In A History of the World in Six Plagues, historian Edna Bonhomme delivers a searing examination of how disease outbreaks—far from being equalizers—have long been shaped by systems of power and inequality. From cholera to COVID-19, Bonhomme traces the global legacy of six major plagues, revealing how public health crises are entangled with race, class, and political policy. Spanning continents and centuries, this urgent and beautifully crafted work is both a meticulous history and a call to rethink how we respond to future pandemics.
We emailed with Bonhomme about the hidden stories behind the world’s deadliest diseases, the intersection of science and social justice, and why history’s greatest epidemics are never just about medicine.
What made you write about the diseases through history that shaped our world?
During the initial days of the COVID-19 lockdown, I was fascinated by the use and misuse of scientific language. I was captivated by how people sought to understand outbreaks, regardless of their familiarity with public health terminology. Phrases such as “ herd immunity “ and “ mass vaccination “ became part of our vocabulary, even as large sections of the world coped with a new reality of confinement. Writing the book allowed me to reflect on the ubiquity of health discourse in our society and explore the evolution of medical discourse in literature, philosophy, and beyond. As a former biologist with a master’s in public health and a doctorate in the history of science, I aimed to examine several case studies where epidemics were tied to varying conditions of confinement and where the language of pathology was also shaped by culture.
A History of the World in Six Plagues blends memoir, history, and reportage. How did your personal experiences shape the way you approached this research?
This book is both personal and philosophical. I explore the conditions for epidemics and how illness is constructed—not just at the physiological level but also in terms of its social implications and bodily experiences. I consider the history of modern epidemics not only a tale of medical intervention but also reflects how we organize contemporary society. It narrates the rise of industrialization as much as it addresses the responses of novelists to the flu outbreak in 1918. I present historical examples that reveal, to some extent, the punitive mechanisms that produce the ‘repressive’ effects of public health and the individual and collective struggles to resist captivity. My research is extensive; I read pandemic novels, sifted through archival newsletters, examined early twentieth-century laboratory reports, and more. I conducted interviews and analyzed peer-reviewed scientific articles. My personal experience is a significant element, demonstrating how outbreaks spark my curiosity. However, as a writer, I believe my work cannot conclude with mere wonder; I must consult archives and an array of resources that can help enliven my texts.
As we approach the fifth anniversary of the COVID-19 lockdowns, what do you think governments and public health institutions have learned—or failed to learn—from the pandemic?
The pandemic reveals what the next epidemic might look like and what we can do to prevent it. Some diseases have not circulated in their regions for millions of years, and in some cases, since before humans existed to encounter them. Our immune systems would not know how to fight back when these prehistoric plagues emerged from the ice. What concerns epidemiologists more than ancient diseases is that existing scourges have relocated, rewired, or even evolved due to warming. During the latter half of the twentieth century, infectious diseases were on the decline: the eradication of smallpox serves as a constant reminder that we should accept nothing less. The last case of smallpox was reported in 1978. The eradication of smallpox is a testament to the power of public health policies when we exercise goodwill and distribute medical resources globally.
In your book you touch on Robert Koch, who is often celebrated as a pioneer in bacteriology, but you highlight the darker aspects of his legacy. I’m always curious and sometimes struggle with how to celebrate complex and sometimes outright people who did great things but lived awful lives. How do you balance navigating honoring legacies like that?
For me, the writing process involved extensive reading and delving into the archives to connect with the evolution of disease fully. Although my book focuses on epidemics from the nineteenth century to the present, reacquainting myself with ancient diseases was beneficial. I was particularly fascinated by diseases that have not circulated in the world for millions of years and, in some cases, existed before humans encountered them- illnesses that evolve. Simultaneously, science has equipped us with tools that have helped some infectious diseases decline, showcasing the brilliance achievable through human innovation. Specifically, vaccines and antibiotics accounted for half of the declines in death rates in developing countries through the late 1970s. Whether one is a literary giant or a scientific luminary, nobody is above criticism. I aimed to understand the history of modern epidemics and how societies have propelled their spread through forced labor, confinement, and austerity.
You discuss how incarceration has exacerbated public health crises, particularly with HIV/AIDS in Bedford Hills and cholera outbreaks in Haitian prisons. What lessons should modern public health policymakers take from these cases?
Angela Davis once noted, “Prisons do not erase social problems; they erase human beings.” What she and many prison abolitionists have established through their work is that forced confinement not only denies people their time and freedom but can also lead to social atrophy. Similarly, prisons, as I argue in my book, can be detrimental to people’s health. The risk of contracting infectious diseases such as HIV, hepatitis C, and tuberculosis is higher in prison than among those who are free. In the United States, the quality of healthcare in prisons is not only substandard but often fails to meet patients’ needs. As the Prison Policy Initiative has pointed out, incarceration can exacerbate both chronic and infectious diseases, contributing to a lower life expectancy in the country. Several policies must be implemented. First, access to healthcare in prisons must be improved, including free psychological support. Ultimately, however, the best way to reduce the spread of both short- and long-term diseases is through decarceration. This can be achieved not only by providing more funding to decrease the prison population but also by creatively exploring abolitionist practices. One way to accomplish this is to provide more extensive support services to individuals and their communities upon release from prison. This includes ensuring that formerly incarcerated people have access to fulfilling employment and adequate housing without discrimination. While these policies may seem ambitious, a humane and just social policy that restores dignity to those temporarily discarded by society can enhance overall public health.
The relationship between war and disease is a recurring theme in your book. How did World War I’s influenza outbreak shape the way we understand pandemics today?
Jean-Paul Sartre once noted, “When the rich wage war, it’s the poor who die.” In times of war, the poor not only disproportionately suffer from the violence of militarization but also become more vulnerable to infectious diseases. While my book discusses this in the context of influenza, we can observe how contagious diseases, such as cholera, have re-emerged in disaster zones like Yemen and Haiti, primarily due to the damage done to medical facilities and sanitation systems. In Sudan, the recent conflict has reignited outbreaks of malaria, cholera, and measles. Moreover, the 2024 polio outbreak in Gaza is believed to have spread due to the destruction of the water treatment facilities in the strip. Polio, which is highly infectious, can lead to paralysis and death. These outbreaks illustrate that military conflict and war are incubators for disease because a territory’s sanitation and healthcare systems are subjected to extreme duress. In addition to taking measures to prevent the spread of contagion, war and the physical damage of war highlight how we must be more careful to save precious lives—no matter people’s backgrounds. Moreover, we owe it to people living in conflict zones to operate outside of a framework of crisis or charity, instead, we should build robust healthcare systems to prevent infectious diseases from flourishing in the first place.
Vaccine skepticism is on the rise, with political figures like Robert F. Kennedy Jr. gaining influence. How does historical skepticism toward vaccines inform the current debate?
Vaccine skepticism was long considered a fringe phenomenon. The Anti-Vaccination Society of America was established in 1879, advocating for homeopathic alternatives and launching legal challenges against vaccine mandates. In the early stages of history, anti-vaxxers tended to be left-leaning. However, in recent years, many Republican counties have adopted skepticism toward immunization programs. Worldwide, anti-vaxxers have capitalized on the growing public mistrust of the medical establishment. Some of this mistrust is linked to skepticism of the intelligence community or democratic leaders, while other aspects are deeply emotive, rooted in fear, anger, or indignation.
For example, in Germany, where I live, a surge of anti-vaxxers has been on full display this week, particularly with the participation of Alternative for Germany, a far-right, ethnonationalist party best known for its anti-immigration views. This party has also opposed vaccination mandates and conventional medicine. In the UK, Reform UK, the right-wing party led by Nigel Farage, has sown doubt about vaccines. Richard Tice, a leader of the Reform UK party, publicly stated on X (formerly known as Twitter), “No to compulsory vaccinations and to vaccinating young children.”
In the US, conservatives have cultivated a culture of skepticism toward medical science, prominently promoting the discredited link between childhood vaccinations and autism, as well as other health issues. This viewpoint coincides with the resurgence of measles over the past decade. According to a report published by the Lancet in 2024, titled ” Contribution of Vaccination to Improved Survival and Health, ” over 150 million lives have been saved through childhood vaccination. As we observe during this contemporary period, medical skepticism and the reversal of public health policies may inflict harm for years or even decades.
Your book is ultimately a call to action. What steps must be taken to build a more equitable public health system that prioritizes marginalized communities?
Sigmund Freud once said, “We are never so defenseless against suffering as when we love.” If we want to exercise compassion for humanity, we should strive to alleviate ongoing harm in the world through our collective actions. I want readers to be curious about disease, illness, and medicine. At the same time, I hope readers can reflect on how the lack of investment in primary, preventive, and chronic health care has left many of their citizens vulnerable to emerging infectious diseases. I would argue that if we want to be more humane, we must be imaginative about how we organize our societies and think deeply about redistributing health resources on a global scale.