States, societies, and Covid-19 in comparative perspective
In the modern era, citizens around the world have come to expect governments to take action to curb the spread and to mitigate the consequences of disease outbreaks. And yet, the quality of those responses varies widely, generating puzzles ripe for comparative analysis: Why are some states more aggressive than others in allocating resources, transmitting information, and seeking to regulate and to transform citizen behaviors? And why do some citizens, and not others, demand and willingly obey such government efforts?
The early decades of the global AIDS pandemic motivated such general questions, and key features of the present Covid-19 pandemic hold many similarities: a highly infectious virus spread rapidly via humans traveling on airplanes to various corners of the world, and then to new networks within those countries. And with respect to both viruses, individuals can be infectious without being symptomatic or realizing their status—a particularly pernicious challenge for control, because a seemingly healthy carrier is more likely to go about their regular routine, exposing others to infection. Moreover, while there is no cure1More recently, antiretroviral drug therapies for HIV have become sufficiently effective to reduce viral loads to the point of no longer being detectable, so arguably almost 40 years into the epidemic, the scientific community is on the brink of a cure. or vaccine for HIV or Covid-19, respected health authorities quickly determined how to avoid transmission, and that knowledge was shared widely across governments, scientists, and through international organizations, such as the World Health Organization (WHO).“When data about disease burdens are collected and disseminated in ways that reinforce such boundaries, including with notions of differentiated vulnerability, this may generate political dynamics that ultimately impede effective policy responses, as was the case with respect to the AIDS epidemic.”
Despite this shared body of scientific knowledge, the imperative of governments and other authorities to enact and to implement policies designed to prevent the spread of a potentially deadly virus has come up against a host of social, political, and economic constraints: it is frequently costly and/or unpleasant to change the behaviors that contribute to transmission—both from the perspective of the state and society. Willingness to bear those costs must be balanced against risk perceptions, which are themselves a function of many factors, including, but definitely not limited to, objective dangers that might be conveyed from an epidemiological perspective. Specifically, I focus on the influence of ethnic, racial, and national boundaries as factors that shape how risks are understood within and across societies. When data about disease burdens are collected and disseminated in ways that reinforce such boundaries, including with notions of differentiated vulnerability, this may generate political dynamics that ultimately impede effective policy responses, as was the case with respect to the AIDS epidemic.2The discussion of the politics of government responses to AIDS draws on research published in Evan S. Lieberman, “The Perils of Polycentric Governance of Infectious Disease in South Africa,” Social Science & Medicine 73, no. 5 (2011): 676–84; Yarrow Dunham, Evan. S. Lieberman, and Steven A. Snell, “Does Stigmatized Social Risk Lead to Denialism? Results from a Survey Experiment on Race, Risk Perception, and Health Policy in the United States,” PLoS One 11, no. 3 (2016); Evan S. Lieberman, Boundaries of Contagion: How Ethnic Politics Have Shaped Government Responses to AIDS (Princeton, NJ: Princeton University Press, 2009); Varun Gauri and Evan S. Lieberman, “Boundary Institutions and HIV/AIDS Policy in Brazil and South Africa,” Studies in Comparative International Development 41, no. 3 (2006): 47–73.
The implications could be profound: in the context of the Covid-19 epidemic, in which the ability to participate fully in social and economic life could eventually be restricted to those thought to be at lower risk, the use of national, race, and ethnic categories to describe disease vulnerability could very well serve to harm those for whom such data collection was intended to help.
Theorizing about boundaries and contagious disease
In the early days of the AIDS epidemic, a wide range of interested observers and government officials around the world attempted to convince citizens of a common threat, and consistently repeated the incantation that HIV “knows no boundaries.” And yet, when it came to forming social and political attitudes about AIDS, it was plain to see at almost every level, that leaders and ordinary citizens interpreted deaths and illnesses in terms of various socially meaningful categories—initially with respect to gay men, but eventually, specific ethnic, regional, and national groups. In India, AIDS was referred to as “Mumbai” disease, and as a problem for particular castes. In South Africa, for a time, blacks referred to it as a “white” disease, and whites as a “black” disease. In Nigeria, Northern Muslims said it was a problem for Southern Christians. And in the United States, AIDS has often been described in terms of Haitians, Africans, and African Americans.
While such claims contained hints of truth, in the sense that at particular moments, higher rates of infection could be detected among certain subpopulations, these stereotyping dynamics falsely conveyed a sense of qualitative difference in risk: this is “their” problem, not “ours.” Such dynamics appeared consistent with the tenets of social identity theory,3For a review, see Leonie Huddy, “From Social to Political Identity: A Critical Examination of Social Identity Theory,” Political Psychology 22, no. 1 (2001): 127–56. which emphasizes human tendencies toward intergroup comparisons and the desire to gain ingroup esteem. Along these lines, in the context of an epidemic, socially and politically meaningful categories can shape discourses of risk, and in turn, political calculations about how to respond.“In some diverse countries such as Brazil at that time, the forging of a strong sense of solidarity across that diversity helped contribute to a politics of shared threat, and development of a more effective response.”
To be clear, ethnic or racial diversity, per se, were not detrimental to government AIDS policies. In fact, in some diverse countries such as Brazil at that time, the forging of a strong sense of solidarity across that diversity helped contribute to a politics of shared threat, and development of a more effective response.4→João Biehl, “The Activist State: Global Pharmaceuticals, AIDS, and Citizenship in Brazil,” Social Text 22, no. 3 (2004): 105–32.
→Gauri and Lieberman, “Boundary Institutions and HIV/AIDS Policy.”
→Richard Parker, “Building the Foundations for the Response to HIV/AIDS in Brazil: The Development of HIV/AIDS Policy, 1982–1996,” Divulgação Em Saúde Para Debate, no. 27 (2003): 143–83. On the other hand, when internal boundaries were already strong—for example, race divisions in the United States, caste divisions in India, etc.—there was a tendency to describe the epidemic not as something that affects all of us equally, but as a problem for some more than for others. Particularly because ethnic and racial animus often involves implicit and explicit reference to ideas of moral worth and hygiene, the politics of the stigmatized condition of being infected or at risk of infection with HIV, was routinely characterized by a blaming and shame-avoidance dynamic, incentivizing some leaders to minimize or to deny risk of infection for co-ethnics or co-nationals. And this tended to stall political action, including on budgetary outlays, prevention programs, and treatment access.
Boundaries and Covid-19: Preliminary observations
Does such a theory have any predictive or explanatory value for the politics of responding to Covid-19? The first few months of the pandemic suggest a few reasons to tentatively respond “yes.” Once again, we have heard repeatedly that “Covid-19 knows no boundaries,” a rallying cry that has been quickly contradicted by government leaders and citizens around the world, who have predictably tried to make sense of the threat of the virus in terms of social boundaries that are familiar—and with some potentially analogous consequences.
First, we have seen a huge emphasis on national boundaries—even in the presumably supranational European context—and many national leaders, especially the US president, have focused on the idea that this infectious disease is “foreign.” Of course, it is true that the very movement of people anywhere in the context of Covid-19 increases the risk of infection, and the fortification of national boundaries is one measure in a public health strategy designed to contain and to control contagion, but metaphors of “foreign-ness” contribute to false notions of the biological susceptibility to disease in terms of “them” and “us.” Indeed, President Trump has referred to Covid-19 as “Wuhan disease” and a “Chinese virus”; and has sought to curb immigration in the wake of the epidemic, exacerbating such notions.
And within national boundaries, certainly in the United States, various commentators have begun to highlight the uneven burden of Covid-19 across racial groups. Initially, rumors spread that “Black people were being spared,” but more recently, with the availability of testing data and further investigation, news reports have highlighted the high prevalence of Covid-19 cases and deaths among African Americans. And on April 18, CNN aired a broadcast entitled, “The Color of Covid,” which further explored this troubling pattern.“Emphasizing the link between race and vulnerability to Covid-19 may serve to reinforce harmful and inaccurate biological notions of racial difference.”
Understandably, many African Americans and progressive public health officials believe it is important to identify and to bring to the public’s attention this unfair health disparity in order to target the problem effectively. But the case of AIDS, and related histories of the racialization of public health epidemics, suggest the need for some caution here. Even well-intentioned efforts could have the unintended effects of harming the overall public health response and exacerbating the very disparities of concern. There is no scientific evidence suggesting that African Americans are, as a group, biologically more susceptible to Covid-19. Rather, as most public health experts point out, higher prevalence and death rates are almost surely due to other correlates of racial identity—including poor underlying health conditions, disproportionate vulnerability in employment circumstances, and mistrust of public health campaigns—rooted in our country’s racist past. And yet, emphasizing the link between race and vulnerability to Covid-19 may serve to reinforce harmful and inaccurate biological notions of racial difference. Oddly, some state-level testing protocols—including in my home state of Massachusetts—use anachronistic race categories that are assigned by health practitioners with little guidance. (Individuals can be classified as “Black/African American,” but not “mixed race”; one can be “Hispanic,” or a series of “Non-Hispanic” categories, but it’s not clear how the very large Brazilian- or Colombian-born populations ought to be classified.)
Moreover, it is not difficult to imagine that if Covid-19 comes to be understood as a “Black” epidemic, this will create false impressions for many white Americans—in the United States’ racially polarized and effectively segregated society—that the virus is “not our problem,” leading to decreased demand for and compliance with public health directives. And such notions may breed resentment among African Americans, who, in turn, may perceive they are being unfairly blamed for the extent of the pandemic. These are the types of unproductive political dynamics that characterized the AIDS epidemic and I fear we could see a repeat if patterns persist.
Comparative analysis offers opportunities to consider alternative pathways. Notably, in Canada, where race and ethnicity are also correlated with Covid prevalence, public health authorities have opted against reporting and collecting Covid-related data in terms of socially constructed ethnic and racial categories, arguing that all should be treated the same. Detractors argue for a US-style approach as described above, highlighting the need to shine a light on health disparities.
Such cross-national differences invite important questions for policy-oriented and political research: Which approach leads to more aggressive outcomes in terms of prosocial attitudes and behaviors? Does highlighting the higher prevalence of some ethnic and/or racially defined groups induce empathy and re-orientation of resources to advance equity? Or does it generate resentment on the part of the high-prevalence group for being “blamed,” and further induce those who identify with groups at lower risk (e.g., whites) to discount the severity of the problem because it will not affect “us”? There may not be a simple answer—for example, pre-existing levels of intergroup trust may condition the effects of reporting on ethnic- or race-based disease prevalence.
Most of those who recommend collecting and disseminating ethnic- and race-based data in the current context do so out of a genuine and laudable concern for routinely disadvantaged minority groups. But well-intentioned tactics can backfire. My point is not that public health officials should abandon the enterprise of collecting racial- and ethnic-based data, but simply that it ought to be done deliberately, cautiously, and with an eye toward the potentially undesirable effects of such collection.
Directions for Covid-related research
Empirical research is necessary to assess the validity of competing claims concerning the effects of different approaches to social boundaries on policies and responses.
Of course, many other variables affect politics and policymaking within and across countries. In the particularly extreme case of the response to Covid-19 in the United States, profound partisanship, and the sitting president’s wild unpredictability and distrust of scientific expertise, have clearly been influential. But even these dynamics are at least partially explainable in terms of group boundaries: Donald Trump’s words and policies on Covid-19 are consistent with his nativist orientation, and racist identity politics;5Princeton, NJ: Princeton University Press, 2019More Info → and partisanship itself is strongly predicted by a number of factors that go deep into this country’s own highly racist past.6Princeton, NJ: Princeton University Press, 2008More Info →
There will be no shortage of social science research on Covid-19, a pandemic that is reshaping economies and political order the world over. I have suggested the prospect of extending theories about the politics of diversity and social boundaries to this context and offered a few observations that suggest the relevance of this approach. Future work should consider how such factors affect risk perceptions, citizen behaviors and government responses—through analyses of surveys, online discourse, policymaking, observed behaviors, testing and other epidemiological and administrative data. In so doing, we must be wary of how existing data collection efforts will structure the answers we get, including, as described above, the highly limited set of race categories used on government reporting forms that do not reflect the more flexible set of identities in use today.
Social scientists have an opportunity and a responsibility to inform policy and practice during this unique and challenging period of world history. Can we use theory and evidence to help guide workable solutions to curb the current pandemic, and to mitigate its damaging effects? For example, what sorts of policies and messages might build solidarity?7Questions we raise in Melani Cammett and Evan Lieberman, “Building Solidarity: Challenges, Options, and Implications for Covid-19 Responses,” COVID Rapid Response White Paper Series (Cambridge, MA, Harvard University, 2020). While we must invest in understanding the biomedical properties of the virus itself, and the various tools and technologies being recommended by public health experts, social, political, and economic factors will inevitably mediate any attempts at implementation. Of course, we have no magic bullets, but we can and should continue to generate propositions and research about how to motivate action toward collective well-being.
→Gauri and Lieberman, “Boundary Institutions and HIV/AIDS Policy.”
→Richard Parker, “Building the Foundations for the Response to HIV/AIDS in Brazil: The Development of HIV/AIDS Policy, 1982–1996,” Divulgação Em Saúde Para Debate, no. 27 (2003): 143–83.