The Big Idea: Eula Biss


The cover art for Eula Biss’s new book, On Immunity: An Inoculation, surprised me at first. I’d expected something stark and edgy—maybe a shiny hypodermic needle against a blank background—to illustrate an exploration of modern vaccine phobia by a young writer known for her understated style.

Instead, the jacket of On Immunity features a detail from an early seventeenth century painting, Achilles Dipped in the River Styx by Peter Paul Rubens. The image is lush and nuanced and drenched in allusion to myth and history and the body and motherhood and love and fear—like Biss’s argument, as it turns out.

Today’s anti-vaccine movement, whose most visible leader is talk show host Jenny McCarthy, has deep roots and broad ramifications. Fear of inoculation has existed for centuries, beginning with the earliest versions of the practice. Over time, fear of vaccines themselves have become inseparable from larger fears, both real and metaphorical: of contamination by the “other,” of having one’s personal integrity compromised, of being forced surrender to one’s individuality for the common good.

In 2009, Biss began delving into these fears as she grappled with her own discomfort about having her infant son vaccinated. Using her personal experience as a narrative thread, Biss draws in subjects as diverse as Voltaire, vampire lit, and the BP oil spill. The openness of her inquiry makes On Immunity an important contribution to a dialogue about vaccination currently dominated by those certain that vaccines are toxic and those equally certain that those who hold this belief are morons.

Biss lives in Chicago and teaches at Northwestern. She is the author of two previous books, The Balloonists, a prose poem about divorce, and Notes From No Man’s Land, a collection of essays about race, for which she won the 2009 National Book Critics Circle Award for Criticism.

I spoke with her recently about On Immunity, about her literary influences, and about whether we really are, as the New York Times suggested recently, in “a golden age for women essayists.”


The Rumpus: In all of your books you’ve come at big subjects from very personal points of entry. With On Immunity, how far was the leap from the personal decision about whether to vaccinate your son to writing a book about vaccination?

Eula Biss: Most of my essays begin with a question that I want to work out for myself, primarily. And often in the course of working that question out I produce a document that feels like it could be made available to other readers. Sometimes that’s not the case, though. Sometimes I embark on a draft and I do clarify something for myself, but I don’t produce something that I think is readable or necessary for other people.

Rumpus: So it’s possible that you could have worked through your decision on paper but not necessarily have moved beyond that?


Biss: Yes, definitely. Especially if I hadn’t run into anything that I thought was interesting or surprising. Actually, when I began doing research I did not intend to write a book or even an essay. I really was just trying to solve my own problem, which was that I was encouraged to vaccinate my son, and I knew I should, but that I’d also heard that many mothers had hesitations, and I didn’t know a lot about those hesitations. So I had to find out more before I moved forward with my decision. And, really, in the grand scope of this project, it didn’t take me very long to answer the biggest one of my personal questions, which was: should I vaccinate this kid on schedule or not? By the time my son was two months old I had read enough to feel comfortable vaccinating him and vaccinating him on schedule.

I had made the decision to follow the schedule, but I also wondered what does this say about my relationship with the government? Does this mean that I’m following government recommendations blindly? What does this mean about my relationship with pharmaceutical companies and the medical system? Does this mean that I accept everything that happens in those realms?

So I was just struggling with what my decision meant, and that’s when the essay began to emerge. And at first it was just going to be an essay, but it got bigger and bigger, and then for a while I thought it would be a very long essay. Then it became clear that it was going to be a book.

Rumpus: Do you remember the moment when you were researching this to sort out your own discomfort and you said: “Whoa! This is about more than me. This is a topic”?

Biss: There were a few moments like that. The research really escalated for me in that I read a number of books that made me think differently.

The first was Bodily Matters by Nadja Durbach, who’s a historian. I read her history of the anti-vaccine movement in Victorian England. The moment I said, “Whoa!” was when I was reading this history of an anti-vaccine movement over a hundred years ago. The fears and anxieties that propelled that movement forward were so similar to my own fears and anxieties that I had to step back and look at my own concerns in a historical context. That was really interesting to me. The actual technology has changed considerably, but the fears have remained, in many ways, static over a very long period of time and in fairly different political contexts. So that’s the moment when I thought, Okay, there’s a lot more going on here than I ever saw or realized and I’m going to have to dig quite a bit deeper into this subject.

Rumpus: Is there something specific about vaccines—about having your body punctured and having foreign material injected into you—that causes more fear and suspicion than other medical treatments? I have patients who have fewer hesitations about heart surgery than about flu shots.

Biss: I can believe that. I do think there is something emblematic about it—and this goes back to before we used needles, right? The smallpox vaccine that was given in the 1800s was not given with a needle but was an incision.

It’s this breaking of the skin paired with the introduction of foreign matter into the body that sets off something that is almost archetypical. It’s part of why I reached back into mythology to begin my discussion of this because I felt that just the act of vaccination was triggering a fear that wasn’t necessarily about that act so much as it was about what it represented to the mind; the metaphors behind it.

The skin is a really powerful metaphor for our protection against all that is outside, a division between external and internal. So to have that protection penetrated becomes metaphorically meaningful. That’s why I picked up I Is An Other by James Geary. His book is all about metaphor, but he has a really illuminating chapter about metaphors that are sourced from the body, about how many of our most basic metaphors, our most often repeated metaphors, are sourced from our bodies.

You can tell from the metaphors that we use that the body is our primary locus of understanding. In some ways we understand everything around us in terms of our own bodies. That made me look at this act as an act that was opening up a metaphorical space for people—to a greater degree than heart surgery, right? When you approach people saying, “You’re going to need heart surgery,” in many cases they’re going to interact with that information literally. There probably is some metaphoric stuff going on there, around the heart. But when I examined my own reservations about vaccination I found that they were almost all based in metaphor. And the more I learned about the actual act and the actual technology, the more comfortable I felt, because almost all my fears and hesitations were about what vaccination symbolized to me, not what it actually was.

Rumpus: Metaphors are important in On Immunity—the vampire motif, for example—but so are concepts that are very real: race and class and feminism and motherhood. What is the relationship between the conceptual and the metaphorical when you’re drilling deeper and deeper into a subject?

Biss: I think part of how this book became so interested in metaphor is that I began to discover that some of the metaphors were masking either really important realities or really important concepts. Issues of race and class, for instance, I felt were getting completely erased or masked by the metaphors that were in use around vaccination.

There are a lot of metaphors around vaccination that involve power, but very few of them acknowledge what I think is one of the more interesting and disturbing power relationships in the situation, which is the relationship between a healthy, middle-class, white person with very good access to medical care who’s chosen not to vaccinate and a poor, lower-class person of color who doesn’t have excellent access to medical care and may not be fully vaccinated because of issues of access rather than philosophical issues.

Rumpus: To clarify, the power differential exists because poor people who are not vaccinating due to access are vulnerable to outbreaks caused by people who choose not to vaccinate.


Biss: Yes. That’s a power relationship that’s, to my eye, very problematic. But when I began writing this book, when people talked about power and corruption around vaccination they were always talking about the power that pharmaceutical companies have or the power that the government has or the power that pediatricians and health care workers have. They weren’t necessarily looking at the power of the unvaccinated body, that kind of social power.

I got into the metaphors in part because I wanted to expose them as flawed or problematic metaphors. And this goes back to Susan Sontag who made the point that if we’re thinking about something through a metaphor that’s flawed, our thinking is going to be flawed. And so I wanted to expose some of these metaphors as inaccurate and bad tools.

Rumpus: The anti-vaccine movement has created some strange bedfellows on the left and on the right, aligning so-called “Whole Foods parents” and Tea Partiers. Why do you think that is? Is this simply about suspicion of authority, of experts?

Biss: I think it’s partly that, but I also think it exposes something about liberal politics. It exposes the libertarian vein that can run through liberal politics. This is an issue where you see people who call themselves liberal and say that they’re concerned with social justice joining the same movement as people who are actually libertarians and more on the far right side of things or part of the Christian right.

I think it has less to do with the suspicion of experts than it has to do with this thing that we treasure and nurture in America, individualism, which can actually be quite damaging if it’s taken to political extremes. And we can see it both on the right and the left.

Rumpus: Have you gotten any feedback that you changed minds of people who were anti-vaccine?

Biss: I got feedback from a friend who read a draft. She mentioned after she read it—and she pushed back on a lot of things and had quite a hearty critique of the book—that she vaccinated her son against hepatitis B. I’ve had a couple of interactions like that, where I’ve learned that it has changed the mind of someone who was vaccine-hesitant or delaying vaccines.

I’m sure you’re familiar with the more extreme position, people who are dedicated to not vaccinating at all. There have been some studies recently that have shown that it’s very, very hard to get someone in that position to change their mind, and that has been my experience in conversations.

Rumpus: As you read the news these last few weeks about Ebola, do you see themes emerge that came up in your research about vaccines?

Biss: Quite a bit. Both of my last two books have been interested in fear, in our tendency to fear things that don’t pose us a threat and interested in where fear intersects with other attitudes, like racism—where fear is a product of racism or an extension of racism or a complement to racism. Just the other evening I was having a conversation with my husband and he said: “I really don’t think people would be reacting the way they’re reacting to Ebola if it had originated in Sweden.” If most of the victims were blond and light-skinned—I think in some ways the fear is about disease, but the fear is also giving people an opportunity to exercise their fear of otherness.

Rumpus: I have no doubt.

Biss: I have no doubt, either. There might still be a reaction, but the reaction would look really different.

Another thing that it’s brought up for me is thinking about quarantine. How awkward and difficult and problematic it is to have quarantine be one of your primary preventative health measures. Recently I was on a radio program, and a listener called in, and she said, “I think that you’re over-emphasizing the role of vaccination in disease prevention.” But Ebola is actually a reminder of how messy and awkward and difficult it is to deal with a disease without vaccination. Quarantine is a pre-modern method for controlling the spread of disease, and we have to go back to this pre-modern strategy when we don’t have vaccination. Which doesn’t mean that we shouldn’t use it. It can be a be a useful and necessary complement to vaccination.

I’ll say just one last thing about quarantine: People make civil rights arguments around vaccination, like, “Oh, my right to my body is being violated,” but I think that many people would find that quarantine feels much more like a violation of civil rights than vaccination. Given the choice, we might actually prefer vaccination.

Rumpus: I’d like to talk a little about your beginnings as a writer. In On Immunity you mention the influence of your dad, a doctor.

Biss: Yes. I wanted him to be the voice of the best of medicine, a reminder to everyone that doctors aren’t all evil arbiters of the establishment

Rumpus: And you also mention your mom, an artist,

Biss: She’s a visual artist, a poet, and a nonfiction writer.

Rumpus: Reading about them I found myself thinking of the surgeon-writer Richard Selzer, who described how his father practiced medicine in an office on the first floor of

his childhood home while his mother, an amateur opera singer, belted out arias upstairs, about how these were the two poles of his young imagination: science and art. Was it like that for you?

Biss: I think that’s true, though at this point in my life and development I’m no longer inclined to think of them as two poles. I think of them much more as two different modes. The driving interests and concerns of both are quite similar. And I do think medicine practiced well is an art. That’s obvious, especially when you read the words of one of these really masterful doctor-writers.

Rumpus: You’ve written many medically-themed essays: “The Pain Scale” and “Relations” (in part about in-vitro fertilization), and, of course, the essays that became On Immunity. Did having this particular combination of parents set the stage for you to think about medical issues in a literary way?

Biss: I do think it gave me access. I remember when I turned twenty-one I went to a fortune teller with my sister, and the fortune teller looked at my palm, and she said: “Ah! You’re interested in medicine! You’re going to be a doctor or a nurse!” and my sister and I fell over laughing. It was so absurd, so out of the range of my interests. Really, though, the way my trajectory of interests has progressed, maybe the palm reader was seeing farther into my future than I knew.

I think that having my father be a doctor, I’m not afraid of medical terminology. A lot of it is familiar to me. My father talked in that terminology. I think that’s a barrier for some people, the language of medicine. The language of medicine doesn’t intimidate me.

Rumpus: I read that in researching On Immunity you slogged through an immunology textbook. I was impressed.

Biss: It took, like, six months. I had to look almost everything up.

Rumpus: You earned an MFA in nonfiction at Iowa. How did your understanding of what nonfiction could be evolve there?


Biss: It helped that I entered nonfiction through poetry. My first book, The Balloonists, which can absolutely be read as an essay, I was thinking of at the time as poetry, just because I didn’t know enough yet about the tradition of the personal essay. I didn’t know that you were allowed to do that in nonfiction. So even though it doesn’t look like poetry in a number of ways, I was calling it poetry because poetry was the only genre I knew of where I’d seen anything like that happening.

I had studied prose poetry quite extensively as an undergraduate. I was lucky to be exposed to Anne Carson early in my career. Anne Carson is so great in terms of giving permission. That sense of “I didn’t know you were allowed to do this”—I had that with every book I read by Anne Carson. I started reading her as an undergraduate, and she just blew a lot of doors open. I loved what she was doing with ideas, but I also loved what she was doing with form. She has a number of pieces which have “essay” in the title but are in fact written in lines like most poems are. And she has work that has the word “poem” in the title and looks a lot like an essay. She’s moving very freely between these genres, making them collide and collapse into each other. I think she’s done a lot for all of us who write, in terms of blowing apart the boxes that genre can become.

Rumpus: You’ve said that your own work straddles poetry and nonfiction, is a hybrid of the two. The usual connotation of “hybrid” is mixing memoir with researched information, perhaps what might have once been called “New Journalism.” How would you characterize your nonfiction? Do you simply think of yourself as an essayist—or is yours a new genre?

Biss: The quick answer is that yes, I usually do think of myself as an essayist. But that category is so broad. Contemporaneously and historically it contains things that are aesthetically incredibly different. And I think that’s part of why I’m comfortable thinking of myself a an essayist. There’s a lot of room within that category to go in a lot of aesthetic directions.

But to get into the more pointed part of your question, the New Journalists have been really important to me, especially Joan Didion, but the other group of writers that have been important to me have been the confessional poets, people like Adrienne Rich and Sylvia Plath. The assertion in their work—and which was truly radical at the time—is that the personal is political, that one can write from one’s life, about one’s life, about one’s body, as a way of way of addressing a political situation or a political idea or problem. That’s an old idea now, but it’s an idea that is still challenging to people, surprisingly. It still can be kind of disorienting for someone to see highly personal material on the page with highly political material. We still like to think of these things as belonging in different spheres.

I think my hybridity has a lot of sources of inspiration. I don’t think it’s brand new. I’m drawing heavily on Didion. I’m drawing heavily on Rich and Plath and other writers. In this latest book I was thinking about and engaging with Sontag. So I’m definitely not striking out alone.

Rumpus: I can’t help but notice that all of the literary influences you’ve mentioned are women: Carson, Plath, Rich, Sontag, Didion. This leads me to ask your reaction to the piece a few weeks ago in the New York Times Book Review, in which Cheryl Strayed and Benjamin Moser were asked whether we are in “a golden age of women essayists.” Both objected to the qualifier “women.” You are being compared with Didion and Sontag and being grouped with other young female essayists like Leslie Jamison, Lia Purpura, Maggie Nelson, and Sarah Manguso. Would it be just as accurate to say that you come out of the tradition of, say, Orwell and to group you with today’s young male essayists? Is there anything particularly female about the modern essay, or is this something we’ve invented as a way of marginalizing young women who write essays?

Biss: That’s a really interesting question. For me it depends on the moment you catch me. I could’ve just as easily have given you a list of writers who have influenced me that would be heavier on the men. And every once in a while people ask me for a list and I provide one, and I realize it’s all authors who are men, and I feel a little chagrined about it. There are men in there for sure. James Baldwin is probably the biggest one. Orwell is, for me, less important. Hemingway was really important to me as a young writer.

Speaking of a “golden age,” I’d be reluctant to say there’s something fundamentally different about a woman essayist than a man essayist. But there have been times, historically, when it certainly wasn’t a golden age for women essayists. For example, I admire the work of Sei Shonagon, a tenth-century Japanese writer. But that wasn’t a great time or place to be a woman writer. There were a lot of barriers.

That doesn’t mean that there aren’t barriers now. One of the things that I’ve been surprised by, actually, in the weeks since my book has come out, is how many of even the positive reviews are laced with sexism. That’s been a reminder to me that this world of writing is, in some ways, different for us women.

Rumpus: Is that on the record, what you just said?

Biss: Yes. I’m happy to say it because most of the reviews have been positive, so this isn’t sour grapes. It’s an observation. A number of the positive reviews have been quite sexist. I wrote about mothers, and I think we reserve a special kind of sexism for women who are mothers. I definitely saw that appearing in much of the coverage of the book.

The “hysterical mom” was the stereotype that was showing up in the reviews. I’m talking about fear and anxiety in my book, and talking about it through myself, so I necessarily showcase some of my own anxiety. But in certain reviews that showcasing of my anxiety is referred to in such a way that it makes me look very much like a hysterical woman.

Rumpus: Some of the emotions you express—your fears for your son’s well-being—are very moving. But it should be remembered, you did explore those emotions with years of research—and a book!

Biss: I’m focusing on my anxiety as part of a cultural critique, but all of that gets lost if a reader is so excited by the fact that a mother has fulfilled their sexist expectations of a mother that they can’t see any further into that moment in the text.

In trying to talk about fear and anxiety I’m coming close to a prejudice that people have about women, and once you get close to that, people cease to be able to see clearly, and the prejudice consumes whatever is happening on the page.


“The Big Idea” features interviews with writers, artists, scientists, activists, and others who take a long and broad view of an issue, problem, or concept, and pursue it over many years. Visit the archives here.

Suzanne Koven MD, MFA is a primary care physician and writer-in-residence at Massachusetts General Hospital in Boston. Her writing has appeared in the New England Journal of Medicine, the Boston Globe, VQR, and elsewhere. Her interview column “The Big Idea” appeared at The Rumpus. Her memoir-in-essays, Letter to a Young Female Physician, will be published by W. W. Norton & Co. on May 4, 2021. More from this author →