Ethics and Security Aspects of Infectious Disease Control: Interdisciplinary Perspectives ed. by C. Enemark, M. Selgelid (review)

First, let me say that Enemark and Selgelid’s edited collection is a valuable contribution to the ongoing debates about the responses to infectious diseases of different kinds. The various chapters focus on the idea of securitisation — not just as a theory of political expediency and/or militarisation (see Segelid and Enemark, 3),¹ but also security as a basic feature of human agency. This serves to ground the ongoing, and sometimes nebulous debates about collective interests (or the rise of National Security rhetoric) set against the individual, that is common in the discourse of pandemic planning. This book can be summarised as an enquiry about what we can expect public health (institutions) to do in emergency circumstances; and, in particular, what security can tell us about agency, rights, public goods and private interests? According to Ole Waever, this is a wider project of “securitization”: the “Discursive and political process through which an intersubjective understanding is constructed within a political community to treat something as an existential threat to a valued referent object, and to enable a call for urgent and exceptional measures to deal with the threat.” ² The contributions to the book, in this regard, excel in defining the scope of such anticipations.

In this review, I want to offer a critique of the approach to securitisation in general, drawing on the relevant chapters of the book. For this purpose, I will focus on pandemic influenza and will take more notice of the chapters that address these concerns (although other issues, such as conducting research during pandemics [Reis and Fung, 9], are also pressing topics covered). In the first part, I look in detail at the contributions in respect to challenging conventions in infectious disease planning. While each contribution is important in its own right, I do find that, overall, the book does not champion any radical proposals for the inevitable occurrence of the “big one”,³ whether it is caused by a nationally occurring disease or one that is released by a terrorist group. In the second part, I pick up on some of the conceptual demarcation used by the various authors.

For many, like me, the response to Influenza A (H1N1) in 2009 did not instil confidence in the adage: “be prepared”. The emerging threat of Influenza A (H7N9) underlines the importance of pandemic planning, but the incremental changes adopted since 2009 have not addressed some basic concerns, for example, with global vaccine production (the time it takes to make, equitable access, breakdowns in the production and delivery system, including the fear that a key player might renege on their contractual obligations),⁴ or research integrity (such as the accusations of conflicts of interest and the reporting and marketing of anti-vials). I do not wish to belittle the steps that have been made, especially in term of the WHO’s attempts to integrate global responses. But, first, improvements, which will take several years to accomplish and are underway, may not be completed by the time the next pandemic occurs; second, confidence in a response is likely to be guided by the last good effort, and in this case, we should have done better in things like communication of realistic predictions; ⁵ and third, I have a sense “regulatory capture” has occurred, whether knowingly or not, policymakers are not always able to distinguish subjective interest from objective goals.

In respect to this last point, the problem with emergent pandemics is that we are dealing with unknowns and there has been a tendency to rely on scientific planning (Carney and Bennett, 12: 2006–2007). Given the limitations of this approach, some have proposed that fundamental changes or (perhaps radical) measures be considered where evidentially previous responses were wide of the mark? For example, during a pandemic, the public takes the brunt of the response, isolation, quarantine, restrictions on movement, and so on. Despite being rolled out...