Critical Inquiry Critical Inquiry

Eugene T. Richardson. Epidemic Illusions: On the Coloniality of Global Public Health. Cambridge, Mass.: MIT Press, 2020. 224 pp.

Review by Alen Agaronov

24 March 2021

Refusing credit for a critical text on colonialism is not out of step, but seldom is this embodied in a book’s form. Epidemic Illusions is a “network-reflexive” text that puts its form ahead of its content to alert readers of “an epidemic of illusions”––or coloniality of knowledge production––without having to succumb to a deficit model of science communication that clouds readers of what else is possible (pp. xxi, 5). Eugene T. Richardson takes us through eight détournements, or ironist “rediscriptions,” that use flash fiction, allegory, and semiotics to pick at public health’s “monopoly on truth” (pp. 14, 6). Completed months into the SARS-CoV-2 pandemic, the book winds back to the West African Ebola virus epidemic half a decade prior to dig into epidemiology’s methodological hegemony. Richardson summons Mikhail Bakhtin, Bertolt Brecht, Antonio Gramsci, Richard Rorty, Edward Said, and “Fanonian algorithms” to reframe statistical models as fables whereby to create a discursive space that is more open to criticism (p. 11).

Using statistical notation, Richardson begins by asking “What is the probability of global health equity in the setting of coloniality?” (p. 3). Redescription 1 is a flash-fiction tale of an an Ivy League graduate who comes to realize that they are a colonizer during a magic-mushroom trip while volunteering abroad. Next to the man’s spiritual quest, Richardson slips in Buddhist Hua-yen philosophy of the interconnectedness of all phenomena to set the early conditions for debating epidemiology’s drawbacks. Redescription 2 uses Socratic dialogue to describe the cover illustration of “The Warren” by Lena Gustafson, which pluralizes Plato’s allegory of the cave into a dizzying network of interconnected nests frequented by chaperones who guide “organic intellectuals of neocolonialism” down different tunnels or truths (pp. 28, 75).

Richardson credits “Nacirema ethnography” and his fluency in “EpidemiologySpeak” for redescription 3, where he produces a mock “commissioned report” on the international response to the West African Ebola outbreak (pp. 29, 11). He observes the “savage rituals” and “tribal fetishes” of the “primitive tribes of Lake Geneva” (the World Health Organization [WHO], where he worked as a consultant)––particularly the Tarcuaerub’s engagement in gnihsup-repap and building cost-effective “Ebola temples” (pp. 35–36, 37). After introducing the actors, redescription 4 semiotically tracks the discursive practices that resulted in “superspreaders” appearing like the cause of the Ebola outbreak and examines how this (mis)representation of disease originated from apolitical epidemiologists and gained traction as it passed through academic journals, the WHO, and finally landed on a UNICEF poster advising West Africans to visit a local health center if they exhibit Ebola symptoms (p. 40). Richardson (unapologetically) photoshops the poster to depict forces like structural adjustment policies, purposive underdevelopment, and barbaric colonialism as more upstream causes of the virus and further instructs affected persons to get care at an “underdeveloped health center” (p. 55).

In his foreword, Paul Farmer compares Richardson to “Gramsci, but more pragmatic” (p. ix). Indeed, thirteen epidemiologists inadvertently authored redescription 5 by falling prey to a “call and response” tactic––responding thrice to Richardson and others’ triggering commentary in The Lancet that applied the prisoner’s dilemma and rationale-choice theory to Ebola virus to debate the equal or higher chances of dying from visiting an Ebola treatment unit versus staying at home (p. 57).[1] However, it is not until Richardson uses the master’s tools in redescription 8 that he begins to play a real Gramscian war of position. Hacking epidemiology, he runs “dissimulations” and performs “counterhegemonic modeling” on a dataset of Black women in South Africa at high risk for HIV acquisition to test his hypothesis that race change––“changing from Black to white” would bring the sample’s HIV incidence down to 0.7 percent (pp. 103, 106). Although formatted to appear like a peer-reviewed article, this paper was previously rejected, and Richardson’s decision to omit reviewers’ comments might be his first display of collegiality. However, he makes up for any loss in transparency by entering the study’s full programming language, or “(R)hetoric,” across six pages in the pre-appendix, which comes prior to the conclusion (as readers don’t read the appendices), along with other tangents (like a Nkrumahtic Oath and botched consent forms from a male-circumcision trial) (p. 103). The book ends with a “Part II”––barely seven pages––whose brevity is justified by part 1’s (ironic) level of forecasting; part 2 is a 2020 commentary on SARS-CoV-2, suggesting that history will continue to repeat itself until epidemiology is decolonized.[2]

Redescriptions 6 and 7 are less ironic in form as Richardson directly calls out epidemiology’s irony for producing the conditions it claims to end. Here the book dives into an area less explored in critiques of big data: causal inference. Richardson argues that models favor downstream causes and––when discussed using causal language––they supply epidemiology a discursive hegemony wherein disease appears like common sense. For example, a series of “not so systematic” reviews of Ebola + mathematical + modelling + transmission return no results after he adds terms like colonialism and racism (p. 76). Richardson condemns the “hermeneutic injustice” performed by “compassionate” global health advocates who inadvertently serve as “transfer mechanisms” for neoliberalism––masking possibilities for redistributive justice with their “bourgeois empiricism” (pp. 95, 49, 96). Adapted from a 2019 Commentary, he shows this in practice by showcasing an article published by researchers at the Harvard T. H. Chan School of Public Health that concluded by saying patients in the Democratic Republic of Congo refused Ebola vaccines due to a “lack of trust” (p. 94). Richardson uses causal diagrams to reimagine how Ebola virus and Ebola illness (not disease) are rather confounded by legacies of atrocities on African people (or Maafa). Ethnographically, and impressively, he ties Ebola virus, Ebola vaccine conspiracies, and Harvard together with an active South African gold mine whose profits are mostly exported to the United States. In the Brechtian sense, the book succeeds in its gestus––or the physical embodiment of social commentary.

Epidemic Illusions will be undoubtedly divisive and critiqued by epidemiologists, including the handful of (purposely) uncredited forward-thinkers in the Global North who are among the pioneers of counterhegemonic modelling (scholars in the Global South are credited). Richardson may be slightly less patient than Gramsci with dismantling discursive hegemonies, but since the book’s release, he has successfully published an empirical paper like the one in redescription 8––epidemiologically linking reparations for descendants of American slaves to SARS-CoV-2 transmission.[3] In this regard, his framing of neoliberal social-distancing regulations and vaccine conspiracies in the context of Ebola are undeniably timely and stretch beyond global or public health to any social inquiry that holds an unhealthy “will to science” (p. 135). Richardson wants solidarity, reflexivity, negotiation with truth, new vocabularies, and a Kantian intersubjectivity (over objectivity). One of the rare targets of his praise is the NGO Partners in Health, where both he and Farmer work. That said, Epidemic Illusions risks being misrepresented as medical anthropology and overlooked in a sea of pandemic-inspired literature, rather than a dramatic intervention modelled after Mahatma Gandhi’s Experiments with Truth (1927) and Boaventura de Sousa Santos’s Another Knowledge is Possible (2007).

[1] See Eugene T. Richardson et al., "The Ebola Suspect's Dilemma," The Lancet Global Health 5, no. 3 (2017): e254–e256.

[2] See Richardson, "Pandemicity, COVID-19 and The Limits of Public Health ‘Science,’" BMJ Global Health 5, no. 4 (2020): e002571.

[3] See Richardson et al., "Reparations for American Descendants of Persons Enslaved in the US and Their Potential Impact on SARS-CoV-2 Transmission," Social Science & Medicine (Feb. 2021): 113741.