Book Review: Infectious Change. Reinventing Chinese Public Health after an Epidemic

Infectious Change. Reinventing Chinese Public Health after an Epidemic. Katherine A. Mason, Stanford CA: Stanford University Press, 2016, pp. 252.

Katherine Mason’s Infectious Change is the first published ethnography on a key epidemiological and public health apparatus in the People’s Republic of China, the Chinese Center for Disease Control and Prevention (China CDC). Mason focuses in particular on of one of its stations in South China, in a city she calls “Tianmai,”—an important destination for China’s internal migrants. The book examines the transformation of the Tianmai CDC in the aftermath of the severe acute respiratory syndrome (SARS) pandemic of 2003, focusing on the practices, aspirations, and struggles of Chinese scientists in the process of reinventing and reenacting public health in response to both day-to-day epidemiological demands and in anticipation of future epidemics. Infectious Change examines in particular the development of public health reform and the self-formation of CDC scientists in relation to local realities, national policy, international imperatives, and their entanglements on the ethnographic ground.

In the context of the recent ethnographic and analytical flourishing in the anthropology of epidemics and epidemiology, and in light of Mason’s already published work, this has been a much-anticipated contribution to the field. Yet, curiously for a work on post-pandemic public health reform, the book does not engage in a sustained manner with the now considerable corpus on the anthropology of epidemics. Reading the monograph, one is surprised to find but passing references to key works on the subject and no reference at all to leading works on the anthropology of epidemiology and influenza in China. Strikingly, mention of simulations or even the book’s discussion of preparedness unfold as if these subjects did not form the ground of an extensive debate among medical anthropologists. Although the fieldwork on which the book is based was conducted mainly between 2008 and 2010, Infectious Change does contain bibliographical references as late as 2015, which makes this omission even more perplexing. Whatever the reason for it, this lacuna limits considerably the book’s contemporary relevance to the field.

At the same time, as is common in so many ethnographies, the study suffers from a limited historical perspective. On the one hand, this regards the specifics of 20th-century history of medicine and public health in China. To give but one example, the notion of the “floating population” (internal migrant workers) is veiled in the mystifying aura of the ethnographic present, when in fact both it and its biomedical pathologization date back at least to the 1894 plague outbreak in Hong Kong. A more careful historical, indeed genealogical, approach would have no doubt led to a richer and more nuanced understanding of key themes in the study. This especially applies to the discussion of the relations between quarantine, state power, modernity, and ethics: When the author states, for example, that, “Quarantine was presented as an outdated practice that might be used only while awaiting the development of superior technology” (p. 163), it should be obvious that, rather than being some ethnographic revelation, this anticipatory formula has been a constitutive part of the technoscientific practice and imaginary of quarantine across the globe for the past two centuries.

More importantly, however, the study’s historiographical limitation regards the stated key subject of the monograph: change. Contrary to expectations, Mason’s study does not attempt to show how the otherwise interesting ethnographic material could be analysed so that an understanding, if not a theory, of public health change in China in the aftermath of the 2003 SARS outbreak may be reached. Again, here the study remains largely on an empirical level without engaging with the rich anthropological and historical corpus on this subject. Instead, the analytical weight of the book seems to revolve around the notion of the “common,” a term that, while etically defined, is then repeatedly projected onto the study’s ethnographic subjects as if it comprised a way in which they theorize public health and their work or subjectivity in it.

It is thus tempting to just leave the book aside, burdened as it is by the above limitations. Yet we would be doing this to our peril, for in spite of it all, Mason’s work provides a much needed, and indeed quite lucid, look into key sociocultural processes at the heart of a local incarnation of China’s leading biopolitical apparatus. Principally in Chapters 2 and 3, the discussion of the importance of guanxi in establishing and acting out relations of trust and responsibility in the context of the CDC offers significant ethnographic insights. This is especially so as regards the author’s examination of “quality data and the production of truths” (p. 96ff) but also in her study of the way in which scientific imaginaries are articulated vis-à-vis research ethics on the ground.

Mason weaves a convincing and compelling ethnography of the day-to-day operations and relations in the Tianmai CDC station, allowing us to grasp the frustration and moral and professional antinomies and struggles of the scientists employed therein. This holds true particularly in the context of the H1N1 response in 2009, when the “lessons of SARS” underlining so many of the reforms since 2003 were put to the test. Reading the relevant chapter (Chapter 4) one feels inexorably drawn into the vortex of a collapsing technoscientific dream of self-realization; as international cooperation over the pandemic wavers and as local guanxi relations are suspended, the self-perception of the CDC professionals as “cosmopolitan, transnational scientists” (p. 178) is dissolved, leaving them to wonder “once again whom they were serving, and whom they were governing” (p. 180). One may agree or doubt that this was the result of the disintegration of what Mason calls the “global health common,” but one thing is certain: Infectious Change brings us for the first time before a hitherto unacknowledged consequence of the 2009 H1N1 crisis, and, at that, in one of the most epidemiologically critical regions of the globe today. It is this invaluable insight that should hold the attention not only of medical anthropologists but also of the wider global health community.

Leave a Reply