Anthropologist Martha Lincoln’s study of cholera in contemporary Vietnam is a rich ethnography of the politics of epidemic disease management. Tracing how the cholera epidemic of 2008–2009 in northern Vietnam was managed by the Vietnamese state and perceived by the population, the monograph reveals two distinct realities: the biopolitical reality of state epidemic management and the lived reality of the Vietnamese working class. As the book observes, the Vietnamese state drove the public narrative on the cause and correct solutions to the cholera epidemic. Instead of foregrounding the goal of reducing the health impact of the disease on the population, the state’s approach reflected its own “political and economic priorities” (22). This failure to prioritize the human health impact of the disease among vulnerable and disenfranchised populations is, the book argues, a consequence of the shift from a socialist framework of public health to a “market socialist” framework that emerged with the economic reforms of 1986. The book stands as a solid case study of the social construction of an epidemiological understanding of cholera, and, to a lesser extent, as a study of how a health system’s transformation from a socialist to a market economy generated negative health outcomes.
Chapter 1 historicizes the presence of cholera in northern Vietnam in relation to different political regimes. It argues that the French colonial state was instrumental in embedding and circulating the cholera vibrio, in part through economic policies that exacerbated poverty and in part through labor policies that increased both the movement and confinement of conscripted and imprisoned populations under inhumane conditions. The analysis of the subsequent socialist period (1945–1975) demonstrates how public health actions can be co-constituted with state-building. The chapter argues that the socialist state constructed public health as a guaranteed “right of citizenship” (45). Lincoln observes that the new socialist doctor “was figured as personifying a radical break from the medical practitioners of the dynastic and colonial periods” (42).
The socialist framework for public health radically changed with economic reforms (Đổi Mới [Renovation]) instituted by the party-state in 1986, which ended universal healthcare and gave rise to a new system based on a mix of public and private sectors. The remainder of the chapter explores how economic liberalization worsened public health outcomes and undermined social protections for the poorest and most vulnerable Vietnamese populations. The chapter concludes that market reform in Vietnam has reshaped the state’s role in health, giving rise to “a much more partial regime of surveillance and intervention” (73) whose actions are guided by the logic of prioritizing the economic health of the state over individual health, to the detriment of the most vulnerable.
Chapter 2 explores the importance of water management to the Vietnamese state. It hops across topics as varied as the relationship between WASH (water, sanitation, and hygiene) and cholera, a longue durée history of irrigation and water management in Vietnam, water as a symbol of the Vietnamese state, and the maintenance of a sanitation infrastructure before and after Đổi Mới. It ends with the observation that the state downplayed the role of contaminated water in the spread of cholera to minimize its own culpability in the rise of the disease.
Every significant epidemic produces scapegoats. Lincoln argues in chapter 3 that the Vietnamese state reconfigured cholera from a disease caused by infected water to a disease caused by market vendors from the countryside selling unsanitary wares (“street food”) in the city. In this way, the government deflected blame from faulty, under-maintained public sanitation systems to individuals who were framed as morally suspect and “less civilized” than the average Vietnamese subject. Both the sellers and their clients were held responsible for careless actions that exposed them to the disease. This ethnographically rich chapter features compelling anecdotes about local understandings of the causes of cholera. What is remarkable about these vignettes is the way they illuminate the effectiveness of government framings in shaping popular narratives of the disease.
Chapter 4 examines the relationship between dog meat consumption and cholera. Although a bit tangential to the core argument of the book, this lively chapter connects the efforts of public health authorities to link dog consumption to cholera to broader Vietnamese discourses on dog meat in relation to masculinity, modernity, class, religion, and other social categories and markers. The final topical chapter, chapter 5, examines the significance of statistics in this story, including the role they played in the state’s effort to deflect its own responsibility for the cholera epidemic. Lincoln argues that the state purposefully collected and circulated falsified and incomplete statistics on the cholera epidemic for political purposes. An uneasy tension arises in this chapter as the discussion makes clear that most statistics collected, even before economic reforms in the 1980s, were highly unreliable, and thus, it is difficult to determine if public health has become worse with economic liberalization. Even as this argument—a central premise of the book—is destabilized, the author argues that “[n]onetheless, it is still possible to make clear claims about the meaning of cholera and the factors that contributed to its spread” (129).
The concluding chapter discusses the unexpectedly effective Vietnamese state response to COVID-19 through the beginning of 2021 in comparison to its poor performance during the cholera epidemic of the previous decade. The conclusions drawn from this comparison are murky. Rather than comparing the state’s logic underlying its distinct approach to each epidemic, Lincoln turns to a discussion of the violent repression of pro-democracy dissidents during the COVID period as evidence that “public commitments of the pandemic response began and ended with the state’s guarantee of physical survival” (163). Lincoln introduces then dismisses an assumed relationship between effective public health and open, democratic governance, judging that the state’s open communication about COVID-19 disease risk did not “contain a promise of increased civic freedoms” (163). The book closes with the observation that the state treated health in Vietnam as essentially a “macroeconomic good” during both the cholera and the COVID-19 epidemic (165).
Epidemic Politics in Contemporary Vietnam confirms the truism that public health must be coordinated through governance structures and is always intertwined with state power and social control. What is perhaps most compelling in the monograph is the evidence that it provides of the extent to which the Vietnamese state could alter the population’s understanding of the disease despite individual lived experiences. It also illustrates that the relationship between health outcomes, political structures, and economic systems is highly context-dependent; no simple formula exists to explain the relationship among the three.
University of California Press