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The politics of pandemics
From smallpox and cholera to today’s threat of avian flu, how a society prepares for and responds to disease has as much to do with politics as with science


By Drake Bennett | November 13, 2005

MIKE DAVIS IS a dreamer of large nightmares. An environmental historian at the University of California, Irvine, Davis is best known for his books ''City of Quartz'' (1990) and ''Ecology of Fear'' (199, fiercely dark meditations on Los Angeles that portray the city as a metastasizing socio-ecological catastrophe, riven by homicidal resentments and sunnily ignorant of a whole series of looming disasters-earthquakes, floods, forest fires, mountain lions in the suburbs, swarms of killer bees-that grow more likely or more deadly every day.

Now, with a lethal new strain of avian flu raising fears of a pandemic, the cataclysmic vision of Davis's new book, ''The Monster at Our Door: The Global Threat of Avian Flu,'' doesn't feel much different from the headlines. The opening of this year's flu season has been punctuated by sharp warnings from organizations like the National Institutes of Health, the Centers for Disease Control, and the World Health Organization of a possible pandemic carrying off as many as 100 million people worldwide. With Washington and the media reverberating with concern, on Nov. 1 the Bush administration announced a $7.1 billion plan to strengthen American defenses against such an outbreak.

But for Davis, avian flu is more than just a global health threat. As he writes in his new book, it is also a symptom of deep social and economic ills-a disease that, if it does develop into a planetwide scourge, will be a largely man-made disaster. As Davis explained in a recent interview, ''We've changed the conditions of the evolution of the disease.'' A pandemic, he writes in the new book, would be ''a destiny...that we have largely forced on influenza.''

''Human-induced environmental shocks-overseas tourism, wetland destruction, a corporate 'Livestock Revolution,' and Third World urbanization with the attendant growth of megaslums-are responsible for turning influenza's extraordinary mutability into one of the most dangerous biological forces on our besieged planet,'' Davis writes. The next flu pandemic, he suggests, will be Mother Nature's revenge on the juggernaut of global capitalism.

Davis is an unabashed Marxist and a hero of the antiglobalization left. Elsewhere on the ideological spectrum the flu threat has taken on different meanings. The conservative Washington Times ran a piece early this year worrying that illegal immigrants might bring a flu pandemic across our borders. Pharmaceutical companies have used the flu threat to push for protection from lawsuits over flu vaccines (something the Bush flu plan gives them). Democratic politicians used it to question the Bush administration's ability to protect the country. And epidemiologists, public health advocates, and many doctors have used it to call attention to what they describe as a dangerously disorganized and underfunded American public health infrastructure.

In other words, perhaps not surprisingly, the avian flu has become politicized, the specter of its frightful lethality commandeered to strengthen the case for a number of different concerns and goals, some more plausibly linked to it than others.

What is striking, however, is the degree to which certain elements of today's influenza debate echo the conflicts over any number of past epidemics. Despite centuries of scientific advancement and an ever clearer picture of the mechanisms of disease, the symbolic and political aspects of epidemics remain largely unchanged. Whether the disease was smallpox in Colonial America, cholera in 19th-century Europe, or influenza just about everywhere in 1918, it appears that how a city or a nation responds to an epidemic has as much to do with an array of social and political issues-attitudes about class, commerce, immigrants, individual rights, and state power-as with science.

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Historically, epidemics have not been good to outsiders. Societies facing an eruption of contagious disease have tended to blame groups that already bear some sort of stigma. Most infamously, in the Middle Ages European Jews were accused of poisoning the water supply and causing the bubonic plague-and were subjected to murderous pogroms as a result. In the 19th century, Irish immigrants were widely blamed for bringing cholera into the United States.

Even when medicine provided a better understanding of the mechanisms of disease (the cholera bacteria, we now know, spread through the drinking supply), xenophobic reactions remained common, reflecting the social tensions of the day. In 1906, 12 years after the discovery of the bacterial origins of the bubonic plague, an outbreak of the disease led San Francisco to quarantine its Chinatown-even though, according to George Annas, a professor at the Boston University School of Public Health, ''there was no bubonic plague in Chinatown at all.''

Annas and other public health scholars see parallels to Boston's own reaction to SARS three years ago. Because the disease originated in Asia, many Bostonians avoided Chinatown, despite the fact that no cases had been reported there (the United States as a whole had eight cases and no deaths). ''[Mayor] Menino had to go to Chinatown to convince Bostonians to eat in Chinatown,'' Annas recalls. ''And you certainly can't get SARS from eating Chinese food.''

But outbreaks have not always been viewed as invasions from without. Since antiquity, there has been another medical tradition in which epidemics were seen, quite literally, as products of the environment. In this model, disease stemmed not from communicable micro-organisms but ''miasmas'' or ''effluvia'' rising off of swamps or garbage or polluted water.

''There had always been two competing theories of diseases,'' explained Dorothy Porter, a historian of medicine at the University of California, San Francisco. One was the theory of contagion on contact; the other was the more ''atmospheric'' miasmatic explanation. ''By the early 19th century,'' Porter said, ''the atmospheric theory of disease had become very fashionable.''

In the 1800s, in particular, the dispute over the two theories was often deeply political. According to the Cambridge University historian Richard J. Evans, 19th-century liberals-whose ideology combined a commitment to free trade with a concern for the health and moral well-being of the poor-tended to prefer forms of miasmatic theory. Conservatives, often less devoted to trade and the cause of the poor and more willing to countenance vigorous government action, just as often tended toward contagionism.

Miasmatism dovetailed with liberal calls to clean up the slums-where diseases were thought to originate-and to reform (coercively, if necessary) the poor who lived there. But there were other, less benevolent concerns as well.

''Contagionism,'' Evans said in an interview, ''commits you to an expensive program of prevention and quarantines, things like disinfection and the isolation of the sick. It's a very, very heavy and vigorous state intervention in society.'' Most importantly, as Porter puts it, ''The advantage politically for a miasmatic theory was that it eliminated the justification for quarantine''-and quarantine, which would choke off the movement of goods, was anathema to free-traders in the increasingly globalized 19th century.

Scientifically, of course, miasmatism was wrong, in some cases cruelly so. When cholera struck Hamburg in 1892, the government paid a heavy price for its combination of laissez-faire politics and doctrinaire adherence to the miasma theory. For years the city, which had hired only miasmatist public health officials, had declined to build a water filtration system. It delayed announcing the outbreak because of the fear of quarantine and did a lackluster job of disinfecting contaminated households. The epidemic, which barely touched the rest of Europe, killed 10,000 of the city's residents.

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Nevertheless, the link between urban squalor-which, after all, can offer a fertile breeding ground for pathogens-and disease is real enough. And today, the idea that illness has a social dimension, if not in the form of effluvia, characterizes much epidemiological thinking.

Many public health experts, for example, see President Bush's flu plan as focusing too much on the flu virus-dedicating almost all of its money to developing vaccines and antiviral drugs-and not enough on minimizing the societal disruptions the virus will create and then profit from to spread further.

''In a pandemic, all sorts of horrible economic or sociopolitical factors immediately emerge,'' says Laurie Garrett, a global health expert at the Council on Foreign Relations. Quarantines and panic temporarily dismember trade and communication networks, creating shortages of all sorts of basic necessities. And American hospitals that have in recent years been increasingly trimmed of excess capacity will lack the equipment, supplies, staff, and even the beds for the sudden inundation of new flu-struck patients. The Bush plan, Garrett charges, does little to address all of this.

''State health departments are woefully underfunded and overstretched,'' says Nancy Krieger, a professor at Harvard's School of Public Health, ''and those are the frontline workers. As [Hurricane] Katrina has shown, ultimately it's the local responders that have to do the bulk of the work.'' And those people too poor to be able to stay home from work in the event of an epidemic, she argues, not to mention those without medical care, will be the ones who suffer and spread the disease the most.

From this perspective, Mike Davis's vision-of avian flu as a man-made monster at our door-takes the idea of pandemic as social phenomenon and stretches it almost to the level of political allegory.

In Davis's telling, even the Great Influenza of 1918, the deadliest pandemic in history, owed much of its toll to the rapacious practices of the Great Powers. ''Much attention in 1918 was on young soldiers dying of it in the Western world,'' he said. ''But in British India somewhere between 12 and 20 million people died.''

Davis lays much of the responsibility for those deaths at the doorstep of the British Raj. For one thing, he argues, British colonial policies created famine conditions in India, exacerbating the mortality rate. For another, he said, ''they built a modern transportation system that reached far into the Indian countryside to move crops to ports, but their expenditures in terms of public health were almost nonexistent.''

That combination, he believes, ''allowed the disease to move at the speed of railroads'' throughout the country. The comparison Davis makes to the contemporary global trade system, which moves at the speed of airliners, and to the recent deterioration of public health infrastructure in many developing countries-something Davis, for one, blames on economic restructuring imposed by wealthy lender nations-could hardly be clearer.

Still, influenza may be among the least politically loaded of epidemic diseases. Spread through the most casual of contact, the flu is largely oblivious to class and race, and doesn't carry the same sort of stigma as AIDS or syphilis or even cholera. And because it spreads so quickly, once it has started there's little time to formulate much of a response at all, political or otherwise.

The 1918 influenza ''really didn't get much politicized,'' said Alfred Crosby, an emeritus history professor at the University of Texas and the author of an authoritative history of the pandemic. ''The truth of the matter is that it moved so fast, by the time people got really conscious of what was going on, the peak had passed and the epidemic was drawing to a close.'' The politics come later. Or, as we're seeing today, they come before.