My guest today is Dr. Edna Bonhomme, author of A History of the World in Six Plagues: How Contagion, Class, and Captivity Shaped Us, from Cholera to COVID-19. I don’t think Dr. Bonhomme wrote her book knowing there’d be a resurgence of measles, but here we are!
I asked Dr. Bonhomme about the history of epidemics and pandemics, both in the U.S. and around the world. Exploring earlier outbreaks sets us up to talk about measles and vaccine skepticism today. These are troubling times, and Dr. Bonhomme pushes us to go deeper and examine the inequities that link official responses to contagion over centuries.
Dr. Bonhomme is a historian of science, a culture writer, and a journalist based in Berlin. Her writing has appeared in The Atlantic, The Guardian, London Review of Books, The Nation, and many other outlets. A condensed transcript, edited for clarity, is below. You can also listen to our conversation on the Skipped History podcast:
Measles, Plagues, and How “Knowledge Isn’t The Problem”
Listen now (40 mins) | Podcast version of my conversation with Dr. Bonhomme
Ben: Let's go back to the 1800s. Could you talk about cholera pandemics?
EB: Cholera was a recurring epidemic and pandemic in the 19th century. In the 1800s, there were various outbreaks that occurred throughout the world, mostly in Europe and North America, but also in East Asia.
Ben: Just to clarify, an epidemic is more geographically contained than a pandemic?
EB: Yes, an epidemic can happen in a city, a state, a whole country, or even multiple countries, whereas a pandemic has a global reach.
And so, when we think about cholera, with the rise of industrialization, you also had the rise of epidemics, such as cholera. As populations grew in cities like London and New York, you also had overcrowded slums, rubbish piling up, and in some cases waterways were unsanitary and ended up being the carriers of contagion.
Some of the first major outbreaks of cholera in the 1800s were in 1831, followed by 1837, 1838, 1848—it kept going and going, turning into pandemics, spreading across regions, touching people in London, Paris, Shanghai, Beijing, and so forth. Often, it was the working classes in cities and also, as I explore, the enslaved on plantations, who suffered the most.
Ben: Most of these transmissions were in the working-class districts of industrial centers, you write, but for the enslaved, “cholera was another scourge” that they couldn't escape.
EB: Yes, I really wanted to focus on the people left out of major histories. Most famously, we learn that people like John Snow—not from Game of Thrones, but the scientist in the 1800s—found a water pump responsible for spreading the contagion in London. But there’s so much more to the story, revealed in the memoirs of people like Harriet Jacobs and Frederick Douglass.
Ben: Totally. For the record, I’d be okay with Jon Snow, King of the North, pivoting and becoming U.S. health secretary right about now.
EB: Ha, yeah... part of the reason I start the book in the mid-1800s is because that’s when the scientific revolution and bacteriology started to have more of an influence. People began to get a sense of how disease spreads.
Ben: Let's go to 1918 and talk about the flu. People may have heard by now that it was misleadingly labeled the Spanish flu. Can you give us a brief history of how that happened?
EB: So influenza, which most people know as the flu, was a disease that really went from being an epidemic to a pandemic around 1918, 1919. Coinciding with World War I, it caused an estimated 50 million deaths worldwide. Some say the death count was as high as 100 million.
People still often refer to it as the Spanish flu, which is a misnomer implying it originated in Spain. But rather, because Spain had a freer press and was more accurately reporting on the number of cases, people associated the disease with Spain.
In other countries, with the rise of the pandemic, there was censorship and suppression of information. This happened in a number of ways: downplaying the pandemic in some cases; denying the effectiveness of masks or quarantines in others. In the case of the U.S., they passed the Sedition Act of 1918, which hindered communication about the disease and made people uncomfortable saying anything negative about the U.S. In Philadelphia, physicians actually marched to say that the press should run more articles about the flu. Their efforts were suppressed as well.
Historians and science journalists have pointed out that the response to the 1918 pandemic, particularly around censorship, shows the importance of transparency and open communication when there’s an outbreak.
Ben: I think we also learned that firsthand five years ago.
EB: Absolutely. The second half of my book thinks about outbreaks that are part of our living memory and considers how knowledge of how to treat them, to an extent, isn't the problem. Rather, major social divisions and inequalities exacerbate disease and shape the response.
Ben: You jump to the 1980s, when we get to HIV/AIDS. What spans that jump in the book—and in the world—is the growth of prisons. I wonder if you can talk about prisons as concrete embodiments of the confinement that so often comes with contagion.
EB: I really consider the question of how prisons shape disease outbreaks. In particular, I wanted to think about how incarcerated people dealt with HIV/AIDS before antiretroviral drugs were made available.
For the most part, I focus on one specific program: the AIDS Counseling and Education Program at the Bedford Hills Correctional Facility, which is a women’s prison in upstate New York. There are several protagonists, including Kathy Boudin, Judy Park, and others who were educators and peer counselors leading workshops on HIV transmission, stigmatization, and testing. They provided support to each other in a time when some people estimated that as much as 20% of their peers had HIV. Basically, peer education provided support to people who were sick and made even more sick by being imprisoned.
So HIV and how people responded to it is the main subject of the chapter, but it also raises major questions about what prison does and does not do—stripping people of their humanity and dignity while doing woefully little to stem the spread of contagions.
Ben: I did not expect (and was delighted to encounter) your exploration of prison abolition in the book.
Speaking of inequities—on an international scale—can you talk about how Ebola revealed fault lines in global public health?
EB: Sure. Ebola is a highly infectious disease, first discovered in the 1970s by a French scientist. It's a disease that has also been mythologized and negatively represented, particularly towards Africans. So it comes with heaps of cultural baggage, I would say, while also being quite dangerous.
In 2014, there was an outbreak of Ebola in West Africa, primarily in Sierra Leone, Liberia, and Guinea. I focus on the outbreak in Liberia and the lockdown in one neighborhood of Monrovia, the capital city. On the one hand, having some form of public health regulation around the spread of diseases and minimizing the spread of the contagion was important. On the other hand, the lockdown was also coupled with militarization. There were burial rituals that people wanted to uphold but weren’t honored, sparking mistrust and disdain for the government.
Ben: You note that Ebola spreads through the exchange of fluids in intimate settings with an infected person. So restricting air travel—which was a go-to countermeasure from Western countries during the outbreak in 2014—maybe shouldn’t have been the priority. "Call me a prude," you add, "but I rarely exchange blood, saliva, or fecal matter with my fellow air travelers."
I have to say it: you’re a prude! I don't know what you're doing on flights but if you're not asking seatmates for a blood test, you’re not doing it right.
EB: Ha, perhaps I'm not.
But you’re touching on a broader question here: ensuring, before outbreaks occur, that countries and cities have adequate sewage systems, access to clean water and, I’ll add, universal health care. One of the more positive outcomes of the outbreak was that it actually helped to open up space for the creation of the African Centres for Disease Control, meant to improve coordination in controlling the spread of diseases.
Ben: And yet foreign aid is not exactly flowing at the moment.
EB: Right. The Africa CDC’s job is all the more complicated now.
But at the end of the day, there is so much wealth to be found in sub-Saharan Africa. There's no reason for people to have to rely on charity to get something as basic as access to health care.
Ben: Maybe that discussion of deeper needs is a good setup for talking about vaccine skepticism, RFK Jr., and the measles outbreak today. Can you help us make sense of all these things?
EB: One thing I’d say is, as long as there's been vaccines, there's been skepticism. Usually, it’s a small minority who questions vaccines, and the political orientation of people who take it on is wide-ranging: from individuals who might be perceived as left-leaning and harbor a non-interventionist approach to medicine—to people who might bear politically fringe, far-right, conservative ideas. We see more of the latter group forming the anti-vaccine movement today.
So, yes, as of March 2025, there’s a measles outbreak in the U.S. There’ve been over 300 cases, with the highest number in Texas. About a third of the cases are people under the age of five. More than two-thirds of them are under the age of twenty. Over the past few decades, there's been a reduction of people getting the MMR vaccine. If you are vaccinated, you are extremely unlikely to get infected.
I want to emphasize: measles is a preventable disease. Children do not need to be getting sick right now. We’re lucky to have the science and technology to address this issue like we did with, say, polio and smallpox.
But instead of getting into a debate about RFK Jr. and vaccine skepticism, I’d push us to go further. We should be fighting for access to free healthcare and to stop many contagion-related issues from arising to begin with. Thirty million people still don't have healthcare in the U.S.—which, I think, shows how little care the U.S. government has for the people who live on this land.
Ben: If I may finish with a quote of yours, you write, “If public health measures are to be an effective weapon… it will mean upending the system that has caused these drastic inequalities. Public health measures applied universally to an uneven and unequal world will not work. That world must be radically rearranged.”
The casual research I did on cholera outbreaks in Randolph County, Illinois produced suggestive evidence that the 1849 outbreak began near the Mississippi River and that the infected people either lived near the river or traveled to that location on business. So rather than the disease spreading, it may be that people were traveling to the disease and returning home with it. There is no evidence in that locality so far that it disproportionately affected people according to social rank, wealth or slave status. There is a monument near Germantown, Illinois thanking God that the cholera plague stopped there. Germantown is 40 miles east of the Mississippi River.
I expect measles outbreaks in the US to get worse as the baby boomers with natural immunity "age out" of the population leaving only people with the lesser vaccine immunity. The measles vaccine fails 5% of the time so that is a population of 16 million who had the vaccine but can get measles. The states where measles has broken out in recent years are primarily border states with high levels of unvaccinated immigrants. If Amish and Mennonites were the problem we would see a different geographic distribution of cases in alignment with those populations.
The measles outbreak in Texas is from a religious faction, Mennonites, who have never taken vaccines. So all the free healthcare and education isn’t going to change that. In Texas we also have a huge influx of illegal immigrants. Why were they not required to be up to date on vaccines before entering our country? Our children can’t easily attend school without being up to date or having an exemption but non citizens were free flowing in? That’s a huge part of this outbreaks cause.