Health & Place 18 (2012) 695–700

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Health & Place

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Guest Editorial

Infectious Insecurities: H1N1 and the politics of emerging infectious disease

article info abstract

Keywords: Responses to the 2009 H1N1 pandemic, and criticisms of those responses, were framed by issues
Health security endemic to the meeting of ‘health’ and ‘security’ as governing domains. Offering an editorial
Swine flu introduction to the selection of papers in this special issue, it is suggested that existing scholarship
H1N1 in the emerging field of ‘health security’ can be categorized according to realist-advocacy, historical-
Biosecurity analytic, problematization and critical-inequality approaches. In contributing to this literature through
Securitization an event-based focus on the pandemic, the papers embrace the opportunity to examine health security
architectures acting and interacting ‘in the event’, to not only speculate over the possible implications
of this governing trope, but to review them. Questions of the scales of governance and associated forms
of expertise, the implications of differing modes of governance (from preparedness to surveillance to
forms of intervention), and the role of health inequalities in the patterning of the pandemic are
identified as key themes running across the papers.
& 2012 Elsevier Ltd. All rights reserved.

1. Introduction: health meets security
y it is increasingly y a matter of being governed by emergency,
in ways that inscribe the logos of war into the logos of peace via
the discourses of security that now proliferate throughout the
politics of ‘life itself’ (Dillon and Lobo-Guerrero, 2009: 17).
The dangerous intermingling of human, animal and viral
ecologies at unprecedented scales and highly pressurized vulner-
abilities has produced the spectre of an emerging infectious
disease (EID) of epic proportions, which threatens to be both
radically accelerated and rapidly distributed through the global
circulations associated with agriculture, trade and travel. Policy,
media and public concern over EID were thrown into sharp relief
by the 2009 global outbreak of swine-origin influenza A H1N1
virus (variously also Swine, Mexican, North American or Califor-
nian ’flu). The H1N1 pandemic highlighted global interconnected-
ness through both the networks of disease distribution and the
global range of biosurveillance, pharmaceutical markets and
global health governance. It crucially also brought to the fore
issues of place-based inequalities exacerbated through unequal
access to medicines and response capabilities. Critically, however,
the 2009 H1N1 pandemic did not just involve the colliding of the
microbial world with the domain of health governance, but of two
different regimes of governing – of health and security.
A growing body of scholarship across a number of disciplines
interrogates the emergence of EID as a pre-eminent health con-
cern and the convergence of this with contemporary security
discourses (Aldis, 2008; Brown, 2011; Cooper, 2006; Davies, 2008;
Elbe, 2005; Fidler, 2003; Ingram, 2005; King, 2002; Lakoff and
Collier, 2008). Within what can only be understood as a loosely
grouped ‘health security literature’, a number of overlapping
trends can be identified. First, realist-advocacy approaches argue
that infectious disease must be recognized as a threat to national
security and responded to within the domain of security. The
broadening of security studies in the 1980s and 1990s added EID
together with other nonmilitary issues such as food and ecological
security to the list of threats to national security, a domain
traditionally focused on external military threats to a country’s
interests, security and survival (Fidler, 2003).1 Together with
governmental and non-governmental analyses and publications
by journalists, think-tanks and institutes, this literature attempts
to reach and influence security policy audiences, particularly in
the US, in a pragmatic strategy to make public health relevant to
the agenda of decision-makers by elevating it to the high politics
of national security (Ingram, 2005; see Fidler, 2003 for a summary
of key reports, publications and outputs). There is also a wealth of
more popular work on the threat of infectious diseases, including
journalist pieces and book length tracts such as Mike Davis’s
(2005) ‘The Monster at Our Door’ and Laurie Garrett’s (1996) ‘The
Coming Plague’. This combined literature has been instrumental in
both defining the focus of health security on communicable
diseases transmitted through both intentional acts of bioterrorism
by rogue states or terrorists and by unintentional spread (McInnes
and Lee, 2006), and in the case of the popularist pieces, in
1
As Fidler (2003) argues, different concepts of security create different visions
of health security, and what came to dominate the approach adopted in the US
was a very particular form of security theory, that Fidler terms ‘the Realpolitik
Perspective’. This understands national security to be achieved through the
maintenance of military and material power, and has had significant implications
for the understanding and practice of health security responses to EID.

1353-8292/$ - see front matter & 2012 Elsevier Ltd. All rights reserved.
doi:10.1016/j.healthplace.2012.01.004
696 Guest Editorial / Health & Place 18 (2012) 695–700
generating an increasingly high-pitched sense of threat and
urgency. As Fidler (2003:856) argues, however, communicable
disease was put on the agenda in a way that much of the literature
had not anticipated, as the move to the ‘high politics’ of security
led to a recentering of state self interest, with broader implications
for public health governance: ‘The anarchical structure and
dynamics of international politics constitute a virus to which public
health is not immune when health and security converge’.
Second, an overlapping current of work adopts an historical–
analytical approach to chart the meeting of health and security,
the rise of concern and attention, and the influences, institutions,
events and key players that pushed EID into the framework of
security. These historical approaches can be either realist or
constructivist, with the latter focusing on the emerging dis-
courses and processes of discursive construction defining ‘health
security’, EID vulnerability and concern (Brown, 2011). Much of
this work is geographically focused on the activities of the US or
the global health governance ambitions of the World Health
Organization (WHO) and the development of the International
Health Regulations (Andrus et al., 2010; Fidler, 2004; Hoffman,
2010). Hoffman (2010), for example, identifies four periods of
global health security governance, the current distinguished by
the hegemonic leadership of the WHO, the primary actor in
constructing the emerging discourse of infectious disease secur-
itization (Davies, 2008). The reframing of health issues from
matters of domestic public health and international develop-
ment, to an imminent threat to international peace, stability and
security, is seen to be a consequence of a number of factors.
These include the wider geopolitical context of post-Cold War
global governance concerns and the global security framework
ushered in by 9/11, with particular concerns centering around
bioterrorism following the US anthrax attacks in 2001 (Davies,
2008; French, 2009; Ingram, 2005; King, 2002, 2003; McInnes
and Lee, 2006); the production of new transnational disease
threats and interconnectedness through globalization, with
states less able to secure their borders through traditional
quarantine approaches (Brown, 2011; Budd et al., 2011; Fidler,
2004; Hoffman, 2010); and the fanning of concerns through a
series of ‘focusing events’, outbreaks of microbial pathogens
including SARS, avian influenza, West Nile virus and Ebola virus
disease, which demonstrated that infectious disease was not just
a concern of distant others, but had the potential to impact
western state’s economic and political stability and their citi-
zens’ health (Ali and Keil, 2008; Collier and Lakoff, 2008; Davies,
2008; Davis, 2005; McInnes and Lee, 2006).
Third, a body of work adopting a ‘problematisation approach’
review the ways in which securitization processes operate,
identifying the rationalities and technologies of health security
whose import into the domain of health is shifting the way in
which infectious disease response is imagined, justified and
conducted (Aldis, 2008; Brown, 2011; Lakoff and Collier, 2008).
Not only is this apparent in the discourses of urgency and threat
that cloak discussions of EID allowing governance through states
of insecurity (Brown, 2011; Lentzos and Rose, 2009; Lo Yuk-Ping
and Thomas, 2010), but also in the re-alignment of the temporal
and spatial scales of health governance (Collier and Lakoff,
2008), the adoption of new forms of surveillance and informa-
tion management (Fearnley, 2008; French, 2009; Parry, this
issue), and the justification of new modes and technologies of
intervention and containment. Lentzos and Rose (2009:231)
distinguish securitization as entailing ‘border controls, regimes
of surveillance and monitoring, novel forms of individuation and
identification, notably those based on biometrics, preventative
detention or exclusion of those thought to pose significant risks,
massive investment in the security apparatus and much more.’
Critically, work within this area has identified the governance of
the future as a distinguishing feature of securitization
(Anderson, 2010a, 2010b; Caduff, 2008). This includes discourses
and practices through which future events are rendered think-
able and constituted as problems (Collier and Lakoff, 2008;
Lentzos, 2006), technologies of futurity (Fisher and Monahan,
2011), and future orientated configurations of anticipation,
contingency planning, preparedness and pre-emption (Lentzos
and Rose, 2009). Davies (2008) argues that this future-orientated
perspective does not go far enough, however, as health security
mechanisms focus on preventing contagion through enhanced
surveillance processes, rather than in preventing the conditions
for the emergence of disease in the first place. While Davies
(2008) suggests that securitisation locks agents into the logic of
defining a referent object and an external threat source, Lentzos
and Rose (2009) suggest that norms and threats are established
through patterns, regularities and irregularities (stochastic var-
iations) of flows. Taken together, developments in the discourse
and practice of security are profoundly impacting the govern-
ance of health.2
Finally, critical-inequality approaches highlight the wider
social, political and economic implications of the securitisation
of health, particularly in terms of the compounding effects of
multiple inequalities (Sparke, this issue; Sparke, 2010). The
meeting of security and health is shown to have occurred in
such a way that privileges security, as attention, money and
resources are redistributed (McInnes and Lee, 2006). At the
global scale the WHO has seen a shift from the universalist
right-to-health ideology of its first five decades, to an over-riding
concern with the management of infectious disease, represent-
ing the strategic interests of western nations (Fidler, 2003). This
domination of the global health agenda by health security is
leading to a broader ‘securitization of health’, with public health
initiatives justified as defensive measures against threat of
epidemics or biological terrorism (Hoffman, 2010). For public
health infrastructure in US, Ingram (2005:533) argues that this
has ‘led to a narrowing of focus, excessive specialization, constraints
on science, and massive misallocations of resources and opportunity
costs’. This analysis applies equally to developing countries, the
perceived ‘reservoirs of disease’ (Brown, 2011; Hoffman, 2010),
who additionally suffer multiple compounding inequalities
stemming from poverty and unequal access to resources, as
health security tends to ‘the fears of the rich rather than the needs
of the poor’ (Brown, 2011:324).
If ‘public health security’ defines policy areas in which
national security and public health concerns now overlap and
has had profound implications in the domain of practice (Fidler,
2003), it also offers opportunities for creative and generative
synergies between critical academic fields. Beyond the literature
on health security, a burgeoning field of scholarship across
geography, anthropology, sociology and the political sciences is
engaged in exploring the wider securitization of the life-world.
This includes attention to the biosecuring of agricultural and
environmental ecologies, questions of biosafety, containment
and laboratory ethics, and concerns over new biotechnologies
and innovations, such as genetic modification and nanotechnol-
ogy. This work is informed by and driving a number of theore-
tical currents, including, although not exclusively, interests in
governmentality and biopolitics (Braun, 2007; Collier et al.,
2004; Cooper, 2006; Dillon and Lobo-Guerrero, 2009; Collier
and Lakoff, 2008); questions of risk, uncertainty and indetermi-
nacy (Donaldson, 2008; Fish et al., 2011; Hinchliffe, 2001);
2
As Kittelsen (2007) argues, however, security itself also changes in its
meeting with infectious disease, as new domains of expertise, new modes of
enforcing borders, and new practices of intervening in the lives of the population
become part of the security matrix.
 Guest Editorial / Health & Place 18 (2012) 695–700
attention to nonhumans and coproduced networks, mobility and
agency (Ali and Keil, 2008; Barker, 2010; Braun, 2008; Clark,
2002; Wallace, 2009); the interrogation of spatial processes of
categorization and boundary-making (Barker, 2008; Donaldson
and Wood, 2004; Mather and Marshall, 2011; Tomlinson and
Potter, 2010); and geopolitical concerns with the interaction
between nation states, processes of globalization, postcolonialism
and modes of inequality (Farmer, 1999; French, 2009; Ingram,
2005, 2009; King, 2002, 2003; Sparke, 2009). These diverse
tendencies together demonstrate that no single theoretical lens is
sufficient to fully encapsulate and respond to the critical issues
raised by the predominance of the EID worldview.
2. Interrogating H1N1
‘The virus writes the rules. And it can change them at any timey’
(Chan, 2009).
It is in this context that the special issue considers the
implications of the securitization of health by focusing on the
2009 outbreak of swine-origin influenza A H1N1 virus. What can
attention to one disease event hope to bring to this literature and
our understandings of security responses to EID? In some ways,
crucial theoretical developments and new areas of enquiry have
proceeded in a disease-driven way. HIV-AIDS, for example, has
arguably marked the literature through attention to geopolitical
concerns over the place of health in global governance as well as
through questions of inequality (Elbe, 2005; Ingram, 2009);
scholarship emerging from reflections on the SARS epidemic drew
attention to the globalised co-produced networks of disease
exchange (Ali and Keil, 2008; Braun, 2008; Fidler, 2004); and
highly pathogenic Avian flu has, through its construction as ‘the
next big thing’ highlighted the future temporalities of disease
governance, what Samimian-Damash (2009) refers to as the ‘pre-
event configuration’, the constellation of anticipatory discourses
and practices (Bingham and Hinchliffe, 2008). What will our
reflections on H1N1 contribute to this field?
In many ways H1N1 has been a test of health security; of the
global and national architecture of surveillance and influenza pre-
paredness planning developed and strengthened in the wake of
SARS (Fidler, 2004). It has also revealed its limits, particularly
through the influence of this architecture over the resulting pan-
demic event. Drawing together debates in public health and
infectious disease management with work on biosecurity and wider
attention to securitisation, the papers in this special issue go beyond
marking the novelty of infectious disease emergence and spread and
resultant security practices, by interrogating the implications of the
health security configuration through a sustained engagement with
its operation during the pandemic. H1N1 offers the opportunity to
consider the modalities of health security governance during the
event of an outbreak, to not only speculate on the possible implica-
tions of this governing trope, but review them.
In particular, the papers raise three issues that emerge as
central to this meeting of security and health in the context of
H1N1: questions over the scale of governance and attendant
spatio-temporal forms of expertise; the ‘eventual’ implications
of new modes of preparedness, surveillance and intervention; and
the emergence of new and differing forms of inequality.
2.1. Scales of governance and spatio-temporal forms of expertise and
intervention
‘Vulnerability is universal’ (Chan 2007: vi, quoted in Brown,
2011, p. 321)
697
H1N1 threw into sharp relief issues of scale and spatial
practices connected to the governance of EIDs. The WHO
announced the global pandemic and international pharmaceu-
tical responded; national preparedness plans were invoked;
national populations were threatened by cross-border foreign
bodies (human, animal and microbe); regional health protec-
tion agencies coordinated with the national centre; local and
urban level health authorities struggled for differentiation; and
individuals were contained and pre-emptively medicated for
the national interest. The question of scales – the correct
spatial scale of governance, the temporal scale of intervention
and action, and the appropriate scale of the response – runs
through the papers.
Much existing work that engages with the different scales of
governance in the response to EID considers the geopolitical
interactions between western and non-western nations, and
attempts to overcome the ‘obstacle of sovereignty’ by providing
authoritative power in infectious disease governance to the WHO
(Davies, 2008:313; Fidler, 2003). Davies (2008) has argued that
the Global Outbreak and Alert Response Network (GOARN) and
the revision of the International Health Regulations (IHR) demon-
strates the WHO’s attempt to retain its authority in global health
governance and centre itself within a justification for a global
response to disease. The papers in this special issue move beyond
these particular geopolitical interactions to consider how the
fixing of H1N1 as a health security event itself produced tensions
through the conflicting spatialities of health governance and
security practices. This begins to address the comparative lack
of attention to questions of health security at local–regional–
national dialectics, in comparison to the wealth of work on the
geopolitics of health and security at national–international
dialectics.
While Birmingham, for example, became a ‘hotspot’ for the
H1N1 pandemic in England, this spatial differentiation was
ignored in the fabrication of a national epidemiological unit
through attempts by the national administration to homogenise
the response at the national level (Chambers et al., this issue).
Bronwyn Parry (this issue) takes these questions into a com-
parative discussion of individual and population-level biosur-
veillance in operation in the US and UK. Through the unification
of these scales, more robust and finely calibrated systems of
biosurveillance are being constructed and imagined, she argues,
which allow for the identification and containment of possible
sick individuals. Infectious diseases therefore not only challenge
the boundaries of regulatory jurisdictions, but the interaction of
different scales of governance.
Through pressure for national level governance and leader-
ship around epidemic scenarios, the governance of disease
becomes part of broader processes of place, nation and world
making (Ingram, 2009; Stephenson and Jamieson, 2009). A
desire to construct the UK as the European country best
prepared for the pandemic (and so civilized, rational, well-
controlled) influenced the scale of the English administration’s
response to the H1N1 pandemic (Barker, this issue). As Matthew
Sparke highlights, however, the place-making geographies of
disease can also work to reinforce inequalities through the
cultural and economic ostracisation of peoples and places
through powerful outbreak narratives, which ‘give microbes a
natural history in the primordial landscape of the developing world’
(Wald, 2008: 46, in Sparke). Whilst drawing out lessons for the
implications of pandemics for shared vulnerability of human,
animal and viral ecologies, Sparke urges attention to this asym-
metric inequality amidst interdependency, the place-based var-
iations in blame, risk, surveillance and response capacity, and
crucially the experience of illness.
698 Guest Editorial / Health & Place 18 (2012) 695–700
2.2. Modes of preparedness, surveillance and intervention
No mass of information will help us pinpoint the precise when,
where and how of the coming havoc. We can only speculate
(Cooper, 2006:119).
The papers question the assumed relationship between the
rationalities and technologies of preparedness, surveillance and
intervention, and the reduction of the social, economic and
biological disruption of disease. The generation of the H1N1 event
was not just a result of the relationship between the virus,
vulnerable human bodies, and international transportation net-
works, but also an outcome of the highly sensitized global
surveillance and preparedness apparatus and its underdeveloped
capabilities to act in a reduced capacity in the event of a mild
pandemic (Barker, this issue). This goes against the very logic of
preparedness, which attempts to prevent the wider disruptive
effects of events through permanent institutional readiness. For
H1N1 in most affected countries, the impacts of containment
policies were greater than the mild profile of disease. In the
context of the UK Chambers et al., this issue discuss interventions
that they argue went beyond the evidence base. They highlight
the prophylactic use of tamiflu, the effects of school closure and
the implications of diverted health care funds as particular causes
for concern.
The H1N1 saga was in many ways defined by questions of
surveillance and wider issues of information production and
management. While Parry draws attention to the potential
dangers of the extension and naturalization of surveillance in
everyday life, and Barker highlights the contribution of surveil-
lance to the production of events, Chambers et al., this issue
question the utility of this informatic hologram of the event for
the actual business of response management. Despite a wealth
of information continuously churned out by government, tradi-
tional and new media sources, laboratories and policy forums,
information-visibility at a local governance level was in many
cases poor, as the epidemiological picture was built at the
regional level.
For Parry, the question of information utility is oversha-
dowed by the information-generating capacity of the biosur-
veillance apparatus and the possibilities for its malevolent use,
as data from everyday or private contexts becomes enrolled in
the broader agenda of the security state. This poignantly high-
lights the importance of academic and community vigilance
over the uses of technologies that facilitate biosurveillance even
in benign and liberal political contexts. As epidemiology is
increasingly mapped through ever more complex and immedi-
ate forms of infodemiology3 (Eysenbach, 2009), privacy, repre-
sentation and control become part of its constellation of
concerns.
Finally, Brigitte Nerlich and Nelya Koteyko consider commu-
nication about pandemic communication itself, in newspaper
articles and online blogs, to address a range of questions related
to the role of the media, official panic, blame, fear and hype
(Nerlich and Koteyko, this issue). They identify what they term as
‘self-blame’ in the reflections of segments of the media over their
role in fueling emotive responses to pandemics and pandemic
warnings, and suggest that a form of ‘digital democracy’ through
new media sources has opened up spaces for discussion and
dissent in the public sphere. However, they warn that this climate
3
Infodemiology and infoveillance are terms coined by Eysenbach (2009) to
describe the way in which electronic information generated through internet use
(such as Google searches, social media status updates, or automatic searches of
news stories) can be used to inform health security responses. Here the term is
extended to include other forms of information that signal individual health
status, which can be enrolled in the visualizing and response to pandemic events.
of self-reflexive blame and counter blame discourses may not be
conducive for ‘fostering vigilance while allaying fears’ (Briggs,
2010).
2.3. New/differing forms of health inequalities
The landscape of political insecurity is not fully congruent with
the landscape of need (Ingram, 2005:539).
The initial identification of H1N1 in the vulnerable bodies of
Mexican rural poor living in proximity to a large American owned
swine processing plant gave us some early hints of the multiple
structural inequalities driving and reinforced by the pandemic.
Sparke traces this ‘epidemiology of inequality’, highlighting the
implications of inequalities in blame, of unequal risk manage-
ment, of response capacity and of medicine access, on the
struggling public health systems of the developing world. Sig-
nificantly, he highlights the ways in which existing forms of
inequality gave rise to the emergence of the ‘flu virus, which then
acts to compound and produce new forms of inequality.
He pushes our understandings of the impact of inequality on
ill-health and disease away from simply treating it as an in-
dependent variable, to a recognition of structural dynamics that
co-produce inequality and negative health outcomes. For EIDs, this
significantly includes cutback in health services, privatization,
structural adjustment policies, industrialized meat production
processes and cross-border labour insecurity.
But this is much more than a story of an emerging EID
stemming from, and disproportionately afflicting the poor of the
global south. As the globally-framed health security concerns of
the privileged west divert attention from more lethal yet every-
day threats of poverty, dirty water and malnutrition, health
security and health become conflicting aims. Yet this funding
misallocation affects not only malaria sufferers in Nigeria, but
also teenage mothers in Birmingham (Chambers et al., this issue).
Cross-border exchanges of dangerous polluting industries and
‘risky bodies’ between Mexico and the USA demonstrate contrast-
ing levels of opacity in the origin and blame stories of the global
media, yet it is also front-line health care providers in the US who
become subject to biosurveillance and enforced vaccination
(Parry, this issue). And the exploitative commodity production
chains of neoliberal globalization are shown to produce both
global health insecurity and local labour insecurity; environmen-
tal ‘bads’ and bad food; and emerge as the most fertile breeding
grounds for both pathogens and pathogenic inequality (Sparke,
this issue).
3. Final Thoughts
‘[H]ow [does] couching concerns through the language of security
and the accompanying rationales that follow construe the under-
standing of what is happening and what is possible?’ (Rappert
and Gould, 2009: 14).
Taken together, the papers in this special issue consider, from
different angles, how and why the modalities of security come to
threaten the values they seek to protect. By challenging our
assumptions over the meanings of security and insecurity, they
highlight the political and ethical challenges of living with risk,
threat and uncertainty. They attempt to go beyond the criticism of
the securitization of health, to consider what a pandemic event
can reveal about the technologies and rationalities of health
security as it interacts with the wider discourses and orderings
in which it is embedded.
Many questions remain. What can the relationship between
public health and health security tell us about the connections
between security and modes of governing in other domains? How
 Guest Editorial / Health & Place 18 (2012) 695–700
widely do we need to re-imagine the production of vulnerability to
EID, and what does this mean for both the systems of response and
our responses to those systems? In what ways do our analyses of the
EID worldview perpetuate a ‘hermeneutics of suspicion’ for all modes
of securing health and EID (Haggerty, 2006), and how can we
envisage and enact better ways of living in an insecure world?
H1N1 was, we now know, a mild virus, which rendered and made
visible the practices and discourses of health security in particular
ways. This does not make H1N1 a non-event, or even the dress
rehearsal for a future, more severe pandemic. What it does offer is the
opportunity to examine health security architectures acting and
interacting ‘in the event’ without the multiple cloaking tragedies a
more virulent virus would inevitably bring. Infectious Insecurities
refers to this world in which emerging infectious disease is dominat-
ing public health governance concern. It also reflects the seemingly
infectious nature of these security modalities themselves.
Acknowledgements
The papers in this special issue were first presented at the
seminar ‘Conceptualising Biosecurity: the Case of Swine Flu’ held
at Keele University in December 2009, the first of five seminars in
the series ‘The Socio-Politics of Biosecurity: Science, Policy and
Practice’, funded by an ESRC seminar series grant (see www.bbk.
ac.uk/environment/biosecurity). Many thanks to my co-organi-
sers Andrew Dobson and Sarah Taylor, and to all the seminar
participants, for good humour and energetic discussions.
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