Time to Get Serious About Public Health

In Sierra Leone, where recent public health campaigns are saving children’s (and parents’) lives.

by Richard Conniff

The PBS/Channel 13 show “The Open Mind” has just aired its interview with me about my book Ending Epidemics: A History of Escape from Contagion. You can take check out the interview here or if 28 minutes is too big a commitment, take a look at the transcript below

HEFFNER: I am Alexander Heffner, your host on The Open Mind, and I’m delighted to welcome our guest today, Richard Conniff. He’s author of Ending Epidemics, A History of Escape from Contagion. Richard, thank you so much for joining me today.

CONNIFF: Thanks. Good to be here.

HEFFNER: Richard, there’s some dispute about whether three years since COVID-19 struck we’re still in what you could call a pandemic. Where do you come out on that?

CONNIFF: Yeah, I think we’re still in a pandemic in the sense that it’s going to come back again seasonally. It’s going to be global, it’s evolving everywhere, and those who aren’t protected, who haven’t gotten vaccinated will be at risk.

HEFFNER: When you titled your book Ending Epidemics: A History of Escape from Contagion, and specifically you identify epidemic, as opposed to pandemic, that was intentional?

CONNIFF: Yeah, that’s intentional. Epidemics are a lot more common. They occur regionally or in individual nations, and pandemics, where it’s the entire world are relatively rare events.

People, especially in this country take for granted our current state of health
and have no conception of the frequency of epidemic disease in our past.

Richard Conniff

HEFFNER: Take us through, in your mind, whether or not the public sufficiently understands that what we encountered in this pandemic was something that for decades and centuries, many strata of society had suffered in what you call epidemics, as opposed to pandemics. Is that fully understood or was that one of the motivations in writing this book?

CONNIFF: Yeah, I don’t think it’s understood at all. It is the reason I wrote the book that is I think people, especially in this country take for granted our current state of health and have no conception of the frequency of epidemic disease in our past and not even in our distant past. So I think I wrote it partly because I’m old. I was born in the middle of the 20th Century, and my father and my uncle both had polio. When I was five, I was in kindergarten. The polio vaccine became available for the first time. And at that point you know, what had been polio season became summer again. And two years before I was born, there was still smallpox in this country. And whooping cough was quite common. It killed 4,000 people a year in the United States. Children. I shouldn’t just say people. It was children under the age of five for the most part. Diphtheria. I live in New England, and there was a massive epidemic of diphtheria in the middle of the 18th century. Okay, I’m going back ways now, but it’s interesting because entire families, 13 children in one family just gone over a period of days. So yeah, there’s a long history of highly infectious diseases. One other example I had measles. People think measles is a trivial disease now. Doctors don’t even see measles anymore, but measles was a brutal experience about 550,000 kids had it the year I had it. 550 died. And so yeah, these are things that people don’t even think about anymore and don’t think about why we are free of these diseases.

THE FORGOTTEN REFORMER WHO MADE CITIES LIVABLE

Edwin Chadwick, revolutionary thinker

By Richard Conniff

This article is excerpted and adapted from “Ending Epidemics: A History of Escape from Contagion” (The MIT Press)

It’s almost impossible now, thank God, to imagine the squalor of London and other supposedly civilized cities in the first half of the 19th century. As the rural poor moved to jobs in the factories of the Industrial Revolution, they overwhelmed the available housing and the adjacent, untended, and often uncovered, cesspools. Entire families commonly huddled together in single rooms, even in windowless basements. Overflowing sewage at times made entire cities feel as if adrift on a sea of human waste.

The result was a second revolution, for urban sanitary reform, and it succeeded largely through the outsize influence of one peculiar man. Edwin Chadwick, now mostly forgotten, was a barrister, journalist, and social reformer. From the early 1830s onward, Chadwick campaigned for the British government to intervene in matters of public health and welfare. He promoted essential urban services, including public water supply and sewerage, street cleaning, and garbage removal. Chadwick’s work transformed the character and well-being of cities not just in Britain but, by example, worldwide. Along the way, he helped to establish the basis for the modern liberal state. “Few men have done so much for their fellow-countrymen as Edwin Chadwick,” biographer R.A. Lewis wrote, “and received in return so little thanks.”

This uncelebrated status is no doubt due both to the lowliness of his chief subject — the disposal of human waste — and to Chadwick’s difficult personality. A sanitarian who was a friend described him in the heroic mode: “firm-set massive build,” “resolute expression,” “nose aquiline,” and “the head altogether large, and to the phrenologist finely developed.”

But photographs from the period show a tall, round-faced figure, in mustache and muttonchops, hair smeared in hanks across his balding scalp, peering out from heavy-lidded eyes with something like disdain. Chadwick made a reputation for prodigious energy, and for his command of the facts of any issue he studied. But he was also humorless and uncompromising toward those who disagreed with him. He made little effort to hide his contempt for aristocratic domination or for foot-dragging by corrupt or indifferent politicians.

He was also a bore, “a really outstanding specimen of bore in an age when the species flourished,” according to the otherwise admiring biography by Lewis. “Mr. Chadwick is not an orator,” a friend acknowledged. “When he first gets up to speak without book he looks an orator, but a few moments dispel the illusion.”

We Thought We’d Beat These Three Diseases. Now’s The Time to Finally Stop Them

By Richard Conniff/The New York Times

There was a time not so long ago when preventing epidemic disease was a cause ordinary people embraced and celebrated. When President Franklin D. Roosevelt called on Americans to join the fight against polio, for instance, he reported that envelopes containing “dimes and quarters and even dollar bills” arrived by the truckload at the White House, “from children who want to help other children to get well.” The March of Dimes went on to fund the development of polio vaccines. When one of them, the Salk vaccine, proved effective, in April 1955, church bells rang out nationwide.

Likewise, in the mid-1960s, when the World Health Organization announced its wildly ambitious plan to eradicate smallpox in just 10 years, people rose to the challenge. Small teams bearing vaccines and a simple lancet called the bifurcated needle were soon moving through the afflicted parts of the planet — by camel across the desert in Sudan, by elephant to ford rivers in India, and by all the more familiar modes of travel. People everywhere lined up to get the peculiar dimpled mark of smallpox vaccination, freeing them from the scourge that had been maiming and killing their families for as long as they could remember.

As many as 150,000 men and women at a time worked on the campaign, and with a final naturally occurring case discovered in Somalia in October 1977, they eradicated smallpox in the wild. For veterans of the “order of the bifurcated needle,” as they called themselves, it was the proudest hour of their lives.

It may seem unlikely that we could ever recapture that determination and excitement about standing up together against a deadly disease. Instead of presenting a unified front against Covid-19, we fought bitterly, and three years on, our shared response seems to be a shell-shocked unwillingness to even think about epidemic diseases.

The Next Big Idea Club Picks “Ending Epidemics”

My new book, Ending Epidemics: A History of Escape from Contagion (MIT Press), is a 2023 selection of the Next Big Idea Club, which writes:

Richard Conniff is an award-winning nonfiction writer. He specializes in the topics of human and animal behavior, with his work appearing in the New York Times, Smithsonian, The Atlantic, and National Geographic, among others. Below, Richard shares five key insights from his book:

1. Public health is a personal story for all of us, and we take it entirely for granted.

Just ask an uncle or a grandmother what kind of diseases they grew up with. In my family, for instance, my father and uncle both had polio as toddlers in the 1920s. My uncle got it worse, with legs that were permanently reduced to sticks. He spent the rest of his life walking with the help of arm braces.

Summer was still polio season when I was a toddler. At that time, polio was killing more than 3100 people a year in this country and paralyzing 21,000. But in 1955, Jonas Salk’s polio vaccine became available and people flocked to get it. I was one of them.

“Polio season” became just summertime.

Progress against infectious disease accelerated from there. My own kids avoided almost all the childhood diseases that were routine for me. A major international effort also began knocking down childhood diseases, with polio, for instance, eliminated from all but two nations by 2019. Now, kids my grandson’s age are being protected against diseases most parents never heard of, like rotavirus, which used to routinely kill small children.

Think about that. (Continue reading.)