View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Sussex Research Online A University of Sussex PhD thesis Available online via Sussex Research Online: http://sro.sussex.ac.uk/ This thesis is protected by copyright which belongs to the author. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Please visit Sussex Research Online for more information and further details Catching the Flu: Syndromic Surveillance, Algorithmic Governmentality and Global Health Security Stephen L. Roberts A thesis submitted to the University of Sussex in fulfilment for the degree of DOCTOR OF PHILOSOPHY Department of International Relations School of Global Studies July 2017 Declaration This work has not been previously accepted in form or substance for any degree and is not being concurrently submitted in candidature for any degree. Signed .................................................................................... (Candidate) Date ........................................................................................ Statement 1 This thesis is the result of my own research investigations, except where otherwise stated. All other sources are acknowledged by citations and footnotes giving explicit references. Signed .................................................................................... (Candidate) Date ........................................................................................ Statement 2 I hereby give consent for my thesis, if accepted, to be made available for photocopying and for inter- library loan, and for the title and summary to be made available to outside organisations. Signed .................................................................................... (Candidate) Date ........................................................................................ *The research and development of this doctoral thesis has been generously supported with funding from the Chancellor’s International Research Scholarship (2013-2016), at the University of Sussex. Total word count: 84 836 2 Abstract This thesis offers a critical analysis of the rise of syndromic surveillance systems for the advanced detection of pandemic threats within contemporary global health security frameworks. The thesis traces the iterative evolution and ascendancy of three such novel syndromic surveillance systems for the strengthening of health security initiatives over the past two decades: 1) The Program for Monitoring Emerging Diseases (ProMED-mail); 2) The Global Public Health Intelligence Network (GPHIN); and 3) HealthMap. This thesis demonstrates how each newly introduced syndromic surveillance system has become increasingly oriented towards the integration of digital algorithms into core surveillance capacities to continually harness and forecast upon infinitely generating sets of digital, open-source data, potentially indicative of forthcoming pandemic threats. This thesis argues that the increased centrality of the algorithm within these next-generation syndromic surveillance systems produces a new and distinct form of infectious disease surveillance for the governing of emergent pathogenic contingencies. Conceptually, the thesis also shows how the rise of this algorithmic mode of infectious disease surveillance produces divergences in the governmental rationalities of global health security, leading to the rise of an algorithmic governmentality within contemporary contexts of Big Data and these surveillance systems. Empirically, this thesis demonstrates how this new form of algorithmic infectious disease surveillance has been rapidly integrated into diplomatic, legal, and political frameworks to strengthen the practice global health security – producing subtle, yet distinct shifts in the outbreak notification and reporting transparency of states, increasingly scrutinized by the algorithmic gaze of syndromic surveillance. 3 Acknowledgements This doctoral thesis represents the conclusion of an ongoing process of research which began, quite earnestly, as many such projects do, in an e-mail exchange in 2011, about potential research interest in exploring emergent practices of syndromic surveillance in global health. From this initial starting point, some years ago now, to the submission of this thesis in 2017, I firstly extend my most sincere thanks to Professor Stefan Elbe, for his competency, and continued support in serving as the primary supervisor of this project. Thank you for helping me to expand my understandings, to test and push me on my perspectives, and for always working in support to allow me to present and extend my research work into exciting and challenging new venues. Together, I think we have made a very good team. I would like to extend additional thanks to Dr Stefanie Ortmann, who served as secondary supervisor on this project for her insight and perspective. I wish to extend my warmest thanks and gratitude to Professor Barbara Prainsack, who, from a chance encounter at a conference in Berlin, quickly became a steadfast mentor, as well as friend. Thank you, for your kind words and your willingness to support and encourage me, always. A warm note of thanks further to my aunt, Austina Garnhum, an educator, who for as long as I can recall has encouraged a love of books, and talked to me about grand ideas and far-away places. Thank you for your love and positivity, you are an inspiration to us all. At the University of Sussex, I also extend my warmest thanks to Miss Clare Rogers of the School of Global Studies, who became my first friend and kindred spirit at Sussex, when I was a young MA candidate. To my PhD friends, Gabrielle Daoust and Béatrice Châteauvert-Gagnon, thank you for sharing this experience with me. Thank you for always being there as a listening ear, for encouragement, for a laugh, and for a glass of wine. I look so forward to celebrating our academic achievements together. For all my friends and my family, in London, and Brighton, on Prince Edward Island, and around the world, thank you for contributing in so many wonderful ways to my life, you all make the ride worthwhile. To my friends at King’s College London, and the London School of Economics (LSE), thank you for your support as I concluded my doctoral research, and for offering me my first academic positions. A message of sincere thanks as well to Dr Anne Roemer-Mahler of the University of Sussex, and Dr Martin French of Concordia University for their engagement, insights, and willingness to serve as examiners for this thesis. Lastly, I send along, my warmest thanks and all my gratitude to Christopher Duffy, whose unparalleled support and faith in me during the years of research and writing, has made all the difference. Thank you for always being there. 4 Contents Declaration ....................................................................................................................................... 2 Abstract .............................................................................................................................................. 3 Acknowledgements ...................................................................................................................... 4 Introduction: Syndromic Surveillance, Algorithmic Governmentality and Global Health Security............................................................................................................. 10 Introduction ........................................................................................................................................... 10 The Expanding Nexus of Health and Security ...................................................................................... 12 Syndromic Surveillance in the Era of Pandemic Threat ....................................................................... 16 Algorithms, Global Health, and Security .............................................................................................. 19 Central Research Question and Theoretical Framework ...................................................................... 22 A Foucauldian Analysis of Health Security, and Surveillance ............................................................. 23 Algorithmic Governmentality, Syndromic Surveillance and Global Health Security .......................... 24 Methodology ......................................................................................................................................... 26 Argument and Structure of Thesis ........................................................................................................ 28 Chapter One: The Rise of Global Health Security ................................................... 32 Introduction ........................................................................................................................................... 32 A Genealogy of Infectious Disease Control ......................................................................................... 34 Populations and Pestilences: Before ‘Global Health’ ........................................................................... 35 Fostering Cooperation towards Global Health: Enter the WHO