Epidemic
The term epidemic (from the Greek epi-, for “upon,” and -demos, for a populace as a political unit) is used in modern medicine to refer to outbreaks of infectious and noncommunicable diseases affecting human communities rather than just an individual or her and his immediate social environment. Epidemics have attracted analyses and commentaries concerning their social, political, and economic impact for millennia. Indeed, the emergence of history in classical Greece as a method for examining the past coincides with such approaches to epidemics, with Thucydides’s account of the “plague of Athens” being the first historical account of an epidemic and the first work to frame a disease outbreak in sociological and anthropological terms (Orwin 1988). In both medical and nonmedical narratives articulated in Europe since the initial iteration of the term in the Hippocratic Corpus, ideas around the “epidemic” became entangled with shifting aetiological and epistemological frameworks and with associated political, cosmological, and moral configurations of “plague” and “pestilence” (Gardner 2019; Slack 1992; F. Snowden 2020). At the same time, whether through exchange and translation or through conquest and colonization, European ideas about epidemics impacted and were in turn shaped by non-European frameworks of diseases affecting human communities, such as Wab_ā (Arabic) and _wenyi (Chinese) (Hanson 2011; Stearns 2011; Varlik 2015). At the end of the nineteenth century, bacteriology provided a new ontological framework for diseases that fostered an integration of medical approaches to epidemics in Western medicine and the propagation of the latter’s framing of epidemics across the globe within the context of colonialism (Latour 1988; Worboys 2000; Chakrabarti 2012).
From the early nineteenth century onward, epidemics came to be framed anew within the sphere of the humanities. Key to this approach to epidemics and its popular appeal was the development of the idea of the Black Death. As Faye Marie Getz (1991) has shown, the notion of the Black Death, used to describe the devastating plague epidemics of the fourteenth century, became fully expressed in the homonymous work of J. F. C. Hecker (1833), from which it became a concept of lasting impact to our days. The transformation of the 1346–53 plague outbreaks into the Black Death involved what Getz has described as a process of gothification that rendered plague into a manifestation of the forces of nature facing humanity and, at the same time, into a world-historical agent imbued with catastrophic properties. Historical reworkings of this thesis up until the midst of the twentieth century maintained various degrees of catastrophism (Coulton 1929; Creighton 1891; Gasquet 1893; Lipson 1929) or focused on presenting modern science’s triumph over infectious diseases (F. Hirst 1953; Zinsser 1935). The focus on discontinuity or the ability of epidemics to usher in radically new social, political, and economic realities was challenged by social, environmental, economic, and cultural histories of epidemics and epidemic control from the 1970s onward (e.g., Carmichael 1986; Brandt 1985; Crosby 1976; R. Evans 1987; Delaporte 1986; Charles Rosenberg 1989b). This led to more nuanced and increasingly theoretically engaged approaches to epidemics by historians as well as to systematic analyses of the ways in which diseases have led to or were impacted by global integration (e.g., Ladurie 1973; Hays 1998; McNeill [1976] 2010; Echenberg 2007). Emerging for the first time in the 1980s from the application of subaltern studies to the history of epidemics and their management in British India (Arnold 1993; Catanach 1988), postcolonial approaches have led to understandings of epidemics as a field for the development and imposition of colonial power as well as for indigenous resistance and innovation (e.g., W. Anderson 2006; Bhattacharya, Harrison, and Worboys 2005; Cueto 2001; Harrison 1999; Kelton 2015; Leung and Liang 2009; Lyons 1992; Mavhunga 2018; Packard 1989; Peckham 2016; Vaughan 1991).
Today the broad field of the medical humanities is informed by nuanced approaches to epidemics that integrate social, postcolonial, comparative, global, and micro- and biohistorical perspectives with anthropological, sociological, geographical, and cultural studies analyses of the social life of epidemics, as both events and ideas, across different sociocultural contexts. Critical medical anthropologists, sociologists, and political scientists, through their interest in the political economy and structural violence, have fostered nondeterministic understandings of the social drivers of epidemics (e.g., Chigudu 2020; Dingwall, Hoffman, and Staniland 2013; Inhorn and Brown 1990; Nguyen and Peschard 2003), most notably through the notion of the syndemic (M. Singer 2009b). At the same time, anthropologists have been active in the study of the way in which the management of epidemics, through prevention and containment, contributes to social inequalities and stigmatization (e.g., C. Briggs and Mantini-Briggs 2016; Farmer 1999a; A. Kelly, Keck, and Lynteris 2019) as well as in developing multispecies approaches to epidemics, especially as regards zoonotic and vector-borne diseases, in dialogue and in critique of emerging One Health perspectives in global health (Bardosh 2016; H. Brown and Nading 2019; Keck and Lynteris 2018). Geographers have in turn contributed nuanced analyses of the spatial aspects of epidemics, with an emphasis on architecture, planning, and the materialities of infection (Hinchliffe et al. 2016; Herring and Swedlund 2010). In the realm of cultural studies, epidemics have been approached both in and as culture. With what started as a focus on diseases as metaphors (Sontag 1989) and enriched by feminist studies, queer studies, and activist approaches to the AIDS/HIV pandemic (Crimp 1988, 2002; Haraway 1991; Martin 1995), cultural studies have focused on the representation of epidemics in novels, films, plays, and video games but also noncorporate cultural practices (e.g., Finkelstein 2020; Hernández 2019; Ostherr 2005; Schweitzer 2018) as well as epidemiology as cultural practice. Understood as based on and in turn promoting the actualization of “outbreak narratives” (Wald 2008), which are derived from synergies between science and the culture industry, epidemiology as cultural practice has been shown to establish contagion not simply as a metaphor but as a central model for understanding social relations and human interactions with the nonhuman world.
Multi- and interdisciplinary approaches to epidemics and epidemiology both within the humanities and the social sciences and in collaboration with the life sciences have led to analyses of both historical and actual epidemics that allow us to understand these as integrated biological and social phenomena but also develop new conceptual frameworks (Bourgeois 2002; Inhorn 1995; Packard and Epstein 1991; Trostle 2005). Nowhere has interdisciplinarity been more crucial than in the examination of pandemics. The notion of the pandemic, like that of the epidemic, emerged in the Hippocratic Corpus but, by contrast to the latter, was not extensively or systematically used before the end of the nineteenth century. Mark Harrison (2017) has argued that the concept was first systematically employed to describe the 1889–91 “Russian flu” pandemic. What, however, gave symbolic and epistemic coherence to the term and put it in common use across the globe was the coverage of the chain of outbreaks of bubonic plague between 1894 and 1959 known as the third plague pandemic. Narratives and visualizations of the outbreaks of plague in the late nineteenth century mobilized the notion of the Black Death in forging for the first time a lay experience of “the pandemic.” Representing even the slightest outbreak as a herald of a world-catastrophic event, they created what until today remains the interlaced temporality of pandemics: events that refer to a present phenomenon insofar as they describe a chain of global infection like COVID-19 but also one that is rendered meaningful and actionable only to the extent that it is seen in relation and comparison to icons of past pandemics (the Black Death, the “Spanish flu” of 1918–19) and their supposed world-historical, catastrophic potential.
As Carlo Caduff (2015) has argued, this means that, at least since the establishment of the emerging infectious diseases framework in the early 1990s (N. King 2004), the idea of the pandemic is always already linked to that of the “next pandemic,” the always deferred epidemiological event that will supposedly face humanity with a crisis of existential risk. Anthropologists have examined in detail how the notion of the “next pandemic” has brought into place biosecurity practices and regimes that have shifted attention away from prevention and toward preparedness (Lakoff 2017; Caduff 2015; Keck 2020; Samimian-Darash 2009). Involving a technoscientific array ranging from sentinels, syndromic surveillance, stockpiling, and culling, preparedness has also come to be seen as a doctrine that frames specific animal species as epidemic “rogues” or “villains” while also framing multispecies interactions (bush meat and wet markets in particular) as the ground zeros of pandemic risk (Bonwitt et al. 2018; Fairhead 2018; Fearnley 2020; Lynteris 2019a; Lynteris 2019b; Narat et al. 2017; N. Porter 2019; Zhan 2005).
The response from the medical humanities to the outbreak of COVID-19 and its management is nested within critical approaches of epidemiology, global health, and epidemic response and is crucially informed by engagements in recent epidemics, such as Ebola and Zika, where a range of scholars became involved both in providing expertise from a distance and in on-the-ground interventions, which have greatly contributed to the development of community-led approaches to epidemic control (P. Richards 2016). Moving away from previous practices of simply “translating culture,” emerging collaborative and interdisciplinary practices have sought to proceed through a critique of conceptual frameworks dominating epidemiology and global health as well as the structural inequalities in collaboration and the latter’s requirements of toning down conceptual and epistemological disparities, including the very definition of collaboration, in the context of epidemic emergencies (H. Brown and Kelly 2014; Elliot and Thomas 2017; Leach 2019; M. Singer 2009a).