Securitization of international public health: implications for global health governance and the biological weapons prohibition regime.
Public health and biological weapons arms control would appear to be two distinct policy arenas with little, if any, overlap in terms of actors involved, problems to address, and solutions to be proposed to better the human condition. Traditionally, security from biological weapons and security from disease were pursued by different actors on both the domestic and the international level. For the former, biodefense and biological weapons (BW) arms control policies were formulated by the military and diplomatic communities, while responsibility for disease prevention and mitigation fell to the public health sectors of states, or to international organizations such as the World Health Organization (WHO). This strict separation has become increasingly blurred.
Starting in the mid-1990s, the possibility of terrorism with biological and chemical weapons has evolved into the number one security threat for military planners and decisionmakers in many countries, most notably the United States. This dramatic shift in threat perception, which was fueled first and foremost by the Aum Shinrikyo 1995 sarin gas attack in the Tokyo subway system and the 2001 anthrax letters sent through the US postal service, had two effects that so far have not been thoroughly analyzed. First, it shifted the balance between biodefense and BW arms control in the fight against biological warfare toward biodefense. The process of readjusting this equilibrium in favor of biodefense has brought with it the second effect: the drafting of public health to fight bioterrorism. (1) While biodefense activities had in the past been geared toward hostile states employing BW, and thus had focused on troop protection in the field by the military forces themselves, this approach was no longer deemed valid in the age of global bioterrorist threats. Those who are "at risk from biological warfare" are no longer a subsection of the population--the armed forces--but are now the population as a whole. Consequently, protective measures had to extend to whole populations as well: enter the public health infrastructure. To better capture and analyze the processes related to this "drafting" of the public health sector, or parts thereof, the concept of "securitization" will be applied. As I have argued elsewhere, such securitization moves have been successfully employed in the United States over the past decade. (2)
The term securitization was introduced into the security studies discourse during the 1990s by a group of scholars, including Ole Waever and Barry Buzan. (3) The development of the concept has to be seen in the context of a more general trend to move beyond a focus on the nation-state and on the provision or analysis of military security issues only. (4) To overcome the shortcomings of some competing approaches to broadening the concept of security, Waever and his colleagues proposed to concentrate on the specificity of security studies and reformulate the concept of security on that basis. Two operations are crucial in this context: speech acts (uttering security) and modalities (threat-defense sequences). (5) The process of securitization is initiated through a
speech act where a securitizing actor designates a threat to a specified referent object and declares an existential threat implying a right to use extraordinary means to fence it off. The issue is securitized--becomes a security issue, a part of what is security--if the relevant audience accepts this claim and thus grants the actor a right to violate rules that otherwise would bind. (6)
If a securitizing speech act is performed successfully--and, as I show in this article, this is by no means always the case--the threat-defense sequence, which has characterized traditional thinking about security, has been successfully put into action for a new issue, one that was previously separate from the security discourse.
There are thus three elements to the securitization process: a securitizing actor, a referent object to be securitized, and an audience that accepts (or rejects) the securitizing move. Thus, by looking at speech acts, the securitization concept allows an observer to analyze and link discursive interventions and policy measures beyond those that would normally be considered appropriate. Usually, such new policy measures would manifest themselves in shifting budgetary priorities.
In applying this framework, I analyze the extent to which threats to public health through the deliberate spread of disease have become securitized. As mentioned above, the emergence of the bioterrorist threat in the mid- to late 1990s has in the United States coincided with a reduced reliance on BW arms control in addressing the specter of biological warfare. Instead, biodefense measures, with the concomitant securitization of public health, have been placed center stage in the effort to counter the newly identified existential threat of bioterrorism.
In order to trace securitization moves and map the resulting changes in international public health discourse and the implications this has for both the globalization of public health and the international regime to prohibit BW, I provide in the next section an overview of the deliberate spread of disease in the form of biological warfare. In the following two sections I briefly describe the tools to fight both deliberate and natural disease; BW arms control; and international public health prior to the emergence of bioterrorism as a new existential security threat. My focus in the subsequent section is on the emergence of bioterrorism as security threat and the securitization moves in relation to public health on the international level, with emphasis on the two discursive spaces of the WHO and the community of Biological and Toxin Weapons Convention (BWC) member states. I conclude with a discussion of the implications for the global governance of public health and BW arms control that result from the identified public health securitization moves.
Biological Warfare as "Deliberate Disease"
The use of disease-causing biological agents, or pathogens, in warfare goes back at least several hundred years. (7) Biological warfare agents are usually grouped into five categories: (1) bacteria, such as Bacillus anthracis, the causative agent of anthrax; (2) viruses, such as the ones that cause smallpox, or Ebola; (3) rickettsiae, such as the organism that causes Q-fever; (4) fungi, such as the Aspergillus fungi; and (5) toxins--nonliving products from microorganisms, plants, or animals--such as botulinum toxin, or ricin. Some of these BW agents are mostly incapacitating, while others have a high lethality. Also, some BW agents will be localized in their effects, while others--due to their contagiousness--may cause widespread epidemics. Following from this diversity, biological warfare agents can be employed in a number of attack scenarios. (8)
To make efforts to implement the prohibitory norm against biological warfare even more challenging, the material, technologies, and know-how needed for offensive military BW programs or the pursuit of terrorist BW attacks are of a so-called dual-use character. Not only can they be used for offensive military purposes, but many of the "ingredients" of a BW program have perfectly legitimate civilian applications. Thus, it cannot be deduced from the mere presence of a seed culture of a particular pathogen or a specific type of equipment that a state pursues an offensive BW program.
Furthermore, the nature and scope of biological warfare has changed dramatically as a result of the revolution in the life sciences. As Malcolm Dando has shown for the "three generations of offensive biological warfare programs" of the twentieth century, all the military programs were "developing on the back of growth in scientific knowledge." (9) This pattern seems to continue. As a panel of life sciences experts concluded in a recent assessment of the threat of advanced BW based on biotechnological methods and processes that was conducted for the CIA,
Classes of unconventional pathogens that may arise in the next decade and beyond include binary BW agents that only become effective when two components are combined ...; "designer" BW agents created to be antibiotic resistant or to evade an immune response; weaponized gene therapy vectors that effect permanent change in the victim's genetic make up; or a "stealth" virus, which could lie dormant inside the victim for an extended period before being triggered. (10)
Thus, problems in fighting the naturally occurring disease agents of today might be dwarfed by the genetically modified agents of the future, putting an ever increasing burden on biodefense and public health systems.
Fighting Deliberate Disease Through Biological Weapons Arms Control
The Structure of the BW Prohibition Regime
The BW prohibition regime rests largely on the 1972 Biological and Toxin Weapons Convention. It is based on the recognition that the use of BW agents constitutes an abhorrent act of warfare and is therefore prohibited. At the same time, peaceful uses of the biosciences are regarded as a legitimate undertaking. According to BWC Article I,
Each State Party to this Convention undertakes never in any circumstances to develop, produce, stockpile or otherwise acquire or retain: (1) Microbial or other biological agents, or toxins whatever their origin or method of production, of types and in quantities that have no justification for prophylactic, protective or other peaceful purposes. (Emphasis added) (11)
This so-called general purpose criterion makes it clear that not only are peaceful uses of the biosciences legitimate undertakings for states parties to the BWC, but so are defenses against the threat or use of BW. This principle is rooted in the belief that the peaceful uses of biosciences cannot be taken for granted--be it for the lack of universality in membership or for a state party not living up to the obligations it has assumed.
Central to the normative guidelines for state action contained in the BW control regime is the non-use norm. It is explicitly spelled out in the 1925 Geneva Protocol and implicitly contained in Article I of the BWC. (12) Of particular relevance to the interrelation between biodefense and public health, and the securitization of the latter, are three further regime norms: the cooperation norm contained in Article X of the BWC; the assistance norm as spelled out in BWC Article VII, according to which state parties will come to each other's assistance in case of the use or threat of BW against one of them; and the internalization norm, as stipulated in Article IV of the BWC. According to the latter norm, state parties have to internalize the prohibitions of the BWC and prevent the activities banned under the BWC from taking place on their territory. Yet, how this is to be accomplished is left to the interpretation of state parties.
Efforts to Strengthen the BW Prohibition Regime
The two central weaknesses of the BW control regime--the absence of a verification principle and the lack of precise rules and procedures that would specify how to implement the norms of the regime in everyday state practice--came to the fore soon after entry into force of the BWC in 1975. The confidence-building measures (CBMs) agreed upon during the Second and Third BWC Review Conferences in 1986 and 1991 represent one attempt to remedy these shortcomings. However, as one review of the data submissions up to 2003 has revealed, implementation of the CBMs was poor. (13)
In parallel to these CBMs, a process was initiated that initially looked into the technical feasibility of potential verification measures for the BWC (during 1992-1993) and led to negotiations on a verification protocol, which lasted from 1995 to 2001. Yet, already the formulation of the negotiating mandate proved contentious and allowed for various diverging goals to be pursued in the negotiations. (14) To speed up negotiations, Ambassador Tibor Toth, chair of the Ad Hoc Group (AHG), developed a compromise text, which he presented to delegations in spring 2001. (15) The July 2001 session of the AHG was scheduled to discuss this compromise text. While there was considerable support for the approach taken by Ambassador Toth, the United States concluded that the overall approach taken in the negotiations up to that point was flawed and the draft protocol text would reduce and not increase security against BW.
The ensuing sense of failure was compounded during the last day of the Fifth BWC Review Conference when the United States came forward with a proposal to terminate the AHG for good. The content of this proposal ran counter to the tacit understanding not to touch the topic of the AHG in order to avoid a breakdown of the review process as well. Moreover, the United States did not inform any of its allies in advance about the content or timing of the proposal. Not surprisingly, this created the impression that the US delegation was deliberately attempting to wreck the conference. The only way to prevent a diplomatic disaster was to adjourn the conference and reconvene one year later, in November 2002. (16) During this second part of the conference, a set of five measures was agreed on to guide discussions among state parties for the years 2003-2005. One of the measures was international cooperation in the fight against infectious disease.
Public Health in the Fight Against Natural Diseases
The International Public Health Regime
Although international cooperation to improve public health started in the middle of the nineteenth century, it was the establishment of the WHO in 1948 that marked the birth of today's international public health regime. (17) When the WHO was set up, its members agreed on the principles that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being" and that the "health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and States." (18) Despite this lofty rhetoric, including peace and security, Anne-Marie Slaughter reminds us that the WHO falls in the category of more specialized international organizations that "address less overtly 'political' subject areas than international and regional security." (19)
During the first three decades of its existence, the WHO attempted to implement its mandate largely through a disease-oriented policy. This rather technical approach found its expression in the adoption of the International Health Regulations (IHR). In it, WHO member states agreed to two normative guideposts for their public health policy. First, they agreed to notify the WHO of outbreaks of diseases covered by the IHR. Initially six diseases were subject to this notification norm: smallpox, typhus, relapsing fever, cholera, malaria, and yellow fever. After a 1981 modification of the IHR, only the latter three had to be reported to the WHO. The primary goal of the IHR "is to ensure the maximum security against the international spread of diseases with minimum interference with world traffic," (20) In addition, the IHR was designed to interfere only marginally with how WHO member states organized their domestic health policies. Rather, its primary target has been to prevent the transborder movement of disease-causing organisms. Only a limited set of requirements--this represented the second, much weaker, normative guidepost of the IHR--has been imposed by the IHR on states to undertake certain public health measures at ports and airports. However, as David Fidler summarizes, the "IHR failed massively to achieve their objective." (21) This failure was first and foremost due to the widespread noncompliance of member states with the reporting requirements under the IHR. Second, the large number of newly emerging or reemerging infectious diseases, especially HIV/AIDS, demonstrated the growing irrelevance of the reduced list of diseases that were to be reported. The World Health Assembly (WHA), the WHO's highest governing body, acknowledged this failure in 1995 and tasked the WHO with revising the IHR. (22) In 2001, WHA Resolution 54.14 "supported the ongoing revision, including criteria to define what constitutes a public health emergency of international concern." (23) Based on the work of an intergovernmental working group, the new regulations were adopted by the WHA in May 2005. (24)
From International to Global Public Health?
Programs to eradicate specific diseases have been departing from this interstate focus of WHO activities and have attempted to interfere much more deeply with capacity-building efforts in member states and the organization of their public health systems. The programs to eradicate smallpox and malaria are two examples of success and failure, respectively, of such programs. (25) A more general shift away from the horizontal strategies based on intergovernmental relations, as embodied in the IHR, was signaled by the "Health for All" declaration agreed on in 1978 in Alma Ata. As Fidler points out with respect to this shift in priorities, "The need of the great powers for the kind of international cooperation embodied in the IHR had all but vanished, leaving the regime without its traditional political engine." (26) This opened the discursive space for addressing and reaffirming health as a fundamental human right, whose realization cannot be limited to the monitoring and reporting of three communicable diseases. The linkage between health and human rights was further strengthened when the WHO integrated efforts to stop the discrimination of those affected by HIV/AIDS into its policies to address the disease. This clearly represented a further step in eroding the sovereignty of states to deal with a crucial public health issue on their own terms. (27) Calls to that end also came from the international development arena, where in the early to mid-1990s the annual reports of the United Nations Development Programme (UNDP) started to focus on human security, with health security being one of its core dimensions. (28)
Intergovernmental public health policies came under additional pressure from a number of globalization-related processes. As Richard Dodgson and Kelley Lee point out, "Globalisation has introduced or intensified trans-border health risks," which include "emerging and re-emerging infectious diseases, various non-communicable diseases ... and environmental change," (29) In particular, the issue of emerging and reemerging diseases has occupied a large part of public health discourse since the early 1990s, both nationally and internationally. (30) This discourse increasingly involves a multitude of nonstate actors in the form of both health-oriented NGOs and multinational corporations. (31) In general terms, globalization has reduced state capacity to adequately address problems in a variety of issue areas--public health among them.
Acknowledging this decreased state capacity, nonstate actors have been brought into the international public health arena as information providers. This has begun to redirect the discourses and processes of international public health away from a purely state-centric approach. Fidler aptly illustrates this trend with the example of NGO-generated disease surveillance data that are now being utilized by the WHO and fed into its Global Outbreak Alert and Response Network (GOARN). The need to harness this additional source of information was identified early in the process of revising the IHR, but the process for formalizing the use of data from nonstate actors then took on a life of its own. The use of nongovernmental disease surveillance data, started in 1997, was approved by the WHA in 2001 and thus preceded the conclusion of the IHR revision in 2005 by several years. (32)
The Emergence of Bioterrorism and the Securitization of Public Health
Following the actual emergence of the use of biological agents by criminals or terrorists, an academic discourse on bioterrorism began to form during the 1970s. (33) For the 1970s, Seth Carus reports eight cases of bioagent use, nine for the 1980s. Figures for bioagent incidents skyrocketed during the 1990s, with much of the increase occurring during the second half of the decade. He identifies 153 cases for the 1990s, which brings the total to 180. However, many of these "cases" took place only in the mind of perpetrators or were hoaxes: Carus puts 137 out of the 180 reported cases in the latter category. (34) A group of US scholars investigated twelve of the most plausible cases, but even of these, three turned out to be apocryphal. (35)
The shift in academic and political discourse that sought to establish whether the new fear of bioterrorism was supported by facts or was "hyped" (36) was triggered by the Aum Shinrikyo attack in March 1995. This attack, in which the nerve agent sarin was released in commuter trains of the Tokyo subway system, killed twelve people and injured several hundred more. (37) Beginning in the mid-1990s, that attack--in conjunction with the Oklahoma City bombing--led to calls in the United States for expanded measures to counter potential bioterrorist attacks, including the utilization of the public health system. However, hardly any corresponding efforts to securitize public health were visible at the international level before the fall of 2001.
After the World Trade Center and Pentagon attacks in the United States on September 11, 2001, and the subsequent anthrax letters sent through the US mail, attempts to securitize public health manifested themselves on a number of levels and led to a variety of institutional responses, such as the G8 global health security initiative, and different policy measures at the European Union level. However, the focus here is on the two discursive spaces with the clearest mandate on the international level to address public health and the biological weapons threat--that is, the World Health Organization and the meetings of state parties to the BWC.
The WHO and the Securitization of International Public Health
In spring 2002, in the aftermath of the anthrax attacks in the United States, the WHO secretariat, in preparation for the Fifty-fifth World Health Assembly (WHA), produced a report entitled "Deliberate Use of Biological and Chemical Agents to Cause Harm." (38) The report points out that in response to such an incident, the organization is to "strengthen public health disease alert systems at all levels, as such a system will detect and respond to diseases that may be deliberately caused." (39) In case the United Nations were tasked to investigate a disease outbreak, the report suggested that the
WHO could be asked to provide technical expertise or to make available its existing resources and mechanisms. Non-public health issues related to investigations of reports on possible use of chemical and bacteriological (biological) or toxin weapons, however, remain the responsibility of the United Nations. If such a request were made, information about the public health response, including the results of epidemiological and laboratory investigations, would be reported by WHO to the government of the country or countries where the event was occurring. (40)
With this statement, the WHO clearly rejects any attempts at international public health being securitized and positions itself outside the BW arms control context. An expansion of the WHO mandate to function as a substitute verification organization for the BWC is rejected.
In the WHA resolution based on this report, member states are urged to adopt national measures regarding disease surveillance, to collaborate in capacity building, and to assist one another in case of a deliberately caused epidemic. These national measures are to be supported by the WHO secretariat through the strengthening of global surveillance mechanisms for infectious disease, the provision of tools and support for member states, and international guidance and technical information that would support public health systems in countering deliberate epidemics. (41)
The Department of Communicable Disease Surveillance and Response in the WHO secretariat had already set up its Programme for the Preparedness for Deliberate Epidemics (PDE) in response to the anthrax attacks in the United States. Following the WHA resolution, PDE was developed into three main areas: (42)
* International coordination and collaboration. This involves the contribution of WHO staff to a variety of meetings organized in the context of the BWC, the North Atlantic Treaty Organization, or the Red Cross.
* National capacity strengthening on preparedness for and response to the deliberate use of bioagents. In this area, the WHO issued recommendations on the development of guidelines, expert networks, and training. One concrete example is Guidelines for Assessing National Health Preparedness Programmes for the Deliberate Use of Biological and Chemical Agents.
* Public health preparedness for diseases associated with the deliberate use of biological agents. In this context, "WHO is strengthening selected disease-specific networks, starting with anthrax. Other priority diseases--identified by a WHO risk assessment--include plague, tularemia, brucellosis, glanders, melioidosis, Q fever, typhus fever ... and smallpox." (43)
All the activities conducted under PDE are being funded by extrabudgetary resources, which are donated by member states with an interest in these issues. The original program budget for the biennium 2002-2003 was below US$1 million, (44) and although this has increased for the period 2004-2005, it still funds only a small team dedicated to preparedness for deliberate diseases.
In parallel to these limited PDE activities, the discourse on the revision of the IHR gained momentum. (45) Following consultations with state parties, the WHO secretariat circulated a first draft of the revised IHR in early 2004. (46) Extensive regional consultations were followed by three rounds of negotiations, which took place in Geneva between November 2004 and May 2005. Already the first draft IHR contained four major new elements that expanded the scope of the IHR considerably. State parties would now be required to "notify all events potentially constituting a public health emergency of international concern"; set up a national IHR focal point; and implement "the minimum core surveillance and response capacities required at the national level in order to successfully implement the global health security, epidemic alert and response strategy." In addition, the revised IHR were conceptualized as the legal framework for that strategy. (47) Although a large part of the discourse on IHR revision was characterised by a consensus on the need to expand the scope of the regulations, just how far such an expansion should go was contested among WHO states parties. Diverging views came to the fore in particular with respect to the question of IHR coverage of chemical, biological, radiological, and nuclear (CBRN) weapons incidents. While some state parties--among them the United States--believed that the IHR could also be utilized to gather information not otherwise obtainable on such incidents, state parties from the developing world, most notably from the Southeast Asian and eastern Mediterranean regional groups, were led in their rejection by Pakistani and Iranian delegates. (48) The evolution of the discourse on notification criteria contained in Annex 2 to the revised IHR is particularly instructive in this regard: the language provided by an Ad Hoc Expert Group report in February 2005 cited the "release into the environment of a chemical or radionuclear agent that has contaminated or has the potential to contaminate a population and/or a large geographical area" (49) as one of the criteria prompting notification to the WHO. In the final version of the IHR, all references to chemical or radionuclear agents have been eliminated, because some delegations argued that their explicit mention would place too much emphasis on CBW scenarios and thus risk going beyond WHO's mandate. (50) Instead, Annex 2 now lists the "spread of toxic, infectious or otherwise hazardous material that may be occurring naturally or otherwise" as one of the criteria for notification. (51) In combination with references to "unexpected and unusual outbreaks of disease" in Annex 2 and in the main body of the text, this wording was able to bridge the divide between those advocating a further-reaching securitization of the revised IHR, including the United States, and those mostly concerned with limiting the degree of transparency that has to be provided under the IHR to information that is "commensurate with and restricted to public health risks," (52) such as Pakistan. Concerning the role played by the WHO bureaucracy in developing this discourse, all interviewed delegates in Geneva agreed that there were few if any signs that the WHO secretariat was acting in a politically motivated way. However, one delegate cautioned that in addition to a genuine motive in wanting to strengthen the IHR, the WHO might also have been "sniffing the political wind" and may have engaged in "strategic positioning, based on past experience of being left behind." (53) In other words, there have been indicators that the WHO bureaucracy might have been receptive to notions of health security in order to jump on the human security train, in an attempt not to be disconnected from a shifting discourse in the UNDP and the UN system at large. However, attempts of the WHO bureaucracy to side with proponents of stronger securitization moves during the IHR revision could not be ascertained.
The WHO's potential role in the fight against the deliberate spread of disease also featured in the report of the UN Secretary-General's High-Level Panel on Threats, Challenges and Change, which the panel delivered in December 2004. (54) In Part 2 of the report, "Collective Security and the Challenges of Prevention," several paragraphs address the challenges of poverty reduction, sustainable development, and the prevention of the spread of infectious disease. Under the heading "New Initiatives," the panel argues that "a new global initiative" is required to "rebuild local and national public health systems throughout the developing world." (55) In addition, WHA members are urged to increase GOARN's "capacity to cope with potential disease outbreaks." (56) Last, and more problematic, the panel recommends that "in extreme cases of threat posed by a new emerging infectious disease or intentional release of an infectious agent, there may be a need for cooperation between WHO and the Security Council in establishing effective quarantine measures." (57)
This notion of WHO-Security Council collaboration is reinforced elsewhere in the report, where under the heading "Better Public Health Defenses," the panel suggests that the "Security Council should consult with the WHO Director General to establish the necessary procedures for working together in the event of a suspicious or overwhelming outbreak of infectious disease." (58) As Graham Pearson has pointed out, with this last statement the panel is "treading on dangerous ground," as it threatens to undermine the WHO's "political neutrality and the widespread recognition that its purpose is to provide assistance to its member states when they are faced with outbreaks of disease." (59) However, this far-reaching securitization move of the High-Level Panel was not followed by the UN secretary-general, whose report mentioned the burden of diseases like malaria, HIV/AIDS, and SARS only in a human security context, not in relation to arms control verification activities. Consequently, his recommendation is limited to a call on WHO member states to agree on the revised IHR during the next WHA session. (60)
The Discourse on Disease Surveillance in the BWC Intersessional Process
When the second part of the BWC Review Conference took place in late 2002, BWC member states decided by consensus to hold annual meetings from 2003 to 2005 that would address, among other things, (61)
enhancing international capabilities for responding to, investigating and mitigating the effects of cases of alleged use of biological or toxin weapons or suspicious outbreaks of disease [and] ... strengthening and broadening national and international institutional efforts and existing mechanisms for the surveillance, detection, diagnosis and combating of infectious diseases affecting humans, animals, and plants. (62)
This reduced program of work is a far cry from the comprehensive approach of the Ad Hoc Group to reach agreement on a legally binding protocol. (63) The discussion on the above-mentioned two agenda items in 2004 led to the inclusion of several substantive paragraphs in the report of the meeting of states parties. (64) In it, BWC member states recognize that
strengthening and broadening national and international surveillance, detection, diagnosis and combating of infectious disease may support the object and purpose of the Convention;... the primary responsibility for surveillance, detection, diagnosis and combating of infectious diseases rests with States Parties, while the WHO, FAO [Food and Agriculture Organization] and OIE [World Organisation for Animal Health] have global responsibilities, within their mandates, in this regard. The respective structures, planning and activities of States Parties and the WHO, FAO and OIE should be co-ordinated with and complement one another. (Emphasis added) (65)
The acknowledgment of the existing mandates of WHO, FAO, and OIE stands in marked contrast to the High-Level Panel report, which, if acted upon, would have led to a part of WHO's activities being securitized. The wording in the report of BWC states parties likewise displays greater consciousness in describing the scenarios in which WHO assistance might be required: it refers to all cases of infectious disease outbreak, not--like the panel report repeatedly--to "suspicious" outbreaks. The latter approach implies already a political judgment, which is anathema to the WHO's perception of its role and mandate.
Implications for the Global Governance of Public Health and the BW Prohibition Regime
This article set out to trace the securitization moves that have been made in relation to international public health (IPH) in the two discursive spaces most relevant to the provision of IPH and security from the threat of biological weapons: the WHO and the meetings of BWC states parties.
The securitizing speech acts that have been discussed in relation to the WHO show that the organization has appeared in three different roles or functions in attempts to securitize IPH: in the context of the UN Secretary-General's High-Level Panel, the WHO appeared as the object of securitization; during the IHR revision process, the WHO served both as discursive space in which the securitization of IPH was debated and as a securitizing actor in its own right. With respect to the latter role, it is worth distinguishing between the promotion of the notion of health security in human security terms and securitizing moves that aim at a more traditional understanding of the concept. As the previous discussion showed, what was supported by the WHO secretariat was the former notion, not the latter. This position was motivated by the preservation of its neutrality, in order to be able to continue the broader roles foreseen in its mandate. Being implicated in verifying the use of biological weapons or other aspects of BWC compliance would compromise this neutrality. (66)
Noteworthy in this context is that all references to health security have IPH as referent object--that is, as that which is to be secured, not global public health. The role of states as central actors in IPH has clearly been reaffirmed by the revised IHR: it is states, not nonstate actors, that have to provide national focal points for the implementation of IHR and also fulfill minimum standards in disease surveillance and reporting. The WHO and NGOs, like the networks contributing to the WHO's GOARN, have only a supporting role.
From this it follows that IPH has so far been only partially securitized. This assessment is supported by a look at the resource allocation for deliberate epidemics. This area of WHO's activities is closest in substantive terms to BW control mechanisms. However, its resources do not form part of the regular WHO budget, but are funded by interested member states. This leads to an institutionalization on a lower level that is more easily reversible in case the specific interests of the states supporting the program on preventing deliberate epidemics should shift. However, PDE represents yet another area in WHO's portfolio in which intergovernmental mechanisms prevail. As Fidler and others have pointed out, such an intergovernmental approach to global public health problems is leading to suboptimal policy outcomes when compared to an approach that strengthens global governance mechanisms. In light of this, the continued preoccupation of parts of WHO's secretariat with BW-related issues poses an obstacle to the transition from international to global public health.
In sum, the attempts to securitize IPH in the context of the WHO have led to a new mix of horizontal (i.e., intergovernmental) and vertical strategies to provide public health. The state as actor in IPH has been strengthened, while at the same time, the new health regulations reach much deeper into states and affect their preparations for public health emergencies of international concern. The definition of such emergencies, however, appears to be much more oriented toward the US Center for Disease Control's list of bioterrorism agents than those disease-causing agents that have caused the most fatalities over the last decade.
As for the implications of the attempted securitization of international public health for the future of the BW prohibition regime, a first question to consider is whether and to what extent the emergence of the WHO as a new actor who "speaks security" in this area will have an impact on the regime. On first glance, the setting up of new organizational structures dealing with preparedness for deliberate epidemics within the WHO secretariat might indicate the creation of a competing actor to a potential future BWC secretariat. However, as the analysis of WHO involvement in the BWC Ad Hoc Group deliberations and the 2002 report on its PDE activities show, WHO has no intention of taking on the role of verifying the use of BW or other aspects of states' compliance with their obligations undertaken under the BWC. Furthermore, at current levels of funding and manpower allocation, WHO's PDE team would not have the capacity to perform such a function in the first place. In sum, then, the WHO is not an actor that should be expected to influence regime development in a major way.
As discussed in the section on the BWC intersessional process, "enhancing international capabilities for responding to ... suspicious outbreaks of disease" and "strengthening and broadening ... the surveillance, detection, diagnosis and combating of infectious diseases" had been selected as issue areas for consideration by BWC states parties for the intersessional process leading up to the 2006 BWC Review Conference. This heightened profile of infectious disease surveillance could positively affect the implementation of three core regime norms: the cooperation norm, the assistance norm, and the internalization norm. However, such a positive effect will depend on the overall approach taken by BWC state parties to utilize the outcomes of the intersessional process. Should BWC state parties, for example, decide to set up a small secretariat to assist state parties in implementing more effectively the provisions of the BWC in general and the recommendations that might flow from the 2003-2005 intersessional process more specifically, such a secretariat could conceivably also take on a few functions that overlap with or utilize the technical assistance WHO provides to its members. It might, for example, tap into the information provided by GOARN and act as a clearing house by assisting member states in identifying, from the wealth of information provided by GOARN, suspicious outbreaks of disease. This would also relieve the WHO of suspicions that it might be misused as a Trojan horse to conduct BWC-related activities in public health guise.
Should the community of BWC state parties not be able to reach consensus during the 2006 Review Conference as to how to build on the work of the intersessional process, the partially securitized IPH regime will not be able to compensate for such a lack of political will. Neither is it to be expected that implementation of the international health regulations will detract from the attention BWC state parties devote to their obligations under this convention. Thus, it will not further weaken the already patchy BWC implementation record of a number of state parties. If, however, the BWC state parties should not be able to utilize the potential contribution of international public health--within the boundaries of the mandate and scope of WHO's activities--through the creation of new organizational structures for the BWC, this would amount to nothing less than another lost opportunity for the strengthening of the BW prohibition regime.
Alexander Kelle is a lecturer in international politics at Queen's University, Belfast. A political scientist, he was previously a Marie Curie research fellow at the Department of Peace Studies, University of Bradford, and a science fellow at Stanford University. Among his recent publications is Controlling Biochemical Weapons: Adapting Multilateral Arms Control for the 21st Century (2006), coauthored with Malcolm Dando and Kathryn Nixdorff.
1. The term is taken from Elin A. Gursky, Drafted to Fight Terror: U.S. Public Health on the Front Lines of Biological Defense (Washington, DC: ANSER, 2004).
2. See Alexander Kelle, Securitization of Public Health in the United States of America: Implications for Public Health and Biological Weapons Arms Control, Bradford Regime Review Paper No. 2, available at www.brad.ac.uk/acad/sbtwc/regrev/Kelle_SecuritizationinUS.pdf.
3. See Ole Waever, "Securitization and Desecuritization," in Ronnie D. Lipp-schutz, ed., On Security (New York: Columbia University Press, 1995), pp. 46-86.
4. See, for example, Richard Ullman, "Redefining Security," International Security 8, no. 1 (1983): 129-153; and Keith Krause and Michael C. Williams, "Broadening the Agenda of Security Studies: Politics and Methods," Mershon Review of International Studies 40, no. 2 (1996): 229-254.
5. Waever, "Securitization and Desecuritization," p. 51.
6. Ole Waever, "The EU as a Sovereign Actor: Reflections from a Pessimistic Constructivist on Post-sovereign Security Orders," in Morten Kelstrup and Michael Williams, eds., International Relations Theory and the Politics of European Integration: Power, Security and Community (London: Routledge, 2000), p. 251.
7. Mark L. Wheelis, "Biological Warfare Before 1914," in Erhard Geissler and John Ellis van Courtland Moon, eds., Biological and Toxin Weapons: Research, Development and Use from the Middle Ages to 1945, SIPRI Chemical and Biological Warfare Studies, No. 18 (Oxford: Oxford University Press, 1999), pp. 8-34.
8. See Dean Wilkening, "BCW Attack Scenarios," in Sidney D. Drell, Abraham D. Sofaer, and George D. Wilson, eds., The New Terror: Facing the Threat of Biological and Chemical Weapons (Stanford: Hoover Institution Press, 1999), pp. 76-114.
9. Malcolm Dando, "The Impact of the Development of Modern Biology and Medicine on the Evolution of Offensive Biological Warfare Programs in the Twentieth Century," Defense Analysis 15, no. 1 (1999): 51.
10. Central Intelligence Agency, Directorate of Intelligence, The Darker Bio-weapons Future, unclassified, Washington, DC, 3 November 2003, p. 1, available at www.fas.org/irp/cia/product/bw1103.pdf.
11. The text of the BWC is available in numerous places; see, for example, the website of the United Nations Office in Geneva, www.unog.ch/bwc.
12. For a comprehensive discussion of the normative structure of the BW regime, see Alexander Kelle, "Strengthening the Effectiveness of the BTW Control Regime: Feasibility and Options," Contemporary Security Policy 24, no.2 (2003): 95-132.
13. Iris Hunger, Confidence Building Needs Transparency: A Summary of Data Submitted Under the Bioweapon Convention's Confidence Building Measures, 1987-2003, September 2005, available at www.biological-arms-control.org/download/hunger_CBM.pdf.
14. Kenneth D. Ward, "The BWC Protocol. Mandate for Failure," Nonproliferation Review 11, no. 2 (Summer 2004): 183-199.
15. Jenni Rissanen, "Chair Releases His 'Composite Text' for Verification Protocol," Disarmament Diplomacy, no. 55 (March 2001), available at www.acronym.org.uk/bwc/archive.htm? (accessed 1 December 2006).
16. See Jenni Rissanen, "Left in Limbo: Review Conference Suspended on Edge of Collapse," Disarmament Diplomacy, no. 62 (January-February 2002): 18-32.
17. Javed Siddiqi, World Health and World Politics: The World Health Organisation and the U.N. System (London: Hurst, 1995), pp. 14-20.
18. See the preamble of WHO's constitution, available at http://policy.who.int/cgi-bin/om_isapi.dll?infobase=Basicdoc&softpage=Browse_Frame_Pg42.
19. Anne-Marie Slaughter, A New World Order (Princeton: Princeton University Press, 2004), p. 22.
20. See World Health Organization, "International Health Regulations," available at www.who.int/csr/ihr/en.
21. David P. Fidler, SARS, Governance and the Globalization of Disease (Basingstoke: Palgrave Macmillan, 2004), p. 35.
22. Ibid., p. 61, footnote.
23. South East Asian Regional Committee, International Health Regulations: Revision Process, Document SEA/RC56/4, New Dehli, 4 July 2003, available at http://w3.whosea.org/meeting/rc/rc56/pdf/RC56-4.pdf, p. 1.
24. Revision of the International Health Regulations, WHO Doc. WHA58.3, 23 May 2005, available at www.who.int/gb/ebwha/pdf_files/WHA58/WHA58_3-en.pdf.
25. On the malaria program, see Siddiqi, World Health and World Politics, pp. 123-191; on smallpox, see F. Fenner et al., Smallpox and Its Eradication (Geneva: WHO, 1988).
26. Fidler, SARS, Governance and the Globalization of Disease, pp. 40-41
27. J. M. Mann, "Human Rights and Aids: The Future of the Pandemic," in J. M. Mann et al. eds., Health and Human Rights: A Reader (London: Routledge, 1999), pp. 216-226.
28. See United Nations Development Programme, Human Development Report 1994: New Dimensions of Human Security (New York: United Nations, 1994), pp. 27-28.
29. Richard Dodgson and Kelley Lee, "Global Health Governance. A Conceptual Review," in Rorden Wilkinson and Steve Hughes, eds., Global Governance: Critical Perspectives (London: Routledge, 2002), p. 98.
30. See, for example, Institute of Medicine (IOM), Emerging Infections: Microbial Threats to Health in the United States (Washington, DC: National Academy Press, 1992); World Health Organization, World Health Report: Fighting Disease, Fostering Development (Geneva: WHO, 1996); and IOM, Microbial Threats to Health: Emergence, Detection, and Response (Washington, DC: National Academy Press, 2003).
31. On the involvement of the latter, see Yves Beigbeder, International Public Health: Patients' Rights vs. the Protection of Patents (Aldershot: Ashgate, 2004).
32. Fidler, SARS, Governance and the Globalization of Disease, pp. 66-67.
33. W. Seth Carus, Bioterrorism and Biocrimes: The Illicit Use of Biological Agents Since 1900 (Washington, DC: National Defense University, February 2001), p. 11; Ron Purver, Chemical and Biological Terrorism: The Threat According to the Open Literature (Ottawa: Canadian Security Intelligence Service, June 1995).
34. Ibid., p. 8.
35. Jonathan Tucker, ed., Toxic Terror: Assessing Terrorist Use of Chemical and Biological Weapons (Cambridge: MIT Press, 2000).
36. Brad Roberts, ed., Hype or Reality: The "New Terrorism" and Mass Casualty Attacks (Alexandria, VA: CBACI, 2000).
37. See Milton Leitenberg, "The Experience of the Japanese Aum Shinrikyo Group and Biological Agents," in Roberts, Hype or Reality, pp. 159-170.
38. See WHO document at www.who.int/gb/ebwha/pdf_files/WHA55/ea5520.pdf.
39. Ibid., p. 2.
40. Ibid., p. 3.
41. See www.who.int/gb/ebwha/pdf_files/WHA55/ewha5516.pdf, p. 2.
42. WHO, Preparedness for Deliberate Epidemics: To Support Member States in Enhancing Their Preparedness and Response Programmes for the Possible Deliberate Use of Biological Agents That Affect Health: Report of Activities for the Biennium 2002-2003, Doc. WHO/CDS/CSR/LYO/2004.7 (Geneva: WHO, 2004), available at www.who.int/csr/delibepidemics/preparedness/WHO_CDS_CSR_LYO_2004_7.pdf.
43. Ibid., p. 5.
44. Ibid., p. 6.
45. Unless otherwise noted, the following account of the discourse on the revised IHR is based on a number of interviews with national delegates involved in this process. Interviews were conducted in Geneva during the week 5-9 December 2005.
46. See WHO Working Group on the Revision of the International Health Regulations, International Health Regulations: Working Paper for Regional Consultations, Doc. IGWG/IHR/Workingpaper/12.2003 (Geneva: WHO, 12 January 2004).
47. Ibid., pp. 2-3.
48. Interviews with delegates in Geneva, 7 and 8 December 2005.
49. WHO, Decision Instrument for the Assessment and Notification of Events That May Constitute a Public Health Emergency of International Concern: Report of the Ad Hoc Expert Group on Annex 2, Doc. A/IHR/IGWG/2/INF.DOC./4 (Geneva: WHO, 22 February 2005), p. 7.
50. Interview with delegate in Geneva, 8 December 2005.
51. WHO, Revision of the International Health Regulations, Doc. WHA58.3 (Geneva: WHO, 23 May 2005), p. 46.
52. Ibid., p. 9. See also Statement for the Record by the Government of the United States of America Concerning the World Health Organizations Revised International Health Regulations (Geneva: US Mission to the United Nations in Geneva, 23 May 2005), available at www.usmission.ch/Press2005/0523IHRs.htm.
53. Interview with delegate participating in the IHR revision process, Geneva, 8 December 2005.
54. A More Secure World: Our Shared Responsibility: Report of the Secretary-General's High Level Panel on Threats, Challenges and Change (New York: United Nations, 2004).
55. Ibid., p. 29.
56. Ibid., p. 29, footnote.
57. Ibid., p. 30.
58. Ibid., p. 47.
59. Graham S. Pearson, The UN Secretary-General's High Level Panel: Biological Weapons Related Issues, Strengthening the Biological Weapons Convention Review Conference Paper No. 14 (Bradford: Department of Peace Studies, University of Bradford, May 2005), p. 16.
60. See In Larger Freedom: Towards Development, Security and Human Rights for All, Report of the Secretary-General (New York: United Nations, 2005), pp. 20-21.
61. On the split 2001-2002 BWC review conference, see Marie I. Chevrier, "Waiting for Godot or Saving the Show? The BWC Review Conference Reaches Modest Agreement," in Disarmament Diplomacy, no. 68 (December 2002-January 2003): 11-16.
62. Final document of the Fifth BWC Review Conference, Doc. BWC/CONF.V/17, p. 3, available at http://disarmament2.un.org/wmd/bwc/pdf/bwccnfv17.PDF.
63. See Kelle, "Strengthening the Effectiveness," note 11.
64. United Nations, Report of the Meeting of States Parties, Doc. BWC/MSP/2004-3 (Geneva: United Nations, 14 December 2004), available at www.opbw.org/new_process/msp2004/BWC_MSP_2004_3_E.pdf.
65. Ibid., p. 4.
66. Although intended in no way as a comprehensive answer, this finding also speaks to the issue recently raised by McInnes and Lee concerning the "lack of conceptual clarity over what WHO and others term 'global health security.'" Collin McInnes and Kelley Lee, "Health, Security and Foreign Policy," in Review of International Studies 32, no. 1 (2006): 23.
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