Preferential Immunity

The following is a guest post by Elliott Prasse-Freeman.

Patient Mayinga N., Ebola case no. 3, behind two nurses at Ngaliema Hospital in Kinshasa, Zaire. 1976. Photo: CDC/Dr. Lyle Conrad.

I visit Uganda’s capital Kampala regularly, and so the city’s recent Ebola outbreak might have seemed relevant to me. And yet, oddly, I didn’t really think much of it. Indeed, despite the generally horrific deaths that befell those folks in that 1990s-era mass-contagion movie, and the fact that the film was inspired by real events in east Africa, my first reaction upon hearing the Ebola news was casual curiosity. It was only upon a doctor friend impressing Ebola’s “it will kill you” nature upon me did I even consider canceling my upcoming trip:

Email from Dr. Spart Heath to the author, 30 July 2012.

Are you in Kampala? Just don't go to Mulago hospital, which you shouldn't be going to anyway. And don't go to Kitaale. Otherwise you're probably fine. If it gets to more than a few hundred cases, I would get the hell out of the country. Ebola, when you take into consideration virulence, mortality, and treatment options, is the deadliest human communicable disease in existence. Good luck getting back into the US coming from Uganda during an epidemic, btw…

Upon considering Dr. Heath’s response, two models for understanding contemporary biopolitics seemed to collide: Heath describes the need for the separation of bodies in space (different hospitals, different bodies able to flee the malady, quarantines for those getting caught in flight) to prevent a disease impervious to cure from ravaging all in its path. My own initial subconscious inclination, however, was the inverse: while diseases might flow throughout Uganda they only devastate certain bodies; mine remains safe. This compelled a number of uncomfortable reflections: whence the arrogance that allowed me to dismiss a disease that causes death by the hemorrhaging of multiple orifices? Was it that I have international SOS MedEvac service that could whisk me away to safety at any moment? Perhaps, but it seems even more internalized: this insurance translates into assurance—the majority of the world dies from infectious diseases that I never encounter because modern medical innovations which are made differentially accessible due to profit considerations have become inscribed on my body itself[i].

[i] Sadly it’s not striking that the medico-technological innovations created by developed states to inoculate against or treat infectious diseases like malaria, rotovirus, or tuberculosis are provided to precisely those people (Westerners) who do not need them. It’s also not surprising that the reason for this is that these technologies have been appropriated by profit-seeking conglomerates which actively prevent the dissemination of these medicines to those who actually do need them by capturing international processes and cutting back-room deals. We live under an amoral and abusive monopoly capitalist system, after all, in which public investments are translated into private profits, where rent seeking is valorized as healthy profit maximization. What is striking, at least to me, is how naturalized this is: of course some life is immunized and some isn’t, simply because of profit maximization imperatives.
Vaccinations and prophylactic medicines are not only superior technologies but deterritorialized ones, in other words something I carry in me, making me not only biologically different than people I encounter but also producing in me a different ontological foundation, a different way of seeing risk, opportunity, meaning: in other words, the world itself.[ii] 
[ii] Anthropologist Didier Fassin outlines the contradiction in humanitarianism between its enunciated claims (of inclusion of all humanity) and its material practices (which divide humanity by privileging certain members and degrading others). Fassin identifies three divisions in particular that are braided into the very fabric of humanitarianism: 1) the most obvious exists between those who do the administering (the aid workers who have the choice to risk themselves) and those who receive the aid, who are administered (the victims, who have no choice, and who are deemed lucky to receive aid); 2) when crises emerge, so do divisions within the humanitarian organization, dividing the Westerners (on whom massive resources are spent for evacuation and health care) from the local staff who stay to die (either rapidly, as in the case of the Rwandan genocide, or slowly, as was the case for the AIDS epidemic for which local staff for a long time did not receive treatment); 3) when crises are discussed, privileged life is not only allowed to speak itself in the first person but also relay someone else’s story (through its own optics) while the “victim” is only allowed to be represented.

Hence, while I never articulated this consciously, I may have implicitly assumed that not only would there be a vaccine for Ebola, but that it was entirely natural for me to have access to it while the people who live in the regions where Ebola is endemic do not. This was a sobering realization and left me wondering if my response exposed an insane-but-real kind of privilege shared by all those from the West with the resources and wherewithal to traverse the globe. (Humanitarians, development workers, academics, and transglobal capitalists exist in the same stratum—after all, they all stay at the same hotels, often eyeing each other with contempt across the buffet bar.) Do we constitute a class of globally immunized bodies, impervious to the threats of the under-developed world?

Elite Secession

Political philosopher Roberto Esposito takes immunization and its political consequences as the structuring principle of modernity itself. In Immunitas, the third book in his series on biopolitics (the form of governance that puts the salvation, production, and regulation of life as its object of intervention), Esposito argues that immunitary tactics have developed in response to fears of contamination that plague the modern imagination.[iii] 

[iii] Roberto Esposito, Immunitas, p 2.
Esposito presents a deconstructive reading of the vast and varied modern social phenomena[iv] that illustrate this paradigm. Distinguishing immunization from either (a) mere destruction of the Other or (b) flight from it is the fact that immunization requires the body to incorporate and becomes changed by a threat so as to neutralize it.
[iv] Encompassing medicine, state craft, theology, ritual, law, the norm.
This reactive response allows the self or community to “restore its own borders that were jeopardized by the common;”[v] immunization hereby acts as a pharmakon—poison and cure in the same vectorseparating the community from itself (with laws, norms, and rituals developing to keep bodies safely separated from one another) to save it from self-annihilation. Simultaneously, because of the interaction necessary to immunization, Esposito also sees it as holding radical potential for connection and communication between self and Other.
[v] p 27. Source here.
[vi] If the interaction with the world is constantly changing the self, then the immune system must constantly adapt its understanding of the self it should not destroy. This way the immune system effectively continually welcoming in the outside as it becomes part of the self.

In this rehabilitatory move Esposito seems to leave immunization under-theorized: if it can bring in new forms of communication why does it also stand as its opposite, that which separates and holds the Other apart, in a safe and stable orbit of separation?

 Leaving aside the theoretico-empirical issues,[vii] what concerns us here is that the immunization model depends on interactiona barrier’s permeability can only be tested when two bodies come in contact.
[vii] How the political choice is made between an immunization that shuts down communing across difference versus one that opens it up seems to be reserved for his next book.

But returning to the example of Western workers in Africa, immunized life described above seems different. It appears to foreclose on any potential communion, standing as immunized a priori, immunized before any interfacing with the Other. Esposito follows Foucault[viii] in conceiving the transformation from the medieval period to the modern one as defined by a move from a fortress model of deflecting or repelling life that threatens (the era of the cast-out leper) to a biopolitical model of incorporating threatening life to use it to immunize the social body against disease (the era of the plague where one infected body can infect all).

[viii] Discipline and Punish: pp 199-200.
 The past 40 years may stand as a further evolution—a third phase that supplants or extends the biopolitical and reintroduces a separation that inverts the leper-model: figurative “lepers” are no longer cast out but rather inscribed with a mark of excision and left to roam the same domains as immunized life—both occupying the same spaces but never interacting.

This reading contests a common (mildly hysterical) claim that elites subject to "globalization" are responding to anxieties about contagion by retreating into cordoned-off spaces. I wonder if it’s not the opposite, a great deterritorialization that extends to the biological. Can this explain the rising number of elites who refuse to immunize their children from common diseases (for fear of autism)? Does their rejection of participation in "herd immunity" signify not only that they don't feel part of the herd, but that they have internalized immunization at the ontological level, it extending so far that they do not feel threatened by the re-emergence of plagues infecting normal people?

This inverts interpretation of gated communities: they are not reactive moves against diseased members of the community, but (a) a proactive move against unimmunized life that disgusts them and (b) a better way of experiencing life: cleaner, purer, etc. Whether it is elites in São Paulo maneuvering across the city by helicopter, Richard Fuld (CEO of one of the terrible banks that stole billions) flowing through Manhattan from penthouse to boardroom without ever having to engage public space at all, or Indian elites “seceding” from normal space in a move which Arundhati Roy describes as "vertical secession," gates are after the immunization not part of it, and are oriented toward maximizing speed. The gate becomes a passageway that exists to allow some forms of life to keep going at the same speed because it slows others down. Elites enjoy immunization by disappearance: their spaces aren't the walled city as much as the horizon, the steppe, the desert they can flee.

Contagion Films: Immunization and Imaginary Community

Soderbergh's Contagion: you, me, and Marion Cotillard are all in this together. Photo: Warner Bros.

Yet if there is a certain swathe of humanity that qualifies as “immunized life,” how to also explain the rise in anxieties about contagion that increasingly permeate the developed world, present in the outsized collective reactions to non-events such as bird and swine flus,[ix] SARS, as well as in mass cultural imaginaries of diseases destroying the world with frightening speed and ferocity?[x] 

[x] The New York Times reviewed Contagion but also ran an op-ed saying that the film was real.

So much rests on the terms of immunization in question. While those in the West are effectively immunized from the underdeveloped world, the seceding elites are further immunized against the rest of the West’s body politic. This has created palpable anxiety in those without private jets about the dissolution of the welfare state and the imagined community that declines along with it. So we might see films such as Contagion (dir. Steven Soderbergh, 2011) trying to perform the community back into being: look, we are all the same during a crisis! The argument that we are all at risk, that we are all in this together bare and naked against a transcendent virus, actually serves the opposite function. Rather than making us feel vulnerable, we feel safe in our shared vulnerability. However comforting that idea may be, we are actually being immunized  from the reality that this shared-risk community enjoys a mostly imaginary existence.