EPILOGUE

ANDREA PATTERSON AND IAN READ

As we send this book to typesetting, the coronavirus gains a deadly foothold

worldwide. It reveals that we have entered a new era of epidemics. Before
any of us had heard of COVID-19 or realized the world would change (or
revert) so suddenly, Jonathan Katz wrote the foreword of this book. In many
ways, it is an eerily prescient choice of epitaph evoking the now all too
apparent issues with testing and quarantine. Katz describes epidemics as
virulently splintering and cleaving. This virulence may be biological, like
the transfer of a virus through sex, the invisible film of a touched surface,
or a breath of air. Yet epidemic diseases are experienced mostly through
their social virulence and exposure of pre-established hierarchies. Indeed,
outbreaks are never egalitarian in their impact, and never cleave in the same
way. People assumed to be “infected” or possessing the insidious power to
“infect” can evoke violent fears that clutch to old prejudice. As Katz wrote,
“beneath that lies an all too human desire to locate, name, enumerate and
then excise the unknowable threats that haunt all existence.”

With anxious eyes we look ahead, but we should also look back. Our current
age of infectious diseases, including HIV/AIDS, Ebola, Zika, and those
caused by the coronaviruses (SARS, MERS, COVID-19), can be blamed on
greater and faster movements of people. Since the early modern era, history
recorded two previous periods that were characterized by an increase in
terrifying plagues. They have marked a significant stage of human
migration and globalization. When the first Europeans and enslaved
Africans crossed the Atlantic Ocean in the late fifteenth and sixteenth
centuries, they unknowingly carried with them a set of destructive diseases
that depopulated the Americas. The specific diseases that killed millions of
indigenous peoples are uncertain; most probably they are smallpox,
measles, and influenza. Europeans took advantage of the devastation to win
wars, enslave, occupy, and settle.

Beginning in the 19th century, revolutions in industry and transportation set

into motion another wave of mass migration. Rapidly evolving urban
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centers became harbors for infectious diseases, among them cholera,

typhoid, dysentery, tuberculosis, and influenza, that depended on a steady
stream of mostly poor and desperate migrants for dispersal. This second
period of epidemics helped create more activist governments and a wave of
public health measures. Such changes were facilitated by an increased
understanding of disease-causing microorganisms and revolutionary drug
discoveries. Modern medicine and public health have vastly improved
control over infectious diseases, reduced mortality rates, and extended life
spans, especially among the wealthier countries.

The third and current era of new epidemics began with the AIDS pandemic
in the 1980s. Environmental degradation, poaching, wildlife trades, and
hyper-globalization increasingly provide fertile grounds for outbreaks that
are less likely constrained to nations or regions. The viruses causing
HIV/AIDS, Ebola, Zika, SARS, MERS, and COVID-19 have “spilled over”
from animals to humans, threatening global populations. As more vectors
carrying pathogens invade new hosts, older and more familiar scourges such
as yellow fever, malaria, and dengue fever dramatically extend their
regional threat, in part, as a result of climate change. Additionally, a
multitude of infectious diseases is becoming increasingly difficult to combat
with our miracle drugs as microorganisms rapidly evolve resistant strains.
We confront alarming questions: What may curb the dramatic rise of
infectious diseases? How are we to address and mitigate the devastation
they may bring?

COVID-19 painfully brings these questions into the public awareness, and
many aspects of this unfolding pandemic reiterate the central message and
findings of this book. Although SARS-CoV-2, the virus responsible for this
disease, seems new and alien, it has a long evolutionary history.
Coronaviruses are a large family of zoonotic pathogens (transmission from
animals to humans) that are widely present in diverse bat and bird species.
They have been a part of human and other animal life for millennia. Some
research suggests an even more ancient viral lineage with a common
ancestor for coronaviruses dating back millions of years.1 These viruses
likely sparked epidemics in the past, some that historians might have
“retrospectively diagnosed” as something else, like influenza.

1 Joel O. Wertheim, Daniel K.W. Chu, Joseph S. M. Peiris, Sergei L. Kosakovsky

Pond, and Leo L. M. Poon, “A Case for the Ancient Origin of Coronaviruses,”
Journal of Virology 87, no. 12 (June 2013): 7039–7045.
https://doi.org/10.1128/JVI.03273-12.
 The Shapes of Epidemics and Global Disease 379

As the current coronavirus pandemic so terrifyingly demonstrates, a virus is

much more than a phylogenetic “curiosity.” The discussion of Ebola
(chapter 13) vividly illustrates that the terror of an epidemic “should not be
assumed to lie in the genetic mutation of the organism itself, but rather in
the pathways we humans create for it.” COVID-19 is undeniably the result
of biological and ecological processes, yet as is true in this pandemic and
the other plagues described in this volume, social, economic, and political
forces can facilitate or curb pathogenic development. While we may be far
from understanding the biochemical and physical processes leading to this
coronavirus infection, we experienced, early on, the tremendous impact
cultural, economic, and political climates can have on its containment and
treatment.

For example, fear of political repercussions prevented and delayed essential

communications about the initial COVID-19 outbreak between the local and
central governments in China, and subsequently between China and the
international community. Similarly, in the early 1990s, AIDS killed
hundreds of thousands in Henan Province, China (chapter 8). Corruption,
deception, and inefficiency characterized government responses to the
epidemic that were aimed to please Beijing’s political leadership rather than
secure the health of citizens in the province. Thus, plasma collection stations
were not closed, despite the known risks involved. A suicide epidemic of
mostly young people in Oceana (chapter 2) presents another case where
local health and healthcare were structured to serve larger, distant
bureaucratic interests. In the 1980s, academics and state officials, blinded
to the root causes of the deaths in unequal world systems and colonialism,
used the tragedy to reinforce those systems.

We witnessed the rapid global spread of COVID-19 with fear of economic

repercussions dictating inadequate policies for its containment in the early
stages of the disease. As a result of not following the advice for containment
and social distancing from governments that dealt with the first wave of
deaths from this pandemic, western societies have thus far experienced a
higher fatality rate and will face far-reaching social, economic, and political
consequences. Considerations that place economic profits over community
health are often (if not generally) at the core of epidemic diseases. The
pursuit of profit may give opportunities to pathogenic disease, and it can
slow reaction when the trade-off is its containment over revenue. When
afflictions are born from consumer habits and mass marketing that make
multinational corporations or governments trillions in profits or tax
revenues, the trade-off is almost impossible. By way of illustration,
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COVID-19 is taking many of its victims from people who suffer pre-
existing conditions, including complications from smoking, poor diets, and
sedentary lifestyles. If the coronavirus is a killer, then “Big Tobacco,” “Big
Food” and “Big Pharma” that mass-produce and manipulate people into
habitually consuming their products are accomplices to the crime (chapter
9). Major corporations have used obfuscation to deny the science that
exposes their role in driving epidemic disease (chapter 10). Similarly,
opioids and guns claim millions of lives worldwide every year, because they
have been so accessible and promoted by special interest groups vested with
medical and political authority.

Social repercussions and stigmatization of individuals (regardless of their

infection status) began well before the World Health Organization declared
COVID-19 a pandemic in March 2020. Politicians and pundits implied
entire regions as “diseased” through labels such as “Chinese virus” or
“Wuhan virus.” We have since seen a rise in hate crimes against Asian
Americans, attacks on foreigners in India, increased antagonism between
rural and urban populations, and younger and older generations. Hate and
blame are familiar features of epidemics, as evidenced in the discussion of
incarceration and sterilization policies directed at leprosy patients in Japan
(chapter 3). Behavior protocols are also less successful when patients are
subject to bias, judgment, and discrimination, factors directly linked to
increased HIV transmission rates in Latino gay communities (chapter 5) and
African-American women experiencing addiction, violence, or
homelessness (chapter 6). Nevertheless, stigmatization already complicates
the tracing of those infected with the coronavirus disease. COVID-19
equally reveals how poverty and race expose vulnerabilities in
disproportionately contracting the disease, in the unequal access to
healthcare and treatment, and the drastically disparate survival rates. This
volume provides useful and relevant analyses of how epidemics impact
marginalized groups (due to culture, race, gender, class, sexuality, and
region) and discusses alternative and promising treatment strategies to
counter these effects, as exemplified in community-based participatory
research.

It is too early into the COVID-19 pandemic to comment on “best” practices

for prevention, diagnosis and containment, nor do we want to speculate on
the trajectory for treatment and drug development. The discussions in this
volume illustrate the complex web of knowledge production, socio-
economic conditions, and power relations that control the fight against
epidemic diseases, particularly in the initial response and early phases of
 The Shapes of Epidemics and Global Disease 381

drug development (chapter 7). What has become abundantly clear, however,
is that an acute international shortage and the lack of foresight to create
sufficient national emergency stockpiles of basic protective gear are now
killing front-line health workers. This is rather incomprehensible given our
recent experiences and unpreparedness with Ebola in Western Africa
(chapter 13) or pandemic influenza. In fact, some of the wealthiest nations
appear as helpless in protecting this crucial first line of defense in the case
of COVID-19 as we were with SARS in 2003 and Ebola in 2014.

COVID-19 provides another instance of how the physical and ideological

worlds are invariably linked. In this pandemic, like others, nature and
society interact to create, sustain, transform, or contain the disease. As we
live (or partly re-live) this pandemic, few would argue that one discipline
alone can or should make sense of it. It certainly commands the broadest of
approaches, an openness to ideas, and far-reaching collaboration of experts
from across vastly different fields. In this volume, we have called this
approach radical interdisciplinarity.

We contend that identifying, surviving, or controlling epidemics requires

more than a collection of diverse (autonomous) disciplinary insights.
Instead, we should create conceptual connections and integrate knowledge.
For example, a collaboration of research in microbiology, immunopathology,
clinical epidemiology, genetics, and mathematical modeling to provide both
the knowledge and technology for a vaccine. We also depend on political
scientists and experienced diplomats to guide us at a moment that, in the
words of United Nations Secretary-General António Guterres, “has no
parallel in the recent past.” Policy decisions to address this crisis need to be
informed by the critical insights historians can provide beyond the recent
past. What can we expect to see in an increasingly interdependent and
hyper-national world? At a time when we move more rapidly towards an
ever more virtual world in which the existing inequalities of the real world
may be amplified? Such questions matter for sociologists. They are equally
relevant for psychologists who study human reaction in the face of shared
external threats. Additionally, artists, linguists, and behaviorists collectively
contribute to our understanding of the many diverse impacts social
distancing may have: through the creation of images that give shape to a
shared meaning and by analyzing actions that are expressed within norms.

A global phenomenon requires a global response. If we embrace open

borders, affordable travel, and global supply chains, then societies will have
to make tough choices by somehow balancing security with liberty. This
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book draws attention to just how precarious and devastating these decisions
can be. COVID-19 already evokes a climate of fear in which everyone can
be seen as a potentially infectious body. Reminiscent of other epidemics, it
can turn people and countries against each other, intensify ideological
divides, deepen racial and class tensions, and reverse social, economic, and
political progress around the world. Still, we are witnessing extraordinary
acts of heroism in the COVID-19 pandemic, in particular doctors and nurses
struggling to save lives when a lack of simple protective gear endangers
their own. As in other crises, there is potential for unity as grassroots
volunteers, billionaire philanthropists, and nations are coming together to
provide services and goods.

Pandemics eventually end. Today, this may occur within globally interconnected
scientific and laboratory systems that share scientific knowledge. Nonetheless,
its implementation requires international norms and efforts, as is the case
with vaccination and therapeutic protocols. We have learned from the recent
past that success is rarely the result of a teleological march of scientific
progress, but rather depends on multiple institutional forces interacting.
“Success” may be fully containing pathogens (e.g., smallpox), transforming
them with therapeutics into far less deadly diseases (e.g., HIV), and
mitigating and monitoring seasonal or endemic threats to which we have no
cure (e.g., influenza). To find appropriate resolutions, we need an
interdisciplinary approach that focuses on innovative ways to address
collective human suffering and encourages inclusive participation to
identify and combat these formidable biosocial forces. This approach is not
secondary to pathology nor independent from epidemiology. When we
challenge established power relationships, redefine the hierarchical flow of
knowledge production, and bridge the gap between the biophysical and
cultural environments, we will affect some control over how epidemics
shape us and we shape them.

—Orange County, California, May 2020

 This is only an excerpt from ​The Sha e f E idemic a d Gl bal Di ea e​.

In e e ed in he e ?

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