Techniques, Technologies and Materialities of Epidemic Control

Abstracts

Hannah Brown

Ebola Separations: Trust and Crisis in West Africa

The Ebola outbreak in West Africa transformed modalities of social connection, from the intimate to the governmental. The epidemic was characterised by the introduction of new forms of separation that aimed to curtail the spread of the disease. This was achieved by trying to change and manage extraordinarily complex relations using a suite of governmental instruments, ranging from by-laws and public health campaigns to the use of specialist treatment centres and force. At the same time, people changed the ways they lived their everyday lives to avoid contact with those who might be sick. These actions had huge implications for possibilities for trust in intimate, governmental and therapeutic relations. Drawing upon fieldwork in Sierra Leone, Liberia and Guinea, this paper explores these forms of separation ethnographically, with a focus on material dimensions of separation. In doing so, we contribute to anthropological discussions on the constitution of forms of trust and separation within social relations.

 

Carlo Caduff

After the Next: Notes on a political form

“We live in times,” writes Brian Massumi, “when what is yet to occur not only climbs to the top of the news but periodically takes blaring precedence over what has actually happened.” This focus on the future has taken a particular shape in the historical present: to prepare for what's to come is to prepare for what's next. Massumi's observation points to the emergence of a new mode of governance-the governance of the next. Operating at the heart of this formation of power is a persistent demand: the demand to consider what's next. The promise, which ostensibly makes this demand optimistic, is that a consideration of the next will permit people to prepare for the catastrophic future. Those who took the necessary time to make the necessary preparations are presumably more likely to survive the coming crisis. But what, in fact, is the next? What kind of structure is at work in this peculiar orientation to the catastrophic future?

 

Luisa Reis Castro

Managing the National: Mosquitoes, Public Health Emergency and Political Turmoil in Brazil

On November 11, 2015, the Brazilian Minister of Health declared the outbreak of newborns with microcephaly in the Northeast a “public health emergency of national importance”. The condition was linked with the mosquito-borne Zika virus and mobilized the country under the motto “a mosquito is not stronger than an entire country”. The country, however, was amidst a political turmoil and extremely divided. On May 2016, President Rousseff’s impeachment process was voted and Temer took over as interim President. He introduced structural changes and financial cuts, such as fusing ministries and proposing a reduction of available resources for the SUS, the Brazilian public health system. Established in 1988, the SUS is federally funded but municipally implemented – a response to the centralized and hierarchical military dictatorship that governed before.

This paper argues that Zika, as well as the political turmoil, transformed mosquito control implementation a national concern. The Sala Nacional de Coordenação e Controle (National Room of Coordination and Control) was established in December 2015 to bring together representatives from seven ministries on weekly meetings with similar Salas from each state, to enable managing mosquito-borne diseases (and political institutions) in national terms. Grounded on interviews with (former) government workers and a brief fieldwork at the Sala Nacional, the paper inquires about public health emergencies and political crisis by analyzing technologies and techniques of national control.

 

Mathieu Corteel

From political arithmetic and big data: A historical epistemology of computational epidemic control

In the 17th century, statistics became a technology of European states. To govern the growth of population and wealth variation a new control system was necessary. The economist William Petty (1623-1687) in Political arithmetic developed the idea of a general collection of data to organise the population and the resources. From that collecting of data, John Graunt (1620-1674) gave birth to epidemiology by the quantitative analysis of natality and mortality. He was the first to analyse the plague from a synoptic perspective on population. From the time of the introduction of statistics as a technology against epidemics, the computational perspective has generated a new epistemic device in medicine. Through the birth of the clinic in the school of Paris during the 19 the century, the centralisation of data in the hospital structure has influenced the use of probability calculus in the formulation of diagnosis and prognosis. Since that introduction of computation in medical knowledge, the medical gaze has been enhanced by virtual technology. At the populational and the individual level, the virtualisation of epidemics through numerical schemas permit a better control of population. Today with big data, the prediction of epidemic breakthroughs is becoming the main project of global instances such as the WHO, the OECD and the UNO 1. Is computational epidemic control the historical origin of a virtualisation of disease? How does this virtualisation organise the prevention of epidemics through techniques such as quarantines?

 

Lukas Engelmann

Diagrams of spatial politics. Maps as techniques of epidemiological formalization in the history of Bubonic Plague.

Practices of mapping have constituted the perception of epidemics throughout history. Maps have been used to track epidemics in their spread, to isolate and contain affected areas, to argue for quarantines, and to arrive at etiological conclusions about the nature of the epidemic. Understanding epidemics through maps foregrounds spatial dimensions, maps visualize epidemics as a series of pathological incidences, resulting in an affection of spaces, ecologies and social bodies. The history of epidemics and the history of their mapping could, to some extent, be understood as inseparable.

The aim of this paper is to situate practices of mapping through the historical lens of Bubonic Plague. Stretching over the ‘longue durée’ of many centuries, the plague has been as much the archetype of epidemiology as it laid ground to systematic approaches of understanding epidemics through geographical maps. Reaching from 16th century visions of quarantine through early 20th century cartographies of a global pandemic to end with 21st century digital approaches to historical geographies, the aim is to isolate different ways of seeing, different modes of representation and different implications deriving from maps of plague through time and space. A history of mapping bubonic plague can then be applied to the larger question of what maps exactly achieve when putting an epidemic in place and how these diagrams of disease ecology establish a way of seeing epidemics, which cannot be achieved otherwise.

 

Ann Kelly

Models, Mayhem and Charismatic Facts: the making of a global health emergency

Global Health attention is intense, but fickle. An awkward compromise of economic interests and geopolitics, moral and epidemiological logics, global health ‘emergencies’ crystalize around distinct and often countervailing values. There are emerging threats and persistent plagues; examples of gross negligence and near-triumph—devastating illness that demand large-scale investment and mundane suffering that could be redressed with the application of minimal resources. But whether it is HIV, Guinea Worm or obesity, the ways in which a public health issue becomes a global concern depends on how its present danger is tied to our collective future. A global health emergency is built upon a vision; it is as much a matter of moral fervour and collective mobilisation, as of fact.  

This paper analyses the modalities of evidentiary charisma at work in the 2014-2015 Ebola Outbreak response. It contextualises the transmission models generated to Ebola's spread through an analysis of the Global Malaria Eradication campaign launched in the mid-1950s and the mathematical model of transmission upon which it was built.   Drawing together these two occasions of global health acceleration—each in their own way ‘races as against time’—this paper explores the peculiar power of evidentiary claims to marshal salience, mobilize resources and short-circuit any other possible future, than the one of its own making.

 

Steffen Kramer

Limits of Capture: Spatial messiness and temporal exceptions in epidemic control

Based on archival records from the parasitology collection of the Communicable Diseases Documentation Centre at the WHO, the paper will discuss the surveillance infrastructure that shaped the department’s practices of disease control as well as their field operations from the 1950s to the 1970s. On the one hand I will discuss the creation of an epidemiological terrain through the use of geographical reconnaissance and surveillance infrastructure, including questionnaires, laboratory devices, protocols and evaluation reports. On the other hand I will show how images of infrastructure themselves circulate upon which the epidemiological terrain is created. Spatial information is sourced from various agencies as well as local field operators, showing the composite and ‚messy‘ nature of centralized spatial information despite attempts to formalize it. Besides those practices of network creation, the archival records also point to the process of maintaining it, through the continual publication of evaluation reports. The reports are synoptic in nature including geographical, climatological, anthropological and entomological information. Within their sphere of capture, mosquito and human behaviour is equally problematized as “technical” in relation to its temporality (e.g. sleeping, breeding, nomadic movement vis-a-vis statistical returns or spraying cycles), creating an alliance among that which escapes. The technicality of maintaining points not so much to the enclosing of terrain, but to a process of on-going synchronization.

 

Christos Lynteris

Mythic-Material Masks: Anti-Epidemic Personal Protection Equipment at the Edge of Humanity

The emergence of epidemic photography at the turn of the 19th century was marked by an increased interest in visualizing operations of epidemic control. From disinfection and fumigation to rat-proofing, vector extermination and the incineration of “infected houses”, photography was employed to portray and propagate methods of controlling infection. At the same time as negotiating the source of disease, and the optimal way to contain or vanquish the latter, however, this visual production was, and continued to be, itself a technology of epidemic control. This paper examines the emergence of photographic configurations of masks and other personal protection equipment (PPE) in the context of the third plague pandemic and their role in establishing a new form of relation between epidemic victims and doctors, paramedics and other anti-epidemic forces. Focusing on the diachronic visual articulation of PPE, and building on previous work on the epidemiologist as a cultural hero, the paper will explore the role of the anti-epidemic mask as a mythic-material apparatus that mediates and at the same time allows the performatively efficacious transformation between different realms of existence. The paper will discuss how these apparatuses play a key role in the configuration of infectious disease outbreaks into sociological and symbolic vortexes in modern times; temporal-spatial events which contain within them and yet always-already defer the biological and ontological end of humanity.

 

Jacqueline Martinelli

AIDS in Switzerland: Facing the Epidemic with a ‘Hot Rubber’

AIDS in the beginning of the disease, also known as “gay related immunodeficiency disease”, appeared in the gay communities in the USA in the early 1980s. Shortly after the AIDS epidemic had broken out epidemiologists defined gay sex as one of the riskiest behaviours. In Europe, Switzerland was affected very early and seemingly hit hardest by the new epidemic. Switzerland therefore engaged from early on in a nation-wide AIDS-prevention campaign, at the centre of which stood the promotion of the condom. Like in many other Western countries, in Switzerland it were activists of the gay movement to call attention to the new disease first. In 1985, the newly founded Aids-Hilfe Schweiz (AHS) launched the “Hot Rubber”, a condom especially designed and promoted for gay men. The idea was to familiarize gay men with a previously exclusive contraceptive tool. In a large poster campaign, the AHS invented the Hot Rubber to give the condom a new image.

 

Alex Nading

On The Causes of Epidemics (and Epidemic Control)

In this talk, I will discuss the multiple ways in which the notion of “cause” shapes epidemic control.  Cause can be framed in at least three ways: as etiology; as reasonable grounds for framing legal or scientific claims; and as a moral goal or purpose.  While these three forms of cause all inform one another, in contemporary global health, an overemphasis on the first and third meanings has occluded the importance of the second. My argument, drawn from preliminary work on a novel epidemic of kidney disease as well as from long-term work on mosquito-borne epidemics, is that the process of framing claims merits more critical scrutiny.  A better understanding of cause as reasonable grounds has the potential to enrich theoretical and practical ideas about “social justice² in health.

 

Branwyn Poleykett

Colonial Rituals of Counting and Containment

The arrival of plague in the Madagascan highlands in the 1920s precipitated a clash between norms of colonial hygiene and Merina practices of relating to and burying the dead. This paper reconsiders the impact of mass death in the context of a demographic crisis while vital technologies of living and prolonging life operated alongside attempts to discipline and adjust Malagasy ways of death. I consider how epidemic deaths became ‘ordinary’ deaths and what this tells us about the social, cultural and epidemiological rituals that enclose crises.

 

Nida Rehman

The anatomy of an experiment: mosquitoes, urban space and medical knowledge at Mian Meer (1901-1909)

In September 1901, soon after the discovery of the Anopheles mosquito as the transmission vector for malaria, the Royal Society dispatched a group of doctors to the disease-ridden military cantonment of Mian Meer outside Lahore to test methods of mosquito control. Their site—a grid of bungalows, barracks and tents—proved deceptively unruly. Manicured lawns, obedient trees and neat watercourses harboured breeding spaces for resilient mosquitoes, while the cantonment's social hierarchies obscured the complexities of the 'human reservoir' of disease. Beyond Lahore, the experiment unfolded in equally antagonistic terms in medical journals and conferences. Its widely criticised failures have since been considered a factor in the Indian government's preference for quinine prophylaxis over environmental control. Closely tracing the practices and procedures deployed at Mian Meer, alongside turn-of- the- century changes in Lahore's urban landscape, this paper examines urban space as an experimental apparatus. It asks how the material-discursive entanglements of malaria control incrementally shape (and are shaped by) urban space, new subjectivities and conceptions of nature in the city. Drawing from urban political ecology and more-than- human geography, it reflects on the ways in which new biopolitical configurations emerge within the nexus of global knowledge production and the everyday geographies of urban life

 

Jacob Steere-Williams

Dipping and Disinfection Across the Late Victorian British Empire

In late nineteenth century British controlled India and South Africa medical officers forcibly ‘dipped’ naked indigenous Indians and Africans in carbolic acid mixtures in an effort to identify, isolate, and control the spread of typhoid fever and bubonic plague. As a co-option of a veterinary public health practice on humans, this historically unexplored practice is a critical lens into the ways in which bodies—gendered, classed, and racialized—were the foci of epidemic control in the period of debates on the relative merits of field-based epidemiology and laboratory-based bacteriology. This paper examines the intricate and power-laden late Victorian practices of disinfection—of people, their feces, and their environments— as they existed alongside attempts to visualize, map, and photograph epidemics of typhoid and plague. This work builds off of Graham Mooney’s idea (Intrusive Interventions, 2015) of disinfection practices in Victorian Britain as examples of state surveillance, but complicates the latter notion via the lens of colonial bodies and environments. 

 

Dora Vargha

Polio eradication as a socialist product

The Global Polio Eradication Initiative is seen today as a flagship project of philantrocapitalism, but its roots lie in the other end of the political spectrum. The Sabin vaccine, used today in global polio eradication campaigns, was first introduced to national vaccination programs in Eastern Europe during the Cold War. It is in Czechoslovakia, Hungary and the Soviet Union where the vaccine was extensively tested and where mass vaccination strategies were formed in the late 1950s. The Sabin vaccine itself is inseparable from the political, social and cultural Eastern European context in which it was tested. Political decisions and scientific assessments regarding disease prevention shaped the development and introduction of the Sabin vaccine, which were based on local experiences in socialist societies. Countries like Hungary went on to play key parts in polio elimination. Its national mass vaccination method from 1959-60 became a model for eradication programs, and its virological data and consistent use of the vaccine for nearly 40 years has informed decisions in global campaigns well into the 21st century. In a way, mass immunization with the Sabin vaccine, this particular Eastern European product of the Cold War outlived its own era and continues to shape global public health campaigns.

 

Meike Wolf and Kevin Hall

Prepare for Assimilation! Cyborg preparedness and the nexus of bodies, infrastructures and a pandemic future

Biopreparedness exercises are commonly depicted as means to prepare for potential outbreak events. The outbreak is framed as being unpredictable, sudden, and disruptive to infrastructures and business continuity. But do exercises really prepare for events? By drawing on the notion of cyborg urbanization (Gandy 2005), the exercise emerges as an intricate practice of doing interfaces between hybrid human bodies and the urban preparedness infrastructures.

In our paper, we will use the case of two biopreparedness exercises and one nurse training to discuss how epidemic control measures are enacted as a heterogeneous set of technologies and practices that aim to bind human bodies, past and present, clinical architecture, and technical artefacts into preventive assemblages. These exercises are built upon a shared scenario of highly pathogenic disease outbreaks (e.g. Ebola, SARS, or Lassa) and are embedded in a larger rationale of urban preparedness. Rather than posing a rational solution to probable events, we will first argue that preparedness exercises translate potential futures into the present through the implementation and stabilisation of infrastructures. In a second step, we analyse how these infrastructures rely on the embodied knowledge and the body techniques of its participants, therefore necessitating continuous attention, investment, and training. The paper draws upon ethnographic fieldwork on influenza preparedness among health professionals, emergency planners, and local authorities in London and Frankfurt.