for Goverment" ARC Concept Nate No.0 Aehopoiy the Catergory Rect Conese an ental, Sc Cara Sei rat he 3008), ¢s8e 08 July 35,2007 9 UDF snetap ones 400.4808 pat National Hose Count Commie oa the Dest applation oF eee haog (weehingon, 30: Nanos Academies Pest. 2004 ita Daly, Catasrapie Boro Wht Re Lane? (Wasting, D, Cater foe Techland Nall Seat Poy, snl Deters Univer, 2063) burke Gast, “The Challenge of Glabst Heath, aes nb 2007. “2 Th chapters se a concern wit dove sng ritiealAnotedge sou contemporary biosecurity intervetions, But they suggest har thers no single st ens hat sou nub to ave a an erating dag sis of isc” tad. In hisses, they ‘eng rom cca ste ht denounce ‘wha ames to ete tera sean texto citation” ae Hanne Lip sy Pre 958 Caller snd Chat, “Date pated: Spee Security and ies ote United States The poponton hacia anayss of ees expert can el ash te ‘aeration ta lsc Webi pos Naw Pr 2600) 305-182 CHAPTER TWO From Population to Vital System NATIONAL SECURITY AND THE CHANGING OBJECT OF PUBLIC HEALTH Andrew Lakoff Iw early 1976, health officials warned the Ford administration that nev strain of influenza had appeared in the United States and threatened to become a deadly mandesnic, A soldier had died én Fort Dix, and others atthe base were Infected ‘vith the vieus, Experts andl officials yathered and quickly recommended a plan of action tothe president: an urgent, intensive program to immunize the entire US, population before the next ia season, at an estimated cost of $135 millon. Such a pogrom had never been tried before —indved, t had only recently become tech- hicaly feasible, But given the perceived scale of the swine flu threat and the new sibility of intervention, public health experts were nearly unanimousabout the ‘tional course of ction: mass vaccination. “If we believe in preventive medicine,” sone Infectious dixeate expert sald, “we have na chnice Three decades ater, in the fall of 2005, the attention of the US. govern nent was again focused on the threat of pandemic influenza, This timethe threat slid not come suddenly; public health officials had been warning of its danger with increasing urgency since the appearance of a deadly strain of the vieus in Hong Kong in. 1997, Bur it seemed that now a major initiative was possible: in wart because of an Increasing perception of the seriousness of tive threat, as the vivus spread globally through poultry stocks and migratory birds; in part as a ‘sult of fallout from the administration's widely percelved fallure to espond to ‘jurricane Katrina, Present Bush described the combination of urgency and uncer ‘uinty posed by avian flu: “Scientists and doctors cannot tell us where or when ‘he next pandemic will stelke, or how severe it will be, but most agree: at somepoint, we are lily to face another pandemic Or # a concerned senator put it ‘Experts no longer ask f such a pandemic could occu, rather they question when it will occus.”* In November, the administration unveiled a $7.1 billon pandemle prepared- nes strategy described by the secretary of health 2s "the most robust proposal ever ‘made for public health at one time."* The plan included funds for disease surveil lance, stockpiling antiviral medicine, and new methods of vaccine production ‘The detallsof the administration's plan were stanply crtiized in the public healt ‘world as overly focused on pharmaceutical interventions, and as underemphasizing the needs of state and local health agencies. But among various commentators, there was remarkable accord on several points. Fest, that pandemic planning was a ‘matter of urgent concer; second, that the nation was currently far ftom adequately prepared for it;and third, that whether or not a pandemic occurred, the process Of preparing for it would strengthen readiness for other potential threats, As the senator put it, ‘even if we are spared ftom flu pandemic tke work that we do today will serve us all well in the event of any national emergency."’ Indeed, the hu threat had become a vehicle for a more general form of plan- ‘lng—one oneated toward a variety of potential threats. The assistant secretary of health sald: ‘Preparedness for a panciemic makes us a nation better prepared for any and all hazards, manmade or natural.” But, he wasned, such a condition. ‘would not come quickly or easily: “Preparedness is journey, not a destination Isa journey that must be nationwide: involve federal state, and local leaders i We're partnership; and include every sector of society." As the secretary put it, foverdue and we're not as well prepared as we need to be, We're better prepaced than we neve yesterday, Well be better prepared tomorrow than Weare today. I'S 1 continuum of preparedness.” The states’ organization of health officers agree: ‘Are we lully prepared? Absolutely not, Weare more prepared than we were several years ago but not prepared enough.” Over the course of three decades, a nev way of thinking about and acting ‘on disease threat had emerged: it was no longer a question only af prevention, bur also—and perhaps even more—-one of preparedness. How did this shift hap: pen? How, ln other words, did a noun of preparedness come to stuctute thought about threats ty public health, and how did a certain set of responses to these thueats become possible? The story Isa complex one, Involving the migiation of ‘echniques initially developed in the milltary and cil defense to other areas of ovemmental intervention, My analysis is centered not on widespread public discussion of biological Ugeats, but rater on particular sites of expertise where a novel way of understand ing ancl intervening in threats was developed and deployed. In what follows, {focus ‘on one particular technique, te scenario-based exercise. argue that this technique served two important Functions: Bs, to penerate an afect of wn ‘of the event itso; and second, to generate knowledge about vulnerabilities in response capability that could then guide intervention, The scenatio-based exe | sugues, i exemplary of the rationality uaderlying the contemporary atic «af national security and public health in the United States ‘Scenatio-based planning can be usefully contrasted with quantitative nethods ‘or managing uncertainty: rsk assessment and insurance are examples of tetiniques that calculate the prubbiliy of future events in order to guide rational action i the present. They rely on historical patterns of incidence to make such calculations. For this form of planning, the foture is the product of calculated declsions made in the present, based on a limited number of possiblities: the past contains the ele nents of what is to come, However, the problem of eatastphe—the evert whose racy in the absence likelihood cannot be known, and whose consequences cannot be managed seers {0 defy such calculations This leads to the question | want ta focus an in what follows: Haw among nattonal secustty and public health experts inthe US, isthe ature prospect of eatastrophe brought into the present as an object of knowledge and intervention? National Security and Public Health Ins 2006 congressional testimony on avian fu preparedness, former Whe House Homeland Security Advisor Richard Falke toall other conceivable threats to U.S, national security, the catastroplae disease ‘coat is and for the foreseeable future will remain the greatest danger we face."™ Given Falkerirath’s ackyround 4s an expett In counterterronisin and nuclear pro lieration, this wasa striking statement —a clear affitmation that national security h sais" When viewed in comparisonStrategists must turn thei attention to a subject that, until recently, had been mostly under the purview of publte healt, 4s Nicholas King and others have shown, his was by no means the fst time U.S, national security concerns had been linked to public heath." To understand the specific impilcations of Falkenath’sclaim-—and its distinction from prior such conjunctures~it is important to analytically disaggregate the concept of “national security." In other words, to ask: What type of seeurty is meant? What are its political objectives ana what are is technical methods? In this context, as we will sec, experts who wete concerned with the catastrophic disease Uheeat did not for ietion.* Nor could thelr approach best be the most part articulate a fogle off described in terms ofa rationality of prevention. Rather, they were engaged in 1g distinetive way of approaching blologicalthreats—one of ongoing, Vigilaat readiness for potential disaster, To show this it wil be useful to Introduce a set of analytic astinctions among formula omns of collective security. Sovereign state security dates from the monarchical states of the seventeenth century, and refers to practices oriented to the defense tte oval sovereignty against foreign enemies using military means, Population ‘security which emerged in the nineteenth century, involves the protection of the national population against regularly occurring internal threats, such as llness, industrial accident, or Infinity. Is exemplary knowledge forms include epidemio- ‘ogy and demography, and its interventions range from socal insurance and public health to uthan infeastrvcture development Howeve:, a number of current secusity initiatives such as pandemic p paredness or ‘critical infrastructure protection ‘of these familiar security frameworks. ln recent yeass, 2 third form, which we ‘do not fi nest into either one «can teem vita ystems security, has become increasingly cent to the polities of security. This form of security is oriented to a distinctive type of threat; the event ‘whose probability cannot be calculated, but whose consequences are potentially ‘alastrophie. ts object of protectin Is not the national testory othe population bbut rather the critical systems that underpin social ancl economic lf. Vita systems Security does not develop knowledge about an enemy or about regularly accurting, ‘events, but eather uses techniques of imaginative enactment to generate knowledge about system sullnerabilities, is interventions are not focused on protecting against Figure 2.1: Forms Of Collective Security woRMATIVE Anterdiction Prevention | Preparedness Tees oF Aasversaries | Regular occuring Unpredictable, tuseare events potenti | Gaastopnic events | i aoe ua es oes rxgianuany | Stategy Epidemgy, Imaginative form oF | demography | enaciment fortnation | Deterordelend ———Dstibuterik | Gauge winsaalty, | against enemy | develop capabiity foreign enemies or modulating the living conditions of the population; instexd, event of they seek to assure the continuous functioning of extical systems in th comegenaty (ee Ryute 2.) ‘Vital systems security came out of one practice of sovereiga state security — ‘iil defense—beginning in the 1960s. Its techniques Were initially developed to ‘approach the threat of nuclear attack, but were gradually extended to approach ‘ther potential catastrophes, ranglag from natural disasters to technological acci- tents, terrorist attacks, and epidemics of infectious disease. As we will we, when ‘fects disease is approached asa problem of population security, interventions «te structured by a logic of prevention; wheteas when itis taken up from the van. lage of vital systems security, the guiding logic Is one of preparedness It shiouid be underlined that these distinctions clo not mark epochal shifts it is not that there nas been an overarching transformation from one forma of secur sity to another, but rather that these forms operate in dynamic relation 10 one