Combating infectious diseases in East Asia: securitization and global public goods for health and human security.

• Author: Caballero-Anthony, Mely
• Position: PREVENTION, MITIGATION and PREPAREDNESS

Since the Asia-wide outbreak of the SARS virus in 2003, the threats from infectious diseases have become more severe. No sooner had the region begun to recover from the devastating impact of SARS than news about the rising incidence of avian influenza cases--on almost a daily basis and with an ever-expanding geographic reach--raised alarm about the potentially imminent outbreak of a pandemic of global proportions. (1) In this era of globalization and regionalization, such infectious diseases have the capacity to detrimentally affect the security and well-being of all members of society and all aspects of the economy. This point was highlighted at the 2006 World Economic Forum (WEF) in Davos, Switzerland with the release of the 2006 Global Risks Report. The report ranked pandemics and natural disasters among the highest in the list of risks currently confronting the international community. The study also concluded that despite the interplay of these multiple global risks and their combined ripple effects, which can be potentially devastating, "disaster planning and crisis management suffer from a number of shortcomings." Among these are limited investment of resources in health systems and varying responses to different assessments of threats. (2)

In a region that has a history of being the breeding ground for flu pandemics, the WEF report has come at a time when an abundance of policy statements, studies and other reports have been written, amidst a flurry of official and non-official meetings, which have altogether raised the urgency within and outside the region of finding a common approach to prevent the outbreak of a new and devastating pandemic. As momentum is building in the international community to increase cooperation in mitigating possible risks from pandemics, it is an opportune time to review current approaches and policies in East Asia, from local to regional levels, which address challenges to health and human security. Of particular interest here is the capacity of states and societies to mitigate the risks and challenges involved. Such a review would speak not only to efforts at combating the threats from infectious diseases, but also to the broader issue of how states respond to other threats from a host of emerging nontraditional security issues. These issues have been defined in the international relations and security studies literature as those threats that are not confined to the conventional notion of deliberate military threats to the physical protection of the state. These issues include environmental degradation, economic security, transnational crimes, ethnic conflicts and infectious diseases. (3)

In some of the recent studies that assess domestic and international approaches to non-traditional security threats, arguments have been raised for states and non-state actors to "securitize" these issues so that immediate attention and resources can be commanded to address the ominous risks that endanger the lives and well-being of states and people. (4) Specifically when applied to the threat of infectious diseases, a point has been made to use the language of "security" in framing this issue in order to persuade the relevant audience of its immediate danger. Analysts who have employed this approach draw heavily from the "securitization theory" proposed by the Copenhagen School, represented by a group of European scholars from the Copenhagen Peace Research Institute. These scholars, who include Barry Buzan and Ole Waever, argue that security is a socially constructed concept. The securitization theory essentially offers a systematic framework to determine how and when a specific issue is perceived as an urgent, existential threat to a given referent object, such as state, a community, the biosphere or the economic system. (5) An issue is successfully securitized when an audience accepts that there is an existential threat to a shared value. (6)

Perhaps as a result of more readily and widely circulated information regarding infectious diseases, there is growing interest among scholars in international relations and security studies to securitize infectious diseases to protect state and human security. Some of these securitization studies, particularly in East Asia, argue for a new perspective in treating these issues as no longer just medical issues but as major security threats to the region requiring the immediate attention of policy makers and defense and security officials. (7) As a result, studies on the broad issue of public health and security are no longer confined to the scientific and medical community. The emerging trend is one of dialogue between health, security and foreign policy communities on the practice of global health security.

However, given the rapid changes in the global environment and the complex interplay of risks associated with pandemics, it may well be that securitization of infectious diseases is no longer sufficient to generate a more effective approach to respond to these threats. As other studies have also shown, the threats of emerging and reemerging pandemics cut across related issues of poverty, natural disaster, migration, drug trafficking and others, and in turn they require the involvement of a wide range of actors beyond the medical, veterinary and agricultural community. (8) Hence, while securitizing infectious diseases can be a decisive approach to respond to such a grave threat, it has to be complemented with other approaches to allow for a comprehensive and integrated method for addressing a complex problem. This paper therefore adopts an eclectic approach in dealing with the broad issue of health and human security. In particular, it examines how the problem of pandemics can be addressed by using the securitization framework and the global public goods (GPGs) approach. Unlike securitization, the latter approach frames infectious diseases as a global public good requiring more inclusive participation, from a wide range of actors, and requiring various policy interventions. This study suggests that complementing securitization with the global public goods approach is highly relevant in the light of the new kinds of mechanisms that are currently being proposed at the local, national and intra-regional levels, such as ASEAN and ASEAN +3. These are considered key to the prevention and containment of the spread of pathogens. Also of special interest are the proposals to develop surveillance mechanisms and health networks, which would be considered equally significant in the prevention and containment of virulent pathogens.

While the proposals for strengthening surveillance mechanisms are indeed crucial in containing the spread of diseases, especially against the imminent threat of avian flu mutating into the next pandemic, the importance of good support infrastructure, provided by sound public health care systems at the national level, cannot be understated. Equally important are the strong national and regional institutions that can facilitate closer cooperation among various actors and agencies across borders. However in a region where the burden of infectious diseases is compounded by poverty, political instability and conflicts, the capabilities of states to provide for basic health care services are starkly uneven. Only a few states have adequate health infrastructure, while some have facilities that are rudimentary at best.

Thus, against the varied and complex set of issues that arise in addressing the threats of infectious diseases, the main objectives of this study are two-fold. First, the study examines the state of public health management in East Asia and reviews the current experiences of state and non-state actors in dealing with infectious diseases like HIV/MDS, SARS and the avian flu. Second, the study explores how a comprehensive framework using securitization and the global public goods approach can better address many of the issues and challenges facing the public health systems in the region, especially against the current period of extreme uncertainty brought on by the looming threat of a global pandemic.

It is often claimed that globalization has brought on new challenges to health and human security. The threat of infectious diseases is not a local problem, but a global concern. I argue therefore that for many developing states in the region, particularly in Southeast Asia, the burden of infectious diseases has reached a critical stage where innovation is needed to strengthen the capacity of public health management in the region. This compels the international community to search for new ways to respond to new threats, even if this means moving away from conventional approaches to managing public health and exploring nonconventional, eclectic approaches in order to generate alternative policies that address the complex challenges of global health security. Hence, a way to do this is to adopt a two-track approach of complementing the securitization framework with the more inclusive global public goods approach in order to provide for a more efficient and sustainable system for the prevention and containment of infectious diseases. In this way, the international community is able to immediately respond to crisis situations and deploy emergency measures if necessary, while also attending to the deeper structural issues and problems of ensuring health security to the wider community, both rich and poor.

The paper therefore proceeds as follows. Following this introduction, section one will briefly review the arguments for the securitization of infectious diseases and the global public goods debate and discuss why these two approaches are not mutually exclusive. Section two examines the experiences of securitization of infectious diseases in the region and highlights some of the problems that emerged. Section three identifies some salient issues in advancing the agenda of securitizing infectious diseases, while...