Thursday, August 11, 2005

The Crystal Ball is Cloudy

Don't know much biology,
Don't know much about a science book,
Don't know much about the French I took . . .

Well, maybe I sell myself a little bit short. But I'm not the same kind of expert Revere is. I have one of those mushy interdisciplinary social science degrees and I just read about weird stuff like immune systems and hemagluttinin and whatnot in my copious free time. Since Revere invited me to contribute here, I thought I should talk about subjects that interest Revere and readers of Effect Measure, but try to give you a different perspective.

As we all know, there have been any number of plagues that have changed the course of history. The Black Death undermined the authority of the church in Europe, and, by dramatically reducing the population, left the survivors in possession of a surplus of land and capital goods. Many historians see these events as major factors in producing the Rennaisance and Reformation, and hence the creation of the modern world. (Destruction is the indispensable servant of creation.)

European diseases, notably smallpox, decimated the civilizations of the Americas and led to the easy conquest of a vast continent by a few Spanish adventurers and priests.

We're still in the middle of it, but the HIV epidemic in the United States has had a profound impact on the culture. For one thing, the organization and activism that it galvanized in the gay community has revolutionized social mores in many parts of the country, while provoking a furious backlash. I think I know where this has to end up, but we're paying a heavy political price in the meantime.

So what will a worldwide pandemic of killer flu mean to the history of the future? If the experience of 1918-19 is any guide, not much. The so-called Spanish flu was definitely memorable. It killed somewhere in the range of 30 million people, considerably more than the Great War. It interrupted commerce, disrupted transportation, there were shortages of physicians and nurses, medical supplies, coffins, undertakers and gravediggers. Bodies piled up in improvised morgues. I haven't found any estimate of the economic cost, but it had to be enormous. Then, the epidemic melted away like the snows of March. It is difficult to see how it had any particular influence on the shape of the post-war world.

Massachusetts, with the country's oldest and once best department of public health, has excellent historical data, so I stole this image from them. The epidemic is undoubtedly the most noticeable single feature of this graph. But snip out 1918-19, and there is nothing left. Just as it is difficult to discern any lasting impact on culture or politics, there is no impact whatsoever on historic trends in mortality. The Spanish flu was just a thief that came in the night, left with his sackful of lives, and vanished without a trace.

The world was very different then, of course. For one thing, a northern hemisphere already mobilized for war readily accepted authoritarian public health measures. Although we were well into the industrial era, we were very far from the extent of interdependence, complexity and global connectedness of today. Many people have speculated about the social, cultural and economic impact of a new killer flu pandemic, but that is all we can really do. I'd like to hear your thoughts. If the Big One comes, will it briefly ravage the planet, leave a lot of grief in its wake, and then we'll just carry on as before (for better or for worse)? Or will it mean more than that?