States’ Response to Epidemics in History

State propaganda has its limits. But ultimately the state has to shoulder its responsibility of provider of public goods and initiate reforms

By S. Chidambaram

The outbreak of epidemics in the past threw all governments in a state of panic, and finding themselves on the horns of dilemma with their immediate response — shaped by self-interest – focusing on the control and manipulation of information. This was done for various reasons: economic, political and social, notwithstanding their deep commitment to deal with the epidemics. Even in countries where their governments’ commitment was not in doubt, they did not lose sight of political considerations.

A few cases of past epidemics can enlighten us about state behaviour during those difficult times.

The outbreak of the Spanish flu of 1918 made headlines immediately after King Alfonso XIII and other officers fell sick. However since Spain remained a neutral country during World War I, no censorship of the press was imposed and the news reached several European countries. However, because of the war, most European states had already imposed censorship and gave little importance to the pandemic because they feared that such bad news might bring down the morale of the soldiers.

When the news reached the United States in March 1918, President Woodrow Wilson too imposed censorship of the press which, out of patriotic duty, followed the official line with the result that about 675,000 Americans died of influenza during the pandemic, ten times as many as during World War. In England, the presence of the pandemic was denied, and the press continued to echo the official line in the public sphere. By the time the epidemic came to an end, the death toll in England had reached 284,000.

In Mauritius, too, when the malaria epidemic broke out in 1867, the majority of doctors thought that the fever was malarial but no formal view was expressed and the official view did not subscribe to it. What led the Medical Assessor on 23 January 1867 to recognize that an epidemic was in the making was not only the number of deaths, but that it had started to attack the rich.

Economic reasons rather the need to protect the population trumped the response of many governments to the pandemics. When news of a malaria epidemic broke out in Ceylon in 1934-1935 and made the headlines on many news channels, the BBC passed on the information to the Colonial Office which sought to allay fears of the epidemic lest it might disrupt trade and tourism. Press statements relayed by the Colonial Office to BBC and Reuters emphasized that there was no risk for visitors to Colombo or to the hill stations, and the news was disseminated in many British colonies.

On the other hand, colonial regimes had always pledged their concern for the people on medical and humanitarian grounds. But one feature of the official propaganda during epidemics was to deflect criticisms of the state for its inaction and inertia and to blame the people for their behaviour and ways of life; in many cases it was the poorer classes who were criticised for their alleged “indiscipline” and “poor sanitation”. When epidemics broke out in India, the colonial government always found fault with overcrowded tenements and other “filthy habits”. In Mauritius, when 40,000 people died of malaria in 1867 in Port-Louis, again it was the poorer classes who bore the brunt of the criticisms although malnutrition, lack of quinine and health infrastructure as well as the failure of sanitary reform were also important contributory factors.

During periods of crisis, the state had to juggle with a number of conflicting interests – those of the corporate sector, the privileged classes, its own political interests and the welfare of the people, with the latter coming last on its list of priorities. One could not expect the state to make public its priorities; it always sought ways to conceal them as it had always been the case in many countries in the past.

Health attention towards the lower classes was completely ignored because epidemics and diseases were usually confined to working class areas.  Things would change when the ruling class discovered that epidemics did not discriminate between different social classes and were the great leveller. From then on, sanitary reform, slums clearance and public health policy figured high on the agenda of governments in England and elsewhere.

One should not be surprised that advice and information from official sources – even when they are reliable – lack credibility not only because of poor communication but because the people either are suspicious of them or have their own cosmologies to explain the outbreak of epidemics and their spread. During the plague crisis in India in 1891, the people opposed colonial measures to deal with the disease because they had their own explanations and solution. They suspected that British colonial policy was designed to gain political control over the people, infringe their way of life and culture, particularly by imposing allopathic medicine over folk medicine – the more so since the British used medicine to prop up their image as modernisers. Contesting Western medicine and its health measures intensified the struggle against British imperialism in India.

What do we find at the end of epidemics? Very often there were reports or commissions of inquiries that would extol the state for having accomplished its objectives and any policy failure was attributed to illiterate and backward populations, forgetting that the state bore a large part of the responsibility in the matter for denying education, employment and healthcare to large swathes of the population. However State propaganda has its limits. But ultimately the state has to shoulder its responsibility of provider of public goods and initiate reforms.

After the 1918 pandemic, the British government had to set up a Ministry of Health in England. Ironically the pandemic contributed to the weakening of colonial governments and their political control over the colonies; it was also a contributory factor to the rise and consolidation of nationalism. In other countries, the lessons were not forgotten and they spurred various reforms.

* Published in print edition on 1 April 2020