Ivermectin is an old medicine used to treat parasitic infections in humans, for everything from river blindness to scabies. It is better known, perhaps, as a deworming medication that farmers and pet owners use to treat everything from cattle to dogs. The medicine has been used around the globe for 40 years. With the onset of COVID-19 -as people were desperate for some treatment, they have seized on different medications as a possible cure-all. The first was hydroxychloroquine, a medication commonly used to treat malaria. I first heard about this medicine from a neighbor, who told me that her spouse was obsessed with it. This was in the spring of 2020, when people in Boston and Cambridge were watching a tent being set up outside of of Massachusetts General Hospital to treat COVID-19 patients. People were desperate for a treatment. After being trumpeted by the Presidents of the United States and Brazil, a series of well-designed scientific studies showed that the medicine had no clear advantages while holding significant risks. As it fell out favor, people then turned to Ivermectin.
Of course, Ivermectin has been shown to have some antiviral properties. But so have many other medications. The question was- what was the evidence that it was useful against COVID-19? Very quickly my timeline on Twitter was filled with people talking about Ivermectin. The most common comment was perhaps that big pharmaceutical companies were hiding their knowledge about Ivermectin because it was off-patent and cheap. Dr. John Campbell -who has an excellent YouTube channel with daily updates on the COVID-19 pandemic- began to highlight Ivermectin as a potential treatment. An Indian state encouraged its use. Desperate people began to go to farmer’s Co-ops to obtain medicine intended for cattle for their use. Countries put Ivermectin into their national guidelines for the treatment of COVID-19, especially in hard-hit Latin America. People with Long COVID reported remarkable recoveries after taking the medicine. But what is the evidence for Ivermectin? …
After the wonderful histories of Alfred Crosby and John Barry, readers might wonder if there is truly anything new left to write about the 1918 influenza pandemic, which killed between 50 and 100 million people world-wide, at a time when the world’s population was much smaller. Laura Spinney’s detailed, beautifully written and insightful work shows how much study can yet be done on this topic.
As Spinney describes in the opening to her book, in the 1990s much of the writing on this pandemic had been done on Europe and the United States. Of course there were exceptions. In Canada Eileen Pettigrew created a rich narrative of people’s experiences from survivors accounts, while Betty O’Keefe and Ian MacDonald told the story of how medical officer Fred Underhill fought the disease in Vancouver, Canada. There were similar accounts of popular experiences with the pandemic in other countries, such as Australia and New Zealand. But voices in Asia, Latin America and Africa were often not included. Since the 1990s there has been a plethora of work in many different nations, at the same that scientific advances have made it possible to have a much better understanding of the pandemic.
Spinney’s history takes full advantage of this study. She also has a gift for seizing upon the lives of individuals to tell a broader story, whether it was a young man in Rio de Janeiro, Brazil or a scientist in Republican China. She weaves together these narratives to create an overarching view that is truly global. After reading the work I find myself curious to learn more details on individuals, such as a woman affected by the pandemic in South Africa, who then created a religious (and perhaps millenarian) movement.
While such individual accounts are powerful, I particularly like chapter fifteen, in which she described how the same virus had dramatically distinct impacts in different places. Why would the same disease cause mortality rates in excess of 80 percent in some remote Alaskan and Labradoran villages, and far lower rates elsewhere? Of course, the flu was not unique in this respect. I wrote an entire book trying to understand the diversity of HIV epidemics in Latin America. What is perhaps most striking to me is that after a century of earnest study, many of these questions remain unanswered.
What is clear was that the pandemic utterly devastated some locations. In Western Samoa, twenty-two percent of the population died. In the Pacific, on the island of Vanuatu perhaps 20 languages died because of the heavy mortality that the virus brought. Given Brazil’s catastrophic response to the COVID-19 pandemic, and the disproportionate impact that the virus is having on Brazil’s Indigenous peoples, might something similar happen in the Amazon rain forest now? As Spinney states, there was a strange paradox to the virus. Cities often saw high mortality rates, but isolation caused terrible vulnerabilities in remote communities.
What was also striking to me was her discussion of the influenza’s aftermath. In part, this was reflected in such societal trends as a loss of faith in science. Will we be struck by a similar trend with COVID-19? But there was also a physical legacy of the virus, as many people suffered either psychological trauma over the loss of loved ones, or debilitating physical effects that lingered long after the virus was gone. Of these, perhaps the most famous was encephalitis lethargica. While it cannot be proven that the 1918 influenza pandemic caused this disorder -again so much remains unknown about this tragedy- the onset of the one was accompanied by the emergence of the other, as some people remained paralyzed -but apparently aware- for decades. Will COVID-19 have similar health effects that linger for more than a generation? The thought is chilling, given that one recent pre-publication from Korea just reported that up to 90 percent of COVID-19 survivors still report symptoms months later.
Still, what most struck me is that we are now having the same debates now that we had over a century ago: “One 2007 study showed that public health measures such as banning mass gatherings and imposing the wearing of masks collectively cut the death toll in some American cities by up to 50 percent (the US was much better at imposing such measures than Europe).” While now it is the US struggling to persuade its citizenry to wear masks, there is a haunting quality to the debates from this time. Some challenges that faced public health authorities then echo during the COVID-19 pandemic now, although (as far as I know) the death threats and public vilification of public health leaders was uncommon in America a century ago. So perhaps things have gotten worse. Spinney’s last two chapters are remarkably prescient for a book that was published in 2018.
I’ve spend much of the last twenty years working on public policy and infectious disease, first with my book on HIV/AIDS, and more recently with Zika and avian influenza. Some factors are constant, such as the fact that conspiracy theories emerge with every pandemic. One of the most common human urges when faced with an outbreak is to find someone to blame. But what depresses me is that I don’t think the historical studies or public policy achievements make much difference in the long run. In 2018 I published an article on wet markets in Hong Kong, which recommended that the special administrative region consider closing them. Of course, COVID-19 did not emerge in Hong Kong, but likely from a wet market in eastern China. One of the reasons that I hate conspiracy theories is that the distract from the real actions that could make people safer. They also make pandemics and outbreaks seem mysterious and unpredictable.
In fact, people have been studying coronaviruses in China since SARS emerged in 2003 precisely because such an event might take place. This was entirely predictable. As I said in an earlier blog post, how much human suffering might have been avoided if China’s wild game markets -which particularly cater to an older and wealthier clientele- had been closed. Yet even the Chinese government -with all its power and influence- either would not or could not do this. And now social media accounts spread tales that this outbreak is caused by 5G, and people in Britain burn cell towers. Two million people have died globally and winter is drawing closer in the northern hemisphere. We all know what happened in November 1918. Now we must now hope that a different virus will have a dissimilar impact.
Yet behind the scenes scientists have laid the groundwork that will allow for vaccines to be more quickly developed, because much basic science work has been completed. For all the frustration with sciences’ failures and limitations, the hope that we have now doesn’t come from conspiracy narratives -which don’t lead to any constructive steps- but from the often ignored work by nearly anonymous scientists in global laboratories. This work lacks the drama of the conspiracy theories, but the time-consuming and methodical study has laid the groundwork for the greatest vaccine push in human history. Conspiracy theories are easy to create. Real public policy or scientific advances are far more difficult, time-consuming and (often) difficult to understand. Spinney’s work is built upon a detailed examination of both the historical and scientific literature that has been built up over the last century, particularly the last twenty years.
It has long gone out of fashion in academia to look for lessons or a moral in history. But if this line of thinking is taken too far, it might lead people to question the value of history entirely. If historical study cannot give us lessons for the present period, isn’t it little more than a hobby for the affluent few? Laura Spinney’s brilliant book shows how a careful understanding of history can provide us the context to better understand current challenges. Sadly, in this current moment, it’s probably difficult to interest people in reading a work about a past outbreak. Spinney’s magisterial, carefully researched and beautifully written book deserves a broad audience. Highly recommended.
Spinney, Laura. Pale Rider : The Spanish Flu of 1918 and How It Changed the World. First US Trade Paperback ed. New York: PublicAffairs, 2018.
See also the following works for more reading on this topic.
Barry, John M. The Great Influenza : The Epic Story of the Deadliest Plague in History. New York: Viking, 2004.
Crosby, Alfred W. America’s Forgotten Pandemic. West Nyack: Cambridge University Press, 2003.
Canadian popular histories:
O’Keefe, Betty, and Ian Macdonald. Dr. Fred and the Spanish lady: Fighting the killer flu. Heritage House Publishing Co, 2004. (Full disclosure: this press also published my history of an evil spirit in Algonquian belief. Please note that I have no control over the price of physical copies of this book on Amazon, which sometimes surges to hundreds of dollars for mysterious reasons. So if you click on this link for my book, please don’t send me unhappy emails to complain about the book’s price).
Pettigrew, Eileen The silent enemy: Canada and the deadly flu of 1918. Saskatoon: Western Producer Prairie Books, 1983.
Vaccine refusal is one of the most difficult health problems of our age. In the Democratic Republic of the Congo a terrible Ebola epidemic is raging -and has just had its first case in the major city of Goma- despite the existence of an effective vaccine. There have been outbreaks of violence directed against public health workers, which have made fighting the outbreak infinitely more difficult. But these workers are not alone. In Pakistan and Afghanistan polio cases are rising, and public health workers have faced threats, stigma and violence as well. Polio is appearing in tests in neighboring countries now, from southwestern China to Iran. While it’s easy to portray the people in these countries who refuse vaccination as being ignorant or uneducated, the truth is that in the United States, Canada and Europe we have a similar problem with vaccine refusal. As I discussed in another post, there was recently an outbreak of measles near Portland, Oregon, which was driven by low-vaccination rates. …
An outbreak of measles in Clark county Washington has led to at least 36 confirmed cases, and quite possibly a dozen more. A recent Oregonian newspaper article by Molly Harbarger had the title “Vancouver-area measles outbreak costs county $187,000 so far.” While we now view measles as a childhood disease, some historians have suggested that it could have caused the Antonine plague that devastated ancient Rome (165-180 AD). Globally, in 1985 nearly 1.2 million people died from measles annually (see slide 3), and many more patients suffered from pneumonia or were left with damaged hearing. Of course, measles is easily preventable with a regularly administered vaccination. This vaccination not only protects the person who receives it, but also babies too young to receive the vaccine, or patients with weakened immune systems, such as people receiving chemotherapy or living with HIV/AIDS.
The outbreak in Clark county was entirely preventable. Too few people had received the vaccination for herd immunity to work. It’s a sign of a larger problem, which is people’s refusal to vaccinate their children against diseases such as Whooping Cough, which is making a come-back in the United States. Public health authorities suggest that one of major factors driving these outbreaks are the conspiracy theories regarding vaccines spread through social media, YouTube and the internet. Interestingly, outbreaks of these vaccine-preventable diseases are no longer primarily happening amongst the poor and marginalized, but rather amongst the educated and privileged. …
Why do conspiracy theories have such enduring power to shape human behavior? My interest in conspiracy theories first began when I was doing fieldwork in Latin America around HIV and AIDS. During this work many people told me narratives about either how the virus was created, or how wealthy corporations were hiding a cure. I then heard conspiracy theories from my students in own my classes, which suggested that HIV did not exist at all. It can be hard now to understand how powerful these conspiracy theories were in an era before effective treatments were globally available to treat this disease. But I had repeated conversations in my classes with students who not only deeply believed that HIV did not exist, but also argued that there was a vast global coverup of the true origins of AIDS, which they ascribed to pesticides, food additives, and recreational drugs.
One aspect of conspiracy theories that most interests me is that they are enormously powerful, yet academics almost completely ignore them in their classrooms. If you look at most syllabi for theory classes (every one I’ve ever seen) in the social sciences you will find that they entirely omit conspiracy theories. At the same time, based on my personal experience, if you spend much time with academics you will hear frequent reference to conspiracy theories. It is true that some of these theories focus on the plans of the administration, which is often composed of their former colleagues. But academics also often use them to explain broader questions of politics and history during informal discussions. But you’ll almost never find conspiracy theories in syllabi, textbooks, classes or academic articles.
For all their importance and power, however, people are incredibly reluctant to discuss them in a serious manner. Part of the challenge is that when starts to study conspiracy theories one can travel down a rabbit hole that starts to make you doubt that you can trust what you know. Some conspiracy theories -such as those surrounding Jade Helm 15- are easy to dismiss. Others have disturbing elements of truth. For a better look at this issue, I strongly recommend the documentary by Charlie Lyne titled, “Personal Truth.” The filmmaker looks at the Pizzagate narrative in the United States, and compares these stories with those surrounding an alleged pedophilia ring -which likely never existed- in England. In both cases, these stories grew because of irresponsible actors, and because people want to believe stories that depict powerful people in a negative light. It’s also all too true that there are painful examples of evil behavior by people in power, which make these narratives believable. …
Apart from Murray in Stranger Things, and the Lone Gunmen in the X-files, most conspiracy theorists don’t have secret knowledge that the majority of humanity is unable to accept. Instead, people turn to conspiracy theories when they feel disempowered and desperate. Conspiracy theories thrive during times of crisis, such as a pandemic, or a profound political crisis. They also emerge at times when trust in government is low. I’ve done work (with my wonderful colleague Leopoldo Rodriguez) on a conspiracy theory in Argentina that focused on the death of government prosecutor Alberto Nisman. In the Argentine case, these conspiracy theories absorbed the news and attention of an entire nation. But during the 2009 influenza pandemic, conspiracy theories became truly global, as people told these narratives from Mexico to Europe. I studied this phenomenon in an article that is open access:
I have a colleague who teaches a course on the rise of populism in Europe, which is an increasingly important topic. What is interesting to me is how quickly populist and nationalist movements have emerged and flourished in the region. Anne Applebaum had an article in the Atlantic on this topic titled “Polarization in Poland: a Warning from Europe.” This beautifully written piece captured the rapidity of these movements’ growth, and their manifold contradictions. What I most liked about this article was her ability to personalize these trends, by talking about her own personal experiences, and how these political forces have torn apart families and friendships. I also liked her point that what is strange about the rise of these forces is that they cannot be explained by the traditional narrative that these movements reflect the hardships of economic recession. Poland has been experiencing a prolonged period of remarkable growth. And yet we see the rise of conspiracy theories and extremist views, which have traditionally perceived in the literature (including my own work) as signs of economic and social crisis. Applebaum’s piece is long-form journalism at its best, and would be an excellent choice for a course on modern Europe, or the rise of Populism.
In Argentina a judge has just ruled that the death of Alberto Nisman was a murder, not a suicide. One of Nisman’s old employees was also charged as an accessory to murder. Nisman’s death has been an ongoing mystery, after he was found dead with a bullet wound in his head, the day that he was supposed to testify to Congress regarding a potential government coverup in the 1994 AMIA bombing.
My colleague Leopoldo Rodriguez and I wrote an article on this topic, which was published at an open-source journal. The focus of our work was the competing conspiracy theories regarding the Nisman case, and how they reflected not only the nation’s political divisions but also its history. If you are interested in this topic, please read our article, which is freely available.
The article ended with these sentences: “The best path forward would likely be for the Argentine state to ask for a panel of international experts to investigate both the AMIA bombing and Nisman’s death. This step is unlikely, given the interests of different political actors and the power of nationalism in Argentine political discourse. Nonetheless, only this step is likely to restore public trust and thereby weaken the power of conspiracy theories in Argentina.”