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

[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 II is found here.]

The President of the United States has problematically utilized geographic references for the coronavirus disease (COVID-19) to play on anxieties of the racialized other, the foreigner and their diseases. Prior to the pandemic, he reportedly complained that Haitians ‘all have AIDS’ when discussing extending temporary protections for Haitian, El Salvadoran, Liberian and other immigrants. This echoes the historical pathologizing of Black, Indigenous and other people of color as disease-ridden and unsanitary. For example, when the smallpox epidemic hit San Francisco in 1876, officials referred to the city’s Chinatown as a ‘laboratory of infection’. The Chinese Exclusion Act, an immigration law passed in 1882, prevented Chinese laborers from immigrating to the United States in part based on biases and stereotypes that they were more likely to carry cholera and smallpox. A century later, the U.S. government ran an HIV camp in Guantanamo Bay, Cuba from 1991 to 1993, which detained 310 Haitians with HIV/AIDS without regard to their refugee and asylum rights or their credible claims of political persecution. This post connects the racialization of COVID-19 to the historical narratives and interventions premised on the suspicion of diseased and uncontrolled racialized bodies coming to infect those in the West. I explore the significance of this legacy for global heath in more detail in Part II of this post and in a forthcoming article in the UCLA Law Review.

The COVID-19 pandemic has surfaced what was always latently there, the racialization of diseases. For example, a 1915 article in the Southern Medical Journal states that Black people were ‘a hive of dangerous germs, perhaps the greatest disease-spreader among the other subspecies of Homo sapiens.’ Racial hierarchies based in part on the racialization of diseases were replicated globally through slavery, colonialism and imperialism. In the United States, Black people were considered a ‘notoriously syphilis-soaked race’ while White people purportedly suffered from polio because of their ‘complex and delicate bodies,’ which made them more susceptible. Scientific racism legitimated explicit and implicit pseudo-scientific distinctions that dehumanize, devalue and denigrate the worth of Black, Indigenous and other people of color. For example, in South Africa, because leprosy was perceived to be a ‘Black disease,’ harsh measures were enacted that allowed for compulsory segregation of all lepers due to fears that the disease was spreading and affecting Whites, while many Black lepers were detained on Robben Island; White lepers were allowed to remain quarantined at home.

Despite significant efforts towards the de-legitimation of scientific racism, the racialization of diseases continues to percolate through processes of socialization that have persisted, morphed and diffused these norms globally. Thus, when H1N1, a novel influenza virus emerged in 2009 in the United States, some were quick to try to identify a ‘foreign source.’ A few commentators blamed Mexican immigrants and ‘illegals’ for bringing the virus across the border. Notably, when mad cow disease spread from the United Kingdom, it did not generate a similar racist or ethnic backlash. The above examples indicate a long history of othering people of color as disease-ridden by nature even though disease carrying microorganisms do not differentiate amongst their victims based on race, nationality, ethnicity or other categories. While microorganisms do not discriminate, institutions, laws, policies, individuals and other actors do. There are countless studies that demonstrate significant racial disparities in healthcare, which illustrate how racial inequality functions as a social determinant of health.

This post illuminates how racialized fears of contagion contributed to the development of the global public health regime. The emergence of this regime was in many ways coterminous with European imperial expansion. Colonial powers increased international cooperation with other imperial powers for the containment of diseases to perfect the expansion of empires and to secure trade routes. For example, between 1851 and 1873, European powers negotiated three different international treaties relating to disease prevention and control, although none were enacted. Colonial powers eventually concluded treaties aimed at determining how restrictive quarantine regulations needed to be to continue the expansion of imperial trade without exposing their populations on the mainland to health risks from colonial territories. Remarkably, during the first half of the twentieth century there were no less than thirteen international treaties relating to cooperation on health control measures. This history is striking given that in 1793, British colonials gave Lenape emissaries items from a smallpox infirmary to intentionally spread diseases to nearby Indigenous peoples. The incongruity of the settler colonial project spreading diseases that decimated Native and Indigenous populations while European colonial powers formulated treaties aimed at protecting their metropoles is telling.

Understood against this background, European imperial powers’ early efforts at global health cooperation were inherently racialized. The first International Sanitary Conferences were convened to address the danger that cholera, yellow fever and the plague posed to Europe. Of these diseases, cholera sparked significant panic having reached Russia from India. Adrien Proust, a member of the French delegation and one of the leading participants in the International Sanitary Conferences, authored several monographs relating to ‘the defense of Europe’ against ‘Asiatic cholera.’ The 1892 Convention thus only addresses cholera and the sanitary control of westbound shipping to European countries based on fears that the Suez Canal might be a conduit for the importation of cholera from India to Europe.

Additionally, in the 1893 Convention, states agreed to notify one another urgently of any outbreaks of cholera within their territories. In 1893, a cholera epidemic in Mecca claimed the lives of 30,336 people. As a result, some Europeans feared that Muslim pilgrims returning to Europe posed a serious threat. Accordingly, the Sanitary Convention of 1894 exclusively focuses on the pilgrimage to Mecca and the precautions to be taken at ports of departure, the sanitary surveillance of pilgrims traversing the Red Sea, and the sanitary regulation of shipping in the Persian Gulf.

The prioritization of diseases of importance to Western interests was critical to the emergence of the global health regime. For instance, Austria-Hungary proposed the conference that led to the adoption of the 1897 Convention following a serious epidemic of the plague in India. Some Europeans feared that Muslim subjects in colonial territories might become infected by Indian pilgrims and bring the plague back with them. Consequently, the International Sanitary Convention of 1897 added the plague as a disease warranting international attention. The Euro-centric focus of the early treaties is also manifested in the 1903 Convention, which consolidated the earlier four conventions. Of its 184 articles, only one relates to yellow fever, which Europeans regarded as a minor concern limited to the Americas.

The calculus changed by the 1926 Sanitary Convention, which modified the 1912 Convention and required international notification for the first confirmed cases of cholera, plague, yellow fever, as well as small pox and typhus. Following WWI, millions of cases of typhus in Poland and the Soviet Union occurred, which increased this disease’s importance on the global health agenda. In 1932, the eastward spread of yellow fever from endemic locations in Latin America and West Africa to other African colonial territories and from there to vital South Asian colonial territories spurred a meeting to discuss greater protection against epidemic diseases. A map showing European airlines routes traveling across the African continent featured prominently at the meeting with representatives from several African colonial territories and British India. European countries subsequently adopted a treaty focused on sanitary and quarantine requirements for aerial navigation. Moreover, during the 1930s, when the Aedes aegypti mosquito was endemic in parts of southern Europe resulting in several outbreaks of dengue, thirteen European countries agreed to prioritize the prevention of the spread of dengue under the International Convention for Mutual Protection Against Dengue.

The inclusion on the list of diseases that deserved international recognition and regulation coincided with the importance of these diseases in Western capitals. It was not as if diseases prioritized by the early global health treaties were the only diseases afflicting populations globally. These treaties did not take place in a vacuum as Western countries formulated the nascent global health regime to perfect the colonial project. This brief synopsis of the history of global health law is crucial for understanding current global health practices.