Science is itself a journey. Every time the climbers reach a summit, they see a new vista of peaks and valleys to explore. The history of science shows that understanding a pandemic pathogen isn’t merely an increment to existing medical knowledge but can also be a paradigm-shifting breakthrough. For each of the main pathogens examined in this book – cholera, influenza, and HIV, plus yellow fever and Ebola, which are covered more briefly – the search for prevention and cure has taken scientists into new terrain they could not have anticipated. Of all the sciences, medicine is the one most focused on the human being as such, and it is notable that it has been biologists who have blurred the boundaries of the human self, imputed agency to microbes, and in other ways challenged the distinction between the natural world and the human, so foundational to our modernist worldviews. Bruno Latour has made the same observation with regard to those hardest of hard scientists, geologists, who coined the word ‘Anthropocene’ to refer to our current era in which human activities are determining the global ecosystem. He writes: ‘No postmodern philosopher, no anthropologist, no liberal theologian, no political thinker would have dared measure the influence of humans on the same scale as rivers, volcanos, erosion and biochemistry.’10 In medicine as in geology, such critique doesn’t come from post-modernist literary theorists, but from the Sherpas of scientific exploration themselves. We will see that this is the case for Covid-19 too.
A Week Is a Long Time
Pandemics move faster than politics. In the early acute phase, the number of cases of a disease can double every few days. It’s a frightening trajectory. A week is a long time for a pathogen, as it is in politics.
Public leaders must act very quickly. Individuals who hold high office are, in general, attuned to their constituents’ anxieties and what those may mean for the political order and their own political standing. They’re not usually very literate in the science of infectious diseases and they don’t have time to learn anything new and complicated. At that moment of darkness and uncertainty as the pandemic storm breaks, ministers and presidents want reassurance – for themselves and so they can provide leadership in the hour of crisis. Their task is to control the narrative, to buy time and calm, so that public health and medicine can control the disease.
A government leader has scientific advisers. For medical issues, that means biomedical scientists. The hierarchy of academic disciplines becomes desperately important at this moment of crisis because this is the order in which the decision-maker consults them, and the weight that their advice carries. This is shown by Nancy Krieger, who compares the number of projects funded by the US National Institutes of Health for the hard biomedical sciences as against social epidemiology: the ratio is 25 to one. Peer-reviewed publications favour the hard biomedical sciences 194 to one.11 Between the academic top table and the rest of the scholarly hall there’s a huge step down – more of a precipice than a gradient. Next in the ranking are the epidemiological modellers, below them the social epidemiologists, and last the medical anthropologists and historians. Ecological scientists sit somewhere in the middle. This hierarchy corresponds roughly to the ‘hardness’ of the science, and depending on where a researcher sits, everyone above him or her is a true ‘hard scientist’ and everyone below a ‘soft’ one. It’s a gendered hierarchy – there are far fewer women in the higher reaches. Those at the farthest end of the hall – who study literature, history, and social anthropology – like to critique and deconstruct the hierarchy and mock the pretensions of those at the top. Meanwhile, hard scientists tend to go softheaded when they cross the boundary into social and political analysis – they turn to platitude and metaphor. They know what ought to be done: it’s just a matter for the public, or society, or whoever, to get on and do it.
Most scientists’ approach to public messaging has been that facts speak for themselves. This hasn’t worked. Towards the end of his book Spillover, the journalist David Quammen inadvertently shows how scientific thinking loses its compass as it crosses this divide. In 500 pages, he vividly describes the work of virologists who hunt down and analyse pathogens that have either made the zoonotic jump from animals to humans or have a fearsome potential do so. It’s fascinating. These scientists are, he says, ‘our sentries’ who will ‘raise the alarm’. Quammen continues: ‘What happens after that will depend upon science, politics, and social mores, public opinion, public will, and other forms of human behavior. It depends on how we citizens respond.’ Those ways of responding are ‘either calmly or hysterically, either intelligently or doltishly’.12 This is true but it also doesn’t get us far: social scientists and political analysts have useful things to say on these topics. They too have their hierarchy, with economists at the top table. But a pandemic is a rare occasion in which economists don’t have a model to hand,13 though they have much to say about what can be done to mitigate the crises of paying for health care, unemployment, and disruption to international trade. Macroeconomic models that take equilibrium as a premise don’t work when – as in a pandemic – there is by definition no equilibrium.
Politicians talk to their friends and financiers in business, who are also used to making complex decisions quickly in uncertain situations. Business school methods that focus on real-world problems can be useful when the data are speculative and the quantitative formulae have just been thrown out of the window. The core business management question is ‘what is going on here?’ and the answer is given by means of a story that makes sense. So far so good. That works when our intuitions have been refined by experiences that fit the problem. But it doesn’t work when the problem follows a new logic for which our thinking need to be rewired – for example a novel pathogen.
The security advisers have a narrative too. Their job includes planning for a full spectrum of hazards, including all manner of nasty surprises. Military officers and intelligence analysts have played out wargames with both humans and natural disasters as the enemy ‘red team’ and have watched how decision-makers respond to the stresses of the unexpected. One of those exercises, repeated every year or so in governments of industrialized countries, is the crisis of a highly contagious germ introduced either by a terrorist with access to a high-security biotech laboratory, or by natural spillover. So the security analysts consider themselves ready – or at least a step ahead of others. But they can’t anticipate what rules a new virus might follow. They also suffer the handicap of those tasked with imagining the unanticipated, which is that in order to make their story credible – plausible enough to convince a jaded politician – they can only break one or two rules about normality at a time. In the same way that a science fiction movie stretches our imagination on one dimension but sticks to a conventional plotline and characterization so as not to bewilder the audience, so too the pandemic disaster scenario hews to an intuitively resonant human script. These rules are written by the scriptwriter. This is why, almost inevitably, the reality of a pandemic will be stranger than fiction or a security studies wargame simulation. This naturally won’t become clear until later. In emergency mode – and most politicians have an adrenaline rush when there is a real emergency, with top-secret briefings with the highest-ranking generals and spy chiefs – those security-based narratives, scary but familiar, will resonate.
Routinely, a political leader will talk to other politicians. The normal calculus of day-to-day politicking about loyalty, jobs, money, and the media doesn’t stop. We hope that in a national emergency, all those become secondary to the public good. One of the virtues of a pandemic-as-national-security drama is that it allows a leader to rise above party politics and set a truly national agenda, even a global one. Every politician also knows that they should never let a crisis go to waste. For some, the chance for partisan gain trumps the public good. There are benefits to pandemics: an opportunity to seize emergency powers and use them to other ends, spend public money with little oversight, and get on with other factional business while public attention is distracted. Some leaders are denialists. A few are devout denialists, who genuinely think the disease is a hoax or truly have faith that