I
want to start with a big question, which is: What, broadly
speaking, are the major ways in which epidemics have shaped the
modern world?
One way of approaching this is to examine how I got interested
in the topic, which was a realization - I think a double one.
Epidemics are a category of disease that seem to hold up the
mirror to human beings as to who we really are. That is to say, they
obviously have everything to do with our relationship to our
mortality, to death, to our lives.
They also reflect our
relationships with the environment - the built environment that
we create and the natural environment that responds. They show
the moral relationships that we have toward each other as
people, and we're seeing that today.
That's one of the great messages that the World Health
Organization (WHO) keeps discussing.
The main part of
preparedness to face these events is that we need as human
beings to realize that we're all in this together, that what
affects one person anywhere affects everyone everywhere, that we
are therefore inevitably part of a species, and we need to think
in that way rather than about divisions of race and ethnicity,
economic status, and all the rest of it.
I had done some preliminary reading and thought this was an
issue that raises really deep philosophical, religious, and
moral issues.
And I think epidemics
have shaped history in part because they've led human beings
inevitably to think about those big questions.
The outbreak of the
plague, for example, raised the whole question of
man's
relationship to God.
How could it be
that an event of this kind could occur with a wise,
all-knowing and 'omniscient divinity'?
Who would allow
children to be tortured, in anguish, in vast numbers?
It had an enormous
effect on the economy.
Bubonic plague killed half the population
of full continents and, therefore, had a tremendous effect on
the coming of the industrial revolution, on slavery and serfdom.
Epidemics also, as we're seeing now, have tremendous effects on
social and political stability. They've determined the outcomes
of wars, and they also are likely to be part of the start of
wars sometimes.
So, I think we can say that there's not a major
area of human life that epidemic diseases haven't touched
profoundly.
Were you trying to make a point about how the way we respond to
these things is often a function of our racial or ethnic or
religious views rather than our general humanity, and that the
response has shown the flaws of human beings in some way? Or
were you making a different point?
I think I was trying to make two points. I think the causal
chain works in both directions.
Diseases do not afflict
societies in random and chaotic ways. They're ordered events,
because microbes selectively expand and diffuse themselves to
explore ecological niches that human beings have created.
Those
niches very much show who we are - whether, for example, in the
industrial revolution, we actually cared what happened to
workers and the poor and the condition that the most vulnerable
people lived in.
Cholera and tuberculosis in today's world move along the fault
lines created by poverty and inequality and the way in which, as
a people, we seem to be prepared to accept that as somehow right
and proper, or at least inevitable.
But it's also true that the
way that we respond very much depends on our values, our
commitments, and our sense of being part of the human race and
not smaller units.
When Bruce Aylward, who led the WHO
mission to China, came back to Geneva at the end of it and was
asked a question very similar to the one you posed, he said that
the major thing that needs to happen, if we are to be prepared
now and in the future, is there has to be an absolutely
fundamental change in our mind-set.
We have,
-
to think that we
have to work together as a human species to be organized to care
for one another
-
to realize that the health of the most
vulnerable people among us is a determining factor for the
health of all of us
-
if we aren't
prepared to do that, we'll never, ever be prepared to
confront these devastating challenges to our humanity
Well, that's a very bleak thought, if I may say so, because I
think it's unlikely we are going to experience that change of
mind-set.
[Laughs] I didn't want to suggest that I'm a great optimist in
this matter, but I do agree it's what needs to happen.
There's
also a dark side to humanity and that is part of the interest of
this.
What choice will we make?
How will we go when we're faced
with this?
I don't think it's predetermined, and a great human
moral drama is being played out in front of us.
The idea of a connection between how we respond to these things
and the prevalence of them is almost Biblical.
I would entirely agree with that.
It really is a matter that
exists at that level and is that big a part of our sense of
moral imperative. I think that's a huge part of the history of
epidemic diseases.
Before this gets too dark, let me ask you a lighter question...
Yeah, I'm sorry to have such interests. My daughters protest.
Are there certain epidemics where the response has shown
something inspiring about humanity?
Oh, I certainly think that.
I think when I said it shows a
mirror to ourselves, it doesn't show just the dark side of
humanity. It also shows the heroic side.
A really good example
is Doctors Without Borders in
the Ebola crisis, and the way in
which they put their lives and their futures knowingly, directly
on the line for no self-interest whatsoever and no reward, but
purely because they were committed to defending the lives and
health of the weakest people in the world.
And
Doctors Without
Borders is doing that every day in many parts of the world, and
they're even now in China confronting this.
I believe that this is something that also does bring out the
highest qualities. Indeed, novels are also written about these
major events. It affects our literature and our culture.
I'm
thinking of the great plague novel, which is "The Betrothed," by
the Italian novelist Alessandro Manzoni.
He talks about the
archbishop of Milan, Cardinal Borromeo, who went into the pest
houses and was willing to lay down his life to look after the
poorest and most unwell people in his flock.
What about in terms of world leaders or regimes responding
positively, or positive political changes arising after an
epidemic?
Absolutely.
I'm thinking about the end of chattel slavery in the
New World. That and the success of the
Haitian rebellion and
Toussaint Louverture was determined, above all, by yellow fever.
When Napoleon sent the great armada to restore slavery in Haiti,
the slave rebellion succeeded because the slaves from Africa had
immunity that white Europeans who were in Napoleon's army didn't
have. It led to Haitian independence...
Also, if one thinks from
the American point of view, this was what led to Napoleon's
decision to abandon projecting French power in the New World and
therefore to agree, with Thomas Jefferson, in 1803, to the
Louisiana Purchase, which doubled the size of the United States.
To flip it around, how often has the existence of these diseases
gone hand in hand with political oppression or been used as an
excuse for political oppression?
I think it has always been also seen as part of political
oppression.
I'm persuaded that the nineteenth century was a
terrible time, not only of rebellion but also of political
oppression. For example, the slaughter of people after
the 1848
revolution in France, in Paris in particular, or after the Paris
Commune.
Part of the reason that this was so violent and
sanguinary was that people who were in command saw that the
working classes were dangerous politically, but they were also
very dangerous medically.
They had the very possibility of
unleashing disasters on the full of society.
I think that was
really a part of this metaphor of the dangerous classes, and I
think that led to, say, the inhumanity of the slaughter of 1871
after the
Paris Commune had been put down.
What have you made of China's response to
this current coronavirus?
That's a really interesting question to ask, and it's one that I
think we're going to need to think about long and hard, because
it has a number of aspects to it that are really complicated.
The first thing is the strong-arm methods introduced by the
Chinese on January 23rd, when they introduced cordon
sanitaire, which is a wholesale quarantine by cordoning off
with soldiers and policemen whole geographical areas and
communities.
In this case, in
Wuhan, a city of some eleven
million, and then the
Hubei Province, which has almost sixty
million people, they decided to impose a lockdown.
That is something which harkens back to plague measures and that
has been repeated over and over, including in the Ebola
epidemic.
The problem with the
cordon sanitaire is that
it's clumsy.
It's a sledgehammer.
It arrives too late and it
breaks down that fundamental element of public health, which is
information. That is to say that, threatened with the lockdown,
people don't cooperate with authorities.
Authorities therefore
no longer know what's going on and people take flight, which
spreads the epidemic.
I was very startled to see that this was
the response of the Chinese government at the outset.
It differs
from the norms of public health, which have developed since the
plague years, which stress case findings of individuals, then
tracing and isolation.
So I was horrified and expected the worst.
It turns out, I
believe, that the regime slowly began to change course. One sees
that, as time went on, the Chinese were very diligent about
collecting records, trying to elicit the cooperation of the
population, in a sense to repair the damage of the early days.
I
think it's a story of more than one response. It wasn't all bad,
and not all good.
I don't quite go along with the response of
the WHO, which
praised this as wonderful public health. That makes me fearful.
Is that to say that other regimes and other countries where
there are strongmen ought to impose lockdowns, as was tried with
Ebola in West Africa, where it didn't work?
That terrifies me.
I
don't think that's the lesson. I think it's the more nuanced
approach, that probably it wasn't working so well in China, and,
indeed, Xi Jinping is willing to say, unlike the World Health
Organization, oddly enough, that there were mistakes that were
made and that they'd had to change course, and that they need to
learn from those mistakes.
I think that's what China was able to
do.
That's interesting, because earlier you were saying that the
World Health Organization, or at least members of it, was
calling on people to find their common humanity, but at the same
time you're saying they're also willing to praise a response
that was, at least initially, somewhat inhumane.
Yes.
I'm not justifying it, but I can say I can understand it,
because it would be terrible to alienate the largest member of
the World Health Assembly and to alienate a country that's in
the midst of this extraordinary crisis.
So I can understand why
it happened.
At the same time, there's been a great deal of
stress on total honesty, producing evidence, communication,
data-based, factual, scientific approaches to public health, and
that is not what happened at the early stages of the Chinese
response. It did come into play later on.
To move back in time a bit, are there broad themes in how
artists have reacted to epidemics?
I think one of the things I've learned about epidemics is that
each disease, as I see it, is like a person.
Each one is an
individual and different from any other. They aren't just
interchangeable causes of death. It depends on the nature of
each individual, and how societies and artists react to them.
It
depends on how many people they kill, if they kill people in
excruciating ways, if they kill children and the young, or if
they leave orphans behind, or if they are familiar diseases or
if they have come from outside.
In the case of plague, it stirs the problems of mortality and
sudden death.
Artists responded to this, particularly on the
Continent. In Catholic countries, the main thrust was to see
this as a reminder that this life is temporary and provisional.
One sees a great attention to themes of suddenness of death,
that is, the danse macabre, where everyone is swept away. Of
course, the use of the hourglass, of bones, of vanitatem.
You
know,
"Vanity of vanities, all is vanity, saith the Preacher."
There's this enormous sense of that, and a sense also of a
worship for plague saints, who were widely depicted.
One can see
this going across Europe - the cult of religiosity, the themes
of sudden death, repentance, and getting your affairs and your
soul in order before the plague might suddenly cut you off.
It
had a transformative effect on the iconography of European art.
You can see this even into the twentieth century with that
wonderful film by Ingmar Bergman, "The Seventh Seal," where the
plague is a metaphor for what Bergman was worried about in 1957,
which is nuclear war.
One can see that it has all the things
that I've been talking about with regard to the plague,
including the danse macabre with which the film ends. You'd see
paintings of the
Grim Reaper coming, and it really is an example
of the persistence of this artistic response to death.
Other diseases provoke different responses.
One could talk about
tuberculosis, and how different it was in the Romantic period,
in the nineteenth century. That's really an odd one, because, to
me, tuberculosis is one of the most gruesome and painful ways to
die, where, in the end, you asphyxiate, and yet, on the other
hand, you'll have it glorified with operatic heroines on the
stage who are perceived as beautiful.
Or "Uncle Tom's Cabin,"
which is not only about slavery. It's also about tuberculosis...
Why was tuberculosis glorified?
I want to say something I hope will make you smile, but I would
like to be able to give you a definitive answer to that.
Human
beings are funny creatures, aren't they? Not all of the things
that are done are easy to understand, but, with regard to
plague, it was a disease that affected everyone.
I think that's
critical. It was the end of the world, the final reckoning, the
final apocalypse.
With tuberculosis, on the other hand, people
thought something that wasn't true. They thought - and the
medical doctrines of the early nineteenth century taught them
this - that it was a disease of the élite, of the artist, of the
beautiful, of the refined, and that it made people much more
beautiful, so that fashion tried to turn women into tubercular
creatures.
You see Toulouse-Lautrec painting an anorexic-looking
woman who's putting rice powder on her face so that she'll look
pale like the tuberculosis people.
The Pre-Raphaelites actually
married their models, who were tuberculosis patients.
Victor
Hugo was told by his friends that he had one great fault as a
writer, which was that he wasn't tuberculous, and therefore he
wouldn't be as great a writer as he would have been otherwise.
There was an American thinker and writer about culture, Arthur
C. Jacobson, who had the idea that America, at the end of the
nineteenth century, as tuberculosis was beginning to recede, was
going to face a crisis for the arts, the sciences, and culture,
because there wouldn't be geniuses anymore the way there had
been in the time of tuberculosis.
That's amazing.
I'm not a Luddite regarding science, but sciences sometimes have
an undertow, and this is one of the undertows of the germ theory
of disease.
The germ theory actually helped to stigmatize the
poor. TB, it insisted, was overwhelmingly not a disease of the
beautiful classes but of the ugly classes who were filthy and
poor. There, the whole interpretation changes.
If you look at
André Gide's "The Immoralist," in the early twentieth century,
he regards his own case of tuberculosis as the most despicable,
disgusting thing that could ever happen.
The idea of a beautiful
disease has disappeared forever, and tuberculosis is never that
again.
Let's end here: we may be seeing a response to an epidemic that
combines tragedy and farce, as we saw a couple of days ago,
where a bunch of health officials got up at the White House and
decided to praise President
Trump as well as talk about what was
happening. Do you have any amusing stories from history of mad
kings or crazy rulers dealing poorly or perhaps tragicomically
with epidemics?
Well, yes.
I'm not sure it's exactly funny, but I think the
reaction of Napoleon to the diseases that were destroying his
rule were tragic and grotesque in a black-humor kind of way,
where he doesn't value the lives of his soldiers.
He's therefore
able to talk about the coming of yellow fever in the West Indies
as a personal insult.
I think that this is something that we might see yet again. It's
something that maybe you can laugh at. Maybe history is best
seen as comedy in retrospect, but I don't think what's about to
happen this next year with regard to this particular epidemic in
the United States is going to be fun at all.
To have officials
in the White House saying,
"Oh, it's nothing more than the
common cold, we've got it under control,"
...when they have
nothing
under control, as far as I can see, and they've put people in
charge who don't even believe in science.
Epidemics and
solipsism are the two things that human nature
can't conquer.
I'm with you on that one...
