THE POLITICIZATION OF COVID-19 — JUST LIKE EVERY OTHER DISEASE
By Vincent Lyn
What Yellow fever aboard a ship 176 years ago can tell us about COVID-19 today.
On February 22nd, 1845 the HMS Eclair, a British naval steamer tasked with interrupting the slave trade along the western coast of Africa, made port in Freetown, Sierra Leone. Though the crew left England with a clean bill of health, by the time the Eclair made it home in late September 1845, more than two-thirds of the original crew of 146 had died of yellow fever. While mortality rates onboard naval vessels of the 19th century were known to exceed 50 percent, the story of the Eclair rocked the British papers and embroiled the international medical and political classes.
In fact, this early incident may help explain some of the political conversation around the Ebola outbreak, the low point of a notably depressing election cycle. On December 10th, 2014 the WHO reported that infection rates in Sierra Leone had surpassed those in Liberia; the total number of cases in Liberia was more than 7,800, but Sierra Leone had about 9,200 as of December 29th. The outbreak was so severe that government officials called to “cancel” Christmas and New Year’s celebrations. The military were restricting the congregation of family and friends as well as travel to and from the capital. The U.K., which provided most of the international aid to Sierra Leone, engaged in a kind of delayed pantomime of American overreactions to Ebola: It rolled out its own version of opaque and extraneous quarantine restrictions for returning healthcare workers.
In Liberia, where the situation slowly improved, fears about the disease’s contagiousness led to a kind of quarantine of politics. Elections originally scheduled for early October were continually postponed until December 20th, 2014 which resulted in a severely depressed turnout. In a nation where years of civil war had deeply undermined trust in government and its institutions, some worried a constitutional crisis would be one of Ebola’s deadliest symptoms. Decrying the politicization of Ebola is noble and natural, but it’s mistaken. Disease and responses to disease are always politicized and always have political consequences. This is an opportunity to better understand the political history of science and, in the case of the Ebola, a colonial legacy that continues today. The Eclair case may help; after all, those who forget the past are condemned to repeat it — isn’t that how the saying goes?
The Eclair first grabbed headlines in England because it was placed in quarantine — something that struck contemporaries as draconian, punishing those who had already suffered the outrages of disease. British port authorities restricted the remaining crew members to the ship, where the sailors continued to die of yellow fever. As the death toll climbed, the crowded and unsanitary conditions of quarantine sparked public outrage. The press demanded a cessation of the quarantine, hailing the survivors as heroes. Eventually the naval authorities buckled under the public pressure and permitted the crew to undergo quarantine in more comfortable quarters on land.
The affair of the Eclair stirred more than just British domestic sentiments. It also sparked two interrelated disputes around international quarantine law and the science of contagion. The outbreak hadn’t been limited only to the Eclair’s crew: The ship had visited the island Boa Vista, a Portuguese colony, and was likely responsible for spreading yellow fever among the island’s inhabitants. By the time the Eclair arrived back in England, yellow fever had reached epidemic levels on Boa Vista. Ultimately, it killed perhaps a third of the local population.
The Portuguese government was furious with what it saw as British negligence. For years, major European powers had tried, and failed, to reach some kind of agreement concerning quarantine measures. In many cases, nations instituted quarantine on the basis of rumors, and the lack of clear international law made quarantine a dirty tactic in colonial commerce. By imposing long and unnecessary quarantines on foreign vessels, nations could impede rivals’ trade. The absence of international agreements on infectious diseases carried from port to port by sailors — illnesses like plague, cholera, and yellow fever — meant that more episodes like that of the Eclair were inevitable.
As if that weren’t enough, there were scientific disputes about the evidence supporting quarantine. In the case of the Eclair, the British government quickly convened an epidemiological committee to investigate the outbreak and the spread of the disease. While the panel managed to smooth over relations with Portugal, it opened a new battleground for two hardboiled medical minds: Sir William Pym and Dr. Alexander Bryson.
At the time, it was widely accepted that remittent malarial fevers — the “marsh miasmata” — were endemic to the coastal regions of Western Africa (and the Caribbean colonies). It was common knowledge that European mariners serving in the colonies could easily catch such diseases. But for Pym and Bryson, the crux of the disagreement between was scientific: Was the yellow fever a severer form of the usual fevers, caused by climate and cleanliness, or was it a separate and highly contagious disease altogether?
Pym had served as a naval surgeon, and headed the British investigation into the outbreak at Boa Vista. He wrote passionately to Parliament about the contagious nature of yellow fever, favoring stringent and mandatory quarantine policies for vessels arriving from ports known to be infected by plague, cholera, and yellow fever. He lauded the British authorities for the unpopular decision of quarantining the Eclair — calling it a victory for public health. This landed him in the crosshairs of Bryson, an energetic Scottish physician and president of the Royal Philosophical Society of Edinburgh. Bryson squared off against Pym and his circle, arguing stridently for the environmental and conditional causes of the disease in medical journals.
Contagionists like Pym formed part of the establishment which wanted an international quarantine law, notes medical historian Mark Harrison. Bryson, and other “anti-contagion” reformers, derided the science of quarantine as “old-fashioned,” “superstitious” and even “Papist” (a British byword for the backward and ritualistic mentality of Continental Catholics). The idea that contagion was not spread through ships was especially appealing to maritime capitalists who saw quarantine laws as an obstacle to the easy movement of goods and cash. These merchants were sympathetic to the medical theory that disease could become contagious, but only under conditions of extreme crowding, oppressive heat, poor ventilation, and bad hygiene — as in the hold of a ship or crowded port towns.
Anti-contagion found a ready audience in Enlightenment Europeans who were ready to see health as a matter of moral responsibility and rationality. Accordingly, health could be controlled and engineered by the advances of Western science. And this offered “scientific” grist for colonial narratives; by tying disease to behavior and natural environment — like the jungles of the African coast and Caribbean plantations — Europeans saw a part of their “civilizing” mission as improving the health conditions of non-European peoples. Scientific concerns about public health helped to justify the economic exploitation of peoples and lands; colonial interests colored contagion theory.
Western aid to Ebola-stricken nations had broken down along the old colonial lines, with little coordination or acknowledgement of the porous nature of the borders there. Though U.S. officially never had colonial ties to Liberia, the nations’ histories are unique and complexly intertwined — Liberia was founded as a colony for former U.S. slaves. American business interests there helped trace our continuing role in Liberia’s health care economy and in the handling of the current outbreak.
The international response to the disease has been bungled from the beginning, failing to stop what experts claim should have been a preventable outbreak. Budget slashing and bureaucracy had stretched the WHO thin, hobbling their efforts at containment. But amidst the finger pointing, perhaps we should pause to consider the long term effects of players like Firestone.
Firestone’s response to the outbreak is surely to their credit, as is the IMF’s $430 million pledge to fight the disease. But Firestone shaped Liberia’s history of political instability and so, like the IMF, shares in the responsibility for a lack of national infrastructure. The sheer startling amount of private spending, together with externally imposed restrictions on domestic health spending give a sense for just how much the response to the disease is dictated by the decisions — and agendas — of outside influences.
The eruption of yellow fever on Boa Vista ultimately burnt itself out, but it would take over half a century for the true cause of yellow fever to be uncovered: a virus borne by mosquitoes. For all the empirical vigor and academic vitriol, neither Pym nor Bryson had got it right — but then, neither had gotten it totally wrong. Ships could bring the disease to unsuspecting harbors in the blood of the infected. And overcrowding made it easier for mosquitoes to pass the disease. But fears around person-to-person transmission were unfounded, as were concerns about unsanitary “climes.” Pym and Bryson’s world views colored their scientific understandings; their political and commercial interests intersected with their medical ones. And that’s not a thing of the past. Fast forward to the present.
The handling of the COVID-19 pandemic in the United States was politicized relatively early, which made responding to the pandemic challenging. Politicization was not, of course, the only issue. The tricky nature of the infection, which can be transmitted before or without symptoms, public health messaging failures or errors, and previous underfunding of public health infrastructure all contributed to the United States’ failed response — resulting in the United States having a disproportionately high rate of both COVID-19 cases and deaths compared to other countries. But politicization had a role. For example, there is evidence that the Trump administration, concerned about the political impacts of the pandemic, put pressure on the Centers for Disease Control and Prevention (CDC) to change not only the guidance it provided but also the scientific reports used by public health officials and other policymakers to make decisions. There is, again, an appropriate role for politics in making decisions in a pandemic situation. But manipulating the scientific evidence on which decisions are made can undermine the ability of politicians of all orientations to make decisions that match values.
Traditionally, vaccines have not been a partisan issue. In the 1960s and 1970s, all states — with a variety of political views — adopted school immunization requirements for a variety of diseases. In the early 2000s, both left-leaning California and right-leaning Texas offered very easy-to-get exemptions from those school mandates. At the other extreme, left-leaning New York used a relatively hard-to-get religious exemption, and West Virginia never offered a non-medical exemption, while Mississippi’s religious exemption was struck down by its Supreme Court in 1979 and never revived.
In 1986, President Ronald Reagan signed a bill to protect the vaccine supply by creating a no-fault program that provided limited liability protections to vaccine manufacturers — though with reservations. The bill was supported by other members of his administration (though opposed by civil servants in the Department of Justice) after being drafted by a Democrat chair of a congressional committee.
In the past few years, struggles around vaccine mandates have become politicized. In many states — including Maine, California, Colorado, Connecticut, and New York — votes on laws regarding school vaccine mandates were along party lines. School vaccine mandates are not just about science; they involve a discussion of values and address views about the balance of parental rights with public health. But the discussion in legislatures often drew on conflicting views of the science. More often than not, opponents of bills aiming to change mandates (not all from one party) echoed or repeated misleading claims made by the anti-vaccine movement. For example, speaking about a bill that would have required doctors to give parents seeking to vaccinate the CDC’s excipient list, Republican Senator Bob Hall from Texas expressed inaccurate statements about vaccines ingredients, for example alleging vaccines contain “fetal parts” and expressing concerns about aluminum in vaccines. The first comment refers, inaccurately, to the fact that a small number of vaccines use viruses grown on cells descended — at long remove — from fetal cells deriving from abortions performed in the 1960s. The remoteness convinces even the most of pro-life commenters that using these vaccines to prevent harm is morally permissible and does not create complicity with abortions. But that is not how anti-vaccine groups present it, including to supporting legislators. As to aluminum, many vaccines contain tiny amounts of aluminum salts to help the vaccine work better — but extensive data supports the experts’ consensus that these tiny amounts of aluminum salts, far smaller than what we are exposed to through food, are not a danger.
In these cases, it is hard not to see the position as the result of misinformation legislators were provided by the anti-vaccine movement rather than a value choice. School mandates work; they reduce rates of outbreaks in the state. When legislators are led to weaken them because of anti-vaccine claims, they may be inadvertently causing direct harm to their constituents — without intending to.
Politicization is already affecting the COVID-19 vaccines’ legal environment, at least to some degree. All states — regardless of political leanings — have arranged for COVID-19 vaccinations, and governors from different parts of the political spectrum — from Democrat Governor Gavin Newsom in California to Republican Governor Kristi Noem in South Dakota — have posted pictures of themselves getting the vaccine. But polls show that vaccine hesitancy is higher among conservatives. This is not a coincidence: The same channels of information that promote claims that the elections were stolen, or QAnon claims, have shared some of the misinformation about COVID-19 vaccines. For example, these sites have shared unverified reports submitted to the government’s passive reporting system — the Vaccine Adverse Events Reporting System (VAERS) — as if they show the vaccines’ risks. In reality, VAERS is a database where anyone can report anything to, and the number of reports, without verification, cannot be reliably used. Further, the number of reports by itself is not enough to show a vaccine caused a specific harm; for example, if in one week 20 people are reported dead within 48 hours after a vaccine, that statistic tells us little without information on how many people would die in those 48 hours regardless of vaccination.. An analysis of VAERS by the expert Advisory Committee on Immunization Practices found no safety signal — no indication of more harms than expected without vaccines — after either the Moderna, Pfizer and J&J vaccines. This kind of misinformation — misrepresenting the number of VAERS reports as showing the vaccines to have high risks — undermines the ability of people to make informed decisions, and if it is present on sites used more by one political group than the general public, it can lead that group to make ill-founded decisions. The people using these sites are not making a value-based decision to avoid the vaccine: They have been misled and are making their choice based on bad facts.
In response to the idea of vaccine passports or employer vaccine mandates, several Republican-controlled legislatures have proposed bills to prohibit businesses from requiring proof of vaccination from customers or employees. Several governors have acted to prevent private entities from requiring vaccines. We can see these as value-based decisions, but, traditionally, the Republican groups valued the freedom of private businesses to make decisions. These measures are directly prohibiting businesses from deciding whether or not to require vaccines — imposing a limit on the market. A reasonable interpretation is to see these measures as a response to the higher level of concern about vaccines among conservatives, linked directly to misinformation of the type described above. The result could be a delay in the ability to safely open some businesses or even an increase in COVID-19 cases in states that do this compared to others.
Values matter, but politically motivated science denial undermines rather than enables people to make valid value-based choices. When people end up with bad facts because the sources they were led to trust are blatantly misleading them, they are not working to achieve their values — they are simply victims of deceit. When misinformation feeds into policy decisions, the result can be decisions that achieve no one’s values and simply lead to harm.
Vincent Lyn
CEO/Founder at We Can Save Children
Director of Creative Development at African Views Organization
Economic & Social Council at United Nations
Middle East Correspondent at Wall Street News Agency
Rescue & Recovery Specialist at International Confederation of Police & Security Experts