From Seasonal Flu to Pandemic Influenza: The Cultural Life of a Virus

Dr. Penelope Ironstone-Catterall

A Research Project Funded by the Social Sciences and Humanities Research Council of Canada


1. Summary of Proposed Research
The aim of this interdisciplinary Cultural Studies research program is to trace the cultural life of the influenza virus(es) in popular discourses in order to more fully understand the discursive processes through which influenza has become a cultural object whose meanings circulate and are negotiated in often contradictory ways. It is my contention that the conflicting meanings of influenza – some of which stem from the tension between sometimes traumatic historical realities of pandemic influenza that have killed millions during short periods of time and contemporary experiences with seasonal “flu”as a relatively benign illness – will influence the ways governments, institutions, corporate entities, medical communities and individuals respond to what many argue is a long-overdue influenza pandemic. This research will explore the cultural life of influenza with the aim not simply of locating, describing and analyzing the places and practices where its complex cultural meanings have been and are now being negotiated, but of considering the implications of these cultural meanings for medical practice, risk and health communication, news-media practices, institutional and government policies and practices, biosecurity and food safety, and community and individual emergency preparedness. It will also consider what the discourse of influenza can contribute to current theories of governmentality as they inform the field of Cultural Studies of Science and Biomedicine.

This research project has three interconnected foci. First, it will provide a socio-historical understanding of popular representations of influenza in print media through archival and historical research. This work will concentrate on five realized or anticipated pandemic moments: the “Spanish Flu” pandemic of 1918-19, the “Asian Flu” pandemic of 1957-58, the “Hong Kong Flu” pandemic of 1968, the controversial 1975 American mass-vaccination campaign for a “Swine Flu” outbreak, and, more recently, the response since 1997 to the H5N1 or “Bird Flu” epizootic and cases of infection in humans. This research will focus on print reporting on influenza both during these pandemic moments and in the period before and after in order to assess changes in the ways influenza was addressed. Second, it will develop a site for media monitoring and analysis that can assess and respond rapidly to current news-media coverage of influenza in print. With the use of qualitative discourse analysis and statistical content analysis software, print media sources will be analysed in order to map out the ways that time, space and subjectivity are being constructed in influenza discourse and to explore the interplay between and conflations of constructions of seasonal flu and pandemic influenza. The aim of this research is to uncover discursive regularities and shifts that may influence responses to the information of influenza. Finally, this project has a broader theoretical aim of addressing how popular discourses of influenza both support and challenge notions of epidemic and pandemic preparedness and the practices and techniques of governmentality that underpin them.

Building on Cultural Studies research that focussed on HIV, this work is theoretically informed by critical perspectives on neoliberal governmentalities and a psychoanalytic approach to the affective dimensions of constructions of risk and uncertainty. Framed by an inductive and grounded methodology, this project will address the ways that the rhetorical rights of reference (which construct subjectivity, space, and time in discourse) have been deployed in influenza discourse and with what effects. Research results will be made available to academic audiences, news media, and government agencies responsible for pandemic preparedness.

2. Detailed Description
2 a. Objectives

[T]he making of a germ panic has never been a wholly conscious or orderly process. Although the general message – that germs are dangerous and must be avoided – is somewhat consistent, popular discourses about infectious disease always contain many contradictory elements. The meanings that scientists, journalists, filmmakers, and advertising agents attach to the menacing microbe vary enormously, and once they advance a particular interpretation of the germ, they immediately lose control of it. (Tomes 2000: 197)

Viruses are neither living nor dead. And yet they take on a cultural life in the signifying practices that arise out of and inform responses to their circulation and movement through animal and human populations. In their ability to give rise to illness and disease, viruses illustrate and underscore the complex interrelations of bodies in diverse social, political, economic and cultural contexts. Rather than being neutral objects of biomedical concern, viruses take on meanings that demonstrate how knowledges are created and disseminated in culture and the effects that these knowledges have on lived, material experiences. As cultural objects, viruses also highlight the fault-lines of cultures, showing how the meanings produced around health, disease, and illness have stakes that extend beyond the spaces often assumed to be their domain: the spaces of the sick bed, the physician’s office, the medical-research laboratory, and so on. Indeed, as more than two decades of Cultural Studies research on HIV and AIDS have shown, the meanings of viruses (and the diseases to which they are linked) are articulated in a wide variety of contexts. The articulation of the meanings of viruses in policy documents, government press announcements and health initiatives, health-communication and promotion literature, film and television, news media and on the internet, popular publishing and self-help manuals, medical textbooks, pharmaceutical-company promotions and on the packages of over-the-counter remedies, emergency-preparedness plans and discourses of biosecurity, and in a myriad of other cultural sites, show how viruses come to take on a cultural life that is quite complex. The meanings a virus takes on in its cultural life can and do inform material practices and relations. The influenza virus(es) are no exception.

This research project takes as its starting point the premise that modes of constructing and representing viruses serve to reflect and inform not only our assumptions about the state of scientific knowledges and medical practices as instruments for intervening in realized or potential health crises, but also our desires regarding political, economic, social and cultural practices in the face of uncertainty. In the case of influenza, my research has already shown that these desires are influenced by the complex and contradictory relationship built through historical experiences with the virus(es). This relationship is both mundane because of the regularity of seasonal epidemics and our own bodily memories of illness, and exceptional because pandemic outbreaks with high rates of morbidity and mortality, such as the pandemic of 1918-19 which is estimated to have killed 20 - 50 million people (Johnson and Mueller 2002), have not only happened but are also widely expected to happen again, and soon (Barry 2004; Davies 2000; Davis 2005; Enemark 2006; Farndon 2005; Garrett 1994; Greene 2006; Hart 2004; Kotalik 2005; Nikiforuk 2006; Ratzan 2006; Revill 2005; Zelicoff & Bellomo 2005). It is in this projection to an anxious futurity of the virus, an anxious futurity that currently finds its focus in the H5N1 strain also popularly dubbed Bird Flu, that our ways and means of thinking and talking about a virus converge with our ways and means of thinking and talking about security and risk, intelligibility and uninitelligibility, certainty and uncertainty. This convergence is where the cultural life of a virus becomes bound to politicality through the construction of ideas about, and responses to, risk and uncertainty in the form of an anticipated pandemic outbreak.

The objectives of this research are to track and provide an analysis of a number of cultural representations in which the meanings of influenza have been and are currently being negotiated. It will combine historical analysis with the analysis of contemporary discourses of influenza in media and popular culture in order to map out the “history of the present” as witnessed by the cultural life of this particular virus. Important to this work will be the weaving together of historical and contemporary discourses through conducting archival and historical research alongside the development of a site dedicated to influenza media monitoring and analysis. Representations in media and popular culture will be analyzed through the lens of a discourse analysis that looks to representational or signifying forms as practices (see Fairclough 1995) that construct, interpret and distribute meanings and generate particular relations to power and ideology. It will focus on the interplay among lived realities, discursive mediation and the social and political landscape (Saukko 2003). In particular, this analysis will unravel certain micro- and macro-discursive operations in the construction of influenza discourse not only to point out the ways that discourse operates to both mark out and elide distinctions between seasonal flu and pandemic influenza, but also to delve into the ways the rhetorical rights of reference are deployed to construct space, time and subjectivity in influenza discourse.

Research I have already conducted on recent popular-science publishing on “Bird Flu” suggests that ways of thinking and talking about the where, when and who of H5N1 have been critical to generating anxiety, rationalizing increased intervention and surveillance of bodies, and legitimizing markets for products ranging from prophylactic pharmaceuticals to Bird Flu survival kits, all of which produce and ascribe a problematic identity and intelligibility to the virus. While there is no consensus in this publishing that H5N1 constitutes the most likely threat for a coming influenza pandemic (see Siegel 2006; Mercola 2006), there has been a tendency to invest this virus with attributes of agency, including, for example, the ability to be a gifted learner, a wily adversary, a crafty disease agent with a repertoire of tricks, an alien with the ability to reduce poultry to “bloody Jell-O,” and “a nasty bastard,” all of which contribute to it being, in the words of virologist Robert Webster, “the one that scares us shitless” (Greger 2006: 31). This research found prevalent representations of an anxious futurity in disease ecologies and anxiety around global interconnectedness and global flows, alongside anxieties related to social difference. These interwoven anxieties have served to support an idea of risk and uncertainty that entrenches particular neoliberal or late-liberal democratic govern-mentalities that produce both affectively and politically loaded responses to the difficult information of pandemic disease (Ironstone-Catterall 2006). My analysis of H5N1 in the context of popular-science publishing illustrates the ways that affective life has been conjured up in support of various practices and techniques of government and self-government under the auspices of managing a coming pandemic. This research underscores the ways cultural representations of pandemic influenza reflect larger social, economic and political concerns with risk management and work to reinforce contemporary techniques and practices of governmentality, not the least of which hinges on individualization of responsibility for emergency preparedness.

This research program will produce an interdisciplinary Cultural Studies perspective on influenza, a topic on which there has been little written generally and nothing from a cultural perspective. Its parameters will enable me to provide a unique theoretical groundwork for thinking about influenza today and a flexible and rapid means of addressing the ways that meanings are created around influenza in contemporary moments. This research aims to provide an understanding of how representations of influenza in media and popular culture influence the meanings constructed around it. While media have often been reproached for making risk a spectacle to capitalize on audience anxiety (Allan 2002; Krause 2006; Lee 2005; Ma 2005; Perry & Lindell 2003; Roche & Muskavich 2003; Schehr 2005; Strassberg 2004; Wallis 2005), they are also widely acknowledged to be key tools in risk communication (see for example Beacco 2002; Covello et al 2001; Leiss 2001, 2004; May 2005; Morton 2001; Simpson 1987; Slater & Raskinski 2005). This work will address the implications of this paradox. It will also provide an answer to the call for greater understanding of cultural influences on the meanings of risk for the purposes of understanding how people respond to risk and health communication and other forms of social marketing (Leiss 1996; Gurabardhi et al 2004; McComas 2006; Taylor-Gooby & Zinn 2006; Rutherford 2000). These meanings have consequences for emergency or pandemic preparedness and collective and individual responses to the difficult information of pandemic disease.

2 b. Context
The cultural life of the influenza virus(es) reveals significant tensions that inhere in discourses of health, disease and illness, a number of which also become apparent in thinking about the production of risk and uncertainty as central organizing concepts around which political, economic, social and cultural concerns are organized. These tensions serve to illustrate some of the limits and liabilities of particular ways of thinking and talking about viruses. They also highlight the ways that cultural constructions and the knowledges they reproduce and reinforce shape material experiences, not only in times of exception or crisis but also in moments that are quotidian. This may be seen in the production of risk- and health-communication strategies, in government policies designed to address epidemic disease, and also in the everyday meanings produced around viruses. Here, mundane activities like hand-washing and cooking a meal have become problematized and subjects of discourses of governance and self-governance. Meanings produced around influenza may support and reinforce strategies and policies designed as health interventions but they may also provide the grounds for resisting the information they contain (Ironstone-Catterall 2006, 2001a, 2001b, 2001c; Britzman 1998; 2000).

The research I will conduct during the tenure of this grant builds on the research I conducted in my doctoral studies on HIV and AIDS. This program draws on my background in social, political and cultural theory, the history of the philosophy of medicine, discourse analysis and semiotics, as well as research I have conducted in the area of Cultural Studies of Risk and Medicine. It will be informed, as all my work has been, by my concern for methodological perspectives that are attentive to the inclusions and exclusions, clarifications and elisions they create (Ironstone-Catterall 2001c, 2003, 2004/5; Saukko 2003). Although focussed on influenza instead of HIV and AIDS, my current research project is greatly indebted to work done on HIV and AIDS in the last decades. In particular, this research is rooted in a number of interventions, critical and theoretical, that have emerged out of thinking about HIV and AIDS which analyse the complicated ways that the meanings of disease are produced not only in biomedical discourse, but also in the discourses of popular culture and media. It grows out of Paula Treichler’s (1999) concern with AIDS as an “epidemic of signification,” Donna Haraway’s (1991) discussion of biopolitics and constitutions of self in immune system discourse, Emily Martin’s (1994) “tracking” of immunity in American culture from polio to AIDS, Cindy Patton’s (2002; 1994; 1990; 1985) critical analyses of the intersection of AIDS discourses and relations of power, Linda Singer’s (1993) theorization of “epidemic logics,” Marita Sturken’s (1997) engagement with the cultural and representational politics of HIV and AIDS, and Catherine Waldby’s (1996) close reading of competing and often conflicting biomedical constructions of knowledge around HIV and AIDS in virology, immunology, and epidemiology. My focus on the cultural life of the influenza virus(es) dovetails with each of these studies in its concern for the material effects of discourse. It looks to a virus as having cultural significances that become telescoped in significant and sometimes damning ways in moments of crisis or epidemic at the same time as it approaches risk and uncertainty as everyday and omnipresent cultural concerns.

This project will engage theories of governmentality in order to more fully contextualize the discourses of risk and uncertainty produced around influenza which reflect and feed into neoliberalism as an organizing logic. Influenza discourse highlights concerns about governmentality as, following Foucault, we may say that assumptions of knowledge shape material experiences in significant ways. We have already seen the material effects of the production of risk and uncertainty in influenza discourse in huge bird culls, quarantines, and mad scrambles to procure limited Tamiflu and vaccine stocks. The example of SARS also shows how political and economic concerns are influenced by the psychical economies of disease outbreaks (Drache, Feldman and Clifton 2003; Ma 2005; Thiers 2003; Wallis and Merlich 2005). It is also seen in practices and techniques that responsibilize individuals, whether it be in the context of influenza vaccination campaigns or discourses of self-help as a means of securing preparedness (Ironstone-Catterall under review).

Foregrounding the production of risk and uncertainty, influenza discourse tells us something about the stakes of presumptions of knowledge and the ideational and material boundary work they serve. They show the manner in which constructions of risk, which is a means of governing in terms of “aggregated futures” and statistical probabilities, and uncertainty, a way of governing futures that are imagined as singular, unique or indeterminate (O’Malley 2004: 13-14), have been curiously conflated in influenza discourse, particularly in discourses surrounding H5N1. This represents an important discursive shift that illustrates the manner in which concepts central to contemporary governmentalties may expand and contract in changing social, political, economic, and cultural contexts (Weir 1996: 383). This historical shift, along with its precursors and the particular approaches to governmentality to which they point, may be mapped through an exploration of discursive shifts that have served to shape historical responses to prior influenza outbreaks, as well as shifts in biomedical understanding of viruses. For example, the “ discovery” of the virus form itself at the end of the 19th century transformed the way influenza and other viral infectious diseases were talked about (van Loon 2002), and has influenced the means deployed to respond to realized and anticipated outbreaks (Allen 2007; Neustadt and Fineberg 2005). Discourses on influenza and the “coming pandemic” also show the ways that affective or psychical life can be summoned up, reworked, directed and redirected, particularly in the forms of the production and reproduction of anxiety and uncertainty in many competing and overlapping quarters, and often in the service of several perceived hazards simultaneously (see Furedi 2002; Glassner 1999).

2 c. Methodology
In order to accomplish the objectives of this research program, I am proposing three interconnected foci for research that are framed by a mixed-methods approach that is inductive and grounded. One focus will be to place influenza in socio-historical context by exploring the history of influenza discourse through archival and other historical research. This retrospective component will map out the ways that influenza has been constructed as an issue, a concern, and a risk while simultaneously attending to the ways that these constructions have created the focus for debates around blame and responsibility, institutional and government preparedness, the role of science and medicine in addressing epidemic disease, “national security,” and the individual and his or her identities as the seat of disease (Blakely 2003). It will concentrate on five realized or anticipated pandemic moments: the “Spanish Flu” pandemic of 1918-19, the “Asian Flu” pandemic of 1957-58, the “Hong Kong Flu” pandemic of 1968, the controversial 1975 American mass-vaccination campaign for a “Swine Flu” outbreak, and, more recently, the response since 1997 to the H5N1 epizootic and cases of infection in humans. Research will focus on influenza discourse in print with a focus on six (6) major North American newspapers in the year(s) before, during, and after each pandemic moment in order to: a) discern a baseline of influenza discourse at each historical conjuncture; b) look to the ways that influenza is addressed during the pandemic moment in order to pinpoint emergent regularities in discourse; and, c) assess resulting changes in influenza discourse. Newspapers will be selected to reflect coverage in national and local (generally in areas central to the realized or anticipated outbreak) venues. Preparing the historical ground for the analysis of contemporary constructions of influenza, this research will concentrate on constructions of time, space and subjectivity in order to understand how discursive shifts have been shaped by social, political, economic, cultural and biomedical concerns of the historical conjuncture in which they take place. The bulk of this research will take place in the first year of this grant. It will be conducted at Library and Archives Canada in Ottawa; the Osler Library of the History of Medicine in Montreal; the Gerstein Science Information Centre Toronto; and the U.S. Library of Congress and the Smithsonian National Museum of American History Kenneth E. Behring Center in Washington, DC. I have selected for this research key libraries and print-media archives which house materials specific to influenza and to the periods of my research.

The second focus concerns contemporary discourses of influenza. It aims to establish an influenza media monitoring and analysis unit that is organized to be flexible (able to address new outbreaks of already-recognized influenza strains as well as new strains that may emerge during the life of this research program) and efficient (able to collect and assess media content expeditiously so as to allow rapid response for the purposes of communicating results quickly). Based primarily on the collection and analysis of news-media representations of influenza in print, supported in part by a subscription to FP Infomart and Clip Genius clipping services which generate current, twice-daily, electronic news-media “clippings” from more than 300 publications and wire services in North America and Europe, this portion of my research program will begin in the first year of the grant and be a central focus in all three years. Although analysis will focus on eight (8) key English language publications from Canada and the United States, including, among others, The New York Times, The Globe and Mail, National Post, USA Today, and The Washington Post, and The Ottawa Citizen, I will create a database of all influenza-related articles pulled by these services in the event an outbreak occurs outside the reporting purview of these major papers. I will use QDA Miner 2.0 and WordStat 5.1 in order to support a mixed-method analysis and the organization of vast amounts of textual data. Together these software packages will enable qualitative discourse analysis and quantitative content analysis. Content will be coded for diegetic content, in particular content that constructs the temporality of influenza in either analeptic (retrospective) or proleptic (prospective) frames, including references to Spanish Flu as historical index or narrative constructions of a “coming pandemic.” Spatial markers will be coded in order to determine how spatial interrelations are constructed, in particular how the spaces of influenza are constructed in local and global terms to determine how flows among the two are construed. Finally, markers of subjectivity and identity will be coded, including pronominal naming of various agents such as public health officials, medical professionals and scientists, politicians and those affected by an outbreak, in order to assess the identities ascribed to influenza, some of which, as we saw with responses to SARS, may be problematic. Content analysis will look to the types and frequency of coverage, from health reporting to economic and political reporting, and will also look to balance of coverage between stories that focus on seasonal flu and those addressing pandemic influenza. Two Research Time Stipends have been requested since reporting on influenza tends to intensify during “flu season” which occurs between October and April of each year. A research assistant will be employed in the collection and coding of this material. The Research Assistnat will be trained to use the software packages mentioned above, help organize and maintain the database, and will also be encouraged to participate in data analysis and the production of documents and conference presentations to disseminate results.

The third focus of this research is more theoretical in its scope and aim. It will explore how the ways we think and talk about influenza reflect contemporary concerns regarding risk and uncertainty more generally. Here discursive mediation of influenza will be brought into conversation with the social and political landscape and the lived realities it serves to frame. It will explore the implications of the cultural life of influenza for theorizations of risk and uncertainty, neoliberal subjectivity and neurotic citizenship (eg. Isin 2004), governmentality (eg. Rose 2006; 1999; 1996; Bratich, Packer and McCarthy 2003), human rights (eg. Agamben 2005; Brown 1995), and security culture (eg. Ericson and Hagarty 1997). It will ask questions that emerge from the two areas of research outlined above to examine how the cultural meanings produced around influenza feed into these broader concerns and also loop back to influence them. This part of my research program is forward-looking insofar as it will focus on the implications of the research findings in the first two parts for policy, for risk and health communication, for epidemic or pandemic preparedness, and for the critical concerns underpinning these. This will be an ongoing focus in all three years of this grant.