An epidemic is a disease that kills the privileged. In normal times, germs recognize the boundaries that separate the poor from the rich; they respect the entitlement to vigorous health that good food, clean housing, and a carefully tutored immune system bestow upon the better off. The confluence of infectious disease with poverty is tolerated perhaps because it implicitly validates social hierarchies. It is as if the debilitating infections and untimely deaths of the lower orders were nature’s way of ratifying the judgment of economy and history in conferring wealth and power on a select few. But in time of plague unforeseen and agonizing death strikes the rich along with the poor, the industrious along with the dissolute, the robustly youthful along with the decrepit elderly. By scrambling the correlations between social status and health, an epidemic nullifies the acknowledged rules about who should live long and who should not, and thus undermines civilization’s most basic function: to predict and regulate the survival of its members. For this reason the dislocations of an epidemic are among the most severe a community can undergo; ever since Moses led the Hebrews out of Egypt, pestilence has been associated with the overthrow of public order and the eclipse of old gods.
This paradigm unraveled when it confronted AIDS, a monster that can’t be slain with magic bullets. Condoms may block the exchange of bodily fluids, but our fears about AIDS have led us back to the age-old impulse to erect social barriers to the spread of disease, to rope off the “carriers”–gays, drug addicts, prostitutes, Haitians–and prevent their contact with “innocents.” One of the most crucial boundaries, one that amplifies America’s racial and class antagonisms and projects them onto a global scale, is the line that separates the famished, untreated third world from the well-fed, overmedicated first. The rift between “advanced” and “underdeveloped” has long been represented as a contrast between the incompatible disease regimens of infection and decay–malaria and cholera at one pole, heart disease and Alzheimer’s at the other. AIDS threatens this dichotomy: it links Africa’s shantytowns with America’s metropolises, and reminds us just how fragile the barrier between them really is.
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The payoff finally comes when army scientists detect the Ebola virus in a colony of monkeys shipped to Reston from the Philippines. The Pentagon reacts with its customary finesse: seal off the area, put on space suits, kill everything. Here Preston is in his element; with chapter headings like “The Mission: 1630 hours, Wednesday” he deploys the terse hysteria of military jargon to impart a sense of urgency to the operation. You would think that a struggle between the U.S. Army and a group of caged monkeys would be a walkover, but here the warrior veterinarians and their simian adversaries are pretty evenly matched. These monkeys are preternaturally truculent; if you even look at them the wrong way, they spit at you and pelt you with virus-laden feces. Then they go for the face, slashing at your eyes with their enormous canines. The soldiers trudge from cage to cage euthanizing the monkeys, carefully avoiding eye contact–until one animal escapes, grabs a syringe, and races toward a young private who hadn’t expected to die that day. (Don’t worry, it’s just one of the many dream sequences Preston feels compelled to throw in.) Anyway, we get the picture: Monkeys are bad news. After reading The Hot Zone, we want to stay away from them, as well as any continents they happen to be living on.
Ironically, the factual history of Ebola that Preston sketchily recounts demonstrates just the opposite. The worst outbreak on record occurred in Zaire in 1976, when a villager infected with the virus showed up at a missionary hospital to get a shot of antimalarial medication. The hospital couldn’t afford disposable syringes, so the Belgian nun who gave him his shot then used the same unwashed needle to inject upwards of a hundred other patients, who carried the infection back to some 55 surrounding villages. Hundreds died before traditional quarantine measures set up by the villagers themselves finally extinguished the outbreak. The pattern is typical. In Africa Ebola epidemics are usually either caused or exacerbated by the use of Western medical technology without an adequate economic base to support it.
McNeill showed that the course of imperialism–the ultimate form of macroparasitism–has often been critically altered by the accompanying dynamics of microparasitism. The diseases that the Spaniards brought to the New World unleashed epidemics that killed off 90 percent of the native inhabitants–a holocaust that proved the decisive factor in the European conquest of the Western Hemisphere. On the other hand, tropical diseases have sometimes thwarted European colonial ambitions, as in 1802 when a yellow-fever epidemic wiped out the 33,000-man army Napoleon sent to restore Haiti to French rule. The outcome of military campaigns has historically hinged more on the vicissitudes of plagues than on the skills of generals. Army camps are ideal breeding grounds for germs, and during 19th-century wars epidemics typically knocked off five to ten times as many soldiers as battlefield wounds. The development of sanitation procedures and mass inoculations at the turn of the century finally banished epidemic disease from the trenches; indeed the vast bloodlettings of World War I owe less to the deadliness of modern weapons than to the success of modern medicine in keeping soldiers alive long enough to be killed by the enemy.
Garrett argues that we must combine sophisticated medicine with a focus on the social and economic circumstances that foster epidemics. Improvements in diet, water quality, and medical infrastructure are indispensable, but they demand political stability. The AIDS catastrophe in central Africa has ridden on the wings of decades of warfare and migrations that disrupted traditional ways of life and drove thousands of impoverished women into prostitution. Here in the United States efforts to stop the spread of AIDS are also hampered by severe sociopolitical dysfunctions. Racism, homophobia, and religious conceptions of AIDS as a form of divine punishment against life-style deviants all continue to block needed public-health measures like condom distribution and needle exchange.
