Since 1961, we’ve been witnessing a slow-rolling cholera pandemic. Unlike earlier ones, it began in Indonesia, not India, and moved across Asia and the Middle East. It reached Africa by 1971 and Italy by 1973. By 1991, it was in South America, where cholera had been eradicated a hundred years earlier. It killed at least three thousand people in Peru. In 1994, it reached the Rwandan refugee camps in the Democratic Republic of Congo. Then it moved on to the earthquake victims in Haiti. In 2008, it reached Zimbabwe, then wracked by a political crisis.
Until recently, it’s been easy to forget, sitting in Brooklyn or Chicago or Denver, that this is how many diseases work: cholera finds the hobbled, the dysfunctional, the disbelieving, the exposed, the weakened, the neglected, the forgotten. It’s a disease we have lived with since at least the fourth or fifth century BCE. It spreads by way of bacteria, not a virus, and the bacteria thrives in sewage, polluted water, mud, poverty, and crisis. It inflicts diarrhea, vomiting, and leg cramps, until the body is dehydrated. Most healthy people survive cholera; dehydration, septic shock, and death—sometimes within hours—come for the rest. Mortality rates increase sharply in any population that has suffered malnutrition, poverty, displacement, or other health risks.
Cholera still kills around ninety-five thousand people a year, a majority of them in Africa, South America, and Asia, where urbanization—not population density, necessarily, but the absence of sanitation and clean water that result from mismanaged urbanization—threatens to increase the death rate. Cholera travels through human and animal feces into the water supply. “To put it bluntly,” the World Health Organization wrote in 2018, “cholera spreads when people have no choice but to eat food or drink water that contain feces.” In 2018, more than two billion people used water sources with fecal contamination; 2.4 billion lacked basic sanitation services. Which is to say that cholera is a killer only when it finds the right environment. “Spread by the faeco-oral route, the disease affects poor people and the most vulnerable,” The Lancet notes.
The most vulnerable. Reporting on frontline workers during the early months of the Covid-19 pandemic caused me to look deeper at parallels between the outbreak in America and the long history of disease and empire. You might think from today’s American reactions that, as Donald Trump put it in mid-March, “We have a problem that a month ago nobody ever thought about.” The American memory is notoriously short, John Dewey warned us. Even the worst of the previous domestic influenza outbreaks are barely remembered. The experiences of disease in India and Africa and Latin America, of course, are well beyond the scope of most American media, which have long struggled to think clearly about the country’s influence abroad. We manufacture our own “progressive” projects, including endless wars and imposed “aid,” even as we court authoritarians in service of our bellicose empire. Some can see this now more clearly in the Trump era, but few have articulated what will end our long-gestating crisis. Like cholera and poverty, Covid-19 is not the crisis; it’s a disease that feeds on our racialized inequalities.
Yet the president has encouraged Americans to see the outbreak of disease as a sneak attack by an “invisible enemy.” Comparison of the current pandemic to 9/11 is everywhere. When politicians do this, notes Anjuli Raza Kolb, a professor of English at the University of Toronto, the effect is “naturalizing.” Such metaphors depoliticize an event, implying that both 9/11 and its supposed analogue are random occurrences. “When we ascribe randomness or non-human agency to events like this,” she told The Revealer’s Kali Handelman, “it’s so easy to ignore the ways our political and economic systems have set up and maintained inequality and how this inequality plays out” in illness and death along the fault lines of race, gender, and class.
The “forgotten” story of the cholera pandemics offers a way toward a necessary analysis of our current international moment, as economies collapse and we live in fear of a second wave until a reliable vaccine is developed and distributed, and as protests rage across the globe. As Raza Kolb told Handelman:
The establishment of a self-conscious and institutionalized . . . discipline called “epidemiology” in the late-nineteenth century in Britain and France, [was] founded in response to the cholera epidemics. Because the discipline was formed in this moment, we have to take seriously that it is a field of study inseparable from the management of empire.
That understanding leads to an intricately related question, recently posed by the American historian and activist Mike Davis: “Is capitalist globalization biologically sustainable?” Ever-expanding corporations develop their extractive branches around the globe, changing ecosystems large and small, extorting labor, governmental subsidies, and natural resources from all of us—but mostly from black and brown populations. The lessons of cholera tell us that while the deaths and demonstrations of Covid-19 are novel, they are not new.
Illness and Imperium
Colonialism, post-colonialism, and corporate globalization have forever been accompanied by broadcasts of benevolence: campaigns that tout infrastructure building, modernization, education, good works. “The relationship between public health and visual culture found its most potent manifestation in the late nineteenth century,” David Serlin wrote in the introduction to Imagining Illness, “the period in which the management of epidemics and the implementation of hygiene paradigms became central fixtures of the modern nation-state.” Public health efforts were characterized, Serlin writes, as “heroic scientists saving vulnerable natives from evil viruses or, alternately, heroic peoples resisting the disciplining activities of medical imperialists.”
But such imperial efforts were only made for the sake of economic power. We know that famine and malnourishment are preconditions for disease. In famine-plagued colonial India, wave after wave of cholera took countless lives. Why? During the Bengal Famine of 1943, as many as three million Indians died—a tragedy that was attributed to yet another unpredictable weather pattern. The British Empire consistently blamed the weather for India’s periodic famines, along with local “culture” and “overpopulation.” At first, the British even attempted to deny the famine when images of starving Indians appeared in Calcutta newspapers.
Like cholera and poverty, Covid-19 is not the crisis; it’s a disease that feeds on our racialized inequalities.
Nobel Prize-winning economist Amartya Sen famously made the argument in 1981 that the famines were the result of poor British governance, not weather. Last year, research led by Vimal Mishra at the Indian Institute of Technology Gandhinagar used historical weather data to prove that the deaths were indeed caused by British policy. Because of World War II, the empire—specifically Winston Churchill—prioritized food resources for soldiers, not hungry civilians in India. Grain imports to the country were prohibited, price inflation and hoarding made food access impossible, and refugees from Burma (now Myanmar) brought disease and put additional stress on the food supply. Instead of fulfilling the promise of establishing “hygiene paradigms” and the “management of epidemics,” the needs of the empire—war, resource acquisition, war for resource acquisition—set up scenarios of suffering, disease, and mass death.
Madhushree Mukerjee and others have pointed to Britain’s “Denial Policy,” which removed rice and thousands of boats from Bengal so that they could not be confiscated by the Japanese Army, which was expected to invade at any time. Mike Davis, in Late Victorian Holocausts, examines weather patterns and other historical documents in India and China to show that public health and living standards in both were higher before British colonial engagement. Even during drought, food security was guaranteed by local systems of storing and distributing excess grains, systems that were upended when colonial rule was established. “India and China,” Davis writes, “did not enter modern history as the helpless ‘lands of famine’ so universally enshrined in the Western imagination.”
Covid-19, unlike cholera, is a zoonotic viral disease caused by a “spillover” event that spreads contagion from animal to human. Our relationship with animals has always had a price. Animal domestication in the Neolithic period likely decreased human height and health because of exposure to animal-related diseases, and today there are increasing health risks as humans come into contact with previously unexposed species, either through commercial practices like logging that take humans into new areas, or transportation routes that cut through new territory.
Events in Africa, for instance, have accelerated the chance of spillover in recent decades. Once commercial fishing began to deplete the fish population off the West Coast of Africa, hundreds of thousands of fishermen were unemployed, and the price of fish, the primary source of protein in the region, became unaffordable. At the same time, logging companies were hacking into new territory in Ghana and elsewhere along the coast. To feed their workmen, the companies hired hunters to find bushmeat. Soon, bushmeat began to replace fish as the primary protein. But it came with a deadly price: the emergence of zoonotic diseases like Ebola.
Democracy, in other words, is not a miraculous salvation from social ills, disease, inequality—unless it is a democracy that prioritizes public health over other mitigating prejudices and leaders’ profit.
Ending the poaching of chimpanzees, elephants, and other wild animals is a cause that the West can rally around, but it’s the symptom of a much larger problem: capitalist globalization has led international corporations to extract labor, hardwood, fish, and other resources from countries that are too weak or corrupt—due to legacies of colonial exploitation—to care for their own people. Last year, two American companies, Roseburg Forest Products and Evergreen Hardwoods, were charged with harvesting protected wood from West Africa. But such charges are infrequent, their penalties no real deterrent.
Governments and their allied economic powers know to govern like a business: monetize all human need, extract every last resource, and conflate ethics with profit until public health and rights are diminished, small enough to drown in a bathtub. It’s an old model; colonial powers worked it for centuries. Which is why William Dalrymple, historian of Britain and India, has pointed to the British East India Company as a blueprint for today’s multinational corporations. “The lobbying power of the largest corporations can even make and break governments,” Dalrymple wrote.
Another factor in the spread of zoonotic disease is the advent of factory farming, what Davis calls the urbanization of animal populations. “Artificially maximizing populations is accelerating evolution of new strains,” Davis said on a recent episode of the podcast The Dig. Rob Wallace, author of Big Farms Make Big Flu, has identified the powerful risks that multinational factory farming create. “The near-entirety of the neoliberal project is organized around supporting efforts by companies based in the more advanced industrialized countries to steal the land and resources of weaker countries,” Wallace said in a recent interview. “As a result, many of those new pathogens previously held in check by long-evolved forest ecologies are being sprung free, threatening the whole world.” Local subsistence farmers are undermined, their property usurped by a profit-hungry government, their independence and health sold to a foreign corporation. Economies of scale, Western nations and corporations alike have found, are the path to plunder. Make it big; siphon more resources.
If capitalist globalization were just pillaging distant forests and jobs, that would be horrifying enough. But it’s also entrapped us in consumer practices that are killing us. And I’m not talking just about pandemic disease here. Plastics, oil and natural gas, combustion engines, fossil-fuel based fertilizers: the entire way of Western life has already endangered the planet. The unprecedented rate of global warming has begun to displace peoples around the world, either from war over resources or from unnatural weather disasters. “Climate and infectious disease intimately interact with one another,” Davis said on The Dig. But until a pandemic brings it home, many of us are able to ignore the pending horror—horror that will upend the lives and health of those in developing countries because of the callous politics and business hegemony of the West.
Democracy on the Lifeboat
We have also been forced, by the pandemic and its attendant demonstrations, to reconsider the unethical and unequal practices of our democratic form of government. In a 2003 article for the New York Times, in the wake of drought and widespread starvation in India, journalist Michael Massing questioned economist Amartya Sen’s research on famines, which posited that democracy, over colonial rule or other forms of governance, ensured that the people would prevent their own starvation. Under the title “Does Democracy Avert Famine?” Massing asked why 350 million Indians were going to bed hungry every night, and why half of all India’s children were suffering from malnutrition, when the government was sitting atop fifty million tons of grain surplus. Massing wrote,
India’s huge food stocks reflect the power of the farm lobby. It has pressed the government to buy grain at ever higher prices, making bread and other staples more and more expensive. To help the hungry, the government has a national network of ration shops, but they have been undermined by widespread corruption and distribution bottlenecks. What’s more, the government, under pressure from the World Bank and other institutions, has reduced its once-generous food subsidies.
Democracy, in other words, is not a miraculous salvation from social ills, disease, inequality—unless it is a democracy that prioritizes public health over other mitigating prejudices and leaders’ profit. Now, in this American moment of structural disintegration, we are witnessing so many failures in American democracy that we are becoming a negative model—providing a roadmap on how to fail. “America once told a story of hope, and not just to Americans,” Katrin Bennhold recently wrote at the New York Times. “But nearly three decades later, America’s story is in trouble.” That’s putting it mildly.
In a Covid-19-ravaged America, the “lands of famine” are our own cities, teeming with people of color who have been deemed responsible for their own deprivations. An existing federal stockpile of personal protective equipment (PPE) was not widely distributed, presidential son-in-law Jared Kushner told us, because it was “supposed to be our stockpile. It’s not supposed to be states’ stockpiles that they then use.” The meatpackers who have tested positive for Covid-19 at a disproportionately high rate? Culture. Overpopulation. They got it “at home. . . because a lot of these folks who work at this plant live in the community, the same building, sometimes in the same apartment,” Kristi Noem, Republican governor of South Dakota, told Fox News.
The list of illegitimate Americans in the time of Covid is long and growing: cities, bastions of minority populations, hotbeds of Democratic voters. Frontline workers. The dying. Anyone “weak” enough to wear a face mask. People who dare to mourn. All of them are being pushed out of the national lifeboat. “Once the disproportionate impact of the epidemic was revealed to the American political and financial elite, many began to regard the rising death toll less as a national emergency than as an inconvenience,” Adam Serwer wrote in The Atlantic. The pandemic is one more example of how our “racial contract” has deemed certain lives of greater value than others. Police departments across the country enforce these false valuations.
“I don’t think it’s an overstatement to say that the hatred and fear of Muslims has been the most persistent driver of U.S. foreign policy for the better part of two decades,” Raza Kolb said in The Revealer, “while anti-Black hatred drives most of our domestic or internal colonial ‘wars.’” We see these wars erupt again, as black and brown bodies are at most risk from disease.
Of course, the “lands of famine” are here, at home, because the international has ceased to exist for much of America and this administration—unless it can be plundered for, say, an election-saving vaccine, as Trump showed when he tried to buy a team of German scientists. And, of course, when we imagine the world’s reservoir of disease, hunger, and poverty, it is still always over there, in “shithole countries.”
But Covid-19 has helped to upend even that delusion. The United States is not under attack; it has failed to react. When searching for reasons to explain why the coronavirus has not affected the African nations, for instance, as it has the United States, Jina Moore, the former East Africa bureau chief for the New York Times, wrote that “a rather obvious possibility stares us in the face: What if some African governments are doing a better job than our own of managing the coronavirus?”
There’s no profit in preparation. That’s another profound lesson of this pandemic. The administration—and let’s face it, most of us—thought it couldn’t happen here, that plagues had been “long ago relegated to history in the American imagination, or to other continents,” as Zadie Smith wrote in The New Yorker. When it did happen, all but those affected were in denial. Supplies were mismanaged or sold to the highest bidder. States were left to find sellers of PPE on their own, making clandestine meetings in parking lots. The scramble for ICU beds, ventilators, and swabs for test kits revealed the inability of the United States to live up to the old World War II-era story of coming together in a crisis. There was no will to stanch the deaths. But there was also no way to do so.
“Local and state health departments—the vital first line of defense—have 25 percent less staff today than they did before Black Monday twelve years ago,” Mike Davis wrote at In These Times in late March. American austerity has closed hospitals, denied nearly twenty-eight million people of health insurance (a number that has surely increased dramatically due to rising unemployment from the pandemic), and permitted the Democrats to think that COBRA—the astronomically expensive government law that gives newly unemployed workers a limited time to maintain their prior insurance—is somehow a solution to our immediate health problem.
Nurses in one of the richest countries in the world have had to wear trash bags. What the pandemic has destroyed, despite the administration’s V-shaped recovery dreams, is belief in what Jennifer Schuessler recently called, “the superiority of America’s brand of free-market democracy,” a commodity that could be “protected by projecting American power around the world.”
America’s global influence is reflected in the corrupted policies of organizations like the International Monetary Fund and the World Bank, which have pushed lean public budgets since the 1970s. These organizations have encouraged “states to privatize key public services like health care in the name of servicing their debts,” Kate Aronoff wrote at The New Republic. Aronoff cites the example of a deal the World Bank brokered with the small African nation Lesotho in 2011: a public-private partnership to modernize health care in the country. The eighteen-year contract with British Netcare cost $32.6 million a year and another $100 million to build. Netcare’s financial obligation was for only 4 percent of construction. Or take another example, Aronoff writes, of countries selling what they can to survive, to fund necessary health and infrastructure projects, or to cover the costs of climate disasters: “Without another source of funds on offer, gas-rich Mozambique—home to massive ExxonMobil, BP, and Shell drilling operations—was forced to take out an IMF loan of $118 million in the aftermath of Cyclone Idai last year.”
But the West’s inability to regulate Big Pharma has also crippled global public health, leaving the world population vulnerable, without necessary research and development on emergent diseases. The old industry adage that drug prices in the United States remain astronomically high because pharmaceutical companies are investing deeply in research and development is simply a lie. They gave up research and development long ago to chase blockbuster drugs that treat limited cancers, arthritis, Crohn’s disease. All important, but they have been prioritized at the expense of rampant and deadly common infections here and around the world. Resistant strains of bacteria, like Methicillin-resistant Staphylococcus aureus (MRSA), have endangered hospital patients in the United States for years. According to the CDC, one in thirty-one hospital patients have a “health-care-associated infection.” American hospitals are dangerous places. Yet, six out of the ten largest pharmaceutical companies have abandoned antibiotics research because there’s no money in it.
The ethical obligations of the industry—to protect the global population with drugs that cure and ameliorate disease for the sake of public health—were supplanted decades ago with the very simple objective of shareholders and stockholders: maximize profit at all costs. This mission is not just a matter of the daily spreadsheet or the ad buy on Google; it is a systemic structure so entrenched that no one with the power to change it can see it as a problem or conceive of how to correct the course. Only the regulation of government can change this state of neglect; if only it had the will. Our current administration has shown that it is devoid of all compassion.
The old industry adage that drug prices in the United States remain astronomically high because pharmaceutical companies are investing deeply in research and development is simply a lie.
In a recent article for Medium, Colin Dickey wrote that Trump has failed to project empathy for those suffering from Covid-19 or grief from the deaths of loved ones. But erasing grief from our collective emotional landscape was a Republican project before Trump ever ran for president. “While the modern Republican party has dismantled crucial government infrastructure over the past two decades—from voting rights, to unemployment, to medical care, to the CDC—it has also quietly dismantled the nation’s communal capacity to grieve, a vital public infrastructure which has left us without a mourner-in-chief, or anywhere to channel our grief at all,” Dickey writes. After 9/11, Bush oversaw the replacement of mourning with revenge. Chants of U-S-A! U-S-A! and harassment of anyone “foreign” in our midst became a way to express what we had lost. Then came the longest war in American history. Dickey writes, “If our grief can be channeled toward political ends—primarily war, but also other forms of supremacy—then it is useful and encouraged. If it cannot, then it is suppressed.”
Trump can’t grieve the dead because he’s still not ready to admit that they exist. But he can’t run away from the death toll forever; the existence of Covid-19 anywhere in the world, we have so quickly learned, means the United States is vulnerable. Black health is public health. Prison health is public health. Detention center health is public health. But also, Ecuadorian, Rwandan, and Indian health is public health. Our geography, our oblivion, our ignored culpability can’t save us now—if one young mother in a detention camp has the fever of Covid-19, we are all at risk. That is the power of pandemic: to remind us of human community, to remind us that if one is sick or poor, exploited or hungry, we all are.