Stefan Elbe

HIV/AIDS and the Changing Landscape of War in Africa

Since the discovery of AIDS more than two decades ago, 60 million people have been infected with HIV, the virus that causes AIDS, and more than 20 million have died from AIDS-related illnesses. The HIV/AIDS pandemic has become a humanitarian and human security issue of almost unimaginable magnitude, representing one of the most pervasive challenges to human well-being and survival in many parts of the world.1 It has taken a particularly heavy toll on sub-Saharan Africa, where AIDS is now the primary cause of death.2 In light of this magnitude, HIV/AIDS is not only having devastating effects on the individuals and families touched by the illness; it is also beginning to have much wider social ramiacations. In some African countries, HIV prevalence rates have reached between 20 and 30 percent of the adult population. In these countries HIV/AIDS is giving rise to a vast array of economic, social, and political problems. The Changing Landscape of War in Africa

Virus alert : security, governmentality, and the AIDS pandemic

Acknowledgments1. Viruses, Health, and International Security2. A Noble Lie? Examining the Evidence on AIDS and Security3. Security in the Era of Governmentality: AIDS and the Rise of Health Security4. National Security: Sovereignty, Medicine, and the Securitization of Aids5. Human Security: Discipline, Healthy Bodies, and the Global Curing Machine6. Risk and Security: Government, Military Risk Groups, and Population Triage7. The Power of AIDS: Responding to the Governmentalization of SecurityReferencesIndex

AIDS, Security, Biopolitics

This article critically engages with recent efforts to frame the global AIDS pandemic as an international security issue. The securitization of HIV/AIDS is significant, the article argues, not just because it is a novel way of conceptualizing the global AIDS pandemic, but also because it marks an important contemporary site for the global dissemination of a biopolitical economy of power revolving around the government of ‘life’. This biopolitical dimension to the securitization of AIDS brings into play a set of potentially racist and normalizing social practices, which, the article argues, international political actors should seek to avoid in their attempts to find appropriate and effective responses to the global AIDS pandemic. Ways of minimizing these dangers are explored in the conclusion of the article.

Strategies for achieving global collective action on antimicrobial resistance

Abstract Global governance and market failures mean that it is not possible to ensure access to antimicrobial medicines of sustainable effectiveness. Many people work to overcome these failures, but their institutions and initiatives are insufficiently coordinated, led and financed. Options for promoting global collective action on antimicrobial access and effectiveness include building institutions, crafting incentives and mobilizing interests. No single option is sufficient to tackle all the challenges associated with antimicrobial resistance. Promising institutional options include monitored milestones and an inter-agency task force. A global pooled fund could be used to craft incentives and a special representative nominated as an interest mobilizer. There are three policy components to the problem of antimicrobials – ensuring access, conservation and innovation. To address all three components, the right mix of options needs to be matched with an effective forum and may need to be supported by an international legal framework.

Securing circulation pharmaceutically: Antiviral stockpiling and pandemic preparedness in the European Union

Governments in Europe and around the world amassed vast pharmaceutical stockpiles in anticipation of a potentially catastrophic influenza pandemic. Yet the comparatively ‘mild’ course of the 2009 H1N1 pandemic provoked considerable public controversy around those stockpiles, leading to questions about their cost–benefit profile and the commercial interests allegedly shaping their creation, as well as around their scientific evidence base. So, how did governments come to view pharmaceutical stockpiling as such an indispensable element of pandemic preparedness planning? What are the underlying security rationalities that rapidly rendered antivirals such a desirable option for government planners? Drawing upon an in-depth reading of Foucault’s notion of a ‘crisis of circulation’, this article argues that the rise of pharmaceutical stockpiling across Europe is integral to a governmental rationality of political rule that continuously seeks to anticipate myriad circulatory threats to the welfare of populations – including to their overall levels of health. Novel antiviral medications such as Tamiflu are such an attractive policy option because they could enable governments to rapidly modulate dangerous levels of (viral) circulation during a pandemic, albeit without disrupting all the other circulatory systems crucial for maintaining population welfare. Antiviral stockpiles, in other words, promise nothing less than a pharmaceutical securing of circulation itself.

We good Europeans: genealogical reflections on the idea of Europe

How can Friedrich Nietzsche’s genealogical ethos contribute to our contemporary thinking about the meaning of the European idea? In seeking to answer this question, the following article sets out by outlining the main aspects of Nietzsche’s genealogical approach. The article then identifies the growing debate on the contemporary ‘crisis’ and ‘meaninglessness’ of the European idea as a site where Nietzsche’s genealogical reflections can be applied creatively and innovatively. There are at least three benefits that emerge from such an engagement. Firstly, Nietzsche’s genealogy of European nihilism can assist in explaining the pessimism that is frequently displayed by contemporary scholars and policy-makers in response to the perceived absence of a more meaningful vision of Europe. Secondly, Nietzsche’s genealogical analysis exposes some of the historical limitations that characterise much of the contemporary debate on the idea of Europe, pointing instead to an alternative conception of the ‘good European’ that seeks to address these limitations. Finally, and most importantly, Nietzsche’s genealogical method is capable of provoking a valuable experience of autonomy in relation to many previous constraints of European culture. Nietzsche’s genealogical ethos can, therefore, be of considerable use in delineating a way of thinking about the European idea in the twenty-first century that neither posits an essentialist idea of Europe, nor restricts itself to a technocratic or functionalist approach to European governance.

Our epidemiological footprint: the circulation of avian flu, SARS and HIV/AIDS in the world economy

ABSTRACT There is growing international concern about the circulation of pathological viruses in the world economy. Reviewing recent scholarship on avian flu, SARS, and HIV/AIDS, this article argues that the contemporary world economy is generating not just an ecological footprint, but also an important epidemiological one. Illustrating the complex interdependencies that exist between economic and microbial systems of circulation, the article highlights the difficult challenges that states confront in trying to shield populations against these viruses within the current international order. Finally, the article also considers recent attempts to scale up international responses to these viruses, including their progressive securitization and the coming into force of a new set of international health regulations – opening up a new chapter in the bio-history of humanity.

Pandemics on the Radar Screen: Health Security, Infectious Disease and the Medicalisation of Insecurity

How is the rise of global health security transforming contemporary practices of security? To date the literature on global health security has sought to trace how the securitisation of global health is affecting the governance of diseases in the international system; yet no-one has analysed – conversely – how the practices of security also begin subtly to change when they become concerned with a growing number of contemporary health issues. This article identifies three such changes. First, health security debates endow our understandings of security and insecurity in contemporary world politics with an important medical dimension. Second, the rise of global health security enables a range of medical and public health experts to play a greater role in the formulation and analysis of contemporary security policy. Finally, health security debates have also encouraged attempts to secure populations through recourse to a growing array of pharmacological interventions and new medical countermeasures. Drawing upon a rich literature in medical sociology, these three transformations in the contemporary practice of security collectively constitute the ‘medicalisation of security’. This novel perspective on the rise of global health security also reveals new limitations inherent in the emerging health–security interface – limitations associated not so much with the processes of ‘securitisation’ already noted in the global health literature, but rather with wider social processes of ‘medicalisation’. Awareness of the additional limitations renders the threat of a future pandemic even more serious than is commonly thought.

Data, disease and diplomacy: GISAID’s innovative contributionto global health

Abstract The international sharing of virus data is critical for protecting populations against lethal infectious disease outbreaks. Scientists must rapidly share information to assess the nature of the threat and develop new medical countermeasures. Governments need the data to trace the extent of the outbreak, initiate public health responses, and coordinate access to medicines and vaccines. Recent outbreaks suggest, however, that the sharing of such data cannot be taken for granted – making the timely international exchange of virus data a vital global challenge. This article undertakes the first analysis of the Global Initiative on Sharing All Influenza Data as an innovative policy effort to promote the international sharing of genetic and associated influenza virus data. Based on more than 20 semi‐structured interviews conducted with key informants in the international community, coupled with analysis of a wide range of primary and secondary sources, the article finds that the Global Initiative on Sharing All Influenza Data contributes to global health in at least five ways: (1) collating the most complete repository of high‐quality influenza data in the world; (2) facilitating the rapid sharing of potentially pandemic virus information during recent outbreaks; (3) supporting the World Health Organizations biannual seasonal flu vaccine strain selection process; (4) developing informal mechanisms for conflict resolution around the sharing of virus data; and (5) building greater trust with several countries key to global pandemic preparedness.

Global Health in International Relations: Editors' Introduction

McInnes, C. J., Davies, S. E., Elbe, S., Howell, A. (2014). Global Health in International Relations: Editorial Introduction. Review of International Studies, 40 (5), 825-834