There is perhaps no more emotive parenting issue at present than vaccination. When Facebook's Mark Zuckerberg last month posted a photograph of his newborn daughter above the caption "Doctor's visit – time for vaccines!" a predictable social-media storm ensued.
In On Immunity: An Inoculation, American academic Eula Biss describes how vaccination fears form part of a broader range of health and parenting anxieties. Among the many insightful passages are those dealing with mortality. Biss recalls once asking her father – a doctor – what causes cancer, and "he paused for a long moment before saying, 'Life. Life causes cancer'."
An observation she makes about the vaccination debate is how the growth of big pharma has led to casual – and typically unfounded – accusations that public health bodies such as the World Health Organisation are driven by commercial interests.
It is as though we have been indoctrinated to see the worst in others. Or as Biss puts it, providing today's idea: "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."
Can I start by putting to you the question posed rhetorically by the “vaccine sceptic” Dr Bob Sears: “Can we fault parents for putting their own child’s health ahead of that of the kids around him?”
“There are some interesting ethical challenges that this raises but, at least in the context of vaccination, I think the question itself is based on a false premise. Sears is implying that the parent who does not vaccinate her child is protecting, rather than endangering, that child’s health. Strong research from all over the world contradicts that premise.
“While there is an altruistic impulse behind many mass vaccination strategies (we vaccinate young children against rubella in order to protect unborn babies from being exposed to the disease), most vaccines serve the individual as well as the collective (and some, like the tetanus vaccine, primarily serve the individual - tetanus is not contagious).
“When Harvard researchers used game theory to explore vaccination decision-making during a hypothetical influenza outbreak, they found that even a purely self-interested individual would benefit from choosing vaccination.
“So, I would rephrase Sears’s question as, ‘Can we fault parents for putting their own child’s health at risk as well as the health of the kids around her?’ And yes, I think we can.”
There are a lot of scare stories surrounding vaccines, and the link to narcolepsy from some of the H1N1 vaccines used in Europe has added to this. Whose advice should one listen to when deciding whether or not to take a vaccine?
“Scare stories are most problematic when people are already primed to be scared. We’ve all heard of people who have died in car crashes, and cars are statistically the most dangerous thing in many children’s lives, but I know very few parents who avoid putting their children in cars.
“Vaccines aren’t perfect, nor can we expect them to be. There are real risks to vaccination, although those risks are statistically minimal when compared to other risks that most of us routinely accept in our everyday lives, like the risks associated with cars.
"Being alive is somewhat dangerous. In my research for On Immunity, I learned that most of us ordinary citizens are remarkably bad at risk assessment. We habitually regard familiar (but fairly dangerous) things as benign, and unfamiliar (but fairly benign) things as dangerous.
“So, whose advice should we follow? When I answered this question for myself, several months after my son was born, I determined that it was most prudent (despite my resistance to authority) for me to trust the advice of the public-health officials who were using abundant, sound epidemiological data to determine whether the benefits associated with a particular vaccine outweighed its risks.”
The introduction of the HPV cervical cancer vaccine has raised concerns among some parents of side-effects and also of sexualising young girls. Are parents right to be wary of the vaccine?
“Now, how in the world is a vaccine sexualising young girls? There are lots of ways that girls are sexualised, particularly in American culture: advertisements in magazines, Disney movies, television commercials, etc. We are constantly fetishising the bodies of young girls while pretending to want to protect them, but I don’t see how the HPV vaccine contributes in any way to this problem.
“The age at which children are recommended to receive the HPV vaccine is based both on the age when the child’s immune system is likely to have the best response to the vaccine and the age when the child is least likely to have been already exposed to the virus.
“Some parents want to delay vaccination against HPV until they think their children are ready to be sexually active. One of the problems with this approach is that a disturbingly high percentage of young women do not have the opportunity to choose when to become sexually active; their first sexual experience is forced on them.
“So far, most of the side effects that the media has associated with the HPV vaccine have been invented, exaggerated or are unproven. In contrast, the consequences of cervical cancer are known, documented and devastating.
“I have a friend, the mother of three young children, who has an advanced HPV cervical cancer. She, like me, is too old to have had the opportunity to be protected by a vaccine. But imagine the pain that she, her husband, her three children, her sisters, and us, her friends, would have been spared if she had been vaccinated.”
You write very vividly about the worry you felt as a new parent over your child’s vulnerability to injury and disease. How do you manage these anxieties now?
“The personal essay tradition, which I am writing within, often uses personal experience as a window into the culture at large. I was always aware, even when my son was a newborn, that my fears and worries were, at least in part, a product of the parenting culture of my time and place.
“I wrote this book to critique that culture and resist its influence on my life. Thinking hard about the fears surrounding vaccination, as well as other fears that new mothers are encouraged to entertain, served for me as a kind of vaccination against runaway anxiety. This is part of why my book is subtitled ‘An Inoculation’.
“I examined my own fears in this book, and exposed them in the process, but I do not, as a matter of principle, live by those fears. I believe, as Marilynne Robinson recently wrote, that, ‘It is potentially a very costly indulgence to fear indiscriminately, and to try to stimulate fear in others, just for the excitement of it, or because to do so channels anxiety or loneliness or prejudice or resentment into an emotion that can seem to those who indulge it like shrewdness or courage or patriotism’.”
ASK A SAGE Question: How do I safeguard my child's health?
Susan Sontag replies: "Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick."