Christian yeah, there are several. I think the most recent one that comes to mind, and probably comes to most everyone elses mind, is the 1918 influenza pandemic in terms of its rapidity, how fast it spread across the world, and its scope and span. In the 19 century the cholera epidemic would be the most, the clearest analogy. Susan we are going to have an opportunity to dig into some of those lessons of history a bit more, but when you look at the response, of course things are so much different for society now. You talk about how important it is to learn lessons from past pandemics and epidemics. What lessons have we clearly learned . Christian what lessons have we clearly learned . That is a good lesson. Im only smiling because as an historian, it is not always clear we have learned lessons from the past. The one lesson we probably envisioned most is to roll out things as methodically as possible, to Pay Attention to reliable news sources, to do our best, to hold off on blaming certain sectors of society from spreading pandemics. We are not seeing a tremendous amount of that at this time, so the clamp down on misinformation perhaps is one of the lessons we have learned that i see playing out now. That is not to say there is not misinformation. Susan the flipside of the question is, are you seeing patterns clearly being repeated . Christian yeah. The patterns i think that are being repeated are, you look at the 1918 epidemic, is the tremendous variety of responses. From within countries, from within states, within around the world. You have italy responding in one way, you have china responding in another way. That is not to say there are examples from the past where the entire world is bonded the same way. That is called responded the same way. That is clearly not the case. Its a mixture of fear, anxiety, and panic. Some examples of panic. But on the other hand, not taking things seriously quickly enough, especially in the United States during 1918, the range of responses was quite remarkable, from taking it seriously to thinking up as just an extreme version of the common cold. Susan staying with that, one of the debates people are seeing on social media, and probably still continuing today, is theres flu every year, thousands of people die from it. So what can we learn from history about the difference between a novel virus like this and the seasonal flu . Christian i think i understand the question. It seems to me that thinking analogizing, medically the coronavirus as a flu, and suggesting it is no worse than the common yearly flu, seems to me a bad idea in several respects. The flu as we know morphed into a Global Pandemic on multiple occasions. So, in my mind, actually the analogy should be more to be concerned about comparisons to the flu, rather than the reaction to be not concerned when we compare it to the flu. In other words, the flu in 1918 in particular, but the 1928 also are two of the worst pandemics in world history. Comparing it to flu in my mind is cause for concern, not cause for complacency. Susan the nih has a graph that helps people understand when things become pandemics. They include these metrics. Why geographic extension, movement, high attack rates and explosiveness, minimal immunity, novelty, effectiveness, contagiousness, and severity. All the ones we are going to talk about clearly fit into that criteria. I am wondering about the infectiousness versus contagiousness. What is the difference there . Christian well, you know, im a historian so i hesitate to answer questions that have no real medical meanings behind them. That refers to the ease which one can catch a disease. I want to leave it at that. Susan i understand. You referenced one aspect of it, the role of fear in pandemics. On a continuum i would say on one level, Public Health officials and government officials want the public to be anxious enough that they can Pay Attention but not move all the way to panic. So can you talk about the role of fear in harnessing past pandemics . Christian yeah. In every past pandemic from the black death through the plague, to cholera in the 19th century, yellow fever, etc. , fear is a clear element of every single one. And you are right, there has got to be a balance between informing the public in a way that makes them want to Pay Attention, but theres a balance of course between setting off waves of panic. You know, in the pandemics i just mentioned, cholera, influenza, and the plague, thats been an unsuccessful balance. In every single one of those there has been a quite remarkable wave of panic and fear. And it it seems to me it comes from the way people naturally react to things that are novel, fastmoving, not well understood, and that cause obviously disease and anxiety and death. In the case of all three of those fear has played an enormous role in the progress of those pandemics. During the 1918, in Great Britain theres clear examples of suppressing information to not cause fear. The same was true in italy. Susan one question, since you are currently teaching courses on the history of disease. Are there more pandemics today than there have been in history . Christian that is a good question. Honestly i have never really thought about it in that way. It is a good question, and it is difficult for me to quantify. In the book that you referred to that i wrote, pandemics a very short introduction, its a small little book. I talked about, at least from an historical professions they have Historical Perspective, the difference between pandemics like what we are seeing right now, coronavirus, thinking back to the flu, and what i talk about in the book as persistent pandemics, malaria, cholera, tuberculosis, hivaids. These pandemics, particularly tuberculosis and hiv, that by all measures, by the eight criteria you read before, are pandemics, but they are very different. They are not acute, they do not have a clear beginning and end. When you factor those in, it seems to me we are quite possibly dealing with more pandemics than we had in the past. 1918, 1900, 1850, we did not have hiv, for example. But to be honest i have never quantified it in the way you are asking. Susan one thing that has happened with every pandemic, the world has become more digitally interconnected and physically interconnected. What impact does that have on pandemics . Christian well, it is the single most important driver of pandemics since the black death, since 1347 when the black death arrived in europe. Its been very, very clear since then that the interconnectedness of the world, even at that time, from the 1340s, early 1350s, was the principal driver of getting the epidemic of plague into almost all parts of europe because of trade networks, travel networks. And that has been absolutely the case for all pandemics since. Cholera when it first arrived in england and the United States in the early 1830s, it would not necessarily have arrived with the speed it did in 1730 as opposed to 1830. So, all pandemics rely entirely on human movement. Pandemics themselves only move based on human movement. Susan and the coronavirus, we saw the first instance of it in january of 2020. There was awaiting by the World Health Organization to declare it a pandemic. I wanted to have you talk a little about the role of the World Health Organization, and how it came into being and how it functions. Christian sure. So, the World Health Organization emerged, like other United Nations organizations, in the wake of world war ii. And initially, its role has changed over the last 60plus, 70plus years. But initially it emerged as a way to deal with the clear Health Problems as a result, a, of the war, but b, as a way to start thinking about what is now called the developing world, and the way in which the developing world could meet the developed world in terms of its health infrastructure, its response to Infectious Disease and so forth. The World Health Organization initially focused on countries particularly hardhit by world war ii and then quickly branched by the late 1940 into india and southeast asia, and then subsequently into africa. And they really worked on the major diseases that were flourishing in those parts of the world, again, particularly africa and south asia. Other parts of the world as well, but focusing on diseases like tuberculosis and malaria, for example. For the first couple of decades in the postworld war ii period, the w. H. O. Was, by any measure, the principal world health authority, both in terms of research, in terms of setting policy, and in terms of setting up responses on the ground. There really was nothing else like it. There were some organizations let the medical Research Council of Great Britain that also deployed doctors around british colonies and so forth. And the w. H. O. Maintained this role as the principal driver of Health Care Policy around the world, intervention, research, throughout the 1960s, running the malaria Eradication Campaign, running the bcg Vaccination Campaign, and the Smallpox Eradication Campaign throughout the 1970s until its successful eradication in the late 1970s. Beginning in the 1980s, the w. H. O. Started to be more and more underfunded, and more competing not necessarily competing in the literal sense of the word, but world banks invested more and more in health, private philanthropies started to emerge, most recently the bill and Melinda Gates foundation. The w. H. O. Maintains its position as an of authority in terms of directives, direction, defining pandemics and so forth, but does not have the same on the Ground Response capacity or role it had in the 1950s, 1960s, and 1970s. As i said, in the last generation or so, its been increasingly less wellfunded. Susan the american Public Health agencies, do they have international status, and are they superseding the role of the w. H. O. . Christian that is a good question. The cdc, in some instances i would say yes. The nih has superseded the World Health Organization in terms of its research capacity. I think in terms of the number one leading body, when the world looks to define things like pandemic, and what should be done on a global scale, i think people still turn to the w. H. O. For that first line of advice, first line of policy direction. Susan so, i want to dig in a little more with what you have referenced. Let me start by asking a question. As an historian with a specialty in pandemics and epidemics, how did you get into this . Christian that is a good question. Originally and i still teach and write on American Indian history, and that was my first area of research. As you may or may not know, and as others may or may not know, Infectious Disease, crowdbased diseases, epidemic diseases, has had a unique effect on American Indian history in a variety of different ways over time. So in my classes i was beginning to teach more and more on Infectious Diseases amongst American Indians. But really specifically, my research has always been on the 20th century. It became clear to me as i became more and more interested in disease in my teaching, in my research areas, disease was having a tremendous impact still well into the 20th century. And im thinking about diseases like crowd diseases, really, as a result of living in poverty on indian reservations, particularly tuberculosis, the number one killer of American Indians up until the 1960s. Historians had not spent a lot of time looking at these things, more contemporary diseases. And i started seeing analogies between the experience of people in, for example, south africa or east africa, india, American Indians. Why were these kinds of populations being more ravaged by tuberculosis than others . As historians tend to do, it cascaded from there into a series of questions. I began to look at the interventions that Health Authorities were designing around tuberculosis, particularly vaccinations, antibiotics. Many of those drug regimens were tested on American Indians and then rolled out around the world. Some of the most Pioneering Research into vaccination and antibiotics was done on American Indian communities and those were rolled out across the planet. Susan a question. Do the Public Health organizations turn to people like yourself have Historical Context in helping to develop future responses . Christian you know, once in a while. I have a good friend and colleague at Johns Hopkins who has written extensively on malaria and Global Health since world war ii. I know that he has been consulted. Historians like Howard Markel at the university of michigan has written extensively in the american journal of Public Health, the american medical association, on a variety of things. What comes to mind most recently is really a classic article on the nonpharmaceutical responses and interventions into the 1918 flu pandemic that he wrote with medical doctors. Its an extraordinary article. So, historians do get involved in trying to think through how history can help contemporary Public Health responses. But you know, as i write in my book, the pandemics book, and more extensively in my tuberculosis book, there does not seem to be a tremendous appetite for learning from the past. Susan and clearly society would benefit if there were. Christian i think so, but a historian would say that. Susan let me ask, what is the earliest reported pandemic . What do historians turn to . Christian sure. So, the plague of justinian, and then the first instance of what we think, almost certainly in the 6th century, was the first instance of plague. Now, doing what is called retrospective diagnosis to determine what a disease was that occurred 1500 to 2000 years ago, in some instances, is really challenging. You have text evidence that describes diseases that sound like what we know now as the plague. But there has been some research on fossil remains, skeletal remains and so forth, thats largely confirmed this justinian epidemic was the plague. The epidemic pandemic really that historians have focused on, the earliest one that historians have focused on more than any other is the black death that arrived in europe in 1347 and lasted until 1352. Thats the one really that, when i teach, i begin there because it really kicks off this period, even though it was so long ago, of responses to epidemics that we still see, things like quarantine, fear, and so forth. Susan one of the interesting aspects of the history of civilization being related to the history of disease, you write in the book at that period of time, being ill was looked at as a punishment from god, and at some point that began to shift into understanding contagion, which then gave less power to churches and more power to the state. I found that an interesting concept. Would you talk about that . Christian sure. You can imagine at a time when Something Like the plague for example arrives in europe in 1347 let me say briefly if it is ok, that the black death really is the first instance of plague in the second wave of plague. A concentrated period between 1347 and 1352. That really defines what we think of as the black death, those years. And the plague itself remained in epidemic and pandemic in europe through the end of the 17th century, and in some isolated instances into the 18th century, before it really vanished in europe. And so over that period of time, you have the first arrival, people having no idea what is going on here, very different conceptions of how diseases are transmitted than what we have now, and they would even have 100 years hence. Also a society that largely believed in god and look for direction and how the world worked. Over time, of course, as early modern life in europe developed, god started to be replaced by science. I do not want to over characterize the classic battle between faith and religion, but you can see it played out in the ways in which people began to respond to plague. So for example, in one of my favorite books, faith, reason, and the plague, a classic of the history of epidemics. He does it all in about 76 pages. It is one of the best books you can read on how epidemics affect a small place. He looks at how when plague arrived in a small town in tuscany in the mid1630s, it was at a time when the town itself in many respects was still governed by religious authorities, and the church was the center of all social activity, to an extent economic activity, and obviously religious activity. But at the same time, italy has begun to really form a, what we would think of as a modern Public Health infrastructure. Some of the first examples of Public Health infrastructure, specific hospitals to contain disease within, placing restrictions on travel, official restrictions on travel, quarantine. And these measures being run by the state, and not by the church. And what he does in this extraordinary book, this tiny little book, is show how the forces of faith and the forces of science and reason i do not want to say that people cannot and body all those things at one time, but how churches and state authorities clashed over how to best respond to the plague as understandings of transmission began to change. An