Sociology of Health & Illness Vol. xx No. xx 2015 ISSN 0141-9889, pp.
12
doi: 10.1111/1467-9566.12359
Book Review
MacPhail, T. The Viral Network: A Pathography
of the H1N1 Inuenza Pandemic. Ithaca, NY: Cor-
nell University Press. 2014. 232pp. 16.24 ISBN
9780-801479830 (pbk)
To follow the global health response to the 2009
H1N1 outbreak, MacPhail offers a science and
technology studies (STS) methodological and
meta-narrative structure, the pathography, which
she suggests is simply doing anthropology for the
twenty-rst century (p. 210). MacPhail demon-
strates how diverse global actors involved in
managing a looming health threat responded to it,
how they imagined future trajectories of the virus,
and how they pursued good information on
which to act, shaping the ongoing (and historical)
story of viruses in the world. Studying a virus, as
a social scientist, requires thinking about viral
human intersections, dependencies, contingencies,
and, importantly, considering the virus as a central
actor. Studying viruses is not enough: we live
with them and thus . . . have become viral our-
selves (p. 10). The pathography, a story-telling/
mapping practice used in virology and epidemiol-
ogy, structures MacPhails story and brings viral
and STS ethnography rmly into the 21st century.
Re-thinking how we must tell stories, she engages
creatively with these complexities.
Through her education in laboratory practices,
working at Hong Kong University and Atlanta-
based US Centers for Disease Control and attend-
ing many global health conferences, MacPhail
links policy decisions to mundane and routine lab-
oratory work and the histories of past epidemics.
In Chapter 1, MacPhail explores how H1N1 phy-
logenetic trees informed epidemiological decision-
making in the 2009 pandemic. Mapping viruses
reveals not just the biological in time and place,
but also social phenomena. These maps are
genealogies, kinship charts, but also material arte-
facts where MacPhail conducts eldwork. Chapter
2, titled The Invisible Chapter, moves through
the steps of lab work which, as MacPhail explains,
fosters a type of relationality (p. 51) that is criti-
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cal in the transformation of viruses as objects that
are ideal and material (following Bowker and
Stars work). Chapter 3 provides a historical
account to describe quarantine practices in cultural
contexts, across viral outbreaks (severe acute respi-
ratory syndrome and H1N1) and geographical
locations (that is, responses in China versus those
in the West). MacPhail attends to the cultural
aspects of viral narratives. China has been por-
trayed as the origin of past and (presumably
future) epidemics, with Hong Kong imagined as
an epicentre of new viruses and global transmis-
sion. MacPhail questions these colonial and post-
colonial stereotypes, and she shows how Hong
Kong scientists have repurposed this narrative to
claim a unique expertise in managing contagions.
In Chapter 4, using the metaphor of the sirens
song, MacPhail shows how the quest to know
viruses distracts and may hamper public health
interventions.
In Chapters 5 and 6 MacPhail demonstrates that
scientic information is a nebulous entity, highly
context dependent and reective of complex net-
works of human interactions and knowledge shar-
ing. Chapter 5 takes up the implicit problem of
uncertainty, rarely articulated as such by Mac-
Phails informants, while Chapter 6 explores the
problem of good information (p. 155). Both chap-
ters invoke STS critiques of objectivity and moral
economies of science. MacPhail points out the
ever-emergence and evolving nature of inuenza
viruses, showing that the way that information gets
taken up and made into policy decisions is hardly
a precise science. MacPhail adds an important
dimension to this literature by considering that
humanity and viruses are deeply entwined.
I accepted MacPhails invitation, in her intro-
duction, to read the last chapter rst, curious to
see how non-linear reading, though always a read-
ers prerogative, might inform earlier chapters.
Alternative academic writing styles, which the
pathography as a frame offers, provide new ways
to think creatively. The sympathetic (yet still criti-
cal) consideration of the heterodox scientists in
2 Book Review
Chapter 7 informed my scepticism when I returned
to the earlier chapters. MacPhail presents scientists
who exist on the periphery of scientic inquiry,
although their heterodoxy stems not from their
methods but from their ndings and what their
interpretations would mean for public health prac-
tice and action. One key scientist, for instance,
doubts that the highly pathogenic H5N1 is a pan-
demic threat to humans (p. 49). Were the viral
scientic majority of a different mind, these scien-
tists could easily be orthodox practitioners. The
modest provocation of scientists who do not con-
form might have served the beginning of the book
well, especially for those less well-versed in an
STS critique of scientic practice and epistemol-
ogy. In MacPhails examples, the contrast between
heterodox and orthodox scientists draws attention
to how the scientic paradigm legitimates certain
kinds of knowledge. Here, heterodoxy differs little
from orthodoxy, reminding us that the information
and knowledge sought are also highly contingent.
Pathography, as an interpretative lens, provides
a compelling alternative to traditional ethnography,
but it could have been further integrated into the
narrative structure. MacPhail tells us that the book
mimics the genetic organization of a virus (p. 15),
but the pathographic function cited at the begin-
ning of each chapter is hard to follow in the body
of the chapters. More discussion of how to do a
social scientists pathography might add to the
project. Nonetheless, MacPhails work is timely
and relevant. As she points out, viruses are literal
and metaphoric parts of the culture of the 21st cen-
tury; both digital and material cultures invoke
virality.
The most palpable absence in MacPhails pro-
ject is the general public, that is, the people
2015 Foundation for the Sociology of Health & Illness
infected with the virus and whose lives public
health interventions shape to stem a possible,
maybe imminent, pandemic. The complex net-
works in public health and scientic research are
well worth an entire book. As MacPhail acknowl-
edges at the end of her introduction, pathographies
are not neatly organised. It would be hard to imag-
ine where MacPhail would have space to include
the public response to institutional interventions,
and yet, the absence is meaningful. This absence
reects how public health experts lose sight of
people affected by health containment strategies.
MacPhail shows how central the virus and its
potential threat are to decisions and debates across
global public health actors. The virus is often so
central that, as the heterodox scientists point out,
these categorical decisions made in the service of
the looming (but never quite denitive) threat may
obscure the real consequences to the interventions
recipients. The pre-emptive slaughter of many ani-
mals because they are the vectors should the virus
spread deprioritises the effects these decisions have
on farmers and consumers of the animals. In short,
pandemic preparations insufciently account for
the quotidian consequences of containment strate-
gies.
Overall, this book offers a provocative addition
to public health courses and will be a valuable text
in medical anthropology, sociology courses and
STS courses. I hope MacPhail keeps pushing the
pathography as methodology, especially as those
of us in interdisciplinary liminalities seek to pro-
ductively engage with the natural sciences.
Samantha D. Gottlieb
University of California, Berkeley