Authoritarianism and the threat of infectious diseases.

Punitive social policy, encompassing the dismantling of the welfare state with the expansion of the penal state and its associated institutions, as nicely stated by Elias Nosrati and Michael Marmot in their Perspective, might indeed be considered an upstream social determinant of health. Nosrati and Marmot's analysis relates to the findings described by Navarro and colleagues, linking political ideology with policies aimed at reducing social inequalities such as welfare state and labour market policies.

The increasingly punitive policy environment in North America, Europe, and some South American countries (eg, Brazil and Argentina) is probably related to the spread of an authoritarian ideology that has xenophobia at its core.

However, a trait of those repulsion speeches that is often missed is how immigrants or strangers are referred to as parasites or contagious agents. Recent examples include the xenophobic and, in some cases violent, acts committed against Asiatic citizens in Western countries since the coronavirus disease 2019 outbreak began, or Donald Trump's statement that “tremendous” infectious disease is pouring across the Mexican border into the USA. Constant upheavals by the Trump and Orbán administrations about migrants, some of Brexit's collateral effects, and statements about refugees by the Italian politician Matteo Salvini and the Spanish far-right Vox party can be understood in this context.

It is not that foreigners cannot transmit threatening infectious diseases; actually, one of the earliest and most devastating examples of how strangers can bring an infective threat was the spread of smallpox by European pioneers, decimating Native American populations. Yet in many contemporary cases, this risk is distorted with political purposes by authoritarian forces. Unfortunately, the message authoritarian forces are delivering is very effective. As Murray and colleagues have shown, in countries with poorer hygienic conditions, disgust for the foreigner and the worst-off among the population is an important driver for support to authoritarian governments.

We need to pay attention to how authoritarian forces shape our frame of mind. Welfare policy is of the outmost importance to avoid this kind of rhetoric. Authoritarian politicians might well end up prescribing more prisons and retaining walls and detention centres, but health professionals should be able to detect manipulation techniques in hate speech that use the infection-related threats as an argument and naturalise such measures.