With a week’s post-thesis holiday in Cornwall, I finally got round to reading Frank Snowden's Epidemics and Society. I found it absolutely gripping. A few things stand out for me from the historical experience (short thread)

1. Social stigmas tend to be greater when a disease is seen as “foreign” (eg plague) or affecting poor (cholera) or marginalised (HIV/AIDS) parts of society, compared to those that have been around for time (smallpox) or that affect elites (polio). Stigmas drive further spread

2. There’s a fascinating account of TB's transition from socially acceptable, even fashionable, to disgusting and stigmatising, that occurred with greater understanding of its infectiousness and as middle and upper classes adapted their behaviours to reduce infection.

2b. However, judgemental attitudes often reinforced existing social prejudices, not necessarily focused on the behaviours that contribute most to infection

3. The 2014 ebola outbreak makes especially clear the role of habitat destruction in epidemic risk: palm oil plantations destroyed West African rainforest, forcing infected bats to relocate into people's gardens, where their droppings caused infection.

4. Microbes occupy the ecological niches that society creates for them. Magic bullet solutions such as vaccines can only work when the poverty and inequality that enable infection are also tackled

4b. Thus the eradication of malaria in Sardinia in the 40s/50s owed as much to economic improvements and public education as to mass use of DDT, hence when the US-led purely-technological strategy was internationalised, it failed

4c. Imposed by governmental elites, counter-disease efforts are often interpreted as mechanisms of social control, or as conspiracies to infect, poison or dispossess. The social, economic and political dimensions are as important as the scientific and medical

5. In summary, we have a global economic system that enables infectious disease.

5a. First, it drives people and wildlife closer by physical expansion in one direction and habitat destruction in the other, enabling diseases to cross the species boundary. Second, by widening inequalities, it makes communities vulnerable to human-to-human infection.

5b. Third, it incentivises governments to cover up outbreaks, for fear of spooking investors, thereby allowing contagion to spread unopposed. And finally, globalisation rapidly converts local outbreaks and national epidemics into global pandemics

So big thanks to Frank Snowden of @yale_history, I learned a lot!