This transcript has been edited for clarity and length.
MCKAY: Our guest today is Laura Spinney, the acclaimed author of Pale Rider: The Spanish Flu Of 1918 and How It Changed the World (2018). It’s a spellbinding history of a past pandemic whose long shadows have been cast over the present pandemic. So, we’re really honoured to have Laura as our guest today….
Laura, as the author of Pale Rider, you have argued (drawing in part upon the works of evolutionary pathologists) that the influenza epidemic of 1918 spread around the world largely because of the unprecedented mingling of people on the Western Front in the First World War. (There are three possible candidates for the location of the first outbreak).
…That suggested to me something of the active role humans can play, sometimes unwittingly, in the spread of diseases. I really love this passage in a recent piece you wrote in the Guardian, which says, “the key thing to understand is that we are not passive bystanders, we form the virus just as it forms us.” …Can you connect this observation to your classic study and then say a bit about what lesson it might suggest to us about passivity and activism in 2020?
SPINNEY: Thanks for a great question. For a long time, throughout the Middle Ages and after, people thought of epidemics and pandemics as acts of God. They were very fatalistic about them. They were just things that struck.
You probably deserved illness, somehow. There was certainly nothing you could do about it – you just had to endure it.
Beginning with germ theory in the middle of the nineteenth century and a better understanding of hygiene and infection control, we started to realize that that wasn’t quite true. You could have an impact on infection. You could control it. And then science evolved.
Now, we understand that, in fact, we shape epidemics and pandemics in a much more fundamental way. We talk about spillover events, zoonotic diseases that come from animals into humans. We shape the whole ecosystem that makes that possible through our use of the environment, through farming, through wildlife trade, and so on. We no longer can think of ourselves as passive bystanders. Once the pandemic is upon us, we understand that we can also shape the virus in terms of how it mutates, how it evolves, how infectious it is, and how severe the infection is.
[One evolutionary biologist maintains] that the reason the 1918 flu was so lethal (it’s estimated to have been at least 25 times more lethal than any other pandemic flu we know about in history) is because of the exceptional conditions that prevailed in the world at that time… You had, on the Western Front, millions of young men… packed into the trenches for shorter or longer periods of time, already not in a very good state, stressed, hungry, tired, suffering from other infections, injuries. Notably, their lungs were often gassed. So, they were very vulnerable to a new infection.
When a new pathogen emerges over time, it should moderate its virulence in order to achieve a more benign equilibrium with its host – us. This didn’t need to happen in the trenches in 1918. There was literally no price to it racing through this population of young men, since they were going to die anyway, and it could it could just easily transmit to the next one. So, the idea is that because of these conditions it stayed virulent far longer than it would have done and still highly contagious and spread around the world, helped again by the movements of troops and civilians at that time…
…We shape the evolution of the virus. Vaccines put enormous selective pressure on the virus. The uneven rollout of the vaccines across the world that we’re seeing at the moment is another way in which we’re shaping its evolution, because the pressure will be on it to escape….
MCKAY: Sticking with this memory of 1918, one of the big themes in the British discussion, especially, has been what some would call the misuse of the memory of 1918… Devi Sridhar of the University of Edinburgh and others have been saying that, really, British planners were fixated on 1918 as the pandemic. That led to fatal policy errors. They made the mistake of treating coronavirus like the flu and left it too late to lock it down, going for a strategy of mitigation rather than elimination. Richard Horton [of The Lancet] says that “imagining Covid-19 as a rerun of the flu led to the greatest science policy failure in a generation.” …Did the heavy, heavy shadow of 1918 have policy effects in 2020? And, more broadly, do historians have a professional obligation to make themselves unpopular by saying: “No, you’re getting history wrong”?
SPINNEY: There’s a certain irony in this conversation. I wrote my book because nobody was talking about 1918. We were approaching its centenary, and nobody was talking about it. Only a year ago, … public health experts were wringing their hands over the fact that we never remember pandemic lessons. We go through this cycle of panic and complacency. We panic when the new pandemic emerges and then we forget it immediately. We don’t learn the lessons, and voilà, the pattern continues.
So, I think it has to be a question of which lessons to take from history. And that, of course, is the nub of it. That’s where all the difficulty lies.
Flu and Covid-19 are fundamentally different diseases. They’re both respiratory diseases, they have some things in common, but the pathogens belong to different families. They behave differently. I think that is what is preoccupying the experts that you talked about, and with good reason.
So, for example (and they they’ve acknowledged this), the consensus on flu is that it cannot be eliminated. It spreads through a population too evenly and too rapidly, that the best you can hope to do is to mitigate it, suppress it. You can’t eliminate it.
And that was the assumption of many countries at the beginning of this pandemic. But Covid-19 doesn’t spread in the same way. It has a different profile in terms of infectiousness, in terms of severity, in terms of the time it takes to move from one person to the next. And incubation period. All these things are very different.
… Even though the 1918 pandemic was caused by flu (which, as I’ve said, behaved differently), [there are practical lessons to be learned from it]. There are quite recent studies that have looked back at the historical data and have shown, for example in the United States (where often the data are best on 1918), that cities or regions that locked down hard and early saved more lives than similar regions or cities that took their time or were less determined about it – both in terms of saving lives, but also in terms of the rapidity of the recovery of their economies.
So, the overall lesson is sort of the same. I think perhaps our tendency to want to compromise all the time – between saving the economy and saving lives – has led us astray….
There are general lessons that we should learn from pandemics, and that we should be tackling in between pandemics, rather than waiting to be reminded by them. So, for example, in 1918, as in every pandemic since and again in this one, they highlight health inequalities in society and health inequalities are a sort of way in for them to society. It’s a way that they get a foothold in a population, through the most vulnerable. There’s nothing stopping us, if we wish to, tackle those problems outside the pandemic and reducing health inequalities, making our health systems more inclusive, and so on.
…I think the good news is that we do seem to learn lessons that we can take away in a general sense,… and our response to this one has been wildly better than our response to 1918 in all sorts of ways. The obvious example is the rapidity with which we’ve developed vaccines – but also, the rapidity with which we detected this novel infection right at the beginning. Some lessons are learned…
MCKAY: It reminds me of your point that humanity seems to suffer three pandemics every century, if you’re looking back over the last 500 years. You’re advising us to keep, in the next pandemic, if we regard this as kind of a “starter pandemic” of the twenty-first century, in the next pandemic we should keep elimination on the table as well as mitigation.
The one lesson we can draw from this is that elimination should not be removed from policy discussions at the outset. … I think the great challenge is how fast people have had to think about this – they had to [make decisions about it] basically…by the middle of January at the latest, before things got out of control….Keep elimination on the table, and not exclude it—as the British case, perhaps, suggests.
SPINNEY: Well, I think that the more general lesson is: Keep your mind and your eyes open….I was speaking the other day to Michael Baker, who is one of the New Zealand epidemiologists who shaped their response. He was really interesting. He’s a vocal proponent of “No Covid.” Elimination. He still thinks it’s possible, at this late stage…. He says that, back in January, he looked at what was happening in Wuhan, a city of 11 million people, and he saw that they’d been able to contain the disease. He thought, if they can do it, then we can do it. He was absolutely flabbergasted when the WHO released its first report back then, which said mitigation and suppression are the way forward (as with the strategies that are normally put in place for flu) and was not even considering elimination…
It’s not that, after the end of January, it would have been too late. It’s just that it gets harder and harder, because you get an exponential growth of outbreaks. So, the earlier you act, the better, and also the earlier you act, the easier it is, because the smaller the problem that you have to contain.
…I was trying to look forward with that piece and say that, next time – because there will be a next time; it’s three pandemics [per century] on average over the last 500 years – but I was just trying to say, “Let’s consider it. Let’s remember that, at the beginning of the next pandemic, we’ll probably know as little [about it] as we did about this disease. So, why rule out elimination, when you are still in a period of maximum uncertainty? Why not consider all the options at that point? What, effectively, is there to lose? Because you can talk about that much stricter lockdown and the impact it has, but if you look at… how much suffering has been entailed by the sort of half-hearted lockdowns that we keep going into and out of, a small, contained, hard lockdown at the beginning might have been much less painful in the long run.
MCKAY: …Compare that with what you see in the many Asian Pacific countries with various political systems: Taiwan, New Zealand, but also China and Vietnam. They were, perhaps, in some cases influenced by different attitudes toward the state and the individual and the state’s right to direct society, but perhaps, also, because many retained a memory of SARS. So, I think maybe when historians look at this over time they’ll say there was a striking difference between how countries responded and one of the fissures they might trace is one between Asia-Pacific countries and Anglo-American ones, which have tended to follow a laissez-faire pattern. Would you agree with that?
SPINNEY: I would, absolutely. We sat and twiddled our thumbs for ages. There’s a sinister dimension to that: “This is a Chinese problem, it’s not our problem” – as if it was going to stay within those borders.
…The countries that have [thus far] done well … are of very different political stripes. The only thing they have in common, really, is that they learned from recent pandemics or epidemics. Memories of SARS are very vivid still in China. It was very frightening. It had a much higher mortality rate than Covid, and most of the… fatalities … occurred on the Chinese mainland. Taiwan also learned, Vietnam also learned, South Korea learned. They all learned the need for certain things – for example, the need to be able to connect information sources in the interest of test-and-trace, to be able to track infection, to identify it early on, and contain it…. That’s even been possible in democratic countries….
So, it’s not that it’s impossible in a democratic system. They’ve proved that. I think what it shows is that experience of previous pandemics is a learning experience for both governments and people. Governments learn, “Okay, we need these tools, … [for] when the moment arrives.” People need to realize that there’s a need to give them those tools. There’s a need for compliance. Solidarity is part of the response. Community compliance is a part of the response. You can see all of that in those countries…
MCKAY: I’ve been really struck by how much people use war metaphors in talking about the pandemic. You yourself talk about a “biological arms race” between a pathogen and its host.
SPINNEY: It’s true.
MCKAY: I noticed many in Anglo-American and Canada used the analogy of the struggle against Nazi Germany. I wonder if there’s a risk of such martial language? Or two risks? One is that it encourages us to think still that we’re at war with nature, we’re at war with a virus, when in fact we have co-evolved with the virus, we’re part of nature, and [it’s] really a question of managing our metabolism with nature in a more rational way, rather than being at war with it. The other risk I see is a transition to martial language in general: we slip into a Cold War way of thinking about attributing this to a malign and malicious Other, desperately trying to undermine our state’s power. We’re really back to the 1950s in terms of a very polarized world…
SPINNEY: I am guilty of using these metaphors, although I try to avoid them as much as possible. My thinking on this has evolved over the last two years or so. I think there’s a few things going on. First of all, I understand why Joe Biden and others use this kind of language. They want to help people get over a kind of natural passivity…. They want to persuade them to act…. Second, I also think that it also reflects the changing understanding of pandemics that we were talking about earlier. The fact that we aren’t passive and that we do shape them. And so there’s a certain justification for talking about it as an enemy which is trying to outwit us…. There is a sense in which we need to outwit it….
The third thing: pandemics, whether we like it or not, are fundamentally political. There’s no better example of that than the naming of the 1918 flu – the Spanish flu – when there was nothing particularly Spanish about it…. It was called that because Spain, being neutral in the war, did not censor its press, and so when the first cases of the flu erupted in Madrid in the late spring of 1918, they were reported in the newspapers. They included the King of Spain, Alfonso the 13th, so it became very visible very quickly. In the belligerent countries, they censored their press….because, supposedly, they didn’t want to lower the morale of their populations….
In our time, [Covid-19 is] taking place in the context of, among other things, a trade war between the US and China. If you look back over the last year, we’ve all seen how the WHO has been used and abused by those two powers. Sometimes it seemed like just an arena for their continuing trade war to be fought out in. That, maybe, is one of the problems that we’ll need to address after this pandemic: to create a stronger global health organization that has more teeth.
I think it’s probably not so damaging for us to use that kind of warlike language if we understand that the enemy is a virus – our enemy is the virus – but, if we think our enemy is China, then it’s not very helpful. Those two understandings will fuel different courses of action…
MCKAY: I’ve noticed how we’re just besieged with a tsunami of numbers. In me, they encourage a doubting outlook: “Hey, I don’t really trust all the numbers very much because they seem like descriptive statistics that cannot actually be totally reliable from some of the countries reporting them.” And secondly, they misrepresent the pandemic as a purely natural phenomenon, like a wave. We keep on talking about “waves” of numbers and “flattening the curves.”… Would you agree with that people have been fighting about the numbers in a way that undermines the credibility of what is the very important enterprise [of epidemiology]?
SPINNEY: …We are not very good at relating to large-scale death, whatever the cause of it. … I tried to explore this a little bit in my book. I was trying at the time to explain to myself, as much as to anyone else, why our memory for pandemics is less good than our memory for wars…. We forgot this terrible catastrophe that killed more than any other disaster in the 20th century and maybe in any other century….
In 1918, there was no such thing as a lab-confirmed diagnosis of that disease. Today,… lots of people are asymptomatic. People may experience mild symptoms at home, never see their doctor,… but go on to have Long Covid later…. There are always all these problems.
The chances are that the figures we’re working with today for Covid-19 are probably underestimates, but we don’t know. It’s easier to count the death toll of a war (at least it was in the days when soldiers wore uniforms and they all fought on battlefields in the same place). The data are more accessible. It’s easier to build a picture of that disaster and get a sense of the scale of it… – whereas, I think the picture of a pandemic takes time to develop, as we draw in the data and as we build on them…. There’s a very different way in which we document these kinds of disasters and then, because of that, in the way that we remember them.
MCKAY: …In your book and your journalism, you pose the question about how we remember pandemics…. As I read your book, you’re saying, “Well, one of the problems of public memory here is that the pandemic didn’t have the right shape. It doesn’t conform to the beginning, middle, and end of a classic narrative structure.”
It’s very hard to tell when a pandemic is over…. We would like a pandemic to conform to our schemas. We think, for example, it should feature a third and final act…. Pandemics don’t conform to our conventional understanding of what a story should look like – with a precise beginning, and also with heroes and villains. The heroes and villains are going to be hard to discern in this one. In Pale Rider, you tell us memory is always a work in progress, and you write in your journalism of plans to commemorate the virus by monuments in London and in Montevideo, Uruguay (where there’s an interesting project in the works). How do you think we’ll commemorate this pandemic, so it might be remembered by future generations?
SPINNEY: Here’s … a shocking statistic. I live in France… and here in the 20s and 30s, there was a kind of a rash of building of monuments to the First World War, about 170,000 of them in all, most of which are still standing. I don’t know of a single monument in this country to the 1918 flu.
The closest I’ve come: I found a simple stone cross on the Swiss side of the border in the Jura Mountains. What’s interesting about that cross is that it’s to the soldiers who died of the flu. And so, even in that one monument, there’s a sort of confounding of the two disasters. Again, the war continues to overshadow the pandemic.
And yet, we know… that the flu killed many more people than the war did. It is quite extraordinary, I think, the overshadowing and the forgetting of the pandemic.
…There’s a debate going on now among memory experts as to whether this one will buck the trend. The thinking is, that this is the first major pandemic in the history of humans to have been digitally witnessed (apart from 2009, which was rather anti-climactic, because it didn’t kill more than a normal flu season in the end)….
That means that anyone in the world who has access to the internet could have, if they wanted, from the beginning of this pandemic, tracked infection rates and mortality rates in (almost) real time. They could have had a general overview of the whole global phenomenon.
That wasn’t the case in 1918: far from it. It took a very long time for people in the world to realize they were looking at one pandemic, rather than lots of local outbreaks of disease (the naming reflects that in fact). There were lots of different names given it to begin with, and it was only later they realized they were dealing with one thing, and it attracted this unfair name, the Spanish Flu.
The idea is that there are a lot more data on servers all over the place, as well as in people’s private archives. There’s a huge collecting effort going on, all around the world, of objects, physical objects, diaries, letters, but also digital content.
So, …if we are better at documenting this one, does that mean we’ll remember it better? And if we remember it better does that mean we’re more likely to take lessons away from it when future pandemics arise? I think that whole that whole debate is really interesting.
…The memorials have already started to be built. The ones that I’ve been looking at have mainly been quite ephemeral. I think that’s partly a sign of the times. The New York Times filled its front page with the names of the dead, trying to capture the humanity of this tragedy… I think that’s really important, because there is something ephemeral about a pandemic. It rushes through and then it’s gone. (Of course, the loss of the individuals is not ephemeral). …You need another dimension as well, which … something that reminds us of the permanency of pandemics. The fact that they are a feature of humanity and have been for thousands of years. On average, there have been three a century for the last 500 years. They’re not that infrequent. There will be others.
…Montevideo provides a really interesting example…. As I understand it from the pictures and the drawings I’ve seen, it’s going to be a bowl in steel and concrete, 40 meters across. You [will] walk out [to it] to along a platform from an urban beachfront in Montevideo. It’s suspended over the South Atlantic, and it’s got a hole in the middle. It’s slightly concave, so it amplifies the sound of the waves which comes up through the holes, and you can look down into the roiling sea.
When you look out from the beach from civilization, so to speak, [the monument] can be hidden in the weather. And it will weather over time. [The message might be:] … we are not the center of everything, we are subordinate to nature, and this threat is always there…. It just needs to be a reminder.
MCKAY: …There’s an optimistic sensibility that some historians bring to this discussion. Okay, over the past 500 years, we’ve had three pandemics per century, roughly speaking. Maybe this century will be worse. Still, this is part of the human experience…. Yet, you cite statistics from France, Britain, Italy, and the United States suggesting that majorities now believe that our civilization is entering a period of general collapse. The French have coined the phrase ‘collapsologie’ (collapsology in English), which they started off as a joke, but actually is now in the Petite Robert — it’s becoming a real word….In some instances, it seems suffused with right-wing Malthusian ideas about…having to control population. Other elements are feeding into it, like, concern over global global climate change. So, I’m just wondering if historians can provide human beings with a more balanced, somewhat more realistic, even optimistic sense of the future based on their research? Would you like to comment on that?
SPINNEY: I like you, love this idea of collapsology. Not that I love the idea of the world collapsing or society’s collapsing, but I think it’s fascinating…. We go through these periods where we think the world is going to end and societies are going to collapse. … I think that historians would probably agree that there are times when a given society is healthier than others, even if they don’t go through the classic cycle of decline-and-fall that nineteenth-century historians talked about….
When I was writing about collapsology, I was writing about the sort of French version of the phenomenon where people are wanting to go back to nature. That’s not the first time in history that’s happened either. And in the French version it’s not just climate change; they’re worried about — although that is a major part of it — but also the sickness of society, the fact that there seems to be these huge and very profound divisions in French society. I think it’s trying to be scientific, to some extent it achieves it …. Maybe in itself, it’s a spur to action. Maybe you need to feel that things have got so bad that now, finally, it’s time we have to act.
The problem with a lot of the collapsologists’ thinking is that it is quite fatalistic. Some of them will tell you the world is going to end in 2030. And if you hear that, [one response might be]: “Well, I’ll go and have a drink, then. There’s nothing I can do.” It’s important… that we have a sense that there are solutions, and I think that historians come in there they can show us how societies passed through these moments previously.
It is true that we are facing unprecedented challenges, notably climate change. But, I think there’s a balance to be struck. People need to feel that they can do something, that they can act to change the situation. Maybe they also need to be a little bit frightened or shaken before they start thinking that way.
… We need to talk up the positives in the world, and the fact that we do change, and we do learn, and we do adapt, and that Malthus has been wrong, so far. We do tend to muddle through and find ways to produce more food for ourselves, for example….
I read, for example, a piece the other day by Stephen Buranyi in The Guardian, saying the vaccines are working. The good news is, the vaccines are working. Let’s hang on to that. I think it’s important to talk up the positives.
MCKAY: You could say, optimistically, that the pandemic has knit us together far more profoundly as one humanity. In many ways, western hubris — our sense of being so much better than everybody else — has been sort of knocked down several pegs. We have enormous lessons to learn from the rest of the world.
SPINNEY: Then there’s a there’s a bit of good news buried in that as well… Now we have been through Covid,… the next generations will have a chance of facing the next pandemic better in our countries because they’ve been through this one. So, I’m not saying it’s good we had a pandemic, but I am saying that there is a silver lining.
MCKAY: Thank you so much, Laura Spinney, for this illuminating discussion.
[Laura Spinney talked with Syndemic on 15 April 2021].
 Laura Spinney, Pale Rider: The Spanish Flu of 1918 and How it Changed the World (London: Vintage, 2018).