The complex linkages between public health and conceptualizations of power and security are ancient. They constitute an important historical tradition of republican political thought, having originated during the halcyon days of the Athenian Empire and having enjoyed their heyday from 1348 until the development of antibiotics in the early decades of the twentieth century. Thus, contemporary debates regarding the supposedly recent “securitization” of health issues ignore such historical context. This ignorance of the role of health as a central materialcontextual factor obfuscates the relationship between disease, its impacts on society, and the evolution of the sovereign states of Europe. These polities clearly perceived pathogens as profound threats to their material interests, their power, and often their survival.
In view of the profound importance of material-contextual factors in republican thought, I propose a “broadening” of the modern conceptualizations of national security to include non-anthropocentric threats such as environmental destruction, migration, and naturally occurring epidemic disease. Thus, I argue for an analytical focus on “threats” as opposed to “enemies.” Such threats may manifest in the form of either temporally constrained events (e.g., the SARS epidemic) or attenuated processes (e.g., the HIV/AIDS pandemic). This distinction is crucial because humans exhibit a psychological tendency to focus on the former, and to ignore the latter, despite the fact that processes may generate powerful long-term negative outcomes for human societies.
Pathogens may constitute a threat to national security through direct and/or indirect impacts on the material interests and the apparatus of the state, which may be moderated to a significant degree by societal and/or contextual factors. The threat presented by contagion is often pathogen-specific, as different pathogenic agents will present variable levels of threat depending on the immunity of the population, the vectors of transmission, and the adaptive capacity of the specific polity involved. Thus, rather than asking whether HIV/AIDS represents a threat to national security, one should ask “Under what specific conditions (viral clade, seroprevalence rate, degree of state capacity, degree of social capital) might HIV/AIDS represent a national security threat to a specific polity (such as Zambia)?” Indeed, I argue specifically that an entire range of infectious diseases, primarily those that kill and debilitate the very young and the very old, are not threats to national security per se, although they would certainly constitute issues of human rights and threaten human security. Measles may be a profound issue of human rights, and of economic development, but it does not typically generate mechanisms (demographic, economic, psychological) that undermine the security of the state. Excessively broad categorizations wherein all pathogens are designated as threats to national security must be eschewed because they obfuscate coherent analysis, and because they undermine the credibility of the argument.
What, then, of our original hypotheses about the relations between contagion, the dynamics of state-society interaction, and effects on international governance? The balance of evidence suggests that the following preliminary conclusions may be drawn at this time, as per the domain specified below.
Infectious disease may generate significant negative outcomes for human health, ranging from debilitation to the death of the human host. Such outcomes range from a sickened population to widespread mortality and the consequent contraction of the population, or the pathogen-specific contraction of defined age cohorts within a given population. For example, the mortality generated by HIV/AIDS is most pronounced in the 15-45 age cohort. Epidemics may also generate pressures for rapid out-migration from affected areas, as people attempt to flee the source of the infection. Of the case studies, HIV/AIDS exhibits profound negative impacts in the domain of demography, particularly as it continues to destroy entire cohorts of young adults and leaves behind massive orphan populations in a climate of destitution. The global demographic impact of the 1918 pandemic influenza was equally significant (at circa 50 million dead), again with a concentration of mortality in the cohort of young (and previously healthy) adults. Conversely, both the SARS epidemic and the BSE/VCJD epidemics have both exhibited relatively minor levels of morbidity and mortality.
The psychological effects of emergent pathogens on the body politic typically include significant levels of uncertainty and difficulties in accurate estimation of risk, contributing to profound emotional responses (notably fear, anxiety, and anger). This affective bias consequently impedes Pareto-optimal rationality. Affective distortions may also facilitate the construction of negative images of the “other,” resulting in stigmatization of the ill, persecution of minorities, and diffuse interethnic or inter-class violence. Emotion may also combine with information that conflicts with individual belief structures to generate cognitive dissonance, wherein individuals engage in denial of the discrepant information in order to minimize psychological pain. Of the four modern cases examined herein, both the SARS and BSE epidemics exhibited considerable psychological impacts through the generation of fear, anxiety, and panic and the stigmatization of domestic minorities and foreign populations. The 1918 influenza seems to have had considerable negative effects on the morale of affected military units and on some factions of civil society. The HIV/AIDS pandemic initially provoked considerable fear and anxiety, but in recent years its principal manifestation has taken the form of stigmatization (and often violence) toward the ill. Consequently, any evaluation of pathogenic threats to national security must take into consideration the possible psychological effects of contagion on factions, state-society relations, and material prosperity. Thus, psychological disruptions may trigger disruptions in the realm of the material-contextual.
Pathogen-induced destruction and/or debilitation of human capital erodes the productivity of workers, imposes direct and indirect costs on families, firms, and the state, and often compromises a society’s ability to generate social and technical ingenuity. Given that the burden of disease typically falls on the poorer segments of the population, the proliferation of pathogens may exacerbate or intensify inter-class hostilities as the gap between rich and poor expands under conditions of contagion. Destruction of the endogenous human capital base will therefore compromise microand macro-level economic productivity, and may severely impair those sectors of the economy that are labor-intensive (e.g., agriculture and mining).
At the macro level, disease may result in a significant contraction in the production possibilities of an economy, perhaps even generating economic dislocation and decline in severe cases. Such contraction consequently imposes constraints on the revenues that the state may extract from the people through taxation, further limiting its capacity to deliver public services. Furthermore, multiple pathogens may interact through co-infection to augment the aggregate burden of disease on a population (e.g., malaria and HIV in sub-Saharan Africa). Severe epidemics may wither local, regional, and perhaps even macro-level domestic and regional economies.
Significant episodes of contagion may shift the dynamics of internal power away from society and toward the state, as the latter imposes draconian controls on the former in an attempt to limit the socioeconomic disruption generated by the pathogen. Within society, diseaseinduced in-group/out-group psychological dynamics will often manifest as identity-based conflicts, generating or exacerbating competition and conflict between socio-economic classes and between elite factions and perhaps manifesting in the form of inter-ethnic conflict. Through the depletion of human capital assets and through declining tax revenues, contagion will induce a sclerotic effect within domestic institutions of governance, compromising the state’s capacity to deliver essential services. As the institutions of governance become increasingly brittle and fragile, governments may exhibit increasing dysfunction and even paralysis. Particularly severe outbreaks of infectious disease may undermine the legitimacy of pre-existing structures of hierarchy and authority within affected systems of governance. This may result in the de-legitimization of dominant societal institutions and religious entities, or the delegitimization of the state itself in the face of its inability to provide required public goods and essential services.
Furthermore, as a result of the de-legitimization of existing structures of authority (including social and religious hierarchies), contagion may induce a breakdown of accepted behavioral norms, resulting in social chaos and generalized lawlessness. Criminal activity may increase, often dramatically, as the state’s capacity to provide public goods, such as law and order, diminishes as a result of disease-induced declines in state capacity. The state, seeking to restore order, may often engage in severe (often draconian) measures to control the people, often provoking violent reactions and resulting in the further destabilization of the polity.
Contagion often proves disruptive to societies, and it is extremely problematic for governance, but it may result in the production of ingenuity that allows societies, economies, and structures of governance to switch to new modes of operation. For example, should the effects of the contagion fail to overwhelm the adaptive capacity of a polity, the shock may act as a catalyst and generate windows of opportunity for change. However, if the shock generated by contagion is too powerful it will exceed the endogenous adaptive capacity of the affected state, and consequently disease may shatter nations, as it did the majority of Amerindian cultures. Thus, the dynamic between contagion and ingenuity is revealed, reinforcing the claims of historians that disease has played an important role in determining the evolutionary trajectory of societies and states.
Outbreaks of infectious disease (e.g., SARS) have the potential to induce the destabilization of regional economies, and to generate a drag on the productivity of the global economy. Outbreaks will typically impede the flow of trade goods from infected to uninfected regions, and such goods may be subject to quarantine or outright embargo. Such pathogeninduced impediments to the flow of goods and persons are exacerbated by fear and panic, which may be manipulated by domestic economic interest groups (as in the BSE affair) or by the global media. In certain cases (such as that of SARS) one may observe the complete embargo of possibly infected goods until the etiology of the pathogen, and its vectors of transmission, can be determined with some precision. Infectious disease may also undermine foreign investment in seriously affected regions because of perceptions of economic and political instability (e.g., HIV/AIDS), and fears that a firm’s workers may succumb to the contagion, eroding the base of human capital within that firm. Thus, risk premiums will be significantly elevated in regions of significant pathogen prevalence. Collectively, this creates problems for global health governance as affected states have powerful disincentives to report outbreaks of disease to the WHO, or to accurately report the extent of the infection.
The balance of evidence suggests that contagion will not generate conflict between sovereign states, despite disease-induced shifts in relative power, but may actually hasten an end to bellicose behavior. Relatively healthy countries will wisely avoid infected regions, insofar as armed conflict functions as a vector of disease transmission, increasing the probability of importing the pathogen in question to one’s homeland through demobilization. Conversely, the evidence suggests that contagion has the capacity to breed political and economic acrimony between sovereign states but will not generate inter-state war. For example, negative outcomes in the domain of economics radiate as externalities to affect the domain of governance. As contagion obstructs international trade and commerce, it may induce political acrimony between affected states and/or regions, or between states and international organizations (as in the case of SARS).
Visitations of contagion expose persistent problems in cooperation between sovereign states and other agents in the realm of global health governance. Over time, differential levels in the aggregate burden of disease on populations may affect the relative power of those countries. Therefore, if a country A experiences serious burdens on population health resulting from the synchronous burden of malaria, onchocerciasis, and HIV/AIDS (for example) its economic productivity will be limited relative to a healthier country B over time. Disease will also likely compromise the infected country’s institutional cohesion and efficacy, and the very capacity of the state to defend itself and to project power. Therefore, ceteris paribus, as a result of the heavy burden of disease on A, its aggregate power is diminished relative to B. Again, this does not seem to generate warfare between the parties in question, but it certainly may affect other political dimensions of country A’s relationship with country B. For example, disease may reinforce existing structures of material inequities between countries. The burden of disease in tropical regions, due to pathogenic endemicity, reinforces the poverty of those affected countries, and traps them in a mutually reinforcing cycle of illness and poverty.
As I have argued, the health of the population is central to economic productivity at the micro, sectoral, and macro levels, and the ingenuity (social and technical) that emanates from a healthy population drives innovation and adaptation. Thus, health generates prosperity, and through processes of extraction (i.e., taxation) the state consequently derives its fiscal resources from this productive population base. Moreover, the state’s investments in the health of its population confer additional legitimacy on the government, and those revenues extracted through taxation may subsequently be converted into public goods (such as education and law enforcement) that honor the social contract and further legitimize the state in the eyes of the people, stabilizing relations between state and society.
Furthermore, the state’s economic resources are fungible and thus readily translated into military power. An expanding economy based on a healthy, productive, and innovative workforce thereby contributes directly to the martial and ideological power of the state over the longer term. In addition, a healthy pool of recruits is essential to maintaining the viability of any modern military, as is the health of a trained and highly skilled officer corps. In aggregate, then, the state’s investments in the population’s health contribute to socio-political cohesion and prosperity, which allow the state to maximize its material (and ideological) interests, to project power abroad, and to ensure its survival. The power and therefore the security of the state is, therefore, directly dependent on the health of its population. As Cicero noted centuries ago, political elites must recognize the wisdom of investing in the health and well-being of the body politic, in their own self-interest. Thus, investments in health create a virtuous spiral (or feedback loop) of increasing prosperity and socio-political stabilization.
Conversely, in the presence of epidemic levels of infection, with attendant debilitation and mortality, the productivity of workers will decline markedly. Poor health impairs cognitive function and consequently limits the production of ingenuity and the development of successful strategies of adaptation. Disease-induced stagnation and/or contraction of the economy and markets will then reduce the revenue streams available to the state through taxation, and correspondingly limit the capacity of the government to honor the social contract by delivering crucial public services. This will then negatively affect public perceptions of the government’s legitimacy. Furthermore, as contagion erodes the human capital resources of affected bureaucracies, it will generate institutional fragility, sclerosis, and even paralysis. Over the longer term, as evident in the HIV/AIDS pandemic, the debilitation and/or mortality of enlisted ranks and of officers creates enormous problems in continuity for military institutions and for law enforcement. Therefore, disease undermines the coherence of the state and its ability to carry out its bureaucratic functions. The failure of the state to deliver public goods in a timely and effective manner will erode the perceived legitimacy of the regime in the eyes of the people.
Significant fear, anxiety, and even panic within a society may result in the stigmatization of the infected, or in the targeting of minority groups and campaigns of discrimination or violence directed toward them. Such psychological “constructions” may generate social instability, which the state perceives as a direct threat to its material interests, leading to governmental intervention (in draconian fashion). Paradoxically, such heavyhanded interventions by the government often trigger societal reactions against the state itself, occasionally manifesting in violence (riot and rebellion).
The balance of the evidence suggests that epidemics and pandemics may exhibit emergent properties. Thus, emphasizing the connectivity between domains, the processes of violent conflict and inter-state warfare may interact with increasing speed of travel, increasing magnitude of trade, burgeoning population pools in mega-cities, and ecological degradation to facilitate the continuing emergence of zoonotic pathogens, and their endogenization within the human ecology. Therefore, we are likely to be confronted with many novel (and pathogenic) microbial agents in the centuries to come.
Such complex and interactive processes of emergence contribute directly to the non-linear manifestations of pathogens as rapidly (often geometrically) expanding epidemics. While there is some preliminary evidence to suggest that certain domestic institutions of governance may respond to epidemic disease in non-linear fashion (i.e., rapid and punctuated change), such patterns of change are also observed at the international level. Therefore, this domain of inquiry requires greater study before any firm conclusions may be drawn.
In the final analysis, emergence and proliferation of infectious agents should logically increase as processes of globalization accelerate. However, disease events will act as biotic countermeasures (negative feedback loops) to slow the processes of globalization through reductions in the movement of trade goods and migrants, the depletion of human capital, and the erosion of economic productivity. In a very real sense, then, infectious disease acts as a negative feedback mechanism (or a natural brake) on the processes of globalization.
On reflection, punctuated-equilibrium theory appears to offer some utility in explaining the political outcomes associated with visitations of contagion. At the level of the sovereign state, the broad spectrum of political history clearly indicates that outbreaks of epidemic disease often resulted in rapid debilitation of military forces, in destabilization of relations between society and the state, and often in fractured or paralyzed domestic institutions of governance. In the most extreme cases, such as plague in Europe or smallpox in the Americas, pathogens resulted in the rapid and non-linear destabilization of entire polities as the contagion exceeded adaptive capacity. In the modern era, one can certainly argue, certain agents of contagion have contributed to the sclerosis and fragility of domestic institutions. For example, the pandemic influenza of 1918 certainly affected the prosecution of the war, as it directly undermined the German offensives in the spring and summer of 1918, undercut the economic productivity of affected polities, stressed Austrian institutions of governance, and even limited the efficacy of the American Expeditionary Forces in the latter months of the war.
The fracturing of domestic institutions is also evident in the case of BSE, wherein the emergence of prions generated rapid and profound institutional changes throughout British, French, and ultimately European structures of governance. The SARS epidemic also resulted in significant non-linear change in domestic structures of governance in affected polities, particularly Canada and China. Conversely, punctuatedequilibrium dynamics are not as apparent in the case of the HIV/AIDS pandemic, although arguably viral-induced stresses have directly contributed to the collapse of the Zimbabwean economy, imperiled the structural cohesion of the apparatus of governance, limited the state’s provision of public goods, and propelled the state into its draconian repression of an increasingly disaffected and rebellious population. Indeed, this enduring consonance between the appearance of contagion and the hierarchical abuses of power by the state against its population is evidence of punctuated-equilibrium dynamics in operation, as the balance of power between society and the state is altered.
At the international level, the punctuated-equilibrium model is equally salient. The case studies illustrate that the 1918 influenza affected the balance of capabilities between the various protagonists in World War I. Further, contagion combined with war to generate stresses that contributed to the rapid demise of empires (German, Austrian, and Ottoman) in the fall of 1918. Thus, pandemic influenza altered the structure and trajectory of international relations in Europe in the decades that followed. Moreover, SARS resulted in the rapid (if ephemeral) empowerment of the World Health Organization relative to its sovereign member states, and BSE resulted in the rapid and permanent reform of various institutions within the construct of the European Union. Finally, the HIV/AIDS pandemic has resulted in the formation of a new division within the UN superstructure (UNAIDS) and has fomented the creation of a multilateral institution (the Global Fund for HIV, Tuberculosis and Malaria).
Epidemic disease often precipitates evolutionary change in affected societies and in the architecture of governance within an affected polity. Conversely, changes in technology, social relations, and ingenuity (technical and social) may stimulate corresponding evolutionary pressures within the microbial realm, accelerating prospects for mutation and the colonization of novel ecological niches. The interaction between human societies and microbes may, then, be seen as co-evolutionary in its dynamics, each side responding to changes in the other over time. Human societies do not simply adapt to some static exogenous environment; they change that microbial environment, leading to the decline of certain pathogens and the rise of new challengers.
In the twentieth century, advances in public health and anti-microbials shifted the balance of power toward human societies. However, there is a significant difference in the velocity of change in each variable, as pathogens possess the capability of rapid genetic mutation, enhanced by the processes of swapping DNA between pathogens via surface antigens and transposons (antigenic shift). As pathogens acquire increased resistance through exposure to our anti-microbial armamentarium, the balance of power begins to shift back toward the microbes. Evidence of this is increasingly apparent in surging mortality from such resistant pathogens as methycillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), multi-drug resistant tuberculosis, and resistant strains of HIV and malaria. Furthermore, humanity’s penchant for ecological degradation only increases the mathematical probability of emergence of novel (and perhaps lethal) pathogens from their natural reservoirs. Such dynamic systems are likely to exhibit oscillations in dominance between microbes and humans over considerable periods of time. Although we humans have enjoyed a recent period of dominance, the lack of significant progress in developing new anti-microbials suggests that the balance may be shifting to favor our microbial adversaries.
Health is a best perceived as a public good—that is, the health that I enjoy reduces the probability that infection may be transmitted from me (as host) to another human being and subsequently proliferate throughout the population. The concept of herd immunity stipulates that not all members of a population (say, of cattle) need be inoculated to provide the entire herd protection against a pathogenic agent. Specifically, only a certain majority of the herd need be inoculated such that the transmission rate of the pathogen is reduced to the extent that it cannot become a self-sustaining epidemic within the community of host organisms (rate >1). The same principle holds for human societies, as the health of my neighbor acts as a public good to enhance my health by limiting the probability of disease transmission throughout the community at large. Health is therefore both non-rivalrous and non-exclusive, and the good health of individuals in a community generates a collective or public good experienced by the polity in question, and perhaps the entire human species.
Conversely, the proliferation of contagion generates externalities, or “public bads,” that impose diffuse and pernicious costs on others in society, and perhaps throughout the global system. Within a society, infected hosts act as vectors for the distribution of a pathogen (or pathogens), inadvertently visiting empirical harm on others. The negative impacts of illness function as externalities, imposing a significant range of costs on the larger society—including health-care costs, rising insurance premiums, the destruction of the endogenous base of human capital (so evident in the HIV/AIDS pandemic), and diminished economic productivity. Furthermore, at the international level, countries that are impoverished and/or destabilized as a result of contagion may consequently generate externalities that affect other countries, other regions, or the international system. For example, the initial failure of China to contain the SARS epidemic resulted in the proliferation of the disease in Southeast Asia and North America, generating significant economic costs to the entire Pacific Rim region. Similarly, the policies of denial and obfuscation by leaders in Zimbabwe and South Africa regarding HIV/AIDS have directly facilitated the prevalence of the pathogen throughout the region, and such entrenchment of the virus in Southern Africa now functions as a mechanism to distribute the pathogen on a global scale.
I have employed a republican revision of the Realist paradigm which holds that certain manifestations of epidemic disease present a distinct threat to the material interests of the sovereign state. This threat is generated through the disease-induced destruction and debilitation of the population, the erosion of productivity and prosperity, fear-induced social destabilization, the disruption of institutions of governance, and the consequent erosion of the state’s power relative to unaffected rivals in the international system.
A caveat, however: orthodox Realist responses that advocate strategies of self-help in an increasingly globalized world are problematic for states with low endogenous capacity. Indeed, even the United States, with its high capacity, had great difficulty containing just one individual who was infected with a highly resistant form of tuberculosis in the spring of 2007. Complex interdependence, a facet of Liberalism, must thus also be imported into republican security theory. Ethnocentric visions of global health that exclusively advocate self-help, to the exclusion of building capacity in the developing countries, are myopic and likely to be ineffective in the global containment of emergent pathogens (e.g., a novel lethal influenza). Republican security theory is therefore a useful analytical lens through which to view the threat posed by contagion; however, the development of endogenous capacity for containment must be supplemented by cooperative international initiatives, as the means by which to effectively maintain surveillance and containment of pathogens on a global scale. Such cooperation is essential to the protection of the material interests of all states. Furthermore, a republican variant of Realist theory allows for interactivity between the domestic and systems level of analysis, such that problems at the domestic level may generate externalities that destabilize the international system.
The best way to curtail future epidemics (and pandemics) is to augment the endogenous capacity of health-care infrastructure and to improve the basal health of populations, particularly throughout the developing countries. Such investments are logical because the fundamental conditions for disease emergence are accelerating as a result of the processes of globalization (increased population density, ecological degradation, rapid transportation technologies, and mass migration), yet in many developing areas disease surveillance and containment capacity is low or nonexistent.
Given that global public health can be understood as a public good, the costs of providing such goods (epidemiological surveillance and containment) should be borne by the international community, although continued diplomatic leadership by a hegemonic coalition of states will doubtless remain central. Further, developed countries should possess (or develop) a level of “surge capacity” to deal with epidemic events that generate mass morbidity and mortality, such as a new lethal pandemic influenza. At present there is little surge capacity within the United States as a result of its uniquely market-driven health-care system. Indeed, there are not enough beds, respirators, and nurses in the United States to effectively deal with a flu pandemic on the level of 1918. The presence of weak and often dysfunctional international institutions that are chronically lacking in funding (the WHO), and which occasionally suffer from politicized and/or weak leadership, complicates proactive responses. While the recently revised International Health Regulations should assist in increasing global response capacity to pathogenic threats, the regime continues to lack any substantive capacity to enforce compliance by its member states. Thus, it is incumbent upon states to lead the way in assembling regional coalitions to deal with emergent health threats.
What further measures should be taken to bring the concept of “health security” into the mainstream of security studies?
Reduce Ethnocentrism Orthodox security analysts remain wedded to the concept that the developing countries are essentially non-strategic, unless petroleum reserves (or terrorists) exist in that region. The prevailing security literature must change to integrate the concerns of developing countries. Moreover, the literature is also guilty of exceptional anthropocentrism, regarding threats to security as resulting exclusively from human agency. As Hurricane Katrina demonstrated, natural processes and events can also generate profound disruptions to the prosperity, coherence, effective governance, legitimacy, and security of sovereign states. The destruction visited on modern societies by the 1918 influenza pandemic and by the modern manifestation of HIV argues for increasingly ecocentric and non-ethnocentric perspectives within the security literature.
Encourage Scientific Literacy As Deudney argues, much of the current political science literature completely disregards those materialcontextual factors that have influenced societies and states over millennia. In this era of faddish post-modernism, such filters of abstraction have grown so pronounced that some social scientists now question the empirical existence of pathogens. Simply put, many political scientists are uncomfortable in the realm of the hard sciences, and very few have any significant understanding of microbiology, epidemiology, or medicine. Thus, the education of social scientists in the core concepts of biology, ecology, and public health will provide for greater comprehension of the risks involved in pathogenic emergence and proliferation. Conversely, those in public health and medicine would do well to become conversant in the tenets of political science, so as to understand the vagaries of the political process.
Counter Threat Myopia The terrorist attacks of 2001, and the subsequent wars in Afghanistan and Iraq have deflected the security community’s attention away from those infectious disease threats which had been on the radar at the United Nations Security Council in the spring of 2001. The prevailing obsession with anthropocentric threats (i.e., terrorism) leaves little cognitive space for scholars or policy makers to be concerned about subtle and attenuated threats, and makes it difficult to observe health and environmental challenges to security.
Increase Historical Literacy In recent years, the discipline of political science (particularly the American school) has bowed to the quantitative orthodoxy of econometrics, and to the dogma of parsimony and linearity. In complex and non-linear systems (such as the interactions between pathogens, economies, states, and societies), an exclusive focus on parsimonious empirical methods may be misleading. Many newly minted PhDs in political science may be able to run advanced multi-variate regressions but have never read the canon of republican political thought embodied in the work of Aristotle, Plato, Thucydides, Machiavelli, Hobbes, Montesquieu and Rousseau. Beyond the historical community, academia is largely unaware of the historical relations between health, governance, and power. In order to acquire a more balanced perspective, political scientists might study more history and anthropology, and less econometrics.
Provision of Evidence As the frequency of catastrophic epidemics has declined, evidence of the malign effects of contagion on state cohesion, power, and security has been relegated to the past (as is true of pandemic influenza) or has been largely dismissed as a scourge of the developing countries. Thus, scholars must be vigilant both in their investigation of the relations between such variables and in their attempts to remind the current generation of our continuing vulnerability to emergent pathogens. As the epidemiologist Stephen Morse reminds us, there is always a novel pathogen in the pipeline of nature. To that end, a deeper and crossnational investigation into the effects of the pandemic influenza of 1918 on prosperity, governance, and security should be conducted posthaste. Further cross-national investigations into the effects of the current HIV/ AIDS pandemic on governance should also be undertaken.
Acknowledge Cognitive Limitations Humans have been programmed biologically to respond to imminent threats, such as a proximate predator. Therefore, they are far more likely to perceive temporally proximate “events” as related to significant threats, as opposed to attenuated and often difficult to observe “processes” such as ecological destruction and the gradual winnowing of a population by consecutive waves of contagion. The environment-and-security debate has been witness to similar issues of societal Attention Deficit Disorder, as few pay attention to the attenuated processes of ozone depletion (or global climate change) until the system reaches a critical threshold, whereupon the issue “suddenly” becomes a profound threat to the human species and to the security of sovereign states. Threats to global health often exhibit similar properties, particularly stealth pathogens such as HIV/AIDS.
While the human species has significantly reduced its vulnerability to contagion over the centuries, this reduction in vulnerability is primarily pathogen-specific. Certain microbial agents (such as pandemic influenza) still represent an enormous threat to the national security of all polities. Profound variance in the capacity of states and in the attributes of populations suggests that different countries will be vulnerable to different pathogens. Thus, one pathogen (e.g., HIV/AIDS) may combine with others to generate a profound burden of disease that threatens the prosperity, stability, and security of a certain country (e.g., Zimbabwe). The same pathogens may not threaten a developed country such as Canada, which instead proved quite vulnerable to the SARS coronavirus. Thus, pathogenic threats to security are highly contextual. Despite technological optimism and anthropocentrism, human societies remain firmly ensconced within the ecological constraints of the natural world, and will remain vulnerable to the continuing processes of pathogen emergence in the centuries to come. Therefore, it would be expedient to accelerate our efforts in improving global population health, and in developing a global infrastructure for the effective surveillance and containment of contagion.
On a positive note, the extreme destabilization witnessed during historical plagues and pestilences has diminished greatly over the centuries. Advances in technical ingenuity have resulted in the development of antimicrobial agents, and in improved nutrition for much of the world’s population. Social ingenuity has also improved over the centuries as the architecture of global health governance has begun to improve, and as national governments now comprehend that excessively draconian (contagionist) policies can spawn and exacerbate existing conflicts between societal factions (or classes) and the state itself. Certain contagionist policies remain in place (such as the necessity for quarantine and social distancing). However, certain polities have become increasingly draconian in the face of contagion, notably China (SARS) and Zimbabwe (HIV).
On a cautionary note, despite humanity’s recent advances in the domain of public health, there is reason to be concerned about the proliferation of resistant infections which diminish the efficacy of our existing anti-microbial armamentarium. Furthermore, pharmaceutical companies often eschew investments in new classes of anti-microbial prophylaxis, claiming that the returns on investment are insufficient. Thus, many of the diseases of the developing countries (e.g., malaria) continue to proliferate because the people they affect are unable to pay exorbitant prices for new classes of medication. The scale and velocity of ecological degradation is troubling, in that disruptions to biological equilibria may generate new niches for pathogenic emergence or mutation. Global climate change is particularly troubling, as it will lead to the latitudinal and altitudinal expansion of vectors (e.g., mosquitoes), permitting the proliferation of various infective agents (e.g., malaria) in human populations that possess no genetic or acquired immunity to the pathogen. In the case of malaria, increasing temperatures will also increase the biting rate of the vectors, and even the incubation rate of the plasmodium itself, intensifying the burden of disease on affected populations. It is certainly reasonable to suspect that climate change may also result in the emergence of novel pathogenic agents that may thrive in warmer and wetter environments.
The centrality of physis to republican political thought facilitates the location of pathogenic threats to national security within the domain of the wider “environmental security” discourse. As human actions continue to generate significant disturbances within the ecosystems of the planet, such deviations facilitate the emergence of novel pathogens and the mutation of existing strains. The hubris of the human species, the ascendance of the ideational and the ignorance of the material, and the illusion that humanity has been liberated from the constraints of the natural world are problematic. The human species must recognize its place within the complex web of life, eschew anthropocentric orthodoxy in favor of ecocentric perspectives, and return a modicum of equilibrium to the biosphere. The development of ecological consciousness (and praxis) in societies and markets, will permit a return to greater biotic equilibrium, reducing the speed of pathogenic emergence and mutation. Through such tactics, humanity may diminish its vulnerability to contagion, and to the chaos it may generate.