How Important is the Weight of History in Shaping Covid Responses?

There’s an interesting pattern that emerges from the coverage of how different countries have performed in their Covid-19 response: it is greatly influenced by their experience of previous disease outbreaks: 

Kerala had Nipah, which made all the difference according to this piece in The Guardian

China had SARS and South Korea had MERS

West Africa, Uganda and DRC had Ebola

But the worst-hit areas – Europe and the US – have a collective narrative that has been shaped by the flu, a much more humdrum disease, with a vaccine. Could this be to blame for a laxer response in parts of both, with great costs?

This is about a society’s readiness to take a threat seriously and make sacrifices while there is still time, more than just health authorities and others learning from the last outbreak, although that’s important too.

There’s also a temporal aspect – memories fade, but Nipah, SARS, MERS, Ebola etc are recent enough that health systems (formal/informal) and social norms are still highly activated in the policy and social consciousness – like a societal immune response. In contrast, Spanish Flu, which caused havoc in Europe after World War One, has since faded from the collective memory – society has lost its antibodies.

This could also help explain another oddity. The pre-Covid global ranking of pandemic preparedness bears no resemblance to countries’ actual performance. In that index, the US ranks first in preparedness, so either the measures they use are inadequate or politics and other factors (such as memory of previous disease responses) play a much much greater role than the index allows for. 

The Index claims it ‘provides a comprehensive assessment of countries’ health security and considers the broader context for biological risks within each country, including a country’s geopolitical considerations and health system and whether it has tested its capacities to contain outbreaks.’ I presume there is some serious rethinking going on about how it measures these things.

There is a global element to this process – the WHO tries to learn lessons and spread them around. According to a recent piece in The New Humanitarian, ‘The 1995 outbreak of Ebola haemorrhagic fever in the Democratic Republic of Congo prompted the World Health Organisation to create global intelligence and response networks that became instrumental when rumours of a “fatal flu” arose in China in late 2002.’ But if this runs up against a different national experience, it seems likely to founder.

Obviously, these are massive generalizations and raise lots of questions:

How has the fact that we know how to prevent the spread of HIV affected the South African and other heavily HIV-affected countries’ responses? Has it made countries with wider ARV availability more complacent than those with higher death tolls?

History is not destiny: Brazil under Lula might well have taken a different path than under Bolsonaro; Kerala under a different health minister might well have done things differently.

In Europe, some countries (Germany) have done much better than others (UK).

I keep coming back to that wonderful quote from Marx about the interaction between history and human agency:

‘Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given and transmitted from the past. The tradition of all dead generations weighs like a nightmare on the brains of the living.’

And there were some dogs that didn’t bark – Zika doesn’t seem to have helped Brazil much. Why not?

One hopeful final thought, does this mean flu will be replaced by Covid in our collective memory, so next time we’ll do better?

When I asked Melissa Parker about this, she pointed out ‘The dark side to responding needs to be foregrounded too … in Uganda Museveni is clearly using COVID-19 to further political power. Superficially, it looks as if he is acting responsibly and able to do so because he is able to capitalize on recent experiences and memories of Ebola, but in practice the brutal imposition of lockdown is creating hunger, and people are afraid of attending health services. Will we see what we saw in Sierra Leone – that more people end up dying of malaria, maternal deaths etc than ever die from COVID-19?’ 

Thanks to Anna Marriott for her suggestions on this post

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Comments

3 Responses to “How Important is the Weight of History in Shaping Covid Responses?”
  1. A good, thoughtful piece.

    You might have added also (except that Oxfam has to mind what it says about governments) that political ideology has played an important role. Three of the worst Covid-19 infested countries – UK, US and Brazil – all have right wing libertarian ideologues in charge, for whom big government and strong institutions are anathema.
    It was once put very clearly (and idiotically) by Boris Johnson in 2006:

    ‘The real hero of Jaws is the mayor. A gigantic fish is eating all your constituents and he decides to keep the beaches open. OK, in that instance he was actually wrong. But in principle, we need more politicians like the Mayor.’

  2. This is really interesting. But I don’t think there ever was a clear learning process around the spread of HIV. You say here that “the fact that we know how to prevent the spread of HIV”. Knowing how HIV is transmitted didn’t stop more than 30 million people becoming infected by 2001 when antiretrovirals started to become widely available. Most histories of HIV are histories of the development of treatment and the advocacy to accelerate and make that treatment more widely available. The years between 1984 and 2001, which is the history of the main spread of the pandemic, are really poorly examined. The current debates on behavioural change in particular don’t reflect the real lessons of HIV social and behaviour change communication that HIV was fundamentally driven by poverty, inequality, gender disparity and closed, rather than open, public debate. The countries which did best (or which ironically Museveni’s Uganda was one) were characterised by good leadership, a commitment to open debate, political pluralism and action and agency by those most affected. But this is a history that has been poorly captured let alone embedded in public health strategies. More on this here by Caroline Sugg https://www.bbc.co.uk/mediaaction/publications-and-resources/policy/briefings/role-of-communication-in-global-health

  3. John Sayer

    Over 40% of SARS deaths (299 of the 744) occurred in Hong Kong, which doesn’t register in your graphics or your analysis.
    UN bodies like the WHO suffer from adherence to formal political protocols in their reporting , fearful perhaps of offending member states. This approach sacrifices real and complete understanding of important lessons related to different health policies.
    Surely the WHO can include health analysis from territories that have separate administrations, separate health systems and separate immigration policies without being accused of breaking any UN principles. If lessons from SARs and COVID-19 do not take account of the policies of Hong Kong and Taiwan, we are putting politics ahead of health.
    Hong Kong is part of the country where COVID-19 began, yet the territory has had just over 1,200 cases, 7 deaths, and virtually no local transmissions over the past several weeks. Taiwan has had no Covid-19 deaths since mid-May with a total of 447 cases and 7 deaths.
    Is anyone interested in lessons from these places, or are the 7.5 million people in Hong Kong and the 24 million in Taiwan not worth factoring into the picture?
    The nation state may possibly not represent the end of history.

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