As clarified in the preface to this book, its subtitle, Geographical Connections, can be interpreted both in terms of the connections or flows that occur in geographic space and the relations between the environmental and social factors that shape disease incidence and unequal health. Two earlier chapters have dealt separately with the mobilities of populations and material goods, and I turn now to the spread – but also the incidence – of infectious disease. Of course, the movements of materials, people and pathogens are all interrelated.

The emergence of a new coronavirus in late 2019/early 2020 has, as Cambridge geographer Matthew Gandy predicted in 2008, brought into the sharpest focus the impact of a new disease (Covid-19), and I consider here, briefly, the origins and wider determinants of the infection. I devote most of my attention to the differential impacts on (and within) nation states, particularly in the Global South, as well as inequities in how the disease has been managed through vaccination. Discussions of global vaccine availability and equity take us back to issues of global governance discussed in Chapter 4.

A key theme in the spread of the virus (SARS-CoV-2) that has transmitted Covid-19 relates to the networks of transmission through international movement, and I consider how changing patterns of air travel have enabled the spatial spread of infections – including newer strains of influenza. But I also consider other emerging and re-emerging infections, including an earlier coronavirus (SARS), as well as Ebola, for which mobilities across borders were less related to air travel but, rather, to road and track. The late Paul Farmer argued, in his last book, that the failure to deal with Ebola can in part be traced back to colonial exploitation and injustice. As he puts it, in west Africa “disease containment was a priority but care was not” (Farmer 2020). Much the same was true about Covid-19 in many parts of the world.

Earlier he was also careful (Farmer et al. 2013) to make the point that empirical research on disease requires not merely comparisons between countries but detailed data collection on local and regional variations in incidence.