Unprepared: Global Health in a Time of Emergency
University of California Press, 2017. 240 pages.
Let us be frank: it is hard to think preparedness in the medical humanities without thinking of Andrew Lakoff. Over the ten years since the publication of his first piece on the subject (2007), Lakoff has developed, expanded and refined the critical study of new public health and epidemiological frameworks of anticipating and preparing for infectious disease epidemics.[i] These works already define the field, and in dialogue with a flourishing array of studies by other medical anthropologists they have come to redefine our understanding of global health as a biopolitical terrain. The monograph Unprepared, published last year by the University of California Press, not only summarizes these works but also fosters their broader theoretical and methodological coherence and propels them through new ethnographic trajectories.
What perhaps most elicits the attention of a reader already familiar with Lakoff’s work and argument is a low-key and yet pervasive theme spanning the book: the imagination. Pandemic threat, Lakoff argues, “can be understood and managed as an unprecedented but potentially catastrophic event whose consequences can only be managed by using methods of imaginative enactment that enable planners to mitigate vulnerabilities,” (p.8). The shift from precaution to preparedness, as understood by Lakoff, requires both a different way of imagining existential risk, and a different way of enacting this imagination as a means of rendering existential risk actionable. Hence the extent to which we can be prepared for the next pandemic depends on the extent to and the ways in which we are able to imagine it as a social and biological event in the first place.
Lakoff provides a potent critique of the international response to the recent Ebola epidemic from an “imaginary” angle that complements well-established claims that (as a technology of global health security) preparedness led to a neglect of the public health infrastructure’s collapse, and the importance of this neglect in implementing contact-tracing, isolation, quarantine, etc. on the ground. He claims that the delay of international response to the outbreak was “at least in part” due to a failure of “administrative imagination: at a crucial stage, health authorities did not conceptualize Ebola as the potential source of catastrophic epidemic, but rather understood it as a disease that could be managed via localized humanitarian care combined with straightforward public heath techniques” (p.141). This failure of the imagination, Lakoff argues, is at first sight surprising, given the importance of Ebola to the rise and consolidation of emerging infectious disease frameworks, and the imaginary investment in Ebola as a “killer virus” in popular and scientific literature as well as novels and films since the early 1990s. “Indeed, the “Super-Ebola” exercise in Honolulu was among the events that helped introduce pandemic preparedness as a central problem for international health,” (p.145). Yet, Lakoff argues, it is precisely the prevailing imagination of the “next pandemic” that caused international complacency on Ebola during the first months of the outbreak. Expecting a novel super-virus, epidemiologists were so entangled in what Carlo Caduff has called the “mutant ontology” of emergence, that they could not imagine that a known virus, like the one that was spreading in West Africa, could lead to a pandemic crisis.[ii]
As Lakoff is keen is to develop a Cold War genealogy of preparedness, it is tempting here to attempt an “imaginary” comparison. Fifty years ago, in one of the first and most profound analyses on the subject, Günther Anders identified an “imagination-deficit” as lying at the core of nuclear catastrophe.[iii] The object of this deficit was not the material impact of nuclear war. This had already become quite apparent in the world-historical atrocity of Hiroshima and Nagasaki, and only required a scalar projection to be envisioned on a global scale. What, by contrast, remained outside the realm of imagination was the temporal impact of this event. This was in Anders’s terms, “over-liminal” (überschwellige); a term used to describe “phenomena that cannot be grasped and intellectually assimilated because they outgrow the size of any of the sensual/conceptual nets”.[iv] In a famous turn of phrase, recently picked up again by Déborah Danowski and Eduardo Viveiros de Castro, Anders specified that the problem with nuclear war is that it signals not simply a time when we will not be, but a time when we will have never been.[v]
Though genealogically linked and drawing on an array of images and ideas of the Cold War, pandemic preparedness markedly differs from them in a number of ways: the existential risk involved is asymmetric, it originates in nature, and it relies not on unilateral action but on human connectedness (contagion). This entails an ontological transformation of catastrophic, end-of-the-world imaginary. In the case of nuclear war, making the unimagined imaginable entailed a concrete hope: that of cancelling the end of the world by means of a universal stasis against the powers or systems that were engineering it in the first place (according to different narratives: the Pentagon/Kremlin, imperialism, militarism, etc.). By contrast, in the case of the next pandemic, making the consequences of the catastrophe imaginable claims no power to stop or delay the event – for the event is in the first place and imagined as being, by its nature, inevitable. Instead its role is to mitigate what Lakoff diagnoses as the “misalignment between the normative rationality of epidemic preparedness and the experience of managing actual disease outbreaks,” (p.166).
Imaginary enactment thus needs to be seen as the pivot between two key aspects of preparedness: as a biopolitical practice that (re)defines and responds to health emergencies, and as a mythic enactment of a new end of the world. Lakoff’s book provides an undisputed milestone in the discussion of the first, while at the same time providing key links to the second. And in so doing, it illuminates how becoming-unprepared is precisely what lies at the arcane heart of preparedness as an apparatus that mobilizes imaginaries and sensibilities of emergency in a perpetual deferral of being-prepared.
As studies in historical ontology, Lakoff’s works have taught us how to see today’s world of epidemic anticipation and control beyond that cornerstone of hygienic modernity: prevention. Unprepared fulfils the promise of his invitation to the dizzying depths of global health security by laying bare how enactments of readiness are intricately and at the same time anxiously linked to an unstable constitution of threat.
Christos Lynteris is Senior Lecturer in Social Anthropology at the University of St Andrews and Principal Investigator of the European Research Council funded project Visual Representations of the Third Plague Pandemic (St Andrews & Cambridge). His research examines biopolitical, epistemological and aesthetic aspects of infectious disease epidemics and epidemiology, with a focus on plague and zoonotic diseases. He is the author of The Spirit of Selflessness in Maoist China (2012) and Ethnographic Plague (2016) and has edited and co-edited a series of works, the most recent of which is Histories of Post-Mortem Contagion: Infectious Bodies and Contested Burials (with Nicholas Evans, 2018).
[i] Andrew Lakoff, “Preparing for the Next Emergency,” Public Culture 19 (2) (2007): 247-271.
[ii] Carlo Caduff, The Pandemic Perhaps: Dramatic Events in a Public Culture of Danger (Berkeley CA: The University of California Press, 2015).
[iii] Günther Anders, Die Antiquiertheit des Menschen, 2 Vols (Munich: C. H. Beck, 2002). For a discussion on the “lack of imagination” in Anders’s work see: Paul van Dijk, Anthropology in the Age of Technology: The Philosophical Contribution of Günther Anders (Amsterdam: Brill, 2000).
[iv] Zygmunt Bauman, “A Natural History of Evil,” S:I.M.O.N (22 March 2012) http://simon.vwi.ac.at/index.php/swl-reader/21-a-natural-history-of-evil.
[v] Déborah Danowski and Eduardo Viveiros de Castro, The Ends of the World, translated by Rodrigo Nunes (Cambridge: Polity, 2016).