Civilization’s Vampire Slayers
I have always been fascinated by the macabre, the occult, and the mysterious. Maybe it was a form of psychological reactance as a Catholic school student from kindergarten to 8th grade? Vampires were always a favorite and I thought it was cool that I lived in Pennsylvania and there was a place with the same suffix called Transylvania that was part of vampire lore. I even climbed the 1400+ stairs of Poenari Castle in the Romanian Carpathian Mountains to see the ruins of what was, I imagine, an impenetrable fortress of Vlad the Impaler, Bram Stoker’s historical Dracula.
Long before microbes were understood, people often explained epidemics through monsters. Vampires, witches, curses, and demons were attempts to impose agency on otherwise mysterious illness.
The vampire is often associated with disease causing rats and bats. His Transylvanian soil required for travel can be “sterilized” with Eucharist wafers to force him to flee back to his home. Vampirism was also thought to be related to tuberculosis as individuals consumed by the disease were thought to be being consumed by vampires rising from coffins.
I’ve written about how I liken being an infectious disease physician to being akin to a Ghostbuster, Indiana Jones, a Man in Black, and an exorcist but it is also like being a vampire slayer.
When it comes to vampire slayers, there is only Buffy — and Faith. I absolutely relished the Romanticism of the movie Buffy the Vampire Slayer but the series starring Sarah Michelle Gellar was really where the parallel with infectious disease was most apparent. Not only did Buffy and her clan have to battle myriad monsters (i.e., different pathogens), they consulted librarian Giles to research what they were up against (i.e., made diagnoses). Different countermeasures were directed at different creatures, just like in infectious disease.
There’s another really poignant scene I’ve been thinking about from that series that concretizes an important point about infectious disease control. When infectious disease control systems are working, they’re invisible. Unbeknownst to the individuals being protected, it is keeping people safe. The “it” here are the epidemiologists, the public health department personnel, the microbiologists, and the infectious disease physicians. To paraphrase Men in Black: they go to places you need not go, see things you need not see. Rarely do they get thanks — infectious disease is one of the least financially lucrative areas of medicine.
This invisibility can also work against them as people are unaware of what is keeping the demons at bay, beating the devil back; the victories are largely invisible to the people they protect. When the outbreak doesn't happen, nobody cheers. When the pandemic doesn't spread past its index case because someone in a state health department noticed a cluster and made the right calls in the first seventy-two hours, nobody hands out awards. When vaccination programs keep measles from circulating in a school, the kids who didn't get encephalitis don't know they didn't get encephalitis. The Ghostbusters don't get a parade after defeating Gozer. They get their funding cut and their lab shut down by an EPA regulator.
Similarly, public health agencies are subject to neglect and cuts in funding, vaccines are devalued and smeared, infectious disease expertise is attacked. We see the results plainly with measles re-establishing endemicity, Ebola outbreaks festering for over a month unnoticed, and minimal situational awareness of avian influenza.
Buffy has spent three years defending Sunnydale High from a parade of horrors — demons, zombies, hyena-possessed students, a principal who turned out to be a robot, and vampires. Nobody talks about it. Nobody acknowledges it. The monsters are fought mostly in the dark, largely alone, and when it's over, the next day proceeds as though none of it happened. The ordinary life of ordinary people continues precisely because someone was doing extraordinary work they couldn't see.
Then, at the prom, a student named Jonathan takes the microphone and reads from a card:
"We're not good friends. Most of us never found the time to get to know you. But that doesn't mean we haven't noticed you. We don't talk about it much, but it's no secret that Sunnydale High isn't really like other high schools. A lot of weird stuff happens here. But whenever there was a problem, or something creepy happened, you seemed to show up and stop it. Most of the people here have been saved by you, or helped by you, at one time or another. We're proud to say that the Class of '99 has the lowest mortality rate of any graduating class in Sunnydale history."
Buffy is named “class protector”.
That’s the closest most people ever get to understanding what public health actually does — not a press briefing, not a policy paper, but a kid at a microphone trying to put words to something he can’t quite name.
That's how infectious disease preparedness and public health work.
The people who keep pathogens from killing you are working with the same energy whether you're paying attention or not.
Prior to this scene Buffy states that she just wants her classmates to have a normal prom, no matter how many people she has to kill.
That’s what the entire infectious disease apparatus is doing as well — trying to give everyone a normal life where they can pursue their values and achieve, free from the dread and disruption of infectious disease.
That is the mission of infectious disease control.
Not to dominate people’s lives. Not to control society. Not to make itself visible.
The goal is to make normal life possible.
But civilization is full of unseen guardians.
Some carry stakes. Some carry microscopes.
Class protector — civilization protector —infectious disease physician.