At first, a few cases of pneumonia of unknown origin began to appear in a fast-growing industrial city in China. The earliest cluster of cases was traced to a wet market that sold wild animals, traditional delicacies whose demand flourished with the new consumerism that has engulfed China since its market-oriented reforms. Soon, local hospitals were becoming swamped with new patients, and healthcare workers themselves began to fall ill. Unable to cure or contain the mysterious new disease, hospitals became the center of new outbreaks. The Chinese government at first tried to censor reports about the new disease, suppressing journalists and healthcare workers who dared blow the whistle. But China’s fast urbanization and new infrastructures facilitated the eruption of the emergent disease into a national epidemic, and the government could no longer hide that something was horribly wrong. To make things worse, in the couple of months since it emerged the previous November, the infection began to spread beyond China’s borders. That an avian or swine flu pandemic might originate in China, where rapid urbanization intersects with a boom in industrial chicken and pig farms, was already well known.1 But scientists around the world were astonished to discover this disease resulted not from influenza, but from a novel coronavirus instead. Recognizing the risk of an impending pandemic, the Chinese government shifted radically from hesitation and denials to forceful quarantines, strict surveillance of whole populations, and massive deployment of biomedical staff and resources. A new specialized hospital was built in a matter of days. Within a few months, the epidemic was successfully contained in China. The year was 2003, and the new disease was named for its symptoms, severe acute respiratory syndrome—SARS.2
This story resonates eerily with the present. A novel strain of coronavirus appeared again sometime in 2019, and within weeks a cluster of patients began to be admitted to hospitals in the metropolis of Wuhan with severe pneumonia, many of them linked to the Huanan Seafood Wholesale Market.3 With unprecedented speed, the outbreak in Wuhan became epidemic across China, and then pandemic around the world, affecting millions on every continent and bringing the global economy to its knees. This new disease, COVID-19, has become a world historical force reshaping the intertwined futures of China and global capitalism.
The origins of COVID-19 and the manner in which various governments controlled (or failed to control) the epidemic has been highly politicized. Public debate in the West focuses on China’s supposedly “backward” cultural practices of consuming wild animals and the perceived problem of authoritarianism suppressing information until it was too late to prevent the local outbreak from becoming a global pandemic. Chinese public debate also blamed wet markets at first, then shifted focus to frozen food imports that might implicate other countries in the origins of COVID-19. Both Chinese and Western discourses converge in a narrative that emphasizes the biomedical capacity of the Chinese government to successfully contain the disease (e.g., quickly building field hospitals, enforcing quarantines, etc.). The goal of this book is to shift debate away from narrow cultural, political, or biomedical frameworks, emphasizing that we must understand the origins of emerging diseases with pandemic potential (such as SARS and COVID-19) in much more complex and structural entanglements of state-making, science and technology, and global capitalism. In other words, the purpose is to guide a global debate toward the most pertinent questions we need to ask to not simply explain the phenomenon of COVID-19, but also to understand how we may be able to prevent the continued emergence of pandemic diseases.
Nothing like this current crisis has been seen in a century. Yet the emergence of SARS in 2002 and its relatively limited spread from China to other countries in Asia, North America, Europe, and beyond during 2003 were undeniably a prelude. Tracing the main characteristics of the SARS outbreak in China—examining why it originated there, how the Chinese government and society responded to the crisis, and in what ways biomedical science, state-making, and global capitalism became entangled by these events—lays the foundation for the book’s subsequent analysis of the novel coronavirus pandemic we are now facing. The “lessons learned” from the SARS outbreak, including advancements in virology, epidemiology, public health governance, and biomedical science, evidently failed to prevent the emergence of another novel coronavirus.
Of course, the scale of the SARS outbreak and the COVID-19 pandemic are radically distinct. Official World Health Organization (WHO) figures place the number of cases of SARS in mainland China at 5,327 and the number of deaths at 349,4 while China effectively contained the COVID-19 epidemic within the country with about 84,000 confirmed cases and about 4,600 deaths by May 2020.5 However, the much more glaring contrast lies in the fact that SARS spread only to another twenty-nine countries, infecting a total of 8,096 people and causing the deaths of about 811 worldwide. COVID-19, on the other hand, has spread to every country in the world, infecting 173 million people and causing about 3.8 million deaths by June 2021. Unfortunately, despite the record development of vaccines, COVID-19 will continue to infect millions and kill countless more, especially as it spreads further among the poorest and most vulnerable in the Global South and becomes endemic. But it is also notable that Europe and the US each confirmed over a million cases of COVID-19 within three months of their first cases of the epidemic, and the number of deaths surpassed tens of thousands; these wealthy regions have faced even larger surges since then. This is, thus, in part a story about the Chinese government’s unparalleled command over biomedical resources and digital surveillance, capacity for mass mobilization of the population, state control of the economy, and the paradoxical nature of this state power as instrument of national development in the era of global capitalism.
The hallmarks of modernity and economic development in China, celebrated as the instruments used by the state to successfully control the epidemic, are at the root of this and other emerging diseases with pandemic potential. Consequently, any critical study of the origins of the COVID-19 pandemic cannot limit itself to biomedical examinations abstracted from politics and place (as much of the scientific literature tends to do), nor to a critique of China’s culture and state (as much of the popular literature tends to do), but must combine them and extend beyond into an analysis of the condition of global capitalist modernity in which China is embedded.
Scholars like Rob Wallace and Mike Davis have shown that the mounting risk of catastrophic influenza pandemics results from the specific political ecologies of capitalist agribusiness that have emerged in recent decades and coalesced above all in southern China.6 “This new age of plagues, like previous pandemic epochs, is directly the result of economic globalization,” explains Davis.7 “Permanent bio-protection against new plagues, accordingly, would require more than vaccines. It would need the suppression of these ‘structures of disease emergence’ through revolutionary reforms in agriculture and urban living that no large capitalist or state-capitalist country would ever willingly undertake.”8 I join Davis in calling for the replacement of capitalist approaches with alternative models for responding to all such plagues. But considering how Donald Trump’s anti-science zealotry shaped the catastrophe, Davis goes on to conclude that these must be models that “put science in command.”9 Keeping China at the center of my analysis, however, also requires problematizing the way biomedical science and practice have become the hegemonic framework through which we understand pandemics, and through which governments, individuals, and corporations react to them. In other words, understanding the origins of COVID-19, and how the Chinese state and society addressed its emergence, requires a critique that delves deeper than global capitalism alone and into the heart of discourses about modernization, development, environmental degradation, and the prospects for global health and sustainability in the new century.
After all, virology, epidemiology, public health governance, and other biomedical sciences are not a politically neutral terrain upon which government officials and the masses can find the supposedly objective truth about diseases like influenza, SARS, and COVID-19, and thus serve unambiguously as guides for how to prevent, mitigate, and respond to such emerging diseases. These diseases can indeed be examined through virology, epidemiology, and clinical characteristics, and responses to them certainly must involve biomedical interventions like vaccines, pharmaceuticals, expanded hospital networks, and strengthened apparatuses of public health surveillance and control. Yet limiting our understanding of emerging diseases to the biomedical conceals the structural conditions of global capitalism that give rise to emerging diseases in the first place and promotes biomedical responses that cannot contain their emergence, but may even increase the risk of viruses “spilling over” from animals to humans, and aggravate the conditions that propel these outbreaks into catastrophic pandemics. Ultimately, therefore, “new ways of thinking about basic biology, evolution, and scientific practice are in order.”10
This is especially the case in China, where the preeminence of modern science and technology is unparalleled.11 Even during the most radical and euphoric periods of Mao’s anti-capitalist revolution, for example, the authority of scientists and scientific institutions were politically and ideologically challenged, but rather than the anti-science zealotry we witness presently among conservatives in the US, there was instead a sincere effort to democratize science and incorporate the practical needs and experiential knowledge of the masses into a modernist project that could serve the interests of the masses and their socialist nation-state in the making.12 With Deng Xiaoping’s model of development, this Maoist transformation of science was abandoned, even as the party and government leadership swelled with scientists and engineers, transforming reform-era China into a “virtual technocracy.”13 Since then, Chinese government and society have pursued science and technology with such fervor and optimism, seeing this as “the essential key to making China globally competitive and addressing the nation’s confounding domestic problems,” that such “scientism” is virtually “immune to social critique.”14 And yet, contemporary China harbors such a powerful convergence of strong state management and rampant capitalist expansion that scientific practice and technological development are hampered, on the one hand, by bureaucratic demands to produce “correct” data that aligns with policy goals even if it does not conform with reality and, on the other hand, by market imperatives that lead to “science that is fragmentary at best and practically ineffective or even harmful at worst.”15 The roots of the current pandemic in outbreaks of novel coronavirus diseases in China, and the manner in which the Chinese state and society have responded to these events through state and market logics, expose this entanglement of state-making and global capitalism through modern science and technology.
Ultimately, bringing this entanglement into focus prefigures a debate about the lessons to be learned from the current pandemic, particularly whether the world should blame China and be wary of what it unleashes into the world, or celebrate and emulate its successful efforts to contain the epidemic and reignite its massive economy through strong state control. And revealing this entanglement also serves as a warning that the recovery of a capitalist economy in China and its political responses to the current crisis reinforce the conditions for infectious diseases with pandemic potential to emerge again and again, and yet this is not about China itself, but about the conditions of global capitalism in which China is embedded.
The next chapter turns to the COVID-19 outbreak that emerged in Wuhan during late 2019 and the failure of the local government to trigger the institutional alarms that were created in the aftermath of SARS. The subsequent chapters trace various stages of the epidemic—the uncertainty among government, scientific, and corporate actors in efforts to contain and control the burgeoning COVID-19 epidemic during January 2020; the surge of the disease across China and into a global pandemic during February and March; and the declaration of victory and the reopening of Wuhan in April. The final chapter describes the persistence of the disease through the end of 2020, analyzes the global capitalist competition and geopolitical tensions exacerbated by the pandemic, and critiques the persistence of the political, cultural, and ecological factors that are intended to drive economic “recovery” but may reinforce the risk of future pandemics. Finally, the epilogue looks back to debates about the origins of COVID-19 and forward to the development of vaccines, underscoring the argument that public debate and research should extend beyond biomedical concerns and the particularities of China to focus on the structural conditions of global capitalism.
But first, a brief note on methodology. I drew upon official reports and statements from various levels of the Chinese government and the WHO; an in-depth engagement with scholarly publications in the fields of biology, virology, epidemiology, medicine, and public health (including important but underinvestigated Chinese-language publications); and also history and social sciences, including anthropology, sociology, political science, geography, economics, and interdisciplinary fields such as environmental, agrarian, development, and global studies. I also extensively examined Chinese and international journalistic and social media materials—including materials that I archived before they were removed or altered. The approach is to formulate a transdisciplinary synthesis that can reframe questions and analysis interlinking various fields.
1. Davis, M. (2006). The monster at the door: The global threat of avian flu. New York: Macmillan.
2. Xu, R., et al. (2004). Epidemiologic clues to SARS origin in China. Emerging Infectious Diseases, 10(6), 1030–1037; Kleinman, A., & Watson, J. (2006). SARS in China: Prelude to pandemic? Stanford, CA: Stanford University Press.
3. Huang, C., et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395(10223), 497–506.
4. The WHO data calculates separately the number of cases/deaths in Hong Kong (1,755/299) and Taiwan (346/73).
5. After that first surge, infections only increased gradually to 116,665 cases and 5,306 deaths by June 16, 2021.
6. Davis, The monster at the door; Davis, M. (2020). The monster enters: COVID-19, avian flu and the plagues of capitalism. New York: OR Books; Wallace, R. (2016). Big farms make big flu: Dispatches on infectious disease, agribusiness, and the nature of science. New York: Monthly Review Press; Wallace, R. (2020). Dead epidemiologists: On the origins of COVID-19. New York: Monthly Review Press.
7. Davis, The monster enters, pp. 16–17. Oldstone, M. (2009). Viruses, plagues, and history: Past, present, and future. Oxford: Oxford University Press; Snowden, F. (2019). Epidemics and society: From the Black Death to the present. New Haven, CT: Yale University Press.
8. Davis, The monster enters, p. 18.
9. Ibid., p. 44.
10. Wallace, Big farms, p. 83.
11. Greenhalgh, S. (2020). Governing through science. In S. Greenhalgh & L. Zhang (Eds.), Can science and technology save China? Syracuse, NY: Cornell University Press.
12. Schmalzer, S. (2016). Red revolution, green revolution: Scientific farming in socialist China. Chicago: University of Chicago Press.
13. Greenhalgh, Governing through science, p. 2.
14. Ibid., p. 3.
15. Ibid., p. 16. See also Mason, K. Divergent trust and dissonant truths in public health science. In Can science and technology save China?, pp. 95–114; Lord, E. China’s eco-dream and the making of invisibilities in rural-environmental research. In Can science and technology save China?, pp. 115–138; Greenhalgh, S. The good scientists and the good multinational. In Can science and technology save China?, pp. 139–162.