Disease and International Relations

Disease and International Relations, a 1-day workshop organised by Professor Mark Harrison and Dr. Jeong-Ran Kim (University of Oxford), took place on February 5 2025, at the Maison Francaise, Oxford. Acknowledging that the threat of infectious disease is often at the heart of international cooperation and competition between nation states and international bodies such as the World Health Organization (WHO) and the World Trade Organization (WTO), the workshop brought together scholars working in the fields of international relations and public health. While one aim of the workshop was to highlight new work in a field of history that has been “unjustly neglected”, the other aim was, through the examination of historical examples, to see whether there were some “common threads” which could help us deal with our present difficulties.

The workshop was divided into three sessions. The first session included presentations by Dr. Jeong-Ran Kim and Dr. Slawomir Lotysz (Institute for the History of Science of the Polish Academy of Sciences, Warsaw).
Dr. Kim’s presentation focussed on the United States (US) military and Disease Control in Korea between 1945-46. As Japan’s control over Korea ceased and the US came to take control of the South of Korea towards the end of the Second World War, thousands of Japanese and Korean refugees from the North now attempted to cross the 38th parallel (the 38 degrees north latitude which formed the border between North and South Korea prior to the Korean war). This migration, however, caused a political, social and humanitarian crisis, and led to large-scale public health interventions. While one part of the presentation focussed on how disease control across the 38th parallel was prompted by concerns among the American troops regarding the “foreignness” of the Korean environment, the fear of ‘oriental diseases’, and a consequent bid to raise the morale of the American troops, the second part of the presentation focussed on quarantine measures and delousing with DDT of Koreans and Japanese migrants who were travelling across the 38th parallel, as they were believed to potentially harbour deadly diseases. The presentation also highlighted how the tensions between the two emergent superpowers (The USA and the USSR) trickled down in the form of competing sanitary measures on the bodies of their Asian subjects. Tracking these interventions, Dr. Kim highlighted the relationship between political refugees, public health interventions, race relations, and international relations.

Dr. Lotysz’s presentation, in contrast, looked at Eastern European medical assistance to North Korea between 1950-57, focussing on questions of humanitarianism and political propaganda. While the South of Korea (on one side of the 38th parallel) received medical and humanitarian aid from the Western powers, the North received aid mainly from countries in the Communist bloc, such as the Soviet Union, China and several countries in Eastern Europe, such as Czechoslovakia, Bulgaria, Hungary, Romania and Poland. Focussing on the aid efforts by this last group of countries, the presentation highlighted how this bloc broke away from the World Health Organization and attempted to develop its own health network, one that was heavily coloured by ideas of at leftist solidarity and “communist internationalism”. In particular, the presentation closely analysed the development of a few “red” hospitals which were built by these medical missions, as well as how “communist internalisation” was actuated in the form of medical journals, advertisements and subsequently translated into political gains.

The second session saw presentations by Dr. Celine Paillette (Universite Paris 1 Pantheon-Sorbonne) and Dr. Benoit Pouget (Sciences Po Aix).

Dr. Paillette’s presentation studied the history of Entente Cordiale (1904)— series of agreements which were signed between France and Britian—, and how it was part of a “globalisation of epidemic control”. By the late 19th and early 20th centuries, diplomatic relations between England and France seemed to be a tipping point, primarily because although both countries had shared, since the 1870s, a “common goal” of establishing a “liberal international sanitary regime” through quarantines, disinfection and surveillance procedures, in practice this proved complicated since the implementation of these norms proved difficult especially in colonial spaces such as British India, Constantinople or even Teheran. Added to this, the global plague pandemic of the late 1890s showed how these two global powers often disagreed and could not fully cooperate in the face of a greater epidemic threat, with tensions rising in areas such as the Persian Gulf and British Hong Kong. However, by the early 1900s, both these countries seemed to move closer to one another’s position, towards a “diplomatic rapprochement”, in which the threat of epidemics played a big part. The presentation highlighted the ways in which the agreements caused varying diplomatic victories for both countries. In doing so, it highlighted how infectious disease risk, and the reaction to it can be used as a lens through which one may map the relationship between international cooperation and competition.

Dr. Benoit Pouget’s presentation focussed on malaria control in French West and Equatorial Africa between 1945-60.  The presentation traced how epidemic control arose as a way for the French to maintain and control what was left of its colonies in Africa after the end of the Second World War. Although epidemic control in the colonies was mainly in the hands of “French players” until the end of the War, the post-war world saw new sets of standards and norms of public health, emblematised by greater internationalism, headed by the World Health Organisation (WHO) and the leadership of the United States. The presentation highlighted how outbreaks of malaria in French Africa created conditions for renewed French intervention in these regions, interventions which, goaded by the need to maintain French sovereignty over these areas, led to “politico-medical arrangements”. These arrangements, while, combating epidemic malaria, also worked to maintain French colonies through a process of “Francization” of international norms and standards. The presentation thus highlighted the networks between epidemic control, colonisation and global health norms.

The third session saw presentations by Dr. Koji Ozaki (Otemae University), Dr. Hyon Ju Lee (Dankook University) and Dr. Hohee Cho (University of Oxford).  Dr. Ozaki’s presentation focussed on issues of quarantines in late 19th century (1870s) Japan. Analysing the Quarantine Committee Meetings conducted in 1878, it highlighted the question of “extraterritorial jurisdiction” in relation to Britain’s relationship with Japan. Focussing on the “letters of instruction” written by Sir Harry Parkes, the British Minister to Japan, it showed how quarantine restrictions became a contentious issue leading to a revision of the British system of extraterritorial jurisdiction in the ports of Japan. Situating the Quarantine Meetings within a network of nested concerns, the presentation helped suggest connections between the rights of extraterrestrial populations, the demands of international health, the imperatives of the Crown, and the anxiety over epidemics.

Dr. Lee’s presentation focussed the entangled histories of Foot-and-Mouth Disease (FMD), the Cowpox Vaccine and the Anti-Vaccination in early 20th century America. Tracing the history of the cowpox vaccine, which was used against epidemic smallpox, the presentation highlighted how technologies against one disease often led to outbreaks of another, leading fears, anxieties, and the call for more stringent regulatory measures. In the late 19th century, cowpox vaccines, as a prophylactic against smallpox, were popularised across the western world. This popularisation led to a growth of international and domestic trade networks which led to the flow of the cowpox vaccine lymph across the world. These networks, however, facilitated at least three FMD epidemics caused by infected cowpox vaccine lymph, in the US between 1908 and 1914. As an epizootic which mainly affected poultry and livestock, FMD was largely damaging and caused huge economic losses. By the time this link between FMD and infected cowpox vaccine lymph was established, the infected lymph was traced back to the H. K Mulford Company based in Philadelphia, who had purchased these from Japan in 1902. The fear of infection and contamination led to calls for stricter regulations, but it also led to the growth of antivaccination sentiments—mainly from religious groups— in the US, which criticised the “poisonous” and “hellish” nature of the technology. In concluding, the presentation stressed on the linkages between epizootics, epidemics, global technology flows, and protest cultures against medical technologies.
 

Dr. Cho’s presentation studied the development and wartime history of the United States Naval Medical Research Unit No.2 (NAMRU-2). During the Pacific War, the Unit was “at the frontlines of experimental medical research”. The Unit was mainly headquartered in Guam, a U.S island territory in the Pacific Ocean, it also had a short-lived branch in Okinawa which was responsible for medical towards the end of the war, with the US attack on Japan.
Of particular interest was Dr. Cho’s detailed descriptions of the nature of work undertaken by NAMRU-2, including the flow of medical information and technologies from the metropole (the United States of America) to the frontier (the islands where laboratory work was being conducted). These flows involved the movement of state-of-the-art medical equipment, journals and even laboratory animals, and how these flows were crucial to the success of NAMRU-2. Dr. Cho’s presentation traced the significance of the work of the Unit in terms of reconciling differences between perceptions of oceanic health—it was assumed, for instance, that the areas that the Unit would go on to study (Japan, or other parts of Oceania) would be particularly disease-ridden and unhealthy—and the realities of the field—it was found, however, that contrary to many expectations, the health in many of these areas and the risk of certain diseases was actually lower. Mapping these exchanges and developments, the presentation highlighted important connections between wartime colonial medicine, medical intelligence, laboratory research and the relationship between laboratory and the field.

Finally, Dr. Mark Harrison’s keynote lecture expanded on the idea of extra-territorial public health intervention, focussing on the role and work of League of Nations Epidemic Commission (LNEC) in Greece between 1922-23. Historically, this was a period of great tumult in the region, since the post-war situation in Greece saw both internal and external political instability. Significantly, thousands of Greeks were flowing into the country in this period from the neighbouring country of Turkey, brought about by an outbreak of war between Greece and Turkey. This migration triggered fears of possible epidemic outbreaks in Greece, and led to the intervention of the Commission, which had already been assisting countries in Eastern Europe and the Baltic in the years following the first World War, in dealing with outbreaks of typhus, which had been devastating these regions. The lecture highlighted the novelty of the Commission’s work as an example of pre-emptive intervention, predicated on the possibility of epidemic, and subsequently political, risk. The question of pre-emptive action was important since prior to this, the League’s intervention had been largely reactive. At the same time, what made the work of the League even more complicated was the fact that it had to coordinate its work of epidemic and disease control not only with the Greek government, but also with a number of other international philanthropic bodies such as the International Red Cross and the recently formed Save the Children. Additionally, the work of the Commission was also largely bifurcated, as, due to its pre-emptive nature, its worked ranged from actual epidemic control measures—including deploying technologies, methods and personnel—and an advisory role. All these factors contributed, then, to the nature of work of the Commission being a departure in the evolution of public health. The lecture highlighted the complexities involved in the process of coordination, and in doing so, made a case for using historical case studies to understand certain “enduring” issues today, including questions of solidarity, sovereignty, political legitimacy, funding, and international cooperation.

As we sit today, the global health order faces a set of new challenges, such as the stalled progress of the Pandemic Treaty, or, for instance, massive political withdrawals from the World Health Organisation (WHO), spearheaded by the exit of the United States of America. This is compounded by fears around the closure of agencies such USAID. While discourses around these movements tend to be largely polarised, historical perspectives, as this roundtable showed, can significantly nuance and help this conversation. What’s more, policy-based decisions which consider historical perspectives can help us find echoes of such movements in the past. Such perspectives may help us resituate such shifts within a larger canvas of “enduring concerns”, and help us interrogate some of the larger, structural, even underlying tensions such movements are based on—tensions between national sovereignty and international cooperation, between internal restructuring and global aid, between national responsibility and international solidarity.

Disease and International Relations workshop, Oxford, 2025 ​