Eugene T. Richardson’s “Epidemic Illusions” is one of the most bold, honest, and important reads of the year. In the face of the Covid-19 pandemic, the likes of which the world has not experienced in over a century, the insights he provides seem timely and tangible. While he mainly draws on his experience working on the front-line to combat the Ebola virus epidemic in West Africa, Richardson’s insight on the coloniality of public health and the underlying inequities that exist, are relevant in the face of any global public health emergency. He asserts that the biggest epidemic he has encountered is not Ebola but is the epidemic of illusions – an epidemic transmitted by the coloniality of knowledge production – the proverbial power of the epidemiological pen.
This book provides a great example of applying a trans-disciplinarily approach to our understanding of pandemics. Grounded in a social science framework, the author brings his cross-continental experience, scholarly erudition, and epistemological understanding of epidemiology to draw our attention to the existing coloniality in addressing pandemics.
Richardson describes ‘coloniality’ as “the matrix of power relations that persistently manifests transnationally and intersubjectively despite a former colony’s achievement of nationhood”. This coloniality – perpetuated in the name of scholarship, research and humanitarian support from the Global North has left the Global South tied and defined by the view of Global North. An extension of colonialism despite so-called decolonization as explained by the author.
The book boldly sets out to explain how “as an apparatus of coloniality, Public Health manages (as a profession) and maintains (as an academic enterprise) global health inequity”. Health interventions during pandemics are not necessarily about prevention, but isolation and containment of the disease to halt its spread to the Global North. To illustrate this point, the author states: “Instead [of treatment measures], the UN Mission for Ebola Emergency Response (UNMEER) and WHO repeatedly endorsed control measures consisting of patient isolation, safe burial practices, contact tracing, and infection control.” Throughout the text, the author paints a vivid picture of the biases in the treatment of the Ebola outbreak, consequently, revealing how mortalities could have been avoided if similar management protocol had been applied equitably across regions. The author continues to draw attention to this gap, stating “Médecins Sans Frontières was one of the few organizations to realize that this bias against treatment was “an institutionalized form of nonassistance” that resulted in “a high number of presumably avoidable deaths.” “The high mortality rates that resulted from this lack of prioritization of aggressive treatment likely had the added impact of hampering isolation efforts”.
Confronting hard truths about global health inequity is commendable. Writing about them in such a distinctive manner that gives voice to realities that are often unspoken, as Richardson has so eloquently done, is impressive. Richardson acknowledges his privilege as a “white upper-middle class male settler-colonist” working in the Global South on behalf of organizations that were formed and are largely funded by the Global North. He goes on to challenge what his position of privilege represents, and the responsibility he accepts to shed light on marginalized perspectives. Richardson stresses that “to decolonize global health, we must give up such celestial yearnings and reject the notion that social inquiry can produce objective, valueneutral, and univocal understanding”. Instead, “we must embrace the critical and the polyvocal”.
The release of this book could not have come at a better time. As conversations are being had about the ethical standards of the Covid-19 vaccine trials, Richardson is sounding an alarm to be conscious of systemic inequalities in conducting vaccine trials and subsequent distribution strategies. In this significant era where the global pandemic has reminded us of human interconnectedness, the world needs to reflect and understand that the disproportionate mortality, we all are witnessing during this pandemic is what many in the Global South have accepted to be a reality that may never have an end in sight in terms of other diseases (P142). Consequently, Richardson recommends that descendants of colonialists seize this opportunity to reflect on structural injustices that have been perpetuated for a long time and “come to the realization that every local outbreak is a pandemic since they are involved in (hu)mankind”.
My only critique is that that book was not called Pandemic Illusions. An epidemic narrows the problem to a localized issue within countries of the Global South. The use of the word pandemic, conversely, acknowledges the pervasive inequalities that exist in public health in the Global South as well as in minority communities in the Global North. By expanding his analysis to include this larger demographic, Richardson’s work would have more weight in the growing scholarship of de-coloniality.
As the COVID-19 pandemic rages on, this book is a must-read for everyone across various global health disciplines, particularly policymakers and those about to enter the field of global health. The content not only helps deconstruct the continuous existence of coloniality in global health, but the author also challenges all players to face the inconvenient truth of the need to do the hard work of reconfiguring global health practice to reflect evenhandedness and allow for more diverse perspectives while committing to decolonization.
Epidemic Illusions: On the Coloniality of Global Public Health