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Pandemic H1N1 and the Construction of a Global Health Security Threat…
Pandemic H1N1 and the Construction of a Global Health Security Threat (Ângela Gomes)
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The securitisation of influenza was not unproblematic.
The influenza pandemic of 2009 turned out to be far milder than anticipated, and much of the scientific basis on which planning had proceeded and resources had been mobilised turned out to be wrong.
The article argues that for an issue to be securitised as a global health threat, it is essential that the United States takes the lead role (or at the very least supports efforts by other leading powers)
Introduction
‘The world is better prepared for an influenza pandemic than at any time in history’
At a global level over US$2 billion had been pledged by the world’s wealthier countries to help poorer countries prepare for a pandemic
Although flu experts spoke of the danger of new pandemic viruses emerging that could cause significant illness and death at the global level, (…)mobilised the global community to respond to this risk by securitising pandemic influenza and lifting it from the arena of public health (…)
It began not in Asia, where great resources had been devoted to pandemic surveillance, but in North America, which was considered to be the last place a pandemic might originate.
In all, the pandemic of 2009 was clearly not a threat to global health security under any definition of security.
Rather, it is to understand the process by which influenza was securitised, and to draw some conclusions about how diseases become securitised at the global level, and which actors and audiences need to be involved in this process.
Securitisation as a Framework for Analysis
The article follows the Copenhagen School in using the concept of securitisation as the organising principle for this study
The Copenhagen School sees securitisation as a subjective process in which a credible actor or actors describe an existential threat, audiences accept this explanation, and measures outside the scope of normal politics are taken to meet this threat.
Three facilitating conditions are required for successful securitisation: it must follow the accepted grammar of security; it must come from an actor in a position of authority to pronounce on security; and it helps (but may not be necessary) if the object can generally be held to be threatening
It is difficult to conceive of an existential threat perceived by countries like China, India, Brazil or Nigeria being securi- tised at the global level unless the United States actively backs and supports this.
Setting the Stage for Securitisation: The Creation of an Issue Culture and the Rise of the Emerging Infectious Diseases World View
While the Copenhagen School’s analysis explains how securitisation takes place, as Sandra Maclean (2008) has observed, it is less successful in explaining why.
Infectious diseases have been described as ‘dreaded risks’, and therefore more susceptible to being seen as threats to security (Enemark, 2007). But why are infectious diseases seen as dreaded risks?
This article suggests that the presence of an ‘issue culture’ or interpretative discourse around a threat moulds perceptions of risks, and also makes securitisation credible.
After the events of 11 September 2011, and in particular the anthrax attacks that followed, this emerging infectious disease discourse was strength- ened and gained salience through concerns about bioterrorism and through the securiti- sation of public health that occurred after public health institutions and officials were drafted into the war against bioterrorism
For an issue culture, or a particular interpretative discourse, to gain prominence, Gamson and Modigliani suggest three determinants: the issue needs to have powerful sponsors; it needs to have cultural resonance; and the messages need to have a successful fit with media norms and practices
(…)The warning was provoked by an incident that had occurred that summer when African green monkeys imported from Uganda (…)for Lederberg this was a portent of the existential threat that diseases caused by hitherto unknown viruses posed to human existence.
In May 1989, following the identification of more examples of infectious diseases caused by previously unknown viruses of zoonotic origin such as Ebola and HIV, (…)
Among the recommendations they made were for the US to ‘take the lead in promoting the development and implementation of a comprehensive global infectious disease surveillance system’ that would help the early detection of new diseases wherever they might occur in the world (Lederberg et al., 1992, p. 6). The IOM report created the foundation for a new focus on emerging infectious diseases framed as global threats to the United States coming from overseas.
The mass media play a key role in the setting of the public agenda, (…)
As important as the fact that key media figures supported and disseminated these ideas was the absence of any authoritative scientific voices dissenting from this world view. Journal- istic practices require ‘balance’ between opposing views, but in this case there were no authoritative opposing views, and the emerging infectious diseases world view was pre- sented as a definitive picture of reality.
Emerging infectious diseases caused by exotic viruses are in many ways a perfect example of the anxieties caused by modernisation.
The social and cultural context within which the emerging infectious disease world view took root can also be understood in the context of the anxieties caused by changes in the world order from one of US dominance to a situation in which the United States is beset by threats, enemies and global anarchy, and where the world is divided between ‘tame zones’ of wealth and security and ‘wild zones’ of poverty and violence.
The threat of exotic viruses coming from the world’s ‘wild zones’ fitted well into this anxious, postmodern world view, and found resonance in popular films, books and other cultural products.
A key feature of the books and movies on emerging infectious diseases was the geography of their narratives. The viruses all came from outside the United States: either from Africa or from unnamed tropical locales.
This search for security concepts that would address the new threats of the post-Cold War world led to several international reports, including those by the Commission on Global Governance
The WHO began using the term global health security in 2001 to describe the global public health measures required to protect the world from transborder infectious disease threats,marking a step in the securitisation of diseases
Thus by the end of the 1990s an issue culture, or an interpretative framework, was in place in the United States that was sensitive to the potential impact that disease could have on national security.
Lending Salience to the Emerging Infectious Diseases World View: 9/11, Bioterrorism, SARS and H5N1 Avian Influenza
The anthrax attacks pushed along the process of securitisation of emerging infectious diseases by blurring the distinctions between naturally occurring infectious diseases and deliberate acts of bioterrorism and placing the response to both within a security frame- work.
These US concerns were reflected at the global level.
Canada hosted the first meeting in November 2001, where the ministers agreed ‘to forge a partnership to address issues of protecting public health and security globally’ and called for ‘global action to strengthen public health preparedness and response to the threat of international biological, chemical and radio-nuclear terrorism’
While the anthrax attacks demonstrated the security fears raised by a bioterrorist event, the SARS epidemic in early 2003 demonstrated how disruptive a newly emerged virus could be in a globalised world.
(…) it also helped to reinforce the notion that emerging infectious diseases always came from somewhere else, whether it was Africa or Asia.
Had SARS not come along, it is not clear whether the next health threat that captured global attention – the H5N1 avian influenza virus – would have been taken as seriously as it was.
(…) when there was greater sensitivity to the potential for the global spread of a new disease
In a post-9/11 world when the United States was acutely sensitive to threats from abroad, it made sense to prepare for this potential threat as well.
While the warnings themselves were not new, the US government and Congress, sensitised to the potential for disaster from abroad, were now primed to prepare for this threat, and the process of securitisation described earlier now began.
But while H5N1 was a major animal health and economic threat, it was not a human health threat to anywhere near the same extent. In 2004, there were 46 human cases, of whom 32 died.
There was also no evidence that infected human beings were able to spread the disease to other humans, a crucial requirement for a virus to cause pandemic influenza.
The Securitisation of Pandemic Influenza
In the Copenhagen School’s analysis, a speech act is the moment that securitisation occurs. As Waever puts it,‘It is by labelling something a security issue that it becomes one’
‘By preparing now, we can give our citizens some peace of mind knowing that our nation is ready to act at the first sign of danger’ (Bush, 2005b). Bush’s speech made it clear that this was an issue that needed to be securitised at the global level: ‘a flu pandemic would have global consequences, so no nation can afford to ignore this threat, and every nation has responsibilities to detect and stop its spread’
Securitisation requires extraordinary measures to be taken to respond to an existential threat.
The measures that were proposed to respond to the pandemic were similar to the response to a terrorist attack, or any other national emergency.
‘Rather than focusing on well-established measures for protecting the lives and health of Americans, policymakers have recently embraced an approach that views public health policy through the prism of national security and law enforcement’
IPAPI was an important mechanism for expanding the securitisation of pandemic influenza at the global level. Under US leadership, a series of ministerial meetings was held (in Washington in 2005, Beijing,Vienna and Bamako in 2006, New Delhi in 2007 and Sharm el-Sheikh in 2008) to raise funds and focus the attention of governments on the threats posed by avian and pandemic influenza.
The IPAPI ministerial meetings showed that pandemic influenza had been raised to the level of a disease that required urgent international action because of the threat it posed to global society.
The US role in securitising influenza was also implemented through the United Nations and the World Health Organization (WHO), and other members of the UN family such as UNICEF and the Food and Agriculture Organization (FAO).
The inclusion of novel human influenza viruses as one of four diseases under the revised International Health Regulations (IHR) (along with smallpox, poliomyelitis and SARS) that countries were automatically required to report to the WHO was a significant indication of the securitisation of pandemic influenza at the global level
Persuasion was backed by significant resources to encourage countries to take measures to detect the first signs of a pandemic quickly, and reduce the chance of its global spread. This was not always welcomed as it led to demands on poorer countries that poultry-raising practices be changed and that resources be poured into pandemic planning exercises.