Welcome to the project, How Epidemics and based at the University of Oxford.
My name is Erica Charters. I'm an associate professor in the history faculty at the University of Oxford.
And I'm Kristen Highton. I'm an independent scholar based in Bethesda, Maryland, which is just outside Washington, D.C.
So over the next few weeks, Christine and I will be interviewing a range of experts to answer the big question, how at the end?
But before we do that here, we'd like to explain why we think this question is important and the broader historical context to the end of epidemics.
This project in some ways had its origin way back in the spring of twenty twenty in what might now be seen as the early days of covid-19.
When Christian asked what might seem like a simple question,
how do epidemics and Christian to remember could really do so back in January of twenty twenty,
when it became quite clear that code was not going to be just a local outbreak.
I remember thinking, oh, I know how this goes, because as historians we think a lot about the origins and the spread of disease
and the broad patterns of epidemic disease are generally quite similar.
covid followed those patterns. But then in early summer, when talk turned to how the epidemic would end and then it was time for it to end,
I realised that I really had no clear idea at all about how epidemics ended it,
not even about plague, which is something that I've worked on for several years now.
So that's when I wrote to you. And I think that's something we continue to find throughout the project.
There's a lot of attention paid to the origin, to the cause of the outbreak of an epidemic and also,
of course, to the unfolding of an epidemic, but very little to the process of ending.
So how do we know an epidemic has ended? Who defines an ending and how do we measure and assess that an epidemic has ended?
And how, therefore, do we know when we can return to normal life?
Do we take our guidance from a mathematical model or from an international health organisation or from when other people around us,
ordinary people, return to their regular patterns of living and of working?
So for this project, we wanted to incorporate all of these different methodologies.
That is these different ways of measuring. But measurement and assessment is not just about numbers.
It can be just as useful to be able to understand how and why normal people return to normal cultural practises,
as it can be to know exact numbers of cases of disease if we want to understand how an epidemic ends.
So for this project, we've worked with a range of researchers, over 40 scholarly experts who all work on disease.
This includes epidemiologists, mathematical modellers, biologists,
but it also includes people who work in politics and development to analyse the role of disease and the impact of disease on society.
It also includes experts such as philosophers who work to define our conceptual understanding of disease.
All of these researchers and details on them and our interviews with them can be found on the project website.
We designed the project in two phases. First, an essay to disentangle our questions from what historians usually think about and to talk
about the importance of including these several different approaches and methodologies.
And then we recruited scholars for a series of online workshops which are now producing a set of essays for print publication,
as well as these interviews. I think what we found is that each scholarly discipline has a different way of understanding disease,
and we're both historians, so we have our specific approach.
So for me, as a historian of medicine, when I study disease in the past, I'm not only analysing disease as a biological phenomenon.
That is on the one hand,
I do incorporate our modern biological understandings of disease to say when I look at smallpox in the sixteen hundreds and the seventeen hundreds,
I do look at how it's transmitted. It's rates of deaths, it's symptoms according to modern biological understandings and smallpox.
But on the other hand, I also examine how those at the time understood.
So within their medical understanding, but also within their social and cultural frameworks,
people in the past have their own strategies for controlling and avoiding disease,
as well as ways in which they lived alongside it and interpreted that.
So in other words, historians see disease not as separate from society, but as part of it.
So epidemics, for example, are not events that come down impact upon society.
We historians don't consider epidemics as external to society as if they're are aliens coming from outer space and invading society.
Instead, historians of medicine start from the position that epidemics like disease in general should be understood as part of society.
So in this approach, disease is part of social and cultural frameworks.
It highlights existing inequalities, for example, or reinforces social tensions and prejudices rather than creating them anew.
So as a historian, I use disease as a way to analyse society as a whole, to reveal and understand the ways that societies function.
Kristen, your research is really much more focussed on the history of measurement.
How does this relate to the disease? So I'm mostly interested in the history of science and mathematics as well as disease
and medicine in that recently has meant looking at metrics and systems of records.
So what gets measured, how it gets measured, and then how those data are used and understood by various individuals and communities.
And that, too, is a great lens to look at a society or community more generally, especially interested right now in how communities,
so scientists and practitioners as well as society at large come to any kind of consensus about what to measure,
what measures and standards are appropriate and what to make.
Of course, dealing with an epidemic produces a whole lot more metrics and records of its own, especially nowadays.
But epidemics also strain and even upend ordinary recordkeeping in the kind of social order is expected to support.
I think epidemics are very interesting as a historical phenomenon, but I also work on the history of disease more broadly,
and one of the points that's important for me to stress is that we need to think about what is an epidemic.
The opposite of an epidemic is not lack of disease, but rather what we might call endemic disease.
I was really struck by this image of the global history through pandemics that's been circulated through
covid-19 in which the all of the history of the world is represented by these balls that are each pandemics.
And the size of the ball is meant to kind of represent the number of people killed by each disease.
This image and what it's telling us about the histories, in some ways, this notion that there's these empty spaces between these balls.
But what's important for me as a historian of disease is to remember that these empty spaces,
those periods of history are not periods in which there was no disease,
but actually in which the world was still full of disease, which is full of what we call endemic disease.
So today in the West, the diseases that we know, such as tuberculosis, heart disease,
diabetes and influenza and these endemic diseases can be just as fatal as epidemic disease.
Cumulatively, for example, endemic disease kills an astonishingly high number of people in a normal year,
and endemic disease is not defined by the type of disease.
Right. So influenza is usually an endemic disease,
but it can become an epidemic disease if suddenly there are higher rates than normal or it brings up in an unusual season.
So epidemics are about diseases that are novel or unusual for that time or that place.
For example, in the 17th and 18th centuries, smallpox in England and in Europe was considered endemic, almost normal in cities.
But it was an epidemic disease, something that you would run away from when it appeared in the countryside.
But if we step back and if we move to a global a global framework, so we say stand in the perspective of the Americas,
there are smallpox was an epidemic disease everywhere, but by contrast, considered as endemic to all of Asia and Europe.
So this notion of what is an epidemic, what is a problem disease, what is a crisis?
Disease relies on an underlying category of endemic disease.
What is normal or acceptable rates of disease?
Just as current discussions, discussions of covid-19 are framed around questions of what is excess death or excess mortality.
And I think we've discovered. Through this project, the disease most often returns to endemic levels at the end of an epidemic as well,
with our experience with effective vaccinations, we tend to think about disease eradication as the end goal.
But that's not usually the way even modern epidemics and.
So, Erica, how do epidemics a question that we hope to find more answers as we develop more research on this project,
but I think what we found so far is that one way of thinking about the end of an epidemic is that it's when society's attention turns elsewhere.
An epidemic is a crisis. It's not just a biological crisis, though.
It's also a political crisis and economic crisis and a social crisis, as we're witnessing now with covid-19.
So what we've both found in our research is how the process of the end of an epidemic often isn't recorded.
Less attention is paid to it precisely because for those who are living through an epidemic, it ends when they can return back to their normal lives.
And so that's when they stop discussing the outbreak, stop discussing the disease, stop paying attention to it, and so stop keeping records.
But what we've also found in our research is that most often, of course, this doesn't mean that the disease has actually ended.
It might disappear for those who are writing records, but that doesn't mean it's gone.
It often instead moves to say other parts of the world, as we've seen with HIV AIDS, which began as an epidemic for the entire world,
but now has become much more of a problem disease in what we call the global
south or a disease might become part of regular cycles or waves of disease,
as we've seen with influenza. So it transforms into an endemic disease.
One of the most interesting things I've learnt is how differently different groups define what the end actually is.
So it's partly, as you say, that we as humans are attuned most to what matters to us and what is going on around us.
And we pay less attention to what's going on somewhere else or people that we don't know.
But in order to understand the full picture, the epidemic and especially pandemic itself,
we have to do some work in order to pull together more points of view.
And part of that is just access to sound information, but it's also that the end is defined differently by the various communities,
both within a society and around the world, and also by the various groups that contribute to bringing that and about.
So we have lots of narratives to look at, lots of ways of making sense of both the data and the experience in hand.
The broad statistics that we're used to looking at as a general public typically see things that a more general level.
So they talk about society as a whole and don't have that kind of specificity.
They gloss over the fact that some communities continue to struggle with the disease long after the epidemic is declared over.
And then by the same token, in international contexts, if there is outside aid coming in,
those outside organisations may decide that things are good enough that they need to move on to the next big crisis,
leaving the people in the society basically to manage on their own.
But that difference in in endings helps make clear why these stories about how
epidemics and epidemics end are so ragged that the endings themselves are different.
And although the fact that they all exist in the same reality means that they interact,
they reflect the interests and ends of the people who are putting the narratives together.
I think this point about the rag and the rag admits of the ends of academics is very
important epidemics and at different times for different groups within one society,
but also within regions and across the world,
which is precisely why studying the ends of epidemics gives us such useful insight into societies and how they work or even how they don't work.
So thank you very much for joining us today.
We have a number of fascinating interviews lined up over the next few weeks, including with an epidemiologist who's working on the end of malaria,
a professor of politics who studies cholera in Africa, and a social historian who researches the history of cholera in England.
We hope you will join us in interviewing the other researchers on the project as we work together to explain how epidemics and.
Thank you.