MEDICAL ANTHROPOLOGY, 28(3): 189–198

Copyright # 2009 Taylor & Francis Group, LLC

ISSN: 0145-9740 print=1545-5882 online
DOI: 10.1080/01459740903070410

EDITORIALS

Biocommunicability and the Biopolitics

of Pandemic Threats
Charles L. Briggs and Mark Nichter

In this article we assess accounts of the H1N1 virus or ‘‘swine flu’’ to draw
attention to the ways in which discourse about biosecurity and global health
citizenship during times of pandemic alarms supports calls for the creation
of global surveillance systems and naturalizes forms of governance. We
propose a medical anthropology of epidemics to complement an engaged
anthropology aimed at better and more critical forms of epidemic surveillance.
A medical anthropology of epidemics provides insights into factors and actors
that shape the ongoing production of knowledge about epidemics, how
dominant and competing accounts circulate and interact, how different

CHARLES L. BRIGGS is the Alan Dundes Distinguished Professor in the Department of

Anthropology of the University of California, Berkeley and the UCB-UC San Francisco Joint
Ph.D. Program in Medical Anthropology, and a member of the editorial board of Medical
Anthropology. He is the author of eight books, including Stories in the Time of Cholera (with
Clara Mantini-Briggs). He is currently researching health news in Cuba, Ecuador, the United
States, and Venezuela and is writing a book on racial profiling and biosecuritization in an
outbreak of bat-transmitted rabies in Venezuela. Correspondence may be directed to him at
the Department of Anthropology, 232 Kroeber Hall, University of California at Berkeley,
Berkeley, California 94720, USA. E-mail: clbriggs@berkeley.edu
MARK NICHTER is Regents Professor in the Department of Anthropology at the University
of Arizona and an associate editor of Medical Anthropology. At the University of Arizona,
he holds joint appointments in the departments of Family Medicine and the Mel and Enid
Zuckerman School of Public Health and coordinates the graduate training program in medical
anthropology. He is actively engaged in research related to global health and his most recent
book is Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics
Matter. Nichter is currently a member of the Institute of Medicine Panel on Emerging Zoonotic
Disease Surveillance. Correspondence may be directed to him at the Department of
Anthropology, Haury Building, University of Arizona, Tucson, Arizona 85721, USA. E-mail:
Mnichter@u.arizona.edu

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stakeholders (citizens, politicians, journalists, and policymakers) access and

interpret information available from different sources—including through a
variety of new digital venues—and what they do with it. These insights
together provide a compelling agenda for medical anthropology and anyone
working in health-related fields.

Key Words: A(H1N1) influenza; biocommunicability; influenza; medical anthropology; swine flu

It was impossible not to notice the arrival of a new virus this spring. The
United States declared a public health emergency. The Mexican government
closed schools, businesses, soccer pitches, and other public places. The
Mexican army distributed truckloads of facemasks. A number of countries
cut air links to Mexico and quarantined feverish passengers returning from
spring breaks and honeymoons. Facemasks started vanishing from Bay
Area pharmacies just after the San Francisco Chronicle reported the
outbreak. And as the World Health Organization (WHO) considered raising
its alert level for the H1N1 influenza to that of a full-fledged pandemic,1 it
was pressured to change its definition to include ‘‘substantial risk of harm to
people,’’ in addition to distribution, to avoid reaching the maximum level
and ‘‘alarming’’ people worldwide.
Several weeks into the ‘‘swine flu’’ pandemic, many news stories and
Internet postings suggested that this flu is, in fact, ‘‘milder’’ than other
seasonal varieties of influenza, prompting acting Centers for Disease
Control and Prevention (CDC) director Richard Besser to complain that
people have ‘‘a sense of having dodged a bullet, a sense that this is over’’
(McNeil 2009). When these lines appear, readers will likely be in a position
to decide whether H1N1 was ‘‘a monster at our door’’ (Davis 2005), a lethal
pandemic of a mutating virus, or just a ‘‘Chicken-Little’’ story ‘‘overblown’’
or ‘‘hyped’’ by public health officials and reporters. ‘‘The perfect storm’’
versus ‘‘just hype’’ equation perfectly recapitulates this organizing frame.
This story of on-again, off-again outbreak and pandemic is precisely
what we come to expect as biological citizens. All of the characters are
playing their roles, and the plot thickens all along the way. For medical
anthropologists, and, for that matter, anyone interested in what lies under-
neath the surface features of these events and the public health surrounding
them, this story of the swine flu, so far, is organized within a dominant
paradigm that shapes our response to epidemics.
A central feature of this paradigm is the epidemic as an opportunity for
knowledge production. The story reveals this plot element and resolves the
potential danger not only of losing lives but of losing knowledge by directing
how the knowledge is to be produced, how it should circulate, who should
receive it, and what they should do about it. Public health officials and
 EDITORIAL 191

reporters like to talk about the ‘‘lessons’’ that potential pandemics of

zoonotic disease teach us about the need for global surveillance systems,
the adequacy of state and local emergency preparedness procedures, and
social mobilization.
We would like to draw attention to yet another set of lessons. The
mediated events surrounding H1N1, first and foremost, teach us about
the pragmatics of biopolitical communication. Here, we would like to focus
on the manner in which H1N1 illustrates knowledge circulation within our
emerging network society with its ever-expanding cyberspace ‘‘nervous
system.’’ These circuits and ‘‘spheres of biocommunicability,’’ at these times
of heightened awareness, resonate and appeal to a politics of global health
citizenship that at once demands global surveillance systems in the name of
biosecurity and accepts new forms of governance during pandemic threats.
The Associated Press’s Mike Stobbe’s widely circulated news story ‘‘Is
Swine Flu ‘The Big One’ or a Flu that Fizzles?’’ captures the current balan-
cing act of whether this flu pandemic is ‘‘real’’ or ‘‘overblown.’’ Politicians
and public health officials have opted for two rhetorical moves, often in the
same sentence, that functioned to sound the alarm and to reassure the public
encountering epidemic scares. In announcing the public health emergency,
Department of Homeland Security (DHS) Secretary Janet Napolitano told
CNN that the public health response so far is ‘‘standard operating proce-
dure,’’ admitting that communication to the public about H1N1 ‘‘sounds
more severe than really it is.’’ A front-page New York Times article by
Robert Pear and Gardiner Harris on April 28, 2009 features both elements
in the lead: ‘‘The Obama administration dispatched high-level officials from
several agencies Monday to allay concerns about swine flu and to demon-
strate that it was fully prepared to confront the outbreak even as the presi-
dent said there was ‘not a cause for alarm’.’’ President Barack Obama
himself noted this paradoxical pairing in his National Academy of Sciences
speech: ‘‘ ‘This is, obviously, a cause for concern and requires a heightened
state of alert’, he said. ‘But it’s not a cause for alarm’ ’’. Later in the same
article, the reporters restated this juxtaposition as a general principle of poli-
tical conduct: ‘‘Finding the right mix of alarm and reassurance is a delicate
task for an elected official.’’ As the article continues, various ‘‘experts’’
repeated that it is ‘‘dangerous’’ for politicians to either ‘‘overreact’’ or
‘‘underreact,’’ but Obama ‘‘managed to get it just right.’’ These breathtak-
ing multiple repetitions emerge in 1,136 words.
Science columnist Ben Goldacre (2009) wrote in The Guardian that he
received scores of requests by journalists to ‘‘balance’’ their stories: ‘‘ ‘We
need someone to say it’s all been overhyped,’ said BBC Wales.’’ Epidemics
become Goldilocks tales—is there too much representation, too little, or just
the right amount? Diverse publics, presented with this troubling ‘‘balancing
192 C. L. BRIGGS AND M. NICHTER

act’’ between taking disruptive precautions or irresponsibly doing nothing,

turned to their own communities of interpretation, the communications they
were exposed to, and what others appeared to be doing around them in real
time and virtual space.
This balancing act has an obvious function. If a virus outruns the knowl-
edge of and the communications about it, it threatens to undermine public
health authority by presenting the specter of a potential bioweapon of mass
destruction that can sneak up dangerously on unaware experts, officials, and
the public. The media, including the Internet, become fora in which all
parties monitored and assessed each other’s compliance with the moral
imperative to circulate information and foster vigilance while allaying fear.
An apparent imbalance is now emerging as the volume of media coverage
diminishes even as cases increase. Interim CDC Deputy Director Anne
Schuchat complained: ‘‘‘[T]here is a perception out there that we are
winding down, that we are in a lull’.’’ That is untrue, she said. The virus
‘‘is actively circulating’.’’ This impression is partly an artifact of the current
CDC policy that restricts laboratory testing for patients who do not require
hospitalization or have ‘‘an acute febrile respiratory illness or sepsis-like
syndrome.’’2
The fear of ‘‘overhyping’’ the HIN1 outbreak is a characteristic feature of
discourse that produces its subject, in this case a public health problem, out-
running the virus itself, which is at the apparent center of this biohistorical
event. In fact, the media monitored its own virus-discourse ratios; New York
Times reporters recently declared: ‘‘Without the news media the public
would be dangerously unaware of the swine flu outbreak, but perhaps with-
out saturation coverage on cable news networks and the velocity of informa-
tion on the Internet, the public would not be so hysterical.’’ Among
themselves, reporters accused other media outlets of losing balance.
To keep up with the spread of the virus, reporters evoked cultural
accounts to explain the purportedly higher case fatality ratio in Mexico.
Apparently, self-medication and delaying visits to appropriate health
providers is a fault of ‘‘Mexican’’ national character. While Mexican health
officials were often lauded by international health experts for being good
global health citizens, reporters frequently cast Mexicans in general as
unhygienic subjects and circulators of disease but not timely information.
The circulation of such a perception possibly contributed to China’s quar-
antining of Mexicans passing through its airports—or even living in its
cities. As Merrill Singer notes in his essay, such critiques and stereotypes
of Mexicans morphed into attacks on Mexico and immigrants on right-wing
U.S. talk radio shows.
While health organizations, politicians, and mainstream media figures all
played their usual roles in this drama, new players—digital ones—entered the
 EDITORIAL 193

scene and provided alternative lines of knowledge circulation. Rather

than relying on advice from health authorities and experts relayed by the
mainstream media, many people (including professionals) accessed the Inter-
net. Some venues supplemented the preceding circuits—such as blogs and
discussion boards run by mainstream media outlets and CDC Web pages.
Other sources of digital communication were generally viewed with deep
suspicion by reporters and public officials who warned the public ‘‘to watch
out for Internet scams selling useless drugs and ineffective masks to treat or
prevent swine flu.’’ Stories available on ‘‘flu Web sites’’ promoting deliberate
infection at ‘‘swine flu parties’’ were deemed to be ‘‘totally nuts’’ by most
health experts. Some Internet fora were credited for ‘‘posts by thoughtful
people’’ who appear to be health professionals using pseudonyms.
Conspiracy theories aside, Internet stories challenged assessments of
H1N1 by officials, experts, and top laboratories. Public interest groups
and NGOs openly questioned the lack of attention on the meat industry
and factory farming as the root causes of both H5N1 (avian flu) and
H1N1.3 Sophisticated Web pages offered compelling, albeit selective, scien-
tific data to a public suspecting that public health scripts may be influenced
by lobbyists—just when confidence in the ethics of big business is at an
all-time low. And as a result of expanding Internet connectivity, critical
assessments of swine flu by scholars like Mike Davis become readily acces-
sible, adding credibility to—in this instance—the meat industry’s culpabil-
ity. Such alternative assessments co-exist with a wide range of conspiracy
theories about H1N1 taking on a life of their own as social facts and forms
of metacommentary.4 For those looking for alternative ‘‘real stories’’ behind
politically correct narratives, the Internet offers an open-access space for the
circulation of knowledge that ties the local to the global instantaneously.
What’s at stake here? Discursive practices are clearly changing. Although
state, international, and corporate biosecurity regimes are increasingly defin-
ing and regulating knowledge about infectious diseases, many among us are
willing to explore alternatives. Any account of infectious disease reifies cer-
tain players, circuits, practices, and forms of authority and imbues them with
different moral and affective characters to produce and hold knowledge. In
the process, competing perspectives are erased or at least subordinated as
unsubstantiated beliefs. When we ask ‘‘Is this real or is it overblown?’’ what
seems to be a grab for agency signals engagement with complex notions
of subjectivity, authority, knowledge, intertextuality, space, time, and
knowledge=action relations. So maybe it’s time to ask a different set of
questions.
The appearance of H1N1 in spring 2009 has a great deal to teach us
about how we understand the circulation of biomedical objects and
responses to them. The Goldilocks formula for swine flu discussions
194 C. L. BRIGGS AND M. NICHTER

illustrates how we rely on oversimplified questions, dichotomies, and

concepts that increasingly lose their grip on emerging trends, gloss over
ambiguities and contradictions, and fail to grapple with crucial details of
particular crises, such as the present one. Much can be gained by distin-
guishing the complexities of how signs circulate from how sign use is repre-
sented and regulated. Reports on the epidemic constituted metapragmatic
accounts—accounts of the accounts—of how epidemiologists, clinicians,
and others produced and circulated knowledge. At the same time, these
reports themselves participated in the pragmatics of creating and dissemi-
nating H1N1 discourse. The problem here, especially from the perspective
of medical anthropology, but for people interested in teasing apart the
stories of H1N1, is that the metapragmatics involved in this case represents
pragmatics selectively. This means particular features and elements of these
events are focused on, organizing them in specific ways in order to regulate
them discursively and practically. The official public health discourse of
H1N1 defined its attempted recipients, how they should receive the material
(be concerned, don’t be alarmed), and what they should do (wash your
hands and stay tuned). Its power emerged especially in posing as a reliable
guide to how circulation was actually taking place.
Charles Briggs characterizes the production, circulation, and reception of
knowledge as communicability, and, when it forms part of (bio)medicalized
domains, as biocommunicability. Biocommunicability emerges in models
that are widely shared but also contested. Some H1N1 discussions centered
around a biocommunicable model that imagined such figures as Chan,
Besser, Napolitano, and Obama making pronouncements intended to circu-
late ‘‘downwards’’ via subordinate officials, clinicians, and reporters to
listeners=viewers=readers and patients. Others accounts tracked the ‘‘flow’’
of epidemic information ‘‘up’’ from clinicians and local health officials to
higher-level officials, other countries, and international organizations. By
the same token, still other voices challenged the privileging of centralized
locations and top-down movement in favor of decentralized, ‘‘local’’ inter-
actions between epidemiological statistics, public figures, and populations.
A second dimension of biocommunicability involves the way in which
multiple accounts, in this case the accounts of H1N1, can be used to map
out a biocommunicable cartography that charts the travels of particular
facts. The New York Times article on President Obama’s H1N1 response
traces a circulation of knowledge that starts with Obama administration
directives to top officials and moves to Obama’s National Academy of
Science’s appearance, daily briefings held ‘‘behind the scenes at the White
House,’’ and statements by Obama’s aides and high CDC and DHS
officials. The article bounces back and forth between accounts of biocom-
municable events and assessments of them by numerous experts and
 EDITORIAL 195

officials. Briggs, in interviews with New York Times health journalists,

found that metapragmatic and pragmatic dimensions do not map one to
one: reporters generally remain in their offices when researching stories,
using e-mail, Web sites, and telephone calls to transform biocommunicable
models into detailed, unique cartographies that construct pragmatic itiner-
aries.
Abandoning the belief that the media merely transports and translates
specialist knowledge to publics and focusing on how knowledge is chosen,
adapted, and transformed empowers audiences both politically and pragma-
tically. Why is health news, shaped by professional ideologies of objectivity
and independence, so closely tied to health-related advertising (from CNN
sponsors to sidebars next to Web health articles)? How do communicable
models differ between media genres, countries, and over time? How do com-
peting biocommunicable models interact, even in a single article, broadcast,
or Web page?
Mediations of health messages and information extend far beyond
‘‘media institutions.’’ Day-to-day work in hospitals, public health offices,
biotech and pharmaceutical corporations, and social-movement–based
organizations is increasingly mediatized, employing journalists and media
consultants to produce objects and representations that are ‘‘newsworthy,’’
will reach particular publics, and can affect health policies and funding
priorities.
This kind of awareness promotes an understanding of the kinds of
biocommunicable models that are acceptable to community groups in
terms of the active or passive nature of roles they are asked to adopt. This
perspective also identifies the lines of communication and command to
which publics are asked to respond. The implications of this awareness
are immense—and truly practical—in that it provides the means of assessing
far more than the assimilation of specific content and concepts. In fact, it
allows all involved to consider how they have been cast in particular com-
municable cartographies and what it might mean to accept the roles offered
to them. Both considerations expose the cultural imaginaries and motiva-
tions that lead specialists to construct and use these models in the first place.
This approach to the politics of knowledge circulation can be socially
extensive. Controlled access to knowledge about health has severely limited
the ability of underprivileged populations to identify alternative ways to
think about and manage health problems as well as publicly challenge the
actions of health officials. This hold on knowledge is rapidly changing in
an era when knowledge is just a Google or other Web search-engine
away—at least for growing segments of the planet.
At present, we know little about when and how people search streams
of knowledge available on the Web, which sources of information are
196 C. L. BRIGGS AND M. NICHTER

accessed and found trustworthy, and, in some institutions and countries,

how people cope with censorship, surveillance, and restrictions on Internet
access. We are beginning to learn how these pragmatic and biocommunic-
able shifts are reshaping clinical interactions, but much research across
scales is needed. We also know little about how access to new forms of
knowledge about health care providers, disease identification and manage-
ment, treatment options, and so on empower users, provide problematic
illusions of agency, or render people overwhelmed from an overabundance
of information, as well as draw attention away from structural issues of
access to health care, environmental justice, and the diverse effects of every-
day racism.
This greater access to the Internet, cell phones, and other communication
devices also provides new opportunities for surveillance that may contribute
to both social control and democracy projects on a global scale. In the midst
of one balancing act there occurs another. On the one hand, an increasing
number of circuits for communicating about health expand opportunities
for the exercise of biopower in a neoliberal state, encouraging personal
responsibility for health. The Internet also affords new opportunities for
panopticon-like surveillance of all manner of activities. On the other hand,
it also provides an opportunity for activities that comprise synopticons,
forms of inverse surveillance of the state by civilians, or of governments
by international watchdog groups having agendas that serve global public
health citizenship. New forms of technology permit citizens to monitor
the activities of officials in the public and private spheres. Influenza surveil-
lance, when viewed through a biocommunicability lens, illustrates that prag-
matic dimensions of production and circulation of health knowledge are
changing, and medical anthropologists need to be attentive to how different
players use technologies on local, national, and global stages.
Public health scientists interested in surveillance for emerging diseases are
finding new ways to engage in digital disease detection through the monitor-
ing of both news streams and Internet traffic for Web searches indicating
that particular diseases like influenza might be on the rise. The identification
of influenza outbreaks through monitoring of Google and Yahoo searches
recently made press, and there is speculation that mobile phone and global
positioning technologies might further enable monitoring, along with the
power of texting and microblogging, to report incidents of sickness and
the actions of health care providers beyond what might be found through
clinic-based monitoring systems. Being able to mine real-time news streams
and citizen reports of disease outbreaks makes it more difficult for nations
and local health authorities to hide disease outbreaks.
Indeed this is one of the main purposes in the creation of the Global
Public Health Intelligence Network as an Internet-based early-warning
 EDITORIAL 197

system that monitors media sources such as news wires and Web sites in
seven different languages for human and animal diseases, negative health
events related to unsafe products, chemical or radioactive incidents, and
so on. If countries are likely to be ‘‘outed’’ by such networks, it behooves
them to report incidents in a timely manner and to be seen as good global
citizens instead of selfish agents trying to protect their self-interests in trade,
tourism, institutional politics, political alliances, and national images.
Anthropologists will need to consider how countries are rewarded in the
press for being ‘‘good global health citizens’’ versus being blamed as bas-
tions of unhygienic subjects. We need to trace the effects on forms of global
governance of adopting particular pragmatic and biocommunicable strate-
gies for addressing virtual and actual epidemics. The experiences of Peru
and Venezuela in the 1991–1993 cholera epidemic, in which the former initi-
ally reported all cases and the latter only laboratory confirmed cases, know-
ing that most would go uncounted (not unlike current U.S. H1N1 policies),
suggests the political-economic consequences of such choices.
We have pointed to ways that pragmatic and biocommunicable dimen-
sions of discussions of epidemics, access to circuits, technologies, and prac-
tices, and ways of modeling circulation can at once exacerbate and reduce
inequities. We have thus highlighted the dangers in telling simple stories
about H1N1, whether they be of a potential biological ‘‘perfect storm’’ that
potentially requires huge investments and coercive measures or an ‘‘over-
hyped’’ story created by unscrupulous journalists and self-interested public
health officials—let alone a laboratory accident or a scam to sell Tamiflu.
The lessons learned include the need for a framework for studying how
such stories get made, how they become credible, and how the story-
production process shapes assumptions about the nature of biomedical
knowledge, who makes it, how it travels, who can receive it, and how dis-
course about epidemics and biosecurity affects budgets, public health infra-
structures, citizenship, and governance. So, not unlike the story of H1N1
itself, the current swine flu epidemic (like the H5N1 avian flu epidemic that
preceded it) provides an excellent laboratory for watching how simplistic
biocommunicable models of knowledge production, circulation, and recep-
tion are recycled in discursively creating and containing a complex situation.
We have laid out how a medical anthropology of epidemics can help make
sense of what factors and actors shape the ongoing production of knowledge
about epidemics, how dominant and competing accounts circulate and inter-
act, how people access and interpret information available from different
sources, and what they do with it—this includes all constituencies, from
ordinary citizens to politicians and policymakers. This type of analysis
complements the possibility of a medical anthropology for epidemic
disease agenda that could be pursued by engaged medical anthropologists
198 C. L. BRIGGS AND M. NICHTER

attempting to assist, for example, in constructing more effective zoonotic

disease surveillance systems attentive to social and cultural factors that
influence risk perception, behavior change, and social cooperation with
health authorities.
Contributing to more effective and more democratic global health
policies and forms of governance will require us, however, to help change
both the pragmatics and metapragmatics that keep some voices from being
taken seriously and from proactively shaping policy and media debates. We
need to identify in the communicable models and pragmatic strategies the
cultural politics and material inequalities that give some people credit for
producing knowledge about health and label the efforts of others noncom-
pliance, ignorance, superstition, or just plain cultural difference. If we are
simply the bearers of other people’s words rather than participants in strug-
gles to break down undemocratic pragmatic structures and biocommunic-
able models, our claim to possess special capacities to confront health
inequities and tackle complex emerging health problems might themselves
be deemed ‘‘overhyped.’’

NOTES

1. According to current WHO guidelines (http://www.who.int/csr/disease/avian_influenza/

phase/en/index.html), a Phase 6 (global pandemic phase) alert is characterized by commu-
nity level outbreaks involving human-to-human spread of a virus into at least two countries
in one WHO region and at least one other country in a different WHO region. Nevertheless,
WHO declared a Phase 6 alert on June 11, 2009.
2. http://www.cdc.gov/h1n1flu/identifyingpatients.htm (accessed May 21, 2009).
3. http://www.grain.org/articles/?id=48 (accessed May 21, 2009).
4. See for example http://www.kxan.com/dpp/health/swine_flu_conspiracy_theories_swirl
(accessed May 3, 2009).

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McNeil, D. G., Jr.
May 8, 2009 Other Illness May Precede Worst Cases of Swine Flu. New York Times. http://
www.nytimes.com/2009/05/09/health/09flu.html (accessed April 30, 2009).
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