The age of epidemics
Outbreaks like COVID-19 are caused by the same fundamental problems as climate change, but the solutions may also be connected

The 2020 coronavirus outbreak swept Australia’s “Black Summer” off the front page, back page, and every page in between.

From late February, when Prime Minister Scott Morrison pre-empted the World Health Organization and declared a pandemic, there was blanket, rolling coverage for almost three months. Other news barely got a look-in – even the April opening of the Bushfires Royal Commission was passed over. Counsel assisting the commission, Dominique Hogan-Doran SC, noted wearily that her staff had identified over 240 previous inquiries and reviews into natural disasters in the country, and “we detect a worrying consistency in the themes explored and repetitive­ness in the recommendations made.”

Soon, however, a sprinkling of media reports joined the dots between worsening climate change and a growing risk of outbreaks like COVID-19. Both are caused by the same fundamental problems: deforestation, urbanisation, overpopula­tion and overconsumption. Intact ecosystems play an important disease regulation role, and a recent paper argued there is growing evidence that the emergence of new infections is caused by envi­ronmental changes, including “a dramatic increase in human appropriation of natural resources to keep pace with rapid population growth, dietary shifts towards higher consumption of animal products and higher demand for energy”. Viewed this way, according to Monash University professor Tony Capon, who is chair of planetary health in the School of Public Health and Preventive Medicine, both climate change and pandem­ics like COVID-19 are symptoms of an unsustainable way of living. “At the societal level we’re over-consuming,” Capon says. “Although clearly there are some people on earth who still don’t have enough material resources, including food to live well, there are at least as many people who are consuming too much. The challenge is to redress that balance.”

The Anthropocene, the new geological epoch in which humans dominate and shape the planet, is fast becoming an “Age of Pandemics”. But what’s causing this new Age of Pandemics? In an article published in The Conversation, Capon, Ro McFarlane and Fiona Armstrong from the Climate and Health Alliance together wrote that COVID-19 was indeed a “wake-up call”, the pandemic and climate crises were “deeply connected”, and the root cause of both was our war on nature. Calling for post-COVID policy responses in Australia to end that war, they quoted Silent Spring author Rachel Carson: “a war on nature is ultimately a war against ourselves.”

Just as the causes of warming and the pandemic are con­nected, so may be the solutions. In the global response to COVID-19, it became clear that countries that put lives ahead of the economy, listened to the experts, invested in their public health system and worked collectively on measures like social distancing and lockdown were more effective at con­taining the virus. The same tactics that worked to “flatten the curve” of coronavirus infections might also help flatten the “climate curve” of rising greenhouse gas emissions. The pandemic was like watching the climate crisis on fast-forward, the conservative Economist argued, and while many economies were in a medically induced coma there was a unique chance to steer the world away from carbon at comparatively low cost. “The harm from climate change will be slower than the pandemic, but more massive and longer-lasting,” wrote the magazine. “If there is a moment for leaders to show bravery in heading off that disaster, this is it.”

For Tony Capon, that is where the United Nations’ Sustainable Development Goals come in, providing an overarching framework for action that would tackle climate change and promote intergenerational health equity. The 17 goals were agreed alongside the Paris Agreement on climate change in 2015, and all members of the UN signed on, including Australia. “Yes, we need to decarbonise the world economy,” says Capon, “but at the same time we have to do other things to protect and promote human health and wellbeing. It can’t just be about carbon. It must be about carbon, but it can’t only be about carbon. It’s about a transi­tion to more sustainable patterns of development around the world, patterns of development that support human health, that enable our future generations of people on earth to enjoy healthy lives as we have.”

It is no coincidence that all three of these experts – Tony Capon, Ro McFarlane and Fiona Armstrong – studied under late ANU professor Tony McMichael, the public health pioneer whose life and work has been an undercurrent of Body Count. The very concept of “planetary health” – which holds that the health of human populations depends on the health of our planet’s life-support systems – is a nod to his 1993 book Plan­etary Overload. The first of three books, Planetary Overload focused on five major environmental problems and how they could impede human health: climate change, ozone depletion, land degradation and impairment of food production, loss of biodiversity, and burgeoning cities.

When McMichael became chair of epidemiology at the pres­tigious London School of Hygiene and Tropical Medicine in 1994, according to one obituary, his belief in the relevance of epidemiological research to the health risks of climate change “bemused” senior colleagues. As another tribute recorded: “It may seem obvious that heat waves, ice storms, droughts, floods and disease-carrying insects expanding their habitat can all maim and kill. But before McMichael, few people thought about climate change in those terms.”

It was a long haul for McMichael, who produced 300-plus scientific papers over the next two decades, but whose research attracted scarce government funding. “It doesn’t seem like real science to them,” McMichael once complained, given the health effects of climate change were “big, unbounded and complex. There aren’t going to be any single bottom-line answers that come out of it.” The problem was particularly acute in his home country – McMichael lamented that the land of drought and flooding rains, after poet Dorothea McKellar’s “My Country”, was becoming a “land of doubts and fuddled brains”. It was not until 2019 that the National Health and Medical Research Council, which had previously awarded McMichael an Australian Fellow­ship, finally made a delicately worded announcement of some $10 million in funding over five years, for multidisciplinary research on the health implications of “environmental change”.

Medicine is a social science and advocacy by medical doctors has a long history, from urban sanitation to occupational health, to environmental health pioneers like immunologist-turned-ecologist Stephen Boyden. The nuclear threat led to the formation of Physicians for Social Responsibility in 1961, vaulting doctors into national and global politics, and in 1985 a related group that included Soviet doctors, the International Physicians for the Prevention of Nuclear War, won the Nobel Prize. One member, Alexander Leaf, drew parallels between nuclear war and climate change:

Physicians and other scientists have served an important function by educating themselves, the public, and politi­cal leaders to the dangers of a nuclear war. We may have a similar function in publicising the potential effects of global atmospheric changes. Only an educated and aroused public is likely to force antiquated nationalistic political systems to cooperate.

Physicians for Social Responsibility set up a health and environ­ment branch in 1992, but its work had little impact beyond a small group of like-minded advocates. McMichael was one of them, writing in the Australian Journal of Public Health that year that, for the first time, one of Earth’s species – us – threatened the global ecosystem on which its own health depended. “The regen­erative and absorptive capacity of the biosphere has its limits,” he warned. “Thresholds, once exceeded, may trigger unexpected events as, for the first time, we push global ecosystems beyond their usually resilient limits.” As his career progressed, McMi­chael recognised that collecting more evidence of this would never be enough to galvanise government action, demanding the health sector “must lift its gaze to bigger, ecological horizons [requiring] a radical extension of the public health agenda”.

Looking back over more than 10,000 years, McMi­chael studied the possible climatic links to previous pandemics, such as the Black Death, and collapses of ancient civilisations from the Sumerians to the Mayans. Previous collapses were more likely to be driven by cooling than warming, McMichael found, and historical evidence of climatic influences on infec­tious disease epidemics was less strong than for hunger and under-nutrition. But this was no guide to a future that would be 3–4 degrees hotter – a level unprecedented throughout the Holocene, the period of study back to the last ice age. Identi­fying the “nutrition–infection linkage”, McMichael wrote that the greatest recurring health risk over past millennia has been from impaired food yields, mostly due to drying and droughts – sometimes lasting decades to centuries. “We moderns,” wrote McMichael, “have not yet been tested.” He continued:

The fact that drought has been the dominant historical cause of hunger, starvation and consequent death casts an ominous shadow over this coming century, for which climate modeling consistently projects an increase in the range, frequency and intensity of droughts … In a warmer future world, the range, rate, and seasonal duration of many infectious diseases is likely to increase, because bacteria at higher temperatures and vector organisms (mosquitoes, fleas, etc.) multiply faster – up to a temperature limit that threatens survival. Infections and infestations will also pose increased risks to agriculture.

This research was a teaser for McMichael’s third book, but tragically he died in September 2014 before he could finish it, at the age of 72. Posthumous publication of the book, titled Climate Change and the Health of Nations, was managed by his partner of 45 years, ANU social scientist Dr Judith Healy. Judith says Tony was still working full blast when he died: “He still had a lot of very important work that he was desperately keen to do, because he knew that he had a limited time, but he also knew that this was a coming crisis that people weren’t paying enough attention to.” Tony had polycystic kidney disease, Judith explains, and he’d had a kidney transplant back in 2004. “He was immune-suppressed but of course he didn’t let that stop him,” she says. “He just kept going around the world as usual.” Tony was in Darwin during naval exercises in 2014, when sailors from around Asia and the Pacific were in town. Though he’d had his flu shot, Tony picked up a strain which wasn’t covered by the vaccine. “In his immune-suppressed state it was very difficult for him to fight off,” Judith says. “He died here in Canberra.”

Australia is good at public health: from setting up modern maternal health services and childcare during the Depression, to the introduction of compulsory seatbelts, banning fireworks, tightening gun laws or mandating plain packaging of cigarettes. Tackling the health effects of climate change remains a glaring omission. Tony McMichael, who was given an Order of Australia in 2007, was a world leader in that fine tradition. His key insight, says Judith, was that climate change “wasn’t going to just affect bees and butterflies and polar bears, it was actually going to affect humans and was a catastrophic threat that was looming ever-closer for humankind and perhaps even an existential threat to our survival”.

Influenza is itself a zoonosis, and Judith sees the bitter irony in her husband’s death. “Tony was vulnerable, and he couldn’t fight off influenza, and influenza’s coming around more frequently these days.” Does she believe there is a body count from climate change? Judith pauses, before answering clearly: “Yes, I think there is a body count and [Tony] was trying to quantify that in later years.” Does Tony’s death mean that he himself is part of the body count? “Yes,” she says, “his death was premature and caused by influenza and its complications.”

Judith says Tony was never one for doom and gloom, despite the grim theme of his life’s work. He remained active on the boards of government commissions and non-government think tanks like the Australia Institute and the Climate Institute. “He tried to stay optimistic, although it was a bit of a battle,” she says. As Australia and the rest of the world fight to contain a pandemic of just the sort he anticipated and feared, it is perhaps fitting that the last word should go to McMichael himself: “It’s likely to be an extraordinary century and we’re going to have to have our wits about us to get through it.”


This is an edited extract from Body Count by Paddy Manning, out now from Simon & Schuster Australia.

Paddy Manning

Paddy Manning is contributing editor (politics) at The Monthly and has worked for the ABC, Fairfax, Crikey and The Australian. He is the author of Body Count: How Climate Change Is Killing Us, Inside the Greens and Born To Rule: The Unauthorised Biography of Malcolm Turnbull.

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