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363 21 Health, Security, and New Biological Threats Reconfigurations of Expertise Stephen J. Collier,The New School Andrew Lakoff, University of Southern California of the critical, reflexive knowledge produced by the social studies of medicine in approaching this terrain. Biosecurity Interventions The World Health Organization’s (WHO) annual world health report for 2007, A Safer Future : Global Public Health Security in the 21st Century, began by noting the success of public health measures during the twentieth century in dealing with great microbial scourges such as cholera and smallpox. But in recent decades, it continued, there had been an alarming shift in the “delicate balance between humans and microbes.” A confluence of factors—demographic changes, economic development, global travel and commerce , and conflict—had “heightened the risk of disease outbreaks,” ranging from new infectious diseases such as HIV/AIDS and drug-resistant tuberculosis to food-borne pathogens and bioterrorist attacks (WHO 2007, 1). The WHO report proposed a framework, “public health security,” for responding to this new landscape of threats that is striking in its attempt to bring together previously distinct technical problems and political domains. Some of the biological threats discussed in the report —particularly the use of bioweapons—have In recent decades, a series of new biological threats has raised both technical and political questions about how to understand and manage disease risk. In this chapter we explore what role the social studies of medicine can play in analyzing these new disease risks. We focus in particular on recent critical scholarship that has examined how existing forms of biomedical and security expertise are being reconfigured in response to new threats such as emerging infectious disease and bioterrorism.1 This work provides insight into how disease threats are being “problematized ,” and therefore it helps us diagnose some of the political, ethical, and technical conflicts that have arisen in response to new or newly perceived threats to health. The chapter begins with an introduction to the issue of securing health as a problem for expert practitioners, and suggests how new disease threats cut across existing fields of expertise and authority. We then look at several domains in which new biological threats have been identified by public health experts, policy makers, and other public authorities: emerging infectious disease, bioterrorism, the life sciences, and food safety. In the third section we describe recent work in the social studies of medicine that has analyzed the new configurations of authority and expertise that have emerged in these domains . In the conclusion we reflect on the role 364 Handbook of Medical Sociology traditionally been taken up under the rubric of national security and approached by organizations concerned with national defense. Others, such as infectious disease, have generally been managed as problems of public health, whose history, though certainly not unrelated to conflict and military affairs, has been institutionally distinct (Fearnley 2008; King 2002).2 The WHO proposal also sought to reconfigure existing approaches to ensuring health. The report emphasized a space of “global health” distinct from the predominantly national organization of both biodefense and public health. “In the globalized world of the 21st century,” it argued, simply stopping disease at national borders is not adequate. Nor is it sufficient to respond to diseases after they have become established in a population. Rather, it is necessary to prepare for unknown outbreaks in advance, something that can be achieved only “if there is immediate alert and response to disease outbreaks and other incidents that could spark epidemics or spread globally and if there are national systems in place for detection and response should such events occur across international borders” (WHO 2007, 11). According to WHO, then, a functioning global health security apparatus would have to focus on preparing for catastrophic disease outbreaks anywhere in the world. The WHO report is one among a range of recent proposals for securing collective health against new or newly recognized biological threats. Other prominent examples include the recent Pandemic and All-Hazards Preparedness Act in the United States, reports on “global biological threats” from prominent think tanks such as the RAND Corporation, new research facilities such as the National Biodefense Analysis and Countermeasures Center, and ambitious initiatives such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the President’s Emergency Plan for AIDS Relief. These proposals build on a growing perception among diverse experts and officials— life scientists and public health officials, policy makers and security analysts—that new biological threats challenge existing ways of understanding and managing collective...

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