COVID-19 could be described as the first data-driven pandemic. While related risks pertaining to privacy and surveillance might seem quite novel and unique to our times, they are a continuation of centuries-old bureaucratic and documentary practice of epidemic and health governance. In this post by Jędrzej Niklas, research associate at Cardiff University and visiting fellow at LSE, the ways in which digital ‘solutions’ for tracing and monitoring are used in response to COVID-19 are juxtaposed with the lessons we can learn from centuries-old disease tracking mechanisms.
Contact-tracing apps, health certificates and temperature scanners are at the core of political debate on how we can live within the existing public health conditions created by the COVID-19 pandemic. Across the world, various data-driven responses to the pandemic (including contact-tracing applications, AI dashboards and immunity credentials) are becoming common. Such tools are intended to achieve clear public health goals: to limit the spread of the virus, recommend treatment, and/or help with testing and tracing. However, as lockdowns are eased, these tools could also play a significant role in determining whether people can travel, shop, enter a school, or return to a workplace.
Consequently, we attribute a lot of power to these systems and the infrastructures behind them. No wonder, then, that many concerns have been raised about these systems. Researchers warn against privacy violations, mass surveillance and discrimination. Debates about centralised and decentralised models of contact-tracing apps also show tensions between national sovereignty and big-tech domination, with a significant number of these proposed interventions being outsourced to the private sector.
While these problems and risks might seem unique to this time, bills of health, certificates and vaccination passports have for a long time been a key element of states’ identification and surveillance machines. These documents are also an evidence of an old and intimate relation between bodies, citizenship and economic and political interests of companies, states and empires.
Bills, consuls and interests
Intensive trade in the face of major epidemics led to the spread of quarantine practice, especially in the Mediterranean, starting in the fourteenth century. Before landing, ships would have to wait in a restricted area for between 20 and 40 days to monitor for any concerning symptoms. Quarantine measures required categorisation and information on where vessels were coming from, their epidemic status, and health conditions among the crew and cargo. Such information was provided by the bills of health (known also as a patente de santé). Sometimes stamped with a seal or decorated with lavish patterns and in other situations just a simple piece of paper, these bills confirmed that vessels left the port in particular conditions, granting it one of the three statuses: foul, suspected, or clean. On arrival, port authorities would verify documents in a special ceremony that involved perfuming the paper and soaking it in vinegar. These bills dictated the “quarantine fate” of the ships, determining if and how long vessels would stay in the detention.
While quarantine and accompanying documents were widely used, its practice was neither standardized nor universal. Usually, documents were issued by local health councils, doctors, port authorities or diplomats. While contemporary contact-tracing apps have triggered a debate on interoperability, historical port authorities complained about the diverse forms of documents. Different languages created quite a few problems too.
For example, in 1831 Maltese administrators demanded additional payment for the official translation from the ship that had a bill written in Greek that “cannot be considered one of the generally known languages of Europe”. Political and economic tensions were involved too: for example, merchants were afraid that consuls would grant foul bills of health to delay particular ships and protect national trade interests. Although authorities usually cooperated with one another, there were also examples of vicious competition. Some travellers noted that consuls had rival approaches to issuing bills and shared different opinions about the epidemic situation at the same port.
Another issue was the reliability of data and scientific competence of the authorities to make decisions that would have important consequences, a problem that we still have today. Clean bills of health did not guarantee that ships were free from diseases, as in the example of the vessel that started the Great Plague of Marseille, which upon its arrival received at least two clean bills of health. Adventurers, corsairs and pirates circumvented or intentionally avoided quarantine restrictions and documentary obligations. There were also examples of counterfeiting, forgery or cheating. In his diaries, English civil servant Samuel Pepys explained that “man may buy a bill of health for a piece of eight, and my enemy may agree with the Intendent of the Sante for ten pieces of eight or so; that he shall not give me a bill of health, and so spoil me in my design, whatever it be”.
Empire and era of individualization
While not always trustworthy and effective, blanket quarantines were for several centuries the dominant form of epidemic governance in Europe and beyond. Colonialism, industrialization, and scientific advancement demanded reforms of the old health practices. While the idea of quarantine itself was questioned, voices were also raised about the need to abolish bills of health, as they were construed as “irksome and profitless formality”.
International sanitary conferences in the 19th century were one of the first attempts to establish new legal regimes, standard bills of health and uniform network of medical authorities. Newer forms of documentation and bureaucracies were closely tied to imperial interests and racialized views about infectious diseases. Driven by fears of cholera, yellow fever and plague, new sanitary laws focused on the regulation of movements of people between the Far and Middle East, India and Europe. The key question of the époque was how to make “lifelines of Empire” passable for commerce and colonial transportation while protecting Europe from so-called “Oriental” diseases. A mix of policies, bureaucrats and infrastructures (like the Suez Canal) functioned as a “semi-permeable membrane” which allowed more targeted and selective policing.
Bills for vessels were still issued but they now covered only some diseases, regions or events. Special attention was paid to pilgrims travelling to Mecca (believed to be the main cause and source of cholera outbreaks). Vessels that transported Muslims had to meet special requirements and were placed under surveillance. Epidemics in colonies also created harsh forms of control and oversight. During the 1896 plague epidemic in India, the British administration introduced special passports and exemption certificates as well as the detention and segregation of suspected railways passengers.
Cables, wires and telegraphs, which improve the speed of communication, also slowly replaced paper bills of health. Sanitary documents increasingly focused on individuals, and less often on ships, trains or steamers, with all the consequences including identification, movement restriction and inspections. This broad shift was related to the new views on public health, and especially vaccination. In various Anglo-Saxon countries, a vaccine scar became a necessary immunity certificate for immigrants. We even “owe” the widespread use of passports to attempts to control the Spanish flu after World War I. Initially, international law considered passports a “temporary measure”, but they soon became indispensable for border, security and health management in societies traumatised by the war.
At first glance, ‘old’ forms of health documents and data practices may have little in common with sophisticated data analysis and AI-driven tools used during the Covid-19 epidemic. But there are some disquieting parallels and signs of historical continuity between those ‘old’ and ‘new’ devices. In fact, as explained by a media scholar, Shannon Matter, traditional and new media have always overlapped.
Public health measures are entangled in a myriad of national interests, geopolitical competition, and economic motivations. Just as 19th century empires often used sanitary documentation and bureaucracy as a proxy in their political activities and quests to control, so big tech companies now try to use the existing information infrastructures to increase their influence and become more “sovereign”; deciding what is better for society, as in the example of conflict over decentralised models of contact tracing apps. The uneasy connection between ‘old’ bills of health and targeted racism also opens up questions about the discriminatory potential of modern digital technologies – of both being ‘counted’ and ‘not counted’.
Historical lenses provide us with a powerful analytical tool to understand new media and name conflicting interests. They can also help to dissect layers of power relations, economic benefits and dependencies. At the same time, the many ways in which people and communities use documents and digital tools can challenge linear narratives of technological determination, and show the whole kaleidoscope of practices and relevancy of local contexts.
This article represents the views of the author, and not the position of the Media@LSE blog, nor of the London School of Economics and Political Science.