Watch the recent webinar featuring special guest Charles Kenny who discusses his most recent book, The Plague Cycle, and why global cooperation during any public health crisis is essential. Charles is a senior fellow and the director of technology and development at the Center for Global Development.
Last year, we saw countries close their borders as they worried about containing the virus’ spread. Governments around the world limited trade and worked to bring critical supply chains related to medical and food production back within their borders. But was this the right response?
Detailing the history of humanity’s struggle with past plagues, Kenny argues the best response is global collaboration, not isolation. He notes the potential for international cooperation on cures and limiting the spread of disease is the best response to future public health issues, such as the global effort to develop the critical COVID-19 vaccine. We need more examples like this if we want to successfully limit the spread of future novel diseases and viruses.
Josh Smith: Thank you Charles for joining and thanks to everyone else as well. I want to introduce Charles first and I want to say about a month and a half ago, sometime in December, I ran into one of Charles’s recent editorials in a political magazine about pandemics closing borders, and I got really excited. It is a great piece. Everyone should go and find and read it, but then, I was looking through other stuff that you have written Charles and I found a manifesto for globalization and I thought, “Oh, this is so great.” This was one of the best things I have read in the last six or seven months, I think. I will share a link in the chat once we get to the Q&A, so everyone can find and read it, but I definitely become a big fanboy in the last two months. Even in your most recent project, you are investigating the history of the disease, and the book is called the plague cycle, everyone who is here should read it. This is going to be a great introduction to the ideas, but I think will only be able to scratch the surface, and I think one of the most exciting elements of the book is that Kenny is really a champion for Global Connections or openness in a world that is becoming more and more oriented towards exclusion and being closed off. A glance at his work at the Center for Global development charity[?]. He has done a lot of research on a lot of different important policy issues. I think the plague cycle is best summarized in this quote. The history of infection teaches a particular lesson to those who want to withdraw from International cooperation. If the disease becomes the excuse for closing borders in deploying Force, the cost of global progress will be immense and that is why I am excited to have you here Charles, and once again just before we get started on talking about the book in depth. There is again a chatbox and a Q&A box. If you enter your Q&As in the Q&A section, we will get to them once we turn towards the audience Q&A, but let us get into it. Thanks again, Charles. I think the best place to start is what motivated you to write the book and in particular, what is the motivation behind the title of plaque cycle?
Charles Kenny: Thanks very much for having me and thanks to everybody for joining. It is great to be virtually here. So I have spent a lot of my life in global development. I used to work at the World Bank and I have been at this Think Tank at the center for Global development for the last ten years or so, which is all about thinking through the policies of rich countries and how they affect the developing world and I read a previous book called getting better, which was basically the story over the last fort or fifty years of global development. It is a broadly positive story. Fewer kids dying young, more people going to school, more people living in countries that are broadly democratic, so on and so forth. It was written ten years ago. It would be a slightly more difficult book to write today, but while I was writing it, one of the big and sort of arguable and not stopped by COVID-19 stories over the last forty or fifty years is the decline in premature mortality. If you just look at the risk of a child dying under the age of five, it is about one-fifth of what it was a few decades ago. And there is one big reason for that and it is infectious diseases and so that got me sort of interested in the topic of infectious disease and their decline which got me interested in the topic of their rise in the first place, and so the plague cycle is basically the history of infectious disease from the beginning if you will until now. Obviously, it skips out a fair amount. It is not an encyclopedia, but broadly, that is what it covers. And the reason for the title of the book is because one of the interesting things that you see looking at infection is the patterns of how they come and go, so we are all fairly familiar with the flu cycle if you will. The kind of once every year, we get flu season, one of the small Silver Linings from the last terrible year has been actually we have not seen much of a flu season. It turns out all the things we are doing against COVID-19 stop people getting the flu, so that is sort of yearly cycle and then there are epidemic cycles that go over a few more years than just once so for example, measles through much of history, was a disease that would come and go and the reason it would come and go is that it would arrive, it would infect a lot of people.
Measles is much more infectious than even COVID-19. In fact, to a lot of people, they would either get sick and die, luckily not too many of them, but some of them will get sick and die or they would get sick and get better. If they got better, they would have immunity. Measles needs a lot of people to infect to sort of keep the cycle going and so after a while, it would run out of new victims if you will and then it would disappear and it would find a new civilization, a new set of towns to [inaudible], but when you are born you do not have a natural immunity to measles and so after a few years of new births, measles could come back and attack all of the newborns and so that is the sort of epidemic cycle and that is years or maybe decades. The plague cycle of the title, if you will, is the plague cycle of the disease that we sort of think of when we think of the Black Death, Yersinia pestis, and that I discovered sort of since writing the book that that disease probably first arrived at least in Europe along with the first Horsemen, riding the first horses to appear in Europe, then maybe, reappeared after the next sort of time we know it reappeared was the plague of Justinian which basically ended the Roman Empire and then the famed Black Death of the 14th century which wiped out the third to two-thirds of the population of Europe and then again, in the 19th century, so that is the kind of multi-century cycle of plagues linked in part to how much trade was going on across Eurasia weather patterns, how dense populations were in Europe. And then, there is this final cycle of disease that worries me a bit, which is the first rise start of civilization infectious diseases like density. There are a lot of people living close together and well-connected and early civilization, early agriculture made communities a lot more dense, put a lot more people close together. That was great for infectious diseases, measles that I mentioned earlier did not exist before we had agriculture and trade because there were not large enough communities to sustain it. So a bunch of diseases emerged in the sort of the first year of pandemics, if you will, at the birth of agriculture and civilization. We then spread them worldwide, famously Columbus, and those who came after him spread a lot of Old World diseases to the Americas and killed off eighty to ninety percent of native populations. And then other European explorers spread diseases to Australia and Japan and so on, so the pandemic era continued until pretty much modern medicine and sanitation hit in the 19th and 20th Century and that goes back to where my original interest lie was that after that, we suddenly saw infectious disease drop off a cliff if you will in terms of death rates, but then, there is this fear of a third pandemic age. The second pandemic age, the cycle coming back again because our victories over infection ironically have created a world that is more connected, more dense, more populated than ever before which is perfect for the emergence of new diseases. And so sort of the Ultimate Cycle is if you will is the idea that we might be coming back into an age of great pandemic death. I do not think we will. I think we will manage to [inaudible] the corner. I think COVID-19 is a disaster but is also a wake-up call. I will help make sure that we do not enter a new age of pandemics and we better control it through Global cooperation. That is my hope at least. So that is the reason for the title. If all the cycles appearing from years through decades through centuries through whole epochs around pandemics, and that is what the book is about.
Josh: Right and I think you write in the book that the problem both in 1918, a hundred and two years ago, and today is that it was not that we did not know what to do, is that we did not do it. So when you say that we needed this wake-up call, what kinds of steps should we be taking to build the institutions, to build the state capacity to respond better next time because I read your book is broadly optimistic, but it does have a sort of pessimistic undertone of we are not a question of if it will happen, but when?
Charles: Yes. I think we will see the emergence of more new diseases. I think you are right. And that is because COVID-19 is not the one-off. In the last few decades, we have seen AIDS, we have NIPA, we have seen [inaudible]. The list goes on. We have seen new versions of all diseases too, so antibiotic-resistant plaque is emerging for example, so I think it is a matter of when or if and the question is how we respond. As you say one of the depressing things about COVID-19 is sort of two sides to the story, right? The optimistic side of the story is never before in human history that we developed a vaccine against a disease as rapidly as we did this time. Never before in human history almost certainly will we roll that out as fast as we are going to which is not to say it is fast enough or equitable enough, but compared to the past, if we have gone back forty years, we would not have had any of the technologies involved in the vaccines we have got so far. If we have gone back two hundred years, we never would have been developed a vaccine against COVID-19, so sign of huge progress, but there are all these old techniques which for some reason we keep on forgetting about. One of the fascinating things that happened in the economic field at least in the early-mid part of last year a whole bunch of papers came out about oh look at the 1918 flu pandemic and they tried masks and they tried social distancing and they tried shutting schools, how did that work them and what happened? Research that would have been really useful to have at the start rather than a few months in and a sign of how much we pretty much completely forgot about 1918 and the Lessons Learned, and 1918 was not the first time. The cover of the plague cycle is an allegory of death, picture of death got his Scythe[?], it draws from a picture from a French newspaper in 1911, which we were sort of the cover art of the newspaper talking about an outbreak of the pneumonic plague in Manchuria, which they dealt with using social distancing and masks and travel restrictions and so on.
I mentioned in the book that Marco Polo talks about the Chinese emperor going to a banquet at the Chinese Emperors, they are all wearing masks to keep there, I cannot remember the exact word, effluence, I think of the food. A lot of the Technologies we have used against covid are not new technologies, but we forgot about how to use them properly and it is really depressing that we do seem to forget these lessons. It is interesting that some of the countries that did best against COVID-19 with those that have recently experienced such as the hardest and they put in place in testing and tracking systems for example, and everybody started wearing masks much more quickly and Taiwan and South Korea have controlled COVID-19 much better than us. So we do seem to forget these lessons. I think to ask your question about how do we avoid that next time, we institutionalize stuff. We need at the national level sort of a stronger CDC, if you will, with more capacity to respond at the federal level and put in strict guidance around things like masking and at the international level, we need a much stronger World Health Organization. The best way we could have prevented COVID-19 would have been if we could have really controlled it in Wuhan in China. China bears some of the responsibility for that. It was not open about the problem early on. Maybe because COVID-19 is asymptomatic, it is just too much to expect that anybody could have caught it and dealt with it early enough and it had the sort of the world responded really rapidly at the start and the rest of the world carries the main burden for that including Europe and the United States of America. Had we responded really hard at the start, we could all be in the position that China is in today where there is not much better COVID-19. Maybe many of us could be in the position of New Zealand today where there is no COVID-19 in the country. That would have had a bunch of good effects. We disable the life, but also, we would have stopped these mutations from happening.
Mutations happen in places where there are lots of getting COVID-19 viruses out there going around reproducing that is what leads to mutations occurring. So we could have been in a much better state if we all acted much faster, much harder, and global coordination and cooperation would really help that and so, I hope the lesson for next time is we put in place stronger institutions at the national level to make sure that we can test and trace at scale very rapidly, but also much stronger Global institutions to make sure that every country can do the same.
Josh: I think New Zealand brings up an interesting question about what you think the effectiveness of immigration and travel restrictions are? New Zealand in a unique situation, but what kinds of measures should countries be taking there if we want to have Global Connections and Global institutions to control the spread of what is a global disease, how do we control and manage just the movement of people?
Charles: So my colleague Michael Clements wrote a paper a couple of months ago now that basically looked at past pandemics and how they spread including the 1918 flu. Now, one thing is he said spread about as fastback in 1918 as they do today, which tells you something about the level of international travel we need in order to stop pandemics spreading worldwide. It has to be less than 1918 at least, right? That is a fraction of what we have got today. We are talking about stopping most travel that happens, eighty to ninety of the travel that happens today, and finally, I can go back further than 1918 to give you an example. Columbus brought back syphilis from the new world on three small caravels and probably did not [inaudible] three. His Shipmates then spread it around Europe fairly rapidly and it spread on through Asia. Some of his Shipmates either ended up on or had friends who ended up on Vasco de Gama ship that went around Africa and found the sea route to India and India got syphilis very quickly. Thanks to Vasco da Gama’s Shipmates. So you need sort of one caravel worth of globalization, if you will, to spread diseases worldwide, so travel bans or travel restrictions as a permanent measure against infectious disease are just not plausible. Travel restrictions immediately after a new pandemic appear sometimes have a role. Now, I mentioned the problem of the asymptomatic nature of COVID-19 in a lot of cases. That is one reason why we think there was COVID-19 in the US months before any talk of travel restrictions from the US government and the same in France and the same in Italy. This disease had already spread way before anybody thought of putting in travel restrictions. Those travel restrictions were then put in a really silly way. As I say in order to have travel restrictions be really effective, you effectively have to move back to pre-Columbian times. You have to move back to zero caravels or allowed to travel. Instead, what governments did was I said, well, we are going to kind of restrict travel, of course, if you are a citizen, you can come back in and exceptions this, exceptions that, exceptions the other.
By the way, we are going to put them in place in a few day’s time. The only thing that did was made a whole load of people go up, better to get home now and massively crowded airports leading to hugely long delays getting through customs and so on. Lots of people crowded around together for hours and hours inside the very last thing you wanted during a pandemic and maybe one of the reasons that New York was hit so hard so early was that JFK in New York was packed out for hours and hours at the time in the day sort of immediately around the announcement of the travel ban, but there are exceptions New Zealand which is where your question started has controlled domestic spread. There is none. The only way it is going to come in is if somebody flies in with it and so having quarantines and multiple testing before somebody who wants to come to New Zealand is allowed into the country makes complete sense to me and I fully support it and the same with Taiwan but most of the world is just so far away from anywhere near that level of control that travel bans just simply do not make much sense. And of course, New Zealand is going to face a choice at some point. I hope not immediately but in eight months twelve months, hopefully by then, a lot of the world have been vaccinated and a lot of New Zealanders will have been vaccinated. It is going to have to open back up. New Zealand is by no means a society that can live without international trade and commerce, not least. It relies heavily on tourism, but obviously, imports a huge amount of stuff. It exports a huge amount of produce as well. It needs globalization in order to have a high quality of life. So it is just not sustainable to cut off all travel forever and at some point, when the risk from covid has gone down because of spreading vaccination programs, they are going to open back up.
Josh: Related to that about the arguments for repatriating supply chains bringing them back into the US or into the individual country it is. I think your New Zealand example gets to the core of this but is that going to be a way for Nations to support their own National Defense or resiliency in the next pandemic?
Charles: So it is irrelevant to most countries. A lot of countries around the world simply do not for example have a domestic pharmaceutical industry and it would be ridiculous for them to try and set up the entire chain of manufacturing that you need in order to create a pharmaceutical industry because their domestic demand is so small, it would lead to massively expensive drugs and just is not plausible. Now, for some countries, the US, the UK, Germany, so on, it is a plausible option, it would make things more expensive, but at least sort of you can imagine it working in theory. My problem with it is it would have the opposite effect from what we want. What we want is for supplies to be more robust and to be enough during a pandemic. Pandemics close things down, so if you suddenly have a pandemic in a country and all of your supply comes from that country you are in trouble. That is actually sort of what started all of this. A lot of our supplies came from China. China was shutting down factories because they had a pandemic and that led to shortages here. Well, you may have noticed, we had a pandemic in the United States as well. If all of our supplies have been coming from the United States, we would have faced exactly the same problem. So what this speaks to is not that you want to repatriate your supply chains, you want to diversify your supply chains. You do not want to be relying on just one country with just one Factory. You want to have multiple factories in multiple countries that you can draw from and that way, you are sort of robust to pandemic outbreaks and also, if there is an earthquake, you robust[?] too that, you are robust[?]in that natural disaster. And so it seems to me that the idea of gosh we have got to think about our medicine Supply chains and PPE supply chain and so on is absolutely right and we were too reliant on too few suppliers and did not have spare capacity, so you can write me thinking about the problem. The proposed solution of re sure everything would make things worse not better.
Josh: A related question to this is how we deal with the exclusion Instinct that you discuss in the book because even before the COVID-19 pandemic you had representatives writing to the CDC saying illegal immigrants are bringing disease. This is a big problem. Throughout history, it is often minority groups or whatever the country experiencing the pandemic does not like gets blamed for the onset of the disease. So you talk in the book about exclusion was originally an effective strategy when we did not have other options, but now, how do we deal with that deep-rooted historical Legacy of exclusion?
Charles: But as you say the book sort of packed full of horrible examples of the other being treated terribly as a result of infection. It starts with the other ape. Apes actually do keep strangers out of their communities for a couple of weeks before admitting them. Partially, we think on the grounds of sort of it is a quarantine system if you will and make sure that they are not sick but sort of far worse than that is what humans do to each other from programs during the black deaths against Jewish populations who supposedly cause the Black Death by poisoning Wells and idea that goes back to the plague of Athens where the Athenians were blaming the Persians having done the same thing, sort of ridiculous and repeated through history the same lies about what the other has done and when it comes to US Immigration policy banning anybody with AIDS coming in at least was sort of on the plus side, I guess was actually aimed at the disease rather than an ethnic group, but was still just an immensely damaging act both for US National Security, but also obviously for the people involved. So it is repeated through history. As you point out, there is some method behind the madness which is to say people from other places quite often do have diseases you have not experienced before. Remind you again of Columbus. So, that is fair enough and two if you find somebody is diseased staying away from them or keeping them away from you. If it is an infectious disease that you know spreads through touch or contact or aerosol, that makes sense, and the six feet rule for COVID-19 makes sense. So there is some reason behind parts of this, but today, two things or three, one is it should be definitely about staying away from sick people rather than groups you consider sick. That is just crazy and so we want our measures to be colorblind if you will and apply to all equally not Mexican immigrants, not in particular ethnic groups and secondly, it just does not make sense really to think of exclusion at Borders or think of exclusion more at Borders than other places. The risk of somebody from one side of the Border compared to the risk of somebody from the other side of the border usually is about the same, so you got to think about what sort of the right level of exclusion is. Isolating the sick individual makes an immense amount of sense, sometimes isolating a community where you think that is the only place of disease is make sense. Rarely, once you have got to the level of a country, it is usually too late and it does not make any sense.
Josh: This reminds me or makes me think of vaccine skeptical communities. What are the right steps forward to make sure that our vaccine reaches as many people as possible? I think vaccines are as your book demonstrates have been powerful ways to extend life spans and save people from untold suffering, but how do we make sure that they reach people who are eligible to get them and get them as fast as possible.
Charles: So the vaccines save millions of lives each year. We wiped out smallpox a disease that killed hundreds of Millions last century and the centuries before. We wiped it out worldwide using vaccines. They are an immensely powerful tool. The parents and people who refuse to get their kids vaccinated or to get vaccinated themselves. I feel sorry for them. Some of them have better reasons than others for their doubts. There is a fairly ugly Colonial history of unsafe vaccination campaigns, for example, using the same needle to vaccinate thousands of people without cleaning it between each vaccination. That is a fantastic way to spread infection. Not stop it. The CIA used vaccine campaigns to try and get intelligence on Osama Bin Laden not surprisingly which made Taliban supporters a little bit skeptical of vaccinations. So, some groups have more or less reason for their vaccine skepticism. In the case of Covid-19, I think it will go down as more and more people get the vaccine and do not get sick from COVID-19 and do not get sick from the vaccination. I should note that some people do have a pretty rough day after the second dose and we should be careful. To be honest about the fact that this may not be a pain-free experience getting the vaccine but it seems to be remarkably safe. So I do think to some extent this is a matter of time as people see that it would be more effective. I do think there is some rule for coercion. I am in favor of rules that say you cannot send your kid to the school with my kid unless your kid is vaccinated. I am amazed at the moment US Navy seems to get enough vaccines to vaccinate at least the crews on aircraft carriers and is saying yes, but it is up to you whether you want to take it or not. That is an interesting move from a national security perspective. I would have thought that you would be telling soldiers to take it and they [inaudible] take it, but there we are. I also think that doctors who spread lies about vaccine efficacy and vaccine safety should be struck off and one of the sorts of the terrible things we have seen in the last few years is doctors sort of pandering to the fears of some of their patients and saying well, I do not actually have any evidence or the statement but because my patients are uncomfortable, I am going to say it is absolutely fine not to take vaccines that is just irresponsible medical practice and those doctors should be struck off. So it is sort of a combination of approaches. I do not think it works to shame those people who do not want to take vaccines. Again, we are not in their heads. We do not know what they are thinking. So sort of morally it is probably wrong to [inaudible] I think they get worse. So I think it needs to be about persuasion and demonstration for individuals backed up with some coercion when it comes to the doctors and to public spaces like schools and hospitals and aircraft carriers.
Josh: I think the development of the vaccine is an example of the kind of connections and the benefits of connections. So I would love to hear you kind of talked about how the vaccine was developed and how policy can contribute to making sure we get the right vaccines quickly in the next pandemic as well.
Charles: And we should have done better. But the reason we did as well as we did with COVID-19 was largely about Global Connections, the genetic code of COVID-19 itself was sort of disentangled by Chinese researchers and spread worldwide within weeks of the outbreak. How to make them that information was shared worldwide from China and South Korea very early on in the pandemic and we all benefited from it. The World Health Organization around a whole bunch of different Trials of treatments taking advantage of the fact that it is much easier to find out if something works when you test it on a hundred thousand people than it is on ten. So taking advantage of global scale to try and get the results as quickly as possible. The vaccines themselves, I mean, so the Pfizer vaccine was sort of research and created by Turkish immigrants living in Germany. And Pfizer itself is a US company that is run by a Greek CEO, you can’t sort of make it more obvious how important globalization is to the speed of our response. I could tell you a similar story about Moderna. I could tell you exactly the same story pretty much about the first Ebola vaccine. These are multi-country efforts. They are multi-country in the research, they are multi-country in the development and they are multi-country in the testing and it makes it faster and better. So it really is a story of Global Connections mattering a huge amount and it is why I think our responses to pandemics seemed vaccine nationalism cannot be, National responses, we really have to think globally.
Josh: I think, on one hand, Global Connections are sharpening our tools to fight the next pandemic, but you also write about how we are blunting those same tools like antibiotics by overuse and what kinds of policy responses do we need to make sure that we have more antibiotics that are more effective and that we are not overusing them to the point where we end up in the next pandemic without antibiotics.
Charles: I read [inaudible] the other day you said the next pandemic has already started and it is the pandemic of antibiotic resistance, I think there is something to that. It is already killing tens of thousands of people a year. By 2050, one prediction is that we are killing ten million people a year unless we do something about it and it is a complex problem that needs multiple things to address, not least more research into new antibiotics and there is a big role for government and international collaboration on that but also much more careful use. A lot if not the majority of antibiotics given to humans each year are given for conditions the antibiotic will not cure and that is because people self-prescribe for a cold as it might be. It is the doctors here a bunch of symptoms and goes, well, that could be a bacteria, so let us give him an antibiotic because at least we will get them out the door and they will stop bothering me. All sorts of reasons why we miss prescribed a whole lot. Add into that the fact that there is a burgeoning global animal population in factory farms that is regularly given small doses of antibiotics to help the growth and actually that is where eighty to ninety percent of the world’s antibiotics go. So it is not to humans. It is to livestock and feeding animals a low dose of antibiotics in a really crowded environment is a fantastic way to allow bacteria to evolve into a version that is antibiotic resistant and then spread around a bunch of other farm animals because they are all right there. So you sell on factory farm at low doses is just a really scary thing and is happening more and more as the world gets richer and eat more meat and so we have to think about how we are going to respond to this problem and there are a bunch of different parts to it there is more search into new antibiotics. There are better rules around a prescription for humans. There is limiting the kind of antibiotics that can be used on farms and the way they can be used. So let us keep some antibiotics just for humans. Thank you very much. And let us make sure that the antibiotics used on farms are not used at low doses for growth promotion and reduce their use overall by improving sanitation. That is true for humans, too. A big reason we use antibiotics is because sanitary approaches are not doing the job properly and so people are getting infections that they would not get if the community they lived in was a bit cleaner and so good old-fashioned, plumbed toilets are a big part of the story here as well. And I would love to see more support for that as well.
Josh: Excellent. One of the questions I wanted to ask as well as you talk about the sanitation revolution and the medical revolution which do you think is more important? It sounds a little bit like sanitation is something we should work on even more or is it something we need both sanitation and increased medical?
Charles: So back to your point about anti-vaxxers, one of the things that anti-vaxxers point to when they say vaccines do not work, we do not need them is in the UK and the US most of the decline in measles deaths for example happened way before there was a measles vaccine, not way before, decades before there was a measles vaccine and the reason is that actually, another approach has really helped reduce the toll from measles including in better sanitation. And so in the rich world, I think it is fair to say that sanitation did a lot of the work. I would not want to put an exact proportion on it, but a lot and then vaccinations came along and a lot more, as did antibiotics and other medical responses. In the developing world, a bunch of places that simply do not have decent sanitary systems and pardon me but shit in a bag and throw it over the wall is kind of the standard in some slums in poor developing countries and they are still seeing much much much lower death rates than we saw in Europe in the last century or we saw in those countries a few decades ago and that the story really is a medical story, so [inaudible] modern medicine, but it cannot and should not stand alone. The death rates from these diseases are still higher in poor developing countries, and they are in rich countries and will remain higher until we also have the sanitary responses alongside. So it cannot be a story of either-or, it has to be a story about having the medical responses is great, but it would be even better, much better to have the sanitary responses as well, but they are expensive, it is expensive to dig big holes in streets and lay down piping and have all the back end system of sewage treatment and water filtration and so on. It is a really complicated engineering challenge and an expensive one made more complicated by who owns the land and so on and so forth. So it is a really expensive endeavor, but it is one that has big benefits to people in developing countries. Obviously, it is a quality of life issue amongst other things, but it also has big global benefits. We reduce the chance that a new infection will spread worldwide if we improve Global Sanitation, and so it is another place where it really makes sense to have a global response to this problem.
Josh: I think we should move already some Q&A from the audience. We have got I think a really interesting question. How is disinformation around Public Health in this pandemic compared to past contagions? Social media is a newer aspect, but it certainly is not the only iteration of Word of Mouth that is always present.
Charles: Missed information has been a common thread through pandemics. If you go back to the Black Death ask your medical expert of choice and they might say that it was to do with Saturn and Mercury being in alignment. A lot of them would talk about my asthma the fact that it was dirty air, unclean air that was causing the plague. Wiser people would point out that those who ran away to the countryside deemed to survive better. There were empiricists out there who were following the evidence a bit but most of history has involved the wrong call on what caused infectious disease and so we actually have too much evidence on how much more widespread misinformation is now than it was in the past where we knew what we were talking about because we [inaudible] had sort of a hundred and twenty, hundred and fifty years of that time and I would struggle to find a case, I think, where there was not at least some misinformation around and again that is partially for good reasons though. Take the COVID-19 outbreak. There is still a lot, we do not fully understand about transmission and certainly about treatment and there was a lot more that we did not understand back at the start. The whole argument over wearing masks, there were some people from the beginning saying everybody should wear masks. There were people of Goodwill pointing out that there was not any evidence that masks worked. There is some suspicion that there were people of Goodwill saying there is no evidence that masks work and you should not wear them, but the real reason they were saying that was because they wanted to keep the masks for the health workers. The noble lie if you will and if there were people doing that I think that is unfortunate, but it is true, we just did not know in this case where the mask work. Looking back and I was not saying this nearly as strongly as the time as I am about to say it looking back really what we should have said was there is no strong evidence that mass will work on the other hand the downside of wearing a mask is fairly small and if they do work, the upside is pretty big and we probably should have been more in that space than at least I was. I was a somewhat early mask proponent, but certainly, not shouting from the rooftops. So, there really is just a lot we do not know and in any space where there is a lot we do not but we are really desperate for answers. We are going to get this information. So it is not you, it has been a constant. If I was to say something positive about COVID-19, I think the amount of harm done by really damaging and really horrible explanations has been less this time than in the past. If you take the plague outbreak in the late 19th century in San Francisco where it was Asian, it was being blamed on the Chinese, and the Chinese American community in San Francisco was treated abominably including having an unreliable plague vaccine stuck in their arms whether they liked it or not. There has been less of that this time than in the past, so in that way, we are doing better. Maybe there has been a bit more of the anti-vaccine because it is in the air but it would be hard to say that it is a lot worse this time than ever before. It is bad this time and it has cost lives and it is terrible, but I am afraid to say it seems to be just a feature of pandemics.
Josh: You have written a lot about the decline of American power and I think this next question relates to China. So I think you are well suited to answer this one as well as what is your biggest concern with respect to infectious diseases in the coming age of international power bouncing between the US and China.
Charles: Lack of coordination I think is probably the short answer to that. What gives me hope is that the eradication of smallpox involved the US and the USSR as it then was working together with the WHO. USSR provided all the vaccines. US did too along with a lot of coordination and the CDC and so it was kind of a joint Global effort even at the height of the Cold War so we have a historical example of the sort of great power rivalry not getting in the way of an effective response to infection and I hope we live up to that. I wish China had been more open at the start and I have not looked at in detail at the latest who report out of China, but I hope it is honest and reflects open access. I do not think that was the big reason for the global spared. I think that maybe a little weak to our reaction time compared to the six weeks where basically the US and Europe and the Americas just sat around and did nothing, so it do not think it was a big part of the reason for our slow response, but it was a factor and I do not think the US or China has done particularly well at thinking globally about vaccines. In the US it has been very much about vaccines for us and we will worry about the rest of the world later. China is actually giving out vaccines to the rest of the world, but there are worries about its efficacy partially because the medical trial results have not been properly published and so both sides are not doing as well as they could in this and I hope that the international coordination, the Who and so on does not get caught up in these increased tensions. As I say, there is a historical precedent for it, not so much and I hope this is another case. If you listen to the Biden Administration more generally and the way it talks about relations with China, there does seem to be some understanding of that kind of concept, for example, when they talk about climate change and of course, there has to be international corporation involving China with climate change because now China [inaudible] more than the United States does. We are not going to solve the climate problem without China. So, on this, we will work together and so I hope and I believe that the same kind of language will be applied to pandemic preparedness, I hope.
Josh: This is a question from one of our students, Lucy. I think it is a really interesting one more about the public policy response within the US and probably for the other countries, what can be done to stop the poor from falling behind while still doing what is necessary to stop the spread of disease?
Charles: I think you would help the poor get ahead of you to stop the spread of disease if you will, so I think this is an area where it is just so blatantly obviously clear that we live on a connected planet and the problems of one of us is a problem of all of us and the way you reduce the risk of pandemics and merging or spreading is in part making sure that every country has a surveillance capacity, the ability to isolate patients, basic Medical Care, proper respect for antibiotics, improved sanitation, the list goes on and if you got the world all of that, you would make the very poorest on the world much better off than they are right now and so I think part of the solution here is greater support for the for low-income communities. I hope we see that there is not much sign yet we are going to if you look at Global Aid flows, they are going down not up for example, so I worry our response will be sort of to narrowly targeted that they will be lots of support for pandemic surveillance and none for sanitation. I guess that is better than most support for either but it is a very partial view of the problem.
Josh: This is another interesting question I had like a lot, infectious disease has been around as long as trade and travel, so why you think we find pandemics so much more forgivable than other disasters as you mentioned mask-wearing and social distancing are new, but we did forget about them a little bit?
Charles: That is a great question. I think that that happened actually been all that many, all that terrible pandemics in recent decades. I mean COVID-19 has killed way more people than it should and has killed a lot of people you would only have to go back to the 1920s or 1930s in the United States for two million Americans dying which was the start of the COVID-19 epidemic, there was some fear that the pandemic, there were estimates that if the United States did not think two million will die, far too many are going to die, but we hope not two million that would have brought the US Death rate from COVID-19 back to the sort of an average infectious death rate for the 1920s 1930s in the United States and that is how much progress we have made and so it is a sign of how much less frequent pandemics have got and we had the experience of Ebola reasonably recently where everybody in the United States got incredibly scared about Ebola with really not much in the way of good reason. I mean a horrible disease and had terrible effects in West Africa was never going to be a big threat in the United States, but at one point, I think it was said in the list of sort of health concerns of United States. It went heart disease Strokes Ebola, that is crazy, and because it turned out that we massively overreacted to the threat of Ebola in the United States. I wonder if I did not make the problem even worse is like “Oh, well, now we know, the pandemic is not an issue for us, look at Ebola,” and so we got even more relaxed than we might have been. So if you sort of add together the distance since the last time there was a really bad pandemic in the United States, which is sort of a hundred years-ish to the fact that the last time we were really worried about a pandemic nothing happened. Maybe that lured us into a particularly false sense of security and I mean, I guess the one more thing I would add is it is actually reasonably strong and about everybody on this Zoom has heard of the black death, for example, there is sort of some shared sense of oh terrible infection, but I think it is very much a historical sense as that happened in the bad old days, maybe again the Silver Lining COVID-19. We will not be thinking that anymore.
Josh: We are down to just the last few minutes, so-
Charles: It is all right.
Josh: I am really excited. Thank you again so much. I think a really great way to end would be what signs do you see for optimism and what signs do you see for concerns that we should be spreading optimism as a way to make sure that we also start tackling those areas of concern?
Charles: Thank you and sorry if I by blathering on too long the questions are not[?] answered. I am broadly an optimistic person, so let me start off with pessimism. Back ten years ago, I used to pretty much year-on-year write a piece for the Atlantic or the Washington Post or somewhere titled this is the best year in human history. And it used to be the gift that kept on giving because every year poverty would go down, premature mortality would go down, the trends on democracy were positive, literacy rates were improving, you name it things were looking at, you could not write that column about this last year. However, you tried to [inaudible] the data. It was a grim and horrible year, but not just a grim and horrible year, it had come after about a five to a ten-year span of basically backsliding global democracy. The most optimistic take is we have plateaued on the level of global democracy. I think you can definitely make the case for worse than that. If you look at climate and our response to it, it has been fairly grim, and then when you add on COVID-19 and it is terrible impacts not just in health, but on the global economy, it has been a grim period and I do not think we are going to bounce back. I hope we bounced back from the health effect fairly quickly. And I think we are going to bounce back from the economic effects for longer and that is in part because a lot of businesses have gone away forever and it takes time to start new businesses, but it is also because a lot of connections that would have happened just are not going to happen. Even if you just think about how much global trade and innovation is based on the sort of serendipitous meeting of people. All of which pretty much stopped last year that is going to be connections lost forever. And so I worry that it is going to be a drag on the global economy for a decade or more. There is the misery.
Charles: Now, the positivity. Covid-19 shifted our progress on extreme poverty, total ninety-day poverty back five or six years on global health, six or seven years. This massive terrible Global pandemic was only equal to sort of six or seven years worth of the progress we have been making. We have been on a pretty good run and I do not think there is a reason to think it will stop. I have just given you a reason to say it might slow down. It may take a bit of time to get back, but I do not think there is any reason to think it is going to stop. 2019 may also be the year where we max out Global carbon dioxide emissions. We need to do a lot better than just plateauing. Obviously, we need to drop them very rapidly to avoid climate change, and we are making progress on that. Covid-19 also is going I hope to lead in a much better preparedness against the risk of pandemics. I do not think there is a reason to think that we will not continue seeing the sort of global progress we have seen for the last few decades forward into the future. And if so, the world is going to be a better and better place.
Josh: Thanks again. Let me share really quickly a Manifest of globalization in the general chat because it is a great essay. I think everyone ought to read it and as well, the book is another great read that everyone should take some time to delve into like I said I learned a lot and I think you are right. There is this great optimistic story we can tell out of the story of COVID-19 for the long run even as much of a dumpster fire year is 2020 was for everyone, but thank you again, Charles. I do not know if you have any last thoughts you want to share with everyone, but I really appreciate your time today.
Charles: Thanks so much for having me. I hope it was in interest and good luck also getting somewhat closer back to normal soon.
Josh: Thank you again. Thanks to everyone for joining us.