Science, Medicine, and Anthropology

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Andrew Lakoff's Unprepared: Global Health in a

Time of Emergency
2018-04-24 08:12:40

By Christos Lynteris

Unprepared: Global Health in a

Time of Emergency

Andrew Lakoff

University of California Press, 2017. 240 pages.

Let us be frank: it is hard to think preparedness in the medical humanities

without thinking of Andrew Lakoff. Over the ten years since the publication
of his first piece on the subject (2007), Lakoff has developed, expanded
and refined the critical study of new public health and epidemiological
frameworks of anticipating and preparing for infectious disease
epidemics.[i] These works already define the field, and in dialogue with a
flourishing array of studies by other medical anthropologists they have
come to redefine our understanding of global health as a biopolitical

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terrain. The monograph Unprepared, published last year by the University

of California Press, not only summarizes these works but also fosters their
broader theoretical and methodological coherence and propels them
through new ethnographic trajectories.

What perhaps most elicits the attention of a reader already familiar with
Lakoff’s work and argument is a low-key and yet pervasive theme
spanning the book: the imagination. Pandemic threat, Lakoff argues, “can
be understood and managed as an unprecedented but potentially
catastrophic event whose consequences can only be managed by using
methods of imaginative enactment that enable planners to mitigate
vulnerabilities,” (p.8). The shift from precaution to preparedness, as
understood by Lakoff, requires both a different way of imagining existential
risk, and a different way of enacting this imagination as a means of
rendering existential risk actionable. Hence the extent to which we can be
prepared for the next pandemic depends on the extent to and the ways in
which we are able to imagine it as a social and biological event in the first
place.

Lakoff provides a potent critique of the international response to the recent

Ebola epidemic from an “imaginary” angle that complements
well-established claims that (as a technology of global health security)
preparedness led to a neglect of the public health infrastructure’s
collapse, and the importance of this neglect in implementing
contact-tracing, isolation, quarantine, etc. on the ground. He claims that
the delay of international response to the outbreak was “at least in part”
due to a failure of “administrative imagination: at a crucial stage, health
authorities did not conceptualize Ebola as the potential source of
catastrophic epidemic, but rather understood it as a disease that could be
managed via localized humanitarian care combined with straightforward
public heath techniques” (p.141). This failure of the imagination, Lakoff
argues, is at first sight surprising, given the importance of Ebola to the rise
and consolidation of emerging infectious disease frameworks, and the
imaginary investment in Ebola as a “killer virus” in popular and scientific
literature as well as novels and films since the early 1990s. “Indeed, the
“Super-Ebola” exercise in Honolulu was among the events that helped
introduce pandemic preparedness as a central problem for international
health,” (p.145). Yet, Lakoff argues, it is precisely the prevailing
imagination of the “next pandemic” that caused international
complacency on Ebola during the first months of the outbreak. Expecting a
novel super-virus, epidemiologists were so entangled in what Carlo Caduff
has called the “mutant ontology” of emergence, that they could not
imagine that a known virus, like the one that was spreading in West Africa,
could lead to a pandemic crisis.[ii]

As Lakoff is keen is to develop a Cold War genealogy of preparedness, it

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is tempting here to attempt an “imaginary” comparison. Fifty years ago, in

one of the first and most profound analyses on the subject, Günther
Anders identified an “imagination-deficit” as lying at the core of nuclear
catastrophe.[iii] The object of this deficit was not the material impact of
nuclear war. This had already become quite apparent in the
world-historical atrocity of Hiroshima and Nagasaki, and only required a
scalar projection to be envisioned on a global scale. What, by contrast,
remained outside the realm of imagination was the temporal impact of this
event. This was in Anders’s terms, “over-liminal” (überschwellige); a term
used to describe “phenomena that cannot be grasped and intellectually
assimilated because they outgrow the size of any of the
sensual/conceptual nets”.[iv] In a famous turn of phrase, recently picked
up again by Déborah Danowski and Eduardo Viveiros de Castro, Anders
specified that the problem with nuclear war is that it signals not simply a
time when we will not be, but a time when we will have never been.[v]

Though genealogically linked and drawing on an array of images and

ideas of the Cold War, pandemic preparedness markedly differs from them
in a number of ways: the existential risk involved is asymmetric, it
originates in nature, and it relies not on unilateral action but on human
connectedness (contagion). This entails an ontological transformation of
catastrophic, end-of-the-world imaginary. In the case of nuclear war,
making the unimagined imaginable entailed a concrete hope: that of
cancelling the end of the world by means of a universal stasis against the
powers or systems that were engineering it in the first place (according to
different narratives: the Pentagon/Kremlin, imperialism, militarism, etc.). By
contrast, in the case of the next pandemic, making the consequences of
the catastrophe imaginable claims no power to stop or delay the event –
for the event is in the first place and imagined as being, by its nature,
inevitable. Instead its role is to mitigate what Lakoff diagnoses as the
“misalignment between the normative rationality of epidemic
preparedness and the experience of managing actual disease outbreaks,”
(p.166).

Imaginary enactment thus needs to be seen as the pivot between two key
aspects of preparedness: as a biopolitical practice that (re)defines and
responds to health emergencies, and as a mythic enactment of a new end
of the world. Lakoff’s book provides an undisputed milestone in the
discussion of the first, while at the same time providing key links to the
second. And in so doing, it illuminates how becoming-unprepared is
precisely what lies at the arcane heart of preparedness as an apparatus
that mobilizes imaginaries and sensibilities of emergency in a perpetual
deferral of being-prepared.

As studies in historical ontology, Lakoff’s works have taught us how to

see today’s world of epidemic anticipation and control beyond that

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cornerstone of hygienic modernity: prevention. Unprepared fulfils the

promise of his invitation to the dizzying depths of global health security by
laying bare how enactments of readiness are intricately and at the same
time anxiously linked to an unstable constitution of threat.

Christos Lynteris is Senior Lecturer in Social Anthropology at the

University of St Andrews and Principal Investigator of the European
Research Council funded project Visual Representations of the Third
Plague Pandemic (St Andrews & Cambridge). His research examines
biopolitical, epistemological and aesthetic aspects of infectious disease
epidemics and epidemiology, with a focus on plague and zoonotic
diseases. He is the author of The Spirit of Selflessness in Maoist
China (2012) and Ethnographic Plague (2016) and has edited and
co-edited a series of works, the most recent of which is Histories of
Post-Mortem Contagion: Infectious Bodies and Contested Burials (with
Nicholas Evans, 2018).

Notes

[i] Andrew Lakoff, “Preparing for the Next Emergency,” Public Culture 19
(2) (2007): 247-271.

[ii] Carlo Caduff, The Pandemic Perhaps: Dramatic Events in a Public

Culture of Danger (Berkeley CA: The University of California Press, 2015).

[iii] Günther Anders, Die Antiquiertheit des Menschen, 2 Vols (Munich: C.

H. Beck, 2002). For a discussion on the “lack of imagination” in Anders’s
work see: Paul van Dijk, Anthropology in the Age of Technology: The
Philosophical Contribution of Günther Anders (Amsterdam: Brill, 2000).

[iv] Zygmunt Bauman, “A Natural History of Evil,” S:I.M.O.N (22 March

2012)
http://simon.vwi.ac.at/index.php/swl-reader/21-a-natural-history-of-evil.

[v] Déborah Danowski and Eduardo Viveiros de Castro, The Ends of the
World, translated by Rodrigo Nunes (Cambridge: Polity, 2016).

AMA citation
Lynteris C. Andrew Lakoff's Unprepared: Global Health in a Time of
Emergency. Somatosphere. 2018. Available at:
http://somatosphere.net/?p=14381. Accessed April 24, 2018.

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APA citation
Lynteris, Christos. (2018). Andrew Lakoff's Unprepared: Global Health in a
Time of Emergency. Retrieved April 24, 2018, from Somatosphere Web
site: http://somatosphere.net/?p=14381

Chicago citation
Lynteris, Christos. 2018. Andrew Lakoff's Unprepared: Global Health in a
Time of Emergency. Somatosphere. http://somatosphere.net/?p=14381
(accessed April 24, 2018).

Harvard citation
Lynteris, C 2018, Andrew Lakoff's Unprepared: Global Health in a Time of
Emergency, Somatosphere. Retrieved April 24, 2018, from
<http://somatosphere.net/?p=14381>

MLA citation
Lynteris, Christos. "Andrew Lakoff's Unprepared: Global Health in a Time
of Emergency." 24 Apr. 2018. Somatosphere. Accessed 24 Apr.
2018.<http://somatosphere.net/?p=14381>

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