Contagious: Cultures, Carriers, and the Outbreak Narrative (review)

In his famous Meditation XVII, consonantly named "Devotions Upon Emergent Occasions," John Donne argues, "No man is an island, entire of itself" and goes on to allegorize the essential community of all humankind. This stands in stark contrast to the isolationist view of lore taken of emerging infectious diseases since the Great Plague and has been the continuing model for maintaining the ideological, political, religious, cultural, and physical status quo of slowly etiolating communities since long before that. The evolutionary view, that communities evolve and are made stronger by change, whether by novel infectious agents, new genes, or new ideas, is discordant with that of the present-day individual, since it inevitably comes at the expense of the individual, whose selfish view, unlike that of evolution, is foreshortened by singular mortality rather than lengthened by a sense of community. This contradiction lies at the heart of the outbreak narrative, carefully explored at length in a timely analysis by Priscilla Wald.

This is undertaken from a humanist, rather than a scientific, perspective, although the author acknowledges the progress in science that has incrementally informed our changing understanding of contagion but not, evidently, our view of it. She makes the point that the familiar outbreak narrative is always used in the explanation and the approach to resolution of the threat of infectious disease, using media examples ranging from journalism to entertainment. Further, she shows that as it unites small communities (small in comparison to the global community) in fear against new disease, it also pits these communities against the nominal "stranger" bearing the new disease. In reportage, the focus almost always involves a personalized source as the (evil) enemy, ranging from the pathogen itself through individuals to minority populations and to entire countries. This both makes for better commercial copy than does dispassionate evaluation and politically unites the community in fear and fascination. The sharp focus on the small picture (science) by dint of the clever combination of scientific authority, money, and an arrogant assumption that has developed over the last century that humankind will prevail, is simpler, cheaper, and easier for politicians to address than the big picture, that of (world) humanity and global health policy, and it has the advantage of (usually) demonstrable hard milestones on the way to the goal of local eradication of disease.

Through objectifying the source/cause of outbreaks, rather than evaluating our responsibility as a part of a world community, the outbreak narrative focuses on blame, emphasizing the differences between communities rather than the similarities and capitalizing on our propensity for fear of unknown people and cultures when we should be educating ourselves about them. This in turn encourages us to close our borders (and with them, our minds) to alternative (i.e., worldwide) possibilities to address issues of emerging infectious disease. Politically, borders represent something we have control over, that we can be seen to be doing something about, by closing them. That national borders are meaningless in the case of pathogens (e.g., influenza) also spread by nonhuman agents, such as migratory birds, is conveniently ignored.

More broadly, it is difficult not to note the significant similarities in the outbreak narrative to the inward-looking initiatives that were mounted after 9/11 in place of the more outward-looking possibilities at the time—and to the Cold War, and even further back to parallels with the political and religious restriction of ideas before the invention of the printing press.

However, while our understanding of the outbreak narrative and the causes of "outbreak" have become more detailed with increasing knowledge, our fear of and fascination with outbreak has evidently undergone no such development. They have remained in the realms of amorphous religious and superstitious reflex, rooted in the village mentality, skilfully egged on by political (and commercial) interests, leading to relinquishment of logic and humanity.

The irony is that although the answers...