It couldn’t happen here. A one-off event, at first as big as the 2008 financial crisis, and then equal to if not bigger than the end of the Second World War. Unique in its reach, impact, and cause. Locking down populations, shifting work, school, and childcare patterns, and reorienting whole health, social, political and economic systems to manage a health crisis all seemingly without precedent. As states start to switch from response to recovery, relaxing lockdowns, and positioning themselves favourably for the inevitable inquiry into what happened that Spring, the same political rhetoric plays out: a one off, could not see it coming, never experienced anything like this, we did what we could. The pandemic is presented as if something so big, a social force, a global phenomenon it is beyond the control of the best scientific research and politics.
Pandemics in this sense are hegemonic. It is no longer economic forces, social norms, or the transnational political elite that shape our lives: it is the health emergency, the virus, that becomes the hegemon. Its hegemony begins with the health sector, any health issue not directly linked to the virus becomes secondary: too bad if you have a heart attack, found a lump, run out of contraception, need a safe abortion, all resources to the hegemon. Cancer becomes viewed as ‘collateral damage.’ Increase in domestic abuse and homicide on account of home isolations are a concerning but unavoidable problem. Development assistance for health shifts towards pandemic preparedness. Wealthy philanthropists suggest moving money away from Polio and Malaria programmes to the virus. All health problems, concerns, decisions, and priorities from the individual to the senior hospital management are viewed through the lens of the hegemonic health emergency.
The hegemonic power of a pandemic then spills over to politics and economics and our everyday lives. Teachers, economists, business owners, politicians, bankers, workers, journalists, and the stories we tell all reoriented to the pandemic. We feed it with the attention and adaptation to our lives. The hegemon reaches every aspect of our lives long after lockdowns are lifted, until another threat comes along to counter it.
Hegemonic power becomes an excuse for a lack of political agency. It is too unforeseen and all-consuming for anything to be done differently. It is not the fault of the politician but forces beyond individual control. To which the answer is clear: viruses may not be socially constructed, but health emergencies are, they become hegemonic through a series of political decisions and agency. Viruses can be contained and controlled. The social and economic impact of pandemics can be anticipated and thus accounted and planned for. Politicians can do something. To suggest otherwise hides a myriad of truths and obscures the trauma of people who have lived through these experiences.
The most obvious truth, is the system of pandemic preparedness that has been built around global health security in the last thirty years of international relations. Someone saw this coming and someone ignored to see it, to read the advice, to take preparations seriously, to see global health and emergencies as a political priority. To not see or consider the impact of a health emergency cruelly belies the seismic impact of Ebola, Cholera, HIV/AIDS, and Zika on the lives of people around the world. It suggests that death, health worker vulnerability, lockdowns, quarantines, economic disaster, secondary impacts of health emergencies are all new, seen only to matter once they impact on the lives of people living in high income countries. It is as if these lives, the lives of others, and the collective trauma and experience of these countries do not count and that there is no precedent or best practice from which politicians and policy-makers can draw, warnings they can heed.
Diseases, health emergencies, outbreaks with huge humanitarian and long-term economic consequences do not happen in high income countries, the west, the global north, the aid givers, the expert senders, the knowledge producers, no, they happen elsewhere. Should an outbreak occur in these territories, there would be preparation, resource, science. Until there wasn’t. We repeat the mistakes of past outbreaks and amplify them through a stance that assumes we would somehow know or do better. We do not learn from other countries in the world, best practice developed by and in Liberia, Brazil, Sierra Leone, China, Hong Kong, and the DRC. At the point in which global health becomes truly global, knowledge and evidence systems become dangerously parochial.
Many countries do not need even need to look abroad to see such evidence, but to their own histories of health emergencies. Histories as recent as the trauma of so many friends and family that cared for and sustained loved ones at the height of the AIDS epidemic in the 1980s and 1990s. This was a time when politicians denied the problem, did not invest in protecting people and health care workers, and stigmatised communities affected by the virus. Like now, this was a time when people sometimes died alone, loved ones told to stay aware for fear of infection or stigma; when people hoped for a cure and offered their bodies for treatment; when there was stigma, shame, and conspiracy; inhumane ‘safe’ burials without family to attend a funeral; when governments twist out of all responsibility and people organise to step in. The memory of the politics of shame, ignorance, and denial lives on in those who witnessed the early history of HIV/AIDS. The pattern repeats itself as if we do not learn or care for the trauma of those who have already suffered.
The pattern itself follows a similar cycle of denial, ignorance, and blame. It has always been thus, from HIV/AIDS to Ebola, they will ignore you until your death can no longer go unnoticed, when the cumulative numbers begin to threaten their own health and stability, and the people demand something must be done. Decisions made by politicians will never be the fault of politicians, it will be the bats and pangolins, the competing power, that under-funded global health institution that they never liked but begrudgingly under-funded or kept in arrears. Scientists will be presented as leaders, the ones informing the decisions, as a public chimera to the ones making the decisions. Health workers will be lauded and celebrated through public displays of gratitude that shift to grief and discomfort as their fatality rate grows within the population. Stark inequalities – race, gender, class – become apparent as those devalued at Christmas become mourned for heroes by Easter. The discomfort grows to rage when you think someone somewhere made the decision as to what constituted basic protection for key workers.
Denial, lies, and conspiracy replace evidence and common sense. The tent poles of public health emergency response – testing, contract tracing, protecting health workers – reduced from absolute necessity to political rhetoric. In the UK, people are told not to burn down 5G masts or attack the key workers keeping the health service and economy going, with no notion that the social contract may be fracturing. The repeated contract to stay home to save lives, don’t burn down 5G masts, weakens when the government does not stay home, save lives, or protect those working in the health system. Nudge people all you want, but the contract only holds up if both parties stick to their side.
Politicians don’t end pandemics people do. Civil society fills the space left by governments: fundraising for health systems, delivering services, producing essential equipment. It is people who collectively organise and care for their neighbours, those who volunteer to trace contacts, to participate in vaccine trials, to share information, to follow the government guidelines. It is those who go to work every day to care for people when they know they are not fully protected that will combat the pandemic. Perhaps people will see what the politicians and governments did and did not do, the decisions they did and did not take, and that another society could grow in response to the hegemonic virus. However should the cycle of the politics of health crises continue, we know that the gaslighting of healthcare and care workers will continue – they will be publicly celebrated but denied a pay rise, inequalities exposed by the outbreak will be reproduced, and civic optimism will make way for the frustration of protracted public inquiries where no-one will accept responsibility for the decisions they made. Politicians and decision-makers will deflect blame to the hegemon – the virus that was seemingly greater than them – but we will know they had choices.
To call it a one off, bigger than politics, the economy and our way of life is to deflect three fundamental issues. The first, that we have seen health crises devastate societies before. We have seen health crises do this throughout low and middle income countries in the last ten years, and globally with the HIV/AIDS crisis. The second, we have learned how to contain and control and mitigate the impact of health crises. However, there is an abiding sense that the arrogance of the elite in high income countries will protect us. Third, how states, societies, and the global community responds and recovers from a pandemic is a choice and a set of decisions. Further weakening of health systems, social welfare, collective health and medicine for all is not inevitable.
While politicians will default to difficult choices made under the hegemony of the pandemic, this ignores the agency of individuals in constructing a counter hegemony. Global health emerged as a means to share best practice, expertise and resources, to develop shared mechanisms in which to protect each other from deadly diseases, and show solidarity in common, global, vulnerability. To beat pandemics is to know that health emergencies and pandemics happen here.
Sophie Harman is Professor of International Politics at Queen Mary University of London.