Lessons From China in Handling Zika, Ebola and Other Global Pandemics

Not every country prepares for global health threats in the same way.

Health workers during the 2014-2016 Ebola outbreak in West Africa. The Chinese view of and response to epidemics differs markedly from that developed in the West. Credit: Reuters

Though a recent outbreak of the Ebola virus in the Democratic Republic of the Congo was quickly quelled after killing three people, fear of rapidly spreading global diseases remains high after West Africa’s 2014-2016 Ebola crisis and last year’s zika, chikungunya and dengue scares in the Americas.

In February, Bill Gates warned that an unknown “airborne pathogen” could soon kill 30 million people in a year and said he has engaged the public health-focused Gates Foundation to prepare for that possibility.

He is not alone. Since the emergence of the H5N1 virus in Hong Kong 30 years ago, global health authorities have been working hard to be ready to take on the next big avian influenza outbreak from Asia.

Birds are particularly suspect because, ecologically speaking, they are the reservoir where flu viruses mutate, and as poultry breeding increases dramatically around the world, the possibility of a new flu virus being transmitted to humans rises.

With its Chinese origins and global impacts, avian flu fear offers an interesting opportunity for a cross-cultural examination of how the East and the West do disease differently.

What do pandemics even look like in China?

The Western history of pathologies

There is no word for pandemic in the Chinese tradition. The term chuan guo liu xing de (literally, an influenza that spreads to all countries) has been introduced in the last 20 years. Traditional terms for epidemics are yi (pest), wenbing and fengbing (diseases caused by heat and wind).

Language influences thinking, and for the human mind to shift from epidemics to pandemics, it needs to have a representation of the world as a totality or a globe.

In China, the change occurred with the introduction of maps by Western missionaries in the 16th century. This gave locals a vision of what Mandarin Chinese called tianxia: everything under heaven.

Mapping the globe is a Western invention and political tool. The notion of the pandemic hinges on the possibility of following emerging infectious diseases as they spread across the globe.

Pandemos, the classical Greek etymological origin of pandemic, does not refer to diseases. Nowhere in the medical treatises of Hippocrates and Galenus, where the Western concept of epidemics is developed (as a disease attached to a place, or epi), does the word appear.

The ancient Greeks were the first to use the word pandemic, but not in the modern sense of a global disease outbreak. Credit: Dedden /Wikimedia

Homer uses pandemos, which literally means all people (pan + demos), in his eighth-century epic poem, The Iliad, to describe a hero who can live in different societies. For him, it has a positive connotation.

Some four centuries later, Plato introduces a negative interpretation of the word in The Symposium, where he makes a distinction between heavenly love, exercised in the dialogue with smart and beautiful young men, and pandemic love, which results from hazardous encounters with men, women or even animals.

In Greek mythology, Pan, god of shepherds and flocks, is an ambivalent deity, a satyr-like being represented in rituals as a goat copulating with humans. His is the power of creation and disorder familiar to pastoral peoples who live in close proximity with nature.

Today, our concept of pandemic disease retains its link to the fear of pathogens crossing between animal species. Christianity borrowed from Plato the ancient idea that pandemos is pathological, and that following the will of God means respecting boundaries between beings.

Pan, the Greek god, often crosses the borders between men and animals. Credit: Marie-Lan Nguyen/Wikimedia, CC BY-NC-SA

The notion was applied to diseases only much later, in the 19th century, when Westerners invaded the tropics and discovered illnesses such as yellow fever and cholera. The historian Mark Harrison tells that one of the earliest uses of the word pandemic is found in the 1860 work of the British officer Robert Lawson, who described disease spreading across the globe in “pandemic waves” based on the magnetic waves model.

We can’t really prepare for global pathogens

The term pandemic really came into its own with the 1918 Spanish flu, which probably started in the United States and went on to ravage Europe, then at war, as well as Africa and India.

After this traumatic global event, which killed between 20 and 50 million people in one year, public health authorities tried to anticipate the next big flu. There were influenza pandemics in 1957 and 1968, caused by the emerging H2N2 and H3N2 viruses.

Eventually, the detection of H1N1 in 1978 and again in 2009, which is similar to the Spanish flu, led to massive vaccination campaigns, especially in the US.

With the advent of genetics-based risk assessment three decades ago, it now became possible to follow the emergence and mutations of pathogens, and respond accordingly.

But what if pathogens don’t follow the rules? Because diseases sometimes develop in a way that cannot be calculated using probability, Western global health authorities now also trying to be ready for the catastrophic effects of diseases that cannot be prevented with biomedical intervention.

This Western style of pandemic preparation has ramped up since the US launched its global war on terror in 2001, with its attendant fear of biological terror.

In ‘28 Months Later’ (2007), an unknown pandemic ravages the British Isles, turning people into zombies.

It’s all about the qi

China takes a wholly different approach to such concerns.

In 2003, after the emergence of SARS strengthened global mobilisation against H5N1, three microbiologists from Hong Kong University, Kennedy Shortridge, Malik Peiris and Guan Yi, argued that the ecology of Hong Kong – a transportation hub located near areas of dense poultry and pig breeding – enabled them to detect emerging influenza viruses before they became pandemics.

They concluded their article, The Next Influenza Pandemic: Lessons from Hong Kong, with the words:

The studies on the ecology of influenza led in Hong Kong in the 1970s, in which Hong Kong acted as a sentinel post for influenza, indicated that it was possible, for the first time, to do preparedness for flu on the avian level.

Shortridge even made a linguistic argument for this hypothesis. He noted that the Chinese character for “house”, jia, depicted a pig under a roof, as if the Chinese language made visible the mutations of viruses in domesticated animals.

Peiris quoted the ancient medical text Classic of the Yellow Emperor (Huangdi Neijing): “The superior physician helps before the early budding of the disease. The inferior physician begins to help when the disease has already developed; he helps when the destruction has already set in”.

And Guan portrayed himself as a virus hunter, able to see human and animal populations from the perspective of the deadly microbes transiting between species.

According to the three microbiologists, China could use its traditional cultural resources to anticipate pandemics.

Chinese traditional medicine discerns no sharp separation between the bodies of humans and those of animals, or between wild and domesticated animals. All bodies share energies, qi, whose balance, following the polarities of yin and yang, can be disrupted by crises.

Good doctors, the Classic of the Yellow Emperor advises, will anticipate the mutations of these energies before they become catastrophic and facilitate a new balance of the qi.

Thus, unlike the Christian tradition, in which the transgression of crossing boundaries between species offends God, in the Chinese perspective, pandemics are a sign that some kind of change, some international rebalancing, is needed.

The emergence of epidemics in China, then, simply calls for a geming – the Chinese word for revolution, which means a change of mandate under heavenly governance. In this view, humans should see pandemics as an opportunity to create a better life ourselves, not to panic.

Written by Frédéric Keck, Directeur du département de la recherche, musée du Quai Branly, Centre national de la recherche scientifique (CNRS).

This article was originally published on The Conversation. Read the original article.