Understanding the Politics of Pandemic Scares
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Auteurs : Mika AaltolaSource :
- Routledge studies in governance and public policy
Abstract
Reactions to pandemics are unlike any other global emergency; with an emphasis on withdrawal and containment of the sight of the infected. Dealing with the historical and conceptual background of diseases in politics and international relations, this volume investigates the global political reaction to pandemic scares. By evaluating anxiety and the political response to pandemics as a legitimisation of the modern state and its ability to protect its citizens from infectious disease, Understanding the Politics of Pandemic Scares examines the connection between international health governance and the emerging Western liberal world order. The case studies, including SARS, Bird Flu, and Swine Flu, provide an understanding of how the world order, global health governance and people's bodies interact to produce scares and panics. Aaltola introduces an innovative new concept of ‘politosomatics’ based on the relationship that links individual stress, strain, and fear with global circulations of power to evaluate the increasingly global bio-political environments in which pandemics exist. This book will be of interest to students and researchers of International Relations, Global Health, International Public Health and Global Health governance.
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DOI: 10.4324/9780203805732
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Dealing with the historical and conceptual background of diseases in politics and international relations, this volume investigates the global political reaction to pandemic scares. By evaluating anxiety and the political response to pandemics as a legitimisation of the modern state and its ability to protect its citizens from infectious disease, Understanding the Politics of Pandemic Scares examines the connection between international health governance and the emerging Western liberal world order. The case studies, including SARS, Bird Flu, and Swine Flu, provide an understanding of how the world order, global health governance and people's bodies interact to produce scares and panics. Aaltola introduces an innovative new concept of ‘politosomatics’ based on the relationship that links individual stress, strain, and fear with global circulations of power to evaluate the increasingly global bio-political environments in which pandemics exist. This book will be of interest to students and researchers of International Relations, Global Health, International Public Health and Global Health governance.</div></front></TEI><istex><corpusName>taylor-francis</corpusName><author><json:item><name>Mika Aaltola</name></json:item></author><arkIstex>ark:/67375/T1V-L5X0P30H-Q</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>N/A</json:string></originalGenre><abstract>Reactions to pandemics are unlike any other global emergency; with an emphasis on withdrawal and containment of the sight of the infected. Dealing with the historical and conceptual background of diseases in politics and international relations, this volume investigates the global political reaction to pandemic scares. By evaluating anxiety and the political response to pandemics as a legitimisation of the modern state and its ability to protect its citizens from infectious disease, Understanding the Politics of Pandemic Scares examines the connection between international health governance and the emerging Western liberal world order. The case studies, including SARS, Bird Flu, and Swine Flu, provide an understanding of how the world order, global health governance and people's bodies interact to produce scares and panics. Aaltola introduces an innovative new concept of ‘politosomatics’ based on the relationship that links individual stress, strain, and fear with global circulations of power to evaluate the increasingly global bio-political environments in which pandemics exist. This book will be of interest to students and researchers of International Relations, Global Health, International Public Health and Global Health governance.</abstract><qualityIndicators><score>9.148</score><pdfWordCount>96777</pdfWordCount><pdfCharCount>571483</pdfCharCount><pdfVersion>1.6</pdfVersion><pdfPageCount>217</pdfPageCount><pdfPageSize>442.201 x 663.307 pts</pdfPageSize><pdfWordsPerPage>446</pdfWordsPerPage><pdfText>true</pdfText><refBibsNative>true</refBibsNative><abstractWordCount>179</abstractWordCount><abstractCharCount>1255</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Understanding the Politics of Pandemic Scares</title><genre><json:string>book</json:string></genre><host><title>Understanding the Politics of Pandemic Scares</title><language><json:string>unknown</json:string></language><publicationDate>2012</publicationDate><copyrightDate>2012</copyrightDate><eisbn><json:string>9780203805732</json:string></eisbn><isbn><json:string>9780415603812</json:string></isbn><pages><first>1</first><last>174</last><total>216</total></pages><genre><json:string>book</json:string></genre><author><json:item><name>Mika Aaltola</name></json:item></author><subject><json:item><value>Routledge studies in governance and public policy</value></json:item></subject></host><ark><json:string>ark:/67375/T1V-L5X0P30H-Q</json:string></ark><publicationDate>2012</publicationDate><copyrightDate>2012</copyrightDate><doi><json:string>10.4324/9780203805732</json:string></doi><id>68CED98322EF8D37B61924E9E44E433E1B5E813A</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/ark:/67375/T1V-L5X0P30H-Q/fulltext.pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/ark:/67375/T1V-L5X0P30H-Q/bundle.zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/ark:/67375/T1V-L5X0P30H-Q/fulltext.tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main">Understanding the Politics of Pandemic Scares</title></titleStmt><editionStmt><edition>1</edition></editionStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://scientific-publisher.data.istex.fr/ark:/67375/H02-CR0WP21S-C">Taylor & Francis</publisher><publisher>Routledge - 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN</publisher><publisher>Routledge - 711 Third Avenue, New York, NY 10017</publisher><availability><licence><p>Taylor & Francis – ebooks</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-QGNTS49S-T">taylor-francis</p><p>© 2012 Mika Aaltola</p><p>2012</p><p>Mika Aaltola</p><p>Routledge is an imprint of the Taylor & Francis Group, an informa business</p><p>The right of Mika Aaltola to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.</p><p>All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.</p><p><hi rend="italic">Trademark notice</hi>: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.</p><p>A catalogue record for this book is available from the British Library</p><p>Aaltola, Mika.<lb></lb>Understanding the politics of pandemic scares : an introduction to global politosomatics/Mika Aaltola.<lb></lb>p. cm. – (Routledge studies in governance and public policy)<lb></lb>Includes bibliographical references and index.<lb></lb>1. Communicable diseases–Political aspects. 2. World politics–<lb></lb>Psychological aspects. 3. World health. 4. Health behavior. I. 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<p><bold>Mika Aaltola</bold> is Academy Fellow, The Finnish Institute of International Affairs, Finland.</p>
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<copyright-statement>© 2012 Mika Aaltola</copyright-statement>
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<imprint-text type="ImprintStatement">Routledge is an imprint of the Taylor & Francis Group, an informa business</imprint-text>
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<imprint-text type="ReproductionStatement">All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.</imprint-text>
<imprint-text type="TrademarkNotice"><italic>Trademark notice</italic>: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.</imprint-text>
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<imprint-text type="CIP">Aaltola, Mika.<break></break>Understanding the politics of pandemic scares : an introduction to global politosomatics/Mika Aaltola.<break></break>p. cm. – (Routledge studies in governance and public policy)<break></break>Includes bibliographical references and index.<break></break>1. Communicable diseases–Political aspects. 2. World politics–<break></break>Psychological aspects. 3. World health. 4. Health behavior. I. Title.<break></break>RA643.A175 2011<break></break>616.9–dc22 2011006694</imprint-text>
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<p>Reactions to pandemics are unlike any other global emergency; with an emphasis on withdrawal and containment of the sight of the infected. Dealing with the historical and conceptual background of diseases in politics and international relations, this volume investigates the global political reaction to pandemic scares.</p>
<p>By evaluating anxiety and the political response to pandemics as a legitimisation of the modern state and its ability to protect its citizens from infectious disease, <italic>Understanding the Politics of Pandemic Scares</italic> examines the connection between international health governance and the emerging Western liberal world order. The case studies, including SARS, Bird Flu, and Swine Flu, provide an understanding of how the world order, global health governance and people's bodies interact to produce scares and panics. Aaltola introduces an innovative new concept of ‘politosomatics’ based on the relationship that links individual stress, strain, and fear with global circulations of power to evaluate the increasingly global bio-political environments in which pandemics exist.</p>
<p>This book will be of interest to students and researchers of International Relations, Global Health, International Public Health and Global Health governance.</p>
</abstract>
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<sec sec-type="abbreviations">
<title><xref ref-type="page" id="page_viii"></xref>Abbreviations</title>
<def-list>
<def-item><term>9/11</term><def><p>11 September 2001, the day when several terrorist attacks took place in the US, including the bombing of the World Trade Centre's twin towers in New York City</p></def></def-item>
<def-item><term>AIDS</term><def><p>Acquired Immune Deficiency Syndrome</p></def></def-item>
<def-item><term>BSE</term><def><p>Bovine Spongiform Encephalopathy</p></def></def-item>
<def-item><term>CDC</term><def><p>Centers for Disease Control and Prevention</p></def></def-item>
<def-item><term>CJD</term><def><p>Creutzfeldt-Jakob Disease</p></def></def-item>
<def-item><term>CNN</term><def><p>Cable News Network</p></def></def-item>
<def-item><term>EC</term><def><p>European Commission</p></def></def-item>
<def-item><term>EU</term><def><p>European Union</p></def></def-item>
<def-item><term>FAO</term><def><p>Food and Agriculture Organization</p></def></def-item>
<def-item><term>HIV</term><def><p>Human Immunodeficiency Virus</p></def></def-item>
<def-item><term>PEPFAR</term><def><p>President's Emergency Plan For AIDS Relief</p></def></def-item>
<def-item><term>SARS</term><def><p>Severe Acute Respiratory Syndrome</p></def></def-item>
<def-item><term>TSE</term><def><p>Transmissible Spongiform Encephalopathy</p></def></def-item>
<def-item><term>UK</term><def><p>United Kingdom</p></def></def-item>
<def-item><term>UN</term><def><p>United Nations</p></def></def-item>
<def-item><term>US</term><def><p>United States of America</p></def></def-item>
<def-item><term>vCJD</term><def><p>Variant Creutzfeldt–Jakob Disease</p></def></def-item>
<def-item><term>WHO</term><def><p>World Health Organization</p></def></def-item>
<def-item><term>WMDs</term><def><p>Weapons of Mass Destruction</p></def></def-item>
</def-list>
</sec>
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<body>
<book-part book-part-type="chapter" book-part-number="1" id="chapter1">
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<title><xref ref-type="page" id="page_1"></xref>Introduction</title>
<alt-title alt-title-type="running-head">Introduction</alt-title>
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<body>
<disp-quote>
<p>Diseases desperate grown</p>
<p>By desperate appliances are relieved,</p>
<p>Or not at all.</p>
<attrib>Shakespeare, <italic>Hamlet</italic></attrib>
</disp-quote>
<p>In emergencies, the prevailing global sentiment is often one of mobilized empathy. The sight of a starving child in Africa may lead to a sense of compassion and the need to rush in to intervene on behalf of this distant sufferer (<xref ref-type="bibr" rid="ref006">Aaltola 2009</xref>). Highly rehearsed ritualistic donor behaviour and rescue efforts may follow. Yet, the sight of the dead and suffering swine fu victims in Mexico in the spring of 2009 led to a sudden global jolt of aversion and fear. The immediate global reflex – a similar reaction to the emergence of those infected by other perceived pandemics – was that of distancing and severing contacts with the site of the unfamiliar and deadly disease outbreak.<xref ref-type="fn" rid="fn1_1"><sup>1</sup></xref> The momentum of pandemic emergencies is towards disengagement with the suffering distant other. It is one of containment, rather than compassion. In this sense, a pandemic's affective flows are unlike other global emergencies – they are seemingly non-compassionate rushes towards withdrawal and to contain the disease in a certain place, spot or ‘zone’. If there is other-interestedness, it is towards the people living close by or towards the ‘general public’, conceived of in terms of national, international and global public health.</p>
<p>These acute global relationships of worried containment shed light on the power-related dynamics of pandemic scares. In this work, I will use the term ‘politisomatics’ (i.e. ‘politico-somatics’) in reference to how lived life individual somatic-level anxieties couple with the hierarchical interconnectedness of the global polity. Politico-somatic relationships interlink the global hierarchy's differential spread of risk – the inequalities in the disease burden together with associated imbalances of wealth and power – with individuals' fears of bodily harm.<xref ref-type="fn" rid="fn1_2"><sup>2</sup></xref> In this context, the world order translates into a configuration of differentially exposed bodies, which, in turn, causes stress and anxiety and leads to market panic, races to develop vaccines, fear of public spaces, wearing of masks, changing social expressions, and other types of disease-related ritualistic
<xref ref-type="page" id="page_2"></xref>
behaviour. The more encompassing political ‘bodies’, such as states or the world order itself, can also be felt as being under pressure and duress. People often sense their wider surroundings and their world as embodiments with which they identify in varying ways and on behalf of which they worry. They feel the world's pains and, as a result, these wider embodiments may turn into bodies in pain. And, it can be suggested, these world related pains have long cultural histories that condition our contemporary sensitivities, as, for example, when it comes to regressive processes and ‘fatal blows’ such as lethal epidemic diseases. These imageries of regressive circulations and flows cannot be anything but intense. Their bangs lead to expectations of corresponding pain in other less expansive bodies, such as individuals' bodies. In this way, actual and feared political pain may become somatized with the result that it is possible to speak about politico-somatics in much the same way as it is possible to discuss psychosomatic or socio-somatic disorders.<xref ref-type="fn" rid="fn1_3"><sup>3</sup></xref></p>
<p>Diseases exist, flourish and die in wider than physical environments, where they adapt to local memories, practices and cultures. For example, the communal responses to avian fu were commonly based on the practical logic developed on the basis of existing stereotypes, media representations, government information campaigns and popular rumours (<xref ref-type="bibr" rid="ref203">Padmawati and Nichter 2008</xref>: 31). Moreover, diseases are embedded in and violently react with the fabric of political power. In this process of mutual adaptation, the responses to diseases inevitably turn into signifiers of the underlying patterns of power. For example, in the early 1980s, the Soviet authorities insisted that HIV was the outcome of an American military experiment that had gone terribly wrong (<xref ref-type="bibr" rid="ref197">Nelkin and Gilman 1991</xref>: 39). The purpose could have been to point out that the United States of America (the US) was a vicious and underhanded superpower that should not be trusted. Moreover, for the Soviet Union, the HIV and AIDS epidemic offered an opportunity to point out that it was AIDS-free because it had no ‘degenerate’ and ‘corrupted’ homosexual elements. However, HIV and AIDS never became a very potent propaganda weapon, partly because it could be externalized into ‘undesirable’ internal elements such as homosexuals, prostitutes and recreational drug users. In other words, many people in the West connected the disease with the ‘unnatural’ gay community, rather than with the general ‘corruptness’ of Western societies. HIV and AIDS were also used effectively by the American neo-conservative movement at the beginning of the 1980s to promote its own message about family values and the need for religious revival in the US (<xref ref-type="bibr" rid="ref005">Aaltola 2008</xref>: 67). It may be further argued that the public meaning of suffering from HIV and AIDS changed the expressive pain behaviour of those who had the syndrome. Their suffering was stigmatized and used for political purposes. The fact that the suffering became more silent was in itself a politico-somatic phenomenon. HIV and AIDS, like many pandemic diseases before and after it, reacted with the prevailing perceptions of power, hostility and enmity. People tend to decipher the world through them and the world tends to give meaning to diseases. Pandemics seem to forcefully register the world of hostility as well as the world's hostility (<xref ref-type="bibr" rid="ref260">Tuan 1979</xref>: 87).</p>
<p><xref ref-type="page" id="page_3"></xref>In the case of pandemics, the power-political embeddings are increasingly global. However, in most studies on lethal epidemic diseases, this macro-level political aspect is missing or only implicitly recognized. There are a few notable studies that have focused on the power aspect of pandemics and researched how public health has interacted with conquest and governance (<xref ref-type="bibr" rid="ref186">McNeill 1976</xref>; <xref ref-type="bibr" rid="ref214">Price-Smith 2009</xref>; <xref ref-type="bibr" rid="ref205">Panisset 2000</xref>). Contrary to the overall overlooking of power and politics, I will chart pandemic diseases and their scares as being inherently power related (<xref ref-type="bibr" rid="ref001">Aaltola 1999a</xref>, <xref ref-type="bibr" rid="ref002">1999b</xref>, <xref ref-type="bibr" rid="ref003">2005a</xref>). I will use the term ‘politico-somatics’ to describe how the constitution and interaction of different embodiments – ranging from the wider political embodiments to the somatic ones – are shaped by macro-level political processes. Political imageries can be deeply integrated into the understanding and awareness of the body. The direct impact of the political context on the various kinds of disease experience and on the practices of pain-expressing behaviour is to be expected. Disease, as a socially interpreted physical and physiological process, is fundamentally shaped by prevailing political culture and practices. In this way, pandemic scares can be identified as polysemous, yet forceful, idioms of distress and anxiety. By using politico-somatics as an analytical concept I will explore how these disease-related hyperbolic and widespread experiences of fear are linked to global power structures, which differentially expose bodies to various risk factors. While the prevailing and underlying political anxieties may be projected into interpretations of pandemic diseases, the opposite is equally likely: the emergence of acute pandemic emergencies reinforces the corresponding imageries of both declining and reviving political power. I will draw from disease-related memories and histories to show how these politico-somatic interactions are supported by traditions of political theory and thought that are still under research.</p>
<p>It can be argued that the recent pandemic scares may be regarded as ‘politico-somatic disorders’. It has been widely recognized that ‘disease behaviour’ – that is, how people express their fear of diseases – is influenced by factors other than physiological ones. For example, people react differently to pain and death in a way that reflects their ‘learning history, socialization, and cultural predisposition to behave in certain ways in particular circumstances’ (<xref ref-type="bibr" rid="ref039">Chapman and Wyckoff 1981</xref>: 35).<xref ref-type="fn" rid="fn1_4"><sup>4</sup></xref> Moreover, this relationship is often perceived as complex and en tangled with ‘cultural, psychological, and physiological factors’ (<xref ref-type="bibr" rid="ref026">Bever 2000</xref>: 581). However, studies on pain behaviour invariably fail to appreciate our political embodiments, their wider interrelatedness, and the associated grammars of politically expressible pain. The politics of bodily suffering, pain and death has two main dimensions. First, physical suffering is a highly iconic and readable part of disease as well as of different forms of political violence. Second, there exists a long tradition in which political bodies – such as societies, communities, empires, states, nations and humanity – have been seen as ‘subjects’ of suffering. In the case of pandemic diseases, which often provoke the image of much hyped ‘blows against civilization’, both the somatic and political embodiments can be seen as suffering and the expressive language of these sufferings can be
<xref ref-type="page" id="page_4"></xref>
Connected. Politico-somatics is a bridging concept in discerning the nexus between the different forms of ‘bodily’ pain.</p>
<p><xref ref-type="bibr" rid="ref243">Susan Sontag (1988)</xref> noted that all attention-catching diseases were always ideally comprehensible entities in their own time. They served to crystallize epochal individual and political fears. I will use this insight to claim that the reason pandemic scares become so ‘scary’ stems from the prevailing declinist imageries and from other historically conditioned political sensibilities, insecurities and vulnerabilities. The present pandemic scares and, very importantly, the silence of pandemics that do not catch public attention are intimately connected with the contemporary construction of crises and threats in global politics. The politico-somatic perspective links the recent phenomenon of pandemic scares to the imageries of political decline and regression of the prevailing world order as a hegemonic embodiment. The central theme in these imageries is that the interaction between different perceived crisis factors and dynamics – as, for example, global warming, the amassing of weapons of mass destruction (WMDs), collapsing public health, economic turbulence, and changing demographics – will further induce the likelihood of eruptions of perceived emergencies and catastrophes. The related uncanny anxiety creates a political context pregnant with anticipation of different imageries of coming bodily discomfort. Such declinist crisis imageries also make the time ripe for perceptions of pandemic emergencies. Furthermore, the appearance of other forms of emergency, especially large-scale wars, heightens still further the expectation of pandemic spectacles. Pandemic scares can be seen as symptomatic of the underlying political power worries. Thus, they embody many fears that stem from visible stress on the existing world order. This world order has been able to provide specific forms of bodily comfort. The blow by a pandemic plague is a major way of imagining and embodying the possible unmaking of this bodily comfort. Thus, the added value of the politico-somatic approach stems from the ability to understand the nexus between macro-level political processes and disease imageries.</p>
<p>The world order, as a hierarchical hegemonic political embodiment, causes incongruence with the more or less peripheral local, national and state embodiments. These conflicts and contestations reflect, in turn, on the individual somatic bodies caught in the middle. All this finds an expression in the ritualistic nuances and entanglements of pandemic scares. Outside of the West, many just suffer, expressing their misery through their local iconic pain language, which does not come under the global public gaze if there is no sense of an uncontained contagion. In other words, pandemics, as embodiments of feared ‘dis-eases’, are reflective of the underlying power flows and circulations in the prevailing human polity. In this sense, the specific forms of pandemic scares reveal the underlying political dynamics. Figuratively speaking, lethal epidemic diseases provide an X-ray of their embeddings (<xref ref-type="bibr" rid="ref119">Herdt 1992</xref>: 8). This resonates well with Sontag's notion that all attention-catching diseases are always ideally comprehensible entities in their own time: they fit their political surroundings, as their alarming nature is constructed from the prevailing declinist fears and from other historically conditioned political sensibilities, insecurities and vulnerabilities <xref ref-type="page" id="page_5"></xref>(<xref ref-type="bibr" rid="ref263">Ungar 1998</xref>: 37). This book examines the overall politico-somatic dynamics of pandemic scares. What are their common tendencies? What do they reveal, and how is that linked to their production and staging? How do political concerns shape the emergence of lethal epidemic diseases? The answers to these questions are based on rediscovering some of the central proto-political myths involved as well as on illustrating how they shape present-day pandemic scares.</p>
<p>The most recent pandemics (Ebola, BSE, SARS, avian flu, and swine flu) have been more like duds – scares with relatively few deaths or low mortality – than feared civilizational blows. However, the spectacular and hyperbolic pandemic scares are themselves worthy of critical examination. Their imageries are so interwoven with the fabric of global politics that, by studying them, crucial knowledge can be gained concerning how power and legitimacy are created through hyperbolized somatic threats. It should be noted that power embedded politico-somatic pains and anxieties can lead to a sense of relief and restored normalcy. The sentiments of fear, anxiety and scare are converted into opportunities for legitimizing power spectacles branded as ‘effective health governance’ till the hyped devastating blow is once again averted and the scare subsides. It can be suggested that disease fears and scares are among the main ways in which the globalizing world is felt and sensed. I will use the dynamics of politicosomatics to illustrate these power-related pandemic sensations and emotions. The phenomenon of politico-somatics allows for a more comprehensive and critical evaluation of how pandemic scares are much more substantive parts of the global experience than would first appear. Pandemic scares are regarded as politico-somatic disorders that link individual level stresses, strains and fears with global circulations of power, and with the global and local polity's production of legitimacy. While examining their underlying dynamics, this book provides an overview and history of recent politico-somatic pandemic scares.</p>
<p>The focus of this book is on the politico-somatic dynamics of recent pandemic scares, which ‘suddenly burst forth in a catastrophic manner’ (<xref ref-type="bibr" rid="ref154">Kilbourne 2009</xref>: 218). The diseases in themselves, as physical phenomena, largely fall outside the scope of this work. The emphasis is on how diseases are interpreted in their social and political contexts and how these interpretative constructs interact with perceived sudden pandemic emergencies. The pandemic scares are defined by hyperbolic attention, which, in hindsight, appears to be ‘grossly disproportional in relation to its low mortality rate’ (<xref ref-type="bibr" rid="ref035">Caballero 2005</xref>: 483). The status of recent pandemic emergencies as ‘scares’ does not detract from their significance. On the contrary, pandemic scares are highly significant situations that highlight the intensively embodied ways in which global politics is inherently glued on to individual bodies. On the one hand, pandemic scares can be seen as bringing the global reaches closer to human bodies in that they contain medicalized topologies of power. Fears and anxieties connected with the circulation of disease agents are always non-abstract. They are deeply felt. People sense their globalized surroundings, thereby creating points of attachment for relevant understanding of their own ‘locatedness’ in the interconnected global embed-dings. Waking up to a world that is experiencing a mysterious disease said to be
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extremely serious and deadly, instantiates a relationship of worry that is bound to have a more than fleeting influence. Through them, people re-remember the high personal stakes involved in the global polity. On the other hand, this interface allows for highly meaningful re-enactments of power, which are seen as highly pertinent to the present circumstances faced by differentially situated individuals. Because these connections to a part have been instantiated just then, they appear to be still murky and ill-defined. They are explicated at the level of abstract public health knowledge. Yet, at the same time, the themes involved – that of plague and people – are ancient. Only the scale has changed and much of the old ‘disease frame’ has been forgotten because of the triumphant claims in the mid-twentieth century that the era of major lethal epidemics was over. The recent pandemic scares reactivate and rearticulate the older and almost instinctive registers of making the interconnectedness and inter-locality of people relevant. The use of the term, politico-somatics, involves an effort to explicate the silent knowledge involved in the disease–politics nexus.</p>
<p>This work is fundamentally about bodily pain, fears of it, and about the pain conducting links between differently embodied kinds of suffering. My main concern is with how pandemic diseases are seen as inflicting bodies of different qualities, both somatic and political. Besides being abstract, the study of politics can be seen as embodied. Its main subject has been the various political bodies – yours, mine, and ours. It has strived to understand also more encompassing embodiments such as polis, state, world and, now, globality. Often, without being aware of it, the corpus of political knowledge has charted the sensual entanglements through which these bodies interact and feel each other. The central conceptual configurations have tried to understand the violence between the bodies as well as to come to terms with the internal violent conflicts of contesting and failing bodies. Much of modernist research energies have focused on the way in which political bodies are constituted and built – that is, on progressive narratives. At the same time, the shadow of the intense regressive processes of decomposition still looms large over the ways in which the world is sensed. Against the background of the unravelling of the modernist progressive paradigm, the central research interest is on how the narrower and larger of our political bodies can become entangled in mutual regression. Politico-somatics entails an awareness of the interrelated nature of embodiments. The pulses of political shivers, pains and convulsions travel through the political fabric, which echoes worries over interrelatedness. These pulses build up and are felt in seemingly disparate ways on different ‘skins’ of the wider and narrower ‘bodies.’</p>
<p>Thus, politico-somatic intimacy involves sensing the world's pains on one's body. The two most distant embodiments – that is, individual bodies and world order – come into direct contact in pandemics and their scares. As a child growing up during the 1980s, I remember when the worst case scenario consisted of a nuclear holocaust. <xref ref-type="bibr" rid="ref212">Posner (2004</xref>: 71) aptly states that ‘during the half century of the cold war …, the catastrophic risk that attracted the most attention was that of a nuclear and a thermonuclear war.’ Imagining what a nuclear holocaust would mean sent shivers down the spine of the young boy that I was.
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It was felt bodily in sweating and nightmares. The worst case scenarios of more recent times have focused on pandemic diseases. Many people, young and old, feel them. Pandemic scenarios have become more ideally comprehensible about our times than the scenes of nuclear war. Pandemics ft their political power surroundings and their alarming nature is sculptured from the prevailing sensibilities concerning what might go wrong. These bodily felt world order anxieties are also involved in the recent pandemic diseases enabled by the ancient sediments of memories written in the language of bodily disfigurement and suffering. An individual nested in and enabled by the world must have near instinctual sense of the power dynamics which enable large-scale disasters.</p>
<p>Turning to the theoretical framework of this book, I remember reading with keen interest <xref ref-type="bibr" rid="ref230">Elaine Scarry's 1987</xref> book, <italic>The Body in Pain</italic>, while lecturing at the University of Minnesota on the nexus between lethal epidemic diseases and world politics during the spring of 2008. In it, I saw many bridgeheads to the politics of pain. As one can imagine, Scarry's work was full of morbidity: the words and many visuals in it described a world of contorted and convulsing human bodies, vivid images of agony, and a masterful account of the unmaking of bodies through the processes of torture and war. The intensity of the pain language brought to my mind the classical account of war, Thucydides' <italic>History of the Peloponnesian War</italic>. For Thucydides (<italic>c.</italic>460 BC–<italic>c.</italic>395 BC ), the deepening and widening vortex of macro-level war induced pulses and co-currents. These emerging sub-currents occurred in the vicinity of the war's rhythmic expression of regressive energy. The increasingly violent circular motions meant that intervals in extreme pain production became progressively shorter: violence kept coming back, cutting across and within bodies in increasingly intense spirals, circling round and back, again and again. The drama that Thucydides describes spreads from the inter-poleis level to local slaughters and to that unforgettable sub-current of war, the Plague of Athens. The holistic nature of Thucydides' work, which covers the macro, local and individual levels, might be better understood through a comparison with how he might have approached contemporary times: the wars fought by the hegemonic power, the US – such as in Iraq and Afghanistan – open a context where individuals' disease-related fears – those of SARS, avian flu and swine flu – can be interpreted as sub-manifestations of the overall dynamics of terror and war in our world. In the same way, the failure of local states and communities from Somalia and Darfur to Afghanistan may be interpreted as symptoms of an underlying wider regressive flow. The crisis at the individual, communal and world levels spill over and result in complex entanglements, the true nature of which cannot be discerned with the customary disciplinary bracketing of the contemporary era.</p>
<p>Thucydides' narrative of the Plague of Athens may be read as a story of how disease causes a political community to regress in the same way as external and internal wars. Moreover, Thucydides' prototypical narrative contextualizes the plague in the wider dynamics of the hegemonic war. He seems to hint that disease is an expected part of a wider violent power struggle. The widening and deepening vortexes of war are a dynamic that engulfs individual polities through
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extreme communal violence and individual bodies through plagues and famines. This nexus between wars and diseases also leads to corresponding expectations and fears for one in the presence of the other. This is a powerful associative tradition. I will further examine the hypothesis that wars provide for a context ripe for the emergence of disease in <xref ref-type="book-part" rid="chapter3">chapter 3</xref>, ‘Understanding the Vortex of War and Disease’. As said before, this connection has a deep cultural history. For example, it is often said that before World War I, more people died because of disease in the context of war than because of actual fighting. Another example is provided by the so-called Spanish Influenza during and immediately after World War I. The war provided the context for the disease through large-scale troop movements. However, besides providing the physical context ripe for a disease, the war heightened the sense of an especially serious disease. To a degree, it was because of the war that the disease was seen as significant. It heightened the sense that political enmities were so deep that they produced a disease, thereby feeding the enemy images. This link could be seen in the use of the disease in the war propaganda of the time (<italic>See <xref ref-type="book-part" rid="chapter6">chapter 6</xref>, ‘The pandemic geography of Avian Flu’</italic>). In <xref ref-type="book-part" rid="chapter4">chapter 4</xref>, ‘Trajectory of a pandemic drama: ebbing and waning of the BSE Crisis in 1996’, I will examine more closely how the BSE scare could be linked to the affective climate created by the War on Terror and the war in Iraq.</p>
<p>Scarry's multidimensional argument was about the unmaking of an individual's world. For Scarry, the painful unmaking refers to a flow of events in which the supporting constructions of everyday life become radically undone.<xref ref-type="fn" rid="fn1_5"><sup>5</sup></xref>Her central notion was that fears of pain and anxiety motivate the making of things in a process of world making. These supporting constructs and architectures become, so to speak, ‘pain relievers’ and ‘pain killers’. They ease the burden of pain by containing some of the burden and moving it onto external supporting and comforting ‘objects’. Thus, troubled by gravity, human beings have created technologies to support their bodies. Troubled by subsistence, they have created organized communities. Troubled by war, famine and disease, they have built states. These supporting constructions, in their turn, reinvent what being human means with inherent liberties and constraints. In this way, relieving pain becomes an important political motivation: a reason for any political architecture is partly to remove discomfort, to relieve pain, and to produce security and the absence of ‘dis-ease’. In other words, a state can be regarded as an object, a political architecture, aimed at relieving particular types of aches and pains. The state, as a made artefact, becomes dependent on the underlying bodily discomfort it aims to relieve. Extending beyond the state, any political order legitimizes its existence through the absence of a particular type of bodily harm, as, for example, terrorism, torture or disease. From such a perspective, the state relieves more territorially bound discomforts, whereas global governance structures relieve other more de-territorial types of pains, such as pandemics, which have notably been constructed as mutating and penetrating political borders.</p>
<p>At the same time, embedded in such a pain relieving context, the absence of bodily pain gets its second order dynamics. Individual bodies become inherently
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linked with and integrated into wider social and political embodiments. Any movements in these embodiments are directly translated into the underlying anxieties concerning bodily pain. In the same way as the anxious awareness that one is lacking a vital medicine creates ominous expectations and fears, the perception that global structures are lacking can lead to fears at the level of somatic security. An argument can be made that this dynamic of worry is fundamental to the recent spectacles that have been termed pandemic scares. Imageries of political disorder are implicated when it comes to the perceived sources of bodily harm. Bodily comfort becomes identified with the existence of political structures and political bodies. Moreover, the ‘suffering’ of these pain relieving bodies becomes synonymous with the acute possibility of somatic physical suffering. This offers one way of understanding the political function of recurring pandemic scares. They create a demand for particular types of governance systems seemingly able to match the challenge of a mutating disease agent, which is able to penetrate natural and political boundaries. In a way, pandemics may have their uses because they address basic bodily needs. The dramatic form of a pandemic scare might offer ways of connecting with people's fears in answering key questions: ‘[w]hat and how pain means, how such meaning can be embodied, how such embodiment can be dramatized, and how such dramatizations can be put to use and made meaningful in a variety of contexts’ (<xref ref-type="bibr" rid="ref012">Allard and Mathew 2009</xref>).</p>
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<title>Theoretical approach: embodied knowledge</title>
<p>The politico-somatic perspective draws from a nexus between somatic sensations and power structures mediated by power sensitive emotional characteristics. It is clear that this framework has to draw theoretical and methodological support from models that take into account the embodied aspect of knowledge. In order to understand how the different modalities of knowledge link together, the recent ‘re-challenge’ of the mechanistic and simplified assumptions concerning the primacy of abstract knowledge in social theory offers a useful bridgehead (<xref ref-type="bibr" rid="ref285">Zerubavel 1997</xref>; <xref ref-type="bibr" rid="ref070">DiMaggio 2002</xref>; <xref ref-type="bibr" rid="ref134">Ignatow 2007</xref>). This critique has led to the development of models that integrate the abstract modality of knowledge with other modalities such as emotional, motor and sensory qualities (<xref ref-type="bibr" rid="ref022">Barsalou 1999</xref>). The emphasis is not on knowing something abstractly and intellectually, but on seeing, feeling and sensing the world. The focus has been on comprehensibly blending other relevant modalities with abstract models. In this way, the abstract topologies – such as systems, grids, diagrams, trees, and hub and spoke models – are embedded in other more felt and sensed modalities such as power, emotions and movement. The need to expand beyond elegant yet hopelessly simplified amodal schemas has been noted, for example, by the research approach basis of the so-called cultural models. These are positioned as embodied intermediaries that fuse abstract thinking with perceptual motor and sensory experiences (<xref ref-type="bibr" rid="ref134">Ignatow 2007</xref>: 124). These more encompassing proposition scenarios capture the core relationships between the key objects and contain emotionally
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charged ‘image schemas’ of the possible interactions between the primary objects of a particular scenario dependent object world (<xref ref-type="bibr" rid="ref057">D'Andrade 1987</xref>; <xref ref-type="bibr" rid="ref161">Lakoff and Kövecses 1987</xref>).</p>
<p>Thus, ‘disease’ and its derivative, ‘pandemic’, can be seen as providing an overall embodied image schematic, a disease object world. Its processes of contagion and spread provide for the understanding of the dynamic interactions between the key objects – ‘I’ extends to ‘we’ and both stand in opposition to ‘them’ and ‘a foreign element’ through a sense of contagion. The object world of a contagious disease is highly embodied because it has been experienced in some way by all. These embodied scenarios of disease involve deeply personal struggles while being inflicted by a serious illness. Most know how diseases limit personal agency within economic, social and political embeddings, which set the possibilities and limits as people struggle to manage their daily lives while sick. The conflicted disease subjectivities and the vicissitudes of their adaptive strategies are deeply felt as people renegotiate their positions within their surroundings. The modalities of this disease object world are, thus, anything but abstract. Emotions of pain and anxiety colour – and marry with – the underlying cognitions and cultural beliefs. The expressed pain behaviour becomes a register of self-and other-knowledge as one navigates the course of an illness (<xref ref-type="bibr" rid="ref206">Parish 2008</xref>). Often, at one point or another, a person becomes dependent on his social safety nets, on authorities, and on medication. In this way, the object world of disease contains the emotions of comfort, compassion and containment as well as fears of exclusion, isolation and aloneness. These emotions are tightly connected with the reconstruction of one's sense of the underlying fabric of social interaction. Through a disease, one becomes aware of the complexities of individuality, family, society, economy, medicine and politics in ways that are hard to express in terms of amodal abstractness.</p>
<p>It can be argued that the highly embodied disease model is readily projectable onto the more encompassing spatio-temporal models concerning the wider surroundings, ranging from the immediate to encompassing notions such as ‘world’, ‘global’ and ‘humanity’. In this way, the world can become embodied through it starting to exhibit disease characteristics. This projection provides the framework for the ‘enactualization’ of global politico-somatics when deeply personal disease experiences blend with the ‘disease,’ affecting these wider conceptual ‘bodies.’ In this connection, it is important to note the power of the disease object world – that is, disease proposition schemas – to contain visually and emotionally charged ‘pictures’ of the dynamic interactions between the key objects (<xref ref-type="bibr" rid="ref161">Lakoff and Kövecses 1987</xref>). Disease heuristic scenarios provide a core relational structure. This structure allows for the embodied interpreting of events in more abstract domains by importing them by analogy from a tangibly concrete realm (<xref ref-type="bibr" rid="ref028">Boroditsky 2000</xref>: 3). Such projected disease scenarios of situated knowledge contain kinaesthetic meanings – that is, spread and contagion – associated with the dynamically changing relationships between key embodied objects. Who are those around me possible endangering me or to whom I might give the disease? How does it feel to get an infection? Should I touch door
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handles or press elevator bottoms? Must I stay home? Can I shake hands and should I be careful when sneezing? The mental projections of this lived life object world into different scenarios existing in the physical, social and political realms are what are at stake in embodied knowledge. The projections of the disease object world's dynamics are omnipresent in our times. While I am writing this, I have been reading newspaper accounts of the fears of adverse economic contagion believed to be spreading from the peripheral Euro zone economies to those in the centre. Without probably being aware of it, <xref ref-type="bibr" rid="ref237">Skillen (2001)</xref> provides an unusually explicit example of how the disease object world can guide the understanding of political level developments:
<disp-quote>
<p>The purpose of surgery on cancerous cells is to remove danger to an otherwise healthy body. However, many political bodies around the world, including those in Afghanistan and a number of other countries, are not healthy. The terrorist cells feed on those unhealthy political bodies. A sharply focused campaign to rid the world of terrorist cells will not by itself help to create or strengthen the healthy states that are needed.</p>
</disp-quote></p>
<p>That said, the projection of diseases onto the world also changes the way in which diseases are felt in private life. The severity, for example, of contagion is continuously being re-imagined and reinvented when it is seen as afflicting different social and political bodies.</p>
<p>The object world of diseases is often used in politics. The kinaesthetic processes involved in the disease object world are used in making sense of things getting out of control and decelerations of spread. The dynamic kinaesthetics are central to the modern understanding of power-political processes and flows. Broadly speaking, the term, ‘contagion’, is used in reference to the idea that political violence – for example, external or internal wars – in one region or state influences the possibility of violence in another region or state (<xref ref-type="bibr" rid="ref172">Li and Thompson 1975</xref>: 63). Political violence and its sub-categories, such as war and terrorism, are often treated in terms of a disease (<xref ref-type="bibr" rid="ref245">Spilerman 1970</xref>; <xref ref-type="bibr" rid="ref284">Zartman 1995</xref>: 9). There are numerous examples equating extreme political violence with disease like a regressive process. Most and <xref ref-type="bibr" rid="ref193">Starr (1980)</xref> refer to ‘war disease’ when they discuss the spread of war. <xref ref-type="bibr" rid="ref113">Hamilton and Hamilton (1983</xref>: 41) state that the main paradigm in terrorism studies holds that ‘terrorist incidents may encourage further violence through a process of imitation or diffusion, giving rise to a dynamics of terrorism analogous to that observed in the spread of a contagious disease’. Or, ‘contagion’ can be used to refer to rapid transmission and spreading of a phenomenon throughout a region that commonly eludes ‘efforts to control its scope, speed and direction’ (<xref ref-type="bibr" rid="ref159">Koslowski and Kratochwil 1994</xref>: 215, 247).</p>
<p>Besides allowing for a culturally deeply entrenched way of understanding violent political processes, the disease object world highlights fundamental tensions. <xref ref-type="bibr" rid="ref243">Susan Sontag (1988</xref>: 63) referred to the ability of the disease metaphor to crystallize the enmities inherent in the world: ‘[f]eelings about evil are projected onto a disease. And the disease (so enriched by meanings) is projected onto the
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world.’ Political enemies turn into potential sources of regressive contagion. The talk about super-spreaders and diseases carries additional embodied ways of picturing rogue and inherently hostile elements. Political enemies are treated as diseasing and diseases are seen as political enemies. They are sources of potentially dangerous physical maladies. In this way, the association of SARS with China allowed for a strengthening of China's otherness as well as making SARS' invisible disease agents more politically understandable. Associating the origin of the mysterious pandemic with the perceived Chinese secrecy gave the disease a narrative form that seemed to clarify its nature. There are many such examples. During the BSE scare of 1996, the disease was seen by many commentators as having emerged out of the ‘reckless’ deregulation policies practised during the Thatcher years in the United Kingdom (the UK). Others, especially in the UK, saw the bans on British bovine products as a sign that the European Union (the EU) was seriously interfering with British sovereignty. The disease was interpreted through the lens of the political contestations of the time (see <xref ref-type="book-part" rid="chapter4">chapter 4</xref>, ‘The Trajectory of a pandemic drama’). In the same way, there is a tendency to see the fight against naturally occurring pandemic diseases as ‘rehearsals’ for the eventuality of a biological terror attack in the context of the War on Terror. This disease frame offers clues also for the present tendency of associating pandemic threats with states that are ‘rogue,’ ‘failed,’ or ‘failing.’ There might be factual reasons for all of these identifications. However, one hypothesis that can be made is that the inherent usability of the disease object world reinforces such underlying enmity dynamics.</p>
<p>Thus, the sentiment of disease, like enmity, provides an important register for feeling and sensing power in world politics. When real or perceived motions in power-politics favour political enemies, they may alarm also because of the disease-related repercussions of such movements. In her review of the emotional modality of international relations, Neta Crawford traces the origin of the term, ‘emotion,’ to ‘political or social agitation and popular disturbance’ (2000: 124).<xref ref-type="fn" rid="fn1_6"><sup>6</sup></xref> Against this power-related background of emotionality, it is not a coincidence that the theories of political movements and political mobilizations have been most receptive to giving emotions a central role in their models (<xref ref-type="bibr" rid="ref141">Jasper 1998</xref>). Research has concentrated on such mobilizing events as moral shocks, frame alignments and collective identities. The movement itself brings about emotions by stirring up passions and by stimulating people. At the minimum, it stirs the existing patterns of understanding what are positive and negative emotions, what should be expressed and hidden, and what are adequate and inadequate responses (<xref ref-type="bibr" rid="ref275">Willer <italic>et al.</italic> 1997</xref>: 573). Sentiments ranging from disdain, superiority, hostility and anger to compassion are equated with the movements and with the changing power relations signalled by the movements. The general idea is that changes in power hierarchies trigger emotions and stimulate participation in further fare-ups of collective feelings. The power status differences are established, challenged and reinforced by emotions (<xref ref-type="bibr" rid="ref177">Lutz and Abu-Lughod 1990</xref>: 14). The emotions produced by the in-group or the in-group vs out-group power structures vary from negative to positive, from enmity to compassion (<xref ref-type="bibr" rid="ref153">Kemper 1991</xref>).
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It can be argued that the use of the disease analogy influences and directs these power-related emotions. The disease frame reinforces attributions of deep seated feelings of enmity and hostility to power shifts that favor actors who have come to be viewed in diseasing terms. For example, globalization as a process of lowering borders is often felt as alarming because it brings places that have been seen as diseased landscapes closer. It is also possible to speculate that the perceived rise of China is sensed through the lens of a diseasing enmity, thereby making the context ripe for perceiving dangerous processes, such as pandemics, as emanating from China.</p>
<p>Thus, the disease frame can be seen as making some power related emotional register more prominent. The perceived global flows of power stimulate their targets according to particular anxieties. These anxieties over the inherent fragility of human beings and humanity during pandemic scares offer insights into how various people sense that they are linked to the world's hierarchical order, and how the increased interconnectedness between the global centre and its peripheries result in a heightened sense of worry that gets embodied in pandemics or fears about them. These linkages translate into harm, terror and horror in more ways than are commonly understood. Anxiety and stress are at their acutest when the ‘fevers of the world’ physically infect people through the main global arteries – the hub and spoke system of air travel (see <xref ref-type="book-part" rid="chapter5">chapter 5</xref>, ‘Vortexes of SARS: anxieties over global air mobility’). These turn into perceived disease vectors and circuits of contagion and seem to demand spectacles of containment and disengagement to stop their dangerous spread. However, these complex emotional relationships can be further disentangled.</p>
<p>Besides highlighting the dynamics of spread and contagion, there are additional nuances that need to be considered for a fuller grip on how the medico-political heuristic is used to symbolize architectures of global power. The basic disease object world schemata include various kinaesthetic sensations. Among the most important of these is the sense of being diluted or submerged by something negative and overwhelming. It can be argued that the fear of submergence provides a specific flavour to disease-related anxieties. Even a quick review of this type of declinist literature reveals a stress on the communal creed – on the moral, religious and cultural underpinnings, as, for example, the ‘American way of life’ or ‘Western values’ (<xref ref-type="bibr" rid="ref132">Huntington 2004</xref>). From this perspective, it is often thought that the primary sign of trouble is the sudden disregard of civic virtues and of the underlying civil religion. The causes of this are easily associated with foreign disease-like elements: the civil character becomes diluted when the hegemony of the preponderant actor turns into its opposite, into submergence, by excessive assimilation of hostile ‘incompatible’ elements.</p>
<p>The thoughts that connect world power with constant fear of decline and fall by submergence may be interpreted as a significant cultural stock narrative that dramatizes the contemporary dynamics of global security. The drama of political health is meant to demonstrate that the core element – the top of the power hierarchy – is not going to be dangerously diluted or rendered not vigorous enough to continue to create security and eradicate ‘dis-ease.’ The associated
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hierarchical imagery points out the differential place of the various nations, ethnicities, regions, religions, civilizations and people. Their interconnectedness is interpreted based on the disease frame. In this spirit, it is often argued that the diligent maintenance of hierarchy's divisions – or the new containment boundaries – is the best guarantee against submergence by a wave of anarchy (<xref ref-type="bibr" rid="ref145">Kaplan 1994</xref>). Robert Kaplan's influential geopolitical imagery is partly composed of ‘cities and suburbs in an environment that has been mastered’. He contrasts this with the Third World, from where he sees a wave of dangerous anarchy emanating. His detached aerial view – the first person account is often based on observations from an airplane – of the ground below seemingly permits him to grasp the politically significant contrasts and patterns between combinations of scenes. He makes all these relevant as part of an overall emotional scene of fear of the imminent chaos spreading from the Third World. This fear of fight – people fleeing and global air fights enabling the feeing – seems to stem from the expansive reaches of the globalized world's hub and spoke infrastructure. It seems that what Kaplan is suggesting as a healthy antidote for the spreading anarchy is the confinement of people to the contours of their territory (<xref ref-type="bibr" rid="ref056">Dalby 1996</xref>: 472). The confinement of people to their territories and the ranking of more compatible and less compatible people offer additional substance to contemporary containment dramas. Significantly, <xref ref-type="bibr" rid="ref132">Huntington (2004</xref>, <xref ref-type="bibr" rid="ref133">2005</xref>) identifies foreign immigrants as one major source of decay and reason for worry. According to <xref ref-type="bibr" rid="ref131">Huntington (1997</xref>: 38), contemporary forms of contact do not cut immigrant umbilical cords in the same way as before. Links and contacts remain, turning people coming from different civilizations into sources of decay and erosion (<xref ref-type="bibr" rid="ref133">Huntington 2005</xref>: 306). The fear of global contact and intimacy can be seen as an additional consequence of the projections of the disease object world. It blends the declinist modality of submergence with the emotional registers of spread and contagion.</p>
<p>Disease as a crucial embodied object world needs further sharpening in order to provide analytical clarity. I will draw from the frame paradigm developed by <xref ref-type="bibr" rid="ref101">Erving Goffman (1974)</xref> to provide methodological support for the further understanding of present-day pandemics and their inherent politico-somatic dynamics. The ‘frame’ offers a way of gaining insight into health governance composed of politico-cultural performances – that is, pandemic scares – and supported by the disease as an embodied cultural form. From a general perspective, the notion of frame refers to an ‘organized and bounded social entity most immediate to the individual's experience’ (<xref ref-type="bibr" rid="ref105">Gonos 1997</xref>: 854). Framed public acts involve heightened and engrossing dramas and spectacles. As the recent approximately three year frequency of pandemic scares shows, these public events tend to be tense, emotional, theatrical and spectacular. Pandemic public drama creates a sense of having its own specific type of reality, which suspends and interrupts the way events normally take place. The frame produces a sense of realness and enhances its performers with a sense of differentially (dis)empowering solidity. In this sense, any frame offers a clear gallery of figures, which allows the spectators and performers ‘to conjure up a desired self-image’ (<xref ref-type="bibr" rid="ref093">Fine and Manning 2003</xref>: 46).
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These dynamic ‘frames’ produce suspended circumstances in which the spectators judge things to be dramatically real and critically meaningful. Highlighting this point, <xref ref-type="bibr" rid="ref102">Goffman (1997</xref>: 150) refers to William James, who argued for a quasi-cognitive, revelatory status of knowing (<xref ref-type="bibr" rid="ref139">James 1985</xref>: 352). This type of knowing means that frames are acknowledged, rather than rationally known; authoritative, rather than freely chosen; and emotionally appealing, rather than cognitively satisfactory. To an important degree, the question of framed realness becomes a function of specific types of attention, as <xref ref-type="bibr" rid="ref102">Goffman (1997</xref>: 150) points out while quoting from William James: ‘[e]ach world, whilst it is attended to, is real after its own fashion; only the reality lapses with the attention.’ The question of realness turns into one of attention: how is attention captured and encapsulated in pandemic spectacles? What is the specific emotional content? How is knowledge revealed, by what figures, and to what audiences? Familiar frames and the shared experiences they contain are fundamentally about fixing the trajectory of acknowledgement and about the production of authority: what is the flow or script of the pandemic spectacle and what can be done with it?</p>
<p>The additional modality of pandemic scares has to do with making the invisible visible. <xref ref-type="bibr" rid="ref164">Bruno Latour's (1988)</xref> idea of the ‘theatre of proof ’ offers a history of the medicine related way of looking at pandemic performances, in which the various protagonists take on their respective roles. The key for them is to demonstrate legitimacy in meeting the challenges posed by the invisible rogue disease elements. Latour's notion draws from a famous 1882 demonstration in which Louis Pasteur revealed the effectiveness of vaccination. The experiment lasted for several days and was the focus of intensive attention by the French media. Twenty-five sheep were vaccinated against anthrax and another 25, which were not vaccinated, were painted with red marks. The success of the demonstration was vividly visible to the onlookers, who witnessed the death of all the animals who were not vaccinated, but were visibly marked. This experiment was widely followed and publicized, and gave medical research an air of certainty. It offered clear-cut revelatory knowledge about the power of the new health science to tame hard to understand, invisible disease agents. Pasteur managed to make the underlying, difficult to comprehend hidden reality visible and controllable. At the level of popular imagination, these laboratory experiments, once transferred into the field, turned into modernity's testing grounds – into theatres of proof. At stake was the legitimacy of modern medicine and the state that had produced it.</p>
<p>This method of demonstration can be argued to still linger. The theatre of proof, as a frame, turned any effective conquering of a disease by public health measures into a power repository, into an opportunity of demonstrating the legitimacy of a particular medicalized ideal of a modern governance structure as an answer to the Hobbesian dilemma of offering refuge from a short, nasty and brutish life. In this way, pandemic scares offer tools for demonstrating power. The key to understanding them as theatres of proof has to do with clearly identified and visible sources of disease and those protagonist agencies that are fighting them. For example, the recent swine flu scare clearly identified from the
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beginning the prominent role of the World Health Organization (WHO). It also identified the cure – vaccine development. The protagonist element of the disease was hyperbolized into a pandemic emergency. The real, rather unexceptional nature of the disease was not initially recognized or it was downplayed under the often used trope of the possibility of more dangerous mutations. Similarly, in the case of SARS in the spring of 2003, the scene was set for WHO to stop the hyperbolized disease threat. The SARS spectacle managed to convey a sense of security as the disease was contained. However, in the case of swine fu, the theatre failed, partially because of public scepticism that the disease scare had been hyped up. The controversies over vaccine purchases, effectiveness and possible side-effects demonstrated the limits of the theatre of proof.</p>
<p>Pandemic spectacles are intense and engrossing dramas in which the power of modern states and their international health regimes are being tested and demonstrated by diligent – highly visible and dramatic – application of modern health sciences. Moreover, the performer of ‘health’ is a figure, an embodiment, which objectively and securely meets the external hostile reality. By proxy, the effectiveness of this performance proves the ‘true’ and ‘authentic’ foundation of the Western political bodies. In this historically well-rehearsed way, any successful act of the health theatre turns into an empowering foundation for political power. Pandemics are refined into governance exercises that are thought to be beyond politics (<xref ref-type="bibr" rid="ref236">Siddiqi 1995</xref>: 196; <xref ref-type="bibr" rid="ref253">Symonds and Carder 1973</xref>: 157).<xref ref-type="fn" rid="fn1_7"><sup>7</sup></xref> However, a closer examination reveals the close co-optive relationship between the demonstrations of health technologies and hegemonic political power.</p>
<p>There are many other possibilities of framing disease as provided by contemporary research literature. I do not want to understate the size and sophistication of this existing research on pandemic fear, global health security and risk perception. For example, it would be possible to treat the recent heath related scares in terms of Beck's famous idea of a risk society. According to <xref ref-type="bibr" rid="ref024">Beck (1999)</xref>, postmodern societies are increasingly risk aware. The failures in risk management and in economies of risks give rise to much societal anxiety and their fears provide stimuli for vast control and surveillance policies. However, this view can be qualified with the claim that epidemics have always been at centre of political communities' self-understanding. <xref ref-type="bibr" rid="ref174">Lindenbaum (2001</xref>: 377) states that diseases can be used as indicators of underlying communal beliefs. A serious epidemic disease illuminates social patterns and political relations between and within various communities. The past manifestations of different plagues have not been that dissimilar from the recent noise made about BSE and avian flu. The differences are rather in degree. The emergence of an increasingly intensive global community is matched by the re-emergence of communal awareness of epidemic diseases and collective rituals in dealing with them. Beck's notions of risk may actually be read as a cultural expression of what epidemics mean for the new globalized community and what its specific variety of collective self-understanding is. These expressions can be quite easily placed in the long cultural history of epidemic diseases and of the political impact they cause. My fundamental aim is to map out a comprehensive treatise on how
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pandemics are political events and how such politics engages our bodily anxieties. I will include primary quantitative materials as much as possible in order to make the cases empirically satisfactory. However, my approach will be qualitative and theoretical. It will draw much support from the conceptual histories of disease perceptions.</p>
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<title><xref ref-type="page" id="page_18"></xref>Containments and compassions of pandemic dramas</title>
<alt-title alt-title-type="running-head">Containments and compassions of pandemic dramas</alt-title>
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<p>The heart fees the unfamiliar as it fees the bad and the harmful.</p>
<attrib>Albertus Magnus</attrib>
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<p>In traditional state-and, inevitably, border-centric political thought, physical separation and geographical distance are often equated with security. The primary vehicle for producing security through distance has been the international political border, which effectively cordons off territorial entities from each other. The identification of borders with security may be seen as an expansive basic conceptualization, which has implications beyond the physical borders of a territorial state. The bordered nature of security lends legitimacy to multifarious political boundaries ranging from cultural, ethnic and socioeconomic to religious and civilizational markers of distinctions – and including the inter-species barrier (<xref ref-type="bibr" rid="ref270">Weiss 1997</xref>: 457). Due to this traditional emphasis on signifiers of separation, the emergence of globality as a process of lowering boundaries and bridging distances is essentially a problematic phenomenon that makes people emotionally insecure. It is in this anxious affective climate of global insecurity, stemming from vanishing borders, that pandemic scares have become epochally comprehensible. From the politico-somatic perspective, the cultural constructions of pandemic diseases are embodied expressions of the underlying anxieties stemming from such global intimacy. These bodily anxieties can be seen as motivating multilevel containment activities. The embodied object world of pandemics instantiates strong containment tendencies.</p>
<p>Thus, it is difficult to conceive of pandemic scares' public health dramas without taking into account the value placed on ‘containment’ and on the striving ‘to contain.’ Cultural geographer Yi-Fu Tuan, in his book, <italic>Landscapes of Fear</italic> (1979: 6), argues that much of human activity is directed towards securing the freedom of human existence from what he calls chaos: <bold>‘</bold>[i]n a sense, every human construction whether mental or material is a component in a landscape of fear because it exists to contain chaos.’ This is especially pertinent to the conceptual configurations of political theory and international thought. Both can be seen as traditions that aim to contain the effects of insecurity, anarchy, and injustice both in and between polities. The disease frame can be further heightened with these underlying dynamics.</p>
<p><xref ref-type="page" id="page_19"></xref>The tracing of the affective contours of global insecurity and containment brings into the limelight other emotional dynamics such as the mobilizations of compassion. In many ways, compassionate activity is one of the situational characteristics of the scenarios of knowledge revolving around alleviation of the sources of global insecurity. I will review here the practices of compassion in order to offer alternative imageries to pandemic scares. The idea behind offering such points of contrast is to contextualize the scenarios of embodied knowledge involved in the related scenarios inherent in frames of compassion and containment. In this way I will tie the respective scenarios schematically together to show broad and novel patterns of nuanced similarity and dissimilarity. Thus, further light can be shed on the politico-somatic nexus of pandemic diseases by juxtaposing their emotional charges, for example, with the dynamics inherent in the traditions of political compassion. Political compassions – as expressed in global humanitarianism or in ‘nearest is dearest’ mobilizations – are often based on action at a distance, as, for example, when some distant sufferers' plight is relieved through charity, voluntary work or aid.<xref ref-type="fn" rid="fn2_1"><sup>1</sup></xref> However, the sentiment of compassion implies global power patterns because such suffering can be seen to be in itself an expression of the global hierarchies and the world order (<xref ref-type="bibr" rid="ref006">Aaltola 2009</xref>). In this way, they are related to the practices of containment, which also accentuate existing power disparities and markers of separation. At the same time, the containment-oriented public health perspective often views humanity as an interlinked whole in that the health of the distant others is intimately linked to the health of everybody. The discourses of global public health often reveal articulations of compassion towards the human polity as a whole. Thus, the panics and scares over pandemic threats may be seen as consisting of a double movement of selective compassion and vigorous containment. In this chapter, I will review how these two essentially nested ‘power moves’ – compassion and containment – can be used to make sense of underlying pandemic insecurities. The working hypothesis of this chapter is that the compassionate worries over public health are entangled with alarm over the general uncontainability of global processes. My aim is to map out the historic complexities involved and, thus, shed light on pandemic scares as embodied expressions of this complex entanglement.</p>
<p>This acute global relationship of compassion, blended with strongly anxious aversion, provides the Janus faced template for the understanding of pandemic scares. Such tangible global emotional charges offer insights into how pandemic experiences intertwine with the geographies of fear and, moreover, with the dynamics of political power production. I am using the term politico-somatics to describe how bodily-felt anxiety couples with the interconnected global landscape in a nexus that, on the one hand, turns power-politics into an embodied or even somatic experience and, on the other hand, gives somatic fears a global extension. The embodied object world of pandemics as somatic experiences opens up in a dynamic relationship between disease agents, methods of infection and individual bodies. This object world, however, is not only personal, it is also predominantly power related and, thus, political in that the scenarios of violent
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diseases have a tendency to embody the underlying patterns of political hierarchy and enmity. That said, it is precisely the personally tangible nature of pandemics that allows them to be used as ways of telling stories of what is at stake in the global order. Taken together, these two juxtaposed object worlds of disease and world order translate into a configuration of differentially exposed bodies which, in turn, give expressive meanings to ritualized pandemic behaviour. The private and collective sentiments of fear, anxiety and scare transform into demands and opportunities for calming power spectacles branded as ‘effective health governance’, the legitimacy of which becomes even more tangible when the devastating blow is averted once again and the scare subsides.</p>
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<title>Black Death and political thought</title>
<p>It may be argued that the seminal Western encounters between plagues and people from the perspective of modern imageries took place during the long centuries of plague on the Continent. It took about 400 years for the plague to run its course and disappear, but not without first killing vast numbers of people in different parts of Europe. Between the landmark years of 1346 and 1721, epidemics that killed more than one-third of local populations at a time were more a rule than an exception (<xref ref-type="bibr" rid="ref186">McNeill 1976</xref>: 10). It was not until after the city of Marseilles had been devastated (1720–21) that the deadly shadow of widespread plague epidemics finally withdrew from continental Europe and, much more gradually, if at all, from popular imageries. The plague swept across Europe several times in the form of inexorable tides, leaving behind not only large-scale destruction, but also major social, religious and political changes. As the role of <italic>Yersinia pestis</italic> as the cause of plague through rats and fleas remained unknown for centuries, people thought of plague as a terrifying and unusual fever that was intimately connected with filth and foul smelling miasma and ultimately tied in with various ideas of broken ‘sacred’ communal boundaries and with different embodiments of foreignness (<xref ref-type="bibr" rid="ref204">Palmer 1982</xref>: 358). Very often, it was assumed that the ultimate reason of plague had to do with God's divine and mysterious providence. This belief was strengthened by the inability of alternative perspectives to satisfactorily explain the connection between the people who died of plague as other than sin or God's will. During the plague years, people were very accustomed to the different pestilences that caused pain, suffering, poverty, desolation, and death. Even in this disease-saturated context, plague was a case apart because of its mysterious pattern of spread, imperspicuity and staying power. Its extraordinary and ominous character led to anxiety and fear, which were unparalleled in European history and which must have left a lasting mark as European international society expanded into an international community.</p>
<p>Despite the distinctiveness of plague, many fail to appreciate its effects on the political and intellectual development of political thought. This disregard leads easily to the misperception that the ramifications of plague were not dramatic and long-lasting. However, plague did leave its marks because it contained powerful, persuasive and constraining narrative charges that were able to create
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lasting associations even when any causal relations had become too entangled and imperceptible to distinguish. These analogical influences are consequential because everyday routines and discourses absorb them effortlessly, extending their impact beyond causal attributions. These profuse complexities were synonymous with plague as a social phenomenon. Through the process by which the wider human context shaped plague as an embodiment, plague became an inseparable part of the multifarious and changing field of human experience. In the process in which plague was actualized as a social phenomenon, people were cast more often than not into passive suffering roles. However, occasionally, plague offered more possibilities for conceptual control and political agency. In other words, the way in which plague's contemporaries perceived it contained many traces from other phenomena and these related and more controllable phenomena traces became synchronous and consistent with one another. For example, the embodiments of plague and war started to interact. A related political embodiment that was evolved in the plague saturated context was that of the fledgling state. Thus, judging by some relevant perspectives, pestilence and international relations first collided, then tangled, and finally combined, actualizing, molding, and reinforcing one another as changed entities. This interacting nexus between state and plague included important points of affinity such as border, threat, enemy and survival. Thus, it can be suggested that the state involved scenarios of knowledge that matured in a context permeated by plague.</p>
<p>During the early modern period, the fight against plague assumed an increasingly secular and physical form as the attempts made to check its spread were formalized in various quarantine and <italic>cordon sanitaire</italic> regulations. The use of soldiers and medical police in upholding the numerous regulations and restrictions, together with occasional violence, gave an increasingly military and political character to the battle against plague, with the result that it began to resemble – metaphorically – a defense against an invading army. The tempting nature of the enemy analogy was reinforced in the Christian tradition, which includes numerous references to plague in connection with war, defeat, and invasion. The analogy between political practices – state, border, and war – and plague became even more pronounced when large-scale troop movements and plague were usually simultaneous and accompanying events. These associations were also highlighted in narratives that often drew strong causal inferences between long distance activities – such as commerce and travel – and plague. The figures of the soldier, sailor, and vagabond were inherently dubious in this context as the general perception was that foreign influences were framed as plaguing. Thus, it may be hypothesized that the plague formed easy to tread narrative paths that did not limit its effect to a few common points of attachment. Rather, these mutually resonating object worlds influenced the maturing of the central political practices and the meanings of their use. This invites the question: did the relationships between different processes lead to the emergence of a synchronic interplay whereby the changes in one phenomenon resulted in changes in the ways of constructing the other phenomena?</p>
<p><xref ref-type="page" id="page_22"></xref>Plague outbreaks were considered causes of significant embarrassment both individually and locally because they were thought to be a mark of the sinful, indecent and unconfined life of a political community. In this context, the threat of plague easily became, or was made, analogous with exogenous enemies and foreign sources, as in the form of rival city states. Foreign powers, foreign elements in general, and domestic minorities – mainly Jews and perceived heretics such as witches – were often thought to be well-poisoners and plague-spreaders during the long plague years. These rudimentary yet infuential analogies were further supported by the conclusion that the spread of plague, with the accompanying economic losses and societal paralysis, was clearly in the interest of rival states. It was often thought that what these outside forces could not achieve by honest means, such as political, economic and strategic competition, was being attained with the help of the plague. Although it often became necessary eventually, it was hard for the proud citizens of city states to imagine that the death and suffering were due to their own moral corruption. Thus, the general argument pointed at the immorality and sins of outside forces or to one's internal minorities, who were deemed to be wickedly and deceptively spreading the plague to the more morally-upright individuals and communities. In this way, the pattern of plague, which was in reality rather random, reinforced existing and emerging imageries of hierarchies and boundaries.</p>
<p>The placing of blame on foreign entities or unwanted internal minorities could justify their harsh and violent treatment and turn public attention away from the authorities' inability to maintain public safety and order. For example, it was not uncommon that the hospitals set up for the containment of quarantined people were also used to imprison politically unwanted elements (<xref ref-type="bibr" rid="ref037">Carmichael 1986</xref>: 108). The references to a foreign threat in connection with plague were not limited to the elements of foreignness within the borders of a city state, but offered possibilities from the point of view of inter-communal competition. It should be noted that the policies and actions based on taking advantage of the disease were less dishonest and sinister than they may sound at first because of the mysterious and puzzling way in which plague spread. Plague manifested itself in a context filled with supernatural, unexplainable and dangerous forces. It is, therefore, quite possible that the officials of city states and the clergy could believe that their explanations and allegations were true, independent of their own political motives. Thus, purposefulness and ignorance often combined dangerously in explosive and unpredictable mixtures. Hidden motives, deception and secrecy, together with well-intended but misguided actions, were a prominent part of the internal and external policies when plague struck.</p>
<p>During the plague years, the more or less arbitrary effectiveness of quarantines as a preferred disease control method manifested itself from time to time in a frightful way and added weight to views critical of them. In hindsight, quarantines offered only a very weak protective barrier against diseases that spread via and from animals (plague and yellow fever) or through water (cholera). On the other hand, experience seemed to suggest that diseases were somewhat contagious. In other words, there existed much scepticism about the idea that climatic,
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hygienic or geographical features caused diseases as the miasmic theory claimed. It was of practical knowledge that diseases spread through contact and proximity. Yet, although quarantines did not work against the plague bearing black rat, the conceptualizations behind quarantines were somewhat logical and persuasive at the time. Moreover, quarantines gave political authorities the means to do something that could be used as proof of their effectiveness in containing the plague. For example, it gave states a means to prevent people from escaping their plagued communities and protected the property of the feeing upper class. Thus, the survival and viability of a state as a political entity under the dramatic conditions of plague required drastic political measures. On the other hand, citizens often associated quarantines with the very thing that quarantine measures were supposed to protect them against. Hence, it was often not the epidemics that caused political disturbances, but the authorities' actions such as quarantines (<xref ref-type="bibr" rid="ref087">Evans 1992</xref>; <xref ref-type="bibr" rid="ref215">Pullan 1992</xref>). From the perspective of sceptics and authorities alike, it can be said that quarantines had a primarily political existence; saving individual lives was of secondary importance.</p>
<p>Despite the mixed success record of the quarantine regulations, their widespread use can be contextualized in the connection of the emergence of states and state boundaries. As said, state boundaries offer a major conceptual connection between politics and epidemic diseases. Several writers have seen the Peace of Westphalia as a turning point in the history of diseases. <xref ref-type="bibr" rid="ref081">Eckert (2000</xref>: 25) perceives a direct link between the establishment of state boundaries and a major decline in plague outbreaks.<xref ref-type="fn" rid="fn2_2"><sup>2</sup></xref> Before the late seventeenth century, the enforcement of quarantine systems was mainly the responsibility of city states. Local quarantines encircling a city or village were the most significant plague control policy. The coming of the state system changed all this. By that time, state interventions efficiently utilized their administrations and large armies. Surveillance also became much more organized. Like natural barriers such as mountain ranges, rivers or oceans, increasingly, effective political borders, too, provided a formidable obstacle to the spread of epidemic diseases. Human-made borders clearly affected epidemics and changed the appearance of randomness by influencing which places were devastated and which were spared by diseases. Through efficient and well-maintained political borders, it was possible to convey a sense of the legitimizing quality of political order. The modality of health started to occupy an even more prominent role in the scenarios of political power. The growing legitimacy of borders and the practice of ‘bordering’ changed the nature of communities. In reference to the emerging well-contained communities, <xref ref-type="bibr" rid="ref082">Ehrenberg (1960</xref>: 7) writes that ‘[t]he narrow space, admitting of little variation, produced a marked unification of the civic type and a very distinct political consciousness.’ Every time an epidemic struck somewhere else, the state's legitimacy as a secure, privileged, inimitable and exemplary entity, predestined and chosen for glory, was reinforced. In many ways, it seems that the need to combat diseases may have intertwined with and complemented the efforts of state building.</p>
<p>Thus, plague imageries may have had important ramifications when it came to the understanding of states as contained, bounded entities. However, the
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cultural history of plague also had a pronounced influence on the development of the imagined antithesis of a state. Plague gave substance to the discourse that later came to be framed as ‘international anarchy’. The conceptualizations concerning the state of nature were made vivid and striking by memorable associations with plague. In the atmosphere of plague, statements such as Hobbes' equation of life in the absence of state as short, nasty and brutish, must have been more persuasive. It is important to note that both the concept of state and the practices constituting the state system developed in a context permeated by large-scale plague epidemics in Europe. This connection between politics and plague can be dismissed as a mere historical coincidence, but there is some evidence to the contrary. I will next provide a general account of the commonalities between the discursive practices of plague and anarchy. My intent is to show that the inherent discursive connection can provide insights into shared discursive dynamics. Plagues have a place in the ways in which interstate power is said to have been traditionally imagined and embodied. This connection provides vital substance to the politico-somatic phenomenon. I will argue that modern day pandemic plagues are not encountered in a historical vacuum. The cultural history of the construction of modern day pandemics draws from the powerful past associations between plague and central political practices. It is possible to entertain the thought that plague may have an often unrecognized place in the established imageries of international relations. This bridgehead influences the manner in which modern day pandemics are constructed and it provides a crucial frame for understanding the trajectories of the plagues of our times.</p>
<p>One way of approaching the common cultural history of plagues and politics is to consider for a moment the plague-ridden affective climate of the early modern mind. Even for the likes of Hobbes (1588–1679), keeping plague from affecting the more intellectual work must have required strenuous effort. The plague certainly caused uncertainty and horror when it swept in one great wave after another over all of Europe. The disease, together with other epidemics such as cholera, syphilis, and yellow fever, filled the imagination of those living at the time. As stated, this same imagination was the birthplace of territorial states. In descriptions of the state of affairs outside of the state, plague and its horrible manifestations offered plenty of persuasive and understandable analogies. In several ways, the emergence of the territorial state can be thought of as a solution to emergencies caused by pestilences such as plague. This brings to mind Scarry's argument reviewed in <xref ref-type="book-part" rid="chapter1">chapter 1</xref>, ‘Introduction’, that political architectures are ultimately legitimized as pain relievers. The territorial state may be seen both as a response and a solution to the uncertainty created by an unknown killer. This is supported by the historical correlation. The emergence of a fully-fledged state system also spelt the end of large-scale plague epidemics in Europe. If the state developed and ‘ripened’ in the disease ridden context of uncertainty, the final triumph of the state was the prelude for the vanishing of the plague from Western Europe. This parallelism must have reinforced the acceptance and legitimacy of states as somehow natural – or even supernatural or divine – entities. A part of this legitimacy is straightforward, yet often missed. States could
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be associated with the effective implementation of the increasingly effective quarantine regulations. The earlier mentioned parallelism between diseases and the state provides an example of how political borders and borders in politics have been present in the history of disease control. This interaction between borders and disease has had a profound, if little explored, role in the history of the respective interlinked worlds.</p>
<p>Besides these broad sketches of parallel histories, it is possible to delineate a more coherent intellectual link between plague and anarchy imageries. Modern notions of international anarchy may be contrasted with a fundamental notion of St Augustine's influential political thought. In his <italic>Confessions</italic> (7.10.16), in a dialogue with God, Augustine remarks: ‘<italic>[e]t inueni longe me esse a te in regione dissimilitudinis, tamquam audirem uocem tuam de excelso</italic> [I realized that I was away from you in the land of unlikeness].’ This <italic>regione dissimilitudinis</italic>, or land of unlikeness, refers to the basic separation between the City of God and the City of Man. The juxtaposition of the realm of heavenly order with the City of Man brought forth the realm of unlikeness as a separate realm. Inherent in the realm of unlikeness is a dystopian vision of a realm of tangible distance from the privileged level of clarity. According to Augustine's authoritative view, the events in the region of unlikeness bear, at best, likeness to entities at the superior level of the City of God. However, the element of likeness in the realm of earthly politics is deeply confused because of the presence of considerable dissimilitude. By themselves, events in the region of dissimilitude are fragmentary, without identity and, therefore, meaningless. They are inherently discontinuous and unlike, in the absence of the firm reference points offered by the City of God, the realm of continuity and likeness. This leads to a twofold distinction between the two realms – on the one hand, between the realm of perfect order and the realm of unlikeness and, on the other hand, between that aspect of the realm of unlikeness that bears likeness to the heavenly order and that aspect that lacks identity, is fragmentary and obscures the heavenly vision in earthly matters. For Augustine, the only way to alleviate that grave and melancholic condition, the manifestations of which included war, fear, violence and indeterminateness, was through a direct connection with the realm of similitude: ‘<italic>[n]on enim locorum interuallis sed similitudine acceditur ad deum</italic> [Not through intervals in space, but through likeness]’ (<italic>De Trinitate</italic> 7:6:12).<xref ref-type="fn" rid="fn2_3"><sup>3</sup></xref> Judging from the relative positions of the two realms, it is not surprising that the production of similitude becomes a higher morally valued goal in many subsequent intellectual endeavours. The making of likeness and removing the conditions prevailing in the <italic>regione dissimilitudis</italic> were acts of pulling together disparate and scattered elements. This could be considered as an almost divine mission for a person in the early ages. For Augustine, the realm of similitude – the City of God – consists of sublime proportions and hierarchical order (<italic>De Ordine</italic>, ii. 8.25). It is held together by the unity of the <italic>res</italic>-principle, producing an intelligible purity that could be understood and consolidated through reason. In Augustine, the <italic>res</italic> is produced through a contained whole coming into existence that was more than the sum of its parts. The <italic>res</italic> turns otherwise disparate entities into conditions of likeness, thereby identifying
<xref ref-type="page" id="page_26"></xref>
each with the other.<xref ref-type="fn" rid="fn2_4"><sup>4</sup></xref> In Augustine's writings and, later, in the writings of Thomas Aquinas, this quality becomes a valued presence in an otherwise indeterminate earthly existence.</p>
<p>Augustine can be seen as operating with pre-existing conceptual configurations in setting his influential distinctions and juxtapositions. Plato, in his <italic>Statesman</italic> (<italic>Politikos</italic>), uses a concept related to Augustinian unlikeness in the form of the ‘sea of diversity’.<xref ref-type="fn" rid="fn2_5"><sup>5</sup></xref> This was a place of unlimited chaos, where the voice of reason – <italic>logismo</italic> – is utterly faint and very difficult to discern. This Platonic notion can be seen as influencing Augustine's later conceptualization of the ‘region of dissimilitude’. This effect may have worked through the direct weight that Plotinus had on Augustine's reading of Plato (<xref ref-type="bibr" rid="ref055">Dahlberg 1988</xref>: 28). The importance of dissimilitude as an early template for the later idea of the ‘state of nature’, which was the template for ‘international anarchy’, becomes clearer through the way in which Augustine describes the region of dissimilitude as characterized by a lust for domination, profound discontinuity, indeterminateness and haphazard communication (Brown 1965: 3). Augustine's idea is that <italic>res</italic> – an orderly collection of things – should be brought about in any self-containing political community.<xref ref-type="fn" rid="fn2_6"><sup>6</sup></xref> When a political community loses its order, or its <italic>res publica</italic>, its composite parts get scattered. The familiarity and alikeness slip away when remoteness, dissimilarity and chaos stream in to engulf what was once a polity.</p>
<p>The mythic sea imagery is important in this connection as the template for the coming into being of more modern political thought's notion of anarchy. The sea of dissimilitude as an antithesis of a polis or polity can be seen to be widely present in the underpinnings of classical political thought. Two influential examples suffice for the purpose of illustration. First, in Plato's pedagogic myth concerning the submergence of Atlantis, an imperial community suddenly caught in a violent deluge, Plato's emphatic warning seems to be that common sense is easily submerged by expressions of the darker side of human nature, by belligerence and avarice. Second, the foundational myth of Athens links the polis to sea vortexes. The notion of a sea of diversity is seen as being present at the birth of Athena. As the Homeric hymns express it, Athena emerges from a sea that swirls in confusion. Thus, fluidity and flux and other Poseidonic qualities are abundant in Athenian iconography. Fittingly, the ‘great movement’ – the Peloponnesian War – unleashed by Pericles' Athens is interpreted figuratively by Thucydides as a ‘chaos, terrible flux, a destructive kind of motion’ (<xref ref-type="bibr" rid="ref191">Monoson and Loriaux 1998</xref>: 291). In the next chapter I will discuss the importance of sea imageries for Thucydides, who was, perhaps, the most influential early proponent of the plagues and politics template.</p>
<p>Mythic ideas concerning the sea of diversity found their way to modern times mainly through Hobbes' sea, water, and vortex conceptualizations. The most influential of these was the state of nature. <italic>Leviathan</italic>, published in 1651, was aptly named after a biblical sea monster. In it, Hobbes remarks famously that the life of man in a state of nature is ‘solitary, poor, nasty, brutish, and short’. This endlessly echoed phrase should be seen in its larger context in the text.
<xref ref-type="page" id="page_27"></xref>
Its immediate textual context details important aspects of Plato's and Augustine's ideas concerning the ‘sea of diversity.’ Confusion is pointed out by lack of navigation and other instruments of moving, measuring time and mapping:
<disp-quote>
<p>There is no place for industry; because the fruit thereof is uncertain: and consequently no culture of the earth; no navigation, nor use of the commodities that may be imported by sea; no commodious building; no instruments of moving, and removing, such things as require much force; no knowledge of the face of the earth; no account of time; no arts; no letters; no society; and which is worst of all, continual fear, and danger of violent death; and the life of man, solitary, poor, nasty, brutish, and short.</p>
<attrib>(3:11)</attrib>
</disp-quote></p>
<p>Furthermore, Hobbes on the state of nature as a state of war is indebted to Thucydides' portrayal of stasis in Corcyra and the Plague of Athens (<xref ref-type="bibr" rid="ref182">Manicas 1982</xref>: 676). In a way, Hobbes, who translated Thucydides' main work into English in 1629, passed the classical conceptual configurations concerning the state of nature into early modern times and beyond. At least from this perspective the lineage leading to the present day image of ‘international anarchy’ is related to that which takes place inside a single political community under conditions of extreme random violence or stasis. It is clear that the themes of civil strife and pestilence found their parallels in the political imagery of Hobbes' contemporaries. It can be argued that these themes became integrated into the way people felt about life outside of the state. Life as nasty, brutish and short could easily find its most concrete examples in the religious wars of the time and in its plague-ridden, collapsed communities.</p>
<p>The staying power of Hobbes' famous quotation is indicative of its strongly embodied quality. The statement become memorable not just because of its conceptual clarity; rather, it was supported by the larger mythology of political thought in the Barthesian sense, and because it was felt and sensed in the vivid, real-life human dramas of its day. Among the most tangible of such embodied elements were the rampant plague epidemics of the time. The state of nature became understandable and representable because it could be understood through the decomposing somatic effect of plague on the human body, life and communality. It is in this history of imageries concerning politics and anarchy that the politico-somatic nexus between somatic and political bodies is anchored.</p>
<p>As already stated, it is not difficult to detect the mutual indebtedness between the varying notions of the region of dissimilitude, the state of nature, and anarchy. An important shift that takes place after Augustine is that the region of similitude is gradually given an increasingly earthly content through the concepts of city, empire, state and sovereignty. The term, ‘state of nature,’ initially referred to a paradise-like being before the Fall in that people were independent and free of domination, rather than wanderers living in destitution and uncertainty. However, it can be claimed that this belief became increasingly hard to defend in the face of plague and religious wars, with the result that a sombre
<xref ref-type="page" id="page_28"></xref>
Augustian view of the nature of man as one of confusion and hardship was introduced. Consequently, the optimistic analysis of human rationality and morality was modified considerably (<xref ref-type="bibr" rid="ref238">Skinner 1988</xref>). In this way, the notions of a political community and those of a state started to be contrasted with terms descriptive of confusion in a way that brought Augustine's bleakness back into the foreground.</p>
<p>Moving on to the more modern concept of international anarchy, the inheritance of the state of nature and the persistence of Augustinian themes are easy to discern. For example, <xref ref-type="bibr" rid="ref036">Caporaso's (1997</xref>: 564) views echo what can be called the modern version of Augustine's tale of two cities. He argues that it is common to think of the ‘[d]omestic society and the international system as demonstrably different.’ Whereas the ‘international system relies on self-help and power bargaining to resolve conflicts,’ the domestic ‘society (not system) is, by contrast, rule-based.’ <xref ref-type="bibr" rid="ref020">Bartelson (1998</xref>: 295) notes this same tendency:
<disp-quote>
<p>if the identity of the international domain has conventionally been defined in terms of its composite states, and the discipline of International Relations in terms of the relationship between these states, then questioning the identity of the state is tantamount to questioning the identity of the international domain itself as well as that of International Relations.</p></disp-quote></p>
<p>It is equally characteristic of the tradition that the way to deal with the distinction between the domestic and international – the two ‘cities’ – is to link them. Just like Augustine and most others, modern thinkers also often succumb to the attraction of drawing an analogy between the two realms. The happenings in the region of dissimilitude can at best resemble those of the ‘intelligible’ realm and, thereby, become understandable through this correspondence. Moreover, <xref ref-type="bibr" rid="ref072">Donelan (1978</xref>: 78–9) critically summarizes this aged line of thought, which renders international relations ‘a wasteland’ of war and of ‘disease, famine and beasts’ in the following sentence: ‘[t]he separate states of the world are islands in a sea of evil.’ <xref ref-type="bibr" rid="ref074">Donelly reiterates (1986</xref>: 602) this phrase in the form of ‘islands of order in the sea of anarchy’ to refer to ‘structured regularity’ in international relations based on regimes. <xref ref-type="bibr" rid="ref066">Deudney (2008</xref>: 245) echoes the often used metaphoric expression in the form of a ‘world order composed of islands of hierarchy in a sea of anarchy’. Against the background of the earlier discussion, statements like these become meaningful. The mythology contained in it is identifiable in the long tradition of political thought. And the references of plague and other pestilences reinforce the sense that the conceptual frame of the state of nature and anarchy are embodied through human experiences with them. The abstract is turned memorable by connecting it with bodily experiences of pain and suffering.</p>
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<sec id="sec2-2">
<title>The emergence of international health</title>
<p>With the aforementioned interactions between the imageries of plagues and politics in mind, I will next turn to a short overview of the historical effort on the
<xref ref-type="page" id="page_29"></xref>
governance of international public health. I will review the main themes of this history from the perspective of the plague–politics nexus. The historical efforts to build an international regime of public health can be seen in two ways. They are usually narrated as a progressive history detailing the milestones in the eradication of a disease and in the emergence of the public health perspective that replaced older, more political, conceptualizations. On the other hand, they are also seen as reflections of age-old imageries whereby various political authorities have tried to frame the world as a locus of borders and contained political entities. This alternative history is based on the creation of international hierarchies and domains of power by influencing popular perceptions concerning the global patterns of disease spread, susceptibility and communicability.</p>
<p>The origins of international health cooperation are usually traced to the nineteenth century International Sanitary Conferences which, according to many modern commentators, ‘represented the earliest examples of international health cooperation, culminating in the establishment of a permanent international health organisation’ (<xref ref-type="bibr" rid="ref236">Siddiqi 1995</xref>: 14). Having said that, it is important to note that there were formal coordination mechanisms that preceded the International Sanitary Conferences. It is possible to argue that the roots of international health cooperation are as old as the state system itself. For example, in September 1652, Genoa and Toscana reached an agreement to stop the spread of plague and to integrate their quarantine regulations. This agreement resolved a crisis, the antecedents of which had to do with the intense political and economic competition between the two city states which had escalated into a mutual imposition of quarantines that hindered trade. Although this convention is a tell-tale sign of the tight and early connection between international relations and epidemics, it
<disp-quote>
<p>has passed totally unnoticed by both general historians and historians of medicine – and yet it represents a revolutionary and enlightened idea which, in the interest of ‘the common health’, envisaged international control and the voluntary relinquishment of discretionary powers by fully sovereign states in the matter of public health.</p>
<attrib>(<xref ref-type="bibr" rid="ref041">Cipolla 1981</xref>: 34)</attrib>
</disp-quote></p>
<p>Even before this agreement, which drew in other Italian city states as well, there were active networks for information-sharing between health officials as well as unofficial coordination of policies. Furthermore, the brief history of the agreement proved that it was possible to channel the actions of states away from unrestricted competition to cooperation in the best interest of all the parties involved. The diligent, persistent and unfailing implementation of quarantine regulations in the name of common interest soon became an arena for competition between ‘respectable’ states, instead of giving priority to openly self-serving political and economic objectives, giving states a first taste of the societal side of international relations. Any failures in implementing the control measures against plague easily resulted in economically crippling counter-measures that could readily be used as an excuse for achieving self-serving objectives by neighbouring states.</p>
<p><xref ref-type="page" id="page_30"></xref>What makes this ignorance of these early attempts deplorable is that it confuses the less significant need for chronological progress, culminating in the World Health Organization (WHO) of today, with the more significant breadth and depth of the interaction between states and epidemics that is not limited to international conferences and organizations, but originates from the ways in which states engage in power-politics in the context of diseases. It could be argued that the most common and powerful influences that affected the origins of international society emerged out of the plague years. From this perspective the international games within European international society have much to do with the development of common means to control plague and coordinated policies against it. The core of international society has to do with overcoming the demoralizing, subdued and opportunistic resignation to anarchy and with learning to control the uncertain international environment in the same way as states learned to coordinate the measures against plague that were considered impossible and even sacrilegious initially. The fledgling international society contained prominently the idea of control, demonstrated particularly by its use by ‘science’ as a signifier to overcome prior conceptualizations, which were characterized by unpredictable changes in fortunes and misfortunes in the context of unrestricted competition and the equally fortune-like recurrences of plague.</p>
<p>Thus, the beginnings of interstate health measure coordination had already developed in the seventeenth century. Starting from integrated quarantine regulations in early seventeenth century Italy, states have tried to stop the spread of epidemics through international health regimes, which, in the name of ‘common health, envisaged international control and the voluntary relinquishment of discretionary powers by fully sovereign states in the matter of public health’ (<xref ref-type="bibr" rid="ref041">Cipolla 1981</xref>: 34). There were several reasons for the internationalization of health, which stemmed from interest conflicts between states and their elite level groups. For example, the interests of the rising merchant class were incompatible with the myriad quarantine regulations imposed on trade by the multiple authorities. In this extremely complex situation, it is difficult to imagine that even a maestro of statecraft could have combined all the interests satisfactorily. The belief that the main objective of a government was not to arouse fear among its own population or to show weakness in the face of rival states motivated careful management of the knowledge concerning the existence of different epidemic diseases. The political intrigues highlighting the sinister motives and hostility of neighbouring states were often used in the face of quarantines and <italic>cordon sani-taire</italic> measures imposed by neighbouring states. These measures often led to the cutting-off of vital food supplies. In these conditions, any disease control measures imposed on the other states led easily to retaliatory measures that further escalated the situation. To complicate matters even further, the fear aroused by quarantines was often as great as the fear of plague itself. Attempts by officials of city states to impose restrictions on movement often resulted in a situation in which the people in quarantine had to choose between harsh punishments for trying to escape or starving to death (<xref ref-type="bibr" rid="ref215">Pullan 1992</xref>: 115). Therefore, the primary way in which the local communities and states responded to outbreaks of plague
<xref ref-type="page" id="page_31"></xref>
was to try and hide them. People who notified the health officials of a local outbreak were easily retaliated against. For example, <xref ref-type="bibr" rid="ref040">Cipolla (1979</xref>: 13) says that during the plague epidemics that hit Northern Italy in 1630–31, ‘[T]he doctor in Busto Arsizio who was bold enough to report the presence of plague in his town in 1630 and by implication requested quarantine controls, brought arquebus fire on himself and lost his life.’</p>
<p>Stemming from a very complex situation, the idea that controlling the plague was in the common interest began to gradually gain ground. The development of a centralized authority and administration first in city states and later in states opened up new avenues for controlling plague. The arrival of plague control at the interstate level was made possible by new views according to which, rather than simply committing oneself to religious piety, something could be done against plague through more earthly means. Although it was still generally agreed that plague was essentially a divine punishment, the idea gained prominence that plague came about through natural channels and worked through physical causes. These new ideas provided administrators with the novel conceptual tools to at least attempt to control the physical side of the plague by implementing changes in its physical context. Moreover, as it became evident that the plague posed a common threat to all emerging states regardless of their moral status, there was growing acceptance of the idea that states should cooperate to control the effects of the disease, not only to individual health, but to the economy as well. Because they strongly interfered with foreign trade, the varying quarantine regulations had become something of a burden for flourishing commerce with the result that the anti-contagionist thought sytem soon found strong supporters among business and government communities. There existed no clear-cut proof that diseases such as yellow fever and cholera were contagious. However, the main motive for government interest, especially of the big maritime powers, to argue for the eradication of quarantines was economic. At the same time, those states that were located close to the main routes of transmission, Russia and the Eastern and Southern European countries, were generally supportive of the quarantine measures. Thus, there seems to have been very eclectic usage of medical views, depending on one's political and economic self-interest, from the very beginning of international health cooperation.</p>
<p>As contacts between European and non-European states increased during the eighteenth and nineteenth centuries, the protection of ‘civilized’ Europe from the more ‘barbarous’ – less hygienic – countries became a primary concern of international sanitary measures. This can also be formulated the other way around: the intimate contact across distances could be easily framed negatively in disease language due to the inherent sense of lowering boundaries and introducing foreign elements. In this way the epidemic diseases of different eras have been used to ‘border’ the emerging geopolitical map: dangers were seen as stemming from the world outside Europe, where the political systems had supposedly defeated pestilences. From the European perspective, eastern countries and regions such as Turkey, Egypt and India were a cause of much worry (<xref ref-type="bibr" rid="ref283">Zacher and Sutton 1996</xref>: 56). For instance, the origins of the cholera that swept Europe
<xref ref-type="page" id="page_32"></xref>
during the 1830s were generally thought to have originated in India and Turkey. Consequently, much of the attention of the first International Sanitary Conference in 1851 was concentrated on issues such as the Muslim pilgrims to Mecca or the sanitary problems in Egypt – not because the European countries were worried about the well-being of the Muslim pilgrims, the Egyptians or the Turks, but because, on the one hand, the perceived interests of European countries were at stake and, on the other hand, the detection of problems in far-away places allowed for states such as France and Britain to showcase their own sanitary skills. Much of the writing at the time reflected the idea that the well-being and interests of Western European countries required that they have the means to control and isolate ‘barbarous’ oriental countries that spread diseases (<xref ref-type="bibr" rid="ref063">Delaporte 1986</xref>: 97). The Western powers, ‘under the guise of international control, sought to lay their hands on the entire system of sanitary protection against the Ottoman Empire, which in turn was regarded by Turkey as violation of its national sovereignty’ (<xref ref-type="bibr" rid="ref232">Schepin and Yermakov 1991</xref>: 55). In this way, international health cooperation was plagued from the outset by political squabbling (<xref ref-type="bibr" rid="ref217">Rao 1992</xref>; <xref ref-type="bibr" rid="ref232">Schepin and Yermakov 1991</xref>; <xref ref-type="bibr" rid="ref236">Siddiqi 1995</xref>). The emerging area of health expertise turned the epidemic spectacle into a contestation between the hegemonic Western health regime and the perceived pre-modern and misguided efforts by the non-Western states and communities.</p>
<p>The imaginary storyline that outlines the history of international health cooperation as progress from the disharmonious initial steps through multiple crises towards efficient organization can be seen as representing the desire to distil politics out of international health. The official WHO narratives detail in a progressive spirit the beginnings and expansion of international health cooperation:
<disp-quote>
<p>Largely provoked by the cholera pandemic of the time, threats of plague and the ineffectiveness of quarantine measures, many European leaders of the mid-19th century began to recognize that controlling the spread of infectious diseases from one nation to another required that they cooperated.</p>
<attrib>(<xref ref-type="bibr" rid="ref272">WHO 2007a</xref>: 90)</attrib>
</disp-quote></p>
<p>These conventional accounts, which highlight the role of the enlightened apolitical collective responsibility, are not only instructive about history per se, but also reveal much about today's international health cooperation's inherent historical ontology and assumptions concerning the nature of politics. This progressive ideological premise is often made in the historical accounts of the international health regime. For example, <xref ref-type="bibr" rid="ref236">Siddiqi's (1995</xref>: 15) otherwise very informative work on the history of international public health institutions makes the following point concerning the first International Sanitary Conference:
<disp-quote>
<p>At the first Conference, the interconnection between world health and world politics was self-evident: each state had sent one physician and one diplomat, each of whom had one vote in the proceedings…. All physicians were
<xref ref-type="page" id="page_33"></xref>
subsequently excluded from the second, third, fourth and fifth International Sanitary Conferences, at which only diplomats discussed disease and its consequences.</p>
<attrib>(<xref ref-type="bibr" rid="ref236">Siddiqi 1995</xref>: 15)</attrib>
</disp-quote></p>
<p>Against this background of what he considers to have been undue politicization, Siddiqi points out the gradual rise to prominence of expert knowledge, especially under the institutional rubric of WHO. He also makes clear how the medical expertise paradigm broadened to include other related realms of expertise: ‘[t]he inability of medical experts alone to eradicate malaria suggested a role for previously unwelcome non-medical experts, such as economists, sociologists, anthropologists and geographers’ (<xref ref-type="bibr" rid="ref236">Siddiqi 1995</xref>: 195). This progressive version of history often inherent in international health narratives amounts to perceiving an imagery ‘emplotment,’ proceeding from a Machiavellian power-political world towards increasingly technical and specialist regimes of functional cooperation. The inherent hope of this framing has been that the repeated positive experiences of cooperation in functional organizations would make possible more ‘constructive’ international cooperation, not hindered by over-politicization. Furthermore, an important argument of this progressive or functional theorizing is the view that the breakdown of the globe into separate sovereign political entities is the main cause for difficulties and failures in maintaining peace and maximizing welfare.</p>
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<sec id="sec2-3">
<title>Public health's compassionate containment dramas</title>
<p>As an ideological construct, public health can be said to share an element of compassion with humanitarian discourse and tradition. To a large extent, public health is compassionate participation in the perceived betterment of humanity. However, it may be suggested that the emphasis placed on the sense of containment makes global public health practices an ideologically distinct mixture of compassion and containment. Diseases are conceptually tightly interwoven with borders, bounded entities, contained wholes and clear hierarchies. For example, during the early 1830s a sense of national self-confidence and belief in its high level of civilization were tangibly present in the French attitudes towards the advancing cholera epidemic. Apparently inspired by a sense of national or civilizational pride, one French citizen proclaimed that cholera could not conquer France because ‘in no other country of (the) globe have civilization, industry, and commerce achieved a higher degree of perfection and in no country but England are the rules of hygiene more faithfully observed’ (<xref ref-type="bibr" rid="ref162">Larrey 1831</xref>: 28). In the end, the high degree of ‘civilization’ that the French and the English attributed to themselves did not spare them from the cholera epidemic. However, it did, for a moment, allow the French to regard themselves as a first class nation at least in comparison to such ‘corrupted’ and ‘disorderly’ countries as India or Turkey (<xref ref-type="bibr" rid="ref063">Delaporte 1986</xref>: 16). In several important ways, the perceived pattern of the disease translated into a supposed hierarchy of political orders. As the
<xref ref-type="page" id="page_34"></xref>
religious explanations of pestilence were gradually complemented and then supplemented by more secular beliefs and attitudes that had to do with administrative and scientific effectiveness, the underlying coupling between perceptions of decay and decline and outbreaks of epidemics remained in place. The legitimacy and viability of a state became dependent on its ability to avoid serious and widespread outbreaks with the result that the asymmetrical distribution of diseases – that is, the ability to keep in check a disease that was rampant elsewhere – was considered to be a powerful legitimating factor. In a sense, the uneven spread of an epidemic disease translated into what can be called ‘containment dramas’. The dramatized disease maps seemed to reveal at a single glance something very powerful about the underlying politically pertinent ‘truths.’</p>
<p>Political compassions entail closely interwoven practices and associated modalities, as, for example, in the form of humanitarian and human rights discourses. These can be seen as separate from power-politics. However, a historically aware overview of them is bound to conclude that the various phases of the humanitarian movement correlate with the periodization of world orders. It seems that compassionate practices and world order go hand in hand with the result that they can be seen as mutually expressive (<xref ref-type="bibr" rid="ref006">Aaltola 2009</xref>: 1–10). There are many historical examples of the compassion–power nexus. For example, the so-called ‘white man's burden’ got much of its substance from racial and evolutionary ‘scientific’ doctrines. This enabled the discourse during the colonial period that the West was not in Africa to conquer, but to help (<xref ref-type="bibr" rid="ref030">Brantlinger 1985</xref>: 167–8). Imperial power gained a compassionate modality and the betterment of people's health in the colonies became a sign of legitimate imperialism: ‘[o]sten-sibly removed from the realm of land and politics, colonization viewed through the lens of salutary medical aid was made to seem essentially humanitarian’ (<xref ref-type="bibr" rid="ref150">Kelm 1998</xref>: 101). World order shapes what is regarded as legitimate forms of compassion and the practices of compassion enable particular kinds of legitimate political hierarchies. This intimate relationship can also be formulated as follows: the generalized object of compassion may be regarded to be the world and its order. One can, for example, feel compassion towards the general state of the world. As the reaction to the 11 September 2001 (9/11) attacks in the US demonstrated, the hegemonic political body can become an object of compassion: some at the level of both polities and individuals felt for the US, the US-led world order, and their privileged place in it – the flowers laid at the gates of American embassies all over the world reflected these political compassions. Or, one can worry over the sustainability of global processes, for instance, by favoring actions to be taken to fght global warming. As is immediately obvious, world order compassions are many. The more specific practices of feeling compassionate towards distant suffering can be seen as enactments of the more general sentiments for a particular world order perceived as legitimate.</p>
<p>What constitutes a global mobilization of empathy? What are the various ingredients in its construction? It is evident that bursts of compassion, as, for example, in the form of humanitarianism, may have widespread consequences in world politics. Cases such as Bosnia, Somalia, Kosovo, and Darfur demonstrate
<xref ref-type="page" id="page_35"></xref>
that compassions can be used as bases for international interventionist actions. Besides being the grounds for state level action, the politicization of visible mass suffering may lead to compassionate mobilization at the grass-roots level. In most cases, these mobilizations are routed through the transnational community and their impetus may provide a strong sense of legitimacy to the various humanitarian NGOs. Acts such as urgent appeals for generosity, spontaneous donations, collection of eyewitness accounts, publicized views from the ground, and testimonies of inhumanity are constituents of such mobilizations. On the other hand, under certain conditions, these mobilizations may include a more or less prominent international aspect. Governments and their organs are propelled into action in international mobilizations of solidarity for people who are perceived to be suffering. In some cases the solidarity is not limited to international emergency aid, coordination of donations or intergovernmental meetings, but proceeds along the path of a humanitarian intervention and even ‘humanitarian war’. Thus, the construction of humanitarian compassions involves factors that influence how human suffering becomes an issue in world politics and how the precise nature of the prevailing world order influences the form and directionality of compassionate activity.</p>
<p>Although political compassion often portrays itself as a genuine, instinctive, human emotion, the more culture-specific synthetic aspects of ‘compassion at a distance’ should not go unrecognized: political compassions often interact with more encompassing nuanced iconographies, sophisticated ‘figuralities’ and intricate patterns of authority. Moreover, the resulting contrived or synthetic forms of political compassion have a strong relationship with the different configurations of world order. As the humanitarian actions target those at the peripheries and margins, they also involve the reconstruction of geopolitical imageries. These spatial imageries identify who is who and by what means the different levels of the power hierarchy legitimately interact and communicate as well as violently clash. From this perspective, the suffering body is also a multiple one. The direction of compassion can be towards individual sufferers as supposedly ahistorical and apolitical configurations. However, it is often the case that the compassion is directed towards bodies that are deemed to be suffering because of their religious, ethnic, gendered, racial and sexual markers. The way in which pain and suffering are ‘seen’ start to take on dimensions that implicate not just the very humanness of the sufferers, but also the more political modalities of the suffering. The suffering becomes recognizable through place-and time-specific political lenses. Moreover, the political dimensions of suffering may highlight the historically conditioned sensitivities of the ‘caring spectator.’ These sensitivities, in turn, are often given shape by the national contexts of the spectators and their respective positions in the world order hierarchies.</p>
<p>The way in which the sufferers of ‘compassionable’ pain are constructed at distant places is closely connected with the earlier mentioned power-political sensitivities. The individualization of the sufferer in modern secular public health, humanitarian and human rights discourses points to an important watershed in the history of sufferer construction. The modern sufferer is often framed
<xref ref-type="page" id="page_36"></xref>
as a contextless apolitical figure, existing in the heavily temporalized situation of an emergency. The figure is made to represent all of humanity through being not more than a human at the mercy of stereotypical inhumanity stemming from the antagonistic rogues or from the mutating agents of destruction. This ‘zooming in’ to the individual level may allow for the construction of the epicentre of suffering, where the voiceless sufferer communicates only through the visual language of individual pain. The complexity – for example, the historicity of various groups of suffering people, their self-understanding and their socially shared meanings placed on the collective suffering – recedes to the background and the definition of the sufferer ‘as a singular category of humanity within [the] international order of things’ crops up (<xref ref-type="bibr" rid="ref181">Malkki 1996</xref>: 379). The distant sufferer, with distinct and shared memories, beliefs and myths about what has happened, why and for what end, is cleansed when the figure is refined into a Westernized form (<xref ref-type="bibr" rid="ref181">Malkki 1996</xref>: 380). It would appear that for a distant sufferer to become a member of the general human polity deemed worthy of assistance, it has to be denied membership of other narrower political communities and collective historical narratives.</p>
<p>The apolitical conditions inherent in this emergency imagery are comparable to those produced by the ‘anti-politics machine’ referred to by <xref ref-type="bibr" rid="ref091">Ferguson (1990</xref>: 17). The term, anti-politics machine, refers to the ‘industries’ that apply presumably ‘technical solutions’ to such political problems as conflict, poverty, suffering and hunger (<xref ref-type="bibr" rid="ref091">Ferguson 1990</xref>: 19). The machine – the interlocking repertoire of established ‘solutions’ and the infrastructures or networks of actors involved – renders politics towards distant others into a series of rational or technical problem-solving exercises. Although this production of subjects is itself a political act, it is political in a specific sense of the word – it is politically privileged by its appearance of being apolitical. Further light can be shed on the humanitarian ‘anti-politics machine’ through <xref ref-type="bibr" rid="ref023">Roland Barthes' (1980</xref>: 45) concept of ‘depoliticized speech.’ The practice of depoliticized speech is based on rooting the political out of one's actions and turning them into something that is self-evident and natural. The sufferer is produced as an ahistorical and universal humanitarian subject in the apolitical governance language of the international agencies administering them (<xref ref-type="bibr" rid="ref181">Malkki 1996</xref>: 378). However, such speech only hides the deep power-political significance of this way of constructing the body in pain. The rendering of an emergency into a realm where perceived ethics, not politics, matters enables specific types of ‘compassionate’ action and their co-option by actors in whose interest it is to turn a distant place into an apolitical object of Western intervention (<xref ref-type="bibr" rid="ref188">Minh Ha 2004</xref>: 269).</p>
<p>Paralleling the construction of the sufferer, two other framings tend to take place. First, the staging of the emergency drama involves the building of a self-image of the helper and an image of the ‘rogue’ and the ‘failed.’ These enmity constructions feed back to the understanding of the sufferer and to the workings of the anti-politics machine. The disembodied sufferer's existence is implicated in the ‘good Samaritan’ actions of the intervening party. The communal level dynamics start to prevail over the sufferer whose real suffering is of secondary
<xref ref-type="page" id="page_37"></xref>
importance to the communal stock narratives of enmity and of one's essential goodness. Those bodies that are related to the category of the ‘other’ suffering are not empathized with; they are regarded in uncompassionate terms. These emergency dramas contain an object world with the intervening protagonist at one end, the ‘bad’ element or the rogue or the failed at the other, and both communal and individual bodies in the middle.</p>
<p>In the prevailing emergency narratives, the empathized-with sufferers are seen in apolitical terms. Paradoxically, this apolitical individual suffering is often still bounded by seeing it as part of a communal body. The significant suffering of others is commonly seen through the lens of a bounded in-group, a political body. More often than not this group is equated with national boundaries (<xref ref-type="bibr" rid="ref218">Reicher <italic>et al.</italic> 2006</xref>). The iconography of such suffering has a long and rich history. The suffering of a political body provides an important embedding for the humanitarian type of suffering:
<disp-quote>
<p>Narratives of pain materialize an abstract entity like the nation-state to its citizenry, transforming it into a body that is symbolically connected to that of the individual … the frequency and intensity of the pain-filled language and the historical persistence of conflicts over sovereignty indicate that the wounds are spread throughout the body politic.</p>
<attrib>(<xref ref-type="bibr" rid="ref034">Burns <italic>et al.</italic> 1999</xref>: 122)</attrib>
</disp-quote></p>
<p>In this culturally significant genre of political pain, the whole polity may suffer. This suffering is a signifier of wider human suffering and, as a result, it often takes precedence over the individual's body in pain in which pain language is turned into a symptom of something bigger and more meaningful taking place at the level of the more encompassing political body. Visuals of individual suffering become contextualized in terms of a wider national or ethnic group's pain. In this way, the plight of a person under Serbian rule in Kosovo was seen as the ethnic or national suffering of the Kosovo Albanians. The suffering of a poison gassed Kurd village in Northern Iraq was turned into the suffering of Kurds as a political community of people.</p>
<p>Let's consider for a moment how the contemporary imageries of an emergency provide a context for the construction of suffering political bodies. There are different types of emergencies: natural (hurricanes, earthquakes, tsunamis and pandemics), technological (industrial accidents) and political (genocides, wars and conflicts). However, the general format of the emergency drama is to an extent shared between them. Whereas in traditional international wars, crises and conflicts, a spatial feature is essential, the contemporary emergency situations often involve a heightened sense of scarcity of time when the window for effective intervention seems to be closing. Thus, emergency situations are first and foremost temporal rather than spatial dramas. Pandemic scares provide good examples of such temporalization, when all attention becomes concentrated on one critical moment in time. Time becomes increasingly salient when the rush to find solutions – cures, vaccinations or cordoning – is accompanied by an
<xref ref-type="page" id="page_38"></xref>
accelerated tempo of events. In its stereotypical ideal form, the emergency plot suggests temporalized imageries of a sequence of events: the initial triggering event, intervening curing activity by the ‘authorities,’ and eventual restoration of normalcy. That said, the sudden disappearance of the regularity inherent in emergencies has also a spatial dimension, which leads to a collapse of vastness and into a sudden condensation of the ‘near’ with the ‘far.’ Whereas spatial distance is a buffer from the effects of international crises, the distance related to emergency dramas turns into something to be crossed by outsiders rushing in to heal the situation while it is still containable in the emergency area. In this sense, the geography becomes concentrated in one tight epicentre or Ground Zero. The rushing in dynamics constructs a situational agency: those able to do so become important protagonist embodiments, while those hindering this activity get marked as antagonist elements.</p>
<p>Thus, emergencies seem to compel involvement, breaking the usual ‘nearest is dearest’ boundaries and allowing emotional bonds at a distance. There has been a considerable amount of research on the emotional dynamics of ‘nearest is dearest’ (<xref ref-type="bibr" rid="ref241">Smith 1998</xref>). <xref ref-type="bibr" rid="ref100">Glover (2000</xref>: 28) points out the inherent contained nature of political sympathies: ‘[c]laims to be treated with respect are often linked to standing within a group. The claim of an outsider may be minimal. Sympathy has similar limitations. The sympathies which really engage us are often stubbornly limited and local.’ Similarly, <xref ref-type="bibr" rid="ref099">Ginzburg (1994</xref>: 49) refers to a tradition of pity extending to Aristotle, which equates distance with strength of feeling. Ginsburg states that extreme distance in space or time leads to indifference. What is implied in this statement is a horizon, the end of identification at the intermediate spatial or temporal distance. However, an emergency blurs this ‘normalcy.’ At the moment of an emergency, the ‘we-communities’ theorized by <xref ref-type="bibr" rid="ref223">Richard Rorty (1989)</xref> may be able to extend their self-identity and solidarity beyond their bounds. We-communities are often statist or national as in the case of US agencies rushing in to stop the spread of SARS before it reached the US.<xref ref-type="fn" rid="fn2_7"><sup>7</sup></xref> However, the global scene of emergencies often animates and empowers wider political embodiments. As the emergency extends we-communal boundaries vis-à-vis distant sufferers, it also extends the we-communities into global embodiments. In this sense, the global can turn into hegemonic or Western as the agencies of Western governance are seen to be able to act and eliminate the danger. While the world zooms in to the epicentre of an emergency, it zooms out to embody itself in a highly power-political way. Examples of this dynamic are numerous in recent pandemic discourse:
<disp-quote>
<p>Once again, nature has presented us with a daunting challenge: the possibility of an influenza pandemic [avian fu]…. Together we will confront this emerging threat and together, as Americans, we will be prepared to protect our families, our communities, this great nation, and our world.</p>
<attrib>(President Bush, 18 November 2005)</attrib>
</disp-quote></p>
<p>President Bush focussed on the emergency caused by the avian fu scare by embodying it in an encompassing template of ‘America's world.’ A pandemic
<xref ref-type="page" id="page_39"></xref>
emergency can be said to contain both these movements as the rushing to zero in is accompanied by zeroing out to imagine the encompassing political body implicated in an emergency.</p>
<p>While keeping in mind the movements in and out that embody those involved and the totality of events in a pandemic object world, I will refocus on the theme of compassionate engagement. It may be argued that besides the political mobilizations for engagement, the politics of global indifference comprises a culturally-crafted tradition that is closely linked with that of humanitarianism. The ‘images of the heart’ are based on skilled use of ‘codes and conventions’ that manage the different outcomes of the action–inaction dialectic. When powerful images manage to create alarm and a spreading sense that something must be done immediately, they do so because they remind one of the powerful images of perceived past emergencies. It is suggested that the practice of emergency engagement consists of combining the right past imagery with current images – for example, the famous image of starved Bosnian Muslim men behind barbed wire in 1992 which reminded people of the images of the Holocaust. The same discursive power is involved in the creation of sanitized and ‘pretty’ images of distant mass suffering that will not react with the old images in ways that would mobilize people for action. In the hybrid idea of humanitarian war, both these aspects of political skills come into play simultaneously. This combinatory synergy clearly reveals the hyperbolic stakes involved, and identifies the protagonist for humanity, the suffering victims, the witnessing audience, and tells them apart from the barbaric antagonists. In this way, while illuminating roles and responsibilities, emergency interventionalism – or zooming in to restore ‘normalcy’ – articulates and acknowledges patterns of power.</p>
<p>The patterns of caring and being indifferent also implicate a third option – the practice of containment, one of distancing, avoiding and removing. This discursive dynamic manages, restrains and keeps in check the patterns of engagement in ways that, in general, lead to distancing and to the erection of physical and/or imaginary boundaries that maintain and signify the distance. <italic>Although different from compassion, containment can be seen as another form of engagement and involvement</italic>. The practices of containment involve highly controlled regulation of contact aimed to stop the communicability of a perceived dangerous element such as a pandemic disease out of the epicentre of an emergency.</p>
<p>One way to approach the difference between movements of compassion and containment is to briefly consider the objects of worry and care in both. The history of political compassion poses an important question concerning the ultimate nature of compassion: is it altruistic behaviour or is it masked selfishness? The logic for compassionate actions might arise from one's own interest: ‘[w]hat is happening to the other person might happen to me one day, therefore, I have to help.’ This type of compassionate interventionism is based on recognition of mutual self-interest (<xref ref-type="bibr" rid="ref240">Slim 2001</xref>: 325). On the other hand, the imaginative act of placing oneself in the position of the sufferer may allow one to better appreciate the other person's suffering, so that one gains better appreciation of the situation that requires helping actions, irrespective of any selfish considerations. Thus, the
<xref ref-type="page" id="page_40"></xref>
basis of compassion may be the better understanding of the other's situation instead of ‘what if this were to happen to me’ type of thinking. The imaginative communicative channel that opens between the spectator and the sufferer has often been thought of in terms of the signs of suffering – tears, crying, twisting and groaning. This elementary and notably embodied communication has been framed in instinctive, iconic terms. Compassion is an altruistic and natural moral reflex. This doctrine centres on the notion of compassion being an irresistible human attitude (<xref ref-type="bibr" rid="ref092">Fiering 1976</xref>: 196). The doctrine of irresistible compassion has competed with more sceptical and cynical perspectives concerning the fundamental nature of compassion. These critical views have been wide-ranging. Some have pointed out the less than altruistic nature of basic animal instincts, while others have stressed the calculative human capacity to co-opt suffering.</p>
<p>These two scenarios of compassion blend partially in a third important way of understanding compassionate engagement with sites of distant suffering. The tendencies to equate compassion with a relatively naturally occurring emotion or with a selfishly motivated calculative sentiment contrast with the view that compassion is a synthetic sentiment that is embedded as one modality in a larger social construct. For example, acts of commiseration can be given communal status whereby they stand for a modern enlightened and sophisticated identity. This compassionate identity is often an empowering embodiment in the present Western culture. Formulated in more normative terms, the more synthetic compassion may be viewed as an enlightened stage in human social evolution, as an emergent property, and as ‘a historical stage in the education of the emotions’ (<xref ref-type="bibr" rid="ref092">Fiering 1976</xref>: 212). These naturalistic and cultural modalities are part of the multidimensional and polysemous discourses of political compassion. They explain to a degree why an engagement with distant sites is ethically, culturally or politically valued.</p>
<p>Containment as a form of controlled engagement is not that different from compassionate interventionism. Containment can also be formulated in terms of it being a selfish, self-regarding activity. For example, the severing of fight connections with Mexico during the spring of 2009 can be seen as motivated by the desire to stop the spread of swine fu to a particular country or place. On the other hand, it is possible to see a pandemic emergency as an instigator of compassion for the more encompassing political identities. I have already discussed the ways in which compassion is often directed primarily towards various types of in-groups or we-communities – ethnicities, nations, or empires. It is important to see how a particular hegemonic world order can become an object of compassion. It is also clear that human polity or humanity may be regarded as an object of the containment type of worry and care. These wider, more encompassing political embodiments are the emergent properties of a pandemic emergency. The practices of compassionate containment can be seen as stemming from such compassion, instead of being only self-interested we-communal activity. However, one should note that the practices of containment also contain worries over narrower and more specific definitions of we-communities. It is often the case that the narrow and more encompassing sentiments are nested within each
<xref ref-type="page" id="page_41"></xref>
other as was indicated in the earlier mentioned remark by President Bush about avian fu: ‘[t]ogether, as Americans, we will be prepared to protect our families, our communities, this great nation, and our world.’ Such sentiments can form an interlocking concentric whole when hegemonic we-communities extend themselves into the wider definition – for example, the West can easily turn into a definition of humanity.</p>
<p>To shed more light on pandemic related compassion as a form of containment it is important to further examine the general nuances of compassion. <xref ref-type="bibr" rid="ref073">Donini (2010</xref>, 224) refers to the three Cs of compassion: compassion as ‘other’-regarding work, compassion as a movement for social reform, and compassion as a world-order conserving and retaining activity. The third option may entail, for example, making sure that excesses of power are mitigated so that the world order does not spin dangerously out of control. A more conscious form of compassion as containment refers to the deliberate incorporation of humanitarian practice in the security strategies of the north (<xref ref-type="bibr" rid="ref073">Donini 2010</xref>, 230). The possibility of compassion fulfilling a containment function has been noted influentially by <xref ref-type="bibr" rid="ref076">Duffield (1998</xref>: 156), who said that humanitarian action can become integrated into the world order ‘to manage symptoms of global polarization and exclusion’. To reiterate, the containment tendency of compassionate action can surface in at least three inter-related ways: containment of the alarming trigger perceptions and imageries (such as managing the availability of the images of the heart); mitigation of some of the most painful characteristics of a world order (such as the birth of the International Red Cross movement); and the more ethical and high-minded strategies that give a good name to the underlying power-politics (such as allowing for power-political action in the legitimizing name of humanitarian intervention).</p>
<p>In international public health discourse, the importance of the move of containment is explicitly articulated. The containment discourse finds its expression in the various overlapping scenarios of ‘containment zone,’ ‘quarantine,’ and ‘<italic>cordon sanitaire.</italic>’ These practices can be seen as forms of compassionate containment. That said, one should not forget the element of indifference – the stubborn fact is that even though pandemic diseases are framed as emerging or re-emerging diseases, many of them have been continuously present in many areas of the world. However, I will concentrate on the various momentary resolutions of the double moves to contain and to show compassion while keeping in mind that emergency situations are highly differential and selective. The imageries of containment, compassion and indifference provide tangible substance to the present-day world order, in which power-political's ‘territories of fear’ animate and make tangible the substance of international public health.</p>
</sec>
<sec id="sec2-4">
<title>Imageries of compassionate containment</title>
<p>One can see that containment related tendencies are present also in the compassionate strategies that target the maintenance of national, regional and global pandemic security. In the pandemic security discourse, there is a marked
<xref ref-type="page" id="page_42"></xref>
tendency to highlight different containment strategies. Generally, the containment strategies focus on containing an emerging disease at the site of its outbreak. The idea is that the containment of a disease in the limited area of its initial occurrence is in practical terms the only available option. Once a pandemic disease has broken out, the efforts have to concentrate on ways of reducing the mortality and morbidity, and on mitigating other consequences. Even if a pandemic outbreak cannot be totally contained, the efforts to do so might serve to delay an all-out pandemic and provide time for the preparation of other actions:
<disp-quote>
<p>The international containment strategy is based on studies suggesting that efforts centred on using antiviral drugs to prevent infection as well as treat cases might contain a pandemic at the site of the outbreak or at least slow its international spread, thus gaining time to put emergency measures in place and develop vaccines.</p>
<attrib>(<xref ref-type="bibr" rid="ref052">Crosse and Gootnick 2007</xref>: 16)</attrib>
</disp-quote></p>
<p>Containment is based on the geographical notion of a ‘containment zone.’ A containment zone is large enough to circumscribe all the known cases and those in close interaction with them. The movement of people across the limits of this zone is restricted.</p>
<p>One way to understand lethal epidemic diseases is to embed them in a political landscape. The evolving disease language becomes a vital part of this political landscape. Borders have played an important role in the history of disease. Various disease control efforts have often concentrated on the physical isolation of pestilence. The practice of quarantine offers a case in point of borders in connection with diseases. Quarantine refers to the isolation of known and possible sources of contamination, whether animals, commodities, things or humans. Quarantine practices started to take shape at the end of the fourteenth century in the context of freely spreading plague epidemics. In its most basic form, quarantine consisted of keeping a ship docked outside of the harbour for 40 days (<xref ref-type="bibr" rid="ref155">Kilwein 1995</xref>). Inland quarantines isolated those actually or probably infected with plague to their homes or to special lazarettos. On a wider scale, it was common practice to establish roadblocks to city gates or along roads to stop dangerous contacts and to stop commerce. The repertoire of methods also included large-scale military <italic>cordon sanitaire</italic> practices involving the isolation of localities, cities and villages in siege-like arrangements (<xref ref-type="bibr" rid="ref239">Slack 1991</xref>). Evidently, borders, diseases and cures are intimately connected from this historical perspective.</p>
<p>The modern pandemic-related containment measures have been coordinated by WHO.<xref ref-type="fn" rid="fn2_8"><sup>8</sup></xref> However, there are states that have declared that efficient worldwide pandemic control measures are in their national interest. The inclusion of pandemic threats in national security strategies anticipates future forceful public health interventions in the case of an alarming outbreak. WHO's World Health Assembly of 2005 started a process to come up with a global protocol for rapid
<xref ref-type="page" id="page_43"></xref>
response and containment in the eventuality of an epidemic breakout. In March 2006, WHO held a global technical meeting to finalize the early containment protocols for pandemic influenza. The draft highlighted the unpredictable nature of pandemic influenza:
<disp-quote>
<p>given the unpredictable behaviour of influenza viruses, no one can know in advance whether the start of a pandemic will begin gradually, following the emergence of a virus not yet fully adapted to humans, or be announced by a sudden explosion of cases, thereby precluding any attempt at containment.</p></disp-quote></p>
<p>In cases where containment was possible, the protocol stated that the mass administration of antiviral drugs must begin within 21 days following the initial detection. This placed much importance on the early detection, investigation and reporting of influenza symptoms. The protocol made it clear that local government cooperation was vital for any efficient response. The immediate control measures included the following:
<list list-type="order">
<list-item><p>Isolation of clinical cases of moderate-to-severe respiratory disease and other patients under investigation in respiratory isolation rooms or single rooms.</p></list-item>
<list-item><p>Identification and voluntary home quarantine of asymptomatic close contacts and daily monitoring for symptom onset.</p></list-item>
<list-item><p>Administration of antiviral drugs for the treatment of cases and, if domestic supplies permit, for the targeted prophylaxis of close contacts.</p></list-item>
<list-item><p>Strict infection control and the use of personal protective equipment in health-care facilities caring for cases during the delivery of health care.</p></list-item>
<list-item><p>Intensive promotion of hand and cough hygiene.</p></list-item>
<list-item><p>Domestic cleaning, using household cleaning products, to reduce transmission via fomites (infectious respiratory secretions on surfaces).</p></list-item>
</list></p>
<p>The exceptional measures, when the situation worsened, included quarantine:
<disp-quote>
<p>The SARS experience suggests that quarantine, applied on a voluntary basis only, is preferable to enforced quarantines and may be equally effective…. At the same time, however, national, sub-national, and local governments should be legally prepared to enforce individual and community-based containment measures if warranted.</p>
</disp-quote></p>
<p>The protocol also recommends methods of ‘social distancing,’ which ‘might increase the likelihood of successful containment.’ Social distancing methods can include the closing of schools and workplaces; cancellation of mass gatherings and public transportation; community based confinement within homes; and border controls. The term, ‘extraordinary public health action,’ is used by national and international public health authorities to refer to rapid containment procedures to stop the start of a pandemic. In the WHO protocols, they must be
<xref ref-type="page" id="page_44"></xref>
considered if evidence suggests that a localized outbreak may have global effects and start a pandemic. These extraordinary measures are established by the local authorities with the help of extensive international assistance and with the expectation of efficient sharing of information and communication. Under such measures, people interaction is restricted in the containment zone: the current version of the WHO Protocol
<disp-quote>
<p>takes a geographically based approach where the initial area of outbreak becomes the main target – the containment zone – in which actions are taken to stamp out the infection and prevent its spread. Within the containment zone and in an area around it called buffer zone, surveillance and community mobilization will check and maintain containment. In the buffer zone, any ‘breakthrough’ cases are quickly detected and isolated.</p>
<attrib>(<xref ref-type="bibr" rid="ref079">Dutta 2008</xref>: 15–16)</attrib>
</disp-quote></p>
<p>Perimeter controls are enforced on the boundaries of the containment zone. Around the buffer zone, there are no perimeter control measures. The protocols are based on an assumption that the state first affected will be willing to accept the interventions, ‘which will be intrusive and could be viewed as infringing on national sovereignty’ (<xref ref-type="bibr" rid="ref086">Eurosurveillance 2006</xref>). Although WHO lacks reinforcement mechanisms to force affected states to participate in the containment strategy, it is clear that other countries would be willing to enforce such policies. For example, the US 2010 National Security Doctrine describes pandemics as one danger that will lead to possible US intervention ‘as we do everything within our power to prevent these dangers.’ Although left unsaid by WHO, it is clear that the military is the only institution able to set up and maintain the containment and buffer zones.</p>
<p>There are many known unknowns and unknown unknowns in pandemic emergency situations. The imageries of the worst case scenarios do not offer much time for effective action, which has to be implemented in the absence of extensive knowledge of the fundamental nature of the (re)emerging pestilence. Because there is much uncertainty, the most likely reaction to a perceived pandemic outbreak is likely to be to mix the expert approach with culturally important stereotypes about violent epidemic diseases. In a review of public health epistemologies, <xref ref-type="bibr" rid="ref018">Baldwin (1999)</xref> sees two major historical trajectories. First, the ideas concerning human to human contagions are old. However, the more precise causation remained mysterious until the nineteenth century. The other school is the ancient and influential localist tradition, which asserted that diseases ‘arose independently in each [location] from various indigenous circumstances’ (<xref ref-type="bibr" rid="ref018">Baldwin 1999</xref>: 3). The contagion school concentrated its efforts on what Baldwin calls ‘quarantinist’ efforts to break the chains of contagion with policies of isolation. The localists could not do much in the case, so they attributed the ultimate cause to astronomical and climate related events. However, once ‘the pertinent conditions had been narrowed to human-made and individual factors in the proximate surroundings, something might be done about them’
<xref ref-type="page" id="page_45"></xref>
(<xref ref-type="bibr" rid="ref018">Baldwin 1999</xref>: 4). Instead of trying to break the circuits of contagion, the quar-antinists focused on sources of pollution, filth and contamination in human communities and in the air surrounding them. Although they originally included a very metaphorical and broad understanding of communal pollution, the quaran-tinist ideas made their way into hygienist thinking, thereby influencing, for example, poor human living conditions. Both localist and quarantinist tendencies have different implications when it comes to the underlying nature of diseases. However, at the practical and also at a metaphorical level, the two schools produced partially intertwined imageries and corresponding policies. One such dimension is the importance placed on containment. Modern day pandemic language is saturated by different nested conceptualizations fixated on the notion of containment. The markings of the perimeters of an affected site are construed in many ways in the corresponding popular imageries. One needs to fence in, create camp-like containment zones, introduce strict physical insulation, stop any attempts to escape and fee, seal the areas of disease, create bio-safety operations, and bring in technological troops and other virus hunters.</p>
<p>Before proceeding to a more detailed analysis of public health practices of containment, it is useful to touch upon the meaning of containment in the nexus of politics and plagues. The link between foreign policy containment and pandemic control has been noted in research literature (<xref ref-type="bibr" rid="ref015">Annas 1999</xref>: 37). So, it seems useful to review the practices of containment in the general international relations discourse, where containment is explicitly about sculpturing the contours of power. I want to point out the parallelism between power-political containment and public health containment, instead of claiming that political containment is primary. On the contrary, there is much truth in <xref ref-type="bibr" rid="ref083">Ellis' (2001</xref>: 106) point about the power of disease to ‘order spatial information’ and to distinguish between safe and unsafe areas. It is clear that the general disease language heavily influences our perceptions concerning political enmities, as was pointed out in <xref ref-type="book-part" rid="chapter1">chapter 1</xref>, ‘Introduction.’ The connection between diseases and enmities has a long cultural history. This history may be read to comprise a proto-theory of politics and plague, which still stimulates contemporary disease imageries. Moreover, the way in which this proto-theory dynamically embodies the object world of disease puts containment in the centre of the narrative. Generally speaking, the perceived effect of diseases on communities can be seen to be about imagined broken and transgressed boundaries, whereas the act of healing is often made to stand for the restoration of proper boundaries and for the virtuous nature of acts of such containment.</p>
<p>In order to further triangulate the political meaning of containment dramas, it is useful to see how they have been used in international relations thought. The strategy of containment is commonly linked with expansive strategies by some actors, as in the case of the US containment of the Soviet Union after World War II. According to <xref ref-type="bibr" rid="ref192">Hans Morgenthau (1955)</xref>, the fundamental aim of expansive actions is to dispose of a prevailing status quo, so as to advantage one's own power position and bring about a more favourable situation. To establish this kind of more advantageous relationship, <xref ref-type="bibr" rid="ref192">Morgenthau (1955</xref>: 54) maintains that
<xref ref-type="page" id="page_46"></xref>
states use three different types of techniques or methods: military, economic and cultural imperialism. The existence of imperialistic policies on the part of some state(s) requires on the part of other state(s) reciprocal actions to resist (containment) or allow (appeasement) changes to the status quo.<xref ref-type="fn" rid="fn2_9"><sup>9</sup></xref> In the traditional realist understanding of major power foreign policy, the policy of containment refers to restraining, restricting and confining the expansion of other state(s) within certain limits that are spelt out in forceful and uncompromising terms. The various reciprocal actions to expansive moves include confinement of an instigator inside some economic, military and cultural limits so as to make the attempts to change the status quo futile:
<disp-quote>
<p>The policy of containment erects a wall, either a real one, such as the Great Wall of China or the French Maginot Line, or an imaginary one, such as the line of demarcation drawn in 1945 between the Soviet orbit and the Western world.</p>
<attrib>(<xref ref-type="bibr" rid="ref192">Morgenthau 1955</xref>: 59)</attrib>
</disp-quote></p>
<p>The strategy of containment is often seen as the preferred option in world politics. It establishes firm limits to a particular world order and renders the actions of different actors legitimate by demarcating a common frame and a grammar for interpretation. The language making containment a normatively sanctioned option in power-politics is deeply entrenched. Such thinking can become important in the nexus of politics and plagues because it reinforces containment oriented cultural forms.</p>
<p>Examples of the influential overlap between medical and political views are many. Diseases interact with power in that they can be read as signs of illegitimating weakness or as demonstrations of unimaginable strength. The production of health has often been framed as a powerful demonstration of the legitimacy of political rule and the absence of health suggests the existence of fundamental injustice and transgressions, not only at the physical level, but in the way political power is upheld. The corresponding mythologies of this link are rich. For instance, when Sophocles' Oedipus ‘intellectually’ kills the Sphinx which had plagued the city of Thebes by answering the riddle it poses to him correctly, he gets the crown and the power. The Sphinx, a hybrid creature half lion, half human – in itself an embodiment of transgressed boundaries – poses a riddle for those trying to save the city: ‘[w]hat has one voice and is four footed, two footed and three footed?’ According to the story, anyone who could solve the riddle would save the city, but the ones that failed would be eaten by the hybrid creature. Oedipus, who is later to kill his father, unwittingly marry his mother and, as a result, tear his own eyes out of his head, answered: ‘man.’ The Sphinx then annihilates herself by throwing herself off the cliff. The correct answer to the Sphinx's question restores health in the city of Thebes and brings it new legitimate rule. It is a very commonsensical answer, which lacks any of the pomp and splendour that might have been expected of something that would save a huge number of lives. It can be taken to symbolize the restoration of commonsense
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borders to the city, which, according to the story, was beset not only by the plague, but, more fundamentally, by the supposedly moral transgression of homosexuality. Oedipus' answer restored the ‘commonsense’ morality of the community, although it is not very self-reflective, which bears upon the later tragic consequences in the story. Oedipus himself, as his name, Oedipus the ‘swollen-footed one’, suggests, used a stick while walking as a youth. The answer he gives is the right answer from the general perspective, although the ‘man’ in the answer does not include Oedipus himself. By producing such a self-alienating answer, he manages to restore the city's health, but at the same time, breaks the sacred boundaries by committing incest and, as a result, excludes himself from that community and is banished from it.</p>
<p>In order to gain better appreciation of disease mythology, it is useful to examine for a moment artistic dramatizations of disease containment dramas. The famous dragon slaying painting, <italic>St George and the Dragon</italic>, by Raphael (1504–06) offers a case in point. The hybrid figure of a dragon is a largely unrecognizable creature to contemporary imagination. The figure of the dragon was used until the early modern times as an allegory of pestilence, which was itself a symbol of sin and evil. In a more embodied everyday sense, the fgure of the dragon had to do with encounters with violent epidemic diseases (<xref ref-type="bibr" rid="ref126">Horden 1992</xref>: 20). The fiery and burning breath of the dragon referred to the equally blistering effect of plague on human bodies. The background of this is comprised of the miasmatic conceptualization of disease causation. The miasmatic perspective stated that the cause of diseases was the bad, polluted and stale air that contaminated communities. Disease did not spread through contact, but through bad air. In this way, the painful symptoms of the plague were caused by stagnant and thereby polluted air, which spread the disease like fire. The fieriness of the dragon was an expression of this conceptualization, which emphasized the ‘mal'airiness of the atmosphere. Bad air took over the political community in a process emphasizing diseases as moral, religious and political complexes.</p>
<p>Raphael's iconic painting is about a community in a terrible crisis, the cause of which is embodied in the figure of the dragon. The scene takes place at the outer perimeter of the community, the centre of which is denoted by the church tower far in the background of the painting. The epicentre of the scene – the confrontation with the dragon – is located at the margins of the community. The limit of its power – <italic>lt. potential</italic> – is a presumed circular perimeter emanating from the centre of the community. This power is being contested by the plaguing dragon, which is being fought by the patron saint of the community, whose relic is kept in the church. The object world of the painting is comprised of the dragon, the saint, the pious sacrificial maiden and the community. The painting may be read to capture the dynamic containment related narrative between these objects. The embodiment of the plague – the dragon – has emerged at the limits of the community. Its existence poses an immanent threat to the existence of the community. To discern the movement within the painting, one should remember the close connection between diseases and the religious conceptualization of morality. The moral content of the painting is signified by the patron saint of the
<xref ref-type="page" id="page_48"></xref>
community, which has been reanimated, and the praying figure in the right hand corner. The praying figure represents the role of piety in protecting against dangerous hybridity, besides being a potential sacrifice or victim. The expression of piety by the members of the community enables the elimination and banishment of the source of contamination. The saintly figure symbolizes the civil religion of the community. Only this embodiment has the power to confront and defeat the hybrid creature, whose confusing hybridity stands for broken, transgressed boundaries. The figure of the saint radiates a higher order over the physical place and the people living inside it. This characteristic quality of saints to radiate ‘potentia’ could exist only if the community maintained the rituals of remembrance enacting what the saint stood for. The socially sanctioned remembering and the cultural rites associated with it represented the cohesion of the community and brought together its members around a sense of the community standing for something higher.</p>
<p>Raphael's painting contains dynamic movement between its key objects. Much of the animating elements have been forgotten by contemporary audiences. The painting has become static for a contemporary viewer; there is no sense of immediacy or alarm. Discerning the movement in it would require memory concerning disease symbolism that many no longer have. The painting can be seen as a re-staging of a pandemic related genre of political painting. It may be argued that this genre contains an influential proto-political theory concerning the nature of the political community. The key to this genre is to perceive it as expressions of alarm, worry and anxiety over secure borders. Raphael's painting ‘takes place’ at the edge of the community. The community as a bounded and contained entity is in danger, which is embodied in the figure of the hybrid creature, the dragon.</p>
<p>Moving to more modern-day containment dramas, there are numerous other examples of this genre of imagining. These re-enactments are meant to arouse general compassion and point to the dangers of uncontained civil irreligion. They also provide an expression of remedy; acts of containment restoring the communal external and internal boundaries can stop decline and the eventual fall. Arnold Böcklin's (1827–1901) painting, <italic>Der Krieg</italic> (1896), represents the same dynamics as Raphael's work. The walled community down below in the painting is being ravaged by pestilences represented by the four horsemen of the apocalypse flying above: Death, War, Famine and Plague. The situation here is even more serious than the scene in Raphael's painting. The image is focused on the four horsemen. The community below is burning. Its walls are collapsing and the gates are wide open. It seems that through the open gates, the vortex of violent chaos has engulfed the community. The horsemen are hurrying away from the collapsed city to its neighbouring ones, symbolizing the spreading nature of violent political regressions. Böcklin's bleak painting lacks the triumphant revivalism of the curative action in Raphael's painting. The armies of violence are on the march. The grand movement is convulsing the civic nature of the <italic>civitas terrana</italic>. In Böcklin, this genre has acquired a deeply melancholic declinist variant.</p>
<p><xref ref-type="page" id="page_49"></xref>The intertwined themes of breaking of boundaries and liminality are present in this genre of containment drama. The external boundary of the community is broken or, at least, there is an acute danger that a source of contamination might be getting into the community. The infliction of the community is connected not just to external forces. Far more importantly, the source of the danger is inside the community, in the form of moral corruption and disobedience of the constitutive (civil) religion. In the genre, diseases are ‘reactive complexes’ stemming from and further inducing broken multidimensional boundaries. Even today, many diseases are readily read as signs of the dubious moral nature of the disease carrier embodiments. For example, HIV and AIDS explicated for some a stereotypical image of sexual contact between members of the same sex, thereby signifying the breaking of old and strict boundaries. It is no wonder that the disease was distorted to mean the ‘gay plague’ when it first appeared in the US in the early 1980s. In a way, HIV and AIDS, as many other diseases with strong moral and political overtones, has been equated with crossed limits and is represented by supposed liminal or peripheral creatures – the African orphan who is wasting away, the Western homosexual, or the injecting drug-user. It seems that at the level of the collective memory much is still remembered and re-enacted when it comes to the genre of containment drama.</p>
<p>The dramaturgy of Sophocles', Raphael's, and Böcklin's containment scenes seems to highlight the link between bodily suffering and communal regression. The co-instantaneous nature of war and plague is made understandable by linking them both to an underlying regressive process or flow whereby community constitutive sacred boundaries have become loose and uncontained: ‘[a]s a disease besetting a whole town, province or area, [the plague] threatened the cohesion of the social bond and called for action and containment upon a mass scale, involving socio-medico-political, and therefore also ethical, decisions’ (<xref ref-type="bibr" rid="ref047">Cooke 2009</xref>: 2). What happens tangibly in the soma of a disease sufferer and what more metaphorically happens to a political community is interlinked in the embodiments of political maladies, which cause the decomposition of the perceived underlying essence of together-mindedness. The importance of the communal staying power is made visual and tangible in the bodily suffering caused by the hybrid monster of war and disease. And the field of expectations is conditioned by this dramatic visual language and its narrative logic is saturated by the looming anxiety of more disease and war. Judged from this perspective, the double movements of compassion and containment start to overlap and become partially just one overall movement. The compassion is felt towards the communal ethos and the curative practice is one of strict containment – of reestablishing, renewing and putting together the boundaries of rule accordance in the community.</p>
<p>Thus, the aforementioned disease imageries are indicative of a powerful cultural construct. The suffering inflicted by both violence and diseases are seen as consequences of an overall communal regression. Construed in such a way, the object world contains a normative directionality. The compassionate curative action is one of restoration or reform of the presumably broken communal
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element. Furthermore, although the curative action deals with the somatic suffering, it is often seen as secondary and a by-product of the curative action at the level of more encompassing and wider political bodies. These bodies have traditionally involved nested and layered embodiments ranging from the local and state level communities to the hegemonic, imperial and global communities. In this language the compassionate containment has different implications, depending on how the primary object of the curative action is construed.</p>
<p>It can be suggested that the central legacy of the proto-politics of disease causation has been the sense of communal threat associated with the transgressions of a community's perceived sacred boundaries. The perceived trans-boundary intermixtures easily signify and start to embody diseasing political regressions. To address this dynamics, public rites are often directed against illegitimate trans-border contacts for they contain the constant possibility of contamination. Unsafe contacts, especially those taking place at a great distance, have often been perceived of in terms of suspicion. <xref ref-type="bibr" rid="ref167">Lee (1998)</xref> offers a fascinating example in her essay on English poet S.T. Coleridge's attitude towards the slave trade. During colonial times yellow fever spread around the world. The common conception was that it did not affect ‘black’ people, although it had very severe consequences for the ‘whites’.<xref ref-type="fn" rid="fn2_10"><sup>10</sup></xref> Because of this unequal effect of the fever, in many parts of the world, it was called ‘strangers’ fever'. Lee cites the literature of the time to point out that the wickedness associated with the slave trade was thought to spread through the social body like a disease. Some thought that the consumers who enjoyed the fruits of the slave trade shared this disease of guilt and were thus inviting the physical malady.<xref ref-type="fn" rid="fn2_11"><sup>11</sup></xref> The nature of the dangerous transgression connected with yellow fever was twofold. First, the disease contained a sense of the inhuman treatment of the ‘blacks’. On the other hand, the chain running from the ‘blacks’ to slave owners, producers and finally to the consumers was in a sense a chain of contagion. The sharing of the guilt also contained the breakdown of the normal barriers between localities and, thereby, between people.</p>
<disp-quote>
<p>it was the geographical movement of this disease that determined its interpretive implications. Because these early medical studies nearly always referred to yellow fever as a Caribbean disease, and since the Caribbean was synonymous with the slave trade and colonial slavery, yellow fever itself became intimately tied to the physical and philosophical effects of slavery. Together, the medical study of yellow fever and the debate on the abolition of the slave trade and of slavery kindled a series of specific concerns … about what happened when ‘foreign’ matter, or ‘foreigners’, became part of the physical or political body.</p>
<attrib>(<xref ref-type="bibr" rid="ref167">Lee 1998</xref>: 675)</attrib>
</disp-quote>
<p>The debate concerning yellow fever illuminates the geopolitical imagery that epidemic diseases have inevitably had.</p>
<p>From a general perspective, an uneven distribution of the disease burden offered culturally accessible ways of embodying and explaining it. This fact
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alone instantiates politico-somatic explanations: the disease often turns into a sign of ‘unnatural’ imperial long distance contact. Second, a disease tends to become a signifier of an unnatural and perverse contact between a foreign, racially different community, which was brought into misery, and the European consumers. The uneven distribution of epidemic diseases turns into a sign of the corrupting effects of a contact between two far-apart localities and into a symptom of imperial decline germinating from its peripheries.<xref ref-type="fn" rid="fn2_12"><sup>12</sup></xref> The logic of an emerging medical topography during the early modern times contained a sense of geographical demarcation and difference. Besides highlighting the differences between far-away localities, racial distinctions were brought up to ‘understand’ the physical and moral aspects of diseases. The ability of the Western colonial powers to subdue most of the world directly or indirectly led to a pronounced sense of racial superiority. Whereas most of the associated distinctions conveyed a legitimizing sense of the white man's burden, the distinctions based on disease topographies showed the other side of the coin. Thus, the power to dominate brought along unimaginable vulnerability (<xref ref-type="bibr" rid="ref117">Harrison 1996</xref>: 70).</p>
<p><xref ref-type="bibr" rid="ref167">Lee's (1998</xref>: 675) point about how the interpretative implications of diseases are determined by their geographical movement is crucial in understanding their reactive political content. The capacity of diseases to afflict some states and regions disproportionately constitutes related dynamics ripe with political associations at the local and global levels and between them (<xref ref-type="bibr" rid="ref222">Robins 1981</xref>). In a general sense such asymmetries can be used as an ingredient to discern who is who in the map of power and who is gaining and losing power. The examples are many: the brutal fate of Napoleon's Grande Armée provides a case in point of the lopsided and decisive effects of lethal epidemics. In the moribund Russian expedition of 1812, the typhus epidemic destroyed most of Napoleon's half a million men. The Russians, largely untouched by the disease, only had to complete the annihilation (<xref ref-type="bibr" rid="ref183">Marshall-Cornwall 1967</xref>; <xref ref-type="bibr" rid="ref222">Robins 1981</xref>). Similarly, the asymmetrical effects of epidemics manifested themselves in the tragic outcome of the contact between the Spaniards and the native Americans: ‘[t]he lopsided impact of infectious disease upon Amerindian populations … offered a key to understanding the ease of the Spanish conquest of America – not only militarily, but culturally as well’ (<xref ref-type="bibr" rid="ref186">McNeill 1976</xref>: 2). When some die and suffer from disease, while others are spared and, moreover, when these patterns ft those existing in political and cultural imageries, diseases send out a powerful, politically pertinent message. A more recent example is that of the very uneven HIV and AIDS burden. The developing countries, especially those in Southern Africa, face a relative disadvantage as compared to the developed global north. Such sharp asymmetries in the distribution of disease can result in, and have resulted in, dramatic changes in the distribution of actual capabilities as well as in the perceptions concerning such capabilities.</p>
<p>Thus, uneven distribution has turned into (dis)empowering stereotypes. As is evident from Thucydides' classical account of the Athenian plague, the uneven way in which the pestilence struck aroused the imagination of many and loaded the epidemic with persuasive analogies to other relevant themes of the day.
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Many of the ancient and biblical conceptual connections carried through until the Middle Ages. During the Middle Ages and the early modern period, one of the most puzzling and mysterious features of plague, which cried out for an explanation, was that it struck in some places and killed most of the people living there, while other places were completely spared. The pattern of its spread attracted culturally meaningful explanations. It caused emotional storms that swept over much of the populations in both the affected and the spared places. In many stereotypical explanations the irregular and asymmetrical pattern of the plague epidemic was thought to be correlated with the relative righteousness of various nations, localities and individuals. As the medieval system was replaced by the state system around the time of the Peace of Westphalia, the nature of epidemics as an international political phenomenon lost much of its religious charge and became instead part of the mythology and political religion surrounding the state itself: its public hygiene, moral sanitation and political health.</p>
<p>During the Middle Ages, the iconic plague figure turned from the classical hybrids into the Christian symbols of godly thunder arrows and equally fiery dragons, which exhaled their poisonous vapours (<xref ref-type="bibr" rid="ref126">Horden 1992</xref>: 47). The dragon that lurked at the city gate ready to kill its inhabitants was a completely inhuman hybrid, an unreal blend of reptiles and birds. Whereas, in the case of the Greek myths, the elimination of the problem required rhetorical healing words – restoring commonsense and political friendship – a task that was much more physical in the case of the disease spreading dragons. However, the thematic emphasizing the healing power of commonsense remained at the centre of containment dramas. In the language of plagues and people, the curing, containing action is often directed to the therapy of the political bodies. <xref ref-type="bibr" rid="ref084">Entralgo (1970</xref>: 177), in his book concerning the classical notions about ‘healing speech’, compares the fundamental aim of political rhetoric to the mission of medicine in that
<disp-quote>
<p>the mission of rhetoric is … not to persuade but to discover the persuasive element that there may be in each case, just as the mission of medicine is not to cure … but to ascertain how and in what measure each patient is curable.</p>
</disp-quote></p>
<p>Every successful act of political rhetoric is based on there being a resonating board of shared ways of interpretation, which the speech act further reinforces and re-stages. The central insight is the equation of the establishment of the shared area of persuasion with the establishment of the general curability as a realm of deliberate politico-medical action. In Entralgo's nuanced study of classical thought, the realms of rhetoric and Hippocratic medicine were highly interchangeable in that the existence of a realm of persuasive and convincing political rhetoric created the conditions that were conducive for the successful therapy of the political body. The locus of ‘health’ becomes a reusable chalkboard for the articulation of various visions for creating and maintaining political communities. In this way, the tangible curing of somatic bodies creeps into politics as the
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proto-theories of health also address how to form self-contained constitutive elements for different political communities. The embodiment of a legitimate political actor is conceived of in terms of its ability to exert a cure or containing influence on the community, whereby the community's persuasive element is given additional staying power.</p>
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<sec id="sec2-5">
<title>The hegemonic containment dramas</title>
<p>The starting point is that containment experiences are vital for the embodied extension of political life: the socially shared and often personally lived containment experiences, for example, at international borders, greatly influence the way in which people understand their belonging and non-belonging to diverse nested national, local and global we-communities. Containment as lived life dramas contain an important political pedagogy based on selective processing and filtering. These dramas of selection that take place, for example, at airports or hospitals are not only physical. The main relevance of these dramas is not that they may be of decisive importance to an individual. The individual dramas are part of a larger cultural schematic, the inherent logic of which is acknowledged in the way people leave it relatively unquestioned. The prioritization of vaccines to certain groups under a pandemic scare is not so much about the content of that particular drama; rather, the main element is the seldom questioned premise on which such containment, selection and bordering is undertaken. Besides acknowledging the basic legitimacy of the schematic, people also implicitly acknowledge and recognize the authority of certain political bodies, which carry on the containment as natural and necessary. When people were quarantined in their hotels during the 2003 SARS scare in Hong Kong, they accepted their fate. The worldwide audience, who saw them trapped in their hotels, felt some pity, but the act itself was mostly accepted as ‘what naturally happens under pandemic situations.’ Moreover, such a salient case of isolation could also have been conducive to a certain sense of security in that some authorities were seen as acting and doing what should be done. The drama sets the imaginary templates for acknowledging the logic and authority therein of separating people into various entities and of crafting hierarchies from them.</p>
<p>It can be argued that the state has always benefitted from the silent acknowledgements and recognition inherent in the dramaturgy of inclusion and exclusion. They have been at the heart of what state sovereignty means. Because a sovereign state's power can be said to be at its most definitive and explicit at the places and situations of containment or bordering, the recent change toward an increasingly well structured, hierarchical world order has had wide ramifications. The change in ‘what is learnt from the containment dramas’ is indicative of the deep qualitative transformation of the global system. The most distinct places for the containment used to be the political borders that separated states. In the global world, such borders have lost some of their importance. However, the scope of containment dramas has expanded to cover new global issues such as pandemic diseases or climate change. These dramas of containment scares spell
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out who is who and at what level in the global hierarchy of power. I will briefly examine the central stock figures and the underlying dramaturgy of the containment spectacles and trace the landscape of the contemporary world order imagination where pandemic scares have found unique expression.</p>
<p>During the twentieth century the spread of the universalistic ideal of citizenship partly replaced the older stock form of containment dramas, which were based on more particularistic and elitist notions. For example, international border practices started to be, at least nominally, based on a system of random checks, whereby most, if not all, people were inspected for travel documents and for security. Similarly, international health was, at its face value, based on universalistic humanistic ideals. In this spirit, various large disease eradication programmes were undertaken to defeat major pandemics in the developing world. But the fledgling international hierarchy after the bipolarity of the Cold War arguably brought about a marked change in this trend. Since the early 1990s, international containment has been defined by a perceived imperative to classify, differentiate and separate the various flows of people. This takes place, for example, at international border crossings, at hospitals and in works of popular culture such as movies and books. Individuals are classified and profiled, their movements differentiated, and the flows of groups of people slowed down or stopped. They are categorized in particular types and classes according to the risks that they pose. The risk groups are in a realm of governance wherein the central rights associated with being a human and citizen can be considerably lifted and restricted.</p>
<p>Pronounced and consequential spirals of suspicion and trust saturate this atmosphere. This personally experienced vortex of danger, fear, anxiety, dis-ease and anger provide an effective setting for politically relevant conditioning and for the contemporary spectacles of power. The border imagery has spread from that of political borders to other realms of bordering. However, much of the discursive dynamics can be interpreted to have remained the same. The fact that most people have personally experienced the crossing of borders gives containment related memory images and stories a high degree of relevance. Such heightened importance makes it understandable that the prevailing hierarchical world order is saturated by the ‘semiosphere’ of the multidimensional physical as well as imaginary border crossings. At these places of bordering, people experience, learn and memorize the effectiveness and status of the order. Are the borders ‘leaking’? Are they secured? Who are the suspicious risk types? Who is authorized to move smoothly across borders and by whom? Who are the figures whose life is made difficult by the containment? Who are the privileged and preferred ones? How thoroughly are people being checked at the security checks? Are pandemic security concerns being addressed by the border officials? Who were checked more closely than the others? How was I treated? Who looked like immigrants, illegals, drug smugglers, prostitutes, or terrorists? Did anyone sneeze on the plane? Who can fly and who has to swim, run or dig? Who has to hide and conceal their identity? These questions and doubts are reinforced by popular culture – for example, movies and evening news – which provides the
<xref ref-type="page" id="page_55"></xref>
visual rhetoric needed for memory and storytelling. Profiling defines a practice whereby people are reduced to figures in a hierarchy of types based, for example, on their skin colour, clothing, background, religion, ethnicity, region and state of origin, socioeconomic status, and spending habits. My argument is that the micro-level containment sentiments are inherently linked to macro-level world order and security-related demands. An individual at the multilevel border crossing becomes a personified abstraction, which derives its meaning partly from the security concerns of the hegemonic world order and partly from the specificities of the more regional and individual dynamics.</p>
<p>The contemporary political environment in which people's reduction to types intertwines with the worldwide production of security is often anxious, tense, charged and dramatic. At their most dramatic, the occasions of containment are highly publicized spectacles. The terror related frames containing no-fy lists, red fags, diverted or stopped fights and intercepting fighter planes accentuate these captivating stories. CNN carried the following news on 12 May 2005:
<disp-quote>
<p>US authorities have released a passenger and his family detained after their transatlantic Air France fight was diverted to Maine Thursday afternoon when the man's name matched one on the US ‘no-fly’ list, federal officials said…. A federal official told CNN that the man's date of birth matched that of a person on the watch list, and the names were a ‘nearly exact match.’ But he was allowed to continue on his way Thursday evening after being questioned, a US Customs and Border Protection official told CNN.</p>
</disp-quote></p>
<p>Pandemic scare imagery can become very much like the terror filled drama of May 2007, when the world followed the tale of a tuberculosis infected man who took multiple fights despite having been ordered not to do so:
<disp-quote>
<p>Federal health authorities said Tuesday that they are looking for people who may have been exposed to a rare and potentially fatal form of tuberculosis from an infected passenger during two trans-Atlantic fights this month. The man, infected with the extensively drug-resistant form of TB known as XDR TB, departed Atlanta, Georgia, on May 12 aboard Air France Flight 385 and arrived in Paris, France, the next day, said Dr Julie Gerberding, director of the Centers for Disease Control and Prevention. The man, who has not been identified publicly, returned last Thursday to North America aboard Czech Air Flight 0104 from Prague, Czech Republic, to Montreal, Canada, then drove into the United States. ‘During these two long fights, the patient may have been a source of infection to the passengers,’ Gerberding told reporters.</p>
<attrib>(CNN, May 29, 2007)</attrib>
</disp-quote></p>
<p>Such presumed ‘close encounters’ stimulate and excite the security sensitive imagination. Such dramatic situations are easily turned into morality plays: containment dramas as morality plays involve fights by the protagonist – often
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presuming the guise of all humanity – against the bad minority of rogues and socially ‘unintegrable’ people such as terrorists or disease carriers.</p>
<p>The figure of the ‘rogue’ is one of the foremost descriptors of the sources of worry in the contemporary world order. In the 1990s the term ‘rogue state’ came to signify illegitimate existence outside the international community and its accepted behavioural norms. Interlinked with the idea of the roguishness of a state are the terms, failed or failing states. Whereas rogue state carries the charge of intentional evil, failed or failing states have a more passive connotation, yet one that highlights similar dangers. The US National Security Strategy, for example, poses that outlier – rogue – states such as Iran can unleash unconventional attacks in the form of bio-terror. Failing or failed states or regions may pose a more passive threat by creating situations conducive to an outbreak of pandemic diseases.</p>
<p>Etymologically, ‘rogue’ derives partly from the medieval term, ‘ragamuffin’, which refers to a demon or devil, and later to a ragged and disreputable person. In the same spirit, <xref ref-type="bibr" rid="ref059">Darwin (1859</xref>: 32) used the term rogue in a reference to a plant that deviates from the ‘proper standards’ in horticulture. The important role played by the rogue figure in the cultural imagination was noted by <xref ref-type="bibr" rid="ref143">Jung (1973</xref>: 10), who generalized that a rogue in the figure of a trickster ‘haunts the mythology of all ages.’ In this light, present-day rogues may be detected in the world political discourse as ‘evildoers,’ ‘enemies of freedom,’ and ‘axes of evil.’ The way one talks about the scheming Iranians, the devilish Saddam Hussein or the deceptive regime of North Korea offers ample evidence that Jung's statement may be valid in the mythology underlying the current world hierarchy. Moreover, the root of the term highlights both ‘devilishness’ and ‘ruthlessness’ (<xref ref-type="bibr" rid="ref247">Spitzer 1947</xref>: 90). The trickster imagery allows for the embodiment of pandemic diseases as well. During the plague years the attention was on witches, well-poisoners, and various other forms of evil disease-carriers. The advent of modern medicine placed disease-carriers inside human bodies. Various microbes were considered to be invisible enemies trying to defeat the body's defences and modern medicine by mutating. Such shape-shifting disease agents are also present in the contemporary imaginaries of (re)emerging disease, which can penetrate political boundaries. These connotations of the term evoke the figures of an ‘infidel’ and a ‘heathen.’ These meanings capture well the contemporary politico-religious definition of illegitimacy in international relations. Whether in the form of a state, terrorist organization or mutating disease, the rogue figure seems to share some common features.</p>
<p>Thus, the rogue element is not static. ‘Monstrous,’ uncontained rogues are seen as able to change their shape. This ‘mutability’ was also one of the most important ingredients of the Western enemy images during the Middle Ages (<xref ref-type="bibr" rid="ref116">Harle 2000</xref>: 55). In keeping with this, both the conceptual and temporal characteristics of hybridity have also been present in the figure of a ‘foreigner’: the foreigner is a figure that is partly recognizable, but natively always a stranger, an unrooted figure that has shifted its identity and can continue to do so. It is telling that foreign minorities were often accused of spreading diseases. Minorities, as
<xref ref-type="page" id="page_57"></xref>
the cases of Jews, Muslims and, later, gypsies indicate, were repeatedly massacred in public rites of pestilence ‘control’ during the European plague years (<italic>c.</italic>1346–1721). Closer to our times, states and communities do not like to announce their epidemic diseases for fear of commercial impact and loss of prestige and image. If a disease crosses into wider publicity the most common reaction is a pattern of blame avoidance and blaming others (<xref ref-type="bibr" rid="ref089">Farmer 2006</xref>). Ultimately, violent epidemics are foreigners' diseases. They embody ‘we’ versus ‘others’ distinctions in making sense of what has happened. The knowledge inherent in them opens up in the imagined geographies of suffering. The hybrid and mutable figures find their associative connections in the supposedly contaminating and polluting groups of people who are easily connected with poisonous, thick and cloudy air. Miasma, or mal-air, was thought to form in places where the air did not circulate or where no sunlight penetrated. The qualities of a plague ‘atmosphere’ were ripe with associative connections to poisoned political and religious power relations. Patterns of blame were predictable only to a degree. Much was left to combinatorial plays of the popular imagination, which innovated with contemporaneous issues to form an embodiment of a disease. However, pre-existing patterns of animosity and hostility provided the main fuel for this creative blame game.</p>
<p>In modern popular culture, rogue defines a continuum along which there exists a whole variety of types – for example, illegal immigrants, economic opportunists, asylum abusers, drug smugglers, suicide bombers, disease carriers and high-risk types. The protagonists of these dramas include such stock figures as watchful authorities, alert border guards, efficient surveillance or security agencies, and politicians ‘who did their job.’ Rogues stand in opposition to these protagonist figures. From a general perspective, morality plays involve a communal verdict, a passing of a judgment about the moral status of the participants. Morality plays can be said to put the limelight on the actors' moral characteristics and their ability to make the right choices. In many ways, morality plays stage events in a manner that highlights the sense of being at a crossroads. The main question becomes how well the actors choose: do their choices reflect progressive or regressive moral characteristics?</p>
<p>Questions of this type are answered at tense, critical moments. From that moment onward, there is a strong sense that events can continue either negatively or positively. Another way of looking at morality plays derives from the iconic Western notion of the Protestant ethic. It can be argued that one major way of doing morally virtuous labour in contemporary times is by sweating over security concerns. The perspiration connected with the feverish agitations of the globalizing world provides the setting for the staging of containment related morality plays. These morality plays contain a stern moral lesson about the disastrous consequences of laxness and lack of vigilance. In this respect the morality plays are not so much focused on the punishment of the wrongdoers as on teaching correct behaviour and the virtues and values of the ‘proper’ figures.</p>
<p>Although good and evil are each illustrated by different and distinct figures, there exists a tense atmosphere of surprise. This is particularly true of the
<xref ref-type="page" id="page_58"></xref>
pandemic dramas that seem to demand constant vigilance against the unknown unknowns. The drama turns into a telling gauge of polity's underlying conditions, which is read through mythic lenses. The tension puts the emphasis on the moral worth and judgement of the respective actors. The set of figures becomes Manichean: those trying to do their utmost to stop the looming doom and those who contribute to the decay of the world community's moral character. In an important way, the unforgettable dramaturgy and visual rhetoric of 9/11 has set the stock plot for subsequent plays, especially in the US. Although striking, the elements of this drama are as familiar as they are ancient. Deviant figures managed to hijack and pervert the sacred icons of modernity – airplanes and skyscrapers. The visual rhetoric of the images was one of distortion and collapse. The inversion of icons portrayed the image of a disintegrating world. The theme of sacred symbols turning into their opposites is an old practice in morality plays – for example, sheep and wolves – which points to the disintegration of reality. The anxiety deriving from transgressed and violated boundaries provides another related ingredient for the plays. They become the setting for attempts to maintain and restore wholeness. At the level of the polity, the dramatic tension is one of a fight against the decline and collapse of the presumed sacred essence of the community.</p>
<p>As a theatre of proof, a pandemic offers in essence a revelatory way of demonstrating the existence of unquestionable power, which can conquer the hostile, rogue element of a pandemic. The bystanders gain confidence that there is a particular method inherent in global governance, which can secure them. One should note that the suspense built into the original theatre of proof was largely artificial. Its conductors knew beforehand what was going to happen. Drawing from this intentional building of drama, one could say it comprises the fourth element of the pandemic theatre of proof. The setting is such that the outcome is known beforehand. It might be because of this that it is not that surprising that pandemic scares have thus far turned out to be only scares. I am not trying to imply that there is a conspiratorial tendency inherent in the machinery of global health. Rather, the staging of the field drama is construed in a way that naturally flows from the cultural premises of plague and people. The reason why, for example, the spread of HIV and AIDS is not framed as a hyperbolic drama similar to that for swine fu might have to do with the instinctive desire to produce theatres of proof that demonstrate legitimate authority.</p>
<p>Pandemic spectacles, as containment spectacles and theatres of proof, are intense and engrossing dramas in which the power of modern states and their international health regimes are being tested and demonstrated by diligent – highly visible and dramatic – applications of modern health sciences. Moreover, the performer of ‘health’ is a figure, an embodiment, which objectively and securely meets the external hostile reality. By proxy, the effectiveness of this performance proves the ‘true’ and ‘authentic’ foundation of the Western political bodies. In this historically well rehearsed way, any successful act of the health theatre turns into an empowering foundation for the Western political power. It is the immense political stakes involved that give the pandemic spectacles their
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central feature. From this perspective, the staging of the theatre of proof is meant to produce an acknowledgement that there is a technology of life, which has a precise nature, definitions and protocols, and is embodied by states or by the hegemonic global polity. The field of a pandemic contains the highly culturally salient and visible signs of this life-sustaining technology: medical personnel in white protective suits, masked doctors and concerned citizens, helicopters hovering around, feld hospitals and military presence have been constant features of post-Cold War epidemic performances and in their more fictitious portrayals in works of popular culture. Another fairly constant feature of the pandemic spectacles has been the culling and burning of animal carcasses. From the perspective entertained here, these visible demonstrations are needed because the pandemic scare is turned into a moment that challenges the underlying truths concerning who possesses life-sustaining technologies. For example, the images of SARS in 2003 provided a drama that demonstrated the goodness of organizations such as WHO, while China was held suspect when it came to its trustworthiness in an increasingly interconnected world. This demonstrative pattern revealed at a single glance to the average Western spectator, the presence of the threat and what was being done about it. The frame of the pandemic theatre of proof conveys power and ideology in these seemingly non-political acknowledgements of who is who on a particular type of disease map. This pedagogic aspect makes it evident that what is done in the name of disease control and eradication is inherently beyond doubt. It recreates a particular way of defining humanity in terms of an inherent power hierarchy. Pandemics are refined into governance exercises that are thought to be beyond politics (<xref ref-type="bibr" rid="ref236">Siddiqi 1995</xref>: 196; <xref ref-type="bibr" rid="ref253">Symonds and Carder 1973</xref>: 157). However, a closer examination reveals the close co-optive relationship between the demonstrations of health technologies and hegemonic political powers.</p>
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<book-part book-part-type="chapter" book-part-number="3" id="Chapter3">
<book-part-meta>
<title-group>
<title><xref ref-type="page" id="page_60"></xref>Understanding the Vortex of War and Disease</title>
<alt-title alt-title-type="running-head">Understanding the Vortex of War and Disease</alt-title>
</title-group>
</book-part-meta>
<body>
<p><xref ref-type="bibr" rid="ref186">William McNeill's (1976)</xref> seminal work, <italic>Plagues and Peoples</italic>, contained vital insights into disease politics, which have often been overshadowed by his masterful account of how diseases – especially smallpox – enabled the Spanish conquest of the Americas by devastating the native populations faster than the Conquistadors were able to move. McNeill's main contribution is his skilful narrative, which intertwines seemingly incompatible histories of conquest and disease. He turns the language of politics into epidemiology and the language of contagion into a description of colonial relationships. Judging from the historical evidence, colonial practices are enabled by the diseases spread by colonialism. And such diseases acquire another layer of significance, which feeds back into the biological causative mechanisms. It seems that the biological nature of disease does not appear in a vacuum. Disease is not solely a phenomenon limited to private individual suffering. Rather, lethal epidemic diseases start to reflect the power-political patterns of a hierarchically ordered global realm. The pattern of disease spread abides by specific global power contours. Diseases turn into registers of an intricate fabric of power, which also enables conquest.</p>
<p>Thus, the unevenly distributed markers of contagion and immunity register and contain the record of power disparities. Much before knowledge about invisible disease agents was brought forth by the Pasteurian revolution in the late nineteenth century, people were aware of the power-related features of diseases. The particular patterns of disease-spread were read as signs of authority and legitimacy. Before the age-old discourse acknowledged states as the containers of authority and legitimacy, politico-religious practices attributed the pattern of disease-spread with communal, religious and earthly authorities. The religious interpretation of diseases construed them as divine punishments and trials. These punishments depended on communal piety and impiety. This interpretation was able to ‘explain’ the spread of deadly diseases in a way that gave meaning to individual fear and physical suffering. The markers of piety came to be read from the bodies of people and from wider communal bodies. The even more distant historical layers of ‘disease language’ attributed disease with wider macro-level power dynamics between polities.</p>
<p>McNeill's account highlighted the relevance of the old accounts that connected disease with power. These accounts had been largely forgotten as the
<xref ref-type="page" id="page_61"></xref>
Pasteurian public health discourse had turned the way in which disease was understood in the twentieth century into matters of apolitical scientific episteme. McNeill's fascinating insight was that the history of human–disease interaction could be divided into two categories: besides the micro-parasitic relationships of infection, there were the macro-parasitic relationships of conquest and dominance from one polity to another in which diseases have played their role, with the conqueror being deadly, not only through advanced weaponry, but also by being a disease carrier.<xref ref-type="fn" rid="fn3_1"><sup>1</sup></xref> This insight was a fresh new articulation of the fundamental relevance of politics in disease processes.</p>
<p>To reiterate, McNeill's relevance should not be limited to history. He managed to bring the political modality of lethal epidemic diseases into a form that is vitally important for the global era. Global connectedness is a realm for both political contestation and epidemiological phenomena. The significance and complexity of this nexus is often bypassed and ignored, although its history and mythology is ancient, and its political proto-theory relatively well developed. In this chapter I will map out the mythical, historical and theoretical narratives that connect politics and disease. These often ignored, yet extremely rich, narratives also stimulate the contemporary political imagination. It may be argued that the central trigger narrative is that of large-scale war. What this means is that war as a cultural configuration leads to an expectation of enmity in the shape of disease.<xref ref-type="fn" rid="fn3_2"><sup>2</sup></xref> From this perspective it is possible to understand, for example, the present-day pandemic scares as being influenced by the general context of the War on Terror initiated by the United States of America (US) after the World Trade Centre bombings in New York City on 11 September 2001 (9/11). It is hypothesized that the rediscovery of the narrative roots involved can enlighten our awareness of political phenomena. The purpose of this rediscovery is to define the narrative dynamics/drive that influences contemporary events, in which these concepts come to play.</p>
<sec id="sec3-1">
<title>Thucydidean proto-theory</title>
<p>Before beginning the review of the first formulation of the nexus in which politics and disease interact, a further distinction is in order. The most acute context for individual suffering is the immediate political community. In order to understand the relevance of the local political community in disease it is important to proceed beyond the spatial static image of a community. Being part of a political community can be understood as a process in which inhabitants' lives intertwine in complex dynamics. Regressive dynamics have always been especially relevant from the perspective of diseases as social constructs. The perceived communal regression and decline are often embodied through disease language. Understood in this way, lethal epidemic diseases become markers of communal dynamics and, more broadly, signifiers of inter-communal processes.</p>
<p>Thus, the frame of politico-somatics is as ancient as politics itself. Much of the current research on political processes focuses on progression – as, for example, sustainability and state building – in line with the overall modernization
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paradigm. It should be noted that epidemics have played a marked role even in this progressive process. The successful eradication campaigns against major killer diseases have lent much credence to the modernization paradigm itself. The absence of disease has become a marker of good state level and international governance. It can be argued that peoples' sense of general health provides a bodily way of experiencing what is meant by good governance. The success in fighting major diseases started to suffer major setbacks from the 1970s as, for example, when the campaign aimed at the eradication of malaria failed to deliver. The growing alarm over the future of global health was further reinforced by the emergence of HIV and AIDS in the 1980s. Progressive interpretations have given ground to more declinist modalities. Despite this, however, regressive linkages and processes have been left mainly unattended. This is true of general political theory, which lacks ways of understanding political decline. Therefore, <xref ref-type="bibr" rid="ref130">Huntington's (1965</xref>: 415) suggestion that when it comes to the regression of political communities, ‘perhaps the most relevant ideas are the most ancient ones,’ is still persuasive when looking for culturally significant models.</p>
<p>For the modern mind, immersion in classical political thought may be useful for the purposes of understanding the different ways in which violent epidemic diseases have been a part of the political frame. One such discursive frame ties together epidemics, political violence and hegemonic war in one overall dynamic. It finds its most distinct and influential formulation in Thucydides' epic, <italic>History of the Peloponnesian War</italic>. The co-occurrence of the pestilences of war, death, famine and plague provides a stock script that may even today be activable in situations where the occurrence of one leads to culturally laden expectations of the other three broad signifiers of political calamity. Thucydides views regression at the individual level, such as somatic and moral diseases, in the dynamic context of the large-scale political movement unleashed by the hegemonic struggle between Athens and Sparta.</p>
<p>In his history of this hegemonic war, Thucydides suggests that a sense of compassion is natural for a participant observer witnessing a macro-scale war (<xref ref-type="bibr" rid="ref248">Stahl 1966</xref>; <xref ref-type="bibr" rid="ref033">Brunt 1967</xref>: 278; <xref ref-type="bibr" rid="ref191">Monoson and Loriaux 1998</xref>: 285). His own compassion aside, Thucydides seems to be suggesting that passions such as anger, haste and hatred were also among the important driving forces of the violent regressive flows that comprised the hegemonic struggle between the powers of Athens and Sparta. Thucydides regards the Peloponnesian war as ‘the vastest movement in human history,’ one violent grand movement – Greek kinesis magiste. His detailed account describes how this vortex of war engulfed all of Greece, causing strong convulsions in both big and small poleis. The pulsating, yet always intensifying, regressive flow led to strong passions, which, in turn, constituted the intensification of the grand flow. Sudden emergencies such as the Stasis of Corcyra and the Plague of Athens, Thucydides can be read to claim, were violently erupting sub-motions of the overall violent regression of the primary hegemonic struggle.<xref ref-type="fn" rid="fn3_3"><sup>3</sup></xref></p>
<p>It is important to note from the beginning that Thucydides' political ideas were greatly conditioned by the Hippocratic medicine of his time. However, it
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should be noted that this was a two-way street – the language of politics also permeated the medical thought of the time. To highlight this pertinent connection, some have suggested that Thucydides was moving well beyond the medical thought of his time by suggesting the dynamics of contagion. However, as <xref ref-type="bibr" rid="ref048">Craik (2001</xref>: 102) points out, the ‘contagion’ reading is an anachronistic interpretation of the <italic>Histories</italic>. Rather than referring to contagion, Thucydides was using a related, but different, idea of flux or flow. In Thucydides' time, ‘flux’ was used to understand various political processes as well as in attempts to construe the realm of bodily physiological changes. This overall model found one expression in the Hippocratic medical thought, where bodily flux was thought to be the source of disease (<xref ref-type="bibr" rid="ref048">Craik 2001</xref>: 102). There was a close link across the soma-psyche boundary: it is important to realize that physical movements and the imbalances caused by them were thought to be the key to human emotions as well as to physical maladies. Human disease and human emotions were both seen as co-instantaneous with changes in bodily humours.</p>
<p>The significance of multidimensional bodily movements also found expression in Thucydides' political thought. It is highly significant that he considered war to be one ‘grand movement,’ which provided the context for many other movements. Passions got unleashed in a war. These war passions caused strong impulses for smaller communal and human side-movements, which, in turn, further fed the broadening and deepening multilevel regression and unravelling. To understand the effects of the overall flow to a political community, one needs to keep in mind the value that Thucydides placed on that most fragile of spaces – the human space. In Thucydides' political thought, the political realm is often defined as a human space. Within the confines of this space humans can manage their destinies and work towards a good life. This space is maintained in between randomness and necessity. There are, on the one hand, happenings which are totally random, in which there is no sensible pattern. Human communities and political deliberations do not have much power over such accidental happenings. On the other hand, there are things that are highly patterned and independent of human endeavour. For example, the sun will rise each morning no matter what human societies decide. In Thucydides' work, much emphasis is placed on the constant need to keep the human space open and to expand it where and when possible – that is, to make more patterned processes dependent on human will and to mitigate the chances that random events would negatively impact the human possibilities of a good life. What is needed for the effective guarding of the political space is provident delay, which grants the time needed for sound political deliberation. It is the human space that gets constricted in political regression. The motions and emotions unleashed by grand dynamics gradually erode the possibilities of having enough time for sound political deliberation.</p>
<p>The overall direction of the political regression is clear. Different forms of lethal violence move from one community to another in the same way as plague. Thucydides read plague as a process of bodily decomposition that progressed deeper into the somatic body – starting from the head and progressing to a fatal intestinal condition – and vertically across human bodies. Similarly, war started
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from the hegemonic macro-level and spread downwards, influencing bigger and smaller poleis. One notable characteristic of Thucydides' flux was the ability of regression to become more intensive as the broadening and deepening grinding spread. It is as if the condition mutates into a more serious form until it simply burns out of fuel. This dynamic mutability was one of increasing intensity in terms of war, but also of spreading intensity in which the underlying condition took on new forms, as in the case of stasis and plague. Importantly, Thucydides links this intensity effect partly to the fear aroused in people at the later stages, when they are more aware of and horrified by the devastating effects of the war on other places and at earlier stages (Thucydides, 3.82.4). There is an added horror in the acknowledgement of impending doom, in knowing the horrible fate that awaits them. This fatalism further undermines the maintenance of the human space and affects all aspects of life, turning them into potent symptoms of impending horror. In this context, the Plague of Athens during the war turned into a sub-story of a horrid fate to come and this sense of fatality enhanced the plague's terrorizing effect.<xref ref-type="fn" rid="fn3_4"><sup>4</sup></xref></p>
<p>Significantly for the embodied kinetic perspective underlying this book, Thu-cydides uses the concept of kinesis (ekinethe, kineo) to refer to the overall vortex and its various side whorls. Kinesis and ekinethe suggest destructive types of ‘movement and instability’ (<xref ref-type="bibr" rid="ref191">Monoson and Loriaux 1998</xref>: 291). Kinesis highlights the general flow-like qualities of the context. However, Thucydides seems to be referring to a more specific type of flow-vortex. The kinetic metaphor of a vortex is appropriate in this context when the associated mythological connotations are considered – that is, the grand movement was set in motion by the sea power, Athens. In mythology, the coming into being of Athens was linked to sea vortexes.<xref ref-type="fn" rid="fn3_5"><sup>5</sup></xref> Moreover, it is highly suggestive that Plato, in his <italic>Statesman</italic>, uses the concept of ‘sea of diversity’ when referring to existence outside or in the absence of a political community. As discussed previously, the inter-poleis space – its ether – was imagined as a sea in flux. Fittingly, the ‘great movement’ unleashed by Pericles' Athens was imagined by Thucydides as a ‘chaos, terrible flux, a destructive kind of motion’ (<xref ref-type="bibr" rid="ref191">Monoson and Loriaux 1998</xref>: 291). For Thucydides, the vortex of war induces pulses and co-currents. New sub-currents occurred in the vicinity of the war's rhythmic expression of energy. The increasingly violent circular motions meant that intervals in extreme pain production become progressively shorter: violence kept coming back, cutting across and within bodies in more intense spirals, circling round and back, again and again, grinding bodies, both somatic and political, to pieces.<xref ref-type="fn" rid="fn3_6"><sup>6</sup></xref> It is within this frame that the Plague of Athens became meaningful and unforgettable as Thucydides' account was later adopted by many commentators as a narrative model for a description of a lethal epidemic disease (<xref ref-type="bibr" rid="ref175">Longrigg 1992</xref>: 27). War and plague became interlinked in a way that still evokes age-old political imagery.</p>
<p>It is highly significant that the macro-level movement did not spread only horizontally between polities. It also turned into increasingly deep vertical vortexes or, as Thucydides descriptively frames it, into deep ‘intestinal disorders’. The more confusing the currents became, the more destructive their effects were
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at multiple, increasingly overlapping, levels. Despite the overall clarity of the violent vortexes, it was anything but clear for those involved. Among the first victims of the regressive kinesis was the collective memory of various people. For Thucydides, shared memory is fundamental for a healthy political community. Thucydides' stated mission is to help people to remember so that they might be better equipped when such violent grand movements strike again in the future, as they will inevitably. The regressing mind may lose memory altogether by reducing it to inevitable necessities – for example, the ‘might is right’ type of memory – or may accommodate the recollection to the immediate violent events and passions of the moment (2.54). Thus, proper collective memory keeps safe past horrors and mistakes. The primary reason for memory is to enable a political community to function as a whole. In Thucydides' account, the same way of remembering makes for the coherence of a political community (<xref ref-type="bibr" rid="ref045">Cogan 1980</xref>: 168). The emergence of splits in communal together-mindedness raises the likelihood of whimsical courses of future communal action. The degenerating state of memory makes it increasingly hard to rediscover the common persuasive element needed for rhetoric virtues. Aristotle intertwines alikeness at the level of common opinions to what is likely and collectively realizable (for example, Nicomachean Ethics I, 1, 1355, b18). Communal together-mindedness is a playground for alikeness and derivation in a way that leads to likeliness and predictability in the steering of the community.</p>
<p>When a grand movement is allowed to proceed unchecked, it starts to affect people by diminishing their ability to remember in the same way and, at the end, to communicate without resorting to violent action. The deep ‘intestinal’ nature of war may be taken to have referred to deep societal movements resulting from and constituting the war, whereby poleis and individuals lost their ‘reserve, the power to check their motion’ (<xref ref-type="bibr" rid="ref191">Monoson and Loriaux 1998</xref>: 292). On one hand, according to Thucydides, these abnormalities referred to local level factionalism and atomization (<xref ref-type="bibr" rid="ref191">Monoson and Loriaux 1998</xref>: 287). The ability to plan and maintain a chosen course of action was overwhelmed by the increasing complexity of the currents. Categories – such as personal, polis and inter-poleis – became confounded (<xref ref-type="bibr" rid="ref046">Connor 1984</xref>: 7). This complex entanglement further fed the vortex.</p>
<p>The deepening vertical vortexes of stasis led to the annulment of the constitutive elements defining individual communities. It also affected individual bodies by causing different types of political violence and suffering. However, this intestinal disorder was more radical than simple annihilation. It coupled with its context – the hegemonic war – and further fed it. Thucydides' description of the Stasis of Corcyra describes an extremely malignant form of political disease. On the one hand, the political community does not only disappear and dissolve, it turns into what can be called an anti-community when its constitutive element transforms into what can be called a de-constitutive element. This means that communal collapse does not stop at the dissolution of a community, but leads to its reversal into an anti-community, or, to use today's vocabulary, into a failed state. This means that the constitutive element turned into its head, into mutually-felt animosity between what previously were members of a community.
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The shared mutual hatred provides the constitutive form for the Thucydidean anti-community: the inherent extremism,
<disp-quote>
<p>in a strict sense, defines the mentality of stasis. The excess of disposition comes to be admired in place of its mean, and the mean to be despised as the deficiency of this excess. Having supplemented the mean as the standard, however, the extreme continuously feeds upon itself: It enjoys a striving for ever fresher extremes, a frenzied struggle to exceed one's rivals at excess itself.</p>
<attrib>(<xref ref-type="bibr" rid="ref201">Orwin 1988</xref>: 835)</attrib>
</disp-quote></p>
<p>Furthermore, the disorder is not destructive only for the community it strikes. It is contagious, too. Thucydides puts forth the idea that the implosion of a political community is inherently tied into inter-communal warfare. A stasis ridden anti-community directs its previously internal bonds outwardly, whereby it actively attracts foreign elements into the internal struggle. Athens and Sparta were willing collaborators in the internal violence of individual poleis since they could not see the difference between the macro-level fight and the struggles of factions in various small communities.</p>
<p>On the other hand, this violent regression spreads simultaneously into the individual level – both in the moral/psychological and physiological senses – as the striking sub-narrative of the Plague of Athens demonstrates. While the convulsions of the stasis atomized Corcyran society into factions and finally into violent, but extremely vulnerable, individuals, the Plague of Athens entailed a parallel story of somatic bodily disintegration. This sub-narrative highlights the influence of the overall ‘movements’ on human bodies as the loci of the soma and the psyche. The suggested direction of the dynamics is clear. The grand movement of hegemonic war gathers intensity and spreads downwards towards smaller communities, which are thus set into disintegrative motion, and to the individual level, where somatic suffering – such as disease, mass murder or mental incontinence (rash actions, selfishness and failure to obey sacred norms) – takes place. The extreme perversion of politics was the breeding ground for the plague as well as the ground whereby its political meanings were construed. Plague continued the intestinal degeneration by decomposing somatic bodies and further inducing an overall sense of horror and unavoidable doom. The plague continued by other means the processes unleashed by the hegemonic struggle. For Thucydides, the plague was an essential constituent as well as a consequence of the war. In the absence of the overall kinesis, the plague could not have been what it became under the grand movement.</p>
<p>The concept of stasis is a process that cannot be adequately understood without taking into account its intimate relationship with lethal diseases and, in particular, with plague. Thucydides' account of how stasis gathered more steam when it spread closely parallels what took place during the Plague of Athens: ‘[i]t first began … in the parts of Ethiopia above Egypt, and thence descended into Egypt and Libya and into most of the king's country’ (2.48). Then the
<xref ref-type="page" id="page_67"></xref>
disease suddenly fell upon Athens, Thucydides tells us, and states that the deaths in Athens became much more frequent: ‘[f]or the plague broke out as soon as the Peloponnesians invaded Attica … committed its worst ravages at Athens, and next to Athens, at the most populous of the other towns’ (2.54). The plague's intensity grew in a manner that reminds one of the stasis' ability to become more serious as people who were struck later know more about its devastating nature. In his highly influential narrative, Thucydides seems to be suggesting that plague is a fundamental part of a grand movement as are individual occurrences of stasis.</p>
<p>The increasing effect of the spreading disease at the individual level is matched at the communal level. Its regressive nature is evident in the way in which plague first affects the head and then spreads malignantly to the bowels.</p>
<disp-quote>
<p>people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath. These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress…. But if they passed this stage, and the disease descended further into the bowels, inducing a violent ulceration there accompanied by severe diarrhoea, this brought on a weakness which was generally fatal.</p>
<attrib>(2.48)</attrib>
</disp-quote>
<p>This regressive process of gradual decomposition was accompanied by the rapid weakening of the manner in which people recognized previously important and even sacred communal norms:
<disp-quote>
<p>The bodies of dying men lay one upon another, and half-dead creatures reeled about the streets…. The sacred places … were full of corpses of persons that had died there, just as they were; for as the disaster passed all bounds, men, not knowing what was to become of them, became utterly careless of everything, whether sacred or profane.</p>
<attrib>(2.53)</attrib>
</disp-quote></p>
<p>The power of norms and beliefs to bind the community together was replaced by open deviance from communal norms:
<disp-quote>
<p>Fear of gods or law of man there was none to restrain them. As for the first, they judged it to be just the same whether they worshipped them or not, as they saw all alike perishing; and for the last, no one expected to live to be brought to trial for his offences, but each felt that a far severer sentence had been already passed upon them all and hung ever over their heads, and before this fell, it was only reasonable to enjoy life a little.</p>
</disp-quote></p>
<p><xref ref-type="page" id="page_68"></xref>Judging from such excerpts, the plague affected the communal body as much as it caused suffering on individual lives and bodies. Plague was a political disease similar to that of stasis, which caused civic collapse.</p>
<p>Popularity of the common values decreased as individual desires became the foremost concern. This led to changes in the meanings of central concepts in the same way that stasis leads to the loss of meaning:
<disp-quote>
<p>Men now coolly ventured on what they had formerly done in a corner, and not just as they pleased, seeing the rapid transitions produced by persons in prosperity suddenly dying and those who before had nothing succeeding to their property…. Perseverance in what men called honor was popular with none, it was so uncertain whether they would be spared to attain the object; but it was settled that present enjoyment, and all that contributed to it, was both honorable and useful.</p>
</disp-quote></p>
<p>This is very similar to the Thucydidean description of stasis as a process aversively affecting norms, memories and language. One of the most striking details of the stasis provided by Thucydides is the way in which words lose their meaning during stasis:
<disp-quote>
<p>Words had to change their ordinary meaning and to take that which was now given them. Reckless audacity came to be considered the courage of a loyal ally; prudent hesitation, specious cowardice; moderation was held to be a cloak for unmanliness; ability to see all sides of a question inaptness to act on any. Frantic violence became the attribute of manliness; caution, plotting, a justifiable means of self-defence. The advocate of extreme measures was always trustworthy; his opponent, a man to be suspected.</p>
<attrib>(3.82)</attrib>
</disp-quote></p>
<p>Thucydides continues his list in a way that highlights the extroverted nature of meaning – the meanings had changed from those instituted though previous interactions to ones characterized by deep hatred and extreme violence. Moreover, the stasis characterized by loss and extroversion of meaning was contagious as it
<disp-quote>
<p>ran its course from city to city, and the places which it arrived at last, from having heard what had been done before, carried to a still greater excess the refinement of their inventions, as manifested in the cunning of their enterprises and the atrocity of their reprisals.</p>
</disp-quote></p>
<p>The slips in meanings caused by plague and stasis were a process that flowed towards private gain and desires, replacing deliberative processes as the ultimate arbiters of meaning. The judgement, Thucydides points out, is not the same in the case of fear and horror as they are in the normal contexts of provident delay. Rather, an inversion takes place through which that which makes sense under a
<xref ref-type="page" id="page_69"></xref>
disease is very different from the common sense prevailing under normal conditions, in which accidents and facts of nature leave space for political deliberation, choice and action – for the existence of the human space. A disease can turn a political community from an area of showing together-and like-mindedness to a locus of split-mindedness in the form of unbound individual desires.</p>
<p>In Thucydides' account, the violent bodily spasms caused by the plague, which are among the most severe symptoms, are also among its last symptoms. The disease has run its course much before the spasms. In the case of stasis, bodily spasms find their parallel in convulsions (kinesis) of the political body. These spasms are uncontrollable and signal the imminent end of a person's life. The violent movements at the later stages of the political diseases of plague, stasis and the grand movement are signs of isolation and apart-mindedness. Thucydides describes how people were left alone, unattended and uncared for. The condition of isolation brought about by the disease is enforced by the selfish and egoistic actions of the diseased, those fearing the disease, and by those who have survived the disease. People did not indulge in any of the activities that would have reaffirmed the existence of a shared sense and common understanding in a political community. Instead, isolation and apart-mindedness prevailed.</p>
<p>To sum up, the idea here is that classical thought contains an influential social construct, a well rehearsed frame of a multidimensional and intertwined regressive process. This process intertwines macro-level politics with other ‘dis-eases’: an epidemic as a regressive and spreading condition is inherently political and hegemonic war as a violent vortex is always disease-like. Moreover, large-scale war predisposes the general moods of worry, fear and horror towards perceptions of somatic diseases. The overall grand flow of hegemonic/imperial war brings along other passions, such as hatred and aggression, which predisposes the overall context towards an intensifying vortex-like flow. This flow starts from the macro-level movements, deepens into problems in larger and smaller polities, and ultimately arouses a situation ripe for self-fulfilling fears and scares of lethal epidemic diseases. The point here is that the ‘dis-ease’ at the level of the individual somatic body may be seen as a part of a larger, grand movement in the macro-level political hierarchy. Occurrences of large-scale war make conditions ripe for all kinds of disease scares.</p>
<p>Thus, in the search for an encompassing schema, I will turn to Thucydides because he represents a classical account of war, which emphasizes its all-encompassing nature. Furthermore, Thucydides integrates emotions, especially compassion, into his view of war as political regression. As said, Thucydides regarded the Peloponnesian war as the greatest motion in human history. He describes how the vortex of war engulfed all of Greece, causing strong convulsions in both big and small poleis. The intensifying, regressive flow led to strong passions, which, in turn, helped to intensify the flow. Sudden emergencies such as the Stasis of Corcyra and the Plague of Athens, Thucydides claims, were emotion laden sub-motions of the overall regression. In a neoclassical reading of this model, I intend to argue that it may be used to illuminate contemporary
<xref ref-type="page" id="page_70"></xref>
emergencies in Iraq and Afghanistan, which are part of the overall macro-motion since 9/11. Building on this holistic model, I will claim that political compassion provides the foremost vector for intensification of the motion that holds different political bodies in the thrall of unstable power-political flows. Being caught by the pains of the global structures, people sense their anxieties and project them into various pandemic scares. The scares ft their global contexts and eras tightly and should not be understood only from an epidemiological perspective.</p>
</sec>
<sec id="sec3-2">
<title>Contexts of contemporary power-political disease</title>
<p>The Thucydidean understanding that the kinetic context of major power contestations provide for a context in which violent lethal diseases are amplified as a political process can be used to shed light on our present-day ways of understanding pandemics. This bridge between conflicts and disease can lead to a better appreciation of the complex entanglements that pandemics have with other major global dynamics. For example, it can be hypothesized that the present-day macro-level turbulence in world politics has recontextualized what pandemics look and feel like. The War on Terror, with its major wars in Iraq and Afghanistan, provides a source of anxiety that can heighten disease-related anxieties. In some important ways, it is possible to claim that pandemic scares embody anxieties that stem from power-political grand movements.</p>
<p>One way of approaching this account is through understanding that the emotional charges involved in global public health – containment and compassion – provide for situational scenarios that overlap with the emotional content of US hegemony and its way of construing its enemies in the ongoing War on Terror. To use Thucydidean language, the grand movement feeds into and is fed by perceptions of major violent epidemics.</p>
<p>The grand kinesis is a context in which modern forms of political compassion have been redefined in comparison to the humanitarian practices that prevailed during the Cold War years. Furthermore, it can be argued that the War on Terror has further recontextualized political demonstrations of compassion and, by definition, humanitarianism. Humanitarian mobilizations have usually been connected with single, isolated spectacles such as Rwanda, Kosovo, Somalia, or Darfur, which are deemed to have local root causes. My main working hypothesis is that this atomization of humanitarian emergencies and detaching them from wider violent processes leaves out the central elements of humanitarian compassion. From the perspective entertained here, many of the largest recent humanitarian events are connected and better appreciated as parts of overall violent, regressive flows underlined by the open ended War on Terror. A large part of political compassion is not only directed to the suffering of distant individual bodies, but also to the suffering of other political bodies; besides empathy for suffering individuals, this also denotes sentimental worry over the world order and compassion for suffering nations and peoples.</p>
<p>The emotions released towards and across political bodies constitute motions and vortexes wherein individual humanitarian spectacles find their political
<xref ref-type="page" id="page_71"></xref>
embedding. Some can be applied to the practices of containment. These practices, which regulate the ways in which fears and anxieties are projected to external actors, demarcate also the boundary between us and them as well as the finer nuances of various overlapping boundary conditions. As was seen earlier, the modern discourses of humanity contain both compassion and containment. What this means is that the institutions of modern humanitarian practice – motivated by long distance related sentiments of compassion – also take part in the containment of the objects of that compassion and the subjects that are seen as being compassionate. In an important manner, the practices of compassion, which are often deemed as legitimate and as sources of legitimacy, are also practices of containment, distinction and ‘other-ing.’ It is this emotional complex of political compassion and containment – compassion that always also constitutes containment – that I intend to approach here. Without this compassion–containment complex it is very difficult to understand how pandemic scares are constructed. Pandemics are among the second order entanglements that result from the ways in which the compassion– containment discourse interacts with the overall power-political flows of our time.</p>
<p>Compelling feelings for others are a multifaceted and influential, yet inadequately, examined political phenomenon. In the study of humanitarian emergencies it is common to reduce compassion for distant others to mere modernist, secular and liberal ethical visions, which derive from enlightenment and humanism. However, political compassion may equally well be contextualized in much older historical strands, in the sentiments felt towards significant in-groups (such as nations and hegemonies or empires). In a sense, compassion implicates a contained group(s) that is not limited to the suffering distant other individual. Compassion contains both its agent and object of action. Often, these are similar: when a state is the agent of compassion, then the object is likely to be a state. When a hegemonic actor such as the US is an agent of compassion, its object is usually a sufferer that signifies its own hegemony.</p>
<p>Moreover, it is suggested that the more modernist version of humanitarianism does not work in a void. It interacts with other older traditions of compassion. Different compassions for in-and out-groups and individuals interact and, in some cases, constitute mutually reinforcing regressive flows. For example, the compassion felt towards the plight of the Iraqi Kurds and Shias immediately prior to the war in Iraq connected the compassionate parties to the internal decomposition of the Iraqi state. The larger context for this compassionate connection was the worry over the threat to Western security posed by the claimed Iraqi weapons of mass destruction. These world order worries blended with particular types of compassion and formed the context for humanitarian compassion for the suffering Iraqi population. The humanitarian compassion for the suffering Iraqis was overwhelmed by other compassions, despite millions of displaced people and tens of thousands of non-combatant deaths. Thus, in the case of Iraq, the compassion was containment based. The fear of alarming loss of control motivated a particular type of hegemonic alarm and compassion.</p>
<p>Compassion implies containment. Compassionate containment's narratives concern global connections and closeness, but they also imply boundaries and
<xref ref-type="page" id="page_72"></xref>
how people are confined to the contours of their geography. At the level of hegemonic embodiment, the politics of compassion contains worries over the all-encompassing nature of US power. Often, these anxieties stem from the effects of contact over long distances on the US led world order. It is clear that such anxieties and declinist sentiments provide ingredients for the diseases of contagion. With the specificities of hegemonic times, it is relatively easy to envision pandemics connected with the feverish agitations of the hegemonic embodiment.</p>
<p>The in-fighting and in-group versus out-group tensions at the level of the hegemonic US body can easily translate into visions of an overall regressive flow. US domestic discussions are full of examples of declinist images. Sometimes these are easy to discern, and sometimes they recede to the background of imperial triumph. The worries over in-group tensions found their manifestation, for example, in the so-called culture wars of 1990. The culture wars were significant because they framed particular hegemonic sensitivities and animated such lofty fear images as Huntington's vision of a clash of civilizations. The perceptions of threat and decline in the US led to particular world order sensitivities that were put into high gear by 9/11, which seemed to ft the underlying fears so well. The societal regression at the level of the hegemonic body was projected outward in the form of felt compassion towards certain types of distant suffering and suffering bodies. The US' hegemonic compassion was felt in Somalia, East Timor, Bosnia and Kosovo. Again, I have to reiterate that such compassion always also borders and contains, as was more obvious in the later cases of Iraq and Afghanistan.</p>
<p>Political compassion is an important tradition mainly because it frames anxieties about world politics in a highly positive way. In many cases the positive framings are used by the actors themselves to understand why they undertake violent means, as in the case of humanitarian intervention. The Western attempts to accentuate the Afghan operations as a way to build a state where human rights would be restored to their proper place is a case in point of the tendency to find a positive framing for power-political acts. Political violence can be understood as a process in which mutually exclusive compassions interact and constitute regressive dynamics. I intend to look at the flows of emotionality involved in the dynamic disintegrative processes of humanitarian emergencies.</p>
<p>Proceeding beyond clear-cut, rational–cognitive imagery to one of political movements, motions and emotions, I will expand the idea that motions between communities and in the overall international setting are naturally unsteady. Unsteadiness of political flows reflects the constant possibility of vorticity, that is, the spiralling circles of inflicting and suffering pain. The social construction of vortex-like violence is highlighted often, for example, in research literature, where there is a strong tradition of using various signifiers of cycles to describe the patterns of political violence and war (<xref ref-type="bibr" rid="ref104">Goldstein 1985</xref>; <xref ref-type="bibr" rid="ref189">Minow 2002</xref>). Another illustrative case of the social construction of international crises as vortexes is provided by the common depictions of crises as unstable downward spiralling flows (<xref ref-type="bibr" rid="ref120">Herrmann and Fischerkeller, 1995</xref>). The presumed crisis vortex is pictured as a dynamic circular engulfing structure. The multiple embodied
<xref ref-type="page" id="page_73"></xref>
metaphors construct international crises in the dynamic context of an exchange – a movement composed of responses and counter-responses. For example, <xref ref-type="bibr" rid="ref168">Leng (1993</xref>: 74) used the embodied analogy of a ‘schoolyard fight’ to characterize a pattern of symmetrically escalating hostility. There are recurring references to downward spirals that grip actors, spin them quicker and quicker, and suck new players into the vortex. This deeply ingrained mental construct, or cultural model, portrays the course of events defined by a downward momentum that keeps increasing and a spiral that keeps reinforcing itself and tightening right into the deep abyss of violence. <xref ref-type="bibr" rid="ref169">Leng (2000</xref>: 268) calls this type of crisis dynamics a ‘spiralling crisis’; a spiralling crisis escalates the situation out of control, driven and fed by what are seen as misperceptions and emotional reactions.</p>
<p>Within such an unstable downwards flow, the sensing of flow currents is crucially important for the actors involved. In a sense, emotional sensitivity becomes a constitutive element of agency in a crisis or emergency situation. Emotional content is fed by the shifting motions of power relations and by the changing positions in a power hierarchy. The images of the emergency – such as eyewitness accounts, news stories and photographs – turn into triggers of complex emotional judgements for both the internal actors and for those beyond. It is this emotionally fed dynamic that offers a helpful, culturally embedded model to enable us to understand the regressive grand movement initiated by 9/11. The political compassions unleashed from that point help to explain one important modality of Afghanistan and Iraq as well as the passions involved in the heightened security concerns.</p>
</sec>
<sec id="sec3-3">
<title>Power-political-emotional-flows</title>
<p>A short review of contemporary research offers evidence that the motion–emotion pairing of the classical topos continues to be relevant. The connection between power and emotions has been examined by several contemporary thinkers. Among them, <xref ref-type="bibr" rid="ref151">Kemper's studies (for example, 1981</xref>) are refreshing for their emphasis on power hierarchy related emotionality. In Kemper's model, emotions consist of actually or imaginatively existing social organizational or social relational conditions: ‘[w]hen these conditions are met, the desired emotions will flow of themselves, authentically’ (<xref ref-type="bibr" rid="ref151">Kemper 1981</xref>: 358). More specifically, the intimate relation may be based on a close connection between power relations and the primary, instinctive or physiological feelings of fear, anger, depression and satisfaction (<xref ref-type="bibr" rid="ref152">Kemper 1987</xref>: 263). Other theorists have put forth different models of emotionality flowing from social relations (<xref ref-type="bibr" rid="ref171">Lewis 1971</xref>; <xref ref-type="bibr" rid="ref231">Scheff 1993</xref>; <xref ref-type="bibr" rid="ref220">Retzinger 1991</xref>). Besides making a distinction between cognitive and more unconscious processes, the literature often points out that some emotions, such as respect and trust, linger on. These moods are chronic and recurring and differ from shorter-term, fare-up emotions such as hatred (<xref ref-type="bibr" rid="ref141">Jasper 1998</xref>: 402).</p>
<p>Compassion, together with the sentiment of containment, can be regarded as a social emotion because its object is other people's emotional expressions – for example, suffering or feeing – and, therefore, it occurs only as part of the
<xref ref-type="page" id="page_74"></xref>
dynamic patterns of social interaction (see, for example, <xref ref-type="bibr" rid="ref042">Clark 1987</xref>: 180). However, compassion is not only a constructive social emotion, it is also a potentially violent political dynamics. The starting point is that the motions inherent in any violent process translate into compassionate emotionality, the objects of which range from social grounds that are near to other groups constituted by distant sufferers; these strong sentiments further contribute to the intensifying of the violent flows. This definition, which is based on the neoclassical model, maintains that motions or changes in power hierarchies cause emotions. In her review of emotional content of international relations, Neta Crawford traces the origin of the English term, ‘emotion’, to ‘political or social agitation and popular disturbance’ (2000: 124). Against this background, it is not a coincidence that the theories of political movements and political mobilization have been so receptive in integrating emotions in their models contrary to the mainstream approaches of social and political sciences, where emotions are relegated to secondary status (<xref ref-type="bibr" rid="ref141">Jasper 1998</xref>: 397). Emotion research has concentrated on referring to such mobilizing events as moral shocks, frame alignments and emerging collective identities. There are a multitude of feelings in and around political movements (<xref ref-type="bibr" rid="ref141">Jasper 1998</xref>: 397). At their minimum, political movements stir the existing patterns of understanding about what are positive and negative emotions, what should be expressed and what hidden, and what constitutes adequate and inadequate responses.</p>
<p>In related literature, emotions can be regarded in a positive light. They empower by translating influence and status into power, that is, into the capacity to produce intended and foreseen effects (<xref ref-type="bibr" rid="ref275">Willer <italic>et al.</italic> 1997</xref>: 573). The emotions produced by power structures vary from negative to positive, from enmity to compassion (<xref ref-type="bibr" rid="ref153">Kemper 1991</xref>: 330). It is equally clear that negative emotions are expressed through the language of positive emotion because the international effective climate favors positive sentiments. It is much easier to express the emotion of enmity through the language of compassion. For example, one can state the compassion felt towards one's own local community, nation, or even Western civilization, in a more legitimate way than one can express open hostility towards some more distant group. This language of compassion provides another example of how the sentiment of containment is signified in contemporary world politics.</p>
<p>Wars – external and internal – have often been constructed as passionate movements in methodological nationalism. Sentiments ranging from disdain, superiority, hostility and anger to compassion are equated with the movements and with the changing power relations signalled by them. The general idea is that changes in power hierarchies trigger emotions and stimulate participation in further fare-ups of collective feelings. The power status differences are established, challenged and reinforced by emotions (<xref ref-type="bibr" rid="ref177">Lutz and Abu-Lughod 1990</xref>: 14). In this way, for example, the social practices of shame and mourning may channel open anger into emotions that strengthen factional or communal solidarity (<xref ref-type="bibr" rid="ref078">Durkheim 1965</xref>: 443). This type of channelling seems to be quite common. But emotions also have a darker side, when they feed antagonisms and mutually exclusive hostile in-group cohesions.</p>
<p><xref ref-type="page" id="page_75"></xref>However, the typologies of various political emotions and their relatedness are relatively meaningless in that they are not embedded into the dynamic context of political flows. Emergencies ranging from the humanitarian to terror related ones provide an important contemporary flow context in which emotions find their rightful place. Despite the apparent suddenness and ad hoc-ism, emergencies are historically well rehearsed activities. They have a history and contain a tradition. From this perspective, an emergency is a pain laden event that suddenly surfaces for a relatively short time period and seems to compel some type of compassion/containment borne out of interventions by concerned outsiders. Moreover, in an emergency, the sense of political stability changes to a sense of a fleeting and threatened existence.</p>
<p>Emergencies contain unique temporal and spatial images and associated sentiments. Whereas a spatial feature is essential in conventional international crises and conflicts, the contemporary emergency practice involves a heightened sense of scarcity of time. The window for effective intervention seems to be closing. This pervasive closing-in sentiment leads to a compelling expectation that something needs to be done now. A particular sense of urgency favours a mood of rapid action and normative preference of haste over time consuming deliberation. All attention becomes concentrated on one critical moment in time. Time becomes increasingly salient when the rush to find solutions is accompanied by an accelerated tempo of events. The expected emotional release seems to indicate a resolution. The overall impression of an emergency suggests a temporalized image of a specific sequence of events – the initial triggering event, the intervening/helping activity and the eventual restoration of normalcy.</p>
<p>On the other hand, the sudden disappearance of regularity that is inherent in emergencies has a spatial dimension as well, which leads to a collapse of vastness and into a sudden projection of intense close-at-home sentiments into a condensed ‘faraway place’. Whereas spatial distance acts as a buffer from the effects of an international crisis, distance as related to humanitarian emergencies turns into something to be crossed by outsiders rushing in to mend the situation. The emergency embedded compassion annuls distance and calls for accompanying sentiments of containment. For example, the supposedly compassionate intervention implicitly makes sure that the distant sufferers are contained to the location of the emergency. In pandemic-related emergencies, the containment of people into a specific geographical location is explicit and encouraged by public reaction. Containment is stressed over compassion, while the acts of separation and isolation are framed as compassionate from the viewpoint of overall global health.</p>
<p>As pointed out in the previous chapter, the compassionate connection formed between the site of an emergency and distant interveners offers a crucial constitutive element of emergency dramas. Emergency compelled involvement leads to the breaking of the usual ‘nearest is dearest’ boundaries and allows the formation of emotional bonds at a distance. However, the underlying necessity of containment is an integral part of compassion laden practices. Political sympathies remain limited to conceptually containing national and cultural identities.
<xref ref-type="page" id="page_76"></xref>
The sight of pandemic sufferers arouses compassion, but it takes the form of severing ties of contact. The suffering of a person with an epidemic disease is a sight that can lead to the political sentiment of indifference. The immediate and first worry is for a community that is closer to home. A pandemic emergency as a political spectacle brings to the fore embodied scenarios that highlight existing boundaries and necessitate the erection of new ones. The compassion for the distant suffering is instinctively relegated to secondary status. Thus, a pandemic emergency blurs ‘normalcy’ in a way that underlines containment over compassion. The erection of various we-communities is a constitutive element of the downward flow involved in pandemic emergencies. And the emotional motion gives rise to a unique ethics of pandemic – the rush for finding a solution and erecting boundaries become an essential virtue.</p>
<p>The emergent flow of a pandemic emergency differs from the dynamics of a common stock humanitarian emergency. Whereas humanitarian spectacles produce a lowering of the boundary between ‘us’ and ‘them’ as interventionist actions are in the foreground, pandemic emergencies make we-communal boundaries tangible. However, both types of emergencies produce complex considerations of connectedness. The hyperbole of contagion in pandemic scares produces a sense of complex entanglement. Contagion engrosses the popular imagination as it envisions scenarios of temporal regression and spatial entanglement.</p>
</sec>
<sec id="sec3-4">
<title>Regressive kinetics of contagion</title>
<p>The perceived sight of a pandemic suffering somewhere causes sudden jolts. These abrupt political convulsions find their embodied parallels in the expressive reaction of people recoiling in the face of an unanticipated threat. This embodied kinetics may be projected into the world of political objects. The sensibility of the recoiling kinetics pervades a pandemic emergency and constitutes situational logics for individuals and their communities. This general kinetics of containment is a scenario that is often alluded to in the relevant national, international and supranational documents. For example, the European Union (EU) document on strengthening coordination on generic preparedness planning for public health emergencies at the EU level (COM 2005605) states:
<disp-quote>
<p>Such generic plans would involve not only medical countermeasures, such as diagnosis, isolation and treatment of cases and the administration of vaccines and prophylactic drugs to at-risk groups and the population at large, but also public order measures, such as restriction of movement and border controls, closing down premises and the cordoning off of specific areas, civil protection measures such as rescue operations.</p>
</disp-quote></p>
<p>The attention clearly is on creating geographical obstacles and distance in order to stop the patterns of infection and contagion.</p>
<p>The dynamics of contagion has a cultural history that links it with failing states and with the practices of bad governance as the following quote from the
<xref ref-type="page" id="page_77"></xref>
US 2010 National Security Strategy illustrates: ‘we seek to mitigate other problem areas, including … the threat of emergent and re-emergent disease in poorly governed states’. Such scenarios actualize in specific interventionism practices vis-à-vis failing or badly governed polities, which are deemed as risks to global health security. The fact that failure to manage health in some local communities is a common source of insecurity for the rest can be seen as leading to specific type of interventionist tendency. This tendency translates into pull interventions in the internal public health governance in particular communities.</p>
<p>As with any type of interventionism it is important to look for motives other than the manifest one, even in the case of health-related interventionism. Health-related interventionist language may offer ways of co-opting for other purposes – for example, the motive to do something to promote public health in developing states can derive from issues unrelated to any public health concerns. Moreover, it might be that public health issues are easy to use as excuses for other forms of interventionism because public health has the appearance of being an apolitical field.</p>
<p>The aim of this chapter is to examine the potential for public health to be co-opted for power-political interests. The flow of power-politics, especially when fixed by security concerns and when there is a perception of a power struggle, easily adapts public health concerns to ft the overall general dynamics. Furthermore, the overall dynamics' main anxieties are always regarding patterns of political animosity and the internal coherence of particular we-communities. In the present-day context, the War on Terror focuses attention on the stability of US hegemony and its internal cohesion and wholesomeness.</p>
<p>It is because of these likely focuses that health based interventionism may be seen as a register of a larger ongoing power struggle. Therefore, it is useful to examine first the potentials for using health interventionism as a means to bring about a sense and perception of political health at home. International health efforts can offer ways of diverting attention from problems closer home and co-opting them for the purposes of bringing about a sense of more coherent and legitimate governance at home.</p>
<p>As a starting point, one can say that as much as there is bad public health governance in the poor developing countries, there are equally acute problems closer to the hegemonic heartlands of the West. The public health systems in the developed nations are under much stress. For example, the emphasis on curative health and on individual health can come at the expense of more general public health measures. The number of uninsured people in the US can be seen as a major public health risk. Another major health issue is the misuse and overuse of antibiotics and other drugs that can lower the ability to contain major diseases and lead to the development of drug resistant superbugs. This poses the risk that drug resistant forms of HIV and AIDS or tuberculosis might become rampant. It is clear from these examples that health governance is experiencing problems in the developed parts of the world too, and not only in the developing regions.</p>
<p>Thus, by constructing pandemic diseases in a way that emphasizes the risks posed by others, developed nations can defect the criticism directed towards
<xref ref-type="page" id="page_78"></xref>
their own health governance. However, there are deeper patterns of co-option and diversion that the contemporary way of pandemic threats offers. These reasons have to do with power trajectories in the key we-communities. The underlying group identities might be experiencing difficulties. At the level of the group and group identity, different diversionary uses of external interventions often stem from the dynamics of in-group solidarity. The politics of compassion and containment provide important solutions to specific types of internal political problems.</p>
<p>One important in-group problem dynamics, shedding light on the political usefulness of the different forms of interventionism, is offered by the practices of diversionary war, or war as a pretext. There is a long tradition of the state – both hegemonic and other – initiating seemingly legitimate humanitarian interventions for ulterior motives (<xref ref-type="bibr" rid="ref106">Goodman 2006</xref>: 107). The image of ‘humanitarian rescue’ can offer attractive opportunities for the safe expression of enmity. Diversionary practices offer insights into the underlying linkages that push and pull different actors to engage with each other.</p>
<p>At first glance, the diversionary use of interventionism seems far removed from the practices of global international health. Nevertheless, even when health interventions do not form the primary avenue of diversionary interventions, they are part of the gamut of different types of interventions. Furthermore, it should be noted that public health measures can be used as a pretext for exporting different sets of values in the name of public hygiene and good heath governance. The US' HIV and AIDS related PEPFAR programme in Africa was accused of spreading traditional American values, for example, in the form of ‘abstinence only’ measures (<xref ref-type="bibr" rid="ref005">Aaltola 2008</xref>: 69). These conservative values were part of the US culture wars and were very prominent for the coherence of a particular in-group in the US during the George W. Bush administration. The associated strand of conservatism was heavily influenced by the evangelical movement and the emergence of the religious right in the US. In this sense, it often refers to the programmatic idea that Christian values should be applied in the public life of the nation. In this context, themes such as abortion, homosexuality and abstinence education have functioned as rallying calls, and these religiously founded ideas have led to strong movements of political mobilization. From this perspective, the PEPFAR program was co-opted by evangelical groups in their missions in Africa. The internal political dynamics came to be projected outwards in the form of various public health interventions.</p>
<p><xref ref-type="bibr" rid="ref166">Lebow's (1981</xref>: 23) general pretext model for foreign interventions includes appeals for wide domestic support as well as for signalling to other states the legitimacy of its actions in the various target states. In terms of rational choice, the diversionary model can be defined as follows: leaders faced with domestic troubles, who anticipate being contested, often choose to undertake foreign interventions to create domestic social cohesion and to divert attention from their domestic problems and to embark upon aggressive foreign policies and wars (<xref ref-type="bibr" rid="ref241">Smith 1998</xref>: 625; <xref ref-type="bibr" rid="ref170">Levy 1988</xref>: 666). The basic rationale of an actor engaged in such externalization of an underlying civil conflict stems from the belief that
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in-group cohesion tends to increase with the onset of foreign interventions. According to this model, the existence of compassion or containment-related arguments lowers the pressure from other actors to stop the intervening state. Therefore, it is in the strategic interest of an aggressive state with in-group problems to argue for action on the grounds of compassion and containment, as, for example, on the grounds of humanitarianism or public health. However, since political emotions are involved, the action is never solely based on rational power-political calculations. Rather, the diversionary action might flow naturally and even unnoticed when an in-group is stimulated by the specificities of political problems and governance regressions in the perceived emergency area.</p>
<p>Most formulations of the diversionary dynamics tend to be rationalistic. Diversion refines the choices available to a political leader, different regime types are differently disposed to diversion, and different types of domestic contestation and conflict have different diversionary outcomes. <xref ref-type="bibr" rid="ref098">Gelpi (1997</xref>: 256) argues that when faced with internal problems, state leaders have at least three approaches from which to choose. First, they can appease the domestic opposition through dialogue and concessions. Second, they can repress and bypass the opposition by more coercive means. Third, they can try to restore a favourable status quo by cohesion creating interventionist activity abroad. The depth of contestation affecting a diversionary in-group has implications for the likelihood of using any of these diversionary strategies. Some studies (<xref ref-type="bibr" rid="ref170">Levy 1988</xref>; <xref ref-type="bibr" rid="ref098">Gelpi 1997</xref>: 262) have suggested that the likelihood of using strong diversionary practices – for example, ‘humanitarian war’ – increases with domestic non-violent protests. However disruptive these protests might be, their consensual general form – such as the use of legally sanctioned means of protest – still signifies a degree of in-group cohesion. A foreign conflict and its accompanying ‘rally round the fag’ effect may offer a solution to these early signs of in-group troubles. When the in-group troubles have escalated to the point of internal violence, foreign war may not seem a viable option. For a disintegrated domestic in-group, anything ‘foreign’ is already conceptually problematic. If systematic interventionism is an option, it may take various forms, ranging from mild interventionism programmes demonstrating one's prestige and benevolence to, at an extreme, war and occupation.</p>
<p>Thus, domestic reasons can lead to various diversionary interventions. The reasons constitute the ‘push factor’ of interventionist practices. It is possible to argue that many of the compassion and containment related interventions – that is, humanitarianism and public health programmes – are at least partly caused by these push factors. While making this argument, it should be noted that the directionality of the push factors – that is, what becomes the target areas or states – is determined by specific culturally conditioned sensitivities. For example, the democratic peace ideal that has dominated the Western political rhetoric since the end of the Cold War terms other governance practices as deviations and into possible sources of insecurity. Keeping this cultural sensitivity in mind, it is possible to recontextualize bad governance with the pandemic security link. Pandemic security may be interpreted as a pretext for more ideologically based
<xref ref-type="page" id="page_80"></xref>
interventions in regions or states deemed as suffering from bad or failing governance.</p>
<p>Besides the push factors, one can see that the directionality of interventionist practices is also decided by ‘pull factors’. Approaching the issue from the Thucydidean neoclassical viewpoint entertained here, regressive communal trajectories have a tendency to get entangled. States experiencing in-group problems are fixated with them. They become sensitive to seeing the signs of similar regressions in other places. At the same time, failing communities that are further along the regressive slope, actively draw in outside interventions. These disintegrating ‘political bodies’ easily become attractive targets for diversion-based outside interventions. In line with the argument delineated here, diversionary practices can be approached from a less strategic or rational perspective, which is more sensitive to the different in-groups' identity dynamics. It is notable that in the rationalistic models, the direction of causality is thought to be straightforward: domestic strife encourages foreign aggression (<xref ref-type="bibr" rid="ref061">Dassel and Reinhardt 1999</xref>: 56). Besides the push factor of the domestic in-group problems, the pull factor of the site where the projection takes place has been rarely considered. It could be equally likely that highly visible problems in some out-group communities stimulate or pull other actors into diversions in the form of highly visible interventionism. The pull factor of a failing political community caught in the vortex of spreading and deepening violence offers further insights into the patterns of co-option between different actors. This general regressive nexus provides a dynamic context for the broader understanding of pandemic spectacles. On the one hand, pandemic scares are reflections of broad anxieties in the viability of the present hegemonic in-group. On the other hand, the interventions made in the name of global health security become ingredients in the overall complex entanglements of a world in crisis. In a world where the distinction between the close by and the distant becomes blurred, various forms of containment based interventions are in high demand. It is in this world that pandemics become extremely scary and their powerful visual rhetoric starts to express other types of enmities. In this complex entanglement, the threat of terrorism starts to resemble a lethal epidemic disease.</p>
<p>The language of contagion brings additional dynamics into the push and pull trajectory of compassion and contagion based interventions. The largely non-cognitive nature of the push–pull effect means that diversionary practices may become less strategic as states drift down the intervention enabled slope.</p>
<p>The contagion models of political conflict shed additional light on the push and pull dynamics involved in diversionary interventions. I will turn next to the various dynamics and schemas for understanding the push and pull factors involved in this extension beyond the ‘nearest is dearest’ boundary and across various suffering political bodies. The morality dramas involved in compassion and containment emergencies are both judgemental and emotionally intense. Their visuals stimulate and compel those far beyond the Ground Zero of the emergency area to intervene. This sudden ‘spread’ of a sense of emergency should be given some conceptual substance. The term, ‘contagion,’ refers to the
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idea that political agitation in one location influences the possibility of similar political contestation in another location either by increasing its likelihood or by causing increasing immunity (<xref ref-type="bibr" rid="ref172">Li and Thompson 1975</xref>: 63). Contagion often refers to the rapid transmission and spreading of disturbances throughout a region in a way that eludes ‘efforts to control its scope, speed and direction’ (<xref ref-type="bibr" rid="ref159">Koslowski and Kratochwil 1994</xref>: 215, 247). Besides suggesting an external factor, the literature on contagion also implies some type of internal condition for the contagion to take hold (<xref ref-type="bibr" rid="ref226">Ross and Homer 1976</xref>: 1). In addition to having external and local constituents, it is noteworthy that the dynamics of contagion depends on the varying political status. For example, <xref ref-type="bibr" rid="ref187">Midlarsky <italic>et al.</italic> (1980</xref>: 272) define a hierarchy effect that makes disturbances contagious when ‘a perceived enemy of much greater size, power and force capability engages in what can be interpreted as the indiscriminate use of violence.’ In this way, violent acts by actors with high international status are more easily imitated by peripheral actors than vice versa. Highly visible violent acts lead to contagion from central places that have a relatively high status, into the more marginal areas.</p>
<p>One key finding seems to be that contagion has quasi-cognitive qualities – it refers, in this sense, to the flows of emotional content or to the spread of a mood, sentiment, attitude or judgement. Contagion can assume different forms. Besides the spread of technical mimicry, the transmission of symbolic–‘performative’ content is central to contagion. Implicit in most contagion literature is a presumption that violence spreads by social example rather than by conscious learning (<xref ref-type="bibr" rid="ref122">Hill and Rothchild 1986</xref>: 718). The dynamics is often linked to human nature, which is regarded as essentially imitative of and responsive to other peoples' behaviour (<xref ref-type="bibr" rid="ref107">Govean and West 1981</xref>: 349). Contagion literature makes constant references to quasi-cognitive social learning (<xref ref-type="bibr" rid="ref224">Rose 1976</xref>: 22; <xref ref-type="bibr" rid="ref122">Rothchild 1986</xref>: 719). To describe contagion, terms such as ‘inspiration’ and ‘stimulations’ are used in research literature. From the perspective of contagion, it seems that unconscious and habitual political dispositions and dynamics matter (<xref ref-type="bibr" rid="ref184">Mayer 1969</xref>: 294). It is asserted repeatedly that contagion is possible if there are endogenous groups with at least the beginnings of identities conducive to political violence (<xref ref-type="bibr" rid="ref122">Hill and Rothchild 1986</xref>: 720). These underlying or dormant identities can be suddenly reanimated as when the wave of nationalism spread around the former Soviet sphere in the first part of the 1990s. It seems that a latent group structure is the prerequisite for contagion to take hold: the more heterogeneous the in-group structure, the more room – or dormant identities – there is for contagion to take hold in some segments of the citizenry. A sense of an underlying fragility can take hold; it can lead to an increasing likelihood of perceived in-group problems in a stronger state and to the increasing possibility of further collapse and failure in an emergency area. Furthermore, it can increase the chances of a diversionary connection between these two entities when the problems of the failed community stimulate the political imagination of the stronger community.</p>
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<title><xref ref-type="page" id="page_82"></xref>Pandemic dynamics and trajectories of enmity</title>
<p>The discourses on contagion and diversion illuminate crucial elements of the underlying directionality of the regressive flow. They also provide ways to understand how pandemic scares and interventionist practices can become constitutive elements of the overall flow.</p>
<p>Contagion, diversion and interventionist literature indicate an underlying common dynamics. First, the local swirls of violence, which rapidly deepen, tend also to spread. Second, much of the spread is based on imitative and non-cognitive processes. Third, violence tends to attract outside forces to intervene. Fourth, there are external (pull) factors and internal (push) factors involved in the interventionist practices, which are based only partly on strategic planning. Fifth, the hegemonic power – that is, the US – is likely to exhibit moderate in-group problems and is, therefore, prone to feel the push and pull effects. These effects intensify the emotionality involved, which can lead to making different types of interventions irresistible.</p>
<p>Pandemic scares provide opportune moments for realizing interventionist pressures. There are two general reasons for this. The first reason stems from the tendency of global heath governance and security to remain relatively apolitical. Their more political content remains relatively under the radar of global attention and, therefore, the pandemic practice offers the ideal excuse for political co-option. For example, the explicitly humanitarian language of health development has been tightly connected with colonial practices. As a frame, it helped in creating the perception that the colonial powers were in the business of helping Africa, rather than conquering it (<xref ref-type="bibr" rid="ref030">Brantlinger 1985</xref>: 167–8). Imperial expansion was turned into a necessary curative and apolitical movement: ‘[o]stensibly removed from the realm of land and politics, colonization viewed through the lens of salutary medical aid was made to seem essentially humanitarian’ (<xref ref-type="bibr" rid="ref150">Kelm 1998</xref>: 101). Besides noticing the intimate connection of public health with empire or nation building, it is important to note that this political function made the related field of expertise very powerful in the domestic context. Its job was to maintain the general perception of curability not only in the more constricted sense of epidemic control, but, in a broader sense, of political progression and health. Among the important demonstrating grounds of curability was what <xref ref-type="bibr" rid="ref164">Bruno Latour (1988)</xref> terms ‘theatre of proof ’ (<xref ref-type="bibr" rid="ref164">Latour 1988</xref>). The core of this health theatre was essentially a laboratory experiment, which became an essential testing ground for modern state governance expertise, transferred into the field – as, for example, into the African landscape. The colonial practice offered ‘fields’ for the demonstrations of efficacy. The related interventionist practices gained political legitimacy when fields, such as in Africa, were made to visibly show signs of Western induced health.</p>
<p>The second reason is that the language of pandemics is part of the more general rubric through which enmity is felt and made tangible in international relations. From this perspective, the ways in which lethal epidemic diseases are made understandable and significant is inherently similar to the ways in which
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political threats are perceived. Consequently, ‘disease language’ tends to acknowledge and reaffirm the existing patterns of political authority and the beliefs about ‘natural’ power hierarchies separating different actors (<xref ref-type="bibr" rid="ref110">Gwyn 1999</xref>; <xref ref-type="bibr" rid="ref163">Larson <italic>et al.</italic> 2005</xref>; <xref ref-type="bibr" rid="ref198">Nerlich 2007</xref>). Moreover, political violence and its sub-categories are commonly treated in terms of a disease (<xref ref-type="bibr" rid="ref245">Spilerman 1970</xref>). In their treatment of state failure, <xref ref-type="bibr" rid="ref284">Zartman (1995</xref>: 9) states that ‘[s]tate collapse is a long-term degenerative disease.’ There are numerous additional examples equating extreme political violence with disease like a regressive process. <xref ref-type="bibr" rid="ref193">Most and Starr (1980)</xref> refer to ‘war disease’ when they discuss the diffusion of war. <xref ref-type="bibr" rid="ref124">Holden (1986</xref>: 875) connects the related phenomenon of aircraft hijacking to ‘skyjack virus.’ <xref ref-type="bibr" rid="ref113">Hamilton and Hamilton (1983</xref>: 41) state that the main paradigm in terrorism studies holds that ‘terrorist incidents may encourage further violence through a process of imitation or diffusion, giving rise to a dynamics of terrorism analogous to that observed in the spread of a contagious disease.’</p>
<p>The general disease discourse offers a useful template for making events in the international realm seem tangible. The embodied object world evoked by using the disease metaphor is everyday enough for people to tangibly understand the intended meaning of political rhetoric. There are umpteen examples of this. Former US President Jimmy Carter stated in a speech on 4 January 1980, soon after the Soviet troops rolled into Afghanistan: ‘[a]ggression unopposed becomes a contagious disease.’ In today's context, these words are meaningful through the analogous associations that they contain. They draw from the dynamics of disease in explaining the meaning of international events. They hyperbolize the importance of the otherwise distant place with individual level danger, immediacy and urgency due to diseases. This same frame was used by US President Barack Obama, according to the book, <italic>Obama's Wars</italic>, by <xref ref-type="bibr" rid="ref280">Bob Woodward (2010)</xref>. Obama stressed that ‘we need to make clear to people that the cancer is in Pakistan.’ The gradual failure of Pakistan, a nuclear state, coupled with the fact that the US' prime enemy, the Al-Qaeda, had established a stronghold in Pakistan, was made concrete by the use of disease language. In his speech of December 1, 2009, President Obama stated, ‘We're in Afghanistan to prevent a cancer from once again spreading through that country. But this same cancer has also taken root in the border region of Pakistan. That's why we need a strategy that works.’</p>
<p>Cases of using the disease frame are too numerous to fully mention here. However, one further general feature of this language dynamics can shed light into how diseases as a frame for understanding enmity conflate with the frame of pandemics as a global threat. The close parallelisms between the two frames have implications for both. The following quote from President Obama's speech in New York at the Millennium Development Goals Summit on 9 September 2010 nicely illustrates such parallelism and its effects: ‘[w]hen millions of fathers cannot provide for their families, it feeds the despair that can fuel instability and violent extremism. When a disease goes unchecked, it can endanger the health of millions around the world.’ Because political enmity and physical diseases have historically been conflated, the arguments for the relevancy of each and/or both can be used in close proximity without betraying any sense of
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mixing apples with oranges. To further examine the parallelism enabled by the embodied sense of diseases and pandemics, the following text from the White House pages on the progress of the Home Land Security is illustrative: ‘[a]ttacks using improvised nuclear devices or biological weapons, as well as outbreaks of a pandemic disease, pose a serious and increasing national security risk. We will focus on reducing the risk of these high-consequence, non-traditional threats.’ The integrated approach to meeting the threats of rogue states and terrorism subsumes many of the defences against naturally occurring diseases. The probable result is that the occurrence of natural epidemic diseases heightens security concerns and recontextualizes the epidemics in quasi-security language.</p>
<p>The language frame's parallelism causes spilling over of the embodied meanings. The various situational scenarios of both naturally occurring pandemics and politically conceived enmities overlap in ways that result in the perception of pandemic threats containing a significant political enmity related knowledge modality. The most significant consequence of this is that security centred language and the language of physical disease share a vital embodied modality without which neither frame is fully meaningful. This sharing between the two overlapping frames can be used to understand present-day perceptions and incidence of pandemic scares – that is, scares in the absence of significant disease outbreaks. The heightened security environment of the last decade easily leads into imagined pandemic embodiment since the template for them is actively present in the figurative discourse of political rhetoric, strategy and practice. Thus, pandemic scares and governance interventions against them are a natural consequence of the overall power-political flows of our time. In the context of the War on Terror, one can echo Susan Sontag's claim that notable diseases are always ideally comprehensible in their own time. And this political modality of the recent pandemic incidences makes them into something other than how they appear in the textbooks of medicine.</p>
<p>The Thucydidean model for major political regressions involves powerful emotional vortexes that spread, intensify and overwhelm small and, eventually, even big actors. It is a model of mutual regression in which the passionate connections between far-away locations provide the channels for constitutive emotional transfers. Caught in mutually regressive processes, the political actors are drawn to each other. Local hatred becomes the ‘cohesive’ emotion, where outside actors are drawn through the compassion felt towards one side of the conflict. From this perspective, it is easy to see how both the Afghanistan intervention in 2001 and the Iraq invasion in 2003 were turned into clear-cut moral dramas in the US. In Afghanistan, the so-called Northern Alliance was deemed to be the protagonist for good things, while the Taliban was treated as the enemy. In the same way, the Iraqi Kurds and Shias were seen as the bodies of suffering. The plight of these two groups was much highlighted in the administration's rhetoric and in media representations. These compassions stimulated the convulsion that the hegemonic power hierarchy faced on 9/11. Taken together with the compassion felt for the hegemony, the compassions comprised an overall vertically and horizontally spreading flow.</p>
<p><xref ref-type="page" id="page_85"></xref>This macro-level regression was dramatically induced by the world order shock of 9/11. The mobilization of that event for the purposes of restoring Western potency provided the background for the later events in Afghanistan and Iraq. These interventions further connected the US as the hegemonic political body to the local regressive flows in these fragile, failed or, eventually, anti-communities. The dynamics of pull and push provided the context for the arousal of other political emotions. They also provided for the mutual contagion of agitation and violence, that is, the suffering of different interlinked political bodies. It is in the frame of this flow that pandemic scares have to be recontextualized. The argument here has been that the interventions in Afghanistan and Iraq, along with many other multilevel interventions, have to be understood as one overall flow.</p>
<p>It is clear that Iraq and Afghanistan were not typical humanitarian or containment interventions, although they were partly justified thus (<xref ref-type="bibr" rid="ref179">Mack 2004</xref>: 683). The just cause and last resort criteria were not fulfilled (<xref ref-type="bibr" rid="ref178">Macfarlane <italic>et al.</italic> 2004</xref>: 977). <xref ref-type="bibr" rid="ref221">Roberts (2006</xref>: 580) says Iraq should be put into the category of ‘transformative military occupation’. His idea is that the US made an effort to fix the failed Iraqi state and restore it from totalitarian rule. The consequences of Afghanistan and, more particularly, Iraq on the shape of humanitarian emergencies and interventions have been noted by many authors (<xref ref-type="bibr" rid="ref178">Macfarlane <italic>et al.</italic> 2004</xref>; <xref ref-type="bibr" rid="ref209">Piiparinen 2007</xref>). The main argument is that Iraq caused a moral vacuum in the arguments for an intervention. The underlying reason for this appears to be the ‘pre-text’ nature of the intervention in Iraq. Iraq can be regarded as a self-interested military action, in which humanitarianism provided only pre-text or post-hoc reasons. I would support this argument because it recognizes Iraq as a form, albeit deviant, of humanitarian intervention. The argument errs in not being able to adequately capture the sentiment of the world order emergency involved in the War on Terror. Moreover, the argument misses out on many of the compassions involved in Iraq and Afghanistan. It also fails to relate these to the root causes of the complex humanitarian emergency in Iraq.</p>
<p>The crisis of interventionism justification caused not only by Iraq and Afghanistan, but also by numerous botched interventions and non-interventions – for example, Somalia, Rwanda, Darfur and Congo – has led to much demand for different types of legitimate governance interventions. Interventions to build local level pandemic preparedness programmes offer some opportunities for actions deemed highly legitimate. The ease of translating these public health interventions into political ones is reinforced by the shared elements between the global health conceptual frame and the security–enmity frame.</p>
<p>In general, hegemonic powers externalize their internal in-group problems and smaller communities collapse, pulling the outside elements in. Thus, while the overall behaviour of all the actors becomes whimsical and erratic, the big states can maintain themselves longer than the small ones. The regressive dynamics works itself through small actors in a sudden, highly visible burst. The small actors caught in the emergency become attractive or even compelling objects for the diversionary pressures of the principle actors. This neoclassical
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holistic dynamic provides a frame for the understanding of modern ideas about contagion and diversion. The dynamics also shed light on the various processes involved in humanitarian emergencies: communal collapse, powerful mobilizations of compassion, outside intervention, and patterns of co-option.</p>
<p><xref ref-type="bibr" rid="ref258">Thürer (1999</xref>: 732) states that a failed state is a cluster concept that ‘does not denote a precisely defined and classifiable situation, but serves rather as a broad label for a phenomenon which can be interpreted in various ways’. The purpose of this chapter was to point out the complicity of the nexus between macro-level turbulence and local level failure for the regressive flows associated with state failure and intervention. <xref ref-type="bibr" rid="ref227">Rotberg (2002</xref>: 90) uses the appropriate metaphor of ‘black hole’ when describing a failed state: ‘[a] collapsed state is a mere geographical expression, a black hole into which a failed polity has fallen.’ This language is appropriate to the vortex model we have developed here. The disappearing political affinity has caused violence, which has turned the community into an anti-community. The additional property of this black hole like anti-community is the intense ‘gravitational pull’ which it exerts on hegemonic power at the initial stages of political regression and which is still able to launch multidimensional diversionary interventions.</p>
<p>The post-9/11 literature on state failure often evinces the argument that it is the special duty of the international community and its member states to rise and meet the responsibility of containing, managing, healing and preventing political regression. Compassion for and worry over the world order are the sentiments mobilizing such interventions. State failures are regarded as implosions caused mainly by endogenous factors. However, foreign intervening powers play a more sinister role in state failures, and this role has rarely been examined. This chapter has given some substance to the notion that the contact between the hegemonic interventionist power, the US, and weak, fragile and failing states, such as Iraq, Somalia and Afghanistan, at different stages of regression, could have led to a coupling phenomenon with a distinctive intensifying dynamic. This dynamic provides ample grounds for the perceptions and scares of violent pandemic diseases.</p>
<p>Political, personal and somatic ‘bodies’ have to face the powerful currents of war and disintegration of political bodies (for example, stasis) and somatic bodies (for example, plague) at multiple levels. The influential medical ideas of Thucydides' time stressed the parallelism between different bodies, and between inner and outer movements (<xref ref-type="bibr" rid="ref202">Padel 1992</xref>: 67). This topos still influences the discourses of political passions and contagions. Political agitations and movements at different levels influenced each other: the linkages aroused political emotions and linked them with personal emotions. Passions and judgements were connected to overall movements and, therefore, they could be properly interpreted only in relation to larger events and contexts (<xref ref-type="bibr" rid="ref282">Young-Bruehl 1986</xref>: 6). The sudden movements at the level of international relations translate into public and private emotions that enable and constitute further macro-level movements.</p>
<p>The systematic and structure oriented field of international relations finds it difficult to make sense of the motion or flow from one moment to the next. The
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meaning carrying aspect of rhythm and tempo is often left untouched as difficult and idiosyncratic. Action in the form of progression of events and development of themes is required to cement the significance of what is happening. The neoclassical model presented here illustrates a more nuanced, yet holistic, understanding of how different aspects of the temporal rhythm connect with each other. The overall encompassing flow is the current that electrifies and animates momentary events such as wars and pandemics. Such a current unifies the different aspects of the political drama. The current unifies in the sense that we can then recognize the interplay between the various aspects of the political process as conductors of a single current that either spreads from one feature to another or flows through several features at one time. Among the layers of meaning in the spread of the violence dynamics are the macro-level power hierarchy (for example, the American unipolarity), local level political regression (for example, the state failure in Afghanistan), and individual suffering (violent deaths and pandemic scares). All of these aspects matter. However, they may be adequately appreciated only when seen as connected by the cultural mediated model of the flow of political violence. This means that although there are different variations of the themes of world order turbulence, local level convulsions, and individual plight emergencies, it should be noted that their prescriptive forces are often triggered under the same circumstances, as parts of the same overall spiralling flow.</p>
<p>My argument is that emotions are important constituents of violent motions. Political emotions communicate underlying changes in micro-and macro-level power hierarchies. Emotions felt over there alarm and agitate. They mobilize further intensification of the regressive dynamics. Demagogues who exploit these sentiments are tempted to stir up and excite demos or particular factions of it. The stirred up situation leads to what Thucydides calls the ‘morbid passion for what is absent’ (Thucydides, 6.13.1). What is absent is in-group coherence and, increasingly, this is sought after by engaging in ‘rally round the fag’ wars against distant enemies. In smaller communities, the desire for together-mindedness finds its perverse fulfilment in the persecution of other factions. As noted, the parallel passions in big and small states can interlock with each other.</p>
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</book-part>
<book-part book-part-type="chapter" book-part-number="4" id="Chapter4">
<book-part-meta>
<title-group>
<title><xref ref-type="page" id="page_88"></xref>Trajectory of a pandemic drama</title>
<subtitle>Ebbing and waning of the BSE crisis in 1996</subtitle>
<alt-title alt-title-type="running-head">Trajectory of a pandemic: BSE crisis 1996</alt-title>
</title-group>
</book-part-meta>
<body>
<boxed-text>
<caption><title>Disease summary</title></caption>
<p>According to World Health Organization (WHO) data, Variant Creutzfieldt–Jakob Disease (vCJD) is a rare and invariably fatal human neurodegenerative condition. vCJD is classified as a transmissible spongiform encephalopathy (TSE) because of the characteristic spongy degeneration of the brain it induces and its ability to be transmitted. vCJD is a new disease that was first described in 1996. Cases of vCJD appear along with TSE in cattle in the form of bovine spongiform encephalopathy (BSE), popularly known as Mad Cow Disease. It appears that the consumption of BSE contaminated bovine products could cause the disease to be passed on to human beings. vCJD affects people of an average age of 29 years. The average duration of the illness, which has no known cure, is 14 months. There were 129 BSE connected cases in the UK (six in France and one each in Canada, Ireland, Italy and the United States) as of November 2002. The potential number of such cases remains uncertain as the disease can have an incubation period of decades.</p>
</boxed-text>
<p>The public images of the outbreak of bovine spongiform encephalopathy (BSE, or Mad Cow Disease) in the United Kingdom (UK), which were broken by media headlines in early 1996, were those of a doomsday scenario. The sick, jerking and stumbling cows that were shown on television hyperbolized the sense of an unnatural situation that was dangerously out control. The emphasis placed on madness during the BSE drama embodied the fears and anxieties of multiple broken boundaries. The complexities of the disease condensed many alarming dynamics of the time: the sense of a perversely industrial pattern of food production, the British countryside somehow becoming more unnatural, the strains on British society associated with the Thatcher years, the Europe-wide concerns over the European Union (EU) expanding, the worries over British sovereignty, and the contested state of the European integration. The BSE tremors were a highly comprehensible refection of the times. Many bewildering and, indeed, maddening developments were condensed into a hyperbolic form in the politico-somatic drama that took place during March–April 1996. Anyone who had eaten any cattle products, as, for example, hamburgers, in the British
<xref ref-type="page" id="page_89"></xref>
Isles was thought to be in danger. The brain eating disease was deeply felt by many. Unknown to them, they suffered from a somatised impact of the political anxieties of their time.</p>
<p>The political drama found its most headline arousing modality in the contestation between the UK government and the EU institutions over the cordon imposed on British bovine products, the subsequent boycott by the UK government of the EU decision, which briefly paralysed it, and of the ongoing Intergovernmental Conference, which is the most sacrosanct part of the EU. These interventions and counter-interventions were all done in the name of public health and scientific evidence. The public health related diversionary interventions and political co-option can be seen as stemming naturally from the ontology of states as results of a bargaining process between various groups and their interests. The pandemic spectacles can be seen as expressions of an in-group contestation in some states or in-group conflicts in a more transnational sense – between the elites of a region. It should be emphasized that international public health interventions and programmes are also parts of a more modernist cosmopolitan framework that transcends state boundaries. In this way, the international public health perspective represents a radical departure from the realist perspective of state thinking. Functionalist and neo-functionalist governance ontologies prevail in international organizations such as the United Nations (UN) and its sub-organizations – such as WHO – and in supranational regionalist organizations such as the EU. In most cases, the target or the ‘field’ of functionalist governance is in regions of the world where public health is considered to be neglected and, thereby, posing a risk for global public health. However, BSE provides a case of a scare of a serious pandemic outbreak occurring in a Western European country, the UK. It also provides a case in which interventions – such as embargoes – justified by public health concerns targeted an advanced Western state. Moreover, these interventions were a subject of intense politicization and controversy: the pandemic scare briefly reshaped political arrangements and the character of interstate relations. They had direct ramifications for the functioning of the EU as the British launched a boycott of the former's intergovernmental processes. At the same time, the BSE scare caused widespread market panic as the consumption of bovine products plunged.</p>
<p>The BSE scare provides a case in point of the ways in which pandemics interact with the power-political dynamics of their time. The BSE incident's political language revolved around the UK's relationship with the EU. The dynamics of the BSE situation posited the UK's Euro-sceptic stance against the integrationist stance of the other European member states and the European Commission (EC). The more entrenched images of enmity also synced with the measures taken to fight BSE. For example, the British press entertained anti-German headlines during the crisis. The ways in which BSE was politicized reflects the underlying close connection between lethal epidemic diseases and enmity: the language of pandemics is part of the more general rubric through which enmity is felt and made tangible in international relations. As was pointed out in the earlier chapters, the general form of disease language tends to be in sync with the existing
<xref ref-type="page" id="page_90"></xref>
patterns of political authority and the beliefs concerning the power hierarchies that separate the different actors.</p>
<p>In this chapter I will chart the political trajectory of BSE in 1996. The chapter links in with the substantive arguments of this book in three ways. First, the BSE crisis illustrated the general dynamics of plagues and politics. Second, it provides an important precursor case for the understanding of the political modality of later pandemic scares. Third, it provides additional elements to the ways in which certain political dynamics could interact with other contemporary political dynamics.</p>
<sec id="sec4-1">
<title>The spectacle of sick, jerking, stumbling cows</title>
<p>The sick, jerking, stumbling cows of the UK came to define European politics in the spring of 1996. BSE rose to international prominence amidst a myriad domestic contentions between the UK and the EU. Studies that demonstrated that BSE in cows was the likely cause of an emerging variant of the human CJD – the vCJD – were beginning to proliferate in late 1995 and early 1996. Most of these studies were dismissed by the UK government as dubious scaremonger-ing.<xref ref-type="fn" rid="fn4_1"><sup>1</sup></xref> However, a scientific study by the Government Surveillance Unit specializing in CJD showed clearly that BSE was the source in at least some cases of human CJD. Because of the growing public outcry over the perceived government secrecy and anxiety over health, on March 20, 1996, the British Secretary of State for Health, Stephen Dorell, was forced to announce the possible link in a statement to the House of Commons:
<disp-quote>
<p>There remains no scientific proof that BSE can be transmitted to man by beef, but the Committee has concluded that the most likely explanation at present is that these cases are linked to exposure to BSE before the introduction of the specified bovine offal ban in 1989. Against the background of this new finding, the Committee has today agreed to the series of recommendations which the government is making public this afternoon.</p>
</disp-quote></p>
<p>Immediately after the British announcement, the EU introduced a ban on British beef and bovine products:
<disp-quote>
<p>Following statements by the United Kingdom Government concerning a possible link between bovine spongiform encephalopathy and the appearance of a number of cases of Creutzfieldt-Jacob disease in that Member State, a meeting of experts on the Scientific Veterinary Committee was held in Brussels on 22 March, the result of which formed the basis of discussions in the Standing Veterinary Committee on 25 and 26 March. In accordance with this Committee's opinion, the Commission adopted a series of temporary measures to protect against BSE.</p>
</disp-quote></p>
<p>The emerging drama gravitated towards taking into account the welfare and confidence of individuals defined in terms of scientific certainty, instead of the
<xref ref-type="page" id="page_91"></xref>
usual political expediency. However, the political controversy was immediate. Although the EC openly recognized that the primary problem was not a real threat to public health, but the perception of a threat, it grounded its primary argument for the imposition of a ban on British beef on scientific advice and evidence.</p>
<p>The aim of this chapter is to examine how the emerging evidence that the animal disease, BSE, was linked with the degenerative vCJD provided a context for playing out national and supranational goals. The concept of the morality play is introduced to point out the importance of public health issues from the perspective of political legitimacy. Furthermore, the ebb and flow dynamics is used as an analytic device to tease out different phases of the BSE crisis. The BSE related morality play ebbed relatively rapidly: the initial phase was defined by a powerful sense of scientific uncertainty. However, soon it became clear that the scientific community could not provide any fundamental answers to the problem. Political considerations came to prevail and were influenced by citizens and consumer rights groups until, in the summer of 1996, the issue evaporated from political relevance. However, the BSE incident had more lasting consequences from the perspective of how pandemics came to be construed.</p>
<p>Diseases are often treated as inflicting populations that exist in a confned geographical space. From this perspective, the history of lethal epidemic diseases is often treated in terms of blows against populations in terms of density, distribution and lethality. For example, it is fairly common to examine how human behavioural patterns, such as the human relationship with domestic animals, affect disease emergence and spread. However, the aim here is to study how diseases inflict political communities and how specifc political communities mould the way in which diseases are interpreted. Rather than accepting the customary human–animal metaphor inherent in the concept of population, the starting point will be the Aristotelian notion of the political animal. The main research questions are how the appearance of the serious epidemic disease associated with BSE reflected the underlying nature of the European political order and what the course of the politicized variant of BSE was. In answering these questions, the BSE crisis of 1996 is interpreted in the guise of a political morality play. In general, morality plays involve a fight by the protagonist – often assuming the guise of all humanity – against the bad elements, the type of which is inherently connected with a specifc political context. Who were the actors who took the role of the protagonists in the BSE morality play? Who gave the appearance of representing European general interests? Who were the deviant elements in these plays?</p>
<p>In answering these questions, it is important to realize that the European political order is constantly shifting and varying. The macro-level movements hide more fleeting rearrangements, which, nevertheless, are more tangible signifiers of what is going on at the more general level. The levels interact and, as such, any micro-level dynamics are a matter of intense interest for the actors involved. The temporal morality plays are framed in terms of the rhythmic ebbing and waning of different issues. Accentuated by the unexpected appearance of BSE,
<xref ref-type="page" id="page_92"></xref>
European politics demonstrated a rhythmic, pulsing movement in international relations. This ebbing and waning initiated attention-catching events, which finally faded into political obscurity in a matter of months. Various contingent and instantaneous stipulations of shared standards of interpretation convey a sense of rhythmic political order. Such a pulse, at its zenith, is extremely compelling. The actors see in it their relative positions. The accentuated, situated scenarios, which were brought into focus by the unexpected and unconventional emergence of BSE, were used as a momentary criterion or standard against which the morality and legitimacy of various actors and their actions were examined and evaluated. It can be argued that the failure to tap into such a rhythm translated into a deficiency in fulfilling the perceived obligations that are essential for membership and the consequent rights of the European society of states. Having a sense of international rhythm, therefore, can be essential to enjoying societal rights, such as the right to be treated with respect in the same way as the other states. Accentuated ‘peculiarities,’ such as the BSE drama, give prominence to actions that are in step with one another simply because going against a current translates into a sense of either crafty strategic thinking or, far more probably and dangerously, into unwise insensitivity and inflexibility in the face of decisive events.<xref ref-type="fn" rid="fn4_2"><sup>2</sup></xref> Any more ‘real’ concerns over general public health based on scientific understanding are easily of secondary importance for the pandemic related public drama's ebbing and waning trajectory</p>
<p>The politically constructed practices of societal responsibility, obligation, credibility and duty were clear in the rhythmic flow of international interactions during the initial phases of the BSE crisis in the winter of 1995–96. Not surprisingly, then, the specifc content of the BSE affair centred on competition over who had most meticulously and fully adhered to the perceived public health standpoint, irrespective of the costs to narrowly perceived national self-interests. However, the public health paradigm soon lost its ability to offer an unproblematic solution and to point to an obvious way of proceeding. As the weeks went by, more leeway opened up for political co-option of the affair. It can be argued that the accented public health paradigm lost its cohesion creating character mainly because of increasing repetition and familiarity with the issues involved. Awareness of and familiarity with the accentuated BSE scenarios grew, greatly increasing the efficiency and skill with which these scenarios were used as political instruments in creating the desired effects by the various parties. The former deviant actors, such as the various national governments and especially the UK, gained ground at the expense of the initial protagonists of public health, such as the EC. The participants of the morality play started to gain ever greater skill and control, instead of being exceedingly constrained by the original sense of the compelling rhythm. The rhythm that had originally emphasized the European public health authorities over the respective national governments gradually started to embody the interests of the EU member states.</p>
<p>The rhythmic transformation that took place in the BSE morality play involved a gradual loss of perception of the extraordinary nature of the situation.
<xref ref-type="page" id="page_93"></xref>
There was a distinct movement away from BSE as a public health scenario to normal and routine political wheeling and dealing between governments. As the driving force of the whole transformation, the BSE morality play also involved politically innovative language games.<xref ref-type="fn" rid="fn4_3"><sup>3</sup></xref> The coming into being of the BSE emphasis in the middle of March 1996 entailed a corresponding move of BSE from a national and functional issue to an entity at the supranational European level. In other words, the coming into being of BSE as an international relations entity initiated a pandemic play that was characterized by both unconventional initial actions and the eventual normalization of affairs. The rumours and claims about the BSE threat started to circulate in earnest in the winter of 1995. The uncertainty peaked in the EC's decision to ban British beef in March 1996, which represented not only a reaction to factors external to the usual politics, but also a conceptual innovation in that BSE was made to look like an acute health threat emanating from the UK. The EC and some EU member states argued that the threat could not be generalized to include European beef production as such. Rather, the health issues were connected with particular British policies, which involved lax oversight and deregulation.</p>
<p>The attempts by the EC and the EU member states to see the BSE scare as a British problem followed the age old pattern of blame fixing when faced with dangerous epidemic diseases. The most common way of making sense of an unknown killer disease has always been localization. The pattern of blame revolves easily around the questions concerning the disease's perceived origin and epicentre. In political terms, this means that epidemics are instinctively territorialized, nationalized, racialized, and sexualized. In this way, the problems of UK farming and food production were attributed to the problems and soundness of UK governance. The national dimension of the blame game was further highlighted by the fact that scientific knowledge about the etiology of the disease was almost non-existent initially. Therefore, there were no historical benchmarks for understanding the disease.</p>
<p>The EU concentrated its efforts on confining the BSE related problems both at the physical and psychological levels by the extraordinary decision to ban British beef and beef products. Once BSE got alarmingly out of control, the mitigation of its ramifications became the top priority. It can be argued that for the EC, the substance of its decisions centred on making the disease geographically and conceptually analogous with the UK and its policies. In other words, the policies aimed at controlling BSE consisted almost exclusively of measures imposed on and required of the UK:
<disp-quote>
<p>The Commission today adopted … measures aimed at protecting against BSE…. The measures … ban the export of all live cattle, beef and beef products from the United Kingdom…. [W]hile the action already taken by the UK Government is a step in the right direction, further action will be required, which is why today's decision invites the United Kingdom to present further proposals to control BSE in the UK.</p>
<attrib>(IP/96/265, March 27, 1996)</attrib>
</disp-quote></p>
<p><xref ref-type="page" id="page_94"></xref>The containment of the BSE crisis comprised of checking the UK as the source of the outbreak. Two factors were emphasized here: the majority of the BSE cases had occurred in Britain and the information concerning the link between BSE and vCJD was made public in the UK:
<disp-quote>
<p>Commenting on the decision, Mr Franz Fischler, the Commissioner of Agriculture and Rural Development, said that following the announcement last week by the UK Government regarding new scientific findings on CJD (Creutzfieldt–Jacob Disease) and a possible link to BSE, the EU's beef industry has been plunged into crisis.</p>
<attrib>(IP/96/265, March 27, 1996)</attrib>
</disp-quote></p>
<p>Thus, the BSE problem was made into a British problem. The control of the disease and its effects required clear concessions from the UK, regardless of whether these measures would have any real effect on the causative agents.</p>
<p>The policy of non-cooperation towards the EU adopted by the UK as it attempted to gain control over the situation, framed the flow of events in a more nationally advantageous way. The British view was that the disease could have originated anywhere and, therefore, singling out the British was unfair and not a sign of European solidarity. After a brief initial hesitation, the interventionist measures by the EU were shown to be repositioning the disease as an infringement of British sovereignty. The UK represented BSE as a general scientific and medical problem, which, according to the UK, was unjustly made to appear as an exclusively British problem. Thus, instead of being fixed, the meanings of the actions of the various actors continued to evolve in the overall context of the gradual fading of the initially emphasized sense. At first, BSE was perceived as something that had clear and legitimate implications for European politics; then as an event, the requirements and implications of which were contested; and, finally, as something overwhelmed by other emerging issues and baseline political issues. The instantaneous transformation of order led to the eventual disappearance of the BSE related public drama from the agenda of high politics and to the usual scientific compartmentalization into a functional issue area.</p>
<p>The emphasis in the BSE morality play rose to international prominence from out of several domestic and European political issues. In crossing the threshold, BSE momentarily coloured its surroundings with attention catching and compelling features, bringing about briefly a sense of a distinctive meaning. Thus, the appearance of BSE entailed an attention-catching and accentuated event with a compelling sense of direction. The acute and overriding need to stabilize the situation by measures aimed at assuring people about the safety of their food was instrumental in crystallizing the spirit of the time in a specifc way. BSE momentarily gave a fixed sense of what was taking place now and would take place in the imminent future.</p>
<p>The accentuated nature of the BSE epidemic derived from five primary sources. First, the disease brought the relationship between the different levels of European governance into the limelight. Europe had to develop a genuine multilevel governance system. Because of this, the BSE drama highlighted the relations
<xref ref-type="page" id="page_95"></xref>
between the various existing layers of the structure. There was a strong sense that the national governance had failed in the UK in ways that were counterproductive for the general interests of European citizens. One of the main concerns was that the various institutions had failed to take into account proper scientific evidence (<xref ref-type="bibr" rid="ref080">Earlslater 1998</xref>: 629).</p>
<p>Second, the disease had crossed the species barrier. Food borne diseases may be regarded as especially marked signifiers of the perceived underlying wrongs and perversions when it comes to the human–animal relationship (<xref ref-type="bibr" rid="ref180">Mahy and Brown 2000</xref>: 33). Third, the disease agent involved in BSE and vCJD was a new one. What prions were and how they led to the disease aroused much scientific debate and public curiosity (<xref ref-type="bibr" rid="ref235">Shimkus 1998</xref>: 82). Fourth, the ‘madness’ of the disease was associated with the out of control food industry, which, out of narrow economic interests, used unsound industrial food production methods (<xref ref-type="bibr" rid="ref234">Shaoul 1997</xref>: 185). Fifth, the specifc impacts of BSE were associated with a modern risk sensitive society and hysteria prone Western European public culture (<xref ref-type="bibr" rid="ref140">Jasanoff 1997</xref>: 221).</p>
<p>The initial announcement by the EU of the ban on British beef and beef products shifted the emphasis away from the usual European political wheeling and dealing to a more unconventional order characterized by the public health drama and shaken consumer confidence. The BSE crisis had been lingering for many years as the growing evidence for the link was hidden by the local and national authorities in the UK. However, the row was started by Stephen Dorell's official announcement on March 20, 1996 about the finding of a new CJD variant quite probably linked to people eating BSE contaminated food. The announcement revealed the possible link with BSE contaminated meat. The resulting market panic and health scare focused on beef products and particularly on beef imported from the UK. The EU announcement introducing the ban on British beef and related products (EC/96/239) set the tone for subsequent international interactions by referring to considerations conventionally beyond the scope of European high politics. The emerging hyperbole gravitated towards taking into account the welfare and confidence of individuals defined in terms of scientific certainty, instead of the usual political expediency.</p>
<p>The way in which BSE as a public health threat accentuated and saturated European politics became increasingly distinct when the EC's actions were reciprocated by the UK:
<disp-quote>
<p>In conclusion, I believe that the steps the Government have taken up to now rest on sound science. Our objective is still to take science as our best guide. Our senior advisor on the science, Professor Pattison, has told us that, with the latest steps we are taking, beef is for all practical purposes safe to eat – safer than it has ever been.</p>
<attrib>(Mr Hogg, House of Commons, April 3, 1996)</attrib>
</disp-quote></p>
<p>Thus, although the EC quite openly recognized that the primary problem was not the real threat to public health, but the perception of a threat, it grounded its
<xref ref-type="page" id="page_96"></xref>
primary argument for the imposition of a ban on British beef on scientific advice and evidence. Similarly, the UK government, openly critical of what it considered the unscientific approach taken by the EU, still full-heartedly endorsed that all decisions should be based on public health considerations defined by the best scientific evidence. After initially agreeing with the decision to impose the ban on its own exports, the UK government started to openly disagree with the EC on the grounds that the latter's actions were based on perceptions rather than on available scientific evidence.</p>
<p>Thus, all the actors involved emphasized that any actions taken had to be based on the best available scientific evidence.</p>
<p>Although public health experts did not have conclusive evidence on the nature of the threat, they supported the use of tried and tested public health measures such as isolation and cordoning. The public health and scientific BSE language emphasized and aimed at the prevention of disease and at the promotion of people's well-being on the basis of the idea that the disease was caused by minute biological agents and could be eradicated by checking the spread of these agents. The prevalent public health perspective narrows and contains the agenda according to which emergency management ideally proceeds to purely medical considerations in an effort not to dilute and weaken the response to the crisis by other ‘extraneous’ political issues. Furthermore, the modern public health perspective deals with immediate health crises by applying to them what has been learned from past incidents: ‘surveillance, education of the susceptible, and simple isolation procedures with infectives’ (<xref ref-type="bibr" rid="ref025">Benini and Bradford 1995</xref>). Public health language derives much of its power from the concepts of progress, reason and enlightenment, which, in combination with the language games of medicine, highlight the idea of individuality rather than nationality, and the concept of universality rather than the state as a primary agent.</p>
<p>As an epistemic community, the public health perspective offers the technical skills and know-how required of governments or international organizations to efficiently manage emerging health hazards. However, the epistemic community is not only in a subservient role vis-à-vis politics. The European and worldwide community of medical scientists, public health specialists, epidemiologists and scientists in other related areas constitute a network of power, which bears major influence on how epidemic diseases are handled. Because of the transnational nature of the scientific community, it cannot be totally controlled by political considerations. A case in point is offered by the inability of the UK government to discourage and prevent the publication of information hinting at a link between BSE and vCJD, the BSE related variant of CJD. The transnational character of the scientific community is a source of possible political tension, which is further reinforced by the prevalent notion that infectious diseases should be managed in a borderless global context since political borders are porous to the causative agents of diseases.<xref ref-type="fn" rid="fn4_4"><sup>4</sup></xref></p>
<p>Within the EU, there existed in 1996 a wide range of institutionalized scientific bodies of both a permanent and more ad hoc nature, which, as sources of ‘expert’ opinion, influenced various political decision makers. The rhythmic
<xref ref-type="page" id="page_97"></xref>
movements of the BSE drama brought to the fore such institutions as the EU's Standing Veterinary Committee and Scientifc Committee and the UK's Spongiform Encephalopathy Advisory Committee. In addition to these institutional bodies, the scientific public health language was shared by and diffused over diverse institutes, universities, research centres and laboratories, which were united by similar procedures and research methods. These research networks were relatively independent of any explicit state and regional political entities, with the result that their interactions were not totally contained within the European context. However, the intergovernmental and governmental bodies could exert effective pressure on many institutions relying on governmental sources for funding, as is made clear by the history of BSE related secrecy and misinformation both in the UK and in the EC. Apart from the research networks directly linked with the scientific and medical approach, a wide array of public advocates, community based organizations, non-governmental organizations and consumer groups highlighted the need for ‘pure’ scientific evidence. Moreover, from the perspective of scientific research, the central prerequisite for any viable research programme was the ability to direct attention in order to get one's research and opinions across, with the result that media formed the key channel for persuasive scientific language regarding BSE, instead of the established governance structures (<xref ref-type="bibr" rid="ref094">Foreman 1994</xref>: 21).</p>
<p>The intimate and longstanding connection between science and politics has been particularly pronounced when, on the one hand, a lack of clear scientific advice and knowledge concerning some politically acute and reactive issue has left room for the need to clarify political viewpoints on scientific ambiguity. On the other hand, the generation of new scientific evidence can result in the re-contextualization of political drama. This influence of new discoveries and evidence was clearly demonstrated by the fact that the BSE drama was propelled into existence as a result of detailed scientific research. Whereas the history of international health cooperation clearly demonstrates the ease with which political considerations can take advantage of scientific disarray and competing theories, the initial accent of the BSE drama illustrated the sporadic, but still substantial, force of scientific evidence over European politics.</p>
<p>Studies began to proliferate in late 1995 and early 1996 demonstrating that BSE in cows was a likely cause of an emerging variant of human CJD. Most of these studies were dismissed by the UK government as dubious scaremonger-ing.<xref ref-type="fn" rid="fn4_5"><sup>5</sup></xref> However, a scientific study by the Government Surveillance Unit specializing in CJD clearly showed that BSE had been the source in at least some cases of human CJD. Consequently, UK Secretary of State for Health Dorell was forced to make a statement to the House of Commons (March 20, 1996), bringing the scientific knowledge into the political context:
<disp-quote>
<p>There remains no scientific proof that BSE can be transmitted to man by beef, but the Committee have concluded that the most likely explanation at present is that these cases are linked to exposure to BSE before the introduction of the specified bovine offal ban in 1989. Against the background of
<xref ref-type="page" id="page_98"></xref>
this new finding, the Committee has today agreed to the series of recommendations which the government is making public this afternoon.</p>
</disp-quote></p>
<p>Thus, the scientific community had managed to mould the context in which British–European policy was going to be played for several months, indicating a shift in the focus of European policy away from the usual discourses endogenous to politics, which took into account public health considerations.</p>
<p>The mystery and scientific uncertainty surrounding BSE and its possible link with CJD not only shrunk the space left for political manoeuvring along the accustomed routes, but, more importantly, gave increasing political influence to various consumer and health related groups. As it soon became evident that conclusive scientific proof could not be achieved without extensive and time consuming research,<xref ref-type="fn" rid="fn4_6"><sup>6</sup></xref> calls for immediate action based on the worst case scenario gathered momentum in all the EU member states, and especially in the UK. The discourse that pressed for immediate action consisted of a wide spectrum of different views united by the idea that a major health disaster might be imminent if drastic actions were not taken to alter the prevailing food production practices – for example, the cannibalistic practice of feeding bone meal to cows – that, according to these perspectives, had produced the disease in the first place. In other words, the central argument behind the concerned and critical attitude had to do with motivating people for necessary change and with pointing at the imminent catastrophe stemming from the perversity of modern lifestyles.<xref ref-type="fn" rid="fn4_7"><sup>7</sup></xref> In the BSE case, the conscientious discourse – that is, the discourse produced by many advocacy, consumer rights and public health groups – proceeded by expressing strong concern over existing food processing methods and intensive farming practices based on the maximization of profit, instead of a respect for the ‘natural’ way of doing things (<xref ref-type="bibr" rid="ref019">Baker and Ridley 1996</xref>: 242). The public health tone of the initial BSE games had not so much to do with scientific attitude and evidence as with a mixture of science, fear, anxiety and concern, which yielded compatible and accordant political decisions. Thus, the scientific language games – trying to establish causal explanations for natural phenomena – were momentarily blended with critical and normative language games – emphasizing the corruptness of secretive state centred politics that had led to unnatural means of taking advantage of nature – to produce the distinctive sense that something special was taking place. By focusing attention on the tradition of secretive, non-transparent and deceptive state practices in public health, various normative discourses turned the ‘better safe than sorry’ type of thinking into primary focus (<xref ref-type="bibr" rid="ref239">Slack 1991</xref>: 119).</p>
<p>The normative emphasis was initially shared by much of the European media. The public discourse highlighted embodied visions of people digesting beef that had been ‘unnaturally’ produced. As such, these discourses turned the attention away from the inconclusive scientific studies and from the bickering between the different governance bodies. BSE turned into an embodied metaphor expressing in a highly emotional way many of the anxieties people felt at the time.</p>
<p>From the perspective of the normative BSE discourse, the natural realm, still unaffected by modern artificial practices, is in a state of natural order and
<xref ref-type="page" id="page_99"></xref>
equilibrium. Not surprisingly then, the root cause of emerging disasters and eruptive calamities is often seen as lying in the destabilizing effects of human action. The revenge of the rainforest argumentation prevailed in the public arenas around Europe. These discourses disregarded the possibility of accidental mutations and natural transformations as a plausible cause for the emergence of new diseases: it is not the external reality that is chaotic, it is the social reality in which we live that is unnatural, hedonistic and, ultimately, self-destructive. Regardless of their diverse missions and reasons, various conscientious groups proceed by perceiving the state and the Union as fundamentally flawed and inadequate in addressing crucial questions satisfactorily. This resulted in pressure to take political action over the disease outside state sanctioned channels, as, for example, to the choices inherent in consumption. The strength of various consumer and animal rights movements led to transnational reactions that caused market havoc. The myriad actors involved relied on informal networks that cut across international borders. Consequently, these actors were able to spread their message and influence people at the grass-roots level, which could not be totally governed by states or international institutions. However, to continue to affect and to order complex international games for long periods of time, the normative BSE actors would have required politically sustainable coherence and a power base. The coherence disappeared as the scientific evidence and actual happenings discounted the idea of an acute public health catastrophe, and the power base vanished as the political language games turned to a vast reservoir of nationalistic language games for their source of legitimacy. In this way, the British media, for example, started to appeal to enemy images that framed the various European governments as hungry to infringe upon British rights. The EU was also mocked as incoherent and incompetent in ways that had been used before and have been used since.</p>
</sec>
<sec id="sec4-2">
<title>The waning trajectory of the BSE drama</title>
<p>After the initial push that set the BSE drama into motion, the focus started to shift from a coherent rhythm driven by public health considerations towards a less coherent order as the political language games started to catch on and no new scientific information further clarifying the issue was immediately forthcoming. The partial admission by the UK government that some of the information it had earlier called ridiculous and outrageous scaremongering was correct after all, questioned the legitimacy of its stance on BSE. However, the ambiguity of the scientific evidence and the contentious nature of the rivalling theories regarding what caused BSE and CJD gave room for political manoeuvring around the issue. Because BSE was caused by an unconventional type of disease agent – a prion – it was difficult to discuss the nature of BSE in a popularized epidemiological context, and consequently, the scientific evidence allowed for both misrepresentation and misinterpretation (<xref ref-type="bibr" rid="ref019">Baker and Ridley 1996</xref>: 242). Instead of the science fiction-like prion hypothesis, the most embodied modality of the BSE saga was the link between the sick, jerking cows and hamburger
<xref ref-type="page" id="page_100"></xref>
meat. The initial alarm caused by the pronouncement of a possible link between BSE and CJD also subsided as soon as it became evident that there were not going to be a large number of deaths in a short period of time because of the disease. Under these conditions, the political debate shifted away from implementing radical changes to taking into account economic repercussions, domestic concerns and international interests, besides the public health and consumer rights viewpoints.</p>
<p>The science-based public health language was attention-catching, but also ambiguous and required interpretation. In other words, the question as to who was the legitimate interpreter and representative of the scientific ‘knowledge’ became extremely important. The legitimacy of public health language has been reinforced by the much publicized advances made concerning disease causation and spread. This scientific expertise has started to provide the anchoring discourse for international governance – the lack of an objective outside authority allowed governments to use trade, economics and politics related considerations to guide their decision making on international health. However, in the modern age, the tension that has traditionally existed between scientific research and politics has had the appearance of having been resolved in favour of the latter as a result of the triumphs of medicine and science against such formidable diseases as plague, cholera and yellow fever. That said, the latter part of the twentieth century witnessed the emergence of new health hazards such as ebola and HIV and AIDS and the re-emergence of old lethal diseases such as tuberculosis (<xref ref-type="bibr" rid="ref013">Altenstetter 1994</xref>: 416). The growing alarm and the associated popular anxiety have led to the perception that public health expertise cannot always handle emerging health hazards. This, in turn, has resulted in more leeway for political concerns in formulating public health policies. Such politicization has been reinforced by the merging of ideological, normative and ethical controversies in dealing with national, regional and global public health issues.</p>
<p>In the BSE context, the ability to achieve political aims was therefore closely connected to the ability to speak in the name of science. Not surprisingly then, the initial BSE drama heavily emphasized the legitimacy of science and medicine over and above mere politics, which meant that to get the acceptance and backing needed for effective policy making, governmental actions on international health could not be openly based on narrow or conventional conceptualizations of national self-interest. Attempts by the political players of the BSE games to speak in the name of science were present throughout the episode. For example, Dorell formulated the UK's position on March 20, 1996 in the following manner:
<disp-quote>
<p>The Committee provides independent advice to government. Its members are not Government scientists; they are leading practitioners in their field and the purpose of the Committee is to provide advice not simply to Government, but to the whole community on the scientific questions which arise in its field. The Government has always made it clear that it is our policy to base our decisions on the scientific advice provided by the advisory committee.</p>
</disp-quote></p>
<p><xref ref-type="page" id="page_101"></xref>The crux of the argument was clear and meant to downplay the scepticism that the government had interfered with expert knowledge or that UK policies were not based on sound and independent scientific advice. The same substantive stance was echoed by the European Council, which, on the conclusion of its June 21–22, 1996 meeting, stated: ‘[s]uch decisions will be taken only and exclusively on the basis of public health and objective scientific criteria and of the judgement of the Commission, in accordance with the existing procedure, that these criteria have been satisfied.’ The Council indicated that there was no politics involved, only science, in its management of the affair. However, as all the parties involved knew, the focus and legitimacy of the scientific advice was blurred during the crisis. This was caused mostly by the inability of scientists and experts to agree on the basic nature and causation of the disease. This left room for political manoeuvring – other, more narrowly political arguments took the leading role, although not one of outright dominance at first.</p>
<p>By the time the UK introduced its policy of non-cooperation, the initial persuasiveness and attention-catching nature of the public health perspective had lost most of its ability to lead the discussion. As the shock and awe receded to the background, political controversies occupied the foreground in the discussion and in the decision making processes. Furthermore, the emphasis shifted increasingly towards calming and soothing actions. Thus, the need to present the reassuring appearance of BSE being under control was a very prominent feature. Because it had become evident by the middle of March 1996 that the BSE matter could not be kept out of public scrutiny, the emphasis shifted to controlling and minimizing the economic and political implications of the situation by appearing vigilant and thorough:
<disp-quote>
<p>The EC today adopted a series of provisional measures aimed at protecting against BSE…. While the evidence suggests that even should there be a link to BSE and CJD, the risk to human health has been eliminated or at worst reduced to a minimal level following the ban in 1989 on putting Specified Bovine Offal (SBO) into the food chain. Nevertheless, added Mr Fischler, given the very serious and volatile situation we find ourselves in today, it is futile to talk about scientific fact or evidence. There is a crisis of confidence concerning beef from the UK on the part of the consumer. This lack of confidence, he said, has rapidly spread throughout the EU with implications for the whole beef sector.</p>
<attrib>(EC Document on March 27, 1996)</attrib>
</disp-quote></p>
<p>After some initial wavering, the language shifted markedly towards emphasizing control of public health risks rather than stressing the centrality of economic disturbances. However, the political management of the public appearance of the disease was still close to the surface:
<disp-quote>
<p>Following the publication of new information by the United Kingdom concerning BSE, the Council emphasizes its determination to put in place all
<xref ref-type="page" id="page_102"></xref>
the necessary measures to ensure that public health is safeguarded. The overriding objective is a high level of health protection based on the best available scientific evidence…. The Council, however, recognizes that decisive action must be taken in order to control and finally eradicate the disease in order to restore confidence in beef.</p>
<attrib>(EC press release on April 3, 1996)</attrib>
</disp-quote>
<disp-quote>
<p>Concluding, Mr Fischler again emphasised that a scientific rather than a political approach represented the best way forward and any attempt to politicise the export ban, as has been happening in recent times, does not serve in any way either to allay consumers' fears or to expedite the easing of the ban.</p>
<attrib>(IP/96/433 on May 22, 1996)</attrib>
</disp-quote></p>
<p>Although the discourse by the EU increasingly took on a public health facade, the position of this stance in the overall trajectory of the BSE drama resulted in it becoming increasingly political as other actors had started to adopt such ‘scientific’ standpoints. The BSE drama that was initially set in motion by nongovernmental actors began to shift and spread in its scope as it was no longer supported by shocking new scientific discoveries or alarming news of arising or projected death rates.</p>
<p>In the context of the gradual waning of the BSE plays of morality and legitimacy, the identification of the UK as the source of BSE and its negative ramif-cations led to counter language games. These mainly British discourses emphasized that BSE was a European, rather than solely a British problem. As far as the UK was concerned, the ban on its beef and beef products on the grounds that they might pose a hypothetical risk to human health was scientifically unfounded and, therefore, politically motivated:
<disp-quote>
<p>The BSE crisis has presented the whole Community with a challenge of major proportions.</p>
<attrib>(Mr Hogg, House of Commons, April 3, 1996)</attrib>
</disp-quote>
<disp-quote>
<p>European leaders in the countries we visited have listened carefully to the British case. There is a growing acceptance of the need to find an urgent European solution to this European problem.</p>
<attrib>(Statement by the UK Foreign Secretary and Minister of Agriculture on June 7, 1996)</attrib>
</disp-quote></p>
<p>The main justification for using the ‘BSE as a Europe-wide problem’ argument was that it reasoned against the justification and legitimacy of the EU's measures against the UK.<xref ref-type="fn" rid="fn4_8"><sup>8</sup></xref> The stances started to harden and appeals to national sentiments started to appear as is apparent from newspaper headlines such as ‘Major Goes to War’ after the May 21, speech by British Prime Minister John Major, in which he announced the policy on non-cooperation: ‘[m]adam Speaker, important
<xref ref-type="page" id="page_103"></xref>
national interests for Britain are involved in this matter. I cannot tolerate these interests being brushed aside by some of our European partners with no reasonable grounds to do so.’</p>
<p>By ceasing to cooperate with EU decision making, the UK highlighted the sense of urgency and alarm it felt over the beef ban and the fact that the BSE drama had become anything but an affair based on and guided by science alone. In the same vein, it was argued by the UK that it had already implemented BSE control measures that went far beyond the measures taken in other member states.</p>
<disp-quote>
<p>We have explained very clearly the extent of the measures we have taken – going well beyond those in many other Member States of the European Union – to ensure the safety of British beef and beef products.</p>
<attrib>(Statement by Prime Minister John Major in the House of Commons on May 21, 1996)</attrib>
</disp-quote>
<p>Thus, the situation in which the UK was the sole target of BSE eradication was considered by the British government as intolerable: it distinctively and publicly pointed to the earlier British actions as reckless, unadvised and showing bad political judgement. As a result, the legitimacy of the British government suffered both domestically and internationally since it was perceived as being unable to contain the disease, which seemed to be in the process of being checked successfully elsewhere. Furthermore, it soon became evident that the crisis was not going to be treated as a common European problem as the British would have hoped, but as a primarily British predicament.</p>
<p>The taming of the BSE hyperbole to ft the interests of one's own nation signified the receding coherence and ordering power of normatively flavoured scientific and consumer rights discourse. To break out of the unfavourable position in which the UK found itself, more crafty arguments were needed than a mere appeal to European mutuality and goodwill. The characteristic thrust of such arguments brought about appeals to national sentiments as is apparent from newspaper headlines such as ‘Major Goes to War’. By stopping its cooperation in EU decision making, the UK highlighted the sense of urgency and alarm it felt over the beef ban and the fact that the BSE play had become anything but an affair based on and guided solely by science. The continuing public health language games on both sides acquired a form that was entirely decided upon by the craft and skill in proceeding with international games.</p>
<p>Concern over the sustainability of a risk-free situation and danger to national health were tangible at the beginning of the BSE affair. Not surprisingly, the pivotal question revolved around the measurability of the risks involved. In other words, how should the real risks be measured, were there any objective criteria for measuring health risks, what were the issues involved besides the immediate public health concerns, and how to best evaluate and balance all the issues that were at stake? Two themes emerged to occupy the central ground. First, the normal or usual state of affairs is that the management of diseases as a compartmentalized area of cooperation is left to presumably politically disinterested
<xref ref-type="page" id="page_104"></xref>
scientists and bureaucrats. From this perspective, the BSE crisis involved a breakdown of the boundary between politics and health as a functional area of cooperation. Second, the emergence of BSE in public consciousness did not only bring about the politicization of international health cooperation, it also resulted in public health rhetoric saturating the political space. Thus, the nature of the BSE drama was embodied in discourses that did not only extend political intrigues to international health issues, but distinctively produced arguments that were a unique mix of politics and science pertinent to the fleeting dynamics of the BSE trajectory.</p>
<p>The combination of political and scientific language games culminated in an emphasis on normalcy. Whereas the notion of normalcy referred to the existence of something that served as a standard for the right type of behaviour under the particular conditions of a health hazard, stability conveyed a sense of firmness of position and continuance without indecision. In other words, the BSE crisis stressed the political ‘sanctity’ of legitimizing and stabilizing appearances. Such appearances mattered very much to the actors of the BSE drama. The following references to the normalizing character of objective scientific criteria drawn from the speeches of Prime Minister John Major to the British Parliament exemplify the transformation of the BSE crisis:
<disp-quote>
<p><italic>April 1, 1996</italic></p>
<p>I emphasized to my European colleagues that, with the measures we have taken, British beef is, on any normal definition of the term, safe.</p>
</disp-quote>
<disp-quote>
<p><italic>May 21, 1996</italic></p>
<p>We shall continue to press the scientific case on our partners and to pursue our own programme to eradicate BSE.</p>
<p>This is based on the scientific evidence that these products are safe, when produced in agreed ways.</p>
<p>We have explained very clearly the extent of the measures we have taken – going well beyond those in many other member states of the European Union – to ensure the safety of British beef and beef products.</p>
</disp-quote>
<disp-quote>
<p><italic>June 24, 1996</italic></p>
<p>But we have the firm commitment from all heads of government in Florence that these decisions will only be taken on the basis of scientific and objective criteria.</p>
<p>The Florence conclusion makes it clear that decisions on each stage will be taken – and I quote – ‘only and exclusively on the basis of public health and objective scientific criteria and of the judgement of the Commission’.</p>
</disp-quote></p>
<p>The UK government's initial stress was on convincing others that the British measures were enough to tackle the problem and that British beef products were safe according to what they said was a ‘normal definition’. The UK was desperately trying to neutralize, normalize and contain a situation that had the potential
<xref ref-type="page" id="page_105"></xref>
of getting completely out of hand. The assurances concerning the safety of and control over the situation, which appealed to the normal definition of the term, ‘safety’, highlighted the desirability of stability and order in the extraordinary BSE situation. Normalcy was given a practical content by associating it with the measures that the UK government had already taken. Thus, normalcy was made dependent on the precautions taken against the extraordinary and unlikely health threat. The British hopes that things would soon return to ‘normalcy’ were dashed. The emphasis shifted to a scientific definition of safety, instead of the normal one. Moreover, the UK government considered that its stance was a scientifically proven one. There were no longer any appeals to the solidarity of the European governments or attempts to convince them. John Major's government began strongly pushing its case that the European institutions had overreacted. During the final phase of the BSE drama, there was a search for solutions to the crisis that allowed each side to claim that they had not backed down. The search for the face saving option also allowed all the parties involved to claim that all decisions were based on the best possible scientific evidence.</p>
<p>After the initial stage, the increasingly political stances of the BSE drama paradoxically highlighted the importance of science, of an objective criterion that should be allowed to speak for itself without any political interference. Scientifc discourses were co-opted by political considerations. The UK made an attempt at stability and order by posing them against the actions and demands of the other member states, which, according to the UK government, clearly deviated worry-ingly, dangerously and wrongly from the customary norms and legitimate guidance provided by the ‘non-political’ scientific standard. However, the crux of the discourses still referred to the desired normalcy as a state of affairs that would be best achieved and guaranteed by practical policy measures. By this point, the actions of the UK government started to take on a much more consistent and, therefore, more comprehensible appearance. The UK government claimed that what had to be contained was no longer the unaccustomed, unpredictable and extraordinary BSE prion, but the unreasonable, unjust and dangerous demands of the other EU states. Thus, the UK government was able to revise its argument and make the BSE crisis appear to be a Continental imposition.</p>
<p>The BSE scare as an exercise in hyperbole came to an end in the summer of 1996. At the Florence summit at the end of June 1996, the whole affair was ‘resolved’ by making it synonymous with a difficult, but politically inert disease that could be managed by scientific, non-political means. After Florence, BSE no longer played a part in European international relations. The political language used by the UK government just before the Florence meeting – highlighting the national interests at stake due to the perceived unjustifiable actions by the Commission and other member states – were not in stark contrast with the way in which the matter was eventually dissolved by the language games of ‘scientific and objective criteria,’ ‘exclusively on the basis of public health,’ and ‘scientists giving a clean bill of health.’ The BSE language, which emphasized the UK's national interests, was actually quite compatible with insulating the whole BSE matter from politics and, incidentally, from the public visibility brought to
<xref ref-type="page" id="page_106"></xref>
it by high politics. The prominence of normal political language at the expense of science dictated that ‘normalcy’ was instrumental in pushing BSE out of the international scene and into a politically indistinct technical realm. To sum up, the UK's BSE language proceeded from, first, highlighting the significance of scientific reason and criteria in vindicating and elevating a normal, stable and safe state of affairs amidst international games via, second, criticizing the extra-political and unjustified motives of the EU to, third, settling the whole affair by defining political normalcy in European politics in a way that excluded BSE.</p>
<p>The British BSE language changed the balance between the attributes of the ‘scientific’ and the ‘political’. In other words, the forces that were unleashed from political control at the beginning of the BSE crisis did not only instantiate themselves in public health concerns, but also entailed the recontextualization of public health as a political phenomenon. During the first phase of the BSE drama, the scientific evidence concerning the possible link between BSE and CJD was denounced as mere hysteria and, consequently, political actions together with the consumer reactions based on that evidence were defined as unjust, undeserved and not based on accurate science:
<disp-quote>
<p><italic>April 1, 1996</italic></p>
<p>Everyone recognized that the present crisis came not from a real health risk, but from unnecessary hysteria across Europe.</p>
<p>I told my colleagues of the impact in this country of the ban on British beef decided in Brussels last week, particularly as it was taken on the basis of considerations other than scientific advice.</p>
</disp-quote>
<disp-quote>
<p><italic>May 21, 1996</italic></p>
<p>I cannot tolerate these interests being brushed aside by some of our European partners with no reasonable grounds of doing so.</p>
<p>Some of our partners are reluctant even to contemplate moves in this direction, for reasons which have nothing whatsoever to do with the science involved.</p>
<p>We cannot continue business as usual within Europe when we are faced with this clear disregard by some of our partners of reason, commonsense, and Britain's national interest.</p>
</disp-quote>
<disp-quote>
<p><italic>June 24, 1996</italic></p>
<p>We will go on doing everything possible to protect public health, restore consumer confidence and secure the interests of the beef industry. Our overriding aim remains, as it has been from the start, the eradication of BSE from Britain.</p>
</disp-quote></p>
<p>In the second phase of the transformation, the policy decisions and the consumer reactions that were first denounced as uncontrollable outbursts of irrational fear and emotion were balanced against the British national interests that were at stake. Not surprisingly, what was considered hysteria and irrationality did not
<xref ref-type="page" id="page_107"></xref>
fare well with political interests. The scientific evidence that was considered unjustifiable from the point of view of national interests was downplayed. The final phase evolved from the fight over the science of BSE into the decision to put away the issue.</p>
<p>For the EU, the supposedly obvious reaction to the publication of new scientific findings in the UK was to halt the sales of British beef products as a precautionary measure. The measures that were considered entirely justifiable included actions with a significant impact on the political and economic interests of the UK. In other words, what had to be done and implemented seemed to flow naturally out of what was proper to the exceptional circumstances of a public health emergency. The spectrum of alternatives was, in other words, considerably reduced and condensed, with the result that only one interpretation of what should be done seemed prudent enough to calm the markets. Under these unusual conditions, the heavy emphasis on the scientific approach seemed to offer a legitimate, stabilizing and calming solution compatible with the essence of the BSE drama because, after all, it was scientific findings that had brought about the crisis in the first place.</p>
<p>It can be argued that the EC turned very inconclusive scientific evidence into an objective standard of safety by banning British beef, thereby setting into motion many of the interpretative dynamics that were distinctive of the BSE crisis. The best scientific evidence, which, in this case, meant the only evidence at hand, became a tool for minimizing the risk to public health. Moreover, the EU's language games proceeded according to the logic that the smaller the perception of risk for public safety, the more fleeting the ramifications of the whole affair for the efficiency and stability of the Common Market. The following quotations from the April 3, 1996 and April 30, 1996 Agriculture Council Meetings and the June 22, 1996 Florence European Council meeting exemplify the transformation of the BSE related rhetoric:
<disp-quote>
<p><italic>April 3, 1996</italic></p>
<p>Following the publication of new information by the United Kingdom concerning BSE, the Council emphasises its determination to put in place all the necessary measures to ensure that public health is safeguarded.</p>
<p>The overriding objective is a high level of health protection based on the best available scientific evidence.</p>
<p>The EU, as well as the United Kingdom, has taken a number of important decisions in order to minimize any potential risk to public health.</p>
</disp-quote>
<disp-quote>
<p><italic>April 30, 1996</italic></p>
<p>The Council considers that the combination of measures put in place by the UK, the proper implementation and follow-up by the Commission, the selective slaughter programme, the additional measures, and lastly, the renewed impetus on the need to rely on sound scientific advice for all future decisions, form part of a process which should allow the export ban to be progressively lifted, on a step by step basis.</p>
</disp-quote>
<disp-quote>
<p><xref ref-type="page" id="page_108"></xref><italic>June 22, 1996</italic></p>
<p>It invites the Commission to present the appropriate decisions when it considers that the necessary conditions, based on scientific and technical advice, have been fulfilled.</p>
<p>Such decisions will be taken only and exclusively on the basis of public health and objective scientific criteria and of the judgement of the Commission, in accordance with the existing procedures, that these criteria have been satisfied.</p>
</disp-quote></p>
<p>The expressions, ‘all necessary measures,’ ‘best available scientific evidence,’ and ‘to minimize any potential risk,’ all determined and defined the nature of what could be done and on what evidence. Moreover, because the best evidence at the time was hopelessly inconclusive, the appropriate measures could not be too detailed and specifc, but had to be aimed at eliminating unknown risks. Thus, regardless of the sense of direction inherent in the initial BSE drama, it resulted in rather sweeping measures that, once in place, redefined the contextual meaning of the subsequent actions.</p>
<p>The surprise and novelty of the situation began to wear off, with the result that the course of action that was initially considered quite appropriate in the extraordinary situation turned into something that needed to be defended and justified. Suddenly, the ‘natural’ meaning of the BSE crisis had become increasingly an object of attention and revision. In the end, the ‘overriding objective’ had changed from a willingness to implement ‘all necessary measures’ to eliminate any potential public health risks to the fulfilment of ‘necessary conditions’ so that the export ban could eventually be lifted. Furthermore, the necessary conditions for the lifting of the ban no longer conveyed a sense of naturalness immediately self-evident to political decision makers, but referred the whole matter to ‘scientific and technical advice’ and to ‘public health and objective scientific criteria.’ The last phase of the BSE order contained a sense of normalcy that indicated that additional pressures such as the necessities inherent in devastating epidemic diseases were no longer significant.</p>
<p>The eradication of BSE, which was taken as the fundamental goal, was defined as a matter of restoring confidence in European beef. However, the whole argument was somewhat self-referential and circular. In other words, the actions aimed at eradication were framed as primarily confidence restoring and only secondarily as geared to fighting the disease as an epidemic entity.</p>
<disp-quote>
<p><italic>April 3, 1996</italic></p>
<p>The Council, however, recognizes that decisive action must be taken in order to control and finally eradicate the disease in order to restore conf-dence in beef.</p>
</disp-quote>
<disp-quote>
<p><italic>April 30, 1996</italic></p>
<p>The UK is expected to put in place a series of measures with the combined objective of safeguarding public and animal health and restoring stability in the markets, consumer confidence, and the single market.</p>
<p><xref ref-type="page" id="page_109"></xref>The Council has heard a report by the veterinary experts who have evaluated the UK proposals, and has considered the UK concept as being a first step in the right direction.</p>
</disp-quote>
<disp-quote>
<p><italic>June 22, 1996</italic></p>
<p>The [EU] presidency declared that if in the meantime, a third country requests a supply of British beef exclusively for its domestic market, the request will be examined by the Commission within the overall framework after consulting the appropriate scientific and veterinary committees.</p>
</disp-quote>
<p>Thus, the EU was soon engaged in eradicating a bafflingly mysterious disease by means that were aimed at the alarming loss of consumer confidence. However, as consumer confidence started to pick up, the distinctive measures imposed on the UK remained because of the original reason, the BSE–CJD link. Despite the fact that the number of BSE cases continued to rise during 1996, the demand for beef and beef products rose significantly. In this environment, the original BSE impetus had lost its steam. The measures taken against the disease and to calm the markets were now mainly left over from the earlier more pressing political atmosphere. The power of the scientific standpoint to defne and point at some logical solution to the BSE problem vanished as the primary actors of the BSE drama began to interpret science, rather than the scientific standpoint being interpreted to them by the expert community.</p>
</sec>
<sec id="sec4-3">
<title>The legacy of the BSE drama</title>
<p>The BSE morality drama acted as an evolving guide to respectable behaviour. The EU's cordoning actions were initially considered inevitable even by the UK government. The apparent political victory achieved by the EU institutions on the BSE issue blended in with other happenings at the time so that the upper hand and initiative gained by the supranational EU was history before it had ever really been gained. The initial positions taken up by each side, which were made more distinct by the proximity of each to the BSE issue, were no longer valid when the focus of politics shifted elsewhere. The agreement reached at the Florence Council meeting on June 21–22, 1996, signalling the disappearance of BSE from the European international scene, was something of an anticlimax to the whole affair, which had been prepared for a more poignant resolution of the hyperbolic public health crisis. At the beginning of the BSE crisis, the general mood was one of a sense of alarm and emergency, which seemed to point at an imminent public health disaster. The awaited disaster failed to materialize in that the whole affair produced only a contestation between the players, which found its clearest expression in the UK's non-cooperation policy vis-à-vis all EU decision making. This policy seemed to bring things to hang in the balance, causing the initial anxiety over the looming public health crisis to recede into the background. However, the political contestation itself failed to produce anything significant as the attention shifted away from BSE politics to other more usual political issues.</p>
<p><xref ref-type="page" id="page_110"></xref>Diseases are reflective of the underlying form of the political community. In this respect, BSE was caused as much by the political situation of the spring of 1996 as it was by the physical disease agent, the prion. This disease morality play had supranational and transnational protagonists. The legitimacy of consumer and public right groups grew after the BSE crisis as did the legitimacy of the European public health authorities. The crisis shaped the underpinnings of the European political space and left a legacy. Sensitivity to health scares has grown after 1996. The associated morality plays provided a recognizable form for political contestation, which has more lately surfaced in relation to food toxins, genetically manipulated food and several different threatening diseases. The sick, jerking, stumbling cows of the UK provided the basic form for an important European morality play. The most lasting legacy of the BSE drama was the way in which the issues ebbed and waned in a matter of months. This same fleeting trajectory has been evident in later pandemic scares such as SARS and avian flu. The BSE crisis demonstrated how a pandemic drama can become a part of high politics. However, it also pointed out the fleeting nature of such dramas. Second, the analysis of the BSE scare exemplified a situation in which the attribution of a disease to one state can lead to an interstate contestation. Third, the BSE drama highlighted the role of a myriad other international, supranational and transnational actors in a public health spectacle.</p>
</sec>
</body>
</book-part>
<book-part book-part-type="chapter" book-part-number="5" id="Chapter5">
<book-part-meta>
<title-group>
<title><xref ref-type="page" id="page_111"></xref>Vortexes of SARS</title>
<subtitle>Anxieties over global air mobility</subtitle>
<alt-title alt-title-type="running-head">Vortexes of SARS: anxieties over air mobility</alt-title>
</title-group>
</book-part-meta>
<body>
<p>The pandemic of SARS struck during the spring of 2003 and was first registered by the World Health Organization (WHO) in Hanoi, Vietnam, in February 2003. By April 2003, media coverage of SARS was at its peak. The disease was first diagnosed by Chinese doctors, but largely attributed as the discovery of Dr Carlo Urbani. By March 2003, there were several hundred infections in Hong Kong, Singapore, Toronto and Taiwan. SARS' primary manifestations are fever that lasts three–seven days, followed by chest pains and breathing problems. The death rate is around 5 percent, according to WHO statistics. When SARS suddenly disappeared by the summer of 2003, around 8,500 people had been identified as being infected, and 800 as having died of the infection.</p>
<p>The Severe Acute Respiratory Syndrome (SARS) scare of 2003 was often linked with the global age of connectedness and interdependency:
<disp-quote>
<p>Old diseases usually spread slowly. Smallpox, for example, was a scourge in Europe for thousands of years before it finally crossed the Atlantic with Christopher Columbus and his men. SARS, on the other hand, moved at the speed of a jet airplane. Within days of its arrival in Hong Kong, it had circled the globe.</p>
<attrib>(<xref ref-type="bibr" rid="ref118"><italic>Health Canada</italic> 2003</xref>: 1)</attrib>
</disp-quote></p>
<p>SARS was seen as threatening because of the global air connections. Air travel is arguably one of the most important signifiers and embodiments of the present world order. SARS contested the health aspect of this global phenomenon and it also brought into question the foundations of the contemporary power hierarchy. Based on the earlier chapter, it is possible to argue that these power anxieties were further inflamed by the build-up to the Iraq war, which created much worry and anxiety over the sustainability and legitimacy of the US led power hierarchy. These complex regressive entanglements connected with individual level somatic sensations through SARS. People felt and sensed the state of world politics without cognizing in an intellectual way the reasons for their fears. It follows that the hub and spoke imagery of air travel can be approached as an embodied cultural model through which many understand global life, and what is meant by global (in)security and power (<xref ref-type="bibr" rid="ref049">Crang 2002</xref>: 571; <xref ref-type="bibr" rid="ref071">Dodge and Kitchin 2004</xref>: 195; <xref ref-type="bibr" rid="ref004">Aaltola 2005b</xref>).</p>
<p><xref ref-type="page" id="page_112"></xref>Although the public performances of public health and disease control are well rehearsed activities that take place according to recognizable patterns, it can be suggested that the major focus of the hegemonic and imperial world order is on deviance. The focus on deviance is mainly due to sensitivity to decline and fall types of processes. From this perspective, the struggle with outbreaks can be regarded as morality plays. Morality plays picture things in a way that is culturally significant: what are the prominent ways of portraying persons of authority and those who are exceptionally deviant? Who are the villains and who are the heroes? It is argued that disease outbreaks stage events in the cloaks of the global and the imperial as well as dangerous and threatening. It puts relevant actors in their respective positions and gives them roles and backgrounds. Actors, such as the Centers for Disease Control and Prevention (CDC) and WHO, get their share of authority and legitimacy.</p>
<p>Morality plays are firstly celebrations of rule following: the world functions according to certain principles and manages to defend its inherent order. These morality plays stress the vigilance of certain central authorities. For example, the role of the American President in disease control is emphasized thus:
<disp-quote>
<p>President Bush is very aware, acutely aware, of the situation of SARS around the world. He pays very close attention to this, has frequent briefings on it, and has particularly been interested in making sure, as you've just heard, that the finest resources of this country – our research establishment, the CDC, NIH and other of our universities and the resources that we have in this country – are effectively and immediately and appropriately mobilized to fight this epidemic.<xref ref-type="fn" rid="fn5_1"><sup>1</sup></xref></p>
</disp-quote></p>
<p>SARS offered global actors the opportunity to demonstrate vigilance, faithful adherence to procedures, and high degree of knowledge. The actions of apparent orderliness, skill and efficiency embodied the existence of imperial knowhow and the prescriptive force of global norms. Such rule ascertaining and according actions signify the health of the underlying political order and reassure the public imagination against declinist imageries.</p>
<sec id="sec5-1">
<title>Wars, decline and SARS</title>
<p>The visions of decline and declinism provide an important background story stock for the narration of pandemic related worries. After all, pandemics are often conceived of in terms of potential fatal blows against civilization. These images of sudden failure, fall or collapse were very much accentuated by the American and Western imageries that came to prevail after the 11 September 2001 terror attacks in the US (9/11). The air was thick with suspense and drama during the build-up to the war in Iraq, which coincided with the SARS scare. In this charged atmosphere of overall geopolitical flux, it is easy to see how SARS, to a degree, became a sub-narrative of the macro-level movement. The same emotional dynamics of high drama and intense fear that were connected to the
<xref ref-type="page" id="page_113"></xref>
process of perceived large-scale warfare began to be projected into the vision of a pandemic outbreak that might cause a fatal blow. The affective climate of the spring of 2003 cannot be insulated to have covered only the dynamics of war. Such intense political emotionality stimulated by the open ended War on Terror and the war in Iraq could easily spill over and cause similar stimulation in terms of heightened sensitivity to failures in disease-related containment dramas.<xref ref-type="fn" rid="fn5_2"><sup>2</sup></xref> Moreover, as reviewed in <xref ref-type="book-part" rid="chapter3">chapter 3</xref>, ‘Understanding the Vortex of War and Disease’, there exist important discursive trajectories conditioned by a long cultural history between plague and politics, which can feed perceptions of disease amidst war. To reiterate, the macro-level war as a context provides the seeds for powerful apprehensions related to diseases. One pertinent link related to the imageries of globalization in the 2000s was offered by the trope of global connectedness as an air mobility network. The fears of the collapsing macro-level global status quo found their speculative worst case scenarios in a pandemic disease seen spreading just because of global air connectedness – the arteries of the global world.</p>
<p>From the perspective of interconnectedness, the global space is not evenly distributed. This aspect of the global space is thicker and more nested near the global centres. More than any other mode of transportation, global air traffic embodies this hub and spoke pattern. At the same time, pandemic diseases – diseases affecting the whole of the ‘pandemos’ – embody fears that the global air traffic system might become a source of infection. While the global hub and spoke system is a signifier of globalization, the pandemics register fear and worry that the processes of globalization are dangerously diseasing. Moreover, air travel arguably provides the most direct means for experiencing what is meant by globalization. People have begun to know and feel what is meant by the global polity through their lived life bodily flows in the hub and spoke dynamic. On the other hand, diseases are among the most highly embodied phenomena. They are easily understood because they are directly experienced by all in one form or the other. Thus, by locating pandemics at the level of global inter-connectedness, it is possible to examine the different embodied modalities of global life and shed further light on the nexus between bodies, plagues and polities – that is, on their politico-somatic connections.</p>
<p>However, the ways in which political power flows and moves have to be taken into account, in addition to locating pandemics at the level of global inter-connectedness. The examination of individual cases like SARS is inevitably hollow without taking into account how the embodied aspect of both global air traffic and pandemic diseases is embedded in the overall vortexes of power. During the spring of 2003, the air was saturated with acute anxieties stemming from the run-up to the Iraq war, which was framed by the US administration as a new phase in the War on Terror, which had started in the wake of 9/11. SARS, when it emerged into global consciousness in February 2003, hyperbolized into existence a pandemic worst case scenario. It was an example of true hot crises, which ‘are startling, as presumed invulnerabilities appear to be challenged’ (<xref ref-type="bibr" rid="ref263">Ungar 1998</xref>: 37). It called into question the very viability, sustainability and
<xref ref-type="page" id="page_114"></xref>
preparedness of the global community and of the underlying power hierarchy. SARS and its overall context of war led to an acute sense that power was on the move and in danger of becoming unravelled. The iconography of the War on Terror has been engrossingly avian. SARS fitted perfectly with this imagery and its avian aspect was easy to comprehend. These linkages and conceptual bridges explain how the SARS scare had relatively independent dynamics of its own, setting it apart from the ‘real’ or ‘factual’ underlying epidemic dynamics.</p>
</sec>
<sec id="sec5-2">
<title>The political meanings of SARS</title>
<p>Diseases are signs that become meaningful in particular contexts. The context is the most significant determinant of the meaning of a disease. Prevalent suspicions, threats and fears are the most common substances of diseases. In many cases, fear is easily associated with existing normative boundaries and especially with perceived boundary violations. Anxiety often stems from a sense of ‘wrong’ types of relationships, which bring together different foreign elements. The images of SARS became associated with such types of global contacts across modern–pre-modern boundaries, across ideological separations, and across West–East demarcations. In the case of SARS, the public imagination focused on the fast global links that cross continental divides in a matter of hours. The fever was associated with the feverish agitations of the ever-changing globalizing world, in which mutating and porous were seen as threatening. The rapid transmission of SARS from Hong Kong to Toronto made tangible the dangers of air travel. SARS seemed to be able to spread rapidly everywhere that the international hub and spoke network of airports spread. From this perspective, it was noteworthy that SARS did not only afflict people. It was also seen as afflicting the system of international travel and, through it, everybody. Flights were cancelled and re-routed, travel warnings were issued, airlines experienced financial hardships, and the tourism industry suffered. International travel was also associated with the disease when people wanted to get out of the infected areas – Hong Kong and Singapore. People fee during epidemics and try to find safety and places with effective medical care. The imagery of SARS also consisted of highly anxious people being screened, profiled and quarantined at airports.</p>
<p>Thus, in the case of SARS, the containment drama was clearly linked to globalization and to the disappearing of vast distances. In a sense it became one of the pathologies of globalization, which includes such issues as environmental disruptions and global warming. However, SARS emerged in a highly politically charged world because the US' war with Iraq was on the agenda. While the BSE crisis reflected the underlying anxieties felt in the European political space, SARS can be seen as a manifestation of anxieties felt over the hegemonic world order. The sense of susceptibility to SARS was connected with declinist visions connected with the danger of political regression and with a blowback from the possible US overstretch. The BSE disease episode in Europe offers some insights into the emergence of SARS as a worldwide health scare in 2003. During the
<xref ref-type="page" id="page_115"></xref>
BSE crisis in Europe, the prevailing political issues and divisions offered the primary framework in which the disease was understood. The disease was made into a British disease caused by the uniquely British political system. In continental Europe, the stubborn refusal of the British to join further integration was seen as somehow connected with BSE. The solution seemed to come from the supranational European Commission, which highlighted its role as the last guardian of European health if national governments should fail in their duties. SARS came to be interpreted in the general spirit of the times. The War on Terror, the Iraq war, the international tension with China, and the anxieties felt over globalization offered SARS its politically reactive content. SARS was an ideally comprehensible disease of its own time. It can be argued to have embodied much of the large-scale power movements of the time.</p>
<p>Although SARS was regarded as a novel and dangerous threat, it was made to ft the large-scale patterns of world politics. In many places the disease was contained to China or to the ethnic Chinese. The idea that China and the Chinese were secretive, closed, incompetent and somehow corrupt provided material for this containment. China's secretive system was seen as one of the most important causative agents: ‘[i]n deciding to hush up the SARS outbreak in Guangdong province in 2002, the Chinese government gave the virus a head start and allowed it to spread globally’ (<xref ref-type="bibr" rid="ref050">Crawford 2007</xref>: 230). China was often seen as an outsider in the international community – limited in its transparency, only partially reformed, and unevenly developed. The White House document titled ‘President Bush's Meeting with the Chinese President’ of 1 June 2003 describes how President Bush praised Chinese willingness ‘to become transparent on the issue of SARS.’ The suspicious attitude towards the Chinese contrasted with the praise received, for example, by Singapore: ‘President Bush commended Singapore for its quick, decisive, and transparent response to SARS.’<xref ref-type="fn" rid="fn5_3"><sup>3</sup></xref> In this way, the disease causation of SARS became politicized: ‘Chinese government control of the means of publication and the lack of clear legal boundaries for free expression in China have inadvertently aided the spread of [SARS] by impeding the free flow of information in the country.’<xref ref-type="fn" rid="fn5_4"><sup>4</sup></xref> The perceived primary reason for the lack of transparency in China was attributed to its closed, one party political system. It can be argued that the message of SARS was clear. It was interpreted by the US authorities and by many observers as a cry for political reform in China so that it could become safely and securely integrated with the global world.</p>
<p>Thus, the interpreted political meaning of SARS only entailed a call for reform in China. Because China was increasingly a part of the global system, the ‘errant’ ways of the Chinese authorities and the closeness of the system was framed as a worldwide threat:
<disp-quote>
<p>[The closeness of the system] impedes the free flow of information in a way that threatens the well-being of PRC [People's Republic of China] citizens and, as the PRC has chose to increasingly participate in global affairs, everyone with whom they interact.<xref ref-type="fn" rid="fn5_5"><sup>5</sup></xref></p>
</disp-quote></p>
<p><xref ref-type="page" id="page_116"></xref>In a way, China turned into the ‘well-poisoners’ and ‘plague spreaders’ of the spring of 2003. Screening, profiling and quarantining of people were common practices during the epidemic. The danger with the imagery associated with these practices was that they were seen to be connected to latent underlying ethnic, racial and national identities. In the case of SARS, the measures seemed to point to China as a political system and to the Chinese as a group of people. The specifying of the people associated with ‘China’ as the most susceptible and, therefore, the most threatening group reinforced lingering ethnic suspicions in many parts of the world.</p>
<p>Appearing amidst fierce international competition, which is highly sensitive to rumours and suspicions, lethal epidemic diseases blend the self-interest of power-politics with honest and genuine willingness to alleviate human suffering. From a historical perspective, parallel to the fierce competition between disease agents and humans, an equally ferocious contention takes place between states. In this context, it is not surprising that decision makers almost instinctively share the view that the most effective means for fighting the negative power-political effects of epidemics is provided by deception and secrecy. The related concept that one should not cause alarm or frighten one's own citizens originates not from the belief that this is beneficial in saving lives, but from the conviction that secrecy is central to any attempts to guarantee a state's viability. During the plague epidemic, the tendency to hide the outbreak of the disease was understandable in a context where widespread information about an outbreak could easily have resulted in the flight of administrators and traders, economically disastrous quarantines, the isolation of large numbers of people, and widespread famine (<xref ref-type="bibr" rid="ref215">Pullan 1992</xref>: 115). Even today, if an attempt to conceal a lethal epidemic disease from the general public fails, states are inclined to use internal minorities or external enemies as scapegoats in the hope that this will divert attention away from their own failings. For instance, it is notable that in each and every country in the world, HIV is believed to have come from abroad. Thus, the political space defined by lethal epidemic diseases opens up possibilities for politically motivated manipulation and opportunities to interpret the actions of others accordingly.</p>
<p>Besides reacting with the dynamics of global travel and with political enmities, the disease reacted with the other fears of the time. The US documents on SARS often highlight the close connection between naturally occurring and intentionally caused outbreaks of disease. It is perceived that the measures aimed against naturally occurring outbreaks offer a way to combat possible intentional outbreaks. The preparedness for naturally occurring diseases was seen as a testing ground for developing preparedness for possible biological warfare. The combined dynamics is captured in the term, ‘health security.’ <xref ref-type="fn" rid="fn5_6"><sup>6</sup></xref> The documents conceive of ‘new health threats’ stemming from ‘(re)emerging diseases and biological warfare agents.’ It should be noted that the dual nature of health security also politicizes the presumably functional calls for cooperation: ‘[g]iven American leadership in the biomedical field and Singapore's advanced research facilities, President Bush and Prime Minister Goh agreed that the two countries
<xref ref-type="page" id="page_117"></xref>
should explore prospects for collaborative efforts … [and] to begin consultations on possible joint projects.’<xref ref-type="fn" rid="fn5_7"><sup>7</sup></xref> From the US perspective, the SARS related outlook was part of a larger vision of the world: the presidential directive, ‘Biodefense for the 21st Century,’
<disp-quote>
<p>provides a comprehensive framework for our nation's biodefense. [It] builds on past accomplishments, specifies roles and responsibilities, and integrates the programs and efforts of various communities – national security, medical, public health, intelligence, diplomatic, agricultural and law enforcement – into a sustained and focused national effort against biological weapons threats.<xref ref-type="fn" rid="fn5_8"><sup>8</sup></xref></p>
</disp-quote></p>
<p>This integrated approach to meeting the threats of terrorism subsumes much of the defence against naturally occurring diseases. The probable result is that the occurrence of natural epidemic diseases heightened the security concerns and re-contextualized the epidemic in a quasi-security language.</p>
</sec>
<sec id="sec5-3">
<title>The avian flow insecurities of SARS</title>
<p>I will examine more closely how SARS became associated with the global hub and spoke network of air transportation because it has been and will continue to be one of the most distinct disease modalities of the global age. SARS has been frequently associated with air travel: ‘the analyses indicate that airline network accessibility was an especially influential variable.’ (<xref ref-type="bibr" rid="ref029">Bowen and Laroe 2006</xref>: 130). The recent background for this link was provided by the popular pandemic imageries of the 1990s:
<disp-quote>
<p>Thanks to changes in <italic>Homo sapiens</italic> activities, in the ways in which the human species lived and worked on the planet at the end of the twentieth century, microbes no longer remained confined to remote ecospheres or rare reservoir species: for them, the earth had truly become a Global Village.</p>
<attrib>(<xref ref-type="bibr" rid="ref096">Garrett 1994</xref>: 571)</attrib>
</disp-quote></p>
<p><xref ref-type="bibr" rid="ref256">Thomas (2006</xref>: 918) compares SARS with the historical encounters with pandemics in this respect:
<disp-quote>
<p>Even in pre-modem times, diseases spread through human contact along trading routes and from key cities…. The outbreak of Severe Acute Respiratory Syndrome (SARS) … showed how quickly regional and global connectivity could be subverted in the spread of infectious diseases beyond national borders.<xref ref-type="fn" rid="fn5_9"><sup>9</sup></xref></p>
</disp-quote></p>
<p><xref ref-type="bibr" rid="ref212">Posner (2004</xref>: 21) points out the counterproductive nature of modern technology:
<disp-quote>
<p><xref ref-type="page" id="page_118"></xref>It might seem that the role of technology in relation to naturally occurring diseases would be wholly positive. Not so. Modern transportation, especially by air, facilitates the rapid spread of new diseases, as does crowding in huge cities, especially in poor countries.</p>
</disp-quote></p>
<p>Moreover, many research articles recount in their narratives of origin stories of individual people spreading the disease. For example, <xref ref-type="bibr" rid="ref050">Crawford (2007</xref>: 16) gives the following SARS travelogue:
<disp-quote>
<p>At first the microbe spread only locally within China, but in February 2003, after a sixty-five-year-old doctor who worked in a hospital in Guangzhou arrived in Hong Kong to attend a wedding, it went global. The doctor checked into room 911 on the ninth floor of the Metropole Hotel and by the time he was admitted to hospital twenty-four hours later he had infected at least seventeen others in the hotel. These people then departed to their various destinations, carrying the virus with them to five separate countries and spawning major epidemics in Vietnam, Singapore and Canada.</p>
</disp-quote></p>
<p>Thus, extensive studies have repeatedly pointed out the heterogeneities of global travel and their link with the spread of influenza pandemics. There is an often noted close relationship between air travel and microbial traffic in the globalizing world (<xref ref-type="bibr" rid="ref011">Ali and Keil 2006</xref>; <xref ref-type="bibr" rid="ref196">Naylor 2003</xref>). Global air travel is based on a system of flows that increasingly interconnect the global metropolises – the hubs – to the spokes of the many global reaches. These differential flows show that global air connectedness is not homogenous and evenly distributed throughout the world. This heterogeneity creates opportunities for the disease pathogens, which favour spreading through the hubs more than reaching all the spokes (<xref ref-type="bibr" rid="ref129">Hufnagel <italic>et al.</italic> 2004</xref>; <xref ref-type="bibr" rid="ref109">Guimera <italic>et al.</italic> 2005</xref>). Whereas some places are more likely to become conducive to a pandemic disease, there are some travellers who are more exposed as well as more likely to pass the disease on to others. <xref ref-type="bibr" rid="ref125">Hollingsworth <italic>et al.</italic> (2007</xref>: 1288) stress that different travel profiles have differential effects on the spread of pandemic diseases. Especially conducive to the spread are the so-called frequent fliers:
<disp-quote>
<p>A small proportion of air travelers make disproportionately more journeys than the rest of travelers. They also tend to interact predominantly with other frequent travelers in hotels and airport lounges. This group has the potential to accelerate global spread of infectious respiratory diseases.</p>
</disp-quote></p>
<p>These two diseasing tendencies are among the many factors that gave SARS its avian character and stressed the need to secure global air traffic flows.</p>
<p>In several important ways, the figures of ‘hub and spoke’ and ‘frequent travel’ became signifiers of a possible horrible failure in the containment drama. These figures seemed to defy the usual notions of protective barriers and <italic>cordons sanitaires</italic>. The containment measures tailored to air traffic seemed inadequate.
<xref ref-type="page" id="page_119"></xref>
For example, the screening measures, although widely used and highly published, proved to be insufficient. WHO recommended that travellers be screened at airports for symptoms and signs of the disease, such as sneezing and fever: ‘[i]n spite of intensive screening, no SARS cases were detected. SARS has an extremely low prevalence, and the positive predictive value of screening is essentially zero’ (<xref ref-type="bibr" rid="ref252">St John <italic>et al.</italic> 2005</xref>: 6). There was a sense of helplessness as the severing of connections did not seem to be an attractive option since air transportation can be seen as the modus operandi of the global order. However, the pandemic scare led to the cutting down of flights and, more importantly, to a decrease in individuals' desire to fly:
<disp-quote>
<p>Within three months of the outbreak, in the period between mid-March and mid-May, the tourism and travel sectors hit an unprecedented low as people began to shy away from traveling to China, Hong Kong, Singapore, and Vietnam. Tourist data from Hong Kong indicated that inbound tourist figures fell, while outbound tourists were down 20 per cent. Since early April, airline passenger traffic on Hong Kong's flagship carrier, Cathay Pacific, decreased by around 75 per cent. In Singapore, tourist travel fell to 75 per cent of previous levels.</p>
<attrib>(<xref ref-type="bibr" rid="ref035">Caballero 2005</xref>: 483)</attrib>
</disp-quote></p>
</sec>
<sec id="sec5-4">
<title>Embodying global medical topology</title>
<p>International public health practices have been intertwined with what can be termed a topological political imagery of the globe. This is based on some spatial organizing heuristics, such as the system of latitudes and longitudes, which are used to categorize and map places and people. These different matrixes and grids, which are used to arrange the basic object world, provide the basic separation of entities which, then, can be imagined as having strongly embodied dynamic interrelationships – such as of contagion, spread and infection. The overall schematic is a quasi-ideological abstraction of a multifaceted embodied experience. The underlying power-related modality is especially essential for a fuller grip on how the medico-political heuristic is used to symbolize architectures of global power.</p>
<p>In order to understand how the modalities link together, the recent re-challenge of the mechanistic and simplified assumptions concerning knowledge offer useful material (<xref ref-type="bibr" rid="ref285">Zerubavel 1997</xref>; <xref ref-type="bibr" rid="ref070">DiMaggio 2002</xref>; <xref ref-type="bibr" rid="ref134">Ignatow 2007</xref>). A common idea in this critical literature has been the development of models that go beyond the mere abstract modality of knowledge (<xref ref-type="bibr" rid="ref022">Barsalou 1999</xref>). The key is to comprehensibly blend other relevant modalities into the amodal abstract models. Thus, it is extremely important to see how abstract topologies – systems, grids, diagrams, trees, and hub and spoke models – are embedded in other more felt and sensed modalities such as power, emotion and movement. As was stated in <xref ref-type="book-part" rid="chapter1">chapter 1</xref>, ‘Introduction,’ the need to expand beyond such amodal schemas has been noted by the research approach based on so-called ‘cultural models’,
<xref ref-type="page" id="page_120"></xref>
which are positioned as embodied intermediaries that fuse abstract thinking with perceptual motor and sensory experiences (<xref ref-type="bibr" rid="ref134">Ignatow 2007</xref>: 124). These more encompassing proposition scenarios capture the core relationships between the key objects and contain emotionally charged ‘image schemas’ of the possible interactions between the primary objects (<xref ref-type="bibr" rid="ref057">D'Andrade 1987</xref>; <xref ref-type="bibr" rid="ref161">Lakoff and Kövecses 1987</xref>). In this context, ‘disease’ and its second order derivative, ‘pandemic’, provide an overall embodied image schematic. Its processes of contagion and spread provide for the understanding of the dynamic interactions between the key objects – ‘I’ extends to ‘we’ and stands in opposition to ‘them’ and ‘a foreign element’. This simplified model is projected into the spatio-temporal models concerning the ‘global’. This model also provides the framework for the enactualization of global politico-somatics. Moreover, it also provides a way of understanding how the abstract signifiers used for the global space – for its ‘arteries’ – become highly meaningful and contentious conceptualizations during a pandemic scare.</p>
<p>The juxtaposition of the disease proposition schematic with the prevailing abstract topologies of global flows can be useful in extending and embodying the abstract models and, thereby, in demonstrating how the disease frame feeds back into our abstract notions concerning the world. It is precisely the ability to zoom in to connectivity and ignore less ‘relevant’ characteristics that is fundamental to the idea of topology, the science of place. The origin of topology is often traced to the Swiss mathematician, Leonhard Euler (1707–83). Euler is famous for his solution to the problem whether it was possible to cross all the seven river bridges connecting two parts of his hometown, Konigsberg, without having to walk twice over any one of them. To prove that some repetition was required in his problem, Euler abstracted it into a system of vertices connected with lines and found that the emerging network needed to hold more vertices to be free from any repetition. From this start, topological maps or networks have come to be used widely as a general solution to problems of this type. Thus, complex phenomena ranging from subway systems, microprocessors and telecommunications to organizational structures, international regimes and world systems can be pictured through topological maps with the accompanying eureka-like sense of being ‘solved’.</p>
<p>Topology's emphasis is on those features of space that are independent of size and shape. For example, a subway map provides such an example in that the lines in it do not represent the actual shape or size of the subway system. Rather, what is important is how things are connected, interlinked and what is their order in relation to each other. The idea is that topological characteristics do not lose their order when they are distorted or bent, as would happen in a map drawn in faithful adherence to exact spatial measurements. <xref ref-type="bibr" rid="ref021">Stephen Barr (1964)</xref> states that
<disp-quote>
<p>topology is curiously hard to define … (it) started as a kind of geometry but it has reached into many other mathematical fields…. In one sense it is the study of continuity: beginning with the continuity of space, or shapes, it generalizes and then by analogy leads into other kinds of continuity – and
<xref ref-type="page" id="page_121"></xref>
space as we usually understand it is left far behind…. A topologist is interested in those properties of a thing that while they are in a sense geometrical, are the most permanent – the ones that will survive distortion and stretching.</p>
</disp-quote></p>
<p>In this way, topology solves the problems associated with real life features by using topological graphs. Machines, for example, have the tendency to break or produce results that are unexpected. Similarly, life does not happen as planned and real life situations do not always correspond to determinate rules. Topology's power is in its ability to hint at the existence of clarity behind all its twisting, breaking and bending and to let things remain unaffected and constant. The combinatory structure of topology usually consists of points and lines, of nodes and links or connectors. One can imagine, for example, that loops represent different cities, whereas links denote the interconnectedness between the cities. In this way, a loop stands for variety, although topology itself concentrates on the invariable and unchanging. The links between nodes may refer to links between separate entities, as in a graph of interstate trade relations, or to the fact that the object of description consists of components, as in a graph of intrastate organization. Overall, the topological approach comprises one of the most important contemporary ways of understanding global connectedness. As such, it is useful to examine it in the context of disease language and containment dramas to get a better idea of how modern infrastructures' modus operandi interacts with the highly embodied dynamics of disease heuristics. This juxtaposition of the disease and typological schemas can make apparent new features and aspects of pandemic scares.</p>
<p>Besides contemporary topological notions such as the global hub and spoke system, disease heuristics has long offered a way of differentiating the globe into one encompassing map of uneven disease burden and spread. Even a brief examination of everyday language reveals that landscape – geography, population, culture and climate – has a strong impact on containment imageries. Powerful national, racial and religious stereotypes connect with geographical and climatic features. In international politics, the discourse connecting people and places has old roots. It played a particularly important part in the history of global colonialism. It is in accordance with these conceptualizations that colonial practices – such as warfare – and diseases interconnect tightly because colonial enterprises included long distance contacts between places and, therefore, opened up routes for perceptions concerning communicability between distant landscapes. Besides the violent establishment of overseas colonies, their maintenance brought up the problems associated with foreign landscapes. It was thought that the Westerners were in constant peril in tropical places. The tropical environment which, on the surface, offered paradise-like surroundings, was thought to be very dangerous to people not native to it. One of the most fundamental lessons of colonialism seems to have been that foreign landscapes were not healthy for those moving from far away if it was not first altered radically. The methods for such modification included the introduction of familiar agricultural plants and landscape
<xref ref-type="page" id="page_122"></xref>
features. The colonial times also brought forth the frame of acclimatization, under which the adaptability of the settlement communities was conceptualized along strongly racial lines (<xref ref-type="bibr" rid="ref108">Grosse 2003</xref>: 189–90).</p>
<p>Also related to the underlying colonial project was the tendency to project we-communal identity projects to supposedly unconquered ‘blank’ places. In a related context, <xref ref-type="bibr" rid="ref121">Hiatt (2002</xref>: 223) states fittingly that unconquered landscapes invite and attract one to fill the space and, in so doing, re-imagine oneself. The more hostile, unsafe and impenetrable the landscape is abstracted to be, the more it can be said to reveal of the character of those who manage to conquer it. The far-off landscape, which was constructed as remote, distant and alien, fascinated the colonial project leaders precisely because it was native, wild and undomesticated. Against this background, the recent land wars in Afghanistan and Iraq can be seen as offering opportunities for the re-imagining and proving of the American character in the same way as the conquering of and competing over the global peripheries during the twentieth century provided a form for nations and leaders to demonstrate their worthiness. The same process of re-imagining one's national identity through interventions in distant lands has been a constant theme in the Western corpus. From this perspective, foreign wars and occupations offer a device for self-reflection and test the status of the underlying national creed and its civil religion. It can be further suggested that the anxiety felt over possible decline and fall turns foreign wars into spectacular rituals of purity. They aim to show the uncontaminated nature of the normative fundamentals to the external world and to the members of the in-group themselves.</p>
<p>The conceptual dynamics associated with diseases often emphasize that diseases originate from somewhere else. Thus, disease language contains geopolitical imageries. For example, HIV and AIDS is customarily seen as originating through contact with some foreign elements that tend to carry a geographical meaning, although notably different ones in different parts of the world. In connection with HIV and AIDS, this ‘somewhere else’ is not a fluid concept, but it has a definite content. HIV and AIDS are turned into a marker of a degenerate landscape either in a sense of poverty and desolation or in the sense of moral problems. In this way, landscapes such as ‘black Africa’ or the ‘San Francisco gay baths’ have a strongly loaded content as places from where the disease originates. It can be suggested that a commonsense idea exists according to which diseases natively belong to a landscape and the picture of a disease is connected with that landscape and with the people seen as the natives there. The scenarios of knowledge stress that in the diseased lands, there are many exceptionable, unhealthy and lethal phenomena. Different communities have their own landscapes and climates. The problem of incompatibility becomes important when things originating from distant places are brought into foreign contexts and into non-native communities. What is important to realize is that such imageries of foreignness are connected with the possibility of insecurity. This blame dynamics was also present during the SARS scare. Although SARS was regarded as a novel disease threat, its meaning was partly synchronized with existing patterns in world politics. The patterns of blame reflected existing political animosities:
<xref ref-type="page" id="page_123"></xref>
in Canada and Taiwan, news reports sometimes blamed Hong Kong; Japanese reporting framed the danger as Chinese and Taiwanese; popular imagination in Taiwan often saw the blame in China; the Chinese press tended to localize the problem to the Guangzhou province; and the Western press blamed China or Asian habits. In many places, the disease was perceived to be associated with China or to people of ethnic Chinese origin. It may be suggested that the images of China as secretive, closed, incompetent and corrupt contributed to this perception. China is still an outsider for the international community and seen as a country with limited transparency, partial reforms and uneven development. The echoes of communist ideology combined with other orientalist notions to construct China as a rogue entity, the connections of which with the rest of the globe seemed to leave the global system vulnerable.</p>
<p>The geopolitical modality of disease language and its containment dramas have prioritized the domestic intra-environments over the external inter-context. The realm beyond the domestic has been left relatively un-systematized or, more likely, developed as the ‘other’ and devised solely for the purposes of illustrating the legitimizing security of the domestic context. The locus outside of the domestic sphere has been left to consist of fragments and other types of incompatibilities, which can be strange and curious as they lack direct resemblance to the intra-paradigm. However, in most cases, the curiosity is replaced by sentiments of fear and repulsion. The intra-paradigm's Apollonian tendencies have compulsively projected themselves on the ways ‘distance’ and ‘foreign’ are understood (see <xref ref-type="book-part" rid="chapter2">chapter 2</xref>, 'Containments and compassions of pandemic dramas'). It seems that the external realms are in acute need of being weeded out or acclimatized into its increasingly close approximation of the domestic realm. The advent of large-scale colonial practices turned the attention to ways and means of achieving immunity from the negative aspects of international contact. Acclimatization, which refers to habituating or inuring something or someone to a new climate, became a way to fight this sense of global vulnerability. There were two ways of achieving some measure of immunity, depending on whether the disease bearing character was given mainly cultural or biological character. Immunity could be gained not only by adapting to or modifying the foreign landscape, ways and traditions, but also by changing the biological aspects of people. On the one hand, the landscape in foreign places could be modified to resemble that in the West by introducing European plants, architecture, crops, fields and so on. The more modest version of this recommended that Europeans should set their foot only in those areas that most resembled their home areas. On the other hand, rather than moulding the landscape, the people themselves could be made less susceptible to foreign maladies. One way of acquiring this kind of immunity was to get more knowledge of the foreign conditions and cultures. This type of learning led to better adaptability and, consequently, to immunity.</p>
<p>From the everyday perspective, the international context outside of the domestic intra-realms seems to lack the intrinsic overarching model. However, it does not lack engrossing details and often violent and even monstrously violent particulars, judging from the screaming contents of the daily news cycles. The
<xref ref-type="page" id="page_124"></xref>
strange, odd, curious and threatening provide content to not just the international sections of the local newspaper. The headlines are indicative of the culturally and theoretically constructed category of ‘international’ itself. It seems to be a vacuum of disconnected oddities, faint references, striking illustrations and generally of ‘other’-ing. The fascination with foreign deviations from the norm has been part of Western culture at least ever since accounts of them were given by respected authors ranging from Herodotus to Aristotle. Explorers such as Marco Polo and Columbus and today's legions of tourists have helped to incorporate the oddities and wonders of our world into the dichotomy between the local and the foreign and, later, into the domestic–international division. The realm of the ‘outside’ is inhabited by fascinating yet often horrifying things, which frequently seem to test and defy the political or moral order found closer to home.</p>
<p>The fearful geopolitical imageries can be exemplified with Samuel Hunting-ton's and Robert Kaplan's widely influential declinist works from the early 1990s. Kaplan's ‘coming anarchy’ vision bears similarity to Samuel Hunting-ton's imagery of civilizational conflict. Huntington's global topology is a network of civilizational nodes, united by connecting lines describing interrelational (in)compatibles. The nodes represent the world's civilizations, which are defined by high religions. The way they are arranged with respect to each other stands for the degrees of cultural separation between them. The length of the connecting line uniting two nodes seems to reflect the general uncertainty of the relationship between two civilizations. Difficulties are likely to occur when two civilizations that are too distant from each other on the map come into contact with each other. The ‘clashes’ make the scene one of a containment drama. Both the Kaplanian and Huntingtonian vision draw particular attention to the dangers of contact between different peoples and cultures. This perception of anxiety is presented as a serious problem for maintaining order in the globalizing world. In a revealing sub-narrative, Kaplan uses a personal experience with suspended and delayed flights to signify the need to stop the spread of anarchy and decay:
<disp-quote>
<p>Returning from West Africa last fall was an illustrating ordeal. After leaving Abidjan, my Air Afrique flight landed in Dakar, Senegal, where all passengers had to disembark in order to go through another security check, this one demanded by US authorities, before they would permit the flight to set out for New York. Once we were in New York, despite the midnight hour, immigration officials at Kennedy Airport held up disembarkation by conducting quick interrogations of the aircraft's passengers – this was in addition to all the normal immigration and customs procedures. It was apparent that drug smuggling, disease and other factors had contributed to the toughest security procedures I have ever encountered when returning from overseas.</p>
<attrib>(<xref ref-type="bibr" rid="ref145">Kaplan 1994</xref>: 76)</attrib>
</disp-quote></p>
<p>The disturbed and torturous flight connection illustrates a problem of global space, yet, in Kaplan's imagination, it also points to the fact that the West is
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protecting itself against being submerged by the coming wave of criminal anarchy. The global airline hub and spoke needs to be secured against the spread of anarchy.</p>
<p>A further review of Kaplan's <italic>The Coming Anarchy</italic> is justified for two reasons: on the one hand, Kaplan's work can be seen as an important precursor to the emergence of the ‘coming plague’ genre, which had become popular by the mid-1990s. On the other hand, Kaplan's imagery illustrates the connection between speculative declinist scenarios on world politics and modern air infrastructure. Related to this, <xref ref-type="bibr" rid="ref158">Knox <italic>et al.</italic> (2007</xref>: 267) point out how the aviopolis imageries include many dystopian elements from diseases, terrorists, drug traffickers and human smugglers to various kinds of distraught and anxious passengers. Exemplifying this genre of declinism, Kaplan reads signs of things to come from the state of the Western and African mobility networks. The Kaplanian world atlas is composed of ‘cities and suburbs in an environment that has been mastered’. He contrasts this with the state of airports in the Third World, from where he sees a wave of ‘criminal anarchy’ spreading. Kaplan states how the landscape below his flight is patterned by fields, roads and hedges or by more urban grids of highways, buildings and streets. This manmade grid-like aspect is read as a signifier of more sophisticated and healthy polities. This contrasts with the decayed landscape of the Third World countries. These are representations of ‘wild’ places that have not yet been moulded into the modern pattern. These places, which Kaplan sees as failing and failed, are too inhospitable for their safe integration into the global polity. Kaplan's epistemic claims for knowledge are based on often repeated narratives of white men's adventures in the deadly dark corners of the world (<xref ref-type="bibr" rid="ref077">Dunn 2004</xref>: 483). Kaplan's way of mediating between the African landscape and his Western readers is not based on emphatic favoring of the local and the sensual. His detached aerial view of the ground below seemingly permits him to grasp the politically significant contrasts and patterns between combinations of scenes. He makes all these relevant as part of an overall emotional scene of fear of the imminent chaos spreading from the Third World. This fear of flight – that is, the suspicion of people on a flight and people fleeing – seems to stem from what an international airport symbolizes: the airport is a symbol of nearly limitless access to distant locations (<xref ref-type="bibr" rid="ref269">Weiss 2001</xref>: 124). Its Kaplanian symbolic antidote is, thus, confinement of people to the contours of their territory (<xref ref-type="bibr" rid="ref056">Dalby 1996</xref>: 472). Declinist dystopias are usually calls for complete reform or, in this case, restoration of a more warrior minded Western imperialism as a mode of secure political control of global flows (<xref ref-type="bibr" rid="ref146">Kaplan 2002</xref>).</p>
<p>Kaplan's arguments reflect how the disease object world – its inherent sense of alarm, hostility and the dynamics of contagion and mutation – can be used to describe a political process. His choice of language highlights the ‘embodiedness’ of disease language to make the political argument concerning the impending anarchy more real and tangible (see <xref ref-type="book-part" rid="chapter2">chapter 2</xref>, ‘Containments and compassions of pandemic dramas’). <xref ref-type="bibr" rid="ref145">Kaplan (1994)</xref> begins his article with the following account of a meeting with an African minister whose eyes, deformed by malaria, became the foreground for a story of a diseased landscape:
<disp-quote>
<p><xref ref-type="page" id="page_126"></xref>The Minister's eyes were like egg yolks, an after-effect of some of the many illnesses, malaria especially, endemic in his country. There was also an irrefutable sadness in his eyes. He spoke in a slow and creaking voice, the voice of hope about to expire.</p>
</disp-quote></p>
<p>Kaplan betrays a sense of imperial nostalgia when he quotes the minister as saying that things had started on the regression slope after the British departed. Kaplan sees that the speed of this regression is now increasing as are its potential global ramifications:
<disp-quote>
<p>As many internal African borders begin to crumble, a more impenetrable boundary is being erected that threatens to isolate the continent as a whole: the wall of disease… And war and refugee movements help the virus break through to more-remote areas of Africa…. As African birth rates soar and slums proliferate, some experts worry that viral mutations and hybridizations might, just conceivably, result in a form of the AIDS virus that is easier to catch than the present strain…. The coming upheaval, in which foreign embassies are shut down, states collapse, and contact with the outside world takes place through dangerous, disease-ridden coastal trading posts, will loom large in the century we are entering.</p>
<attrib>(<xref ref-type="bibr" rid="ref145">Kaplan 1994</xref>: 80)</attrib>
</disp-quote></p>
<p>The main coastal trading hubs will remain the last bastions of some type of governance, according to Kaplan. He sees that the same processes are taking place in many other Third World areas such as India and Pakistan. The processes link with global arteries through the large cities that are dangerously connected with the dynamics of collapse, which accentuate the possibilities of mutating disease. The mutating forms of disease can be understood to be for Kaplan a trope of the larger processes of anarchy: ‘[t]his future map – in a sense, the “Last Map” – will be an ever-mutating representation of chaos.’ The mutability is made into a foremost sign of the ominous global age in which the containment drama is seen as failing. Kaplan's ‘last map’ can be recognized as an example of medical topology.</p>
<p>Tying in with the overall theme of integrated versus marginal and possibly regressive landscapes is the theme of health (<xref ref-type="bibr" rid="ref128">Hoskins 1970</xref>).<xref ref-type="fn" rid="fn5_10"><sup>10</sup></xref> It is clear enough that poor health is easily connected with relative levels of depopulation. Diseases almost instinctively bring to the mind images of dying and fleeing people. The presence of diseases, defined in this manner, is an important and noticeable part of the landscape. Diseases exist in places that are deemed as unrewarding enough or life not to be integrated into the larger human-made patterns. These places are closely associated with diseases. They become diseased landscapes. In this way, the image of disease is embedded into marginal landscapes. Diseases bring depopulation and decay. In this way, the images of depopulated places turn into symbols of disease in the same way as ruined villages and crumbling towns were a constant reminder during the plague years of the danger of the disease.</p>
<p><xref ref-type="page" id="page_127"></xref>The term ‘medical topography’ is often used to refer to the enterprise of mapping geography according to the prevalence level of different diseases. The practice of medical topography started largely through experiences with new and devastating diseases during colonial times. New diseases spread from the newly ‘discovered’ lands to Europe as well as from Europe to the newly colonized areas (<xref ref-type="bibr" rid="ref027">Bewell 1999</xref>). <xref ref-type="bibr" rid="ref014">Anderson (1996</xref>: 95) argues that a disease manifestation on a body was believed to be caused by hereditary endowment, life history and environmental influence. Connected with a sketchy notion of geographical separateness, the concept of race was taken to be perhaps the most meaningful descriptive device to portray the sum total of these different factors (<xref ref-type="bibr" rid="ref053">Curtin 1964</xref>). Another important differentiating aspect of colonialism was between the dominating and the dominated. The ability of the West to subdue most of the world directly or indirectly led to a pronounced sense of superiority. Whereas most of the distinctions conveyed a sense of power and security for the West, the distinctions based on disease topographies showed the other side of the coin – the power to dominate brought along vulnerability because global power brought along physical closeness (<xref ref-type="bibr" rid="ref117">Harrison 1996</xref>: 70). The diseased exchanges developed and paralleled the commonsense ideas that connected geography with diseases and diseases with geography. To reiterate, what is important to note in the connection of medical topography and with diseased landscapes is that diseases were not only physical, but also manifestations of a much more encompassing nature. Diseases are often read as signs of moral and political regression, instead of merely reflecting poor physical health. Another important aspect of medical topography was that it brought into existence the modality of international existence based on disease and diseasing processes such as contagion and spread. In other words, colonization was about the spread of diseases just as much as it was about the trade of valuables, such as spices, gold and slaves.</p>
<p>Medical topography made the term, ‘disease spreaders’, more tangible by pointing out the disastrous results of human movement, but especially of travel back and forth. These associations between frequent travel and disease are still powerful (<xref ref-type="bibr" rid="ref125">Hollingsworth <italic>et al.</italic> 2007</xref>: 1288; <xref ref-type="bibr" rid="ref050">Crawford 2007</xref>: 29). ‘Frequent travellers’ contain the same associations as ‘super-spreaders.’<xref ref-type="fn" rid="fn5_11"><sup>11</sup></xref> Such perceived ‘rootlessness’ has been assumed to wreak havoc not only on the people moving, but also on those staying in different locations. In this respect, medical topography has strong implications beyond itself. The practices of describing and mapping the geographical features of diseases have started to seem to contain a logical narrative about global interconnectedness. This narrative form has tied disease into localities, but also notified the dangers of excessive contact with ‘exotic’ landscapes. It points to the bad consequences of hybridity – in the form of those who are in-between the domestic and the foreign (sailors, soldiers, and so on). The disease schematic has started to evolve into an object world with protagonist and antagonist figures and with dynamic interrelationships. I have been arguing that this object world's repercussions at the individual somatic level offer tangibility for its use in understanding wider processes, such as global politics. They can also be perceived to form a direct channel between global politics and individual somatic sensations.</p>
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<title><xref ref-type="page" id="page_128"></xref>SARS, power and air mobility</title>
<p>Power and mobility are highly interchangeable terms in the canon of Western modernity. Air mobility heightens this nexus (<xref ref-type="bibr" rid="ref165">Lawrence 2004</xref>: 230). Commenting on Frank Norris' (1901) epic novel, <italic>The Octopus</italic>, <xref ref-type="bibr" rid="ref085">Eperjesi (2004</xref>: 59) states that ‘by seeing America as an empire on the move, Norris sanctified not only the nation's status as carrier of world history but, more importantly, its actions and entanglements in the world beyond its borders.’ Norris' work portrays the continuation of the American ‘destiny’ beyond its territory and the Western frontier. Eperjesi's criticism echoes <xref ref-type="bibr" rid="ref054">Daileda's (2008</xref>: 225) conclusion concerning America on the move: ‘[t]ransportation in all its modes embodies the uniquely American ideal of Manifest Destiny.’ <xref ref-type="bibr" rid="ref054">Daileda (2008</xref>: 225) points out the exceptionality of air travel vis-à-vis the emergent, more expansive notions of the ‘final’ frontier. The expansion of the horizon, the final frontier, was not so much a physical barrier, but a function of making power as movable as possible and, in practice, engineering various technologies of mobility to solve the obstacles for the emergence of a truly mobile form of hegemonic power. This logic of US, yet also Western, power on the move led to the establishment of relatively de-territorial, decentralized and networked hegemonic structures (<xref ref-type="bibr" rid="ref115">Hardt and Negri 2001</xref>: xi–xiii, 160). However, the emergent power-political context is not static: instead, it consists of a dynamic flow in which the nodal points are flexible and may move. This ‘floating power’ is best embodied in the air carrier battle groups (<xref ref-type="bibr" rid="ref095">Friedman 1988</xref>: 384).<xref ref-type="fn" rid="fn5_12"><sup>12</sup></xref> The framing of air mobility sheds further light on the wider entanglements of SARS.</p>
<p>As people flow, power is on the move and finds its expressive language in the varying tempos of the mobile bodies. The humming regularity of the national, regional and global aero-mobility systems is often used to constitute and signify the power of the respective ‘movers’ in global politics. The opposite is equally expressive: the regular disturbances in the hub and spoke dynamics translate into decreasing or lack of power. Moreover, these aero-mobility specificities are about people making sense of their regional and global surroundings. Their expressive language is about the respective people trying out their narrower and wider political embodiments and learning to mediate between them. The answers to the question, ‘Who am “I,” “you,” “we,” and “they” among the wider gallery of figures?’, are embedded in the kinaesthetics of people and in flows of power, ascending upwards and slipping downwards. The expressive language of this power–mobility nexus finds its parallel in the choreographies of today's hip-hop dance, where artists tend to ‘obsess over … power-moves’ (<xref ref-type="bibr" rid="ref233">Sengupta 1999</xref>). Power moves are dance's most impressive, stirring and provoking elements, which are further accentuated by being put into various contrasting combinations. Such kinaesthetic assemblages of moving bodies are related to the characteristics of any successful political movement in a more traditional sense, as, for example, ‘for protest to succeed, it must produce a feeling of moving ahead; it must force people to take notice’ (<xref ref-type="bibr" rid="ref229">Rustin 1976</xref>: 42). This aspect of embodied power moves is vital when one wants to shed light on how
<xref ref-type="page" id="page_129"></xref>
and why aero-mobility dynamics is so entangled with the trajectories of power-politics.</p>
<p>SARS' expressive characteristics had much to do with its ability to disrupt the air flows of people and goods. Modern pandemic diseases interfere with the power and mobility nexus and, thus, gain an important register. They change the relative power status of various places and can even threaten to shut down the whole global mobility system. During SARS, the status of the internal air mobility system was under intense scrutiny as people saw it as a sign of the devastation that the disease could bring with it. On the one hand, there were fears that air travel would collapse, leading to regression of the global order based on it. On the other hand, there were poignant and engrossing anxieties over the ability of the hub and spoke network to bring the disease closer home into the domestic spheres.</p>
<p>If nothing else, ‘hub and spoke’ is an abstract designation of a multifaceted embodied transportation experience. The tight conceptual bridge between hegemonic or imperial governance structures and hub and spoke political architecture is often made in research literature (<xref ref-type="bibr" rid="ref194">Motryl 1999</xref>; <xref ref-type="bibr" rid="ref111">Hafner-Burton <italic>et al.</italic> 2009</xref>; <xref ref-type="bibr" rid="ref149">Kelly 2007</xref>; <xref ref-type="bibr" rid="ref242">Smith 2005</xref>). For example, <xref ref-type="bibr" rid="ref208">Phillips (2005</xref>: 3) sees that the distinctly ‘hub and spoke’ set of regionalist arrangements in the Americas has allowed the US to ‘capture control of the governance agenda and to ensure that the regional economic regime takes a form consistent with US interests and preferences.’ The accompanying air travel imageries are not limited to how people feel when they fly though the global aviopolis. The sentiments of air travel are ways of embodying global order based largely on air mobility flows. This power-related modality is especially vital for getting a fuller grip on how it is used to symbolize the architectures of global power. One might expect that the kinaesthetic cultural models making sense of (de)accelerations and stabilities are especially suited to shed light on the nexus of aero-mobility and power. This kinaesthetic approach turns the hub and spoke model into a multidimensional model in which the sensory and emotional meanings easily interact with the political signifiers of the abstract architecture.</p>
<p>The best known example of the hub and spoke as a political model involves the US imagery of the Pacific security system after World War II. The model became popularly known in the 1980s as the hub and spoke alliance structure. It meant that the US (the hub) maintained a system of bilateral security arrangements with individual Pacific Rim states (the spokes) without a strong multilateral regime (<xref ref-type="bibr" rid="ref017">Baker 1991</xref>: 1; <xref ref-type="bibr" rid="ref216">Pyle 2007</xref>: 225). Similar to a system of airplane routing, all the arrangements were supposed to converge in a US ‘hub’. From an embodied perspective, one important reason for the rise of the hub and spoke as an international relations cultural model was that those innovating and experimenting with extensive notions such as ‘the Pacific security architecture’ were among the foremost frequent fliers. Experts, university professors, decision makers and politicians were all among the global elite who were able to live and prosper through the existence of the hub and spoke based aero-mobility dynamics. For them, the system's physicality was embodied knowledge. It seemed to
<xref ref-type="page" id="page_130"></xref>
reveal something worthy and significant with a single relatively self-evident schematic. The memories of the resurgence of the US' global role during the so-called Reagan Revolution in the 1980s paralleled the rise in the symbolic power of the hub and spoke mobility. Although the hub and spoke system had already emerged in the 1950s, it gained wide societal visibility through the wave of deregulation that hit the airline industry in the early 1980s.</p>
<p>Moving beyond the commonplace abstract models of the security studies, airports and their networks may be seen as kinaesthetic, mobile contexts (<xref ref-type="bibr" rid="ref265">Urry 2009</xref>). <xref ref-type="bibr" rid="ref158">Knox <italic>et al.</italic> (2007</xref>: 265) call airports ‘spaces of flows’ that emphasize temporal qualities such as process, speed, improvisation and flexibility over the more spatial notions of space and networks. <xref ref-type="bibr" rid="ref038">Castells (1996</xref>: 412) defined flow as the ‘purposeful, repetitive, programmable, sequence of exchange and interaction between physically disjointed positions held by social actors.’ It may be argued that the qualitatively different velocities, accelerations and decelerations bring a necessary kinaesthetic element to the understanding of flow-like phenomena. It seems that Castells' remark concerning the primary sequential character of the flow is quite correct: the aero-mobility flows contain step by step and stop and go types of patterns. Accordingly, it may be assumed that the experiences with different types of events while in the aero-mobility flow are constituted through a contrasting succession of accents. They ‘punctuate’ the flow into meaningful totalities, giving its narrativity its full stops, commas, questions marks, exclamation marks, and so on: the taxi drive into the airport, check-in, passing the security check, rushing to the boarding gate, entering the plane, take-off, and so on. While the SARS epidemic was happening, air movements gained a more pandemic punctuation as people were screened for fever, containment measures were established, flights were discontinued, and people were quarantined in their hotels. This pandemic grammar was further highlighted by the fear of flying and the fear felt over those who were flying and, thus, possibly spreading the disease.</p>
<p>On the other hand, the engrossing accents can frame other even disparate and merely coincidental events. These ‘confluences’ lead to a heightened sense that something ‘big’ is about to happen. The epistemology of these moments is based on the power of revelatory experiences that seem to show and demonstrate at once that a particular state of affairs prevails. This is connected with what <xref ref-type="bibr" rid="ref101">Goffman (1974)</xref> denotes as a ‘frame.’<xref ref-type="fn" rid="fn5_13"><sup>13</sup></xref> My argument is that the events connected with aero-mobility dynamics provides one of the foremost conditions under which ‘we’ think power becomes real, authority is recognized and knowledge is shown to be true. The modern aviopolis itself can be said to be based on such revelatory epistemology: for example, aero-mobility is said to be in a constant reactive mode of experiencing different types of ‘shocks.’ This state has been referred to as ‘constant shock syndrome’: ‘[t]here is no doubt that the public has become highly sensitized to risk, both real and perceived. Besides the passengers, the airport itself has emerged as a dynamic context of continual reflexivity, self-monitoring and self-repair’ (<xref ref-type="bibr" rid="ref158">Knox <italic>et al.</italic> 2007</xref>: 266). The rhythmic pulse of the flow is such that, besides producing a sense of sequential monotony, it brings forth sometimes violent consonances within the broader
<xref ref-type="page" id="page_131"></xref>
contours of social interaction. Besides pandemic diseases, airlines are vulnerable to world economic (the 2008 recession) and geopolitical events (9/11) as well as to natural catastrophes (the volcanic ash cloud episode) and accidents (the crash of the plane carrying the Polish political elite). It should be noted that this shock proneness turns the aviopolis into a gauge of things that are ‘big’ and ‘shocking.’ The SARS scare got additional hyperbolic value because it caused a major jolt to international air travel. Its value as something major and potentially devastating was revealed as it disturbed the air mobility flows.</p>
<p>Besides experiencing and generating constant shocks, airports are revelatory contexts because they are geared towards the detection of deviance. Airports, as a mental context, do work in creating a sense where people's supposed true intentions are revealed by placing them in an emotional regime centring on suspicion, security and trust. During the SARS scare, people were being checked to find out whether they were potential disease carriers. People were checked for certain symptoms – such as fever – and their point of origin – whether they were coming from the outbreak areas. Of course, such checks were akin to finding a needle in a haystack:
<disp-quote>
<p>Health-related border controls were another source of controversy throughout the outbreak and afterward. Toronto airports used information cards with screening questions and secondary assessments and interviews as needed. A large-scale Canadian pilot project involving thermal scanners resulted in millions of screening transactions and thousands of referrals of passengers for further assessment by nurses or quarantine offcers, but not a single case of SARS was identified. In Hong Kong, border controls using temperature checking and screening forms remain in place, especially now that SARS has recurred in China. There is no international consensus on appropriate travel screening and border controls.</p>
<attrib>(<xref ref-type="bibr" rid="ref195">Naylor <italic>et al.</italic> 2004</xref>)</attrib>
</disp-quote></p>
<p>Yet, the checks and screening created a particular sentiment of suspicion and gave an air of security. At least, something was being done. In this way, individuals were reinvented and given their SARS-specific identities through the technologies of international self. However, the airport as a machine type of imagery has to be qualified. It can be argued that the airport is constructed to offer spaces for spontaneous experimentation that ‘tends’ – instead of determining – to produce certain effects (<xref ref-type="bibr" rid="ref008">Adey 2008</xref>; <xref ref-type="bibr" rid="ref264">Urry 2003</xref>; <xref ref-type="bibr" rid="ref062">Deleuze 1988</xref>). The experimentation with different subject positions and corresponding political embodiments in the aero-mobility ‘playpens’ produces predictable, yet not determined, results due to the inherent logic of the aviapolis. This logic is combinatorial because the lived life experimentation in the aviapolis is made meaningful and illustrative by the existence of different ways of combining and mediating it with the rest of the experience. This play is about how the ‘Legos’ of this aero-mobility playpen can be arranged and combined and how they cannot. Moreover, this logic – of how the political embodiments of ‘mine,’ ‘yours,’ ‘ours,’
<xref ref-type="page" id="page_132"></xref>
and ‘theirs’ can be recombined and, thus, reconstituted with wider and narrower political bodies – has a relatively established cultural history.</p>
<p>The claim that aero-mobility's political imagery is connected with that of global security has received scant research attention. Recently, the specifics of securing air traffic flows have been linked to other aspects of global security and world politics: ‘[a]ir flights are centrally significant microstructures within the performances involved in the global order’ (<xref ref-type="bibr" rid="ref265">Urry 2009</xref>: 32). <xref ref-type="bibr" rid="ref009">Adey <italic>et al.</italic> (2007</xref>: 780) express a similar vision: ‘[i]ndeed … it has been argued the air transport industry provides one of the most highly visible articulations of power.’ Drawing from <xref ref-type="bibr" rid="ref115">Hardt and Negri's (2001)</xref> empire argument and <xref ref-type="bibr" rid="ref003">Aaltola's (2005a)</xref> hub and spoke analogy, <xref ref-type="bibr" rid="ref265">Urry (2009</xref>: 34) implies that aero-mobility is based on ‘a dynamic and flexible systemic structure articulated horizontally across the globe.’ This dynamic and flexible framework is connected with the existing mode of hegemonic governance (<xref ref-type="bibr" rid="ref115">Hardt and Negri 2001</xref>: 13–4; <xref ref-type="bibr" rid="ref003">Aaltola 2005a</xref>: 268). The aero-mobility system may be approached as a beacon of the modern, liberal and cosmopolitan ideals of diffused power. However, airports are also seen as representing the contemporary totalitarian power (<xref ref-type="bibr" rid="ref010">Agamben 1998</xref>: 123; <xref ref-type="bibr" rid="ref069">Dillon and Reid 2000</xref>: 117). It seems that airports are central yet polysemous cultural signifiers. It follows that the hub and spoke imagery can be approached as an embodied cultural model through which many understand global life and what is meant by global security and power (<xref ref-type="bibr" rid="ref049">Crang 2002</xref>: 571; <xref ref-type="bibr" rid="ref071">Dodge and Kitchin 2004</xref>: 195). Next, we need to consider the more specific characteristics and repercussions of the hub and spoke model. <xref ref-type="bibr" rid="ref158">Knox <italic>et al.</italic> (2007</xref>: 267) point out how the aviopolis imageries include many dystopian elements ranging from diseases, terrorists, drug traffickers and human smugglers to different kinds of distraught and anxious passengers.</p>
<p>The hub and spoke imagery's ontology is based on modern versions of cosmopolitanism and liberalism. While referring to <xref ref-type="bibr" rid="ref003">Aaltola's (2005a)</xref> hub and spoke analogy, <xref ref-type="bibr" rid="ref137">Ikenberry (2009</xref>: 85) illustrates how the air traffic system is often read as a microcosm of the emerging global order. Ikenberry draws an explicit parallel from the changing global power hierarchy to the aviopolis, where all the ‘major power centers (airlines) have their own distinct and competing hub and spoke system.’ The change into a hub and spoke pattern is what he indicates might be happening to the global hierarchy of power. He makes a distinction between a more unipolar hub and spoke arrangement and a multilateralist situation in which actors coordinate their actions based on mutually agreed upon and shared rules and principles. Earlier Pax Americana hub and spoke relationships were clearly more unilateralist: one hub made the decisions and expected the others – the spokes – to follow suit (<xref ref-type="bibr" rid="ref136">Ikenberry 2006</xref>: 241, 248). In <xref ref-type="bibr" rid="ref137">Ikenberry's later 2009</xref> analogy, the hub and spoke is considerably more ‘fragmented’ and with multiple competing hubs and partially overlapping major and minor spokes. Ikenberry's world vision sees the major powers – China and the US – as airlines that run their competing yet partially overlapping and coexisting hub and spoke systems.</p>
</sec>
<sec id="sec5-6">
<title><xref ref-type="page" id="page_133"></xref>Pandemic air travel and the construction of ‘SARS spreaders’</title>
<p>In the context of SARS, <xref ref-type="bibr" rid="ref050">Crawford (2007</xref>: 29) uses the antagonistic term, ‘super-spreader,’ for a figure that in more technical language is referred to as an ‘index case’: ‘the virus spread round the globe, aided by super-spreaders (like the doctor at the Metropole Hotel in Hong Kong) and fast international air travel.’ Similarly, <xref ref-type="bibr" rid="ref200">Noun and Chyba (2008</xref>: 208) state that ‘during the early stages of the SARS pandemic, a single patient, the ‘super-spreader,’ infected every one of 50 health workers who treated him’. The super-spreader figure soon started to appear in the popular accounts of SARS. The <italic>Sunday Telegraph</italic>, for example, reported on March 23, 2003 the following scene:
<disp-quote>
<p>As he shuffled through the lobby of the Hotel Metropole, the elderly professor was feeling feverish and faint. At the lift, he steadied himself for a moment in the open doorway before his body convulsed in a series of wracking coughs that sprayed fine droplets of saliva onto the walls and the people waiting inside.</p>
</disp-quote></p>
<p>This super-spreader figure has a cultural history that connects it with the figure of ‘Patient Zero,’ which was much used in the 1980s in connection with HIV and AIDS. There was much speculation about the original Patient Zero, Gaetan Dugas, who, through his work as an air steward, was able to fly and spread the disease to others. Varying numbers of infections have been linked to him.</p>
<disp-quote>
<p>In the early 1980s, in the early stages of the worldwide AIDS epidemic, epidemiologists at the Centers for Disease Control and Prevention in Atlanta identified a Canadian flight attendant, Gaetan Dugas, as part of a cluster of men with AIDS who were responsible for infecting large numbers of other gay men in many different cities around the world…. Although later studies debunked the theory that Dugas was the source of the North American epidemic, there is no question that Dugas, who claimed to have had hundreds of different sexual partners each year, infected many people.</p>
<attrib>(<xref ref-type="bibr" rid="ref190">Mitchell 2009</xref>: 50)</attrib>
</disp-quote>
<p>It is highly illustrative that Mitchell goes on to state that ‘Dugas was a hub in the network of sexual contacts.’ This blending of Patient Zero with the air travel trope of ‘hub’ has been used by others. <xref ref-type="bibr" rid="ref050">Crawford (2007</xref>: 20) equates the super-spreaders of HIV and AIDS with hubs of large-scale sexual networks enabled by their work in commercial sex or their ‘promiscuous’ gay activities. Besides being connected with illicit and promiscuous sex, Crawford uses another air travel trope, ‘city hopping,’ to drive home the point about the dangers involved.</p>
<p>Thus, it is clear that the figure of a super-spreader carries with it a multidimensional understanding of threat and failure of the pandemic containment drama. The term, super-spreader, ceases to be a mere technical epidemiological
<xref ref-type="page" id="page_134"></xref>
term. It turns into a signifier that blends together into one figure multiple engrossing images and then projects them into the context of major metropolitan hotels and into the global aviopolis. Whereas in the containment dramas of terrorism, the rogue figure is under suspicion of being a martyr for his cause, the containment dramas of pandemics have invented the culturally comprehensible figure of a super-spreader. It enables the underlying invisible world of viruses to be made visible.</p>
<p>Next, I will review a ‘comprehensive chronology of SARS related events’ as published in the WHO publication, ‘SARS – How a Global Epidemic was Stopped’ (2006). I will examine how the chronology frames international air travel in the context of SARS.</p>
<p>The WHO report notes February 21, 2003 as the point at which SARS went international:
<disp-quote>
<p>Index case of the Metropole Hotel outbreak arrives from Guangdong; international spread of virus begins: Professor LJL, a 64-year-old physician from Guangzhou, arrives (infected with the SARS virus) to attend a wedding. He developed fu-like symptoms on 15 February, having been infected in the hospital where he worked [see 30 January]. At least 16 other guests and one visitor are infected during his one-night stay in room 911 of the Metropole Hotel.</p>
</disp-quote></p>
<p>This item in the chronology states the profession, a professor and physician, of the index case. The chronology does not explicitly use the term, ‘super-spreader.’ Rather, it refers to ‘super-spreading events.’ The context is an international metropolitan hotel in Hong Kong. This is significant because the profession implies two things. First, it implies that the doctor was probably infected in Guangdong through his work as a medical doctor. Second, it also brings the disease to a new level when, instead of an average local person, a person with membership of the global elite catches the disease. Besides placing the person identified in such a way in the hotel, he is also placed at a social event, a wedding, to bring forth the ideas of intimacy and contagion. This item of the chronology also explicates what a super-spreading event looks like. In a short period of time – one night's stay – the person passes the infection on to 16 other people in the hotel. Since the hotel was an international one, there is a sense that these 16 people could also turn into super-spreaders. The doctor turns into a super-spreader and the hotel into a disease hub.</p>
<p>The chronology reviews how the doctor further spread the disease before dying:
<disp-quote>
<p>Professor LJL is admitted to the intensive care unit of the Kwong Wah Hospital for respiratory failure. Besides the hotel guests, three members of his family (wife, daughter, brother-in-law) and one nurse at the hospital are infected. Professor LJL will die on 4 March.</p>
</disp-quote></p>
<p>Perhaps signifying the importance of this event and the doctor's role, it is notable that the doctor is identified with the initials, ‘LJL’, whereas the more peripheral
<xref ref-type="page" id="page_135"></xref>
non-index cases are left relatively nameless. This further identifier could also be interpreted as signalling the doctor's higher position in a hierarchy of SARS types.</p>
<p>The next item in the chronology that indicates further international spread is dated February 26, 2003:
<disp-quote>
<p>Hanoi index case is hospitalized: Mr JC, a 48-year-old merchandise manager from New York, is admitted to the Hanoi-French Hospital. He arrived in Viet Nam on 23 February after travelling to China and Hong Kong. Since his arrival, he has had fever and respiratory symptoms. The WHO offce in Viet Nam will be notified of the case the next morning, and its advice sought.</p>
</disp-quote></p>
<p>As in the case of most of the infected persons, the chronology points out the profession of the index case. The mention of what he does for a living is meant to be relevant in imagining how he might have been infected and where. The infection of an international businessman implies a high possibility of many contacts. It is also a signifier of frequent international travel, a worrying sign.</p>
<p>The next item on the chronological list reports the spread of SARS to Singapore:
<disp-quote>
<p>Singapore index case is hospitalized: Ms EM is admitted to Tan Tock Seng Hospital with pneumonia. She has been unwell since returning from a shopping trip to Hong Kong on 25 February. The 22-year-old, who stayed in room 938 at the Metropole Hotel [see 21 February], will pass on the virus to 22 close contacts.</p>
</disp-quote></p>
<p>This index case is identified, not through her profession, but through consumption related activity. She is a tourist who has been on an international shopping trip. She is also associated with an earlier super-spreader at the Hotel Metropole.</p>
<p>On March 2, 2003, the chronology notes the spread of SARS from the province to the capital of China:
<disp-quote>
<p>First Beijing index case is hospitalized: A 27-year-old businesswoman from Shanxi Province is admitted to a military hospital in Beijing, and later transferred to an infectious-disease hospital. She is believed to be the first imported case in Beijing…. She developed symptoms on 22 February in Guangdong and sought medical attention in Shanxi, passing on the virus to two doctors and a nurse there, as well as to 10 health workers at the two Beijing hospitals, and to eight friends and members of her family, including her parents, both of whom will die from SARS.</p>
</disp-quote></p>
<p>Again, the chronology indicates that the fact of the index case being a businesswoman is especially relevant in the further spread of SARS.</p>
<p>On the same day, there is a further worrying development in Hong Kong:
<disp-quote>
<p><xref ref-type="page" id="page_136"></xref>A 72-year-old Canadian tourist is admitted to St Paul's Hospital. He was infected during his stay at the Metropole Hotel. He will pass on the virus to three health workers, five visitors, and one patient at St Paul's. Two family contacts of these cases will also be infected. On 8 March, he will be transferred to the intensive care unit of Queen Mary Hospital, where no further transmissions will be recorded.</p>
</disp-quote></p>
<p>This case is identified through the Canadian's status as a tourist. Being a tourist is regarded as a significant status for it implies possibilities of an international and, in his case and in the case of the New York businessman, intercontinental pattern of spread.</p>
<p>On March 3, 2003, the chronology mentions a clearly protagonist event:
<disp-quote>
<p>Dr Urbani examines Hanoi index case: In Hanoi, WHO's communicable disease expert in Viet Nam, Dr Carlo Urbani, examines Mr JC, the American businessman who was admitted to the Hanoi-French Hospital on 26 February with a severe form of pneumonia. Dr Urbani sends a report to WHO's Regional Office, emphasizes the need for strict infection controls, and arranges for Mr JC's serum and throat swabs to be sent to laboratories in Tokyo, Atlanta, and Hanoi.</p>
</disp-quote></p>
<p>The chronology makes an exception here in identifying an eventual victim of SARS, Dr Urbani, by his full name. His activity is seen in an inherently positive light in the otherwise unemotional disease chronology. He is not identified as a spreader, but as a disease warrior whose vigilance was one of the most important turning points in the SARS narrative. One gets a sense that the chronology mentions one of its own when it highlights the role of Dr Urbani. He is turned into the vigilant and hard-working hero of the chronology. Because of this position, it may be argued that his probable role in passing on the disease is not considered worth mentioning. Actually, his possible position as a super-spreader is downplayed by later mentioning his unselfish hospitalization in Hong Kong, when he alerted others of his condition and kept his distance from other people at the Hong Kong airport:
<disp-quote>
<p>Dr Urbani leaves for Bangkok, where he is to give a presentation at a meeting on tropical diseases the next day. He has a fever and is immediately isolated and hospitalized on arrival. He infects no other passengers on his flight or health workers' (11 March 2003). He represents a model of how to act in a pandemic emergency.</p>
</disp-quote></p>
<p>The super-spreader types get an additional figure on March 4, 2003 in the form of a further alarming case in Hong Kong:
<disp-quote>
<p>Index case of outbreak at Prince of Wales Hospital is hospitalized: A 26-year-old airport worker, Mr CT, is admitted to ward 8A of Prince of
<xref ref-type="page" id="page_137"></xref>
Wales Hospital with pneumonia. He has had fever, chills, and rigours since 24 February. His fever and chest condition gradually improves after admission and his case is never categorized as a severe community-acquired pneumonia. Hence, the case is not reported and infection-control measures are not applied. Mr CT was infected when visiting the Metropole Hotel. He will pass on the virus to 143 Hong Kong residents: 50 health workers, 17 medical students, 30 patients in ward 8A, 42 visitors to ward 8A, and four members of his family.</p>
</disp-quote></p>
<p>There are several noteworthy aspects in this case. First, the profession of this nodal index case is that of an airport worker, implying the high possibility of him being in contact with flyers from different global locations. Second, his account also highlights the importance of vigilance and carefulness in diagnosing the disease. Any failures might have disastrous consequences.</p>
<p>Besides reporting on the start of the epidemic in Hanoi, on March 5, 2003, the chronology recounts the spread of SARS to Canada:
<disp-quote>
<p>Toronto index case dies: Ms KSC, 78 years old, dies in her Toronto, Ontario, home. The death certificate attributes her death to heart attack. In fact, she died from SARS acquired at the Metropole Hotel in Hong Kong. Before dying, she has passed the virus on to four members of her extended family, who will then spark the Toronto outbreak.</p>
</disp-quote></p>
<p>Again the chronology reports misdiagnosis and recounts its negative consequences. The chronology also implies a failure in the containment and follow-up procedures since the index case's stay at the Hotel Metropole should have been suspected by then. This stands in contrast with the next item in the chronology:
<disp-quote>
<p>Mr JC, the Hanoi index case who has been medically evacuated, arrives at the Princess Margaret Hospital, where he will die on 13 March. The WHO Regional Office informs Hong Kong and Singapore officials about his transfer. Singapore is informed because the medical evacuation team is from Singapore. Because of strict infection controls, no health worker in the Princess Margaret Hospital is infected by Mr JC.</p>
</disp-quote></p>
<p>The vigilance and clear communication in this case are clearly pointed out. Proper procedures seem to have been followed. The same sense that progress is being made in getting the situation under control is pointed out in the March 7, 2003 item on the developing situation in Vietnam:
<disp-quote>
<p>The situation is rapidly escalating, with 12 Hanoi-French Hospital staff now hospitalized and more falling ill. Three of six employees at Mr JC's offce also have high fever. The WHO Representative writes to the Ministry of Health and Hanoi-French Hospital, urging them to control the outbreak by
<xref ref-type="page" id="page_138"></xref>
creating a task force, strengthening infection controls, and closing the hospital to other patients. WHO sends out an alert about the Hanoi outbreak to the Global Outbreak Alert and Response Network (GOARN) and requests assistance.</p>
</disp-quote></p>
<p>Although there were further alarming cases, this chronology details how WHO is getting its machinery working.</p>
<p>The chronology next accounts for further cases in Toronto:
<disp-quote>
<p>Mr TCK, the 44-year-old son of Ms KSC [see 5 March], arrives at the emergency department of Scarborough Hospital, Grace division, in Toronto. He complains of high fever, severe cough, and breathing difficulties. While waiting 18 to 20 hours to be admitted, he passes on the virus to three other people in the emergency department. Mr TCK is isolated after a respirologist suspects tuberculosis.</p>
</disp-quote></p>
<p>It seems from this account that the authorities in Toronto were not managing the disease effectively. Contacts had apparently not been followed and isolated in a careful manner. Furthermore, it is notable that the account mentions Mr TCK's long wait in the emergency room. The impression of laxness is reinforced. On the same day, the chronology lists how ‘Mr CKL, a 55-year-old former guest at the Metropole Hotel in Hong Kong, is admitted to Vancouver General Hospital’. The health authorities in Vancouver are seen as more vigilant than those in Toronto: ‘[b]ecause of his travel history, infection-control procedures are implemented. The virus does not spread in Vancouver.’ The identification of this index case with his ‘travel history’ allows the authorities to act. History of travel turns into a way of diagnosing danger.</p>
<p>By 12 March 2003 WHO issues its first global alert on SARS. At this point the chronology turns increasingly into an account of the different health authorities' actions and effective collaborations. Advance against the spread of the disease is being made. The effectiveness of containment actions is clearly indicated by the item on March 15, 2003:
<disp-quote>
<p>In Frankfurt, German authorities await the arrival of flight SQ25, which stops in transit from New York to Singapore; full protection against infection is ready. As soon as the plane lands they quarantine it and remove a 32-year-old physician who treated the two cases in Singapore's Tan Tock Seng Hospital at the start of the month, and developed symptoms while attending a medical conference in New York. Before he boards the plane home, he phones a colleague in Singapore saying that he is unwell and returning to Singapore. The colleague advises the Singapore authorities, who in turn advise the German authorities through WHO. As they thought, the physician has SARS. All the passengers and crew are followed up for signs of infection. The physician passes on the virus to his wife and mother-in-law, who were travelling with him, and to one crewmember. All recover.
<xref ref-type="page" id="page_139"></xref>
None of the other passengers or the participants at the medical conference develops infection.</p>
</disp-quote></p>
<p>The sense of the doctor's vast global connections is highlighted. He was clearly a potential index case. However, the danger is averted because of effective communication and shift actions by the German authorities. The story itself is a prototypical stock narrative of a pandemic disease scare: a person with access to the international elite's social gathering places and to global air travel becomes infected.</p>
<p>On March 15, 2003, according to the chronology, WHO issues an emergency travel advisory and names ‘the fatal illness’:
<disp-quote>
<p>Prompted by the SQ25 event, WHO issues a rare travel advisory as evidence mounts that the virus is spreading by air travel along international routes. WHO names the mysterious illness after its symptoms – severe acute respiratory syndrome (SARS) – and declares it ‘a worldwide health threat’. WHO issues the first case definitions of suspect and probable cases of SARS, and calls on all travellers and airlines to be aware of the signs and symptoms.</p>
</disp-quote></p>
<p>This travel advisory further heightens the association of SARS with global air travel networks. The naming of the disease in conjunction with the travel advisory can be interpreted as an attempt to fight the mystery and speculation surrounding the disease. By giving it a name it was turned into a matter of scientific knowledge and its handling was associated with efficient health expertise. The importance of the travel advisory is made even more tangible as the chronology account of the same day notes a significant case of in-flight transmission of SARS:
<disp-quote>
<p>Widespread transmission occurs on fight CA112: Flight CA112 leaves Hong Kong for Beijing. On the flight is 72-year-old Mr LSK, who is already very sick from SARS. He was infected while visiting his brother in ward 8A of Prince of Wales Hospital, where a 26-year-old pneumonia patient was being treated. At least 22 of the 119 passengers and two of the eight crew-members on that flight will develop SARS – the only event with widespread in-flight SARS transmission. Mr LSK is also the second index case for Beijing, where at least 59 of his contacts develop SARS.</p>
</disp-quote></p>
<p>Mr LSK was a significant super-spreader as he managed to be the source of two waves of spread. This event further hyperbolized air travel's inherent dangers. However, on March 17, 2003, the chronology mentions how WHO takes a stance against travel restrictions. It states that restriction of travel and trade are unjustified.</p>
<p>Overall, WHO's SARS chronology can be said to constitute a rather typical progressive modernist health narrative. The international and local health
<xref ref-type="page" id="page_140"></xref>
authorities – even the Chinese ones after their initial attempts to cover up – were portrayed as gradually taking a leadership role as the situation became clearer. At the same time, it should be noted, the chronology brought into being – or interpolated – a range of more passive suffering or victim figures. These ‘lesser’ subjectivities' positions were described as non-cognizant, hopeless and in disarray. The opposing, antagonistic figures included those that were markedly indifferent: these figures of indifference, lack of will or negligence left other people exposed to the disease. Curiously enough, the most antagonist figures were the ‘index cases’ or ‘spreaders’. In most cases, they were associated with frequent international travel: international businesspersons, frequent travellers, and shoppers and tourists, who came to be carriers of the disease. Often, in the travelogues of international shock that affect air travel, these figures' adventures come to define the resilience and preparedness of the global community. These figures would be extreme road warriors, the diehard professional citizens of global connectedness in crisis. Moreover, as a heroic representation, these figures may be framed as multi-mobile in that they do not get stuck in airports or hotels, but blow ahead aided by a sense of duty and rewarded by honour in duty fulfilled. In the SARS travelogues, these figures turned into potential super-spreaders.</p>
<p>Thus, as a deviant figure, a super-spreader is somewhat paradoxical. This international executive or frequent traveller is usually the protagonist figure of global progress, whose work and consumption fuels not only airports' duty free shops, but also the global economy. One example of the importance of these figures is offered by the so-called Smart Border Plan, which was started in 2002 between the US and Canada. The explicit aim of this programme is to increase border security, while speeding up ‘legitimate’ travel for business and pleasure. To qualify as a legitimate traveller under the programme, one needs to fill out an application and pass an interview. The application includes personal details, past work history and places of residence during the past five years. It is indicative that in the post-9/11 environment, consumer habits are used to provide one of the most important indicators of passengers' ‘true’ identity. The role of consumption is increasingly important for the legitimacy of a modern state such as the US. Spending and the ‘American consumer’ has become the focus of state building and communal civic culture (<xref ref-type="bibr" rid="ref185">McGovern 2003</xref>: 68). National identities are increasingly fused with consumption as a way of life. Moreover, consumerism is intertwined with the notion of the Western civilization:
<disp-quote>
<p>Consumerism and modernism are joined at the hip because consumption is an indispensable part of the civilizing process. The process of consumption, of expressing our identity through tastes and possessions, changes the entire field of interaction. It makes possible new kinds of social identity.</p>
<attrib>(<xref ref-type="bibr" rid="ref254">Sznaider 2000</xref>: 297)</attrib>
</disp-quote></p>
<p>Because the relationship between salaried work and desired material and non-material products is made through credit, people are tied to their jobs to maintain
<xref ref-type="page" id="page_141"></xref>
a certain lifestyle and quality in life. Regular payment schedules to creditors create the much desired constancy. The ability to keep a record of this valued constancy is an additional benefit of the credit system. The recognition of who is who in the system is made more efficient by the quantification of associated types based on credit records.</p>
<p>It may thus be argued that this ‘protagonist turned into hostile and antagonist super-spreader’ is used partly to articulate anxieties inherent in the modern consumptive life. This provides further evidence of how the anxieties stemming from the pandemic threats contain a contestation of the present global way of life and its world order context. The pandemic inventory of protagonist and antagonist figures contains a fear that the protagonist will turn out to be an antagonist. As such, the distinctions between the many types are fine and nuanced. SARS can be seen as having provided a particularly well-suited topos for the restaging of the hierarchical world order imagination. The pandemic ‘eye,’ which has been trained through frequent exposure to pandemic scares, quickly scans around for different figures and types. This eye belongs not only to the border or security guard. It belongs potentially to any person placed in the intensity of intersecting people in the hub and spoke network of air travel. People recognize the types and remember their own respective positions among them. The airport experience has an ontological quality that connects airport behaviour to the production of identities. Airports have become the loci of reassurance and security against the submergence of identities and against disruptions in the vital flows. They signify the security of the imagined worldwide political community. In this way, the whole community is present in the halls of international entry and exit hubs. The experience sets up an image around which people can deposit not only their anxieties, but also themselves (<xref ref-type="bibr" rid="ref058">Daniels <italic>et al.</italic> 2001</xref>: 386). It seems that the question of ‘how real the security threats actually are’ is less significant than the perceived need to secure the continued existence of the imaginary landscape in which ‘cosmopolitan,’ ‘global,’ and ‘Western’ people safely belong.</p>
</sec>
<sec id="sec5-7">
<title>Conclusion</title>
<p>The chronology makes it clear that the spread of SARS was eventually brought to a halt by the use of old-fashioned methods. These included ‘surveillance, education of susceptible, and simple isolation procedures with infectives’ (<xref ref-type="bibr" rid="ref025">Benini and Bradford 1995</xref>). Despite the seeming success of the public health actions, SARS left some lingering doubts when it came to the sustainability of global public health. The ability of SARS to disrupt societal organization was one of its most notable popular images. It was perceived as a global danger that manifested itself at the local level as a local danger threatening to spread globally. However, this nexus seems to necessitate taking global responsibility for the local level handling of the disease threat. SARS was a networked disease and a disease of networks at many levels. At the macro level, it was seen as having the ability to force the closure of modern life support systems and turn upside down the polities that rely on them. At the micro level, it meant actions such as closure of
<xref ref-type="page" id="page_142"></xref>
schools, turning hotels, hospitals and apartment complexes into containment zones, and paralysing cross-border movements. In a way, SARS was interpreted to have come with the ominous demand for reorganization. It demanded reimagining social organization, expert governance, and hammered home the importance of resilience and preparedness as the key signifiers of legitimacy. The reframing of vulnerability made a disease like SARS an even more ideally comprehensible entity in our times. In a way, the ‘coming plague’ dynamics has been integrated into the global affective climate and into new methods of global governance.</p>
<p>One aspect of the ongoing ‘grand movement’ is global ‘deterritorialization’. This was generally seen as the breathing place for SARS as well as the later avian and swine flu. Disappearing physical barriers have led to a situation in which human interaction across vast distances occurs almost anywhere and everywhere in the world. It is likely that the feverish agitations of the globalizing world can increase the likelihood of age old narrative tracks being triggered, which emphasize the diseasing influence of boundary violations. From this perspective, it is understandable that there is a considerable amount of anxiety and fear, which stems when long existing borders start to become increasingly porous and when the compressed global space decreases the importance of buffering geographical distance. The globalized community cannot be described convincingly any more as an archipelago of separate national birds' nests. Much hybridization and multidimensional nesting has taken place at the level of identities and communities because new methods of global interconnectedness have expanded social spaces beyond geopolitically identifiable locations. However, this hybridization takes place in a world with still strong local – often xenophobic and non-transnationalistic – identities. This changing ideological landscape is ripe for the markers of insecurity to turn into signifiers of pandemic fears and scares in ways that reflect older patterns of enmity. As Beck pointed out, societies turn into paranoid sites ‘where even an unsubstantiated claim about a threat to public health is likely be taken seriously’ (<xref ref-type="bibr" rid="ref176">Loosemore <italic>et al.</italic> 2006</xref>: 230). The state reacts to its increasing geographical fuzziness by hyperbolizing its effectiveness in maintaining public health and hygiene. The discourses of pandemics are likely to be used to create senses of security utterly unrelated to what pandemics as epidemiological phenomena are supposed to be.</p>
</sec>
</body>
</book-part>
<book-part book-part-type="chapter" book-part-number="6" id="chapter6">
<book-part-meta>
<title-group>
<title><xref ref-type="page" id="page_143"></xref>The pandemic geography of Avian Flu</title>
<alt-title alt-title-type="running-head">The pandemic geography of Avian Flu</alt-title>
</title-group>
</book-part-meta>
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<p>Avian influenza refers to an illness caused by viruses adapted to birds. When it occurs in domesticated poultry it can rapidly kill more than 90 percent of the flock and its spread can usually be stopped only by killing all the domestic birds in the affected area. The causative virus, H5N1, can spread to humans, but human to human transmission has not been observed. WHO data indicates that, till late 2010, some 300 people have died of avian flu in 12 countries since the discovery of the virus. The alarm over the virus stems from the possibility that it could mutate into a form that allows for rapid human to human transmission.</p>
<p>The earlier chapter dealt with the kinaesthetic flow-like modalities of modern pandemic containment dramas. The political imagery of SARS was based on securing global flows to contain the disease. The bird flu scare had similar avian connotations, but these connotations did not explain the flow-security of the modern globalizing world. Instead, they focused on the relevance of the migration of wild birds. The purpose of this chapter is to highlight further modalities of the pandemic scares, but it is premised on illustrating the narrative trajectory of the scare (see <xref ref-type="book-part" rid="chapter4">chapter 4</xref>, ‘Trajectory of a pandemic drama: ebbing and waning of the BSE Crisis in 1996’) and the flow-like containment drama (see <xref ref-type="book-part" rid="chapter5">chapter 5</xref>, ‘Vortexes of SARS: anxieties over global air mobility’). The avian flu episode highlighted the traditional means of framing supposedly violent pandemics. The genre of speculative worst case scenarios were a fleature of the scare, which offered the means for the various authorities to stage powerful experiences of communality. I will examine newspaper articles from the <italic>New York Times</italic> and <italic>Helsingin Sanomat</italic>, a mainstream Finnish daily, to show how avian flu's speculative rhetoric provided the means to tell stories of we-communal purity, preparedness and health, and of narrating the dangers of faraway places and their cultures.</p>
<p>In his <italic>New York Times</italic> book review published on November 27, 2005, Matt Steinglass examined <xref ref-type="bibr" rid="ref060">Mike Davis' (2006)</xref> book, <italic>The Monster at Our Door: The Global Threat of Avian Flu</italic>. The debate that ensued highlights the discourse dynamics of recent epidemic scares. Davis' argument is that humanity is going to face a catastrophic encounter with a pandemic influenza if it does not stop sleepwalking. His rhetoric or, more clearly, pedagogic strategy is to alarm his readers through the powerful descriptors he bestows on emerging viruses.
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Drawing from centuries old imageries, Davis claims that these ‘monsters at our door’ are ‘extraordinary shape-shifters,’ capable of ‘ultrafast evolutionary adaptation.’ Davis explains that the ‘root’ causes for the coming into being of such threats are the profit focused pharmaceutical industry and the breakdown of the leadership in world health, in combination with the social changes in the globalizing world, as, for example, the increasing urbanization. Davis and his supporters see these two factors as posing an extraordinary strain on ‘human solidarity.’ On the other hand, environmental changes, such as global warming, are going to cause an upheaval in the man–nature relationship.</p>
<p>In his review of Davis' book, Matt Steinglass finds these often mentioned points valuable, but considers the main argument rhetorical. In other words, it is not the description it claims to be, but an advocacy piece meant to hype up the book and to foster a particular way of thinking about global health. Steinglass says, ‘[People like Davis] are wielding apocalyptic anxiety as a tool toward a greater end: the construction of a global system of influenza surveillance and vaccine research and delivery to protect mankind wherever the next pandemic does, inevitably, break out.’ The pandemic speak that Steinglass points out is not value neutral. It interacts with the other political worries of the time – with wars, terrorism and globalization in the present era. It inevitably contains a particular vision of human solidarity, namely, of the particular ‘prepared’ shape of the political order that would be adequate to meet the challenge of the shape-shifting mutable enemy.</p>
<p>It may be argued that scare imagery transformed from the nuclear holocaust of the 1980s to the pandemic outbreaks of the 1990s and 2000s. As CNN reported on its webpage on February 21, 2007:
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<p>No act of modern warfare, with the possible exception of a nuclear exchange between major world powers, has the potential to threaten as many lives and cause as much disruption to the global economy as the H5N1 avian infulenza would if it makes the evolutionary leap that allows it to spread among humans as quickly and as lethally as it has among birds.</p>
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<p>Perhaps more than any research related book that epitomized this change was <xref ref-type="bibr" rid="ref096">Laurie Garrett's <italic>The Coming Plague</italic> (1994)</xref>. The basic crux of Garrett's work was that exotic viruses were jumping out of their tropical habitats due to the developing global transportation networks that connected air routes to road-building in developing countries. Humanity was becoming more exposed as its links extended to tropical places, and remoter global reaches became increasingly accessible. Disease language or pandemic speak often identifies disease scares with remote places. These regions are further identified with poverty and overcrowding, two factors that are seen as compounding the problem. The uneven disease burden in certain places, combined with inadequate public health measures, is perceived as a global risk – a risk to developed countries. According to Davis and Garrett, this development has been further induced by growing populations and population densities that create opportunities for diseases to
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mutate into more virulent forms. This pandemic talk integrates with the other declinist sensitivities such as global warming and ozone depletion, which are seen as further inducing the danger of the inevitably coming plague.</p>
<p>In pandemic speak, there are clear hero figures, the protagonists for all humanity. <xref ref-type="bibr" rid="ref096">Garrett (1994</xref>: 596) calls them ‘disease cowboys’: ‘I have been privileged to know many of the people in this book. They are heroes of a special kind: bonding science, curiosity, and humanitarian concern, combined with a special practical, “let's get it done” attitude.’ Garrett was not alone in defining this type of protagonist figure. <xref ref-type="bibr" rid="ref213">Preston (1995</xref>: 115) uses the heroic term, ‘virus hunter,’ and <xref ref-type="bibr" rid="ref274">Willis (2003</xref>: 1) sees a special class of people whom he calls ‘germ warriors.’ <italic>Newsweek</italic> (May 22, 1995) terms those who fight for humanity's survival in pandemic ‘hot zones’ as ‘commandos of viral combat.’ <xref ref-type="bibr" rid="ref075">Drexler (2002)</xref> gives a fuller description: ‘[m]odern adventures like to up the ante, but even the most extreme sports wouldn't produce the adrenaline of a race against pandemic influenza or a cloud of anthrax at the Super Bowl.’ These hero figures are hybrid scientist-warriors who have masculinized fleatures. Their existence is seen as evidence of humanity's ability to fight back. Their fictitious attributes are meant to reassure. But I would suggest that the most important function of these is to turn pandemic outbreaks into high drama with fitting protagonist figures. However, these accounts of pandemic dramas ignore the fact that such figures do not exist in a political vacuum. The public health establishment can be seen to provide the protagonist figures for the containment drama. On the other hand, these dramas embody much more powerful communal tropes. The power that is acknowledged and the authorities that are recognized during a pandemic scare are not only those of expert figures. Rather, it may be argued that the more powerful embodiments during global pandemic scares are political forces on whom people are used to relying. These embodiments are connected with the national and international structures that are seen as maintaining the viability of the global experiment.</p>
<p>The militaristic language of pandemic speak points to one important framing of pandemics – security threats. They are seen as security threats for two reasons: they can devastate national readiness, test communities' preparedness, and they can be used as weapons of war. <xref ref-type="bibr" rid="ref213">Preston's <italic>The Hot Zone</italic> (1995)</xref> participated in the construction of the popular frame for pandemic scares through a few detailed, yet highly dramatic case histories. Preston described Ebola, the most fleared epidemic of the mid-1990s, and it is important to note that he extended his Ebola histories to indicating the possible weaponized forms of deadly diseases. His gripping narrative reinforced the link between naturally occurring diseases and their potential use as biological weapons. Pandemics became securitized and the ‘speak’ acquired a military dimension, accentuating the national security relevance of any pandemic disease. The national readiness aspect is treated as a high importance security issue, yet it is also pointed out to be lacking in pandemic speak. The speak invariably points towards the general unpreparedness to manage large disease outbreaks. Preparedness levels are low. <xref ref-type="bibr" rid="ref075">Drexler (2002)</xref> influentially argues that the contemporary times are only a brief
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lull or interlude in the history of devastating disease. It is highly telling that the arguments of the ‘coming plague’ bypass the real here and now pandemic of HIV and AIDS, which does not seem to be devastating enough to the global structures to merit hyperbolic attention. The argument seems to be that more devastating pandemics are coming and polities lack both readiness and resilience. Pandemic speak hyperbolizes mutating disease agents into enemy-like entities. The embodied images of bodily pain used in popularized accounts are graphic: they list haemorrhagic smallpox, skin lesions and liquefying organs. Not only are these scare images used in reference to new epidemics, but micro-evolution is seen as pushing existing diseases such as tuberculosis and malaria to mutate and develop immunity to previously effective drugs. The international community and its leading states are seen as losing their ability to fight back. Pandemic language is a call to arms against the hypothetical invisible enemy.</p>
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<title>Key popular frames</title>
<p>In popular accounts, pandemics are commonly placed under highly securitized and militaristic frames. This has been noted by several social scientists:
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<p>Since the emergence of HIV/AIDS in the 1980s, social scientists and sociologists of health and illness have been exploring the metaphorical framing of this infectious disease in its social context. Many have focused on the militaristic language used to report and explain this illness, a type of language that has permeated discourses of immunology, bacteriology and infection for at least a century.</p>
<attrib>(<xref ref-type="bibr" rid="ref267">Wallis and Nerlich 2005</xref>)</attrib>
</disp-quote></p>
<p>Evidently, when the perception of acute pandemic disease intertwines with the production of security by polities, whether they be local, national, regional or global, the situation becomes tense, charged and dramatic. The heightened sense of looming disaster thickens the air and sets the engrossing ‘pandemic frame’. This frame has to do with what is at stake, what is taking place, and what have been the past precedents. Besides the frame, the ‘performers’ become vital figures and embodiments in epidemic related political dramas. Performers are those who are expected to do something and whose actions are judged. The ‘spectators’ of the drama are usually the presumed Western ‘common person,’ whose health is perceived to be under threat and who is also seen as evaluating the actions of the various performers. Often the media comes to represent the spectators and their judgments as well as to reflect the actions of the performers of the pandemic dramas.</p>
<p>The ‘plague frame’ is often utilized in connection with epidemics. The plague frame contains two vital characteristics – it is a benchmark and a memory. All communities have long histories with epidemic diseases. The one with plague is perhaps the most unforgettable. Plague destroyed communities in Europe and Asia starting from the early fourteenth century and lasting well into
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the eighteenth century. Due to this intense experience, the use of the plague metaphor tells us about the lethal nature of an epidemic. First, it implies a high fatality rate. Estimated death counts for the Black Death were around 75 million. It is generally accepted that the plague killed more than half of Europe's population from 1347 to 1351. The disease appeared throughout Europe in every generation all through the 1700s.</p>
<p>Second, it sets the benchmark when it comes to a horrid, short and vivid way of dying. The incubation period for plague from infection to appearance of symptoms is generally six days. The first symptom is usually a gangrenous pustule at the point of the flea or rat bite; this is followed by the swelling of the lymph nodes in the armpits, groin and neck, depending on where the flea bite was; then comes the haemorrhaging, which causes the purplish blotches called buboes; haemorrhaging produces cell necrosis and intoxication of the nervous system.</p>
<p>Third, there is a historically established stock narrative, which turns ‘plagues’ into highly scripted occasions. The plague genre of narrating an outbreak of a disease began with Thucydides' account. His ancient treatise established the ‘proper’ voice for chronicling pestilence – detached, clinical, carefully detailed descriptions. This tradition was continued by authors such as Samuel Pepys, Daniel Defoe and, later, Albert Camus and Connie Willis, among many countless others. These authors attempted to speak about the collective suffering and dissolution of the community through the figure of the plague. Usually, there is a sense of an apocalyptic purification: the religious perspective during an epidemic of plague was that plague separated the damned from the saved with the end result being purity. Death was blamed on communal sin and immorality. The ‘cure’ for the ‘dis-ease’ was associated with the opposite.</p>
<p>Fourth, the return to normalcy required acts of sacrifice, decontamination and purification. These acts often took the form of highly visual inflictions of pain, which ranged from the burning of witches to the slaughter of minorities to the modern day dramatic actions, which involve mass slaughter and culling of animals.</p>
<p>The plague frame gives an additional historical precursor modality to the containment drama that has been the key frame in this book. Besides the plague framing, there are other important modalities. <xref ref-type="bibr" rid="ref267">Wallis and Nerlich (2005)</xref> point out that pandemics are treated as ‘killers,’ and ‘wars’ are waged against them. The war metaphor tends to refer to violated boundaries as the disease spreads. The preparation and containment are treated as a defence strategy against a foreign military enemy. The level of enmity, however, portrays an existential struggle, as, for example, when a pandemic is framed as the ‘number one threat to humanity.’ Military metaphors are rampant in this ontological, warlike situation: pandemic disease ‘strikes,’ medical specialists ‘wage a battle,’ the international community needs to adapt on a ‘war footing,’ plans are drawn to ‘combat the threat’ and to devise an ‘effective defence,’ and ‘armies’ of disinfection squads take control of the hotspot. The war frame's dynamics also compels one to identify the enemy and devise an appropriate defence. For example, HIV and
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AIDS related ‘wars’ have been fought with billions of dollars against the virus itself. However, more often than not, the virus is made more alive by locating it in certain segments of the community: homosexuals, prostitutes, truck drivers and drug users. After this localization, the defence is no longer based solely on epidemiological or public health research, but on different practices of communal stigmatization, marginalization, containment and isolation. The question is not only where the hotspot is, but also who the associated disease carriers are, and their possible routes of spreading the infection. In political terms, this means that the disease is territorialized, nationalized, ethnicized racialized and sexualized: HIV and AIDS was territorialized into Africa, racialized into Afro-American communities, and sexualized into gay communities. SARS was nationalized into China and BSE was contained in the UK. Avian flu was localized into Indonesia, Turkey and much of Asia. Swine flu became a Mexican disease.</p>
<p>Pandemics are also embodied as killer diseases. The killer imagery contains such entities as hurt communities, hammered corporations, knocked profits, damaged states and gripped cities. The disease is seen as having malevolent intentions: it ‘lingers’ in social spaces, it ravages cities, it is ‘rampant’. It can even have a ‘hit list’. In this language, ‘victims’ take the place of ‘patients.’ The emphasis of this framing is on those who are associated with the killer disease. Pandemic disease is often pictured as killing people. This framing carries with it the associated connotations of guilt, blame, and responsibility. The crisis frame is also part of the securitized atmosphere of a pandemic disease. There is a sense of a crossroads, of the situation being at a knife's edge. This situation seems to demand large-scale resource mobilization and avoidance of scare, alarm and panic, words that are often used as headline level sub-framings of pandemic disease. The killer metaphor is somewhat less militaristic and more communal than the war framing. ‘The killer’ is regarded to be inside the community, whereas war is fought with outside elements. For example, HIV and AIDS have been treated as the masked killer or silent killer. In the killer context, there is talk about surveillance, about tracking the killer to stop its murderous path. Whereas the war frame localizes, the killer frame puts emphasis on the scarcity of time. Temporalization, in this context, refers to time becoming increasingly salient, to the hurry to find a cure or solution, and to the general acceleration in the tempo of events. The sense of political stability changes in an instant to a sense of fleeting and threatened existence when a seemingly serious pandemic disease strikes. The scarcity of time leads to the importance of doing something – of finding a cure or escaping the effects – immediately. The situational ethics starts to favour fast and drastic actions – the temporalized frame changes the nature of actions that are deemed legitimate and necessary. The sense of haste under a disease frame favours bold, swift and highly visible actions. The drastic actions taken during the BSE epidemic of 1996 and the extravagant burning of tens of thousands of animal carcasses during the 2002 food and mouth epidemic in Britain illustrate the type of actions that are favoured in the time of politicized diseases. The jolting reactions to SARS and swine flu also offer cases in point. What from
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the perspective of a healthy political deliberation might appear as unreasoned actions and undue haste, turn into legitimate and virtuous ways of proceeding when an epidemic strikes.</p>
<p>Thus, pandemic speak is evidently prone to securitization. Military and conflict related metaphors are used to understand a pandemic disease. However, this is only one side of a proverbial coin that cannot be used as a metaphor without its flip side: disease-related imagery is often used to understand political violence. This dual character animates modern disease language and renders it politically useful. The treatment of a somatic body as a battlefield of agents of immunity and agents of disease finds its parallel in a political language that treats political violence as disease-like regressive processes. Political enemies are often treated in terms of disease language. They are virulent cancers, aggressive plagues and violent contagious diseases. In today's context, these metaphoric terms are meaningful through the embodied associations that they contain. They draw from the dynamics of disease in explaining the meaning of international events, thereby connecting international relations with individual level danger, immediacy and urgency due to diseases. This bridgehead is meaningful also in its reference to the global context, where actions are taken in geographically and conceptually distant places. Distance, one of the primary fleatures of globalization, draws attention to the planet's farthest reaches: the global polity is seen as a body that connects previously inaccessible peripheries – such as the caves of Afghanistan or the tribal areas of Pakistan – to the central places. These embodied metaphors of the global world are rendered meaningful by the disease metaphor.</p>
<p>Politics as a disease frame works simultaneously with the earlier mentioned disease frames. It can be hypothesized that there is no pandemic scare that would not also entail the political modality. Jumping to a contemporary example, against this background, it is easy to understand that when bubonic plague hit the Indian city of Surat in 1994, concern over the international political repercussions led initially to attempts to hide the problem and, once that had become impossible, to downplay the seriousness of the outbreak (<xref ref-type="bibr" rid="ref261">Tysmans 1996</xref>; <xref ref-type="bibr" rid="ref160">Krishnan 1994</xref>). The Indian government has tried persistently to rid itself of the image that Western countries often associate with postcolonial, developing countries – that they are uncivilized, weak, chaotic and second-rate states, inherently unable to take care of their own citizens. The failure of the containment drama translated into India's lack of power and agency, which was deemed unfitting for the world's most populous democracy. What made the outbreak of bubonic plague an even more embarrassing and conspicuous sign of incapability was the fact that the knowledge of how it spreads and how it can be cured and eradicated has been there for a full century. In political power dramas, an outbreak of this type was ‘a euphemism to embarrass a less developed country in the hopes of making the more developed look better and safer’ (<xref ref-type="bibr" rid="ref173">Lin 1995</xref>: 2913).<xref ref-type="fn" rid="fn6_1"><sup>1</sup></xref></p>
<p>On the other hand, the stock narrative of an epidemic disease contains a well established dynamic that easily leads to the attribution of death and destruction to foreign sources and political adversaries. This tendency has been particularly
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pronounced during periods of heightened inter-state conflict and world order tensions. Not surprisingly, the spread of HIV and AIDS in the early 1980s was soon adopted for politically advantageous purposes. The Soviet authorities insisted that HIV was the outcome of a US military experiment that had gone terribly wrong (<xref ref-type="bibr" rid="ref197">Nelkin and Gilman 1991</xref>: 39). It can be argued that the purpose was to point out that the US was a vicious and underhanded superpower that should not be trusted. Furthermore, for the Soviet Union, the HIV and AIDS epidemic offered an opportunity to point out that it was free from HIV and AIDS, that it had no ‘degenerate’ and ‘corrupted’ homosexual elements. In the West, HIV and AIDS was attributed to marginalized internal elements such as homosexuals, prostitutes, and drug users. In other words, many people in the West connected the disease with the ‘unnatural’ ways of the gay community, rather than with the general ‘corruptness’ of Western societies on the whole. It was effectively used by the American neoconservative movement in the beginning of the 1980s to promote its own message about family values and the need for religious revival in the US. During the Cold War, the HIV and AIDS epidemic did make some international relations appearances, not because of its deadliness, but because of the age old political reactivity of lethal epidemics.</p>
<p>A further example of how political enmity and epidemic disease imageries overlap and reinforce each other is offered by the 1918 Spanish Flu episode. The flu came from the US across the Atlantic Ocean before turning into a significant outbreak. Influenza started spreading among the British forces in Spain, thus the name. ‘Within a few cycles of infection, it was apparent that the disease had become more virulent, with a tenfold increase in the death rate amongst cases’ (<xref ref-type="bibr" rid="ref199">Nicholson <italic>et al.</italic> 2007</xref>: 102). The more virulent viruses spread throughout the world:
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<p>the outbreak of influenza … swept through Europe and America in 1918, reaching the remote wastes of Alaska and the most isolated of island communities. It is estimated that half the world's population was infected, and that of those infected, one in twenty died.</p>
<attrib>(<xref ref-type="bibr" rid="ref112">Hallam 2004</xref>: 19)</attrib>
</disp-quote></p>
<p>The death rate was much higher than in a generic influenza pandemic. The disease hit people in the 20–40 years' age group. While this marked pattern greatly induced flear, it made the disease especially deadly among soldiers and greatly complicated the war efforts. Conceptually, the disease turned into one important modality of the war. This connection was explicated to the home audience during World War I. For example, the US poster campaigns equated the ways in which the Spanish Flu spread – coughs and sneezes – with the notable weapon of the war – poison gas. One US Public Health Service poster had the slogan: ‘Coughs and Sneezes – As Dangerous as Poison Gas Shells – Spread of Spanish Influenza Menaces Our War Production.’ Fighting the disease was seen as a way to fight the war. In this way, the epidemic disease connected with the underlying patterns of hostility. Further examples, are provided by the health
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propaganda that tried to tackle tuberculosis in the first half of the twentieth century. Tuberculosis can be seen as providing much of the background for the contemporary influenza imagination. A French poster had an image of a family being protected by the Maiden of France carrying a shield. The text states: ‘<italic>Achetez le Timbre – Antituberculeux – Protégez-vous Contre la Tuberculose</italic>.’ Another poster has an image of a bleeding and dying German eagle emblem, which has a sword run through its body with the text: ‘<italic>2 Fléaux – Le Boche et La Tuberculose – l'Aigle Boche Sera Vaincu – La Tuberculose Doit l'Etre Aussi</italic>.’ The public health posters connect the national struggle against tuberculosis with national defence. The protective barriers of the national border and the human body are equated in these messages. The iconography is militaristic. The multilevel politico-somatics of lethal epidemic disease is represented visually.</p>
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<title>Avian Flu's pandemic geography</title>
<p>The pandemic containment dramas contain a strong moralist note in which effective power stems from a sense of transgressed boundaries and the haste to restore them. The sense of legitimacy becomes connected with actions to reaffirm or reinvent a sense of a constitutive communal element (<xref ref-type="bibr" rid="ref174">Lindenbaum 2001</xref>; <xref ref-type="bibr" rid="ref225">Rosenberg 1992</xref>). Such a political context and dynamics favour notable and even drastic actions to eliminate the hostile antagonistic elements. In modern times, when the causative agents are connected with microscopic disease carriers (viruses, bacteria, and other microbes), the protagonists face the dilemma of how to fight the invisible disease agents in drastic and highly visible ways. High-tech facilities, people in protective gear and militarized disease containment measures provide some reassuring markers of security. The mass culling of animals and the burning of their carcasses also offer means for demonstrations of power in fighting the scare stemming from the perceptions of a dangerous outbreak. These visible demonstrations are often accompanied by the containment that takes place at a more imaginary level. Acts of containing can also proceed by explicitly or implicitly associating the carriers with certain localities or with an ethnically, nationally or culturally distinct group of people. As has been pointed out earlier, such stigmatizing usually draws from culturally salient patterns of enmity. The nuances of these blame games are intricate and depend on the exact nature of the perceived disease as well as other attention-catching dynamics occurring in the same temporal context. It should be noted that the frenzies of an outbreak context produce tangible suspicions that go beyond detecting and embodying the antagonistic disease itself. There are groups and localities that may not be directly connected with the illness, yet which will attract questions, hesitation and mistrust. The affective climate of an outbreak scans for suspicious types based on hunches and impressions. Under this frame, a whole variety of suspect-types can emerge: tourists, drug addicts, air travelers, truck drivers, prisoners, prostitutes, homosexuals, food production industries, greedy politicians, and so on. These types find their historical equivalents in the more aged, collective memories about polluters, vagabonds, plague spreaders, and well-poisoners.</p>
<p><xref ref-type="page" id="page_152"></xref>Thus, the pandemic containment dramas involve the passing of a communal verdict – a judgment is passed about the public hygienic status of those involved. This judgemental quality puts the limelight on a group's values and its ability to make the correct choices. Does the group obey disease control measures? Does it rally to the call for doing something in the name of public safety? Thus, the stress is on checking how well people choose in the course of the heightened spectacle. From this perspective, the vital question is how their choices reflect the desire of the community to regain and re-establish medico-moral health. There are two main ways of framing the evaluative aspect of the outbreak scene. First, the evaluation of legitimacy can take place in the indeterminate context of the outbreak itself. Dramas of this type highlight the temporal element of being at a critical crossroads: from that moment onwards, there is a strong sense that events can continue either negatively/regressively or positively/progressively. The term, ‘critical’, is itself a medical term. The root concept, <italic>lt. criticus</italic>, refers to the decisive point in the course of a disease. Interpreted in this way, crisis refers to the moment at which irreversible processes of progression or regression are initiated as manifestations of the worth of the participating actors. The hotspots of outbreaks get additional political substance and influence the way in which the underlying disease is interpreted and dealt with. Second, pandemic containment dramas can manifest themselves in a more proactive way, in the spectacular acts of being on guard, sounding alarm, and in diligent surveillance. In these frames, the sense of legitimacy derives from the ability to maintain a certain sense of safety and the absence of outbreaks or hotspots. It can be argued that one major way of doing morally virtuous labour in contemporary times is by sweating over health related concerns. The perspiration shed over the feverish agitations of the globalizing world provides the setting for the staging of the epidemic in such proactive containment dramas. These situations contain a stern moral lesson about the disastrous consequences of laxness and lack of vigilance. In this respect, the morality plays are focused on the teaching of correct behaviour and the virtues and values of a well functioning – healthy – global order and governance.</p>
<p>These two variants of the containment drama tie in with the overall movements in the global power hierarchies. The emergence of acute changes and disruptions at the level of power-politics, such as war, lead to acute sensitivity towards movements at the level of the containment dramas. The appearance of large-scale moves in the power positions find one trigger perception in the tropes of failing and failed polities. These states and regions can function as measures of overall changes and transformations. Consequently, it is at them that much of the containment drama is focused. They cause much worry and much activity is directed towards them in both critical and proactive ways. An example of proactive containment drama is offered by <xref ref-type="bibr" rid="ref097">Garrett's (2000)</xref> tellingly titled book, <italic>Betrayal of Trust: The Collapse of Global Public Health</italic>. The dynamics of collapse, decline and fall are highlighted in the context of a narrative about how health in the global heartlands is intimately tied up with the poor state of public health in the global hinterlands. Garrett argues that the ‘covenant’ between
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people and their rulers, which, according to her, is essentially based on the regimes being able to provide health, is breaking down in many parts of the world. The breakdown of public health infrastructure means that diseases such as HIV and AIDS, diphtheria, typhoid and drug resistant tuberculosis are rampant. Garrett says that many diseases are caused by bad governance, mismanagement and kleptocracy. This is not a problem of only less developed regions. The overuse of antibiotics in the most developed states risks the emergence of drug resistant ‘superbugs’. Furthermore, the book argues that earlier successes with lethal epidemic diseases have led to a culture of complacency and diverted resources from public health to individual health. Garrett's influential arguments highlight the need for a constant proactive approach to global public health. Governments and organizations should be aware that the best route to sustainable global health is a holistic approach and overall strategic situational awareness. <xref ref-type="bibr" rid="ref075">Madeline Drexler's (2002)</xref> book, <italic>Secret Agents: The Menace of Emerging Infections</italic>, offers an additional argument for proactive containment. According to Drexler, the contemporary times are witnessing a brief interlude between major pandemic diseases. This interlude has led to lowering of the levels of preparedness. The pandemics are just round the corner and today's societies are not ready to face them. First, the microevolution has allowed disease agents to develop resistance to previously effective drugs. Second, this same vicious cycle is reinforced by the over-prescription of medication and by the use of anti-bacterial products. The third regressive element highlighted by Drexler is the growing global disparity in health, which imperils all countries. Drexler's argument follows the same narrative trajectory as Garrett's work in highlighting the need to do something right now proactively to avoid an ominous future.</p>
<p>Thus, diseases are deemed to have a context – they are perceived as a phenomenon with ecology (<xref ref-type="bibr" rid="ref126">Horden 1992</xref>). The conceptual topography of disease is seen as an unhealthy and disease causing environment. Even modern ideas concerning disease prone environments reiterate disease as a contextual phenomenon link. <xref ref-type="bibr" rid="ref276">Christopher Wills (1996</xref>: 8) talks in his book about the interaction between plagues and people and how he will explore the view of ‘just how and why such disturbances of the ecological balance can give rise to plagues’. These same ideas concerning perceived imbalances and disturbances inherent in the context ripe for disease are often present in the emerging pandemic disease narratives so prevalent in our times. Often, the attention turns to the disturbances of ecology in Africa caused by spreading modernity in the form of urbanization, building of infrastructure, and ‘penetrating’ the supposedly pristine African rainforests. It seems that the construction of the contemporary disease landscape tends towards embodying the worries felt over the modern lifestyle. These worries register the perceived perversion caused when modernity integrates pre-modern places in the hinterlands of the global world. It is not only the physical environment of these distant ‘pre-modern’ places that is seen as posing a grave threat to the globalizing world; the distant peoples' customs, too, seem to play a prominent part in such constructions of pandemic insecurity. The seemingly
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alien and somehow ‘bad’ habit of eating monkeys has been highlighted in the myths about the origin of both Ebola and HIV and AIDS. There are many such examples. During the avian flu scare, there was a lot of talk about the difficulty of humans getting the disease because it required close contact with domesticated birds. Newspaper stories detailed how those who caught the infection were living in areas of the world where the dead birds were eaten or their faeces handled by the people. Such unhygienic, unsanitary and, thereby, diseasing handling was associated with certain parts of the world. This social environment, conducive for disease communicability, was projected to Asia and Africa. It was not seen as a real concern in the West. In a way, the ‘real’ threat seemed to stem from the perceived unhealthy interaction between people and domestic birds in the distant lands, which, through the global networks, was more connected than ever before to the global heartlands.</p>
<p>It seems that the invisible nature of the disease agents causes problems for the modern construction of danger, which tends to highlight the visual element in its representation. The importance of visuals can provide clues to the constant linking of disease with a foreign landscape that is pre-modern, dirty and unsanitary (<xref ref-type="bibr" rid="ref259">Tomes 1998</xref>). The hidden is made visual in a way that is based on and reinforces old conceptualizations regarding why diseases emerge and spread. Although diseases agents are an invisible enemy, they are seen as having their natural loci in contaminated landscapes in which poor states can be visually represented. Landscapes seem to offer ways of rendering the invisible visible. However, in the West, the invisibility of the disease agents poses a more difficult task because the representability – that is, the basic preconditions for creating sensible representations – is not there. The West forms the top of the global hierarchy and, as such, its landscape is not described through signifiers of filth, dirt and pre-modern habits. The overuse of antibiotics and anti-bacterial products offer for the modern mind ways of understanding why the West might be susceptible to (re)emerging diseases. Besides this dynamics, there are some diseasing influences that are seen as hampering modernity's fight against diseases. One such causative dynamics is offered by the idea that the global world is going too fast in its lowering of boundaries between distant locations. Another important frame for the popular understanding of disease threats is the intentional terrorist or hostile activity that aims to release dangerous disease agents into the West. The vulnerability of the West to such biological strikes was made tangible by the anthrax mailings in the US soon after 9/11. The threat is often associated with high-tech production of weapons grade disease agents. Similar technological dangers are seen in modern industrial food production, which is occasionally framed as a threat. This framing was important in the BSE scare of 1996 (see <xref ref-type="book-part" rid="chapter4">chapter 4</xref>, ‘Trajectory of a pandemic drama: ebbing and waning of the BSE Crisis in 1996’). That said, it is often the case that pandemic diseases are not signified by connecting them to the Western cosmopolitan landscape. They are rendered invisible there, whereas, in the more distant reaches of the globe, conventional signs of pre-modern ways of living are used to make diseases readable for the modern mind.</p>
<p><xref ref-type="page" id="page_155"></xref>Thus, the margins and peripheries can be thought of in the spatial (for example, outlying and distant) and temporal (for example, less developed or pre-modern) sense as offering ways of representing (re)emerging pandemic diseases. Various marginal and shadowy figures offer elements for the visualization of diseases as in the case of slums, prostitutes, terrorists, drug users, members of sexual minorities, and marginal cultures, all of which offer examples of the pertinent ways of framing diseases. On the one hand, the old traditional bonds can be represented as unraveling as in the case of loosening social structures and political allegiances. The situations are often associated with the notion of ‘failing’ or ‘failed,’ which are considered to be among the most salient signifiers of danger in the contemporary global setting. One the other hand, the landscape can be dangerously disturbed due to new emerging bonds, which create a dangerous ‘hybridity’ between modern and traditional civilizations. The resulting practice of landscaping – that is, tying people to their places – refers to representing or picturing something as part of a larger context. It conveys a sense of spatial distance between the subject and the object as in the case of actual landscape painting. The distance is laid out or pictured as a continuous whole. This landscaping refers to the active modification of the scene so as to de-emphasize some fleatures while embellishing others. Landscape painting is commonly defined as the depiction of a scene by the technical means of art. It contains a strong presence of conventions, norms, beliefs and practices. However, in the case of disease landscaping, the notion of causation and cure pervades the way in which the global landscape, composed of locations, is represented, ornamented and modified. The causation and cure are embellished, whereby other fleatures are concealed and ignored. Descriptions of inherently diseased peripheral landscapes, usually outside of the West, proceed by embellishing the diseasing factors, such as unsanitary conditions, dirt and wayward local customs. Thus, the emphasis is not only on picturing at a distance, but also action at a distance.</p>
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<sec id="sec6-3">
<title>The politics of disease speculation</title>
<p>Before turning to an analysis of the primary texts of the avian flu scare, it would be useful to bring to light an additional aspect of disease language – the pronounced presence of speculative language in the context of pandemic scares. The avian flu episode, in particular, was based largely on speculative worst case scenarios. The disease itself had been long-present in wild and domestic birds. The worst case scenarios proceeded by supposing that the disease could mutate and jump to humans. There were some cases in which this did happen. However, these cases did not show any evidence that the disease could spread from humans to humans. It was speculated that such mutation was going to happen in the future. Much of the other speculation concerning national and international preparedness was based on the presumption that the disease would mutate into a more dangerous form. The speculation concerning the preparedness of the various polities can be associated with the genre of political speculation. Various
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visions of decline and revival are largely speculative, yet when connected with a horrible pandemic they become strangely tangible and concrete.</p>
<p>The speculative speech has a long tradition in politics. It can be said to provide an alternative political epistemology of its own. The scientific revolution, which brought with it a critical attitude towards subjectivity and language, has made the issue more complex. The ability to engross people's thinking with speculative metaphors has been critically re-evaluated. It is often suggested that political language and deliberation ought to be guided by rational and intellectual criteria (<xref ref-type="bibr" rid="ref277">Wiser 1977</xref>: 427). Figurative language and especially metaphors have been criticized for their tendency to mislead and misinform. From this perspective, when reality is translated into the form of language, it takes on an increasingly mystical and mythological content, which should be avoided. In addition to the problem of distorting values and beliefs, irrational speculation leads to naming things that do not realistically exist. It is often argued that unconstrained speculation blurs the line between fantasy and reality. The basic logico-empirical argument seems to be that saying something is so-and-so does not necessarily make things so-and-so. Statements are perceived to be independent of empirical facts: ‘the statement, “The site of Atlantis has been sought by many,” neither entails nor presupposes that “the site of Atlantis exists.” Rather, it is logically independent of it’ (<xref ref-type="bibr" rid="ref279">Wolterstorff 1961</xref>: 348). However, the power of words and the speculative tradition of thought can make us believe that there is a connection between a statement and perceptions concerning empirical facts. How would one evaluate the factuality of, for example, the claim that Iraq had weapons of mass destruction (WMDs)? It can be seen as a false claim, for it did not refer to something that really existed. It can be maintained that the status of the claim was a mistaken one or a deceptive one. That said, this designation of status might ignore the position that the claims concerning WMDs had in the political world. They were true in the more pragmatic sense of allowing the US to conduct a war that was deemed useful or necessary for other reasons. One can claim that the speculative side of the recent pandemic scares could have had a similar function in political imageries and in political speech acts. They allow for doing things with words so as to make intentional political visions more tangible and persuasive. If these visions are considered worthy and important, the factuality is rendered of secondary importance. From this perspective, the pandemic speculations have an inherent use in the sense of allowing the creation of political imageries that can be seen as fundamental to political communities and for political communication.</p>
<p>Thus, the powerful, commonsensical strain of thought, which can be said to derive from the empirical epistemology fundamental for modern expertise, suggests that we cannot meaningfully speak about non-existent things. However, a curious and stubborn fact is that there exists a strong tradition in the Western political canon for making the very argument that the existence of something can be inferred if it can be properly named (<xref ref-type="bibr" rid="ref246">Springborg 1995</xref>: 356). Support for this tendency can be derived from many classical sources, as, for example, from the sophistic and rhetorical traditions. According to an early modern writer, Giordano Bruno, things do not have to objectively exist in order to be effective:
<disp-quote>
<p><xref ref-type="page" id="page_157"></xref>An apparent bond is enough, for the imagination of what is not true can truly bind, and by means of such imagination, that which can be bound can be truly bound; even if there were no hell, the thought and imagination of hell without a basis in truth would still really produce a true hell, for fantasy has its own type of truth.</p>
<attrib>(<xref ref-type="bibr" rid="ref032">Bruno 1998</xref>: 165)</attrib>
</disp-quote></p>
<p>According to Bruno's thinking, speculative fantasy as a mode of truth and envisioning provides another way of formulating reality besides basing it on the foundation of physically existing factuality. Clearly, besides the effects of the modern epistemological preferences of factuality, the fantastical modes of knowing have not perished from our times. For example, the evolutionism/creationism battle in American schools highlights the influence of non-scientific epistemology in today's world. Yet, the same epistemology can be found in much more mundane aspects of knowing and speaking.</p>
<p>When considering the status of things that lack factuality in the real world, their power should not be underestimated. Such things, if properly introduced, can lead to a strong sense of a referent object. In a related context, <xref ref-type="bibr" rid="ref266">Eric Voegelin (1997)</xref> regarded political concepts as ‘evocations’. His use of the term referred to the formative rather than descriptive nature of political concepts:
<disp-quote>
<p>Above all, the political idea is only to a limited extent descriptive of any reality; its primary function is not a cognitive, but a formative one. The political idea is not an instrument of description of a political unit, but an instrument of its creation.</p>
<attrib>(<xref ref-type="bibr" rid="ref266">Voegelin 1997</xref>: 226)</attrib>
</disp-quote></p>
<p>The power of concepts to work as evocations is relevant for the purpose of this book: political speech is not meant to refer to reality, but to create one. The relevance is further highlighted when the modality of the communal sacred is connected with the proper use of the evocative concepts – the methods of the sacred are used to create the desired political reality. The aspect of the communal experience should not be disregarded. The encompassing cultural elements assist in the creation of certainty even if it is in contradiction with scientific rationale or modern intellectual criteria. These speculative modes of meaningful existence and of knowing are extremely important politically, for they are involved in the construction of frames of the everyday experience.</p>
<p>The speculative genre enables acknowledgement of authority and legitimacy even when the intellectual substance of the performatives is weak. The recognition of something as meaningful and significant is often based on persuasion, rather than on intellectually convincing facts. This means that everything need not be argued for. Persuasion may be based on images, perceptions and senses. It is based on certain shared beliefs that unite the members of a political community. Often, the persuasive element contains a fair amount of mystery and myth. Because of this, it is resistant to efforts of rigorous intellectual scrutiny.
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This is why believable statements based on speculative resources may be made without much need to defend them. For example, there is no need to elaborate on the statement, seen in many Western newspapers, that Saddam Hussein was ‘like a rat in a hole’ when captured by the American forces. In the same way, when Saddam Hussein stated before an Iraqi audience that the American president was a ‘snake,’ no further arguments were needed, although the statement sounded ridiculous in Western interpretations. Both these statements were understood by their respective audiences because they reaffirmed the sense of community and the community's commitment to shared values, and because questioning them would have questioned one's membership in that community and one's commitment to those values.</p>
<p>According to Rousseau, it is more important for a legislator to persuade people of the existence of a shared communal element than to convince them through rational argument. For Rousseau, the central characteristic of an effective legislator was, therefore, first, to be able to see what the specific conditions for the existence of a political community were and, second, to gain the consent of its people to proceed according to those conditions through skilful persuasion (<xref ref-type="bibr" rid="ref148">Kelly 1987</xref>: 322). Thus, the most important thing was to be able to communicate to people the understanding and principles one wished them to adopt. <xref ref-type="bibr" rid="ref228">Rousseau (1979</xref>: 67) argues that preference should be given to making people understand how things should be, rather than how they are. The problem with intellectual convincing language is that it is not available to the multitude, or, even when available, it is not very effective (<xref ref-type="bibr" rid="ref148">Kelly 1987</xref>: 324). This is why the legislator has to use other means of communication to persuade the public. Instead of bringing the whole of his message forward for judgment, he must present himself as a worthy judge. By assuming this role, the legislator can convey legitimacy and obtain the desired acceptance from the community (<xref ref-type="bibr" rid="ref148">Kelly 1987</xref>: 324). However, Rousseau points out that this persuasion must be based on the presuppositions shared by the community and not on forceful indoctrination. <xref ref-type="bibr" rid="ref148">Kelly (1987</xref>: 324), quoting Rousseau's <italic>Emile</italic> on education, writes that the legislator ‘must necessarily have recourse to another order of authority, which can win over without violence and persuade without convincing’. What, then, are the means of persuasion sans convincing? Kelly continues, ‘People must already be open to some form of persuasion’ (<xref ref-type="bibr" rid="ref148">Kelly 1987</xref>: 326). Thus, the real persuasive element already exists within the community. So, persuasion is possible through invocations of the shared underlying element that constitutes the community in one form or the other. The art of the legislator is the art of repeating this element to gain authority and admiration. Messages that simultaneously reaffirm the underlying sense of commonness and consist of a self-contained way of picturing them may lead to unquestioned acceptance of certain desired forms of political behavior.</p>
<p>Thus, rather than relying on facts, narratives of communal speculation try to teach the way of interpreting and to give a sense of belonging and sharedness to a community that is familiar with such speculative narratives. In other words, speculation can offer a way of looking at things that highlights the role of
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unquestioned authority. They draw from reificated knowledge resources to make the narrative persuasive. Such speculative language contains elements that instruct the community on how to picture the speculation. <xref ref-type="bibr" rid="ref067">Diamond (1991</xref>: 226) gives a religious example of this type of communication:
<disp-quote>
<p>Someone may have a picture of the Baptism of Jesus, which shows, besides one man pouring water on the head of another, a dove above their heads, and above that the head of an old man; perhaps there are some people with wings on the sides. For the man who has the picture, it is ‘how he pictures the Baptism of Jesus.’</p>
</disp-quote></p>
<p>It is important to note that the function of such narratives in politics is not so much to convince, but to reaffirm the constitutive communal element. They contain not only powerful signifiers, but also a way of interpreting – or picturing – them. This way of passing on visions works because the inherent inconsistencies go unnoticed or, if they are apparent, are tolerated. The sense of communal experience overrides any need for empirical verifiability. In many ways, the speculation concerning avian flu provides a case in point about the overall reasons for using speculative language. It may be argued that factuality was of secondary importance for the developing of the worst case scenarios during the avian flu scare. The primary function was to envision a more resilient global community that could secure itself and reform itself according to the notion of ‘preparedness.’<xref ref-type="fn" rid="fn6_2"><sup>2</sup></xref></p>
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<sec id="sec6-4">
<title>Avian Flu's landscapes in the <italic>New York Times</italic>, 1983–2005</title>
<p>During the first six months of 2006, avian flu enabled several politically effective uses of the containment drama. This political play was connected with the inter-relational potentials inherent in the different imaginary interfaces that border and separate political entities from one another. This chapter starts with the hypothesis that avian flu – as were many preceding pandemic scares – was used to reproduce existing power hierarchies. This re-staging was based on turning its pattern of spread into political high drama. My aim is to examine the ways in which avian flu was commoditized in public discourse. I will exemplify the avian flu containment dramas with the help of the <italic>New York Times</italic>' (<italic>NYT</italic>'s) news articles because they illustrate contemporary America's disease language. I will contrast the US discursive dynamics with the disease language of a smaller country, Finland, using news articles of the Finnish newspaper, <italic>Helsingin Sanomat</italic>. The idea behind choosing these two newspapers is to compare and contrast them in order to see if common containment drama trajectories exist between the two. The idea is also to examine the spread and diffusion of the Western disease language. The central guiding questions of the analysis are: what are the means by which avian flu was put in rhythm with existing political categories? Does the newspaper discourse correspond to the general pandemic scare trajectory and sequence examined in <xref ref-type="book-part" rid="chapter4">chapter 4</xref>? These guiding questions
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are meant to shed further light on this more specific research task: what and whose political purposes did avian flu serve and what stereotypical constructions were used to Americanize and ‘Finnonize’ the avian flu narrative? Answers to these questions are sought in the narrative bridges formed between avian flu and central communal identity markers.</p>
<p>In the context of avian flu, the was a lot of discussion, for example, on people's relationship with nature, on the issue of industrial food production, on the changing world, on Asian and African cultures, on Nordic efficiency, and on Finnish ‘purity.’ Of particular interest was the discussion concerning the worst case scenario: what would happen if something utterly devastating were to happen in the US or in Finland? The imageries of how society would function in such a situation relates directly with the perceived essential qualities of the respective political communities. The speculative qualities of the situation were further fed by the fact that only the birds fell sick. The pandemic outbreak itself – human to human communicable avian influenza – was not factual.</p>
<p>In the study of pandemic scares and their political function it is easy to note when various pandemic diseases have been used to articulate popular perceptions concerning the world. When domestic Western audiences have followed the spread of diseases, it is customary to attach other than medical perceptions to the underlying message. For example, the Parisian newspapers followed first with keen curiosity when the cholera epidemic started in 1830. Its beginnings in India were used to highlight the big differences between the living conditions in India and France. France's healthy living style was attributed to its civilization. When the disease spread to Turkey, similar politically motivated cultural statements were made. However, as the disease spread further to Europe, the sense of curiosity changed to more worried explanations. It seemed that the European civilization was not immune to the disease. However, it was claimed that France was exceptional in its public health measures and it would be saved from the disease. In the end, France and even Paris were not saved. This example reveals how diseases can be used to reinforce people's perceptions concerning the various hierarchical understandings of the world. Diseases tease people's interest. They understand the stakes involved. It is probably because of the tangibility of lethal epidemic diseases that they are so useful in narrating stories of difference and political health.</p>
<p>In the media, a dangerous epidemic disease or its tangible threat often reveals itself as an omen of a dangerous future. It is framed as a sign of its times when prognostication of the future seems to bear ominous content. The manifest message seems to be an outcry for attention and for gearing up preparations. Diseases are turned into calls for action that put pressure on policy makers to respond. In this way, diseases do not strike populations, as the medical–scientific perspective claims. Their scares strike political communities, which have a strong preordained sense of what should be done. These stem from past memories concerning violent pandemic diseases and with the popular imageries of past encounters. This politico-historical background provides the main ingredients for the media's construction of its pandemic framings. The containment drama gives
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the central dramaturgy for a suspenseful message. The disease gets its meaning in the exchange between the key societal actors concerning the main meanings at stake: what is the central plot? Who are the pivotal actors? What are the historical precedents? What has been learnt? What issues interact often with a disease scare? What momentary parallels can be drawn? In answering these questions, the disease starts to portray something tangible concerning the construction of communal sentiments as well as the main hostile or antagonist elements. Although the dramatic portrayals of emerging diseases tend to stress the striking novelty and acuteness, much is still dependent on the speculative construction of a worst case scenario that inevitably draws from the existing communal memories and stereotypes. In this way, disease scares tend to reflect and embody the existing communal and inter-communal power hierarchies, yet, at the same time, make poignant the dangers involved in any drastic changes and power failures (<xref ref-type="bibr" rid="ref110">Gwyn 1999</xref>; <xref ref-type="bibr" rid="ref163">Larson <italic>et al.</italic> 2005</xref>; <xref ref-type="bibr" rid="ref198">Nerlich 2007</xref>).</p>
<p>Now I will review <italic>NYT</italic>'s news stories on avian flu from 1983 to 2005. The first stories appeared before the pandemic scare that brought the disease into very intense focus. The idea is that these stories will shed light on how the disease developed into the cultural construct that it is today. The first avian flu news story was printed on December 13, 1983. It was a short piece that briefly overviewed the containment and quarantine policies that were thought would stop the spread of the ‘deadly’ disease of birds in Pennsylvania and New Jersey. The spread of avian flu to domestic and wild birds was actively followed during the winter of 1983–84. In a story published on February 26, 1984, the disease was claimed to have killed some 75 percent of the chickens and left the rest of the birds unprofitable. It was pointed out that the disease was considered so virulent that when it is noticed all the birds in the flock are culled and buried to stop its spread.</p>
<p>There is a notable difference here from the modern avian flu narrative. No one seems worried about the disease crossing the inter-species boundary to humans. A human variant of avian flu is not an issue at all. The disease is seen solely as an economic and food production related issue. The main disease control measure is the mass culling and destroying of hens and chickens. Because there is no speculation concerning the human variant, there is no flear of consumer panic in <italic>NYT</italic>'s stories. The consumers did not have any anxieties over the food produced in the beginning of the 1980s. The contemporary conceptual bridges between food production and illnesses had not yet been formed. These conceptual bridges started to develop during the late 1980s. The first such discursive innovation was the worry over the mutability of the flu in birds. The first news story in <italic>NYT</italic> that highlighted such mutability as a worrying aspect was published on February 23, 1986. In the story, there was a description of the new phase of the disease in the state of Connecticut. The story pointed out how the disease had mutated into a form that could kill about 10 percent of the flock in a single day. The story said that this was in stark contrast with the earlier variant, which was not as deadly. In this way, awareness about the disease's ability to mutate started to gain attention. Avian flu was re-framed as a disease that had
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mutated into a more dangerous form and might continue to do so in the future. The last news concerning the disease for ten years was published on August 16, 1987. The story on that day overviewed the disease's mutability and its pattern of spread on the eastern coast of the US from 1983 to 1984, during which period, millions of birds were ‘destroyed’.</p>
<p>The next news story about avian flu is dated December 21, 1997. It is an interview with two specialists on the issue, Kennedy F. Shortridge, a microbiologist at the University of Hong Kong, and Dr Daniel Lavanchy, the head of the World Health Organization's influenza programme. This story managed to capture many new conceptual bridges and innovations on avian flu. It is worth reviewing it at length. The domestic focus had changed here into an international one. The headline emphasized that China was seen as the centre point of the disease as it spread. The news story started with the following graphic statement: ‘[a] violent-yellow sign stencilled with interlocking black rings and a single word hangs over Kennedy F. Shortridge's laboratory. That word is “Biohazard”.’ The story thus made it clear from the start that it dealt with something that was potentially devastating. The hyperbole present in this story portrayed a very changed affective climate as compared to the earlier news stories.</p>
<p>Several conceptual innovations had taken place. It is immediately clear that the disease had been reframed as a potential biohazard, a word that echoed the then recent experiences with Ebola in Zaire during the spring of 1995. Ebola was connected with the eating of badly cooked monkey meat. The Ebola scare highlighted the vulnerability of the global community to fast spreading contagion via the international transportation infrastructure. The word, ‘pandemic,’ had also emerged into global awareness by the late 1990s. It had started to be a marker of great anxiety and worry. Another important template for the changed understanding of avian flu was the experience with another potential food borne scare, BSE or Mad Cow Disease. BSE changed the way in which animal-borne diseases were understood. Its form brought into awareness new conceptual bridges and innovations. BSE was connected with economic disturbances and market reactions; it was mystified into a complex fed by rumours, lack of information, and by the presence of a novel disease agent, a prion; it was turned into a myriad of new administrative practices such as obligatory marking of the origin of bovine products. It conveyed a tangible sense of anxiety over the dangers inherent in modern industrial food production; it was politicized and localized when many cautionary measures were directed against the UK. The continued reframing of avian flu combined with the other disease discourses that were prominent during the mid to late 1990s.</p>
<p>Thus, the way in which <italic>NYT</italic> framed avian flu was deeply entangled with the politico-medical landscape of the late 1990s. Another new element in the stories was the foresight aspect of the containment drama, which was connected with the mutability element. Although the disease had not yet become a significant threat, according to the story, it could turn into a lethal epidemic disease in the future. Because of the prognostications, the ‘seeds’ of a future pandemic needed to be handled carefully. It was because of this that the story emphasized the
<xref ref-type="page" id="page_163"></xref>
utmost diligence in the handling of the disease. The bio-containment facilities were in themselves further markers of danger in the pandemic discourse. The great concern felt over the handling of the disease in the story reinforced military metaphors that have now become a norm in pandemic spectacles. The containment had to be done by the most modern weapons in the arsenal of the global health community. These bio-containment, protective gear, and disease warrior tropes were widespread in the epochal works of popular culture. Pandemic movies such as <italic>The Outbreak</italic> brought to people's attention certain ways of talking about a pandemic disease. Popular works in nonfiction, such as Laurie Garrett's extremely influential work, <italic>The Coming Plague: Newly Emerging Diseases in a World out of Balance</italic> (1994), further induced worries and curiosity. These works also reinforced certain expectations, which had to be taken into account by <italic>NYT</italic> and also by the global public health community. Pandemic diseases interested people and brought into prominence new fields of authority and expertise. Against the background discourse, the <italic>NYT</italic> story acknowledged the great potential danger of avian flu. At the same time, the story asserted that the world had high technological readiness for fighting such pandemics.</p>
<p>However, the focus on China reiterated that there were some weak spots in the preparedness to fight disease, and these spots on the globe could turn into disease hotspots. The use of the words, ‘a violent yellow sign,’ was purposefully polysemous enough to allow for the connection with the US' discourse of the ‘yellow danger’. China was turned into a new danger because of its teeming cities and different ideological system, and its veil of secrecy could be seen as being conducive for the emergence of pandemic threats. The story claimed that the disease jumped from animals to humans for the first time in China. Because China provided the context conducive for the jump dynamics, the story implicitly assumed that China could provide the location for future such jumps, too. The story explained its reasoning through references to the ancient agricultural practices in China. The combination of pre-modern and modern practices prevalent there seemed to make China the ideal ‘incubator’ for avian flu: ‘the emergence of a new influenza virus, while not necessarily this particular one, seemed inevitable, given both ancient agricultural practices in China and the current system of farming in Guangdong province, the source of much of Hong Kong's food.’ While China as a whole was seen as the main reservoir of the disease, southern China was described as the influence hub: ‘ “China is the principal reservoir for influenza,” [Mr Shortridge] said, “and southern China is the influenza epicenter.” ’ The sense that China contained hybridity and dangerous transgression was associated in the story with the mix of pre-modernity with modernity. China was admittedly a modern economic juggernaut; however, within China, there were dangerous pre-modern practices that were now seen as being too intimately connected with the rest of the globe. The story went on to explain how the mixing of practices and humans with animals in China was a cause for worry: ‘[a]nd because in most southern Chinese villages, ducks and chickens and pigs and people all live in very close contact, often with the animals next to or even in houses, influenza viruses moved into pigs and then to humans.’
<xref ref-type="page" id="page_164"></xref>
The interview story was very confident in its ability to locate avian flu in China, although many aspects of the disease remained mysterious. Through the act of localization, China itself was turned into a hostile element. It is possible to link this sense of enmity with the high political tensions between China and the West, which were present in the pre-9/11, late 1990s. This hostility resonated with much older orientalist images of China, which conceived of it as a mysterious place and gave room for corresponding politico-medical speculation.</p>
<p>Much of the speculation was connected with various scenarios of the future. According to the story, the nature of avian flu – its mutability and its ability to jump the species barrier – were widely understood. This wide agreement led, according to the story, to the inevitable question concerning the possibility that the new mutations could lead to a worldwide pandemic that submerged the whole world. Besides the hyperbole, there was a brief sceptical note: ‘Dr Lavanchy [the head of the WHO's influenza programme] told reporters that he expected that, with better surveillance, the number of known cases would rise. But he added, “I can personally assure you there is no cause to panic.” ’ The story referred to a more anticlimactic possibility that the very perception of the danger could derive in the main from the vastly better disease surveillance methods: ‘[Mr Shortridge states that] for all we know it might go to humans and completely fade away.’ So, it could be that there was nothing that new in avian flu. However, this possibility is largely bypassed and discounted by the hyperbolic possibility of a pandemic avian flu. It could be that such a possibility of uneventfulness was just too uninteresting for a time that embodied its anxieties in spectacular diseases.</p>
<p>The next stories were published in 2003; there were several news stories dealing with diseases in the SARS context. These stories differed in their affective climate from the stories of 1997. They did not speculate as much as they refocused on the domestic context of avian flu. It seems that the domestic disease was not as interesting as the disease in China. For one, the US was not turned into the locale of a pandemic. In this respect, the US was treated in a notably different manner from China. The non-speculative stories treated the disease as an ordinary animal disease. The central position was given to the economic repercussions, which included consumer reactions and large-scale culling programmes. It seems that the greater geographical, cultural and political distance enabled ‘wilder’ interpretations and prognostications than a disease in an intimately close domestic context. A disease that caused a global pandemic was much easier to connect with a distant location such as China than with the US. It could be that the elliptic treatment of avian flu in the US was partially caused by the saturation of the collective psyche with SARS stories. Pandemic scares seem to allow for public focus in only one place at a time. The SARS stories also focussed much attention on China. Because of the association of SARS with China, the spread of avian flu in the US was not considered that eventful. The real worry was China and not the US.</p>
<p>During the first part of 2004, <italic>NYT</italic>'s focus changed from China to the reporting of diseases in other countries. There were news stories on the occurrence of
<xref ref-type="page" id="page_165"></xref>
avian flu in East Asia and in Northeast Asia. The role of China was pushed to the background and it was referred to in passing when the discussion turned to the perceived origin of the disease. Moreover, these stories brought out a new theme in which the spread of the disease in wild birds provided the main eye catching element. On January 27, 2004, <italic>NYT</italic> published a story on how the pattern of spread was closely connected with migratory birds:
<disp-quote>
<p>Tucked among broad-leafed banana groves and emerald rice paddies in west-central Thailand, the bird sanctuary here is one of the few jungle oases where migratory ducks, storks and other wildflowl can spend their winters in safety. They come from as far as India and Siberia.</p>
</disp-quote></p>
<p>This connection created new alarm and worry that went beyond farming and culling. Now wild birds became the target of the containment drama. The movement of the diseased birds around the world was tracked continuously. Cases were reported around Asia and increasingly close to the West. This conceptual development heightened the sense of scare exponentially.</p>
<p>Another notable fleature of these news stories was the focus on efforts by public health authorities to defleat the potential pandemic. In the beginning of 2004, <italic>NYT</italic> focussed on the efforts of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), together with the pharmaceutical industry, to develop new drugs and vaccines. For example, on February 5, 2004, the paper reported on the progress of the development of a vaccine for avian flu. At the same time, the news story stated that the disease was not likely to spread in the US because the farms there were being monitored carefully and because important bans had been implemented. The fuss about avian flu died down early in the summer of 2004, although many stories warned that the nation should be prepared for a re-emergence of the disease. During the fall of 2004, the stories focussed on preparing for another outbreak. International measures and cooperation were reviewed in the context of vaccine development. On September 12, 2004, <italic>NYT</italic> carried the following headline: ‘A War and a Mystery: Confronting Avian Flu.’ Attention was directed to the occasional bits of news on the various outbreaks of avian flu in Asia. Speculation concerning other possible disease vectors also drew some attention. For example, on September 3, 2004, <italic>NYT</italic> carried a new worrying headline: ‘Study Finds Bird-Flu Virus can Spread among Cats.’ During the following year, <italic>NYT</italic> concentrated on worries over lagging efforts to fight the disease, as in the headline of September 9, 2005: ‘The Frontlines in the Battle against Avian Flu are Running Short of Money.’ At the same time, there was a lot of focus on medical advances against avian flu. On April 5, 2004, the newspaper reported on a new drug, Tamiflu: ‘Should We All be Stocking Tamiflu?’ At this point, it seems that there were concrete policies that could be taken up to raise the national preparedness. The US government's efforts to stock Tamiflu and other medications were reported. The stories highlighted the opportunities opening up in the fight against the potential disease. At the same time, the news stories pointed out the inequalities in the global public
<xref ref-type="page" id="page_166"></xref>
health efforts; some governments were seen as not doing enough, while some were seen as too mismanaged and poor. These deficiencies in the global effort were seen as risking a failure in the fight against avian flu. During the winter, the next phase in the avian flu construct started when the pandemic scare took over from the baseline reporting.</p>
<p>The pandemic flears are projected into existing border imagery. The containment drama inherent in the pandemic scares reinforces these imagined borders. The perceived global differences were complex, yet they were reinforced in the avian flu scare. The <italic>NYT</italic> articles drew attention to, first, the separation between the domestic and the international. Second, the West as a certain identifiable way of life was seen as an extension of the US domestic sphere; it was not Western Europe that was of concern in the news stories. Third, China was made to represent a bounded entity the difference of which was distinct. The existing patterns of political enmity fed the rendering of Asia and China as a hotbed of global fevers. Fourth, the more temporal boundary between the modern world and the pre-modern one was highlighted in the way China was construed as the possible disease hotspot. Finally, a boundary was drawn between nature and humanity. This boundary was seen as dangerously threatened by Chinese habits, whereby people and animals lived in close proximity. This interspecies boundary was signified by the danger of virulent mutability. All of these boundaries were framed as being transgressed by the emerging avian flu pandemic. From this perspective, it seems that the curing activity was made tantamount to border restoring activity. Those agencies that were able to maintain national and global public health were also at the same time authorities that could re-establish viable boundaries and the bounded nature of legitimate political communities. National preparedness plans were among such border maintaining and transgression eliminating activities.</p>
</sec>
<sec id="sec6-5">
<title>Avian Flu landscapes in <italic>Helsingin Sanomat</italic>, 2006</title>
<p>I will now turn to Finland's most widely read daily, <italic>Helsingin Sanomat</italic>, and its news stories on avian flu during the height of the 2006 scare. This analysis is meant to examine the geographical spread of the narrative dynamics expressed in <italic>NYT's</italic> pandemic speak. The Finnish example also indicates how pandemic scares can become templates for the creation of legitimate national political power.</p>
<p>As in the US, the pattern of avian flu's spread was a matter of intense concern in Finland during 2005–06. The spread of the disease in migratory birds was seen as a highly dramatic and scary prospect because it linked Finland's millions of wild birds with the fleared disease of distant lands. The disease was followed almost daily in <italic>Helsingin Sanomat</italic>. Related aspects such as national preparedness were a focus of lengthy fleatures and editorials. An important turning point was the February 17, 2007 editorial, which stated that ‘since the bird flu dangerous to humans has already reached the shores of the Baltic Sea, it is only a matter of time before it reaches Finland.’<xref ref-type="fn" rid="fn6_3"><sup>3</sup></xref> Besides following the pattern of the
<xref ref-type="page" id="page_167"></xref>
disease's spread, there was also much focus on speculation and on presenting the worst case scenarios. The editorial of January 15, 2006 was headlined, ‘There has to be Thorough Preparation for the Coming of the Worldwide Epidemic.’ This editorial pressed the need to prepare for a scenario in which ‘almost two million citizens were infected and 10,000 could even die.’ The newspaper said there was an acute need for a ‘plan concerning what groups would get vaccines and drugs in case there were not enough for everybody’. The preparations, according to the newspaper, should be based on the pessimistic scenario that there would not be enough medicines for the whole Finnish population. <italic>Helsingin Sanomat</italic> speculated that the disease was not only going to mutate into a human to human form, but it was also going to strike populations in a situation where there was a scarcity of vaccines and drugs. In hindsight, it seems that this starting point was intentionally gloomy, enabling dramatic and suspenseful speculation concerning choices that have to be made between different population groups. The newspaper stressed that the processes should be as ‘transparent’ as possible and that there should be an open debate on the merits of the inevitable unequal alternative in a crisis situation.</p>
<p>The January 15, 2006 editorial also discussed the worldwide unequal distribution of the disease burden: ‘Finland, among other wealthy nations, has bought its reserved seating ticket in the vaccine queue and has started its preparations for a pandemic.’ Despite the earlier gloomy speculation about worst case scenarios, the editorial continued to point out Finland's advantageous situation:
<disp-quote>
<p>The Finns are with the rest of the Western European citizens and North America's wealthy population in the best possible situation when the pandemic strikes. We take care of our poorest people and the aim is to vaccinate the whole population in a couple of weeks.</p>
</disp-quote></p>
<p>It is possible to argue that the newspaper was locating ‘health’ in the world. It described not only the pattern of pandemic spread, but also pointed out how health and immunity are unevenly spread in the world. The Finns are seen as being in a highly advantageous position. Besides locating Finland within healthy nations, <italic>Helsingin Sanomat</italic> locates the possible source of the illness: ‘[w]hen the pandemic's causative virus starts its spread from some developing nation, it depends on the preparedness and aid of the industrialized world how efficiently the spread can be stopped or at least hindered.’ The newspaper's worldwide disease scenario is founded on a disease that starts from a developing nation and about which the rich countries can do something. The wealthy countries are identified as belonging to the West as a cultural sphere – Western Europe and North America. It is notable that the newspaper does not include Asia's wealthy nations in this definition. If read closely, the newspaper reiterates in its disease speculation a very familiar story about the West and Finland being seen as wealthy, healthy and immune.</p>
<p>A news story published on February 13, 2006 carried the headline, ‘Vaccine Allocated to All Finns.’ The story went on to explain that Finland had a plan if
<xref ref-type="page" id="page_168"></xref>
the pandemic really did strike. Curiously enough, the story went on to speculate about a situation in which there would not be enough vaccines for everybody:
<disp-quote>
<p>The general principle is that everybody will get a vaccine. Plans have however been made in Finland for a situation where there is not enough vaccines for one reason or another. The very first people who would be vaccinated are the medicare staff. After that, the order would be based on how many living years the vaccination could probably save. This depends on the age of the person, and also on the severity of the epidemic.</p>
</disp-quote></p>
<p>The story went on to detail in a highly precise way how and in what order different people would be vaccinated. The reader was left with the impression that the story was really about the authorities having an exact plan of action against the pandemic. The Finnish authorities were prepared for pandemics of different kinds and knew what to do in any situation. The main message was one of precision and meticulous preparedness; it was one of discipline and order. The story concluded with a speculative disease scenario:
<disp-quote>
<p>One can cut the infection risk by forbidding, for example, public events and by closing schools and day care centres. This can be done even before the start of the real epidemic…. The pandemic would probably cause changes to social ways – for example, shaking hands or sneezing into one's hand would no longer be reasonable…. If the pandemic were to be really wide, it would affect society in many ways. The authorities have devised plans whereby the most vital functions of society would be secured even in a crisis situation. These include, for example, energy supply, food supply, and transportation and data communication connections.</p>
</disp-quote></p>
<p>It would seem that the story put a lot of trust in the contingency plans devised by the authorities. Society's ways would be altered, yet the vital functions would be maintained. The Finnish state would be able to systematically protect itself against a deadly disease.</p>
<p>The next editorial of <italic>Helsingin Sanomat</italic> on avian flu was published on January 19, 2006. It dealt with the international meeting in Beijing on the need to help the developing world cope with avian flu. The newspaper put forward what it stated was ‘an extreme worst case scenario’, which was based on the emergence of human to human transmissible avian flu. The editorial highlighted the concern expressed by the Food and Agriculture Organization's (FAO's) representative at the meeting that the disease would spread from Turkey to Africa: ‘What if the disease spread south from Turkey to Africa?’ In this connection, the editorial put forth a more detailed scenario of how the disease might mutate into a deadly pandemic: ‘[t]he situation would become even more catastrophic if the disease were to mutate into human-to-human form in Africa. In that continent, there are not enough doctors, laboratories or hospitals even now to take care of sick people.’ It might not be surprising that the newspaper's extreme worst case
<xref ref-type="page" id="page_169"></xref>
scenario was focused on Africa becoming the hotspot of the pandemic. As already pointed out, the reactions to pandemics usually localize the disease somewhere. <italic>Helsingin Somat</italic> perceived that the disease, the origin of which was located in Asia, was going to take hold in Africa. This geo-medical imagery is based on the idea that Europe was somehow in a safer position. It might be argued that the foundations of this horror scenario are based on stereotypes concerning different continents and their cultures. The turn for the worse is projected to take place in Africa. Finland is isolated from this diseasing dynamic: ‘[t]he probability of Finns getting avian flu is minimal even if birds that have died of the disease are found in Finland.’ The editorial associated the Finnish ‘immunity’ with their cultural habits concerning domestic animals. The newspaper's editorial of March 12, 2006 explicated some of these healthy habits:
<disp-quote>
<p>It is of course sad that birds are dying of the disease; however, it does not cause a big danger for people. The Finns have not been carrying dead bird carcasses in their bare hands or fingered their faeces or eaten blackberries contaminated by fresh bird droppings.</p>
</disp-quote></p>
<p>The Finns' clean cultural predisposition is contrasted with the less clean habits perceived to prevail in Asia and Africa.</p>
<p>Western historical narratives of disease origins tend to associate dangerous diseases with tropical concepts and especially with Sub-Saharan Africa. This tendency seems to be present in <italic>Helsingin Sanomat</italic>'s speculative perceptions concerning avian flu. The basic scenario expressed by the newspaper reinforces common presuppositions and, thereby, the scenarios become more believable and sound more right. The disease is made more understandable and tangible by localizing it geographically. Through such disease narratives, the prevailing stereotypes concerning Asia, Africa, the West and Finland are reinvigorated as they are seen as pertinent to our times.</p>
<p>Among the most conspicuous tropes used by the newspaper is preparedness. Preparedness comes up as the basic rationale for the prolifc speculation concerning what might happen in a pandemic context. These preparedness speculations are revealing for they make a distinction between different local communities' abilities to cope with the disease. On March 2, 2006, <italic>Helsingin Sanomat</italic> detailed how the Finnish capital area of Helsinki was preparing for the disease in a different manner from the more rural agricultural communities. The news story was based on the assumption that it was only a matter of time before the disease would spread to Finland. The story said that ‘in Finland, the authorities are prepared for the discovery of dead birds’. The story detailed how containment and surveillance zones had been set up. If dead birds were found – not very uncommon in Finland at any time – the first person to be called was the municipal veterinarian. It would seem that the marching order was being portrayed as having been carefully calculated: after the veterinarian, the emergency services would arrive to remove the carcasses. Third, the police would be called in to cordon off the area and set up warning signs. The story explained that laws
<xref ref-type="page" id="page_170"></xref>
and regulations to enable an ‘efficient’ disease control mechanism had been implemented. The visualized actions were set out as clear, down to earth, rational and carefully planned.</p>
<p>On the same day, the newspaper published a news story on the further spread of the disease in wild migratory birds. It stated that close by, south of Stockholm, dozens of infected birds had been found. The suspense was growing by this time because the disease was getting closer to Finland. This find was made even more worrying by the use of the term ‘aggressive’ in connection with the disease. The story stressed all the strong measures that Sweden had implemented in response to the disease. Sweden was seen as preparing itself for the pandemic eventuality. The army had been called in to help, the various municipalities were practising pandemic drills, surveillance and warning methods had been geared up, and the crisis level had been raised. A local person was interviewed. He claimed: ‘[w]e eat chicken here even now. In Italy and France, they speak about eating better food than in Finland. Now they can think again. The Nordic countries can manage crises like this in a better way.’ Besides highlighting the Nordic preparedness, the story examined what it called ‘rational’ reactions by the Swedes. The consumers had altered their eating habits and the people were calm. The story quotes a local Swede, who says, ‘I eat chicken, but only Swedish chicken. It is safe.’ The sense of safety and security is connected with the Nordic cultural context. The overall impression is that the ‘aggressive’ variant of the disease cannot gain a foothold in Sweden because of the Nordic way of life as defined by rationality, a systemic approach and efficiency.</p>
<p>In this way, the avian flu is given a geopolitical character. This means that the disease and immunity are localized. The spread turns into a familiar political narrative. One notable element in <italic>Helsingin Sanomat's</italic> stories is that the spread from the east through Russia did not receive much attention. However, on the same day, March 2, 2006, the newspaper published an interview with two experts. One of them, Professor Liisa Sihvonen, said she fleared that the disease might come closer to ‘us’ sooner than people thought. She said the main reason for this had more to do with human practices than with the migration of birds: ‘[t]he disease is spread when carrier poultry and contaminated meat are transported from one area to another by legal and illegal means.’ The story went on to point out how in the Black Sea region, fish farming facilities spread the disease because the feed used for the fish was from poultry farms. The fish, in turn, spread the disease to the birds. Prof. Sihvonen said that there were underlying cultural reasons for the spread and for the difficulties in enforcing workable sanitary rules: ‘[f]or example, in Africa and Asia, birds have been always allowed to walk unhindered in backyards.’ The story does not say that such ‘lax’ hygiene practices are also common to many European states. The story seems to claim that the disease spreads because of negligence and criminal conduct and because of difficult to change pre-modern cultural habits.</p>
<p>The scare subsided by mid-March. <italic>Helsingin Sanomat</italic> declared the crisis to be over in its editorial of March 12, 2006. The editorial was titled, ‘Avian Flu Already a Mental Sanity Problem’. The earlier speculations and presentations of
<xref ref-type="page" id="page_171"></xref>
extreme horror scenarios were now seen as resulting in mental health problems: ‘Avian flu has developed into a health danger even in Finland – a danger for mental health.’ The paper's criticism was directed at irrational manifestations of people's flears: ‘[d]ucks are being chased away from the holes that are cut in the ice for winter swimming enthusiasts’; ‘People tried to remove a poor goose to another lake and it paid with its life.’ This sudden concern over animal ethics was surprising considering the worldwide culling of birds. A better way of understanding the newspaper's message was that it was trying to negatively assess the hysteria that had reached Finland. This hysteria and alarm had cause irrational reactions in a previously sane Finland. The editorial can be seen as emphasizing that the Finns should remain calm and rational. In this new situation, the newspaper had lost its appetite for speculation. The editorial expressed its remorse over the changing situation: ‘[t]he main responsibility over the hysteria lies with the media because the big headlines and sales posters have instigated unnecessary flear. It is not unnecessary to prepare for the avian flu, yet there is no reason for hysteria.’</p>
<p>An additional interpretation for this change of heart is related to the overall typical trajectory of a pandemic scare. Because pandemic threats are at the end difficult to make tangible, they can be easily mystified, localized and politicized into readily marketable ‘products’ that tell stories about we-communal purity, rationality, efficiency and preparedness. As the situation often changes for the better when more facts are known, the scare loses its vigour. Through reiteration and repetition, the ability of diseases to cause flear and worry subsides. The editorial tellingly noted: ‘[i]n Finland, there are notably more real health problems than the danger posed by avian flu. Tens of thousands of people die of preventable lifestyle illnesses. These are probably too close for them to cause flear and scare-mongering.’</p>
</sec>
<sec id="sec6-6">
<title>Why the scare?</title>
<p>To summarize the way in which the <italic>Helsingin Sanomat</italic> publicized the avian flu episode in the spring of 2006, it can be hypothesized that the newspaper tried to understand the disease based on common stock transnational and national disease language. The disease offered a locus for the re-staging of the national sentiments of communality. A lot of attention was focused on speculative dramas of communal preparedness. These speculative models conveyed a strong sense of the communal identity of a well functioning Nordic state. The genre of these news stories and editorials was common to disease-related containment dramas. It was related to science fiction horror stories. As such, the newspaper did not publish any facts. Rather, it ended up producing facts in the context of echoing a typical nationalistic narrative. The newspaper participated in national connective rituals, which turned national sentiments into tangible politico-somatic experiences. The same pattern was used by <italic>NYT</italic> in its ‘early’ texts on avian flu. As the conceptual bridge for pandemic drama in the 1990s, the disease was useful in narrating geospatial political relationships. This manner of sustaining the
<xref ref-type="page" id="page_172"></xref>
national imagined community syncs with any emerging pandemic scare to ft the overall political purpose. In a way, the political narrative gets an overall medical form that is seemingly apolitical. When politics is medicalized in this way, the underlying political messages become easier to tell and are more readily acknowledged by the reader. However, such types of fusion between political and public health inevitably interfere with public health efforts. They become sporadic and impulsive, guided first by the whimsies of hyperbole, and second, by collapsing interest when attention shifts to other issues.</p>
<p>The ways of representing the invisible threat with stereotypical visual markers can lead to paradoxical situations. In <xref ref-type="book-part" rid="chapter4">chapter 4</xref> I reviewed how during the 1996 BSE crisis, actions against the disease were first and foremost against its visible signs – the market and consumer panic and embargoes – and only secondly against the disease itself. However, because of the physicalized logic of modern disease causation, the more politically motivated actions had to be framed in terms of public health. This led to a spiral in which the European Union and the UK government were committed to drastic measures against a disease they were claiming to be largely imaginary. To an important degree, the physical framing of politically motivated actions ended up reificating the imaginary disease and, thereby, concretization of people's flears. These mechanisms were also at play during the avian flu scare. The effects of the horror waiting to happen on people's bodies were seen in many places from the empty meat shops to the mass destruction of animal carcasses. Thus, the actions of disease control that were meant to work against ‘hysteria’ failed because they unintentionally made the disease seem more real. This dynamics of ‘disease magic’ creates the semblances of horrible diseases for the purposes of reanimating the underlying communal sentiments. By turning the invisible disease causation into visible actions – culling of birds, devising preparedness plans, and intensively following the geographical spread in migratory wild birds – the disease was turned into its most ‘concrete’ form. It scared and caused much anxiety because of the way in which it was constructed. At the end, the disease disappeared because its sociopolitical construction required attention that turned to other matters. Avian flu, as a physical fact, did not vanish. Yet its disappearance from the public purview led to a sense that something effective had been done. This belief, although politically useful, was mistaken. At the same time, people's beliefs concerning the stereotypically understood geographical landscapes were reinforced.</p>
<p>The media interpretations can be seen as variants of legitimacy plays that tested the believability and viability of the underlying patterns of authority. They highlighted certain national and international actors as demonstrably legitimate. Media framing of disease stresses the action of preparing for the eventuality of a pandemic outbreak as well as the action of arming societies with the necessary tools to cope. In this way, political authorities that ft the need to prepare and develop curative tools benefit from the publicity brought about by the media and popular culture portrayals. Authorities that manage to ft the protagonistic portrayals benefit from the overall narrative drive. They are seen as representing healthy political communities and, moreover, being conducive for the future
<xref ref-type="page" id="page_173"></xref>
strengthening of communal sustainability against the antagonist agents of disease. Besides riding on the tide of collective acceptability, these actors have to ft the prevailing sentiments concerning the antagonist agents. These agents of disease are loosely connected with the underlying world of invisible disease agents. Rather, the antagonists make the difficult to understand physical causative agents identifiable through a few key terms that are seen as essential explaining factors of the fleared regressive flow. The antagonist dynamics are, in the media portrayals of our time, associated with mutability and with the ability to jump species boundaries. It is against these jumping and shape-shifting agents that the protagonist authorities have to aim their actions in order to continue to be acknowledged and recognized as agents of health.</p>
<p>One curious aspect of the avian flu scare was that there were strong beliefs and suspicions concerning the low probability of the worst case scenarios. Despite this, the scare was very much focused on the worst case scenarios. Public attention proceeded with the assumption that even though low, the risks involved were of such magnitude that preparations had to be made. This might seem to be commonsensical. The creative energies seemed to require constant innovativeness in maintaining a sense of drama and in finding new ways of being concerned over the potentially deadly avian flu. It was as if the public wanted to relive these disease scares and learn, through them, how extreme bodily harm could be averted. However, repeated pandemic scares can strain the public's ability to react and support strong actions. The hangover and controversies that followed the swine flu scare provide proof of that. That said, it is clear that proceeding on worst case scenarios can serve other than health related functions. The gearing up of preparedness can heighten the re-staging of the communal sentiments and sense of together-mindedness that are seen as desirable for other motives. Western society seems to be highly anxious over the sustainability of the world order developed and established by it. In this sense, ulterior motives stemming from the need to secure itself might provide a better answer to the question why pandemic scares are continuously restaged in the current form. The overall macro-level war context – as in the War on Terror – requires dramas that teach people the fragility and vulnerability of the world order in which they concretely understand how their own physical safety might be at stake. Pandemic scares offer material for such drills. The politico-somatic link makes these pedagogic scares extremely effective in narrating what is at stake and what must be done to secure the situation. Finally, the recurring pandemic spectacles channel the concerns, worries and flears over the sustainability of the modern Western way of life into a form that is manageable because of their speculative nature, yet acutely tangible for they connect people's somatic bodies directly to power-political power renewal rituals.</p>
</sec>
</body>
</book-part>
<book-part book-part-type="chapter" book-part-number="7" id="Chapter7">
<book-part-meta>
<title-group>
<title><xref ref-type="page" id="page_174"></xref>Beyond global public health</title>
<alt-title alt-title-type="running-head">Beyond global public health</alt-title>
</title-group>
</book-part-meta>
<body>
<p>In <xref ref-type="book-part" rid="chapter2">chapter 2</xref>, ‘Containments and Compassions of Pandemic Dramas’ I reviewed the nexus between plague and power through its prototypical containment drama depictions in works of art. I used Raphael's and Böclin's paintings to exemplify the historical depth of the imageries relating to this nexus. The use of art to make a point is itself an often used epistemological tool that relies on the value position of art in our society. It seems persuasive to argue through art. I was basically claiming that the politico-somatic nexus makes sense and has a refined form since it has been depicted in works of high culture for hundreds of years. This link offers also a bridgehead for going beyond the claims of plagues and power having a rarefied higher form. Going beyond global public health's supposed form involves a recovery of the embodied substance of health worries as parts of different lived life scenarios of situated practices. Fittingly, in his <italic>Art as Experience</italic>, <xref ref-type="bibr" rid="ref065">John Dewey (1980</xref>: 7) wants to remove art from the high pedestal on which it has been placed and reposition it in the stream of everyday life and as a part of the ‘significant life of an organized community’. According to Dewey, art punctuates and accents the ‘emotions and ideas that are associated with the chief institutions of social life’. In this way, Dewey intends to recover ‘the continuity of aesthetic experience with normal processes of living’ (1980: 10). Through this move, he also redefines the term, ‘art.’ Art was part of everybody's life and, as a practice, in everyone's possession. The value of this repositioning is due to the practical worth of doing so: through everyday art, anybody can beautify, refine and expand their everyday experience. Similarly, going beyond public health involves the rediscovery of global health worries as a modality of everyday life. The aim is to empower, to gain from the increased self-awareness about the forms that give rise to much anxiety as people's lives become intertwined with the fabric of global life. Such de-centering and de-glorifying of the hyperbolic descriptor of ‘pandemics’ allows for a re-examination of many lived life anxieties that go into the building of such lofty fears. Going beyond is an activity that attempts to disentangle the often unrecognized complexities that are lumped under the title, ‘pandemic.’ This disentanglement aims at showing the complex web of life that makes pandemics ideally comprehensible signifiers of ‘fatal blows’ pertinent to our times.</p>
<p><xref ref-type="page" id="page_175"></xref>The Deweyan practice of rediscovery is a means to an end – just and fair democracy. Art can be seen as containing a general transformative tendency besides establishing a shared persuasive element for a community of people. The transformative element, for Dewey, is one of recombination. It extends and reshuffles existing cultural connections, acts as a catalyst in thinking beyond the taken for granted, offers new insights, and broadens the potential for new meanings (<xref ref-type="bibr" rid="ref103">Goldblatt 2006</xref>: 17). Such a transformational process highlights the ability of innovative imageries to refine people's thinking and open their minds to new and alternative connections. <xref ref-type="bibr" rid="ref065">Dewey (1980</xref>: 131) quotes approvingly from Albert Barnes:
<disp-quote>
<p>There are in our minds in solution a vast number of emotional attitudes, feelings ready to be re-excited when the proper stimulus arrives, and more than anything else, it is these forms, this residue of experience, which … constitute the artist's capital. What is called the magic of the artist resides in his ability to transfer these values from one field of experience to another, to attach them to the objects of our common life, and by his imaginative insight, make these objects poignant and momentous.</p>
</disp-quote></p>
<p>My intention is that in this manner, by the mapping out of the disease-related cultural form's inherent imageries, new ways of rediscovering the more encompassing entanglements of ‘pandemics’ be opened up in order to facilitate the going beyond activity. For now, it seems that when people hear the descriptor, ‘pandemic outbreak’, they stop thinking and get stuck in the ritualistic behavioural patterns of a pandemic emergency. They are so engrossed by the signifier of a ‘fatal blow’ that they are not cognizant of the fundamental function that pandemics play and could play in their wider scenarios of situated life.</p>
<p>To help us on, Dewey's work on art seems to suggest a refined memory – a residue of experience – that can be used in the ‘magical’ reattachment of feeling, value and meaning to a new circumstance in ordinary life. The excitable memory cues provide a vehicle for rendering new events ‘poignant and momentous.’ This transformative and democratic magic of ‘every man as an artist’ appears to ft well into the scheme of things in experimental and even serendipitous trying out of one's wider surroundings. Pandemics can turn from detached signifiers of doom into sources of insights into how we feel and sense our surroundings, and into how we might change them. <xref ref-type="bibr" rid="ref065">Dewey's (1980</xref>: 122) notion that the transformative function of imageries provides ‘knowledge of something else’ seems to find its place in the tradition of innovative memory, in which memories are not only about the past, but a vehicle for ‘remembering’ something anew. Thus, it is possible to find justification for the Deweyan combinatory plays that rely on such rediscovery and the gaining of insights by experimentally trying out different combinations of images and, thereby, forming new imageries. This type of ‘combinatorics’ refers to the possibility of transformative remembering of the possibilities of richer and more democratic lives. Pandemics might at first seem to contain too much forceful, violent and brute factuality to allow for playing
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and tinkering around. However, as I have tried to show in this work, pandemics are already as they stand works of power, knowledge and culture. Our conceptions of them are rich and they contain much historical experimentalism and ‘transformativity.’ This part should be repossessed as the pandemic cultural form is one of the foremost ways of feeling, sensing and knowing about our global surroundings.</p>
<p>From the perspective of Deweyan transformative combinatorics, the act of seeing new connections allows for the recognition of knowledge of the ‘what if ’ type. The ability of this type of knowledge to convey new types of certainty derives from the intensity of the accompanying experience. When the intensity reaches a high point, the term, ‘revelatory,’ seems appropriate. Such moments when hitherto unattained possibilities are ‘acknowledged’ contain a guiding tendency whereby people act ‘in deference to’ what they have acknowledged (<xref ref-type="bibr" rid="ref064">Dewey 1958</xref>: 144). These poignant and momentous revelatory moments carry with them a particular sense of certainty about what is taking place. This sense of reality can be seen as a function of being engrossed with events in a particular way. Interpreted thus, the sense of reality becomes a quality attached to circumstances; certain ways of being engrossed with events produce a sense that the situation is especially real and true. It is significant that <xref ref-type="bibr" rid="ref101">Erving Goffman (1974</xref>: 2), the developer of the frame analysis used in this work, located himself in the tradition of Dewey and ultimately William James, and followed James' modus operandi expressed in the question, ‘Under what circumstances do we think things are real?’ The emergent moment may reveal something as real. For example, the revelatory moments of pandemics rely on specific circumstances and situational characteristics to carry meaning and start to be revelatory. For instance, as shown in <xref ref-type="book-part" rid="chapter6">chapter 6</xref>, ‘The Pandemic Geography of Avian Flu,’ it needed many conceptual innovations and reconfigurations – such as mutability and crossing the inter-species boundary – to become engrossing. The engrossing images of dead birds and animals being culled carried with them a profound message about the meaning of the times and what should be done, but only as a function of the right circumstances. Gaining awareness of these situational characteristics might offer ways of understanding pandemics in a more innovative and transformative way.</p>
<p>Furthermore, Dewey's thought, in connection with Goffman and James, points to the non-cognitive emphasis in general pragmatist thought. It is possible to contextualize Dewey's ideas about extending and transforming meaning with the Jamesian emphasis that religious-like experiences have a fundamental role in the way meaning and certainty are apprehended. James highlights the role of non-cognitively gained pre-conceptual revelations over empirically verified objectivity. He seems to suggest that the broad aspect of experience is fuelled by non-cognitively gained disclosures (<xref ref-type="bibr" rid="ref139">James 1985</xref>: 352). This suggests that the grounding of everyday experience is not abstract and intellectual, but non-cognitive, emotional, and quasi-religious (<xref ref-type="bibr" rid="ref139">James 1985</xref>: 397). This resonates well with the notion of Ludwig Wittgenstein – who was a close reader of James and influenced by Dewey's philosophy of education – that knowledge is based on
<xref ref-type="page" id="page_177"></xref>
acknowledgment (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 378). For Wittgenstein, to know was often connected with the recognition of authorities. The important point here is that this acknowledgment is not based on occasions of reasoned choice, but on moments of believing, learning, experiencing, growing up, inheriting and accepting. This type of knowledge requires constant reminding and reminders. Wittgenstein says these reminding ‘pictures’ are best understood in their practical function. They should not be given a more foundational character because they are artificial aids of rather limited and specific use (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 89). In this sense, we could rediscover pandemics as something other than sublime images of fatal blows. We could relocate them in the functions they serve in recognition of authorities and power, and in causing sanctioned types of acknowledgments. For example, one political use of pandemic imagery is to make the ideal of a prepared, sustainable and resilient society more acceptable and legitimate. Rediscovering pandemics – that is, going beyond them – can involve democratization of these societal goals, which often seem anything but democratic.</p>
<p>Wittgenstein's emphasis of reminders provides one further element to the current pandemic related combinatorics. More precisely, his later philosophy may be used to shed some light upon the degrees of freedom in the underlying combinatorics. Discernible wholes of language, in the Wittgensteinian sense of language games, do not come together in some strictly formal way (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 108).<xref ref-type="fn" rid="fn7_1"><sup>1</sup></xref> Wittgenstein uses the term, ‘family resemblance,’ to bring forth the elusive and indeterminate character of language use (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 23, 67). He continuously points out the dangers of an omnipresent and more imprisoning use of language games. He sees that language games – that is, scenarios of situated knowledge – can and often do ‘conjure up’ fairly determinate senses that go beyond mere family resemblance (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 426–8). On the one hand, thus, language games can be used in an imprisoning way of conveying how things must be. On the other hand, language offers a highly desirable way of showing, demonstrating and teaching how things could be. In the second sense, the means of social activity can be used to bind actions and things loosely and innovatively together, whereby the game brings up whole patterns of similarity and dissimilarity: ‘[t]he language games are rather set up as objects of comparison which are meant to throw light on the facts of our language by way not only of similarities, but also of dissimilarities’ (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 130). Besides this character of language games, they have a more dogmatic use, which can ‘hold us captive’ (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 115). The ‘picture’ invoked by a language game holds people captive and they ‘cannot get outside of it,’ for it lies in their language and language seems to repeat it to them ‘inexorably’ (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 105). Reminding, in this Wittgensteinian sense, refers to the activity of offering objects of comparison meant to awaken those captivated by determinate ideas of knowledge and authority. This understanding of ‘going beyond’ offers a way to ‘unfreeze’ the consolidated memory systems. The Wittgensteinian continuum between ‘showing how things can be’ and ‘demonstrating how they must be’ offers a clue to the political use of image combinations that comprise modern
<xref ref-type="page" id="page_178"></xref>
ideas about pandemics. My efforts in this book have been concentrated on reminding readers of a whole gamut of interrelationships between pandemics and their somatic and political surroundings. In a nutshell, the very idea of politico-somatics is connected with getting us unstuck from our pandemic imageries so that we are not held captive by them and they are no longer able to repeat themselves on us inexorably.</p>
<p>The democratization of pandemics aims at making its connections with the daily lives of people and their political contexts more evident. The pandemics-related public health discourse often relies on an opposite movement: making pandemics more insular, more of a field of expert knowledge, and less of an issue of people and their politics. Further light can be shed on the relatively undemocratic field of pandemics through Susan Sontag's masterful account of the disease metaphors of bodily illnesses. In her pioneering <italic>Illness as a Metaphor</italic>, <xref ref-type="bibr" rid="ref244">Sontag (2001)</xref> ponders over the cultural history of the different conditions of being ill in Western societies. Distinct diseases have highly readable social meanings, with long and mutating historical roots. The most horrid and culturally memorable of these diseases involve the regressive bodily processes of decomposition. They are readable not only in a cognitive way, but also in more embodied ways. These killer diseases have their own temporal tempos. Time becomes of essence as there is a rush to find a cure. This temporization changes the situation of ethics as long term deliberation becomes a vice and hectic rush prevails as a virtue. The tempo of events becomes accentuated by the perceived progress of the disease as it spreads across and deeper into people and their communities. Besides bringing its own time and according ethics, disease emergencies contain their own affective regime. Fear and anxiety saturate the air. The dimension of power changes as well. The authorities that are recognized and the knowledge that is acknowledged come to be seen from the perspective of their ability to provide a sense of relief from pain. The communities themselves change as more and more people become inhabitants of what Sontag calls ‘the kingdom of the sick.’ This medically maintained domain inhabited by sick people was a deeply personal focus for Sontag. Illness was more than a metaphor for Sontag. She survived two cancers, but died after a long and painful illness when a third cancer claimed her. Her knowledge of the isolating conditions in the kingdom of the sick is deeply embodied. The ways in which the diseases decomposed her body is closely mirrored in the way she was stripped away from her usual social relationships and in the way she became de-individualized in the medical machinery in the frantic search for a cure. As a template for a community, the ‘hospital’ provides for quite a different set of rights and responsibilities for its citizens than the communal metaphor of a ‘polis.’ This brings to my mind a child's drawing I saw while I was working as a good governance expert in an EU-India programme meant to educate the media on HIV and AIDS. The drawing carried the caption: ‘This man is being chased by HIV and HIV is trying to stab him with the dagger of sadness and loneli-ness!’<xref ref-type="fn" rid="fn7_2"><sup>2</sup></xref> The captivating and mentally disempowering quality of the signifier ‘pandemic’ has much to do with this basic observation.</p>
<p><xref ref-type="page" id="page_179"></xref>Although the desirable going beyond would involve recognition that diseases are always political, the modern global health governance language often treats perceived health issues in terms of the so-called functions, rather than in terms of territorial entities such as states. The functionalist perspective involves a conceptual move away from the relevance of possible specific territorial concerns and people's embeddedness in their specific geographical contours. The conceptual move contrasts with the territorial approach, which puts the emphasis on political markers of discontinuity, on the other signifiers of political separation: while borders disjoin the political powers by attaching them to a plurality of territories, it conjoins the map into one whole consisting of similar homogenous territorial entities. In offering a substantive alternative to traditional politics, the (neo)functionalist approach treats the possible adversative power relations between political entities as an obstacle to rational decision making. Functional-ism imagines the relationship between a rational planning approach and a traditional political perspective as potentially at odds: power is connected to politicization and seen as having a negative impact on rational problem solving in various functional areas of cooperation. The functional ideal, according to which efficiency and accountability is connected with proven technical expertise, is prone to distil what is considered to be undue politicization out of the functional fields of cooperation. A corresponding measure of efficiency starts from the idea that the most commonsensical thing to do is to entrust the matter to experts with scientifically grounded practical knowhow.</p>
<p>To understand the radical nature of functionalism, one needs to appreciate the way in which it defines ‘a function.’ The roots of the concept draw from the perception that human needs can be ordered hierarchically. The most basic human needs form the basis of what is meant by functions. These basic needs, such as food and health, highlight the importance placed on the material and natural needs of human beings as biological organisms. From this perspective it may be argued that the function of human health comprises a distinct area similar to the material needs of food and sustenance. The idea is that the more basic the need, the more clearly it should be beyond politics and politicization. The argument is that people's basic physical, social, material and mental wants and needs have to replace divided and narrow political considerations in the interest of building more prosperous and peaceful polities.</p>
<p>Because of the desire to keep disease out of politics, it is useful to further examine the interface between traditional politics and modern functionalist practice. It is clear that politics has a positive role to play even from the functionalist perspective. The positive role of politics consists of arguments, disagreement and debates that do not disturb rational expertise. Politics, in this respect, consists of the capability and willingness to act to establish and maintain the separation of politics in a more negative sense and the function of public health. For example, the willingness to establish the European Food Security Agency reflects the positive role that politics can play in order to enable experts to do their work. Politicians can allocate the necessary resources for functional areas and to experts. Such positive politics establishes and maintains the institutional
<xref ref-type="page" id="page_180"></xref>
framework for any effective functional expertise. Besides being connected with important institutional arrangements, public health work involves a more mundane, yet equally necessary, role for politics – one has to choose the personnel to work in the functional field, allocate money for the building of offices and laboratories, finance large-scale inspection programs, and so on. Often, this seems rather clear-cut and straightforward, but, as the controversies over stem cell research illustrate, there is no guarantee that these decisions can be left to the public health experts themselves. As long as the justifications and reasons are based on common rational interest, this role of politics is not seen as harmful even when it results in low levels of disagreement as long as they do not result in the paralysis of expertise. The politics internal to a functional field is perceived in a similar way. Experts can argue over the best course of action in maintaining public health. Even though the public perception is usually one of there being only a single best course of action, there usually exist multiple ways in which a problem can be solved. The belief is that this type of expert ‘politics’ is instrumental and even necessary for the advancement of right and effective programmes. Scientific debates, disagreements and compromises are not seen in themselves as political in the negative sense of the word. From the functionalist perspective, negative politics, therefore, involves failure to control a disease because the protective barriers and borders between functions and politics are dangerously crossed. What this means is that negative politics is in many respects synonymous with diseases themselves as when Chinese secrecy was seen as a factor in the initial spread of SARS. The controlling of diseases and maintaining of public health has a lot to do with the ability to keep negative politics out of the functional field so that it cannot ‘pollute’ common interests. In this context, it should be noted that attempts to ignore, bypass and deny politics lead easily into technocratic naivety as the way in which a particular perception of a disease influences a whole gamut of responses ranging from people's reactions to the way in which governments and institutions continuously reassess their situation awareness.</p>
<p>Even a cursory look at the recent avian fu debate, to cite just one example, reveals that different actors have their own at least partly incompatible goals, and illuminates how the politics of health will defy any attempts to differentiate between positive and negative forms of politicization. For example, on the surface, the sharing of epidemiological data and samples with the World Health Organization (WHO) seems the self-evident, right thing to do. It is in accord with the common wisdom that such sharing benefits the whole of humanity and human polity. WHO has a 50-year-old system for sharing influenza virus samples. Countries donate samples to WHO so that private manufacturers relying on the data can maintain the effectiveness of vaccines. However, this system had to be renegotiated in early 2007, when Indonesia refused to send samples to WHO. Indonesia's concern was that it did not stand to gain from the system and that the real beneficiaries were the Western governments in terms of vaccine supplies and the pharmaceutical companies in terms of economic profits. The vaccines developed from the samples were too expensive for developing
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countries such as Indonesia, while the Western countries were emptying their markets. Another important reason for the Indonesian decision was its willingness to negotiate with specific drug companies. Indonesia wanted to give its samples directly to a specific pharmaceutical company, bypassing the WHO system. This arrangement would have guaranteed Indonesia more direct benefits in terms of supplies and shared profits. In the end, the crisis was resolved by granting Indonesia the ‘final say’ when it came to the commercialization of drugs developed based on Indonesian data.</p>
<p>Among the most distinct role differentiation among the pandemic crisis actors is the one between pharmaceutical traders and public health authorities (<xref ref-type="bibr" rid="ref007">Abbot, 2005</xref>). Big pharma's investment related arguments have to fit into the general functionalist ethics inherent in the health care paradigm. The pharmaceutical industries' rhetoric highlights the importance of having strong intellectual property rights protections in place: patents need to be protected and price controls resisted. These policies, so the argument goes, will benefit the poor as well because the industry can then undertake costly and expansive drug development. However, public health advocates argue that the common benefit has to allow room for governments to break patents so that the poor will also have access to life saving innovations. Health is seen as a priority over the protection of intellectual property rights. Both stands have their lobbyists and supporters.</p>
<p>The public health framework has gained some independence from the state system and it has the proven ability to capture people's sympathies, which cannot be tapped in their totality by a state-centric world-view. At the mythological level, the transnational spirit of public health has some protagonist figures that draw identifcation, respect and a sense of awe. These figures inspire and embody to a degree the otherwise technocratic, abstract character of global public health. In moving beyond, the protagonists and their imageries provide clues to how global public health can be independently embodied. Usually these protagonist heroes suffer adverse circumstances while they carry on with the healing activity and reform mission. These heroic figures are humanitarian because of the pain they have to endure for the sake of helping others. However, they are figures that can at times represent the nodal point between the individual's and humanity's embodiments relatively unmediated by national hagiographies and narratives. The present-day gallery of such figures include, in addition to the aid workers in distant places, scientists who try to develop new cures. It is at this level that the cosmopolitan framings of global public health can find their heroic embodiments and offer some substantive alternative to the traditional political embodiments. The gallery of heroic inventors – such as Koch and Pasteur – can become articulated as a gallery of human progress in general, instead of national manifest destiny.</p>
<p>Thus, there are some notable hero figures in pandemic spectacles. The heroism of unselfish other-interested health care workers and the diligent hard work of the officials of the various public health agencies are often noted in pandemic narratives. These figures are made to stand out above the political realm in a pantheon reserved for the heroes and martyrs of humanity. The hagiography
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of humanity, as defined in the public health discourse, includes some exceptional people who died fighting pandemics and whose memory is commemorated at many places – in the media, on the Internet and in journals – that are receptive for the idea of a humanity that transcends national states. One such notable figure was that of Dr Carlo Urbani, who died fighting SARS. The eulogy carried on Dr Urbani in the <italic>New England Journal of Medicine</italic> (<xref ref-type="bibr" rid="ref219">Reilley <italic>et al.</italic> 2003</xref>: 1951) of May 15, 2003 is telling. It makes a revealing statement: ‘[i]n some ways, the SARS outbreak in Hanoi is a story of what can go right, of public health's coming before politics.’ Public health is taken as a higher order realm that should at least in emergency situations prevail over political considerations. The eulogy continues by pointing out the importance and also the risks involved in being part of the first line of defence in public health:
<disp-quote>
<p>First-line health-care providers quickly alerted the WHO of an atypical pneumonia. Dr Urbani recognized the severity of the public health threat. Immediately, the WHO requested an emergency meeting on Sunday, March 9, with the Vice Minister of Health of Vietnam. Dr Urbani's temperament and intuition and the strong trust he had built with Vietnamese authorities were critical at this juncture. The four-hour discussion led the government to take the extraordinary steps of quarantining the Vietnam French Hospital, introducing new infection-control procedures in other hospitals, and issuing an international appeal for expert assistance. Additional specialists from the WHO and the Centers for Disease Control and Prevention (CDC) arrived on the scene, and Médecins sans Frontières (MSF, or Doctors without Borders) responded with staff members as well as infection-control suits and kits that were previously stocked for outbreaks of Ebola virus.</p>
</disp-quote></p>
<p>The personal efforts of Dr Urbani are seen as instrumental in the efforts of various public health agencies to realize the grave nature of the situation and in getting the political officials in Vietnam to allow for the introduction of public health driven policies. The eulogy ends by stressing the pride that the medical community feels in the heroic deeds of Dr Urbani:
<disp-quote>
<p>it is clear that Dr Urbani's decisive and determined intervention has bought precious time and saved lives. We remember Dr Urbani with a mixture of pride in his selfless devotion to medicine and unspeakable grief about the void his departure has left in the hearts of his colleagues around the world.</p>
</disp-quote></p>
<p>Public health embraces a form of humanity based political theology. The corresponding heroes' gallery and hagiography can provide clues to the particular ways in which the pandemic narrative proceeds. These prototypical figures empower individuals and organizations that are seen fighting the pestilence in ways that give them political clout and agency. However, despite these progressive heroes and functionalist ideology, the power of the public health narratives still captures our attention and holds us captive of the state-centric figure
<xref ref-type="page" id="page_183"></xref>
galleries and political theologies. These sources of meaning should be considered because they are historically significant and because national politics still provides the forums for democratic deliberation.</p>
<p>Thus, it is difficult to conceive of pandemic scares' public health dramas without taking into account the traditional value placed on the dramas of ‘containment’ and on the effort ‘to contain.’ Cultural geographer Yi-Fu Tuan, in his book, <italic>Landscapes of Fear</italic> (1979: 6), argues that much of human activity is directed as constructing material and conceptual technologies to secure human existence free from what he calls chaos: ‘[i]n a sense, every human construction whether mental or material is a component in a landscape of fear because it exists to contain chaos.’ This is especially pertinent to the conceptual configurations of political theory and international thought. Both can be seen as traditions that aim to contain the effects of insecurity, anarchy and injustice in and between polities. Thucydides saw politics as an activity aimed at maintaining and, if possible, expanding the most human of spaces, political space, against the mechanistic ideas of necessity and absence of alternatives – the ‘might is right’ type of thinking – and against the accidental qualities of complex human to human or human to nature relationships – for example, passions of the moment. He saw war and plague as factors that constricted the political space to the point of hysteria, factionalism and lack of deliberation. Defined from this perspective, politics turns into a supportive construction aiming at the creation of healthy political communities. Thucydides seems to suggest how shared memories and shared beliefs embedded in them contribute to the emergence of a consensual communal realm of persuasibility (<xref ref-type="bibr" rid="ref045">Cogan 1980</xref>: 168). This resource is seen as vital for governability because any significant splits in communal together-mindedness may lead to the possibility of potentially disastrous whimsical and erratic actions. From this classical perspective, it can be stated that political rhetoric and deliberation are seen as being based on the existence and on the continuous rediscovery of the area of together-mindedness: the mission of political rhetoric is not to persuade, but to rediscover and reinvent the underlying persuasive element (<xref ref-type="bibr" rid="ref084">Entralgo 1970</xref>: 177). Communal together-mindedness can be seen as a playground of alikeness and contrast in a way that leads to likeliness and predictability when it comes to the future course of the community. This classical background may be seen as foregrounding the more modern ideas concerning building containment oriented frameworks that constrain the perceived sources of erratic, accidental and chaotic actions and events. However, these classical ideals place much emphasis on the need to safeguard the realm of political deliberation against haste and hyperbole.</p>
<p>Throughout this book, I have highlighted how the modern public health frame manifest technocratic expert qualities are overshadowed by a coded language of the considerably older discourse of intertwined plagues and power. One of the most prominent reasons why the explicitly medical and epidemiological language of the contemporary global health community inevitably borrows from these older signifiers is the basic reality that its disease language is fully embodied with complex appealing polysemy. The centuries of interaction
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between diseases and politics have produced a mutually resonating object world that enables discussing political processes as disease like processes and discussing physical diseases in terms of hostile enemies against whom it is possible to wage wars. Because abstract knowledge of global public health cannot resonate with such historically embedded meanings, it is bound to resort to using quasi-political language. This public health language insinuates, suggests and says indirectly things that are pertinent to the lives of people in their political embed-dings. Let us consider an obvious example of this need to embody and anchor the abstract medical realms. This context is made apparent by descriptions of how the human immunity system functions:
<disp-quote>
<p>White blood cells are responsible for protecting the body from invasion by foreign substances such as bacteria and viruses. The majority of white blood cells are produced in the bone marrow, where they outnumber red blood cells by 2 to 1. However, in the bloodstream, there are about 600 red blood cells for every white blood cell. There are several types of white blood cells. Granulocytes and macrophages protect against infection by surrounding and destroying invading bacteria and viruses, and lymphocytes aid in the immune defence. Granulocytes are prepared by apheresis or by centrifugation of whole blood. They are transfused within 24 hours after collection and are used for infections that are unresponsive to antibiotic therapy.</p>
</disp-quote></p>
<p>This prototypic account, which imagines a system of human immunological defence against ‘invading’ disease agents, is from the webpage of the American Red Cross.<xref ref-type="fn" rid="fn7_3"><sup>3</sup></xref> The language of political enmity makes the internal workings of human physiology more tangible by comparing it to the military response against an invading foreign army. Furthermore, the workings of the human body are understood to be relating to a system in which ‘reds’ are the nutrient carrying workers defended by the guardian ‘whites’. The respective roles of the whites and reds are given meanings that remind us of the societal roles of owners and labourers during the time when white blood cells were first discovered, described at the turn of the twentieth century. From this perspective, the accounts of human immunology draw from conservative political visions of ideal harmony. These accounts turn the descriptions of the hard to understand invisible world into stimulating and easy to grasp imageries. One should note that the borrowings from the world of politics into the world of immunology are not merely descriptive. Some of the ideological content of the political world also gets transferred into the world inside the human bloodstream. Organized and systematized knowledge/power configurations access the world of expert and scientific knowledge. A representative quote from a scientific journal further underscores this tendency:
<disp-quote>
<p>An academic domain is established when the knowledge within is systematized. We have acquired knowledge by conquering the evils that have attacked and threatened humankind. In the case of germs, humans identifed
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them and invented methods to control them. But more importantly, the experiences of fighting against various diseases were collected and systematized into the academic field of bacteriology. The knowledge systematized into an academic field can never be lost through the generations, and it can be readily utilized by anyone thereafter.</p>
<attrib>(<xref ref-type="bibr" rid="ref281">Yoshikawa 1999</xref>: 1)</attrib>
</disp-quote></p>
<p>The notion of scientific progress often narrates itself in terms of an increasingly successful carefully planned and executed military campaign. The demonstration of the authority of scientific knowledge draws from a theatre of proof whereby expert knowledge authority is revealed, rather than cognitively and intellectually proven. Such revelatory demonstrations would be harder to come by without the existence of the plague and power template.</p>
<p>Similarly, accounts of pandemic challenges share the same dramaturgy as the defence of the contemporary world order against its visions of enemies in the so-called ‘rogue’ elements that are ‘spreading’ through failed and failing polities. This dramaturgy is as ancient as it is embodied. For example, Hippocrates' medical models were embodied in the narrative form that Thucydides utilized in his <italic>History of the Peloponnesian War</italic> and Hippocrates can be argued to have borrowed from the political theories of his own time. From this perspective it is not surprising that this shared cultural form is omnipresent in contemporary pandemic imageries and in their interpretations by political authorities. Let's consider another example of the ideological underpinnings of the plague to power nexus: The President's Emergency Plan for AIDS Relief (PEPFAR) in the US aimed to alleviate the plight of those suffering from HIV and AIDS in Africa. Africa, as the world's perceived periphery, became a signifier of the looming general state of affairs and a bad omen of things to come in the 1990s. This connection made the pestilences in the hierarchical world order's peripheries hyperbolic and anticipated. With increasing and accelerated global connectedness, the periphery is no longer a place only for demonstrating Western goodness through acts of charity, healing and humanitarianism. The periphery's conditions, disorders and diseases have been worried about and turned into prognoses for the future. Deriving from this perspective, there is a lot of prestige to be derived from ‘curative’ and containing actions in Africa. Former US President George W. Bush used the Lazarus miracle allegory of Christianity to point out how American initiative could bring the African people back from certain death in his speech on Africa and AIDS on April 29, 2003. His explicit reference was to the new HIV and AIDS policies of the US, which ‘gave hope’ to the otherwise doomed people of Africa:
<disp-quote>
<p>There are only two possible responses to suffering on this scale. We can turn our eyes away in resignation and despair, or we can take decisive, historic action to turn the tide against this disease and give hope of life to millions who need our help now. The United States of America chooses the path of action and the path of hope.</p>
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<p><xref ref-type="page" id="page_186"></xref>In the same speech, Bush drew an explicit connection between the high political agenda and AIDS:
<disp-quote>
<p>We believe that everyone has a right to liberty, including the people of Afghanistan and Iraq. We believe that everyone has a right to life, including the children in the cities and villages of Africa and the Caribbean.</p>
</disp-quote></p>
<p>The Lazarus allegory refers to such concrete instances of helping to save people as well as the more abstract ability to set people free from oppression and death. However, the Lazarus effect has also the effect of designating the US as an almost sacred community – that of the helper and the healer. In the context of the African HIV and AIDS disaster, Bush assumes the high role of a sacred benefactor. While highlighting the near messianic role of the sole superpower in the world today, he points out the moral roots of HIV and AIDS in Africa – the lack of the right types of values and social practices, rather than the rampant social exclusion, marginalization and economic destitution of Sub-Saharan Africa.<xref ref-type="fn" rid="fn7_4"><sup>4</sup></xref> The Bush administration's eagerness to concentrate on the ABC (Abstinence, Be faithful, and correct and consistent Condom use) approach to HIV and AIDS reveals the promotion of ‘right’ morals as the proper method of fighting the spread of the syndrome. What the US administration is spreading is not medical know-how, but the values it thinks are the proper bases of a sustainable way of life.<xref ref-type="fn" rid="fn7_5"><sup>5</sup></xref> It also gives a prominent role to the various faith based organizations fighting HIV and AIDS. The story of Lazarus is one of conversion and production of belief. Akin to this, the Bush administration's policy on HIV and AIDS in Africa, through its emphasis on the role of abstinence and marital fidelity, designates the moral community that Africa should join in order to fight HIV and AIDS successfully. This example indicates how before HIV and AIDS was translated into an eradication program in Africa, it needed to be made societally and ideologically understandable. Even any seemingly expert driven program has to be based on consensus over the underlying values and over what constitutes a proper program in the first place.</p>
<p>The points which are taken by relevant actors as persuasive and based on which some knowledge becomes acknowledged are also the starting points of the eradication and containment policies of international functional organizations, such as WHO. The large context of arriving at such consensus is moulded by the overall contemporaneous processes. The values and ideologies inherent in the zeitgeist inevitably spill over onto the global public health efforts because, in the absence of addressing these processes, any talk about pandemics would not be coherent or persuasive. Pandemics as frames are extremely real. However, this sense of realness does not necessarily have to do with our perception of them as being factual in the sense of our ideas of them corresponding with the state of affairs in the physical world. Some have claimed that pandemics are not such a hyperbolic threat as they are made to be:
<disp-quote>
<p>[The pandemic worst case scenario] makes good press copy, attracts TV cameras, and raises grant funding. Are influenza pandemics likely?
<xref ref-type="page" id="page_187"></xref>
Possibly, except for the preposterous mortality rate that has been proposed. Inevitable? No, not with global warming and increasing humidity, improved animal husbandry, better epizootic control, and improving vaccines. This does not have the inevitability of shifting tectonic plates or volcanic eruptions. Pandemics, if they occur, will be primarily from respiratory tract pathogens capable of airborne spread. They can be quickly blunted by vaccines, if administrative problems associated with their production, distribution, and administration are promptly addressed and adequately funded.</p>
<attrib>(<xref ref-type="bibr" rid="ref154">Kilbourne 2009</xref>: 218)</attrib>
</disp-quote></p>
<p>It can be suggested that pandemics are more factual in the sense of what the coherence theory of truth states. The threat posed by pandemics appears persuasive and factual because the pandemic frame and cultural form fits well with other ideas of threat that are pertinent. Different worst case scenarios lend mutual support to each other. Pandemics are believable because they allow for the articulation and addressing of more generalized fears and anxieties. They provide a speculative locus for envisioning ‘better’ global societies that are ‘prepared’ and ‘resilient’.</p>
<p>Thus, it is possible to see how ideologies play a role in public health efforts and how public health promotes political visions to defeat dystopian pandemic threats. The threat posed by pandemic diseases is accented and hyperbolized partly because it is ‘the standard operating procedure’ in the present global polity, which faces many anxieties connected with the global lowering of borders. However, as has been pointed out through this book, there is nothing inherently new or surprising in this. Diseases have always allowed for the effective articulation of political dystopias. They have always been played up if knowledge about them has not been able to be played down and suppressed. Diseases are relevant as one of the foremost grounds of political imageries and loci of the normative shoulds and should-nots. However, pandemic imageries' political uses have been altered recently due to the processes of globalization. The global lowering of boundaries and barriers has created a more interconnected world. Although this process is generally seen as a preferred change, much hesitation and worry remain. Pandemic speculation provides a high reading on the Richter scale of global fears. At the same time, much of the overall substance remains shared. Pandemics rehearse the prominent themes when it sees threats arising from the failed and failing places of the world. The good practice stories concerning mutating disease elements that penetrate borders resonate well with the ontological imageries of the War on Terror.</p>
<p>Thus, it is possible to redefine pandemics differently from how they are usually used in speculative scenarios about the ‘coming plague’. Talk about pandemics represents a re-examination of contemporary ways of articulating pain, and also of the ways in which pains and fears of pandemics articulate the modern global experience. People's everyday beliefs, values and practices concerning different scenarios of pain and suffering contain an important power-political modality. The fears and pains involved in one of the most global ways of
<xref ref-type="page" id="page_188"></xref>
suffering – pandemics – give deeply sensible coherence to the ways of feeling globality and flows of power in the global space. Pandemics arouse fear of immediate danger for the people living in the global north, yet they also narrate stories of the obvious health disparities between the global north and south. The globally constituted existence exerts considerable influence on individual level suffering and anxieties and opens new avenues of sensing and feeling global worries in bodily ways. The social construction of pandemics registers the many fears and anxieties felt by the perceived distortions and transgressions of the contemporary world. Because of this, pandemics can be reframed to embody also the complexities entailed in ethical subjectivity and right actions. This realization that pandemics are political and embodied may allow for their repossession to be parts of lived life in an empowering and democratic way. They are not hyperbolic and sublime; in fact, people's fears of them are anything but hyperbolic and sublime.</p>
</body>
</book-part>
</body>
<back>
<notes>
<title><xref ref-type="page" id="page_189"></xref>Notes</title>
<fn-group>
<label>1</label><title>Introduction</title>
<fn id="fn1_1"><label>1</label><p>Albertus Magnus states that in <italic>Metaphysics</italic> that ‘the heart fees the unfamiliar as it fees the bad and the harmful.’</p></fn>
<fn id="fn1_2"><label>2</label><p>The ‘root’ causes of most violent epidemics can be traced to multilevel political structures and dynamics, which provide the macro-level context for the disease causing agents (<xref ref-type="bibr" rid="ref090">Fassin 2007</xref>; <xref ref-type="bibr" rid="ref088">Farmer 2004</xref>; <xref ref-type="bibr" rid="ref142">Joralemon 2009</xref>). The local and global circulations of disease agents are largely in accordance with structural imbalances and inequalities in terms of nationality, ethnicity, gender and wealth. Although recent literature on the anthropology of suffering has highlighted it, this aspect of disease is not a recent revelation. Rather, it can be argued that it has always been encoded in the nuanced quasi-cognitive beliefs about diseases.</p></fn>
<fn id="fn1_3"><label>3</label><p>The theory of socio-somatics is used in reference to those social processes through which patterns of social interaction have an influence on the somatic process, such as heart rate, perspiration or blood pressure, and vice versa (<xref ref-type="bibr" rid="ref157">Kleinman and Becker 1998</xref>). These mediating social patterns can refer to various social practices such as humiliation, expressed pain behaviour and mourning: ‘a person's context … influences the severity and type of symptoms experienced’ (<xref ref-type="bibr" rid="ref138">James and Prilleltensky 2002</xref>: 1134).</p></fn>
<fn id="fn1_4"><label>4</label><p>See also <xref ref-type="bibr" rid="ref031">Bronfen 1998</xref>.</p></fn>
<fn id="fn1_5"><label>5</label><p><xref ref-type="bibr" rid="ref230">Scarry (1987</xref>: 7) uses the term, ‘radical epistemological doubt’, to describe these processes in which violence goes hand in hand with non-acknowledgements of former knowledge and the accompanying unravelling of knowledge/power relationships.</p></fn>
<fn id="fn1_6"><label>6</label><p>Emotion centred language is omnipresent even in contemporary rational and system oriented theorizing. Realist ontologies are based on despair over the faws in human nature and the fragility of human achievement (<xref ref-type="bibr" rid="ref043">Clark 1989</xref>: 83). This sentiment of despair is paired with constant worry and fear over the unpredictability of events. The more liberalist ontologies build on the possibilities of hope.</p></fn>
<fn id="fn1_7"><label>7</label><p>The medicalized governance language renders the politics of the distant other into a series of rational/technical problem solving exercises. Although this production of subjects is itself a political act, it is political in a specific sense of the word: It is politically privileged by its appearance of being apolitical. Further light can be shed on this by <xref ref-type="bibr" rid="ref023">Barthes' (1980</xref>: 45) concept of ‘depoliticized speech’. The practice of depoliticized speech is based on rooting the political out of one's actions and turning them into something self-evident and natural.</p></fn>
</fn-group>
<fn-group>
<label>2</label><title>Containments and compassions of pandemic dramas</title>
<fn id="fn2_1"><label>1</label><p>Compassion may be viewed as the general sentiment motivating actions at a distance and across global space, i.e., of effectively influencing far-off events without being in close contact. These practices have gained influence as legitimate practices in the
<xref ref-type="page" id="page_190"></xref>
global context, where political borders have lost their place among the foremost practices of containment.</p></fn>
<fn id="fn2_2"><label>2</label><p>For a more detailed debate on why plague disappeared, see <xref ref-type="bibr" rid="ref044">Cliff <italic>et al.</italic> (2009)</xref>.</p></fn>
<fn id="fn2_3"><label>3</label><p>See <xref ref-type="bibr" rid="ref055">Dahlberg (1988)</xref>.</p></fn>
<fn id="fn2_4"><label>4</label><p>In Augustine, the lack of <italic>res</italic> at the spiritual level refers to the existence of demonic forces. The earthly counterparts of the demons are, for example, law breakers and criminals, or people who break the earthly order.</p></fn>
<fn id="fn2_5"><label>5</label><p>Benjamin Jowett translates this term as ‘infinite chaos.’ However, Harold N. Fowler uses ‘boundless sea of diversity’ in the Harvard edition. See also <xref ref-type="bibr" rid="ref055">Dahlberg (1988</xref>: 27–8).</p></fn>
<fn id="fn2_6"><label>6</label><p>For example, Book x of <italic>Confessions</italic>.</p></fn>
<fn id="fn2_7"><label>7</label><p>For example, in a magazine interview, Clarence Peters, the head of the Special Pathogens Branch of the Centers for Disease Control and Prevention (CDC), made the following statement: ‘[w]hen [Mr Peters] learns of an outbreak, he asks a series of questions: Is the problem here [in the United States]? How easily can it get here? If it gets here, how easily can it spread?’ (<italic>Business Week</italic>, August 21, 1995: 72–3).</p></fn>
<fn id="fn2_8"><label>8</label><p>‘WHO Interim Protocol: Rapid Operations to Contain the Initial Emergence of Pandemic Influenza’ (Geneva: <xref ref-type="bibr" rid="ref273">WHO, October 2007b</xref>).</p></fn>
<fn id="fn2_9"><label>9</label><p>Appeasement, as a reciprocal gesture, aims at bringing about valued and advantageous tranquillity and calm, which guarantees the overall status quo, albeit at the expense of some other principles, goals, values, or needs. Soothing or pacifying an imperialistic state entails conciliatory efforts and gestures to overcome hostility and the need to change the status quo. These conciliatory gestures are considered minor compared to the probable disadvantage caused by major changes in the prevailing order. The main risk of appeasement is that it reciprocates demands for changing a status quo with actions more befitting to demands for minor adjustment within prevailing power relations (<xref ref-type="bibr" rid="ref192">Morgenthau 1955</xref>: 60).</p></fn>
<fn id="fn2_10"><label>10</label><p><xref ref-type="bibr" rid="ref156">K. Kiple (2001)</xref> examines the issue of unequal distribution. Immunity against yellow fever is acquired. So, if you have the disease once, you will develop immunity. However, the ‘black’ population seemed to have an extra immunity, which Kiple calls ‘special’. <xref ref-type="bibr" rid="ref268">S. Watts (2001)</xref> attacks this view of inherited immunity, calling it racist, because Kiple's view suggests that yellow fever originated from Africa and that ‘blacks’ are natural workers, better able to adapt to harsher conditions than ‘whites’.</p></fn>
<fn id="fn2_11"><label>11</label><p>The association between yellow fever and the slave trade was strengthened by the fact that the final horrible stages of the disease brought along vomiting of a strange blackness, which was believed to be a clear sign of guilt.</p></fn>
<fn id="fn2_12"><label>12</label><p>The dangerous, difficult and antagonistic nature of travel along the main commercial sea routes further reinforced the sense of unnatural connection (<xref ref-type="bibr" rid="ref053">Curtin 1964</xref>).</p></fn>
</fn-group>
<fn-group>
<label>3</label><title>Understanding the vortex of war and disease</title>
<fn id="fn3_1"><label>1</label><p><xref ref-type="bibr" rid="ref068">Jared Diamond's (2005)</xref> <italic>Guns, Germs and Steel</italic> further reinforces this point by pointing out how virulence, rather than virtuosity, led to European dominance of the world.</p></fn>
<fn id="fn3_2"><label>2</label><p>It is noteworthy that the Greek root concept, ‘nosos’, describes both the condition of political chaos/confusion and an outbreak of epidemic disease.</p></fn>
<fn id="fn3_3"><label>3</label><p>Aristotle also uses the medical terminology of his times in relation to political violence. For him, stasis refers to the coming into being of an arrest in the overall motion of a polis. The emergence of multiple contradictory movements halts the overall telos. This equation of stasis with the medical disequilibrium of a body was also shared by Plato (<xref ref-type="bibr" rid="ref144">Kalimtzis 2000</xref>: xv, 19).</p></fn>
<fn id="fn3_4"><label>4</label><p><disp-quote><p>When the god was asked whether they [the Lacedaemonians] should go to war, heanswered that if they put their might into it, victory would be theirs, and that hewould himself be with them. Events were supposed to tally with this oracle. For theplague broke out as soon as the Peloponnesians invaded Attica, and never entering <xref ref-type="page" id="page_191"></xref>Peloponnese (not at least to an extent worth noticing), committed its worst ravages in Athens, and next to Athens, at the most populous of the other towns.</p>
<attrib>(Thucydides, 2.47)</attrib></disp-quote></p></fn>
<fn id="fn3_5"><label>5</label><p>In the Homeric hymns, the sea swirls in confusion (ekinethe) at the birth of Athena. Thus, fluidity and flux and other Poseidonic qualities are abundant in Athenian iconography.</p></fn>
<fn id="fn3_6"><label>6</label><p>‘A more fitting image of stasis motion would be to visualize it as movement that has strayed off the main highway […] travel along the side roads leads to nowhere, for these are endlessly and hopelessly looped’ (<xref ref-type="bibr" rid="ref144">Kalimtzis 2000</xref>: 125).</p></fn>
</fn-group>
<fn-group><label>4</label><title>Trajectory of a pandemic drama: ebbing and waning of the BSE Crisis in 1996</title>
<fn id="fn4_1"><label>1</label><p>In a letter to a mother of a CJD victim on March 19, 1997, British Prime Minister John Major maintained that no link existed between BSE and CJD.</p></fn>
<fn id="fn4_2"><label>2</label><p>The necessity of the sense of rhythm in wise politics is most prominently pictured in Machiavelli. Success in political games depends on the ability to act at the right time, which is facilitated by prudent understanding of the moment's requirements and by a sense of political rhythm.</p></fn>
<fn id="fn4_3"><label>3</label><p>The British attempt to restrain and subdue the measures unleashed by the EU ban on British beef by blocking the EU's decision making offers a case in point of an innovative venture of giving a new appearance to an acute problem in order to enable the international actors to better manage the situation.</p></fn>
<fn id="fn4_4"><label>4</label><p>The public health model concentrates on a problem solving perspective that is mainly medical in its character. First, the problem is defined and then the procedures that have worked previously in similar situations are vigorously and painstakingly applied. The emphasis is not on the other, more social and political aspects of a disease such as economic welfare, trade and poverty, which are considered important, but secondary to the main objective of controlling the outbreak.</p></fn>
<fn id="fn4_5"><label>5</label><p>In a letter to the mother of a CJD victim on March 19, 1997, British Prime Minister John Major maintained that no link existed between BSE and CJD.</p></fn>
<fn id="fn4_6"><label>6</label><p><xref ref-type="bibr" rid="ref019">Baker and Ridley (1996</xref>: 239–40) report on the difficulty of arriving at conclusive scientific evidence:
<disp-quote>
<p>[a] major problem in studying prion diseases results from the long time course over which these diseases develop. Although the incubation period may be as short as a few months in some mouse and hamster adapted scrapie models, in large animals, the incubation period in acquired cases ranges from two to several years, depending on the route of contamination, and in acquired cases in humans (e.g., iatrogenic cases and kuru), it ranges from two to 30 years. This makes the collection of epidemiological data, the identification of causative events, and experimental transmission studies (other than in rodents) very difficult.</p>
</disp-quote></p></fn>
<fn id="fn4_7"><label>7</label><p>The following example from <italic>Newsweek</italic> (May 22, 1995: 19) might shed some light on these language games: ‘Until recently, most experts thought of new viral diseases as accidents of genetic mutation. But of late, they have become less fearful of random genetic change – and more terrified by the effects of human social change.’</p></fn>
<fn id="fn4_8"><label>8</label><p>The scientific side of the British argument proceeded by denying the possibility of maternal transmission of BSE and CJD, which would justify the wholesale slaughter of the offspring of affected animals. In the case of older animals, it was argued that no slaughter programme was likely to have any effect because
<disp-quote>
<p>it is impossible to target with any accuracy cattle that may be incubating BSE, and killing all 11 million cattle in the UK in less than the three–four years (by which time the epidemic will be virtually over) is not practicable.</p>
<attrib>(<xref ref-type="bibr" rid="ref019">Baker and Ridley 1996</xref>: 242)</attrib>
</disp-quote></p></fn>
</fn-group>
<fn-group>
<label><xref ref-type="page" id="page_192"></xref>5</label><title>Vortexes of SARS: anxieties over global air mobility</title>
<fn id="fn5_1"><label>1</label><p>‘O'Neil, Fauci Discuss President's AIDS Initiatives’, May 3, 2003, White House.</p></fn>
<fn id="fn5_2"><label>2</label><p>This worried and fearful Western affective was captured by <xref ref-type="bibr" rid="ref135">Ikenberry (2004</xref>: 146): ‘will the American empire suffer the fate of great empires of the past: ravaging the world with its ambitions and excesses until overextension, miscalculations, and mounting opposition hasten its collapse?’</p></fn>
<fn id="fn5_3"><label>3</label><p>‘Joint Statement between the United States of America and Singapore,’ May 6, 2003, White House.</p></fn>
<fn id="fn5_4"><label>4</label><p>‘Expert Commission Links Spread of SARS, China's Legal System,’ May 10, 2003, US State Department.</p></fn>
<fn id="fn5_5"><label>5</label><p>‘Expert Commission Links Spread of SARS, China's Legal System,’ May 10, 2003, US State Department.</p></fn>
<fn id="fn5_6"><label>6</label><p>‘Fact Sheet: Health Security Initiative,’ October 21, 2003:
<disp-quote>
<p>The across-the-board improvements to the nation's biodefense capabilities have vastly increased day-to-day security for all Americans, not only against threats posed by terrorists, but for medical response in the wake of natural catastrophes and in response to naturally-occurring biological hazards such as SARS.</p>
</disp-quote></p></fn>
<fn id="fn5_7"><label>7</label><p>‘Joint Statement between the United States of America and Singapore,’ May 6, 2003.</p></fn>
<fn id="fn5_8"><label>8</label><p>‘Biodefense Fact Sheet,’ April 28, 2004.</p></fn>
<fn id="fn5_9"><label>9</label><p>In the case of the Spanish fu, the mass mobilization of armies, together with new transportation technologies, provided a breeding ground for the first influenza pandemic. In studies of general influenza, the disease is often connected with the coming into being of the global transportation infrastructure: ‘not until the 1889–90 pandemic, when railroads and steamships were available to transport man and virus, can we document a truly worldwide pandemic. Earlier influenza outbreaks were more localized and the global seasonal pattern harder to discern’ (<xref ref-type="bibr" rid="ref207">Patterson 1986</xref>: 10).</p></fn>
<fn id="fn5_10"><label>10</label><p>Abandoned dwellings and ruins in the landscape have always been telltale signs of epidemics or endemic diseases (<xref ref-type="bibr" rid="ref128">Hoskins 1970</xref>: 120).</p></fn>
<fn id="fn5_11"><label>11</label><p>Perhaps, to fight off this connotation, <xref ref-type="bibr" rid="ref145">Kaplan (1994</xref>: 70), who himself is a frequent intercontinental traveller, states that ‘merely to visit West Africa in some degree of safety, I spent about $500 for a hepatitis B vaccination series and other disease prophylaxis.’</p></fn>
<fn id="fn5_12"><label>12</label><p><xref ref-type="bibr" rid="ref147">Kaplan (2005</xref>: 53) calls aircraft carriers ‘the supreme icon of American wealth and power’ and <xref ref-type="bibr" rid="ref127">Horowitz (2010</xref>: 65) declares that ‘short of the atomic bomb, nothing signifies the power of a great nation like … a fleet of aircraft carriers’.</p></fn>
<fn id="fn5_13"><label>13</label><p><xref ref-type="bibr" rid="ref101">Goffman (1974</xref>: 2). For revelatory epistemology – i.e., non-cognitive moments of knowledge disclosures – see <xref ref-type="bibr" rid="ref139">James (1985</xref>: 352).</p></fn>
</fn-group>
<fn-group>
<label>6</label><title>The pandemic geography of Avian Flu</title>
<fn id="fn6_1"><label>1</label><p>Examples of trying to save face by hiding and concealing are numerous. For example, the fear that a disease could be seen as a symbol of a state that is in ruins, with the corresponding political and economic consequences, led the Gabonese government to try and hide an outbreak of Ebola in 1996 and to confiscate blood samples from international health workers (<xref ref-type="bibr" rid="ref262">Troy 1996</xref>: 22). A further example of attempts to conceal an epidemic disease is provided by Thailand's efforts to conceal an outbreak of cholera in 1997 by calling it ‘severe diarrhoea.’</p></fn>
<fn id="fn6_2"><label>2</label><p>For the use of different truth theories in the pandemic context, see <xref ref-type="bibr" rid="ref114">Hammond (2007</xref>: 19–20).</p></fn>
<fn id="fn6_3"><label>3</label><p>All the translations from Finnish are mine.</p></fn>
</fn-group>
<fn-group>
<label><xref ref-type="page" id="page_193"></xref>7</label><title>Beyond global public health</title>
<fn id="fn7_1"><label>1</label><p>A language game ties words together with simple actions and things: ‘the term, “language game,” is meant to bring into prominence the fact that the speaking of language is part of an activity or of a form of life’ (<xref ref-type="bibr" rid="ref278">Wittgenstein 1968</xref>: 34).</p></fn>
<fn id="fn7_2"><label>2</label><p><italic>HIV/AIDS Media Manual 2005</italic>. <uri>www.aidsandmedia.net/manual05.htm</uri></p></fn>
<fn id="fn7_3"><label>3</label><p><uri>www.redcrossalabama.org/all.htm</uri></p></fn>
<fn id="fn7_4"><label>4</label><p>The root causes of most violent epidemics can be traced to the multilevel political structures and dynamics which provide the macro-level context for the disease causing agents (<xref ref-type="bibr" rid="ref090">Fassin 2007</xref>; <xref ref-type="bibr" rid="ref088">Farmer 2004</xref>; <xref ref-type="bibr" rid="ref142">Joralemon 2009</xref>).</p></fn>
<fn id="fn7_5"><label>5</label><p>Western public heath discourse appears to use the tropes of ‘lifestyle’ and ‘way of life’ to articulate the broader, more encompassing normative vision that accounts for social, economic and political structures (<xref ref-type="bibr" rid="ref255">Tesh 1988</xref>).</p></fn>
</fn-group>
</notes>
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</ref-list>
<sec sec-type="index">
<title><xref ref-type="page" id="page_206"></xref>Index</title>
<list list-type="simple">
<list-item><p>9/11 <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_58">58</xref>, <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_73">73</xref>, <xref ref-type="page" rid="page_84">84</xref>–<xref ref-type="page" rid="page_86">6</xref>, <xref ref-type="page" rid="page_112">112</xref>, <xref ref-type="page" rid="page_113">113</xref>, <xref ref-type="page" rid="page_131">131</xref>, <xref ref-type="page" rid="page_140">140</xref>, <xref ref-type="page" rid="page_154">154</xref>, <xref ref-type="page" rid="page_164">164</xref></p></list-item>
<list-item><p>Aaltola <xref ref-type="page" rid="page_1">1</xref>–<xref ref-type="page" rid="page_2">2</xref>, <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_78">78</xref>, <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_132">132</xref></p></list-item>
<list-item><p>Africa <xref ref-type="page" rid="page_1">1</xref>, <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_49">49</xref>, <xref ref-type="page" rid="page_51">51</xref>, <xref ref-type="page" rid="page_78">78</xref>, <xref ref-type="page" rid="page_82">82</xref>, <xref ref-type="page" rid="page_122">122</xref>, <xref ref-type="page" rid="page_124">124</xref>–<xref ref-type="page" rid="page_126">6</xref>,<xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_153">153</xref>, <xref ref-type="page" rid="page_154">154</xref>, <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_168">168</xref>–<xref ref-type="page" rid="page_170">70</xref>, <xref ref-type="page" rid="page_185">185</xref>, <xref ref-type="page" rid="page_186">186</xref></p></list-item>
<list-item><p>airlines <xref ref-type="page" rid="page_114">114</xref>, <xref ref-type="page" rid="page_131">131</xref>, <xref ref-type="page" rid="page_132">132</xref>, <xref ref-type="page" rid="page_139">139</xref></p></list-item>
<list-item><p>airport <xref ref-type="page" rid="page_53">53</xref>, <xref ref-type="page" rid="page_114">114</xref>, <xref ref-type="page" rid="page_118">118</xref>, <xref ref-type="page" rid="page_119">119</xref>, <xref ref-type="page" rid="page_124">124</xref>, <xref ref-type="page" rid="page_125">125</xref>, <xref ref-type="page" rid="page_130">130</xref>–<xref ref-type="page" rid="page_132">2</xref>,<xref ref-type="page" rid="page_136">136</xref>, <xref ref-type="page" rid="page_137">137</xref>, <xref ref-type="page" rid="page_140">140</xref>, <xref ref-type="page" rid="page_141">141</xref></p></list-item>
<list-item><p>anarchy <xref ref-type="page" rid="page_14">14</xref>, <xref ref-type="page" rid="page_18">18</xref>, <xref ref-type="page" rid="page_24">24</xref>–<xref ref-type="page" rid="page_28">8</xref>, <xref ref-type="page" rid="page_30">30</xref>, <xref ref-type="page" rid="page_124">124</xref>–<xref ref-type="page" rid="page_126">6</xref>, <xref ref-type="page" rid="page_183">183</xref></p></list-item>
<list-item><p>Aristotle <xref ref-type="page" rid="page_38">38</xref>, <xref ref-type="page" rid="page_65">65</xref>, <xref ref-type="page" rid="page_124">124</xref></p></list-item>
<list-item><p>Asia <xref ref-type="page" rid="page_123">123</xref>, <xref ref-type="page" rid="page_146">146</xref>, <xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_154">154</xref>, <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_165">165</xref>–<xref ref-type="page" rid="page_167">7</xref>, <xref ref-type="page" rid="page_169">169</xref>,<xref ref-type="page" rid="page_170">170</xref></p></list-item>
<list-item><p>Athens <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_26">26</xref>, <xref ref-type="page" rid="page_27">27</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_64">64</xref>, <xref ref-type="page" rid="page_66">66</xref>, <xref ref-type="page" rid="page_67">67</xref>, <xref ref-type="page" rid="page_69">69</xref></p></list-item>
<list-item><p>avian flu <xref ref-type="page" rid="page_2">2</xref>, <xref ref-type="page" rid="page_5">5</xref>, <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_38">38</xref>, <xref ref-type="page" rid="page_41">41</xref>, <xref ref-type="page" rid="page_110">110</xref>, <xref ref-type="page" rid="page_143">143</xref>,<xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_151">151</xref>, <xref ref-type="page" rid="page_154">154</xref>, <xref ref-type="page" rid="page_155">155</xref>, <xref ref-type="page" rid="page_159">159</xref>–<xref ref-type="page" rid="page_166">66</xref>, <xref ref-type="page" rid="page_168">168</xref>–<xref ref-type="page" rid="page_173">73</xref>,<xref ref-type="page" rid="page_176">176</xref>, <xref ref-type="page" rid="page_180">180</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Baltic Sea <xref ref-type="page" rid="page_166">166</xref></p></list-item>
<list-item><p>Barr, Stephen <xref ref-type="page" rid="page_120">120</xref></p></list-item>
<list-item><p>Barthes, Roland <xref ref-type="page" rid="page_27">27</xref>, <xref ref-type="page" rid="page_36">36</xref></p></list-item>
<list-item><p>Beck, Ulrich <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_142">142</xref></p></list-item>
<list-item><p>biodefense <xref ref-type="page" rid="page_117">117</xref></p></list-item>
<list-item><p>biological warfare <xref ref-type="page" rid="page_116">116</xref></p></list-item>
<list-item><p>Bosnia <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_39">39</xref>, <xref ref-type="page" rid="page_72">72</xref></p></list-item>
<list-item><p>bovine spongiform encephalopathy (BSE) <xref ref-type="page" rid="page_5">5</xref>, <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_88">88</xref>–<xref ref-type="page" rid="page_110">110</xref>, <xref ref-type="page" rid="page_114">114</xref>, <xref ref-type="page" rid="page_115">115</xref>, <xref ref-type="page" rid="page_143">143</xref>, <xref ref-type="page" rid="page_148">148</xref>,<xref ref-type="page" rid="page_154">154</xref>, <xref ref-type="page" rid="page_162">162</xref>, <xref ref-type="page" rid="page_172">172</xref></p></list-item>
<list-item><p>Bruno, Giordano <xref ref-type="page" rid="page_156">156</xref>,<xref ref-type="page" rid="page_157">157</xref> Bush, George <xref ref-type="page" rid="page_38">38</xref>, <xref ref-type="page" rid="page_41">41</xref>, <xref ref-type="page" rid="page_78">78</xref>, <xref ref-type="page" rid="page_112">112</xref>, <xref ref-type="page" rid="page_115">115</xref>, <xref ref-type="page" rid="page_116">116</xref>,<xref ref-type="page" rid="page_185">185</xref>, <xref ref-type="page" rid="page_186">186</xref></p></list-item>
<list-item><p>Böcklin, Arnold <xref ref-type="page" rid="page_48">48</xref>–<xref ref-type="page" rid="page_49">9</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Camus, Albert <xref ref-type="page" rid="page_147">147</xref></p></list-item>
<list-item><p>Canada <xref ref-type="page" rid="page_55">55</xref>, <xref ref-type="page" rid="page_88">88</xref>, <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_118">118</xref>, <xref ref-type="page" rid="page_123">123</xref>, <xref ref-type="page" rid="page_137">137</xref>, <xref ref-type="page" rid="page_140">140</xref></p></list-item>
<list-item><p>Carter, Jimmy <xref ref-type="page" rid="page_83">83</xref></p></list-item>
<list-item><p>Centers for Disease Control and Prevention (CDC) <xref ref-type="page" rid="page_55">55</xref>, <xref ref-type="page" rid="page_112">112</xref>, <xref ref-type="page" rid="page_133">133</xref>, <xref ref-type="page" rid="page_165">165</xref>, <xref ref-type="page" rid="page_182">182</xref></p></list-item>
<list-item><p>China <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_13">13</xref>, <xref ref-type="page" rid="page_46">46</xref>, <xref ref-type="page" rid="page_59">59</xref>, <xref ref-type="page" rid="page_115">115</xref>, <xref ref-type="page" rid="page_116">116</xref>, <xref ref-type="page" rid="page_119">119</xref>, <xref ref-type="page" rid="page_123">123</xref>, <xref ref-type="page" rid="page_131">131</xref>, <xref ref-type="page" rid="page_132">132</xref>, <xref ref-type="page" rid="page_135">135</xref>, <xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_162">162</xref>, <xref ref-type="page" rid="page_163">163</xref>–<xref ref-type="page" rid="page_166">6</xref></p></list-item>
<list-item><p>cholera <xref ref-type="page" rid="page_22">22</xref>, <xref ref-type="page" rid="page_24">24</xref>, <xref ref-type="page" rid="page_31">31</xref>–<xref ref-type="page" rid="page_33">3</xref>, <xref ref-type="page" rid="page_100">100</xref>, <xref ref-type="page" rid="page_160">160</xref></p></list-item>
<list-item><p>Cipolla, Carlo <xref ref-type="page" rid="page_29">29</xref>–<xref ref-type="page" rid="page_31">31</xref></p></list-item>
<list-item><p>combinatorics <xref ref-type="page" rid="page_175">175</xref>–<xref ref-type="page" rid="page_177">7</xref></p></list-item>
<list-item><p>compassion <xref ref-type="page" rid="page_1">1</xref>, <xref ref-type="page" rid="page_10">10</xref>, <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_18">18</xref>, <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_33">33</xref>–<xref ref-type="page" rid="page_37">7</xref>, <xref ref-type="page" rid="page_39">39</xref>–<xref ref-type="page" rid="page_41">41</xref>,<xref ref-type="page" rid="page_48">48</xref>–<xref ref-type="page" rid="page_50">50</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_69">69</xref>–<xref ref-type="page" rid="page_76">76</xref>, <xref ref-type="page" rid="page_78">78</xref>–<xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_84">84</xref>–<xref ref-type="page" rid="page_86">6</xref>, <xref ref-type="page" rid="page_123">123</xref>,<xref ref-type="page" rid="page_125">125</xref>, <xref ref-type="page" rid="page_174">174</xref></p></list-item>
<list-item><p>contagion <xref ref-type="page" rid="page_4">4</xref>, <xref ref-type="page" rid="page_10">10</xref>–<xref ref-type="page" rid="page_14">14</xref>, <xref ref-type="page" rid="page_31">31</xref>, <xref ref-type="page" rid="page_44">44</xref>, <xref ref-type="page" rid="page_45">45</xref>, <xref ref-type="page" rid="page_50">50</xref>, <xref ref-type="page" rid="page_60">60</xref>, <xref ref-type="page" rid="page_63">63</xref>,<xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_76">76</xref>, <xref ref-type="page" rid="page_80">80</xref>–<xref ref-type="page" rid="page_82">2</xref>, <xref ref-type="page" rid="page_86">86</xref>, <xref ref-type="page" rid="page_119">119</xref>, <xref ref-type="page" rid="page_120">120</xref>, <xref ref-type="page" rid="page_125">125</xref>, <xref ref-type="page" rid="page_127">127</xref>,<xref ref-type="page" rid="page_134">134</xref>, <xref ref-type="page" rid="page_162">162</xref></p></list-item>
<list-item><p>containment <xref ref-type="page" rid="page_1">1</xref>, <xref ref-type="page" rid="page_10">10</xref>, <xref ref-type="page" rid="page_13">13</xref>, <xref ref-type="page" rid="page_14">14</xref>, <xref ref-type="page" rid="page_18">18</xref>, <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_22">22</xref>, <xref ref-type="page" rid="page_33">33</xref>, <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_39">39</xref>–<xref ref-type="page" rid="page_50">50</xref>, <xref ref-type="page" rid="page_52">52</xref>–<xref ref-type="page" rid="page_55">5</xref>, <xref ref-type="page" rid="page_57">57</xref>, <xref ref-type="page" rid="page_58">58</xref>, <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_71">71</xref>, <xref ref-type="page" rid="page_73">73</xref>–<xref ref-type="page" rid="page_76">6</xref>,<xref ref-type="page" rid="page_78">78</xref>–<xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_85">85</xref>, <xref ref-type="page" rid="page_94">94</xref>, <xref ref-type="page" rid="page_113">113</xref>–<xref ref-type="page" rid="page_115">15</xref>, <xref ref-type="page" rid="page_118">118</xref>, <xref ref-type="page" rid="page_121">121</xref>,<xref ref-type="page" rid="page_123">123</xref>–<xref ref-type="page" rid="page_130">30</xref>, <xref ref-type="page" rid="page_133">133</xref>, <xref ref-type="page" rid="page_134">134</xref>, <xref ref-type="page" rid="page_137">137</xref>, <xref ref-type="page" rid="page_138">138</xref>, <xref ref-type="page" rid="page_142">142</xref>, <xref ref-type="page" rid="page_143">143</xref>,<xref ref-type="page" rid="page_145">145</xref>, <xref ref-type="page" rid="page_147">147</xref>, <xref ref-type="page" rid="page_149">149</xref>, <xref ref-type="page" rid="page_151">151</xref>–<xref ref-type="page" rid="page_153">3</xref>, <xref ref-type="page" rid="page_159">159</xref>–<xref ref-type="page" rid="page_163">63</xref>, <xref ref-type="page" rid="page_165">165</xref>, <xref ref-type="page" rid="page_166">166</xref>,<xref ref-type="page" rid="page_169">169</xref>, <xref ref-type="page" rid="page_171">171</xref>, <xref ref-type="page" rid="page_174">174</xref>, <xref ref-type="page" rid="page_183">183</xref>, <xref ref-type="page" rid="page_186">186</xref></p></list-item>
<list-item><p>cordon sanitaire <xref ref-type="page" rid="page_21">21</xref>, <xref ref-type="page" rid="page_30">30</xref>, <xref ref-type="page" rid="page_41">41</xref>, <xref ref-type="page" rid="page_42">42</xref></p></list-item>
<list-item><p>Crawford, Neta <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_74">74</xref>, <xref ref-type="page" rid="page_115">115</xref>, <xref ref-type="page" rid="page_118">118</xref>, <xref ref-type="page" rid="page_127">127</xref>, <xref ref-type="page" rid="page_133">133</xref></p></list-item>
<list-item><p>Creutzfeldt Jacob Disease (CJD) <xref ref-type="page" rid="page_88">88</xref>, <xref ref-type="page" rid="page_90">90</xref>,<xref ref-type="page" rid="page_91">91</xref>, <xref ref-type="page" rid="page_94">94</xref>–<xref ref-type="page" rid="page_96">6</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Darwin, Charles <xref ref-type="page" rid="page_56">56</xref></p></list-item>
<list-item><p>Davis, Mike <xref ref-type="page" rid="page_143">143</xref>, <xref ref-type="page" rid="page_144">144</xref></p></list-item>
<list-item><p>declinism <xref ref-type="page" rid="page_112">112</xref>, <xref ref-type="page" rid="page_125">125</xref></p></list-item>
<list-item><p>Defoe, Daniel <xref ref-type="page" rid="page_147">147</xref></p></list-item>
<list-item><p>Dewey, John <xref ref-type="page" rid="page_174">174</xref>–<xref ref-type="page" rid="page_176">6</xref></p></list-item>
<list-item><p>disease language <xref ref-type="page" rid="page_31">31</xref>, <xref ref-type="page" rid="page_42">42</xref>, <xref ref-type="page" rid="page_45">45</xref>, <xref ref-type="page" rid="page_60">60</xref>, <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_83">83</xref>, <xref ref-type="page" rid="page_89">89</xref>,<xref ref-type="page" rid="page_121">121</xref>–<xref ref-type="page" rid="page_123">3</xref>, <xref ref-type="page" rid="page_125">125</xref>, <xref ref-type="page" rid="page_144">144</xref>, <xref ref-type="page" rid="page_149">149</xref>, <xref ref-type="page" rid="page_155">155</xref>, <xref ref-type="page" rid="page_159">159</xref>, <xref ref-type="page" rid="page_171">171</xref>,<xref ref-type="page" rid="page_183">183</xref></p></list-item>
<list-item><p>distant other <xref ref-type="page" rid="page_1">1</xref>, <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_36">36</xref>, <xref ref-type="page" rid="page_71">71</xref></p></list-item>
<list-item><p>diversionary war <xref ref-type="page" rid="page_70">70</xref></p></list-item>
<list-item><p>Dorell, Stephen <xref ref-type="page" rid="page_90">90</xref>, <xref ref-type="page" rid="page_95">95</xref>, <xref ref-type="page" rid="page_97">97</xref>, <xref ref-type="page" rid="page_100">100</xref></p></list-item>
<list-item><p>Drexler, Madeline <xref ref-type="page" rid="page_145">145</xref>, <xref ref-type="page" rid="page_153">153</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>ebola <xref ref-type="page" rid="page_5">5</xref>, <xref ref-type="page" rid="page_100">100</xref>, <xref ref-type="page" rid="page_145">145</xref>, <xref ref-type="page" rid="page_154">154</xref>, <xref ref-type="page" rid="page_162">162</xref>, <xref ref-type="page" rid="page_182">182</xref></p></list-item>
<list-item><p>Egypt <xref ref-type="page" rid="page_31">31</xref>, <xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_66">66</xref></p></list-item>
<list-item><p>embodied knowledge <xref ref-type="page" rid="page_9">9</xref>, <xref ref-type="page" rid="page_11">11</xref>, <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_129">129</xref></p></list-item>
<list-item><p>emergency <xref ref-type="page" rid="page_4">4</xref>, <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_35">35</xref>–<xref ref-type="page" rid="page_42">42</xref>, <xref ref-type="page" rid="page_44">44</xref>, <xref ref-type="page" rid="page_73">73</xref>, <xref ref-type="page" rid="page_75">75</xref>, <xref ref-type="page" rid="page_76">76</xref>,
<xref ref-type="page" id="page_207"></xref>
<xref ref-type="page" rid="page_79">79</xref>–<xref ref-type="page" rid="page_81">81</xref>, <xref ref-type="page" rid="page_85">85</xref>, <xref ref-type="page" rid="page_96">96</xref>, <xref ref-type="page" rid="page_107">107</xref>, <xref ref-type="page" rid="page_109">109</xref>, <xref ref-type="page" rid="page_136">136</xref>, <xref ref-type="page" rid="page_138">138</xref>, <xref ref-type="page" rid="page_139">139</xref>,<xref ref-type="page" rid="page_169">169</xref>, <xref ref-type="page" rid="page_175">175</xref>, <xref ref-type="page" rid="page_182">182</xref>, <xref ref-type="page" rid="page_185">185</xref></p></list-item>
<list-item><p>emotions <xref ref-type="page" rid="page_5">5</xref>, <xref ref-type="page" rid="page_9">9</xref>, <xref ref-type="page" rid="page_10">10</xref>, <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_13">13</xref>, <xref ref-type="page" rid="page_40">40</xref>, <xref ref-type="page" rid="page_63">63</xref>, <xref ref-type="page" rid="page_69">69</xref>, <xref ref-type="page" rid="page_70">70</xref>,<xref ref-type="page" rid="page_72">72</xref>–<xref ref-type="page" rid="page_75">5</xref>, <xref ref-type="page" rid="page_79">79</xref>, <xref ref-type="page" rid="page_85">85</xref>–<xref ref-type="page" rid="page_87">7</xref>, <xref ref-type="page" rid="page_174">174</xref></p></list-item>
<list-item><p>Euler, Leonhard <xref ref-type="page" rid="page_120">120</xref></p></list-item>
<list-item><p>Europe <xref ref-type="page" rid="page_20">20</xref>, <xref ref-type="page" rid="page_24">24</xref>, <xref ref-type="page" rid="page_30">30</xref>–<xref ref-type="page" rid="page_32">2</xref>, <xref ref-type="page" rid="page_51">51</xref>, <xref ref-type="page" rid="page_56">56</xref>, <xref ref-type="page" rid="page_76">76</xref>, <xref ref-type="page" rid="page_88">88</xref>–<xref ref-type="page" rid="page_99">99</xref>, <xref ref-type="page" rid="page_101">101</xref>–<xref ref-type="page" rid="page_111">11</xref>, <xref ref-type="page" rid="page_114">114</xref>, <xref ref-type="page" rid="page_115">115</xref>, <xref ref-type="page" rid="page_123">123</xref>, <xref ref-type="page" rid="page_127">127</xref>, <xref ref-type="page" rid="page_146">146</xref>, <xref ref-type="page" rid="page_147">147</xref>, <xref ref-type="page" rid="page_150">150</xref>, <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_166">166</xref>, <xref ref-type="page" rid="page_167">167</xref>, <xref ref-type="page" rid="page_169">169</xref>, <xref ref-type="page" rid="page_170">170</xref>, <xref ref-type="page" rid="page_172">172</xref>, <xref ref-type="page" rid="page_179">179</xref></p></list-item>
<list-item><p>European Commission (EC) <xref ref-type="page" rid="page_89">89</xref>, <xref ref-type="page" rid="page_115">115</xref></p></list-item>
<list-item><p>European Council <xref ref-type="page" rid="page_101">101</xref>, <xref ref-type="page" rid="page_107">107</xref></p></list-item>
<list-item><p>European Union <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_76">76</xref>, <xref ref-type="page" rid="page_88">88</xref>, <xref ref-type="page" rid="page_103">103</xref>, <xref ref-type="page" rid="page_104">104</xref>, <xref ref-type="page" rid="page_172">172</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Finland <xref ref-type="page" rid="page_159">159</xref>, <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_166">166</xref>–<xref ref-type="page" rid="page_171">71</xref></p></list-item>
<list-item><p>France <xref ref-type="page" rid="page_33">33</xref>, <xref ref-type="page" rid="page_55">55</xref>, <xref ref-type="page" rid="page_88">88</xref>, <xref ref-type="page" rid="page_151">151</xref>, <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_170">170</xref></p></list-item>
<list-item><p>frequent traveller <xref ref-type="page" rid="page_127">127</xref>, <xref ref-type="page" rid="page_140">140</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Garrett, Laurie <xref ref-type="page" rid="page_117">117</xref>, <xref ref-type="page" rid="page_144">144</xref>, <xref ref-type="page" rid="page_145">145</xref>, <xref ref-type="page" rid="page_152">152</xref>, <xref ref-type="page" rid="page_153">153</xref>,<xref ref-type="page" rid="page_163">163</xref></p></list-item>
<list-item><p>Genoa <xref ref-type="page" rid="page_29">29</xref></p></list-item>
<list-item><p>Germany <xref ref-type="page" rid="page_89">89</xref>, <xref ref-type="page" rid="page_138">138</xref>, <xref ref-type="page" rid="page_139">139</xref>, <xref ref-type="page" rid="page_151">151</xref></p></list-item>
<list-item><p>global governance <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_58">58</xref>, <xref ref-type="page" rid="page_142">142</xref></p></list-item>
<list-item><p>global health governance <xref ref-type="page" rid="page_179">179</xref></p></list-item>
<list-item><p>Goffman, Erving <xref ref-type="page" rid="page_14">14</xref>, <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_130">130</xref>, <xref ref-type="page" rid="page_176">176</xref></p></list-item>
<list-item><p>Guangdong <xref ref-type="page" rid="page_115">115</xref>, <xref ref-type="page" rid="page_134">134</xref>, <xref ref-type="page" rid="page_135">135</xref>, <xref ref-type="page" rid="page_163">163</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>health security <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_77">77</xref>, <xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_116">116</xref></p></list-item>
<list-item><p>Helsingin Sanomat <xref ref-type="page" rid="page_143">143</xref>, <xref ref-type="page" rid="page_159">159</xref>, <xref ref-type="page" rid="page_166">166</xref>–<xref ref-type="page" rid="page_171">71</xref></p></list-item>
<list-item><p>Helsinki <xref ref-type="page" rid="page_169">169</xref></p></list-item>
<list-item><p>Hippocratic medicine <xref ref-type="page" rid="page_52">52</xref>, <xref ref-type="page" rid="page_62">62</xref></p></list-item>
<list-item><p>HIV/AIDS <xref ref-type="page" rid="page_2">2</xref>, <xref ref-type="page" rid="page_49">49</xref>, <xref ref-type="page" rid="page_51">51</xref>, <xref ref-type="page" rid="page_58">58</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_77">77</xref>, <xref ref-type="page" rid="page_78">78</xref>, <xref ref-type="page" rid="page_100">100</xref>,<xref ref-type="page" rid="page_116">116</xref>, <xref ref-type="page" rid="page_122">122</xref>, <xref ref-type="page" rid="page_133">133</xref>, <xref ref-type="page" rid="page_146">146</xref>–<xref ref-type="page" rid="page_148">8</xref>, <xref ref-type="page" rid="page_150">150</xref>, <xref ref-type="page" rid="page_153">153</xref>, <xref ref-type="page" rid="page_154">154</xref>,<xref ref-type="page" rid="page_178">178</xref>, <xref ref-type="page" rid="page_185">185</xref>, <xref ref-type="page" rid="page_186">186</xref></p></list-item>
<list-item><p>Hobbes, Thomas <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_24">24</xref>, <xref ref-type="page" rid="page_26">26</xref>, <xref ref-type="page" rid="page_27">27</xref></p></list-item>
<list-item><p>holocaust <xref ref-type="page" rid="page_6">6</xref>, <xref ref-type="page" rid="page_39">39</xref>, <xref ref-type="page" rid="page_144">144</xref></p></list-item>
<list-item><p>Hong Kong <xref ref-type="page" rid="page_53">53</xref>, <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_114">114</xref>, <xref ref-type="page" rid="page_118">118</xref>, <xref ref-type="page" rid="page_119">119</xref>, <xref ref-type="page" rid="page_123">123</xref>,<xref ref-type="page" rid="page_131">131</xref>, <xref ref-type="page" rid="page_133">133</xref>–<xref ref-type="page" rid="page_139">9</xref>, <xref ref-type="page" rid="page_162">162</xref>, <xref ref-type="page" rid="page_163">163</xref></p></list-item>
<list-item><p>hub-and-spoke <xref ref-type="page" rid="page_9">9</xref>, <xref ref-type="page" rid="page_13">13</xref>, <xref ref-type="page" rid="page_14">14</xref>, <xref ref-type="page" rid="page_111">111</xref>–<xref ref-type="page" rid="page_114">14</xref>, <xref ref-type="page" rid="page_117">117</xref>–<xref ref-type="page" rid="page_119">19</xref>,<xref ref-type="page" rid="page_121">121</xref>, <xref ref-type="page" rid="page_125">125</xref>, <xref ref-type="page" rid="page_128">128</xref>–<xref ref-type="page" rid="page_130">30</xref>, <xref ref-type="page" rid="page_132">132</xref>, <xref ref-type="page" rid="page_141">141</xref></p></list-item>
<list-item><p>humanitarian war <xref ref-type="page" rid="page_35">35</xref>, <xref ref-type="page" rid="page_39">39</xref>, <xref ref-type="page" rid="page_79">79</xref></p></list-item>
<list-item><p>humanitarianism <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_39">39</xref>, <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_71">71</xref>, <xref ref-type="page" rid="page_79">79</xref>, <xref ref-type="page" rid="page_85">85</xref>,<xref ref-type="page" rid="page_185">185</xref></p></list-item>
<list-item><p>humanity <xref ref-type="page" rid="page_3">3</xref>, <xref ref-type="page" rid="page_10">10</xref>, <xref ref-type="page" rid="page_13">13</xref>, <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_33">33</xref>, <xref ref-type="page" rid="page_35">35</xref>, <xref ref-type="page" rid="page_36">36</xref>, <xref ref-type="page" rid="page_39">39</xref>, <xref ref-type="page" rid="page_40">40</xref>,<xref ref-type="page" rid="page_41">41</xref>, <xref ref-type="page" rid="page_56">56</xref>, <xref ref-type="page" rid="page_59">59</xref>, <xref ref-type="page" rid="page_71">71</xref>, <xref ref-type="page" rid="page_91">91</xref>, <xref ref-type="page" rid="page_143">143</xref>–<xref ref-type="page" rid="page_145">5</xref>, <xref ref-type="page" rid="page_147">147</xref>, <xref ref-type="page" rid="page_166">166</xref>,<xref ref-type="page" rid="page_180">180</xref>–<xref ref-type="page" rid="page_182">2</xref></p></list-item>
<list-item><p>Huntington, Samuel <xref ref-type="page" rid="page_13">13</xref>, <xref ref-type="page" rid="page_14">14</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_124">124</xref></p></list-item>
<list-item><p>Hussein, Saddam <xref ref-type="page" rid="page_56">56</xref>, <xref ref-type="page" rid="page_158">158</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Ikenberry, John <xref ref-type="page" rid="page_132">132</xref></p></list-item>
<list-item><p>India <xref ref-type="page" rid="page_31">31</xref>–<xref ref-type="page" rid="page_33">3</xref>, <xref ref-type="page" rid="page_51">51</xref>, <xref ref-type="page" rid="page_126">126</xref>, <xref ref-type="page" rid="page_149">149</xref>, <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_165">165</xref>, <xref ref-type="page" rid="page_178">178</xref></p></list-item>
<list-item><p>in-group <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_37">37</xref>, <xref ref-type="page" rid="page_40">40</xref>, <xref ref-type="page" rid="page_71">71</xref>, <xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_74">74</xref>, <xref ref-type="page" rid="page_78">78</xref>–<xref ref-type="page" rid="page_82">82</xref>, <xref ref-type="page" rid="page_85">85</xref>,<xref ref-type="page" rid="page_87">87</xref>, <xref ref-type="page" rid="page_89">89</xref>, <xref ref-type="page" rid="page_122">122</xref></p></list-item>
<list-item><p>international health <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_28">28</xref>–<xref ref-type="page" rid="page_33">33</xref>, <xref ref-type="page" rid="page_54">54</xref>, <xref ref-type="page" rid="page_58">58</xref>, <xref ref-type="page" rid="page_77">77</xref>,<xref ref-type="page" rid="page_78">78</xref>, <xref ref-type="page" rid="page_97">97</xref>, <xref ref-type="page" rid="page_100">100</xref>, <xref ref-type="page" rid="page_104">104</xref></p></list-item>
<list-item><p>International Red Cross <xref ref-type="page" rid="page_41">41</xref></p></list-item>
<list-item><p>International Sanitary Conferences <xref ref-type="page" rid="page_29">29</xref>, <xref ref-type="page" rid="page_32">32</xref>,<xref ref-type="page" rid="page_33">33</xref></p></list-item>
<list-item><p>interventionism <xref ref-type="page" rid="page_35">35</xref>, <xref ref-type="page" rid="page_39">39</xref>, <xref ref-type="page" rid="page_40">40</xref>, <xref ref-type="page" rid="page_76">76</xref>–<xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_82">82</xref>, <xref ref-type="page" rid="page_85">85</xref>,<xref ref-type="page" rid="page_87">86</xref>, <xref ref-type="page" rid="page_91">91</xref></p></list-item>
<list-item><p>Iran <xref ref-type="page" rid="page_56">56</xref></p></list-item>
<list-item><p>Iraq/Afghanistan <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_73">73</xref>, <xref ref-type="page" rid="page_84">84</xref>, <xref ref-type="page" rid="page_85">85</xref>, <xref ref-type="page" rid="page_86">86</xref>,<xref ref-type="page" rid="page_122">122</xref>, <xref ref-type="page" rid="page_186">186</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>James, William <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_176">176</xref></p></list-item>
<list-item><p>Jews <xref ref-type="page" rid="page_22">22</xref>, <xref ref-type="page" rid="page_57">57</xref></p></list-item>
<list-item><p>Jung, Carl <xref ref-type="page" rid="page_56">56</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Kaplan, Robert <xref ref-type="page" rid="page_14">14</xref>, <xref ref-type="page" rid="page_124">124</xref>–<xref ref-type="page" rid="page_126">6</xref></p></list-item>
<list-item><p>Kemper, David <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_73">73</xref>, <xref ref-type="page" rid="page_74">74</xref></p></list-item>
<list-item><p>kinesis <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_64">64</xref>–<xref ref-type="page" rid="page_66">6</xref>, <xref ref-type="page" rid="page_69">69</xref>, <xref ref-type="page" rid="page_70">70</xref></p></list-item>
<list-item><p>Kosovo <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_37">37</xref>, <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_72">72</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Latour, Bruno <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_82">82</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>McNeill, William <xref ref-type="page" rid="page_3">3</xref>, <xref ref-type="page" rid="page_20">20</xref>, <xref ref-type="page" rid="page_51">51</xref>, <xref ref-type="page" rid="page_60">60</xref>, <xref ref-type="page" rid="page_61">61</xref></p></list-item>
<list-item><p>Major, John <xref ref-type="page" rid="page_102">102</xref>–<xref ref-type="page" rid="page_105">5</xref></p></list-item>
<list-item><p>medical topography <xref ref-type="page" rid="page_51">51</xref>, <xref ref-type="page" rid="page_127">127</xref></p></list-item>
<list-item><p>memory <xref ref-type="page" rid="page_48">48</xref>, <xref ref-type="page" rid="page_49">49</xref>, <xref ref-type="page" rid="page_54">54</xref>, <xref ref-type="page" rid="page_55">55</xref>, <xref ref-type="page" rid="page_65">65</xref>, <xref ref-type="page" rid="page_146">146</xref>, <xref ref-type="page" rid="page_175">175</xref>, <xref ref-type="page" rid="page_177">177</xref>,<xref ref-type="page" rid="page_182">182</xref></p></list-item>
<list-item><p>Mexico <xref ref-type="page" rid="page_1">1</xref>, <xref ref-type="page" rid="page_40">40</xref></p></list-item>
<list-item><p>migratory birds <xref ref-type="page" rid="page_165">165</xref>, <xref ref-type="page" rid="page_166">166</xref>, <xref ref-type="page" rid="page_170">170</xref></p></list-item>
<list-item><p>Millennium Development Goals <xref ref-type="page" rid="page_83">83</xref></p></list-item>
<list-item><p>morality play <xref ref-type="page" rid="page_55">55</xref>, <xref ref-type="page" rid="page_57">57</xref>, <xref ref-type="page" rid="page_91">91</xref>–<xref ref-type="page" rid="page_94">4</xref>, <xref ref-type="page" rid="page_110">110</xref>, <xref ref-type="page" rid="page_112">112</xref>, <xref ref-type="page" rid="page_152">152</xref></p></list-item>
<list-item><p>Morgenthau, Hans <xref ref-type="page" rid="page_45">45</xref>, <xref ref-type="page" rid="page_46">46</xref></p></list-item>
<list-item><p>Muslim Pilgrims <xref ref-type="page" rid="page_32">32</xref></p></list-item>
<list-item><p>Muslims <xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_39">39</xref>, <xref ref-type="page" rid="page_57">57</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>nearest-is-dearest <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_38">38</xref>, <xref ref-type="page" rid="page_75">75</xref>, <xref ref-type="page" rid="page_80">80</xref></p></list-item>
<list-item><p>New York <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_83">83</xref>, <xref ref-type="page" rid="page_124">124</xref>, <xref ref-type="page" rid="page_135">135</xref>, <xref ref-type="page" rid="page_136">136</xref>, <xref ref-type="page" rid="page_138">138</xref></p></list-item>
<list-item><p><italic>New York Times</italic> <xref ref-type="page" rid="page_143">143</xref>, <xref ref-type="page" rid="page_159">159</xref></p></list-item>
<list-item><p>Nordic <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_170">170</xref>, <xref ref-type="page" rid="page_17">17</xref></p></list-item>
<list-item><p>Norris, Frank <xref ref-type="page" rid="page_128">128</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Obama, Barack <xref ref-type="page" rid="page_83">83</xref></p></list-item>
<list-item><p>Oedipus <xref ref-type="page" rid="page_46">46</xref>–<xref ref-type="page" rid="page_47">7</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Pakistan <xref ref-type="page" rid="page_83">83</xref>, <xref ref-type="page" rid="page_126">126</xref>, <xref ref-type="page" rid="page_149">149</xref></p></list-item>
<list-item><p>pandemic <xref ref-type="page" rid="page_1">1</xref>–<xref ref-type="page" rid="page_10">10</xref>, <xref ref-type="page" rid="page_12">12</xref>–<xref ref-type="page" rid="page_20">20</xref>, <xref ref-type="page" rid="page_24">24</xref>, <xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_37">37</xref>–<xref ref-type="page" rid="page_45">45</xref>, <xref ref-type="page" rid="page_48">48</xref>, <xref ref-type="page" rid="page_53">53</xref>–<xref ref-type="page" rid="page_56">6</xref>, <xref ref-type="page" rid="page_58">58</xref>, <xref ref-type="page" rid="page_59">59</xref>, <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_70">70</xref>–<xref ref-type="page" rid="page_72">2</xref>, <xref ref-type="page" rid="page_75">75</xref>–<xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_82">82</xref>–<xref ref-type="page" rid="page_93">93</xref>, <xref ref-type="page" rid="page_110">110</xref>–<xref ref-type="page" rid="page_113">13</xref>, <xref ref-type="page" rid="page_117">117</xref>–<xref ref-type="page" rid="page_123">23</xref>, <xref ref-type="page" rid="page_125">125</xref>, <xref ref-type="page" rid="page_129">129</xref>–<xref ref-type="page" rid="page_131">31</xref>, <xref ref-type="page" rid="page_133">133</xref>, <xref ref-type="page" rid="page_134">134</xref>, <xref ref-type="page" rid="page_136">136</xref>, <xref ref-type="page" rid="page_139">139</xref>, <xref ref-type="page" rid="page_141">141</xref>–<xref ref-type="page" rid="page_143">3</xref>, <xref ref-type="page" rid="page_146">146</xref>, <xref ref-type="page" rid="page_152">152</xref>, <xref ref-type="page" rid="page_176">176</xref>, <xref ref-type="page" rid="page_187">187</xref>, <xref ref-type="page" rid="page_188">188</xref></p></list-item>
<list-item><p>passions <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_65">65</xref>, <xref ref-type="page" rid="page_69">69</xref>, <xref ref-type="page" rid="page_73">73</xref>, <xref ref-type="page" rid="page_86">86</xref>, <xref ref-type="page" rid="page_87">87</xref>, <xref ref-type="page" rid="page_183">183</xref></p></list-item>
<list-item><p>Pasteur, Louis <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_60">60</xref>, <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_133">133</xref>, <xref ref-type="page" rid="page_181">181</xref></p></list-item>
<list-item><p>patient zero <xref ref-type="page" rid="page_133">133</xref></p></list-item>
<list-item><p>Peloponnesian War <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_26">26</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_69">69</xref>, <xref ref-type="page" rid="page_185">185</xref></p></list-item>
<list-item><p>PEPFAR programme <xref ref-type="page" rid="page_78">78</xref>, <xref ref-type="page" rid="page_185">185</xref></p></list-item>
<list-item><p>Pepys, Samuel <xref ref-type="page" rid="page_147">147</xref></p></list-item>
<list-item><p>plague <xref ref-type="page" rid="page_4">4</xref>, <xref ref-type="page" rid="page_6">6</xref>–<xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_20">20</xref>–<xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_42">42</xref>, <xref ref-type="page" rid="page_45">45</xref>–<xref ref-type="page" rid="page_49">9</xref>, <xref ref-type="page" rid="page_51">51</xref>, <xref ref-type="page" rid="page_52">52</xref>,
<xref ref-type="page" id="page_208"></xref>
<xref ref-type="page" rid="page_56">56</xref>–<xref ref-type="page" rid="page_58">8</xref>, <xref ref-type="page" rid="page_60">60</xref>, <xref ref-type="page" rid="page_62">62</xref>–<xref ref-type="page" rid="page_64">4</xref>, <xref ref-type="page" rid="page_66">66</xref>–<xref ref-type="page" rid="page_69">9</xref>, <xref ref-type="page" rid="page_86">86</xref>, <xref ref-type="page" rid="page_90">90</xref>, <xref ref-type="page" rid="page_100">100</xref>, <xref ref-type="page" rid="page_113">113</xref>, <xref ref-type="page" rid="page_116">116</xref>, <xref ref-type="page" rid="page_125">125</xref>, <xref ref-type="page" rid="page_126">126</xref>, <xref ref-type="page" rid="page_142">142</xref>, <xref ref-type="page" rid="page_144">144</xref>–<xref ref-type="page" rid="page_147">7</xref>, <xref ref-type="page" rid="page_149">149</xref>, <xref ref-type="page" rid="page_151">151</xref>, <xref ref-type="page" rid="page_153">153</xref>, <xref ref-type="page" rid="page_163">163</xref>, <xref ref-type="page" rid="page_174">174</xref>, <xref ref-type="page" rid="page_183">183</xref>, <xref ref-type="page" rid="page_185">185</xref>, <xref ref-type="page" rid="page_187">187</xref></p></list-item>
<list-item><p>Plague of Athens <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_27">27</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_64">64</xref>, <xref ref-type="page" rid="page_66">66</xref>, <xref ref-type="page" rid="page_69">69</xref></p></list-item>
<list-item><p>Plato <xref ref-type="page" rid="page_26">26</xref>, <xref ref-type="page" rid="page_27">27</xref>, <xref ref-type="page" rid="page_64">64</xref></p></list-item>
<list-item><p>political pain <xref ref-type="page" rid="page_2">2</xref>, <xref ref-type="page" rid="page_37">37</xref>, <xref ref-type="page" rid="page_48">48</xref></p></list-item>
<list-item><p>political violence <xref ref-type="page" rid="page_3">3</xref>, <xref ref-type="page" rid="page_11">11</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_65">65</xref>, <xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_81">81</xref>, <xref ref-type="page" rid="page_83">83</xref>, <xref ref-type="page" rid="page_87">87</xref>, <xref ref-type="page" rid="page_149">149</xref></p></list-item>
<list-item><p>politico-somatics <xref ref-type="page" rid="page_1">1</xref>–<xref ref-type="page" rid="page_6">6</xref>, <xref ref-type="page" rid="page_10">10</xref>, <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_120">120</xref>, <xref ref-type="page" rid="page_151">151</xref>, <xref ref-type="page" rid="page_178">178</xref></p></list-item>
<list-item><p>Preston, Richard <xref ref-type="page" rid="page_145">145</xref></p></list-item>
<list-item><p>Prion <xref ref-type="page" rid="page_95">95</xref>, <xref ref-type="page" rid="page_99">99</xref>, <xref ref-type="page" rid="page_105">105</xref>, <xref ref-type="page" rid="page_110">110</xref>, <xref ref-type="page" rid="page_162">162</xref></p></list-item>
<list-item><p>public health <xref ref-type="page" rid="page_1">1</xref>, <xref ref-type="page" rid="page_3">3</xref>, <xref ref-type="page" rid="page_4">4</xref>, <xref ref-type="page" rid="page_6">6</xref>, <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_18">18</xref>, <xref ref-type="page" rid="page_19">19</xref>, <xref ref-type="page" rid="page_29">29</xref>, <xref ref-type="page" rid="page_30">30</xref>, <xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_33">33</xref>, <xref ref-type="page" rid="page_35">35</xref>, <xref ref-type="page" rid="page_41">41</xref>–<xref ref-type="page" rid="page_45">5</xref>, <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_76">76</xref>–<xref ref-type="page" rid="page_79">9</xref>, <xref ref-type="page" rid="page_82">82</xref>, <xref ref-type="page" rid="page_85">85</xref>, <xref ref-type="page" rid="page_89">89</xref>, <xref ref-type="page" rid="page_91">91</xref>–<xref ref-type="page" rid="page_93">3</xref>, <xref ref-type="page" rid="page_95">95</xref>, <xref ref-type="page" rid="page_99">99</xref>–<xref ref-type="page" rid="page_110">110</xref>, <xref ref-type="page" rid="page_112">112</xref>, <xref ref-type="page" rid="page_117">117</xref>, <xref ref-type="page" rid="page_119">119</xref>, <xref ref-type="page" rid="page_141">141</xref>, <xref ref-type="page" rid="page_142">142</xref>, <xref ref-type="page" rid="page_144">144</xref>, <xref ref-type="page" rid="page_145">145</xref>, <xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_150">150</xref>–<xref ref-type="page" rid="page_153">3</xref>, <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_163">163</xref>, <xref ref-type="page" rid="page_165">165</xref>, <xref ref-type="page" rid="page_166">166</xref>, <xref ref-type="page" rid="page_172">172</xref>, <xref ref-type="page" rid="page_179">179</xref>–<xref ref-type="page" rid="page_184">84</xref>, <xref ref-type="page" rid="page_186">186</xref>, <xref ref-type="page" rid="page_187">187</xref></p></list-item>
<list-item><p>pull factors <xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_82">82</xref></p></list-item>
<list-item><p>push factors <xref ref-type="page" rid="page_79">79</xref>, <xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_82">82</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>quarantine <xref ref-type="page" rid="page_21">21</xref>–<xref ref-type="page" rid="page_23">3</xref>, <xref ref-type="page" rid="page_25">25</xref>, <xref ref-type="page" rid="page_29">29</xref>–<xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_41">41</xref>–<xref ref-type="page" rid="page_43">3</xref>, <xref ref-type="page" rid="page_53">53</xref>, <xref ref-type="page" rid="page_114">114</xref>, <xref ref-type="page" rid="page_116">116</xref>, <xref ref-type="page" rid="page_130">130</xref>, <xref ref-type="page" rid="page_131">131</xref>, <xref ref-type="page" rid="page_138">138</xref>, <xref ref-type="page" rid="page_161">161</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Raphael <xref ref-type="page" rid="page_47">47</xref>–<xref ref-type="page" rid="page_49">9</xref>, <xref ref-type="page" rid="page_174">174</xref></p></list-item>
<list-item><p>Regression <xref ref-type="page" rid="page_4">4</xref>, <xref ref-type="page" rid="page_6">6</xref>, <xref ref-type="page" rid="page_48">48</xref>–<xref ref-type="page" rid="page_50">50</xref>, <xref ref-type="page" rid="page_61">61</xref>–<xref ref-type="page" rid="page_64">4</xref>, <xref ref-type="page" rid="page_66">66</xref>, <xref ref-type="page" rid="page_69">69</xref>, <xref ref-type="page" rid="page_72">72</xref>,<xref ref-type="page" rid="page_76">76</xref>, <xref ref-type="page" rid="page_79">79</xref>, <xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_84">84</xref>–<xref ref-type="page" rid="page_87">7</xref>, <xref ref-type="page" rid="page_114">114</xref>, <xref ref-type="page" rid="page_126">126</xref>, <xref ref-type="page" rid="page_127">127</xref>, <xref ref-type="page" rid="page_129">129</xref>,<xref ref-type="page" rid="page_152">152</xref></p></list-item>
<list-item><p>Rogue, failed <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_36">36</xref>, <xref ref-type="page" rid="page_37">37</xref>, <xref ref-type="page" rid="page_56">56</xref>–<xref ref-type="page" rid="page_58">8</xref>, <xref ref-type="page" rid="page_185">185</xref></p></list-item>
<list-item><p>Rorty, Richard <xref ref-type="page" rid="page_38">38</xref></p></list-item>
<list-item><p>Rwanda <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_85">85</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Scarry, Elaine <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_24">24</xref></p></list-item>
<list-item><p>sea imagery <xref ref-type="page" rid="page_26">26</xref></p></list-item>
<list-item><p>Serbia <xref ref-type="page" rid="page_37">37</xref></p></list-item>
<list-item><p>severe acute respiratory syndrome (SARS) <xref ref-type="page" rid="page_5">5</xref>, <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_13">13</xref>, <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_38">38</xref>, <xref ref-type="page" rid="page_43">43</xref>, <xref ref-type="page" rid="page_53">53</xref>, <xref ref-type="page" rid="page_59">59</xref>, <xref ref-type="page" rid="page_110">110</xref>–<xref ref-type="page" rid="page_120">20</xref>, <xref ref-type="page" rid="page_122">122</xref>, <xref ref-type="page" rid="page_128">128</xref>–<xref ref-type="page" rid="page_131">31</xref>, <xref ref-type="page" rid="page_133">133</xref>–<xref ref-type="page" rid="page_143">43</xref>, <xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_164">164</xref>, <xref ref-type="page" rid="page_180">180</xref>, <xref ref-type="page" rid="page_182">182</xref></p></list-item>
<list-item><p>Siddiqi, Javed <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_29">29</xref>, <xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_33">33</xref>, <xref ref-type="page" rid="page_59">59</xref></p></list-item>
<list-item><p>Singapore <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_114">114</xref>–<xref ref-type="page" rid="page_116">16</xref>, <xref ref-type="page" rid="page_118">118</xref>, <xref ref-type="page" rid="page_119">119</xref>, <xref ref-type="page" rid="page_135">135</xref>, <xref ref-type="page" rid="page_137">137</xref>, <xref ref-type="page" rid="page_138">138</xref></p></list-item>
<list-item><p>sociosomatics <xref ref-type="page" rid="page_2">2</xref></p></list-item>
<list-item><p>Somalia <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_85">85</xref>, <xref ref-type="page" rid="page_86">86</xref></p></list-item>
<list-item><p>Sontag, Susan <xref ref-type="page" rid="page_4">4</xref>, <xref ref-type="page" rid="page_11">11</xref>, <xref ref-type="page" rid="page_84">84</xref>, <xref ref-type="page" rid="page_178">178</xref></p></list-item>
<list-item><p>Sophocles <xref ref-type="page" rid="page_46">46</xref>, <xref ref-type="page" rid="page_49">49</xref></p></list-item>
<list-item><p>Soviet Union <xref ref-type="page" rid="page_2">2</xref>, <xref ref-type="page" rid="page_45">45</xref>, <xref ref-type="page" rid="page_150">150</xref></p></list-item>
<list-item><p>Spanish influenza <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_150">150</xref></p></list-item>
<list-item><p>St. Augustine <xref ref-type="page" rid="page_25">25</xref>–<xref ref-type="page" rid="page_29">9</xref></p></list-item>
<list-item><p>stasis <xref ref-type="page" rid="page_27">27</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_64">64</xref>–<xref ref-type="page" rid="page_69">9</xref>, <xref ref-type="page" rid="page_86">86</xref></p></list-item>
<list-item><p>state <xref ref-type="page" rid="page_2">2</xref>–<xref ref-type="page" rid="page_4">4</xref>, <xref ref-type="page" rid="page_6">6</xref>–<xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_11">11</xref>, <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_18">18</xref>, <xref ref-type="page" rid="page_20">20</xref>–<xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_34">34</xref>, <xref ref-type="page" rid="page_35">35</xref>, <xref ref-type="page" rid="page_37">37</xref>, <xref ref-type="page" rid="page_38">38</xref>, <xref ref-type="page" rid="page_42">42</xref>–<xref ref-type="page" rid="page_44">4</xref>, <xref ref-type="page" rid="page_46">46</xref>, <xref ref-type="page" rid="page_47">47</xref>, <xref ref-type="page" rid="page_50">50</xref>–<xref ref-type="page" rid="page_53">3</xref>, <xref ref-type="page" rid="page_55">55</xref>–<xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_64">64</xref>, <xref ref-type="page" rid="page_65">65</xref>, <xref ref-type="page" rid="page_67">67</xref>, <xref ref-type="page" rid="page_71">71</xref>, <xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_74">74</xref>, <xref ref-type="page" rid="page_76">76</xref>–<xref ref-type="page" rid="page_90">90</xref>, <xref ref-type="page" rid="page_92">92</xref>, <xref ref-type="page" rid="page_93">93</xref>, <xref ref-type="page" rid="page_96">96</xref>–<xref ref-type="page" rid="page_99">9</xref>, <xref ref-type="page" rid="page_103">103</xref>–<xref ref-type="page" rid="page_105">5</xref>, <xref ref-type="page" rid="page_110">110</xref>, <xref ref-type="page" rid="page_116">116</xref>, <xref ref-type="page" rid="page_120">120</xref>, <xref ref-type="page" rid="page_122">122</xref>,<xref ref-type="page" rid="page_126">126</xref>, <xref ref-type="page" rid="page_140">140</xref>, <xref ref-type="page" rid="page_142">142</xref>, <xref ref-type="page" rid="page_146">146</xref>, <xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_149">149</xref>, <xref ref-type="page" rid="page_152">152</xref>–<xref ref-type="page" rid="page_154">4</xref>,<xref ref-type="page" rid="page_168">168</xref>, <xref ref-type="page" rid="page_170">170</xref>, <xref ref-type="page" rid="page_171">171</xref>, <xref ref-type="page" rid="page_179">179</xref>, <xref ref-type="page" rid="page_181">181</xref>, <xref ref-type="page" rid="page_182">182</xref></p></list-item>
<list-item><p>Steinglass, Matt <xref ref-type="page" rid="page_143">143</xref>, <xref ref-type="page" rid="page_144">144</xref></p></list-item>
<list-item><p>supernatural <xref ref-type="page" rid="page_22">22</xref>, <xref ref-type="page" rid="page_24">24</xref></p></list-item>
<list-item><p>Surat <xref ref-type="page" rid="page_149">149</xref></p></list-item>
<list-item><p>Sweden <xref ref-type="page" rid="page_170">170</xref></p></list-item>
<list-item><p>swine flu <xref ref-type="page" rid="page_1">1</xref>, <xref ref-type="page" rid="page_5">5</xref>, <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_40">40</xref>, <xref ref-type="page" rid="page_58">58</xref>, <xref ref-type="page" rid="page_142">142</xref>, <xref ref-type="page" rid="page_148">148</xref>,<xref ref-type="page" rid="page_173">173</xref></p></list-item>
<list-item><p>sympathy <xref ref-type="page" rid="page_38">38</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>terrorism <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_11">11</xref>, <xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_83">83</xref>, <xref ref-type="page" rid="page_84">84</xref>, <xref ref-type="page" rid="page_117">117</xref>, <xref ref-type="page" rid="page_134">134</xref>, <xref ref-type="page" rid="page_144">144</xref></p></list-item>
<list-item><p>theatre of proof <xref ref-type="page" rid="page_15">15</xref>, <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_58">58</xref>, <xref ref-type="page" rid="page_59">59</xref>, <xref ref-type="page" rid="page_82">82</xref>, <xref ref-type="page" rid="page_185">185</xref></p></list-item>
<list-item><p>Thucydides <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_26">26</xref>, <xref ref-type="page" rid="page_27">27</xref>, <xref ref-type="page" rid="page_51">51</xref>, <xref ref-type="page" rid="page_62">62</xref>–<xref ref-type="page" rid="page_69">9</xref>, <xref ref-type="page" rid="page_86">86</xref>, <xref ref-type="page" rid="page_87">87</xref>,<xref ref-type="page" rid="page_147">147</xref>, <xref ref-type="page" rid="page_183">183</xref>, <xref ref-type="page" rid="page_185">185</xref></p></list-item>
<list-item><p>topology <xref ref-type="page" rid="page_119">119</xref>–<xref ref-type="page" rid="page_121">21</xref>, <xref ref-type="page" rid="page_124">124</xref>, <xref ref-type="page" rid="page_126">126</xref></p></list-item>
<list-item><p>Toronto <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_114">114</xref>, <xref ref-type="page" rid="page_131">131</xref>, <xref ref-type="page" rid="page_137">137</xref></p></list-item>
<list-item><p>Toscana <xref ref-type="page" rid="page_29">29</xref></p></list-item>
<list-item><p>travelogue <xref ref-type="page" rid="page_118">118</xref>, <xref ref-type="page" rid="page_140">140</xref></p></list-item>
<list-item><p>Tuan, Yi-Fu <xref ref-type="page" rid="page_2">2</xref>, <xref ref-type="page" rid="page_18">18</xref>, <xref ref-type="page" rid="page_183">183</xref></p></list-item>
<list-item><p>tuberculosis <xref ref-type="page" rid="page_55">55</xref>, <xref ref-type="page" rid="page_77">77</xref>, <xref ref-type="page" rid="page_100">100</xref>, <xref ref-type="page" rid="page_138">138</xref>, <xref ref-type="page" rid="page_146">146</xref>, <xref ref-type="page" rid="page_151">151</xref>,<xref ref-type="page" rid="page_153">153</xref></p></list-item>
<list-item><p>Turkey <xref ref-type="page" rid="page_31">31</xref>–<xref ref-type="page" rid="page_33">3</xref>, <xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_160">160</xref>, <xref ref-type="page" rid="page_168">168</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>United Kingdom (Britain) <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_88">88</xref>, <xref ref-type="page" rid="page_90">90</xref>,<xref ref-type="page" rid="page_93">93</xref>, <xref ref-type="page" rid="page_94">94</xref>, <xref ref-type="page" rid="page_101">101</xref>, <xref ref-type="page" rid="page_103">103</xref>, <xref ref-type="page" rid="page_106">106</xref>, <xref ref-type="page" rid="page_107">107</xref>, <xref ref-type="page" rid="page_148">148</xref></p></list-item>
<list-item><p>United Nations <xref ref-type="page" rid="page_89">89</xref></p></list-item>
<list-item><p>United States <xref ref-type="page" rid="page_2">2</xref>, <xref ref-type="page" rid="page_55">55</xref>, <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_88">88</xref>, <xref ref-type="page" rid="page_185">185</xref></p></list-item>
<list-item><p>Urbani, Carlo <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_136">136</xref>, <xref ref-type="page" rid="page_182">182</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>Vietnam <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_118">118</xref>, <xref ref-type="page" rid="page_119">119</xref>, <xref ref-type="page" rid="page_137">137</xref>, <xref ref-type="page" rid="page_182">182</xref></p></list-item>
<list-item><p>Voegelin, Eric <xref ref-type="page" rid="page_157">157</xref></p></list-item>
<list-item><p>vortex <xref ref-type="page" rid="page_7">7</xref>, <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_13">13</xref>, <xref ref-type="page" rid="page_26">26</xref>, <xref ref-type="page" rid="page_48">48</xref>, <xref ref-type="page" rid="page_54">54</xref>, <xref ref-type="page" rid="page_60">60</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_64">64</xref>, <xref ref-type="page" rid="page_65">65</xref>,<xref ref-type="page" rid="page_69">69</xref>, <xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_73">73</xref>, <xref ref-type="page" rid="page_80">80</xref>, <xref ref-type="page" rid="page_84">84</xref>, <xref ref-type="page" rid="page_86">86</xref>, <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_113">113</xref>, <xref ref-type="page" rid="page_143">143</xref></p></list-item>
<list-item><p>vortex of war <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_60">60</xref>, <xref ref-type="page" rid="page_62">62</xref>, <xref ref-type="page" rid="page_64">64</xref>, <xref ref-type="page" rid="page_69">69</xref>, <xref ref-type="page" rid="page_113">113</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>war <xref ref-type="page" rid="page_4">4</xref>, <xref ref-type="page" rid="page_6">6</xref>–<xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_11">11</xref>, <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_21">21</xref>, <xref ref-type="page" rid="page_25">25</xref>–<xref ref-type="page" rid="page_28">8</xref>, <xref ref-type="page" rid="page_35">35</xref>, <xref ref-type="page" rid="page_37">37</xref>, <xref ref-type="page" rid="page_39">39</xref>, <xref ref-type="page" rid="page_45">45</xref>, <xref ref-type="page" rid="page_48">48</xref>, <xref ref-type="page" rid="page_49">49</xref>, <xref ref-type="page" rid="page_54">54</xref>, <xref ref-type="page" rid="page_59">59</xref>–<xref ref-type="page" rid="page_66">66</xref>, <xref ref-type="page" rid="page_69">69</xref>–<xref ref-type="page" rid="page_72">72</xref>, <xref ref-type="page" rid="page_74">74</xref>, <xref ref-type="page" rid="page_77">77</xref>–<xref ref-type="page" rid="page_79">9</xref>, <xref ref-type="page" rid="page_83">83</xref>–<xref ref-type="page" rid="page_87">7</xref>, <xref ref-type="page" rid="page_102">102</xref>, <xref ref-type="page" rid="page_103">103</xref>, <xref ref-type="page" rid="page_111">111</xref>–<xref ref-type="page" rid="page_116">16</xref>, <xref ref-type="page" rid="page_121">121</xref>, <xref ref-type="page" rid="page_122">122</xref>, <xref ref-type="page" rid="page_126">126</xref>, <xref ref-type="page" rid="page_129">129</xref>, <xref ref-type="page" rid="page_144">144</xref>, <xref ref-type="page" rid="page_145">145</xref>, <xref ref-type="page" rid="page_147">147</xref>, <xref ref-type="page" rid="page_148">148</xref>, <xref ref-type="page" rid="page_150">150</xref>, <xref ref-type="page" rid="page_152">152</xref>, <xref ref-type="page" rid="page_156">156</xref>, <xref ref-type="page" rid="page_165">165</xref>, <xref ref-type="page" rid="page_173">173</xref>, <xref ref-type="page" rid="page_183">183</xref>–<xref ref-type="page" rid="page_185">5</xref>, <xref ref-type="page" rid="page_187">187</xref></p></list-item>
<list-item><p>War on Terror <xref ref-type="page" rid="page_8">8</xref>, <xref ref-type="page" rid="page_12">12</xref>, <xref ref-type="page" rid="page_61">61</xref>, <xref ref-type="page" rid="page_70">70</xref>, <xref ref-type="page" rid="page_77">77</xref>, <xref ref-type="page" rid="page_84">84</xref>, <xref ref-type="page" rid="page_85">85</xref>, <xref ref-type="page" rid="page_113">113</xref>–<xref ref-type="page" rid="page_115">15</xref>, <xref ref-type="page" rid="page_173">173</xref>, <xref ref-type="page" rid="page_187">187</xref></p></list-item>
<list-item><p>we-community <xref ref-type="page" rid="page_38">38</xref>, <xref ref-type="page" rid="page_40">40</xref>, <xref ref-type="page" rid="page_41">41</xref>, <xref ref-type="page" rid="page_53">53</xref>, <xref ref-type="page" rid="page_76">76</xref>–<xref ref-type="page" rid="page_78">8</xref>, <xref ref-type="page" rid="page_122">122</xref>, <xref ref-type="page" rid="page_143">143</xref>, <xref ref-type="page" rid="page_171">171</xref></p></list-item>
<list-item><p>Willis, Connie <xref ref-type="page" rid="page_145">145</xref>, <xref ref-type="page" rid="page_147">147</xref></p></list-item>
<list-item><p>Wills, Chistopher <xref ref-type="page" rid="page_153">153</xref></p></list-item>
<list-item><p>witch hunts <xref ref-type="page" rid="page_22">22</xref>, <xref ref-type="page" rid="page_56">56</xref>, <xref ref-type="page" rid="page_147">147</xref></p></list-item>
<list-item><p>Wittgenstein, Ludwig <xref ref-type="page" rid="page_176">176</xref>, <xref ref-type="page" rid="page_177">177</xref>, <xref ref-type="page" rid="page_193">193</xref></p></list-item>
<list-item><p>World Health Assembly <xref ref-type="page" rid="page_42">42</xref></p></list-item>
<list-item><p>World Health Orgization <xref ref-type="page" rid="page_16">16</xref>, <xref ref-type="page" rid="page_30">30</xref>, <xref ref-type="page" rid="page_32">32</xref>, <xref ref-type="page" rid="page_33">33</xref>, <xref ref-type="page" rid="page_42">42</xref>–<xref ref-type="page" rid="page_44">4</xref>, <xref ref-type="page" rid="page_59">59</xref>, <xref ref-type="page" rid="page_88">88</xref>, <xref ref-type="page" rid="page_89">89</xref>, <xref ref-type="page" rid="page_111">111</xref>, <xref ref-type="page" rid="page_112">112</xref>, <xref ref-type="page" rid="page_119">119</xref>, <xref ref-type="page" rid="page_134">134</xref>–<xref ref-type="page" rid="page_139">9</xref>, <xref ref-type="page" rid="page_143">143</xref>, <xref ref-type="page" rid="page_164">164</xref>, <xref ref-type="page" rid="page_180">180</xref>–<xref ref-type="page" rid="page_182">2</xref>, <xref ref-type="page" rid="page_186">186</xref></p></list-item>
</list>
<list list-type="simple">
<list-item><p>yellow fever <xref ref-type="page" rid="page_50">50</xref>, <xref ref-type="page" rid="page_100">100</xref>, <xref ref-type="page" rid="page_190">190</xref></p></list-item>
</list>
</sec>
</back>
</book>
</istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Understanding the Politics of Pandemic Scares</title><subTitle>An introduction to global politosomatics</subTitle></titleInfo><titleInfo type="alternative"><title>Understanding the Politics of Pandemic Scares</title></titleInfo><name type="personal"><namePart type="given">Mika</namePart><namePart type="family">Aaltola</namePart><description>Mika Aaltola is Academy Fellow, The Finnish Institute of International Affairs, Finland.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="book" displayLabel="N/A" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-94FB0L8V-T"></genre><originInfo><publisher>Routledge</publisher><place><placeTerm type="text">2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN</placeTerm></place><publisher>Routledge</publisher><place><placeTerm type="text">711 Third Avenue, New York, NY 10017</placeTerm></place><dateIssued encoding="w3cdtf">2012</dateIssued><copyrightDate encoding="w3cdtf">2012</copyrightDate><edition>1</edition></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><tableOfContents displayLabel="chapters-included-in-book">Introduction page_1; Containments and compassions of pandemic dramas page_18; Understanding the Vortex of War and Disease page_60; Trajectory of a pandemic drama : Ebbing and waning of the BSE crisis in 1996, page_88; Vortexes of SARS : Anxieties over global air mobility, page_111; The pandemic geography of Avian Flu page_143; Beyond global public health page_174;</tableOfContents><physicalDescription><extent unit="references">285</extent></physicalDescription><abstract>Reactions to pandemics are unlike any other global emergency; with an emphasis on withdrawal and containment of the sight of the infected. Dealing with the historical and conceptual background of diseases in politics and international relations, this volume investigates the global political reaction to pandemic scares. By evaluating anxiety and the political response to pandemics as a legitimisation of the modern state and its ability to protect its citizens from infectious disease, Understanding the Politics of Pandemic Scares examines the connection between international health governance and the emerging Western liberal world order. The case studies, including SARS, Bird Flu, and Swine Flu, provide an understanding of how the world order, global health governance and people's bodies interact to produce scares and panics. Aaltola introduces an innovative new concept of ‘politosomatics’ based on the relationship that links individual stress, strain, and fear with global circulations of power to evaluate the increasingly global bio-political environments in which pandemics exist. This book will be of interest to students and researchers of International Relations, Global Health, International Public Health and Global Health governance.</abstract><note type="supplier">AEL Data</note><relatedItem type="host"><titleInfo><title>Understanding the Politics of Pandemic Scares</title><subTitle>An introduction to global politosomatics</subTitle></titleInfo><name type="personal"><namePart type="given">Mika</namePart><namePart type="family">Aaltola</namePart><description>Mika Aaltola is Academy Fellow, The Finnish Institute of International Affairs, Finland.</description><role><roleTerm type="text">author</roleTerm></role></name><genre type="book" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-5WTPMB5N-F">book</genre><originInfo><publisher>Routledge</publisher><place><placeTerm type="text">2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN</placeTerm></place><publisher>Routledge</publisher><place><placeTerm type="text">711 Third Avenue, New York, NY 10017</placeTerm></place><dateIssued encoding="w3cdtf">2012</dateIssued><copyrightDate encoding="w3cdtf">2012</copyrightDate><edition>1</edition></originInfo><subject><genre>book-collection</genre><topic>Routledge studies in governance and public policy</topic></subject><identifier type="eISBN">9780203805732</identifier><identifier type="ISBN">9780415603812</identifier><part><date>2012</date><extent unit="pages"><start>1</start><end>174</end><total>216</total></extent></part></relatedItem><relatedItem type="references" ID="ref001" displayLabel="bib001"><titleInfo><title>International epidemics: A short expedition to places inhabited by states and mad cows</title></titleInfo><name type="personal"><namePart type="family">AALTOLA</namePart><namePart type="given">Mika</namePart></name><relatedItem type="host"><titleInfo><title>Medicine, Conflict and Survival</title></titleInfo><genre>journal</genre><part><date>1999</date><detail type="volume"><caption>vol.</caption><number>15</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>235</start><end>254</end></extent></part></relatedItem></relatedItem><relatedItem type="references" ID="ref002" displayLabel="bib002"><name type="personal"><namePart type="family">AALTOLA</namePart><namePart type="given">Mika</namePart></name><titleInfo><title>Rhythm, Exception and Rule in International Relations: The Case of Mad Cow Disease</title></titleInfo><genre type="book">book</genre><note type="content-in-line">Aaltola, Mika (1999b) Rhythm, Exception and Rule in International Relations: The Case of Mad Cow Disease, Tampere: Studia Politica Tamperensis.</note><originInfo><publisher>Studia Politica Tamperensis</publisher><place><placeTerm type="text">Tampere</placeTerm></place></originInfo><part><date>1999</date></part></relatedItem><relatedItem type="references" ID="ref003" displayLabel="bib003"><titleInfo><title>The international airport: The hub-and-spoke pedagogy of the American empire</title></titleInfo><name type="personal"><namePart type="family">AALTOLA</namePart><namePart type="given">Mika</namePart></name><relatedItem type="host"><titleInfo><title>Global Networks</title></titleInfo><genre>journal</genre><part><date>2005</date><detail type="volume"><caption>vol.</caption><number>5</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>261</start><end>278</end></extent></part></relatedItem></relatedItem><relatedItem type="references" ID="ref004" displayLabel="bib004"><name type="personal"><namePart type="family">AALTOLA</namePart><namePart type="given">Mika</namePart></name><name type="personal"><namePart type="family">HäMäLäINEN</namePart><namePart type="given">Pekka</namePart></name><titleInfo><title>When Disease Makes History: Epidemics and Great Historical Turning Points</title></titleInfo><genre type="book">book</genre><note type="content-in-line">Aaltola, Mika (2005b) ‘Politicized pandemics: Threat of diseases and political decision making in a global age,’ in Pekka Hämäläinen (ed.) 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No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.</accessCondition><accessCondition type="use and reproduction" contentType="trademarknotice">Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.</accessCondition><accessCondition type="use and reproduction" contentType="britishlibrary">A catalogue record for this book is available from the British Library</accessCondition><accessCondition type="use and reproduction" contentType="cip">Aaltola, Mika.Understanding the politics of pandemic scares : an introduction to global politosomatics/Mika Aaltola.p. cm. – (Routledge studies in governance and public policy)Includes bibliographical references and index.1. Communicable diseases–Political aspects. 2. World politics–Psychological aspects. 3. World health. 4. Health behavior. I. Title.RA643.A175 2011616.9–dc22 2011006694</accessCondition><accessCondition type="use and reproduction" contentType="typesetinfo">Typeset in Timesby Wearset Ltd, Boldon, Tyne and Wear</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-QGNTS49S-T">Taylor-Francis</recordContentSource><recordOrigin>Converted from (version 1.2.8) to MODS version 3.6.</recordOrigin><recordCreationDate encoding="w3cdtf">2020-03-04</recordCreationDate></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/T1V-L5X0P30H-Q/record.json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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