An Interview with Nicholas Christakis

This transcript has been edited for clarity and length.

IAN MCKAY: Thank you so much for joining us this evening for this session of Syndemic, our series on the challenges Covid-19 has posed for humanity…

Nicholas Christakis is one of the world’s most influential and respected interpreters of the Covid- 19 crisis. In 2013, Christakis moved from Harvard to Yale University, where he is Professor in the Department of Sociology with additional appointments in the Department of Ecology and Evolutionary Biology, Statistics and Data Science, Biomedical Engineering, Medicine and in the School of Management. In 2018, he was appointed Sterling Professor, the highest honour bestowed on Yale faculty. His third book Blueprint: The Evolutionary Origins Of A Good Society (2019) built on his already highly influential interpretation of social networks and made the New York Times bestseller list. His recent study, Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live^[1] (2020) focuses on the profound and enduring impact of coronavirus… in the US and is sure to stand as one of the most influential interpretations of the recent crisis…. Welcome, Nicholas Christakis.  

NICHOLAS CHRISTAKIS: Thank you, Ian. … I’m just going to put some ideas on the table, and then we can have a conversation with the time that’s remaining.

All of us happen to be alive during a once-in-a-century event. Something very unusual is happening to us as a species. A new pathogen has been introduced into our midst and this pathogen is going to be with us, forever.

From the point of view of the pathogen, it is having what is known as an ecological release. It’s like an invasive species, as if we had taken rats to an isolated Pacific island and introduced them there and they overran the place. Our bodies are the island to the virus. The rat [the virus] has found untouched territory in us. We have no natural immunity to this pathogen, and it’s going to spread and spread and spread among us like any other living thing would do. (There’s some debate about whether viruses are living or not – but for the purposes of this conversation, it’s acting in a Darwinian way, like any other living thing.)

We know quite a bit about the pathogen at this point. ([Speaking] candidly, we knew most of these things about the pathogen very early on, by January of 2020.) For example, we know that the pathogen is reasonably deadly. It kills between 0.5 and 0.8% of the people that it infects. That’s known as the infection fatality rate – the IFR. And if you get symptoms of the disease, it’s about twice as deadly; between 1 and 1.6% of people who get symptoms of the disease will die… I was a hospice doctor for many years. I took care of people who were dying, so I didn’t often take care of primary infections, but I knew enough to know that an infectious disease that kills 1% of the people it infects is a serious infection. You would not take that lightly.

And we also know that [with] this disease now, the mortality rate varies by age. If you’re less than 20 and you get an infection, you (maybe) have a one-in-ten-thousand chance of dying. If you’re in your 50s and you get an infection and you have symptoms from it, maybe a 1% chance of dying. If you’re in your 70s or 80s and you get symptoms from it, you’ve got about a 20% chance of dying. That’s a serious infection. And we also know how transmissible, how infectious is this disease…

One of [Covid-19’s] other intrinsic properties was its spreadability, its infectiousness. This is quantified by the famous so-called R₀ [R-naught] or the basic reproduction number.  That number for this virus is three. For each case of the virus, in a non-immune, normally interacting host population, it creates three new cases. That’s also quite infectious.

The seasonal flu, for example, might have an R₀ of 1.5, barely able to reproduce itself. If you’re infected, you infect one other person (plus half an extra person).  In fact, having an R₀ above one is what makes a disease epidemic. It rises and rises with time, because each case creates more than just itself.

[Imagine that you] took these two parameters and you plotted them on a graph for all the respiratory pandemics of the last hundred years.  So, on the x-axis, you put the severity or the lethality of the condition, and on the y-axis, the infectiousness. In the upper right, you would have the 1918 influenza pandemic, which was the most lethal respiratory pandemic we’ve had in the last 100 years.  Down here, in the lower left, we would have the 2009 H1N1 pandemic. All of us lived through that pandemic. Probably none of us really think about it or remember it, because it wasn’t very lethal. It just gave you the sniffles. In the middle, you would have the 1957 influenza pandemic, which was the second most deadly pandemic we’ve had in the last hundred years (until now). In the United States, it killed 110,000 Americans… So, Covid-19, based on these parameters, is between 1957 and 1918 [in terms of its lethality].  You could have discerned this ab initio, from the beginning, back in January, because these parameters were released by Chinese scientists and later in February by Italian scientists. There was nothing surprising at all… about what has happened to us since then.

One of the reasons I wrote the book is that I was so frustrated… by the awful public discourse we were having about this epidemic, especially on the part of our leaders, who were minimizing the risk and, as it turns out (we later learned), simply suppressing the evidence that was available…. I do not think we are at the beginning of the end of this pandemic, but we are, thankfully, approaching the end of the beginning, at least in North America…

You may have been paying attention to what is happening in some of the more populous regions around the world, like in India, in Indonesia, in Brazil, now in sub-Saharan Africa, where the epidemic,… because of new variants, is taking off. And we are once again reading headlines that are astonishing. In India, for example, … the funeral pyres are burning day and night, just like on the fields of Troy 3,000 years ago when Homer’s Iliad described this kind of event.  In fact, one of the things that I would say is that, while the way we have come to live in the time of Covid-19 may feel alien and unnatural,… it’s actually neither of those things.

Plagues are a feature of the human experience. They’re in the Bible. They’re in Homer… – one of our oldest extant written things begins with a plague.  That’s how The Iliad begins…Plagues are in Shakespeare, they’re in Cervantes, they’re in countless pieces of literature in the non-Western tradition. So, what happened in 2020 was not new to our species. It was just new to us. We thought what was happening was so nuts, so crazy, so unjust, so wrong that we had to endure this. Yet, our ancestors have had these experiences. We forget.

We human beings forget and are shocked.  Yet, the irony is that we had an oral tradition, not just in literature, but also in religion. So many of my Jewish friends … in 2020 said, their whole lives they’ve been doing the Passover Seder, talking about the Biblical plagues. Now it felt different, as they were saying the Seder.

So, our ancestors tried to warn us about this, with our oral traditions. We also had a scientific memory among medical historians…  We have expertise in our society that looks to the past and says, “Wait a minute, something similar is happening right now.” And yet, we had no collective personal memory. There were very few people who had personally experienced such a serious epidemic – certainly very few people in North America would have this experience. And this is one of the reasons, I think, we were caught off-guard.

These plagues unfold in almost a stereotypic way, not just epidemiologically but also socially…. It’s important to understand that plagues require collective action (often, not always, state power) to respond to them. You cannot fight an invading army alone.

If the Canadians were to take up arms and come to the border and invade the United States, my grabbing my gun and going to the frontier would be useless against that. Even if every American citizen grabbed their gun and ran to the frontier, that would also be useless. We would have to coordinate our defence, and this type of coordination that is required reflects the collective nature of the threat that we are facing. This is a contagious disease that is afflicting all of us at the same time.

Many people began to think that… state actions (like closing schools and closing borders) …were the problem. Actually, it’s the virus that is the problem. One estimate of the economic impact of the virus in the United States …was executed by Larry Summers, the former treasury secretary, and David Cutler, a former colleague of mine at Harvard, also an economist. They call this the 16-trillion-dollar virus: eight trillion dollars in economic damage to our society and eight trillion dollars in loss of life, disability, illness, and so on.

This is a cataclysmic event in the history of our society. It is an economic shock that is almost as great as the Great Depression. I don’t think people fully appreciate the magnitude of this yet. And many people, … wrongly think that it’s our actions (or state actions in particular) that are causing the problem, but this is not correct. It’s the virus that’s doing it.

This physical distancing and this economic collapse, this slowing down, have been features of plagues for thousands of years. For example, during the Plague of Justinian… which was over 1,500 years ago,  historian and priest John of Ephesus had this to say: “And in all ways everything was brought to nought, was destroyed, and turned into sorrow. Buying and selling ceased and the shops with all their worldly riches beyond description and the moneylenders’ large shops (he means the banks) closed. The entire city then came to a standstill, as if it had perished. Thus, everything ceased and stopped.” Such accounts of the effects of epidemic disease are now eerily familiar, aren’t they? …

It’s very hard to have an economy or a functioning society when people are unable to interact, because a germ is spreading that kills them. This is a very stereotypic feature of plagues. And there are others, too… For example, fear, lies, and denial have always been companions of plagues, for thousands of years. In fact, denial is such a constant feature of epidemics that we might even think of denial as an essential aspect of an epidemic.

In other words, we might even add social factors to our epidemiological definition of what it means to have an epidemic. If you see plague as one of the four horsemen of the apocalypse, mendacity is its squire, following right behind it. So, you can look at social networks (as my lab has) –… you can mathematically analyze the spread of germs across social connections –  from me, to my friend, to my friend’s friends, and so on. And misinformation is right behind it.  And this type of superstition and mendacity has been a feature of plagues for thousands of years, as… has been denial.

So, when I saw denial rear its head again a year ago as that pandemic was crashing upon our shores,  at the highest levels of government (for example in the White House, but not just there – elsewhere as well), I was, on the one hand, completely dismayed and disappointed, but on the other hand, completely unsurprised. Denial is a feature of plagues.  Not just in our leaders, frankly, [but also] in the person on the street. And it’s almost a human response: nobody wants to believe this is happening. We would rather deny and not believe that it’s happening.

There’s some scientific work my lab has done (if you’re interested) in what we call “dueling contagions.” One of the ways that you can think about epidemics is that there is a biological contagion (as the virus spreads from person to person) and, in parallel to that, there are social contagions (for example, of accurate or inaccurate information and behaviours [about] mask-wearing or vaccination)….Your probability of putting on a mask… depends on whether your friends are wearing a mask or your friend’s friends are wearing a mask… So, you have a biological contagion and, parallel to that, you have social contagion. In a sense, the question is: which one is going to win? Will the social contagion outstrip, in some sense, the biological contagion?

Plagues are also a time of blame. It is very typical that we blame others. During the bubonic outbreaks, for example, there was a rise in anti-Semitism: the Jews were blamed. Hundreds of people, Jews especially, were burnt at the stake, buried alive, and tortured in the most unspeakable ways during the time of plague. (Interestingly, Pope Clement VI, who was the Pope during the first outbreak of plague in 1347, was surprisingly enlightened… on this topic….) We also saw the same thing, for example, with the HIV epidemic in the United States. Gays were blamed or Haitians were blamed or IV drug users were blamed. And during the Covid-19 pandemic, immigrants are blamed.  Always, we wish to blame some other person for our predicament.

There’s an interesting set of ideas as to why we might do that. And one idea that I think may hold some water is that human beings find it more appealing to imagine that there’s human agency behind the calamity that has befallen us, that actually some other humans are responsible. That’s much more appealing than the alternatives, which are, for example, that it’s an implacable god that hates us – that’s not very appealing. Or that it’s the inexorable workings of the natural world – which is also not appealing. So, I think, if you have to pick between nature, God or someone else is at fault – we pick someone else. And this is one of the reasons why blame has been a feature of plagues, in my judgment…

Plague is a time of meaning… They are a time of loss. Grief walks the streets during times of plague. We lose our lives, we lose our livelihoods, and we lose our way of life. And the kind of psychological malaise that we have seen recently has been described, also, for thousands of years. [Emperor] Marcus Aurelius talks about it during [Rome’s] plague of 2,000 years ago. Yes, the deaths from the germ were bad, he said, but in some ways the psychological depression was worse….

And what we had to do, and we still will have to do, is to implement a series of responses that I like to think of in keeping with something known as the “Swiss Cheese Model.” The Swiss Cheese Model was … introduced by psychologist James Reason about 30 years ago to think about the failure of complex socio-technical systems, systems that have biological, human, and technological components. Why do they fail? And he thought that there were layers of defence, like slices of Swiss cheese, each slice of which was good but imperfect – there were some holes in it.

So, you can imagine, for example, [with respect to] our layers of defence against Covid: masking is a layer, and vaccination is a layer, and quarantine is a layer, and testing is a layer, and hand-washing is a layer, and school closure is a layer, and border closure is a layer. So, each of these is a layer of defence, but each of these is not perfect. There are some holes in each layer… You should have the intuition that, if you have a single layer of defence, the virus could penetrate that layer (if it happened to line up with a hole), but if you lined up several layers of defence, by the time you got to the third or fourth piece of Swiss cheese, there would be no sequence of holes that was perfectly aligned.

This is why we need to implement more than one layer of defence, [and] why, for example. school closure alone … or border closure alone [are] not enough – and also, incidentally, why vaccination alone is not enough. Vaccines are fantastic but they are not perfect, and this is why, for some time, we’re going to need not only to be vaccinated but engage in certain other layers of defence, like mask-wearing and gathering bans, and so on.

There’s another important epidemiological idea that I would like to introduce. Then I’m going to talk a little bit about the sort of three phases of epidemics and close with some final remarks. The idea I’d like to put on the table is this notion of herd immunity.

Now herd immunity is an old concept in epidemiology and it’s the idea that a population of people can be immune from a condition, even if not every individual within the population is immune. For example, if you vaccinate 96% of the population against measles and one of the 4% of unvaccinated people gets measles, you don’t get an outbreak, because there’s no one for them to spread it to. They’re surrounded by immune individuals. That 96% is the herd immunity threshold and you should have the intuition that the more contagious is a disease, the more infectious it is, the higher its R₀,  the higher the herd immunity threshold. And you can compute the herd immunity threshold by a standard formula, which is R₀ -1 divided by R_0. So, for an R₀ of 3, that’s 3 -1 divided by three. That means 67% percent of the population needs to be immune (either naturally, because they survived the infection, or artificially, because they were vaccinated before you reached this threshold)….

With that little bit of epidemiological background, let me talk about what are going to be the three phases of the epidemic: the acute, the intermediate, and the post-pandemic phases. The acute phase of the epidemic is when we’re feeling the full biological and epidemiological impact of the virus.  That’ll last until we reach herd immunity, either naturally or artificially through vaccination… It’s going to last through the end of 2021, the beginning of 2022.  We’re going to be living in a changed world: wearing masks, having other kinds of non-pharmaceutical interventions that we use to cope with it, as the virus moves through the population. But, eventually, we will reach this important threshold.  Thank goodness, we’re able to do it mostly through vaccination…

Then we’re going to enter the intermediate phase… at the beginning of 2022. That’s going to last about a year or two, until the end of 2023. That is when we are coping with the clinical, psychological, economic, and social aftershocks of the virus. It’s like a tsunami has washed ashore. Now, the waters have receded, which is great – but, we now need to cope with all the damage.

Probably five times as many people as die of the disease, will have some kind of long-term disability. (I’m not talking about Long …Covid). You’ve recovered from Covid, but your body has been damaged by the infection. You have pulmonary fibrosis, you have psychiatric or neurological sequelae, or renal, or cardiac, or pancreatic problems.

In the United States, if as many as a million people die, we might have five million Americans that are going to need clinical care, who will need resources and hospitals and clinics and other attention. We’re going to have millions of children that have missed school and lost a year of schooling who will need attention. We’re going to have the psychological sequelae. We’re going to have millions of Americans who lost their jobs. Millions of businesses have closed and will need to be recapitalized. All of this will take time for us to cope with. And if you look at the history of epidemics, that typically takes a year or two (to the end of 2023 approximately, [in this case]). These are not hard-and-fast dates.  They’re going to feather into each other.  

Then we will enter the post-pandemic phase. I think that’s going to be a little bit of a party, a little like the Roaring Twenties of the 20th century. I think people will have been cooped up for a long time, and now they’re going to relentlessly seek out social interactions in nightclubs and restaurants and bars and sporting events and political rallies and musical concerts. We might see some sexual licentiousness and some change in sexual mores. (My sister, when she’s heard me talk about this, says “Nicholas you should always hasten to add that that forecast only applies to unmarried couples.”)  When I made a remark like this a few months ago, …one of the New York tabloids, the New York Post,  gave me …the headline treatment: “Yale professor predicts orgy.” That’s not what I’m saying. I’m just saying that it’s quite natural for human beings who have been denied social interactions, when the danger threat is finally behind us, to have more liberal kinds of social interactions.

Also, during times of plague, people save their money. They become more abstemious and risk-averse, either because they fear getting sick, they want to conserve their resources, or because the economy has collapsed and there’s nowhere to spend money. But when the plague is over, people spend liberally. This has been seen for thousands of years. So you typically have an economic boom afterwards. I think we’re going to see an entrepreneurial boom and also, perhaps, an efflorescence of the arts and a kind of very effervescent period of time when we finally put the epidemic behind us.

These respiratory pandemics come in waves. Despite vaccination levels right now, we’re going to have a good summer, but it’s a kind of false relief. We’re going to have another bad winter next winter. It won’t be as bad as last winter, but we are going to see rising mortality again in the coming winter, probably the re-imposition of some of the non-pharmaceutical interventions….

I think we are the first generation of humans alive to have been able, in real time, to invent a specific and effective countermeasure speedily enough so that we can modify the course of the epidemic. Our ancestors, when coping with these threats, could do no such a thing… These vaccines have been a godsend….  

The new variants that have emerged could put a spanner in the works and affect some of the timing that I … outlined schematically a moment ago. I think the rich nations of the world, including the United States and Canada but also European countries, Japan and so on, China too, by the way, have a moral, economic, and epidemiological rationale for vaccinating the world. I think there’s a moral necessity for us to vaccinate the world. We are the richest nation on earth; we are the scientifically most sophisticated nation; we profess to global leadership; we should lead (and I include Canada in this). We have an economic rationale, as well.  We need global supply chains to be [sustained]; we need trading partners – other countries. To be rich ourselves, we need people to trade with, and so we need to vaccinate them.

Finally, we have an epidemiological rationale (even if you don’t buy the moral argument and you don’t buy the economic argument). In a … very selfish, save-your-skin argument, you should care that there are places around the world where the virus is running rampant and could mutate into worrisome strains that will inevitably come to our shores and kill us.

So, for all these reasons, I think we should vaccinate the world… It will cost just 50 billion dollars to vaccinate 70% of the world. The return on that, some have estimated, [would be] many trillions of dollars…

A couple of final remarks. I think it’s important to understand that, bad as this epidemic is, it could have been so much worse. There’s no God-given reason this pathogen only kills 1% of the people it infects. It could have killed 10% or 30%.  We could have been facing a bubonic-plague-type situation in the 21st century, in our rich, scientifically advanced democracies. It’s astonishing to contemplate, isn’t it?

It’s just dumb luck that the virus is this lethal and not more lethal. The next pandemic could be [more] lethal. Unlike bubonic plague or cholera, for example, which are caused by bacteria, for which we have many effective antibiotics, we have no good drugs to treat viruses to speak of. So, our only hope is through vaccination – and it takes time to invent vaccines.

So, a deadly virus that kills 10 or 30 % of the population – …like in the movie Contagion – [would entail] an astonishing devastation in our society. This is why these threats need to be seen as a national security threat.  They require great probity, not just on the part of the citizenry, but also in the part of our leaders. That’s why I was so disgusted at the way we were misled and poorly led in so many of the countries around the world, which could have (and should have) known better.

There’s some evidence that these zoonotic diseases – these diseases that originate in animals and leap to humans – are rising with time and that the inter-pandemic interval is shortening. So, earlier, at the beginning of my remarks, I said these epidemics come every 50 or 100 years, but some people fear – and I am among them – that they now may be coming every 30 to 50 years, for example. Plus, they’re stochastic – meaning that they could come at any time. Just because it took 50 years for this to happen, the next one could come in five years…

So, plagues offer new challenges and new opportunities…. I’ve highlighted some of the ways in which they elicit some bad qualities in us. They also elicit good qualities, like collaboration and cooperation, and the deployment of our wisdom and science to confront the threats… The fact [is] that thousands of scientists … laboured for decades to produce the knowledge that was useful to us; that the world mobilized; international organizations co-operated; scientists around the world cooperated; tens of thousands of citizens volunteered for these epidemics; and countless other sacrifices were made; people sacrificed their money; some health care workers sacrificed their lives to care for us; …so-called essential workers, truckers and people delivering food and so on, took tremendous risks to keep our economy somewhat functional.  There were many wonderful qualities that we manifested…

I’d like to close with a quote from Albert Camus’s  famous novel La Peste, which is a fictionalized account of a plague sweeping … Oran in Algeria in the 1940s (but is based on an 1849 cholera outbreak and also surely on bubonic plague outbreaks that swept North Africa and Europe in prior centuries). The protagonist of this book is a physician by the name of Dr. Rieux and here’s what Camus writes: “Dr. Rieux resolved to compile this chronicle so that some memorial of the injustice and outrage done them might endure and to state quite simply what we learn in time of pestilence: that there are more things to admire in men and women than to despise.” And that’s very much how I feel about life in general. I’m an optimist. I think we’re a miraculous species…. We will see the other side of this 21^st-century plague.

MCKAY: The causal drivers of the pandemic are still debated, with much attention of late, perhaps stimulated by geo-politics as much as by science, focused on the possibility of ‘lab leak’ from facilities in China (and you cast scientific doubt on that speculation in Apollo’s Arrow)….Social scientists and epidemiologists working in the Marxist tradition have argued that many of these causal drivers behind these pandemics are related to what they call the “metabolic rift” between nature and humanity opened up by capitalist accumulation since the eighteenth century and the rise of fossil capitalism… with specific reference to factory farming, accelerated resource exploitation in hitherto undeveloped areas, and the emergence of vast slum populations lacking basic services and acutely vulnerable to health crises. Within this research tradition, Covid-19 is seen a moment of the more general environmental crisis threatening humanity.

I notice you said that the interval between these epidemics is shortening. If you look at the number of these zoonotic diseases that are arising , it’s really quite striking how many have emerged since the 1970s from areas in which there a lot of industrial farms, there is a lot of deforestation, there is a rapid, and stark, conquest of new territory. They say…that species like horseshoe bats…will start ranging abroad, they will be swept up into the huge trade winds that globalization has set in motion. If you want to address this pandemic, you have to address neoliberal globalization.

I sense that you’re more in tune to what one might call “perennialist” interpretations: “This is just part of the human condition and will be going through these [ever so often].” What would you say to Marxists who are more struck by the unusual dangers set in motion by global climate change?

CHRISTAKIS: There’s so much in that question. First of all, there is a connection between climate change and pandemic. As we modify the climate, we lead to mass migrations of humans, we deforest the land, we change the terrain of animals – so we come into more contact with animals, and that leads to more opportunities for zoonotic leaps. And there’s no doubt that there is a connection, in my judgment, between climate change and pandemic disease.

But the broader argument there, I would reject, in some sense. And there’s many pathways we could go down…. Pathogens have always been a feature of our environment. These bacteria and viruses preceded us by hundreds of millions of years. They were on the planet long before we were. They infected us with delight, long before we had capitalism and any other kind of thing Marxists would be concerned with.

However, there is a narrow truth, that the way of living of human beings is connected to these types of pandemics. But it’s not the onset of the industrial revolution [that matters], it actually goes back to the agricultural revolution. So, about ten thousand years ago, we begin to domesticate plants and animals – the agricultural revolution begins. Shortly thereafter, about eight thousand years ago, we invent cities. It’s the special combination of large agglomerations of humans living chock-a-block with their domesticated animals that gave rise to many of the first pandemics. You don’t really have pandemic disease when you have five million human beings occupying the entire planet, living in groups of thirty in hunter-gatherer bands.  They’re not interacting in such a way that can give rise to [it]. You need large agglomerations. Many people trace back, for example, the origin of measles to Rome. Rome was an enormous city … and you had a million people living right next to domesticated cattle. We’ve now have been able to trace, with genetic analysis, that measles probably arose from a mutation of a disease that afflicts cattle, called rinderpest. So, the argument that our way of life has contributed to pandemics is, in that sense, true. But it’s not a recent thing. It goes back a few thousand years….

…Yes, I am a perennialist, in the sense that I think there are fundamental qualities of human beings that have been shaped by natural selection. For example, this includes our capacity to love each other. We form a sentimental attachment to our mates… We befriend each other, which is a very unusual feature of species… We form long-term, non-reproductive unions with other members of our species – namely, we have friends. This is very rare. We do it, certain primates do it, elephants do it, certain Cetaceans do it. So, natural selection has shaped certain features of our social life – our capacity for love, our capacity for friendship, and so on….  And that’s intrinsic to human beings. That’s seen universally. There is, of course, a debate in anthropology between cultural universalism and cultural relativism. An old debate. I’m (kind of) on the universalist side… All I’m saying is that there are universals. I’m not saying that they’re the only interesting thing. Because, of  course, history and culture matter. And there’s a tremendous variety of human social forms. But I would reject the Marxian idea that we are endlessly malleable… Stalin thought this….There’s a sense in which Marxism and genetics have been in tension for quite a while. Those are some responses to your question.

QUESTION FROM THE AUDIENCE: You wrote your book early on [in the pandemic]. Does 2021 change any of the conclusions you reached in it?

CHRISTAKIS: Honestly, I would say no. This pandemic has followed the pandemic play-book… The vaccines came faster than I thought, but not much faster. I thought they might come in the first quarter of 2021, and that would be miraculous if it did happen…. It would save lives – but it wouldn’t modify the basic trajectory of the pandemic. Vaccines came even earlier than that. They were announced in November, 2020, and by December, 2020, the … vaccinations began. So that was a little bit faster, but not that much faster. One of the things that’s unusual for pandemics – usually, with the passage of time, the lethality of the [pathogen] tends to decline. But there have been exceptions…. In 1918 epidemic, the second wave was four times as deadly as the first wave. And I’m little worried we’re seeing that with Covid… With the variants especially, we are not seeing a rapid decline in mortality impact…

…I discussed the lab leak hypothesis in the book. I say that the zoonotic leap was more likely. I still believe it’s more likely…When I wrote the book, I might have thought the lab-leak was a 10% possibility. Now, maybe I think it’s a 20% probability, let’s say. So, more…The way the Chinese are acting in a secretive way raises suspicions. If it’s not a lab-leak, why don’t you release the data, so we can know that it wasn’t?…I still think the zoonotic leap is more likely…

QUESTION FROM THE AUDIENCE: We share a continent and a long border. Should we be concerned by the vaccination rates in the US?…

CHRISTAKIS: …The higher the percentage of people vaccinated, for sure, the better. Use of superior-quality vaccines is also helpful. You want as many people vaccinated as possible and you want the highest level of immunity possible. For example, 70% vaccinated with the Sinopharm Chinese vaccine is not the same as 70% vaccinated with the Moderna vaccine or the Novavax vaccine…I suspect Canadians, in the end, will have a higher percentage vaccinated, because you’re more community-minded than the US…. So, yes, that’s better…

QUESTION FROM THE AUDIENCE: This is a question that floats somewhere around the idea of the layering of grief in the last year and a half and the specificity of the confluence of the last year and a half….I remember one of my students saying to me that it’s exhausting to live through so many varieties of major historical change at the same time. One of the things I’ve been thinking about is, …is it one kind of historical change,… a new instantiation of a repeated historical [pattern]? Is there something particular about the confluence here? What about the way protests against particular kinds of injustice have flared in the last year?

CHRISTAKIS: …I’m not one of those people who goes, ‘Kids these days.’ I’ve devoted … my life to the education of the next generation. I like and admire young people. I enjoy their company. But, at the same time, you have to recognize that they’re young, and we are the faculty. This idea that there is something really awful about their predicament is false…Their age cohort, sixty years ago was, at the age of twenty, exiting on Normandy beach and being shot down by machine-guns. So, there’s absolutely no sense in which they are actually worse off than prior generations. Uniformly, on average, everyone alive today is vastly better off than…every student alive thirty or fifty years ago.

The same thing goes, by the way, for racial issues. Yes, we are still a society in progress. Yes, we have more to do when it comes to racial equality. But the belief that we are now living in some period of racism that surpasses what was seen, for example, during the Civil Rights movement, when we still had lynchings, that’s just false. If you just look at inter-racial marriage, … we live in a different and better world than we did fifty years ago. So, on the one hand, I would say to the young people, “Yes, I hear where you’re coming from. And it is stressful to have these experiences – of protest and plague… But, in fact, you are not worse off than kids thirty or fifty or a hundred years ago.”

A second point: There’s an empirical observation in the history of epidemics, which is these epidemics often seem to come [in association with other phenomena]. There’s a perfect storm that afflicts society…You often see plagues during times of war, during times of famine, during times of heightened inequality. All of these things [interact]. Some people theorize that they literally all go together.  So, your point about how the students are observing that there’s a lot going on – in a way, they’re right. This has also been seen in the past.

…Plagues are often a time of meaning. In historical time, this was manifested through religion. During times of plague, people’s religiosity typically goes up. Gallup surveys in the United States show the same thing [happening] during Covid-19. Even though churches were closed, prayer went up, appeals to a deity went up. It’s a pretty common human response. When death is in the street, people start turning to religion. (By the way, when the plague ends, you return to the previous secularism. That’s one of the reasons religion will plummet [afterwards])…We also see that in occupational choices. Applications to medical school and nursing school are booming. Young people find meaning in engaging in helping professions. Everyday workers, blue-collar workers, found new meaning and purpose in their lives… These individuals now found new meaning in the work. They were essential workers….

When death is in the streets in the form of plague and people are stuck at home, they think about ‘What’s important to me in my life? What’s important to me in society? What kind of society do I want to live in?’ And I think this contributed, as well, profoundly, to the protests that we saw….Plagues do intersect with these… broader meanings, these broader themes in society.  

QUESTION FROM THE AUDIENCE:… [As a teacher]I think that what I saw [in 2020] was earnest young people in a crisis of meaning. How are they going to make sense of, and take action in, a world that seems to be just spinning around them in so many ways?….I didn’t want to be the “sage on the stage” and tell them everything’s going to be OK. I felt the way I should respond to that is, I should be in the middle of it with them…

CHRISTAKIS: [On pedagogy, I agree with that approach to sharing their concerns.] Aligning yourself with your students means saying, “This is what it means to be alive in the world. This is what it mean to be an adult. It’s tough. It’s confusing. It’s dangerous. It’s risky. It’s hard to know what to do. Yes, I hear you.” I think you’re exactly right….

MCKAY: I might ask a question, drawing from your book, about the United States. Yours is a profoundly American book, at points laceratingly self-critical of your country’s handling of the pandemic. What explains the extent to which the US case now serves many people as a cautionary tale, rather than as an uplifting example, for how a nation can engage with something like Covid-19? 

CHRISTAKIS:  …I’m ashamed of how we did as a nation. It’s appalling. I honestly can’t believe it, given our wealth and our sophistication and our democratic rule. I’m astonished at how poorly we fared…. I take the previous administration to task in Apollo’s Arrow. And I’m also…stunned at my fellow citizens in our nation. They were poorly led, but not enough of them rose to the challenge that is before us.

But, I think it’s always a bad idea to bet against the United States…. I think of James Baldwin, who said, in a famous interview, “It is precisely because I love the United States so much that I reserve the right to criticize her endlessly.” And that’s sort of how I feel. We are a free society. I am free to criticize our society and our government, thank goodness. And I intend to do so. I agree with you that we really did poorly.

… There’s an opportunity here for the United States and the other rich democracies to vaccinate the world – to show leadership. I worry that we’re not doing that…We also have a geopolitical reason to do this. Why we’re not racing to vaccinate the world – I don’t understand, honestly….

MCKAY: On that question of vaccines, you’d also have to factor in property rights – intellectual property rights, which some countries wanted to suspend during the course of the pandemic, and a lot of the rich countries, Canada included,… said, “Hands off our property rights. We really want a profitable enterprise.”

CHRISTAKIS:  I think that’s a mis-direction, frankly. We can rely on plain old capitalism to solve the problem. When Americans in the Second World War needed more tanks and jeeps than anyone else, the government just bought them….The property-rights issue is almost a bit of posturing, by various countries of the world, on both sides of [that question].

We just need to find fifty billion dollars – which is peanuts… Just buy [vaccines] from the pharmaceutical companies. They’ll get the fifty billion – OK, that’s fine. That’s the solution, in my judgment….Even if we liberalized the IP, there isn’t the manufacturing capability around the world, the distributional capability, to do this. We have so many other issues that could be more effectively solved. In this case, I think, just let the market do its job…That will be faster in the end….    

MCKAY: It goes back to the…need for a strong government.

CHRISTAKIS:  Yes. And good leadership. And a willing citizenry. You have to come to Canadians and say, “We’re all going to have to pay more taxes. And for this reason – we’re going to vaccinate the world. It’s the right thing to do, and we’re Canadian, and we’re going to do it because we need to prevent deaths on a planetary scale.”…

MCKAY: You wrote this book in Summer, 2020,… before the ‘Great Barrington Declaration’ debate really got going in the Fall, and the mask-debate was just coalescing….  On both issues, you were up against loud voices in the public sphere, including those of fellow medical specialists. Would you agree that both debates suggested how difficult it has become for intellectuals to wade into controversies, particularly in the age of social media? Have you, yourself, personally, paid a price for taking these positions?

CHRISTAKIS:  …Not with respect to the pandemic. The opinions advanced by the people in the Great Barrington Declaration are wrong…. It’s not crazy for them to articulate those views. They’re right, insofar as they’re saying, “Look, we also need to consider the costs of these non-pharmaceutical interventions.” That’s correct… I take issue with the way they minimized some of the risks of the pathogen, and I also don’t agree with their conclusion, which is that we’d be better off having done less…

In an ideal world, we would try to keep politics out of science. (This is also an old philosophical topic, by the way: people have been talking whether science can ever be apolitical at all… for hundreds of years…). My [ideal] is that we can, to the extent possible, depoliticize it and try to  form a scientific opinion that is true to the world. Then we can have an ideological debate at that point, having formed this opinion about what is actually true of the world. Then we can disagree about what to do about that. We can fight about what’s true, but we can use the scientific method to come to some sort of consensus on that. And I think that the fantasy that this virus was just the flu, or the fantasy that this virus would just go away, was just a lie. And we now know that many of the people who were saying that, knew they were lying… They should be held to account.

MCKAY: Thank you, Nicholas, for an excellent talk and a wonderful Question and Answer Session. Thank you so much.

[Nicholas Christakis spoke to Syndemic on 24 June 2021].

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[1] Nicholas A. Christakis, Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live (New York, Boston and London: Little, Brown Spark, 2020).

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