Epidemics are commonly perceived as events, ruptures that detach present and future from what has gone before (Lynteris 2016; Kelly et al. 2020). Epidemic control has been framed as top-down emergency intervention, aiming to save lives from a single threat, here and now (Lachenal 2013; Redfield 2020). Yet, epidemics and anti-epidemic measures do not arise ex nihilo; they are connected to past events and processes and condition future ones, as they reconfigure spaces and infrastructures, intervene into the natural environment, and transform bodies and relations (Gilles-Vernick et al. 2013; Geissler & Prince 2020; Bannister 2021). Attending to the sedimentation and layering of past epidemic traces, our project moves beyond studies of singular events, foregrounding instead duration, persistence and entanglement across time (Greene & Vargha 2020; Roth 2020). Doing so, it links and moves beyond four areas of scholarship:
(i) Critical anthropology of Global Health:
Since the millennium, anthropologists have studied ‘Global Health’ programmes against infectious diseases (Biehl & Petryna 2014; Meinert & Whyte 2014). These rely on ‘vertical’, top-down approaches, advanced technical solutions and emergency time-scales (Nguyen 2010; McKay 2018); they restructure and fragment health systems and facilities, change medical practices and patient concerns (Langwick 2008; Prince & Marsland 2013; Street 2014; Brown 2016); and their rapid development results in ephemerality, presentism and amnesia (Graboyes & Carr 2016). To counter these tendencies, our project will trace overlooked continuities and entanglements of Global Health across time.
(ii) Anthropology of epidemics:
Anthropologists have studied epidemics’ social and political-economic contexts, attended to lived realities of disease outbreaks, and helped improve mitigating responses – e.g. to HIV/AIDS (e.g. Fassin 2007; Hardon & Moyer 2014) and Ebola (Abramovitz 2017; Richards 2016). They have highlighted intersections of epidemics, economies and ecologies (Brown & Kelly 2014), and of global epidemics and security (Caduff 2015). More recently, epidemics of chronic disease such as diabetes and cancer, and ‘syndemics’ of different diseases entangled by social conditions have come into view (Singer 2011; Livingston 2012; Moran-Thomas 2019; Prince 2021). Studying epidemics as momentous events, social scientists paid less attention to overlaps and simultaneity, which is the focus of our study (Charters & McCay 2020).
(iii) History of medicine in Africa:
Medical historians, focusing on biomedical institutions (Vaughan 1990; Tilley 2011), showed that disease control campaigns were distinctive, ideologically charged colonial projects that continued after independence (Comaroff & Comaroff 1993, Packard 1984). Public health systems of young African nation states were often essentially systems of epidemic control, emphasizing top-down, technology-driven ‘campaigns’, foreign interventions, biosecurity and territorial control (Bashford 2007). Little attention has been paid to how the striking continuities and sequence of disease control have cumulatively shaped present landscapes and ecology, social collectives, mobilities and infrastructures.
(iv) Anthropology of traces:
Scholars of post-socialist, post-industrial and post-colonial social formations have shown how modernity’s material remains sediment in bodies and objects, landscapes, social relations, habits and structures (Olsen & Pettursdottir 2014; Hoffmann 2017; Yarrow 2017), (re)producing enduring domination and ‘ruination’ (Stoler 2008; Gordillo 2014). Examining remains of modern medical intervention, e.g., hospital architectures (Roth 2019), paperwork (Manton 2017) patient groups (Robbins 2008), burial sites (Poleykett 2018), or toxic and drug residues (Bornman et al. 2010; Laborde 2018; Desclaux & Barranca 2020), we will expand this inquiry to include persistent chemical and somatic alterations, modified terrain and plant life, national medical logistics and border infrastructures, and enduring social collectives. We will pursue traces’ reference to the past, as well as their future transformative potential.
Africa offers our inquiry fruitful terrain. More than elsewhere, its public health was shaped by effects of and responses to epidemics. Colonial occupation introduced new diseases and spread existing ones (Packard 1984), and experimental health interventions often proceeded with little regard for populations or natural environment (Rottenburg 2009), with incisive effects on landscape, ecology and political economy, social structure and bodies (Mavhunga 2018) – contributing their share to colonial ‘ruination’ (Stoler 2008). Postcolonial public health built upon inherited expertise and infrastructures, before being curtailed by 1980s austerity policies and overburdened by HIV/AIDS (Prince 2013). Since then, Global Health modalities shape African epidemic control, often through fragile parallel structures (Meinert & Whyte 2014).
As the continent now faces Covid-19, Ebola, emerging infections and antibiotic resistant pathogens, alongside HIV and ‘epidemics of chronic disease’ (Vaughan et al. 2021), our project will produce new knowledge about how traces of past disease outbreaks and control shape both the present and the future. The importance of remainders of epidemics is precisely that they remain present, forming the social and ecological landscapes upon which current and future disease outbreaks and interventions – and people’s daily lives – take place.
While staying open to the surprising diversity of epidemic remains, we will explore the empirical manifestations and theoretical implications of five types of lasting traces, selected on the basis of prior research. Each is studied in-depth in one specific workpackage, but they also invite comparison across WPs: WP1, chemical: how insecticides, drugs and vaccines are deployed within, but outlast, control projects, and how their persistence is embodied and detected; WP2, ecological: how epidemic control altered relations between organisms, species and their environments, affecting future life; WP3, spatial: how responses to epidemics imagine and organize space, durably reshaping spatial patterns and practices of cross-border circulations, sanitary control and surveillance; WP4, infrastructural: how disease control relies on or generates monitoring and provision infrastructures, and how these frame future possibilities for protecting health; WP5, social: how social relations and collectives of patients or professionals may outlast particular epidemics, adapt or dissolve.