Mark Harrison is Professor of the History of Medicine and Director of the Wellcome Unit for the History of Medicine at the Uni

Mark Harrison

Mark Harrison is Professor of the History of Medicine and Director of the Wellcome Unit for the History of Medicine at the University of Oxford. He has written widely on the history of war, imperialism and medicine and more recently on the history of disease and globalization, some aspects of which are analyzed in his book Contagion: How Commerce has Spread Disease (Yale University Press, 2012). His previous books include The Medical War: British Military Medicine in World War One (Oxford University Press, 2010), Medicine in an Age of Commerce and Empire (Oxford University Press, 2010), Medicine and Victory: British Military Medicine in World War Two (Oxford University Press, 2004), Disease and the Modern World: 1500 to the Present Day (Polity, 2004) and Climates and Constitutions: Health, Race, Environment and British Imperialism in India 1600-1850 (Oxford University Press, 1999), Public Health in British India (Cambridge University Press, 1994).

Risk and Security in the Age of Pandemics

Abstract

Like earlier periods of economic and political integration, the current wave of globalization has been accompanied by anxiety about the spread of disease – not only classic pandemic diseases such as influenza but many new ones such as SARS and BSE/vCJD. The increased speed and frequency of international travel, global chains of product distribution and environmental changes have seemingly combined to make an epidemiological catastrophe inevitable, or so it would seem from the pronouncements of many working in the field of public health. Governments have responded to this increased sense of threat by greater vigilance at national borders and by drafting detailed contingency plans for the coming emergency: nowhere more so than in East Asia, which many suppose to be in the epidemiological ‘front-line’. Some historians and policy analysts see parallels between the present and the imperial past, for example in the stigmatization of countries in the East and Global South. Such analogies, however, offer little real insight into the complex and rather unstable situation which now faces us. In this lecture I seek to ascertain what difference globalization has actually made to our perception of disease and attempts to prevent it.

The epidemiological world of the age of high imperialism was a Manichean one which portrayed the Orient and the tropics as inherently dangerous, on account of both their climates and cultures. Recent constructions of the threat of pandemic disease display some similarities to those of the past but they differ in important respects. One of the key differences, I shall argue, is the centrality of notions of risk and the practice of risk assessment. Although by no means absent from preventive medicine before the twenty-first century, risk has come to dominate the ways in which we think about the threat posed by infectious disease. The threat of disease is now defined largely in terms of the risk posed by individual states and the extent to which they are able to meet international standards in public health. These standards are not always clearly defined but the process of risk assessment purports to scientific objectivity: a claim which is naïve at best and at worst a dangerous fiction. As I hope to show in this lecture – using examples drawn mostly from Asia – calculations of epidemiological risk are never objective and are always contested. Each state – each interested party – is a player in a game with high stakes, for with an assessment of risk comes the prospect of reputational and financial loss.

Globalization is not the sole cause of the rise of this ‘risk society’, as Ulrich Beck has famously termed it, but it has moulded it into a particular form. It has shaped perceptions of disease in two ways. Most obviously, globalization has drawn attention to the risks shared by all humanity and has produced something approaching a sense of obligation on the part of nation states to fulfil their role as responsible global citizens. At the beginning of the present century, the emergence of this global consciousness in public health gave rise to optimism that the World Health Organization might become the major player in global health, rising above the interests of individual nation states. However, globalization has also produced fractures within the world of public health and it is these which I believe to be of greatest significance.

The intense competitive pressure produced by globalization has led states increasingly to defend their interests, although in doing so they have often cloaked them in the mantle of global responsibility. One obvious example of this is the use of quarantines and sanitary embargoes to protect domestic industries against foreign competition. At the same time, governments are quick to denigrate rivals with claims that they are slow to meet their sanitary obligations. Such claims rest on calculations of risk and a cadre of experts has emerged to conduct such assessments: all in the employ of national governments rather than global agencies. The result has been a bewildering series of claims and counter-claims, with various countries – Western and Asian – being stigmatized depending on the circumstances and interests involved. With the rise of countries like China, the West is now just as often on the receiving end of sanitary blame as the East. Sanitary threats no longer seem to issue from any particular part of the world but shift constantly, sometimes drawing on older stereotypes, but often creating new ones. Institutions of global governance such as the World Health Organization and the World Trade Organization attempt to adjudicate these conflicting claims but their ability to do so is constrained by the ambiguity of international sanitary law and the feebleness of the sanctions at their disposal.

The threat of disease in the globalized world is therefore multi-centred and hotly contested, not only between nation states and trading blocs but within them. Certain threats are even held to be transnational in nature, such as the threat allegedly posed to health by large agro-industrial corporations. But the present phase of global integration is characterized not only by its preoccupation with risk but with its concomitant, ‘security’. Over the last two decades there have been numerous demands for the ‘securitization’ of public health; that is, to make the relationship of public health to national security more explicit and to elevate security to the top of the health agenda. Health security has two main elements. The first of these is ‘biosecurity’ within state borders, which attempts to neutralize the hazards which may arise from activities such as farming and food processing and retailing. The second is security at the border: the sanitary policing of immigration, trade and so forth. There is nothing new about either of these forms of security but they now rest largely on calculations of risk and these risks are generally constructed to the advantage of some and the disadvantage of others. Moreover, the purported objectivity of risk assessments provides a justification for actions designed to further certain interests and which are in some cases coercive.

This lecture seeks to unpack some of these risk narratives and to see who stands to benefit from them. However, its ultimate purpose is to show how the risk-security axis produces selectivity and instability, and that purported measures of sanitary security are often illusory.