On Immunity : An Inoculation (9781555973278) (11 page)

In the event of a pandemic, thimerosal, which allows for more rapid production and distribution of vaccines, might yet be as essential in this country as it is in other countries. For now, we use expensive single-dose vaccines for the same reason many other wealthy countries do—because we can. SafeMinds, an autism advocacy group that was among the most vocally opposed to the exemption for thimerosal in the Minamata treaty, repeatedly suggested that the exemption was motivated by money. It was, in the sense that it was informed by the need for affordable vaccination in low-income countries. The groups that opposed the exemption, as global health researchers would observe in
Pediatrics
, were all nongovernmental groups like SafeMinds from high-income countries where vaccination rates would not be affected by a ban on thimerosal. Wealthier countries have the luxury of entertaining fears the rest of the world cannot afford.

C
APITAL,” KARL MARX WROTE, “is dead labor, that, vampire-like, only lives by sucking living labor, and lives the more, the more labor it sucks.” Vampires sucked the blood of the sleeping in ancient Greece and spread plague in medieval Europe, but after the industrial revolution, novels began to feature a new kind of vampire, the well-dressed gentleman who would become an enduring emblem of capitalism. During his 2012 presidential campaign, venture capitalist Mitt Romney, whose status as living or undead was the subject of some sporting debate, frequently found himself compared to a vampire. After transforming into a “vulture capitalist” in the primaries, he became a full-fledged vampire capitalist in Barack Obama’s campaign ads. “It was like a vampire,” a steel-worker said of the company Romney cofounded, Bain Capital. “It came in and sucked the life out of us.”

The idea of an ambitious vampire sucking the life out of honest workers resonated in a country where the value had so recently been sucked out of nearly every home. Vampirism was behind a housing crisis set off by a rash of predatory loans to home owners who lacked the ability to repay them. These loans, bundled and sold to investors, came to be known as “toxic assets” when they lost their value.

The understanding that capital can itself be toxic leads, almost inevitably, to a fear of capitalism polluting every endeavor. At the close of the 2009 H1N1 influenza pandemic, when it was clear that the flu had not caused the high mortality rates health officials had initially feared, the chair of the health committee for the Council of Europe accused the World Health Organization of colluding with pharmaceutical companies and creating a “false pandemic” to sell vaccines. The WHO met this accusation with equanimity, their spokeswoman saying, “Criticism is part of an outbreak cycle.” The WHO then invited twenty-five independent influenza experts from twenty-four countries to evaluate its actions during the pandemic.

In reading the report prepared by these experts, I paused for a long moment over a passage proposing that a fund be established to provide for the child care needs of WHO workers who could expect to be called away in the event of a pandemic. This passage was just an aside, a minor logistical note, but what caused me to pause was the evocation, for a moment, of the lived lives behind the effort to control disease. It is easy to forget that an organization known as the “WHO” is composed of actual individuals, with children and child care concerns like my own.

The independent experts found no evidence that commercial interests had influenced the WHO or attempted to influence it, and no evidence that the WHO had wrongfully exaggerated the pandemic. Their report explained that one of the reasons certain precautions taken by the WHO could seem, in hindsight, out of proportion with the actual threat posed by the pandemic is that the organization had been preparing for a possible outbreak of avian influenza H5N1, a highly lethal strain, and initial reports had suggested that the fatality rate of H1N1 might also be quite high. “Influenza viruses are notoriously unpredictable,” the chairman of the committee noted in his introduction to the report, adding that we were “lucky” this time. “In the Committee’s view,” the report concluded, “the inference by some critics that invisible commercial influences must account for WHO’s actions ignores the power of the core public-health ethos to prevent disease and save lives.”

The extent to which it is hard to imagine an ethos powerful enough to compete with capitalism, even if that ethos is based on the inherent value of human lives, is suggestive of how successfully capitalism has limited our imaginations. “Occupy immune systems,” a friend joked when she heard I was writing about vaccination, but I did not immediately recognize the joke and spent some time searching the Web for an organization called Occupy Immune Systems. The possibility did not seem unlikely. At that moment, the Occupy movement was carrying the declaration “We are the 99%” from Wall Street to Chicago to San Francisco, rapidly becoming an ongoing global protest of capitalism.

Immunity is a public space. And it can be occupied by those who choose not to carry immunity. For some of the mothers I know, a refusal to vaccinate falls under a broader resistance to capitalism. But refusing immunity as a form of civil disobedience bears an unsettling resemblance to the very structure the Occupy movement seeks to disrupt—a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent.

Dracula
, published shortly after the third and final volume of Marx’s
Capital
, is fairly easily subjected to Marxist interpretation. “Like capital, Dracula is impelled towards a continuous growth,” the literary critic Franco Moretti writes, “an unlimited expansion of his domain: accumulation is inherent in his nature.” What makes Dracula terrifying, Moretti argues, is not that he likes blood or enjoys blood, but that he needs blood.

The drive toward capital, as
Dracula
suggests, is inherently inhumane. We are justified in feeling threatened by the unlimited expansion of industry, and we are justified in fearing that our interests are secondary to corporate interests. But refusal of vaccination undermines a system that is not actually typical of capitalism. It is a system in which both the burdens and the benefits are shared across the entire population. Vaccination allows us to use the products of capitalism for purposes that are counter to the pressures of capital.

Observing that we have waged wars on poverty and drugs as well as cancer, Susan Sontag writes, “Abuse of the military metaphor may be inevitable in a capitalist society, a society that increasingly restricts the scope and credibility of appeals to ethical principle, in which it is thought foolish not to subject one’s actions to the calculus of self-interest and profitability.” In such a society, preventive measures to protect public health require elaborate justifications. War, Sontag suggests, is one of the few activities in which we are not expected to consider practicality and expense. Declaring a metaphorical war on a disease is how we justify the inevitable impracticalities of protecting the most vulnerable among us.

My son was three years old by the time the CDC released their estimate of how many people worldwide had died from H1N1 in 2009, when he was an infant. The death toll calculated by the CDC, somewhere between 150,000 and 575,000, made the severity of H1N1 comparable to a typical seasonal outbreak of influenza. But this flu had killed young people disproportionately. In the United States, ten times more children died of H1N1 than die in a typical flu season. Worldwide, somewhere around 9.7 million years of potential human life had been lost in the pandemic.

“Follow the money,” a friend of mine says in defense of the theory that vaccination is a profit-driven scheme controlled by pharmaceutical companies with unchecked influence over government and medicine. My conversation with her reminds me of Eve Sedgwick’s essay on paranoia, in which she recounts a conversation with her friend Cindy Patton during the first decade of the AIDS epidemic. Sedgwick asked Patton what she thought about rumors that the HIV virus was part of a plot engineered by the US military, and Patton said she couldn’t muster much interest. “I mean,” Patton said, “even suppose we were sure of every element of a conspiracy: that the lives of Africans and African Americans are worthless in the eyes of the United States; that gay men and drug users are held cheap where they aren’t actively hated; that the military deliberately researches ways to kill noncombatants whom it sees as enemies…. Supposing we were ever so sure of all those things—what would we know then that we don’t already know?”

A Nigerian barber said, of the idea that vaccines were a Western plot against Muslims, “If the White man really wanted to destroy us, there are many other easier ways to do it. They can poison our coca-cola …” I tend to agree. And I suspect that Coca-Cola, unpoisoned, is more harmful to our children than vaccination.

Just because we have enemies, Sedgwick proposes, does not mean we have to be paranoid. Our cynicism may be justified, but it is also sad. That so many of us find it entirely plausible that a vast network of researchers and health officials and doctors worldwide would willfully harm children for money is evidence of what capitalism is really taking from us. Capitalism has already impoverished the working people who generate wealth for others. And capitalism has already impoverished us culturally, robbing unmarketable art of its value. But when we begin to see the pressures of capitalism as innate laws of human motivation, when we begin to believe that everyone is owned, then we are truly impoverished.

W
HENEVER I COMPLAINED of a sore throat as a child, my father would press his fingers gently behind my jawbone, checking for swollen lymph nodes. “I think you’re going to be okay,” he would say upon completing his examination. This was his verdict, too, when I called him from college, miserably ill with what he identified as “probably influenza.” I asked him if there was anything I could do and he suggested, to my disappointment, drinking plenty of fluids. Then he recommended his grandmother’s prescription for a bad cold—buttered toast dipped in warm milk. He described the way the butter floated on the surface of the milk and how comforting he found his grandmother’s care. I wanted to know if there was some sort of medicine I could take, but what I needed, my father understood, was comfort. As an adult, I still never cease to feel a little surprise when a doctor reaches behind my jawbone to check for swollen nodes. I associate the tenderness of that gesture with my father’s care.

Paternalism has fallen out of favor in medicine, just as the approach to fathering that depends on absolute authority no longer dominates parenting. But how we should care for other people remains a question. In his discussion of efforts to control childhood obesity, the philosopher Michael Merry defines paternalism as “interference with the liberty of another for the purposes of promoting some good or preventing some harm.” This type of paternalism, he notes, is reflected in traffic laws, gun control, and environmental regulations. These are limits to liberty, even if they are benevolent. Interfering with the parenting of obese children, he argues, is not necessarily benevolent. There is risk in assigning risk. Children who are already stigmatized for their body type are further targeted. And families who are identified as “at risk” for obesity become at risk to discriminatory oversight. The prevention of risk, Merry observes, is often used to justify a coercive use of power.

Autonomy
is usually imagined as the alternative to paternalism. But in what is sometimes called the “restaurant model” of medicine, the paternalism of doctors has been replaced by the consumerism of patients. We order tests and treatments from a menu based on our consumer research. And the doctor, who was a father in the paternalistic model, is now a waiter. The idea that the customer is always right, imported to medicine, is a dangerous dictum. “If you keep telling people that it’s just a marketplace and that they’re just clients and that the autonomy of the patient is what must be served to make them happy customers,” the bioethicist Arthur Caplan warns, “then you have a collapse of professionalism in the face of consumer demand.” Doctors may be tempted to give patients what we want, even when it is not good for us.

“Why does the term ‘paternalism’ have such bad press in medical circles?” asks physician John Lee. “Did everyone really have such a hard time with their dad that the reason seems self-evident?” He is paternalistic, Lee admits, but “in a good way.” A return to paternalism, good or bad, is not the only alternative to consumerism. In a response to Merry’s critique of paternalism, the educator Barbara Peterson proposes that we think of the problem of childhood obesity in terms of maternalism. Caretaking, she suggests, is not an inherent threat to liberty. “From a feminist, caring framework,” Peterson writes, “
liberty
is not defined as complete separation and independence from the parent.” If fathering still reminds us of oppressive control, mothering might help us imagine relationships based not just on power, but also care.

“If you’re going to get medical care,” my father says, “you’re going to have to trust someone.” I have called to ask his advice about a surgery my son’s pediatrician has recommended. My father is happy to offer his thoughts, but he is also quick to remind me that he is not a pediatrician. He does not want to be the only doctor I am willing to trust.

He is, in fact, usually the first doctor I consult. When my son woke at dawn one morning with his face so swollen from an allergic reaction that the whites of his eyes were bulging over the irises, I called my father. Did I have to go to the emergency room, I wanted to know, or could I wait until the doctor’s office opened in a couple hours? I could wait, my father assured me, and the swelling was not dangerous. “It’s just fluid,” he said. I now repeat
it’s just fluid
in my mind every time my son’s eyes swell.

My son has unusually severe allergies, which he developed at an unusually young age. His pediatrician calls him her “outlier” because he is a statistical anomaly. By the time he turned three, his allergies had led to swelling in his nasal cavity, and this swelling had led to painful sinus infections, which we had cured with antibiotics several times, but which inevitably returned. After the third round of antibiotics, the pediatrician suggested surgery to remove his adenoids, which had swelled so much that they were completely blocking his nasal passage.