When plagues meet: if we can learn from the past we can change the future

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Photo by Sergey mikheev on Unsplash

“I guess the last lesson I’ve learned as an AIDS activist and the hardest one to learn, is that fights are never won. They just go on and on. They are. And yet they must be fought. They must, must, still, continually, and forever, be fought. Over and over and over, they must be fought.”

Almost the final words from Larry Kramer’s updated and expanded Reports from the holocaust: the story of an AIDS activist, published in 1994. And then the book’s parting shot: “I’ll think of ways to continue to raise hell.”

He did too. The man who had enraged many gay men with his novel Faggots in 1978 continued to rage on our behalf, whether we liked it or not, for the next four decades. But in May this year, as the world paused, he let out his last breath and his roiling presence left us.

Kramer died of pneumonia, not COVID-19. Yet his passing could scarcely have been timelier nor his call to action more relevant. In myriad ways — from local lives to global headlines — two plagues have found themselves in an inescapable embrace.

As COVID-19 tightened its grip, Maggie O’Farrell, whose novel, Hamnet, is set against the recurrence of bubonic plague, reflected that perhaps, in coping with it, we are looking to ingrained history lessons about earlier plagues.

For me, as this crisis unfolded, the lens of HIV became irresistible. I returned to Kramer, to Randy Shilts’ earlier book, And the Band Played On, and David France’s remarkable and more recent volume, How to Survive a Plague. I did so in search of clues, not just about the present horror but as to what the future might — could — hold.

Forty years ago, the arrival of HIV framed our world, and those of others on the margins, but governments were scandalously slow to act. By contrast, the response to COVID-19, for all its manifest failings and glaring inconsistencies, has been urgent and global. It’s hard to avoid the conclusion that the difference is, well…the economy stupid.

It is worth remembering that it took two years to even begin to identify HIV, that it was another 13 before the arrival of antiretroviral therapy, and another decade still before PrEP became available. That there is still no vaccine. That stigma is still pervasive and that misconceptions among the public still abound. The global death toll is 32 million and still rising.

No wonder then that the discourse COVID-19 has spawned is replete with painful reminders, its lexicon relentlessly familiar. Testing, antibodies, T-cells — even the name Anthony Fauci. I could go on. None of this is new.

Such resonances we have tripped over daily. But what, if anything, can 40 years of tackling HIV tell us about our way out of this present crisis and creating a better world beyond it?

I do not have all the answers to that question anymore than anyone else. And much of what I offer here is borrowed from others, wiser than me. But on World AIDS Day, here are twelve things to think about.

  1. This plague will change us. For all the inevitable yearning from some — but not all — for a pre-COVID-19 world, tomorrow has been altered. There is no going back. Neither should there be.
  2. Some of that change will be personal. As Andrew Sullivan has reflected, just as AIDS did, COVID-19 will have far-reaching consequences for how we relate to one another — and for our sense of what really matters.
  3. What governments do is paramount. But they must work with experts and citizens. If they eschew either or both, still worse allow political considerations to override them, they will fail.
  4. This is a long game. The astonishingly speedy arrival of vaccines is cause for hope but we are a long way from out of the woods. There are no magic wands, world-beating or otherwise.
  5. We cannot control the virus. We can only control our responses to it both individually and institutionally. We cannot eliminate risk, but we can mitigate and manage it. And some will choose not to.
  6. Plagues hit the poorest hardest. The economic challenge created by COVID-19 puts the financial crisis of a decade ago in the shade. But austerity is not the solution — investment is critical.
  7. If we ignore or perpetuate inequalities of access to treatment between the developed and developing worlds, we will reap the consequences. In a globalised world, there are only porous borders for the virus.
  8. Vulnerability to plagues is man-made, not God-given. Structures, systems and processes must hardwire kindness, dignity and human rights. They are the hard edge, not the soft filling.
  9. We must commemorate those who have died. As Matthew D’Ancona has urged, we must find ways to acknowledge the scale of the loss. Memorials and monuments don’t bring people back to life but remembrance matters.
  10. We must be prepared for the next pandemic. It will come. If we have not learnt the lessons of this one by the time the starting gun goes, it will be too late. And lives will be needlessly lost again.
  11. The root cause of plagues is environmental. We didn’t invent COVID-19 any more than HIV. But we did incubate them. So to quote Mary Robinson, ‘we must make climate change personal in our lives.’
  12. As David France said in After Surviving: A Great Gift, a lot of good can come from a lot of death. But sloganising and grandstanding gets us nowhere. We must talk to each other, not ourselves— especially those hardest hit. And we must act.

This list is just that. It’s not exhaustive. It’s probably not in the right order. And there’s almost certainly a glaring omission or two. The collective trauma the virus will beget springs to mind. Whatever light exists at the end of the tunnel, plague shadows are unending. We must face that head-on.

Today of all days, it seems fitting to end where I began — with Kramer. In his speech, Some Thoughts About Evil, delivered at Yale University on December 2nd, 1993, he looked back at his activism through that first brutal decade.

“I’d always hoped my words would make a difference, that anybody who was telling the truth would and could make a difference. I’ve learned otherwise. I’ve learned that people can be left to die, quite intentionally, in this country of ours. Many different kinds of people. I’ve learnt that democracy does not protect one and all. I have learned that democracy is a sham. I have learnt that democracy protects only the straight white man with the money and the power to demand that he be protected. I have learned that everybody else is pretty much left to die.”

These words are seared with Kramer’s trademark anger. They are words from another time, about another plague, in another place. But in truth, I know that anger. I have felt it, and I’m lucky enough to count the personal losses of those years in 10s, not 100s.

You might flinch at my citation. Kramer's style was not everyone’s cup of tea. As Andrew Sullivan remarked in his obituary, he preferred reasoned dialogue to Kramer’s aggressive provocations, but both approaches were necessary.

You can argue that here in the UK, we did a lot better back then. I’m not so sure. And you can argue that here, we did a lot better this time around too. But not everyone will feel that way.

Sullivan again: “Plagues destroy but through the devastation, they can rebuild and renew.” Whether this one will — well that’s up to us. And if we really want to change the future, we could do worse than channel a bit of Larry.

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