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This week we got monumental news in a pandemic: The World Health Organization approved the widespread use of the first vaccine against malaria. For the first time, the half of the world’s population still threatened by the mosquito-borne disease can get protection at rates up to 50 percent—a development most crucial for young children, who make up the bulk of malarial deaths. Poor people worldwide will now be eagerly waiting to see if they will get access to the potentially life-saving shot.

Meanwhile, here in the United States, we are in month ten of a nationwide meltdown over a far more effective, and completely free, vaccine. Half the U.S. adult and teenage population had been vaccinated against COVID-19 as of July, but the pace has since then slowed to a relative crawl. Our current 65 percent vaccination rate puts us on a par with poorer hemispheric neighbors like Ecuador and El Salvador, and far behind the most prolific vaccinators in the United Arab Emirates, Portugal, Malta, and Cuba, all of whom have given at least one dose to upwards of 84 percent of their peoples.

This should be surprising given our wealth and power—and the fact that the United States was, you know, one of the principal countries where the COVID vaccine was invented. But to anyone who knows the United States, it shouldn’t be a surprise. As in so many things—from democracy to labor rights to music—our country has long produced some of the greatest innovators of vaccine science as well, as the fiercest and obstinate forces of reaction against it.

The best examination of that paradox I’ve read is a book called On Immunity, by the essayist Eula Biss. Published several years before the pandemic, in 2014, Biss explores the thinking around immunity and vaccines through history, literature, myth, and popular culture, from Grimms’ fairy tales to Silent Spring, as mediated by Biss’s own experiences as a writer and a mother. What has remained with me about the book for years is that it remains grounded in science (Biss is, in a word, pro-vaccine) while evincing deep empathy for those whose skepticism of the systems that produce, distribute, and mandate vaccines lead them to the wrong—and mutually destructive—conclusions.

For instance, Biss recounts America’s first inoculation mandate, ordered by George Washington during the Revolutionary War. A deadly smallpox epidemic was ravaging the colonies; the British were mostly immune because they had, for the most part, survived the disease as kids. Washington ordered all new recruits inoculated—a process in which pus is taken from an infected person’s blister and put into a healthy person’s arm for the purpose of triggering a milder form of the deadly and easily spread disease. This was obviously risky, but the best option at the time; the first vaccine—so named because it meant injecting people with a weakened form of the milder disease of vaccinia, or cowpox—was over two decades away.

That story, unfamiliar to many before COVID, has become a touchstone of pro-vaccine Facebook groups during the pandemic. But Biss offers some complicating details. For one, she says Washington was hesitant—issuing the order several times only to withdraw it several days later. He was only convinced to implement it once rumors started circulating of a British plan to intentionally spread smallpox to the Continental Army as a biological weapon. (Thomas Jefferson was also a big proponent of inoculation: Annette Gordon-Reed recounts in her equally great Hemingses of Monticello the lengths Jefferson went to ensure that his enslaved half-sister-in-law, Sally Hemings, be inoculated when she arrived to wait on—and eventually become sexually involved with—him in Paris.)

But, Biss argues, “if we owe the existence of this nation in some part to compulsory inoculation, we also owe some of its present character to the resistance against compulsory vaccination. Early vaccine refusers were among the first to make legal challenges to the growing reach of police power in the United States.” Not only did they prevent the state from forcing vaccinations “at gunpoint,” she writes, but they also helped pave the way for the legalization of abortion: as Biss notes, pivotal reproductive freedom cases, including Roe v. Wade, relied in part on the precedent set by a 1905 case called Jacobson v. Massachusetts, in which “a minister defended his refusal of vaccination on the grounds that a previous vaccination had damaged his health.” (Jacobson has also been cited to support all manner of evils as well, including the notorious eugenics case of Buck v. Bell.)

Some, trying to understand the refusal of millions of Americans to avail themselves of a life-saving preventative—preferring far riskier interventions like self-medicating with less-proven and even outright dangerous treatments, or just taking their chances with COVID and dying—point out the exogenous factors working against them: decades of distrust engendered by the for-profit medical, insurance, and pharmaceutical industries; communal memories of predatory medical experiments, especially within the Black community.

Those are all real. But over the course of the book, she points to the even more intrinsically American conflict that lies beneath all of that: our ongoing struggle to understand how interconnected we are as a society, in a culture that above all else prizes the individual. That, I think, is what we are really talking about when we argue over freedom and vaccine mandates, and why it is so infuriating when anti-vaxxers (or those trying to grift them) insist that society simply respect their choice as individuals.

The fact is that we are all in this together—that everyone who could, medically, get the vaccine but chooses not to puts not just themselves but everyone around them at risk, and is thus prolonging the pandemic. As Biss writes: “Our bodies may belong to us, but we ourselves belong to a greater body composed of many bodies. We are, bodily, both independent and dependent.”

Approaching such people with empathy and respect in the first instance, as Biss does, may be key. Failing that, facing a mortal threat as Washington once did, the power of the state will have to compel them. Biss’s ultimate recommendation—her “inoculation,” as the book’s subtitle proposes—is to learn to think of ourselves as living in a big, unkempt, wild garden, on whose survival we all depend.

Edited by Sam Thielman

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