Epidemics and Society by Frank M Snowden review illuminating and persuasive – The Guardian

A detail from Pieter Bruegel the Elders The Triumph of Death (c1562): Epidemics have never stopped being a fact of life and death for hundreds of millions of people. Photograph: Granger Historical Picture Archive/Alamy

Twenty years ago, the US Department of Defense set out a clear warning: Historians in the next millennium may find that the 20th centurys greatest fallacy was the belief that infectious diseases were nearing elimination. The resultant complacency has actually increased the threat.

Along with other western nations, federal and state governments in America had spent the previous decade or so dismantling public health programmes dealing with communicable diseases in order to concentrate funds on degenerative illnesses: diabetes, heart disease, cancer, stroke. Corporate investment in the development of new vaccines and antibiotics almost dried up, as if the battle that humans had waged over millennia against plague and pestilence had now been won at least in the developed world. Michael Osterholm, the Minnesota state epidemiologist, informed US Congress in 1996: I am here to bring you the sobering and unfortunate news that our ability to detect and monitor infectious disease threats to health in this country is in serious jeopardy. . . . For 12 of the states or territories, there is no one who is responsible for food or water-borne disease surveillance. You could sink the Titanic in their back yard and they would not know they had water.

In the years since, as Frank Snowdens illuminating history shows, that indifference became endemic. The World Health Organization has argued for years that the mechanics of our globalised economy, the dramatic increase in urbanisation and mass intercontinental travel has exponentially increased the chances for infectious disease to mutate and spread. It identified a record 1,100 worldwide epidemic events between 2002 and 2007. A year later, researchers identified 335 new human diseases that had emerged since the development of the polio vaccine in the late 1950s, most of them originating in animals (many in bats). Their names now run the gamut from A to Z from avian flu to Zika, Snowden notes, and scientists caution that far more potentially dangerous pathogens exist than have so far been discovered. Yet still, when he finally acknowledged the destructive presence of Covid-19 in his nations population, the primary response of the president of the US was one of genuine surprise: Who would have thought?

Snowden, an emeritus professor of history at Yale, believes that epidemic disease has shaped nations and civilisations every bit as starkly as economics or politics or war. One of the more depressing realisations in reading this necessary and persuasive book is that almost every line of it would apparently come as news to Donald J Trump: the terrible decades and centuries in the shadow of the bubonic plague, the desperate blight of smallpox and cholera and typhus and polio, and the enormous advances in public health brought about by sanitation and vaccination and antibiotics. All of that cumulative hard-won wisdom the triumphs of Edward Jenner and Joseph Lister and Alexander Fleming and Florence Nightingale and Jonas Salk in persuading governments of the possibilities of their science was erased from history by a president who believes injections of disinfectant might represent a novel cure.

Napoleons expansionist dreams were defeated by his inability to contain the spread of infections in his armies

Snowdens book began as an undergraduate lecture course at Yale during the immediate aftermath of Sars and Ebola, which exposed for him the vulnerability of modern society to sudden outbreaks of infectious diseases. No such course then existed. Snowden examined not only how the modern world was created in large part in response to the primary plague event, the Black Death, but also how that event still shadows the response of governments to epidemics.

The trial and error measures of quarantine (the Venetian practice of holding the crew of trading ships in isolation for 40 days) and lockdown established a style of public health that conferred upon authorities the legitimating appearance of acting resolutely, knowledgably, and in accord with precedent. Sometimes those measures were justified, sometimes not, but in recent times, this book shows, they have been employed in large part to hide and mitigate a criminal lack of preparedness for what, with proper international coordination and immediate application of best practice, should be a predictable and manageable event.

Of all the conditions that promote virulent disease, hubris emerges across the centuries as a prime mover. Napoleons expansionist dreams were ultimately defeated not by the collective will of rival generals, but by his inability to predict or contain the spread of infections in his armies: he was defeated in the Caribbean in 1803 by an outbreak of yellow fever, and then in Russia in 1812, where the then largest assembled military force in human history was undone by dysentery and typhus.

In an updated introduction to his book, Snowden traces a comparable arrogance in our own leaders, who have allowed global inequalities to foster the illusion that infectious diseases, old and new, are a thing of the past. As we enter the next phase of this pandemic, it is worth keeping in mind that there were, in 2014, more people suffering with TB, for example, than at any time in history (because of Covid restrictions, it is predicted that 1.4 million more people will die of that disease by 2025). Epidemics have never stopped being a fact of life and death for hundreds of millions of people across the world. Now that their presence has been brought home to all of us again, Snowden argues, the old wisdom that saved human societies in the past must be brought to the front and centre of government: salus populi, suprema lex esto, as the ancients had it; public health must be the highest law, and all else follows from it.

Epidemics and Society: From the Black Death to the Present by Frank M Snowden is published by Yale University Press (16.99). To order a copy go to guardianbookshop.com. Free UK p&p over 15

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Epidemics and Society by Frank M Snowden review illuminating and persuasive - The Guardian