Society and disease: Lessons on pandemic from the pages of history
While doing research as an undergraduate in Australia during the late-1970s, Naomi Rogers stumbled upon some dusty volumes of the British Medical Journal in her university’s medical library. They hadn’t been used in a very long time, but for Rogers — who was searching for debates, from the 1870s and 1880s, about whether women should be admitted to medical schools — there was something “magical” in those pages. At the time torn between a career in music or history, she began to lean toward life as a historian.
Since joining the Yale faculty full time in 2001, Rogers has taught the history of medicine, specializing in disease and public health, gender and health, disability, feminist activism, and alternative medicine. Named a full professor in 2015, she has written about epidemic polio in two of her books, “Dirt and Disease: Polio Before FDR” and “Polio Wars: Sister Kenny and the Golden Age of American Medicine,” and is now working on a book that examines health activism since 1945.
During the COVID-19 pandemic, Rogers, professor in the history of medicine and history in the Faculty of Arts and Sciences, has been called upon by the media and others to offer a historical perspective on epidemics, public health, science, and medicine. She recently spoke with YaleNews about what past epidemics can teach us about the present crisis, what the pandemic has taught her as a historian, and how a rise in misinformation and anti-science sentiments during a public health emergency is nothing new.
The conversation has been edited and condensed.
You began your career as a historian of medicine just as the AIDS crisis was unfolding. Do you see any parallels between our experience of COVID-19 and AIDS?
I approach that question with humility, because I remember that many senior colleagues of mine in the 1980s were called upon by reporters to talk about AIDS. Then, we hadn’t had much time to bring a more nuanced understanding of what a pandemic means in its particular time, and there were a lot of things we historians of medicine got wrong. While we understood some of the big issues around AIDS, such as discrimination and inadequate public health messaging, the constant hope all the way through the 1980s was that there would be a vaccine in just a couple of months. In many ways, when I look back on my dissertation, which sought to link the 1916 polio epidemic to our experience with AIDS, it was incredibly short-sighted, and much of it hasn’t stood the test of time.
I do think this is a very different pandemic to be living through. AIDS was never seen as something that could harm everybody. It was seen as a targeted disease, even as a punishment for particular kinds of behavior by certain kinds of people, mostly gay people.
As a historian, it has been interesting to watch how we are dealing with a disease where it’s clear that anybody is a potential spreader and anybody is potentially vulnerable. It has profound implications for personal behavior changes. While AIDS also resulted in personal behavior changes, the disease was first really understood by the gay community, and also sex workers, as one that required behavior changes — safer sex through the use of condoms.
Was community fear as widespread during the polio epidemic as it has been with COVID?
Polio was mainly viewed as a children’s disease, but that, of course, meant that every parent was concerned as well. It was a frightening community problem because nobody knew how it spread or who might be infected with the virus. Children who developed paralysis sometimes got better. But sometimes they didn’t, and there was no way to predict that.
There were desperate efforts to come up with ways to protect the community. Even though public health professionals had been saying for years that polio is not spread by insects like mosquitoes, during the 1950s a lot of communities, including New Haven, paid for DDT spraying. It was a just-in-case kind of measure.
A particular challenge during the COVID pandemic is a disagreement about science itself, as we’ve seen with anti-science messaging, misinformation, or a lack of trust in scientific research. Is this something new?
No, it’s not. It’s actually something I’ve always been interested in, the sort of diverse, sometimes contradictory ways that people have sought to explain what’s happening and, in some ways, disagree with the public health and science guidance.
Recently in the United States and in some other countries, public health officials have not been speaking with one voice. I’m struck, for example, by how all the television networks have three or four medical consultants. Why do we have several on every network?
For many decades, especially after the 1918 flu epidemic, the public health establishment believed it had come up with really effective ways to educate people about the importance of public hygiene, personal hygiene, and, in the case of emerging vaccines, what was and was not a safe drug. But during the polio vaccine development in the 1950s, there was a reemergence of an anti-vaccine movement which we’d seen in the 19th century. There was an argument that while polio might be spread by a virus, it wasn’t why so many children were being paralyzed. Other explanations were given, the most popular being that parents were feeding their children too much sugar, salt, and soda, leading to poor nutrition. Poor nutrition was seen as the cause of the body’s vulnerability, and so the polio virus or any other virus, it was thought, was much more likely to make children very sick.
In the case of COVID-19, many people are hesitant about the vaccines because of how swiftly they were developed. How do public health officials convince people of a vaccine’s benefit?
What people mostly fear is that the vaccines were produced in a rushed period of time; they are afraid that scientists were influenced by outside forces to falsely say that this vaccine is safe or safe enough. But it should be pointed out that this vaccine was developed by research groups that have been working on coronaviruses for many years and have well-honed skills in DNA-type vaccine production. We are building on well-established methods, ones that are not new.
Does history teach us anything about how to sway anti-vaxxers?
People used to think that anti-vaxxers were ignorant, perhaps uneducated and out of touch, and that what they needed were helpful educational programs that would show them how wrong they are. We know now that’s naïve, and you don’t talk to people who disagree with you by patronizing them. I don’t know that we have quite figured out the best ways to reach anti-vax communities, because they are so diverse. You can’t design a one-size-fits-all educational project and imagine that you are going to reach everyone.
In the last 20 years, one of the things the public health establishment did extremely effectively was to make vaccinations part of a structural default system, rather than asking people if it would be okay to vaccinate their children or themselves. For example, you can’t send your children to public school if they haven’t been vaccinated. Because of this structural system, it was unusual for parents to refuse. In the future I would be amazed to hear if many schools would be willing to admit children not vaccinated against COVID.
Has the pandemic raised new questions for you as a historian?
I’ve had a number of questions about the logistics of the polio vaccine rollout in the 1950s and 1960s. I know almost nothing about the logistics, because historians have not been asked that question. Some historians are beginning research on the history of contact tracing, which we also don’t really know very much about.
The pandemic has forced me in particular to be an adviser and mentor familiar with online primary and secondary materials, which the Yale undergraduates I’m advising are using to write their senior essays. I now have to beef up my understanding of the kinds of sources available to them, how they search for them, and what they might be able to find or not find. That’s a whole kind of teaching I’ve never done before.
Has COVID brought greater attention to the value of history of medicine and science as an academic field?
One of the things that has greatly heartened me is that there is now a wider recognition that thinking about science and medicine from a humanities point of view is not just a kind of luxury but a valuable resource. We are lucky here at Yale to have a vibrant group of scholars who’ve been exploring the history of medicine and science. We need humanities people to answer “Where does our disgreement over the response to COVID come from? Did it exist before or was it invented by COVID? What is the relationship between disease and racial disparities?” These are big questions that some of us have been addressing for many years.