Bioterrorism, Infectious Disease and Globalisation
Is Inequality and/or Health a Security Threat?
We are witnessing an unprecedented “political revolution in the area of health” (Fidler 2005, p.179). No impregnable wall exists between a world that is “healthy and well fed and one that is impoverished and malnourished” (Brundtland 2003, p.417). Currently, since the word “international” hints to an interstate framework that no longer represents the locus of the security problems faced by the world population, the terms “global security and “world security” have been adopted instead. The end of the Cold War led to an overdue interest in the reconceptualization of commonly held assumptions about security, with the 1990s being characterized by a greater focus on the individual and societal dimensions of security and post cold war approaches being marked by an interest towards threats, faced by both state and non-state actors (Bilgin 2003, p.207). Ominous threats of bioterrorism, pandemics of rapidly spreading infectious diseases and trade-related bio crises are features of the interconnected globalizing world which have led to a range of actors, including academics, the United Nations, and non-governmental organizations, especially the WHO, to cast light on “human security” and subsequently on health and security, which have become intertwined as a result of changes within the security and health policy communities (Rushton 2011, p.779). The links between the latter and global political, economic and social processes have become key in the international agenda, with significant implications for how security has come to be formulated and practiced. However, the politicization of global health is significantly contentious, leading to considerable debates whereby health as security has been combined in “antagonistic frameworks” (Fidler 2007, p.43), since “the global and humanitarian objectives of the global health field do not fit readily into the state-centred perspective of national security” (Feldbaum et al. 2006, p.196). Many have argued that there is the risk that health will be subdued to powerful security interests, therefore masking deep divisions in methods, aims and values (Rushton 2011, p.779). Hence, to what extent does health represent a security threat? What models of health and governance can be considered valuable in an era where states are perceived as incapable of developing public policy on their own? This paper will answer the above questions by delving into the interconnectedness between human security and health security, followed by the three main developments which have contributed to the securitization of the field, mainly bioterrorism, infectious disease, and globalisation and lastly, the issues related to health security, concluding that health represents a paramount threat to human life.
Human security is characterized by two central aspects: firstly, safety from chronic diseases such as hunger, disease and repression, and secondly, protection from “sudden and harmful disruptions” in the patterns of daily life (UNDP 1994, p. 23). “Health security is at the vital core of human security – and illness, disability and avoidable death are “critically pervasive threats” to human security” (UNDP 2003, p. 96). Individuals rather than states embody the main object of security, making health security, “better equipped to capture the importance of addressing illness of the lives of ordinary individuals”, while incorporating a wide range of communicable and non-communicable diseases (Elbe, 2005, pp. 415–6). Other than the shift in the referent object whereby both the global and the individual levels began to be taken into account, human agency was another important factor which further broadened the security agenda. In point of fact, with greater social movements and the globalisation of global health issues, action by governments became more reactive and a number of powerful and influential individuals began placing health on the foreign and security agenda. For example, the former head of the WHO, Gro Harlem Brundtland, cast light on the changing nature of public health in a more globalized world, emphasizing that it was closely interconnected with broader social and political trends. It was during his tenure that the term “global health security” was first coined and implemented. Holbrooke, President Clinton’s ambassador to the UN, was also a significant player in the securitization of HIV/AIDS, introducing it on the Security Council’s agenda after a visit to Africa, where he realized the scale of the pandemic and that the aid-based approaches that were being utilised were ineffective to deal with the scope of the crisis (McInnes 2013, p.327-8). Other than these two essential aspects, which help explain why and how health security has come to play a significant role in the policy agenda, as a result of changing patterns of health and disease, there are three other developments, which are crucial to gaining a deeper understanding on the interconnectedness between health and security and that will be delved into in the next three sections of the paper, namely: concerns about bioterrorism, emerging and resurgent infectious diseases, and increased travel and migration dictated by globalisation with important implications for global insecurity.
The role of Bioterrorism
As far as bioterrorism is concerned, several attacks using biological weapons have been carried out in the past, driven by both the potential of causing harm to mass populations and the low cost of such weapons. The use of biological weapons by Iraq against its Kurdish population in 1988, and suspicions that it was stockpiling anthrax before the Gulf War of 1991-92, the attack on the Tokyo subway using sarin by the Aum Shinrikyo cult in 1995 and the attempt to spread salmonella in the US by the followers of Rajneesh Bhagwan, all lead to greater awareness that non-traditional terrorists were becoming better organised and that biological weapons could become the arms of choice for ‘rogue states’ seeking to override the powerful in terms of conventional military weaponry. Hence, the focus within the public health community became that of enhancing response and recovery, bearing in mind that “we will not be able to prevent every act of biological weapon terrorism”. However, there are three main problems that have risen in response to the risk of bio-terror. To begin with, there has been tension between an internationally versus domestically focused strategy. As a matter of fact, after the anthrax attacks, the US, followed by other countries such as the UK, increased its stockpiling of the smallpox vaccine and because of this large scale purchasing, worldwide provisions were in short supply (McInnes and Lee 2006, p.12-14). This strategy raised international concerns over “hoarding by a few states to the detriment of others”. There were also tensions resulting from the decision of the US to back out of negotiations on the Biological Weapons Convention, whereby the priority for the country seemed that of focusing on domestically based security measures, rather than an international approach, which, according to many, would have led to more positive results. The second issue is whether the priority should be on defence or prevention. The first case involves accepting that bioterrorist attacks will take place and that a nationally focused strategy should be acquired, characterized by domestic counter-terrorist agencies and ‘at the border controls’, as well as a greater use of the public health system in order to defend the population against such attacks. Whereas prevention, encompasses international cooperation on intelligence and diplomatic efforts to make the supply of such weapons more difficult. In this case, even though public health would be important in monitoring activities, it would not be the main element in combating the attacks (McInnes 2013, p.333-4).
Migration, infectious diseases and weaponized pandemics
Infectious diseases and their capacity to cross borders and undermine the well-being of domestic populations and the economic and military capacity of states, have played a major role in highlighting the importance of health as a security threat. One the most dramatic global health impacts has been the HIV/AIDS pandemic, which, as recognised by the 2000 UN Security Council special session on the HIV/AIDS threat to Africa, “may pose a risk to stability and security (UN Security Council 2000, p. 2)”. This has been dictated by the disproportionate HIV infection rate amongst security forces, the economic burden that stemmed from the disease, greater social fragmentation, its use as a weapon of war through rape and reluctance to send or receive peacekeepers (McInnes and Lee 2006, p.8), marking the first instance in which a health issue was debated “at the high table of realpolitik” (Hough 2015, p.260). There are also other infections, of potentially epidemic proportions, including Ebola, the West Nile virus and monkey pox (McInnes 2013, p.326) which have increased concerns over the health and economic safety of the global population, urging member states to actively improve epidemic alert and measures to ensure “global health security” (McInnes and Lee 2006, p.10). Furthermore, the 2002-03 SARS outbreak is an explicit example that illustrates the speed and the extent to which new diseases can spread. In fact, it began in Southern China in November 2002 and started to spread internationally in February 2003. By the time it came under control, in August 2003, 8,422 cases had been identified in 29 countries with 908 fatalities, leading to enormous economic losses, with the highest one counting US$100 billion. One of the major responses to these diseases has been the enforcement of border controls and the regulation of migration (McInnes and Lee 2006, p.9). Overall, there are three main reasons for which these developments have sparked greater concerns in the security community. First, the spread of these diseases poses a direct threat to the health and well being of the people that the states are there to protect, including, for the first time in centuries, the populations of Western sphere. Second, pandemics have the potential to cause social destruction and the effective functioning of states. In point of fact, confidence in the state can be reduced if it is not able to provide a basic level of protection, social inequalities arise if just the rich portion of the population has access to medical treatment leading to public disorder and public services may be undermined if people die or are unwilling or unable to work. Third, they can also lead to economic decline, as mentioned above, by significantly increasing government spending on health, reducing productivity and investment as a consequence of a lack of business confidence, and raising insurance costs for health provision (McInnes and Lee 2006, p.16). Moreover, one of the main issues related to infectious diseases has been the focus on “selected infections that have the potential to move from the developing to the industrialised world” threatening the privileged few. This risks leading to the development of a “fortress mentality” dominated by the control of the transmission of infectious agents by regulating the flow of certain people and goods (McInnes and Lee 2006, p.11-12).
Globalization: the double edged sword
Another significant role has been played by globalisation, which represents for health a double-hedged sword, being characterized by both threats and challenges. As a matter of fact, it has been regarded as an “irrepressible source of geographic transgression, rendering the idea of territoriality moot” (King 2002, p.773) but it has also brought about new opportunities (Hough 2015, p.262). Globalization has been dictated by economic, cultural and demographic factors, as well as global environmental change and technological development. As far as demographic globalisation is concerned, history has shown that epidemics and pandemics have taken place when previously isolated human populations mix. In point of fact, certain human groups can develop immunities to certain diseases that can be deadly if encountered by humans who have evolved from other geographic areas: holiday ailments are a clear example of how the phenomenon continues to persist. Furthermore, the higher levels of human movement around the globe have led to the transportation of dangerous diseases all over the globe in ever-greater quantities. “Between 70% and 86% of the measles outbreaks in Europe are believed to have been imported from travellers returning from Asia and Africa” (Chen and Wilson 2008, p. 1421). Henceforth, global social change is a root of the problem rather than the cure (Hough 2015, p.256). Additionally, with economic globalisation, the spread of trade links has lead to a rise in the potential routes for disease to spread. The globalisation of food production and movement has been characterized by the globalisation of food-borne illnesses. In 2011, more than forty people were killed by the outbreak of Escherichia coli (E. coli) in Germany and despite the high levels of bureaucracy, scientists were unsure where the vegetables infected by the bacteria originated, while politicians in the European Union started blaming each other. Due to the loss of income resulting from the international panic associated to epidemics, governments have started to downplay or deny the existence of diseases due to the economic costs of doing so (Hough 2015, p.257). Most interestingly, cultural globalisation has resulted in the transmission of unhealthy practices and “lifestyle illnesses” associated with modernisation, to Less Developed Countries (LDCs) (Hough 2015, p.259). For instance, the consumption of high-fat and high-sugar foods has spread minor health problems such as heart disease, obesity and diabetes, which claims as many lives in Asia as AIDS (Mathers and Loncar, 2006), to many LCDs. Lung cancer is more common due to increased tobacco smoking, and alcohol and narcotic drugs, with associated issues of addiction and infections via needles, are regarded as cultural imports (McMurray and Smith, 2001). Even global environmental change has had a tremendous impact on the spread of certain diseases. “Tropical diseases related to insect vectors native to equatorial areas, are becoming more and more common in areas with more temperate climate” (Hough 2015, p.257). In the US, the West Nile virus has been reaching as far north as New York every summer since 1999. The erosion of the ozone layer has led to a rise in skin cancer, which has increased by 1800% from 1930 to the end of the century in the US (UNEP, 2002: Chapters 3 and 4). Lastly, urbanisation and overcrowding, stemming from globalisation, have augmented diseases related to poor sanitation. Similarly, urban encroachment in rural areas has generated the spread of diseases associated with the rural environment to the urban sphere. In addition, certain human-driven changes to the environment have damaged the equilibrium in various ecosystems, such as the dam projects in Africa, which have contributed to the rise in water-breeding vectors. Lastly, technological changes have also strengthened the ability to detect and respond to disease outbreaks at the global level, many of which are associated with technologically advanced societies, such as nosomical, hospital acquired diseases, which affect 37,000 people a year in the European Union. However, globalisation has had the negative effect of globalising resistance, with pathogens and pests developing immunities to the pesticides and antibiotic drugs used against them (Hough 2015, p.258-9).
The cost of Security
Nonetheless, the securitizing move is not unproblematic. There are three issues that it is crucial to consider when analysing the link between health and security. Firstly, who controls the agenda? The debate is guided by security policy which focuses on the health risks that are believed to threaten the national interest, regional stability or international security, rather than striving for a healthier world population (McInnes 2013, p.335) Moreover, the agenda is dominated by the national security interests of the West over the individual security of individuals outside the western hemisphere. The US preference for unilateralism has created many tensions, in that the country has failed to support or fully participate in certain policy measures, outlining its national interests and role as a hegemon and provider of global security as a justification. The prevailing view “has been that pre-eminence and the primacy of sovereignty mean it cannot sign up to global initiatives on the same terms as other countries” (Ingram 2005, p. 385). The second refers to the narrow issues that are considered part of the security arena, whereas infectious diseases such as TB and malaria, as well as non-communicable diseases such as tobacco-related illnesses and cardio-vascular disease, are not to be part of the agenda even if they kill millions each year. Western policies on the liberalization of international trade have even boosted the sales of tobacco, deemed as “a weapon of mass destruction”, with the Framework Convention on Tobacco Control providing limitation controls on its sale and promotion (McInnes 2013, p.335). Thirdly, another issue concerns the referent object: whose health and whose security, are at risk? The state level is still given greater importance than the individual level, as exemplified by the fact that bioterrorism and the disruption it can cause to the state, unlike tobacco which has no implications for its security and stability, is deeply entrenched in the programme (McInnes 2013, p.335-6) Assessing the differences between individuals’ and governments’ concerns, Booth argued that individuals’ security should come first. This is for three reasons. Firstly, even if states can be deemed as providers of security, some often make large portions of their population insecure in attempting to secure themselves. Second, even those states that are successful in providing security “are generally doing so as a means to an end, not as an end in itself”. Lastly, the differences in both the character and the capacity of states make them “unlikely to engage in a comprehensive approach to security” (Bilgin 2005, p.208-9). However, it is certainly true that the WHO has looked beyond the state, striving for a new ‘governance strategy’, “in which governments, intergovernmental organizations and non-State actors collaborate in a ‘new way of working’ by contributing toward a common goal through science, technology and law rather than through anarchical competition for power” (Fidler 2005, p.392). This approach, while not completely abandoning the state as the referent object, is different from the classical regime that preceded it, as it deals with threats that were previously handled under separate regimes under a “single comprehensive governance strategy”, receiving information from non-governmental as well as state sources, unlike in the past (Fidler, 2005, p. 363).
To conclude, after having examined how the public health community and the foreign and security policy communities are interconnected, health can be considered one of the most momentous security threats of the current century. This has been highlighted through the analysis of the concept of human security, which has illuminated the need to address health security, as well as the fast-moving nature of infectious disease, bioterrorism and the impact of globalisation, other than how the securitizing move has brought to light numerous issues, especially regarding the referent object and the narrow conceptualisations that dominate the mainstream policy agenda. This has been dictated by the social, political and economic impacts that have been addressed in the paper, calling for dominant security actors to think and act in terms of global security, advancing growth, development and peace. Even if the outcome of the process of transcending tensions between unilateralist and internationalist visions is still questionable, one thing is for sure: the health of 7.5 billion people cannot be left to luck or chance. Given our geopolitical climate, our duty and responsibility is that of ensuring the safety and security of our citizens and multilateralism in the health security sphere has to be attained in order to overcome the divisions that currently dominate the international system (Ingram 2005, p. 386).
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