Learning from the history of pandemics

Asia Health World

Author: Michael Shiyung Liu, Shanghai Jiao Tong University

In 1972 microbiologists Macfarlane Burnet and David White predicted that ‘the future of infectious diseases … will be very dull’. COVID-19 has been anything but.

A painting depicting Mona Lisa wearing a face mask and gloves is pictured at Changchun Street Primary School of Wuhan during a government-organized media tour following the coronavirus disease (COVID-19) outbreak, in Wuhan, Hubei province, China, 4 September, 2020 (Reuters/Aly Song).

A painting depicting Mona Lisa wearing a face mask and gloves is pictured at Changchun Street Primary School of Wuhan during a government-organized media tour following the coronavirus disease (COVID-19) outbreak, in Wuhan, Hubei province, China, 4 September, 2020 (Reuters/Aly Song).

The pandemic has mocked modern public health and medical science worldwide. The United States — the society with the most ‘advanced’ medicine and public health — tops mortality rates. It had an epidemic policy and infrastructure in place that the Trump administration dismantled in 2018. China — a country with a population of 1.43 billion— saw only a slim fraction compared to the cases discovered among a US population of 330 million.

Columnists at The New York Times scoffed at Wuhan’s January lockdown policy, but two months later several European cities enacted similar restrictions. There is no major difference between the Wuhan lockdown and the cordon sanitaire that prevented yellow fever or cholera in 19th century Britain. In a megacity like Wuhan, modern information exchange technologies, transportation of medical resources and even the effective execution of political power all play crucial roles in stopping the spread of an unknown virus.

But rather than recognise the effectiveness of Wuhan’s lockdown, the column focused instead on the non-transparency of the policies, while questioning the credibility of the public health sectors in China. In the following months, the debate about the transparency of China’s pandemic statistics further blocked mutual coordination and damaged trust between societies.

The debate on the transparency of official epidemic reporting has a long history and featured during the establishment in the 1920s of the League of Nations Health Organization, the predecessor to the World Health Organization (WHO). International coordination for pandemic prevention has weathered many obstacles since the 18th century. The accomplishment of an international health infrastructure under the WHO is therefore a centrepiece of globalisation in the 21st century.

‘Diseases have no political boundaries’ is the widely-used expression for advocating international coordination in the public health arena. Looking back in East Asia, for example, the public health risks that acquired international attention were associated with the panic of pandemics during the first half of 20th century. The inequalities between colonial societies and western powers brought obstacles to information exchange and health promotion. The competition between colonial powers and sovereign states also added to tensions between colonial medicine and the practices of international health, both of which played essential roles in shaping health governance.

But common ground for public health did exist in East Asia in the 1930s among three major organisations: The League of Nations Health Organization (LNHO), the Far Eastern Association of Tropical Medicine (FEATM) and the International Health Division (IHD) of the Rockefeller Foundation. The LNHO brought an international framework to link the health needs of the East and the West, the FETM created an unofficial network to bypass the limitations of the Westphalian system, while the IHD poured funding and medical ideas into the key institutions of international health in East Asia.

It still took four decades for the United States to harvest former efforts and put ‘old wine in new bottles’, in the form of the WHO Regional Office for the Western Pacific (WPRO). The WPRO would promote international health as a means to protect US interests and provide an agency to secure allies in the region, a mission that was written in pages of documents and correspondences among the three organisations. The Trump administration’s withdrawal from the WHO makes a mockery of the historical endeavour to create a foundation for international health.

From AIDS to Ebola and SARS, now COVID-19, contagious viruses continue to threaten and disrupt. Historians, who never lost interest in pandemics, have much to offer. Learning the history of the interactions between East Asian organisations of international health illuminates a constant phenomenon: as medical technologies advance, social biases and political frictions prevent international cooperation, particularly in the exchanging of experiences with public health measures like quarantine and medical and scientific research on disease.

Charles Rosenberg argues for the importance of identifying similarities between pandemics, especially in the ways that societies inquire into the origin of an outbreak, the ways they demand urgent state intervention and the ways in which collective responsibility can be a framework for communal support. These insights should inspire societies to consider why various strategies are adopted in different contexts.

While all societies demand a political response, the response to pandemics varies from restrictive quarantine without concern for human rights to ignoring public health warnings and preventative actions. All these responses have repeatedly appeared in the past. Pandemics eventually resolve by a process, as Rosenberg put it, that ‘starts at a moment in time, proceeds on a stage limited in space and duration, follows a plotline of increasing revelatory tension, moves to a crisis of individual and collective character, then drifts toward closure’.

This drama is playing out with COVID-19 — first in China and then in many countries worldwide. History can be a resource to provide inspiration and understanding for controlling pandemics under different social contexts and is just as essential as the natural sciences are for generating quarantine strategies and treatments. The end of the pandemic depends on a combination of the life cycle of the virus and earnest human efforts at vaccine development and treatment. Equally important is the social awareness to prevent human bias impeding international cooperation.

Michael Shiyung Liu is Distinguished Professor at the School of Humanities, Shanghai Jiao Tong University, and Professor at the Asian Studies Center, the University of Pittsburgh, Pennsylvania.