Infectiously Radical

It can be difficult to sum up Ayesha Khan in a succinct or accurate way. Infectious disease scientist, political activist, writer, abolitionist, ecologist – none of them fully hit the mark. Looking at Khan’s socials, you’re presented with a kaleidoscope of biology, anti-capitalism, and environmental justice that has clearly captured the attention of more than 150,000 followers.

I caught up with Ayesha half way through a forced house move (the old apartment’s roof collapsed after a snowstorm). We managed to squeeze in a video chat, tucked into our own respective corners with less-than-stellar wifi, and covered everything from race to medical school to capitalism.

What led you into infectious disease?
 

I was born in an impoverished rural town in Bangalore, India. My family is very mixed with many different lineages and heritages. My dad is essentially Afro-Indian and Hindu and from a coastal town on the Malabar coast. Growing up, I noticed early on that there was a disproportionate amount of people in my community specifically dying of a cold or drinking bad water. I was grounded in my cultural context, trying to understand the land that I was on and the world around me. At the same time, I was thinking about how there couldn’t be a specific biological reason for increased illness within our community. Now, I realize I was trying to grapple with bioessentialism – race as a risk factor, sort of thing. I came to realize there’s a strong social-political context that explains why certain communities are disproportionately targeted by infectious diseases. And to this day it’s the number one cause of death in the Global South.

I immigrated when I was about six years old, and since then I’ve bounced around as a refugee in the diaspora looking for a center. I’ve lived a good part of my life in what is known as the Middle East in the North Africa region, largely in the Persian Gulf. I went to middle school in Moscow. I had one high school in Saudi Arabia. I saw very early on that governments are terrible everywhere, but there are also people doing good work everywhere. I understood that a lot of communities were struggling with the same sorts of issues in terms of human health outcomes. Marginalized communities everywhere had similar health outcomes, died of similar things, and had higher morbidity or mortality for similar reasons regardless of location. This remained very obvious when I came to the US. 

As I grew older, I had to deal with the fact that capitalist healthcare systems, almost everywhere, are profiting from sickness – without ever addressing the core root to social conditions that are making people sick in the first place. No one walks out with a prescription for food and water. I realized that we try to address disease in a vacuum – as if it is totally unaffected by the environment around it.

Everything I do now is still focused on the things that I cared about at the beginning: understanding microbial ecology and studying microbes. But not for the sake of dominating them or annihilating them. Studying microbes helps you realize that they embody principles of energy, non-hierarchical systems of organization, and inter and intra species collaboration in how they structure their communities.

What was medical school like as a neurodivergent person – and how has your experienced changed?
 

I think what’s changed is my understanding of the colonization of very logical human responses to correction – or, to put it another way, the pathologization of divergence in general. Without going down the biological route, we exist in multitudes. And many of us are now even rejecting the label “neurodivergent” because it has more biological implications; instead there’s a move towards “divergent” because you can’t really separate the mind and the body. It’s all one system. But you can’t separate me from my environment either. So I’ve somewhat let go of the illusion of individuality. I’m always thinking about the impact of being socialized under oppressive systems and what it does to our global health.

Where do you focus your attention?
 

I focus a lot on understanding trauma, and how it manifests in our bodies and systems as infection, but also in how they trickle down. I’m also focusing on decolonizing medicine, and specifically psychiatry because I think it’s a beautiful example of an entire branch of medicine that’s based on social constructs. It’s made up of diagnostic criteria that are impossible – even today – to validate with biomarkers. In infectious disease, I do actually have to culture something to be able to say what the etiology is. But in the case of psychiatry, it’s just an arbitrary list of criteria and boxes that we have to check. What hit me is realizing that medicine pathologizes the individual right to fall out of line in some way.

So you think society, politics, health, and science are inextricably intertwined… 
 

I believe everyone, regardless of what they do, has to ask themselves about the choices they have to make. For example, if I care about providing care, am I really achieving that in the systems that I’m working within? Am I using the tools offered to me by the system? So far, the answer has been no. So much of my work has been focused on looking at healing through a much more politicized, collectivist lens.

In this oppressive society, 99 percent of us understand that the way we are raised and socialized impacts our health, the way we think, how we perceive the world, and our role within that world. But that’s harder to figure out when you’re lacking something and have no idea what it feels like to be in the presence of that same thing. I think that’s what people around the world, especially in colonial countries, are dealing with – a vacuum of culture and community. It’s this desperate search for meaning, purpose, and validation that we all need to survive, but we’ve been left to find our own validation systems because we haven’t been given a community safety net. 

Now I ask myself this question pretty regularly: What does capitalism prevent us from doing? Many solutions to global problems are already out there, but they involve us thinking outside the boxes that we’ve been raised in (or the cages that we’ve been confined to thinking within). We should wonder: How have collectivist cultures existed in the past and how do they exist today? What are the ways of connecting and relating with each other and the land that we live on? One pattern that I’ve recognized is that capitalism reduces everything to overly simplistic binaries – good and bad, right and wrong, positive and negative. And it’s essentially the same in the medical system. Our approach to healthcare is reductive – even though there’s plenty of research to support different kinds of public health measures.

There’s a reason that medicine around the world focuses solely on public and community halls. If you think that we really care about keeping people healthy, it makes sense to say that we need to provide them with the basic social conditions that are required to have a baseline level of health, right? Everyone needs food, water, shelter, and community. So the answers are already there. But people look at things in a vacuum – because they see themselves in a vacuum; they see themselves as separate from nature, not part of it. They see themselves as an individual, and spend their whole life aspiring to some arbitrary metric of success – not recognizing that, rather than aspiring to win, they aspiring for someone else to lose.

But that thinking and behavior is never going to lead us to what we’re all seeking, which is meaning, purpose, contentment, joy, and a reason to live. Capitalism has essentially created a crisis of meaning. And so, people attach their work to something that can give them meaning. You may not realize that you’re born into a society that deprives you of the right to live, which essentially means you don't matter; no one does, nothing does – not unless it can be extracted or exploited for profit. We’re all objectified and commodified – and so is the land and everything on it.

Can you imagine if the overarching goal of medicine wasn’t to make profit or climb the ladder to some hypothetical position in academia? What if there was no hierarchical system? For example, why on earth should I have more money than a sanitation worker, if both are considered essential to society? Think of the meaningful ways we could contribute to the community. Maybe the best way isn’t hanging people’s life over their head by constantly making them worry about where their next meal is coming from. 

And yet, despite these constraints we’ve still pursued innovation. To me, this doesn’t seem like anything other than a pressure cooker.

In terms of antimicrobial resistance, how scared should we be for the future?
 

We see results as combatting something – it’s this colonial urge to dominate, conquer, and defeat. And we take the same approach in medicine. But recently there’s been a shift to understanding. For example, we’ve acknowledged the microbiome and how every individual is an ecosystem; trillions of bacteria are living in and on you – and our health is intrinsically tied to their health. It seems this oppositional, combative relationship we have with microbes is shifting to something more commensal.

Throughout COVID-19, we saw people trying to address infectious diseases through the lens of capitalism and colonialism. Take something as simple as vaccine apartheid. Where does that logic come from? You’ve got to ask, with so much innovation and creativity in the world, how can any single corner of the world still not have equitable access to vaccines during a pandemic?

Going back to your question, we’re struggling to fund the discovery of new antibiotics because they’re not profitable – the pharmaceutical industry makes much more profit from chronic medication because people are depending on them for the rest of their lives. There’s always going to be more incentive, if the profit margin is right. 

In the same way that you can’t restrict an infection to any particular organ in your body, you can’t restrict infection to just one part of the world or restrict oppression. People may think it’s not affecting them, but it is – you’ve probably just told yourself it’s not because you’ve never known the other side of this reality.

Most AMR is not due to overuse of antibiotics in hospitals, but overuse of antibiotics in agriculture – industrialized capitalist factory farms that mass produce brutal abuse of animals, because they are also objectified. The fertility of soil everywhere is dramatically decreasing because we’re pumping herbicides and pesticides into the ground because it’s the best way to maximize yield.

Unless we acknowledge that our health is inextricably tied to the health of every living being within our ecosystem, I don’t think we’re actually going to be able to fight or defeat AMR. We need to get to the point where we see ourselves as in sync and in collaboration with microbes.

Do you see any sort of professional pushback for being politically vocal?
 

Until three or four years ago, I was very much the “good diversity” hire. It was a good story. Institutions loved me because I was the person who came from nothing to climb the colonial ladder. My work today has really required me to step back from all of that; I no longer speak on career panels (because I’m no longer invited to do that sort of stuff!). Rather than an active “pushback,” I think people have realized that they are not able to exploit me as much as they thought they would be able to. I don’t get all of the opportunities, and it leaves some of my peers scared. But I’ve been able to process it slowly and attach meaning and purpose to my community outside the system. I think once you step out of the unfettered chase of accolades, awards, and grants, you are more dismissed than being  actively pushed back on. The political work for sure has limited my opportunities in terms of where I can apply for fellowships. But it’s also led to me having to do a lot more work on myself to be successful.

If you could say one thing to the entire world, what would it be?
 

We need each other. We should care for each other. We should take care of each other. We should protect each other, keep each other safe, and feed each other. Whichever way you can, embody our right to interdependence.

You can check out Ayesha’s work directly on their substack, their website, and their instagram.