We know for certain that pandemics are potentially very destructive phenomena. The most lethal ones have with good reason become the stuff of history books. To take but one particularly ravaging example, the Spanish Flu (1918–1920) claimed somewhere between 20 and 50 million lives worldwide, and infected about a third of the planet’s population—etching a sombre imprint onto our collective memory (Blakely 2006). Today, 100 years later, as we keep finding new ways to bring nature under our control, many are still concerned—and some are literally terrified—that nature might “strike back” in the form of a devastating pandemic.
Creators of fiction capitalize keenly on this fear. In recent years there has been a veritable outbreak of books and films that revolve around epidemics and pandemics—set off, perhaps, by the occurrence of an actual pandemic (the so-called “swine flu”) in 2009. Book readers and movie goers have been simultaneously entertained and terrified by stories such as Steven Soderberg’s film, Contagion (2011), Emily St. John Mandel’s sci-fi novel Station Eleven (2014), the zombie-pandemic apocalypse, World War Z (2006/2013), not to mention Margaret Atwood’s hugely popular MaddAddam trilogy (2003–2013).
Such “epidemic entertainments” (see Tomes 2002) are not, however, the only discourses that make room for our pandemic fears. In The End of Epidemics, medical doctor and epidemiologist, Jonathan D. Quick, provides a telling example that pandemic alarmism even thrives within medical discourse. A future pandemic “has the potential to wipe out millions of us, including my family and yours, over a matter of weeks or months,” Quick writes, adding that this “looming threat to humanity” is a scenario that “makes the threat posed by ISIS […], a ground war, a massive climate event, or even the dropping of a nuclear bomb on a major city pale by comparison” (2018: 15):
[A] replay of the 1918 Spanish flu – against which we are not yet prepared – could hit every major city in the world within 200 days, claim more than 300 million lives, ravage national economies with the force of the Great Recession, and close public services and business around the globe. (Quick 2017)1
To be clear, Quick is neither an entertainer nor a creator of fiction. He is a specialist giving expert advice, and his aim is to tell us how we can improve public health preparedness around the world, so that lives that would now be lost can be saved in a future pandemic. Still, his scenarios suggest that even medical experts occasionally peddle in pandemic apocalypse.
This type of pandemic alarmism can be problematic, however. For while it is certain that pandemics can be very destructive, it is not certain that they will be so, and to stir our fears in the face of a perceived pandemic threat can all too easily turn into a situation resembling the “boy who cried wolf” (Nerlich and Koteyko 2012). To illustrate: While the seasonal influenza typically causes 290,000–650,000 respiratory deaths worldwide (WHO 2018), the death toll of the 2009 pandemic—technically termed A(H1N1)pdm09—has been estimated from 123,000 to 203,000 (Simonsen et al. 2013), making it an infinitely less destructive event than what the likes of Quick envision. In fact, many felt that the 2009 pandemic was one such that did not live up to its name. One commentator jokingly referred to as the “the little harmless Piglet virus” (Hafstad 2009).
At least in part because it turned out to become a so much milder disease than what was suggested by both authorities and media at the outbreak, the 2009 pandemic quickly became the scene of contestation—and it is far from the only such episode to have become just that. Why did the health authorities sound the alarm so violently? Were there really grounds for doing so? Who did sound the alarm? Was the media rather more to blame than the authorities? Did anyone have ulterior motives? What was—and what should be—the nature of the relation between the WHO, national health authorities, and the big pharmaceutical companies? Also: Might the vaccines actually be dangerous? Had the authorities in fact joined in a conspiracy with Big Pharma to drug the population?
The fact that all these questions and many more were asked during and after the 2009 pandemic, might illustrate that such episodes are shot through with uncertainty. Uncertainty, we should note, is not the same as a threat, nor is it equal to fear, though it is intimately connected with both. We can think of uncertainty as a mental and emotional space that we cannot fill using reliable methods. Our natural tendency is to fill such space, however, and in the absence of reliable methods that generates “knowledge,” we proceed to fill it with all sorts of other things—hopes and fears, expectations and entitlements, scepticism and doubt.
One aspect of pandemic uncertainty concerns the disease itself. It is not necessarily clear, at any point in the course of a pandemic, how the disease will develop, what its effects will be. During the 2009 pandemic, for instance, scientific experts and other commentators worried that this mild disease might mutate, and hence present us with a much more acute predicament. It is part of the purpose of this book, however, to show that uncertainty in the face of a pandemic concerns much more than the epidemiology of the disease. While questions about how far and how fast the disease spreads, how lethal it will turn out to be, whether and how it will mutate, and so on, are real and important questions on which any serious pandemic response must rest, it would be wrong to think that these are the only questions that need answering, the only spaces of uncertainty that need filling. Rather, medical uncertainty is entangled with all sorts of other concerns that have little to do with the disease as such. It is the contention of this book that our pandemic perception and response is a messy blend of epidemiology and culture, medicine and politics, science and society.
More specifically, with the title of this volume, Pandemics, Publics, and Politics, we want to suggest that the epidemiology of the disease (Pandemic) will always be entangled with issues of public communication (Public), as well as with systems and practices of governance (Politics). To say that these entities are “entangled” is to point out that epidemiology and medical response are themselves communicative and political phenomena. Epidemiological research and monitoring do not take place in a cultural or social vacuum, but rather within particular institutions, where culturally conditioned actors perform more or less routinized practices according to the conventions of their historically contingent scientific disciplines. As far as output goes, the knowledge generated by this scientific community is literally of no use if it does not integrate with the systems of governance in place, or if it does not translate that knowledge into an idiom that lay people can understand and use.
For these reasons, we believe that preparedness in the face of pandemics requires a more sophisticated understanding of the many extra-medical facets of the disease. Among other things, we need to understand better how we tend to fill spaces of uncertainty with content that does not emanate from a scientific discourse, and which might not be what is needed in order to prepare. We need thus a broader and more heterogeneous understanding of what a “pandemic” is made up of, where that term does not simply denote a medical phenomenon which threatens human culture and society, but rather a phenomenon which, in many unpredictable ways, already is human culture and society. This does certainly not mean that we should disregard the role—actual or ideal—of epidemiologists. But it does mean that we should acknowledge that our capacity for pandemic response rests not on epidemiological expert knowledge alone, but also on other sorts of expertise—concerning the political systems that are designed to transform that knowledge into action, as well as concerning pandemic communication. Preparedness in the face of pandemics might even require expertise concerning “alternative expertise” or even anti-expertise movements, for how can we effectively transform medical knowledge into workable public health advice if a substantial part of the population distrusts mainstream medical knowledge?
To illustrate: Today, a case can probably be made against alarmists like Quick. A new Spanish Flu seems unlikely today, not least because medicine, and the public health apparatus, including disease prevention and control, has progressed greatly in the last 100 years. Vaccines and vaccination schemes are one obvious advance. But because pandemics are more than medical phenomena, it is uncertain how great our advances have really been. To be certain that we are now in a better position to respond to a pandemic, we would have to have made advances in our knowledge of communication and politics that could match those we have made within epidemiology.
To put it plainly, we need not just to know the new virus that emerges, but also what new forms of communication and social interaction that have emerged since the last comparable crisis. We might illustrate this by the simple fact that, since the latest pandemic, the use of social media has gone up, while the reading of traditional newspapers (and viewing of TV news) has gone down. What does it mean for a pandemic response that news is now in 2.0 mode? A whole host of sub-questions emerge: How does the so-called “#republic” (Sunstein 2017) create new conditions in which to communicate science advice in a situation of pandemic (or similar) crisis? Where has the recent spike in vaccine skepticism come from, and how can it be countered? How does one establish credibility as epidemiological expert in a situation where an increasing number of people entertain the idea that pandemics are a conspiracy concocted by the health authorities?
These are just some of the questions that stand out as essential, both in their own right and for the practical purpose of pandemic preparedness and response. The chapters of this book can only begin to answer some of them, and there will be much left to do. The point, however, is that if we open up the study of pandemics and pandemic response to new fields of—humanities and social science—research, we need to do so constantly, in an effort to understand how the society that constantly emerges brings with it a new set of conditions for our responsive capacity. To put it differently, a pandemic becomes a pandemic only because the disease is new, but culture and politics moves at least as fast as nature, so that, by the time a new disease looms, we do not just have a new disease to deal with, we also have to deal with the new society that has emerged since the previous pandemic. And while medical science has ways of monitoring, identifying, and responding to new viruses, we have no corresponding method for public communication or for politics. In these fields, we cannot predict the future and we are typically not in “control.” This makes the ambition to learn from pandemics exceedingly difficult. To expect, argue Craddock and Giles-Vernick, that we by studying past pandemics can arrive at “a list of easy steps to follow for current and future preparedness plans or intervention measures,” would be “detrimental in its simplicity and overgeneralization” (2010: 2). This is not just, as they ...