The pharmaceuticalisation of security: molecular biomedicine, antiviral stockpiles, and global health security

Pharmaceuticals are now critical to the security of populations. Antivirals, antibiotics, next-generation vaccines, and antitoxins are just some of the new ‘medical countermeasures’ that governments are stockpiling in order to defend their populations against the threat of pandemics and bioterrorism. How has security policy come to be so deeply imbricated with pharmaceutical logics and solutions? This article captures, maps, and analyses the ‘pharmaceuticalisation’ of security. Through an in-depth analysis of the prominent antiviral medication Tamiflu, it shows that this pharmaceutical turn in security policy is intimately bound up with the rise of a molecular vision of life promulgated by the biomedical sciences. Caught in the crosshairs of powerful commercial, political, and regulatory pressures, governments are embracing a molecular biomedicine promising to secure populations pharmaceutically in the twenty-first century. If that is true, then the established disciplinary view of health as a predominantly secondary matter of ‘low’ international politics is mistaken. On the contrary, the social forces of health and biomedicine are powerful enough to influence the core practices of international politics – even those of security. For a discipline long accustomed to studying macro-level processes and systemic structures, it is in the end also our knowledge of the minute morass of molecules that shapes international relations

Pandemics, Pills, and Politics

The fascinating story of Tamiflu's development and stockpiling against global health threats.orld's most prominent medical countermeasure, Tamiflu.A pill can strengthen national security? The suggestion may seem odd, but many states around the world believe precisely that. Confronted with pandemics, bioterrorism, and emerging infectious diseases, governments are transforming their security policies to include the proactive development, acquisition, stockpiling, and mass distribution of new pharmaceutical defenses. What happens—politically, economically, and socially—when governments try to protect their populations with pharmaceuticals? How do competing interests among states, pharmaceutical companies, regulators, and scientists play out in the quest to develop new medical countermeasures? And do citizens around the world ultimately stand to gain or lose from this pharmaceuticalization of security policy?Stefan Elbe explores these complex questions in Pandemics, Pills, and Politics, the first in-depth study of the world’s most prominent medical countermeasure, Tamiflu. Taken by millions of people around the planet in the fight against pandemic flu, Tamiflu has provoked suspicions about undue commercial influence in government decision-making about stockpiles. It even found itself at the center of a prolonged political battle over who should have access to the data about the safety and effectiveness of medicines.Pandemics, Pills, and Politics shows that the story of Tamiflu harbors deeper lessons about the vexing political, economic, legal, social, and regulatory tensions that emerge as twenty-first-century security policy takes a pharmaceutical turn. At the heart of this issue, Elbe argues, lies something deeper: the rise of a new molecular vision of life that is reshaping the world we live in

Entangled security: science, co-production, and intra-active insecurity

This article advances a new account of security as an intensely relational and ontologically entangled phenomenon that does not exist prior to, nor independently of, its intra-action with other phenomena and agencies. Security's ‘entanglement’ is demonstrated through an analysis of the protracted security concerns engendered by ‘dangerous’ scientific experiments performed with lethal H5N1 flu viruses. Utilising methodological approaches recently developed in the field of Science and Technology Studies (STS), the article explicates the intensely ‘co-productive’ dynamics at play between security and science in those experiments, and which ultimately reveal security to be a deeply relational phenomenon continuously emerging out of its engagement with other agencies. Recovering this deeper ontological entanglement, the article argues, necessitates a different approach to the study of security that does not commence by fixing the meaning and boundaries of security in advance. Rather, such an approach needs to analyse the diverse sites, dynamics, and processes through which security and insecurity come to intra-actively materialise in international relations. It also demands a fundamental reconsideration of many of the discipline's most prominent security theories. They are not merely conceptual tools for studying security, but crucial participants in its intra-active materialisation

Who owns a deadly virus? Viral sovereignty, global health emergencies, and the matrix of the international

This article investigates the global inequities imbricated in the international response to lethal viruses. It does so by developing a virographic approach to the study of international relations that builds upon the matrix methods pioneered within black feminist thought for unraveling particularly complex forms of interlocking oppression. Performing such a virography of international relations exposes the multifaceted economic, racial, and epistemological disparities embedded in the international management of emergent viruses. It further demonstrates how those multiple axes of international inequality intersect during viral outbreaks to form a deadly matrix of global subjugation—vital abandonment—that repeatedly deprives the world's majority population from equitable access to life-saving biomedical interventions. It finally also reveals how diplomatic assertions of viral sovereignty, that is, claiming legal ownership of pathogens, are directly enrolling lethal viruses now in the political strategies of countries seeking to resist their vital abandonment. Overall, a virography thus contributes to the broader study of international relations by foregrounding the global salience of epidemiological injustices and positionalities, by capturing the actant power of lethal viruses in contemporary world politics, and by intimating that the “international” can itself be studied as a continually reconfiguring matrix of interlocking and historically conditioned global inequities

Bioinformational diplomacy: global health emergencies, data sharing and sequential life

Global health emergencies – like COVID-19 – pose major and recurring threats in the 21st century. Now societies can be better protected against such harrowing outbreaks by analysing the detailed genetic sequence data of new pathogens. Why, then, is this valuable epistemic resource frequently withheld by stakeholders – hamstringing the international response and potentially putting lives at risk? This article initiates the social scientific study of bioinformational diplomacy, that is, the emerging field of tensions, sensitivities, practices and enabling instruments surrounding the timely international exchange of bioinformation about global health emergencies. The article genealogically locates this nascent field at the intersection of molecularised life, informationalised biology and securitised health. It investigates the deeper political, economic and scientific problematisations that are engendering this burgeoning field. It finally analyses the emergent international instruments developed by governments, scientists and industry to facilitate more rapid global sharing of bioinformation through novel practices of data passporting. Overall, the in-depth study of bioinformational diplomacy reveals just how deeply, and even constitutively, international relations are entangled with the life sciences – by carefully tracing how laboratory practices of sequencing life at molecular scale also end up recontouring the play of sovereignty, power and security in international relations

Haggling over viruses: the downside risks of securitizing infectious disease

This article analyses how the 'securitization' of highly pathogenic avian influenza (H5N1) contributed to the rise of a protracted international virus-sharing dispute between developing and developed countries. As fear about the threat of a possible human H5N1 pandemic spread across the world, many governments scrambled to stockpile anti-viral medications and vaccines, albeit in a context where there was insufficient global supply to meet such a rapid surge in demand. Realizing that they were the likely 'losers' in this international race, some developing countries began to openly question the benefits of maintaining existing forms of international health cooperation, especially the common practice of sharing national virus samples with the rest of the international community. Given that such virus samples were also crucial to the high-level pandemic preparedness efforts of the West, the Indonesian government in particular felt emboldened to use international access to its H5N1 virus samples as a diplomatic 'bargaining chip' for negotiating better access to vaccines and other benefits for developing countries. The securitized global response to H5N1 thus ended up unexpectedly entangling the long-standing international virus-sharing mechanism within a wider set of political disputes, as well as prompting governments to subject existing virus-sharing arrangements to much narrower calculations of national interest. In the years ahead, those risks to international health cooperation must be balanced with the policy attractions of the global health security agenda

Securing circulation pharmaceutically: antiviral stockpiling and pandemic preparedness in the European Union

Governments in Europe and around the world amassed vast pharmaceutical stockpiles in anticipation of a potentially catastrophic influenza pandemic. Yet the comparatively ‘mild’ course of the 2009 H1N1 pandemic provoked considerable public controversy around those stockpiles, leading to questions about their cost–benefit profile and the commercial interests allegedly shaping their creation, as well as around their scientific evidence base. So, how did governments come to view pharmaceutical stockpiling as such an indispensable element of pandemic preparedness planning? What are the underlying security rationalities that rapidly rendered antivirals such a desirable option for government planners? Drawing upon an in-depth reading of Foucault’s notion of a ‘crisis of circulation’, this article argues that the rise of pharmaceutical stockpiling across Europe is integral to a governmental rationality of political rule that continuously seeks to anticipate myriad circulatory threats to the welfare of populations – including to their overall levels of health. Novel antiviral medications such as Tamiflu are such an attractive policy option because they could enable governments to rapidly modulate dangerous levels of (viral) circulation during a pandemic, albeit without disrupting all the other circulatory systems crucial for maintaining population welfare. Antiviral stockpiles, in other words, promise nothing less than a pharmaceutical securing of circulation itself

European nihilism and the meaning of the European idea: A study of Nietzsche's 'good Europeanism' in response to the debate in the post-Cold War era.

One of the novel aspects of the European debate in the post-Cold War era is the deliberate attempt by scholars and policy-makers to articulate a more meaningful idea of Europe. Such an idea, it is hoped, would enhance the legitimacy of the European Union and could provide the basis for a European identity capable of mitigating against the rise of nationalist and racist violence in Europe. After more than a decade, however, a compelling vision of Europe that would fulfil these aspirations is still widely deemed to be lacking. The question that arises, therefore, is why, in fact, it is proving so difficult to articulate a more meaningful idea of Europe in the post-Cold War era, and how, concomitantly, this difficulty might be addressed. In response to this question, the present thesis offers a detailed analysis of the largely unexplored European thought advanced by the German philosopher Friedrich Nietzsche towards the end of the nineteenth century. For, the thesis argues, Nietzsche's thinking about Europe can still significantly illuminate our understanding of the current impasse by contextualising the latter within the larger problem of European nihilism, or meaninglessness, resident in the cultural configuration of European modernity. On the basis of this understanding, moreover, the thesis subsequently turns towards a consideration of Nietzsche's own idea of the 'good European' which he developed in response to the experience of meaninglessness in modern European culture. This idea of what it means to be a 'good European,' the thesis concludes, can assist contemporary scholars of European affairs in delineating a response to the current impasse which neither posits an essentialist idea of Europe, nor falls back onto a technical and functional approach to European governance

The political economy of molecules: vital epistemics, desiring machines and assemblage thinking

Could the most miniscule of objects, imperceptible to the human eye, enact whole new political economies? The suggestion may seem odd, but this article shows that tiny molecules are already engendering new regimes of value across the fields of global health and biodefense. Delving genealogically into the onto-epistemology of the life sciences, the article thus traces the protracted molecular reconfigurations of state-market relations underpinning the global bioeconomy and civilian biodefense today. Using methodological precepts developed through assemblage thinking, this evolving patchwork of new constellations is conceptualized as a global molecular assemblage. Attending to the lively play of molecules in the world advances the post-Foucauldian, molecular study of biopolitics by exploring how scientific shifts in our ‘vital epistemics’ contour state-market relations. It further contributes to the development of a post-human international political economy that is more sensitive to the ways in which artefacts (like molecules) too exhibit particular kinds of ‘agency’ and ‘force’ in the world. Finally, it also enhances the field’s ability to make unconventional, hitherto overlooked and multi-scalar connections in the study of political economy through the creative use of assemblage thinking. In the case of molecules, such assemblage thinking can – quite literally – reveal the value of ‘life’

Drilling down in norm diffusion: norm domestication, “Glocal” power, and community-based organizations in global health

Norm diffusion scholarship analyzes how states come to agree and adopt new international norms. Yet, formal adoption of a new norm does not in itself guarantee that a government will also implement it domestically, and very little international relations scholarship drills down deep enough to examine whether and how new international norms are subsequently integrated, incorporated, and translated at sub-state level. This article initiates a research agenda on norm “domestication” through the first in-depth study of how international norms in the field of global health are locally incorporated by community-based organizations (CBOs). Drawing upon multi-sited international fieldwork in Uganda, Ukraine, and El Salvador, the paper uncovers three norm domestication strategies used by CBOs of people affected by HIV/AIDS: harnessing political divisions within national governments, circumventing government policy with international help, and mounting legal challenges to government policy. The article argues that these CBO strategies represent “glocal” forms of power capable of forging local–global connections through combined practices of norm allying, norm implementation, and norm intertwining. These subtler processes of norm domestication, the article concludes, ultimately require a reconceptualization of norm diffusion not just as a transnational phenomenon, but as a “multi-local” process during which norms are concurrently localized across diverse geographic locales