Lurking beneath the metaphor of viral contagion in The Viral Network is an aspect of the viral experience so fundamental as to be absent from much of the explicit discussion in the book: the power to inflict suffering, and to do so differentially. The viral represents connectivity, to be sure, but it also represents the pain and suffering that that connectivity can create. Perhaps more to the point in the context of MacPhail’s discussion, not all nodes in the network are equal either in their ability to create or ease suffering, or in their likelihood of being made to endure it. To extend one of the book’s more evocative metaphors, the ‘superorganism’ of global health has a brain (the center) that exercises profound control over other organs (the periphery).
This is a book on expertise, so it is perhaps not the place to delve deeply into the highly unequal global suffering and equally unequal fear of suffering that drives so much of the discursive power of viral pandemics — except perhaps to note that the very real specter of death surely partners with what the author terms “strategic uncertainty” in driving the cycle of funding, research, and fear that keeps the engine of pandemic preparedness chugging along. That the outsized fears of contagion on the part of some of the wealthiest places on Earth — a category into which one could place Hong Kong, despite its postcolonial status — match up poorly with the actual distribution of suffering caused by viral outbreaks is now an aphorism among social scientists studying global health. The recent Ebola outbreak and its concentration in some of the poorest parts of the world provides only one recent illustration of how viruses spread in ways that are so far from the vision of “pandemic humanity” that MacPhail describes at the end of her book as to make this vision tragically comedic. The steep slopes of global geopolitical power almost always track viral suffering and death more closely and accurately than any epidemiological model. Epidemiologists know this well — and yet they keep building their models, trying to keep deadly viruses, as WHO has often articulated it, “at their source.” The always unspoken addendum being, “in the poor places that are going to suffer anyway.”
This is what SARS and avian flu wrought: a fantastical notion of a just world unified against a common enemy, against the background of a grossly unequal burden of existing and potential suffering. And yet the flip side of differential suffering and power is that those “experts” residing in the less powerful nodes of the global viral network are left to implement this impossible vision with little power to shape what the vision should or could be. MacPhail points out that in Hong Kong public health scientists were “global partners” who nonetheless had a highly delimited ability to shape global best practices. Pandemic control protocols continued to be made by and for Western nations, particularly the U.S., with junior partners subject to criticism if and when they went down their own paths in attempting to achieve the goals outlined in official preparedness plans.
As I have described previously in my own work (Mason 2010), Chinese public health professionals on the other side of the border from Hong Kong drew upon their own experiences with the SARS epidemic to design and implement harsh H1N1 control measures like the ones MacPhail describes. Such measures included mass fever checks, border quarantines, and involuntary collection of bodily fluids. My interlocutors’ decision to draw upon China’s authoritarian powers to attempt to control an uncontrollable virus was motivated by a sense of professional striving as well as by a belief that disease control with Chinese characteristics could and should be a more perfect version of global preparedness. Without the bothersome problems of democracy and human rights claims, Chinese public health professionals felt they could do what needed to be done — thus fulfilling the “temporary authoritarianism” fantasies of MacPhail’s informants. They thought, perhaps naively, that strict quarantine and isolation procedures would reward them with upward mobility within the global public health superorganism. The backlash they instead felt highlighted for them the global hierarchies of power. They were “partners,” yes, but until they did things the “Western” way, they would only ever be junior partners at best. Their power over their own people was, from their perspectives, no match for the power that U.S.-dominated science continued to have over them and their aspirations.
Katherine A. Mason is Assistant Professor of Anthropology at Brown University and a Robert Wood Johnson Foundation Health and Society Scholar at Columbia University. She is the author of After SARS: The Rebirth of Public Health in a Chinese ‘City of Immigrants’ (Stanford, in press).