'HUMANS NOT JUST PATHOGENS’

If it seems self-evidently true that’s only because the case has been made by Oxford historians intersecting with the broader media throughout the pandemic: epidemics deserve study within their broader cultural, political, scientific, and geographic contexts.

‘Pathogens don’t have agency but humans do,’ says Dr Charters, Professor of the Global History of Medicine at the University.

‘At the start of a pandemic, it’s quite clear, or at least appears to be. There is a crisis focused on the actual infection. Society rallies around prevention and cure. The end of the pandemic is another matter. It is asynchronous – different times, different geographies – and it is structured around politics and society as well as medical judgement.’

In a recent summary article referencing the many ends of pandemics in eighteen different case studies covering everything from 17th century plague to late twentieth century HIV/AIDS, Professor Charters notes how the ‘ending’ is different to closure, and how ‘it involves human beings chasing after lightning-fast biological developments, and slow-moving bureaucracies following suit later on.’

That much has already been seen in 2022, where restrictions have been totally lifted in parts of Europe and the UK, while China has been going through another lock down.

The rest is about scale and severity. If lots of people are dying then a disease compels action by political leaders.

But at a certain point, despite still being potentially fatal, a pandemic recedes ‘to being just in the background’, says Dr Charters.

Scientists refer to this as the moment when a once epidemic disease becomes endemic, although Professor Charters stresses that the term evades close definition.

In an earlier essay for the history of science journal Centaurus, Charters and independent scholar Kristin Heitman defined the endphase as ‘the point when the urgency of the disease outbreak has sufficiently diminished so that public attention is redirected to the moral and social crises that the disease has engendered or exposed’.

The unfortunate corollary is that the disease itself hasn’t necessarily disappeared. COVID-19 is here to stay, it would seem.

This ‘end of a pandemic but not of the disease’ is entirely typical, viewed historically.

The other inconvenient truth is that the end of the pandemic marks the start of a wider sense of reckoning, where for instance public expenditure during the crisis comes to bear on society in the form of debt, whether private or sovereign.

Earlier in the pandemic in May 2020, Mark Harrison, Oxford’s Professor of the History of Medicine, wrote about earlier pandemics.

He noted that almost without exception, pandemics have historically resulted in racial and class-based divisions, economic strife, extreme politics and prolonged civil unrest, as suffering populations and authorities sought answers and scapegoats for their plight.

Much of this turbulence tends to erupt around or after the ‘end’ of a pandemic.

Professor Charters, who spoke to QUAD for this article, notes how there is also a profound moral and social dimension to illness.

Early on in the pandemic the term ‘super spreader’ suddenly infected the public consciousness as early sufferers of COVID-19 were observed to have re-entered the UK from foreign travel, bringing back the disease and spreading it.

There was an implicit accusation of wrong doing against a background of widespread fear. No one wanted to admit, even to themselves, that they had it while testing was complex.

A year later it was no big deal to say you had COVID; the tests were ubiquitous and freely available, while the disease itself was better understood.

A similar trajectory continued right up to the end of restrictions in the UK, and beyond. By the time restrictions were lifted, COVID infections were widespread. Shortly after the end of the restrictions as many as three million people were recorded as having COVID 19 in the UK, the largest number at any point in the pandemic. Yet suddenly, there was, as least officially, no longer a crisis as such and much less appetite for discussing it.

As Professor Charters has pointed out in another recent publication for her college, Wolfson, 'The end process is thus a period of moral reckoning, with discussions of ‘lessons learned’ and the crafting of narratives featuring heroes and villains.  In this process, societies look both backwards and forwards as the past epidemic is re-interpreted as a morality tale that will help prevent future catastrophes, thus restoring faith in the ability of human agency to face the power of nature.'

Oxford University will on 24-25 June celebrate the fiftieth anniversary of the History of Medicine Programme within the Faculty of History.

It was only because the University had already banked so much careful research on previous pandemics such as cholera, typhus and small pox in previous centuries and diverse geographies, that when COVID struck they could slam into top gear and race to provide cogent, rational structures and interpretations based on the past, acknowledging at the time that ‘These varied histories also remind us that we are currently in the midst of a chaotic drama of uncertainty, within our own unstable and unfolding narrative.’

Supported by the Wellcome Trust and by the University of Oxford's OUP John Fell Research Fund, Professor Charters conducted multiple fascinating interviews with different scholars both at Oxford and other institutions, to draw together complex, nuanced, multi-disciplinary perspectives.

The overall project How Epidemics End: A multidisciplinary project

is based at Oxford's Centre for the History of Science, Medicine, and Technology and Oxford's Centre for Global History and is led by Professor Erica Charters.

At the end of a discussion Professor Charters also points out that while the start of pandemics may appear to be clear cut, actually they are far from it.

To this day, experts continued to debate where AIDS originated, and how long it has existed.

COVID 19 is similarly complex in respect of its origins, and the subject of furious debate.

Who suffers the most from a disease in society, and what that is held to mean, are perennial debates in political and cultural history.

Or as Dr Charters says, ‘disease needs to be understood in its social context.’

With the insights of professional historians what that means and how it may weigh on the present, can be more usefully elucidated.