Book Review: The Pandemic Perhaps: Dramatic Events in a Public Culture of Danger

The Pandemic Perhaps: Dramatic Events in a Public Culture of Danger. Carlo Caduff, Berkeley: University of California Press, 2015, 254 pp.

The Pandemic Perhaps presents a thoughtful ethnographic examination of the public culture of danger, specifically as the contemporary sense of impending doom has come to be linked ever more tightly to the assumed threat of a deadly influenza pandemic. More specifically still, it is a journey through the scientific, as well as governmental and corporate, reconstruction of the United States in the name of pandemic preparedness at a time when the biological world appears to be getting out of our control.

In that such a pandemic—on anything near the scale that we repeatedly have been warned about—has not occurred since the rise of a state-supported encompassing environment of fear, topically it is an ethnography of the possible, of the pending, of the perhaps. Locationally, it is the product of research conducted in microbiology laboratories and in scientific/policy meetings and conferences of nature of prophetic speech and associated action on the politicized stage of science-driven public health. In that this issue at hand is difficult terrain, Caduff tries to be very clear about what the book is not about: It is not about patient experience of illness, nor is it concerned with improving infectious disease planning. Indeed, the book is not focused on influenza per se as a biological event or process, or as a concern of applied medical anthropology. Also the book is not about why catastrophic influenza prophecy has failed, nor is it focused on finding culprits or even speaking truth to power. Rather, it is about the shape of social anxiety as a product of scientific prophecy about impending infectious disease calamity. Thus, although it is about influenza, it is more about influenza as culture than influenza as disease.

By way of setting the stage for what is to come, the book begins with a history of the emergence of the influenza virus as a laboratory dweller. This entails developing an account of the efforts of microbiologists, or as Caduff calls them, the “microbe farmers,” to study the pathogen, although it long remained invisible to them with available technology. This exploration of the making of scientific knowledge fits within and is influenced by the growing subfield of the anthropology of science as social practice (i.e., as a type of behavior that is subject to the same modes of examination that turned the mysteries of the Kula ring or the symbolic complexities of the Balinese cock fight into meaningful and knowable cultural constructions).

In their work with influenza, especially in the challenging effort to develop animal models of the disease, microbiologists came to realize there are no true disease- specific symptoms of influenza but rather quite varied species-specific indicators of pathogenic presence. Animal species are biologically constrained to produce different symptoms of infection, so influenza in a chicken looks startlingly different than influenza in a human. Moreover, influenza is so difficult to diagnose that even in individual human cases, physicians are now taught to identify the less precise syndrome of influenza-like illness. Because of this complexity, it is the laboratory and not the clinic that has become the dominant site in identifying an influenza outbreak. In this transition, and despite internal rivalries and conflicts among scientists, the prophetic social voice of the microbe farmers was born and empowered with a tense tone of urgency and danger.

Within this backgrounding of the human shadow on the disease of concern, the book takes up key moments in the complex tale of influenza as a disease of people, starting with the controversial and confusing swine flu pandemic—as it was labeled by WHO—in 2009. The appearance of the swine flu strain, first identified in Mexico and soon after in the United States, is used by the author to explore the underlying questions: What is a virus as a unique identifiable entity, and, moreover, what is a distinct viral strain, given the
rapid mutation rate of the entity in question? Ultimately, the questions at hand are presented historically, as well as in contemporary practice: How do microbiologists know influenza and precisely what do they know?

In emphasizing that despite the global ballyhoo it triggered, swine flu proved to be more of a bust than a beast, the book unfortunately fails to consider the subordinated populations for whom swine flu was, in fact, particularly devastating worldwide. Swine flu may not have lived up to the constructed definition of a global influenza pandemic, nor did its appearance justify yet another highly profitable vaccine effort by the pharmaceutical companies, but it had significantly greater adverse health effects in ethnic minority communities, exposing a health disparity of serious note, something not mentioned that is worth stressing.

A book on the science of influenza would not be complete without examination of the tensions of experimental genetic virus manipulation in the laboratory, which, in light of the focus on prophetic pronouncement in science, raises the highly relevant issue of the self-fulfilling prophesy: the Frankensteinian virus made in the lab and not in the wild. In investigating this issue, Caduff shows how anxieties about manufactured lethal viruses empowered security advocates to steer both public thinking and policymaking, including pushing for more intense anti-bioterrorist measures and for a more intense policing of scientific activity and international communication. In this examination, the author relies on Foucault’s notion of the politics of life and his excavation of the security of the state to make sense of the role of laboratory science in advanced state governance.

From this issue, it is but a short step to a consideration of state-managed preparatory initiatives and all policies and programs designed to limit the impact of a lethal influenza pandemic. This whole undertaking, Carduff argues, was launched under the banner of participatory demography and improved public health, but closer examination reveals it as an effort in limited participation, minimal social input, and maximal focus on protecting state infrastructure. Critical to this part of the ever-unfolding influenza story was the impact of Hurricane Katrina on disaster preparedness. The great deluge occurred in two waves, first the hurricane and second the social handing of the legacy of the storm in the management of people through pandemic preparedness. People must be prepared to sacrifice because pandemics are like hurricanes, hence we must always prepare for the worst as sooner or later it will (perhaps) blow in.

There is a lot to learn here about the many facets of influenza as a factor in human social life and artifact in modern science. In using this book as a text, it is important to remember that it is not pitched to the undergraduate reader, nor does it address many issues that a broad medical anthropology class or even a more focused anthropology of infectious disease class might want to take up in the discussion of influenza. It is, however, a worthy advance in the anthropology of science as an expression of human involvement in the creation of knowledge and the impacts of that endeavor on the world outside of university wet laboratories. The book ends with a brief mention that viral anxieties are in no small part driven by factors like the world- shaking effects of industrialization, urbanization, refugee mobilization, environment destruction, and the unsettling realization that borders are not protective from pathogens, people, ideas, or change. This is a point that might have been made earlier and with greater integration to have more fully emphasized the social structural origins of prophetic science.

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