Tropical and Colonial Medicine

Tropical medicine was a crucial aspect of colonial subjugation and expansion. For example, French colonial authorities in Senegal used the bubonic plague to further segregationist ends by closely linking the Black population to the disease, since they conceived of Black people as a “barbaric collective that threatened the order and health conditions in the ‘European’ city.”Footnote ² In previous work, I define the “racialization of diseases” as the attachment of racial meaning to ailments based on the racial groups that tend to be socially associated with a given illness.Footnote ³ Consequently, even though the infection rate among Black Africans was not any higher than any other racial group, French authorities imposed harsh measures in Senegal, which included “burnings of huts, along with the formation of quarantine camps.”Footnote ⁴ They also imposed a cordon sanitaire that would segregate the city well after the 1914 outbreak of the plague in Dakar.Footnote ⁵ Similarly, for the British colonial authorities in Sierra Leone, the preferred method of fighting malaria was residential segregation.Footnote ⁶ Several analyses have demonstrated how sanitation concerns were used as a pretext for furthering segregationist ends.Footnote ⁷

Tropical medicine took place in settings that often depended on the coercive power of the colonial administrative state to implement its interventions.Footnote ⁸ Tropical medicine was generative for colonialism. As advances took place in the field, it furthered imperialist ends by enabling troops to better cope with unfamiliar diseases to be healthy to fight Indigenous populations resisting colonial domination and subjugation. Unsurprisingly then, tropical medicine grew to specifically focus on vector-borne diseases and infectious disease control, since these diseases had the greatest implications for the expansion of colonial empires.

Additionally, efforts to improve the health of subordinated populations in internal or external colonies were explicitly tied to racial capitalism, wherein being usable and being a thing of importance is a functional relationship between dominant and subordinated groups.Footnote ⁹ States arguably only developed public health systems to improve the ill health of Black, Indigenous, and other people of color as scientific knowledge expanded to confirm that germs know no color line.Footnote ¹⁰

Because disease carrying microorganisms do not differentiate among their victims, those concerned for white health could not afford to ignore Black health. Jim Crow laws in the United States could not prevent germs from measles, tuberculosis, pneumonia, or typhoid from spreading, which necessitated action that included historically subordinated groups in public health interventions.Footnote ¹¹ In South Africa, concern for the health and wellness of Black people was driven primarily by their proximity to the white population and the potential negative impact that this might have on white interests.Footnote ¹² For example, 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.Footnote ¹³ While many Black lepers were detained on Robben Island, white lepers were allowed to remain quarantined at home.

Colonial Medicine to Global Health

In the first part of the twentieth century, there were about thirteen international agreements on global health.Footnote ¹⁴ Colonial powers prioritized global health because they wanted to coordinate sufficiently restrictive quarantine regulations that would facilitate the unimpeded expansion of imperial trade without exposing their populations in the mother country to diseases from colonial territories.Footnote ¹⁵

European colonizers prioritized defensive measures against contagion from racialized and “diseased” territories when formulating the global health regime. Adrien Proust, one of the leading French voices during the International Sanitary Conferences, authored several works on “the defense of Europe” against exotic diseases.Footnote ¹⁶ The 1892 Convention solely addressed cholera due to concerns that the Suez Canal could be a conduit for the introduction of cholera from India to Europe.Footnote ¹⁷ Consequently, the 1893 Convention required state parties to inform each other without delay if any outbreaks of cholera occurred within their territories.Footnote ¹⁸

Additionally, European powers feared that Muslim pilgrims returning to Europe posed a serious threat, following a cholera epidemic in Mecca.Footnote ¹⁹ The Sanitary Convention of 1894 was thus singularly dedicated to the pilgrimage to Mecca.Footnote ²⁰ Similarly, following a serious epidemic of the plague in India, some Europeans were anxious that their other colonial territories might be affected.Footnote ²¹ Subsequently, the International Sanitary Convention of 1897 added the plague as a disease warranting international prioritization and notification.Footnote ²²

These treaties exemplify how colonial powers shaped not only the emergence of the global health regime, but what diseases deserved international attention and prioritization. This was also reflected in the International Sanitary Convention of 1926, which modified the 1912 Convention and required international notification for the first confirmed cases of cholera, the plague, yellow fever, as well as smallpox and typhus.Footnote ²³ Notably, there were millions of cases of typhus in Poland and the Soviet Union following World War I. The expansion of the list of diseases that deserved international recognition under the 1926 Convention coincided with the importance given to these diseases in the Global North.

During the 1930s, the Aedes aegypti mosquito was endemic in parts of southern Europe, and several outbreaks of dengue arose as a result.Footnote ²⁴ Subsequently, thirteen European countries agreed to prioritize the prevention of the spread of dengue under the International Convention for Mutual Protection Against Dengue.Footnote ²⁵ It was not as if diseases prioritized by these treaties were the only diseases afflicting populations globally.

Members of the new League of Nations also endeavored to “take steps in matters of international concern for the prevention and control of disease.”Footnote ²⁶ Yet, commentators concluded that, “as compared with what it has done for other parts of the world . . . the Health Committee of the League of Nations itself has done remarkably little for the African continent.”Footnote ²⁷

It was not until the 1944 modification of the International Sanitary Convention that the global public health regime began requiring state parties to send epidemiological information for diseases not pre-ordained as significant by Western capitals.Footnote ²⁸ Under the 1944 Convention, state parties were to send so far as possible regular notifications of communicable diseases in their countries.

The multiple overlapping obligations from earlier conventions led to a complex situation where some states were parties to some instruments and not others.Footnote ²⁹ In 1969, the WHO Health Assembly revised, consolidated, and renamed the International Sanitary Regulations the “International Health Regulations.” The basic premise of the system remained the same––notification requirements for named infectious diseases, which would then trigger an international response that imposed travel and trade restrictions to contain the spread of disease. While the names of the treaties and the substance changed incrementally over the years, the prioritization of white interests in their enactment remained constant.Footnote ³⁰

Back to the Future

Unlike predecessor institutions, the World Health Organization was to be global not just in name but in substance. Its constitution states that, “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”Footnote ³¹ Yet, the current regime under the 2005 International Health Regulations does not refer to historic or ongoing racial discrimination in public health or medicine.Footnote ³² This failure to engage explicitly with race obscures the role of racism and subordination in global health.Footnote ³³

The Regulations ignore the structural conditions in the international system that give rise to and limit the ability of states to develop core capacities. The Regulations assign primary responsibility for implementing health measures to combat infectious diseases to national authorities.Footnote ³⁴ State parties have a legal obligation to develop better functioning health systems to detect, surveil, report, verify, and respond to disease;Footnote ³⁵ and are also legally obligated to cooperate to help build health capacities.Footnote ³⁶ Yet, the Regulations do not specify how this should be operationalized. Thus, legacies of subordination and continued inequities that have rendered states vulnerable to epidemic and pandemic diseases are unaccounted for in the Regulations. Regrettably, some of the proposed amendments to the Regulations from the United States tend to narrowly focus on bolstering early detection efforts without sufficient attention to historical vulnerabilities and lack of capacity.Footnote ³⁷

Moreover, the present system provides state parties with substantial opportunity to make choices shaped by implicit or explicit racism. For example, during the COVID-19 pandemic, some states made decisions informed by “outdated but persistent settler-colonial conventions that have mapped illness and disease on to racialized peoples and certain geographic regions.”Footnote ³⁸ The World Health Organization declared COVID-19 a public health emergency of international concern on January 30, 2020, and consistently “advise[d] against the application of travel or trade restrictions to countries experiencing COVID-19 outbreaks.”Footnote ³⁹ However, by February 27, 2020, thirty-eight countries had already reported measures “that significantly interfered with international traffic in relation to travel to and from China or other countries, ranging from denial of entry of passengers, visa restrictions, or quarantine for returning travelers.”Footnote ⁴⁰ A newspaper in France even carried the headline “Yellow Alert” on its front page.Footnote ⁴¹ Moreover, the understanding of the disease as racialized and “foreign” constrained the space for consideration of community transmission within the United States.Footnote ⁴² The racialization of COVID-19 led to public health law and policy decisions that assumed that the virus was engaged in racialized transmission efforts, checking documents and nationalities to determine whom to infect next.Footnote ⁴³ This was evident in the overreliance on blanket travel bans as a magical solution to stop the spread of a highly infectious novel disease concomitant with the lackadaisical approach to implementing screening measures at airports in the United States and elsewhere.

Early reactions were not merely efforts at disease containment. The racial and colonial logics influencing COVID-19 law and policymaking were evident in innumerable ways throughout the course of the pandemic. A prime example, was the swift decision by countries in the Global North to cut off southern African countries following South Africa's genomic sequencing of the Omicron variant.Footnote ⁴⁴ Instead of being rewarded for tracing and alerting the world to a variant that was already circulating in continental Europe,Footnote ⁴⁵ the United Kingdom, and the United States,Footnote ⁴⁶ the European Union and others were hasty to make decisions informed by “Afrophobia,” as the president of Malawi termed it.Footnote ⁴⁷ One newspaper published a literal depiction of the racialization of diseases—replete with brown viruses with exaggerated phenotypical Black features traveling on a boat with the South African flag toward European shores.Footnote ⁴⁸ This fear of the racialized other and their diseases is a powerful reminder of how the history of diseases and responses to diseases is linked to politics of racial exclusion and subordination.