Pandemic
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In the United States, it was antagonism toward gay people and injecting drug users most at risk of HIV that thwarted early containment efforts. The Centers for Disease Control withheld funding for educational programs that included instructions on how to avoid HIV (through safe sex) that they deemed overly “explicit.” The U.S. Senate prohibited financing for AIDS education materials if they “promoted” homosexuality. For more than two decades, the government banned federal funding for programs that provided injecting drug users with sterile syringes that would reduce their risk of contracting HIV for fear of sanctioning drug use.36
People with AIDS were fired from their jobs, deprived of insurance, health care, and other services, and subjected to violent assaults. In a 1992 survey, more than 20 percent of people with HIV or AIDS said they’d been physically victimized due to their HIV status. Haitians were similarly marginalized, after scientists noticed that clusters of Haitians had been infected with HIV. Many of these cases traced back to the ballooning epidemic in gay men, and the booming sex tourism trade that brought Western tourists into Haiti, but the idea that Haiti itself, with its unhygienic conditions and exotic Voudon rituals, had spread the virus captured the public imagination. “We suspect that this may be an epidemic Haitian virus,” a National Cancer Institute physician told the press in 1982, “brought back to the homosexual population in the United States.”37
“Haitians lost jobs, friends, homes and the freedom to emigrate,” remembers the Haitian American writer Edwidge Danticat. “Children, including myself, were taunted or beaten in school by their peers. One child shot himself in a school cafeteria in shame.” The Haitian tourism industry was destroyed.38
The arrival of West Nile virus in the United States provided another opportunity for people to blame despised—and wildly off the mark—scapegoats. Bioterrorism had long preoccupied certain sectors of the American political establishment, despite the fact that harnessing pathogens for warfare had rarely been attempted in modern times, and even then, mostly unsuccessfully. Members of the Japanese cult Aum Shinrikyo were known to have visited Zaire during an Ebola outbreak, but they apparently found that virus too difficult to weaponize. Besides that, and the poisoning of salad bars with salmonella in Oregon in 1981 by followers of the cult leader Bhagwan Shree Rajneesh, on the eve of West Nile virus’s arrival, there’d been more angst about bioweapons than actual bioweapons themselves. (This was before the 2001 anthrax attacks on the United States, in which five were killed and seventeen sickened.)39
Nevertheless, when West Nile virus arrived in New York City in 1999, government officials were quick to suspect a bioterror attack at the hands of the hated Iraqi president Saddam Hussein.
Paltry evidence was brought to bear: the CDC had sent samples of West Nile virus to an Iraqi researcher back in 1985, and an Iraqi defector named Mikhael Ramadan had claimed that Hussein had weaponized the virus. Among other things, Ramadan said he’d worked as Saddam Hussein’s double. “In 1997,” Ramadan wrote in his 1999 memoir In the Shadow of Saddam, “on almost the last occasion we met, Saddam summoned me to his study. Seldom had I seen him so elated. Unlocking the top right-hand drawer of his desk, he produced a bulky, leather-bound dossier and read extracts from it,” detailing the “SV1417 strain of the West Nile virus—capable of destroying 97 pc of all life in an urban environment.”40
Even putting aside the gross exaggeration of West Nile virus’s virulence—which is less than 1 percent, and which relies upon a complicated transmission sequence from birds to mosquitoes to humans, and does not actually spread directly from one person to another—Ramadan’s account seemed fanciful. Even the tabloid newspaper that published an excerpt from the book, the Daily Mail of London, had to acknowledge that the book was possibly fraudulent, and its publisher admitted that it mostly just wanted to publish a good story. Nevertheless, The New Yorker published a long account by the writer Richard Preston detailing suspicions that Hussein had weaponized West Nile virus and unleashed it upon New York.
Bioweapons analysts at the CIA were “uneasy,” Preston wrote. A top scientific adviser to the FBI told Preston that the fact that the West Nile virus outbreak seemed natural supported the idea that it was indeed a terrorist plot. “If I was planning a bioterror event,” he explained, “I’d do things with subtle finesse, to make it look like a natural outbreak.” Indeed, added Secretary of the Navy Richard Danzig, bioterrorism was “hard to prove.” But it was also “equally hard to disprove.”41
Even short epidemics, like the one SARS caused, have led to violent scapegoating. In 2003, hundreds of Canadians fell ill with SARS after a Toronto resident returned from Hong Kong infected with the virus. Two hospitals in Toronto had to be closed down, all nonessential medical services came to a halt, and thousands of people who had visited the hospitals voluntarily quarantined themselves for ten days. Spain and Australia issued warnings not to travel to the stricken city. In the panicked hysteria that followed, Asians of all stripes—whether they’d traveled abroad or not—found themselves singled out for social exclusion.42
Chinese Canadians were shunned on the subway.43 “If you sneeze or cough,” one remembered, “you could empty the train!” White Canadians pulled their jackets over their faces when passing Asians in hallways and wore masks in their offices if they had Asian coworkers. “As far as I’m concerned,” one Asian Canadian overheard a coworker saying, “the whole community should be locked up.” Families told their children not to play with Asian kids at school, employers withdrew job offers to Asian candidates, and landlords kicked Asian families out of their homes. Hate mail besieged organizations such as the Chinese Canadian National Council: “you people live like rats and eat like pigs and spread dirty, dirty, dirty disease around the world,” one letter read. Losses to Chinese-owned businesses in Toronto reached up to 80 percent. “Asians were afraid to go anywhere,” one Asian Canadian remembers.44
Epidemic-fueled violence has befallen other species, too. It made a certain amount of sense, in the beginning of the Lyme disease outbreak, to target deer. Early studies had found that the ticks that carry the disease fed on deer, and that on islands where deer were eradicated, tick populations fell. Plus, the nationwide deer population had zoomed from 250,000 in 1900 to 17 million by the mid-1990s. The animals rampaged through forests and destroyed suburban lawns and gardens.45
But follow-up research showed that deer had nothing to do with infecting ticks—the ticks pick up the bacteria that cause Lyme disease from rodents. Nevertheless, bloodthirst for the antlered animals rose.46 Towns and counties across Connecticut, Massachusetts, New Jersey, and elsewhere expanded their deer-hunting seasons and opened up previously off-limits public lands to deer hunters. In Nantucket, orange-vested hunters from as far afield as Texas and Florida descended upon the island to stalk the animals. “Something has to be done,” a Nantucket resident insisted. “People are going to die from this.”47 The History Channel created a reality television show to capture the rapidly expanding hunt, following camo-wearing deer hunters as they convinced the well-heeled residents of suburban Connecticut to allow them to shoot deer—“infamous for causing car accidents and spreading Lyme disease” as the show’s website put it—on their property. (That series was titled, grievously, Chasing Tail.)48
The authoritarian government of Hosni Mubarak ordered a similar slaughter, this one of Egypt’s three hundred thousand pigs, during the H1N1 influenza pandemic of 2009. There was no evidence that pigs had played a role in spreading H1N1. The virus originated in pigs, which is why it was initially called “swine” flu, but it was a human pathogen: people caught it from each other. Egypt hadn’t suffered even a single case of H1N1 flu at the time. Nevertheless, upon government orders, bulldozers and pickup trucks scooped up scores of swine. Some were killed with knives and clubs. “A large number of the pigs were herded into pits,” The Christian Science Monitor reported, “and buried alive.”
The bloodbath did little to quell H1N1’s spread. It did, however, dest
roy the livelihood of the pigs’ owners, the trash collectors called zabaleen of Egypt’s embattled Christian minority.
In this case, scapegoating in reaction to one pathogen increased people’s vulnerability to other ones. The pigs played an important role in protecting the public’s health, by being used by the zabaleen to consume the organic portion of the household waste they collected door-to-door. In Cairo, their pigs processed 60 percent of the city’s trash. Deprived of their pigs, the zabaleen stopped collecting trash altogether. When the government’s attempt to replace them failed—the international waste collection companies the government hired expected Egyptians to pack their garbage into bins for periodic pickup, which they didn’t like to do—trash accumulated on the streets, threatening Egyptians with filthborne contagions. “On any given day,” wrote one visiting reporter, “a given neighborhood becomes a ‘no man’s land’ of garbage.” The slaughter of the pigs, said one community leader in Cairo, “was the stupidest thing they ever did … just one more example of poorly informed decision makers.”
Ultimately, while the people of Egypt skirted the disease risks posed by their trash buildup, the Mubarak regime didn’t fare as well—it fell during the Arab Spring revolution two years later.49
* * *
Epidemics are not the only social crises that have led to attacks on health-care workers and medical interventions. Vaccination campaigns have triggered similar waves of violent rejection and reprisals. But while the cause is different, the result is the same: efforts to contain pathogens are undermined, allowing epidemics to unfold.
Around the world, from the villages of northern Nigeria to the suburbs of Los Angeles, people have rejected vaccines and those who administer them, accusing them of a range of misdeeds, from undermining Islam to poisoning babies with chemicals. The WHO’s campaign to eradicate polio, launched in 1998, is a good example. Rumors about the safety and purpose of the vaccine abound. In Nigeria, Muslim leaders said that the polio vaccine was contaminated with HIV and secretly meant to sterilize Muslims. The governor of Kano state halted the campaign for a year.50 In North Waziristan, Pakistan, Taliban leaders claimed that the vaccine teams were a cover for an espionage campaign.51 In Bihar and Uttar Pradesh in India, people alleged that the shot was contaminated with pig’s blood and contraceptives.52 And these suspicions often flared into violence. In northern Nigeria, vaccinators were assaulted and barred from entering homes. In Pakistan in 2012, militants began targeting vaccine workers, along with parents who agreed to have their children vaccinated. By 2014, they’d killed sixty-five vaccine workers.53
The reasons behind the violence are undoubtedly variable and rooted in local circumstances. But like societies gripped by epidemics of new disease, the Muslim societies that rejected Western-led vaccine campaigns were in the throes of a similarly existential crisis: a rising tide of anti-Muslim sentiment in the United States and Europe and the looming threat of military intervention. And Western vaccinators may have seemed like agents of destruction the same way that clinicians seemed the abettors of Ebola in the forests of Guinea and the Irish the conveyers of cholera in nineteenth-century New York. They had, in fact, been known to participate in coercive, secretive campaigns. During the 1970s campaign to eradicate smallpox, American vaccinators in South Asia had smashed down doors and held down crying women to administer the shots.54 In the Philippines, people had been rounded up at gunpoint to be vaccinated against smallpox.55 In 2011, the Central Intelligence Agency had used a sham hepatitis B vaccination campaign as a cover to collect information that led to the assassination of Al Qaeda leader Osama bin Laden in Pakistan.56
Whatever the reason, wherever vaccine refusals took hold, polio surged. And it spread. Nigeria’s polioviruses spread into northeastern Ghana, Benin, Burkina Faso, Chad, Mali, Niger, and Togo. Poliovirus in India spread southward to Congo, triggering an outbreak among older, unvaccinated people. “We’ve got two hospitals with hundreds of paralyzed people and many dead,” the WHO’s Dr. Bruce Aylward told The New York Times in 2010. In just two weeks that year, Indian poliovirus paralyzed more than two hundred people in Congo.57 Poliovirus from Pakistan migrated into China, which hadn’t seen indigenous polio transmission since 1994, and, amid the wreckage of a brutal civil war, into Syria in 2013.58 In 2014, the World Health Organization was forced to declare a global health emergency.59
Deep mistrust of vaccines and vaccinators has allowed once tamed pathogens to cause outbreaks in the United States and Europe as well. Despite the fact that vaccination played a decisive role in reducing cases of pertussis, measles, and chicken pox in the United States, when the government started requiring that children receive a battery of vaccinations before entering school in the 1980s, resistance to vaccines and mistrust of vaccinators mounted. Pop-music acts such as the Refusers railed against vaccination programs, as did celebrities such as the actors Jenny McCarthy and Jim Carrey. Thousands of websites assailing the risks of vaccination sprang up on the Internet.60
Vaccine refusals in the United States follow the same contours as they do elsewhere. The existential crisis that seems to fuel the mistrust in this case—roughly, the industrial contamination of nature—is more amorphous, but the vaccines and vaccinators targeted for reprisals are similarly imbued with malevolent power. One of the most popular antivaccine arguments is that the measles-mumps-rubella combination vaccine is endowed with the mysterious power to cause the poorly understood and increasingly common condition of autism. This claim is as exaggerated and conspiratorial as was the claim that doctors killed people with cholera to dissect their bodies in the nineteenth century, or that the polio vaccine is designed to sterilize Muslims. It’s plainly contradicted by the facts. The 1998 research paper that alleged a link between the MMR vaccine and autism has been widely debunked and was withdrawn by the journal that published it. Plus, a 2013 study found that autism can be effectively detected in children at the age of six months, well before any would have been vaccinated against measles, negating any causal link between the two. The claim continues to make the rounds regardless.61
Another popular antivaccine claim is that drug companies push vaccines solely to make more money. This too is contrary to fact. Corporate influence on vaccine promotion is relatively slim. Indeed, drug companies have considered vaccines so unprofitable that during the 1990s and 2000s, many abandoned the vaccine business altogether. Between 1998 and 2005, nine vaccines required for routine childhood immunizations suffered chronic shortages as a result.62
But while vaccines neither cause autism nor drive the bottom lines of drug companies, they are the concentrated result of elaborate industrial processes. For people who fear industrial contamination, that’s sufficient grounds to reject them. After all, vaccine skeptics who advise families to eschew vaccines don’t object to the concept of immunization, in which bodies are exposed to a weakened pathogen to prophylactically build up immunity to it. The magazine Mothering, for example, which focuses on natural parenting techniques, suggests that in lieu of vaccination against chicken pox, families throw “pox parties,” at which children infected with chicken pox purposely infect others. “Pass a whistle from the infected child to the other children at the party,” the magazine advises. What they object to is not immunization but its delivery via the vaccine, a synthetic product of industrial processes that is injected directly into the body.63
The rage and frustration of the vaccine-promoting pediatricians and public-health experts on the receiving end of this mistrust is palpable. Nearly 40 percent of pediatricians surveyed by the American Academy of Pediatrics in 2005 claimed that they’d refuse to provide care to any family that rejected vaccines.64 At a gathering of public-health experts in Atlanta in 2012, a speaker discussed the problems with the “anti-vaccinology” crowd. At one point, he broadcast an illustration of an MRI scan of the cartoon character Bart Simpson’s head, his minuscule brain prominently highlighted. “I think this may be one of the anti-vaccinologists,” he muttered theatrically, to tit
ters from the audience. “No, I shouldn’t say that!”65
As vaccine refusals have spread, the protections they provided against pathogens are fraying. Amid a rising tide of antivaccine suspicion, nineteen U.S. states allowed parents to exempt themselves from vaccinating their school-age children for “philosophical” reasons. Fourteen states, including California, Oregon, Maryland, and Pennsylvania, passed laws making it easier for parents to exempt their children from vaccination than to actually vaccinate them.66 By 2011, more than 5 percent of kindergarteners in public schools in eight states had not been vaccinated.67 Seven percent of schoolkids in Marin County, one of the wealthiest counties in California, were unvaccinated for philosophical reasons. That’s enough to undermine “herd immunity” against pathogens like measles, whereby pathogens are deprived of sufficient numbers of susceptible people to spread. Without herd immunity, pathogens can infect both unvaccinated people and those who can’t be vaccinated, like infants.
Measles had been formally declared eliminated from the United States in 2000; by 2011, there’d been over a dozen new outbreaks, including one that began in late 2014 at the Disneyland theme park in California. Within two months, that outbreak had infected 140 people in seven states. (The governor of California eliminated personal and religious belief exemptions for vaccines a few months later.)68
Skepticism about vaccines, in particular the MMR, is even more widespread in Europe. In 2006, more than half of the French populace had not received the required two doses of measles vaccine.69 Neither had 16 percent of the British populace in 2011.70 An epidemic of measles started in Bulgaria in late 2009, spreading into Greece and ultimately to thirty-six countries across Europe. France and Britain were particularly hard hit.71 By 2011, more than fourteen thousand people fell ill with measles in France. Across the Continent, measles sickened over thirty thousand.72