What we can learn from the history of epidemics

Part 1: History of the pandemics

Howard Phillips on how pandemics shaped South African history

My original interest was in the 1918 Spanish flu but after I taught a course at UCT on epidemics to history students, I wanted to expand my knowledge. The best way to know something is to teach it and  to write about it, so I wrote a short book, Plague, Pox And Pandemics: A Jacana Pocket History of Epidemics in South Africa, where I looked at five major epidemics in South Africa’s history.

The first one, smallpox, occurred in South Africa at the beginning of the 18^th century. It was a devastating disease. It gravely affected not just colonists and slaves, but also the indigenous Khoi community. It was as if a bush fire had swept through the Khoi community. Three major outbreaks in 1713, 1755 and 1767 effectively ended the ability of that component of the indigenous population to survive as a distinct, independent community. They had initially posed a challenge to the Dutch settlers but the disease soon decimated them. The same was true in  the Americas when settlers came there from Europe because they brought with them infectious diseases unknown across the Atlantic. Locals had no immunity to these diseases which  decimated the indigenous population. The question that many historians often ask is, how did a small number of settlers conquer and dominate a much larger local population in Latin America which included the powerful empires of the Incas and Aztec? The main reason is because of  their low immunity to these diseases. In South Africa, a similar process occurred in the 18^th century, with the Khoi being the locals who were decimated by diseases like smallpox which, consequently, contributed significantly to shaping the early South African colonial society.

The second epidemic I looked at was bubonic plague. At the end of the 19^th century, the  bubonic plague hit South Africa as part of the world-wide pandemic that started in China in 1870. At the beginning of the 20^th century, the South African War was underway.  Bubonic plague was carried by fleas on rats in grain brought in to feed horses of the British cavalry. When these rats died, it then spread to the human population via fleas. This disease was not as big a killer as smallpox, but it caused fear across the world because of its association with the Black Death of the 14^th century. The authorities responded by asking: “Who is to blame? Who is bringing it here? Who are those that are the carriers?” This search for someone to hold responsible is a pattern true across history at all times, at all places. Fingers are often pointed to  a group of outsiders, a minority, or those who are different. In 1901, that was black Africans in Cape Town. As a consequence, they were forcibly removed from District 6 to a site out on the Cape Flats. That was the beginning of the residential segregation of Africans in Cape Town. This was followed by racial segregation of Africans in Port Elizabeth, in King Williams Town, and in Johannesburg. That epidemic of bubonic plague, even though it was not a big killer,  gave the authorities the opportunity to undertake residential segregation. From that flowed the subsequent creation of separate African townships, on the fringes of South African towns, for Africans. They were forced to settle there by law.

The third epidemic is the Spanish flu of 1918. The Spanish flu was another disaster for South Africa. In a span of six weeks, South Africa lost 5-6% of its population. It is a stunning figure. About 300 000 to 350 000 people died in the course of 6 to 8 weeks. It was part of a worldwide pandemic. What is particularly unusual is that it killed young adults more than any other section of the population. Usually, influenza is a big threat to the very young and the very old because their immune systems are still developing or beginning to wane. However, in 1918, young adults, between 18-35 years old, died in their thousands, which meant that many parents of young children died, making many children orphans. In a matter of weeks, sometimes days, orphans were created on a scale that was unprecedented. How does a society deal with that? As  a result of the Spanish flu many children lived their lives without one or both parents. To me the most poignant illustration of this came in an interview in 1998 with a man who was born in 1908 and who lost his mother, when he was 10 years old, during the Spanish flu of 1918. I spoke to  him when he was almost 90 years old and he said to me: “My mother died in the Spanish flu of 1918 and I have missed her ever since.” The emotional, psychological effect the Spanish flu had on that man for the rest of his life, as well as on the other millions and millions of orphans created in the world by this epidemic, is  one of its longest lasting consequences. One cannot measure sadness, one cannot measure bereavement, but both clouded the lives of many millions around the world for the rest of the 20^th century Another consequence of the 1918 epidemic was that the authorities realized that  South Africa lacked a central public health system that could deal with such an epidemic. As a result, within months, South Africa passed legislation to set up a department of public health. This was established in 1919 and was the beginning of the current public health department.  

The 4^th pandemic that I looked at was polio in the 1940s and 1950s. Polio is a very unusual disease. It does not kill in vast numbers, but attacks the nervous system and can cripple people for life, rendering them unable to walk. One of the greatest fears was that young children would be crippled for life. What is very unusual is that, unlike most epidemic diseases,  polio poses the greatest risk to middle-class children who had not been exposed to it before because of the sanitary environment in which they had been reared. For South Africa, in the early apartheid era, this meant it was mainly white children who were infected. This was an enormous source of anxiety to the all-white government as it raised a question about the future of the white race. The fear was that if children were being crippled, it was going to be difficult to  produce a healthy next generation. The threat of polio led to enormous mobilization of resources and collection of funds to find a cure. In the 1950s, teams in the United States developed an effective preventive vaccine. As a consequence, children were automatically vaccinated against polio. In South Africa, from the 1960s onwards you would rarely see any new cases of polio.

Finally, HIV/AIDS began in South Africa from the 1980s and it is still underway today. It is a different type of epidemic. It is not a rapid, sweeping epidemic like coronavirus or the Spanish flu. It is a slow moving pandemic. Unlike other pandemics in which you die quickly after being infected, in the case of HIV/AIDS it can be up to six to eight years between infection and death. People who are infected become a long standing responsibility for their families. Moreover, from 2008 the growing roll-out of antiretroviral therapy began to reduce the number of new infections. For the last 30 years, HIV/AIDS has had a major impact on the population. Like the 1918 Spanish flu, AIDS created many orphans and the implications of that are enormous. Grandparents had to look after their grandchildren because their parents had died from AIDS. In some cases, young children as young as 10 years old had to look after their younger brothers and sisters because their parents had died, which is a disastrous social situation.

Those are the five epidemics looked at in Plague, Pox and Pandemics: A Jacana Pocket History of Epidemics in South Africa. In each case they have been a major shaper of South African society.

Patterns across pandemics

In many cases, the initial response of the government and those involved in the economy is denial: “Don’t worry, this has been exaggerated, it is not so bad”. During the second phase is that it is no longer possible for government to continue denying what is going on because cases are escalating, and people are dying. Therefore, the response is emergency mobilization to  get resources up and running. I think that is where we are in South Africa at the moment with the Covid-19 pandemic. At first, you see if there is something that can actually treat or even cure the disease. Since we have neither a cure nor a preventive vaccine, we have to go to a very old response to infectious pandemics: quarantining and social distancing. You try to keep people away from each other because that is the way you think you are able to protect yourself and your family. We do not really know how widely the South African population is affected, but the virus continues to spread. The majority of South Africans, particularly the urban population, live in overcrowded homes with poor hygiene and living conditions that make social distancing an impossibility. In such conditions the virus can spread easily and quickly. That is one of the reasons why I think the government is so desperately trying to contain the pandemic. We have also seen cooperation and collaboration between individuals and communities.