May 12, 2021

Off the Shelf: ‘Contagion,’ a Book on the Interplay of Commerce and Illness

Luckily, “Contagion,” published by Yale University Press, actually offers a fresh historical overview of the interplay between disease and commerce, politics and international diplomacy. The author, Mark Harrison, is a professor of medical history at Oxford University and knows this material inside out. Both his scholarship and his reach are impressive. The book charts how business and government handled, or mishandled, just about every significant outbreak of cross-border disease from the Black Death of the 1300s to more recent scares including SARS, mad cow disease and the Mexican swine flu scare of 2009.

Professor Harrison’s thesis, that the spread of disease is intertwined with the spread of trade, isn’t exactly groundbreaking. I mean, before the advent of tourism, how else other than war would disease spread if not via commerce? Long before anyone knew there was such a thing as a germ, countries suspected that disease, especially plague, traveled along trade routes, especially via shipping. The quarantining of ships for sanitary reasons began as an antiplague measure at Dubrovnik in 1397, and was quickly adopted in Italy.

The association between plague and trade, Professor Harrison shows, reinforced Renaissance-era biases about the rise of mercantilism. It’s a situation somewhat similar, if you think about it, to the way that the spread of AIDS reinforced antigay biases in the 1980s.

The author notes that the Bishop of Rochester, writing in 1375, saw plague as a penalty for the “great falsehood” that was “practiced in measures, charging interest, weights, scales, adulteration, lies and false oaths.” Plague victims in Renaissance literature were sometimes called “merchandise.”

An awful lot — maybe too much — of Professor Harrison’s book concerns the evolution and uses of quarantine. In just about every age and every country, merchants accepted having their goods quarantined as a necessary evil when disease was rampant. But their patience tended to be short-lived otherwise.

The Dutch, who apparently ran tight but very grimy ships, were forever having their ships quarantined, and they were known to respond with what Professor Harrison calls “tit for tat” health measures, quarantining the ships of those who dared quarantine their own. In time, certainly by the 1700s, quarantine had become an instrument of statecraft, an excuse for protectionism and, sometimes, a reason to go to war.

“It was now clear,” Professor Harrison writes, “that the imposition of sanitary measures was likely to be considered an act of aggression.”

In time, of course, the world grew up, and the Europeans had everyone agree on international rules for this sort of thing.

If you’re getting the sense that much of this book is about the role of governments and not corporations in dealing with disease, you are correct. One could make the point, in fact, though the author does so lightly, that business interests have been a positive force in the suppression of disease.

Time and again, from an outbreak of plague in India in the 1700s to the present day, governments have leapt to wipe out such outbreaks in large part because they fear a loss of international investment, Professor Harrison shows.

Given his grasp of the subject, I was eagerly awaiting Professor Harrison’s take on the balancing of commercial and health interests in today’s world. “Contagion,” alas, devotes but a single chapter — “Disease and Globalization” — to such 21st-century scourges as SARS. That is a shame, because the author makes some provocative points, including a portrayal of SARS as a classic media scare, a disease that ultimately infected barely 8,500 people, killing 876.

SARS, which was identified a decade ago, certainly had the potential to ricochet around the world overnight, but it didn’t, and Professor Harrison argues that the resulting damage to global trade, especially Asian tourism, was avoidable. He blames harum-scarum public-health announcements that, in the hands of 21st-century media, turned worst-case scenarios into perceived likelihoods.

The “net effect” of television and Internet coverage on world audiences, he argues, “was probably to engender panic and increase their sense of vulnerability.”

That sense of vulnerability, he says, has enabled governments like China’s, which has intermittently enacted rules against outside beef and poultry, to use the fear of disease as a fig leaf for protectionism.

The upshot, the author argues, is that while the world appears to be taking a more serious look at public health, “anxiety over pandemic preparedness” makes it “easier for national governments to take actions which exceeded international norms and to justify patently protectionist measures as legitimate responses to disease.”

Moreover, Professor Harrison writes that “the tendency of governments to abuse sanitary precautions is perhaps even more evident now than it was in the 1890s.” He adds that “the present system is not only commercially disruptive, but it affords scant protection for our health.”

THIS is so, he says, because quarantine and border security can go only so far to stanch the spread of new diseases. The most likely incubators of future pandemics, he says, are huge factory farms that serve as breeding grounds for mutated animal-to-human microbes — “an evolutionary fast-track,” in other words, for germs. Until these factories are regulated more aggressively or eliminated, he says, traditional measures will be doomed to failure.

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