The dual system of tuberculosis control in the USSR: an analysis of totalitarian fragmentation and the structural dynamics of the infectious process.
Keywords:
carceral epidemiology; tuberculosis; Soviet Union; post-Soviet states; dual system of tuberculosis control; structural determinants of infection; diffusion processes; epidemiological morphology.Abstract
Tuberculosis (TB) in the Soviet Union and the post-Soviet region developed within a unique configuration of political, institutional, and scientific structures. A dual system of TB control emerged in the USSR, characterized by the simultaneous promotion of public health campaigns and the maintenance of large-scale carceral institutions that served as chronic reservoirs of infection. This system was reinforced by the epistemological and ideological features of Soviet phthisiology, which systematically excluded key structural determinants—particularly the penal system—from scientific and professional discourse. This article examines the formation, persistence, and infectious consequences of the Soviet “dual system” of TB control and analyzes its legacy in contemporary post-Soviet infectious dynamics. It also evaluates the structural, epistemological, and institutional constraints within Soviet and post-Soviet phthisiology that shaped scientific problem definition and methodological practice. The study employs an interdisciplinary approach combining historical epidemiology, institutional analysis, diffusion theory, and elements of the anthropology of taboo. Primary materials include published and unpublished scientific works, historical testimonies, epidemiological datasets, and institutional documentation. Analytical categories were derived from structural epidemiology, morphological models of infectious diffusion, and frameworks for understanding knowledge production in constrained scientific environments. The analysis demonstrates that the Soviet TB system was defined by: (1) the central epidemiological role of carceral institutions; (2) the ideological structuring of scientific discourse; (3) the reproduction of epistemic taboos that obscured structural drivers of infection; and (4) the emergence of long-term diffusion patterns shaped by state coercive systems. Post-Soviet TB dynamics continue to reflect these historical conditions. Contemporary expert communities exhibit resistance to conceptual innovation, contributing to the persistence of outdated explanatory paradigms. The Soviet and post-Soviet TB epidemics cannot be fully understood through biomedical or behavioral frameworks alone. Instead, they must be analyzed as products of long-term interactions between state structures, institutional epistemologies, and systemic infectious reservoirs. Overcoming the legacy of the dual system requires explicit integration of structural determinants—especially those associated with incarceration—into epidemiological research, public health planning, and professional education.
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Data Availability Statement
Data sharing is not applicable to this article as no new datasets were generated or analysed.