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The False Securitisation of Ebola Mia Lombardi (1414932) 2015 This dissertation is submitted as part of an MA degree in Geopolitics, Territory and Security at King’s College London 1 2 The recent outbreak of Ebola in West Africa prompted an unprecedented international response. This thesis engages with the Copenhagen School theory of securitisation to argue that this response was, in fact, largely led by panic discourse. As a result, effective response to the disease was compromised. The false securitisation of Ebola is a victim in sorts of the expansion of the neo-liberal concept of security, and this work will also draw on the history of public health and colonial stigmatisation to demonstrate how treating something as a security threat can sometimes do more harm than good. With many thanks to Professor De Genova for his support and insight throughout this project Mia Lombardi 3 The False Securitisation of Ebola List of Contents: List of Tables List of Figures Chapter One: Introduction 1.1 Introduction……………………..…………….5 1.2 Research Aims and Rationale…………..……..5 1.3 Structure………………………………….……6 1.4 Methodology……………………………..……7 Chapter Two: Theory and Review 2.1 Securitisation Theory…………..…………..…9 2.2 Literature Review……………………..…..…..9 Chapter Three: Case Studies 3.1 HIV/AIDS………………………….……..…..14 3.2 SARS…………………………………..……..17 3.3 H5N1…………………………………..……..18 3.4 Summary of Recurrent Themes………..…..…20 Chapter Four: Ebola and the Securitisation Process 4.1 Elite Discourse………………………………..23 4.2 Acceptance of Securitisation by Audience.……26 4.3 Extra-Normal Response ………………………28 4.4 Summary and Evaluation of Success ……..…..30 Chapter Five: Analysis of Effect of Securitisation Process on Response ….34 Chapter Six: Conclusion ………………..…………..38 Final Thoughts…………..……………39 Appendix One A1.1 Geography Department Risk Assessment Form A1.2 Geography Department Research Ethics Screening Form List of References Titled …………………..………..42 List of Tables T.1 Case Studies: Summary of Recurrent Themes ..……20 T.2 Evidence of Speech Acts in Securitisation Process…24 List of Figures F.1 Number of Cases by Ebola Data Source: Liberia Confirmed…31 F.2 Number of Cases by Ebola Data Source: Guinea Confirmed…31 F.3 Number of Cases by Ebola Data Source: Sierra Leone Confirmed…32 4 Chapter One 1.1 Introduction “An impenetrable boundary is being erected that threatens to isolate the continent as a whole: the wall of disease” (Kaplan 1994:36). If a state aims to protect the lives of it’s citizens, then it must recognise that threats come in forms other than those detailed in conventional military and war terms. Despite the continued state based focus of International Relations Theory, the concept of what is considered a security threat has undoubtedly been expanding since the end of the Cold War. At this point, climate change, organised crime, migration flows and infectious disease all started to come under the umbrella of ‘security.’ This was mirrored with the enlargement of institutions as networks of power, expanding the roles of non-state actors. The threat of infectious disease specifically is not a modern phenomena; the bubonic plague, historical cases of syphilis, measles and Spanish influenza were all highly damaging cases of infectious disease outbreaks with global reach (Altman 2003:419). What is new however, and what will be examined in this study in recognition of the above rather dystopian quote, is the way they are packaged and presented as a ‘security’ threat. From the outset, it is established that the utility of the term ‘security’ itself is inherently limited. As there is no one commonly accepted definition, it follows that the meaning is constantly in dispute. Thus, the definition varies based on who is utilising it, and the use of the term can never be neutral. Indeed, one can often only identify their particular brand of security through the prefix that precedes it; there is always an agenda to be served. This thesis aims to understand how the discourse around security, particularly through study of the critical theory of securitisation, influences response and reaction to what is deemed a ‘threat’. 1.2 Research Aims and Rationale Research in this thesis is both critical and exploratory. Using Securitisation Theory, the study will examine the securitised nature of infectious disease, and subsequent implications in terms of effect on response. By moving towards an inter-disciplinary approach and applying the securitisation process to an issue that is more typically within the realm of public health than security, this study aims to trace the perception of disease as an existential threat, and through case study use demonstrate the continued significance of the relationship between security and public health. 5 Works examining the securitisation of infectious disease are becoming more common, however these tend to accept without question the process of securitisation as laid out by the Copenhagen School. This thesis will critically question the process, specifically to determine to what extent it has taken place with regards to the recent outbreak of Ebola. To further the school of thought in this area, it will then examine the effects that the application of this process may have directly had on the response to Ebola. It will be concluded that the process of securitisation has taken place only to a certain extent, and with potentially highly damaging outcomes. 1.3 Structure This thesis will first present a review of the literature concerning securitisation as a concept, the extension of the concept of security to include infectious disease, and the nature of response to this. Identification will be made of the strengths and limitations of these works, which will be influential within this study and which academic areas will be progressed. Chapter three will examine the contextual background through study of past cases linking security and infectious disease; namely HIV/AIDS, SARS and H5N1, and trace the development of the relationship over time. Evaluation will be made of the extent to which these cases were securitised, and the effects this had on the response to them. Any recurrent themes found will later be examined with respect to Ebola. The securitisation of Ebola specifically will then be examined in depth in chapter four, whilst maintaining that three key assumptions must be present for securitisation to have truly been said to have taken place. Here, I will engage with what Stritzel refers to as the securitising trilogy; the presence of a securitising actor who engages in the application of an elite discourse, the elevation of a threat beyond normal responsive measures, and the acceptance of the rhetoric of existential threat by an audience (Stritzel 2007:358). Due to the relatively recent nature of the phenomenon, it is predicted that the third aspect may prove the most difficult to find evidence for. To this end, securitisation will be deemed to have taken place if the first two assumptions are found to be fulfilled, and there is some level of evidence for the third. Primary evidence will be presented here to aid discussion about the success of the securitising trilogy. 6 Evaluation of previous works has shown that they often act as a validation of the existence of a securitisation process, as opposed to offering a critique of its success. The original nature of this project comes from the evaluation of the extent to which securitisation has taken place, as opposed to the singular acceptance that is has. In chapter five, the thesis will link the process of securitisation with response to the crisis, attempting to establish a causal relationship. This again goes one step further than the majority of works who examine either the securitisation process, or the response to the crisis, but do so as separate and distinct areas of study as opposed to linking the two. This thesis argues that this link is key as flaws or disparities in the securitisation process may help to explain the shortcomings in the response to Ebola. Throughout the project, I will indicate potential directions for future research, as well as recognising limitations of the current work. This will act as a guidance for any works to follow. 1.4 Methodology To answer the research question with sufficient vigour, this thesis follows certain ontological and epistemological guidance. The piece is essentially immersed in constructivism, which itself has an epistemological base in the interpretivist position (Marsh & Furlong 2002). This position rejects positivism in that it does not believe that the world can be in existence independently of our knowledge of it- we can only interpret the world through our own construction. There is no independent existence outside interpretation, thus the study of the application of discourse is crucial. The conclusion that knowledge cannot be neutral provides one of the key justifications for this research, in that the way a phenomena is presented will affect the reaction to it. In other words, the discourse surrounding Ebola has determined the reaction to it, as securitisation “places security outside an objective condition” (McInnes & Rushton 2012:119). This essay will emphasise the use of qualitative sources, particularly through the use of a multi case study foundation. The nature of the theory being examined makes it apt to utilise qualitative source, ie. “non statistical techniques used to gather data about a social phenomena […] used for creating understanding, subjective interpretation, and critical analysis” (McNabb 2015:273). This selection has been made based on the fact that the study involves the interpretation of evidence to draw conclusions about social process, and the effect of the application of discourse on these processes. The use of multiple case studies allows the comparison of phenomena across varying contexts, especially how processes and interactions are influenced by different factors. 7 A combination of both primary and secondary sources will be utilised. In terms of assessing the three central assumptions of securitisation theory, political speeches and discourse will be examined to draw out evidence of securitisation in elite discourse. Public opinion polls will aid assessment of the degree to which this discourse has been accepted by an audience, and evidence of laws and legislation will demonstrate the impact of this process on policy response. Secondary sources in the form of existing academic literature will further inform the debate and provide theoretical and analytical background. Though the works examined are largely geopolitical in tradition, a number of schools of thought will be examined to provide depth to the analysis. In terms of positionality, this work aims to be largely critical in tone, but draws no preconceptions with regards to expected outcomes. The use of primary sources will support this development of argument without the influence of existing analysis. 8 Chapter Two 2.1 Theoretical Framework Since its inception, the Copenhagen School has been the dominant approach in examining the nature and construction of security. Particularly since the events of 9/11 and subsequent ‘War on Terror’, the question of what constitutes a security threat has been applied to a range of phenomena such as immigration, health and climate change (McDonald 2008:563). To this end, there is now a vast swathe of literature examining the theory and its manifestations. Numerous attempts have been made to criticise, clarify and further the theory, and large sections of analysis within this thesis will fall under this category. What should be remembered is that ‘securitisation’ and ‘security’ are not one and the same. Securitisation is merely a process by which a phenomena may become presented as a security threat; the key is in the perception, as opposed to the actuality of the threat. Securitisation is a theoretical framework through which exclusionary logic and processes can be critically examined, and thus exceptional measures legitimised. Buzan, Waever and de Wilde identify securitisation as a form of, “linguistic representation,” by which an issue is presented as an existential threat (McDonald 2008:563). This ‘securitising move’ thus establishes the presence of a threat, dependent on the presence of audience acceptance of the discourse. Thus, the speech act constructs the security threat. Waever (1995:56) indicates that security is not a part of normal politics; instead, the process of securitisation indicates a failure of normal politics. The ultimate result of successful securitisation is the suspension of ‘normal’ politics and introduction of extra-normal measures through which to deal with the ‘threat’. Through analysis of this process, we can discern how and why issues are responded to in a certain way. The link between infectious diseases and security has thus far largely been based on the unstated implication that they are not a security issue in themselves, and only become so through the discursive practice of securitisation. 2.2 Literature Review The motivation for this study follows the assertion by Enemark (2007:8) that “health threats most suitable for securitisation are outbreaks of infectious diseases- specifically those that inspire a level of dread disproportionate to their ability to cause illness and death.” This description seems almost tailor made to the case of Ebola; an epidemic with an almost negligible presence in the US 9 and Western states, but who’s virility and rapid spread throughout Western Africa has generated a significant level of fear about its potential for harm. Davies (2008:298) has further elaborated on how awareness of the potential damage of an outbreak of infectious disease has encouraged Western governments to frame their responses in national security terms. Huysmans (2006) suggests that if solely the economic aspect of a threat is addressed in discourse, this is an example of selective securitisation. Altman (2003) built on this in determining that political and social structures directly affect how a country reacts to a disease. This link between the structure of the state and its relationship with global health challenges was further developed by McMurray & Smith (2001), who show how as states develop economically, global health challenges become more prevalent due to the erosion of borders. In response to this, Brower & Chalk (2003) articulated the need to foster strong links between substate, state and international agencies in order to effectively address security threats with links to disease. This evidence of the importance of taking context into account when assessing the securitisation process will be recognised throughout the thesis. The US National Strategy states that; “Public health challenges like pandemics (HIV/AIDS, Avian Flu) […] recognise no borders. The risks to social order are so great that traditional public health approaches may be inadequate, necessitating new strategies and responses” (White House 2006). This discussion of new strategies will form the basis for examination of the extra-normal response to Ebola. In terms of policy response, Deudney (1990) identifies five likely characteristics of response once a threat has been elevated to national security level; a sense of urgency and willingness to spare no expense, basing policy planning on worst case scenarios, zero-sum logic, dominance of short term focus, and a binary us vs them mindset. Aldis (2008:370) supports this in detailing how the link between security discourse and health policy is having significant ramifications in terms of international tensions. Walt (1991) puts forth the dangers of expanding the realm of security studies, suggesting that excessive broadening of the topic risks losing intellectual coherence. Wilkinson (2007) suggests that it is impossible to apply securitisation theory to cases outside of Europe. He argues that the assumption that the European understanding of state is common the world over introduces a 10 normative dimension to the use of ‘state’ and ‘society’ in securitisation literature. Furthermore, he argues that the exclusion of other forms of expression through sole focus on the speech act, makes the theoretical framework fundamentally flawed outside a European context where other forms of expression may be dominant. Fidler (2007:2) has argued that global health is now entering a ‘postsecuritisation’ phase, whilst Pereira (2008) argues that the connection between security and health has its roots in Western Colonialism, and acts as a activist tool. These critical works on the securitisation process will be considered throughout analysis. This thesis will mainly identify with two of the three claims typically associated with health security; the threat to individuals and nations of fast moving infectious disease, and the social, political and economic effects that can threaten the stability of a state as a result of the prevalence of a disease (Feldbaum & Lee 2004:22). This study will not address the use of biological weapons, though it is recognised that this is also an aspect of the securitisation of global health. 11 Chapter Three: Case Studies Understanding of the priorities different actors assign to the threats posed by diseases provide insight into the way they respond to such threats. Disease, pandemic and fear of infection by an ‘other’ are by no means new phenomena. Hippocrates wrote about dangers associated with spread of disease, and Egyptian mummies from as far back as 3000 years old have displayed signs of smallpox pandemic. For thousands of years, leprosy, syphilis, cholera and typhoid were simply a part of everyday life, though a distinct lack of medical understanding was clear, with many believing diseases emerged and spread through miasma, or ‘bad air.’ Watts (1997) has argued that this fear of tropical diseases was used as a justification for colonial expansion, based on the argument that these diseases proved a lack of ability to govern one’s selves. In 1962 however, Sir McFarland Burnett stated that, “by the end of the Second World War it was possible to say that all of the major practical problems of dealing with infectious disease had been solved” (Brachman 2003:684).One could tentatively identify this as the point where the focus on infectious diseases began to wane. In the US in particular, it was at this point that federal resources began to be redirected to other concerns. Peterson (2002:47) argues that diseases tend to occur in cycles; as a population becomes immune or the disease dies out naturally, it will move on to another vulnerable population. In this way, the diseases discussed below are simply three in a long line of past and future outbreaks. The key consideration in their discussion however is the evolution of how they have been presented. Historical evidence shows that a fear of others combined with a fear of an infectious disease is a very dangerous combination. Edwards (2014) argues that within Western political discourse, there is evidence of an underlying panic that infection may spread from developing to developed countries, citing a history of nationalism and neo-colonialism as a key influence on this. This corroborates Deudney’s (1990) projection of a widespread use of ‘us’ and ‘them’ binaries in disease narrative, and the evidence below will examine whether this has been also seen in response to the Ebola epidemic. Foucault (1984) studied the response of governments to infectious disease, asserting that control was displayed through “ideological manipulation” (similar to the speech act in securitisation), whilst inappropriate systems of quarantine encouraged a “practice of rejection.” The ‘stigma theory’ put forth by Goffman (1965) explains how use of discourse surrounding a disease 12 can both justify and rationalise the stigma, and subsequently make measures such as segregation appear legitimate. Many would identify the events of 9/11 as a turning point in how national security is conceptualised. McDonald (2008:567) argues that since 2001, the body of literature on securitisation has turned increasingly towards the classification of groups of people, identities, the demarcation of limits and characterising of people as threats to these limits. Though often used in reference to migrants and immigration, these themes can also be applied to the study of infectious disease. What’s more, this practice is not accidental- there has been a clear choice to present people in this way. Fidler (2005) also identifies 9/11 as a turning point; from here on, the US merged all phenomena that may be viewed as a threat into one narrow definition of security, upon which they could keep a tight focus and launch a common response. Essentially, 9/11 cemented the idea of an asymmetric war against an unpredictable and unseen enemy in the eyes of US policy makers, and the threat of Ebola and other infectious diseases falls squarely into this category (Pereira 2008). Walt (1991:212) mentions HIV/AIDS in his evaluation of security studies, yet does not make any wider reference to infectious disease. This would indicate that the link between infectious disease and security had not yet been fully established in the political agenda at this point.Though the link between infectious disease and security has seen to have become much more prominent over the last decade, those diseases which have more long term rather than acute effects, have lower levels of mortality and are seen to be more geographically localised are less likely to be represented in such terms (Feldebaum & Lee 2004:25). Put simply, those diseases which tend to be perceived as a security threat are not those that in reality pose the largest threat to population health, but instead those which have sparked ‘epidemic induced fear’ amongst political elites and citizens (Labonte & Gagnon 2010:5). In his work on HIV in Haiti, Farmer (1992) identifies how the power relations surrounding the disease generated an ‘epidemic of discrimination’, by which misconceptions about both the disease and the carriers were formed not from epidemiological fact, but from pre-existing views of the Haitians embedded in the North American psyche. This spread of racist preconceptions (essentially of a black person engaged in voodoo rituals and promiscuous sexual activities) distracted from the real root of the problem, and created a blame narrative that skewed future response to the disease. 13 A similar trend was identified by Geshekter (1995) who again examines the racial stigmatisation of black sexuality by Western narratives, and how medical narrative in fact was highjacked as a justification for racial responses against certain ethnic groups. Through study of how focus on alleged sexual promiscuity and other cultural practices drowned out study of socioeconomic factors, he concluded that engaging in an “alarmist rhetoric is ultimately selfdefeating” (Geshekter 1995:14). These studies have suggested that the intersection of medical/ public health discourse and popular opinion can both legitimise inappropriate responses to disease and produce a culture of panic around pandemics. As has been shown, the perception of a disease impacts the response to it to a far greater extent than was previously believed. The following case studies represent not only a basis from which to identify commonalities through which to assess the securitisation of Ebola, but also act as an attempt to track the changes in the perception, presentation and response to infectious disease over time. 3.1 HIV/AIDS Human Immunodeficiency Virus (HIV) was in 2003 the fourth leading cause of death in the world, and the first in Africa. Altman (2003) indicates that the CIA and other government advisories have been pushing the US Government since the 1990s to consider HIV as having the potential to have a significant impact on both national and international security. In reality, it has only been since the early 2000s that has been recognition of a need to address it as a security issue. Much more so than Ebola, HIV has the potential to (and is currently showing great skill in) undermining the long term health of entire populations, breaking down societal and family structures, and overwhelming entire nations. Why then did it take up until this point for it to be recognised as a security issue? Unlike with the cases of SARS and Ebola, when a sudden spike in cases at a certain point in the outbreak caused the jump to securitisation of the threat, the AIDS epidemic was far more incremental in nature. In January 2000, the UN Security Council officially recognised the link between the epidemic and international security, stating that, “HIV/AIDS has a qualitatively different impact than a traditional health killer such as malaria. It rips across social structures, targeting a young continent’s young people […] by cutting 14 deep into all sectors of society it undermines vital economic growth – […] it is setting up the terms of a desperate conflict over inadequate resources” (Malloch Brown 2000). Elbe (2005) identifies this speech act (Resolution 1308) as the turning point in the securitisation process, and suggests that from this point onwards, AIDS was successfully perceived as an existential threat. Up to this point, though the damaging impact of AIDS had been recognised by US elites, responses has been focused on how to protect the US as a nation, as opposed to combating the diseases themselves Interestingly, Walt (1991:213) specifically stated that HIV/AIDS was something that should not be considered as a part of the security nexus. It has been widely recognised that the way AIDS is presented as an issue will directly affect the response to it, particularly in terms of political commitment. Preventing the spread of HIV is neither difficult nor expensive on an individual level, but the social and economic impacts of the disease elevate the problem exponentially. Thus unlike in the case of Ebola where securitisation was used as a tool to ensure rapid response and mobilisation against the disease, for AIDS the securitisation process is more a tool through which to change attitudes and fundamental social behaviours. HIV is a prime example of a case where we must expand the meaning of security, yet also recognise that any possible solution must be internal and state based; foreign health workers and vaccines cannot cure the AIDS epidemic. What was seen in the case of HIV/AIDS is that the initial securitising process involved little presentation of hard evidence. When the Security Council later challenged these claims, the influence of the speech act was undermined and a process of desecuritisation began. Evidence supporting the key securitising claims was being called into question by Barnett and Dutta (2008) and de Waal (2005). The AIDS, Security and Conflict Initiative (ASCI 2009:12) concluded that “earlier more alarmist relationships that were assumed to exist between national state-level security and HIV/AIDS are not bourne out by the evidence.” As shown, doubts about evidence can detrimentally impact the perception of threat (McInnes & Rushton 2012:120). This is significant because it indicates that the process is not just one way, and is not just binary in nature. Overall however, the securitisation process has since been widely accepted to have been successful. The AIDS-security link subsequently created a much more prevalent international profile, including inclusion in the UN Millennium Development Goals agenda, a G8 fund to help in 15 the ‘fight’ against AIDS, and the Bush Administration’s ‘Presidents Emergency Plan for AIDS Relief’ (PEPFAR). AIDS had been elevated to a new political level, which justified super-normal response and responded to this with new tools and resources. This reasoning was universally accepted- a huge scale of audience acceptance had occurred. What was interesting in the AIDS case is that a multi-level of securitisation was seen. As examined by McInnes and Rushton (2012), the original audience then went on to become a securitising actor at the second level. The Clinton Administration who had first been convinced of the threat for example, then went on to present a securitising discourse to the Security Council who acted as the audience; the audience had been empowered. Securitisation had not been a top down process, but took a cyclical form. We should take this conclusion with some level of caution however. It has been indicated that the presence of resolution 1308 was not in fact conclusive proof of the acceptance of AIDS as an existential threat, but instead simply a continuation of the existing work of the council. Within the resolution, AIDS was presented as a peacekeeping operation, and a narrow focus on international peace between states. As opposed to widening the remit of what was considered to come under the umbrella of ‘security’, it simply added another issue to the list of those which act as a threat to our existing concept of security. Thus, existing analyses of the securitisation process with regards to AIDS may be somewhat over-simplistic. What’s more, the focus by the Copenhagen School on the ‘moment’ in which an issue becomes conceptualised as a threat may be inappropriate in this case. This approach suggests that there is no incremental nature of threat; it either is, or it isn’t, a threat to security. In the case of AIDS, which had been a severe outbreak long before it was recognised as a threat by the US and Security Council, this criticism certainly seems apt. What remains however is that ultimately, and however partial, the securitisation of AIDS achieved the goal of mobilising funding and state dedication to meeting the crisis. Huge resource commitments and program generation has been seen, with the number of people being treated for the disease worldwide reaching over five million (McInnes & Rushton 2012:130). 16 3.2 SARS The Sudden Acute Respiratory Syndrome (SARS) breakout was fundamentally different to that of Ebola because it happened in a region of strong governance with widespread political legitimacy and ample funds with which to respond to the crisis. Despite this however, the SARS outbreak blindsided health and government agencies at the time, and subsequently was the catalyst for creating a movement towards a more unified and integrated response to global infectious disease control. As later evidence will show however, this move may not have been as successful as was hoped. The key point of discussion here is the source of the securitisation; as the Chinese government actively worked to cover up the outbreak, the WHO acted as the main source of securitising discourse. When the Chinese government first learned of the outbreak, they unintentionally facilitated the spread of the disease by covering up its emergence in the hope of protecting their trade and tourism industries (Specter 2015). The reluctance to report openly on the disease led to the WHO to seek epidemiological information from other sources, including media reports and individual doctors (Fidler 2007). This indicates that response to an outbreak is not solely a sovereign concern; the expansion of the role of non state actors in meeting the threat has been a part of the expansion of the traditional sense of security. Certainly, an example of extra normal response can be seen, but this time not originating with states. The impact of culture is also pertinent here; Wishnick (2010) argues that securitising a health threat would be tantamount to the Chinese government admitting that they were unable to safeguard their own populations. In a state of political nature such as China, the internal disruptions this admission of a relinquishing of sovereignty could create had the potential to be more damaging than the threat of the disease itself. What’s more, it is recognised that it is more difficult to examine the securitisation process in totalitarian states such as these, as the separation between ‘normal’ and ‘security’ politics is much more difficult to distinguish (Curley & Herington 2011). The picture in the wake of a securitisation process can appear bleak and wasteful. Once the SARS crisis had dissipated, a 1200 bed hospital built in rapid response to the crisis was abandoned (Huang 2014). It had been built specifically to treat the disease, and had no place following the crisis. This is a stark reminder of the brief and fleeting nature of securitisation. 17 3.3 H5N1 “If you define national security as something that could kill millions of Americans and completely disrupt the way we live our lives, then avian flu is as big a threat as a nuclear strike on a city” (Quinones 2006). Evidence suggests that the US was significantly more active in securitising avian flu than other political entities. Unlike international organisations such as the WHO, the US Government has a clear and direct link to a distinct population group, over which it arguably has significant policy influence. In November 2005, President Bush introduced the National Strategy for Pandemic Influenza, which encouraged Congress to allocate $7.1billion dollars to prepare for a pandemic (Youde 2008). It must be noted that these funds were primarily focused on domestic preparation; very limited allowance was made for combating the disease abroad. The US conceptualising of the threat in national security terms was evident in a wide range of discourse; “If this [human to human transmission] does occur, in the worst case scenario, it could kill millions of people, cripple economies, bring international trade to a standstill, and jeopardise political stability.” (Dobriansky, P. Undersecretary of State for Democracy and Global Affairs, 2006.) Youde (2008) argues that the securitisation of avian influenza was not complete, as no extranormal responses were ultimately taken in response to the disease. Arguably however, this is a flawed assessment; it is not the case that responses outside the ‘normal’ political realm must occur, merely that an audience has been sufficiently convinced of the degree of an existential threat that they would support these measures. There is evidence preparation for these extra normal responses; former advisor to the Secretary of Health on public health preparedness Osterholm suggests; “Border security would be made a priority, especially to protect potential supplies of pandemic-specific vaccines from nearby desperate countries. Military leaders would have to develop strategies to defend the country and also protect against domestic insurgency […] Even in unaffected countries, fear, panic, and chaos would spread as international media reported the daily advance of the disease around the world.” 18 Pillar Three in the US National Strategy for Pandemic Influenza, Response and Containment notes the use of, “government authorities to limit non-essential movements of people, goods and services,” as well as including widespread quarantine and use of the military. The measures also recommend the acquisition of resources before other governments and nations can gain access to them. Note, this is for a disease that has been assessed to have, “limited, inefficient and unsustained human to human spread” (CDC 2010). What’s more, there has never been a reported human case in the US or Europe, let alone a death from the disease in these countries. The closest in fact to the US border has been a lone case in Canada in 2013, long after the main outbreak which happened predominantly 2006-2007. The lack of sustained human to human transmission combined with the absence of human cases in the US certainly gives weight to the argument that the response was inappropriate. The fear here is more in the potential mutation of the flu virus into a strain that will be much more easily able to spread between humans; therefore it appears that there has been a large scale confusion between risk (potential) and threat (actual). The response certainly seems to vastly exceed the actuality of the disease. Interestingly, Asian and sub-Saharan African states; those who are actually experiencing the disease to the greatest extent; have avoided taking a securitising approach. Instead, they have approached the avian flu outbreak in a public health rather than a national security capacity (Youde 2008:168). Why then does it seem the countries most at risk of outbreak are the least likely to consider the disease an existential threat? Youde (2008) proposes two justifications; firstly, that the outbreak of avian flu is just one of many existential threats for these countries and thus little will be achieved by securitising it, and secondly that they are largely marginalised countries, thus calling avian flu a security threat would do little to galvanise the international community and even less to mobilise resources domestically, where there are likely to be little to none to spare. To add to this, this study would argue that the fear of cementing the us vs. them dichotomy may influence the way a developing country presents a disease; these countries simply cannot afford to be marginalised any more than they already are. It may also open the door for ‘first world countries’ to dictate how others should respond to the crisis; this return to a form of neo-colonialism has the potential to yield a highly damaging response. The securitisation of avian influenza had two main policy impacts. Firstly, the competitive rush by governments to secure vaccines combined with a lack of global supply resulted in a total breakdown of health co-operation and lack of co-ordinated response, particularly between 19 developed and developing countries. Furthermore, the disease became a political bargaining toolthe West wanted to track and access the virus, whilst developing countries saw this as a source of negotiation for greater aid and benefits provisions (Elbe 2010). It appears that significant negatives outweighed the positives of securitising the disease. 3.4 Summary of Recurrent Themes The real question remains, why, after all of the experiences of infectious diseases discussed above, did the response to Ebola still fall short to the degree that it did? This is not the last pandemic that we will see, and thus far the lessons of our past mistakes do not seem to be resonating. T.1 Case Studies: Summary of Recurrent Themes Outbreak Response Securitisation? Lessons Learnt HIV/AIDS Large scale focus led by the US and Security Council Evidence of both processes of securitisation, and subsequently desecuritisation. The former was successful in mobilising resource and political commitments, and moving response programs from relatively weak Health Ministries to higher levels of government. Shiffman (2008) determined resources had been diverted away from building health infrastructure in developing countries SARS 2002 Political leaders facilitated Efforts were largely made by the spread by covering up government to avoid securitisationemergence of the disease instead, dialogue came from nonstate actors Calls for a more unified and integrated global response to infectious disease control. H5N1 2006-7 Drew focus away from other health concerns; congress allocated $3.8billion to prepare for the pandemic- greater than the annual budget to combat HIV (currently infects 40 million), and 50% more than the Global Fund allocates to 117 countries to combat malaria (350-500 million infections annually) Recognition of wasteful use of resources. Attempts made largely by the US government, but some have argued these were incomplete. The most affected states avoided a securitisation approach, choosing instead to focus on public health policy. (Specter 2015, Youde 2008, Shiffman 2008.) Across all cases, it appears that the securitisation process is a lot more complicated than the theoretical process outlined by the Copenhagen School. Firstly, there is not just one securitising actor; discourse can be presented by political elites, organisations or even the media, which has 20 come to play an increasing role in shaping the perceptions of the public regarding a number of issues. Secondly, the process is not absolute. Even in the case where the three necessary conditions have been fulfilled, issues are not held at the same level of concern, ie. there can be different degrees of securitisation. What’s more, the effects are not lasting. McDonald (2008) questions how we know at what point the securitisation process has been successful, yet evidence shows that this may be too simplistic of a question to ask. It is most often the case that once an issue has been securitised, it will only remain perceived as a threat for a relatively short period of time. In fact, the key catalyst for the dissipation of the perception of threat is the rise of a new security issue. Thus, security remains a dynamic concept, and in this way it could be said that securitisation is damaging the attempts to seek a universally accepted concept of security. Failure to define security (ie. what is, and what is not a security threat) risks turning the term into one devoid of any real meaning, and thus largely defunct (McInnes & Rushton 2012:116). In hindsight, commentators have indicated that conflating health policies with security concerns generates ‘panic politics’, a situation in which hasty and often ill thought out responses are prioritised over attempts to combat problems at the source, or provide for long term reconstruction. Panic politics can be extremely wasteful in terms of misguided resources, manpower and international efforts. Whats more, it can be self-reinforcing, as the damaging effects caused by inappropriate responses may deepen the severity of the problem and thus appear to justify the use of a security rhetoric (Wang 2014). Going back to Deudney (1990) however, the responses to these threats certainly seem to fulfil a number of his predictions. Worst case scenario thinking appears prevalent in the discourse examined on avian flu; Dave Nabarro, the UN policymaker heading up the response to the pandemic predicted up to 150 million deaths, whilst Dr Irwin Redlener at the National Centre for Disease Preparedness predicted up to one billion. Whilst some may argue that it is best to be prepared for the worst case scenario, it has since become clear that there is a very fine distinction between total preparedness (which many would argue was never in fact reached) and panic. Us vs. them thinking is also prevalent in responses, particularly with respect to the protection of borders and stockpiling of vaccines and medical supplies. This appears to completely overlook the fact that diseases do not respect sovereignty or national borders, and in all likelihood the most effective response will be an internationally co-ordinated one. Fidler (1998:3) seems correct in his assertion that, “Infectious disease measures historically have served as demarcations by which ‘we’ protect 21 ourselves from the diseases of ‘others’.” The search for a human agent, ie. a need to have a recipient for blame, created harmful narratives around all three case studies, and especially in the case of AIDS, ultimately generated a backlash against the carriers of the disease. Widespread use of the military and stockpiling of drugs are also arguably short term reactions; they do not build long term capability to respond to epidemics effectively. Focus on just one disease does not make much sense in terms of strengthening public health capacity. The fact that the ‘lesson learnt’ in all three cases is very similar is worrying- if we are failing to adapt our responses following lessons from previous outbreaks such as these, it is likely that we will simply repeat the same mistakes in the future. It will be discussed later on the extent to which this issue has been seen in the case of Ebola. It appears that for something to be a direct and clear threat to life is not enough to categorise it as a health security threat; obesity and lifestyle related cancers for example receive nowhere near as much hype and attention as the case studies discussed here. This is where the significance of the Copenhagen School comes into play. Through securitisation theory, they attempt to explain why certain issues are categorised as security threats, whilst others remain firmly in the public health agenda. The legitimacy of the speech act, as opposed to the mortality or pervasiveness of a disease, is the key to the extent to which it is perceived as a threat. In each case, the presence to varying degrees of a process of securitisation impacted how the disease was perceived, and subsequently how it was responded to. Speech acts made claims utilising traditional security language, in attempts to bring the diseases into the realm of traditional security concerns, and away from the public health arena. Construction of a threat to national security opens up a much more extensive range of responses. As will be seen in later analysis, this study will examine whether this same process has been seen with the case of Ebola, and how, as in these cases, the response varied as a result. 22 Chapter Four This chapter will renew the focus on Ebola specifically, first in evaluation of the securitising process and secondly, taking direction from the discussions above to evaluate the actual and potential links between the securitisation of Ebola and the international response to it. For the most part, the focus is mainly on the US, both due to the more readily available data and the role of the US as a major international power. It is argued that the effects of the securitisation process are more easily observed in the US. 4.1 Elite Discourse The Copenhagen School argues that issues become threats through the use of language, “the utterance itself is the act […] a state representative moves a development into a specific area, and and thereby claims a special right to use whatever means necessary to block it” (Waever 1995:55). In this section, the speeches of political elites will be presented and examined, to show their potential to shape the securitisation process through application of discourse and determination of mode of response to the crisis. It should be noted that the word ‘security’ specifically does not have be present in discourse necessarily for it to form part of a securitising claim- words such as ‘threat’ and ‘survival’ are equally as potent. Vuori (2008:77) claims that in a securitising speech act, the speaker must have to, “present or have proof of the truth of his/her claim.” In a number of the speech acts presented below, the speaker failed to give proof, or probably even hold proof of their claims. If this came to be questioned as a result, there is the potential for a desecuritising process to ensue as doubts over the validity of claims begin to grow, similar to that which occurred in the case of HIV/AIDS (McInnes & Rushton 2012). It is possible that this process may have links to the cyclical nature of securitisation which was discussed with regards to the lasting power of a claim, though this would need to be examined in more detail before any conclusive remarks could be made. What has become apparent thus far is how the production of panic has stemmed largely from the use of medical discourse and authority to legitimise the securitisation process. This is a move away from the traditional political elite towards a much more niche securitising actor, and has been previously demonstrated in the case of AIDS in Africa. T.2 Evidence of Speech Acts in Securitisation Process 23 Securitising Actor Context Representation of Ebola- is it depicted as a security concern? Mode of Security Barack Obama Presents virus as an existential threat, to legitimise a realist response. “This is more than a health crisis. This is a growing threat to regional and global security” National Thom Tillis, North Carolina Senate Candidate, 2014 Refers to ‘bad actors’ who are coming across the border into America and carrying Ebola with them Human WHO 2014 "The number of reported cases Medical and deaths vastly underestimate the magnitude of the outbreak” David Nabarro, Senior UN Coordinator “The outbreak is moving ahead of efforts to control it” Medical Gayle Smith, Senior Director at the National Security Council “This is not an African disease. This is a virus that is a threat to all humanity” International Dr Tom Frieden, Director of Centre of Disease Control "The level of outbreak is Medical beyond anything we’ve seen, or even imagined” Dr Joanne Liu, International President of Doctors Without Borders "Infectious bodies are rotting in National the streets” Discussion of Response Calls for total sealing and securing of the border. Reinforces ‘us’ and ‘them’ binaries Recommends rapid identification of infected people, restricting movements and travel, containment of infected peoples both to ensure proper treatment and prevent transmission of disease to others. Social mobilisation is key. Calls for urgent responseemphasises that the need cannot be overstated “Riots are breaking out. Isolation centres are overwhelmed. Health workers on the front line are becoming infected and dying in shocking numbers. Entire health systems have crumbled” 24 Securitising Actor Context Representation of Ebola- is it depicted as a security concern? UN Security Council Emergen Unprecedented effect of Ebola cy declared threat to international meeting peace and security. 18th Septembe r 2014 Mode of Security Discussion of Response International Launched appeal for $1billion dollars, warning that complacency would be fatal. Elevated Ebola from international public health emergency to threat to international peace and security. (Boseley 2014, Bradner 2014, Burnett 2015, Maron 2014, UN 2014, WHO 2014.) In each of the above cases, a clear attempt has been made to represent Ebola as a security threat. Many elevate it onto an international stage, and worryingly there is some evidence of constructing the carriers of the disease as a threat, as opposed to the disease itself. This phenomena will be examined further in later discussion. Williams (2003) and Moller (2007) have suggested that solely looking at discourse as a source of securitisation is too narrow a focus. Instead, they argue that images and visual representations are just as important in constructing a threat. This would thus expand the role of the securitising actor, as well as the form of discourse presented, to include the media. Indeed, panic around contagion is largely produced as a form of media spectacle; a large amount of influence and control over public reactions are held by a small group of actors. Essentially, current outbreaks have shown that the media has the power both to incite and to stop the spread of fear around infectious disease. Extending the theoretical framework to embody these additional forms of representation could be an important step in continuing the modern relevance of securitisation theory. Important here however is the question of intentionality. Buzan et al (1998:21) argue that the construction of a threat is undertaken with the purpose of legitimising a certain response; thus, it is clear why a political elite would be the instigator of this process. Waever (1995:63) further corroborates this, stating that the securitisation process is, “imbued with intentionality.” What is less clear however is the intent which the media and other such actors may have with regards to supporting the securitisation process. The media is neither likely to be seeking to, or have the ability to engage in extra-normal political efforts. Hansen (2007) has argued that images may convey a different meaning dependent on whom is viewing them, and thus it is difficult to project a certain agenda through the use of them. As seen, the means through which something is constructed as a threat is still very much open to debate. 25 4.2 Acceptance of Securitisation by an Audience The existence of a speech act in itself is not sufficient for an issue to be securitised; the audience must also accept that extra-ordinary reactions are justified in response to the threat (Youde 2008). Balzacq (2010) has criticised the Copenhagen School for placing too many conditions on what a speech act must fulfil in order to be successful. Instead, he argues that the context and nature of the audience plays a much more significant role than was previously thought. The relationship between the audience and speech act is a highly nuanced one. It is recognised that although the use of public polls can not provide answers to specific questions (for example, “does the public think it beneficial to securitise infectious disease for security purposes”), they can provide a general indication of the direction of support or movement of public opinion. At the end of 2014, over one fifth of Americans voiced fears about catching the virus (22%); this exceeds the proportion of the population who were concerned about the risks of contracting H1N1 (swine flu) in 2009, despite the vastly higher prevalence of the latter in the US at the time. At the times of questioning respectively, just six Americans were believed to have contracted the Ebola virus, whist between 14 and 34 million were believed to have been infected with H1N1. What’s more, the six Americans infected were all believed to have been so in West Africa, in the very epicentre of the outbreak, as opposed to within the borders of the USA (Dugan 2014). The deadliness of the disease appears to have more influence than the number of cases themselves, with nearly a fifth saying America will experience either a ‘major crisis’ or ‘outbreak’ of Ebola, despite the fact that there is no evidence that any person has contracted the disease whilst in the US. In terms of healthcare concerns, Ebola ranks as the third most severe healthcare concern (17%), behind affordable healthcare (19%) and access to healthcare (18%), but a long way ahead of cancer and obesity, which both placed at 10%. The previous most pressing health concern AIDS barely registered as an issue in 2014, with just 1% naming it as a top healthcare concern (Saad 2014). At the time of this survey, only one of those who was being treated in the US for Ebola was still undergoing treatment, whilst two of the four had fully recovered and been declared virus free. A number of US health workers who has contracted the disease overseas had also been declared virus 26 free by this point. It appears that the process of securitisation has had the effect of widening the perception gap; that is, people focus on their chance of death if they were to contract the disease (there is no vaccine or cure), as opposed to the arguably more logical threat of contracting the disease in the first place (minimal in developed countries). Huang (2014) has presented evidence that in parallel cases, individuals have experienced economic loss as a result of irrational efforts to avoid being infected during an outbreak. In short, this shows a distinct lack of risk management. Despite the fact that Americans seem convinced of the health risk to themselves, it does not appear that they have confidence in the US Government to handle the problem. Thus, it appears that even though they have accepted the securitising discourse as presented to them by an elite, they do not have faith in this elite to solve the problem they are presenting. This in itself could have harmful consequences; by presenting Ebola as an existential threat that requires super normal action to combat it, but then failing to inspire faith that they can successfully implement these extra normal responses, the US political elites risk inciting a loss of political popularity at the polls, a degree of social unrest and an uncertain political future. In examination of historical surveys concerning the top US healthcare problem, there are clear trends to indicate that the case studies previously examined spike in public concern for a short period of time, before failing to appear in subsequent surveys at all. This has seen to be true of both H5N1 in 2005, and H1N1 in 2009. This would reflect the above argument that securitisation is a cyclical, not an absolute process, with the greatest effect on the reduction of perception of threat being the introduction of a new securitised issues. The above evidence indicates that US citizens clearly perceive Ebola as a health concern, but is it less clear whether this also applies to Ebola as a security concern, which would be the key indicator of whether the securitisation discourse has truly been accepted or not. In further polls, it is seen that Ebola ranks 8th in the list of ‘top US problems,’ a position which shows it is seen as a severe concern to the nation as a whole, not just solely in healthcare terms (McCarthy 2014). Though it falls short of concerns over the economy, immigration and unemployment, which are traditional concerns, the fact that Ebola outweighs education, crime and violence, and the situation in Iraq/ISIS would indicate that the securitising process has been successful in the US. Though it is not explicitly stated that the population is viewing Ebola as a security threat, they are certainly 27 viewing it as a severe problem facing the nation. Thus it is determined that the third assumption of the process of securitisation; audience acceptance of the discourse; has found to be present in the US. Interestingly, there appears to be a variance in the degree of success of the acceptance of the securitising discourse. Despite responses remaining relatively constant over the variables of gender and age, there was a large disparity in responses across levels of education. 22% of adults who had never attended college, and 19% of those who had a low level of college education named Ebola as the top US healthcare problem when surveyed. In contrast, just 11% of those with a record of four years or more of college education named it as a top threat. Des Jarlais et al (2006) reached similar conclusions in their study of reactions to AIDS, determining that greater knowledge and education was generally found to correlate with less stigmatisation. This evidence would appear to indicate that there is a potential for further future research into the impact of education levels on the degree of receptiveness of an audience to a securitising discourse, with the evidence here suggesting that those with low levels of education may be more likely to accept the discourse. Thus, the question of why representations resonate with particular groups is a significant one, and this thesis would argue that this concept is as of yet under-explored within the Copenhagen School framework. 4.3 Extra-Normal Response The above evidence indicates that both a presentation of an existential threat within discourse and an acceptance of the existence of this threat by an audience has been successful. The third aspect of Stritzel’s securitising trilogy is an extra-normal response, i.e. one that goes beyond the usually accepted political measures. This does not have to be an actual response however; just the fact that both political elites and audience are willing for the measures to go ahead indicate success in this area. A massive influx of donor funds could certainly be seen to fall under the category of extranormal politics; though overseas aid and donation is a part of everyday politics, financial contributions on this scale are not seen as a common occurrence. This response is also directly linked to the WHO’s application of securitising discourse, which included an appeal for funds within it. In total, over $375 million USD has been received by the WHO from donors, including governments and private companies. It is difficult to assess whether these donations have drawn money away from other sources, however past cases would suggest that this may have been the 28 case. Feeny & McGillivray (2004) have detailed how if a donor makes the decision to support one cause, they must decrease funding in other areas in order to support this new donation. Furthermore, Perin & Attaran (2003) indicate that a bandwagon effect may occur, whereby if an issue is prioritised by certain influential actors, others are likely to follow suit in moving this issue to the top of their agenda. Shiffman (2008) has concluded that several trends identify the displacement of funds away from other health issues and towards the HIV/AIDS efforts. These papers collectively warn against the marginalisation of other health issues in the face of epidemic. Despite criticism from President Obama and UN Secretary General Ban Ki-Moon, health workers returning to New Jersey and New York faced compulsory quarantine procedures (Wang 2014). The stigmatisation of health workers both at the epicentre of the disease and when returning to their home countries is worrying. Studies of both SARS and AIDS found that diseases associated with ‘stranger’ groups had harmful stigmatising effects, and were often led by popular opinion and psychological similarities as opposed to epidemiological fact. Sarah Crowe, a worker on the front line with UNICEF describes how “Ebola psychosis is paralysing […] they almost talk nostalgically about the long civil war here, a time where the enemy could be seen and the bullets could be dodged” (Gregory 2014). This desire for a concrete enemy as opposed to a constructed threat is indicative of the harmful consequences of securitisation, especially for those on the ground. Australia’s response has been among the most extreme, retracting all entry-visas for those originating in countries affected by Ebola, and a suspension of all humanitarian funds allocated to fight Ebola (Wang 2014). The chances of Ebola reaching Australia are minimal, and thus the framing of the threat in this way certainly appears to have provoked an extra-normal response. Allusions to the “nightmarish Dickensian spectacle” of poverty and disease as described by Kaplan (1994:30) are found to be unnecessary, and entirely harmful. The neoclassical works of Kaplan in fact exemplify the ruinous preconceptions which are embedded in both academic and popular opinion, and as will be later shown, can have detrimental effects on response to crises such as these. Kaplan is particularly relevant here as his work considered West Africa as the source of departure from civilisation in the 21st century, “reverting to the Africa of the Victorian atlas (Kaplan 1994:46). In fact, I would argue that his work is based on false premise and is a prime example of the false securitisation and exaggerated discourse that tends to surround large scale crisis such as the Ebola outbreak. 29 4.4 Summary and Evaluation of Success At this point, the hype surrounding Ebola has largely dissipated. As of January 2015, the number of new cases was falling and the risk of re-emergence was limited to Sierra Leone (Burnett 2015). Although the Ebola outbreak may have been a priority for the WHO, their capacity to respond to it had been severely restricted by the budget cuts that had dominated previous years. The budget for responding to outbreaks has been cut by some 50% from $469 million USD in 2012 to $208 million in 2014 (Lancet 2014). The eradication of smallpox showed how successful global health cooperation can be, yet unfortunately current attempts seem to be lacking in both commitment and funds. This contrasts with the questionable use of military resources- by April 2015, the US had spend $360million on the Ebola mission in West Africa; the majority of this was spend on deployment of the military. A huge degree of wastage has been seen in the use of the funds; out of 20 Ebola treatment units build by the US military, 9 had never seen a single patient and the remaining 11 had only treated 28 patients between them (Lancet 2014). This is a prime example of resources being misguidedly directed towards a project where they would generate the most positive public response (i.e. by US population and donors) as opposed to where they actually may be effective e.g. in rebuilding local healthcare systems. The fact that the main countries affected by the disease (Guinea, Sierra Leone and Liberia) have all suffered civil unrest in the recent past and continue to experience instability, political tensions and growing isolationism may have affected how they responded to the disease (Burci 2014). The dynamics of the context in which the securitisation process has taken place can be seen to hold a much more important role than was previously thought. This thesis would argue that historical association can hold just as much influence as the speech act, in terms of an audiences perception of a threat. Lipschutz (1995:8) states that security discourses are “the products of historical structures and processes […] of conflicts between societal groupings and the interests that besiege them.” In recognition of this, the next chapter will discuss in detail the potential influence of context on the securitisation process. The ultimate sign of a successful mobilisation through securitisation is evidence of protection of the referent object. In this case, it is difficult to assess the impact on certain factors such as societal unrest and political mistrust, as these are more likely to be assessed in the long run. 30 What we can examine now however is the disease in its most basic form; the number of confirmed cases and deaths. Fig. 1 Number of Cases: Libera Confirmed Fig. 2 Number of Cases: Sierra Leone Confirmed 31 Fig 3. Number of Cases: Guinea Confirmed (WHO 2015: Ebola Situation Reports) The WHO declared the Ebola outbreak a ‘Threat to International Peace and Security’ on the 18th September 2014 (WHO 2015). If the securitisation was successful in mobilising resources and political commitments, it would follow that the number of new cases would begin to decline after this point. It is recognised that halting the outbreak of an infectious disease is a multifaceted process and it would be naive to expect to see an instant decrease in the number of new cases, but some level of downward trend would be expected to emerge. Interestingly, it is in the weeks following this declaration that the number of new cases in Liberia peaked, and subsequently began to decline. It was difficult to identify any form of such trend in Guinea, whilst the peak in Sierra Leone came much later in the course of the outbreak. 32 It is very difficult to attribute any progress directly to the securitisation process- diseases have natural life spans, and a number of factors can contribute to their growth and decline. It may be useful for future research to expand this area of study, with more integration and recognition of these external factors, in order to determine the extent to which political and resource mobilisation as a result of the securitisation process really did help to slow the spread of the disease. Thus, this chapter concludes that the securitisation of Ebola was successful on all three terms, yet it’s impact is questionable. The next chapter will examine this impact in greater detail. 33 Chapter Five- Analysis of Effect of Securitisation Process on Response It is clear that any level of securitisation will have a complicating effect on health cooperation and response. This chapter will assess the link between the securitisation of Ebola and the response to it, and through this determine whether the benefits have outweighed the risks of the process. This follows the warning set forth by Buzan et al (1998:29); “One has to weigh the always problematic side effects of applying a mind-set of security against the possible advantages of focus, attention and mobilisation.” This thesis argues that the process was flawed from the outset, because the means to address the crisis simply did not exist, both in terms of funds (as previously discussed with regards to the WHO) and political structures. Thus emerges the false securitisation of Ebola. Buzan, Waever and de Wilde (1998:29) in fact argue that one should be wary of securitising non-military threats. This action, they say, signals a fundamental political failure to address the problem within the realm of ‘normal’ politics. Based on this assertion, the fact that any level of securitisation at all has taken place indicates that governments have already failed from the outset. The US, Canada, Russia and China have all claimed to have developed or accelerated production and trials for treatment of the virus. Though there is little evidence publicly available for this, based on the conclusions drawn from past case studies it seems likely that this fast-tracking has come at the expense of other clinical trials. Perhaps the greatest danger arising from the securitisation of Ebola is the effect on other diseases. Not only was funding and research diverted away from other traditional health concerns in an attempt to combat Ebola, but the overwhelming of clinics with Ebola patients caused them to become non-functional, thus expanding the risk posed by other diseases. In effect, by attempting to combat Ebola, the response increased the risk in other medical areas exponentially. It is not only in the case of research and vaccines that this negative effect may occur however. Fear of contracting SARS was found to cause a 35.2% reduction in those seeking inpatient care, 23.% for ambulatory care and 16.7% for dental care. Thus, there is evidence that individual health also suffers (Des Jarlais et al 2006). Due to the interconnected nature of globalisation, stigmatisation may in fact help to spread a disease as a result of this avoidance of healthcare. Suppressing or false spread of information is the key catalyst of this fear. 34 The general argument goes that securitisation is a necessary process, because of the difficulty of mobilising against a relatively distant and indirect threat. This thesis argues that the securitisation focus was misplaced. Instead of focusing on the spread of Ebola into the US, i.e. the referent object being the state, discourse should have focused on the internal effects of Ebola within the affected states; state collapse, population displacement and the like. Developed countries should place less focus on the securitisation of infectious disease with the aim of protecting its citizens from contamination from abroad, and more on a more concentrated global effort to eliminate these diseases at their source. The securitisation of Ebola drew on the popular and historical presentation of the African continent as the geographical embodiment of “tropical disease, poverty and war” (Holmes 2014). In doing so, it has emphasised that many still appear only willing to invest in health research or response when it affects ‘us’; as stated by Gellman (2000), “when the rich lose the fear, they are not willing to invest in the problems of the poor.” Overlooking multiple warnings from Medecins Sans Frontieres, the WHO only declared Ebola an ‘international public health emergency’ following the infection of two American missionaries. Put bluntly, the Ebola crisis further exposed the flawed paradigms through which we view global health. The WHO did not make this declaration because it feared the disease truly has the potential to become a global pandemic; if it were to ever cross the borders of the more developed countries, the health care structures are advanced enough that the disease would be contained quickly (Lancet 2014). Thus, the emergency was declared solely to elevate response. Securitisation of Ebola had the revealing effect of unmasking a lack of appropriate framework to provide a co-ordinated response at global level. Unfortunately, this shows that similar lessons from past outbreaks have been overlooked. The fact that repeated warnings from MSF were overlooked by the WHO, then once recognised followed by somewhat chaotic funding appeals and attempts to make up for lost time clearly show a lack of leadership and decisive action. Appeals for emergency funding indicate a lack of preparedness, and raises questions regarding the sustainable nature of response. One could ask however, how much worse may the situation have been without the securitisation process? There could be a case made for the fact that without it, the response would have been yet more disjointed and unfocused. Drawing on this, a key recommendation can be made. The International health community must galvanise support to increase funding into 35 diseases that do not directly threaten Western countries, before they are allowed to spread in this manner. One way of doing this may be the use of conditioned aid to incentivise the production of drugs and vaccines that countries may otherwise not have the capacity to produce. The use of quarantine in Sierra Leone as a response to the panic was largely damaging. The fact that quarantines were only partially enforced not only created a false sense of security which encouraged those not within quarantine areas to travel as normal (even though they may have also been infected with the virus), but the disjointed and selective attempts at quarantine led to an increased risk of public disorder (Godwin & Haenlein 2015). Equating health with security runs the risk of implying that a military response is the most appropriate. The use of the military in response to the crisis was arguably a risky move, as it signified the first time the army had been mobilised since the end of the Sierra Leonean civil war; “Medicine in khaki is not only inefficient, it is bad practice. In much of Africa, public health has struggled to free itself from the way it was implicated in coercive colonial control measures” (de Waal 2014). The UK responded to it’s former colony through a Joint Inter-Agency Taskforce and dedication of 750 troops, building treatment centres, clinics and training local health workers. The Sierra Leonean military was praised for its response, especially in staffing checkpoints and acting as static guard for those areas that had been deemed as quarantined (Godwin & Haenlein 2015). In fact, by 28th June 2015, Sierra Leone had seen 13,119 confirmed cases, resulting in 3932 deaths (WHO 2015). This gives a mortality percentage of 29.9%. In comparison, the mortality rates in Guinea and Liberia were 66.5% and 45% respectively. It must be noted however that the UK has been engaging in Sierra Leone since the end of the Civil War in 2002, and the effective responses here are largely as a result of this long term structural support. Thus, the process of securitisation cannot be said to have played a large response in elevating the response in Sierra Leone, and was perhaps superfluous to requirements; the true success in response was due to existing reconstruction efforts. 36 Successful attempts to elevate the threat in Western discourse has not led to positive effects at the epicentre of the virus. An existing lack of trust in the state led to the spread of rumours that Ebola was a government scheme to extract profits from organ harvesting and secure funding from developed countries to pursue its own agendas. Attacks by local people on health workers, body collectors and anyone seen to be coming in from the ‘outside’ have been common throughout the crisis, and signify a fundamental government failure to connect with their populations (Godwin & Haenlein 2015). The securitisation process also failed to address fundamental flaws in the response to the epidemic; traditional practices of washing the bodies of those who had succumbed to the disease and large scale public gatherings including the infected were not recognised to have been a key cause of the spread of the disease, despite the fact that it is now recognised that in Guinea, around 60% of Ebola deaths were linked to these traditional practices (WHO 2015). Even when a crisis has achieved a high degree of political commitment and funding, without local understanding and recognition of the context in which the disease is spreading, any response will be flawed from the outset. There are inherent contradictions in response; advocates of human security argue that the key to challenging the traditional security framework and thus effectively addressing human security problems is to move away from military and state based security. In many cases however, it appears that they appeal to and attempt to work within the nationalist security framework in order to meet their human security goals. In effect, attempting to challenge the system whilst also utilising it to further their own agenda; somewhat of a contradiction. 37 Chapter Six: Conclusion The securitisation of Ebola was a concerted effort to alter the status of the disease. Securitisation can therefore be seen as a form of strategy; a form of plan used when “interests collide and forms of resolution are required” (Freedman 2013:6). What’s more, the fact that the securitisation of infectious disease is a trend and not an isolated incident is very clear. Securitisation has historically been shown to monopolise government activities, spread significant (and largely unfounded) fear, and detrimentally impact the movement of people and money within the economy. Panic reactions have the potential to fuel discrimination, and even restrict the basic enforcement of human rights. It suggests that global health issues are not worth addressing in their own right; only warranting attention when the national security interests of a state such as the US is affected (Peterson 2002). Unfortunately, the response to Ebola has been indicative of these predicted effects. With an undue focus on containment, the securitisation of Ebola has simply reinforced the binary conditions of ‘us’ and ‘them’, ‘civilised’ and ‘uncivilised’ that have been displayed in response to infectious disease throughout history. The warning put in place by de Wall, “the language of warfare risks turning infected people […] into objects of fear and stigma” (2005:2) has become a reality. In his writings on fear, Robin (2004) seeks to show how as a phenomenon, it unites. This thesis has shown the opposite; not only a deepening of pre-existing senses of self and other, but also the creation of new distinctions. In the case of Ebola, this fear was endemic, misguided, and thus magnified. The hypothesis by Rushton (2011) that ‘global health security’ only really means securing the Westcontainment rather than prevention- has largely been seen to be true. The securitising discourse has simply reinforced the distinctions between developed and developing countries; it remains true that the study of disease is largely a “discourse that constructed the space of the tropics as other, and thus as racially pathological” (Cameron Smith 2007). This study has found that the link between health and security is fundamentally skewed. That is not to say that it is not important to try and prevent the spread of infectious disease, but to say that the way in which responses are being generated and prioritised may be flawed. Though the securitisation of Ebola may have been successful, it was not justified. Thus results the false securitisation of Ebola; false in both its process and its purpose. 38 Final Thoughts A few days prior to the submission of this thesis, I was passing through a US airport following a number of weeks outside the UK, during which time I had had very limited access to news outlets. Dominating the path through security were unmissable and severe warnings about the dangers of MERS- Middle East Respiratory Syndrome. Of Ebola, there was no sign. Once so prevalent, Ebola warnings were now conspicuous in their absence. It appears that the fickle cycle of securitisation continues. 39 3 RISK ASSESSMENT FORM AND ASSOCIATED DOCUMENTATION After reading through ALL risk categories, please select RISK TYPE A or B below. 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