COVID-19 Symposium: COVID-19 and the Racialization of Diseases (Part II)

[Matiangai Sirleaf is a Professor of Law at the University of Pittsburgh School of Law. Her expertise includes public international law, global public health law and international human rights law.]

Part I of this post details how European powers enacted treaties that prioritized diseases considered most relevant to protecting Western colonial interests. It helps to elucidate how the racialization of diseases and their valuation informed the emergence of the global health regime and highlights how the development of this regime often depended on the coercive power of the colonial administrative state to implement public health measures. This post analyzes how the racialization of diseases is accomplished more subtly and indirectly under the current global health architecture.

It was not until the 1944 modification of the International Sanitary Convention that the global health regime began requiring state parties to generally send epidemiological information for any communicable diseases, irrespective of whether they had been preordained by Western powers as significant. The creation of the World Health Organization (WHO) reflects a broad vision for societal change that is manifest in the founding documents of other post-WWII international institutions. The WHO’s constitution recognizes the right to health and notes that its enjoyment ‘is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.’ The WHO is also premised on the right of equality as well as the principle that the health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and states.

The International Health Regulations of 2005, broadens the system of state surveillance and notification for infectious diseases. Significantly, member states gave the WHO the power to define a Public Health Emergency of International Concern (PHEIC), ‘an extraordinary event, which is determined… (i) to constitute a public health risk to other States through the international spread of disease and (ii) to potentially require a coordinated international response.’ Yet, the determination of when a given disease constitutes an international emergency is a decision informed either explicitly or implicitly by a determination of the worth, utility and importance of the populations impacted and their proximity to Western interests.

The 2014-2015 Ebola epidemic, which went from an unfortunate situation in a ‘backward’ region to a significant public health emergency of international concern strikingly illustrates this. In March of 2014, the humanitarian organization Doctors Without Borders began sounding the alarm that the scale of the Ebola outbreak in West Africa was ‘unprecedented.’ Yet, it was not until August of 2014 that the WHO declared Ebola a PHEIC and it was only at this point that it unveiled a framework for attempting to contain the epidemic. The WHO initially determined that from a numbers perspective, the Ebola outbreak did not rise to the level of an international emergency. Yet, this approach failed to take account of the unique characteristics of the outbreak in the sub-region. Under pressure, the WHO seized on the fact that —someone from Liberia who was infected with Ebola traveled to Nigeria—as an opportunity to revise its initial flat-footed stance toward the disease. The 2014 Ebola epidemic was evidently ‘international’ as it had traveled across several borders in the West African sub-region to upend things. Thus, the possibility of the disease spreading was already present. Yet, the comparatively trivial number of cases that occurred in Europe and the United States turned Ebola into a crisis calling for international action.

The Ebola epidemic of 2014 resuscitated historical images of Black African bodies as uncontainable and disease-ridden and sparked racialized fears. The death of Thomas Eric Duncan who was the first Ebola case in the United States is illuminating. Two healthcare workers in Dallas, Texas contracted Ebola while providing him care shortly after his arrival from Liberia. Although they recovered, racialized fears of contagion in the United States were almost instantaneous with children of African immigrants in Dallas taunted as ‘Ebola kids’ and two students from Rwanda (2,600 miles from West Africa) sent home from a New Jersey elementary school for 21 days. Additionally, a Texas college sent out letters to prospective students from Nigeria informing them that they were no longer accepting applications from countries with ‘confirmed Ebola cases,’ despite the WHO declaring Nigeria ‘Ebola-free.’ A middle school even placed a principal on paid administrative leave for a week for attending a funeral in Zambia (2,770 miles from West Africa) despite it also having no cases of Ebola. Ebola transformed from a ‘local’ disease in ‘Africa,’ to  a significant international one that might touch and concern Western interests.

Yesterday it was Ebola, today these racialized fears of contagion are manifesting with the COVID-19 pandemic. The pandemic has reinvigorated the 19th century strain of thought that maintains that all things Asian are a threat to the Western world with a newspaper in France recently carrying the headline ‘Yellow Alert.’ People have physically attacked students of Asian descent in cities like London and in San Fernando. Moreover, individuals that present as Asian are being racially profiled, kids have tried to ‘test’ other kids for coronavirus, and some institutions have tried to normalize xenophobia and racism as understandable reactions to COVID-19. The racialization and mapping of the disease onto certain countries and their progeny, but not others is also playing out at the global level.

We have seen some states completely elide the global health regime with entirely uncoordinated country-specific measures. Some of these responses are premised on defensive measures against contagion from racialized others. The United States is a paradigmatic example. It initially attempted to travel ban its way out of the spread of a novel virus, by banning foreign nationals who had traveled to China in the last 14 days from reentering. This runs counter to WHO’s usual guidance, which discourages travel and trade bans, as they can make it harder to help nations respond to outbreaks. Moreover, while travel bans in limited circumstances may prove helpful at the very early stages of an outbreak as a means to buy time and shore up the health system’s ability to respond to a potential external shock, when used alone they do not serve as an effective prophylactic measure. Further, the United States did not use COVID-19 diagnostic tests produced by the WHO in favor of generating its own. Yet, delays in developing a reliable test, plus a limited and faulty domestic supply, as well as restrictions on testing based on travel history, meant that the virus was likely spreading locally undetected for a while.

The racial and imperial logics influencing some of the United States’ decision-making was apparent in myriad ways. The President’s incessant characterization and understanding of the disease as ‘foreign’ initially limited the space for consideration of community transmission. Additionally,  colonial logics was manifested in the decision to protect certain metropoles with the initial exclusion of the United Kingdom from the expanded travel ban that the United States imposed on a number of European countries. Further, the lax screening measures and crush at airports from those Americans hastily returning from the recently banned countries belie a genuine policy aimed at mitigating risks of transmitting COVID-19. The racializing of diseases underlying some of the U.S. administration’s policies is also evident in the fallacy of thinking that the disease is somehow engaged in border control efforts and checking passports, nationalities and ethnicities to figure out who to infect next. This practice harkens back to 1900 when San Francisco battled the plague and White people were allowed to leave the impacted areas, but Chinese and Japanese Americans needed to show a health certificate before they were allowed to leave.

The response from global actors to the COVID-19 pandemic reminds us quite powerfully how the history of diseases and responses to diseases is linked to colonial and ongoing politics of racial exclusion. The material effects of the racialization of diseases exacerbates racial subordination and violates the fundamental human rights of historically subordinated groups. Some states have looked to return ‘back to the future’ of the early global health regime and have prioritized ad hoc and piecemeal responses. Yet, deepening globalization and the mobility of people makes it nearly impossible to fight pandemic diseases in this racialized and counterproductive manner. The COVID-19 pandemic is a wake-up call from inside all our houses to strengthen health systems globally as well as the global health architecture to better respond to existing and emerging diseases. It is also a timely reminder of the shared obligations of actors to ensure greater protection from highly infectious diseases and of the need for effective global action and solidarity.