Epidemic!
Alternative treatments for global ailments
Pranjal Tiwari and Danee Voorhees

It has been a bizarre experience living in Hong Kong amid the current outbreak of Severe Acute Respiratory Syndrome (SARS) that began earlier this year and observing some of the trends that have taken place. We seem to have become a panicked and confused city with foreign nationals leaving en masse, sensationalist news coverage filled with incongruous information, and streets crowded with mask wearers and sellers. Normal life has been profoundly interrupted. People have been advised to stay home as much as possible; schools have been closed for nearly a month; restaurants and hotels have seen business down by 80 to 90 percent.

It’s not that SARS is nothing to worry about — it is, after all a new disease and has affected well over 1,000 people in the city — but in our current social and economic organization, responses to infectious disease outbreaks, like reactions to other emergencies, can serve to reinforce the oppressive hierarchies and structures of power that dominate our societies.

Perhaps that’s not such a groundbreaking observation on its own, but in imagining a better world, one of the most difficult considerations seems to be how participatory societies could react to an emergency like SARS without creating or reinforcing such oppressive hierarchies/structures and fundamentally compromising their norms.

Cover-Ups and Gloss-Overs

The role of oppressive institutions has been evident in Hong Kong. From the start of the outbreak, the government’s reaction has been with the interests of business elites firmly in mind. Initially, the details of the disease and extent of the outbreak were covered up by the government which feared affecting investment and explicitly stated its uneasiness about affecting the city’s massive tourism industry. It was recently revealed, for example, that the public list of SARS patients did not include the name of a high profile expatriate businessman who had contracted the disease. When the government was finally pressured to release the information, one of the victim’s colleagues remarked: “They have taken a week to own up to the fact that SARS is also affecting wealthy people who live in the top end of town.”

As it became clear that this cover-up was ineffective, that keeping quiet about SARS was actually achieving little in preventing fears among privileged classes — reflected in sluggish markets, a general slump in economic activity, and massive flight of foreigners — government actors turned instead to a rhetoric of aggressive reassurance.

James Tien, Chairman of the Liberal Party described the situation as “a war against an unseen enemy, and one we must not lose.” (Where have we heard that before?) It was also revealed to the public that the government’s War Council would strategize against this enemy in their “purpose-built bunker in the basement of the Central Government Offices if an emergency were declared.” Most recently, Betty Tung, the wife of Chief Executive Tung Chee Hwa, launched a symbolic clean-up program called Operation Unite, sponsored by local business elites (or community leaders as they call themselves), through which an army of 10,000 volunteers would disinfect public housing estates and dirty streets. The tangible anti-viral effects of such moves are, of course, questionable at best. The military vocabulary and tough talking action plans are aimed more at securing support and faith in the power of the state in a time of emergency.

I’m sure the dangers of such a public relations boost for oppressive hierarchies are fairly evident but to look at one specific example, James Tien, quoted above as battling against an “unseen enemy,” is himself known as an enemy of the poor to migrant workers’ groups, having recently successfully concluded a campaign for a tax targeted specifically at the wages of Hong Kong’s foreign domestic helpers. The current emergency is an opportunity to gloss this over, for Tien to project himself as a strong community leader in an embattled and confused city.

Moreover, the advice of medical experts, when mixed with a rhetoric of fear, has led to a general level of distrust in the city. “People aren’t wearing masks to keep their own germs to themselves,” says Klaudia Kong, a 28-year-old Hong Kong resident who refuses to wear a face mask. “They’re wearing them because they don’t trust anybody else.”

SARS and the National Security State

A similar situation can been seen internationally. Indeed, if James Tien is employing rhetoric reminiscent of the war on terrorism in Hong Kong, we can only imagine what kind of language has been used in the US to talk about this disease.

The SARS outbreak in the US seems to have been used to further justify the emerging national security state, fed by the spectre of bioterrorism. SARS was recently added to the list of diseases for which the Center for Disease Control has the power of forcible quarantine, an authority that was originally demanded by Secretary for Health and Human Services Tommy Thomson in 2001 in the event of a biological warfare attack. Aside from the public relations value of such a move, the goal of expanding an avenue of domestic state power was also achieved as National Guard units would be used to enforce the CDC’s authority.

For the Bush regime, it seems to have been easy to exploit both the emergence of SARS and the position of the CDC as specialists to further the current agenda of expanding domestic repression. As Senator Max Cleland recently said, Congressmen “realize the CDC is a national security agency now.” Like other national security agencies, the CDC saw an expansion of its funding in the current climate of fear with its 2002 budget jumping to around $4.4 million. “We would have limped along, business as usual,” Cleland said. “Now, four weeks later, we’ve got a record budget passed.”

The main means by which information from medical experts is relayed to the public, media reporting of SARS in the US has been laden with fear and hysteria. In one incident on April 1, US TV networks interrupted their coverage of the Iraq invasion to bring viewers live footage of an American Airlines flight from Tokyo that had just touched down at San Jose, California. The cabin crew feared that five people aboard might be showing symptoms of SARS - the basis for the alert, it turned out, was that the passengers had simply coughed.

The Hysteria Virus

At a recent telebriefing held by the CDC, several frightening questions were posed by journalists. Some questions asked whether SARS was a “fire drill for bioterrorism,” incorrectly equating disease outbreak with a terrorist attack. Several other journalists played up the role of SARS as an external threat, one question being whether airlines have “routinely allowed obviously sick passengers to board international flights bound for the United States, and that Customs officials sometimes let them into the country.” This question is asking whether US officials are routinely allowing an external threat to enter by being soft on the issue of borders, a theme that has become routine whether the media is discussing illegal immigrants from Mexico or Arab terrorists. Such discussions have already helped to further elements of the Bush agenda — the proposed budget for the Border Patrol, for example, saw an increase of US$2.2 billion this year.

Another journalist actually made an explicit link between SARS and non-white populations in the US: “Among the 115 U.S. cases how many of those occur within the Asian population, and is there a greater risk of encountering SARS within a Chinatown of a U.S. major city?” she asked. The equation of SARS and Asians, like the linking of SARS and terrorism, is a logical fallacy — an improper use of the and function — but the scapegoating of foreigners in Chinatown for spreading disease is an easily believed sensationalism. “You’ve never seen so many ‘For Lease’ signs in Chinatown,” said David Lee of the Chinese-American Voters Education Committee in San Francisco, commenting to the San Jose Mercury News on the decline of many Chinatown businesses.

Businessmen in Central Park West could be carrying SARS after returning from trips to Worst Affected Areas. However, this view is met with considerably less hype and hysteria, even though the disease is said to have travelled to over 20 countries via air travel. In fact, cases of SARS in Vietnam, the Philippines, and Singapore were originally traced to an infected businessman who travelled to each of these places before dying … perhaps an interesting side effect of global capitalism?

Capitalist globalization has certainly been a theme running through the reporting of the business press and elite newspapers in the US and internationally on this issue. Many have mutated the disease to fit the agenda of China-bashing. Such editorials have generally turned viable arguments about the Chinese government’s “lack of transparency” in handling the SARS crisis into support for the country’s continuing history of increasing transparency for foreign investment and neoliberal trade regimes. A recent opinion piece in the South China Morning Post, for example, noted that “China’s hopes of being accepted as one of the world’s leading nations has suffered a setback … for China to join the modern world, it will have to … embrace concepts of openness not only regarding trade rules, but in other spheres as well.”

Reporting in Hong Kong itself has also been full of sensationalism, which Tim Yan Lim, ex-Chairperson of the Hong Kong Journalists’ Association, says is nothing new to journalism around the world. “Given the market structure, we can expect sensationalism for some time,” he said. Crises sell.

Another Approach to Health

Like most people in the city, I have been avoiding crowds, wearing a face mask, and regularly washing my hands, trying to do what I can to avoid infection. I realize that there is little choice but to act responsibly and take the advice of medical experts.

I don’t think this is necessarily a bad thing. During an infectious disease outbreak, it makes sense to pay reasonable attention to the group carrying out research into the disease and its cure. On an abstract level, this is a dependence based on trust, the hope that an informed group is looking after our interests and working to prevent millions from dying.

The problem comes with moving from the abstract to our present system of social and economic organization and seeing how this dependence can be exploited by power. Medical experts and health departments — like all institutions — are today closely linked to oppressive structures. These hierarchies end up being indirectly but crucially supported when we feel the very real need to take the advice of specialists and experts in an emergency situation.

How can we change this? In a more agreeable society, we could say that these hierarchies would not exist. A more localized medical system, for example, would allow us to take health-related advice without it being filtered through oppressive institutions. Moreover, changing fundamental aspects of modern capitalist life and social relations would have a profound effect on our immune systems, says Greg Nigh, a physician and activist in Portland, Oregon.

“I would suggest to you that the progressive decline of immune competence in industrial societies is precisely because of the products of capitalist production that have invaded our bodies and their living spaces. … Our bodies are filled with chemicals … our lives are filled with stress: work, financial, body image, relationship, etc. In short, we are creating a world in which simply living is immunosuppressive.”

But it does not seem enough to simply say that social relations would be different in the future. Nigh explains that responses to an infectious disease epidemic would have to come out of a more participatory medical system, one that is more democratic in terms of its overall approach to the concept of health.

“In a participatory community, I believe that the actual practice of medicine looks very different. The system doesn’t simply treat disease. For example, in any sensible system, the health care system is integrated with the food production system, because health and food are two sides of the same coin.

“Conventional medicine is not to be thrown out. Not at all. MRIs and CT scans and other technologies are still important, but imagine a health care system that people actually wanted to use, a system that we looked forward to using, a system that left us feeling more vital after an encounter with it.” He goes on to suggest that, in such a community, care is local, personal. It is not simply a system that gives us a product and sends us on our way.

Specifically referring to an outbreak of infectious disease, supportive care would take on a much more active role. This would involve “therapies that enhance the body’s ability to fight infection, not therapies that compromise that ability.” For those whose life is at risk, more invasive procedures may be necessary.

Such a response may be near impossible to imagine within today’s health care industry — particularly in Hong Kong during these times.

But perhaps it is because the alternatives are so difficult to imagine that the issues of popular health and effective responses to health crises should be central to movements organizing towards wider social change.