Farewell to the God of Plague: Chairman Mao's Campaign to Deworm China by Miriam Gross (review)

In Farewell to the God of Plague: Chairman Mao's Campaign to Deworm China, Miriam Gross retells the story of Mao Zedong's war against snail fever, a chronic vector-borne disease caused by parasitic flatworms. In 1949, the year that the Chinese Communist Party (CCP) gained power, snail fever—otherwise known as schistosomiasis, bilharzia, or big belly disease—was endemic in the waterways and lakes of south and central China, putting millions of lives at risk and jeopardizing agricultural production. By 1958, at the end of the Great Leap Forward, when Mao penned his triumphalist poem "Farewell to the God of Plague"—from which Gross takes the title of her book—the disease had been brought under some control.

In reality it was far from eliminated. The years after 1959 witnessed a resurgence of the disease as the campaign disintegrated and the People's Republic of China (PRC) experienced a devastating famine. While the anti-snail campaign was revived under Mao's direction during the Cultural Revolution, the focus shifted away from rural health in the late 1970s with Deng Xiaoping's reforms. And notwithstanding a China World Bank Loan Project launched in the early 1990s to tackle the disease, snail fever has persisted as a public health threat in China.

Mao's radical campaign against snail fever, however, is often hailed as one of the most effective public health campaigns in the history of the PRC. It is widely viewed as an exemplary bottom-up health intervention, a patriotic mass mobilization that inspired the World Health Organization's Declaration on Primary Health in 1978 at Alma-Ata with its progressive vision of "Health for All."

Gross's Farewell to the God of Plague unsettles this conventional view and challenges assumptions about the unity and mass cooperation that Maoist primary health care relied upon in its disease-control campaigns. In the main, the book is concerned with a grassroots viewpoint. Drawing upon a wide range of primary sources, including a rich archive of newly accessible material from provincial and municipal archives, the book examines how villages and local cadres sabotaged Mao's intrusive deworming crusade and its efforts to regulate personal hygiene. The drivers of this resistance were complex and stemmed from a congeries of economic, political, and cultural factors. Among the most interesting questions that Gross asks is this: given the lack of support for Mao's anti-snail fever campaign on the part of Chinese villagers and rural cadres, how and why did it succeed? Or, as she formulates it in her introduction, how did the state manage to overcome "human, technical, and organizational challenges" to succeed at the local level?

Gross's answer to this key question is surprising. The campaign was effective, she contends, largely because of its promotion of treatment, rather than its prevention efforts geared to snail eradication and environmental sanitation. The emphasis in the existing literature has tended to be on the decentralization of health services that encouraged mass mobilization for prevention. In contrast, Gross argues that the crucial factors were grassroots science and a local leadership that enabled mass treatment.

The book focuses on three sites with very different geographies, demographics, disease distributions, and educational levels: Shanghai, which served as the national headquarters for the snail fever campaign, Qingpu, which became the test site for the campaign, and Yujiang in Jiangxi Province, with a predominantly rural population and a far less developed educational and health care infrastructure.

In tracing the intermeshing strands of the campaign—focused on education, prevention, and treatment—across these sites, Gross recasts the anti-snail fever war as a far more convoluted negotiation of interests than is usually recognized. She shows how the campaign was differently inflected in different places and at different stages. She argues that efforts to modify personal hygiene and sanitation behavior through a program of education...