Abstract
In Epidemic Orientalism: Race, Capital, and the Governance of Infectious Disease, Alexandre White discusses how discourse around the need to sanitize native populations and Black or Brown populations has developed over time into the regulatory machinery that is used to accomplish the public health aspects of pandemic control, while reinforcing and oftentimes strengthening cultural factors during control efforts and into post-pandemic periods. Notably, the author pursues the idea that a West versus Rest view might reasonably cause errors while promoting racist interpretations of the world. To begin, the author notes that international health regulations that seek to promote global standards for disease control and prevention, managed by the World Health Organization, are built on the back of a racist colonial history. This machinery specifically seeks to encourage lower-resource areas of the “rest” of the globe to adopt public health standards created and evaluated by western physicians and scientists to act as the West's first line of defense. Thus, through a historical lens, White argues that attempts to control today's diseases can be directly linked to descriptions of disease control in the past.
Disease prevention and control seek to attain two main goals: to prevent diseases from spreading through a community and to isolate cultural and economic resources during the pandemic spread. These two guiding lights have long been tied together as necessary for infectious disease control through studies of smallpox, yellow fever, and other epidemics in communities and at times when a disease might have killed large swaths of a population and erased whole communities. In societies with the highest death counts, it is always true that those who survived are at high risk of death due to lack of health care, exposure, or even dehydration or starvation because their communities lack the social resources necessary for survival. While these effects have been outlined during the COVID-19 pandemic as country economies failed, many of those who survived COVID-19 will recall the constant threat of health care collapse that was embodied in the view that we must work to flatten the epidemic curve.
Infectious disease epidemics are challenging because controlling the spread of infectious diseases requires power. Societies are often faced with controlling the loving interactions and economic transactions occurring between people. These controls are often enacted within and between communities while relying only on existing governmental structures with diverse histories and unequal social standing. Places where powerful governments casually impede citizen activities and movements often feel greater comfort in limiting interactions between people. Populations and people with the least power are the most susceptible to efforts to control spread even when they are not the locus of that spread.
Early failed COVID-19 projects are rife with trying to lay the blame for COVID-19 on nonwestern regions, including labeling COVID-19 the Kung Flu, Snake Flu, or Chinavirus, and similar names for COVID-19 variants. Yet, as White notes, taking a West-versus-Rest view of the world creates missteps exactly when our decisions have the most ability to avert infections and avoid casualties. Pandemic control textbooks suggest that isolating infected individuals to reduce spread within regions is critical and requires careful data collection to identify carriers. Early in the U.S. pandemic the Centers for Disease Control and Prevention erroneously attributed the spread to Chinese travelers, those from the place where the novel coronavirus was first detected. Yet at the time of this assertion, local cases were already spreading and when tracked were mostly transferred from other western nations with stronger ties, like Italy or the United Kingdom.
New diseases arriving in communities are directed by existing social structures (Clouston and Link 2021). Powerful people living in powerful societies often seek opportunities to appear exceptional. They use their power, highlight their prestige, and flaunt their freedoms. Thus, even though richer areas were among those communities hit first due to greater global travel to those places, a more pervasive narrative has been that the COVID-19 virus attacked those who were more vulnerable (i.e., older, racial/ethnic minority, disadvantaged, homeless, or sick people). Exceptionalism resulted in the view that healthy people and communities could effectively ignore the disease and expect to survive its effects, with one result being the lagging adoption of pandemic control measures, including face masks, alongside slowed uptake of life-saving technologies, including vaccines (Clouston, Hanes, and Link 2023).
Efforts to control pandemics that specifically rely on racist or orientalist understandings of the world are bound to fail. They use people’s “over there” worldviews without recognizing how those working over there are the first line of defense for all those people saying that it is “certainly not me.” Throughout the treatise, White elucidates how epidemic Orientalism is often propelled by a desire to maintain national pride by denigrating others. Yet, White usefully notes that the viewpoint of these regulations often presupposes a global power dynamic propping up these guidelines.
I worry whether we might ever be able to escape colonial history. Existing public health infrastructure arose out of efforts to both understand and control infectious diseases before they spread so far that they cannot be controlled. The most effective public health response efforts empower local public health officials to immediately respond within their own communities to address infectious disease threats with impunity. Yet, quarantines and containment policies are extraordinary powers to bestow on any one person and are not powers that we should remove. One juxtaposition that was ignored is how the powers of isolation and quarantine are steeped in colonial history but are also critically important tools when responding to new outbreaks of known or novel infectious diseases.
Ultimately, Epidemic Orientalism does exactly what it aspires to do. It convinced me that ongoing racist discourses and policies are strengthened during epidemics. These policies use our raw fear, at times when we are most vulnerable, to specifically legitimate the current political powers at the expense of those who are most vulnerable. My hope is that this leads us to future work that can expand beyond recognition of unequal outcomes to action oriented toward increasing transparency and trust at exactly the time when the next epidemic arises.