Haitians plead with riot police
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Haitians plead with riot police in Port-au-Prince after tear gas was fired into a refugee camp amid growing tensions as a result of the cholera epidemic
In the wake of major outbreaks of diseases like cholera and Aids comes violent mistrust of scientists and politicians. Historian Richard Evans looks at possible lessons for the future.
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One of the most devastating cholera epidemics of modern times is still in progress in Haiti and likely to get worse. It follows on the heels of a major earthquake early in 2010 and a hurricane, which combined to leave one and a half million people homeless by the end of the year.

The spread of the disease was accelerated by poor sanitation in the camps set up for earthquake victims. Water supplies were inadequate or unhygienic and the resources and organisation to provide proper waste removal facilities were lacking, with the result that the epidemic is continuing, with the total number of people affected expected to exceed 800,000 by the end of this year and more than 11,000 fatalities.

The disorganisation of the state, combined with low standards of public education, made an already desperate situation even worse. One of the most shocking aspects of the epidemic was the outbreak of riots against the UN "stabilisation force" in Haiti, whose Nepalese members were widely blamed for bringing the disease to the country. This was despite the 12,000-strong force having little contact with the population and playing little or no role in dealing with the consequences of the earthquake. But it was seen in some quarters as propping up a generally hated government. Violent disturbances expressed popular outrage in the face of a previously unknown disease.

Such popular disturbances during epidemics are nothing new. In the early 1830s, the arrival of cholera in Britain provoked widespread assaults on doctors, who were accused of poisoning people in order to obtain fresh corpses for the anatomy schools - an echo of the notorious Burke and Hare murders not long before. In Naples in 1884 and in parts of Russia in 1892, there were disturbances as people resisted the attempts of a corrupt or remote and authoritarian state administration to impose quarantines during cholera epidemics and forcibly remove the sick to isolation in hospitals. The medical profession was accused of poisoning the poor in order to reduce the burden they imposed on the state.

For broadly comparable reasons, the African National Congress saw the Aids epidemic that began under apartheid in the 1980s as the result of a plan by the white-supremacist South African government to reduce the numbers of the black majority population. A subsequent ANC government rejected the first effective therapy - AZT, made available in 1998 - as an expensive confidence trick by drug companies and agents of "western medicine". For South African president Thabo Mbeki and his supporters, the idea that Aids was spread by sexual contact was an expression of western stereotypes about African sexuality.

The result was that HIV spread unchecked, the number of South Africans infected with the virus reaching an estimated 5.7 million or 12% of the population in 2007, the highest proportion in any country in the world. More than 300,000 people were dying of Aids in South Africa each year in the mid-to-late 2000s. It was only with the defeat of Mbeki in the 2008 election and the replacement of his health minister that the government's position began to change and the situation to improve.

What conclusions can we draw from all this? As new epidemic diseases strike, scientific opinion is initially uncertain and often divided. The mass media and the internet allow dissident scientists to gain a hearing, just as they did in the more restricted media environment of the 19th century. Governments and politicians are frequently driven to choose the science that best serves their interest, or their ideological standpoint.

Politicians are often impatient with the caution of scientists. On the other hand, scientists are sometimes wary of voicing opinions they know will be unpalatable to governments.

It's too simple to say that the public should trust scientists. Why should they, when scientists can get things wrong?

The state can arouse suspicion and even outright hostility if it fails to explain itself to the public, invades and curtails their civil liberties by policing measures, or fails to provide people with basic levels of health, sanitation and education, as in Haiti. Accurate and as far as possible objective and balanced information is therefore vital as a means of giving the public a choice.

Nobody can say what new epidemics and infections may arise in the future, but we can be certain that they will occur. History may not help us learn how to prevent them, but it can teach us lessons about how we can deal with them when they arrive, try to minimise their impact, and take steps to avoid their recurrence.

These aims can only be achieved in a democratic context where state, medical scientists and the public have some degree of mutual trust and respect.


Richard J Evans is Regius Professor of History and President of Wolfson College, University of Cambridge. On Monday evening he will deliver the Sense About Science annual lecture "Epidemics and refuseniks: The birth of state responsibility". The full lecture will be available exclusively on guardian.co.uk as a podcast.