In lieu of an abstract, here is a brief excerpt of the content:

Reviewed by:
  • Review of Unprepared: Global Health in a Time of Emergency by Andrew Lakoff
  • Kristen Shorette
Review of Unprepared: Global Health in a Time of Emergency By Andrew Lakoff University of California Press, (https://www.ucpress.edu/book.php?isbn=9780520295766) $29.95 paperback. 240 pages

The recent upsurge in global health emergencies constitutes a public threat that is as potentially catastrophic as it is unpredictable. Beginning with the HIV/AIDS epidemic of the 1980s, the regular emergence of new and mutated pathogens has become increasingly frequent. All evidence suggests the trend will continue. However, as the book's title suggests, the emergence of each new infectious disease exposes a persistent lack of global institutional preparedness to prevent pandemics. In Unprepared, Andrew Lakoff offers an engaging analysis of the evolving state of emergency response to global health crises. The culmination of a series of comparative analyses leads Lakoff to conclude that the logic underlying the global health security system is both historically contingent and responsible for its own repeated failures. Debates among and between experts in a variety of fields are intertwined with public scrutiny and amplified by the combination of the urgency and uncertainty of the threat. Unprepared is an impressive account of outcomes based on their counterfactuals.

Before navigating through a series of outbreak episodes that illustrate serial post hoc adjustments to what has come to be known as global health security, Lakoff introduces the macro-historical context that amplifies the pandemic threat. Contemporary geopolitical relationships, demographic trends, and the international exchange of goods, services, and people create unique challenges to detecting and containing outbreaks of infectious diseases. These challenges are compounded by the involvement of a wide array of participants. Experts in the newly formed field of global health security are joined by infectious disease specialists, nongovernmental organizations, corporations, diplomats, and journalists, among others.

To explain global public health experts' chronic unpreparedness for the threat du jour, Lakoff takes an historical ontological approach. He analyzes the processes by which a global health security apparatus haphazardly consolidated over the course of several decades. He begins with the observation that responses to infectious disease threats are surprisingly detached from the characteristics of the diseases themselves. Instead, they exist within a generalized technocratic [End Page 1] regulatory framework that may or may not be appropriate for any given situation. Lakoff's analytical strategy hinges on stepping back—chronologically and conceptually—questioning each otherwise taken-for-granted premise along the way. He questions preparedness as governance strategy and explains how it came to structure the thoughts and actions of infectious disease experts.

Lakoff locates the origins of the preparedness approach in the civil defense techniques developed in the United States during the Cold War. He traces a series of debates over the most effective approach to protecting the public from all urgent and uncertain threats. Ultimately, a "continuous state of readiness" (chapter 1) strategy replaced statistical prediction of risk. The "generic biological threat" (chapter 2) of bioterrorism later brought together the fields of civil defense and public health. Lakoff's comparison of responses to flu outbreaks in 1976 and 2005 highlights the significance of the transition from prevention to preparedness. He later revisits this still unresolved tension within the "fragile assemblage" (chapter 5) of a heterogeneous set of actors who have a common goal of protecting the public from catastrophic events that may or may not happen. New debates on viral research, its unintended consequences, and intellectual property rights follow.

In his analysis of "two regimes of global health" (chapter 3), Lakoff reveals a close link between organizational goals and structure. The comparison of humanitarian biomedical organizations on the one hand, and the World Health Organization on the other, illustrates the ethical, political, and technical dimensions of institutionalizing a global health governance system. The WHO's formal adoption of the preparedness strategy raises new questions. What constitutes a "public health emergency of international concern"? Who establishes the criteria for intervention and withdrawal? Who benefits? In answering these questions, Lakoff looks to the "real time biopolitics" (chapter 4) centered on tensions between global and national authorities. The consequent imposition of a technocratic global health emergency response system based on preparedness rather...

pdf

Share