Biopolitical Surveillance and Public Health in International Politics
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BIOPOLITICAL SURVEILLANCE AND PUBLIC HEALTH IN INTERNATIONAL POLITICS 9780230619951ts01.indd i 10/28/2009 9:32:23 PM This page intentionally left blank BIOPOLITICAL SURVEILLANCE AND PUBLIC HEALTH IN I NTERNATIONAL POLITICS Jeremy Youde 9780230619951ts01.indd iii 10/28/2009 9:32:24 PM BIOPOLITICAL SURVEILLANCE AND PUBLIC HEALTH IN INTERNATIONAL POLITICS Copyright © Jeremy Youde, 2010. All rights reserved. First published in 2010 by PALGRAVE MACMILLAN® in the United States—a division of St. Martin’s Press LLC, 175 Fifth Avenue, New York, NY 10010. Where this book is distributed in the UK, Europe and the rest of the world, this is by Palgrave Macmillan, a division of Macmillan Publishers Limited, registered in England, company number 785998, of Houndmills, Basingstoke, Hampshire RG21 6XS. Palgrave Macmillan is the global academic imprint of the above companies and has companies and representatives throughout the world. Palgrave® and Macmillan® are registered trademarks in the United States, the United Kingdom, Europe and other countries. ISBN: 978–0–230–61995–1 Library of Congress Cataloging-in-Publication Data Youde, Jeremy R., 1976– Biopolitical surveillance and public health in international politics / Jeremy Youde. p. cm. ISBN 978–0–230–61995–1 (alk. paper) 1. Public health surveillance—International cooperation. 2. World health. 3. Biopolitics. I. Title. RA441.Y68 2010 362.1—dc22 2009015740 A catalogue record of the book is available from the British Library. Design by Newgen Imaging Systems (P) Ltd., Chennai, India. First edition: January 2010 10 9 8 7 6 5 4 3 2 1 Printed in the United States of America. 9780230619951ts01.indd iv 10/28/2009 9:32:24 PM for Mom and Dad This page intentionally left blank C ONTENTS Acknowledgments ix Abbreviations xi Introduction 1 1 Biopolitical Surveillance in the International Arena 15 2 Global Public Goods, Cooperation, and Health 41 3 Smallpox: Defeating the Scourge and Provoking Resistance 63 4 HIV/AIDS and Human Rights as an Evolving Strategy 89 5 SARS: Collaboration and Resistance 113 6 The International Health Regulations 147 Conclusion: Balancing Global Public Goods and Privacy: A Human Rights Approach to Biopolitical Surveillance 177 Notes 189 Bibliography 221 Index 241 9780230619951ts01.indd vii 10/28/2009 9:32:24 PM This page intentionally left blank ACKNOWLEDGMENTS This book would have never emerged without the support and encour- agement of the political science departments at two remarkable insti- tutions. Grinnell College was kind enough to provide me with a professional home and a stimulating intellectual environment for two years. My former teachers and undergraduate advisors proved just as helpful when I was a colleague as they had been during my student days there. My thanks go to Eric Carter, Dionne Bensonsmith, Bob Grey, Wayne Moyer, Ira Strauber, Barb Trish, and Eliza Willis for their insights, suggestions, and support. The University of Minnesota Duluth has provided me with the space to expand my academic hori- zons and develop my arguments. My colleagues welcomed me with open arms and kept me laughing. Jake Caceres, Mary Caprioli, Mary Currin-Percival, Runa Das, Geraldine Hughes, Mark Jennings, Garrick Percival, Paul Sharp, Any Shuster, and Joe Staats kept me on my academic toes and provided much needed encouragement for this project. The UMD College of Liberal Arts has provided me with the funds through its Travel Grants and Chancellor’s Small Grants Programs to attend conferences where I presented some of the ideas that found their ways into this book. Jack Amoureux, Stephanie Carvin, Harry Gould, Eric Heinze, Yanzhong Huang, Sara O’Brien, Drew Price-Smith, Meg Shannon, Tracy Hoffman Slagter, Brent Steele, and Kate Wolf have offered insights, provided suggestions, pointed me toward helpful readings, tried to steer me away from pitfalls, and generally kept me sane over the years. Trish Siplon made one comment to me in passing when she gave a presentation at Grinnell in April 2008 that crystallized the previously amorphous arguments I present here—though I take all responsibility for any muddledness that remains. I am also indebted to Palgrave’s anonymous reviewers. They challenged me in the best possible way, and the book’s arguments are stronger for it. Farideh Koohi-Kamali, Robyn Curtis, and Rachel Tekula at Palgrave must be 9780230619951ts01.indd ix 10/28/2009 9:32:25 PM xACKNOWLEDGMENTS among the most delightful and hard-working people in academic publishing today, and I thank them for all of their faith and assis- tance. I’d be remiss if I didn’t thank the baristas at coffee shops in Grinnell, Iowa City, Duluth, and Minneapolis. I wrote much of this book in coffee shops, and their hospitality and caffeine proved invalu- able. My partner Ben has offered the love, support, and encourage- ment that keep me going on a day-to-day basis. I dedicate this book to my parents, Jerry and Cynthia. It’s the least I can do for the people who gave me the space and autonomy to develop into who I am today. 9780230619951ts01.indd x 10/28/2009 9:32:25 PM A BBREVIATIONS ACT-UP AIDS Coalition to Unleash Power AIDS Acquired immune deficiency syndrome ARVs Antiretroviral drugs ASOs AIDS service organizations CCP Chinese Communist Party CDC Centers for Disease Control and Prevention DoD Department of Defense EIS Epidemic Intelligence Service GEIS Global Emerging Infections Surveillance and Response System GIVS Global Immunization Vision and Strategy GOARN Global Outbreak Alert and Response Network GPA Global Program on AIDS GPG Global public goods GPGH Global public goods for health HIV Human immunodeficiency virus HOLN Health Office of the League of Nations HRW Human Rights Watch ICCPR International Covenant on Civil and Political Rights IHR International Health Regulations ISB International Sanitary Bureau ISC International Sanitary Convention ISR International Sanitary Regulations MDGs Millennium Development Goals NESRI National Economic and Social Rights Initiative NGOs Nongovernmental organizations OIHP L’Office International d’Hygiene Publique OMCWA Office of Malaria Control in War Areas PEPFAR President’s Emergency Plan for AIDS Relief PLWHAs People living with HIV and AIDS 9780230619951ts01.indd xi 10/28/2009 9:32:25 PM xii A BBREVIATIONS SARS Severe acute respiratory syndrome SARS-CoV Severe acute respiratory syndrome coronavirus TAC Treatment Action Campaign UDHR Universal Declaration of Human Rights UNAIDS Joint United Nations Program on HIV/AIDS USAID United States Agency for International Development WHA World Health Assembly WHO World Health Organization 9780230619951ts01.indd xii 10/28/2009 9:32:26 PM I NTRODUCTION Humanity officially won the battle against one of the world’s most dreaded microbial killers on May 8, 1980. Meeting in Geneva, the assembled representatives to the World Health Assembly (WHA), the World Health Organization’s (WHO) decision-making body, accepted the report of a commission of eminent scientists about international efforts to eradicate smallpox. Twenty-two years after the erstwhile Soviet Union first proposed that WHO commit itself to the complete elimination of smallpox, three years after the diagnosis of the last- known natural case of smallpox, and nearly two years after the world’s last-known death from smallpox,1 WHA resolution WHA33.3 “declare[d] solemnly that the world and its peoples have won freedom from smallpox, which was a most devastating disease sweeping in epi- demic form through many countries since earliest time, leaving death, blindness and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia and South America.”2 The eradication of smallpox is an amazing milestone. Here was a disease that had afflicted humans for thousands of years, causing an estimated 300 to 500 million deaths in the twentieth century alone— and the international community wiped it off the face of the planet (except for a few samples for research purposes in two high-security labs) after only two decades of dedicated efforts.3 Efforts to get rid of this killer disease overcame the intense ideological divisions of the cold war, serious shortcomings in funding, and incredible logistical difficulties. States of all ideological stripes came together to combat a common microbial enemy, and they prevailed. They collaborated to establish an extensive health surveillance system and provide a global public good to all the countries of the world, regardless of the amount of their contribution. Although some may laud these efforts as an incredible example of international altruism, the smallpox eradication campaign was (and remains) incredibly controversial for a number of reasons. In their quest to ensure sufficient coverage, vaccinators occasionally behaved in an unethical manner and potentially violated human rights in some communities—vaccinating people without their consent, breaking 9780230619951ts02.indd 1 10/27/2009 12:38:16 PM 2 S URVEILLANCE AND HEALTH IN POLITICS into houses, and failing to respect local medical beliefs. The cam- paign provoked resentment for violating state sovereignty, imposing particular policies and goals without considering the needs and resource capabilities of local communities. Rumors spread in some areas that the smallpox vaccination was really an instrument of Western control and domination, designed to sterilize the recipient or allow Western states to infect local populations. Some human rights and public health groups expressed concerns about the international community’s intentions in promoting a massive, invasive, and costly smallpox eradication campaign instead of addressing other, more pressing health concerns. They worried about the surveillance aspects of the eradication programs, fearing that the oversight would extend into additional areas without any recourse. They feared that their cit- izenship status would come to depend upon their health status, and that their basic collective and individual human rights would not be respected. The same surveillance components that inspired so much faith among the campaign’s leaders that they could succeed encour- aged concern, fear, and hostility about its potentially malevolent pur- poses among others.