To Health and Back

To Health and Back is a podcast about how health and medicine decisions from the past inform our present.

Show Notes: The Politicization of HIV 07/16/2021

Transcript: The Politicization of HIV 07/01/2021

Transcript: The Politicization of HIV In this episode of “To Health and Back,” we’ll hear from Pat Thomas — a journalist and the author of “Big Shot: Passion, Politics, and the Struggle for an AIDS Vaccine” — to evaluate the politicization of the HIV epidemic and the ways in which the COVID-19 pandemic has been similarly politicized. Check out the show notes 0:13, Madeline Laguaite: Hello, and welcome to “To Health and Back,” a podcast about how health, medicine, and wellness decisions from the past help inform us today. I’m your host, Madeline Laguaite. Laguaite: In this episode, I’m sitting down with journalist Patricia Thomas to talk about her experience reporting on the AIDS crisis, and how HIV and AIDS was politicized similarly to the way in which COVID was politicized. Laguaite: Before we dive in, I wanted to explain the difference between AIDS and HIV because I’ve often seen them used interchangeably. HIV is a virus that attacks the cells in your body that help you fight off infection. That means you’re much more vulnerable to other diseases and infections. If HIV isn’t treated, it can lead to the disease AIDS. HIV is spread by contact with certain bodily fluids of an infected individual. So most commonly, that’s going to be during unprotected sex or through sharing needles. Once you have HIV, your body can’t get rid of it, and there’s not an effective cure. Once you’re infected with HIV, you have it for life. Laguaite: Today, however, we have HIV medicine, called antiretroviral therapy, or ART that lets people living with HIV live long, healthy lives. It also prevents the spread of HIV to their partners. People can also use other effective methods like PREP — which stands for pre-exposure prophylaxis — to prevent themselves from getting HIV through drug use or sex. Laguaite: Scientists think HIV was in the U.S. as early as 1960. But doctors first noticed something was wrong in the early ’80s when they noticed clusters of pneumocystis pneumonia and a rare cancer called Kaposi’s sarcoma in gay men living in San Francisco, Los Angeles, and New York City. The resulting AIDS epidemic was very politicized for a few reasons. Laguaite: People were very, very uncomfortable learning about how HIV is spread, and that was certainly a catalyst for the disease to be politicized. The AIDS epidemic is also fueled by inequality because the disease exposes and intensifies both economic and social injustices. In fact, even though AIDS was first identified in 1981, then-President Ronald Reagan didn’t even mention it publicly until years later in 1985. By that time, around 16,000 people had died. Here’s a clip I found from Sept. 17, 1985, when Reagan was asked if he’d support a massive government research program against AIDS, similar to the one that Nixon launched against cancer. 2:55, Ronald Reagan: I have been supporting it for more than 4 years now. It’s been one of the top priorities with us and over the last 4 years and including what we have in a budget for ’86, it will amount to over a half a billion dollars that we have provided for research on AIDS, in addition to what I’m sure other medical groups are doing. And we are $100 billion or $100 million in the budget this year. It’ll be $126 million next year. So this is a top priority with us. Yes, there’s no question about the seriousness of this and the need to find an answer. 3:33, Laguaite: Even before Reagan addressed it, AIDS wasn’t taken seriously. In 2015, Scott Calonico created a short documentary called “When AIDS Was Funny,” and it included audio of press conferences that show Reagan’s deputy press secretary, Larry Speakes, and journalists cracking jokes about the AIDS epidemic. The journalist interviewing Speakes is Lester Kinsolving. The full audio is available on Calonico’s website but I’ve included a clip of it here. 4:01, Lester Kinsolving: Does the President have any reaction to the announcement by the Center for Disease Control in Atlanta that A-I-D-S is now an epidemic in over 600 cases? Larry Speakes: A-I-D-S? I haven’t got anything on it. 4:13, Kinsolving: Over a third of them have died. It’s known as “gay plague.” [Press pool laughter] Kinsolving: No, it is. It’s a pretty serious thing. And 1 in every 3 people that get this have died, and I wonder if the President is aware of this? 4:23, Speakes: I don’t have it. Are you? Do you? Kinsolving: You don’t have it. Well, I’m relieved to hear that, Larry. Speakes: Do you? Kinsolving: No, I don’t. Speakes: You didn’t answer my question. How do you know? Kinsolving: Does the President... in other words, the White House looks on this as a great joke? Speakes: No, I don’t know a thing about it, Lester. Kinsolving: Does the President— does anybody in the White House know about this epidemic, Larry? Speakes: I don’t think so. I don’t think there’s been any— Kinsolving: Nobody knows? Speakes: There’s been no personal experience here, Lester. Kinsolving: No, I mean, I thought you were keeping— 4:50, Speakes: Doctor— I checked thoroughly with Dr. Ruge this morning and he’s had no— [Press pool laughter] [Speakes laughing] Speakes: —No patients suffering from A-I-D-S or whatever it is. Kinsolving: The President doesn’t have gay plague? Is that what you’re saying? Or what? Speakes: Nope, didn’t say that. Kinsolving: Didn’t say that? Speakes: I thought I heard you in the State Department over there. Why didn’t you stay over there? [Press pool laughter] Kinsolving: Because I love you, Larry! Speakes: Oh, I see. Well, I don’t... let’s don't put it in those terms, Lester. [Press pool laughter] Kinsolving: Oh, I retract that! Speakes: I hope so. 5:05, Laguaite: Another journalist refers to it as a “fairy tale,” referencing a derogatory term for gay people that was common in the 20th century. Journalist: A leading environmentalist has described the President's speech on Saturday as a fairy tale. Is there any reaction to that? 5:21, Speakes: Not true. [Press pool laughter] Speakes: Fairy tales are not true and this one’s true. Lester’s ears perked up when you said fairies. [Press pool laughter] Speakes: He has an abiding interest in that. 5:38, Laguaite: All that being said, I have Pat here with me now to talk more about the crisis. Hi, Pat, and welcome to the show. Pat Thomas: Hello! Laguaite: How are you? Thomas: Good. How about you Madeline? Laguaite: Pretty good, pretty good. Thomas: My name is Patricia Thomas. Most people call me Pat. I’m a professor emerita and the former Knight Chair in Health and Medical Journalism at the University of Georgia. But before that, before the past 15 years of my life, I was a working journalist. I wrote for many publications for physicians and scientists. And I also was the editor of a large consumer health newsletter, the Harvard Health Letter, based at the Harvard Medical School in Boston, but I spent my wild youth in the San Francisco area, which is how I got interested in the AIDS epidemic in its very earliest days, because I knew people who were in the medical arena and I knew people in the gay community there. So my radar picked this up pretty early, even though I was living in Atlanta during the early ’80s. And so I have a lot of experience in this arena. 6:43, Laguaite: Although scientists believe HIV existed prior to the ’80s, Pat said she remembers the exact moment she really became aware of AIDS. 6:52, Thomas: I became aware of AIDS in San Francisco in 1981, while having dinner with a friend who I knew from Stanford. I went to graduate school at Stanford. He went to medical school there. He was a resident in hematology and oncology at San Francisco General and UC San Francisco, and he was horrified to see Kaposi’s sarcoma, a rare cancer which typically is seen in elderly Jewish men and men of Mediterranean descent. But in this instance, these cancers, these horrible disfiguring blotches, which then, you know, kill you in the long run, he was seeing these cases in young men who looked just like him: white, affluent, gay, urban, San Francisco-ites, and they had this cancer. Thomas: So when he told me about that, which was right about the same time the first publication came out in CDC’s weekly morbidity and mortality weekly report. That report was of pneumocystis pneumonia among a small coterie of gay men in L.A. So here’s my friend in San Francisco saying weird cancer among young white gay men, and meanwhile, in L.A., weird pneumonia, and guess what? They’re all dying. In 1983, I wrote my first stories about AIDS. 8:14, Laguaite: Pat continued reporting on the crisis. Although she lived in Atlanta during the time, she wrote for several New York-based publications and described the experience. 8:25, Thomas: I wrote one story about that — about medical care in San Francisco. I wrote another story about a nonprofit organization called the Shaunti Project, which was sort of a— now, we would call it a community mutual aid society. But it was basically a community of people — gay people and church people — who realized that men dying fast of this disease had lost their jobs, were too weak to go to the grocery store, nobody’s walking their dog, and so people banded together to help them and that was the Shaunti Project. Thomas: And so I went to a rally on Castro Street, which is the big gay shopping district in San Francisco — gay male shopping district and bars — and there was this huge street rally to celebrate the 49ers. I don’t know whether they had just won a playoff game or I don’t recall, but at any rate, some football party in the street and it was just huge and exuberant, and Castro was packed wall-to-wall with people dancing and drinking takeaway cups. And I had just interviewed an epidemiologist that day. And he said to me, that his studies — Andrew Moss was his name, he’s published many, many times — he said, “You know, in this gay male community in San Francisco, within a year, 1 in 3 of these men could be dead.” And I stood on this crowded, exuberant party street, and I thought, “Oh my god. One out of every three people could be missing from this party if the 49ers have another good year because they will be dead?” And as a medical reporter, I’ve never felt viscerally a statistic just dropped down on me like, “Whoa, look at this.” So I wrote about that, too. 10:10, Laguaite: More than a year ago, scientists began Phase 1 trials of an experimental vaccine for COVID-19. Years before that, Pat did something similar. Laguaite: I read that you were among the first of healthy volunteers to be injected with an experimental DNA vaccine for AIDS. Can you— Thomas: That’s right. Laguaite: OK, can you tell me a little bit about that? And what made you decide to do that? 10:35, Thomas: Yeah. Once I started doing the reporting for what would become my book, “Big Shot,” I had to write a book proposal. And in order to write that book proposal, I had to talk to a lot of people and do a lot of background research so I would know what book I was trying to write. And my first I don’t know, 50 interviews, or so, what really kept emerging to me is, as we would say, in chemistry, the rate-limiting step — the place where there’s a bottleneck and progress bogs down — is clinical trials. Thomas: So scientists had a lot of ideas about how to make a preventive vaccine that would protect healthy people against AIDS and work in the laboratory and in animal models is — it’s not cheap by any means — but it’s not as expensive as mounting an ethical, scientifically-credible, clinical trial, because you have live humans, and you have to recruit them and test them and qualify them and bring them in places and do things to them. So that’s very expensive. And the government had really backed away — backed away — from spending money on clinical testing of HIV vaccines in 1994, for a variety of reasons, which were political. Thomas: And so once I realized that clinical trials were probably the bottleneck, one of my sources said to me, “Well, if you want to help, you can do what anybody can do, which is volunteer for a clinical trial.” And I was like, “Oh, I guess I could.” So what they wanted were healthy individuals at very low risk for contracting HIV. And then we were, I was one of the first two dozen people to take what they call a DNA or naked DNA vaccine, which is synthesized in a lab contains a portion of the DNA, or the RNA for a vaccine for the HIV virus, and it induces a cellular immune response to that. So you know, it didn’t seem like much of a risk to me. Thomas: It was an enormous pain in the butt and it taught me why affluent white people are overrepresented in NIH clinical trials, which are done in Bethesda, because for the per diem rate and the travel allowance they give you, if you didn’t have some of your own money, you could never afford to go back and forth to Bethesda to participate in these trials. Plus, you had to put a lot of trust in these people that whatever they were injecting in your arm wasn’t going to kill you and of course, people of color lack that trust. But people of color who are low income could not have afforded to go back and forth to Bethesda 17 times. I mean, I went 17 times in one year because of the study. Now, I didn’t have a lot of money. I would quit my job and was reporting a book, but I was very motivated. And I had enough money that if I lost $30 on every trip to Bethesda, it was not going to make me noticeably deeper in credit card debt than I already was. So I just went ahead and did it. Thomas: And of course, it was a disappointment that this product — this candidate vaccine — did not prove protective. That was very disappointing. I— who wouldn’t love to be in the clinical trial that works? We’re reading stories now about people who volunteered for the clinical trials of the Pfizer, Moderna vaccines or the J&J vaccines, and they’re happy to have made a contribution, you know, to this enormous scientific step forward. 13:53, Laguaite: Like Pat mentioned, she wrote a book called “Big Shot: Passion, Politics and the Struggle for an AIDS Vaccine,” and she spoke to the process of it. 14:03, Thomas: Yes, I was the editor of the Harvard Health Letter, and one of my responsibilities was polling the 24 Harvard Medical School faculty members who were my board members to make out kind of a questionnaire, a survey, but surveying them about what they thought were the 10 most important advances in medicine, scientific advances in medicine in the past year, and then I’d write this, you know, wrap-up story that would run in January, and you know, was a look back. And so I was writing the one that was January of 1997, or probably December of ’96, and I was writing to look back on top 10 medical advances in 1996. Well, that was the year that highly active antiretroviral therapy or HAART became available, and it was utterly game-changing for people who were infected with HIV. It made HIV not a death sentence. And at that time, people had been dying. You’d learn you had AIDS. You’d go home and you tell your parents, “I’m gay, I’m dying. I have AIDS, and you’re probably dead in 14 months.” I mean, I think that was the average time from diagnosis to death. Thomas: So here I’m writing a story about this revolutionary, new treatment so effective, and I’m thinking, “We have this treatment that’s so good. Why don’t we have a vaccine that can prevent this terrible disease in the first place, instead of trying to do something about it later, when people have one foot in the grave practically?” So that idea came to me in the shower. And it’s always you scratching your head. You get these inspirations and I said, “You know, if I don’t know why there is no HIV vaccine, and I’m the editor of the Harvard Health Letter, then chances are that most people who are less privileged in terms of their access to information — most people probably have no idea why there is no HIV vaccine.” Thomas: So I set out to answer that question. And I found, of course, that there were barriers, enormous scientific barriers. It’s hard to make a vaccine, to keep HIV from getting into ourselves, and leading to AIDS. Money. Vaccines are not as profitable as treatments and never will be a shot that you get once a year or once every 2 years, never going to make the money have a pill you take every day. So pharmaceutical companies are not going to do it without a big infusion of money. And I think that’s exactly what we saw with Operation Warp Speed. What will go down in history as President Trump’s positive contribution to the history of medicine will be the enormous amounts of money put into vaccines because that’s what it takes. It takes a lot of money. And then politically. 16:38, Laguaite: Just as COVID was heavily politicized. HIV was as well. At the beginning of the episode, we heard examples of the politicized nature of the AIDS epidemic. But Pat elaborated even further on that. 16:51, Thomas: Because AIDS was — the first communities that it penetrated were gay people, people of color, people engaged in sex work, and really poverty. That’s a big thing, because it got into those communities. First, they were marginalized. They didn’t have the political pull of other communities when the disease hit, and they were easy to other you know, the gay man who still today make up the largest percentage about three-quarters of all newly diagnosed cases of HIV in the late ’60s in San Francisco. Thomas: These were boys who came to San Francisco having been disowned by their families, beaten up at school, shunned. They were the lepers of their world, and sometimes killed because they were gay. So when they flocked to San Francisco, and the post-Stonewall gay liberation movements began in 1968, being free to express their sexuality was their most important political issue. It’s a little bit like people today who think that their guns are their only issue. Gay men thought that their sexuality was their only issue. And it was so important to them after the lives that they had led in the communities where most of them came from. So the casual sex, the bars on Castro — this was the definition of living life to its fullest. Thomas: And so, you know, when you have a president, a Republican president, like Ronald Reagan, and you have federal legislators, members of Congress, Senators, they found it so easy to demonize these libertarians. And you know, most men are really queasy about the idea of gay male sex. They want to watch lesbians, but they don’t want to hear anything about gay men. And so it’s very easy to other these men and demonize them and say, “This is not where public money should go.” So when I began to work on my book, I quickly identified these sets of barriers. And I thought, “Well, I’ll just find me some people who are trying to change this.” People who believe that yes, treatments are important, but what we really need is something to keep the world, the uninfected world, safe, because you’ve studied the history of medicine, the only thing that’s ever defeated an infectious disease is a vaccine, and the only public health intervention more important than the smallpox vaccine and the polio vaccine are flush toilets. I mean, those are, those are your major public health interventions. So you know, I thought a vaccine was important, and so did the researchers I wrote about and in my book, what I did is I tracked from the early ’80s through 2000, the history of people I told the stories, the narrative stories of people who made finding a preventive vaccine their whole life. And there were a lot of these people and they worked for companies and they work for... /episode/index/show/tohealthandback/id/19677332

The Politicization of HIV 07/01/2021

Show Notes: Vaccine Hesitancy and Skepticism 06/08/2021

Transcript: Vaccine Hesitancy and Skepticism 06/08/2021

Transcript: Vaccine Hesitancy and Skepticism In this episode of ”To Health and Back,” we’ll hear from Dr. René F. Najera — an epidemiologist and editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia — to see explore the history of vaccines and vaccine skepticism, and how that same skepticism exists today. Check out the show notes . NOTE TO LISTENERS: This conversation was recorded before the U.S. resumed Johnson & Johnson vaccinations. 0:13, Madeline Laguaite: Hello, and welcome to “To Health and Back,” a podcast about how health, medicine, and wellness decisions from the past help inform us today. I’m your host, Madeline Laguaite. Laguaite: In this episode, I’m sitting down with Dr. Najera to talk about the history of vaccine skepticism and how those past instances reflect what we’re seeing today with the COVID-19 vaccines. 0:36, René F. Najera: You know, there was vaccine skepticism before there were vaccines and that’s something that always kind of befuddled people like, “What do you...? What do you mean?” 0:44, Laguaite: Vaccines skepticism today comes in light of the COVID-19 pandemic. On December 11, 2020, the U.S. Food and Drug Administration issued the first emergency use authorization for a vaccine for the prevention of COVID-19 and people 16 years and older, which allowed the Pfizer-BioNTech vaccine to be distributed in the U.S. Later, the Moderna and Johnson & Johnson vaccines were approved as well. Laguaite: However, on April 13, 2021, the Centers for Disease Control and Prevention (CDC) and the FDA recommended a pause in the use of Johnson & Johnson vaccine. Of the almost 7 million doses administered so far in the U.S., a small number of reports of a rare and serious type of blood clot had been reported and people after receiving it. All reports happened among women from the ages of 18-48, and symptoms occurred 6-13 days after vaccination. Dr. Richard Besser, who was the acting CDC director in 2009, spoke about the implications of the Johnson pause on C-SPAN on April 18, 2021. 1:53, Richard Besser on C-SPAN: First, I do think taking a pause was the right response. We have a number of systems to report what are called vaccine adverse events. And then they’re investigated to see is this something that was just occurring in a timeframe related to vaccination, like someone that had a heart attack and they had a vaccine last week, but it wasn’t caused by the vaccine? Or is it something that the vaccine actually could have caused? And so, in these systems of reporting, they detected six cases of a very rare type of blood clot in women who were all younger than 50 within 2 weeks of having received the J & J vaccine. 2:36, Laguaite: Although the Johnson & Johnson vaccine use resumed on April 23 at the recommendation of both the CDC and the FDA, public health experts were worried and still worry about how that pause could impact vaccine hesitancy and skepticism in the U.S. Still, vaccine hesitancy isn’t new. Here with me to talk more about vaccines and the history behind them is Dr. Najera. Hi, Dr. Najera, and welcome to the show. Najera: Hi, how are you? Laguaite: Hi, I’m good. How are you? Najera: I’m doing well. Laguaite: Could you state your name and sort of tell the audience who you are? 3:11, Najera: Yeah, so my name is René Najera. I am an epidemiologist, Dr. Public Health. I’m a senior epidemiologist at a local health department that shall go unnamed. But my reason for being here is that I’m the editor/project director of the History of Vaccines project by the College of Physicians of Philadelphia. 3:30, Laguaite: Although public mistrust of vaccines is currently an issue, it’s been a problem in the world of public health for some time now. We could look to the case series published in The Lancet in 1998, by Andrew Wakefield and 12 of his colleagues that suggested the measles, mumps, and rubella — the MMR vaccine — could cause autism in children. Laguaite: Like I mentioned, vaccine skepticism begins way before that study. And like Dr. Najera said earlier, vaccine skepticism precedes vaccines themselves. He pointed to waves of smallpox in the 18th century and gave me an idea of what it was like. 4:05, Najera: So, back in the early 1700s — smallpox a disease that was terrible, horrible, horrible disease, 30% death rate. If you survive that, you were scarred. A lot of people would actually commit suicide from the scarring because they just couldn’t bear looking at themselves. And almost everybody got it, you know? It would go around in waves, not pandemics, which is like, it happens worldwide at the same time, right? It would go around in waves every 15-20 years. So every generation, you build up enough people who are susceptible, and then boom, it would hit you. Everybody who knew something about medicine had to find a way to stop it. And at the time, we scientists didn’t know what a virus was. There was no such thing as a microscope. There were hints that there was something infectious going on. There were hints that your body that’s something to protect you after infection because once you got it, you know, you were immune afterward. So there were these little hints here and there. 4:58, Laguaite: But inoculation techniques didn’t originate in Europe. Researchers and historians say that the two most likely origins were either China or India, and Dr. Najera spoke about the former. 5:10, Najera: But if you go back 1,000 years, the Chinese would... they realized that if you took some of the scabs from the smallpox and you dried it out in the sun, and then you ground it up into dust, and if you inhale that you got some sort of immunity from it, again, probably a lot of trial and error, probably a lot of observational studies, nothing really scientific. And so they did it. And it worked. And it was called variation or inoculation. And this practice then leaves China through the Silk Road, heads to West India, they pick it up. Middle East, they pick it up. North Africa, they pick it up, but it doesn’t make any inroads into Europe; It just kind of, you know, “It’s one of those things, those people over there do. They’re kind of weird. You know, they’re not like us, sophisticated Western people.” 5:57, Najera: This practice didn’t make it to America until much later, in the early 1700s. This enslaved man is picked up in Africa and taken into Boston and he is sold to a congregation at a church and the congregation gives him as a gift to their Reverend Cotton Mather. Cotton Mather was involved in the Salem witch trials. But he basically notices that the slave, Onesimus, is immune to smallpox; he doesn’t have any scarring. He’s fairly older. And he says, “What is protecting you and why do you have this scar? And what is that?” And he said, “Well, they gave us smallpox without actually giving it to us.” And Cotton Mather got kind of curious and says, “Tell me more.” And so Onesimus describes a procedure where they would take somebody with smallpox and take a little lancet and lance the pox and get the tissue or the fluid and then put it in their arms. And they were sold at a higher price because they were now immune from smallpox, and that would make them profitable. Najera: And so Cotton Mather goes to a friend who’s a physician last name of Boylston, and says, “Hey, is there anything to this?” And so most write some letters to some friends and colleagues in Europe, and they say, “There’s this woman who is married to the British ambassador, her name is Lady Mary Montague.” And they traveled to Turkey — a British ambassador to Turkey went there. And it wasn’t called Turkey. At the time, it was the Ottoman Empire. And she had written back saying that there’s this practice of doing that in the Ottoman Empire, and people are immune. And there’s this whole process to it. It’s very controlled, you know, you don’t want to get too much of the smallpox; you want to get just enough to give immunity. You want to do it under the supervision of somebody who knows what they’re doing. And they didn’t know this at the time ... a major variola and a minor variola, and they said, “You don’t want to get the bad one, major. You want to get the minor and give that to people.” It wasn’t that minor. It was like 5% death rate. So she writes letters to her friends and colleagues again, and my colleagues, I mean, people in the higher echelons of society in Britain, say, “Look, I just had my child inoculated. And he had a fever for a little bit, but he got over it, and he didn’t develop smallpox. You guys should look into this.” Najera: But her letters, Boylston’s letters, other people’s letters start traveling the world and there’s confirmation that it works. So then a ship arrives in Boston in the early 1700s, 1710s or so. And the sailors have smallpox and it had been a while since the last smallpox outbreak. So here we are. We are beginning with smallpox outbreak, and Cotton Mathers immediately tells Boylston, “Hey, this inoculation thing — Let’s try it. It’s worth doing. Let’s just go for it.” So they inoculate themselves. They inoculate their families. They inoculate of the slaves working for them. And it seems to work. If you look at the death rates of people who got smallpox the natural way, it was about 10 times worse than the people who were inoculated, because you then inoculate everybody on time, some of them were already infected. 8:50, Laguaite: But just like today, not everyone was a fan of the inoculation idea. 8:56, Najera: So Boylston and Mathers say that to the townspeople, “Hey, let’s do inoculation.” And people lose their minds. They firebombed Cotton Mather’s house. They wrote very dissenting opinions in the press. Cartoons were made. They were saying, “No. 1, why would you put the filth in us? No. 2, what are you doing listening to a slave? What does he know? No. 3, what are you doing listening to the Ottomans? What do they know?” It snowballs from there. And this is kind of the same reaction that you get in other places. You know, they just have this adverse reaction to inoculation. Najera: Later on, in the Revolutionary War, Washington is defeated at a battle up in New York State or what would be New York State and he realizes that it’s because his troops are sick with smallpox, that the British had smallpox and a lot of them already are in that immunized. Now they’re immune from get having smallpox, they are the ones that survived. Right? And so he hears about inoculation, and he forcefully inoculates his troops. Like he actually had people held down and given the inoculation against their will, because he said, “Look, we’re not going to lose the war because you get smallpox.” And you have several instances of this. Benjamin Franklin writes the opening to a pamphlet talking about the benefits of inoculation. Like in “Hamilton,” “To every action, there’s an equal opposite reaction” and people rebel against it. They’re like, “No. 1, the government is not going to tell me what to do with my body. No. 2, yeah. You don’t know what you’re doing.” This is all before the first vaccine. 10:21, Laguaite: But the first true anti-vaccine sentiment evolved around the early 19th century with the first vaccine. 10:28, Najera: The first vaccine happens in 1796, which is a smallpox vaccine that is taking cowpox and doing the same thing that you did with smallpox; you just did it with cowpox. Cowpox doesn’t cause severe diseases that causes the scarring, doesn’t cause death. You kind of feel icky for a while, but you get over it. And then you’re immune against not just smallpox, but others as we found since and other smaller poxviruses. That is the first time that there’s this anti-vaxxer sentiment growing. So by the time the first vaccine comes around, it’s already the groundwork is already laid out. They already have their talking points. They already have their celebrity figures who are opposed to this. President John Adams was, you know, he heard about the smallpox vaccine. And he was like, “I know.” Thomas Jefferson, he heard about it. He was like, “Oh, that’s interesting. Let’s look into it.” And he kind of helped promote it. So the groundwork was already there by the time the first vaccine comes around. Najera: First vaccine comes around and you see the cartoons, “Oh, this cowpox vaccination is going to turn you into a cow.” If that sounds familiar, you know, to the COVID vaccines, “The mRNA vaccine is gonna alter your DNA, make you into something nonhuman,” you know? “They’re taking the cells from the cow and putting into you.” Now we hear, “They’re taking fetal cells and putting them into you.” Moral grounds and religious grounds. “If God wanted you to die from this, and you’re just gonna die from it, sorry.” And now you hear religious figures saying the same thing: “No, no, don’t get tested. Don’t get vaccinated. If God wants you to suffer, then you’re going to suffer, OK?” You know, those kinds of things. Unfortunately, now you have mass media, social media, you have people who have huge followings on the internet that they say something and a lot of people listen to them. And we found in our research in public health that people listen to people who are like them. And so all you need is a critical mass of people listening to you as an influencer. And that critical mass will influence a ton of more people just spreads. And so it’s the same thing with pro-vaccine, we try to reach the critical mass of people who will tell their peers the benefits of vaccination and, and get that going. And it’s kind of the reason why vaccination programs for kids are so successful, you still have vaccination for school requirements up in the ‘90s. Because for the most part, you don’t you know, you hear about things that happened, but you don’t see them. You don’t see... they say that children turn autistic. “Well, no, they were always autistic.” They just kind of figured it out later on. Najera: You don’t see the deaths that anti-vaccine people say that exist. You don’t see those kind of things. And so that’s why it’s been it’s been so successful. The only problem is that there’s things like measles, that if you drop down below 95-96%, you start messing with herd immunity, and outbreaks come back. But the history of the anti-vaccine movement has been around longer than vaccines, and it’s kind of it’s kind of annoying that it hasn’t died out, and they just keep recycling the same thing over and over again. You know, in the mid-1800s, the British Empire said, “OK, everybody get vaccinated against smallpox,” and they actually call themselves the National Anti-Vaccine League because they couldn’t sound like a villain more than that. And then they spread their tentacles throughout the whole world, sending letters everywhere, and then there was one created in the U.S. that would actually fundraise off of the fear of vaccines. Using the talking points of “the government can’t tell you what to put into your body,” “you’re healthy enough as it is,” “just live a healthy life and you won’t get sick.” Najera: And then the moral grounds. If it was meant to be, it was meant to be and things like that. And so they came about and they start suffering some blows in the 1900s because science has advanced now we have microscopes. Now, we know what things are. There’s more respect towards scientists. It was a golden era of science. People like Pasteur who found the vaccine for rabies were hailed as a hero. There was a doctor, Haffkine, who found the vaccine for cholera and for the plague in India — probably averted millions of deaths from those in India. They’re held as heroes and there’s more of that happening. 14:21, Laguaite: Mandatory COVID vaccinations are a hot topic as various colleges like Yale and Columbia just to name a few plan on requiring COVID vaccinations come fall. Government intervention in the context of vaccinations and public health is especially relevant today. But it’s historically relevant as well. 14:38, Najera: And then the Supreme Court steps in. There was a man by the name of Jacobson in Massachusetts who didn’t want to pay a fine of he wasn’t vaccinated. He said that he had some really bad vaccine reactions when he was a kid and he wasn’t going to get the vaccine and neither were anybody that he would look after. And the state said, “That’s fine, but you pay a $5 fine,” which in today’s dollars is close to $100, $50? And he said, “No, I’m not.” And he took it all the way to the Supreme Court. Supreme Court said, “Actually, yeah, the state cannot forcefully vaccinate you, but they can fine you because they have that power.” Under the 10th amendment is the police powers of the states. And that echoes in us with us today, 100 years later, because the interventions for COVID that you see — whether to wear a mask or not, whether to social distance or not — is very locally controlled or state-controlled because of that decision. Because the Supreme Court then said, “Yes, it’s not up to the federal government. It’s up to the state and local governments to enforce public health laws.” And it came from this anti-vaxx sentiment of “No, I’m not. I’m not getting it.” And it happens today. Najera: Later on, another court decision is Zucht v. King. They sued the school system saying, “No, you cannot require me to be vaccinated for school” and again, the Supreme Court said,”Yes, yes, they can. Your right to be free of vaccination does not preclude the right of the entire population to be free from disease. They cannot force you to get vaccinated, but they can fine you or they can prevent you access to public spaces.” And you see that now, right? “You can’t make me wear a mask.” Well, no, but we won’t let you into the store, or we won’t let you into public buildings and stuff like that. That’s the thing about history. That’s the thing I’ve learned in managing the history of vaccines and running the project as it keeps repeating itself over and over and over and over again. So whenever somebody brings to me something “new,” quote, unquote, that the anti-vaxxers have done, I’ve been like, “No, there’s nothing new under the sun when it comes to them.” I’m not surprised anymore by the things that they say. I’m disappointed. 16:30, Laguaite: Although Black, Latino, and indigenous people, along with other people of color, are overrepresented in serious COVID-19 cases, vaccine hesitancy among these communities can complicate the decision to be vaccinated. And Dr. Najera spoke to the skepticism. 16:47, Najera: So you’re talking about 300+ years of terrible abuses to people whose origins come out of Africa. And that community alone — which is not a community, it’s many communities — is just time after time, the abuses you read about these and you become more as I say, “woke.” But you become more aware of all of that has happened and you’re like “Well, no wonder they’re going to be skeptical of the vaccines given by the government. It’s the same government that enslaved their ancestors.” And in some cases, you still have some people who are alive whose grandparents were enslaved. Najera: You have the Tuskegee experiment in which you know that there’s a misconception in the African-American community that people were given syphilis. That’s not what happened. What happened is that people who had syphilis were told not to seek care. They were told that they were already getting care when they were not. And this is in an era of an era of antibiotics already. So they... /episode/index/show/tohealthandback/id/19406000

Vaccine Hesitancy and Skepticism 06/07/2021

Transcript: In Conversation with Rachel Priest 05/03/2021

Transcript: In Conversation with Rachel Priest In this episode of “To Health and Back,” we’ll hear from Rachel Priest, the content editor at The Bitter Southerner, to hear about her personal experiences with xenophobia as a transracial adoptee. Check out the show notes . NOTE TO LISTENERS: This conversation was recorded 2 days before the Atlanta spa shootings on March 16, 2021. 0:13, Madeline Laguaite: Hello, and welcome to “To Health and Back,” a podcast about how health, medicine, and wellness decisions from the past help inform us today. I’m your host, Madeline Laguaite. 0:23, Laguaite: And in this bonus episode, I’m sitting down with my best friend and former college roommate of 4 years, Rachel Priest, to talk about xenophobia and some of her personal experiences this past year and during the novel coronavirus pandemic. Laguaite: The COVD-19 pandemic has fueled xenophobia, specifically anti-Asian sentiment across the globe, and Rachel has experienced that firsthand. So Rachel, welcome to the show. Do you want to introduce yourself and tell us who you are? 0:53, Rachel Priest: Yeah! Hey, Mads, thank you so much for having me on your podcast. Yeah, I’m Rachel and the content editor at The Bitter Southerner, which is this incredible publication where we basically just tell stories of the South, you know, both the good — there’s a lot to celebrate of the South, obviously — And also, you know, we aren’t afraid to talk about the bad as well. So I’m really loving that. And I’ve been there for about 7 months now. So it’s been really great. And I am excited to be here with my best friend and roommate. We’ve had, you know, similar... I feel like, you know, we’re sitting down and talking about this for the podcast, but we’ve also had conversations throughout the past year about these things, as they have happened, and you know, even before this, too, so. 1:34, Laguaite: Yeah, I think it I think it kind of says a lot, just the fact that we’ve had this exact conversation so many times, especially just the past year. 1:44, Priest: I know. I mean, it’s crazy to think that recently it’s been the 1-year anniversary since America has shut down and since it was declared a pandemic, but I feel like even a year ago, we were, again, like having similar conversations. And yeah, it’s crazy how much time has passed, but how little has changed in regards to xenophobia. And actually, it seems like it’s gotten worse in some ways, and I don’t know if that’s because of more national media attention, but yeah. So I’m so glad that we’re able to talk about this and bring some light to it because I feel like in some of the conversations I’ve had with family members or other friends or co-workers that or other people, I feel like some of them have been like, “I had no idea this is going on,” which yeah, you know, I think that for them, it’s always easy to ignore things that don’t impact you directly. And so I think for them, it’s obviously not impacting them because most of them have been white and so if they don’t have to pay attention, or if this is not something that they’ve seen, then they wouldn’t know, but most Asian people have been really aware of this the past year, especially, so. 2:52, Laguaite: Yeah. Can you just give us a little background? So you were born in China, right? 2:56, Priest: Yeah. So I was born in China, and I was adopted a couple days before I was 1 year old. And I grew up in Minnesota, and then I moved to Georgia when I was in high school. So that’s kind of background. So my adoptive family is, yeah, white, Caucasian. 3:11, Laguaite: Yeah, OK. I know that we just mentioned that COVID has added even more instances of racism, but have you faced anti-Asian rhetoric or attitudes in the past when you were growing up? 3:23, Priest: Yeah. So it’s a really interesting question. I mean, I think as a whole, not really, just because I think that their white privilege often protected me. I think that whenever I was seen with them, people understood that I was, “one of them,” like I was not seen as Chinese or Asian, I was just seen, as, my mom’s adopted daughter, and I think that there has been that umbrella of privilege that I was able to enjoy. I’m trying to think like, there was a couple instances in elementary school, and people would make fun of my eyes and stuff like that, and, you know, pull them back at the corners, which is interesting, too, because I remember seeing recently that there’s some sort of maybe makeup trend that was going on that would make it look like your eyes are a little more like curved at the end and the Asian community, people were like, “That’s not right.” It’s kind of not an appropriation but I think it’s turning into something that has been often seen as setting people apart and making it you know, “stylish” for white people to do, which is interesting. And that’s not just happened to the Asian-American community or the Asian community, but also happened to Black hair, or you know, nails and stuff like that, that have often been seen as these things that set them apart from their white counterparts, but once kind of white people move into that space and take it over, then it’s seen as trendy. Priest: And so, kind of going back to your original question. I didn’t experience it too much. Because again, like I said, I lived under my parents and my family’s white privilege, but it’s something I’ve definitely noticed. Post-college is kind of when I really really experienced a lot of racism against me or I guess was more aware of it just because again, I was no longer associated with my white family. I was kind of on my own, and people didn’t see me as part of this white family, and they just saw me as an individual. And so I think then they were able to take their own preconceived notions or their stereotypes or their fear, or stereotypes, all those things, and really channel them at me. And yeah, so I think it’s only been within the past couple of years that I’ve really experienced a lot of it. Priest: And I think we’ll get to talking about this later too but I think it’s interesting because I think that for a lot of younger Asian Americans, a lot of them are scared, not necessarily for them, but for their parents. Because there’s been a lot of instances of violence, especially against elderly Asian people, in like New York and California, where there’s large concentrations of Asian populations. And so luckily, that’s something I don’t have to worry about because my family is white. And so that is... luckily for me, I don’t have to carry that burden or that stress being like, “Are my parents going to be OK, like walking outside or doing just everyday life things?” I think that’s my experience and other Asian or Chinese adoptees who are adopted by white parents, again, I think that their experience is different than other— like, my experience is different in a lot of ways, but also similar in a lot of ways to other Asian Americans right now. 6:27, Laguaite: Yeah. OK. So maybe in the past, you’ve faced some microaggressions like being called other people’s names at work... 6:37, Priest: Yeah, yes. 6:38, Laguaite: So that sort of thing. Um, and I’m laughing because I know you. Of course, it’s not, it’s definitely not funny. But it’s— 6:45, Priest: No, yeah, yeah. 6:45, Laguaite: I do think it is kind of funny how often this happens to you, though, you know, how often these little like microaggressions happen. 6:52, Priest: Yeah. Yeah, for sure. 6:54, Laguaite: But if you’re comfortable, can you tell me a little bit about some recent examples of racism or xenophobia that you faced, in the past year or? Yeah, I guess a year, it’s been? 7:04, Priest: Yeah. So I mean, I would say that some of them weren’t necessarily COVID-related, but just ignorance or racism in general. But I think that in the context of this last year, I think that things that I would have kind of been able to just brush off and be like, “They didn’t mean any harm by that,” I think has carried a lot, more weight, because you’re never sure, like, “Is this person saying this because they’re ignorant, and obviously their intentions aren’t bad?” but again, within the context of this past year, when you’re seeing all these headlines, and you’re reading about all these people have been attacked, like questions as ignorant as like, “Where are you from?” which usually for people that don’t look American — and American, in this context, being white American — people being like, “Oh, where are you from?” Usually, they’re trying to ask about your ethnicity. I mean, that’s happened to me twice in the last year. And both times, I don’t think that it was necessarily from a point of malice, but again, at the same time, it does carry this like, much heavier weight of, “Are they asking me because they’re scared of me, or because they want to like distance themselves from me, or because they want to do any of the things that have happened to other Asian people?” Like I’ve seen people are like— they’ve been punched, they’ve been spit on, they’ve been pushed, all these things. So I think that that’s kind of been the main, you know, some of the bigger things have happened to me personally. Priest: So last year, I moved back home with my parents for a couple months, kind of as things were happening, and now my parents live in a suburb of Dallas. And the neighborhood they live in is predominantly white. You know, there’s definitely people of color there, but it’s a pretty affluent area outside of Dallas, and so— Laguaite: And that’s Dallas, Texas, right? Priest: Yeah, sorry. And so yeah, we would go on walks as a family and you know, my parents are white. And then I have three brothers who are not adopted, and so they’re white. And then it’s me and my sister. And so sometimes we’ll all go out, walk around the neighborhood, and it was fine. You know, nothing happened. But one time, it was just me and I was walking and these kids who — again like these were kids too, so I can’t again say if this is like, racially motivated — but these kids are riding their bikes, and one of them screamed at me. He’s like, “You have coronavirus!“ something like that, he like “Coronavirus!“ and then he like coughed and he just rode away and I think I was mostly taken aback like again, it just always takes you out of the moment when you— again, like you feel like this is your home and you feel like you should be able to live a life like I should be able to live my life like my friends or my parents or my brothers and like not have things like that happen to me. So I feel like when that happened to me, I was like, “That’s crazy.“ And I just like obviously didn’t respond and again, like it was a kid, so I was not going to scream at him or do anything. Laguaite: Right. Priest: And so I just finished my walk and I got home and I was talking my parents about it and I definitely got emotional or more emotional than I thought I would. But I was telling them what happened and they were like, “Well, it could just be something they saw on the internet, like, I’ve seen this. People have kind of been doing this.” Which I definitely think is probably true. I’m guessing that or I would hope that it’s not like he heard that from his parents. But at the same time, I don’t think it would have happened to my family or my brothers or other white people. Like, I don’t think that would have happened. Laguaite: Yeah. Priest: And it never did happen again, like that was kind of like a single instance. But I think it kind of just kind of goes to show that it really only takes like one instance. And after that happened, I definitely was like, more cautious about walking around. And I was definitely more self-conscious about walking around in my neighborhood. And again, that was mostly just like a verbal — I don’t even know if I’d call it an attack either like, it was just, it was something and that set me on guard and made me super self-conscious about the way I looked. So that was that was kind of like the bigger instances I remember this last year. Priest: And, you know, there was one instance too, and this again, this wasn’t racially motivated at all— or no, I’m sorry, this isn’t specifically COVID-related, but I was talking on the phone with someone. I had to get insurance for my car. And so I was talking to this person and we were just chatting as she was kind of filling out paperwork and stuff like that. And I told her my middle name, which is the name that was given to me by the orphanage, so it’s Chinese, and this woman, I told her, I was like, “Oh, I was adopted,” and she was like, “Oh, you sound so American.” And I think like— Laguaite: You are American. 11:33, Priest: Like, “Yes, I am.” Laguaite: Wow. Priest: But again, like, I think, again, just in those instances, not necessarily COVID-related, and not, again, not malicious, and not coming from like, a mean, hateful place, but again, I think it sends out a clear message that to be like “fully American,” you have to be white, you have to have a European- or American-sounding name, you have to not have an accent, like all these things that are— Laguaite: You have to fit the mold. Priest: You have to fit the mold and I think that we’ve had this conversation before and there’s such a movement to like be proud of your heritage and be proud of who you are. You shouldn’t have to hide these things, which I 100% agree with, but at the same time, it does make it hard. Like, yeah, you can be proud of these things, but at the same time, you know that you’re going to face some consequences, like, whether they’re people like judging you without meeting you or whether they— you know, like, I think there’s been a lot of studies about even job applications. Like if you have a name that’s not, again, perceived as American, you’re maybe less likely to get certain jobs or job interviews because people just don’t think you can do the job well. 12:40, Laguaite: Wow. I mean, and this is this sort of goes back to what you said about some of these instances, not necessarily being rooted in like, they’re not, they’re not meant to be malicious, maybe. But I think and I think this was pre-COVID, maybe or like pre-lockdown, but I remember you telling me about this instance, where you went to like Disney World or something in Florida and a woman asked if it was your, maybe first time visiting? 13:10, Priest: Yeah. It was actually— So we were driving back and I was with my small group from church and we stopped at this restaurant, and this woman, I was standing in line with her. And this was, honestly, this was right before the country locked down so people knew about COVID. They knew it was coming. And there was a lot of obviously, misinformation out there. Laguaite: Yeah. Priest: And I think there’s a lot— I think, too like thinking back on this time, even though people had the right information, there was just so many competing narratives about what our country would do and would people eve get it here? There is so much uncertainty. But this woman was standing next to me in line, and she kept looking at me, and I was like obviously on guard, because at the time too, the news was very... Now, national media has been more conscious about saying things and stuff like that but the thing at the time, too, especially under the leadership of then-President Donald Trump, he was calling it still and he’s still calling it now like “the China virus,” or “Chinese virus,” or “the Wuhan flu,” like, all these things. And so again, I had that in the back of my mind as this woman kept looking at me. And I was like, “Oh.” So eventually, I made eye contact with her and she’s like, “Oh, hi.” I was like, “Oh, hi.” You know, so we just like talking and I was wearing— I don’t know if I was wearing like a Georgia sweatshirt, but she eventually was like, “Oh, do you go to school here?” And I was like, “Yes.” I was like, “I go to the University of Georgia.” And so we are chatting. And she’s like, “Oh, well, how do you like it here?” You know, like, it was my first time and I was like, “Um, great?” You know, I’ve lived here for my whole life. So I guess it’s fine. Maybe not as fine now. Laguaite: Yeah, yeah. Priest: So yeah, so like that has just, again, not coming from a necessarily malicious place, but same time, like I mentioned earlier, questions like that can... they carry just so much more weight now. Laguaite: Yeah. Priest: Because of the heightened anti-Asian sentiment and racism that’s prevalent right now. 15:00, Laguaite: Yeah. And I think it’s an interesting contrast too, because even when you and I went to Nashville, Tennessee, last year for spring break. So this was like... COVID was happening, but it was pre— it was basically pre-lockdown. So, 2 weeks before. Yeah, so when we were in Nashville, we were at some public place, like a restaurant or a bar or something, and it was interesting, because there was this certain man or like group of men who were trying to make... you know, trying to have a conversation with you, and it seemed like they wanted to talk to you because you were — using his words — “exotic” or, you know, that kind of thing and then post that trip. So after that trip, after lockdown, the sentiment completely reversed, you know? So no longer— Well, I’m, again, making a pretty broad generalization, but now it’s more like these instances that we’re hearing about on the news are rooted in like, malicious racism. 16:02, Priest: Yes. Yeah. That’s such a good point you bring up because yeah, like during that trip, yeah... 16:07, Laguaite: Multiple times, actually, now that I’m thinking back like, this wasn’t a “one and done” type of— 16:11, Priest: Yeah, there was a couple of times, but yeah, I think, one of the stereotypes or one of the ways that, especially Asian women, are viewed in this country are viewed as “exotic” and there’s a lot of fetishization that happens. Laguaite: Yeah. Priest: Asian women especially are fetishized and viewed as “exotic” and there’s been a lot of studies about where this is rooted. And I mean, you can, again, you can trace a lot of these things back to a couple instances, and just how they’ve grown and yeah. But yeah, like you said, it’s interesting because at that time, again, my ethnicity was viewed as, I don’t know. Like to want? 16:48, Laguaite: Yeah. You know, something like desirable or like something sexy or erotic. Priest: Yeah. And not in a good way. Laguaite: Exactly, the worst way, because again, like, how did that make you feel when that guy was like, “You look exotic. Where are you really from?” That was the thing. He kept asking, “Where are you from? Where are you from?” 17:07, Priest: Yeah. Yeah, we were both— So, it was Madeline and I and we were at this... I think it was a bar, right? Laguaite: Yeah. Priest: Yeah, there was this guy. There was this group of three men. It was so gross. They kept like— 17:19, Laguaite: Three white men. 17:19, Priest: Yes, three white men. They’re just like talking to all these women, but eventually one of them came up to me and he was like, “Where are you from? Where are you from?” And I was like, “I’m from here.” And I mean, Madeline was there too. And she also stood up for me and was like, “She’s American.” 17:35, Laguaite: Yeah. “She’s from here.” He kept pressing. Priest: Yeah. Laguaite: He kept asking where... /episode/index/show/tohealthandback/id/18960746

Show Notes: In Conversation with Rachel Priest 05/03/2021

Bonus Episode: In Conversation with Rachel Priest 05/03/2021

Transcript: Xenophobia 04/26/2021

Transcript: Xenophobia 0:11, Madeline Laguaite: Hello, and welcome to “To Health and Back,” a podcast about how health, medicine and wellness decisions from the past help inform us today. I’m your host, Madeline Laguaite. In this episode, I’m sitting down with Dr. Alexandre White to talk about past instances of xenophobia and racism in the context of disease and the implications these past instances have. Here’s a snippet of our conversation. 0:40, Alexandre White: What we’ve seen in the last year or so, especially in the relationship between pandemic threat and the rise globally, but especially in the United States, of anti-Asian racist violence, really fundamentally how dangerous not only words and phrasing and framing of disease can be, but also, I think, more specifically, the ways in which racist legacies continue to inform our present and the ways in which racism is structurally built into the United States in the ways that we need to confront this not only in the field of civil rights or through legislation, but also you know, deeply rooted in public health and medical practice access to care, access to treatment and the ways in which racism operates in every aspect of life, and we need to as a result confront it fundamentally in every aspect of life. 1:38, Laguaite: The COVID-19 pandemic has fueled xenophobia, specifically anti-Asian sentiment, across the globe. About a year ago in May 2020, the secretary-general of the United Nations, António Guterres, had this to say. 1:53, António Guterres: We must act now to strengthen the majority of our societies against the virus of hate. That is why I’m appealing today for an all-out effort to end hate speech globally. 2:03, Laguaite: Guterres is just one of many public health officials to condemn xenophobia. Since the beginning of the pandemic, Asian Americans, in particular, have seen spikes in discrimination, anti-Asian sentiments, and violence. In fact, just a week before our conversation, eight people, many of whom were Asian women were murdered in shootings at spas in Georgia. Though the motive has yet to be confirmed, the killing sparked fear, outrage, and uncertainty in the Asian American community. Laguaite: Here to talk more about xenophobia and racism is Dr. White, I connected with Dr. White through some of his published work centered around the social effects of infectious epidemic outbreaks. 2:48, White: My name is Alexandre White, and I’m an assistant professor of sociology and the history of medicine at Johns Hopkins University and School of Medicine. 2:56, Laguaite: Because we’re talking about anti-Asian sentiment and violence, Dr. White pointed out the implications of having a single racial category for the 48 countries that span the continent of Asia. 3:08, White: And I think it’s also important to note that, you know, the racial category, Asian—obviously, lumping the largest continent of the world into a single racial category—was itself a bureaucratic flattening of difference and categorization for the purposes of American racial categorization. So even when we talk about anti-Asian violence, it’s reflective of these particular forms of racial categorization that really emerged in the late 19th century. 3:35, Laguaite: So during the past two years especially, we've seen lots of anti-Asian sentiment, attitudes, and violence. And in your article, “Historical linkages, epidemic threat, economic risk and xenophobia,” you mentioned that the U.S. has a history of anti-Chinese sentiment, in particular, in response to epidemics. So can you talk a little bit about that as well? 3:57, White: Yeah, yeah, absolutely. I mean, I think it's really important, especially right now, to recognize the ways in which particularly anti-Asian racism is deeply structural, and is as structural in the United States as any other form of racism that we see today. I think some of the most dangerous and pervasive stereotypes around racism against the Asian community and populations of Asian descent is that either it's purely interpersonal, as we see in kind of the narratives of especially and prior to the attacks of the last week and the week before, these attacks seem to be caused as we normally see by just “bad apples,” who were doing terrible things, and that really ignores the ways in which actually, the racialization of people of Asian descent and exclusions are deeply human into the fabric of America's racist history. Laguaite, 4:56: The Page Act of 1875 was the first restraint federal immigration law in the United States. The law was named after a Republican in California, Representative Horace Page, and aim to “end the danger of cheap Chinese labor and immoral Chinese women,” according to Dr. George Anthony Peffer, in his article “Forbidden Families.” Dr. White also spoke on the Page Act and its implications. 5:26, White: We can go back to 1875 with the passage of the Page Act, which was the first racially exclusionary immigration law passed in the United States, that banned the immigration of Chinese women to the United States who were perceived... a justification for this largely emerged out of this perception that Chinese women were more immoral or guilty of sexual misdeeds, or were going to come over and engage in sex work that would then corrupt the morality of largely white American men. Laguaite: Wow. White: But within that, there was also this powerful and dangerous public health narrative that the Asian population somehow carried more virulent venereal diseases that would upset the epidemic landscape of the United States. 6:13, Laguaite: But the Page Act wasn't the only racially exclusionary law passed in the US. 6:19, White: Later, in 1882, the more encompassing Chinese Exclusion Act was passed, which banned all immigration of both men and women to the United States on similar grounds, ultimately that were intersectional in nature. These are gendered sexualized, as well as racialized justifications, for exclusion. And the Chinese Exclusion Act also focused on this particular justification of the threat of infectious diseases emanating from Asia. 6:46, Laguaite: OK. And these like exclusionary acts in the 19th century, what were typical American attitudes regarding that kind of law? 6:57, White: I can't speak to it in full but I do know that there was significant and virulent anti-immigrant and especially anti-Asian immigrant fervor in the United States. So, these policies were supported. And, and they were intrinsically exclusionary in their force. We see in these acts and in these histories, and in many ways, the ways in which racial categorization and racialization is fundamentally relational. 7:30, Laguaite: One of the specific outbreaks Dr. White has studied is the 1901 bubonic plague outbreak that swept through British colonial Cape Town. Colonial officials use the outbreak as an opportunity to turn to racist responses to public health concerns. Officials rationalized “existing and unfounded racist segregationist beliefs and forcibly removed most of the city's black population from its homes and neighborhoods.” And that's just one example of racialized quarantine. In 1899, during a plague outbreak, authorities in Honolulu quarantined and burn the city's Chinatown. 8:14, White: But on top of this, you know, there were also numerous moments of racialized quarantine that looks very similar in many ways to the quarantine we discussed in Cape Town. When plague arrived in Honolulu, the response by American public health authorities there was to quarantine off the entire Chinatown section of the city of Honolulu. 8:35, Laguaite: So what did this quarantine look like? 8:37, White: This, of course, was not a was not an equal quarantine. And in fact, borders of the quarantine space was gerrymandered in ways that allowed for white-owned businesses and white homes to be excluded from this quarantine and ultimately, in a devastating moment of violence. As public health actors traveled through attempting to sanitize and quote-unquote cleanse homes of bubonic plague with essentially burning infected homes down. The fire expanded, got out of control, and burned much of the city's Chinatown to the ground, obviously, leaving many people homeless and also without places of work, which would go on to have devastating effects. 9:21, Laguaite: These types of racialized quarantines have had lasting effects, Dr. White said. 9:26, White: And we saw similar forms of racialized quarantine against Asian populations also in response to periodically when it arrived in San Francisco from 1900-1904. They've reflected very similar patterns. So we see this long history of the invocation of disease threat and racial anxieties when it comes to people of Asian descent that I think, you know, we've seen invoked again, very disturbingly, into tremendously violent and oppressive effect in 2020 and 2021. 9:57, Laguaite: Dr. White mentioned the historical importance of the exclusionary acts, and explain to me the implications these acts had for future U.S. legislation. 10:07, White: So many Asian migrants came to the United States in the 19th century, in some ways in response to the lack of free labor that was eliminated through the abolition of slavery in the United States after the Civil War. And thus, migrants were forced, coerced, and brought into the United States to make up for that loss of labor. And as a result, especially early Asian immigrants of the United States were associated with, negatively, with African Americans, with formerly enslaved black people, and the connotations were very similar in terms of the racial categorizing. And also, we can see that these exclusion acts that I mentioned, also laid the groundwork for things like Donald Trump's Muslim ban, as well as other exclusionary immigration policies in the 20th century. So we can see here how systems and structures of racism, build on one another and interrelate different groups that are racialized and powerful and devastating and oppressive ways. 11:11, Laguaite: Having studied social effects of infectious epidemic outbreaks was xenophobia and anti-Asian sentiment and violence today something you expected when COVID-19 first began? 11:26, White: It was certainly something I was very concerned about. Laguaite: OK. White: And, you know, I think what we've seen in this pandemic is the invocation of a host of historical tropes that we've seen before, through the 19th century and 20th century and beyond. were, you know, especially particular anxieties about the ways in which epidemics are going to affect commerce effect, trade effect, global economics, become co-constituted or co-constituted with particular anxieties about populations within blamed for spreading disease. And we've seen time and time again, that disease and epidemics are a very powerful justification for ascribing human difference, especially in culture, you know, when we can assign some sort of pathological flaw to cultural behaviors that were and are, you know, incredibly but now, outside of a pandemic situation, you know, it becomes a very effective way of mobilizing racist anxieties. And I think very unfortunately, we're seeing that continuing in the present. 12:35, Laguaite: On that note, do you think that former President Trump's usage of phrases like, “the China virus” or “Kung Flu,” do you think that worked to perpetuate some of these stereotypes and violence? 12:49, White: Absolutely. I think that there's little doubt to that. The history of racial anxieties when it comes to diseases that can emerge from ages is long-standing. And this becomes a way of, and I think we see this very much former President Trump's narratives of or the ways in which he narrated the COVID-19 pandemic, we see the ways in which there's a civilizational superiority logic that comes through in attempting to assign blame to an entire geography for the emergence of a disease so that I really would not only not give these ostensively racial slurs any credence, but I would also ask a philosophical question, which is, you know, to what extent do origins of diseases actually matter when, you know, pandemic epicenters move? And the fact of the matter is, you know, the United States has been the epicenter of this pandemic for some time, until unsurprisingly, like so many things. When it comes to racist ideologies. The concept holds no water, but also the justifications are paradoxical and make no sense. 13:53, Laguaite: Dr. White said there are many important lessons we can take from historical instances of racism and xenophobia. 14:01, White: Most critically, we need to stop thinking about the spread of infectious disease as somehow being the result of inferior unhygienic, unsanitary practices that can be leveled across an entire population, right, or an entire group or a culture or an ethnic group or a racial group. You know, these are not epidemics are not, they don't they just, they simply don't work that way. Diseases emerge in different places at different times. And you know, it's for this very reason, that the World Health Organization, for instance, does not or no longer advocates for the naming of novel diseases, and ascribing that name to a place we know COVID-19 is COVID-19 in large part because of the stigmatizing effects that you know, locating a disease or interpreting a disease name with a particular location as we try to avoid that. Now for these precise reasons, and you know, what we need to recognize this is far from any sort of cultural, behavioral or social practice carried by individuals or groups or the blame that we ascribe to them in various racist, gendered or ethnically insensitive and violent ways, we need to recognize how the social factors that exist within a society fundamentally lead to the perpetuation of an epidemic lead to greatest or more severe outcomes and epidemic we've seen, especially in United States, the ways in which economic and racial inequities and inequalities in our society are leading to very significant deaths morbidities, but also inequalities in how this pandemic is being felt across the United States and who is living and who is dying. You know, we see that racism, far from being able to explain any sort of differences in or being able to explain any sort of cause for an epidemic actually kills at far higher rates during an epidemic. And these racist logics are incredibly violent, incredibly dangerous, and hinder public health practices and legacies of racism, structural racism, very much have lasting and pertinent effects on how pandemics play out. 16:10, Laguaite: Well, thank you so much for talking to me, Dr. White. 16:13, White: Thank you. Thank you. My pleasure. 16:17, Laguaite: Across the U.S., protests have called for an end to Asian discrimination in anti-Asian violence. If you're looking to support the Asian American and Pacific Islander communities, the Asian Americans and Pacific Islanders in philanthropy, which is also called the AAPIP, has a list of resources to combat the rise in anti-Asian violence. You can find it at apip.org. Laguaite: This has been “To Health and Back.” Thanks again for joining me on this health history journey. Tune in next time for a bonus episode featuring another discussion on xenophobia. Until then, don't forget to rate the podcast and subscribe. Feel free to shoot me an email at [email protected]. And I'm also on Twitter, Instagram and Facebook as @healthandback. Thanks. See you next time. /episode/index/show/tohealthandback/id/18868070

Show Notes: Xenophobia 04/26/2021

Show Notes: Xenophobia In this episode of “To Health and Back,” we’ll hear from Dr. Alexandre White, an assistant professor of sociology and history of medicine at Johns Hopkins University, to see how past instances of xenophobia (including in policy) are reminiscent of the racism and discrimination toward Asian Americans in the U.S. today. Read the transcript for this episode SHOW NOTES: Read more about the 1899-1901 bubonic plague quarantine in Honolulu. Check out this recent study that explores the extent to which phrases like “Chinese virus” were associated with anti-Asian sentiment. Check out this resource directory that includes how to report incidents, places to donate, educational resources, statistics, news articles and resources for allies. Check out this resource directory to combat increased anti-Asian violence in the wake of COVID-19. Read Sam Cabral’s article about hate crimes toward Asian Americans in the U.S. during the pandemic. Read about the Page Act, an anti-immigrant law that specifically targeted Asian women. Learn about how COVID has fueled anti-Asian racism and xenophobia across the globe. Read Dr. White’s article about xenophobia in the time of quarantine. Read George Anthony Peffer’s work about emigration experiences of Chinese women under the Page Act. Read more about Dr. White and his work. Check out this archive about Chinese immigration history in the U.S. Check out this clinician’s guide to combating anti-Asian sentiment. Read about (or listen to) the rise in anti-Asian attacks during COVID-19. Read Dr. White’s exploration of two epidemics in 1901 Cape Town, the bubonic plague and smallpox. Read about (or listen to) António Guterres’ statement on xenophobia via his Twitter account, @antonioguterres. Read more about Chinese immigration and the Chinese Exclusion Acts. MUSIC CREDIT Track: Floating Effortlessly — Artificial.Music & From Ashes [Audio Library Release] Music provided by Audio Library Plus Watch: Free Download/Stream: /episode/index/show/tohealthandback/id/18867491

Xenophobia 04/26/2021

Transcript: Episode 2, 'Mask Wearing' 04/12/2021

Transcript: Episode 2, 'Mask Wearing' 0:17, Madeline Laguaite: Hello and welcome to "To Health and Back," a podcast about how health, medicine, and wellness decisions from the past help inform us today. I'm your host, Madeline Laguaite. Laguaite: In this episode, we're talking about the history of mask wearing, especially during the 1918 influenza pandemic. We'll hear from Dr. Alex Navarro, the assistant director for the Center for the History of Medicine at the University of Michigan. Laguaite: When Dr. Navarro and his colleagues began studying the 1918 flu pandemic, he didn't really expect the research they did to have an impact on public health policy today. Here to talk about that research, specifically mask wearing in 1918, is Dr. Alex Navarro. Hi, Dr. Navarro and welcome to the show. 1:06, J. Alexander Navarro: Hi, Madeline. 1:08, Laguaite: As I mentioned in a previous episode, experts have made lots of comparisons between COVID-19 and earlier pandemics like the 1918 influenza pandemic. Luckily for me, Dr. Navarro has spent more than a decade studying the 1918 flu pandemic. 1:24, Navarro: Yeah, my name is J. Alex Navarro, and I'm the associate director at the Center for the History of Medicine at the University of Michigan. I have spent the past 15-16 years now studying influenza and not that entire time. But we started at the Center about 15 years ago, studying the 1918 influenza pandemic. We were asked by first the Defense Department, of all places, to look at what we ended up labeling provisional escape communities. And these are small, typically small, communities in the United States... A few of them are sub-communities, so like college campuses, for example, in the United States that in the fall of 1918—which was the deadliest wave of that pandemic—managed to more or less escape influenza, meaning that they had zero or one perhaps death, and generally very few cases, although there were some places that had large case counts, but managed to not have any deaths. Navarro: And the Defense Department was interested in finding out why and they wanted to know, with the possibility of another influenza epidemic. This was 2005. So the threat at the time was thought to be H5N1, avian influenza, a very deadly form of the disease that was lurking around in Southeast Asia. They thought, well, the military thought, could we load people up in the event of an outbreak somewhere in the globe, before it became an epidemic and a pandemic? Could we load up military assets on ships and send them out to sea, for example, and can we sort of emulate what these escaped communities did? That kicked off the work. Navarro: But you know, what Gunnison, Colorado, for example—a town of 1,300 people in a county of about 5,000 people—did in 1918 very different than what we could do today with a pandemic of a respiratory disease, such as we found out with COVID. You know, those are two very different populations. You can potentially isolate a small community that's already isolated. It's much more difficult to do an entire city, entire state. We have a lot more interest, e-commerce now, etc. Navarro: And so building on that work, the CDC then asked us to look at the 1918 pandemic, from the perspective of what American cities did. What they did was social distancing, mask wearing, etc. We did that work we showed that it did... that went into the pandemic guidance provisions that the CDC put out back in 2007 and the Department of Health and Human Services. 3:39, Laguaite: All the work and research that Dr. Navarro put in these last 15 or so years came in handy when more and more COVID cases started to pop up around the world in early 2020. 3:50, Navarro: Fast forward to today, really this time last year with the spread of COVID, and those plans were dusted off. And that's one of the reasons why we had the social distancing and mask recommendations rolled out is largely because of the work that we did and some other groups did, looking at that data from 1918. Yeah, I mean, it's not every day that historians get to have an impact on public policy, particularly public health policy. We really never imagined that would be the case. We hoped that it wouldn't. In fact, we would have been happier leaving those plans gathering dust on the shelf rather than dust them off and have to use them. But you know, here we are. We always knew it was a matter of "when" not "if," but you never think that "when" is going to happen during your lifetime. 4:36, Laguaite: At this point, we're all too familiar with mask wearing and mask ordinances. If I remember correctly, our local mask ordinance began sometime in July of 2020. And these local mask ordinances varied across the nation, though they had one main goal: to help slow the spread of COVID-19. And as it turns out, there were mass ordinances back during the 1918 pandemic. 5:01, Navarro: Yeah, there were. So mask use was still—certainly for the general public—it was pretty novel. There had been some mask use in 1911 in Manchuria. There was an outbreak of pneumonic plague and there was a physician, a Chinese mentoring physician who had been trained in Cambridge, who advocated the use of face masks for the public, realizing this was a respiratory disease, highly deadly, near 100% fatality. Despite pneumonic plague, there were people, including some American physicians, who went over to monitor who refused to wear a mask and died as the result. 5:41, Laguaite: Medical professionals have used face masks in surgical settings for over 100 years and the first documented instance was in 1897. The mask used was a single layer of gauze covering the mouth, and it was meant to protect the patient from infection at the surgical site. It wasn't until the 1940s and 1950s that antibiotics and septic techniques were used as major players of infection control methods within a surgical setting. So what did that look like in 1918? 6:14, Navarro: By 1918, the use of face masks in the surgical theater was fairly widespread, but still not universal. That really didn't come out for another maybe two decades. But I would say about two-thirds of physicians use face masks when performing surgeries or other procedures, building on the work of Semmelweis, and Pasteur and Lister and Koch etc, and realizing, 'Oh, now we're several decades into modern germ theory.' 6:44, Laguaite: The influenza pandemic of 1918 happened during the same time period as World War 1. Thanks to the overcrowding and global troop movement during the war, the 1918 flu was able to spread pretty extensively. Both the lack of treatments and vaccines and the vulnerabilities of healthy young adults spawned this major public health crisis reminiscent of the one we're in today. The flu pandemic of 1918 was responsible for at least 50 million deaths globally. Dr. Navarro said that back then, there were facemask recommendations and mandates coming from experts. Still, that doesn't mean every city or every region was adhering to these ordinances. 7:25, Navarro: In terms of the general public using face masks, there were plenty of recommendations nationwide to use masks and when locally and regionally to use face masks. But the mandates typically with the exception of Indianapolis, for example, typically tended to be done in western states and communities. So Los Angeles toyed around with the idea of issuing a mandatory facemask ordinance. They ultimately did not. Denver did, Seattle, Sacramento, Oakland. In Utah, they considered a statewide mask mandate but they ultimately did not. And it tended to be out west and it had to do with several factors. One was, there were a few influential and one, in particular, a physician named Woods Hutchinson, who was from the East Coast but traveled around and California sort of going up and down the coast, telling local communities to wear face masks and to issue these ordinances. And so he had some impact on the local decisions to do that. And also it was a little bit having to do with the timing. Although the influence of the second wave of the influenza pandemic hits pretty rapidly, it spreads from epicenters in Boston and New York almost simultaneously in late August, early September. And then it spreads within a matter of about 3 or 4 weeks across the nation. The exact shape of those epidemic curves is slightly different as you go across the nation. So it looks different in the East than it does in the Midwest. And it looks different in the West, and it does it in the Midwest or, or the east. And so partly because of the timing. It's a little bit more dragged out in the West. Those a lot of those communities resorted to mandatory facemask ordinances as a way of controlling the spread of the disease. 9:09, Laguaite: We know that the first known depiction of medical personnel wearing a face mask and surgery during the late 19th century was a single sheet of gauze. What about the types of masks worn in 1918? 9:21, Navarro: They were all types of masks. Not all that uncommon from what we're used to today, with the difference being that they did not have any N95 respirators back then, although the general public doesn't generally have those today either. But the types of surgical masks that are fairly common now you can find on online etc, that a lot of people are using... they didn't have those either. That sort of electrostatically charged, the Tyvek plastic material. The most typical mask in 1918, at least in the beginning of the fall would have been made of several plies of surgical gauze. So people think of surgical gauze and they think of cheesecloth, but it was actually much more densely woven than that. It's a pretty densely woven cloth. And two plies that would probably—I'm not an expert in this—but probably would be fairly similar to some of the better-made cloth face masks that most of us are using today when we go out and about. 10:14, Laguaite: So were these effective? 10:18, Navarro: So certainly not 100% effective. But probably roughly analogous to what we're using today. So maybe 70%-80%, depending on how they're used. The problem was, of course, that this is the time of World War I, and so surgical gauze is in high demand, but short supply. And so you have organizations like the Red Cross, and volunteers stitching masks for sale. Those, in some communities, run out pretty quickly. And so in places where they pass these mask ordinances, the ordinance is not all that dissimilar from today saying, basically, 'Cover your face with something.' And so to entice people, they even tell fashion-conscious women that they can wear a chiffon veil if they want. So some of the face coverings were probably not effective at all. And we don't really know in terms of compliance, how many people wore them regularly, what type they were, etc. But, roughly speaking, I'd say that generally, most people, you know, would have been wearing some fairly effective, certainly not 100%, but some fairly effective face covering 11:32, Laguaite: During the COVID-19 pandemic, adherence to mask ordinances and social distancing guidelines have been a key issue. What did mass compliance look like back then in 1918? 11:43, Navarro: That being said, there were plenty of communities where we have lots of data that there were very high levels, relatively high levels of noncompliance, or at least very high levels of vocal noncompliance. So, you know, we may have seen 70%-80% people wearing masks. I'm not sure if it was that high. But that 20%-30% that weren't were really vocal about not wearing them. And so places like San Francisco, you may have heard of the Anti-Mask League is formed in San Francisco and Denver had a really hard time getting people to wear masks and they had to keep watering down the mask ordinance because essentially, no one was wearing them. In fact, the mayor at one point in Denver says you'd have to have half the city forcing the other half to wear them, just to get any sort of compliance. So they were like today, uncomfortable to wear. And like today, we live in a nation, the United States and I think a lot of Western democracies, where we hold our individual freedoms and liberties very dearly, and to have the quote, unquote, "the government" tell us that we have to wear a face mask flies in the face of that and we don't like that. And so a lot of people said the same types of arguments back then that they have been saying today. 13:02, Laguaite: Given his extensive background in the 1918 flu pandemic, I asked Dr. Navarro if he expected so much resistance to mask wearing today. 13:11, Navarro: Yes and no. So I'll say yes, we certainly saw lots of... In fact, I just wrote an article about this for the American Journal of Public Health. We saw lots of evidence of some forms of noncompliance with pushback in 1918. So typically, the types of social distancing orders, we call them nonpharmaceutical interventions. Those types of interventions that were issued in 1918, mostly centered around things like isolation and quarantine, which we know work. In fact, New York City only resorted to isolation and quarantine and did a very good job of it and could have done better had they implemented more social distancing measures, but actually did fairly well for it considering a densely populated urban area, in the midst of the epicenter of the epidemic. They did very well just, robust isolation and quarantine and contact tracing. Navarro: But most communities that issued closure orders, they closed places of public amusement, so pool halls, bowling alleys, movie theaters, performance theaters, cabarets—those were the places that were closed. Now, of course, if you're an effective business owner, and of course, you're being told initially by public health officials that this epidemic will burn through pretty quickly, you're thinking you might only be closed for a few weeks. And so initially, and also it's wartime. So there's a high sense of civic duty and patriotism. So you go ahead, and if you're a theater owner or manager, you realize that people aren't going to come to a theater during a pandemic anyway, so let's do our part and get through this very quickly. Well, when it starts to roll on, you know, 3, 4 or 5 weeks in some places, and these orders are still in place, then people start to balk. And they say, "Well, you know, we've lost 10s of $1,000s of dollars on lost revenues, and we have employees who we can't pay." And this is before welfare and workman's compensation and unemployment and all this and the social safety net that we have today. And so you have a lot of people relying on charity. Navarro: You have churches that are closed, either because they were recommended to close their following, or in some places, depending on the laws, they were ordered to close. They comply, they start to push back. They're pushing back in places where saloons may not be closed, for political reasons and social reasons. They're places where workmen who didn't have access to a kitchen, or the ability to cook their own food, could get a meal, as well as lots of drinks. And they tend to be very crowded places. And so you have clergy saying, "Why can you have people go after work, belly up to a bar crowded with people, but they can't come once a week on Sunday, to hear a sermon for their spiritual needs?" So we do see lots of those types of pushback in 1918 and of course, with facemasks. 15:52, Laguaite: Even with these parallels between the COVID-19 pandemic today and the 1918 pandemic, there was one huge difference that Dr. Navarro mentioned: the nature of the pushback. 16:03, Navarro: The big difference between 1918 and 2019, 2020 and 21 is that the political nature, the ideological nature, and the partisanship of that push back is drastically different today. There really... we don't have the evidence that in 1918, in the fall wave, that push back to the public health measures was politicized in any way. So these orders were issued in Democratic states and cities and in Republican states and cities. And it didn't take... there may have been a slight ideological hue to, for example, refusing to wear face masks on supposed constitutional grounds. But that ideology did not necessarily correlate with politics and political party affiliation the way it has today. And certainly, you know, we've seen with former President Trump and some of his statements and actions. If you compare that to 1918, Woodrow Wilson, who was president then, was essentially silent on the issue of the influenza pandemic. A lot has been made about that. Some people have claimed that that was all part of this sort of conspiracy, see, to cover up the pandemic, or to censor it. That wasn't really the case. It was just that like today, public health was in 1918, the domain of state and local governments. The difference is that now we live in a post-Great Depression, post-New Deal era, where we have now a more robust federal government, and we have come many of us have come to expect and more robust federal response to whatever the national crisis may be, whether it's public health, natural disaster, etc. That didn't exist in 1818. So it wasn't odd that Wilson, as president, didn't really come out and say much to control or do anything about the pandemic. People look to their local leaders. A difference today, we look to local and state leaders as well as to the federal government, and then to have somebody like Donald Trump, and lots of other Republicans in office or in media pushing misinformation, disinformation, and in some cases, saying that the virus was a hoax, etc—that was drastically different than 1918. 18:27, Laguaite: With regard to what we can learn from the prevention methods used in 1918, Dr. Navarro said, we have to look at the data that we do have. 18:37, Navarro: So, I will say this. In our study in 2007, looking at these nonpharmaceutical interventions, because of the way that they were overlapped with one another, it was very difficult—basically impossible—for us to say with any confidence in any one of those nonpharmaceutical interventions, isolation, quarantine, school closures, closing of businesses, public gathering brands, or face masks, that any single one of those contributed X percent to the reduction in cases and deaths. What we do know is that taken together, those cities that implemented those measures earlier, that layer them so it wasn't just school closures... Several of those types of interventions layered on top and kept them in place for as long as possible—those cities fared better. So what I would say is that we have much better data today that face masks do indeed work, that they are very effective, although not 100%, in reducing transmission when worn properly. 19:40, Laguaite: Complacency is a dangerous trap to fall in, especially during a pandemic. 19:45, Navarro: We don't want to have a face mask on and give ourselves a false sense of security that we can have just a simple face covering, not an N95, and we can be face-to-face with strangers or with family members who don't live in our house. For example, if you're in an area where there's a hotspot and think that you're safe... The way this was explained to me and the way I've been explaining it to people—I think this is perfect—is that if you imagine each of these interventions as a piece of Swiss cheese, they all have holes in them. But if you layer several of those pieces together, hopefully, the hole doesn't go through the entire stack. And so, face masks are an incredibly important part. But so is hand washing, social distancing, staying out of congregated areas until we get this under control. Navarro: Vaccines are a much more important part of today than they were in 1918. We didn't really have effective vaccines in 1918. And there were some vaccines that were developed. They thought they were dealing with a bacterial infection, not not not a viral one. They didn't have that... /episode/index/show/tohealthandback/id/18694706

Show Notes: Mask Wearing 04/12/2021

Mask Wearing 04/12/2021

Show Notes: Episode 1, 'Early Outbreaks' 03/29/2021

Transcript: Episode 1, 'Early Outbreaks' 03/29/2021

Transcript: Episode 1, 'Early Outbreaks' Madeline Laguaite: Hello and welcome to "To Health and Back," a podcast about how health, medicine, and wellness decisions from the past help inform us today. I'm your host, Madeline Laguaite. Laguaite: In this episode, we're talking about early pandemics and epidemics, and what some of those earlier outbreaks can teach us today. We'll hear from Dr. Nan McMurry, the director for collection development at the University of Georgia libraries. She earned a doctorate in the history of medicine and teaches in the UGA History Department on a part-time basis. Laguaite: So I actually met Dr. McMurry through a class I took with her during my undergraduate career here at the University of Georgia. It was called the history of medicine. And in truth, the material we covered in that class and Dr. McMurry herself inspired this podcast, so I thought she would be the perfect first-ever guest to talk for this episode about earlier outbreaks and how they can relate to the pandemic we're living through. Laguaite: From the Black Death in the 1300s, to outbreaks of cholera in the 1800s, to the current COVID-19 pandemic today, experts that study the history of medicine say the one thing that doesn't change is human nature. Here to talk about that human nature with us is Dr. Nan McMurry. Hi, Dr. McMurry, and welcome to the show. Dr. Nan McMurry: Hey, how are you? Laguaite: I'm good. How are you? McMurry: I'm good, too. It's been a long time. Laguaite: I know, I know. McMurry: So I'm Nan McMurry and I have kind of an unusual job at UGA. My primary responsibility is in the university libraries, and I'm the director for collection development and collection development is the part most people have never heard of. It's the part of the library where we choose the materials we're going to have in the collection, so books or journals or databases. There are real human beings who do that, not robots. And so we have a team of people, and I'm the head of that team. But I also work directly with certain subjects. McMurry: And then because I have this academic background, where my doctorate is specifically in the history of medicine, I've been able to teach on kind of part-time basis in the history department. So that's how my class that you took came about. Laguaite: OK, awesome. McMurry: You might think that somebody like me would really find living through a pandemic now really— I mean, I find it interesting, but I don't find it fun. You know, it's kind of a little lesson that I learned, ooh, this isn't so good to be in the middle of it. Laguaite: OK, so you've studied all sorts of earlier outbreaks, epidemics, and pandemics. What are some of the things that stand out to you most, especially with regard to human nature? McMurry: You know, our medicine and our public health and the knowledge and the technology have changed a lot, but the human nature? Mmm mm. That's been really striking to me watching this pandemic unfold is just how little we've changed in our attitudes, and our fears. We tend to think, 'Oh, we're so invincible with their science.' But when you have a new disease, that medicine and science are not as effective against or not as effective right away, then all those old attitudes come right, right out of the woodwork. McMurry: Here's a historical example. It's so easy when you look back in the past to say, 'Oh, yeah, that was so dumb.' And yet we do it all the time. So there's a particular smallpox epidemic that happened in 1721 in Boston, and smallpox came in onboard a ship. And the captain of the ship steered the ship away from the docks and onto an island where it could be isolated with this person who had smallpox. But then there were other sailors on board who said, 'I'm not sick. Oh, you know, I've been at sea a long time and I want to have some fun.' So they sneak rides on little boats into town, and party it up and mingle and all that, and then they go back to their ship, and oops, then they come down with smallpox. So that's how smallpox got into the city and caused a horrible epidemic. And it's that kind of thing where people are just thinking about, 'Well, what do I want?' Laguaite: Dr. McMurry said there are plenty of striking similarities to earlier outbreaks and the COVID-19 pandemic that come to mind. McMurry: Well, let's pick a cholera epidemic, for example. Laguaite: OK. McMurry: So when cholera was ravaging Europe, in England in 1832, Americans knew about it because there were newspapers and they were aware of what was happening, but there was kind of a complacency like, 'Oh, we have the big ocean between us.' There were two kinds of complacency, so 'the ocean will save us.' And then the other complacency was, 'Well, cholera is just a disease that affects poor people, and we're Americans and we don't really have we don't have those kind of masses of poor peasants and city dwellers. We have sturdy, American farmers.' American exceptionalism, basically another form of that. Laguaite: OK. McMurry: And so a lot of people thought even if cholera made it across the ocean, it wouldn't be a problem, because Americans would just fight it off. And I think we had not exactly that attitude, but I think we were a little too complacent about the excellence of our public health, that— because you remember all that, 'Oh, it won't come here. Oh, it won't make many people sick. Oh, it won't be a big problem.' There was a lot of dismissive—and not so much among our public health officials, but among some other people—that it wouldn't be a problem. And it turned out to be a terrible problem, and we lost the opportunity to get on top of it early. Laguaite: The way in which authorities communicate risk is similar to whether it's a natural disaster like a flood or a pandemic, the central concepts of risk communication are present throughout history. McMurry: A parallel that kind of cuts through all epidemics is, the first thing your authorities will tell you is there's nothing to worry about, sort of every time. And sometimes newspapers or the news media will suppress it as well, sometimes not. Sometimes they're right out there, investigating and revealing but smallpox epidemics, yellow fever epidemics, even the plague, where they tried to be communicative with each of the towns and say, 'Oh, there's plague. It's coming.' Usually, you tried to keep it a secret until it was sort of impossible to keep a secret, then you'd admit 'Oh, yeah, by the way, we've got plague.' Laguaite: But why try to keep things quiet? McMurry: There's several reasons communities do that. And one is just leaders always assume that people will panic if they're told the truth, and maybe they would. But when they're not told the truth, all kinds of other things go wrong. So you know, I don't know what the answer to that is. But it's particularly disheartening to be told there's nothing to worry about. And then any choices you might have made at that stage—if you had been told there was something to worry about—aren't available to you anymore. McMurry: But the other reason, at least in the past, that leaders and news media, will try to keep it quiet, it was because of the economic impact. So as soon as you admit you've got a deadly disease in your midst, well, a bunch of people are going to leave town, first of all. And who can afford to leave town? Wealthier people who run the businesses. If they all go, then the people who are left not only are having to face a disease, but they don't have any way to make a living. So you know, it was terribly disruptive to cities to communities. But also, as soon as everybody else gets wind that you've got a disease, nobody's going to do business with you. You sort of cut yourself off or somebody else cuts you off. But that would be another reason for trying to keep it quiet. Laguaite: Who people should turn to for advice during a public health crisis is another long-standing debate and an issue that was relevant centuries ago. McMurry: This is another smallpox connection. So in the 1700s... I mean, the normal response to an unfamiliar or just any disease, a scary disease is, is to run away if you can. That's a very common thing or to or to try to avoid it anyway, shut yourself in your house or shelter at home, all those things we're familiar with. But in the 1700s, they came up with a treatment that was called inoculation. I mean, it's kind of confusing, because we use that word today. But what they meant back then was actually giving somebody a real case of smallpox, not a safe virus or anything. Laguaite: Got it. McMurry: But the idea was they had seen that some cases of smallpox really were mild and you weren't very sick, and then you were immune for the rest of your life. So some people thought if they could figure out a way to control it so that you got a mild case, it was a risk that—it wasn't perfectly safe—but it was a risk worth taking. And of course, this provoked a huge debate because you were giving people something that could kill them. So all of that just to say, a feature of the debate was who really ought to be the authority to speak on this. McMurry: And I think that's something we've seen over and over again with COVID. It's interesting, in the case of the smallpox epidemic, it was actually the ministers, the religious figures and leaders of the time that were saying, 'Let's try this new technique.' And it was the doctors who were saying, 'No, that's dangerous.' Which is exactly opposite of what you would expect. But in today's world, we've seen a lot of that where we have scientists who know what they're talking about. They don't know everything, and they have to revise what they say, but they sure know a lot more than I do. McMurry: But who are we listening to? We're listening to politicians who feel perfectly free to say whatever they like and to think that they are well informed. Why do they think that? Or celebrities, there's so much celebrity culture. 'I'm going to do what my favorite movie star does.' So that whole question of whom should you listen to? Laguaite: Even the concept of quarantining—a concept I wasn't really familiar with until I had to quarantine for 10 days during the novel coronavirus pandemic—has been used as a preventative measure since the 14th century, with the spread of black death. McMurry: Yeah, so so that's a really interesting point because I remember reading back last summer, somebody was complaining about our public health response. And they said, 'It's just been so medieval.' And I thought, 'Oh, don't be so...' you know, because it's really during the Middle Ages that a lot of our public health—the things we do for public health, even today. We've evolved a lot, but those basic ideas of yeah, quarantine. And that's not to say that those things weren't ever done before. But it's really the experience with the plague that sort of cements it in places. This is the way you try to keep your community safe. Laguaite: That's not to say that quarantining in the Middle Ages is the same process as today. Still, the general principles are there. McMurry: You know, the first thing you would try to do was find out if plague was headed your way. And so some communities like like Venice is a really good example would basically send out spies, because Venice was sort of a... we think of it as a city, but in that time, it was it was a big city state that spread over a big region, almost like a country. And so the Venetians, they have this trading empire, and they were always on the alert for, and they're also kind of on the frontier with the Ottoman Empire and the Holy Roman Emperor Empire to the north. And at least the Venetians thought that those two empires were really slack about keeping the plague away. So they sent their own agents or often merchants to say, 'Keep your ear to the ground. If you hear about anything, we got to know about it.' McMurry: So they were very vigilant about where plague might come from and about setting up border crossings and making ships quarantine in the harbor. They had all kinds of things they could do. So they would also do things with travelers. They had things that you can think of as health passes. If you were a traveler, it's kind of like having a COVID test today: 'Look, see? I'm negative. I'm safe.' They would just have some kind of document that you could carry with you if you're traveling during plague times and say, 'It's OK, I'm safe. You can let me in your town.' Laguaite: But what if all of those preventative measures fail? McMurry: If all that failed, and it often did, and you get a plague outbreak in your own town, well, the first thing they would try to do is isolate people in their homes. So that's another kind of quarantine. And so when we say that we generally mean... I mean the myth about it is, 'Oh, people were shut up and locked in and left to starve.' Well, no, it just meant they tried to keep you from coming out of your house. But you could still have somebody bring food to you or that kind of thing. And sometimes people sneaked out anyway. McMurry: It was a good idea, except that the plague is really being spread via the rats and the fleas. So even if you keep the people apart, the disease tends to still spread. If keeping people in their homes wasn't doing it, then the next thing they would often do when they got just too many victims all over the town, then the next thing you would do would be, try to put up a plague hospital and isolate people there. Partly from the standpoint of, 'Well, we can care for people better if they're all together,' but also from the standpoint of, 'Let's put them all together where they can't spread it to the rest of us.' And that tended to be more people who were poor or otherwise powerless. If you were wealthy and you lived in your big mansion, they probably weren't going to drag you away to a plague hospital, you got to stay home. But yeah, so they had a lot of things that they would try to do. And there was the same kinds of turmoil over like, say they do want to, 'Let's start a hospital for these people,' then there would be, 'Well, not in my neighborhood. Not in my backyard. You can't use this building.' There's that same kind of conflict that we see today. Laguaite: While many people usually look down upon past health measures, she said we can and should look at our own current public health system through an equally harsh lens. McMurry: And when we say, 'Oh, yeah, but those things didn't work because they kept having plague outbreaks.' Well, yes. But then you can't measure the epidemics that didn't happen. You can't say those didn't happen because of the quarantines. You just don't know. It's just always interesting to me that we're really quick to criticize people in the past and say, 'Well, they had quarantines but they didn't work at all,' and seeing that as a failure of public health. We've got a COVID pandemic all over the world. Does that mean our public health efforts are totally useless and misguided? No. Laguaite: Even though the outbreaks, epidemics, and pandemics we've been talking about happened centuries ago, Dr. McMurry said there are many lessons we can take from them. McMurry: [We need] to think really, really, really carefully about the kind of communications that are done. I know I know people can react in really crazy ways. I mean, people who are going to react in crazy ways are going to do that anyway. And there are other people who are really concerned and intelligent and conscientious. How about tell them? McMurry: And I think it's also really hard for people to understand that an epidemic is always an evolving thing. And so you're told one thing today and something different tomorrow. Well, sometimes that's because people have been trying to withhold information, but sometimes it because they just don't know. They're doing the best they can at any point along the spectrum. If leaders would communicate better with the rest of us, and if we would understand that they don't know everything, and the situation is going to change and have some patience and compassion about that... It's just so hard. McMurry: And I think another thing would be—this cuts across way more than just medicine—trying to be prepared for bad things to happen. Because if you go a long time with no bad things happening, you tend to get complacent, and nobody wants to spend money on something that might not happen. So natural disasters, we could be better prepared for that. We can't always predict them or prevent them, but we could be better prepared to manage them. Same thing with a disease outbreak, it's a kind of natural disaster, but it's sort of a different kind. Some of the sorts of public health infrastructure that we've had in the past that cost money to be well prepared. Don't let that go away. That's worth spending money on, and try to educate people to say that, if we don't have an outbreak of disease, that doesn't mean that somebody was just trying to scare you. It means that your public health worked, and value that instead of just saying, 'Oh, we put all that tax money into something that never happened. Well, yeah, that's exactly what you want to happen.' Laguaite: During the COVID-19 pandemic, xenophobia and blatant discrimination toward Asian Americans in the U.S. was a huge issue. In fact, we have an upcoming episode specifically on xenophobia that we've seen in the U.S. this past year. But as it turns out, that was an issue in the past too, and it's one of the most valuable lessons we can apply to today's pandemic. McMurry: Well, you know, I guess another thing would be try to avoid blaming people for— because you were talking about discrimination against Asians for this. You know, using ugly words like the 'China virus.' Nobody can help where it comes from. McMurry: So like with yellow fever, because most people who had it who lived in the South in the 1800s, in, at least in these cities, where yellow fever would tend to occur, would often have had... And this is another parallel with COVID. A bad case of yellow fever has really striking symptoms. But a mild case of yellow fever is no different from any little flu kind of bug with a fever and aches and pains, but then you get over it in a couple days. And you have immunity after that. So a lot of people were immune without even knowing it or thought that their protection derived from living in a particular place for a long time. They didn't know about viruses, and they didn't really know about immunity, but they knew if you had grown up in someplace like New Orleans, you weren't likely to get yellow fever. McMurry: So what that meant was that they would blame it—they would call it a stranger's disease—and they would blame it on immigrants, or anybody who had lived there a long time. You know, these people are saying, 'We would be fine if we didn't have all these extra people coming in among us,' and so I mean, that was a reality in the sense that people who had never been exposed to yellow fever before are more likely to get it. But it wasn't their fault, and they didn't bring it on purpose. So that kind of thing is very discouraging when you see that still happening today. Laguaite: Dr. McMurry said another critical lesson we need to consider is being aware of how outbreaks and pandemics like the COVID-19 pandemic affect different populations disproportionately. McMurry: If we could be more aware and sympathetic to how epidemics affect different parts of the population... That's been brought home to us and that people who are frontline workers and often people of color are in that category. If a new disease is affecting them more, well, respond to that. It's kind of a legacy, really, of blaming diseases in the past on poverty, not in the sense of oh, in a sympathetic way, but in a 'these people are dirty and ignorant and lazy and they don't care. They don't bother to keep themselves clean or try... /episode/index/show/tohealthandback/id/18515675

Early Outbreaks 03/29/2021

Season 1 Trailer 03/22/2021

To Health and Back

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