child from later getting a more serious version of the same disease.

[00:07:24] JONATHAN: And, you know, you're hitting the nail on the head there. I mean, that's, that was the calculus that a lot of people were making back then. And it's the calculus that people are making today. And I think it's important. I mean, um,one of my friends, a historian named, uh, Farren Yero, her project is all about, original, uh, attempts at variolation under the Spanish empire, um, where they were, bringing smallpox in the bodies of enslaved people to the new world. Like that was the container that they were then using to then kind of scoop out and put into, into people in, in Mexico and, and, and their, and their colonies. And so, like, there is this, you know, very invasive Imperial, uh, you know, history, but as you note, you have to, you know, run these risk benefit calculations right from the beginning of American history.

 you talk in, in, in, on immunity about George Washington, trying to balance that ledger in his mind between the risk of, very leading his troops and the risk of a major smallpox epidemic that could have, you know, wiped out the American revolution. Uh, can you, can you talk a little bit more about that?

[00:08:40] EULA: Yeah. Yeah. This came after, um, Washington lost a major battle. I think it was the first major loss of the revolutionary war. Um, and he lost it because so many of his troops were sick. There was a smallpox epidemic going on at the moment and he didn’t want to have to force variolation on his troops, but I think he also saw the possibility that the war could be lost to this epidemic. And so that's, as I understand it, that's the calculation that was going on for him. and he did end up forcing the variolation of all of his troops. and that wasn't something that his troops were necessarily happy about at that time. You know, this is a dangerous therapy that he's insisting on. This is from, um, Michael Welch's book, Pox Americana. It's a great history of, it's kind of like a legal history of both of smallpox in the US but of how many of our laws today originated in conflicts around disease and vaccination,

[00:09:55] JONATHAN: Yeah. I mean, I know you've talked about how conversations about vaccination are often conversations about other things. This kind of goes to the heart of what we're talking about here, right? Because to put it mildly, there's a lot of bad faith in the conversation about vaccines, vaccine mandates, and specifically the COVID vaccine. I don't know, it's something that I've had a hard time navigating myself. And it's one of the reasons why I really wanted to talk to you because I feel like you've explored a lot of these questions, you know, before the fact. One of the things that reading On Immunity did for me, was it gave me an extreme amount of empathy for people who make a different choice, as much as I think is a horrible choice, but just to understand a little bit where they're coming from. Not everybody who is refusing a vaccine is doing so because they're just an absolute moral monster.

[00:10:58] EULA: You know, back in 2009, when I first started writing about this part of the problem was that vaccination was very often framed as a question of personal choice. Like, like many things are framed in our society. You know, we're, we're very focused on personal choice and individualism. Um, it's more common now to see vaccination framed as a question of civic responsibility or civic duty, which is what I think it is. But it took quite a bit of time kind of mucking around in the information and the science of vaccination before I came to understand that myself. So much of the conversation back then in 2009, was still you, it might be helpful to say this is also in the moment of the H 1 N 1 pandemic, right? So there was kind of a special intensity around vaccination when I started writing about it because of H 1 N 1. When I was reading about vaccination in say, you know, the magazines that I picked up , in the waiting room at my, midwife's office or you know, the pediatrician's office or, popular newspapers, almost all those places, vacs vaccination was framed as a matter of personal choice. And you should make the choice that you're most comfortable with was how it was framed. I, I don't think that's how we should talk about vaccination, but I do think that it is useful to understand what is going on for people who feel resistant to vaccination, because what we're really dealing with with vaccination is. Uh, technology, that is a consensus technology. It works best if we all agree to do it. So we're not really used to building consensus in this society and this governance structure. and so I think we're fairly rusty around consensus building skills, but that's where we need to go. And I think part of that consensus building project is to understand why people who don't vaccinate don't vaccinate. So back in 2009, you know, part of what I learned in my research and my research included just casual conversations with other parents. So on playgrounds and on beaches and at my son's daycare and preschool, I was just talking to other parents about their decisions. And I found that there were lots of reasons why, people were hesitant around vaccination or didn't vaccinate or delayed vaccines. and that's backed up by research too, that we now know that that's true, that there is not one homogenous anti-vax position. That it's a very diverse, philosophical stance. People take the stance for lots of different reasons and sometimes don't even take it intentionally. Sometimes people don't vaccinate because of their situation in life. It's not a deliberate decision.

Various people associate vaccination with institutions and entities that they're deeply mistrustful of. And in many cases they have every reason to be mistrustful of those entities. So some, Some people who are very familiar with the long history of the medical establishments failure to, effectively treat women and women's health are, you know, for feminist reasons. Suspicious of vaccination and suspicious of what they see as a kind of paternalistic authority of doctors.

Does that mean that it serves women not to be vaccinated? No. But does that mean that some women have legitimate reasons to be kind of cautious around medical care? Yes, I think so. And the same is true for African-Americans, you know, there's a number o