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In this episode of “To Health and Back,” we’ll hear from Pat Thomas — a journalist and the author of “Big Shot: Passion, Politics, and the Struggle for an AIDS Vaccine” — to evaluate the politicization of the HIV epidemic and the ways in which the COVID-19 pandemic has been similarly politicized.

Read the transcript for this episode here. SHOW NOTES: * Amazon: Check out Pat Thomas’ book, “Big Shot: Passion, Politics, and the Struggle for an AIDS Vaccine.” * American Journal of Public Health: Learn about the politics surrounding the public response to AIDS. * History.com: Read about how U.S. leaders and politicians stayed largely silent for 4 years, even as AIDS and HIV became a full-blown epidemic. * HIV.gov: Read about HIV and AIDS, and the difference between the two. * HIV.gov: Check out this timeline that covers the AIDS and HIV epidemic. * National Institutes of Health: Read about the process behind the first COVID-19 vaccine. * Ronald Reagan Presidential Library: Listen to former President Ronald Reagan answer questions during the Sept. 17, 1985 press conference. * Scott Calonico: Read about Scott Calonico and his work. * Scott Calonico/Ronald Reagan Presidential Library: Listen to audio from former President Ronald Reagan’s press conference on Oct. 15, 1982. * Vanity Fair: Watch Scott Calonico’s documentary, “When AIDS Was Funny.” * The Washington Post: Read about the course of the epidemic in 1985.

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Big Shot: Passion, Politics, and the Struggle for an AIDS Vaccine

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Check out the show notes here.

0:13, Madeline Laguaite: Hello, and welcome to “To Health and Back,” a podcast about how health, medicine, and wellness decisions from the past help inform us today. I’m your host, Madeline Laguaite.

Laguaite: In this episode, I’m sitting down with journalist Patricia Thomas to talk about her experience reporting on the AIDS crisis, and how HIV and AIDS was politicized similarly to the way in which COVID was politicized.

Laguaite: Before we dive in, I wanted to explain the difference between AIDS and HIV because I’ve often seen them used interchangeably. HIV is a virus that attacks the cells in your body that help you fight off infection. That means you’re much more vulnerable to other diseases and infections. If HIV isn’t treated, it can lead to the disease AIDS. HIV is spread by contact with certain bodily fluids of an infected individual. So most commonly, that’s going to be during unprotected sex or through sharing needles. Once you have HIV, your body can’t get rid of it, and there’s not an effective cure. Once you’re infected with HIV, you have it for life.

Laguaite: Today, however, we have HIV medicine, called antiretroviral therapy, or ART that lets people living with HIV live long, healthy lives. It also prevents the spread of HIV to their partners. People can also use other effective methods like PREP — which stands for pre-exposure prophylaxis — to prevent themselves from getting HIV through drug use or sex.

Laguaite: Scientists think HIV was in the U.S. as early as 1960. But doctors first noticed something was wrong in the early ’80s when they noticed clusters of pneumocystis pneumonia and a rare cancer called Kaposi’s sarcoma in gay men living in San Francisco, Los Angeles, and New York City. The resulting AIDS epidemic was very politicized for a few reasons.

Laguaite: People were very, very uncomfortable learning about how HIV is spread, and that was certainly a catalyst for the disease to be politicized. The AIDS epidemic is also fueled by inequality because the disease exposes and intensifies both economic and social injustices. In fact, even though AIDS was first identified in 1981, then-President Ronald Reagan didn’t even mention it publicly until years later in 1985. By that time, around 16,000 people had died. Here’s a clip I found from Sept. 17, 1985, when Reagan was asked if he’d support a massive government research program against AIDS, similar to the one that Nixon launched against cancer.

2:55, Ronald Reagan: I have been supporting it for more than 4 years now. It’s been one of the top priorities with us and over the last 4 years and including what we have in a budget for ’86, it will amount to over a half a billion dollars that we have provided for research on AIDS, in addition to what I’m sure other medical groups are doing. And we are $100 billion or $100 million in the budget this year. It’ll be $126 million next year. So this is a top priority with us. Yes, there’s no question about the seriousness of this and the need to find an answer.

3:33, Laguaite: Even before Reagan addressed it, AIDS wasn’t taken seriously. In 2015, Scott Calonico created a short documentary called “When AIDS Was Funny,” and it included audio of press conferences that show Reagan’s deputy press secretary, Larry Speakes, and journalists cracking jokes about the AIDS epidemic. The journalist interviewing Speakes is Lester Kinsolving. The full audio is available on Calonico’s website but I’ve included a clip of it here.

4:01, Lester Kinsolving: Does the President have any reaction to the announcement by the Center for Disease Control in Atlanta that A-I-D-S is now an epidemic in over 600 cases?

Larry Speakes: A-I-D-S? I haven’t got anything on it.

4:13, Kinsolving: Over a third of them have died. It’s known as “gay plague.”

[Press pool laughter]

Kinsolving: No, it is. It’s a pretty serious thing. And 1 in every 3 people that get this have died, and I wonder if the President is aware of this?

4:23, Speakes: I don’t have it. Are you? Do you?

Kinsolving: You don’t have it. Well, I’m relieved to hear that, Larry.

Speakes: Do you?

Kinsolving: No, I don’t.

Speakes: You didn’t answer my question. How do you know?

Kinsolving: Does the President... in other words, the White House looks on this as a great joke?

Speakes: No, I don’t know a thing about it, Lester.

Kinsolving: Does the President— does anybody in the White House know about this epidemic, Larry?

Speakes: I don’t think so. I don’t think there’s been any—

Kinsolving: Nobody knows?

Speakes: There’s been no personal experience here, Lester.

Kinsolving: No, I mean, I thought you were keeping—

4:50, Speakes: Doctor— I checked thoroughly with Dr. Ruge this morning and he’s had no—

[Press pool laughter]

[Speakes laughing]

Speakes: —No patients suffering from A-I-D-S or whatever it is.

Kinsolving: The President doesn’t have gay plague? Is that what you’re saying? Or what?

Speakes: Nope, didn’t say that.

Kinsolving: Didn’t say that?

Speakes: I thought I heard you in the State Department over there. Why didn’t you stay over there?

[Press pool laughter]

Kinsolving: Because I love you, Larry!

Speakes: Oh, I see. Well, I don’t... let’s don't put it in those terms, Lester.

[Press pool laughter]

Kinsolving: Oh, I retract that!

Speakes: I hope so.

5:05, Laguaite: Another journalist refers to it as a “fairy tale,” referencing a derogatory term for gay people that was common in the 20th century.

Journalist: A leading environmentalist has described the President's speech on Saturday as a fairy tale. Is there any reaction to that?

5:21, Speakes: Not true.

[Press pool laughter]

Speakes: Fairy tales are not true and this one’s true. Lester’s ears perked up when you said fairies.

[Press pool laughter]

Speakes: He has an abiding interest in that.

5:38, Laguaite: All that being said, I have Pat here with me now to talk more about the crisis. Hi, Pat, and welcome to the show.

Pat Thomas: Hello!

Laguaite: How are you?

Thomas: Good. How about you Madeline?

Laguaite: Pretty good, pretty good.

Thomas: My name is Patricia Thomas. Most people call me Pat. I’m a professor emerita and the former Knight Chair in Health and Medical Journalism at the University of Georgia. But before that, before the past 15 years of my life, I was a working journalist. I wrote for many publications for physicians and scientists. And I also was the editor of a large consumer health newsletter, the Harvard Health Letter, based at the Harvard Medical School in Boston, but I spent my wild youth in the San Francisco area, which is how I got interested in the AIDS epidemic in its very earliest days, because I knew people who were in the medical arena and I knew people in the gay community there. So my radar picked this up pretty early, even though I was living in Atlanta during the early ’80s. And so I have a lot of experience in this arena.

6:43, Laguaite: Although scientists believe HIV existed prior to the ’80s, Pat said she remembers the exact moment she really became aware of AIDS.

6:52, Thomas: I became aware of AIDS in San Francisco in 1981, while having dinner with a friend who I knew from Stanford. I went to graduate school at Stanford. He went to medical school there. He was a resident in hematology and oncology at San Francisco General and UC San Francisco, and he was horrified to see Kaposi’s sarcoma, a rare cancer which typically is seen in elderly Jewish men and men of Mediterranean descent. But in this instance, these cancers, these horrible disfiguring blotches, which then, you know, kill you in the long run, he was seeing these cases in young men who looked just like him: white, affluent, gay, urban, San Francisco-ites, and they had this cancer.

Thomas: So when he told me about that, which was right about the same time the first publication came out in CDC’s weekly morbidity and mortality weekly report. That report was of pneumocystis pneumonia among a small coterie of gay men in L.A. So here’s my friend in San Francisco saying weird cancer among young white gay men, and meanwhile, in L.A., weird pneumonia, and guess what? They’re all dying. In 1983, I wrote my first stories about AIDS.

8:14, Laguaite: Pat continued reporting on the crisis. Although she lived in Atlanta during the time, she wrote for several New York-based publications and described the experience.

8:25, Thomas: I wrote one story about that — about medical care in San Francisco. I wrote another story about a nonprofit organization called the Shaunti Project, which was sort of a— now, we would call it a community mutual aid society. But it was basically a community of people — gay people and church people — who realized that men dying fast of this disease had lost their jobs, were too weak to go to the grocery store, nobody’s walking their dog, and so people banded together to help them and that was the Shaunti Project.

Thomas: And so I went to a rally on Castro Street, which is the big gay shopping district in San Francisco — gay male shopping district and bars — and there was this huge street rally to celebrate the 49ers. I don’t know whether they had just won a playoff game or I don’t recall, but at any rate, some football party in the street and it was just huge and exuberant, and Castro was packed wall-to-wall with people dancing and drinking takeaway cups. And I had just interviewed an epidemiologist that day. And he said to me, that his studies — Andrew Moss was his name, he’s published many, many times — he said, “You know, in this gay male community in San Francisco, within a year, 1 in 3 of these men could be dead.” And I stood on this crowded, exuberant party street, and I thought, “Oh my god. One out of every three people could be missing from this party if the 49ers have another good year because they will be dead?” And as a medical reporter, I’ve never felt viscerally a statistic just dropped down on me like, “Whoa, look at this.” So I wrote about that, too.

10:10, Laguaite: More than a year ago, scientists began Phase 1 trials of an experimental vaccine for COVID-19. Years before that, Pat did something similar.

Laguaite: I read that you were among the first of healthy volunteers to be injected with an experimental DNA vaccine for AIDS. Can you—

Thomas: That’s right.

Laguaite: OK, can you tell me a little bit about that? And what made you decide to do that?

10:35, Thomas: Yeah. Once I started doing the reporting for what would become my book, “Big Shot,” I had to write a book proposal. And in order to write that book proposal, I had to talk to a lot of people and do a lot of background research so I would know what book I was trying to write. And my first I don’t know, 50 interviews, or so, what really kept emerging to me is, as we would say, in chemistry, the rate-limiting step — the place where there’s a bottleneck and progress bogs down — is clinical trials.

Thomas: So scientists had a lot of ideas about how to make a preventive vaccine that would protect healthy people against AIDS and work in the laboratory and in animal models is — it’s not cheap by any means — but it’s not as expensive as mounting an ethical, scientifically-credible, clinical trial, because you have live humans, and you have to recruit them and test them and qualify them and bring them in places and do things to them. So that’s very expensive. And the government had really backed away — backed away — from spending money on clinical testing of HIV vaccines in 1994, for a variety of reasons, which were political.

Thomas: And so once I realized that clinical trials were probably the bottleneck, one of my sources said to me, “Well, if you want to help, you can do what anybody can do, which is volunteer for a clinical trial.” And I was like, “Oh, I guess I could.” So what they wanted were healthy individuals at very low risk for contracting HIV. And then we were, I was one of the first two dozen people to take what they call a DNA or naked DNA vaccine, which is synthesized in a lab contains a portion of the DNA, or the RNA for a vaccine for the HIV virus, and it induces a cellular immune response to that. So you know, it didn’t seem like much of a risk to me.

Thomas: It was an enormous pain in the butt and it taught me why affluent white people are overrepresented in NIH clinical trials, which are done in Bethesda, because for the per diem rate and the travel allowance they give you, if you didn’t have some of your own money, you could never afford to go back and forth to Bethesda to participate in these trials. Plus, you had to put a lot of trust in these people that whatever they were injecting in your arm wasn’t going to kill you and of course, people of color lack that trust. But people of color who are low income could not have afforded to go back and forth to Bethesda 17 times. I mean, I went 17 times in one year because of the study. Now, I didn’t have a lot of money. I would quit my job and was reporting a book, but I was very motivated. And I had enough money that if I lost $30 on every trip to Bethesda, it was not going to make me noticeably deeper in credit card debt than I already was. So I just went ahead and did it.

Thomas: And of course, it was a disappointment that this product — this candidate vaccine — did not prove protective. That was very disappointing. I— who wouldn’t love to be in the clinical trial that works? We’re reading stories now about people who volunteered for the clinical trials of the Pfizer, Moderna vaccines or the J&J vaccines, and they’re happy to have made a contribution, you know, to this enormous scientific step forward.

13:53, Laguaite: Like Pat mentioned, she wrote a book called “Big Shot: Passion, Politics and the Struggle for an AIDS Vaccine,” and she spoke to the process of it.

14:03, Thomas: Yes, I was the editor of the Harvard Health Letter, and one of my responsibilities was polling the 24 Harvard Medical School faculty members who were my board members to make out kind of a questionnaire, a survey, but surveying them about what they thought were the 10 most important advances in medicine, scientific advances in medicine in the past year, and then I’d write this, you know, wrap-up story that would run in January, and you know, was a look back. And so I was writing the one that was January of 1997, or probably December of ’96, and I was writing to look back on top 10 medical advances in 1996. Well, that was the year that highly active antiretroviral therapy or HAART became available, and it was utterly game-changing for people who were infected with HIV. It made HIV not a death sentence. And at that time, people had been dying. You’d learn you had AIDS. You’d go home and you tell your parents, “I’m gay, I’m dying. I have AIDS, and you’re probably dead in 14 months.” I mean, I think that was the average time from diagnosis to death.

Thomas: So here I’m writing a story about this revolutionary, new treatment so effective, and I’m thinking, “We have this treatment that’s so good. Why don’t we have a vaccine that can prevent this terrible disease in the first place, instead of trying to do something about it later, when people have one foot in the grave practically?” So that idea came to me in the shower. And it’s always you scratching your head. You get these inspirations and I said, “You know, if I don’t know why there is no HIV vaccine, and I’m the editor of the Harvard Health Letter, then chances are that most people who are less privileged in terms of their access to information — most people probably have no idea why there is no HIV vaccine.”

Thomas: So I set out to answer that question. And I found, of course, that there were barriers, enormous scientific barriers. It’s hard to make a vaccine, to keep HIV from getting into ourselves, and leading to AIDS. Money. Vaccines are not as profitable as treatments and never will be a shot that you get once a year or once every 2 years, never going to make the money have a pill you take every day. So pharmaceutical companies are not going to do it without a big infusion of money. And I think that’s exactly what we saw with Operation Warp Speed. What will go down in history as President Trump’s positive contribution to the history of medicine will be the enormous amounts of money put into vaccines because that’s what it takes. It takes a lot of money. And then politically.

16:38, Laguaite: Just as COVID was heavily politicized. HIV was as well. At the beginning of the episode, we heard examples of the politicized nature of the AIDS epidemic. But Pat elaborated even further on that.

16:51, Thomas: Because AIDS was — the first communities that it penetrated were gay people, people of color, people engaged in sex work, and really poverty. That’s a big thing, because it got into those communities. First, they were marginalized. They didn’t have the political pull of other communities when the disease hit, and they were easy to other you know, the gay man who still today make up the largest percentage about three-quarters of all newly diagnosed cases of HIV in the late ’60s in San Francisco.

Thomas: These were boys who came to San Francisco having been disowned by their families, beaten up at school, shunned. They were the lepers of their world, and sometimes killed because they were gay. So when they flocked to San Francisco, and the post-Stonewall gay liberation movements began in 1968, being free to express their sexuality was their most important political issue. It’s a little bit like people today who think that their guns are their only issue. Gay men thought that their sexuality was their only issue. And it was so important to them after the lives that they had led in the communities where most of them came from. So the casual sex, the bars on Castro — this was the definition of living life to its fullest.

Thomas: And so, you know, when you have a president, a Republican president, like Ronald Reagan, and you have federal legislators, members of Congress, Senators, they found it so easy to demonize these libertarians. And you know, most men are really queasy about the idea of gay male sex. They want to watch lesbians, but they don’t want to hear anything about gay men. And so it’s very easy to other these men and demonize them and say, “This is not where public money should go.” So when I began to work on my book, I quickly identified these sets of barriers. And I thought, “Well, I’ll just find me some people who are trying to change this.” People who believe that yes, treatments are important, but what we really need is something to keep the world, the uninfected world, safe, because you’ve studied the history of medicine, the only thing that’s ever defeated an infectious disease is a vaccine, and the only public health intervention more important than the smallpox vaccine and the polio vaccine are flush toilets. I mean, those are, those are your major public health interventions. So you know, I thought a vaccine was important, and so did the researchers I wrote about and in my book, what I did is I tracked from the early ’80s through 2000, the history of people I told the stories, the narrative stories of people who made finding a preventive vaccine their whole life. And there were a lot of these people and they worked for companies and they work for universities and for the government and they tried really, really, really hard in an uphill battle. And we still don’t have a vaccine.

19:56, Laguaite: Pat also spoke to how the discourse about HIV and AIDS change From the ’80s, to the 2000s, when her book came out.

20:04, Thomas: The image of it as a disease of someone other than mainstream Americans that I mean— the Reagan years, you know, those years really enabled most Americans to believe that this wasn’t their disease. Now, gradually, the death of their sons and husbands and nephews chipped away at that, but admitting that a disease was transmitted by sex and the sharing of needles for intravenous drug use? That was pretty hard for most Americans to do, even as the heterosexual spread of the disease moved into the 1 in 4 area, but most of those women were women of color, or they were women in some other country. And so that that idea that they weren’t mainstream people who were affected, that was a persistent thing.

Thomas: Now, the Clinton years helped. Clinton made a big commitment to vaccine development in something called the of the state speech, a forerunner of Donald Trump’s commitment to Operation Warp Speed. I’m not sure if Donald Trump knew that when he did Operation Warp Speed, but his advisors I will bet you did. But no, the disease remained and remains to this day stigmatized because we still live in a very homophobic and racist culture. And those are the enemies of effective public health intervention. But we also need to think about the resistance of the people most at risk, because as I said, gay people in the ’80s were they were single-issue voters. What they wanted was sexual liberation. They did. And of course, that changed with the rise of the AIDS activist groups who were white, college-educated, living on the coasts. Educated white men realized, if we don’t take action to lobby for ourselves, no one else is, and so that that movement was tremendously effective. But even those activists met resistance from their peers and friends. These public health measures are always going to feel to the young and dumb, they’re always going to, or the old and obstinate, they’re always going to feel like somebody is being you’re wagging me and telling me not to do what I want to do. And that public health just faces that all the time.

22:27, Laguaite: Giiven her experience reporting during the AIDS epidemic, and as a queer journalist, myself, I also wanted to know if Pat had faced any societal stigma.

Laguaite: And I kind of wanted to jump back to something you mentioned earlier about activists having a hard time during this period just because of all the societal stigma. So was that something that you faced while you were reporting in the newsroom or outside with sources?

22:54, Thomas: Yeah, well, our ideas— I have thought a lot about this, because, you know, I’m gay. And I’ve always been gay. But when I was covering the early days of AIDS for national publications for physicians, and I’d be in the newsroom at the first International AIDS Conference in ’95, the third in Washington and ’97, the fifth in Montreal. In the newsroom, there was one out gay person. And that was Randy Schultz because his whole career in San Francisco was based on the fact that he was the first openly gay man hired by a mainstream newspaper. There were a lot of gay men and women working for mainstream news organizations, trust me, but the belief that was that if you were a member of a specialized community, you could not be fair and objective in your coverage of that community. So a lot of us in the newsrooms at these international meetings and the smaller HIV meetings we covered, a lot of us had the feeling that if our top editors knew that we were part of this community, they would take us off the beat, you know? We’d be back on cholesterol, and that’s so bizarre because now, of course, the push with newsrooms is we cannot have fair coverage of our whole communities unless our newsrooms are inclusive and diverse. And we have reporters who look like the demographics of the audience we serve, but that’s the opposite of how we were of the social pressures we felt in the news business in the ’80s.

Thomas: And I will never forget in the newsroom of the Washington International AIDS Conference, and I will believe it was ’87. There was a huge cicada bloom that year, I remember walking this conference over bodies of you know, Brood whatever. Anyway, in that newsroom, there was a woman who worked for an advocacy group on Cape Cod, I want to say Provincetown or someplace. And she— we all knew each other a lot, but she went around and she was like, “We’re having a lunch of all the gay journalists. Meet us at such and such a place and So I went there at lunchtime.” And I will tell you, I was surprised to see who else was at that table. People from The Post and the Wall Street Journal and a lot of places who were not especially men who were not identifiably gay. They were not on my gaydar. They were conservative, big-city reporters, but they were not they were gay men, and they were pissed.

Thomas: So yeah, we just kept trying to write the fairest, best coverage we could. But they’re really bad together, although I think it was also in ’87 that the National Gay and Lesbian Journalists Association was organized. And you know, that was a step forward. But honestly, they really believed that gay people could not write about a disease that mostly affected gay people. Now, how does that make sense? That is having such a low opinion of our moral fiber and what sways our judgment calls as reporters. You know, they treated us like we had no ethics, no professional ethics, which was just wrong.

Thomas: Yeah, there was a lot of us. I mean, David Frace’s book, when he writes about the early days of AIDS in New York, you know, he knew plenty of gay journalists. The trouble is, a lot of them are dead. Randy Schultz is dead. I went to Randy Schultz’s funeral. Just these gay men who reported on AIDS, they were part of the community, and a lot of them are not with us now.

26:24, Laguaite: That must have been difficult. How did you, you know, sort of mitigate covering something that’s so devastating to a community like that?

26:36, Thomas: Needless to say, during the Reagan years, and during the reporting of this book, and during a lot of other administrations, I felt angry about how my people have been disrespected, and shunted aside and not treated like valuable contributing members of society. I think it’s inevitable that you would feel that but what it sometimes does is if you can channel that, that anger into determination to redress what you think is wrong, then that’s a powerful force. That’s a powerful motivational force. I think that’s part of what carried me through, you know, the 5 years of my life that I spent working on this book because you don’t get a big advance for a narrative nonfiction book about essentially scientific research. Even if you try to put a lot of social context and turn it into a narrative with character, plot, action nevertheless, advances, low. So you know, I scrambled for money, I was lucky to get some grants from private foundations. I won one prize along the way that helped. I would work, doing work for hire writing pieces for Harvard and other institutions for high pay. And then I would turn around and take that money and send myself on a reporting trip somewhere that I needed to go. That vaccine trial was subsidized a ton of interviews because I would kind of paid for to go to Washington and I would just schedule a ton of interviews while I was there, but it was hard. It was some tough years, it was very lean years to pay for this book myself, and then to have it come out a week after 9/11 when no one cared. Terrorism ruled. If you hadn’t written about the Middle East or terrorism, you were kind of screwed in that marketplace. And by the way, terrorism is often used to move the spotlight off of a public health crisis and divert funding. This is exactly what happened with AIDS. After 9/11, no one gave a shit about AIDS. AIDS fell. And I can tell you as someone whose book didn’t sell 12 copies, you know, it fell off the public agenda for about 2 years and the Trump administration, terrorism has been their buddy. We want to talk about terrorism. Well, not domestic terrorism, but we want to talk about terrorists and immigrants. We don’t want to talk about how what you really need to do to stay safe is wear a mask and stay home for a while. We really don’t want to talk about that.

Thomas: So the lack of investment in sound preventive strategies, the skepticism of the public, who basically doesn’t want to stop doing what they enjoy doing and doesn’t want to stop living life, the way they live it these are all totally predictable, and they are typical of the AIDS years and the COVID years, no different. And then the other thing that’s gonna happen here, and I think a little bit of it is happening now. Just as there was a skeptical backlash against the public health recommendations, we are also I believe, going to see a wave of survivor guilt. The people who poo-pooed the recommendations and as a result, lots of people died, including people they loved and were related to you hearing some of this regret come out in interviews now. I think you can definitely hear it and Dr. Deborah Birx now that she’s talking about some of her experiences in the White House. I don’t think Tony Fauci feels like he has anything to regret. Maybe that early mask advice doesn’t sit too well with him now. But, yeah, a lot of commonalities.

30:18, Laguaite: Given your experience, and especially covering diseases, did you expect COVID to be politicized in the end?

Thomas: Oh, absolutely. Absolutely. It’s easy to stay to stigmatize them as foreign. I knew that would happen. I knew that what happened knew it and especially with since Trump had used China as a straw man for many, many things. You know, it’s obvious that this was going to be the politics of it a foreign play, nothing to do with us. We’ve cut off travel, it’s all cool. And by the time you’ve cut off travel, the bar the horse has already left the barn. You know, we saw that with SARS, you know, MERS, all these things, these viruses, they move fast. Just need one person in one hotel somewhere, you know?

31:02, Laguaite: During the COVID pandemic, former President Donald Trump suggested researchers look into whether COVID could be treated by UV light. He also tweeted about hydroxychloroquine, an anti-malarial drug that's controversially used to fight COVID-19. Although the Food and Drug Administration cautioned against using it to fight COVID Trump advocated it as a treatment. In a similar way, desperation for a treatment for HIV and AIDS was a huge issue.

31:31, Thomas: Desperation for treatment also sparks lunacy about what might constitute treatment. I mean, can we fight this by putting a strong light into your body? Can we fight this by injecting bleach? You know, does hydroxychloroquine work? During the early days of HPV anti-retroviral therapy, the movie Dallas Buyers Club is based on fact, and there were bands of desperate, mostly gay men importing all kinds of crap from everywhere and ingesting it because they were desperate. They knew they were gonna die if something didn’t help and they're willing to try anything. And the problem with that is it’s an open door for quacks and profiteers. There was always a snake oil salesman. And as my physician friends said, back when they had a few drugs, a small armamentarium of antivirals, and that would help treatments ways of approaching pneumocystis pneumonia, things that would help a little bit. They were OK most of them who said they were OK with somebody taking mega doses of vitamin C, advocated by Nobel laureate Linus Pauling or some of these other herbal things, as long as the people didn’t turn their backs on conventional therapy, which they knew helped by a small percentage. And I think we see a lot of that in American culture, especially with the rise of the Internet, people who think that they don't need to take the COVID vaccine because I don’t know, their belief in God will help or their diet will help. So that’s just that is also a universal theme. Just desperation causes people to open themselves to all sorts of fraud and misuse and profiteering and that’s a terrible thing. And the Internet has made it worse. God, I sound like person who hates the internet, who actually use the internet. You know, I'm not, I'm not sitting here in la la land. But I do believe that it’s that it has brought a lot of peril for people who are not educated to think critically.

33:30, Laguaite: Well, thank you so much for taking some time out of your day to chat with me.

Thomas: It’s been fun. Yeah, thank you, Madeline for thinking of me.

Laguaite: Although we do have vaccine options for COVID through companies like Pfizer, Moderna, and Johnson & Johnson, there is no vaccine for HIV and AIDS. About 1.2 million people in the US are living with HIV, and it still disproportionately affects certain populations, like racial and ethnic minorities and gay and bisexual men. To see a list of global and local HIV and AIDS organizations, check out the show notes on social media or via the To Health and Back website.

Laguaite: This has been To Health and Back. Thanks again for joining me on this health history journey. Tune in next time. Until then, don't forget to rate the podcast and subscribe. Feel free to shoot me an email at healthandback@gmail.com and I'm also on Twitter, Instagram and Facebook as @healthandback. Thanks. See you next time.

View Details

In this episode of “To Health and Back,” we’ll hear from Dr. René F. Najera — an epidemiologist and editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia — to see explore the history of vaccines and vaccine skepticism, and how that same skepticism exists today.

Read the transcript for this episode here. SHOW NOTES: * CDC: Read about how to find a COVID-19 vaccination site near you. * Centers for Disease Control and Prevention (CDC): Read more about the CDC’s decision to resume the use of Johnson & Johnson’s Janssen COVID-19 vaccine. * C-SPAN: Listen and watch as Dr. Richard Besser speaks on the implications of pausing the use of the Johnson & Johnson COVID-19 vaccine. * EpidemioLogical: Read more of Dr. René F. Najera’s writing. * The History of Vaccines: Read about Dr. Najera and his role as editor of The History of Vaccines site. * The History of Vaccines: Read about the history of smallpox. * The Indian Journal of Psychiatry: Read about the MMR vaccine and autism, including the retraction and fraud. * Johns Hopkins Medicine: Read about COVID-19 vaccines and people of color. * Journal of the Royal Society of Medicine: Read about the origins of inoculation. * Medium: Read Dr. Najera's writing on Medium.com. * Our World in Data: Read about and examine coronavirus (COVID-19) vaccinations data. * U.S. Food and Drug Administration (FDA): Read more about the FDA issuing an emergency use authorization for the first COVID-19 vaccine.

MUSIC CREDIT

View Details

In this episode of ”To Health and Back,” we’ll hear from Dr. René F. Najera — an epidemiologist and editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia — to see explore the history of vaccines and vaccine skepticism, and how that same skepticism exists today.

Check out the show notes here.

NOTE TO LISTENERS: This conversation was recorded before the U.S. resumed Johnson & Johnson vaccinations.

Laguaite: In this episode, I’m sitting down with Dr. Najera to talk about the history of vaccine skepticism and how those past instances reflect what we’re seeing today with the COVID-19 vaccines.

0:36, René F. Najera: You know, there was vaccine skepticism before there were vaccines and that’s something that always kind of befuddled people like, “What do you...? What do you mean?”

0:44, Laguaite: Vaccines skepticism today comes in light of the COVID-19 pandemic. On December 11, 2020, the U.S. Food and Drug Administration issued the first emergency use authorization for a vaccine for the prevention of COVID-19 and people 16 years and older, which allowed the Pfizer-BioNTech vaccine to be distributed in the U.S. Later, the Moderna and Johnson & Johnson vaccines were approved as well.

Laguaite: However, on April 13, 2021, the Centers for Disease Control and Prevention (CDC) and the FDA recommended a pause in the use of Johnson & Johnson vaccine. Of the almost 7 million doses administered so far in the U.S., a small number of reports of a rare and serious type of blood clot had been reported and people after receiving it. All reports happened among women from the ages of 18-48, and symptoms occurred 6-13 days after vaccination. Dr. Richard Besser, who was the acting CDC director in 2009, spoke about the implications of the Johnson pause on C-SPAN on April 18, 2021.

1:53, Richard Besser on C-SPAN: First, I do think taking a pause was the right response. We have a number of systems to report what are called vaccine adverse events. And then they’re investigated to see is this something that was just occurring in a timeframe related to vaccination, like someone that had a heart attack and they had a vaccine last week, but it wasn’t caused by the vaccine? Or is it something that the vaccine actually could have caused? And so, in these systems of reporting, they detected six cases of a very rare type of blood clot in women who were all younger than 50 within 2 weeks of having received the J & J vaccine.

2:36, Laguaite: Although the Johnson & Johnson vaccine use resumed on April 23 at the recommendation of both the CDC and the FDA, public health experts were worried and still worry about how that pause could impact vaccine hesitancy and skepticism in the U.S. Still, vaccine hesitancy isn’t new. Here with me to talk more about vaccines and the history behind them is Dr. Najera. Hi, Dr. Najera, and welcome to the show.

Najera: Hi, how are you?

Laguaite: Hi, I’m good. How are you?

Najera: I’m doing well.

Laguaite: Could you state your name and sort of tell the audience who you are?

3:11, Najera: Yeah, so my name is René Najera. I am an epidemiologist, Dr. Public Health. I’m a senior epidemiologist at a local health department that shall go unnamed. But my reason for being here is that I’m the editor/project director of the History of Vaccines project by the College of Physicians of Philadelphia.

3:30, Laguaite: Although public mistrust of vaccines is currently an issue, it’s been a problem in the world of public health for some time now. We could look to the case series published in The Lancet in 1998, by Andrew Wakefield and 12 of his colleagues that suggested the measles, mumps, and rubella — the MMR vaccine — could cause autism in children.

Laguaite: Like I mentioned, vaccine skepticism begins way before that study. And like Dr. Najera said earlier, vaccine skepticism precedes vaccines themselves. He pointed to waves of smallpox in the 18th century and gave me an idea of what it was like.

4:05, Najera: So, back in the early 1700s — smallpox a disease that was terrible, horrible, horrible disease, 30% death rate. If you survive that, you were scarred. A lot of people would actually commit suicide from the scarring because they just couldn’t bear looking at themselves. And almost everybody got it, you know? It would go around in waves, not pandemics, which is like, it happens worldwide at the same time, right? It would go around in waves every 15-20 years. So every generation, you build up enough people who are susceptible, and then boom, it would hit you. Everybody who knew something about medicine had to find a way to stop it. And at the time, we scientists didn’t know what a virus was. There was no such thing as a microscope. There were hints that there was something infectious going on. There were hints that your body that’s something to protect you after infection because once you got it, you know, you were immune afterward. So there were these little hints here and there.

4:58, Laguaite: But inoculation techniques didn’t originate in Europe. Researchers and historians say that the two most likely origins were either China or India, and Dr. Najera spoke about the former.

5:10, Najera: But if you go back 1,000 years, the Chinese would... they realized that if you took some of the scabs from the smallpox and you dried it out in the sun, and then you ground it up into dust, and if you inhale that you got some sort of immunity from it, again, probably a lot of trial and error, probably a lot of observational studies, nothing really scientific. And so they did it. And it worked. And it was called variation or inoculation. And this practice then leaves China through the Silk Road, heads to West India, they pick it up. Middle East, they pick it up. North Africa, they pick it up, but it doesn’t make any inroads into Europe; It just kind of, you know, “It’s one of those things, those people over there do. They’re kind of weird. You know, they’re not like us, sophisticated Western people.”

5:57, Najera: This practice didn’t make it to America until much later, in the early 1700s. This enslaved man is picked up in Africa and taken into Boston and he is sold to a congregation at a church and the congregation gives him as a gift to their Reverend Cotton Mather. Cotton Mather was involved in the Salem witch trials. But he basically notices that the slave, Onesimus, is immune to smallpox; he doesn’t have any scarring. He’s fairly older. And he says, “What is protecting you and why do you have this scar? And what is that?” And he said, “Well, they gave us smallpox without actually giving it to us.” And Cotton Mather got kind of curious and says, “Tell me more.” And so Onesimus describes a procedure where they would take somebody with smallpox and take a little lancet and lance the pox and get the tissue or the fluid and then put it in their arms. And they were sold at a higher price because they were now immune from smallpox, and that would make them profitable.

Najera: And so Cotton Mather goes to a friend who’s a physician last name of Boylston, and says, “Hey, is there anything to this?” And so most write some letters to some friends and colleagues in Europe, and they say, “There’s this woman who is married to the British ambassador, her name is Lady Mary Montague.” And they traveled to Turkey — a British ambassador to Turkey went there. And it wasn’t called Turkey. At the time, it was the Ottoman Empire. And she had written back saying that there’s this practice of doing that in the Ottoman Empire, and people are immune. And there’s this whole process to it. It’s very controlled, you know, you don’t want to get too much of the smallpox; you want to get just enough to give immunity. You want to do it under the supervision of somebody who knows what they’re doing. And they didn’t know this at the time ... a major variola and a minor variola, and they said, “You don’t want to get the bad one, major. You want to get the minor and give that to people.” It wasn’t that minor. It was like 5% death rate. So she writes letters to her friends and colleagues again, and my colleagues, I mean, people in the higher echelons of society in Britain, say, “Look, I just had my child inoculated. And he had a fever for a little bit, but he got over it, and he didn’t develop smallpox. You guys should look into this.”

Najera: But her letters, Boylston’s letters, other people’s letters start traveling the world and there’s confirmation that it works. So then a ship arrives in Boston in the early 1700s, 1710s or so. And the sailors have smallpox and it had been a while since the last smallpox outbreak. So here we are. We are beginning with smallpox outbreak, and Cotton Mathers immediately tells Boylston, “Hey, this inoculation thing — Let’s try it. It’s worth doing. Let’s just go for it.” So they inoculate themselves. They inoculate their families. They inoculate of the slaves working for them. And it seems to work. If you look at the death rates of people who got smallpox the natural way, it was about 10 times worse than the people who were inoculated, because you then inoculate everybody on time, some of them were already infected.

8:50, Laguaite: But just like today, not everyone was a fan of the inoculation idea.

8:56, Najera: So Boylston and Mathers say that to the townspeople, “Hey, let’s do inoculation.” And people lose their minds. They firebombed Cotton Mather’s house. They wrote very dissenting opinions in the press. Cartoons were made. They were saying, “No. 1, why would you put the filth in us? No. 2, what are you doing listening to a slave? What does he know? No. 3, what are you doing listening to the Ottomans? What do they know?” It snowballs from there. And this is kind of the same reaction that you get in other places. You know, they just have this adverse reaction to inoculation.

Najera: Later on, in the Revolutionary War, Washington is defeated at a battle up in New York State or what would be New York State and he realizes that it’s because his troops are sick with smallpox, that the British had smallpox and a lot of them already are in that immunized. Now they’re immune from get having smallpox, they are the ones that survived. Right? And so he hears about inoculation, and he forcefully inoculates his troops. Like he actually had people held down and given the inoculation against their will, because he said, “Look, we’re not going to lose the war because you get smallpox.” And you have several instances of this. Benjamin Franklin writes the opening to a pamphlet talking about the benefits of inoculation. Like in “Hamilton,” “To every action, there’s an equal opposite reaction” and people rebel against it. They’re like, “No. 1, the government is not going to tell me what to do with my body. No. 2, yeah. You don’t know what you’re doing.” This is all before the first vaccine.

10:21, Laguaite: But the first true anti-vaccine sentiment evolved around the early 19th century with the first vaccine.

10:28, Najera: The first vaccine happens in 1796, which is a smallpox vaccine that is taking cowpox and doing the same thing that you did with smallpox; you just did it with cowpox. Cowpox doesn’t cause severe diseases that causes the scarring, doesn’t cause death. You kind of feel icky for a while, but you get over it. And then you’re immune against not just smallpox, but others as we found since and other smaller poxviruses. That is the first time that there’s this anti-vaxxer sentiment growing. So by the time the first vaccine comes around, it’s already the groundwork is already laid out. They already have their talking points. They already have their celebrity figures who are opposed to this. President John Adams was, you know, he heard about the smallpox vaccine. And he was like, “I know.” Thomas Jefferson, he heard about it. He was like, “Oh, that’s interesting. Let’s look into it.” And he kind of helped promote it. So the groundwork was already there by the time the first vaccine comes around.

Najera: First vaccine comes around and you see the cartoons, “Oh, this cowpox vaccination is going to turn you into a cow.” If that sounds familiar, you know, to the COVID vaccines, “The mRNA vaccine is gonna alter your DNA, make you into something nonhuman,” you know? “They’re taking the cells from the cow and putting into you.” Now we hear, “They’re taking fetal cells and putting them into you.” Moral grounds and religious grounds. “If God wanted you to die from this, and you’re just gonna die from it, sorry.” And now you hear religious figures saying the same thing: “No, no, don’t get tested. Don’t get vaccinated. If God wants you to suffer, then you’re going to suffer, OK?” You know, those kinds of things. Unfortunately, now you have mass media, social media, you have people who have huge followings on the internet that they say something and a lot of people listen to them. And we found in our research in public health that people listen to people who are like them. And so all you need is a critical mass of people listening to you as an influencer. And that critical mass will influence a ton of more people just spreads. And so it’s the same thing with pro-vaccine, we try to reach the critical mass of people who will tell their peers the benefits of vaccination and, and get that going. And it’s kind of the reason why vaccination programs for kids are so successful, you still have vaccination for school requirements up in the ‘90s. Because for the most part, you don’t you know, you hear about things that happened, but you don’t see them. You don’t see... they say that children turn autistic. “Well, no, they were always autistic.” They just kind of figured it out later on.

Najera: You don’t see the deaths that anti-vaccine people say that exist. You don’t see those kind of things. And so that’s why it’s been it’s been so successful. The only problem is that there’s things like measles, that if you drop down below 95-96%, you start messing with herd immunity, and outbreaks come back. But the history of the anti-vaccine movement has been around longer than vaccines, and it’s kind of it’s kind of annoying that it hasn’t died out, and they just keep recycling the same thing over and over again. You know, in the mid-1800s, the British Empire said, “OK, everybody get vaccinated against smallpox,” and they actually call themselves the National Anti-Vaccine League because they couldn’t sound like a villain more than that. And then they spread their tentacles throughout the whole world, sending letters everywhere, and then there was one created in the U.S. that would actually fundraise off of the fear of vaccines. Using the talking points of “the government can’t tell you what to put into your body,” “you’re healthy enough as it is,” “just live a healthy life and you won’t get sick.”

Najera: And then the moral grounds. If it was meant to be, it was meant to be and things like that. And so they came about and they start suffering some blows in the 1900s because science has advanced now we have microscopes. Now, we know what things are. There’s more respect towards scientists. It was a golden era of science. People like Pasteur who found the vaccine for rabies were hailed as a hero. There was a doctor, Haffkine, who found the vaccine for cholera and for the plague in India — probably averted millions of deaths from those in India. They’re held as heroes and there’s more of that happening.

14:21, Laguaite: Mandatory COVID vaccinations are a hot topic as various colleges like Yale and Columbia just to name a few plan on requiring COVID vaccinations come fall. Government intervention in the context of vaccinations and public health is especially relevant today. But it’s historically relevant as well.

14:38, Najera: And then the Supreme Court steps in. There was a man by the name of Jacobson in Massachusetts who didn’t want to pay a fine of he wasn’t vaccinated. He said that he had some really bad vaccine reactions when he was a kid and he wasn’t going to get the vaccine and neither were anybody that he would look after. And the state said, “That’s fine, but you pay a $5 fine,” which in today’s dollars is close to $100, $50? And he said, “No, I’m not.” And he took it all the way to the Supreme Court. Supreme Court said, “Actually, yeah, the state cannot forcefully vaccinate you, but they can fine you because they have that power.” Under the 10th amendment is the police powers of the states. And that echoes in us with us today, 100 years later, because the interventions for COVID that you see — whether to wear a mask or not, whether to social distance or not — is very locally controlled or state-controlled because of that decision. Because the Supreme Court then said, “Yes, it’s not up to the federal government. It’s up to the state and local governments to enforce public health laws.” And it came from this anti-vaxx sentiment of “No, I’m not. I’m not getting it.” And it happens today.

Najera: Later on, another court decision is Zucht v. King. They sued the school system saying, “No, you cannot require me to be vaccinated for school” and again, the Supreme Court said,”Yes, yes, they can. Your right to be free of vaccination does not preclude the right of the entire population to be free from disease. They cannot force you to get vaccinated, but they can fine you or they can prevent you access to public spaces.” And you see that now, right? “You can’t make me wear a mask.” Well, no, but we won’t let you into the store, or we won’t let you into public buildings and stuff like that. That’s the thing about history. That’s the thing I’ve learned in managing the history of vaccines and running the project as it keeps repeating itself over and over and over and over again. So whenever somebody brings to me something “new,” quote, unquote, that the anti-vaxxers have done, I’ve been like, “No, there’s nothing new under the sun when it comes to them.” I’m not surprised anymore by the things that they say. I’m disappointed.

16:30, Laguaite: Although Black, Latino, and indigenous people, along with other people of color, are overrepresented in serious COVID-19 cases, vaccine hesitancy among these communities can complicate the decision to be vaccinated. And Dr. Najera spoke to the skepticism.

16:47, Najera: So you’re talking about 300+ years of terrible abuses to people whose origins come out of Africa. And that community alone — which is not a community, it’s many communities — is just time after time, the abuses you read about these and you become more as I say, “woke.” But you become more aware of all of that has happened and you’re like “Well, no wonder they’re going to be skeptical of the vaccines given by the government. It’s the same government that enslaved their ancestors.” And in some cases, you still have some people who are alive whose grandparents were enslaved.

Najera: You have the Tuskegee experiment in which you know that there’s a misconception in the African-American community that people were given syphilis. That’s not what happened. What happened is that people who had syphilis were told not to seek care. They were told that they were already getting care when they were not. And this is in an era of an era of antibiotics already. So they could have been given antibiotics and cured from syphilis, but because the scientists wanted to see what syphilis will do to people, when there was already plenty of documentation of what syphilis would do, again, the government and the scientists could have prevented a lot of death and suffering, and they didn’t because they were racist.

Najera: And then you have Henrietta Lacks. Henrietta Lacks neither she nor any of her relatives, or anybody close to her, benefited from her cells but so many other people have. You have institutions located in cities that are predominantly Black, that conduct a lot of a lot of research, and use a lot of people of color, for their research. And then it never— the benefits of that research rarely, if ever, gets back to them. So you have this history that just goes way back and keeps repeating itself. Anybody who knows anybody knows about this, and you cannot be surprised that they would be skeptical of a vaccine. So that is mostly in the African-American community.

18:34, Laguaite: The Latino community has also historically faced discrimination in the medical sphere.

18:40, Najera: In the Latino community, what you have going on there with Central Americans is that there was a time in the ‘70s and ‘80s when pharmaceutical companies went to Central America. They conducted experiments that actually benefited the people who were in the experiment of medicine work, but then they said, “Oh, the medicine works. We’re out.” And then the people were like, “Well, can we get the medicine?” and like you have to pay thousands of dollars for the doses? Why? And so there was that abuse.

Najera: There were medical experiments on the contraception pill in Puerto Rico that went sideways. Because contraception pills cause a higher rate of blood clots and other things. And when they were perfecting that, there were side effects, and people in Puerto Rico — remember that the people of Puerto Rico as well had an island, a beautiful island that I’ve been to, called Vieques and it was being bombed by the U.S. Navy for target practice. So you have that history in the Latino community. You have the fear of those who are undocumented, “No, I’m not gonna put myself on any registry. I’m not going to register for the vaccine. I’m just going to keep me laying low because I don’t want to be deported.” And you have all of that going on as well. So it’s understandable.

19:40, Laguaite: Dr. Najera touched on some of the abuses indigenous people in particular face at the hands of the U.S. as well.

19:47, Najera: And then you get to the Native Americans, right? And then the Trail of Tears, the forced removal from their land, the taking of their children to make them whiter — things of that nature. And again, it’s like, “OK, well, yeah I understand why you wouldn’t you trust what is called the Indian Health Service to give you the vaccines that you need.” And it’s sad because they are the ones that are being affected the most by COVID-19. And they are the ones who are being targeted the most as well by anti-vaccine groups. You see it all the time. You see these luminaries, anti-vaccine luminaries reaching out and saying, “We’re doing this for social justice. Stay away from the vaccine,” when in fact, they’re doing the opposite. They’re causing more death and disability in those groups, as we know. I don’t know what the solution to that would be. I sometimes I think that a model like South Africa of the Truth and Reconciliation efforts that were done after apartheid kind of really worked, and having something like that here where we as scientists sit down and say, “Yes, our predecessors were horrible to your predecessors, even to yourself and we don’t want to do that anymore.” And including more people of color, a little bit more diversity in the scientists that speak out.

Najera: I was I was watching the Congress hearings, just now Dr. Fauci all the white guy, right? So while he is very appealing to a scientist or geeks about him, he doesn’t really have that impact with a young urban African-American kid who’s barely getting by who probably has lead poisoning from the house that he lives in or she and so “Fauci? Fauci? Who’s that? I have other people that I look up to who don’t encourage me to get vaccinated.” And so yeah, it’s a struggle. It’s a struggle. We’re making inroads through scientific means: focus groups, surveys, we recruit marketing people who know how to sell things to people because that’s what we’re doing. Basically, we’re selling the vaccine without actually cashing in on it. Contrary to popular belief, so it’s an issue and it’s rough.

21:43, Laguaite: The history behind and surrounding the polio vaccine is a good example of health inequity regarding vaccinations.

21:51, Najera: I wrote an article on medium.com called when the vaccine — and I wrote this back in September of last year — and when the COVID vaccine rolls out, it’s not going to be equitable, is it? I use the example of the polio vaccine. When the polio vaccine rolled out, the kids who were left out in the cold were the African-American children, for the most part, because this was done in collaboration with schools. So you’re targeting children. So who better to target than the schools or to partner with than the schools, and this was shortly after Brown v. Board. So the schools were not desegregated yet, although they were on their way. And so who benefits the most? White, affluent children and even there’s some evidence that even white poor children in the South did not benefit from the polio vaccine as much as their white, affluent counterparts. And so you know, you have those inequities. Time after time it happened. Then with the polio vaccine, it has happened with the HPV vaccine. At the very beginning of it, if you didn’t have insurance, you couldn’t get it. And so who doesn’t have insurance? More often than not, poor individuals who are people of color, who, because of their lack of health insurance, don’t go and get their annual exams, and they end up being the women who have cervical cancer because of something that was completely preventable, and completely treatable, and then it got out of control. So you know, those kind of issues always pop up.

23:03, Laguaite: It’s these inequities and discrimination within medical settings that led to what Dr. Najera calls public health 3.0.

23:11, Najera: We call it public health 3.0. So public health 1.0 was going after these infectious diseases, so, potable water to get rid of things like cholera; sanitation, to get rid of communicable diseases; STI, sexually transmitted infections. So that was probably 1.0. Then we moved into public health 2.0 and we went through after chronic diseases, cancer, diabetes, obesity, things like that. Mental health. And then now we’re moving into public health 3.0, where we are bringing it all together, along with the social determinants of health, you know, where do you live? How much money do you have? How old is your house, things that you cannot really control that much also influenced your health. And so that’s where we are now, where do you come from? What zip code do you live in? And there’s this whole campaign about zip codes, and they say, “Oh, what zip code you live in determines your health.” It’s called the ecological fallacy and epidemiology, but I can see where they’re going. I’m not going get too technical on that. But yeah, yeah, we’re probably health 3.0.

Najera: We’re looking at the environment and influence social environment, physical environment, and environment to comment affects public health, and in that vaccines play a role. Because as climate change happens, for whatever reason, it happens, right? When you have that nonsense debate going on, as climate change happens, you have more mosquito-borne diseases Zika. Taught us a lesson back in 2016. We’re going to need a vaccine for that, eventually. Yellow fever: there’s a safe and effective vaccine for that. And then dengue fever, there was a vaccine, but it had to be pulled from the market because it was causing more trouble than the disease itself, mostly in children. So that needs to be refined. As that happens, as populations migrate, we’re going to need to catch them all up on their vaccines before we integrate them into the school systems. We see that with the kids at the border right now, even though there’s really good vaccination programs in Central America and Mexico, they still need to be caught up with some of their vaccines. A couple of years ago, when measles was going around, there was a shelter in Texas that just had a huge measles outbreak. They had a couple of children who died from influenza. Things that don’t usually happen.

25:14, Laguaite: The political environment also has an effect on public trust in vaccines.

25:22, Najera: On the one hand, the Trump administration botched the response to COVID-19 kind of. Things could have been much better. On the other hand, they did throw a lot of money at the vaccine development, and that’s probably why we have a vaccine so fast, although we could talk about mRNA vaccines being around since 1990. But you know, it’s part of that. There was that to be said. Because people like to say that to me sometimes, like, “Can you say anything good about the Trump administration and COVID-19?” Yeah, the vaccines. Operation Warp Speed. And that’s it. So yeah, the political environment as well has an influence in all of this and going back to the anti-vaxxers, they latch onto those things. You know, we used to think that anti-vaccine people were mostly suburban crunchy granola moms, right? More likely than not: liberal, well educated, college-educated. Blah, blah, blah. But now it’s shifted. Now you see in anti-vaccine groups and individuals targeting right-wing, anti-government from supporting people for their fundraising efforts that goes back and forth like that as well in the future if it suits them, they’ll go after a whole other group because that’s kind of how they operate. They try to get to the to majority of people that can fill their bank accounts.

26:34, Laguaite: I also wanted to ask Dr. Najera about mRNA vaccines and the history behind them. Although there’s lots of discussions today about these types of vaccines, they’re not exactly new.

26:46, Najera: Yeah, so back in the 1990s. Well, actually, before the 1990s, scientists figured out that your cells, when you had to make a protein, or when your cell had to multiply the DNA in your nucleus, the nucleus of your cell would send a signal out to the rest of the cell: “Hey, started making insulin,” for example. And that message went in the form of mRNA — messenger RNA — and messenger RNA goes out and gives you instructions, a template for a protein and then your ribosomes make the protein. Insulin, saliva, tears, whatever you need to make. It comes in that single hormones, etc. And in the 1990s, scientists figured out that there were these mice who had what is called diabetes insipidus, they’re missing an antidiuretic hormone. And they said, “Well, what if we were to send the message the mRNA in there and say, “Hey, make the make the hormone.” And so they did. And they were very successful at it. And it started from there.

Najera: The problem was that they couldn’t scale it up because more advanced immune systems like apes, as we are, would take the mRNA and immediately attack and get rid of it before it could do its job. Then in 2005, while eating — this is my theory — while eating M&Ms, something somebody figured out like, “Oh, what if we put the mRNA in a shell?” And so they did it. They put it in lipid nanoparticle shell. Lipid is fat. And so that way, it would elude the immune system and get to the cells where it needed to work. The mRNA gets to the cell, the cell absorbs it. And then the mRNA signal says, “Hey, make protein hormone antibodies against cancer cells.” That’s what it was being used for. Then COVID-19 happened.

Najera: Shortly before COVID-19, they were already working on other infectious diseases. They said, “Hey, what if we tell the cells to make the spike protein that looks like the spike protein on the virus and that way, the cell will make that protein and your immune system will react against that protein and make antibodies in your you’re good to go.” So I said, “OK, let’s let’s get a shot.” And instead of going sequentially, they — because of the money that came in from Operation Warp Speed — they did everything they had to do at the same time. So at the same time that they were perfecting the lipid nanoparticle, they were recruiting people for the vaccine trial, at the same time that they were splicing the mRNA with the proper signal that they needed, they were already looking at people’s immune responses to other to the previous infection from COVID. This is 6 months already into the COVID pandemic. They said, “OK, this is the mRNA signal that works. This is the outcome of it. This is the safety of the preservative. So let’s just go and run with it.”

Najera: My wife actually participated in the Moderna mRNA trial, starting in July. And she reports the same symptoms that I got, when I got the vaccine of my arm. It really hurt the first one, the first shot. Second shot, I actually got like a flu-like illness and was laid out. And if you know the man flu, it’s pretty bad. I was laid out for a day, but then feel fine by the third day. Same thing with her. And so the mRNA vaccine is just a new technology. Now we’ve hit this new leap with the mRNA technology, we don’t need to grow the virus in the lab, we just need to know some lab in China opened up the virus and did the DNA analysis or RNA analysis on it and gave us a sequence and then here in our lab, we put the mRNA together, we don’t even need to grow the virus, we don’t need to worry about biosecurity here. We just have the mRNA we package it and that’s the vaccine minutes good to go. So that’s a that’s a heck of a leap, right? You don’t need these enhanced biosecurity labs all over the place; you just need to wherever the disease pops up, you want to you want to look into it. You can text message the with the code of the virus, it’s that short. ATC GTT. I guess it’s you because it’s RNA. So, yeah, this is a heck of a leap because now, we can crack open any virus out there any bacteria out there, create the mRNA and then our own cells will create the proteins against which will react and give immunity.

Najera: And that is huge. I personally don’t invest in BioPharm, biopharma or Big Pharma to not have conflicts of interest. But I’m very curious and very enthusiastic about what is coming down the pike because a lot of vaccines are going to be made this way now. It’s super safe. It’s quick turnaround. So if anything else pops up on the horizon, another pandemic we’ll have a vaccine just as fast if not faster, and it seems to be it seems to be working right at the county where I work. The number of cases and deaths and long-term care, which were the first ones to get vaccinated have dropped precipitously, and they’re super low. The safety profile is excellent as well, you know, almost 100 plus million people vaccinated in the United States, nothing like what we saw with Johnson & Johnson.

31:28, Laguaite: We recorded our conversation a few days after the Johnson & Johnson vaccine was paused. I asked Dr. Najera for his take.

31:37, Najera: Johnson & Johnson, there’s issues there that are being sorted out, which is actually a good thing. You know, it’s a good thing that six cases of 7 million people actually triggered this pause, because that means that the system is working, that the system that anti-vaxxers say is nonexistent for safety, it actually exists. And it’s actually there. You know, I tweeted out a few anti-vaxxers. And I said, “Well, you’ve said that nobody’s watching out for safety. But yeah, this happens with Johnson & Johnson, do you have any comment?” and it’s crickets or I get blocked. So yeah, you know, we’re into a brave new world of vaccination with mRNA. And hopefully, that’ll make vaccines even safer, because in the future, I can swab myself send it up to send out to a company like we do now with 23andme and other others, and they can look at the genes that’ll make up my immune system and say, “OK, you know what? We were going to tailor the vaccine to your immune system, so you don’t get hives, you don’t get a bad allergic reaction, a fever, etc.” You get immune, but you don’t get all those other things with it. Personalized vaccines in the future. It’s coming, and I’m super excited about it.

32:40, Laguaite: Some people are left wondering why they need to get a COVID-19 vaccine, especially if they’re not at high risk for the disease. Dr. Najera shed some light on the importance of getting vaccinated.

32:51, Najera: For the most part, COVID is... this is the honest truth, it’s a benign disease, right? It’s not the 5%, 10%, 30% mortality rate that we see with other diseases. That’s all fine and good. Children are not being affected. My daughter has been going to daycare hasn’t had any issues. On the other hand, it’s not a benign disease. Enough people are dying and people are getting sick from it. We have the long haulers from COVID and we don’t really know what’s going to be the long-term effects of even an asymptomatic infection. We’re learning more from it, you know, but why? Why do we even need to go through that if we can end it all with a vaccine? For other coronaviruses and the human populations, they cause head colds, they cause severe respiratory illness at times, not not a big deal. We kind of become adapted to them. This is probably going to be the fifth one that does that. But why if you can avoid a cold a year, you know, why not? When something that it’s very safe. It’s very effective.

Najera: We humans are really, really bad at estimating risk. When the 737 aircraft had issues, there were two crashes. Terrible, sad. A few 100 people died. That’s not good. But at the same time, millions of people traveled on those planes without any issues. We grounded them, right? We grounded them. I know of people who didn’t want to fly anymore, not even 737. That was another time. Not that not the one that had issues. They just didn’t want to do it. You know, they went online when they bought their tickets and made sure that it wasn’t a 737 flight, they were getting. Flying is the safest — to quote Superman — is one of the safest ways to travel. But we get scared by those instances. There’s about 30,000 people a year that die in car accidents, and yet we jump on a car all the time. I drive. I commute to work and back and I never think about those 30,000 people that have died and it doesn’t horrify me. I guess there’s something about falling out of the sky that horrifies people. And so you know, risk and that’s that’s the kind of thing, a lot of anti-vaccine or vaccine-hesitant parents are talking to me and they say, “There’s a 1 in a million but why be the one the 1 in a million?” And I said, “Well, you had more risk of getting killed on your way to groceries, than then you do on your way to getting the vaccine” and they kind of like, you see the wheels turning. And so while on the one hand, yes, it’s true when people say, “Oh, it’s less than 1% of people who get COVID will die.” Yes, it’s true, but enough people are dying, it’s going to become endemic if we don’t do something about it. So it’s going to cause disease in the future. More children have died from COVID during the pandemic than that from influenza on average, in the last 5 years. So it’s obviously affecting children at some degree. Just why go through that if we can get out if you can get a shot and that’s it and we ended and it’s over?

Najera: The other thing is the you have to think long-term. This is not going to be our last pandemic. We had one in 2009 and we got super lucky because we already had testing for flu. We already had the flu vaccine ready to go. We had a certain time of year that although it doesn’t work as well as it should, it does prevent severe disease. So all those things were in place and you know, most of us were already used to getting a flu shot every year so there wasn’t as much hesitancy there. And so we got super lucky. This one we got kind of lucky that even with a relatively not good response from our government, we still managed to not get a lot of people killed, although half a million, still a lot. We’re sort of lucky that mRNA technology exists. And so this is all a learning towards the next thing.

Najera: One of the things that keeps me up at night, it’s called Nipah virus out in Australia and Southeast Asia in one of its cousins. They’re both cousins of rabies, and they’re airborne. And so you can imagine airborne rabies, that does keep me up at night. Because if we had one of those pandemic epidemic of that up to up to 30-70% mortality rate, that’s an extinction-level event, right? And so when you say, “Well, what is me getting a vaccine now have to do with, if something like that happens?” Because now we get to practice for that happening, should it ever happen. And the chances of it happening are increasing because people are moving into the animal habitats, animals are moving into where we live, we’re coming into close contact with bats and with wild animals that carry these things. And you could have a situation like that. And so we need to be prepared. As a society, I need to, as an individual, I need to learn to get my vaccines on time to follow my physicians’ advice, it’s just part of being a responsible part of society.

37:24, Laguaite: For those who are nervous and haven’t gotten their vaccines yet, but are eligible, Dr. Najera recommends it.

37:30, Najera: So, it would be very easy for me to say to not be afraid, right? Like I know the science. I’ve read the books, and I’ve done it. I crunched the math. I’ve taken the vaccine myself. My wife took it as well. But I must say that when I went to take my toddler to get her first shots when she was a baby, I did kind of have a visceral response. When I saw those, the needles go into her like, it did make me afraid. And like for a quarter of a second, I thought, “Well, what if I’m wrong? What if the science is wrong?” And then and then the rational brain took over and said, “No, no, no, like, you know it’s safe. She’ll be OK.” The same thing with me when I do these, you know, I do these interviews and stuff like that. A lot of them are in Spanish. And I try to connect to people in that way, saying, “Look, I’m an immigrant. I grew up in Mexico, I’m here now and I totally get it. I’m you.” I did I, for the longest time, even though I came here legally, I didn’t want to get on any registry because I had heard about the importation. I heard about all these things. And so you know, people were like, “Oh, yeah,” and we hadn’t, and then wanted to get the vaccine. So that those are the kind of conversations a peer to peer more than authority on down. That seemed to work. And so in that we in public health, we are reaching out to community leaders to religious leaders, and others and partnering up with them to deliver those messages.

38:45, Laguaite: Because the COVID-19 pandemic was so politicized, some experts think that added to the fear of vaccines and the public mistrust surrounding them.

38:54, Najera: I think that we need to put things aside that get in the way or make us fearful. For some people, it’s politics. You know, they like to believe President Trump when he says, “I got COVID and I got through it fine.” You didn’t. You ended up in the hospital and you were lucky in that, by the way, you’re the president of United States. And by the way, you’re a millionaire. You know, other people cannot be that lucky. We need to put aside the politics. We need to put aside the skepticism in science. And there’s a lot of that rolling around, too. It’s shifted a little bit it went from, “No, there’s no such thing as global warming. No, there’s no such thing as climate change” to “OK, maybe there is, but we’re not causing it.” So maybe we can keep pushing in that direction of like, “No, there isn’t, we really should get off of fossil fuels.” So you know, we need to get rid of those things. We need to put those things aside, but it’s a very difficult conversation to have. And we tend to again, we tend to listen more to our peers. In your example, your dad is more likely to listen to people who are like him in every sense of the word. And so if you can find somebody the counterfactual to your dad, somebody his age, socioeconomic status, his family history, etc, who has gotten the vaccine, use them as an example. And that would probably push him more than an authority figure saying you must get your vaccine. And even you, you might even be an authority figure in that equation. So somebody who are their peers, and we see this all the time we see it with gun safety. So people who the government says, “Hey, you probably should put away your guns because the kids might get it.” “Oh, no, you’re trying to take away my second amendment rights.” Fair enough. But then when you have the local Gun Club, sell gun safes, or sell gun locks, they buy it up, like, “Oh, yeah, absolutely. So it’s a good idea. I thank you for thank you for doing it.” It’s super interesting, right from a bystander have like, what happened, what just happened? But that’s how human psychology works, and that the big liberal sociology works in that. Yeah, we tend to listen to our peers and so that is what I would say to somebody. Like if your dad came to me and said, “I’m really worried about the vaccine,” I would say, “Well, look, there’s so and so and so and so, who are of your generation, they would understand and they got their vaccine, why don’t you listen to them?”

41:08, Laguaite: Dr. Najera also emphasized the importance of those untold stories in the history of vaccines.

41:14, Najera: I think there’s a lot of untold stories in the history of vaccines. A lot of people that were involved in, we make the mistake sometimes of glorifying one person out. You know, the Jonas Salk for the polio vaccine. And in doing that, we exclude a lot of people from that discussion, because I didn’t know somebody might say, “I didn’t go to college, I’m not a doctor, I’m not white, I’m not blah blah blah, I’m not that person.” But the history of vaccines is very varied and very rich. And so you have Onesimus, who was enslaved, was African, became African American. You know, he was deeply involved in the history of it seems very, very influential in that. There are women there are, there are LGBT people who were involved in it. And I think telling those stories, and it’s coming. What the project is also aiming to do in the next few months or next few years, telling those stories also matter. Because it also helps avert some of the influence that anti-vaccine people have. If you look at the anti-vaccine movement in the United States, they’re mostly white men or white women have an upper socioeconomic status. They do not represent the variety of people in the U.S. and but they still reach out. And they’re doing a really good job of marketing like that. And so I think we can counter with the stories of men and women and people of color and LGBT community, people who contributed to the history of vaccines that have led us to this moment when we can really for the first time, probably, in the history of humanity, stop a pandemic without letting it run its natural course. And I’ve heard the next one. And so yeah, I think that’s worth saying that people should really research that when people say online, do your own research. Yeah, do your own research, but look into the history of vaccines, as it relates to people who are like you and who are not like you, and the contributions that they made, because those are also interesting stories and that game that we can model towards our own understanding of history and understanding of science.

43:16, Laguaite: This was such a great conversation. I really appreciate you taking so much time to talk to me.

43:20: Najera: Yeah, no problem anytime.

43:24, Laguaite: As of June 5, 2021, the U.S. has administered 301.6 million doses and that number will continue to rise. For us vaccinated folks, it sounds like the next thing we’ll need to do could be the COVID-19 booster shots, but scientists still don’t have many answers about that yet. For now, the CDC recommends that everyone 12 years old and older get a COVID vaccine for children 12 and older the Pfizer vaccine is the only one available.

43:56, Laguaite: This has been “To Health and Back.” Thanks again for joining me on this health history journey. Tune in next time for a discussion on the politicization of COVID. Until then, don’t forget to rate the podcast and subscribe. Feel free to shoot me an email at healthandback@gmail.com and I’m also on Twitter, Instagram and Facebook as @healthandback. Thanks. See you next time.

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In this episode of “To Health and Back,” we’ll hear from Rachel Priest, the content editor at The Bitter Southerner, to hear about her personal experiences with xenophobia as a transracial adoptee.

Check out the show notes here.

NOTE TO LISTENERS: This conversation was recorded 2 days before the Atlanta spa shootings on March 16, 2021.

0:23, Laguaite: And in this bonus episode, I’m sitting down with my best friend and former college roommate of 4 years, Rachel Priest, to talk about xenophobia and some of her personal experiences this past year and during the novel coronavirus pandemic.

Laguaite: The COVD-19 pandemic has fueled xenophobia, specifically anti-Asian sentiment across the globe, and Rachel has experienced that firsthand. So Rachel, welcome to the show. Do you want to introduce yourself and tell us who you are?

0:53, Rachel Priest: Yeah! Hey, Mads, thank you so much for having me on your podcast. Yeah, I’m Rachel and the content editor at The Bitter Southerner, which is this incredible publication where we basically just tell stories of the South, you know, both the good — there’s a lot to celebrate of the South, obviously — And also, you know, we aren’t afraid to talk about the bad as well. So I’m really loving that. And I’ve been there for about 7 months now. So it’s been really great. And I am excited to be here with my best friend and roommate. We’ve had, you know, similar... I feel like, you know, we’re sitting down and talking about this for the podcast, but we’ve also had conversations throughout the past year about these things, as they have happened, and you know, even before this, too, so.

1:34, Laguaite: Yeah, I think it I think it kind of says a lot, just the fact that we’ve had this exact conversation so many times, especially just the past year.

1:44, Priest: I know. I mean, it’s crazy to think that recently it’s been the 1-year anniversary since America has shut down and since it was declared a pandemic, but I feel like even a year ago, we were, again, like having similar conversations. And yeah, it’s crazy how much time has passed, but how little has changed in regards to xenophobia. And actually, it seems like it’s gotten worse in some ways, and I don’t know if that’s because of more national media attention, but yeah. So I’m so glad that we’re able to talk about this and bring some light to it because I feel like in some of the conversations I’ve had with family members or other friends or co-workers that or other people, I feel like some of them have been like, “I had no idea this is going on,” which yeah, you know, I think that for them, it’s always easy to ignore things that don’t impact you directly. And so I think for them, it’s obviously not impacting them because most of them have been white and so if they don’t have to pay attention, or if this is not something that they’ve seen, then they wouldn’t know, but most Asian people have been really aware of this the past year, especially, so.

2:52, Laguaite: Yeah. Can you just give us a little background? So you were born in China, right?

2:56, Priest: Yeah. So I was born in China, and I was adopted a couple days before I was 1 year old. And I grew up in Minnesota, and then I moved to Georgia when I was in high school. So that’s kind of background. So my adoptive family is, yeah, white, Caucasian.

3:11, Laguaite: Yeah, OK. I know that we just mentioned that COVID has added even more instances of racism, but have you faced anti-Asian rhetoric or attitudes in the past when you were growing up?

3:23, Priest: Yeah. So it’s a really interesting question. I mean, I think as a whole, not really, just because I think that their white privilege often protected me. I think that whenever I was seen with them, people understood that I was, “one of them,” like I was not seen as Chinese or Asian, I was just seen, as, my mom’s adopted daughter, and I think that there has been that umbrella of privilege that I was able to enjoy. I’m trying to think like, there was a couple instances in elementary school, and people would make fun of my eyes and stuff like that, and, you know, pull them back at the corners, which is interesting, too, because I remember seeing recently that there’s some sort of maybe makeup trend that was going on that would make it look like your eyes are a little more like curved at the end and the Asian community, people were like, “That’s not right.” It’s kind of not an appropriation but I think it’s turning into something that has been often seen as setting people apart and making it you know, “stylish” for white people to do, which is interesting. And that’s not just happened to the Asian-American community or the Asian community, but also happened to Black hair, or you know, nails and stuff like that, that have often been seen as these things that set them apart from their white counterparts, but once kind of white people move into that space and take it over, then it’s seen as trendy.

Priest: And so, kind of going back to your original question. I didn’t experience it too much. Because again, like I said, I lived under my parents and my family’s white privilege, but it’s something I’ve definitely noticed. Post-college is kind of when I really really experienced a lot of racism against me or I guess was more aware of it just because again, I was no longer associated with my white family. I was kind of on my own, and people didn’t see me as part of this white family, and they just saw me as an individual. And so I think then they were able to take their own preconceived notions or their stereotypes or their fear, or stereotypes, all those things, and really channel them at me. And yeah, so I think it’s only been within the past couple of years that I’ve really experienced a lot of it.

Priest: And I think we’ll get to talking about this later too but I think it’s interesting because I think that for a lot of younger Asian Americans, a lot of them are scared, not necessarily for them, but for their parents. Because there’s been a lot of instances of violence, especially against elderly Asian people, in like New York and California, where there’s large concentrations of Asian populations. And so luckily, that’s something I don’t have to worry about because my family is white. And so that is... luckily for me, I don’t have to carry that burden or that stress being like, “Are my parents going to be OK, like walking outside or doing just everyday life things?” I think that’s my experience and other Asian or Chinese adoptees who are adopted by white parents, again, I think that their experience is different than other— like, my experience is different in a lot of ways, but also similar in a lot of ways to other Asian Americans right now.

6:27, Laguaite: Yeah. OK. So maybe in the past, you’ve faced some microaggressions like being called other people’s names at work...

6:37, Priest: Yeah, yes.

6:38, Laguaite: So that sort of thing. Um, and I’m laughing because I know you. Of course, it’s not, it’s definitely not funny. But it’s—

6:45, Priest: No, yeah, yeah.

6:45, Laguaite: I do think it is kind of funny how often this happens to you, though, you know, how often these little like microaggressions happen.

6:52, Priest: Yeah. Yeah, for sure.

6:54, Laguaite: But if you’re comfortable, can you tell me a little bit about some recent examples of racism or xenophobia that you faced, in the past year or? Yeah, I guess a year, it’s been?

7:04, Priest: Yeah. So I mean, I would say that some of them weren’t necessarily COVID-related, but just ignorance or racism in general. But I think that in the context of this last year, I think that things that I would have kind of been able to just brush off and be like, “They didn’t mean any harm by that,” I think has carried a lot, more weight, because you’re never sure, like, “Is this person saying this because they’re ignorant, and obviously their intentions aren’t bad?” but again, within the context of this past year, when you’re seeing all these headlines, and you’re reading about all these people have been attacked, like questions as ignorant as like, “Where are you from?” which usually for people that don’t look American — and American, in this context, being white American — people being like, “Oh, where are you from?” Usually, they’re trying to ask about your ethnicity. I mean, that’s happened to me twice in the last year. And both times, I don’t think that it was necessarily from a point of malice, but again, at the same time, it does carry this like, much heavier weight of, “Are they asking me because they’re scared of me, or because they want to like distance themselves from me, or because they want to do any of the things that have happened to other Asian people?” Like I’ve seen people are like— they’ve been punched, they’ve been spit on, they’ve been pushed, all these things. So I think that that’s kind of been the main, you know, some of the bigger things have happened to me personally.

Priest: So last year, I moved back home with my parents for a couple months, kind of as things were happening, and now my parents live in a suburb of Dallas. And the neighborhood they live in is predominantly white. You know, there’s definitely people of color there, but it’s a pretty affluent area outside of Dallas, and so—

Laguaite: And that’s Dallas, Texas, right?

Priest: Yeah, sorry. And so yeah, we would go on walks as a family and you know, my parents are white. And then I have three brothers who are not adopted, and so they’re white. And then it’s me and my sister. And so sometimes we’ll all go out, walk around the neighborhood, and it was fine. You know, nothing happened. But one time, it was just me and I was walking and these kids who — again like these were kids too, so I can’t again say if this is like, racially motivated — but these kids are riding their bikes, and one of them screamed at me. He’s like, “You have coronavirus!“ something like that, he like “Coronavirus!“ and then he like coughed and he just rode away and I think I was mostly taken aback like again, it just always takes you out of the moment when you— again, like you feel like this is your home and you feel like you should be able to live a life like I should be able to live my life like my friends or my parents or my brothers and like not have things like that happen to me. So I feel like when that happened to me, I was like, “That’s crazy.“ And I just like obviously didn’t respond and again, like it was a kid, so I was not going to scream at him or do anything.

Laguaite: Right.

Priest: And so I just finished my walk and I got home and I was talking my parents about it and I definitely got emotional or more emotional than I thought I would. But I was telling them what happened and they were like, “Well, it could just be something they saw on the internet, like, I’ve seen this. People have kind of been doing this.” Which I definitely think is probably true. I’m guessing that or I would hope that it’s not like he heard that from his parents. But at the same time, I don’t think it would have happened to my family or my brothers or other white people. Like, I don’t think that would have happened.

Laguaite: Yeah.

Priest: And it never did happen again, like that was kind of like a single instance. But I think it kind of just kind of goes to show that it really only takes like one instance. And after that happened, I definitely was like, more cautious about walking around. And I was definitely more self-conscious about walking around in my neighborhood. And again, that was mostly just like a verbal — I don’t even know if I’d call it an attack either like, it was just, it was something and that set me on guard and made me super self-conscious about the way I looked. So that was that was kind of like the bigger instances I remember this last year.

Priest: And, you know, there was one instance too, and this again, this wasn’t racially motivated at all— or no, I’m sorry, this isn’t specifically COVID-related, but I was talking on the phone with someone. I had to get insurance for my car. And so I was talking to this person and we were just chatting as she was kind of filling out paperwork and stuff like that. And I told her my middle name, which is the name that was given to me by the orphanage, so it’s Chinese, and this woman, I told her, I was like, “Oh, I was adopted,” and she was like, “Oh, you sound so American.” And I think like—

Laguaite: You are American.

11:33, Priest: Like, “Yes, I am.”

Laguaite: Wow.

Priest: But again, like, I think, again, just in those instances, not necessarily COVID-related, and not, again, not malicious, and not coming from like, a mean, hateful place, but again, I think it sends out a clear message that to be like “fully American,” you have to be white, you have to have a European- or American-sounding name, you have to not have an accent, like all these things that are—

Laguaite: You have to fit the mold.

Priest: You have to fit the mold and I think that we’ve had this conversation before and there’s such a movement to like be proud of your heritage and be proud of who you are. You shouldn’t have to hide these things, which I 100% agree with, but at the same time, it does make it hard. Like, yeah, you can be proud of these things, but at the same time, you know that you’re going to face some consequences, like, whether they’re people like judging you without meeting you or whether they— you know, like, I think there’s been a lot of studies about even job applications. Like if you have a name that’s not, again, perceived as American, you’re maybe less likely to get certain jobs or job interviews because people just don’t think you can do the job well.

12:40, Laguaite: Wow. I mean, and this is this sort of goes back to what you said about some of these instances, not necessarily being rooted in like, they’re not, they’re not meant to be malicious, maybe. But I think and I think this was pre-COVID, maybe or like pre-lockdown, but I remember you telling me about this instance, where you went to like Disney World or something in Florida and a woman asked if it was your, maybe first time visiting?

13:10, Priest: Yeah. It was actually— So we were driving back and I was with my small group from church and we stopped at this restaurant, and this woman, I was standing in line with her. And this was, honestly, this was right before the country locked down so people knew about COVID. They knew it was coming. And there was a lot of obviously, misinformation out there.

Laguaite: Yeah.

Priest: And I think there’s a lot— I think, too like thinking back on this time, even though people had the right information, there was just so many competing narratives about what our country would do and would people eve get it here? There is so much uncertainty. But this woman was standing next to me in line, and she kept looking at me, and I was like obviously on guard, because at the time too, the news was very... Now, national media has been more conscious about saying things and stuff like that but the thing at the time, too, especially under the leadership of then-President Donald Trump, he was calling it still and he’s still calling it now like “the China virus,” or “Chinese virus,” or “the Wuhan flu,” like, all these things. And so again, I had that in the back of my mind as this woman kept looking at me. And I was like, “Oh.” So eventually, I made eye contact with her and she’s like, “Oh, hi.” I was like, “Oh, hi.” You know, so we just like talking and I was wearing— I don’t know if I was wearing like a Georgia sweatshirt, but she eventually was like, “Oh, do you go to school here?” And I was like, “Yes.” I was like, “I go to the University of Georgia.” And so we are chatting. And she’s like, “Oh, well, how do you like it here?” You know, like, it was my first time and I was like, “Um, great?” You know, I’ve lived here for my whole life. So I guess it’s fine. Maybe not as fine now.

Laguaite: Yeah, yeah.

Priest: So yeah, so like that has just, again, not coming from a necessarily malicious place, but same time, like I mentioned earlier, questions like that can... they carry just so much more weight now.

Laguaite: Yeah.

Priest: Because of the heightened anti-Asian sentiment and racism that’s prevalent right now.

15:00, Laguaite: Yeah. And I think it’s an interesting contrast too, because even when you and I went to Nashville, Tennessee, last year for spring break. So this was like... COVID was happening, but it was pre— it was basically pre-lockdown. So, 2 weeks before. Yeah, so when we were in Nashville, we were at some public place, like a restaurant or a bar or something, and it was interesting, because there was this certain man or like group of men who were trying to make... you know, trying to have a conversation with you, and it seemed like they wanted to talk to you because you were — using his words — “exotic” or, you know, that kind of thing and then post that trip. So after that trip, after lockdown, the sentiment completely reversed, you know? So no longer— Well, I’m, again, making a pretty broad generalization, but now it’s more like these instances that we’re hearing about on the news are rooted in like, malicious racism.

16:02, Priest: Yes. Yeah. That’s such a good point you bring up because yeah, like during that trip, yeah...

16:07, Laguaite: Multiple times, actually, now that I’m thinking back like, this wasn’t a “one and done” type of—

16:11, Priest: Yeah, there was a couple of times, but yeah, I think, one of the stereotypes or one of the ways that, especially Asian women, are viewed in this country are viewed as “exotic” and there’s a lot of fetishization that happens.

Laguaite: Yeah.

Priest: Asian women especially are fetishized and viewed as “exotic” and there’s been a lot of studies about where this is rooted. And I mean, you can, again, you can trace a lot of these things back to a couple instances, and just how they’ve grown and yeah. But yeah, like you said, it’s interesting because at that time, again, my ethnicity was viewed as, I don’t know. Like to want?

16:48, Laguaite: Yeah. You know, something like desirable or like something sexy or erotic.

Priest: Yeah. And not in a good way.

Laguaite: Exactly, the worst way, because again, like, how did that make you feel when that guy was like, “You look exotic. Where are you really from?” That was the thing. He kept asking, “Where are you from? Where are you from?”

17:07, Priest: Yeah. Yeah, we were both— So, it was Madeline and I and we were at this... I think it was a bar, right?

Laguaite: Yeah.

Priest: Yeah, there was this guy. There was this group of three men. It was so gross. They kept like—

17:19, Laguaite: Three white men.

17:19, Priest: Yes, three white men. They’re just like talking to all these women, but eventually one of them came up to me and he was like, “Where are you from? Where are you from?” And I was like, “I’m from here.” And I mean, Madeline was there too. And she also stood up for me and was like, “She’s American.”

17:35, Laguaite: Yeah. “She’s from here.” He kept pressing.

Priest: Yeah.

Laguaite: He kept asking where you were really from.

17:39, Priest: Yeah, and I kept answering. I was like, “I’m American. Like, I’m from the US.” And he was like, “No, no, what’s your nationality? Which nationality?” And finally, Madeline was like, “Do you mean her ethnicity?” And he’s like, “Yeah, yeah.” I was like, “Oh.”

17:51, Priest: And you know, it was interesting too, because at one point, he was like, “I’m German. I’m like English. I’m French.” Again, like, he just didn’t know how to verbalize it in the correct way.

18:03, Laguaite: He also described himself— a self-described WASP. White Anglo-Saxon Protestant.

18:11, Priest: Yes. So again, like to your back to your point.

Laguaite: Yeah.

Priest: It’s just interesting to see how they have flipped. And I think something that Madeline and I have discussed is, I would say that Asian people and the stereotypes about Asian people in this country are not necessarily... they’re not as harmful, physically, to like Asian people, until recently, right before COVID. Like, they weren’t necessarily... I think that again, like the Asian stereotype is that like, we’re smart. We are doctors and lawyers. And it’s interesting, too, because—

Laguaite: Like, good at math?

Priest: Yeah. Good at math.

Laguaite: We’ve talked about that before.

Priest: Like, all these things, and that they’re hard workers and all this stuff. And it’s interesting, too, because on the TikTok—

18:51, Laguaite: On the TikTok.

18:53, Priest: It makes me sound so old. On TikTok, there was this video that was circulating actually, that I saw and it was like, this white man, maybe he was in his ’20s or ’30s and he said... let’s see... his line was... let me see. Let me find it. OK: “If America is so racist, why are Asians are the highest earners in America?” which again, just goes to prove that these stereotypes are still being perpetuated and still being believed. And I think I’ve said this before to Madeline and I’ve talked to some other friends about it, but being Asian in this country hasn’t always necessarily meant the same things as being Black or Latino.

Laugaite: Yeah.

Priest: Like, you know, we’re not stereotyped as dangerous necessarily, or as undocumented like all these other like, definitely more harmful, like physically harmful stereotypes before COVID. But not I mean, physically harmful, but still, like harmful themselves. Just because we’re not being like, we’re all dangerous, that doesn’t mean that these stereotypes still impact the community, and impact the way that kids see themselves orso many other things. So it’s crazy.

20:03, Laguaite: Wow. Well, yeah. I know, this is a huge question. But I mean, what’s the answer? How should the U.S. tackle xenophobia?

20:15, Priest: Wow. I think just... that’s a good question.

20:21, Laguaite: Yeah. OK. And we can come back to that, too, but I know like you had said something about how the national-level communication could have— Oh, and actually, that brings me to another point that I wanted to mention the “China virus.”

Priest: Yes.

Laguaite: So let’s, why don’t we actually take a little bit of time if you have it to address that because I mean, I’m still like, just flabbergasted that anyone still uses that phrase. But for example, you know, when you heard former President Trump say, you know, describe COVID-19 as the “China virus,” I mean, what was that like for you?

21:03, Priest: I mean, I think again, it just puts a target on people’s backs, and it just makes people be like, “Well, this is must be their fault.” If not only are people just kind of saying this, but the president again, then-President of the United States is like, calling it the “China virus,” like, I think it gives them license to really target Asian people. So last year too I wrote a story for my capstone class about anti-Asian sentiment.

Laguaite: Yeah.

Priest: And I think the thing too is I interviewed, I guess, as for students I interviewed three students and one of them was Chinese, one of them was Korean, and one of them was Filipino. But they all experienced racism because of the way they look and I think that’s something too that’s dangerous because I would say as a whole white people can’t tell people from Asia, Eastern Asian countries apart and so all these people get really lumped into this a conglomerate of like, “This person, they must be Chinese.” And so, therefore, we must, say something or like, do something, like all these things. And going back to the original question, like again, it just hurt to have him say that, and even after reporters brought up to him a couple times, they’re like... I remember watching the press conference where this reporter, they’re like, “President Trump, there has been a rise in violence against the Asian-American community.” And again, this is back in 2020, last March, April, May. They’re like, “Do you think that calling it the ’China virus,’ ’Chinese virus,’ is dangerous?” and his response was like, “No, it comes from there, why would it be dangerous for them?” which again, just goes to show his ignorance and even recently, he put out a statement, as a private citizen now. And he still called it the “China virus.” He said, COVID-19 and, in parentheses, he said, OK so he sent out this statement on March 10, of this year, and he said, “I hope everyone remembers when they’re getting the COVID-19, (often referred to as the China Virus vaccine)” and then he went on the rest of his statement. Again, that just goes to show that even now, and even with more national media attention surrounding the violence happening against the Asian-American community here, he still is persistent on calling it that and perpetuating that harmful... I don’t even know if stereotype is the right word, but just the harmful rhetoric around COVID-19 and again, just really putting a target on people’s backs. And so yeah, that’s how that made me feel.

Priest: And I think going back to your original question of what can America do? What can this country do to protect Asian Americans? Or what can we do to get rid of xenophobia? But yeah, again, I speak from like my own experience, and I speak as one person of a whole community, and so I think that it starts really at people advocating and again, like, also more national media attention. I think that historically, at least from what I’ve seen, the Asian community in America has been really underreported. I think there’s a lot of issues in media, like I think I think we both can both discuss this and obviously, we both work in the media, which is a very obviously broad statement.

Laguaite: Yeah.

Priest: I mean, I think just like more attention about it and or more attention surrounding it, more coverage of those instances. And also, again, like, not only attention but making sure that people are held accountable for the things they do do is really important and not just brushing it aside as something that is harmless or something that is a joke. I think too, something that I remember hearing earlier, one of the first questions you asked me was what kind of experiences did I have growing up?

Laguaite: Oh, yeah. Right.

Priest: And I think that is something that happened then, I think, still happens today, among adults, is that when something happens... When it happened to me when I was younger and kids were pulling back their eyes and like pretending to speak Chinese, whatever that is, and saying like syllables they thought sounded like Chinese. You know, if I was like, “That’s mean,” they’d be like, “Well, I’m just joking.”

Laguaite: Like, “Can’t you take a joke?”

25:12, Priest: Yeah, “Can’t you take a joke?” And I think that’s so toxic and so dangerous. It not only belittles how they’re feeling about the situation but again, it makes it OK for this person under the guise of being “funny.” And I think that as we’re going forward, making sure that you do call those things out. And you call them out among kids, you call them out among adults, you call them out among things happening in the news, or like just holding people accountable for their actions. And not again, bury it under, like, “They didn’t mean it that way,” or “They’re just making a joke,” or “This is just one person.” Again, I think there’s so much more attention that can be brought and should be brought to make sure that these things don’t happen anymore, because it’s not OK.

26:00, Laguaite: Yeah. And, I mean, OK, so something you mentioned, like you just mentioned it, but how do you think that people like me could be better allies to the Asian-American community during this time? You know, just speaking from, I guess, your point of view and perspective?

26:17, Priest: Yeah, I mean, I think that the first step or the first... the easiest thing someone can do is just, like stand up for their friend or their family member or whoever they’re with, or even if you’re not with someone, and you just see this happening, just again, like, use your privilege to speak up on behalf of other people. And yeah, I think that’s the easiest thing. And I think that’s like something that we have talked about a lot and something that again, like you’ve done incredible, like, going back to the bar situation, like Madeline was there, you know, she’s standing up, and she’s like, “She’s told you this, like, you’re not asking the right question. Like, if you’re going to be racist, you might as well ask the right question.”

26:54, Laguaite: Yeah, I think that’s exactly what I said.

26:56, Priest: You might as well ask the right question.

27:00, Laguaite: Yeah. You might as well use the right phrase.

27:05, Priest: The right phrase, like language, terminology. So I think it’s as easy as that. And obviously, there’s been a lot of media attention surrounding the bad things that have happened towards Asian Americans in this country now. Last spring, there was a family that was stabbed. Recently, there was a woman arrested for coughing and pepper-spraying an Asian Uber driver in San Francisco. There was another woman in New York, who was spit upon with her baby, and called the “Chinese virus.” Again, there’s been so many instances.

Priest: But I think also, too, there’s been a couple of great stories of communities sticking up for their neighbors. I was reading this story of this family, and I believe was in California, and it was an Asian family in this neighborhood, mostly white neighborhood. And they kept getting random... like these teenagers that come in, like knock on their door, and throw things at their house and stuff like that. And this community kind of banded around this family, and they would like, sit outside and watch, like, they just like sit outside in their lawn, to make sure that these people weren’t being harassed. And that’s not happening everywhere and that’s not something that you shouldn’t... like, if that’s not happening in your community, you can’t really do much like that but yeah I mean, if things like that happen, that’s another great way to just, again, stick up and what people need most of all right now is just support and knowing that their friends and family care about them and are concerned about them. And even one of my friends a couple of weeks ago texted me and she’s like, “I’ve been seeing everything happening, like, I just hope you’re OK.”

Laguaite: Oh, that’s sweet.

Priest: Which is really sweet. That just meant a lot to me, knowing that she is someone who is not Asian and is aware of what’s happening and wanting to check in on me and wanting to make sure I’m OK. Because I think that something that I have talked about and I have had experiences with this, especially with, you know, me being Chinese and being adopted by a white family, I think that it’s easy for my family to be colorblind and not in like a bad way. But you know, just see me as like their cousin or their granddaughter, which is fine. You know, like, that’s good. I’m glad they’re not like being like, “You’re different because you’re Chinese.” But at the same time, I think that in a lot of ways it can be harmful too, because then if they see me as not someone that’s facing these issues, and they see it happen to other people, other Asian people, but they’re like, “Oh, like, that’s just other Asian people like that wouldn’t happen to my family member because she’s one of us.”

Laguaite: Yeah, the “one of us” thing.

29:35, Priest: Yeah. And so I think going back to my point, just checking on people and standing up for them, when you see things like that happen. If there’s something happening in your neighborhood, or something happening to people, just like standing up or doing what you can to help them during this time is just super, super important. I think that that is one way that people can help and I think that racism is not going to go away after this pandemic and xenophobia is not going to go away. It hasn’t gone away. It’s been here for hundreds, thousands of years. And again, also not just toward the Asian-American community. Like any really community of color in this country has faced their own sort of hardships because of their race and their ethnicity. It can kind of seem daunting sometimes to be like, “How can I tackle or how can I make this better for this whole community?” And the answer is like you as a single person can’t, but you as a single person can do any of those things I talked about, like sticking up for your friend or sticking up for someone nearby. It doesn’t have to be your friend, like just being vocal and using your voice or your privilege to really speak up and again, just doing what you can on a micro level, and then as legislation attempts to get passed, so you can support them. Something that happens for most grassroots type of movements is like contact your representatives, or contact whoever you need to contact and make sure that different laws get passed, so that these things — hate crimes and xenophobia — you know, again, people are held accountable for what they do. My hope is that once people do, then other people will stop doing it, because they know that there’s consequences because, as everyone knows, but things that happen in communities of color I think for the longest time, people have just been able to get away with it.

Laguaite: Yeah.

Priest: And so there’s not really a consequence. But I think that hopefully, legislation can be passed. And but yeah, until then, just, you know, stick up for your, for your friends or stick up for any Asian person that you see or—

Laguaite: Check in on them.

Priest: Yeah, check in on them.

31:38, Laguaite: Well, awesome. Thank you so much for talking to me, Rach.

Priest: Yeah, no, thanks for letting me on your podcast.

Laguaite, 31:44: So yeah, if you’re comfortable, where can the people find you on social? Like your professional Twitter maybe? Or where can they find your writing? Because I don’t know if I mentioned but, or Rachel mentioned, but she’s a writer and a freelancer.

31:57, Priest: Yes. Yeah. On Twitter, you can find me at @rz_priest, like a Catholic priest. So P-R-I-E-S-T. And I have a website like my online portfolio where you can find writing and some photography, actually, I think at the same thing, but without the underscore so it’s just rzpriest.com.

32:19, Laguaite: Awesome. Well, thank you again, Rach, seriously.

Priest: Thanks so much, Mads. This was so much fun.

32:23, Laguaite: This has been to “To Health and Back.” Thanks again for joining me on this health history journey. Tune in next time. Until then, don’t forget to rate the podcast and subscribe. Feel free to shoot me an email at healthandback@gmail.com. And I’m also on Twitter, Instagram and Facebook as @healthandback. Thanks. See you next time.

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Check out the transcript here.

SHOW NOTES:

American Journal of Public Health, 2021: Check out this recent study that explores the extent to which phrases like “Chinese virus” were associated with anti-Asian sentiment.
Anti-Asian Violence Resources: Check out this resource directory that includes how to report incidents, places to donate, educational resources, statistics, news articles and resources for allies.
Asian Americans/Pacific Islanders in Philanthropy: Check out this resource directory to combat increased anti-Asian violence in the wake of COVID-19.
BBC: Read Sam Cabral’s article about hate crimes toward Asian Americans in the U.S. during the pandemic.
The Bitter Southerner: Read Rachel Priest’s personal essay following the aftermath of the Atlanta spa shootings in March 2021.
Grady Newsource: Read Priest’s article about the rise in racism against the Asian and Asian-American communities.
Human Rights Watch: Learn about how COVID has fueled anti-Asian racism and xenophobia across the globe.
The New England Journal of Medicine, 2021: Check out this clinician’s guide to combating anti-Asian sentiment.
NPR: Read about (or listen to) the rise in anti-Asian attacks during COVID-19.
Rachel Priest: Read more about Priest via her website.
Twitter: Follow and read more of Priest’s work via Twitter.

MUSIC CREDIT:

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NOTE TO LISTENERS: This conversation was recorded 2 days before the Atlanta spa shootings on March 16, 2021.

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0:11, Madeline Laguaite: Hello, and welcome to “To Health and Back,” a podcast about how health, medicine and wellness decisions from the past help inform us today. I’m your host, Madeline Laguaite. In this episode, I’m sitting down with Dr. Alexandre White to talk about past instances of xenophobia and racism in the context of disease and the implications these past instances have. Here’s a snippet of our conversation.

0:40, Alexandre White: What we’ve seen in the last year or so, especially in the relationship between pandemic threat and the rise globally, but especially in the United States, of anti-Asian racist violence, really fundamentally how dangerous not only words and phrasing and framing of disease can be, but also, I think, more specifically, the ways in which racist legacies continue to inform our present and the ways in which racism is structurally built into the United States in the ways that we need to confront this not only in the field of civil rights or through legislation, but also you know, deeply rooted in public health and medical practice access to care, access to treatment and the ways in which racism operates in every aspect of life, and we need to as a result confront it fundamentally in every aspect of life.

1:38, Laguaite: The COVID-19 pandemic has fueled xenophobia, specifically anti-Asian sentiment, across the globe. About a year ago in May 2020, the secretary-general of the United Nations, António Guterres, had this to say.

1:53, António Guterres: We must act now to strengthen the majority of our societies against the virus of hate. That is why I’m appealing today for an all-out effort to end hate speech globally.

2:03, Laguaite: Guterres is just one of many public health officials to condemn xenophobia. Since the beginning of the pandemic, Asian Americans, in particular, have seen spikes in discrimination, anti-Asian sentiments, and violence. In fact, just a week before our conversation, eight people, many of whom were Asian women were murdered in shootings at spas in Georgia. Though the motive has yet to be confirmed, the killing sparked fear, outrage, and uncertainty in the Asian American community.

Laguaite: Here to talk more about xenophobia and racism is Dr. White, I connected with Dr. White through some of his published work centered around the social effects of infectious epidemic outbreaks.

2:48, White: My name is Alexandre White, and I’m an assistant professor of sociology and the history of medicine at Johns Hopkins University and School of Medicine.

2:56, Laguaite: Because we’re talking about anti-Asian sentiment and violence, Dr. White pointed out the implications of having a single racial category for the 48 countries that span the continent of Asia.

3:08, White: And I think it’s also important to note that, you know, the racial category, Asian—obviously, lumping the largest continent of the world into a single racial category—was itself a bureaucratic flattening of difference and categorization for the purposes of American racial categorization. So even when we talk about anti-Asian violence, it’s reflective of these particular forms of racial categorization that really emerged in the late 19th century.

3:35, Laguaite: So during the past two years especially, we've seen lots of anti-Asian sentiment, attitudes, and violence. And in your article, “Historical linkages, epidemic threat, economic risk and xenophobia,” you mentioned that the U.S. has a history of anti-Chinese sentiment, in particular, in response to epidemics. So can you talk a little bit about that as well?

3:57, White: Yeah, yeah, absolutely. I mean, I think it's really important, especially right now, to recognize the ways in which particularly anti-Asian racism is deeply structural, and is as structural in the United States as any other form of racism that we see today. I think some of the most dangerous and pervasive stereotypes around racism against the Asian community and populations of Asian descent is that either it's purely interpersonal, as we see in kind of the narratives of especially and prior to the attacks of the last week and the week before, these attacks seem to be caused as we normally see by just “bad apples,” who were doing terrible things, and that really ignores the ways in which actually, the racialization of people of Asian descent and exclusions are deeply human into the fabric of America's racist history.

Laguaite, 4:56: The Page Act of 1875 was the first restraint federal immigration law in the United States. The law was named after a Republican in California, Representative Horace Page, and aim to “end the danger of cheap Chinese labor and immoral Chinese women,” according to Dr. George Anthony Peffer, in his article “Forbidden Families.” Dr. White also spoke on the Page Act and its implications.

5:26, White: We can go back to 1875 with the passage of the Page Act, which was the first racially exclusionary immigration law passed in the United States, that banned the immigration of Chinese women to the United States who were perceived... a justification for this largely emerged out of this perception that Chinese women were more immoral or guilty of sexual misdeeds, or were going to come over and engage in sex work that would then corrupt the morality of largely white American men.

Laguaite: Wow.

White: But within that, there was also this powerful and dangerous public health narrative that the Asian population somehow carried more virulent venereal diseases that would upset the epidemic landscape of the United States.

6:13, Laguaite: But the Page Act wasn't the only racially exclusionary law passed in the US.

6:19, White: Later, in 1882, the more encompassing Chinese Exclusion Act was passed, which banned all immigration of both men and women to the United States on similar grounds, ultimately that were intersectional in nature. These are gendered sexualized, as well as racialized justifications, for exclusion. And the Chinese Exclusion Act also focused on this particular justification of the threat of infectious diseases emanating from Asia.

6:46, Laguaite: OK. And these like exclusionary acts in the 19th century, what were typical American attitudes regarding that kind of law?

6:57, White: I can't speak to it in full but I do know that there was significant and virulent anti-immigrant and especially anti-Asian immigrant fervor in the United States. So, these policies were supported. And, and they were intrinsically exclusionary in their force. We see in these acts and in these histories, and in many ways, the ways in which racial categorization and racialization is fundamentally relational.

7:30, Laguaite: One of the specific outbreaks Dr. White has studied is the 1901 bubonic plague outbreak that swept through British colonial Cape Town. Colonial officials use the outbreak as an opportunity to turn to racist responses to public health concerns. Officials rationalized “existing and unfounded racist segregationist beliefs and forcibly removed most of the city's black population from its homes and neighborhoods.” And that's just one example of racialized quarantine. In 1899, during a plague outbreak, authorities in Honolulu quarantined and burn the city's Chinatown.

8:14, White: But on top of this, you know, there were also numerous moments of racialized quarantine that looks very similar in many ways to the quarantine we discussed in Cape Town. When plague arrived in Honolulu, the response by American public health authorities there was to quarantine off the entire Chinatown section of the city of Honolulu.

8:35, Laguaite: So what did this quarantine look like?

8:37, White: This, of course, was not a was not an equal quarantine. And in fact, borders of the quarantine space was gerrymandered in ways that allowed for white-owned businesses and white homes to be excluded from this quarantine and ultimately, in a devastating moment of violence. As public health actors traveled through attempting to sanitize and quote-unquote cleanse homes of bubonic plague with essentially burning infected homes down. The fire expanded, got out of control, and burned much of the city's Chinatown to the ground, obviously, leaving many people homeless and also without places of work, which would go on to have devastating effects.

9:21, Laguaite: These types of racialized quarantines have had lasting effects, Dr. White said.

9:26, White: And we saw similar forms of racialized quarantine against Asian populations also in response to periodically when it arrived in San Francisco from 1900-1904. They've reflected very similar patterns. So we see this long history of the invocation of disease threat and racial anxieties when it comes to people of Asian descent that I think, you know, we've seen invoked again, very disturbingly, into tremendously violent and oppressive effect in 2020 and 2021.

9:57, Laguaite: Dr. White mentioned the historical importance of the exclusionary acts, and explain to me the implications these acts had for future U.S. legislation.

10:07, White: So many Asian migrants came to the United States in the 19th century, in some ways in response to the lack of free labor that was eliminated through the abolition of slavery in the United States after the Civil War. And thus, migrants were forced, coerced, and brought into the United States to make up for that loss of labor. And as a result, especially early Asian immigrants of the United States were associated with, negatively, with African Americans, with formerly enslaved black people, and the connotations were very similar in terms of the racial categorizing. And also, we can see that these exclusion acts that I mentioned, also laid the groundwork for things like Donald Trump's Muslim ban, as well as other exclusionary immigration policies in the 20th century. So we can see here how systems and structures of racism, build on one another and interrelate different groups that are racialized and powerful and devastating and oppressive ways.

11:11, Laguaite: Having studied social effects of infectious epidemic outbreaks was xenophobia and anti-Asian sentiment and violence today something you expected when COVID-19 first began?

11:26, White: It was certainly something I was very concerned about.

Laguaite: OK.

White: And, you know, I think what we've seen in this pandemic is the invocation of a host of historical tropes that we've seen before, through the 19th century and 20th century and beyond. were, you know, especially particular anxieties about the ways in which epidemics are going to affect commerce effect, trade effect, global economics, become co-constituted or co-constituted with particular anxieties about populations within blamed for spreading disease. And we've seen time and time again, that disease and epidemics are a very powerful justification for ascribing human difference, especially in culture, you know, when we can assign some sort of pathological flaw to cultural behaviors that were and are, you know, incredibly but now, outside of a pandemic situation, you know, it becomes a very effective way of mobilizing racist anxieties. And I think very unfortunately, we're seeing that continuing in the present.

12:35, Laguaite: On that note, do you think that former President Trump's usage of phrases like, “the China virus” or “Kung Flu,” do you think that worked to perpetuate some of these stereotypes and violence?

12:49, White: Absolutely. I think that there's little doubt to that. The history of racial anxieties when it comes to diseases that can emerge from ages is long-standing. And this becomes a way of, and I think we see this very much former President Trump's narratives of or the ways in which he narrated the COVID-19 pandemic, we see the ways in which there's a civilizational superiority logic that comes through in attempting to assign blame to an entire geography for the emergence of a disease so that I really would not only not give these ostensively racial slurs any credence, but I would also ask a philosophical question, which is, you know, to what extent do origins of diseases actually matter when, you know, pandemic epicenters move? And the fact of the matter is, you know, the United States has been the epicenter of this pandemic for some time, until unsurprisingly, like so many things. When it comes to racist ideologies. The concept holds no water, but also the justifications are paradoxical and make no sense.

13:53, Laguaite: Dr. White said there are many important lessons we can take from historical instances of racism and xenophobia.

14:01, White: Most critically, we need to stop thinking about the spread of infectious disease as somehow being the result of inferior unhygienic, unsanitary practices that can be leveled across an entire population, right, or an entire group or a culture or an ethnic group or a racial group. You know, these are not epidemics are not, they don't they just, they simply don't work that way. Diseases emerge in different places at different times. And you know, it's for this very reason, that the World Health Organization, for instance, does not or no longer advocates for the naming of novel diseases, and ascribing that name to a place we know COVID-19 is COVID-19 in large part because of the stigmatizing effects that you know, locating a disease or interpreting a disease name with a particular location as we try to avoid that. Now for these precise reasons, and you know, what we need to recognize this is far from any sort of cultural, behavioral or social practice carried by individuals or groups or the blame that we ascribe to them in various racist, gendered or ethnically insensitive and violent ways, we need to recognize how the social factors that exist within a society fundamentally lead to the perpetuation of an epidemic lead to greatest or more severe outcomes and epidemic we've seen, especially in United States, the ways in which economic and racial inequities and inequalities in our society are leading to very significant deaths morbidities, but also inequalities in how this pandemic is being felt across the United States and who is living and who is dying. You know, we see that racism, far from being able to explain any sort of differences in or being able to explain any sort of cause for an epidemic actually kills at far higher rates during an epidemic. And these racist logics are incredibly violent, incredibly dangerous, and hinder public health practices and legacies of racism, structural racism, very much have lasting and pertinent effects on how pandemics play out.

16:10, Laguaite: Well, thank you so much for talking to me, Dr. White.

16:13, White: Thank you. Thank you. My pleasure.

16:17, Laguaite: Across the U.S., protests have called for an end to Asian discrimination in anti-Asian violence. If you're looking to support the Asian American and Pacific Islander communities, the Asian Americans and Pacific Islanders in philanthropy, which is also called the AAPIP, has a list of resources to combat the rise in anti-Asian violence. You can find it at apip.org.

Laguaite: This has been “To Health and Back.” Thanks again for joining me on this health history journey. Tune in next time for a bonus episode featuring another discussion on xenophobia. Until then, don't forget to rate the podcast and subscribe. Feel free to shoot me an email at healthandback@gmail.com. And I'm also on Twitter, Instagram and Facebook as @healthandback. Thanks. See you next time.

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In this episode of “To Health and Back,” we’ll hear from Dr. Alexandre White, an assistant professor of sociology and history of medicine at Johns Hopkins University, to see how past instances of xenophobia (including in policy) are reminiscent of the racism and discrimination toward Asian Americans in the U.S. today.

Read the transcript for this episode here. SHOW NOTES: * The American Association of Immunologists: Read more about the 1899-1901 bubonic plague quarantine in Honolulu. * American Journal of Public Health, 2021: Check out this recent study that explores the extent to which phrases like “Chinese virus” were associated with anti-Asian sentiment. * Anti-Asian Violence Resources: Check out this resource directory that includes how to report incidents, places to donate, educational resources, statistics, news articles and resources for allies. * Asian Americans/Pacific Islanders in Philanthropy: Check out this resource directory to combat increased anti-Asian violence in the wake of COVID-19. * BBC: Read Sam Cabral’s article about hate crimes toward Asian Americans in the U.S. during the pandemic. * History.com: Read about the Page Act, an anti-immigrant law that specifically targeted Asian women. * Human Rights Watch: Learn about how COVID has fueled anti-Asian racism and xenophobia across the globe. * Johns Hopkins Medicine: Read Dr. White’s article about xenophobia in the time of quarantine. * Journal of American Ethnic History, 1986: Read George Anthony Peffer’s work about emigration experiences of Chinese women under the Page Act. * Krieger School of Arts and Sciences, Johns Hopkins: Read more about Dr. White and his work. * National Archives: Check out this archive about Chinese immigration history in the U.S. * The New England Journal of Medicine, 2021: Check out this clinician’s guide to combating anti-Asian sentiment. * NPR: Read about (or listen to) the rise in anti-Asian attacks during COVID-19. * Social Science History, 2017: Read Dr. White’s exploration of two epidemics in 1901 Cape Town, the bubonic plague and smallpox. * Twitter, 2020: Read about (or listen to) António Guterres’ statement on xenophobia via his Twitter account, @antonioguterres. * U.S. Department of State: Read more about Chinese immigration and the Chinese Exclusion Acts.

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0:17, Madeline Laguaite: Hello and welcome to "To Health and Back," a podcast about how health, medicine, and wellness decisions from the past help inform us today. I'm your host, Madeline Laguaite.

Laguaite: In this episode, we're talking about the history of mask wearing, especially during the 1918 influenza pandemic. We'll hear from Dr. Alex Navarro, the assistant director for the Center for the History of Medicine at the University of Michigan.

Laguaite: When Dr. Navarro and his colleagues began studying the 1918 flu pandemic, he didn't really expect the research they did to have an impact on public health policy today. Here to talk about that research, specifically mask wearing in 1918, is Dr. Alex Navarro. Hi, Dr. Navarro and welcome to the show.

1:06, J. Alexander Navarro: Hi, Madeline.

1:08, Laguaite: As I mentioned in a previous episode, experts have made lots of comparisons between COVID-19 and earlier pandemics like the 1918 influenza pandemic. Luckily for me, Dr. Navarro has spent more than a decade studying the 1918 flu pandemic.

1:24, Navarro: Yeah, my name is J. Alex Navarro, and I'm the associate director at the Center for the History of Medicine at the University of Michigan. I have spent the past 15-16 years now studying influenza and not that entire time. But we started at the Center about 15 years ago, studying the 1918 influenza pandemic. We were asked by first the Defense Department, of all places, to look at what we ended up labeling provisional escape communities. And these are small, typically small, communities in the United States... A few of them are sub-communities, so like college campuses, for example, in the United States that in the fall of 1918—which was the deadliest wave of that pandemic—managed to more or less escape influenza, meaning that they had zero or one perhaps death, and generally very few cases, although there were some places that had large case counts, but managed to not have any deaths.

Navarro: And the Defense Department was interested in finding out why and they wanted to know, with the possibility of another influenza epidemic. This was 2005. So the threat at the time was thought to be H5N1, avian influenza, a very deadly form of the disease that was lurking around in Southeast Asia. They thought, well, the military thought, could we load people up in the event of an outbreak somewhere in the globe, before it became an epidemic and a pandemic? Could we load up military assets on ships and send them out to sea, for example, and can we sort of emulate what these escaped communities did? That kicked off the work.

Navarro: But you know, what Gunnison, Colorado, for example—a town of 1,300 people in a county of about 5,000 people—did in 1918 very different than what we could do today with a pandemic of a respiratory disease, such as we found out with COVID. You know, those are two very different populations. You can potentially isolate a small community that's already isolated. It's much more difficult to do an entire city, entire state. We have a lot more interest, e-commerce now, etc.

Navarro: And so building on that work, the CDC then asked us to look at the 1918 pandemic, from the perspective of what American cities did. What they did was social distancing, mask wearing, etc. We did that work we showed that it did... that went into the pandemic guidance provisions that the CDC put out back in 2007 and the Department of Health and Human Services.

3:39, Laguaite: All the work and research that Dr. Navarro put in these last 15 or so years came in handy when more and more COVID cases started to pop up around the world in early 2020.

3:50, Navarro: Fast forward to today, really this time last year with the spread of COVID, and those plans were dusted off. And that's one of the reasons why we had the social distancing and mask recommendations rolled out is largely because of the work that we did and some other groups did, looking at that data from 1918. Yeah, I mean, it's not every day that historians get to have an impact on public policy, particularly public health policy. We really never imagined that would be the case. We hoped that it wouldn't. In fact, we would have been happier leaving those plans gathering dust on the shelf rather than dust them off and have to use them. But you know, here we are. We always knew it was a matter of "when" not "if," but you never think that "when" is going to happen during your lifetime.

4:36, Laguaite: At this point, we're all too familiar with mask wearing and mask ordinances. If I remember correctly, our local mask ordinance began sometime in July of 2020. And these local mask ordinances varied across the nation, though they had one main goal: to help slow the spread of COVID-19. And as it turns out, there were mass ordinances back during the 1918 pandemic.

5:01, Navarro: Yeah, there were. So mask use was still—certainly for the general public—it was pretty novel. There had been some mask use in 1911 in Manchuria. There was an outbreak of pneumonic plague and there was a physician, a Chinese mentoring physician who had been trained in Cambridge, who advocated the use of face masks for the public, realizing this was a respiratory disease, highly deadly, near 100% fatality. Despite pneumonic plague, there were people, including some American physicians, who went over to monitor who refused to wear a mask and died as the result.

5:41, Laguaite: Medical professionals have used face masks in surgical settings for over 100 years and the first documented instance was in 1897. The mask used was a single layer of gauze covering the mouth, and it was meant to protect the patient from infection at the surgical site. It wasn't until the 1940s and 1950s that antibiotics and septic techniques were used as major players of infection control methods within a surgical setting. So what did that look like in 1918?

6:14, Navarro: By 1918, the use of face masks in the surgical theater was fairly widespread, but still not universal. That really didn't come out for another maybe two decades. But I would say about two-thirds of physicians use face masks when performing surgeries or other procedures, building on the work of Semmelweis, and Pasteur and Lister and Koch etc, and realizing, 'Oh, now we're several decades into modern germ theory.'

6:44, Laguaite: The influenza pandemic of 1918 happened during the same time period as World War 1. Thanks to the overcrowding and global troop movement during the war, the 1918 flu was able to spread pretty extensively. Both the lack of treatments and vaccines and the vulnerabilities of healthy young adults spawned this major public health crisis reminiscent of the one we're in today. The flu pandemic of 1918 was responsible for at least 50 million deaths globally. Dr. Navarro said that back then, there were facemask recommendations and mandates coming from experts. Still, that doesn't mean every city or every region was adhering to these ordinances.

7:25, Navarro: In terms of the general public using face masks, there were plenty of recommendations nationwide to use masks and when locally and regionally to use face masks. But the mandates typically with the exception of Indianapolis, for example, typically tended to be done in western states and communities. So Los Angeles toyed around with the idea of issuing a mandatory facemask ordinance. They ultimately did not. Denver did, Seattle, Sacramento, Oakland. In Utah, they considered a statewide mask mandate but they ultimately did not. And it tended to be out west and it had to do with several factors. One was, there were a few influential and one, in particular, a physician named Woods Hutchinson, who was from the East Coast but traveled around and California sort of going up and down the coast, telling local communities to wear face masks and to issue these ordinances. And so he had some impact on the local decisions to do that. And also it was a little bit having to do with the timing. Although the influence of the second wave of the influenza pandemic hits pretty rapidly, it spreads from epicenters in Boston and New York almost simultaneously in late August, early September. And then it spreads within a matter of about 3 or 4 weeks across the nation. The exact shape of those epidemic curves is slightly different as you go across the nation. So it looks different in the East than it does in the Midwest. And it looks different in the West, and it does it in the Midwest or, or the east. And so partly because of the timing. It's a little bit more dragged out in the West. Those a lot of those communities resorted to mandatory facemask ordinances as a way of controlling the spread of the disease.

9:09, Laguaite: We know that the first known depiction of medical personnel wearing a face mask and surgery during the late 19th century was a single sheet of gauze. What about the types of masks worn in 1918?

9:21, Navarro: They were all types of masks. Not all that uncommon from what we're used to today, with the difference being that they did not have any N95 respirators back then, although the general public doesn't generally have those today either. But the types of surgical masks that are fairly common now you can find on online etc, that a lot of people are using... they didn't have those either. That sort of electrostatically charged, the Tyvek plastic material. The most typical mask in 1918, at least in the beginning of the fall would have been made of several plies of surgical gauze. So people think of surgical gauze and they think of cheesecloth, but it was actually much more densely woven than that. It's a pretty densely woven cloth. And two plies that would probably—I'm not an expert in this—but probably would be fairly similar to some of the better-made cloth face masks that most of us are using today when we go out and about.

10:14, Laguaite: So were these effective?

10:18, Navarro: So certainly not 100% effective. But probably roughly analogous to what we're using today. So maybe 70%-80%, depending on how they're used. The problem was, of course, that this is the time of World War I, and so surgical gauze is in high demand, but short supply. And so you have organizations like the Red Cross, and volunteers stitching masks for sale. Those, in some communities, run out pretty quickly. And so in places where they pass these mask ordinances, the ordinance is not all that dissimilar from today saying, basically, 'Cover your face with something.' And so to entice people, they even tell fashion-conscious women that they can wear a chiffon veil if they want. So some of the face coverings were probably not effective at all. And we don't really know in terms of compliance, how many people wore them regularly, what type they were, etc. But, roughly speaking, I'd say that generally, most people, you know, would have been wearing some fairly effective, certainly not 100%, but some fairly effective face covering

11:32, Laguaite: During the COVID-19 pandemic, adherence to mask ordinances and social distancing guidelines have been a key issue. What did mass compliance look like back then in 1918?

11:43, Navarro: That being said, there were plenty of communities where we have lots of data that there were very high levels, relatively high levels of noncompliance, or at least very high levels of vocal noncompliance. So, you know, we may have seen 70%-80% people wearing masks. I'm not sure if it was that high. But that 20%-30% that weren't were really vocal about not wearing them. And so places like San Francisco, you may have heard of the Anti-Mask League is formed in San Francisco and Denver had a really hard time getting people to wear masks and they had to keep watering down the mask ordinance because essentially, no one was wearing them. In fact, the mayor at one point in Denver says you'd have to have half the city forcing the other half to wear them, just to get any sort of compliance. So they were like today, uncomfortable to wear. And like today, we live in a nation, the United States and I think a lot of Western democracies, where we hold our individual freedoms and liberties very dearly, and to have the quote, unquote, "the government" tell us that we have to wear a face mask flies in the face of that and we don't like that. And so a lot of people said the same types of arguments back then that they have been saying today.

13:02, Laguaite: Given his extensive background in the 1918 flu pandemic, I asked Dr. Navarro if he expected so much resistance to mask wearing today.

13:11, Navarro: Yes and no. So I'll say yes, we certainly saw lots of... In fact, I just wrote an article about this for the American Journal of Public Health. We saw lots of evidence of some forms of noncompliance with pushback in 1918. So typically, the types of social distancing orders, we call them nonpharmaceutical interventions. Those types of interventions that were issued in 1918, mostly centered around things like isolation and quarantine, which we know work. In fact, New York City only resorted to isolation and quarantine and did a very good job of it and could have done better had they implemented more social distancing measures, but actually did fairly well for it considering a densely populated urban area, in the midst of the epicenter of the epidemic. They did very well just, robust isolation and quarantine and contact tracing.

Navarro: But most communities that issued closure orders, they closed places of public amusement, so pool halls, bowling alleys, movie theaters, performance theaters, cabarets—those were the places that were closed. Now, of course, if you're an effective business owner, and of course, you're being told initially by public health officials that this epidemic will burn through pretty quickly, you're thinking you might only be closed for a few weeks. And so initially, and also it's wartime. So there's a high sense of civic duty and patriotism. So you go ahead, and if you're a theater owner or manager, you realize that people aren't going to come to a theater during a pandemic anyway, so let's do our part and get through this very quickly. Well, when it starts to roll on, you know, 3, 4 or 5 weeks in some places, and these orders are still in place, then people start to balk. And they say, "Well, you know, we've lost 10s of $1,000s of dollars on lost revenues, and we have employees who we can't pay." And this is before welfare and workman's compensation and unemployment and all this and the social safety net that we have today. And so you have a lot of people relying on charity.

Navarro: You have churches that are closed, either because they were recommended to close their following, or in some places, depending on the laws, they were ordered to close. They comply, they start to push back. They're pushing back in places where saloons may not be closed, for political reasons and social reasons. They're places where workmen who didn't have access to a kitchen, or the ability to cook their own food, could get a meal, as well as lots of drinks. And they tend to be very crowded places. And so you have clergy saying, "Why can you have people go after work, belly up to a bar crowded with people, but they can't come once a week on Sunday, to hear a sermon for their spiritual needs?" So we do see lots of those types of pushback in 1918 and of course, with facemasks.

15:52, Laguaite: Even with these parallels between the COVID-19 pandemic today and the 1918 pandemic, there was one huge difference that Dr. Navarro mentioned: the nature of the pushback.

16:03, Navarro: The big difference between 1918 and 2019, 2020 and 21 is that the political nature, the ideological nature, and the partisanship of that push back is drastically different today. There really... we don't have the evidence that in 1918, in the fall wave, that push back to the public health measures was politicized in any way. So these orders were issued in Democratic states and cities and in Republican states and cities. And it didn't take... there may have been a slight ideological hue to, for example, refusing to wear face masks on supposed constitutional grounds. But that ideology did not necessarily correlate with politics and political party affiliation the way it has today. And certainly, you know, we've seen with former President Trump and some of his statements and actions. If you compare that to 1918, Woodrow Wilson, who was president then, was essentially silent on the issue of the influenza pandemic. A lot has been made about that. Some people have claimed that that was all part of this sort of conspiracy, see, to cover up the pandemic, or to censor it. That wasn't really the case. It was just that like today, public health was in 1918, the domain of state and local governments. The difference is that now we live in a post-Great Depression, post-New Deal era, where we have now a more robust federal government, and we have come many of us have come to expect and more robust federal response to whatever the national crisis may be, whether it's public health, natural disaster, etc. That didn't exist in 1818. So it wasn't odd that Wilson, as president, didn't really come out and say much to control or do anything about the pandemic. People look to their local leaders. A difference today, we look to local and state leaders as well as to the federal government, and then to have somebody like Donald Trump, and lots of other Republicans in office or in media pushing misinformation, disinformation, and in some cases, saying that the virus was a hoax, etc—that was drastically different than 1918.

18:27, Laguaite: With regard to what we can learn from the prevention methods used in 1918, Dr. Navarro said, we have to look at the data that we do have.

18:37, Navarro: So, I will say this. In our study in 2007, looking at these nonpharmaceutical interventions, because of the way that they were overlapped with one another, it was very difficult—basically impossible—for us to say with any confidence in any one of those nonpharmaceutical interventions, isolation, quarantine, school closures, closing of businesses, public gathering brands, or face masks, that any single one of those contributed X percent to the reduction in cases and deaths. What we do know is that taken together, those cities that implemented those measures earlier, that layer them so it wasn't just school closures... Several of those types of interventions layered on top and kept them in place for as long as possible—those cities fared better. So what I would say is that we have much better data today that face masks do indeed work, that they are very effective, although not 100%, in reducing transmission when worn properly.

19:40, Laguaite: Complacency is a dangerous trap to fall in, especially during a pandemic.

19:45, Navarro: We don't want to have a face mask on and give ourselves a false sense of security that we can have just a simple face covering, not an N95, and we can be face-to-face with strangers or with family members who don't live in our house. For example, if you're in an area where there's a hotspot and think that you're safe... The way this was explained to me and the way I've been explaining it to people—I think this is perfect—is that if you imagine each of these interventions as a piece of Swiss cheese, they all have holes in them. But if you layer several of those pieces together, hopefully, the hole doesn't go through the entire stack. And so, face masks are an incredibly important part. But so is hand washing, social distancing, staying out of congregated areas until we get this under control.

Navarro: Vaccines are a much more important part of today than they were in 1918. We didn't really have effective vaccines in 1918. And there were some vaccines that were developed. They thought they were dealing with a bacterial infection, not not not a viral one. They didn't have that technology until the early '30s. And so they weren't really effective. Today, we have vaccines—that will increase. But we also have these other variants that are circulating that could be very dangerous. They're much more transmissible, it seems. We could have another one pop up. And so we have to get it under control. Face masks are an important part of that. If we allow the pandemic... it's starting to come down now. But if it flares up again, these viruses always mutate. And there's always a chance for one of those mutations to be a more dangerous one. And so we want to control as much as possible transmission. Face masks are definitely an important part of that. We have better data today. We know that they worked in 1918. We don't know how well they worked because we have different technology for the construction today. We don't really have data about compliance back then. We know that they were an essential part, then we know that they are definitely an essential part of the plan today.

21:34, Laguaite: So what will future historians say about the current pandemic we're living through?

21:39, Navarro: You know, I sadly, think that we are going to be talking about... future historians are going to be talking about this pandemic, and all of the lessons that were not learned over the 102-year intervening years between 1918 and 2020, 2021. And that's really the sad part. We have a much better understandings of the science and medicine behind viruses today that simply didn't exist in 1918. They knew that viruses existed, but they didn't really know what viruses were. And we didn't really know that influenza virus existed until 1933 in pigs and 1935 in humans.

Navarro: We have much better technology today. We were able to produce these vaccines. A 95% effective vaccine for a virus is incredible. And we did that so quickly. I mean, that's the beauty of science and really dedicated, hard-working scientists. But we knew when we were working back in 2007, when we were contacted by the CDC, that whatever the new virus, whether it was a new strain of influenza, or coronavirus, that was going to emerge. It was going to be a novel strain. It was going to take time to isolate it, to genotype it, and to develop effective therapies and vaccines against it. And what do you do in that intervening time? Well, you resort to the old standbys: contact tracing, isolation and quarantine, social distancing, mask wearing for respiratory diseases. And some places did very well. Other places did not do very well. But unfortunately, I really don't think that any place in the United States did very well for as long as we needed to.

Navarro: When these measures were implemented back in the spring, we really needed to keep them in place in some form, until we have herd immunity from vaccine rollouts. And we haven't done that. And if you look at the three spikes—the three surges of the disease—they correlate with people getting together for the summer holidays than the winter holidays, along possibly with more contagious variants spreading and colder weather where people naturally congregate more indoors. 1918 showed us that it's very difficult to get people to follow these orders for a long time. Some cities did it for about 5-6 weeks in 1918. I was surprised that we actually did longer than that in the spring, but I knew that we needed to do longer still.

Navarro: One of the big differences between COVID or the SARS-CoV-2 virus and influenza virus. They're different viruses. COVID is a much more contagious disease and as a result, without getting into the math of it, basically the more contagious diseases, the more transmissible it is, the higher that threshold for herd immunity is. So we always knew going in that we were going to have a much higher threshold for herd immunity from COVID than we would for influenza, which was about 30%-35%. About 70%, it might be 80% or higher now with these new, more transmissible strains circulating. And so that means that we have to do even better keeping these social distancing measures in place and really strictly following them.

Navarro: And I think what we've seen is that anytime those social distance measures were peeled back just a little bit by authorities, it, unfortunately, gives the idea to the population that well, maybe it's OK to get together. So, "I haven't seen my friends, my family in a while. Things are getting better. The officials said indoor dining is allowed, so maybe let's go and do that, or we can get together in bars." And it just gives— and then people get whiplash back and forth, because they're constantly being told, "No, you shouldn't. But yes, it's OK. You can get together in small groups. Now, we have to peel that back." Now, some of that is naturally ebb and flow. We want to keep our economy functioning, etc. This is a very difficult thing to do for public policymakers. But from a public health standpoint, I think it's a really bad idea to give people that false hope that it's okay to get back together. And then they are going to do it and then you get mad at them for getting back together.

25:57, Laguaite: Well, thank you so much for taking the time to talk with me today, Dr. Navarro. It was so good to hear from you.

Laguaite: In the United States, the COVID pandemic continues between emerging variants and restrictions easing up, it can be hard to keep track of all the information. For now, the Centers for Disease Control and Prevention recommend everyone aged two and older wear a mask to protect themselves and others. Still, a mask isn't meant as a substitute for social distancing. So these masks should be worn in addition to stay at least six feet apart. The CDC also recommends that face masks be worn completely over the nose and mouth fitting snugly without any gaps.

Laguaite: This has been "To Health and Back." Thanks again for joining me on this health history journey. Tune in next time for a discussion on xenophobia. Until then, don't forget to rate the podcast and subscribe. Feel free to shoot me an email at healthandback@gmail.com and I'm also on Twitter, Instagram and Facebook as @healthandback. Thanks. See you next time.

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In this episode of "To Health and Back," we'll hear from Dr. J. Alexander Navarro, the assistant director of the Center for the History of Medicine at the University of Michigan, to see what mask-wearing looked like during the 1918 influenza pandemic.

Read the transcript for this episode here. SHOW NOTES: * CDC: Read about the 1918 flu pandemic * Center for the History of Medicine, University of Michigan: Read about Dr. J. Alexander Navarro and his work. * Early Human Development, 2020: Read about adherence to face mask use during both the COVID-19 and 1918 influenza pandemics. * Emerging Infectious Diseases, 2006: Read about the work of Dr. Navarro and his team, who studied "nonpharmaceutical interventions used to mitigate the second, and most deadly, wave of the 1918–1920 influenza pandemic in the United States." * Forbes: Read Kiona N. Smith's article about the Anti-Mask League. * Health Affairs: Read about the failures of mask-wearing in 1918, and why we need to wear masks today. * Influenza Archive, Center for the History of Medicine, University of Michigan: Check out this resource on the influenza pandemic of 1918-1919. Dr. Navarro is the co-editor-in-chief of "The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia." Dr. Navarro researched and wrote the online encyclopedia’s essays elucidating 50 American cities’ experiences during the pandemic. * Journal of the Royal Society of Medicine, 2015: Read about the use of facemasks during surgical procedures. * Michigan Health: Read Dr. Navarro's article about mask resistance in 1918.

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In this episode, we'll talk to Dr. Nan McMurry, historian and head of collection development at the University of Georgia libraries, to see what lessons we can take from early outbreaks.

Read the transcript for this episode here. SHOW NOTES: * CDC: Read about the 1918 flu pandemic * Harvard University: Read about the 1721 smallpox outbreak in Boston * Hospitalfield: Read Sophie Byatt's essay on plague hospitals * International Encyclopedia of Public Health, 2008: Read more about quarantine through history * NPR: Read about yellow fever's impact on New Orleans * Past & Present, 1988: Read about cholera in 19th-Century Europe * World History Encyclopedia: Read more about the Black Death

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Madeline Laguaite: Hello and welcome to "To Health and Back," a podcast about how health, medicine, and wellness decisions from the past help inform us today. I'm your host, Madeline Laguaite.

Laguaite: In this episode, we're talking about early pandemics and epidemics, and what some of those earlier outbreaks can teach us today. We'll hear from Dr. Nan McMurry, the director for collection development at the University of Georgia libraries. She earned a doctorate in the history of medicine and teaches in the UGA History Department on a part-time basis.

Laguaite: So I actually met Dr. McMurry through a class I took with her during my undergraduate career here at the University of Georgia. It was called the history of medicine. And in truth, the material we covered in that class and Dr. McMurry herself inspired this podcast, so I thought she would be the perfect first-ever guest to talk for this episode about earlier outbreaks and how they can relate to the pandemic we're living through.

Laguaite: From the Black Death in the 1300s, to outbreaks of cholera in the 1800s, to the current COVID-19 pandemic today, experts that study the history of medicine say the one thing that doesn't change is human nature. Here to talk about that human nature with us is Dr. Nan McMurry. Hi, Dr. McMurry, and welcome to the show.

Dr. Nan McMurry: Hey, how are you?

Laguaite: I'm good. How are you?

McMurry: I'm good, too. It's been a long time.

Laguaite: I know, I know.

McMurry: So I'm Nan McMurry and I have kind of an unusual job at UGA. My primary responsibility is in the university libraries, and I'm the director for collection development and collection development is the part most people have never heard of. It's the part of the library where we choose the materials we're going to have in the collection, so books or journals or databases. There are real human beings who do that, not robots. And so we have a team of people, and I'm the head of that team. But I also work directly with certain subjects.

McMurry: And then because I have this academic background, where my doctorate is specifically in the history of medicine, I've been able to teach on kind of part-time basis in the history department. So that's how my class that you took came about.

Laguaite: OK, awesome.

McMurry: You might think that somebody like me would really find living through a pandemic now really— I mean, I find it interesting, but I don't find it fun. You know, it's kind of a little lesson that I learned, ooh, this isn't so good to be in the middle of it.

Laguaite: OK, so you've studied all sorts of earlier outbreaks, epidemics, and pandemics. What are some of the things that stand out to you most, especially with regard to human nature?

McMurry: You know, our medicine and our public health and the knowledge and the technology have changed a lot, but the human nature? Mmm mm. That's been really striking to me watching this pandemic unfold is just how little we've changed in our attitudes, and our fears. We tend to think, 'Oh, we're so invincible with their science.' But when you have a new disease, that medicine and science are not as effective against or not as effective right away, then all those old attitudes come right, right out of the woodwork.

McMurry: Here's a historical example. It's so easy when you look back in the past to say, 'Oh, yeah, that was so dumb.' And yet we do it all the time. So there's a particular smallpox epidemic that happened in 1721 in Boston, and smallpox came in onboard a ship. And the captain of the ship steered the ship away from the docks and onto an island where it could be isolated with this person who had smallpox. But then there were other sailors on board who said, 'I'm not sick. Oh, you know, I've been at sea a long time and I want to have some fun.' So they sneak rides on little boats into town, and party it up and mingle and all that, and then they go back to their ship, and oops, then they come down with smallpox. So that's how smallpox got into the city and caused a horrible epidemic. And it's that kind of thing where people are just thinking about, 'Well, what do I want?'

Laguaite: Dr. McMurry said there are plenty of striking similarities to earlier outbreaks and the COVID-19 pandemic that come to mind.

McMurry: Well, let's pick a cholera epidemic, for example.

Laguaite: OK.

McMurry: So when cholera was ravaging Europe, in England in 1832, Americans knew about it because there were newspapers and they were aware of what was happening, but there was kind of a complacency like, 'Oh, we have the big ocean between us.' There were two kinds of complacency, so 'the ocean will save us.' And then the other complacency was, 'Well, cholera is just a disease that affects poor people, and we're Americans and we don't really have we don't have those kind of masses of poor peasants and city dwellers. We have sturdy, American farmers.' American exceptionalism, basically another form of that.

Laguaite: OK.

McMurry: And so a lot of people thought even if cholera made it across the ocean, it wouldn't be a problem, because Americans would just fight it off. And I think we had not exactly that attitude, but I think we were a little too complacent about the excellence of our public health, that— because you remember all that, 'Oh, it won't come here. Oh, it won't make many people sick. Oh, it won't be a big problem.' There was a lot of dismissive—and not so much among our public health officials, but among some other people—that it wouldn't be a problem. And it turned out to be a terrible problem, and we lost the opportunity to get on top of it early.

Laguaite: The way in which authorities communicate risk is similar to whether it's a natural disaster like a flood or a pandemic, the central concepts of risk communication are present throughout history.

McMurry: A parallel that kind of cuts through all epidemics is, the first thing your authorities will tell you is there's nothing to worry about, sort of every time. And sometimes newspapers or the news media will suppress it as well, sometimes not. Sometimes they're right out there, investigating and revealing but smallpox epidemics, yellow fever epidemics, even the plague, where they tried to be communicative with each of the towns and say, 'Oh, there's plague. It's coming.' Usually, you tried to keep it a secret until it was sort of impossible to keep a secret, then you'd admit 'Oh, yeah, by the way, we've got plague.'

Laguaite: But why try to keep things quiet?

McMurry: There's several reasons communities do that. And one is just leaders always assume that people will panic if they're told the truth, and maybe they would. But when they're not told the truth, all kinds of other things go wrong. So you know, I don't know what the answer to that is. But it's particularly disheartening to be told there's nothing to worry about. And then any choices you might have made at that stage—if you had been told there was something to worry about—aren't available to you anymore.

McMurry: But the other reason, at least in the past, that leaders and news media, will try to keep it quiet, it was because of the economic impact. So as soon as you admit you've got a deadly disease in your midst, well, a bunch of people are going to leave town, first of all. And who can afford to leave town? Wealthier people who run the businesses. If they all go, then the people who are left not only are having to face a disease, but they don't have any way to make a living. So you know, it was terribly disruptive to cities to communities. But also, as soon as everybody else gets wind that you've got a disease, nobody's going to do business with you. You sort of cut yourself off or somebody else cuts you off. But that would be another reason for trying to keep it quiet.

Laguaite: Who people should turn to for advice during a public health crisis is another long-standing debate and an issue that was relevant centuries ago.

McMurry: This is another smallpox connection. So in the 1700s... I mean, the normal response to an unfamiliar or just any disease, a scary disease is, is to run away if you can. That's a very common thing or to or to try to avoid it anyway, shut yourself in your house or shelter at home, all those things we're familiar with. But in the 1700s, they came up with a treatment that was called inoculation. I mean, it's kind of confusing, because we use that word today. But what they meant back then was actually giving somebody a real case of smallpox, not a safe virus or anything.

Laguaite: Got it.

McMurry: But the idea was they had seen that some cases of smallpox really were mild and you weren't very sick, and then you were immune for the rest of your life. So some people thought if they could figure out a way to control it so that you got a mild case, it was a risk that—it wasn't perfectly safe—but it was a risk worth taking. And of course, this provoked a huge debate because you were giving people something that could kill them. So all of that just to say, a feature of the debate was who really ought to be the authority to speak on this.

McMurry: And I think that's something we've seen over and over again with COVID. It's interesting, in the case of the smallpox epidemic, it was actually the ministers, the religious figures and leaders of the time that were saying, 'Let's try this new technique.' And it was the doctors who were saying, 'No, that's dangerous.' Which is exactly opposite of what you would expect. But in today's world, we've seen a lot of that where we have scientists who know what they're talking about. They don't know everything, and they have to revise what they say, but they sure know a lot more than I do.

McMurry: But who are we listening to? We're listening to politicians who feel perfectly free to say whatever they like and to think that they are well informed. Why do they think that? Or celebrities, there's so much celebrity culture. 'I'm going to do what my favorite movie star does.' So that whole question of whom should you listen to?

Laguaite: Even the concept of quarantining—a concept I wasn't really familiar with until I had to quarantine for 10 days during the novel coronavirus pandemic—has been used as a preventative measure since the 14th century, with the spread of black death.

McMurry: Yeah, so so that's a really interesting point because I remember reading back last summer, somebody was complaining about our public health response. And they said, 'It's just been so medieval.' And I thought, 'Oh, don't be so...' you know, because it's really during the Middle Ages that a lot of our public health—the things we do for public health, even today. We've evolved a lot, but those basic ideas of yeah, quarantine. And that's not to say that those things weren't ever done before. But it's really the experience with the plague that sort of cements it in places. This is the way you try to keep your community safe.

Laguaite: That's not to say that quarantining in the Middle Ages is the same process as today. Still, the general principles are there.

McMurry: You know, the first thing you would try to do was find out if plague was headed your way. And so some communities like like Venice is a really good example would basically send out spies, because Venice was sort of a... we think of it as a city, but in that time, it was it was a big city state that spread over a big region, almost like a country. And so the Venetians, they have this trading empire, and they were always on the alert for, and they're also kind of on the frontier with the Ottoman Empire and the Holy Roman Emperor Empire to the north. And at least the Venetians thought that those two empires were really slack about keeping the plague away. So they sent their own agents or often merchants to say, 'Keep your ear to the ground. If you hear about anything, we got to know about it.'

McMurry: So they were very vigilant about where plague might come from and about setting up border crossings and making ships quarantine in the harbor. They had all kinds of things they could do. So they would also do things with travelers. They had things that you can think of as health passes. If you were a traveler, it's kind of like having a COVID test today: 'Look, see? I'm negative. I'm safe.' They would just have some kind of document that you could carry with you if you're traveling during plague times and say, 'It's OK, I'm safe. You can let me in your town.'

Laguaite: But what if all of those preventative measures fail?

McMurry: If all that failed, and it often did, and you get a plague outbreak in your own town, well, the first thing they would try to do is isolate people in their homes. So that's another kind of quarantine. And so when we say that we generally mean... I mean the myth about it is, 'Oh, people were shut up and locked in and left to starve.' Well, no, it just meant they tried to keep you from coming out of your house. But you could still have somebody bring food to you or that kind of thing. And sometimes people sneaked out anyway.

McMurry: It was a good idea, except that the plague is really being spread via the rats and the fleas. So even if you keep the people apart, the disease tends to still spread. If keeping people in their homes wasn't doing it, then the next thing they would often do when they got just too many victims all over the town, then the next thing you would do would be, try to put up a plague hospital and isolate people there. Partly from the standpoint of, 'Well, we can care for people better if they're all together,' but also from the standpoint of, 'Let's put them all together where they can't spread it to the rest of us.' And that tended to be more people who were poor or otherwise powerless. If you were wealthy and you lived in your big mansion, they probably weren't going to drag you away to a plague hospital, you got to stay home. But yeah, so they had a lot of things that they would try to do. And there was the same kinds of turmoil over like, say they do want to, 'Let's start a hospital for these people,' then there would be, 'Well, not in my neighborhood. Not in my backyard. You can't use this building.' There's that same kind of conflict that we see today.

Laguaite: While many people usually look down upon past health measures, she said we can and should look at our own current public health system through an equally harsh lens.

McMurry: And when we say, 'Oh, yeah, but those things didn't work because they kept having plague outbreaks.' Well, yes. But then you can't measure the epidemics that didn't happen. You can't say those didn't happen because of the quarantines. You just don't know. It's just always interesting to me that we're really quick to criticize people in the past and say, 'Well, they had quarantines but they didn't work at all,' and seeing that as a failure of public health. We've got a COVID pandemic all over the world. Does that mean our public health efforts are totally useless and misguided? No.

Laguaite: Even though the outbreaks, epidemics, and pandemics we've been talking about happened centuries ago, Dr. McMurry said there are many lessons we can take from them.

McMurry: [We need] to think really, really, really carefully about the kind of communications that are done. I know I know people can react in really crazy ways. I mean, people who are going to react in crazy ways are going to do that anyway. And there are other people who are really concerned and intelligent and conscientious. How about tell them?

McMurry: And I think it's also really hard for people to understand that an epidemic is always an evolving thing. And so you're told one thing today and something different tomorrow. Well, sometimes that's because people have been trying to withhold information, but sometimes it because they just don't know. They're doing the best they can at any point along the spectrum. If leaders would communicate better with the rest of us, and if we would understand that they don't know everything, and the situation is going to change and have some patience and compassion about that... It's just so hard.

McMurry: And I think another thing would be—this cuts across way more than just medicine—trying to be prepared for bad things to happen. Because if you go a long time with no bad things happening, you tend to get complacent, and nobody wants to spend money on something that might not happen. So natural disasters, we could be better prepared for that. We can't always predict them or prevent them, but we could be better prepared to manage them. Same thing with a disease outbreak, it's a kind of natural disaster, but it's sort of a different kind. Some of the sorts of public health infrastructure that we've had in the past that cost money to be well prepared. Don't let that go away. That's worth spending money on, and try to educate people to say that, if we don't have an outbreak of disease, that doesn't mean that somebody was just trying to scare you. It means that your public health worked, and value that instead of just saying, 'Oh, we put all that tax money into something that never happened. Well, yeah, that's exactly what you want to happen.'

Laguaite: During the COVID-19 pandemic, xenophobia and blatant discrimination toward Asian Americans in the U.S. was a huge issue. In fact, we have an upcoming episode specifically on xenophobia that we've seen in the U.S. this past year. But as it turns out, that was an issue in the past too, and it's one of the most valuable lessons we can apply to today's pandemic.

McMurry: Well, you know, I guess another thing would be try to avoid blaming people for— because you were talking about discrimination against Asians for this. You know, using ugly words like the 'China virus.' Nobody can help where it comes from.

McMurry: So like with yellow fever, because most people who had it who lived in the South in the 1800s, in, at least in these cities, where yellow fever would tend to occur, would often have had... And this is another parallel with COVID. A bad case of yellow fever has really striking symptoms. But a mild case of yellow fever is no different from any little flu kind of bug with a fever and aches and pains, but then you get over it in a couple days. And you have immunity after that. So a lot of people were immune without even knowing it or thought that their protection derived from living in a particular place for a long time. They didn't know about viruses, and they didn't really know about immunity, but they knew if you had grown up in someplace like New Orleans, you weren't likely to get yellow fever.

McMurry: So what that meant was that they would blame it—they would call it a stranger's disease—and they would blame it on immigrants, or anybody who had lived there a long time. You know, these people are saying, 'We would be fine if we didn't have all these extra people coming in among us,' and so I mean, that was a reality in the sense that people who had never been exposed to yellow fever before are more likely to get it. But it wasn't their fault, and they didn't bring it on purpose. So that kind of thing is very discouraging when you see that still happening today.

Laguaite: Dr. McMurry said another critical lesson we need to consider is being aware of how outbreaks and pandemics like the COVID-19 pandemic affect different populations disproportionately.

McMurry: If we could be more aware and sympathetic to how epidemics affect different parts of the population... That's been brought home to us and that people who are frontline workers and often people of color are in that category. If a new disease is affecting them more, well, respond to that. It's kind of a legacy, really, of blaming diseases in the past on poverty, not in the sense of oh, in a sympathetic way, but in a 'these people are dirty and ignorant and lazy and they don't care. They don't bother to keep themselves clean or try to avoid disease.' All of that kind of negative thinking.

McMurry: Even though if you ask somebody, 'Is that what you think today? They say, 'Well, no, of course not.' And yet, I feel like it's in the background somewhere, that when people who maybe don't look like you are getting sick, it's a little too easy to dismiss it or to say, you know, to sort of use the same excuses, some people use, 'Well, you didn't try hard enough' or 'You made bad choices.' Those kinds of lines that we hear a lot sometimes migrate over into the disease world as well. And that's just really unfortunate. I wish we could confine ourselves to scientific ideas and think about how the diseases really spread. If they are more prevalent in a particular population, there's a reason for that, and that reason's probably not moral.

Laguaite: Now, there have been a lot of comparisons drawn between the COVID-19 pandemic and the 1918 influenza pandemic lately, because there are tons of similarities there. It's interesting to think about how historians will look back on this pandemic, and Dr. McMurry, can you shed some light on this hypothetical?

McMurry: Yeah, I've thought about that. I think there'll be that tendency to pass judgment and say, 'With all of their scientific prowess, why did this disease have...?' They will be analyzing our failures, so to speak, and they won't be fair about it, because I don't think people will become better at judging human nature in the future than we are now. That will still be a problem. So it's good that they will analyze it that way and see where failure occurred where it didn't have to, but at the same time, any new disease or any big scale pandemic, people do the best they can, most of the time. I mean, yes, there are these negative attitudes and problems and things that go wrong, but most people are trying really hard. And I think the situation is evolving so quickly, in terms of what you know, and what you're able to do. And the future will not be forgiving about that. Because by that time, it's all over and they see hindsight and they see a final outcome, whereas we're still right in the middle of it.

McMurry: You know, I think they will judge our inability and our unwillingness to do fairly simple things to stay safe. And that is still just mind-boggling to me. I just don't understand that attitude of, 'Yeah, but you know, I haven't been out to eat in a really long time, so I'm just gonna go.'

Laguaite: Right.

McMurry: I think in the future historians, or whoever it is, will be just kind of astonished in, like, we look back at the Black Death. And we see things like persecution of the Jews or the flagellants who went around beating themselves. We see bizarre things like that that we just can't count for. Well, I think in the future, people will look at like refusal to wear a mask, and the way that became politicized, and that people would actually harm each other, kill each other over being asked to take simple precautions. They'll lok back on that and they'll say, 'Oh, how medieval,' which is still unfair. So it's kind of a mixture of saying, there will be some things that we really couldn't help and we did our very best that we'll get criticized for, and then there'll be other things where we absolutely deserve condemnation of posterity.

Laguaite: Well, thank you so much for talking with me today, Dr. McMurry. It was so good to hear from you.

McMurry: You bet. Bye.

Laguaite: Just because human nature hasn't changed much doesn't mean that we're doomed to make the same mistakes today. Being aware of some of these past public health situations and responses should help inform the decisions we make today.

Laguaite: As new variants emerge, public health officials continue to urge people to wear a mask, stay 6 feet from other people who don't live in your household, and to avoid crowds.

Laguaite: This has been "To Health and Back." Thanks again for joining me on this health history journey. Tune in next time for a discussion on the history of mask wearing. Until then, don't forget to rate the podcast and subscribe. And feel free to shoot me an email at healthand back@gmail.com. I'm also on Twitter, Instagram and Facebook as @healthandback. See you guys next time.

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In this episode of "To Health and Back," we'll talk to Dr. Nan McMurry, historian and head of collection development at the University of Georgia libraries, to see what lessons we can take from early outbreaks.

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Madeline Laguaite