STORIES FOR THE INTERPANDEMIC
HUNDREDS OF diseases, most of which are not covered in this book, can be shared between other animals and people. I have selected only those which illustrate clearly what I think are the most important issues we are facing in this globally interconnected, multiple-pandemic-plagued world.
At first glance, understanding how infections jump from other animals to people is not rocket science. They can be transferred through insects, environmental contamination, and direct contact, which includes situations where we rub noses with them as well as when they bite us, as in rabies, or we bite them, as in food. Knowing how they are transmitted means that preventive measures are obvious, at least for individuals. None of these measures are foolproof, but all of them are reasonably effective. Washing your hands with soap after handling possibly infected packages, animals, or meat will take care of many viruses, bacteria, and parasites; so-called antibacterial soaps and lotions and sprays are unnecessary and may only encourage the evolution of more aggressive microbial populations. Wearing a long-sleeved shirt outdoors and using insect repellents will help keep the mosquitoes and ticks in check. Cooking your food will kill bacteria like Salmonella on the surface of—and parasites like Toxoplasma inside—your meat. Cleaning up dog poop and disposing of it by composting, or building mini-biodigesters in dog parks, will help keep a variety of parasites and bacteria out of general circulation.
Communicable diseases, by definition, don’t come as single cases, and solutions for individuals, while important, need to be embedded in bigger initiatives. Even some preventive measures at the community level are straightforward. However, as we have discovered in the midst of the COVID-19 pandemic, they do require us to elect vertebrates in political office, and for all of us to have a sense of global equity to share the necessary resources to implement them. Social distancing with solidarity is how some people are describing this balance between individual safety and collective health. Animal and human vaccination programs for rabies, anthrax, brucellosis, Ebola virus disease, and various influenzas are all attainable using our current knowledge and technology.
How to compost manure and dead animals, instead of burning or simply burying them, and some knowledge of how energy can be generated through biodigesters, which I discuss in my book The Origin of Feces, should be in the training manual for every person dealing with infectious diseases. Composting not only kills most bacteria and viruses but also generates useful fertilizer. Even developing a cheap, injectable reproductive control drug for male dogs should be relatively easy if any pharmaceutical company or funding agency could be persuaded to make it a priority. Cattle can be screened for various diseases, such as sleeping sickness, before being allowed into new, disease-free areas.
GLOBAL PATTERNS OF zoonoses reflect complex social and ecological changes that go well beyond individuals and communities. It’s messy, but really, we know what needs doing, and have for a long time. If we look over the natural history of zoonoses and their emergence or re-emergence in the early twenty-first century, the general causes are a mixture of things. Often humans have created new urban or agricultural ecosystems in the ruins of older, non-human-dominated ecosystems. Ebola, Marburg, Chagas, SARS-COV, and SARS-COV-2 emerged in part because people invaded new territories where other animals and their microbes have lived in some rough kind of harmony for millennia.
Animals such as rats, raccoons, and coyotes have adapted to and changed human settlements, bringing with them viruses such as rabies and hantavirus, bacteria such as leptospires, and a variety of parasites. Economies of scale and monocultures in agriculture have created ideal conditions for the generation of epidemics of avian influenza, salmonellosis, and SARS-COV-2. Fast global travel and unfettered free trade have fostered the spread of epidemics. Loss of biodiversity, social inequity, marginalization of poor people, and the rapid sprawl of slums with bad housing, inadequate water, and standing sewage have created ecosystems that change the patterns of old infectious diseases and create opportunities for new ones. Climate change, much of it human induced, is contributing to the destabilization of ecosystems and the dispersal of animals and microbes into new areas. Talk of (re)creating natural harmony or ecological stability is an illusion.
In 1848, Rudolf Virchow, a renowned medical pathologist, was sent by the Prussian government to investigate the causes of a typhus epidemic in Upper Silesia. After intensive investigation, he submitted a report that recommended a program that included “full employment, higher wages, the establishment of agricultural co-operatives, universal education and the disestablishment of the Catholic church.” Okay, that last bit was pushing his luck, but the rest made sense.
In 1992, the Institute of Medicine in the United States published a report on the resurgence and emergence of infectious diseases. They identified the following causes: human demographics and behavior; technology and industry; economic development and land use; international travel and commerce; microbial adaptation and change; and breakdown of public health measures. The report suggested better surveillance, vaccine and drug development, vector control (primarily through better pesticides), and human behavioral changes—for instance with regard to sexual relations and antibiotic use—as being appropriate responses. There was no mention of regulating land use or working for more equitable economic development, health insurance, or paid sick leave.
In 2008, more than 150 years after Virchow’s report, WHO published a review of evidence related to the social determinants of health. The authors, no flaming revolutionaries, declared that “social injustice is killing people on a grand scale” and recommended that governments work to “improve daily living conditions, including the circumstances in which people are born, grow, live, work and age” and to “tackle the inequitable distribution of power, money and resources—the structural drivers of those conditions—globally, nationally and locally.”
A few years later (in 2012), a review of progress since the 1992 report noted that new diseases, such as SARS and H5N1, had emerged since that first report, but that the most important advances in twenty years were “genomics-associated advances in microbial detection and treatment, improved disease surveillance, and greater awareness of EIDs [emerging infectious diseases] and the complicated variables that underlie emergence.” So, none of the serious causes were addressed, and few epidemiologists—at least in the meetings I attended—were surprised to see COVID-19 galloping over the horizon.
If we have known for many years what needs to be done to prevent pandemics, why haven’t we acted? What these reports do not explicitly acknowledge, and what is not explicit in any list of “things to do to prevent a pandemic,” is that in any such complex situation, we are faced with trade-offs. There is not a single, over-riding, science-based “truth,” and many times, solutions to some problems create new ones. These “wicked problems” are everywhere around us, and central to the issues we are facing with regard to preventing future pandemics.
I recall how pleased I was when the vultures disappeared from the riverbanks in Kathmandu; the missing scavengers were at first a sign of success. Later I learned that vultures were dying all over the Indian subcontinent in huge numbers; in some places up to 9 7 percent of certain kinds of vultures had died. At first, investigators had thought it was some kind of viral epidemic. Then they discovered that a pain-killing drug, diclofenac, was being used in large doses throughout India to keep older cattle in comfort as they died. This in itself would seem to be a good and humane act. However, the vultures that fed on the carcasses of these cattle developed kidney failure and visceral gout (a buildup of uric acid); people recognized them by the way their heads drooped. The birds died soon after. The consequences of losing this major scavenger could be devastating, as semi-feral dogs congregate around rotting carcasses, spreading rabies and other diseases. Parsis, who place their dead in Towers of Silence in Mumbai for the vultures to clean up, are wondering what will happen to their religious practices. I pondered whether the lack of vultures I had seen along the river in Kathmandu was a sign of success in controlling butchering activities or evidence of other feedback loops, the tragic consequences of the desire to keep cattle out of pain.
Pulcher threw his sacred chickens overboard because he didn’t like the messages they were delivering. In some ways, the killing of millions of chickens in the face of H5N1 avian influenza virus is a similar act of defiance. A scientist—who is, if nothing else, a reader of omens—might ask why the chickens in Southeast Asia were becoming infected. One answer is that wild birds and livestock traders brought the virus to them. How did this happen? The draining of swamps and restructuring of landscapes for human use throughout the world has narrowed the options for wild birds to nest and to rest. Hence the birds are being forced into closer proximity to each other (more stress, more shedding of microbes) and to other species (more sharing of microbes and faster microbial evolution). They are also being channeled into smaller and fewer flight pathways, many of them close to expanding human settlements and agricultural enterprises.
Traders who are trucking and shipping poultry from place to place are responding to economic policies advocated by those in power. Those policies are put into place because urban dwellers want to eat more meat, and they want to pay less for it. Economies of scale and global trade in agriculture bring down prices at the grocery store, making many foods affordable not just for wealthy city dwellers, but also for low-income people. Economies of scale and global trade also create ideal conditions for the emergence and spread of many new diseases.
When viewed at this larger scale, the “whys” and “becauses” of any particular outbreak can go out in many different directions, and across geographic and political scales, with different winners and losers and feedback loops that are weakened (as between local farming practices and local environments) or created (as between local farming practices and global markets).
An outbreak on a particular chicken farm might be related to how the birds are housed, how crowded together they are, what other species live on the farms, what kinds of “bio-security” are available, and the structure of markets. These factors, in turn, have to do with urban demands for certain kinds of food, with economics and culture, and with who has power (both electrical, which is required to manage intensive poultry barns, and political, which is required to manage economic markets). The spread of an epidemic has to do with the technical capacity for diagnosis and response, with the value of fighting cocks and show birds, with education of poor people, and women in particular, with communication among those working with the health of people and other animals, and with drugs and hospitals available at the points where the epidemics start, which are often poor and marginalized.
What I have said about avian influenza can be said as well about just about every other emerging infectious disease. Abandonment of small farms may be seen as good (by some ecologists, for instance, who celebrate expanded habitats for wildlife) or bad (by epidemiologists concerned about the spread of Lyme disease associated with increased deer populations on those abandoned farms). Hiking through the woods is both good for one’s personal health (exercise, fresh air) and possibly risky (Lyme disease, West Nile). The dogs in Kathmandu were both community police and carriers of disease. At an international conference in 2006, a scientist from Turkey described how the killing of chickens to stop the spread of avian influenza resulted in outbreaks of tick-borne diseases in Turkish villages. The chickens had served as an important way of controlling ticks.
The rapidity and scale of changes associated with human activity now far exceed what we have seen before in our brief sojourn on this planet. We are sliding over the cusp of rapid climate change and environmental change. On the one hand, the openness and speed of sharing information during the COVID-19 pandemic has given the world more opportunities than ever to respond in adaptive ways.
On the other hand, the speed and scope of the pandemic, as well as the waves of floods, storms, droughts, and fires over the past decade, should give us pause. Can we get ahead by simply working longer hours and running faster? Will a quantum computer or a 5G network save us?
Can we build theoretical and mathematical models based on our data that will help us predict, or better yet stop, the next pandemic? In the midst of the COVID-19 pandemic, the models were everywhere in evidence, guiding many national and international policies. What became quickly apparent was that there was not a single scientific model and hence not one global policy. There were many models and many policies.
As long as we don’t confuse the models with the world around us, we can learn a great deal from them. Some complex systems theorists, trying to grapple with this, have described the world we live in as a series of nested hierarchies. As an individual, I have physical and social boundaries and an internal set of rules by which I function. I am also a member of a family with rules and boundaries, which is a member of various communities, each with its own rules and boundaries. By virtue of the fact that I eat, drink, perspire, breathe, urinate, and defecate, I can also be described according to my membership in several nested ecological systems.
The twentieth-century philosopher Arthur Koestler referred to each level in this hierarchy as a “holon,” being both a whole and a part. The environmental scientist Henry Regier calls these nested hierarchies “holonocracies”; with its resonance of “democracy” and “autocracy,” this term emphasizes mutual power relationships and responsibilities. The infinity-sign (or lazy-eight) idea of panarchy used by the Resilience Alliance, and which I introduced earlier, emphasizes the interplay between change and persistence across levels and over time.
We might ask, in relation to the Resilience Alliance model, whether we are entering a creative destruction phase. If so, then we are not only facing perilous times ahead, but we also have an unprecedented opportunity for those who desire democratic, just, and ecologically sustainable global change and renewal. The danger lies in how the power relationships play out between the destruction of the old and the creation of the new. The collapse of the USSR should be a danger flag: in the turbulent passage from old to new, oligarchs and autocrats took control of resources and power, and democratic renewal was thwarted. In the midst of the COVID-19 pandemic, one can already see autocrats (both in government and in private businesses) using a model of power relationships, expertise, and administrative control appropriate for emergency rooms and disasters to seize political and economic control. For those who wish to see a resilient, just, sustainable future, the destruction that occurs in the midst of a pandemic opens a small window in which to assert ourselves, to organize, and to act creatively.
One of the big challenges for us non-autocrats is that the questions we are asking, and the future we would like to see, require us to accommodate and evaluate many perspectives. As a veterinarian, I think of this as a clinical judgment, bringing together information from a laboratory, clinical observations, epidemiologic patterns, and patient history. For those interested in health and environmental policies this is even more challenging. Even if we accept that there might be different legitimate ways of seeing the world, the “clinical decision” is a collective one. Philosophers Silvio Funtowicz and Jerry Ravetz, building on their work with uncertainty in environmental risk assessments and the social problems that complicate our understanding of scientific knowledge, have called this publicly engaged science “post-normal.” Going beyond “postmodern,” in which many different viewpoints merely stand side by side, they propose that many different kinds of evidence and perspectives need to be called upon to understand the world, define problems, and resolve issues in such a way as to sustain a convivial human existence on the earth. Post-normal science, they have argued, is most appropriate in situations where “facts [are] uncertain, values in dispute, stakes high and decisions urgent.” At its core, post-normal science is a democratization of science, and I have yet to find a better way to think about the sorts of challenges we face with zoonoses, EIDS, and pandemics.
The main character in William Boyd’s novel Armadillo is searching for a word to signify the opposite of serendipity. “Serendipity” is derived from Serendip, an earlier name for what is now Sri Lanka. Heroes in an old Persian folktale had the faculty of making happy and unexpected discoveries by accident. Boyd suggests that a term to mean the opposite of “serendipity” be based on a fictional country that is cold and barren, called Zembla. Thus, “zemblanity” would be “the faculty of making unhappy, unlucky, and expected discoveries by design.” This faculty is certainly what characterizes the disciplines to which I have devoted my professional career—epidemiology, environmental, and biomedical sciences. We think some things, such as feces in water or diesel fumes in air or smoking cigarettes, might cause people and animals to get sick, so we set up studies to prove that this is so. To the surprise of no one except those who are making money by dumping this stuff into our air and water, we find they do cause disease. Much global monitoring of disease and environmental status is also characterized by zemblanity. But the problems of the twenty-first century are unpredictable, and the future, thankfully, is uncertain. To co-create a more convivial world, we need a new serendipitous science, a post-normal science, a science that is not afraid to look at everything, to accommodate uncertainty, mystery, struggles for justice, and to admit storytelling into its campfire circle of models and laboratory results. It is a delicate balancing act.
After decades of studying zoonoses, epidemics, and pandemics, and working with communities in all parts of the world to help them put that scientific knowledge to use in ways that might improve their daily lives, let me offer my story about how I have come to think about science. In the seventeenth century, during a rare interpandemic phase of the bubonic plague, and in the midst of multiple wars, René Descartes argued that, by dividing the world into smaller and smaller pieces for observation, we could “render ourselves the lords and possessors of nature,” and, in so doing, improve our health. Descartes argued that people should step away from the books of the old masters, and go out to observe the world in real time. Fair enough, although most students since then have learned their science from books. Still, since the seventeenth century, Cartesian science at its best has enabled us to learn a great deal about the things of which the universe is made. In terms of COVID-19 and other pandemics, for instance, Cartesian science has enabled us to identify bacterial and viral structures, develop vaccines, and put into place protocols to reduce the spread of disease. And yet, the notion of becoming the “lords and possessors of nature” eludes us. Why might this be? Zoonoses and pandemics, and, in particular COVID-19, have brought with them questions of how we understand, and respond to, the forces of nature.
The world is not just the stuff around us. In a pandemic, it’s not just the viruses, other animals, and people that matter. What holds our world together are the relationships among them. These relationships are expressed—for lack of a better word—through conversations. We know about a few of these conversations, those expressed in the sounds animals make and biochemical transmissions among insects and between insects and plants. Others, like gravity and atomic forces, we know not because we see or hear them but only by their effects. Since many of these tangled and shifting conversations around us cannot be brought into a controlled laboratory, our understanding of them is at a very rudimentary stage.
What we struggle with, as people, and, more specifically, as scientifically trained scholars, is finding a language that can not only encompass complex uncertainty but enable us to engage in it more fully. Until now, we have learned to lecture the living things with which we share the planet using the very blunt language of bulldozers and pesticides. Pandemics, embedded as they are in globe-spanning social-ecological webs, are the world’s response to our shouted lectures. Do we know how to listen, to respond in creative ways, to respond again to the responses, to understand how we are changed even as we change that which is around us and defines us? What is the language that will enable us to converse in other than the most instinctual, trivial, brutal, bullying, and dysfunctional manner? Is this the as-yet-unknown language we need to tell our collective story? If this seems far-fetched as a way to think about pandemics and zoonoses, it is perhaps because we are still, as a species, so young. Nevertheless, in the midst of this very post-normal pandemic, we are learning.
One of the lessons from the 2020 COVID pandemic is that, rather than aspiring to be “lords and possessors” of nature, perhaps we should strive to be surfers, riding and adapting to the movement of forces we cannot control. But how?
In 1001 Arabian Nights, Sultan Schahriar feels betrayed by his first wife. He seeks his revenge on women in general by having his grand vizier present him with a fresh bride every night and then having her strangled (by the grand vizier) the next morning. Scheherazade, beautiful daughter of the grand vizier, decides to put herself on the line for the sake of all women. In a successful, non-violent stratagem, she recruits her less-than-beautiful sister, Dinarzade. Every day, just before dawn, her sister awakens her and asks Scheherazade to tell her a story. The sultan is, of course, listening in and is left at dawn wanting to hear more. Every day, the sultan decides to spare her, and eventually he falls in love, first with Scheherazade’s stories and then with her; he abandons his brutal, tyrannical, obsessive plans. She lives a long and meaningful life and is celebrated by young people and peace activists the world over.
The tale of Scheherazade is, finally, a tale about all of us. The earth, like Schahriar, has cut the heads off many species before us. Global history is replete with sudden or slow mass extinctions. The earth is literally built from the bones and decomposed molecules of our forebears. We humans, too, have betrayed our hosts and the bacteria who collaborated to make us possible. If we are not soon to go the way of the glyptodont and the pterosaur, then our global human family needs a good dose of psychotherapy—not just any therapy, but a narrative therapy, in which we have reimagined and retold our tale as one of survival, justice, ecological at-home-ness, and conviviality. To find this story requires a (re)search effort beyond anything we have tried before; like Scheherazade, our lives depend on it.
All of us, as global citizens, are participants in this narrative. We are all Scheherazade, the beautiful storyteller, and Dinarzade, the one who elicits this insurrection of marginalized stories from all over the world. These stories are not just of people but also of every living thing and of the earth itself. The stories in this book have been about diseases, diseases that, like Pulcher’s chickens, are a voice, a reminder, a calling. The agents that cause disease in people and other animals and plants are thriving communities of tiny living beings; diseases are the consoling and horrific reminder that we are not alone, that our story has many voices, and that sometimes, if we ignore them, the tiniest of voices will inhabit our bodies and speak to us of mysteries we have ignored.
Claudius Pulcher no doubt lost his battle at Drepana in 249 BC as the result of the usual mix of bad timing and poor maritime skills. Still, one wonders about the sacred chickens that refused to eat. We don’t have to believe that birds are omens, as part of some complicated spiritual mathematics, for us to take home important messages. If I were to articulate what I think Pulcher’s Omen is, it is this: that all natural events tell us something well beyond the immediate causes we identify, and that if we observe carefully, we might yet survive another millennium here.
As I observed in my own work in the Caribbean and Central America, East Africa, Asia, and Canada, resolution of complex problems requires good theory, risky social engagement, and a willingness to live creatively with unresolved arguments and tensions. In these community-based ecosystem approaches to health, drawing on the best evidence from conventional science, even as we struggle with the experiences and power dynamics in communities, there has always been tension, and there are never any final, definitive experiments. From a veterinary point of view, a dead animal has all the same chemical and structural elements as a living one. The main difference between roadkill and a live dog is that in the live one, there are constant, dynamic, unresolved tensions.
We may have more sophisticated, scientific understanding of the world than ever before, but where are the stories—and more than that, where is the collective, global narrative—that can help us make sense, and give meaning to the storms of facts and information and opinions that assail us? And if we cannot agree on a grand global narrative, what, at the very least, are we looking for in this novel of novels? On what resources can we draw? Social solidarity? Love? Experience? Poetry? Nietzsche famously proclaimed that “Without music, life would be a mistake” and also that “We should consider every day lost on which we have not danced at least once.” All good, but where is the story in this? Perhaps the story, a collective story encompassing all of these things, is yet to be told; we are telling it with how we live, and how we listen to each other.
Albert Camus once declared that there is more to admire in people than to despise. In the midst of the COVID-19 pandemic, after decades of snarling, misanthropic uprisings of populist nativism and many religious leaders reviving the worst strands of their complex traditions, I would rephrase that. There is at least as much, and probably more, to admire in people as there is to despise.
The global lockdowns related to COVID-19 would seem to bear this out. With the availability of Internet resources, scientists, academic institutions, private companies, and governments have openly shared information in ways that were unimaginable even five years ago. And although there have been racist attacks against Asian-looking people, and continued slurs on immigrants, legal or otherwise, many more stories have emerged of people singing together from balconies in Italy, or on YouTube, sharing home-education tips, and delivering groceries to people under quarantine. Undocumented immigrants have continued to gather our food crops, and newly arrived immigrant health workers have put their lives on the line for others. If some of the solidarity and insights provoked by COVID-19 can be carried forward into the narratives that shape the post-pandemic world, we will all be better off.
Homo sapiens, the Latin name given to our species by self-important European aristocrats, may have been wishful thinking. “Wise man” is certainly not a name based on any scientific evidence of our wisdom. Perhaps we can reimagine wisdom as a goal to which our species can aspire. We are a gift from nature that she will take back to herself when we die and the microbes recycle us. Bringing together our best political, religious, ecological, evolutionary, and philosophical stories with the artifacts we unearth through our best scholarly investigations, our work is to jostle and sing and shout and whisper them into something greater than the sum of the data, a multilayered, multiperson, multiethnic, multispecies tale of life on this planet.
The natural history of zoonoses tells us that our struggle with infectious diseases is not a war—or, if it is, it is a war against ourselves. The microbes are all around us, in us, and in our animal companions on this planet. Our struggle is ultimately one of global solidarity and keen, careful ecological awareness. I was once informed, by someone concerned about overpopulation and the limits to growth, that, as an epidemiologist, by saving people’s lives, I was part of the problem. In the end, there is no logical or scientific study that proves we should care about ourselves or about the planet we live in and the other living beings with whom we share it. The care we take is a moral stance.
The ancient Indo-European word for “earth,” dhghem, gave us not only the word “human” but also the word “humus,” the organic component of soil created by bacteria, as well as the words “humble” and “humane.” In this new task, we are all observing the world, collectively, as if for the first time, and constructing meaning from it. In the age of gun-toting peace-makers, God-fearing hell-raisers, and utopian pillagers, at a time when all the previous global stories have brought us rack and ruin, this is no small task. The good news is that, community by community, the world over, in the midst of a fearful pandemic, a novel global vision is emerging, revealing a planet full of complexity and mystery and beauty we never suspected was there, a world unexplored because we lacked the theoretical and practical tools. From this novel vision is emerging a global novel, full of stories, intriguing and wonderful tales hiding in the shadows of our grand delusions. The biosphere might yet spare us. Or, if the stories don’t save us, they will at least, on our deathbed, in the last days of our species, have us saying, “We did quite all right, didn’t we? We left a story of ourselves worth telling the universe.”