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Public Health and National Security in the Global Age: Infectious Diseases, Bioterrorism, and Realpolitik

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Public Health and National Security in the Global Age: Infectious Diseases, Bioterrorism, and Realpolitik Maurer School of Law: Indiana University Digital Repository @ Maurer Law Articles by Maurer Faculty Faculty Scholarship 2003 Public Health and National Security in the Global Age: Infectious Diseases, Bioterrorism, and Realpolitik David P. Fidler Indiana University Maurer School of Law, [email protected] Follow this and additional works at: https://www.repository.law.indiana.edu/facpub Part of the International Law Commons, International Public Health Commons, and the National Security Law Commons Recommended Citation Fidler, David P., "Public Health and National Security in the Global Age: Infectious Diseases, Bioterrorism, and Realpolitik" (2003). Articles by Maurer Faculty. 416. https://www.repository.law.indiana.edu/facpub/416 This Article is brought to you for free and open access by the Faculty Scholarship at Digital Repository @ Maurer Law. It has been accepted for inclusion in Articles by Maurer Faculty by an authorized administrator of Digital Repository @ Maurer Law. For more information, please contact [email protected]. PUBLIC HEALTH AND NATIONAL SECURITY IN THE GLOBAL AGE: INFECTIOUS DISEASES, BIOTERRORISM, AND REALPOLITIK DAVID P. FIDLER* INTRODUCTION: LINKING PUBLIC HEALTH AND NATIONAL SECURITY In the not too distant past, attempts to connect public health and national security would have raised eyebrows and perhaps con- descending sympathy from experts in both areas. The discipline of public health focuses on "what we, as a society, do collectively to assure the conditions in which people can be healthy."1 Although public health has long been an issue in international relations,2 public health studies have had a strong domestic focus. For exam- ple, public health law texts "in the United States from the twentieth century... contain little or no discussion of international consider- ations."3 Even when public health analysis ventures beyond the domestic to consider international aspects of population health, the issues examined, such as the cross-border transmission of infec- tious diseases, 4 do not typically involve the problems at the heart of national security studies, such as the military balance of power. By contrast, the study of national security traditionally has concen- trated analysis on external threats, mainly of a military nature, to a country's interests, security, and survival.5 Historically, analysts in * Professor of Law and Ira C. Batman Faculty Fellow, Indiana University School of Law-Bloomington. An earlier version of this Article was delivered at a seminar at the London School of Hygiene and Tropical Medicine on May 30, 2002. Support for the research and writing of this article was provided by a Fulbright New Century Scholarship. 1. INSTITUTE OF MEDICINE, THE FUTURE OF PUBLIC HEALTH 1 (1988); see also Mark A. Rothstein, Rethinking the Meaning of Public Health, 30J.L. MED., & ETHICS 144 (2002) (dis- cussing the meaning of "public health"). 2. David P. Fidler, The Globalization of Public Health: The First 100 Years of International Health Diplomacy, 79 BULL. WORLD HEALTH ORG. 842 (2001). 3. David P. Fidler, Tony D. Perez, & Martin S. Cetron, InternationalConsiderations, in LAW IN PUBLIC HEALTH PRACTICE 93, 93 (R.A. Goodman et al. eds., 2002). 4. See, e.g., Arthur L. Reingold & Christina R. Phares, Infectious Diseases, in INTERNA- TIONAL PUBLIC HEALTH 139 (Michael H. Merson et al. eds., 2001). 5. CHEM. & BIOLOGICAL ARMS CONTROL INST. & CTR. FOR STRATEGIC & INT'L STUDIES INT'L SEC. PROGRAM, CONTAGION AND CONFLICT: HEALTH AS A GLOBAL SECURITY CHALLENGE 2 (2000) [hereinafter CONTAGION AND CONFLICT] ("Historically, the concept of national security has focused on the use of military power to protect national borders and interests abroad."); Dennis Altman, UnderstandingHIV/AIDS as a Security Issue, in HEALTi IMPACTS OF 787 The Geo. Wash. Int'l L. Rev. [Vol. 35 this field have not studied public health problems as national security threats. Arguments linking public health and national security have, however, become frequent in the past seven to eight years. 6 Increased concerns about the proliferation of biological weapons and the potential for bioterrorism have brought national security and public health closer together than has traditionally been the case. The perpetration of bioterrorism in the United States in October 2001 brought the public health-national security connec- tion more prominence and policy attention. This Article examines the linkage of public health and national security in order to understand the origins, nature, and future implications of this new development in the foreign policy arena. Analyzing the public health-national security linkage is impor- tant for many reasons. This linkage connects, for example, public health with developments in the area of security studies7 and debates about the nature and meaning of national security.8 Dif- ferent perspectives on what "security" means compete for atten- tion, and the literature that brings public health and national security together forces those in public health to contemplate these different perspectives and how they relate to the public health mission of protecting population health. The linkage also challenges those studying national security to consider issues, such as the relationship of public health to a state's material capabilities, previously alien to national security debates. The different per- spectives on the meaning of security further relate to larger theo- retical concepts concerning the structure and dynamics of GLOBALIZATION: TOWARDS GLOBAL GOVERNANCE 33-34 (Kelley Lee ed., 2003) ("For most of the twentieth century, the impact of two world wars and the succeeding 50 years of the Cold War meant that security remained defined almost entirely in military terms."); Press Release, Council on Foreign Relations, Council Establishes Senior Fellowship in Global Health and Foreign Policy with a Grant from the Bill & Melinda Gates Foundation (Apr. 25, 2003), at http://www.cfr.org ("Widespread disease such as HIV/AIDS and SARS relate directly to U.S. national security in ways that were unimaginable just a few years ago."). 6. CONTAGION AND CONFLIGcT, supra note 5, at vii (arguing that "today's world, in which globalization and the information revolution bring people and problems together in surprising ways, finds health and security intersecting with greater frequency"). The lead- ing developments in this linkage are analyzed in Section I.B infra. 7. Joseph S. Nye, Jr. & Sean M. LynnJones, InternationalSecurity Studies: A Report on the State of the Field, INT'L SECURTv, Spring 1988, at 5; Stephen M. Walt, The Renaissance of Security Studies, 35 INT'L STUD. Q. 211 (1991); David A. Baldwin, Security Studies and the End of the Cold War, 48 WORLD POL. 117 (1995). 8. John Baylis, Internationaland Global Security in the Post-Cold War Era, in THIE GLOBAL- IZATION OF WORLD POLITICS: AN INTRODUC.TION TO INTERNATIONAL RELATIONs 253 (John Baylis & Steve Smith eds., 2d ed. 2001); Roland Paris, Human Security: ParadigmShift or Hot Air?, INT'L SECURITY, Fall 2001, at 87. 2003] Public Health and National Security in the Global Age international relations. The linking of public health and national security thus raises deeper theoretical issues and controversies about world politics in the global era. First, using the literature that posits and analyzes the public health-national security linkage, this Article examines the emer- gence of the concept of "public health security," which refers to the policy areas in which national security and public health con- cerns overlap (Part I). Delineating the overlap requires defining both "public health" and "national security," which proves difficult with both terms. Second, in connection with defining security, this Article examines four different conceptions of security-the realpo- litik, common, human, and ecological security perspectives-and how these conceptions produce different visions of public health security (Part II). This analysis focuses on the two dominant themes in the literature on the public health-national security linkage: the threats posed by emerging and reemerging infectious diseases and biological weapons. Contrary to most of the literature on the public health-national security linkage, I argue that the real- politik security perspective is relevant to thinking about how to con- ceptualize public health security. Finally, this Article assesses how recent events involving the United States inform the scope and substantive concept of public health security, and what these developments tell us about the rela- tionship between public health and theories of international rela- tions (Part III). This Article argues that the evidence to date indicates that the realpolitik perspective on national security is driv- ing the development of the concept of public health security in the United States. This part of the Article concludes by examining whether the conceptual and practical analyses of realpolitik-driven notions of public health security hold deeper implications for understanding public health in the age of the globalization of infectious diseases and point to the economic, military, and geopo- litical interests of the great powers determining the direction of infectious disease diplomacy. I. THE PUBLIC HEALTH-NATIONAL SECURrrY LINKAGE DEVELOPS A. Public Health as a National Security Concern? Public health problems, especially infectious diseases, have been the focus of diplomatic activity among states since at least the mid- The Geo. Wash. Int'l L. Rev. [Vol. 35
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