Peter C. Doherty: Pandemics Have Had "Enormous Influence" on History [INTERVIEW]tags: public health, history of medicine, pandemics
Robin Lindley (firstname.lastname@example.org) is a Seattle writer and attorney, and features editor for the History News Network. His interviews with scholars, writers and artists have appeared in HNN, Crosscut, Writer’s Chronicle, Re-Markings, Real Change, The Inlander, and other publications. He is a former chair of the World Peace through Law Section of the Washington State Bar Association. He has a special interest in the history of medicine.
My characteristics as a scientist stem from a non-conformist upbringing, a sense of being something of an outsider, and looking for different perceptions in everything from novels, to art to experimental results. I like complexity, and am delighted by the unexpected. Ideas interest me.
-- Dr. Peter C. Doherty, Nobel Biography (1996)
Pandemic. The word strikes fear in our hearts.
Catastrophic infectious diseases such as plague, tuberculosis, cholera, and influenza have altered human societies throughout history. Populations have been devastated from typhus in ancient Greece and pestilence that weakened the Roman Empire to the Spanish influenza of 1918-1919 that killed 50 to 100 million people worldwide.
In virtually every major war, more people have died from disease than from combat. And biological warfare has been with us for millennia as ancient and medieval armies lobbed disease-ridden cadavers or animals into besieged cities, and more recently as British soldiers in 1763 supplied smallpox-infected blankets to Native Americans with devastating results.
Nobel Prize-winning immunologist and author Dr. Peter C. Doherty recently sat down at a cozy coffee shop in the Wallingford district of Seattle and talked about history, pandemics, bioterrorism, his career, and more.
In his new book Pandemics: What Everyone Needs to Know (Oxford), Dr. Doherty explains how pandemics work and introduces infectious disease concepts. Dr. Doherty concedes that the thought of pandemics is terrifying, and climate change, global travel, and drug-resistance complicate treatment of diseases such as SARS, HIV, and tuberculosis, but he is also reassuring. He writes that the deadliest pathogens can be readily detected and confined, that we’re learning more about prevention, and that information and preparation are critical in defeating pandemics.
Dr. Doherty also discussed his other new book, Their Fate Is Our Fate: How Birds Foretell Threats to Our Health and Our World (The Experiment}, on how birds warn us about threats to health -- including disease and climate change. In the book, he presents intriguing discussions of the history and biology of this sentinel species as well as how scientists can learn about human perils from birds.
Dr. Doherty and his collaborator, the Swiss scientist Dr. Rolf Zinkernagel, won the Nobel Prize in Physiology or Medicine in 1996 for their work showing how the infection-fighting T cells of the immune system recognize and protect against viruses. Dr. Doherty said “it was a chance discovery,” which is described in his Nobel lecture on “Cell Mediated Immunity in Virus Infections” on the Nobel Prize website. The following year, he was named "Australian of the Year."
Dr. Doherty currently serves as the Michael F. Tamer Chair in the Department of Immunology at St. Jude's Children's Research Hospital, in Memphis, Tennessee, and as Laureate Professor of Microbiology and Immunology at the University of Melbourne. In addition to numerous scholarly articles and Pandemics and Their Fate is Our Fate, Dr. Doherty wrote the essential guide for all aspiring geniuses, The Beginner's Guide to Winning the Nobel Prize: Advice for Young Scientists, and A Light History of Hot Air.
Here are a couple of Dr. Doherty’s rules for winning a Nobel Prize: “Try to solve major problems and make really big discoveries,” and “Have fun, behave like a winner.”
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Robin Lindley: You urge that a knowledge of history is critical in understanding pandemics. What are a few things historians should know about pandemics and infectious disease?
Dr. Peter Doherty: There’s been a number of good books on pandemics and how that affected the march of history, but it’s a subject that was very much ignored in the history of human beings until recently.
It’s had enormous influence. For instance, Alexander the Great died of malaria when he was quite young.
There were massive social consequences in the whole of that Mediterranean region. You’ve got thalassemic disease [Mediterranean anemia] and that’s an adaption to escape malaria because you get the sickness in your cells and the malaria parasite starts growing, and you get the genetic pressure of malaria on those people.
And people in wars: in the Second World War, probably more people died of infectious disease than died of gunshots. Always. In the Civil War, many more people died of infections [than in combat].
In his book Sick from Freedom, historian Jim Downs presents his research on the medical consequences of emancipation. Many freed blacks died of smallpox and other diseases because of the lack of any medical care or an organized medical system to support their new status.
Yes. That’s likely. Barbara Tuchman wrote a wonderful book about the disastrous fourteenth century, an age of social chaos. But I don’t recall she said anything much about the effects of the plague.
The Black Death [of 1348] killed about a third to the half of the population [of western Europe]. A TV series tracing the development of the English language noted that it had an enormous effect. In England initially, all the common people spoke Anglo-Saxon and the hierarchy spoke French or Latin, but when the Black Death came along, it killed so many people -- particularly in the upper echelons and religious orders -- that it mixed up the language and English became much more used in the Administration and Royal Court.
The reason English is so powerful is that we have so many words that convey subtle difference, and we got there because we’ve taken words from a variety of languages and used them to derive a spectrum of meanings. You can say that the development of the English language was very much driven by that infectious disease catastrophe.
As an undergraduate I wrote a paper on the Black Death of 1348 as a cause of England’s Peasant's Revolt of 1381.
There was a connection. The Peasant’s Revolt resulted from the shortage of labor that resulted in better conditions for a time, and then the king, under pressure from the barons, clamped down again, and that’s why they rebelled.
And more recently, you have the devastating influenza epidemic of 1918-1919, and that killed more American soldiers than died in combat.
It killed many more people worldwide than the First World War, and it devastated areas that weren’t involved in the war [such as the] Pacific islands. Alaska was particularly hard hit, though they tried to keep it out and thought they could because the only connection was the steamers that went up there. But it still got in, and it killed a lot of people. In fact, Jeffrey Taubenberger eventually recovered the virus.
So the virus was carried by ships: John M. Barry wrote that it actually came from American [Army] recruit camps, and it probably came from Asia to those camps, which multiplied it because you had so many men together. The American Expeditionary Forces then carried it to the trenches. And both sides concealed what was happening, because they didn’t want to give the impression to the enemy that there was a weakness in their soldiers.
Influenza badly affected the island countries. The only place that was protected was Eastern Samoa, which was controlled by the U.S. Navy, and they shut it up tight, and kept it shut. Western Samoa, controlled by New Zealand -- a democratic, nice country -- got the flu, badly.
It didn’t get to Australia until 1919, and wasn’t nearly so severe by the time it arrived over the subsequent years, it was thought that the 1918 virus had disappeared, but it had just lost its virulence.
With a pandemic virus, sometimes the first wave can be relatively mild, the second wave can be very severe, and then it attenuates and becomes less severe or even disappears or you get a mutant version.
You write that influenza contributed to the German defeat in 1918.
That’s what [German General Erich von] Ludendorff said at the time of the treaty.
In her book on the 1918-1919 flu, American Pandemic, historian Nancy Bristow points out that 625,000 Americans died from the flu -- more than ten times the combat deaths of Americans in World War I, but the devastation of the flu was forgotten almost immediately here.
Even though it was a terrible pandemic, I think it was part of the normal social structure in a way, whereas the war was such a traumatic event with all of these men who came back after being gassed or maimed or blinded. The actual horror of the war was such that people didn’t want to deal with the additional horror of the virus pandemic.
If a “1918” virus came back, we’d do a lot better with it because a lot of people died of secondary bacterial infections and we can treat them now with antibiotics. The other thing is we’re actually getting very good at the science, even much better than we were a decade ago. I think we could get a lot of flu vaccine out very quickly.
Do we know what caused the plague in Athens that killed Pericles and many others in about 429 BC?
The plague in Athens was written up by Thucydides, the historian of the Peloponnesian Wars. My understanding is that it may have been typhus, not plague. Thucydides makes a famous statement that those who were sick and recovered could nurse the sick and not be infected a second time. This is the first written description of immunity. And he said this “protection” was specific to the plague. That is, they could catch others things but not the plague.
So that’s the first ever definition of human immunity, and it took more than two thousand years to catch up with Thucydides. Even Jenner’s explanations [of vaccination in the late eighteenth century] didn’t tell how immunity worked. It’s not until the mid-nineteenth century that Pasteur begins to understand there are infectious organisms. We had an idea of contagion as diseases clearly spread, but the idea of infection is relatively recent.
With tuberculosis, we did not know what was infecting [people] and no idea what was killing them until [Robert] Koch came along in the nineteenth century. It’s extraordinary really that it took so long.
You’ve also written about a parrot flu in the U.S. in the late 1920s.
That was psittacosis. We call it parrot flu and it’s a bacterial infection we catch from parrots. A friend of mine pointed out that historian Jill Lepore had written about it, and I re-tell the story and credit her. They had a number of cases in Baltimore in 1929 and 1930, at the time of the financial crash. A small number of people died but the population at large was terrified. There was a great furor in the newspapers. I think H. L. Mencken wrote that it was “a reflection of the American national hypochondria.”
Two very hands-on public health officers from the government health authority died, and the general consternation this disease outbreak caused led to the establishment of the National Institutes of Health -- so our wonderful NIH came from parrots!
You discuss bioterrorism in Pandemics. Isn’t there a long history of warring groups using infected animals as weapons to destroy their enemies?
Yes. Just like in Monty Python, they catapulted infected animals into besieged areas. And anthrax was used a biological weapon in the Second World War. An island off the coast of Scotland was heavily contaminated with anthrax. I think that’s been cleaned up, but it was from experiments done by the British.
And of course there was anthrax mailed through the postal service at the time of 9/11. Anthrax is a very effective terror weapon. You put it in the mail and it creates great fear. That’s bioterror. But actually using these weapons to kill a lot of people is a very unlikely scenario. You could probably do it if you had armies that are stable and entrenched like in World War I and you vaccinated your own people and released the infectious agent. But we’re not going to have that kind of war anyway.
Anthrax is a weapon of terror but it’s not a pandemic cause. If we did have a pandemic flu virus, for example, we’d create the vaccine to treat it.
You also write about a history of birds as sentinels or as harbingers of threats to human health.
Yes. There’s the canary in the coal mine [that warned of toxic emissions]. There are stories about geese in Scottish whisky distilleries that warned of thieves, and geese that alerted the Romans to invading barbarians. There’s a whole history and mythology of birds. The Egyptians had bird-headed gods such as Isis as so forth. And birds, especially eagles, are symbolic in many cultures.
The use of chickens as bird sentinels developed in the 1940s and 1950s to monitor the spread of insect-borne viruses that would grow in birds and mosquitoes. They are also used to monitor the spread of West Nile virus in the U.S., where flocks of chickens were parked around the country. Those that survive being infected via mosquitoes make antibodies that can be detected by routine testing.
Did this use of chickens start in the U.S.?
I don’t know where it started actually. We were doing it from the 1950s in Australia because we were trying to follow the spread of viruses that are closely related to West Nile .
The great insect virus labs were at Yale where Jordi Casals-Ariet, the brother of the cellist Pablo Casals, was a great early virologist at Yale. There has always been great public health interest in the U.S. in insect-borne illness, perhaps reflecting that, well into the late nineteenth century, malaria and yellow fever got as far north as the St. Lawrence Seaway. They even had cases in Montreal.
I appreciate your comment that you always take the historical context into account when you discuss issues.
History helps us understand the reason why. The whole tragedy of history is developing now with climate change. It’s a looming human disaster and the appalling fact is that we can’t seem to mobilize ourselves to act, even though such action is quite possible. It’s just awful. But it’s politically polarizing and a question of economics because great, powerful, groups, like oil., coal and gas companies stand to lose from remedial action. The energy companies and others are putting an enormous amount of money into denial. If there was an alternative science to that proposed by the IPCC [Intergovernmental Panel on Climate Change] they could fund it, but they’re only funding denial.
What are the birds showing us about climate change?
A lot of the evidence emerges very slowly and it’s not consistent, but many of the bird and butterfly species that migrate north-south toward the equator are shortening their range and are not going as close to the equator. This can cause big problems with food availability, as they get to a site at the wrong time during migration. That’s also happening within some sub-species that don’t migrate as far, and they’re becoming more prominent while the ones migrating farther are decreasing in numbers -- a test of Darwinian evolution actually.
Another great concern is that seabird numbers are down 50 percent worldwide. It’s partly because of overfishing and partly from habitat degradation. And it could be tied to ocean acidification that’s damaging shellfish like mollusks and oysters.
What are some other lessons from the birds and human health problems?
What the bird stories tell us is the importance of citizen involvement, citizen science if you like. One of the problems with science education [and] with biology [in particular] is that it’s very descriptive and it can quickly become boring if we don’t probe underlying principles.
I think we want to encourage more citizen involvement. Now birdwatchers may not have any science training at all, but they love looking at birds. What happens is that the ornithologists design studies and the Audubon Society recruits birdwatchers to do bird counts, or the “backyard bird project” where you record the species in your backyard. Organized volunteer groups may go for two weeks or more of “cannon netting” where they shoot up a net and catch birds, so they can weigh and band them, or even attach transmitters to track their migration. Perhaps without realizing it, such committed people are making a major contribution to serious science.
There are similar projects like Earth Watch and Environment Watch that people do now, and everyone has a cell phone and a camera. If people are interested in a particular species or life form, they may count the same sites over and over at different times of the year, and so on. Once you do that, you’re actually doing science.
That’s how the July 4 butterfly count came about. Volunteers have a protocol and take on an area and do the same counts at the same time every year.
That’s how we can involve more people in science, by making them part of it. This is an emerging effort and there’s a lot of interest.
Your book on pandemics provides an overview for lay readers and tackles intriguing questions such as “What is snot?”
It’s really a book to help people understand infectious disease and immunity and how it works. What I wanted to do was to talk about prevention and give an idea of the nature and likelihood of the threats that are out there. The publishers hope to get it into colleges as a primer on infectious disease.
Your writing has been praised for its clarity and accessibility.
I’ve always liked writing and, in fact, in school, I thought about becoming a journalist. I would have been working for the Murdoch press and would likely have ended up as a depressed, morally bankrupt alcoholic.
You’ve done some remarkable work to demystify science and you emphasize the importance of correct use of words that many of us just throw around, such as the distinction between bacterial and viral disease.
Yes, for example malaria is caused by a protozoan or a bacterium [not a virus]. It shows the depth of ignorance that journalists, for example, can confuse a drug and a vaccine. That’s so basic. You inject the drug and the drug gradually does its job and is gone, but you inject the vaccine and it creates an immune response that stays. There’s a huge difference.
And now you have controversy as celebrities without a background in science attack the very idea of vaccination.
It’s a total disaster. We have a culture where people don’t even recognize their level of ignorance and there’s no desire to really find out.
And you started your career in veterinary science.
Yes. It was the British system [of education] in Australia so you went straight to professional training right out of high school. So I decided to study veterinary science at the age of 16. If I’d gone to an American college, I’d probably have been a historian or a political scientist.
What inspired you to pursue a career in immunology after your work in veterinary medicine?
My cousin was a medical virologist who trained in Australia and was very bright academically. He worked for the government and attended the Harvard School of Public Health. At that time there was a tremendous effort, funded by the Rockefeller Foundation, to discover and characterize mosquito-borne viruses, and he isolated the Ross River virus in Australia, which causes human epidemic polyarthritis with rash. It’s very similar to the Chikungunya virus, which spread recently into India and into Southern Europe.
I was intrigued by what he did, but I didn’t want to do medical work because I didn’t want to be a doctor. My 16-year-old idea of a doctor was someone who sat in a room and listened to people whine about their imaginary ailments.
I was very altruistic and decided to work on infectious diseases of animals and save the world by producing more food. At that phase of life, I was going to the Methodist Church and reading Hemingway, Sartre and Aldous Huxley, so you can imagine how confused I was.
What do you think of science education in the United States?
You have really passionate young people in graduate programs who are committed and tremendously enthusiastic. But getting even basic principles into a broader spectrum of the community is difficult. The American college is wonderful because it gives you some science and some arts, but some students manage to learn nothing and escape completely unscathed.
I’ve just been to Athens, Georgia, which is a nice university. It has the agricultural and veterinary school and liberal arts and some big government projects. Their congressman is a medical doctor who not only believes that evolution is the work of the devil; he also thinks that the science of embryology is the work of the devil -- that human development is the work of the devil. So he’s a physician who went through his whole medical training and was totally turned off from the science. He’s learned the medical trade but he’s learned nothing of the intellectual basis for what he’s doing. It’s extraordinary, and it’s not uncommon.
There’s a sense that people in China and India are getting better training in the sciences than students in the U.S.
It’s their culture. In Europe, our ancestors slept through the winter. It was very cold and there wasn’t much food around so they didn’t do much. The Chinese, seven days a week, 365 days a year, were tending rice paddies. That’s part of it, but the triumph of our more “relaxed” culture has been the European Enlightenment. In recent years, the Enlightenment itself is being turned back.
It seems that some American fundamentalist Christians view science as anathema.
They’re interesting. Some fundamentalist groups are very upset about climate change and the destruction of God’s creation. They want to do something about it and can be very good on environmental issues. And some are not so good and identify with the extremist community and focus on God, not on the world we live in.
If you look at the history of Protestantism, the defining point is when people could read the Bible. That led to not accepting authority, but taking everything from the Bible. The six thousand year [age of earth] nonsense came from a bishop in Dublin, in the Church of Ireland, who went back and counted generations, and that became the dogma. Then they have to reject just about all have the science, and it really gets quite mad.
Would more government support of science education improve the overall understanding of science in the U.S.?
I’m not sure. A lot of Americans don’t like their view of the world disturbed and science is constantly in revolution and overturning. Science is never quite right, that’s it’s own irony. Conservatives say, “That’s the way it is and always will be,” but that’s not how science works. It’s in constant turmoil.
That constant flux may be intimidating for some people.
I don’t know why it’s so intimidating. It’s not that difficult.
You deal with terrible pandemics in your new book, but you seem very optimistic about the ability to treat most future illnesses.
You can never tell if something might come out that is truly horrible, but if people think the climate change will be solved because God will send some great plague, forget it. That’s a cop out.
Another thing that annoys me is the American Fear Industry. With this constant terror and “be terribly afraid” mantra comes the largely useless monitoring of emails and all the security at airports. Some of this has become quite mad.
And all of these people who are carrying guns: I had dinner with a former DA [district attorney] in Oregon and he said that more than half of gun deaths are suicides. It’s too easy. It takes a lot more to cut your wrist than to pull a trigger. People get depressed and act spontaneously with a gun, and they probably would not do it if they couldn’t just pick up a gun and, bang!
It must be especially challenging to address infectious diseases in poverty-stricken nations of the developing world.
In 2009, the swine flu in the West was relatively benign. I think about 350 children died in the U.S. Older people didn’t die because they had persistent antibodies from infection with a cross reactive that was circulating before 1950. A lot of younger, pregnant women ended up in critical care, and some otherwise healthy young adults needed a heart-lung machine to breathe. It was very bad in some indigenous populations, including Amerindians and Australian aboriginals and it was very bad in India. Part of this may be a reflection of poor, underlying health in these groups, but there may also be some basic genetic susceptibilities
And isn’t it critical to have an effective public health structure?
You absolutely need a functioning public health system, and you have a very good structure in the U.S. with the CDC [Centers for Disease Control] out front. This is a very important service and, in cutting costs, we have to be careful with regard to public health. It cannot be done by the private sector. I believe in taxation and that rich people should pay 90 percent tax on anything over five million a year, with a 100% percent exception for philanthropy and /or investing in creating real jobs for their fellow U.S. citizens
And there’s been a great shift of wealth from the middle class to the richest Americans in the past few decades.
If that wealth was in the hands of the middle class, they’d spend it, and the country would be in much better shape economically. There’s a lot of money washing around but what’s happening with it? There are lots of $100 million+ yachts parked on the French Riviera, Every two years they need to be cleaned, at a cost of about ten million dollars. Think what you could do with ten million dollars in some of the NGOs, for example. The millions are in the hands of the wrong people.
Is there anything you’d like to add about what you hope the public will consider about health and science issues?
One thing is to get the kids in science learning early and keep the public health services strong.
Also, the left needs to be less virulent about the drug and vaccine companies because, quite frankly, if we didn’t have those private industries, we would not be in a position to get vaccines out there. We need to look at these issues rationally. I’m a believer in the capitalist system for producing products rapidly and efficiently. We cannot degrade that and expect a rapid response in the face of a major pandemic threat.
But I think American capitalism has gone down the wrong track for short-term profit, whereas some European (and most Asian) companies are investing a lot in long-term strategies and in vaccine and drug development. Some of the U.S. companies are relying too much on universities for their research and buying it when it’s already developed. If we cut back on university and NIH funding, that won’t be available either.
America does not have as cheap a labor force as China, though we’re getting there. But America’s real advantage is that it’s an open society where science is actually done very well. If you stop funding that science, you will cut back America’s competitive capacity.
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