In the last piece I wrote on the controversy surrounding the origins of the COVID-19 pandemic, I tried mightily not to exceed the range of what we can positively assert at this stage (which is very little, since the one thing seemingly everyone can agree on is that much of the salient evidence that would help us resolve the matter has likely been lost or suppressed by this point). To the extent I came down on anyone's side, however, it was to plump for what I dubbed the "weak" version of the lab leak hypothesis: namely, the thought that SARS-CoV-2 emerged in the wild, but may nonetheless have made the jump to human-to-human transmission through contact with scientific field researchers, or within a lab where bat populations were brought in from the field to be studied.
This remains one available theory of the case; but I no longer feel as confident as I did earlier this week in rejecting the "strong" version of the hypothesis out of hand. (Indeed, I would challenge anyone to read this piece by Nicholson Baker, this one by Nicholas Wade, and this one by Milton Leitenberg, and emerge from them without a new—if discomfiting—openness to the "strong" lab leak scenario). According to this version of events, recall, SARS-CoV-2 never existed in the wild—and may not even have been inside a bat—but rather was engineered in a lab through gain-of-function research conducted with "humanized" mice (that is, research animals genetically altered to more closely resemble human susceptibility to viruses).
It's a thesis that sounds at first far-fetched, I admit, but it must be borne in mind that: 1) such experiments need not be undertaken with ill intent, but rather are frequently pursued in the service of pandemic preparedness; 2) we know that the Wuhan Institute for Virology was explicitly conducting gain-of-function research of this sort (with U.S. funding) in order to make bat coronaviruses more virulent and transmissible in humans; and 3) numerous scientists and commentators warned against the dangers of precisely this variety of research, arguing it might inadvertently cause the very pandemic—should the engineered virus escape—that it was originally supposed to prevent.
Of course, all of that amounts only to a series of eerie coincidences and circumstantial evidence that prove nothing. But the evidentiary basis for the rival zoonotic hypothesis rests on nothing more solid, despite the efforts of some virologists to assert that the question has been settled in its favor. Among the eyebrow-raising passages of a pre-print review a number of these scientists recently posted online is one in which they assert that samples from the Huanan seafood market in Wuhan (collected after the wild animals sold there were removed and the facility scrubbed down) contain traces of SARS-CoV-2. This is true, but they fail to mention that these samples were entirely consistent with the widespread later human-to-human transmission in Wuhan that found its way into the market, without ever being communicated through an animal host.
In the paragraph following, the authors acknowledge that an earlier lineage of SARS-CoV-2 was not found in the wet market samples, calling into question the idea that the virus most likely originated from the animals sold there. They address this by speaking of the potential for "multiple spill-over events" involving animal-to-human transmission in more than one wet market in Wuhan. Which, of course, is certainly possible. But the lab leak theory rests on the same kind of hypotheticals. We are thus dealing on both sides with speculations that rely for their plausibility on a compelling set of circumstances.
Simply pointing out—as the authors of the pre-print do—that most other pandemics have emerged naturally (the authors concede the big exception to this rule, however: a flu pandemic in 1977 linked to laboratory research, as well as small outbreaks caused by prior lab leaks) is not sufficient to rule out the "human origins" hypothesis in this case—especially when that theory is tied to a particular kind of high-risk research (gain of function) that has not existed for very long, and which has been controversial among scientists worried about pandemic leak for as long as it has existed.
So if we don't really know the answer, and quite possibly can't ever know the answer, due to the combination of the natural atrophy of evidence over time and the well-documented campaign of suppression undertaken by Chinese authorities (a matter of public record which, concerning as it is, is consistent with multiple potential origins of the virus, since arguably none of them reflect particularly well on the country's ruling party), then we may ask: does it matter?
A friend put this question to me explicitly, after I had spilled my guts about my gathering sense of horror at the possibility that this whole catastrophe was the result of human error. Suppose the truth really has been lost to the sands of time and the memory hole of a modern Orwellian state. Does that change anything meaningful about what needs to happen now? The same things still apply, right? We still need to mask up, vaccinate the world, conquer this virus, and prepare for the next pandemic.
All of that is certainly true. But the two hypotheses nonetheless do seem to have radically different implications for the specifics of public policy and pandemic preparedness, and they add up to very different framings of how we perceive our present plight. After all, my guiding narrative up to this stage of the pandemic was one that cast the scientific and medical professions in a heroic light. They were the voices of enlightened truth confronting the ignorant rabble that didn't want to wear a mask and entertained ludicrous conspiracy theories against the vaccine and other commonsense public health measures. The chief takeaway for me from casting an eye back on the past year was that humanity had been woefully underprepared for the threat of pandemic disease. We should have listened earlier to the scientists who were aware of this possibility and tried to warn us. We should have invested more in viral research and pandemic preparedness.
And again, as I say, all of that is no doubt still true. But it does put rather a different accent on the matter if in reality, investing in pandemic preparedness—far from being a missed opportunity—was precisely the thing that caused the pandemic.* After all, it was the U.S. government and its public health experts that in part funded at least some of the gain-of-function experiments being conducted on bat coronaviruses in Wuhan. This much is a matter of public record. If it was these experiments that created the COVID-19 pandemic, then the lesson for public policy must be significantly more nuanced than simply arguing that we need to fund more virology studies and invest in more programs for pandemic readiness. No doubt, we should still invest in some of these, but the argument also needs to be about funding the right kind of research, and under the right safety conditions.
But so what? asks my friend. The world is complicated. Public policy questions are complicated. They always have been. Why should any of this surprise us? Of course we need to still fund scientific research, while making sure at the same time that it does not yield counterproductive results. We are not in a fundamentally different position than we were before. All the above lessons really confirm is the truism that we need to be wise in our spending choices, learn from mistakes, and use the benefits of science to combat the unintended consequences that may have stemmed from the same.
All of which is fair enough. Even if this pandemic was sparked in a lab, we still need to follow public health guidelines now, get the vaccine, and scale up immunization and boost vaccine production worldwide (including through lifting intellectual property obstacles) for the sake of the vast portions of humanity that remain unprotected and to ward off vaccine-resistant mutations. Even if SARS-CoV-2 was human-engineered, it doesn't change the fact that we need further scientific research now to help us weather the crisis. It doesn't alter the truth of the earlier warnings that scientists have been dispensing for decades about the risks of viruses bred in the wild; and thus, even if if could be decisively shown (and we repeat—it has not yet been so established) that virology research caused the pandemic, we would still need more and better virology research to deal with that very predicament.
Again, true, true. But one of the other voices in my head, as I confronted this information, has been the stern finger-wagging tone of the twentieth-century social critic Ivan Illich, whose classic book on the health care sector, Medical Nemesis, has been my companion this past week. And I know precisely what Illich would say about this proposed solution of funding more medical research to combat the negative consequences of earlier medical research. He would say that this is precisely the sort of resource-intensive death spiral in which all aspects of industrial civilization specialize.
According to Illich, it is a typical tactic of self-perpetuation for large-scale bureaucratic institutions to first create a problem, and then use that very problem as a justification for expanding their domain of control. It's a kind of development-as-protection-racket: we got you into this mess; but now only we can help get you out of it.
When it comes to the medical establishment (which Illich sees as only one branch of the larger phenomenon of industrial civilization, and bearing the same problems), Illich groups these tendencies under the heading of iatrogenesis—literally, the creation of additional disease through, rather than in spite of, medical intervention. While Illich identifies a number of instances of what he calls "clinical iatrogenesis"—that is, actions of doctors operating under medical license that caused, rather than prevented, human illness—that were familiar to the 1970s, we would now have several more to add to the list.
It so happens that this week I watched Alex Gibney's new documentary The Crime of the Century, for instance, and it served as a potent reminder that the opioid epidemic—a mass die-off event that rivals the U.S. impact of COVID-19 in the scale of its mortality—was essentially iatrogenic in origin. So was Ebola, although it was sparked by an earlier and arguably less safety-conscious generation of medical practitioners (in that case, Belgian nurses who provided intravenous injections in Africa in the 1970s using unsterilized needles). So, as we saw above, was the 1977 flu pandemic. And so—if the lab leak theory turns out to be true—is the COVID-19 pandemic that still rages around the world. Added up, that is a high death toll from iatrogenesis indeed. One could scarcely ask for more salient confirmation of Illich's central thesis, with which he begins his book: "The medical establishment has become a major threat to health."
Is Illich right, then? And if so, what is to be done about it? I think from what we have seen already we can agree with Illich that organized medicine and scientific research have at times caused as much or more damage as they've solved. Indeed, who can have paid attention to the career of modern technology and not come away already convinced of that fact? But we do wonder what the alternatives might be, in that case.
Here it should be stated as a preliminary matter that Illich is no reactionary. He would not dispense with all doctors, and he does not doubt the value (no one acquainted with the evidence could) of proven techniques of modern science-based medicine (antibiotics, immunization, rehydration as a treatment for diarrheal diseases, etc.). But he does call into question the notion that access to and the administration of these proven strategies must be reserved for professionals only. Particularly when those same medical professionals may be the cause of disease and sickness themselves, in some cases, he argues, the creation of those new afflictions ought not to be used as a pretext to grant even more power and resources to those same professions. If he were alive to face our present crisis, I have no doubt, he would tell us: don't necessarily conclude from the theory that virology caused the virus that we need more funding for virologists!
Let's say this is all based on nothing, however; suppose the lab leak turns out to be a total red herring. Would Illich then be completely refuted? Hardly. Any way we slice the question of its origins, COVID-19 surely is a "disease of development." If the weak version of the lab leak hypothesis is true, then it was the penetration of natural environments by researchers that sparked the pandemic. If the pure zoonotic theory favored by some prominent virologists is ultimately confirmed, then the culprit is still human interference in the natural habitats of wildlife—in that case through capturing wild animals for sale in the wet markets. So yes, Illich is right under any of the available scenarios. However SARS-CoV-2 came to be born, modern industrial civilization is in some sense to blame for it. It's heads, he wins; tails, we lose.
Okay, but then—if we have internalized the lessons of William McNeill's Plagues and Peoples, discussed last time—we realize that essentially every epidemic disease is a problem of development. If the human animal had stayed put in one place and only ever occupied one environment, we would long since have evolved a stalemate with the local microscopic pathogens—an "equilibrium" that would have allowed for our mutual co-existence. Epidemics only erupt when a pathogen that has evolved a stasis with a different animal host happens to make the leap into our midst; and this in turn only happens as a result of humans migrating into new natural environments, cutting down new forests and habitats, and coming into contact with new forms of wildlife.
Epidemic disease is thus inseparable from development; but as soon as we realize this, we realize too that development is inseparable from being human. If we define "development" so as to include all mobility and interaction with new natural environments, we see there is no human community that has ever entirely avoided it.
I'm not sure Illich would dispute this; nor does he propose eliminating the benefits of industry and development entirely, any more than he seeks to wholly set back the clock on modern scientific medicine. Instead, he proposes that we agree to keep development and industry within certain limits. We should allow for it, he argues, only up to the point at which it begins to interfere with human autonomy and human freedom.
A wholly admirable proposition, we may think. But at once, there is a problem. How exactly are we to regulate the extent of growth? Are we to monitor and prevent the sale of consumer goods beyond a certain volume? Are we to outlaw certain technological innovations? Are we to say, with Robert Frost in one of his poems: Bounds should be set/To ingenuity?
Maybe so. But to enforce such restrictions, we would surely need to construct another vast modern bureaucracy of surveillance and regulation in turn**; and thus, we very quickly find ourselves in yet another of the self-perpetuating cycles that Illich diagnosed above. Indeed, he foresees and warns against this eventuality, writing that it would be "not desirable to base the limitation of industrial societies on a shared system of substantive beliefs [...] enforced by the police."
But it is hard to guess what else he could mean by his favored proposal, when he calls later on in the same chapter for "politically determined limits" to be set upon "the natural boundaries of human endeavor." Politics is about nothing other than the manipulation and deployment of the coercive powers of the state. "Politically determined limits," were they to be set, would have to be established through some version of police power; and thus Illich's argument risks giving rise to yet another professionalized bureaucracy: the innovation-police and consumption-hunters, who ensure human industrial and economic activity do not surpass certain bounds. And indeed, we do already try to police the worst and most harmful kinds of growth in our present societies. This is simply called regulation, however, and as Illich knows better than most, it is wholly compatible with—rather than inimical to—the maintenance of modern civilization.
None of this is to say we cannot learn from Illich's critiques of the arrogant claims of professionalization and the menace posed by iatrogenesis on a grand scale. Clearly, recent history has given plenty of confirmation to both, regardless of what ultimately proves to be the case with respect to the origins of COVID-19. But there is no option of simply blaming medicine, blaming science, or blaming modernity. Every factor at play here—the sources of epidemic disease, as well as the tools we have to combat it; the risks posed by scientific research, as well as the means to regulate those methods and ensure their safety—are alike aspects of modern civilization.
Instead of speaking of monoliths, therefore—of reducing "medicine" to a single entity, or doing the same for "capitalism," or "industrialism," or any other abstraction, we need to realize that each of those entities is full of internal contention and warring tendencies.The devices we have to overcome the evils of medicine and professionalization themselves belong to the domain of medicine, and the same could be said for every other dimension of modern (and as soon as we start to pull on what we mean by "modern," we discover that we mean simply "human") life. We must use them and improve them, rather than spurn the whole enterprise.
But of course, to know how to use them, we need to know in all its discomfiting detail how existing scientific and medical practices may in fact have contributed to the present pandemic crisis. This is why it is not enough to say that it doesn't matter, that we need not look too closely. This is why we cannot say the stakes are nil in the controversy surrounding COVID's origins. This is why we must aver that the controversy matters, and to the extent it is still possible at all to do so, we must get to the bottom of it through a frank and thorough investigation.
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* The situation appears even worse for pandemic preparedness research if we reflect that it is quite possible that no naturally-evolved pathogen would likely be as destructive in its effects on our species as one artificially designed for human-to-human transmission through gain-of-function research. After all, as William McNeill points out in Plagues and Peoples, viruses that make the initial jump from animals to humans through natural evolution tend to be extremely deadly but result in limited spread. This is because they have evolved to last inside a different animal host, and are not adapted to allow for prolonged survival inside humans. SARS-CoV-2, by contrast, seems distinctly well-adapted for transmission between humans, because it is not as virulent as some of its naturally-evolved predecessors (SARS and MERS, e.g.), and therefore allows for greater asymptomatic and community spread.
** This is in substance the chief objection raised against Illich's theories by Keith Thomas in a 1983 review essay.
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