BIOPOLITICS AND THE INFLUENZA PANDEMICS OF 1918 AND 2009 IN THE UNITED STATES: POWER, IMMUNITY, AND THE LAW Open Access
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There is a point at the furthest reaches of the hypothetical pandemic influenza spectrum that is marked by a combination of greatest scarcity of medical resources and maximum disease severity. A severe pandemic was one of the two scenarios considered by U.S. federal government planners in their 2005 pandemic influenza plans, and it was modeled on the conditions of the 1918 pandemic and especially the experience of cities like Philadelphia, where hospital morgues ran out of room and bodies were stacked in hallways. Bruno Latour has shown that the line that distinguishes great epidemics and wars is vanishingly fine. And this is not simply due to their existential weight, but also due to the discourses, power effects, politics, and societal responses they generate. "Can war really provide a valid analysis of power relations, and can it act as a matrix for techniques and domination?" Although acknowledging that power relations cannot be confused with the relations of war, Foucault answered his own question affirmatively in his January 21, 1976, lecture at the Collège de France. "[W]ar," he asserted, "can be regarded as the point of maximum tension, or as force-relations laid bare." This dissertation represents a partial genealogy of the "clinical gaze" of public health (or social medicine, as Foucault called the field) at two points in the history of humanity's perpetual war against microbes and in the history of modern biopolitics: the 1918 and 2009 influenza pandemics. The pandemics are my two central case studies, though the broader context matters greatly--World War I in the case of the first pandemic, and decades of public health `preparedness' for bioterrorism (inflicted by either humans or Mother Nature) in the case of the second pandemic. I use a range of sources, from archival correspondence and letters, to the medical and scientific literature of the respective periods to inform me about the functioning of the biopolitical apparatus, i.e., the American public health system, during the pandemics. The theoretical framework for the dissertation consists of three related concepts from the works of Michel Foucault, Giorgio Agamben, and Roberto Esposito that enable an analysis of the biopolitics (the calculated management of life) in contemporary American society. War, military and medical, is the common thread that runs through both pandemics--war as an immune or even autoimmune reaction of the body, the political body, and the State against its microbial or human Others (immigrants, the poor); war as the impetus for the state of exception that suspends the rule of law (e.g., of civil liberties, of separation between civilian and military elements); and war as a power effect of increasingly penetrating and multi-layered knowledge about the population and the internal and external threats to its health. Given the hybrid provenance of the public health field, I draw on a dense matrix of disciplines: on the one hand, law, ethics, microbiology, and epidemiology, and on the other hand, philosophy, history, and the human sciences approach to analyzing the public health field, its discourses, and its functioning.