New Pandemics, Old Politics. Alex de Waal
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opposite is true: they work best when they are consensual and precise – the two go together because contagion control is best done locally by ordinary people. The most encouraging examples of joint learning by communities and epidemiologists are in the global south or among minorities.
This points to a third problem with the ‘war on disease’: its imperial lineage. Rich countries typically don’t have the humility to accept lessons from former colonies. An African slave introduced smallpox inoculation to North America in 1720 but his contribution isn’t widely known and his real name isn’t known at all. Recent Ebola outbreaks were overcome by African people’s science, and one of the saddest episodes in Covid-19 policy is that African countries have not valued that experience and have instead regressed to copying centrally planned European lockdowns, which are hopelessly ill suited to their circumstances. Again, we can also learn from AIDS. Many of the most effective HIV prevention programmes were set up in partnership with injecting drug users and sex workers. We would all be much safer if we could respect ‘the wisdom of whores’.20
Social activists and social scientists are unprepared for pandemics. They don’t even have a paradigm to shift. What they do – consult, reflect, discuss – seems like a leisurely enterprise suited to a less urgent time, that is, afterwards. Implicitly, we accept centrally directed, expert-designed, and coercive measures because we assume they are a stopgap until biomedicine delivers a definitive cure. The technical term for behavioural and social measures is ‘non-pharmaceutical interventions’, or NPIs – which betrays their second-level standing. But these NPIs are the response, and because they are necessary and painful, it is important to have public discussion and consent. Can this be done fast? A year after Covid-19 appeared, it’s evident that it should have been done at the beginning.
Those who believe they have ‘won’ a war are least likely to appraise candidly why they have prevailed, crediting successes to their skill and perseverance and not to their enemies’ blunders – and still less to extraneous factors such as that under-appreciated arbiter of the battlefield, disease. Winners can be slow learners. This book also shows how historic ‘victories’ in the ‘war on disease’ have led to hubris or amnesia. Biomedical advances such as vaccines deliver genuine public goods, but – as virologists today appreciate – that is no cause for complacency. Which brings us to our last and biggest challenge.
The ‘war on disease’ also doesn’t speak about the ravages of ecological destruction and the resulting disaster for the health of living things, including us. It makes microbes into enemies to be eliminated. Our conquest and dominion over the planet are on course to be the ultimate Pyrrhic victory. This is the calamitous Anthropocene: the result not of people as such, but of the organization of resource exploitation, manufacturing and agro-industrial production, massively concentrated human habitation and accentuated movement. Ecologists have been warning that deforestation and loss of wetlands are disrupting the habitats of bats, monkeys, and wild geese, risking more and more viral spillovers, and that industrial farming and urbanization are creating dangerous ecologies where viruses adapt more rapidly. Doctors have also been warning about the fast-approaching post-antibiotic era brought about by the reckless overuse of antibiotics, both by over-prescription by physicians and pharmacies, and in industrial livestock and fish farming. The new global ecology has been created by us but microbes are the quickest to adapt to it. The political-economic logics at work here are similar to those driving global heating and the climate crisis: the political clout, money, and readiness to lie and cheat by the corporations that profit from over-exploiting the planet are more powerful than the counter-pressure for responsible stewardship. Today, medical scientists and epidemiologists are joining environmental scientists in insisting that it isn’t enough to identify and eliminate the next microbial culprits for contagious disease: we have also to stop the ecological devastation that is generating them. Each pandemic pathogen has forced science to think more deeply about the nature of disease. So too it compels us to think differently about how society is organized and politics is run. Pandemic Covid-19, along with its causes and social crises, is a chance for the urgent and inescapable task of rethinking Homo sapiens’ place on this planet that we have too long considered ours.
Notes
1 1. See, among others: Cox 2020; Nie et al. 2016.
2 2. Osterholm 2005, p. 72; 2020 at 26.00.
3 3. The scale is reproduced and critiqued in Caduff 2015, pp. 174–5.
4 4. I discuss this in chapter 5. This definition was for influenza but it transfers readily to Covid-19.
5 5. A similar form of words was used by the WHO’s Bruce Aylward (see Aylward 2020).
6 6. Murray 2020 at 10.01. A closer parallel might be election forecasting while the candidates are breaking the rules and disrupting the process.
7 7. Margaret Chan, ‘World Now at the Start of 2009 Influenza Pandemic’, statement to the press, 11 June 2009.
8 8. See Kay and King 2020 for an exploration of this issue.
9 9. The CDC also asked the public not to buy respirator masks, fearing that there would not be enough for health workers.
10 10. Latour 2017, p. 117.
11 11. Krieger 2011, p. viii.
12 12. Quammen 2012, p. 515.
13 13. Peter Sands is a rare economist who recognizes this (see Sands et al. 2016).
14 14. Krieger 2011, p. 43; Stefanou-Konidaris 2020.
15 15. Hanna and Kleinman 2013; Krieger 2011.
16 16. Larson 2020, p. xxvii.
17 17. Richards 2016, p. 145.
18 18. In this book, I am going to keep a respectful distance from the writings of Michel Foucault, but I must acknowledge his insight that the disciplinary powers of the modern state were constructed around apparatuses of excluding, confining, and surveilling communicable diseases. The difficulty of bringing Foucault into such a discussion is that to do justice to his thought and engaging with the literature requires more space than is available.
19 19. Article 22 of the International Covenant on Civil and Political Rights guarantees freedom of association but carves out exemptions for public health.
20 20. This refers to the title of Lisa Pisani’s 2008 book.
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