Medical anthropologists and historians, this book argues, are last in line as authorities on pandemics, including the current one. First in line are the “hard” scientists. But science rarely offers certainties, and the political leaders who obediently “follow the science” are often ill-equipped to operate in the surrounding softer social and behavioral realms. They turn to platitude and metaphor. Most readily, they adopt the militaristic narrative of a war on disease: the microbe is an “invisible enemy” or an “invader” to be identified and defeated. Crime supplies a parallel metaphor: the scientist as detective, in search of the pathogen culprit. Policing pathogens merges into policing people, even in language: “lockdown” has the resonance of response to a prison disturbance.

How these pandemic narratives repeatedly emerged, and the repeated misunderstandings they gave rise to, is the topic of this book. The author, Alex de Waal, is an anthropologist and political scientist at Tufts University. His writings have mainly dealt with famine, conflict, and human rights in Africa, but he proves equally informed and engaging on this broader canvas. Three past pandemics are discussed: cholera in nineteenth century India and Europe, the Great Influenza of 1918–2019, and HIV/AIDS in the United States and Africa. A fourth, labeled pandemic X, is the one that did not happen: what SARS or Ebola could have become, what bioterrorism wargames envisage, or what is dramatically played out in some fiction and movies. And fifth is the actual pandemic that arrived, Covid-19, “the least unexpected pandemic in history.” The accounts are brief but finely crafted, situating the medical science in its governing political context. In place of the “disease detective plotline” de Waal offers an “evolutionary-ecological storyline.” The contrast is most evident in approaches to explanation: “The mainstream biomedical virologist focuses on the jackpot winning numbers. The ecologist asks what determines the odds, which means looking at how the casino is organized.”

Cholera presents the clearest origin story for a war on disease with Robert Koch's identification of the bacillus in Calcutta and his successful “defeat” of it in the 1892 outbreak in Hamburg. There was a prehistory, famously John Snow's water-pump handle in early Victorian London, and a lingering postwar outside Europe: in de Waal's biting conclusion, “Cholera was a pandemic of colonial conquest that the colonists finally succeeded in confining to the colonies.” The influenza pandemic of 1918–1919 was more puzzling and yielded no equivalent story of war and defeat. Emerging in the trenches of the Western Front in World War I, it killed some 60–100 million people worldwide, the biggest mass fatality since the Black Death, but it ended on its own with no biomedical solution. Viruses were then unknown. Only much later was the story reconstructed, of the flu virus attaining extreme lethality through genetic mutation and recombination in a constricted and demographically specialized setting—with its descendants the flu viruses that circulate seasonally today.

The chapter on HIV/AIDS is the most detailed, reflecting the author's Africanist expertise. HIV's origins as a pandemic in humans are complicated. Zoonotic transmissions from apes are a part of it, but, in de Waal's retelling, so is the role of health interventions (“iatrogenic transmission”) and the “colonial reorganization of sex” in mining work camps. The heated disputes on this topic, with national and institutional reputations at stake, are echoed in those surrounding the origins and early spread of the Covid-19 virus. The AIDS after story, however, is more hopeful than what may be in prospect for Covid, where “selective vaccine provision may soon become the greatest ever inequality in health care history.” De Waal describes a partnership of biomedical science with a bottom-up movement he calls emancipatory public health, together changing society “so that we can manage AIDS and cohabit with endemic HIV.” The same possibility remains for the new pandemic: “Covid-19 may yet be the emancipatory catastrophe we need.” —G.McN.

这本书认为，医学人类学家和历史学家在流行病方面排在最后，包括目前的流行病。排在第一位的是“硬”科学家。但科学很少能提供确定性，而乖乖“追随科学”的政治领导人往往没有能力在周围较软的社会和行为领域中运作。他们转向陈词滥调和隐喻。最容易的是，他们采用了对疾病进行战争的军国主义叙事：微生物是一个“看不见的敌人”或“入侵者”，需要被识别和击败。犯罪提供了一个平行的比喻：科学家作为侦探，寻找病原体的罪魁祸首。即使在语言上，警务病原体也会融入警务人员中：“封锁”具有对监狱骚乱的反应的共鸣。

这些流行病的叙述是如何反复出现的，以及它们引起的反复误解，是本书的主题。作者 Alex de Waal 是塔夫茨大学的人类学家和政治学家。他的著作主要涉及非洲的饥荒、冲突和人权，但事实证明，他在这幅更广阔的画布上同样见多识广并参与其中。讨论了过去的三种流行病：19 世纪印度和欧洲的霍乱、1918-2019 年的大流感以及美国和非洲的艾滋病毒/艾滋病。第四种，标记为 X 大流行，是没有发生的：SARS 或埃博拉病毒可能会变成什么样，生物恐怖主义兵棋推演的设想是什么，或者在某些小说和电影中戏剧性地上演了什么。第五是真正到来的大流行，Covid-19，“历史上最意想不到的大流行。” 这些叙述简短但精心制作，将医学置于其执政的政治背景中。代替“疾病侦探情节”，德瓦尔提供了“进化生态故事情节”。对比在解释方法中最为明显：“主流生物医学病毒学家关注头奖中奖号码。生态学家询问是什么决定了胜算，这意味着要看赌场的组织方式。”

霍乱展示了一场疾病战争最清晰的起源故事，罗伯特·科赫在加尔各答发现了这种杆菌，并在 1892 年汉堡的爆发中成功地“击败”了它。有一个史前时期，著名的约翰·斯诺在维多利亚早期的伦敦的水泵手柄，以及欧洲以外挥之不去的战后：在德瓦尔的尖刻结论中，“霍乱是殖民征服的流行病，殖民者最终成功地将其限制在殖民地。” 1918 年至 1919 年的流感大流行更加令人费解，并没有产生类似的战争和失败故事。它出现在第一次世界大战的西线战壕中，在全球造成约 60-1 亿人死亡，这是自黑死病以来最大的大规模死亡事件，但它在没有生物医学解决方案的情况下自行结束。那时病毒是未知的。

关于艾滋病毒/艾滋病的章节最为详细，反映了作者的非洲专业知识。HIV作为人类流行病的起源是复杂的。来自猿的人畜共患病传播是其中的一部分，但是，在德瓦尔的复述中，健康干预（“医源性传播”）和“性的殖民重组”在采矿工作营中的作用也是如此。围绕 Covid-19 病毒的起源和早期传播的争论在这个话题上引起了激烈的争论，国家和机构的声誉受到威胁。然而，接踵而至的艾滋病比 Covid 的前景更有希望，因为“选择性疫苗的提供可能很快就会成为医疗保健史上最大的不平等”。德瓦尔描述了生物医学科学与他称之为解放公共卫生的自下而上运动的伙伴关系，共同改变社会，“以便我们能够控制艾滋病并与流行的艾滋病毒同居”。新的流行病仍然存在同样的可能性：“Covid-19 可能仍然是我们需要的解放性灾难。” ——G.McN。