Siren Song: A Pathography of Influenza and Global Public Health
This dissertation analyzes the various scientific, political and cultural narratives about and the official public health responses to the recent 2009 H1N1 influenza pandemic. The historical planning emphasis on avian influenza, or `bird flu,' unintentionally created a large amount of uncertainty about how to respond to the threat from a milder, less severe, strain of influenza. I suggest that the specter of a future deadly global pandemic of avian influenza spurred a fascination or myopia in global health policy reminiscent of the mythical danger of listening to the Greek Sirens' song. Throughout this dissertation, I attempt to make sense out of the various and still-emerging accounts of the "swine flu" or 2009 H1N1 outbreak. Thus, I define `pathography' here as the combined historical, biological, social, political, economic and cultural narratives of the 2009 pandemic. The first section explores the historical and biological origins of influenza. Chapter one examines influenza research and early attempts to sequence the H1N1 virus. I use the genetic structure of the virus to suggest that public health agencies are related through a `viral kinship.' Chapter two details the material processes involved in the sequencing and discovery of influenza viruses. In it, I argue that what virology laboratories construct through these material processes of DNA sequencing is not - reductio ad absurdum - the virus itself, or even simply `knowledge' about a virus, but rather a complex network of scientists, laboratories, farms, public health institutions and other `actors' involved in the circulation of influenza samples and genetic information about influenza viruses. Chapter Three explores Hong Kong's history as an international `lab' for disease research, its local identity crisis as a former colony and current position as a Chinese city, and its unique role within global scientific and public health networks. The H1N1 virus is not simply a symbol of the complex global forces that shaped its emergence and its spread, the microscopic 2009 H1N1 virus embodies those macroscopic forces. Using the terms of molecular biology itself, I would like to suggest here that influenza viruses are not born sui generis out of larger economic, political or social processes, but are both created from and used to create the worlds in which they inhabit. The second section of the dissertation deals with this macro-level of analysis, or the political and cultural ramifications of influenza pandemics. Chapter four examines the seemingly new paradigm shift within global public health from the use of a scientific "certainty" to a biological and situational "uncertainty" as one of the foundations of response to infectious disease outbreaks. Chapter five analyzes the production, collection and sharing of epidemiological information during a pandemic. Scientific facts about the virus and the pandemic were freely circulated and agreed upon, but their cultural and political interpretations needed to be continuously negotiated. I argue that not only are cultural politics alive and well, but that they played a vital role in the global response to the influenza outbreak. Finally, I argue that to understand the pandemic as more than just a biological, social, political or historical event, one must look at all these narratives at once. The influenza virus is not thus merely a symbol of our times or for an increasingly globalized world; instead, I argue that it has partially constructed - and continues to shape - the contours of our world.