Steven Thrasher: Health policy

October 13, 2022 1:16:17
Kaltura Video

Steven W. Thrasher, Ph.D., is the inaugural Daniel H. Renberg Chair of social justice in reporting (with an emphasis on issues relevant to the LGBTQ community) and an assistant professor of journalism. Racial Foundations of Public Policy is a speaker series that focuses on the historical roots and impact of race in shaping public policy as both a disciplinary field and as a course of action. October, 2022.



0:00:21.6 Celeste Watkins-Hayes: Welcome to our second event of this year's Racial Foundations of Public Policy speaker series, hosted by the Center for Racial Justice at the Gerald R. Ford School of Public Policy at the University of Michigan. I am Celeste Watkins-Hayes, Director of the Center and Interim Dean here at the Ford School. I'm also a Professor of Public Policy and Sociology here at U of M. At the Ford School and the Center for Racial Justice, we seek a world in which people are able to achieve their full human potential regardless of race, ethnicity, gender, sexuality, class, and other categories that have been used to divide and systematically marginalize people. We train leaders here who understand the critical role of public policy in improving our world. We recognize the power of public policy to bolster or undercut our life opportunities and experiences, and we see policy analysis as a critically important tool for us to measure, reflect, historically examine, and help us define the way forward. This Racial Foundations of Public Policy series augments the work that is already being done at the Ford School in the area of social equity.

0:01:33.7 CW: At the Center for Racial Justice, we seek to illuminate evidence-based solutions and support the changemakers who advocate for sound, just, and fair public policies. We take an intersectional approach, seeking to expand knowledge and highlight strategies and tools that address the complex intersections between public policy and race, gender, sexuality, class, and other social categories. As we examine the fraught histories and consequences of some of our policies and the transformative power of others, we learn a valuable lesson: Effective and just public policy can only be achieved if we bring diverse perspectives to the table. This fall, the CRJ will feature a cadre of scholars to deliver virtual presentations and conversations with me on the historical roots and contemporary currents of race and reproductive justice, health policy, LGBTQ rights, and housing policy. Our esteemed speakers this semester have included Melissa Murray from NYU Law, Steven Thrasher from Northwestern, who is here with us today, Bianca Wilson from UCLA, and John Robinson from Princeton. We encourage you to review our website for the dates of those events.

0:02:47.9 CW: Now, I am truly delighted to introduce you to today's speaker, Dr. Steven Thrasher. Steven Thrasher holds the inaugural Daniel Renberg Chair at Northwestern's Medill School, the first journalism professorship anywhere to focus on LGBTQ Scot research. He is also on the faculty of Northwestern's Institute for Sexual and Gender Minority Health and Wellbeing. An interdisciplinary scholar who's received grants from the Alfred P. Sloan and Ford Foundations, Dr. Thrasher is an internationally recognized expert on race, social epidemiology, and the criminalization of disease, who has addressed universities and medical institutions around the world. In 2020, he served as a national surrogate to presidential candidate Senator Bernie Sanders, advising the campaign on its healthcare priorities. He's written about HIV, COVID-19, and monkeypox... And then monkeypox epidemics for The New York Times, Guardian, Atlantic, and BuzzFeed News, as well as in numerous scholarly journals.

0:03:55.2 CW: His first book, The Viral Underclass: The Human Toll When Inequality and Disease Collide, was published in August by Celadon Books and Macmillan Publishing to wide acclaim. The book has received starred reviews from Kirkus Reviews, Booklist, and Publishers Weekly, was named one of the best books of August by Apple and Amazon, was named one of the best politics and current affairs books of the fall by Publishers Weekly, was named a must-read editor's pick by USA Today, and he's currently a finalist for the 2022 POZ Best in Literature Award for the best depictions in HIV/AIDS literature, and is a long list finalist for the American Library Association's 2023 Andrew Carnegie Medal for Excellence in Nonfiction Literature. Steven holds a PhD in American Studies, and you can find him on Twitter, where he is an avid tweeter. Love to follow his feed. To follow his work. So Steven, thank you so, so much for being with us. We are so honored to have you, colleague and friend, and congratulations on the success of the book, and thank you for raising these issues and for elevating these issues, and I'm so excited to be in conversation with you today.

0:05:15.9 Dr. Steven Thrasher: Well, thank you so much, Dean Watkins-Hayes. It's great to be reconnected with you. And I've been thinking lately a lot about how we first met at the Blackness and AIDS panel that we did in 2016 at the American Studies Association, and it's just been really great to be connected to you and a number of scholars who really care about AIDS and race, and thank you for all of the ways that you've inspired me, and happy to be in conversation with you.

0:05:42.8 CW: Oh, you are welcome. We're gonna have a great conversation. So I would love for you to talk about the book, The Viral Underclass. I would love for you to talk about the book and to tell us the story of how you came to write this book. Given all of your other work and all of your experiences, how did you get to this place, to this point, to be writing The Viral Underclass? 

0:06:09.9 DT: Well, it's been about an eight-year journey, in one sense. It really began, or the seeds for it began when I was still a full-time journalist in 2014, and an editor at BuzzFeed News, Mark Schoofs, who's edited about AIDS for... And did work about AIDS for a long time, said he had a story he wanted me to look into about a young man named Michael Johnson who had been arrested for HIV transmission exposure. He was accused of exposing or transmitting HIV to six different men. He was 21 or 22 at the time, and he was facing life in prison. And so I went and started a report on that story and learned about the criminalization of HIV, and found out that it's really bad public policy, that it dissuades people from getting tested, it doesn't help, just punishes sickness without making the health better for the public in any way, and it's also very racially utilized.

0:07:02.2 DT: I found out that the majority of people in most jurisdictions who are prosecuted for HIV are Black, even in places like Canada, where they're only 3% of the population, and that was certainly the case in Missouri. So I started reporting on this case, and I found out that Michael was not the sort of monster that he'd been portrayed who was intentionally trying to transmit HIV to people, but he was really sitting at the intersection of a lot of the terrible things in our society: Homophobia, racism. He was a very successful college athlete who was only here from graduation, but he couldn't really read. And so, he was very much a scapegoat for all these kind of overlapping systems and the anxieties about HIV and AIDS. And I wrote a feature about that. My editor said, "I think that you'll be working on this for a long time." I don't know if he knew I'd still be working on it eight years later.

0:07:51.0 DT: But then I went to Ferguson later that fall when I was starting my PhD program, but I was writing for The Guardian. And then the editor had heard that I had already been to St. Louis working on this other story, and they wanted me to go because I had some lay of the land. And I asked the HIV people that I had worked with on the previous story about Michael Johnson what I should be looking for, and they told me that they'd been in the Canfield Green Apartment Complex, that there was, there had been some new transmission of HIV in the area, and that Ferguson had this higher rate of HIV and AIDS. So I started really understanding that there is this relationship between HIV infections, HIV infections that would progress on to AIDS diagnoses, which can take many years, and also concentrations of Black poverty and police violence, and I started kind of working with a map around that, which eventually became the basis of my dissertation, which was called Infectious Blackness, that I did in American Studies. I was trained under a medical anthropologist that was in conversation with a lot of sociologists. I brought in some journalism. It was very much an interdisciplinary project about understanding HIV criminalization and the criminalization of sickness as illustrating a kind of systemic racism. It intersected with homophobia and other things, but I was primarily writing about how it intersected with racism.

0:09:09.4 DT: And so then I came to Northwestern, and I began my job at the Medill School of Journalism. I was trying to think about what kind of book I would write. I was pleased to learn that as someone with my home tenure line in a journalism school, I could actually write a book for a trade press. And I was trying to think about what exactly the form of it would take, was it gonna primarily be kind of a narrative story about Michael Johnson, or was it gonna be about race in some other way? When COVID happened. And the COVID pandemic happened right when I was getting ready to start pitching my book. And I didn't know at the time, like, "Am I gonna lose my job at Northwestern, since I'm the, you know, sort of the last hired?" I didn't know whether people would still be buying books. My agent, Tanya McKinnon, had had no meetings. This was in the weeks where sort of nobody was doing any business and we were all locking down, those of us who could, and not going out, but she said quite rightly, she thought eventually, people are gonna watch everything they can on Netflix, and they're gonna keep reading books, which is actually what happened, book sales went up a lot that year.

0:10:16.8 DT: And she asked to look at my dissertation again at that point, and she saw this phrase, The Viral Underclass, that I had named the last chapter of my dissertation. And I had used this phrase. This phrase comes from an activist I think you probably have met or talked to at some point, Sean Strub, who is an activist about stopping the criminalization of HIV, and he had originally used it to describe the phenomenon through which people living with HIV are just living under a separate set of laws. In the history of the United States, we do have times where people are explicitly governed under racist laws that name race, and this happens with anti-miscegenation laws and things like that. But for the most part, the laws in the US don't explicitly say, "If you're Black, you're subjected to this law, and if you're White, you're subjected to that law," but that's the case with HIV. People living with HIV, even infants who are born with HIV, are living under this different set of laws, and so that's how Sean coined the term viral underclass. And I've heard activists using it, and that's why I ended my dissertation this way, it's sort of the last scene in my dissertation. Michael Johnson had been approved to get out eventually from prison early, but he was still... He was still locked up, it was gonna be about another year before he actually got out.

0:11:29.7 DT: And I met these activists at a conference who were planning how to roll back the laws around HIV, and some people were calling for the abolition of the laws and saying that was the only way that fairness could be achieved, and some people wanted to just modernize them and say, "People who are living with what's called the detectable viral load, with amount of virus in their system that they could transmit to others, maybe they should still be able to be prosecuted, but people who have an undetectable viral load, who are taking HIV medications should not be able to be prosecuted," and they thought that there would be more success with that. And so these activists were saying that's creating this viral underclass of people who still have a viral load, and the reason they don't have, the reason they a viral load, it's because they're poor, often Black, and homeless. Those are the reasons why they still have this viral load, and it would be unfair to use it, to use that as a way to still prosecute them.

0:12:23.9 DT: So after talking to Tanya about it, and then eventually selling my book to my wonderful editors at Celadon Books, I wanted to use The Viral Underclass as an analytic to write about kind of the past and things I had reported on, the dynamics I was seeing, but also to write about the COVID-19 pandemic. And I came to this kind of clearly in sort of an aha moment when I started realizing that the people who were getting COVID-19 and dying in those early days... I was in New York, where there were sirens constantly there were hundreds of people dying a day. And the parts of the city where the people were actually dying were the same maps where people still get HIV at high rates and die of AIDS. And so I started trying to understand why do these extremely different viruses. They're so different in the way they move and the way they behave, but it's the same kind of people getting them.

0:13:13.7 DT: And so I wanted to use The Viral Underclass as an analytic to write about how and why it is that the same kinds of populations are affected by these different viruses. And the big move for me from the dissertation project was understanding through primarily a vector of race, which is a very important one, and it's still the first one that I use in the book, but I looked at 12 different vectors through which the viral underclass is produced. Race is the first one, but I also write about how the law acts as a vector, how ableism acts as a vector, how austerity is a vector in different countries around the world. I try to have a little bit of an international analysis, even though a lot of it's about the US, and even speciesism, the way that we interact with other species can be a vector to how this underclass is produced. So that's how I came to the work.

0:14:02.7 CW: Very interesting. So one of the things that I'm really interested in unpacking with you is when we talk about health inequities, we often use terms like social determinants of health. We argue that those kinds of larger structural factors; racism, homophobia, sexism, but then we also talk about material conditions like poverty, homelessness, lack of access to health care, give way to health disparities, whether we're seeing disparities in rates on the basis of race when we're talking about HIV, COVID, etcetera. And what I hear you saying is an additional layer of analysis where you're saying, yes, there is this relationship between social disparities of health and... I mean, social determinants of health and health disparities or what I like to call injuries of inequality, which are arguing that the people who find themselves on the receiving end of that then become criminalized and find themselves in a situation where there's a criminalization element to their illness that we have not fully accounted for in our conversations around public health. It's not just the experience of health disparity, it's health disparity and the additional criminalization of experience around that disparity, around that injury of inequality.

0:15:25.4 CW: So I wonder if you can talk about that in that thread, in historical context, because what you're pointing to is that that is not a new relationship when we look at other illnesses, when we look at how this has played out over time, so... And one of the things that we'd like to do is kinda trace the historical genealogies around how do we end up at this stage? How do we end up to the place where illness is criminalized in this kind of way and we see these disparities play out? So I just wonder if you can trace that for me in historical context. Was HIV the first time that we saw that? And what other illnesses does it remind you of when you think about that relationship? 

0:16:11.0 DT: Sure. I was just writing down some notes. So historically, kind of where I begin in the book is with the transatlantic slave trade, and I thought a lot throughout the pandemic about language itself. I have particularly, one colleague, Steven Meldrum, and I were thinking in the beginning of everything happening with COVID about the way that the language that public health people use and even scientists use was sort of circulating through social media. This is very much, our pandemic of COVID is like a viral pandemic that's also happening through viral media, which is creating other dynamics. And so one of the words we would hear would be host and vector. And sometimes, scientists are using them in ways that are disrespectful, but a lot of times, they're using them sort of in a way that they're talking to each other in ways we don't wanna carry into the public conversation. We should never think of human beings as a host. We shouldn't reduce one another to that, even though two lab workers might kinda be talking about the way that a virus has to replicate inside a host.

0:17:10.6 DT: And so, I really like to think about vectors as systems, sometimes they're physical places. And I'm sure you're familiar with the story of the "patient zero", a French-Canadian flight attendant who was incorrectly blamed for bringing HIV to North America. The vector, in that case, is sort of international travel and homophobia and not knowing how to help people when they were trying to get help with a disease that was completely new. And so the Atlantic slave trade is one of the biggest vectors of disease transmission in human history, and that doesn't mean that that's the fault of the enslaved people. Capital would come from Europe, it would go to Africa, they would convert the capital into human beings, the human beings would be put onto the ships. The ship itself was an enormous vector by itself. Maybe 20-25% of people don't even live in the crossing, or if they're quarantined, many more die of disease then. And the colonizers are bringing together sort of all these people very quickly who have not built up immunity to different kinds of pathogens. So that is an enormous vector, and there's a long history that comes from that process, and an unfair relationship with Blackness is considered out of that by a lot of Whiteness in America, but the vector itself is the slave trade.

0:18:35.0 DT: And so, I kind of moved from that historically through a lot of different health disparities that happened, as you were noting, throughout US history. A very kind of important moment was there was a smallpox outbreak and a campaign to deal with it after the Civil War, and it would have almost created something like universal healthcare, and a lot of White people didn't want it because they didn't want Black people to also get it. But the criminalization element happens at various stages through US history. I understand it primarily through HIV and AIDS. The story of Mary Mallon, of course, is very important. She had typhoid, and she was a Irish immigrant in a period of time... To quote another scholar, a period of time before the Irish were White or considered White in the United States. And she was a working-class person, and so there were a lot of dynamics about how she was treated.

0:19:33.0 DT: I start to understand it mostly through HIV and AIDS, and I think a lot about the ways that the law itself produces... It produces a criminalization, but it also produces a kind of scientific understanding. I'm sure you know that Bruno Latour died earlier this week, and he was a thinker that was very helpful in me understanding science and technology studies and the way these things affect each other, so kind of on the good end of things, as my colleague, or a former colleague... I mean, still colleagues, just at different universities, as Steven Epstein at Northwestern writes about the activist group ACT UP, and the work that they did to push the government and to push scientists and corporations to change the way that vaccine trials happened and treatment trials happened in such a way that they converted a process that took 10 years that could maybe be done in one year, and we're all benefits. All of it... All of us who... The billions of people who've been vaccinated around the world for COVID-19 are beneficiaries of this work that they did, where as activists, they affected the scientists, the scientists affected the law and regulations and so on and so forth. With HIV criminalization, I saw a very, very different thing happening that's quite unfortunate, where a kind of scientific knowledge is produced by the law in a very bad way.

0:20:52.7 DT: So the HIV... The AIDS Law of Missouri that was involved in the Michael Johnson case was written in the 1980s, and it was written in a time where AIDS was considered a death sentence, and it hadn't been updated for decades. And the prosecutor in the case that I was covering, who was a very, very effective prosecutor, I didn't really like him personally, but he was an extremely good prosecutor, what he was trying to do, he absolutely kept any new knowledge about AIDS out of the courtroom. And the defense kept trying to say, don't treat this as life in prison. Don't treat this as a death sentence. It can be treated with a pill a day. People live their normal length of lives once they're properly medicated, for the most part. And so he kept that knowledge out, and so the jury eventually sentenced Michael to 30 years... They sentenced him to 30 years in prison. And that became a way that the state sort of reinforced that this was true; those jurors believed it was true. A lot of news media covering it believed it was true, and so that creates a kind of scientific understanding that will have effects throughout the rest of the society, and it criminalizes it. It very much treats HIV as a criminal matter. And I'm seeing the law criminalize things like this in very, very dangerous and scary ways right now.

0:22:10.6 DT: For example, if anyone happened to catch, and I highly recommend it, if you haven't seen it, the interview that Jon Stewart did with the Attorney General of the State of Arkansas, he's grilling her in a way that journalists should, but it took Stewart to do it, about this law that Arkansas passed banning gender-affirming care for minors, and that care happened in consultation with parents and doctors and all kinds of people, but the state of Arkansas has made it illegal. Florida's doing something similar. They've also effectively made it so that people living on Medicaid cannot get access to gender-affirming treatment either, so effectively, it's making it so the poor can't get that kind of treatment. And there, that makes the process of being a trans person healthy and well under standards that have been understood and studied for about four decades and are approved of by all the major medical organizations and all the LGBT organizations, the state has made those illegal. And so that not only creates bad health outcomes in general, it creates very, very specific bad health outcomes for people, in particular, in terms of viruses.

0:23:16.7 DT: If you were getting or were wanting to get hormone treatment through your healthcare provider, then you would get that safely with sterile syringes under a doctor's support. If you're not getting it from there, then the odds are that you will get it somewhere in the contraband market, which immediately ups the likelihood of you getting HIV, hepatitis, things of that nature, and also just not getting the other healthcare that you need. And then you could also be criminalized for it; the act of trying to become healthy in ways that we've understood now for decades for trans people is now criminalized. So that's one of the major ways that I was thinking through this book that applies to Black people in a disparate way, but as I write about in some chapters, it's not only Black people, and particularly things like the opioid crisis in poor parts of the United States, austerity budgets in European countries; a lot of these things make the ability to stay healthy and well for people criminalized.

0:24:15.3 CW: So that's another important piece of the argument that's so interesting. So you're saying that when we talk about the viral underclass, it's not just people who have experienced health challenges that then fall under high levels of surveillance and kind of punitive action, like the Michael Johnson case, but it's also people who, because of their social status, find themselves excluded from healthcare systems and services in ways that raise their and elevate their risk for infection and exposure to illness. So, I think this is so... And then it becomes potentially a cycle in terms of a person who is getting gender-affirming care, but doing so in a way that potentially exposes them to HIV, and then they're kind of in this cyclical dynamic in terms of potentially being prosecuted around HIV transmission laws that are still active in several states. And I wonder, why haven't we seen that kind of criminalization with something like COVID? There was a brief moment in time where there was conversation around do you prosecute people who aren't wearing masks, or people where you can point to a case of transmission? So I wonder if you can talk about this in the context of the situation of... The pandemic of COVID; what's different? How do we think about that in the context of your argument around the viral underclass? 

0:25:55.5 DT: Sure. So I think that some ways, we have criminalized COVID. And I do think with HIV and also with monkeypox, there's particularly sexualized and racialized ways that they are... That they have a lot of stigma, and that in some ways, it was reflected in the law. As you were saying, at the beginning of COVID, many countries around the world have made various things with COVID criminalized. In the US, the biggest ways we had it were brief times with masking, where it was almost entirely, in New York City, 49 out of 50 cases were all Black people, quarantine, and...

0:26:29.1 CW: Where people were prosecuted for not having the mask.

0:26:31.4 DT: They're prosecuted for not having the mask, for having to be in by curfew. There are these horrific stories of Black essential workers. One, I think, was a nurse practitioner who was beaten by the police in the middle of the night coming from his job. So there were ways that that happened. And this may be... I might write an afterword in the paperback version of the book, but one thing I'm thinking specifically around the law is that this STS frame I was talking about, it creates a form of scientific understanding that has incorrect, still has real material consequences.

0:27:03.6 DT: So for example, when the CDC shifted from a 10-day window to a five-day window for how long that you should not be... You could quarantine after your exposure, and there was another paper this week that showed that that's really not good; it should still be 10 days. So when the CDC says five days and it's over, I'm now starting to hear stories of parents whose kids are testing positive on day six, seven, and eight, and they're being threatened with truancy. And similar with people's jobs. If you're sick with COVID for five days, and then you're still sick on day six, seven, or eight, and you're testing positive, and your job says, "CDC says five days, come back to work," that is kind of a criminalization of the sickness, and it's certainly making it so that people could be punished financially, if not actually through the criminal courts.

0:27:52.5 DT: Something similar has happened with monkeypox as well, where people were getting month-long quarantines and just absolutely breaking down because they were not getting any financial support. And so, in that way, the state's putting them in a position where they're saying the person has to stay at home and quarantine, which is somewhat for their health. My friends who had monkeypox say it was pretty horrific in terms of pain, so they probably wouldn't wanna be out and around, but if you don't have work that you can do from home or if you're too sick to work during that time, you're basically being punished; the person's staying home to protect the rest of the population, and so the society should be financially supporting them. So if you say to someone, "You get this diagnosis and you have to lose your income for a month," that's also putting people at heightened risk for things like eviction and hunger and things that could lead to further damages to health, but also could lead to a kind of criminalization. Most people in the United States cannot afford to live without a month of their earnings without other bad things happening in their life.

0:28:53.3 CW: So, one of the things that I think is so helpful about your book is to really help us to understand the importance of thinking very critically about criminalization efforts. And I wonder, what do you say to people who say, "Well, this is an important... Deterrence is an important public health tool, and that strategy is really important for us to be able to encourage people to do behaviors that we think are in the interest of public health." How would you respond to that argument? The deterrence is... The stick is... Well, is sometimes more powerful than the carrot, I guess is another way to phrase it.

0:29:37.8 DT: Yeah, so deterrence is important, and the unfortunate thing that happens with HIV criminalization; other things too, but this is the one I'm most familiar with, is that prosecutions create deterrence to actually getting tested. So, most HIV laws in the US... And you can say there's sort of a similar analogy with COVID or monkeypox as well, but most HIV laws are predicated upon if you know your status, if you know that you're HIV-positive, then you can be prosecuted if you don't disclose your status before you engage in activities with people through which they could become positive themselves. It's most commonly applied to sex and injection drug use, and it's sort of most insidious and it's been tacked on as a sentence enhancer with "Blue Lives Matter" laws that have cropped up in the last few years in such a way that if somebody is HIV-positive, they're arrested by the cops, and the cop bangs their head against the sidewalk and they start bleeding, they can actually be charged with attempted murder of a police officer. That's obviously a way that, no, that's not gonna happen; there's no way that that would lead to transmission. But the primary way that it plays out is people are prosecuted for not disclosing their status. And you can't be prosecuted if you don't know your status.

0:30:56.3 DT: So, it's yet another barrier of stigma that makes it harder for people to become aware of their status. The people that I worked with in St. Louis for years, they've done this work; it's very difficult work to get people tested for HIV. They were mostly poor, Black young men and gay men who they were trying to get tested because they're the most at risk. And these young men see somebody arrested and sentenced to prison for life, effectively do not wanna get tested even more so; like, their numbers went really down once they saw that. And so we want people with an infectious disease to know that they can come forward and they're going to be taken care of. And we had some moments that that happened here in the United States; they weren't long enough, but we had some moments where people were becoming infected with COVID in New York City, where I spent a good chunk of the pandemic. They could call, and the city would deliver food to you, would bring anything to you that you needed. If you were sick or someone in your family needed to quarantine; they eventually took months to do this, it was too long, they eventually made free hotel rooms available to you or your family to quarantine with COVID so that you didn't infect other people.

0:32:07.1 DT: And that's what we need to have when anyone has an infectious disease. We need to know that they don't... That they're not gonna feel ashamed... They're not gonna be financially harmed. You have no incentive to test regularly if you know you're going to lose your way to earn a living. If you make people have to have a decision between "Am I going to eat and have a roof over my head, or am I going to work while I'm sick?" They're probably going to choose to work while they're sick, and we can't sort of say that's just their ethical fault. If we give them the options to know that if you come forward and you're not going to work, but you're gonna get the pay that you would have gotten for work anyway, and you are going to be fed, and your family is gonna be okay, you're not going to be evicted, and you're not gonna go hungry, that's the best way. That is the carrot, I guess. But I do think that a lot of people don't understand that the major problem with deterrence, with criminalizing sickness is you make it so that people don't want to know. And we want people to know. We want them to know with monkeypox... And we want them to know with monkeypox and not think, "I'm facing... I could lose a month's earnings, therefore I'm not gonna get tested." We want them to know like, "Come forward. You won't be judged. You will be taken care of." And that's the best way to actually stop transmission through the public body.

0:33:25.7 CW: So, when I think about policy prescriptions that come out of your book, it's very clear that decriminalization is a really important prescription that you offer, and what I also read in your work and hear you saying is the importance of safety nets as another really important public health strategy. And I wonder if you can talk a little bit more... As you know, I write a lot about health safety nets, and it's one of the kind of key things that I think about in my work, and I wonder if you can talk about safety nets. You talked a bit about the examples of giving people access to housing, making sure that they have economic sustenance, and I wonder why you think we are so reluctant to provide safety nets. Why is it such a politically controversial idea? And are there specific ways that we can make the argument or push for certain strategies and certain safety nets that could be effective? So I wonder if you could... Essentially, what I'm asking you to talk about is what is the political resistance to it, and then what are the actual prescriptions you would offer in terms of what kind of safety net you think would be most effective... Safety nets do you think would be most effective? 

0:34:52.2 DT: Sure. So the way that people are averse to them and want to avoid them and kinda see safety nets as toxic is, it's just something that happens under sort of neoliberal capitalism: The idea that everything must be paid for, people should take on risk themselves and not collectively, even though... And we see this time and time again, where it would make sense to pay for something, like you wanna stop an HIV transmission or COVID transmission before it happens, because there are going to be all these other costs that come after that time. But sometimes, the prioritization of profit is one of the reasons why these kinds of safety nets are avoided. As you've seen in your own work, there are these ways that HIV and AIDS have created these safety nets that were missing in certain communities prior to this, and viruses can kinda be guides to where we can say we wanna deal with this one thing, but if we deal with it, we need to provide all these other forms of support to stop that from happening.

0:35:49.1 DT: So, with the COVID-19 pandemic, one of the biggest safety nets that we saw, and I think this is absolutely important with any kind of public health, was housing. And the United States did have for a few years or a couple of years an eviction moratorium. And we know clearly from evidence that once people are evicted, their lives cascade out of control in all kinds of ways, but specifically around infectious disease. Homelessness is one of the biggest indicators about who is likely to become HIV-positive, and also very much so who is living with HIV, and their HIV's gonna advance on to AIDS. Nobody should get AIDS anymore. It takes too long, from the time somebody is infected, to AIDS; it takes years. There's no reason why we shouldn't be able to intervene in those years and get them the medication that they need. But not having a stable home is one of the most common reasons why people either never get on treatment in the first place or why they cannot adhere to daily treatment. Research early on in the... Well, I'd say like in the first six, seven, eight months of the COVID-19 pandemic also quickly found that being homeless was a huge indicator of becoming infected with COVID and dying of COVID. Homelessness is... It just creates such terrible social determinants of health that if you get any sort of disease or pathogen, you're much more likely to get seriously ill and die.

0:37:08.3 DT: So housing, I think, is the most important safety net. Having... This sounds very basic, but having access to healthcare... And free healthcare or free at the point of service is really important. And again, as a matter of policy, we saw this during the COVID-19 pandemic; there were huge campaigns and efforts to get people vaccinated without cost. We vaccinated 200 million people or so. Treatment as well was paid for by the federal government for a while, so we know, which public health has shown in other countries as well, if you want people to partake in a campaign for the public body, make it free at the point of service and make it as widely available as possible and it will work. And that also stops what I think of as sort of a secondary engine of creating a viral underclass in the United States, is that if you have a public service like the NHS in England, which had it's own challenges, but it had an infrastructure that was built up. Regardless of that though, if you go into the NHS for anything, you don't leave with a bill. And in the United States, you can leave with a bill that's debilitating for tens or hundreds of thousand dollars, or even a million dollars. And that kind of debt and owing that kind of money can also put people on a path to ruination.

0:38:22.1 DT: So I think that the most important things are access to healthcare, access to housing, and trying to create the least amount of stigma as possible so people know that they can come forward and they're gonna be taken care of. And the social safety net, at a certain level, does need the state, especially when people are losing wages or need access to flexible housing. Such a common story in the COVID-19 pandemic was multiple people are living in a small space and then everyone gets sick. So access to temporary housing in that way is really important. But also, it's... Yeah, also, it's important to see the ways that, just having people know that they're gonna get what they need from the beginning will help them. And people were filling in the gaps in lots of ways. People were doing mutual aid, all kinds of organizations were helping one another, but at a certain point, the state needs to be involved to get things like lost wages and temporary housing.

0:39:22.7 CW: One of the things also that I so much appreciate about your work is that you have a global... You not only have a historical perspective, but you have a very global perspective. And you're thinking about what you learn through comparison and analysis outside of the United States. And I wonder if you can comment on do we see viral underclasses in other countries in context? I suspect the answer is yes, but I wonder if you can comment on what are the differences and the contours of how it plays out in other places. And I also wonder if you can just kinda comment on what a global perspective does for you to be able to further refine your argument about the viral underclass. So first, do we see viral underclasses in other contexts, and it, does it look just like it does in the US? 

0:40:17.8 DT: So yes, we do see viral underclasses, and in my book, I do look at a few other countries, even though I'm primarily focused on the United States. The thing that I find most particular to the US is that we spend so much money on healthcare, more than any other country in the world, and yet we put the people who could become part of the viral underclass or who are already in it in this position where once you become infected, that can sort of ruin you for the rest of your life financially in ways that they are gonna have lots of effects on your health as well.

0:40:48.3 DT: And that's not so much a dynamic that I see in other countries; that seems to be particular American or US-ian. But I do see it in other countries. I write primarily in my book a little bit about France, but I write a fair amount about Korea, South Korea, where there was a very different... There was a very different relationship to this virus and this pandemic, which had... And that country had a lot better results than the United States. But I do a close reading of the movie Parasite, and there are all kinds of ways that poor people are still, of course, unduly affected.

0:41:22.2 DT: And there was... Early on in the COVID-19 pandemic in South Korea, there was a way that you could see criminalization and homophobia creating a viral underclass. So after Seoul had their first wave, which wasn't anything like the United States, their second wave began, and they had a very effective contact tracing, but they traced it to a gay neighborhood, and in particular to one bar in plan gay sauna. And it's also, like in the United States, it's a very, very homophobic country. So again, people are afraid to come forward. And one person who apparently gave truth about almost everything in his story, except he lied about having a job, because he presumably... We don't know who he is, but presumably didn't want his employers to know that he'd had this... Potentially had had this virus, or perhaps that he was gay, and then he was sent to prison for three years.

0:42:13.3 DT: So that's a deterrent to getting people to come forward, but blaming gay people for that and conflating gay people with that does create a viral underclass. The bar and the sauna were very forthcoming. They had really good information about who had been in the facility. They were very helpful in doing the contact tracing. But if you then punish them through homophobia, that's gonna create secrecy and worse health effects. And I write a lot about a case study in Greece. I just happened to go to Greece while I was writing my dissertation; I had a dissertation writing fellowship. And I was gonna look into some things about HIV that some of our colleagues, including John Schneider, I don't know if you have worked with him, John Schneider at the Third Coast Center for AIDS Research. And I knew that I wanted to check in with some HIV work that was being done in Greece, but I wasn't planning to do much deep research, and I wanted to take a break from American police violence.

0:43:03.9 DT: And then within about a week of my being in Greece, a young person was kicked to death in a really horrific mob kicking and hitting death in the middle of Athens; four of the people involved were police officers. And it turned out that he was the most prominent HIV activist in the country and was a very, very out, queer LGBT rights and migrant rights activist named Zak Kostopoulos. And so, as I've now been investigating his murder for the past three years; I write an entire chapter about him in my book, it was interesting to see for me, as an American, as to how many of the same things I saw in the United States were happening completely outside of the transatlantic slave trade, kind of completely out of my frame of Blackness and Whiteness within the United States, or even sort of European colonialism happening within Europe. And the way that I saw this most clearly was that Athens's, Greece's main mode of transmission is, for HIV is... It's the case in several countries, is through injection drug use.

0:44:04.3 DT: And in the 2000s, they'd had really effective campaigns to bring that down through safe injection sites and sterile syringe exchanges and doing street work, just going out and giving people syringes in the street; it actually didn't even cost that much money, but they had a lot of success. And then in Greece's housing crash or economic crisis, which was a couple of years after the US's, the EU took over and enacted all of this austerity and cut all of these budgets, including the budgets for these health campaigns that had gone out to people. And so, Athens's rate of HIV went up 3000% in just four years before efforts were taken to bring it back down.

0:44:46.8 DT: And so that was a place where I saw how austerity, sort of the desire to cut the expenses of the government so that the wealthiest can have more money, that burden is burdened by the viral underclass. Zak Kostopoulos became HIV-positive during that period. There are ways that the government can push... Can try to end viruses, or certainly can direct them one way or another. And so, when a government will say, "We're not gonna pay for sterile syringes anymore," they're in essence opening up, knowingly, the veins of people to HIV, and also their entire networks. And a similar thing has happened here in the United States, particularly with the opioid crisis, sometimes in very, very majority White areas of the country: Indiana, Appalachia, West Virginia; places where the surveillance networks have already been dismantled, there's nobody really looking for STIs, and then if HIV or hepatitis work their way into circles where the opioid crisis leads to a lot of injection drug use, those viruses can move very quickly through networks. And if those states have cut those kinds of social services, they're in essence letting that happen. The county where Michael Johnson was prosecuted cut their only STI clinic like a year into his prosecution.

0:46:08.9 DT: And I'm really worried right now; I was just talking to my students about this this week. There was a report, I think it was in the Times, about how 66 clinics that perform abortions have closed since the Dobbs decision. And if that's anything like what's happening in other states, those clinics that performed abortions very well might have been the only places where people were getting STI testing, STI treatment, and any kind of LGBT-affirming healthcare. So the likely closure of these places for abortion is likely also pulling back surveillance networks and attempts to mitigate STIs and viruses like HIV in wide swaths of the country.

0:46:49.9 CW: And this leads to a really important question about... Continuing about this... The conversation about geography. I wonder if you can talk about rural, suburban, and urban dynamics as it relates to the viral underclass, because for a long time, particularly when I think about the idea of the urban underclass that was a popular descriptor in the '80s and the early '90s, it was almost always understood to be an urban kind of inner city phenomenon. And one of the things that I hear you talking about is this importance of other kinds of geographies and the ways in which these inequities are showing up, not only in our central cities, but they're also showing up in rural areas and suburban landscapes as well, often undetected because of differences in infrastructure, differences in attention, the kind of spaciousness of populations and access to services. So I wonder if you can really talk about why it's so important in our analysis to really be able to look at all of those different contexts to fully understand what's happening, rural, suburban, and urban.

0:48:06.0 DT: Sure. So first, I'll say something about the term underclass, which when I gave a talk before, you had told me that I needed to make sure I put that into my book to talk about the ways that William Julius Wilson and Herbert Gans talk about the underclass, and I had it in a draft of the book, and then it got edited out. Maybe I'll put it back into the... Maybe I'll mention it in the afterword in the paperback edition, because every time I give talks, it's always a sociologist that asks me about that missing part of the book. And I do say this very briefly; I'm talking about... I'm accepting underclass as a condition of capitalism.

0:48:42.5 DT: Capitalism creates different classes. I don't see it in any sense of shame. I'm just saying that this is a reality of capitalism, that it creates underclasses. The underclass has a certain relationship to viruses, and viruses also can help us understand how that class structure creates different experiences with health. And I think you're really right. There's a deep, important need to understand across geographies within the United States and across the world, and I hope that, in some ways, my book has added a positive contribution to this. I kind of started understanding this, as someone who's lived in big cities most of my life, when I did start looking at how the fastest-growing HIV outbreak in the history of the country was in 2014-2015 in rural Scott County, Indiana. And then I started seeing in Appalachia that there were these various places, largely driven in tandem with the opioid crisis, where viruses were moving very quickly, particularly hepatitis and HIV.

0:49:45.5 DT: And in the ways that AIDS was very much seen as an urban/Black problem in the 80s and 90s, and you could see the concentrations of it, and it was happening in other parts of the country too with less attention, but it was very, very much concentrated in urban cities in North America that had this real connection to deindustrialization. When you look at the Bronx and Brooklyn in the 1980s and 1990s in the maps of where HIV and AIDS was, similarly with hip hop culture, a lot of it is happening in tandem with deindustrialization and the poverty that's happening there.

0:50:23.2 DT: And then you can see the same thing is happening with deindustrialization across the United States. It's not happening in exactly the same timeframe. A lot of it happened in a couple decades later. But wherever you see steel mills that are shut down and coal mines that have shut down and people having access to good jobs, unions; unions are both important in terms of economics, but also just the feeling of connection to community, as these things were obliterated by the economic down-spiral and the losing of the tax base in lots of parts of the US, very similar things were happening there.

0:50:55.8 DT: And so I think that it's important to see that we have a lot of solidarity. We don't have to see sort of urban versus rural as two distinct things that don't share common values and common needs. And you've probably seen in your work... There are all kinds of ways that the cities that were initially hit the hardest by AIDS: San Francisco, Los Angeles, New York, Chicago, that they've built up quite a robust infrastructure, and numbers have been going in the right way in lots of ways through targeted campaigns, particularly things like PrEP and trying to get pre-exposure prophylaxis to stop infection from happening in younger populations, and so that's happening in urban places and not as much in rural places, and so that's something that needs to be addressed.

0:51:43.6 DT: I think it's also important to... Even though my theory of the viral underclass is thinking across viruses, but the differences of particular viruses and particular pandemics are important, and they shouldn't be ignored. For example, monkeypox is being dealt with in big cities and, from what I can tell, almost nowhere else. I was shocked when I was at Cornell University two or three weeks ago, which is at Tompkins County, New York, and Cornell, that town, Ithaca, is one of the densest concentrations of PhDs in the country, and no monkeypox shots had been given out. There is simply hadn't been any given out in that entire county. And as I've talked to people around the country, I've met people where... I haven't talked to anyone in certain states that's been able to get it yet. If they, some of them haven't heard about it very much, or think it's not an issue in the area. Some people are really desperate to get it and simply can't get it. And so I think that we need to look at, yes, a lot of the transmissions are happening in New York or Chicago, but it's important to vaccinate the people that are part of that network. You know, we're not static in the United States. And then similarly, in other countries as well, the particulars are important, but we are...

0:53:00.6 DT: We're all connected to one another in these processes. The last thing I'll say on this is, the monkeypox epidemic was well predictable within the United States; we'd seen information coming out of Canada and Europe for months before that. But a really important moment is in 2017, when a Nigerian doctor, whose last name was Ogoina, had had a patient with what he thought was monkeypox, but it seemed mysterious; they didn't fit the criteria of why they should have it, and then over the next year, was only seeing it amongst men who have sex with men. And prior to this time, monkeypox was not understood to really move sexually, and certainly not within sexual networks. And so he said that... He wrote a paper and saying like, "I think we really need to study this more. I need money. I need resources to study and see like, is it moving sexually? Is it moving through genital secretions?" And nobody paid attention to him around the world.

0:53:58.8 DT: So if the US thought it was in our interest to take care of what's happening in rural Nigeria, which it is in our interest, but it's also important for those people... You know, helping people in other parts of the world. If we saw that, yes, there is a relationship. There's a relationship between what's happening in Wuhan, China and what's happening in urban and rural Nigeria, and we're all kind of connected. At some point, we may all be connected by these viruses. So we can't really just sort of see national borders as a line of defense, or cities as the only places that these have to be dealt with.

0:54:37.1 CW: Really helpful, and... So, Steven, our conversation is being broadcast online, but it's also being broadcast in our classroom. So, Dr. Dominique Adams-Santos and I have a class called Racial Foundations of Public Policy, and the students are watching, and they have sent in some questions, so I wanna get to some of their questions. So in what ways has the broader reach of the COVID-19 pandemic affected the cultural understanding of the spread of viruses in our communities? What lessons do we seem to have grasped in ways that feel similar or perhaps different from previous epidemics? 

0:55:20.3 DT: So, there was an understanding and theory that COVID could happen to anybody, and it was often called the great equalizer in the United States in the first couple of months that it was being experienced here. In a certain sense, it's true, in a way. In theory, anyone could become infected by it. The odds of people becoming infected by it, certainly that first year, were extremely different. Somebody doing face-to-face work as a cashier is going to have much worse odds in encountering the virus than somebody who's working from home and having all their food delivered by Uber Eats and their packages coming from Amazon. So there was a difference, but there was the kind of thought that we're all in this together, and the virus itself can move extremely casually. There's not a difference... For instance, HIV and AIDS moves in prison, so HIV is a much less efficient virus. But prison guards are not like... They're not sort of still at risk of HIV, or they're not at a very high risk of HIV working at prison, but they are for COVID, and there are these ways that even very wealthy people cannot avoid the people who earn less money from them entirely. And that way, there is something kinda democratic about viruses; if given the possibility, they will just move and try to replicate wherever they can.

0:56:42.4 DT: So, that has been a lesson. We had an experiment in socialized medicine on a scale we've never seen before by having these free vaccines that were given to try to get them to everybody as quickly as possible. That was something we learned from when we were socialized to accept vaccines, so I've thought a lot about how the monkeypox epidemic happening is so affected in good ways, and in challenging ways, with COVID-19; very good that... I think if the US had been able to snap their fingers and say, "We had 10 million vaccines in June of last year," they would have gotten rid of them very quickly. Gay men would have been very willing to accept them, because we've been socialized into doing this as adults in a way we haven't been for a long time. And then there were also challenges, because people bring with them sort of their assumptions of COVID, the assumptions of how the virus is going to move, and the monkeypox virus moves very differently, acts very differently, so there are challenges with that. But it's generally good that we've had the experience of going through something together and having a common understanding of it.

0:57:49.1 DT: The thing that I find kind of saddest is we've been forced to confront repeatedly that we share one public body, and our fates are intertwined to some degree; we have different levels of risk, but our fates are intertwined. And literally, biological matter from me to you can travel and change your body, and the same can happen to mine and change your DNA. But I feel like there's this very... This almost violent revanchism to try to get away from that and push people back to feeling like they're individually minded. The illustration I use in class that does this the most is showing the MTA's poster for the subway system in New York with two people smiling, saying, "I do this for you. You do this for me," where they're both wearing masks. And now they have one of somebody wearing a mask incorrectly, saying, "You do you."

0:58:41.7 DT: And that's kind of the move that a lot of public policies move towards, because we've built a lot of solidarity in ways. I don't think that's... I think that's gonna have a political life beyond this one moment, but there's a lot of attempts in policy to push people back to a more individualistic mindset about their destinies.

0:59:01.8 CW: Thank you for that. I wonder if we can talk about this idea of... At what point do you think about... One of the things that's so interesting about your book is its interdisciplinary nature. And our students are often kinda grappling with this idea of how do you think about building coalitions, how do you think about speaking to multiple audiences, how do you think about using multiple tools of knowledge to be able to make a set of arguments. And I wonder if you can talk about that, because what's really clear is your grasp of public policy, of legal frameworks, of history, of the arts, in terms of you writing about the film Parasite. And I wonder if you can talk about what is that... How does that help you achieve your goals particularly in policy conversations? 

1:00:04.1 DT: So I think my book is very much an American studies book, that's where I did my PhD and I like... And I actually... I don't know if I've ever told you this, but when I was thinking about doing a PhD, I initially thought I'd do it in Sociology. And I met with a bunch of... Yeah, I applied to one program. But a number of people said to me, American studies might be good for you. It's good for former journalists, or acting... Or continuing... Recovering journalists. Because you can use different modes... You can use different methods for whatever problem you're dealing with, whatever situation you're studying at the time. So I was really happy. I was surprised. I didn't know if my editors would let me have like a chapter where I was mostly writing about Parasite, but they very much welcomed it.

1:00:46.6 DT: So I like to show that there are different ways to think about the world. And viruses to me have been incredible teachers, biologically and metaphorically, politically, scientifically, almost even spiritually in understanding the world. And over the past three years, we've been very aware of how they have shaped almost every aspect of our human lives. And I think I kind of came to that understanding having not... I mean, I was alive, but I was a child at the beginning years of AIDS. As an adult, I've really become aware of the ways that AIDS has created community, culture, relationships about science, but also around culture and art and queerness and queer theory that have very much en-richened my life.

1:01:33.7 DT: So I wanted to think about different ways that I could think about this virus, because it just affects so many different parts of life that we need different ways to deal with it. From a policy standpoint, I don't know, there are parts of my book that I think are very policy-oriented, even though they seem a bit pie in the sky. So where I'm writing... In the chapter called The Liberal Carceral State, I'm writing about how one of the reasons why we did not see the drop of COVID things with the Biden administration that we maybe hoped we would after the Trump administration was so cavalier with many things. Because incarceration is such a part of US life, going between parties in many ways, embraced by the Democratic Party. Since I wrote the book, President Biden has said that he wanted to hire 100,000 more cops. Just like President Clinton did in the 1990s. And that's money that could be going to other places. Ironically, the day President Biden was wanting to go announce that he wanted to hire these cops, he could not because he got COVID.

1:02:43.5 DT: And so, I feel like in some ways we're making the same mistakes. But at a policy level, I try to talk to people, and there are a couple of different places where you can meet them. I think a large majority of the US now kind of can look at policing and say, policing is being asked to do all these different things, and you could take a bunch of them out and spend the money better. And I think there's a pretty broad understanding that, yeah, you can have psychiatric checks, you could have certain things that would make it so that the police aren't doing so much and other social services could be better funded. There is also a belief that abolition... None of it's working and it needs to be abolished and something completely new needs to come in its place, which is more how I think of things. But something I've told to people from... I guess, this is sort of policy perspective, is that I think a lot about the death of George Floyd.

1:03:38.3 DT: And Floyd died obviously, everyone knows by being killed by a police officer. What a lot of people forget if they even knew it in the first place, is that when his autopsy was done, he had the novel Coronavirus. He'd recently been infected by it. And so I think a lot about how... Had Floyd lived from the police encounter, would he possibly have also died of COVID? And then coming back from the moment of infection and the moment of his death... 'Cause I think thinking about police violence, it's not just about the moment of the shooting. And transmissions of viruses as well, it's not just about that moment you have to step back. I think about how the City of Minneapolis was spending like, 38%... 37%, 38% of their budget on police. And so I think about had George Floyd lost his job as tens of millions of people did in the beginning months of the COVID pandemic, what if Minneapolis had been spending that money capitalizing and helping people like him? Making sure that they had food, making sure they had housing. He might not have ever been in that Cup Food Store. He very well might not have ever come into contact with the police and still be alive.

1:04:44.5 DT: And so that's the way that I kinda think about policy people and saying that we're making agendas for our country with our values by how we're creating budgets over time. And those budgets create certain realities. And we can create realities where viral transmission was not happening as much as it is.

1:05:04.5 CW: There's a question from a student about the possibilities around universal healthcare. And the student writes, "One concept that stood out to me from the book, is that health insurance should not be tied to employment. At the start of the COVID-19 pandemic, so many people lost jobs and their health insurance along with those jobs leading not only to housing instability, as you described, or reduced access to healthcare, all during the global pandemic. What do you see is the most feasible path towards universal healthcare in the United States?" The student would like to know.

1:05:34.1 DT: The most feasible path to me seems, and it would just take getting rid of maybe not that many Democratic donors, would be something like Medicaid for All... Or Medicare for All. Medicare is incredibly popular. It's been around for decades. There's an infrastructure for it. And not only has the support of a vast majority of Democratic voters, it actually has the support of a majority of Republican voters. So this is not something that the country doesn't want. They do want it. But it's mostly political interference from the Democratic donor class that wants to include... Wants to keep carrying on with private insurance. So to me that's one way that's most likely or most politically viable. The other one that I've been sad to see go was that we had an infrastructure in this country. It was put together by a lot of spit and prayer and tape and volunteerism. But we got to a point where we were vaccinating 4 or 4.2 million people a day in the United States.

1:06:33.6 DT: And I thought that should have been a model for us. We might not have always been able to do that much, but we could have created... We could have kept large parts of that infrastructure in such a way that you could just go get your... You could go to a sports stadium on certain weekends of the month and get your COVID booster, your updated booster. You could go there once a year to get your flu shot. Something like monkeypox or meningitis comes up, you can also go to that same place to get it. And so, we did it. We sort of made that infrastructure on the fly, and I think that there's a possibility that we could certainly do certain things like that, particularly around infectious disease, so that we're not kind of lurching from thing to thing. We know that everyone needs to get a flu shot every year. There should be like a major... It's important. This is COVID. Vaccines were important, and there's no reason we can't make a permanent or flex permanent system at least to deal with those kinds of things.

1:07:25.5 CW: And it's interesting. So would you say, given the models, 'cause I'm interested in your point around the resistance to universal healthcare. And I'm also thinking about the vote, that there was definitely a huge amount of disapproval from the right as well, when you think about the attacks on the Affordable Care Act and things like that. And I hadn't really thought about some of the things that we saw in COVID in terms of large-scale vaccine efforts and rollouts as moves towards evidence or moves towards more universal healthcare practices. And it's interesting. It's like, many people, I think didn't think about it that way. Or maybe they did, and that was part of some of the resistance around vaccines, for example. Of this idea of, "I don't wanna take something that we're all supposed to take and the government's telling me to take."

1:08:20.6 CW: So it's so interesting in terms of how you're drawing these parallels. And another huge part that's really obvious are these kinda cultural ideologies. And the role of say, social media in spreading these cultural ideologies and reinforcing these culture ideologies in terms of how we think of things like health, healthcare, illness, etcetera. So I wonder if you could just comment on one of the big elephants in the room, which is social media and the internet in this conversation, in ways that are operating very different from when we would say writing in the time... We would be writing in the time of the HIV epidemic, for example. Can you talk about that as a sort of pillar of this conversation? Yeah.

1:09:08.3 DT: I think that... To me, one of the most powerful things of the last few years has been that all of humanity has been going through some version of the same thing with very different... You know, different levels of risk, different ways that were coming out. But every human on this planet has somehow been affected by something happening at the same time, and with the ability to communicate with others. That's never happened before in human history where... I was constantly in contact with friends in Europe, South America, a little bit in China, a lot in Korea and Africa. Like, "What's happening? What's happening in your place of the world?" So there was the social dynamic of whether or not people agree with socialism. We were socialized in a way we never have been before that adults could go... Like you could just show up somewhere, and the government's gonna give you this medicine you need without paying for it. We've not had that experience before in the United States; certainly nothing like it on this scale.

1:10:04.8 DT: I think that... And I'll come back to your social media part of it in just a second. I think a lot of hesitancy I've seen around accepting vaccines was for some of the reasons I already said. But also from people who've been left for dead in the health system already. I think if you're a person who's had cancer or had other life-threatening illnesses, and the systems kind of said, "Alright, you're on your own, and you can live or die, and we don't care." Like, it gets very hard when then the government comes and says, "Come take this free thing. It's gonna help you or help your neighbors." Like you're inclined to be distrustful. And I think that we're paying a price for that.

1:10:43.4 DT: Now social media I find very interesting for how we're connecting about it. We're gonna be studying it for the rest of our lives. I think, as I was saying, there was a circulation of knowledge that hadn't happened before, both in terms of people trying to understand what was happening, in terms of the kinda language used, preprints of paper... You know, papers. Papers... No one or... The vast majority of the Earth would never have heard of that a... Pre-peer review are now sort of circulating amongst millions of people. But in some ways, I think it's a little overdetermined. I think there's a lot of belief with social media and also with more traditional Fox News that it's poisoning people. In some ways it is. But the vast majority of elderly people in this country, like 95% of people over 75, I think, got vaccinated. And that's Fox News's audience. Those Fox News viewers of a certain age got vaccinated. And they got vaccinated because the United States spent a lot of money and put a lot of resources to go to nursing homes, to go to the villages, to go to retirement communities, and they got almost everybody vaccinated regardless of their party affiliation.

1:11:55.0 DT: Now, over time, party affiliation has started to take in... Take on a bigger valence in who's gotten boosted and who's not gotten boosted. But the people who haven't gotten boosted did not become... A lot of them do not become antivax, it's just that the delivery system that made it possible disappeared. So sometimes, I think we should worry a little less about what Fox is doing or what social media is doing and think about how can we systemically get to people and get more people vaccinated. But people have endless stories, including me. I've had very painful stories within my own family about sort of the role of social media snake oil people, and the ways that it's created... This I've seen a lot of. It's created huge divisions within families. And that, I think, is going to be a real lasting legacy of this pandemic.

1:12:41.0 CW: Wow. The last question will be another student question, and it's this: In the preface to the book, I was struck by the line, "Then think again about your place in it all. About what you have done and what more you can do." What can we, Dr. Thrasher, as students and young professionals, do to help expose and fight the frameworks of the viral underclass, their experiences, and the forces and systems that create it? 

1:13:14.3 DT: I think that's from Jonathan's foreword, before my pen kicks in. But in terms of what you can do. As students, you have the opportunity, while you're here in school, to kinda follow your passions and figure out what you love doing and what you wanna do. And take as much advantage of that as you can before the market tries to force you into maybe spending your time the way you don't want to. Regardless of the kind of work that you are going into, I encourage you to organize your workplace. One of the... There's been one RA dorm... Or one RA campus, and then one entire college, Grinnell in Iowa, that's organized their... That has organized their entire student worker body, and that will give you really great skills.

1:14:07.1 DT: The reason why we've seen so much organizing with Amazon and Starbucks around the country is in direct reaction to the kinds of conditions people were fighting to get safer places for COVID. Safer workplaces during COVID. And so regardless of the kind of work that you're gonna be doing understanding that you don't have to do it alone and that you can do in concert with other people will help you personally, will help your communities and fellow workers, and will help you create the kind of world that we need to have to address climate change. And I guess the last thing I'll say about this was I was very struck in reporting on the book and also, in my own experiences, for friends of mine who had been kinda full-time office workers, and how much more satisfaction they had in their lives while they were working at home. Not just 'cause they were working at home, but so many people actually took delight in doing things like getting groceries for their elderly neighbors and being part of mutual aid networks in that way.

1:15:01.1 DT: And so I would say, as students, take notice of what actually brings you joy in your day-to-day life and try to incorporate that into the kind of life that you're going to lead. And often, I have found like people like to feel like they're needed, and they like to feel that they're cared about. And so trying to create a world where you are needed and cared about and don't feel like you're just being exploited and doing things you don't like, but actually feel like you're in an interdependent relationship with other people of mutual care, I think that is something that you can do that's really valuable.

1:15:33.4 CW: Dr. Steven Thrasher, this has been so helpful in illuminating. The book is called The Viral Underclass. I invite people to check it out. It is such an important piece of work, The Viral Underclass: The Human Toll When Inequality and Disease Collide. Thank you so much for being with us. We appreciate you joining us. And to our audience, we thank you. This has been another segment of Racial Foundations of Public Policy. We thank you on behalf of the Center for Racial Justice at the Ford School of Public Policy at the University of Michigan. Thank you so much. Take care, and be well.

1:16:12.4 DT: Thank you.