Pandemics, Pills, and Politics

En-Capsulating Security: Could a Pill Strengthen National Security?

Hardly a year goes by of late in which a new infectious disease outbreak does not capture the world’s fears and imagination – from HIV/AIDS, SARS and pandemic flu, through to Ebola and Zika. Even as I write, another Ebola outbreak in Africa is threatening to spread into a dense urban area, thereby putting the world on an ‘epidemiological knife edge’ according to the World Health Organization (WHO). And every time there is such a new outbreak, one of the first questions we instinctively ask is: Is a safe medicine or vaccine against this deadly disease available?

This reaction is only natural. Who, after all, would not wish to have access to safe and effective medicines when faced with potential exposure to a lethal pathogen. Unfortunately, however, such ‘medical countermeasures’ were not readily available to the world during the vast majority of recent outbreaks. No doubt that limited the number of lives that could be saved, and the public reassurances that might have been given in order to stem the debilitating epidemic of fear accompanying such outbreaks. In many cases, governments and communities had to rely instead on much more traditional and age-old public health interventions – like contact tracing, isolation of infected patients, quarantines, social distancing measures, and so forth.

Such a sorry global state of affairs appears quite counter-intuitive, especially when viewed against the backdrop of all the many medical and scientific advances achieved during the twentieth century, and which have given the world historically unprecedented abilities to control a plethora of deadly bacteria and viruses. Many diseases that would have been an automatic death sentence in the past, can today be cured or even averted by recourse to routine medical interventions. All the while, the pharmaceutical industry continues to be immensely profitable, busily devising new treatments for a wide array of medical conditions, and the field of biomedicine continues to advance the frontiers of scientific and medical knowledge.

Exactly why, then, should it prove so hard for governments to ensure that safe and effective medical countermeasures are available to people who need them during deadly new outbreaks? That is the central question that motivated the writing of Pandemics, Pills, and Politics: Governing Global Health Security. Diving head-first into this little-known world of ‘medical countermeasures’, the book takes a closer look at one of the world’s most prominent exemplars: the antiviral medication Tamiflu. Taken by millions of people around the planet in the fight against pandemic flu, Tamiflu is not just a fascinating pharmaceutical product, but one that has also courted controversy. Tamiflu has provoked suspicions about undue commercial influence in government decisions to create vast national stockpiles of the antiviral in response to H5N1. It also found itself at the center of a prolonged political battle over who should have access to the data about the safety and effectiveness of medicines. All of this means that Tamiflu has stood at the heart of global health security in a way that no other recent medical countermeasure has.

Yet it turns out that there is also much more to the Tamiflu story than all those headline-grabbing controversies alone. Carefully tracing each step in the fascinating ‘life’ of this antiviral also begins to unravel the mystery of why the commercial development of new medical countermeasures remains such a vexing challenge – even today. Shadowing the life of Tamiflu reveals that the entanglement of commercial pharmaceutical development with wider security considerations generates an array of new difficulties and obstacles at virtually every stage in the lifecycle of a new medical countermeasure. In fact, the book uncovers ten such challenges in total – divided into three broader groups of ‘acquisition’, ‘procurement’ and ‘deployment’ challenges.

Overall, I hope people will take away from the book not just an improved understanding of the many challenges involved in developing new medical countermeasures. I hope that they will also appreciate the profound tensions that emerge between pharmaceutical companies, governments, regulators, international organizations and scientists when the world of pharmaceuticals collides with the world of national security – tensions that some countries are only able to resolve through the creation of whole new pharmaceutical regimes aimed at strengthening global health security. But most importantly of all, I hope that readers will learn that the meaning and practice of security is itself also changing today because our underlying conception of life is evolving – a process I call the molecularization of security.

Stefan Elbe is the director of the Centre for Global Health Policy and a professor of international relations at the University of Sussex. He is the author of Pandemics, Pills, and Politics: Governing Global Health Security, Strategic Implications of HIV/AIDS, Security and Global Health, and Virus Alert: Security, Governmentality, and the AIDS Pandemic.