Controlling the Coronavirus: Examining Nation States and their Approach towards Fighting Viral Diseases

While we cannot predict the next pandemic, better policy and infrastructure can be created to contain it.

In December 2019, the Covid–19, a type of coronavirus, originated from the Huanan seafood wholesale market in Wuhan, China, and since then has steadily turned into a global epidemic with nearly 80,000 confirmed cases being reported from across Asia, the United States, and Europe. Covid–19 symptoms can range from mild respiratory ailments to death resulting from severe pneumonia, with a vaccine yet to be created for this rapidly mutating virus. 

China’s response to the outbreak has been swift, especially when compared to its reaction to the severe acute respiratory syndrome (SARS) outbreak in 2002, which was another animal–origin virus that emerged from China’s Guangdong province and spread to 37 countries. The then Chinese government flatly denied the existence of the SARS outbreak and also censored the press that attempted to report upon it, before admitting its existence nearly six months after the virus originated. Now, the Chinese government has shut down the city of Wuhan, immediately assembled a research team to fight the virus, and also shared information with other countries. With a mounting death toll, the Chinese President, Xi Jinping, called the virus China's largest health emergency.

However, despite this “swift” response to the virus, outbreaks across the world are rampant: according to the World Health Organization (WHO), there have been 1483 epidemic events in 172 countries between 2011 and 2018. Covid–19, SARS, H1N1, and also the bird flu pandemic all originated from meat markets with poor hygiene conditions. Low-income and middle-income countries that have poor health infrastructure are also at a heightened risk of such diseases. India, with its high population, densely packed urban centres, and the lack of facilities and set protocol in case of a viral outbreak, is in a precarious state—last year alone, India had over 27,000 cases of swine flu. The death rate in India during the height of the epidemic was 6.63%, as compared to the global average of 0.02%.

Moreover, history suggests that the developed world is discriminatory in its response to viruses that originate from the global South—medicines are stocked, and the West is given preferential access to vaccines, often at the expense of others. In the present context, the Chinese community across the world has been subject to incidents of racial profiling.

This reading list looks at the multifaceted social, economic and medical responses to past disease outbreaks, assesses nations’ preparedness for such situations, and looks at how the marginalised tend to be the worst affected from such diseases.

1) India’s Response to Epidemics

The H1N1 virus still persists in India. In 2019 alone, over 1,000 people died due to the virus. Writing in 2015, five years after the global H1N1 pandemic, T Jacob Jon writes that the Indian government is yet to take such outbreaks seriously. Measures to collect data, which would make for better policy, were still absent. Jon says that data on the number of seniors and children that died due to the flu was not collected as they were “statistically insignificant,” and there is no real-time public health surveillance. These steps are avoided by stating that influenza is a “trivial problem.”

Expecting that the virus would settle down and cause endemic flu similar to pre-pandemic seasonal flu was an error. H1N1 pdm09 remains a killer virus for healthy adults and pregnant women, in addition to those with chronic diseases and at extremes of age. This is an inherent biological property of H1N1 pdm09 virus … For “epidemiology intelligence” the government needs information to quantify the disease burden and identify risk factors. What proportion of the population developed influenza-like illness? What proportions had flu A or B, and how many had H3N2 or H1N1? From the perspective of epidemiology, test results should be applied to population denominators—but that is a lot of work. Such data are essential for designing a national policy of vaccination against flu. The union government, it seems, has washed hands of the responsibility by stating that the ball is in the state governments’ courts.

John also argues that despite India’s increasing wealth post-liberalisation, little investment has been made in public healthcare. Moreover, it is geared towards treating symptoms, and is not preventive in nature. Writing within the context of the Ebola outbreak in 2014, John argues in favour of a few essential health structures to check the spread of a virus in India.

The Government of India should name one “event manager” who would develop a plan of action in case Ebola enters India, through a traveller. India should create a mechanism for the event manager to communicate with every hospital in the country to inform the dos and don’ts. Doctors take a history of the patient’s illness; this should include travel history. Also, the event manager should be the spokesperson for the government to inform the public authentic information. If this process is closely linked with all states and union territories, then every state will be prepared. 

2) Falling between the Cracks

Xiang Biao and Theresa Wong write that migrants end up being the worse affected by outbreaks not only due to their socio-economic status, congested neighbourhoods, and lack of requisite knowledge, but also due to the fact that they lie outside state support systems. Writing on the SARS virus, they argue that the informal nature means that the migrants did not flee to different parts of China from Guangdong due to the outbreak, but rather because of the lack of opportunities due to the ensuing economic disruption.

The SARS outbreak triggered strong reactions from the international business community, urban middle-class residents, government and international agencies. For example, in Beijing and many other cities, all the entertainment businesses were forcefully closed by the authorities. Travel, catering, hotel businesses were hit the hardest. These sectors are exactly where many migrant workers are employed, and in a time of crisis, they are the first to be fired. Some of these workers had to move back home or to other places, which may contribute to the spread of the disease.

3) Questioning Nations and Their Approach to Disease Fighting

Cindy Patton writes that for organisations such as the WHO to function freely within the states’ borders is a rejection of their territorial sovereignty and something that countries—especially those in the developed world—loathe to do. 

Declaring a global pandemic amounts to a double suspension of rules. First, countries must relinquish their sovereignty over disease (and in essence, over their own populations) to the WHO, which has been endowed to “see” pandemics and determine which of the “normal” civil rights – to circulate, to cross borders, to choose whether to be vaccinated, and so on—are appropriate to suspend. 

Further, Patton writes that during the SARS outbreak, numerous nations refused to accept the WHO’s declaration of a global pandemic and began to stock more influenza treatment and vaccines than they needed, and later accused WHO of collaborating with big pharma for the rise in prices.

To date, there is no evidence of any collaboration between the WHO and Pharma, big or small (in fact, the WHO was very active in spreading around the vaccine orders). But that is a side issue, not only in the report, but also in our consideration of the practice of empire in the context of disease. While the “old empires” seem to have drifted away, their annexation strategies survive in the supranational non-government organisations that contend with new (post-colonial) nationalisms, regional consortium (European Union), and corporations that act like states.

4) Discriminatory Responses to Outbreaks

Writing on the Ebola virus outbreak, Pallavi Mishra says that the manner in which western countries report on the global South is troubling: media outlets project the cause of such diseases as a lack of development, unregulated markets, and poor hygiene conditions, rather than focus on extractive policies that have rendered such nations poor.

One important question which needs an immediate answer is why the disease is getting transferred from animal to humans residing in these countries. Africa has emerged as a new destination of neo-imperial activities because of its rich mineral and natural resources, which has resulted in deforestation and mining. Because of deforestation, wild animals are compelled to go out of their natural habitats, which is responsible of human–animal confrontation. It has been found that in the last 20 years infectious diseases of human beings have been zoonotic (diseases transferred from animals). (Leach 2008b) 

Moreover, there are ethical issues in the access to vaccines—American patients were provided with the trial drug, zmapp, to fight Ebola, while Nigerians’ requests were not heeded. Mishra argues that in cases where any medical intervention is necessary to save lives, the developed world restricts access on grounds of “security.”

If the value of human life is equal then why there is a question of ethics for black Africans and not for white Americans for the same drug …  There are two regimes of global health at work, according to Lakoff, one, which works to provide global health security, and the other, which works towards humanitarian relief intervention for tropical diseases. The global South gets protection under humanitarian relief interventions, but with a lot of restrictions and constraints in order to protect the global North from external threats, as in the case of EVD. This is certainly a question of treatment ethics on the part of the health governing bodies.

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