In an era of sophisticated technological advances and medical breakthroughs, the study of communicable disease seems to fall far more squarely within the purview of modern science than the humanities classroom.

The benefits of studying epidemics through a historical lens may seem irrelevant to modern public health concerns. Bygone plagues like the black death and the Spanish flu call to mind ghastly historical dramas and Monty Python skits, ostensibly far removed from the sanitized comforts of modernity. However, the contours of the COVID-19 pandemic actually bear a striking resemblance to many historical plagues.

While modern medical advances — such as vaccines, pharmaceutical agents and centralized public health agencies — have significantly improved health outcomes in some communities, many of the most pernicious social and political consequences of communicable disease persist.

Epidemics do not exist in a biomedical vacuum. They have always been configured by collective experience, ecological circumstances and social values. As people travel, interact and occupy shared spaces, microbes spread alongside patterns of human sociability and commerce. Our perceptions and framing of epidemic diseases are constructed through many social forces that are often intimately intertwined with bureaucratic processes, political agendas, structural racism and entrenched socioeconomic disparities.

Historical analysis remains an indispensable tool for understanding the deeply rooted social causes and consequences of epidemic disease.

Teaching historical epidemics at Roosevelt

Examining rats for bubonic plague in New Orleans

As a historian, my interest in epidemics began long before the current pandemic struck.

Inspired by Roosevelt’s social justice mission and interdisciplinary curriculum, I began teaching the history of epidemics several years ago. I wanted to address historical processes of medicalization and how social and cultural assumptions about disease have influenced the development of public health systems.

The stories of disease emergence also call attention to how the pernicious legacies of colonialism and the genesis of the global economy continue to influence political responses to pandemics. The patchwork of divergent COVID-19 containment policies and strategies across the globe not only reinforces the divide between the global haves and have-nots, but also reveals just how quickly pathogens overwhelm our vulnerabilities.

Pathogens don’t care about international borders and political ideologies. The folly of privileging personal freedoms over the spirit of global cooperation and scientific expertise has clearly been to our detriment, as evidenced by the staggering rates of COVID-19 in the United States.

Historically, epidemics generally become infamous when outbreak narratives try to contain communicable disease by locating where it originated. Narratives fueled by scientific knowledge, medical expertise and global cooperation ideally provide our best chance of mitigating the damage wrought by the proverbial Pandora’s Box of pathogens.

However, as history reveals, the outbreak narrative constructed by context-specific forces such as the media, popular opinion, religious dogma and political influence, is rarely without biases. These narratives have often led to targeting marginalized populations or nefariously exploiting diagnosis as a mode of social control. The global north has a long history of medical discrimination masquerading as public health mandates, from the scapegoating of Jews during the 14th-century European black death epidemic to the reprehensible Tuskegee syphilis study of 1932–72, which subjected Black men to appallingly unethical medical experimentation and deliberate denial of treatment.

Typhoid Mary and the dangerous biases of COVID-19

U.S. Army Hospital Number 30, Royat, France: Patients at moving picture show wearing masks because of an influenza epidemic

The connection between discrimination, medical stigma and the politics of blame and responsibility that has underscored many epidemics is perhaps most famously exemplified by the case of Mary Mallon, otherwise known as “Typhoid Mary.”

Mallon was an Irish cook in Oyster Bay, New York who public health authorities forcibly quarantined during a 1906 typhoid outbreak. As a “healthy carrier,” Mallon did not experience symptoms of the disease, but public health officials still identified her as the source of an outbreak that infected several members of the household in which she worked.

Perhaps this containment strategy might have been more effective had it been uniformly required of all asymptomatic carriers, but it was arbitrarily imposed on marginalized people like Mary Mallon. As a working-class, Irish immigrant who occasionally cohabitated with a man to whom she was not married, Mallon did not conform to norms of middle-class white femininity. Thus, she posed a threat to the dominant social order. Although her forced isolation was supposedly a public health directive to prevent her from transmitting typhoid to others, it was also a product of moral panic and bigotry.

Mallon’s identification as a so-called healthy carrier certainly serves as an important cautionary tale relevant to our own experience with the COVID-19 pandemic. Just as some people now refuse to follow social distancing and mask-wearing mandates because they wrongly believe they cannot infect others in the absence of symptoms, so too did Mary Mallon have profound misgivings about her identification as a public health threat.

Unlike the relatively minor convenience of wearing a mask that has become the ubiquitous symbol of the COVID-19 pandemic, however, Mallon’s penance was far more severe. She remained in a state of involuntary quarantine for 23 years during her virtual imprisonment and isolation on North Brother Island.

Racism and epidemics

Public health quarantine poster from early 20th-century Connecticut

Engrained prejudices and dangerous biases continue to dominate much of the outbreak narrative of COVID-19. The rhetoric advanced by the Trump administration, which repeatedly identified COVID-19 as “the China Virus,” is riddled with a dangerous medical nativism that not only labels certain nationalities and immigrant groups as inherently diseased, but has also directly resulted in a rise in hate crimes and violence targeting Asian Americans.

Sadly, the COVID-19 pandemic is not the first time that racist rhetoric and the policing of non-white bodies have informed the global North’s response to epidemic disease.

Long before the advent of centralized public health agencies, many colonial projects unleashed devastating epidemics on indigenous populations: smallpox in the case of the Americas, cholera in British India and sleeping sickness of the early 20th century in East Africa. These epidemics resulted from large-scale movements of people and domestic animals mandated by colonial management.

Early colonists saw the disparity in infectious-disease mortality as a sign of the righteousness of the European imperial project and evidence of the relative frailty of colonized bodies. That disparity eventually hardened into racial hierarchies based on the eugenic fiction of innate biological differences. However, the European body was not invincible in the face of pathogens, as evidenced by the staggering 30 to 70% mortality rates in the first year of European settlement on the Gold Coast of West Africa.

Epidemics also demonstrate that medical discourse has also historically employed silence and the language of exclusion as a means of perpetuating racist binaries. In the case of yellow fever, which devastated the American South through much of the 19th century, colonial stereotypes about the innate immunity of Black bodies to yellow fever led to the exclusion of African Americans from the historical record, which instead generated a heroic narrative of white suffering and sacrifice. White people embraced the stereotype of Black immunity as a justification for slavery and coerced African Americans to work in perilous, mosquito-infected conditions that were deemed unsafe for whites.

Although yellow fever no longer poses a threat to the global North, the legacies of colonialism and its characteristic binaries continue to pervade the associations between pathogens and places in modern epidemics. In the American and European worldview, the “Ebola” virus has cemented colonial stereotypes of Africa as filthy and primitive in contrast with the medical modernity of the global North.

COVID-19 and existing injustice

Although the diseases mentioned in this essay represent radically different contexts in time and place, the uncanny similarities among them should serve as a reminder that COVID-19 remains a litmus test of our own institutionalized inequities and disparities.

From the documented racial inequities of COVID-19 vaccine distribution to the vastly disproportionate number of COVID-related deaths within communities of color in the United States and beyond, tackling this epidemic isn’t just a matter of high-tech laboratory research. It will also require introspection to recognize how public health events heighten and exacerbate systemic inequalities.

While the peril of communicable disease remains a global threat, the lessons of past epidemics offer a unique opportunity to explore history from a vantage point that lays bare the best and the worst of humanity in times of crises.

The persistence of epidemic diseases, like COVID-19, continues to reinforce the importance of collective responsibility and the dangers of prioritizing individual entitlements over the health of populations.