A few thoughts on the #COVID19 pandemic from a historical perspective. I’m not an epidemiologist. But I wrote a book on the history of global health politics in the 20th century, and I think a historical approach helps to contextualize current events. 1/
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Let’s start with terminology, semantics, and narratives. The term “pandemic” is everywhere right now. And without making any statement on whether or not it is justified in this case, it definitely comes with a lot of connotations and raises certain expectations. 2/
Most importantly, “pandemic” evokes the specter of global carnage. But there is no scientifically agreed upon definition. It basically means: worldwide spread of disease – but it does not necessarily indicate particularly high fatality rates or any drastic effects at all. 3/
Take the swine flu pandemic of 2009/10 that initially inspired many of the same fears as #COVID19. It was also the first time the World Health Organization declared a Public Health Emergency of International Concern under the International Health Regulations. 4/
But measured against the somewhat dramatic expectations (a pandemic! Caused by the same H1N1 virus that was responsible for the deadly Spanish Influenza!) the pandemic luckily had rather mild effects more along the lines of the seasonal flu. 5/
As a matter of fact, in the aftermath of the swine flu pandemic WHO was heavily criticized for unnecessarily fueling fears. Much of WHO’s subsequent reluctance to declare a Health Emergency stems from that. 6/
In any case, even when used correctly / justifiably, the term “pandemic” still comes with a host of associations and connotations that, at the very least, can be misleading. Coverage of public health issues should always reflect that. 7/
Of course, #COVID19 does not appear in a vacuum. Since the late 1990s, seemingly never-ending waves of infectious diseases rolling over the planet have given rise to a heightened sense of threat, particularly in the Western world. 8/
SARS, avian influenza, and swine flu have garnered a lot of political and public attention – as have the Ebola epidemic in West Africa in 2014 and the appearance of the Zika virus in the tropics in 2015/16. 9/
Experts have long warned that globalization facilitates the dissemination of pathogens, and it is certainly no coincidence that outbreak scenarios and apocalyptic visions of global pandemics endangering the very survival of humanity have been a staple in popular fiction. 10/
Such potential emergencies have been accompanied by passionate pleas from scientists, politicians, and activists directed at the international community to act in solidarity against the rising public health dangers. However, such rallying cries always fade away quickly. 11/
The fact that the Democratic Republic of Congo experienced the second worst Ebola epidemic in recorded history in the spring of 2019, for instance, barely caused a reaction in the West – at least nothing even remotely comparable to the panic of 2014. 12/
This, then, is another aspect we should keep in mind: The public health discourse, as agitated and outright alarmist as it can be at times, is fundamentally fast-paced and oblivious in nature. 13/
Let’s look into the history of how the international community – and the “Western” world, in particular – has dealt with and reacted to infectious disease. When international health threats appear, the public discourse often focuses on the idea of quarantine. 14/
As a general practice, quarantine measures are thousands of years old. They were also at the center of the International Sanitary Conferences of the second half of the 19th century that established public health as a matter of international diplomacy and law. 15/
International cooperation in the 19th century started from the assumption that diseases did not respect national boundaries and that some form of trans-border regime was necessary. 16/
The Sanitary Conferences were mostly a European affair and very much focused on protecting the continent from plague, yellow fever, and most importantly cholera, which originated in South Asia and spread around the globe in several waves starting in the 1830s. 17/
Interestingly, the goal of the Conferences was not to ratchet up quarantine measures, but rather to standardize and codify a catalogue of permissible measures in order to prevent overreactions and unnecessarily harsh procedures that disrupted international trade. 18/
It is important to remember that until the late 19th century it was unclear or at least highly contested what caused cholera and other diseases. That changed with the advent of bacteriology and virology and the rapid discovery of pathogens from the 1870s onwards. 19/
The discovery of pathogens did not only strengthen the case for quarantine measures. It also gave rise to utopian hopes of ending infectious disease altogether: Once it was clear what caused disease, all that was left to do was to find ways to eliminate those “germs.” 20/
Such hopes, however, receded to the background in the interwar period. The devastations caused by infectious disease in the aftermath of the First World War made it abundantly clear how vulnerable humanity still was. 21/
The most famous example is of course the Spanish Flu of 1918-20, the deadliest pandemic in recorded history, that infected hundreds of millions of people and killed somewhere between 50 and 100 million people around the globe. 22/
Less well-known is the typhus epidemic that devastated Eastern Europe in the aftermath of the War and directly led to the founding of the League of Nations Health Organization – the first such organization with global aspirations. 23/
Yet the League shifted its focus away from infectious disease in the 1930s. In the aftermath of the Global Depression contemporaries re-discovered the discipline of social medicine that concentrated on the social, economic, and political determinants of health. 24/
The 1940s, however, saw the pendulum swing back to a focus on infectious disease and a return of the utopian promises of the “golden age” of bacteriology and virology, as contemporaries believed to have found unprecedentedly powerful weapons against disease. 25/
The term “magic bullets” was often used to describe a host of technical and biomedical innovations: new vaccines, sulphonamides, antibiotics, powerful insecticides – they were perceived as game changers in humanity’s long struggle with disease. 26/
Arguably for the first time in the history of human conflict, military leaders no longer needed to reckon with infectious disease as a major factor (or, as health expert Neville Goodman put it in 1952: humans were finally free “to massacre each other unhampered by epidemics") 27/
Most American observers regarded the Second World War as a public health triumph. The insecticide DDT, in particular, was seen as a marvel, as it was drastically superior to any hitherto available insecticide. 28/
DDT proved twenty-five times more effective against the larvae of mosquitoes, and adult mosquitoes would perish if they landed on a surface sprayed with DDT, even if it had been treated months earlier. 29/
Moreover, DDT could be produced synthetically and was much cheaper than all the alternatives, and humans, at least in the short term, did not show symptoms of poisoning when exposed to the substance. 30/
The successful containment of a typhus epidemic that had threatened to ravage the civilian population of Naples, Italy, in the Winter of 1943/44, even amongst disastrous hygienic circumstances, was widely attributed to the use of DDT and hailed as a historic achievement. 31/
And while tropical diseases, especially malaria, had been amongst the biggest concerns for U.S. forces in the first year of the Pacific War, causing more than half of all casualties, from 1943 onwards they quickly became a mere afterthought. 32/
Public reactions to DDT were ecstatic: It was celebrated as the “super delouser” (Newsweek) that would bring “Freedom from Insect Pest” (Reader’s Digest); some called for “Our Next World War – Against Insects” (Popular Mechanics). 33/
The euphoria surrounding the new super weapons notwithstanding, the 1940s were also characterized by heightened fears and a sense of acute threat of infectious disease which was intimately bound to the pervasive perception of witnessing the dawn of a new “global age.” 34/
This new era in human history was thought to be characterized by an unprecedented level of global interconnectedness, caused by modern transportation, communication, and weapons technologies. 35/
The deliberations over a post-war public health regime were dominated by the idea of a rapidly “shrinking world,” which became one of the leitmotivs of this phase. 36/
As Brock Chisholm, the first Director-General of WHO, put it: „Until quite recently, man’s environment has been his locality only, his village or town or at most his own country. ... This situation has changed entirely: the environment of every person is now the whole world.“ 37/
Many contemporaries feared that this supposedly unprecedented level of interdependence was inherently dangerous, for it seemed to allow diseases to spread all over the planet with staggering speed. 38/
If that was the case, then no one would be safe from harm unless everyone was; the health of any individual was inextricably bound to that of every other person on earth. By the end of 1945, such perceptions had crystallized in the idea of a collective state of “world health” 39/
Consequently, quarantine measures were widely discarded as anachronistic. The only choice was “to control, to the point of eradication, communicable disease at its source,“ as the U.S. delegation to the 1946 International Health Conference in New York argued. 40/
As the U.S. Congress put it in a joint resolution in November 1945, the new World Health Organization would have “to wipe out disease everywhere,” and to lead the world in the coming “great international crusade against disease.” 41/
In the 1950s and 60s, in particular, this globalized conception of health would form the basis on which ideas of worldwide disease eradication could flourish and animate visions of creating a world without disease. 42/
Most famously, the World Health Organization launched a global Malaria Eradication Program in 1955 that focused on the use of insecticides, specifically DDT, against mosquitoes as the disease vector (it obviously failed to eliminate malaria). 43/
And in 1967, WHO embarked on a global Smallpox Eradication Campaign, designed as a massive immunization effort, which succeeded in realizing its central goal: The last smallpox case in history was detected in Somalia in October 1977. 44/
The history of these global eradication campaigns is complex and I won’t even try to do it justice here. My book focuses on the malaria program, specifically, which was one of the largest and most ambitious undertakings of international cooperation in the Cold War era. 45/
For the purpose of thinking through the history of how the international community and the industrialized world in particular have reacted to the threat of infectious disease, I’ll highlight a few aspects from this era of “eradicationism” in the 1950s and 60s. 46/
Crucially, the acute sense of threat that had characterized the 1940s did not persist for long – such perceptions have always waxed and waned. What made the prolonged eradication efforts possible was, first and foremost, a specific geopolitical constellation. 47/
In the post-war era, perceptions, interests, motives, and objectives in the Global North and the post-colonial world converged, leading multiple actors to conclude that it was in their best interest to pursue “eradication” through a project planned and coordinated by WHO. 48/
In the late 1940s, disease control efforts, especially against malaria, were measured by their contribution to alleviating the alleged “world food crisis.” And from the mid-1950s onwards, communicable diseases were primarily understood as an obstacle to economic growth. 49/
This perception momentarily propelled malaria eradication to prominence in the international political discourse and enabled the World Health Organization to play a significant role, as both the “West” and post-colonial elites were focused on economic “development.” 50/
However, contemporaneous observers increasingly questioned the relationship between public health and economic development over the course of the 1960s, and new issues rose to the center of attention towards the end of the decade. 51/
In a drastically changed international political landscape – one characterized by fears over “overpopulation,” environmental concerns, and the intensifying critique of some of the core tenets of development politics in general – interest in global public health faded. 52/
Put differently, the place of disease control on the international agenda largely depended on the relative importance it was being awarded for the solution of problems in other areas. 53/
The World Health Organization has always depended on the ebbs and flows of international political discourse while it can do little itself to influence the tides. 54/
What about the utopian idea of a world without disease though? After all, did smallpox eradication not prove that it was possible? The smallpox case is unique in world history, as for the first and to this day only time, mankind rid itself of an infectious disease entirely. 55/
And not just any disease, but a plague that had, for centuries, struck fear in the hearts of people like few other scourges. Yet by the late 1970s, few people were under the illusion that humanity was on the cusp of defeating infectious disease once and for all. 56/
On the contrary, while the old plagues were still affecting millions, the appearance of new, exotic pathogens such as the Marburg or Lassa viruses seemed to herald a bleak future. 57/
And in 1976, the world anxiously monitored the situation in the Democratic Republic of Congo, where another hemorrhagic fever spread along the river Ebola from which it took its name. 58/
The appearance of HIV/AIDS in the early 1980s, finally, gave rise to a widespread perception that the world (well, the “Western” world) was experiencing the “return of infectious disease.” 59/
This brings us back to the late 20th and early 21st centuries. The widespread fear that in our globalized world pathogens spread rapidly and thus constitute an acute danger for everyone on the planet is certainly reminiscent of the 1940s and 50s. 60/
Yet conceptions of a collective state of “world health” and visions of creating a world without disease only exist on the margins, as the belief in “magic bullets” has evidently vanished. Some very different ideas influence the current thinking about public health. 61/
Epidemiologists and historians of medicine in particular often emphasize that human civilization will have to find a way to accommodate disease and learn to live with pathogens. 62/
Especially in the West, there has been a pronounced tendency to seek protection from disease through isolation from “infected” areas; it is certainly not a coincidence that scholarly interest in the quarantine measures of the nineteenth-century has re-awakened. 63/
I wish I could wrap this up with some easy lessons for how to deal with #COVID19. But, of course, history doesn’t provide those. However, a few patterns emerge that I think we – and especially those who influence coverage of the events – should be aware of. 64/
Matters of international health are considered important either if they are seen as obstacles to progress in other areas (food production, economic growth, national security...); or when they are perceived as an acute threat to the well-being of people in the Global North. 65/
These are all fleeting constellations, however. Attempts to demonstrate how health, education levels, economic productivity, population growth, etc are all interrelated might, under certain circumstances, help to mobilize massive resources for the fight against disease. 66/
As the record clearly indicates, however, these very same equations can, depending on which variable is emphasized, lead to public health efforts being relegated to obscurity. Similarly, perceptions of acute danger tend to have a fairly short shelf life. 67/
And some of the most pressing global health concerns, like diarrheal diseases, for instance, never even appear on the West’s radar, since they do not necessarily conform to ideas of plagues and epidemic outbreaks that traditionally inspire fear in the public imaginary. 68/
In order to improve the living conditions of people around the globe, it would be better to break out from these well-established patterns. 69/
As a matter of fact, one justification for international cooperation that is less dependent on ephemeral attention spans and the ebbs and flows of the larger political discourse is readily available: the immediate alleviation of human suffering through public health measures. 70/
Right now, all the attention is, understandably, focused on #COVID19. Once the immediate danger is passed, I think we should take a fresh look at the cyclical dynamics of fear/crisis and indifference/oblivion that shape the coverage and our perception of global public health./end
