Snowden, Frank M. (2019) Epidemics and Society: From the Black Death to the Present. New Haven and London: Yale University Press.
At the beginning of the present global pandemic, the President of Ireland, Michael D. Higgins, was among many who warned about the impact of the Covid-19 virus on Africa. This was all consistent with his long record of solidarity with the developing world. The spectre of ‘mass fatalities’ was invoked by President Higgins as part of his appeal for greater international attention and aid for Africa in the shadow of what was assumed to be a looming crisis. A contrasting perspective on the present crisis, however, was provided by Julius Maada Bio, the President of Sierra Leone. In his first public statement on the threat of the Coronavirus – and it was a very real threat, as he acknowledged – he had this to say:
“We have alerted our healthcare personnel and strengthened our healthcare systems across the country. We are determined to prevent the incidence and spread of the virus. But we are also extremely cautious that like Ebola, by the time we identify one positive case, we would have had several dozen disease contacts. We cannot afford to wait for a positive case. We are not going into imminent lockdown. Our actions and the preventive measures we take now as individuals and as communities are critical to ensuring we don’t have to. This is not a time to panic. I have held consultative meetings with fellow Sierra Leoneans right across board including those persons who managed the Ebola crisis. To my mind, this is a time for close attention to detail, focus, and intense discipline.”
Since then, Sierra Leone, like most of Africa, has evaded the worst the coronavirus can throw at affected populations. Or evaded it for now, at least. The reasons for this remain unclear, but it may be due to several factors, including the very high percentage of young people in African societies, and the possibility of previous exposure to other coronaviruses. A recent piece in London’s Financial Times, however, stresses the ways in which African public health officials reacted swiftly to the initial news of the Covid-19 outbreak, and worked hard to make sure that if their societies could not be locked down, then the borders through which the virus might leak could at least be barricaded against it.
The final outcome of Africa’s battle with this new threat remains unknown at the time of writing (November 2020). What the coronavirus pandemic has shown for all continents, however, and not just Africa, is the direct and intimate connection between epidemic and pandemic infectious diseases and the social context in which human beings succumb to, or escape from, those diseases. This brings me to the book under review here – Epidemics and Society, by Frank M. Snowden.
Based on a Yale University undergraduate course, Snowden’s book is a wide-ranging survey of the history of epidemics from antiquity to the present day. He mentions for example, the plague of Athens, which was once speculatively ascribed to Ebola, but which now appears to have been an outbreak of Typhoid fever. Some of the historical cases were new to me – the role of Napoleon’s invasion of Haiti in sparking new patterns of malarial infection, for example, which wrecked his military campaign to retake the post-revolutionary island. In peacetime, too, disease can exploit human social interaction to spread and become chronic. Malaria in 19th century Sardinia was enabled by land speculation that led to environmental degradation, and the spread of stagnant ponds that were ideal breeding sites for the disease’s vector, the mosquito Aedes Aegypti.
Snowden takes the story up to the present day, and shows us the ways in which infectious diseases have not only frustrated human hopes for their eradication, but have grown to be threats to national and international security, at least in the eyes of the United States government and the United Nations. As readers of this blog will be aware, one of the starkest examples of the renewed threat of disease in the twenty-first century was the Ebola Virus Disease epidemic which struck Guinea, Liberia and Sierra Leone six years ago. Those readers will want to know how Snowden handles his account of the experience of the Upper Guinea Coast countries – and they will want to know if his account is accurate. What in other words, can we say about his account of the relationship between epidemics and society in the Upper Guinea Coast region?
Others may differ, but I can’t say that I noticed anything remarkably flawed or inaccurate in that account. Those of us who followed, or lived through, the EVD crisis will find much that is familiar in Snowden’s retelling of the episode. He quite rightly rejects those who implied that some local African defect was responsible for the epidemic: “We should be very clear that the rapid spread of Ebola is not due to 15,000 episodes of bush meat eating frenzy” (here, Snowden is quoting the US congressional testimony of “the anthropologist and physician Paul Farmer, who had served as an emergency responder during the crisis”). He’s also reasonably good about the cultural ideas that mandate funeral practices that had an unfortunate role in spreading the virus.
This is also where he shows the limits of the place for anthropology in his account. A big part of his book’s overall account of epidemics and their role in human history is an account of how the past few hundred years have seen a real revolution in human understanding of disease, and disease-causing agents. This knowledge has allowed the development of modern public health as what Donald Acheson called the “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.”
Anthropology’s contribution to this work involves much more than the study of the ‘exotic’ aspects of diet and funeral rituals: the militarization of the Liberian government’s counter-Ebola strategy in the opposition stronghold of West Point, Monrovia, for example, involved deeply social and cultural factors, which could be, and have been, studied by anthropologists. Abramowitz et al (2015) note that there was more at work here than just the deployment of military force to an urban neighbourhood largely loyal to the political opposition in Liberia: there was also the recruitment of local men to surveillance and alert activities which, in their own way, posed the threat of ‘remilitarization’, in a social context still dealing with the legacy of the Liberian civil war. She and her colleagues also give a richly detailed portrait of the various ways in which people in urban Liberia responded individually and collectively to EVD, and to the aftermath of the virus. Children orphaned by the disease became the community’s responsibility, and the community had to reintegrate survivors while memorialising those of its members who had been lost to the epidemic (2015).
Anthropologists can help understanding of such cases by outlining the ways in which everyday life, state policy, and the structures of kinship and other social relationship shape human relationships with the environment in general, and our relationships with emerging infectious disease threats in particular (see, for example, Adia Benton’s comments on the ways in which real life and media images of epidemics converge to assist the militarization of the United States’ epidemic response in 2014). Snowden doesn’t mention these aspects of the social side of epidemic disasters at all, nor does he discuss the anthropological angle on epidemics as social phenomena. This isn’t necessarily a point against him: he can’t have been expected to include everything in his book, or even in his chapter on Ebola and SARS. But, as he notes in that chapter, those outbreaks were only preludes to the outbreak of pandemic diseases like Covid-19. That disease, in its turn, will be a prelude to other, future, crises. If we anthropologists have a role to play in understanding those past and future events, then it won’t be by trafficking in the ‘exotic’ or even the unexpected (which begs the question, unexpected to whom?). We should respond to Snowden’s book with works of our own, in which we spell out the role anthropology can play in the art and science of responding to public health threats.
In the meantime, the global Coronavirus pandemic continues. It will have to end sometime, but so far there is no end in sight. A key feature of the present pandemic is that it has involved the decompression of space and time, thrusting people everywhere out of the social relationships which had been built up by globalization, and slowing down their interactions with the outside world. The world hasn’t stopped globalizing, but the assertion of national authority to fight the viral threat has changed the ways in which global relations are formed (the same global relationships that allowed the spread of Covid-19, and, before it, SARS and Ebola). Whether this assertion of the national (in the form Julius Maada Bio ordered, for instance) will survive the pandemic of today, or the pandemics of the future, remains to be seen. What does seem likely is that local social and cultural structures and ideas will be of even more importance in understanding what’s going on when people and their communities are threatened by emerging infectious diseases. In that case, there will be a vital role for anthropologists. We could learn a lot from reading books like Epidemics and Society, especially if we can write popular texts on disease and society that are as accessible to the layperson as Snowden’s is.
 https://www.irishtimes.com/news/politics/michael-d-higgins-warns-of-mass-fatalities-in-africa-due-to-coronavirus-1.4275585?mode=sample&auth-failed=1&pw-origin=https%3A%2F%2Fwww.irishtimes.com%2F news%2F politics%2 Fmichael-d-higgins-warns-of-mass-fatalities-in-africa-due-to-coronavirus-1.4275585.
 Kazanjian, Powel. Ebola in antiquity? Clinical Infectious Diseases 61, 6 (15 September 2015): 963–68. https://doi.org/10.1093/cid/civ418. Snowden (2019: 14) refers to recent DNA research as identifying Typhoid as the disease agent in the ancient Athenian epidemic.
 O’Kane, David, and Rosabelle Boswell. ‘Heritage’ and ‘cultural practice’ in a globalized disaster: a preliminary thematic analysis of documents produced during the Ebola epidemic of 2013–2015. Globalizations 15, 5 (2018): 622-635.
 Acheson, Donald. Public Health in England. London: Department of Health, 1988.
 Abramowitz, Sharon Alane, Kristen E. McLean, Sarah Lindley McKune, Kevin Louis Bardosh, Mosoka Fallah, Josephine Monger, Kodjo Tehoungue, and Patricia A. Omidian. Community-centered responses to Ebola in urban Liberia: the view from below. PLOS Neglected Tropical Diseases 9, 4 (9 April 2015): e0003706. https://doi.org/10.1371/journal.pntd.0003706.
 Benton, Adia. The epidemic will be militarized: watching outbreak as the West African Ebola epidemic unfolds. Cultural Anthropology (2014). https://culanth.org/fieldsights/the-epidemic-will-be-militarized-watching-outbreak-as-the-west-african-ebola-epidemic-unfolds.