GLOBALIZATION AND DISEASE - When China sneezes, the world…panics! The SARS crisis (Chapter 9)       Return to Unit List

Economists have long used the metaphor of disease to illustrate how the world’s major economies are mutually dependent on each other for their well being. "When America sneezes," some say, "Europe catches cold." But the SARS crisis of 2003 reminds us that the illnesses spread by the networks of globalization are not just metaphorical. SARS, or Severe Acute Respiratory Syndrome, is a virus that emerged in southern China’s Guangdong Province in late 2002. Originally carried in animals it somehow made a leap to humans and by February, 2003, over 300 people in Guangdong had been hospitalized with symptoms of severe pneumonia. The virus initially attacks the lungs but spreads rapidly to other vital organs and muscles; it can be fatal without early detection and intensive medical intervention. How it spreads among humans is still not entirely understood, but the fact that the virus managed to very rapidly spread from Guangdong to 29 countries around the world, causing over 8,000 infections and nearly 800 deaths, has made SARS an effective case study in globalization.

For example, the SARS crisis revealed how the scale and speed with which people move about the world today makes containment of disease very difficult. Some two million people cross an international border every day worldwide, and the health of the global economy depends upon that movement being relatively unrestricted. SARS made clear the conflict between keeping global linkages flowing and preventing disease from spreading. When the World Health Organization advised travelers to avoid the city of Toronto in an effort to contain the further spread of the virus, Canada’s economy was estimated to lose $30 million a day as a result. The WHO took some criticism (particularly from Canada) for overreacting to the virus but, in response, claimed that it was responsible for protecting the world from disease rather than protecting the global economy.

In this way, SARS also revealed the extent to which most economies still depend upon the free-flowing movements of people. Rather than travel to places where SARS cases had been found, many businesspeople relied on telecommunications and electronic media to conduct their international business. But given the devastating economic impact that cities like Hong Kong, Beijing, and Toronto suffered, conference calls and email are a poor substitute for face-to-face contact. Still, the crisis was taken up as an opportunity for the governments of Hong Kong and China to promote newly initiated online distance learning programs when schools were closed for several weeks. Internet retail providers also saw a burst of sales in response to the crisis as well.

Finally, SARS also reveals the uneven nature of globalization and the inequalities underlying global linkages. This is seen in two ways: On the one hand, the disease received a tremendous amount of global attention despite its relatively small impact in terms of actual infections and fatalities (SARS took nearly 800 lives over a course of six months, while some 8,500 people die of AIDS every day). For some, SARS captured the world’s attention because it impacted key hubs of globalization—Hong Kong, Toronto, B eijing—whereas the much greater killers AIDS and malaria are endemic in sub-Saharan African regions often thought to be left behind by globalization. On the other hand, the impact of SARS in China brought renewed attention to the striking inequalities that have developed in that country as it engages with the global economy.

Start your exploration of the crisis by reading and looking at the following sites:

The impact of the WHO’s travel restrictions on Hong Kong are evident in this story on "Hong Kong’s sorrow-tinged celebrations" from the BBC, but by mid-July, 2003 it was becoming apparent that the economic impact of SARS in Asia was not as dire as was being predicted at the height of the outbreak, as reported by the BBC, "Asia shrugs off SARS’ economic impact."

It seems that the longer term impact SARS had on places like Hong Kong were more emotional than economic. This can perhaps best be captured by the fact that the 9th floor of the Metropole Hotel, from where the virus first spread after arriving from Guangdong in the infected body of doctor Liu Jianlun, is now referred to as "ground zero," a term which recalls the atomic blast that leveled Hiroshima Japan at the end of World War II and, of course, the September 11, 2001 terrorist attacks in the United States. The comparison becomes almost cosmic when we learn the room number that Dr. Liu stayed in at the Metropole: 911.

While China shrugged off the economic damage rather easily, the political implications of SARS are much more serious for the country’s leadership. See this analysis by China scholar Joseph Fewsmith in the Stanford University Hoover Institute’s China Leadership Monitor .

Finally, for a discussion of SARS and inequality, see Harvard Medical School Professor Paul Farmer’s article from The Nation . For a contrast to Farmer’s view, see "The new killer threatening rich and poor alike," by Martin Woollacott , who argues that SARS might succeed in finally convincing the developed world that it is not immune to large scale infectious diseases, often thought to thrive only in poor countries. And, on the ways SARS reveals growing inequalities in China, see Anthony Kuhn’s article in the Los Angeles Times, "China may reap a bitter SARS harvest." Much of Kuhn’s article is also summarized in the July, 2003 edition of Migration News.

Issues for discussion and further exploration:

  1. Some historical perspective is always a useful thing in world regional geography. The SARS crisis is no exception. Several of the above reports make reference to the European "Black Death" of the medieval era, and at the time many were wondering if SARS would be the next plague to cause millions of deaths around the globe. Hong Kong’s 100 days of global isolation was tellingly referred to as Hong Kong’s "Dark Age" and like the days of the plague, SARS caused widespread fear, panic, and unwarranted discrimination against those believed to be carrying the virus. But diseases have traveled the world before and caused far worse suffering. The SARS outbreak offers an opportunity to dig deeper. Using the resources of your textbook and your library, do some research on an historical disease outbreak and compare your findings with what you know about SARS. Likely events would be the Spanish influenza epidemic of 1918-19, the Bubonic Plague of Medieval Europe (the "Black Death"), or the impact of diseases brought by Europeans to the new world in the 15th and 16 th centuries. Based on what you find, consider these questions:
    1. Did people overreact to SARS?
    2. Did the WHO overreact?
    3. Was the fear and panic unjustified?
    4. Or, do you think the widespread alarm actually prevented SARS from indeed becoming the next "Black Death"?
  2. How much risk are you willing to accept in order to travel and spend time in other countries? Many in Hong Kong, for example, were shocked that the WHO advised travelers to stay away from the city altogether during the outbreak. In Hong Kong, a city of over 6 million, only 1,755 of whom were confirmed to have contracted the virus, commentators pointed out that visitors ran a greater risk of getting hit by a bus while crossing the street than they did of catching SARS. As Mike Smith of Toronto puts it in "The day the world caught a cold," "You have a better chance of being hit by a comet than contracting Sars."
    1. Say you are a journalist for a major newspaper. Your editor gives you a choice of writing a story on SARS in Hong Kong, AIDS in Zambia, Malaria in Congo, or Tuberculosis in Laos. In order to write the story, you must spend several weeks in one of these places. Which would you choose and why? Which do you think would involve the least amount of risk?
    2. To help with your decision, visit the World Health Organization’s online factsheets for HIV/AIDS, malaria, and Tuberculosis.
    3. Have a vote in your class to find out which disease was regarded as involving the least risk by your classmates.
  3. Because it impacted places that were plugged into the global web of electronic media, SARS inspired a tremendous amount of news, reports, and chatter on the internet. Government and health agency web sites, like the WHO’s or Hong Kong’s Department of Public Health, saw huge amounts of traffic as people sought the latest information and tips on how the disease was spreading and how to prevent getting it. But SARS also inspired a more irreverent and aesthetic impulse. Digital artists in Hong Kong, China, Taiwan, and other countries impacted by SARS began producing and circulating often humorous and poignant SARS images, most of which featured the ubiquitous surgical masks which became the chief visual symbol of the outbreak.
    1. To get a sense of these SARS images, visit BoingBoing.net’s SARS Art Project. Many of these mages are funny and irreverent, while others are more serious. BoingBoing is a collaborative web log devoted to digital culture. The SARS Art Project features 26 images, arranged in order of the alphabet, with detailed notes and links for further exploration.
    2. SARS-art follows a long tradition of grassroots artwork that responds to trauma, such as the AIDS quilt that covered the Mall in Washington, the spontaneous memorials decorating New York fire stations after the September 11, 2001 attacks, and Hmong women in Thai refugee camps embroidering the horrors of the Vietnam war.
    3. What do you think of SARS-inspired art? Do you find it in poor taste? Or is it a healthy response to trauma? What kinds of messages can you read in the SARS art pieces that you’ve viewed?

Additional SARS resources for futher exploration: