Health consists of having the same diseases as one’s neighbors,” the English writer Quentin Crisp once quipped. He was right. And what is true of the individual seems to be true of societies as a whole. “Parasite stress,” as scientists term it, has long been a factor in human relations, intensifying the fear and loathing of other peoples.
For a while, it seemed that we had transcended all that. But, as Ebola reminds us, fundamental problems remain. No longer confined to remote rural locations, Ebola has become an urban disease and has spread uncontrollably in some western African nations, in the absence of effective healthcare.
Ebola has also revived the Victorian image of Africa as a dark continent teeming with disease. And the dread of Ebola is no longer confined to the West. Indeed, it tends to be more apparent throughout Asia than among Americans and Europeans. In August, Korean Air terminated its only direct flight to Africa due to Ebola concerns, never mind that the destination was nowhere near the affected region of the continent, but thousands of miles to the east in Nairobi. North Korea has also recently suspended visits from all foreign visitors – regardless of origin. Anxiety about Ebola is more acute in Asia because epidemics, poverty, and famine are well within living memory.
The roots of this mentality lie deep in our history. After humans mastered the rudiments of agriculture 12,000 years ago, they began to domesticate a greater variety of animals and came into contact with a wider range of infections. But this happened at different times in different places, and the resulting imbalance gave rise to the notion that some places were more dangerous than others.
Thus, when the disease we call syphilis was first encountered in Europe in the late 1490s, it was labelled the Neapolitan or French disease, depending on where one happened to live. And, when the same disease arrived in India, with Portuguese sailors, it was called firangi roga, or the disease of the Franks (a term synonymous with “European”). The influenza that spread around the world from 1889 to 90 was dubbed the “Russian Flu” (for no good reason) and the same was true of the “Spanish Flu” of 1918 to 19. It is safe to assume they were not called these names in Russia or Spain.
We are still inclined to think of epidemic disease as coming from somewhere else, brought to our doorstep by outsiders. Notions of infection first developed within a religious framework – pestilence came to be associated with vengeful deities who sought to punish transgressors or unbelievers. In the European plagues of 1347 to 51 (the “Black Death”), Jews were made scapegoats and killed in substantial numbers.
But the Black Death began a process whereby disease was gradually, albeit partially, secularized. With nearly half the population dead from plague, manpower was precious and many rulers attempted to preserve it, as well as to reduce the disorder that usually accompanied an epidemic. Disease became the trigger for new forms of intervention and social separation. Within states, it was the poor who came to be stigmatized as carriers of infection, on account of their supposedly unhygienic and ungodly habits.
Countries began to use the accusation of disease to blacken the reputation of rival nations and damage their trade. Quarantines and embargoes became a form of war by other means and were manipulated cynically, often pandering to popular prejudice. The threat of disease was frequently used to stigmatize immigrants and contain marginalized peoples. The actual numbers of immigrants turned away at inspection stations such as Ellis Island was relatively small but the emphasis placed on screening certain minorities helped shape public perceptions. During an epidemic of cholera in 1892, President Benjamin Harrison notoriously referred to immigrants as a “direct menace to public health,” singling out Russian Jews as a special danger.
But as the global economy matured constraints such as quarantine and embargoes became cumbersome. The panicky response to the re-emergence of plague in the 1890s, in cities such as Hong Kong, Bombay, Sydney and San Francisco, created enormous disruption. Trade came to a standstill and many businesses were destroyed. Great Britain and the United States proposed a different way of dealing with disease based less on stoppages and more on surveillance and selective intervention. Combined with sanitary reform in the world’s greatest ports, these measures were able to arrest epidemic diseases without disrupting commerce. The international sanitary agreements of the early 1900s marked a rare example of cooperation in a world otherwise fractured by imperial and national rivalries.
The present effort to contain Ebola will probably succeed now that more personnel and resources have been sent to the afflicted countries. But our long-term security depends on the development of a more robust global health infrastructure capable of pre-emptive strikes against emerging infections. If there is one positive thing to note about the reaction to Ebola it is that governments have responded, albeit belatedly, to growing public demand. A more inclusive, global identity appears to be emerging, with a substantially recalibrated understanding of our cross-border responsibilities in the realm of health. Whether this awareness and improvised crisis management translates into a long-lasting shift in how we tackle fast-spreading contagions remains an open question – a life-and-death one.
Mark Harrison is Professor of the History of Medicine and Director of the Wellcome Unit for the History of Medicine, Oxford University. He is author of Contagion: How Commerce has Spread Disease (Yale University Press, 2013). He wrote this for Zocalo Public Square.