paper

Political Mobilization of Avian Influenza: Patterns of Collaboration and Co-option under
Pandemic Frame
By Mika Aaltola
University of Minnesota
aalto007@umn.edu
Abstract
The article reviews different historically and culturally conditioned role positions available to
actors under pandemic dramas. Although it concentrates on the contemporary scene of Avian
Influenza, the aim is to examine the precursor epidemic scares such as BSE and SARS. To make
sense of the patterns of collaboration and possible co-option, paper reviews history of interaction
between international politics and epidemic diseases. This history can be better appreciated
though the concepts of legitimacy and pedagogy plays. International actors use pandemics to
further their own visions of world order. In the present case, this means that pandemics are
turned into demonstrations, theaters of proof, of the value of hegemonic order. The alarm and
panic over these short-term human and animal epidemics has often reached spectacular proportions
although the actual human health consequences have been less than dramatic. The aim is to
review specific cases to determine what situations in international politics are predisposed to the
politicization of diseases and what type of diseases are especially prone to this.
“Once again, nature has presented us with a daunting challenge:
the possibility of an influenza pandemic... Together we will confront
this emerging threat and together, as Americans, we will be
prepared to protect our families, our communities, this great nation,
and our world.”
President Bush, November 2005
In his New York Times Book review published on November 27, 2005, Matt Steinglass examines
Mike Davis’ book The Monster at our door: The Global Threat of Avian Flu. The debate that
ensues highlights the discourse dynamics of recent epidemic scares. Mike Davis’ argument is
that humanity is going to face catastrophic encounter with a pandemic influenza if it does not
stop sleepwalking. His rhetoric strategy is to alarm though powerful descriptors given to the
emerging viruses: These “monsters at our door” are “extraordinary shape-shifters” capable of
“ultrafast evolutionary adaptation”. The root causes for the coming into being of such threats are
two-fold: profit-focussed pharmaceutical industry and break-down of the leadership in world
health together with social changes in the globalizing world (e.g. third world urbanization) pose
extraordinary strain on “human solidarity”. On the other hand, environmental changes, such as
global warming, are going to cause an upheaval in the nature-humanity relationship. Stainglass
considers these often mentioned points valuable but considers the main argument rhetorical: It is
not a description it claims to be but an advocacy piece meant hype up the book and to foster particular
way of thinking about global health: “[People like Davis] are wielding apocalyptic anxiety
as a tool toward a greater end: the construction of a global system of influenza surveillance
and vaccine research and delivery to protect mankind wherever the next pandemic does, inevitably,
break out”. Pandemic-speak is closely related to earlier genre of health propaganda which
serves multiple purposes under the shadow of pandemic anxiety.
Davis’ argues for the importance of “human solidarity”, togerthermindedness. This definition of
polity reminds of classical formulations of politics as a human space for deliberation over conditions
of just and happy life. Rhetoric, as part of political deliberation, is based on the existence
and on (re)discovery of the area of together-mindedness because it allows for further persuasion.
Entralgo (1970, 177) compares this to the mission of medicine in that “the mission of rhetoric is
… not to persuade but to discover the persuasive element that there may be in each case, just as
the mission of medicine is not to cure… but to ascertain how and in what measure each patient is
curable”. My aim to examine various actors of the pandemic-scares to established they visions
of “human solidarity”. Avian Influenza scare is the focus of this paper although the approach is
more general. The role of different stake-holders needs to be mapped out vis-à-vis each other in
any comprehensive study of pandemic emergencies (Padmawati and Nichter 2008, 32). What
type of political arguments are involved in their global health rhetoric? What are the roles available
for the customary actors of international relations? What type of co-optive and collaborative
patterns have materialized during the recent Avian Flu scare?
Contemporary Pandemic Frame
Although the transmission of avian flu to humans takes place almost exclusively through domesticated
species much of the attention is focused on the disease in wild birds (Jennings and
Read 2006, 21). This highlights one of the most persistent themes of recent pandemic scares:
Humanity relation to nature. In his tellingly titled book Landscapes of Fear, geographer Yi-Fu
Tuan expresses a crucial aspect of lethal epidemic diseases when he states that “sickness forcefully
directs a people’s attention to the world’s hostility”. The association between sicknesses
and hostilities is the key point. It can be interpreted in two ways. First, epidemics direct the attention
to the hostility between nature and humanity. Read in terms of a legitimacy play, many
of the recent health scares translate into crossing-of-the-species-barrier dramas. The common
theme is that the border that should not have been violated have been crossed with the result that
nature has turn hostile to the human ways. The recent examples of the crossing of the species
barrier dramas have included HIV/AIDS. It was reported early on that the pandemic originates
from Africa where it jumped from chimpanzees to humans (e.g. Fauci, 1999). This story was
revisited in Keele et al. (2006) study that but the epicenter of the transmission to the southern
Cameroon and to the decade of 1930s. The study was done in the atmosphere charged with concern
over Avian Flue crossing the species boundary to humans. The Mad Cow disease provides
another example of the anxieties associated with the species barrier (e.g. Mahy and Brown
2000). Many diseases are connected with the pathologies of globalization. Ebola 1996 spread
in what was then Zaire was blamed to new infrastructure development in Africa and the anxiety
is caused explained by the possibility that global hub-and-spoke system of air travel can spread
the deadly disease all around the world in a matter of hours. Many (re)emerging diseases are
also associated with environmental degradation and global warming. They are seen as signs of
failures by the globalizing world community and of nature fighting back over ‘unnatural’ human
ways.
Second, the idea resonates with hostility within humanity. Namely, the multi-dimensional fractions
that run across humanity become acute when epidemics receive their communal interpretation.
Especially, the political boundaries of states and nationalities provide signifiers that provide
good resonating boards for an acute epidemic disease. Both the Mad Cow disease and
SARS offer evidence of this. Before spring 1996 BSE was considered as contained disease as it
was thought to be contained to animals and largely to Britain. The crises of 1996 turned the disease
into British disease signifying the independent minded Europe-policy and de-regularization
under Thatcher government. SARS was regarded as novel disease threat and perceived as especially
dangerous problem. Moreover, its meaning was partly synchronized with existing patterns
in world politics. The patterns of blame reflected existing political animosities: In Canada and
Taiwan news reports blamed Hong Kong, Japan blamed Taiwan, Taiwan blame China, the Chinese
press blamed people from the Guangzchou province, and the Western press blamed China.
In many places, the disease was perceived to be associated with China or to the people of ethnic
Chinese origin. It may be suggested that the images of China as secretive, closed, incompetent,
and corrupt contributed to this perception. China still is an outsider of the international community
and seen as a country with limited transparency, partial reform, uneven development.
It may be argued that pandemics are produced through patterns of collaboration between a diversity
of actors representing different relevant background themes. These themes vary with epochs.
Diseases are reflexive of the underlying form and state of the prevailing political community
and its power hierarchy. In this sense, diseases are revealing. They provide an X ray of
their embeddings (Herdt 1992, 8). It may be argued that different political environments develop
different politicised pandemics: For example, Ebola’s emergence in the bi-polar world of 1976
raised little concerns whereas its post-Cold War era re-emergence in Zaire 1996 led to worldwide
attention and scare. The BSE crisis of 1996 stemmed from the underlying anxieties felt
over the enlargement and deepening integration in the Europe and that the SARS of 2003 had a
lot to do with the growing pains of the U.S. led world order. In this respect, Susan Sontag’s
(2001) notion of epidemic diseases as always ideally comprehensible entities in they own time
can be appreciated.
Thus, diseases exist, flourish, and die in bio-political environments where they adapt to local
memories, practices, and power hierarchies. In the case of pandemics, this environment is
global. Community responses to the avian flu were commonly based on practical logic developed
based on existing stereotypes, media representations, government information campaigns,
and popular rumours (Padmawati and Nichter 2008, 31). Often the studies indicate an adaptive
wisdom that stems from the local memories of past epidemics. This cultural resource is considered
as resourceful knowledge base which can be operationalized (Zhang and Pan 2008). A lot
of value is attached to these communal coping mechanisms although they are seen as very different
from the responses of modern international community. These communal responses are
deemed to be rational and scientific. However, the qualitative difference does not change the
fact that even the responses of the international community are based on collective memories and
practices. Embedded in these practices are power hierarchies which, consequently, are reproduced
in any communal crisis such as pandemic emergency. Ungar (1998, 37) states that hot
crises “are startling, as presumed in-vulnerabilities appear to be challenged”. The air is thick of
fear and the issues involved are on everybody’s lips. What then are the relevant features of the
contemporary epoch. The macro-level power-structure if hegemonic, unipolar. As in most cases
of hegemonic world order, the major focus is on deviance. The drama of world politics is often
animated by different visions of possible decline and regression. The ways in which pandemic
scares are enabled reflect these themes.
Risk Society and Precursor Diseases
It is possible to treat the recent heath related scares in terms of Beck’s famous idea of a risk society.
According to Beck (e.g. 1999) the post-modern societies are increasingly risk aware. The
failures in risk management and in economies of risks give rise to much societal anxiety and
their fear provide stimuli for vast control and surveillance policies. However, this view can be
contrasted with the hypothesis that epidemics have always been at centre of political communities
self understanding. Lindenbaum, who provides (2001, 377)) an overview of this debate,
states that diseases can be used as indicators of the underlying communal beliefs. A serious epidemic
disease illuminates social patterns and political relations between and within various
communities. Beck’s categorical statements could be countered by historical perspective that
reveals the huge importance placed on diseases throughout human history. The contextdependent
manifestations of this important commonness have not been that dissimilar from the
recent noise made about mad cows and feverish birds. The differences are rather in degree. The
emergence of an increasingly intensive global community is matched by the re-emergence of the
communal awareness of epidemic diseases and collective rituals dealing with them. Beck’s notions
of risk may actually be read as cultural expression of what epidemics mean for the new
globalized community and what its specific variety of collective self-understanding is. These
expressions can be quite easily placed in the long cultural history of epidemic diseases and of
the political impact they cause.
To better appreciate contemporary disease imagination, review of some specific epidemics is
needed. Influenza perhaps more than any other pandemic is seen as a human influenced and
technologically induced. In the case of the Spanish Flu, the mass mobilization of armies together
with new transportation technologies provided a breeding ground for the first influenza pandemic.
In the studies of general influenza, the disease is often connected with coming into being
of the global transportation infrastructure. For example, David Patterson (1986) states that “not
until the 1889-1890 pandemic, when railroads and steamships were available to transport man
and virus, can we document a truly worldwide pandemic.” Previous influenza outbreaks were
more localized, and the global seasonal pattern were harder to discern.
As pointed out in the cases of influenza, the recent conceptual history of diseases reinforces the
link between various technologies of the global space and human diseases. The source of major
health risks are increasingly seen as stemming from specific technologies: ”In a primitive society,
the major hazards are those posed by nature. In complex modern society the acts of individuals
or corporate bodies may also involve serious hazards to other members of society” (Phillips
et al. 2000). The sense of exposure to the global space leads to increasing vulnerability. Anxieties
are treated at individual level: "... anxiety about bird flue gets translated into anxiety about
the Christmas turkey” (Corcoran and Peillon 2006). This projection is induced by the mechanization
and technologization of the everyday life (work-, domestic and public places). Peoples
dependence on technology leads to visions of dependence-related failures. This sentiment reinforces
disease related awareness and puts such phenomena as bioterrorism, drug resistance, and
pandemics stemming from the global warming to the forefront of popular imagination. Cloning,
industrial food production, medical trials, pollution, genetic engineering, and toxicity elicit conflictual
sentiments. This imagination identifies the likely source of ’the coming plague’ as originating
from hybrids between modernity (technology, industry) and nature.
The recent Avian Flu scare is an event along a long sequence of pandemic spectacles. This sequence
contains the relevant memories and modes of representation which render contemporary
events meaningful in a particular way. Out the resent pandemic scares SARS, re-emerging Tuberculosis,
and Mad Cow Disease (BSE) appear the most relevant. They also provide three different
aspects of the Avian Flue discourse: Tuberculosis provides the background frame for flulike
pandemics, SARS provides for the exceptional sense of emergency, and BSE discourse enabled
the hybrid between animals, food production, and politics.
Tuberculosis: In 1882, Robert Koch, singled out the organism, Mycobacterium tuberculosis, that
caused TB. Pattern of contagion though human contact was also described. The prevention plans
included the separation of infected people, sometimes by force. Old miasmatic ideas suggested
cures such as being exposed to fresh. Disease also influenced social habits ranging from a
frowned upon spitting to the romanization of the diseases (e.g. Sontag 2001). Early 20th century
witnessed large scale health programs against the disease that often took of the form of a “war on
Consumption”. By late 1940s, antibiotics led to an appearance that tuberculosis had been defeated.
However, as the attention decreased the programs and drug-development that highly dependent
on maintaining political commitment suffered. Recent resurgence in the United States
and other industrialized countries has taken place among certain communities and “risk groups”.
In 1993 the WHO declared TB "a global health emergency".
SARS: Severe Acute Respiratory Syndrome (SARS) was first discovered in Feb. 2003. The ensuing
SARS pandemic lasted 8 months. During the epidemic, there were about 8,000 known
cases, with 800 deaths. The death rate of SARS was estimated at 15% (90% of SARS cases occurred
in health care workers). SARS is believed to be a strain of the Corona virus, which is
linked to the common cold. Symptoms include a high temperature and a dry cough. More severe
respiratory symptoms follow within 10 days and many patients develop pneumonia. There is no
vaccine, but antibiotics and antiviral drugs have improved cases in some patients. The disease is
actually difficult to transmit and is passed by close contact with a person infected. This would
result with breathing in the droplets that are breathed in when the patient coughs. Hong Kong
announced early on that 80% of SARS cases could be tracked to a doctor in the Guangdong region
of China. China reported the disease a full four months after discovering it, by then point
305 had fallen ill and 5 had died.
In the pandemic discourse, state is often seen as an obstacle to the effective public health actions.
States are seen as secretive, non-transparent, and deceptive (e.g. Slack 1991, 119). For example,
SARS challenged China in several ways (e.g. Freedman 2004). The control of the outbreak in
such populous and rapidly urbanizing posed significant dilemmas. However, the political front
posed more noticeable and international marked problems for legitimacy management. The apparent
secrecy and denial led to a wide spread perception that China with its different political
system was the root cause behind the epidemic. Chinese government was perceived to be
opaque in its handling of the disease and was accused of excessive several times during the outbreak.
The government in China was seen as trying to cover the severity of the epidemic. For
example, on April 18, TIME magazine reported that health officials in Beijing tried to cover-up
the scale of the city's SARS infections by driving around dozens of patients in ambulances and
moving others to hotels during hospital inspection visits by WHO officials. The secrecy of any
government is seen as having many detrimental effects. It allows for the further spread of the
disease and delays the ability for the world to prepare and research possible vaccines for the illness.
Furthermore, secrecy can encourage media-fed hysteria. Many felt that the disease was
sudden and quick spreading when, in fact, it had been spreading for a full 4 months. This furthered
the sense of urgency and increased anxiety for the average citizen. It made it appear as
though one could contract the disease while walking down the street. The perceived Chinese secrecy
during the SARS outbreak prompted a large political backlash, with many countries calling
for reform in China. SARS turned into a tool of transformational diplomacy.
Blame was, thus, one of the memories of SARS. Seen as an Asian, and specifically Chinese disease,
SARS created several antagonist roles. China was blamed by governments and the WHO
became the protagonist of the story. It also showed the dangers of globalization and interconnectedness.
Chinese minorities all around the world were treated with suspicion. On the other
hand, SARS quickly became a disease caused by globalization and international travel. Unlike
diseases like HIV/AIDS, SARS was not stereotypes as a diseases of ‘immorality’, but was seen
as a disease of the globalizing world. It was a seen as a wake-up call to realize that international
travel brings us closer to each other and this, in turn, allows for the introduction of “foreign” diseases.
Mad Cow Disease: The sick, jerking, stumbling cows of Britain became to define European politics
during the spring of 1996. Before that spring bovine spongiform encephalopathy was considered
contained disease. It was contained in specific animals and largely to Britain. British
Secretary of Health’s announcement on March 20, 1996 on the finding of new CJD variant able
to cross the species boundary initiated the sudden crisis. The announcement raised the strong
possibility of a link between the new variant in humans and BSE-contaminated meat.
One way to approach the crisis and appreciate its legacy is to examine the novelty of BSE. The
origin of the sense of “madness” is indicative of the complex nature of health scares. First of all,
the association of the disease with prions, which were new type disease agents, reinforced the
mystery surrounding the disease (Yam 2001, 12). Shimkus (1998, 82) refers to the situation under
the title “Mad Cows, Strange Science”. In this way, the “madness” of BSE was often associated
with the uncertain science and with the unclear methods of testing of the disease. Secondly,
the madness was also associated with the unrestrained and “deregulated” nature of the
various actors involved. Two players receive particular attention in the literature: the food industry
and the British government. The food production industry, it was thought, wanted only to
make money and to cut costs. For example, Shaoul (1997, 182) concluded that the inner logic of
the food industry, driven by financial interests, was a public health problem. Much blame was
based on industrial food processing methods and intensive farming practices based on the maximizing
of profit instead of a respect for “natural” ways of doing things (Baker & Ridley 1996,
242; Hildebrandt et al. 2002).
An additional aspect of the formative Mad Cow experience was that the madness also signified
the panic and hysteria caused by the disease. The theme of health scare offered an additional
element for the understanding of Mad Cows. The health scare was seen as a fundamentally irrational
process that can under certain circumstances overwhelm rational behavior. For example,
Jasanoff (1997) has studied the cultural antecedents of the BSE scare. He points out the tendency
of European culture to over-react and to react irrationally in panic. Finucane (2002) emphasizes
the role of cultural perceptions of risk in connection with food-related illnesses. The
situation in Europe was one of advancing integration and enlargement of the communal boundaries.
At this political level, the context of BSE was very fluid and unstable, which may have
promoted the notion of Mad Cow disease “madness” (Aaltola 1999). The culturally charged
meanings led to nationalistic reactions and stereotypes, which were further fed by the sensationalistic
press (Giesecke 2000). Different quarantines and bans put in place by various Member
States and the Commission were seen as driven by panic and scare rather than rational decision
making.
When BSE became identified with United Kingdom and its previous policies, the European
Commission was able to look legitimate and decisive. Partly this 'success' stemmed from the
historically condition perception that states are secretive when it come to their public heath problems.
It can be argued that, for the European Commission, the substance of valorous decisions
centered on making the disease geographically and conceptually analogous with the United
Kingdom and its policies. In other words, the policies aimed at controlling BSE consisted almost
exclusively of measures imposed on and required of the United Kingdom. The containment of
the BSE crisis comprised of checking the United Kingdom as the source of the outbreak. Two
factors were usually emphasized here: majority of BSE cases occurred in Britain and the information
concerning the link between BSE and CJD was made public in the United Kingdom.
Thus, the BSE problem was localized into a British problem. The control of the disease and its
effects required clear concessions from the United Kingdom, regardless of whether these measures
would have any real effect on the causative agents. The dynamics of BSE situation profiled
national authorities as corrupt and, therefore, incapable of taking care of their own people. The
general message told a story of supranational power of the European Union’s institutions as the
last guarantor of people’s physical security and explicated national authorities as the problem.
An important legacy of Mad Cow Disease was that it reinforced one perceived illegitimate form
of pandemic collaboration. Too close marriage like relations between the government and industry
are seen deducing from the focus of the common interest. During the Mad Cow crisis, the
previous de-regulation of the food industry was deemed irresponsible. Deregulation, a lax administrative
culture, and excessively close interests of government and industry are held directly
responsible for the dangerous situation (Kleinert 1998).
Different pandemic dramas
As the mythology and history of plagues manifests when the physical diseases agents are given
cultural interpretations, some common patters emerge. They are often treated as omens, puzzles,
warnings, retributions, and teachings. They inevitably turn into signifiers of moral transgressions
with a political message about the necessity of restoring legitimate communal boundaries.
In the sense of global community, they translate into re-establishing the structure and firmness in
face of fluidity. More often that not, plague plays highlighted the existence of horizontal level
boundaries such as political borders between nations. These boundaries can be re-established
though the drama of potential or real quarantines, cordon sanitaire, and embargoes. The vertical
boundaries of hierarchical political order are more perceptual. However, in the increasingly delocalized
global community, the re-acknowledgment of the hierarchical world order is where the
emphasis is in the pandemic plays. The diseases influencing the marginal areas are easily translated
into most threatening one. The hierarchy threatened by the rising Chinese political clout
and Asian economies is re-established in the SARS and Avian Influenza plays. The threat stemming
from the 'below' is ultimately managed by Western institutions, states, and expertise.
Global health plays are dramatic. They re-stage the ‘real’ drama of human struggles and points
to the fragility of human existence. The drama associated with an acute pandemic shows itself in
communal reactions. From a historical perspective, this drama usually involves fits of what may
be called civil religious righteousness. Namely, people look for se-curing in their perceived
communal strength and traditional perceptions of communality. What comes about are outbursts
of customs, family values, nationalism, and ethnicity. The essential elements connected
with ones sense of belonging to a group are highlighted and strongly expressed. The other side
of these bursts that bring out the essential elements is that they repulse the unessential as harmful
and suspect. People are marginalized and stigmatized. In plague-ridden Europe, for example,
the normal communal responses to plague included the building of churches, giving of alms, pilgrimage,
burning of witches (mainly young women), and the killing of the Jews and other ‘foreign’
groups which were forced into the role of ‘plague spreaders’ or ‘well-prisoners’. The act of
fleeing has always been a vital part of the communal reactions to epidemics. Interpreted as a
metaphor, it sums up the common communal reaction to epidemics: People flee away from diseased
landscapes or isolate/quarantine themselves from the peoples associated with the disease.
This background illuminates one of the central roles in the pandemic plays, namely, that of the
antagonism of the humanity.
The deviant figure has a history that needs to be taken into account. At the mythic level of the
community, the slaying of the disease spreading ‘monsters’ was often performed by saintly figures
– e.g. saints, communal or ancestral spirit, and piety in general. It appears that diseases as
physical maladies were inseparable from their moral and political implications. The transgressions
standing behind outbreaks of epidemics were first and foremost of moral in nature. Because
moral transgressions translated easily into the language of violated border, epidemic disease
have had powerful political consequences between different communities and polities of
people.
Protagonists of the ‘plague plays’ are commonly conceived as problem solvers. The way in
which the myths frame diseases was that there was a riddle connected with them. Namely, disease
as a physical yet also always moral question was so framed as to require the exercise of
judgement in discovering its meaning and devising appropriate response. The coming of Christian
middle ages manifested a marked change in the way diseases were portrayed. The deviant
figure embodying the disease turned into a dragon. The monster that lurked at the edge of the
polity ready to kill its inhabitants was a hybrid creature half reptile, half bird with a foul fiery
dragon breath. The figure of dragon had a fiery hot breath. The deadliness of dragon breath was
related to then common notion that diseases were caused by bad air, or mal-air, miasma. The
struggle with the dragon – e.g. the famous hagiography of saint George slaying the dragon -lead
it to be either slain or driven back to where it came from, to caves. In the caves, there was always
damp and stagnant air. The driving of the beastly disease away (i.e. purifying the communal
atmosphere), required physical acts of courage and sacrifices. The disease-emergency called
for fearless dragon slayers. But more than anything else, the elimination of disease was connected
with moral judgement.
Plagues were and still often are taken to be manifestations of communal immorality and evil.
The sense of broken transgressed boundaries are much present in the iconography of contemporary
epidemic emergencies. Sars and Avian flu have often been treated as fevers caused by
globalizing world which contains dangerous transgression, porous boundaries, and hybridity. In
the case of Avian Flu, much anxiety stems from long distance routes of bird migration and from
the fact that industrial food production connects Western consumption of poultry with distant
poultry farms. The morality play of Avian influenza is animated by the sense of rapid global
spread, somatic connection to distant lands through food, nature turning into a threat, and localities
exposed without ability to protect themselves. It is in relation to these anxieties that Avian
influenza legitimacy plays actualize.
Legitimacy plays
Epidemics related legitimacy plays contain a strong moralist tendency. They are used to reaffirm
or reinvent the sense of civil religion and ideology (Lindenbaum 2001, 264; Rosenberg 1992,
279) and as signifiers of communal values and beliefs (e.g. Turner 1957). Legitimacy play involves
a fight by the protagonist – often presuming the guise of all humanity – against the bad
elements of perceived hostile nature. These elements are seldom the viruses, bacterias, or other
disease agents. Rather, disease and diseasing agents become easily associated with some minority
community or antagonist political entity. These two extreme types define a continuum along
which there exist a whole variety of other types: e.g. emigrants, tourists, drug-addicts, airtravelers,
truck-drivers, prostitutes, homosexuals, food production industries, greedy politicians,
and so on. These types find they ancestors in the more aged collective memories about polluters,
untouchables, plague-spreaders, and well-poisoners. The protagonists of the morality plays include
such stock figures as watchful doctors, alert health surveillance institutions, efficient national,
international and transnational health agencies, and politicians ‘who did their job’.
Legitimacy plays involve a communal verdict, a passing of a judgement about the moral status of
those involved. Legitimacy plays can be said to put the limelight on actors’ values and their ability
to make correct choices. The main question becomes how well actors choose: Do their
choices reflect progressive or regressive moral health? In connection with lethal epidemic diseases,
the underlying moral health may be interpreted either in retroactive or proactive context.
Retroactive legitimacy plays set stage for spectacles where events are at their critical stage.
From that moment onwards, there is a strong sense that events can continue either negatively/
regressively or positively/progressively. In their contemporary form, these morality plays are set
in ‘hot spots’ where epidemics are being contained by people wearing masks and protective gear.
The proactive legitimacy plays manifest themselves in spectacular acts of being on guard, sounding
alarm, and surveillance. Namely, it can be argued that one major way of doing the morally
virtuous labor in contemporary times is through sweating over the health related concerns. The
perspiration in the connection of the feverish agitation of the globalizing world provides the setting
for the staging of the epidemic related morality plays. These morality plays contain a stern
moral lesson about the disastrous consequences of laxness and lack of vigilance. In this respect,
the morality plays are not so much focused on teaching of correct behavior, the virtues and values
well functioning – i.e. healthy – global order and governance.
In the context of a legitimacy play, it is possible examine pandemic scares as moral panics. There
are various types of moral panic. A common dichotomy exists between elite induced and spontaneous
grassroots type of crises (Goode and Ben-Yehuda 1994). These crises give different
roles to different actors. For example, spontaneous crises can lead to elite reassurance of the
status-quo and of the sense of invulnerability. The opposite may also occur when the general
population is not engrossed by a sense of panic but ignores the alarmist signals coming from different
elite groups. This type of failure might indicate in-group problems within the elite. Thus,
it seems that the situation is often a mixed one: Different in-groups compete over the sense of
crisis and reflect the opinions of their respective audiences at the grass-roots level. In many
ways, the emergence of an epidemic frame indicates who is who at the elite and grass-roots level.
Besides the different participants of the spectacle, there are events that are deemed to be beyond
the control of the actors. There is the initial sense of alarm over a threat from within or without
the community. The may be a sense of natural, unnatural, or human origin of this alarm. However,
the sense of surprise is crucial for the emergence of an engrossing disease frame. This unexpectedness
can be due to temporal of conceptual nature of the initial happening. The timing of
the event may be surprising. For example, something that is already known by its nature reemerges.
this was the case of the outbreak of the bubonic plague in Surat, India 1994. The conceptually
unexpected happenings demand attention because of their novel nature. For example,
it may be suggested that HIV/AIDS re-invented the meaning of an epidemic disease in the 20th
century or BSE with its mysterious nature – e.g. prions – was salient because of its originality.
What is temporally and conceptually unexpected is dependent of the specific community and
relative of the communities self-identity. This means that community’s memory is more important
than its history when one evaluates what is surprising in sense of timing and in the sense of
nature.
When the perception of acute epidemic disease intertwines with polity’s – whether it is local, national,
regional, or global - production of security the situation becomes tense, charged, and dramatic.
The heightened sense of looming disaster thickens the air and sets the engrossing frame.
The frame has to do with what is at stake, what is taking place, and what are the past precedents?
Besides the frame, the performers become vitals in epidem ic related political dramas. Performers
are those who are expected to do something, who do something, and whose actions are
judged. Spectators of the drama are the everypersons whose health is perceived to be under
threat and who are also seen as the evaluating judged of the various performers. Often the media
becomes to represent the spectators and their judgments.
History of Political Epidemic Plays
When one considers the potential collaborative forms that epidemics can take in politics, it is
useful first to review the specific history of human reactions to epidemics that cross political
boundaries. Although much of the interplay between lethal epidemics and the realm of states’
interaction is contingent upon specific circumstances, some general, recurring, and conventional
themes and shapes can be detected:
A. Destability: Disease can strike some individual statesperson causing power vacuums, internal
squabbling, periods of indecision, and increasing uncertainty.
B. Imbalance: The uneven distribution of the burden of disease among states can cause shifts
in the prevailing balance of power.
C. Signifier: Epidemics are evidence about the bad shape of governance in some states that
can be read as a sign of weakness.
D. Propaganda: Lethal epidemic diseases can offer effective propaganda tools in eroding
perceptions about the enemy.
E. Co-option: A state can use the outbreak of some lethal infectious disease as an excuse for
politically motivated actions such as a military manoeuvre or economic sanctions.
F. Scare: Epidemics cause panic and drastic reactions that can cause economic hardship (e.g.
in the shape of market failures and loss of tourism).
From the perspective of this paper, I will bypass political plays that revolve around decisionmakers
illness (see e.g. Robins 1981, 154; L’ Etang 1970; Park 1986; and Karlen 1984).
B. Asymmetry effect of lethal epidemic diseases: The capacity of diseases to afflict some states
disproportionately constitutes an important way in which epidemics react with international relations
(Robins 1981). In general sense, it can be used to discern who is how in the world map in
terms of power. In more specific cases, asymmetry affects the outcomes of specific turns of
events. The brutal fate of Napoleon’s Grande Armée provides a case in point of the lopsided and
decisive effects of lethal epidemics. In the case of the moribund Russian expedition of 1812, the
typhus epidemic destroyed most of Napoleon’s half a million men. The task left to Russians,
largely untouched by the disease, was to complete the annihilation (Marshall-Cornwall 1967 and
Robins 1981). Similarly, the asymmetric effects of epidemics manifested themselves in the
tragic outcome of the contact between Spaniards and native Americans: “The lopsided impact of
infectious disease upon Amerindian populations therefore offered a key to understanding the ease
of the Spanish conquest of America – not only militarily, but culturally as well” (McNeill 1977,
2). The historian of the Peloponnesian war, Thucydides, who himself was inflicted by plague
gives a valuable and dramatic account of the consequences of asymmetry in the distribution of
epidemic disease (Thucydides 1990, 399, 401). Although plague was not the only factor which
brought about the eventual demise of Athens, it did deprive Athens of much of its war-waging
capability against its formidable enemy. More recent example is that of very uneven HIVbudern.
The developing countries especially in souther Africa face relative disadvantage compared
to the developed north. Thus, sharp asymmetries in the distribution of disease can result in
and have resulted in dramatic changes in the distribution of capabilities.
Moreover, the uneven distribution turns easily into disempowering stereotypes. As is evident
from the account by Thucydides, the uneven way in which the pestilence struck aroused the
imagination of many and charged the epidemic with persuasive analogies to other concepts.
Many of these ancient and biblical analogies carried through until the Middle Ages. During the
Middle Ages and the early modern period, one of the most puzzling and mysterious features of
plague that cried out for an explanation was that it struck in some places and killed most of the
people living there, while other places were completely spared. The pattern of spread attracted
culturally meaningful explanations. For example, it was very common to perceive plague as divine
retribution for sinful communal ways. In many stereotypic explanations, the irregular and
asymmetric pattern left behind by the epidemic of plague correlated with the relative righteousness
of various nations, localities, and individuals.
As the medieval system was replaced by the state system around the time of Westphalia, the nature
of epidemics as an international political phenomenon lost much of its religious charge and
became instead part of the mythology surrounding the concept of state. The ‘innate’ tendency of
states to derive legitimacy from a certain sense of physical and moral superiority in respect of
other states led to the common belief that other states or groups of states were more prone to the
horrors of epidemics. Every time that an epidemic struck somewhere else, the state’s legitimacy
as a secure, privileged, inimitable, and exemplary entity predestined and chosen for sovereignty
was reinforced. During the early 1830s, this sense of national self-confidence and pride was particularly
conspicuous in French attitudes towards the advancing cholera epidemic. Apparently
inspired by the sense of national pride, one French citizen proclaimed that cholera could not conquer
France because “in no other country of globe have civilization, industry, and commerce
achieved a higher degree of perfection and in no country but England are the rules of hygiene
more faithfully observed” (Larrey 1831, 28). In the end, the high degree of ‘civilisation’ that the
French and English attributed to themselves did not spare them from the cholera epidemic.
However, it did, for a moment, allow some French people to regard themselves as a first-class
nation at least in comparison to such “corrupted” and “disorderly” countries as India or Turkey
(Delaporte 1986, 16). As the religious explanations of pestilence were gradually complemented
and supplemented by beliefs and attitudes that had to do with administrative and scientific actions,
the underlying coupling between concepts such as decay or decline and disease-related notions
such as death, suffering, and fear, remained in place. The legitimacy and viability of a state
became dependent on its ability to avoid outbreaks of lethal epidemics, with the result that the
asymmetrical distribution of diseases - i.e., the ability to keep in check a disease that elsewhere
was rampant - was considered to selectively reinforce the legitimacy of states.
C. Decline: Public health is, thus, not only important in the eyes of one’s own citizens; it also
provides an invaluable instrument in proving political community's worth as a full and respected
entities. The vital power political dimension of public health translates into attempts to prove
one’s ability to abide by the international standards of public health. In international proclamations
concerning public health measures, states make use of such concepts as diligence, dutifulness,
and readiness. Thomas Hobbes famously justified the existence of states in terms of them
making people’s lives less short, nasty and brutish. The ability to provide external security is the
most common reading of this. States provide for people’s right to belong to certain bordered territory.
However, states have had a historical pressure to provide for their citizens also in other
sense. They have to provide economic well-being, property rights, rule-of-law, religion, and culture.
However, it can be claimed that one of the foremost ways that states can fulfil their constitutive
function is through contributing of seeming to contribute to the health of populations.
Starting from the quarantine regulations in the 14th century Italy, states have tried to stop the
spread of epidemics as a one of the fundamental elements of people’s se-curity. A rampant epidemic
disease is easily read as a state failure and the imaginary turns into one of decline and declinism.
An important constituent of a state or politic al community in general (e.g. empire) is
the ever present possibility that it may decline and even fall.
In the declinist framing of an epidemic diseases, the epidemic becomes only on symptom of
more acute and dangerous ‘political dis-ease’. In modern literature, the term state failure or failing
state can be associated with this type of frame. When the state cannot fulfil its basic modern
function of providing for the heath of its citizens, the stigma of failure can be associated with a
state or a region. This type of marginalization is in evidence when one reviews the way in which
current news concerning sub-Saharan Africa are framed. The frame and the fact that the prevalence
of HIV/AIDS is very high in these regions cannot be without consequences when it becomes
to they flows of structural power. Much labour, human security, financial investments,
and production capacity is lost when the life expectance in some states of the southern African
has fallen below 40 years. In many cases, those people whose life is ‘short, nasty, and brutish’
are from certain areas and groups inside the state. From a perspective, the state-ness is not distributed
evenly throughout the territory. When this condition cannot be kept at the margins outside
of the view of the outside world and in many cases from the national self-awareness serous
image and prestige problems may result.
In the absence of any objective measure of a state’s relative capabilities, the persuasive analogies
and connotations associated with a serious outbreak of an infectious disease can cause serious
harm to a state’s international standing. As bubonic plague hit Indian city of Surat in 1994, concern
over the international repercussions led initially to attempts to hide the problem and, once
that had become impossible, to efforts to downplay the seriousness of the outbreak. 8 The Indian
government has tried persistently to rid itself of the image that Western countries often associate
with developing countries, namely, that they are uncivilized, weak, chaotic, and second-rate
states inherently unable to take care of their own citizens. This Western view translates into India’s
lack of political and economic influence that is unfitting to the world’s most populous democracy.
What made the outbreak of bubonic plague an even more embarrassing and conspicuous
sign of incapability was the fact that the knowledge of how it spreads and how it can be
cured and eradicated has been there for a full century. In power political games, an outbreak of
this type was “a euphemism to embarrass a less developed country in the hopes of making the
more developed look better and safer” (Lin 1995, 2913). The fear that a disease can be seen as a
symbol of a state that is in ruin, with the corresponding political and economic consequences led
the Gabonese government to try and hide an outbreak of Ebola in 1996 and to confiscate samples
from international health workers (Troy 1996, 22). A further example of attempts to conceal an
epidemic disease is provided by Thailand’s efforts to conceal an outbreak of Cholera in 1997 by
calling it a case of ‘severe diarrhoea’. Such a tendency to hide diseases in an attempt to avoid
international embarrassment, which could potentially harm the state’s political and economic interests,
can be witnessed all over the world. As the British failed attempts to hide the BSE demonstrated,
states are rarely totally open about the outbreak of a potentially serious epidemic disease.
They have lot to loose in terms if respect, legitimacy, and status.
D.Propaganda: As forcefully as they impose themselves on communities, diseases have always
called for explanation. During the years of plague, the pestilence was a divine punishment for
sin and moral corruption. Not surprisingly, for a short moment when the epidemic of plague
struck, the city-states and other localities became citadels of righteousness. However, as time
passed by and as people grew more accustomed to plague and to the fact that it killed both the
righteous and the corrupt in equal numbers, regardless of their moral merits, the divine origin of
plague had to give way to more mundane explanations. The various ways in which its contemporaries
viewed plague were closely interwoven with the existing political conditions. In other
words, what was politically expedient also became a tool in controlling the societal effects of
plague. The plague-spreaders and well-poisoners become people’s enemies, and people’s enemies,
whether domestic or foreign, were easily presented as plague-spreaders and well-poisoners.
These foreign elements and states which were already viewed in negative terms were not hard to
come by in apportioning the blame.
As the state system became increasingly stabilised, the range of potential plague-spreaders expanded
accordingly to include the state’s external enemies. The effects of plague at the individual
level were intertwined with the broader societal and international considerations. The experiences
at various levels were connected together through parallel metaphoric dynamics that
mingled plague with evil and enemies instead of conceptually differentiating between them. Because
the analogy between plague and sinful life brought shame upon the proud citizens of citystates,
it was relatively easy to claim that plague originated from foreign and evil elements. This
logic was reinforced by an uncomplicated deduction, namely, it was clearly in the interests of
enemy states that the epidemic of plague would cause devastation and disorder to their rival.
What the enemy states could not accomplish through honest economic and political competition
they now achieved through the vicious act of spreading plague. Thus, it was not difficult through
governmental persuasion to convince the patriotic citizens that the misfortune in the form of disease
was not due to their own failures and practices of bad governance, but was somehow caused
by the enemy’s immorality and trickery. Thus, it may be suggested that there exists a natural
tendency to project emerging epidemic diseases into to the existing patterns of hostility. For example,
whether having to do with reality or not, the way on which both SARS and Avian Flu has
been associated with China provides some supports for this hypothesis.
The concept of epidemic thus contains well-established narrative dynamic that easily lead to the
attribution of death and destruction to foreign sources and political adversaries. This tendency
has been particularly pronounced during periods of heightened inter-state conflict. Not surprisingly,
the spread of AIDS in the early 1980s was soon adopted for politically advantageous purposes.
The Soviet authorities insisted that the AIDS virus was the outcome of an American military
experiment that had gone terribly wrong (Nelkin & Gilman 1991, 39).11 The purpose was to
point out that the United States was a vicious and underhanded super-power that should not be
trusted. Furthermore, for the Soviet Union, the AIDS epidemic offered an opportunity to point
out that it was AIDS-free: that it had no ‘degenerated’ and ‘corrupted’ homosexual elements.
However, AIDS never became a very potent propaganda weapon because it could be further attributed
to undesirable internal elements such as homosexuals, prostitutes, and drug-users. In
other words, many people in the West connected the disease with the ‘unnatural’ homosexual
population rather than with the general ‘corruptness’ of Western societies. It was effectively
used by the American neo-conservative movement in the beginning of 1980s to promote its own
message about family values and the need for religious revival in America. During the Cold
War, the lethal AIDS epidemic did make some international relations appearances not because of
its deadliness, but because of the age-old political reactivity and charge contained in lethal epidemics.
The discourse about any pandemic influenza often refers to the 1918 Spanish Flu as a benchmark
outbreak. It came from America across Atlantic before turning into a significant outbreak.
Influenza started spreading among the British forces in Spain, thus the name: “Within a few cycles
of infection, it was apparent that the disease had become more virulent, with a 10-fold increase
in the death rate amongst cases” (Nicholson, Webster, and Hay 2007, 102). This more
virulent virus spread throughout the world. The death rate become about 10 times higher than in
a generic influenza pandemic. The disease hit people in the 20-40 year age group. This made it
especially deadly among the soldier and greatly complicated the war efforts:
The co-option between the war and pandemic became clear in the health propaganda of the time
as is apparent from the poster above.
Tuberculosis can been seen as providing much of the background for the contemporary influenza
imagination. From this perspective, it is useful to view some of the health propaganda posters
from the beginning of 20th century.
The above posters from France connect the national struggle with tuberculosis with national defence.
Protective barriers of national border and human body were equated. The iconography of
epidemic diseases is militaristic. This strong tendency is still present in the contemporary language.
For example, the frantic struggle to contain SARS in 2003 was associated with wider national
security prerogatives. The U.S. documents on SARS often highlight the close connection
between naturally occurring and intentionally inflicted outbreaks of diseases. The foremost connection
is that the measures against naturally occurring outbreaks are conceptualized also as important
practice grounds for fighting bioterrorism. The combined dynamics is captured in the
term “health security”. The documents conceive “new health threats” stemming from (re)emerging
diseases and biological warfare agents”. From the U.S. perspective, the SARS related outlook
was a part of a larger vision to the world: The presidential directive, Biodefense for the 21st
Century, “provides a comprehensive framework for our nation’s biodefense. [It] builds on past
accomplishments, specifies roles and responsibilities, and integrates the programs and efforts of
various communities – national security, medical, public health, intelligence, diplomatic, agricultural
and law enforcement – into a sustained and focused national effort against biological weapons
threats”.17 The probable result of the integrated approach is that the occurrence of natural
epidemic disease heightens urgency the security concerns and re-contextualizes the epidemic in
question in quasi-security language.
E.Diseases as co-optive pretense: Diseases do not appear in the domestic and international
realms as distinct entities void of any reactivity with already existing political conceptions. In
other words, decision-makers speak about diseases in a language that is laden with analogies and
connotations that are meaningful from the perspective of state as an entity with a history, identity,
and role. Diseases linked up with the most common international relations concepts of strategy,
deception, and secrecy and, on the other hand, with the idea of enemy. By assigning the role of
plague-spreaders, well poisoners, and conspirators to some external enemy, such as to Catholics,
Protestants or other states, or to conspicuous internal groups, such as Jews, witches, and enemies
of the state, a state could both divert people’s anxiety and frustrations away from its own actions
and justify its actions against these perceived enemies. It was not extraordinary that, during the
epidemic, the hospitals set up to accommodate all the patients were full of political enemies; nor
it is extraordinary in modern times for politically unwanted elements to find themselves in quarantine
or isolation of one form or another. The manipulation and trickery have not been confined
to the abuse of internal enemy images, but they have also been extended to the level of international
interaction.
The management of epidemics can be an act put on deliberately to divert attention or to legitimize
actions that would have been otherwise unjustifiable. States’ declarations of intention are
often deceptive and misleading. Throughout the history of states’ interaction with epidemics, it
has been very difficult to distinguish between state’s genuine efforts to minimize the health implications
of epidemics and their opportunistic attempts to minimize or gain political benefits
from an outbreak. States have been well-placed to take advantage of the mystery surrounding
such diseases as plague in the seventeenth century, cholera in the nineteenth century, and the human
variant of the Creautzfeld Jocob disease, in the twentieth century. Moreover, the character
of this manipulation is entirely dependent on one’s position in international interaction. The
truth-value of different points of view is notoriously difficult to ascertain. However, mere appearances
and suspicions are enormously compelling reasons for taking conventionally appropriate
actions in international relations, which means that propaganda and prestige are of immense
importance that has to be taken into account in managing epidemics.
International relations have witnessed some attempts to use epidemics as pretense for military or
strategic gain. States have used regulations whose original purpose was to stop the spread of
epidemics by containment in order to “reap political benefit” (Delaporte 1986, 142). For instance,
the French restoration government used epidemics as an excuse to declare a cordon sanitaire
against Spain that at the time was in the middle of a revolution. The French monarchy
feared that the revolution might spread to France, and therefore an army was deployed along the
border, under the pretext of the cordon sanitaire (Bertier de Sauvigny 1966, 191). The United
States’ government considered the term blockade to be too offensive during the 1962 Cuban missile
crisis (White 1996, 142). So instead of a blockade, the Americans officially imposed a quarantine,
which carried at least some sense of international legitimacy. The long co-evolution between
states and epidemics has fixed and ritualized some compelling analogies that carry with
them a sense of legitimacy that cannot be dismissed even when abused without equally appealing
counter-arguments.
Ever since the beginning of the modern state system, it was important for a state’s viability that
its vital economic interests were taken into account when decisions were made concerning actions
against epidemics. In other words, various economic and political considerations emerged
as strong arguments for and against the use of drastic quarantine and cordon sanitaire measures.
It was not long after the introduction of quarantine measures that state authorities started to use
quarantines to advance the interests of their own trade and industry. There was a great temptation
to make favorable exemptions from the quarantine regulations. The resulting political situation
was highly complex and intricate, as the interests of the affected parties were often conflicting
and irreconcilable. The disagreements over the most effective and reasonable policies extended
beyond mere domestic considerations into international relations, which meant that miscalculations
could have potentially serious repercussions. Thus, the internationally shared
disease-related language provided ways of legitimizing otherwise politically impossible decisions
which were primarily motivated by economic and political self-interest, ruthless ambition,
and power politics.
As the BSE/CJD crisis demonstrated, the imposition of disease related restrictive regulations
against a certain state will almost certainly lead to accusations that the real motives behind these
actions are economic and political. The economic vitality of a state and, consequently, its relative
capabilities depend very much on the level of economic and political content of relevant
domestic actors. Not surprisingly then, the well-being of most vital parts of the economy, such
as agriculture, tourism, or foreign trade is a very important determinant of a state’s policies. In
many respects, the German ban on American pork products in 1880 offers a case in point of the
relative ease at which real health concerns are intertwined with economic protectionism and political
interest: “The German ban has proved the most interesting animal product ban of the era
because it was clearly argued on sanitary grounds but was consistently tinged with a very different
motive, namely, the protection of domestic livestock producers in particular and economic
nationalism in general” (Hoy & Nuget 1989, 199). The health scare was based on the discovery
that meat infected with trichinella spiralis could kill humans. Regardless of the ‘true’ motives of
the ban, it is clear that the dispute had much to do with protectionism not only because the
American side believed so but also because the ban benefited Germany’s own pork industry
(Snyder 1961, 4). The ban was lifted in 1891 after the adoption by the United States Congress of
satisfactory meat inspection laws. Although the ban on American pork and the lifting of the ban
were grounded in reasonable public health arguments, the episode as a whole clearly illustrates
how legitimate health concerns are intimately connected with the concept of national interest.
F. Market reactions: One the most common narrative paths of the recent epidemic related reactions
has been the predictable market reactions. When a mad cow or sick poultry is found, the
consumer reactions or their expectation will cause havoc in the markets. These reactions are
caused by expectation or reality of changes in consumption patterns or of establishment of trade
barriers between states. In the globalizing world, this reaction is one of the most common communal
reactions to the anxiety provoked by diseases. Recent epidemic based market reactions
have not only been contained to food production industry.
One of the formost aspects of the physical space of global fevers such as SARS and Avian Flu
has been the connectedness with the global infrastructure. Especially SARS was connected to
the backbone of global culture, the hub-and-spoke structure of the international air-travel. There
is a close relationship between air travel and microbial traffic (Ali & Keil 2006: Naylor 2003).
SARS created problems for the aviation industry because the rapid spread of the condition was
associated with intercontinental flight connections. The markets speculated that the industry
most under pressure from SARS were the airlines. The spread of foot and mouth diseases in
Britain, cause much additional costs that the airlines had to digest. The feverish pace of the
global interconnections is mostly based on the hub-and-spoke system by the topology of international
airports. It is perhaps not surprising that the industry most under pressure is the aviation
industry. Whereas the aviation industry represents the crossing of political and continental
boundaries, the food production industry brings with it the perception of crossing the nature versus
humanity divider. What ever, the underlying narratives are, the fact remains that in today’s
international political economy markets reactions provide a key way in which lethal epidemic
diseases are gauged.
In the case of the Avian Influenza, the collaborative pattern that was significant for different actors
perceived legitimacy was the one between institutions and industry. Among the most distinct
role differentiation among the pandemic-crisis actors is one between pharmaceutical traders
and public health protectors (e.g. Abbot 2005). Big pharma investment related arguments have
to fir the general humanitarian frame. Their role highlights the common interest related importance
of having strong property rights protections. Patents need to be protected and price controls
resisted. These policies, so the argument goes, will benefit also the poor because the industry
can undertake expansive drug development. The public health protectors argue for that the
common benefit has to give room for the governments to break patents so all also the poor will
be able to have an access to life saving innovations. Health is seen as a priority over the protection
of intellectual property rights. These two roles have their lobbyist and supporters. Among
the states, the intellectual property rights are promoted by the U.S. and other Western governments
whereas the public health promoters finds supporters among the developing countries such
as Brazil and South Africa.
It is important to point out that these new perception influence collaborative arrangement. For
example, when industrial accidents are perceived to be more likely and devastating, the relationship
that community groups have with industrial one is negatively influenced. The situation
leads to new patterns of conflict and coalition. Loyalties shift to reflect the underlying perceptions
of liabilities and blame. This collaborative dynamics delegitimizes close cooperation between
industry and state. Any perception of this can lead an assignment of blame for the disease,
its hiding, and failures in its control to these collaborative relationships.
The perceived illegitimacy of collaboration with industrial interests has emerged during the avian
influenza scare. Two anti-viral drugs called Tamiflu and Relenza which both have patent protection.
This means that the patent holders have the ability to limit the manufacture of their respective
drugs to their own company or contractors. At the current pace of production, it will take 10
years for Roche to adequately supply world demand for Tamiflu stockpiles. For example, the
U.S. currently has stockpiles for less than 1% of the American population while the WHO recommends
stockpiles for 40% of the population. The unequal distribution of vital medicine is
clear. Only about 30 countries are purchasing large quantities of the two drugs. This means that
the most developing countries will have no access to vaccines and antiviral drugs.
Pedagogic and proof plays
Another feature always present in politics of lethal epidemic diseases is the idea of teaching, political
pedagogy. Health education is pervasive characteristic in most if not in all of human societies.
Didactic plays are rooted in this deep cultural resource. The didactic plays refers to
spectacles that starts by dialectical definition which is then amplified and dramatized by narrative
and rhetoric in order to teach effectively to the just uninitiated to the global health issues as
well as advise those with more experience. Namely, pandemic related didactic drama comes in
two forms: Introductory didactic plays and advanced didactic plays. Didactic aspect subordinates
the unfolding spectacle to the exigencies of the pedagogic purpose of the political variant
of a pandemic. This characteristic varies from direct ‘preaching’ of the facts of by now politicized
pandemics to refraining from explicit moralizing and trusting the reader to draw its own
lessons from the outcome of the story. The work teaches the facts and figures but also advanced
moral attitude (prudence). Information is directed to the less initiated and the more nuanced
deeper story to those more deeply immersed. These two levels are subordinated in that the teaching
of the fact and figures in based on a framework that also teaches right consciousness and attitude
towards the globalizing world.
The frame actualizes in pandemic performances. Latour's (1988) idea of 'theater of proof' can
offer a history of medicine related way of looking into these performances where different actors
take their own roles and form collaborative relationships. The idea draws from the famous experiment
in 1882 though which Pasteur revealed the effectiveness of vaccination. The experiment
lasted for several days and was the focus of intensive attention by the French media.
Twenty-five sheep were vaccinated against anthrax. Other twenty five who were not were
painted with red markings. The success of the demonstration was highly visible for the onlookers
who witness the death of all the animals who were not vaccinated. The fame of this experiment
was enormous. It offered a clear-cut common-sensical revelatory knowledge into the
power of new health science. Pasteur managed to make the underlying difficult to comprehend
the hidden reality visible. These types of experiments were repeated around the world. At the
level of popular imagination, these laboratory experiments transferred into the field turned into
modernity's testing grounds, into theaters of proof. At the stake was the legitimacy of modern
medicine and the state that had produced it.
What qualities are inherent in the pandemic theater of proof? Latour's idea is that scientistic
theater of proof is powerful because of its seeming objective clarity. In this sense, Latour’s theater
of proof refers to “a physical space where the objects of science are said to be freed from rhetorical
distortions, faulty vision, and the inadequacies of the ‘lesser’ senses” (Crawford 1996,
67). In the same way, the universalizing ethos of the pandemic spectacle contains a tendency to
see it not as a social setting. Humanity vis a vis inhumanity turns into a direct confrontation with
the nature. In this setting, representative of health is a figure that observes directly the external
reality. This position is provided to it by the ‘true’ and ‘authentic’ foundations of the Western
civilization. The staging of the theater of proof is meant to produce an acknowledgement that
there is a technology of life which has precise
nature, definitions, and protocols.
Pandemic scare becomes a moment that renders transparent the underlying truths concerning
who promotes heath and who does not. For example, images of SARS in 2003 provided drama
that demonstrated the goodness of organizations such as WHO and hold China as suspect when it
come to its trustworthiness in increasingly inter-connected world. This legitimacy pattern became
reveal with single gaze at the media representations of SARS spreading in Hong Kong.
Theater of proof conveys power and ideology in the seemingly non-political acknowledgement
of the evident.
The pedagogic play makes it evident that what is done in the name of disease control and eradication
is beyond doubt. It benefits whole humanity. Pandemics turn into governance exercises
that are thought to be be beyond politics, at least negative politics.
Modern health propaganda has highlighted the general human interest as its main motivating factors.
Because of this apparent humanity, the political agenda of health policies often go uncognized.
However, even a cursory look into the Avian Flue debates reveals that different actors
have their own at least partly incompatible goals. For example, the sharing of epidemiological
data and samples with the WHO seems on the surface of it the self-evident right thing to do. It
accords to the common wisdom that such sharing benefits the whole of humanity, human polity.
WHO has had a 50 year old system for sharing influenza virus samples. Countries donate sample
to WHO so that manufacturers relying on the data can maintain the effectiveness of the vaccines.
This system had to be renegotiated in early 2007 when Indonesia refused to send samples
to WHO. Indonesian concerns was that it did not stand to gain from the system and that the real
beneficiaries were the Western governments in terms of vaccine supplies and pharmaceutical
companies in terms of profits. The vaccines developed from the samples were too expensive for
the developing countries when Western countries were emptying the markets. Another important
reason for the Indonesian decision was its willingness to negotiate with specific drug companies.
Indonesia wanted to give samples directly to a specific pharmaceutical company by passing
WHO system. This arrangement would have guaranteed Indonesia more direct benefits in terms
of supplies and shared profits. At the end, the crisis was resolved by granting Indonesia ‘final
say’ when it came to the commercialization of drugs developed based on Indonesian data.
The controversy over sharing data illuminates the politics of health: alternative visions, different
agendas, co-optive purposes, and clashing interests. It differentiates among actors and defines
the way in which they collaborate. Even the modern expert-driven functionalist health governance
recognizes some legitimate forms for politics. Positive politics is often seen as setting the
institutional framework for the expertise (Siddiqi ). Institutions and programs have to be established
and allocated resources. Second, public health involves more mundane yet equally necessary
role for politics. Namely, one has to choose the personnel to work in the functional field,
allocate money for the building of offices and laboratories, finance large-scale inspection programs,
and so on. As long as the justifications and reasons are based on common interest, this
role of politics is not seen as harmful even when it results in disagreements as long as they do not
result in the paralysis of expertise. Perceived harmless disagreement includes for example ‘competition’
of states over the right to host health institutions. Third, there is also the politics of expert
debates over the most effective policies. Experts can argue over the best course of action in
maintaining public health. Scientific debates, disagreements, and compromises in the field of
expertise are not seen in themselves as political in the negative sense of the word.
When reading public health literature, it soon becomes apparent that the line between positive
politics and negative politicization is crossed when politics does not enable functional field but
co-opts it for some other purposes. General opinion seems to be that such co-option leads to less
affective health policies and that it reflects badly on the perceived legitimacy of global health
policies. However, it should be noted that careful co-option relies on at least seemingly effective
and legitimate global health. Namely, this type of co-option leads to a ‘partnership’-type of collaboration
between those professing to the modern global health perspective and those with other
agendas. This partnership tends to reaffirm and re-establish the underlying rhetorical persuasiveness
of public health perspective while serving additional goals. Besides this, it is possible
to conceive two other forms of collaboration. Co-option may be based on hierarchical situation
where global health is directly subordinated to some other goals, such as strong vision of national
security. Health becomes defined as a one front in a wider struggle for a preferred goal. For example,
the U.S. HIV/AIDS related PEPFAR programs – part of ‘transformational diplomacy’ -
explicitly aim at preventing state-failures and spread of terrorism through effective health programs.
Third possible collaborative arrangement involves actors who purposefully resign from
the modern public health paradigm. For example, Indonesian refusal to share samples might
been seen a direct challenge to the expert-based health governance. Alternative co-optive form
of collaboration is the apparent lack of transparency of some actors. China was accused of this
during the 2003 SARS and later Avian Flu scares. This perceived co-option leads often to negative
prestige and lowering of international status. These co-optive roles can be named as supportive,
transformative, radical, and deviant
An example of the apparent supportive co-option is the recent regime-development stemming the
Avian Flu. Important recent development has been the formation of International Partnership on
Avian and pandemic Influenza. According to the U.S. Department of State, the partnership aims
to elevate the avian influenza issue on national agendas, coordinate efforts among donor and affected
nations, mobilize and leverage resources, increase transparency in disease reporting and
the quality of surveillance; and build local capacity to identify, contain and respond to an influenza
pandemic. On the U.S. side the partnership participation is coordinated by the Department
of State. Department of state established in March 2006 the Avian Influenza Action Group. This
group is collaborated by the Departments of Health and Human Services, Agriculture, Homeland
Security, Defense, and the U.S. Agency for International Development and other agencies. The
process lea to an unbinding declaration (“global partnership initiative”). Among other things this
text states that “[…] enhanced global cooperation on avian and pandemic influenza will provide
a template for global cooperation to address other types of health emergencies. The transformational
aspect is hidden behind global governance of public health language.
The coming-plague narratives provide a crucial element of the imagined scene for the pandemic
performances. There exists a growing strand of literature that reinforces the idea that several historical
turning points have come about when a serious epidemic disease has inflicted a population
(e.g. McNeil, Diamond). The impact of lethal epidemic diseases is described in terms of
catastrophic blows against populations that exist in confined geographical space – e.g. the collapse
of Maya-culture or the ability of Spaniards to conquer the Americas. Epidemics manifest
themselves in geographical confines by affecting mortality, population density and distribution,
and behavioral patterns. In this general line of research, it is fairly common to examine how often
uncognized human behavioral patterns – e.g. the relationship between humans and domestic
animals - affected the emergence, spread, and distribution of diseases (Diamond). The metaphor
of ‘population’ has in recent research been complemented by the concept of civilization. Especially
in the research dealing the first contact between the Europe and Amerindia civilizations,
there is tendency to treat the impact in terms of disease exchange between civilizations. The hypothesis
about syphilis and smallpox as the vital factor in the civilizational contact are rampant.
Although these interesting theorems are somewhat misplaced. they matter. Much of this influential
interdisciplinary discourse uses population and civilization based ideas of human behavior.
This discourse can be further illuminated by contrasting it with other notions of politics. For
example, a wider look into political theory should reveal that the human behavioral cohesion is
not due only to geographical barrier but mainly to the existence of multidimensional political
boundaries. This basic realization is often bypassed by the slogan that ‘political borders are porous
to diseases’.
In this respect, there seem to be a ‘human animal’ metaphor inherent in the popular concept of a
population. Apparent by-passing of the Aristotelian notion of humans as political animals living
in polities instead of populations is itself a political practice. It refers to the desire to treat epidemics
as apolitical threats. The terms chosen at meant to do work. They make politics disappear.
Politics is made cease at the populational or civilizational levels. Population metaphor
contains a sense of individuals whereas the modern civilization is used to evoke a sense of widest
possible human polity, humanity. This dual movement finds its most natural home in the contemporary
humanitarian thought.
At the level of metaphoric political bodies, sufferer is imagined in terms of an individual or humanity.
Individual as the body-in-pain is the topos of modern humanitarian compassion. The
individualization of sufferer points to an important watershed in the history of suffererconstruction.
The modern sufferer is often a contextless figure existing in the heavily temporalized
situation of health emergency. The figure represents all humanity through being human at
the mercy of outside elements of inhumanity – i.e. birds spreading Avian Flu or cows turning into
Mad Cow polluted hamburgers. This ‘zooming-in’ to the individual level allows for the construction
of the epicenter of suffering where voiceless sufferer communicates only through the
visual language of hospital patients or health-care workers with protective gear.. The complexity
– e.g. the historicity of various groups of people, they self-understanding, and the variance of
importance placed on collective suffering – recedes to the background and the patient as an expression
of humanity pain crops up. The distant sufferer in some far-way location, with distinct
and shared memories, beliefs, and myths about what has happened, why, and for what end, is
cleansed when the figure is refined into Westernized form, into generic representation of what,
how, and where might go wrong (e.g. Malkki 1996, 380). For a distant sufferer to become a
member of the general human polity, it has to be denied the membership of other seemingly narrower
political communities.
The perceived apolitical conditions inherent in the humanitarian imagery of ‘human polity’ are
comparable to those produced by related notion of developmentalism (Ferguson 1990). The term
‘anti-politics machine’ refers to the “development industries” application of technical solutions to
such political problems as conflict, poverty, suffering, and hunger. The machine – i.e. developmentalist
discourse, repertoire of established ‘solutions’, and the infrastructures/networks of actors
involved – renders the politics of distant others into a series of rational/technical problemsolving
exercises. Although this production of subjects is itself a political act, it is political in a
specific sense of the word: It is politically privileged by its appearance of being apolitical. The
humanitarianist ‘anti-politics machine’ can be shed some further light through Ronald Barthes’
(1980) concept of ‘depoliticized speech’. The practice of depoliticized speech is based on mythologizing
the political out of actions and turning them into something self-evident, required,
and essential. The sufferer becomes produced as an ahistorical and universal humanitarian subject
in the apolitical governance-language of the international agencies (Malkki 1996, 378).
However, such speech only hides the deep power-political significance of this way of constructing
the body-in-pain. The rendering of humanitarianism a realm where ethics not politics matters
enables specific types of humanitarian action and its co-option by actors in whose interest it is to
turn distant place into apolitical object of Western intervention (e.g. Minh Ha 2004, 269).
The apolitization of governance action in epidemic emergencies is among the most important
places to look for the ways in which politics and power hierarchies matter. All the actors talk in
behalf of the humanity. The failure and success in this process is relative. Some actors politicize
better than others. This circulation of legitimacy provides the stage for the political performances
of pandemic emergencies. To answer these questions, it may be suggested that diseases
manifest themselves in engaging and engrossing public plays of legitimacy and of experimentation
with various instruments of international legitimacy.
Avian Flu becomes apoliticized in particular way through the legitimacy, pedagogic and proof
plays. Firstly, the scare becomes localized. Diseases are identified with a particular area and,
often, with particular people - racialized, gendered, sexualized, and ethnicized. In both the Avian
Flu and SARS, the people who diseases were considered alarming were found in Asia. These
people are on the foreground of Western media because of outsourcing and fast economic
growth. Both print and TV media used repetitious images such as Asian citizens in masks and
animals in Southern Chinese “wet markets”. Another important aspect of pandemics is they tendency
to temporalize the situation. Time becomes increasingly salient. There is a rush to find a
cure or solution, to track and isolate the carriers. The tempo of globalizing world can easily find
its correspondence in the disease imagery. It is often the case that conclusive scientific proof
cannot be achieved without time-consuming research. This situation often leads to immediate
actions based on the worst case scenario. Often the worst case imagery blends with stereotypic
and popular beliefs.
Avian influenza scare has made the governments worldwide have spent billions planning for a
potential influenza pandemic: buying medicines, running disaster drills, and developing strategies
for tighter border controls. These actions are seemingly apolitical because they take place
inside the humanitarian frame. They are perceived as necessary and unavoidable. The policies
that are prepared to fight possible human pandemic concentrate of the different isolation procedures.
Isolation is aimed separating individuals with the infectious illness in their homes, in
hospitals, or in designated facilities. The quarantines bring about the separation and restriction
of the movement, i.e. of a group of people, who, while not yet ill, have potentially been exposed
to an infectious agent. The isolation plans often referred to different forms of social distancing,
e.g. within the workplace, social distancing measures could take the form of placing moratoriums
on hand-shaking, substituting teleconferences for face-to-face meetings, staggering breaks,
posting infection control guidelines). It is clear that there would be closing of places of assembly
such as churches, schools, and theaters. At the level of national and international borders the
plans included drastic modifications in movement patterns: Restricting movement at the border,
instituting reductions in the transportation sector, and applying cordon sanitaire procedures.
The ‘apolitical machine’ of avian flu works through two major programs. At international level,
avian influenza has led to two cooperative initiatives:
1. U.S. initiated International Partnership on Avian and Pandemic Influenza
2. Global Preparedness Plan of WHO
The American initiated Partnership is meant to improve international surveillance, transparency,
timeliness, and response capabilities. President Bush, UN General Assembly, September 2005:
“As we strengthen our commitment to fighting malaria and AIDS, we must also remain on the
offensive against new threats to public health such as the avian influenza. If left unchallenged,
this virus could become the first pandemic of the 21st century. We must not allow that to happen.
Today I am announcing a new International Partnership on Avian and Pandemic Influenza.
The Partnership requires countries that face an outbreak to immediately share information and
provide samples to the World Health Organization. By requiring transparency, we can respond
more rapidly to dangerous outbreaks and stop them on time.” Partnership's apparent emphasis is
on transparency. Transparency means international access and wide collaboration with the international
community. It requires countries facing an outbreak to immediately share information
and provide samples to the WHO. WHO plan assists WHO Member States and those responsible
for public health, medical, and emergency preparedness to respond to pandemic influenza-related
threats. It is meant assess risks and come up with preparedness plans that can then be recommended
to Member States.
Conclusion
It can be argued that global political space is in flux, constantly shifting and changing. The primary
concern is over the consequences of previous national, ethnic, and religious boundaries being
rapidly transgressed. The conventional borders that have been the foundation of world-view,
trust, and loyalty are becoming porous and weak. New process such as global warming and war
against terror are capturing imagination. The declinist sentiments anxieties and concerns over
the nature, purpose and consequences of events provide much of the dynamics for prevailing
pandemic frame. It is in this frame that pandemics like Avian Flu actualizes as a global concern
that embodies much of the myriad of the background anxieties. Beside anxieties, the episodic
pandemic dramas provide a staging ground for demonstrations of legitimacy, effectiveness, and
power. The episodes turn it highly readable plays that transform and can be used to influence the
background frame. These captivating plays are used as a momentary criterion or standard with
which the morality and legitimacy of various political actors. Failures translate into a deficiency
in fulfilling perceived obligations that are essential for membership and the consequent rights of
the increasingly global community.
Avian Flu is read as a reminder of world's networked nature. The apparent necessity to secure
the global network is judged to demand increased coordination and harmonization or preparedness,
prevention, response and containment activities. The ability of potential Avian Influenza
outbreak to close down schools, hospitals and other public spaces and, in general, to disrupt societal
organization was one of its most notable popular images. It was perceived as global danger
that manifested itself at local level. This connection nececiated global reposibility on the local
level handling of the disease threat. The speard of the disease from one localtion to another
triggered the 'global' and animated or enable manifold of global actors, such as the hero of the
story WHO. In away, the disease came with a message that demanded re-organization. It demanded
re-imagining social organization and gave opporturnities for now actors to emerge and
also required flexibility from the existing networks. The disease questioned multiple and heterogenous
connections that had existed by becoming a hyperbolized public spectacle.
References (incomplete)
Abbot, F. M. (2005). The WTO Medicines Decision: World Pharmaceutical Trade and the Protection
of Public Health. The American Journal of International Law. 99, 2: 317-358.
Beck, U. (1999). World Risk Society. Cambridge: Blackwell.
Crawford, T. H. (1996). Imaging the Human Body: Quasi Objects, Quasi Texts, and the Theater
of Proof. /PMLA/. 11, 1: 66-79.
Fauci (1999). ?. N Engl J Med.
Freedman, Amy (2004). The SARS Crisis and Challenges to regimes legitimacy in China. Conference
papers – New England Political Science Association.
Goode, E. and Ben-Yehuda, N. (1994). Moral Panics: The Social Construction of Deviance:
Cambridge: Blackwell.
Herdt, Gilbert (1992). Gay Culture in America. Boston: Beacon Press.
Jennings, Roy and Read, Robert (2006). From Influenza: Human and Avian in Practice. London:
Royal Society of Medicine.
Keele et al. (2006). Chimpanzee Reservoirs of Pandemic and Nonpandemic HIV-1. Science.
May 25th.
Latour, Bruno (1988). The Pasteurization of France. Cambridge: Harvard University Press.
Lindenbaum, Shirley (2001). Kuru, Prions, and Human Affairs: Thinking about epidemics. Annual
Review of Anthropology. 30: 363-385.
Mahy, B. W. J. and Brown, C. C. (2000). Emerging zoonoses: crossing the species barrier.
Revue-Scientifique-Et-Technique-De-L-Office-International-Des- Epizooties. 19, 1, Apr: 33-40.
Padmawati, Siwi and Nichter, Mark (2008). Community response to avian flu in Central Java,
Indonesia. Anthropology & Medicine. 15, 1: 31-51.
Patterson, D. K. (1986). Pandemic Influenza, 1700-1900: A Study in Historical Epidemiology.
London: Rowman & Littlefield Publishers, Inc.
Shimkus, J. (1998). Infection control. Mad cows and weird science. Hosp-Health-Netw. 72, 11:
62.
Sontag, Susan (1988). AIDS and Its Metaphors . New York: Farrar, Strauss and Giroux.
Rosenberg, C (1992). Explaining Epidemics and Other Studies in the History of Medicine.
Cambridge: Cambridge University Press.
Turner, V. (1957). Schism and Continuity in an African Society. Manchester: Manchester University
Press.
Ungar, Sheldon (1998). Hot Crises and Media Reassurance: A Comparison of Emerging Diseases
and Ebola Zaire. British Journal of Sociology. 49, 1: 36-56.
Weiss, Meira (1997). Signifying the Pandemics: Metaphors of AIDS, Cancer, and Heart Disease.
Medican Anthropology Quarterly. 11. 4: 456-476.
Zhang, Letian and Pan, Tianshu (2008). Surviving the crisis: Adaptive wisdom, coping mechanisms
and local responses to avian influenza threats in Haining, China. Anthropology & Medicine.
15, 1: 19-30.