Pandemics: A history of discrimination

Repeatedly throughout history, pandemics have evolved beyond being ‘just a health crisis’ into social phenomenons that have strained society economically, politically, and culturally for years.  

While the diseases themselves respect no boundaries, colours, or ethnicities, they often breed stressful environments that expose the true nature of our social and human values. It is within these circumstances in which pandemics unveil the clear health disparities between socioeconomic classes, as well as the vilification of minorities in media and public health responses. 

In this respect, a dissection of the COVID-19 pandemic today will quickly show a reflection of the same discriminatory practices that still existed centuries before. 

The spread of COVID-19 and xenophobia

Sinophobia - the fear of Chinese people - became widespread soon after COVID-19 first appeared in China in December 2019. While the virus-related vitriol appeared all over the world, it was expressed in various forms.

In places where Asians are a visible minority, discrimination against Chinese populations and other communities of Asian descent were fuelled by superficial stereotypes. Headlines such as "Yellow peril'', "Chinese virus panda-monium" and "China kids stay home" appeared in French and Australian newspapers. Over 75% of parents and 76% of youth from Chinese American families had reported experiencing instances of racial discrimination during the same time that the term “COVID” had been searched the most on Google in America.

While the same sort of racism surfaced in Asia, the anti-Chinese rhetoric took a deeper, more xenophobic tone. In Singapore and Malaysia, hundreds of thousands people participated in online petitions to ban Chinese nationals from entering the country - with both countries’ governments implementing some form of entry ban. Likewise, in Japan, Chinese people were labelled as “bioterrorists”, and conspiracy theories about Chinese people infecting locals proliferated across Indonesia. 

However, the racism didn’t just stop at the media. Much of the bigotry against the Chinese was politically motivated. The rhetoric that casted the virus as “foreign” was one insisted by the former President of the United States, Donald Trump. By using the expressions “Chinese virus” and “Wuhan virus”, Trump implies that the nation is facing an external threat and plays to his supporters’ cognitive bias against outsiders and immigrants, as well as their fear of contagion (racial, social, cultural or otherwise). In fact, this move was so deliberate that Factbase reported that the President used the expression “Chinese virus” more than 20 times in a period from March 16 and March 30. According to a 2020 UC San Francisco study, this led to a drastic increase in anti-Asian Twitter hashtags.

It’s not the first time that a pandemic has disproportionately impacted minorities. When we look at history, we find such discriminations has always existed, and that the system has repeatedly failed to protect its most vulnerable and disadvantaged citizens from contagious diseases. In attempting to understand why, it’s important to look at the ways economic ideologies, political ideologies, histories, and legacies of colonialism and racism shape international epidemic responses.

Discrimination against ethnic groups and classes solidified during the wave of immigration in the 1800’s

History suggests that disease outbreaks have often been accompanied by a rise in xenophobic or racist sentiment. There is often a misguided belief that ‘outsiders’ are more susceptible to disease and infecting others as they are perceived to be dirtier, eat strange foods and live in cramped spaces.

1849: Cholera

Seven cholera pandemics have occurred globally, including the first outbreak in India in 1817. Yet, American authorities denied its contagiousness when it first spread in the 1830s. 

Like COVID-19, the epidemic fell most heavily on the inhabitants of impoverished inner-city areas. It was the same in the Five Points area of New York, where Catholic-Irish immigrants were packed into rudimentary timber dwellings lacking running water and sanitation. 

At the time, the Protestant nativist movement was dominant, as well as its anti-Catholic, anti-immigrant animus. Many Americans believed poverty arose from personal moral failures and assumed these sufferers were also the most reprobate. 

Hence, despite believing that cholera is non-infectious, many Americans shut their homes and hearts to the immigrants. As a result, the Irish bore 40% of the mortality. By contrast, wealthy New Yorkers from Protestant backgrounds generally escaped the ravages of cholera by fleeing to the country.

Whilst many initially believed that Protestant values and simple ‘American’ lifestyles would protect them from the scourge, by 1949, New Yorkers could no longer ignore the link between cholera and poverty. In 1854, when English physician John Snow demonstrated that cholera was transmitted in water, the case for sanitary reform became overwhelming. Recognising that cholera was linked to overcrowding, unhygienic housing, and poor sewerage disposal, American sanitarians pressured boards of health to provide cities with safe water systems. Later, these boards became the models for local and state public health agencies.

1892: Typhus

More often, pandemics are occasions for discrimination against ethnic and social groups.

In January 1892, 200 Russian Jews, fleeing riot and famine in their home country, travelled in steerage and arrived in New York. They settled in the slums of the Lower East Side. Shortly after, when New York was struck by typhus, the city’s sanitary authorities blamed the outbreak on recent Jewish immigrants and quarantined them on North Brother Island in the East River. By contrast, passengers who had travelled in the first-class sections of ships were not quarantined.

While detaining the immigrants, authorities used excessive force and quarantined them in the unsanitary “typhus houses” for three months. Of the 1200 immigrants arrested, 120 died in the houses. In addition, the U.S. Senate Committee on Immigration proposed legislation to tighten immigration requirements for Jews and Italians.

The situation in Germany was no different. For example, during the typhus epidemic, Jews were not allowed in German swimming pools. 

1916: Polio

The 1916 “infantile paralysis” crisis in New York is another example of how xenophobia leads to discriminative health responses. 

The initial outbreaks of polio were centred on “Pig Town”, an Italian neighbourhood in South Brooklyn. Here, recent immigrants from Naples lived in tenements surrounded by piles of stinking garbage and free-roaming pigs. As cases of polio multiplied and the papers filled with heartbreaking accounts of dead or paralysed infants, the publicity sparked a wave of anti-Italian prejudice. 

While the Italian mortality rate for polio was low, the 1,348 polio cases contracted by those of Italian nativity in New York City was the highest for any immigrant group, second only to the 3,825 cases among the native-born. However, because there were so many Italian immigrants living in tightly concentrated neighbourhoods, and because immigrants were viewed by many as a marginal and potentially subversive influence upon society, the incidence of Italian polio made a dramatic impact upon the imagination of a public already shaken by the virulence of the epidemic and the youth of its victims.

While Upper East Siders fled to their homes on Long Island, heavily armed policemen patrolled roads and rail stations to prevent Italians leaving the city. Health officers went door to door in Brooklyn to enforce isolation measures and hospitalisations. Towns like Oyster Bay, on Long Island, became notorious when wealthy estate owners — among them former President Theodore Roosevelt — blamed poor Italian and Polish residents for the polio epidemic and made the police seize children and issue fines for uncollected trash. In reality, non-paralytic cases of polio had already been circulating under the radar in Vermont since 1890.

The media has always played a role in scapegoating minorities

During pandemics people often look for scapegoats. The media has played a critical role in shaping the public belief system in times of crisis. In a time when social media use is ubiquitous, “media psychology” can be a double-edged sword. For pandemics, however, the role of media has been more of a victimiser than a saviour. 

1838: Smallpox

Like COVID-19, smallpox was erroneously linked to the Chinese people. 

When B.C. joined Canadian Confederation in 1871, the Canadian government initiated a system to recruit and attract Chinese labour to supplement the growing requirements of building the Canadian Pacific Railway. Thousands of Chinese workers were hired and arrived by boat. Around this time, white communities were growing disgruntled at the presence of Asian settlers in the cities.

In the media, China began being coined “the cradle of smallpox” and “Sick Man of Asia”. Americans and Europeans believed that the Chinese were the carriers of alien diseases. By 1885, Canada had passed the Chinese Immigration Act which placed a “head tax” on all Chinese immigrants. Quarantine officers at the ports were ordered to inspect all on board of Chinese origin, stripping down and examining any Chinese person suspected to be sick. 

Travellers and missionaries played a crucial role in spreading such rumours. For example, Charles Toogood Downing, who visited China in the 1830s, wrote of the infection,

“This dreadful malady is supposed to have originated among the Chinese, and to have spread westward in a gradual manner among the natives of Western Asia, until it became as prevalent with the people of Europe, as among those of the Centre Kingdom.” 

While China remains the origin of smallpox in the American official reports, the CDC now states that it was the European settlers brought smallpox to America in the 17th Century.

2014: Ebola

Fear can make people hostile, and so can racism.

BBC reported many instances of racism following the ebola outbreak in West Africa. For example, a New Jersey school sent two Rwandan students back to their home country for no apparent reason.

Likewise, a Texas college informed prospective students from Nigeria that they had recently stopped accepting applications from countries with confirmed Ebola cases. Interestingly, at that time, Ebola was no longer present in Nigeria. 

Most notably, immigrants living in Dallas, where the first case of Ebola in the U.S was recorded, reported facing “unfair treatment”. 

The media was instrumental in fear-mongering and exacerbating an already sensitive issue. For example, one article in Africa Today noted that American media fuelled the otherisation of Africa and Africans.

Regardless of the cause, these actions helped reinforce Africa’s image as a “dark and diseased” continent among Westerners. 

1880s: Tuberculosis

Tuberculosis (TB), then called consumption, was rampant among African Americans. According to civil rights activist W.E.B. Du Bois, in 1900, death rates due to TB, pneumonia, and diarrhoea were 2 to 3 times higher in African Americans than white people.

By 1900, TB became less common among white Americans in Virginia. The main reasons for this disproportionate distribution were better nutrition and sanitation. Consequently, TB was increasingly viewed as the disease of the poor. 

Over the years, TB was killing more African Americans than white Americans both on the state and national levels. Between 1910 and 1920, the number of infected Black Americans was 4 to 6 times that of infected white Americans in Philadelphia. 

Similarly, in Indiana, public health officials recognised that death rates were significantly higher among African Americans in the early 1900s. Public funding to fight TB in African Americans only became available in 1919.

Nationwide, the TB death rate among non-white people between 5 and 14 years was 155 per 100,000, compared to 23 per 100,000 in white children in 1915. 

Even after decades, the burden of TB and associated stigma did not stop haunting Black people. For instance, in 1950 (circa), the Florida State Board of Health distributed pamphlets - with an image of two black men - to encourage the public for early detection of TB. 

COVID-19 & HIV: How public health responses differed

There's little doubt that the human immunodeficiency virus that causes AIDS and the new coronavirus responsible for COVID-19 share several terrifying characteristics. Both announced themselves to the US in dramatic fashion: HIV lurking in the bloodstreams of men who died puzzling, premature deaths; coronavirus and COVID-19 racing from China and eventually to the US in the lungs and on the fingertips of unsuspecting travellers.

Both HIV and the coronavirus can be transmitted by someone who is infected but shows no symptoms. Both attack otherwise healthy people. While some are more vulnerable to infection than others, both viruses can kill anyone who gets sick.

Much as the AIDS crisis transformed sexual behaviour and education worldwide, the coronavirus has forced entire nations to change their habits as scientists race to find effective treatments, and – hopefully – a vaccine.

However, what is difficult to ignore is the clear disparity in public health responses.

4 ways HIV/AIDS was neglected

Untreated HIV/AIDS has a case fatality rate (CFR) of 80%. In contrast, the CFR for COVID-19 is 2%–3%.

Despite the higher mortality rate, HIV/AIDS received little attention from the authorities and media. Unlike the coronavirus, which has led to a global shutdown to slow transmission, AIDS was initially seen as afflicting the population of stigmatised groups, such as the “Four-H Club” members (homosexuals, heroin users, haemophiliacs, and Haitians).

1. Low budget

In the early years of the AIDS epidemic, people infected with the virus faced certain death, often within just a few years after infection. Though many in the medical and public health fields lobbied to direct funding and research efforts to the growing crisis, US government response was very slow. 

In 1982, the government allocated a total of $15 million to AIDS research ($5 million to CDC and $10 million to NIH). The amount is equivalent to $42 million in 2021. In contrast, this year, funding for COVID-19 reached $350 billion.   

2. Delays in identifying the crisis

It is widely believed that HIV originated in Kinshasa, in the Democratic Republic of Congo around 1920 when HIV crossed species from chimpanzees to humans. Up until the 1980s, we do not know how many people were infected with HIV or developed AIDS. HIV was unknown and transmission was not accompanied by noticeable signs or symptoms.

3. Lack of progress with the vaccine

In current times, millions of lives have been saved because of rapid deployment of effective vaccines against COVID-19. And yet, it has been 37 years since HIV was discovered as the cause of AIDS, and there is no vaccine. 

4. Lack of media coverage

In contrast to 2020’s almost round-the-clock media coverage of COVID-19, it took a high-profile celebrity case to make the general population realize how widespread HIV/AIDS was becoming. The first major turning point in AIDS awareness came on July 25, 1985, when actor Rock Hudson, a friend of the Reagans, revealed he had AIDS, and died two months later.

To make up for the shortfall in media attention, AIDS patients and advocates in groups like ACT UP resorted to raising awareness for the climbing death rate through bold actions, from spreading the ashes of AIDS victims over the White House lawn and organising funeral processions carrying the bodies of AIDS victims.

Minorities bear the majority of the health burden

Almost every pandemic has disproportionately impacted minorities throughout history. Too often, minorities are denied the right to an adequate standard of living, including housing, food, water and sanitation, and find little choice but to live in overcrowded, unhygienic conditions, with limited or no access to health services. This is a combination which increases the health burden of pandemics on communities and migrants, and massively hinders the ability of authorities to effectively put in place the early testing, diagnostics and care vital for effective comprehensive public health measures.

COVID-19 deaths and colour: A tale of disparities

Racial disparities became evident during the COVID-19 pandemic. The CDC reports that hospitalisation rates among non-Hispanic American Indians or Alaska Natives were about 5 times those of non-Hispanic whites.

Similarly, non-Hispanic Black people and Hispanic or Latino people had a hospitalisation rate about 4.7 times that of non-Hispanic whites.

Like hospitalisation rates, death rates also showed huge disparities. CDC data revealed that the burden of COVID death is higher among the Hispanic/Latino, non-Hispanic Black, and non-Hispanic American Indian or Alaskan Native ethnicities.

• Hispanics constitute 19.40% of the US population, but they account for about 36% of all COVID-19 deaths. 

• Non-Hispanic, Black Americans constitute about 13% of the population, yet they account for nearly 23% of all COVID-19 deaths. 

• Non-Hispanic American Indians or Alaska Natives constitute 0.70% of the population, but they account for 2.6% of all COVID-19 deaths. 

Contrarily, non-Hispanic Whites, who constitute about 60% of the population, account for 33% of all fatalities.  

African Americans have among the highest HIV death rates 

Due to a range of vulnerabilities such as higher incidence of poverty, overcrowded housing conditions, and high concentration in jobs where social distancing is difficult, immigrants and minorities are at a much higher risk of COVID‑19 infection than the native-born. Studies in a number of OECD countries found an infection risk that is at least twice as high as that of the native-born.

According to HIV.gov and the CDC, African Americans constitute just 13% of the U.S. population but represent 41% of people with HIV. Likewise, Hispanics/Latinos, who constitute 18% of the U.S. population, represent 23% of people with HIV. Over 1 in 4 new HIV diagnoses in the US in 2018 involved African American gay men and bisexual men. 

Moreover, HIV death rates also have significant differences among different races. For example, the death rate in Black/African Americans is 19.8/100,000, about 7 times that in Whites and 3 times that in Hispanic/Latino.

There is a notable difference in death rates between African and European Countries. African countries have the highest death rates (more than 100/100,000), while European countries have the lowest death rates (less than 1/100,000). The average worldwide death rate for HIV/AIDS is less than 10 per 100,000.

Shailesh Sharma is a medical writer and holds a Bachelor's degree in Pharmacy.