Why Pandemics Give Birth To Hate: From Bubonic Plague To COVID-19

The pandemic has been responsible for an outbreak of violence and hate directed against Asians around the world, blaming them for the spread of COVID-19. During this surge in attacks, the perpetrators have made their motives clear, taunting their victims with declarations like, "You have the Chinese Virus, go back to China!" and assaulting them and spitting on them.

The numbers over the past year in the U.S. alone are alarming. As NPR has reported, nearly 3,800 instances of discrimination against Asians have been reported just in the past year to Stop AAPI Hate, a coalition that tracks incidents of violence and harassment against Asian Americans and Pacific Islanders in the U.S.

Then came mass shooting in Atlanta last week, which took the lives of eight people, including six women of Asian descent. The shooter's motive has not been determined, but the incident has spawned a deeper discourse on racism and violence targeting Asians in the wake of the coronavirus.

This narrative – that "others," often from far-flung places, are to blame for epidemics – is a dramatic example of a long tradition of hatred. In 14th-century Europe, Jewish communities were wrongfully accused of poisoning wells to spread the Black Death. In 1900, Chinese people were unfairly vilified for an outbreak of the plague in San Francisco's Chinatown. And in the '80s, Haitians were blamed for bringing HIV/AIDS to the U.S., a theory that's considered unsubstantiated by many global health experts.

Some public health practitioners say the global health system is partially responsible for perpetuating these ideas.

According to Abraar Karan, a doctor at the Brigham and Women's Hospital and Harvard Medical School, the notion persists in global health that "the West is the best." This led to an assumption early on in the pandemic that COVID-19 spread to the rest of the world because China wasn't able to control it.

"The other side of that assumption is, 'Had this started anywhere else, like in the U.S. or the U.K. or Europe, somehow it would've been better controlled, and a pandemic wouldn't have happened,'" says Karan, who was born in India and raised in the U.S. He has previously worked with the Massachusetts Department of Public Health to respond to COVID-19.

China's response was not without fault. The government's decision to silence doctors and not warn the public about a likely pandemic for six days in mid-January caused more than 3,000 people to become infected within a week, according to a report by the Associated Press, and created ripe conditions for global spread. Some of the aggressive measures China took to control the epidemic – confining people to their homes, for example — have been described as "draconian" and a violation of civil rights, even if they ultimately proved effective.

But it soon became clear that assumptions about the superiority of Western health systems were false when China and other Asian countries, along with many African countries, controlled outbreaks far more effectively and faster than Western countries did, says Karan.

The Twitter Blame Game And Its Repercussions

Some politicians, including former President Donald Trump publicly blamed China for the pandemic, calling this novel coronavirus the "Chinese Virus" or the "Wuhan Virus." They consistently pushed that narrative even after the World Health Organization (WHO) warned as early as March 2020, when the pandemic was declared, that such language would encourage racial profiling and stigmatization against Asians. Trump has continued to use stigmatizing language in the wake of the Atlanta shooting, using the phrase "China virus" during a March 16 call to Fox News.

A report by researchers at the University of California at San Francisco (UCSF), released this month, directly linked Trump's first tweet about a "Chinese virus" to a significant increase in anti-Asian hashtags. According to a separate report by the Center for the Study of Hate and Extremism, anti-Asian hate crimes in 16 U.S. cities increased 149 percent in 2020, from 49 to 122.

"Diseases have often been racialized in the past as a form of scapegoating," says Yulin Hswen, an assistant professor of epidemiology and biostatistics at UCSF and lead author of the study on Trump's tweet. Sometimes, it's to distract from other events that are occurring within a society, such as the early failures of the U.S. response to the pandemic, says Hswen.

Suspicion tends to manifest more during times of vulnerability, like in wartime or during a pandemic, says ElsaMarie D'Silva, an Aspen Institute New Voices fellow from India who studies violence and harassment issues. It just so happened that COVID-19 was originally identified in China, but, as NPR's Jason Beaubien has reported, some of the early clusters of cases elsewhere came from jet setters who traveled to Europe and ski destinations.

"What you're seeing in the U.S. is this pre-existing, deep-seated bias [against Asians and Asian Americans] – or rather, racism – that is now surfacing," says D'Silva. "COVID-19 is just an excuse."

A Racist History In Global Health

For Karan, though, the problem lies deeper — with the colonialist history of global health systems.

"It's not that the biases are necessarily birthed from global health researchers," he says. "It's more that global health researchers are birthed from institutions and cultures that are inherently xenophobic and racist."

For example, the West is usually regarded as the hub of expertise and knowledge, says Sriram Shamasunder, an associate professor of medicine at UCSF, and there's a sense among Western health workers that epidemics occur in impoverished contexts because the people there engage in primitive behaviors and just don't care as much about health.

"[Western health workers] come in with a bias that in San Francisco or Boston, we would never let [these crises] happen," says Shamasunder, who is co-founder and faculty director of the HEAL Initiative, a global health fellowship that works in Navajo Nation in the U.S. and in eight other countries.

In the early days of COVID-19, skepticism by Western public health officials about the efficacy of Asian mask protocols hindered the U.S.'s ability to control the pandemic. Additionally, stereotypes about who was and wasn't at risk had significant consequences, says Nancy Kass, deputy director for public health at the Johns Hopkins Berman Institute of Bioethics.

According to Kass, doctors initially only considered a possible COVID-19 diagnosis among people who had recently flown back from China. That narrow focus caused the U.S. to misdiagnose patients who presented with what we now call classic COVID symptoms simply because they hadn't traveled from China.

"Inadvertently, we [did] a disservice both to patients who need[ed] care and to public health," says Kass.

It's reminiscent of the HIV/AIDS epidemic in the 1980s, Kass says. Because itwas so widely billed as a "gay disease," there are many documented cases of heterosexual women who presented with symptoms but weren't diagnosed until they were on their deathbeds.

That's not to say that we should ignore facts and patterns about new diseases. For example, Kass says it's appropriate to warn pregnant women about the risks of traveling to countries where the Zika virus, which is linked to birth and developmental defects, is present.

But there's a difference, she says, between making sure people have enough information to understand a disease and attaching a label, like "Chinese virus," that is inaccurate and that leads to stereotyping.

Karan says we also need to shift our approach to epidemics. In the case of COVID-19 and other outbreaks, Western countries often think of them as a national security issue, closing borders and blaming the countries where the disease was first reported. This approach encourages stigmatization, he says.

Instead, Karan suggests reframing the discussion to focus on global solidarity, which promotes the idea that we are all in this together. One way for wealthy countries to demonstrate solidarity now, Karan says, is by supporting the equitable and speedy distribution of vaccines among countries globally as well as among communities within their own borders.

Without such commitments in place, "it prompts the question, whose lives matter most?" says Shamasunder.

Ultimately, the global health community – and Western society as a whole – has to discard its deep-rooted mindset of coloniality and tendency to scapegoat others, says Hswen. The public health community can start by talking more about the historic racism and atrocities that have been tied to diseases.

Additionally, Karan says, leaders should reframe the pandemic for people: Instead of blaming Asians for the virus, blame the systems that weren't adequately prepared to respond to a pandemic.

Although WHO has had specific guidance since 2015 about not naming diseases after places, Hswen says the public health community at large should have spoken out earlier and stronger last year against racialized language and the ensuing violence. She says they should have anticipated the backlash against Asians and preempted it with public messaging and education about why neutral terms like "COVID-19" should be used instead of "Chinese virus."

"Public health people know there is a history of racializing diseases and targeting particular groups," says Hswen. "They could have done more to defend the Asian community."

Joanne Lu is a freelance journalist who covers global poverty and inequity. Her work has appeared in Humanosphere, The Guardian, Global Washington and War is Boring. Follow her on Twitter: @joannelu

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