Securitization of Infectious Diseases and ‘Foucauldian’ International
Relations: Approaching the Western Global Hegemonic Argument
Ricardo Pereira
University of Coimbra
Paper presented at WISC 2008 – Second Global International Studies Conference, Panel
“Security Discourses,” Faculty of Social Sciences, University of Ljubljana, 23-26 July
2008. This is work in progress, and will be subject to further revisions. Please do not
cite it. Thank you.
Abstract: There is a generalized consensus today around the idea that infectious diseases
such as HIV/AIDS, tuberculosis, malaria, avian flu, etc., have become security issues,
as leading Western global powers, the World Health Organization and the United
Nations’ system recognize, together with large parts of the activist and academic
communities. But for how long has it that been? Leading scholar in the field David
Fidler writes about it as a recent, “revolutionary” (Fidler, 2005) process intimately
connected to post-September 11 counterterrorist and post-2003 SARS outbreaks
measures and other events. In this paper I introduce a “historical-political” perspective
aimed at discussing Fidler’s view. Putting forward Michel Foucault’s “analytics of
power,” I aim to explore the ramifications between such securitization and
developments in the rise and reinforcement of hegemonic globalizing liberal power after
the end of the Cold War. As I start this account with a focus on 1990s human security
paradigm in security and relations between the West and the former colonial world, I
assess the power role epidemiological surveillance has played since the 1830s.
Biographical note on the author:
Doctoral student in International Relations: International Politics and Conflict
Resolution at the Centre for Social Studies, University of Coimbra, funded by the
Foundation for Science and Technology. Feedback is highly appreciated through the email address: pereirarjr@yahoo.com.
1
Introduction1
In the July 2008 issue of the Bulletin of the World Health Organization,
Margaret Chan (director-general of the World Health Organization [WHO]), Jonas Gahr
Støre (Norwegian minister of foreign affairs) and Bernard Kouchner (French minister of
foreign and European affairs, and holding the European Union’s presidency through
December 2008) called for a growing linkage between foreign policy and health.
Acknowledging the long tradition of health as being taken as “very low politics”
(Fidler, 2005), they assert “when foreign policy-makers do pay attention to public
health, it has tended to be in times of crisis such as with SARS2 and avian flu” (Chan et
al., 2008). Illustrating with the recent Foreign Policy and Global Health Initiative 3,
Chan, Støre and Kouchner’s position is aligned with recent incursions by a “technical”
organization such as WHO in the slippery domains of foreign affairs, in which a
security horizon has been all too present. WHO and other intergovernmental and nongovernmental bodies in health (UNAIDS is an excellent example) have been keen in
“securitizing” the provision of health services as a means to fulfill global, Western-led
stabilization purposes, as the 2007 World Health Report showed (WHO, 2007b)
Arguably starting as a means to obtain further visibility and corresponding
higher volume of funds by and for the activist world (Peterson, 2002), the healthsecurity nexus discourse has been particularly successful in terms of lifting the health
dimension up to the high ranks of security and defense policies. Namely the deadliest
epidemics (HIV/AIDS, tuberculosis, and malaria) and those more directly menacing the
1
This paper is part of my nascent doctoral project on the global policies for infectious diseases,
particularly with regard to prevention and treatment of the human immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS), and the corresponding technologies that discuss, strategize
and articulate with other topics in Western states’ foreign agendas.
2
SARS stands for “severe acute respiratory syndrome.”
3
The Global Health and Foreign Policy Initiative includes Brazil, France, Indonesia, Norway, Senegal,
South Africa and Thailand.
2
West (usually food- and migrant birds-related: brucellosis, SARS and avian influenza)
have already made it to the strategic documents of the United States (House, 2006) and
the European Union (Solana, 2003). Yet, contextual aspects related to September 11,
post-Cold War “new wars” and neo-liberal globalizing pushes and other interrelated
phenomena (urbanization, migration, refugees, etc.) are also inscribed in the whole
picture. However, is not there a genealogy in these processes beyond the Cold War’s
end, the September 11 and the 2003 SARS outbreaks?
Historically, public health regulation has relied, at the national scale, on health
departments, and, at the international level, on WHO and other intergovernmental
settings. This field also belonged to development aid agendas. Though at a relatively
smaller scale, epidemiology has also been important for the military structures, notably
during the Cold War, in terms of research and development of biological weaponry. The
Western victory of the Cold War and the perspective of democratization and global
human rights promotion have favored the international health provision agenda,
crystallized through the Millennium Development Goals. Nonetheless, at the same time,
due to the change of threat perception in the West – from the overt attacks against the
national territorial integrity by an inimical state or alliance of states to “new threats” of
a deterritorialized and multiform nature – health and other human-related dimensions
have been growingly inserted in Western defense agendas. At the same time,
intervention in disease has become instrumental to those agendas.
The first part of this paper consists on the presentation of the concept of
infectious disease and its inclusion in the human security paradigm. Human security is
particularly emphasized with the aim of reinforcing the current importance of nonmilitary issues (pandemics, migrations, state failure, etc.) to the strategic concepts of the
3
West. Human security accounts for an expression of Western soft power displayed both
bilaterally or multilaterally (through the United Nations’ system and other), under
several auspices: sustainable development of poor regions; conflict prevention and postconflict reconstruction; peacekeeping missions; etc. I will analyze relations between
health security and other human security dimensions. Drawing from scholarship on
international health law by David Fidler, the second part focuses on a “juridicalinstitutional” argument put forward in order to explain current processes of
securitization in health, arguably grounding its mainstream discourse. That argument
accounts for the crossover between post-September 11 “war on terror” and the 2003
SARS outbreaks, and the consecration that securitization received in the latest, 2005
revision of WHO’s International Health Regulations (IHR). The third section introduces
another argument with an aim to discuss the former one. Debating the first United
Nations’ Security Council session dedicated to a “health threat” (HIV/AIDS), in
January 10, 2000, and its consequences, I adopt a lens more attentive to a securitization
constructed around historical-political elements. Starting from Michel Foucault’s
reflection on the Western polity and nature of power, I seek to present that session as an
eminent response to a contemplation of a “dark side” of globalization (as British
sociologist Anthony Giddens famously put it) directly threatening the West. No matter
contextual as it may be, such contemplation is rooted in around two hundred years of
Western experience in public health intervention as global securitizing practice.
4
Epidemics and Human Security
Infectious diseases are caused by an organism that penetrates the body, grows
and multiples in cells, tissues and body cavities, and constitute the main cause of death
in the world. They tend to emerge and remerge according to the conditions of the
ecosystems where human beings live in (Prescott, 2007). Diseases that have been
receiving more attention are, on the one hand, HIV/AIDS, tuberculosis and malaria,
and, on the other hand, avian influenza, SARS and brucellosis (also known as “mad cow
disease”). The response to the former set has been mostly under the auspices of grand
funding schemes, such as the Joint United Nations Programme on HIV/AIDS
(UNAIDS), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund),
and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), in
conjunction with other public and private initiatives. These programs were established
to prevent and treat the most lethal diseases in the world, especially in Southern and
Eastern Africa, but with an increasing focus in other world countries/regions: India,
China and South-eastern Asia, the Caribbean, Russia and Eastern Europe. Those
diseases are generally transmitted via sexual and reproductive relations, drug injection
and needle sharing, and lack of sanitation, food and water. Often diseases such as
tuberculosis appear and disseminate opportunistically in people already living with
AIDS. These diseases account for the greatest cause of death in the world, and their
effects are felt at the family and community levels. As far as the latter sort of diseases
goes, they are animal-transmitted, and as they enter the food chain, they pose a direct
threat to the populations. Despite its (still) low score in inflicted deaths, Western and
international authorities often picture them as likely to resemble the 1918 Spanish Flu.
Whereas the number of AIDS, tuberculosis and malaria deaths “suffices” in order to
5
explain the political, social and financial relevance of those epidemics and raise
awareness and funding schemes, the case of avian flu is revealing from a political (and
security) point of view. Although it can vastly hit the globe, I argue that the very direct
threat that they pose to the West (as it has been doing in Western Europe) bares the
logics behind its prevention and research. The reverse rationale is adaptable to the case
of WHO’s classification of specific diseases as “neglected.” Diseases such as buruli
ulcer, dengue/dengue haemorrhagic fever, dracunculiasis (guinea-worm disease),
fascioliasis, human African trypanosomiasis, leishmaniasis,
leprosy, lymphatic
filariasis, neglected zoonoses, onchocerciasis, schistosomiasis, soil transmitted,
elminthiasis, trachoma, and yaws, coincidently were long eradicated in the West. Rare
cases emerge as a result of travel or immigration.
The topic of infectious diseases has been inserted in the most recent Western
strategic concepts in articulation with other issues that, reflecting a vision of national
security centered in globalization-related threats, surpass the structuralist, statecentered, Cold War-like conceptions of International Relations.
[These] new flows of trade, investment, information, and technology are
transforming national security. Globalization has exposed us to new challenges
and changed the way old challenges touch our interests and values, while also
greatly enhancing our capacity to respond. Examples include: Public health
challenges like pandemics (HIV/AIDS, avian influenza) that recognize no
borders. The risks to social order are so great that traditional public health
approaches may be inadequate, necessitating new strategies and responses. (The
White House, 2006: 47, my emphasis)
“In much of the developing world, poverty and disease cause untold suffering
and give rise to pressing security concerns. (...) New diseases can spread rapidly
and become global threats.” (Solana, 2003: 5-6)
Throughout the Cold War, strategic alliances between states were established
according to a notion of state survival and balance of power, as the leading neo-realist
school at the time promoted. Parallel to that, however, perhaps due to “very low
6
politics” (Fidler, 2005), the international health domain appeared as a remarkable
example of international regime. WHO helped to build confidence among its members,
actually to the point of contributing to a focus on the human rights agenda, under the
auspices of the 1978 “Health for All” Alma-Ata Declaration. Nevertheless, the end of
the Cold War and the hegemonic expansion of the neo-liberal model to market economy
brought about changes more in terms of nature of threat than subject of threat. As
bipolar competition ends and neo-liberalism expands globally, state relations are not
bound to cause so much preoccupation from a security viewpoint as “non-traditional
threats” do, often regarded as the price Western modern, globalizing society had to pay
for the sake of its own lifestyle and ontological security (Giddens, 1995). I mean:
environmental imbalances, rapid urbanization in non-industrialized countries, irregular
migrations, religious fanaticism and terrorism, ethnic wars, refugees, Western urban
insecurities, racism and xenophobia, etc. These threats, or risks, did not nullify
geopolitics;
they
complemented
it
with
a
biopolitical
element,
instead.
Conceptualizations on that have been highly informed by 1980s Sociology and captured
in International Relations by “constructivist” approaches. In that regard, the
“Copenhagen School” (Buzan et al., 1998) has been very prolific thanks to its
securitization theory, which analyses the primary role of language in the “speech-act”
formulation of security (Wæver, 1995).
In general terms, the “new threats” I refer to are described by Anthony Giddens
as “dark side” of globalization drawing from what Ulrich Beck has called “risk society”
(Beck, 1992). Risk society essentially corresponds to late modern, post-industrial
European society, characterized by insecurity and conditioned to risk management.
Analyzing German industrialization’s impacts, which parallel to national wealth, has led
to pervasive pollution affecting the whole of society, Beck addresses modernity’s
7
“boomerang effects” (Beck, 1998). Boomerang effect illustrates the risks that economic
globalizations’ advantages have caused, especially since its vast expansion since the end
of the Cold War. One of such risks – turned out as actual hazard in September 11, 2001
– was global terrorism. With regard to epidemics, a risk and hazards have pronouncedly
been associated with the deterioration of many populations’ living standards in
developing countries, particularly in Africa. Phenomena such as “new wars” (Kaldor,
1999) and “failed states” (Zartman, 1995) have strongly potentiated that negative trend.
These phenomena appear as both cause and effect of the threats mentioned above. At
the end of the day, they make the world’s poorest regions – where nonetheless many
natural resources, highly valued by the international markets, are located – less
unimportant for the international system than we would initially believe.
The paradigm of human security emerged as a political and instrumental
response to the problems that new wars and failed states have posed. Growingly
informing, for example, the nascent European defense and foreign security policies,
human security has been embedded since the early 1990s in the UN’s conflict
prevention, peacekeeping and post-conflict reconstruction missions. It was so defined
by the United Nations Development Program (UNDP):
Human security can be said to have two main aspects. It means, first, safety from
such chronic diseases as hunger, disease and repression. And second, it means
protection from sudden and hurtful disruptions in the patterns of daily life –
whether in homes, in jobs or in communities. (UNDP, 1994)
It embodies the early 1980s ambition of several authors in Security Studies
(Homer-Dixon, Ullman, etc.) in terms of enlarging the concept of security in which
threat builds less in function of states and more in function of populations and their
well-being. In this way, it nears Peace Research’s line of investigation focused on the
exploration of a more comprehensive sense of peace proportionately to an enlarged idea
8
of violence (Galtung, 1996). Peace Research has had a direct influence in former UN
secretary-general Boutros Boutros-Ghali 1992 Agenda for Peace (1995), where the
definition of human security above was built on.
As a result of the institutional environment where it was fabricated, the human
security paradigm tended to pursue a Southward orientation, towards the “traditional”
peripheries of the international system. Yet, the paradigm turned out to be increasingly
applied to the central spheres of the international system. It also embraces Western
realities, i.e. public and private interventions among marginalized, or excluded,
populations (migrants and ethnic minorities, either longtime settlers or newcomers), in
the name of multicultural conviviality and mitigation of rising racist and xenophobic
movements in Western metropolises. Human security shifts from focusing preferably on
the Global South towards growing preoccupation for the “South in the North” (Santos,
2004). The emancipating and pacifist mission assigned to human security developed in
the midst of the Cold War was co-opted by Western powers as a renewed form of
foreign interventionist agenda aimed at containing turbulence and chaos in the Third
World, and simultaneously securing markets and vital natural resources. That agenda
has been taking place in a combination of “sustainable development” initiatives and
“emergency relief actions” (Duffield, 2007). These processes are initiated and pressured
by different actors though: political and economic elites, developmental and
humanitarian non-governmental organizations, celebrities, etc.
It is relevant to clarify that pathogenic agents only appear as menacing human
beings when they, first, infiltrate human ecology and afterwards penetrate and develop
themselves within the human body. Thus, those agents as such do not pose any threat.
What is actually convertible to a threat status are peoples, societies and, in the last
analysis, states. If we perceive the major measures against disease detection, prevention,
9
care and eventual cure of populations, we define as security objective the contention of
the multiplication of the number of people carrying the agent, as well as the social
impact that such multiplication potentiates and probably provokes. The securitized
people are those “at risk”, those “vulnerable”, if not those making up “dangerous
classes” (Hardt and Negri, 2004). Whereas in Southern and Eastern Africa they are,
among the general population, “orphans and vulnerable children,” in China, India,
Russia, and the West, drug injectors, migrants, homosexuals and the general mass of
“marginalized ones.” Conversely, the securitizing agents tend to be most powerful
groups in society (political and economic elites and the military), where power is more
“‘sedimented’ (rhetorically and discursively, culturally, and institutionally) and
structured in ways that make securitizations somewhat predictable and thus
subject to probabilistic analysis” (Williams, 2003: 514)
The securitization narrative of diseases is not elaborated in an isolated fashion. It
has been complexly mastered with five sorts of topics: “war on terror;” “failed states,”
“new wars,” and “uncontrolled migrations;” globalization; current medical practices;
and social and behavioral changes.
The response to the terrorist attacks against the United States in September 11,
2001, inaugurated an era of asymmetric, global and apparently endless war. The war on
terror aims to identify and combat the means of dissemination of terror, namely biologic
ones, as reports of mail being distributed with anthrax hit the headlines in the aftermath
of September 11. In this way, the inscription of health security in the overall question of
terrorism and counterinsurgency takes place in a conclusive mode, as part of subjection
of the several areas of governance to the struggle against international terrorism. Yet, it
should be underlined that the biological threat is not reducible to agents such as anthrax.
10
Andrew Price-Smith (2002) has produced an exhaustive work on the relation
between health indicators and state capacity, which paved an investigative avenue for
research on epidemics’ impact on several societal fields. Authors writing on incidence
in the population underline the mutual direct reinforcement of disease proliferation and
disruption of the socio-economic tissue, collapse and war feeding (Elbe, 2003; Peterson,
2002). Other authors have established linkages between HIV-orphaned “vulnerable”
children and delinquency. The circumstance that many children and youths find
themselves on their own might lead to the formation of pockets of delinquency that
provoke instability, even politically, with probable extremist associations (Garrett,
2005). Lyman and Morrison (2006) have suggested that countries like Nigeria and
South Africa offer safe havens for recruitment of children and youths for jihadist, antiWestern activities home and abroad. Yet it should be remarked that this attention paid to
children is prior to September 11. It was first elaborated by Richard Holbrooke, former
United States ambassador to the United Nations in 2000 after visiting some African
countries. I’ll come back to his statements later on. For now let us quote Jefferson’s
synthesis of the point:
Simply put, a disturbing new formula may be emerging; AIDS creates
economic devastation. Economic devastation creates an atmosphere where
stable governments cannot function. When stable governments cannot
effectively function, terrorism thrives by exploiting the underlying conditions
that promote the despair and the destructive visions of political change. (…)
…AIDS has created a steady stream of orphans who can be exploited and
used for terrorist activities. (Jefferson, 2006: 6-7)
To the triangle epidemics/state capacity/conflict I add irregular migratory
movements. Apart from being considered themselves a security object, migrants pose a
threat to public health in the countries they enter, in function of their limited or
inexistent access to health care for detection and care. Migrations are, furthermore,
phenomena that economic globalization has been pushing as markets merge through
11
circulation of people and goods. One should then enumerate the following eco-social
determinants of health: crossborder trade, climate change, fast urbanization and
intercontinental tourism. Brower and Chalk (2003) included the relevant dimension of
excessive use of antibiotics, which contributed for the emergence of more resistant
strains of viruses. Expressing the moralist tension present particularly in the domain of
sex-related diseases, those authors found another set of causes in
the higher acceptance of multiple sexual partners and permissive homosexuality
particularly in the Western countries [and] the Asian strong sex industries, and
the growing prevalence of intravenous drug use. (Brower and Chalk, 2003: 2628; my emphasis)
According to its basic definition, the concept of human security presents itself as
an eminently emancipating, pacifist and human rights-centered doctrine. It is in that
vein that I believe that it is enthusiastically studied today by many International Law
and International Relations students and widely promoted by the activist community.
The domain of epidemics has indeed been a clear-cut example of camouflaging a topic
as security issue as a strategy for attracting scarce resources to real human dramas
(Altman, 2003). As mentioned, WHO dedicated the World Health Report in 2007 to
“security in health,” and, in the AIDS arena, UNAIDS’ executive-director Peter Piot has
been using the AIDS-security next as a persuasion narrative (Elbe, 2008).
Yet, human security unfolds two interconnected problems. One is its
ambivalence, as Duffield (2006) pointed out:
in a single concept the idea of human security […] contains the optimism of
sustainable development while, at the same time, it draws attention to the
conditions that menace international stability (Duffield, 2006: 9).
In totally opposite terms, Garret (2005: 41) confirms that same consideration, as she
writes about HIV/AIDS, human rights and security: “As vital as the human rights
agenda is in the HIV pandemic, however, it ought not to be permitted to befuddle
12
attention to security.” The second problem – and we will develop it more profoundly
two sections ahead – has been raised by Huysmans (2002), who argues that, once
securitized, it is theoretically impossible to desecuritize a social topic, that is, return it to
a kind of “asecurity” political, societal, cultural arenas, preferable to a military one. This
consideration is targeted at the Copenhagen School, which, recognizing the ethical
dilemma of inducing a state of exception for a non-military issue, proposes another
sphere for the issue to be tackled. Following 1930s scholarship by Schmitt (1996) on the
supreme role of the chief of state in the institution of a state of exception, that separates
friends from foes and gives potential for the introduction of military means, the
securitization theorists recognize that civil liberties and democratic order might be
under jeopardy in that event.
13
Securitization: Juridical-Institutional Argument
Legal scholar David Fidler draws attention to the reconfiguration that global
health governance’s “constitutionalism” has been undergoing in the light of September
11 e 2003 SARS outbreaks (Fidler, 2004). Fidler traces the historiography of such
“constitutionalism” as of 1948, when WHO was founded, and earlier international
conferences. As successor to the European hygienist conferences in the 19th century,
WHO has gained reputation for inculcating an international cooperation based upon
1969 IHR. Such regime consolidates what Fidler has designated Microbialpolitik, that
is, an international agenda fundamentally guided by allied fight against disease (Fidler,
1999).
Fidler perceives the 2003 SARS outbreaks and corresponding structuring
responses of contingency as a turning point in the understanding of epidemics as object
of national and international security. According to the author, 2003 inaugurates “the
new world order in public health,” in which global health governance adopts the United
States federal model in the context of crisis in health at the global scale. The functions
of that model are: provision of national security; regulation of international trade;
preparedness support and response to epidemic crisis; and protection of human rights
(Fidler, 2004). Fidler proceeds holding that such “new order” matches the postSeptember 11, broader counterterrorist response. Thus, he confirms the security tone
advanced by the United States leadership, in which all areas of government were
merged towards a more efficient and engaged reaction. Finally, Fidler affirms that the
2005 revision of the IHR reoriented WHO’s mandate, since it may be specifically
serving national and international policies:
14
Less clear is whether the new IHR might embroil WHO in the politics of
national and international security to the detriment of its core public health
functions. Although it makes some experts uncomfortable, the potential for
terrorism involving weapons of mass destruction connects public health to
security concerns. (Fidler and Gostin, 2006: 92)
The 2005 revision calls for the necessity to establish partnerships with other
“interested” sectors, notably the armed forces. Moreover, it has to be stressed the actual
paradigm change in the whole philosophy of the revised IHR. A striking case relates to
the possibility of “containment at the source,” together with the typical border controls
for people and goods (WHO, 2007a). Such situation allows for, as I’ve mentioned
above when citing the discussion about the relation between state of exception and
development aid (Duffield, 2007), further foreign interventions, namely with military
means, to take place for the sake of epidemic contention.
Fidler’s legalist analysis appears as limited vis-à-vis a profounder discussion
about the different rationales guiding state involvement in global public health, since it
stresses the contextual dimensions of epidemic crisis (and that Chan, Støre and
Kouchner underlined above), and not structural ones. A critical political approach to this
topic credits many other agents with regulating capabilities (multilateral programs, state
bilateral initiatives, non-governmental networks and partnerships), where intense power
agendas do pop up. In the next section I propose a historical-political approach to
epidemic management, where historical experience is all too fundamental.
15
Securitization: “Historical-Political” Argument
Instead of stressing events such as September 11 or SARS outbreaks I am rather
more attentive to an important happening that took place a couple of years before that,
i.e. the first session of the United Nations’ Security Council dedicated to a health issue
(HIV/AIDS), in January 10, 2000. This session was followed by others under the
auspices of the Security Council and the United Nations’ General-Assembly, which
resulted in a financial reinforcement of UNAIDS. Two years later, in 2002, the Global
Fund was launched, and in 2003 PEPFAR was similarly established.
It is remarkable that the first grand HIV/AIDS international momentum at the
political level took place in the Security Council, and moreover introduced by the
Clinton Administration. Contrarily to what would somehow be expected, it was neither
discussed in the General-Assembly, nor brought to the fore by some hard-hit country in
Southern Africa. More than some accurate context, this event is revealing for the
complex chain of phenomena that it induced. In my view, that date expresses the
contemplation of a disturbing “dark side” of globalization, whose genealogy ought to be
explored. United States ambassador to the United Nations, Richard Holbrooke,
expressed it finely, and hence should be cited at length:
Watching kids sleep in the gutters in Lusaka, [Zambia], knowing that they will
become either prostitutes or rape victims, either getting or spreading the disease,
because there's no shelter for them, and that the government is doing nothing
about it, makes a powerful impression on you. (…)
I said: "Look at the facts; it's not simply a humanitarian issue. If a country loses
so many of its resources in fighting a disease which takes down a third of its
population, it's going to be destabilized, so it is a security issue." (…)
Anyway, that was years ago. That issue is over. Everyone now accepts our
definition of AIDS as a security issue -- it's self-evident. (Holbrooke, 2006)
The genealogy of securitization goes back to the rise of liberal political regime
in Europe since the 17th century, and whose global expansion and consolidation were
16
favored by international public hygienist surveillance as of the 1830s. Given this
structure, it is relevant to briefly review French historian-sociologist-philosopher
Michel Foucault’s work on the analytics of power, and other authors that followed and
namely applied it in the field of International Relations.
Inverting the principle by General von Clausewitz that “war is the continuation
of politics of other means,” Foucault maintains that modern societies in Europe, with
the end of religious wars and rise of nation-states since the 17th century, started to be
managed in function of the eminence of war, even in times of formal peace. Hence,
according to Foucault (2006), “politics is the continuation of war by other means.” As a
result, there is a change in the idea of sovereignty, which is based less on juridical and
territorial premises and more on political terms.
[I]n opposition to the philosophical-juridical discourse, that builds on the
problem of sovereignty and law, this discourse [that Foucault analyses] is
essentially a historical-political discourse, a discourse in which the truth works
as a weapon for a partisan victory, a discourse soberly critical and, at the same
time, intensively mythical (Foucault, 2006: 287)4
The nature of the power performed by the sovereign agent starts to be less
located in the capacity of taking life. On the contrary, the sovereign is both capable of
either fostering life and impede it to the point of life. This is a power taking human
beings at the aggregate level (populations) and life in general as its object, and has been
designated “biopower,” and expresses the 18th century scientific effort of measuring and
regulating all dimensions of life through rates on birth, mortality, schooling,
employment, criminality, etc. This change has implied thinking the human being as an
“être biologique” (biological being), a natural species, yet with political life and power.
My translation from the text in Portuguese language: “(...) em oposição ao discurso filosófico-jurídico
que se ordena no problema da soberania e da lei, este discurso [o de Foucault] é um discurso
essencialmente histórico-político, um discurso em que a verdade funciona como uma arma para uma
vitória partidária, um discurso sobriamente crítico e, ao mesmo tempo, intensamente mítico.”
4
17
Biopower is totalitarian, although with a tremendously ambivalent design, which allows
it to manage surplus populations vis-à-vis the sovereign agent’s survival and
expansionist objectives. Holding society under control, in the last analysis, biopower
provides the prevalence of the superior race, in which the concentration camp is not just
a symbol of the regime and an institutional practice under a state of exception, but also a
locus of scientific efficiency. Therefore, two major case-studies are the Nazi genocides,
and at the time of writing the unlawful imprisonments at Guantanamo Bay detention
centre (Agamben, 2005). Contrarily to previous absolutist regimes, biopower
necessitates to be rationalized, justified.
It was no longer considered that this power of the sovereign over his subjects
could be exercised in an absolute and unconditional way, but only in cases
where the sovereign’s very existence was on jeopardy: a sort of right of
rejoinder. If he was threatened by external enemies who sought to overthrow
him or contest his rights, he could then legitimately wage war, and require his
subjects to take part in the defense of the state; without “directly proposing their
death,” he was empowered to “expose their life” […] But if someone dared to
rise up against him and transgress his laws, then he could exercise a power over
the offender’s life: as punishment, the latter could be put to death. (Foucault,
1984: 258)
The concept of biopower is linked to the concept of biopolitics, that started to be
used by Foucault later, and basically meaning the same. It is supplemented by the
concept of governamentality (governamentalité), that is, a discursive-material device
(dispositif) of security embodying rationalities and technologies of government,
comprising
discourses, institutions, architectural forms, regulatory decisions, laws,
administrative measures, scientific statements, philosophical, moral and
philanthropic propositions (Foucault, 1980: 184).
Yet, those technologies do not necessarily use violence to force people do what
the sovereign likes (Lemke, 2001). In liberal societies that would be very complicated to
manage for the sake of the system’s own sustainability. Frequently control is exerted
18
through “ideological manipulation or rational argumentation, moral advice or economic
exploitation” (Lemke, 2000: 5). The target is, nevertheless, the anatomic body in its
most comprehensive political sense and at very different scales: from the professional
setting to the dietary/beauty regime (Lemke, 2000: 13).
Michael Dillon and Luis Lobo-Guerrero (2008) consider that biopolitics is a
security device that expresses an “evolving economy of power relations,” whose most
recent development can be assessed through the term of “emergency.” Emergency – that
illustrates public health-related interventions’ rationale in the post-September 11 and
post-2003 SARS outbreaks – is a form of contingency that the biopolitical liberal
governance
does
confront.
That
governance
is
performed
via
a
set
of
governamentalizing technologies, both prophylactic and regulatory, whose objective is
to maximize governance’s profits. However, they add the idea of circulation within a
territorial and biological (population-related) framework, which basically correspond to
the idea of markets. In globalizing, neo-liberal times, there is a tendency for some
discontents to denounce markets’ deregulation as technical wording for “wild
capitalism.” Deregulation is but to be comprehended as a sophisticated technology of
control in which refinement in collection and analysis of statistical information on
market agents’ behaviors is fundamental. Self-regulation of the markets corresponds to
the idea of biopolitical self-governance. However, what should be highlighted for our
discussion on infectious disease is that such self-governance is highly dilemmatic and
risky. Indeed, in the same way that liberal economic globalization requires large
flexibility in consumption and investment facilitated by movements of people, goods,
services and finances, this platform is also utilized for such illicit activities as
criminality or terrorism. It also permits more easily constructed realities at personal and
19
mediated (through communications technologies) on phenomena growingly subjected
scenario-building exercises. Risks emerge as a contingency of the system that can be
commoditized, commercialized and managed as insurances, yet to specific limits. As
François Ewald put it, there are two opposite directions-limit, where infectious diseases
are located in one of them:
toward the infinitely small-scale (biological, natural, or food-related risk), and
toward the infinitely large-scale (major technological risks or technological
catastrophes) (Ewald, 1993: 222).
Impossible to be fully calculated and secured, these risks are nevertheless inscribed in
the rationalities and technologies of governance under the categories of precaution and
prevention. Yet, it should be stressed that risk management is carried out in function of
information, quantitative and qualitative, often leading to a problem of speculation. That
can be undermining in terms of the sustainability of the rationality that masters the very
mechanism of governance. In any case, an efficient management of risk management
constitutes a powerful means of power consolidation, reinforcing the individualism that
liberal philosophy has defended ever since, in opposition, for example, to the notion of
solidarity as an alternative or complementary logic.
The conceptualization explored by Foucault is very informative with regard to
an alternative model of structuring constitutionalism in global (health) governance. The
image of a nubleuse (nebulous) (Cox, 2005) meets what is proposed above in my
appreciation of Fidler’s adoption of the United States federal model. Such picture builds
on strong political density, where many networks of governmental and nongovernmental agents interact formal and informally at a transnational level.
International public health was a very important vector in the webbing of relations,
offering a political perspective that moves way beyond the Microbialpolitik claim.
20
Alison Bashford (2006) reports that, in function of the establishment of border
epidemical check-ups and quarantine systems, surveillance mechanisms were installed
at the global scale uniting metropolises and colonies. Thus, national surveillance and
hygienist measures moved beyond from the national sphere on to the rest of the world,
cementing Western power territorially and biologically. Such process is rooted in the
response to a cholera epidemic affecting the European powers in the 1930s which paved
the way for the several international hygienist conferences during the 19th century. In
this regard, the international sanitary institutions of the two world wars’ interval were
very decisive. In those years, health issues are essentially taken as technical matters by
the League of Nations’ Health Office. According to Bashford, its mission is to collect
information from the national administrations, in order to control diseases such as
malaria, smallpox and sleeping sickness, in close collaboration with the Economics
Office of the organization. General population-related dossiers tended to be studied in
its migratory and trade dimensions, excluding issues such as birth control, and sexual
and reproductive health. The author provides several examples on how, despite direct
enquiry, those latter matters were untouched by the League of Nations under the basis
of not being part of the organization’s mandate. Today sexually and maternally
transmitted diseases obtained such recognition, and concentrate much political and
funding support. Partly that has to do with the increasing pressure displayed by the
health and activist sectors. But partly that has also to do with the securitization that
Holbrooke above expressed, and the activist world has contributed to through its
politicization methods. The problem is, again, the already mentioned ambivalence in
which security at human level reveals, and the very concept of biopower, or biopolitics,
unfolds. Security: made by whom, target at whom and for what purpose? This question
gets more and more serious and disturbing when one realizes that an overall sense of
21
inequality in human global relations is at the core of the problem, and that the leading
system is not proving to fulfill.
From an ethical point of view, the essential problem with biopolitics as
securitization of bodies and societies is that it works towards the establishment of
normalizing political objectives, (subtly) discriminating what is superfluous,
unnecessary and impure. In his discussion of HIV/AIDS securitization, Elbe (2005)
warns about the potential for implementation of public measures furthering an already
very stigmatizing HIV status, regardless of prevention strategies.
Yet, it should be reiterated that biopolitics has an ambivalent design does foster
life as well. Though acknowledging the historical disciplining role of public health as
stabilizer in societal power relations, Didier Fassin (2005) argues that biopolitics as
public health securitization has limits as such. In today’s times of decaying,
underinvested public health services, Fassin holds that health access is a way for “les
sans papiers” (undocumented immigrants) and “banlieues” (outskirts) residents being
granted social citizenship. In similar fashion, though at another scale, one should
mention 1996 WHO Report Health as a Bridge for Peace that stresses health access as
international pacifier (Galtung, 1997). Associated with the first post-Cold War Balkan
wars’ aftermath, it gathered WHO’s Emergency and Humanitarian Action Departments
and some medical organizations (Skinner and Sriharan, 2007; Thoms and Ron, 2007;
Levy, 2002; Barbara, 2004).
Due to the conceptual ambivalence, the context of analysis should be taken into
due account, particularly in terms of the actors at stake and the roles they play. A quick
conclusion leads to the idea that public health as securitizing method is initiated top-
22
down (from the political elites down to society as a whole), and as civic rights
expression goes bottom-up (started by excluded groups’ representatives), as the latter
Fassin’s case suggests. Yet, the problem of power remains quite omnipresent, as the
strain between securitization and rights reclaiming can be solved through “co-option” of
the latter may happen as a result of liberal technological governance.
23
Conclusion
David Fidler (2005) is quite right when affirming that major epidemiological
concerns are “revolutionizing” the way International Relations researchers have viewed
them, from an “uninteresting” topic to a relatively prominent one as part of post-Cold
War human security paradigm. The general issue of Western securitization of infectious
diseases is mostly, and hierarchically, connected to scenarios of biological agents spread
for terrorist purposes, outbreaks of diseases transmitted within the food chain, and wide
proliferation of major diseases such as HIV/AIDS, tuberculosis and malaria among
weak states in Southern and Eastern Africa.
The adoption of “historical-political” lens vis-à-vis a “juridical-institutional” one
allows us to come to, not only denser, but also, perhaps, more surprising conclusions
about the “true” nature of epidemiology and public health in the whole Western global
security project. First, its surveillance mechanisms, structural elements of epidemic
control, preparedness and response, helped cementing world system of dominance, first
and foremost, over the colonial world, ever since the 19th century. Hygienism has been,
for instance, particularly instrumental with regard to the implementation of powerful
white-supremacist, racist regimes, as the South African experience has strongly proved
(Youde, 2005: 5-6). Second, as several authors have pointed out with regard to
HIV/AIDS global preventive instruments (Barnett and Prins, 2006; Bray, 2003;
McInnes, 2006), securitization of specific scenarios, namely the catastrophic ones on the
nexus orphanage-social disruption-state collapse-violence, are not only highly
speculative (creating a “truth effect” under a non-evidence basis), but also appear as a
24
renewal of older forms of Western security worries (i.e. indigenous state incapability
and failure) that post-colonial experience has precipitated.
25
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