← New Books Network
New Books Network
Julia Ross Cummiskey, "Virus Research in Twentieth-Century Uganda: Between Local and Global" (Ohio UP, 2024)
01:32:21
Loading summary
Transcript39 lines
- [00:00]
A
Hello, everybody. This is Marshall Po. I'm the founder and editor of the New Books Network. And if you're listening to this, you know that the NBN is the largest academic podcast network in the world. We reach a worldwide audience of 2 million people. You may have a podcast or you may be thinking about starting a podcast. As you probably know, there are challenges basically of two kinds. One is technical. There are things you have to know in order to get your podcast produced and distributed. And the second is, and this is the biggest problem, you need to get an audience. Building an audience in podcasting is the hardest thing to do today. With this in mind, we at the NBM have started a service called NBN Productions. What we do is help you create a podcast, produce your podcast, distribute your podcast, and we host your podcast. Most importantly, what we do is we distribute your podcast to the NBN audience. We've done this many times with many academic podcasts and we would like to help you. If you would be interested in talking to us about how we can help you with your podcast, please contact us. Just go to the front page of the New Books Network and you will see a link to NBN Productions. Click that, fill out the form, and we can talk. Welcome to the New Books Network.
- [01:07]
B
Welcome to the New Books Network. My name is Ifa Befikwashi, your host. Today I am joined by Dr. Julia Kaminsky to talk about her new book, virus research in 20th century between local and global. Dr. Kaminsky is an assistant professor in the Department of the History of Medicine at the Johns Hopkins University School of Medicine. Her research focuses on the history of global health research, policy and practice in Africa. Thank you for being here, Julia. How are you?
- [01:38]
C
Thank you so much for having me. I'm doing well, thanks. How are you doing?
- [01:41]
B
I'm doing well. I am very excited to talk to you about this book. And to start, I just want to invite you to just tell us a bit more about yourself, about your research, and about how you came to the research of global health and policy in Africa, and specifically in Uganda.
- [02:01]
C
Sure, it is a long and winding story, so I'm going to try to keep it brief, but I do think this is something that I often tell students when I'm teaching or advising, that I think I am a case study in why it's okay if you don't always know exactly where you want to go, especially in your 20s, and that you can take some kind of twists and turns and that that doesn't mean that you're wasting time. So, anyway, I Grew up outside of Philadelphia. And I wanted to be a whole lot of different things growing up. I wanted to be a poet for a while. I wanted to be a veterinarian. And then in middle school, I discovered these memoirs of the people that we sort of talk about as the disease detectives. A lot of these guys were doctors in the Centers for Disease Control's Epidemic Intelligence Service. And they're the ones who wrote memoirs about, you know, quote unquote, discovering Ebola and Lassa fever. And that's when I decided I wanted to be an epidemiologist, which was something that most people didn't expect to hear from a seventh grader. So I was really interested in public health. I was really interested in the kind of detective work that went along with public health. And it really appealed to me that public health was an interdisciplinary kind of a field where somebody like me, who loved to read, who loved to hear stories, but who also really loved science, could bring those things together. So I went to college at Carleton College in Minnesota. It's a liberal arts college. They did not have a public health undergraduate major, which turned out to be great for me. And I was advised to major in whatever I wanted, that all of it would be good preparation for public health. And that was something that I could pursue in graduate study. And I took a history class with a professor named Parnas and Gupta on the history of women in South Asia. And it just blew my mind. I had never thought that history could be like what she was teaching us in terms of thinking critically about not just what happened, but why we know what happened. How do we know what happened? How does our understanding of what happened change when we emphasize different sources? How do we pay attention to what isn't in the sources? How do we try to grapple with what we can't know? And around the same time, I came across an article on the history of smallpox eradication campaigns in South Asia and the impact that the strategies for achieving eradication had on some of the obstacles that they were facing with polio eradication. And it just. It was like this light bulb moment of this history that I had just learned was so fascinating, had real relevance for the kind of public health that I was interested in. So I decided to be a history major. I was pre med for most of college. I took organic chemistry one and two. That's a whole other story. But I was always ambivalent about going to medical school. I think I knew pretty much all along that I didn't really want to practice medicine. But again, those people whose memoirs I had learned about public health through. All of them were MDs. And I just assumed that was kind of what you had to do. But the more I was learning about public health, the more I learned there are a lot of different ways into it. So I went to Columbia University and did a master's degree in public health. And Columbia had a program where you could focus on history, ethics and policy and public health. And once again, I was great. This is, this is perfect. I still don't have to like, choose. I can still do all three. It was really fantastic training, you know, basic training in epidemiology, biostatistics, environmental health, all the basics, but also really careful inquiry into how do we understand how public health decisions were made? How do we understand how people balance the benefits of public health interventions against their costs? Are there possible harms? How do we think about whose interests are being served in public health interventions and what duties do we have to protect minority interests? Or is it always appropriate to put the well being of the greatest number of people, the greatest good for the greatest number? So all of these questions were questions that were central to my training, not peripheral to it, and I'm really grateful for that. So after I got my master's in public health, I got a job with the New York City Department of Health and Mental Hygiene in the Bureau of STD Control and did some really interesting work there for a couple of years. I was working with some of the STD clinics that the department ran across the city. I was working with people who were doing HIV testing, syphilis testing, gonorrhea testing, and people who were developing and implementing and evaluating programs in those clinics, doing everything from screening for substance abuse and trying to create referrals for substance abuse treatment programs to evaluating new, at the time, implementing PCR tests to try to detect HIV earlier than the rapid antibody test could detect it. And got a real introduction into public health in practice and the day to day work of what it involves. You know, the ways in which individual people make decisions and how the personalities affect what happens and how. It's not, you know, it's not that we weren't doing what we said we were doing on paper, but there's a lot more to it. And I think one of the things I was thinking about at the time was I had always been really interested in international public health and global health, but I found myself returning to the things I had learned and thinking, if it's this complicated doing public health in New York City, you know, with Americans treating other Americans in a city that we all lived in and it is still so hard to figure out what's the right thing to do. Do we really understand the needs of our patients? Do we really understand, you know, what's driving health trends in the public? You just have to assume that that's amplified when you're talking about people from one country going to another country. You know, it was hard enough to come up with a policy that worked in nine STD clinics in five different boroughs in one city. To imagine what it means to create policies that are going to work globally. It just, it was another kind of point for me to reflect on why this was so challenging. I worked there for two years and then I got a job with Montefer Medical center in their school based health program. And that's around the time that I knew for sure I wanted to go back and do a PhD because I loved the people I was working with. I loved the program, I loved the mission that we had. But my day to day responsibilities were primarily managing people and I did not love that. And I just, I, I never really thrived in a 12 month, 9 to 5 job. I think the academic life, some people thrive in it and some people really struggle with it. I, I thrive on that sort of rhythm of like peak times and down times. And so, so while I was working at Montefiore, I was applying to PhD programs and I had the great good fortune of applying to a program that had Randall Packard on the faculty here at Johns Hopkins. And I say I was lucky because I didn't really know how to apply to PhD programs. And in retrospect I didn't really do it right. But luckily Randy saw my application and he knew that this program, the History of Medicine at Johns Hopkins, would be the right program for me, that it was going to offer the kind of deep historical training that would help me to start to answer some of these questions I was asking. But also a program that really valued thinking about how this can be relevant for contemporary policy and practice. And so yeah, I came to Baltimore, did my PhD. After I finished my PhD, I went to the University of Tennessee at Chattanooga. I hit the jackpot. I got a tenure track job right out of my PhD, moved to Chattanooga, loved a lot of things about living in Chattanooga. I was the African history professor, assistant professor there for about seven years. And then a position opened up back at Johns Hopkins. And yeah, I landed my dream job back here.
- [10:17]
B
It's nice to have you here, I guess, you know, like at Johns Hopkins doing this work and just Listening to you talk about your journey to this book, I can see all the layers of that experience sort of playing out in the story that you tell. So tell us about the book. What is this book about? What are the main interventions? What is the story that you're telling? Very compelling story about virus research in Uganda. And it's a story about, you know, place people, you know, all these things. So just sort of lay that out for us. What, what, what is the book about?
- [10:59]
C
Yeah, I, I always find it really hard to talk about the book and I didn't understand why people would say that when I listened to these interviews in the past. No, I do, but. But it's also really exciting. I. So the book grows out of my dissertation research and at least the way I remember it, it's a topic I kind of stumbled onto. Of course, who knows how I've rewritten this history in my head over the course of 15 years. But I knew, I didn't really know what I wanted to write my dissertation on. I knew I wanted to be about global health in Africa and I didn't want it to be a story that was just about people in Atlanta or Geneva or New York and what they were doing in other places. And so I was just trying to read really widely and I came across this very short article. I think it was two pages in a biomedical journal and it was a profile of the Uganda Virus Research Institute. And it talked about how it opened in 1936 and how it had been operating since then. And I thought to myself, like, that's unusual to have an institution that was founded during the colonial period that has lasted for. I mean, they're coming up on their 90th anniversary next year and I thought, oh, I should see what historians have written about this place. Maybe that'll give me some ideas. Maybe it'll, you know, prompts. And that was it. I couldn't find any historical work on this place. And so at the same time I was also exploring another possibility, which was the history of the Rakai Health Sciences Program, which is an. An HIV A community co. Community based cohort study in central Uganda that has been one of the most foundational research programs to establish information about the AIDS pandemic and the AIDS epidemic in East Africa. And I discovered really quickly that they're affiliated with the Uganda Virus Research Institute. So it kind of seems like serendipity. So I picked that as my dissertation topic and dug into it. And in terms of the book, I mean, the book grew out of the dissertation research, but it did really end up being a different thing. So in the book, I look at the history of the Uganda Virus Research Institute as an opportunity to look at the history of global health. Taking as the starting point this locale in Uganda, in Entebbe, and looking at the history of international and global health through the lens of what it was like to work there. What were the problems they were trying to solve, what were the obstacles to their work, what were the opportunities that they identified. Trying to think about how does the history of global health look different when we start there instead of starting at the CDC or at the whole. And one of the things that I found that I really don't think would have come to my attention if I hadn't been looking at this place that was operating over the course of decades was that the relationship between local and global was so much more complicated than I think comes across in most of the scholarship that invokes those categories. So there's this category of local partner that I think will be really familiar to anybody who's done international development work, international health work. You know, there's some varieties of it, sometimes it's an implementing partner. But basically the idea is when there are these international programs, partly as a response to critiques of quote, unquote, parachute science or parachute projects, that the international entity has to identify a locally based entity to be a partner in that work. And the way that we talk about international or global and local, I started to notice, becomes kind of euphemistic. There are a lot of assumptions about what those two categories represent that are not explicit sometimes that have to do with race, that have to do with resources, that have to do with our understanding of where expertise is located and what it looks like. And by looking at the history of the Uganda Virus Research institute over about 80 years, what I could see was that I couldn't place individual people or the institute itself in one or the other of those categories. And that I argue in the book, part of the reason it was able to survive for so long was because it could take on the qualities of either global or local in different moments in order to achieve strategic purposes. And the people that worked there did the same thing. So that's the central argument of the book, is that local and global are relative terms. And if we want to understand how global health works, we need to recognize that people that are labeled as local are not limited to that role. And that in fact, they are often global in some senses, and vice versa. But also that there's real power in enacting Both kinds of roles. I think there's an assumption usually that the global partner has a lot of power. And even in histories that have looked at the power that local partners can use, it's often framed as kind of resistance or pushback or emphasis. And what I found was that actually locality can be a really powerful identity to use to achieve certain outcomes. So that's, that's the overall argument that I. That I try to make in the book. And I do that by looking at. Looking really closely at the people who were working in Entebbe across the time that the Institute has been open, what they were doing, what they were saying about, what they were doing, what they were saying to each other and to their collaborators across the globe. And really taking a close look at the archival evidence, I was able to do oral history interviews with a number of people who worked at the Institute over time. And this is kind of what came out to me of what this place can tell us about the history of global health that maybe we wouldn't find if we were looking at some other place.
- [17:11]
B
It's a really fascinating story and we'll get more into some of the details and talk about some of the people later on. But for now, I want to invite you to talk a little bit more about your methodology. I think perhaps as a result of the main intervention that you're making.
- [17:29]
C
You.
- [17:29]
B
Make very sort of intentional methodological moves here to really highlight how power is working in this space, across time, in different. In different situations. I'm thinking here about how you approach the language in your archive, especially your colonial archives, when it comes to categories of workers and people in the space. One other thing that I was really struck by was how you use photographs. Specifically when you chose to use photographs and when you chose not to use photographs. I'm thinking about your. That when you're talking about Burkitt's lymphoma and you choose to describe rather than show photographs. And I just want to invite you to talk about the decision making process and what you intend for the reader to get out of that.
- [18:33]
C
Yeah, thank you. What a great question. I want to start by just saying I think I have been so lucky to work with such thoughtful people in a lot of different environments and capacities. And any good decisions I've made methodologically have been the result of my learning from other people, not in their scheme entirely. So I'll try to point some of those out. But one of the things I love about history, and particularly African history, is it is such a. Even though a lot of our work is conducted individually, at least, the way I've been trained. And the community that I have been lucky enough to be a part of has always emphasized that this is a collaborative endeavor, this is a community endeavor, that nobody gets it right if they just try to do it all by themselves. And particularly as a white North American historian of Africa, that I need to be thoughtful about my interventions and how I'm using my sources. So, I mean, methodologically, in the simplest sense, the book is a very classic history book. I am a historian. I love works that are much more ethnographically informed. But that has not ever been my particular strong suit. So it relies heavily on archives and oral history interviews and review of published literature. But the archives, as you allude to, are challenging because one of the hazards of doing a history of a place that has existed for almost a century as a colonial institution, as an institution in the period of decolonization through multiple political regimes, has survived a civil war, has, you know, faced a number of different contexts, is that the archives are not. They're not consistent. Sometimes I tend sometimes to think in metaphors from high school history, from, excuse me, high school science classes, and I'm like, there's no constant variables, right? So, for example, from the period of 1936 to 1950, the Rockefeller foundation was. Was a real driver of the program. They were basically co sponsors of the program. And the Rockefeller foundation infamously kept phenomenal records, right? And the Rockefeller Archive center up in Sleepy Hollow is just a phenomenal place to do research. And I just want to give a shout out to the archivists at the Rockefeller Archive center, because this project, I can't imagine it getting off the ground without them. And what they taught me about using archives. But I have diaries for all of the Rockefeller employed scientists who worked, I mean, day by day. Just here's what I did, here's how many mice I killed, here's how many different diets I tried for those. I mean, just, you know, the minutiae that's available, it is. It is overwhelming in its volume, and it can be. It can create a false sense of. Of intimacy and authenticity, I think. But it also gives you so much fodder. After 1950, the Rockefeller foundation was no longer directly funding the Institute in the same way it was no longer directly employing people who worked at the institute. And so the traces of the VRI at the Rockefeller foundation, no government. So there are pretty good archives. There are extraordinary archives at Kew, of course, and there is great documentation there, but it tends to be at a level quite a bit removed from the day to day compared to the Rockefeller archives, and of course, is, you know, written. I mean, I don't think I need to review for listeners to this podcast exactly all the problems of using colonial archives. But, yeah, I mean, very much a challenge in reading against the grain, thinking about what's really happening, thinking about what they're not telling you. And then the UVRI itself has an archive, but it is an archive that has never really had. The UVRI has never had the opportunity to put the kind of resources towards that archive that would make it easily accessible to researchers, or until very recently, even house it in conditions that were going to protect it from damage. So it's very uneven, it's unprocessed, or at least at the time that I was using it. So I was really just going through stacks of folders with no idea what I would find. And unfortunately, there was a fair bit of damage to a lot of the documents in the archive. And I'm really excited that the UVRI has been. They know what a valuable resource they have, and the people there absolutely are doing everything they can to preserve it, which is fantastic. So there were periods that I cover in the book where one of those archives would have a lot of material and the other two would have very little, or vice versa. And then there were periods where, frankly, the archives did not have that much. And so how to tell a story that would have some continuity, that would have some narrative coherence, while I was sort of jumping between what kinds of historical voices I had access to, was really challenging, and I'm glad it was relatively successful. But you mentioned language, and I suspect the example you have in mind is the use of the word boy to describe a lot of the workers in the archive. Sorry, a lot of the workers at the institute who were described in the archive and. Yes. So most of the Ugandans who are employed at the Institute throughout the colonial period were in what were often described as unskilled positions, although they were not at all unskilled. Right. They. They required a great deal of skill and they were often referred to as monkey boys or. Or they use the term. And this is where I have to give credit to a reviewer, because I. I knew how problematic the term was, and I knew, as I was reading that that referred to, in most cases, grown men who were responsible for supporting their families and who in a lot of cases, had demonstrated and developed great expertise in their areas. But I had just sort of stopped seeing the word. I just it just didn't stick out to me. And it was when the book was sent to, to readers before publication that one of the readers pointed out to me that this is really jarring to see this word come up. And I'm so grateful that they pointed it out because as soon as that was pointed out to me, it was immediately obvious there's no reason to keep repeating this, right? It does not add value. And so I went through and I replaced that word in most cases with worker, because I thought, well, what I'm really saying is these are monkey workers or laboratory workers or animal house workers. That's what they were. But I also didn't want to erase the use of the word because it also does of course, signify something about the way that the people using that term thought about the people working for them. So I made a decision to leave it in brackets so it would be visible to the reader that that was a change I was making. But again, I just, I kick myself for not having thought of it on my own. But I'm, you know, this is one of the many reasons why having other people read your work is so important. And I did I think about that. The other term that I thought a lot about was the term scientist. So before the 1970s, there really were not Ugandans or Africans who were thought of as scientists at the institute. Scientists was a term that was reserved for almost exclusively white, almost exclusively male research workers who had earned doctoral level degrees and were recognized as scientists by their peers who were understood to be conducting original research. You know, that required creativity and analytical thought on their part. And everybody else was an assistant or a technician. And I knew I wanted to problematize this idea that the only people doing real scientific work were these people who had claimed to the title scientist. But I had reservations about retrospectively applying the term scientist to a bunch of other people. And that's partly because over the course of the story of the UVRI who had claimed that title did change. And by the time you get to the 1970s, the 1980s and into the present, there are many Ugandans and other black Africans who have earned the title scientist by achieving those same markers that had been required of people in earlier decades, right? They had doctoral level training, they were recognized as such by their peers. And I didn't want to ally the difference between that and and the earlier Ugandan workers who did not have those credentials, who were never offered the opportunity to earn those credentials, who would never have been recognized by people with MDs and PhDs as scientists. I wanted. I didn't want to erase the historical change that occurred. So I decided to use the term researcher because I thought it emphasized the fact that they were, in fact, engaged in research work. They were not, quote, unquote, mere technicians or assistants. But it allowed me to still look at a change over time, and who was allowed to be considered a scientist, because that seemed meaningful to me. In terms of photographs, I mean, part of the choices are logistical, right? I would have loved to include three times as many photographs, and that's just not possible. But you're right. So, for example, right? One of the sections of the book talks about Burkitt's lymphoma. And this is a form of cancer that, in the time that I'm writing about, primarily afflicted children in particular parts of Africa. And it's characterized by really aggressive tumor formation on the jaw and other parts of the face. And in the archive, there are whole albums of photographs of children who have these tumors. And the photographs are really powerful. So in some ways, you know, it was tempting to include them. But again, this is where, being part of a number of different communities, I've been lucky enough to listen to and to participate in conversations about what forms of harm does history do? What are the ways in which historians can perpetrate violence, inadvertently or otherwise? And that was very much on my mind as I was looking at these photographs and thinking about the fact that, you know, consent was certainly not part of the process. The pain that these children are in is often quite visible. And knowing that they didn't have a choice about whether or not to be photographed, that, you know, if a child today in the United States has a picture taken of them in a clinical setting for that picture to be published, you know, the amount of consent that has to be given and permission must be given by the parents, sent by the child. And it didn't feel right to take advantage of the fact that those. The protections hadn't been afforded to these children. And so I tried doing it without the photographs, and I tried just describing them. And I concluded that I could achieve what was useful and necessary for me to achieve without them. And it seemed to me that the possible benefits of including them did not outweigh the possible harms of including them. So that was a choice I make. I think, you know, people. People deal with this decision a lot, particularly in the history of medicine or the history of anything, where these violent images occur. And I think that there are times when using them confront the reader with something that they need to be confronted with. But I think in this case it would not have been useful. And I also reminded myself, I mean, anyone can Google image search childbirth, lymphoma. So you know, that's a choice that the reader can make for themselves about whether they want to seek these images out because they're readily available.
- [30:25]
B
When did making plans get this complicated? It's time to streamline with WhatsApp, the secure messaging app that brings the whole group together. Use polls to settle dinner plans, send event invites and pin messages so no one forgets mom 60th and never miss a meme or milestone. All protected with end to end encryption. It's time for WhatsApp message privately with everyone. Learn more at WhatsApp.com limu game and.
- [30:53]
C
Doug Limu and I always tell you to customize your car insurance and save hundreds with Liberty Mutual. But now we want you to feel it. Cue the emu music. Limu Save yourself money today. Increase your wealth. Custom made and save. We save. That may have been too much feeling. Only pay for what you need@liberty mutual.com Liberty Liberty Liberty.
- [31:17]
B
Liberty Savings.
- [31:18]
C
Very unwritten by Liberty Mutual Insurance Company and affiliates. Excludes Massachusetts.
- [31:21]
B
Yeah, I mean, I think the descriptions that you give are, as you say, you know, perfectly sufficient to sort of drive home the seriousness of what you're writing about. And so I want to invite you then now to talk about these three viruses that the UVRI sort of evolves through over the course of the 20th century and what each era sort of brings with it. Right. You have, interestingly, like different cohorts. Right. Of researchers that come up at different times. Each sort of virus has its particular cohort and they're navigating sort of these politics that you have already alluded to in thinking about what is local, what is global, how do you make research legible, how do you sort of, you know, communicate findings and all these things. So can you talk about the viruses and how the UVRI sort of evolves through each one?
- [32:28]
C
Sure. So, yeah, I chose to structure the book in three parts. And in each part I focused on one virus or potential virus that the Institute was looking at. And I did that for a lot of reasons. One was just I had to have some form of selection because I could have written a 12 volume history of this place. And I hope that there will be more histories of the Uganda Virus Research Institute, because while this is in many ways an institutional history, it is absolutely not an exhaustive history of the Institute. And there's so much going on. But as I was going through the research, and particularly as I was looking at the annual reports of the Institute, which is another just incredible source that I had access to, it became clear that over the course of the history of the Institute, there were really three periods that coincided with three viruses. So the institute was founded in 1936 as the Yellow Fever Research Institute, and that's what it was supposed to be doing. It was founded in order to answer the question of is there yellow fever in East Africa? And if so, is it newly in East Africa, or has it always been there? Because at the time, the colonial medical authorities believed there was no yellow fever in East Africa. There was only basically antibody evidence that there were people who had experienced yellow fever infection. And the British in particular, were really worried because the Indian subcontinent at the time, they knew that the mosquitoes that carry yellow fever were abundant in the subcontinent, but there was no history of yellow fever infection. So the nightmare scenario was that yellow fever was migrating eastward across Africa and that eventually it would hit the port cities on the Indian Ocean and jump ship and arrive in India and wreak havoc on the colonial economy in the 1930s. So that was the mission of the Institute, was to resolve this apparent paradox of what they called silent yellow fever, and then to determine what, if anything, was preventing yellow fever from moving further east. And that was its. That was admission. But at the time, the way you isolated yellow fever was to try to find someone infected with yellow fever and take their blood and inject it into mice and try to perpetuate the virus through multiple generations of mice. Because at the time, it was not possible to culture viruses in vitro. They could only be done in living animals. And I should say, at 19:36, without getting into too much of the technicalities of it, the whole. The very definition of a virus was different than it is today. So in 1936, the definition of a virus was something that transmits disease, something that causes disease that can be transmitted from organism to organism that's so small that even our finest filters can't filter it. So they're sometimes called filterable viruses. So they were out there just taking blood from all kinds of people, trying to find evidence of past yellow fever infection and preferably recent yellow fever infection, to try to identify this silent yellow fever and catch it kind of in the act, so to speak. And along the way, what happened was that they found a whole bunch of other viruses. So the Institute, in this period and in subsequent years, discovered Zika virus, which, of course, became big news. As I was writing my dissertation, Chikungunya virus, West Nile virus, Anyang virus, Uganda S virus, all kinds of viruses. But mainly this was all in pursuit of yellow fever. And that coincided with the period in which the institute was first a joint enterprise of the Rockefeller foundation and the colonial government and then a colonial enterprise alone. And it was fitting that this be an institute that was dedicated to research that in many ways had nothing to do with benefiting Ugandans. This was not a problem of sick Ugandans. In fact, the whole paradox was that nobody appeared to be getting sick with yellow fever. It was about protecting the interests of colonial, imperial, economic exchanges, of trade, of military excursions. This is really about protecting colonial and imperial interests. So that was sort of part one is what does that mean? And what kind of science gets done anyway? Because of course it's one thing to say that you're just interested in yellow fever, but they made all these other discoveries. They advanced virological techniques. They learned because studying yellow fever involved studying mosquitoes and monkeys and the habitat, habitats in which these animals. They developed really deep knowledge of the ecology of different parts of Uganda. And this opened up new scientific opportunities. So that's part one. Part two picks up kind of after the yellow fever. Questions have pretty much been answered. I mean they basically, long story short, they discovered yellow fever. Yes, there was yellow fever in East Africa. Yes, there had been yellow fever the Bernese Africa for a long time. It had a really complicated ecology which was similar to, but not exactly the same as the ecology of quote unquote jungle yellow fever in Brazil. But in the meantime a really effective vaccine had been developed. They implemented a vaccine and some of these questions just seemed less urgent. But in the meantime they had made a pretty good case that having a virus research center in Uganda could produce really valuable knowledge. And just the fact that they'd identified all these other viruses allowed them to make a case that they should continue to do this work. That there were still things about yellow fever that weren't really well understood, but also there were all these other viruses that could pose a threat in the future. And they had also kind of along the way started doing some reference work for the local hospitals and things like that. And it was really useful to have a laboratory in Uganda that could provide some answers about people that were experiencing virus caused disease. So in part two, it opens with the closing of one of the field laboratories that had been really central to the yellow fever research. And a moment when the institute kind of needed a mission, right? It had got buy in that it should continue to exist, but it didn't have that. Driving like this is the question we're trying to answer. They were just sort of out there looking to improve knowledge of virus borne diseases. And they were also having more trouble getting sufficient funding. So the colonial government funded it. But colonial funding was, you know, I think, as historians have pointed out over and over, great and not that reliable. And they always had to be competing for not only colonial funds against every other kind of project, but also other medical projects. And they needed something that would make them stand out as a place that should get funding. And this also coincides with the period when people were starting to talk about independence more. The British certainly were still talking about Ugandan independence in the 1950s as something that was way off in the future. But they were at least paying lip service, the idea that they were trying to build towards it. Ugandans, on the other hand, were really impatient to gain independence. And so part two of the book unfolds over the years immediately preceding into and then following independence. And so in addition to this question of where to get funding, there was also this question of how this colonial institute could become an East African institute and ultimately a Ugandan institute. So again, long story short, a surgeon named Dennis Burkitt had noticed this tumor syndrome and had done some fieldwork. He'd gone on what he called tumor safaris and mapped out the locations where this tumor seemed to exist. Because it was, it was, it did appear to be what they called geographically limited. Not everybody, even across Africa, seemed to be equally at risk of developing this tumor. It seemed to be people in particular places. And Alexander Hadow, who was at the time the director of the virus institute, saw some of these maps that Burkitt had made and thought they looked a lot like the maps of where yellow fever antibodies had been found. And so he posited that perhaps Burt's lymphoma might actually be caused by a mosquito borne virus. That would explain why particular regions that tended to coincide with a certain range of altitude, a certain range of maximum and minimum temperature, and a certain range of annual rainfall were conducive to mosquito reproduction and therefore mosquito borne viruses. And this was a hot topic at the time. This search in the 1960s was on for human cancer viruses. Up until this point, cancer had been understood to be something that was not related to infectious disease. And someone had identified a virus that caused tumors in chickens, which raised the theoretical possibility that there might be viruses that cause tumors in humans. And there was a lot of money going into this research from the National Science foundation in the United States, from the Imperial Cancer Research Fund in the United Kingdom. And Haddo, I think very strategically realized that if the Institute could stake a claim to this kind of research, that would be very much in its best interest. And what they had that set them apart from institutions anywhere else in the world was proximity to communities where this tumor occurred and expertise in studying mosquito borne viruses. So he really mobilized around attracting people to come to Entebbe to research this possibly vector borne virus that would cause a human cancer. Now in the long run, they did not identify a mosquito borne virus that caused Burkitt's lymphoma. They did do a lot of work that ultimately contributed to the, what is now the understanding that Burkitt's lymphoma is caused by infection with Epstein Barr virus and really intense exposure to malaria. That appears to be the causal pathway that leads to a lot of cases of Burkitt's lymphoma. But it was a big part of the Institute's research at the time. That was never the only thing they were doing. There was always other research going on. But what I found after examining the records was that Burkitt's lymphoma was kind of the, it was the, it was the fundable research that to some extent subsidized the rest of the research at the Institute. And it also, I think, marked a new stage in the Institute's position in the world. And this is the period where I argue in the book that they kind of invented this category of the local partner. Because up until then research at the Institute was done by people employed to work at the Institute. They were full time institute researchers. And it's in the period of the Burkitt's lymphoma research that you first start seeing these teams of researchers who are employed by another institution who are placed in Entebbe for a fixed period of time and hosted at their facilities, but working with varying degrees of autonomy from the core staff of the Institute. And that was something that the Institute researchers themselves were really ambivalent about. They did not like the idea that the research at the Institute wasn't their research or that they were seen as just local facilitators of the research these other people were doing. But at the time this seemed like their best bet for staying open to attract these outside researchers. So not only was it a different kind of virus that they were researching, there was also a different mode of what it meant to be a Ugandan virus research institute. It became a place that, to paraphrase some of the Archival records had to be known as a good place for other people to come do research. They didn't use the term local partner, but a lot of the qualities that they describe as being what they had to offer are the same qualities that local partners today would say they have. So solid built infrastructure, quality, highly trained technical staff, accounting capacity, grant reporting capacity, access to field locations and specimens and test subjects. And so that's the period where this paradigm really gets established. And one of the things that I want to emphasize is that at the time this was not seen as them establishing a new paradigm for research that would become normal. This was seen as a stopgap measure. And they were very explicit about this. This was something that they thought would be necessary for this period immediately at least surrounding independence, when a lot of the North American and European based scientists were leaving Uganda and new expatriate researchers were not coming to replace them. But there weren't enough fully trained African and particularly Ugandan researchers to staff the institute. And they were really worried that the institute would no longer appear credible as an international institution. So they thought this is a way to solve that problem while we train up new generations of youth on and scientists while we establish our reputation as an independent institution and then we'll be able to go back to like it'll be UVRI scientists at UVRI doing research. And instead that became the new normal and that that transitions into part three of the book which primarily focuses on HIV and aids. So right around the time that the Burkitt's lymphoma research ended in 1979, it's just a few years before you see evidence of the first HIV AIDS cases in Uganda. And in some ways AIDS AIDS allowed the institute to survive and to grow. In the 1980s and 1990s it really fell into a state of neglect. In the 1980s there was a civil war in Uganda. There was no domestic funding. It had between the period of independence and 1979 it had been administered by the East African community, but the East African community collapsed. There was no funding from there. And so talking to people who were there at the time, I mean technically the institute remained open, but they talk about just a couple of people barely doing any research, mainly continuing to occupy the buildings to prevent them from being requisitioned by the military basically. And there are some great stories about the ways in which they, they used rumors about dangerous viruses to prevent the military from requisitioning the facilities. But in 1986 when Museveni came into power, he was one of the first African heads of state to really call attention to the AIDS crisis. And that was partly because of an early report that show showed that a really high percentage of his army was infected. And the UVRI was the place that knew how to research viruses. They knew how to handle safety protocols, they knew how to process viruses. And so there came this infusion of resources, partly from the state, but mainly the state was sort of offering political support. And then, as researchers from across the world wanted to understand the AIDS epidemic in Africa, the UVRI became one of the places they came. The UVRI by that period was under the umbrella of the Ministry of Health in Uganda. It was a state institution. And so it became a requirement if you wanted to do research on AIDS in Uganda, that you had to be collaborating through the uvri. And so it brought in enormous amounts of expertise, of resources. And part of the challenge of writing about this period for me was how to write about a period where, you know, ethnographers like Joanna Crane have done really good work showing how these North American and European AIDS research projects kind of reshaped the landscape of Central and East Africa around AIDS research projects, and how in many ways, the interests of these internationally based organizations trumped local priorities, local initiatives. And that was not really what I. That's not incorrect. I don't think that that analysis is wrong. But what I found is that looking at what was happening in the 1980s and the 1990s in Uganda, having seen what had been happening there for the previous 50, 67. Sorry, I can't subtract all those seven years. That looked really different. And it was easier for me to see the ways in which the Ugandan scientists were advocating for what they needed, the way that they were shaping their negotiations with foreign researchers to ensure that they were not just instruments for implementing priorities that were developed far away, but how they were managing access to those resources in order to accomplish their own goals and to achieve their own priorities. And that was a story. I wanted to do justice to this without dismissing the very real critique of the way that international global health research has often prioritized the needs of researchers based in the global north, so to speak, while also taking seriously the claims of every Ugandan researcher I spoke to that they were not puppets of any other research program. They were autonomous peers in these projects. And indeed, that is something that I found. And again, I think it required understanding that the fact that they might be the local partner on a research project didn't mean that their role was restricted to implementation, to, you know, Liaising with the communities that they could use their local status to be really powerful partners in these projects and that they could also be global, that they. You know, one of the quotes that I love from one of my interviews was in the 1990s, when you would go to international AIDS conferences, wearing a name tag that said you were from Uganda, gave you status, like Uganda was where the exciting research was happening. And I wanted to. I wanted to do justice to both of those perspectives.
- [52:08]
B
I think this is maybe a good time to delve more deeply into a big theme in the book.
- [52:16]
C
Right.
- [52:16]
B
Especially as you're thinking through relationships, which is race, and it runs through the whole book. And so can you talk a little bit more about race, how it's functioning in this place at different. In all these different eras, and gender as well, which is. Is also present, perhaps to a lesser extent, but, you know, something talk about there too, right, that it's not, you know, women are not. They don't feature as prominently as, you know, men. So can you say more about that? Tell us the story about race and gender that's playing out over the course of the years?
- [53:01]
C
Yeah, I'll start with gender, just because I agree that gender is a very present phenomenon in the story that I tell in the book, or it's very present in the story that I'm trying to tell, but I ultimately didn't have a lot to say about gender, and I thought about that, and I wish I could, and I do think that a different historian, looking at the same sources I had, would be able to say something really interesting about gender over time. And there were aspects of it that I. I decided not to highlight as much. So, for example, in the 19, and I'm forgetting what year, but it was either the late 70s or I think it was the early 80s, when you get the first female quote, unquote, scientist who's hired as a scientist. Right. There were women always at the institute who were working in a variety of capacities, but the first time somebody was appointed to one of the scientific staff lines wasn't until the 1980s. And, and I know there's some really interesting stuff going on there and some of it I have a bit of insight into, but it really. It is something that I. I wish I'd had more time to get into, but I also, you know, no project can do everything. And I. I thought it was. I guess I. I don't want to say much about it because I really think that I couldn't do justice to the importance of that topic. And I really excited to see what other people do with it. Race, on the other hand, was very present and not inexplicable, inescapable. I will say my thinking about race in the project changed over the time that I was working on it. I started my PhD in 2010. I started working on this project really in 2012, 2013. I finished my dissertation in 2017 and knew I was going to a job where I would be the African historian. And so I was thinking a lot about race and what it meant to be a white Africanist, talking in Africa seminar here at Hopkins with other people who are doing work that was much more explicitly about race, reading some history of engagement more explicitly the race, and trying to decide what I wanted to do with that in my own work, where I tended to be thinking less in terms of race and more in terms of national origin. And I think that really reflects the way global health talks about it. Until pretty recently, global health didn't really talk about race that much to the extent that we were thinking critically about the relationships between different players in global health that tended to be about national origin, institutional affiliation, low and middle income countries versus high income countries. Race really was not very often an explicit category. And so at the time I finished the dissertation, I think I had incorporated some, but not that much. It just, I had sort of told myself, it's just, you know, that not every story about Africa had to be a story about race. And this just really wasn't, which I think was naive. I was revising the book hypothetically starting in 2017, but it took me a little while. I had a lot of teaching in Tennessee and I was doing a lot of things. And I would say that I started such a cliche, but I think I really started grappling with it in the summer of 2020. I was doing. I had a postdoctoral fellowship in Baltimore for 2019, 2020, where I had very little teaching. And I had really dedicated time to get on a project. And I was fortunate to have, in addition to the mentorship of Randall Packard, who had just been a phenomenal advisor all along and was also working with Mary Fassell, who's an early modernist who does not work on Africa, but who's a great reader for just, you know, what's your intervention here? What's the story you're trying to tell? Why does it matter? And she was really encouraging me to unpack the dissertation and think seriously about what I wanted the book to do. And of course, in the summer of 2020, we were all in lockdown for Covid. And then there were the Black Lives Matter uprisings. And there were a lot of conversations I was having with people on zoom and on social media about what does it mean to talk about race, and what does it mean to decide not to talk about race? And that that is a choice. And that is a choice that sometimes seems neutral or harmless and often is not. And so I started looking at my work through that lens and thinking about the places in my sources where people were not talking about race explicitly, but clearly what they were describing, the decisions they were made, were really strongly informed by ideas about race. And that it became more and more obvious that a failure to take that seriously was to adopt, you know, an attitude toward race that a lot of the historical actors had adopted, which was not useful. So I started thinking a lot more about that. In 2021, I also became the interim Director of Africa Studies at utc, which is a whole other story. But the best thing that came out of that for me was I ended up in conversation with all of these people who were not necessarily part of the History department, were not necessarily Africanists, but were steeped in Black studies in, you know, critical approaches to race. And that just opened up all new vantage points and new ways of thinking that I. That I tried to. To let inform my analysis. And so it. It was a really deliberate process of going back and. And basically trying to find places in the manuscript where I hadn't raised race explicitly, but it very clearly was part of what was going on. And just trying to. To call that out and to name it for what it was and to think about the ways in which the scholarship around race and racism needed to inform not only the story of the Uganda Virus Research Institute, but the story of global health. And so that's what I tried to do. I don't think that I succeeded in fully. I mean, I don't know. These projects are like, done done. But I am glad to hear that as a reader. That is something that was evident. And I hope that this can be an invitation for people looking at other places to think about, yeah, how is gender, how is race shaping these things? How is that framing these relationships? How is it constraining the universe of possibilities that appear to anyone at any given moment that allowed one think about what this research could do, what these questions could include? And that's something that I think is really critical for global health moving forward as well.
- [59:50]
B
No, it comes through very strongly. So I would say you are successful there. The other thing, and I think it's they're not entirely separate, but it's a word that actually comes up quite a bit. Extraction. Even when we, you know, from the very beginning we're talking about, you know, they're drawing blood and you're thinking they're extracting actual blood. You know, just the scientific process. Right. Is so kind of exploitative. Yeah, well, it's. Yeah, right. It's like you're, you're taking, Right. It's a constant taking of things, of very intimate things from people. So I just want to invite you to sort of talk about the extractiveness of this industry, really that we're talking about here, global health and how that sort of. I don't know if I have a fully formed question here, but how does the industry, the people that are doing this work, how are they grappling with the extractiveness of this? And then as the history progresses and then the makeup of the institute changes over time and you get now actual, as you've already explained, Ugandans, you know, being at the forefront of this work and facilitating some of this work. How, how do we think about extraction here? If you could talk. I don't know if that makes sense at all.
- [61:30]
C
It absolutely does.
- [61:31]
B
The word comes up. So I was just curious, you know, your thoughts on that.
- [61:36]
C
It really is. I mean, in a way, I think. I mean, one of the things that I, I don't know how much this is serendipity and how much this is self fulfilling, but I really do think it maps onto the three phases book as well. And so it's like, you know, I don't know which came first. The three parts are the way I see things changing. But, you know, in the first period of the book, the 1936-1950 extraction was seen. It was a colonial institute and the colonial endeavor was fundamentally extractive. Right. And so it was understood to be absolutely the right, the privilege and in fact the responsibility of colonial workers to extract things from Uganda and from Ugandans and put them to their highest and best use. That was, I mean, you know, there's, there's almost a manifest destiny to it, right? This idea that it was the responsibility of British colonizers to, to capitalize on these resources. And so, yeah, I mean, this, this idea that you could go into a village and require that everybody line up and allow you to draw blood. I mean, nobody even blinked at that in any of the sources I have, not a single person says, you know, a little like, no, I mean, it was just completely taken for granted, you know, and to the extent that they would observe that in some places this was easier than others. It was really just, you know, described as sort of the irrational recalcitrants of the natives to being, you know, they're so superstitious, they don't understand. And then in the second period of the book, they are very explicitly observing that the times, they are changing. And some of them see this as cause for regret, right? Like, they just don't. You just can't do good science the way you used to be able to. You just can't. You know, you can't just make people line up and stick their arms out. And what a loss this is to great science. And there are other people going, I actually don't think this is such a bad thing, you know, and. And in fact, this is one of those moments where, you know, I think after I had really honed in on this local global argument, things stuck out to me in the archive that hadn't stuck out to me before. Like, there's this one case where this white British missionary in West Nile district in northwestern Uganda who was a partner on a project to have a Burkitt's lymphoma cohort study, was writing to the first Ugandan director of the virus research Institute and basically saying, you people from Entebbe, you don't know local conditions. You don't understand. Like, you can't just come into this neighborhood and collect as much blood as you want and just assume that if the government says it's okay, you can do whatever you want. And I just had this moment of like, wait a second, wait a second, wait a second. Who's lecturing who? On, like, local sensitivity. And. And again, neither of them was like, I know this might seem weird. Like, this was totally. And it made me realize that the assumptions I was making about who counted as a local expert and who counted as an international authority did not map completely onto these people. But this is a period when, yeah, some people were quite reluctantly acknowledging that you had to have some buy in by the people whose blood or bodies were being used as resources for research. And the extraction had to be negotiated, and there had to be forms of compensation which could be material or could be in, you know, persuasion that this was something that was going to benefit their community or help to heal their children. And then in the period of AIDS research, you know, the ethics have evolved. There is certainly a language around consent that didn't exist in earlier periods. And particularly informed consent for biomedical research. There are pretty extensive institutional processes that are designed to govern forms of extraction, although they are imperfect. But it's also the period in the book where the stakes for the communities where the research being done are the highest. This is not a case like of yellow fever, of people coming in and researching a disease that nobody thinks they have. This was a case of, of an emergency. So in some ways, what can look like extraction was actually seen as bringing resources. And that became, of course, even more powerful when research became associated with access to life saving drugs. And so I think the relationship between the people from whom blood and other specimens were extracted and the researchers and the research itself is different. I mean, for one thing, when we're looking at the. So most of the research that I discuss in part three of the book is being done by the Rakai Health Sciences program, or as it was called at the time, the Rakai Project. And the scientific, well, the staff, the entire staff of that project, from top to bottom, is majority Ugandan. And in many cases, especially among the sort of second generation of researchers, it is people who grew up in the communities that are being researched. And so it's very different from some outsider coming in and extracting specimens and then leaving and never explaining what was done. And of course, this is. I was just reading a post this morning from somebody commenting, somebody not in Africa, somebody in the United States who's a member of a minority community, describing how just incessantly she and other people are asked to be participants in school research projects and things like that and that. And just that zero times has anyone followed up and given her the results, invited her to participate in any benefit from it. And so I do want to emphasize, I mean, this is, it is not something that we've solved and it is not something that only happens transnationally. But I think that there's, I think there is some improvement. And I think that the Rakai Health Sciences program in particular, from its very beginning was very deliberate about thinking about AIDS research as something that was not just being done in the community or on the community, but with the community and to some extent by the community. Now, I don't want to suggest that it's perfect or that there are not qualities of extraction, or that everybody feels like everything is great. That's, you know, I don't think that's ever the case, but I do think that that represents a meaningful change in what it means to do research in Uganda from what had happened in earlier generations. And I think that there are a lot of best practices that come out of that work that should and could be adopted much more Widely. Yeah.
- [68:37]
B
Well, I think it's a really interesting sort of aspect of your book in that everything really sort of points back to your major intervention, which is this sort of artificial line between local and global and who has what kind of expertise and who can make what claims to what kind of knowledge. Right. And I mean, I think we've been talking about this this whole time, but I want us to sort of like delve even deeper into it. Like you said, you know, sort of when this category emerged in that sort of post independence period in Uganda, it really was meant to be like a temporary thing, right. Like a stopgap where then you'd go back to a previous model of, you know, people at the institute doing the research. But then it becomes this thing where, as you say, everybody recognizes a local, like that term local, partner, local, whatever. But then one of the other things that you talk about in the book, which is really interesting to me, is this idea of what it means to translate knowledge about a place or about a virus, whatever, into legible language for a wider audience and how that plays into what kinds of claims people make about the kinds of expertise that they have. Right. And I think maybe in line with that too, if you could talk about this is event that happens again with the Burkitt's lymphoma research where there's a little tiff or fight between like people. It's like, I don't, you know, it's like proprietary, like there's a proprietary nature, that sort of like thing that develops, right. Where people want to ensure that they are getting credit for their expertise and what, you know, can you talk more about that? About the idea of translation and legibility and then proprietariness that sort of develops around claims to expertise.
- [71:04]
C
That is such a good question. I'm thinking about it. I think there's, I mean, these are big questions in the history of science and medicine more broadly. Right. I mean, the history of science, so much of the history of science is about on what grounds can you make claims and how do you have to qualify them? Do they apply universally? Do they apply only under certain circumstances and if so, what circumstances? I mean, I think in many ways there's this kind of enlightenment ideal of science around the search for laws of nature that apply everywhere. And then so much of the history of science is people grappling with the fact that in many cases that's not an achievable outcome of scientific research. And for historians of science, looking at the ways in which even claims to universality or broad Application often really do have to be qualified. And I think that that is one of the questions about the science in Africa is, you know, what makes African science? Is African science any different than science somewhere else? And what makes it African? Is it just that it happens in Africa? Is it research system by Africans or. I think, you know, there's a growing body of literature that is just absolutely fascinating and I am so excited to see grow about what does it mean to think about different epistemologies and African epistemologies and what makes them African. And so I think that's a big question and it is something that I think is interesting because it's not only a dilemma that historians grapple with, but that the scientists themselves grapple with in every generation. Not necessarily in those terms. We're not generally talking about different epistemological claims, but this question of, I mean, oh, I mean, the amount of archival documents about how to make sure that the mouse studies conducted in Uganda can be compared to mouse studies conducted in New York and in Rio and in Geneva. Because it's like, you know, okay, well, we've got genetically identical mice, or at least, you know, as close as we can figure out, we've bred them from the same ones. I mean, they would ship mice from lab to lab to make sure that they were as close to the same. And then, you know, you wanted to feed them the same thing so they'd be comparable. But it turned out if you feed these genetically very, very similar, if not identical mice the same thing in Rio and in Entebbe and Entebbe, their fertility plummets. Like you have to feed them something different. And they don't know if that's because of the altitude or their temperature or what. But okay, so now they're not on the same diet. So are they comparable and all these different things? And that's just the laboratory based things. And I hope that the book contributes to this really interesting historiography of the history of lab, the history of the field science and the interaction between them. But this takes on then other dimensions when you're looking at these ecological studies. So one of the things that I think is really interesting about the institute is before people were really talking about what in some ways is what people are now talking about as one health, this idea that human health is inextricably related to the health of other animals of environments, that, that human health is not, it's not removable from these really complex ecologies in which we live. That was very much the way they were thinking about yellow fever in the 1930s and the 1940s. I mean, they were absolutely committed to this idea. If you wanted to understand yellow fever, you had to learn where different breeds of mosquito would lay eggs at, you know, what kinds of plants, what kinds of weather, all these different things. So, and it relates to the founding question of the institute. I mean, one of the questions was, is there yellow fever in East Africa? And if so, is it the same yellow fever that they have in West Africa, and is it the same yellow fever that they have in Brazil? And so this question of universality versus local specificity was absolutely something they were thinking about. And one of the things that I tried to trace through the books is the different ways that they tried to either resolve that paradox of how something that you have to study in one place can tell you something about other places, or to emphasize the lack of universality. Why it's really important to understand something here because it's different. And I think it's a tension that sometimes they perceive as a handicap and sometimes I think it's actually a very generative tension, something that allows people to ask particular kinds of questions that turn out to be really revealing. So, yeah, I don't think I can sum it up any more concisely than that. When it comes to proprietaryship and priority, I think this is also really interesting. So one kind of classic history of science for medicine question is who did it first? Right? And it's not something I'm particularly interested in, but it was certainly something that scientists at the time, in these different periods we're interested in. So this question of, you know, who gets credit for isolating a virus that might be linked to Burkitt's lymphoma is really important. And I think part of what was helpful for me looking at this is like, what was at stake for them, right? I mean, yes, professional pride, absolutely no question. But also, you know, if credit went to a researcher who's affiliated with the Imperial Cancer Research Fund and whose office address is in London, even if it is based on a research he did while he was stationed in Entebbe for 18 months, then it's going to look like this is why you invest in the Imperial Cancer Research Fund in London, not this is why you invest in the Uganda Virus Research Institute in Entebbe. And the stakes of being able to claim priority and being able to get credit, especially in a period where there are very explicit, very loud opinions that there's no point in investing in science in Africa because there's just no capacity There. There's no natural talent there. Or even if there was, the obstacles to, you know, building successful institutions, Right. Like the return on investment would be too low. So there are real stakes to being able to claim these successes. And that was, that was interesting. And then also just seeing. Yeah, I guess, I mean, there's a. There's a certain delight as a historian in seeing the juxtaposition of the very, very consequential and be very, very petty. Yeah, just right there in the same letter.
- [77:46]
B
No, I think one of the. To your point, there's a lot of drama in history. And so, you know, it's always fun when you encounter some of them.
- [77:56]
C
Right.
- [77:57]
B
Especially it's sometimes like moments of lightness that release the valve of some of the very serious things that we're confronting in the archives and reading about. So I enjoyed that about, about the book. The interpersonal relationships and sort of how they throw into relief some of these bigger questions that you're looking at, but also just, you know, little moments of, like, absurdity and, you know, lightness in there as well. So just to sort of start to round up here, I think most people now think perhaps more about viruses right. Post 2020, everybody beyond sort of the, you know, the flu shots that we've been getting for how many years now, everybody's sort of like very sort of aware of viruses and, you know, how quickly they can spread and maybe a little even more knowledgeable about the research into viruses and different viral infections. And you sort of end the book by looking a little at the present and a bit more into the future in light of COVID Zika, which, as you know, was discovered a long time ago, but had a comeback as well recently. And then Ebola, which is constantly sort of percolating a little bit. So can you say a little bit more about that and about the UVR now, the UVRI now, and sort of the work that is ongoing there?
- [79:37]
C
Yeah, absolutely. One of the things that I really love about the series that the book is in, and it's the Perspectives on Global Health series from Ohio University Press, is that it's actually a requirement of the series that a historical work be brought up to the present. And that was not a problem for me. I always wanted to bring it up to the present. But I really like the way that they have prioritized, making the connections between the past and the present really explicit. And that's something that I find really rewarding. I have been the annoying family member who is warning everybody at every holiday gathering that it's just a matter of time before there's a catastrophic flu pandemic again, since I was in middle school. And so there has been a certain degree of, I told you still, vindication. I'm not going to lie. Okay, fine, it wasn't flu, but I stand by it. There will be. It was a virus. It was a virus, it was a respiratory virus. And I'm not feeling particularly optimistic about influenza either. So, yes, I have occasionally found myself laughing that I think every historian to a certain extent wants. Well, at least I always wanted to be relevant. Right. I really wanted to do work that was relevant. And I definitely found myself in the summer of 2020 thinking I could stand to be a little less relevant. But yeah, I think that the evidence has been present all along that viruses pose a significant threat to human health. And there's a degree of complacency around success of the biomedicine that I'm going to oversimplify in a way that's going to make my history of medicine self cringe. But to be very simplistic about it, I think there's the degree of complacency that was largely driven by the success of antibiotics, and that is a complacency that we really can't afford. For one thing, even antibiotics have limitations. We've seen a rise in antibiotic resistant infections over decades, and we've also never been nearly as good at dealing with viruses as we have been with bacteria. But the research has made extraordinary strides in understanding how they work, how we can prevent them. I mean, the development of MRNA vaccines was just such an extraordinary accomplishment. And I saw a lot of misunderstanding and ignorance about history in the wake of the release of these vaccines. And I think that historians have work to do on helping people understand that this didn't come out of nowhere. I think the perception for a lot of people was, you know, this disease came out of nowhere and then so did the vaccines, and that's why they're not trustworthy. And I can see how that, I mean that, yes, I think in a lot of ways that was the way people experienced it. But knowing more about the history of viruses and the history of research on viruses and the history of research on vaccines tells a really different story and one that I think would actually give people a lot more confidence. Similarly, you know, another narrative that has come out of the COVID pandemic has been about the risk of laboratories, you know, this question of a laboratory origin of virus. And I'm not here to weigh in on where Covid came from. But what I will say is, I mean, the, the degree of protection that is afforded to us by having virus research laboratories around the world is immeasurable. And Ebola is such a good example because Uganda has had numerous outbreaks of Ebola over the past several decades. And, and none of them have been nearly as catastrophic as they've been in other parts of the continent. And part of that is because there is a reference laboratory that is equipped to very, very quickly diagnose Ebola so that appropriate measures can be taken. And that is, that is critical. I think that sometimes these research laboratories are seen as at worst a liability or a risk and at best, kind of a luxury, and they're not. They're absolutely foundational to having a public health infrastructure that can respond to rapidly changing threat profiles to bring experience and expertise to bear. I don't know that I'm always a popular lecturer, but I like to remind my students that every time they hear somebody say that Covid was a once in a lifetime pandemic, they should, they should immediately remember that first of all, it's not even the first pandemic in most of our lifetimes. I mean, the AIDS pandemic, it's been catastrophic. And that it's almost. I mean, I, I will bet everything I have that it won't be the last. That everything from ecological encroachment to increasing speed and volume of global travel to global climate change, all of these things are making it more likely that we're going to confront new outbreaks of viral disease that pose a risk to humans and to animals. I mean, I also often quiz my students so they know which two diseases have been eradicated deliberately. And they all know smallpox. And most of them don't know rinderpest. Rinderpest is the second disease that infects cattle. And part of the reason that was so important was not because rinderpest made people sick, but because it could absolutely devastate a, a food environment and cause catastrophic famines. And so it's not just about viruses that are going to kill us. It's about viruses that could wreak havoc on our food systems on all kinds of things. So yeah, without sounding like an absolute doom spreader, I think that one of the things that I really want people to take away from this book is that responding to and understanding viral disease requires long term investment. And the kinds of research that you can do at the Uganda Virus Research Institute today are not kinds of research that you could do at a place that you start up tomorrow that you can't just pick up where they left off, that every research project they do benefits from the generations of tacit knowledge of shared wisdom, of experience, of infrastructure, of relationships with communities, of relationships with clinicians. And if you don't invest in that when you don't think you need it, it will not be there when you realize you do. And that is something that is true of so much of public health. But I think that this is one of those areas of public health that a lot of people think very little about. And why should it matter to me, living in Maryland, whether or not there's a virus research laboratory in Entebbe? And I want people to realize it matters a lot.
- [86:36]
B
Yeah, I think the book shows that.
- [86:40]
C
Thank you.
- [86:41]
B
So, right before we wrap up, I want to invite you to talk about your next project. What can we expect from you next? And no pressure, but when?
- [86:53]
C
That's a really good question. The project that I'm working on now is still in its early stages, so I don't have a release date for anything. But it grows out of something that I saw when I was working in Uganda on this project, the Rakai Health Sciences program. At the time that I was doing a lot of my research in 2013, 2014, 2015, was launching a major campaign to promote male circumcision for HIV prevention. And I just was kind of taken aback by the various strategies that I saw for promoting this, not in a good or bad way, just so, like, I didn't expect that. And so I started paying a lot more attention to health communication. Basically, you know, how does research or not research something like this? Right. How do people who have claims to expertise in what will make people healthy or keep them healthy, how do they get that message out to the people that need it? And so I'm looking at the history of mass public health communication in East Africa, which a lot of which is going to be about this phenomenon of social marketing and the way that what had until the. The 1960s and the 1970s really been thought of more as health education or health promotion, something that was largely done by people who are either educators by training, or medically trained nurses and doctors. How that space gets, I'm going to say, infiltrated, although I don't necessarily mean it in the sort of pejorative way that that, but by people who have marketing and advertising experience and this question of what's the right way to get people to adopt services or behaviors or products in the name of health. And so I'm interested in looking, I kind of have a few sort of points that I definitely want to be part of the story. And I haven't yet quite worked out the best way to link them together. So there's the circumcision promotion efforts that I saw in the 2010s. There is the work around social marketing of family planning and particularly contraception in the 1970s and the 1980s. And then there's this much older history of invoking health to sell commercial products, some of which are arguably not about health at all. That goes back to the earliest forms of print media in East Africa. And I'm trying to figure out what's the through line here. You know, is it about claims to expertise is about tracing the contours of what makes someone healthy and how we imagine health and what. What qualities do we associate with it. So, as I say, it's very early phases. I wish I had a more coherent version, but there are. I feel like I know what certain chapters of the project are going to be about, but I'm still having a little bit of a hard time deciding exactly what the thing as a whole will be. But I'm really excited about it.
- [89:59]
B
It sounds fascinating and so we will be looking forward to seeing that. Thank you so much for being here, Julia. It was nice talking to you.
- [90:09]
C
Thank you so much. This is a wonderful conversation.
- [90:12]
B
It really. And it's a wonderful book. So thank you for coming. And the book title is virus research in 20th century Uganda between Local and Global. And we've been talking to Dr. Julia Kaminsky.
- [90:31]
C
SA.