In The Viral Network, Theresa MacPhail examines our collective fascination with and fear of viruses through the lens of the 2009 H1N1 pandemic. In April 2009, a novel strain of H1N1 influenza virus resulting from a combination of bird, swine, and human flu viruses emerged in Veracruz, Mexico. The Director-General of the World Health Organization (WHO) announced an official end to the pandemic in August 2010. Experts agree that the global death toll reached 284,500. The public health response to the pandemic was complicated by the simultaneous economic crisis and by the public scrutiny of official response in an atmosphere of widespread connectivity. MacPhail follows the H1N1 influenza virus's trajectory through time and space in order to construct a three-dimensional picture of what happens when global public health comes down with a case of the flu.The Viral Network affords a rare look inside the U.S. Centers for Disease Control, as well as Hong Kong's virology labs and Centre for Health Protection, during a pandemic. MacPhail looks at the day-to-day practices of virologists and epidemiologists to ask questions about the production of scientific knowledge, the construction of expertise, disease narratives, and the different "cultures" of public health in the United States, Europe, Hong Kong, and China. The chapters of the book move from the micro to the macro, from Hong Kong to Atlanta, from the lab to the WHO, from the pandemic past in 1918 to the future. The various historical, scientific, and cultural narratives about flu recounted in this book show how biological genes and cultural memes become interwoven in the stories we tell during a pandemic. Ultimately, MacPhail argues that the institution of global public health is as viral as the viruses it tracks, studies, and helps to contain or eradicate. The "global" is itself viral in nature.
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The Viral Network
E X P E R TISE C U L T U R E S A N D T E C H N O L O G I E S O F K N O W L E D G E
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First published 2014 by Cornell University Press First printing, Cornell Paperbacks, 2014 Printed in the United States of America
Library of Congress CataloginginPublication Data
MacPhail, Theresa, 1972– author. The viral network : a pathography of the H1N1 influenza pandemic / Theresa MacPhail. pages cm. — (Expertise) Includes bibliographical references (p. ). ISBN 9780801452406 (cloth : alk. paper) ISBN 9780801479830 (pbk. : alk. paper) 1. H1N1 influenza. 2. Epidemics—Social aspects. 3. Public health— Social aspects. 4. Medical anthropology. I. Title. RA644.I6M33 2014 614.5'18—dc23 2014025187
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10 9 8 7 6 5 4 3 2 1 10 9 8 7 6 5 4 3 2 1
Acknowledgments
ListofAbbreviations
ProloguetoaPathography
Contents
1.SeeingthePastorTellingtheFuture?OntheOriginsof Pandemics and the Phylogeny of Viral Expertise
2.TheInvisibleChapter(WorkintheLab)
3.Quarantine,EpidemiologicalKnowledge,andInfectiousDisease Research in Hong Kong
6.TheAnthropologyofGoodInformation:DataDeluge,Knowledge, and Context in Global Public Health
vii xi
1
18 48
75
108
132
152
v i C o n t e n t s
7.TheHereticsofMicrobiology:Charisma,Expertise,Disbelief, and the Production of KnowledgeEpilogue
NotesReferences
179 204
213 223
Acknowledgments
Writinganacknowledgmentssectionisaverydauntingtask.Somanyindividuals and institutions are responsible for the production of this book that I am at a loss as to where to begin my thanks. However, this project would not have been possible at all without the generosity of the epidemi ologists and scientists who allowed me to observe them, to participate in their daytoday lives, to interview them, to learn their lab techniques, and to share their bevy of knowledge and experience with me. My sincerest gratitude goes out to them—both for letting me work with them and, more importantly, for their tireless efforts to keep all of us safer. The men and women who work in public health are, I can attest, some of the most dedi cated, smart, unflagging, and overworked people on this planet. If it weren’t for them, we’d all be a lot sicker. Special thanks to Rohit Chitale, Kira Chris tian, Mike Schwartz, Fred Leung, and most importantly, Ray Arthur. IwouldalsoliketoextendaspecialthankstoChrisAnsellandAnnKeller at the University of California, Berkeley, who supported part of this research with their National Science Foundation grant. It was under
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their auspices that I began this research and I will be forever indebted to both of them for their insights, guidance, and support. As well, I’d like to extend thanks to the interdisciplinary team of researchers that worked together to collect data for the project: Erik Baaskeslov, Sahai Burrowes, and Mark Hunter. Especially Mark, who provided me with the amazing timeline that appears in the introduction to this book. WhileinCalifornia,Iwasfortunatetohavesomeexcellentmentorsand readers of my work: the indefatigable Vincanne Adams, Cori Hayden, Kevin O’Brien, Lawrence Cohen, Sharon Kaufman, Charles Briggs, and Nancy ScheperHughes. At New York University, I was privileged to learn strategies for success from Robin Nagle, Robert Dimit, Rayna Rapp, and Emily Martin. My writing here would not have progressed as smoothly without them. I also want to thank my compatriots at New York Univer sity who provided me with happy hours, movies, conversation, laughter, and all the miscellaneous distractions so crucial to good thinking: Mario Caro, Alan Itkin, Georgia Lowe, Steve Moga, and Amber Musser. The Ph.D. candidates in my twoweek intensive writing workshops at NYU were often an invaluable source of inspiration; my gratitude to Laurie Benton, Kathy Talvecchia, and Anne BernadetteWaters for giving me the opportunity to mentor these beginning scholars as I finished writing this book. Institutionalsupportforbothmyresearchandmywritingwasprovidedby the University of California, Berkeley, and the D. Kim Foundation. A version of chapter 5 was published as “A Predictable Unpredictability: The 2009 H1N1 Pandemic and the Concept of ‘Strategic Uncertainty’ within Global Public Health,”Behemoth3 (3): 55–77. AveryspecialthanksmustgotoXinLiu,whonotonlytaughtmehow to ask the right questions, but counseled that answers are always to be found while reading another book, doing more research, and writing. Another special thanks to Tim Choy, who provided me with the solidarity and insights that could only come from a fellow Hong Kong scholar. His notes on my Hong Kong chapters made all the difference. Andrew La koff also could not have been more helpful, nor a better champion for my work. And then, of course, there is the person who first started me on my anthropological wanderings: Stefan Helmreich. Without him, I’d prob ably still be a journalist. Infinite gratitude is due my series editor, Dominic Boyer, without whom this book would be a pale shadow of itself. Dominic,
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in sum, coached and pestered and encouraged me into being a far better scholar and academic writer. I thank him for encouraging me to be both bold and more concise. And thanks, too, to editor Peter Potter, who recog nized the early potential of this project. Andfinally,thepersonalthanks.ToEricPlemons,thebestwritingpartner anyone has ever had, a “thank you” doesn’t even begin to cover it. My brilliant friend Matt Lawlor, scientist extraordinaire, took the time to painstakingly check my explanations of the virus’s biology. I owe him many libations. To the wonderful women of the Science and Technology Studies writing group: Jade Sasser, Martine Lappe, Katie Hasson, Rachel Washburn. To Sam HowardSpink, for coffee and jelly bean breaks. To my University of California, Berkeley friends, who continue to provide me with inspiration, but especially: James Battle, Shana Harris, Andy Hao, Katie Hendy, Liz Kelley, Kelly Knight, Xochitl Marsilli Vargas, Amelia Moore, Suepattra May Slater, and Emily Wilcox. To my chosen family, without whom I could do nothing well: Pat, Cara, Rebecca, Robin, Mark, Annika, Jan Fak, Glen, Jon, Martha, Jason, Andrea, and Hugh. To Sloan, a special thank you for putting up with me during fieldwork and my dis sertation process, and for reminding me on a weekly basis that I am a solid writer. I hope I can return the favor someday. Andfinally,toKyleLevenick,forshowingmehowtosay“yes”moreoften in the longform improvisation that is life.