Friday, January 4, 2019

Short Book Reviews: A Vaccination Medical Thriller

Kingdom of Needle and Bone by Mira Grant (Subterranean Press) belongs in the tradition of
epidemic thrillers, always a favorite of mine for their medical neepery. In this story, a measles-like a virus (“Morris’s Disease”) results in a loss of immunity to all pathogens. Besides the illness itself, with its fever, rashes, and so forth, the patient’s immune system loses the ability to “remember” being exposed to any other infection. Therefore no immunization to any disease gives protection. The mortality rate from this disease is very high, but worse yet is that the survivors are left without the ability to fight off future infections of any type. The only way they can survive is by complete quarantine, which figures prominently in the story.

The story begins with journalistic descriptions of Patient Zero, her fatal illness, and the spread of the disease, which is highly contagious and easily spread by contact with inanimate objects such as door knobs. A more personal view of the unfolding catastrophe comes through the point of view of that child's aunt, Dr. Isabelle Gauley, a physician who later devises a strategy to save humankind from the epidemic. Some medical thrillers jump from one point of view to the next, showing the many different and varied experiences as characters either succumb to whatever plague has arisen or take part in finding a solution. By focusing on just one character who has a personal relationship to the first victim and who also has complicated relationships with other members of her family, Grant skillfully sets up the surprising twist at the end. Cataclysmic historical events — like the Black Plague of the 14th Century CE — affect multitudes but can be emotionally remote unless dramatized through the lives of individual characters. Grant achieves both the world-changing nature of a pandemic and the intimate journey and ultimate personal responsibility of a small set of characters.

One of the most interesting aspect of this story, a biting social commentary on public issues today, is the question of personal bodily autonomy. Widespread refusal to vaccinate children lowers herd immunity to the point that communicable diseases easily spread. We see that today in unprotected populations with outbreaks of preventable diseases like measles, whooping cough, and polio. Faced with a high mortality rate from highly infectious Morris's Disease, public health authorities in Kingdom of Needle and Bone mandate immunization with rare medical exceptions. That raises the question about which principle takes precedence: the individual right of self-determination or the health and the very lives of the community, especially those who are immunocompromised and cannot be vaccinated. The central character, Dr. Gauley, argues:

“There are always going to be people who insist that vaccination is a personal choice, and that if we take that choice away, we must necessarily take other choices away — that the right to refuse a vaccine is the same as the right to refuse to donate a kidney, or the right to say that no one else is allowed to use your body as a life support system without your full and knowing consent.”

Following the principle of unintended consequences, pro-vaccination public health officials find themselves unwillingly allied with anti-abortion forces who see both as a violation of bodily autonomy. But where does personal liberty end and survival of the human species prevail?

This thoughtful medical thriller adds a nuanced moral perspective without bashing the reader over the head with any particular viewpoint, and while engaging the reader in a fast-paced, absorbing read.

The usual disclaimer: I received a review copy of this book, but no one bribed me to say anything about it.

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