00:00:04.291 --> 00:00:09.708
[Score: eerie, slow waves]

00:00:50.416 --> 00:00:54.041
This is the story of the constant invader

00:00:58.125 --> 00:01:00.375
There is still no easy road to victory

00:01:00.375 --> 00:01:02.416
In the battle we are waging to save lives

00:01:06.375 --> 00:01:09.708
Everyone fled from the victims
for fear of the dread disease

00:01:10.750 --> 00:01:13.166
But by far the most horrible element of the tragedy

00:01:14.041 --> 00:01:16.000
was the mystery of its origin

00:01:16.458 --> 00:01:19.916
No one knew what or who carried the plague

00:01:21.458 --> 00:01:22.916
[window squeaking]

00:01:22.916 --> 00:01:24.375
[chalk scratching]

00:01:26.875 --> 00:01:32.291
[Score: somber, resonant]

00:01:50.458 --> 00:01:55.333
[whistling wind]

00:02:06.583 --> 00:02:11.125
SONIA SHAH: Before germ theory, people thought
diseases were part of the environment

00:02:12.333 --> 00:02:16.958
Each human had different
balances of humors in their body

00:02:16.958 --> 00:02:19.333
and that intersected with the climate and the weather

00:02:20.708 --> 00:02:23.291
Microbiologists discovered that: “well, wait a second...”

00:02:23.291 --> 00:02:26.000
It’s not your bad morals

00:02:26.000 --> 00:02:27.833
that’s making you sick with cholera

00:02:27.833 --> 00:02:29.708
It's actually this little tiny microbe

00:02:34.500 --> 00:02:36.500
The solution finally came

00:02:36.500 --> 00:02:39.125
by way of this odd little contraption

00:02:40.833 --> 00:02:42.750
Anyone know what this is?

00:02:42.750 --> 00:02:43.875
- It looks like a can opener

00:02:44.625 --> 00:02:45.000
-No

00:02:46.458 --> 00:02:47.791
It’s the first microscope

00:02:52.500 --> 00:02:54.333
[papers rustling]

00:02:55.500 --> 00:02:58.208
It was feared that the disease
would reach New York shortly

00:02:58.208 --> 00:02:59.750
and that nothing could be done to stop it

00:03:00.333 --> 00:03:01.583
The epidemic did arrive

00:03:01.583 --> 00:03:04.583
and later spread its fearful hand
over Europe as well

00:03:11.708 --> 00:03:16.333
Not until 1883 did Robert Koch
discover the germ that caused cholera

00:03:16.833 --> 00:03:20.833
In the preceding year Koch had found
the germ responsible for tuberculosis

00:03:23.166 --> 00:03:28.333
SONIA SHAH: Ever since then I think we have really
re-characterized our relationship with disease

00:03:28.333 --> 00:03:31.208
as if we are pure and uncontaminated

00:03:31.208 --> 00:03:35.458
and these external invaders are out to get us

00:03:38.000 --> 00:03:41.583
- Only within the last century have we learned to recognize

00:03:41.875 --> 00:03:45.583
that what we call disease is only a ripple on the surface

00:03:45.583 --> 00:03:47.916
of an incredibly complex microcosm

00:03:47.916 --> 00:03:49.166
of fungus...

00:03:51.208 --> 00:03:52.458
and bacteria...

00:03:56.958 --> 00:03:58.708
and cell

00:03:58.708 --> 00:04:03.833
An unseen world in which the materials
of life are constantly transformed

00:04:04.375 --> 00:04:08.208
and the life itself wages a
never ending battle for survival

00:04:08.208 --> 00:04:11.583
[liquid bubbling]

00:04:15.375 --> 00:04:21.125
[Soundscape: bells ringing and liquid, otherworldly sounds]

00:04:37.333 --> 00:04:39.250
[squelching]

00:04:42.666 --> 00:04:48.833
- Nature or life is competition,
struggle, battlefield, war

00:04:48.833 --> 00:04:50.666
It’s a zero sum game

00:04:50.666 --> 00:04:56.708
That has become so deeply embedded
in science, certainly...

00:04:56.708 --> 00:04:59.291
but also in our cultural thinking

00:04:59.833 --> 00:05:04.958
[Music plays: fanfare]

00:05:06.208 --> 00:05:08.916
[horse galloping]

00:05:09.125 --> 00:05:11.625
[Dramatic music]

00:05:13.333 --> 00:05:16.583
SONIA SHAH: And that really lends
itself to technological fixes

00:05:17.625 --> 00:05:21.000
You see this in how we talk about contagious diseases

00:05:21.000 --> 00:05:24.458
We talk about our armamentarium
of chemical weapons

00:05:24.458 --> 00:05:27.458
vaccines and drugs, etc...

00:05:32.875 --> 00:05:34.916
Specific toxicity is the idea

00:05:34.916 --> 00:05:38.416
that you can develop something that will kill the pathogen

00:05:38.708 --> 00:05:40.791
but leave the host unharmed

00:05:41.916 --> 00:05:45.041
[suspenseful music]

00:05:47.083 --> 00:05:48.166
[low frequency buzz]

00:05:52.958 --> 00:05:54.083
[low frequency buzz]

00:05:56.583 --> 00:05:57.875
[liquid bubbling]

00:05:57.875 --> 00:06:01.041
HANNAH LANDECKER: This idea really
came from Paul Ehrlich

00:06:01.041 --> 00:06:04.125
in the late 19th century and early 20th century

00:06:04.125 --> 00:06:05.666
a German biochemist

00:06:05.666 --> 00:06:08.666
who is best known for developing Salvarsan

00:06:09.208 --> 00:06:13.541
the first widely effective drug against syphilis

00:06:13.541 --> 00:06:17.916
[Score: curious, lilting]

00:06:20.791 --> 00:06:25.083
One of the actors at the time described specific toxicity

00:06:25.083 --> 00:06:29.041
as a means for killing the uneconomic species

00:06:29.041 --> 00:06:32.291
and leaving the economic species untouched

00:06:34.666 --> 00:06:37.541
[liquid bubbling]

00:06:44.125 --> 00:06:46.125
[glass clinking]

00:06:48.875 --> 00:06:50.541
[Dramatic music]

00:06:52.916 --> 00:06:53.916
[popping sound]

00:06:55.916 --> 00:06:59.291
- Men have devised a number
of very ingenious weapons

00:06:59.291 --> 00:07:02.166
in their struggle against the forces of nature

00:07:06.791 --> 00:07:10.208
- What are these miraculous substances that kill bacteria?

00:07:11.166 --> 00:07:13.166
- We call them antibiotics

00:07:13.541 --> 00:07:19.041
In Greek: “Anti” means against

00:07:19.958 --> 00:07:24.125
“Bios” stands for life

00:07:28.916 --> 00:07:32.291
- The story of this great adventure
begins with the earth itself

00:07:32.833 --> 00:07:35.541
whose soil teems with a strange microbial warfare

00:07:38.041 --> 00:07:39.958
Soil specimens from every part of the world

00:07:39.958 --> 00:07:42.291
were shipped to the Brooklyn laboratories of Pfizer

00:07:42.291 --> 00:07:44.083
to be studied and carefully tested

00:07:44.083 --> 00:07:47.291
and convert their bacteria fighting ability into drugs

00:07:47.291 --> 00:07:49.791
that would act against disease in man

00:07:50.791 --> 00:07:52.708
[liquid splashing]

00:07:53.583 --> 00:07:57.916
HANNAH LANDECKER: We often think of antibiotics
as something that humans invented

00:07:58.166 --> 00:08:04.166
but of course they are a metabolic capacity
of something like a fungus or a bacterium

00:08:05.333 --> 00:08:09.416
You start with something like a penicillium mold

00:08:09.416 --> 00:08:14.000
growing on a particular fruit,
purchased in a particular small town

00:08:14.666 --> 00:08:20.250
and we just enormously magnify
that property and that capacity

00:08:20.250 --> 00:08:23.541
through this process of industrial growth

00:08:24.416 --> 00:08:28.708
[Score: bass hum and high-pitched popping]

00:08:37.166 --> 00:08:39.416
[mechanical whirring]

00:08:46.166 --> 00:08:50.208
They were legitimately considered a miracle drug

00:08:50.208 --> 00:08:53.791
People who should have died, in fact got better

00:08:54.125 --> 00:08:56.500
and they got better because their infections could be treated

00:08:56.500 --> 00:08:57.416
and they got better because their infections could be treated

00:08:58.291 --> 00:09:03.458
And so this led to a major emphasis
on the use of antibiotics

00:09:03.458 --> 00:09:05.916
[engine noise]

00:09:05.916 --> 00:09:07.916
[glass clinking]

00:09:12.541 --> 00:09:17.500
[Score: otherworldly soundscape]

00:09:23.541 --> 00:09:33.916
HANNAH LANDECKER: But antibiotics arrived on a scene of
biochemical transformation of life worlds that was already well underway

00:09:35.333 --> 00:09:38.333
[pesticide spraying]

00:09:39.250 --> 00:09:42.250
[motor whirring]

00:09:49.875 --> 00:09:53.791
- We must fight our insect
enemies with every weapon

00:09:53.791 --> 00:09:57.041
our imagination and science can devise

00:10:02.916 --> 00:10:06.916
Insects are subject to certain contagious virus

00:10:06.916 --> 00:10:11.333
bacterial and fungus diseases which are harmless to man

00:10:12.041 --> 00:10:18.708
Entomologists are learning how to start deadly
epidemics of these diseases among insect pests

00:10:19.458 --> 00:10:22.583
Another form of biological warfare

00:10:22.583 --> 00:10:27.666
is to discover, transplant and
encourage the activities of parasites

00:10:27.666 --> 00:10:32.708
that are known to attack and destroy the
insect enemies we want to be rid of

00:10:36.541 --> 00:10:42.416
HANNAH LANDECKER: These war metaphors are
definitely along this line of confidence

00:10:42.416 --> 00:10:46.291
that humans actually could
control the world to that extent

00:10:46.291 --> 00:10:52.041
that they could kill all the things that were
getting in the way of economic progress

00:10:52.041 --> 00:10:56.333
or health and leave the good things untouched

00:10:56.333 --> 00:10:58.708
[dramatic music]

00:11:06.291 --> 00:11:08.916
[electronic beep]

00:11:10.541 --> 00:11:13.166
[beeping continues]

00:11:18.291 --> 00:11:23.500
[heavy breathing]

00:11:23.500 --> 00:11:28.416
[Score: muffled soundscape]

00:11:38.583 --> 00:11:40.958
- Her body is just like a little country

00:11:40.958 --> 00:11:43.291
that has been invaded by an enemy army

00:11:44.291 --> 00:11:47.875
[Score: eerie high pitched tone]

00:11:47.875 --> 00:11:53.541
This invading army is so tiny that it
can be seen only through a microscope

00:11:55.583 --> 00:11:58.708
Its soldiers are the germs of communicable disease

00:12:04.500 --> 00:12:08.708
A communicable disease is one which
can be caught from someone else

00:12:09.291 --> 00:12:13.291
This means that the germs have to leave the body of a sick person

00:12:13.291 --> 00:12:15.791
and enter the body of one who is well

00:12:16.041 --> 00:12:20.541
[Score: ominous soundscape, repeating tones]

00:12:27.458 --> 00:12:33.666
- I noticed when I was reading about
the campaign against tuberculosis

00:12:33.916 --> 00:12:38.833
that they were using words like catechism or commandments

00:12:38.833 --> 00:12:43.833
Here are the Ten Commandments to
keep you safe from tuberculosis

00:12:44.291 --> 00:12:52.166
And it got me thinking about both the religious
overlay in concepts of cleanliness, purification

00:12:52.166 --> 00:12:54.916
that's a really ancient concept

00:12:54.916 --> 00:13:01.666
but even more so, if you obey
God's rules, you will be safe

00:13:01.666 --> 00:13:06.375
and now in this case, God was communicating
through public health science

00:13:09.708 --> 00:13:12.708
[Score: ethereal, ominous]

00:13:20.708 --> 00:13:24.416
[Score: ominous music builds]

00:13:36.166 --> 00:13:38.541
- All over this broad land of ours

00:13:38.916 --> 00:13:41.958
a bitter war is being fought against tuberculosis

00:13:42.541 --> 00:13:46.541
Able warriors armed with modern weapons are on the firing line

00:13:47.416 --> 00:13:48.833
How goes the battle?

00:13:49.791 --> 00:13:52.458
Come with me on a journey and let's see

00:13:52.458 --> 00:13:54.000
what is being done

00:13:58.666 --> 00:14:00.916
- We will send Consuela to a sanatorium

00:14:00.916 --> 00:14:02.541
and there she will get well

00:14:03.708 --> 00:14:08.041
- Yes, I have seen them, they are beautiful

00:14:08.458 --> 00:14:09.666
but we are poor

00:14:10.791 --> 00:14:13.583
Those places are for rich people

00:14:14.208 --> 00:14:16.458
not for people like us

00:14:17.041 --> 00:14:18.666
- No, no! They’re for all

00:14:19.541 --> 00:14:22.500
All people in an enlightened community

00:14:22.500 --> 00:14:26.541
know that tuberculosis is not only a personal misfortune

00:14:26.541 --> 00:14:29.083
but that it threatens every household

00:14:29.083 --> 00:14:31.541
Tuberculosis knows no line

00:14:31.541 --> 00:14:34.041
of race, religion or social status

00:14:34.416 --> 00:14:37.458
So people gladly support a sanatorium

00:14:37.458 --> 00:14:40.416
knowing that thereby their own children will be protected

00:14:52.541 --> 00:14:54.000
- I'm getting better, George

00:14:54.000 --> 00:14:57.458
Doctor Gordon said I was so
sensible to come to see him so early

00:14:58.791 --> 00:15:01.166
George, how about you?

00:15:02.291 --> 00:15:03.333
[cough]

00:15:07.041 --> 00:15:07.916
[cough]

00:15:08.583 --> 00:15:09.916
What you've got to do now

00:15:09.916 --> 00:15:11.583
is to keep your good health

00:15:11.583 --> 00:15:13.916
Don't use up too much of your energy

00:15:13.916 --> 00:15:15.416
either in work or play

00:15:15.416 --> 00:15:16.916
or staying out late at night

00:15:17.416 --> 00:15:20.583
Eat well balanced meals and get plenty of fresh air

00:15:21.958 --> 00:15:25.875
[Score: erratic melodic phrases]

00:15:29.916 --> 00:15:32.166
- The thing that we keep telling ourselves about illness

00:15:32.166 --> 00:15:33.916
is that it's a fluke

00:15:33.916 --> 00:15:35.291
or that it doesn't exist

00:15:35.291 --> 00:15:36.541
and that if it does

00:15:36.541 --> 00:15:38.791
then oh well, you messed up in some way

00:15:38.791 --> 00:15:40.083
at some time

00:15:40.458 --> 00:15:44.041
This is a really great thing for capitalism

00:15:45.708 --> 00:15:50.916
If your illness is caused purely
by your own foolish choices

00:15:51.666 --> 00:15:54.416
then capitalism doesn't need to give you healthcare

00:16:01.791 --> 00:16:03.833
[metal clinking]

00:16:06.250 --> 00:16:08.666
[Score: ominous, building]

00:16:09.458 --> 00:16:12.333
[cough]

00:16:13.541 --> 00:16:16.666
- We must teach our people that tuberculosis is curable

00:16:16.666 --> 00:16:21.666
And we must show them that every person
with tuberculosis is a menace to his family

00:16:21.666 --> 00:16:24.250
if his case isn’t put under a doctor at once

00:16:24.250 --> 00:16:30.125
[Score: cascading electronic melodies]

00:17:03.166 --> 00:17:07.666
- We had learned to see Lister's septic
ferments with our mental eye

00:17:09.541 --> 00:17:12.541
- Pa coughed and Ma coughed and Junior caught the sniffles

00:17:12.541 --> 00:17:15.583
Bill sneezed and Jill wheezed and Sister went kerchoo

00:17:15.583 --> 00:17:18.666
They called up the doctor and asked for his prescription

00:17:18.666 --> 00:17:20.791
Here's what he said to do

00:17:21.625 --> 00:17:23.416
Buy Listerine, try Listerine

00:17:23.416 --> 00:17:27.458
NANCY TOMES: Probably advertising was a bigger

00:17:27.458 --> 00:17:31.166
promoter of the germ theory initially than doctors

00:17:31.166 --> 00:17:32.833
or public health educators

00:17:34.666 --> 00:17:37.458
And by the early 20th century

00:17:37.458 --> 00:17:40.750
the public health leaders are realizing

00:17:40.750 --> 00:17:41.625
that they need to have more
effective ways to communicate

00:17:41.625 --> 00:17:44.625
that they need to have more
effective ways to communicate

00:17:48.958 --> 00:17:54.833
They basically borrow techniques
from selling soap and Listerine

00:17:54.833 --> 00:17:59.916
and use them to sell ideas
about how to stay well

00:18:01.958 --> 00:18:02.708
[liquid splashing]

00:18:03.583 --> 00:18:05.083
- Now, let's get this quite clear

00:18:05.083 --> 00:18:06.875
You sneeze into the handkerchief

00:18:06.875 --> 00:18:08.083
and then put the handkerchief

00:18:08.083 --> 00:18:09.458
into a bowl of disinfectant

00:18:09.458 --> 00:18:10.416
to kill the germs

00:18:12.333 --> 00:18:13.083
[liquid splashing]

00:18:13.833 --> 00:18:16.458
- Edgar was careless about his meals

00:18:16.458 --> 00:18:17.750
didn't eat right

00:18:17.750 --> 00:18:19.333
stayed out late at night

00:18:19.333 --> 00:18:21.333
when he ought to have been in bed

00:18:21.333 --> 00:18:24.083
All that put a strain on his body

00:18:24.083 --> 00:18:27.583
and one day we germs saw our chance to escape

00:18:28.083 --> 00:18:32.583
All we need is a dark place in the body

00:18:32.750 --> 00:18:36.333
where soap and water can’t get at us

00:18:36.833 --> 00:18:40.208
Oh how soap and water kill us

00:18:42.000 --> 00:18:43.916
- Disease germs are dangerous

00:18:44.125 --> 00:18:45.333
because they make you sick

00:18:45.333 --> 00:18:47.625
if too many of them get inside of you

00:18:48.083 --> 00:18:50.083
and they can be on almost anything

00:18:50.083 --> 00:18:52.666
that children touch or handle

00:18:52.666 --> 00:18:53.875
- Who said that?

00:18:54.458 --> 00:18:55.958
- Soapy’s the name, partner

00:18:57.000 --> 00:18:59.958
-Why, you’re a living cake of soap

00:18:59.958 --> 00:19:01.083
- Big as life, Billy

00:19:03.083 --> 00:19:06.416
NANCY TOMES: It's much easier to tell people

00:19:06.416 --> 00:19:09.875
to keep themselves safe by individual behaviors

00:19:10.458 --> 00:19:14.666
and deflect attention from the structural conditions

00:19:14.666 --> 00:19:17.583
that may make it almost impossible

00:19:17.583 --> 00:19:20.500
for a person to protect themselves

00:19:20.500 --> 00:19:22.458
by these individual measures

00:19:23.208 --> 00:19:26.208
[Score: unnerving melodies, bells]

00:19:34.583 --> 00:19:37.625
- When holding people responsible for their choices

00:19:37.625 --> 00:19:39.166
regarding their health

00:19:39.166 --> 00:19:41.000
we also need to really take a look at

00:19:41.000 --> 00:19:43.208
whether they actually had any or not

00:19:43.208 --> 00:19:45.458
What choices are we really giving people

00:19:45.458 --> 00:19:48.583
to help them be healthy and avoid disease and death

00:19:50.916 --> 00:19:53.916
[Score: tense, arrythmic] 

00:19:57.625 --> 00:20:02.083
NANCY TOMES:  One of the principles
of progressive era public health

00:20:02.083 --> 00:20:06.958
was that germs know no class or color line

00:20:07.708 --> 00:20:12.875
It still left room for the targeting of particular groups

00:20:13.125 --> 00:20:17.458
as being harbors of infectious disease

00:20:19.500 --> 00:20:20.875
- There's another sore spot

00:20:20.875 --> 00:20:22.333
on the optimistic picture.

00:20:22.833 --> 00:20:24.583
Certain racial groups

00:20:24.583 --> 00:20:27.208
such as Negroes, Mexicans and Indians

00:20:27.583 --> 00:20:30.458
suffer heavy losses from tuberculosis

00:20:30.458 --> 00:20:34.750
The death rate among Negroes is
three times as high as among whites

00:20:39.291 --> 00:20:41.833
NANCY TOMES: Atlanta is the best example

00:20:42.666 --> 00:20:46.500
Black leaders were calling out the systemic inequalities

00:20:46.500 --> 00:20:49.208
that Black communities faced and saying:

00:20:49.208 --> 00:20:53.708
“It’s no wonder that we have higher
rates of diseases like tuberculosis”

00:20:54.458 --> 00:20:57.125
So Black anti-tuberculosis societies

00:20:57.125 --> 00:20:59.333
try to do for their communities

00:20:59.333 --> 00:21:02.583
what their White counterparts were doing in the North

00:21:03.208 --> 00:21:09.083
to try to address the lack of basic sanitation
in many poor Black neighborhoods

00:21:14.083 --> 00:21:19.583
And yet, simply by calling attention
to the rates of tuberculosis

00:21:19.583 --> 00:21:22.250
among poor Black Atlantans

00:21:22.250 --> 00:21:25.708
it reinforced this other narrative

00:21:25.708 --> 00:21:29.000
that the best way to deal with this
problem was to segregate

00:21:29.875 --> 00:21:32.875
to just make that Jim Crow stronger

00:21:33.708 --> 00:21:36.250
[Music plays: TB Blues, Josh White]

00:21:46.958 --> 00:21:49.500
Too late, too late

00:21:49.500 --> 00:21:53.000
Too late, too late

00:21:53.000 --> 00:21:56.000
Too late

00:21:58.458 --> 00:22:00.125
It's too late

00:22:00.125 --> 00:22:02.708
Too late

00:22:02.708 --> 00:22:05.916
Too late, too late, too late

00:22:09.625 --> 00:22:12.625
TB is killing me

00:22:16.083 --> 00:22:19.333
You know I’m like a prisoner

00:22:20.083 --> 00:22:23.708
Always wishing he's free

00:22:39.500 --> 00:22:44.625
[Score: sparse, expansive soundscape]

00:23:00.250 --> 00:23:05.583
- The way that bacteriology and immunology
developed in the late 19th century

00:23:06.083 --> 00:23:10.458
coincided with the ways that nation states
started thinking about themselves

00:23:12.833 --> 00:23:14.750
- There are mechanisms within the body

00:23:15.083 --> 00:23:18.333
that defend us against the invasion from outside

00:23:19.625 --> 00:23:22.583
Our first lines of defense are nonspecific

00:23:23.458 --> 00:23:25.083
For example, the skin

00:23:25.583 --> 00:23:27.208
a simple mechanical barrier

00:23:28.166 --> 00:23:31.041
a break triggers off an internal defense system

00:23:31.208 --> 00:23:32.458
within the blood

00:23:33.791 --> 00:23:36.041
[liquid trickling]

00:23:38.958 --> 00:23:42.458
PRISCILLA WALD:  The fear of disease
was used to justify nativism

00:23:42.458 --> 00:23:44.833
to justify keeping immigrants out

00:23:52.416 --> 00:23:54.041
[liquid plopping]

00:24:03.333 --> 00:24:06.166
- For centuries, it has been well
known that epidemic diseases

00:24:06.166 --> 00:24:08.333
follow the lines of commerce and travel

00:24:09.291 --> 00:24:10.666
During colonial times

00:24:10.666 --> 00:24:12.375
and in the early days of our republic

00:24:12.375 --> 00:24:14.166
many outbreaks of smallpox and cholera

00:24:14.166 --> 00:24:16.541
were the result of cases brought in by vessels

00:24:17.958 --> 00:24:21.041
The danger of introduction of diseases from abroad

00:24:21.041 --> 00:24:22.791
has paralleled in growth

00:24:22.791 --> 00:24:25.541
the remarkable development of
transportation on the sea

00:24:26.541 --> 00:24:27.833
on the land

00:24:28.833 --> 00:24:29.916
and in the air

00:24:33.333 --> 00:24:35.458
- But you must remember that by the
time your children are grown up

00:24:35.458 --> 00:24:37.708
air travel will be general

00:24:37.708 --> 00:24:39.333
and the danger of smallpox

00:24:39.333 --> 00:24:40.708
which comes from abroad

00:24:40.708 --> 00:24:42.333
even greater than it is today

00:24:44.916 --> 00:24:48.291
- Unfortunately, in some
countries, contagious diseases

00:24:48.291 --> 00:24:50.333
exist in an endemic state

00:24:50.333 --> 00:24:51.791
that is, permanently

00:24:53.583 --> 00:24:54.916
India, for instance

00:24:54.916 --> 00:24:58.541
has certain areas that are always infected with cholera

00:24:58.541 --> 00:25:01.041
This plague can extend to Western Europe

00:25:02.958 --> 00:25:06.166
In Africa, some forms of malaria still rage

00:25:06.458 --> 00:25:09.416
Germs that might easily be transmitted to South America

00:25:09.416 --> 00:25:11.791
[tense music]

00:25:12.916 --> 00:25:15.333
And cholera in Japan could strike suddenly

00:25:15.333 --> 00:25:17.458
at the West Coast of the United States

00:25:23.291 --> 00:25:26.541
- Maritime quarantine is now administered
by the Public Health Service

00:25:26.541 --> 00:25:30.291
at all the ports of the United States and its possessions

00:25:31.041 --> 00:25:34.291
The service has been given quarantine
jurisdiction over all ships

00:25:34.291 --> 00:25:36.916
and all persons, both citizens and aliens

00:25:36.916 --> 00:25:39.166
coming into American ports from abroad

00:25:39.916 --> 00:25:42.166
[crowd murmuring]

00:25:43.875 --> 00:25:46.541
NAYAN SHAH: In the wake of the Chinese Exclusion Law

00:25:46.541 --> 00:25:49.166
we begin to develop these immigration stations

00:25:49.166 --> 00:25:51.916
across the country, on every border

00:25:54.666 --> 00:25:57.958
- In past years, thousands of aliens
arrived at Ellis Island daily

00:25:58.166 --> 00:26:00.541
and each one had to undergo an examination

00:26:00.541 --> 00:26:03.416
at the hands of the medical officers
of the Public Health Service

00:26:09.333 --> 00:26:14.333
- There's always been quarantines around
someone who had typhoid or smallpox

00:26:14.333 --> 00:26:18.291
but now there's greater scrutiny around diseases

00:26:18.291 --> 00:26:22.666
that could seem to make it impossible for you to earn a living

00:26:28.666 --> 00:26:32.291
Exclusion based on one of these kinds of diseases

00:26:32.291 --> 00:26:36.041
is really about predicting someone’s future fitness

00:26:36.041 --> 00:26:38.583
whether they're likely to be a public charge

00:26:38.583 --> 00:26:42.291
They're likely to need the support of charity

00:26:42.291 --> 00:26:44.416
or the government in order to survive

00:26:46.458 --> 00:26:49.416
- Many of them arrived, only to be
turned back at our very gates

00:26:49.416 --> 00:26:51.791
because of mental or physical defect

00:26:51.791 --> 00:26:54.291
This was a necessary but somewhat cruel procedure

00:26:55.166 --> 00:26:58.333
NAYAN SHAH: It’s just such a striking problem

00:26:58.333 --> 00:27:02.666
to collapse the idea of a biological parasite

00:27:03.166 --> 00:27:05.166
within one's body

00:27:05.166 --> 00:27:08.541
and being a social parasite onto society

00:27:09.666 --> 00:27:13.041
[Score: dark, brooding]

00:27:27.291 --> 00:27:29.708
Even though we think a lot about public health

00:27:29.708 --> 00:27:31.541
as imposing regulations

00:27:31.541 --> 00:27:34.083
what they're really trying to do is change conduct

00:27:35.458 --> 00:27:38.791
They're trying to persuade you that if
you change your behavior, it’s healthier

00:27:40.458 --> 00:27:44.208
and these ideas about: healthy, moral, good...

00:27:44.208 --> 00:27:47.166
are all being circulated in different ways

00:27:51.666 --> 00:27:55.166
- People have forgotten how many
laws there were in the United States

00:27:55.166 --> 00:27:57.291
requiring people who were disfigured

00:27:57.291 --> 00:27:59.458
or veterans who’d lost limbs

00:27:59.458 --> 00:28:01.208
or people who were blind

00:28:01.208 --> 00:28:04.208
that they could not appear in public

00:28:10.458 --> 00:28:12.666
It's the aesthetics of white supremacy

00:28:13.083 --> 00:28:14.958
that it isn't just survival of the fittest

00:28:14.958 --> 00:28:17.291
It's also who is most beautiful

00:28:17.291 --> 00:28:18.833
who deserves to live

00:28:18.833 --> 00:28:20.916
who looks like a leader

00:28:26.666 --> 00:28:29.416
NAYAN SHAH: There’s a combination of using

00:28:29.416 --> 00:28:34.041
different kinds of scientific expertise and moral authority

00:28:36.541 --> 00:28:38.833
at a moment that middle class norms

00:28:38.833 --> 00:28:40.916
are actually just being invented

00:28:41.416 --> 00:28:43.083
they're collecting information

00:28:43.083 --> 00:28:44.708
about how people live on the ground

00:28:44.708 --> 00:28:49.333
to sort of articulate certain kinds
of behaviors and practices as norms

00:28:49.541 --> 00:28:52.166
and others as, “This could be a danger”

00:28:52.166 --> 00:28:54.291
This could be a threat to your health

00:28:56.083 --> 00:29:00.000
[Jazz music]

00:29:02.541 --> 00:29:05.458
- The places that infect the city and infect its people

00:29:06.208 --> 00:29:08.416
The places with the easy pickups

00:29:09.041 --> 00:29:11.333
Yes, these are the danger spots

00:29:11.333 --> 00:29:14.041
the places that breed syphilis

00:29:15.166 --> 00:29:18.708
Syphilis is the sniper, the saboteur behind the lines

00:29:19.083 --> 00:29:22.666
but it strikes, not in the field, not in the camps

00:29:22.666 --> 00:29:24.166
but in the towns

00:29:24.166 --> 00:29:26.666
That is where syphilis must be fought

00:29:28.041 --> 00:29:30.541
[dark, foreboding music]

00:29:33.333 --> 00:29:35.000
PATRICIA WILLIAMS: Morals committees

00:29:35.000 --> 00:29:36.250
particularly in small towns

00:29:36.250 --> 00:29:38.208
would come after women and examine them

00:29:38.208 --> 00:29:39.458
for gonorrhea and syphilis

00:29:39.458 --> 00:29:42.666
and then put them in homes and prisons

00:29:44.833 --> 00:29:46.458
[footsteps]

00:29:46.458 --> 00:29:48.583
- Young, old

00:29:48.583 --> 00:29:51.375
city girls, farm girls

00:29:51.375 --> 00:29:55.333
good, bad, average girls

00:29:56.875 --> 00:29:59.708
[footsteps]

00:30:01.125 --> 00:30:04.833
[Score: unnerving, subdued]

00:30:06.916 --> 00:30:09.958
PATRICIA WILLIAMS: One of the cases that I worked on

00:30:09.958 --> 00:30:11.208
when I was in practice

00:30:11.208 --> 00:30:13.375
was a case called Madrigal v. Quilligan

00:30:13.708 --> 00:30:14.958
and that was in the 1970s

00:30:14.958 --> 00:30:16.375
It was still being appealed

00:30:16.375 --> 00:30:18.708
and this was a case involving USC Medical Center

00:30:19.500 --> 00:30:21.916
where there had been a policy within the hospital

00:30:21.916 --> 00:30:25.708
of sterilizing anyone who came in who was on welfare

00:30:25.708 --> 00:30:27.291
and had three or more children

00:30:27.291 --> 00:30:30.208
and I remember going through what they produced

00:30:30.208 --> 00:30:33.083
as evidence of consent for these women

00:30:33.083 --> 00:30:35.000
and it was appalling

00:30:35.583 --> 00:30:38.583
There were cases of women who
had supposedly given their consent

00:30:38.583 --> 00:30:41.333
while they were anesthetized

00:30:41.333 --> 00:30:43.958
The abuses were palpable and recent

00:30:43.958 --> 00:30:48.000
[Score: unnerving, subdued]

00:30:52.166 --> 00:30:54.291
[footsteps]

00:30:54.958 --> 00:30:59.916
PRISCILLA WALD: Contagion is used to configure
belonging and community

00:30:59.916 --> 00:31:02.000
Who belongs? Who’s a threat?

00:31:13.333 --> 00:31:17.083
[soundscape: inner space as outer space]

00:31:20.708 --> 00:31:21.583
- This is an age

00:31:21.583 --> 00:31:23.208
that men of the future, looking back

00:31:23.208 --> 00:31:25.041
will call the age of promise

00:31:25.041 --> 00:31:26.875
For the restless mind of man is open

00:31:26.875 --> 00:31:29.458
and every vision has validity

00:31:29.875 --> 00:31:31.916
Spectacular frontiers lie waiting

00:31:31.916 --> 00:31:34.583
in the fabulous worlds beyond the telescope

00:31:37.708 --> 00:31:39.000
And in the mysterious world

00:31:39.000 --> 00:31:41.083
that lives beneath the microscope

00:31:43.291 --> 00:31:45.041
[sounds of machine powering up]

00:31:46.208 --> 00:31:49.208
- Phase one calls for miniaturizing a submarine

00:31:49.208 --> 00:31:51.666
with crew and surgical team

00:31:51.666 --> 00:31:53.708
and injecting it into the carotid artery

00:31:54.208 --> 00:31:55.208
- How small will it be?

00:31:55.458 --> 00:31:57.125
- About the size of a microbe

00:31:57.125 --> 00:31:59.458
- If the other side ever gets hold of a thing like that!

00:32:02.708 --> 00:32:05.333
[sound of machine powering down]

00:32:05.333 --> 00:32:06.708
[beeping]

00:32:06.958 --> 00:32:08.333
- Standby for injection

00:32:08.333 --> 00:32:09.250
- Right

00:32:13.333 --> 00:32:14.208
Inject

00:32:14.208 --> 00:32:14.833
[click]

00:32:16.166 --> 00:32:18.958
[whooshing]

00:32:21.750 --> 00:32:23.458
- The sub is nuclear powered

00:32:23.458 --> 00:32:24.375
and we'll be tracking it

00:32:24.375 --> 00:32:27.083
just as we would any radioactive tracer

00:32:28.958 --> 00:32:32.541
[Score: gentle, ethereal] 

00:32:34.625 --> 00:32:36.208
PRISCILLA WALD: In the 1950s

00:32:36.208 --> 00:32:40.458
new technologies gave science a much clearer picture

00:32:40.708 --> 00:32:43.333
of what exactly a virus was

00:32:43.333 --> 00:32:46.125
and this became a source of fascination

00:32:46.125 --> 00:32:48.500
and found its way into the mainstream media

00:32:50.083 --> 00:32:52.875
[liquid sloshing, dripping]

00:32:53.833 --> 00:32:56.083
One of the things scientists were talking about

00:32:56.083 --> 00:33:01.000
is how viruses entered and took over the nucleus of a cell

00:33:01.000 --> 00:33:03.125
and began to reproduce itself that way

00:33:03.125 --> 00:33:06.125
and that it could go dormant for years

00:33:06.458 --> 00:33:09.458
[liquid dripping]

00:33:15.916 --> 00:33:18.333
- Beneath the electron microscope

00:33:18.333 --> 00:33:22.166
science has found and photographed the viruses

00:33:23.083 --> 00:33:25.000
the smallest forms of individual life

00:33:25.000 --> 00:33:26.666
with power to multiply

00:33:26.666 --> 00:33:28.750
Some viruses bring splendor

00:33:28.750 --> 00:33:30.250
to the natural world

00:33:32.833 --> 00:33:35.541
But others bring disease to man

00:33:37.083 --> 00:33:38.916
Influenza

00:33:38.916 --> 00:33:40.875
smallpox

00:33:40.875 --> 00:33:41.791
polio

00:33:43.000 --> 00:33:44.583
trachoma

00:33:48.875 --> 00:33:51.750
PRISCILLA WALD: This was really when the Cold War

00:33:51.750 --> 00:33:53.375
was, dare I say, heating up

00:33:57.708 --> 00:34:00.583
- You might call this a college town, Communist style

00:34:01.958 --> 00:34:04.208
this nameless American city

00:34:04.208 --> 00:34:06.125
deep in the vastness of the Soviet Union

00:34:07.333 --> 00:34:10.000
It stands as a symbol of Russian treachery

00:34:10.333 --> 00:34:13.333
of long-range Communist conspiracy

00:34:15.416 --> 00:34:19.333
PRISCILLA WALD: Communists started to get talked about as viral

00:34:19.333 --> 00:34:23.208
and viruses started to get talked about as Communists

00:34:23.208 --> 00:34:26.333
or fifth columnists hiding among us

00:34:29.958 --> 00:34:32.958
- Many diseases survive in man

00:34:32.958 --> 00:34:36.083
and are spread from person to person

00:34:36.458 --> 00:34:38.083
- By these actions, he has proved himself

00:34:38.083 --> 00:34:40.500
to be a dangerous enemy to the proletariat

00:34:41.333 --> 00:34:43.458
He must be treated as such

00:34:43.458 --> 00:34:45.458
as an ugly remnant

00:34:45.458 --> 00:34:48.458
of a diseased, bourgeois class

00:34:48.958 --> 00:34:52.875
He must be eradicated before the contagion can spread

00:34:53.250 --> 00:34:56.333
PRISCILLA WALD: So ideologies, dangerous ideas

00:34:56.583 --> 00:34:58.458
are contagious in the same way

00:34:58.458 --> 00:35:00.583
that microbes are contagious

00:35:00.583 --> 00:35:02.083
and it helps represent

00:35:02.083 --> 00:35:05.708
the particular threat to the body politic of ideas

00:35:07.958 --> 00:35:10.958
- White cells may seem like some inhuman organism

00:35:10.958 --> 00:35:12.708
crawling about the body

00:35:12.708 --> 00:35:14.625
but in truth they are a critical defense

00:35:14.625 --> 00:35:17.625
against invasion by foreign organisms

00:35:18.000 --> 00:35:20.583
Here, a white cell consumes bacteria

00:35:21.000 --> 00:35:23.750
First it engulfs and then it destroys

00:35:25.291 --> 00:35:27.250
DORA VARGHA: Again, you have this coincidence

00:35:27.250 --> 00:35:30.083
of the scientific identification of the T cells

00:35:30.083 --> 00:35:32.000
and you have this inescapable

00:35:32.000 --> 00:35:34.708
cultural and political Cold War context

00:35:37.375 --> 00:35:38.875
And so what happens is

00:35:38.875 --> 00:35:42.958
this really gets ingrained into how we think about disease

00:35:42.958 --> 00:35:45.333
and how it's discussed in scientific terms

00:35:45.333 --> 00:35:46.958
and also in popular terms

00:35:48.416 --> 00:35:51.625
[buzzing]

00:35:53.958 --> 00:35:55.333
[liquid splashing]

00:35:59.041 --> 00:36:01.458
[8 bit gunfire]

00:36:03.250 --> 00:36:07.000
- One by one, cells are bursting, liberating viruses

00:36:08.125 --> 00:36:11.875
The technical name for this kind of cell destruction is lysis

00:36:12.041 --> 00:36:13.000
[popping]

00:36:13.000 --> 00:36:13.125
These viruses are cell killers

00:36:13.125 --> 00:36:15.416
These viruses are cell killers

00:36:19.291 --> 00:36:20.500
[distorted squeak]

00:36:21.125 --> 00:36:25.291
- Another cultural obsession of this moment is aliens

00:36:25.291 --> 00:36:27.875
and the idea of invasive aliens

00:36:27.875 --> 00:36:32.333
which metaphorically, very easily
connects to invasive viruses

00:36:39.750 --> 00:36:43.625
Probably the main storyline that I find gets picked up

00:36:43.625 --> 00:36:45.125
in the mid 1950s

00:36:45.125 --> 00:36:48.250
comes from Jack Finney's story “Body Snatchers”

00:36:48.250 --> 00:36:50.625
which gets popularized in 1956

00:36:50.625 --> 00:36:53.291
as the film, Invasion of the Body Snatchers

00:36:54.250 --> 00:36:57.625
[Score: dark, sparse, eerie]

00:36:58.250 --> 00:37:01.375
And the premise is that aliens come down

00:37:01.375 --> 00:37:04.416
and they take the form of human beings

00:37:04.916 --> 00:37:06.916
and they spread like a contagion

00:37:08.541 --> 00:37:11.000
So people are really anxious and suspicious

00:37:11.000 --> 00:37:14.250
and they don't know who is infected and who isn’t

00:37:16.000 --> 00:37:16.875
- Valley Spring

00:37:17.125 --> 00:37:18.000
- The third truck

00:37:18.000 --> 00:37:19.000
- That’s our town

00:37:20.541 --> 00:37:22.083
and all the towns around us

00:37:22.916 --> 00:37:25.375
It's a malignant disease, spreading through the whole country

00:37:26.500 --> 00:37:29.458
- They’re here already! You’re next!

00:37:31.166 --> 00:37:34.041
[Ominous music] 

00:37:37.000 --> 00:37:38.666
- No! It isn’t possible

00:37:39.500 --> 00:37:41.916
- It reproduces itself at amazing speed

00:37:42.625 --> 00:37:44.625
This pulsating, Doctor...

00:37:44.625 --> 00:37:46.750
- as though they were breathing

00:37:46.750 --> 00:37:47.625
- Yes

00:37:47.625 --> 00:37:49.375
- Human plants

00:37:49.375 --> 00:37:50.333
- Superhuman

00:37:51.625 --> 00:37:52.875
- Sleep

00:37:53.750 --> 00:37:54.375
Sleep

00:37:54.375 --> 00:37:58.041
PRISCILLA WALD: Human beings
tend to want to see our threats

00:37:58.041 --> 00:38:01.291
as sinister, as deliberate, as enemies

00:38:01.291 --> 00:38:03.625
and not just as sort of indifferent

00:38:03.625 --> 00:38:05.750
and yet beating us all the same

00:38:07.000 --> 00:38:09.875
[darts thudding into targets]

00:38:12.000 --> 00:38:13.375
- We don't hate you

00:38:13.375 --> 00:38:15.416
We came here from a dying world

00:38:16.250 --> 00:38:17.458
We adapt

00:38:18.041 --> 00:38:19.375
and we survive

00:38:20.041 --> 00:38:22.375
The function of life is survival

00:38:22.375 --> 00:38:22.916
[screaming]

00:38:22.916 --> 00:38:23.500
[crash]

00:38:26.250 --> 00:38:26.583
[glass breaking]

00:38:27.125 --> 00:38:28.250
[crowd laughing]

00:38:29.750 --> 00:38:31.500
[static buzz]

00:38:35.416 --> 00:38:38.000
[dramatic music[

00:38:38.000 --> 00:38:40.708
[crowd screaming]

00:38:53.250 --> 00:38:57.083
[Score: Intense, building, low rumble] 

00:38:59.875 --> 00:39:02.250
- Permanently infected zones are localized

00:39:02.250 --> 00:39:04.416
but may cover large areas of territory

00:39:04.416 --> 00:39:06.875
sometimes entire continents

00:39:06.875 --> 00:39:08.875
Modern transport poses new dangers

00:39:08.875 --> 00:39:11.125
of complete, universal contagion

00:39:13.250 --> 00:39:15.916
The struggle against epidemics is a global one

00:39:15.916 --> 00:39:18.125
for the danger of death is worldwide

00:39:23.750 --> 00:39:26.250
Then what is the answer?

00:39:35.750 --> 00:39:37.958
Within the framework of the United Nations

00:39:37.958 --> 00:39:39.666
a new organization exists

00:39:39.666 --> 00:39:41.541
to promote the welfare of all people

00:39:42.250 --> 00:39:44.000
The World Health Organization

00:39:44.416 --> 00:39:47.291
In its first assembly, July 1948

00:39:47.291 --> 00:39:49.041
Director General, Dr. Chisholm

00:39:49.041 --> 00:39:52.041
declared that this organization was physically prepared

00:39:52.041 --> 00:39:54.416
to raise the health level of all people

00:39:54.416 --> 00:39:56.750
and to forever destroy the human afflictions

00:39:56.750 --> 00:39:59.500
of malaria, cholera, tuberculosis and syphilis

00:40:00.083 --> 00:40:03.041
The prime objective of the World Health Organization

00:40:03.041 --> 00:40:06.125
is the fight against disease on a global scale

00:40:09.791 --> 00:40:15.375
- The idea that scientists and public health actors

00:40:15.375 --> 00:40:20.750
can wage war successfully against disease

00:40:20.750 --> 00:40:22.500
seems to have a very long history

00:40:22.500 --> 00:40:25.666
so even in colonial times

00:40:25.666 --> 00:40:31.708
there's constantly imagery and official publicity

00:40:31.708 --> 00:40:35.250
talking about the war against the malarial mosquito

00:40:35.250 --> 00:40:38.541
the war against disease bearing insects

00:40:42.041 --> 00:40:44.708
and it was all part of the colonial processes

00:40:44.708 --> 00:40:47.666
that allowed the argument to be made

00:40:47.666 --> 00:40:50.125
that colonial rule was a good thing

00:40:50.125 --> 00:40:51.541
because it brought in science

00:40:51.541 --> 00:40:54.291
and it allowed these magnificent battles

00:40:54.291 --> 00:40:57.041
against vectors to be fought and won

00:40:58.500 --> 00:41:02.791
[Score: bright, whistling tones]

00:41:11.125 --> 00:41:14.125
[Score: eerie, resonant]

00:41:33.375 --> 00:41:34.750
Actually, the colonial subjects

00:41:34.750 --> 00:41:37.375
are often referred to as ants and termites

00:41:37.375 --> 00:41:40.291
and colonial rulers are the people
who would bring the problem

00:41:40.291 --> 00:41:42.875
caused by the ants and termites to heel

00:41:43.375 --> 00:41:45.500
[compressed air being pumped]

00:41:47.666 --> 00:41:50.000
[Airplane engine]

00:41:53.125 --> 00:41:55.875
- Epidemics, no matter what part
of the world they may infect

00:41:55.875 --> 00:41:58.791
are a potential danger to all other nations

00:41:58.791 --> 00:42:02.375
a worldwide system of medical
control will exist everywhere

00:42:03.916 --> 00:42:06.583
- When the W.H.O is formed in 1948

00:42:06.583 --> 00:42:09.125
there is a clamor for a system

00:42:09.125 --> 00:42:13.416
that provides equitable access to health for all

00:42:15.500 --> 00:42:20.250
and this is not divorced from
the decolonizing moment

00:42:20.250 --> 00:42:24.625
in international relations and politics in the post-war era

00:42:27.750 --> 00:42:30.541
[crowd noise]

00:42:30.541 --> 00:42:32.208
[drumming]

00:42:43.083 --> 00:42:44.833
- The establishment of international governance

00:42:44.833 --> 00:42:46.833
around health security specifically

00:42:47.500 --> 00:42:50.333
I believe, has at its base a conviction

00:42:50.625 --> 00:42:53.375
that newly independent, formerly colonized people

00:42:53.375 --> 00:42:56.000
in fact, cannot be responsible for themselves

00:42:56.000 --> 00:42:58.000
and because they cannot be
responsible for themselves

00:42:58.000 --> 00:43:00.791
in terms of managing their population or their sanitation

00:43:00.791 --> 00:43:02.750
or their health care systems

00:43:02.750 --> 00:43:04.625
they are a threat to global health

00:43:04.625 --> 00:43:06.583
and so global health to me

00:43:06.583 --> 00:43:08.833
is always in defense of First World health

00:43:13.125 --> 00:43:14.625
- In vast areas in Africa

00:43:14.625 --> 00:43:16.166
there are countless persons suffering

00:43:16.166 --> 00:43:18.750
from many strange and exotic diseases

00:43:18.750 --> 00:43:21.208
some of which are found nowhere else in the world

00:43:21.750 --> 00:43:23.291
These diseases greatly interfere

00:43:23.291 --> 00:43:25.875
with the economic development of the tropical countries

00:43:25.875 --> 00:43:29.000
and hamper the exportation
of enormous reservoirs

00:43:29.000 --> 00:43:32.000
of material resources so much
needed by the free world

00:43:32.791 --> 00:43:33.791
Furthermore

00:43:33.791 --> 00:43:36.916
there's a constant threat of the
spread beyond the tropics

00:43:39.125 --> 00:43:41.375
Research in the field of tropical medicine

00:43:41.375 --> 00:43:44.000
is of more than academic or altruistic concern

00:43:44.000 --> 00:43:46.250
to the people of the United States

00:43:46.250 --> 00:43:48.625
because our own economy is involved

00:43:48.625 --> 00:43:51.875
60% of our imports come from the tropical countries

00:43:59.708 --> 00:44:01.625
- Care and healthcare in particular

00:44:01.625 --> 00:44:04.875
have long been used and interpreted

00:44:04.875 --> 00:44:06.416
in very particular ways

00:44:06.416 --> 00:44:10.750
that suited the designs of colonizing countries

00:44:14.041 --> 00:44:16.875
[metallic creaking]

00:44:19.375 --> 00:44:21.375
What constituted the biggest threats

00:44:21.375 --> 00:44:24.500
to the smooth running of colonies

00:44:24.500 --> 00:44:28.250
and the smooth uninterrupted extraction
of labor and natural resources

00:44:28.250 --> 00:44:30.041
were epidemics

00:44:31.000 --> 00:44:32.791
[liquid bubbling]

00:44:35.041 --> 00:44:38.041
The healthcare that was offered
from colonial governments

00:44:38.041 --> 00:44:42.000
obviously also contributed to population statistics

00:44:43.541 --> 00:44:45.625
and all of that knowledge could be used

00:44:45.625 --> 00:44:49.541
to corral the colonized population more effectively

00:44:50.333 --> 00:44:54.416
[Score: tense, high-pitched, building]

00:44:55.833 --> 00:44:59.125
SANJOY BHATTACHARYA: It is from this statistical turn

00:44:59.125 --> 00:45:01.375
that epidemiology appears

00:45:04.500 --> 00:45:08.875
Epidemiological forecasting, calculations, profiling

00:45:08.875 --> 00:45:12.500
is done in extremely political ways

00:45:14.541 --> 00:45:17.875
[footsteps]

00:45:19.708 --> 00:45:22.041
But what was absolutely fascinating

00:45:22.041 --> 00:45:23.875
was how this sanitary science

00:45:23.875 --> 00:45:27.666
was married to anthropological understandings

00:45:27.666 --> 00:45:30.041
about who was developed,
who was less developed

00:45:30.041 --> 00:45:31.875
who was gentle and who was not

00:45:39.291 --> 00:45:42.250
[Soundscape: muffled, underwater echoes]

00:45:42.250 --> 00:45:44.083
[Score: ominous drone]

00:45:49.541 --> 00:45:53.500
and so it was also a way of
dividing society through science

00:45:54.416 --> 00:45:57.125
[footsteps]

00:46:04.291 --> 00:46:06.750
ANJULI RAZA KOLB: There was a
consolidation of epidemiology

00:46:06.750 --> 00:46:08.791
as an extension of colonial care

00:46:12.333 --> 00:46:15.166
[Soundscape: fire crackling]

00:46:15.625 --> 00:46:18.625
The truly important role that disease plays

00:46:18.625 --> 00:46:21.375
is a moral and conceptual one

00:46:25.125 --> 00:46:28.541
It's really the sculpting of will

00:46:28.541 --> 00:46:29.625
that it accomplishes

00:46:29.625 --> 00:46:31.000
I think, more than anything

00:46:33.625 --> 00:46:36.000
To marshal human sacrifice

00:46:36.000 --> 00:46:37.875
both of the colonized population

00:46:37.875 --> 00:46:40.500
and of the people who were
doing the dirty work of empire

00:46:44.000 --> 00:46:45.625
[footsteps, running]

00:46:49.375 --> 00:46:50.750
[rifle shots]

00:46:52.666 --> 00:46:54.125
[rifles and cannons firing]

00:46:58.041 --> 00:46:59.416
[shouting]

00:46:59.750 --> 00:47:04.208
[Score: plangent, echoing melodies]

00:47:08.291 --> 00:47:09.916
- In the 19th century

00:47:09.916 --> 00:47:14.916
when Germany was involved in colonial
practices on the African continent

00:47:14.916 --> 00:47:18.625
Robert Koch, who won the Nobel Prize in 1905

00:47:18.625 --> 00:47:21.833
for having understood tuberculosis and cholera

00:47:22.166 --> 00:47:25.000
the same person, set up this camp

00:47:25.000 --> 00:47:27.916
and experimented on about a thousand Africans

00:47:30.125 --> 00:47:33.041
He wanted to find the cure for sleeping sickness

00:47:33.041 --> 00:47:35.041
and that particular illness

00:47:35.041 --> 00:47:37.375
made it so that people were lethargic

00:47:37.375 --> 00:47:41.041
and weren't as productive as some
of the European colonialists wanted

00:47:43.500 --> 00:47:47.000
He gave, without the consent of Africans, Atoxyl

00:47:47.000 --> 00:47:49.416
which is a reagent that contains arsenic

00:47:49.416 --> 00:47:53.000
and many of those people turned out worse than before

00:47:56.625 --> 00:47:59.875
This was kind of a blueprint for
other concentration camps

00:47:59.875 --> 00:48:02.541
that would happen on the African continent

00:48:05.041 --> 00:48:08.666
and many of the architects of German colonial science

00:48:08.666 --> 00:48:11.875
ended up being involved in the Nazi project

00:48:11.875 --> 00:48:13.500
two decades later

00:48:17.291 --> 00:48:21.041
[Score: melancholy, subdued]

00:48:23.041 --> 00:48:26.125
[whistling wind]

00:48:27.083 --> 00:48:29.500
LIOBA HIRSCH: When it comes
to medical care, even today

00:48:29.500 --> 00:48:31.375
we're always expected to be grateful

00:48:31.375 --> 00:48:33.375
and to receive it without comment

00:48:35.500 --> 00:48:40.250
That dynamic perpetuates a lot
of the colonial power differentials

00:48:40.250 --> 00:48:42.666
that still shape global health today

00:48:49.875 --> 00:48:52.166
[mechanical clicking]

00:48:55.875 --> 00:48:59.541
- We started with a germ so tiny

00:48:59.541 --> 00:49:02.875
that only a powerful microscope could reveal it

00:49:02.875 --> 00:49:06.125
and now this little germ has led us into a battle

00:49:06.125 --> 00:49:09.291
so big that it involves the whole world

00:49:10.625 --> 00:49:13.375
- Stopping the disease completely was the goal

00:49:13.375 --> 00:49:15.750
But how can you stop a disease like smallpox?

00:49:15.750 --> 00:49:18.291
especially under these conditions

00:49:18.291 --> 00:49:20.083
when it has so many paths to cross

00:49:22.291 --> 00:49:25.875
SANJOY BHATTACHARYA: International
discussions about smallpox eradication

00:49:25.875 --> 00:49:29.416
started as soon as the W.H.O was created

00:49:29.416 --> 00:49:35.000
Just as regional offices in decolonizing
countries came together

00:49:35.000 --> 00:49:37.833
to demand that smallpox be eradicated

00:49:37.833 --> 00:49:40.708
They also came together to demand

00:49:40.708 --> 00:49:46.208
that access to primary, secondary
and tertiary healthcare be improved

00:49:48.916 --> 00:49:52.541
So right from this time,
there was a competition

00:49:52.541 --> 00:49:58.000
between those who wanted better health systems

00:49:58.000 --> 00:50:01.958
and those who wanted immunization campaigns

00:50:01.958 --> 00:50:04.375
against different diseases

00:50:07.958 --> 00:50:09.458
[metallic creaking]

00:50:10.166 --> 00:50:13.000
[crowd noise]

00:50:15.708 --> 00:50:19.208
The third view was that you can
provide strong immunization

00:50:19.208 --> 00:50:22.458
through strong primary healthcare structures

00:50:22.458 --> 00:50:25.708
If you have community health
workers in each district

00:50:25.708 --> 00:50:27.958
you then know from the data being collected

00:50:27.958 --> 00:50:30.041
about what diseases are a problem

00:50:30.708 --> 00:50:35.083
You then deploy district-appropriate
immunization methods

00:50:36.833 --> 00:50:38.750
- So of course, health development

00:50:38.750 --> 00:50:41.750
cannot be achieved by proxy

00:50:43.083 --> 00:50:48.000
It has to be carried out by the
people concerned themselves

00:50:49.083 --> 00:50:53.166
W.H.O has shown how to set up
the permanent structures

00:50:53.166 --> 00:50:56.125
required in the health and many other sectors

00:50:56.125 --> 00:51:01.375
to make sure that technology
becomes accessible to the masses

00:51:01.375 --> 00:51:04.333
and not just to the privileged few

00:51:05.875 --> 00:51:08.958
The Alma Ata Declaration on primary healthcare

00:51:08.958 --> 00:51:10.875
now ten years old

00:51:10.875 --> 00:51:13.625
clearly mapped out the road

00:51:13.625 --> 00:51:16.541
on which we are firmly engaged

00:51:20.125 --> 00:51:23.125
SANJOY BHATTACHARYA: So the
smallpox eradication program

00:51:23.125 --> 00:51:27.500
was imagined, run and delivered at a time

00:51:27.500 --> 00:51:32.041
when the idea of universal access to health

00:51:32.041 --> 00:51:36.541
meant strong, publicly funded healthcare services

00:51:36.541 --> 00:51:39.708
[Score: Building, optimistic]

00:51:42.583 --> 00:51:45.333
Day to day, campaigns around the world

00:51:45.333 --> 00:51:48.333
were run by health workers

00:51:48.333 --> 00:51:51.625
whose voices we have systematically lost

00:51:51.958 --> 00:51:54.458
in these institutional histories

00:51:58.500 --> 00:52:00.083
The smallpox eradication program

00:52:00.083 --> 00:52:04.666
is considered one of the biggest
triumphs of global public health

00:52:04.666 --> 00:52:05.750
in the 20th century

00:52:05.750 --> 00:52:08.375
if not, the greatest success

00:52:18.625 --> 00:52:21.500
- When the history of this period comes to be written

00:52:21.500 --> 00:52:26.625
the conquest of disease will be revealed
as one of its greatest achievements

00:52:27.750 --> 00:52:31.125
- But Professor, what's to become of all my tribe

00:52:31.125 --> 00:52:33.750
with that kind of thing going on?

00:52:34.000 --> 00:52:36.291
- This is a fight to the finish

00:52:36.291 --> 00:52:38.375
and man is going to win this fight

00:52:39.875 --> 00:52:41.708
Goodbye, Mr. Germ

00:52:44.375 --> 00:52:48.125
- Can some other disease be consciously
eradicated by the efforts of man?

00:52:48.125 --> 00:52:51.250
and my opinion, unfortunately, is no

00:52:51.250 --> 00:52:55.208
because every other disease
either has an animal reservoir

00:52:55.208 --> 00:52:57.625
or it has a human carrier system

00:52:57.625 --> 00:53:02.625
or we don't have a cheap, safe, easy, effective vaccine

00:53:02.625 --> 00:53:03.791
or preventative measure

00:53:09.625 --> 00:53:13.416
SANJOY BHATTACHARYA: Polio
eradication was launched in 1988

00:53:14.166 --> 00:53:21.250
and of course, the 1980s are marked
by greater World Bank and IMF interventions

00:53:21.250 --> 00:53:23.083
in national healthcare systems

00:53:24.875 --> 00:53:28.625
linked to very insistent demands

00:53:29.000 --> 00:53:31.625
that health systems be privatized

00:53:31.625 --> 00:53:34.458
that public investment into health be cut

00:53:36.500 --> 00:53:38.916
- We need to restructure the world’s economy

00:53:38.916 --> 00:53:42.750
and to change the patterns of
world trade and investment

00:53:42.750 --> 00:53:46.750
so that everyone gets a
decent share of a bigger pie

00:53:57.000 --> 00:53:58.958
- She has to pay for their services

00:53:58.958 --> 00:54:01.125
and pay for their medicines

00:54:01.125 --> 00:54:04.041
and she has to beg the social welfare

00:54:04.041 --> 00:54:05.250
to reduce the fees

00:54:05.250 --> 00:54:07.875
Otherwise her children will not be treated

00:54:11.708 --> 00:54:14.458
This is what we are doing
to the future generation

00:54:14.458 --> 00:54:17.083
to the next generation of Filipinos

00:54:17.083 --> 00:54:18.333
in exchange for the debt

00:54:22.333 --> 00:54:24.375
SANJOY BHATTACHARYA: A lot of the justification

00:54:24.375 --> 00:54:29.083
for the need and importance
of polio eradication

00:54:29.083 --> 00:54:31.625
constantly relied on

00:54:31.625 --> 00:54:34.875
exclusionary, high-income country centered

00:54:34.875 --> 00:54:38.208
triumphalist histories of smallpox eradication

00:54:43.625 --> 00:54:44.625
That is

00:54:44.625 --> 00:54:47.458
we can sit in a couple of big cities

00:54:47.458 --> 00:54:49.125
in high income countries

00:54:49.125 --> 00:54:50.708
develop some ideas

00:54:50.708 --> 00:54:52.833
and we will then simply give those ideas

00:54:52.833 --> 00:54:57.333
to health managers in low and
middle income countries

00:54:57.333 --> 00:55:00.000
and they just have to follow our orders

00:55:00.000 --> 00:55:02.458
and polio will be eradicated

00:55:06.583 --> 00:55:08.333
And so there is opposition

00:55:08.333 --> 00:55:12.583
because health ministries that have
very little money in the first place

00:55:12.583 --> 00:55:16.583
need to spend it on fighting a
large number of diseases

00:55:16.583 --> 00:55:17.625
not just one disease

00:55:21.583 --> 00:55:23.333
In the last five to ten years

00:55:23.333 --> 00:55:26.083
the international organizations have realized

00:55:26.083 --> 00:55:28.750
that they cannot just march into a province

00:55:28.750 --> 00:55:30.833
and then go up to people and say:

00:55:30.833 --> 00:55:32.958
you have to get immunized against polio

00:55:37.375 --> 00:55:40.083
You can't just eradicate a disease

00:55:40.083 --> 00:55:43.250
if a country has weak health systems

00:55:50.125 --> 00:55:53.166
In the two countries where polio still remains

00:55:53.166 --> 00:55:55.625
in Afghanistan and Pakistan

00:55:55.625 --> 00:55:59.541
usually women vaccinators are
being targeted for their work

00:56:02.583 --> 00:56:04.666
It is because it has been linked

00:56:04.666 --> 00:56:06.875
very damagingly to the discourse

00:56:06.875 --> 00:56:08.208
about the war against terror

00:56:08.208 --> 00:56:09.541
[knocking]

00:56:09.833 --> 00:56:10.958
[knocking]

00:56:11.291 --> 00:56:12.791
[knocking]

00:56:15.125 --> 00:56:16.583
- We found a safe house

00:56:16.583 --> 00:56:19.541
but we can't get a vantage
point to fire a telescope

00:56:19.541 --> 00:56:21.125
over the balcony wall

00:56:21.750 --> 00:56:24.458
[radio chatter]

00:56:24.958 --> 00:56:28.708
ANJULI RAZA KOLB: The idea that the
CIA could use a vaccination ruse

00:56:28.708 --> 00:56:31.333
in order to gather DNA from Bin Laden’s family members

00:56:31.333 --> 00:56:37.333
and thereby perform this
extraction of this one evil body

00:56:37.333 --> 00:56:40.250
had this kind of fantasy that
there would be no collateral

00:56:40.250 --> 00:56:43.083
[Score: tense, thrilling]

00:56:45.708 --> 00:56:47.333
and in this instance

00:56:47.333 --> 00:56:49.208
that collateral took the form

00:56:49.208 --> 00:56:54.458
of a now decade-long rise in polio, hepatitis B

00:56:54.458 --> 00:56:57.958
and deeply terrified anti-medical

00:56:57.958 --> 00:57:00.208
and anti-vaccine sentiment in the region

00:57:02.375 --> 00:57:03.833
It's hard to overstate the importance

00:57:03.833 --> 00:57:07.625
of polio almost having been
eradicated from planet Earth

00:57:07.625 --> 00:57:09.083
and then becoming endemic again

00:57:09.083 --> 00:57:10.708
in Pakistan, Afghanistan

00:57:11.708 --> 00:57:13.958
I think it tells us so much

00:57:13.958 --> 00:57:17.125
about how an idea of help

00:57:17.125 --> 00:57:19.333
an idea of villainy

00:57:19.333 --> 00:57:24.833
has served neo-liberal and
neo-imperial interests for 200 years

00:57:25.625 --> 00:57:29.875
[Score: deep bass swell]

00:57:32.875 --> 00:57:35.333
[explosion]

00:57:44.750 --> 00:57:46.583
[explosion]

00:57:59.208 --> 00:58:01.833
- The same enemy who strikes in the dark

00:58:01.833 --> 00:58:04.625
who obeys no rules of warfare

00:58:04.625 --> 00:58:06.333
This is your enemy

00:58:07.000 --> 00:58:08.208
Remember her

00:58:11.125 --> 00:58:12.333
[footsteps]

00:58:14.791 --> 00:58:17.791
[Score: sparse, staccato]

00:58:19.458 --> 00:58:22.458
- From the dark primordial pools

00:58:22.458 --> 00:58:24.833
out of the very air they breathed

00:58:24.833 --> 00:58:26.875
so it seemed to our ancestors

00:58:26.875 --> 00:58:28.875
came their ancient enemy

00:58:29.291 --> 00:58:30.166
Malaria

00:58:32.708 --> 00:58:35.125
Wise men tried to cast them out

00:58:35.125 --> 00:58:38.125
but malaria remained the great scourge

00:58:38.125 --> 00:58:41.875
destroying more of the human
race than any other disease

00:58:43.583 --> 00:58:46.625
[mosquito buzzing]

00:58:46.625 --> 00:58:49.000
- Something new must be found

00:58:49.000 --> 00:58:51.583
to fight the menace of the disease bearing insect

00:58:52.833 --> 00:58:55.833
[Score: optimistic]

00:58:58.333 --> 00:59:00.083
- DDT was this miracle drug

00:59:00.083 --> 00:59:01.750
to control insects

00:59:01.750 --> 00:59:03.833
It didn't seem to affect anything else

00:59:03.833 --> 00:59:05.875
from what people could see at that time

00:59:07.333 --> 00:59:09.625
and there was a sense in the State Department

00:59:09.625 --> 00:59:14.958
that DDT could be used for a
political propaganda campaign

00:59:16.750 --> 00:59:19.750
- I consider this amazing chemical

00:59:20.208 --> 00:59:22.208
the most valuable contribution

00:59:22.208 --> 00:59:25.125
of our wartime medical research program

00:59:25.125 --> 00:59:27.583
to the future health and welfare

00:59:27.583 --> 00:59:28.958
not only of this nation

00:59:28.958 --> 00:59:30.875
but of the entire world

00:59:30.875 --> 00:59:32.458
[splashing]

00:59:36.458 --> 00:59:39.875
- Simultaneous with the bombing
of our two legged enemy

00:59:39.875 --> 00:59:42.708
we went after the mosquito with DDT spray

00:59:42.708 --> 00:59:45.500
[airplane engine]

00:59:50.083 --> 00:59:52.458
SONIA SHAH: We could just spend not that much money

00:59:52.458 --> 00:59:54.000
and we'll get rid of malaria

00:59:54.000 --> 00:59:55.583
and we'll be heroes. Right?

00:59:55.583 --> 00:59:57.583
and this will be a way to win hearts and minds

00:59:57.583 --> 00:59:58.458
during the Cold War

00:59:58.458 --> 00:59:59.958
and the W.H.O. signed on

00:59:59.958 --> 01:00:00.958
the C.D.C. signed on

01:00:00.958 --> 01:00:02.958
to this global eradication campaign

01:00:02.958 --> 01:00:04.750
and hundreds of thousands of people

01:00:04.750 --> 01:00:07.000
fanned out across the developing world

01:00:07.000 --> 01:00:09.375
with DDT and just sprayed it everywhere

01:00:11.166 --> 01:00:13.500
[liquid spraying]

01:00:20.083 --> 01:00:22.000
- You've got to work out strategy

01:00:22.000 --> 01:00:25.208
tactics, personnel, transport

01:00:26.208 --> 01:00:27.625
You think like a doctor

01:00:28.208 --> 01:00:30.333
You plan like a general

01:00:30.333 --> 01:00:32.375
[boat engine]

01:00:37.791 --> 01:00:39.875
[footsteps]

01:00:45.083 --> 01:00:46.875
SONIA SHAH: Of course, at the same time

01:00:46.875 --> 01:00:49.375
the Rockefeller Foundation and other entities

01:00:49.375 --> 01:00:54.250
were trying to really convince
farmers in developing countries

01:00:54.250 --> 01:00:55.583
to use more DDT

01:00:55.583 --> 01:00:58.000
and more chemicals in their agriculture

01:00:58.000 --> 01:01:00.625
and this was seen as a way to improve yields

01:01:00.625 --> 01:01:02.375
and end hunger

01:01:06.750 --> 01:01:10.791
[Score: repeating groove]

01:01:13.583 --> 01:01:16.083
When it rains, the residue washes off

01:01:16.083 --> 01:01:17.833
and it goes off into the streams

01:01:17.833 --> 01:01:18.833
and rivers and wetlands

01:01:18.833 --> 01:01:20.833
and puddles where mosquitoes breed

01:01:20.833 --> 01:01:22.958
And so all the larvae that are breeding there

01:01:22.958 --> 01:01:24.458
that are exposed to it

01:01:24.458 --> 01:01:26.333
if they don't die, they get stronger

01:01:26.333 --> 01:01:27.583
and they get resistant

01:01:28.833 --> 01:01:31.041
[underwater movements]

01:01:31.041 --> 01:01:34.083
[water running]

01:01:35.708 --> 01:01:37.708
and it happened fast enough

01:01:37.708 --> 01:01:40.250
that it was within the five year funding cycle

01:01:41.708 --> 01:01:46.333
Funding collapses and malaria
just skyrockets up again

01:01:46.333 --> 01:01:49.541
except this time, the mosquitos are resistant to DDT

01:01:49.541 --> 01:01:53.541
and all its fellow allied insecticides as well

01:01:58.375 --> 01:02:00.916
- Ronald, what was this strange thing?

01:02:00.916 --> 01:02:03.875
- We found the mosquito had a
strong instinct of self preservation

01:02:03.875 --> 01:02:05.500
[airplane engines]

01:02:05.500 --> 01:02:07.958
- Our cadets have earned their wings

01:02:07.958 --> 01:02:10.000
Full fledged fighter pilots

01:02:10.000 --> 01:02:11.708
ready for action

01:02:14.208 --> 01:02:15.875
[airplane engine]

01:02:15.875 --> 01:02:19.375
[high-pitched whistling]

01:02:20.375 --> 01:02:22.833
[screaming]

01:02:23.250 --> 01:02:25.541
[fanfare]

01:02:29.750 --> 01:02:33.333
[mosquito buzzing]

01:02:35.208 --> 01:02:37.708
[hissing]

01:02:38.583 --> 01:02:41.791
[Score: ominous bass swell] 

01:03:05.083 --> 01:03:06.958
[mechanical chime]

01:03:08.458 --> 01:03:12.750
- At first, only gays and IV drug
users were being killed by AIDS

01:03:14.250 --> 01:03:17.083
But now we know every one
of us could be devastated by it

01:03:20.708 --> 01:03:21.833
The fact is

01:03:23.625 --> 01:03:25.000
that if not stopped

01:03:25.000 --> 01:03:28.250
it could kill more Australians than World War Two

01:03:41.750 --> 01:03:44.250
[wind blowing]

01:03:45.458 --> 01:03:46.958
- Hello!

01:03:50.000 --> 01:03:52.583
Is anyone there?

01:03:56.208 --> 01:03:59.000
[footsteps]

01:04:11.583 --> 01:04:12.458
[footsteps]

01:04:12.458 --> 01:04:15.083
How do we come to re-imagine

01:04:15.083 --> 01:04:18.083
or to re-conceptualize what it is to be human

01:04:18.083 --> 01:04:20.333
through the lens of a pandemic

01:04:20.333 --> 01:04:27.291
which is projected as leading
to an event of human extinction

01:04:28.458 --> 01:04:34.625
[Score: Tense, dramatic]

01:04:40.583 --> 01:04:42.208
-Hello!

01:04:43.958 --> 01:04:45.708
- And we've all watched the films

01:04:45.708 --> 01:04:47.583
about a pandemic apocalypse

01:04:47.583 --> 01:04:50.458
sometimes involving zombies and sometimes not

01:05:01.625 --> 01:05:02.458
[metallic clicking]

01:05:09.250 --> 01:05:12.833
This imagination really becomes central

01:05:12.833 --> 01:05:14.833
to cultural representations

01:05:14.833 --> 01:05:16.958
and cultural forms in the West

01:05:16.958 --> 01:05:18.458
since the 1990s

01:05:18.458 --> 01:05:21.625
when we have this idea of emerging infectious diseases

01:05:25.750 --> 01:05:28.708
PRISCILLA WALD: Epidemiologists,
infectious disease specialists

01:05:28.708 --> 01:05:30.375
identified HIV

01:05:30.375 --> 01:05:33.625
and a cluster of other catastrophic diseases

01:05:33.625 --> 01:05:34.875
like Ebola

01:05:34.875 --> 01:05:37.833
Marburg, Bolivian hemorrhagic fever

01:05:37.833 --> 01:05:40.708
and they said, “This is all part of one phenomenon”

01:05:40.708 --> 01:05:42.708
that we're going to call disease emergence

01:05:42.708 --> 01:05:47.583
And it is the result of development
practices and globalization

01:05:50.083 --> 01:05:54.958
We are inhabiting places where
human beings haven’t lived before

01:05:54.958 --> 01:05:58.750
and encountering microbes to
which we’re immunologically naive

01:06:01.625 --> 01:06:03.458
CHRISTOS LYNTERIS: Up until AIDS

01:06:03.458 --> 01:06:08.166
the main idea was that we have a
set number of known diseases

01:06:08.458 --> 01:06:12.375
plague, malaria, yellow fever, cholera, you name it

01:06:12.375 --> 01:06:14.000
These are diseases that do not
really belong to modernity

01:06:14.000 --> 01:06:16.250
These are diseases that do not
really belong to modernity

01:06:16.250 --> 01:06:17.875
We still have to fight them

01:06:17.875 --> 01:06:20.250
and they will eventually be eradicated

01:06:20.250 --> 01:06:20.750
like smallpox was

01:06:20.750 --> 01:06:21.416
like smallpox was

01:06:21.416 --> 01:06:23.875
and we will be free of all infectious diseases

01:06:25.375 --> 01:06:30.333
[Score: brooding, slowly building] 

01:06:32.833 --> 01:06:34.958
Then with HIV/AIDS

01:06:34.958 --> 01:06:36.666
there is a new chapter

01:06:39.666 --> 01:06:44.791
but it no longer describes infectious
diseases as an old enemy

01:06:46.541 --> 01:06:49.791
Rather than having ancient
enemies that have no future

01:06:49.791 --> 01:06:51.666
we have the future itself

01:06:53.791 --> 01:06:57.083
Diseases that are lurking in some animals

01:06:57.083 --> 01:06:58.291
or in the jungle

01:06:58.291 --> 01:07:00.125
These are all colonial frameworks

01:07:00.125 --> 01:07:04.083
which are slowly reaching the developed world

01:07:04.083 --> 01:07:05.541
and may threaten humanity

01:07:05.541 --> 01:07:07.208
even with extinction

01:07:12.166 --> 01:07:13.916
[birdsong]

01:07:15.791 --> 01:07:17.458
[explosion]

01:07:17.958 --> 01:07:18.791
[gunfire]

01:07:18.791 --> 01:07:19.541
[scratching]

01:07:19.541 --> 01:07:20.291
- Argh!

01:07:24.083 --> 01:07:25.041
[crash]

01:07:25.958 --> 01:07:26.916
[monkey shrieking]

01:07:28.875 --> 01:07:32.916
PRISCILLA WALD: The outbreak narrative
comes out of a set of conventions

01:07:32.916 --> 01:07:36.291
the way images and language and plot lines

01:07:36.291 --> 01:07:39.791
circulate from scientific and medical texts

01:07:39.791 --> 01:07:41.541
through the mainstream media

01:07:41.541 --> 01:07:44.541
and into popular fiction and film

01:07:48.333 --> 01:07:52.583
and it shapes how we think
about the idea of outbreaks

01:07:52.583 --> 01:07:55.708
of catastrophic communicable disease

01:07:55.708 --> 01:07:58.041
and how we think about its origins

01:07:58.041 --> 01:07:59.041
how we address it

01:07:59.041 --> 01:08:00.916
and the consequences of doing so

01:08:05.666 --> 01:08:07.541
[sirens]

01:08:13.083 --> 01:08:14.791
[metallic click]

01:08:14.791 --> 01:08:16.875
[air inflating]

01:08:20.708 --> 01:08:22.583
- A battle against an epidemic

01:08:22.583 --> 01:08:25.666
unfolding in the countryside and cities

01:08:31.041 --> 01:08:33.583
Speculation seems to surround the origin

01:08:33.583 --> 01:08:34.791
of this phenomenon

01:08:35.541 --> 01:08:37.958
theories include an airborne plague

01:08:37.958 --> 01:08:41.041
a toxic chemical spill, bioterrorism

01:08:41.041 --> 01:08:43.041
and even a space borne virus

01:08:44.166 --> 01:08:45.791
[electronic whirring]

01:08:47.833 --> 01:08:49.666
[broken glass crunching]

01:08:49.666 --> 01:08:52.666
[ominous music]

01:08:58.083 --> 01:08:59.583
PRISCILLA WALD: Think about a microscope

01:08:59.583 --> 01:09:04.208
A microscope lets you see certain things in much more detail

01:09:05.541 --> 01:09:08.333
but at the same time, obscures a bigger picture

01:09:10.958 --> 01:09:12.083
so the outbreak narrative

01:09:12.083 --> 01:09:16.416
similarly, since it shows us
how to think about a problem

01:09:16.416 --> 01:09:19.166
it also obscures other possibilities

01:09:23.541 --> 01:09:24.333
- Above zero

01:09:24.333 --> 01:09:26.208
it starts growing at a horrendous rate

01:09:26.208 --> 01:09:28.083
reaching its peak infectivity

01:09:28.083 --> 01:09:29.583
at about five degrees centigrade

01:09:29.583 --> 01:09:31.291
at which time, its reproductive rate

01:09:31.291 --> 01:09:33.166
the speed with which it multiplies

01:09:33.166 --> 01:09:35.541
reaches massive proportions

01:09:40.166 --> 01:09:41.416
- It's figuring us out

01:09:41.416 --> 01:09:42.666
faster than we're figuring it out

01:09:42.666 --> 01:09:44.166
- It doesn't have anything else to do

01:09:50.333 --> 01:09:53.333
[Score: Tense, building]

01:09:55.333 --> 01:09:56.541
[brakes screeching]

01:09:58.166 --> 01:09:59.333
[metallic clinking]

01:09:59.333 --> 01:10:00.166
[whirring]

01:10:08.083 --> 01:10:10.291
[sirens]

01:10:14.041 --> 01:10:16.916
- But I have been gathering the
latest intelligence estimates

01:10:17.416 --> 01:10:18.458
of our situation

01:10:24.041 --> 01:10:27.041
PRISCILLA WALD: In the outbreak narrative, conventionally

01:10:27.041 --> 01:10:29.958
the disease is spreading from the Global South

01:10:29.958 --> 01:10:31.416
to the Global North

01:10:31.416 --> 01:10:34.333
so maps will reinforce the sense

01:10:34.333 --> 01:10:37.458
of particularly dangerous pathologized spaces

01:10:37.458 --> 01:10:41.041
out of which anything might arise

01:10:50.541 --> 01:10:51.666
[crashing]

01:10:52.291 --> 01:10:53.875
[waves crashing]

01:11:02.791 --> 01:11:04.166
In the film “Outbreak”

01:11:04.166 --> 01:11:07.416
there's a mercenary camp in Zaire

01:11:07.416 --> 01:11:09.208
and at the beginning of the film

01:11:09.208 --> 01:11:11.166
Donald Sutherland, who is a general

01:11:11.166 --> 01:11:12.458
and works for USAMRIID

01:11:12.458 --> 01:11:15.541
authorizes the nuking of this camp

01:11:15.541 --> 01:11:18.541
in order to contain this horrific virus

01:11:19.083 --> 01:11:20.541
- It’s even worse than I thought

01:11:20.541 --> 01:11:22.333
Get the plane there by 1900 hours

01:11:22.333 --> 01:11:23.541
- Well, shouldn’t we at least...

01:11:23.541 --> 01:11:24.791
- Get the plane, Billy

01:11:24.791 --> 01:11:25.958
[explosion]

01:11:26.916 --> 01:11:28.166
[coughing]

01:11:28.833 --> 01:11:31.125
[hacking cough]

01:11:31.125 --> 01:11:35.291
PRISCILLA WALD: When this virus finds its
way into a northern California town

01:11:35.291 --> 01:11:39.041
and Donald Sutherland again wants to nuke the problem

01:11:39.041 --> 01:11:39.833
Everyone says to him,

01:11:39.833 --> 01:11:42.416
“But you can't do that, sir, these are Americans”

01:11:42.416 --> 01:11:44.916
[crowd shouting]

01:11:47.083 --> 01:11:49.458
Certain populations are expendable

01:11:49.458 --> 01:11:50.416
others are not

01:11:50.416 --> 01:11:53.666
and this is part of the stigmatizing, the bias

01:11:53.666 --> 01:11:56.583
the racism of the outbreak narrative

01:11:57.166 --> 01:11:58.291
[car horns]

01:11:59.375 --> 01:12:01.916
[gunfire]

01:12:03.291 --> 01:12:04.416
[explosion]

01:12:04.666 --> 01:12:05.916
[gunfire]

01:12:06.458 --> 01:12:08.375
[agitated crowd]

01:12:10.208 --> 01:12:11.250
[explosions]

01:12:11.250 --> 01:12:13.875
[fire crackling]

01:12:18.291 --> 01:12:22.833
[Score: ominous, swelling, then receding]

01:12:27.791 --> 01:12:29.083
[engine revving]

01:12:32.333 --> 01:12:35.166
CHRISTOS LYNTERIS: So infectious diseases are the future

01:12:36.458 --> 01:12:37.833
They are inevitable

01:12:37.833 --> 01:12:39.291
They cannot be prevented

01:12:41.291 --> 01:12:43.125
So the only thing we can do about them

01:12:43.125 --> 01:12:44.708
is to be prepared

01:12:48.916 --> 01:12:50.916
[crashing, hissing]

01:12:50.916 --> 01:12:51.916
[screaming]

01:12:53.166 --> 01:12:54.583
[alarm ringing]

01:12:56.333 --> 01:12:57.791
[screaming]

01:12:57.791 --> 01:12:59.333
- No!

01:13:00.041 --> 01:13:01.166
- The bio-political shift

01:13:01.166 --> 01:13:03.458
from prevention to preparedness

01:13:03.458 --> 01:13:04.916
shifts not only attention

01:13:04.916 --> 01:13:08.041
but also funding from primary healthcare

01:13:08.041 --> 01:13:10.666
to these very abstract systems

01:13:11.083 --> 01:13:12.708
[alarm buzzer]

01:13:18.875 --> 01:13:20.625
RICK BRIGHT: We had several plans

01:13:21.208 --> 01:13:22.333
We had exercises

01:13:22.333 --> 01:13:24.541
we had pandemic response plans

01:13:24.541 --> 01:13:27.041
we had national response plans

01:13:27.041 --> 01:13:29.291
we had departmental response plans

01:13:29.291 --> 01:13:32.208
we had office response plans

01:13:32.208 --> 01:13:35.166
We had many plans, Nora

01:13:36.958 --> 01:13:41.250
However, most of those
plans are still on the shelf

01:13:44.791 --> 01:13:47.208
[creaking]

01:13:52.916 --> 01:13:55.916
[Score: tense, building]

01:14:01.125 --> 01:14:03.916
ANJULI RAZA KOLB: The figure of disease both activates

01:14:03.916 --> 01:14:07.208
our sense of deep fear and emergency

01:14:07.791 --> 01:14:09.041
and also tells us

01:14:09.041 --> 01:14:11.791
if we all get in line and do the following things

01:14:11.791 --> 01:14:12.416
it'll all be okay

01:14:12.416 --> 01:14:13.708
and we'll be able to manage it

01:14:18.791 --> 01:14:21.625
[Score: dark, oppressive]

01:14:29.625 --> 01:14:30.833
[laughter]

01:14:35.333 --> 01:14:36.541
[car horn]

01:14:37.041 --> 01:14:38.291
[multiple car horns]

01:14:38.666 --> 01:14:41.416
- From its origins in Guinea, early in the year

01:14:41.833 --> 01:14:44.708
the Ebola virus caught the world off guard

01:14:44.708 --> 01:14:47.416
moving swiftly to neighboring Liberia

01:14:47.416 --> 01:14:48.666
and Sierra Leone

01:14:48.666 --> 01:14:50.416
claiming thousands of lives

01:14:50.416 --> 01:14:53.041
and requiring a massive global response

01:14:53.041 --> 01:14:54.916
to help bring it under control

01:14:56.083 --> 01:14:57.666
- Looking at the commentaries

01:14:57.666 --> 01:15:00.666
and the images around Ebola, for example

01:15:00.666 --> 01:15:01.958
it looked like a war

01:15:01.958 --> 01:15:04.083
like a war on a state

01:15:04.083 --> 01:15:08.916
rather than actually a war on a disease

01:15:08.916 --> 01:15:11.958
but that disease was being carried by people

01:15:12.291 --> 01:15:13.416
[car horn]

01:15:20.250 --> 01:15:21.375
[crowd noise]

01:15:22.416 --> 01:15:26.041
LIOBA HIRSCH: I'm not discounting the
role that the armed forces played

01:15:26.041 --> 01:15:28.416
in containing the Ebola outbreak in West Africa

01:15:28.416 --> 01:15:30.750
but by focusing only on the emergency

01:15:30.750 --> 01:15:33.583
what we lose sight of is that

01:15:33.583 --> 01:15:36.916
if the IMF and the World
Bank hadn’t contributed

01:15:36.916 --> 01:15:41.416
to the structural underfunding of
health infrastructures in West Africa

01:15:41.416 --> 01:15:42.791
for decades

01:15:42.791 --> 01:15:45.583
maybe we wouldn't have needed
the armed forces to intervene

01:15:52.958 --> 01:15:57.166
- We must build on the momentum of this Ebola response

01:15:57.166 --> 01:16:00.666
to improve health services for all Congolese

01:16:00.666 --> 01:16:03.958
They deserve to be protected from all health risks

01:16:03.958 --> 01:16:07.833
not only those that make headlines

01:16:09.250 --> 01:16:11.416
KEIJI FUKUDA: We're going to see outbreaks

01:16:11.416 --> 01:16:12.708
and emerging infectious diseases

01:16:12.708 --> 01:16:13.291
and emerging infectious diseases

01:16:13.291 --> 01:16:15.791
continue indefinitely into the future

01:16:16.583 --> 01:16:18.166
By far the best chance

01:16:18.166 --> 01:16:19.958
that we have to reduce them

01:16:19.958 --> 01:16:22.166
is that between the outbreaks

01:16:22.166 --> 01:16:26.166
we actually use that time to strengthen the things

01:16:26.166 --> 01:16:28.791
which are needed to deal with outbreaks better

01:16:28.791 --> 01:16:33.416
Unfortunately, the lesson from
history and contemporary times

01:16:33.416 --> 01:16:36.208
is that we don't learn that lesson

01:16:36.208 --> 01:16:38.708
and so once an outbreak is over

01:16:38.708 --> 01:16:40.708
we have a strong rush

01:16:40.708 --> 01:16:43.416
to go on to business as usual

01:16:46.000 --> 01:16:48.541
PATRICIA KINGORI: These military
metaphors are quite useful

01:16:48.541 --> 01:16:51.166
but they also have enormous drawbacks

01:16:51.166 --> 01:16:53.333
There's no scope for thinking about after

01:16:55.416 --> 01:16:56.750
The local people have to stay

01:16:56.750 --> 01:17:00.291
and often deal with all the fallout of interventions

01:17:00.291 --> 01:17:02.458
that maybe weren't thought through

01:17:02.458 --> 01:17:03.833
or enacted quickly

01:17:04.291 --> 01:17:05.791
So really, for lots of people

01:17:05.791 --> 01:17:08.125
Ebola still hasn't ended

01:17:08.125 --> 01:17:10.416
There is a real power dynamic

01:17:10.416 --> 01:17:12.666
that's becoming more and more apparent

01:17:12.666 --> 01:17:14.958
Who gets to say it’s ended?

01:17:14.958 --> 01:17:16.541
[children talking]

01:17:18.291 --> 01:17:20.416
[footsteps, birdsong]

01:17:21.750 --> 01:17:23.166
LIOBA HIRSCH: All that we're willing to do

01:17:23.166 --> 01:17:25.916
is make cash loose in an emergency

01:17:25.916 --> 01:17:27.708
and then it's always already too late

01:17:29.458 --> 01:17:32.916
In this way, we're sort of moving
from emergency to emergency

01:17:32.916 --> 01:17:34.416
And that emergency model

01:17:34.416 --> 01:17:39.875
also allows us to keep that white savior,
brown diseased person dynamic

01:17:39.875 --> 01:17:44.875
that was established through colonialism, intact

01:17:47.958 --> 01:17:51.166
That dynamic of who needs to be saved

01:17:51.166 --> 01:17:54.166
and who has the tools to save

01:17:54.166 --> 01:17:57.916
is one of the foundational stones
of how we view global health

01:17:57.916 --> 01:17:59.375
and global health initiatives

01:18:04.208 --> 01:18:06.916
[bats screeching]

01:18:08.041 --> 01:18:11.625
- Over the last 50 years, we've had
over 300 of these new pathogens

01:18:11.625 --> 01:18:14.708
either emerge completely anew
or re-emerge into new places

01:18:14.708 --> 01:18:16.291
where they've never been seen before

01:18:18.166 --> 01:18:21.708
70% of these microbes originate
in the bodies of animals

01:18:24.041 --> 01:18:27.125
Humans are invading wildlife habitat all over the planet

01:18:28.541 --> 01:18:30.958
and when we do that, of course
we lose a lot of wild species

01:18:30.958 --> 01:18:34.250
It’s why we're in the middle of this mass extinction event

01:18:35.208 --> 01:18:38.208
[tractor engine]

01:18:40.916 --> 01:18:43.916
[squeaking]

01:18:53.416 --> 01:18:56.375
[coyote yelping]

01:18:57.291 --> 01:18:58.916
But the species that remain

01:18:58.916 --> 01:19:02.541
they have to crowd into smaller
and smaller fragments of habitat

01:19:02.541 --> 01:19:05.416
that are more likely to be close to where humans live

01:19:07.375 --> 01:19:09.416
[possum growling]

01:19:09.416 --> 01:19:11.416
We're creating more and more opportunities

01:19:11.416 --> 01:19:13.416
for the microbes that live in their bodies

01:19:13.416 --> 01:19:15.291
to spill over into our bodies

01:19:16.416 --> 01:19:18.416
[bats squeaking]

01:19:24.416 --> 01:19:26.416
[car passing]

01:19:27.791 --> 01:19:32.083
PRISCILLA WALD: We are the traffic engineers who
are moving our microbes around the globe

01:19:32.083 --> 01:19:34.291
They are not conscious enemies

01:19:34.291 --> 01:19:35.666
that are thinking about

01:19:35.666 --> 01:19:37.416
how they can outsmart us

01:19:37.416 --> 01:19:41.166
[beeping]

01:19:43.541 --> 01:19:45.916
SONIA SHAH: When we talk about
infectious diseases

01:19:45.916 --> 01:19:48.375
as a problem of invasion

01:19:48.375 --> 01:19:51.791
we only look at the presence or absence of the germ

01:19:54.583 --> 01:19:56.708
Especially for new diseases

01:19:56.708 --> 01:20:00.416
we can't come up with drugs and vaccines fast enough

01:20:00.416 --> 01:20:03.791
to prevent all of the death and disruption

01:20:03.791 --> 01:20:06.958
that happens when you have that first wave of a new disease

01:20:10.291 --> 01:20:14.333
We need to think more deeply about
how human health is connected

01:20:14.333 --> 01:20:16.333
to animal health and ecosystem health

01:20:16.333 --> 01:20:20.875
so that we can have lasting
solutions to those new diseases

01:20:20.875 --> 01:20:25.541
[Score: Wistful, sparse]

01:20:29.416 --> 01:20:31.916
[water running]

01:20:34.958 --> 01:20:38.583
ANJULI RAZA KOLB: There’s so much
about the origins of zoonotic diseases

01:20:38.583 --> 01:20:43.791
that affect people that we must actually
think of as slow forms of violence

01:20:43.791 --> 01:20:45.791
that begin with deforestation

01:20:45.791 --> 01:20:48.375
but then end with what looks to be

01:20:48.375 --> 01:20:51.458
a super fast, massive worldwide pandemic

01:20:54.541 --> 01:20:57.166
We wind up with these spectacular events

01:20:57.166 --> 01:20:58.625
that looks fast

01:20:58.625 --> 01:21:01.083
and it looks heavy and furious

01:21:01.083 --> 01:21:10.041
and it is the result of incredibly slow
chiseling away at functional ecosystems

01:21:10.041 --> 01:21:14.291
And it will also have these
incredibly slow and longterm effects

01:21:14.708 --> 01:21:17.291
[water rushing]

01:21:24.166 --> 01:21:29.166
PRISCILLA WALD: And this also is the
legacy of racial and settler colonialism

01:21:39.583 --> 01:21:45.666
And so beginning by addressing
the inequities in our population

01:21:45.666 --> 01:21:50.291
will, I believe, allow us to think more broadly

01:21:50.291 --> 01:21:52.000
about how we inhabit the planet

01:21:57.208 --> 01:22:00.791
[Score: swelling, building]

01:22:10.583 --> 01:22:13.416
[rain falling]

01:22:16.250 --> 01:22:17.833
[birdsong]

01:22:21.291 --> 01:22:25.583
[Score: wistful, sustained tones]

01:22:31.000 --> 01:22:36.333
- Because of historical redlining and
displacement and segregation

01:22:36.333 --> 01:22:40.333
African-American communities
are more likely to be in floodplains

01:22:44.875 --> 01:22:47.541
[thunder]

01:22:47.541 --> 01:22:51.083
[water rushing]

01:22:51.083 --> 01:22:55.000
[gale blowing]

01:22:55.041 --> 01:22:56.541
[rain falling]

01:23:03.125 --> 01:23:04.750
[footsteps]

01:23:06.958 --> 01:23:10.541
[squelching]

01:23:13.291 --> 01:23:16.708
SONIA SHAH: Pathogens are able
to spread through dirty water

01:23:16.708 --> 01:23:20.541
And we're going to see this more
with the climate crisis unfolding

01:23:25.875 --> 01:23:29.000
LEO WOODBERRY: It's not now and then that we hear

01:23:29.000 --> 01:23:32.916
about something happening that’s related to the climate

01:23:32.916 --> 01:23:35.750
It's every single day

01:23:35.750 --> 01:23:39.375
You know, we have to believe that
we’re capable of doing better

01:23:39.375 --> 01:23:41.416
and having a better world

01:23:43.958 --> 01:23:46.958
With the increasing impacts of climate change

01:23:47.708 --> 01:23:51.458
and injustice, lack of equity

01:23:51.958 --> 01:23:53.208
lack of caring

01:23:53.208 --> 01:23:59.166
we are literally looking at the possible
end of civilization as we know it

01:23:59.166 --> 01:24:03.791
so I don't think we have the
luxury of not being engaged

01:24:15.458 --> 01:24:17.791
[Music plays: After the end of the world / Sun Ra]

01:24:18.208 --> 01:24:19.833
- After the end of the world

01:24:20.083 --> 01:24:21.416
Don't you know that yet?

01:24:22.208 --> 01:24:24.250
It's after the end of the world

01:24:24.250 --> 01:24:25.625
Don't you know that yet?

01:24:25.958 --> 01:24:28.333
It's after the end of the world

01:24:28.333 --> 01:24:29.708
Don't you know that yet?

01:24:30.208 --> 01:24:32.208
It’s after the end of the world

01:24:32.333 --> 01:24:34.208
Don’t you know that yet?

01:24:34.208 --> 01:24:36.458
It’s after the end of the world

01:24:36.458 --> 01:24:37.958
Don't you know that yet?

01:24:38.208 --> 01:24:39.708
It’s after the end of the world?

01:24:40.208 --> 01:24:41.833
Don’t you know that yet?

01:24:42.333 --> 01:24:43.833
It’s after the end of the world

01:24:44.208 --> 01:24:45.791
Don’t you know that yet?

01:24:46.375 --> 01:24:48.083
It’s after the end of the world

01:24:48.458 --> 01:24:49.833
Don’t you know that yet?

01:24:49.833 --> 01:24:51.708
[birdsong]

01:24:53.416 --> 01:24:57.416
[Music: dissonant, oppressive]

01:25:00.583 --> 01:25:03.750
- We lost the entire population of the world

01:25:05.583 --> 01:25:07.333
Only about 1% of us survived

01:25:10.916 --> 01:25:12.000
[piano key chimes]

01:25:12.291 --> 01:25:13.166
[door slamming]

01:25:17.583 --> 01:25:19.500
BHARAT VENKAT: We tend to think of cure as final

01:25:19.541 --> 01:25:21.458
as the end of treatment

01:25:21.458 --> 01:25:22.208
and the end of illness

01:25:22.208 --> 01:25:23.958
the end of suffering more generally

01:25:25.458 --> 01:25:27.833
but this is a really narrow vision of what cure is

01:25:27.833 --> 01:25:29.333
or what cure can be

01:25:29.333 --> 01:25:32.041
It's one that's focused narrowly on the body

01:25:32.041 --> 01:25:36.375
It's not necessarily focused on thinking about what it is

01:25:36.375 --> 01:25:37.875
that made you sick in the first place

01:25:40.958 --> 01:25:43.500
The other model is more transformative

01:25:43.500 --> 01:25:45.375
or revolutionary

01:25:45.500 --> 01:25:46.750
You're cured

01:25:46.750 --> 01:25:48.875
and you become something else entirely

01:25:54.958 --> 01:25:57.541
In places like disability activism, for example

01:25:57.541 --> 01:25:58.750
the cure that you need

01:25:58.750 --> 01:26:02.708
is not about the individual
becoming what they used to be

01:26:02.708 --> 01:26:05.750
or what they should be in
some ideal, ableist mode

01:26:05.750 --> 01:26:08.708
but it's actually about transforming society

01:26:08.708 --> 01:26:12.958
about revolutionizing modes of
access, of infrastructure

01:26:12.958 --> 01:26:14.958
of the way we live our lives

01:26:20.083 --> 01:26:26.833
- Antimicrobial resistance poses a fundamental,
long term threat to human health

01:26:26.833 --> 01:26:29.958
sustainable food production and development

01:26:29.958 --> 01:26:32.833
It’s not that it may happen in the future

01:26:32.833 --> 01:26:35.500
It is a very present reality

01:26:36.625 --> 01:26:40.000
- The world is heading towards a post antibiotic era

01:26:40.000 --> 01:26:44.791
in which common infections will once again kill

01:26:44.791 --> 01:26:48.125
[raspy coughing]

01:26:54.666 --> 01:26:55.916
BHARAT VENKAT: So when we think about tuberculosis

01:26:55.916 --> 01:26:58.833
we tend to think of this kind of staid narrative

01:26:58.833 --> 01:27:01.750
It was incurable for thousands of years

01:27:01.750 --> 01:27:05.208
and then antibiotics emerged
in the early to mid 20th century

01:27:05.208 --> 01:27:07.000
and suddenly it's curable

01:27:07.000 --> 01:27:10.208
and now, in this moment of rising antibiotic resistance

01:27:10.208 --> 01:27:12.375
it's perhaps incurable again

01:27:14.208 --> 01:27:15.375
But what we’re seeing now

01:27:15.375 --> 01:27:18.500
are these cases of drug
resistance that are so severe

01:27:18.500 --> 01:27:21.500
that none of the drugs we
currently have work anymore

01:27:21.500 --> 01:27:24.458
It's being referred to as totally
drug resistant tuberculosis

01:27:25.458 --> 01:27:27.833
and the story is too easy

01:27:27.833 --> 01:27:30.333
If you go back to the pre-antibiotic era

01:27:30.333 --> 01:27:32.000
sanatoriums were huge

01:27:32.000 --> 01:27:36.333
precisely because it was thought that
by being there you’d be healed by nature

01:27:36.333 --> 01:27:37.833
also with good nutrition

01:27:37.833 --> 01:27:39.875
also with graduated exercise

01:27:42.583 --> 01:27:45.083
So there's one sanatorium
on the outskirts of Chennai

01:27:45.083 --> 01:27:47.000
known as Tambaram Sanatorium

01:27:47.000 --> 01:27:49.750
which came from being a
big tuberculosis sanatorium

01:27:49.750 --> 01:27:53.583
to being one of the first places
to treat HIV patients in India

01:27:55.208 --> 01:27:59.125
And now you have both HIV, HIV-TB co-infected

01:27:59.125 --> 01:28:01.583
and multi-drug resistant tuberculosis patients

01:28:01.583 --> 01:28:03.208
who are all being seen there

01:28:06.333 --> 01:28:07.500
When you say

01:28:07.500 --> 01:28:10.958
“We need to have broader social
and political interventions”

01:28:10.958 --> 01:28:14.583
that aren't focused so much on
getting an antibiotic into someone

01:28:14.583 --> 01:28:16.375
which is still important

01:28:16.375 --> 01:28:19.708
but also making sure that they
have clean air and ventilation

01:28:19.708 --> 01:28:21.875
making sure that they have good working conditions

01:28:21.875 --> 01:28:24.083
food on the table, a higher minimum wage

01:28:25.375 --> 01:28:26.875
All of these things

01:28:26.875 --> 01:28:29.833
are not necessarily what we think
of when we think about cure

01:28:34.791 --> 01:28:37.583
KEIJI FUKUDA: By using such
large amounts of antibiotics

01:28:37.583 --> 01:28:42.833
we've really accelerated the
rise in antimicrobial resistance

01:28:42.833 --> 01:28:44.583
[liquid bubbling]

01:28:46.291 --> 01:28:47.458
[rattling]

01:28:48.583 --> 01:28:51.125
HANNAH LANDECKER: We literally rub it on people's skin

01:28:51.125 --> 01:28:53.583
feed it to them, inject it into them

01:28:54.458 --> 01:28:57.541
put it on plants, put it in animals

01:29:00.208 --> 01:29:02.708
[grain pouring]

01:29:04.291 --> 01:29:05.833
[birds chirping]

01:29:06.333 --> 01:29:09.708
- And the effect on the nation's farm
economy has been spectacular

01:29:09.708 --> 01:29:11.666
[jazzy music]

01:29:13.208 --> 01:29:15.708
- Speed it into refrigerated trains and trucks

01:29:15.708 --> 01:29:17.250
Get it rolling without delay

01:29:17.583 --> 01:29:21.583
Ship it out to meet America’s
appetite for one more day

01:29:24.541 --> 01:29:28.416
KEIJI FUKUDA: By giving it in very large
amounts to animals and to people

01:29:29.416 --> 01:29:30.416
they’re excreted

01:29:30.416 --> 01:29:31.958
That goes into the environment

01:29:31.958 --> 01:29:34.916
It goes into water, so it goes into soil

01:29:35.416 --> 01:29:36.000
and then it begins to also act as
an evolutionary force out in nature

01:29:36.000 --> 01:29:40.875
and then it begins to also act as
an evolutionary force out in nature

01:29:41.666 --> 01:29:44.333
[gulls crying]

01:29:45.708 --> 01:29:47.333
[turkeys squawking]

01:29:47.333 --> 01:29:50.458
HANNAH LANDECKER: People were
aware, almost right away

01:29:50.458 --> 01:29:54.541
that the use of antibiotics could
cause antibiotic resistance

01:29:56.041 --> 01:29:58.791
They thought you could always find another drug

01:29:58.791 --> 01:30:02.291
that wouldn't be met with resistance

01:30:03.416 --> 01:30:06.416
[rattling]

01:30:08.958 --> 01:30:13.833
[Score: optimistic, vibrant, building] 

01:30:22.458 --> 01:30:22.666
KEIJI FUKUDA: At the level of science

01:30:22.666 --> 01:30:24.041
when you look at this rhetoric

01:30:24.041 --> 01:30:27.166
used to describe antimicrobial resistance

01:30:27.166 --> 01:30:28.833
the war on microbes

01:30:30.625 --> 01:30:34.041
in fact, we have a much more
sophisticated understanding

01:30:34.041 --> 01:30:37.541
that the relationship between microbes and people

01:30:37.541 --> 01:30:39.666
is part of the natural world

01:30:43.458 --> 01:30:44.625
[liquid dripping]

01:30:44.625 --> 01:30:47.125
We benefit from microbes a lot

01:30:47.125 --> 01:30:49.250
Sometimes they make us sick

01:30:49.916 --> 01:30:52.791
We coexist in a very large world

01:30:53.541 --> 01:30:56.000
There are many more microbes
than there are people

01:30:58.250 --> 01:31:00.666
[liquid dripping]

01:31:06.291 --> 01:31:09.416
- The idea that there will be
some kind of breakthrough

01:31:09.416 --> 01:31:10.416
in this arms race

01:31:10.416 --> 01:31:16.916
that means that we can control and
subdue the threat is very ironic

01:31:16.916 --> 01:31:20.166
considering that bacteria evolve resistance

01:31:20.166 --> 01:31:26.208
precisely because of the selective pressure
that antibiotics puts onto those communities

01:31:26.208 --> 01:31:30.041
so in my eyes, it's an un-winnable war

01:31:41.583 --> 01:31:43.791
Your microbiome changes every time you eat

01:31:43.791 --> 01:31:46.250
every time you move to a new environment

01:31:46.250 --> 01:31:48.958
every time you meet somebody new

01:31:48.958 --> 01:31:50.458
and that's really disruptive

01:31:50.458 --> 01:31:54.000
to the idea of us being individual humans

01:31:54.000 --> 01:31:56.958
or even, how human are we?

01:32:08.500 --> 01:32:10.958
HANNAH LANDECKER: The chemotherapeutic vision

01:32:10.958 --> 01:32:13.958
was managing life with death

01:32:15.833 --> 01:32:17.708
Managing life with life

01:32:17.708 --> 01:32:24.583
is this idea that the cultivation of biodiverse microbes

01:32:24.583 --> 01:32:30.208
may be something which outcompetes pathogens in a body

01:32:30.208 --> 01:32:34.708
in a way that is perhaps even more
protective than other measures

01:32:37.958 --> 01:32:41.083
The microbial world and all of its diversity

01:32:41.083 --> 01:32:46.458
are actually allies in the pursuit of better health

01:32:46.458 --> 01:32:50.958
better food, better environments of various kinds

01:32:55.041 --> 01:32:57.875
IONA WALKER: In terms of generating new metaphors

01:32:57.875 --> 01:32:59.750
the microbiome is really interesting

01:32:59.750 --> 01:33:03.625
to think of as an ecosystem within ourselves

01:33:03.625 --> 01:33:06.250
as part of a larger ecosystem

01:33:06.250 --> 01:33:09.208
[Score: Optimistic, escalating]

01:33:13.500 --> 01:33:17.000
ELENA SEMINO: There is a lag, always,
between scientific understandings

01:33:17.000 --> 01:33:18.833
and popular understanding

01:33:21.208 --> 01:33:26.208
The metaphors that we use sometimes
reflect earlier cultural stages

01:33:27.583 --> 01:33:31.500
The idea, for example, of us coexisting with bacteria

01:33:31.500 --> 01:33:34.750
is maybe harder to convey

01:33:34.750 --> 01:33:37.708
than the idea of some kind of external aggressor

01:33:40.583 --> 01:33:43.083
However, if we go back in history

01:33:43.083 --> 01:33:46.458
the idea of the humors in the body

01:33:46.458 --> 01:33:48.083
needing to be in balance

01:33:48.083 --> 01:33:52.208
in order for well-being to be experienced

01:33:52.208 --> 01:33:55.958
is actually something that is part of our cultural history

01:33:58.750 --> 01:34:02.833
So harmony, balance, cooperation

01:34:02.833 --> 01:34:05.833
living with, rather than fighting against

01:34:05.833 --> 01:34:08.625
are much more helpful metaphors

01:34:08.625 --> 01:34:10.583
and much more conducive to solutions

01:34:10.583 --> 01:34:13.208
that are going to be beneficial to everyone

01:34:20.708 --> 01:34:22.833
- We have had years and years

01:34:22.833 --> 01:34:26.000
of conceptual and methodological development

01:34:26.000 --> 01:34:28.625
of One Health approaches

01:34:29.708 --> 01:34:34.750
which show that this aggressive
othering of microorganisms

01:34:34.750 --> 01:34:36.500
and their hosts and vectors

01:34:36.500 --> 01:34:38.000
is counterproductive

01:34:39.583 --> 01:34:43.083
and that instead we need a more pro health

01:34:43.083 --> 01:34:45.833
rather than anti disease approach

01:34:58.791 --> 01:35:02.916
- We can get a lot of benefits from
having more biodiversity around us

01:35:02.916 --> 01:35:05.875
and more resilience in our societies
and our ecosystems

01:35:05.875 --> 01:35:08.833
but we also will have to shoulder
some more of the risks

01:35:12.583 --> 01:35:15.583
[Score: stirring, swelling]

01:35:16.958 --> 01:35:18.041
It still could be a very good life

01:35:18.041 --> 01:35:19.000
It still could be a very good life

01:35:19.000 --> 01:35:21.458
and it could be a life that
many more of us could have

01:35:21.458 --> 01:35:22.833
and enjoy together

01:35:22.833 --> 01:35:24.500
[birdsong]

01:35:24.750 --> 01:35:25.958
and I think that is the price we will want to pay

01:35:25.958 --> 01:35:27.875
and I think that is the price we will want to pay

01:35:27.875 --> 01:35:30.541
because that's going to be better than

01:35:30.541 --> 01:35:33.500
the collapse of these ecosystems

01:35:33.500 --> 01:35:35.791
and the endless pandemics

01:35:35.791 --> 01:35:39.750
where we have to rush to come
up with some new vaccine

01:35:39.750 --> 01:35:41.500
that only some people are going to get

01:35:41.500 --> 01:35:43.000
That's what we're seeing right now

01:35:43.000 --> 01:35:44.833
The beginnings of that world

01:35:46.333 --> 01:35:50.791
[Soundscape: bubbling, rumble]

01:36:02.666 --> 01:36:04.625
We're asked to always atomize, right?

01:36:04.625 --> 01:36:06.625
How do we solve for health care?

01:36:06.625 --> 01:36:08.625
Well, so much of health outcomes

01:36:08.625 --> 01:36:12.333
have to do with social and economic factors

01:36:12.333 --> 01:36:14.250
But what we want to do as a society

01:36:14.250 --> 01:36:18.750
is have robust ways to manage
outbreaks when they happen

01:36:18.750 --> 01:36:21.541
to support individual people and communities

01:36:21.541 --> 01:36:24.458
when there is disease that can’t be cured

01:36:24.458 --> 01:36:30.333
to provide the circumstances by which
more people live disease free lives

01:36:30.333 --> 01:36:34.625
or lives where their diseases are managed

01:36:38.416 --> 01:36:41.208
[iron lung breathing]

01:36:42.083 --> 01:36:45.083
[mechanical whirring]

01:36:50.666 --> 01:36:52.208
BHARAT VENKAT: One of the real shames here

01:36:52.208 --> 01:36:54.625
is that in investing so intensely

01:36:54.625 --> 01:36:56.541
in getting rid of these diseases

01:36:56.541 --> 01:36:58.708
bringing them down to absolute zero

01:36:58.708 --> 01:37:00.291
we don't invest in other things

01:37:10.625 --> 01:37:12.375
- The solutions that we need

01:37:12.375 --> 01:37:15.000
to improve prevention and chronic care

01:37:15.000 --> 01:37:17.666
are by and large, the same solutions we need

01:37:17.666 --> 01:37:19.625
to prevent the next pandemic

01:37:19.625 --> 01:37:21.000
and what I worry about is

01:37:21.000 --> 01:37:23.625
that people will look at those as two different things

01:37:23.625 --> 01:37:24.666
and invest differently

01:37:24.666 --> 01:37:26.000
and create different silos

01:37:26.625 --> 01:37:28.416
[footsteps]

01:37:39.500 --> 01:37:43.000
- People have really forgotten
what public health means

01:37:43.000 --> 01:37:44.000
Public

01:37:44.666 --> 01:37:46.250
is for the people

01:37:46.250 --> 01:37:49.166
Public is funded by the people

01:37:49.166 --> 01:37:51.791
Public is not for profit

01:37:51.791 --> 01:37:56.500
Public is for the least fortunate

01:38:05.791 --> 01:38:06.958
JOHANNA HEDVA: The fantasy

01:38:06.958 --> 01:38:09.041
and the kind of magic trick

01:38:09.041 --> 01:38:11.916
that ableism and capitalism pulled

01:38:11.916 --> 01:38:15.708
is to make you believe that you’re
always in the black with your body

01:38:15.708 --> 01:38:17.166
and if you get into the red, it's like

01:38:17.166 --> 01:38:19.500
Oh no! This is a big problem

01:38:26.291 --> 01:38:34.541
Disability really insists that
the body is always insolvent

01:38:36.791 --> 01:38:41.416
and so, therefore we shouldn't
have to manage it alone

01:38:52.250 --> 01:38:55.583
DANA BROWN: How unbelievably relieving

01:38:55.583 --> 01:38:58.666
would it be for a patient

01:38:59.291 --> 01:39:03.416
to think that it’s not just my responsibility

01:39:03.416 --> 01:39:07.250
to navigate a devastating diagnosis

01:39:07.583 --> 01:39:10.291
a whole bunch of unaffordable medications

01:39:10.291 --> 01:39:14.208
reworking my living situation as my mobility changes

01:39:14.208 --> 01:39:15.833
figuring out work

01:39:16.416 --> 01:39:19.541
What if it's our responsibility to build a society

01:39:20.291 --> 01:39:23.041
that naturally takes care of people?

01:39:23.041 --> 01:39:25.666
and that leaves space for different needs?

01:39:26.166 --> 01:39:28.791
[scissors snipping]

01:39:29.541 --> 01:39:32.166
[rain falling]

01:39:42.750 --> 01:39:44.166
SHANTANU NUNDY: There's this disconnect

01:39:44.166 --> 01:39:46.416
between how care is so discrete

01:39:46.416 --> 01:39:48.541
and how health is actually continuous

01:39:48.541 --> 01:39:50.166
Meaning that care...

01:39:50.166 --> 01:39:51.916
So you see your doctor

01:39:51.916 --> 01:39:53.166
then you see a doctor

01:39:53.166 --> 01:39:54.416
then you get hospitalized

01:39:54.416 --> 01:39:55.916
and you pick up a medication

01:39:55.916 --> 01:39:57.333
But health

01:39:57.333 --> 01:39:58.583
How we're feeling every day

01:39:58.583 --> 01:40:01.625
our well-being, our blood sugars

01:40:01.625 --> 01:40:04.000
our blood pressures, that's continuous

01:40:04.000 --> 01:40:04.916
It’s dynamic

01:40:04.916 --> 01:40:06.166
It's changing all the time

01:40:10.416 --> 01:40:12.166
If we were to design a system

01:40:12.166 --> 01:40:15.166
that deeply recognized that health is continuous

01:40:15.166 --> 01:40:17.041
how would we create it differently?

01:40:23.916 --> 01:40:27.166
LIOBA HIRSCH: I think if we
abandon that war metaphor

01:40:27.166 --> 01:40:28.750
we move away from this

01:40:28.750 --> 01:40:31.791
very militaristic concept of intervention

01:40:32.166 --> 01:40:35.041
towards visions that understand

01:40:35.041 --> 01:40:37.791
that we’re not all functioning bodies

01:40:37.791 --> 01:40:39.000
that have to perform every day

01:40:39.000 --> 01:40:41.166
which is a very capitalist idea

01:40:41.166 --> 01:40:44.333
but that we need care on an everyday basis

01:40:44.333 --> 01:40:49.583
and that care needs to involve more than
a very clinical interpretation or understanding

01:40:50.791 --> 01:40:56.083
Hopefully that would enable us
to move towards health justice

01:41:01.333 --> 01:41:03.208
- We could continue

01:41:03.208 --> 01:41:06.666
and we might continue to live with fear

01:41:07.250 --> 01:41:08.750
that my health is a possession

01:41:08.750 --> 01:41:10.625
I'm going to protect at all costs

01:41:10.625 --> 01:41:13.208
Everyone else out there, you’re on your own

01:41:16.833 --> 01:41:19.208
But I think what we are trying to learn

01:41:19.208 --> 01:41:22.375
in this process is the mutuality of care

01:41:28.458 --> 01:41:30.833
LIOBA HIRSCH: It would benefit all of us, really

01:41:30.833 --> 01:41:33.583
and would hopefully lead to a conception of health

01:41:33.583 --> 01:41:34.583
that is beautiful

01:41:34.583 --> 01:41:37.875
and freeing and generous and kind

01:41:37.875 --> 01:41:42.541
[Score: hopeful, sustained tones]

01:41:45.666 --> 01:41:47.375
BHARAT VENKAT: So say we were to expand

01:41:47.375 --> 01:41:50.250
beyond this kind of really narrow, individualistic

01:41:50.250 --> 01:41:51.833
and final sense of cure

01:41:51.833 --> 01:41:55.083
and thought about investing in the long term

01:41:55.083 --> 01:41:56.208
investing in people

01:41:56.208 --> 01:41:57.458
over the course of their lives

01:41:57.458 --> 01:41:59.875
and communities over the course of generations

01:42:08.708 --> 01:42:10.541
Thinking about cure beyond the individual

01:42:10.541 --> 01:42:13.208
beyond the body and beyond the end

01:42:13.208 --> 01:42:16.125
is about what a more capacious vision of cure could be

01:42:16.125 --> 01:42:19.458
one that incorporates family, society, infrastructure

01:42:19.458 --> 01:42:21.083
our air, our waters

01:42:21.083 --> 01:42:22.958
our environments more broadly

01:42:27.083 --> 01:42:33.708
It's really about: how do we invest
in a way to let people thrive

01:42:33.708 --> 01:42:36.458
and thriving doesn't necessarily mean becoming immortal

01:42:36.458 --> 01:42:37.583
living forever

01:42:37.583 --> 01:42:41.583
thriving doesn't mean being
perfectly healthy all the time

01:42:41.583 --> 01:42:45.833
Thriving means being able to live with
the conditions you experience

01:42:45.833 --> 01:42:51.583
and not have those conditions be made
worse by the society in which you live

01:42:51.583 --> 01:42:53.333
[birdsong]

01:42:54.083 --> 01:42:59.166
It means being able to live with
and through all of the pain

01:42:59.166 --> 01:43:02.125
and all of the suffering, but also all of the joy

01:43:04.375 --> 01:43:08.666
[Score: expansive, tranquil]

01:43:12.291 --> 01:43:14.875
[birdsong]

01:43:26.083 --> 01:43:30.166
[wind through trees]