Wednesday, 1 July 2020

The Historian’s Kaleidoscope – Making Sense of Medical History in Times of a Pandemic

In this blog post, Dr Claas Kirchhelle, Lecturer of the History of Medicine at University College Dublin (Wellcome Trust University Award) and Fellow of the Oxford Martin School, urges medical historians to critically reflect on the implications of the COVID-19 pandemic for their field.

Trying to make sense of COVID-19 is to look through a kaleidoscope. Within its brief existence, the virus has revealed the incredible complexity of interspecies relationships, economic interdependencies, health system designs, international relations, the many fallouts of the climate emergency, and differing cultural perceptions of disease and biomedicine. It has also unleashed a storm of attempts by historians, social scientists, and public commentators to make sense of the present against the backdrop of previous epidemics and pandemics.

From late January 2020 onwards, academic journals, websites, blogs, and media outlets saw a burst of contributions analysing the current pandemic in light of earlier ones, commenting on exacerbated social and racial inequalities, cultural biases in attributing causes and solutions, the biopolitics of lockdown, and hopes for a unified drive for a cure. Initial responses were soon complemented by a second layer of debates about how far one pandemic could be compared to another, ground-zero empiricism, and whether anything meaningful could be said before COVID-19 itself had become history.

As a medical historian, I followed debates with a mix of fascination and exhaustion. Holed up in my apartment, I was taking it in turns with my partner – also an academic – to care for our confused toddler while trying to meet funding and publication deadlines. In between writing, zoom calls, and potty training, I was, however, struck by the way that many exchanges were missing their mark. The version of history that was being debated was often too grand or too diminutive to adequately reflect the discipline’s value for public debates and decision-making.

Critics were of course right to highlight that it was too early to provide grand analyses and wrong to make facile comparisons to earlier pandemics. Nobody can accurately predict how interactions between this novel pathogen and its human hosts will evolve and it will likely take decades to retrospectively unpick the complex biosocial interactions that brought us here. However, history is also not as speechless as some seem to imply. While I would distrust anyone proposing a definite analysis of COVID-19, I would be similarly wary of those waiting for the elusive point when current events have ‘safely’ become history.

The COVID-19 pandemic is a biological and social event that is the result of contingent emergence. However, it is playing out within the structural constraints of a human and environmental playing field that was shaped over decades – if not centuries. Historians are uniquely placed to appreciate both the contingency of SARS-CoV-2 and to analyse its pandemic playing field. The relevance of such analyses for decision-making and public discourse is great. I have plenty of colleagues whose excellent work on vaccines, public and global health, infectious disease, mental health, and civil emergencies makes them ideally placed to provide critical context for varying policy responses. Scholars of the medical humanities can also highlight implicit biases and shaky data underpinning some of the epidemiological, behavioural, and economic models guiding current policy. By looking back at previous pandemic or epidemic events, some may even be able to make educated guesses about likely social flashpoints, governance problems, finance bottlenecks, and ethical dilemmata. None of the colleagues I know would make the claim that historical analysis holds universal answers. However, I think that many of them would be comfortable saying that decontextualized policymaking and public debates can be just as flawed – and that expertise from the medical humanities should be represented in official expert bodies.

Reflecting on my own work on antibiotics, laboratory surveillance, and infectious disease control, I have become keenly aware of the kaleidoscopic qualities of the current crisis. All of my research fields have been affected. COVID-19 has accelerated many of the structural constraints that have long prevented equitable and unbiased health provision, international coordination, and global solidarity. However, it has also provided interesting points of departure.

Writing about change, challenges, and prospects in the areas I know best has aided my own historical sense-making and prompted useful exchanges with other disciplines. Together with colleagues from the biomedical and environmental sciences, I have drawn on historical precedents to warn about the likely rise of antibiotic use to deal with bacterial superinfections and resulting selection for antimicrobial resistance (AMR). However, we were also keenly aware that the unprecedented global sharing of scientific information about COVID-19, formation of patent pools, and mobilisation of public funds may also point to new solutions for the long-standing ‘empty pipeline’ problem for antibiotic development. With collaborators from the social sciences, I have reflected on the chequered past of human infection studies in accelerating vaccine development but also exploiting marginalised and colonial populations. We warned that the race for effective SARS-CoV-2 vaccines and the growing tendency to ‘offshore’ trials necessitated a new international framework for infection studies. I was also honoured to reflect on how contagious disease can bring out the best and worst in societies with my former PhD supervisor. Interviews with talented and genuinely interested journalists have also allowed me to stress how the history of drug and vaccine development makes it clear that ensuring equitable access must be at the forefront of current decision-making.

None of these points are particularly revolutionary and I do not pretend to be able to offer a comprehensive interpretation of an unfolding global crisis from the desk in my bedroom. It is, however, clear to me that COVID-19 is rapidly changing the fields I study and the way I see their history. Although I may only be able to see individual pieces of this vast kaleidoscope of change, the time to critically reflect on these changes started in January 2020. To publish these reflections is to stimulate debate, add a critical longitudinal and structural take to public sense-making, and – in my case – to optimistically push for some good things to come out of this global event.

Claas Kirchhelle

Dr Claas Kirchhelle is a Lecturer in the History of Medicine at University College Dublin’s School of History. His research explores the global history of antibiotics, infection control, and the microbial environment. Supported by a Wellcome Trust University Award, he is currently writing an interdisciplinary history of global infectious disease surveillance after 1920. Claas studied history at the Universities of Munich (MA, 2012), Chicago (MA, 2011), and Oxford (DPhil, 2016). He has published across the humanities and biomedical sciences and was awarded the University of Oxford’s 2016 Dev Family Prize for the best dissertation in the history of medicine and the 2020 ICOHTEC Turriano Prize for Pyrrhic Progress. Antibiotics in Anglo-American Food Production (Rutgers University Press). A new monograph on the history of British animal welfare science, activism, and politics is forthcoming with Palgrave Macmilan (2021). Claas has extensive experience in public engagement and broadcasting and co-curated the award-winning Back from the Dead (2016/2017) and Typhoidland (2020/2021) exhibitions on penicillin and the past, present, and future of typhoid control.