Tuberculosis in the borderlands: migrants, microbes and more-than-human borders

Multidrug-resistant tuberculosis (MDR-TB) has been a widely recognized threat since the TB epidemic was declared a global emergency in the 1990s. The epidemic is particularly critical in the borderlands where humans and microbes move across geographic borders. In this article, we explore the contingency of human-microbe relations in Thailand-Myanmar borderlands. Initially constituted by the colonial encounters, the Siam–Burma border’s continuing existence was constantly enacted, negotiated, and co-produced through the entangled interplay of various actors, microbes and pharmaceuticals included. We examine how global forms such as biomedical science, epidemiological practices, and public health interventions were actualized in an attempt to control MDR-TB in this borderland. While disease surveillance and control were seemingly hindered by the permeability of the border and geographic mobility of migrants, the potency of Mycobacterium tuberculosis to lie dormant in human bodies for long periods of time without symptoms posed an additional challenge to epidemiological attempts to segregate the healthy from the contaminated. Combining ethnographic materials from Umphang District, Tak Province at the western border of Thailand with national policy analysis, natural history, and microbiological insights, we reveal how the indeterminacy of borders and complex microbe-human entanglements necessitate changes in the prevailing biocontainment model of infectious disease control. We propose that disease surveillance and response need to transcend the rigid geographic notion of space and include a more flexible topological conception of spatiality that embraces the fluidity of pharmaceuticals, microbes, and human relations. This reinvention of the spatial approach in epidemic control begins by attending more closely to the entanglement of human-microbe relations in the more-than-human borders.