Assembling Epidemics: Disease, Ecology and the (Un)natural

8 September 2017 - 9 September 2017

SG1/2, CRASSH, Alison Richard Building, 7 West Road, Cambridge, CB3 9DT

Registration for this event is now open. Please email to confirm your attendance at this conference.

Epidemic events have profoundly shaped human perceptions of the natural world and human ways of relating to and engaging with nature. Across everyday speech and in the health related sciences, vocabularies and registers of nature and naturalness are used to describe the complexity and ground the contingency of epidemic outbreaks. Epidemics are often seen and acted upon as resulting from an anthropogenic imbalance in nature. Equally, epidemics are events that exacerbate the marginalization of oppressed and stigmatized people, naturalizing their vulnerability to pathogens by associating their practices, relations and ways of being with contagion and crisis.

Critical perspectives in historical and social sciences have argued that epidemics should be seen not as a rupture in the natural order, but rather as politically ordained and socially distributed crises. Epidemics, from this perspective, are created out of scarcity, neglect, as well as structural and slow violence.

Bringing together interdisciplinary discussions across medical anthropology, social epidemiology, political ecology and human geography, this conference connects perceptions of the natural world as a threat to human health, and of epidemics as a result of human intervention in the natural, to practices and trajectories (discursive, aesthetic, and political) of naturalization.

Possible questions to be addressed include but are not limited to:

  • How are epidemic events used to exclude, enclose, and expropriate and what are the trajectories of the natural and unnatural in this process?
  • What happens when the distribution of “naturally occurring” and globally distributed phenomena (violence, disaster, poverty) are grouped together and politicized as an epidemic?As emerging epidemics may flow down pathways created by already exhausted bodies, debilitated social relations, and compromised immune systems – how can we understand the co-constitution of multiple, intersecting, and coterminous disease
  • As emerging epidemics may flow down pathways created by already exhausted bodies, debilitated social relations, and compromised immune systems – how can we understand the co-constitution of multiple, intersecting, and coterminous disease emergences and disease experiences?
  • Michelle Ziegler has argued that evocations of epidemics as “natural” events rooted in environments as “landscapes”, shifts focus from disease environments as anthropogenic, obscures the role played by human relations as key to creating pathways for contagion, and depoliticizes epidemic response by shifting political responsibility away from human action (Ziegler, 2016). How might a historically informed theory of landscapes as constructed, unintentional, or processual (Gandy, 2016; Fraser, Leach and Fairhead, 2014) shift our perspectives on the political ecology of epidemics?
  • How do theories about the emergence of epidemics from particular environments produce and stabilize “race” as a coherent category?
  • How have naturalistic approaches in arts, natural sciences and human sciences – aiming for the fullest description of the natural world with minimal mediation – shaped our understanding of disease?
  • How is the contention that visualization (maps, photographs, scientific diagrams and illustrations) stabilizes and naturalizes hierarchy and difference supported or challenged by study of the visual representation of epidemics?
  • How are “invisible” epidemics of non-communicable diseases produced as unnatural, for example, in the case of the presence of diseases of (supposed) surplus and overconsumption where they are assumed not to exist?
  • What has the language of entanglement done for understanding disease events within multispecies frames? Which hierarchical, unnatural, deterritorialised, extra-proximate and separate relations has this paradigm obscured? 
  • What is the historical and contemporary impact of equilibrium approaches to epidemics, whether these focus on human-made imbalance or on epidemics as nature’s re-balancing act? How do claims of “naturalness” produce each proposition?
  • How useful are epidemic registers of virality and contagion when it comes to capturing complex, multiscalar and etiologically indeterminate biosocial phenomena?

 

Convenors

Christos Lynteris (University of Cambridge)

Branwyn Poleykett (University of Cambridge)

Nicholas Evans (University of Cambridge)

Lukas Engelmann (University of Edinburgh)

 

Sponsorship

Supported by the Centre for Research in the Arts, Humanities and Social Sciences (CRASSH) at the University of Cambridge and by the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013) / ERC grant agreement no. 336564.

 

Visiting CRASSH

Information on finding CRASSH and accessibility is available online. CRASSH is based at 7 West Road, Cambridge CB3 9DT.

Friday 8 September 09:00 – 09:20

Registration

09:20 - 09:30

Introduction

09:30 - 11:30

Panel One: Visions and Visibilities
 

Michael Kosoy (Centers for Disease Control and Prevention)

Entanglement of the Visible and the Invisible Components of Emerging Zoonoses
 

Nida Rehman (University of Cambridge)

Not Seeing like a State: The Aesthetics and Politics of Mosquito Landscapes
 

Christos Lynteris (University of Cambridge)

Pandemic Visions, Human Mastery and Eschatological Reversal

 

Discussant: Branwyn Poleykett (University of Cambridge)

11:30 - 12:00

Coffee

12:00 - 13:30

Panel Two: Emergence and Origins
 

Guillaume Lachenal (Université Paris Diderot)

Landscapes of Emergence in South-East Cameroon. Fieldnotes from the Birthplace of HIV.
 

Tamara Giles-Vernick (Institut Pasteur), Lys Alcayna-Stevens (Collège de France, Laboratoire d'Anthropologie Sociale), Victor Narat (Institut Pasteur)

A Pre-History of Zoonotic Outbreaks: Rethinking Human-Animal “Contact”

 

Discussant: Christos Lynteris (University of Cambridge)

13:30 - 14:30

Lunch

14:30 - 16:30

Panel Three: Epidemic Knowledge
 

Karen Sayer (Leeds Trinity University)

The Suffolk Plague: Rats Generating Knowledge
 

Ilana Löwy (Cermes3, CNRS)

Zika Epidemics in Brazil:  the Knowns and the Unknowns
 

Nick Evans (University of Cambridge)

Putting Plague on Trial: Uncertainty and Knowledge in a Colonial Epidemic 

 

Discussant: John Henderson (Birkbeck University of London)

16:30 - 17:00

Coffee

17:00 - 18:30

Keynote Speaker:

Ian Harper (University of Edinburgh)

Lessons for Global Health from the Control of Tuberculosis

Saturday 9 September 09:00 - 10:30

Panel Four: Evidential Practices

Marissa Mika (University College London)

Under Pressure: Chronic Stress and Chronic Disease in South Africa


Ann Kelly (King’s College London)

Ebola Vaccines and Epidemics as Research Events 

 

Discussant: John Manton (The London School of Hygiene & Tropical Medicine)

10:30 - 11:00

Coffee

11:00 - 12:30

Panel Five: Animals and the State
 

Saurabh Mishra (University of Sheffield)

"Public Cattle,” Epizootics and the State in Colonial India
 

Freddie Stephenson (University of Nottingham)

Schrödinger's Cat?: The Management of Bubonic Plague in Shanghai's International Settlement in the Early Twentieth Century.

 

Discussant: Rohan Deb Roy (University of Reading)

12:30 - 13:30

Lunch

13:30 - 15:00

Panel Six: Disease Control


Marlee Tichenor (University of Edinburgh)

Thresholds: Malaria, Risk, and Disentangling Epidemics


Lukas Engelmann (University of Edinburgh)

Fumigating the Nation: Disinfection in 1900 Argentina

 

Discussant: Clare Chandler (The London School of Hygiene & Tropical Medicine) 

15:00 - 15:30

Closing Discussion

Fumigating the Nation: Disinfection in 1900 Argentina

Lukas Engelmann (University of Edinburgh)

The paper tells the story of early-twentieth-century epidemic prophylaxis in Buenos Aires through the lens of an industrial disinfection apparatus. The Sulfurozador was acquired and integrated in the capital's sanitary administration by the eminent epidemiologist José Penna in 1906 to translate the successful disinfection practices of global maritime sanitation into the urban epidemic control in Argentina. Furthermore, the machine's design allowed public health authorities to move beyond previous campaigns against specific diseases and establish a new paradigm of ‘general prophylaxis’. By contrast, this new apparatus promised effective destruction of all imaginable pathogens, insects as well as rodents. With the arrival of bubonic plague in Argentina by 1900, public health campaigns focused on exterminating rats and disrupting their urban habitat. Where the idea of foreign threats and imported epidemics had dominated the thinking of Argentina's sanitarians, plague renewed the fear of hidden epidemic threats within the fabric of the capital's dense environment. The Sulfurozador appealed to Argentina's medico-political elite as it offered lasting protection and catalysed the invention of a principle of ‘general prophylaxis’. The apparatus embodied the modernisation of traditional sanitary sulphurisation practices in the bacteriological age while it preserved the urban environment - the terrain - as a principal site of public health intervention. Thus, the Sulfurozador allowed Penna and his colleagues to sustain a longstanding utopian vision of all- encompassing social, bodily and political hygiene deep into the twentieth century.

 

Putting Plague on Trial: Uncertainty and Knowledge in a Colonial Epidemic

Nick Evans (University of Cambridge)

In the final years of the nineteenth century, a plague epidemic swept through India, killing thousands a week. The colonial establishment soon found that their own narrative resources were insufficient to describe and give shape to this epidemic. Hoping to establish a publicly accessible truth about plague, the British government created a Commission of Inquiry into the disease, which examined witnesses – both British and Indian – from across the subcontinent. Plague had been put on trial. At one level, this commission reveals much about the uncertainties involved in assembling a colonial epidemic. I also argue that close attention to the form of the inquiry can point us toward more fundamental uncertainties that structured the project of British colonialism. This history of uncertainty can be brought into dialogue with recent anthropological work on uncertainty in the modern world. 

 

A Pre-History of Zoonotic Outbreaks: Rethinking Human-Animal “Contact”

Tamara Giles-Vernick (Institut Pasteur), Lys Alcayna-Stevens (Collège de France, Laboratoire d'Anthropologie Sociale), Victor Narat (Institut Pasteur)

This talk will explore a kind of ‘pre-history’ of zoonotic outbreaks, by examining how epidemiologists, virologists, and other biomedical researchers have explained zoonotic outbreaks through the notion of “contact”. Human-animal “contact” is frequently raised as an important driver of such cross-species pathogenic transmissions and the interdisciplinary literature examining zooanthroponoses largely contends that “more human-animal contact leads to more risk.” Yet the very basis of this proposition, the term “contact,” has not been rigorously analysed. Colleagues and I evaluated how the term is used to explain cross-species spillovers, with a focus on human-nonhuman primate (NHP) engagements and pathogenic transmissions. We found that “contact”, though frequently used, is employed inconsistently and imprecisely across this literature, overlooking the range of pathogens, their transmission routes and directions, and the people, practices, ecologies, histories, and political economies that shape them. By overlooking these factors, biomedical investigators of zoonotic disease tend to enshrine certain practices (hunting and butchering) as the only activities catalysing spillover while naturalising gender, ethnic, national and other differences as risk factors for pathogenic transmission.

Offering an alternative way of understanding zoonotic spillover, we discuss research conducted in southeastern Cameroon, which examines the convergences of people, animals and pathogens and the historical, social and environmental processes that may facilitate cross-species spillovers.

 

Ebola Vaccines and Epidemics as Research Events

Ann Kelly (King’s College London)

The 2013-2016 West African Ebola Outbreak was both a catastrophic public health disaster and a rare research opportunity. This paper analyses how the tensions between the humanitarian imperatives of disease control and the epistemic conventions of bioscientific inquiry played out in the accelerated development, testing and licensure of Ebola vaccines. Beginning with the epidemiological projections of the disease's spread, the paper develops the notion of evidentiary charisma to capture the varying power of experimental designs and data packages to marshal public health salience, recruit moral legitimacy and short-circuit scientific contestation. Attention to the charismatic dimensions of Ebola vaccine R&D helps to unpick the simultaneous appeals to exception and convention in the unfolding of a global health crisis, and to trace the normative and technical contours of the emerging paradigm of emergency research.

 

Entanglement of the Visible and the Invisible Components of Emerging Zoonoses

Michael Kosoy (Centers for Disease Control and Prevention)

Some components of infectious diseases can be visualized and measured, while the predominant parts of these extremely complex systems remain invisible and hidden. A common expectation is that information arrived from analysis of manifested components of pathogens and infected individuals can lead to better understanding and more accurate predictions of epidemics. Such an expectation could be illusory with a realization of complexity and interconnectedness of relations between microbes, animals, people, disease manifestations, environmental and social conditions that can trigger epidemics. Partially ‘visible’ elements are entangled into the complex of hidden relations. Emergent properties of epidemics become evident only after diseases appear from the ‘invisible’ side. To measure ‘unseen’ we need additional dimensions. How much and what kind of information we need to value or ignore for making a meaningful choice between variables reflecting a status of epidemics? Paradoxical logic is proposed for orientation and assembling the visible and the invisible elements of the complex ‘host-pathogen-environment-community’ network. In the paper, I intent to define specific hierarchical levels in investigation of epidemics according to the shift of perspectives in the ‘visibility-hiddenness’ dimension.

 

Landscapes of Emergence in South-East Cameroon. Fieldnotes from the Birthplace of HIV.

Guillaume Lachenal (Université Paris Diderot)

The forests of South-East Cameroon are known to be the “birthplace of HIV,” where simian ancestors of the virus circulating in local chimpanzees “crossed-over” to human hosts in the early 20th century. Based on biological, historical and ethnographic research conducted recently in that region, my paper will propose an ecological perspective on the emergence of HIV, challenging “naturalistic” narratives about the pandemic origins. I will discuss in particular how recent explorations of the medical and political history of colonial Cameroon, as well as epidemiological research on the iatrogenic transmission of hepatitis C virus complicate classic understandings of HIV as a zoonosis, highlighting the role of human technology and agency in past and present viral emergence.

 

Pandemic Visions, Human Mastery and Eschatological Reversal

Christos Lynteris (University of Cambridge)

Although today epidemics are perceived as deriving from “nature” or from humanity’s interaction with it, a trope often used to describe the impact of the “next pandemic” hankers back to an age and time where epidemics were seen as having supernatural rather than natural causes: the pandemic apocalypse. This paper critically examines this term, arguing that when taken seriously the examination of the “end of the world” imaginary surrounding the “next pandemic” reveals much more than just an idiomatic relic of premodern understandings of epidemics. In particular the paper will examine how this imaginary is underlined by a reversal in the eschatological temporality of premodern visions of the End; a reversal that reconfigures the relation between the time of the end and the end of time and institutes the loss of mastery as the key relation between humanity and nature in the age of disease emergence.

 

Zika Epidemics in Brazil:  the Knowns and the Unknowns.

Ilana Löwy (Cermes3, CNRS)

In October 2015, doctors from North Eastern Brazil reported an alarming increase in the number of babies born with microcephaly (abnormally small head). They strongly suspected a link between this phenomenon and an epidemics of Zika in the region. In November 2015 the Brazilian ministry of health declared a “Nationally Important Health Emergency” and called women at reproductive age to delay pregnancies and protect themselves from mosquitoes. Three months later, in February 2016, the WHO’s Emergency Committee recommended the declaration of Zika as a Public Health Emergency of International Concerns (PHEIC). The wave of Zika related inborn impairments peaked in North Eastern Brazil in summer (winter in northern hemisphere) 2015-2016. In other regions of Brazil, the incidence of Zika-related inborn anomalies was much lower than in the North East,; it  remained stable for a year. The number of  babies born with Zika-related impairments decreased in late 2016, and inborn Zika practically disappeared from Brazil in 2017. In November 2016 WHO put end to the definition of Zika as PHEIC; the Brazilian health ministry declared end of the emergency state in May 2017. The epidemics—or rather the present-time epidemic wave --is officially over, but  this did not put an end to numerous interrogations about the Zika outbreak in Brazil . My talk will  be focused on such interrogations. It will trace the “unknowns” of Zika epidemics, including the “unknown knowns” or “public secretes:” elements which are known in principle but became invisible in public debates and interventions. It will examine the consequences of a very partial understanding of epidemiology and pathology of Zika outbreak and an unwillingness to discuss selected elements related to this outbreak, and will discuss the possible effects of the declaration of “end of Zika epidemics.”

 

Under Pressure: Chronic Stress and Chronic Disease in South Africa

Marissa Mika (University College London)

In 2013, South Africa's head of Statistics Pali Lehohla made headlines while discussing the results and implications of South Africa's 2011 General Household Survey. The survey indicated that white South Africans experience a high burden of mortality and morbidity related to hypertension. Lehohla attributed this discrepancy in part to the high fat diets and minimal exercise regimens of white South Africans. But he went further and attributed these discrepancies to racial and cultural differences, saying that white South Africans were not as "happy" as black South Africans. Lehohla said "closer cultural relationships and equality between black South Africans" was protective against hypertension, and that the disease was a result of "not being very comfortable and happy with life." The South African medical community quickly rebuked Lehohla's comments, arguing that it was racially crude gloss that obscured the major risk factors for hypertension and rendered black hypertension invisible. This presentation presents a think piece on stress in South Africa that is part of a new project on critical histories of disease transitions South Africa. I suggest that stress, in its most expansive medical, metaphorical, and somatic terms, offers us a point of entry into doing historical and contemporary work on disease transitions in South Africa that allows us to work across rather than within the constraints of the quadruple burden of disease and its various silos of health care.

 

"Public Cattle," Epizootics and the State in Colonial India

Saurabh Mishra (University of Sheffield)

This paper examines the operations of the veterinary establishment in India during the long nineteenth century, charting its transformation from an adjunct of the military department, to an autonomous department with an independent existence. It will focus, in particular, on the late-nineteenth century, when the autonomous department was created, veterinary colleges were established, and research institutions began to be formed to work on animal diseases. The second part of the paper will focus mostly on the issue of scientific research, using the example of the Imperial Bacteriological Institute at Muktesar, which was not only an institute of nationwide importance but also received visits from leading bacteriological authorities from Europe (such as Robert Koch). The workings of the institute will be examined in some detail, as well as its motivations, financial compulsions, and larger impact/role.

 

Not Seeing like a State: The Aesthetics and Politics of Mosquito Landscapes

Nida Rehman (University of Cambridge)

Over a century ago, William Gorgas declared that killing mosquitoes required thinking like one.

Understanding mosquito habits and habitats to manage vector-borne diseases remains a mainstay of public health practice today. In Lahore, a city beset by seasonal outbreaks of dengue fever since a major epidemic in 2011, neighbourhood perambulations, field inspections, “hotspot” classifications, geo-tagged vectors and patients, and data-driven alerts enable not only the quantitative management of epidemic disease, but also its qualitative naturalization in urban space. This paper reports on on-going ethnographic fieldwork, examining how situated understandings of urban nature shape, and are shaped by, dengue and its control practices. Considering the aesthetic, phenomenological and political dimensions of this work through the lens of landscape, I ask how and what the public health state sees, and crucially, does not see. In its entanglement with mosquitoes, epidemic events and ecological crises, how does the state configure itself to understand urban landscapes in particular ways, while some spaces, people and processes, remain invisible or are (constitutively) excluded? Using a conceptual and methodological framework that brings together literature on bureaucratic governmentality, urban political ecology and more-than-human landscapes, the paper explores how landscape—what is seen and not seen—sets the terms for differential measures of success, while the mosquito—who shapes and unsettles this optical framework—often does not see like a state.

 

The Suffolk Plague: Rats Generating Knowledge

Karen Sayer (Leeds Trinity University)

In October 1901, four people in Frenston, Suffolk, died of what was suspected to be "pneumonic plague", and further investigation revealed that East Anglian rats were implicated. By 1918, it had resulted in 16 human fatalities. Though it had been preceded by incidences of plague in the port at Glasgow, August-September 1900, when 16 victims died, and what were reportedly similar outbreaks in Liverpool, in 1901 and Govan, in 1903, it was this 1910 outbreak in rural England that caused alarm. This paper will address the response to the outbreak of plague in Suffolk, its relationship to the international response at the time to the third pandemic and why the response was so heightened in this instance. It will focus on the production of expertise about and knowledge networks centred on rats.

 

Schrödinger's Cat?: The Management of Bubonic Plague in Shanghai's International Settlement in the Early Twentieth Century

Freddie Stephenson (University of Nottingham)

In the early twentieth century, the Shanghai Municipal Council headlined the International Settlement's anti-plague program under the banner of "No Rats. No Plague." The phrase was widely employed in the Council's reports and discussions, whilst being displayed prominently on all government issued notices, pamphlets, and proclamations related to public health. Such materials, published in English and Chinese, were pedagogic, seeking to advise the population on how to sanitize their actions and surroundings. For Shanghai's Western medical authorities, a high priority was to encourage residents and business owners to keep cats. Felines, with their long history of domestication for pest control, were agents that introduced a state of protection against the plague. The Municipal Council carried the idea of a cat owning house as a house safe from the plague directly into policy. Initially, buildings with a cat were considered sufficiently plague proof to the extent that they were exempted from medical inspections and cleansing. Problems gradually emerged, however, related to determining "the question of cat or no cat." Detailing the developments in this cat question, and examining them through the prism of Schrödinger's famous thought experiment, this paper elaborates the constitution of colonial logic in treaty port Shanghai, how it operated, and to what effect. The paper argues that the ideas underpinning Schrödinger's cat, such as multiple or ambiguous states of being, parallel and capture the racial notions of both people and places in the semi-colonial settlement. Moreover, the paper argues that such parallels, in a quotidian setting, serve as a reminder of the factors predicating meltdowns in moments of crisis, whilst also highlighting the persistent influence of human factors on the spread of disease.

 

Thresholds: Malaria, Risk, and Disentangling Epidemics

Marlee Tichenor (University of Edinburgh)

Included within Goal 3 - the health goal - of the Sustainable Development Goals is the aim that by 2030 the global community will "end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases." Tracking this SDG is broken down into the indicators of new HIV infections per 1,000 uninfected population, along with TB and Hepatitis B incidence per 100,000 population and malaria incidence per 1,000 population. These incidence rates are then compared against regional- or country-level epidemiological data to determine whether they are "normal" incidences or epidemics. Drawing on my doctoral ethnographic research on malaria control efforts in Senegal, this talk will discuss moving thresholds with regards to malaria parasite diagnosis and epidemic surveillance, and the intensification of quantified risk with the centrality of data production for securing quality health care in the emerging SDG era. Within this context and in this talk, I will ask when do endemic diseases like malaria become epidemics, for whom, and for what purpose? What causality is given for these endemics-turned-epidemics, and what does "ending epidemics" of malaria really mean?