Q: How does bioterror feel more personal than any other risk?
A: After the World Trade Center disaster, I was really struck by how fatalistic New Yorkers were about the collapse of the towers and the deaths of thousands of neighbours, friends, family members. On the other hand, there was the postal anthrax outbreak a few weeks later, and five people died. Now, that’s sad, but the reaction to that was people were ironing and microwaving their mail, buildings got evacuated every time somebody thought they saw white powder, there was near-hysteria.We recognize that terrible things happen in the world, but when it seems like “there’s something I should be doing to protect myself,” it resonates in a different way. We ask ourselves, “Did I do something wrong? Should I be protecting my own health by not indulging in some behaviour or by adopting some new behaviour?” In the past quarter-century or so, we’ve personalized risk much more dramatically.
Q: What factors contributed to that change?
A: I think AIDS is the big one. I don’t mean HIV per se, but the AIDS epidemic, which is to say the story we’ve told ourselves about what AIDS means. The premier explanation for AIDS, that’s been adduced at least in North America and Europe, has been moralistic: “It’s about behaviour, people doing something wrong.” It’s not just: “Infections happen”; or, “Here’s yet another example of a contagious microbe spreading through the population.”
Q: What story do we tell ourselves about the Spanish flu?
A: “Something is going to creep up and invade us”—which is ironic, because in fact the 1918 flu very likely began in the U.S. But we call it the Spanish flu because at the time, newspapers were censored in the countries that were at war. So in the U.S., England, France and Germany, though people were sick and dying, there was literally no mention of the flu. Spain, however, was neutral in World War One, so the Spanish newspapers carried reports of this epidemic, and the story is that people started calling it the Spanish flu because that’s where it was reported.
Q: What story could we tell ourselves about the swine flu? “People shouldn’t vacation in Mexico?”
A: I worry that if we allow ourselves to exaggerate our fears about what this—so far—quite small outbreak of a new strain of flu means, we’re going to start hearing from the anti-immigration people who want to make the fences between the U.S. and Mexico higher. We’re going to hear from the ideologues who want to blame it either on capitalism or on what they claim is Obama’s socialist agenda. It’ll bring out the crusaders.
Q: You say that old-fashioned public health measures are the best ways to deal with a flu outbreak. Why is it so difficult for people to believe in tried and true responses?
A: The methods already in place in Mexico City—closing schools, temporary bans on public gatherings, travel restrictions—have been used for hundreds of years, and they seem to be working so far. But we have this double-edged sword of knowledge: we’ve got access to so much information now that we can know in a few instants what’s happening anywhere in the world. That could be reassuring if we wanted it to be, but we have these fantasies about a terrible pandemic with millions of deaths, and it’s very easy to interpret the wealth of information that’s available at the click of a mouse as validating our fears. I want to be clear: it’s still possible that something really bad will happen. But at this point, a week into our awareness of the outbreak centred in Mexico, we’re not looking at a very bad flu outbreak.
Q: When the hype of an epidemic—like the avian flu epidemic a few years ago—isn’t borne out, does it create an incentive for the media to ratchet up the threat level the next time in order to get people’s attention?
A: I think we’re always worried. We carry anxieties with us, and the stories that public health people and the media tell simply fuel those fears. I don’t see that it’s ever been hard to sell us on the idea that we should be worried about some new thing: the obesity epidemic, the ADHD epidemic, the restless leg syndrome epidemic. But it’s a two-way street: if we didn’t want to read those stories, they wouldn’t be published or broadcast. We want to hear about epidemics, in part because they seem to tell us something about this anxiety we have about what’s wrong with modern life. The obesity epidemic seems to talk to us about the addictiveness of modern life, or about the toxicity of the food supply. It’s interesting because actually, we’re pretty safe. Compare North America to Africa or other developing countries: our kids aren’t dying of diarrhea or malaria. Yet we’re fascinated by epidemics. At least we no longer, as they did in the 14th century, burn Jews when an epidemic comes. Civilization has made some progress.
Q: But we still have trouble keeping something like the flu in perspective.
A: Exactly. There have been 149 deaths in Mexico as of this morning. Let’s say all are attributable to this flu, which we don’t know yet. Well, that’s one bad weekend on the roads in the U.S. But no one thinks of auto accidents in terms of a public health crisis.
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