Was Johnson and Johnson either uniquely or principally responsible for the epidemic of opioid abuse and death by overdose in Oklahoma, or elsewhere?
The United Nations Children’s Fund is probably the greatest mass-poisoner in human history—not deliberately, of course, but inadvertently. It encouraged and paid for the drilling of tube wells in Bangladesh without realizing that the groundwater was dangerously high in arsenic content. It promoted the wells this to reduce the infant mortality rate from infectious gastroenteritis and in this it succeeded. Indeed, it trumpeted its success to such an extent that it found it hard to recognize that, in the process, it had exposed tens of millions of people to arsenic poisoning, and was very late in recognizing its responsibility in the matter.
Another United Nations agency, its peacekeeping force in Haiti, was responsible for the most serious epidemic of cholera of the twenty-first century so far. Before 2010, cholera had been unknown in Haiti despite the country’s poverty and lack of hygiene. Then, from 2010 to 2018, it suffered outbreaks of cholera that have affected perhaps a tenth of the population and caused between 10,000 and 80,000 deaths (the exact figure will never be known).
The evidence suggests that cholera was brought to Haiti by United Nations peace-keeping troops from Nepal. Whether Haiti needed peacekeeping troops at all may be doubted: at the time it suffered from civil unrest rather than from war. One suspects that the peacekeeping force was employed more to keep the Haitians from leaving Haiti than to keep the peace.
Be that as it may, some Nepali troops arrived fresh from a cholera epidemic in Nepal, established a camp next to the Artibonite River from which many Haitians drew their water. The Nepalis emptied their sewage directly into the river, and some of them were infected with the cholera germ. There was soon an outbreak of cholera among the local population of extraordinary violence. The Haitians guessed at once that the Nepali troops had brought the cholera, but this was strongly denied.
Two books (to my knowledge) have so far been published about the cholera epidemic in Haiti, one by an emeritus professor of epidemiology in California, R. R. Frerichs, Deadly River: Cholera and Cover-Up in Post-Earthquake Haiti (Cornell University Press, 2016) and the other published earlier this year, Renaud Piarroux, Choléra: Haïti 2010 – 2018, histoire d’un désastre (CNRS Éditions, 2019). I hope both books will be read by political scientists, sociologists, psychologists, and others interested in how, when political interest prevails over the desire for knowledge, untruth can triumph for a time even in purely scientific matters. Reading them, I recalled a line from the Marquis de Custine’s great travelogue, Russia in 1839, published in 1843, in which he said (I quote from memory), ‘The Tsar makes war on truth, and triumphs in the struggle.’
The prima facie evidence about the introduction of the germ into Haiti by the Nepali soldiers was very strong. First, the very fact that there was so sudden an outbreak in a country that had never suffered from the disease before suggested that it had been introduced from without. Second, the first cases appeared near the Nepali encampment. Third, it was known that Nepal was experiencing an epidemic itself at the time. Fourth, there were credible witnesses to say that nauseous waste was emptied directly into the river from the encampment, and there was an open cesspit nearby dug by the encampment. Subsequent investigation demonstrated that the cholera germ was genomically almost identical to—very nearly the same as—that which caused the epidemic in Haiti.
Nevertheless, enormous intellectual energy went into denying the obvious. No doubt there was a partly-honorable reason for this (if it is ever honorable to dissemble in such a matter), namely that if it were officially recognized and accepted that the Nepalis, whose presence was felt to be an occupation anyway, were the cause of the disaster, their lives might be in danger from the enraged local population. This seems to me a false argument, because if a peacekeeping force cannot defend itself against the largely-unarmed local population, it can hardly be expected to keep the peace. But I recognize this was at least a legitimate concern.
What was the alternative theory of the origin of the epidemic? First it was denied—against all epidemiological principles since at least John Snow and his brilliant demonstration more than a century and a half ago of the Broad Street pump as the source of an epidemic of cholera in London—that the origin of the epidemic was of any importance, it being claimed that the urgency was to treat and save the many thousands who fell ill of the disease. But second it was claimed that the epidemic was caused by the spread of cholera germs already present in Haiti (although from when and how was left unstated), and that were suddenly caused to multiply enormously because a change in climatic conditions and an earthquake, which between them first provoked and then maintained the epidemic.
What is shocking is not that there should have been an alternative theory to the one that proposed that the Nepali troops brought the disease to Haiti, because science is not just the adoption of an a priori argument but the choice of the best alternative available according to the evidence. What was shocking was the degree to which the proponents of the environmental theory were prepared to lie both by commission and omission to support their theory, for example by dissembling about the place and timing of the first cases. What is also alarming is the extent to which United Nations officials and some of the mainstream medical press—notably the Lancet—was willing to be complicit in the obfuscation. Only the persistence of Professor Piarroux and his scientific collaborators allowed the truth to emerge and be accepted, and as a consequence almost to eliminate the disease from a country that has of late been among the most unfortunate in the world.
Of course, no Nepali soldier deliberately brought cholera to Haiti, any more that UNICEF deliberately poisoned millions of Bangladeshis. On the other hand, negligence on a large scale was almost certainly involved. The UN employed Nepali soldiers for a task which possibly did not even have to be done because they were cheap—in monetary terms. But you hardly have to be Robert Koch to know that special care has to be taken when moving people from a cholera area to one that is free of cholera (I myself was once briefly held in an isolation camp in Iran, having passed through Afghanistan—where there was cholera—to Iran where there was not). Both the Nepali and the UN authorities were therefore seriously, indeed devastatingly, negligent.
But the United Nations was born with Original Virtue, and certainly with Original Legal Immunity, which is the nearest we come to innocence these days. The Haitian population has received no compensation for the introduction of one of the few plagues that it did not already suffer from. One’s blood boils to read of almost casual dishonesty of UN functionaries, willing dupes, and condescending editors of journals who preferred to save the image of the United Nations than prevent death on a large scale, and in the end did neither.
If you want to know that way of the world at its worst, read these two books.