Some thoughts, from a historical perspective, on the striking tension between the truly global nature of the #coronavirus challenge on the one hand, and, on the other, the responses around the globe that have been distinctly national in scope and uncoordinated in character. 1/
The realization that diseases and pathogens don’t respect national borders has formed the very basis of international health politics in a “modern” sense and has guided transnational cooperation in the realm of public health since the mid-nineteenth century. 2/
When 12 states sent representatives to the first International Sanitary Conference in Paris in 1851, establishing public health as a matter of international diplomacy and law, they did so because they were convinced that some form of border-crossing health regime was necessary 3/
However, the 19th century Sanitary Conferences were mostly a European affair and very much focused on protecting the continent from plague, yellow fever, and most importantly cholera through a set of codified quarantine measures. 4/
From the start, ideas of „internationalization” and perceptions of threat from infectious disease were intertwined: the rapid dissemination of cholera, which originated in South Asia and spread around the globe in several waves starting in the 1830s, exemplifies this dynamic. 5/
The cholera pandemics were directly caused by a new quality and quantity of cross-border movement of people and goods, made possible by new modes of transportation. But cholera also acted as a catalyst for ideas of globalization and the world becoming ever more interconnected. 6/
This has really been the leitmotif in the modern history of global public health: In the “West” perceptions of globalization have almost always been accompanied by a heightened sense of threat from infectious disease and by appeals to reinforce existing quarantine regimes. 7/
In the 1970s, for instance, in the midst of what is sometimes referred to as a “second globalization,” the appearance of new pathogens such as the Marburg, Lassa, or Ebola viruses seemed to herald a bleak future – and sparked fears of exotic diseases invading “the West.” 8/
Since the late 1990s, SARS, avian influenza, and swine flu have garnered a lot of political and public attention – as have the Ebola epidemic in West Africa in 2014 and the appearance of the Zika virus in the tropics in 2015/16. 9/
In this respect, the distinctly national reactions we are currently witnessing during the #COVID19 pandemic are very much in line with how “Western” societies have tended to react to the threat of large-scale epidemics historically. 10/
Interestingly, though, there was specific period in which reactions diverged from this pattern: At the height of the 1940s “globalism,” many contemporaries shared a vision of the world coming together as One in order to combat the threat of infectious disease. 11/
I focus on this in my book on the history of global health politics in the 20th century, the title of which was inspired by the decidedly utopian vision that contemporaries laid out for the future of humanity: A World Without Disease. 12/ wallstein-verlag.de/9783835319196-…
Crucially, the 1940s were certainly – much like the present – characterized by heightened fears and a sense of acute threat of infectious disease which was intimately bound to the pervasive perception of witnessing the dawn of a new “global age.” 13/
This new era in human history was thought to be characterized by an unprecedented level of global interconnectedness, caused by modern transportation, communication, and weapons technologies. 14/
Wilbur Sawyer, UNRRA’s Director of Health and former director of the Rockefeller Foundation’s International Health Division, often spoke of “the astounding increase in the rapidity of travel and communications“ in the 1940s. 15/
In the immediate aftermath of the Second World War, deliberations over a post-war international public health regime were dominated by the idea of a rapidly “shrinking world,” which became one of the leitmotifs of this phase. 16/
From a crucial U.S. senate report of November 1945: “Particularly in our shrinking world, the spread of disease via airplane or other swift transport across national boundaries gives rise to ever-present danger.“ 17/
As Brock Chisholm, the first Director-General of WHO, put it: „Until quite recently, man’s environment has been his locality only, his village or town or at most his own country. ... This situation has changed entirely: the environment of every person is now the whole world.“ 18/
Many contemporaries feared that this supposedly unprecedented level of interdependence was inherently dangerous, for it seemed to allow diseases to spread all over the planet with staggering speed. 19/
According to the U.S. State Department: „In the age of aviation disease travels faster than ever, and becomes a threat to the highly developed countries with their vast centers of communication even more than to remote and undeveloped regions of the world.” (June 1945) 20/
If that was the case, then no one would be safe from harm unless everyone was; the health of any individual was inextricably bound to that of every other person on earth. By the end of 1945, such perceptions had crystallized in the idea of a collective state of “world health” 21/
Consequently, quarantine measures were widely discarded as anachronistic in the 1940s: „While quarantine has been prominent in international health activities from the beginning,” Wilbur Sawyer remarked, “it is rapidly being relegated to a secondary place.” 22/
General James S. Simmons, U.S. Army Medical Corps, told Congress in June 1947: „We have passed the age when we can think in terms of isolation in connection with health and disease; for from this viewpoint we truly live in one world.” 23/
The only choice was “to control, to the point of eradication, communicable disease at its source,“ as the U.S. delegation to the 1946 International Health Conference in New York argued. 24/
As the U.S. Congress put it in a joint resolution in November 1945, the new World Health Organization would have “to wipe out disease everywhere,” and to lead the world in the coming “great international crusade against disease.” 25/
In the 1950s and 60s, in particular, this globalized conception of health would form the basis on which ideas of worldwide disease eradication could flourish and animate visions of creating a world without disease. 26/
The initiatives and interventions that followed from such conceptions dramatically influenced the lives of hundreds of millions of people and had massive and often unintended consequences. They deserve a critical and nuanced interpretation, which is what I try in the book. 27/
What is striking, however, is the fact that this idea of “world health” combined a heightened sense of threat from infectious disease not with a call for enhanced quarantine, but with a vision of markedly intensified international cooperation and global communion. 28/
There’s a certain universalist idealism that animated those who founded @WHO. In the words of Brock Chisholm: „this ideal should be to draw lines boldly across national boundaries and should be insisted on at whatever cost to personal or sectional interests.” 29/
It also informed @WHO’s downright utopian mission: to work towards „the attainment by all peoples of the highest possible level of health,“ with health defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ 30/
I’m not advocating against the measures we’re seeing now – the travel restrictions, the calls for social distancing (stay home and stay away from other people, people!). But once we come out on the other side of this #COVID19 emergency, we’ll have to figure out what’s next. 31/
And it is worrisome that the responses to this #coronavirus crisis have been distinctly national in scope and character (or sometimes even nationalist and xenophobic), largely uncoordinated on the supranational level, and rather piecemeal. 32/
The visions of “world health” that emerged in the 1940s might serve as a bit of an antidote, a much-needed corrective to isolationist or nationalist tendencies – a reminder that it is possible to imagine a different way of tackling the challenges of the global age. /end
