Epidemics Have Lost the Plot Guillaume Lachenal, Gaëtan Thomas

Bulletin of the History of Medicine, Volume 94, Number 4, Winter 2020, pp. 670-689 (Article)

Published by Johns Hopkins University Press

For additional information about this article https://muse.jhu.edu/article/786010

[ Access provided at 23 Mar 2021 17:58 GMT from Columbia University Libraries ] Epidemics Have Lost the Plot

guillaume lachenal and gaëtan thomas

Summary: This article draws on Charles Rosenberg’s classic essay “What Is an Epidemic?” (1989) to reflect on the complex narrative structures and temporalities of epidemics as they are experienced and storied. We begin with an analysis of Rosenberg’s use of Albert Camus’s The Plague and a discussion of how epidemics have been modeled in literature and in epidemiology concomitantly. Then, we argue that Charles Rosenberg’s characterization of epidemics as events bounded in time that display narrative and epidemiological purity fails to account for the reinvention of life within health crises. Adopting the ecological, archaeological, and anthropological perspectives developed within African studies enriches the range of available plots, roles, and temporal sequences and ultimately transforms our way of depicting epidemics. Instead of events oriented toward their own closure, epidemics might be approached as unsettling, seemingly endless periods during which life has to be recomposed. Keywords: epidemics, outbreak narrative, crisis, Albert Camus, colonial medicine, AIDS activism, African public health

The second wave has come for Charles Rosenberg’s essay. More than thirty years after its publication, “What Is an Epidemic?” has been read as never before in the past months, becoming a stimulating, if unlikely, companion for COVID times. A text written as a reinterpretation of the history of epidemics through the experience of AIDS is now reinterpreted through our experience of the COVID-19 pandemic. A mundane sentence reads like secretly planted wisdom for our troubled times; a passing anecdote seems strangely prophetic—see how neatly the story about the “glass enclosed cubicle” designed to allow a “child with AIDS” to attend class in Florida (p. 575) loops back on the images of Plexiglas partitions and distance marks taped off in every primary school today. Cholera revisited by HIV- AIDS, revisited by coronavirus; epidemics and their narratives nested into

Gaëtan Thomas’s research was supported by REACTing-Inserm, project “Science, information et decision entre ouverture des données et fermeture des frontières,” coordinated by Daniel Benamouzig.

670 Bull. Hist. Med., 2020, 94 : 670–689 Epidemics Have Lost the Plot 671 one another. This is perhaps where the conversation should begin: how do we as historians confront the complex, palimpsest-like structures and temporalities of epidemics as they are experienced and storied, without flattening them as “constants”? How helpful is a simple model like the one proposed by Rosenberg, which, drawing from the literary analogy with Albert Camus’s The Plague, identifies in epidemics a recurring dramaturgic structure?1 Or, to put it differently, how do we emancipate the historical narration of epidemics from a set of literary tropes cemented by centuries of intertextuality? To answer these questions, we follow the invitation of the BHM edi- tors to make a step aside and read “What Is an Epidemic?” from the perspective of African colonial and postcolonial histories of epidemics and medicine. Such an operation might be termed, to borrow from Africanist colleagues, a “post-coronial” perspective:2 a reexamination of our historical habits in light of the current crisis,3 combined with a somewhat classical postcolonial move, which uses the detour through histories of (post) imperial peripheries to reveal the silences and situatedness of a seemingly universal model and to suggest alternatives framings.4 We further expose how Rosenberg’s dramaturgic pattern can be read as an instance of epidemiological imagination, which aligns (or fails to reflect on the mutual shaping of) narrative arcs and epi-curves. This curve fitting of epidemic narratives is mired down in a twentieth-century Euro-American era that believed in the conquest of infectious diseases and perceived AIDS as a semi-scandal for that reason.5 In a recent commentary of this essay, Richard Keller pointed that modeling epidemics as discrete events is rather “limiting . . . as a tool for thinking about the pandemic,” as it cuts it away from the “broader experience of late capitalist modernity, or of peak Anthropocene.”6 Building on this remark, we contend that the dramaturgic modeling of epidemics fails

1. Albert Camus, The Plague, trans. Robin Buss (London: Penguin, 2020). 2. Fanny Chabrol et al., “La pandémie de Covid-19 et ses « après » vus d’Afrique,” Politique africaine, https://polaf.hypotheses.org/5001. 3. P. Wenzel Geissler and Ruth J. Prince, “Corona, How Are You?,” Africa Is a Country, https://africaisacountry.com/2020/05/corona-how-are-you; Guillaume Lachenal and Gaëtan Thomas, “L’histoire immobile du coronavirus,” in Comment faire? (Paris: Le Seuil, 2020), 62–70. 4. Warwick Anderson, “Where Is the Postcolonial History of Medicine?,” Bull. Hist. Med. 72, no. 3 (1998): 522–30. 5. Jeremy A. Greene and Dora Vargha, “How Epidemics End,” Boston Rev., June 26, 2020, https://bostonreview.net/science-nature/jeremy-greene-dora-vargha-how-epidemics-end/. 6. Alex Langstaff, “Pandemic Narratives and the Historian,” Los Angeles Rev. Books, May 18, 2020, https://lareviewofbooks.org/article/pandemic-narratives-and-the-historian/. 672 guillaume lachenal and gaëtan thomas to account for the reinvention of life within health crises. Going beyond the intellectual strategy of using Africa as the continent that “does not fit” global models, we argue that adopting the ecological, archaeological, and anthropological perspectives dear to African studies might enrich the range of available plots, roles, and temporal sequences and ultimately transform our way of depicting epidemics. Instead of events oriented toward their own closure, epidemics might be approached as unsettling, seemingly endless, periods during which life has to be recomposed. The Plague guides our commentary for two reasons: First, its structure highlights the potentials and pitfalls of framing epidemics as crises bounded in time. We propose a genealogy to the idea that epidemics fit into a four-act sequence, “a conventionally structured play,” as illustrated, according to Rosenberg, by the narrative of The Plague. And second, this novel, set in Oran, written by an author whose life is intertwined with Algerian history, is well known for the almost complete elision of what was colonial in its colonial setting and for the notorious absence of the “Arabs” who were the main victims of the fictional epidemic.7 Focusing on African histories of epidemics, our commentary reintroduces these ghostly presences, and other people living within and through epidemics, to the narrative.

The Dramatic Curve: Epidemics, Dramaturgy, and Narration The decision to pick Camus’s novel as a model for narrating an epidemic was a daring one since this midcentury French allegorical fiction stands apart in the European literary canon of plague descriptions. From Thucydides’s History of the Peloponnesian War to Daniel Defoe’s A Journal of the Plague Year and Alessandro Manzoni’s The Betrothed, there is an established tradition of literal texts—as much as a work of fiction can be—on plagues. The European literary canon has given epidemics a central role, not only because storytelling needed them as an escape strategy in a situation of crisis but also because, as a dramatic device, they provided a “powerful and inevitable background against which the masquerade of life with all its pleasures defines itself.”8 In addition, the genre of plague

7. Conor Cruise O’Brien, Camus (London: Fontana, 1970); Edward W. Said, Culture and Imperialism (New York: Knopf, 1993); Jacqueline Rose, “Pointing the Finger,” London Rev. Books 42, no. 9 (2020): 3–6. 8. David Steel, “Plague Writing: From Boccaccio to Camus,” J. Eur. Stud. 11, no. 42 (June 1, 1981): 88–110, quotation on 90. See also Ernest B. Gilman, Plague Writing in Early Modern England (Chicago: University of Chicago Press, 2009). Epidemics Have Lost the Plot 673 literature was transformed by the surge of gay auto-fiction around the time Rosenberg’s essay was published, as the AIDS epidemic became a central concern across artistic and literary practices in the United States and Europe. But in contrast to the contemporary literature on AIDS, as well as celebrated historical texts in the same genre, The Plague’s structure and style serve an allegorical function. Camus was unambiguous about his intentions. In a letter to Roland Barthes, he wrote, “The Plague, which I wanted to be read on a number of levels, nevertheless has its obvious content the struggle of the European resistance movements against Nazism.”9 The collective fight against the disease, the superior interests of society, the sense of duty of individuals, are to be read as parable for the fight against fascism in the context of the Nazi occupation of France. “In allegorical structure,” posits the cultural critic Craig Owens, “one text is read through another, however fragmen- tary, intermittent, or chaotic their relationship may be.”10 As an allegory, The Plague lacks the texture of a classical novel. Arabs are not the only conspicuous absence in the text (victims of another occupation); it also lacks supporting characters and vignettes that breathe life into a novel’s narration.11 Oran is deprived of its most emblematic features and feels like any city in mainland France.12 The narrator is so omniscient and his commentary so general that it is hard to believe, as disclosed in the final chapter, that he is the protagonist doctor Rieux himself, even though his tone, as critic Conor O’Brien sharply noted, “slightly stilted, consciously didactic and at times verging on pompous—recurrently suggests the conversation of a provincial doctor.”13 This “objective tone”—the expression is Camus’s—might explain The Plague’s appeal to historians seeking enduring patterns in epidemics.14 After all, the narrator provides a form of analysis “from above” that resembles the discourse of social sciences. However, literal readings of The Plague embark on an unconformable journey, since they deliberately resist the push built into the text toward a different level of meaning.

9. Albert Camus, Lyrical and Critical Essays (New York: Knopf, 1968), 338. 10. Craig Owens, Beyond Recognition: Representation, Power, and Culture, ed. Scott Bryson, Barbara Kruger, Lynne Tillman, and Jane Weinstock (Berkeley: University of California Press, 1992), 54. 11. Camus removed from the successive drafts the character of a high school teacher, originally central to the story, because he seemed excessively sentimental in the context of a crisis. Albert Camus, Œuvres Complètes, vol. 2 (Paris: Gallimard, 2006), 1148. 12. O’Brien, Camus (n. 7), 45. 13. Ibid., 44. 14. Camus, Œuvres Complètes (n. 11), 1164. 674 guillaume lachenal and gaëtan thomas

Putting aside “Camus’s philosophical intentions” (p. 565), Charles Rosenberg focuses on the self-apparent temporal structure of The Plague. The novel is formally divided into five parts—and not four—echo- ing indeed the conventional structure of tragedy.15 Furthermore, it is crammed with time markers that depict the epidemic as a staged event. For example, the narrator recognizes the end of a “period full of troubling signs” in the death of the concierge, before the word “plague” was even “spoken for the first time.” “In the first stage of the plague,” he notes, separated lovers “were the privileged ones,” since they focused on their own loss instead of the larger crisis. “Extreme confusion affected only the final moments of the pestilence.” And “at the second stage of the plague the memory also went.”16 In the narrative economy of the allegory, this sharp and transparent sequencing serves the easy conversion of one level of meaning to another, as the plot converges toward the final victory over the disease, or France’s liberation from Nazism. It fosters the idea that collective efforts and individual sacrifices lead to a favorable, albeit temporary, ending. While the book was published in the aftermath of the Second World War, most of The Plague was prepared in the early 1940s, while Camus was in metropolitan France. In such a context, the temporal structure conveys a strong sense of hope projected toward the future. But when transposed onto the literal story of the fight against an epidemic, it transforms into the “master narrative of plague as a disease that can be eradicated only by (European) human action.”17 Such a narrative is especially problematic in the case of the ongoing AIDS epidemic, whose diverse and drawn-out trajectories across the globe have undermined any attempts to outline a clean, linear sequence oriented toward an ending. This ending also reflects broader conventions of storytelling. In this regard, the quadripartite structure highlighted by Charles Rosenberg strongly echoes the fundamental rules of narratology: in a good story, an undesired event is initially met with denial and surprise, but as the scope of disturbance extends, characters have no choice but to acknowledge the event and to act, all this leading to the path of a progressive return to normal. This standardized scheme has shaped the ways in which any number of crises, not just epidemics, have been recounted and narrativ- ized, making them appropriate frameworks for well-structured stories. As

15. Margaret E. Gray, “Layers of Meaning in La Peste,” in The Cambridge Companion to Camus, ed. Edward J. Hughes, Cambridge Companions to Literature (Cambridge: Cam- bridge University Press, 2007), 165–77. 16. Camus, The Plague (n. 1), quotations on 28, 43, 88, 203, and 209. 17. Nükhet Varlık, “Rethinking the History of Plague in the Time of COVID-19,” Cen- taurus 62, no. 2 (2020): 285–93, quotation on 290. Epidemics Have Lost the Plot 675 anthropologist Brian Larkin remarks, “Crisis follows the classic structure of narratology established by Vladimir Propp, Tzetan Todorov, Gérard Genette, and the Russian formalists: a state of equilibrium is disrupted by an event or crisis, equilibrium is restored or altered, and a state of balance is once again achieved.”18 The capaciousness of this framework helps explain why, in the first months of 2020, COVID-19 generated so many comparisons with past epidemics and other disasters: they were all superimposed within a narrative structure polished and fine-tuned through centuries of intertextuality. These narrative structures are undeniably among the most powerful rhetorical tools. They are also comforting, by their very immobility—the repetition of maxims and aphorism reassure “pertubated organizations,” wrote Roland Barthes in 1975, in a few lines that may evoke the mediatic rush toward historians’ wisdom at the beginning of the COVID-19 pandemic : “When some disturbance arises, I attenuate it by confiding myself to a fixity which exceeds my powers: ‘Actually, it’s always like that.’”19 But these narrative constants should be handled with care, and whether or not they are a meaningful basis for interpretation and action remains uncer- tain. As several historians have remarked in recent months, the exercise of historical analogies and the trope of the “lessons of history” are riskier than they seem.20 Analyses based on precedents prove problematic, as they might orient actors toward irrelevant strategies. “History, after all, teaches everything, including the opposite,” noted Reinhart Koselleck in his essay on the structures of repetition in history.21 Camus’s novel is strikingly care- ful and reflexive in that respect, which is quite ironic considering its use in the context of the COVID-19 pandemic. While the trope of historical comparison is mise-en-abyme across The Plague, with various metaphors and comparisons involving great epidemics from the distant past, the novel also warns the reader against the fallacies of lessons and prophecies based on a simplified history.

18. Brian Larkin, “The Form of Crisis and the Affect of Modernization,” in African Futures: Essays on Crisis, Emergence, and Possibility, ed. Brian Goldstone and Juan Obarrio (Chicago: University of Chicago Press, 2016), 39–50, quotation on 39. 19. Roland Barthes, Roland Barthes, trans. Richard Howard (Berkeley: University of Cali- fornia Press, 1994; 1975), quotation on 179. 20. Robert Peckham, “COVID-19 and the Anti-lessons of History,” Lancet 395, no. 10227 (2020): 850–52; Guillaume Lachenal and Gaëtan Thomas, “COVID-19: When History Has No Lessons,” History Workshop, March 30, 2020, https://www.historyworkshop.org.uk/ covid-19-when-history-has-no-lessons/. 21. Reinhart Koselleck, Sediments of Time: On Possible Histories (Stanford, Calif.: Stanford University Press, 2018), 169. 676 guillaume lachenal and gaëtan thomas

Some predictions were based on bizarre calculations involving the number of the year, the number of deaths and the number of months already spent under the plague. Others established comparisons with the great plagues of history, bringing out the similarities (which these prophecies called “constants”) and, by means of no less peculiar calculations, claimed to extract information rela- tive to the present outbreak. But the ones that the public liked best announced a series of events, any one of which might be the one that the town was currently enduring, their complexity allowing for any interpretation. Nostradamus and Saint Odile were thus consulted daily and never in vain. What remained common to all the prophecies was that, in the last resort, they were reassuring. The plague, however, was not.22 Literary critics often refer to the stereotypical sequence described above as a narrative arc, or a U-shaped story, to borrow an expression from the critic Northrop Frye.23 The trough of the curve signals the tipping point of the calamity and the beginning of a return to normalcy. An early visualization of this sequence was realized in 1863 by the German playwright Gustav Freitag in his Die Technik des Dramas. Freitag famously represented narrative resolution in a five-stage pyramidal curve. In what we can only describe as a momentous conjuncture, Freitag’s diagram was contemporary with the first attempts to standardize and predict the course of epidemics.

Figure 1. An early visualization of the narrative arc by German playwright Gustav Freitag. Freitag famously represented narrative resolution in a five-stage pyramidal curve. Gustav Freytag, Die Technik des dramas (Leipzig: S. Hirzel, 1905), 177.

In 1840, in a pivotal report, William Farr coined a formula that described the dynamic of smallpox outbreaks in England and Wales. He reiterated

22. Camus, The Plague (n. 1), quotation on 258. 23. Northrop Frye, The Great Code: The Bible and Literature (New York: Harcourt Brace Jovanovich, 1982). Epidemics Have Lost the Plot 677 his attempts two decades later, with a similar equation successfully used to predict the outcome of a rinderpest epidemic among cattle in Eng- land.24 As epidemiologist Paul Fine noted, “Farr thought he had here hit upon a fundamental natural law of epidemic phenomena, comparable almost to Newtonian physical laws.”25 Farr’s work was developing in the context of the European outbreaks of cholera, which generated rich sci- entific iconography. Epidemics were taking graphic shape, even though the notion of epidemic waves, omnipresent in current discussions and representations of COVID-19, remained metaphorical during most of the nineteenth century.26

Figure 2. Representation of an epidemic model from William Farr, Report on the Mortality of Cholera in England, 1848–9 (London: W. Clowes, 1852), Wellcome Collection.

24. John M. Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr (Balti- more: Johns Hopkins University Press, 1979). 25. Paul E. M. Fine, “John Brownlee and the Measurement of Infectiousness: An Histori- cal Study in Epidemic Theory,” J. Roy. Statist. Soc. 142, no. 3 (1979): 347–62, quotation on 349. 26. David S. Jones and Stefan Helmreich, “The Shape of Epidemics,” Boston Rev., June 26, 2020, https://bostonreview.net/science-nature/david-s-jones-stefan-helmreich-shape-epidemics. 678 guillaume lachenal and gaëtan thomas

These representations culminated in the perfectly symmetrical curves of British epidemiologist John Brownlee, who, half a century after William Farr, drew on his mathematical “law” to represent the course of epidemics.27 There is still much to research to reconstitute this intertwined history of attempts to establish narrative and epidemiological models organized around a discrete event.28 “What is an epidemic?” certainly stood at the intersection of these two impulses, just as it left the coproduction of narrative arcs and epidemic curves out of its reflection. How the experience of epidemics, such as cholera in Freitag’s Germany or typhus in Camus’s Algeria, shaped the art and theory of European storytelling is a question for literary historians—one might add to the investigation other narratives playing with epidemic plots, such as Thomas Mann’s cholera novella Death in Venice, which evokes the corpus of plague literature and has been described as a parody of Freitag’s dramaturgic sequence,29 or Jean-Paul Sartre’s movie script Typhus, a colonial epidemic drama written during World War II with strong didactic intentions.30 The idea that an epidemic displays the narrative purity of a crisis—a concept whose assumptions have already been questioned by historians and anthropologists working on Africa31—is an obvious pattern recurring through this history.

Off the Plot: Epidemics in Africa Africa is an appropriate place to start in search of narratives of epidemics at odds with the event-like, dramaturgic structure identified by Rosenberg. Epidemics appear to have neither beginnings nor ends on the continent, where the reassuring distinction between endemic and epidemic disease has been consistently blurred. Charles Rosenberg’s rock-solid definition of a “true epidemic” as “episodic,” exceptional, and “highly visible” (p. 563) does not hold for long: all through the twentieth century, colonial doctors and tropical medicine experts struggled with metaphors and categories to account for recurring outbreaks of smallpox, yellow fever, or sleeping sickness. While they were archetypal “epidemics” seen from a distance, the French doctors called them grandes endémies and thought of

27. Fine, “John Brownlee and the Measurement of Infectiousness” (n. 25). 28. To do so, one might draw on the thought-provoking study of Priscilla Wald, Contagious: Cultures, Carriers, and the Outbreak Narrative (Durham, N.C.: Duke University Press, 2008). 29. Volkmar Hansen, Thomas Mann (Stuttgart: Metzler, 1984), 60. 30. Jean-Paul Sartre, Typhus (Paris: Gallimard, 2007). 31. Janet L. Roitman, Anti-Crisis (Durham, N.C.: Duke University Press, 2014); Goldstone and Obarrio, African Futures (n. 18). Epidemics Have Lost the Plot 679 them as a crucial domain of biopolitical intervention,32 while textbooks often termed them “endemo-epidemic diseases.” One’s epidemic, it seems, is always the other’s “outbreak”; and one’s “outbreak” is the other’s endemic “flare up.”33 A simple look at the chronologies of plague and cholera pandemics, comfortingly shelved as numbered global events, reveals the strange status of the African region as a place of pandemic afterlives. The third plague pandemic ended in the mid-twentieth century; yet in 2017, the capital of Madagascar went through a major epidemic of pneumonic plague, killing 221 persons. Succeeding to the Seventh Cholera pandemic, which struck Africa in the 1960s, the Eighth Cholera pandemic is ongoing, a fact sometimes denied, and has led to major epidemics in several African countries in the past twenty years, including a nationwide disaster in Zimbabwe in 2005.34 As if pandemics lingered in the African cul-de-sac, laying their hats among the poor, their temporality suspended in ecosystems and populations. The continent, once a scene of success for eradication programs (the last human case of smallpox, Somalia 1977), is also a repository of partly failed attempts (malaria, yaws, guinea worm, polio); a place where epidemics end, and where they refuse to do so. The “last mile” of eradication is often very long in Africa, sometimes simply infinite; the final efforts to track the last cases of smallpox, sleeping sickness—as it was hoped in the 1950s—or poliomyelitis have been the occasion of an escalation in public health hubris and state violence, at the expense of pressing health issues and care infrastructures.35 In a recent publication, Jeremy Greene and Dora Vargha proposed a rich reflection on epidemic endings, based on an inspiring critique of Rosenberg’s framework. “At their best,” they write, “epidemic endings are

32. Jean-Paul Bado, Les grandes endémies en Afrique, 1900–1960 (Paris: Karthala, 1996). 33. For a discussion, written in the context of French colonial medicine, on the impos- sibility to draw boundaries between the “handy” concepts of epidemic and endemic diseases, see Charles Nicolle, Destin des maladies infectieuses, 3rd ed. (Paris: Presses Universitaire de France, 1939), 129–31. See also Margaret Pelling, “‘Bosom Vipers’: Endemic versus Epidemic Disease,” Centaurus 62 (2020): 294–301. 34. Myron J. Echenberg, Africa in the Time of Cholera: A History of Pandemics from 1817 to the Present (New York: Cambridge University Press, 2011); Simukai Chigudu, The Political Life of an Epidemic: Cholera, Crisis and Citizenship in Zimbabwe (New York: Cambridge University Press, 2020). 35. Elisha P. Renne, The Politics of Polio in Northern Nigeria (Bloomington: Indiana Univer- sity Press, 2010); Claire Magone, “The Last Mile: Should We Still Believe in the Eradication of Polio?,” Books and Ideas, January 30, 2014, https://booksandideas.net/The-Last-Mile.html; Guillaume Lachenal, The Lomidine Files: The Untold Story of a Medical Disaster in Colonial Africa (Baltimore: Johns Hopkins University Press, 2017). 680 guillaume lachenal and gaëtan thomas a form of relief for the mainstream ‘we’ that can pick up the pieces and reconstitute a normal life. At their worst, epidemic endings are a form of collective amnesia, transmuting the disease that remains into merely someone else’s problem.”36 African populations, we might add, have often been the “someone else” of medical history, conveniently placed outside the “mainstream we” who numbers pandemic waves and celebrates prog- ress with fanfare. But beginnings are no tidier than ends. Another irony of Charles Rosenberg’s “traditional” definition of epidemics is his exclusion of “aspects of humankind’s biological history” with no origin, that “proceed with imperceptible effect until retrospectively ‘discovered’ by historians and demographers” (pp. 563–64). Although it wasn’t obvious in 1988, a moment of obsessive debates around the “patient zero” in the United States, the AIDS epidemic precisely falls in this biohistorical category (taking it as a reference would require to simply reverse Rosenberg’s definition: “a true epidemic is a trend, not an event”).37 The search for the beginnings of the AIDS epidemic quickly led to Africa, and decades of research have since gradually set back the clock toward the early twentieth century.38 Historians and virologists have retrospectively rediscovered the rampant presence of HIV strains in mid-twentieth-century Central Africa (or not so rampant, according to Jacques Pépin, who suggested that HIV infection caused visible mass mortality among workers of the Congo- Océan railroad in the 1930s).39 These studies raise indirectly the retrospective, but fertile, question- ing of “the imperial dispositions of disregard,”40 combining erratic public health systems, racial hierarchies, and clinical incompetence, which led field doctors and tropical medicine experts to “miss” the first signs of the epidemic for decades. With the exception of a few unclear clinical descriptions of opportunistic infections in African patients from the late 1950s, the first properly described, retrospectively identifiable, cases are now famous European patients: a Belgian nun and a Norwegian sailor.

36. Greene and Vargha, “How Epidemics End” (n. 5). 37. Randy Shilts, And the Band Played On: Politics, People, and the AIDS Epidemic (New York: St. Martin’s, 1987); Richard Andrew McKay, Patient Zero and the Making of the AIDS Epidemic (Chicago: University of Chicago Press, 2017). 38. Jacques Leibowitch, Un virus étrange venu d’ailleurs (Paris: Grasset, 1984); Mirko D. Grmek, History of AIDS: Emergence and Origin of a Modern Pandemic (Princeton, N.J.: Princ- eton University Press, 1990); Tamara Giles-Vernick et al., “Social History, Biology and the Emergence of HIV in Colonial Africa,” J. Afr. Hist. 54, no. 1 (2013): 11–30. 39. Jacques Pépin, The Origins of Aids (Cambridge: Cambridge University Press, 2011). 40. Ann Laura Stoler, Along the Archival Grain: Epistemic Anxieties and Colonial Common Sense (Princeton, N.J.: Princeton University Press, 2008), 237. Epidemics Have Lost the Plot 681

In other words, the early history of the AIDS epidemic in Africa does demonstrate that it is always possible to ignore an epidemic, and that ignorance is socially and historically produced along specific, often racial, lines. And the later phase of the story—the episode of South African AIDS “denialism”—reminds us that denial is not a phase preceding “inevitable” acknowledgment, as in Rosenberg’s model, but an always available option, even when bodies pile up.41 As Myron Echenberg has also noted, even a “spectacular” disease like cholera may not achieve the status of public issue in a racialized state like South Africa.42 There is a politics of visibil- ity, concern, and ignorance, and to paraphrase Bruno Latour, “enough is never enough” for an epidemic to be recognized—the COVID-19 disaster is an all too fresh reminder of the political and technical work needed to bring an epidemic to existence.43 Historical studies of epidemics in Africa have engaged, like the rest of African studies, a long-term conversation with anthropology and the natural sciences. Many works in that subfield have stressed the impor- tance of a very broad framing of epidemics, health, and disease: African societies, including their colonial expert minorities, have a long history of understanding, and responding to, epidemics in social, political, and ecological terms. As our discipline at large (history of medicine, critical global health, medical anthropology) is taking more and more clearly an “ecological turn,” through a deepening conversation with the environmental humanities, we might say that African societies, let alone African studies, have been championing “planetary health” approaches for a very long time.44 Among the classic examples, the vast historiography of the late nineteenth-century crisis affecting Central and Southern Africa links epidemic phenomena (sleeping sickness, smallpox), epizootics (rinderpest), demographic collapse, agricultural systems, biological invasions, ecological, cultural, and religious change, and, last but not least, a colonial conquest that was essentially perceived, to quote Steven Feierman, as an “assault on health.”45 The specific history of sleeping sickness, the ecological disease par excellence, which is caused, diagnosed, and controlled

41. Didier Fassin, When Bodies Remember: Experiences and Politics of AIDS in South Africa (Berkeley: University of California Press, 2007). 42. Echenberg, Africa in the Time of Cholera (n. 34), 147. 43. Bruno Latour, Science in Action: How to Follow Scientists and Engineers through Society (Cambridge, Mass.: Harvard University Press, 1987), 7. 44. James H. Dunk et al., “Human Health on an Ailing Planet—Historical Perspectives on Our Future,” N. Engl. J. Med. 381, no. 8 (2019): 778–82. 45. Steven Feierman, “Struggles for Control: The Social Roots of Health and Healing in Modern Africa,” Afr. Stud. Rev. 28, nos. 2/3 (1985): 73–147, quotation on 119. 682 guillaume lachenal and gaëtan thomas at the scale of landscapes, is a textbook case,46 but the complex environmental interplay of climate, agriculture, famine, and epidemics has also been described for an apparently less complex (i.e., nonvectorial) disease like cholera.47 Such framings impose a different temporal and narrative regime, where the event-like structure of epidemics is complicated by what Achille Mbembe described as the “interlocking” of epochs: an African experience of time that is “neither a linear time nor a simple sequence in which each moment effaces, annuls, and replaces those that preceded it, to the point where a single age exists within society.”48 Following him we might say that epidemics are best understood (and experienced) as contemporary to previous ones, nested into one another, like Russian dolls. To give one example of such copresence of deep and recent epidemic pasts, Lachenal and colleagues in Eastern Cameroon have described how the sleeping sickness crisis of the early to mid-twentieth century was linked with other epidemics through causal chains involving multispecific ecologies and health infrastructures and technologies. In the Nyong basin, the trypanosomiasis epidemic was a direct consequence of the late nineteenth- century rubber boom: gatherers of latex, which was collected on wild trees and vines growing in forest zones, were exposed to tse-tse flies, like the porters and navigators transporting the rubber along the recently opened (i.e., deforested) Nyong river; the development of markets and afflux of traders facilitated transmission at the regional scale, while the decline of agriculture transformed local landscapes, favoring the breed- ing of flies in bushy areas. The response to the epidemic was based on further deforestation of the Nyong valley (a priority of German colonial doctors) and on well-known mass campaigns of screening and treatment, intensified by the French colonial health services from the mid-1920s.49 It

46. Jean-Paul Chrétien, “La crise écologique de l’Afrique Orientale au début du XXe siècle. Le cas de l’imbo au Burundi entre 1890 et 1916,” in Questions sur la paysannerie au Burundi (Paris: Université du Burundi/Centre de Recherches Africaines (Paris I), 1987), 55–93; Tamara Giles-Vernick, Cutting the Vines of the Past: Environmental Histories of the Central African Rain Forest (Charlottesville: University of Virginia Press, 2002); Mari Webel, The Poli- tics of Disease Control: Sleeping Sickness in Eastern Africa, 1890–1920 (Athens: Ohio University Press, 2019); Clapperton Mavhunga, The Mobile Workshop. The Tsetse Fly and African Knowledge Production (Cambridge, Mass.: MIT Press, 2018); Helen Tilley, “Ecologies of Complexity: Tropical Environments, Africa Trypanosomiasis, and the Science of Disease Control in Brit- ish Colonial Africa, 1900–1940,” Osiris 19 (2004): 21–28; Kirk Aden Hoppe, Lords of the Fly: Sleeping Sickness Control in British East Africa, 1900–1960 (London: Praeger, 2003). 47. Echenberg, Africa in the Time of Cholera (n. 34), 175. 48. Achille Mbembe, On the Postcolony (Berkeley: University of California Press, 2001), 16. 49. Guillaume Lachenal, Le médecin qui voulut être roi. Sur les traces d’une utopie coloniale (Paris: Le Seuil, 2017), 27–39. Epidemics Have Lost the Plot 683 is now increasingly clear that the sleeping sickness campaigns accelerated the emergence of both hepatitis C and HIV virus in the region (known as the site where several HIV-1 strains emerged), through the practice of unsterile injections and other invasive procedures at industrial scale.50 The last stage is the emergence since the 1970s of a hitherto unknown disease, Buruli ulcer, a debilitating skin infection caused by a mycobac- teria concentrated in Cameroon in the Nyong basin. Epidemiological research have linked the Buruli ulcer epidemic to climatic and landscape change, and especially to the development of agriculture in the Nyong river bed, whose forest cover was destroyed in the early twentieth century as part of sleeping sickness control efforts.51 To close the loop of that multiepidemic sequence, Buruli ulcer is also, like tuberculosis, another mycobacterial disease associated with HIV infection and immunosuppres- sion.52 Such ecological understanding of pathogenic successions (which also includes animals, and especial apes and bats) is a familiar feature of African epidemic histories, traceable in both the “lay epidemiology” of local populations and in the writings of the French “ecology of disease” school, especially the geographer Maximilien Sorre, a reader of colonial Pastorian research, who developed the concept of “pathogen complex” in the 1930s.53 Such perspective has the potential to recast major epidemic emergence like AIDS and Ebola in an “Anthropocene” political ecology, rather than in the narrow frame of zoonotic emergence and crisis. The dramaturgy of epidemics, seen from an African perspective, thus needs to be extended in time, stretching backward and forward: as Didier Fassin, Wenzel Geissler, Simukai Chigudu, Tamara Giles-Vernick, and Eric Silla have stressed in various African contexts, epidemics materialize a “presence of the past,” a bodily and ecological inscription of history.54 The

50. Njouom Richard et al. “The Burden of Hepatitis C Virus in Cameroon: Spatial Epi- demiology and Historical Perspective,” J. Viral Hepat. 8 (2018): 959–68. 51. Tamara Giles-Vernick et al., “The Puzzle of Buruli Ulcer Transmission, Ethno-ecological History and the End of ‘Love’ in the Akonolinga District, Cameroon,” Soc. Sci. Med. 129 (2015): 20–27. 52. Guillame Lachenal et al., “Neglected Actors in Neglected Tropical Diseases Research: Historical Perspectives on Health Workers and Contemporary Buruli Ulcer Research in Ayos, Cameroon,” PLOS Negl. Trop. Dis. 10, no. 4 (2016): e0004488. 53. Maximilien Sorre, Les fondements biologiques de la géographie humaine. Essai d’une écologie de l’homme (Paris: Armand Colin, 1943); Guillaume Lachenal, “Outbreak of Unknown Origin in the Tripoint Zone,” Limn 5 (2014): 8–11. 54. Paul W. Geissler, Guillaume Lachenal, Noemi Tousignant, and John Manton, eds., Traces of the Future: An Archeology of Medical Science in Africa (Bristol: Intellect, 2016); Fassin, When Bodies Remember (n. 41); Chigudu, Political Life of an Epidemic (n. 34); Giles-Vernick et al., “Puzzle of Buruli Ulcer Transmission” (n. 51); Eric Silla, People Are Not the Same: Leprosy and Identity in Twentieth-Century Mali (Oxford: James Currey, 1998). 684 guillaume lachenal and gaëtan thomas epidemic event itself is not always eventful, nor revealing in its predictive course. Its historicity rather calls for an archaeological sensitivity, attentive to the traces of the past it actualizes and to the material, affective, political, and biological remnants it leaves for the future—epidemics, as Terence Ranger’s analysis of millenarian movements in colonial East Africa have taught us, are not self-contained sequences or crises to be overcome, but beginnings, moments of revelation and prophecy oriented toward the distant future of social reform and decolonization.55

Reinventing Life within the Crisis Alongside the articulation of patterns through an analysis of temporality, “What is an epidemic?” is centered on the issue of moral interpretation and judgment. Of course, this emphasis is at odds with tragedy, the very genre that shaped The Plague’s temporal structure, as the sense of fatality and lack of explanation, two defining features of tragedy from the Greeks to Racine and Shakespeare, waned with the advent of a bourgeois sen- sibility and the comforting research of moral certitudes.56 “Epidemics,” Charles Rosenberg argued, are “well suited to the concerns of moralists” (p. 564). They trigger archetypal forms of blame: “Whether it was Jews poisoning wells, doctors seeking anatomical subjects, or the landlords and employers who forced them to live in unventilated hotels, poor people often found their own structure of blame—and meaning—in which to place an epidemic” (p. 569). The emphasis on moral interpretation reflects Rosenberg’s personal interest in religious history. It also echoes “maximalist” stances on the social impact of epidemics, which have been criticized for their tendency to focus on malicious behaviors and social disintegration at the expense of stories of resilience, survival, personal and collective agency, or even unexceptional and ordinary stories within epidemics.57 Accounting for “banality” amid crisis—a key intellectual challenge identified long ago in African studies58—is often lost in the way.

55. Terence Ranger, “Plagues of Beasts and Men: Prophetic Responses to Epidemic in Eastern and Southern Africa,” in Epidemics and Ideas: Essays on the Historical Perception of Pestilence, ed. Paul Slack and Terence Ranger, Past and Present Publications (Cambridge: Cambridge University Press, 1992), 241–68. 56. As George Steiner argues, the middle-class spectator of the romantic period “was not prepared to take the risk and revelation implicit in tragedy. He wished to shudder briefly or dream at ease.” Steiner, The Death of Tragedy (New York: Knopf, 1961), 116. 57. Lee Mordechai and Merle Eisenberg, “Rejecting Catastrophe: The Case of the Jus- tinianic Plague,” Past & Present 244, no. 1 (2019): 3–50. 58. Jean-François Bayart, L’Etat en Afrique. La politique du ventre (Paris: Fayard, 1989), 19. Epidemics Have Lost the Plot 685

In the historiography of epidemics, this maximalist approach has been reinforced by an overreliance on a certain kind of literary sources. The idea that epidemics put societies and individuals to the test is undoubt- edly central to the European literary canon on plagues, which is made of many stories about fear, rejection, and false accusations of contamina- tion. Even though one could establish an alternative corpus, from Samul Pepys’s Diary to Adalbert Stifter’s Granit, that would stress pleasure and persistence within epidemics, the tropes of social and personal upheaval have consolidated across generations of writers, a phenomenon that leads us with others to question the distinction between enduring historical patterns and literary conventions.59 As Paul Slack noted in his introduction to the collective volume Epidemics and Ideas (another landmark by-product of the renewed interest for epidemics in the early AIDS era), “One can never be entirely sure about the extent to which chroniclers of epidemics concentrated on social dislocation, the failure of doctors, flights to and from religion, rumours of poisoned wells, and similar phenomena simply because Thucydides and later writers down to Defoe taught them to look for them. It is a possibility which historians need at least to be aware of.”60 However, this issue extends beyond methods involving literary sources, since historians of modern and contemporary medicine, whose work rarely relies on those kinds of materials, similarly have to deal with a set of preexisting tropes and stereotypes around the nature of epidemics. There is a social demand for identifying, in historical sources, scenarios and roles that repeatedly manifest themselves in popular media and discourse around epidemics. Categories and archetypes become reified, feeding social expectations and ultimately shaping the approaches of social scientists toward epidemics. Confrontational AIDS activism, which emerged between the late 1980s and the turn of the 2000s—from Act Up in New York to the Treatment Action Campaign in Cape Town—strongly challenged the moral interpretation of epidemics. Perhaps one of the richest legacies of AIDS activism is indeed an extraordinary collective experiment on the tactical uses of narration, dramaturgy, and representations—to use a term omnipresent in 1980s social critique and identity politics. In the 1980s, vectors of blame in the West mostly issued from conservative forces who intended to use them politically, often raising eyebrows—think of Jean-Marie Le Pen’s infamous declaration on “sidatoriums.”61 In response to these interventions, but also to preconceived ideas and problematic depictions of people living with

59. Gilman, Plague Writing (n. 8). 60. Paul Slack, “Introduction,” in Slack and Ranger, Epidemics and Ideas (n. 55), 1–20. 61. Michael Pollak, Les homosexuels et le sida: sociologie d’une épidémie (Paris: Métailié, 1988). 686 guillaume lachenal and gaëtan thomas

AIDS—often by liberal artists and writers—activists created counterimages and narratives of what it meant to live in the epidemic.62 As the issue of representing AIDS took center stage, the intensity of the political fight was counterbalanced in many of these organizations with a sense of queer irony, not least toward essentializing labels.63 Philippe Mangeot, a former president of Act Up Paris and co–script writer of the movie 120 Beats per Minute, recently recalled: “We staged our anger, we transformed it into a weapon, but inside Act Up, angry people were impossible, they were irrelevant, one would like to say: ‘Take off your costume, it’s just us.’”64 Behind the standardized script of an epidemic, the political history of AIDS is characterized by different layers of contestation, appropriation, and derision of assigned roles and moral interpretation. Coupled with an emphasis on what James Scott has called the “hidden transcripts” of marginalized groups, the activist critique of representations has accompanied a marked interest in the way preexisting scripts are disturbed by the emergence of political subjectivities within epidemics.65 This process has been well studied in the context of sub-Saharan Africa. Simukai Chigudu has stressed how, during the 2008 cholera outbreak in Zimbabwe, Harare township residents, who were already deeply affected by a series of crises, “forcefully assert[ed] their claim for political status, social recognition and belonging as rights-bearing members of the nation- state.”66 In spite of the considerable losses suffered by township com- munities in Harare, a new register of critique emerged, which targeted the government’s handling of the outbreak. Political subjectivities were further strengthened by residents’ local adaptation to the cholera crisis. Surviving an epidemic might afford a social status and a raison d’être. The literature on “therapeutic citizenship” in the context of the African AIDS epidemic has amply demonstrated that some AIDS patients acquired “an extraordinary agency and sense of purpose” after becoming therapeutic

62. Douglas Crimp, “Portrait of People Living with AIDS,” in Melancholia and Moralism: Essays on AIDS and Queer Politics (Cambridge, Mass.: MIT Press, 2002), 82–107; Act Up Paris, Le SIDA, Combien de Divisions? (Editions Dagorno, 1994). 63. Gregg Bordowitz, The AIDS Crisis Is Ridiculous and Other Writings, 1986–2003, ed. James Meyer (Cambridge, Mass.: MIT Press, 2004). 64. Valentin Chémery et al., “Mémoire Vive. Politique et Sida Dans ‘120 Battements Par Minute’ Interview with Philippe Mangeot,” Vacarme, January 2018, https://vacarme.org/ article3087.html. 65. James C. Scott, Domination and the Arts of Resistance: Hidden Transcripts (New Haven, Conn.: Yale University Press, 1990). 66. Chigudu, Political Life of an Epidemic (n. 34), 156. Epidemics Have Lost the Plot 687 activists.67 Many others, it should be added, found an analogous oppor- tunity for self-reinvention in the context of Christian (especially pente- costalist) churches, where practices and theologies have been profoundly transformed by the HIV-AIDS epidemic.68 One might consider that the moral question is only displaced, from assigning blame to revendicating a social status possessing a strong moral dimension. However, the attention to the voice of patients might have larger methodological implications. Exploring the intertwined histories of state violence, biopolitics, epidemics, and African prophetic movements in colonial Belgian Congo, Nancy Hunt identifies the voices of the “vernacu- lar” in missionary archives and local songs. In the midst of brutality and disciplinary projects, she describes reveries, dances, and celebrations—an everyday life that is not immune to trauma and violence but certainly not reducible to them either. A Nervous State has profound significance for historians working on epidemics: it seeks life within tragedy and contests the idea that a medical event should be tightly circumscribed in time— “Anticipation and reverie pushed historical narration away from event- aftermath, away from situating subjects from the 1920s as irremediably under the imprint of terrible imperial violence.”69 In the early 1990s, AIDS activists were also dancing. Continuing to “be promiscuous in an epidemic” was a day-to-day project in Act Up’s meeting rooms.70 Life had to be defended—that is, reinvented. These experiences point toward what might be missing in Rosenberg’s model, and in many historical accounts of epidemics: the possibility of an inventive appropriation of the crisis and of its prewritten scripts, that Georges Canguilhem identified to “health,” defined as “a certain latitude, a certain play”71—“a capacity for activity, for motion” in the words of Hunt, that “begins with skills in acute observation—without denial—and moves

67. Steven L. Robins, From Revolution to Rights in South Africa: Social Movements, NGOs & Popular Politics after Apartheid (Scottsville, South Africa: University of Kwazulu-Natal Press, 2008), 137; Vinh-Kim Nguyen, The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS (Durham, N.C.: Duke University Press, 2010). 68. Ruth Prince, Philippe Denis, and Rijk van Dijk, “Introduction to Special Issue: Engag- ing Christianities: Negotiating HIV/AIDS, Health, and Social Relations in East and Southern Africa,” Africa Today 56, no. 1 (2009): v–xviii. 69. Nancy Rose Hunt, A Nervous State: Violence, Remedies, and Reverie in Colonial Congo (Durham, N.C.: Duke University Press, 2016), 242. 70. On sexual desire and AIDS activism in the United States, see Crimp, Melancholia and Moralism (n. 62); Deborah B. Gould, Moving Politics: Emotion and ACT UP’s Fight against AIDS (Chicago: University of Chicago Press, 2009). 71. Georges Canguilhem, Knowledge of Life (New York: Fordham University Press, 2008), 132, quoted in Hunt, Nervous State (n. 69), 2. 688 guillaume lachenal and gaëtan thomas toward irony.”72 As stressed by Achille Mbembe and Janet Roitman in the context of Cameroon in the 1990s, a country then facing various crises, laughing permits the subject to “regain possession of self”; it creates “distance between the subject who laughs and the object of mockery.”73 In times of individual and collective crisis, laughter is “a form of social expression,” beautifully analyzed by Julie Livingston in her ethnography of an oncology ward in Botswana. “In its recognition of the absurd,” laughter does not only respond to “the threat of social rupture,” but also reestablish the social by reaffirming norms and values.74 Such skills have shaped the cultural experience of AIDS in Africa, in a context of political violence, state collapse, and mass deaths, helping reinvent ways to live, die, mourn, forget, fight, and celebrate in a pandemic. Here, there is definitely an African lesson for our corona times—and an incitation to track ongoing disruptions in too neat epidemic sequences. Let’s end with an image. It is maybe not an accident that the most shared “meme” of the first wave of the pandemic on social media (in addition to the “flatten the curve” diagram) was coming from Africa: the video of the “coffin dance” from Ghana, first posted on TikTok in February and shared and distorted millions of times since, that showed four talented professional pallbearers dancing at a funeral as they carried the coffin.75 Memes are always mysterious, resisting to interpretation and comment and problematizing at the same time clichés and stereotypes—and this one especially (the video was not shot in the COVID context). It refers to a dramatization and commoditization of funerals that is familiar to observ- ers of twentieth-century Africa;76 its global success is likely to be one of a cathartic laugh in front of a spectacle of disaster, denial, and impotence. But it is tempting to see it as a celebration of that capacity for playing with

72. Hunt, Nervous State (n. 69), 253. 73. Achille Mbembe and Janet Roitman, “Figures of the Subject in Times of Crisis,” Pub. Cult. 7, no. 2 (1995): 323–52, quotation on 352. 74. Julie Livingston, Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic (Durham, N.C.: Duke University Press, 2012), 147–48. 75. For a full story about the video, see https://www.vice.com/amp/en_us/article/dygb7z/a-morbid-internet-fully-embraces-the-ghanaian-funeral-meme?__twit- ter_impression=true and https://www.huffingtonpost.fr/entry/coffin-dance-meme- porteurs-de-cercueil-origine_fr_5e9da1d1c5b6d361fde70976?ncid=tweetlnkfrh pmg00000001. 76. Filip De Boeck, “Beyond the Grave: History, Memory and Death in Postcolonial Congo/Zaïre,” in Memory and the Postcolony: African Anthropology and the Critique of Power, ed. Richard Werbner (London: Zed Books, 1998), 21–57; Rebekah Lee and Megan Vaughan, “Death and Dying in the History of Africa since 1800,” J. Afr. Hist. 49, no. 3 (2008): 341–59. Epidemics Have Lost the Plot 689 roles, narratives, and stereotypes—including the all too predictable cliché of death and loss: as a celebration of health in the midst of a pandemic.

Guillaume Lachenal is professor in history of science at médialab, Sciences Po, Paris.

Gaëtan Thomas is a historian of medicine and science, currently working as a postdoctoral fellow at médialab, Sciences Po, Paris.