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The elusive but useful epidemic

Does the ‘preparedness industry’ predict calamity or promote the illusion of a ‘risk-free’ life?

By Leigh E. Rich

Dread: How Fear and Fantasy Have Fueled Epidemics From the Black Death to Avian Flu
By Philip Alcabes
Public Affairs
April 2009
336 pages

When it comes to many of today’s epidemics, perhaps, as FDR warned during the height of the Great Depression, “the only thing we have to fear is fear itself.”

This is the message epidemiologist Philip Alcabes examines in his recent book, Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu. Alcabes, a professor of urban public health at Hunter College’s School of Health Sciences in New York, does not deny or downplay the real suffering that accompanies illness and disease; instead, he mixes and matches the guises of scientist and historian to explore what epidemics—from the time of antiquity to the present—reveal about human society.

What he discovers is “not all disease outbreaks spark us to tell an epidemic story” and, thus, not all epidemics are equal.

For instance, a simple search for the term “epidemic” in the news returns items about diabetes, HIV/AIDS, swine flu, obesity, bullying, sports injuries, sex addiction, credit card debt, “capital destruction,” cybercrime, mean girls, body phobias, narcissism, entitlement and “spring break rape,” to name a few. Whether all of these are “true” epidemics, defined as the incidence of more cases than expected of a particular disease in a population or area during a given time, is another story.

And that is exactly what interests Alcabes.

Why do we label some concerns “epidemics” but ignore others? Oddly enough, the number of people affected has little to do with it.

On the surface we might think an epidemic is primarily defined by “‘the germ’ or ‘the disease’—something that is making people sick,” Alcabes says. “But this can’t be the whole answer, because so many things make people sick and yet are never discussed as epidemics.”

Take, for example, deaths on America’s roadways or malaria in Africa.

“In the book I give the example of vehicle fatalities. In the U.S., roughly 40,000 people die each year in or because of accidents involving cars, motorcycles, trucks, etc. That’s about three times as many as die of AIDS,” he emphasizes, “and it’s more than die of flu—it’s about four times as many as died of swine flu in 2009, since that was a particularly mild form of flu.

“But there’s no ‘epidemic of vehicle accidents.’

“Nor is there talk of an ‘epidemic’ of malaria in Africa,” he adds, “even though 750,000 African children, plus a large number of adults, die of malaria every year. So it clearly isn’t just the possibility of mass mortality that makes us talk about epidemics. The epidemic is a story of deeper-seated anxieties.”

In other words, epidemic stories, or narratives, are all about dread.

The 2001 anthrax attacks that emerged in the wake of Sept. 11 provide a case in point: The 22 incidents of anthrax contracted from letters laced with the bacterium’s spores resulted in the death of five. The hype that ensued, however, further underscored fears of bioterrorism in the United States and reinvigorated government funding for biodefense.

An epidemic’s narrative, Alcabes explains in Dread, does not always align with the scale of damage but speaks more to a society’s angst about death and social disruption.

“Epidemics give us a way of talking about things that make us anxious and fearful.”

It is in this way that epidemics are useful, he says. If society’s fears fuel the formation of “epidemics,” the epidemic narratives further promote prejudices and drive the design of industries created to mitigate those fears.

In Dread, Alcabes takes to task what he deems the “preparedness industry”—“whose job it is,” he contends, “to foresee calamity. Or, to put it differently, whose job it is to redirect interest, and funding, away from conventional public-health pursuits and toward expensive and tech-heavy interventions.”

He offers the example of the U.S. government’s response to the H1N1, or swine, flu pandemic.

“The preparedness industry was in high gear in 2009, with the advent of swine flu. Self-evidently, had it not been for the preparedness campaign, the U.S. would not have spent $7.65 billion on responding to H1N1 flu, including paying $1.6 billion to pharmaceutical companies to produce over 200 million doses of a marginally effective vaccine, of which less than a third was ever even administered to Americans.

“To give a sense of the fiscal footprint of the preparedness industry, the Department of HHS [Health and Human Services] in fiscal year 2011 will spend less than $1 billion for training of health care providers to go to underserved areas, $290 million on access to health services, $300 million for integration with global health activities. In other words, the claims about swine flu being the next big epidemic allowed a lot of taxpayer money to go into private hands — a large amount even by the standards of normal DHHS appropriations.”

Alcabes does not condemn our desire and need to predict problems in order to prevent or control them.

“We don’t want to sacrifice that,” he emphasizes. “… You want that early earning system.”

That said, he underscores the importance of attending to crises that are happening now—such as the earthquake in Haiti where “the suffering [is] observable”—rather than “what we’re being told to be afraid of.”

And, more importantly, he advises being skeptical of both “imagined” epidemics and “people who claim to have a crystal ball.”

“The quest for the risk-free life is a salable commodity. There are institutions, corporations in America that … can make a lot of money” by tapping into our fears.

“The epidemic story,” Alcabes writes in Dread, “is filled, always, with anxieties that make us tick. It’s a story we should read conscientiously, aware of who is telling it and what the message is, bearing in mind that the risk-free life is a mirage.” 

Rich, L. E. (2010, April 16). The elusive but useful epidemic: Does the ‘preparedness industry’ predict calamity or promote the illusion of a ‘risk-free’ life? Leigh Rich Freelance: five2seven.

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