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Book Review: New Pandemics, Old Politics: Two Hundred Years of War on Disease and its Alternatives by Alex de Waal

Published by Anonymous (not verified) on Mon, 10/05/2021 - 9:16pm in

In New Pandemics, Old Politics: Two Hundred Years of War on Disease and its AlternativesAlex de Waal offers a new political history of epidemics, identifying and critiquing a repeated mobilisation of the ‘war metaphor’ of pandemic disease to show our persistent (mis-)framing of biological illness. The book is an extremely comprehensive and fascinating history of previous epidemics, their metaphors and manifestations, and a highly thought-provoking read in our current times, writes Hannah Farrimond

New Pandemics, Old Politics: Two Hundred Years of War on Disease and its Alternatives. Alex de Waal. Polity. 2021.

Find this book (affiliate link): amazon-logo

Alex de Waal both starts and finishes his new book by outlining the challenge of writing about an ongoing pandemic; details date, policies change and recommendations look naïve. Despite this disclaimer, however, de Waal’s New Pandemics, Old Politics holds up remarkably well to the current historical waves of COVID-19 because, in identifying and critiquing the ‘war metaphor’ of pandemic disease, he has touched on something enduring about our persistent (mis-)framing of biological illness.

This book is essentially a political history of epidemics, with a whole heap of lessons for today. De Waal’s basic thesis, outlined in Chapter One, is that using a war metaphor story, which starts with an invading pathogen which has to be fought on the ‘front-line’ and is eventually solved by a medical miracle such as drugs or a vaccine, is misguided. Metaphorical thinking is prevalent in times of crisis; we clutch at coherent stories to make sense of chaos. War metaphors are also favoured by those who fancy themselves as ‘Great Leaders’, as a way of subjugating competing political, scientific and business forces and as a method of controlling the narrative.

De Waal points out, however, that metaphors affect what we think and do. The military metaphor facilitates actions that would be inappropriate in peace-time. One, for example, is the pressure for consensus; dissenting or alternative voices are seen as detrimental to the ‘war effort’. Similarly, the need to act as one nation, rather than selfishly, is hammered into the population. Intrusive or surveillance measures are justified in war. Those advocating for democracy and social justice can be positioned as ‘saboteurs’ if they dissent. Finally, the war on disease narrative is also a ‘script for conquest’ (11), a colonisation of the world through Western biomedicine which is not sensitive to either human contexts or the natural world.

Photo by Mika Baumeister on Unsplash

Having laid out his primary thesis, de Waal then proceeds to analyse major chapters in the history of epidemic disease, particularly cholera, influenza, HIV/AIDS and Pandemic X (an imaginary ‘Big One’), pulling out their political and narrative significance. Giving each of the epidemics a character, he describes cholera as a pantomime villain: naïve, gross and savage in its effects on the human body (Chapter Two). Cholera represents the start of the war metaphor, through the ‘battle’ of Robert Koch, the German microbiologist whose triumphant discovery of the cholera bacillus put to rest, once and for all, competing theories of transmission.

However, the story of the war metaphor is not a simple one. In Chapter Three, de Waal shows that in many ways, the influenza pandemic of 1916-18 does not follow the triumph of the typical war against disease. Characterised as ‘The Joker’ who played the deadliest pandemic trick ever, it arrived, unexpectedly, at the end of World War One, killed between 60-100 million people, and left, lacking any triumphant medical victory. The more interesting question, for de Waal, is why this story is so quietly told: perhaps through collective shock, a lack of fit with the optimism of the American Roaring Twenties or its representation as a failure of science which took decades to isolate and vaccinate against it. The reason remains unclear.

The ongoing story of HIV/AIDS, in Chapter Four, is also more complicated than your average war metaphor can capture. HIV/AIDS is described as a ‘shadow’, invisibly transmitted, waiting often years or even decades to emerge in its more fatal form. De Waal writes extensively about the long history of HIV/AIDS viral development, and its entwined history with colonialism, for example, through the mobilisation of immigrant workers away from families, creating the necessary ‘webs of sexual interaction’ which drive HIV/AIDS. De Waal also identifies ‘the activism of gay men that made AIDS exceptional and created an entirely new model of emancipatory public health’ (136), such as through campaigning for inclusive policies, changing trial protocols and shaming pharmaceutical companies into lowering the price of anti-retroviral therapy drugs, reconfiguring HIV into a different type of chronic illness entirely. HIV/AIDS is thus not an ‘outbreak’ story in the classic mode, having neither a clearly defined beginning nor end, and containing a multiplicity of other stories within it.

Reading these chapters provides many lessons in relation to COVID-19. I was put in mind, during the cholera chapter, of contemporary debates about whether COVID-19 is aerosolised or primarily droplet-based, and the profound implications for public health of this knowledge. The story of influenza reminds us that people’s responses can tend as much towards collective forgetting as remembrance. There are clear parallels between the emancipatory public health of HIV/AIDS and the activist-led movements to medically recognise Long Covid. De Waal’s book is most valuable as a tool for making us think through today.

Indeed, de Waal’s last chapter is on COVID-19. In some ways, what de Waal says when he gets to the ongoing pandemic is relatively limited, because as he himself acknowledges, policy recommendations would date. This does mean, however, that we cannot really see what removing the war metaphor would look like. This difficulty, of what to do instead, is not a problem unique to de Waal. Susan Sontag, in her classic text Illness as Metaphor, states that medicine should avoid metaphors when speaking about disease, but that doesn’t really take us anywhere, given both authors have established the human need for stories. One suggestion de Waal does make is that we might develop an emancipatory public health, which is less focused on individual pathogens and more on the conditions in which such pathogens flourish: particularly social injustice, and our own (unhealthy) manipulation of the natural world. He is, of course, correct: we created the conditions in which COVID-19 is now flourishing and our lack of preparedness, well-articulated in the Pandemic X chapter of this book, is acute. That does not tell us, however, what to do today.

The other fly in the ointment of de Waal’s theory is that, unlike some of the epidemics he details in this book, such as influenza and HIV, it looks very much like COVID-19 will conform to the classic ‘outbreak’ storyline: in the endgame of medical vaccines. The emergence of medicine’s ‘silver bullet’ is going to reinforce the war story, not challenge it. Politicians are already using vaccine saviour stories to block out other less palatable ones.

For me, the book provoked thinking about WHY we are still stuck on war metaphors to describe our tricky social problems: we have had ‘The War on Drugs’, ‘The War on Poverty’ and ‘The War on Terror’. Even climate change has to be fought. Perhaps it is a question of who is using the metaphor. For example, less masculine and aggressive terminology, such as sports metaphors (the ‘Team of Five Million’), has been used to motivate action against COVID-19 in New Zealand by the female leader Jacinda Ardern.

To conclude, de Waal’s book is an extremely comprehensive, fascinating political history of previous epidemics, their metaphors and manifestations, and as such, a highly thought-provoking read in our current times.

Note: This review gives the views of the author, and not the position of the LSE Review of Books blog, or of the London School of Economics. The LSE RB blog may receive a small commission if you choose to make a purchase through the above Amazon affiliate link. This is entirely independent of the coverage of the book on LSE Review of Books.

Banner Image Credit: Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19, formerly known as 2019-nCoV. Photo by CDC on Unsplash.


Book at Lunchtime: The Political Life of an Epidemic – Cholera, Crisis and Citizenship in Zimbabwe

Published by Anonymous (not verified) on Thu, 04/02/2021 - 8:23pm in

TORCH Book at Lunchtime webinar on The Political Life of an Epidemic – Cholera, Crisis and Citizenship in Zimbabwe written by Professor Simukai Chigudu. About the book:
Zimbabwe's catastrophic cholera outbreak of 2008–9 saw an unprecedented number of people affected, with 100,000 cases and nearly 5,000 deaths. Cholera, however, was much more than a public health crisis: it represented the nadir of the country's deepening political and economic crisis of 2008. This study focuses on the political life of the cholera epidemic, tracing the historical origins of the outbreak, examining the social pattern of its unfolding and impact, analysing the institutional and communal responses to the disease, and marking the effects of its aftermath.
Across different social and institutional settings, competing interpretations and experiences of the cholera epidemic created charged social and political debates. In his examination of these debates which surrounded the breakdown of Zimbabwe's public health infrastructure and failing bureaucratic order, the scope and limitations of disaster relief, and the country's profound levels of livelihood poverty and social inequality, Simukai Chigudu reveals how this epidemic of a preventable disease had profound implications for political institutions and citizenship in Zimbabwe.
Panel includes:
Professor Simukai Chigudu is an Associate Professor of African Politics at Oxford and a Fellow of St Antony's College. Prior to academia, he was a medical doctor in the National Health Service where he worked for three years. He is principally interested in the social politics of inequality in Africa, which he examines using disease, public health, violence, and social suffering as organising frameworks. He has conducted research in Zimbabwe, Uganda, The Gambia, Tanzania and South Africa.
Professor Sloan Mahone is an Associate Professor of the History of Medicine at Oxford University. She specialises in the history of psychiatry and neurology in Africa as well as the history of medicine and psychiatry globally. Her current research projects, funded by the National Institute of Health Research (NIHR) and Oxford's James Martin School, involve the implementation of oral history programmes on epilepsy in Africa and in resource poor settings globally. She is a member of Oxford's Epilepsy Research Group. Professor Mahone has also worked extensively in historical research and community development in Zaire (Democratic Republic of the Congo), South Africa, Botswana, Zimbabwe, Uganda, Tanzania, and Zanzibar.

Doctor Jon Schubert is a Leverhulme Trust Early Career Fellow at Brunel University. He is a political and economic anthropologist working on state institutions, infrastructures, and transnational trade in Angola and Mozambique. He is the author of Working the System: A Political Ethnography of the New Angola and has previously held postdoctoral research positions at the universities of Leipzig and Geneva.