Practice English Speaking&Listening with: 5/11/2020 Conversation on Covid-19 | Michael Willrich

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Welcome, everybody.

I'm Sunil Amrith, interim director of the Mahindra

Humanities Center at Harvard, for another installation

of our series of conversations on COVID-19.

I'm really pleased today to have with me Professor

Michael Willrich, whose [INAUDIBLE] professor

of history at Brandeis and author of Pox,

An American History, which was published back in 2011

and which, it seems, more timely than ever today.

Thank you so much, Michael, for joining us.

Well, thanks for having me.

It's great to be here.

I wonder if you could start by telling us

a little bit about the smallpox epidemic

that swept through the United States

at the very beginning of the 20th century and the course

that that epidemic took.

Sure.

It was kind of a wave of epidemics, really, that

crested across the United States between 1898 and 1903,

ultimately affecting every state in the union

and most local communities from the South up to Alaska.

And also, there were outbreaks in the US colonial holdings,

possessions in the Philippines and in Puerto Rico.

So it was really the full picture of the United States

during this period.

And it was a really complicated set of epidemics

because some of them were of classic smallpox--

very severe, killing 25% of the people they infected,

the kinds of horrifying experiences

that were known to world history.

And some of them-- many of them, in fact--

were epidemics of a new strain of the virus that has since

been called variola minor to distinguish it

from the classic variola major.

And in this case, the case fatality rates

in local communities could be about 2%,

close to what we're seeing with COVID-19, or even as low as 1%

And so there was a lot of conflict over how

to diagnose these outbreaks.

And this also was one of the contributing factors

to all of the dissension around public health

during these epidemics.

Thank you.

A key argument in the book, of course,

is that this was a pivotal moment

in the history of public health in the US,

especially in terms of compulsory vaccination.

So what was the major legal and legislative shifts

that took place around this epidemic,

with legacies that, of course, continue to this day?

Yeah, so I mean, the power of local governments,

and state governments as well, to respond

to epidemics is part of what's known broadly as the police

power, the power to regulate or interfere

with individual liberty or property rights

in the name of the general welfare.

And public health has always been the strongest case

for this kind of power.

So quarantines, setting up isolation hospitals

and taking people there against their will,

the power to vaccinate people whether they

want to be vaccinated or not--

a whole set of technologies, old and new,

put into service during these epidemics.

How did things change?

Well, there was a mass of litigation

that came from people first at the states and then making

their way up to the federal courts and the Supreme Court,

ultimately, that challenged the right of state

and local governments to carry out compulsory vaccination,

whether as a requirement for children

to enter the public schools or whether it

was a requirement for anyone to leave

their homes during an epidemic.

And ultimately, the Supreme Court

confirmed the decisions of lower courts

that these measures were perfectly constitutional.

And the Supreme Court, in an opinion

that really drew on language from lower courts,

likened these powers to the powers of governments

to protect the people during a military invasion.

And so they said that the individual has no more right

to refuse this order than an individual had the right

to refuse a conscription order.

And so there's a very strong endorsement

of police power given by the Supreme Court,

but also a series of reservations and qualifications

that come in the same decision from 1905, including

a basic premise that these measures must be reasonable,

that they must be a response to actual necessitous

circumstances, and they must be carried out

in a way that really does the least

harm to individual citizens.

One other piece of the legal legacy

of these epidemics that's hugely important

is the development of a system of licensing and regulation

of vaccine production, which did not exist through these years

I'm talking about and which was one of the reasons

that the epidemics were and the public health response was

such a contentious matter.

Because governments were ordering people

to be vaccinated and people had their children

vaccinated, but those same governments did nothing

to ensure that the vaccines on the market

were effective and safe.

So the Biologics Control Act, which

came out of these epidemics, an act of Congress,

was also a hugely important legacy.

There were others, but these are two of the main ones.

One of the very powerful things you do [INAUDIBLE]

is to tell this as a story also of inequality [INAUDIBLE],,

particularly the ways in which immigrants

and African American communities were disproportionately

targeted for police action.

I wonder if you could say a little bit more about that.

Yeah, I mean, it has certainly strong resonances

today with what we're seeing.

First of all, immigrants and African American,

members of the working class generally in American cities,

but also in the rural South, were most vulnerable

to the disease of all the populations because of the way

that they were living in very thickly populated areas,

the way that they were largely neglected

by the medical establishment during normal times.

And then when the outbreaks occurred,

these same communities really were

the first to be targeted for quarantine and compulsory

vaccination.

So you have scenes on the Upper East Side, East Harlem

area of New York in 1901 in the winter of vaccination squads,

these teams of public health officers

and lancet-bearing physicians accompanied

by police with billy clubs going into tenement neighborhoods,

cordoning off blocks, entering the buildings

in the middle of the night, knocking on doors,

inspecting the premises, inspecting people's arms

to see if they had the scar of a recent vaccination--

if they didn't, ordering them to be vaccinated on the spot,

sometimes carrying these out by force.

There were riots.

There were people running, taking to the rooftops,

the whole thing.

But the most poignant moments in these episodes

were when public health officials had to--

or chose to or had to-- take children away,

infected children away from their mothers' arms

and take them off to the pest hospital, which

was in the middle of an island in the East River.

These were scary scenes, and they

were unimaginable in other parts, other more affluent,

wider areas of New York or other communities.

So race was a huge and ideas about race

were a huge animating factor throughout these epidemics.

So this is a story [INAUDIBLE] vaccination, but also

of quarantine.

And there are very vivid descriptions

in the book of the pest houses.

What were conditions like in the pest houses?

How were they structured?

What was the experience like to the best of [INAUDIBLE]??

Yes, so I mean, every community during an epidemic

would throw together a pest house, usually,

in the smaller communities, by commandeering a house

at the edge of town and taking it over and then bringing

patients, bringing infected people

from around the community into this place.

In big urban centers like Boston and New York,

these pest houses would frequently

be located in buildings on islands like North Brother

Island in New York or one of the islands

in the harbor of Boston.

And then within them, there was very little

that doctors could do to treat smallpox other

than to try to treat people for discomfort,

try to provide some sort of basic sense of care.

But these spaces were understood to be places

where the poor were taken.

And they were reviled among working class people

in American communities, and they were reviled also

by people, often working class people as well,

in whose communities they would be placed during an emergency.

So there were many episodes I found

during my research of neighborhoods

rising up when a pest house had been put in their midst

and, in fact, tearing it down or burning it down,

sending it aflame--

obviously, driving the people out first.

But these were very, very controversial institutions

of a world gone by.

It reminds me a lot, actually, of the plague epidemic in India

at precisely the same moment in the 1890s

where the plague hospitals were reviled.

And they were reviled not just because of the intrusiveness

that they represented, but also because they

were places which, quite reasonably,

poor people thought they would be sent

to die because not that many people returned from some

of these institutions.

So there was a resonance there which

I certainly was struck by.

And people [INAUDIBLE] taken away from their families,

right?

And in a way, in many of these communities--

and I think in India probably as well, right--

the best chances that infected people had of survival

was being cared for by family members who

would be constantly watching over them

and taking care of them, so yeah.

So another major theme of the book

is, of course, the theme of resistance to vaccination.

And you've already mentioned that briefly

in terms of the litigation.

But what forms did that resistance tale?

Yeah, so it took all kinds of forms--

and this became just a particular obsession for me,

was tracking these out-- but ranging

from organized resistance of groups

that formed anti-vaccination leagues,

had their own literature, not wildly

dissimilar from the anti-vaxxers today.

But from them, there were also groups

of working people who formed organizations,

very temporary organizations, to go down to a town hall

and demand that compulsory vaccination be ceased.

There were also parents who, with their children,

staged school strikes who would either withhold their students

from the schools or take them down to local schools

unvaccinated and demand that they be allowed to matriculate,

to take classes.

In closer quarters or in environments

where there's already a great deal of tension around race

or class, you see these sort of spontaneous riots

occur when the vaccinators show up on the scene.

But some of my favorite examples just

involves everyday subterfuge, like forging

vaccination certificates.

And my favorite of all examples is the forging

of the vaccination scar.

So vaccination produced a distinctive cicatrix,

a nickel-sized scar usually on the arm where

the vaccine was carried out.

And health authorities actually looked for this scar.

They could recognize it.

They could discern how recently it had happened and so on.

And so some folks who wanted to pretend

that they had been vaccinated or that their children had

would take a little bit of nitric acid, quite diluted,

and put it on the skin at this place,

leave it on for about three or four minutes, and dab it off.

And it would leave behind, after a few days, a scar that

looked very much like a recent smallpox scar--

so people literally marking their bodies as forgery, yeah.

That's amazing.

And in terms of the arguments they're

using against vaccination, are these arguments

about individual liberty?

Are they about safety?

How did those different factors come together?

Well, so this is one of the things that really, I think,

distinguishes this period, is because they had

so many good arguments to make.

So yes, personal liberty, constitutional liberty,

common law rights, parental rights, masculine rights-- all

of this rights discourse was very much powerfully invoked

during this period against what was a growing state.

But at the same time, there are arguments

about medical liberty, about thought,

about ideas, about freedom of conscience, which

were quite compelling to many observers

at the time in a period in which the regimentation

and regulation of medicine itself

was occurring at a very rapid pace.

Then there were the health concerns, which

were really quite reasonable.

Vaccine was the product of a combination of the stable

and the laboratory.

Vaccines were harvested from the underbellies of calves,

taking vaccinia-- or what previously had been cowpox back

in the day but, in the early 20th century,

would have been vaccinia virus-- from the sores on cows

and sometimes providing some sort of glycerin or some dish

additive in the laboratory that would stabilize it and remove

some of the impurities.

And then next thing you know, it's

being scraped into the arms of little children.

Well, many people had complications associated

with this, ranging from the very typical sore arm

and fever, which would put people out

of work for several days in a time

when there's no workers comp, no system for compensating

laborers who lose their wages temporarily.

Or in the worst cases that occurred,

vaccines became contaminated with tetanus spores.

And so there are episodes such as occurred in Camden in 1901

where children died of post-vaccination tetanus

that was traced to the tetanus itself.

So there are a host of arguments,

ranging from the libertarian to the very practical.

So to turn to our current moment-- and of course,

we're talking to each other from our houses on Zoom.

To turn to the current pandemic, governments, universities,

all of us as citizens are putting a lot of hope

that a vaccine against the coronavirus

will be found in the not-too-distant future.

Reading your book has reinforced to me, of course,

the sense that finding a vaccine is not the end of the story.

And I wonder if you could say a little bit more

about vaccination in society in our moment.

Yeah, I mean, whew.

I think most of us right now are pining for a good vaccine

or, really, for many, many vaccines

that would be effective, produced

in different countries.

But yeah, so I mean, there would need

to be decisions made about how vaccination would be carried

out, under what circumstances, where it would be required,

where it would be voluntary.

I mean, I think that initially, that the general public would

be running to this vaccine rather than away from it,

as was often the case in the early 20th century.

But in the past 15, 20 years, there's

been a rising anti-vaccination movement.

And if these protests out in front of statehouses

are any indication, we can expect that some of those folks

will object to any measure to make this COVID-19

vaccine compulsory.

And again, under our laws in the United States,

much has changed in the 20th century

and the early 21st century with the growth

of the federal government, but these are still

going to be state measures.

And so we can expect that there will

be wide variation among the states in terms of how they

carry out vaccination just as there is right now with regard

to social distancing, or there's a real conflict going on,

as you know, among different states.

Michael, thank you so very much for talking to us.

This has been absolutely fascinating.

Thank you.

It's been my pleasure.

The Description of 5/11/2020 Conversation on Covid-19 | Michael Willrich