key: cord-0035496-kj2tnw8q
authors: Davies, Sara E.
title: Advocating Global Health Security
date: 2016-10-07
journal: Global Insecurity
DOI: 10.1057/978-1-349-95145-1_14
sha: fa2d87399d65df44828506f9737cba29447982ee
doc_id: 35496
cord_uid: kj2tnw8q

For the last two decades, a recurring strategy employed by health professionals, scientists, and diplomats has been to play the ‘health security card’ to achieve particular trade, diplomatic, strategic, and development goals. The presumption has been that the securitisation of health will harness global political leadership and resources. This marriage of health issues to security logic has been met with a mix of applause, caution, and critique. In particular, there have been growing claims that the successful global health initiatives such as, the Global Fund for AIDS, TB, and Malaria (Global Fund) and the Global Alliance for Vaccine Immunization (GAVI) were achieved without asserting their necessity on security considerations. Thus, what difference does the association of security to health make for the success and longevity of global health initiatives? In this chapter, I answer this question through comparing a case where the security logic was deliberately deployed to frame the ‘health emergency’ (Framework Convention on Tobacco Control), against a case where human rights logic was used to advocate for its creation (the GAVI). I critically explore the conditions under which linking securitisation with an international health initiative captures and maintains political leadership and resources.

first resolution on Global Health and Foreign Policy in 2008 (A/63/33). The UNGA also adopted resolution A/69/1 giving support to the measures recommended by UN Secretary-General to contain the Ebola outbreak (A/69/389 2014).

The decision of the UNSC to adopt three resolutions on health matters in 15 years and the UNGA sessions on global health and foreign policy have received mixed views. Some point to these events as illustration of the weakness of the global health security narrative (Youde 2014) . In particular, it has been noted that the Ebola outbreak in 2014 was initially met with no international capacity outside of the World Health Organization (WHO) to respond to this crisis. The creation of the UN Mission on Ebola Emergency Response (UNMEER) in September (2014) was the first, and some argue should be the last, effort to respond to a viral outbreak (Panel of independent experts 2015). Others contend that, given that there is no procedure under the UN Charter for the General Assembly or Security Council to examine health matterslet alone develop a mission like UNMEERbroader UN engagement in health beyond the WHO could point to the success of the global health diplomacy (McInnes 2015) . The question is what does successful global health diplomacy look like? Do we see in practice the securitisation of health as essential to pursue international diplomatic engagement in global health?

There have been recent claims that the successful international engagement in health initiatives such as the Global Fund for AIDS, TB, and Malaria (Global Fund) and Millennium Development Goals (MDGs) have been achieved without asserting their necessity 'primarily on security considerations ' (McInnes and Rushton 2013: 16 ; see also Sridhar 2012; Gagnon and Labonte 2011) . However, the assumption remains that linking health issues, specifically health emergencies and infectious disease outbreaks to security discourse will create more opportunities for diplomatic cooperation and engagement (see Feldbaum et al. 2010; Hafner and Shiffman 2013) . This chapter explores this argument beginning with the period where the phrase 'global health diplomacy' and 'global health governance' began to gain usage in international relations in the 1990s. In the first part of the chapter I briefly present the conceptual history of health security and its relationship to 'global health diplomacy'. I explore the argument that the success of global health diplomacy has come from the preponderant use of security language, referents, and discourse (cf. Elbe 2011; Feldbaum et al. 2010; Kickbusch et al. 2007; McInnes and Rushton 2013) . In the second part of the chapter I examine two cases, one where a type of security logic was deliberately employed to frame the 'health emergency' (Framework Convention on Tobacco Control or FCTC) and one where human rights logic was initially deployed when advocating for its creation (the Global Alliance for Vaccine Immunization or GAVI). I evaluate what 'health security' looks like in these global health initiatives and explore the presumption that 'security discourse' must be present in comparing these two major, successful global health initiatives.

States have a history of formal international agreements addressing health matters and health threats, particularly infectious diseases, from the Decree of Quarantine in Ragusa-Dubrovnik in 1377 (Mackowiak and Sehdev 2002) to the International Sanitary Conference in 1851 (Fidler 2003) and the revised International Health Regulations in 2007 (Davies et al. 2015) . However, the treatment of health as a 'low politics' priority at the international level remained the case through most of the formative years of nation-building in the nineteenth and twentieth centuries (Fidler 1999) . This was in spite of its great strategic benefit for colonial era expansion, winning wars and rapid industrialisation (Diamond 1997) .

In contemporary politics, a range of actorssuch as foreign governments, non-governmental organisations (NGOs), pharmaceutical companies, private donors, and international organisationsdrive a variety of different health agendas that influence priorities within individual states and affect the resources that are available to individual health workers and opportunities for patients (Youde 2012) . Likewise, the post-Second World War Bretton Woods system had a profound influence upon health-care policy and practice around the world, with key lending institutions like the World Bank promoting particular health-care systems and policies in their lending programmes (Sridhar 2012) . In this period, key discourses such as 'Health for All', the Essential Medicines List, and Right to Health emerged in the absence of linkage to security. These discourses brought in a range of actors including international organisations, NGOs and transnational corporations with the power to shape health opportunities and outcomes within and amongst states (Gagnon and Labonté 2011) . In the 1990s, however, foreign and defence ministries became increasingly interested in global health policyparticularly infectious diseaseswhich would be referred to as having a 'securitising' effect on health (McInnes and Lee 2006) .

During the 1990s, key events combined with a paradigm shift in International Relations (IR) and security studies (particularly in Western developed countries with the end of the Cold War) (Paris 2001) to connect security to health (Enemark 2007; Collier and Lakoff 2008) . Acute awareness was growing amongst Western states that they were not immune to health events such as infectious disease outbreaks. The outbreak and spread of HIV across developing and developed countries during the 1980s; fear of biosecurity attacks with the breakdown of security in laboratories across the former Soviet Union (Koblentz 2010) ; sudden outbreak of the plague in India in 1995 and the arrival of West Nile virus near New York City in 1999; and the return of 'slow-burn' diseases thought eradicated such as Tuberculosis (TB), measles and meningitis in the United States, United Kingdom, and Australia (Price-Smith 2002). As well, new strains of disease, such as haemorrhagic dengue fever and drug-resistant malaria were on the rise due to significant climate change impact in South Asia, Southeast Asia, and Pacific (Kim and Schneider 2013) .

Andrew Price-Smith argues that prior to President Clinton's appointment of the National Science Council on Emerging and Re-Emerging Infectious Diseases in 1995, developed states had grown complacent to the fact that 'despite their enormous technological and economic power, it is extremely unlikely that developed countries will be able to remain an island of health in a global sea of disease ' (2002: 122) . Clinton's move created a wave of interest in other developed countries, particularly the United Kingdom, Australia, and Canada, all shifting to appreciate and contextualise health threats in foreign policy terms (McInnes and Lee 2012: 32). Until then, on the rare occasion that health policy was discussed at the international level it was in relation to (mostly) infectious disease outbreaks such as plague and cholera, or large-scale efforts such as the mass immunisation programme led by WHO to eradicate smallpox. During infectious disease outbreaks, emphasis had been squarely placed on the responsibility of the host state and regardless of the capacity of its public health system to effectively respond (Fidler 1999) .

Meanwhile, the spread and scale of HIV/AIDS raised fears about its potential to threaten state cohesion and national economies. There was a particular focus on military forces being at risk of HIV infection, and the political insecurity these infectious could bring in societies (Singer 2002; Elbe 2006) . The apparent potential for HIV/AIDS to cause state collapse or serious disruption that could ricochet throughout neighbouring states was considered a realistic scenario in sub-Saharan Africa, as well as some parts of South and East Asia and the Pacific (Shisana et al. 2003; Ramiah 2006; Price-Smith et al. 2007) . It was specific reference to the threat of HIV/AIDs on peacekeepers that led to the first resolution on health, Resolution 1308, being passed in the UN Security Council in 2000 (UNSC 2000) .

In response to these developments, a host of analysts, including Solomon Benatar (1998 Benatar ( , 2002 , Peter W. Singer (2002) , Robert Ostergard (2002) , called for IR to engage with the economic, humanitarian, political, and security ramifications of the AIDS epidemic. At the same time, David Fidler and Andrew Price-Smith called for equal attention to the economic, political, and social insecurity that stems from a range of infectious diseases already prevalent in countries (Fidler 2003; Price-Smith 2002) . Using quantitative analysis of the relationship between infectious diseases and state capacity, Price-Smith claimed that 'infectious disease [already] constitutes a verifiable threat to national security and state power' (Price-Smith 2002: 19) . Health security, Price-Smith (2002: 9) argued, referred to the threat of the disease on particular populations as well as the country's economic and political stability becoming unsustainable as a result of a pathogen wiping out the core population base. While a disease may have a different impact in different states:

[I]ncreasing levels of disease correlate with a decline in state capacity. As state capacity declines and as pathogen-induced deprivation and increasing demands upon the state increase, we may see an attendant increase in the incidence of chronic sub-state violence and state failure. State failure frequently produces chaos in affected regions as neighbouring states seal their borders to prevent the massive influx of disease-infected refugee populations. Adjacent states may also seek to fill the power vacuum and may seize valued territory from the collapsing state, prompting other proximate states to do the same and so exacerbating regional security dilemmas. (Price-Smith 2002: 15) In a similar vein, David Fidler's seminal 1999 book International Law and Infectious Diseases argued that with the increased risk of drug-resistant microbes in the twenty first century, as identified by public health officials (Institute of Medicine 1992; Heymann 1996), it will become important to 'understand the international politics of infectious disease control, or microbialpolitik' (Fidler 1999: 19) . Microbialpolitik, argued Fidler, was 'wrapped up not only in traditional concerns such as sovereignty and power but also in the implementation of scientifically sound infectious disease policies at the national and international levels' (ibid.).

Both Fidler and Price-Smith argued that the risk of newly emerged infectious diseases and drug-resistant infectious diseases required that all governments engage with the problem as if they were threats to national security. Likewise, Laurie Garrett argued in 2001 that 'a sound public health system, it seems, is vital to societal stability and, conversely, may topple in the face of political or social stability or whim. Each affects the other: widespread political disorder or anti-governmentalism may weaken a public health system, and a crisis in the health of the citizens can bring down a government' (Garrett 2001: 5) .

These ideas continued to influence the global politics of health into the twenty-first century (Fidler 2009; Davies 2012) . In a 2010 study on the influence of global health on foreign policy, Feldbaum and his colleagues found that most discussion and policy from diplomatic engagement focused on the interplay of national interests and security, which meant that most diplomacy focus and discussion was on the containment of infectious diseases (Feldbaum et al. 2010: 87) . At the time, WHO also immersed itself in the health security argument:

Collaboration between Member States, especially between developed and developing countries, to ensure the availability of technical and other resources is a crucial factor not only in implementing the [International Health] Regulations, but also in building and strengthening public health capacity and the networks and systems that strengthen global public health security will. (WHO 2007: 13) Of course, health diplomacy refers to the pursuit of international health cooperation on matters of concern to states ( Kickbusch et al. 2007) . It is the amalgam of cooperation in areas where there is the possibility of genuine technical cooperation for a diverse range of diseases (Youde 2012: 25) . However, because health diplomacy involves the interplay of national interests, power and diplomatic compromise, 'state interests have been critical to either the success or obstruction of such agreements . . . and issues of national security remain atop the foreign-policy hierarchy' (Feldbaum et al. 2010: 87) .

The counter-narrative to the health security discourse described above is that the securitisation of health promotes an instrumental pursuit of health. To capture foreign policy interest and engagement, global health discussions produce a 'hierarchy of illnesses' whereby some health issues receive interest and resources whilst other equally deadly health matters do not (Youde 2012: 160) . Jeremy Shiffman's (2006: 411-420 ) work on the peaks and troughs of investment in global health initiatives has revealed that despite disease burden to a population, some infectious diseases (i.e. HIV/AIDS) consistently attract stronger short-term investment from donor statesprimarily those that are contagious or linked to the national security interests of donor states. However, it would be a mistake to assume that the threat of infectious disease alone encapsulated all diplomatic engagement with health issues at the turn of the twenty-first century.

The rise of non-traditional security has also been attributed to the increased influence of the introduction of different social science methods and theories to International Security Studies (Buzan and Hansen 2009: 188) . This has influenced research into the subject matter of security studies and IR. If insecurity and grievances amongst the population played a large part in the civil wars that gripped the 1990s (Fearon and Laitin 2003) , engagement with health is not just a security concern for developed states but also for developing states. In other words, appreciations of health security were not one-dimensional. It was possible to advocate for a vision of health security that sought to protect individuals as much states. Indeed, a human centred appreciation of securitycoined 'human security' by the 1994 United Nations Development Programme (UNDP) Human Development Report (see MacFarlane and Khong 2006)sought to redefine the 'traditional' security with issues and concepts under the umbrella term 'non-traditional' security, including health (Chalk 2006) .

Thus, there does appear to be a significant relationship between international health events and the direction of research and policy engagement (Davies 2012) . In the last decade, events such as the United Nations Security Resolution on HIV/AIDS (S/Res/1308) and SARS create an explosion of IR engagement with global health governance, particularly in the area of health security. This 'phenomenon' has been witnessed again with the Ebola outbreak (Youde 2014) . Amongst all these engagements, two key approaches have emerged. First, those who accept the inevitability of a 'narrow' approach to health and IR, focused on infectious diseases and bioterrorism as security threats (Koblentz 2012) . Alternatively, there are those who articulate a broader vision related to development, state capacity, and cross-national health issues (Shiffman 2006; Nunes 2014; Rushton and Williams 2012) . One of the central claims of the former approach is that health securitisation is an effective way of galvanising diplomatic engagement amongst states and other actors, resulting in the allocation of political will and material resources (Collier and Lakoff 2008; Elbe 2011; Hafner and Shiffman 2013) .

In the next part of the chapter I examine this core assumption. In particular, I explore whether the effectiveness of health initiatives is tied to their securitisation, focusing on the examples of two major health initiatives. I examine the Tobacco Free Initiative (TFI) and the GAVI. Interest in these two cases comes from exploring the above presumption that security and health, particularly concerning infectious diseases, drives, and delivers policy momentum. While there is debate about whether that momentum translates into 'real' policy progress or whether it is mere rhetoric deployed at particular crises/events with no lasting impact, there is no debate that health security has dominated global health and foreign policy discourse (Feldbaum et al. 2010; McInnes and Rushton 2013) . Below, I briefly examine the dominance of health security in successful global health initiativesone where you would expect it to be deliberately deployed (GAVI) and one where it was not (TFI). TFI and GAVI, I contend, are interesting cases precisely because they confound the issueframing conventions about the relationship between health and security.

A global health initiative is defined in this chapter as 'an emerging and global trend in health. They are usually focused on state, international organisation and public-private partnerships. Global initiatives typically target specific diseases and are supposed to bring additional resources to health efforts' (WHO 2015).

This section briefly compares two international health initiatives: the TFI and GAVI. The TFI sought to reach an international agreement under international law that countries would adopt to regulate the sale and production of tobacco. This global health initiative was in aid of preventing the unchecked rise of tobacco related illnessesnon-communicable diseasesincluding cancer (various), emphysema, heart disease, stroke, and diabetes (to name a few). In the case of the TFI, and in light of the literature discussion concerning health security above, it would be expected that there was little to no presence of security discourse in the early days of this initiative. It was (and is) about introducing tobacco control legislation, addressing unregulated sale and distribution of tobacco to address preventable tobacco-related diseases in young populations in already over-burdened public health-care systems (Roemer et al. 2005) . In contrast, the GAVI is a public and private partnership between states, international organisations, pharmaceutical companies, and philanthropic donors that sought cooperation amongst this diverse group of actors to manufacture, purchase and deliver life-saving vaccines against deadly infectious diseases in the most remote, dangerous and impoverished locations around the world. GAVI is, ostensibly, the initiative where it would be expected to see initial employment of 'security' rhetoric given it is addressing the health insecurity of under five children in need of vaccination from, mostly, contagious infectious diseases. In fact, the immediate previous iteration of GAVIthe Child Vaccination Initiativeused security type discourse such as 'mission', 'operation', and 'threat'' under the steerage of a former US defence army medic (see Muraskin 2002) .

These cases were also selected because they shared some important features. Both the TFI and the GAVI are concerned with one specific health concerntobacco and immunisation; both were launched within a similar time where health security discourse was gaining policy attention; both initiatives required the involvement of multiple stakeholders, including national governments, to enjoy success. The main difference, of interest to this chapter, is that the association of security with the health issue confound the type of cases analysed to date in the IR literature on global health security. I reveal below that the non-communicable, 'slow moving' health threat engaged more securitised discourse than the high morbidity communicable health threat. The comparison of the two cases was organised around a common framework involving three steps.

First, understanding the rhetoric and concepts used to frame the initiative. Each initiative has produced a significant volume of material outlining its purpose, scope and mandate. For the purposes of this chapter, I focused on the 'founding' document for each initiative. In the case of TFI, the Framework Convention on Tobacco Control, adopted by the World Health Assembly in 2003, 8 years after the Convention was first proposed in the 1995 World Health Assembly. The Framework Convention was the outcome of the TFI and details 'a regulatory strategy to address addictive substances; in contrast to previous drug control treaties, the WHO Framework Convention asserts the importance of demand reduction strategies as well as supply issues' (WHO 2003) . Included in the Framework Convention document analysed is an Annex 2, which details the history of drafting the Framework from 1995 to 2003. For GAVI, the document analysed is the GAVI Meeting of the Proto-Board in Seattle, July 1999. This document details GAVI's terms of reference, mission, objectives, functions, structure, milestones, and budget priorities.

An interest in the discourse used in the founding document of each initiative is informed by the premise outlined in the above literatureto what extent security frames were employed to justify, conceptualise, and operationalise these two global health initiatives which remain, successfully, in place today.

Second, once accepting the premise that securitisation is deliberately engaged the two documents were analysed to identify a set of 'benchmarks' to guide its assessment of the extent to which a health initiative has aligned with security. Both documents were examined in detail for the presence of 'speech acts' (Hansen 2012 )the initiative itself or actors associated with the initiative identified an existential threat or risk and speech acts that called for the adoption of extraordinary measures. Was the initiative itself referred to as 'security', 'threat', or 'risk'. Who was the 'referent object' identifiedthe group threatened; who was the functional actor capable of protecting the referent object from the identified threat (Buzan et al. 1998: 26-39) ; and what was the 'scale' of securitisation utitlised to emphasise the need for extraordinary measures (Buzan and Weaver 2009) .

Third, discourse analysis (Hansen 2012) . In this case, the discourse within the two documents were analysed using NVivo Software. For the purposes of this chapter, I refer to three query searches conducted to analyse the perspectives being presented in the two documents concerning the threat the initiative is addressing, who the initiative is 'protecting' and who is responsible for such protection. To facilitate answering these three levels of inquiry, three query searches within NVivo of each document were conducted: (1) word frequency analysis, (2) text search of 'security' terms and, and (3) text search of 'other' normative terms (development, rights, economy). A word tree was then developed for the second and third text searches with a 'in context' search up to ten surrounding words (on either side) to enable understanding of the context and usage of the key words, i.e. 'threat' or 'poor' being searched in the document. The word frequency search assisted with identifying the primary actors discussed in the documentsi.e. who was identified as the referent actor intended for that initiative versus the functional actor necessary to give effect to the initiative.

Discourse analysis of the TFI and GAVI documents produced three key findings. The first, unexpected, find was that the TFI initiative was framed just as much in security terms as was GAVI. The number of securitisation 'speech acts' (Hansen 2012) searched and located in the Framework Convention was practically the same at GAVI -0.08% and 0.07%, respectively (speech act terms: secure, threat, risk, mission, extraordinary, urgent). In both cases, the presence of security language was less than 1% of each document. What was significant was that in the search for 'other' normative terms (terms: responsible, rights, develop, needs, poor)the Framework Convention was comparatively high at 1.05%, and a similar search for GAVI came at 0.4% references. However, given the Framework Convention is a legal document the presence of 'right/rights' partly accounts for high percentage compared to GAVI. Contextual analysis of these terms reveals further detail in how the documents framed the problem, the referent actor and the functional actor (see Table 14 .1).

In the Framework Conventiondespite higher use of 'other' (nonsecurity) normative language than GAVIthere is a clear disposition towards identifying the state as the 'functional' actor responsible for taking measures necessary to protect the population from tobacco sale, use, and morbidity. The Convention directly refers to populations at risk (women and minors) and the need for member states to support civil society capacity to inform and educate tobacco awareness in these populations. Again, this is a legal instrument so the emphasis on member states is not surprising as they are the only signatories. However, even in 'other normative' references to rights, responsibilities and needprimary emphasis remains on the state as the functional actor protects the population at risk of addiction rather than alternative dominant frames such as the right to health, the right to information. The Framework Convention leans towards more 'traditional' security language in conceptualising the In the case of GAVI, the 0.07% security references in contrast with its 0.4% 'other' references hints at a different frame being brought to this initiative. However, it is not particularly clear until, again, the broader context of these terms is analysed. In the case of GAVI the focus is overwhelming on the 'mission' of the alliance and ensuring institutional clarity to support the primary focusthe right of the child to immunisation. This is clearly stated as seen above, particularly in the mission and responsibility statements (Table 14 .1). The only time the roles of functional actors are associated with either security or other terms are in the context of securing commitment from actors (broad range of board membership from states to international organisations, pharmaceutical companies, and civil society), and development of health sector capacity.

Despite GAVI addressing the containment of infectious disease, there is no threat language present. Securitised speech acts are practically absenteven when 'security' terms are located. The emphasis is overwhelming on rights and alleviating deprivation. Both initiatives confound the expectations prior to analysisthe infectious disease focused initiative is 'under-securitised' in comparison to the non-communicable focused initiative.

Finally, hinted at above, the emphasis on primary actors in these two documents revealed key similaritiesboth focus on the institutional arrangements and the actors most closely associated with these arrangements. In the case of GAVI the board (comprised of international organisation, civil society, member states, pharmaceutical, and philanthropic members) is the primary functional actor; in the case of the TFI, the actor that looms largest is the organisation (namely, WHO) followed by signatory states to the Convention. Discussion about the population who are to benefit and arguably be empowered from these initiatives, is not discussed as much as the organisation and accordingly the implementation arrangements around the initiative itself. To some extent, given the nature of these two documents, this is not surprising. However, its presence in two documents for two very different initiatives may reveal that the pathology of organisations rather than the framing of an initiative requires further study when engaging with the comparative success and failure of global health diplomacy (Barnett and Finnemore 2003; Hanrieder 2015) .

What is the value of securitisation when it comes to building and sustaining global political interest in health issues? Some contend that global health security has not run its course and continues to have utility in building state interest, particularly the resources of foreign affairs and defence departments, to secure global health diplomacy objectives (Kickbusch et al. 2007; Feldbaum et al. 2010; Elbe 2011) . Others contend it is a 'smokescreen' that captures short bursts of attention that are episodic and may have immediate impact but no essential 'follow through ' (McInnes and Rushton 2013) . In this chapter, I explored how global health initiatives securitise and what becomes of them. I deliberately chose two successful initiatives with the expectation that one had securitised a conventional health issuevaccine preventable infectious diseasesand one had nottobacco regulation. In examining the cases of TFI and GAVI, I looked at their core document: their mission and value statements reflected in, respectively, the Framework Convention on Tobacco Control and the first meeting documents of GAVI. Speech acts, identified as the hallmark of securitising moves, were analysed in both documents and contrasted with 'non-securitisation' or 'other normative' language.

The Framework Convention engaged in more securitising language or 'speech acts' compared to GAVI but both contained more references to human rights and responsibilities discourse. In neither case did it appear as if actors had taken a conscious decision to securitise the issue any more than they chose to articulate the issue in terms of human rights obligations. In the case of the Framework Convention where a focus on security was expected and to a greater extent seen here was an equally strong presence of human rights and 'sovereignty as responsibility' language. The security discourse may have helped capture attention but it was not the only discursive tool at play and neither did it obviously displace other discourses. In the case of GAVI, the initiative identified its primary mission as fulfilling the rights of the child; whereas for TFI, emphasis was member states fulfilling their responsibility to address the threat of tobacco related illness from tobacco usage. GAVI appears to have a single referentthe right of the child to health via immunisation; while TFI related to a multitude of actors. The operationalisation of the initiative(s) and their embeddedness in global health architecture dominated the discussion far more than the framing language. Framing language constituted a relatively small part of the discourse compared to the consuming discussion of institutional design. What this comparison of two global health initiatives reveals is that whilst security discourse might help capture the attention of states, it has not necessarily overtaken other policy frames such as human rights and 'sovereignty as responsibility language'. Indeed, the key priority seems to be not whether the international community should be engaged with these issues, but the appropriate institutional design for initiatives to achieve these health goals.

Between isolationism and mutual vulnerability: A south-north perspective on global governance of epidemics in an age of globalization

Health security as a public health concept: A critical analysis

securitizing global health: a view from maternal health

Pathology of international organizations

Global disparities in health and human rights

South Africa's transition in a globalizing world: HIV/AIDS as a window and as a mirror

The HIV/AIDS pandemic: A sign of instability in a complex global system

The evolution of international security studies

Macrosecuritisation and security constellations: Reconsidering scale in securitisation theory

Security: A new framework for analysis

Disease and the complex processes of securitization in the Asia-Pacific

Biosecurity interventions: Global health and security in question

Dynamics of HIV/AIDS in China and India: Assessing governmental response

What contribution can International Relations make to the evolving global public health agenda?

Health among Nations: Is there a place for health in international relations?

Disease diplomacy

Guns, germs, and steel: The fates of human societies

Should HIV/AIDS Be securitized? The ethical dilemmas of linking HIV/AIDS and security

Haggling over viruses: The downside risks of securitizing infectious disease

Should health professionals play the global health security card?

Disease and Security: Natural plagues and biological weapons in East Asia

Ethnicity, insurgency, and civil war

Global health and foreign policy

International Law and international diseases

Emerging trends in international law concerning global infectious disease control

After the revolution: Global health politics in a time of economic crisis and threatening future trends

The challenges of global health governance

Biosecurity in the global age: Biological weapons, public health and the rule of law

International norm dynamics and political change

human rights in global health diplomacy: A critical assessment

The return of infectious disease

Betrayal of Trust: The collapse of global public health

Global Alliance for Vaccines and Immunization (1999) Meeting of the Proto-Board

Biosecurity Reconsidered: Calibrating Biological Threats and Responses

How to do (or not to do): Tracking data on development assistance for health

The emergence of global attention to health systems strengthening

The path dependent design of international organizations: Federalism in the World Health Organization

WHO decides on the exception? Securitization and emergency governance in global health

Reconstructing desecuritisation: The normative-political in the Copenhagen School and directions for how to apply it

Controlling epidemic diseases

The evolution, etiology and eventualities of the global health security regime

Emerging Infections: Microbial threats to health in the United States

Global health diplomacy: Training across disciplines

Evolution of drug resistance in Malaria parasite populations

From biodefence to biosecurity: the Obama administration's strategy for countering biological threats

Human security and the UN: A critical history

The origin of quarantine

HIV/AIDS and securitization theory

WHO's next? Changing authority in global health governance after Ebola

Health, security and foreign policy

Global health and international relations

The last years of the CVI and the Birth of the GAVI

Questioning health security: Insecurity and domination in world politics

Politics in the hot zone: AIDS and the threat to Africa's security

Final report of the Ebola Interim Assessment Panel

Human security: Paradigm shift or hot air?

Ecological theory and international relations

Contagion and chaos: Disease, ecology and National Security in the era of globalization

Introduction

The health of nations: Infectious disease, environmental change, and their effects on national security and development

The decay of state capacity: HIV/AIDS and South Africa's National Security

Non-Traditional security in Asia: Dilemmas in securitization

Origins of the WHO framework convention on tobacco control

What makes the world Hang together? Neo-utilitarianism and the social constructivist challenge

Frames, paradigms and power: Global health policy-making under neoliberalism

Donor funding priorities for communicable disease control in the developing world. Health Policy and Planning

Global health challenges for human Security

Who sets the global health research agenda: The challenge of multi-bi financing

A/66/115, 24 February

Resolution on the responsibility of the Security Council in the maintenance of international peace and security: HIV/AIDS and international peacekeeping operations. S/Res/1308

The renaissance of security studies

The world health report 2007: A safer future: Global public health security in the 21st century

Injecting greater urgency into global tobacco control

Enter the fourth Horseman: Health security and international relations theory

Global health governance

The Ebola outbreak in Guinea

Legitimising Rejection: International Refugee Law in South East Asia" (Leiden: Martinus Nijhoff, 2007), and four edited books. She has published a number of articles in internationally recognised journals such as International Affairs, Security Dialogue