Introduction

Epidemics emerge from specific, local concatenations of biological and social processes. Through the prism of culture, medical anthropologists have sought to understand how social processes both constrain and shape infectious diseases. In an era of self-conscious globalization, anthropologists have moved beyond the realm of "traditional" culture to examine how the cultures of bio-medicine and of transnational institutions interact with local forms of knowledge, practice, and power. This makes anthropologists well-placed to examine the cultural dynamics of the interface between global and local social relations and, from this viewpoint, examine the biosocial processes underlying emerging infectious diseases today. Advances in the application of molecular biological techniques to the study of epidemics promise to deepen understanding of these biosocial processes. Coordinated mapping of biosocial processes through ethnographic and molecular methods holds the potential to make a substantial contribution to the emerging discipline of emerging infectious diseases.

Most commentators agree that the 1992 publication of an expert committee report on emerging infections was a seminal moment that set the stage for subsequent efforts to address this issue. The committee defined emerging infections as "new, re-emerging, or drug-resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future" (Institute of Medicine, 1992, p. 3; see also Woolhouse & Dye, 2001, p. 981). This definition sets out a distinction between three microbial causes of new epidemics: new pathogens, old pathogens that have resurged, and pathogens that have changed through the acquisition of drug resistance. Research on emerging epidemics has described an ever-expanding array of pathogens and their effects, largely using epi-demiological and laboratory methods (Krause, 1998; Thompson, 2000; Woolhouse & Dye, 2001). Examples of new pathogens include HIV, of course, but also prions — the cause of "mad cow disease"—and Hepatitis C virus

(HCV). Tuberculosis has re-emerged as a serious threat to public health in many parts of the world, riding on the coattails of the HIV epidemic. A large part of this threat comes from the creation of drug-resistant tuberculosis resulting from inadequate tuberculosis (TB) control mechanisms. To this medically induced, or iatrogenic, epidemic we may add the continuing evolution of drug-resistant strains of other common bacterial species; for example, methicillin-resistant staphylococciae (MRSA), penicillin-resistant neisseriae gonorrhoea (PRNG), and vancomycin-resistant enterococciae (VRE).

This biomedically inspired classification is a useful first approach, but only hints at the processes that trigger such epidemics. This taxonomy of pathogens (new, re-emerging, transformed) points to their historical dimension, that is, to how their ability to produce epidemics differs through time. The anthropology of emerging infectious diseases investigates the processes by which new or old pathogens produce infectious disease epidemics. In other words, rather than being a "surface" science concerned with describing the distribution of epidemics across a geographical landscape, anthropologists pose archeological questions, concerned with recovering the myriad social processes that sediment as epidemics in different social and geographical contexts. In seeking to explain differences between epidemic scale and intensity in different localities in terms of their social context, anthropologists are concerned both with unearthing "root causes" of epidemics, as well as accounting for the full social dimension of their impact on societies and individuals. These tasks call for both an ethnographic approach devoted to understanding everyday life in all its complexity, and a historical approach that traces the biosocial genealogies of epidemics (Inhorn & Brown, 1997; Kiple, 1993).

As more anthropologists research emerging infections, the full comparative potential of this research will become more visible. By working across cases, the anthropology of emerging infectious diseases aims to identify common "deep" biosocial processes that register on the epidemiological surface, at the same time as it undertakes to capture the full social complexity of epidemics as they emerge. Dealing with both causes, and effects of emerging infections requires both an historical and an ethnographic approach. Engagement with emerging infectious diseases, which highlight the unexpected consequences of social inequality, the plight of the world's poor, and the shortcomings of global public health in today's globalizing world, has made medical anthropology an increasingly politicized discipline (Farmer, 1999; Whitman, 2000).

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