‘Humans develop conditions for the epidemics to flourish’
FRANK SNOWDEN, professor emeritus of history and medical history, Yale University
In 2019, Frank Snowden, professor emeritus of history and medical history at Yale University, published a book that was a result of four decades of research. Called Epidemics and Society: From the Black Death to the Present, the book is an exhaustive look at many centuries of humanities struggles with infectious diseases. And, as it turns out, it was well timed. “Each epidemic is unique, and each one tells us something about the society in which it occurred,” Snowden said in an interview to
Rudraneil Sengupta
over Skype from Rome. Snowden spoke about the things that the disease reveals about societies, and the ways in which pandemics have shaped public health. Edited excerpts:
When your book came out last year, did you ever think that pandemic was around the corner?
While researching the book, I had been listening to the warnings and I was aware of the possibility—in the book I say that we have a ticking time bomb, because we live in a world of microbes and we create channels, because of the way our societies are structured, that microbes can exploit. I did think that I would live to see a pandemic like this, though I could not have known it would happen so soon.
Anthony Fauci, who needs no introduction now, in a testimony to the US Congress in 2005 said that if you live in the Caribbean, meteorologists can tell you that you ought to prepare because a hurricane is in your future, it’s inevitable, though no one can tell you the date and how strong it will be. He said it’s exactly the same in the field of virology. Epidemiologists can tell you about the inevitability of a pandemic challenge, and that there is no reason to believe it will be less violent than the Spanish Influenza of 1918. We had these warnings but we ignored them to our peril.
My book came out in October,
Covid-19 began in December. I came to Rome to do research only for the city to be totally transformed by this tragic event. I had a mild case of Covid-19, and as a result I’ve also been quarantined at home for three weeks, and today is the first day I have been released from quarantine. I’ve been daydreaming for days about visiting the market! Before I went into quarantine and I was still going to the market, what seemed interesting was the degree of compliance here in Rome. The lines in the markets were full of people talking about things like, ‘I wonder if this is what it was like in the last war’, or ‘could London in the Blitz have been like this?’ And the local newspaper had an article that said that this is the first time in 3000 years of Rome’s history that Romans have ever been obedient.
What do you mean when you say we create channels that microbes exploit?
The 19th Century was the era of industrial revolution and it created diseases transmitted via the oral/fecal route, cholera and typhoid, because industrialisation meant the sudden flooding of European cities by populations from the countryside for whom no preparations had been made and who overwhelmed the urban infrastructure. There was no clean water supply, no sewer systems, and dangers of contaminated water or food. Society at that time created an environmental niche for diseases like cholera and typhoid to exploit.
I would define Covid-19 as the first pandemic of globalization. The niches it exploits are massive population growth, crowding and mega cities; an industrial model that encourages rapacious growth without counting the environmental cost. By destroying biodiversity and animal habitat, we are bringing humans into relationships with animal reservoirs of disease that humans hardly encountered in the past. Spillover events are becoming more and more common. All the recent epidemics have been caused by it—Avian flu, MERS, SARS, Ebola. Then there is 24-hour transport by air across the world. So, let’s say if there is a new virus in Jakarta in the morning, it can be in Los Angeles by nightfall. These are not vulnerabilities put upon us by god or nature. This is not a random event, not something out of the blue or a Biblical plague. Humans provide the conditions for epidemics to flourish.
Can we ever be prepared for an epidemic?
The history of the recent century of epidemic diseases is that whenever one has just struck, there is a flurry of responses, of devoting funds on public health. After a while people are tired of spending those funds and amnesia sets in. We have not taken seriously the need to prepare. We did not need to be vulnerable in this way, and the tragedy here is that this is a pandemic that has caught has when we were least ready and much of the suffering and death could have been preventable. South Korea were unusual in that they took the message to heart from their previous experiences, and met the challenge with readiness. We could all have been like South Korea.
I have hope for a paradoxical reason. Covid-19 may well become endemic, and we may have to refigure our lives according to this new reality, certainly unless an efficacious vaccine is developed. One of the blows to the vaccine strategy that’s not much talked about is the discovery that people who recover from the disease do not necessarily have a robust immunity to it. The vaccine developers have to teach the body to do something that nature itself doesn’t do. The best vaccines have been for diseases in which those who experience the dis51.2% ease, small pox for example, develop lifelong immunity.
If we are unable to take that route, then we have to reconfigure our cities, reconfigure our relationship with the environment, reconfigure our health care systems. None of that will happen soon. In the short term I am not optimistic and I do believe there are waves of the opposite, which is to find scapegoats, to blame immigrants, to put up national barriers. Xenophobia, nationalism…these are pseudo solutions to a real problem. Two of the leaders in the world in this regard, President Donald Trump in the US, and (Jair) Bolsanaro in Brazil—who is to say that they will not be swept aside by the failure of their approach in dealing with the disease? Nature may impose upon us the necessity to think in a coherent and science-based way if we wish our economies and our societies to survive, and I believe we do wish to survive.
Is there a lesson in history about the lasting political effects of epidemics? As a necessary measure, governments are exercising sweeping powers right now—what happens when the pandemic passes?
It’s not easy to answer because there is no single lesson in history. If you look at the Spanish Influenza of 1918, it was largely forgotten. It was overshadowed by the war, by the Russian revolution, the peace making process afterwards… despite the fact that very strenuous and sweeping measures were taken—governments introduced compulsory masking, assemblages were forbidden—a great deal of what we are seeing now, happened back then, but nowhere did this disease lead to a rise in new authoritarianism. The powers enacted were set aside and life went on again.
Sometimes epidemics can lead to liberating movements –Haitian independence and its relationship to yellow fever is an example. I think it’s dangerous to imagine an inevitable reaction or result as a legacy of Covid-19 because that would mean that it would be unplanned, and outside our control. In fact, what happens in the long run depends on us. It is possible to imagine the democratic or environmental consequences as being positive, but they won’t happen unless people put their heads together and insist that they happen. A crisis can also be a stimulant for necessary reforms.
What effects do epidemics have on public health policies?
One silver lining in the dark cloud of epidemics is the profound legacy it leaves behind on public health. The Bubonic plague shaped public health in Europe. If a Florentine from the 15th century were to come forward in a time machine to now, many of things we are doing would be familiar to him. There were plague costumes—gowns coated with wax and masks that doctors wore then. They had rods to keep people at a distance for social distancing. Also, the plague hospitals – overcrowded and struggling, with doctors and medical personnel being at great risk. He would have known all about quarantine, which was introduced back then.
Or let’s talk about an English person with enormous influence in this regard — Edwin Chadwick, who brought in a sanitary revolution in England to counter cholera in the 19th century, retrofitting British cities with sanitary features – sewers, running water, the water closet – it transformed daily life. Regulation building codes we follow now are also gifts of the 19th century coming to terms with epidemic diseases.
And we are all waiting right now with bated breath for a vaccine. Would we even have had the concept if it was not for Edward Jenner in the 18th Century developing the small pox vaccine?
The word “unprecedented” is applied to what’s happening now quite liberally, but it seems to me that it has precedence going far back in history. The tools we are using, we would not have them without this history. Nor are the effects unprecedented – that people are losing some of their religion, and that religion may be a belief in rapacious global capitalism, or nationalism. A lot of belief systems are likely to be transformed, and this is not the first time it’s happened, and undoubtedly won’t be the last.