From Spanish Flu To Trump's Handling Of Coronavirus Crisis: 'Government Intervention Can Have Unexpected Effects'

You start your book with the Spanish Flu. Why this starting point?

'Until the Spanish Flu outbreak in 1918, good health in the United States was a private matter: your own responsibility. There were welfare organisations, but the government kept its distance. This changed with the Spanish Flu when the government began to assume responsibility. More people died from the Spanish Flu than from WWI, which also affected mobilisation. There was talk about an extreme security threat.'

How did this develop further?

'The peak came in the 1930s with President Franklin Roosevelt and in the 1960s with Lyndon Johnson: a liberal period. At that time, there was consensus that, yes, the government can help the population, provide welfare, support families, and assist with unemployment. Everything we now take for granted in the USA began in a period of about thirty years. Since the 1960s, we've seen resistance to this from the conservative side of politics and the wider American society. The view emerged that government interventions actually make things worse or are about control over the population. This desire for individual choice and responsibility led to the privatisation of much healthcare. So, we're dealing with this issue again in the 21st century.'

And is that due to Donald Trump's influence?

'Trump is on the side of privatisation and sees public health as something to profit from. His role during the COVID-19 pandemic was also very damaging. You can't expect a government to get it right immediately, but Trump fuelled conspiracy theories and undermined the foundations for a governmental response. Our book doesn't specifically address Trump, but it's clear that he has no interest in regulation.

Kamala Harris, on the other hand, has long supported Medicare, an insurance primarily for the elderly. She backs the Affordable Care Act (also known as Obamacare). She supports the right to abortion, something that has considerable implications for health care. She continues the liberal tradition-the role of government to support people in need.'

So, if Trump were re-elected, you don't see things going in the right direction?

'No, absolutely not. When he was president, he wanted to eliminate the Affordable Care Act, but that failed. His last budget proposal included a provision for $800 billion in cuts to Medicare over ten years. This is someone who has no respect for its purpose, namely helping the elderly.

The push to privatise healthcare is something people outside the US should consider carefully. Just look at the developments over the past forty years in the United Kingdom. With an ageing population, more and more money is needed.'

The book covers various diseases, with multiple authors contributing. Which chapter do you find particularly interesting?

'The chapter on AIDS and reproductive rights, written by Emma Day (Oxford). In the 1980s, it became known that if you were a pregnant HIV-positive woman, there was a high chance you would transmit HIV to your child. You saw a conservative focus on female reproductive rights: you should consider abortion. Which is, of course, odd, because conservatives are usually against it. But they also favour social control. This is a good example of how a government responds to a health threat with prejudice.

There's always an inherent bias regarding gender, ethnicity, and social or economic status. If you look at groups that spread diseases more quickly, you end up with areas where people are often from a minority group, have low incomes, poor nutrition, and poor air quality. If they pose a health risk to others, you want to restrict them instead of helping them out of that situation, say the conservatives. So those who are already suffering, suffer even more. That's where it goes wrong.

So don't assume that when the government acts, it always does good or achieves its intended goals, because of this built-in bias. But there are also enough examples where nothing was done, and it turned into chaos, like with COVID and Trump. The book shows how government intervention can have unexpected effects-or causes.'

Can you tell us more about that?

'The Americans focused for a while on eradicating smallpox and malaria in Africa. That's seen as something good. George W. Bush supported an anti-AIDS campaign in Africa, but he was motivated by concerns about population growth, migration, and protecting the US from external threats: a double dynamic.

Helping another society-that's something the US did, and people got used to it, until COVID. The global leader was not visible, and China stepped in, offering free COVID vaccinations and building positive relations in Eastern Europe, especially in Serbia. Now there's a new dynamic, with China included.'

But COVID came from China?

'Yes, and they never helped in the process of finding out what exactly happened.'

Still, you just mentioned that they tried to help other societies around the world.

'I think they realised there was a PR disaster, so they wanted to take control of the narrative. And they did, for instance by distributing worldwide the free Sinovac vaccines. There was also a campaign to spread disinformation, such as claims that democracies were particularly ineffective in responding to the virus, as if autocratic regimes were much better, something that was completely untrue. The source of the virus was also queried. The market in Wuhan is now gone. Removing what happened or imprisoning doctors who revealed the truth about Chinese hospitals is not the answer. It is better to acknowledge that transparency is the best possible option to prevent further outbreaks in the future.'

Giles Scott-Smith would like to thank his co-authors: Gaetano Di Tommaso and Dario Fazzi.

Text: Magali van Wieren

Images: iStock, Arash Nikkhah