Covid-19: Surveillance and Security
The problem of anticipating and managing epidemics is not new. From the 19th century, yellow fever, smallpox, cholera, and other diseases passed through urban centers in the US and Europe with devastating consequences, shaping the emergence of public health as a new responsibility of government and reconfiguring state–citizen relations inconsequential ways (Rosenberg, 1987).
In recent decades, experts have worried that global transportation, trade, urbanization, environmental change, agricultural practices, and a host of other factors are producing potent incubators and transmission pathways for new viruses with pandemic potential.
Novel viruses like HIV, SARS, avian influenza, Ebola, and MERS have given credence to such predictions, elevating pandemic preparedness to a high position on the global health agenda (Keck, 2015).
Growing concern about pandemic risk has informed recent reorientations at the nexus of international law and global health.
The 2005 revisions to the International Health Regulations (IHR) sought to protect ‘‘global public health security,’’ treating the infectious disease as threat not only to public health, but to social, economic, and political stability (Elbe, 2006; Ingram, 2008; Lakoff, 2015).
The IHR created new obligations for states to act in accordance with WHO assessments of risk, including by reliably supplying domestic public health information to WHO for global pandemic risk assessment purposes.
Avian influenza has figured centrally in this ‘‘securitization’’ of global health (Lakoff, 2015). Flu viruses evolve rapidly and have the potential to be highly infectious. In 1997, the discovery in Hong Kong of a new, highly virulent avian flu led to the culling of 1.5 million chickens in three days (Webster and Hulse, 2005).
Since then, it has remained a major locus of public health concern and has been increasingly characterized as a threat not just to human health, but also to the global economy and to political stability (and therefore national security), particularly in Southeast Asia.
In 2005 Barak Obama, then the junior senator from Illinois wrote in The New York Times that it was necessary to add to the list of security threats like rogue nuclear states and terrorists ‘‘another kind of threat [that] lurks beyond our shores, one from nature, not humans—an avian flu pandemic’’ (Obama and Lugar, 2005).
Various versions of the national security strategy of the United States have listed the risk of pandemic disease among the threats to national security that ‘‘recognize no borders’’ (e.g. U.S. Department of State 2006).
Alongside these reframings of pandemic risk, a discourse of urgency has taken shape around the need to build scientific mechanisms to anticipate, identify, and address such threats.
Advocates of surveillance have lamented what they see as the complacency of the international community, which they in turn attribute to a global public that is insufficiently concerned because it grasps neither the risk of nor the devastating consequences of, a serious pandemic.
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They suggest this complacency is a function of asymmetry in capacities for imagining and predicting the future. Whereas infectious disease and public health experts can see clearly the future that is brewing in the poultry farms of
Southeast Asia, the public has long since forgotten the pandemics of their great-grandparents’ world.
The 2011 Hollywood film ‘‘Contagion’’ was an attempt to engender such capacities of imagination in the movie-going public. Steven Soderburgh called upon Ian Lipkin (2011), a prominent infectious disease specialist at Columbia University, to help him create a movie about a flu-like pandemic ‘‘that didn’t distort reality but did convey the risks that we all face from emerging infectious diseases.’’
Lipkin and his scientific team constructed a hypothetical scenario for a novel zoonotic virus, modeling its spread from bat to pig to human and across the global population, and the screenplay was written to follow the script of Lipkin’s epidemiological scenario.
In an op-ed in The New York Times, Lipkin explained the significance of this 21st- century morality play. ‘‘Is this fiction? Yes. Is it real? Absolutely.’’
Published on 11 September 2011, the implication was clear enough: Nature is the most powerful global terrorist and sooner or later will launch a devastating attack.
This inevitable future, according to Lipkin (2011), demands a globally coordinated effort ‘‘to monitor human, animal, and environmental health, optimize electronic health records, mine nontraditional data sources like the Internet for early signs of outbreaks and invest in a state-of-the-artwork force.’’
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In addition, it requires unconstrained efforts to innovate new medical countermeasures, including diagnostics and vaccines.
In short, in the narrative frame of global public health security, public well- being depends upon scientific capacities to ‘‘to protect our future’’ through forms of research and surveillance that push back the horizon of prediction.