The West and the Rest
Historian Draws Lessons from Past Pandemics
When a disease event becomes a pandemic, looking at it through a lens of science informs leaders to gauge the threat—transmission rate, illness severity, mortality—and organize a response to mitigate its effects.
For centuries, though, a system of imbalanced international disease controls and power politics have shaped pandemic response, argued Dr. Alexandre White, who is mining NLM archives to illuminate this history. He discussed some of his findings at a recent NLM History of Medicine lecture.
“The ongoing global pandemic of Covid-19 perhaps has laid bare the politics of global relations work at the heart of pandemic governance,” said White, assistant professor, Johns Hopkins University and associate director of its Center for Medical Humanities and Social Medicine.
“It is much clearer now,” he said, “that an epidemic, far from signifying solely a biological threat to life, is also an economic and political phenomenon, which produces cascading, conjoined effects including xenophobia, nationalist fervor, racial oppression as well as the exposure of the health effects of racism and its dark violent disparities.”
The history of international infectious disease control, said White, has largely involved powerful imperial North American and European nations elevating themselves as models of hygiene and sanitation, threatened by diseases entering from less sanitary nations. For centuries, imperial powers have driven the narrative, developing assumptions and courses of action based on global disease threats that endanger health, travel and trade.
“We can see the ways in which these rooted and continuing social imbalances operate in epidemics, especially while we’re living through them,” said White, “but also by looking at the history of human responses to epidemic threat.”
By the late 19th century, most of Europe and North America developed sanitation systems that helped control food and waterborne diseases in urban areas. And, as the west learned to control or eradicate such insect-borne diseases as yellow fever and malaria, attention turned toward chronic disease and population health.
“The eradication of smallpox, the mostly successful eradication of polio and the development of vaccines against childhood diseases like measles, mumps and rubella have made these formerly devastating illnesses in the west cosmopolitan centers a concern only if there’s significant lack of vaccination,” said White, “or if anti-vaccination discourses take hold.”
By the 1980s, optimism abounded that perhaps the era of global infectious disease was over. Then the HIV/AIDS pandemic arrived, killing tens of millions while highlighting health inequalities, unequal access to resources and at times apathy.
Before the Covid-19 pandemic struck in 2020, many leaders in the west presumed technological and medical advances made the developed world immune to novel infectious disease. When the latest wave of Ebola hit West Africa in 2014, it was contained in the region.
“In places far away from the epicenter of the epidemic,” said White, “we watched as victims of Ebola died lonely deaths, far away from their loved ones, to be buried under intense sanitary controls.” The prolonged epidemic was blamed on local traditions and ignorance of science, “pathologized as the markers of backwards people and unhealthy behavior.”
Such practices as social distancing and quarantine “were seen as scrambling practices of a bygone era, wholly alien from the sanitized spaces of modern hospitals and cosmopolitan streets,” he said. “Epidemics of disease disproportionately having greater effects outside of the overdeveloped west than within highlight, perhaps, a myth whose cracks are emerging today under Covid-19.”
That myth, he said, contends that sanitary controls and biomedical intervention separate the west from those suffering from infectious disease throughout the rest of the world.
To elucidate, White coined the term “epidemic Orientalism,” a twist on the premise of the 1978 book Orientalism by Edward Said. This colonizing and polarizing worldview, rooted in an outlook of western superiority, White explained, has dominated epidemic responses, regulations and controls for centuries.
“The heightened scrutiny and bias against non-Europeans who were blamed for spreading disease historically resulted in aggressive, racist and xenophobic responses carried out in the name of health controls,” he said.
Back in 1901, for example, an epidemic of bubonic plague in then British-ruled South Africa resulted in the forced removal of most of Cape Town’s Black African population to a racially segregated quarantine camp. This act, noted White, was a precursor to racially segregated townships during apartheid.
Similar scrutiny was foisted upon Muslims traveling from India through the Persian Gulf into western Europe during the Hajj in the 19th century. Muslim pilgrims were perceived as a particular threat for spreading cholera. Sea lane closures risked leaving tens of thousands of Muslims stranded in the Arabian desert without food, water or shelter.
“Rather than focusing upon eradicating disease at the source or eradicating its causes,” said White, “the focus of control turned to its prevention of transfer to Europe.”
Today, the Covid-19 pandemic has exposed anti-Chinese sentiment, which has reared its ugly head before in U.S. pandemic response.
“Public health actors in the late 18th and 19th centuries believed a variety of diseases, including parasitic diseases, were more common among Chinese immigrants,” said White, and used this rationale as the basis for exclusion, especially at western ports of entry.
When bubonic plague spread in Honolulu in 1900, city administrators quarantined Chinatown, excluding White American-owned businesses adjacent to the quarantine site.
“The quarantine posed considerable hardships on [the Chinese population] within, limiting employment, movement and access to supplies,” said White.
This form of epidemic Orientalism was reflected in 19th-century legislation, said White. The Page Act of 1875 banned immigration of Chinese women to the U.S., on the perception that they were sex traffickers carrying virulent diseases. And the Chinese Exclusion Act of 1882 banned all Chinese immigration to the U.S. Such laws paved the way for exclusionary immigration laws against Mexicans, Central and South Americans and East Europeans.
“The Covid pandemic exposes the terrifying nearness of the 19th century—its violence, its pandemics and everyday loss of life,” said White.
“This idea of a West against the rest of the world framework needs to be fundamentally challenged in future infectious disease controls and regulations…for us to develop more equitable, effective and responsive pandemic [policies].”