As a scholar of medical history, Gregg Mitman has studied infectious disease outbreaks over several centuries, in various parts of the world. The current pandemic has him thinking hard about the stories we will eventually tell (indeed, are already telling) about the global impact of COVID-19.
This May, Mitman (who is Vilas Research and William Coleman Professor of History, Medical History and Environmental Studies) is teaming up with professor Susan Lederer (Robert Turell Professor of Medical History and Bioethics) to teach a course for medical students entitled Outbreak! Epidemics, Migration, and the Changing Contours of Global Health.
Epidemics are as old as humanity. We asked Professor Mitman for his thoughts on the current COVID-19 crisis, as a historian who brings, to his scholarship and teaching, an interest in understanding the ways in which political economy, cultural values and beliefs, and scientific knowledge intersect in shaping the interactions between people and environments over time.
Mitman’s short film, In the Shadow of Ebola (part of the Independent Lens series from PBS), offers an intimate portrait of a family and a nation torn apart by the Ebola outbreak in 2014-2015. Distrust and fear, quarantines and roadblocks, eventually gave way to community mobilization, as people in Liberia built trust and networks of care to combat the virus’s spread. His current book project is tentatively titled Bloodborne: Invasion and the Politics of Disease.
You have written about the social, political, environmental and public health impacts of disease outbreaks in recent history. What are you noticing, as the current global pandemic unfolds, that reminds you of the past?
There are common patterns to the stories that Western nations often tell as an outbreak unfolds. First are the origin stories. The virus is almost always seen as a foreign body—an invader from another place. When political leaders refer to COVID-19 as the “Wuhan virus” or foreign virus, they are playing into xenophobic fears and racial stigmatization that often accompany disease outbreaks. In 1900, bubonic plague, which had recently appeared episodically in Asia, reached American shores. Asian immigrants living in San Francisco’s Chinatown were singled out for quarantine and mandatory inoculation and denied railroad passage without a health certificate after a Chinese-American man, Chick Gin, died of the disease. Similarly, during the 2014-2015 Ebola outbreak, people from the West African nations of Guinea, Liberia, and Sierra Leone found themselves objects of public fear, suspicion, and scapegoating. We should not be playing into fears and erecting walls that alienate us from each other. Viruses don’t discriminate based on race, ethnicity, class, creed, or political party. We are in this together. And, together, we can combat the spread of this novel coronavirus.
What troubles you the most? Up until very recently, I have been struck by how hard it has been to convince family members, friends, and colleagues of the need to institute strict public health measures—social distancing, home isolation of cases, self-quarantines, eliminating travel. We must seriously alter our behaviors if we are to flatten the curve. It is not just for the sake of protecting one’s own health. It is about protecting the health of America’s most vulnerable population, including the elderly, those with underlying health conditions, and our homeless population, undocumented immigrants, and those without health insurance. Epidemics always expose the fault lines in society; they make visible the deep fissures in our social safety nets, or lack thereof, whereby the most vulnerable suffer the greatest burdens and consequences. We also need to consider all those who might not be able to receive care for other life-threatening illnesses because of overwhelmed healthcare systems, which are already operating at near capacity. We saw this happen with the Ebola outbreak in West Africa. Admittedly, Liberia at the time had nowhere near the kind of public health infrastructure that exists in the United States. But far more people likely died of other diseases, such as malaria, and complications associated with childbirth, than of Ebola because they had no access to proper treatment as healthcare facilities became overwhelmed during the outbreak. We are already seeing hospitals in Italy having to make heartbreaking decisions about who will be allowed to live and who will die as resources become scarce.
In your film, In the Shadow of Ebola, a family recounts how the Liberian people’s distrust of government made treatment and prevention more difficult. Are there any similar dynamics playing out with COVID-19, here in the U.S. and abroad?
The biggest ally we have in confronting an epidemic is public trust. In Liberia, fourteen years of civil conflict had eroded, for good reason, trust in government and the military. The Liberian government’s quarantine on West Point, the poorest and most vulnerable community in Monrovia, escalated fears, suspicions, and mistrust as the police and military swept in. Riots broke out. A young man was shot and killed. The quarantine was lifted. It fell to respected figures, including radio DJs, musicians, and community health leaders, like Mosoka Fallah, the acting director of the recently established National Public Health Institute of Liberia, to help rebuild trust within communities. When that happened, local people on the ground began to mobilize and take action. It turned the tide on the Ebola outbreak.
In the United States, trust in each other, in scientific experts, and in government has unfortunately been eroded by political polarization. Conflicting statements by political leaders, widespread misinformation circulating on television and social media, and sheer disregard of leading expert medical opinion does little to help build public consensus and trust. But that is what we most need.
It seems as if many parts of the world are grinding to a (temporary) halt, and I’m wondering if there are historical parallels to this. What have been the economic impacts of past pandemics?
Before the development of a vaccine in the 1930s, yellow fever had long been a threat to global trade and commerce. Quarantine was one defense, but it came with a costly economic impact on commercial trade. An 1878 epidemic that originated in Havana, Cuba cost the American South upwards of $200 million in lost revenues as the disease swept up the Mississippi River from New Orleans to St. Louis, killing twenty thousand people, and striking fear before and behind its wake. That figure amounted to 2.3 percent of the U.S. gross national product. In today’s dollars, it equals approximately $5.2 billion.
Does a pandemic have a “silver lining?” Can a country come out stronger and better in some way? Certainly, the Ebola outbreak in West Africa, which devastated the economies of Guinea, Liberia, and Sierra Leone, was a wake-up call for the need to revitalize health services and build more robust public health infrastructures and disease surveillance systems. In Liberia, it led to the creation of the National Public Health Institute of Liberia, which now has in place a much more robust system for surveillance, contact tracing, case management, and community mobilization than existed before the Ebola outbreak. I have been struck at how quickly the government has acted in response to the first case of COVID-19 that has appeared in Liberia. The contrast between the 2014 Ebola response and the current COVID-19 response is striking. When the coronavirus pandemic has subsided, there will certainly be a great deal of inquiry about public health preparedness, not only in the United States, but around the globe. As Yale Law School professors and health activists Amy Kapczynski and Gregg Gonsalves have recently suggested, “the question today is whether we can learn something from coronavirus that might not only help us mitigate the harm of this pandemic, but build a new infrastructure of care that allows us to better protect the most vulnerable—and us all.”
Gregg Mitman is both the founding director of the Nelson Institute’s Center
for Culture, History and Environment, and the founder of the Tales from
Planet Earth Film Festival that brought together artists, academics, and
the public to explore and further the power of storytelling through
film.