Pod Insights American Scandal The Plague of San Francisco | From Plague to COVID: What We Still Haven’t Learned | 5 About this episode Physician and historian Dr. Howard Markel reflects on the legacy of the 1900 San Francisco plague and how its lessons still echo in today’s public health crises. Drawing on decades of research and firsthand experience, Markel explains why trust, transparency, and early action are critical—and why we continue to struggle with them.
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0:00 Lindsay Graham? Audible subscribers can binge new seasons of American Scandal early and ad-free right now. Join Audible in the Audible app or by subscribing on Apple Podcasts.
0:21 Lindsay Graham? From Wondery, I'm Lindsay Graham, and this is American Scandal.
0:44 Lindsay Graham? In 1900, the bubonic plague arrived in San Francisco. The disease spread quietly at first until bodies began to appear in Chinatown. Then it was up to Dr. Joseph Kinian, one of the country's top public health officials, to try and contain the outbreak. But Kinian quickly found himself battling more than just a disease. City officials feared panic and economic collapse. Business leaders prioritized profits over safety. Newspapers denied the plague's existence, and anti-Chinese racism turned a public health emergency into a political firestorm. Dr. Kinian's efforts were therefore met with resistance, denial, and sabotage, and in the end, he was pushed out. Over a century later, many of those same tensions resurfaced as COVID-19 spread throughout the world.
1:29 Lindsay Graham? Once again, we saw how public safety efforts were eroded by the distrust of science, politicization of health measures, and institutional failures at the highest levels. My guest today is Dr. Howard Markel. He's a physician and historian who has written extensively about the history of epidemics, quarantine, and the public health institutions we rely on in times of crises. We'll talk about what we've learned and failed to learn from past infectious diseases, and how politics, greed, and misinformation continue to shape the way we respond. Our conversation is next.
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3:14 Lindsay Graham? Dr. Howard Markel, welcome to American Scandal.
3:16 Speaker 03 Thank you for having me.
3:18 Lindsay Graham? Let's start with perhaps what might be the biggest fear in public health, a major pandemic, a disease so deadly it wipes out portions of the population and leaves the world in a sort of post-apocalyptic state. Is any such disease likely, let alone possible?
3:34 Speaker 03 Well, you know, if you were designing the perfect virus to spread quickly and attack a, in air quotes, a virgin population that had not experienced that particular virus, COVID-19 is a pretty good choice. I mean, we were really devastated by that. And it was easily transmissible by coughing or sneezing or breathing, you know? That's the nightmare scenario. Other things that are, have been pandemics in the past, a cholera, for example, that's been cleaned up quite a bit by, you know, indoor plumbing and clean water supply. Because that's a gastrointestinal virus, but something that is so easily spread.
4:18 Speaker 03 That was the scary scenario we had been talking about for many, many years. And it is interesting that for all of our plans for influenza, then coronavirus, which I can tell you as a pediatrician needs to see a dozen times a day during the winter, but a milder version that looked like a common cold. But coronavirus really came out of nowhere, if you will, and really, really devastated a great many people.
4:45 Lindsay Graham? But those are the pandemics we're aware of and have dealt with in the past. The more science fiction version of this is not only one that is highly transmissible, but highly deadly.
4:54 Speaker 03 Well, COVID was pretty deadly, by the way. As a historian of medicine, I'm uncomfortable with the future by definition. But I would suspect there are hundreds of viruses brewing out there in different animal communities. The bat community, for example, is the specially hot zone of crazy viruses that are growing. But because these viruses are circulating in different species and potentially mutating, we don't know what the next strain of whatever will look like and how strong it may be. And I can tell you that having been around people who predict these things forever, we're often wrong about that.
5:39 Speaker 03 But we're talking about something easily transmissible, which is likely by respiratory viruses. So that includes a whole, several families of viruses. Influenza, coronavirus, parvovirus, adenovirus, and so on. One of the things we need to do is to surveil what's going on. What is circulating out there, not just in America, but say in Africa or in China? We also need all these countries to be far more transparent about what's brewing and being transparent about sharing viral samples when something pops up, an epidemic slash pandemic, so that we can make proper vaccines and antivirals against them. That didn't happen with COVID.
6:23 Speaker 03 In fact, China was very uncooperative, both with their transparency of what was going on and in terms of vaccine production, which also is a nightmare for public health. Because if a country makes a bad vaccine or a vaccine that doesn't work, an ineffective vaccine, that doesn't help in terms of the spread of that disease. It actually potentially worsens it.
6:47 Lindsay Graham? So it sounds like although the pure television apocalypse is probably unlikely, another pandemic is very likely, though when and where we don't know. But walk us through how such a pandemic might begin and how public health officials would need to address it. Is there some sort of standard operating procedure? Or is each situation, each disease, each nation, each locality so different that it requires a different approach?
7:12 Speaker 03 No, no, there are very standard protocols for all kinds of outbreaks, whether they're gastrointestinal, if they're the easily transmitted respiratory viruses we're talking about, tuberculosis control, HIV/AIDS control. There are actual protocols that have been written and are updated by the CDC and the public health service, as well as other countries, of what they would do for various situations. Every developed country has some type of a CDC or a public health arm. In an ideal world, they would all be on the internet, talking to one another immediately. And we're seeing a cluster of people dying of, you know, pulmonary situations.
7:55 Speaker 03 It's clearly infectious and that goes out everywhere. And then they start saying, hey, we've actually cultured this from somebody. We're going to share the sample with the lab in Hamburg and the lab in Washington or Atlanta, and they're going to get the genome of it and so on and so forth. But without that transparency, without that constant communication, without that constant surveillance, you can't have the right actions that need to follow. With all those things, you can do a pretty good job, and you could never have done a better job than today because it's so fast, the way we could talk to one another and figure things out. It took centuries to figure. Figure out the microbe of plague, your city of pestis. It took several years for HIV AIDS.
8:39 Speaker 03 It took eight days for SARS to get the actual virus. It took a day or two to get COVID. That is progress. We also have very standard procedures of diagnosis, of isolating people, of using social distancing measures. You know, for example, the measures that we use to shut down businesses, public closures and so on. We developed that, my laboratory at the University of Michigan and the Centers for Disease Control, using 1918 flu data. But we have been planning for this kind of stuff. Tabletop exercises and experimental exercises and public health protocols for years, for decades.
9:25 Lindsay Graham? Your reference to using data of the 1918 flu to combat the COVID-19 epidemic makes me think that we've had over 100 years of increased understanding of disease and infrastructure to fight it. What do you think have been the greatest public health victories over the last 100 years?
9:44 Speaker 03 Well, that's just one of them that you've just mentioned. I mean, we didn't even know anything about viruses in 1918. In fact, they thought influenza was caused by a bacteria called Haemophilus influenzae. And they made the wrong vaccine to that particular microbe, which would not treat viral influenza at all. But all the processes of how we handle an infectious disease today. You know, for example, China started reporting cases in mid to late January of 2020. We had the genome, the actual map of this virus, within days. And then the vaccine, which we thought would take years,
10:27 Speaker 03 because it was a tough virus to make a vaccine against. They pulled off the shelf this mRNA vaccine technology, which was really being developed 10 or 15 years back for cancer vaccines as science fiction-ish.
10:43 Speaker 03 As that sounds, but because that technology existed, we short tracked or fast tracked, I guess I should say, that vaccine. The other vaccines that we give and that I've given forever as a pediatrician, you know, against all sorts of diseases, diphtheria, pertussis, whooping cough, polio, measles, you know, been a pediatrician for over 40 years. I never seen a case of measles, although I might see one now. I've never seen a case of polio. I haven't seen a case of chickenpox in years because we have vaccines for all that. And that is a good thing. That's like nine out of the 10
11:24 Speaker 03 greatest hits in medicine. So there's an amazing amount of progress that has been made in the last century. But what was neat about using the 1918 data for social distancing was that you needed a period where there wasn't anything for infectious disease but hiding, because that's what social distancing is. It doesn't cure you. It doesn't make you immune. It just buys time in a modern era to make vaccine, which is exactly what we did. So we use the old to help the new. Really remarkable, I think. Combination of the two.
12:01 Lindsay Graham? Do you believe it might be part of the success of vaccines, especially the measles vaccine? That is exactly as you state, we haven't seen these diseases in a long time. And so we forget perhaps their danger?
12:14 Speaker 03 Absolutely. I mean, measles is one of the safest vaccines around. It's very cheap. It's about 24 cents a dose or less. And it has been used forever. It's one of the safest vaccines around. But no one remembers how sick you get with real measles. And the fact that some, a minority of them, but some kids get terrible brain disease and some die. Okay? So it's a disease best avoided, but nobody, nobody remembers it. So it said they, they, they focus on that risk that they heard that it might cause autism, which has been, of course, disproven by every modern and major scientist. ...body in the world.
12:56 Speaker 03 That guy Andrew Wakefield, who made that fake study and it was published in Lancet years ago, has been deemed by Time Magazine, "One of the worst scientists of all time." And it's well deserved. But they keep bringing that trope back and our current Secretary of Health and Human Services is not helping things any by casting doubt on vaccines. But we don't have all of these terrible killers that used to routinely kill children and adults all the time, a hundred years ago.
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15:31 Lindsay Graham? In addition to misinformation, like the dangers of vaccine, it seems also that there is almost always some sort of denial to any major disease outbreak, denial by business leaders or politicians and press. Why is denial or even cover-up such a recurring theme in public health crises?
15:50 Speaker 03 Well, it's one of the great no-no's and common realities of epidemics past and present. There's a variety of reasons why somebody or a group or an institution might cover up an epidemic. Business concerns, for example, have traditionally not liked the declaration of a public health emergency because commerce often stops. You know, commerce requires the flow of goods and services and people from one place to another. So if that supply chain, which has become even more complex and more dependent, you know, each day on something coming from Pakistan to China to America or vice versa, you know,
16:30 Speaker 03 in a matter of a day or so, that is very tenuous, very fragile and easily broken. Governments sometimes don't like to announce that they have a pandemic brewing. China with SARS, for example, in 2003, they covered that up and it caused the spread of it. By the way, the good thing was it only caused about 8,000 deaths in the world, but coronavirus, which they were also very slow to tell other countries about, that inevitably, absolutely...
17:03 Speaker 03 Cause further spread of that disease when it was still an epidemic and might have been contained a bit better if there was more transparency. So yeah, concealment is is frequent. Why people would lie about that as a doctor, I have no clue. It's counterproductive. It never ever works. And yet it's something that institutions have done quite a bit over over over centuries.
17:31 Lindsay Graham? So given that there are real economic costs to public health restrictions and policies, how do policymakers balance that cost against the benefits of safety measures, especially when a new disease is unknown and untested?
17:45 Speaker 03 It's very tough. There's that tug of war that you just mentioned, commercial concerns, which are not insignificant. You know, I mean, commerce is important versus public health concerns. Now, as a doctor and someone who's worked in public health, I rely on the ancient Roman law tenet, which is that the health of the many outweigh the the needs of the few. So the health of the population, I would argue, when it's facing down a terribly deadly infectious disease outweighs the need of business to continue. I have had many colleagues on the opposite side of that argument. You know, it's a multi-lane approach, too. It's
18:23 Speaker 03 not just closures versus open. You know what I mean? There's a there's lanes of, you know, let's say, school closures, which wasn't something that worked very well for coronavirus because kids didn't seem to get it as much as adults. But that would be something very valuable. For example, during influenza epidemics, would antivirals or an antibiotic or stockpiling or face mask? That was another big area of confusion. There's many lanes, there's many approaches, but when pandemics happen or epidemics happen, it's often a zero-sum game that if your approach wins, mine loses, or mine doesn't get funded. And that kind
19:05 Speaker 03 of football game is very frustrating and very difficult to maneuver and negotiate, I must confess, and I've been in the middle of them. And the inability to surmount those problems costs people's lives. You can't stall. You can't wait. You can't delay when you're trying to save lives.
19:25 Lindsay Graham? As we saw in our series about the bubonic plague in San Francisco and as we witnessed in the COVID-19 pandemic, these tensions are real and are very political. How do public health officials manage this game of football? How do they maintain balance?
19:40 Speaker 03 Well, they're a lot better at it now than the 1901 epidemic of bubonic plague than it was primarily a quarantine of San Francisco's Chinatown and bubonic plague was thought to be, literally, I'm quoting the newspaper, "a disease of rice eaters," Chinese people, Asian people, "but would not spread to meat eaters," meaning Anglo, like Californians. And if you looked at the quarantine line, it was literally Chinatown, even though Chinese people might be crossing the street to work in a hotel. And it was very, very, very suppressive. And both the federal government, what was the precursor to the Public Health Service,
20:20 Speaker 03 and the local public health government in San Francisco made the Chinese people living in Chinatown take a bubonic plague vaccine, the half-kind vaccine, which was not entirely safe. It's a very unwieldy, dirty vaccine, if you will. It wasn't all that protective, and it could cause problems, including getting plagued. So it wasn't like a vaccine like today. It was kind of a vaccine you would not line up to take. And the Chinese people were aghast at having to line up and being forced to do this. So they sued the government and used the 14th Amendment, which I love. These immigrants used the 14th Amendment that all people need to be treated equally, and they weren't. And they won. Sometimes
21:05 Speaker 03 the underdog wins. Most times, they don't. What we have gotten better at, I would argue, we're not perfect at it, but we've gotten better at treating people like human beings, you know? We're not throwing them off on a quarantine island just to suffer and/or die. We have translators. We are concerned with those that we social distance, that they have access to, you know, human contact, medical contact, food, et cetera. It's way different than when we threw typhoons. Floyd Mary on North Brother Island in the nineteen teens. We still have a long way to go towards improvement. We saw during the COVID nineteen pandemic in America that there were some outbreaks of
21:47 Speaker 03 nativism and ugly behavior towards Asian people. We saw that some people didn't want to treat COVID people. We saw that with HIV AIDS. And we knew that HIV was contracted in a very specific way. And yet there were doctors and nurses who wouldn't treat HIV patients back then. So there's all these kinds of tensions. Underlying it all is our natural fear of getting sick by a microscopic invisible organism. It's terrifying to most of us if we admit it.
22:18 Lindsay Graham? In our series, Joseph Kenyon was a doctor severely hampered in his efforts to fight the plague by his personality in many cases. He was a gifted doctor, but he was a bit perhaps arrogant and argumentative. How are public health officials today trained in the art of communication?
22:35 Speaker 03 Kenyon's a fascinating guy. He was a lab guy, though, you know? He was never meant for that role. And there are many actors on the stage of a public health crisis, but not one person can do all of them. But today, public health officials, you know, whether they work for municipal or a state or the federal government or NGOs, even in medical school, are trained how to deal with different constituencies and to change the tenor, how you describe something, how you explain something, you know? How I would explain COVID to a medical student or to a colleague is very different than a child or a teenager to a parent.
23:20 Speaker 03 We were not taught this forty years ago. Another thing that has changed vastly in medicine and public health from Kenyon's day to today is that, first of all, a very small number of all men, it was all men who were in this field. Back then, the US Marine Hospital Service, because it wasn't the United States Public Health Service till nineteen twelve, these were about a hundred 150 men who came from, you know, mostly eastern universities, Yale, Harvard, Johns Hopkins. There were often white Anglo-Saxon Protestants. There were a few Jewish members, but they were in the minority. There were no African Americans, you know, a handful of women involved.
24:05 Speaker 03 And there was real cultural differences. And I got to tell you, even when I was an intern at Johns Hopkins in 1986, you know, the residents, these were blond-haired, blue-eyed, preppy fraternity members of eastern establishments, treating largely, for example, in East Baltimore, African-American patients from very impoverished backgrounds, Latino immigrants. It was a real culture shock and it didn't work very well all the time. There was a lot of arrogance and bad behavior. There still exists, it's not perfect, but we are getting better at it, I'm glad to say. And I've seen that over my own career.
24:47 Speaker 03 But the people I write about, like Joseph Kinian, were beyond arrogant. And it was a disaster. It was a disaster.
24:55 Lindsay Graham? Well, if there was a foil to Kenyon, it might have been Dr. Rupert Blue, who kind of emerged as a bit of the hero of the plague in San Francisco. Why was Blue better than Kenyon in the final analysis?
25:07 Speaker 03 Well, Blue's an interesting guy, by the way. And in some books, some secondary histories, particularly about the flu pandemic, have made fun of him and stupidly so, they don't understand his career. He was actually a pretty good public health worker. He was also surgeon general. So he rose to the top. And individuals who rise, you know, to that level are often very good. Not always, but often they become that role because they are gifted at a particular thing. And Blue was good at the politics of public health. And you have to remember that the first word in public health is public. And you have to deal with a huge constituency of different types of people
25:48 Speaker 03 with different types of goals, aspirations, needs, et cetera. And you have to constantly. Really adjust your message to those different constituencies because most people don't want to do what you're asking them to do. And most people are afraid that you're going to in some way impinge on their liberties. So to tightrope, very few people are good at it. And particularly then where they were really flying by the seat of their pants. They were figuring it out on their own. They weren't going to school yet, you know, in 1901 to learn how to be a good public health official. And a lot of them are not so good. A lot of them are really more like police officers, if you will.
26:32 Speaker 03 They are medical professionals.
26:35 Lindsay Graham? You mentioned the ineffectiveness and just blatant racism of the quarantine of Chinatown during the 1900 plague in San Francisco. It seems that race and racism are constant themes in public health matters. Why is it that race is so often used as a scapegoat during a health crisis?
26:55 Speaker 03 Why do we scapegoat? We love to blame people. You know, human beings love to blame one group or one target for whatever disaster befalls them, even if it's completely false. Now, frequently, because germs do travel in the bodies of living beings, certain travelers have brought an infection from point A to point B. And they might be from country X, Y, or Z, you know? And that might not be a particularly desirable country to country Q, you know? Remember when HIV started in the eighties and it was blamed a lot on Haitians? And that was a so-called risk factor.
27:36 Speaker 03 It wasn't a risk factor at all to be from Haiti. It was a risk factor because it was in the seventies, a very popular gay vacation spot where there was a great deal of sexuality going on, as there was in places like New York and San Francisco. So there was a great deal of virus passing around. But it wasn't because people were from Haiti per se, but that was something people blamed. You know, the FDA would not allow Haitians to donate blood till, unless... Ten years ago, I forget when they lifted the ban, but it was because of HIV. We blamed Russian Jews for importing cholera and typhus into New York in 1892.
28:16 Speaker 03 It's just a common ugly theme, racism slash nativism slash anti-immigrant fervor. So we're at real risk for that right now, where anti-immigrant fervor is so strong. And the president has really used immigrants as a scapegoat for lots of things. So I do worry about that particular combination, that very volatile combination.
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29:24 Lindsay Graham? For decades, two legendary brands fought for the hearts of American bikers, Indian Motorcycle and Harley-Davidson. The battle looked a lot like Coke versus Pepsi or Ford versus Chevy, but tastes changed and Indian didn't adapt fast enough. The icon all but died. Then came the con men, the dreamers, a string of spectacular failures that kept Indian in the grave, until one company finally got it right. This is the story of an improbable revival and the reignition of an old rivalry. Hey, I'm David Brown, the host of the podcast Business Wars, and every season we bring you the true stories behind the companies that shape our world. Indian's new owners are going all in, but an existential crisis looms. Can Indian and Harley recruit enough younger riders to survive?
30:07 Lindsay Graham? Make sure to follow Business Wars wherever you get your podcasts. Audible subscribers can binge all episodes of Business Wars early and ad-free right now. Join Audible in the Audible app or by subscribing on Apple Podcasts.
30:26 Lindsay Graham? Turning to your work, you mentioned studying the practice of quarantine and social distancing and this idea that was very much in the early days of the COVID-19 pandemic, the flattening of the curve. Can you talk more about your work and what you found and how it was used during the COVID-19 pandemic?
30:43 Speaker 03 I was called by the Department of Defense early on in 2005 because then-President George W. Bush became concerned about a potential influenza pandemic, which we had in 2009, by the way, but it was not terribly deadly. But that's when we started looking at 1918 data. And I and my colleague Martin Citron from the Centers for Disease Control, who was then the Director of the Division of Quarantine and Global Migration, well, you got two guys who study quarantine, one guy who studies the history of it and one who
31:25 Speaker 03 implements it in case of emergencies. But they wanted to look at something called escape communities. There were seven or eight communities that basically shut their doors during the 1918 flu. And as long as their doors were shut, no trains were coming in, no schools were open, no saloons were open, flu did not cause deaths or cases. It was incredible. But once they opened their doors, of course, flu came in and did what it did. So I thought to myself, and I said to my colleague Marty Citron, the escape communities are the rarity. That's the exception rather than the rule. We want to look at all the cities because all the cities did something. They all did quarantines. They
32:06 Speaker 03 all did school closures. They all did public gathering bans. But they didn't do them all at the same time. They didn't roll them out in the same way. And they didn't always do it effectively, especially if they did it late. And what we found is that those cities in America in 1918, we looked at 43 of them, later expanded it to 50 cities, those that started their social distancing measures early, that did them for a long time and layered them, meaning they did more than one, had far fewer deaths and cases of flu than those that did not. And their curve was flattened, meaning instead of a typical epidemic curve, which is a huge bump, it
32:51 Speaker 03 rises very quickly and then falls over time, but there's a huge area under that curve. By flattening the curve, there's fewer cases over time, but over a longer period of time, which is good because you have fewer people running to the hospital at the same time, which overloads hospitals and emergency rooms and respirators or what have you. And you buy time, particularly in the modern era, and not in 1918, but in 2020, that you could develop a vaccine and then immunize your population. And that's exactly what we showed. And the term flattening the curve is kind of a funny story. Marty and I were
33:34 Speaker 03 working late at night because we had a deadline from the president not only to do the study, but get it published within a year, do all this work, collate it, study it, review it, publish it, all within a year. And so we used to order food at night. And to get food into a federal facility is a pain in the neck because that's to go through dozen quarantine machines. And we ordered Thai food one day and I ordered pot Thai and I was really looking forward to it. And the fluffy noodles, because they come in one of those styrofoam containers. So instead of a nice fluffy mound of, you know, pot Thai noodles, it was one big board, one flat board of noodles. And I said, hey, Marty, look like the food did what we're trying
34:16 Speaker 03 to do. They flattened the curve. And that's where the phrase came from. But it became a very instrumental part of the COVID-19 pandemic before we had vaccine. Studies in both Nature and the Proceedings of the Royal Academy of London showed it probably saved three or maybe even 400 million lives. So it sounds a little braggadocio, but as a doctor, I am real pleased to have been part of that.
34:45 Lindsay Graham? So it definitely sounds like this was a horrible moment, but your moment to shine. But I'm also wondering, what was it like to watch yet again, the pandemic descend into a political fight?
34:57 Speaker 03 Let's go first to, okay, when, when the world does badly, if you're a student of quarantine, you do well. It's a weird thing to say, but I had prepared my entire career and life for that moment. So as a physician, as a historian, as a scholar, as a professor, I must confess, it was incredibly exciting to be part of that. I was being interviewed or talked to or on, you know, Zoom calls half my day, every day for two years. And to see something that we worked on for so long and so hard, actually helped people was very, very gratifying.
35:35 Speaker 03 But then to see how then and now current President Trump politicized it and denigrated and diminished science to create all this doubt. I knew there would be some, but the level is just incredible. I mean, even I get angry emails from people, you ruined my life because you advocated the shutdown. So the way it's been politicized and fake newsified is very frightening because at this point, I am no longer willing to debate people like vaccine, pro or con. No, no, this is not a debate. This is not a matter of opinion.
36:15 Speaker 03 It's a matter of fact, of provable, reproducible facts. And the facts are about the COVID vaccine. It's one of the safest vaccines we ever produced. It's been in billions of arms without, you know, serious effects. So this kind of nonsense is really troubling to me. I think we have to do the best we can to prevent another crisis from happening because it's a matter of life and death.
36:43 Lindsay Graham? Not only do we need to hopefully prevent another crisis from happening, but we need to learn from the lessons of COVID-19 and preserve the trust in public health. Do you think there's a playbook to regain that trust? What could we have done differently?
37:00 Speaker 03 Well, I think a different chief executive might have helped. I really do. A lot of things went really well, particularly the speed with which we got the vaccine. And the shutdown was actually very effective in terms of cutting down cases. There is no hospital in the world that has 100 respirators in the basement ready to go in case of a crisis. Those are very carefully calibrated machines. They have to be cared for. So that type of shortage is going to be difficult to surmount. Stockpiling antivirals might work, but you know, they expire. Vaccines do help and getting
37:40 Speaker 03 them every six to eight months because this is a viral vaccine that, like the flu vaccine, that does not extend long-term immunity. Doesn't mean the vaccine is bad. It's just the biology of that virus and that vaccine. So we have to do that as well. But with so many people from CDC either being fired or retiring, so many government scientists leaving the fold, it is a very scary time in terms of playbook. And I'm hoping the generation of students that we have trained, who are now young doctors and young public health professionals, will assume the mantle because it's not very good right now. Public
38:22 Speaker 03 health confidence is at the lowest it's ever been in the past century and a half.
38:28 Lindsay Graham? The opposite to this problem of too much information, too varied information, is perhaps what I alluded to earlier, the amnesia that inevitably occurs after a pandemic, the forgetting of information, that how dangerous things were or how difficult things were. Talk about this amnesia and why you think it happens.
38:46 Speaker 03 I call it the last act of most epidemics and pandemics. We tend to forget because that's normal. And once you're done with an epidemic crisis or a pandemic crisis, you don't want to think about it. You want to move on, unless you're somebody like me who's, you know, that's how I earn my living. But most people don't want to do that. The forgetting is the biggest problem because then you lose touch with the preparing and you have to constantly prepare for these crises. And it costs a lot of money, even though you don't see a benefit. You know, we have fire stations all over our cities and we don't see the fire trucks come out all the time. But we're willing to pay for that because in case our house does burn, we want them coming. The health department
39:28 Speaker 03 is the same way. We have to fund it. We have to support it because when there is a fire slash epidemic, those trucks can come out roaring with what they need to do. And we have to get back to that. We have to fund it. We have to support it. And we have to find a way to shut the fear mongers and the rumor mongers and the people who are spewing out non-truths. We have to find a way to quiet them down. They have freedom of speech. It's the United States, thank goodness. You have the right to an opinion, but you don't have the right to your own set of facts and your own set of science. That's just nonsense. And we have to call that out. We're not doing a good enough job doing that, frankly.
40:11 Lindsay Graham? Throughout our conversation, you've expressed some skepticism about our current ability to prepare for the next pandemic. What steps would you take to help us be better prepared?
40:25 Speaker 03 Well, I don't have this ability or power, but I would start by getting somebody who can convince the President of the United States and his people how dire the situation is. To restore the surveillance of thousands of viruses at stations around the world, to restore the scientific integrity of the CDC, as well as the EPA, by the way, because as temperature changes and climates changes, we can expect different microbial results.
40:56 Speaker 03 To continue to fund, support and benefit the men and women who give their careers to public service at the municipal, state and federal and international levels of public health. We've had presidents who have done this, by the way, from both sides of the aisle. But this current president doesn't put much stock in it. And that's gonna bite us. I can't tell you when, but that's gonna bite us. That's not skepticism. That's definite. That's gonna happen. We live in a world of microbes and we never conquer them. At best, we wrestle them to a draw.
41:40 Speaker 03 But with a changing world of temperature, climate, the movement of masses of people from one place to another, different infections brewing in different parts of the world, and this whole interspecies mingling is a Russian roulette of bad results. It's not a good game. It's not a game I wanna play.
42:00 Lindsay Graham? Taking the other side, let's look to the men and women who gave their careers to public service, as you mentioned. Who are some of the heroes currently fighting the good fight?
42:13 Speaker 03 One of my heroes is Anthony Fauci, who just recently retired, who literally is the world's expert on infectious diseases. Okay, I mean, I remember some people complaining when I was at Cambridge University, I was a visiting professor, well, Fauci acts like he's the world's expert. I said, well, he is. He literally is. I know him. I've rounded with him. He's a remarkable man, very kind and generous man and a brilliant man. He was a great hero. The people who won the Nobel Prize for the mRNA vaccines that went for COVID, they did remarkable things. Even Big Pharma, I mean Pfizer really cranked it out, as did Moderna.
42:56 Speaker 03 And then there's many unsung men and women heroes who, they know who they are and the patients they helped know who they are, but there's There's literally millions of doctors, nurses, orderlies who were there, who put themselves at risk, who had their salaries cut during the pandemic, okay, but still were there because that's what healthcare professionals do. That is the calling. That's the profession. So I have faith in that. And I have faith, having taught medical students and public health students for so many decades, that it's a special kind of a person who
43:34 Speaker 03 goes into those fields. And I am very optimistic about the coming generation and their interest in global health, their interest in public health, their interest in community health. And I'm hopeful that we'll fix this. But tick tock, tick tock, time's a-wasting.
43:53 Lindsay Graham? So Dr. Howard Markel, thank you so much for talking with me on American Scandal today.
43:58 Speaker 03 My pleasure. My pleasure. Thank you.
44:00 Lindsay Graham? That was my conversation with physician, historian, and professor Howard Markel. He's the former director of the Center for History of Medicine at the University of Michigan, and author of multiple books, including When Germs Travel and Quarantine: East European Jewish Immigrants and the New York City Epidemics of 1892.
44:23 Lindsay Graham? From Wondery, this is episode five of The Plague of 1900 for American Scandal. In our next series, in 2010, an explosion on the Deepwater Horizon drilling rig killed 11 crewmen and triggered an environmental catastrophe in the waters off Louisiana. It was the largest marine oil spill in history, and cost its operator BP tens of billions of dollars in fines and damages. But it was no freak accident. The deadly disaster on Deepwater Horizon was enabled by industry-friendly regulators, years of cost-cutting, and a corporate culture that put profits above everything else.
45:02 Lindsay Graham? American Scandal is only possible because of listeners like you, so thank you. And don't miss an episode. Be sure to follow American Scandal on Audible or wherever you get your podcasts. And Audible subscribers can binge new seasons of American Scandal early and ad-free right now. Join Audible in the Audible app or by subscribing on Apple Podcasts. And to find out more about me, including my other podcasts, my live show, the history tours I'm arranging, and all sorts of other things, go to historyishuman.com. That's historyishuman.com.
45:38 Lindsay Graham? American Scandal is hosted, edited, and executive produced by me, Lindsay Graham for Airship. Sound design by Gabriel Gould. Supervising sound designer Matthew Filler. Music by Thrum. This episode was produced by John Reed. Managing producer Emily Burke. Development by Stephanie Jens. Senior producer Annie Beckerman. Executive producers are William Simpson for Airship, and Jenny Lauer Beckman, Marshall Louis, and Aaron O'Flaherty for Wondery.
46:12 Speaker 04 Journalist Tristan Redmond goes where no son-in-law should ever go. Deep into his wife's family history, digging up the cold case of who murdered her great-grandmother. Because, I should mention, he thinks the murderer might actually be the beloved family patriarch. For the best bingeable series like Ghost Story, listen to the Audible True Crime Podcast wherever you get your podcasts.
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