The Preventable Return of Deadly Diseases

26:35And there was a lot of hard work to build trust. Exactly. I mean, Elvis is such a great example. What is that about? It's about building trust and reminding people that there's a lot of very serious, thoughtful expertise that goes in to trying to develop safe medical interventions and that we're in it together. That's why there has to be trust is because we breathe the same air, we share the same space and the decisions that we make don't just affect our own health. I was thinking about you and your work and your especially work on Rome. The day before I record this interview with you, I was at a farmer's market with my wife and we're wandering around and early September in Washington, D.C., a semi-tropical city.

27:19And I was saying, you know, I was quoting to her, your observation that the ancient city of Rome produced a hundred thousand pounds of human feces every day. And here we are in this market and there are no flies. and there are no flies because all the meat products are carefully wrapped the fish products are carefully wrapped people who touch meat and fish touch them through um what the wrapping around the product but also the plastic gloves on their hands and while there are fruits and vegetables that in the plain air again that they are they are under regimes that keep them protected and there are no flies and they're and and uh and we'll all of course when we get at home wash it again anyway.

27:57But this is a series of layered defenses, the product of human practices and human insight and human wisdom. And maybe the people who have the meat or the fish in plastic don't exactly understand how microbes work, but they do know you shouldn't have meat or plastic out in the open air, meat or fish out in the open air. Exactly. I mean, that's a great example of how the scientific understanding then works its way into our daily lives and to habits that we don't even necessarily think about. But that was a process. I mean, that took time. And it didn't just happen spontaneously. It happened because reformers promoted knowledge.

28:38You know, the fly is a great example. People came to realize that flies are vectors of disease. And there were massive campaigns, including by the Boy Scouts, to educate people and to try and control diseases. There's a technological element of it. You know, the windows in my house have window screens that were the product of engineers who figured out how to let airflow out, but not little bugs. And there's a government role. And, you know, our food safety cultures are the product of science and society, but also of smart public regulation that makes sure that, you know, we on a daily basis. You said something I want to pick up on because I think it might have gone by some listeners and viewers too fast.

29:29And it's an unusual concept, so I want to strike it. You referred to diseases being old or new. You pay a lot of tribute to your great predecessor in this field, William McNeil, who wrote a book 50 years ago called Plagues and Peoples. And one of the unexamined assumptions of that book is the diseases we have today are the diseases we've always had. and if you pull up a caveman grave you don't find them sick of these diseases he would say is because well the populations were so small the densities were so light that they couldn't communicate the disease one to another but the disease was there lurking just waiting for cities and with the benefit of more modern investigative techniques half a century later you point out that some diseases are old some are new and they're constantly changing that so the smallpox as we know it was not the smallpox that would have hit previous generations of human beings.

30:18Yeah, exactly. You're right. It's worth slowing down over this, that our disease pool, so the hundreds of bacteria and viruses that are adapted to try and take advantage of human hosts, are a product of our own history. And if you went back 10 ,000 years ago, sort of at the transition from hunting, gathering to farming, there's a very different disease pool. Now there's always been infectious diseases. Humans have infectious diseases, just like other animals. Chimps are closest primate relatives. They have infectious diseases. But actually if you start, it's a, this is kind of a revealing comparison.

30:56The human disease pool is much worse than the other great apes. And the reason why is because of our history, how we live. We domesticate animals, We build trade networks. We build cities. And the microorganisms that cause disease take advantage of that. And particularly because of sort of advances in our ability to sequence DNA, we've come to start to get a much richer picture of the evolutionary history of our pathogens. And one of the headlines is just that a lot of the big diseases of human history were not there in the Pleistocene and the Ice Age when we were hunter-gatherers. They evolve, they adapt, and they constantly adapt.

31:39And so we control one disease, but then another is going to pop up. But I also would emphasize too that, you know, we can, if we can never completely win this war, we can control the situation if we use all of the tools at our disposal. And that's why the average human life expectancy has more than tripled in the last 200 years. It's an amazing, it's the greatest accomplishment in the history of our species. It's a technical, social, medical miracle of enlightenment, of science, of wise policy. We have tripled the average human life expectancy because we've controlled infectious diseases, but we can never declare victory because they'll keep evolving.

32:21And one of the most important drivers of that tripling of the average human life expectancy is the sharp decline in child mortality. when when people say uh we did fine before i don't think that is how heart-rending the life of the typical human being was before the modern era that you just everyone buried children you describe the story of the roman emperor mark mark mark mark aurelius he and his wife had 14 children to outlive their parents you say i mean sometimes modern people say well maybe the ancients didn't love their children as much and didn't get as upset they were just they were just used to this constant heartbreaking, they had to adapt to it.

32:58But liberating human beings from that horror where so many children died before the age of one, so many more died before the age of five, the chance of reaching age 18 was already put you on the lucky half of human life. Yeah, that's right. And you made this point that sometimes historians have said that people in the past had different attitudes towards their children. And I'm sure there, of course, there were differences, but whenever we have sources, you know, they loved their kids. Like we love ours. I was just reading some of the letters of John Evelyn, who's a really interesting English scientist, the late 17th, early 18th century.

33:37This isn't that long ago. And, you know, he talks about losing, losing his kids. And so what we know is now infectious disease. And he says, here ends my joy, right? These people were, were broken by this heartache and trauma. They had to go on, but that didn't make it less horrible at a human level. And the burden of infectious diseases falls disproportionately on children. Their bodies are developing immunity. They're developing hygiene practices. As a father of four, I can tell you that's a process. And their bodies have to learn to fight off infections, but they're vulnerable. And in the past childhood was simply a gauntlet and a much smaller portion of children came through it.

34:22Let's talk specifically about measles because for some reason, and I can't follow the trail of crazy that produced this outcome, but the measles vaccine is the one that seems to have most attracted hostility from the crackpot element of society. Tell us a little bit about what measles used to be and the story of how it was overcome. And if you want to speculate, Maybe as a historian, you don't, but if you do, why this vaccine is the one that the crackpots hate so much? Yeah. So measles is a remarkable infectious disease. It's viral. It's caused by RNA virus that is the most contagious disease we know of, which is quite remarkable.

35:03It's a respiratory disease. So if a person infected with measles walks into a room of unvaccinated people and coughs, there's a higher risk that those people will get infected than any other disease we know. It's really, really contagious. It's kind of an old disease. It depends on your perspective. It's only 2 ,000, 3 ,000 years old. It evolves to adapt to humans when we build big cities. Because it's so contagious, it has to have big populations. it's a pretty severe disease that can be extremely severe if your immunity is weakened and this is also like really characteristic of the disease and i think it's critical to your to your question about why does this draw crackpots measles is so contagious it became basically ubiquitous and it's a disease that if you're healthy if you're an affluent kid with good food and and care, you're almost always going to be okay if you get measles.

36:02If you're nourished, if you're not co-infected with a bunch of other things, the mortality rate for measles is pretty low. That doesn't mean it's not zero. But if your immunity is compromised, if you have other infections, if you're poor and hungry, if you're in any other way compromised, measles can be really dangerous. And so we wanted a vaccine against measles. We worked hard to develop one in the 50s against 53. A measles vaccine is brought out. And it becomes part of the compulsory vaccination schedule because it's a relatively severe disease in all people and very dangerous for the vulnerable.

36:43And measles vaccination becomes almost universal. Now, measles is also, So it's interesting, too. It's a it's an RNA virus that doesn't it can't mutate quite as much as other viruses because it's so well adapted to what it does. And so it's very stable and the vaccine is very effective. It's one of the reasons why you can usually get a measles vaccination as a kid and it's going to last for decades and decades. Once you build antibodies to it, you're you're pretty safe. So we were winning against measles big time. In fact, smallpox is the only human pathogen that we've driven completely to extinction.

37:24It's gone. There's no naturally occurring smallpox anymore. Measles was sort of on that path. We'd completely eradicated it from the United States. And then anti-vax sentiment started to kind of latch on to this particular vaccine. There's debunked non-science that sometimes is invoked. But I think it has to do a lot with the fact that measles, the biology of it makes it extremely differential in its effects. If a healthy kid gets measles, they're probably going to survive. Not always, but 98%, 90 % of the time. But it's a vaccine that you get because of its protection of society. It's so contagious that if you get measles, you're going to spread it.

38:14And no vaccine is 100%. I want to emphasize that. No vaccine is ever 100%. The immune system is too complicated. The measles vaccine is extremely effective. And it's a vaccine that you get not only to protect yourself, but to protect the herd. And in a polarized society where we have deeply individualistic values, the idea that you would receive this medical intervention because it protects the broader society has become an argument that doesn't seem to have the purchase that it used to. it should. We had measles gone from the US. We could get rid of measles globally if we had the political willpower.

38:58We were on the path to send it the way of smallpox, but now it's back. And so it's like a virus that exploits the pathologies of our society almost. You talk about how the pathologies of our society, which includes social and political pathologies, make us vulnerable. And one of them is that modern Americans seem to value protection for themselves, particularly their children particularly. But when you say, look, you're actually doing this to protect others, they say, well, then why would I bother? And we saw that, I think, very much during the COVID-19 debate, where COVID did not present that much of a threat to healthy middle-aged adults.

39:33It presented a very large threat to older people. And the question was, how much should healthy middle-aged adults circumscribe themselves for the benefit of older people? And there was a considerable voice in our society that said zero, nothing. Yeah, that's right. And I mean, I like to point out that the COVID-19 pandemic was not very dangerous to healthy kids. And the biology behind that shaped the entire perception and social response, right? I mean, I think there will be another pandemic. If a pandemic affects children, heaven forbid, the whole attitude of our society will be shaped by that.

40:12And our response to COVID very much was shaped by the fact that it affected different groups. And look, I think we need to have candid conversations about this too, right? I don't think the response to COVID was in any sense an A, but it did. It affected kids in school. It affected parents with hourly wage jobs, different from people with salaries, big companies, different from little companies. These are hard questions. They're hard on a good day. They're hard when you have an honest approach to the science and the political trade-offs. And they're just impossible when you're pretending bunk science is real and when you don't have trust in a society.

40:53Well, I was struck again, to cite your Roman book, by, again, the eternal human ability to focus on what we care about in the face of things that we don't understand. And as the Roman world became more and more swept by pandemics after about the year 200, that the Romans argued, well, was this happening because they were neglecting the old gods, or was this happening because they weren't switching fast enough to a new god? And from a modern point of view, it says, you know, Jupiter's Jesus, it's not going to make a lot of difference in the face of smallpox or bubonic plague, but they believed it did, and they had these intense arguments about who is to blame, the adherence of the old religions or the promoters of the new religion.

41:34Yeah, I mean, the very first scene in Western literature is in Homer's Iliad, and the god Apollo has sent a plague. I mean, these are very deep human ways of responding to disease. It's, you know, particularly in a world where you don't have germ theory and you don't know about microbes, you look to blame something or someone. And it sort of speaks to a deep human tendency to moralize diseases that we need to try and understand with the cool enlightenment reason. Well, let's finish by talking about how we understand and how we respond, that modern societies have built these institutions of public health and scientific research that have become increasingly internationalized.

42:24And scientists form a kind of global fraternity, and they often share information. As repressive as China has become, Chinese scientists shared information as they discovered it about the shape and form of the COVID-19 virus with their Western counterparts. and there are these largest large systems of infrastructure i think a lot of us tend to think those institutions are always there have to be there can't be damaged by human choice but we have seen in just the past few months an unprecedented degree of damage done to these institutions without going into politics can you talk about modern medical research as a human social achievement how it was built how it could be vulnerable yeah i mean it is an institution It's an institution in the sense that it was built by lots of people, lots of hard work over many, many years.

43:17It has purely sort of philosophical dimensions. I mean, I mentioned Jenner and in my book on infectious diseases, I talk about Jenner a lot because he his career sort of embodies the best of the 18th century enlightenment and its empiricist foundations. Right. He doesn't say, trust me, this works. He sets up experiments. And if you read his his book on vaccination that sort of announces it to the world, it's just a series of case studies. And science is a human enterprise. It's not perfect. It's why we set up institutions to reinforce our best tendencies to check one another. And the kind of empiricist spirit of don't trust me, let's verify this very carefully is sort of at the root of it.

44:06And we try and then put together systems of institutions that draw out our best, that mobilize our greatest weapon is our ability to innovate, to come up with solutions and to work together. And science is a human institution. And in particular, the medical science in America is a crowning glory of this country. It was created deliberately and particularly by massive amounts of investment in the 1980s and 1990s that were scaled up in order to try and conquer the things that make us sick and that shorten our lives and have done immeasurable good, not just for America. but ideas spread and they've done tremendous good globally.

45:00I think when historians look back, they'll say, this is one of the things we did really well, that we did right. We invested. We research diseases that hurt people here. We research diseases that hurt people globally, like tuberculosis, partly because we care about humanity, partly because we know that our health is all intertwined, that if tuberculosis lurks in other populations, it's going to evolve, it's going to adapt, and that can come back and hurt Americans. But now the scientific enterprise, the institutions of science within universities and beyond have been swept up in the polarization of our society.

45:41And that's not just tragedy, it's going to have real world impacts. And I think we all have to try and step back and say, we need to recognize the importance of these institutions that are not in any way meant to belong to one side or another in our political wars. They need to be neutral ground. And it's very hard. The problem politically is that it's very hard to know where the price is paid, but it will be paid. The COVID pandemic was brought to bay by mRNA vaccines. Those depended on huge investments in basic science upstream 10, 20 years in advance. And so it'll be very difficult politically in 10 years, 20 years to say that this is happening and it didn't have to happen because we didn't have to undermine the NIH and the CDC and so on.

46:37But we need to have long-term thinking. We need to recognize the importance of these institutions, their neutrality, and really take pride in what they've accomplished and what they still are going to accomplish if we believe in them. Because the next pandemic is coming, as you say, and when it comes, it will be more or less catastrophic according to how well prepared we were, both scientifically and also socially. And this is a year in which we don't look very well prepared in either dimension, and let's hope we do better in the years ahead. Yeah, exactly. the, the, it's a sad fact we're less prepared today than we were for, for COVID-19.

47:14We don't know when the next pandemic will threaten us, but we know that it will, it will come someday. Kyle Harper, thank you so much for joining me today. Thanks, David.

47:32This podcast is supported by Anthropic, the public benefit corporation behind Claude. Everyone's got a hard question about AI. Your job, your kids, where it's going. Anthropic was built to surface those questions and share what it finds along the way. Because there's hope in hard questions. Ask yours at claude.ai slash Spotify and keep thinking. That's claude.ai slash Spotify.

48:03The perfect lunch combo. That first bite of your favorite sub followed by ice cold Pepsi. Add a couple of friends and now that's next level. Suddenly the laughs get louder, the stories keep flowing, and the food tastes better. Because Pepsi brings out more flavor, more fun, and more of the moment. Food deserves Pepsi. Grab a Pepsi Zero Sugar today. Thanks so much to Kyle Harper for joining me today on the David Frum Program. Remember, if there are young people in your life, please be sure that they are properly vaccinated. And take care of yourself too. It's supposed to be a tough flu season this year.

48:39Make sure you have your flu shot and your COVID booster as well to protect you and those you care about. As promised, I'm going to end this segment with a discussion of a book. Last week, I talked about Mary Shelley's Frankenstein. This week, I'm going to talk about a work of political philosophy. I'm driven to this work by the recent tragic events in the country, The assassination of Charlie Kirk and the really dangerous reaction we have seen in many, many quarters to that terrible crime. I'm going to quote something. You've probably heard it before, but Robert Kennedy's words the night that he heard that Martin Luther King had been assassinated.

49:15This may be one of the greatest improvised speeches in American history. Robert Kennedy was in Indianapolis. He himself had only a couple of months left to live. He didn't know that, of course. He was going to be assassinated in June of 1968 when Martin Luther King was assassinated in April. Kennedy was talking to a group of his supporters who have mostly, if not overwhelmingly, African-American. The mood was one of tremendous anger because it was already clear that King had been assassinated by a white racist for white supremacist reasons. I want to quote the key passage from Robert Kennedy's speech.

49:48For those of you who are black and are tempted to be filled with hatred and distrust at the injustice of such an act against all white people, I can only say that I feel in my own heart the same kind of feeling. I had a member of my family killed, but he was killed by a white man. But we have to make an effort in the United States. We have to make an effort to understand, to go beyond these rather difficult times. My favorite poet was Aeschylus. He wrote, in our sleep, pain which cannot forget falls drop by drop upon the heart until in our own despair against our will comes wisdom through the awful grace of God.

50:25And Robert Kennedy continued, what we need in the United States is not division. What we need in the United States is not hatred. What we need in the United States is not violence or lawlessness, but love and wisdom and compassion toward one another and a feeling of justice toward those who still suffer within our country. Now, that's not the tone we from the present leadership of the United States, not remotely. What we see is an incitement of the hatred and division that Robert Kennedy warned about. And that's the inspiration, that presence of that mood of division is what inspires my book Choice this week.

50:59The book I'm going to talk about is a book by a German philosopher named Carl Schmitt, and the book is called The Concept of the Political. Now, Schmitt wrote many books quite rapidly over his enormously long life. He lived to be age 96. He was born in the Kaiser's Germany. He lived to see Helmut Kohl be chancellor of Germany. But the concept of the political is his most important book. And I read it in a reading binge this spring. I read a lot of Carl Schmitt this spring because Schmitt is an increasingly important person in the MAGA world. And unlike a lot of influences, which are kind of indirect and people don't know who the influence is, people in MAGA world are quite conscious of the influence of Schmitt upon them.

51:35So let's talk about him and understand what is going on here and how this book written almost a century ago matters so much to our time. Now, Schmidt benefited. Schmidt was born, as I said, in the Kaiser's Germany. He served in the First World War in a non-combat role. So when the war ended, he didn't understand why Germany had lost, and he felt the bitterness and betrayal that so many Germans did. And his politics turned increasingly on a dark path. In the 1930s, he would end up a supporter of Hitler and a court philosopher in the 1990s. But he lived long enough, as I said, he lived to be 96, to see his ideas taken up by post-liberals of the left and right.

52:14He became quite popular in the 1960s with a certain kind of leftist because Schmidt's first idea was to reject what he called liberalism, what you would call democracy. And he argued, the problem with liberalism is it's all negotiation. I'm going to quote him a little bit. It's a cautious half measure in the hope that the decisive bloody battle can be transformed into a parliamentary debate and permit the decision to be suspended forever in an everlasting discussion. Now, it's true. People who are liberals and Democrats prefer everlasting discussion to bloody battles. Schmidt thought that was all wrong.

52:45Schmidt's most famous thought, and it's contained in this book, the concept of the political, compiled from lectures he delivered in the dying days of the Weimar Republic, was this. There's a fundamental question about the study of politics, which is, what is politics? What's it for? What's it supposed to do? And there's an answer, an ancient answer that goes all the way back to Aristotle. Politics is the study of how human beings live together in communities. And the work of politics is to find the best way to live in a community. Now, some people might say the best way is to live in accordance with the will of God.

53:15Other people might say the best way is to live in equality. Other people might say the best way is to maximize liberty. but that's what politics, according to Aristotle, is the study of how we live together in communities. Karl Schmitt said that is all wrong. That's all wrong. Aristotle's wrong. Politics is not the study of community. Politics is the study of enmity, the study of hatred. That is the essence of the political. As he says in his book, the specific political decision, sorry, the specific political distinction to which political actions and motives can be reduced is that between friend and enemy.

53:50Now, he's not talking here about friend and enemy as in foreign friends and foreign enemies, that the politicalists, that Germany decides, will it fight France? Will it fight Poland? Both? Neither? You know, the idea that war and peace are prerogatives of the sovereign, that's an ancient idea. No, he was saying something much more powerful, much more potent, much more dangerous, much more dark, which is the essence of politics within a society is deciding who in that society is friend and who is foe, who is inside, who is outside, who is enemy, who is to be hated, and who is to be prized. Not just across borders.

54:23This is not the power to make war. This applies within the national community, the power to decide that some people are enemies of the community, to be treated as enemies, to be potentially murdered. That is the essence of the Schmidt idea. And that was the teaching that the Nazis, they didn't need him to give it to them, but that he, the kind of rationalization and justification that he gave to Nazi power and made him the person whom the Nazis looked to, to write a constitution if they'd ever gotten around to finishing the constitution they contemplate. Politics is the art of inciting hatred by some in the community against others in the community.

54:55And you can see that that concept of the political is one that the president and the people around him are acting on. That is their politics. And one of the things that is really striking about Trump is how completely random and even nihilistic it is. Trump can be on any side of any question. Trade, he could change his mind tomorrow. It's quite arbitrary that he's for Ukraine and against, for Israel and against Ukraine. Could do it the other way around and his people would follow him. He's been on every side of the abortion issue. He's been on every side of the gay rights issue. I will live, I think, to see him flip-flop even on immigration.

55:27He's backing away now from this imprisonment of 300 Korean engineers and he's now sort of semi-apologizing for it or coming as close as he ever does. Trump can be anywhere. The one thing that he is consistent about is his method of politics. And that is the division of the society, the creation of enemies, and the use of those enemies to rally people to be his supporters. And this is an idea that maybe has been, look, it's every divisive person's pattern of behavior in any kind of social situation. But to turn this into a theory of politics and a basis of politics, to use it as a way to justify the kind of politics that we've seen, that is Carl Schmitt's distinctive contribution.

56:09When you see people on the Magalrights citing Schmidt, because he's German, because his language can often be quite dense, because he wrote books full of very abstruse words, that the malignity of what he's saying is easy to overlook for those who don't actually read the books. and it's kind of surprising when you read the books and encounter the malignity to realize there are people who read these same books as I read this spring and reacted not with horror but with wide open discovery. This is how to do it. What we've seen in recent days in the United States is a kind of imperviousness to information on the part of those who wish to be aggrieved and that is what we are seeing now.

56:50The playing of the victim to justify aggression, the invention of enemies in order to live in a perpetual state of enmity, and the invocation of threats to justify the overturning of the system of liberal democracy that protects us all. When you hear the president speak, when you hear the people around him speak, you're hearing the words of Carl Schmitt. They're not very nice words. They're not words that it is a pleasure to read, but they're words we need to know and understand and to reckon with, because some of those powerful thoughts of our species are some of the worst thoughts of our species.

57:23Thanks for joining me today on the David Frum program. Thanks to Kyle Harper again for talking to me about the history of infectious disease. Thanks to all of you for watching. I hope you will like and support the program and any platform you can use it, whether you watch or whether you listen. And as always, the best way to support the work of the show is by subscribing to The Atlantic to read my work there and all of my colleagues. I hope you will please consider doing that. See you next week. Thanks for watching.

58:12This episode of The David Frum Show was produced by Nathaniel Frum and edited by Andrea Valdez. It was engineered by Dave Grine. Our theme is by Andrew M. Edwards. Claudine Abed is the executive producer of Atlantic Audio, and Andrea Valdez is our managing editor. I'm David Frum. Thank you for listening. Hi, Ryan Reynolds here for Mint Mobile. Are you looking for a beach read this summer? May I suggest your big wireless bill. It's got suspense, mystery, a slightly flat emotional arc, and a shocking twist where you realize you've been overpaying the entire time. Fortunately, though, Mint's story is better.

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