A short modern history of disease-naming, shaming, and international health diplomacy.
As Covid-19 swept the world in March 2020 and gained momentum in the United States, President Donald Trump and members of his administration repeatedly referred to Covid-19 as ‘the Chinese virus’. US Republican Senator John Cornyn asserted ‘China is to blame because the culture where people eat bats and snakes and dogs and things like that’, going on to claim that China had also been responsible for other global health threats including MERS (Middle Eastern Respiratory Syndrome, first identified in Saudi Arabia in 2012), and swine flu (first detected in the US in 1998). Meanwhile in the UK, the Chair of the parliamentary Foreign Affairs Committee, Tom Tugendhat, criticised the Chinese government for its failures in tackling the emerging epidemic. It was no coincidence that these attempts to blame China came in the midst of not only a pandemic, but ongoing political and economic tensions between the US/UK and China.
Covid-19 has become a fulcrum around which states have constructed narratives of their own successes and the failures of their rivals. It has become another weapon in the arsenal of international diplomacy. But this is a tradition with long-standing precedents. Across the history of contagion, national responses have been as driven as much by political considerations as by expert medical advice. Contagions can be tools for attributing ‘blame’ and criticising apparent system-wide failures, for building reputation and good will, and for furthering power rivalries through other means. To adapt Clausewitz for the current crisis: health policy in the midst of contagion is the continuation of international politics whilst wearing a face mask.
Writing of the arrival of syphilis into Europe in the early sixteenth century, Francesco Guicciardini wryly noted it was known as ‘the French disease’ within the Italian states, and by the French as ‘the Neapolitan disease’. Across sixteenth century Europe, syphilis was embroiled in, and reflective of, European power politics: Russians named it ‘the Polish Disease’; the Poles attributed it variously to the German states and to Russia; in Tudor England, engaged in its perennial power-struggle with its near neighbour, it was inevitably known as ‘the French disease’; whilst the Turks called it ‘the Christian disease’.
This naming-and-blaming was mapped with exactitude onto the tensions, conflicts and rivalries of Europe, because names carry power. In blaming the other for the disease, the French and Neapolitans were commenting more widely on the legitimacy of their own actions, and the illegitimacy of the other. So too, the Athenian plague of 430-427 BCE that killed perhaps one-third of the population, as reported on by Thucydides, was ascribed to the attacking Spartans poisoning the wells. Athens could ascribe its military loss to the Spartan lack of honour, not its own failings. Similarly, disease narratives around the newly emergent HIV and AIDS epidemic in eastern and central Africa in the 1980s saw ‘others’, usually political or economic rivals, as the agent of infection: from Tanzanian villagers blaming Ugandan traders for bringing the virus to them (and vice versa); to the subversion of the French abbreviation, SIDA, Syndrome d’Immuno-Deficience Acquiseto Syndrome imaginaire pour décourager amoureux, reflecting widespread narratives across Francophone Africa (and wider) about the use of colonial medicine to undermine African bodies.
Disease shaming and international politics
In November 2002, a new virus emerged in the Chinese province of Guandong, before spreading across south-east Asia, Europe and North America to 29 countries, infecting around 8,500 people (most of them in China). Severe Acute Respiratory Syndrome (SARS) was also labelled ‘the Chinese disease’, not only in recognition of its origin, but (as now) as a political commentary upon the Chinese government. Democracy was better able at dealing with public health, and therefore, one might assume, with wider social and economic policy.
As well as being a point of potential blame, SARS also presented an opportunity for action for the Chinese government, as it turned to facemask diplomacy to re-assert its legitimacy as a global actor. It engaged closely with international health actors after its initial period of denial; and provided significant support for Taiwan in dealing with its own epidemic. In doing so, SARS allowed China to emphasise its interests in Taiwan, and the closest of links between the two, in a velvet glove of public health intervention, enclosing the iron heart of its territorial claims.
We can see both of these echoed in the current responses to the Covid-19 pandemic: whether the attempts to blame rival powers and undermine their legitimacy or status as responsible global powers; or through the efforts of new facemask diplomacy. China, for example, has sent equipment to many different countries (those to the UK in boxes pointedly emblazoned with a reworking of the World War Two slogan, ‘Keep calm and combat coronavirus’). Russia, also embroiled in a series of tense stand-offs with both the US and the EU, and facing international criticism for its human rights record, has sent ventilators and other equipment to both not only in the spirit of international solidarity, but as a pointed comparison between its own preparedness and strength and that of its rivals.
Stigmatising the other
The problem is that the blame-game is not just a spat between national leaders: it has implications for wider society. Epidemics and contagions provide a space in which older, race- and moral-based narratives about health and sickness can emerge and re-emerge. In fourteenth century Europe, Jewish communities paid a heavy price for rumours as to their complicity in spreading Black Death (conveniently allowing secular and religious authorities to seize the riches of those killed or exiled). During the SARS epidemic, there was an upturn in xenophobic attacks on people of (assumed) ‘Asian’ heritage. In Toronto, for example, many people stopped visiting Chinese restaurants, avoided close contact with people of assumed Chinese heritage, and blamed Chinese-Canadians for being a source of contamination.
‘Foreigners-in-the-midst’ have always been a vulnerable target for public fears, often stoked by governments and officials. Syrian refugees were (incorrectly) blamed in 2015 for bringing ‘flesh-eating’ leishmaniasis into the US. And asylum seekers in camps in Mexico were seen by US officials as a reservoir of chicken pox, and denied entry even when they had valid reasons. The rise of tuberculosis in the 2010s in the UK was blamed on immigration from poorer global regions. An official report presented a more nuanced picture: the rise was largely occurring in non-UK born groups. But it was not their ethnicity or geographic area of origin that was to blame, but the poor, overcrowded and badly ventilated housing many had been forced into on arrival. It was not their race which was the problem, but their poverty. The deprivation causing the increase was entirely UK-made, not imported.
So the fact we have seen with Covid-19 a restating of race-based understandings of health is hardly surprising. Public and official narratives have once more reverted to outdated and unscientific race-based discourses, attributing moral values and culpability to those narratives.
Pulling up the drawbridge
In the nineteenth century states dealt with the risks of contagion by quarantine, isolation, and screening. Emerging epidemics and outbreaks of disease in other countries would be halted at national borders, keeping the foreign danger out. The growth of global health institutions from the late nineteenth century and especially in the twentieth saw some (but still limited) widening of the policy gaze, as experts and governments increasingly agreed that collaboration and cooperation were the only sensible response to global health threats.
The response to SARS was held up in its aftermath as a turning point in global health, showing the ways in which global cooperation could control and limit a dangerous virus. What the response to Covid-19 has suggested is that the lure of nationalism has remained powerful. States have locked down their borders in ways that go beyond medical advice; they have competed for scarce resources; rich countries have looked to their own epidemics and done little to help prevent similar scale ones occurring in other, less wealthy, global regions, Africa most especially. All this despite the very clear evidence saying failure to address this pandemic globally leaves everyone more vulnerable.
Health responses do not exist in a vacuum. It is not a coincidence that this turn has occurred during a sweep of populist nationalism across many parts of the world, and the retreat of global powers from international cooperation. Nationalist forces have pulled at economic policy and world trade; donors have increasingly defended international development commitments on the basis of strategic national self-interest; and global health, right at the point where a global response has been needed like never before, has retreated back within national borders. Facemask diplomacy has left all of us more vulnerable and less able to respond effectively.