Book Review: How Plagues Are Intertwined With Social Justice

Conor here: I think the question posed at the end is one a lot of people are working through, and none of the answers are reassuring.

By Ramin Skibba, an astrophysicist turned science writer and freelance journalist who is based in the Bay Area. He has written for WIRED, The Atlantic, Slate, Scientific American, and Nature, among other publications. Originally published at Undark.

It seemed unthinkable. What began as a few coronavirus cases in Wuhan, China, quickly spread throughout the country and to every corner of the world. Global society ground to a halt as governments sought to stem Covid-19’s relentless advance. All told, some 1.2 million Americans have died to date, life expectancy plummeted by nearly three years from 2019 to 2021, and student test scores dropped precipitously, while the global death toll grimly ramped up to more than 7 million people.

Today, as debates continue about the coronavirus’s origins, the efficacy of vaccines and lockdown measures, and glaring health care inadequacies, a few health and science writers have striven to place the pandemic in a broader historical context by assessing past pandemics or epidemics through a Covid-19 lens.

Among them is Edna Bonhomme, an American science historian and writer based in Berlin, whose new book, “A History of the World in Six Plagues: How Contagion, Class, and Captivity Shaped Us, from Cholera to COVID-19,” examines the threads connecting cholera, sleeping sickness, influenza, Ebola, HIV/AIDS, and Covid-19. It joins a number of other recent accounts providing historical perspectives on the Covid-19 era, including “Until Proven Safe,” by Geoff Manaugh and Nicola Twilley, and “The Wisdom of Plagues,” by Donald G. McNeil, Jr.

What sets Bonhomme’s book apart is her focus on class and racial inequalities, and her attention to the injustices of confinement. Throughout her incisive analyses, she deftly weaves in stories of affected people often neglected in other historical accounts, in an effort “toward understanding how disease management is influenced by how society defines humanity.”

Along the way, she also spots some silver linings, highlighting people who have responded to public health crises not with fear and isolation, but with solidarity and empathy.

In her view, while epidemic diseases do not necessarily create inequalities and injustices, they tend to spotlight and exacerbate them. She begins with early 19th-century outbreaks of cholera, which hit enslaved people in the American South particularly hard. Bonhomme shows that some authorities and medical professionals at the time viewed Black people as being biologically susceptible to disease, maternal mortality, and other ailments.

But, of course, cholera was connected to the conditions of slavery. She amasses plenty of evidence: Beyond the captivity itself and the everyday violence they were subjected to, enslaved people were cooped up in unsanitary cabins with little ventilation and contaminated water, were overworked and underfed, and had access to little or poor medical care.

In her discussions of subsequent plagues, she notes similar impacts on confined people living on plantations and in concentration camps, prisons, and enforced quarantines. For example, Bonhomme scrutinizes the conditions of East Africans living in German colonies in the early 1900s in present-day Tanzania and Uganda. Many Africans afflicted with sleeping sickness were placed, often against their will, in medical “Konzentrationslager” (concentration camps), where German physicians like Robert Koch studied them for research.

While documenting the suffering and surveillance of those Africans, she also makes a compelling case that concentration camps did not begin with the Nazis: “The practice and technology is older and far wider reaching than what I could ever have known,” she writes.

Koch and his colleagues did manage to make a number of medical advances, she notes. In the case of sleeping sickness, he eventually proved that it was transmitted by bites of tsetse flies, which are endemic to Central, Eastern, and Southern Africa. That crucial discovery, along with Louis Pasteur’s renowned work, led to the development of germ theory, the notion that pathogenic microorganisms cause diseases.

Even so, Bonhomme argues, Koch’s work came at the expense of Africans’ health: Though he worked within a scientific and medical research project, the top priority in those colonies was maintaining Germany’s imperial power. He was ultimately awarded with a Nobel Prize in 1905, even though he inhumanely experimented on Africans as “nonconsensual research subjects,” she writes.

That period, she maintains, fits into a longer pattern of pseudoscience and medical racism, extending from plantation medicine to colonial medicine to prison medicine. Pseudoscience in particular has a long history — everything from myths that “bad air” or an evil eye were the cause of maladies to the misinformation that Covid vaccines cause cancer. But racism in medicine has its own sordid past, in which wealthier, usually White, people receive better health services, while the poor and non-White are denied such access and are also subjected to experimental testing of unproven treatments.

In addition, Bonhomme shows how misinformation about diseases can have far-reaching consequences. In 2014, for example, some journalists and the Liberian government suggested that Ebola was spread by the consumption of bushmeat, such as from monkeys, leading to an official ban on the hunting and sale of wild meat. But she cites a virologist in Liberia who pointed out that Ebola was mainly transmitted through other infected humans, and she points to a study showing that bushmeat bans only exacerbated tensions and people’s distrust in outbreak responders. The sensationalist focus on the consumption of wild meat, which came with racial overtones, ended up creating a rupture between public health messaging and Liberians’ everyday experience, she argues.

Bonhomme chronicles case after case of racism and xenophobia in official approaches to plagues, treatments, and medical research, arguing that race science and medical racism persist into the 21st century, even if they aren’t promulgated as widely or openly as before. One minor, though revealing, example she cites is the Robert Koch Institute in Berlin, a public health agency she followed during the pandemic to track Covid’s spread and impact throughout Germany, but which also resisted calls for renaming as Germans reckon with the country’s colonial past.

But Bonhomme is careful not to view those afflicted by disease and coping with racial inequities over time as abstract victims. Instead, she tries to share their experiences through extensive interviews and archival documents. For example, she writes at length about the activists who co-founded the AIDS Committee for Education, or ACE, which in the 1980s and 1990s counseled and provided social services to incarcerated women living with HIV. “For the most part, ruthless systems such as a prison can and do degrade and deform people — yet collective acts that generate agency can provide sustained solidarity among prisoners.”

She also discusses Virginia Woolf and other authors who sought to endure their encounters with plagues and quarantines by writing about them, and examines relevant works by writers like Susan Sontag, James Baldwin, Audre Lorde, and Angela Davis.

In the end, after surveying the devastation wrought by Covid-19 and other plagues over the centuries, Bonhomme concludes that responses to infectious diseases will inevitably falter as long as so many people remain in captivity and lack health care, housing, and food — and when there is a general lack of public empathy and collective action.

“What does it mean that we have become immune to the deaths of the poor, the dispossessed, and the disenfranchised?” she asks toward the end. “This is the moral question that I am still working through.”