Pandemic Syllabus

Disease has never been merely a biological phenomenon. Instead, all diseases—including COVID-19—are deeply social phenomena: in their origins, in their spread, in their impacts, and in the responses they engender among populations. Disease can also run into and catalyze larger historical currents, as the anger coming to a boil in the past weeks has shown us.

Yet more often than not, such a social, holistic view is rarely found in the public discourse around a disease. Instead, ever since the “bacteriological revolution,” almost a century and a half ago, we have found ourselves prisoners of a rigid set of formulaic scripts, which constrain our ability to understand, respond to, and prevent disease. We have silenced the voices of those who sought better health for all through social justice and universal economic opportunity. We have entrusted exclusive authority over health to the specialized knowledge, laboratories, and institutions of scientific medicine. And we have not reflected on the underlying assumptions embedded in the terms and institutions we use to mediate disease.

Such narrowness has had real consequences. But the current moment has renewed and forced reflection. At some point in early 2020, COVID-19 ceased being a distant rumor or something that those in Western countries could banish as just a SARS-like “Eastern thing” (itself a byproduct of selective memory, given SARS’s impact on Toronto). Rather, COVID-19 suddenly became an all-consuming fact of life around the world, with anxious people casting about frantically for protection, advice, or reassurance.

These people turned, of course, to doctors, hospitals, and public-health authorities. But to a surprising and frankly disorienting extent, they also turned to historians. Scholars accustomed to being politely ignored or used mostly to provide narrative background music now found themselves earnestly beseeched for words of wisdom that would help us make sense of this profound upheaval. Geographic variation in 1918 flu death rates, the successes and failures of vaccination campaigns, and the lessons to be extracted from HIV/AIDS, among other episodes, suddenly became objects of public fascination.

We are three historians of public health who focus on different time periods and geographic areas. We have constructed this syllabus to provide a range of voices and perspectives that give context not just to COVID-19 but also to the medical, scientific, cultural, political, and economic structures that shape this and other pandemics. They are structures that, beyond biology alone, are often what make pandemics selectively—and unequally—deadly.

We designed this syllabus as a challenge to status quo thinking on disease. We did so with the knowledge that it would be perfectly possible to create a dozen such credible and entirely different reading lists. This particular syllabus is anchored by four goals:

Our first goal is to scrutinize narratives of technoscientific salvation. Common public celebratory stories of illness—plague, yellow fever, cholera, influenza, smallpox, and, yes, COVID-19—have been produced within power structures that often serve entrenched interests, in particular notions of universal, technological interventions and Western biomedicine as “saviors” that can ignore the politics of context. By circumscribing “public health” as a narrow domain that occurs outside larger societal currents, this status quo script has limited our ability to think bigger in our responses to all manner of health threats, everything from “ordinary” chronic diseases to terrifying pandemics like COVID-19.

Shedding light on an equally troubling narrative—a self-celebratory triumphalism that often colors accounts of public-health victories—is our second goal. This syllabus certainly catalogs some big wins of the public-health enterprise when it comes to infectious-disease control. But it also shows that “public health” is deeply rooted in xenophobic and racist ideology, which blamed disease outbreaks on contamination by foreigners or racialized outsiders; in theological beliefs, which punished moral transgression with divine retribution in the form of illness and death; and in a Victorian perspective, which views the world through the class-inflected lens of medical mandarins. Public health was rooted in a colonizing enterprise and tied to the deeply unequal operations of global capital. These priorities were affirmed, validated, and sustained through public-health research institutions, tropical-medicine laboratories, and interventions in colonized societies that segregated and contained locals; limited medical cures and therapies to saving lives in the military; offered sanitary cordons to a ruling elite; and focused on trying to keep “productive” labor in plantations and factories healthy to serve the interests of imperial trade. Put another way, public health has been the contingent story both of progress and of exclusion and stigma. And its victories have often only been partial, built on the backs of the marginalized and leaving many people behind.

Exclusion and inclusion point to a third goal: worldliness. Much of the English-language writing on COVID-19 has been provincial. One mark of that is obvious: such writings’ accelerated appearance once COVID-19 reached American shores. We have tried hard here to avoid a “West and the Rest” approach, while not ignoring the outsize importance of the United States and Western Europe in shaping—for better or for worse—the public-health agenda. Ultimately, COVID-19 underscores that a health injury to one country is a health injury to all. A reading list should reflect that.

The syllabus’s last purpose is rooted in who we are. As faculty in the Health & Societies major at the University of Pennsylvania and in the Center for the History and Ethics of Public Health at Columbia University’s Mailman School of Public Health, we teach students who aspire to all kinds of careers and approach health from a number of disciplinary angles. We’ve included bits of our own work here, so that you can get a sense of the different ways we approach things, warts and all.

Our syllabus is underpinned by a strong belief that the long view effectively equips readers to leave with a sober understanding of public health’s many limitations but also a sense of positive and liberatory alternatives. Besides bringing to greater awareness what much of society—including even some public-health professionals—would rather forget, history also, in the words of historian Christopher Hamlin, allows one “to go back to the beginning, to recover possibility in the past,” and “to open our eyes to the possibilities we confront in the present.”¹ Last but not least, we acknowledge that a great deal of public-health history writing still needs to uncover and pay attention to themes and issues of intersectionality of power relating to race, ethnicity, class, and gender. May these readings serve as an initial step to open up further debate on both everyday and systemic injustices relating to disease risks and access to health as these have been exposed and exacerbated by COVID-19.

The overwhelming majority of readings here are thus by historians and about the past, though the syllabus is dotted with cross-disciplinary selections, too. Our hope is that this list—like any good course—is merely a starting point, one that spurs readers to embark on their own lines of inquiry. To that end, we want to acknowledge and embrace other efforts toward that goal, like the #CoronavirusSyllabus spearheaded by Alondra Nelson, which spans a wider disciplinary scope and covers a larger gamut of questions, and thank Dr. Nelson for her support of this effort.

We proceed in three parts. The first three weeks provide the reader with a vocabulary and heuristics for parsing pandemics and the underlying social determinants and inequities that determine their decidedly nonrandom course. The next six weeks examine public health and infectious-disease control in a number of cross-national contexts and time periods, highlighting indisputable triumphs—and noting the asterisks that must be placed next to them. The final two weeks come full circle, moving away from case studies and into two sets of readings that consider uncertain paths forward, both for public health generally and COVID-19 specifically.

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Week One

The Rhetoric of Contagion and -demics

“Disease” is an elusive entity. It is not simply a less than optimum physiological state. The reality is obviously a good deal more complex; disease is at once a biological event, a generation-specific repertoire of verbal constructs reflecting medicine’s intellectual and institutional history, an occasion of and potential legitimation for public policy, an aspect of social role and individual—intrapsychic—identity, a sanction for cultural values, and a structuring element in doctor and patient interactions. In some ways disease does not exist until we have agreed that it does, by perceiving, naming, and responding to it.

—Charles E. Rosenberg (1992)

• Bob Crawford and Ben Sawyer, “The Outbreak Narrative with Priscilla Wald,” The Road to Now (podcast), April 6, 2020
• Charles E. Rosenberg, “Explaining Epidemics” and “Framing Disease: Illness, Society, and History,” in Explaining Epidemics and Other Studies in the History of Medicine (Cambridge University Press, 1992)

 

Week Two

Inequality and the Patterning of Disease

 

• Bruce G. Link and Jo Phelan, “Social Conditions as Fundamental Causes of Disease,” in “Forty Years of Medical Sociology: The State of the Art and Directions for the Future,” edited by Mary L. Fennell, extra issue, Journal of Health and Social Behavior (1995)
• James Colgrove, “The McKeown Thesis: A Historical Controversy and Its Enduring Influence,” American Journal of Public Health, vol. 92, no. 5 (2002)
• Simon Szreter, “Rethinking McKeown: The Relationship between Public Health and Social Change,” American Journal of Public Health, vol. 92, no. 5 (2002)
• Allan Mitchell, “An Inexact Science: The Statistics of Tuberculosis in Late Nineteenth-Century France,” Social History of Medicine, vol. 3, no. 3 (1990)
• David S. Barnes, “The Rise or Fall of Tuberculosis in Belle-Epoque France: A Reply to Allan Mitchell,” Social History of Medicine, vol. 5, no. 2 (1992)

 

Week Three

The Impact of “Germ Theory” in Cross-National Context

• Nancy Tomes, “The Making of a Germ Panic, Then and Now,” American Journal of Public Health, vol. 90, no. 2 (2000)
• Mary P. Sutphen, “Not What but Where: Bubonic Plague and the Reception of Germ Theories in Hong Kong and Calcutta, 1894–1897,” Journal of the History of Medicine and Allied Sciences, vol. 52, no. 1 (1997)
• Michael Worboys, introduction to Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (Cambridge University Press, 2000)
• Maynard W. Swanson, “The Sanitation Syndrome: Bubonic Plague and Urban Native Policy in the Cape Colony, 1900–1909,” Journal of African History, vol. 18, no. 3 (1977)
• Rajnarayan Chandavarkar, “Plague Politics and Epidemic Politics in India, 1896–1914,” in Epidemics and Ideas: Essays on the Historical Perception of Pestilence, edited by Terence Ranger and Paul Slack (Cambridge University Press, 1992)

 

Week Four

Prior Governmental Responses to Epidemics

Technical solutions for disease control have a variety of complex social implications.

—Evelyn Hammonds (1999)

• Isaac Chotiner, “How Governments Respond to Pandemics Like the Coronavirus” (interview with Richard J. Evans on 1892 cholera epidemic in Hamburg), New Yorker, March 18, 2020
• Howard Markel, Harvey B. Lipman, J. Alexander Navarro, et al., “Nonpharmaceutical Interventions Implemented by US Cities During the 1918–1919 Influenza Pandemic,” JAMA, vol. 298, no. 6 (2007)
• Steven Burg, “Wisconsin and the Great Spanish Flu Epidemic of 1918,” Wisconsin Magazine of History, vol. 84, no. 1 (2000)
• Mridula Ramanna, “Coping with the Influenza Pandemic: The Bombay Experience,” in The Spanish Influenza Epidemic of 1918: New Perspectives, edited by Howard Phillips and David Killingray (Routledge, 2003)
• Katherine A Mason, “Reflecting on SARS, 17 Years and Two Flu-Like Epidemics Later,” Somatosphere, March 16, 2020

 

Week Five

Eradication (I)—Victory over Pathogens

• Donald Henderson, “Smallpox Eradication: A Cold War Victory,” World Health Forum, vol. 19 (1998)
• Smallpox oral histories, Global Health Chronicles, created by the David J. Sencer CDC Museum at the Centers for Disease Control and Prevention and the Emory Center for Digital Scholarship
• Sanjoy Bhattacharya, “Reflections on the Eradication of Smallpox,” Lancet, vol. 375, no. 9726 (2010)

 

Week Six

Eradication (II)—The Underside of Triumph

 

• Sanjoy Bhattacharya and Rajib Dasgupta, “Smallpox and Polio Eradication in India: Comparative Histories and Lessons for Contemporary Policy,” Ciência e Saúde Coletiva, vol. 16, no. 2 (2011)
• Paul Greenough, “Intimidation, Coercion, and Resistance in the Final Stages of the South Asian Smallpox Eradication Campaign, 1973–1975,” Social Science and Medicine, vol. 41, no. 5 (1995)
• Christian W. McMillen and Niels Brimnes, “Medical Modernization and Medical Nationalism: Resistance to Mass Tuberculosis Vaccination in Postcolonial India, 1948–1955,” Comparative Studies in Society and History, vol. 52, no. 1 (2010)
• Anne-Emanuelle Birn, “Small(pox) Success?,” Ciência e Saúde Coletiva, vol. 16, no. 2 (2011)

 

Week Seven

Racism, Xenophobia, and the Rhetoric of Blame

 

• Absalom Jones and Richard Allen, A Narrative of the Proceedings of the Black People, during the Late Awful Calamity in Philadelphia, in the Year 1793: And a Refutation of Some Censures, Thrown upon Them in Some Late Publications (1794)
• Rana Asali Hogarth, “The Myth of Innate Racial Differences between White and Black People’s Bodies: Lessons From the 1793 Yellow Fever Epidemic in Philadelphia, Pennsylvania,” American Journal of Public Health, vol. 109, no. 10 (2019)
• Alan M. Kraut, “Immigration, Ethnicity, and the Pandemic,” Public Health Reports, vol. 125, suppl. 3 (2010)
• Natalia Molina, “Borders, Laborers, and Racialized Medicalization Mexican Immigration and US Public Health Practices in the 20th Century,” American Journal of Public Health, vol. 101, no. 6 (2011)
• Samuel Roberts, “‘Where our Melanotic Citizens Predominate’: Locating African Americans and Finding the ‘Lung Block’ in Tuberculosis Research in Baltimore, Maryland, 1880–1920,” in CrossRoutes, the Meanings of “Race” for the 21st Century, edited by Paola Boi and Sabine Broeck (Transaction, 2003)
• Nayan Shah, “Cleansing Motherhood: Hygiene and the Culture of Domesticity in San Francisco’s Chinatown, 1875–1900,” in Gender, Sexuality, and Colonial Modernities, edited by Antoinette Burton (Routledge, 1999)

 

Week Eight

The Lessons of HIV/AIDS (I)—From Stigmatization and Death Sentence to Chronic Disease

Undoubtedly, the lack of action, from the general public on down to the president, was and is directly tied to the conception of AIDS as a disease of white gay men, black and Latino/a drug users, and other marginal people engaged in “immoral behavior.”

—Cathy Cohen (1999)

• National Institutes of Health, episode of the Medicine for the Layman series on AIDS, featuring an interview with Anthony Fauci (1984)
• John Iliffe, “Origins” and “Containment,” in The African AIDS Epidemic: A History (Ohio University Press, 2005)
• Steven Epstein, “The Construction of Lay Expertise: AIDS Activism and the Forging of Credibility in the Reform of Clinical Trials,” Science, Technology, and Human Values, vol. 20, no. 4 (1995)
• ACT UP Oral History Project, coordinated by Jim Hubbard and Sarah Schulman
• Paul Farmer, “From Haiti to Rwanda: AIDS and Accusations,” in Partner to the Poor: A Paul Farmer Reader, edited by Haun Saussy (University of California Press, 2010)
• David Ho, interview for “The Age of AIDS,” Frontline, PBS (transcript drawn from four interviews conducted in New York and China in April and June 2005, and March 2006)

 

Week Nine

The Lessons of HIV/AIDS (II)—Progress on Whose Backs? Who Got Left Behind?

 

• Emily Bass, “How to Survive a Footnote: AIDS Activism in the ‘After’ Years,” n+1, no. 23 (2015)
• Randall M. Packard and Paul Epstein, “Epidemiologists, Social Scientists, and the Structure of Medical Research on AIDS in Africa,” Social Science and Medicine, vol. 33, no. 7 (1991)
• Julie Livingston, “AIDS as Chronic Illness: Epidemiological Transition and Health Care in South-Eastern Botswana,” African Journal of AIDS Research, vol. 3 no. 1 (2009)
• Robert E. Fullilove, “Did Mass Incarceration Cause the HIV/AIDS Epidemic in the US?” TEDMED Day CUMC video, July 6, 2013
• Gretchen Gavett, “Timeline: 30 Years of HIV/AIDS in Black America,” Frontline, PBS, July 10, 2012

 

Week Ten

“Public Health”—Where From and Where Next?

Public health belongs to social justice quite as much as to civil engineering or epidemiology. It is inescapably, not incidentally, a matter of political philosophy in the grandest and broadest sense.

—Christopher Hamlin (1998)

• Christopher Hamlin, “Could You Starve to Death in England in 1839? The Chadwick-Farr Controversy and the Loss of the ‘Social’ in Public Health,” American Journal of Public Health, vol. 85, no. 6 (1995)
• Anne-Emmanuelle-Birn, “Gates’s Grandest Challenge: Transcending Technology as Public Health Ideology,” Lancet, vol. 366, no. 9484 (2005)
• David S. Barnes, “Historical Perspectives on the Etiology of Tuberculosis,” Microbes and Infection, vol. 2, no. 4 (2000)
• Kavita Sivaramakrishnan, “The Return of Epidemics and the Politics of Global-Local Health,” American Journal of Public Health, vol. 101, no. 6 (2011)
• Evelyn Hammonds and Susan Reverby, “Toward a Historically Informed Analysis of Racial Health Disparities Since 1619,” Amerian Journal of Public Health, vol. 109, no. 10 (2019)

 

Week Eleven

COVID-19 and the Path Forward

 

• Alex de Waal, “New Pathogen, Old Politics,” Boston Review, April 3, 2020
• Andrew Liu, “‘Chinese Virus,’ World Market,” n+1, March 20, 2020
• Aruna Roy and Saba Kohli Davé, “Analysing Kerala’s Response to the COVID-19 Pandemic: When People and Governments Come Together,” Economic and Political Weekly, May 2, 2020
• Merlin Chowkwanyun and Adolph L. Reed Jr. “Racial Health Disparities and Covid-19: Caution and Context,” New England Journal of Medicine, May 6, 2020
• Thomas Levenson, “The Term Wuhan Virus Treats COVID-19 as a Chinese Scourge—and Ignores an Ugly History,” The Atlantic, March 11, 2020

 

This article was  commissioned by Caitlin Zaloom.