SARS in China: Prelude to Pandemic? (review)

Historically, a number of major epidemics have had their origin in China, including the 1957 Asian flu, the 1968 Hong Kong flu, and the 1977 Russian flu. As the first global health crisis of the twenty-first century, SARS posed a serious threat to international health security, the functioning of health systems, and the stability of economies and societies worldwide. As the two editors of this volume observe, the local response evident in China was "as much a consequence of the global reaction to SARS as a reaction to the infection itself " (p. 2). Therefore, SARS in China not only makes a significant contribution to China studies but also provides important clues about the state of preparation for global health challenges such as avian flu.

There is no shortage of literature pertaining to the topic of this volume. What makes SARS in China different is that it suggests a new approach to understanding human epidemics. Challenging the "isolationist and elitist conventions" of traditional academic disciplines, the volume provides an extensive and comprehensive treatise on the SARS outbreak in China. The contributing authors have examined almost all the major aspects of the epidemic-epidemiological, political, economic, social, cultural, psychological, and moral. They are from disciplines covering anthropology, political science, sociology, psychiatry, economics, and epidemiology. They include both scholars and practitioners-indeed, several of the authors themselves were on the frontlines of the battle to understand and control SARS. The editors have done an excellent job to make sure that this manifold and transdisciplinary perspective does not compromise the coherence and clarity of the volume.

Perhaps equally important, the book as a whole not only addresses SARS as a mirror reflecting the macro-historical process or a way of illustrating changing public health practices, but also discusses its possible role as the causative agent of social, economic, and political change. Unlike the tremendous media coverage of SARS, the book situates the unfolding of the disease in the context of popular fears and of economic and political process at the national and international levels. In particular, it recognizes the importance of "rational bureaucratic language, biomedical knowledge, and political ideologies" in shaping the social response to SARS (p. 3).

In chapter 2, Megan Murray observes that one of the main challenges in containing SARS was a general medical and epidemiological uncertainty. Even today, epidemiologists still do not have a clear idea about the origin, transmission, virulence, and sustainability of SARS. In chapter 7, Lee and Wing imply that this lack of biomedical knowledge, coupled with the difficulty of controlling the behaviors that cause the transmission of the disease and the absence of effective treatment, had the potential for reinforcing and intensifying popular fears. The fear and anxiety of the unknown is suggested by the outpouring of SARS-related humor and jokes across the country during the crisis. Yet, as Hong Zhang argues convincingly in chapter 8, these widespread SARS-related jokes not only answered psychological needs but also spoke to "the emergence of a degree of government latitude [that] allows the public to engage in different modes of expression and to voice social criticisms and dissatisfactions" (p. 166). Like the SARS-related jokes and humor, stigmatization became a weapon that allowed the society to cope with the uncertainties and fear. What Kleinman and Lee suggest in chapter 9 is that the indigenous Chinese model of stigma carries particularly strong moral, emotional, and social consequences, given the crucial role that social networks play in regulating individual behavior and the lack of development of advocacy and legal measures against discrimination in China.

The fear and panic were further magnified by the initial government cover-up and subsequent reverse course in responding to SARS. The chapters by Alan Schnur, Joan Kaufman, Tony Saich, and Erik Eckholm reveal two critical weaknesses inherent in an authoritarian system: first, authoritarian countries lack effective feedback...