A Cure for COVID-19 Will Take More Than Personal Immunity

At a press briefing on March 22, Donald Trump announced: “We’re at war, in a true sense we’re at war, and we are fighting an invisible enemy.” Yet viruses are not sovereign nations; they don’t have armies, navies or air forces. They might not even be alive. So perhaps war is not only an inadequate metaphor, but one that is fundamentally flawed.

The bellicose terms used to make sense of COVID-19 stem from a series of profound changes in medical thinking sparked by the cholera epidemics that beset Europe during the 19th century. Because the repeated waves of infection appeared to track back from India along colonial trade routes, they quickly assumed the status of “invasions.” In response, a series of International Sanitary Conferences—forerunners of the World Health Organization—convened between 1851 and 1911. These conferences brought together medical and scientific experts, diplomats, lawyers and military leaders to debate how to implement the only viable strategies then available against the rapid spread of infections: quarantine, cordon sanitaire and fumigation. These remain among our most viable responses even today.

Fusing the military imagery embedded in the popular representations of cholera with the legal rhetoric of the International Sanitary Conferences, Russian zoologist Elie Metchnikoff (1845–1916) characterized “immunity” as a form of “host defense.” Metchnikoff’s innovation shifted the primary locus of medical intervention from the collective to the individual. This metaphor became infused into modern medicine and informs the notion that our immune systems defend us against disease.

Metchnikoff’s formulation of immunity-as-defense helped to explain the new vaccines that were being developed at the time, but this narrow perspective overlooked how collectives contribute to the progression of disease. It assumed that if an individual could be vaccinated, that would solve the collective problem. However, individual organisms are not singularities; we only exist in complicated contexts with other living beings both near and far. Indeed, that’s why we are now exhorted to wash our hands, to maintain social distance and to avoid unnecessary physical contact. That’s literally what contagion means: touching together.

While we might assume that our immune systems should defend us against pathogenic microbes, our communal systems actually do much of the heavy lifting to keep us healthy or to help us heal. When these collective capacities are not maintained, or when they fail, they reveal the unequal vulnerabilities to which different individuals are exposed.

Communal systems support immune systems at very basic levels. As the disproportionate numbers of people of color, of working people and of incarcerated people afflicted by COVID-19 show us, an individual’s capacity to heal depends not only upon the organism’s innate capacity to sustain its vitality in the face of interactions with microbes. This healing capacity itself depends upon social and environmental resources, like adequate food and shelter, as well as ongoing health care throughout one’s life.

Immune systems cannot adequately “defend” us in the absence of such communal systems. The strong correlation between comorbidities and severe symptoms of COVID-19, as well as the unequal distributions of these cofactors across racial, ethnic and class differences, proves this point. Individual immunity presupposes community. Unfortunately, at the same time, the use of immunity to frame our responses to the pandemic can allow us to neglect this communal context.

Today’s political leaders still rely on metaphors of immunity and military defense to think about infectious diseases, but this fails to account for the ways in which a collective action—or the lack thereof—can either enhance or mitigate the spread of disease. But isn’t this the lesson we need to learn most from the current pandemic? That taking care of each other is actually another way to take care of ourselves; not just in times of sickness, but in those moments when we take health most for granted.

There are no enemies in pandemics, and this is not a war. Rather it’s an occasion for us to develop new ways to live together that can mitigate our common vulnerabilities as living beings. Perhaps it’s not only time to support our immune systems, but also to ramp up our communal systems. You can’t have one without the other.