Sick, Sad World

In the five years since the World Health Organization declared Covid-19 a global pandemic, the fact that humans react to pathogens politically has become impossible to ignore. The spiky orb of a SARS-CoV-2 particle does not care whom it infects—it wants only to reproduce inside a host. And yet in the United States, Covid-19 disproportionately sickened and killed indigenous, black, and Hispanic people. Poor communities bore the brunt of pandemic mortality, with people living in poorer counties almost twice as likely to die of Covid-19 as people living in more affluent counties. “The life cycle of the diseases [microbes] cause rests on the political order of things: the medical advancements that come with understanding the science of contagion, as well as the social dynamics that form our environment,” historian of science Edna Bonhomme writes in A History of the World in Six Plagues: How Contagion, Class, and Captivity Shapes Us. Put another way, contagions like Covid-19 spread in ways that both reflect and reproduce societal divisions that are born out of how we define who is deserving of health, autonomy, and care.

As a scholar of microbiology and public health and as the daughter of working-class Haitian immigrants who arrived in Miami shortly before Haitians were scapegoated as spreaders of HIV/AIDS, Bonhomme brings a deeply compassionate perspective to her study of epidemic disease. She roots her new book in the stories of individuals and communities who were subjected to captivity and constraint, from enslaved people on Southern plantations who were vulnerable to the spread of cholera amid successive pandemics in the mid-1800s, to women with HIV/AIDS in Bedford Hills Correctional Facility in New York in the 1980s. In looking closely at how we react to the threat of contagion—and whom we deem acceptable to confine—Bonhomme also illuminates how we might reorder our worlds in order to “challenge the conditions that condemn certain people to premature death.” As communities worldwide continue to grapple with the reverberations of the backlash to Covid-19 public health measures, the lessons offered in A History of the World in Six Plagues could not be more urgent.

Edna and I met while organizing together in the Freelance Solidarity Project, a division of the National Writers Union. We spoke via Zoom on the last day of February, with Edna freshly arrived in Miami from Berlin, where she has been living for the past several years. Our conversation has been edited for length and clarity.

—Kristen Martin

Kristen Martin: Your book’s title is A History of the World in Six Plagues. With a title like that, the book could have been a recitation of outbreaks and discoveries by scientists, but it’s very much not that. How did your project take shape?

Edna Bonhomme: The project began well before I wrote the book, insofar that I have always been thinking about science, the natural world, medicine, and disease. But in a professional sense, having studied microbiology in undergrad and public health as well, I often felt that my education focused so much on microorganisms and the power and agency they had—or even the “great men of science” who were a part of discovering certain microorganisms—rather than how society functioned, what it meant to feel ill, and also just how other social factors concerning disease may impact someone.

And fast forward to the Covid-19 pandemic and the lockdowns more specifically, I was reminded again how epidemics are something that people have lived with for centuries, and yet we encounter them fundamentally in different ways, depending on our social status, how much access to wealth we have, whether or not we feel safe, and ultimately what confinement means, and how we cope with that. And so the book was really very much a constellation of both professional and personal experiences that I’ve had, and wanting to find a more empathetic and philosophical approach to thinking about how disease impacts society.

KM: In each chapter, you begin with a disease outbreak, and you use that as this window into a larger meditation and exploration on specific instances of confinement as related to that outbreak, and how that affected how people got sick and dealt with their illnesses, while looking at the social and political context in which these outbreaks were occurring. How did you develop the framework and structure?

EB: This isn’t a strictly and straightforward historical book in the ways that people often read history of medicine or history of science books, and it doesn’t have the descriptive format that can, on the one hand, be quite riveting and exciting, especially for people who want to know exactly the number of people who died from a particular epidemic or outbreak, and/or the major actors involved. As a writer, I’m constantly trying to experiment and to make things exciting for people, or at least consider how various marginalized subjects, or maybe well-known subjects, can be looked at with a new set of eyes.

And so in terms of thinking about how I can be better as a writer, that was part of the inspiration for me to figure out how to organize the chapters so that it could at least set people in the specific time and spaces that I spoke of. So when I thought about, what would it mean for an epidemic to impact people on a plantation? I thought, okay, well, what does the plantation look like? How is it felt by people who are enslaved? What is the physical structure? What are the profit margins that certain enslavers were concerned about? And to what extent did people exchange information to either help or hinder the health of an enslaved person? I often started or thought about each chapter by centering on a person. And so the cholera chapter, I was mostly focusing on Harriet Jacobs. The second chapter on sleeping sickness, on Robert Koch. The third chapter [on influenza], mostly on Virginia Woolf. But I also try to think about other figures and peoples who are actively involved in or experiencing some of these epidemics, or even challenging them.

The other part that I thought was important is the afterlife of these epidemics. So each of the chapters, doesn’t just stop at like, okay, an outbreak occurred and x amount of people died. For example, with cholera on the plantations, after emancipation and during Reconstruction in the United States, we had a resurgence of medical schools at historically black colleges. And that impacts how people view health as something that should be universal and available to every human being. And so for a brief moment, if Reconstruction had come to live out in the way that I would have liked, maybe there would have been universal health care in the United States.

KM: You mentioned that in the sleeping sickness chapter, you start with Robert Koch. You’re exploring sleeping sickness in German colonies in East Africa in the early 1900s, what those outbreaks looked like, and how they were influenced by this German microbiologist Koch and how he carried out experiments on Africans, in these, as you call them, medical concentration camps. You make an interesting choice to wait until a little bit into the chapter to explain that he’s a key figure in the development of germ theory, and that he was the recipient of a Nobel Prize, and that he’s still celebrated in Germany, where he has an institute named after him. I wonder if you could talk about that choice that you made—the way that you’re framing his involvement in East Africa.

EB: I had seen on social media, among some progressive and decolonial German scholars and activists and students, the campaign to try to remove the name of Robert Koch from the highest public health institute in Germany. And part of that is linked to a very ongoing and public debate in the German context of how to decolonize certain spaces, how to deal with museum providence and repatriating objects, even the bones of formerly colonized people on the African continent. And knowing that Robert Koch was part of that was something that I thought was fascinating. My first introduction to Robert Koch was in high school when I learned about the Koch postulates—the four principles for us to understand the causal relationship between a microbe and a disease. And so Koch, for me, was one of the many figures and people that I had learned about in this matter-of-fact way for their contribution to biology, and getting this revised and more multidimensional person, by virtue of living in Germany and seeing what activists are writing about and the debates that were circulating, gave me the opportunity to take a little pause to think, Okay, well, let me learn about the place that I’m living in.

KM: One of the things that is a really resounding theme across the book is the complexities of quarantine and confinement. You write about how there are times when it’s important to have confinement to stop the spread of a contagion, but at the same time, we’re curbing people’s freedom when we do that. There’s very much nuance and complexity here. How did your ideas about captivity and confinement develop as you were doing the research and engaging with these narratives of people who have been confined, your own experience of confinement during Covid-19, and your experience as a black woman?

EB: Well before the writing of this book, I was actively thinking about quarantine as a historical category, specifically for my dissertation, which looked at plagues in North Africa and the Middle East during the eighteenth and nineteenth centuries. When I was doing dissertation work in Cairo, Tunis, and also France and the UK, the trade records that I read through very much were seeing quarantine as the easiest and most straightforward manner to confine disease. Lazarettos were developed in port cities such as Venice and Marseille to ensure that if goods were coming from the colonies and someone might have been sick with not just the bubonic plague, but perhaps even cholera, malaria, whatever, then there could be a space for that ship, or the people on that ship, to remain for a bit of time, so that the disease wouldn’t spread elsewhere. And at least in the historical context that I was looking at, often quarantine was written about in a straightforward manner, even if in practice, on the ground, it might have looked different. Perhaps people broke those rules, people swam up to shore—I can imagine very few people want to stick around with their shipmates for thirty to forty days after having spent some months with them, if not a year.

But coming back to the question of the contemporary context and confinement, especially as it relates to Covid, I would say that I often have very complicated opinions about it. On the one hand, at moments in which we didn’t know very much about the disease, and what we did know is that it was a highly contagious respiratory infectious disease, confinement—or at least social distancing—could be a way to minimize the spread. I do agree that the some of the social distancing measures could be effective up to a point, and I think that having a collective way of thinking about it seemed like a good approach. At the same time, the collective approach to that social distancing measure in itself wasn’t enough. If people needed to take time off from work for whatever reason, if they got sick—and not just from Covid, but from anything else—there should have been adequate compensation on the part of governments for people who lost wages, including musicians and artists, and extra pay for essential workers. Not just clapping for health workers as they’re going to their jobs, but actually paying them a living wage.

A lot of governments did a disservice to the various members of society by not allowing the space for there to be more aid, but beyond that, there should have been town halls, public discussions, so that people could better understand what an infectious disease is. I especially thought there could have been an opportunity to really get people going with more evidence-based approaches to thinking about science, contagion, and so forth, as opposed to what did happen is that it became an opening for skeptics who then seize upon it for some disingenuous reasons. You know, critiquing a certain form of lockdown measures as purely draconian without thinking actively about how we might work around some of these public health measures and the needs that people might have, and to also dispel pseudoscience and the sometimes legitimate fears that some people had.

KM: That makes me think about this moment in the book, in the chapter about the 2014 Ebola outbreak in West Africa, when you’re talking about how people in Liberia were really distrustful of public health and the government’s response, and how that was made worse by a militarized lockdown. And you raise the question of how to engage with a community that does not trust public health officials. That question feels really urgent here in the United States, as we’re at this moment where we’ve just had this public health and vaccine skeptic, Robert F. Kennedy Jr., installed as the head of the Department of Health and Human Services. What are some things that you feel public health officials need to do in order to gain the trust of the public?

EB: In the United States, there are plenty of legitimate reasons for everyday individuals not to trust the government when the government does so little for people. In the absence of a universal health care system that provides for people, it can be easy for certain individuals to feel like they can decide for themselves how to best deal with their health. Right now, there’s a measles outbreak happening in Texas, and part of that isn’t just the outbreak happening at this given moment, but a couple decades of people not opting into vaccinating their kids for measles and so forth. At this point, around twenty-six million people in the country still don’t have health care.

Trust for public health officials—or more specifically, I should say, public health officials with peer-reviewed scientific backing—cannot happen with the massive austerity that is happening in the United States, cannot happen if there’s not a universal health care system, cannot happen when the United States continues to increase its military budget. The contradictions that are alive and flourishing in America also then lead people down a black hole of misinformation. And of course, it isn’t the case that everyone who happens to also be suffering under neoliberalism in the United States and not having health care is necessarily a skeptic. In fact, sometimes some of the most well-off people are skeptics, as we see with the current secretary of Health and Human Services—he is well-off and comes from a legacy political family.

I wonder what would have happened if Medicare for all had become successful as a campaign? What would have happened if, in 2010 when the debates around revising the health care system for the Affordable Care Act had actually put universal health care on the table? Just because it’s not happening right now or hasn’t happened doesn’t mean it’s not something to strive for. And this is perhaps the moment, living through the aftermath of Covid—and it’s still ongoing, obviously—that politicians need to do better. The left needs to grow and have this as part of its platform, and it should also be integrated with health care unions, nurses’ unions, doctors’ unions, so that it’s not just a theoretical principle of universal health care.

KM: Definitely. There’s another thread in the book where you’re pointing out the limits of global public health as well. And that feels really also prescient right now because we’re at this point where the Trump administration has just completely decimated the United States Agency for International Development. Even yesterday, I was reading about how the State Department said it was cancelling more than 90 percent of foreign aid contracts, including for projects supporting public health measures for the current Ebola outbreak in Uganda, and the distribution of HIV treatments all over the world. I think it’s very easy to feel despair that the United States is backing out of this, but you also point out that there are a lot of limits to public health measures by NGOs funded by programs like USAID. What is truly needed in that regard?

EB: When I was a master’s student of public health at Columbia, I spent some time going to Haiti and a little bit in the Dominican Republic. Part of that was doing a practicum where I saw in real time, in the Haitian context mostly, how various NGOs were implanted into that country, allegedly to provide aid to Haitians, a lot of it having do with health. This was both before and in the aftermath of the 2010 earthquake. And being in Cap-Haitien before the earthquake, and then Port-au-Prince after the earthquake, in seeing the ineffectiveness of most of these NGOs in doing what they set out to do, and also just the ways in which some of these NGOs were built to ensure that they stayed in power, as opposed to thinking about more creatively like, what would it mean to build longer term programs that were run exclusively by Haitians, and provided the very robust primary and essential infrastructure so that NGOs wouldn’t be needed in the first place? It made me quite disillusioned about NGOs and foreign aid, even if some of that could be a lifeline for families.

I have not been in a situation in which I relied on a foreign power to provide me charity, so I know that that there’s some privilege for me to critique it as an outsider. But I know that people also want dignity in their lives, so that they don’t have to rely on a charity-based program. The solution would mean reimagining power dynamics and relationships and really giving people what they’re owed without it being tied to charity. People should have access to antiretroviral drugs no matter where they are, but it shouldn’t be at the whim of an international organization that is backed by the largest military power in the world.

KM: You write about your main argument in the book being about how “pandemics start small, grow large due to negligence, and leave behind rot that we generally don’t bother to clean up before the next pandemic arrives.” Obviously we have not done that in the United States in the aftermath of Covid-19. And in fact, we’re in this big backlash moment against even thinking about Covid-19. What would be one thing that you would hope that we as Americans do to address the rot?

EB: I haven’t lived in the United States for seven years now, and I’ve had a little taste of what social democratic reforms can at least do for a nation state and to people, even if it’s not perfect, and even if there’s other issues at hand. In the German context, the rise of the far right is alive and real, but at the same time, there’s paid parental leave for up to a year, no matter your citizenship status. And I say this because you know what needs to happen is that the people I came from, the working class, however you want to define it, need to organize in such a way that the very real economic and social pain that people experience should be articulated in a way that is actually addressed vis-à-vis economic, political reorganization. As opposed to what has been taken up by the right in America—cosmetic, social, cultural wars that will not actually ensure that you have secure and safe housing, will not ensure that you can pay the rent next month, or that your food is safe, and something that you could afford.

The working class in the United States, at times, has been effective at organizing itself, particularly during the Progressive Era and in the 1930s, during the Depression and even during the Reconstruction period, which Robin D.G. Kelley writes about. You had a flourishing of people who had been had experienced the worst form of confinement and liberated themselves, and then suddenly decided, okay, we have a right to free, universal education, or we have a right to housing, or at least land and space that we can call our own, and we need to form structures and systems to establish that. And so when people collectively organize in a way that’s about the very real issues that impact their daily lives, as opposed to picking a scapegoat to demonize, then that can be an effective way to at least start to initiate change.

But it can’t happen when someone like Trump or RFK Jr.—without evidence—is blaming trans kids, DEI, or a vaccine for your troubles. This is a distraction at best, but it’s also just quite harmful to the those who have been targeted.