Contagion: How Commerce Has Spread Disease

Mark Harrison
Yale Press
ISBN: 0300123574
A Review by Susan Froetschel

Over the centuries new diseases have emerged, striking centers of commerce with lethal force and puzzling the best scientific and political minds of their day:  bubonic plague, yellow fever, cholera, rinderpest, bovine spongiform encephalopathy, severe acute respiratory syndrome or avian influenza.

The chaos also gave way to international consensus and regulations expected to protect populations and the economy. Mark Harrison in Contagion: How Commerce Has Spread Disease focuses on centuries of public response to contagious diseases and development of international boards and policies. Of course, governance is slow, unwieldy and imperfect at any level. “There is nothing new in the abuse of sanitary controls for economic and political gain but it is perhaps surprising that the situation persists despite international agreements and institutions of global governance.”

Harrison notes that public responses to epidemics are swayed by compelling stories. Perhaps that’s why he avoids that narrative device and instead presents a solid history of policymaking and attempts at international agreement over the course of six centuries. Readers who anticipate dark descriptions of disease or suspenseful investigations, as encouraged by chapter headings like “Merchants of death” or “The evils of quarantine,” will be disappointed.  Instead, Harrison offers critical assessments of the evidence behind competing theories and policies on disease over the centuries, relaying the rush of confusion and guessing whenever society first encounters a strange phenomenon – along with denial of responsibility and blame on outsiders. 

Governments and businesses with protectionist leanings can quickly take advantage of such panics to endorse widespread and costly screenings, blockades, quarantines, standards and excessive restrictions. Ironically, heavy-handed, unfair controls tend to encourage deception, panic, and backlashes that spread disease – as was the case when plague struck Hong Kong on the mid-1800s. Thousands fled the city as British troops conducted house-to-house searches, and the disease quickly spread to southern China. Minimal response is political, too, and Harrison points to the Russians quickly lifting a ban on US pork in 2009 amidst the H1N1 outbreak while seeking approval for entry into the World Trade Organization.

Regulations are most effective when individuals are convinced to cooperate via reliable communication, not rigid controls, Harrison argues.

Experimentation is inevitable, and armed services have historically contributed to gains in medical expertise. Governments or leaders of commerce often promote measures that may or may not work, but can’t do great harm other than exacting economic costs. For example, to combat yellow fever which stems from a mosquito bite – and a disease that ravages the Congo and Sudan today – some governments and businesses promoted sanitation improvements. Agreements on sanitary regulations would not have been possible without the system of international diplomacy developed after 1815, Harrison explains, and that led to steadily increasing liberalization and standards. By the mid-1800s, sanitation boards included foreign delegates to inspire confidence in trading. The same international communications and diplomacy leads to rigorous, public comparisons of policies and conditions and back-and-forth accusations.  By the 20th century, Latin American nations bristled over “sanitary imperialism” of the United States. A strong diplomatic system ensures that no state, however powerful, can afford to ignore international opinion for very long, according to Harrison.  “Sanitary regulations … reflect the expectations of other powers as much as perceived threats to health domestically – a statement which might apply to any nation, even today.”

With such crises, governments find it easier to engage in excessive rather than lax regulation.

Increasing speed in transportation with growing numbers of participants complicated investigations and understanding of contagions. In embracing technological measures to advance trade, whether steamships or air travel, leaders of commerce or government were not intent on spreading disease and suffering. A notable exception could be those involved in the slave trade, a horrific business that receives sparse attention from Harrison, other than a detailed summary of the 1845 quarantine ordeal of a British ship assigned to suppress slave trafficking. Another exception might be modern factory farming, described by Harrison as a fast-track for pathogen mutation.

Harrison’s title seems to put  commerce on the dock. But by its very definition trade is not a one-sided affair. Consumer desire drives demand for affordable, exotic, novel or superior goods, and consumers in prosperous, free societies willingly line up to purchase the products tainted by disease or moral failings. In a connected world of instant communications, few can claim ignorance of a product’s origins for very long, and even in the mid-1800s, with the establishment of telegraph networks, communications about symptoms, diseases, trade conditions could be delivered to Europe, India or the Americans within minutes. Contagion’s argument could have benefited from compelling tales of willful consumers or traders.

Likewise, the book is light but not completely void on profiles of policymakers, authorities or medical researchers and their insights. No doubt it is because the study of any global epidemic requires years of trial and error by countless and unnamed officials, caregivers and human subject, before the chance connections of details contribute to an identification of patterns and understanding of the cause and cure. The book is most enlightening with descriptions of politicians cherry-picking through reports and evidence to present details that support their own pet theories and assessments behind an individual’s sudden change of heart, whether from courage or political pressure.

Despite today’s global governance on health, or maybe because of it, public approaches to managing outbreaks of disease over multiple layers of government will be messy and imperfect, with responses inevitably deemed unfair. Regulations simply can’t keep pace with development and technological progress, and security against diseases can never be absolute. Governments are rigid, and politicians resist  reversing their positions. Too many theories or shifting details prompt the public to question the reliability of experts. Every health official, whether at the community level or with the World Health Organization, must use care in avoiding exaggeration while erring on the side of caution. Competition for government funds is as fierce as ever, and Harrison suggests that, as a result of crisis response to disease, public health may have shed its humanitarian associations to become another feature of national security.

Globalization drives response to disease as much as disease itself, and Harrison notes that “the most important consequence of globalization from a public health standpoint is not, perhaps, the wider circulation of disease or even the rapidity with which it can spread in an age of cheap international air travel. It is the pressure which globalization places on sanitary regulations.” Once vectors are discovered and regulations imposed, no one can ever know how many or which lives are saved.  

The book offers broad lessons on policymaking that could be useful for managers of other cross-border challenges such as climate change. Every disease, every weather disaster, can strike after a brief warning  with varying economic impact, depending on which region and industry is hit. The crisis drives response.

Over the centuries, new diseases emerged and followed the trails of commerce, triggering panic and a rash of policymaking.