The 20th century saw an unprecedented reduction in dying from infectious diseases. It became the norm that most people in the Western world would live into their eighth decade or longer. Accidents, rare diseases, murders, and suicides do still claim the lives of young people, but such events are seen as tragic and unnatural. Death itself has increasingly been banished from public life, confined to specialized institutions like nursing homes and hospitals. For many people in affluent countries, it’s now almost possible to live as if death didn’t exist.
The germ theory of disease provides us with an elegant model for medical progress. It suggests that every disease might have a discrete cause which can be isolated and attacked, and that doing so will cure the patient. The scientific study of microbes first started in the 17th century. In 1796 germ theory started to show practical benefits with the invention of the first smallpox vaccine. In the 1920s, antibiotics were invented. The success of penicillin during the Second World War inaugurated a new era of optimism about the power of pharmaceuticals to end disease. Government funding for medical science greatly increased after the war, leading to new success stories like the vaccination campaign that virtually eliminated polio by the early sixties.
These medical breakthroughs were accompanied by post-war prosperity and the flourishing of a mass consumer society in the West. In his 1967 book Society of the Spectacle, the heterodox Marxist Guy Debord described the world created by advertising as one in which “it is strictly forbidden to grow old”. The Baby Boomer generation came of age at a time when pop culture was creating a new value system. Youth ceased to be a transitory stage, instead becoming the telos of life itself. Of course, this value was not literally attainable. A generation raised on youth culture would eventually grow old and die just like every generation before it. The collective crisis of having to die might be delayed but couldn’t be avoided entirely, as we would see with the Covid-19 debacle.
In 1967, Guy Debord described the world created by advertising as one in which “it is strictly forbidden to grow old”.
The fact that more people were living longer in the post-war era also meant that more were dying of diseases of old age. Many then came to think that even these diseases, particularly cancer, could be conquered in the same manner as infectious diseases earlier in the century. In 1971, Nixon declared a war on cancer. This meant a major mobilization of money and scientific resources comparable to the Apollo Missions or the Manhattan Project. The War on Cancer inherited the institutional biases of government-funded science. The vaccination campaign against polio had empowered virologists. Many thought their skills could be used against cancer as well, as it was believed that retroviruses turn normal cells into cancer cells. But it was not to be. Germ theory had met its limits. To this day, the cause of cancer remains mysterious.
AIDS, the world’s most political disease
In the last couple of decades of the twentieth century, a new plague came to grip the public imagination. The US’s Center for Disease Control first used the term Acquired Immune Deficiency Syndrome in 1982. AIDS was not a disease like other diseases. As a syndrome, it encompassed an array of different conditions. The clinical presentation varied from patient to patient and location to location. In San Francisco, AIDS was likely to show up as skin lesions, whereas in central Africa tuberculosis or severe diarrhea might be called AIDS. All these diseases were said to be united by having a single microbial cause, the Human Immunodeficiency Virus (HIV).
The discovery of HIV was announced at a US government press conference in 1984. HIV was a retrovirus like the ones that had been investigated for cancer. Indeed scientists who started their careers researching cancer then took over the fight against AIDS. At the press conference, the US Secretary for Health and Human Services, Margaret Heckler, was optimistic, going so far as to predict that a vaccine would be available within a couple of years. This proved wide of the mark: forty years later there is still no HIV/AIDS vaccine.
At the 1984 press conference, the US Secretary for Health and Human Services Margaret Heckler went so far as to predict that a vaccine against AIDS would be available within a couple of years.
It became conventional wisdom that AIDS was a contagious disease caused by a single infectious agent that potentially anyone could catch. At the time of the press conference, most cases in the US were among homosexual men, but throughout the eighties, the media kept predicting that it was only a matter of time before AIDS spread to the general population through heterosexual intercourse.
Amid this media-generated hysteria, few seemed to notice that AIDS did not behave much like an infectious disease. In the US, the epidemic largely stayed within well-defined risk groups – chiefly promiscuous homosexual men and intravenous drug users, as well as hemophiliacs and other frequent recipients of blood products. None of these groups could fairly be characterized as healthy, even before catching HIV. Regardless of any particular pathogen, their bodies’ ability to fend off infections had already been weakened. An HIV infection could thus be seen as a consequence as much as the cause of a compromised immune system. AIDS is perhaps a more complex disease – or constellation of diseases –than a monocausal germ theory would allow.
AIDS is perhaps a more complex disease – or constellation of diseases – than a monocausal germ theory would allow.
In an interview near the end of his life, pioneering AIDS researcher and physician Joseph Sonnabend said that the focus on HIV to the exclusion of all other factors was a political settlement between Christian conservatives and gay rights activists. This may sound paradoxical, but both sides had something to gain from this narrative. For conservatives, the threat of a deadly sexually transmitted pathogen was an opportunity to scare people back into practicing traditional morality. For gay activists, it was a way to win public sympathy by portraying themselves as merely unlucky in being the first group to catch it.
Both Christian conservatives and gay rights activists had something to gain from the AIDS narrative.
AIDS became the world’s most political disease at a time when politics as such was being transformed. By the late eighties, the Cold War was winding down. Politics in the 19th and 20th century had been defined by the struggle between capitalism and “really existing” socialism. Now that capitalism had won a decisive victory, there was no alternative social order on the horizon. For most of its history, the left had hoped that a mass mobilization of the working class could overthrow the existing order and replace it with one based on cooperation instead of exploitation. Now such revolution no longer seem like a realistic possibility, but catastrophe continued to loom large in the public’s mind. Increasingly, leftists turned to “scientific” predictions of disaster as a source of opposition to the system. At the same time, the older ideal of a universal politics based on class came to be replaced by a proliferation of minorities organized in terms of racial, ethnic, or sexual identity. These groups might define themselves as left-wing but often their demands had little to do with the traditional egalitarian aims of socialism.
Increasingly, leftists turned to “scientific” predictions of disaster as a source of opposition to the system. At the same time, the older ideal of a universal politics based on class came to be replaced by a proliferation of minorities organized in terms of racial, ethnic, or sexual identity.
We can see these various tendencies coming together in the militant AIDS activist group known as the AIDS Coalition to Unleash Power (ACT UP). The group was founded in 1987 by author and activist Larry Kramer. Kramer was known for his apocalyptic rhetoric. In his public speeches, he portrayed AIDS as possibly the worst plague in human history, and heaped abuse on public officials for not doing enough to stop it. Yet Kramer’s renegade style ultimately served the same goals as the mainstream institutions of medical science. Both activists and the establishment had an interest in promoting public awareness of AIDS in order to secure funding and win power for themselves.
ACT UP employed confrontational tactics usually associated with the left, yet its demand for deregulation and faster approval for new pharmaceutical products was more characteristic of the libertarian right. What’s more, ACT UP sought to politicize aspects of life that previously had hardly been thought of as political at all. AIDS activists frequently charged the Reagan administration with having “allowed” HIV to spread, or even committing “genocide” by failing to stop it. In their righteous fury, they almost seemed to be protesting the inherent frailty of the human body as much as any particular policy. At the time, this was an innovation, but it would be a harbinger of much to come. AIDS marked the eclipse of class politics by bio-politics.
Covid activism: Unto the elimination of death
So far, the 21st century has not produced any medical breakthroughs comparable to the invention of Penicillin. This relative dearth of technical advances stands in inverse proportion to the rise of the political use of medical science as a form of social control. The fact that medical science governs more of our lives than ever before may superficially look like progress; yet the Covid-19 crisis showed that faith in our ability to control disease has become a threat to humanity.
The Covid-19 crisis showed that faith in our ability to control disease has become a threat to humanity.
In spring of 2020, humanity embarked on a radical species-wide experiment to control the spread of a respiratory virus. Lockdown had never been tried before, but overnight became presented as unquestioned scientific consensus. Lockdown varied in strictness from place to place. In some countries, Covid protocol was enforced by police; in others it was more like a lifestyle that you adopted on a semi-voluntary basis. Lockdowns were highly authoritarian, but it would be a mistake to think they didn’t have a base of popular support. Like AIDS before it, Covid unleashed grassroots activist energy. Especially in the US, the UK, and continental Europe, it was common for leftists to demand stricter mandates and longer school and business closures.
Covid activists often used the rhetorical framework that groups like ACT UP had pioneered decades earlier. In 2020 and 2021, it was common for left-wing activists to blame the state for “allowing” Covid to spread. The underlying assumption here is worth examining. Covid spreads through breathing. In order to control its spread, the government would have to strictly regulate the most immediate aspect of our lives: our in- and exhales. The fact that this was considered legitimate by most leftists and a large portion of people across the political spectrum showed just how far bio-politics had come by the second decade of the 21st century.
It was common for left-wing activists to blame the state for “allowing” Covid to spread. Covid spreads through breathing. In order to control its spread, the government would have to strictly regulate the most immediate aspect of our lives: our in- and exhales.
One of the most salient features of Covid was that it was vastly more deadly for the elderly. In places with younger populations, such as sub-Saharan Africa, the virus passed through and hardly made a dent on annual mortality. For a country to have a high Covid death rate, it was necessary that growing old be the norm there. The media often ignored this by reporting all Covid deaths as if they were preventable. Deaths from respiratory infections among the elderly were measured by the scale of violent deaths from past wars and terrorist attacks. It came to seem like the enemy was not any particular disease, but the very fact of being mortal.
Deaths from respiratory infections among the elderly were measured by the scale of violent deaths from past wars and terrorist attacks.
The Covid pandemic showed us what happens when a culture whose main value is youth grows old. Commercial novelties ultimately can’t fend off death. Yet existential questions of how to live are replaced by technical ones of how to control disease: since it isn’t possible to live forever, the best we can do is try to stop the spread of germs. But no new medical breakthrough will deliver us from this crisis. We just need to learn how to live and die again.
