SARS in Context: Memory, History, Policy (review)

The 2003 outbreak of severe acute respiratory syndrome (sars) almost seems like a distant memory in Canada today, yet we are well reminded by this volume that incidents like sars raise perplexing public policy questions. During the sars outbreak, which resulted in forty-four deaths in Canada, comparisons were liberally and frequently drawn in the media with past pandemics, such as the Black Death and, most often, the 1918–19 influenza pandemic. Media versions of epidemic histories made some historians, called upon to comment on sars, uneasy. In part, this collection of essays was motivated by a desire to promote a richer dialogue between disease history and public health practice than can be conducted in the media during a moment of perceived crisis.

The collection, including contributions from historians, medical practitioners, health economists, and policy analysts, grew out of a 2004 symposium at Queen’s University. It feels exploratory, which is understandable. given the immediacy of the post-sars context. The disease historians draw parallels and contrasts between sars and the histories of plague, cholera, smallpox, influenza, tuberculosis, and sexually transmitted diseases; mostly, but not exclusively, in a Canadian context. Heather’s MacDougall’s essay on Toronto allows scholars of sars to set disease-management strategies in the long view, as she examines responses to a range of infectious diseases in that city over two hundred years.

Georgina Feldberg argues that diseases such as sars, bse, and Avian flu alarm the public because ‘they appear to shatter the historical record’ of medical triumph over disease; however, as the persistence of tuberculosis demonstrates, this is not an accurate perception. Dr James Young, Ontario’s commissioner of public security during sars, informs us that at the beginning of the outbreak public health officials simply did not know whether this was ‘the big one’ (20). As he admits, ‘We had no reliable diagnostic test, no vaccine, and no treatment’ – hardly a story of medical triumph (21). In this, sars resembles the 1918–19 influenza pandemic. At the same time, the poor and marginalized, in this country and globally, have never had the luxury of forgetting the devastation of infectious diseases. Thus, Feldberg calls for a ‘reintegration of the social, political, and the biomedical within public health initiatives’ to address this reality (118).

Arthur Sweetman cites epidemiological research that demonstrates the power of community responses to disease. Members of the public will make behavioural changes to avoid infection when disease prevalence is high. This helps to contain disease outbreaks. One problem is that mixed signals from media and government can complicate this tendency. Sweetman criticizes the federal government’s belated use of Employment Insurance benefits to encourage those potentially exposed to sars to undergo voluntary quarantine; the policy was implemented too late, and communicated too poorly, to make quarantine an effective disease-containment strategy (136). Yet, in a historical context, even an imperfect offering of income support for those affected by disease must be considered a positive public policy development.

Jurisdictional conflict over health policy occurs often in the context of Canadian federalism. Lazar and Wilson argue that it interfered with a coordinated response to sars, and they promote a stronger central government role in managing public health and disease. This has already begun to emerge, through the Public Health Agency of Canada, for example. Questions about governance, and who will bear the cost of disease control, are potentially problematic beyond national boundaries; this is not a new thing, as debate and conflict over cordon sanitaire and maritime quarantine is older than the nation state itself. We appear little closer to a satisfactory resolution of these questions than were the residents of fifteenth-century Europe, despite the existence of the World Health Organisation and other transnational institutions. Several authors in this collection refer, without critical comment, to ‘disease surveillance’ in the context of globalization, and to the pairing of public health with national security. This should cause us concern. New work by US...