global health

The possible coronavirus pandemic

Hong Kong. Photo by Shawn Smallman

Even though it’s only been a few days, my last blog post is becoming out of date with amazing speed. This article in Eurosurveillance describes much of what we know to date. In Wuhan, China there is evidence that the corona virus outbreak is beginning to overwhelm the health care system. The New York Times has had disturbing videos taken from inside the hospitals, where dead people lay in the halls, and a patient begs a doctor to save her. He turns and strides away without a word. The South China Morning Post has incredible coverage of the outbreak. In one article, Mimi Lau described how desperately ill people were turned away from treatment at one overwhelmed hospital after another. Of course, it’s also important to note than in these hospitals, where health care workers are short on equipment, gloves, masks and medicines, people are still working to care for patients at great personal risk.

Novel Coronavirus outbreak in China

Fighting SARS Memorial, Hong Kong, These busts and plaques commemorate health care workers who volunteered to fight SARS, and then sadly were infected and died. Photo by Shawn Smallman

As I write this blog post all travel has been banned in Wuhan, and two neighboring cities (Huanggang and Ezhou) in China. The cause for this travel ban is a novel coronovirus, which is currently called nCoV2019, although it will likely receive a new name soon. Coronaviruses are a virus that causes respiratory diseases, such as SARS in 2003, and MERS in the Middle East. SARS was a bat virus that passed through a civet cat at a Wet Market, and then jumped to humans. Although the outbreak was ultimately brought under control, it was contained at a very high cost. The Fighting SARS Memorial pictured above commemorates Hong Kong health care workers who died while serving their patients. …

Vaccine refusal

Vaccine refusal is one of the most difficult health problems of our age. In the Democratic Republic of the Congo a terrible Ebola epidemic is raging -and has just had its first case in the major city of Goma- despite the existence of an effective vaccine. There have been outbreaks of violence directed against public health workers, which have made fighting the outbreak infinitely more difficult. But these workers are not alone. In Pakistan and Afghanistan polio cases are rising, and public health workers have faced threats, stigma and violence as well. Polio is appearing in tests in neighboring countries now, from southwestern China to Iran. While it’s easy to portray the people in these countries who refuse vaccination as being ignorant or uneducated, the truth is that in the United States, Canada and Europe we have a similar problem with vaccine refusal. As I discussed in another post, there was recently an outbreak of measles near Portland, Oregon, which was driven by low-vaccination rates. …

Pass the Olive Oil, Please

I want to thank Caitlyn Ark for this wonderful blog post, which she wrote based on her experience doing a study-abroad class this summer.

Pass the Olive Oil, Please
The Healthy Diet of a Social Mediterranean, Caitlyn Ark

As I was leaning off the side of our very large, but only slightly crowded, ferry, I watched the gentle crashing of the startlingly wine blue waters below me. Wine deep, wine rich, I thought to myself, which something that the Ancient Greeks, who sailed these same waters, originally coined, intertwining food with the natural landscapes from which they come from.[1] The day was warm, but the kind of warm that drifted down from the bright Mediterranean sun to eventually settle on my shoulders like a soft shawl. I found myself at the bow of our boat, searching for the small nip of the wind to kick up my hair and offer a slight reprieve from the warm air. The Mediterranean is an oligotrophic sea, meaning it is very low in nutrients, so I was surprised to note that I could see schools of small fish darting around socially near the top of the water, playing a marine version of follow-the-leader. …

Diet and Global Health

What is the single most important factor in shaping global health in the developed world? Interestingly, it does not appear to be access to the most technologically sophisticated medical technology. In the chapter on health in our textbook, I start by saying: “Chile, Costa Rica, Cyprus, Guadalupe, Hong Kong, Israel, Malta, Martinique, Singapore, and the United Arab Emirates are a diverse set of nations and territories. Yet they all have one fact in common: their citizens live longer than those of the United States, as do the citizens of many developed countries (Smallman and Brown, 2015, p. 236). Lee Miller and Weilu have an article titled “These are the World’s healthiest nations” in Bloomberg (February 24, 2019) which looks at global health statistics. The methodology looked at a number of factors -not only life expectancy- to rank countries. The top five countries were Spain, Italy, Iceland, Japan and Switzerland. There are many such rankings, and each one has methodological questions or choices. But all such national rankings of health can leave you questioning what you think you know, particularly about the role of diet in health. …

Measles and conspiracy theories

An outbreak of measles in Clark county Washington has led to at least 36 confirmed cases, and quite possibly a dozen more. A recent Oregonian newspaper article by Molly Harbarger had the title “Vancouver-area measles outbreak costs county $187,000 so far.” While we now view measles as a childhood disease, some historians have suggested that it could have caused the Antonine plague that devastated ancient Rome (165-180 AD). Globally, in 1985 nearly 1.2 million people died from measles annually (see slide 3), and many more patients suffered from pneumonia or were left with damaged hearing. Of course, measles is easily preventable with a regularly administered vaccination. This vaccination not only protects the person who receives it, but also babies too young to receive the vaccine, or patients with weakened immune systems, such as people receiving chemotherapy or living with HIV/AIDS.

The outbreak in Clark county was entirely preventable. Too few people had received the vaccination for herd immunity to work. It’s a sign of a larger problem, which is people’s refusal to vaccinate their children against diseases such as Whooping Cough, which is making a come-back in the United States. Public health authorities suggest that one of major factors driving these outbreaks are the conspiracy theories regarding vaccines spread through social media, YouTube and the internet. Interestingly, outbreaks of these vaccine-preventable diseases are no longer primarily happening amongst the poor and marginalized, but rather amongst the educated and privileged. …

Wet Markets and Avian Influenza

Map of Hong Kong by Shawn Smallman, Apple pencil in Procreate

This week I had an article published: “Wet Markets and Avian Influenza: Public Policy Decisions in Hong Kong.” Because the Journal of International and Global Studies is open source, you can read the article by clicking on the link above if you are interested. You can also read the abstract here:

After the emergence of H5N1 avian influenza in 1997 Hong Kong implemented a sophisticated system to regulate live poultry markets. While this system is well designed and thorough, it also has limitations. The rise of H7N9 avian influenza (which is typically acquired through contact with poultry, including in live markets) makes this an appropriate time to revisit the ethical and practical issues related to this trade. Based on data from field observations of live markets in Hong Kong, and interviews with experts in the field, this paper recommends that the government of Hong Kong create a committee to examine the pros and cons of ending live poultry markets in this Special Administrative Region.

Shawn Smallman, 2018

The 1918 Flu Pandemic

“Virus” by ddpavumba at

The 1918 influenza pandemic was the disease outbreak that took the greatest toll in the twentieth century. Globally, perhaps between fifty and a hundred million people died. There are a wealth of wonderful books on the topic. I particularly recommend both Alfred Crosby, America’s Forgotten Pandemic and John Barry, The Great Influenza. Eileen Pettigrew’s Silent Enemy is an excellent popular account of Canada’s experience of the pandemic.

Years ago I was visiting a graveyard in Portland, Oregon. There were three graves next to each other, a man, a woman, and a child, who had all died within a few days of each other in November, 1918, almost certainly from the flu. It’s hard to imagine now what that lived experience must have been like. So many families have stories of ancestors who fought in World War One and survived, only to die on their way home.

My own grandfather was traveling in the Peace River country of northern Alberta at the time. He had decided that he was bored on the farm in southern Ontario. He and a friend had set out on an adventure to travel to the Yukon. Then his friend came down with the flu that fall in 1918. Although they never did make it to the Yukon, my grandfather helped to get his friend Frank home, where -as far as I know- he had a long and happy life. Of course, this was only one insignificant moment in the global disaster that impacted families from India to Australia, and took tens of millions of lives.

There is a fascinating new podcast series on this outbreak, which is well-researched and thoughtfully presented: Going Viral: the Mother of All Pandemics. The presenters have deep historical knowledge, and have invested an immense amount of time in preparing this engaging work. I enjoyed their trip to the former battlefields of France to try to track down the pandemic’s origin with Dr. John Oxford. One would think that there wasn’t much new left to say on this topic. Yet in their search for the true origins of the pandemic they look at provocative thinking and current debates, such as Mark Osborne Humphries’ idea that perhaps the pandemic actually began in China. They are also engaging speakers; one can imagine listening to them as a student, and being captured by their lecture style. You can find the podcast on iTunes and similar venues. Given the proliferation of H7N9, the diversification of influenza clades, and the fact that we still don’t have a universal influenza vaccine, this history remains sadly relevant. Highly Recommended. If you are interested to learn about more recent debates, you can also read my own work on influenza and pre-pandemic vaccines as well as conspiracy theories. Both of these articles are publicly available for free. You can also find more freely available articles on influenza here.

Shawn Smallman, 2018.


Fighting Conspiracy Theories

“Witness Howard Brennan sitting in the identical spot across from the Texas School Book Depository four months after the assassination. Circle “A” indicates where he saw Oswald fire a rifle at the motorcade.” By Howard Leslie Brennan [Public domain], via Wikimedia Commons. Caption text from Wikimedia Commons also.
Apart from Murray in Stranger Things, and the Lone Gunmen in the X-files, most conspiracy theorists don’t have secret knowledge that the majority of humanity is unable to accept. Instead, people turn to conspiracy theories when they feel disempowered and desperate. Conspiracy theories thrive during times of crisis, such as a pandemic, or a profound political crisis. They also emerge at times when trust in government is low. I’ve done work (with my wonderful colleague Leopoldo Rodriguez) on a conspiracy theory in Argentina that focused on the death of government prosecutor Alberto Nisman. In the Argentine case, these conspiracy theories absorbed the news and attention of an entire nation. But during the 2009 influenza pandemic, conspiracy theories became truly global, as people told these narratives from Mexico to Europe. I studied this phenomenon in an article that is open access:

Shawn Smallman, “Whom Do You Trust? Doubt and Conspiracy Theories in the 2009 Influenza Pandemic” Journal of International and Global Studies, Vol. 6, No. 2: pp. 1-24. While its helpful to document instances of conspiracy theories, it’s more important to understand how to combat them when they can cause damage, particularly in the field of global health. How do health authorities fight conspiracy theories about vaccination, which are not only making it more difficult to eradicate polio, but also costing health workers their lives?

Book Review of Diniz’s Zika

Diniz, D., & Grosklaus Whitty, Diane R. (2017). Zika : From the Brazilian backlands to global threat. London: Zed Books.

This brief book is built upon extensive ethnographic fieldwork with mothers, doctors and scientists during Brazil’s Zika outbreak. The translation from Portuguese by Diane Grosklaus Whitty is masterful. Translation is always hard, and I have read too many books by Brazilian authors that suffered from overly formal wording, or endless run-on sentences. On a very small scale I understand this challenge from translating quotes in my first two books, for which I could easily spend an hour for a single statement. Of course, a developed narrative -with multiple voices-  is an exceptional challenge.  Diniz was very fortunate with her or the press’s choice for a translator. The prose is clear, energetic and yet still carries the feel and beauty of Portuguese. …

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